IFB Portable Toilets 2027-2029 due 12-4-26~1.pdf

TOWN OF DENNIS

INFORMATION AND SPECIFICATIONS FOR BIDDERS

RENTAL/LEASE OF ADA WHEELCHAIR ACCESSIBLE PORTABLE

TOILETS WITH MAINTENANCE

BID OPENING DATE:

Friday, December 4, 2026

11:00AM

Table of Contents:

• Legal Notice

Section I - General Information for Bidders Section II - Technical Specifications Section III - Non-Technical Specifications

Form A - Bid Price Quote Form B - Certificate of Non-Collusion & Statement of Tax

Compliance Form C - Certification of Non-Segregated Facilities Form D - Certificate of Authority Form E Qualification Statement Form F - Final Checklist

Other:

• Addenda Acknowledgement (if applicable)

• CORI Acknowledgement Form – required for all maintenance staff prior to commencement of work.

LEGAL NOTICE

INVITATION FOR BIDS

Sealed, written bids must be submitted no later than 11:00AM on Friday December 4, 2026, and must be submitted to Kelly Race, Administrative Analyst, at Dennis Town Hall, 685 Route 134, South Dennis, MA 02660 at which time bids will be opened publicly. Such Bids must be received in sealed envelopes, clearly marked on the outside of the envelope: "ADA Portable Toilets with Maintenance."

The intent of this procurement is to provide ADA wheel chair accessible portable toilets with cleaning and maintenance services for various locations as per specifications. Specifications are available on-line at www.town.dennis.ma.us quick link can be found at Procurement (Bids/RFPs).

All Bids, will be opened at Town of Dennis Town Hall, 685 Route 134, South Dennis, MA 02660, 11:00 A.M., Friday, December 4, 2026. Bids must be received in sealed envelopes, clearly marked on the outside of the envelope: "Bid: ADA Portable Toilets with Maintenance."

Bids received after the time and date established herein for the opening of bids shall not be accepted or considered, regardless of the cause for delay in the receipt of such bids. All bids for this project are subject to the provisions of Massachusetts General Laws, Chapter 30B. The Town of Dennis reserves the right to reject any and all bids, to waive any informality in bidding, and to make the award as may be determined in the best interests of the Town.

"An Equal Opportunity Municipality - AA/MBE" http://www.town.dennis.ma.us/

SECTION I – GENERAL INFORMATION FOR BIDDERS

1.0 INTENT, RECEIPT AND OPENING OF BIDS

1.1 The Town of Dennis, acting under the authority of its duly appointed Chief Procurement

Officer or said designee, hereinafter referred to as the Awarding Authority, will receive sealed bids from interested bidders to provide cleaning and maintenance services for multiple comfort stations at various locations as per specifications.

1.2 Such bids, addressed to Kelly Race, Administrative Analyst, must be received in sealed envelopes, clearly marked on the outside of the envelope: “ADA Portable Toilets with Maintenance”. All bids will be received at the Dennis Town Hall, 685 Route 134, South Dennis, MA 02660, no later than 11:00AM, Friday, December 4, 2026, at which time they will be publicly opened and read as per advertisement.

1.3 Bids received after the time and date established herein for the opening of bids shall not be accepted or considered, regardless of the cause for delay in the receipt of such bid(s).

2.0 BID FORM

2.1 Each bidder must submit the following forms which are included in this bid package:

FORM A - BID PRICE QUOTE FORMS

FORM B - CERTIFICATE OF NON-COLLUSION & STATEMENT OF TAX

COMPLIANCE

FORM C - CERTIFICATION OF NON-SEGREGATED FACILITIES

FORM D - CERTIFICATE OF AUTHORITY, with the corporate seal stamped in the appropriate space provided on said form.

FORM E - QUALIFICATIONS STATEMENT. In cases where the bidder is a corporation, the bidder shall also complete.

FORM F - Final Checklist

Other:

• Addenda Acknowledgement (if applicable)

• CORI Acknowledgement Form – required for all maintenance staff prior to commencement of work.

