CSA_Draft.pdf

Revised 8-6-2024

Agreement # CSA-2024-3019 Page 1 of 11

Contracted Services Agreement with [INSERT CONTRACTOR NAME]

# CSA-2024-3019

THIS AGREEMENT is made and entered into as of the last date signed below between the School Board of Volusia County, Florida (hereinafter referred to as “BOARD”), a body corporate pursuant to s. 1001.40, Florida Statute, whose principal place of business is 200 North Clara Avenue, DeLand, Florida, 32720 and [insert CONTRACTOR Legal Name here] (CONTRACTOR) whose principal place of business is [insert CONTRACTOR’s address here].

WHEREAS, the BOARD is interested in procuring the CONTRACTOR’s Multifunction devices & services Districtwide, and

WHEREAS, Florida Administrative Code 6A-1.012(11)(a) authorizes district school boards to acquire this solution by direct negotiation and contract with the CONTRACTOR, as best fits the needs of the school district as determined by the district school board; and

WHEREAS, CONTRACTOR desires to provide their Multifunction devices & services Districtwide, NOW, THEREFORE, in consideration of the premises and of the mutual covenants contained herein and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the Parties hereby agree as follows:

1. TERM OF AGREEMENT: The term of this Agreement shall commence on 1/8/2025 and continue until

1/7/2028 The BOARD reserves the right to renew/re-negotiate any or all prices, terms, conditions, and specifications of the contract upon mutual agreement by both the BOARD and the CONTRACTOR.

Notwithstanding any other termination referenced herein or attached hereto, The BOARD reserves the right to terminate this agreement within 30 days prior to the start of each fiscal year (July 1) during the term of this agreement without cause or subject to any penalties or additional obligations.

2. RENEWAL/EXTENSION: The BOARD reserves the right to renew/re-negotiate any or all prices, terms, conditions, and specifications of the contract for up to one (1), three (3) year optional renewal periods upon mutual agreement by both the BOARD and the CONTRACTOR. Renewals must be submitted in writing with the signature of the CONTRACTOR’S Authorized Representative(s). Renewals are contingent upon satisfactory performance evaluations by the BOARD and are subject to the availability of funds. NOTE:

Upon exhaustion of all renewal periods, the BOARD also reserves the right to extend the agreement for a period not to exceed six (6) months and is subject to the same terms and conditions as set forth in the initial agreement and any written amendments/modifications signed by the parties. There may be only one

(1) extension of the agreement unless failure to meet the criteria set forth in the agreement for completion of the services is due to events beyond the control of the CONTRACTOR. The CONTRACTOR will be notified when the recommendation has been acted upon by the BOARD.

3. STATEMENT OF WORK: The CONTRACTOR’s responsibilities are defined in Exhibit A. During the term of this agreement, all communications regarding the day-to-day activity and professional services outlined in this agreement will be conducted between the CONTRACTOR and BOARD. In the event of a conflict of interest between the terms and conditions of this agreement and any exhibit or attachments, the terms and conditions of this agreement shall prevail, and the following descending order of precedence shall be observed:

a) Agreement # CSA-2024-3019

b) Exhibit A – Statement of Work and Fee Schedule

c) Attachment A – Drug Free Workplace Certification (If Applicable)

d) Attachment B – Contracted Services Agreement (CSA) Submittal Checklist

4. LOCATION OF SERVICES: Performance of services cited above will be conducted at various locations

Agreement # CSA-2024-3019 Page 2 of 11 district wide.

5. DUTIES: The CONTRACTOR shall report to and coordinate activities with an administrator designated by the Superintendent of Schools herein referred to as “ADMINISTRATOR”. The ADMINISTRATOR assigned to act in all matters pertaining to this agreement and to authorize services, accept and approve all reports, drafts, products, and/or invoices is [insert Administrator Name, Title, Phone # Ext: XXXXX, and Email].

Communication to schools should be limited to services currently contracted and provided to students. All other communication should be routed through the ADMINSTRATOR. This communication includes, but is not limited to; grant funding, budget allocations, recruitment and additional offered or alternate methods of service. There shall be no direct contact from the CONTRACTOR to any schools, board members or personnel other than those specifically authorized by the ADMINISTRATOR and this contract.

6. COMPENSATION & PAYMENT: Based upon the completion of services described above, the

CONTRACTOR shall receive compensation based on the agreed upon rates as defined in Exhibit A.

