ONC_Full-RFP-with-Attachments.pdf

Request for Proposals

(RFP)

For

Architectural and Engineering Services for Interior & Exterior Construction

Ozaukee Nonprofit Center Connectivity and Workspace Expansion Initiative

Proposals will be received by Ozaukee Nonprofit Center at 2360 Dakota Drive, Grafton, WI until 4:00 PM, CDT, on Thursday, May 8, 2025, and shall be addressed and marked as follows:

Ozaukee Nonprofit Center Inc.

Attn: Ozaukee Nonprofit Center Connectivity and

Workspace Expansion Initiative

2360 Dakota Drive Grafton, WI 53024

Issued April 17, 2025

By: Ozaukee Nonprofit Center

Inc.

Request for Proposals Notice for Architectural and Engineering Services for

Interior & Exterior Construction for Ozaukee Nonprofit Center Connectivity and

Workspace Expansion Initiative

Official Public Notice

Proposals will be received by Ozaukee Nonprofit Center Inc. at its office at 2360 Dakota

Drive, Grafton, WI 53024 until 4:00 PM CDT on Thursday, May 8, 2025, for professional architectural and engineering services related to the design of interior and exterior improvements at the Ozaukee Nonprofit Center facility in Grafton, Wisconsin.

This project is funded through the State of Wisconsin’s Flexible Facilities Program

(FFP), supported by the U.S. Department of Treasury’s Capital Projects Fund (CPF).

The goal of the project is to enhance digital connectivity and improve access to shared-use space for work, education, and healthcare monitoring across the facility. As part of the Connectivity and Workspace Expansion Initiative, the selected firm will be responsible for providing full architectural design services, including code-compliant and permit-ready drawings, space planning, and cost estimation.

Key elements of the renovation include a redesigned main entrance, an outdoor eco-wellness space with raised gardens for outdoor education, telehealth access room modifications, ADA-compliant restroom upgrades, and improvements to shared-use conference and meeting spaces. This solicitation is for design services only and does not include construction management or contractor oversight.

The award to be let under this solicitation is subject to a financial assistance agreement between Ozaukee County and the State of Wisconsin Department of Administration.

Ozaukee Nonprofit Center Inc. is the designated sub-grantee. The successful firm will be required to comply with all applicable federal, state, and program regulations related to the FFP grant. All correspondence regarding this project should reference Ozaukee

Nonprofit Center Inc. and the Connectivity and Workspace Expansion Initiative.

The Request for Proposals is available on our website at www.ozaukeenonprofitcenter.com or at the Ozaukee Nonprofit Center office at 2360

Dakota Drive, Grafton, WI 53024. Copies of the Request for Proposals may also be obtained from Ozaukee Nonprofit Center, Inc. by calling (262 376-5272 between 9:00 and 4:00 or by email: carissa@oznc.org.

http://www.ozaukeenonprofitcenter.com/ mailto:carissa@oznc.org

Request for Proposals

(RFP)

Architectural and Engineering Services for Interior & Exterior Construction

Ozaukee Nonprofit Center Connectivity and Workspace Expansion Initiative

April 17, 2025

Table of Contents

1.0 Introduction 4

2.0 Project Description 6

3.0 Scope of Services 7

4.0 Proposal Content and Submission Requirements 8

5.0 Selection Criteria 11

6.0 Timeline 12

RFP Attachments to be Included in A/E Contract:

RFP Exhibits to be Completed and Returned with Proposal

• Exhibit 2 – Disclosure of Potential Conflict of Interest Form

• Exhibit 3 – Certification Regarding Lobbying (SIGN/RETURN with Proposal)

• Exhibit 4 – Disclosure of Lobbying Activities Form (only if applicable) (SIGN/RETURN ONLY if you have Lobby Activities to Disclose)

1.0 Introduction

Ozaukee County, Wisconsin has been awarded federal funding from the Flexible Facilities Program (FFP) and Ozaukee Nonprofit Center is the sub-grantee managing the renovation and expansion of the current facility.

