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Item #04 Approval of Motor Fuels – Tank Wagon Deliveries
1141r ocoee florida AGENDA ITEM COVER SHEET Meeting Date: October 18, 2016 Item # �1 Reviewed By: Contact Name: Stephen C. Krug Department Director: Contact Number: 6002 City Manager: mil- Subject: Motor Fuels — Tank Wagon Deliveries. Background Summary: The City is a member of the Central Florida Purchasing Cooperative where Orange County is the lead agency in solicitations that can benefit multiple municipalities. The City approved utilizing this purchasing power for petroleum products on May 1, 2012, for bulk transport loads delivered to the Public Works complex and tank wagon loads delivered to remote sites throughout the City. The County has awarded a new contract for providing the tank wagon load deliveries and is in the process of executing the new contract. Public Works is requesting Commission approval to utilize the new contract (Y16-1081) with Atlas Oil Company, and assigned to Quick Fuels Fleet Services, LLC, for as long as the contract remains valid. Issue: Request the City Commission approve the purchase of petroleum products through the existing Orange County term contract via the Central Florida Purchasing Cooperative for tank wagon load deliveries. Recommendations Recommend the City Commission approve the purchase of petroleum products through the Orange County Term Contract No. Y16-1081, Motor Fuels —Tank Wagon Deliveries with Atlas Oil Company, and as assigned to Quick Fuel Fleet Services, LLC, for as long as the contract remains valid and up to the amounts incorporated into the budget. Attachments: Orange County Interim Contract Y16-1081, Atlas Oil Company. Letter of Assignment. Financial Impact: The purchase of petroleum products is adequately funded through the fuel, oil and lubricant line items in the budget. Type of Item: (please mark with an x') Public Hearing For Clerk's Dept Use: Ordinance First Reading >6 Consent Agenda Ordinance Second Reading Public Hearing Resolution Regular Agenda x Commission Approval Discussion& Direction Original Document/Contract Attached for Execution by City Clerk Original Document/Contract Held by Department for Execution Reviewed by City Attorney .1 N/A Reviewed by Finance Dept. N/A Reviewed by ( ) N/A 2 AS O I L C O M P A N Y Fuel Distribution&Supply Management September 29, 2016 RE: Mobile Refueling Services Location Dear Valued Customer: On behalf of Atlas Oil Company, I am pleased to announce that, effective as of September 28,2016,Atlas Oil Company assigned to Quick Fuel Fleet Services, LLC ("Quick Fuel"), certain of Atlas Oil Company's interests in the performance of mobile refueling services for the above-referenced location. Accordingly, commencing on September 28, 2016, Quick Fuel will perform the mobile refueling services at the above- referenced location. For any questions relating to mobile refueling services performed prior to September 28, 2016, please contact your Atlas Oil Company sales or customer service representative. As a leading fuel services provider,Quick Fuel offers comprehensive fueling programs designed to improve efficiencies, increase productivity and make businesses more competitive. As a customer of Quick Fuel, you will benefit from Quick Fuel's continuous drive towards innovation, excellence, integrity, accountability and teamwork! • Innovation. Quick Fuel deliveries are completed utilizing a fully automated system to enhance reliability, deter fraud and limit human error. • Excellence. Quick Fuel maintains close working relationships with major oil companies to ensure that you receive only top quality, high-performance fuels. • Integrity. Quick Fuel offers unprecedented access to up-to-date fueling and fleet data using the QuickNet®on-line customer portal. • Accountability. Quick Fuel rigorously trained, hazmat-qualified drivers ensure deliveries are handled in an environmentally safe manner. • Collaboration. Quick Fuel's teams of sales and customer service representatives are at the ready to provide custom solutions that satisfy your unique fueling needs. The Atlas Team of Professional Drivers, Operations Team and Management that you have come to know and trust will be transitioning and becoming members of the Quick Fuels Team. Steve Leavitt and Billy Berry will continue to support your accounts and ensure that the excellent service you have come to know and expect continues into the future. 24501 Ecorse Road, Taylor MI 48180 (800) 878-2000 - Phone A Quick Fuel representative will contact you soon. In the meantime, if you have any questions, please contact Mike Merritt,Director—National Mobile Refuelin Sales(b email mmerrittacobusenergy.com, or by phone 704.968.8818), —. You can also continue to reach Steve Leavitt(by email steveleavitt(a�quickfuel.com or by phone 954-609-1856)or Billy Barry(by email billvberry(a,quickfuel.com or by phone 407-467-2627). Quick Fuel looks forward to serving you! Very truly yours, Very truly yours, ATLAS OIL COMPANY QUICK FUEL FLEET SERVICES,LLC eitA414 1 / By: Bob Kenyon By: Chuck Jacobus President and COO CEO 24501 Ecorse Road, Taylor MI 48180 (800) 878-2000 -Phone Krug, Stephen From: Tolbert, Joyce Sent: Monday, October 03, 2016 9:54 AM To: Krug, Stephen Subject: Atlas Letter Attachments: Atlas and Jacobus Notice to Customers re Assignment (September 28 2016).pdf Steve, Atlas' letter attached. From: Hambley, Shirley Sent: Thursday, September 29, 2016 11:48 AM To: Tolbert, Joyce; Anthony, Vanessa Cc: Brosonski, Pam; Thomas, Stephanie Subject: FW: Notice to Customers This is a notice from Atlas Oil. • From: Sandra Ray [mailto:sray(@atlasoil.com] Sent: Thursday, September 29, 2016 11:29 AM Subject: Notice to Customers Please see the attached notice. Thank you. Sandra Rayl Executive Assistant sray(&atlasoil.com I www.atlasoil.com V 313.662.3618 I F 313.447.3235 335 E Maple, Birmingham MI 48009 Simon Group Holdings We've Gone Social! Like Us. 1 r•.j PROCUREMENT DIVISION CARRIE WOODELL,MPA,CFCM.,CPPO,C.P.'VI.,APP, Manager T'a 4(M1 E South Street 2"d Floor-Kept! To:Post Office Box 1393.Orlando.FL 32502-1393 PH- .407-X 56 AA 1 t V- *X6-5X 1. U Y 1 D 6 TERM CONTRACT NO.Y16-1081 MOTOR FUELS —TANK WAGON DELIVERIES TO: Atlas Oil Company 24501 Ecorse Road Taylor, MI 48180-1641 This is to inform you that the Orange County Board of County Commissioners hereby enters into a term contract subject to the following: TERMS AND CONDITIONS 1. Acceptance: This contract is our acceptance of your offer in response to our Invitation for Bids No. Y16-1081, MOTOR FUELS — TANK WAGON DELIVERIES - Term Contract, and is subject to all terms and conditions therein. 2. Term of Contract: A. This is a term contract for the time period specified in the referenced Invitation for Bids, for the products/services covered by this contract. The County is not obligated to purchase any minimum amount of products or services, unless otherwise stipulated in the Invitation for Bids. B. This contract is effective September 1, 2016, and shall remain in effect through August 31, 2017. The estimated contract award for this period is $1,900,000. C. This contract may be renewed upon mutual agreement as provided in the Invitation for Bids. Any amendments to this contract must be in writing and signed by both parties. Such amendment(s) must be signed by the representative of the Orange County Procurement Division to be valid, binding, and enforceable. D. This contract may be cancelled or terminated as provided for in the Invitation for Bids. Page 1 of 2 3. Ordering against Contract: A. Unless otherwise specified in the Invitation for Bids, the County will place orders by issuance of a numbered Delivery Order against this contract. Each Delivery Order will specify the quantity, description and location for delivery. B. The obligations of Orange County under this contract are subject to need and availability of funds lawfully appropriated for its purpose by the Board of County Commissioners. 4. Taxes: The County has the following tax exemption certificates assigned. A. Certificate of Registry No. 59-70-004K for tax free transactions under Chapter 32, Internal Revenue Code; B. Florida Sales and Use Tax Exemption Certificate No. 85-8012622266C-0. 5. Invoicing: A. Invoices must be submitted, in duplicate, referencing this contract number and the Delivery Order to: Orange County Fleet Management Division 4400 S. Vineland Road Orlando, FL 32811 Phone (407) 836-8210 B. Invoices against this contract are authorized only at the prices stated in your bid response, unless otherwise provided in the Invitation for Bids. 6. All requirements contained in any addenda to the solicitation for this procurement are part of and hereby incorporated into this contract. BOARD OF COUNTY COMMISSIONERS ORANGE COUNTY, FLORIDA BY: lattotu Melisa Vergara, CPPB Q Procurement Division DATE: ei s 5/ 1 L Page 2 of 2 BID RESPONSE FORM IFB Y16-1081-MR All charges including, but not limited to, drop charges, pump charges, split delivery charges and/or minimum freight charges shall be included in the discount or mark-up from the OPIS price. There are no, and shall not be, provisions for added charges. Indicate a discount with a negative (-) and mark-up with a plus (+). Estimated annual gallons of all fuels are stated in Delivery Schedule A. FIXED DISCOUNT (-) OR MARK-UP (+) PRICE PER GALLON SUBTRACTED FROM OR ADDED TO THE OPIS AVERAGE PRICE(S) PER GALLON POSTED FOR THE TAFT TERMINAL ITEM NO. DESCRIPTION 1. 87 Octane gasoline, as specified $ (. x35 per gallon 2. 89 Octane gasoline, as specified $ 0. X35 per gallon 3. 93 Octane gasoline, as specified $ 4. /35- per gallon 4. Undyed Diesel fuel, as specified $ O. 13f per gallon 5. Dyed Diesel fuel, as specified $ Q• /35- per gallon , TL AS OIL Company Name IMPORTANT NOTE: When completing your bid, do not attach any forms which may contain terms and conditions that conflict with those listed in the County's bid documents(s). Inclusion of additional terms and conditions such as those which may be on your company's standard forms shall result in your bid being declared non-responsive as these changes will be considered a counteroffer to the County's bid. Delivery shall be not later than two (2) calendar days After Receipt of Order (ARO) per Special Terms and Conditions. Inquiries regarding this Invitation for Bids may be directed to Melisa Rivera, Senior Purchasing Agent, at Melisa.Rivera @ocfl.net Bid Response Documents -The following documents constitute your bid: A. Bid Response Form, Authorized Signatories/Negotiators, Drug-Free Workplace, Schedule of Sub-contracting, Conflict/Non-Conflict of Interest Form, E- Verification Certification, and current W9, Relationship Disclosure Form and Orange County Specific Project Expenditure Report. Please make sure forms are fully executed where required. B. Qualifications of Bidders information, per Special Terms and Conditions. C. Completed attached reference documentation. Page 26 THE FOLLOWING SECTION MUST BE COMPLETED BY ALL BIDDERS: Company Name: / TL R S OIL Cot y NOTE: COMPANY NAME MUST MATCH LEGAL NAME ASSIGNED TO TIN NUMBER. CURRENT W9 MUST BE SUBMITTED WITH BID. TIN#: D-U-N-S®# `4/-- 735— ‘ 10 217/50/ feoRsE oX (Street No. or P.O. Box Number) (Street Name) (City) rcdrMx gr/i0 (County) (State) (Zip Code) Contact Person: 11 ST�Ve Lea✓1 Phone Number: 959-0?99 1g73Fax Number: 3/.1- 1191-02000 Email Address: EMERGENCY CONTACT /1 Emergency Contact Person: STeve, 2 edV 771 Telephone Number: 93-9-297--/y73 Cell Phone Number: 9c$ cm- 115-4 Residence Telephone Number: Email: 5Le'ava f f ee.'- ACKNOWLEDGEMENT OF ADDENDA The Bidder shall acknowledge receipt of any addenda issued to this solicitation by completing the blocks below or by completion of the applicable information on the addendum and returning it not later than the date and time for receipt of the bid. Failure to acknowledge an addendum that has a material impact on this solicitation may negatively impact the responsiveness of your bid. Material impacts include but are not limited to changes to specifications, scope of work/services, delivery time, performance period, quantities, bonds, letters of credit, insurance, or qualifications. Addendum No. - , Date Jtole .Z.2, 'VA Addendum No. , Date Addendum No. , Date Addendum No. , Date Page 27 AUTHORIZED SIGNATORIES/NEGOTIATORS The Bidder represents that the following principals are authorized to sign bids, negotiate and/or sign contracts and related documents to which the bidder will be duly bound. Principal is defined as an employee, officer or other technical or professional in a position ca gable of substantial! influencing the development or outcome of -n activit required to perform the covered transaction. Name Title Telephone Number/Email QDb 4- qu FUQICUO 3)3 ( 35O9 cit) ofS0,14C arcciu6" 1OT I 51e, 0(0/ail/ to (Si.f ure) (Date) CUQ I Coo (Title) ------ CL a eabek Pt iety (Name of Business) The Bidder shall complete and submit the following information with the bid: Type of Organization Sole Proprietorship Partnership Non-Profit Joint Venture Corporation State of Incorporation: Va- Principal Place of Business (Florida Statute Chapter 607): City/County/State THE PRINCIPAL PLACE OF BUSINESS SHALL BE THE ADDRESS OF THE BIDDER'S PRINCIPAL OFFICE AS IDENTIFIED BY THE FLORIDA DIVISION OF CORPORATIONS. • Federal I.D. number is 3� J3)251-i/1'1 Page 28 DRUG-FREE WORKPLACE FORM The undersigned Bidder, in accordance with Florida Statute 287.087 hereby certifies that TL-A 5 OIL. C. MP)W V does: Name of Business 1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, 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 a copy of the statement specified in Paragraph 1. 4. In the statement specified in Paragraph 1, notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Florida Statute 893 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 Paragraphs 1 thru 5. As the person authorized to sign this statement, I certify that this firm complies fully with above requirements. Bidder's Signature Date o _ 4- m 0 C V a N Q 2 �II w sl 0 V 0 O ca c a c .0 o p to AC U P. c o p.