ATTACHMENTS_1-5_(Single_Project)_(15).pdf

COVER PAGE

BUSINESS NAME & ADDRESS: CONTACT INFORMATION:

Business Name Name of Contact Individual

Address Contact Address

City, State, Zip Contact City, State, Zip

Business Telephone Number Contact Telephone Number

Business email address Contact email Address

DUNS NUMBER (Dun & Bradstreet)

ATTACHMENT 1

ADDENDUM RECEIPT VERIFICATION

Complete and submit this document in the order and manner as indicated in the QUALIFICATION STATEMENT FORMAT section of this RQS.

ATTACHMENT 1

ADDENDUM RECEIPT VERIFICATION

The undersigned acknowledges receipt of the following addenda to the Documents (Give number and date of each):

Addendum No. Dated

Addendum No. Dated

Addendum No. Dated

Addendum No. Dated

Company

Signature

Title

ATTACHMENT 2

CONFIDENTIAL AND/OR PROPRIETARY INFORMATION

EXEMPTION FORM

ATTACHMENT 2

Confidential and/or Proprietary Information Exemption Form

In the table below, Respondents shall identify specifically any information contained in their Response which they consider confidential and/or proprietary and which they believe to be exempt from disclosure, citing specifically the applicable exempting law. A generic notation that information is “confidential” is not sufficient. Failure to provide the Procurement and Contracts Division Office with a detailed explanation and justification including statutory cites and specific reference to your Proposal detailing what provisions, if any, you believe are exempt from disclosure, may result in your entire Qualification Statement being subject to disclosure in accordance with Chapter 119 of the Florida Statutes.

Page No. Section Applicable Exempting Law

Detailed Explanation/Justification with specific language from the Florida Statute that would allow this item to be

Confidential/Proprietary

An additional page may be utilized for the above table; however, this form should be signed and submitted with your Qualification Statement.

Signature

Print Name and Title

Name of Company

Date

ATTACHMENT 3

MINORITY/WOMEN-OWNED BUSINESS ENTERPRISE

PARTICIPATION FORM

Procurement and Contracts Division Page 28

ATTACHMENT “3”

MINORITY/WOMEN-OWNED BUSINESS ENTERPRISE PARTICIPATION FORM

Chapter 57, Article II, Minority Business Enterprise (MBE), and Article III, Women-Owned Business Enterprise (WBE) of the Orlando City Code, establishes goals of 18% (MBE) and 6% (WBE), respectively, of the City's annual monetary value of contracts and subcontracts for supplies, services and construction to be awarded to Minority and Women-Owned Business Enterprises (M/WBE). The Respondent awarded a contract shall make a good faith effort to ensure that 18% of the dollar amount of the contract is performed by MBEs and 6% of the dollar amount of the contract is performed by WBEs.

1. Policy:

It is the policy of the City of Orlando that MBEs and WBEs shall have the maximum feasible opportunity to participate in the performance of City contracts. As used in this solicitation and any resulting contract, the term "minority business" is defined as a business firm which is at least 51% owned and controlled by minority group members and which has been officially certified or recognized by the City as an MBE. The minority ownership must exercise actual day-to-day management and independent control. For the purpose of this definition, minority group members are Blacks, Hispanics, Asians, Pacific Islanders, Alaskan Natives, and American Indians. As used in this solicitation and any resulting contract, the term "women-owned business" means a business firm which is at least 51% owned and controlled by women and which has been officially certified or recognized by the City as a WBE. The women ownership must exercise actual day-to-day management and independent control. Only those companies which are certified or recognized by the City on or before the date set for submittal of qualification statements may be utilized to meet the goals established by Chapter

57. A listing of certified and recognized M/WBE’s is available at:

https://cityoforlando.mwdbe.com/Default.asp

2. List of MBE/WBE Firms Performing Work on the Contract:

Respondent shall state whether respondent itself is a City certified or recognized MBE or WBE firm. If your company is currently certified, please enter the certification number and the expiration date in spaces provided below or submit with your response a copy of the notification received from the City stating that your company is recognized by the City as a Minority/Women-Owned Business Enterprise:

