T26-19 - Bid Specs.pdf

COLUMBIA COUNTY BOARD OF COUNTY COMMISSIONERS

PROJECT NUMBER T26-19

2025-2026 Annual Resurfacing – D4 SE Adams Str

NOTICE TO CONTRACTORS

Notice is hereby given that sealed bids will be received in the Columbia County Manager’s office until 2:00 P.M. on July 23, 2026 for Columbia County Project No. T26-19. This office is located on the second floor of the Courthouse Annex at 135 Hernando Avenue, Room 203 Lake City FL 32055.

Mixing existing surface and base course in place, and then placement of new asphalt pavement in one course - 165 lbs/sy - 20’ in width. This roadway length is approximately 7300 LF or 1.39 miles.

Scope of work includes, mixing in place, finishing mixed base, grading, asphaltic concrete pavement, erosion control, grassing, painted pavement markings, and incidental items.

The Bid Forms and Construction specifications may be obtained from the County’s web site at http://www.columbiacountyfla.com/PurchasingBids.asp. Deadline for questions regarding construction plans, specifications, and/or bid documents must be received before 2:00 P.M. on July 16, 2026.

The successful bidder will be required to furnish the County Manager with a 5% bid bond with submittal, and if selected, furnish the County Manager with a performance bond and proof of liability insurance prior to commencing work.

The Columbia County Commission reserves the right to reject any or all bids and to add to the contract or delete from the contract to stay within their funding capabilities.

http://www.columbiacountyfla.com/PurchasingBids.asp http://www.columbiacountyfla.com/PurchasingBids.asp

GENERAL INSTRUCTIONS TO BIDDERS

These instructions will bind bidders and conditions herein set forth, except as specifically qualified in special bid and contract terms issued with any individual bid.

1. The following criteria are used in determining low responsible bidder:

The ability, capacity and skill of bidder to perform required service.

Whether the bidder can perform service promptly or within specified time.

The determined character, integrity, reputation, judgment, experience and efficiency of bidder.

The performance of previous contracts with Columbia County or entities similar to

Columbia County.

The suitability of equipment or material for County use.

The ability of bidder to provide future maintenance.

2. Payment Terms are net thirty (30) unless otherwise specified. Favorable terms, discounts, may be offered and will be considered in determining low bids if they are deemed by

Purchasing Department to be advantageous to the County.

3. All bids should be tabulated, totaled and checked for accuracy. Where applicable, the provided unit price will prevail in case of discrepancies or other errors.

4. All requested information shall be included in the envelope. All desired information must be included for your bid to receive full consideration.

5. If anything on the bid request is not clear, you should contact the Purchasing Director immediately.

6. A bidders list is available at the Purchasing Office.

7. Quote all prices F.O.B. our warehouse or as specified in bid documents.

8. Each proposal shall be clearly marked on the outside of the envelope including Fed Ex, UPS or other delivery service envelopes, as a sealed bid. The name of the item being bid shall be shown on the outside in full.

9. The County shall not be liable for any bid opened prematurely if that bid was not sealed in a properly marked envelope.

10. If only one (1) bid is received, the bid may be rejected and re-advertised or excepted if determined to be in the counties best interest.

11. Bids received late will not be accepted. It is the bidder’s sole responsibility to ensure proposals are timely delivered and received before the deadline.

12. Telephone and facsimile bids will not be accepted under any circumstances. Should a timely delivered bid be misplaced by the County but later found before ranking occurs, the bid will be considered. A bidder may request a receipt showing the day and time a bid envelope is delivered to the appropriate office of the County.

13. Bids requiring bid bonds will not be accepted if bond is not enclosed. Cash or certified check will be accepted in lieu of bond except on construction projects with a project budget exceeding $40,000.

14. Upon request of the Purchasing Office or County Manager, a bidder must provide proof that the bidder has the requisite organization, capital, plant, stock, ability, and experience to perform the contract contemplated by the Request for Proposals/Qualifications or

Invitation to Bid.