<U a h 0 o €co O Q ..,c m a) 1- -p E 48 CD Ca as Cl- CI co -c F- Z c Uo(1)i Q ce CS 2 Z T U O O co o CO en • r- tn } 2 O O z, co J 1:13 m C LL L V i a U ca CD ci) c c o c o a ,a v U -o m O c co a N o Er) `o vl 0 11 qk cUa c J .11 c 1.... Nv=, v `� ill t7 0 = N to Cl) c e) O� a E iii N c co R Cu aa)ic c 0 0 EL) a Q a , o U t CONFLICT/NON-CONFLICT OF INTEREST STATEMENT CHECK ONE To the best of our knowledge, the undersigned bidder has no potential conflict of interest due to any other clients, contracts, or property interest for this project. OR [ ] The undersigned bidder, by attachment to this form, submits information which may be a potential conflict of interest due to other clients, contracts, or property interest for this project. LITIGATION STATEMENT CHECK ONE [ ] The undersigned bidder has had no litigation and/or judgments entered against it by any local, state or federal entity and has had no litigation and/or judgments entered against such entities during the past ten (10) years. [ ] The undersigned bidder, BY ATTACHMENT TO THIS FORM, submits a summary and disposition of individual cases of litigation and/or judgments entered by or against any local, state or federal entity, by any state or federal court, during the past ten (10) years. ic1724.5 0.EL Co M F4/// CO ' 'NY NAME rr y1,! 'ZED SIGNATURE I 11 NAME (PRINT OR PE) aii 1 Oi TITL Failure to check the appropriate blocks above may result in disqualification of your bid. Likewise, failure to provide documentation of a possible conflict of interest, or a summary of past litigation and/or judgments, may result in disqualification of your bid. E VERIFICATION CERTIFICATION Contract No.Y16-1081-MR I hereby certify that I will utilize the U.S. Department of Homeland Security's E-Verify system in accordance with the terms governing the use of the system to confirm the employment eligibility of the individuals classified below. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duties shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida statutes. All persons, including subcontractors and their workforce, who will perform work under Contract No.Y16-1081-MR, Motor Fuels Tankwagon Deliveries, within the state of Florida. NAME OF CONTRACTOR: 79 TL A 5 01`L CtM Mil Y ADDRESS OF CONTRACTOR: L.215-0/ ec4 Z5E Al. /4y4r, ik,c iq 04 gSI Id AUTHORIZED SIGNATURE: ,EV TITLE: fiC60 DATE: 0w June 22, 2016 BOARD OF COUNTY COMMISSIONERS ORANGE COUNTY, FLORIDA IFB #Y16-1081-MR MOTOR FUELS — TANK WAGON DELIVERIES ADDENDUM NO. 1 To all bidders: The following are questions with respective answers for the above Invitation for Bids: 1. Question - How much is the estimated annual volume for each product? The annual estimated amounts can be found on page 56-61, Delivery Schedule A, Estimated Annual Usage, Tank Wagon Deliveries. ACKNOWLEDGEMENT OF ADDENDA A. The bidder shall acknowledge receipt of this addendum by completing the applicable section in the solicitation or by completion of the acknowledgement information on the addendum. Either form of acknowledgement must be completed and returned not later than the date and time for receipt of the bid. B. Receipt acknowledged by: Authorized Signer Date Signed Title Name of Bidder IFB #Y16-1081-MR Addendum No. 1 Page 1 of 1 Issue Date: June 10, 2016 INVITATION FOR BIDS #Y16-1081-MR NOTICE IS HEREBY GIVEN that the Board of County Commissioners of Orange County, Florida, henceforth referred to as the County is accepting sealed bids for: MOTOR FUELS TANKWAGON DELIVERIES TERM CONTRACT Sealed bid offers in an original and three (3) copies for furnishing the above will be accepted up to 2:00 PM (local time), Thursday, June 30, 2016, in the Procurement Division, Internal Operations Centre II, 400 E. South Street, 2nd Floor, Orlando, FL 32801. Copies of the bid documents may be obtained from the Orange County Procurement Division at the above address. Copies may be requested by phoning (407) 836-5635 or by download from the Internet at: http://apps.ocfl.net/orangebids/bidopen.asp Carrie Woodell, MPA, CPPO, CFCM, C.P.M. Acting Manager, Procurement Division NOTICE TO BIDDERS To ensure that your bid is responsive, you are urged to request clarification or guidance on any issues involving this solicitation before submission of your response. Your point- of-contact for this solicitation is Melisa Rivera, Senior Purchasing Agent at Melisa.Rivera@octl.net. TABLE OF CONTENTS DESCRIPTION PAGE GENERAL TERMS AND CONDITIONS 2-14 SPECIAL TERMS AND CONDITIONS 15-24 SPECIFICATIONS 25 BID RESPONSE FORM 26 EMERGENCY CONTACTS 27 ACKNOWLEDGEMENT OF ADDENDA 27 AUTHORIZED SIGNATORIES/NEGOTIATORS 28 REFERENCES 29-30 DRUG-FREE WORKPLACE FORM SCHEDULE OF SUBCONTRACTING FORM CONFLICT/NON-CONFLICT OF INTEREST FORM E-VERIFICATION CERTIFICATION RELATIONSHIP DISCLOSURE FORM RELATIONSHIP DISCLOSURE FORM - FREQUENTLY ASKED QUESTIONS (FAQ) ORANGE COUNTY SPECIFIC PROJECT EXPENDITURE REPORT EXPENDITURE REPORT- FREQUENTLY ASKED QUESTIONS (FAQ) AGENT AUTHORIZATION FORM EXHIBIT A- LEASED EMPLOYEE AFFIDAVIT EXHIBIT B - COMMERCIAL GENERAL LIABILITY EXHIBIT C- COMMERCIAL GENERAL LIABILITY EXHIBIT D -WORKERS COMPENSATION & EMPLOYEES LIABILITY INSURANCE POLICY EXHIBIT E -WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US i GENERAL TERMS AND CONDITIONS 1. GENERAL INFORMATION These specifications constitute the complete set of requirements and bid forms. The bid response page(s), and all forms listed on the bid response page(s) shall be completed, signed, and sealed in an envelope bearing the bid number on the outside and mailed or presented to the Procurement Division on or before the specified time and date. Failure to comply with the preceding requirements shall result in the rejection of the bid. Bids submitted by e-mail, telephone or fax shall not be accepted. An e- mailed or a faxed bid shall be rejected as non-responsive regardless of where it is received. It is the sole responsibility of the Bidder to ensure that their bid reaches the Procurement Division. All bids, unless otherwise specified, must be delivered to the following address no later than the time and date specified in the solicitation: Procurement Division Internal Operations Centre II 400 E. South Street, 2nd Floor Orlando, FL 32801 Bidders are cautioned that they are responsible for delivery to the specific location cited above. Therefore, if your bid is delivered by an express mail carrier or by any other means, it is your responsibility to ensure delivery to the above address. This office will not be responsible for deliveries made to any place other than the specified address. The County shall not be responsible for delays caused by any occurrence. The time/date stamp clock located in the Procurement Division shall serve as the official authority to determine lateness of any bid. The bid time shall be scrupulously observed. Under no circumstances shall bids delivered after the time specified be considered. Late bids will be returned to the Bidder unopened. The decision to refuse to consider a bid that was received beyond the date/time established in the solicitation shall not be the basis for a protest pursuant to the Orange County Code (Procurement Ordinance). All bids must be typewritten or filled in with pen and ink, and must be signed in ink by an officer or employee having authority to bind the company or firm. Errors, corrections, or changes on any document must be initialed by the signatory of the bid. Bidders shall not be allowed to modify their bids after the opening time and date. Bid files may be examined during normal working hours, thirty (30) days after bid opening or upon recommendation for award, whichever occurs first. Bidders desiring to view these documents are urged to schedule an appointment. For information concerning this bid, please contact the Procurement Division at the address listed above or by calling 407-836-5635. Please specify the bid number for which you are inquiring. Page 2 2. QUESTIONS REGARDING THIS SOLICITATION All questions or concerns regarding this Invitation for Bids shall be submitted by email to Melisa.Rivera @ocfl.net, no later than 5:00 PM Monday, June 20, 2016 to the attention of Melisa Rivera, Procurement Division, referencing the IFB number. When required the Procurement Division shall issue an addendum to the Invitation for Bids. The addendum shall be available on the Internet for access by potential Bidders. Bidders are instructed not to contact the initiating division directly. No oral interpretation of this Invitation for Bids shall be considered binding. The County shall be bound by information and statements only when such statements are written and executed under the authority of the Manager, Procurement Division. This provision exists solely for the convenience and administrative efficiency of Orange County. No Bidder or other third party gains any rights by virtue of this provision or the application thereof, nor shall any Bidder or third party have any standing to sue or cause of action arising there from. 3. PRICE/DELIVERY Price(s) bid must be the price(s) for new goods, unless otherwise specified. Any bids containing modifying or "escalator" clauses will not be considered unless specifically requested in the bid specifications. "Acceptance" as herein used means the acceptance by Orange County after the Manager, Procurement Division or authorized agent has, by inspection or test of such items, determined that they fully comply with specifications. Deliveries resulting from this bid are to be performed during the normal working hours of the County. Time is of the essence and the Contractor's delivery date must be specified and adhered to. Should the Contractor, to whom the order or contract is awarded, fail to deliver on or before the stated date, the County reserves the right to CANCEL the order or contract and make the purchase elsewhere, and the Contractor shall be required to compensate the County for the difference in price paid for the alternate goods. The Contractor shall be responsible for making any and all claims against carriers for missing or damage goods. Partial shipments will be acceptable unless otherwise stated. 4. FEDERAL AND STATE TAX The County is exempt from Federal and State Sales and Use Taxes for tangible personal property (Certificate of Registry for tax transactions under Chapter 32, Internal Revenue Code and Florida Sales/Use Tax Exemption Certificate). The Manager, Procurement Division will sign an exemption certificate submitted by the Contractor. Contractors doing business with the County shall not be exempted from paying sales tax to their suppliers for materials to fulfill contractual obligations with the County, nor shall any Contractor be authorized to use the County's Tax Exemption Number in securing such materials. Page 3 5. ACCEPTANCE/REJECTION/CANCELLATION The County reserves the right to accept or to reject any or all bids and to make the award to that bidder who, in the opinion of the County, will be in the best interest of and/or the most advantageous to the County. The County also reserves the right to reject the bid of any bidder who has previously failed in the proper performance of an award or to deliver on time contracts of a similar nature or who, in the County's opinion, is not in a position to perform properly under this award. The County reserves the right to inspect all facilities of bidders in order to make a determination as to the foregoing. The County reserves the right to waive any irregularities and technicalities and may, at its discretion, request a re- bid. Award will be made to the lowest responsive and responsible bidder as determined by the County. The County reserves the right, and the Manager, Procurement Division has absolute and sole discretion, to cancel a solicitation at any time prior to approval of the award by the Board of County Commissioners when such approval is required. The decision to cancel a solicitation cannot be the basis for a protest pursuant to the Orange County Code. 6. BRAND NAME OR EQUALS/DEVIATIONS Unless otherwise specified, the mention of a particular manufacturer's brand name or number in the specifications does not imply that this particular good is the only one that will be considered for purchase. This reference is intended solely to designate the type or quality of good that will be acceptable. Equal offers will be considered and must include descriptive literature and/or specifications. Failure to provide descriptive literature and/or specifications with equal offers will result in the disqualification of the bid. The determination as to whether any alternate good or service is or is not equal shall be made solely by the County and such determination shall be final and binding upon all bidders. The County reserves the right to request and review additional information to make such a determination. Although the County provides for the consideration of alternate bids, it reserves the right to make an award in the best interest of the County. Award may not necessarily be given to the lowest bid offered. The Bidder shall be responsible for reading very carefully, and understanding completely, the requirements and the specifications of the items bid upon. Unless the bid is in response to a "Brand Name or Equal" requirement, deviations from the specifications will only be considered if requested in writing prior to the date and time specified for receipt of bids. Deviations, if accepted, will be specifically addressed in writing via an addendum to this Invitation for Bids. Any goods or services that are not in compliance with the specifications will not be accepted. 7. NO BID Where more than one item is listed, any items not bid upon shall be indicated as "NO BID". Page 4 8. CONFLICT OF INTEREST The award is subject to provisions of applicable State Statutes and County Ordinances. All bidders must disclose with their bid the name of any officer, director, or agent who is also an employee of Orange County. Further, all bidders must disclose the name of any County employee who owns, directly or indirectly, an interest of ten percent (10%) or more in the Bidder's firm or any of its branches. Should the Contractor permanently or temporarily hire any County employee who is, or has been, directly involved with the Contractor prior to or during performance of the resulting contract, the contract shall be subject to immediate termination by the County. 9. LEGAL REQUIREMENTS All applicable Federal and State laws and County ordinances that in any manner affect the items covered herein apply. Lack of knowledge by the Bidder shall in no way be a cause for relief from responsibility. A. Contractors doing business with the County are prohibited from discriminating against any employees, applicant, or client because of race, religion, color, disability, national origin, gender, or age with regard to but not limited to the following: employment practices, rates of pay or other compensation methods, and training selection. B. Minority/Women Business Enterprises (M/WBE) indicates a business entity of which 51% or more is owned and operated by a minority. In this instance, minority group members are citizens of the United States or lawfully admitted permanent residents who are Black, Hispanic, Women, Native American, Asian-Pacific, Asian-Indian. Businesses wishing to participate in the County procurement process as an M/WBE are required to complete a certification application to attain recognition as such. You may contact the Procurement Division or the Business Development Division for information and assistance. 