Backup Documents 03/25/2025 Item #16C 2 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 C 2
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney
Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney
Office no later than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with
the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Risk Risk Management
2. County Attorney Office County Attorney Office
4. BCC Office Board of County
Commissioners
4. Minutes and Records Clerk of Court's Office r- �I 75 96
3
5. Procurement Services Procurement Services �t' °��
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event
one of the addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Osmanis Nieves Borjas -Procurement Contact Information 239-252-2220
Contact/Department
Agenda Date Item was March 25, 2025 Agenda Item Number AGENDA.# 16.C.2
Approved by the BCC
Type of Document Agreement Number of Original 1
Attached Documents Attached
PO number or account N/A 24-059-NS Komline-Sanderson
number if document is Komline- Corporation
to be recorded
Sanderson
Corporation
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature STAMP OK N/A
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be ONB
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the ONB
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's ONB
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on March 25,2025,and all changes N/A is not
made during the meeting have been incorporated in the attached document. The an option for
County Attorney's Office has reviewed the changes,if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the N/A is not
BCC,all changes directed by the BCC have been made,and the document is ready for the an option for
Chairman's signature. this line.
16C2
GENERAL SERVICE AGREEMENT (NON-SOLICITATION)
# 24-059-NS
for
KOMLINE-SANDERSON BELT PRESS EQUIPMENT, PARTS,AND SERVICES
THIS AGREEMENT, made and entered into on this 'r day of a-LV^ 202 -� , by
and between Komline-Sanderson Corporation, authorized to do business in the State of Florida ,
authorized to do business in the State of Florida, whose business address
is 12 Holland Ave, Peapack, New Jersey 07977 (the
"Contractor" also referred to as "Supplier") and Collier County, a political subdivision of the
State of Florida, (the "County"). (Any reference to"contractor"In this Agreement shall.for the purposes of this Agreement
be interpreted as"supplier"when referring to Komline-Sanderson Corporation.1
WITNESSETH:
1. AGREEMENT TERM. The Agreement shall be for a one ( 1 ) year period,
commencing I upon the date of Board approval; or❑ on and
terminating on one ( 1 ) year(s) from that date or until all outstanding Purchase
Order(s) issued prior to the expiration of the Agreement period have been completed or
terminated.
T-he- gt-mity-+h a DVr en-a €1-wtk-}hV eeae nt—ef-the-Con traetoy; pe e Y th e
A peen en --uur di fl-e e-ternns &s:t ' nV i41-thi -Agre m@Rt-fef
)-additional ( _)-ye ¢s}p e
se-ef 4..tefti4-31;3&r-te
the and of th st-
T-he--G•eorty-Marlagefr-of his-desitwee, ma dices#ie�, e she-AA( e meRY
o1de all-ef-the terms-an ed-in this Agxee cnt fertiprto-e ed
e,d-e;g1 y (1 r, or hitrdesig+lc.:, ch„,11 give-the-GGRtiaeter
written netiee-e-t, xtend-the-A ee e -p4e # end-ef
the-AgFeeme-ht term the-iR-e#feet
2. COMMENCEMENT OF SERVICES. The Contractor shall commence the work upon
acceptance of Purchase Order❑4 etisee-te-RKseeed: by the Contractor.
3. STATEMENT OF WORK. The Contractor shall provide services/products in accordance
with the terms and conditions of this Agreement, 0 Exhibit A - Scope of Services,
attached to this Agreement❑� Exhibit B- Fee Schedule, attached to this Agreement and
made an integral part of this Agreement.
Services/products acquired through this Agreement have been authorized through the
approval of a❑■ Single/Sole Source Waiver,❑€xet tie�o-'- le-Ger-ripetitive-:�eesrs;
I I Other*
Page 1 of 18
General Service Agreement Non-Solicitation
*Modified Section 2[2024__ver.2]
(.;AO
i6C2
3.1 This Agreement contains the entire understanding between the parties and any
modifications to this Agreement shall be mutually agreed upon in writing by the Parties,
in compliance with the County's Procurement Ordinance, as amended, and Procurement
Procedures in effect at the time such services are authorized.
4. THE AGREEMENT SUM.
❑ The-Geunt h U-pay-the entreater-fer-the p&rfermarse-e-this-Agr en -based-cry
E-- B Foe-Sehedulo, attaehed-he eto--and the-priee--methodelogy--as-defined-iR
Seetie„ },er4t-wil-be de-upa,-receipt-ef-e-prepe ihveiee and-upan-appr l
by-the-Geunty's-Gehtfa et-Ad min istr-ative-AgentIPrejeet-M anagarrand-ir emp!isroe-wit4
6#ap'�, ^ la- .tats.;ether Arise-known-a> t#e-"Leeaa-Gave nme t-larompt-Payment
Asti':
EU The County shall pay the Contractor for the performance of this Agreement an
estimated maximum amount of up to Two Hundred Thousand Dollars
($200,000 ), per County fiscal year, based on units/services furnished per
Exhibit B- Fee Schedule, attached hereto and the price methodology as defined in
Section 4.1. Payment will be made upon receipt of a proper invoice and upon approval
by the County's Contract Administrative Agent/Project Manager, and in compliance with
Chapter 218, Fla. Stats., otherwise known as the "Local Government Prompt Payment
Act". The execution of this Agreement shall not be a commitment to the Contractor to
order any minimum or maximum amount. The County shall order items/services as
required but makes no guarantee as to the quantity, number, type or distribution of
items/services that will be ordered or required by this Agreement.
❑ tef-for-the-perger-ma-ase-af--t- is Agreement an-
eeti Bunt-sf
) r-Getnty-fiscal-yearrbas el-se-unite rvices-fum e uaat
te-the-eueted-pfieed-e fered-by-t#e-G^ + e- -a-speeiti tique-et-fex
eth f4elee y{-itf-Seetiarr 4-4,-Ppry'aie will-be-macieweh
feeei pe ppyo.el-la -tl-e-Geu #yl:r-gen#re# mthistrative
Age t/Prejeet-; e v ia41e7€-V i} } . Ga tti.-ettheivis4,141nt^rw
ou "k a' ent-Pfempt-Flaymen1—Aetl:
4.1 Price Methodology (as selected below):
❑ Lump-Sum (F-fixed Price ,f+fm-fixed-total- is. fe,F g f a-prejeet he e
tfa eforrod from tie ty e—t eah4t ran aa-buei , s
laou' e3o es presen-te-rather, the contrastor muct pefferm to the
s-atiefeetien of the Geuhty-r-projee manage e a eat-fe•r-t4 e-fix r e-ee-ntraet
is-autheri4-
Page 2 of 18
General Service Agreement Non-Solicitation
[2024_ver.2]
CIO
i6C2
0 Time and Materials: The County agrees to pay the contractor for the amount of labor
time spent by the contractor's employees and subcontractors to perform the work(number
of hours times hourly rate), and for materials and equipment used in the project (cost of
materials plus the contractor's markup). This methodology is generally used in projects in
which it is not possible to accurately estimate the size of the project, or when it is expected
that the project requirements would most likely change. As a general business practice,
these contracts include back-up documentation of costs; invoices would include number
of hours worked and billing rate by position (and company(or subcontractor)timekeeping
or payroll records), material or equipment invoices, and other reimbursable
documentation for the project.
n Unit Price: The County agrees to pay a firm total fixed price (inclusive of all costs,
including labor, materials, equipment, overhead, etc.) for a repetitive product or service
delivered (i.e. installation price per ton, delivery price per package or carton, etc.). The
invoice must identify the unit price and the number of units received (no contractor
inventory or cost verification).
4.2 Any County agency may obtain services under this Agreement, provided
sufficient funds are included in their budget(s).
4.3 Payments will be made for services furnished, delivered, and accepted, upon
receipt and approval of invoices submitted on the date of services or within six (6) months
after completion of the Agreement. Any untimely submission of invoices beyond the
specified deadline period is subject to non-payment under the legal doctrine of "'aches"
as untimely submitted. Time shall be deemed of the essence with respect to the timely
submission of invoices under this Agreement.
4.4 The County, or any duly authorized agents or representatives of the County, shall
have the right to conduct an audit of Contractor's books and records to verify the accuracy
of the Contractor's claim with respect to Contractor's costs associated with any Payment
Application, Change Order, or Work Directive Change.
4.5 ❑� Travel and Reimbursable Expenses: Travel and Reimbursable Expenses
must be approved in advance in writing by the County. Travel expenses shall be
reimbursed as per Section 112.061 Fla. Stats. Reimbursements shall be at the following
rates:
Mileage $0.44.5 per mile
Breakfast $6.00
Lunch $11.00
Dinner $19.00
Airfare Actual ticket cost limited to tourist or coach class fare
Rental car Actual rental cost limited to compact or standard-size
vehicles
Lodging Actual cost of lodging at single occupancy rate with a cap of
no more than $150.00 per night
Page 3 of 18
General Service Agreement Non-Solicitation
[2024_ver.2]
CA
16C2
Parking Actual cost of parking
Taxi or Airport Limousine Actual cost of either taxi or airport limousine
Reimbursable items other than travel expenses shall be limited to the following: telephone
long-distance charges, fax charges, photocopying charges and postage. Reimbursable
items will be paid only after Contractor has provided all receipts. Contractor shall be
responsible for all other costs and expenses associated with activities and solicitations
undertaken pursuant to this Agreement.
5. SALES TAX. Contractor shall pay all sales, consumer, use and other similar taxes
associated with the Work or portions thereof,which are applicable during the performance
of the Work. Collier County, Florida as a political subdivision of the State of Florida, is
exempt from the payment of Florida sales tax to its vendors under Chapter 212, Florida
Statutes, Certificate of Exemption #85-8015966531C.
