Attachment L, Required Documents for Respondents.pdf

The State of Florida

Department of Management Services

Request for Proposals (RFP)

Telecommunications Infrastructure Project Services 3

RFP No: DMS-24/25-264

Attachment L, Required Documents to be Submitted by Respondent

Division of State Purchasing 4050 Esplanade Way, Suite 360

Tallahassee, FL 32399-0950

Ron DeSantis, Governor Pedro Allende, Secretary

Contents

FORM 1 – PUR 1355 FOREIGN COUNTRY OF CONCERN ATTESTATION

FORM 2 - PUR 2023 PROVISION OF COMMODITIES PRODUCED BY FORCED LABOR

FORM 3 - PRINCIPAL PLACE OF BUSINESS LETTER

FORM 4 - CONTACT WORKSHEET

FORM 5 – NOTICE OF CONFLICT OF INTEREST

FORM 6 – NON-COLLUSION AFFIDAVIT

FORM 7 - STATEMENT OF NO PRIOR DISQUALIFYING INVOLVEMENT

FORM 8 - SUBCONTRACTING

FORM 1 – PUR 1355 FOREIGN COUNTRY OF CONCERN

ATTESTATION

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 a Governmental Entity 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, 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:

FORM 2 - PUR 2023 PROVISION OF COMMODITIES

PRODUCED BY FORCED LABOR

Pursuant to section 287.1346(4)(b), Florida Statutes, this written certification must be completed by a member of the company’s senior management, as defined in section 287.1346, F.S., when the company submits a response to a solicitation for the provision of commodities and before the company enters into or renews a contract for the provision of commodities.

I certify that to the best of my knowledge, the commodities offered to the Department by the entity named below have not been produced, in whole or in part, by forced labor.

Entity Name: __________________________________

Senior Management’s Printed Name: ________________________________

Senior Management Member’s Title: ________________________________

Signature: __________________________________ Date: _________________

FORM 3 - PRINCIPAL PLACE OF BUSINESS LETTER

[Date]

[Contact Name] [Company Name] [Company Address] [City, State, Zip]

The Bidder shall indicate where its principal place of business is located and provide a completed Form 6 to the Department in response to the solicitation.

Principal place of business (please select only one)

☐ The Bidder has its principal place of business within Florida. Complete the following fields if this box is selected:

Printed Bidder (Vendor) Name: ___________________________

Authorized Representative Signature: ___________________________

Authorized Representative Printed Name: ________________________

Date: _____________________________

☐ The Bidder has its principal place of business outside of Florida

***THE BELOW SECTION APPLIES FOR A BIDDER WHOSE PRINCIPAL PLACE OF

BUSINESS IS OUTSIDE OF FLORIDA (“Out-of-State”) ONLY***

****If the section below is not completed and the Bidder has selected that its company has a principal place of business outside of Florida, the Bidder will be deemed non-responsive.

If Bidder’s principal place of business is outside of the State of Florida, the following must be completed by an attorney licensed to practice law in the state in which the company’s principal place of business is located.

NOTICE: Section 287.084(2), Florida Statutes, provides that “a vendor whose principal place of business is outside this state must accompany any written bid, proposal, or reply documents with a written opinion of an attorney at law licensed to practice law in that foreign state, as to the preferences, if any or none, granted by the law of that state to its own business entities whose principal places of business are in that foreign state in the letting of any or all public contracts.”

LEGAL OPINION ABOUT STATE PREFERENCES

This section shall be completed by an Attorney at law licensed to practice in the state in which the company’s principal place of business is located if outside of Florida. The Bidder must provide the requisite details to the attorney completing this form.

I, [Insert Name], certify I am an attorney licensed to practice law in [Insert State], the state in which the above listed company (Bidder) has its principal place of business.

(Please Select One)

☐ The Bidder’s principal place of business is in the State of _________________ and it is my opinion that the laws of that state do not grant a preference to business entities whose principal places of business are in that state in the letting of any or all public contracts.

