ITB-25-051-KY_Bid_Submittal_Package.pdf

INVITATION TO BID

ITB-25-051-KY

CHEMICALS FOR PUBLIC WORKS

PLANT OPERATIONS

BID SUBMITTAL PACKAGE

BUSINESS INFORMATION: CONTACT INFORMATION:

Company Name (as it appears on the W9) Name of Owner/Partner/Officer

Business Address Title/Position of Owner/Partner/Officer

Business City, State, Zip Contact Address

Business Telephone Number Contact City, State, Zip

Business Email Address Contact Telephone Number

F.E.I.N. Contact Email Address

U.E.I. Number (Replaced DUNS Number) SIGNATURE OF OWNER/PARTNER/OFFICER

FOR THIS SUBMITTAL TO BE CONSIDERED VALID, IT IS MANDATORY THAT THE

SUBMITTAL BE SIGNED IN THE SPACE PROVIDED ABOVE

The City reserves the right to accept any or all submittals, to waive informalities, and to reject all or any part of any submittals as they may deem to be in the best interest of the City.

This Bid Submittal Package is a mandatory form to ease tabulation and analysis; however, additional supportive forms can accompany it.

An officer or representative who has official authorization to sign on behalf of the company/vendor/business MUST sign this Form. Failure to sign in the space provided above will result in the submittal being rejected.

Submittals not received by the advertised due date and time (see Bidding Instruction Terms and Conditions section) will be returned to the sender unopened.

Signing the Bid Submittal Package affirms that the original Solicitation document has not been altered in any way.

Respondents must acknowledge all issued addenda by confirming below. Failure to acknowledge may result in a non-responsive submittal.

The failure of a Respondent to submit/confirm acknowledgment of any addenda that affects price(s), is considered a major irregularity and may be cause for rejection of the Submittal.

The undersigned acknowledges receipt of all issued addenda.

☐ Please check box to confirm.

The City will receive shipment within 15 calendar days from date vendor receives official

Purchase Order: ___________ (initial here)

Each Respondent shall furnish the information required on each Bid Submittal Package and each accompanying sheet thereof on which an entry is made.

The following items must be completed and included as part of your submittal.

Failure to complete and return required forms may result in your proposal being deemed non-responsive and not considered for award.

FORMS, ATTACHMENTS, AND EXHIBITS

The following forms are attached as indicated below.

BID FORM

REFERENCES

CONFLICT OF INTEREST FORM

NON-COLLUSION/LOBBYING CERTIFICATION FORM

HUMAN TRAFFICKING AFFIDAVIT

FOREIGN COUNTRY OF CONCERN ATTESTATION FORM

DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS CERTIFICATION

BID RETURN LABEL

BID FORM

To: Procurement Division

City Hall, Suite 1030

CITY OF ALTAMONTE SPRINGS

225 Newburyport Avenue Altamonte Springs, FL 32701

The undersigned hereby declares that after carefully examining the solicitation documents, the Bidder is fully aware of all conditions affecting such work/items, for which bids/proposals were advertised to be returned by 11:00 a.m., Wednesday, August 27, 2025 does hereby submit the following bid for completion of said work/item.

BASE BID

ITEM

# DESCRIPTION

ESTIMATED

ANNUAL

QTY

UOM UNIT PRICE EXTENDED

PRICE

1 Phosphoric Acid (Corrosion Control) 10000 GAL $ $

2 Aluminum sulfate 54000 GAL $ $

3 Liquid sodium bisulfite 1000 GAL $ $

4 MicroC 2000 36500 GAL $ $

5 Liquid sodium hypochlorite 1200 GAL $ $

BASE BID GRAND TOTAL $

LIST OF REFERENCES

As per the General Specifications Section, below is a list of at least three (3) client/customer references including company name, contact person, and telephone number. The reference should be similar in scope/specifications (including size, cost, complexity/uniqueness, etc.) as the project/work/service/item described in this solicitation. If the reference contact information is not correct, current, or unavailable, the City is not responsible for obtaining correct/current/available contact information and may elect to consider the reference as non-responsive.

Therefore, the Bidder should ensure the reference contact information is correct, current, and available to the City.