6. NOTICES. All notices from the County to the Contractor shall be deemed duly served if
mailed or emailed to the Contractor at the following:
Company Name: Komline-Sanderson Corp.
Address: 12 Holland Ave
Peapack, New Jersey 07977
Authorized Agent: Fitsum Tesfaye
Attention Name & Title: With a copy to: info@komline.com
Telephone: (908)234-1000
E-Mail(s): fatesfaye@komline.com
All Notices from the Contractor to the County shall be deemed duly served if mailed or
emailed to the County to:
Board of County Commissioners for Collier County, Florida
Division Director: Matt McLean
Division Name: PUD-Engineering and Project Management
Address: 3299 Tamiami Trail E
Naples FL 34112
Administrative Agent/PM: Wayne Karlovich
Telephone: (239)252-5372
E-Mail(s): wayne.karlovich@colliercountyfl.gov
Page 4 of 18
General Service Agreement Non-Solicitation
[2024_ver.2]
6C2
The Contractor and the County may change the above mailing address at any time upon
giving the other party written notification. All notices under this Agreement must be in
writing.
7. NO PARTNERSHIP. Nothing herein contained shall create or be construed as creating a
partnership between the County and the Contractor or to constitute the Contractor as an
agent of the County.
8. PERMITS: LICENSES: TAXES. d eemplianee-wtth--Seetien--21-8: ;4S.;a-Il-rermits
nQeesser-y-er-t# -p tie»-ef-the-Wor!malt-b b-taiY.e y-t"e-Ger, Faster-T-lae Couty
will-net-be-obligated to pay foFatlyr-perMits-ebta•i ed-by-Su bee nt Facto r-s-
Bayme-rr#-far .dl-suof ermits--issued-key-tlhe-Gew ty shall-be-pr-oeessed-intecnally-by-the
Getwi-tli--Refl-Gettil-ty-per-mits-FreisessaFy-fef-the-proseoution-of-the-Werk-sheil-be
prsett n ai4-€sr uete : The Contractor shall also be solely responsible
for payment of any and all taxes levied on the Contractor. In addition, the Contractor shall
comply with all rules, regulations and laws of Collier County, the State of Florida, or the
U. S. Government now in force or hereafter adopted. The Contractor agrees to comply
with all laws governing the responsibility of an employer with respect to persons employed
by the Contractor.
9. NO IMPROPER USE. The Contractor will not use, nor suffer or permit any person to use
in any manner whatsoever, County facilities for any improper, immoral or offensive
purpose, or for any purpose in violation of any federal, state, county or municipal
ordinance, rule, order or regulation, or of any governmental rule or regulation now in effect
or hereafter enacted or adopted. In the event of such violation by the Contractor or if the
County or its authorized representative shall deem any conduct on the part of the
Contractor to be objectionable or improper, the County shall have the right to suspend the
Agreement of the Contractor. Should the Contractor fail to correct any such violation,
conduct, or practice to the satisfaction of the County within twenty-four (24) hours after
receiving notice of such violation, conduct, or practice, such suspension to continue until
the violation is cured. The Contractor further agrees not to commence operation during
the suspension period until the violation has been corrected to the satisfaction of the
County.
10. TERMINATION. Should the Contractor be found to have failed to perform his services in
a manner satisfactory to the County as per this Agreement, the County may terminate
said Agreement for cause; further the County may terminate this Agreement for
convenience with a thirty (30) day written notice. The County shall be the sole judge of
non-performance.
In the event that the County terminates this Agreement, Contractor's recovery against the
County shall be limited to that portion of the Agreement Amount earned through the date
of termination. The Contractor shall not be entitled to any other or further recovery against
the County, including, but not limited to, any damages or any anticipated profit on portions
of the services not performed.
Page 5 of 18
General Service Agreement Non-Solicitation
[2024_ver.2]
CAf)
i 6 C 2
11. NO DISCRIMINATION. The Contractor agrees that there shall be no discrimination as to
race, sex, color, creed or national origin or any other class protected by federal or Florida
law.
12. INSURANCE. The Contractor shall provide insurance as follows:
A. 0 Commercial General Liability: Coverage shall have minimum limits of
$1,000,000 Per Occurrence, $ 2,000,000 aggregate for Bodily Injury Liability
and Property Damage Liability. The General Aggregate Limit shall be endorsed to apply
per project. This shall include Premises and Operations; Independent Contractors;
Products and Completed Operations and Contractual Liability.
B. I Business Auto Liability: Coverage shall have minimum limits of
$1,000,000 Per Occurrence, Combined Single Limit for Bodily Injury Liability and
Property Damage Liability. This shall include: Owned Vehicles, Hired and Non-Owned
Vehicles and Employee Non-Ownership.
C. ❑� Workers' Compensation: Insurance covering all employees meeting Statutory
Limits in compliance with the applicable state and federal laws.
The coverage must include Employers' Liability with a minimum limit of$1,000,000
for each accident.
D. ❑ Professional Liability: Shall-tee ai ed-by-the-Ge#raster-to-ens rc its legal
lfabllity-fa elaimc arising out of the pe-tfermanee--ef-prefessi
Ag moment. Cont a ureives-itfef e te•ty-a nst CeuR } 'ms under
th1 is-iris rartce. Sut a".a a eh 1 I e l4i i#tee€-not Ices than $ each
e5 'ni-a""'iad agg-e
❑gv e grail-he aininaum-limits of$ -pet ela+fn-
rr ❑ - veragt shall
have-min4m4Fs-l+mi f-$ pe elaim-
6- ❑ - : Goveage-&hall
claiFnt
lH-❑ - S` e-shall
have minimum limits of$ per claim.
Special Requirements: Collier County Board of County Commissioners, OR, Collier
County Government shall be listed as the Certificate Holder and included as an
"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
Contractor's policy shall be endorsed accordingly.
Page 6 of 18
General Service Agreement Non-Solicitation
[2024_ver.2]
16C2
Current, valid insurance policies meeting the requirement herein identified shall be
maintained by Contractor during the duration of this Agreement. The Contractor shall
provide County with certificates of insurance meeting the required insurance provisions.
Renewal certificates shall be sent to the County thirty (30) days prior to any expiration
date. Coverage afforded under the policies will not be canceled or allowed to expire until
the greater of: thirty (30) days prior written notice, or in accordance with policy provisions.
Contractor shall also notify 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 Contractor from its insurer, and nothing contained herein
shall relieve Contractor of this requirement to provide notice.
Contractor shall ensure that all subcontractors comply with the same insurance
requirements that the Contractor is required to meet.
13. INDEMNIFICATION. To the maximum extent permitted by Florida law, the Contractor
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, whether resulting from any claimed breach of this
Agreement by Contractor, any statutory or regulatory violations, or from personal injury,
property damage, direct or consequential damages, or economic loss, to the extent
caused by the negligence, recklessness, or intentionally wrongful conduct of the
Contractor or anyone employed or utilized by the Contractor in the performance of this
Agreement. This indemnification obligation shall not be construed to negate, abridge or
reduce any other rights or remedies which otherwise may be available to an indemnified
party or person described in this paragraph.
This section does not pertain to any incident arising from the sole negligence of Collier
County.
13.1 The duty to defend under this Article 13 is independent and separate from the duty to
indemnify, and the duty to defend exists regardless of any ultimate liability of the Contractor,
County and any indemnified party. The duty to defend arises immediately upon
presentation of a claim by any party and written notice of such claim being provided to
Contractor. Contractor's obligation to indemnify and defend under this Article 13 will survive
the expiration or earlier termination of this Agreement until it is determined by final judgment
that an action against the County or an indemnified party for the matter indemnified
hereunder is fully and finally barred by the applicable statute of limitations.
14. AGREEMENT ADMINISTRATION. This Agreement shall be administered on behalf of
the County by the Public Utilities Division
15. CONFLICT OF INTEREST. Contractor represents that it presently has no interest and
shall acquire no interest, either direct or indirect, which would conflict in any manner with
the performance of services required hereunder. Contractor further represents that no
persons having any such interest shall be employed to perform those services.
Page 7 of 18
General Service Agreement Non-Solicitation
[2024_ver.2j
CM)
16C2
16. COMPONENT PARTS OF THIS AGREEMENT. This Agreement consists of the following
component parts, all of which are as fully a part of the Agreement as if herein set out
verbatim: ❑ 6eRt etir's..P epeealT 0 Insurance Certificate(s), ❑■ Exhibit A Scope of
Services, El Exhibit B Fee Schedule, subsequent quotes, and ❑■ Other
Exhibit/Attachment: Grant Provisions and Affidavit Regarding Labor and Services
17. APPLICABILITY. Sections corresponding to any checked box ) expressly apply to
the terms of this Agreement.
18. SUBJECT TO APPROPRIATION. It is further understood and agreed by and between
the parties herein that this Agreement is subject to appropriation by the Board of County
Commissioners.
19. PROHIBITION OF GIFTS TO COUNTY EMPLOYEES. No organization or individual
shall offer or give, either directly or indirectly, any favor, gift, loan, fee, service or other
item of value to any County employee, as set forth in Chapter 112, Part III, Florida
Statutes, Collier County Ethics Ordinance No. 2004-05, as amended, and County
Administrative Procedure 5311. Violation of this provision may result in one or more of
the following consequences: a. Prohibition by the individual, firm, and/or any employee of
the firm from contact with County staff for a specified period of time; b. Prohibition by the
individual and/or firm from doing business with the County for a specified period of time,
including but not limited to: submitting bids, RFP, and/or quotes; and, c. immediate
termination of any Agreement held by the individual and/or firm for cause.