Ozaukee Nonprofit Center invites interested and qualified firms to submit written Proposals for Architectural and Engineering services (A/E). Ozaukee Nonprofit Center intends to use the results of this RFP to evaluate and select a firm in order to award a fixed price contract for the below listed A/E Services.

Small business firms, minority-owned business enterprises (MBEs), women-owned business enterprises (WBEs), disabled veteran-owned businesses (DVBs) and labor surplus area firms are encouraged to submit a proposal for consideration.

The selected firm will provide architectural and engineering (A/E) services to support the Ozaukee Nonprofit Center Connectivity and Workspace Expansion Initiative. This includes the design of both interior and exterior improvements throughout the existing facility. A/E services will cover: (1) exterior improvements including the design of a new eco-wellness space with raised gardens for outdoor education and a reimagined front entrance to improve accessibility and visibility; (2) entrance and exit modifications to improve user flow and accessibility for areas such as the new telehealth rooms; (3) renovation design for shared-use spaces, including a large conference room, three smaller meeting rooms, and flexible workspaces intended to support hybrid and community use; (4) restroom redesigns that incorporate accessibility features and align with ADA requirements; and (5) the preparation of code-compliant, permit-ready architectural drawings, including conceptual, 60%, and 100% design sets.

The selected firm will also provide the following design-phase services as outlined in the project budget:

• Schematic Design: Conceptual layouts, initial floor plans, and elevations

• Design Development: Detailed interior layouts and building system coordination

• Construction Documents: Permit-ready architectural drawings and technical specifications

• Interior Design and Space Planning: Room layouts, furniture arrangements, and material/finish selection

• Code Compliance and Permitting: Ensuring all designs meet ADA and local building codes, and coordination with permitting authorities

The firm will also provide preliminary design narratives, outline specifications, and conceptual cost estimates for proposed improvements. While this contract will not include construction management or direct oversight, cost estimates must reflect the full scope of the project, including HVAC replacement and other non-architectural elements, to ensure total costs remain within the approved construction budget. These services will not include digital infrastructure installation, technology planning, or audiovisual equipment coordination, unless structural accommodations are required.

Ozaukee Nonprofit Center has budgeted $505,000 to complete construction of this project. This amount must account for all construction-related expenses, including HVAC replacement and project management services. A maximum of $70,000 has been allocated specifically for Architectural and Engineering Services under this RFP. Federal funding is provided through a

Flexible Facilities Program (FFP) grant administered by the State of Wisconsin Department of Administration in partnership with Ozaukee County. All applicable federal requirements and FFP clauses will apply to this contract.

All services shall support the overarching FFP program goal of enabling digital access, remote work, education, and health monitoring for underserved populations.The award and execution of any contract resulting from this RFP is contingent upon the continued availability of federal funds.

Ozaukee Nonprofit Center reserves the right to modify, postpone, or cancel this RFP and/or any resulting agreement if funding becomes unavailable or is withdrawn for any reason.

Ozaukee Nonprofit Center is seeking proposals from firms with experience with at least one

FFP Grant or another State/Federal grant. Construction is anticipated to begin by October 1, 2025, following architectural design and permitting. All work must be completed no later than

September 30, 2026, in alignment with the FFP grant performance period. Extensions may be considered based on grant approval. Proposal must comply with the requirements and conditions of employment and contracting with the FFP grant, and Federal and State regulations.

Pre-Submittal Open House: An optional walk-through of the Ozaukee Nonprofit Center facility will be held on Thursday, May 1, 2025, from 1:00 PM to 3:00 PM. Interested architectural firms are encouraged to attend. No formal presentation will be given.

These services will be conducted under a contract with Ozaukee Nonprofit Center Inc.

The contract will be regulated according to the provisions of all Federal, State and local laws and ordinances that are applicable.

