EXHIBITS_A-L.pdf

EXHIBIT A

PROPOSER'S CERTIFICATION

I have carefully examined the Solicitation and any other documents accompanying or made a part of this Solicitatoin.

I hereby propose to furnish the goods or services specified in the Solicitation at the prices or rates quoted in my Proposal. I agree that my Proposal will remain Firm for a period of up to one hundred eighty (180) days in order to allow the College adequate time to evaluate the Proposals.

I agree to abide by all conditions of this Proposal and understand that a background investigation may be conducted by the College prior to award.

I certify that all information contained in this Proposal is truthful to the best of my knowledge and belief. I further certify that I am duly authorized to submit this Proposal on behalf of the Proposer as its act and deed and that the Proposer is ready, willing and able to perform if awarded the Contract.

I certify, under oath, that this Proposal is made without prior understanding, agreement, connection, discussion, or collusion with any other person, Firm or corporation submitting a Proposal for the same product or service, and is all respects fair and without fraud. I further certify that no officer, employee or agent of the College or of any other Proposer has a financial interest in this Proposal. I further certify that the undersigned executed this Proposer's Certification with full knowledge and understanding of the matters therein contained and was duly authorized to do so.

Name of Business:

Name & Title:

Signature:

Mailing Address or, if different from your principal place of business:

Address:

City, State, Zip:

Telephone Number: Email:

DUNS #: Company Tax ID #:

Note: (The College only requires Company Tax Id numbers. The College is not requesting individual social security numbers.)

Personally appeared before me, the undersigned authority, who after first being sworn to me, affixed his/her signature in the space provided above on this _____ day of _________________, 20__ by _______________

□ personally known to me or □ produced identification

Signature of Notary Public

State of ____________________ County of _________________ My commission expires: ________________

EXHIBIT B

PROPOSER INFORMATION AND SIGNATURE FORM

All respondents certify by their signature, hereto, that they have read and understand the conditions and specifications of this solicitation and that they have the authority, capacity and capability to sign this document on behalf of the Firm and will perform according to the conditions and specifications of this solicitation.

Company Name

Purchasing Address

City State Zip code

Remit to Address City State Zip code

Phone # Fax # Web page address

Address of Parent Company (if applicable)

City State Zip code

Contact Person (for project notification) Title

Email Address Phone #

Federal Employer Tax Identification Number (TIN):

Or, Social Security Number (SSN)

OWNERSHIP (Please check all applicable boxes):

Company is at least 51% owned, controlled, and actively managed by: Minority Person(s,) Woman/Women, Disabled Vet, LDB

If minority owned, check applicable boxes. Please attach your Minority Certification

Native American (includes American Indian, American Eskimo, American Aleut, and Native Hawaiian) Asian Indian American (includes India, Pakistan, and Bangladesh) African American Asian Pacific American (includes oriental) Hispanic American

Entity Making Submittal:

Parent Company Subsidiary Division Branch Office

Type of Company or Joint Venture:

Corporation Partnership Sole Proprietorship Joint Venture Other

Year Company or Joint Venture Established: ___________ Company Name or Joint Venture’s Years of Experience in this type of business: _______Years Former Names. List names under which the company or joint venture has done business. (Indicate N/A, if not applicable):

(Please Type or Print Clearly)

Name (Print): _____________________________________________________ Title: ______________________________________________

Signature: ___________________________________________________________________ Date: __________________________________

EXHIBIT C

CONFLICT OF INTEREST STATEMENT AND DISCLOSURE STATEMENT

CHECK ONE

[ ] The undersigned Firm has no potential, real or apparent, conflict of interest due to any other clients, contracts, or property interest for this project.

OR

[ ] The undersigned Firm, by EXHIBIT to this form, submits information which may be a potential conflict of interest due to other clients, contracts, or property interest for this project.

LITIGATION STATEMENT

Please answer the following questions Yes or No. If you answer yes to any of the questions, provide a full explanation below the question. (Attach additional pages if needed.)

Has your Firm or any of it officers received a reprimand of any nature or been suspended by the Florida Department of Business and Professional Regulation (FDBR) or any other regulatory agency or professional association within the last ten (10) years? □ YES □ NO

1. Has your Firm or any member of your Firm been declared in default, terminated or removed from a contract or job related to the services your Firm provides in the regular course of business within the last ten (10) years?

