Agenda 09/24/2019 Item #16D 1 (Award Contract #19-7627 to Coastal Concrete Products, LLC)09/24/2019
EXECUTIVE SUMMARY
Recommendation to approve an agreement related to the award of Invitation to Bid (ITB) 19-7627
to enhance four Bus stops on Fleischmann Boulevard, to include two pull outs and two shelter
improvements, to Coastal Concrete Products, LLC d/b/a Coastal Site Development in the amount
of $261,050.00 and authorize the Chairman to execute the attached agreement.
OBJECTIVE: To bring existing Collier Area Transit (“CAT”) bus stops into compliance with the
Americans with Disabilities Act (“ADA”) and install bus shelters and amenities to better serve the
passengers by providing them a stable and covered area to wait for the bus.
CONSIDERATIONS: On June 3, 2019, the Procurement Services Department posted Invitation to Bid
(ITB) No. 19-7627 for the Fleischmann Blvd Force Main Replacement, Bus-pull out, & Bus Shelter
Construction project. The County sent out 26,134 notices of the ITB, and interested contractors
downloaded one hundred six (106) bid packages. On July 16, 2019, the County received five (5) bid
responses, as summarized below.
Company
Name
City County ST Base Bid ALT
#1
ALT
#2
ALT #3 Base +
ALT
1,2,3
Responsive
/
Responsibl
e
Coastal
Concrete
Products
LLC d/b/a
Coastal Site
Development
Fort
Myers
Lee FL $255,500 $3,700 $1,400 $450 $261,050 Yes/Yes
Douglas N.
Higgins, Inc.
Naples Collier FL $272,800 $3,000 $1,500 $500 $277,800 No/ Yes
Quality
Enterprises
USA, Inc.
Naples Collier FL $282,650 $3,600 $1,400 $7,425 $295,075 Yes/Yes
Haskins, Inc. Bonita
Springs
Lee FL $288,000 $4,200 $1,300 $11,000 $304,500 Yes/Yes
Florida
Mulch Inc.
St
Cloud
Osceola FL NO BID NO BID --/--
Staff reviewed the bids received and determined that Coastal Concrete Products, LLC d/b/a Coastal Site
Development is the lowest responsive and responsible bidder in t he amount of $261,050. The low bid is
below the engineer’s estimate. The Engineer of Record completed its review of the low bidder’s
references, the bid tabulation, and bid responses/documents, and provided the attached Engineer’s
Recommendation for Award to the low bidder. Staff recommends awarding the contract to the lowest
bidder, Coastal Concrete Products LLC. dba Coastal Site Development, for a total contract amount of
$261,050.
This project will facilitate the improvement of four (4) CAT bus stop sit es as recommended in the ADA
Transition plan adopted by the Collier County Board of County Commissioners (Board) on November 18,
2014. Those four (4) stops will also receive bus shelters and/or associated amenities to better serve CAT
16.D.1
Packet Pg. 1469
09/24/2019
passengers.
FISCAL IMPACT: Funding for the estimated amount of $261,050 is available within the FTA 5307
FY16 Grant Fund (424) Project 33482 in the amount of $42,598.50, 5339 FY18 Grant Fund (424) Project
33591 in the amount of $100,000 and FTA 5307 FY 18 Grant Fund (424) Project 33570 in the amount of
$118,451.50.
LEGAL CONSIDERATIONS: This Item is approved as to form and legality, and requires majority vote
for Board approval. -SRT
GROWTH MANAGEMENT IMPACT: This project meets current Growth Management Plan
standards to ensure the adequacy and availability of viable public facilities.
RECOMMENDATION: To approve an agreement related to the Award of Invitation to Bid No. 19 -
7627 to Coastal Concrete Products, LLC d/b/a Coastal Site Development, in the amount of $261,050 for
the “Fleischmann Blvd Force Main Replacement, Bus-pull out, & Bus Shelter Construction,” and
authorize the Chairman to sign and execute the attached agreement.
Prepared By: Liz Soriano, Project Manager, Public Transit & Neighborhood Enhancement Division
ATTACHMENT(S)
1. 19-7627 - NORA - Executed (PDF)
2. 19-7627 Bid Tabulation - r1 (PDF)
3. 19-7627 Solicitation - r1 (DOCX)
4. [linked] 19-7627 CoastalConcrete_VendorSignedBonds (PDF)
5. 19-7627 - DELORA (PDF)
16.D.1
Packet Pg. 1470
09/24/2019
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.D.1
Doc ID: 9861
Item Summary: Recommendation to approve an agreement related to the award of Invitation to
Bid (ITB) 19-7627 to enhance four Bus stops on Fleischmann Boulevard, to include two pull outs and
two shelter improvements, to Coastal Concrete Products, LLC d/b/a Coastal Site Development in the
amount of $261,050.00 and authorize the Chairman to execute the attached agreement.
Meeting Date: 09/24/2019
Prepared by:
Title: Project Manager – Growth Management Department
Name: Liz Soriano
08/30/2019 10:43 AM
Submitted by:
Title: Division Director - Pub Tran & Nbrhd Enh – Public Transit & Neighborhood Enhancement
Name: Michelle Arnold
08/30/2019 10:43 AM
Approved By:
Review:
Public Transit & Neighborhood Enhancement Caroline Soto Additional Reviewer Completed 08/30/2019 10:50 AM
Procurement Services Opal Vann Level 1 Purchasing Gatekeeper Completed 08/30/2019 10:54 AM
Public Transit & Neighborhood Enhancement Michelle Arnold Additional Reviewer Completed 08/30/2019 11:03 AM
Public Transit & Neighborhood Enhancement Omar Deleon Additional Reviewer Completed 08/30/2019 4:18 PM
County Attorney's Office Sandra Herrera Additional Reviewer Completed 09/03/2019 11:53 AM
Board of County Commissioners Jim Flanagan Additional Reviewer Completed 09/03/2019 1:24 PM
Public Services Department Kimberley Grant Level 1 Reviewer Completed 09/03/2019 2:37 PM
Procurement Services Ted Coyman Additional Reviewer Completed 09/05/2019 2:52 PM
Public Services Department Todd Henry Level 1 Division Reviewer Completed 09/05/2019 3:21 PM
Grants Carrie Kurutz Additional Reviewer Completed 09/06/2019 1:00 PM
Grants Erica Robinson Level 2 Grants Review Completed 09/09/2019 1:55 PM
Public Services Department Steve Carnell Level 2 Division Administrator Review Completed 09/10/2019 9:33 AM
County Attorney's Office Scott Teach Level 2 Attorney Review Completed 09/10/2019 10:37 AM
Office of Management and Budget Laura Wells Level 3 OMB Gatekeeper Review Completed 09/10/2019 11:58 AM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 09/12/2019 8:59 AM