15. Any alterations, erasures, additions, or omissions of required information or any changes to specifications or bidding schedule are done at the risk of the bidder. Any bid will be rejected that has a substantial variation, that is; a variation that affects price, quantity, and quality or delivery date (when delivery is required by a specific time).

16. When requested, samples will be furnished to the County free of expense, properly marked for identification and accompanied by a list where there is more than one (1) sample. The

County reserves the right to mutilate or destroy any sample submitted whenever it may be to the best interest of the County to do so for the purpose of testing.

17. The County will reject any material, supplies or equipment that did not meet the specifications, even though the bidder lists the trade names or names of such material on the bid or price quotation form.

18. The unauthorized use of patented articles is done entirely at the risk of the successful bidder.

19. The ESTIMATED QUANTITY given in the specifications or advertisements is for the purpose of bidding only. The County may purchase more or less than the estimated quantity and the vendor must not assume that such estimated quantity is part of the contract.

20. Only the latest model equipment as evidenced by the manufacture’s current published literature will be considered. Obsolete models of equipment not in production will not be acceptable. The equipment shall be composed of new parts and materials. Any unit containing used parts or having seen any service other than the necessary tests will be rejected. In addition to the equipment specifically called for in the specification, all equipment catalogued by the manufacturer as standard or required by the State of Florida shall be furnished with the equipment. Where required by the State of Florida Motor

Vehicle Code, vehicles shall be inspected and bear the latest inspection sticker of the

Florida Department of Revenue.

21. The successful bidder on motor vehicle equipment shall be required to furnish with delivery of vehicle, certificate of origin and any other appropriate documentation as required by the

Florida Motor Vehicle Department.

22. Prospective bidders are required to examine the location of the proposed work or delivery and determine, in their own way, the difficulties, which are likely to be encountered in the prosecution of the same.

23. All materials, equipment and supplies shall be subject to rigid inspection, under the immediate supervision of the Purchasing Department, its designee and /or the department to which they are delivered. If defective material, equipment, or supplies are discovered, the contractor, upon being instructed by the Purchasing Department or designee, shall remove, or make good such material, equipment, or supplies without extra compensation.

It is expressly understood and agreed that the inspection of materials by the County will in no way lessen the responsibility of the Contractor release him from his obligation to perform and deliver to the County Sound and satisfactory materials, equipment, or supplies.

The Contractor agrees to pay the costs of all tests upon defective material, equipment, or supplies or allow the costs to be deducted from any monies due him from the County.

24. Unless otherwise specified by the Purchasing Department all materials, supplies, or equipment quoted herein must be delivered within thirty (30) days from the day of notification or exceptions noted on bid sheets.

25. A contract will not be awarded to any corporation, firm, or individual who is, from any cause, in arrears to the County or who has failed in former contracts with the County to perform work satisfactorily, either to the character of the work, the fulfillment or guarantee, or the time consumed in completing the work.

26. Reasonable grounds for supposing that any bidder is interested in more than one proposal for the same item will be considered sufficient cause for rejection of all proposals in which he is interested.

27. Submitting a proposal when the bidder intends to sublet the contract may be a cause for rejection of bids or cancellation of the contract by the County Manager.

28. Unless otherwise specified, the County reserves the right to award each items separately or on a lump sum basis whichever is in the best interest of the County.

29. 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.

30. The County reserves the right to reject any quotations or specifications and the right to waive minor discrepancies as to all bidders equally, when such rejection or waiver is deemed to be in the best interest of the County. For unit priced items, the County may elect to purchase part, all, or none of the materials, supplies, or equipment specified in a bid.

31. The bidder or the bidder's authorized representative or agent must sign the bid in the space provided. Unsigned bids will be rejected. Signature must be "wet" signatures in ink.

Typewritten or printed signatures will not be accepted.