□ YES □ NO

If yes, indicate company name, contact name and telephone number, and reason for early cancellation/termination of contract.

2. Has your Firm had filed against it or filed any requests for equitable adjustment, contract claims, litigation and/or judgments during the past ten (10) years? □ YES □ NO

If answered yes, include a summary and disposition of the case, the outcome or status of suit and the monetary amounts involved.

I hereby certify that all statements made are true and I agree and understand that any misstatement or misrepresentation of falsification of facts shall be cause for disqualification of your proposal and forfeiture of rights for further consideration of this proposal process.

Company Name Name (Print)

Authorized Signature Title

Failure to provide the information requested, including documentation relating to potential conflicts of interest, or summary of past litigation and/or judgment may result in disqualification of your proposal.

EXHIBIT D

SWORN STATEMENT UNDER SECTION 287.133 (3) (a), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES

THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL

AUTHORIZED TO ADMINISTER OATHS.

This sworn statement is submitted to:

This sworn statement is submitted by:

Whose business address is:

and (if applicable) its Federal Employer Identification Number (FEIN) is:

(If entity has no FEIN, include the Social Security Number of the individual signing this sworn statement)

1. My Name is and my relationship to the entity named above is:

2. I understand that a "public entity crime" as defined in Section 287.133(1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or of the United States, including, but not limited to, any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. I understand that "convicted" or "conviction" as defined in Section

287.133 (1) (b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without adjudication of guilt, in any federal or state trial court of record, relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non-jury trial, or entry of a plea of guilty or nolo contendere.

3. I understand that an "affiliate" as defined in Section 287.133(1) (a), Florida Statutes, means:

(1) A predecessor or successor of a person convicted of a public entity crime; or (2) An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate.

4. I understand that a "person" as defined in Section 287.133(1) (e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity.

5. Based on information and belief, that statement which I have marked below is true in relation to the entity submitting this sworn statement. [Please indicate which statement applies.]

6. Neither the entity submitting this sworn statement, nor one or more of the officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity, has been charged with and convicted of public entity crime subsequent to July 1, 1989.

7. There has been a proceeding concerning the conviction before a hearing officer of the State of Florida, Division of Administrative Hearings. The final order entered by the hearing officer did not place the person or affiliate on the convicted vendor list. [Please attach a copy of the Final Order.

8. The person or affiliate was placed on the convicted vendor list. There has been a subsequent proceeding before a hearing officer of the State of Florida, Division of Administrative Hearings. The final order entered by the hearing officer determined that it was in the public interest to remove the person or affiliate from the convicted vendor list. [Please attach a copy of the Final Order.]

The person or affiliate has not been placed on the convicted vendor list. [Please describe any action taken by or pending with the Department of General Services.]

Date: Signature:

Personally appeared before me, the undersigned authority, who after first being sworn to me, affixed his/her signature in the space provided above on this _____ day of _________________, 20______ by __ ________________________________________________________________

□ personally known to me or □ produced identification

Signature of Notary Public

State of

County of

My commission expires:

EXHIBIT E

REFERENCES

In the spaces provided below, the Respondent shall list all names under which it has operated during the past five (5) years.

On the following pages, the Respondent shall provide the information indicated for three (3) separate and verifiable clients. The clients listed must be for work similar in nature to that specified in this solicitation. The same client may not be listed for more than one (1) reference and confidential clients shall not be included. In the event the Respondent has had a name change since the time work was performed for a listed reference, the name under which the Respondent operated at that time must be provided in the space provided for Respondent’s Name.

Clients that are listed as subcontractors in the response will not be accepted as Past Performance references under this solicitation. Entities having an affiliation with the Respondent (i.e. currently parent, subsidiary having common ownership, having common directors, officers or agents or sharing profits or liabilities) may not be accepted as Past Performance references under this solicitation.

Additionally, the College reserves the right to contact references other than those identified by the Respondent to obtain additional information regarding past performance. Any information obtained as a result of such contact may be used to determine whether or not the Respondent is a “responsible Respondent”.