Grants Therese Stanley Additional Reviewer Completed 09/13/2019 12:57 PM
16.D.1
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09/24/2019
County Manager's Office Nick Casalanguida Level 4 County Manager Review Completed 09/14/2019 12:57 PM
Board of County Commissioners MaryJo Brock Meeting Pending 09/24/2019 9:00 AM
16.D.1
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16.D.1.a
Packet Pg. 1473 Attachment: 19-7627 - NORA - Executed (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
Project No:19-7627 Strategist:Jim Flanagan No. of Notices:26,134
Project Title:Fleishmann Blvd Force Main Replacement, Bus Pull-out and Bus Shelter Construction Project Manager:Liz Soriano No. of Downloads:106
Bid Date:07/18/19 Omar DeLeon No. of Bid Resposnses Rec'd:5
BID TABULATION
BIDDER:
Coastal Concrete
Products LLC dba
Coastal Site
Development
Douglas N. Higgins,
Inc
Quality Enterprises
USA Inc Haskins Inc Florida Mulch Inc Engineer's Estimate
Item No.QTY Unit Item Description Total Total Total Total Total Total
Stop ID 50 1 LS STORM DRAINAGE; BUS PULL OUT; CURB; SIDEWALK; INSTALLATION OF BUS
SHELTERS WITH AMENITIES
$81,000 $92,000 $84,650 $85,000 NO BID $95,286
Stop ID 50 1 LS SANITARY SEWER FORCE MAIN WORK $17,500 $45,000 $70,000 $38,000 $0 $49,550
Stop ID 51 1 LS CURB; SIDEWALK & BENCH PAD; INSTALLATION OF BENCH $29,000 $13,800 $10,000 $42,000 $0 $16,473
Stop ID 162 1 LS BUS PULL OUT; CURB; SIDEWALK; INSTALLATION OF BUS SHELTERS WITH
AMENITIES
$89,000 $92,000 $89,000 $95,000 $0 $103,842
Stop ID 163 1 LS CURB; SIDEWALK; INSTALLATION OF BUS SHELTER WITH AMENITIES $39,000 $30,000 $29,000 $28,000 $0 $39,963
$255,500 $272,800 $282,650 $288,000 $0 $305,114
$255,500 $272,800 $282,650 $288,000 NO BID
ALTERNATES
ALTERNATE 1
Site ID 50 1 LS 522-2, SIDEWALK CONCRETE, 6" THICK, 62 SY (-) DEDUCTED ($2,500)($3,000)($3,200)($3,500)$0 $0
Site ID 50 1 LS 526-1-2, ARCHITECTURAL PAVERS (PERVIOUS), 62 SY ADD AT ACCESS PATH $6,200 $6,000 $6,800 $7,700 $0 $0
TOTAL - ALTERNATE 1 $3,700 $3,000 $3,600 $4,200 $0 $0
ALTERNATE 2
Site ID 51 1 LS 522-2, SIDEWALK CONCRETE, 6" THICK, 24 SY (-) DEDUCTED ($1,000)($1,500)($1,250)($1,400)$0 $0
Site ID 51 1 LS 526-1-2, ARCHITECTURAL PAVERS (PERVIOUS), 24 SY ADD
AT ACCESS PATH
$2,400 $3,000 $2,650 $2,700 $0 $0
TOTAL - ALTERNATE 2 $1,400 $1,500 $1,400 $1,300 $0 $0
ALTERNATE 3
All Stop Sites 11 EA SABAL PALMS RELOCATION AND/OR
SHADE TREE PLANTINGS (TREE FURNISHED BY OTHERS)
$450 $500 $7,425 $11,000 $0 $0
TOTAL - ALTERNATE 3 $450 $500 $7,425 $11,000 $0 $0
Opened By:Jim Flanagan
Witnessed by:Barbara Lange
Completed Bid Schedule
Completed Bid Forms: (Solicitation pages 3-13)
Bid Response Form (Form 1)Y Y Y Y
Exhibit N - Contractors Key Personnel Assigned to the Project - (Form 2)Y Y Y Y
Material Manufacturers (Form 3)Y Y Y Y
List of Major Subcontractors (Form 4)Y Y Y Y
Statement of Experience of Bidder (Form 5)Y Y Y Y
Trench Safety Act Acknowledgement (Form 6)Y Y Y Y
Bid Bond (Form 7)Y Y Y Y
Insurance and Bonding Requirements (Form 8)Y Y Y Y
Conflict of Interest Affidavit (Form 9)Y Y Y Y
Vendor Declaration Statement (Form 10)Y Y Y Y
Immigration Affidavit Certification (Form 11)Y Y Y Y
Vendor Substitute W-9 (Form 12)Y Y Y Y
Bidders Checklist (Form 13)Y Y Y Y
Copies of required information attached
Company's E-Verify Profile Page or MOU Y Y Y Y
Copy of Active Registration with Current FL Divisions of Corporations Y Y Y Y
Copy of Active General Contractors License with Depart. of Business & Professional Regulation Y Y Y Y
Copy of Local Business Tax Receipt (Collier County)n/a Y Y n/a
Grant Required Bid Forms
Certification Regarding Debarment, Suspension, and Other Respnsibility Matters (GCA-2)Y Y Y Y
Certification of Lower-Teir Participants Regarding Debarment, Suspension, and other Ineligibility and Voluntary Exclusion (GCA-3)Y Y Y N
Conflict of Interest Certification (GCA-4)Y Y Y Y
Anticipated Disadvantaged, Minority, Women or Veteral Participation Statement (GCA-5)Y Y Y Y
Construction Contractors Bid Opportunity List (GCA-6)Y Y Y Y
Certification Regarding Lobbying (GCA-7)Y Y Y Y
Acknowledgement of Terms, Conditions and Grant Clauses (GCA-8)Y Y Y Y
Acknowledgement - Receipt of Addendum
Addendum #1 Y Y Y N
Strategist: Confirm validity w/FL Divisions of Corporations on-line Y Y Y Y
Strategist: Confirm validity of GC License w/DPBR on-line Y Y Y Y
Strategist: Confirm Insurance and Bonding Requirements Y Y Y Y
Strategist: CONFIRM ALL BID DOCUMENTS COMPLETED AND SIGNED:Y Y Y N
Contractor's Office Location:Fort Myers, FL Naples, FL Naples, FL Bonita Springs, FL
County:Lee Collier Collier Lee
BASE BID TOTAL
16.D.1.b
Packet Pg. 1474 Attachment: 19-7627 Bid Tabulation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
COLLIER COUNTY
BOARD OF COUNTY COMMISSIONERS
CONSTRUCTION INVITATION TO BID
FOR
Fleishmann Blvd Force Main Replacement,
Bus Pull-out and Bus Shelter Construction
SOLICITATION NO.: 19-7627
Jim Flanagan, PROCUREMENT STRATEGIST
PROCUREMENT SERVICES DIVISION
3295 TAMIAMI TRAIL EAST, BLDG C-2
NAPLES, FLORIDA 34112
TELEPHONE: (239) 252-8946
Jim.Flanagan@colliercountyfl.gov (Email)
This proposal solicitation document is prepared in a Microsoft Word format (Rev 8/22/2017). Any
alterations to this document made by the Vendor may be grounds for rejection of proposal,
cancellation of any subsequent award, or any other legal remedies available to the Collier County
Government.
16.D.1.c
Packet Pg. 1475 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
INVITATION TO BID - COUNTY BID NO. 19-7627
Fleishmann Blvd Force Main Replacement and Bus Shelter Construction
Sealed bids for the construction of Fleishmann Blvd Force Main Replacement, Bus Pull-out and Bus Shelter Construction will
be received electronically until 3:00 P.M. LOCAL TIME, on the 18th day of July, 2019 on the County’s on-line bidding system:
https://www.bidsync.com/bidsync-cas/. All bids will be publicly opened and read aloud. Any bids received after the time and
date specified will not be accepted and shall be returned unopened to the Bidder. The anticipated project budget is: $300,000.