20. COMPLIANCE WITH LAWS. By executing and entering into this Agreement, the
Contractor is formally acknowledging without exception or stipulation that it agrees to
{ comply, at its own expense, with all federal, state and local laws, codes, statutes,
ordinances, rules, regulations and requirements applicable to this Agreement, including
but not limited to those dealing with the Immigration Reform and Control Act of 1986 as
located at 8 U.S.C. 1324, et seq. and regulations relating thereto, as either may be
amended, as well as the requirements set forth in Florida Statute, §448.095; taxation,
workers' compensation, equal employment and safety including, but not limited to, the
Trench Safety Act, Chapter 553, Florida Statutes, and the Florida Public Records Law
Chapter 119, if applicable, including specifically those contractual requirements at F.S. §
119.0701(2)(a)-(b) as stated as follows:
IT IS THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO
THIS CONTRACT. IF THE CONTRACTOR HAS QUESTIONS REGARDING THE
APPLICATION OF CHAPTER 119, FLORIDA STATUTES, IT SHOULD CONTACT THE
CUSTODIAN OF PUBLIC RECORDS AT:
Communications, Government and Public Affairs Division
3299 Tamiami Trail East, Suite 102
Naples, FL 34112-5746
Telephone: (239) 252-8999
Email: PublicRecordRequest(a�colliercountyfl.gov
Page 8 of 18
General Service Agreement Non-Solicitation
[2024_ver.2]
16C2
The Contractor must specifically comply with the Florida Public Records Law to:
1. Keep and maintain public records required by the public agency to perform the
service.
2. Upon request from the public agency's custodian of public records, provide the
public agency 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 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 the public agency.
4. Upon completion of the contract, transfer, at no cost, to the public agency all
public records in possession of the Contractor or keep and maintain public
records required by the public agency to perform the service. If the Contractor
transfers all public records to the public agency 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 the public agency, upon
request from the public agency's custodian of public records, in a format that is
compatible with the information technology systems of the public agency.
If Contractor observes that the Contract Documents are at variance therewith, it shall
promptly notify the County in writing. Failure by the Contractor to comply with the laws
referenced herein shall constitute a breach of this Agreement and the County shall have
the discretion to unilaterally terminate this Agreement immediately.
21. OFFER EXTENDED TO OTHER GOVERNMENTAL ENTITIES. Collier County
encourages and agrees to the successful Contractor extending the pricing, terms and
conditions of this solicitation or resultant Agreement to other governmental entities at the
discretion of the successful Contractor.
22. PAYMENTS WITHHELD. The County may decline to approve any Application for
Payment, or portions thereof, because of defective or incomplete work, sobseem€'3y
di ver dam, bsequeRt-i tepeeti . The County rnaay-nLflli€y-the-wheIe-er y
paft--Gf-allyam egt-p ek ly-is&wed and the Cody may withhold any
payments otherwise due to Contractor under this Agreement er—a, ,otcr Agreement
• ' ee-n-the-Geun1ty-mo d CosnfreeteF, to such extent as may be necessary in the County's
opinion to protect it from loss because of: (a) defective Work not remedied; (b) third party
claims failed or reasonable evidence indicating probable fling of such claims; (c) failure of
Contractor to make payment properly to subcontractors or for labor, materials or
equipment; (d) reasonable doubt that the Work can be completed for the unpaid balance
of the Contract Amount; (e) reasonable indication that the Work will not be completed
Page 9 of 18
General Service Agreement Non-Solicitation
*Modified Section 22[2024_ver.21
16C2
within the Contract Time; or (f) unea4isfaeto-ry-p eseeution-e-the-Werk-by the
Gs„rr-aster r(g) any other material breach of the Contract Documents.
If any conditions described above are not remedied or removed, the County may,
after three (3) days written notice, rectify the same at Contractor's expense. The
Gew ty-a1s9-ma ffset-against u , ants-uue-6°atmetEr-the-^msu1 t-ef anOigwidated
e-r-aaligtti«ated-ebligatie e€Cze eter-te-the-6et+ntys whether-relating-te-er-arisieg-etrt
of this--Agr-eemont or arty-et, -Agreenaeet=bveen,--Gentr-actc, an:t-the-6st
If a subcontractor is a related entity to the Contractor, then the Contractor shall not
mark-up the subcontractor's fees. A related entity shall be defined as any Parent or
Subsidiary of the Company and any business, corporation, partnership, limited liability
company or other entity in which the Company or a Parent or a Subsidiary of the
Company holds any ownership interest, directly or indirectly.
23. C s ti r—UP. C^ rite ee- ep-th- -Pr t site--elan at all-timcc-of
de",is;fttabish aY t tefials arising-eut-ef-the-Wert-the-eer letien--ef
the-Werk, G eve-all-debrts-r-hitahieh-arid waste--eteFiale#se r d
at erg be Pr-o;est-site, ae-well-as--tall feels;a-pplia ees onctruetion-equipment--ard
maehinefy-and-st l: atefialsrafid-shalNeave-t a Projeet-site-eleah:
24. STANDARDS OF CONDUCT: PROJECT MANAGER, SUPERVISOR, EMPLOYEES.
The Contractor shall employ people to work on County projects who are neat, clean,
well-groomed and courteous. Subject to the American with Disabilities Act, Contractor
shall supply competent employees who are physically capable of performing their
employment duties. The County may require the Contractor to remove an employee it
deems careless, incompetent, insubordinate or otherwise objectionable and whose
continued employment on Collier County projects is not in the best interest of the County.
25. n WARRANTY. Contractor warrants that the material and workmanship going
into the Contractor's Product is of good quality and in conformity with the best
commercial practice. Unless otherwise stated parts found to be defective in
material or workmanship under normal use and service within 90 days one
year after shipment installation will be repaired or replaced without charge
F.O.B. original point of shipment, the responsibility of Contractor being limited
to the cost of the defective parts. Decomposition by chemical action and wear
caused by the presence of abrasive materials shall not constitute defects. In
no event shall Contractor be liable for consequential or special damages, or
for transportation, installation, adjustment, or other expenses which may arise in
connection with such replacement or repair. THIS WARRANTY IS EXPRESSLY
MADE IN LIEU OF ANY AND ALL OTHER WARRANTIES EXPRESS OR
IMPLIED INCLUDING THE WARRANTIES OF MERCHANTABILITY AND
FITNESS. Equipment may be returned for credit or replacement only after
written Contractor authorization and shipping instructions. Contractor further
warrants to the County that all materials and equipment furnished under the Contract
Documents shall be applied, installed, connected, erected, used, cleaned and
conditioned in accordance with the instructions of the applicable manufacturers,
fabricators, suppliers or processors except as otherwise provided.
Page 10 of 18
General Service Agreement Non-Solicitation
*Modified Section 25[2024_ver.2]
CM 1
i 6 C 2
26. ❑TEST-S--AND-INSREcrIO 4S--lf-the-Gentmst-Peeunents or-c edes, lair ;
crdinanees—wies--cr-regalat:sns-ef-any--publie-auth y-having-ju-risdietie;--over the
Pfejee e 4 , aa-y-pie-Wenk-te--be-speeifieally-inspeeted--toted-ar•
egpre?,/ed, Corrtetef-shall assume-full- espeRsini-lity-thcrcfore, pay-all -seats-i;a
eeeneetierAher✓vkath-led-furnish-te-the-Certify-the-r ul -sv ifieato.. of nepestien-;
tasting—ef--apereval. All-inepeetiens, test or--apprevale--shall--be-pe,feFn ed-in---a
a^er-grid-by eryam,,azatlefs-aeeeptable4e-the Gin ty-
27. ❑PRO -ION-OF-1,6 K-
A Gentrastor shall fully-protect-the-Wock-frof-less-er damage-and-shall bear-the-eest
of-awr-eush-less-e,-atnage-uattl-fi payment has been-made--I€-Ger ra tear
anyene .whet Gent1eter-as-legally-lable-is-reepe reible-for--aa -lees-er-4apnage
t nhe--We r-sthe erl the-Getaety--er-Gaut -se-palate
eeRi aeteeGo.. , shall-bc chargod-with-the-ea a Ry trsn eC-neseesu y
te-Fep ase-see less-er-damage shall--sbe-deduetert-fret mat-rtts due to
GoAtracter.
l --Gsntt-aetor shall net--leader-per + r e-leaded in any
ea aenec that will danger the ctr-ttettre;-t hall-Gentrootor subject any-part of-the
Wong 3r-adjaeet eperty-to stresses-er--pressuFes-that-wilt danger-it-
C. C a ntractor shall-net dirt-u -ariy-benehct a;;-estanlished-by-the-Geurtty-�r�ith respest
e-the-Prejest—ll:-Gentr-astsr, er is C1468-Petfeeters, agents or anyone, for apse
Contractor is legally liabl , • r r
inn 4-19enshtenk-e-and
he"lial ie-fer-alt-ses,ts-t 'e tn thefe`7 th;
28. SUBMITTALS AND SUBSTITUTIONS. Any substitution of products/materials form
specifications shall be approved in writing by the County in advance.
29. CHANGES IN THE WORK. The County shall have the right at any time during the
progress of the Work to increase or decrease the Work. Promptly after being notified of a
change, Contractor shall submit an estimate of any cost or time increases or savings it
foresees as a result of the change. Except in an emergency endangering life or property,
or as expressly set forth herein, no addition or changes to the Work shall be made except
upon modification of the Purchase Order by the County, and the County shall not be liable
to the Contractor for any increased compensation without such modification. No officer,
employee or agent of the County is authorized to direct any extra or changed work orally.
