Bid No________________

Format of Bid Proposal & Required FormsBid Proposal Check List

Non-Technical Specifications

Section 00300

1. Form of Proposal - Project Title

A. Base Bid Amount

B. Contract Time

C. Bid Security

D. Addenda Receipt

E. Principal's Declaration

F. Sub Bidder Listing

G. Bidders' No-Bid

2. Public Entity Crime Statement

3. Conflict of Interest Certificate

4. Qualification Certification Form is required.

5. Office of Economic Opportunity (OEO) Requirements

A. Proposed Schedule of OEO Participation-Base Bid OEO Form 1

B. Proposed Schedule of OEO Participation (On Alternates Only) OEO Form 1A

C. Letter of Intent to Perform as a Subcontractor OEO Form 2

D. OEO Identification Affidavit OEO Form 2A

E. Prime Contractor Affidavit OEO Form 3

F. Pre-Award Waiver for Good Faith Efforts OEO Form 4. Must be submitted if goals are not met in OEO Form 1.

G. OEO Monthly Participation Report OEO form 5

H. Change Order Participation OEO Form 6

6. Additional OEO Forms (OEO Forms 5, 6) These forms needed during construction.

7. Certification Regarding Drug Free Workplace Requirements

8. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion

9. Non-Collusion Affidavit

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Bid No________________

SECTION 00300 FORM OF PROPOSAL

BID NO. ________________________

DCSB PROJECT NO. _______________

PROPOSAL FOR: (Project Title)

SUBMITTED BY: (Firm)

CONTRACTOR'S FEDERAL TAX ID NO.

CONTRACTOR'S LICENSE NO:

QUALIFIER'S NAME:

ADDRESS:

TELEPHONE/FAX:

DATE SUBMITTED:__________________________, 20

TO: DUVAL COUNTY SCHOOL BOARD OF DUVAL COUNTY, FLORIDA

The undersigned Bidder, as a Principal, named herein, declares that he fully represents his Firm and is authorized to enter into legal agreements; that this Proposal is made freely and without connection with other persons, companies or parties submitting other Proposals; that this Proposal is in all respects fair and in good faith, without collusion or fraud; and that all parties directly interested in this Proposal are listed herein.

The Bidder further declares that he has examined the site(s) of the Work and informed himself fully in regard to all conditions pertaining to the site(s) where the Work is to be performed; that he has read and examined the Drawings, Specifications and other Contract Documents for the Work and has satisfied himself fully in regard to the Work to be performed.

The Bidder proposes and agrees, if this Proposal is accepted, to enter into a Contract with the Duval County School Board of Duval County, Florida, in contract form specified, to furnish all necessary materials, equipment, machinery, tools apparatus, means of transportation and labor necessary to complete the Contract in full and complete accordance with the requirements of the Drawings and Specifications and other Contract Documents acceptable to the Duval County School Board of Duval County, Florida. The Bidder acknowledges that additional money will not be allowed for extra work except as set forth in the attached General Conditions and Contract Documents. Pursuant to Florida Statutes, Duval County School Board (Owner) is exempt from Florida Sales Tax on the purchase of construction material and equipment and has elected to exercise this right. All bids are to be submitted with all applicable taxes included.

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Bid No________________

A. BASE BID PROPOSAL:

The Bidder proposes and agrees to furnish all labor, material and equipment necessary to accomplish the Work in accordance with the Drawings and Specifications for the lump sum price of Jean Ribault High School No. 96: Dollars ($ ___________________________)DCSB Project No. M-83980

B. CONTRACT TIME:

Bidder agrees to commence the work under this Contract on a date to be specified in a written Notice to Proceed and shall Substantially Complete all work thereunder within ___ consecutive calendar days and shall obtain Final Completion of all work thereunder within 30 consecutive calendar days after Substantial Completion. Additional Contract Time shall not be granted except by Change Order. This time includes average rain days and holidays.