A non-mandatory pre-bid conference shall be held at the Procurement Services Division, Conference Room A, at 10:00 a.m.
LOCAL TIME on the 20th day of June, 2019, at which time all prospective Bidders may have questions answered regarding the
Bidding Documents for this Project.
Bids shall be received on line by the Bid Date of July 18, 2019. No bid shall be considered unless it is made on unaltered Bid forms
which are included in the Bidding Documents. One contract will be awarded for all Work. Bidding Documents may be examined
on the Collier County Procurement Services Division Online Bidding System website: https://www.bidsync.com/bidsync-cas/.
Copies of the Bidding Documents may be obtained only from the denoted website. Bidding Documents obtained from sources
other than the Collier County Procurement Services Division website may not be accurate or current.
Each bid shall be accompanied by a certified or cashier ’s check or a Bid Bond in an amount not less than five percent (5%) of the
total Bid to be retained as liquidated damages in the event the Successful Bidder fails to execute the Agreement and file the required
bonds and insurance within ten (10) calendar days after the receipt of the Notice of Award. The Successful Bidder acknowledges
and agrees that it shall execute the Agreement in the form attached hereto and incorporated herein.
The Successful Bidder shall be required to furnish the necessary Payment and Performance Bonds, as prescribed in the General
Conditions of the Contract Documents. All Bid Bonds, Payment and Performance Bonds, Insurance Contracts and Certificates of
Insurance shall be either executed by or countersigned by a licensed resident agent of the surety or insurance company having its
place of business in the State of Florida. Further, the said surety or insurance company shall be duly licensed and qualified to do
business in the State of Florida. Attorneys-in-fact that sign Bid Bonds or Payment and Performance Bonds must file with each
bond a certified and effective dated copy of their Power of Attorney.
In order to perform p ublic work, the Successful Bidder shall, as applicable, hold or obtain such contractor's and business licenses,
certifications and registrations as required by State statutes and County ordinances. Before a contract will be awarded for the Work
contemplated herein, the Owner shall conduct such investigations as it deems necessary to determine the performance record an d
ability of the apparent low Bidder to perform the size and type of work specified in the Bidding Documents. Upon request, th e
Bidder shall submit such information as deemed necessary by the Owner to evaluate the Bidder's qualifications.
The Successful Bidder shall be required to finally complete all Work within Three Hundred Sixty-Five (365) calendar days from
and after the Commencement Date specified in the Notice to Proceed. The final completion days includes substantial completion
days of Three Hundred Thirty-Five (335) calendar days, with an additional Thirty (30) calendar days to final completion. Should
Contractor fail to achieve Substantial Completion within the number of calendar days established herein, Owner shall be entitled to
assess, as liquidated damages, but not as a penalty, One Thousand Two Hundred Forty One Dollars ($1,241) for each calendar
day thereafter until Substantial Completion is achieved. Unless otherwise specified, work will be limited to the hours of 7:00 am
a.m. to 7:00 pm p.m., Monday through Friday. The Owner reserves the right to reject all Bids or any Bid not conforming to the
intent and purpose of the Bidding Documents, and to postpone the award of the contract for a period of time which, however, shall
not extend beyond one hundred twenty (120) days from the bid opening date without the consent of the Successful Bidder.
BOARD OF COUNTY COMMISSIONERS, COLLIER COUNTY, FLORIDA
BY: /s/ Edward F. Coyman, Jr.
Director, Procurement Services Division
16.D.1.c
Packet Pg. 1476 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
FORM 1 - BID RESPONSE FORM
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
Fleishmann Blvd Force Main Replacement, Bus Pull-out and Bus Shelter Construction
BID NO. 19-7627
Full Name of Bidder
Main Business Address
Place of Business
Telephone No. Fax No.
State Contractor's License #
State of Florida Certificate of Authority Document Number
Federal Tax Identification Number
DUNS # CCR# Cage Code
To: BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA
(hereinafter called the Owner)
The undersigned, as Bidder declares that the only person or parties interested in this Bid as principals are those named
herein, that this Bid is submitted without collusion with any other person, firm or corporation; that it has carefully
examined the location of the proposed Work, the proposed form of Agreement and all other Contract Documents and
Bonds, and the Contract Drawings and Specifications.
Bidder proposes, and agrees if this Bid is accepted, Bidder will execute the Agreement included in the Bidding
Documents, to provide all necessary machinery, tools, apparatus and other means of construction, including utility
and transportation services necessary to do all the Work, and furnish all the materials and equipment specified or
referred to in the Contract Documents in the manner and time herein prescribed and according to the requirements of
the Owner as therein set forth, furnish the Contractor's Bonds and Insurance specified in the General Conditions of
the Contract, and to do all other things required of the Contractor by the Contract Documents, and that it will take full
payment the sums set forth in the following Bid Schedule:
Unit prices shall be provided in no more than two decimal points, and in the case where further decimal points
are inadvertently provided, rounding to two decimal points will be conducted by Procurement Services Division
staff.
16.D.1.c
Packet Pg. 1477 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
FORM 2 - CONTRACTOR’S KEY PERSONNEL ASSIGNED TO THE PROJECT
Fleishmann Blvd Force Main Replacement, Bus Pull-out and Bus Shelter Construction
Bid No. 19-7627
Name Personnel Category
Construction Superintendent
Project Manager
16.D.1.c
Packet Pg. 1478 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
FORM 3 - MATERIAL MANUFACTURERS
THIS FORM MUST BE COMPLETED OR BID SHALL BE DEEMED NON-RESPONSIVE
All Bidders shall confirm by signature that they will provide the manufacturers and materials outlined in this Bid
specifications, including compliance with Florida Statute 255.20 to provide lumber, timber and other forest products
produced and manufactured in the State of Florida as long as the price, fitness and quality are equal. Exceptions (when
equals are acceptable) may be requested by completing the Ma terial Manufacturer Exception List below. If an
exception for a manufacturer and/or material is proposed and listed below and is not approved by Engineer/Project
Manager, Bidder shall furnish the manufacturer named in the specification. Acceptance of this form does not constitute
acceptance of material proposed on this list.
Complete and sign section A OR B.
Section A (Acceptance of all manufactures and materials in Bid specifications)
On behalf of my firm, I confirm that we will use all manufacturers and materials as specifically outlined in
the Bid specifications.
Company: _____________________________________________________________
Signature: ___________________________________________ Date: _________
Section B (Exception requested to Bid specifications manufacturers and materials)
EXCEPTION MATERIAL EXCEPTION MANUFACTURER
1.
2.
3.
4.
5.
Please insert additional pages as necessary.
Company: __________________________________________________-_________________
Signature:______________________________________________________ Date ________
16.D.1.c
Packet Pg. 1479 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
FORM 4 - LIST OF MAJOR SUBCONTRACTORS
THIS LIST MUST BE COMPLETED OR BID MAY BE DEEMED NON-RESPONSIVE
The undersigned states that the following is a list of the proposed subcontractors for the major categories outlined in
the requirements of the Bid specifications.
