Mandatory Forms Binder (1).pdf

AUTHORITY TO EXECUTE SOLICITATION AND

CONTRACT

A. If the Vendor is a Corporation, attach to this page a certified copy of corporate resolutions of the

Board of Directors of the Corporation authorizing an officer of the Corporation to execute the Solicitation and the Contract contained within this document on behalf of the Corporation. The CITY would prefer the use of the attached sample Resolution.

B. A corporation to which a contract is to be awarded will be required to furnish certificates as to its corporate existence.

CERTIFIED RESOLUTION

I, ___________________________________________________ (Name), the duly elected Secretary of

________________________________ (Corporate Title), a corporation organized and existing under the laws of the State of_______________________________________, do hereby certify that the following Resolution was unanimously adopted and passed by a quorum of the Board of Directors of the said corporation at a meeting held in accordance with law and the by-laws of the said corporation.

"IT IS HEREBY RESOLVED THAT ____________________________________________________ (Name)"

The duly elected _________________(Title of Officer) of __________________________ (Corporate Title) be and is hereby authorized to execute and submit a Solicitation and Bid Bond, if such bond is required, to the City of Parkland for: _______________________________________________________________ and such other instruments in writing as may be necessary on behalf of the said corporation; and that the Solicitation, Bid Bond, and other such instruments signed by them shall be binding upon the said corporation as its own acts and deeds. The secretary shall certify the names and signatures of those authorized to act by the foregoing resolution.

The City of Parkland shall be fully protected in relying upon such certification of the secretary and shall be indemnified and saved harmless from any and all claims, demands, expenses, loss or damage resulting from or growing out of honoring, the signature of any person so certified or for refusing to honor any signature not so certified.

I further certify that the above resolution is in force and effect and has not been revised, revoked or rescinded.

I further certify that the following are the name, titles and official signatures of those persons authorized to act by the foregoing resolution.

AUTHORIZED SIGNATURE NAME

TITLE DATE

BACKGROUND CHECK AFFIDAVIT

STATE OF FLORIDA _____________________)

COUNTY OF ___________________________)

I, the undersigned, being first duly sworn, do hereby state under oath and under penalty of perjury that the following facts are true:

1. I am over the age of 18 and am a resident of the __________________(City and State).

2. My full legal name is ______________________________________.

3. I am the ________________________ (title) of ________________________________ and I certify that I have the authority to make the representations set forth within this Affidavit.

4. ____________________________________________ (Company legal name) intends to enter into an agreement/Purchase Order with the City of Parkland, Florida (“City”) to provide the services detailed in Solicitation # _____________________(the “Agreement”).

5. The fulfillment of the Background Check requirement shall be conducted through State, National and Sexual Offender/Predator criminal history record databases.

6. I hereby certify that, in accordance with Section 2-142.5 of the City Code, I have, at the Company’s expense, completed a criminal background check for each person employed by or under contract with ___________________(Company Name) as a subcontractor, consultant, or sub-consultant who will perform work or services in or on City Property in close proximity to facilities with minors, the elderly or persons with special needs, or where the services are of a nature which would reasonably warrant background checks, as set forth in Section 2-142.5 of the City Code, and will obtain a criminal background check for those employees on an annual basis thereafter to the extent the term of the Agreement exceeds one year.

7. I hereby certify that based upon the result of the criminal background check, no employee, contractor, nor subcontractor or subconsultant who has been convicted of an offense or who has entered a plea of nolo contendere for any crime set forth in Section 2-142.5 shall perform work on City property where the contractor or any subcontractor or employees will perform work or services in close proximity to facilities with minors, the elderly or persons with special needs or where the services are of a nature which would reasonably warrant background checks.

8. I certify that ______________(Company Name) shall maintain records of the criminal history checks for each person doing such work on City Property during the contract period and for one (1) year thereafter and shall make such records available for inspection and verification by the City.

[THIS SPACE LEFT INTENTIONALLY BLANK]

BACKGROUND CHECK AFFIDAVIT

9. I attest that all personnel used in the performance of the work under the Agreement have had a criminal background check and have met the requirements of Section 2-142.5 and Solicitation # _________________ and are eligible to perform the work for the City, on City property.

Executed this _________________________day of __________________, 20_____.

By_____________________________________ (Signature)

By_____________________________________ (Name and Title)

CERTIFICATION & ACKNOWLEDGEMENT

OF BUSINESS TYPE

This form must be submitted with the solicitation package on the specified solicitation opening date. The undersigned vendor certifies that this solicitation package is submitted in accordance with the specifications in its entirety and with full understanding of the conditions governing this solicitation.

