Certfication, Questionnaire _ Requirements affidavit.pdf

BID SUBMITTAL QUESTIONNAIRE – CONSTRUCTION

SECTION 1 – BID CERTIFICATION

This certification/questionnaire is REQUIRED and must be fully completed and submitted electronically.

Solicitation No:

BID NUMBER

Solicitation Title:

PROJECT 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 – QUESTIONNAIRE

1. Provide the names of each owner (stockholder, sole proprietor, and partner), director, or officer of the company below. Submit additional names on a separate sheet if required.

Owner Ownership percentage Directorship/Office type

2. Provide at least three (3) references of work similar in size and nature to the work referenced in the solicitation.

Project No. BID NUMBER Project Title PROJECT TITLE

Reference No.1

Firm Name:

Contact Individual Name and Title:

Address:

Telephone:

Contact's Email:

Narrative on Scope of Services Provided:

Reference No.2

Telephone:

Reference No.3

Telephone:

Additional Reference

Telephone:

3. Has the applicant company's construction license(s) been revoked during the last five (5) years?

YES NO

If yes, why?

4. Have any owners, directors, officers, or agents of the applicant company had a l icense revoked during the last five (5) years?

5. Is the applicant company currently barred by a governmental agency from bidding work as a prime or subcontractor?

If yes, state the debarment period and the reason(s) for debarment.

6. Has a surety completed, or paid for completion, of a project on behalf of the applicant company within the last five (5) years?

7. Has the applicant company or any of its owners, directors, officers, or agents been convicted of a crime or had a claim that was filed in a court and mediated or arbitrated during the last five (5) years?

8. Is the applicant company a parent, subsidiary, or holding company for another construction company?

If the answer is "yes," identify the company and type of relationship(s) below:

Company Type of affiliation (parent or subsidiary) Period of affiliation

9. Is an owner, director, officer, or agent of the applicant company affiliated with another company?

If the answer is "yes," provide the following information for each individual and the affiliated company.

Individual's name Affiliated company's name Period of affiliation

Type of affiliation (e.g.

officer, director, owner, or employee)

10. Is the applicant company currently the debtor in a bankruptcy case, or file for bankruptcy during the last five (5) years?

If yes, explain and attach, as applicable, the relevant case and court documents, including (but not limited to) the original petition, including the case number and the date that the petition was filed; a copy of the bankruptcy court's discharge order, and any other document that ended the case, if no discharge order was issued.

11. Has any owner, director, officer, or agent for the applicant company, or has any business organization in which any such person was an owner, director, officer, or agent filed for or been discharged in bankruptcy within the past five (5) years?

If yes, explain and attach a copy of the discharge order, an order confirming the plan, and, if a Corporate Chapter 7 case, a copy of the notice of commencement.

12. Has any owner, director, officer, or agent of the applicant company owned or managed a construction company under any other name in the last five (5) years?

If yes, explain.

13. Has the applicant company been assessed or paid liquidated damages on any project during the past five (5) years, whether the project was publicly or privately owned?

14. Are there currently any liens, suits, or judgments of record pending against any owner, director, officer, or agent for the company that is related to the construction activities of a business organization?

15. Has the applicant company or any of its owners, officers, or partners ever been convicted (criminal) or found liable (civil) for making either a false claim or material misrepresentation to any public agency or entity?

16. Has the applicant company or any of its owners, officers, or partners ever been convicted of any federal or state crime?

17. Is any officer, director, employee agent, or immediate family member (spouse, parent, sibling, and child) of any officer, director, employee, or agent an employee of the City of Miami Beach?

If yes, state name, title, and share of ownership

Name Title Share (%) of Ownership

18. Pursuant to City Ordinance No.2016-3990, the City shall not enter into a contract with a business unless the business represents that it does not and will not engage in a boycott as defined in Section 2-375(a) of the City Code, including the blacklisting, divesting from, or otherwise refusing to deal with a person or entity when such action is based on race, color, national origin, religion, sex, intersexuality, gender identity, sexual orientation, marital or familial status, age or disability. Does the applicant agree to comply with this prohibition?

19. Is the applicant a small business concern owned and controlled by a veteran(s) (certified by the State of

Florida Department of Management Services or a service-disabled veteran business enterprise (certified by the United States Department of Veterans Affairs)?