The undersigned acknowledges its responsibility for ensuring that the Subcontractors for the major categories listed
herein are “qualified” (as defined in Ordinance 2017-08 and Section 15 of Instructions to Bidders) and meet all legal
requirements applicable to and necessitated by the Contract Documents, including, but n ot limited to proper licenses,
certifications, registrations and insurance coverage. The Owner reserves the right to disqualify any Bidder who
includes non-compliant or non-qualified Subcontractors in its bid offer. Further, the Owner may direct the Succes sful
Bidder to remove/replace any Subcontractor, at no additional cost to Owner, which is found to be non -compliant with
this requirement either before or after the issuance of the Award of Contract by Owner. (Attach additional sheets as
needed). Further, the undersigned acknowledges and agrees that promptly after the Award of Contract, and in
accordance with the requirements of the Contract Documents, the Successful Bidder shall identify all Subcontractors
it intends to use on the Project. The undersigned further agrees that all Subcontractors subsequently identified for any
portion of work on this Project must be qualified as noted above.
Major Category of Work Subcontractor and Address
1. Electrical
2. Mechanical
3. Plumbing
4. Site Work
5. Identify other subcontractors
that represent more than 10%
of price or that affect the
critical path of the schedule
Company: ___________________________________________________________________
Signature: __________________________________________________ Date: _________
16.D.1.c
Packet Pg. 1480 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
FORM 5 - STATEMENT OF EXPERIENCE OF BIDDER
The Bidder is required to state below what work of similar magnitude completed within the last
five (5) years is a judge of its experience, skill and business standing and of its ability to conduct
the work as completely and as rapidly as required under the terms of the Agreement.
1.
_______________________________________ ____________________________________________
(project name) (project owner)
_______________________________________ ____________________________________________
(project location) (Owner’s address)
_______________________________________ _________________________ __________________
(project description) (Owner’s contact person) (tit le)
________________________ $_____________ _________________ _________________________
(project start/completion dates) (contract value) (phone) (email)
2.
_______________________________________ ____________________________________________
(project name) (project owner)
_______________________________________ ____________________________________________
(project location) (Owner’s address)
_______________________________________ _________________________ __________________
(project description) (Owner’s contact person) (ti tle)
________________________ $_____________ _________________ _________________________
(project start/completion dates) (contract value) (phone) (email)
3.
_______________________________________ ____________________________________________
(project name) (project owner)
_______________________________________ ____________________________________________
(project location) (Owner’s address)
_______________________________________ _________________________ __________________
(project description) (Owner’s contact person) (title)
________________________ $_____________ _________________ _________________________
(project start/completion dates) (contract value) (phone) (email)
16.D.1.c
Packet Pg. 1481 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
FORM 5 - STATEMENT OF EXPERIENCE OF BIDDER
4.
_______________________________________ ____________________________________________
(project name) (project owner)
_______________________________________ ____________________________________________
(project location) (Owner’s address)
_______________________________________ _________________________ __________________
(project description) (Owner’s contact person) (title)
________________________ $_____________ _________________ _________________________
(project completion date) (contract value) (phone) (email)
5.
_______________________________________ ____________________________________________
(project name) (project owner)
_______________________________________ ____________________________________________
(project location) (Owner’s address)
_______________________________________ _________________________ __________________
(project description) (Owner’s contact person) (title)
________________________ $_____________ _________________ _________________________
(project completion date) (contract value) (phone) (email)
6.
_______________________________________ ____________________________________________
(project name) (project owner)
_______________________________________ ____________________________________________
(project location) (Owner’s address)
_______________________________________ _________________________ __________________
(project description) (Owner’s contact person) (title)
________________________ $_____________ _________________ _________________________
(project completion date) (contract value) (phone) (email)
Company: ___________________________________________________________________
Signature: __________________________________________________ Date: _________
16.D.1.c
Packet Pg. 1482 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
FORM 6 - TRENCH SAFETY ACT
Bidder acknowledges that included in the various items of the bid and in the Total Bid Price are costs for complying with the Florida
Trench Safety Act (90-96, Laws of Florida) effective October 1, 1990. The Bidder further identifies the cost to be summarized below:
Trench Safety
Measure
(Description)
Units of
Measure
(LF,SY)
Unit
(Quantity)
Unit
Cost
Extended Cost
1.
2.
3.
4.
5.
TOTAL $
Failure to complete the above may result in the Bid being declared non -responsive.
Company: __________________________________________________________________________
Signature: __________________________________________________ Date: ________________
16.D.1.c
Packet Pg. 1483 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
FORM 7 - BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we _____________________________ __________________________ (herein
after called the Principal) and ____________________________________________, (herein called the Surety), a corporation
chartered and existing under the laws of the State of _____________ wit h its principal offices in the city of ____________________
and authorized to do business in the State of ______________________ are held and firmly bound unto the
__________________________________________________ (hereinafter called the Owner), in the fu ll and just sum of
____________________________________________ dollars ($_________________) good and lawful money of the United States
of America, to be paid upon demand of the Owner, to which payment well and truly to be made, the Principal and the Suret y bind
themselves, their heirs, and executors, administrators, and assigns, jointly and severally and firmly by these presents.
Whereas, the Principal is about to submit, or has submitted to the Owner, a Bid for furnishing all labor, materials, equipmen t and
incidentals necessary to furnish, install, and fully complete the Work on the Project known as Bid No. 19-7627 Fleishmann Blvd
Force Main Replacement, Bus Pull-out and Bus Shelter Construction.
NOW, THEREFORE, if the Owner shall accept the Bid of the PRINCIPAL and the PRINCIPAL shall enter into the required Agreement
with the Owner and within ten days after the date of a written Notice of Award in accordance with the terms of such Bid, and give such
bond or bonds in an amount of 100% the total Contract Amount as specified in the Bidding Documents or Contract Documents with
good and sufficient surety for the faithful performance of the Agreement and for the prompt payment of labor, materials and supplies
furnished in the prosecution thereof or, in the event of the failure of the PRINCIPAL to enter into such Agreement or to give such bond
or bonds, and deliver to Owner the required certificates of insurance, if the PRINCIPAL shall pay to the OBLIGEE the fixed sum of
$______________ noted above as liquidated damages, and not as a penalty, as provided in the Bidding Documents, then this obligation
shall be null and void, otherwise to remain in full force and effect.
IN TESTIMONY Thereof, the Principal and Surety have caused these presents to be duly signed and sealed this ______ day of
________________, 20 .
Principal
BY (Seal)
Surety
(Seal)
Countersigned
Appointed Producing Agent for
Upon notification that its Bid has been awarded, the Successful Bidder will execute the Agreement form attached to the Biddin g
Documents within ten (10) calendar days and deliver the Surety Bond or Bonds and Insurance Certificates as required by the Con tract
Documents. The bid security attached is to become the property of the Owner in the event the Agreement, Insurance Certificate s and
Bonds are not executed and delivered to Owner within the time above set forth, as liquidated damages, for the delay and addit ional
expense to the Owner, it being recognized that, since time is of the essence, Owner will suffer financial loss if the S uccessful Bidder
fails to execute and deliver to Owner the required Agreement, Insurance Certificates and Bonds within the required time perio d. In
the event of such failure, the total amount of Owner’s damages, will be difficult, if not impossible, to de finitely ascertain and quantify.
It is hereby agreed that it is appropriate and fair that Owner receive liquidated damages from the Successful Bidder in the e vent it
fails to execute and deliver the Agreement, Insurance Certificates, and Bonds as required hereunder. The Successful Bidder hereby
expressly waives and relinquishes any right which it may have to seek to characterize the above noted liquidated damages as a penalty,
which the parties agree represents a fair and reasonable estimate of Owner’s act ual damages at the time of bidding if the Successful
Bidder fails to execute and deliver the Agreement, Insurance Certificates, and Bonds in a timely manner.