Any modifications to this Agreement shall be in compliance with the County Procurement
Ordinance and Procedures in effect at the time such modifications are authorized.
30. AGREEMENT TERMS. If any portion of this Agreement is held to be void, invalid, or
otherwise unenforceable, in whole or in part, the remaining portion of this Agreement shall
remain in effect.
Page 11 of 18
General Service Agreement Non-Solicitation
I2024_ver.2]
CAO
16C2
31. ADDITIONAL ITEMS/SERVICES. Additional items and/or services may be added to this
Agreement in compliance with the Procurement Ordinance, as amended, and
Procurement Procedures.
32. DISPUTE RESOLUTION. Prior to the initiation of any action or proceeding permitted by
this Agreement to resolve disputes between the parties, the parties shall make a good
faith effort to resolve any such disputes by negotiation. The negotiation shall be attended
by representatives of Contractor with full decision-making authority and by County's staff
person who would make the presentation of any settlement reached during negotiations
to County for approval. Failing resolution, and prior to the commencement of depositions
in any litigation between the parties arising out of this Agreement, the parties shall attempt
to resolve the dispute through Mediation before an agreed-upon Circuit Court Mediator
certified by the State of Florida. The mediation shall be attended by representatives of
Contractor with full decision-making authority and by County's staff person who would
make the presentation of any settlement reached at mediation to County's board for
approval. Should either party fail to submit to mediation as required hereunder, the other
party may obtain a court order requiring mediation under section 44.102, Fla. Stat.
33. VENUE. Any suit or action brought by either party to this Agreement against the other
party relating to or arising out of this Agreement must be brought in the appropriate federal
or state courts in Collier County, Florida, which courts have sole and exclusive jurisdiction
on all such matters.
34. I KEY PERSON : 1_. he-Ge ter's personnel-and r-anagemeen --t -be--t lized-for
this-pFejeet-el l-be-kiiewledgeable-i efiareas of epert sc. T;e-Oet ty-Fesewes-the
right to pe fe ri-i tiga ions as may-be deemed- cces etcnt
per-sef s-will-bc utilized in the per-fer as ac-e-ef4he agree ctor shall as„ig-n
as-n-nie y-peeialc as-neeessary-te-eempletethe-seMees on a timely-basis,and-eaeh-per&en.
assigned shall-be-ava+lab-leer-afi-a a t-ef4irr;e adequate-to-meet--the-rested-servic-e
date:--The chinless-tare-fellewing-eenditiens are
a et-1-)- occd replacoments--ha etter qualifieatierrs
cn rider-e eficnce. (2) that the Cozynty-is-aetine-as-possible:•
The-Gentraeter shall make col R ereialleasena er-GeuRty-within
seven (7) days of the c inat-appreval-e€-preposed lasemcnt
per-se nek
U AGREEMENT STAFFING. The Contractor's personnel and management to be
utilized for this Agreement shall be knowledgeable in their areas of expertise. The
County reserves the right to perform investigations as may be deemed necessary to
ensure that competent persons will be utilized in the performance of the Agreement.
The Contractor shall assign as many people as necessary to complete required services
on a timely basis, and each person assigned shall be available for an amount of time
adequate to meet required servic
35. ❑ORDER-OF PRE-OEDENCE. In the even+ of any confl t "
Agreement and other Supplier provided documents, and/or the County's Board
approved Executive Summary, the Agreement shall take precedence.
Page 12 of 18
General Service Agreement Non-Solicitation
Modified Section 35[2024_ver.2]
CAO
16C2
■ ORDER OF PRECEDENCE (Grant Funded). In the event of any conflict between or
among the Agreement and other Supplier provided documents, and/or the County's
Board approved Executive Summary, the terms of the Agreement shall take
precedence, except the terms of any Supplemental Conditions (FEMA Packet -
Exhibit C") shall take precedence over the Agreement. To the extent any conflict in the
terms of the Agreement and other Supplier provided documents and/or the
County's Board approved Executive Summary cannot be resolved by application
of the Supplemental Conditions, if any, or the Agreement, the conflict shall be
resolved by negotiation and mutual decision signed by both parties, so long as it
doesn't conflict with any Grant requirements.
36. ASSIGNMENT. Contractor shall not assign this Agreement or any part thereof, without
the prior consent in writing of the County. Any attempt to assign or otherwise transfer this
Agreement, or any part herein, without the County's consent, shall be void. If Contractor
does, with approval, assign this Agreement or any part thereof, it shall require that its
assignee be bound to it and to assume toward Contractor all of the obligations and
responsibilities that Contractor has assumed toward the County.
37. SECURITY. The Contractor is required to comply with County Ordinance 2004-52, as
amended. Background checks are valid for five (5) years and the Contractor shall be
responsible for all associated costs. If required, Contractor shall be responsible for the
costs of providing background checks by the Collier County Facilities Management
Division for all employees that shall provide services to the County under this Agreement.
This may include, but not be limited to, checking federal, state and local law enforcement
records, including a state and FBI fingerprint check, credit reports, education, residence
and employment verifications and other related records. Contractor shall be required to
maintain records on each employee and make them available to the County for at least
four(4)years. All of Contractor's employees and subcontractors must wear Collier County
Government Identification badges at all times while performing services on County
facilities and properties. Contractor ID badges are valid for one (1) year from the date of
issuance and can be renewed each year at no cost to the Contractor during the time
period in which their background check is valid, as discussed below. All technicians shall
have on their shirts the name of the contractor's business.
The Contractor shall immediately notify the Collier County Facilities Management Division
via e-mail (DL-FMOPS( colliercountyfl.qov) whenever an employee assigned to Collier
County separates from their employment. This notification is critical to ensure the
continued security of Collier County facilities and systems. Failure to notify within four (4)
hours of separation may result in a deduction of$500 per incident.
Collier County Sheriffs Office (CCSO) requires separate fingerprinting prior to work being
performed in any of their locations. This will be coordinated upon award of the contract. If
there are additional fees for this process, the Contractor is responsible for all costs.
Page 13 of 18
General Service Agreement Non-Solicitation
Modified Section 35 [2024_ver.2]
CAO
16C2
38. M SAFETY. All Contractors and subcontractors performing service for Collier County are
required and shall comply with all Occupational Safety and Health Administration (OSHA),
State and County Safety and Occupational Health Standards and any other applicable
rules and regulations. Also, all Contractors and subcontractors shall be responsible for
the safety of their employees and any unsafe acts or conditions that may cause injury or
damage to any persons or property within and around the work site.
Collier County Government has authorized the Occupational Safety and Health
Administration (OSHA) to enter any Collier County Facility, property and/or right-of-way
for the purpose of inspection of any Contractor's work operations. This provision is non-
negotiable by any division/department and/or Contractor. All applicable OSHA inspection
criteria apply as well as all Contractor rights, with one exception. Contractors do not have
the right to refuse to allow OSHA onto a project that is being performed on Collier County
Property. Collier County, as the owner of the property where the project is taking place
shall be the only entity allowed to refuse access to the project. However, this decision
shall only be made by Collier County's Risk Management Division Safety Manager and/or
Safety Engineer.
(Remainder of page intentionally left blank-signature page to follow)
•
Page 14 of 18
General Service Agreement Non-Solicitation
[2024 ver.2]
C.O
16C2
IN WITNESS WHEREOF, the parties hereto, by an authorized person or agent, have executed
this Agreement on the date and year first written above.
ATTEST: BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
Crystal K. Kinzel, Clerk of the Circuit
Court and Comptroller
By: 11,..4We'd-.' 1 i'ICt-4 1--- By:
‘44%.....A€01104-ft
„enest as to Chairman's
Bu L. aunders Chairman
Dated:, °q ', /2 signature only
(SEAL)
Contractor . Witnesses: Komiine-Sanderson Corporation
:::ntract0r
• -1.11(tt.1.NPvt/ti -e
Contractor's First Wifrtess i nature
V 0 /r eat lc0
11(a/co tType/print signature and title'T
Type/print witness na e
�h / ,/
Contractor' S s econd Witness
eo-f- ley nA.t
TType/print witness namet
•: (fed to d Legality:
•
'be... „ County Attorney
rint Name
Page 15 of 18
General Service Agreement Non-Solicitation
[2024_ver.2]
16C2
Exhibit A
Scope of Services
j following this page (pages 1 through 1 )
❑ this exhibit is not applicable
Page 16 of 18
General Service Agreement Non-Solicitation
[2024_ver.2]
1 6 C2
AGREEMENT No. 25-059-NS
Exhibit A
Scope of Services
Contractor shall provide equipment,parts and services of the Komline-Sanderson Belt Filter Press
dewatering equipment from Komline-Sanderson. Services include, without limitation, installation,
start-up and testing, preventative maintenance, troubleshooting, repairs, and installation of new
equipment and repair/replacement parts, and training as necessary.
Equipment, parts,and services shall be furnished upon request by the County through a purchase
order and responded to according to the County's determination of urgency for the request.
Parts, labor rates, and applicable markups shall be in accordance with the Fee Schedule. Hourly
labor rates shall be inclusive of all overhead, insurance, profit, and use of company owned
equipment(excluding rental equipment).
Normal business hours shall be 7:00am to 4:00 pm, Monday through Friday, excluding County-
observed holidays. Overtime hourly rates shall be limited to County requests for service initiated
outside of the normal business hours (anything over eight hours a day) or in the event of a
declared local state of emergency. Vendor shall be paid in accordance with the fee schedule
overtime rate. Overtime charges must be approved by the County.