Services are not-to-exceed $XXX during the term of this agreement as compensation for all work and services performed and authorized by the ADMINISTRATOR. Any and all expenses, such as travel to, from and within Volusia County, lodging, sustenance, materials, supplies, and necessary equipment are considered to be covered by the rate unless agreed upon in advance. The CONTRACTOR shall be required to submit an invoice to the ADMINISTATOR upon completion of services. Payment will be made in accordance with Section 218.70, Florida Statutes, et. seq., the Local Government Prompt Payment Act.

An IRS W-9 form must be completed and attached to this agreement.

7. RECEIVING/INVOICING: No payment will be made for commodities ordered without proper purchase order authorization. The BOARD shall pay the CONTRACTOR pursuant to and in accordance with the promulgations set forth by the State of Florida’s Prompt Payment Act (Florida Statutes Section 218. 70).

Payment shall not be made until delivery has been completed, inspected, and accepted by the BOARD in the quality and quantity ordered. Payment will be accomplished by submission of invoice, in duplicate, with Purchase Order Number referenced thereon and mailed to the address set forth on the purchase order or sent via e-mail transmission to the district Administrator. Payment in advance of delivery by the BOARD cannot be made. All invoices submitted must contain the following detailed information in order to be processed for payment:

a) Purchase Order number

b) Date or time of monthly statement

c) Name of district employee(s) that authorized purchase

d) Itemized parts and supplies

8. TAXES: The district is exempt from Federal Excise Tax and Florida sales tax. Certificates are available at the Procurement Department website: Procurement Department - Volusia County Schools (vcsedu.org).

9. PRICE RE-DETERMINATION: Once each year on the anniversary date of the Contract, including any renewal periods thereof, the awarded CONTRACTOR may, but is not obligated to, petition the Procurement Department Representative for one or more price redeterminations where such price redetermination(s) is/are necessitated by documented increases in the cost of wages. Petitions for price redeterminations must clearly substantiate the requested increase and shall be made within thirty (30) days of the anniversary date of the Contract (i.e., the calendar day and month when the Contract became effective) and only after the Contract has been in effect for at least one year. The written request for redetermination should not be in excess of the relevant pricing index change. Any such petition shall be made only for those price redetermination categories specified herein. Unless otherwise expressly set forth in this Agreement, no other price redeterminations shall be allowed. All price redeterminations, once issued, shall be prospective from the date of approval unless otherwise approved by a duly executed amendment to the contract. NOTE: The BOARD reserves the right to reject any written price adjustments submitted by the CONTRACTOR and/or to not exercise any otherwise available option period based on such price adjustments if needed.

a) Basis for Price Redeterminations. The petition for price redetermination must be based on the increased costs of wages. Price redeterminations will be based solely upon changes in pricing or https://www.vcsedu.org/directory/departments/financial-services/procurement https://www.vcsedu.org/directory/departments/financial-services/procurement

Agreement # CSA-2024-3019 Page 3 of 11 costs documented by either the Employment Cost Index (ECI) or Producer Price Index (PPI), whichever is applicable, as published by the Bureau of Labor Statistics. The base index number for the ECI and PPI will be for the quarter in which the Agreement was initiated. Any subsequent price redeterminations will use the last price redetermination approved for that price redetermination category as the “base index number.” The BOARD shall, if deemed necessary, have the right to audit the CONTRACTOR’S records, including, but not limited to, payroll records to verify or otherwise investigate the validity of any price redetermination request.

b) Wage Price Redetermination. When requesting a price redetermination based upon an increase in wage costs, the CONTRACTOR shall refer to and utilize the Employment Cost Index, Total Compensation, Private Industry, Index Number and Occupational Group as prepared by the Bureau of Labor Statistics in the U.S. Department of Labor. Wage price redetermination increases shall be granted only by reason of wage increases associated with the CONTRACTOR’S employees or subCONTRACTORs performing work or services pursuant to the Agreement.

c) Minimum Wage Price Redetermination. If the minimum wage increases during the term of the

Agreement, including any renewal or extension period thereunder, the CONTRACTOR may petition the Director of the Procurement Department for price redetermination for those job categories where the pay to the CONTRACTOR’S employee(s) is the current minimum wage. Upon verification of the information provided, the BOARD will grant an increase of exactly the amount of the minimum wage increase (not the percentage increase). The CONTRACTOR must increase the pay to the employee(s) by the amount the CONTRACTOR’S requested, which shall not exceed the amount of the minimum wage increase. The amount paid to the CONTRACTOR will be the increase plus any written and documented increase in FICA, Medicare, and Workers' Compensation insurance. The CONTRACTOR’S must supply written documentation of any other increase that is beyond the scope and control of the CONTRACTOR. All written documentation must satisfy the reasonable expectations of the Director of the Procurement Department and Internal Auditor.

i. Example: Minimum wage increases from $7.31 to $7.56 per hour. The CONTRACTOR may petition for an increase of $0.25 per hour to be paid to the affected employee(s) and shall provide written and documented cost increases for FICA, Medicare, and Workers' Compensation. The resulting increase in costs shall be incorporated into fees/rates billed to the BOARD.

