OEBO Schedules 1-2 Fillable.pdf

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GRINDER, REMOVE, REPLACE AND INSTALL, AT PBIA
Solicitation number
RFQ 680 110719-51/HS 2
Issued by
Palm Beach County, Florida

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Written by GovTribe AI ·

This is a fillable bidding and procurement form document issued by Palm Beach County's Office of Equal Business Opportunity (OEBO) that establishes the framework for contractor and subcontractor participation in county solicitations. The document consists of multiple schedules designed to track and verify Small Business Enterprise (SBE) and Minority/Women Business Enterprise (M/WBE) participation throughout the bidding and contract performance phases. Schedule 1 requires prime contractors to list all proposed subcontractors and subconsultants, identifying the dollar amounts or percentages of work to be completed by each tier and categorizing businesses by certification status and demographic characteristics including minority and women-owned classifications. Schedule 2 functions as a binding letter of intent between prime contractors and subcontractors at any tier, requiring detailed scope of work descriptions with corresponding unit prices, quantities, and total price or percentage allocations for each line item. Schedule 3 serves as a subcontractor activity tracking form completed monthly or upon final payment to document actual work performed, payment amounts, contract revisions, and change orders. Schedule 4 appears to include notarized certification requirements.

The forms mandate that all subcontractors and subconsultants at any tier properly execute Schedule 2 documents and submit them with bid proposals, with failure to do so potentially resulting in non-counted participation. Bidders must specify whether participating firms are certified SBE, WBE, MBE, M/WBE, or non-certified and provide Palm Beach County certification dates where applicable. The documentation requires detailed itemization of work scope, pricing verification, and demographic information of business owners. SBE credit is limited to areas for which the business holds certification. These forms were last revised in February 2019 for Schedules 1-2 and September 2019 for Schedule 2, establishing current compliance requirements for all county contract solicitations and project submissions.

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REVISED 02/28/2019

OEBO SCHEDULE 1

LIST OF PROPOSED CONTRACTOR/CONSULTANT AND SUBCONTRACTOR/SUBCONSULTANT PARTICIPATION

SOLICITATION/PROJECT/BID NAME: _________________________________________ SOLICITATION/PROJECT/BID No.: ______________________________________

NAME OF PRIME RESPONDENT/BIDDER: ADDRESS: _________________________________________________________

CONTACT PERSON: _______________________________________________________ PHONE NO.: ___________________________ E-MAIL:______________________

SOLICITATION OPENING/SUBMITTAL DATE: ___________________________________ DEPARTMENT: ______________________________________________________

PLEASE LIST THE DOLLAR AMOUNT OR PERCENTAGE OF WORK TO BE COMPLETED BY THE PRIME CONTRACTOR/CONSULTANT ON THIS PROJECT.

PLEASE ALSO LIST THE DOLLAR AMOUNT OR PERCENTAGE OF WORK TO BE COMPLETED BY ALL SUBCONTRACTORS/SUBCONSULTANTS ON THE

PROJECT.

(Check all Applicable Categories) Non-SBE M/WBE SBE DOLLAR AMOUNT OR PERCENTAGE OF WORK

Name, Address and Phone Number Minority/Women Small

Business Business Black Hispanic Women Caucasian Other (Please Specify)

1.

2.

3.

4.

5.

(Please use additional sheets if necessary) Total ___ _____ __ ______ _________ _________ _________

Total Bid Price $________________________________________ Total SBE - M/WBE Participation _____________

I hereby certify that the above information is accurate to the best of my knowledge: ____________________________________________________________ ______________________________________ Signature Title

Note: 1. The amount listed on this form for a Subcontractor/subconsultant must be supported by price or percentage listed on the properly executed Schedule 2 or attached signed proposal.

2. Firms may be certified by Palm Beach County as an SBE and/or an M/WBE. If firms are certified as both an SBE and/or M/WBE, please indicate the dollar amount under the appropriate category.