2.0 Project Description

(1) Connectivity and Workspace Renovations

With the support of Flexible Facilities Program (FFP) funds, the Ozaukee Nonprofit Center (ONC) is undertaking a facility-wide renovation to enhance access to high-speed internet and improve the physical layout of its shared nonprofit workspace. The 4,500-square-foot project focuses on creating flexible, tech-enabled environments that support work, education, and healthcare monitoring within the building. The scope of the project spans both interior and exterior areas, with the goal of improving ADA accessibility, enhancing shared-use functionality, and creating an inclusive and modern nonprofit hub for the community.

The renovations will include design improvements to the building’s front entrance, interior entry/exit updates to support new telehealth spaces, upgrades to conference and meeting rooms, and bathroom remodels to meet ADA and accessibility standards. A new eco-wellness outdoor space with raised gardens will be created to support outdoor education, well-being, and connectivity. These improvements are intended to foster collaboration among partner agencies while supporting community members in need of digital access, wellness resources, and remote workspaces.

The design will also account for critical infrastructure updates, including HVAC system replacement, though installation of these systems is outside the scope of this RFP. The A/E firm will provide all necessary plans and documentation required to support permitting, code compliance, and construction of these physical improvements.

In addition to the above, the A/E firm will support the following components of the project:

• Site design and layout planning

• Utilities coordination (as applicable to architectural design)

3.0 Scope of Services

The selected A/E firm will be required to enter into an agreement using the AIA Standard Short Form of Agreement (AIA Document B105™–2017), with applicable federal and state compliance attachments incorporated as part of the executed contract

The selected company will serve as and perform the functions of architect and engineering for a Flexible Facilities Program award, including the following:

• Conduct necessary work to produce the technical documentation including final design criteria, preliminary and final drawings, outline specifications, written description of the project and value-engineering activities.

• Complete the final design contract documents. We would defer to the Architects recommendations for proper code requirements/products for all areas.

Ozaukee Nonprofit Center Inc. anticipates that the selected firm will provide the following A/E services, but is not limited to (Responses to this RFP are encouraged to suggest other tasks and duties that may be applicable and useful to the Ozaukee Nonprofit Center):

1. Attend Project Kick-Off Meeting – A/E firm will be required to meet with County staff.

Detailed schedule and team members will be finalized.

2. Review Existing Documentation – A/E firm shall familiarize themselves with:

• The project site

• Preliminary designs

• Municipal zoning codes

• Review any applicable FFP grant requirements

3. Attend Periodic Progress Meetings – Attendance at periodic meetings to update progress may be required

4. Prepare Conceptual Design Plans for Interior & Exterior Construction – The A/E firm shall submit conceptual design plans that include a conceptual estimate of probable construction costs. Conceptual design plans shall include space requirements and room layouts for all programmed spaces by function to include space requirements for major equipment. The A/E firm will be responsible for the design, space planning, and layout of all improvements, ensuring ADA accessibility and optimal use of shared spaces.

The selected firm will be responsible for incorporating soundproofing specifications into the architectural design for three meeting rooms, including wall assemblies and materials that support acoustic privacy. Additionally, the firm will provide interior layout planning and schematic design services to support effective use of space across conference, meeting, and healthcare monitoring rooms. This includes layout and flow recommendations for furniture, equipment, and access.

All digital infrastructure and sound system equipment will be procured and installed separately; however, the architectural design must accommodate necessary conduit, wall penetrations, or mounting surfaces where needed. Architectural design may also include coordination of signage placement to comply with FFP visibility requirements;

signage production and installation are excluded from this scope.

5. Preparation of Design Plans (60%) – A/E firm shall submit the 60% design plans, specification, and estimate. Meet with Ozaukee Nonprofit Center staff to discuss the designs and identify changes made to the plans since the Conceptual Design plans.

6. Preparation of Final Plans (100%) – Following approval of the 60% plans, specifications, and estimate by Ozaukee Nonprofit Center, A/E firm shall prepare final construction plans for the project.

7. Limited Pre-Construction Consultation – The A/E firm may be asked to provide limited consultation during the pre-construction or permitting phases and should be available to clarify drawings or attend onboarding meetings with selected contractors, as needed.

The services outlined in this Scope of Work are consistent with the deliverables described in the $70,000 Architectural and Engineering Services budget line of the approved FFP grant budget narrative. This alignment will support ONC’s compliance and reimbursement documentation.