Business Name:

Certification Number:

Expiration Date:

Responses will also be evaluated on the basis of meaningful MBE and WBE participation in subcontracts. The participation must be such that the firms will be performing useful business functions according to custom and practice in the industry, and the firms will be performing work within their certification classification. Please fill in the boxes below. Anticipated percentage participation means the percentage of the total dollar amount of the contract to be performed by the MBE and WBE subcontract firm(s). Additional boxes or pages may be added by a respondent if necessary.

https://cityoforlando.mwdbe.com/Default.asp

Procurement and Contracts Division Page 29

MBE SUBCONTRACTOR UTILIZATION

Subcontractor’s Name and City Certification

Number:

Description of Work to be Performed:

Anticipated Percentage Participation

1.

2.

3.

4.

TOTAL MBE %

Procurement and Contracts Division Page 30

WBE SUBCONTRACTOR UTILIZATION

Subcontractor’s Name and City Certification

Number:

Description of Work to be Performed:

Anticipated Percentage Participation

1.

2.

3.

TOTAL WBE %

3. Affirmative Statement. (Please mark the box for “Yes” below if you agree to the following statement. Please mark the box for “No” if you do not.)

□ Yes or □ No - Respondent hereby makes an affirmative declaration that it will make a good faith effort to achieve 18% MBE subcontracting participation and 6% WBE subcontracting participation on this contract.

Failure to mark either box will be deemed a “No” response for purposes of proposal evaluation and scoring. MBE and WBE percentage participation means the percentage of the total dollar amount of the contract to be performed by the subcontractor firms(s).

4. Reports. Respondents awarded a contract shall submit periodic reports of participation by MBE and WBE firms in such form and manner and at such time as the City or the MBE Director may prescribe. Monthly status reports shall be provided to the MBE Director at his request.

The MBE Office shall have the right to review and audit records, receipts, and documents upon reasonable notice.

5. Deviations. During the course of the contract, any deviation from the MBE and WBE participation identified in the Respondent’s Qualification Statement or in a specific task assignment by a Respondent must be reported to, and approved in writing by, the MBE Director. Deviations shall only be allowed for good cause. Failure to comply shall result in the City imposing penalties, which may include suspension or debarment from obtaining future City contracts.

Procurement and Contracts Division Page 31

6. Miscellaneous. For further information regarding this program, please refer to Chapter 57 of the Code of the City of Orlando or contact:

Minority Business Enterprise Office City Hall at One City Commons, 8th Floor

400 South Orange Avenue Orlando, Florida 32801-3302

(407) 246-2623

There shall be no third-party beneficiaries of the MBE or WBE provisions of the contract. The City shall have the exclusive means of enforcement of Chapter 57 of the City Code and contract terms. No right of action for non-signatories of the contract is intended or implied. The City is the sole judge of compliance and whether a good faith effort has been made under Chapter 57 and the contract.

ATTACHMENT 4

VETERAN BUSINESS ENTERPRISE PARTICIPATION FORM

ATTACHMENT 4

VETERAN BUSINESS ENTERPRISE PARTICIPATION FORM - RQS

In order to foster economic development and business opportunities, promote the growth and development of local businesses, and rectify the economic disadvantages of service-disabled veterans and wartime veterans who have made extraordinary sacrifices on behalf of the nation, the City of Orlando has adopted a Veteran Business Enterprise (“VBE”) Preference. For further information regarding this program, please refer to Chapter 7 of the Code of the City of Orlando.

In order for a respondent to receive credit either itself or for listing a VBE subcontractor, the respondent and/or subcontractor for which credit is sought must perform useful business functions on the contract, have its principal place of business in the Metropolitan Statistical Area (“Orlando MSA”) (i.e. Orange, Lake, Seminole or Osceola Counties) and be a certified veteran business enterprise by the State of Florida Department of Management Services (“DMS”) as set forth in Section 295.187 of the Florida Statutes as of the date set for submittal of bids. For purposes of the City’s VBE Program, respondent’s “Principal Place of Business” has been defined by Chapter 7 of the City Code to mean the location identified by a respondent as its principal place of business with respect to a solicitation, which location may be either (i) the main business office of the respondent where the chief executive officer, or equivalent person, maintains his or her primary office, or (ii) the office where the majority of the work related to the City solicitation will be performed.

