DOA 26-6 ADDENDUM NO. 1.pdf

DOA 26-6 Addendum No. 1

June 26, 2026

BOARD OF COUNTY COMMISSIONERS

PALM BEACH COUNTY, FLORIDA

PALM BEACH COUNTY DEPARTMENT OF AIRPORTS

PROJECT NAME: Airport Facilities & Systems Consultant Services

PROJECT NUMBER: DOA 26-6

DESCRIPTION: Request for Proposals (Qualifications Based Selection Process)

ADDENDUM NUMBER 1

Date of Issue: June 26, 2026

This addendum modifies or interprets the proposal documents by additions, deletions, clarifications, corrections, or other type of modifications. Addenda will become part of the

Contract Documents. Proposers, upon receiving addenda, shall insert same into the Proposal

Documents.

It is required that Addendum Number 1 be signed in the Acknowledgement of Receipt below and attached to the Proposal and become part of the Proposal.

Acknowledgement of Receipt of Proposer

ADDENDUM NO. 1

This addendum includes the following:

1. Pre-Proposal Conference Virtual Meeting Link

Microsoft Teams meeting

Join: https://teams.microsoft.com/meet/263641844084029?p=iy9G20i1gUpUFbeEuu

Meeting ID: 263 641 844 084 029

Passcode: jq9W75Pr

Need help? | System reference

Dial in by phone

+1 872-242-8934,,491924295# United States, Chicago

Find a local number

Phone conference ID: 491 924 295#

2. Questions

Question: I’d like to request the fillable pdfs or Word versions of the required forms.

Response: Fillable forms have been attached to Addendum No. 1.

Question: I’d like to please request fillable pdfs and/or Word versions of the required forms for the subject pursuit. Requested forms include:

• Proposal Certification Form (Attachment B).

• Consultant Responsibility Form (Attachment C)

• Conflict of Interest Disclosure Form for each member of the team (Attachment D)

• Completed OSBD Schedule 1 and Schedule 2 (Attachment E)

• Required Federal Certifications (Attachment F)

• DBE Schedule 6A (Attachment G)

Response: Fillable forms have been attached to Addendum No. 1.

Question: Per page 7 of 113 of the RFP PDF, under Section B. Disadvantaged Business

Enterprise, #2. Goal: No DBE goal has been established for this solicitation. Therefore, please confirm that DBE Schedule 6A (Attachment G) is NOT required due to the goal being

0%.

If the form is still required, please provide guidance on how to complete it.

Response: Refer to IV. B. 3. In order to be deemed responsive to this solicitation, all

Proposers are required to submit with their proposal the DBE Schedule 6A. To complete

Schedule 6A, please list your firm and sign DBE Schedule 6A.

Question: I’d like to please ask the following questions for clarification for the subject pursuit (DOA 26-6 RFP Airport Facility & Systems Consultant Services ):

• In Section D. Required Proposal Contents, bullet 5 says to Provide current Standard Form

330 to include those personnel within the prime consultant firm or sub-consultants, who have similar experience. (Length, as required). Please clarify whether or not a FULL SF330 is required here (Sections A-D, Sections E, F G, and H), or if only SF330 Section E: Resumes are required in this section. We interpret the bullet to mean ONLY SF330 Section E:

Resumes is required here.

• In Section D. Required Proposal Contents, bullet 6, says to provide Five (5) verifiable references for work of a similar nature completed in the last ten (10) years. This can be accomplished in the Standard Form 330. Please clarify whether or not a FULL SF330 is required here (Sections A-D, Sections E, F G, and H), or if only SF330 Section F: Projects are required in this section. We interpret the bullet to mean ONLY SF330 Section F: Projects is required here.

Response: Please submit the entire Standard Form 330 as part of the Proposal

Submission.

Question: I’d like to please ask the following questions for clarification for the subject pursuit (DOA 26-6 RFP Airport Facility & Systems Consultant Services):

With the SBE goal of 20%, we are seeking clarification on how to complete SBD Schedules

1 and 2 (Attachment E) in light of Section IV.A.3, which requires submission of these forms even though no subconsultants will be proposed. Our questions are as follows:

1. Schedule 1 Completion. Since no subconsultants are being proposed should

Section B be marked as "TBD"?

2. Subcontractor Identification on Schedule 2. Schedule 2 is structured as an OSBD

Letter of Intent — a binding document requiring the subcontractor's legal name, SBE certification date, and authorized signature. Since no subconsultants are being proposed at this stage, should these fields be marked "TBD"?

