Attachment VI PUR 7801.docx
DOCX document 31 KB Posted
- Attached to
- Statewide Disaster Debris Removal
- Solicitation number
- ITB-12666
- Issued by
- Leon County, Florida
About this file
The document is a Vendor Certification Form (PUR 7801) for the Florida Department of Corrections (FDC) and Leon County's Invitation to Bid (ITB-24-149) for Statewide Disaster Debris Removal. The solicitation seeks responsive vendors to provide comprehensive debris removal services across Florida's correctional facilities, covering vegetative debris, construction and demolition debris, hazardous waste, white goods, vehicles, and other disaster-related materials. The contract will have an initial term of up to three years with potential renewal for an additional three years, with bids due on June 13, 2025, at 2:30 pm and an anticipated agency decision in July 2025.
The procurement emphasizes vendor compliance and operational capabilities, requiring registration in the MyFloridaMarketPlace system, maintaining a drug-free workplace, and meeting correctional facility security standards. The solicitation encourages participation from diverse businesses, including minority-owned, women-owned, and veteran-owned enterprises. Vendors must complete extensive certifications, including not participating in boycotts of Israel, not being on scrutinized company lists, using the E-Verify system for new employees, and attesting to various legal and operational standards. While specific budget ranges are not detailed, the contract will be funded through FEMA grants, with procurement policies applied consistently across federal and non-federal funding sources.
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Other files
| File | Type | Posted |
|---|---|---|
| Addendum #003 TL Revision ITB-24-149 .pdf | ||
| Addendum #002 TL Revision ITB-24-149.pdf | ||
| Addendum 004 QA ITB-24-149.pdf | ||
| FDC ITB-24-149.pdf | ||
| Attachment VI PUR 7801.docx | DOCX document | |
| FDC ITB-24-149.pdf | ||
| Attachment VI PUR 7801.docx | DOCX document | |
| FDC ITB-24-149.pdf | ||
| Addendum #002 TL Revision ITB-24-149.pdf | ||
| Addendum #003 TL Revision ITB-24-149 .pdf | ||
| Attachment VI PUR 7801.docx | DOCX document | |
| Addendum #002 TL Revision ITB-24-149.pdf | ||
| FDC ITB-24-149.pdf |
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Text version
Attachment VI – Vendor Certification Form (PUR 7801)
FDC ITB-24-149
Vendor Certification Form
I hereby certify the following on behalf of the vendor identified below:
| Customer Indicator (Required, N/A, Determined by Vendor) |
| Vendor Indicator (Certified, N/A) |
| Certification |
| Choose an item. | |
| Choose an item. | Regardless of the dollar value of the goods or services provided, in accordance with the requirements of section 287.135(5), F.S., the vendor is not participating in a boycott of Israel and is not on the State Board of Administration’s “Quarterly List of Scrutinized Companies that Boycott Israel,” available at https://www.sbafla.com/governance/global-governance-mandates/ |
| Choose an item. | |
| Choose an item. | If the goods or services to be provided are $1 million or more, in accordance with the requirements of section 287.135, F.S., the vendor is not on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Terrorism Sectors List (collectively, “Scrutinized List of Prohibited Companies”); does not have business operations in Cuba or Syria; and is not on the State Board of Administration’s “Scrutinized List of Prohibited Companies” available under the quarterly reports section at https://www.sbafla.com/reporting/ |
| Choose an item. | |
| Choose an item. | The vendor is not on the Suspended Vendor List; it and its suppliers, subcontractors, or consultants to be utilized under the contract are not on the Convicted Vendor, Discriminatory Vendor, or Antitrust Violator Vendor Lists; and there is no pending or threatened action, proceeding, or investigation, or any other legal or financial condition, that would in any way prohibit, restrain, or diminish the vendor’s ability to satisfy the contract obligations. |
The vendor is hereby informed of the provisions of sections 287.133(2)(a), 287.134(2)(a), and 287.137(2)(a), F.S., that identify the impacts to the vendor's ability or its affiliates’ ability to respond to the competitive solicitations of a public entity; to be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with a public entity; or to transact business with a public entity if it, or its affiliates, are placed on the Convicted Vendor, Discriminatory Vendor, or Antitrust Violator Vendor Lists of the Department of Management Services. The vendor is hereby further informed of the provisions of section 287.1351, F.S., that identify the impacts to the vendor’s ability to enter into or renew a contract with an agency, as defined in section 287.012, F.S., if it is placed on the Suspended Vendor List of the Department of Management Services.
| Choose an item. | |
| Choose an item. | If the contract grants the vendor access to an individual’s personal identifying information, the vendor is not prohibited from entering into the contract pursuant to section 287.138, F.S., and has completed the Form PUR 1355, “Foreign Country of Concern Attestation Form,” available at http://www.flrules.org/Gateway/reference.asp?No=Ref-15843, and attached it hereto. |
| Choose an item. | |
| Choose an item. | If the vendor is a common carrier, as defined in section 908.111, F.S., or a contracted carrier, it is not prohibited from entering into the contract pursuant to section 908.111, F.S., and has completed the Form PUR 1808, “Common Carrier or Contracted Carrier Attestation Form,” available at http://www.flrules.org/Gateway/reference.asp?No=Ref-14614, and attached it hereto. |
| Choose an item. | |
| Choose an item. | The vendor is registered with, and uses, the E-Verify system for all newly hired employees in accordance with section 448.095, F.S.; and has not, within the last year, had a contract terminated under section 448.095(5)(c), F.S., by a public employer, contractor, or subcontractor, as defined by section 448.095(1), F.S. |
| Choose an item. | |
| Choose an item. | The vendor is in compliance with all applicable disclosure requirements set forth in section 286.101, F.S., and has not been deemed ineligible for a grant or contract funded by a state agency pursuant to section 286.101(7), F.S. |
| Choose an item. | |
| Choose an item. | If the contract is between a nongovernmental entity and a governmental entity, in accordance with section 787.06, F.S., the vendor has completed an affidavit signed by an officer or a representative of the vendor under penalty of perjury attesting that the vendor does not use coercion for labor or services as defined in section 787.06, F.S. |
[the Customer may add rows to this table for additional certifications required by law or rule]
By signing below, I certify that I am authorized to complete and submit this Vendor Certification Form on behalf of the vendor.
Vendor Information Signatory
Name Signature Date
FEIN Typed or Printed Name
Title
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