C. BID SECURITY:

Bidder agrees that in the case of failure on his part to execute the said Contract and the Performance Bond within ten (10) consecutive calendar days after receiving same, the Bid Security accompanying this Proposal and the monies payable thereon, shall be paid into the funds of the Duval County School Board of Duval County, Florida, as Liquidated Damages for such failure; otherwise the Bid Security accompanying this Proposal shall be returned to the undersigned.

Attached hereto is a certified check on ________________________________________________

Bank of ___________________________________________________________ in the amount of

($ ___________________) or a Bid Bond in an amount not less than five percent (5%) of the bid amount made payable to the Duval County School Board of Duval County, Florida. Submit original and copy of Bid Security.

D. ADDENDA RECEIPT:

Bidders shall acknowledge below the receipt of Addenda, if any, to Plans, Specifications and Contract Documents

ADDENDUM NO. _______________________ DATED ______________________

ADDENDUM NO. _______________________ DATED ______________________

ADDENDUM NO. _______________________ DATED ______________________

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Bid No________________

ADDENDUM NO. _______________________ DATED ______________________

LEGAL SIGNATURE: _____________________________________________

TITLE: _______________________________________________________

E. PRINCIPAL'S DECLARATION:

The Bidder shall provide below the full names, business address and business and emergency telephone numbers of persons and firms directly interested in the foregoing bid. List sole proprietors, partners or corporate officers as appropriate:

NAME ADDRESS TELEPHONE NUMBERS

LEGAL SIGNATURE:

TITLE:

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Bid No________________

F. SUB-BIDDER (SUBCONTRACTOR) LISTING:

A. The Bidder shall identify on the attached SUB-BIDDERS LIST those Sub-Bidders (Subcontractors, suppliers, manufacturers, etc.) he intends to Subcontract with should he be awarded a Contract resulting from this Proposal.

1. He shall indicate each Subcontractor, supplier, product or material manufacturer, fabricator or equipment manufacturer by trade or specialty listed on the SUB-BIDDERS LIST.

2. He shall indicate each Subcontractor, supplier, product or material manufacturer, fabricator or equipment manufacturer by trade or specialty if their work exceeds five percent (5%) of the total bid amount and is not listed on the attached SUB-BIDDERS LIST.

3. The Bidder shall also indicate any major division of work performed by his own forces listed on the attached SUB-BIDDERS LIST or which exceeds five percent (5%) of the total bid amount. Bidder is cautioned not to list his own forces for work he does not intend to perform or for which he is not legally qualified.

B. Bidders failing to identify on the attached SUB-BIDDERS LIST the Subcontractors, suppliers, product or material manufacturers, equipment manufacturers, fabricators, etc., listed (or others of 5% or more of total bid) may be disqualified and bid may be rejected.

Instructions:

1. List all sub-bidders where the amount to be paid each Sub-Bidder exceeds five percent (5%) of bid amount.

2. Company name and telephone MUST be included.

3. Specify if the sub-bidder is a material-supplier only.

4. If additional space is need, complete on separate sheet of 8.5x11 paper and label accordingly.

5. Do not include alternates.

Mechanical:

Other:_____________________________________________________________________

__________________________________________________________________________

Specialties: ______

LEGAL SIGNATURE:

TITLE:

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Bid No________________

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Bid No________________

G. BIDDER’S “NO-BID”

UNABLE TO SUBMIT A BID? We sincerely hope this is not the case. If your firm cannot submit a bid at this time, please provide the information requested in the space provided below and return it to:

Executive Director Facilities Design and Construction

Duval County School Board 1701 Prudential Drive, 5th Floor Jacksonville, Florida 32207

We have received an Invitation to Bid No. _________________ ______

Title of Project ____________________________ ____________________

Opening Date ___________________________.

We are unable to submit a bid at this time due to the following reasons:

_________________________________________________________ _________

______________________________________________________ ____________ ______________________________________________________ ____________

Name of Firm _________________________________________________ ___

Signature and Title ______________________________________ ________

Street Address or P.O. Box ____________________________ ___________

City, State, Zip Code ________________________________ ____________

If submitting a "No Bid," RETURN BID PACKAGE TO DESIGN PROFESSIONAL at the address indicated herein.