2.2 Bid forms must be completed in ink or by typewriter. The bid price for each item on the form shall be stated in figures. Discrepancies between the indicated sum of any column(s) and the correct sum of any column(s) will be resolved in favor of the correct sum. All bid forms must be signed by an officer of the company authorized to enter into contracts.

3.0 BID DEPOSIT

3.1 Not Required

4.0 COMPARISON/AWARD OF BIDS

4.1 Bids will be compared on the basis of the amount of proposed cost to the Town. The

Town reserves the right to award the bid for daily cleanings or 3 times per week. An award decision will be made in the best interests of the Town and using these additional criteria:

4.2 The Town reserves the right to award this bid to one vendor capable of performing all work associated with this bid specification capable of performing either the cleaning and maintenance services to the permanent beach comfort station facilities.

a. Meeting specification,

b. Previous successful experience,

c. Lowest responsive and responsible bidder. The Town reserves the right to utilize base price or base price + add alternate for award depending which is in Town’s best interest.

5.0 WITHDRAWAL OF BIDS

5.1 Any bid may be withdrawn prior to the opening of bids. However, bidders may not withdraw or modify their bid for a period of sixty (60) days following the opening of bids.

6.0 ADDENDA AND INTERPRETATIONS

6.1 All questions by prospective bidders as to any information contained within SECTION II

TECHNICAL SPECIFICATIONS of this bid package must be made in writing to Kelly Race, Administrative Analyst, 685 Route 134, South Dennis, MA 02660. No oral interpretations will be given to any bidders as to the meaning of the specification documents or any part thereof. Any addendum to this bid will be sent to all bidders who received bid specifications.

7.0 EXAMINATION

7.1 By submitting a bid, the bidder warrants that they have thoroughly examined the specifications and is fully acquainted with all conditions and restrictions pertaining to the bid items. No claim for any extra work or extension of time will be allowed for failure to observe this requirement. Conditional bids will not be accepted.

8.0 ABILITY AND EXPERIENCE

8.1 The Awarding Authority will not award a bid to any bidder who cannot furnish satisfactory evidence of their ability to do the work or deliver any material or equipment under this bid.

8.2 The Awarding Authority may make such investigation as it deems necessary to determine the above and a bidder shall furnish any information requested in this regard and shall furnish the same under oath if required.

8.3 The bidder shall provide a list of five (5) references.

8.4 The bidder must have a minimum of five (5) years’ experience with services requested.

9.0 RIGHTS OF THE AWARDING AUTHORITY

9.1 The Awarding Authority may reject any bids that are incomplete, conditional, or obscure or that contain additions or erasures that are not initialed or other such irregularities.

9.2 The Awarding Authority reserves the right to reject any and all bids, to waive any informality in the bidding and to make an award as may be determined to be in the best interests of the Town. All Awards will be contingent on a successful CORI of staff.

10.0 TAXES

10.1 Materials purchased by the Contractor for use in accordance with these specifications are exempt from Massachusetts Sales Tax. The tax-exempt number shall be provided by the Town. The Contractor shall pay all other applicable federal and state taxes.

11.0 AGREEMENT DOCUMENTS

11.1 The plans, specifications and addenda shall form part of the Agreement between the

Town and the successful bidder, and the provisions thereof shall be binding upon the parties hereto. The table of contents, titles, headings, running headlines and marginal notes contained herein and in said documents are solely to facilitate reference to various provisions of the contract documents and in no way affect, limit, or cast light on the interpretation of the provisions to which they refer.

12.0 DEFINITIONS

12.1 The following terms as used in this Section are respectively defined as follows:

a. “Contractor or Successful Bidder”: An individual, partnership, or corporation with whom this Agreement is made by the Town.

b. “Town or Awarding Authority” shall mean the Town of Dennis, MA, acting through its Town Administrator.

13.0 CONTRACTOR RECORDS

13.1 The Contractor shall retain their records for at least six (6) years after final payment under the Agreement between the parties. During this period, the Town, the Inspector or Attorney General or any authorized representative of the Town shall have the right to inspect these records.

14.0 CONFLICTING SPECIFICATIONS

14.1 Wherever a conflict exists between these Specifications and Massachusetts laws, rules or regulations, said laws, rules or regulations of Massachusetts shall prevail.

