Marler_and_Beasley_Park_additional_parking_PurchasingPreSolicitationForm.pdf

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Okaloosa County Purchasing Department Request for Solicitation

NOTE: The information below is required. This form must include Scope of Work (SOW). Purchasing cannot begin solicitation process until complete. Attach additional documents if necessary.

Solicitation Title: _____________________________________ Date: _________________

Requesting Department: ________________________________

Department Point of Contact: ____________________________ Director/Manager Approval

Office: _________________ Cell: _________________ Email:

Solicitation Type (Please Check Service Type and Solicitation Type)

___ Construction ____ Engineering ____ Specification ____ Service ____ Prof Service _____ General

_____ Invitation to Quote (ITQ):

_____ Invitation to Bid (ITB):

_____ Request for Proposal (RFP):

_____ Invitation to Negotiate (ITN):

_____ Request for Qualifications (RFQ):

Requires at least three quotes and is based on lowest most responsive price. (Under $50,000)

Based on lowest most responsive price. (Over $50,000)

Based on qualifications and price.

Based on qualifications and price/uses negotiations to receive the best responses.

Based on qualifications only. Florida CCNA Federal Brooks Act may apply. CCNA compliance, Applies to Engineers, Architects, and Surveyors.

Compliance with Florida’s CCNA or the Federal Brooks Act required? Yes ____ No____

Is there a schedule deadline for delivery/completion or phases/milestones? Please specify:

(Schedule of phases and milestones are aligned to a work breakdown structure and are included in the SOW)

Pre-Bid Meeting: Yes ____ No ____

Bonding Required: Yes ____ No ____

Davis Bacon Required: Yes ____ No ____

Mandatory: Yes ____ No ____

Bond Type (performance, bid, etc): _____________

Buy America Required: Yes ____ No ____

Other special provisions required for solicitation? If yes, describe below. If no, enter N/A.

Liquidated Damages/Retainage: __________________________________________________

Previous/Current Contract Number: ___________________ Expiration Date:____________

Okaloosa County Purchasing Department Request for Solicitation

NOTE: The information below is required. This form must include Scope of Work (SOW). Purchasing cannot begin solicitation process until complete. Attach additional documents if necessary.

Budget and Funding Information

Funding Source? Please specify Funding Type (COUNTY, FEMA, FAA, FTA, FDOT etc.):

If Grant funded, provide grant title/number: __________________________________________

If Grant not awarded/final, describe solicitation status and/or funding options:

Grantor approval/concurrence required before advertising or at contract approval process?

Yes____ No_____ N/A____

Project Number, if applicable: __________________________

Department Account Number Amount

Estimated Budget

Independent Cost Estimate (ICE) accomplished and provided? Yes____ No_____ (Independent Cost Estimate, if required, due prior to solicitation deadline.)

Scope of Work Development

Intent/Scope of Work Summary Statement (Attach Word® format document if required):

Okaloosa County Purchasing Department Request for Solicitation

NOTE: The information below is required. This form must include Scope of Work (SOW). Purchasing cannot begin solicitation process until complete. Attach additional documents if necessary.

Other Requirements

Specify Insurance Requirements: _________________________________________________ (Choose from the risk management template choices)

Specify Terms of Resulting Contract/Agreement: ___________________________________ (Term of performance - usually 3 years with two 1 year renewals)

Consultant assisting with Scope of Work, Cost Estimate, or providing supporting documents for solicitation? Yes___ No____ Consultant Name: _______________________

IT requirements: ___ Yes ___ No. If yes, please have IT sign off on scope prior to submittal to Purchasing. _________________________________

Newspaper Requirements: All formal solicitations are required to be advertised in the newspaper.

Please provide the Dept Number for charges _______.

Legal Advertisements are charged to budget account 549901 or you may have us charge ________.

Potential Vendors for Project

Purchasing Use Only

Approved for Advertising: __________________________ Date: __________________ Signature

Assigned to: ____________________________

Solicitation Number: _____________________