REQUEST FOR STATEMENTS

OF QUALIFICATIONS

FOR ENGINEERING DESIGN, PLANNING,

PRELIMINARY ENGINEERING

FOR CITY OF CHIPLEY

RFQ NO. 2026-01

POST OFFICE BOX 1007

1442 JACKSON AVENUE

CHIPLEY, FLORIDA 32428

(850) 638-6350

CITY OF CHIPLEY, FLORIDA

REQUEST FOR QUALIFICATIONS FOR ENGINEERING DESIGN,

PLANNING, PRELIMINARY ENGINEERING

The City of Chipley, herein referred to as the “City”, is seeking sealed proposals from interested and qualified consultant firms in the State of Florida with experience in Engineering Design, Planning, Preliminary

Engineering, as well as Construction and Engineering Inspection Services on a Continuing Contract basis. It is the intent of the city to select and negotiate an agreement with a firm or firms to perform general engineering services required by the city for various projects. The selected firm(s) shall serve as the City of Chipley’s

Planning, Preliminary Engineering, Design Engineer and/or Construction and Engineering Inspection

Services (CEI) consultant for projects as they are assigned as well as projects identified in the City’s Capital

Improvement Plan including State Revolving Fund (SRF) Facilities Plan, FDEP SRF OSG funding, United

States Department of Agriculture (USDA), Rural Development, Resilient Florida Funding, and Rural

Infrastructure funds.

All questions must be submitted in writing to Mrs. Patrice Tanner, City Administrator, and may be emailed to ptanner@cityofchipley.com. A complete copy of the RFQ may be downloaded at www.cityofchipley.com.

All RFQ’s will be ranked on an individual and equal basis.

The City desires a firm that has proven ability and is capable of designing and administering construction contracts; inspecting construction work and activities; ensuring completion of construction as required by, City of Chipley, Federal, and State standards, plans and specifications; meeting permitting and other applicable agency requirements; invoicing timely and accurately; and handling all FDOT EEO, Wages, DBE and OJT filing, interviewing and other requirements in a timely and responsible manner.

To be considered, the Firm must submit an original and three (3) copies of the RFQ in a sealed envelope or package, clearly marked with the Firm’s or individual’s name and address, and the words “RFQ No. 2026-01

ENGINEERING SERVICES”. RFQ’s will be received by either hand delivery to the City of Chipley City

Clerk located at 1442 Jackson Avenue, Chipley, Florida or by regular mail to City of Chipley, Attention: City

Clerk, Post Office Box 1007, Chipley, Florida 32428 by the closing date.

RFQ Deadline: July 1, 2026, at 2:00 p.m., local time.

Late submittals received after the aforementioned deadline date, either by mail or otherwise, will not be considered and will be returned unopened. The time of receipt will be determined by the time received by the

City of Chipley City Clerk. It is the sole responsibility of the firm for assuring that the RFQ is received by the

City Clerk by the designated date and time. No faxed, electronic or oral RFQ will be accepted.

Award will be made to the best responsive Firm(s), but the City reserves the right to reject any or all RFQ’s.

The City of Chipley reserves the right to reject the RFQ of a firm who has previously failed to perform properly or complete on time contracts of a similar nature, or the RFQ of a firm who, in the sole opinion and discretion of the City of Chipley is not in a position to perform the contract.

SPECIAL NOTE:

The City requires a business license to be purchased for the privilege of engaging in any business within the city limits. Please contact the Finance Office for requirements and a fee schedule.