Should the Vendor need to hire a subcontractor, the subcontractor charges may be invoiced at
cost plus 10% markup. A copy of the subcontractor's invoice shall be required with the Vendor's
invoice. The subcontractor's hourly rate may not exceed the Vendor's hourly rates listed on the
fee schedule.
Should the Vendor need to rent equipment to complete the project, rental charges may be
invoiced at cost plus 10%markup. A copy of the rental receipt showing the cost shall be required
with the Vendor's invoice. Ancillary charges may be transferred to the County in the actual
amount; however, mark-ups will not be allowed on taxes, freight/shipping, and/or permits.
Shipping charges must be identified at the time of providing a quote and shall be paid at cost with
documentation provided with invoice.
Additional Warranty Clause:
GUARANTEE — Komline-Sanderson warrants that the material and workmanship going into the
Komline-Sanderson's Product is of good quality and in conformity with the best commercial
practice. Unless otherwise stated parts found to be defective in material or workmanship under
normal use and service within 90 days after shipment will be repaired or replaced without charge
F.O.B.original point of shipment,the responsibility of Komline-Sanderson being limited to the cost
of the defective parts. Decomposition by chemical action and wear caused by the presence of
abrasive materials shall not constitute defects. In no event shall Komline-Sanderson be liable for
consequential or special damages, or for transportation, installation, adjustment, or other
expenses which may arise in connection with such replacement or repair. THIS WARRANTY IS
EXPRESSLY MADE IN LIEU OF ANY AND ALL OTHER WARRANTIES EXPRESS OR IMPLIED
INCLUDING THE WARRANTIES OF MERCHANTABILITY AND FITNESS. Equipment may be
returned for credit or replacement only after written Komline-Sanderson authorization and
shipping instructions.
16C2
Exhibit B
Fee Schedule
0 following this page (pages through 2
(1 this exhibit is not applicable
Page 17 of 18
General Service Agreement Non-Solicitation
[2024_ver.2]
C.:1to
ibC2
Agreement No. 25-059-NS
Exhibit B
Fee Schedule
Hourly Rate: $200.00
(Normal hours are Monday through Friday, 7:00 am—4:00 pm, excluding County observed holidays).
Hourly labor rates shall be inclusive of all overhead, insurance, profit, and use of company owned
equipment(excluding rental equipment).
Overtime Rate: $300.00
(Overtime rate shall apply to hours outside of normal hours or in the event of a declared local state of
emergency.)
Equipment Rental Markup: 10%
(Rental invoice shall be provided as backup documentation.)
Subcontractor Markup: 10%
(Subcontractor invoice shall be provided as backup documentation.)
Travel and Reimbursable Expenses must be approved in advance in writing by the County. Travel
expenses shall be reimbursed as per Section 112.061 Fla. Stats.
PARTS LIST
Part Number Unit Price Part Number Unit Price
0390209 $ 237.00 37A2017 $ 736.00
0390211 _ $ _ 425.00 37A2018 $ 1,050.00
0390213 $ 299.00 37A2019 $ 1,180.00
0394025 $ 7.00 37A2020 $ 206.00
03Q0145 $ 720.00 37A2021 $ 808.00
03Q0149 $ 640.00 4086 (37'-8") $ 1,906.00
03Q0151 $ 78.00 4086 (47'-1") $ 2,469.00
03Q0152 $ 83.00 4086 (47'-5") $ 2,286.00
03Q0176 $ 67.00 4086 (49'-11") $ 1,539.00
03Q0181 $ 637.00 4086 (51'-7") $ 1,915.00
03Q0229 $ 189.00 6391021 $ 152.00
25Q1529 $ 22.00 6395832 $ 2,190.00
28R1504 $ 7.00 6395871 $ 3,800.00
37A2012 $ 580.00 90X0207/90K0306 $ 140.00
CA()
tbr2
4 V
Part Number Unit Price
Z0390210/0390255 $ 579.00
Z0394025 $ 157.00
Z03Q0114 $ 222.00
Z03Q0159-2 $ 431.00
Z25Q1529X7-2 $ 225.00
Z43A0917 $ 655.00
Z43Q1005 $ 586.00
Z6391021 (2M) $ 154.00
Z6395830/90B3034 $ 4,420.00
Z6395859/90B3034 $ 4,040.00
Z90X0207/90K0306 $ 140.00
Z90X0474/90X0475 $ 504.00
i6C2
Other Exhibit/Attachment
Description: Federal Provisions & Affidavit Regarding Labor and Services
0 following this page (pages through 12 )
❑ this exhibit is not applicable
Page 18 of 18
General Service Agreement Non-Solicitation
[2024_ver.2]
16C2
EXHIBIT I
FEDERAL CONTRACT PROVISIONS AND ASSURANCES
FEDERAL EMERGENCY MANAGEMENT AGENCY
PUBLIC ASSISTANCE
The supplemental conditions contained in this section are intended to cooperate with,to supplement, and
to modify the general conditions and other specifications. In cases of disagreement with any other section
of this contract,the Supplemental Conditions shall govern.This is an acknowledgement that FEMA financial
assistance will be used to fund all or a portion of the contract.
Pursuant uniform requirements of federal awards (2 CFR Part 200.23)the definition of CONTRACTOR is
an entity that receives a Contract/Purchase Order.
Compliance with Federal Law,Regulations and Executive Orders:The Sub-Recipient(County)agrees
to include in the subcontract that (i) the subcontractor is bound by the terms of the Federally-Funded
Subaward and Grant Agreement, (ii) the subcontractor is bound by all applicable state and Federal laws
and regulations, and (iii) the subcontractor shall hold the County harmless against all claims of whatever
nature arising out of the subcontractor's performance of work under this Agreement,to the extent allowed
and required by law.
Specifically, the Contractor shall be responsible for being knowledgeable and performing any and all
services under this contract in accordance with the following governing regulations along with all applicable
Federal law, regulations, executive orders, FEMA policies,procedures, and directives.
o 2 C.F.R. Part 200 Uniform Administrative Requirements, Cost Principles, and Audit
Requirements for Federal Awards
o 44 C.F.R. Part 206
o The Robert T.Stafford Disaster Relief and Emergency Assistance Act, Public Law 93-
288, as amended,42 U.S.C. 5121 et seq., and Related Authorities
o FEMA Public Assistance Program and Policy Guide
EXHIBIT I-1
11/24
0
I6C2
EXHIBIT I
FEDERAL CONTRACT PROVISIONS AND ASSURANCES
Access to Records: 1)The contractor agrees to provide the County,the Florida Department of Emergency
Management, the FEMA Administrator, the Comptroller General of the United States, or any of their
authorized representative's access to any books, documents, papers,and records of the Contractor which
are directly pertinent to this contract for the purposes of making audits, examinations, excerpts, and
transcriptions.(2)The Contractor agrees to permit any of the foregoing parties to reproduce by any means
whatsoever or to copy excerpts and transcriptions as reasonably needed. (3) The contractor agrees to
provide the FEMA Administrator or his authorized representatives' access to construction or other work
sites pertaining to the work being completed under the contract. (4) In compliance with section 1225 of the
Disaster Recovery Act of 2018,the County and the Contractor acknowledge and agree that no language in
this contract is intended to prohibit audits or internal reviews by the FEMA Administrator or the Comptroller
General of the United States.
Buy Clean: The County encourages the use of environmentally friendly construction practices in the
performance of this Agreement. In particular, the County encourages that the performance of this
agreement Includes considering the use of low-carbon materials which have substantially lower levels of
embodied greenhouse-gas emissions associated with all relevant stages of production, use, and disposal,
as compared to estimated industry averages of similar materials or products as demonstrated by their
environmental product declaration.
Changes: To be allowable under a FEMA grant or cooperative agreement award,the cost of any contract
change, modification, amendment, addendum, change order, or constructive change must be necessary,
allowable, allocable,within the scope of the grant or cooperative agreement, reasonable for the scope of
work, and otherwise allowable.
DHS Seal, Logo, and Flags: The County must obtain written permission from Department of Homeland
Security prior to using the DHS seals,logos,crests,or reproductions of flags,or likenesses of OHS agency
officials. This includes use of DHS component (e.g., FEMA, CISA, etc.) seals, logos, crests, or
reproductions of flags,or likenesses of component officials. The contractor shall not use the OHS seal(s),
logos, crests, or reproductions of flags or likenesses of OHS agency officials without specific FEMA pre-
approval.
Domestic Preference for Procurements: The Contractor should, to the greatest extent practicable and
consistent with law, provide a preference for the purchase, acquisition, or use of goods, products, or
materials produced in the United States.This includes, but is not limited to, iron, aluminum, steel,cement,
and other manufactured products.
For purposes of this section: "Produced in the United States" means, for iron and steel products, that all
manufacturing processes,from the initial melting stage through the application of coatings, occurred in the
United States.
Build America, Buy America Act (BABAA): FEMA Public Assistance Funding is not subject to Buy
America preference pursuant the following guidance: Programs and Definitions: Build America. Buy
America Act l FEMA.gov
License and Delivery of Works Subject to Copyright and Data Rights: The Contractor grants to the
County, a paid-up, royalty-free, nonexclusive, irrevocable,worldwide license in data first produced in the
performance of this contract to reproduce, publish, or otherwise use, including prepare derivative works,
distribute copies to the public, and perform publicly and display publicly such data. For data required by
the contract but not first produced in the performance of this contract,the Contractor will identify such data
and grant to the County or acquires on its behalf a license of the same scope as for data first produced in
the performance of this contract. Data, as used herein, shall include any work subject to copyright under
17 U.S.C. § 102, for example, any written reports or literary works, software and/or source code, music,
choreography,pictures or images,graphics,sculptures,videos,motion pictures or other audiovisual works,
sound and/or video recordings,and architectural works.Upon or before the completion of this contract,the
Contractor will deliver to the County data first produced in the performance of this contract and data
EXHIBIT I-2
11/24
1bC2
EXHIBIT
FEDERAL CONTRACT PROVISIONS AND ASSURANCES
required by the contract but not first produced in the performance of this contract in formats acceptable by
the County.