☐ The Bidder’s principal place of business is in the State of ______________ and it is my opinion that the laws of that state grant the following preference(s) to business entities whose principal places of business are in that state in the letting of any or all public contracts: [Please describe all applicable preference(s) only as it relates to preference(s) granted to business entities whose principal place of business is in the state listed herein]

[E.g., State of X offers 5% preference to business entities whose principal place of business is in state of X:]

Printed Bidder (Vendor) name: ______________________________

Authorized Bidder signature: ______________________

Authorized Representative Printed Name: ________________________

Date: ___________________

Printed Attorney name: _______________________________

Authorized signature of attorney: _____________________

Email address of attorney: ____________________________

Telephone number of attorney: ________________________

Date: _________________

FORM 4 - CONTACT WORKSHEET

REQUEST FOR PROPOSALS (RFP) FOR TELECOMMUNICATION INFRASTRUCTURE PROJECT SERVICES 3

RFP NO: DMS-24/25-264

Contractor should enter a response directly below each question or statement. Additional rows may be added as required.

The column Region(s) applies to which Region(s) the employee will be servicing during the life of this Contract or the Region in which they are located and will be covering during the services of this Contract. For instance, office personnel, a Contractor Project Manager, the personnel for invoicing, or scheduling, may be able to cover multiple Regions, but a technician providing on-site (the location of the Project or Moves, Adds, and Changes) services will be listed under the Region in which their service facility resides.

1. Please provide the Contractor Project Manager(s), the main contact(s), for the Contractor who will be in charge of work and providing submittals during the life of the Contract resulting from the Request for Proposal and the specific Region(s) in which they are responsible.

Contractor Project

Manager(s)

Physical Address

Office Phone

Number

Cell Phone

Number

Email Address

Region(s) Duties Years of Employment with the Respondent

Estimated Percentage of Time to be Spent on

TIPS Services

THIS SPACE INTENTIONALLY LEFT BLANK

2. Please provide information on the employee for the Contractor who will be in charge of scheduling of work crews for the Contractor during the life of the Contract resulting from the Request for Proposal, if different than the Contractor Project Manager and the specific Region(s) in which they are responsible.

Name Physical Address Office Phone

Number

Cell Phone

Number

Email Address

Region(s) Duties Years of Employment with the Respondent

Estimated Percentage of Time to be Spent on TIPS Services

3. Please provide information on the employee for the Contractor who will be in charge of invoicing during the life of the Contract resulting from the Request for Proposal.

Name Physical Address Office Phone

Number

Cell Phone

Number

Email Address

Region(s) Duties Years of Employment with the Respondent

Estimated Percentage of Time to be Spent

4. Please provide information on the employee for the Contractor who has the BICSI Registered Communications Distribution Designer

(RCDD) certification and will be available as needed dependent on the Project during the life of the Contract resulting from the Request for Proposal.

Name Physical Address Office Phone

Number

Cell Phone

Number

Email Address

Region(s) Duties Years of Employment with the Respondent

Estimated Percentage of Time to be Spent

5. Please provide information on the employees for the Contractor performing services on-site that has certifications and training which aids in the ability to obtain Manufacturer warranties for Projects during the life of the Contract resulting from the Request for Proposal.

Name Type of Training/Certification

Product Manufacturer

Region Duties Years of Employment with the Respondent

Estimated Percentage of Time to be Spent

6. Please provide information on the employees for the Contractor performing services on-site that has certifications and training which aids in the ability to perform services for Projects during the life of the Contract resulting from the Request for Proposal.

Name Type of Training/Certification

Industry Certification Name (i.e.

BICSI)

Region Duties Years of Employment with the Respondent

Estimated Percentage of Time to be Spent

7. Please provide the contact for each Subcontractor scheduling work and providing submittals during the life of the Contract resulting from the Request for Proposal.

Name Physical Address Office Phone

Number

Cell Phone

Number

Email Address

Region(s) Duties Years of Employment with the Respondent

Estimated Percentage of Time to be Spent

8. Please provide the location for each Service Facility(s) within in the Region(s) bid during the life of the Contract resulting from the

Request for Proposal.