Company Name:

Address:

City, State, Zip Code Contact Person Business Phone: Email Address:

Project/Svc/Item Description:

Contract/Order Amount: Completed/Delivered:

Company Name:

Address:

City, State, Zip Code Contact Person Business Phone: Email Address:

Project/Svc/Item Description:

Contract/Order Amount: Completed/Delivered:

3 Company Name:

Address:

City, State, Zip Code Contact Person Business Phone: Email Address:

Project/Svc/Item Description:

Contract/Order Amount: Completed/Delivered:

4 Company Name:

Address:

City, State, Zip Code Contact Person Business Phone: Email Address:

Project/Svc/Item Description:

Contract/Order Amount: Completed/Delivered:

5 Company Name:

Address:

City, State, Zip Code Contact Person Business Phone: Email Address:

Project/Svc/Item Description:

Contract/Order Amount: Completed/Delivered:

THIS FORM MUST BE COMPLETED AND RETURNED WITH BID SUBMISSION

CONFLICT OF INTEREST STATEMENT FORM

A. I am the of with a local office in [Insert Title] [Insert Company Name] and principal office in _.

B. The entity hereby submits an offer to ITB-25-051-KY, titled CHEMICALS FOR PUBLIC WORKS PLANT OPERATIONS.

C. The AFFIANT has made a diligent inquiry and provided the information in this statement affidavit based upon its full knowledge.

D. The AFFIANT states that only one submittal for this solicitation has been submitted and tendered by the appropriate date and time and that said above-stated entity has no financial interest in other entities submitting a proposal for the work contemplated hereby.

E. Neither the AFFIANT nor the above-named entity has directly or indirectly entered into any agreement, participated in any collusion or collusive activity, or otherwise taken any action which in any way restricts or restraints the competitive nature of this solicitation, including but not limited to the prior discussion of terms, conditions, pricing, or other offer parameters required by this solicitation.

F. Neither the entity nor its affiliates, nor anyone associated with them, is presently suspended or otherwise prohibited from participation in this solicitation or any contract to follow thereafter by any government entity.

G. Neither the entity nor its affiliates, nor anyone associated with them, have any potential conflict of interest because and due to any other clients, contracts, or property interests in this solicitation or the resulting project.

H. I hereby also certify that no member of the entity’s ownership or management or staff has a vested interest in any City Division/Department/Office.

I. I certify that no member of the entity’s ownership or management is presently applying, actively seeking, or has been selected for an elected position within the City of Altamonte Springs government.

J. In the event that a conflict of interest is identified in the provision of services, I, the undersigned will immediately notify the City in writing.

By the signature(s) below, I/we, the undersigned, as authorized signatory to commit the firm, certify that the information as provided in, Conflict of Interest Statement Form, is truthful and correct at the time of submission.

AFFIANT SIGNATURE

Typed Name of AFFIANT

Title

STATE OF

COUNTY OF

Sworn to (or affirmed) and subscribed before me by means of __ physical presence or __online notarization this _____ day of__________________20___, by ________________________, who is personally known to me or has produced ______________________ as identification.

(stamp)

NOTARY PUBLIC

NON-COLLUSION/LOBBYING CERTIFICATION FORM

A. This sworn statement is submitted with Invitation to Bid, or Contract Number ITB-25-051-KY, titled CHEMICALS FOR PUBLIC

WORKS PLANT OPERATIONS.

B. This sworn statement is submitted by ____________________________________ whose business address is [Name of entity submitting sworn statement] and (if applicable) its Federal Employer Identification Number (FEIN) is (If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement.

C. My name is and my relationship to the above is ________________.

[Please print name of individual signing]

D. NON-COLLUSION PROVISION CERTIFICATION.

The undersigned hereby certifies, to the best of his or her knowledge and belief, that on behalf of the person, firm, association, or corporation submitting the bid certifying that such person, firm, association, or corporation has not, either directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action, in restraint of free competitive bidding in connection with the submitted bid. Failure to submit the executed statement as part of the bidding documents will make the bid nonresponsive and not eligible for award consideration.

E. LOBBYING CERTIFICATION.

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

1. No Federal and/or City 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 either directly or indirectly an officer or employee of the City, City Council Member of Congress in connection with the awarding of any City Contract.

2. If any funds other than Federal and/or City appropriated funds have been paid or will be paid to any person for influencing or attempting to influence a member of t h e City Council or an officer or employee of the City in connection with this contract, the undersigned shall complete and submit Standard Form-L “Disclosure Form to Report Lobbying”, in accordance with its instructions.