14.2 Each bidder’s attention is directed to the fact that all applicable Federal, State and municipal laws, rules, regulations and by-laws shall apply to these Specifications and subsequent Agreement as though they were written out and attached herein.

15.0 MATERIALS, SERVICES AND FACILITIES

15.1 It is understood that, except as otherwise specifically stated in these documents, the

Contractor shall provide and pay for all materials, labor, tools, equipment, power, transportation, etc. necessary to execute, complete and deliver the work within the specified time. Any work necessary to be performed after regular hours, on Sundays, or Legal Holidays, shall be performed without additional expense to the Town and only after written permission of the Town is given.

16.0 CONTRACTOR'S OBLIGATION

16.1 The Contractor shall and will, in good workmanlike manner, do and perform all work and furnish all supplies and materials, machinery, equipment, facilities and means, except as herein otherwise expressly specified, necessary or proper to perform and complete all the work required by this contract, within the time herein specified, in accordance with the provisions of this contract and said specifications and in accordance with the directions of the Town as given from time to time during the progress of the work. The Contractor shall observe, comply with, and be subject to all terms, conditions, requirements, and limitations of the contract and specifications, and shall do, carry on, and complete the entire work to satisfaction of the Town.

17.0 PROTECTION OF WORK AND PROPERTY

17.1 The Contractor shall at all times safely guard the Town's property from injury or loss in connection with this contract. He shall at all times safely guard and protect his own work, and that of adjacent property, from damage. The Contractor shall replace or make good any such damage, loss or injury unless such is caused directly by errors contained in the contract or by the Town, or his duly authorized representative.

17.2 In case of an emergency that threatens loss or injury of property and/or safety of life, the Contractor will be allowed to act, without previous instructions from the Town, in a diligent manner. He shall notify the Town immediately thereafter. Any claim for compensation by the Contractor due to such extra work shall be promptly submitted to the Town for approval.

Where the Contractor has not taken action but notified the Town of an emergency threatening injury to persons or damage to the work or any adjoining property, he shall act as instructed or authorized by the Town.

17.3 The Contractor shall assume full responsibility for the following:

a. To store his apparatus, materials, supplies, and equipment in such orderly fashion at the site of the work as will not unduly interfere with the progress of his work, the work of any other contractor, or the general public.

b. To provide suitable storage facilities for all materials which are liable to injury by exposure to weather, theft, breakage or otherwise;

c. To clean up and remove frequently all refuse, rubbish, scrap materials, and debris caused by his operations, to the end that at all times the facilities and general surroundings shall present a neat, orderly and workmanlike appearance;

d. To provide Town with a list of all cleaning chemicals along with the MSDS (Material Safety Data Sheets).

18.0 CONTRACTOR’S TITLE TO MATERIALS

18.1 No materials or supplies for the work shall be purchased by the Contractor or by any subcontractor subject to any chattel mortgage or under a conditional sale contract or other agreement by which an interest is retained by the seller. Upon submission of a request for payment, the Contractor warrants that they have good title to all materials and supplies used in their work, free from all liens, claims or encumbrances.

19.0 INSPECTION OF MATERIALS AND WORKMANSHIP

19.1 All materials and workmanship used pursuant to these specifications shall be subject to adequate inspection by the Town. Any material or workmanship not meeting specification or deemed acceptable by the Town shall be replaced or repaired at the Contractor’s expense. All cleaning chemicals must be approved by the Town’s Health Department prior to being used for cleaning and sanitation in the comfort stations.

20.0 “OR EQUAL” CLAUSE

20.1 Whenever a material, article or piece of equipment is identified on the plans or specifications by reference to manufacturers or vendors names, tradenames, catalogue numbers, and other similar identification methods, it is intended merely to establish a standard. Any material, article or equipment or other manufacturers or vendors performing adequately the duties imposed by the general design will be considered equally acceptable provided the material, article, or equipment so proposed is, in the opinion of the town, of equal substance and function. It shall not be purchased or installed by the Contractor without the Town’s written approval.