Region Physical Address of the Service Facility Phone Number

FORM 5 – NOTICE OF CONFLICT OF INTEREST

Company Name:

For the purpose of participating in the solicitation process and complying with the provisions of Chapter 112, F.S., the company states the following conflict(s) of interest exists as noted below.

If there are none, write N/A in the applicable section(s) below.

The persons listed below are corporate officers, directors or agents and are currently employees of the State of Florida or one of its agencies:

The persons listed below are current State of Florida employees who own an interest of five percent (5%) or more in the company named above:

Name of Respondent Signature of Authorized Representative

Print Name Date

FORM 6 – NON-COLLUSION AFFIDAVIT

I state that I ____________________________ of _________________________________, (Name and Title) (Name of Firm) am authorized to make this statement on behalf of my firm and its owner, directors and officers. I am the person responsible in my firm for the price(s) and amount(s) of this Proposal, and the preparation of the Proposal, I state that:

1. The price(s) and amount(s) of this Proposal have been arrived at independently and without consultation, communication or agreement with any other Provider, potential provider, Proposal or potential Proposal.

2. Neither the price(s) nor the amount(s) of this Proposal, and neither the approximate price(s) nor approximate amount(s) of this Proposal, have been disclosed to any other firm, vendor, Respondent, or potential Respondent, and they will not be disclosed before Proposal opening.

3. No attempt has been made or will be made to induce any firm or persons to refrain from submitting a Proposal for this Contract, or to submit a price(s) higher that the prices in this Proposal, or to submit any intentionally high or noncompetitive price(s) or other form of complementary Proposal.

4. The Proposal of my firm is made in good faith and not pursuant to any agreement or discussion with, or inducement from, any firm or person to submit a complementary or other noncompetitive Proposal.

5. ____________________, its affiliates, subsidiaries, officers, director, and employees (Name of Firm) are not currently under investigation, by any governmental agency and have not in the last ten (10) years been convicted or found liable for any act prohibited by state or federal law in any jurisdiction, involving conspiracy or collusion on any public contract.

I state that I and the named firm understand and acknowledge that the above representations are material and important and will be relied on by the State of Florida for which this Proposal is submitted. I understand and my firm understands that any misstatement in this statement is, and will be treated as, fraudulent concealment from the State of Florida of the true facts relating to the submission of Proposals for this Contract.

Dated this _______ day of ____________

Name of Firm:

Signed by:

Print Name:

FORM 7 - STATEMENT OF NO PRIOR DISQUALIFYING

INVOLVEMENT

I, as an authorized representative of the Respondent, certify that nothing in section 287.057(19)(c), F.S., (below), prohibits the Respondent’s entry into any Contract resulting from this solicitation.

287.057 Procurement of commodities or contractual services. —

(19)(c) A person who receives a contract that has not been procured pursuant to subsections (1)-(3) [of s. 287.057, F.S.] to perform a feasibility study of the potential implementation of a subsequent contract, who participates in the drafting of a solicitation or who develops a program for future implementation, is not eligible to contract with the agency for any other contracts dealing with that specific subject matter, and any firm in which such person has any interest is not eligible to receive such contract. However, this prohibition does not prevent a Respondent who responds to a request for information from being eligible to contract with an agency.

Name of Respondent’s Organization Signature of Authorized Representative and

Date

Print Name

FORM 8 - SUBCONTRACTING

Complete the information below for all subcontractors that will provide services to the Respondent to meet the requirements of the resultant contract, should the Respondent be awarded. Submission of this form does not indicate the Department’s approval but provides the Department with information on proposed subcontractors for review.

Please complete a separate sheet for each subcontractor.

There will be subcontractors for this solicitation: YES ____ or NO ____ (place a checkbox where applicable). Respondents are not required to complete the remainder of this form when checking “NO”.

Service:

Company Name:

Contact:

Address:

Telephone:

Fax:

Current certification from the Department’s Office of Supplier Development certification: Yes ________ No ___________ W-9 verification: Yes ________ No ___________

In a job description format, describe below the responsibilities and duties of the subcontractor based on the technical specifications or statement of work outlined in this solicitation.