32. Any bidder may withdraw his/her bid at any time before the time set for the opening of the bids.

33. It is mutually understood and agreed that if at any time the Purchasing Department or designee shall be of the opinion that the contract or any part thereof is unnecessarily delayed or that the rate of progress or delivery is unsatisfactory, or that the contractor is willfully violating any of the conditions or covenants of the agreement, or executing the same in bad faith, the Purchasing Department or his/her designee shall have the power to notify the contractor of the nature of the complaint. Notification shall constitute delivery of notice, or letter to address given in the proposal. If after three (3) working days of notification the conditions are not corrected to the satisfaction of the Purchasing Officer, he shall have the power to take whatever action necessary to complete the work or delivery and the expense shall be deducted from any paid by the County out of such monies as may become due to the said contractor. In case such expense shall exceed the last said sum, then and in that event, the bondsman or the contractor, his/her executors, administrators, successors, or assigns, shall pay the amounts of such excess to the County on notice made by the Purchasing Department or his/her designee of the excess due.

34. If the bidder proposes to furnish any item of foreign make or product, he shall write

“foreign” together with the name of the originating country opposite such item on a proposal.

35. Any complaint from bidders relative to the invitation to bid or attached specifications shall be made prior to the time of opening bids; otherwise, the bidder waives any such complaint.

36. Contracts may be cancelled by the County with or without cause on thirty- (30) days advance written notice.

37. All contractors submitting bids for road projects in excess of $250,000 must be pre-qualified with the Florida Department of Transportation and shall provide proof of such qualification.

38. Any bidder affected adversely by an intended decision with respect to the award of any bid, shall file with the Purchasing Department for Columbia County, a written notice of intent to file a protest not later than seventy-two (72) hours (excluding Saturdays, Sundays and legal holidays), after the posting of the bid tabulation. Protest procedures may be obtained in the Purchasing Department.

39. A person or affiliate who has been placed on the convicted vendor's list following a conviction for a public entity crime may not submit a bid on a contract to provide any goods or services to Columbia County, may not submit a bid on a contract with Columbia County for the construction or repair of a public building or public work, may not submit bids on leases of real property to Columbia County, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with Columbia County, and may not transact business with Columbia County for a period of 36 months from the date of being placed on the convicted vendor list.

40. Vendor/Contractor shall utilize the U.S. Department of Homeland Security’s E-Verify system, in accordance with the terms governing use of the system, to confirm the employment eligibility of;

All persons employed by the Vendor/Contractor during the term of the Contract to perform employment duties within Florida; and

All persons, including subcontractors, assigned by the Vendor/Contractor to perform work pursuant to the contract with the County.

41. Contractor shall register on line at https://www.columbiacountyfla.com/PurchasingBids.asp for this specific project. All addendums are delivered via email through this website, and it is the contractor’s responsibility to ensure all addendums are used in the bid submittal.

https://www.columbiacountyfla.com/PurchasingBids.asp

2025-2026 Annual Resurfacing – D4 SE Adams Str

BID PROPOSAL

THE UNDERSIGNED hereby proposes to furnish all materials, labor and supervision for the construction of the subject project including conformance with the construction requirements and specifications for the following unit prices:

Contractor Name (PRINT): __________________________

Contactor Signature: __________________________

PAY ITEM NOTES

MOT

Shall include all elements required per FDOT standards and include temporary centerline/stop bar delineation at all non working times, stationing/offsets, and any edge of pavement reclamation where required.

Silt Fence

Shall be placed at all areas of potential stormwater runoff as directed by the Engineer.

Mixing Existing Pavement Average depth shall be 8-10 inches and shall be achieved with a mixing machine or engineer approved equivalent. Mixing depth shall be to the bottom of the existing base layer/top of subgrade.

Finishing Mixed Base/Shoulder Includes construction layouts required, scarifying, shaping, shoulder clipping, compacting, finishing, and priming for placement of asphalt and sod. 2% cross slope shall me maintained. If roadway is in superelevation, cross slopes shall match existing superelevation slopes.

Borrow Shall be placed at direction of engineer

Subsoil Exc.

Item includes cost to remove 2’ of unsuitable material and replace with suitable fill in 6” lifts meeting density requirements and shall be performed at direction of engineer

Asphalt 12.5

Includes placement of SP 12.5 @ +/-165 lb/sy. To maintain level access to driveways, an apron shall be required at all driveway locations unless other directed by engineer and will be paid for under this item.

