INTENT TO QUALIFY UTILITY CONTRACTORS

FOR THE

CITY OF LAKELAND

PIPELINE, PUMP STATION/TREATMENT,

AND CONSTRUCTION MANAGEMENT

AT RISK (CMAR) SERVICES

December 4, 2024

RFQ No. 2025-RFQ-009

Prepared for

CITY OF LAKELAND WATER UTILITIES

501 East Lemon Street Lakeland, Florida 33801-5079

Prepared by

KIMLEY-HORN AND ASSOCATES, INC.

109 South Kentucky Avenue

Lakeland, Florida 33801

Project No. 046194050

TABLE OF CONTENTS TOC - 1 046194050 / June 2024

INTENT TO QUALIFY UTILITY CONTRACTORS

PIPELINE, PUMP STATION/TREATMENT, AND CONSTRUCTION MANAGEMENT

AT RISK (CMAR) SERVICES

TABLE OF CONTENTS

PREQUALIFICATION REQUIREMENTS

Invitation to Qualify Prequalification Agreement

EXHIBIT 1: PROCUREMENT AND CONTRACTING REQUIREMENTS GROUP

Division 00 Procurement and Contracting Requirements

Section 00 42 00 - Bidder Qualification Statement

00 45 19 - Non-Collusion Affidavit

00 45 40 - Trench Safety Act Compliance

00 45 46 - Public Crimes Statement

00 45 60 - Drug Free Program Certification

TECHNICAL SPECIFICATIONS AND BID FORM (NOT INCLUDED). WILL BE

PROVIDED SEPARATELY WITHIN EACH BID PACKAGE.

City of Lakeland

Pipeline, Pump Stations/Treatment, and CMAR Services 00 00 00-3

SECTION I - SCOPE AND INTENT

A. Purpose:

The City of Lakeland (the City) is seeking to pre-qualify contractors for each of the four categories of work, including pipelines, pump stations/treatment plants, CMAR, and other services. The Pre-Qualified contractors will compete for a series of work orders associated with the construction of infrastructure projects as they become available from the City or City’s design consultant, or requested CMAR services, as deemed appropriate by the City.

This section defines the project and the minimum information that the City requires of a utility contracting firm to be considered for Pre-Qualified status. It also describes the process and criteria that the City will use to evaluate the Statement of Qualifications (SOQ) submitted by each firm and select the Pre-Qualified firms for each category.

These Contractors will then be asked to provide bids to the City for the construction of design packages, emergency work, misc. work, or CMAR services. The amount of work can vary based on the needs of the City, and the volume of work listed is by no means a guarantee of the amount of work that may become available. The lowest, most acceptable bidder will be selected by the City to perform the construction from among the successful prequalified contractors unless otherwise noted by the City. The total scope of work for the prequalified contractors to compete upon consists of various emergency and/or planned work on any of the City’s infrastructure, and CMAR Services. Before any prequalified contractor is awarded more than one work package they will need to demonstrate to the satisfaction of the City that they have sufficient resources to fully satisfy the City’s budget, schedule and quality requirements.

Miscellaneous Utility Projects The pre-qualified contractors may be asked to prepare bids for miscellaneous utility projects such as Grit System Improvements, Tank Cleaning/Hauling Grit, Emergency Repairs, Install/Replace/Repair Utilities, Pump/Lift Station Rehabilitation, CMAR services of AC Water Main Replacement project, or other projects not yet identified. The City makes no guarantee of the number or value of other miscellaneous utility projects that the pre-qualified contractors will be asked to bid on.

Number of Pre-Qualified Contractors The City expects to qualify at least four (4) utility contractors but the number of prequalified contractors selected will be within the discretion of the City.

B. General Background:

The City is seeking contractors with experience in either pipeline construction, pump station/treatment construction, or CMAR services for emergency and/or planned infrastructure work.

