RFP ATTACHMENT A

PROPOSAL CERTIFICATION FORM

CM SERVICES FOR

NORTH COUNTY COURTHOUSE RENOVATIONS

PROJECT #: P-2024-006280

(Proposer must complete, sign and return with proposal)

I hereby certify that I am submitting my company’s proposal and understand that by virtue of executing and returning with this proposal this Proposal Certification Form, I certify that all information is correct and I understand the contents and accept the conditions of the Request for Proposal and this Proposal Certification Form.

Acknowledgment of Supplements:

Proposer has checked the County’s on-line Vendor Self-Service (VSS) system at https://pbcvssp.pbc.gov/vssprd/Advantage4 for any supplements to this RFP that may have been issued prior to the deadline for receipt of proposals and understands all supplements issued by the County.

The Proposer acknowledges the following supplement(s):

Supplement # dated Supplement # dated__________

SBD Commitment:

Proposer acknowledges that the APIs applicable to the construction phase(s) of this Project, including any mandatory SBE goal applicable to the construction subcontracts, will be determined by the County’s Goal Setting Committee prior to the subcontractor bidding of each Guaranteed Maximum Price Amendment. Proposer agrees to comply with said goal(s) during the construction phase(s) of the Project if awarded the Contract which shall be deemed material terms of any resulting contract.

Commercial Non-Discrimination Certification:

The undersigned Proposer hereby certifies and agrees that the following information is correct: In preparing its response on this Solicitation, the Proposer has considered all proposals submitted from qualified, potential subcontractors and has not engaged in "discrimination" as defined in the County’s Commercial Nondiscrimination Policy as set forth in Resolution 2025-0748 as amended, to wit: discrimination in the solicitation, selection or commercial treatment of any subcontractor, vendor, supplier or commercial customer on the basis of race, color, national origin, religion, ancestry, sex, age, marital status, familial status, sexual orientation, disability, or genetic information, or on the basis of any otherwise unlawful use of characteristics regarding the subcontractor’s, vendor's, supplier's or commercial customer's employees or owners; provided that nothing in this policy shall be construed to prohibit or limit otherwise lawful efforts to remedy the effects of discrimination. Without limiting the foregoing, "discrimination" also includes retaliating against any person or other entity for reporting any incident of "discrimination." Without limiting any other provision of the solicitation, it is understood and agreed that, if this certification is false, such false certification will constitute grounds for the County to reject the proposal submitted by the Proposer for this Solicitation, and to terminate any contract awarded based on the response. As part of its proposal, the Proposer shall provide to the County a list of all instances within the immediate past four (4) years where there has been a final adjudicated determination in a legal or administrative proceeding in the State of Florida that the Proposer discriminated against its subcontractors, vendors, suppliers or commercial customers, and a description of the status or resolution of that complaint, including any remedial action taken. As a condition of submitting a proposal to the County, the Proposer agrees to comply with the County’s Commercial Nondiscrimination Policy as described in Resolution R2025-0748 as amended.

PROPOSER (firm name):

FIRM ADDRESS:

PRINT NAME OF AUTHORIZED REPRESENTATIVE:

EMAIL ADDRESS OF AUTHORIZED REPRESENTATIVE:

PHONE NUMBER OF AUTHORIZED REPRESENTATIVE:

SIGNATURE OF AUTHORIZED REPRESENTATIVE:

TITLE: DATE:

RFP Attachment A/Page 2 of 2

RFP ATTACHMENT A-1

ADDENDUM TO PROPOSAL CERTIFICATION FORM

(Proposer must complete, sign and return with proposal)

As part of its proposal, the Proposer shall provide to the County a list of all instances within the immediate past four (4) years where there has been a final adjudicated determination in a legal or administrative proceeding in the State of Florida that the Proposer discriminated against its subcontractors, vendors, suppliers or commercial customers, and a description of the status or resolution of that complaint, including any remedial action taken.

The Proposer must select the appropriate box:

_____ Proposer certifies that Proposer has had no final adjudications in Florida of discrimination against subcontractors, vendors, suppliers or commercial customers in the immediate past four (4) years.

_____ Proposer has attached to this form a list of all instances within the immediate past four (4) years where there has been a final adjudicated determination in a legal or administrative proceeding in the State of Florida that the Proposer discriminated against its subcontractors, vendors, suppliers or commercial customers, and a description of the status or resolution of that complaint, including any remedial action taken.