Seed and Mulch

Shall be placed at all disturbed areas not sodded, as directed by the engineer.

Sod Includes cost to place sod in areas directed by the engineer.

ITEM UNIT QUANTITY UNIT COST TOTAL

1 Mobilization LS 1 2 Maintenance of Traffic LS 1 3 Silt Fence LF 800 4 Mixing Existing Pavement (+/- 10") SY 16222 5 Finishing Mixed Base and Shoulder SY 21000 6 Borrow CY 200 7 Subsoil Excavation CY 2500 8 Asphaltic Conc. SP 12.5 - Structural TN 1380 9 Seed and Mulch LS 1

10 Sod - 42" SY 5700 11 Painted Pavement Markings LS 1

TOTAL:

Painted Pavement Markings

Shall include striping the roadway back to existing layout and shall include stop bars at all stop conditions, centerline/edgeline striping (2 coats each)

ALL ITEMS MAY BE INCREASED, DECREASED, OR OMITTED AS DIRECTED BY THE ENGINEER.

• ALL MATERIALS AND CONSTRUCTION SHALL CONFORM TO BOTH THE REQUIREMENTS OF THE LATEST FDOT STANDARD SPECIFICATIONS FOR ROAD AND BRIDGE CONSTRUCTION AND THE LATEST FDOT DESIGN STANDARDS.

• ALL INCIDENTAL WORK INCLUDED IN THESE ITEMS. ALL UNIT PRICE AND TOTAL SPACES MUST BE FILLED IN TO

CORRELATE WITH EACH ITEM

Company Name: (SEAL)

Authorized Company

Representative:

Printed Name Signature

Attested By:

Printed Name Signature

Total Bid Amount:

Date:

General Requirements

I. General.

Mixing existing surface and base course in place, and then placement of new asphalt pavement in one course - 165 lbs/sy - 20’ in width. This roadway length is approximately 7300 LF or 1.39 miles.

Scope of work includes, mixing in place, finishing mixed base, grading, asphaltic concrete pavement, erosion control, grassing, painted pavement markings, and incidental items.

II. Contract Time

The contract time shall be 60 calendar days from the date of contract execution. The contractor will be required to return executed contract to Erica Jones, Columbia County Purchasing Director and Chad Williams, Columbia County Engineer, within 14 days of Board approval. Time can be extended by mutual agreement between both parties. Liquidated damages shall be based on FDOT specifications. No work is allowed on Saturdays, Sundays, and/or County designated holidays.

Contractor shall provide a construction schedule with the bid package detailing time frames/lines showing how the project will be constructed. The schedule will be taken into consideration in the bid review process and bids submitted without the schedule could be reason for a bid to not receive full consideration.

III. Construction and Materials

All construction methods and materials shall conform to the requirements of the latest edition of the Florida Department of Transportation Design Standards and Florida Department of Transportation Standard Specifications for Road and Bridge Construction.

V. Maintenance of Traffic

Contractor shall provide Maintenance of Traffic and it shall conform to the requirements of the latest edition of the Florida Department of Transportation Design Standards.

Flagging will be required and only one traffic lane may be closed between the hours of 8:30 A.M. to 4:30 P.M. only.

All construction signage shall be provided by the contractor.

CENTERLINE DELINEATION SHALL BE REQUIRED AT ALL NON-WORKING TIMES.

VI. Compensation

Payment shall be made on a monthly basis on work completed with 5% retainage. Contractor invoice shall include Columbia County Invoice Cover Sheet.

SECTION VII. FORMS

FORM A

VENDOR INFORMATION AND SIGNATURE FORM

Vendor Name

Trade License (If applicable)

Contact Person(s)

Street Address with City, State and Zip Code

Mailing Address (If different from Above)

Phone Number

Fax Number

E-Mail

Proposer will do the work as ____Individual ____Joint Venture ____Partnership

____Corporation

Date and State of Incorporation

DATE:_____________ STATE: _________________

Name of partnership or joint venture

By signing below, the submission shall be deemed a representation and certification by the

Proposing Firm that you have investigated all aspects of the solicitation, have read and understand the solicitation, and acknowledge all addenda.