EQUAL OPPORTUNITY EMPLOYER/HANDICAP ACCESSIBLE/FAIR

HOUSING JURISDICTION

Advertised: June 3, 2026 and June 10, 2026 mailto:ptanner@cityofchipley.com http://www.cityofchipley.com/

INSTRUCTIONS FOR SUBMITTING QUALIFICATIONS RFQ NO. 2026-01

ENGINEERING DESIGN, PLANNING, PRELIMINARY ENGINEERING

I. Statement of Qualifications must be received by: July 1, 2026 at 2:00 p.m., local time.

II. Statement of Qualifications can be mailed or delivered to:

If delivered in person or overnight mail:

City of Chipley

Attn: City Clerk

1442 Jackson Avenue

Chipley, FL 32428

If by mail: City of Chipley

Attn: City Clerk

P.O. Box 1007

Chipley, FL 32428

Note: Late submittals received after the aforementioned deadline date, either by mail or otherwise, will not be considered and will be returned unopened. The time of receipt will be determined by the time received in the City of Chipley City Hall. It is the sole responsibility of the firm for assuring that the RFQ is received by the designated date and time. No faxed, electronic or oral RFQ will be accepted. No oral interpretations will be made to any firm as to the meaning of specifications or any other contract documents. In accordance with Florida Statutes

287.057(23), “Respondents to this solicitation or persons acting on their behalf may not contact, between the release of the solicitation and the end of the 72 hour period following the agency posting the notice of intended award, excluding Saturdays, Sundays, and state holidays, any employee or officer of the executive or legislative branch concerning any aspect of this solicitation, except in writing to the procurement officer or as provided in the solicitation documents. Violation of this provision may be grounds for rejecting a response.”

III. Submittal must be sealed and marked:

“RFQ No. 2026-01 ENGINEERING SERVICES”

Proposers must submit one (1) original (so identified) and three (3) additional copies of their proposal.

IV. Statement of Qualifications must be complete and include the forms attached.

Interested Parties shall submit all required forms and information simultaneously with Statement of Qualifications, which forms and information become a part of the property of the City of

Chipley and will not be returned to the firm unless a written request to withdraw is received prior to Wednesday, July 1, 2026 at 2:00 p.m., local time. These items apply to and become a part of the terms and conditions of the qualification package submitted. Any exceptions must be in writing.

Notice is hereby given that the City of Chipley will receive Statement of Qualifications from interested parties until Wednesday, July 1, 2026 at 2:00 p.m., local time at its offices located at

1442 Jackson Ave., Chipley, FL 32428. Any Statement of Qualifications received thereafter will not be considered.

Award will be made to the best responsive Firm, but the City reserves the right to reject any and all RFQ’s. The City of Chipley reserves the right to reject the RFQ of a firm who has previously failed to perform properly or complete on time, contracts of a similar nature, or of a firm who, in the sole opinion and discretion of the City of Chipley is not in a position to perform the contract.

Interpretations of the RFQ, clarification of qualifications specifications and requirements or changes to the RFQ which have a material effect will be documented and communicated to responsive firms only by written addenda provided by City staff.

The successful firm will be required to submit additional forms, including, but not limited to: Non-

Collusion Affidavit and Conflict of Interest Forms.

All qualifications submitted shall be subject to acceptance or rejection and the City of Chipley specifically reserves the right to accept or reject any and all qualifications, to waive any technicalities and formalities in the qualification process and award the RFQ in part or in any manner deemed to be in the best interest of the City.

The undersigned understands that any conditions stated above, clarifications made to the above, or information other than that requested should be stated in writing, on a separate sheet.

Print or Type Name of Individual, Print or Type Name of Company

Partner or Corporation

Title Address

Authorized Signature City, State and Zip Code

Email Company Phone Number

Part 1. Intent and General Information

1.1 The City of Chipley is soliciting letters of interest and statements of qualifications from registered, qualified consulting firms in the State of Florida, pursuant to Section 287.055, Florida Statutes, known as the Consultant Competitive

Negotiation Act (CCNA), to provide Engineering Services (see section 2 for details). The procedures for selection of the consultant(s) will be in accordance with

ALL applicable procurement requirements set forth by the Federal Government, the

State of Florida, and the procedures set forth in this statement of qualification request. All responses received will be evaluated in accordance with the selection criteria and corresponding point system, which is further explained below.