10. UNIFORM COMMERCIAL CODE The Uniform Commercial Code (Florida Statutes, Chapter 672) shall prevail as the basis for contractual obligations between the Contractor and the County for any terms and conditions not specifically stated in this Invitation for Bids. 11. MISTAKES In the event of extension error(s), the unit price will prevail and the Bidder's total offer will be corrected accordingly. In the event of addition errors, the extended totals will prevail and the Bidder's total will be corrected accordingly. Bidders must check their bid where applicable. Failure to do so will be at the Bidder's risk. Bids having erasures or corrections must be initialed in ink by the Bidder. 12. AVAILABILITY OF FUNDS The obligations of the County under this award are subject to the availability of funds lawfully appropriated for its purpose by the State of Florida and the Orange County Board of County Commissioners, or other specified funding source for this procurement. Page 5 13. EEO STATEMENT It is hereby declared that equal opportunity and nondiscrimination shall be the County's policy intended to assure equal opportunities to every person, regardless of race, religion, sex, sexual orientation and gender expression/identity, color, age, disability or national origin, in securing or holding employment in a field of work or labor for which the person is qualified, as provided by Section 17-314 of the Orange County Code and the County Administrative Regulations. Further, the Contractor shall abide by the following provisions: A. The Contractor shall represent that the Contractor has adopted and maintains a policy of nondiscrimination as defined by applicable County ordinance throughout the term of this contract. B. The Contractor shall allow reasonable access to all business and employment records for the purpose of ascertaining compliance with the non-discrimination provision of the contract. The provisions of the prime contract shall be incorporate by the Contractor into the contracts of any applicable subcontractors. 14. BID TABULATION AND RESULTS Bid tabulations shall be available thirty (30) days after opening on the Orange County website at: http://apps.ocfl.net/orangebids/bidresults/results.asp or upon notice of intended action, whichever is sooner. 15. BID FORMS All bids must be submitted on the County's standard Bid Response Form. Bids on Bidder's quotation forms shall not be accepted. 16. FLORIDA PREFERENCE In the event this Invitation for Bids is to acquire personal property and the lowest responsive and responsible bid submitted in response to this Invitation for Bids, is by a bidder whose principal place of business is in a state other than Florida and such state or political subdivision thereof grants a preference for the purchase of personal property to a person whose principal place of business is in said state, then Orange County Florida may award a preference to the lowest responsive and responsible bidder having a principal place of business within the State of Florida. Such preference shall be equal to the preference granted by the state in which the lowest responsive and responsible bidder has its principal place of business. This section shall not apply to transportation projects in which Federal aid funds are used. Any bidder whose principal place of business is outside the State of Florida must accompany any written bid documents with a written opinion of an attorney at law licensed to practice law in that foreign state, as to the preferences, if any or none, granted by the law of that state to its own business entities whose principal places of business are in that foreign state in the letting of any or all public contracts. Reference Florida Statutes 287.084. Page 6 17. RECIPROCAL PREFERENCE In the event the lowest responsive and responsible bid submitted in response to any Invitation for Bids is by a bidder whose principal place of business is in a county other than Orange County, and such county grants a bid preference for purchases to a bidder whose principal place of business is in such county, then Orange County may award a preference to the (next) lowest responsive and responsible bidder having a principal place of business within Orange County, Florida. Such preference will be equal to the preference granted by the county in which the lowest responsive and responsible bidder has its principal place of business except as provided below. 1. Effective July 1, 2015 the reciprocal local preference will not apply to construction services in which 50 percent or more of the cost will be paid from state-appropriated funds which have been appropriated at the time of the competitive solicitation. 2. If the solicitation involves a federally funded project where the funding source requirements prohibit the use of state and/or local preferences, the reciprocal local preference will not be applied. 18. POSTING OF RECOMMENDED AWARD AND PROTESTS The recommended award will be posted for review by interested parties at the Procurement Division and at: http://apps.ocfl.net/OrangeBids/AwardsRec/default.asp prior to submission through the appropriate approval process and will remain posted for a period of five (5)full business days. • Orange County Lobbyist Regulations General Information http://www.orangecountvfl.net/OpenGovernment/LobbinqAtOranqeC ountv.aspx A lobbying blackout period shall commence upon issuance of the solicitation until the Board selects the Contractor. For procurements that do not require Board approval, the blackout period commences upon solicitation issuance and concludes upon contract award. The Board of County Commissioners may void any contract where the County Mayor, one or more County Commissioners, or a County staff person has been lobbied in violation of the black-out period restrictions of Ordinance No. 2002-15. • Orange County Protest Procedures http://www.orangecountvfl.netNendorServicesNendorProtestProced ures.aspx Failure to file a protest with the Manager, Procurement Division by 5:00 PM on the fifth full business day after posting, shall constitute a waiver of bid protest proceedings. Page 7 19. BID AND RELATED COSTS By submission of a bid, the Bidder agrees that any and all costs associated with the preparation of the bid will be the sole responsibility of the Bidder. The Bidder also agrees that the County shall bear no responsibility for any costs associated with the preparation of the bid including but not limited to any administrative or judicial proceedings resulting from the solicitation process. 20. CONTRACTUAL AGREEMENT This Invitation for Bids shall be included and incorporated in the final contract or purchase order. The order of contract precedence will be the contract (purchase order), bid document, and response. Any and all legal actions associated with this Invitation for Bids and/or the resultant contract (purchase order) shall be governed by the laws of the State of Florida. Venue for any litigation involving this contract shall be the Ninth Circuit Court in and for Orange County, Florida. 21. PUBLIC ENTITY CRIME Section 287.133(3)(d), Florida Statutes, provides that the Florida Department of Management Services shall maintain a list of the names and addresses of those who have been disqualified from participating in the public contracting process under this section. http://www.dms.mvflorida.com/business operations/state purchasing/yen dor information/convicted suspended discriminatory complaints vendor lists/convicted vendor list A person or affiliate who has been placed on The Convicted Vendor list following a conviction for a public entity crime shall not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, shall not submit bids on leases of real property to a public entity, shall not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with a public entity, and shall not transact business with any public entity in excess of the threshold amount provided in Florida Statute Section 287.017, for CATEGORY TWO for a period of thirty-six (36) months from the date of being placed on The Convicted Vendor List. 22. DRUG-FREE WORKPLACE FORM The Drug-Free Workplace Form is attached and shall be completed and submitted with your bid. 23. SUBCONTRACTING Bidders subcontracting any portion of the work shall state name and address of subcontractor and the name of the person to be contacted on the attached "Schedule of Subcontractors Form". 24. CONFLICT OF INTEREST FORM Bidder shall complete the Conflict of Interest Form attached hereto and submit it with their bid. Page 8 25. ETHICS COMPLIANCE The following forms are included in this solicitation and shall be completed and submitted as indicated below: A. Orange County Specific Project Expenditure Report -The purpose of this form is to document any expenses incurred by a lobbyist for the purposes described in Section 2-351, Orange County Code. This form shall be completed and submitted with all bid responses to an Orange County solicitation. Any questions concerning this form shall be addressed to the purchasing agent identified in the applicable solicitation. B. Relationship Disclosure Form —The purpose of this form is to document any relationships between a bidder to an Orange County solicitation and the Mayor or any other member of the Orange County Board of County Commissioners. This form shall be completed and submitted with the applicable bid to an Orange County solicitation. No contract award shall be made unless these forms have been completed and submitted with the bid. Any questions concerning these forms shall be addressed to the purchasing agent identified in this solicitation. Also, a listing of the most frequently asked questions concerning these forms is attached to each for your information. 26. SUBMISSION OF BID The bid must be mailed or hand delivered in a sealed envelope to: ORANGE COUNTY PROCUREMENT DIVISION Internal Operations Centre II 400 E. South Street, 2nd Floor Orlando, Florida 32801 Bidders must indicate on the sealed envelope the following: A. Invitation for Bids Number B. Hour and Date of Opening C. Name of Bidder Bids received after the time, date, and/or at the location specified, due to failure to identify the envelope with the above information shall be rejected. 27. COPIES Copies of documents, records, materials, and/or reproductions requests will be charged in accordance with Orange County's fee schedule. Copyrighted materials may be inspected, but cannot be copied or reproduced per Federal law. 28. PROPRIETARY/RESTRICTIVE SPECIFICATIONS If a prospective bidder considers the specification contained herein to be proprietary or restrictive in nature, thus potentially resulting in reduced competition, they are urged to contact the Procurement Division prior to bid opening. Specifications which are unrelated to performance will be considered for deletion via addendum to this Invitation for Bids. Page 9 29. ASSISTANCE WITH SPECIFICATIONS Any prospective bidder who assisted the County in developing or writing the specifications contained herein are requested to so note such on the bid response page. 30. PAYMENT TERMS/DISCOUNTS The County's payment terms are in accordance with Florida Statute 218, Local Government Prompt Payment Act. Cash discounts for prompt payment shall not be considered in determining the lowest net cost for bid evaluation purposes. 31. PATENTS AND ROYALTIES Unless otherwise provided, the Contractor shall be solely responsible for obtaining the right to use any patented or copyrighted materials in the performance of the contract resulting from this Invitation for Bids. The Contractor, without exception, shall indemnify and save harmless the County and its employees from liability of any nature or kind, including cost and expenses for or on account of any copyrighted, patented, or unpatented invention, process, or article manufactured or supplied by the Contractor. In the event of any claim against the County of copyright or patent infringement, the County shall promptly provide written notification to the Contractor. If such a claim is made, the Contractor shall use its best efforts to promptly purchase for the County any infringing products or services or procure a license, at no cost to the County, which will allow continued use of the service or product. If none of the alternatives are reasonably available, the County agrees to return the article on request to the Contractor and receive reimbursement, if any, as may be determined by a court of competent jurisdiction. 32. INDEMNIFICATION To the fullest extent permitted by law, the Contractor shall defend, indemnify, and hold harmless the County, its officials, agents, and employees from and against any and all claims, suits, judgments, demands, liabilities, damages, cost and expenses including attorney's fees of any kind or nature whatsoever arising directly or indirectly out of or caused in whole or in part by any act or omission of the Contractor or its subcontractors, anyone directly or indirectly employed by them, or anyone for whose acts any of them may be liable; excepting those acts or omissions arising out of the sole negligence of the County. 33. CLARIFICATIONS It is the Bidder's responsibility to become familiar with and fully informed regarding the terms, conditions and specifications of this Invitation for Bids. Lack of understanding and/or misinterpretation of any portions of this Invitation for Bids shall not be cause for withdrawal of your bid after opening or for subsequent protest of award. Bidder's must contact the Procurement Division, at the phone number on the bid cover sheet prior to bid opening, should clarification be required. Page 10 Modification or alteration of the documents contained in the solicitation or contract shall only be valid if mutually agreed to in writing by the Bidder and the County. 