Return this form ONLY.

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Bid No________________

FLORIDA STATUTES ON PUBLIC ENTITY CRIMES

THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS.

1. This sworn statement is submitted to ______ ____ (print name of the public entity)

by:____________________________________________________________________________(print individual's name and title)

whose business address is_________________________________________________________ and (if applicable) its Federal Employer Identification Number (FEIN) is ______________________.

(If the entity has no FEIN, include the Social Security and, if applicable, Federal Employee Identification Number (FEIN) of the individual signing this

sworn statement: __________________________. If the entity has no FEIN, include the

Social Security Number of the individual signing this sworn statement_______________________.

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 or 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 that "convicted" or "conviction" as defined in Paragraph 287.133(1)(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 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. I understand that an "affiliate" as defined in Paragraph 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 36 months shall be considered an affiliate.

5. 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 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 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.

6. 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.)

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Bid No________________ ______ Neither the entity submitting this sworn statement, nor any of its officers, directors, executives, partners,

shareholders, employees, members, or agents who are active in 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 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 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)

Date:__________________________________

STATE OF ______________________________________

COUNTY OF _____________________________________

Sworn to and Subscribed Before Me This _____ Day of ________________, 20_____.

Personally Known _________________________ _____________________________ (NOTARY PUBLIC) OR Produced Identification __________________ _____________________________

(NOTARY PUBLIC) Notary Public - State of ______________________________________________________________________ (Type of Identification) My Commission Expires: _____________________________

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Bid No________________CONFLICT OF INTEREST CERTIFICATE

Bidder must execute either Section I or Section II hereunder relative to Florida Statute 112.313(12). Failure to execute either section may result in rejection of this bid proposal.

SECTION I

I hereby certify that no official or employee of the City or independent agency requiring the goods or services described in these specifications has a material financial interest in this company.

______________________________ ____________________________________________Signature Company Name

______________________________ ____________________________________________Name of Official (type or print) Business Address

________________________________________City, State, Zip Code

SECTION II

I hereby certify that the following named City official(s) and employee(s) having material financial interest(s) (in excess of 5%) in this company have filed Conflict of Interest Statements with the Supervisor of Elections, 105 East Monroe Street, Jacksonville, Duval County Florida, prior to bid opening. Name Title or Position Date of Filing

_______________________ ________________________ ____________________

_______________________ ________________________ ____________________

___________________________________ ___________________________________Signature Company Name

__________________________________ ___________________________________Print Name of Certifying Official Business Address

_________________________________________City, State, Zip Code

PUBLIC OFFICIAL DISCLOSURE

Section 126.111 of the Purchasing Code requires that a public official who has a financial interest in a bid or contract make a disclosure at the time that the bid or contract is submitted or at the time that the public official acquires a financial interest in the bid or contract. Please provide disclosure, if applicable, with bid.

Public Official Position Held Position or Relationship with Bidder

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Bid No________________

QUALIFICATION CERTIFICATION FORM

Bidder certifies that in the past 5 years it has successfully completed at least two projects of similar size and complexity to the one bid herein.

Project Name Project Number

Bidder

DATE NAME OF PROJECT OWNER OWNER REP# $ VALUE SQFT

I hereby certify the foregoing to be true and correct.

(Name) (Date)

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PROPOSED SCHEDULE OF SBE and/or M/WBE PARTICIPATION (FORM 1)

Project Title:

Date:

Code(see

below)

Firm Name Phone # Scope of Work to be Subcontracted

(indicate if the Contract will include Labor and Material)

Dollar Value

Codes Code Description Total Dollar Value ($) Percentage of Base Bid (%)

AA African American Participation ___________________ __________________

HANA Hispanic, Asian, Native American Participation

___________________ __________________

WBE Women Owned Participation ___________________ __________________

SBE Small Business Enterprise ___________________ __________________

TOTAL Participation ___________________ __________________

The undersigned will enter into a formal Agreement with the SBE and/ or M/WBE firms (Subcontractors/Proposers) identified herein for work listed in this schedule conditioned upon execution of a contract with the Duval County Public School.