It is the intent of this request to meet all requirements of the various federal agencies and all agreements resulting from this request should be expected to include all requirements and contract language required by the agencies involved, the Code of

Federal Regulations, State of Florida, and Federal Emergency Management Agency

(FEMA), US Department of Housing and Urban Development, Federal Highway

Administration, United States Department of Agriculture, Federal Aviation

Administration, Florida Department of Transportation, and various other State and

Federal Agencies requirements even though the specific language is not included in this request. Each work assignment will be issued by separate task assignment/task order, and additional requirements or language may be added to the task assignment if needed because of the type of project or funding source.

1.2 PROHIBITION OF LOBBYING IN PROCUREMENT MATTERS. Except as

(if) expressly set forth in the City of Chipley Procurement Ordinance Policy during the blackout period, which is the period between the time the submittals for invitation for bid or the request for proposal, or qualifications, or information, or the invitation to negotiate, as applicable, are received at the City of Chipley, and the time the City

Council awards the contract, no proposer, no lobbyist, principal, or other person may lobby, on behalf of a competing party in a particular procurement matter.

Violation of this provision may result in disqualification of a violating party.

Part 2. Scope of Services

2.1 The purpose of this Request for Qualifications will be for various road construction and other City projects. The projects may include roadway construction, structural engineering, water/wastewater, development and redevelopment, design tasks, engineering assessments, disaster recovery efforts and other services, as required.

The City of Chipley is seeking to retain the services of a consultant firm with experience in Engineering Design, Planning, Preliminary Engineering, as well as

Construction and Engineering Inspection Services on a Continuing Contract basis.

Consultant Firms must demonstrate expertise in the following areas as applicable to the submittal:

Preparation or interpretation of bid documents, drawing, and specifications

Knowledge of FDOT standards, plans and specifications

Coordination of the design and bidding processes

Knowledge of applicable State and Federal Laws and regulations Permitting requirements and other applicable agency requirements Timely and accurate reporting and/or approval of invoicing

Knowledge of FDOT, FAA, CDBG, USDA, DEO and Other Program requirements

Asphalt mix designs

Concrete mix designs

Storm water design, calculations, and analysis

Asphalt and concrete placement Traffic Signals and lighting

Program management Planning Environmental

2.2 Service to be performed may include, but not be limited to: prepare design drawings and specifications, prepare reports and studies, conduct planning activities, prepare and submit weekly reports of consultants’ activities and time, verify and ensure that design packages, reports and records are submitted on schedule and are accurate, attend design and construction meetings and coordinate with county, prepare meeting minutes, coordinate with utilities for design and construction, coordinate with property owners for right of way design, review and approve submittals and shop drawings, verify and approve As-Built drawings, verify quantities, and other activities as needed to complete the engineering or as directed by the City Administrator or as needed to complete the various projects.

Company/Firm shall be FDOT pre-qualified as applicable to perform the services required under this contract and shall meet all requirements of the City.

The City of Chipley encourages small, minority and disadvantaged business enterprises to respond to this solicitation. Consultants are further encouraged to utilize sub consultants from one of these enterprises.

Part 3. Evaluation Criteria

3.1 The following criteria will be used in the evaluation process to determine the successful respondent(s):

COMPANY/FIRM QUALIFICATIONS AND EXPERIENCE

The overall ability and capability of firm to perform the required engineering, design, planning, and CEI services, based on proposed personnel, past work history, references, and other information that consultant submits including statements and letters of reference from previous clients. This will also include the ability to follow the directions provided in this request. The maximum total for this category is

Twenty (20).

ABILITIES TO PROVIDE REQUIRED SCOPE OF SERVICE

To include organization profile of proposed Professional Engineers, Architects, Planners, Engineer Interns, and Design Technicians(s); specific names and functions of personnel assigned to the project; resumes of personnel assigned to the project (to include years of experience and years with the submitting company). Submitted personnel shall not be changed without written approval of the City Administrator.

The maximum total for this category is Twenty (20).

