Qualifications Statement.PDF

This Section is a MODIFIED version of EJCDC® C-451, Copyright © 2018 by the National Society of Professional Engineers, American Society of Civil Engineers, and American Council of Engineering Companies, or is based in part on excerpts from EJCDC documents.

Those portions of the text that originated in published EJCDC documents remain subject to the copyright.

QUALIFICATIONS STATEMENT

ARTICLE 1—GENERAL INFORMATION

1.01 Provide contact information for the Business:

Legal Name of ___________:

Corporate Office

Name: Phone number:

Title: Email address:

Business address of corporate office:

Local Office (if different from Corporate Office)

Name: Phone number:

Business address of local office:

Bidder Contact Information (if different from Corporate Office)

Contact Phone number:

1.02 Provide information on the Business’s organizational structure:

Form of Business: ☐ Sole Proprietorship ☐ Partnership ☐ Corporation

☐ Limited Liability Company ☐ Joint Venture comprised of the following companies:

1.

2.

3.

Provide a separate Qualification Statement for each Joint Venture.

Date Business was formed: State in which Business was formed:

Is this Business authorized to operate in the Project location?

(Attach proof of authorization)

☐ Yes ☐ No ☐ Pending

This Section is a MODIFIED version of EJCDC® C-451, Copyright © 2018 by the National Society of Professional Engineers, American Society of Civil Engineers, and American Council of Engineering Companies, or is based in part on excerpts from EJCDC documents.

Those portions of the text that originated in published EJCDC documents remain subject to the copyright.

1.03 Identify all businesses that own Business in whole or in part (25% or greater), or that are wholly or partly (25% or greater) owned by Business:

Name of business: Affiliation:

Address:

Name of business: Affiliation:

Name of business: Affiliation:

Address:

1.04 Provide information regarding the Business’s officers, partners, and limits of authority.

Name: Title:

Authorized to sign contracts: ☐ Yes ☐ No Limit of Authority: $

Name: Title:

Authorized to sign contracts: ☐ Yes ☐ No Limit of Authority: $

Name: Title:

Authorized to sign contracts: ☐ Yes ☐ No Limit of Authority: $

Name: Title:

ARTICLE 2—LICENSING

2.01 Provide information regarding licensure for Business:

Name of License:

Licensing Agency:

License No: Expiration Date:

Name of License:

Licensing Agency:

License No: Expiration Date:

ATTACH COPIES OF VALID LICENSE(S) IN ACCORDANCE WITH SECTION 489.113, FLORIDA

STATUTES (SECTION C-410).

ARTICLE 3—DIVERSE BUSINESS CERTIFICATIONS

3.01 Provide information regarding Business’s Diverse Business Certification, if any. Provide evidence of current certification.

Certification Certifying Agency Certification

Date

☐ Disadvantaged Business Enterprise

This Section is a MODIFIED version of EJCDC® C-451, Copyright © 2018 by the National Society of Professional Engineers, American Society of Civil Engineers, and American Council of Engineering Companies, or is based in part on excerpts from EJCDC documents.

Those portions of the text that originated in published EJCDC documents remain subject to the copyright.

☐ Minority Business Enterprise

☐ Woman-Owned Business Enterprise

☐ Small Business Enterprise

☐ Disabled Business Enterprise

☐ Veteran-Owned Business Enterprise

☐ Service-Disabled Veteran-Owned Business

☐ HUBZone Business (Historically Underutilized) Business

☐ Other

☐ None

ARTICLE 4—SAFETY

4.01 Provide information regarding Business’s safety organization and safety performance.

Name of Business’s Safety Officer:

Safety Certifications

Certification Name Issuing Agency Expiration

4.02 List on Schedule D all pieces of major equipment that the Business owns or leases and designate which will be available for use on this Project.

ARTICLE 5—FINANCIAL

5.01 Provide information regarding the Business’s financial stability. Provide the most recent audited financial statement. If such audited financial statement is not current then provide the most current financial statement. Pursuant to section 119.071(1)(c), Fla. Stat. any financial statement that the City requires a prospective bidder to submit in order to respond to a bid for a public works project is exempt from public inspection and disclosure.

Financial Institution:

Business address:

Date of Business’s most recent financial statement: ☐ Attached

Date of Business’s most recent audited financial statement: ☐ Attached

This Section is a MODIFIED version of EJCDC® C-451, Copyright © 2018 by the National Society of Professional Engineers, American Society of Civil Engineers, and American Council of Engineering Companies, or is based in part on excerpts from EJCDC documents.

Those portions of the text that originated in published EJCDC documents remain subject to the copyright.

