Bid Certification, Questionnaire and Affidavits _ Formal (1) (2).pdf

SECTION 1 – BID CERTIFICATION FORM

Solicitation No:

Solicitation No.

Solicitation Title:

Solicitation Title

BIDDER'S NAME:

NO. OF YEARS IN BUSINESS:

NO. OF YEARS IN BUSINESS

LOCALLY:

NO. OF EMPLOYEES:

OTHER NAME(S) BIDDER HAS OPERATED UNDER IN THE LAST 10 YEARS:

BIDDER PRIMARY ADDRESS (HEADQUARTERS):

CITY:

STATE:

ZIP CODE:

TELEPHONE NO.:

TOLL FREE NO.:

FAX NO.:

BIDDER LOCAL ADDRESS:

CITY:

STATE:

ZIP CODE:

PRIMARY ACCOUNT REPRESENTATIVE FOR THIS ENGAGEMENT:

ACCOUNT REP TELEPHONE NO.:

ACCOUNT REP TOLL-FREE NO.:

ACCOUNT REP EMAIL:

FEDERAL TAX IDENTIFICATION NO.:

By virtue of submitting a bid, Bidder agrees: a) to complete and unconditional acceptance of the terms and conditions of this document, inclusive of this solicitation, all specifications, attachments, exhibits and appendices and the contents of any Addenda released hereto; b) to be bound, at a minimum, to any and all specifications, terms and conditions contained herein or Addenda; c) that the Bidder has not divulged, discussed, or compared the proposal with other bidders and has not colluded with any other bidder or party to any other bid; d) that Bidder acknowledges that all information contained herein is part of the public domain as defined by the State of Florida Sunshine and Public Records Laws; e) the Bidder agrees if this bid is accepted, to execute an appropriate City of Miami Beach document for the purpose of establishing a formal contractual relationship between the Bidder and the City of Miami Beach, Florida, for the performance of all requirements to which the bid pertains; and f) that all responses, data and information contained in the bid submittal are true and accurate.

The individual named below affirms that s/he is the principal of the applicant and duly authorized to execute this questionnaire. The contents of said document(s) are complete, accurate, and correct to the best of their knowledge and belief.

Name of Bidder's Authorized Representative:

Title of Bidder's Authorized Representative:

SECTION 2 - ACKNOWLEDGEMENT OF ADDENDUM

After the issuance of the solicitation, the City may release one or more addenda to the solicitation, which may provide additional information to bidders or alter solicitation requirements. The City will strive to reach every Bidder, having received solicitation through the City's e-procurement system. However, Bidders are solely responsible for assuring they have received all addenda issued pursuant to the solicitation. This Acknowledgement of Addendum section certifies that the Bidder has received all addendum released by the City pursuant to this solicitation. Failure to obtain and acknowledge receipt of all addenda may result in proposal disqualification.

Enter Initial to Confirm Receipt

Enter Initial to Confirm Receipt

Enter Initial to Confirm Receipt

Addendum 1 Addendum 6 Addendum 11

Addendum 2 Addendum 7 Addendum 12

Addendum 3 Addendum 8 Addendum 13

Addendum 4 Addendum 9 Addendum 14

Addendum 5 Addendum 10 Addendum 15

If additional confirmation of addendum is required, submit under separate cover.

SECTION 3 - CONFLICT OF INTEREST

All Bidders must disclose the name(s) of any officer, director, agent, or immediate family member (spouse, parent, sibling, and child) who is also an employee of the City of Miami Beach. Further, all Bidders must disclose the name of any City employee who owns, either directly or indirectly, an interest of ten (10%) percent or more in the bidder entity or any of its affiliates.

YES NO

If yes, please disclose the name(s):

FIRST AND LAST NAME OCCUPATION

SECTION 4 - FINANCIAL CAPACITY

When requested by the City, each Bidder shall arrange for Dun & Bradstreet to submit a Supplier Qualification Report (SQR) directly to the City. The cost of the preparation of the SQR shall be the responsibility of the Bidder. The Bidder shall request the SQR report from D&B at:

https://www.cialdnb.com/third-party-risk/supplier-qualifier-report

Bidders are responsible for the accuracy of the information contained in their SQR. It is highly recommended that each Bidder review the information contained in its SQR for accuracy prior to submittal to the City and as early as possible in the solicitation process. For assistance with any portion of the SQR submittal process, contact Dun & Bradstreet at 800- 424-2495.