CLIENT REFERENCES FOR SIMILAR PROJECTS

Letters of reference included. The maximum total for this category is Twenty (20).

ENGINEERING EXPERIENCE ON SIMILAR PROJECTS

Each similar project description must include a list of the proposed team members who worked on the project. The maximum total for this category is Twenty (20).

OVERALL PRESENTATION

This will include the ability to follow the City directions provided in this request. The maximum total for this category is Twenty (20).

Part 4. Terms and Conditions

4.1 Conformity and adherence to the terms and conditions of this solicitation shall be a condition considered by the Selection Committee as part of its review process.

Individuals or firms submitting Letters of Interest and Statements of Qualifications for this RFQ shall not contact individual members of the City Council, nor the members of the Selection Committee during the evaluation and interview process, excepting only if required regarding other work with the City, but shall not discuss this RFQ except to submit questions in writing. The selection committee will be appointed by the City of Chipley. Individual committee members will be removed from the committee if unable to participate in all reviews, and scoring will be based on scores by the remaining committee members. Any and all questions must be directed, in writing, to the City Administrator.

4.2 In determining submission acceptance, any data submitted or related to the offeror’s proposal, required or voluntary, shall be subject to evaluation as deemed appropriate and in the best interest of the city, including the conduct of the offeror or any representative of the offeror with regard to any City official or employee.

4.3 Submittals in response to this Solicitation will be reviewed against the criteria listed herein above, and award of contract(s) shall be made in accordance with local procurement procedures and applicable regulations of the State of Florida.

4.4 Submittals will be evaluated on the basis of submitted materials, references, and interviews as applicable.

4.5 A selection committee will review all Requests for Qualifications and make a recommendation to the City Council based on the established proposal evaluation criteria. A selected group of Consultants may be required to make an oral presentation to the Selection Committee. If needed, such a presentation will provide an opportunity for the Consultants to clarify the information provided in their proposal. If an oral presentation is required, the final decision of the Selection

Committee will be based on the overall tabulation from the oral presentation. The

Selection Committee will present its recommendations to the City Council for final determination and award.

4.6 One (1) original and Three (3) copies for a total of Four (4) paper copies of each submission must be received in a sealed envelope (package) prominently marked on the outside with the words “RFQ No. 2026-01 ENGINEERING SERVICES”.

4.7 Submissions shall be directed to the attention of Patrice Tanner, City

Administrator, and received by the date and time specified herein. The City

Administrator shall not be responsible for any misdirected or mislabeled submissions, or those handled by delivery persons, couriers, or the U.S. Postal

Service. Submissions shipped in express, overnight or courier envelopes, boxes or packages must be prominently marked on the outside of such envelopes, boxes or packages with the words, “RFQ No. 2026-01 ENGINEERING SERVICES” and the contents sealed as required.

4.8 Solicitation by the City of Chipley to consultants, firms and individuals is based on this advertisement. The advertisement may also be found on the City of Chipley’s web site http://www.cityofchipley.com. Firms or individuals submit responses on a voluntary basis, and therefore are not entitled to compensation of any kind. The City, its officers and agents, assume no liability or indebtedness for any cost or inconvenience incurred by any individuals or firms in the preparation, submission, presentation or documentation of any response or proposal.

4.9 The deadline for receipt of submittals or alternate submittals in response to this request is as indicated above. Submission by FAX or other electronic media will not be accepted under any circumstances. Late submissions will not be accepted but will be returned unopened to the sender at the sender’s expense. Final determination of closing time and acceptance or rejection of submittals will be determined.

4.10 Drug Free Workplace: A notarized Drug Free Workplace Certification must accompany each submission, in accordance with the Florida Administrative Code, Department of Management Services, and Division of Purchasing. Those responding to this Solicitation may submit certification by statement on their letterhead or elect to submit the State of Florida Certificate, showing compliance with the minimum

State of Florida requirements.