Signature: ________________________________________

Title: ________________________________________

Under penalties of perjury, I declare that I have read for foregoing conditions and instructions and the facts as revealed to the DCPS herein are true to the best of my knowledge and beliefs.

This form is required by DCPS and must be submitted with the bidder’s or proposer’s response to bid or Request for Proposal (RFP). If this form is not submitted at the time of submittal, the bid or RFP will be rejected.

OEO Form 103/2015

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PROPOSED SCHEDULE OF SBE and/or M/WBE PARTICIPATION(ON ALTERNATE NO. _____) (Form 1A)

Project Title:

Date:

Code Firm Name Phone # Scope of Work to be Subcontracted

(indicate if the Contract will include Labor and Material)

Dollar Value

Codes Code Description Total Dollar Value ($) Percentage of Base Bid (%)

AA AFRICAN AMERICAN ___________________ __________________

HANA Hispanic, Asian, Native American Participation

___________________ __________________

WBE Women Owned Participation ___________________ __________________

SBE Small Business Enterprise ___________________ __________________

TOTAL Participation ___________________ __________________

The undersigned will enter into a formal Agreement with the SBE and/or M/WBE firms (Subcontractors/Proposers) identified herein for work listed in this schedule conditioned upon execution of a contract with the Duval County Public School.

Signature: ________________________________________

Title: ________________________________________

Under penalties of perjury, I declare that I have read for foregoing conditions and instructions and the facts as revealed to the DCPS herein are true to the best of my knowledge and beliefs.

OEO Form 1ARevised 12/9/2014

Section 00300 Revised 04/2015 00300 - 13DCSB Non-Tech (Front End Specs)

LETTER OF INTENT TO PERFORM AS A SBE and /or M/WBE SUBCONTRACTOR/PROPOSER (FORM 2)

TO: _________________________________________________________________________________(The name of General Contractor/Consultant)

DCSB PROJECT NAME & NO.:_________________________________________________________

____________________________________________________________________________________

The undersigned intends to perform work in connection with the above project as (check one):

[ ] an individual [ ] a corporation [ ] a partnership [ ] a joint venture

The status of the undersigned is confirmed as a qualified SBE and/or M/WBE contractor by the DCSB Office of Economic Opportunity.The undersigned is prepared to perform the following work in connection with the above project:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(Specify in detail, work items or parts thereof to be performed)

at the following price: $______________. Of which, _________ Percent (%) of the dollar value of this subcontract will be sublet and/or awarded to non-minority subcontractors.

The undersigned agrees to enter into a formal Agreement with you to perform the above work, if you are awarded the prime contract. (For Professional Services contracts, proposers need not enter into contractual agreements with any SBE or M/WBE at this time.)

________________________(Date)

________________________(Telephone Number)

________________________(Fax Number)

____________________________________(S/MBE Firm Name)

____________________________________(Type or Print Name)

____________________________________(S/MBE Firm Address)

____________________________________(Signature)

____________________________________(City State & Zip Code)

___________________________________(Title)

____________________________________(M/WBE Firm Name)

____________________________________(Type or Print Name)

____________________________________(M/WBE Firm Address)

____________________________________(Signature)

____________________________________(City State & Zip Code)

___________________________________(Title)

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OEO FORM 2

OFFICE OF ECONOMIC OPPORTUNITYIDENTIFICATION AFFIDAVIT

(Form 2A)

STATE OF ___________________

COUNTY OF _________________

I HEREBY DECLARE AND AFFIRM THAT I AM THE ________________________________

____________________________________________________________________________________(Give Title: Owner, President and duly authorized representative of Co-Venturer, etc.)