Project #1:

Project Name:

Type of Project/Service:

Address:

Contracting Agency/Client:

Contact Name and Phone #:

Contact Email Address and Fax #:

Contract Amount: Date Work Performed:

Project #2:

Project Name:

Type of Project/Service:

Address:

Contracting Agency/Client:

Contact Name and Phone #:

Contact Email Address and Fax #:

Contract Amount: Date Work Performed:

Project #3:

Project Name:

Type of Project/Service:

Address:

Contracting Agency/Client:

Contact Name and Phone #:

Contact Email Address and Fax #:

Contract Amount: Date Work Performed:

EXHIBIT F

ADDENDUM RECEIPT VERIFICATION

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

Addendum No. Dated

Addendum No. Dated

Addendum No. Dated

Addendum No. Dated

Addendum No. Dated

FAILURE TO SUBMIT ACKNOWLEDGMENT OF ANY ADDENDUM THAT AFFECTS THE PROPOSAL PRICES IS CONSIDERED A MAJOR IRREGULARITY AND WILL BE CAUSE FOR REJECTION OF THE PROPOSAL.

Company Name

Authorized Signature

Name (Print or Type)

Title

EXHIBIT G

DRUG FREE WORKPLACE FORM

The undersigned contractor, in accordance with Florida Statute 287.087 hereby certifies that

_______________________________________________________does:

NAME OF BUSINESS

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 bid 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 bid, 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 contendere to, any violation of Florida Statute 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 contractor complies fully with above requirements.

Signature

Print Name

Date

EXHIBIT H

MINORITY BUSINESS ENTERPRISE/WOMAN BUSINESS

ENTERPRISE CERTIFICATE

If firm is NOT claiming to be a minority or woman business enterprise, submit form with “NM- Non-Minority Type”. (Notarization NOT Required). If your firm is greater than 51% owned and controlled by a woman or minority, please complete this certificate.

I HEREBY DECLARE AND AFFIRM that I am the ___________________________ (Title) representative of the firm of_____________________________________ (Company Name) minority business enterprise _________________ (Minority Type**) as defined by Valencia College in the specifications for _____________________________________________________________ (Project Name & Number) that I will provide information requested by COLLEGE to document this fact. The foregoing statements are true and correct and include all material necessary to identify and explain the operations of _______________________ (Company Name) as well as the ownership thereof. Further, the undersigned does agree to provide COLLEGE current, complete and accurate information regarding actual work performed on the project, the payment therefor and any proposed changes in any of the arrangements hereinabove stated and to permit and audit an examination of the books, records and files of the above named company by authorized representative of COLLEGE. It is recognized and acknowledged that the statements herein are being given under oath and material misrepresentation will be grounds for terminating any contract which may be awarded in reliance hereon. Termination is understood to forfeiture of payment for all work not performed at time of notification.

I DO SOLEMNLY DECLARE OR AFFIRM UNDER THE PENALTIES OF PERJURY THAT THE CONTENTS OF THE FOREGOING DOCUMENTS ARE TRUE AND CORRECT, AND THAT I AM AUTHORIZED, ON BEHALF OF THE ABOVE FIRM, TO MAKE THIS AFFIDAVIT. (Signature of Company's Authorized Representative)

State of County of City of

On this ________________ day of _____________________, 20_____, before me, in the foregoing affidavit and acknowledged that he (she) executed the same in the capacity therein stated and for the purpose therein contained.

In witness thereof, I hereunto set my hand and official seal.

(Notary Public)

My commission Expires: _____________________________

* If you are not claiming a minority or woman owned status, please mark NA for minority type and only a signature is required. You do not need to have this document notarized.

** Minority Type: # M1 Black American Man; M2 Hispanic American; M3 Asian American; M4 Native American (Eskimo & Aleutian); M5 Native Hawaiian; M6 Small Business; M7 Disabled; M8 American Woman; M9 Black American Woman; and NM Not Minority. (Must have greater than 51% minority ownership) "Minority/Woman Business Enterprises that file false misrepresentation of their MBE/WBE status shall be found guilty of a felony of the second degree and be debarred from bidding no less than 36 months pursuant to 287.094 Florida Statute".