4.11 Public Entity Crimes Statement: By submitting a response to this solicitation, the responder acknowledges that any person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids 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 any public entity, and may not transact business with any public entity in excess of the threshold amount provided in section 287.017, for CATEGORY TWO for a period of thirty-six (36) months from the date of being placed on the convicted vendor list.

4.12 Certification Regarding Debarment, Suspension, and Other Responsibility

Matters: The prospective primary participant must certify to the best of its knowledge and belief, that it and its principals are not presently debarred, suspended, http://www.cityofchipley.com./ proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency and meet all other such responsibility matters as contain on the attached certification.

4.13 Employment Eligibility Verification:

A. Contractor agrees that it will enroll and participate in the federal E-Verify

Program for Employment Verification consistent with requirements outlined in

Chapter 448.095, Florida Statutes. Contractor further agrees to provide the City, within thirty days of the effective date of this contract/amendment/extension, documentation of such enrollment in the form of a copy of the E-Verify [“Edit

Company Profile” screen], which contains proof of enrollment in the E-Verify

Program (this page can be accessed from the “Edit Company Profile” link on the left navigation menu of the E-Verify employer’s homepage).

B. Contractor further agrees that it will require each subcontractor that performs work under this contract to enroll and participate in the E-Verify Program within sixty days of the effective date of this contract/amendment/extension or within sixty days of the effective date of the contract between the Contractor and the subcontractor, whichever is later. The Contractor shall obtain from the subcontractor(s) a copy of the “Edit Company Profile” screed indicating enrollment in the E-Verify Program and make such record(s) available to the

Agency upon request.

C. Contractor shall utilize the U.S. Department of Homeland Security’s E-Verify system to verify the employment eligibility of: (1) all persons employed during the term of the Agreement by Contractor to perform employment duties within

Florida; and (2) all persons (including subcontractors) assigned by Contractor to perform work pursuant to the Agreement.

a. Contractor must use E-Verify to initiate verification of employment eligibility for all persons employed during the term of the Agreement by

Contractor to perform employment duties within Florida within 3 business days after the date of hire.

b. Contractor must initiate verification of each person (including subcontractors) assigned by Contractor to perform work pursuant to the

Agreement within 60 calendar days after the date of execution of this contract or within 30 days after assignment to perform work pursuant to the

Agreement, whichever is later.

D. Contractor further agrees to maintain records of its participation and compliance with the provision of the E-Verify program, including participation by its subcontractors as provided above, and to make such records available to the City or other authorized state entity consistent with State requirements.

E. Compliance with the terms of the Employment Eligibility Verification provisions is made an express condition of this contract and the City may treat a failure to comply as a material breach of the contract.

4.14 The consultant selected may be required to demonstrate that the consultant has no vested, fiscal or financial interest in a business, firm or corporation which would directly or indirectly gain, profit or benefit from the activities, tasks, design work, reports, records or recommendations of such consultant.

4.15 Chipley Time (Central Standard Time) is hereby established as the Official

Time of the City of Chipley.

4.16 Unlike the private sector, the public sector which is funded by public money requires complex procedures and systems by law. In order to ensure that the public funds are well spent, as well as to maintain credibility of the public entity, those systems and procedures are sealed and confidential until opened and evaluated, following which they are documented and audited periodically, being subject to public scrutiny and accountability.

By its very nature, a comprehensive evaluation process of many submissions by a

City-approved Selection Committee, including verification of performance records, references, and related issues, is a complex and lengthy process. As a result, telephone or fax request for “status reports” and ranking results cannot be honored during the evaluation process. The evaluation process will be conducted in a public meeting(s).

Upon request, ranking results will be faxed or emailed to all individuals and firms submitting a response to this Solicitation following conclusion and tabulation of the evaluation scores. Each Board-approved, short-listed firm will be notified by fax or email following the preliminary and final scoring and tabulation process.

4.17 No oral interpretations will be made to any Proposer as to the meaning of the

Proposal/Contract Documents. Any inquiry or request for interpretation received at least 72 hours prior to the submittal time indicated above will be given consideration.