_____________________________________________________________________ whose address is (Name of Firm)____________________________________________________________________________________

(Address)

I hereby declare and affirm that I am a certified Small Business Enterprise (SBE) with DCPS and/or a Minority/ Women Business Enterprise (M/WBE) with DCPS as defined by the contract documents cited below, and that I will provide on request information to document this fact.

This firm is interested in quoting/bidding on the following categories of work being procured by the Duval County School Board under Project No. _______________.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(Specify in detail, work items or parts thereof to be performed)Attachment

Under penalties of perjury I declare that I have read the foregoing conditions and instruction and the facts are true to the best of my knowledge and beliefs.

(Date) (Signature) (Title)

OEO Form 2ARevised 03/2015

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PRIME CONTRACTOR AFFIDAVIT

STATE OF ________________

COUNTY OF __________________

BEFORE ME, THE UNDERSIGNED AUTHORITY, THIS DAY PERSONALLY APPEARED _____________

_______________________________________________ (NAME OF CONTRACTOR) HEREBY KNOWN AS THE

“AFFIANT,” WHO BEING BY ME FIRST DULY SWORN, DEPOSES, AND SAYS:

THAT THE AFFIANT IS A CONTRACTOR WHO IS SUBMITTING A BID ON A DUVALCOUNTY PUBLIC SCHOOL PROJECT.

THAT IN CONJUNCTION WITH THE SUBMISSION OF THIS BID IN ORDER TO COMPLY WITH THE REQUIREMENTS OF THE DUVAL COUNTY SCHOOL BOARD’S SMALL AND MINORITY/ WOMEN BUSINESS PROGRAM, THE AFFIANT, PRIOR TO THE DATE OF THIS AFFIDAVIT, HAS CONTACTED THE SUBCONTRACTORS LISTED ON THE OFFICE OF ECONMOIC OPPORTUNITY (OEO) FORM 1, SCHEDULEOF SBE AND/OR M/WBE PARTICIPATION, WHO HAS AGREED TO ENTER INTO A CONTRACT ON THE PROJECT ASSUBCONTRACTORS/SUPPLIERS FOR THE WORK INDICATED IN THE BID TO THE DCPS.

_______________________________________AFFIANT’S NAME

SWORE TO AND SUBSCRIBED BEFORE ME UNDER OATH THIS ____________ DAY OF

________________________ 20 ____.

____________________________________________

NOTARY PUBLIC’S SIGNATURE

____________________________________________

NOTARY PUBLIC’S NAME (TYPE OR PRINT)

PERSONALLY KNOWN ___________________ PRODUCED IDENTIFICATION _______________________

TYPE OF IDENTIFICATION PRODUCED _______________________________________________________

OEO FORM 303/2015

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Pre-Award Waiver for Good Faith Efforts (OEO Form 4)

Note: Completion of this form is not required if established goals are met or exceeded.

□ Minority/Women Business Enterprises (M/WBE) □ Small Business Enterprise (SBE)

CONTRACTOR FIRM:

PROJECT TITLE:

PROJECT NUMBER: DATE:

The bidder may request a full or partial waiver of the mandatory Small, Minority and Women Business Enterprise goals established for the project for good cause by submitting this Form 4 and documentation to the OEO. Under no circumstances shall waiver of a mandatory subcontracting requirement be granted without submission of adequate documentation of Good Faith Efforts by the vendor and careful review by the OEO. A prime contractor will need a minimum score of 80 points in order to demonstrate a good faith effort. Any act or omission by the District shall not relieve the bidder of this responsibility. The OEO shall base its determination of a waiver request on the following criteria:Criteria listed below are excerpted from the DCPS Policy 7.72 and the Procedures Manual. A response is required to address each cited paragraph. Additional pages may be added as necessary.

1. Prime Contractor Attendance at DCPS pre-bid conference, if held: □ Yes □ No □ Not Held (5 points)

2. Whether and when the bidder provided written notice to all certified MWBE/SBE listed in the DCPS OEO Directory that can perform the type of work to be subcontracted and advising the MWBE/SBE of the specific work the bidders intends to subcontract; acknowledgement of MWBE/SBE interest in the contract is being solicited; and how to obtain information for the review and inspection of contract plans and specifications. (20 points)

Provide complete list of all MWBE/SBE solicited.