BUSINESS ADDRESS OF VENDOR:

Company Name

Contact Person

Address

City State Zip

Telephone No. Fax No.

Email Address:

Federal ID. No. or Social Security No.

INDICATE WHICH TYPE OF ORGANIZATION BELOW:

Individual Partnership Corporation LLC Other

DRUG-FREE WORKPLACE FORM

The undersigned vendor 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’ policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and 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 subsection (1).

4. In the statement specified in subsection (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 Chapter 893 or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction.

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

6. Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section.

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

Proposer's Signature

Proposer's Printed Name

E-VERIFY COMPLIANCE VERIFICATION FORM

E-Verify Form Notary Rev. 2-2-2026

Solicitation No./Title: ________________________________________________________

Company/Firm: ___________________________________________________________

The Affiant by virtue of the signature below certifies that:

1. Contractor and any sub-contractors are aware of, and shall comply with, all of the requirements set forth in Section 448.095, Florida Statutes, including but not limited to registration and use of the E-Verify System to verify the work authorization status of all new employees

2. Contractor and its subcontractors are registered with and are utilizing the U.S. Department of Homeland Security’s E-Verify System to verify the work authorization status of all new employees.

3. Contractor will not enter into a contract with any subcontractor unless each party to the contract registers with and uses the E-Verify System. Subcontractor(s) shall provide Contractor with an affidavit stating that Subcontractor does not employ, contract with, or subcontract with unauthorized aliens.

Contractor shall retain a copy of the Subcontractor’s Affidavit and provide a copy to the City.

4. Failure to comply with Section 448.095, Fla. Stat. shall result in termination of the resulting Contract/Purchase Order, if awarded. Any challenge to termination under this provision must be filed in the Circuit Court no later than 20 calendar days after the date of termination. If the contract is terminated for a violation of the statute by the Contractor, the Contractor may not be awarded a public contract for a period of one (1) year after the date of termination.

5. Contractor is liable for any additional cost incurred by the City as a result of the termination of the Contract/Purchase Order for failure to adhere to Section 448.095, Fla. Stat.

By executing this form, I, ______________________________, being duly authorized by and on behalf of, Contractor, verify Contractor’s compliance with Section 448.095, Fla. Stat. I hereby declare under penalty of perjury that the foregoing is true and correct.

Authorized Signature: _________________________ Date: _____________________

Print Name: __________________________________ Title: ______________________

FOREIGN (NON-FLORIDA) CORPORATE STATEMENT

FOREIGN (NON-FLORIDA) CORPORATIONS MUST COMPLETE THIS FORM

DEPARTMENT OF STATE CORPORATE CHARTER NO.

If your corporation is exempt from the requirements of Section 607.1501, Florida Statutes, YOU MUST CHECK BELOW the reason(s) for the exemption. Please contact the Department of State, Division of Corporations at (904) 488-9000 for assistance with corporate registration or exemptions.

607.1501 Authority of foreign corporation to transact business required.

(1) A foreign corporation may not transact business in this state until it obtains a certificate of authority from the Department of State.

(2) The following activities, among others, do not constitute transacting business within the meaning of subsection (1):

_____(a) Maintaining, defending, or settling any proceeding.

_____(b) Holding meetings of the board of directors or shareholders or carrying on other activities concerning internal corporate affairs.

_____(c) Maintaining bank accounts.

_____(d) Maintaining officers or agencies for the transfer, exchange, and registration of the corporation's own securities or maintaining trustees or depositories with respect to those securities.

_____(e) Selling through independent contractors.

_____(f) Soliciting or obtaining orders, whether by mail or through employees, agents, or otherwise, if the orders require acceptance outside this state before they become contracts.

_____(g) Creating or acquiring indebtedness, mortgages, and security interests in real or personal property.

_____(h) Securing or collecting debts or enforcing mortgages and security interests in property securing the debts.

_____(i) Transacting business in interstate commerce.

_____(j) Conducting an isolated transaction that is completed within 30 days and that is not one in the course of repeated transactions of a like nature.

_____(k) Owning and controlling a subsidiary corporation incorporated in or transacting business within this state or voting the stock of any corporation which it has lawfully acquired.

_____(l) Owning a limited partnership interest in a limited partnership that is doing business within this state, unless such limited partner manages or controls the partnership or exercises the powers and duties of a general partner.

_____(m) Owning, without more, real or personal property.

(3) The list of activities in subsection (2) is not exhaustive.

(4) This section has no application to the question of whether any foreign corporation is subject to service of process and suit in this state under any law of this state.