ARTICLE 6—SURETY INFORMATION

6.01 Provide information regarding the surety company that will issue required bonds on behalf of the Business, including but not limited to performance and payment bonds.

Surety Name:

Surety is a corporation organized and existing under the laws of the state of:

Is surety authorized to provide surety bonds in the Project location? ☐ Yes ☐ No

Is surety listed in “Companies Holding Certificates of Authority as Acceptable Sureties on Federal Bonds and as Acceptable Reinsuring Companies” published in Department Circular 570 (as amended) by the Bureau of the Fiscal Service, U.S. Department of the Treasury?

☐ Yes ☐ No

Mailing Address (principal place of business):

Physical Address

Phone (main): Phone (claims):

Aggregate Bonding Capacity:

Available Bonding Capacity as of Bid:

ARTICLE 7—INSURANCE

7.01 Provide information regarding Business’s insurance company(s), including but not limited to its Commercial General Liability carrier. Provide information for each provider.

Name of insurance provider, and type of policy (CLE, auto, etc.):

Insurance Provider Type of Policy (Coverage Provided)

Are providers licensed or authorized to issue policies in the Project location? ☐ Yes ☐ No

Does provider have an A.M. Best Rating of A-VII or better? ☐ Yes ☐ No

Mailing Address

Physical Address

This Section is a MODIFIED version of EJCDC® C-451, Copyright © 2018 by the National Society of Professional Engineers, American Society of Civil Engineers, and American Council of Engineering Companies, or is based in part on excerpts from EJCDC documents.

Those portions of the text that originated in published EJCDC documents remain subject to the copyright.

Phone (main):

Phone (claims):

ARTICLE 8—CONSTRUCTION EXPERIENCE

8.01 Provide information that will identify the overall size and capacity of the Business.

Primary type of work the Business performs:

Average number of current full-time permanent employees:

Estimate of revenue for the current year:

Estimate of revenue for the previous year:

Estimate of dollar value presently under contract:

Business an equal employment opportunity employer: ☐ Yes ☐ No

Does the Business have a written drug and alcohol policy? ☐ Yes ☐ No

Does the Business have a written Quality

Assurance/Quality Control Program: ☐ Yes ☐ No

8.02 Provide information regarding the Business’s previous contracting experience.

BUSINESS YEARS OF EXPERIENCE WITH PROJECTS LIKE THE PROPOSED PROJECT:

As a general contractor: As a joint venture:

Has Business, or a predecessor in interest, or an affiliate identified in Paragraph 1.03:

Been disqualified as a bidder by any local, state, or federal agency within the last 5 years?

☐ Yes ☐ No

Been barred from contracting by any local, state, or federal agency within the last 5 years?

☐ Yes ☐ No

Been released from a bid in the past 5 years? ☐ Yes ☐ No

Defaulted on a project or failed to complete any contract awarded to it? ☐ Yes ☐ No

Refused to construct or refused to provide materials defined in the contract documents or in a change order? ☐ Yes ☐ No

Been a party to any currently pending litigation or arbitration? ☐ Yes ☐ No

Are there any judgments, claims, disputes or litigation pending or outstanding involving the

Business, a predecessor in interest, an affiliate identified in Paragraph 1.03 or a Business officers or partners identified in Paragraph 1.04? ☐ Yes ☐ No

Has a Business officers or partners identified in Paragraph 1.04 defaulted on a project or failed to complete any contract awarded to it? ☐ Yes ☐ No

Provide full details in a separate attachment if the response to any of these questions is Yes.

This Section is a MODIFIED version of EJCDC® C-451, Copyright © 2018 by the National Society of Professional Engineers, American Society of Civil Engineers, and American Council of Engineering Companies, or is based in part on excerpts from EJCDC documents.

Those portions of the text that originated in published EJCDC documents remain subject to the copyright.

8.03 List all projects currently under contract in Schedule A and provide indicated information.

8.04 List 5 projects completed in the last 5 years in Schedule B and provide indicated information to demonstrate the Business’s experience with projects similar in type and cost of construction.

8.05 In Schedule C, provide information about key individuals whom Business intends to assign to the Project. Key individuals include the Project Manager, Project Superintendent, Quality Manager, and Safety Manager, as applicable. Resumes may be provided for Business’s key leaders as well.

8.06 List 5 business references from other project Owners. Each reference must include the following information: the Firm/Company Name, Firm/Company Address, Firm/Company Contact Person, and Firm/Company Telephone Number.