Provide the date letters were transmitted (MWBE/SBE will be canvassed as to who sent them letters and what date they were received.) Provide a copy of solicitation and all other letters sent to M/WBE/SBE. Recommended information in your solicitation letter should have included, but was not be limited to, the following:

Project specific information Name of Prime Contractor Areas of work available for subcontracting Contact person’s name and phone number

(SBE and M/WBE firms will be canvassed regarding your responsiveness to their calls and project information they received from

your firm.) Bonding requirements of your firm Availability of specifications and plans

through your office. Bid opening date and all addendum

information. Your requirements/time frames/payment

schedules.

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3. Has the bidder selected feasible portions of work to be performed by SBE and M/WBE, including, where appropriate, breaking into subcontracts or combining elements of work into feasible units? The ability of the bidder to perform work with its own work force will not in itself excuse a bidder from making positive efforts to meet the established goals. (15 points)

If appropriate, detail any subcontracting category that you have broken down to assist SBE and M/WBE firms and list firms that have been made aware of this reduced scope.

Subcontracting Category MWBE/SBE FIRM

4. Has the bidder provided interested MWBE/SBE firms with assistance in reviewing the contract plans and specifications? Name the MWBE/SBE firms provided assistance, and describe how your firm provided such assistance including documentation (15 points)

5. Whether the bidder advertised in general circulation, trade association, and/or minority/women – focused media concerning the subcontracting opportunities. (5 points)The minority focused papers include:BLACK HISPANIC OTHER

________ ___________ ___

List which paper carried your ad and attach a copy of the ad

6. Has the bidder followed up initial solicitations of interest by contacting MWBE/SBE’s to determine with certainty whether the MWBE/SBE was interested? (15 points)

Name the MWBE/SBE you followed up with and describe your follow up efforts.

7. Has the bidder negotiated in good faith with interested MWBE/SBE, not rejecting MWBE/SBE as unqualified without sound reasons and based on a thorough investigation of their capabilities? (10 points)

a. Provide a detailed statement of the reasons why subcontracts were not entered into with a sufficient number of MWBE/SBEs to meet the established goals.

b. Provide a list of MWBE/SBE Subcontractors you deemed unqualified and provide an explanation of the conclusion you reached.

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c. For those MWBE/SBE Subcontractors contacted, but determined to be unavailable, provide either:i. A signed letter to the bidder from the MWBE/SBE stating they are unavailable;

ORii. A statement from the bidder that the MWBE/SBE refused to submit a letter after a

reasonable request; and a detailed statement from the Bidder of the reasons for the bidder’s conclusion.

8. Has the bidder effectively used the services of available minority/women community organizations; minority/women contractors’ groups; local, state and federal minority/women business assistance offices; and other organizations that provide assistance in the recruitment and placement of minority/women business enterprises? (5 points)List small or business enterprise organizations and minority/women organizations contacted.

Organization Person ContactedPhone

NumberDate

Contacted

9. Describe any efforts to advise and assist interested MWBE/SBE Subcontractors in obtaining supplier relationships, bonds, lines of credit, or insurance. (10 points) Please provide a list of MWBE/SBE Subcontractors you assisted.

_______________________________ _________ ____________________SIGNATURE OF COMPANY OFFICIAL DATE COMPANY ADDRESS

_______________________ ______________________________________________ PRINT NAME CITY/STATE/ZIP

_______________________ _______________ _______________________POSITION TELEPHONE FAX

OEO FORM 403/2015

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OFFICE OF ECONOMIC OPPORTUNITYUTILIZATION REPORT

(OEO Form 5) Name of Contractor / Consultant: For the Time Period of:

Project Title: Project No.:

Total Contract Amount: Contact Person: Phone#: Email: Annual Contract If Annual, please note Activation No.: SBE Goal: _______________ W/MBE Goal: ________________

Type of Project: A/E Construction Design Construction Management Professional Services

Code Firm Name Scope of Work Monthly Payments Cumulative Payments

PERCENTAGE OF OVERALL CONTRACT COMPLETION: ___________%The undersigned hereby affirms and declares that the above listed firms were actually employed in the performance of work services under this contract, and further that each such firm earned and has been paid the stated amounts for their respective efforts.