No Obligation by Federal Government:The Federal Government is not a party to this contract and is not
subject to any obligations or liabilities to the non-Federal entity,contractor, or any other party pertaining to
any matter resulting from the contract.
Program Fraud and False or Fraudulent Statements or Related Acts: The Contractor acknowledges
that 31 U.S.C. Chap. 38 (Administrative Remedies for False Claims and Statements) applies to the
contractor's actions pertaining to this contract.
Prohibition on Covered Telecommunications Equipment or Services: (a)Definitions.As used in this
clause, the terms backhaul; covered foreign country; covered telecommunications equipment or services;
interconnection arrangements; roaming; substantial or essential component; and telecommunications
equipment or services have the meaning as defined in FEMA Policy,#405-143-1 Prohibitions on Expending
FEMA Award Funds forcovered Telecommunications Equipment or Services As used in this clause—
(b) Prohibitions.
(1) Section 889(b) of the John S. McCain National Defense Authorization Act for Fiscal Year2019, Pub. L.
No. 115-232, and 2 C.F.R. §200.216 prohibit the head of an executive agency on or after Aug.13, 2020,
from obligating or expending grant, cooperative agreement, loan, or loan guarantee funds on certain
telecommunications products or from certain entities for national security reasons.
(2) Unless an exception in paragraph (c)of this clause applies, the contractor and its subcontractors may
not use grant,-cooperative agreement, loan, or loan guarantee funds from the Federal Emergency
Management Agency to:
(i) Procure or obtain any equipment, system, or service that uses covered telecommunications
equipment or services as a substantial or essential component of any system, or as critical technology
of any system;
(ii) Enter into, extend, or renew a contract to procure or obtain any equipment, system, or service that
uses covered telecommunications equipment or services as a substantial or essential component of
any system,or as critical technology of any system;
(iii)Enter into,extend,or renew contracts with entities that use covered telecommunications equipment
or services as a substantial or essential component of any system,or as critical technology as part of
any system;or
(iv) Provide, as part of its performance of this contract, subcontract, or other contractual instrument,
any equipment, system, or service that uses covered telecommunications equipment or services as a
substantial or essential component of any system,or as critical technology as part of any system.
(c) Exceptions.
(1)This clause does not prohibit contractors from providing—(i).A service that connects to the facilities of
a third-party, such as backhaul, roaming, or interconnection arrangements; or (ii). Telecommunications
equipment that cannot route or redirect user data traffic or permit visibility into any user data or packets that
such equipment transmits or otherwise handles.
(2) By necessary implication and regulation, the prohibitions also do not apply to: (i). Covered
telecommunications equipment or services that: a. Are not used as a substantial or essential component
of any system; and b. Are not used as critical technology of any system. (ii). Other telecommunications
equipment or services that are not considered covered telecommunications equipment or services.
(3)Reporting requirement.
EXHIBIT I-3
11/24
0
16C2
EXHIBIT I
FEDERAL CONTRACT PROVISIONS AND ASSURANCES
(1) In the event the contractor identifies covered telecommunications equipment or services used as a
substantial or essential component of any system, or as critical technology as part of any system, during
contract performance, or the contractor is notified of such by a subcontractor at any tier or by any other
source, the contractor shall report the information in paragraph (d)(2) of this clause to the recipient or
subrecipient,unless elsewhere in this contract are established procedures for reporting the information.
(2) The Contractor shall report the following information pursuant to paragraph (d)(1) of this clause: (i)
Within one business day from the date of such identification or notification:The contract number;the order
number(s), if applicable; supplier name; supplier unique entity identifier (if known); supplier Commercial
and Government Entity (CAGE) code (if known); brand; model number(original equipment manufacturer
number, manufacturer part number, or wholesaler number); item description; and any readily available
information about mitigation actions undertaken or recommended.(ii)Within 10 business days of submitting
the information in paragraph (d)(2)(i) of this clause: Any further available information about mitigation
actions undertaken or recommended. In addition, the contractor shall describe the efforts it undertook to
prevent use or submission of covered telecommunications equipment or services,and any additional efforts
that will be incorporated to prevent future use or submission of covered telecommunications equipment or
services.
(e) Subcontracts. The Contractor shall insert the substance of this clause, including this paragraph(e), in
all subcontracts and other contractual instruments.
Providing Good, Safe Job to Workers: Pursuant to FEMA Information Bulletin No. 520, the contractor
will comply with all applicable federal labor and employment laws.To maximize cost efficiency and quality
of work, the contractor commits to strong labor standards and protections for the project workforce by
creating an effective plan for ensuring high-quality jobs and complying with federal labor and employment
laws. The contractor acknowledges applicable minimum wage, overtime, prevailing wage, and health and
safety requirements, and will incorporate Good Jobs Principles wherever appropriate and to the'greatest
extent practicable.
Rights to Inventions Made Under a Contract or Agreement: Exempt from FEMA Public Assistance
Funding
Socioeconomic Contracting: The Contractor is encouraged to take all necessary steps identified in 2
C.F.R. § 200.321(b)(1)-(5) to ensure small businesses, minority businesses, women's business
enterprises,veteran owned businesses,and labor surplus area firms are considered when possible. Such
consideration means: (1)These business types are included on solicitation lists; (2) These business types
are solicited whenever they are deemed eligible as potential sources; (3) Dividing procurement
transactions into separate procurements to permit maximum participation by these business types; (4)
Establishing delivery schedules (for example,the percentage of an order to be delivered by a given date
of each month) that encourage participation by these business types; (5) Utilizing organizations such as
the Small Business Administration and the Minority Business Development Agency of the Department of
Commerce;and(6)Requiring a contractor under a Federal award to apply this section to subcontracts.
Suspension and Debarment: (1)This contract is a covered transaction for purposes of 2 C.F.R. pt. 180
and 2 C.F.R.pt. 3000.As such the contractor is required to verify that none of the contractor, its principals
(defined at 2 C.F.R. § 180.995), or its affiliates(defined at 2 C.F.R. § 180.905) are excluded (defined at 2
C.F.R. § 180.940) or disqualified (defined at 2 C.F.R. § 180.935). (2)The contractor must comply with 2
C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000,subpart C and must include a requirement to comply with
these regulations in any lower tier covered transaction it enters into. (3) This certification is a material
representation of fact relied upon by the County. If it is later determined that the contractor did not comply
with 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000, subpart C,in addition to remedies available to the
County, the Federal Government may pursue available remedies, including but not limited to suspension
and/or debarment. (4)The bidder or proposer agrees to comply with the requirements of 2 C.F.R. pt. 180,
subpart C and 2 C.F.R.pt.3000,subpart C while this offer is valid and throughout the period of any contract
EXHIBIT I-4
11/24
C
16C2
EXHIBIT I
FEDERAL CONTRACT PROVISIONS AND ASSURANCES
that may arise from this offer.The bidder or proposer further agrees to include a provision requiring such
compliance in its lower tier covered transactions.
Contractors must sign and submit a debarment certification to the County with each bid or offer. See
Certifications and Assurances and the end of this document.
Procurement of Recovered Materials (§200.323) (Over$10,000): In the performance of this contract,
the Contractor shall make maximum use of products containing recovered materials that are EPA-
designated items unless the product cannot be acquired—a) Competitively within a timeframe providing
for compliance with the contract performance schedule; b) Meeting contract performance requirements; or
c)At a reasonable price.
Information about this requirement, along with the list of EPA-designated items, is available at EPA's
Comprehensive Procurement Guidelines webpage:Comprehensive Procurement Guideline(CPG)Program)US
EPA. The Contractor also agrees to comply with all other applicable requirements of Section 6002 of the
Solid Waste Disposal Act.
The Contactor should,to the greatest extent practicable and consistent with the law,purchase, acquire, or
use products and services that can be reused, refurbished, or recycled; contain recycled content, are
biobased,or are energy and water efficient;and are sustainable.
Termination for Cause and Convenience(over$10,000): See Standard Purchase Order and/or Contract
Terms and Conditions
Byrd Anti-Lobbying Amendment(31 U.S.C. § 1352 (as amended) (over$100,000): Contractors who
apply or bid for an award of more than$100,000 shall file the required certification. Each tier certifies to the
tier above that it will not and has not used federal appropriated funds to pay any person or organization for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress,officer
or employee of Congress, or an employee of a Member of Congress in connection with obtaining any
federal contract, grant, or any other award covered by 31 U.S.C. § 1352. Each tier shall also disclose any
lobbying with non-federal funds that takes place in connection with obtaining any federal award. Such
disclosures are forwarded from tier to tier up to the County who in turn will forward the certification(s)to the
federal agency.
Contractors must sign and submit a lobbying certification to the County with each bid or offer exceeding
$100,000. See Certifications and Assurances and the end of this document.
Contract Work Hours and Safety Standards Act (CWHSSA) (40 U.S.C. 3701-3708) (over$100,000):
Where applicable,all contracts awarded by the solicitor in excess of$100,000 that involve the employment
of mechanics or laborers must include a provision for compliance with 40 U.S.C. 3702 and 3704, as
supplemented by Department of Labor regulations (29 CFR Part 5).
Compliance with the Contract Work Hours and Safety Standards Act.