3. Modification of this form is not permitted and will be rejected upon submittal.

OEBO LETTER OF INTENT – SCHEDULE 2

Revised 09/17/2019

A completed Schedule 2 is a binding document between the Prime Contractor/consultant and a Subcontractor/subconsultant (for any tier) and should be treated as such. The Schedule 2 shall contain bolded language indicating that by signing the Schedule 2, both parties recognize this Schedule as a binding document. All Subcontractors/subconsultants, including any tiered Subcontractors/subconsultants, must properly execute this document. Each properly executed Schedule 2 must be submitted with the bid/proposal.

SOLICITATION/PROJECT NUMBER: ________________________________________________________________________________

SOLICITATION/PROJECT NAME: __________________________________________________________________________________

Prime Contractor: ___________________________________________Subcontractor:______________________________________ (Check box(s) that apply) � SBE � WBE � MBE � M/WBE � Non-S/M/WBE Date of Palm Beach County Certification (if applicable):_______________.

The undersigned affirms they are the following (select one from each column if applicable):

Column 1 Column 2 Column 3

� Male � Female � African-American/Black � Asian American � Caucasian American � Supplier � Hispanic American � Native American

S/M/WBE PARTICIPATION – S/M/WBE Primes must document all work to be performed by their own work force on this form. Failure to submit a properly executed Schedule 2 for any S/M/WBE participation may result in that participation not being counted. Specify in detail, the scope of work to be performed or items supplied with the dollar amount and/or percentage for each work item. S/M/WBE credit will only be given for the areas in which the S/M/WBE is certified. A detailed proposal may be attached to a properly executed Schedule 2.

Line Item

Item Description Unit Price Quantity/ Units

Contingencies/ Allowances

Total Price/Percentage

The undersigned Subcontractor/subconsultant is prepared to self-perform the above-described work in conjunction with the aforementioned project at the following total price or percentage:

Print Name of Prime Print Name of Subcontractor/subconsultant

By: _____________________________________________ By: ________________________________________________

Authorized Signature Authorized Signature

Print Name Print Name

Title Title

Date: ___________________________________________ Date: ______________________________________________

If the undersigned intends to subcontract any portion of this work to another Subcontractor/subconsultant, please list the business name and the amount below accompanied by a separate properly executed Schedule 2.

Price or Percentage:

Name of 2nd/3rd tier Subcontractor/subconsultant

Schedule1
Schedule 2 fillable
Schedule3
OEBO SCHEDULE 3
SUBCONTRACTOR ACTIVITY FORM
PROJECT NAME
PRIME CONTRACTOR NAME
PROJECT SUPERVISOR
I hereby certify that the above information is accurate to the best of my knowledge ...