If the CONTRACTOR bills the BOARD at a higher price according to any price redetermination granted by the BOARD, and the CONTRACTOR fails to increase the hourly rate paid to the employee for the same period, the CONTRACTOR will be considered in Agreement default and the Agreement will be immediately terminated.

d) Price Redetermination Calculation. All Price Redeterminations shall be calculated and submitted as follows:

Example: CONTRACTOR indicated that thirty percent (30%) of the cost to provide the product/service is directly attributed to the redetermination category (wages).

Current applicable PPI = ................................................$200.50 Base index PPI = ......................................................... - $179.20 PPI increase dollars = ………...……………………………. $21.30

PPI increase percentage ($21.30 / $179.20 = .1189) ……...………….11.9%

Unit cost of the service is ......................................................................... $100.00 30% of $100.00 is directly attributed to the redetermination category........ $30.00 $30.00 × 11.9% = ..........................................................................................$3.57 New unit price for the product/service is ($100 + $3.57) ...........................$103.57

e) Expiration Upon Failure to Agree to Price Redetermination. If the BOARD and the CONTRACTOR cannot agree to a price redetermination pursuant to the terms and conditions of this Agreement, then the Agreement will automatically expire without penalty or further expense to either party after a period

Agreement # CSA-2024-3019 Page 4 of 11 of six (6) months following the CONTRACTOR’S initial request for such price redetermination.

Requests for price redeterminations not made in accordance with the provisions of said Agreement shall be deemed null and void and shall not be a valid reason or pretext for expiration or termination of the Agreement. If the Agreement expires pursuant to the terms and conditions of this Agreement, the BOARD reserves the right, at no expense, penalty, or consequence to the BOARD, to award any tasks thereunder to the next available most responsive and responsible CONTRACTOR.

10. WARRANTY: All warranties express and implied, shall be made available to the BOARD for goods and services covered under this CSA. At no expense to the BOARD, the vendor shall correct any and all apparent and latent defects that may occur within the expressed or implied standard warranty period.

11. TRAVEL: Travel is not allowable for this agreement; however, providers will continue to be paid their hourly rate when traveling location to location on an emergency basis as determined by the district. Travel will be reimbursed in accordance with the BOARD’s travel policies and procedures.

12. INDEPENDENT CONTRACTOR: It is agreed and understood that the CONTRACTOR is an independent

CONTRACTOR and that the BOARD shall exercise no supervisory authority or control over the CONTRACTOR or CONTRACTOR’S employees in the performance of this agreement. Neither the CONTRACTOR nor the CONTRACTOR’S employees shall be deemed to be agents or employees of the BOARD and any representation to the contrary by the CONTRACTOR or its employees shall constitute a violation of this agreement and shall be grounds for immediate termination.

13. INJURIES: The CONTRACTOR acknowledges the CONTRACTOR’s responsibility to obtain appropriate insurance coverage for the benefit of the CONSULTANT and his/her employees. The CONTRACTOR waives any rights for recovery from or for any injuries that may be sustained while performing services under this agreement.

14. CONFLICT OF INTEREST: The CONTRACTOR shall not employ, contract with, or otherwise utilize the services of any officer or employee of the School BOARD of Volusia County. The CONTRACTOR certifies that its owner, officers, directors or agents or members of their immediate family do not have an employee relationship or other material interest with the School BOARD of Volusia County. An exemption of this is provided for non-duty hours in the district. To avoid a conflict of interest, tutoring services provided by any officer or employee of the School BOARD of Volusia County must be conducted before or after the BOARD’s instructional period for the day or when school is not in session.

15. NON-DISCRIMINATION: The CONTRACTOR represents and warrants to the BOARD that CONTRACTOR does not and will not engage in discriminatory practices and that there shall be no discrimination in connection with CONTRACTOR’S performance under this agreement on account of race, color, sex, religion, age, handicap, marital status or national original. CONTRACTOR further covenants that no otherwise qualified individual shall, solely by reason of his/her race, color, sex, religion, age, handicap, marital status, or national origin be excluded from participation in, be denied services, or be subject to discrimination under any provision of this agreement.