(1) Overtime requirements. No contractor or subcontractor contracting for any part of the contract work
which may require or involve the employment of laborers or mechanics shall require or permit any such
laborer or mechanic in any workweek in which he or she is employed on such work to work in excess of
forty hours in such workweek unless such laborer or mechanic receives compensation at a rate not less
than one and one-half times the basic rate of pay for all hours worked in excess of forty hours in such
workweek.
(2)Violation; liability for unpaid wages; liquidated damages. In the event of any violation of the clause set
forth in paragraph (b)(1) of this section the contractor and any subcontractor responsible therefor shall be
liable for the unpaid wages and interest from the date of the underpayment. In addition, such contractor
and subcontractor shall be liable to the United States (in the case of work done under contract for the
w Y EXHIBIT I-5
11/24
r��°
16C2
EXHIBIT I
FEDERAL CONTRACT PROVISIONS AND ASSURANCES
District of Columbia or a territory, to such District or to such territory), for liquidated damages. Such
liquidated damages shall be computed with respect to each individual laborer or mechanic, including
watchpersons and guards, employed in violation of the clause set forth in paragraph (b)(1) of this section,
in the sum of$32 for each calendar day on which such individual was required or permitted to work in
excess of the standard workweek of forty hours without payment of the overtime wages required by the
clause set forth in paragraph (b)(1).
(3)Withholding for unpaid wages and liquidated damages—
(i) Withholding Process. The County may, upon its own action, or must, upon written request of an
authorized representative of the Department of Labor, withhold or cause to be withheld from the
contractor so much of the accrued payments or advances as may be considered necessary to
satisfy the liabilities of the prime contractor or any subcontractor for any unpaid wages; monetary
relief,including interest;and liquidated damages required by the clauses set forth in this paragraph
(b)on this contract,any other federal contract with the same prime contractor,or any other federally
assisted contract subject to the Contract Work Hours and Safety Standards Act that is held by the
same prime contractor (as defined in § 5.2). The necessary funds may be withheld from the
contractor under this contract, any other federal contract with the same prime contractor, or any
other federally assisted contract that is subject to the Contract Work Hours and Safety Standards
Act and is held by the same prime contractor,regardless of whether the other contract was awarded
or assisted by the same agency, and such funds may be used to satisfy the contractor liability for
which the funds were withheld.
(ii) (ii) Priority to withheld funds. The Department has priority to funds withheld or to be withheld in
accordance with paragraph (a)(2)(i) or(b)(3)(i) of this section, or both, over claims to those funds
by:
(A) A contractor's surety(ies), including without limitation performance bond sureties
and payment bond sureties;
(B) A contracting agency for its reprocurement costs;
(C) A trustee(s) (either a court-appointed trustee or a U.S. trustee, or both) in
bankruptcy of a contractor, or a contractor's bankruptcy estate;
(D)A contractor's assignee(s);
(E)A contractor's successor(s); or
(F)A claim asserted under the Prompt Payment Act, 31 U.S.C. 3901-3907.
(4) Subcontracts. The contractor or subcontractor must insert in any subcontracts the clauses set forth in
paragraphs (b)(1) through (5) of this section and a clause requiring the subcontractors to include these
clauses in any lower tier subcontracts. The prime contractor is responsible for compliance by any
subcontractor or lower tier subcontractor with the clauses set forth in paragraphs (b)(1)through (5). In the
event of any violations of these clauses,the prime contractor, and any subcontractor(s) responsible will be
liable for any unpaid wages and monetary relief, including interest from the date of the underpayment or
loss, due to any workers of lower-tier subcontractors, and associated liquidated damages and may be
subject to debarment, as appropriate.
(5)Anti-retaliation.It is unlawful for any person to discharge,demote, intimidate,threaten, restrain,coerce,
blacklist,harass,or in any other manner discriminate against,or to cause any person to discharge,demote,
intimidate, threaten, restrain, coerce, blacklist, harass, or in any other manner discriminate against, any
worker or job applicant for:
EXHIBIT I-6
11/24
i6C2
EXHIBIT I
FEDERAL CONTRACT PROVISIONS AND ASSURANCES
(i) Notifying any contractor of any conduct which the worker reasonably believes constitutes a violation
of the Contract Work Hours and Safety Standards Act(CWHSSA) or its implementing regulations
in this part;
(ii) Filing any complaint, initiating, or causing to be initiated any proceeding, or otherwise asserting or
seeking to assert on behalf of themselves or others any right or protection under CWHSSA or this
part;
(iii) Cooperating in any investigation or other compliance action, or testifying in any proceeding under
CWHSSA or this part;or
(iv) Informing any other person about their rights under CWHSSA or this part."
Further Compliance with the Contract Work Hours and Safety Standards Act.
(1)The contractor or subcontractor must maintain regular payrolls and other basic records during the course
of the work and must preserve them for a period of three years after all the work on the prime contract is
completed for all laborers and mechanics, including guards and watchpersons, working on the contract.
Such records must contain the name; last known address, telephone number, and email address; and
social security number of each such worker; each worker's correct classification(s) of work performed;
hourly rates of wages paid;daily and weekly number of hours actually worked;deductions made;and actual
wages paid.
(2) Records to be maintained under this provision must be made available by the contractor or
subcontractor for inspection, copying, or transcription by authorized representatives of the Department of
Homeland Security, the Federal Emergency Management Agency, and the Department of Labor, and the
contractor or subcontractor will permit such representatives to interview workers during-working hours on
the job."
Clean Air Act(over$150,000): 1. The contractor agrees to comply with all applicable standards, orders
or regulations issued pursuant to the Clean Air Act,as amended,42 U.S.C.§7401 et seq. 2.The contractor
agrees to report each violation to the County and understands and agrees that the County will, in turn,
report each violation as required to assure notification to the Federal Emergency Management Agency,and
the appropriate Environmental Protection Agency Regional Office. 3. The contractor agrees to include
these requirements in each subcontract exceeding $150,000 financed in whole or In part with Federal
assistance provided by FEMA.
Federal Water Pollution Control Act (over $150,000): 1. The contractor agrees to comply with all
applicable standards,orders, or regulations issued pursuant to the Federal Water Pollution Control Act,as
amended, 33 U.S.C. 1251 et seq. 2. The contractor agrees to report each violation to the County and
understands and agrees that the County will,in turn, report each violation as required to assure notification
to the Federal Emergency Management Agency, and the appropriate Environmental Protection Agency
Regional Office. 3. The contractor agrees to include these requirements in each subcontract exceeding
$150,000 financed in whole or in part with Federal assistance provided by FEMA.
Administrative, Contractual, or Legal Remedies (over $250,000): Unless otherwise provided in this
contract, all claims, counter-claims, disputes and other matters in question between the local
government and the contractor, arising out of or relating to this contract, or the breach of it,will be decided
by arbitration,if the parties mutually agree, or in a Florida court of competent jurisdiction.
EXHIBIT I-7
11/24,
r_,a°
16C2
EXHIBIT I
FEDERAL CONTRACT PROVISIONS AND ASSURANCES
CONSTRUCTION ACTIVITIES
Equal Employment Opportunity Clause (§60-1.4); Except as otherwise provided under 41 C.F.R. Part
60, all contracts that meet the definition of"federally assisted construction contract"in 41 C.F.R. § 60-1.3
must include the equal opportunity clause provided under 41 C.F.R. §60-1.4.
During the performance of this contract,the contractor agrees as follows:
(1)The contractor will not discriminate against any employee or applicant for employment because of race,
color,religion,sex,sexual orientation,gender identity,or national origin.The contractor will take affirmative
action to ensure that applicants are employed,and that employees are treated during employment without
regard to their race, color, religion, sex, sexual orientation, gender identity, or national origin. Such action
shall include, but not be limited to the following:
Employment, upgrading,demotion,or transfer;recruitment or recruitment advertising;layoff or termination;
rates of pay or other forms of compensation; and selection for training, including apprenticeship. The
contractor agrees to post in conspicuous places, available to employees and applicants for employment,
notices to be provided setting forth the provisions of this nondiscrimination clause.
(2) The contractor will, in all solicitations or advertisements for employees placed by or on behalf of the
contractor, state that all qualified applicants will receive consideration for employment without regard to
race, color,religion, sex,sexual orientation, gender identity, or national origin.
(3)The contractor will not discharge or in any other manner discriminate against any employee or applicant
for employment because such employee or applicant has inquired about, discussed, or disclosed the
compensation of the employee or applicant or another employee or applicant.This provision shall not apply
• to instances in which an employee who has access to the compensation information of other employees or
- applicants as a part of such employee's essential job functions discloses the compensation of such other
employees or applicants to individuals who do not otherwise have access to such information, unless such
disclosure is in response to a formal complaint or charge, in furtherance of an investigation, proceeding,
hearing, or action, including an investigation conducted by the employer, or is consistent with the
contractor's legal duty to furnish information.
(4)The contractor will send to each labor union or representative of workers with which he has a collective
bargaining agreement or other contract or understanding, a notice to be provided advising the said labor
union or workers'representatives of the contractor's commitments under this section,and shall post copies
of the notice in conspicuous places available to employees and applicants for employment.
(5)The contractor will comply with all provisions of Executive Order 11246 of September 24, 1965, and of
the rules, regulations,and relevant orders of the Secretary of Labor.
(6)The contractor will furnish all information and reports required by Executive Order 11246 of September
24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will
permit access to his books, records,and accounts by the administering agency and the Secretary of Labor
for purposes of investigation to ascertain compliance with such rules, regulations, and orders.