Upon receipt of the signed and approved agreement and Purchase Order, the undersigned proposes to commence work at the site
within five (5) calendar days from the commencement date stipulated in the written Notice to Proceed unless the Project Manag er, in
writing, subsequently notifies the Contractor of a modified (later) commencement date. The unders igned further agrees to
substantially complete all work covered by this Bid within Three Hundred Thirty Five (335) consecutive calendar days, computed
by excluding the commencement date and including the last day of such period, and to be fully completed to the point of final
acceptance by the Owner within Thirty (30) consecutive calendar days after Substantial Completion, computed by excluding
commencement date and including the last day of such period.
16.D.1.c
Packet Pg. 1484 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
Respectfully Submitted:
State of
County of
, being first duly sworn on oath deposes and says
that the Bidder on the above Bid is organized as indicated and that all statements herein made are made on behalf of such Bid der and
that this deponent is authorized to make them.
__________________________________________________, also deposes and says that it has examined and carefully prepared its
Bid from the Bidding Documents, including the Contract Drawings and Specifications and has checked the same in detail before
submitting this Bid; that the statements contained herein are true and correct.
(a) Corporation
The Bidder is a corporation organized and existing under the laws of the State of _______________, which operates under the l egal
name of ______________________________________________, and the full names of its officers are as follows:
President
Secretary
Treasurer
Manager
The __________________________________ is authorized to sign construction bids and contracts for the company by action o f its
Board of Directors taken _____________________________, a certified copy of which is hereto attached (strike out this last se ntence
if not applicable).
(b) Co-Partnership
The Bidder is a co-partnership consisting of individual partners whose full names are as follows:
The co-partnership does business under the legal name of:
(c) Individual
The Bidder is an individual whose full name is ________________________________, and if operating under a trade name, said
trade name is ________________________.
Complete for information contained in (a) Corporation, (b) Co -Partnership or (c) Individual from previous page.
DATED
Legal Entity
BY:
Witness Name of Bidder (Typed)
Witness Signature
Title
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before me this ____ day of ___________, 20 , by
______________________________________, as _____________________ of ____________________________________, a
_______________ corporation, on behalf of the corporation. He/she is personally known to me or has produced
_____________________________ ___________________________ as identification and did (did not) take an oath.
My Commission Expires:
(Signature of Notary)
NAME:
(Legibly Printed)
(AFFIX OFFICIAL SEAL) Notary Public, State of
16.D.1.c
Packet Pg. 1485 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
FORM 8 - INSURANCE AND BONDING REQUIREMENTS
The Vendor shall at its own expense, carry and maintain insurance coverage from responsible companies duly authorized to do
business in the State of Florida as set forth in EXHIBIT B of this solicitation. The Vendor sha ll procure and maintain property
insurance upon the entire project, if required, to the full insurable value of the scope of work.
The County and the Vendor waive against each other and the County’s separate Vendors, Contractors, Design Consultant,
Subcontractors, agents and employees of each and all of them, all damages covered by property insurance provided herein, except
such rights as they may have to the proceeds of such insurance. The Vendor and County shall, where appropriate, require simi lar
waivers of subrogation from the County’s separate Vendors, Design Consultants and Subcontractors and shall require each of them
to include similar waivers in their contracts.
Collier County shall be responsible for purchasing and maintaining its own liability insurance.
Certificates issued as a result of the award of this solicitation must identify “For any and all work performed on behalf of Collier
County”, or, the specific solicitation number and title.
The General Liability Policy provided by Vendor to meet the requirements of this solicitation shall name Collier County, Florida, as
an additional insured as to the operations of Vendor under this solicitation and shall contain a severability of interests pr ovisions.
The Certificate Holder shall be named as Collier County Board of County Commissioners, OR, Board of County Commissioners in
Collier County, OR Collier County Government, OR Collier County. The Certificates of Insurance must state the Contract Number ,
or Project Number, or specific Project description, or must read: For any and all work performed on behalf of Collier County.
The amounts and types of insurance coverage shall conform to the minimum requirements set forth in EXHIBIT B with the use of
Insurance Services Office (ISO) forms and endorsements or their equivalents. If Vendor has any self -insured retentions or deductibles
under any of the below listed minimum required coverage, Vendor must identify on the Certificate of Insurance the nature and amount
of such self- insured retentions or deductibles and provide satisfactory evidence of financial responsibility for such o bligations. All
self-insured retentions or deductibles will be Vendor’s sole responsibility.
Coverage(s) shall be maintained without interruption from the date of commencement of the Work until the date of completion and
acceptance of the scope of work by the County or as specified in this solicitation , whichever is longer.
The Vendor and/or its insurance carrier shall provide thirty (30) days written notice to the County of policy cancellation or
non-renewal on the part of the insurance carrier or the V endor. The Vendor shall also notify the County, in a like manner, within
twenty-four (24) hours after receipt, of any notices of expiration, cancellation, non -renewal or material change in coverage or limits
received by Vendor from its insurer and nothing contained herein shall relieve Vendor of this requirement to provide notice. In the
event of a reduction in the aggregate limit of any policy to be provided by Vendor hereunder, Vendor shall immediately take s teps to
have the aggregate limit reinstated to the full extent permitted under such policy.
Should at any time the Vendor not maintain the insurance coverage(s) required herein, the County may terminate the Agreement or
at its sole discretion shall be authorized to purchase such coverage(s) and charge the Vendor for such coverage(s) purchased. If
Vendor fails to reimburse the County for such costs within thirty (30) days after demand, the County has the right to offset these costs
from any amount due Vendor under this Agreement or any other agreement between the County and Vendor. The County shall be
under no obligation to purchase such insurance, nor shall it be responsible for the coverage (s) purchased or the insurance company
or companies used. The decision of the County to purchase such insurance coverage(s) shall in no way be construed to be a waiver
of any of its rights under the Contract Documents.
If the initial or any subsequently issued Certificate of Insurance expires prior to the completion of the scope of work, the Vendor shall
furnish to the County renewal or replacement Certificate(s) of Insurance not later than ten (10) calendar days after the expiration da te
on the certificate. Failure of the Vendor to provide the County with such renewal certificate(s) shall be considered justifi cation for
the County to terminate any and all contracts.
16.D.1.c
Packet Pg. 1486 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
Collier County Florida
Insurance and Bonding Requirements
Insurance / Bond Type Required Limits
1. Worker’s Compensation Statutory Limits of Florida Statutes, Chapter 440 and all Federal Government
Statutory Limits and Requirements
Evidence of Workers’ Compensation coverage or a Certificate of Exem ption issued
by the State of Florida is required. Entities that are formed as Sole Proprietorships
shall not be required to provide a proof of exemption. An application for exemption
can be obtained online at https://apps.fldfs.com/bocexempt/
2. Employer’s Liability
$1,000,000 single limit per occurrence
3. Commercial General
Liability (Occurrence Form)
patterned after the current
ISO form
Bodily Injury and Property Damage
$1,000,000 single limit per occurrence, $2,000,000 aggregate for Bodily Injury Liability
and Property Damage Liability. This shall include Premises and Operations;
Independent Contractors; Products and Completed Operations and Contractual
Liability.