Bidder shall have Dun & Bradstreet submit its Supplier Qualifier Report directly to the City, with the bid or within three (3) days of request by the City.

https://www.cialdnb.com/third-party-risk/supplier-qualifier-report

SECTION 5 - REFERENCES AND PAST PERFORMANCE

Project No. SOLICITATION NO.

Project Title SOLICITATION TITLE

Bidder shall submit at least three (3) references for whom the Bidder has completed work similar in size and nature as the work referenced in the solicitation.

Reference No.1

Firm Name:

Contact Individual Name and Title:

Address:

Telephone:

Contact's Email:

Narrative on Scope of Services Provided:

Reference No.2

Firm Name:

Contact Individual Name and Title:

Address:

Telephone:

Reference No.3

Firm Name:

Contact Individual Name and Title:

Address:

Telephone:

SECTION 6 - STANDARD TERMS AND CONDITIONS

The Standard Terms and Conditions are available at https://www.miamibeachfl.gov/city-hall/procurement/standard-terms-and-conditions/ By virtue of submitting a bid, Bidder attests that they have read and understand the applicable Standard Terms and Conditions as indicated in the solicitation.

Project No. SOLICITATION NO.

Project Title SOLICITATION TITLE

SECTION 7 - VENDOR CAMPAIGN CONTRIBUTIONS

Bidders are expected to be or become familiar with the City's Campaign Finance Reform laws, as codified in Sections 2-487 through 2-490 of the City Code https://library.municode.com/fl/miami_beach/codes/code_of_ordinances?nodeId=SPAGEOR_CH2AD_ARTVIISTCO_DIV5CAFI

RE.

Bidders shall be solely responsible for ensuring that all applicable provisions of the City's Campaign Finance Reform laws are complied with and shall be subject to all sanctions, as prescribed therein, including disqualification of their bid submittal, in the event of such non-compliance.

Are there any individuals or entities (including your sub-consultants) with a controlling financial interest that have contributed to the campaign, either directly or indirectly, of a candidate who has been elected to the office of Mayor or City Commissioner for the City of Miami Beach?

If yes, list the name (first and last name) of individuals, occupation, amount, and date:

First and Last Name Contributor Occupation Amount Date of Contribution

SECTION 8 – SUSPENSION, DEBARMENT, OR CONTRACT CANCELLATION

Has Bidder ever been debarred, suspended, or other legal violation, or had a contract canceled due to non-performance by any public sector agency?Click or tap here to enter text.

If the answer above is "YES," Bidder shall submit a statement detailing the reasons that led to action(s):

https://www.miamibeachfl.gov/city-hall/procurement/standard-terms-and-conditions/ https://library.municode.com/fl/miami_beach/codes/code_of_ordinances?nodeId=SPAGEOR_CH2AD_ARTVIISTCO_DIV5CAFIRE https://library.municode.com/fl/miami_beach/codes/code_of_ordinances?nodeId=SPAGEOR_CH2AD_ARTVIISTCO_DIV5CAFIRE

SECTION 9 - BYRD ANTI-LOBBYING AMENDMENT CERTIFICATION FORM

APPENDIX A, 44 CFR PART 18 – CERTIFICATION REGARDING LOBBYING

Certification for Contracts, Grants, Loans, and Cooperative Agreements

The undersigned Bidder certifies, to the best of their knowledge, that:

1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.

3. The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.

This certification is a material representation of the fact upon which reliance was placed when this transaction was made or entered into.

Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, USC § 1352 (as amended by the Lobbying Disclosure Act of 1995). Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

The undersigned Bidder certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Bidder understands and agrees that the provisions of 31 USC § 3801 et seq. apply to this certification and disclosure, if any.

By virtue of submitting a bid, Bidder certifies or affirms its compliance with the Byrd Anti-Lobbying Amendment Certification.

Title of Bidder's Authorized Representative:

SECTION 10 –SUSPENSION AND DEBARMENT CERTIFICATION

The Bidder acknowledges that:

(1) This Contract is a covered transaction for purposes of 2 CFR pt. 180 and 2 CFR pt. 3000. As such, the Bidder is required to verify that none of the Bidder, its principals (defined at 2 CFR § 180.995), or its affiliates (defined at 2 CFR § 180.905) are excluded (defined at 2 CFR § 180.940) or disqualified (defined at 2 CFR § 180.935).