16. HOLD HARMLESS/INDEMNIFICATION: Subject only to the limitations of §768.28, Florida Statutes, the

BOARD agrees to indemnify and hold harmless CONTRACTOR from and against any and all claims, suits, actions, damages, or causes of action arising out of the negligent acts of the BOARD arising out of or in connection with the provisions of this agreement. The BOARD does not waive sovereign immunity except as provided by §768.28, Florida Statutes. CONTRACTOR agrees to indemnify, hold harmless, and defend the BOARD from and against any and all claims, suits, actions, damages, or causes of action arising out of the negligent acts of CONTRACTOR arising out of or in connection with the provisions of this agreement.

If CONTRACTOR is a state agency or subdivision as defined in §768.28, Florida Statutes, nothing herein shall be constructed to extend CONTRATOR’S liability beyond that provided in §768.28, Florida Statutes.

17. PROOF OF INSURANCE: The CONTRACTOR must provide proof of Liability Insurance with the appropriate coverage prior to commencement of service. The School Board of Volusia County Schools, 200 N. Clara Ave, DeLand, FL, 32720 will be designated as the CERTIFICATE HOLDER. The insurance carrier shall notify the Board at least thirty (30) days prior to canceling any of the specified coverage.

Agreement # CSA-2024-3019 Page 5 of 11

a) Commercial General Liability: $1,000,000.00 each occurrence, $2,000,000.00 aggregate.

b) Comprehensive Automobile: If vendor is providing transportation services (other than charter bus) $2,000,000.00 along with underinsured / uninsured motorist limits.

c) Workers’ compensation: If services involve heavy labor, then worker’s comp is required in accordance with FS 440.

18. ASSIGNMENT: The CONTRACTOR’S obligations under this agreement may not be assigned or transferred to any other person, firm, or corporation without the prior written consent of the

ADMINISTRATOR.

19. INTELLECTUAL PROPERTY: (When Applicable) Intellectual Property shall be defined as copyrightable works, ideas, discoveries, inventions, and application for patents and patents. Any improvements to Intellectual Property held by the CONTRACTOR, further inventions or improvements, and any new items of Intellectual Property discovered or developed under the terms of this agreement shall be property of the BOARD. The CONTRACTOR shall sign all documents necessary to protect the rights of the BOARD in such Intellectual Property, including the filing and/or prosecution of any applications for copyrights or patents.

The CONTRACTOR shall be responsible for ensuring that it/his/her activities comply with all copyright and patent law, and that the appropriate approval and/or licensure(s) are obtained where required by law.

20. GOVERNING LAW & VENUE: This agreement shall be construed in accordance with the laws of the State of Florida. Any dispute with respect to this agreement is subject to the laws of Florida, venue in Volusia County, Florida. Each party shall be responsible for its own attorneys’ fees and costs incurred as a result of any action or proceeding under this agreement.

21. JESSICA LUNSFORD ACT – HOUSE BILL 1877 AND BACKGROUND CHECK: In the event the requirements include the need for CONTRACTOR to visit schools with students present, CONTRACTOR agrees to comply with all requirements of Sections 1012.32 and 1012.465, Florida Statutes, and all of its personnel who (1) are to be permitted access to school grounds when students are present, (2) will have direct contact with students, or (3) have access or control of school funds, will successfully complete the background screening required by the referenced statutes and meet the standards established by the statutes. This background screening will be conducted by the BOARD in advance of CONTRACTOR or its personnel providing any services under the conditions described in the previous sentence.

CONTRACTOR shall bear the cost of acquiring the background screening required by Section 1012.32, Florida Statutes, and any fee imposed by the Florida Department of Law Enforcement to maintain the fingerprints provided with respect to CONTRACTOR and its personnel. The Parties agree that the failure of CONTRACTOR to perform any of the duties described in this section shall constitute a material breach of this Agreement entitling the BOARD to terminate this Agreement immediately with no further responsibilities or duties to perform under this Agreement. CONTRACTOR agrees to indemnify and hold harmless the BOARD, its officers and employees resulting from liability or claims made by any person who may suffer physical or mental injury, death or property damage resulting in the CONTRACTOR’s failure to comply with the requirements of this Section or with Sections 1012.32 and 1012.465, Florida Statutes. The following link was designed to assist with JLA compliance: JLA Certified. NOTE: Only applicable to contracted vendors who are permitted access on school grounds when students are present, who have direct contact with students, or have access to or control of school funds.