4. Indemnification To the maximum extent permitted by Florida law, the Contractor/Vendor shall defend,
indemnify and hold harmless Collier County, its officers and employees from any and
all liabilities, damages, losses and costs, including, but not limited to, reasonable
attorneys’ fees and paralegals’ fees, to the extent caused by the negligence, recklessness,
or intentionally wrongful conduct of the Contractor/ Vendor or anyone employed or
utilized by the Contractor/Vendor in the performance of this Agreement.
5. Automobile Liability $1,000,000 Each Occurrence; Bodily Injury & Property Damage,
Owned/Non-owned/Hired; Automobile Included
6. Other insurance as noted:
Watercraft $ __________ Per Occurrence
United States Longshoreman's and Harborworker's Act coverage shall be maintained
where applicable to the completion of the work.
$ __________ Per Occurrence
Maritime Coverage (Jones Act) shall be maintained where applicable to the
completion of the work.
$ __________ Per Occurrence
Aircraft Liability coverage shall be carried in limits of not less than $5,000,000 each
occurrence if applicable to the completion of the Services under this Agreement.
$ __________ Per Occurrence
Pollution $ 1,000,000 Per Occurrence
Professional Liability $ ___________ Per claim & in the aggregate
Project Professional Liability $__________ Per Occurrence
Valuable Papers Insurance $__________ Per Occurrence
Cyber Liability $__________ Per Occurrence
Technology Errors & Omissions $__________ Per Occurrence
16.D.1.c
Packet Pg. 1487 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
7. Bid bond
Shall be submitted with proposal response in the form of certified funds, cashiers’ check
or an irrevocable letter of credit, a cash bond posted with the County Clerk, or proposal
bond in a sum equal to 5% of the cost proposal. All checks shall be made payable to the
Collier County Board of County Commissioners on a bank or trust company located in
the State of Florida and insured by the Federal Deposit Insurance Corporation.
8. Performance and
Payment Bonds
For projects in excess of $200,000, bonds shall be submitted with the executed contract
by Proposers receiving award, and written for 100% of the Contract award amo unt, the
cost borne by the Proposer receiving an award. The Performance and Payment Bonds
shall be underwritten by a surety authorized to do business in the State of Florida and
otherwise acceptable to Owner; provided, however, the surety shall be rated as “A-“ or
better as to general policy holders rating and Class V or higher rating as to financial size
category and the amount required shall not exceed 5% of the reported policy holders’
surplus, all as reported in the most current Best Key Rating Guide, p ublished by A.M.
Best Company, Inc. of 75 Fulton Street, New York, New York 10038.
9. Vendor shall ensure that all subcontractors comply with the same insurance requirements that he is required to meet. The
same Vendor shall provide County with certificates of insurance meeting the required insurance provisions.
10. Collier County must be named as "ADDITIONAL INSURED" on the Insurance Certificate for Commercial General
Liability where required. This insurance shall be primary and non -contributory with respect to any other insurance maintained
by, or available for the benefit of, the Additional Insured and the Vendor’s policy shall be endorsed accordingly.
11. The Certificate Holder shall be named as Collier County Board of County Commissioners, OR, Board of County
Commissioners in Collier County, OR Collier County Government, OR Collier County. The Certificates of Insurance must state
the Contract Number, or Project Number, or specific Pro ject description, or must read: For any and all work performed on behalf
of Collier County.
12. On all certificates, the Certificate Holder must read: Collier County Board of Commissioners, 3295 Tamiami Trail East,
Naples, FL 34112
13. Thirty (30) Days Cancellation Notice required.
14. Collier County shall procure and maintain Builders Risk Insurance on all construction projects where it is deemed necessary. Such
coverage shall be endorsed to cover the interests of Collier County as well as the Contractor. Premiums shall be billed to t he
project and the Contractor shall not inc lude Builders Risk premiums in its project proposal or project billings. All questions
regarding Builder’s Risk Insurance will be addressed by the Collier County Risk Management Division.
5/30/19 – CC
___________________________________________________________________________________________________________
Vendor’s Insurance Statement
We understand the insurance requirements of these specifications and that the evidence of insurability may be required within five (5)
days of the award of this solicitation. The insurance submitted must provide coverage for a minimum of six (6) months from the date
of award.
Name of Firm
_______________________________________ Date ____________________________
Vendor Signature
_________________________________________________________________________
Print Name
_________________________________________________________________________
Insurance Agency
_________________________________________________________________________
Agent Name
___________________________________ Telephone Number ________________
16.D.1.c
Packet Pg. 1488 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
FORM 9 - CONFLICT OF INTEREST AFFIDAVIT
The Vendor certifies that, to the best of its knowledge and belief, the past and current work on any Collier County project affiliated
with this solicitation does not pose an organizational conflict as described by one of the three categories below:
Biased ground rules – The firm has not set the “ground rules” for affiliated past or current Collier County project identified
above (e.g., writing a procurement’s statement of work, specifications, or performing systems engineering and technical
direction for the procurement) which appears to skew the competition in favor of my firm.
Impaired objectivity – The firm has not performed work on an affiliated past or current Collier County project identified
above to evaluate proposals / past performance of itself or a competitor, which calls into question the contractor’s ability to
render impartial advice to the government.
Unequal access to information – The firm has not had access to nonpublic information as part of its performance of a
Collier County project identified above which may have provided the contractor (or an affiliate) with an unfair competitive
advantage in current or future solicitations and contracts.
In addition to this signed affidavit, the contractor / vendor must provide the following:
1. All documents produced as a result of the work completed in the past or currently being worked on for the above-mentioned
project; and,
2. Indicate if the information produced was obtained as a matter of public record (in the “sunshine”) or through non-public (not in
the “sunshine”) conversation (s), meeting(s), document(s) and/or other means.
Failure to disclose all material or having an organizational conflict in one or more of the three categories above be identified, may
result in the disqualification for future solicitations affiliated with the above referenced project(s).
By the signature below, the firm (employees, officers and/or agents) certifies, and here by discloses, that, to the best of their knowledge
and belief, all relevant facts concerning past, present, or currently planned interest or activity (financial, contractual, o rganizational,
or otherwise) which relates to the project identified above has been fully disclosed and does not pose an organizational conflict.
Firm: ____________________________________________________________________________
Signature and Date:_________________________________________________________________
Print Name: _______________________________________________________________________
Title of Signatory: __________________________________________________________________
16.D.1.c
Packet Pg. 1489 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
FORM 10 - VENDOR DECLARATION STATEMENT
BOARD OF COUNTY COMMISSIONERS
Collier County Government Complex
Naples, Florida 34112
Dear Commissioners:
The undersigned, as Vendor declares that this response is made without connection or arrangement with any other person and this
proposal is in every respect fair and made in good faith, without collusion or fraud.
The Vendor agrees, if this solicitation submittal is accepted, to execute a Collier County document for the purpose of establishing a
formal contractual relationship between the firm and Collier County, for the performance of all requirements to which the solicitation
pertains. The Vendor states that the submitted is based upon the documents listed by the above referenced Solicitation. Further, the
vendor agrees that if awarded a contract for these goods and/or services, the vendor will not be eligible to compete, submit a
proposal, be awarded, or perform as a sub-vendor for any future associated with work that is a result of this awarded contract.