PROPOSER (firm name):

PRINT NAME OF AUTHORIZED REPRESENTATIVE:

SIGNATURE OF AUTHORIZED REPRESENTATIVE:

TITLE: DATE:

RFP Attachment B/Page 1 of 1

RFP ATTACHMENT B

CERTIFICATION OF BUSINESS LOCATION FORM

(A Proposer desiring local office points must complete, sign and return with proposal)

In accordance with the Palm Beach County Local Preference Ordinance, as amended, a preference may be given to: (1) respondents having a permanent place of business in Palm Beach County (“County”) or (2) respondents having a permanent place of business in the Glades that are able to provide the goods and/or services to be utilized within the Glades. To receive a local preference, respondents must have a permanent place of business within the County or the Glades, as applicable, prior to the County’s issuance of the solicitation. A Business Tax Receipt which is issued by the Palm Beach County Tax Collector, authorizes the respondent to provide the goods/services being solicited by the County, and will be used to verify that the respondent had a permanent place of business prior to the issuance of the solicitation. The respondent must submit this Certification of Business Location (“Certification”) along with the required Business Tax Receipt at the time of bid or quote or proposal submission. The Business Tax Receipt and this Certification are the sole determinant of local preference eligibility. Errors in the completion of this Certification or failure to submit this completed Certification will cause the respondent to not receive a local preference.

In instances where the respondent is exempt by law from the requirement of obtaining a Business Tax Receipt, the respondent must: (a) provide a citation to the specific statutory exemption; and (b) provide other documentation which clearly establishes that the respondent had a permanent place of business within the County or the Glades prior to the date of issuance of the solicitation. The County hereby retains the right to contact said respondent for additional information related to this requirement after the bid/quote/proposal due date.

I. Respondent is a:

Local Business: A local business has a permanent place of business in Palm Beach County.

(Please indicate):

Headquarters located in Palm Beach County

Permanent office or other site located in Palm Beach County from which a vendor will produce a substantial portion of the goods or services.

Glades Business: A Glades business has a permanent place of business in the Glades.

(Please indicate):

Headquarters located in the Glades

II. The attached copy of respondent’s Palm Beach County Business Tax Receipt verifies respondent’s permanent place of business in Palm Beach County.

THIS CERTIFICATION is submitted by __________________________________, as (Name of Individual)

who hereby certifies that the information stated above is true and correct and that the Palm Beach County Business Tax Receipt is a true and correct copy of the original. Further, it is hereby acknowledged that any misrepresentation by the Respondent on this Certification is considered an unethical business practice and is grounds for sanctions against future County business with the Respondent.

(Signature) (Date)

RFP ATTACHMENT C

CONFLICT OF INTEREST DISCLOSURE FORM

CONTRACTOR/SUBCONTRACTOR represents that it presently has no interest, either direct or indirect, which would or could conflict in any manner with the performance of services for the County, except as follows:

(Attach additional sheets as needed.)

CONTRACTOR/SUBCONTRACTOR further represents that no person having any interest shall be employed for said performance. By signing below, CONTRACTOR/SUBCONTRACTOR certifies that the information contained herein is true and correct and constitutes all current potential conflicts of interest which may influence or appear to influence CONTRACTOR’s/SUBCONTRACTOR’s judgment or quality of services being provided to the County.

CONTRACTOR/SUBCONTRACTOR shall promptly notify the COUNTY in writing by certified mail of all potential conflicts of interest that may arise in the future through any prospective business association, interest or other circumstance which may influence or appear to influence CONTRACTOR’s/SUBCONTRACTOR’s judgment or quality of services being provided to the County. Such written notification shall identify the prospective business association, interest or circumstance, the nature of work that CONTRACTOR/SUBCONTRACTOR may undertake and request an opinion of the COUNTY as to whether the association, interest or circumstance would, in the opinion of the COUNTY, constitute an unacceptable conflict of interest if entered into by the CONTRACTOR/SUBCONTRACTOR.

If, in the sole opinion of the COUNTY, the prospective business association, interest or circumstance of CONTRACTOR/SUBCONTRACTOR would constitute an unacceptable conflict of interest to the COUNTY, the COUNTY shall so state in the notification and the CONTRACTOR/SUBCONTRACTOR shall not enter into said association, interest or circumstance.

This DISCLOSURE is submitted by (Name of Individual:) __________________________, as (Title/Position:) ___________________________of (Name of Firm:) ____________________________ who hereby certifies that any misrepresentation by the CONTRACTOR/SUBCONTRACTOR on this Disclosure is considered an unethical business practice and is grounds for sanctions against future County business with the CONTRACTOR/SUBCONTRACTOR.

Signature Date

RFP Attachment C/Page 1 of 1