There is one exhibit included with this Intent to Qualify (herein called “ITQ”). Exhibit 1 contains all of the Division 0 – Bidding and Contract Documents for review. These are the forms and conditions that the Pre-Qualified Contractors will use for any specific Request for Proposal (RFP) issued by the City. The Contractor must agree to the use of these documents. The actual and CMAR Services 00 00 00-4 bid form is not included and will be sent to the qualified contractors with each of the bid packages when issued.

C. Tentative Schedule

ITEM DESCRIPTION/ACTION DATE

1. Pre-Qualification meeting, City Purchasing

REFER TO DATES IN

OPENGOV

2. Public receipt of all properly completed Statement of Qualifications (SOQ)

REFER TO DATES IN

OPENGOV

Note: All times and dates are noted as tentative. The City reserves the right to change any action, time or date as in the best interest of the City.

D. Project Duration:

The Contract shall remain in effect for one (1) year with four possible one (1) year extensions, unless terminated as provided for herein.

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SECTION II - CONTRACTOR’S QUALIFICATIONS

1. Company Description:

The Contractor shall provide a brief history of the company (or companies if a joint venture).

Complete the Questionnaire that is part of Section III of this ITQ for the project category of choice. The information requested below may repeat some of the information required in the Questionnaire but provides the Contractor an opportunity to elaborate on specific issues of concern to the City. Page limit: 2 pages plus Questionnaire and documentation.

2. Company Personnel:

The Contractor shall provide an Organizational Chart and list of key company personnel who would be directing or managing work associated with this ITQ. This would likely include personnel from the job superintendent to the company President. The personnel information provided should include: person’s name, title, office location, educational background, brief employment history, and years of experience in the construction of related project category.

If applicable, include and identify key subcontractors that the firm intends to use on the work along with their resumes. Page limit: 8 pages.

3. Previous Experience Narrative:

Only submit information on the categories submitting for (i.e. pipeline, pump station/treatment, CMAR, and Other).

For pipeline construction category (if applicable), the description of relevant project experience shall include the years of installing pipelines. Of interest to the City are projects constructed within the last five (5) years. Include the following information for each: the name of the project, the name of the Owner/municipality for which the work was performed, the diameter of the pipe installed, the materials of construction of the pipe, the installation method employed (open cut, jack and bore, microtunnel, HDD, etc.), the approximate length of each installation, the initial project budget/schedule, and the final budget/schedule.

Provide a project reference and contact information for these projects. Page limit: 8 pages.

For pump stations/treatment plants category (if applicable), the description of relevant project experience shall include the years of installing pump stations or treatment plants. Of interest to the City are projects constructed within the last five (5) years. Include the following information for each: the name of the project, the name of the Owner/municipality for which the work was performed, size of pump station installed, capacity of treatment plant constructed, pipeline installation method employed (jack and bore, HDD, etc.), the initial project budget/schedule, and the final budget/schedule. Provide a project reference and contact information for these projects. Page limit: 8 pages.

For CMAR services category (if applicable), the description of relevant project experience shall include the years of service as a CMAR for utility projects. Of interest to the City are projects constructed within the last five (5) years. Include the following information for each:

the name of the project, the name of the Owner/municipality for which the work was performed, information regarding experience and qualifications of CMAR’s key staff to be and CMAR Services 00 00 00-6 assigned to the services, any significant or unique accomplishments, recognition, or awards received, the initial project budget/schedule, and the final budget/schedule. Provide a project reference and contact information for these projects. Page limit: 8 pages.

For Other services category (if applicable), the description of relevant project experience shall include the years of service of items not included within the pipeline, pump stations/treatment, and CMAR categories (i.e. grit removal, electrical and instrumentation, pipe lining, telemetry, etc). Of interest to the City are projects constructed within the last five

(5) years. Include the following information for each: the name of the project, the name of the Owner/municipality for which the work was performed, information regarding experience and qualifications of key staff to be assigned to the services, any significant or unique accomplishments, recognition, or awards received, the initial project budget/schedule, and the final budget/schedule. Provide a project reference and contact information for these projects. Page limit: 8 pages.

