Required_Forms_Revised_2025.docx

Procurement Services Division

Vendor Check List

IMPORTANT: PLEASE REVIEW CAREFULLY AND SUBMIT WITH YOUR PROPOSAL/BID. ALL APPLICABLE DOCUMENTS SHALL BE SUBMITTED ELECTRONICALLY THROUGH OPENGOV. VENDOR SHOULD CHECKOFF EACH OF THE FOLLOWING ITEMS. ALL DOCUMENTS REQUIRING EXECUTION SHOULD BE EITHER BY WET SIGNATURES OR VERIFIABLE ELECTRONIC SIGNATURES. FAILURE TO PROVIDE THE APPLICABLE DOCUMENTS MAY DEEM YOU NON-RESPONSIVE/NON-RESPONSIBLE.

|_| General Bid Instructions has been acknowledged and accepted.

|_| Collier County Purchase Order Terms and Conditions have been acknowledged and accepted.

|_| Form 1: Vendor Declaration Statement

|_| Form 2: Conflict of Interest Certification

|_| Proof of status from Division of Corporations - Florida Department of State (If work performed in the State) - http://dos.myflorida.com/sunbiz/ should be attached with your submittal.

|_| Vendor MUST be enrolled in the E-Verify - https://www.e-verify.gov/ at the time of submission of the proposal/bid.

|_| Form 3: Immigration Affidavit Certification MUST be signed and attached with your submittal.

|_| E-Verify Memorandum of Understanding or Company Profile page should be attached with your submittal.

|_| Form 4: Certification for Claiming Status as a Local Business, if applicable, has been executed and returned. Collier or Lee County Business Tax Receipt should be attached with your submittal to be considered.

|_| Form 5: Reference Questionnaire form must be utilized for each requested reference and included with your submittal, if applicable to the solicitation.

|_| Form 6: Grant Provisions and Assurances package in its entirety, if applicable, are executed and should be included with your submittal.

|_| Vendor W-9 Form.

|_| Vendor acknowledges Insurance Requirements and is prepared to produce the required insurance certificate(s) within five (5) days of the County’s issuance of a Notice of Recommend Award.

|_| The Bid Schedule has been completed and attached with your submittal, applicable to bids.

|_| Copies of all requested licenses and/or certifications to complete the requirements of the project.

|_| All addenda have been signed and attached.

|_| County’s IT Technical Architecture Requirements has been acknowledged and accepted, if applicable.

|_| Any and all supplemental requirements and terms has been acknowledged and accepted, if applicable.

Form 1: Vendor Declaration Statement

BOARD OF COUNTY COMMISSIONERS

Collier County Government Complex Naples, Florida 34112

Dear Commissioners:

The undersigned, as Vendor declares that this response is made without connection or arrangement with any other person and this proposal is in every respect fair and made in good faith, without collusion or fraud. The Vendor hereby declares the instructions, purchase order terms and conditions, requirements, and specifications/scope of work of this solicitation have been fully examined and accepted.

The Vendor agrees, if this solicitation submittal is accepted by Collier County, to accept a Purchase Order as a form of a formal contract or to execute a Collier County formal contract for purposes of establishing a contractual relationship between the Vendor and Collier County, for the performance of all requirements to which this solicitation pertains. The Vendor states that the submitted is based upon the documents listed by the above referenced solicitation. The Vendor agrees to comply with the requirements in accordance with the terms, conditions and specifications denoted herein and according to the pricing submitted as a part of the Vendor’s bids.

Further, the Vendor agrees that if awarded a contract for these goods and/or services, the Vendor will not be eligible to compete, submit a proposal, be awarded, or perform as a sub-vendor for any future associated work that is a result of this awarded contract.

IN WITNESS WHEREOF, WE have hereunto subscribed our names on this _____ day of _____________, 20__ in the County of _______________, in the State of _____________.