(2) The Bidder must comply with 2 CFR pt. 180, subpart C and 2 CFR pt. 3000, subpart C, and must include a requirement to comply with these regulations in any lower-tier covered transaction it enters into.

(3) This certification is a material representation of fact relied upon by the City. If it is later determined that the Bidder did not comply with 2 CFR pt. 180, subpart C and 2 CFR pt. 3000, subpart C, in addition to remedies available to the City, the Federal Government may pursue available remedies, including but not limited to suspension or debarment.

(4) The Bidder agrees to comply with the requirements of 2 CFR pt. 180, subpart C and 2 CFR pt. 3000, subpart C, while this offer is valid and throughout any contract that may arise from this offer. The Bidder further agrees to include a provision requiring such compliance in its lower tier covered transactions."

By virtue of submitting a bid, Bidder certifies or affirms its compliance with the Suspension and Debarment Certification.

SECTION 11 – CODE OF BUSINESS ETHICS

Pursuant to City Resolution No.2000-37879, the Bidder shall adopt a Code of Business Ethics ("Code") and submit that Code to the Procurement Division with its response or within three (3) days upon receipt of the request. The Code shall, at a minimum, require the Bidder to comply with all applicable governmental rules and regulations, including, among others, the conflict of interest, lobbying, and ethics provision of the City of Miami Beach and Miami Dade County.

Bidder shall submit firm's Code of Business Ethics within three (3) of request by the City. In lieu of submitting the Code of Business Ethics, the Vendor may indicate that it will adopt, as required in the ordinance, the City of Miami Beach Code of Ethics, available at http://www.miamibeachfl.gov/city-hall/procurement/procurement-related-ordinance-and-procedures/

Bidder adopts the City of Miami Beach Code of Business Ethics.

Bidder will submit the firm's Code of Business Ethics within three (3) days of request by the City.

SECTION 12 – DRUG-FREE WORKPLACE CERTIFICATION

The Drug-Free Workplace Certification is available at:

https://www.miamibeachfl.gov/wp-content/uploads/2019/04/DRUG-FREE-WORKPLACE-CERTIFICATION.pdf

By virtue of submitting a bid, Bidder certifies or affirms it has adopted policies, practices, and standards consistent with the City's Drug-Free Workplace Certification.

SECTION 13 – VETERAN BUSINESS ENTERPRISES PREFERENCE

Pursuant to City of Miami Beach Ordinance No. 2011-

3748, https://library.municode.com/fl/miami_beach/codes/code_of_ordinances?nodeId=SPAGEOR_CH2AD_ARTVIP R_DIV3COPR_S2-374PRPRPRVECOGOSE the City shall give a preference to a responsive and responsible bidder which is a small business concern owned and controlled by a veteran(s) or which is a service-disabled veteran business enterprise, and which is within five percent (5%) of the lowest and best Bidder, by providing such Bidder an opportunity of providing said goods or contractual services for the lowest responsive bid amount. Whenever, as a result of the foregoing preference, the adjusted prices of two (2) or more bidders, which are a small business concern owned and controlled by a veteran(s) or a service-disabled veteran business enterprise, constitute the lowest bid pursuant to an ITB, RFP, RFQ, ITN or oral or written request for quotation, and such bids are responsive, responsible and otherwise equal with respect to quality and service.

The award shall be made to the service-disabled veteran business enterprise.

Is the Bidder a service-disabled veteran business enterprise certified by the State of Florida?

Is the Bidder a service-disabled veteran business enterprise certified by the United States Federal Government?

SECTION 14 – AFFIDAVIT OF COMPLIANCE WITH CONTRACTING WITH ENTITIES OF FOREIGN COUNTRIES OF

CONCERN FLORIDA STATUTE 287.138

Bidder has reviewed Section 287.138 of the Florida Statutes and certifies that, under penalty of perjury, it does not meet any of the criteria listed in Section 287.138(2)(a)-(c) of the Florida Statutes.