Certifying Agency Certification Type

20. SECTION 21 - 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

21. Financial Capacity. At the time of request by the City, Bidder shall request that Dun & Bradstreet submit its Supplier Qualifier Report directly to the City, within three (3) days of request. Bidder shall arrange for Dun & Bradstreet to submit a Supplier Qualification Report (SQR) directly to the City. No proposal will be considered without receipt (when requested) from the City of the SQR directly from Dun & Bradstreet. 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.

22. 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 contractor 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 contractor certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the contractor 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.

https://www.miamibeachfl.gov/wp-content/uploads/2021/04/2016-29375-Resolution-Moratorium-for-North-Carolina-Mississipi.pdf https://www.miamibeachfl.gov/wp-content/uploads/2021/04/2016-29375-Resolution-Moratorium-for-North-Carolina-Mississipi.pdf https://www.cialdnb.com/third-party-risk/supplier-qualifier-report

23. Suspension And Debarment Certification The Contractor acknowledges that:

(1) This Contract is a covered transaction for purposes of 2 CFR pt. 180 and 2 CFR pt. 3000. As such, the contractor is required to verify that none of the contractor, 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 Contractor 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 contractor 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 Contractor 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 contractor 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.

24. 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?

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

25. 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?

YES NO

26. 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?

27. Cone Of Silence Pursuant to Section 2-486 of the City Code, all procurement solicitations, once advertised and until an award recommendation has been forwarded to the City Commission by the City Manager, are under the "Cone of Silence." The Cone of Silence ordinance is available at https://library.municode.com/fl/miami_beach/codes/code_of_ordinances?nodeId=SPAGEOR_CH2AD_ARTVIISTCO_DIV4PR

_S2-486COSI

Any communication or inquiry in reference to this solicitation with any City employee or City official is strictly prohibited, with the exception of communications with the Procurement Director or his/her administrative staff responsible for administering the https://library.municode.com/fl/miami_beach/codes/code_of_ordinances?nodeId=SPAGEOR_CH2AD_ARTVIISTCO_DIV4PR_S2-486COSI https://library.municode.com/fl/miami_beach/codes/code_of_ordinances?nodeId=SPAGEOR_CH2AD_ARTVIISTCO_DIV4PR_S2-486COSI procurement process for this solicitation, providing said communication is limited to matters of process or procedure regarding the solicitation. Communications regarding this solicitation are to be submitted in writing to the Procurement Contact named herein with a copy to the City Clerk at rafaelgranado@miamibeachfl.gov.

By virtue of submitting the bid, Bidder certifies that it complies with the Cone of Silence Ordinance, pursuant to Section 2-486 of the City Code.

28. Code Of Business Ethics Pursuant to City Resolution No.2000-23789, the Bidder shall adopt a Code of Business Ethics prior to executing a contract with the City. The Code of Business Ethics shall be submitted to the Procurement Department with its response or within three (3) days of request by the City. 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 Code. In lieu of submitting the Code of Business Ethics, Bidder 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 will submit the firm's Code of Business Ethics within three (3) days of request by the City.

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

29. Lobbyist Registration & Campaign Contribution ReQUIREMENTS This solicitation is subject to, and all bidders are expected to be or become familiar with, all City lobbyist laws, including lobbyist registration requirements and the prohibition on campaign contributions, including:

• Lobbyist Registration Requirements sections 2-397 through 2-485.3 of City Code (https://library.municode.com/fl/miami_beach/codes/code_of_ordinances?nodeId=SPAGEOR_CH2AD_ARTVIISTCO_

DIV3LO)

• Campaign Contribution Requirements sections 2-487 and 2-488 of City Code (https://library.municode.com/fl/miami_beach/codes/code_of_ordinances?nodeId=SPAGEOR_CH2AD_ARTVIISTCO_

DIV5CAFIRE)

By virtue of submitting a bid, Bidder certifies or affirms that they have read and understand the above Lobbyist Registration & Campaign Contribution Requirements.

30. Non-Discrimination The Non-Discrimination ordinance is available at:

https://library.municode.com/fl/miami_beach/codes/code_of_ordinances?nodeId=SPAGEOR_CH2AD_ARTVIPR_DIV3COPR_S

2-375NSCCOREWA

By virtue of submitting the bid, Bidder agrees it is and shall remain in full compliance with Section 2-375 of the City of Miami Beach City Code.