8.07 List bidder, subcontractors and suppliers to be used for all portions of the Work. If self-performing, so list.

Service Contractor /Subcontractor /Supplier Name

Contractor /Subcontractor /Supplier Address

Contractor /Subcontractor /Supplier License Number

This Section is a MODIFIED version of EJCDC® C-451, Copyright © 2018 by the National Society of Professional Engineers, American Society of Civil Engineers, and American Council of Engineering Companies, or is based in part on excerpts from EJCDC documents.

Those portions of the text that originated in published EJCDC documents remain subject to the copyright.

ARTICLE 9—REQUIRED ATTACHMENTS

9.01 Provide the following information with the Statement of Qualifications:

A. If Business is a Joint Venture, separate Qualifications Statements for each Joint Venturer, as required in Paragraph 1.02.

B. Diverse Business Certifications if required by Paragraph 3.01.

C. Financial statements as required by Paragraph 5.01.

D. Attachments providing additional information as required by Paragraph 8.02.

E. Schedule A (Current Projects) as required by Paragraph 8.03.

F. Schedule B (Previous Experience with Similar Projects) as required by Paragraph 8.04.

G. Schedule C (Key Individuals) information about the key individuals listed, as required by Paragraph 8.05.

H. Schedule D (Equipment) as required by Paragraph 4.02.

I. Schedule E - Public Entity Crimes Statement under section 287.133(3)(a), Fla. Stat.

J. Schedule F - Anti-Human Trafficking Affidavit under section 787.06(13), Fla. Stat.

K. Additional items as pertinent.

9.02 Optional Attachments

A. Schedule G - Preference with Drug-Free Workplace Programs under section 287.078, Fla.

Stat.

This Section is a MODIFIED version of EJCDC® C-451, Copyright © 2018 by the National Society of Professional Engineers, American Society of Civil Engineers, and American Council of Engineering Companies, or is based in part on excerpts from EJCDC documents.

Those portions of the text that originated in published EJCDC documents remain subject to the copyright.

This Statement of Qualifications is offered by:

Business:

(typed or printed name of organization)

By:

(individual’s signature)

Name:

(typed or printed)

Title:

(typed or printed)

Date:

(date signed)

(If Business is a corporation, a partnership, or a joint venture, attach evidence of authority to sign.)

Attest:

(individual’s signature)

Name:

(typed or printed)

Title:

(typed or printed)

Address for giving notices:

Designated Representative:

Name:

(typed or printed)

Title:

(typed or printed)

Phone:

Email:

This Section is a MODIFIED version of EJCDC® C-451, Copyright © 2018 by the National Society of Professional Engineers, American Society of Civil Engineers, and American Council of Engineering Companies, or is based in part on excerpts from EJCDC documents. Those portions of the text that originated in published EJCDC documents remain subject to the copyright.

Schedule A—Current Projects

Name of Organization

Project Owner Project Name

General Description of Project

Project Cost Date Project Completed

Key Project Personnel Project Manager Project Superintendent Safety Manager Quality Control Manager

Name

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference)

Name Title/Position Organization Telephone Email

Owner

Designer

Construction Manager

Project Owner Project Name

General Description of Project

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference)

Name Title/Position Organization Telephone Email

Owner

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference)

Name Title/Position Organization Telephone Email

Owner

This Section is a MODIFIED version of EJCDC® C-451, Copyright © 2018 by the National Society of Professional Engineers, American Society of Civil Engineers, and American Council of Engineering Companies, or is based in part on excerpts from EJCDC documents. Those portions of the text that originated in published EJCDC documents remain subject to the copyright.

Schedule B—Previous Experience with Similar Projects

Name of Organization

Project Owner Project Name

General Description of Project

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference)

Name Title/Position Organization Telephone Email

Owner

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference)

Name Title/Position Organization Telephone Email

Owner

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference)

Name Title/Position Organization Telephone Email

Owner

This Section is a MODIFIED version of EJCDC® C-451, Copyright © 2018 by the National Society of Professional Engineers, American Society of Civil Engineers, and American Council of Engineering Companies, or is based in part on excerpts from EJCDC documents. Those portions of the text that originated in published EJCDC documents remain subject to the copyright.

Schedule B—Previous Experience with Similar Projects

Name of Organization

Project Owner Project Name

General Description of Project

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference)

Name Title/Position Organization Telephone Email

Owner

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference)

Name Title/Position Organization Telephone Email

Owner

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference)

Name Title/Position Organization Telephone Email

Owner

This Section is a MODIFIED version of EJCDC® C-451, Copyright © 2018 by the National Society of Professional Engineers, American Society of Civil Engineers, and American Council of Engineering Companies, or is based in part on excerpts from EJCDC documents. Those portions of the text that originated in published EJCDC documents remain subject to the copyright.