8. Prepare Bid Documents for Internal & Exterior Construction – The A/E firm will prepare bid-ready documents. Any participation in procurement-related meetings may be requested separately, as needed and appropriate under FFP guidance.

4.0 Proposal Contents and Submission Requirements

1. Proposal Cover Letter

2. Project scope statement describing the work to be undertaken, include the services outlined in the Solicitation, any modifications or expansion of the scope provided to deliver the Architect and Engineering /cost effective components.

3. Project work plan indicating mechanisms proposed to coordinate the work effort with

Ozaukee Nonprofit Center.

4. Proposer’s profile and a clear concise statement with:

a. Examples indicating past performance and familiarity with the type of work detailed in the solicitation.

b. Provide 3 written references from previous clients with similar projects and all references give excellent response on quality of service. (Attach references and contact information)

c. A list of client references for which Proposer provided similar services as described in the RFP.

5. Project team statement indicating the professional and technical qualifications of the key persons who will be assigned to the project and their responsibilities within the Scope of

Services.

6. Detailed cost estimate for Architectural and engineering services.

7. Proposers must include the following completed and signed forms as part of their submission. These forms are required to ensure compliance with the Flexible Facilities

Program (FFP) and federal procurement regulations:

• Exhibit 2 – Disclosure of Potential Conflict of Interest Form

• Exhibit 3 – Certification Regarding Lobbying

• Exhibit 4 – Disclosure of Lobbying Activities Form (only required if lobbying activities need to be disclosed)

Proposal placed in the same order as described in above. The Proposal Cover Sheet must be signed by the submitter or authorized representative and dated. The pages of the Proposal must be numbered in consecutive order and should not exceed the maximum sheet size of 8.5” x 11.”

• Ozaukee Nonprofit Center Inc. will consider proposals from contractors with experience completing projects funded by FFP or similar state/federally funded projects.

• Responsible proposal will demonstrate the ability to complete the architect and engineering services.

If awarded, a firm fixed-price contract award shall be made in writing. Ozaukee Nonprofit Center Inc. can, however, decide not to make the award to any of the proposers. Ozaukee Nonprofit Center Inc. may reissue the project under certain conditions (i.e., proposals are not responsible, or the proposals do not contain information necessary to evaluate the proposals).

If you have any questions regarding this Request for Proposals, please contact: Carissa Barnes, carissa@oznc.org or 262-376-5272.

Other Conditions of Proposal Submittal

1. Only one Proposal will be accepted from any person, firm, or entity.

2. No proposal will be accepted from any person, firm or entity that is in arrears for any obligation to Ozaukee Nonprofit Center Inc., is debarred from contracting for federally funded projects, or that otherwise may be deemed irresponsible or unresponsive by Ozaukee Nonprofit Center Inc. or the elected officials of Ozaukee County, Wisconsin.

3. All proposals submitted become public information and may be reviewed by anyone requesting to do so at the conclusion of the evaluation process.

4. Requirements and conditions of employment and contracting to be observed for compliance Enterprise/Women owned Business Enterprise, and Federal Labor Standards apply to this project.

For a listing of state and Federal Regulatory Requirements visit.

https://energyandhousing.wi.gov/Pages/AgencyResources/FFP-Implementation-Resources.aspx

Directions for Proposal Submission

Complete proposals must be delivered to Ozaukee Nonprofit Center, Inc. office in a sealed envelope on or before 4:00 pm Thursday, May 8, 2025. Proposals that arrive in the office after 4:00 pm Thursday, May 8 2025 will be rejected.

Direct submissions to:

Ozaukee Nonprofit Center Inc.

Attn: Ozaukee Nonprofit Center Connectivity and

Workspace Expansion Initiative

2360 Dakota Drive Grafton, WI 53024

Ozaukee Nonprofit Center Inc. reserves the right to reject any and all Proposals not meeting the requirements of this Request for Proposals for architect and engineering services.