34. CERTIFICATION OF INDEPENDENT PRICE DETERMINATION By submission of this bid, the Bidder certifies, and in the case of a joint bid each party thereto certifies as to its own organization, that in connection with this procurement: A. The prices in this bid have been arrived at independently, without consultation, collusion, communication, or agreement for the purpose of restricting competition, as to any matter relating to such prices with any other bidder or with any competitor. B. Unless otherwise required by law, the prices which have been quoted in this bid have not been knowingly disclosed by the Bidder and will not knowingly be disclosed by the Bidder prior to opening, directly or indirectly to any other Bidder or to any competitor; and, C. No attempt has been made or shall be made by the Bidder to induce any other person or bidder to submit or not to submit a bid for the purpose of restricting competition. 35. SUCCESSORS AND ASSIGNS • The County and the Contractor each binds itself and its partners, successors, executors, administrators, and assigns to the other party of this Contract and to the partners, successors, executors, administrators, and assigns of such other party, in respect to all covenants of this Contract. Except as above, neither the County nor the Contractor shall assign, sublet, convey or transfer its interest in this Contract without the written consent of the other. Nothing herein shall be construed as creating any personal liability on the part of any officer or agent of the County which may be a party hereto, nor shall it be construed as giving any rights or benefits hereunder to anyone other than the County and the Contractor. 36. PRICING/AUDIT The Contractor shall establish and maintain a reasonable accounting system, which enables ready identification of Contractor's cost of goods and use of funds. Such accounting system shall also include adequate records and documents to justify all prices for all items invoiced as well as all charges, expenses and costs incurred in providing the goods for at least five (5) years after completion of this contract. The County or its designee shall have access to such books, records, subcontract(s), financial operations, and documents of the Contractor or its subcontractors, as required to comply with this section for the purpose of inspection or audit anytime during normal business hours at the Contractor's place of business. This right to audit shall include the Contractor's subcontractors used to procure goods under the contract with the County. Contractor shall ensure the County has these same rights with subcontractors and suppliers. Page 11 37. EMPLOYEES OF THE CONTRACTOR All work under this contract shall be performed in a professional and skillful manner. The County may require, in writing, that the Contractor, remove from this contract any employee the County deems incompetent, careless, or otherwise objectionable. 38. TOBACCO FREE CAMPUS All Orange County operations under the Board of County Commissioners shall be tobacco free. This policy shall apply to parking lots, parks, break areas and worksites. It is also applicable to Contractors and their personnel during contract performance on County owned property. Tobacco is defined as tobacco products including, but not limited to, cigars, cigarettes, e-cigarettes, pipes, chewing tobacco and snuff. Failure to abide by this policy may result in civil penalties levied under Chapter 386, Florida Statutes and/or contract enforcement remedies. 39. CONTRACT CLAIMS "Claim" as used in this provision means a written demand or written assertion by one of the contracting parties seeking as a matter of right, the payment of a certain sum of money, the adjustment or interpretation of contract terms, or other relief arising under or relating to this contract. Claims made by a Contractor against the County, relating to a particular contract shall be submitted to the Manager, Procurement Division in writing clearly labeled "Contract Claim" requesting a final decision. The Contractor also shall provide with the claim a certification as follows: "I certify that the claim is made in good faith; that the supporting data are accurate and complete to the best of my knowledge and belief; that the amount requested accurately reflects the contract adjustment for which the Contractor believes the County is liable; and that I am duly authorized to certify the claim on behalf of the Contractor." Failure to document a claim in this manner shall render the claim null and void. No claim shall be accepted after final payment of the contract. The decision of the Manager, Procurement Division shall be issued in writing and furnished to the Contractor. The decision shall state the reasons for the decision reached. The Manager, Procurement Division shall render the final decision within sixty (60) days after receipt of Contractor's written request for a final decision. The Manager, Procurement Division decision shall be final and conclusive. The Contractor shall proceed diligently with performance of this contract pending final resolution of any request for relief, claim, appeal or action arising under the contract and shall comply with any final decision rendered by the Manager, Procurement Division. Page 12 40. VERIFICATION OF EMPLOYMENT STATUS Prior to the employment of any person under this contract, the Contractor shall utilize the U.S. Department of Homeland Security's E-Verify system to verify the employment eligibility of all new employees hired by the Contractor during the contract term, and an express requirement that Contractors include in such subcontracts the requirement that subcontractors performing work or providing services pursuant to the state contract utilize the E-Verify system to verify the employment eligibility of all new employees hired by the subcontractor during the contract term. For more information on this process, please refer to United States Citizenship and Immigration Service site at: http://www.uscis.gov/portal/site/uscis. Only those employees determined eligible to work within the United States shall be employed under this contract. By submission of a bid in response to this solicitation, the Contractor affirms that all employees in the above categories shall undergo e-verification before placement on this contract. The Contractor shall commit to comply with this requirement by completing the E-Verification certification, attached to this solicitation. 41. CONFIDENTIAL INFORMATION In accordance with Chapter 119 of the Florida Statutes (Public Records Law), and except as many be provided by other applicable State or Federal Law, all proposers should be aware that Invitation for Bids and the responses thereto are in the public domain. Bidders must identify specifically any information contained in their response which they consider confidential and/or proprietary and which they believe to be exempt from disclosure, citing specifically the applicable exempting law. If a Bidder fails to cite the applicable exempting law, we will treat the information as public. 42. FEDERAL REQUIREMENTS In the event this Contract is paid in whole or in part from any federal government agency or source, the specific terms, regulations and requirements governing the disbursement of these funds shall be specified herein and become a part of this clause. All Contracts in excess of one hundred thousand dollars ($100,000) shall comply with all the requirements of Section 114 of the Clean Air Act (42 USC 7401 et seq.) as amended and Section 308 of the Federal Water Pollution Control Act (33 USC 1251 et seq.) as amended. 43. PUBLIC RECORDS COMPLIANCE (APPLICABLE FOR SERVICE CONTRACTS) Orange County is a public agency subject to Chapter 119, Florida Statutes. The Contractor agrees to comply with Florida's Public Records Law. Specifically, the Contractor shall: Page 13 1. Keep and maintain public records required by Orange County to perform the service. 2. Upon request from Orange County's custodian of public records, provide Orange County with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law. 3. Ensure that public records that are exempt or confidential and exempt from the public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the Contractor does not transfer the records to Orange County. 4. Upon completion of the contract, Contractor agrees to transfer at no cost to Orange County all public records in possession of the Contractor or keep and maintain public records required by Orange County to perform the service. If the Contractor transfers all public record to Orange County upon completion of the contract, the Contractor shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the Contractor keeps and maintains public records upon completion of the contract, the Contractor shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to Orange County, upon request from Orange County's custodian of public records, in a format that is compatible with the information technology systems of Orange County. 5. A Contractor who fails to provide the public records to Orange County within a reasonable time may be subject to penalties under section 119.10, Florida Statutes. 6. IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT : Teresa Miller, Procurement Public Records Liaison 400 E. South Street, 2nd Floor, Orlando, FL 32801 407-836-5897 Teresa.Miller(a�ocfl.net Page 14 SPECIAL TERMS AND CONDITIONS 1. QUALIFICATION OF BIDDERS This bid will be awarded to a responsible, responsive bidder, qualified by experience to provide the work specified. The Bidder shall submit the following information with the bid: A. List and brief description of similar work satisfactorily completed with location, dates of contract, names, addresses, email addresses and telephone numbers of owners by completing the attached reference sheets. B. Listing of sub-contractors on the Schedule of Sub-Contractors form and a listing of what those sub-contractors will be providing in the way of products and services to Orange County on a separate sheet of letterhead stationery. C. Listing of Contractor's personnel by name, title, telephone number and e- mail address, who will be responsible for the Orange County account including ordering and invoicing. Failure to submit the above requested information may be cause for rejection of your bid. The determination on whether a bidder is responsible or not shall be at the sole discretion of the County. Although the County may request the submission of a minimum number of contracts similar to the requirements of this solicitation with certain minimum dimensions, quantities, dollar values, etc., the County's determination of a bidder's responsibility shall not be solely based on the number of similar procurements the bidder provides but the entirety of the bidder's qualifications. 2. LICENSES AND PERMITS Prior to furnishing the requested product(s), it shall be the responsibility of the Contractor to obtain, at no additional cost to Orange County, any and all licenses and permits required to complete all contractual requirements. These licenses and permits shall be readily available for review by the Manager, Procurement Division or authorized designee. 3. BID ACCEPTANCE PERIOD A bid shall constitute an irrevocable offer for a period of ninety (90) days from the bid opening date or until the date of award. In the event that an award is not made by the County within ninety (90) days from the bid opening date, the Bidder may withdraw their bid or provide a written extension of their bid. 4. AWARD Award shall be made on an "All-or-None Total Bid", or "All-or-None Total Estimated Bid" basis to the lowest responsive and responsible Bidder. If the Bidder fails to respond, they will be considered non-responsive. Page 15 5. EVALUATION/AWARD Bids will be evaluated on the basis of: A. Fixed discount/mark-up price per gallon to the OPIS (Oil Price Information Service) average price. B. Check of references. C. Compliance with contract terms, conditions and specifications. D. Capability Survey — The County reserves the right to perform a complete facilities and capability survey of each bidder prior to award, and utilize the results to determine if the bidder has the capability to successfully perform under this contract. The County also reserves the right to waive this survey for any bidder who has performed in a satisfactory manner under the current and/or a previous Orange County fuel contract. E. Award will be made on an "All-or-None Total Estimated Bid" basis to the bidder providing the lowest fixed markup or highest fixed discount per gallon to the OPIS average price. 6. BID PRICES A. For petroleum motor fuels, 87, 89 and 93 octane gasoline, ultra low sulfur diesel fuel, undyed and dyed, bidders shall submit on the Bid Response Form a fixed discount or fixed mark-up price to be subtracted from or added to the OPIS average price(s) per gallon posted for Orlando to arrive at the purchase price per gallon for each fuel type and/or grade listed. Note: All grades of gasoline petroleum motor fuels as referenced above are E-10 when sourced from the Taft Terminal. The fixed discount/mark-up shall remain firm during the entire contract period and each subsequent twelve (12) month period agreed upon, and shall include, but not be limited to profit, overhead, drop charges, split delivery charges, delivery charges, pump charges, freight charges and all other costs incurred by the vendor, with the exception of fees and taxes, for delivering fuel to those locations listed on Delivery Schedule A, plus any locations that may be added to the contract at a later date, to include other governmental agencies located within Central Florida. The day's final OPIS prices(s) per gallon posted for Thursday of each week shall be utilized to arrive at the purchase price per gallon of fuel(s) delivered the following Sunday through Saturday. The County receives the Thursday final OPIS Wholesale Rack prices directly from OPIS. EXAMPLE: OPIS price(s) posted Thursday, May 19, 2016 shall be utilized to arrive at the purchase price per gallon for fuel(s) delivered Sunday, May 22, 2016 through Saturday, May 28, 2016. In instances where a Thursday is a holiday, i.e. Thanksgiving, the day's final OPIS price(s) posted for the Wednesday preceding that Thursday holiday shall be used. Page 16 B. Vendor shall be responsible for correctly invoicing each agency/entity utilizing this contract. Taxes shall be listed as separate line items on all invoices. 7. F.O.B. POINT The F.O.B. point will be a destination within Orange County. The bid shall include all costs of packaging, transporting, delivery and unloading. This shall include inside delivery if requested to the designated point within Orange County. 