Please check one of the following if your firm is NOT a corporation:

(I) _____ Partnership, Joint Venture, Estate or Trust (II) _____ Sole Proprietorship or Self Employed

NOTE: This form MUST be included with your bid if you claim an exemption or have checked I or

II above. If you do not check I or II above, your firm will be considered a corporation and subject to all requirements listed herein.

VENDOR/PROPOSER'S CORRECT LEGAL NAME

SIGNATURE OF AUTHORIZED AGENT OF VENDOR/PROPOSER

Foreign Countries of Concern Prohibited Affidavit Pursuant to Section 287.138, Florida Statutes

Entity name: ______________________________________________________________________________

Vendor FEIN:_______________________________________________________________________________

Address:___________________________________________________________________________________

City:___________________________________________________ State: ______________Zip:____________

Phone number:_____________________________ Email Address: _________________________________

In compliance with Section 287.138 Florida Statutes, this Affidavit must be completed by an officer or representative of any entity that is submitting a bid, proposal, quote, or other response, or otherwise entering into, renewing, or extending a contract with the City of Parkland (“City”), a governmental entity, that would give the entity access to an individual’s personal identifying information.

Accordingly, the undersigned, on behalf of the entity listed above (“Entity”), hereby attests under penalty of perjury as follows:

1. Entity does not meet any of the criteria set forth in Paragraphs 2 (a)-(c) of Section 287.138, F.S., as such terms are defined therein, as updated.

a. The Entity is not owned by the government of a foreign country of concern;

b. The government of a foreign country of concern does not have a controlling interest in the Entity;

c. The Entity is not organized under the laws of or has its principal place of business in a foreign country of concern.

2. Entity acknowledges that any contracts, bids, proposals, quotes, or other responses will not be accepted from Entity unless and until this completed and executed Affidavit is received by the City.

3. Failure or refusal to submit this Affidavit as required shall be cause for immediate termination of any existing contracts by the City.

4. The Attorney General may bring a civil action in any court of competent jurisdiction against an entity that violates this requirement.

5. Pursuant to Section 92.525, Florida Statutes, under penalties of perjury, I, the undersigned officer or representative of the undersigned Entity, declares that I have read the foregoing statement and that the facts stated in it are true, and are made for the benefit of, and reliance by the City.

Foreign Countries of Concern Prohibited Affidavit Pursuant to Section 287.138, Florida Statutes

Entity Name

By: ______________________________________________________________________________________ Authorized Signature

Print Name and Title: ______________________________________________________________________

Date: _______________________________________________

Affidavit Attesting to Noncoercive Conduct for Labor or Services

Nongovernment Entity name: ________________________________________________________________(“Vendor”)

Vendor FEIN:_______________________________________________________________________________

Address:___________________________________________________________________________________

City:___________________________________________________ State: ______________Zip:____________

Phone number:_____________________________ Email Address: _________________________________

As a nongovernmental entity executing, renewing, or extending a contract with a government entity, Vendor is required to provide an affidavit under penalty of perjury attesting that Vendor does not use coercion for labor or services in accordance with Section 787.06, Florida Statutes.

As defined in Section 787.06(2)(a), coercion means:

1. Using or threatening to use physical force against any person;

2. Restraining, isolating, or confining or threatening to restrain, isolate, or confine any person without lawful authority and against her or his will;

3. Using lending or other credit methods to establish a debt by any person when labor or services are pledged as a security for the debt, if the value of the labor or services as reasonably assessed is not applied toward the liquidation of the debt, the length and nature of the labor or service are not respectively limited and defined;

4. Destroying, concealing, removing, confiscating, withholding, or possessing any actual or purported passport, visa, or other immigration document, or any other actual or purported government identification document, of any person;

5. Causing or threatening to cause financial harm to any person;

6. Enticing or luring any person by fraud or deceit; or

7. Providing a controlled substance as outlined in Schedule I or Schedule II of Section 893.03 to any person for the purpose of exploitation of that person.

As a person authorized to sign on behalf of Vendor, I certify that Vendor does not use coercion for labor or services in accordance with Section 787.06.

Written Declaration

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

By: ______________________________________________________________________________________ Authorized Signature

Print Name and Title: ______________________________________________________________________

Date: _______________________________________________

NON-COLLUSIVE AFFIDAVIT

I, the undersigned, do hereby state under oath and under penalty of perjury that the following facts are true:

(1) I, _______________________________________________________________________

(Owner, Partner, Officer, Representative or Agent) of has submitted the attached solicitation;

(2) I am fully informed respecting the preparation and contents of the attached solicitation and of all pertinent circumstances respecting such solicitation;

(3) Such solicitation is genuine and is not a collusive or sham solicitation;

