RFQ-23-37 Complete and Return.pdf

RFQ-23-37 Submittal Cover Page

Date

Name of Company

Authorized Signature

Printed Name Title/Position

Physical Address

City State Zip

Email address

Telephone Number / Fax Number

Received Addenda #’s___________________________________________________________

List all “Professional Association/Sub-Consultants’ (companies that you will be in association with for this project):

Key Team members and addresses of principal office:

ATTACHMENT A

FIRM INFORMATION / CERTIFICATION

1. Legal Name of Firm. Indicate if the Firm is a Corporation, Joint Venture, Partnership, etc.:

2. Name/Title of contact person for the Firm:_________________________________________________

3. Local business and mailing address:_____________________________________________________

4. Primary business and mailing address:___________________________________________________

5. Telephone Number: ( ) Fax: ( )

The above-named Firm affirms and declares:

A. That the Firm understands all requirements for the RFQ and states they will comply with all the stipulations included in the RFQ package.

B. That the Firm is of lawful age and that no other person, firm or corporation has any interest in this

Proposal or in the contract proposed to be entered into except as expressly stated below.

C. That this qualification proposal is made without any understanding, agreement, or connection with any other person, firm or corporation making a proposal for the same purpose, and is in all respects fair and without collusion or fraud except as expressly stated below.

D. That no officer or employee or person whose salary is payable in whole or in part from the City’s Treasury is, shall be or become interested, directly or indirectly, surety or otherwise in this Proposal; in the performance of this Contract; in the supplies, materials, equipment and work or labor to which they relate; or in any portion of the profits thereof.

E. That the Firm has received and carefully examined all Addenda issued prior to Opening.

F. All statements made by the Firm in the Proposal are true and accurate as of the Proposal submittal date.

IN WITNESS WHEREOF, this Proposal is hereby signed and sealed as of the date indicated.

ATTEST: FIRM:

___________________________________ BY:_______________________________(SEAL)

Witness (Authorized Signature in Ink)

Witness (Printed Name of Signer)

CORPORATE SEAL (Printed Title of Signer) (Where Appropriate)

(Date)

(ACKNOWLEDGEMENT OF FIRM, IF A CORPORATION)

STATE OF ________________________

COUNTY OF ________________________

The foregoing instrument was acknowledged before me this ________ day of ___________________, 20_____, by ___________________________________, who is personally known to me or who has produced ____________________________________ as identification and who did take an oath and who executed the foregoing instrument as _____________________________________ of ___________________________, a ______________________________ corporation, and who severally and duly acknowledged the execution of such instrument as such officer aforesaid, for and on behalf of and as the act and deed of said corporation, pursuant to the powers conferred upon said officer by the corporation’s Board of Directors or other appropriate authority of said corporation, and who, having knowledge of the several matters stated in said foregoing instrument, certified the same to be true in all respects.

He/She is personally known to me or has produced _______________________________ as identification.

WITNESS my hand and official seal the date aforesaid.

_________________________________________ (Signature of the Person taking Acknowledgment)

_________________________________________ (Name of Acknowledger Typed, Printed and Stamped)

_________________________________________ (Title or Rank)

_________________________________________ (Serial Number if Any)

(ACKNOWLEDGEMENT OF FIRM, IF A PARTNERHSIP OR INDIVIDUAL)

STATE OF ________________________

COUNTY OF ________________________

The foregoing instrument was acknowledged before me this ________ day of ___________________, 20_____, by ___________________________________, who is personally known to me or who has produced ____________________________________ as identification and who did take an oath and who executed the foregoing instrument as a member of the firm _____________________________________ (if applicable) and acknowledged the execution of same, for and on behalf of and as the act and deed of said firm, for the uses and purposes therein expressed.

He/She is personally known to me or has produced _______________________________ as identification.

WITNESS my hand and official seal the date aforesaid.

_________________________________________ (Signature of the Person taking Acknowledgment)

_________________________________________ (Name of Acknowledger Typed, Printed and Stamped)

_________________________________________ (Title or Rank)

_________________________________________ (Serial Number if Any)

Affidavit of Prime Bidder

Non-Collusion The contractor/vendor is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; such Bid is genuine and is not a collusive or sham Bid; neither the said Bidder nor any of his officers, partners, owners, agents, representatives, employees or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly with any other Bidder, firm or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or has refrained from bidding in connection with such Contract;

nor in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other Bidder, firm or person to fix the price or prices in the attached Bid or of any other Bidder; nor has fixed any overhead, profit or cost element of the Bid price, or the Bid price of any other Bidder; nor has secured through any collusion, conspiracy, connivance or unlawful agreement, any advantage against the City of Winter Haven or any person interested in the proposed Contract; and the price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the Bidder or any of its agents, representatives, owners, employees, or parties in interest, including this affiant.

Drug-Free Workplace The contractor/vendor certifies that it is a drug-free workplace and has a substance abuse policy in accordance with and pursuant to Section 440.102, Florida Statutes.

Affidavit Certification Immigration Laws City of Winter Haven will not intentionally award City contracts to any contractor who knowingly employs unauthorized alien workers, constituting a violation of the employment provisions contained in 8 U.S.C. Section 1324 a(e) {Section 274a(e) of the IMMIGRATION AND NATIONALITY ACT (“INA”). City of Winter Haven may consider the employment by any contractor 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 CANCELLATION OF THE CONTRACT BY CITY OF WINTER HAVEN. The contractor/vendor attests that they are fully compliant with all applicable immigration laws (specifically to the 1986 Immigration Act and subsequent amendments).

(Signed)__________________________________________

Signature

Name – printed

Title