8. DELIVERY Delivery time is of the essence in the award of this Invitation for Bids. Delivery shall be no later than two (2) calendar days from receipt of delivery order, Monday through Friday, unless other arrangements have been made with the ordering agency/entity. The Contractor shall contact each location prior to delivery to make arrangements for an agency/entity representative to be present at time of delivery. The Contractor shall contact all other agencies/entities utilizing this contract to obtain their ordering procedures. Bids submitted which fail to meet this requirement will be cause for rejection. Failure of the awarded Contractor to meet this delivery requirement will result in default and immediate termination of the delivery order or contract. It is hereby understood and mutually agreed to by and between parties hereto that the time of delivery is an essential condition of this contract. 9. TERMINATION A. Termination for Default: The County may, by written notice to the Contractor terminate this contract for default in whole or in part (delivery orders, if applicable) if the Contractor fails to: 1. Provide goods or services that comply with the specifications herein or fails to meet the County's performance standards 2. Deliver the goods or to perform the services within the time specified in this contract or any extension. 3. Make progress so as to endanger performance of this contract 4. Perform any of the other provisions of this contract. Prior to termination for default, the County shall provide adequate written notice to the Contractor through the Manager, Procurement Division, affording the opportunity to cure the deficiencies or to submit a specific plan to resolve the deficiencies within ten (10) calendar days (or the period specified in the notice) after receipt of the notice. Failure to adequately Page 17 cure the deficiency shall result in termination action. Such termination may also result in suspension or debarment of the Contractor in accordance with the County's Procurement Ordinance. The Contractor and its sureties (if any) shall be liable for any damage to the County resulting from the Contractor's default of the contract. This liability includes any increased costs incurred by the County in completing contract performance. In the event of termination by the County for any cause, the Contractor shall have, in no event, any claim against the County for lost profits or compensation for lost opportunities. After a receipt of a Termination Notice and except as otherwise directed by the County the Contractor shall: 1. Stop work on the date and to the extent specified. 2. Terminate and settle all orders and subcontracts relating to the performance of the terminated work 3. Transfer all work in process, completed work, and other materials related to the terminated work as directed by the County. 4. Continue and complete all parts of that work that have not been terminated. If the Contractor's failure to perform the contract arises from causes beyond the control and without the fault or negligence of the Contractor the contract shall not be terminated for default. Examples of such causes include (1) acts of God or the public enemy, (2) acts of a government in its sovereign capacity, (3) fires, (4) floods, (5) epidemics, (6) strikes and (7) unusually severe weather. B. Termination for Convenience: The County, by written notice, may terminate this contract, in whole or in part, when it is in the County's interest. If this contract is terminated, the County shall be liable only for goods or services delivered and accepted. The County Notice of Termination shall provide the Contractor thirty (30) calendar days prior notice before it becomes effective. A termination for convenience may apply to individual delivery orders, purchase orders or to the contract in its entirety. 10. AS SPECIFIED All goods delivered shall meet the specifications herein. Goods delivered not as specified shall be returned at no expense by Orange County. The County may return, for full credit, any unused goods received which fail to meet the County's performance standards. Replacement goods meeting specifications shall be submitted within a reasonable time after rejection of the non-conforming goods. Page 18 11. COMPLIANCE WITH OCCUPATIONAL SAFETY AND HEALTH By submission of a bid in response to this solicitation, the Bidder certifies that all material, equipment, etc., contained in their bid meets all OSHA requirements. Bidder further certifies that if they are the awarded Contractor, and the material, equipment, etc., delivered is subsequently found to be deficient in any OSHA requirements in effect on date of delivery, all costs necessary to bring the material, equipment, etc., into compliance with the aforementioned requirements shall be borne by the Contractor. 12. CODES AND REGULATIONS The Contractor shall strictly comply with all Federal, State and local codes and regulations. 13. PAYMENT Partial payments for the value of goods received and accepted may be requested by the submission of a properly executed invoice, with supporting documents if required. Payment shall be made in accordance with Florida Statute 218, Local Government Prompt Payment Act. Payment for accepted equipment/goods/services shall be accomplished by submission of an invoice, in duplicate, to: Orange County Fleet Management Division 4400 S. Vineland Rd. Orlando, FL 32811 Phone 407-836-8210 In the event additional County Departments or other public entities utilize this contract, invoices are to be sent directly to the Department or entity placing the order. 14. SAFETY AND PROTECTION OF PROPERTY The Contractor shall at all times: A. Initiate, maintain and supervise all safety precautions and programs in connection with its services or performance of its operations under this contract. B. Take all reasonable precautions to prevent injury to employees, including County employees and all other persons affected by their operations. C. Take all reasonable precautions to prevent damage or loss to property of Orange County, or of other Contractors, consultants or agencies and shall be held responsible for replacing or repairing any such loss or damage. D. Comply with all ordinances, rules, regulations, standards and lawful orders from authority bearing on the safety of persons or property or their protection from damage, injury or loss. This includes but is not limited to: Page 19 o Occupational Safety and Health Act (OSHA) o National Institute for Occupational Safety & Health (NIOSH) o National Fire Protection Association (NFPA) o American Society of Heating, Refrigeration & Air-Conditioning Engineers (ASHRAE) E. The Contractor shall also comply with the guidelines set forth in the Orange County Safety & Health Manual. The manual can be accessed online at the address listed below: http://www.orangecountyfl.net/VendorServices/OrangeCountySafety andHealthManual.aspx 15. INSURANCE REQUIREMENTS Vendor agrees to maintain on a primary basis and at its sole expense, at all times throughout the duration of this contract the following types of insurance coverage with limits and on forms (including endorsements) as described herein. These requirements, as well as the County's review or acceptance of insurance maintained by Vendor is not intended to and shall not in any manner limit or qualify the liabilities assumed by Vendor under this contract. Vendor is required to maintain any coverage required by federal and state workers' compensation or financial responsibility laws including but not limited to Chapter 324 and 440, Florida Statutes, as may be amended from time to time. The Vendor shall require and ensure that each of its sub-Vendors providing services hereunder (if any) procures and maintains until the completion of their respective services, insurance of the types and to the limits specified herein. Insurance carriers providing coverage required herein must be licensed to conduct business in the State of Florida and must possess a current A.M. Best's Financial Strength Rating of A- Class VIII or better. (Note: State licenses can be checked via www.floir.com/companvsearch/ and A.M. Best Ratings are available at www.ambest.com) Required Coverage: ® Commercial General Liability - The Vendor shall maintain coverage issued on the most recent version of the ISO form as filed for use in Florida or its equivalent, with a limit of liability of not less than $500,000 per occurrence. Vendor further agrees coverage shall not contain any endorsement(s) excluding or limiting Product/Completed Operations, Contractual Liability, or Separation of Insureds. The General Aggregate limit shall either apply separately to this contract or shall be at least twice the required occurrence limit. Required Endorsements: ® Additional Insured- CG 20 26 or CG 20 10/CG 20 37 or their equivalents. Note: CG 20 10 must be accompanied by CG 20 37 to include products/completed operations. Page 20 Z Waiver of Transfer of Rights of Recovery- CG 24 04 or its equivalent. Note: If blanket endorsements are being submitted please include the entire endorsement and the applicable policy number. ® Business Automobile Liability - The Vendor shall maintain coverage for all owned; non-owned and hired vehicles issued on the most recent version of the ISO form as filed for use in Florida or its equivalent, with limits of not less than $500,000 per accident. In the event the Vendor does not own automobiles the Vendor shall maintain coverage for hired and non-owned auto liability, which may be satisfied by way of endorsement to the Commercial General Liability policy or separate Business Auto Liability policy. Required Endorsements: ® MCS-90- for operations governed by the Sections 29 & 30 of the Motor Carrier Act of 1980 ® Workers' Compensation - The Vendor/Contractor shall maintain coverage for its employees with statutory workers' compensation limits, and no less than $100,000 each incident of bodily injury or disease for Employers' Liability. Elective exemptions as defined in Florida Statute 440 will be considered on a case-by-case basis. Any Vendor/Contractor using an employee leasing company shall complete the Leased Employee Affidavit. Required Endorsements: ® Waiver of Subrogation-WC 00 03 13 or its equivalent ® Pollution Liability- with a limit of not less than $1,000,000 per occurrence/claim When a self-insured retention or deductible exceeds $100,000 the COUNTY reserves the right to request a copy of Vendor most recent annual report or audited financial statement. For policies written on a "Claims-Made" basis the Vendor agrees to maintain a retroactive date prior to or equal to the effective date of this contract. In the event the policy is canceled, non-renewed, switched to occurrence form, or any other event which triggers the right to purchase a Supplemental Extended Reporting Period (SERP) during the life of this contract the Vendor agrees to purchase the SERP with a minimum reporting period of not less than two years. Purchase of the SERP shall not relieve the Vendor of the obligation to provide replacement coverage. By entering into this contract Vendor agrees to provide a waiver of subrogation or a waiver of transfer of rights of recovery, in favor of the County for the workers' compensation and general liability policies as required herein. When required by the insurer or should a policy condition not permit the Vendor to enter into a pre-loss agreement to waive subrogation without an endorsement, then Vendor agrees to notify the insurer and request the policy be endorsed with a Waiver of Subrogation or a Waiver of Transfer of Rights of Recovery Against Others endorsement. Page 21 Prior to execution and commencement of any operations/services provided under this contract the Vendor shall provide the County with current certificates of insurance evidencing all required coverage. In addition to the certificate(s) of insurance the Vendor shall also provide endorsements for each policy as specified above. All specific policy endorsements shall be in the name of the Orange County Board of County Commissioners. For continuing service contracts renewal certificates shall be submitted immediately upon request by either the County or the County's contracted certificate compliance management firm. The certificates shall clearly indicate that the Vendor has obtained insurance of the type, amount and classification as required for strict compliance with this insurance section. Vendor shall notify the County not less than thirty (30) business days (ten business days for non- payment of premium) of any material change in or cancellation/non-renewal of insurance coverage. The Vendor shall provide evidence of replacement coverage to maintain compliance with the aforementioned insurance requirements to the County or its certificate management representative five (5) business days prior to the effective date of the replacement policy (ies). The certificate holder shall read: Orange County Board of County Commissioners do Procurement Division 400 E. South Street, 2nd Floor Orlando, Florida 32801 16. CONTRACT TERM/RENEWAL A. The contract resulting from this Invitation for Bids shall commence effective upon issuance of a term contract by the County and extend for a period of one (1) year. The contract may be renewed for two (2) additional one (1) year periods, upon mutual agreement of both parties. If any such renewal results in changes in the terms and conditions, such changes shall be reduced to writing as an amendment to this contract and such amendment shall be executed by both parties. B. The initiating County department(s) shall issue delivery/purchase orders against the term contract on an "as needed" basis. C. If the quantity of a unit priced item in this contract is an estimated quantity and the actual quantities ordered are more than 50% above the estimated quantity, the County shall enter into negotiations with the Contractor for a lower unit price which shall be incorporated into the contract. Failure of the Contractor to agree to a reduced unit price may result in the termination of the contract and re-solicitation of the requirement. D. Any order issued during the effective period of this contract, but not completed within that period, shall be completed by the Contractor within the time specified in the order. The contract shall govern the Contractor's and the County's rights and obligations with respect to that order to the extent as if the order were completed during the contract performance period. Page 22 17. USE OF CONTRACT BY OTHER GOVERNMENT AGENCIES At the option of the Contractor, the use of the contract resulting from this solicitation may be extended to other governmental agencies, including the State of Florida, its agencies, political subdivisions, counties, and cities. Each governmental agency allowed by the Contractor to use this contract shall do so independent of any other governmental entity. Each agency shall be responsible for its own purchases and shall be liable only for goods or services ordered, received and accepted. No agency receives any liability by virtue of this bid and subsequent contract award. 