By the signature(s) below, I/we, the undersigned, as authorized signatory to commit the firm, certify that the information as provided in, the Non-Collusion/Lobbying Certification Form, is truthful and correct at the time of submission.

AFFIANT SIGNATURE

Typed Name of AFFIANT

Title

STATE OF

COUNTY OF

Sworn to (or affirmed) and subscribed before me by means of __ physical presence or __online notarization this _____ day of__________________20___, by ________________________, who is personally known to me or has produced ______________________ as identification.

(stamp) NOTARY PUBLIC

HUMAN TRAFFICKING AFFIDAVIT

Instruction: “Contractor,” defined as any person or nongovernmental entity seeking to engage in business with the City of Altamonte Springs (“City”), must complete the following form.

The undersigned, on behalf of Contractor, hereby attests as follows:

A. Contractor understands and affirms that Section 787.06(13), Florida Statutes, prohibits the City from executing, renewing, or extending a contract to entities that use coercion for labor or services.

B. Contractor hereby attests, under penalty of perjury, that Contractor does not use coercion for labor or services as defined in Section 787.06(2), Florida Statutes.

I, the undersigned, am an officer or representative of the nongovernmental entity named below, and hereby represent that I: make the above attestation based upon personal knowledge; am over the age of 18 years and otherwise competent to make the above attestation; and am authorized to legally bind and make the above attestation on behalf of the Contractor. Under penalties of perjury, I declare that I have read the forgoing document and that the facts stated in it are true. Further Affiant sayeth naught.

Contractor:

Authorized Signature: Date: Printed

Name:

Title:

STATE OF COUNTY OF

The foregoing instrument was acknowledged before me by means of ☐ physical presence or ☐ online notarization, this day of , 20 , by

, as on behalf of the company/corporation. They ☐ are personally known to me or ☐ have produced as identification.

Signature of Notary Public

Name of Notary Typed, Printed or Stamped My Commission Expires:

FOREIGN COUNTRY OF CONCERN ATTESTATION

(PUR 1355)

This form must be completed by an officer or representative of an entity submitting a bid, proposal, or reply to, or entering into, renewing, or extending, a contract with a Governmental Entity which would grant the entity access to an individual’s Personal Identifying Information. Capitalized terms used herein have the definitions ascribed in Rule 60A-1.020, F.A.C.

______________________ is not owned by the government of a Foreign Country of Concern, is not organized under the laws of nor has its Principal Place of Business in a Foreign Country of Concern, and the government of a Foreign Country of Concern does not have a Controlling Interest in the entity.

Under penalties of perjury, I declare that I have read the foregoing statement and that the facts stated in it are true.

Printed Name:

Title:

Signature: Date:

https://www.flrules.org/gateway/RuleNo.asp?title=GENERAL%20REGULATIONS&ID=60A-1.020 https://www.flrules.org/gateway/RuleNo.asp?title=GENERAL%20REGULATIONS&ID=60A-1.020

DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS CERTIFICATION

As required by 2 CFR 200, for persons entering into a contract, grant or cooperative agreement over $25,000 involving the expenditure of Federal funds, the undersigned certifies for itself and its principals that:

A. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency;

B. Have not within a three-year period preceding this application been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

C. Are not presently indicted for or otherwise criminally or civilly charged by a Government entity (Federal, State, or local) with commission of any offenses enumerated in paragraph (B) of this certification; and

D. Have not within a three-year period preceding this application had one or more public transaction (Federal, State, or local) terminated for cause or default; and

Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach an explanation to this application.

Printed Name / Title of Representative Contract / Purchase Order Number

Signature of Representative Date

BID SUBMITTAL LABEL

Cut along dotted line and tape or glue to a standard #10 envelope, mailing envelope, or box.

Company Name: Place Business Address: Postage Business Address: Here City/State/Zip: ______________________________

HAND DELIVER OR MAIL TO

PROCUREMENT DIVISION

CITY HALL, SUITE 1030

CITY OF ALTAMONTE SPRINGS

225 NEWBURYPORT AVENUE

ALTAMONTE SPRINGS FL 32701-3697

BID NUMBER: ITB-25-051-KY

BID TITLE: CHEMICALS FOR PUBLIC WORKS PLANT OPERATIONS

Due Date:

Due Time: 11:00 a.m.