Persons requesting ADA assistance accommodations for hearing and speech impaired may contact Carissa Barnes, CEO, at 262-376-5272 or carissa@oznc.org.

Proposals must include a detailed cost estimate for the full scope of services, along with a fee schedule for all personnel expected to work on the project. This schedule should outline hourly rates by position or role, anticipated hours, and any applicable overhead or administrative fees.

Cost estimates should clearly indicate whether they are fixed or time-and-materials based.

Individuals/firms interested in being considered for this project must submit a Proposal detailing qualifications, technical expertise, management, and staff capabilities, related prior experience, and a detailed cost estimate for the Scope of Services described above.

The objective of the sealed Proposal process is to objectively select the most responsive and responsible Proposal.

Contact Information

For Request for Proposal packages, all interested persons and firms should go to:

www.ozaukeenonprofitcenter.org. Contact Carissa Barnes, CEO, between the hours of 9:00 am to 4:00 pm, Monday-Friday, at 262-376-5272 to ask questions or request additional information, as needed.

Companies that intend to submit a Proposal should send notification of intent to Ozaukee Nonprofit Center Inc. with the person’s/firm’s name and contact information in case of addenda or other changes. Additionally, the Request for Proposals may be sent to those companies that are included on the Ozaukee Nonprofit Center contact list specifically created for this solicitation.

Those who Ozaukee Nonprofit Center Inc. has sent a Request for Proposal and those who have provided contact information through a request for a copy of the Request for Proposals or through a notification of intent will receive all information regarding the Request for Proposals. The information may include, but is not limited to, any Addendums to the Request for Proposals, answers to inquiries received regarding the Solicitation, or changes to the schedule.

Interested proposers have the responsibility of understanding what is required by this Request for Proposals. During the review of the solicitation, if the proposer discovers any errors, omissions, or ambiguities within the solicitation, they should identify them in writing and call them to the immediate attention of Ozaukee Nonprofit Center Inc. prior to the Request for Proposals submission deadline. Ozaukee Nonprofit Center Inc. shall not be held responsible for any person’s/firm’s lack of understanding of the project.

Questions for clarification concerning this Solicitation must be in writing via email to Carissa Barnes, CEO on or before 4:00 pm, May 2, 2025. After this date, questions involving the content or intent of the proposal will not be answered. All questions will be responded to Carissa Barnes, CEO, in writing via email, and provided to all parties requesting a Request for Proposals packet for which Ozaukee Nonprofit Center Inc. has the contact information and treated as an addendum to the Request for Proposals packet.

Ozaukee Nonprofit Center makes no representations as to the conditions of the project other than those representations made herein, and no employee or any other representative Ozaukee Nonprofit Center has the authority to make any oral or written representations as to the conditions of the project. Companies should only contact the person designated above regarding this Solicitation and should not contact Ozaukee Nonprofit Center’s staff or Board members. County Chief Executive Officer, Ozaukee County, Village/Town of Grafton members, any committee members, or any other government staff for clarification on this Request for Proposals.

Addenda Interpretations If it becomes necessary to revise any part of this Request for Proposals, a written addendum will be provided. Ozaukee Nonprofit Center Inc. is not bound by any oral clarifications changing the scope of the work for this project. All addenda issued by Ozaukee Nonprofit Center Inc. will become part of the official Request for Proposals and will be emailed to all Proposers of record based upon contact information on record at the original time of issuance or subsequently provided.

http://www.ozaukeenonprofitcenter.org/

5.0 Selection Criteria

A committee selected by Ozaukee Nonprofit Center will evaluate the submitted Proposals and award to the most responsive and responsible proposal when all evaluation criteria are considered.

Right to Reject Proposals The evaluation committee reserves the right to reject any and all proposals.