18. BID PREFERENCE In accordance with the Minority Women Owned Business Enterprise (MWBE) Ordinance, award of a contract resulting from this Invitation for Bids may be made to the lowest responsive and responsible Orange County certified MWBE bidder provided that the bid does not exceed the overall lowest responsive and responsible bidder by the following percentages for the bid amounts listed: A. 8% - Bids Up To $100,000 B. 7% - Bids Greater Than $100,000 to $500,000 C. 6% - Bids Greater Than $500,000 to $750,000 D. 5% - Bids Greater Than $750,000 to $2,000,000 E. 4% - Bids Greater Than $2,000,000 to $5,000,000 F. 3% - Bids Greater Than $5,000,000 In accordance with the Service Disabled Veteran Business Ordinance, award of a contract resulting from this Invitation for Bids may be made to the lowest responsive and responsible registered Service Disabled Veteran bidder provided that the bid does not exceed the overall lowest responsive and responsible bidder by the following percentages for the bid amounts listed: A. 8% - Bids Up To $100,000 B. 7% - Bids Greater Than $100,000 to $500,000 C. 6% - Bids Greater Than $500,000 to $750,000 D. 5% - Bids Greater Than $750,000 to $2,000,000 E. 4% - Bids Greater Than $2,000,000 to $5,000,000 F. 3% - Bids Greater Than $5,000,000 In the event of a tie between an M/WBE and an SDV with all else being equal, the award shall be made to the firm with the lowest business net worth. 19. METHOD OF ORDERING The County shall issue Delivery (Purchase) Orders against the contract on an as needed basis for the goods or services listed on the Bid Response Form. Page 23 20. CONDITIONS FOR EMERGENCY/HURRICANE OR DISASTER - TERM CONTRACTS It is hereby made a part of this Invitation for Bids that before, during and after a public emergency, disaster, hurricane, flood, or other acts of God that Orange County shall require a "first priority" basis for goods and services. It is vital and imperative that the majority of citizens are protected from any emergency situation which threatens public health and safety, as determined by the County. Contractor agrees to rent/sell/lease all goods and services to the County or other governmental entities as opposed to a private citizen, on a first priority basis. The County expects to pay contractual prices for all goods or services required during an emergency situation. Contractor shall furnish a twenty-four (24) hour phone number in the event of such an emergency. 21. REFERENCES A contact person shall be someone who has personal knowledge of the Bidder's performance for the specific requirement listed. Contact person shall have been informed that they are being used as a reference and that the County may be contacting them. More than one person can be listed but all shall have knowledge of the project. The reference shall be the owner or a representative of the owner. Contractors who provided services under the referenced project (contract) shall not be accepted as references. DO NOT list principals or officers who shall not be able to answer specific questions regarding the project. Failure of references listed to respond to the County's inquiries may negatively impact the responsibility of the Bidder. 22. REQUIREMENTS CONTRACT This is a Requirements Contract and the County's intent is to order from the Contractor all of the goods or services specified in the contract's price schedule that are required to be purchased by the County. If the County urgently requires delivery of goods or services before the earliest date that delivery may be required under this contract, and if the contractor will not accept an order providing for accelerated delivery, the County may acquire the goods or services from another source. The County's requirements in this contract are estimated and there is no commitment by the County to order any specified amount. If the estimated quantities are not achieved, this shall not be the basis for an equitable adjustment. If the Manager, Procurement Division determines that the Contractor's performance is less than satisfactory, the County may order the goods or services from other sources until the deficient performance has been cured or the contract terminated. Page 24 SPECIFICATIONS Gasoline, unleaded, antiknock (octane) index minimum 87 (RON + MON)/2, maximum allowable lead 0.05 gram per gallon, per A.S.T.M. specification D4814, complying with state of Florida gasoline inspection laws. Gasoline, unleaded, antiknock (octane) index minimum 89 (RON + MON)/2, maximum allowable lead 0.05 gram per gallon, and volatility class suitable for Florida at time of scheduled use, per A.S.T.M. specification D4814, complying with state of Florida gasoline inspection laws. Gasoline, unleaded, premium, antiknock (octane) index minimum 93 (RON + MON)/2, maximum allowable lead 0.05 gram per gallon, per A.S.T.M. specification D4814, complying with state of Florida gasoline inspection laws. Oil, diesel fuel, grade no. 2-D ultra low sulfur fuel (.0015 mass % sulfur, 40 cetane min.), for use in over the road diesel engine, per A.S.T.M. specification D975, complying with Florida Department of Agriculture and Consumer Services standards 5F-2.001. Oil, diesel fuel, red dye, grade no. 2-D ultra low sulfur fuel (.0015 mass % sulfur, 40 cetane min.), for use in off the road diesel engine, per A.S.T.M. specification D975, complying with Florida Department of Agriculture and Consumer Services standards 5F- 2.001. Ethanol, E-10 blend (10 percent ethanol and 90 percent gasoline), shall meet ASTM specification D4806-07 for denatured fuel ethanol for blending with gasolines for use as automotive spark-ignition engine fuel. All tank wagon loads of gasoline and/or diesel fuel shall be delivered in metered trucks and a metered delivery ticket shall be issued upon completion of delivery. FUEL DELIVERY FOR DESIGNATED COUNTY VEHICLES The Contractor shall have the ability to fuel designated County vehicles where they are located on or off of County property. For this purpose, the Contractor shall provide a Contractor owned fuel management system able to electronically capture, via a bar code affixed to the vehicle by the Contractor, the vehicle ID, fuel type and quantity dispensed and the time and date when the dispensing occurs. All applicable fueling information shall be electronically transmitted to the County on a daily basis. The Contractor fuel dispensing vehicle shall dispense fuel obtained directly from the terminal and not from a secondary fuel storage site. Fueling locations for the vehicles shall be communicated to the Contractor as applicable to facilitate the fueling activities. At the time of this solicitation, the current afterhours fuel delivery site for designated County vehicles is 8100 Presidents Dr., Orlando, FL. Addresses for the fueling of designated County vehicles may be added, deleted or changed as necessary. Page 25 BID RESPONSE FORM IFB Y16-1081-MR All charges including, but not limited to, drop charges, pump charges, split delivery charges and/or minimum freight charges shall be included in the discount or mark-up from the OPIS price. There are no, and shall not be, provisions for added charges. Indicate a discount with a negative (-) and mark-up with a plus (+). Estimated annual gallons of all fuels are stated in Delivery Schedule A. FIXED DISCOUNT (-) OR MARK-UP (+) PRICE PER GALLON SUBTRACTED FROM OR ADDED TO THE OPIS AVERAGE PRICE(S) PER GALLON POSTED FOR THE TAFT TERMINAL ITEM NO DESCRIPTION 1. 87 Octane gasoline, as specified $ per gallon 2. 89 Octane gasoline, as specified $ per gallon 3. 93 Octane gasoline, as specified $ per gallon 4. Undyed Diesel fuel, as specified $ per gallon 5. Dyed Diesel fuel, as specified $ per gallon Company Name IMPORTANT NOTE: When completing your bid, do not attach any forms which may contain terms and conditions that conflict with those listed in the County's bid documents(s). Inclusion of additional terms and conditions such as those which may be on your company's standard forms shall result in your bid being declared non-responsive as these changes will be considered a counteroffer to the County's bid. Delivery shall be not later than two (2) calendar days After Receipt of Order (ARO) per Special Terms and Conditions. Inquiries regarding this Invitation for Bids may be directed to Melisa Rivera, Senior Purchasing Agent, at Melisa.Rivera(cr�ocfl.net Bid Response Documents - The following documents constitute your bid: A. Bid Response Form, Authorized Signatories/Negotiators, Drug-Free Workplace, Schedule of Sub-contracting, Conflict/Non-Conflict of Interest Form, E- Verification Certification, and current W9, Relationship Disclosure Form and Orange County Specific Project Expenditure Report. Please make sure forms are fully executed where required. B. Qualifications of Bidders information, per Special Terms and Conditions. C. Completed attached reference documentation. Page 26 THE FOLLOWING SECTION MUST BE COMPLETED BY ALL BIDDERS: Company Name: NOTE: COMPANY NAME MUST MATCH LEGAL NAME ASSIGNED TO TIN NUMBER. CURRENT W9 MUST BE SUBMITTED WITH BID. TIN#: D-U-N-S®# (Street No. or P.O. Box Number) (Street Name) (City) (County) (State) (Zip Code) Contact Person: Phone Number: Fax Number: Email Address: EMERGENCY CONTACT Emergency Contact Person: Telephone Number: Cell Phone Number: Residence Telephone Number: Email: ACKNOWLEDGEMENT OF ADDENDA The Bidder shall acknowledge receipt of any addenda issued to this solicitation by completing the blocks below or by completion of the applicable information on the addendum and returning it not later than the date and time for receipt of the bid. Failure to acknowledge an addendum that has a material impact on this solicitation may negatively impact the responsiveness of your bid. Material impacts include but are not limited to changes to specifications, scope of work/services, delivery time, performance period, quantities, bonds, letters of credit, insurance, or qualifications. Addendum No. , Date Addendum No. , Date Addendum No. , Date Addendum No. , Date Page 27 AUTHORIZED SIGNATORIES/NEGOTIATORS The Bidder represents that the following principals are authorized to sign bids, negotiate and/or sign contracts and related documents to which the bidder will be duly bound. Principal is defined as an employee, officer or other technical or professional in a position capable of substantially influencing the development or outcome of an activity required to perform the covered transaction. Name Title Telephone Number/Email (Signature) (Date) (Title) (Name of Business) The Bidder shall complete and submit the following information with the bid: Type of Organization Sole Proprietorship Partnership Non-Profit Joint Venture Corporation State of Incorporation: Principal Place of Business (Florida Statute Chapter 607): City/County/State THE PRINCIPAL PLACE OF BUSINESS SHALL BE THE ADDRESS OF THE BIDDER'S PRINCIPAL OFFICE AS IDENTIFIED BY THE FLORIDA DIVISION OF CORPORATIONS. Federal I.D. number is Page 28 REFERENCES List three (3) customers during the past ten (10) years for which you provided, goods or services similar to those specified in the solicitation in the spaces provided below. Provide the owner's name, contact person, address, email address, telephone number, and date services were performed, as described. 1. Company Name: Owner's Name: Description of goods or services provided: Contract Amount: Start and End Date of Contract: Contact Person: Address: Telephone Number: Email Address: 2. Company Name: Owner's Name: Description of goods or services provided: Contract Amount: Start and End Date of Contract: Contact Person: Address: Telephone Number: Page 29 Email Address: 3. Company Name: Owner's Name: Description of goods or services provided: Contract Amount: Start and End Date of Contract: Contact Person: Address: Telephone Number: Email Address: Page 30 DRUG-FREE WORKPLACE FORM The undersigned Bidder, in accordance with Florida Statute 287.087 hereby certifies that does: Name of Business 1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, 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 a copy of the statement specified in Paragraph 1. 4. In the statement specified in Paragraph 1, notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Florida Statute 893 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 Paragraphs 1 thru 5. As the person authorized to sign this statement, I certify that this firm complies fully with above requirements. Bidder's Signature Date 0 a) c L 3 '0 0 O 0 O C Q d cc 73 O +r C 0 0 0 0 (2 a _a c c = o o co c 0 0 C CU E ° -0 Zr) p E It To 8 U O a) 00,. d G. 0. a) a) 0 z c a) U V) ce 1— . U O 2 0 V o c m CO ao6i � T �/ VJ >- L u_ _4 -0 N Z a) N ILI J CO L Q LL Q W -o I c U c° U) u) c o C trzl o fs c (0 o .Q- U .0 cca CU L C0 O L r) L Ha) +0+ N c O O V. c9 C a) 0 0 0 U) C) m _a CD O m CD u) N (0 0 a) .c 0 E E Z as v Z c (a o a) 0_ u) u) E u) N 0 Q 0_ 0 CONFLICT/NON-CONFLICT OF INTEREST STATEMENT CHECK ONE [ j To the best of our knowledge, the undersigned bidder has no potential conflict of interest due to any other clients, contracts, or property interest for this project. OR [ j The undersigned bidder, by attachment to this form, submits information which may be a potential conflict of interest due to other clients, contracts, or property interest for this project. LITIGATION STATEMENT CHECK ONE [ ] The undersigned bidder has had no litigation and/or judgments entered against it by any local, state or federal entity and has had no litigation and/or judgments entered against such entities during the past ten (10) years. [ ] The undersigned bidder, BY ATTACHMENT TO THIS FORM, submits a summary and disposition of individual cases of litigation and/or judgments entered by or against any local, state or federal entity, by any state or federal court, during the past ten (10) years. COMPANY NAME AUTHORIZED SIGNATURE NAME (PRINT OR TYPE) TITLE Failure to check the appropriate blocks above may result in disqualification of your bid. Likewise, failure to provide documentation of a possible conflict of interest, or a summary of past litigation and/or judgments, may result in disqualification of your bid. E VERIFICATION CERTIFICATION Contract No.Y16-1081-M R I hereby certify that I will utilize the U.S. Department of Homeland Security's E-Verify system in accordance with the terms governing the use of the system to confirm the employment eligibility of the individuals classified below. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duties shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida statutes. All persons, including subcontractors and their workforce, who will perform work under Contract No.Y16-1081-MR, Motor Fuels Tankwagon Deliveries, within the state of Florida. NAME OF CONTRACTOR: ADDRESS OF CONTRACTOR: AUTHORIZED SIGNATURE: TITLE: DATE: RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY PROPOSER For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the Bidder and shall be submitted to the Procurement Division by the Bidder. In the event any information provided on this form should change, the Bidder must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON BIDDER: Legal Name of Bidder: Business Address (Street/P.O. Box, City and Zip Code): Business Phone: ( ) Facsimile: ( ) INFORMATION ON BIDDER'S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Bidder's Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone: ( ) Facsimile: ( ) Page 1 Part II IS THE BIDDER A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE BIDDER'S EMPLOYEE? YES NO IS THE BIDDER OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded "YES" to any of the above questions, please state with whom and explain the relationship. (Use additional sheets of paper if necessary) Page 2 Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Date Printed Name and Title of Person completing this form: STATE OF . COUNTY OF . I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. Page 3 FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County's Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant's item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC. In particular, the applicant needs to disclose whether any of the following relationships exist: (1) the applicant is a business associate of the Mayor or any member of the BCC; (2) any person involved with the approval of the item has a beneficial interest in the outcome of the matter and is a business associate of the Mayor or any member of the BCC; (3) the applicant is a relative of the Mayor or any member of the BCC; or (4) the Mayor or any member of the BCC is an employee of the applicant. (See Section 2-454, Orange County Code.) HOW ARE THE KEY RELEVANT TERMS DEFINED? Applicant means, for purposes of a development-related project, the owner, and, if applicable, the contract purchaser or owner's authorized agent. Applicant means, for purposes of a procurement item, the bidder, offeror, quoter, respondent, and, if applicable, the authorized agent of the bidder, offeror, quoter, or respondent. Business associate means any person or entity engaged in or carrying on a business enterprise with a public officer, public employee, or candidate as a partner, joint venture, corporate shareholder where the shares of such corporation are not listed on any national or regional stock exchange, or co-owner of property. In addition, the term Page 1 includes any person or entity engaged in or carrying on a business enterprise, or otherwise engaging in common investment, with a public officer, public employee, or candidate as a partner, member, shareholder, owner, co-owner, joint venture partner, or other investor, whether directly or indirectly, whether through a Business Entity or through interlocking Parent Entities, Subsidiary Entities, or other business or investment scheme, structure, or venture of any nature. (See Section 112.312(4), Florida Statutes, and Section 2-452(b), Orange County Code.) Employee means any person who receives remuneration from an employer for the performance of any work or service while engaged in any employment under any appointment or contract for hire or apprenticeship, express or implied, oral or written, whether lawfully or unlawfully employed, and includes, but is not limited to, aliens and minors. (See Section 440.02(15), Florida Statutes.) Relative means an individual who is related to a public officer or employee as father, mother, son, daughter, brother, sister, uncle, aunt, first cousin, nephew, niece, husband, wife, father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, sister-in- law, stepfather, stepmother, stepson, stepdaughter, stepbrother, stepsister, half brother, half sister, grandparent, great grandparent, grandchild, great grandchild, step grandparent, step great grandparent, step grandchild, step great grandchild, person who is engaged to be married to the public officer or employee or who otherwise holds himself or herself out as or is generally known as the person whom the public officer or employee intends to marry or with whom the public officer or employee intends to form a household, or any other natural person having the same legal residence as the public officer or employee. (See Section 112.312(21), Florida Statutes.) DOES THE RELATIONSHIP DISCLOSURE FORM NEED TO BE UPDATED IF INFORMATION CHANGES? Yes. It remains a continuing obligation of the applicant to update this form whenever any of the information provided on the initial form changes. WHERE DO THE RELATIONSHIP DISCLOSURE FORM AND ANY SUBSEQUENT UPDATES NEED TO BE FILED? For a development-related item, the Relationship Disclosure Form and any update need to be filed with the County Department or County Division where the applicant filed the application. For a procurement item, the Relationship Disclosure Form and any update need to be filed with the Procurement Division. WHEN DO THE RELATIONSHIP DISCLOSURE FORM AND ANY UPDATES NEED TO BE FILED? In most cases, the initial form needs to be filed when the applicant files the initial development-related project application or initial procurement-related forms. However, with respect to a procurement item, a response to a bid will not be deemed unresponsive if this form is not included in the initial packet submitted to the Procurement Division. If changes are made after the initial filing, the final, cumulative Relationship Disclosure Form needs to be filed with the appropriate County Department or County Division processing the application not less than seven (7) days prior to the scheduled BCC agenda date so that it may be incorporated into the BCC agenda packet. When the matter is a discussion agenda item or is the subject of a public hearing, and an update has not been made at least 7 days prior to BCC meeting date or is not included in the Page 2 BCC agenda packet, the applicant is obligated to verbally present such update to the BCC when the agenda item is heard or the public hearing is held. When the matter is a consent agenda item and an update has not been made at least 7 days prior to the BCC meeting or the update is not included in the BCC agenda packet, the item will be pulled from the consent agenda to be considered at a future meeting. WHO WILL REVIEW THE INFORMATION DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM AND ANY UPDATES? The information disclosed on this form and any updates will be a public record as defined by Chapter 119, Florida Statutes, and may therefore be inspected by any interested person. Also, the information will be made available to the Mayor and the BCC members. This form and any updates will accompany the information for the applicant's project or item. However, for development-related items, if an applicant discloses the existence of one or more of the relationships described above and the matter would normally receive final consideration by the Concurrency Review Committee or the Development Review Committee, the matter will be directed to the BCC for final consideration and action following committee review. CONCLUSION: We hope you find this FAQ useful to your understanding of the Relationship Disclosure Form. Please be informed that if the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance or law governing relationship disclosures, the ordinance or law controls. Also, please be informed that the County Attorney's Office is not permitted to render legal advice to an applicant or any other outside party. Accordingly, if the applicant or an outside party has any questions after reading this FAQ, he/she is encouraged to contact his/her own legal counsel. Page 3 k ORANGE COUNTY SPECIFIC PROJECT EXPENDITURE REPORT This lobbying expenditure form shall be completed in full and filed with all application submittals. This form shall remain cumulative and shall be filed with the department processing your application. Forms signed by a principal's authorized agent shall include an executed Agent Authorization Form. This is the initial Form: This is a Subsequent Form: Part I Please complete all of the following: Name and Address of Principal (legal name of entity or owner per Orange County tax rolls): Name and Address of Principal's Authorized Agent, if applicable: List the name and address of all lobbyists, Contractors, contractors, subcontractors, individuals or business entities who will assist with obtaining approval for this project. (Additional forms may be used as necessary.) 1. Name and address of individual or business entity: Are they registered Lobbyist? Yes or No 2. Name and address of individual or business entity: Are they registered Lobbyist? Yes or No 3. Name and address of individual or business entity: Are they registered Lobbyist? Yes or No 4. Name and address of individual or business entity: Are they registered Lobbyist? Yes or No 5. Name and address of individual or business entity: Are they registered Lobbyist? Yes or No 6. Name and address of individual or business entity: Are they registered Lobbyist? Yes or No 7. Name and address of individual or business entity: Are they registered Lobbyist? Yes or No 8. Name and address of individual or business entity: Are they registered Lobbyist? Yes or No Page 1 Part II Expenditures: For this report, an "expenditure" means money or anything of value given by the principal and/or his/her lobbyist for the purpose of lobbying, as defined in section 2-351, Orange County Code. This may include public relations expenditures including, but not limited to, petitions, fliers, purchase of media time, cost of print and distribution of publications. However, the term "expenditure" does not include: •Contributions or expenditures reported pursuant to chapter 106, Florida Statutes; •Federal election law, campaign-related personal services provided without compensation by individuals volunteering their time; •Any other contribution or expenditure made by or to a political party; •Any other contribution or expenditure made by an organization that is exempt from taxation under 26 U.S.C. s. 527 or s. 501(c)(4), in accordance with s.112.3215, Florida Statutes; and/or •Professional fees paid to registered lobbyists associated with the project or item. The following is a complete list of all lobbying expenditures and activities (including those of lobbyists, contractors, Contractors, etc.) incurred by the principal or his/her authorized agent and expended in connection with the above-referenced project or issue. You need not include de minimus costs (under $50) for producing or reproducing graphics, aerial photographs, photocopies, surveys, studies or other documents related to this project. Date of Name of Party Description of Activity Amount Paid Expenditure Incurring Expenditure TOTAL EXPENDED THIS $ REPORT Page 2 Part Ill Original signature and notarization required I hereby certify that information provided in this specific project expenditure report is true and correct based on my knowledge and belief. I acknowledge and agree to comply with the requirement of section 2-354, of the Orange County code, to amend this specific project expenditure report for any additional expenditure(s) incurred relating to this project prior to the scheduled Board of County Commissioner meeting. I further acknowledge and agree that failure to comply with these requirements to file the specific expenditure report and all associated amendments may result in the delay of approval by the Board of County Commissioners for my project or item, any associated costs for which I shall be held responsible. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date Signature of o Principal or o Principal's Authorized Agent (check appropriate box) Printed Name and Title of Person completing this form: • STATE OF • COUNTY OF I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. Page 3 FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE SPECIFIC PROJECT EXPENDITURE REPORT Updated 3-1-11 WHAT IS A SPECIFIC PROJECT EXPENDITURE REPORT (SPR)? A Specific Project Expenditure Report (SPR) is a report required under Section 2-354(b) of the Orange County Lobbying Ordinance, codified at Article X of Chapter 2 of the Orange County Code, reflecting all lobbying expenditures incurred by a principal and their authorized agent(s) and the principal's lobbyist(s), contractor(s), subcontractor(s), and Contractor(s), if applicable, for certain projects or issues that will ultimately be decided by the Board of County Commissioners (BCC). Matters specifically exempt from the SPR requirement are ministerial items, resolutions, agreements in settlement of litigation matters in which the County is a party, ordinances initiated by County staff, and some procurement items, as more fully described in 2.20 of the Administrative Regulations. Professional fees paid by the principal to his/her lobbyist for the purpose of lobbying need not be disclosed on this form. (See Section 2-354(b), Orange County Code.) WHO NEEDS TO FILE THE SPR? The principal or his/her authorized agent needs to complete and sign the SPR and warrant that the information provided on the SPR is true and correct. A principal that is a governmental entity does not need to file an SPR. HOW ARE THE KEY RELEVANT TERMS DEFINED? Expenditure means "a payment, distribution, loan, advance, reimbursement, deposit, or anything of value made by a lobbyist or principal for the purpose of lobbying. This may include public relations expenditures (including but not limited to petitions, flyers, purchase of media time, cost of print and distribution of publications) but does not include contributions or expenditures reported pursuant to Chapter 106, Florida Statutes, or federal election law, campaign-related personal services provided without compensation by individuals volunteering their time, any other contribution or expenditure made by or to