Under penalties of perjury, I declare that I have read the foregoing conditions and instructions and the facts are true to the best of my knowledge and beliefs.

Signature Title

Date

NOTE: THIS FORM MUST BE COMPLETED AND SUBMITTED WITH CONTRACTOR’S REQUEST FOR MONTHLY AND FINAL PAYMENTS. IN ADDITION, PLEASE SUBMIT A COPY OF THIS FORM DIRECTLY TO

THE OFFICE OF ECONOMIC OPPORTUNITY AT: 4880 BULLS BAY HIGHWAY, JACKSONVILLE, FL 32219

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OFFICE OF ECONOMIC OPPORTUNITYCHANGE ORDER PARTICIPATION FORM

Name of Contractor/Consultant

Project Title:Date:

SBE, M/WBE/Non-SBE/Non-MBE

Firms Name

Phone # Scope of Work to be subcontracted (indicate if the contract will include labor &

material)

Dollar Value of Change

Order

Code Code Description Total Dollar Value [$]

Percentage of Contract Amount as a result of the Change Order[%]

AA African American Participation ___________

HANA Hispanic, Asian, Native American Participation

___________

WBE Women Owned Participation ___________

SBE

TOTAL

Small Business Enterprise Participation

___________ ________________Please attach the justification letter to this form along worth any necessary backup data.

ADDITIONAL INFORMATION:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Signature: __________________________________

Title: _____________________________________

OEO FORM 6Revised 3/2015

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CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS

The grantee certifies that it will provide a drug-free workplace by:

(a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the grantee’s workplace and specifying the actions that will be taken against employees for violation of such prohibition;

(b) Establishing a drug-free awareness program to inform employees about –

(1) The dangers of drug abuse in the workplace;(2) The grantee’s policy of maintaining a drug-free workplace;(3) Any available drug counseling, rehabilitation and employee assistance programs, and(4) The penalties that may be imposed upon employees for drug abuse violations occurring in the

workplace.

(c) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph (a);

(d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will-

(1) Abide by the terms of the statement; and(2) Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no

later than five days after each conviction;

(e) Notifying the agency within ten days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction;

(f) Taking one of the following actions, within 30 days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted-

(1) Taking appropriate personnel action against such an employee, up to and including termination; or(2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program

approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency;

(g) Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a), (b), (c), (d), (e) and (f).

_________________________________________________________Typed Name and Title of Certification Official

____________________________ ________________Signature Date

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This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, 13 CFR Part 145. The regulations were published as Part VII of the May 26, 1988 Federal Register (pages 19160-19211). Copies of the regulations are available from local offices of the U.S. Small Business Administration.

(BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON NEXT PAGE)

(1) The prospective primary participant certifies to the best of its knowledge and belief that it and its principals:

(a)

(b)

(c)

(d)

Are not presently debarred, suspended, proposed for disbarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency;

Have not within a three-year period preceding this application been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under 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;

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 (1)(b) of this certification; and

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.

(2) Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective primary participant shall attach an explanation to this proposal.

Business Name

Date By Name and Title of Authorized Representative

Signature of Authorized Representative

SBA Form 1623 (10-88)Section 00300 Revised 04/2015 00300 - 24DCSB Non-Tech (Front End Specs)

Certification RegardingDebarment, Suspension, and Other Responsibility

Matters Primary Covered Transactions

Certification RegardingDebarment, Suspension, and Other Responsibility

Matters Primary Covered Transactions

Certification RegardingDebarment, Suspension, and Other Responsibility

Matters Primary Covered Transactions

Certification RegardingDebarment, Suspension, and Other Responsibility

Matters Primary Covered Transactions

Certification RegardingDebarment, Suspension, and Other Responsibility

Matters Primary Covered Transactions

Certification RegardingDebarment, Suspension, and Other Responsibility

Matters Primary Covered Transactions

Certification RegardingDebarment, Suspension, and Other Responsibility

Matters Primary Covered Transactions

INSTRUCTIONS FOR CERTIFICATION REGARDING DEBARMENT

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

2. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation shall disqualify such person from participation in this transaction.