Responses will be reviewed based on the following criteria:

1. Project Coordinator/Lead's Experience Maximum 20 Points A. 3 or more years experience with FFP or other federal/state 20 Points programs B. 2 years experience 15 Points C. 1 years experience 10 Points D. Less than 1 year experience 5 Points E. No experience 0 Points

2. Firm’s Project Completion Background Maximum 20 Points

A. Completion of 3 or more previous, similar type projects within 20 Points proposed time frame & budget

B. Completion of 2 similar projects 15 Points C. Completion of 1 similar project 10 Points D. Working on 1 similar project; not completed 5 Points E. No work on a similar project 0 Points

3. References from Similar Projects Maximum 20 Points

A. Respondent lists 3 previous clients with similar projects 20 Points and all references give excellent response on quality of service

B. Respondent lists 2 previous clients 15 Points C. Respondent lists 1 previous client 10 Points D. Respondent lists no previous references 0 Points

4. Responsiveness to Specifications of Project/RFP Maximum 20 Points

A. Needs of project are fully addressed in Proposal 20 Points B. Needs of project are somewhat addressed in Proposal 10 Points C. Needs of project are not addressed/resolved in Proposal 0 Points

5. Budget Maximum 10 Points

A. Budget within Ozaukee Nonprofit Center 10 Points capacity as proposed

B. Budget slightly above Ozaukee Nonprofit Center 5 Points capacity as proposed; potentially feasible with modest adjustment

C. Budget not reasonably within Ozaukee Nonprofit Center 0 Points capacity as proposed; would require extensive adjustment to be feasible

6. Minority or Women Business Enterprise or Disadvantaged Maximum 5 Points Business Enterprise firm* A. Firm is MBE, WBE or DBE firm 5 Points

B. Firm is not MBE, WBE or DBE firm 0 Points

7. Small Business Firm Maximum 5 Points

A. Firm is a small business 5 Points B. Firm is not a small business 0 Points

Selection Process Schedule

Ozaukee Nonprofit Center anticipates authorizing a contract for this work and issuing a notice to proceed no later than June 15, 2025. The scope of services will take place over a twelve-month period. Ozaukee Nonprofit Center’s goal is to have the project completed no later than September 30, 2026, if possible. Responding persons/firms should comment on the above schedule as part of their proposal and state how realistic it is to achieve substantial completion of the work by September 30, 2026.

Communication and Clarification Restrictions

All inquiries regarding this RFP must be directed in writing to Carissa Barnes, CEO of the Ozaukee Nonprofit Center, at carissa@oznc.org. Responses will be provided via email to all known proposers and, if necessary, posted as formal addenda. No verbal clarifications or representations will be binding. Firms should not contact ONC board members, ONC staff, Ozaukee County officials, or committee members regarding this RFP. Any unauthorized contact may result in disqualification from the selection process.

6.0Timeline

RFP Issuance Date April 17, 2025

Pre-Submittal Open House May 1, 2025, from 1:00 PM - 3:00 PM

Proposals due by 4:00 pm May 8, 2025

Notice of Intent to Award sent to A/E firms May 27, 2025

A/E Firm under Contract by June 15, 2025

Construction Start Date: Construction is expected to begin on or around October 1, 2025, pending completion of the design phase and procurement of construction services.

Exhibit II - Federal and State Compliance Attachments

The following forms are included in this RFP for reference and future compliance. Some forms may be required at the proposal stage, while others will be required prior to contract execution.

Respondents are strongly encouraged to review all materials in advance of submission.

• Conflict of Interest Disclosure Form (FFP-03-01)

• FFP Contract Terms & Requirements (24 CFR 570.489(h))

• Lobbying Certification Form (FFP-03-04)

• Disclosure of Lobbying Activities Form (SF-LLL)

All forms originate from the FFP Implementation Handbook and can also be accessed online at:

Division of Energy, Housing and Community Resources (DEHCR) Flexible Facilities Program – Potential Conflict of Interest Disclosure

Potential Conflict of Interest Disclosure AttachFFP-03-01 Form v.2024-11-25

POTENTIAL CONFLICT OF INTEREST DISCLOSURE

Pursuant 2 CFR 200.318, decisions concerning the federal grant funds must be free of undisclosed personal or organizational conflicts of interest, both in fact and in appearance. No employee, officer, or agent of the grantee or subrecipient may participate in the selection, award, or administration of a contract supported by a federal award if they have a real or apparent conflict of interest. Conflict of interest provisions within the Code of Federal Regulations must be addressed as part of procurement and contracting processes. Grantees, subrecipients, and contractors must disclose in writing any potential conflict of interest. Documentation of any disclosure of a potential conflict of interest and the grantee’s review of the potential conflict must be provided by the grantee to the State of Wisconsin Department of Administration (DOA) Division of Energy, Housing and Community Resources (DEHCR) for review prior to proceeding with contracting.