(3) Neither the said nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affiant, have in any way colluded, conspired, connived or agreed, directly or indirectly, with any other Vendor, firm, or person to submit a collusive or sham solicitation in connection with the work for which the attached solicitation has been submitted; or to refrain from bidding in connection with such work; or have in any manner, directly or indirectly, sought by agreement or collusion, or communication, or conference with any Vendor, firm or person to fix the price or prices in the attached solicitation or of any other Vendor, or to fix an overhead, profit, or cost elements of the solicitation price or the solicitation price of any other Vendor, or to secure through any collusion, conspiracy, connivance, or unlawful agreement any advantage against (Recipient), or any person interested in the proposed work;

(4) The price or prices quoted in the attached solicitation are fair and proper and are not tainted by any collusion, conspiracy, connivance, or unlawful agreement on the part of the Vendor or any other of its agents, representatives, owners, employees or parties in interest, including this affiant.

PUBLIC ENTITY CRIME STATEMENT

“A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to public entity, may not be awarded or perform work as a Proposer, supplier, sub-Proposer, or consultant under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list.”

I state that this Proposer complies with the above.

Signed: __________________________________________

Printed Name: _____________________________________

Date: _____________________________________________

SCRUTINIZED VENDOR CERTIFICATION

I, _______________________________________, on behalf of ____________________________, Print Name and Title Contractor Name

Certify that ____________________________ does not:

Contractor Name

1. Participate in a boycott of Israel; and

2. Is not on the Scrutinized Companies that Boycott Israel List; and

3. Is not on the Scrutinized Companies with Activities in Sudan List; and

4. Is not on the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List; and

5. Has not engaged in business operations in Syria.

Submitting a false certification shall be deemed a material breach of contract. The City shall provide notice, in writing, to the Contractor of the City’s determination concerning the false certification. The Contractor shall have ninety (90) days following receipt of the notice to respond in writing and demonstrate that the determination of false certification was made in error. If the Contractor does not demonstrate that the City’s determination of false certification was made in error then the City shall have the right to terminate the contract and seek civil remedies pursuant to Florida Statute § 287.135.

Section 287.135, Florida Statutes, prohibits the City from: 1) Contracting with companies for goods or services in any amount if at the time of bidding on, submitting a proposal for, or entering into or renewing a contract if the company is on the Scrutinized Companies that Boycott Israel List, created pursuant to Section 215.4725, F.S. or is engaged in a boycott of Israel; and 2) Contracting with companies, for goods or services over $1,000,000.00 that re on either the Scrutinized Companies with activities in the Iran Petroleum Energy Sector List, created pursuant to s. 215.473, or are engaged in business operations in Syria.

As the person authorized to sign on behalf of the Contractor, I hereby certify that the company identified above in the section entitled “Contractor Name” does not participate in any boycott of Israel, is not listed on the Scrutinized Companies that Boycott Israel List, is not listed on either the Scrutinized Companies with activities in the Iran Petroleum Energy Sector List, and is not engaged in business operations in Syria. I understand that pursuant to section 287.135, Florida Statutes, the submission of a false certification may subject the company to civil penalties, attorney’s fees, and/or costs. I further understand that any contract with the City for goods or services may be terminated at the option of the City if the company is found to have submitted a false certification or has been placed on the Scrutinized Companies with Activities in Sudan list or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List.

Signature Date

QUALIFICATIONS STATEMENT

The undersigned certifies under oath the truth and correctness of all statements and all answers to questions made hereinafter:

Name of Company:

Address:

Street

City State Zip

Telephone No. ( ) Fax No. ( )

How many years has your organization been in business under its present name? Years

If Bidder is operating under Fictitious Name, submit evidence of compliance with Florida

Fictitious Name Statute:

Under what former names has your business operated?

At what address was that business located?

Are you Certified? Yes No If Yes, ATTACH A COPY OF CERTIFICATION

Are you Licensed? Yes No If Yes, ATTACH A COPY OF LICENSE

Do you have the required insurance coverage’s set forth in the ITB?

Yes No If Yes, ATTACH A COPY OF INSURANCE CERTIFICATES (GENERAL

LIABILITY, AUTOMOBILE, WORKERS COMPENSATION)

Has your company or you personally ever declared bankruptcy?

Yes No If Yes, explain:

Susan Reutlinger Cross-Out

Are you a sales representative distributor broker or manufacturer of the commodities/services bid upon?

Have you ever received a contract or a purchase order from the City of Parkland or other governmental entity? Yes No

If yes, explain (date, service/project, bid title, etc)

Have you ever received a complaint on a contract or bid awarded to you by any governmental entity?

Yes No If yes, explain:

Have you ever been debarred or suspended from doing business with any governmental entity?

Yes No If yes, explain:

Qualifications Statement Form - v. 2026