Schedule C—Key Individuals

Project Manager

Name of individual

Years of experience as project manager

Years of experience with this organization

Number of similar projects as project manager

Number of similar projects in other positions

Current Project Assignments

Name of assignment Percent of time used for this project

Estimated project completion date

Reference Contact Information (listing names indicates approval to contact named individuals as a reference)

Name Name

Title/Position Title/Position

Organization Organization

Telephone Telephone

Email Email

Project Project

Candidate’s role on project

Candidate’s role on project

Project Superintendent

Name of individual

Years of experience as project superintendent

Years of experience with this organization

Number of similar projects as project superintendent

Number of similar projects in other positions

Current Project Assignments

Name of assignment Percent of time used for this project

Reference Contact Information (listing names indicates approval to contact named individuals as a reference)

Title/Position Title/Position

Organization Organization

Telephone Telephone

Email Email

Project Project

Candidate’s role on project

Candidate’s role on project

This Section is a MODIFIED version of EJCDC® C-451, Copyright © 2018 by the National Society of Professional Engineers, American Society of Civil Engineers, and American Council of Engineering Companies, or is based in part on excerpts from EJCDC documents. Those portions of the text that originated in published EJCDC documents remain subject to the copyright.

Safety Manager

Years of experience as project manage

Years of experience with this organization

Number of similar projects as project manager

Number of similar projects in other positions

Current Project Assignments

Name of assignment Percent of time used for this project

Reference Contact Information (listing names indicates approval to contact named individuals as a reference)

Title/Position Title/Position

Organization Organization

Telephone Telephone

Email Email

Project Project

Candidate’s role on project

Candidate’s role on project

Quality Control Manager

Years of experience as project superintendent

Years of experience with this organization

Number of similar projects as project superintendent

Number of similar projects in other positions

Current Project Assignments

Name of assignment Percent of time used for this project

Reference Contact Information (listing names indicates approval to contact named individuals as a reference)

Title/Position Title/Position

Organization Organization

Telephone Telephone

Email Email

Project Project

Candidate’s role on project

Candidate’s role on project

This Section is a MODIFIED version of EJCDC® C-451, Copyright © 2018 by the National Society of Professional Engineers, American Society of Civil Engineers, and American Council of Engineering Companies, or is based in part on excerpts from EJCDC documents. Those portions of the text that originated in published EJCDC documents remain subject to the copyright.

Schedule D – List of Major Equipment

Condition Acquired Value

Available for this Project?

Project Name Owner’s Contact Person Item Purchase Date

Telephone:

This Section is a MODIFIED version of EJCDC® C-451, Copyright © 2018 by the National Society of Professional Engineers, American Society of Civil Engineers, and American Council of Engineering Companies, or is based in part on excerpts from EJCDC documents. Those portions of the text that originated in published EJCDC documents remain subject to the copyright.

Schedule E - PUBLIC ENTITY CRIMES STATEMENT

SWORN STATEMENT UNDER SECTION 287.133(3)(a), FLORIDA STATUTES, ON PUBLIC

ENTITY CRIMES.

THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICAL AUTHORIZED TO ADMINISTER

OATHS.

1. This sworn statement is submitted to (Print name of the public entity) by

(Print individual’s name and title) for

(Print name of entity submitting sworn statement) whose business address is and (if applicable its Federal Employer Identification Number) is

(if the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement: ).

2. I understand that a “public entity crime” as defined in Paragraph 287.133(1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or with the United States, including, but not limited to, any proposal or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.

3. I understand that “convicted” or “conviction” as defined in Paragraph 287.133(1)(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non-jury trial, or entry of a plea of guilty or nolo contendere.

4. I understand that an “affiliate” as defined in Paragraph 287.133(l)(a), Florida Statutes, means: a predecessor or successor of a person convicted of a public entity crime: or an entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term “affiliate” includes those officers, directors, executives’ partners, shareholders, employees, members and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm’s length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate.

5. I understand that a “person” as defined in paragraph 287.133(1)(e), Florida Statues, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract in which it proposes or applies to bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term “person” includes those officers, directors, executives, partners, shareholders, employees, members and agents who are active in management of an entity.

This Section is a MODIFIED version of EJCDC® C-451, Copyright © 2018 by the National Society of Professional Engineers, American Society of Civil Engineers, and American Council of Engineering Companies, or is based in part on excerpts from EJCDC documents. Those portions of the text that originated in published EJCDC documents remain subject to the copyright.