Authorized Signature:

Printed Name of Signer:

Date Signed:

Title of Signatory:

Non-Collusion Affidavit

STATE OF_____________________

COUNTY OF

I state that I

__________________________________________________of

(Name and Title) (Name of Firm) am authorized to make this affidavit on behalf of my firm and its owner, directors and officers. I am the person responsible in my firm for the price(s) and amount(s) of this Response, and the preparation of the Response. I state that:

1. The price(s) and amount(s) of this Response have been arrived at independently and without consultation, communication or agreement with any other Provider, potential provider, Proposal, or potential Proposal.

2. Neither the price(s) nor the amount(s) of this Response, and neither the approximate price(s) nor approximate amount(s) of this Response, have been disclosed to any other firm or person who is a Piovicler, potential Provider, Proposal, or potential Proposal, and they will not be disclosed before Proposal opening.

3. No attempt has been made or will be made to induce any firm or persons to refrain from submitting a Response for this contract, or to submit a price(s) higher that the prices in this Response, or to submit any intentionally high or noncompetitive price(s) or other form of complementary Response.

4. The Response of my firm is made in good faith and not pursuant to any agreement or discussion with, or inducement from, any firm or person to submit a complementary or other noncompetitive Response.

5.

its affiliates, subsidiaries, officers, director, and employees (Name of Firm) are not currently under investigation, by any governmental agency and have not in the last three years been convicted or found liable for any act prohibited by State or Federal law in any jurisdiction, involving conspiracy or collusion with respect to Proposal, on any public contract, except as follows:

I state that I and the named firm understand and acknowledge that the above representations are material and important, and will be relied on by the Board of County Commissioners of Columbia County, Florida for which this Response is submitted. I understand and my firm understands that any misstatement in this affidavit is, and shall be treated as, fraudulent concealment from the State of Florida of the true facts relating to the submission of responses for this contract.

Dated this day of

Name of Organization:

Signed by:

Print Name:

Being duly sworn deposes and says that the information herein is true and sufficiently complete so as not to be misleading.

The foregoing instrument was executed before me this day of

20 ,by as of who personally swore or affirmed that he/she is authorized to execute this document and thereby bind the Corporation, and who is personally known to me OR has produced as identification.

(stamp) NOTARY PUBLIC, State of

Public Entity Crimes Statement

SWORN STATEMENT UNDER SECTION 287.133(3) (a), FLORIDA STATUTES: THIS

FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER

OFFICER AUTHORIZED TO ADMINISTER OATHS.

This sworn statement is submitted with Proposal, ITN, or Contract Number

2. This sworn statement is submitted by [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 Number of the individual signing this sworn statement:

3. My name is and my relationship to the above is [Please print name of individual signingi

4. I understand that a “public entity crime” as defined in section 287.133(l)(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 in Florida or with an agency or political subdivision of any other state or with the United States, including, but not limited to, any proposal or contract for goods or services to be provided to any public entity or an agency or political subdivision and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.

5. I understand that ‘convicted or ‘conviction’ as defined in section 287.133(1) (h), 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, non-jury trial, or entry of a plea of guilty or nob contenders.

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

a. A predecessor or 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 has 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 facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding thirty-six (36) months shall be considered an affiliate.

7. I understand that a ‘person as defined in section 287.133(1) (e), Florida Statutes, 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/proposals or applies to bids/proposals 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.

8. Based on information and belief, the statement, which I have marked below, is true in relation to the entity submitting this sworn statement. [Please indicate which statement applies].

Neither the entity submitting this sworn statement, nor any officers, directors, executives, partners, shareholders, employees, members, or agents who is active in the management of the entity, nor any affiliate of the entity have been 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, 1 989, AND [Please indicate which additional statement applies].

There has been a proceeding concerning the conviction before a judge or hearing officer of the State of Florida, Division of Administrative Hearings, or a court of law having proper jurisdiction. The final order entered by the hearing officer or judge did not place the person or affiliate on the convicted Contractor list. [Please attach a copy of the final order.]