Ozaukee Nonprofit Center Connectivity and Workspace Expansion Initiative

Instructions: In Parts A. and B. below, please check the box next to any person listed, and/or add the name and title of other persons not listed but who are involved with the project, that you have a known family or business relationship. Select “None of the Above” if you have no known family or business relationship with the individuals listed and have none to add. In Part C., describe the relationship(s) with each person for which you checked the box in Parts A. and B. In Part D., enter your typed or printed name, title, signature, company/firm name, and signature date.

PART A. ELECTED OFFICIALS:

☐ Lee Schlenvogt, Chairman, Ozaukee County Board

☐ Patrick Foy, Chairperson, Ozaukee County Health & Human Services Committee

☐ Bruce Paape, Committee Member, Ozaukee County Health & Human Services Committee

☐ Ariba Khan, Committee Member, Ozaukee County Health & Human Services Committee

☐ Connie Kincaide, Committee Member, Ozaukee County Health & Human Services Committee

☐ Matthew Dolsky, Committee Member, Ozaukee County Health & Human Services Committee

☐ Tim Schoonenberg, Co-Chair, Ozaukee Nonprofit Center Building & Finance Committee

☐ Joe Kassander, Co-Chair, Ozaukee Nonprofit Center Building & Finance Committee

☐ Don Schoonenberg, Committee Member, Ozaukee Nonprofit Center Building & Finance Committee

☐ Michael Weber, Committee Member, Ozaukee Nonprofit Center Building & Finance Committee

☐ Jonah Turner, Committee Member, Ozaukee Nonprofit Center Building & Finance Committee

☐ Roy Dietsch, Committee Member, Ozaukee Nonprofit Center Building & Finance Committee

☐ Victor Campbell, Committee Member, Ozaukee Nonprofit Center Building & Finance Committee

☐ Jerry Faust, Committee Member, Ozaukee Nonprofit Center Building & Finance Committee

☐ Kathleen Schilling, Committee Member, Ozaukee Nonprofit Center Building & Finance Committee

☐ OTHER (Please specify):

☐ NONE OF THE ABOVE

PART B. OTHER PERSONS INVOLVED WITH PROJECT:

☐ Jason Wittek, Policy & Budget Analyst, Ozaukee County

☐ Carissa Barnes, CEO, Ozaukee Nonprofit Center

☐ OTHER (Please specify):

☐ NONE OF THE ABOVE

PART C. DESCRIPTION OF RELATIONSHIP(S):

https://www.ecfr.gov/current/title-2/part-200/section-200.318#p-200.318(c)

Flexible Facilities Program – Potential Conflict of Interest Disclosure

Potential Conflict of Interest Disclosure AttachFFP-03-01 Form v.2024-11-25

PART D. CERTIFICATION: By signing below, I certify the information provided above is true, accurate, and correct. I also acknowledge and understand that the name of any contractor with a potential conflict of interest will be disclosed at the Ozaukee Nonprofit Center Building & Finance Committee meeting in which bids and/or proposals are discussed.

Potential conflicts of interest will be reviewed in accordance with 2 CFR 200.318.

Printed Name of Contractor Representative Title Signature

Name of Entity (i.e., name of business/company, firm, or organization) Date Signed [MM/DD/YYYY]

Flexible Facilities Program (FFP) – Lobbying Certification

Lobbying Certification AttachFFP-03-04 Form v.2024-11-25

LOBBYING CERTIFICATION

Certification for Contracts, Grants, Loans, and Cooperative Agreements

The undersigned certifies, to the best of their knowledge and belief, that:

(1) No Federal 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 an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying

Activities'' [at https://www.gsa.gov/system/files/SFLLL_1_2_P-V12b.pdf] in accordance with its instructions.