All such changes or interpretations will be made in writing by email in the form of an addendum and, if issued, will be distributed by email or sent by other available or electronic means to all attending prospective proposers prior to the established due date.

4.18 Evidence of registration and statement of professional liability insurance.

Evidence of current professional registration (engineering) in the State of Florida

A Certificate of Insurability acceptable to the City shall accompany each proposal or alternate proposal in the amounts as prescribed by State and City.

Professional Liability Insurance: The Vendor shall purchase and maintain such insurance as will protect him from claims which may arise out of or result from the

Vendor’s operations under the terms and conditions of the RFQ. Liability insurance shall be obtained at the Vendor’s expense and in his name as the insured, which

Certificate shall show City of Chipley as an additional named insured. Liability insurance on a form approved by the City and including endorsements for contractual liability and such other endorsements appropriate for the Work required by this Bid as may be required by the city. The limit of liability for this coverage shall not be less than

$250,000.00 CSL per occurrence.

General Liability, with combined single limits of not less than $1,000,000 per occurrence. The only aggregate limit acceptable is a “project aggregate” and the

Certificate must show an appropriate endorsement (ISO CG2501) or equal.

Business Auto Liability Insurance, with combined single limits of not less than

$200,000 per occurrence and is to include bodily injury and property damage liability arising out of operation, maintenance or use of any auto, including owned, not-owned and hired automobiles and employee non-ownership use.

Workers’ Compensation Insurance, as required by the State of Florida.

$100,000 each accident and $100,000 each employee

$500,000 policy limit for disease

Engineer Professional Liability with an occurrence limit of not less than $250,000.

Note that these insurance requirements will change from time to time. Amounts of insurance will meet the minimum amounts and limits required by the State of

Florida, Washington County and City of Chipley.

4.19 The Proposer and all subcontractors must be licensed and registered as applicable in the City of Chipley and the State of Florida to perform the work required by this

Project. The Proposer shall furnish the City with a list of all sub-contractors performing work on this project. The successful vendor is required to have proper license as required by the State of Florida and City of Chipley and present a copy of such license in the submittal package. It will be the vendor’s responsibility to determine through these organizations which type of license is required.

4.20 Statement of Qualifications shall be prepared utilizing the following organizational format. Each of the required sections must begin on a new page and be separately tabbed for identification of the section. The statement shall include the following sections:

1. Submittal Cover Sheet (1 page)

2. Executive Summary or Letter of Introduction (3 pages)

3. Firm qualifications and capabilities (5 pages)

4. Qualifications, resumes, certifications, and licenses of proposed professional personnel (8 pages)

5. Client references for similar projects (# of Letters of Reference) (1 page)

6. Experience on similar projects (5 pages)

7. Evidence of registration and statement of professional liability insurance and license(s) (2 pages)

8. Affidavits and Acknowledgements (as provided in RFQ)

The criteria under which each proposal is evaluated will be as follows:

CONTINUING ENGINEERING SERVICES

THE CITY OF CHIPLEY

PROPOSAL EVALUATION CRITERIA

CRITERIA POINTS

AVAILABLE

l. Qualifications and Experience 20

2. Ability to provide required scope of service. 20

3. Client References for Similar Projects 20

4. Engineering Experience on Similar Projects 20

5. Overall Presentation 20

TOTAL: 100

DRUG FREE WORKPLACE CERTIFICATE

"I, the undersigned, in accordance with Florida Statute 287.087, hereby certify that

NAME OF FIRM

• Publishes a written statement notifying that the unlawful manufacturer, distribution, dispensing possession, or use of a controlled substance is prohibited in the workplace given above, and specifying actions that will be taken against violations of such prohibition;

• Informs employees about the dangers of drug abuse in the work place, the firm's policy of maintaining a drug free working environment, and available drug counseling, rehabilitation and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations.

• Gives each employee, engaged in providing commodities or contractual services that are under bid or proposal, a copy of the statement specified above.