IN WITNESS WHEREOF, WE have hereunto subscribed our names on thi s _____ day of _____________, 20__ in the County of
_______________, in the State of _____________.
Firm’s Legal Name:
Address:
City, State, Zip Code:
Florida Certificate of
Authority Document
Number
Federal Tax
Identification Number
*CCR # or CAGE Code
*Only if Grant Funded
__________________________________________________________________________
Telephone:
Signature by:
(Typed and written)
Title:
16.D.1.c
Packet Pg. 1490 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
Additional Contact Information
Send payments to:
(required if different from
above)
Company name used as payee
Contact name:
Title:
Address:
City, State, ZIP
Telephone:
Email:
Office servicing Collier
County to place orders
(required if different from
above)
Contact name:
Title:
Address:
City, State, ZIP
Telephone:
Email:
Secondary Contact for this
Solicitation:
Email:
Phone:
16.D.1.c
Packet Pg. 1491 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
FORM 11 - IMMIGRATION AFFIDAVIT CERTIFICATION
This Affidavit is required and should be signed, notarized by an authorized principal of the firm and submitted with formal solicitation
submittals. Further, Vendors are required to enroll in the E-Verify program, and provide acceptable evidence of their enrollment, at
the time of the submission of the Vendor’s proposal. Acceptable evidence consists of a copy of the properly completed E -Verify
Company Profile page or a copy of the fully executed E-Verify Memorandum of Understanding for the company. Failure to include
this Affidavit and acceptable evidence of enrollment in the E-Verify program may deem the Vendor’s proposal as non-
responsive.
Collier County will not intentionally award County contracts to any Vendor who knowingly employs unauthorized alien workers,
constituting a violation of the employment provision contained in 8 U.S.C. Section 1324 a(e) Section 274A(e) of the Immigration
and Nationality Act (“INA”).
Collier County may consider the employment by any Vendor of unauthorized aliens a violation of Section 274A (e) of the INA. Such
Violation by the recipient of the Employment Provisions contained in Section 274A (e) of the INA shall be grounds for unilate ral
termination of the contract by Collier County.
Vendor attests that they are fully compliant with all applicable immigration laws (specifically to the 1986 Immigration Act and
subsequent Amendment(s)) and agrees to comply with the provisions of the Memo randum of Understanding with E-Verify and to
provide proof of enrollment in The Employment Eligibility Verification System (E -Verify), operated by the Department of Homeland
Security in partnership with the Social Security Administration at the time of sub mission of the Vendor’s proposal.
Company Name ____________________________________________________________________
Print Name
Title _______________________
Signature
Date _______________________
State of ___________________
County of _________________
The signee of these Affidavit guarantees, as evidenced by the sworn affidavit required herein, the truth and accuracy of this
affidavit to interrogatories hereinafter made.
Commission No.:
16.D.1.c
Packet Pg. 1492 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
FORM 12 - VENDOR SUBSTITUTE W – 9
Request for Taxpayer Identification Number and Certification
In accordance with the Internal Revenue Service regulations, Collier County is required to collect the following information
for tax reporting purposes from individuals and companies who do business with the County (including social security numbers
if used by the individual or company for tax reporting purposes). Florida Statute 119.071(5) requires that the county
notify you in writing of the reason for collecting this information, which will be used for no other purpose than herein stated.
Please complete all information that applies to your business and return with your quote or proposal.
1. General Information (provide all information)
Taxpayer Name ________________________________________________________________________________
(as shown on income tax return)
Business Name (if different from taxpayer name)
Address ____________________________________ City ______________________________________________
State ______________________________________ Zip______________________________________________
Telephone __________________ Email_____________________
Order Information (Must be filled out)
Address ___________________________________
Remit / Payment Information (Must be filled out)
Address ____________________________________________
City __________
State ________ Zip ___________
City _____________
State _________ Zip______________
Email ____________________________________ Email ____________________________________________
2. Company Status (check only one)
Individual / Sole Proprietor Corporation Partnership
Tax Exempt (Federal income tax-exempt entity
under Internal Revenue Service guidelines IRC
501 (c) 3)
Limited Liability Company
Enter the tax classification
(D = Disregarded Entity, C = Corporation, P = Partnership)
3. Taxpayer Identification Number (for tax reporting purposes only)
Federal Tax Identification Number (TIN) _______________________________________________________________
(Vendors who do not have a TIN, will be required to provide a social security number prior to an award).
4. Sign and Date Form: Certification:
Under penalties of perjury, I certify that the information shown on this form is correct to my knowledge.
Signature
___________________________________________________________
Date
______________________________
Title
_______________________________________________________________
Phone Number
________________________
16.D.1.c
Packet Pg. 1493 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
FORM 13 - BIDDERS CHECKLIST
IMPORTANT: Please read carefully, sign in the spaces indicated and return with your Bid. Bidder should
check off each of the following items as the necessary action is completed:
1. The Bid has been signed.
2. The Bid prices offered have been reviewed.
3. The price extensions and totals have been checked.
4. Bid Schedule has been completed and attached.
5. Any required drawings, descriptive literature, etc. have been included.
6. Any delivery information required is included.
7. The following on-line standard documents have been reviewed in Bidsync:
1. Construction bid instructions form
2. Construction services agreement
3. Purchase order terms and conditions
8. All of the following bid forms have been completed and signed:
1. Bid Form (Form 1)
2. Contractors Key Personnel (Form 2)
3. Material Manufacturers (Form 3)
4. List of Major Subcontractors (Form 4)
5. Statement of Experience (Form 5)
6. Trench Safety Act (Form 6)
7. Bid Bond Form (Form 7)
8. Insurance and Bonding Requirements (Form 8)
9. Conflict of Interest Affidavit (Form 9)
10. Vendor Declaration Statement (Form 10)
11. Immigration Law Affidavit Certification
(Form 11)
12. Vendor Substitute W-9 (Form 12)
13. Bidders Checklist (Form 13 – this form)
14. Business tax Receipt (Collier County
Businesses Only)
15. Signed Grants Provisions Package (if
applicable
9. Copies of required information have been attached
1. Company’s E-Verify profile page or memorandum of understanding
2. Certificate of Authority to Conduct Business in State of Florida
3. Any required professional licenses – valid and current
(ie: General Contractors license, Underground Utility and Excavation, Builders,
Trade Contractors, etc., as applicable, requested and/or required.)
10. If required, the amount of Bid bond has been checked, and the Bid bond or cashier’s check has been
submitted.
11. Any addenda have been signed and acknowledgement form attached and included.
12. The Bid will be uploaded in time to be received no later than the specified opening date and time, otherwise
the Bid cannot be considered.
Bidder Name
Signature & Title Date
16.D.1.c
Packet Pg. 1494 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
***FOR REVIEW ONLY – NOT REQUIRED UNTIL AWARD IS MADE – PLEASE SEE CONSTRUCTION AGREEMENT***
EXHIBIT B-1: PUBLIC PAYMENT BOND
Fleishmann Blvd Force Main Replacement, Bus Pull-out and Bus Shelter Construction
Bond No.
Contract No. 19-7627
KNOW ALL MEN BY THESE PRESENTS: That _______________________________
__________________________________________________________, as Principal, and
_______________________________________________________________, as Surety, located at
______________________________________________________ (Business Address) are held and firmly
bound to _______________________________ as Obligee in the sum of
_________________________________________________ ($_____________) for the payment whereof
we bind ourselves, our heirs, executors, personal representatives, successors and assigns, jointly and
severally.