(3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into.

Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

Statement for Loan Guarantees and Loan Insurance

The undersigned states, to the best of their knowledge and belief, that:

If any funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this commitment providing for the United States to insure or guarantee a loan, the undersigned shall complete and submit Standard Form-LLL, ''Disclosure of Lobbying Activities'' [at https://www.gsa.gov/system/files/SFLLL_1_2_P-V12b.pdf] in accordance with its instructions. Submission of this statement is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required statement shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

FFP PROJECT GRANTEE NAME

(LOCAL/TRIBAL GOVERNMENT):

ENTITY’S ROLE ON THE FFP PROJECT (select one):

☐ Grantee (i.e., Local/tribal government awarded the FFP grant funds from the State of Wisconsin/DEHCR)

☐ Subrecipient (i.e., Non-profit or government entity receiving FFP grant funds as a ‘pass-through’ from the Grantee to implement the FFP project)

☐ Prime Contractor (i.e., contracting entity awarded the contract by the Grantee or Subrecipient)

☐ Subcontractor (i.e., contracting entity awarded the contract by the Prime Contractor or another contractor)

ENTITY’S ORGANIZATION NAME:

PRINTED FULL NAME OF ENTITY’S

AUTHORIZED REPRESENTATIVE:

TITLE OF AUTHORIZED REPRESENTATIVE:

SIGNATURE OF AUTHORIZED

REPRESENTATIVE: DATE:

https://www.gsa.gov/system/files/SFLLL_1_2_P-V12b.pdf https://www.gsa.gov/system/files/SFLLL_1_2_P-V12b.pdf

DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046

(See reverse for public burden disclosure.)

1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:

a. contract a. bid/offer/application a. initial filing

b. grant b. initial award b. material change

c. cooperative agreement c. post-award For Material Change Only:

d. loan year _________ quarter _________

e. loan guarantee date of last report ______________

f. loan insurance

4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is a Subawardee, Enter Name and Address of Prime:

Tier ______, if known :

Congressional District, if known : Congressional District, if known :

6. Federal Department/Agency: 7. Federal Program Name/Description:

CFDA Number, if applicable: _____________

8. Federal Action Number, if known : 9. Award Amount, if known :

10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address if (if individual, last name, first name, MI): different from No. 10a )

(last name, first name, MI ):

11. Signature:

Print Name:

Title:

Telephone No.: _______________________ Date:

Authorized for Local Reproduction

Standard Form LLL (Rev. 7-97)

Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less that $10,000 and not more than $100,000 for each such failure.

Prime Subawardee

Federal Use Only:

INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES

1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.

2. Identify the status of the covered Federal action.

3.

4.

5. If the organization filing the report in item 4 checks "Subawardee," then enter the full name, address, city, State and zip code of the prime Federal recipient. Include Congressional District, if known.

6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizationallevel below agency name, if known. For example, Department of Transportation, United States Coast Guard.

7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance

(CFDA) number for grants, cooperative agreements, loans, and loan commitments.

8.

9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5.

10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action.

(b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a). Enter Last Name, First Name, and Middle Initial (MI).

11. The certifying official shall sign and date the form, print his/her name, title, and telephone number.

This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employeeof any agency, a Member of Congress, an officer or employeeof Congress, or an employeeof a Member of Congress in connectionwith a coveredFederalaction. Completeall items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.

Identify the appropriateclassification of this report. If this is a followup report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previouslysubmitted report by this reporting entity for this covered Federal action.

Enter the full name, address, city, State and zip code of the reporting entity. Include CongressionalDistrict, if known. Check the appropriateclassification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee,e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number;

Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001."

According to the PaperworkReduction Act, as amended,no persons are required to respond to a collection of information unless it displays a valid OMB Control Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Managementand Budget, Paperwork Reduction Project (0348-0046), Washington, DC 20503.