21.0 WAIVER

22.1 Neither the inspection by the Town or agents, nor any act or thing done by the Town other than an express waiver shall operate as a waiver of any provision of this Agreement, nor shall any waiver of any breach of this Agreement be held to be a waiver of any other or subsequent breach. Any remedy provided in this Agreement shall be taken and construed as cumulative, that is, in addition to any other remedy herein provided.

22.0 RESPONSIBILITY FOR WORK

22.1 The Contractor shall take all responsibility for the work and take all precautions for preventing injuries to persons and property in or about the Work. The Work shall be entirely at the Contractor's risk until the same is fully completed and accepted, and he will be held liable to an amount not less than the Owner's interest in the same as shown by payments on account.

23.0 LAWS AND REGULATIONS

23.1 The Contractor shall keep himself fully informed of all State and National laws and municipal ordinances and regulations in any manner affecting those engaged or employed in the Work or in any way affecting the conduct of the work, and of all such orders and authority over the same. If any discrepancy or inconsistency is discovered in these Specifications, or Contracts for the Work in relation to such laws, ordinances, regulations, orders or decrees, he shall forthwith report the same to the Town in writing. He shall at all times observe and comply with and shall cause all his agents and employees to observe and comply with all such laws, ordinances, regulations, orders and decrees and shall protect and indemnify the Town and its officers and agents and servants against any claim or liability arising from or based on the violation of such laws, ordinances, regulations, orders, or decrees whether by himself or his employees.

24.0 CONTRACTOR'S INSURANCE

24.1 Insurances:

The selected bidder shall maintain such insurance as will protect it from claims under the worker's compensation acts and claims for bodily injury, death, or property damage which may arise from the performance of its service under the proposed Contract. The bidder shall maintain, as a minimum, insurance coverage as follows:

Comprehensive General Liability Bodily Injury: $500,000 Each Occurrence $1,000,000 Aggregate Property Damage: $500,000 Each Occurrence $1,000,000 Aggregate

Automobile Liability Bodily Injury: $500,000 Each Occurrence $1,000,000 Aggregate Property Damage: $500,000 Each Occurrence $1,000,000 Aggregate

Umbrella Policy General Liability: $1,000,000

Worker’s Compensation as required by Massachusetts General Laws

The Town requires that the successful bidder submit a certificate of insurance in the amounts specified above. The contract will not be effective and the Town will not authorize or pay for any services performed prior to contract signing. No contract will be signed until the correct certificate of insurance is received.

The Town further requires that all certificates name the Town as an "Additional Insured."

With the exception of Worker's Compensation and Automobile Liability, the Town will not accept being named as "Certificate Holder" only. Please be aware that there may be a charge for this type of policy, so check with your insurance agent prior to bid submission.

Proof of Worker's Compensation Insurance coverage must be provided prior to signing of a contract with the successful bidder.

SECTION II – TECHNICAL SPECIFICATIONS

The Town of Dennis seeks proposals from interested bidders to provide ADA Wheel Chair Accessible Portable Toilets with cleaning and maintenance services at various locations as specified. Specifications of the services to be performed are shown below.

The successful contractor shall obtain annual pumping permits, to be issued by the Dennis Health Department, to pump, recharge and stock all portable toilets daily during beach season only. Pre and Post season pumping, cleaning and stocking will only be required 3 days a week. The permit(s) will be at no charge to Contractor.

A. PROPOSED RENTAL/LEASE OF ADA WHEEL CHAIR ACCESSIBLE

PORTABLE TOILETS

BEACH/PARK LOCATIONS

1. PRE-SEASON: The Town of Dennis seeks to rent/lease ADA Wheel Chair Accessible

Portable Toilets, located throughout the Town, north and south of Route 6. The locations include the following for the pre-season (March 1st through the Friday of Memorial Weekend:

NORTH SOUTH

Corporation Beach (2) - 1 gated West Dennis Beach (2)

Mayflower Beach (1) Cold Storage Beach (1) Wixon Courts (1) Johnny Kelley Park (1)

2. BEACH SEASON: The Town of Dennis seeks to rent/lease ADA Wheel Chair Accessible Portable Toilets, located throughout the Town, north and south of Route 6.