WHEREAS, Principal has entered into a contract dated as of the ____ day of _______________ 20 ,
with Obligee for ____________________________________ in _______________________ accordance
with drawings and specifications, which contract is incorporated by reference and made a part hereof, and
is referred to herein as the Contract.
THE CONDITION OF THIS BOND is that if Principal:
Promptly makes payment to all claimants as defined in Section 255.05(1), Florida Statutes, supplying
Principal with labor, materials or supplies, used directly or indirectly by Principal in the prosecution of the
work provided for in the Contract, then this bond is void; otherwise it remains in full force.
Any changes in or under the Contract and compliance or noncompliance with any formalities connected
with the Contract or the changes do not affect Sureties obligation under this Bond.
The provisions of this bond are subject to the time limitations of Section 255.05(2). In no event will the
Surety be liable in the aggregate to claimants for more than the penal sum of this Payment Bond, regardless
of the number of suits that may be filed by claimants.
IN WITNESS WHEREOF, the above parties have executed this instrument this _____ day of
______________ 20 , the name of each party being affixed and these presents duly signed by its
under-signed representative, pursuant to authority of its governing body.
16.D.1.c
Packet Pg. 1495 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
Signed, sealed and delivered
in the presence of:
PRINCIPAL
BY:
Witnesses as to Principal NAME:
ITS:
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before me this _____day of ___________ 20___, by
____________________________, as __________________________ of
_________________________________, a ___________ corporation, on behalf of the corporation. He/she
is personally known to me OR has produced_____________ as identification and did (did not) take an oath.
My Commission Expires:
(Signature of Notary)
NAME:
(Legibly Printed)
(AFFIX OFFICIAL SEAL) Notary Public, State of
Commission No.:
ATTEST: SURETY:
(Printed Name)
(Business Address
(Authorized Signature)
Witnesses to Surety (Printed Name)
16.D.1.c
Packet Pg. 1496 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
OR
As Attorney in Fact
(Attach Power of Attorney)
Witnesses (Printed Name)
(Business Address)
(Telephone Number)
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before me this ____ day of ___________________, 20 ,
by _______________________________________, as ___________________________ of
____________________________________ Surety, on behalf of Surety. He/She is personally known to
me OR has produced _______________________________________ as identification and who did (did
not) take an oath.
My Commission Expires:
(Signature)
Name:
(Legibly Printed)
(AFFIX OFFICIAL SEAL) Notary Public, State of:
Commission No.:
16.D.1.c
Packet Pg. 1497 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
***FOR REVIEW ONLY – NOT REQUIRED UNTIL AWARD IS MADE – PLEASE SEE CONSTRUCTION AGREEMENT***
EXHIBIT B-2: PUBLIC PERFORMANCE BOND
Fleishmann Blvd Force Main Replacement, Bus Pull-out and Bus Shelter Construction
Bond No.
Contract No. 19-7627
KNOW ALL MEN BY THESE PRESENTS: That _______________________________
________________________, as Principal, and ______________________________
_____________________________, as Surety, located at
______________________________________________________________________ (Business
Address) are held and firmly bound to ________________________________________________, as
Obligee in the sum of
______________________________________________________________________
($_______________) for the payment whereof we bond ourselves, our heirs, executors, personal
representatives, successors and assigns, jointly and severally.
WHEREAS, Principal has entered into a contract dated as of the ____________ day of
__________________________________, 20 , with Obligee for
______________________________________________________________________ in accordance
with drawings and specifications, which contract is incorporated by reference and made a part hereof, and
is referred to herein as the Contract.
THE CONDITION OF THIS BOND is that if Principal:
1. Performs the Contract at the times and in the manner prescribed in the Contract; and
2. Pays Obligee any and all losses, damages, costs and attorneys' fees that Obligee sustains because
of any default by Principal under the Contract, including, but not limited to, all delay damages, whether
liquidated or actual, incurred by Obligee; and
3. Performs the guarantee of all work and materials furnished under the Contract for the time specified
in the Contract, then this bond is void; otherwise it remains in full force. Any changes in or under the
Contract and compliance or noncompliance with any formalities connected with the Contract or the changes
do not affect Sureties obligation under this Bond.
The Surety, for value received, hereby stipulates and agrees that no changes, extensions of time, alterations
or additions to the terms of the Contract or other work to be performed hereunder, or the specifications
referred to therein shall in anywise affect its obligations under this bond, and it does hereby waive notice
of any such changes, extensions of time, alterations or additions to the terms of the Contract or to work or
to the specifications.
This instrument shall be construed in all respects as a common law bond. It is expressly understood that
the time provisions and statute of limitations under Section 255.05, Florida Statutes, shall not apply to this
bond.
In no event will the Surety be liable in the aggregate to Obligee for more than the penal sum of this
Performance Bond regardless of the number of suits that may be filed by Obligee.
16.D.1.c
Packet Pg. 1498 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
IN WITNESS WHEREOF, the above parties have executed this instrument this _____ day of
_______________, 20 , the name of each party being affixed and these presents duly signed by its
undersigned representative, pursuant to authority of its governing body.
Signed, sealed and delivered
in the presence of: PRINCIPAL
BY:
Witnesses as to Principal
NAME:
ITS:
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before me this ____ day of ______________, 20 , by
___________________________________________, as _____________________________ of
_________________________________, a ______________________ corporation, on behalf of the
corporation. He/she is personally known to me OR has produced __________________________
______________________ as identification and did (did not) take an oath.
My Commission Expires:
(Signature)
Name:
(Legibly Printed)
(AFFIX OFFICIAL SEAL) Notary Public, State of:
Commission No.:
16.D.1.c
Packet Pg. 1499 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
ATTEST: SURETY:
(Printed Name)
(Business Address)
(Authorized Signature)
Witnesses as to Surety (Printed Name)
OR
As Attorney in Fact
(Attach Power of Attorney)
Witnesses (Printed Name)
(Business Address)
(Telephone Number)
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before me this ____ day of ______________, 20 , by
_________________________, as ___________________ of _____________________________, a
__________________________ Surety, on behalf of Surety. He/She is personally known to me OR has
produced _____________________________ as identification and who did (did not) take an oath.
My Commission Expires:
(Signature)
Name:
(Legibly Printed)
(AFFIX OFFICIAL SEAL) Notary Public, State of:
Commission No.:
16.D.1.c
Packet Pg. 1500 Attachment: 19-7627 Solicitation - r1 (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
16.D.1.ePacket Pg. 1501Attachment: 19-7627 - DELORA (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
16.D.1.ePacket Pg. 1502Attachment: 19-7627 - DELORA (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
16.D.1.ePacket Pg. 1503Attachment: 19-7627 - DELORA (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
16.D.1.ePacket Pg. 1504Attachment: 19-7627 - DELORA (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
16.D.1.ePacket Pg. 1505Attachment: 19-7627 - DELORA (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
16.D.1.ePacket Pg. 1506Attachment: 19-7627 - DELORA (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
16.D.1.ePacket Pg. 1507Attachment: 19-7627 - DELORA (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
16.D.1.ePacket Pg. 1508Attachment: 19-7627 - DELORA (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
16.D.1.ePacket Pg. 1509Attachment: 19-7627 - DELORA (9861 : 19-7627 Fleischmann Blvd, Bus-pull out & Bus Shelter)
29th
August
29th
August