SECTION 15 - AFFIDAVIT OF COMPLIANCE WITH SECTION 2-375-1 PROHIBITION AGAINST CONTRACTING WITH

PARTIES THAT BOYCOTT ISRAEL

The Bidder certifies that it has reviewed Section 2-375-1 of the Code of the City of Miami Beach, is not engaged in a boycott of Israel, and agrees not to engage in such a boycott for the duration of its contract.

http://www.miamibeachfl.gov/city-hall/procurement/procurement-related-ordinance-and-procedures/ https://www.miamibeachfl.gov/wp-content/uploads/2019/04/DRUG-FREE-WORKPLACE-CERTIFICATION.pdf https://library.municode.com/fl/miami_beach/codes/code_of_ordinances?nodeId=SPAGEOR_CH2AD_ARTVIPR_DIV3COPR_S2-374PRPRPRVECOGOSE https://library.municode.com/fl/miami_beach/codes/code_of_ordinances?nodeId=SPAGEOR_CH2AD_ARTVIPR_DIV3COPR_S2-374PRPRPRVECOGOSE

SECTION 16- AFFIDAVIT OF COMPLIANCE WITH ANTI-HUMAN

TRAFFICKING LAWS FLORIDA STATUTE 787.06(13)

Pursuant to section 787.06(13), Florida Statutes, this portion of the form must be completed by an officer or representative of the nongovernmental entity executing, renewing, or extending a contract with a governmental entity.

By virtue of submitting a bid, Bidder certifies or affirms its compliance with the Human Trafficking Laws Certification.

Enter the name and title of the bidder's authorized representative:

SECTION 17 - SMALL AND DISADVANTAGED BUSINESS CERTIFICATION

Pursuant to Resolution 2020-31519, the City is tracking the Small and Disadvantaged Businesses, as certified by Miami-Dade County, that have been certified as a Small or Disadvantaged Business by Miami-Dade County.

Does Bidder possess Small or Disadvantaged Business certification by Miami-Dade County?

SECTION 18 - LGBT BUSINESS ENTERPRISE CERTIFICATION

Pursuant to Resolution 2020-31342, the City is tracking the utilization of LGBT-owned firms that have been certified as an LGBT Business Enterprise by the National Gay and Lesbian Chamber of Commerce (NGLCC).

Does Bidder possess LGBT Business Enterprise Certification by the NGLCC?

SECTION 19 - FAIR CHANCE REQUIREMENT

The Fair Chance Ordinance No. 2016-4012 is available at:

https://library.municode.com/fl/miami_beach/codes/code_of_ordinances?nodeId=SPAGEOR_CH62HURE_ARTVFACHO R

By virtue of submitting a bid, Bidder certifies that it has adopted policies, practices, and standards consistent with the City's Fair Chance Ordinance. Bidder agrees to provide the City with supporting documentation evidencing its compliance upon request.

Bidder further agrees that any breach of the representations made herein shall constitute a material breach of contract and shall entitle the City to immediate termination for cause of the agreement, in addition to any damages that may be available at law and in equity.

SECTION 20- MORATORIUM ON TRAVEL TO

AND THE PURCHASE OF GOODS OR SERVICES FROM MISSISSIPPI

Pursuant to Resolution 2016-29375, the City of Miami Beach, Florida, prohibits official City travel to Mississippi, as well as the purchase of goods or services sourced in Mississippi. Bidder shall agree that no travel shall occur on behalf of the City to Mississippi, nor shall any product or services it provides to the City be sourced from this state.

By virtue of submitting a bid, Bidder agrees it is and shall remain in full compliance with Resolution 2016-29375 https://www.miamibeachfl.gov/wp-content/uploads/2021/04/2016-29375-Resolution-Moratorium-for-North-Carolina-Mississipi.pdf

SECTION 21 - LIVING WAGE

If applicable, pursuant to Section 2-408 of the City of Miami Beach Code (as currently stated or as may be amended), covered employees shall be paid the required living wage rates (https://www.miamibeachfl.gov/city-hall/procurement/procurement-related-ordinance-and-procedures/). Any payroll request made by the City during the contract term shall be completed electronically via the City's electronic compliance portal.

https://library.municode.com/fl/miami_beach/codes/code_of_ordinances?nodeId=SPAGEOR_CH62HURE_ARTVFACHOR https://library.municode.com/fl/miami_beach/codes/code_of_ordinances?nodeId=SPAGEOR_CH62HURE_ARTVFACHOR https://www.miamibeachfl.gov/wp-content/uploads/2021/04/2016-29375-Resolution-Moratorium-for-North-Carolina-Mississipi.pdf https://www.miamibeachfl.gov/city-hall/procurement/procurement-related-ordinance-and-procedures/ https://www.miamibeachfl.gov/city-hall/procurement/procurement-related-ordinance-and-procedures/