The locations include the following for the beach season (Saturday of Memorial Day weekend through Columbus Day):

NORTH SOUTH

Chapin Beach (2) - gated Inman Beach (2) - gated

Corporation Beach (2) - 1 gated South Village Beach (2) - gated Bayview Beach (1) Haigis Beach (1) - gated

Sea Street Beach (1) Glendon Beach (2) gated Howes Street Beach (1) Seaview Park (1)

Scargo Beach (1) Bass River Park (1) Harborview Beach (1) Old Town Hall Bike Path (1) Nobscussett Road Parking Lot (1) Wixon Courts (2)

POST SEASON: The Town of Dennis seeks to rent/lease ADA Wheel Chair Accessible Portable Toilets, located throughout the Town, north and south of Route 6. The locations include the following for the post season (Tuesday after Columbus Day through December 1)

NORTH SOUTH

Corporation Beach (1) West Dennis Beach (2)

Mayflower Beach (1) Cold Storage Beach (1) Wixon Courts (1) Johnny Kelley Park (1)

2. An award decision will be made in the best interests of the Town.

BASE BID:

The successful contractor shall clean, pump, stock and maintain the above-mentioned portable toilets daily during the beach season, at Beach Locations prior to 7:00AM. Pre and Post season locations will be cleaned, pumped and stocked 3 days a week, at the convenience of the contractor.

ADD ALTERNATE (Town award of Add Alternate at sole discretion of Town):

GOLF COURSE LOCATION must be billed separately from Beach/Park locations

2027 April 1 through November 30th 3 units Highlands, 2 units Pines 2028 April 1 through November 30th 3 units Highlands, 2 units Pines 2029 April 1 through November 30th 3 units Highlands, 2 units Pines

The successful contractor shall clean, pump, stock and maintain the above-mentioned portable toilets daily, cleaning times at convenience of Contractor.

Portable Toilet location(s) determined by Golf Director.

3. The successful contractor shall clean, pump, stock and maintain the portable toilets daily.

4. Signage will be posted noting the daily scheduled cleaning times by Contractor.

5. The daily pumping, cleaning, stocking and maintenance of the portable toilets consist of the following:

a. Cleaning ceilings, walls, floors and fixtures with water, detergents and disinfectants to the satisfaction of or at the direction of the Town. Upon inspection by Town, if it is found the cleaning did not meet the Towns’ guidelines, the contractor will be required to return within one hour of notification at their own expense to perform cleaning again. Material Safety Data Sheets (MSDS) must be provided to the Town for all products used to clean during the length of the contract.

b. Emptying of trash receptacles and the pick-up of trash or waste material in and around the portable toilet(s).

c. Stocking paper hand towels, toilet paper and hand sanitizer (minimum 60% alcohol), as per Board of Health.

d. Contractor employees to wear face mask and surgical gloves when performing cleaning activities.

e. Pumping/Recharging daily, permits in accordance with Dennis Health Department.

6. The successful contractor shall have all portable toilets cleaned and stocked no later than

7:00 AM daily. Contractor to lock the gate, if applicable, behind them so no other vehicles can enter while servicing and when they leave.

7. The successful contractor shall be responsible for the opening of each gate to go in and service. Contractor to lock the gate, if applicable (if locked when they arrive), behind them so no other vehicles can enter while servicing and when they leave.

8. The successful contractor shall report any damage to a comfort station to the Dustin

Pineau, Beach Director (508) 326-4153, Maryellen Fabiano-Stowe, Golf Director (508) 694-2037 or Jeff Marcotte, Facility Manager (508) 326-9043 as soon as it is discovered.

Items broken (soap dispenser, towel dispenser, toilets etc.) must be reported to Town within 24 hrs.

SECTION III – NONTECHNICAL SPECIFICATIONS

1. Bidder Qualifications: Interested bidders must meet the qualifications listed below to be considered as a qualified bidder by the Town of Dennis. Minimum of five (5) years’ experience in the care and maintenance of restroom facilities, preferably the care and maintenance of municipal beach restroom facilities.