Firm’s Legal Name:

Address:

City, State, Zip Code:

Florida Certificate of Authority Document Number

Federal Tax Identification Number *CCR # or CAGE Code *Only if Grant Funded

Telephone:

Email:

Signature by:

(Typed and written)

Title:

Additional Contact Information

Send payments to:

(required if different from above)

Company name used as payee

Contact name:

Title:

Address:

City, State, ZIP

Telephone:

Email:

Office servicing Collier County to place orders (required if different from above)

Contact name:

Title:

Address:

City, State, ZIP

Telephone:

Email:

Form 2: Conflict of Interest Certification Affidavit

The Vendor certifies that, to the best of its knowledge and belief, the past and current work on any Collier County project affiliated with this solicitation does not pose an organizational conflict as described by one of the three categories below:

Biased ground rules – The firm has not set the “ground rules” for affiliated past or current Collier County project identified above (e.g., writing a procurement’s statement of work, specifications, or performing systems engineering and technical direction for the procurement) which appears to skew the competition in favor of my firm.

Impaired objectivity – The firm has not performed work on an affiliated past or current Collier County project identified above to evaluate proposals / past performance of itself or a competitor, which calls into question the contractor’s ability to render impartial advice to the government.

Unequal access to information – The firm has not had access to nonpublic information as part of its performance of a Collier County project identified above which may have provided the contractor (or an affiliate) with an unfair competitive advantage in current or future solicitations and contracts.

In addition to this signed affidavit, the contractor / vendor must provide the following:

1. All documents produced as a result of the work completed in the past or currently being worked on for the above-mentioned project; and,

2. Indicate if the information produced was obtained as a matter of public record (in the “sunshine”) or through non-public (not in the “sunshine”) conversation (s), meeting(s), document(s) and/or other means.

Failure to disclose all material or having an organizational conflict in one or more of the three categories above be identified, may result in the disqualification for future solicitations affiliated with the above referenced project(s).

By the signature below, the firm (employees, officers and/or agents) certifies, and hereby discloses, that, to the best of their knowledge and belief, all relevant facts concerning past, present, or currently planned interest or activity (financial, contractual, organizational, or otherwise) which relates to the project identified above has been fully disclosed and does not pose an organizational conflict.

Company Name

Signature

Print Name and Title

State of ___________________

County of _________________

The foregoing instrument was acknowledged before me by means of ☐ physical presence or ☐ online notarization, this ______ day of ____________ (month), (year), by (name of person acknowledging).

(Signature of Notary Public)

(Print, Type, or Stamp Commissioned Name of Notary Public) Personally Known OR Produced Identification

Type of Identification Produced

Form 3: Immigration Affidavit Certification

This Affidavit is required and should be signed, by an authorized principal of the firm and submitted with formal solicitation submittals. Further, Vendors are required to be enrolled in the E-Verify program (https://www.e-verify.gov/), at the time of the submission of the Vendor’s proposal/bid. Acceptable evidence of your enrollment consists of a copy of the properly completed E-Verify Company Profile page or a copy of the fully executed E-Verify Memorandum of Understanding for the company which will be produced at the time of the submission of the Vendor’s proposal/bid or within five (5) day of the County’s Notice of Recommend Award.

FAILURE TO EXECUTE THIS AFFIDAVIT CERTIFICATION AND SUBMIT WITH VENDOR’S PROPOSAL/BID MAY DEEM THE VENDOR’S AS NON-RESPONSIVE.

Collier County will not intentionally award County contracts to any Vendor who knowingly employs unauthorized alien workers, constituting a violation of the employment provision contained in 8 U.S.C. Section 1324 a(e) Section 274A(e) of the Immigration and Nationality Act (“INA”).

Collier County may consider the employment by any Vendor of unauthorized aliens a violation of Section 274A (e) of the INA. Such Violation by the recipient of the Employment Provisions contained in Section 274A (e) of the INA shall be grounds for unilateral termination of the contract by Collier County.

Vendor attests that they are fully compliant with all applicable immigration laws (specifically to the 1986 Immigration Act and subsequent Amendment(s), that it is aware of and in compliance with the requirements set forth in Florida Statutes §448.095, and agrees to comply with the provisions of the Memorandum of Understanding with E-Verify and to provide proof of enrollment in The Employment Eligibility Verification System (E-Verify), operated by the Department of Homeland Security in partnership with the Social Security Administration at the time of submission of the Vendor’s proposal/bid.