3. Schedule 2 Listing Anticipated Roles. Should these be entered in the "Item

Description" column of the SBE Participation table?

Response: If the SBE goal is to be attained through subconsultants, list anticipated roles, disciplines or service categories on Schedule 1 and Schedule 2 for which SBE certified subconsultants may be used. The Proposer must also indicate anticipated SBE utilization in a percentage per IV.A.3. The anticipated roles shall be entered in the Item Description of Schedule 2.

This Addendum includes the following attachments:

Fillable forms

END OF ADDENDUM No 1

ATTACHMENT B

PROPOSAL CERTIFICATION FORM

DESIGN PROFESSIONAL SERVICES FOR

AIRPORTS GENERAL CONSULTANT SERVICES DOA 26-6

(Proposer must complete, sign and return with proposal)

I hereby certify that I am submitting my company’s proposal and understand that by virtue of executing and returning with this proposal this Proposal Certification Form, I certify that all information is correct and I understand the contents and accept the conditions of the Request for

Proposal and this Proposal Certification Form.

Acknowledgment of Supplements:

Proposer has checked the County’s on-line Vendor Self-Service (VSS) system at https://pbcvssp.pbc.gov/vssprd/Advantage4. for any Supplements to this RFP that may have been issued prior to the deadline for receipt of proposals and understands all supplements issued by the

County.

The Proposer acknowledges receipt of supplement(s) as follows:

Supplement # dated Supplement # dated

SBE Participation. Proposer has committed to the following:

__% SBE participation as set forth on the SBD Schedule 1 and Schedule 2 completed and submitted by Proposer. Proposer shall comply with said goal(s) if awarded the Contract which shall be deemed material terms of any resulting contract.

Commercial Non-Discrimination Certification:

The undersigned Proposer hereby certifies and agrees that the following information is correct: In preparing its response on this Solicitation, the Proposer has considered all proposals submitted from qualified, potential subconsultants/subcontractors and has not engaged in "discrimination" as defined in the County’s Commercial Nondiscrimination Policy as set forth in Resolution R2025-

0748 as amended, to wit: discrimination in the solicitation, selection or commercial treatment of any subconsultant/subcontractor, vendor, supplier or commercial customer on the basis of race, color, religion, disability, sex, age, national origin, ancestry, marital status, familial status, sexual orientation, or genetic information, or on the basis of any otherwise unlawful use of characteristics regarding the subconsultant/subcontractor’s, vendor's, supplier's or commercial customer's employees or owners; provided that nothing in this policy shall be construed to prohibit or limit otherwise lawful efforts to remedy the effects of discrimination that have occurred or are occurring in the County’s relevant marketplace of Palm Beach County. Without limiting the foregoing, "discrimination" also includes retaliating against any person or other entity for reporting any incident of "discrimination." Without limiting any other provision of the solicitation, it is understood and agreed that, if this certification is false, such false certification will constitute https://pbcvssp.pbc.gov/vssprd/Advantage4 grounds for the County to reject the proposal submitted by the Proposer for this Solicitation, and to terminate any contract awarded based on the response. As part of its proposal, the Proposer shall provide to the County a list of all instances within the immediate past four (4) years where there has been a final adjudicated determination in a legal or administrative proceeding in the State of Florida that the Proposer discriminated against its subconsultants/subcontractors, vendors, suppliers or commercial customers, and a description of the status or resolution of that complaint, including any remedial action taken. As a condition of submitting a proposal to the County, the

Proposer agrees to comply with the County’s Commercial Nondiscrimination Policy as described in Resolution R2025-0748 as amended.

PROPOSER (firm name):

PRINT NAME OF AUTHORIZED REPRESENTATIVE:

SIGNATURE OF AUTHORIZED REPRESENTATIVE:

TITLE: DATE:

ATTACHMENT C

CONSULTANT RESPONSIBILITY DISCLOSURE FORM

BEFORE COMPLETING THIS FORM, READ

EACH QUESTION CAREFULLY AND ANSWER COMPLETELY

(This disclosure must be completed, signed and returned with proposal)

CONSULTANT RESPONSIBILITY DISCLOSURE

Entity Name: ___________________________________________________________________________________

Entity Address: _________________________________________________________________________________

City ____________________________________________ State __________ Zip ________-______