Schedule 4 fillable

Text2:
NAME OF PRIME RESPONDENTBIDDER:
Text3:
Text4:
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Text7:
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Check Box1:
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2: Off
0: Off
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1: Off
2: Off
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Total Bid Price:
Text15:
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SOLICITATIONPROJECT NUMBER:
SOLICITATIONPROJECT NAME:
Prime Contractor:
Subcontractor:
Date of Palm Beach County Certification if applicable:
Line ItemRow1:
Item DescriptionRow1:
Unit PriceRow1:
Quantity UnitsRow1:
Contingencies AllowancesRow1:
Total PricePercentageRow1:
Line ItemRow2:
Item DescriptionRow2:
Unit PriceRow2:
Quantity UnitsRow2:
Contingencies AllowancesRow2:
Total PricePercentageRow2:
Line ItemRow3:
Item DescriptionRow3:
Unit PriceRow3:
Quantity UnitsRow3:
Contingencies AllowancesRow3:
Total PricePercentageRow3:
Line ItemRow4:
Item DescriptionRow4:
Unit PriceRow4:
Quantity UnitsRow4:
Contingencies AllowancesRow4:
Total PricePercentageRow4:
Line ItemRow5:
Item DescriptionRow5:
Unit PriceRow5:
Quantity UnitsRow5:
Contingencies AllowancesRow5:
Total PricePercentageRow5:
Line ItemRow6:
Item DescriptionRow6:
Unit PriceRow6:
Quantity UnitsRow6:
Contingencies AllowancesRow6:
Total PricePercentageRow6:
at the following total price or percentage:
Print Name of Prime:
Print Name:
Date:
Print Name of Subcontractorsubconsultant:
Print Name_2:
Title_2:
Date_2:
Title:
Project Name:
Name of 2nd3rd tier Subcontractorsubconsultant:
Price or Percentage:
By:
By_2:
Type of Identification:
OR Produced Identification:
Print Type or Stamp Commissioned Name of Notary:
Notary Public State of Florida:
20:
day of:
Sworn to and subscribed before me this:
COUNTY OF:
Name Title of Person executing on behalf of Subcontractor:
SUBCONTRACTORSUBCONSULTANT VENDOR CODE:
PRIME CONTRACTORCONSULTANT VENDOR CODE:
TASK ORDERWORK ORDERDELIVERY ORDERPURCHASE ORDER NO:
DEPT:
Project No:
Month:
YYYY:
DD:
MM:
Prime Contractor Name:
Monthly or Final payment of:
This is to certify that:
I hereby certify that the above information is accurate to the best of my knowledge:
Check Box19:
6:
6: Off
5: Off
4: Off
3: Off
2: Off
1: Off
0: Off
5:
6: Off
5: Off
4: Off
3: Off
2: Off
1: Off
0: Off
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2: Off
1: Off
0: Off
0:
6: Off
5: Off
4: Off
3: Off
2: Off
1: Off
0: Off
Actual Starting DateRow8:
Amount Paid to Date for SubcontractorRow8:
Amount drawn for Sub to DateRow8:
Amount drawn for Sub this PeriodRow8:
Revised Contract AmountRow8:
Approved Change OrdersRow8:
Total Contract AmountRow8:
Name of SubcontractorsRow8:
Actual Starting DateRow7:
Amount Paid to Date for SubcontractorRow7:
Amount drawn for Sub to DateRow7:
Amount drawn for Sub this PeriodRow7:
Revised Contract AmountRow7:
Approved Change OrdersRow7:
Total Contract AmountRow7:
Name of SubcontractorsRow7:
Actual Starting DateRow6:
Amount Paid to Date for SubcontractorRow6:
Amount drawn for Sub to DateRow6:
Amount drawn for Sub this PeriodRow6:
Revised Contract AmountRow6:
Approved Change OrdersRow6:
Total Contract AmountRow6:
Name of SubcontractorsRow6:
Actual Starting DateRow5:
Amount Paid to Date for SubcontractorRow5:
Amount drawn for Sub to DateRow5:
Amount drawn for Sub this PeriodRow5:
Revised Contract AmountRow5:
Approved Change OrdersRow5:
Total Contract AmountRow5:
Name of SubcontractorsRow5:
Actual Starting DateRow4:
Amount Paid to Date for SubcontractorRow4:
Amount drawn for Sub to DateRow4:
Amount drawn for Sub this PeriodRow4:
Revised Contract AmountRow4:
Approved Change OrdersRow4:
Total Contract AmountRow4:
Name of SubcontractorsRow4:
Actual Starting DateRow3:
Amount Paid to Date for SubcontractorRow3:
Amount drawn for Sub to DateRow3:
Amount drawn for Sub this PeriodRow3:
Revised Contract AmountRow3:
Approved Change OrdersRow3:
Total Contract AmountRow3:
Name of SubcontractorsRow3:
Actual Starting DateRow2:
Amount Paid to Date for SubcontractorRow2:
Amount drawn for Sub to DateRow2:
Amount drawn for Sub this PeriodRow2:
Revised Contract AmountRow2:
Approved Change OrdersRow2:
Total Contract AmountRow2:
Name of SubcontractorsRow2:
Check Box18:
6: Off
5: Off
4: Off
3: Off
2: Off
1: Off
0: Off
Actual Starting DateRow1:
Amount Paid to Date for SubcontractorRow1:
Amount drawn for Sub to DateRow1:
Amount drawn for Sub this PeriodRow1:
Revised Contract AmountRow1:
Approved Change OrdersRow1:
Total Contract AmountRow1:
Name of SubcontractorsRow1:
PROJECT SUPERVISOR:
PRIME CONTRACTOR NAME:
PROJECT NAME:
PROJECT:
SUBCONTRACTOR ACTIVITY FOR MONTH ENDING:

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