3. The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction. If is is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default.

4. The prospective primary participant shall provide immediate written notice to the department or agency to which this proposal is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

5. 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 department or agency to which this proposal is submitted for assistance in obtaining a copy of those regulations (13 CFR Part 145).

6. The prospective primary 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 entering into this transaction.

7. The prospective primary participant further agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion--Lower Tier Covered Transactions," provided by the department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.

8. 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 ineligibility of its principals. Each participant may, but is not required to, check the Nonprocurement List.

9. 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 is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

10. Except for transactions authorized under paragraph 6 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 or agency may terminate this transaction for cause or default.

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NON-COLLUSION AFFIDAVITState of FLORIDA

Contract /RFP / ITB No. ________________________

County of DUVAL

(Title)

(Name of Firm)

and I am authorized to execute this affidavit on behalf of my firm, its owners, directors, and officers. I am the person responsible in my firm for the price(s), guarantees and the total financial commitment represented in the firm's offer.

I hereby attest that:

(1) The price(s) and amount(s) in the offer have been arrived at independently and without consultation, communication or agreement with any other contractor, respondent, or potential respondent.

(2) Neither the price(s) nor the amount(s) of the offer, and neither the approximate price(s) nor approximate amount(s) of the offer, have been disclosed to any other firm or person who is a respondent or potential respondent, nor were they disclosed prior to opening of offers.

(3) The offer from my firm is made in good faith and no attempt has been made to induce any firm or person to refrain from submitting an offer, or to submit an offer higher than our offer, or to submit any intentionally high or noncompetitive offer or other form of complementary offer.

(4) _____________________________, its affiliates, subsidiaries,(Name of Firm)

officers, directors, employees 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 bidding, proposing or offering on any public contract, except as follows:

I attest that ________________________________________________________(Name of Firm)

understands and acknowledges that the above representations are material and important, and will be relied on by DUVAL COUNTY PUBLIC SCHOOLS in awarding the contract for which this offer is submitted. I understand and my firm understands that any misstatement in this affidavit is and shall be treated as fraudulent concealment from DUVAL COUNTY PUBLIC SCHOOLS of the true facts relating to submission of offers for this contract.

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(Signature) (Date)

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INSTRUCTIONS FOR COMPLETION OF NON-COLLUSION AFFIDAVIT

1. This Non-Collusion Affidavit is material to any contract awarded utilizing federal funds.

2. This Non-Collusion Affidavit shall be executed by the member, officer, or employee of the offering firm who makes the final decision on prices and the amount(s) quoted in the proposal.

3. Proposal rigging and other efforts to restrain competition and the making of false sworn statements in connection with the submission of offers are unlawful and may be subject to criminal prosecution. The person who signs the Affidavit shall examine it carefully before signing and assure himself or herself that each statement is true and accurate, making diligent inquiry, as necessary, of all other persons employed by or associated with the respondent with responsibilities for the preparation, approval or submission of the offer.

4. In the case of an offer submitted by a joint venture, each party to the venture must be identified in the proposal documents, and an Affidavit must be submitted separately on behalf of each party.

5. The term "complementary offer'' as used in the Affidavit has the meaning commonly associated with that term in the solicitation process, and includes the knowing submission of offers higher than the offer of another firm, an intentionally high or noncompetitive offer, and any other form of an offer submitted for the purpose of giving a false appearance of competition.

6. Failure to file a completed Affidavit in compliance with these instructions will result in disqualification of the offer.

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