4. General Project Approach:

Based on the project description, the accompanying documents and available information, describe the general approach the firm would use to accomplish the work. Specific issues of concern that should be addressed are:

1. Technical approach and personnel assignment – discuss the general approach the Contractor would take to execute the project and the personnel. Identify related work in Florida and reference back to the Experience Narrative, if appropriate.

2. Project Management and Scheduling – discuss the proposed project management system including approach to sequencing the work, schedule tracking and adjustment, dealing with unanticipated conditions/events, document management, and change orders. Include company work load/availability projection for 2025-2029 and companies methodology of ensuring adequate staffing for projects.

3. Maintenance of vehicular and pedestrian traffic, it is important to the City to understand the Contractor approach to management and reduction of impact to the community. This includes ‘public relations’ aspect of the work as well as the technical features. Reference to similar past projects is suggested.

4. Site Safety – the Contractor is responsible for site safety and the City is very conscious of the hazards that can accompany this type of construction in commercial and suburban settings. Relate information provided in the information package to the actual project execution.

5. Page limit: 10 pages.

5. Additional Information:

The Contractor may provide additional information to that requested above, if it deems it to be pertinent to more fully characterize the Contractor’s value to the City or describe why the City should select the firm. Page limit: 2 pages.

Note: For page limits, front and back counts as 2-pages. Organizing tabs are not included in the page count. Font for the narrative sections shall be Arial or similar, 11-pt minimum.

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SECTION III - EVALUATION AND SELECTION

Each of the submittal qualification packages will be reviewed by City of Lakeland Water Utilities staff members. The review team will also evaluate the requested narratives for clarity, relevance and insight.

An Evaluation Matrix will be used (see copy attached) in determining the short-listed firms.

Interviews of the contractor teams by the selection committee may occur to assist in the shortlisting effort. Be sure to answer the points listed above as required and give special attention to the matrix in your answers.

ITEM

DESCRIPTION

MAXIMUM

POINTS

TOTAL

POINTS

1.

Three References of Projects of Similar Scope and Magnitude Within the Past 5 Years for each category of bid (pipelines, pump stations/treatment, CMAR)

2. General project approach based on review of the company profile

3.

Information provided in the questionnaire. The information must be presented accurately, clearly, and in a professional manner.

4 Previous experience of Contractor 7

5 Contractors Safety Record 7

6. Financial and bonding ability of the Prime Contractor to perform this work

7.

Length of Time in Business (Prime Contractor)

8. 2025 – 2029 Work Load Projections 7

9.

Key Personnel (Background and Positions)

10.

Team Organization Chart (Include In-House and the Disciplines to be Subcontracted)

11. Willingness to meet time & budget 7

12. Local Business Preference 5

Total Available Points: 100 and CMAR Services 00 10 00-1

The number of prequalified contractors selected will be within the discretion of the City.

Those selected receiving the highest point values after the evaluation will be considered the City’s Pre-Qualified Contractors for this project, and comprise the organizations selected to provide bids in the future. The Qualified Contractors will be invited to enter into a Prequalification Agreement with the City and the form of agreement with each bid shall be a Task Authorization issued by the City.

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00 42 00-0

SECTION 00 42 00

BIDDER QUALIFICATION STATEMENT

The Bidder warrants the truth and accuracy of all statements and answers herein contained.

(Include additional sheets if necessary.)

THIS QUALIFICATION STATEMENT MUST BE COMPLETED AND SUBMITTED WITH

YOUR BID.

Part I General Information

Company Name:

Mailing Address:

Physical Address:

Name of Contact:

Telephone Number: ( ) Fax: ( )

Form of Business: Corporation ____ Partnership ____ Sole Proprietor ____

Age of Firm:_________

Number of Full-Time Employees:

Administrative, Project Management, and General Office

Field Superintends and Foreman

Skilled Labor and Trades

General Labor and Unskilled Labor

List categories and types of work within each category in which your firm is qualified and performs work on a regular basis, using additional sheets if needed.