Phone Number (______) ______-________

E-MAIL: _____________________________

Contact Name: ______________________ Title __________________

Entity Classification: Corporation _____ , Partnership ___ Sole Proprietorship _____ , Other _____(please explain)

(If Corporation, State where incorporated _____ , Date of Incorporation ____/____/______) ________________

All applicants answer this:

1. How many years has your organization been operating under your present business name? ____________

2. List all previous business names of your organization:

3. How many years’ experience has your organization had as a:

Design Consultant _____________

4. Enter your Federal Employer Identification Number (FEIN): __________________________

Dunn & Bradstreet Number (D&B): ____________________________________

The term “affiliate” means a predecessor or successor of a firm under the same, or substantially the same, control or a group of business entities which are connected or associated so that one entity controls or has the power to control each of the other business entities. The term “affiliate” includes the officers, directors, and shareholders active in management. The ownership by one business entity of a controlling interest in another business entity or a pooling of income among business entities is evidence that one business entity is an affiliate of another.

PLEASE COMPLETE QUESTIONS 5 and 6 USING THE ABOVE DEFINITION OF “AFFILIATE”.

5. Has the firm, an affiliate, an officer, a director, an agent, an employee or a member of your firm, or that of an affiliate, ever been indicted, had criminal information filed against it, pled guilty, pled no contest, or been convicted of any act prohibited by state or federal criminal law which involves fraud, bribery, collusion, conspiracy, violation of state or federal antitrust laws, or material misrepresentation committed in any federal or state jurisdiction with respect to any public contract?

Yes ______ No ______ If yes, please explain in detail _________________________________________

6. Please state whether your firm or any of your affiliates are presently or have ever been barred or suspended from bidding, proposing or contracting on any public contract(s)?

Yes ______ No ______ If yes, please explain in detail _________________________________________

7. Within the past 10 years, has your firm failed to successfully complete any work awarded to you?

Yes ______ No ______ If yes, please explain in detail _________________________________________

8. Has your firm or any of its owners, officers and directors ever filed for protection of the bankruptcy court, have pending any petition in bankruptcy court or made an assignment for the benefit of creditors?

Yes ______ No ______ If yes, please explain in detail _________________________________________

9. Total number of full time, regular employees in your company: ___________ If this number has changed in the past 2 years, please explain ______________________________________________________________________________

10. Consultant hereby represents and warrants that, if selected, the firm has sufficient staff and financial resources to complete the projects assigned under the contract.

Remainder of this page left blank intentionally

CERTIFICATION

I, the undersigned authority, hereby certify that the information submitted herewith, including any attachment hereto, is true and accurate to the best of my knowledge and belief under perjury of law.

By:

(Print)

(Signature)

Title:

Date:

STATE OF FLORIDA

COUNTY OF PALM BEACH

The foregoing instrument was acknowledged before me by means of ___ physical presence OR ___ online notarization, this day of , 20 , by , who is personally known to me or who has produced as identification and who did not take an oath.

Notary Public

ATTACHMENT D

CONFLICT OF INTEREST DISCLOSURE FORM

(Must be completed by Proposer and any subconsultants and returned with proposal)

PALM BEACH COUNTY CONFLICT OF INTEREST DISCLOSURE FORM

CONSULTANT/SUBCONSULTANT represents that it presently has no interest, either direct or indirect, which would or could conflict in any manner with the performance of services for the County, except as follows:

(Attach additional sheets as needed.)

CONSULTANT/SUBCONSULTANT further represents that no person having any interest shall be employed for said performance. By signing below, CONSULTANT/SUBCONSULTANT certifies that the information contained herein is true and correct and constitutes all current potential conflicts of interest which may influence or appear to influence CONSULTANT/SUBCONSULTANT’S judgment or quality of services being provided to the County.

CONSULTANT/SUBCONSULTANT shall promptly notify the COUNTY in writing by certified mail of all potential conflicts of interest that may arise in the future through any prospective business association, interest or other circumstance which may influence or appear to influence

CONSULTANT/SUBCONSULTANT’S judgment or quality of services being provided to the County.

Such written notification shall identify the prospective business association, interest or circumstance, the nature of work that CONSULTANT/SUBCONSULTANT may undertake and request an opinion of the

COUNTY as to whether the association, interest or circumstance would, in the opinion of the COUNTY, constitute an unacceptable conflict of interest if entered into by the CONSULTANT/SUBCONSULTANT.