22. DRUG-FREE WORKPLACE: In accordance with the Board’s “Drug-Free Workplace General Policy” employees shall not possess or be under the influence of tobacco products, alcohol, drugs, or any illegal substances while on Board property or while in direct contact with students. Vendors will be required to assure that assigned personnel work in a drug-free environment and will conduct themselves in a manner that does not violate the Board’s standards for employment. NOTE: Only applicable to contracted vendors who are permitted access on Board property or contracted vendors who have direct contact with students.

A Certification Form is required when applicable.

23. CONFIDENTIALITY OF STUDENT RECORDS: The CONTRACTOR understands and agrees that it is subject to all federal and state laws and the School Board rules relating to the confidentiality of student information. CONTRACTOR further agrees to comply with the Family Educational Rights and Privacy Act https://www.vcsedu.org/directory/departments/human-resources/office-of-professional-standards/jessica-lunsford-act-jla

Agreement # CSA-2024-3019 Page 6 of 11

(“FERPA”) 34 C.F.R. 99. CONTRACTOR shall regard all student information as confidential and will not disclose the student information to any third party.

24. FLORIDA’S PUBLIC RECORDS LAWS: This contract shall be subject to Florida’s Public Records Laws, §119 Florida Statutes. CONTRACTOR understands the broad nature of these laws and agrees to comply with Florida’s public records and laws relating to records retention.

25. CHILD NEGLECT: The CONTRACTOR and its employees shall be subject to the requirements of §39.201 Florida Statutes that requires the reporting of child abuse or child neglect to the State of Florida, Department of Children and Families via the Florida Abuse Hotline 1-800-962-2873.

26. NO THIRD-PARTY BENEFICIARIES: The parties expressly acknowledge that it is not their intent to create or confer any rights or obligations in or upon any third person or entity under this agreement. Nothing herein shall be construed as consent by an agency or political subdivision of the State of Florida to be sued by third parties in any matter arising out of any contract.

27. TERMINATION: This Agreement may be canceled with or without cause by the BOARD during the term hereof upon thirty (30) days written notice to the other party of its desire to terminate this Agreement.

28. NON-APPROPRIATION: The CONTRACTOR understands and agrees any, and every contract is subject to the availability of funds to the BOARD to purchase the specified products/services. As used herein, a “non- appropriation” shall be defined as an occurrence wherein the BOARD, in any fiscal period, does not allocate funds in its budget for the purchase of the specified products/services or other amounts owed pursuant to any Contract, from the source of funding which the BOARD anticipates using to pay its obligations hereunder, and the BOARD has no other funds, from sources other than taxes, which it deems to be available to pay its obligations under Contract. The BOARD may terminate a contract, with no further liability to the CONTRACTOR, effective the first day of a fiscal period provided that:

a) A non-appropriation has occurred, and

b) The BOARD has provided the CONTRACTOR with written notice of termination not less than fifteen

(15) days before the proposed termination date.

c) Upon the occurrence of such non-appropriation the BOARD shall for payment for any fiscal period for which funds have not been appropriated.

29. FEDERAL GRANTS TERMS AND CONDITIONS: For any agreement that involves, receives or utilizes

Federal Grants funding, the terms and conditions of Exhibit B shall be considered a part of the agreement, and the CONTRACTOR accepts and acknowledges that it is and will continue to be in compliance with said terms and conditions for the term of the award.

30. SEVERABILITY: If any clause or provision of this agreement is illegal, invalid or unenforceable under present or future laws effective during this term hereof, then the remainder of this agreement shall not be affected thereby; and in lieu of each clause or provision of this agreement which is illegal, invalid or unenforceable, there shall be added, as part of this agreement, a clause or provision as similar in terms to such illegal, invalid or unenforceable clause or provision as may be possible and as may legal, valid and enforceable.

31. SURVIVORSHIP: Those provisions which by their nature are intended to survive the expiration, cancellation, or termination of this agreement, including, by way of example only, the indemnification and Confidentiality provisions, shall survive the expiration, cancellation, or termination of this agreement.