The person or affiliate was placed on the convicted Contractor list. There has been a subsequent proceeding before a court of law having proper jurisdiction or a judge or hearing officer of the State of Florida, Division of Administrative Hearings. The final order entered by the judge or hearing officer determined that is was in the public interest to remove the person or affiliate from the convicted Contractor list. [Please attach a copy of the final order.]

The person or affiliate has not been placed on any convicted vendor list. [Please describe any action taken by or pending with the State of Florida, Department of Management Services.]

By the signature(s) below, IJwe, the undersigned, as authorized signatory to commit the firm, certify that the information as provided in Attachment “C”, PLiblic Entity Crimes, is truthful and correct at the time of submission.

AFFIANT

Typed Name of AFFIANT

Title

STATE OF

County OF

The foregoing instrument was executed before me this day of

20 ,by as of who personally swore or affirmed that he/she is authorized to execute this document and thereby bind the Corporation, and who is personally known to me OR has produced

Drug-Free Workplace Certification

The drug-free certification form below must be signed and returned with the solicitation response.

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 pi’ohihited 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’ 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.

3. Give each employee engaged in providing the commodities or contractual services that are under bid/proposal a copy of the statement specified in the first paragraph.

4. In the statement specified in the first paragraph, notify the employees that, as a condition of working on the commodities or contractual services that are under bid/proposal, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nob contenclere to, any violation of chapter 893, Florida Statutes, or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) Days after such conviction.

5. Impose a sanction on, or require 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.

6. Make a good faith effort to continue to maintain a drug-free workplace through implementation of the foregoing provisions.

By the signature(s) below, IJwe, the undersigned, as authorized signatory to commit the firm, certify that the information as provided in this Drug-Free Workplace Certification, is truthful and correct at the time of submission.

AFFIANT

Typed Name of AFFIANT

Title

STATE OF

County OF

The foregoing instrument was executed before me this day of

20, by as of who personally swore or affirmed that he/she is authorized to execute this document and thereby bind the Corporation, and who is personally known to me OR has produced

Conflict of Interest Statement

STATE OF

County OF

Before me, the undersigned authority, personally appeared who was duly sworn, deposes, and states:

I am the________________________________ of

______________________________________with a local office (Insert Title) (Insert Company Name) in___________________________ and principal office in

Said entity is submitting this proposal/offer to

1. The AFFIANT has made diligent inquiry and provided the information in this statement affidavit based upon its full knowledge.

2. The AFFIANT states that only one submittal for this solicitation has been submitted and tendered by the. appropriate date and time and that said above stated entity has no financial interest in other entities submitting a proposal for the work contemplated hereby.

3. Neither the AFFIANT nor the above named entity has directly or indirectly entered into any agreement, participated in any collusion or collusive activity, or otherwise taken any action which in any way restricts or restraints the competitive nature of this solicitation, including but not limited to the prior discussion of terms, conditions, pricing, or other offer parameters required by this solicitation.

4. Neither the entity nor its affiliates, nor anyone associated with them, is presently suspended or otherwise prohibited from participation in this solicitation or any contract to follow thereafter by any government entity.

5. Neither the entity nor its affiliates, nor anyone associated with them, have any potential conflict of interest because and due to any other clients, contracts, or property interests in this solicitation or the resulting project.

6. I hereby also certify that no member of the entity’s ownership or management or staff has a vested interest in any County Office or Department.

7. I certify that no member of the entity’s ownership or management is presently applying, actively seeking, or has been selected for an elected position within Columbia County government.

8. In the event that a conflict of interest is identified in the provision of services, I, the undersigned will immediately notify the County in writing.

Typed Name of AFFIANT

Title

STATE OF

County OF

The foregoing instrument was executed before me this day of

20 ,by as of who personally swore or affirmed that he/she is authorized to execute this document and thereby bind the Corporation, and who is personally known to me OR has produced

CERTIFICATE REGARDING LOBBYING AND DEBARMENT, SUSPENSION, AND

OTHER RESPONSIBILITY MATTERS

1. Lobbying

As required by Section 1352, Title 31 of the U.S. Code, and implemented at 28 CFR Part 69, for persons entering into a grant or cooperative agreement over $100,000, as defined at 28

CFR Part 69, the applicant certifies that:

A. 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 any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with the making of any federal grant, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal grant or cooperative agreement.