If, in the sole opinion of the COUNTY, the prospective business association, interest or circumstance of

CONSULTANT/SUBCONSULTANT would constitute an unacceptable conflict of interest to the

COUNTY, the COUNTY shall so state in the notification and the CONSULTANT/SUBCONSULTANT shall not enter into said association, interest or circumstance.

This DISCLOSURE is submitted by (Name of Individual:) __________________________, as

(Title/Position:) ___________________________of (Name of Firm:) ____________________________ who hereby certifies that any misrepresentation by the CONSULTANT/SUBCONSULTANT on this

Disclosure is considered an unethical business practice and is grounds for sanctions against future County business with the CONSULTANT/SUBCONSULTANT.

Signature

Date

OSBD SCHEDULE 1

SOLICITATION/PROJECT/BID NAME: ______________ _ SOLICITATION/PROJECT/BID NO.: _____________ _

SOLICITATION OPENING/SUBMITTAL DATE: ______________ COUNTY DEPARTMENT: __________________

Section A PLEASE LIST THE DOLLAR AMOUNT OR PERCENTAGE OF WORK TO BE COMPLETED BY THE PRIME CONTRACTOR/CONSULTANT* ON THE PROJECT:

NAME OF PRIME RESPONDENT/BIDDER: __________________ ADDRESS: ___________________ _

CONTACT PERSON: _____________________ _ PHONE NO.: __________ E-MAIL:. _____________

Non-SBE SBE PRIME'S DOLLAR AMOUNT OR PERCENTAGE OF WORK: _____________ _

SBE Prime's must include their percentage or dollar amount in the Total Participation line under section B.

Section B PLEASE LIST THE DOLLAR AMOUNT OR PERCENTAGE OF WORK TO BE COMPLETED BY ALL SUBCONTRACTORS/SUBCONSULTANTS ON THE PROJECT BELOW:

(Check all Applicable Categories) DOLLAR AMOUNT OR Subcontractor/Sub consultant Name

PERCENTAGE OF WORK

Non-SBE SBE

1. □ DI

2. □ □

3. □ □

4. □ □

5. □ □ (Please use additional sheets if necessary)

Total Bid/Offer Price$. ______________

Total

Total Certified SBE Participation $

I hereby certify that the above information is accurate to the best of my knowledge:

Title

Note: 1.

Name & Authorized Signature

The amount listed on this form for a Subcontractor/sub consultant must be supported by price or percentage listed on the properly executed Schedule 2 or attached signed proposal.

2. Only those firms certified by Palm Beach County at the time of solicitation due date are eligible to meet the established OSBD Affirmative Procurement Initiative (API). Please

3. Modification of this form is not permitted and will be rejected upon submittal.

4. If a Mandatory API goal applies, failure to submit a properly executed Schedule 2 will result in a determination of non-responsiveness to the solicitation.

OSBD LETTER OF INTENT- SCHEDULE 2*

A completed Schedule 2 is a binding document between the Prime Contractor/consultant and a Subcontractor/subconsultant � any tier) and should be treated as such. All Subcontractors/subconsultants, including any tiered Subcontractors/ subconsultants, must properly execute this document. If a Mandatory API goal applies, failure to submit a properly executed Schedule 2 will result in a determination of non-responsiveness to the solicitation. Each properly executed Schedule 2 must be submitted with the bid/proposal.

SOLICITATION/PROJECT NUMBER:------------------------------

SOLICITATION/PROJECT NAME:--------------------------------

Prime Contractor:___________________.Subcontractor:_________________ (Check box(s) that apply)

□ SBE □ Non-SBE □ Supplier Date of Palm Beach County Certification (if applicable): _______

SBE PARTICIPATION - SBE Primes must document all work to be performed by their own work force on this form. Specify in detail, the scope of work to be performed or items supplied with the dollar amount and/or percentage for each work item. When applicable, identify the line item(s) associated with the service/product being supplied. SBE credit will only be given for the areas in which the SBE is certified. A detailed quote/ proposal may be attached to a properly executed Schedule 2 for additional information.

Line

Item

Item Description Unit Price Quantity/

Units

Contingencies/

Allowances

Total Price/Percentage

The undersigned Subcontractor/subconsultant is prepared to self-perform the above-described work in conjunction with the aforementioned project at the following total price or percentage: ________________

If the undersigned intends to subcontract any portion of this work to another Subcontractor/subconsultant, please list the business name and the amount below accompanied by a separate properly executed Schedule 2.