a political party, or any other contribution or expenditure made by an organization that is exempt from taxation under 26 U.S.C. s. 527 or s. 501(c)(4)." (See Section 112.3215, Florida Statutes.) Professional fees paid by the principal to his/her lobbyist for the purpose of lobbying are not deemed to be "expenditures." (See Section 2-354, Orange County Code.) Lobbying means seeking "to encourage the approval, disapproval, adoption, repeal, rescission, passage, defeat or modification of any ordinance, resolution, agreement, development permit, other type of permit, franchise, vendor, Contractor, contractor, recommendation, decision or other foreseeable action of the [BCC]," and "include[s] all communications, regardless of whether initiated by the lobbyist or by the person being lobbied, and regardless of whether oral, written or electronic." (See Section 2-351, Orange County Code.) Furthermore, lobbying means communicating "directly with the County Mayor, with any other member of the [BCC], or with any member of a procurement committee." (See Section 2-351, Orange County Code.) Lobbying also Page 1 means communicating "indirectly with the County Mayor or any other member of the [BCC]" by communicating with any staff member of the Mayor or any member of the BCC, the county administrator, any deputy or assistant county administrator, the county attorney, any county department director, or any county division manager. (See Section 2-351, Orange County Code.) Lobbying does not include the act of appearing before a Sunshine Committee, such as the Development Review Committee or the Roadway Agreement Committee other than the BCC. Principal means "the person, partnership, joint venture, trust, association, corporation, governmental entity or other entity which has contracted for, employed, retained, or otherwise engaged the services of a lobbyist." Principal may also include a person, partnership, joint venture, trust, association, corporation, limited liability corporation, or other entity where it or its employees do not qualify as a lobbyist under the definition set forth in Section 2-351 of the Orange County Code but do perform lobbying activities on behalf of a business in which it has a personal interest. DOES THE SPR NEED TO BE UPDATED IF INFORMATION CHANGES? Yes. It remains a continuing obligation of the principal or his/her authorized agent to update the SPR whenever any of the information provided on the initial form changes. WHERE DO THE SPR AND ANY UPDATES NEED TO BE FILED? The SPR needs to be filed with the County Department or County Division processing the application or matter. If and when an additional expenditure is incurred subsequent to the initial filing of the SPR, an amended SPR needs to be filed with the County Department or County Division where the original application, including the initial SPR, was filed. WHEN DO THE SPR AND ANY UPDATES NEED TO BE FILED? In most cases, the initial SPR needs to be filed with the other application forms. The SPR and any update must be filed with the appropriate County Department or County Division not less than seven (7) days prior to the BCC hearing date so that they may be incorporated into the BCC agenda packet. (See Section 2-354(b), Orange County Code.) When the matter is a discussion agenda item or is the subject of a public hearing, and any additional expenditure occurs less than 7 days prior to BCC meeting date or updated information is not included in the BCC agenda packet, the principal or his/her authorized agent is obligated to verbally present the updated information to the BCC when the agenda item is heard or the public hearing is held. When the matter is a consent agenda item and an update has not been made at least 7 days prior to the BCC meeting or the update is not included in the BCC agenda packet, the item will be pulled from the consent agenda to be considered at a future meeting. WHO WILL BE MADE AWARE OF THE INFORMATION DISCLOSED ON THE SPR AND ANY UPDATES? The information disclosed on the SPR and any updates will be a public record as defined by Chapter 119, Florida Statutes, and therefore may be inspected by any interested person. Also, the information will be made available to the Mayor and the BCC members. This information will accompany the other information for the principal's project or item. Page 2 CONCLUSION: We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney's Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Page 3 AGENT AUTHORIZATION FORM I/We, (Print Bidder name) , Do hereby authorize (print agent's name), , to act as my/our agent to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, (IFB NUMBER AND TITLE) , and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Signature of Bidder Date STATE OF • COUNTY OF I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public Notary Public for the State (Notary Seal) of My Commission Expires: EXHIBIT A LEASED EMPLOYEE AFFIDAVIT I affirm that an employee leasing company provides my workers' compensation coverage. I further understand that my contract with the employee leasing company limits my workers' compensation coverage to enrolled worksite employees only. My leasing arrangement does not cover un-enrolled worksite employees, independent contractors, uninsured sub-contractors or casual labor exposure. I hereby certify that 100% of my workers are covered as worksite employees with the employee leasing company. I certify that I do not hire any casual or uninsured labor outside the employee leasing arrangement. I agree to notify the County in the event that I have any workers not covered by the employee leasing workers' compensation policy. In the event that I have any workers not subject to the employee leasing arrangement, I agree to obtain a separate workers' compensation policy to cover these workers. I further agree to provide the County with a certificate of insurance providing proof of workers' compensation coverage prior to these workers entering any County jobsite. I further agree to notify the County if my employee leasing arrangement terminates with the employee leasing company and I understand that I am required to furnish proof of replacement workers' compensation coverage prior to the termination of the employee leasing arrangement. I certify that I have workers' compensation coverage for all of my workers through the employee leasing arrangement specified below: Name of Employee Leasing Company: Workers' Compensation Carrier: A.M. Best Rating of Carrier: Inception Date of Leasing Arrangement: I further agree to notify the County in the event that I switch employee-leasing companies. I recognize that I have an obligation to supply an updated workers' compensation certificate to the County that documents the change of carrier. Name of Contractor: Signature of Owner/Officer: Title: Date: AWR° CERTIFICATE OF LIABILITY INSURANCE DATE ISAMIDDYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policyties)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME. 1. Name of Agent or Broker PHONE ENS, I NCI Street Address FOIESS City,State,Zip NSURERISI AFFORDING COVERAGE NAILS IN SURER A IN-SURED IN SUFEP.B �j 2. Name of Insured INSUPERC 3. Street Address INILSEY D City, State,Zip IN SURER E: IN COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION Of ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. rISR- -AGM SLER POLICY EFF POLICY ERP pp LTR TIPS OF ISSURANCE INER NVQ FLAKY NUMBER ISMTCIYYY) IPANDOYYYYt U. LENTS GENERAL LIABILITY _ EALG-13C.CLRRENCE 3. COA.ERGAL GENERAL.LIBLPY C OR=R'EB 4. 5. 6. 7 -WRA _ °REVISES 1EE occurrence_ ICLAIMS-MACE OCILL R RED=J'(P Any lair cencn. RERSC:NAL a AD91N RY _ s DB.ERAL AGGREGATE _ CELL AUCFEGATE UNIT APPLES PER eRCCLCTS..COyJF p AOG I�I I I.ELT I I LOC AUTCMOBILE UABILITY CDReI lEJSiNG�.7L✓R� — = acmes ANY ALTO O ECCILY NJURY(Per perm, . ALL CANED SCSEDUI cn ECCILY INJURY(Per a[cWYi AUTOS _AUTOS - -FED SLOE NDNADA-D =RCFERTY DAMAGE — AUTOS =or accI:LNT. LMBPELLA LUIB OCCAA EACH OCCURRENCE Ec( EE UAB CLAMS-MACE A:C'.REGATE DED fI R--Om«� AGRIIERS_ : r AND EMPLOYERS LLWBIRY 1 O. Y/N I T�tYTEIIf�'S I lair M'I=W.OPF!E—DR.FANINERESECUrrvE r = EAC i.ACCIDENT CAF10ER�AEREFN EXC'.LCFC: N'A —`. (Mandatory In NH) EL.DISEASE•EA EAP.AYEE I Y el.ne•Cire 1n]CC DE_CRIPTCN L}ERA—'WS beton, EL.DISESE-=CLICY_IAR S 11 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(Attacti ACORD fat,AOSIG<raI RYSnark.SolodulA•more cpaoe K mulled) Orange County Government is additionally insured on the General Liability Policy. A waiver of subrogation applies in favor of Orange County Government, its agents,employees, and officials on the Worker's Compensation Policy. CERTIFICATE HOLDER CANCELLATION 13. Orange County Board of County Commissioners SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WLL BE DELIVERED IN Procurement Division ACCORDANCE WITH THE POLICY PROVISIONS. 400 E. South Street AUTHCPIZED REPRESENTATIVE Orlando, Florida 32801 14. 111988-2010 ACORD CORPORATION. All rights reserved ACORD 25(201(105) The ACORD name and logo are registered marks of ACORD ORANGE COUNTY CERTIFICATE OF INSURANCE REVIEW GUIDE 1. PRODUCER: Agent's name and address must be shown along with contact name phone,fax,and email address. 2. INSURED: Legal name and address of the entity entering into the contract or agreement 3. INSURERS AFFORDING COVERAGE&NAIC#: Name of the insurance company that is insuring the line of coverage_The INSURER and applicable letter will be used throughout the certificate to indicate the lines of coverage placed with a particular insurance company.A letter must be shown in the INSUR LTR section for each coverage line listed on the certificate_ 4. ADDL INSR: Signifies whether coverage indudes additional insured status.Very few agents use this section_ Additional insured status is usually discussed in the Description of Operations/Locations/Vehides section. S.SUBR WVD: Signifies that a waiver of subrogation is in valid for each line of coverage as indicated. 6.POLICY NUMBER: A poky number should be listed for each line of coverage for which commercial insurance is being provided. 7.POLICY EFFECTIVE/EXPRA TJON DATES: Effective and expiration dates should fall within the time frame of the inception of the contract or agreement. 8.UMITS: As required in the written agreement.The general aggregate should be at least twice the per occurrence limit for all continuing service contracts_If the aggregate limit applies separately then the PROJECT box should be marked. 9.AUTOMOBILE LIABILITY: The ANY AUTO box is preferable however;some organizations do not own vehicles so the other boxes may be marked. 10.WORKERS'COMPENSATION: Look cioselyto see if any proprietor,partner,or executive officer is excluded_If so,please contact Risk Management for waiver approval.The WC STATUTORY LIMITS box must be selected. 11.OTHER: This section is used for other coverage such as professional liability and employee dishonesty.The same rules apply with regards to poky numbers,effective and expiration dates and limits. 12.DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES: This section typically contains any special or qualifying language such as additional insured status or waivers of subrogation_If additional space is needed an ACORD 101 should be attached.Please note that these certificates are for information only and do not confer any rights upon the certificate holder_This is why we also ask for the specific policy language or endorsement specifying that these provisions are in place. 13.CERTIFICATE HOLDER: Orange County Board of County Commissioners should be listed as the certificate holder.Individual departments and divisions should not be listed as the primary certificate holder. 14.AUTHORIZED REPRESENTATIVE: This section should contain the signature of the person authorized to issue the certificate on behalf of the insurance company. WI Review Guide Revised 07/2014 EXHIBIT B COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED — DESIGNATED PERSON OR ORGANIZATION This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s)Or Organization(s) The following are additional insured under the Professional Liability section of this policy (already included under the GL by form#86571). YOUR MEDICAL DIRECTORS AND ADMINISTRATORS, INCLUDING PROFESSIONAL PERSONS, BUT ONLY WHILE ACTING WITHIN THE SCOPE OF THEIR DUTIES FOR THE NAMED INSURED AS MEDICAL DIRECTORS AND ADMINISTRATORS; AN INDEPENDENT CONTRACTOR IS AN INSURED ONLY FOR THE CONDUCT OF YOUR BUSINESS AND SOLELY WHILE PERFORMING SERVICES FOR A CLIENT OF THE NAMED INSURED, BUT SOLELY WITHIN THE SCOPE OF SERVICES CONTEMPLATED BY THE NAMED INSURED; STUDENTS IN TRAINING WHILE PREFORMING DUTIES AS INSTRUCTED BY THE NAMED INSURED; ANY ENTITY YOU ARE REQUIRED IN A WRITTEN CONTRACT (HEREINAFTER CALLED ADDITIONAL INSURED)TO NAME AS AN INSURED IS AN INSURED BUT ONLY WITH RESPECT TO LIABILITY ARISING OUT OF YOUR PREMISES OR OPERATIONS: Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily Injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of you ongoing operations; or B. In connection with your premises owned by or rented to you. EXHIBIT C POLICY NUMBER: COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED — DESIGNATED PERSON OR ORGANIZATION This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s)Or Organization(s) ORANGE COUNTY BOARD OF COUNTY COMMISSIONERS ATTN: PROCUREMENT DIVISION 400 E. SOUTH STREET, 2nd FLOOR ORLANDO, FL 32801 Information required to complete this Schedule, if not shown above,will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily Injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of you ongoing operations; or B. In connection with your premises owned by or rented to you. EXHIBIT D WORKERS COMPENSTION AND EMPLOYEES LIABILITY INSURANCE POLICY WC 00 03 13 2ND Reprint Effective April 1, 1984 Advisory WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Name of Person or Organization: ORANGE COUNTY BOARD OF COUNTY COMMISSIONERS ATTN: PROCUREMENT DIVISION 400 E. SOUTH STREET, 2nd FLOOR ORLANDO, FL 32801 ©1983 National Council on Compensation Insurance,Inc. ©NCCI Holdings, Inc. EXHIBIT E POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 24 0410 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: ORANGE COUNTY BOARD OF COUNTY COMMISSIONERS ATTN: PROCUREMENT DIVISION 400 E. SOUTH STREET, 2nd FLOOR ORLANDO, FL 32801 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right to recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "Products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. 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