31. 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_ARTVFACHOR 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.

32. Public Entity Crimes Please refer to Section 287.133(2)(a), Florida Statutes, available at:

https://www.flsenate.gov/Laws/Statutes/2012/287.133 By virtue of submitting the bid, Bidder agrees with the requirements of Section 287.133, Florida Statutes, and certifies it has not been placed on the convicted vendor list.

33. 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_ARTVIPR_ mailto:rafaelgranado@miamibeachfl.gov http://www.miamibeachfl.gov/city-hall/procurement/procurement-related-ordinance-and-procedures/ https://library.municode.com/fl/miami_beach/codes/code_of_ordinances?nodeId=SPAGEOR_CH2AD_ARTVIISTCO_DIV3LO https://library.municode.com/fl/miami_beach/codes/code_of_ordinances?nodeId=SPAGEOR_CH2AD_ARTVIISTCO_DIV3LO 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 https://library.municode.com/fl/miami_beach/codes/code_of_ordinances?nodeId=SPAGEOR_CH2AD_ARTVIPR_DIV3COPR_S2-375NSCCOREWA https://library.municode.com/fl/miami_beach/codes/code_of_ordinances?nodeId=SPAGEOR_CH2AD_ARTVIPR_DIV3COPR_S2-375NSCCOREWA https://library.municode.com/fl/miami_beach/codes/code_of_ordinances?nodeId=SPAGEOR_CH62HURE_ARTVFACHOR https://www.flsenate.gov/Laws/Statutes/2012/287.133 https://library.municode.com/fl/miami_beach/codes/code_of_ordinances?nodeId=SPAGEOR_CH2AD_ARTVIPR_DIV3COPR_S2-374PRPRPRVECOGOSE

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?

YES NO

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

CONTINUED ON THE FOLLOWING PAGE.

https://library.municode.com/fl/miami_beach/codes/code_of_ordinances?nodeId=SPAGEOR_CH2AD_ARTVIPR_DIV3COPR_S2-374PRPRPRVECOGOSE

34. Sub-Contractors Providing Services to this Project:

Subcontractor Work to be completed % of work to be performed

Name:

Tel:

Email:

Name:

Tel:

Email:

Name:

Tel:

Email:

Name:

Tel:

Email:

Name:

Tel:

Email:

Name:

Tel:

Email:

Name:

Tel:

Email:

Name:

Tel:

Email:

Name:

Tel:

Email:

Name:

Tel:

Email:

Name:

Tel:

Email:

35. Affidavit of Compliance with 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.

36– 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.

37 - 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.

If yes, please disclose the first and last name(s) and occupation:

FIRST AND LAST NAME OCCUPATION

38 - 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.

39– CANDIDATE SERVICES DISCLOSURE

In accordance with Section 2-379 of the City Code, the City is prohibited from entering into a contract with any individual or entity if the individual, entity, or a principal or officer of the entity has performed compensated services for a candidate for the office of Mayor or City Commissioner within two years prior to the issuance of this solicitation.

Exceptions. The provisions of Section 2-379 do not apply to:

(a) Any individual or entity that provides goods to a candidate for office.

(b) Any individual or entity that provides services to a candidate for office if those same services are regularly performed by the individual or entity in the ordinary course of business for clients or customers other than candidates for office. This includes, without limitation, banks, telephone or internet service providers, printing companies, event venues, restaurants, caterers, transportation providers, and office supply vendors.

(c) Any individual or entity which performs licensed professional services (including, for example, legal or accounting services).

If the entity is not exempt, as noted above, within the past two years, has the business entity submitting the bid, or any principal or officer of the business entity submitting the bid, performed services for compensation for a candidate for the office of Mayor or City Commissioner of the City of Miami Beach?

https://www.miamibeachfl.gov/wp-content/uploads/2019/04/DRUG-FREE-WORKPLACE-CERTIFICATION.pdf https://www.miamibeachfl.gov/wp-content/uploads/2019/04/DRUG-FREE-WORKPLACE-CERTIFICATION.pdf https://www.miamibeachfl.gov/city-hall/procurement/standard-terms-and-conditions https://www.miamibeachfl.gov/city-hall/procurement/standard-terms-and-conditions