Name of 2nd/3rd tier Subcontractor/subconsultant

Print Name of Prime

By:_________________ Authorized Signature

Print Name

Title

Date: __________________

*Revised 6.5.2025 pursuant to Emergency Ordinance 2025-014, approved on June 3, 2025

Price or Percentage: ______________ _

Print Name of Subcontractor/subconsultant

By:------------------ Authorized Signature

Print Name

Title

Date: ___________________

F-1

CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY, AND

VOLUNTARY EXCLUSION-LOWER TIER PARTICIPANT

The Consultant certifies that:

(a) This Contract is a covered transaction for purposes of 2 CFR, Part 180. As such, the

Consultant is required to verify that none of the Consultant, 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).

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

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

(d) The Consultant agrees to comply with the requirements of 2 CFR Part 180, subpart C while this offer is valid and throughout the period of any contract that may arise from this offer. The

Consultant further agrees to include a provision requiring such compliance in its lower tier covered transactions, including submission to Consultant of this Certification completed by its suppliers, subcontractors and subconsultants.

CONSULTANT NAME: _______________________________________________________

ADDRESS: ____________________________________________________________

CONSULTANT’S AUTHORIZED OFFICIAL:

Name and Title Signature Date

F-2

CERTIFICATION REGARDING LOBBYING

Certification for Contracts, Grants, Loans, and Cooperative Agreements

(To be submitted with each bid or offer exceeding $100,000)

The undersigned Consultant certifies, to the best of his or her 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 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

U.S.C. § 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 Consultant, ______________________________________________________, certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Consultant understands and agrees that the provisions of 31 U.S.C. § 3801 et seq., apply to this certification and disclosure, if any.

Signature of Consultant’s Authorized Official

Name and Title of Consultant’s Authorized Official

Date

ATTACHMENT G

EXHIBIT 1

RESTRICTIONS ON LOBBYING CERTIFICATION

FOR ALL PROCUREMENTS OVER $100,000 INVOLVING CONSTRUCTION/ARCHITECTURAL AND

ENGINEERING/ACQUISITION OF ROLLING STOCK/PROFESSIONAL SERVICE CONTRACTS/OPERATIONAL

SERVICE CONTRACTS/ TURNKEY CONTRACTS

The undersigned certifies, to the best of his or her knowledge and belief, that:

1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the Bidder or Offeror, 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 sub-awards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all sub-recipients shall certify and disclose accordingly.

This certification is a material representation of 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 section 1352, title 31, U.S. CodeC. § 1352. 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 certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the undersigned understands and agrees that the provisions of 31 USC A3801, et seq., apply to this certification and disclosure, if any.

(Date) (Signature)

(Print Name)

(Title)

(Company)

Note: This certification must accompany each proposal or offer exceeding $100,000. Pursuant to 31 USC §3801(c)(1)-(2), any person who makes a prohibited expenditure or fails to file or amend a required certification or disclosure form shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such expenditure or failure.

EXHIBIT 3

FEDERAL TAX LIABILITY AND RECENT FELONY CONVICTIONS DISCLOSURE

The CONSULTANT certifies that:

1. The CONSULTANT does not have any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability;

and

2. The CONSULTANT was not convicted of the felony criminal violation under any Federal law within the preceding 24 months.

3. The CONSULTANT agrees to flow this requirement down to all lower tier participants (subcontractors), without regard of the value of any subagreement.

(Company)

Less than $500,000

$500,000-$1 Million $1 Million - $2 Million

$2 Million - $5 Million $5 Million and $8 Million $8 Million - $10 Million $10 Million & above

Less than $500,000 $500,000-$1 Million $1 Million - $2 Million

$2 Million - $5 Million $5 Million and $8 Million $8 Million - $10 Million $10 Million & above

Less than $500,000 $500,000-$1 Million $1 Million - $2 Million

$2 Million - $5 Million $5 Million and $8 Million $8 Million - $10 Million $10 Million & above

Less than $500,000 $500,000-$1 Million $1 Million - $2 Million

$2 Million - $5 Million $5 Million and $8 Million $8 Million - $10 Million $10 Million & above

Less than $500,000 $500,000-$1 Million $1 Million - $2 Million

$2 Million - $5 Million $5 Million and $8 Million $8 Million - $10 Million $10 Million & above

1Include all firms whether or not DBEs or Small Businsess Concerns. Mutiple pages may be included.