B. If any funds other than federal appropriated funds have been paid or will be paid 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 this federal grant or cooperative agreement, the undersigned shall complete and submit

Standard Form LLL – “Disclosure of Lobbying Activities”, in accordance with its instructions.

C. The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subgrants, contracts under grants and cooperative agreements, and subcontracts) and that all subrecipients shall certify and disclose accordingly.

2. Debarment, Suspension and Other Responsibility Matters

As required by Executive Order 12549, Debarment and Suspension, and implemented at 28

CFR Part 67 –

A. The applicant certifies that it and its principals:

I. Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of federal benefits by a State or Federal court, or voluntarily excluded from covered transactions by any federal department or agency;

II. Have not within a three-year period preceding this application been convicted of or had a civil judgement rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

III. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (a)(ii) of this certification; and

IV. Have not within a three-year period preceding this application had one or more public transactions (Federal, State or local) terminated for cause or default. (b) Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach an explanation to this application.

As the duly authorized representative of the applicant, I hereby certify that applicant will comply with the above referenced certifications.

Typed Name of AFFIANT

Title

STATE OF

County OF

The foregoing instrument was executed before me this day of

20 , by as of

, who personally swore or affirmed that he/she is authorized to execute this document and thereby bind the Corporation, and who is personally known to me OR has produced as identification.

HUMAN TRAFFICKING AFFIDAVIT

Affiant swears under pain and penalty of perjury that the company or entity does not use coercion for labor or services as defined by Florida Statute § 787.06 which is hereby incorporated by reference.

(Company or Entity Name)

Affiant who is an Officer/Authorized Representative of Company or Entity:

(Signature)

(Date) (Printed Name)

STATE OF ________________________ )

COUNTY OF ______________________ )

Sworn to and subscribed before me this _______ day of _________, 202__ by ___________________________________, by means of physical presence and ________who is personally known to me or ________ has produced _____________________________ as identification.

(NOTARY STAMP) Notary Public

W-9Form

(Rev, October2018) Department of the Treasury lnten,al Revenue Service

Request for Taxpayer Identification Number and Certification

Go to www.irs.govfFormW9 for Instructions and the latest information.

Give Form to the requester. Do not send to the IRS.

3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only One of the 4 Exemptions (codes apply only to following seven boxes. certain entities, not individuals; see instructions on page 3):

Individual/sole proprietor or U C Corporation U S Corporation U Partnership U TrustJestate single-member LLC Exempt payee code f any)

Umited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)

Note; Check the appropriate box In the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting LLC if the LLC is classified as a single-member LLC that Is disregarded from the owner unless the owner of the LLC code ‘if srianother LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that ‘ is disregarded from the owner should check the appropriate box for the tax classification of its owner.

U Other (see instructions) ‘ f4pprei (0 ccv,o,t3 ,noh,to,ed ado 5’,., U.S.)

5 Address (number, Street, and apt, or suite no.) See Instructions. Requester’s name and address (optional)

6 City, state, arid ZIP code

7 Ust account number(s) here (optional)

IiII Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other — — entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TiN, later, or Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Employer ldonttflcat on number Number To Give the Requester for guidelines on whose number to enter. — — —

ITIII Certification — — —

Under penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and

2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue

Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and

3. I am a U.S. citizen or other U.S. person (defined below); and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retrement arrangement (IRA), and generally, payments other than Interest and dMderids, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part Il, later.

Sign I Signature of Here u.s. person’ Date

General Instructions • Form 1099-DIV (dividends, Including those from stocks or mutual funds)

Section references are to the internal Revenue Code unless otherwise • Form 1 099-MISC (various types of income, prizes, awards, or gross noted. proceeds) Future developments. For the latest information about developments • Form 1099-B (stock or mutual fund sales and certain other related to Form W-9 and its Instructions, such as legislation enacted transactions by brokers) after they were published, go to www.irs.gov/FormW9.