• Notifies the employees that as a condition of working on the commodities or contractual services that are under bid or proposal, the employee will abide by the terms of the statement and will notify the employer of any conviction of, plea of guilty or nolo contendere to, any violation of

Chapter 1893, or of any controlled substance law of the State of Florida or the United States, for a violation occurring in the workplace, no later than five (5) days after such conviction, and requires employees to sign copies of such written [*] statement to acknowledge their receipt.

• Imposes a sanction on, or requires 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.

• Makes a good faith effort to continue to maintain a drug free workplace through the implementation of the drug free workplace program.

"As a person authorized to sign this statement, I certify that the above-named business, firm or corporation complies fully with the requirements set forth herein."

Authorized Signature

Date

STATE OF:

COUNTY OF:

Sworn to and subscribed before me this day of , 2026.

Personally known or produced Identification .

[Type of Identification]

Signature of Notary Public:

My Commission Expires:

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

This SWORN statement is submitted with bid number:

1.

By: ______________________________________________________________________________

(PRINT INDIVIDUALS NAME AND TITLE)

For: ________________________________________________________________________________

(PRINT NAME OF ENTITY SUBMITTING SWORN STATEMENT)

whose business address is_____________________________________________________________________

CITY STATE ZIP VOICE PHONE

and (if applicable) its Federal Employee Identification Number (FEIN) is: __________________________

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 of the United States, including, but not limited to, any bid or contract for goods or services to be provided to any public entity or an agency of 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 “convicted” or “conviction” as defined in Paragraph 287.133 (a)(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 or record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, nonjury trial, or entry of a plea of guilty or nolo contendere.

4. I understand that an “affiliate” as defined in Paragraph 287.133 (1)(a), Florida Statutes, means:

A. A predecessor or a successor of a person convicted of a public entity crime; or

B. An entity under the control of any natural person who is active in the management of the entity and who had 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 facia case that no one person controls another person. A person who knowingly enters 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.

I UNDERSTAND THAT A “PERSON” AS DEFINED IN Paragraph 287.133(1)(e), Florida Statutes, means any natural person or entity organized under the laws of any state of the United States with the legal power to enter into a binding contract and which bids 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.

1. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this SWORN statement.

SWORN STATEMENT UNDER SECTION 287.133 (3)(a), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES - CONTINUED

[INDICATE WHICH STATEMENT APPLIES]

______ Neither the entity submitting this SWORN statement, nor any of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity has 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, shareholders, 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.

______ The entity submitting this SWORN statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or as a 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 of 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).

STATEMENT OF UNDERSTANDING

I understand that the submission of this form to the contracting officer for the Public Entity Identification in

Paragraph one (1) above is for that Public Entity Only and, that this form is valid through December 31 of the calendar 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 (2) of any change in the information contained in this form.

AUTHORIZED SIGNATURE

Sworn to and subscribed before me this _______ day of _______________________, 20____.

Personally known ___________ OR Produced identification ___________________________________

SHOW TYPE OF IDENTIFICATION PROVIDED

Notary Public-State of __________ My commission expires _______________

(PRINTED / TYPED/ OR STAMPED COMMISSIONED NAME OF NOTARY PUBLIC)

CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND

VOLUNTARY EXCLUSION FOR FEDERAL AID CONTRACTS

(Compliance with 49CFR, Section 29.510)

Instructions for Certification

1. By signing and submitting this certification with the proposal, the prospective lower tier participant is providing the certification set out below.

2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the Department may pursue available remedies, including suspension and/or debarment.

3. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is submitted. If at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

4. The terms 'covered transaction', 'debarred', 'suspended', 'ineligible', 'lower tier covered transaction', 'participant', 'person', primary covered transaction', 'principal', 'proposal', and

'voluntarily excluded', as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the person to which this proposal is being submitted for assistance in obtaining a copy of those regulations.

5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the Department or agency with which this transaction originated.

6. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled: Certification Regarding Debarment, Suspension, Ineligibility and

Voluntary Exclusion - Lower Tier Covered Transaction", without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.

7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the

Nonprocurement List.

8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant are not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the

Department may pursue available remedies, including suspension and/or debarment.

It is certified that neither the below identified firm nor its principals are presently suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

Name of Consultant:

By: Date:

Authorized Signature:

Title:

ANTI-KICKBACK AFFIDAVIT

STATE OF

COUNTY OF

I, the undersigned, hereby duly sworn, depose and say that no portion of the sum negotiated will be paid to any employees of , its elected officials and or its design consultants, as a commission, kickback, reward or gift, directly or indirectly by me or any member of my firm or by an officer of the corporation.

Authorized Signature

Title

STATE OF:

COUNTY OF:

NON-COLLUSIVE AFFIDAVIT

STATE OF

COUNTY OF

, being first duly sworn, deposes and says that:

1. He/she is the Owner, (Owner, Partner, Officer, Representative or Agent) of

, the firm that has submitted the attached submittal;

2. He/she is fully informed respecting the preparation and contents of the attached submittal and of all pertinent circumstances respecting such solicitation;

3. Such submittal is genuine and is not collusive or a sham;

4. Neither the said firm nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affiant, have in any way colluded, conspired, connived or agreed, directly or indirectly, with any other firm or person to submit a collusive or sham submittal in connection with the Work for which the attached submittal has been submitted; or to refrain from submitting in connection with such work; or have in any manner, directly or indirectly, sought by person to fix the price or prices, or to fix any overhead, profit, or cost elements of the fees negotiated or of any other firm, or to secure through any collusion, conspiracy, connivance, or unlawful agreement any advantage against (Recipient), or any person interested in the proposed work;

Signed, sealed and delivered

In the presence of:

AUTHORIZED SIGNATURE

WITNESS

PRINTED NAME / TITLE

WITNESS

CERTIFICATION FOR DISCLOSURE OF LOBBYING

ACTIVITIES ON FEDERAL-AID CONTRACTS

(Compliance with 49CFR, Section 20.100 (b))

The prospective participant certifies, by signing this certification, that to the best of his or her knowledge and belief:

(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 federal 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'', 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.

The prospective participant also agrees by submitting his or her proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed, $100,000 and that all such subrecipients shall certify and disclose accordingly.

Authorized Signature:

DISCLOSURE OF LOBBYING ACTIVITIES

1. Type of Federal Action:

a. contract

b. grant

c. cooperative agreement

d. loan

e. loan guarantee

f. loan insurance

2. Status of Federal Action:

a. bid/offer/application

b. initial award

c. post-award

3. Report Type:

a. initial filing

b. material change For Material Change Only:

Year: Quarter:

Date of last report:

(mm/dd/yyyy)

4. Name and Address of Reporting Entity:

Prime Subawardee

Tier , if known:

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

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

(if individual, last name, first name, MI):

b. Individuals Performing Services (including address if different from No. 10a)

(last name, first name, MI):

11. 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 available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

Signature: _ _ _

Print Name:

Telephone No.: Date (mm/dd/yyyy):

Federal Use Only:

Authorized for Local Reproduction Standard Form LLL (Rev. 7-

97)

INSTRUCTIONS FOR COMPLETION OF SF-LLL

DISCLOSURE OF LOBBYING ACTIVITIES

This disclosure form shall be completed by the reporting entity, whether sub-awardee 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 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 a covered Federal action.

Complete all 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.

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. Identify the appropriate classification of this report. If this is a follow-up 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 previously submitted report by this reporting entity for this covered Federal action.

4. Enter the full name, address, city, State and zip code of the reporting entity. Include

Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the sub-awardee, e.g., the first sub-awardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

5. If the organization filing the report in item 4 checks "Sub-awardee," 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 organizational level 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. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Qualifications (RFQ) 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., "RFQ-DE-90-001."

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.

According to the Paperwork Reduction 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.