EXHIBIT I

FINANCIAL ATTESTATION

This is not a request for your full financial statements; however, the College reserves the right to review your financial statement if such a review is in its best interest.

The requested data should be derived and/or calculated from the most recent financial statements prepared by an Independent Accounting Professional (IAP). (Examples of an IPA include the independent CPA, Tax accountant, and financial statement preparer or similar professional). The need for accurate financial information is important to the College. Providing false or grossly inaccurate information may disqualify you or your company from doing business with the College under this or future solicitations.

This form must be signed by the proposer and IAP that prepared and reviewed your firm’s most recent annual financial statement and be submitted with your response package.

1. Proposer Name:

2. Name of IAP that completed the review of your company’s most recent annual financial statement:

Is the Independent Accounting Professional preparing or assisting in the preparation of this worksheet, certified?

Yes No .

If certified, please indicate the certification of the IAP _________________________________. (I.e. CPA, CMA, CGMA, EA, etc.)

After review of the Consultant’s most recent audited financial/statement, as their IPA we have defined below:

1. Which year is the annual financial statement information being derived from? _________

2. Did the Proposer report a positive cash flow during the reporting year? Yes____ No ____

3. Did the proposer report a net after tax profit during that year? Yes____ No ____

4. The Proposer’s total assets are:

5. The Proposer’s total liabilities are: ________

6. The Proposer’s equity is:

“IAP” “Proposer”

Signature: Signature:

Name: Name:

Title: Title:

EXHIBIT J

DISPUTES DISCLOSURE FORM SUMMARY OF LITIGATION

Answer the following questions by placing a check “” in the box after “YES” or “NO”. If you answer “YES”, please explain via attachment.

Disclosure can be limited to the regional/district office, which will be supporting this Contract.

1. Has your firm, or any of its officers, received a reprimand of any nature or been suspended by the Department of Professional Regulation or any other regulatory agency or professional association within the last five (5) years?

YES NO

2. Has your firm, or any member of your firm, been declared in default, terminated or removed from a contract or job related to the services your firm provides in the regular course of business within the last five (5) years?

YES NO

If YES, indicate company name, contact name and telephone number, length of service provided, and reason for early cancellation/termination of contract.

3. Has your firm had filed against it or filed any requests for equitable adjustment, contract claims or litigation in the past five (5) years that is related to the services your firm provides in the regular course of business?

YES NO

If YES, state the nature of the request for equitable adjustment, contract claim or litigation, a brief description of the case, the outcome or status of suit and the monetary amounts involved.

I hereby certify that all statements made are true and agree and understand that any misstatement or misrepresentation or falsification of facts shall be cause for forfeiture of rights for further consideration of this solicitation:

Printed or Typed Name Title

Authorized Signature (Officer) Date

EXHIBIT L

BYRD ANTI-LOBBYING AMENDMENT (31 U.S.C. 1352, AS AMENDED)

CERTIFICATION REGARDING LOBBYING (44 C.F.R. PART 18)

REQUIRED FOR ANY OFFER OR CONTRACT EXCEEDING $100,000

Offerors/Contractors who apply or bid for an award of $100,000 or more MUST file this required certification. Each tier certifies to the tier above that it will not and has not used federal appropriated funds to pay any person or organization 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 obtaining any federal contract, grant, or any other award covered by 31 U.S.C. 1352. Each tier shall also disclose any lobbying with non-federal funds that takes place in connection with obtaining any federal award. Such disclosures are forwarded from tier to tier up to the recipient.

The undersigned Offeror/Contractor 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

Offeror/Contractor, 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 an employee of any agency, a member of Congress, an officer or an employee of Congress, or an employee of a member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned Offeror/Contractor shall complete and submit Standard Form- LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions.

(3) The undersigned Offeror/Contractor 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 Offeror/Contractor, , Full Legal Name of Offeror/Contractor (including any “Doing Business As” (“DBA”) Name(s) certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Offeror/Contractor understands and agrees that the provisions of 31 U.S.C. §3801 et seq., apply to this certification and disclosure, if any.

Signature of Offeror’s/Contractor’s Authorized Official Date Signed

Printed Name Offeror’s/Contractor’s Authorized Official Title of Offeror’s/Contractor’s Authorized Official