• Form 1099-S (proceeds from real estate transactions) Purpose of Form • Form 1099-K (merchant card and third party network transactions)

Art individual or entity (Form W-9 requester) who is required to file an • Form 1098 (home mortgage interest), 1 098-E (student loan interest), information return with the IRS must obtain your correct taxpayer 1098-T (tuition) identification number (flN) which may be your social security number • Form 1 099-C (canceled debt) (SSN), Individual taxpayer identification number (1TIN), adoption

• Form 1 099-A (acquisition or abandonment of secured property)taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other Use Form W-9 only if you are a U.S. person (including a resident amount reportable on an infon’nation return. Examples of information alien), to provide your correct TIN.

returns Include, but are not limited to, the following. If you do not return Fom, W-9 to the requester with a TIN, you might

• Form 1099-INT (Interest earned or paid) be subject to backup withholding. See What Is backup withholding, later.

Cat. No. 10231X Form W-9 (Rev. 10-201 8)

1 Name (as shown on your Income tax return). Name Is required on this line; do not leave this line blank

2 Business name/disregarded entity name, If different from above

C,) S

Ca a.

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Form W-9 (Rev 10-2018) Page2

By signing the filled-out form, you:

1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued),

2. Certify that you are not subject to backup withholding, or

3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners share of effectively connected income, and

4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, Is correct. See What is FATCA reporting, later, for further Information.

Note: If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9.

Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person If you are:

• An indMdual who Is a U.S. citizen or U.S. resident alien;

• A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States;

• An estate (other than a foreign estate); or

• A domestic trust (as defined in Regulations section 301.7701 -7).

Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax under section 1446 on any foreign partners’ share of effectively connected taxable income from such business. Further, in certain cases where a Form W-9 has not been received, the rules under section 1446 require a partnership to presume that a partner isa foreign person, and pay the section 1446 withholding tax. Therefore, if you are a U.S. person that Is a partner in a partnership conducting a trade or business In the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid section 1446 withholding on your share of partnership income.

In the cases below, the following person must give Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States.

• In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the entity;

• In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally, the U.S. grantor or other U.S. owner of the grantor trust and not the trust; and

• In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a grantor trust) and not the beneficiaries of the trust.

Foreign person. If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person, do not use Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities).

Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a “saving clause.” Exceptions specified In the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes.

If you are a U.S. resident alien who Is relying on an exception contained in the savin9 clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items.

1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien.

2. The treaty article addressing the income.

3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions.

4. The type and amount of income that qualifies for the exemption from tax.

5. Sufficient facts to justify the exemption from tax under the terms of the treaty article.

Example. Article 20 of the U.S,-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes If his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protoco and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption.

If you are a nonresident alien or a foreign entity, give the requester the appropriate completed Form W-8 or Form 8233.

Backup Withholding What Is backup withholdIng? Persons making certain payments to you must under certain conditions withhold and pay to the IRS 24% of such payments. This is coiled “backup withholding.” Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, payments made in settlement of payment card and third party network transactions, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding.

You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable Interest and dividends on your tax return.

Payments you receive will be subject to backup withholding if:

1. You do not furnish your TIN to the requester,

2. You do not certify your TIN when required (see the instructions for

Part II for details),

3. The IRS tells the requester that you furnished an incorrect TIN,

4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dMdends on your tax return (for reportable interest and dividends only), or

5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only).

Certain payees and payments are exempt from backup withholding.

See Exempt payee code, later, and the separate Instructions for the Requester of Form W-9 for more information.

Also sea Special rules for partnerships, earlier.

What is FATCA Reporting?

The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all United States account holders that are specified United States persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code, later, and the Instructions for the Requester of Form W-9 for more information.

Updating Your Information You must provide updated Information to any person to whom you claimed to be an exempt payee If you are no longer an exempt payee and anticipate receiving reportable payments in the future from thIs person.