2. The successful bidder shall provide with their bid the name and telephone number of at least five (5) reference contact persons involving prior and/or ongoing contracts for portable toilet maintenance services. Failure to do so may be grounds for non-award. All staff is required to adhere to the Town of Dennis CORI Policy and complete CORI form attached to bid specification. Contract award is subject to a successful CORI.

3. Any questions regarding these specifications should be directed to Dustin Pineau, Beach and Recreation Director (508) 326-4153, Maryellen Fabiano-Stowe, Golf Director (508) 694-2037 or Jeff Marcotte, Facilities Manager, 508-326-9043.

FORM A

RENTAL/LEASE OF ADA WHEELCHAIR ACCESSIBLE PORTABLE TOILETS

WITH MAINTENANCE

BID PRICE QUOTE

The above referenced company agrees to furnish ADA wheelchair accessible portable toilets with maintenance services as indicated.

2027 Pre Season March 1st through Friday prior to Memorial Day $_______________ 2027 Memorial Day weekend to Columbus Day (2nd Monday in October) $_______________ 2027 Post Season (Tuesday after Columbus Day thru Veteran’s Day $_______________ 2028 Pre Season March 1st through Friday prior to Memorial Day $_______________ 2028 Memorial Day weekend to Columbus Day (2nd Monday in October) $_______________ 2028 Post Season (Tuesday after Columbus Day thru Veteran’s Day $_______________ 2029 Pre Season March 1st through Friday prior to Memorial Day $_______________ 2029 Memorial Day weekend to Columbus Day (2nd Monday in October) $_______________ 2029 Post Season (Tuesday after Columbus Day thru Veteran’s Day $_______________ Total Base Bid Price in Words Total Base Bid Price in Numbers

2027 April 1 through November 30th 3 units Highlands, 2 units Pines 2028 April 1 through November 30th 3 units Highlands, 2 units Pines 2029 April 1 through November 30th 3 units Highlands, 2 units Pines

ADD ALTERNATIVE (Additional portable toilets at Golf Courses as indicated above):

Golf Alternate Price in Words Golf Alternate Bid Price in Numbers

TOTAL BID PRICE (Base Bid + Add Alternate) – Town has sole discretion to award

Total Price in Words Total Base Bid Price in Numbers

Company Name Authorized Signatory & Title

Address Printed Name

Email address Corporate Seal Telephone #

FORM B

CERTIFICATE OF NON-COLLUSION

The undersigned certifies under penalties of perjury that this bid or proposal has been made and submitted in good faith and without collusion or fraud with any other person. As used in this certification, the word “person” shall mean any natural person, business, partnership, corporation union, committee, club or other organization, entity, or group of individuals.

Company Name: _____________________________

Address: _____________________________

Name & Title of Signatory: _____________________________

Date: _____________________________

STATEMENT OF TAX COMPLIANCE

Pursuant to Massachusetts General Laws, Chapter 62C, Section 49A, I certify under the penalties of perjury that ______________________________ has fully complied with all laws of the Name of Entity

Commonwealth of Massachusetts relating to the payment of taxes.

Company Name: _____________________________

Address: _____________________________

Name & Title of Signatory: _____________________________

Social Security or Federal Identification Number: _____________________________

FORM C

CERTIFICATION OF NON-SEGREGATED FACILITIES

The Bidder certifies that it does not maintain or provide its employees any segregated facilities at any of their establishments, and that they do not permit employees to perform services at any location under their control where segregated facilities are maintained. The Bidder agrees that a breach of this certification will be a violation of the Equal Opportunity clause in any contract resulting from acceptance of this bid. As used in this certification, the term “segregated facilities” means any waiting rooms, work areas, restrooms and washrooms, restaurants and other eating areas, timeclocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, color, religion, or national origin, because of habit, local custom or otherwise.

The Bidder agrees that (except where they have obtained identical certification from proposed subcontractors for specific time periods) they will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from provisions of the Equal Opportunity clause, and that they will retain such certifications in their files.

Note: The penalty for making false statements in offers is prescribed in 18 U.S. Code Section 1001.