6. I understand that a person or affiliate who has been placed on the convicted vendor list following the conviction for a public entity crime, may not submit a bid, proposal or reply on a contract to provide goods or services to a public entity, may not submit a bid, proposal or reply on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids, proposals, or replies on leases of real property to a public entity, may not be awarded or perform work as a Contractor, supplier, subcontractor, or Consultant under a contract with a public entity, and may not transact business with any public entity in excess of the threshold amount as provided in Section 287.017, Florida Statutes, for Category Two for a period of 36 months from the date of being placed on the convicted vendor list.

7. Based on information and belief, the statement that I have marked below is true in relation to the entity submitting the sworn statement. (Please indicate which statement applies.)

Neither the entity submitting this sworn statement, nor any officers, directors, executives, partners, shareholders, employees, members, or agents who are active in management of the entity, nor any affiliate of the entity have been charged with and convicted of a public entity crime subsequent to July 1, 1989.

The entity submitting this sworn statement, or one or more of the officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity have been charged with and convicted of a public entity crime subsequent to July 1, 1989.

The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholder, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. However, there has been a subsequent proceeding before a Hearing Officer and the State of Florida, Division of Administrative Hearings and the Final Order entered by the hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list (attach a copy of the final order).

This Section is a MODIFIED version of EJCDC® C-451, Copyright © 2018 by the National Society of Professional Engineers, American Society of Civil Engineers, and American Council of Engineering Companies, or is based in part on excerpts from EJCDC documents. Those portions of the text that originated in published EJCDC documents remain subject to the copyright.

I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALANDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017 FLORIDA STATUTES FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS

FORM.

(Signature)

Sworn to and subscribed before me by means of (select one:) [ ] physical presence or

[ ] online notarization, this day of __________________________, 2025, by

_____________________________________________________, who is [select one:]

[ ] personally known to me –or— [ ] has produced a Florida driver’s license as identification.

Personally known____________________________ _____________________________________________

OR Produced Identification____________________ Notary Public – State of Florida

My Commission Expires__________________________

Type of Identification

(Printed, typed or stamped commissioned name of

Notary public)

This Section is a MODIFIED version of EJCDC® C-451, Copyright © 2018 by the National Society of Professional Engineers, American Society of Civil Engineers, and American Council of Engineering Companies, or is based in part on excerpts from EJCDC documents. Those portions of the text that originated in published EJCDC documents remain subject to the copyright.

Schedule F - ANTI-HUMAN TRAFFICKING AFFIDAVIT

Instructions: This form must be completed by an officer or representative of an entity entering into, renewing, or extending, a contract with the City of Treasure Island.

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 of Treasure Island from executing, renewing, or extending a contract to entities that use coercion for labor or services, with such terms defined as follows:

• “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 services 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, Florida Statutes, to any person for the purpose of exploitation of that person.

• “Labor” means work of economic or financial value.

• “Services” means any act committed at the behest of, under the supervision of, or for the benefit of another. The term includes, but is not limited to, forced marriage, servitude, or the removal of organs.

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, 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 Vendor. Under penalties of perjury, I declare that I have read the forgoing document and that the facts stated in it are true.

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 _____________________________, 2025, 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: _______________ http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0800-0899/0893/Sections/0893.03.html

This Section is a MODIFIED version of EJCDC® C-451, Copyright © 2018 by the National Society of Professional Engineers, American Society of Civil Engineers, and American Council of Engineering Companies, or is based in part on excerpts from EJCDC documents. Those portions of the text that originated in published EJCDC documents remain subject to the copyright.

Schedule G (optional): Preference to Businesses with Drug-Free Workplace Programs Pursuant to Section 287.087, Florida Statutes

DRUG-FREE WORKPLACE CERTIFICATE

IDENTICAL TIE BIDS: Pursuant to Section 287.087, Florida Statutes, preference shall be given to businesses with Drug-Free Workplace Programs. Whenever two or more bids which are equal with respect to price, quality, and service are received for the procurement of commodities or contractual services, a bid received from a business that certifies that it has implemented a Drug-Free Workplace Program shall be given preference in the award process. Established procedures for processing tie bids will be followed in the event that none of the tied bidders have a Drug-Free Workplace Program. In order to have a Drug-Free Workplace Program, a business shall:

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 company’s 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 of the Florida Statutes, or of any controlled substance law of the United States or any state, for a violation occurring in the work place no later than five (5) days after such conviction or plea.

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 or who has pled.

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.

Signature

Printed Name