Company Name

Signature

Print Name and Title

State of ___________________

County of _________________

The foregoing instrument was acknowledged before me by means of ☐ physical presence or ☐ online notarization, this ______ day of ____________ (month), (year), by (name of person acknowledging).

(Signature of Notary Public)

(Print, Type, or Stamp Commissioned Name of Notary Public) Personally Known OR Produced Identification

Type of Identification Produced

Form 4: Vendor Submittal – Local Vendor Preference Certification

(Check Appropriate Boxes Below)

State of Florida (Select County if Vendor is described as a Local Business) |_| Collier County |_| Lee County

Vendor affirms that it is a local business as defined by the Procurement Ordinance of the Collier County Board of County Commissioners and the Regulations Thereto. As defined in Section Fifteen of the Collier County Procurement Ordinance:

Local business means the vendor has a current Business Tax Receipt issued by the Collier County Tax Collector prior to bid or proposal submission to do business within Collier County, and that identifies the business with a permanent physical business address located within the limits of Collier County from which the vendor’s staff operates and performs business in an area zoned for the conduct of such business. A Post Office Box or a facility that receives mail, or a non-permanent structure such as a construction trailer, storage shed, or other non-permanent structure shall not be used for the purpose of establishing said physical address. In addition to the foregoing, a vendor shall not be considered a "local business" unless it contributes to the economic development and well-being of Collier County in a verifiable and measurable way. This may include, but not be limited to, the retention and expansion of employment opportunities, support and increase to the County's tax base, and residency of employees and principals of the business within Collier County. Vendors shall affirm in writing their compliance with the foregoing at the time of submitting their bid or proposal to be eligible for consideration as a "local business" under this section. A vendor who misrepresents the Local Preference status of its firm in a proposal or bid submitted to the County will lose the privilege to claim Local Preference status for a period of up to one year under this section.

Vendor must complete the following information:

Year Business Established in |_|Collier County or |_| Lee County: ________

Number of Employees (Including Owner(s) or Corporate Officers):_________

Number of Employees Living in |_| Collier County or |_| Lee (Including Owner(s) or Corporate Officers):_______

If requested by the County, Vendor will be required to provide documentation substantiating the information given in this certification. Failure to do so will result in vendor’s submission being deemed not applicable.

Sign and Date Certification:

Under penalties of perjury, I certify that the information shown on this form is correct to my knowledge.

Company Name: _________________________________________

Date: _____________________________

Address in Collier or Lee County: _____________________________________________________________________

Form 5 Reference Questionnaire

(USE ONE FORM FOR EACH REQUIRED REFERENCE)

Solicitation:

Reference Questionnaire for:

(Name of Company Requesting Reference Information) (Name of Individuals Requesting Reference Information)

Name:

(Evaluator completing reference questionnaire)

Company:

(Evaluator’s Company completing reference)

Collier County has implemented a process that collects reference information on firms and their key personnel to be used in the selection of firms to perform this project. The Name of the Company listed in the Subject above has listed you as a client for which they have previously performed work. Please complete the survey. Please rate each criteria to the best of your knowledge on a scale of 1 to 10, with 10 representing that you were very satisifed (and would hire the firm/individual again) and 1 representing that you were very unsatisfied (and would never hire the firm/indivdiual again). If you do not have sufficient knowledge of past performance in a particular area, leave it blank and the item or form will be scored “0.”

Project Description: ___________________________

Completion Date: _____________________________

TOTAL SCORE OF ALL ITEMS

FORM 6

IF APPLICABLE

GRANT PROVISIONS AND ASSURANCES FORMS ARE PROVIDED IN SEPARATE PACKAGE AND MUST BE COMPLETED AND EXECUTED IN ITS ENTIRTY AND RETURNED WITH THE SUBMISSION OF THE BID/PROPOSAL.

FAILURE TO DO SO MAY DEEM YOU NON-RESPONSIVE.

CONFIRM ALL REQUIRED LICENSES AND FORMS ARE COMPLETED AND EXECUTED IN ITS ENTIRTY AND RETURNED WITH THE SUBMISSION OF THE BID/PROPOSAL.

FAILURE TO DO SO MAY DEEM YOU NON-RESPONSIVE.

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