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List categories for which your firm regularly subcontracts others, using additional sheets if needed. List the name(s) of subcontractors proposed for this project (i.e. electrical subcontractor).

List the name(s) of suppliers proposed for this project.

List equipment that your firm currently owns, using additional sheets if needed.

Describe your firm’s preventative maintenance / predictive maintenance program for equipment in and out of the field.

List equipment that your firm typically rents, using additional sheets if needed.

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What specific steps have you taken to examine the physical conditions at or contiguous to the site, including but not limited to, the location of underground utilities?

Does your firm have a written quality assurance/quality control program? Yes No

. If yes, please provide a copy.

Does your firm have a written safety program? Yes ______ No ______. If yes, please provide a copy.

Does your firm employ the critical path method for scheduling? Yes No , if your firm does not employ the critical path method, please describe your scheduling procedure in detail attaching additional sheets if needed.

Does your firm employ computerized scheduling? Yes No , if your firm does not use computerized scheduling, please explain why your firm does not attaching additional sheets if necessary.

If your firm uses computerized scheduling, please list the software used.

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Business Volume

Indicate the annual dollar volume for the past five years.

2019 $ _______________________________

2020 $ _______________________________

2021 $ _______________________________

2022 $ _______________________________

2023 $ _______________________________

Indicate the volume of work for which you presently have contracts, but have not started or completed to date: $ .

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00 42 00-4

Financial Information

For a firm showing a net worth in excess of $1,000,000, the applicant must provide, with the questionnaire, a copy of its financial statement as audited or reviewed for its last fiscal year, prepared in accordance with the standards of the American Institute of Certified Public

Accountants. The statement must be prepared by an independent certified public accountant registered and licensed under the laws of any state. Balance sheets, income statements, a statement of retained earnings, supporting schedules and notes, and the opinion of the independent auditor must accompany the financial statement. A compiled Financial Statement is not acceptable. Firms that do not have individual financial reports must provide a Parent Firm

Pledge of Net Worth form.

Bonding

Name of Bonding Company

Address

Contact

Telephone

Total Bonding Capacity

Single Project Capacity

Current Bonding in Effect

Note: The City will keep financial information confidential to the extent provided by law.

Insurance

Name of Insurance Agent

Address

Contact Telephone

Commercial General Liability $

Workers Compensation $

Business Automobile Liability $

Umbrella Liability $

Builders Risk / Installation Floater $ and CMAR Services

00 42 00-5

Crane or Riggers Liability $

Professional Liability $

Insurance requirements suitable to the pipeline, pumpstation/treatment, and construction management at risk (CMAR) projects and this prequalification have been set by the City and is attached. If you do not currently meet the limits required by the City, are you able to obtain insurance as required by the City?

Part II Company Personal and Affiliates:

1. List the principal officers in your firm, or if not a corporation the owners. Please include titles attaching additional sheets if necessary.

2. List the members of your firm that are involved in the management and supervision of projects other than those listed above attaching additional sheets if necessary.

3. List all owners (including individuals, companies or corporations) owning 10% or more of the firm attaching additional sheets if necessary.

4. List affiliates of the applicant including but not limited to joint ventures, subsidiaries, parent company, companies owned and controlled by the parent company, and any company or firm having some mutual owners as the applicant which does business with the applicant attaching additional sheets if necessary and CMAR Services

00 42 00-6

5. Identify each of those listed in Question 4 above who also own 10% or more financial interest in any other firm applying for prequalification for this project attaching additional sheets if necessary.