In accordance with City Code, a respondent or subcontractor that is both a qualifying VBE and a City certified or recognized Minority Business Enterprise (“MBE”) or Woman Owned Business Enterprise (“WBE”) may not receive scoring consideration for more than one status. Accordingly, a respondent should list itself or an eligible subcontractor as either an MBE/WBE or as a VBE, but not both. In the event that a respondent mistakenly lists itself or a qualifying VBE subcontractor who is also a City certified or recognized MBE or WBE firm for consideration for scoring as both a VBE and as a MBE or WBE subcontractor in its proposal, the respondent shall receive scoring consideration for whichever status results in a higher score for the respondent’s proposal.

There shall be no third party beneficiaries of the Veteran Business Enterprise Preference provisions of this solicitation or resulting contract. The City of Orlando shall have the exclusive means of enforcement of the Veteran Business Enterprise Preference Ordinance and any contract terms. No right of action for non-signatories of the contract is intended or implied. The City of Orlando is the sole judge of compliance. All solicitations and submittals awarded will be evaluated in accordance with Chapter 7 of the Code of the City of Orlando.

Respondents awarded a contract shall submit periodic reports of participation by VBE firms in such form and manner and at such time as the City or the City’s Minority Business Enterprise (MBE) Director may prescribe. At a minimum, the successful Proposer shall submit to the City within thirty (30) days of completion of all work performed under the contract a final report detailing the portion of the work performed by VBE firms and the percentage of work subcontracted to each. The City shall have the right to review and audit records, receipts, and documents upon reasonable notice.

If Respondent is a qualifying VBE, please complete the boxes below:

Respondent’s Name:

Respondent’s Principal Place of Business

Florida DMS Certification

Number :

1.

If Respondent is proposing to utilize any VBE subcontractor(s) which are currently certified by the State of Florida Department of Management Services and have their principal place of business in the Orlando MSA, please list such subcontractor(s) in the boxes below:

VBE Subcontractor’s Name:

VBE Subcontractor’s Principal Place of Business

Florida DMS Certification

Number :

1.

2.

ATTACHMENT 5

CERTIFICATION REGARDING PROHIBITION AGAINST

CONTRACTING WITH SCRUTINIZED COMPANIES

ATTACHMENT 5

CERTIFICATION REGARDING PROHIBITION AGAINST CONTRACTING WITH

SCRUTINIZED COMPANIES

I hereby certify that neither the undersigned entity, nor any of its wholly owned subsidiaries, majority-owned subsidiaries, parent companies, or affiliates of such entities or business associations, that exists for the purpose of making profit have been placed on the Scrutinized Companies that Boycott Israel List created pursuant to s. 215.4725 of the Florida Statutes, or are engaged in a boycott of Israel.

In addition, if this solicitation is for a contract for goods or services of one million dollars or more, I hereby certify that neither the undersigned entity, nor any of its wholly owned subsidiaries, majority-owned subsidiaries, parent companies, or affiliates of such entities or business associations, that exists for the purpose of making profit are on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Terrorism Sectors List, created pursuant to s. 215.473 of the Florida Statutes, or are engaged in business operations in Cuba or Syria as defined in said statute.

I understand and agree that the City may immediately terminate any contract resulting from this solicitation upon written notice if the undersigned entity (or any of those related entities of respondent as defined above by Florida law) are found to have submitted a false certification or any of the following occur with respect to the company or a related entity: (i) it has been placed on the Scrutinized Companies that Boycott Israel List, or is engaged in a boycott of Israel, or (ii) for any contract for goods or services of one million dollars or more, it has been placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Terrorism Sectors List, or it is found to have been engaged in business operations in Cuba or Syria.

Name of Consultant:____________________________________

By:__________________________________________________ (Authorized Signature)

Title:_________________________________________________

Date:_________________________________________________