Company Name: _____________________________

Address: _____________________________

FORM D

CERTIFICATE OF AUTHORITY

(Corporations Only)

At a duly authorized meeting of the Board of Directors of _______________________________ Name of Corporation it was VOTED that _____________________________________ of this company is authorized Name and Title to execute contracts and bonds in the name of and on behalf of this company, and affix its corporate seal hereto; and such execution of any contract obligation in this company’s name and on its behalf, said obligation to be valid and binding upon this company.

A True Copy Attested, Company Name: _____________________________

Address: _____________________________

I hereby certify that I am the clerk of _______________________________; that the above Name of Corporation vote has not been amended or rescinded and remains in full force and effect as of the date of this contract.

Name of Clerk: _____________________________ Corporate Seal

FORM E

QUALIFICATION STATEMENT

The Bidder certifies that ___________________________________ meets the Bidder Name of Company

Qualification Requirement of a minimum of five (5) years’ experience in the care and maintenance of similar restroom facilities.

Name & Title of Signatory: _________________________________________

FORM F

FINAL CHECKLIST

Form A – Bid Price Quote ___________

Form B - Non-Collusion Statement & Tax Compliance ___________

Form C - Certificate of Non-Segregated Facilities ___________

Form D - Certificate of Authority (if applicable) ___________

Form E – Qualifications Statement ___________

Form F – Final Check List ___________

OTHER:

Bid Deposit (5% of total bid) ___________

Addenda Acknowledgement (if applicable) ___________

CORI Acknowledgment Forms – all staff (after award) ___________

Town of Dennis 685 Route 134, South Dennis, MA 02660 / Telephone: (508) 394-8300 ∙ Fax (508) 394-8309

CRIMINAL OFFENDER RECORD INFORMATION (CORI)

ACKNOWLEDGEMENT FORM

TO BE USED BY ORGANIZATIONS USING CONSUMER REPORTING AGENCIES TO CONDUCT CORI

CHECKS FOR EMPLOYEMENT, VOLUNTEER, SUBCONTRACTOR, LICENSING, AND HOUSING

PURPOSES

The Town of Dennis is registered under the provision s of M.G.L. c. 6, § 172 to receive CORI for the purpose of screening current and otherwise qualified prospective employees, subcontractors, volunteers, license applicants, current licensees, and applicants for the rental or lease of housing.

As a prospective or current employee, subcontractor, volunteer, license applicant, current licensee, or applicant for the rental or lease of housing, I understand that a CORI check will be submitted for my personal information to the Massachusetts Department of Criminal Justice Information Services (DCJIS). I hereby acknowledge and provide permission to the Town of Dennis to submit a CORI check for my information to the DCJIS. This authorization is valid for one year from the date of my signature. I may withdraw this authorization at any time by providing the Town of Dennis with written notice of my intent to withdraw consent to a CORI check. I also understand that this form is a CORI acknowledgement form and I am entitled to additional consumer reporting disclosure forms under the Fair Credit Reporting Act. If I have not received those disclosures, I should contact the Town of Dennis to request this information.

FOR EMPLOYMENT, VOLUNTEER, AND LICENSING PURPOSES ONLY: The Town of Dennis may conduct subsequent CORI checks within one year of the date this Form was signed by me provided, however, that the Town of Dennis must first provide me with written notice of this check.

By signing below, I provide my consent to a CORI check and acknowledge that the information provided on Page 2 of this Acknowledgement Form is true and accurate.

Signature Date

Complete back side of this form Attach Photo ID

SUBJECT INFORMATION:

Last Name First Name Middle Name Suffix

Maiden Name (or other name(s) by which you have been known)

Date of Birth Place of Birth

Last Six Digits of Your Social Security Number: ________-____________

Sex: ____ Height: ____ft. ____in. Eye Color: _________ Race: ___________

Driver’s License or ID Number: _____________________ State of Issue: ___________

Mother’s Full Maiden Name Father’s Full Name

Current and Former Addresses:

Street Number & Name City/Town State Zip

Street Number & Name City/Town State Zip

OFFICE USE ONLY:

The above information was verified by reviewing the following form(s) of government issued identification:

VERIFIED BY: __________________________________________________

Name of Verifying Employee (Please Print)

Signature of Verifying Employee

TOWN OF DENNIS