Part III Business Type & Other Information

1. If a partnership: list names and addresses of partners; if a corporation: list names of officers, directors, shareholders, and state of incorporation; if joint venture: list names and address of venturers and the same if any venture is a corporation for each such corporation, partnership, or joint venture:

2. If your company is a corporation, what is the date of incorporation: and what state is it incorporated:

3. How many years has your business been in business as a prime contractor , and as a subcontractor .

4. If your company is licensed to do business in the State of Florida, please provide your license number , classification , and expiration

5. In whose name is the above license issued:

6. If you have a chief estimator, what is their name:

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00 42 00-7

7. Has your company defaulted on any public project in the preceding 10 years? If yes, please include the governmental agency, project, date, location, and a detailed explanation using additional sheets if necessary.

Yes _____No _____Explain

8. Has your firm or any officer of your firm been indicted, charged, pled guilty, or convicted of any offenses that resulted in firm being debarred or excluded from bidding or performing any governmental work, if yes please describe in detail using additional sheets if necessary.

Yes No

Explain

9. Is your firm under the protection of the bankruptcy court, has any pending petitions in bankruptcy court, or have you made assignment for the benefit of creditors, if yes please describe in detail using additional sheets.

Yes No Explain

10. In the last 10 years has your firm received any unsatisfactory safety ratings or been in violation of any OSHA requirements/regulations, if yes, please explain in detail using additional sheets if needed. Yes No

11. Has your firm or any parent/subsidiary firms been denied prequalification in the last 10 years by any federal, state, or local agency or political subdivision, if yes, please explain in detail using additional sheets if needed. Yes No

00 42 00-8

12. In the last 10 years, has your firm filed a formal claim against any owner, if yes, please explain in detail using additional sheets if needed. Yes No

13. In the last 10 years, has any owner filed a formal claim against your firm, if yes, please explain in detail using additional sheets if needed. Yes No

14. In the last 10 years, has your firm been assessed liquated damages by any owner, if yes, please explain in detail using additional sheets if needed. Yes No

15. Describe and give the dates and owner of the last three government projects completed which are similar in type, different in size showing the range of projects worked on (for a public entity) (Not older than five years year). Include contact name, phone number and contract amount:

(1)

(2)

(3)

00 42 00-9

16. Describe and give the dates and owner of the last two emergency repair government projects completed which are similar in type, size and nature as the one proposed (for a public entity).

Include contact name, phone number and contract amount:

(1)

(2)

Check which category(s) your company is looking to qualify for (may select multiple):

Pipelines Pump Station/Treatment Plant

Construction Management at Risk (CMAR) Other (Describe)

For chosen category of work, please check items in which you have experience:

Pipelines:

Augur Boring - 24-inch diameter casing and less

Augur Boring - Greater than 24-inch diameter casing and greater

Horizontal Directional Drill – 24-inch diameter or less

Horizontal Directional Drill – 24-inch diameter or greater

Pipelines, Development, 8-inch diameter and smaller

Pipelines, Urban and Renewal, 8-inch diameter and smaller

Pipelines, Development, 12-inch diameter and smaller

Pipelines, Urban and Renewal, 12-inch diameter and smaller

Pipelines, Development, 24-inches and smaller

Pipelines, Development, 42-inches and smaller

Pipelines, Development, 42-inches and larger

00 42 00-10

Pump Stations/Treatment Plants:

Treatment Plan Experience – 1MGD – 5MGD

Treatment Plant Experience – Between 5MGD -10 MGD

Treatment Plant Experience – 10 MGD and Above

Pump Size Experience – 25-50 HP

Pump Size Experience – 50-100 HP

Pump Size Experience – 100-200 HP

Pump Size Experience – 200 HP and above

Sewer Bypass Pumping, 18-inches and smaller

Sewer Bypass Pumping, 18-inches to 36-inches

Sewer Bypass Pumping, 36-inches and larger

Construction Management at Risk (CMAR):

Underground Water or Wastewater Utilities as CMAR

Water or Wastewater Treatment Plant Rehabilitations as CMAR

Pump Station/Lift Station as CMAR

Other:

Grit Removal

Pipe Lining

Electrical & Instrumentation

Telemetry

END OF SECTION

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Revised: July 2023 00 45 19-1

SECTION 00 45 19

NON-COLLUSION AFFIDAVIT

State of

County of

, being first duly sworn, deposes and says that:

Name

(1) He is of , the

Title Company Bidder that has submitted the attached bid;

(2) He is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid;

(3) Such Bid is genuine and is not a collusive or sham Bid;

(4) Neither the said Bidder not 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 if any other Bidder; not has fixed any overhead, profit or cost element of the Bid price, or the Bid price of any other Bidder; not has secured through any collusion, conspiracy, connivance or unlawful agreement, any advantage against the City of Lakeland, Florida or any person interested in the proposed Contract;

And

(5) 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.

(Signed)

Name

Title

Subscribed and sworn to before me this day of , 20

Revised: July 2023 00 45 19-2

Signature

Title

My commission expires and CMAR Services

Revised: September 2023 00 45 40-1

SECTION 00 45 40

TRENCH SAFETY ACT COMPLIANCE

Trench Excavation Safety System and Shoring, Special (Trench Excavation) General:

1. The Contractor shall comply with the Florida Trench Safety Act (90-96), Laws of FL.

effective October 1, 1990.

2. The Contractor(s) performing trench safety excavation on this Contract shall comply with to these standards as adopted by the Department of Labor and Employment Security (DLES).

3. By submission of his bid and subsequent execution of this Contract, the Contractor certifies that all trench excavation done within his control shall be accomplished in strict adherence with OSHA trench safety standards contained in including all subsequent revisions or updates to these standards as adopted by the Department of Labor and Employment Security.

4. The Contractor also agrees that he has obtained or will obtain identical certification from his proposed Subcontractors that will perform trench excavation prior to award of the subcontracts and that he will retain such certifications in his files for a period of not less than three years following final acceptance.

5. The Contractor shall consider all available geotechnical information in his design of the trench excavation safety system.

6.

deficiencies will be corrected on the spot or the job may be closed. Imminent danger citing will result in the immediate cessation of work. Work will resume when the danger is corrected.

7. Bidder acknowledges that included in the various items of the proposal and in the Total Bid Price will be costs for complying with the Florida Trench Safety Act (90-96), Laws of FL. effective October 1, 1990.

THIS PAGE INTENTIONALLY LEFT BLANK

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SECTION 00 45 46

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

THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY

PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS.

1. This sworn statement is submitted to the City of Lakeland, Florida by for

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

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

2. 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 such an agency or political subdivision of any other state or of the United States and involving anti-trust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.

3.

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, nonjury trial, or entry of a plea of guilty or nolo contendere.

4. Florida Statutes, means:

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1.) A predecessor or successor of a person convicted of a public entity crime: or 2.) 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 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 s length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters in to 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.

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 and which bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity.

6. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. (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 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 the 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. 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).

I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING

OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR

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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 OF ANY CHANGE IN THE INFORMATION

CONTAINED IN THIS FORM.

(Signature)

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

Personally known

OR Produced Identification Notary Public-State of

(Type of Identification) My commission expires

(Printed, Typed or Stamped Commissioned Name of Notary Public) and CMAR Services

Revised: September 2023 00 45 60-1

SECTION 00 45 60

DRUG-FREE PROGRAM

CERTIFICATION

Contract No.:

Title/Description:

I, , (name) (title) of , hereby certify that this firm has implemented

(name of firm) a drug-free workplace program in accordance with the provisions of Section 287.087, Florida Statutes.

(Signature) (Date)

287.087 Preference to businesses with drug-free workplace programs. --Whenever two or more bids, proposals, or replies that are equal with respect to price, quality, and service are received by the state or by any political subdivision for the procurement of commodities or contractual services, a bid, proposal, or reply received from a business that certifies that it has implemented a drug-free workplace program shall be given preference in the award process. 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 business'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.