32. PUBLIC RECORDS COMPLIANCE: In addition to other contract requirements provided by law, the CONTRACTOR must comply with Florida public records laws, including but not limited to chapter 119, Florida Statutes, and section 24 of article I of the Constitution of Florida, and specifically agrees to:

a) Keep and maintain public records required by the school BOARD to perform the services;

Agreement # CSA-2024-3019 Page 7 of 11

b) Upon request from the school BOARD’s custodian of public records, provide the school BOARD with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law;

c) Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the CONTRACTOR does not transfer the records to the school BOARD; and

d) Upon completion of the contract, transfer, at no cost, to the school BOARD all public records in possession of the CONTRACTOR or keep and maintain public records required by the school BOARD to perform the service. If the CONTRACTOR transfers all public records to the school BOARD upon completion of the contract, the CONTRACTOR shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the CONTRACTOR keeps and maintains public records upon completion of the contract, the CONTRACTOR shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the school BOARD, upon request from the school BOARD’s custodian of public records, in a format that is compatible with the information technology systems of the school BOARD.

Failure of the CONTRACTOR to abide by the terms of this provision shall be deemed a material breach of this agreement and the School BOARD of Volusia County, Florida may enforce the terms of this provision in the form of a court proceeding and shall, as a prevailing party, be entitled to reimbursement of all attorney’s fees and costs associated with that proceeding. This provision shall survive any termination or expiration of the contract.

IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119,

FLORIDA STATUTES, TO THE CONTRACTOR’S DUTY TO PROVIDE PUBLIC RECORDS RELATING

TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT:

CUSTODIAN OF PUBLIC RECORDS (386) 734-7190 ext. 20110 or 20138 publicrecordsrequest@volusia.k12.fl.us

200 N. Clara Ave., DeLand, FL 32720

33. ENTIRE AGREEMENT: This document incorporates and includes all prior negotiations, correspondence, conversations, agreements, and understandings applicable to the matters contained herein and the parties agree that there are no commitments, agreements or understandings concerning the subject matter of this Agreement that are not contained in this document. Accordingly, the parties agree that no deviation from the terms hereof shall be predicated upon any prior representations or agreements, whether oral or written.

[The remainder of this page intentionally left blank.] mailto:publicrecordsrequest@volusia.k12.fl.us

Agreement # CSA-2024-3019 Page 8 of 11

IN WITNESS WHEREOF, the Parties hereto have made and executed this Agreement on the date first above written.

School Board of Volusia County, Florida DeLand, FL

Signature Date

Ms. Jamie M. Haynes, School Board Chairman Printed Name & Title

Dr. Carmen J. Balgobin, Superintendent

Vendor Name City, State

EXHIBITS:

A – Statement of Work and Fee Schedule

ATTACHMENTS:

A – Drug Free Workplace Certification (If Applicable) B – Contracted Services Agreement (CSA) Submittal Checklist

CONTRACTOR CONTACT INFORMATION:

NAME & TITLE

ADDRESS

Phone:

Email:

Agreement # CSA-2024-3019 Page 9 of 11

EXHIBIT A

STATEMENT OF WORK AND FEE SCHEDULE

Agreement # CSA-2024-3019 Page 10 of 11

Attachment “A”

DRUG-FREE WORKPLACE CERTIFICATION

The CONTRACTOR, in accordance with Florida Statue 287.087 hereby certifies that _____________________________________________ (Name of CONTRACTOR) DOES:

1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition.

2. Inform employees about the dangers of drug abuse in the workplace, the business’s policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, employee assistance programs and the penalties that may be imposed upon employees for drug abuse violations.

3. Give each employee engaged in providing the commodities or contractual services that are under contract a copy of the statement specified in Paragraph 1.

4. In the statement specified in Paragraph 1, notify the employees that, as a condition of working on the commodities or contractual services that are under contract, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contender to, any violation of Chapter 893 or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction.

5. Impose a sanction on or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee’s community, by any employee who is so convicted.

6. Make a good faith effort to continue to maintain a drug-free workplace through implementation of Paragraphs 1 thru 5.

As the person authorized to sign this statement, I certify that this firm complies fully with the above requirements.

Signature of Authorized Officer: __________________________________________________________

Printed Name and Title: _________________________________________________________________

Date: ______________________

Attachment B

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Contracted Services Agreement (CSA) Checklist

Item Description Reference Paragraph(s)

1 Exhibit A – Statement of Work and Fee Schedule

3 and 6

IRS W-9

Certificate of Insurance (COI) (as applicable)

Attachment A - Drug-Free Workplace Certification Form (if applicable)

5 Signed Contracted Services Agreement 33

NOTE: No Purchase Order or Notice to Proceed will be issued until ALL applicable checklist items have been submitted in full to the Procurement Department.

CONTRACTOR’S SIGNATURE DATE

PRINTED NAME AND TITLE

COMPANY NAME