2To determine if your business qualifies as "small" for government contracting purposes, use SBA’s Size Standard Tool: https://www.sba.gov/federal-contracting/contracting-guide/size-standards/size-standards-tool

3ONLY LIST NAICS CODES FOR THE WORK PROPOSED FOR THIS PROPOSAL

North American Industrial Classification System (NAICS) Codes - this list is not exclusive or exhaustive, but provided for informational purposes. For Additonal Codes: https://www.census.gov/naics/

LIST COMMON CODES

Code No. Classification Category

No

Yes

Yes

Yes

Small Business Concern (SBC)

Other (Neither a DBE or SBC)

Disadvanted Business Enterprise (DBE)

Other (Neither a DBE or SBC)

Disadvanted Business Enterprise (DBE)

Disadvanted Business Enterprise (DBE)

Small Business Concern (SBC)

No

Yes

No

BIDDERS LIST

Name of All Proposers1 Firm's Address (include State and Zip Code) Age of Firm (Number of

Years)

Annual Gross Receipts of Firm (Mark Applicable Range (X or ))

North American Industrial Classification System Codes for Work

Proposed to be Performed by Firm

(NAICS)3

https://www.census.gov/naics/

Indicate Category of Firm2

(Mark Applicable Range (X or ))

Will Firm Be Participating in this Contract?

(Yes or No) (Mark Applicable Range (X or ))

If Firm will be Participating in this Contract, indicate

Anticipated Percentage (%) of Participation in this Contract

Small Business Concern (SBC)

Other (Neither a DBE or SBC)

NoCity State Zip Code

City State Zip Code

City State Zip Code

City State Zip Code

Disadvanted Business Enterprise (DBE)

Small Business Concern (SBC)

Other (Neither a DBE or SBC)

Yes

City State Zip Code

Disadvanted Business Enterprise (DBE)

Small Business Concern (SBC)

Other (Neither a DBE or SBC) No

ATTACHMENT G EXHIBIT 4 - SCHEDULE 6A

RFP NO. DOA 26-6

Airport Facilities Consultant Services - PALM BEACH COUNTY DEPARTMENT OF AIRPORTS

Exhibit 5

TRADE RESTRICTION CERTIFICATION

The CONSULTANT certifies that with respect to this solicitation and any resultant contract, the CONSULTANT –

1) is not owned or controlled by one or more citizens of a foreign country included in the list of countries that discriminate against U.S. firms as published by the Office of the United States Trade Representative (USTR);

2) has not knowingly entered into any contract or subcontract for this project with a person that is a citizen or national of a foreign country included on the list of countries that discriminate against U.S. firms as published by the USTR; and

3) has not entered into any subcontract for any product to be used on the Federal project that is produced in a foreign country included on the list of countries that discriminate against U.S. firms published by the USTR.

This certification concerns a matter within the jurisdiction of an agency of the United States of America and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under Title 18 USC § 1001.

The Offeror/Contractor must provide immediate written notice to the Owner if the Offeror/Contractor learns that its certification or that of a subcontractor was erroneous when submitted or has become erroneous by reason of changed circumstances. The Contractor must require subcontractors provide immediate written notice to the Contractor if at any time it learns that its certification was erroneous by reason of changed circumstances.

Unless the restrictions of this clause are waived by the Secretary of Transportation in accordance with 49 CFR § 30.17, no contract shall be awarded to an Offeror or subcontractor:

1) who is owned or controlled by one or more citizens or nationals of a foreign country included on the list of countries that discriminate against U.S. firms published by the USTR; or

2) whose subcontractors are owned or controlled by one or more citizens or nationals of a foreign country on such USTR list; or

3) who incorporates in the public works project any product of a foreign country on such USTR list.

Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render, in good faith, the certification required by this provision. The knowledge and information of a contractor is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

The Offeror agrees that, if awarded a contract resulting from this solicitation, it will incorporate this provision for certification without modification in all lower tier subcontracts. The Contractor may rely on the certification of a prospective subcontractor that it is not a firm from a foreign country included on the list of countries that discriminate against U.S. firms as published by USTR, unless the Offeror has knowledge that the certification is erroneous.

This certification is a material representation of fact upon which reliance was placed when making an award. If it is later determined that the Contractor or subcontractor knowingly rendered an erroneous certification, the Federal

Aviation Administration (FAA) may direct through the Owner cancellation of the contract or subcontract for default at no cost to the Owner or the FAA.

(Company)