(7) In the event of the contractor's noncompliance with the nondiscrimination clauses of this contract or with
any of the said rules, regulations, or orders, this contract may be canceled, terminated, or suspended in
whole or in part an the contractor may be declared ineligible for further Government contracts or federally
assisted construction contracts in accordance with procedures authorized in Executive Order 11246 of
September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in
Executive Order 11246 of September 24, 1965,or by rule, regulation,or order of the Secretary of Labor, or
as otherwise provided by law.
(8) The contractor will include the portion of the sentence immediately preceding paragraph (1) and the
provisions of paragraphs(1)through (8)in every subcontract or purchase order unless exempted by rules,
EXHIBIT I-8
11/24
co
16C2
EXHIBIT I
FEDERAL CONTRACT PROVISIONS AND ASSURANCES
regulations, or orders of the Secretary of Labor issued pursuant to section 204 of Executive Order 11246
of September 24, 1965, so that such provisions will be binding upon each subcontractor or vendor.The
contractor will take such action with respect to any subcontract or purchase order as the administering
agency may direct as a means of enforcing such provisions,including sanctions for noncompliance:
Provided, however, that in the event a contractor becomes involved in, or is threatened with, litigation with
a subcontractor or vendor as a result of such direction by the administering agency, the contractor may
request the United States to enter into such litigation to protect the interests of the United States.
Davis Bacon Act: Exempt under FEMA Public Assistance Funding
Copeland Anti-Kickback Act: Exempt under FEMA Public Assistance Funding
EXHIBIT I-9
11/24
GPI
1 6 C 2
EXHIBIT I
FEDERAL CONTRACT PROVISIONS AND ASSURANCES
Compliance with Federal Law, Regulations,And Executive Orders
and Acknowledgement of Federal Funding
Certification
This is an acknowledgement that FEMA financial assistance will be used to fund all or a portion of the
contract. The contractor will comply with all applicable Federal law, regulations, executive orders, FEMA
policies, procedures,and directives.
If the Contractor subcontracts any of the work required under this Agreement, a copy of the signed
subcontract must be available to the County for review and approval. The Contractor agrees to include in
the subcontract that(1)the subcontractor is bound by the terms of this Agreement, (ii)the subcontractor is
bound by all applicable state and federal laws and regulations, and (iii) the subcontractor shall hold the
County and the Grantor Agency harmless against all claims of whatever nature arising out of the
subcontractor's performance of work under this Agreement,to the extent allowed and required by law.The
County may document in the quarterly report the Contractor's progress in performing its work under this
agreement.
On behalf of my firm, I acknowledge,the grant requirements identified in this document.
Vendor/Contractor Name A0,41 14,9, - Sar',Lc/.c_- ��-✓�' '' '
Date 77/l
1
Authorized Signature
EXHIBIT I-10
11/24
CA0
16C2
EXHIBIT I
FEDERAL CONTRACT PROVISIONS AND ASSURANCES
CERTIFICATION REGARDING DEBARMENT,SUSPENSION, INELIGIBILITY
and VOLUNTARY EXCLUSION
Contractor Covered Transactions
(1) The prospective subcontractor of the Sub-recipient, Collier County, certifies,by submission of this
document, that neither it nor its principals is presently debarred, suspended, proposed for debarment,
declared ineligible,or voluntarily excluded from participation in this transaction by any Federal department
or agency.
(2) Where the Sub-recipient's subcontractor is unable to certify to the above statement,the prospective
contract shall attach an explanation to this form.
CONTRACTOR
By:
Signature
Name and Title
/?i /7; 0( /,✓ hGte
Street Addre s
�.� k /�J ;/ 07 c/77
City, State,Zip
UEI Unique Entity Identifier(for SAM.gov verification)
1---/7 Lr
Date
Sub-Recipient Name: Collier County Board of County Commissioners
DEM Contract Number: TBD
FEMA Project Number: TBD
EXHIBIT I-11
11/24
PTO
6C,2
EXHIBIT I
FEDERAL CONTRACT PROVISIONS AND ASSURANCES
COLLIER COUNTY
ANTICIPATED DISADVANTAGED,MINORITY,WOMEN OR VETERAN PARTICIPATION STATEMENT
Status will be verified. Unveer able statuses will require the PRIME to either proisde a revised statement or provide source documentation that validates a
status.
A. PRIME VENDOR/CONTRACTOR INFORMATION
PRIME NAME PRIME FED NUMBER CONTRACT DOLLAR AMOUNT
rc li'i pit•-%ir•. v- C < IC. Aik: iy I (Yc1�J.S C � (: L�. h
ISTHE PRIME A FLORIDA-CERTIFIED OISADVA)ITAGEO, yrrERidl y N ';1}{E ACTIVITY OF THIS CONTRACT...
MINORITY OR WOMEN BUSINESS ENTERPRISE? DBE% Y IJ LOFLSTRUCTIOFI? Y N
(DBEr 1.I BFAV 5E I OR HAVE A.SMALL DISADVAATAGED
BU91t ES SA CERTIFICATION FROM THE SMALL BUSINESS MBE? N COTISULTAT.ON? Y N
ADMINISTRATION? ASERy10E DISABLED VETERAN? WBE? Y II OTHER? Y N
soc BA? ti' N
IS TkES SUBMISSION A REVISION? Y N IF YES,RELtSION NUMBER
B. IF PRIME HAS SUBCONTRACTOR OR SUPPLIER WHO IS A DISADVANTAGED MINORITY,WOMEN OWNED,SMALL
BUSINESS CONCERN OR SERVICE DISABLED VETERAN,PRIME IS TO COMPLETETHIS NEXT SECTION
DBE M/wBE SUBCONTRACTOR OR SUPPFJER TYPE OF WORK OR ETHNICITY CODE SUB/SUPPLIER PERCENT OF CONTRACT
VETERAN NAME SPECIALTY (Ste Below) DOLLAR AMOUNT DOLLARS
(
TOTALS:
C. SECTION70 RE:COMPLETED BY PRIME VENDOR/CONTRACTOR
NAME OFF SU_BMM/ITTER DATE TITLE OF SUBMITTER
EMAIL ADDRESS OF PRIME(SUBMITTER) TI:LEPI ONE[LUMBER - FAX NU MBER
f Lkt.L'r'%'kiiA41'r( t r,tl .lf t 'l %L S 1/ 1 - %(11' t.'.� ) _ ,`r/ '• '/ YI
NOTE:This information if Wed to[tack and report,antrcipated DBE cc MBE participation in federally-funded contracts.The anticipated DBE or
MBE amount is voluntary and Wilt not become part of the contractual terms.This form must be submitted at time of response to a
solkitation.If and when awarded a County contract,the prime will be asked to update the information for the grant compliance riles.
ETHNICITY CODE
Black American BA
Hispanic American ILA
Native American NA
Subcont.Asian American SAA
Asian-Pacific American APA
Non-Minority Women NAtW
other-not of arm other group listed O
D.SECTION TO BE COMPLETED BY COLLIER COUNTY
DEPARTMENT NAME COWER CONTRACT F IIFB;RFP or PO/PEO) GRANT PROGRAM/CONTRACT
ACCEPTED BY: DATE
EXHIBIT I-12
11/24
re%
I 6 C 2
EXHIBIT I
FEDERAL CONTRACT PROVISIONS AND ASSURANCES
LOBBYING CERTIFICATION
(To be submitted with each bid or offer exceeding$100,000)
The undersigned [Contractor]certifies,to the best of his or her knowledge,that:
1.No Federal appropriated funds have been paid or will be paid,by or on behalf of the undersigned,to any person
for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer
or employee of Congress,or an employee of a Member of Congress in connection with the awarding of any Federal
contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative
agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant,
loan, or cooperative agreement.
2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing
or attempting to influence an officer or employee of any agency, a Member of Congress,an officer or employee of
Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or
cooperative agreement, the undersigned shall complete and submit Standard Form- LLL, "Disclosure Form to
Report Lobbying,"in accordance with its instructions.
3.The undersigned shall require that the language of this certification be included in the award documents for all
subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative
agreements)and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was
made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction
imposed by 31, U.S.C. § 1352(as amended by the Lobbying Disclosure Act of 1995).Any person who fails to file
the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000
for each such failure.
The Contractor certifies or affirms the truthfulness and accuracy of each statement of its certification and
disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. Chap. 38,
Administrative Remedies for False Claims and Statements, apply to this certification and disclosure, if any.
Contractor(Firm Name) a�
Signature of Co/ntrac oof's Authorized Official
4V1 �1e,„ i Gra
Name and Title of Contractor's Authorized Official
/74 .5
Date
EXHIBIT I-13
11/24
16C2
AFFIDAVIT REGARDING LABOR AND SERVICES
Effective July 1, 2024, pursuant to§787.06(13), Florida Statutes,when a contract is executed,renewed,or extended
between a nongovernmental entity and a governmental entity, the nongovernmental entity must provide the
governmental entity with an affidavit signed by an officer or a representative of the nongovernmental entity under
penalty of perjury attesting that the nongovernmental entity does not use coercion for labor or services.
Nongovernmental Entity's Name: Komline-Sanderson Corporation
Address: 12 Holland Avenue,PO Box 257,Peapack,New Jersey 07977
Phone Number: +1(908)234-1000
Authorized Representative's Name: Robert J.Vander Meulen
Authorized Representative's Title: EVP&CFO
Email Address: rjvandermeulen@komline.com
AFFIDAVIT
I, Robert Vander Meulen (Name of Authorized Representative),as authorized representative attest
that Komline-Sanderson Corporation (Name of Nongovernmental Entity)does not use coercion for labor or
services as defined in §787.06, Florida Statutes.
Under penalty of p /jury,I declare that I have read the foregoing Affidavit and that the facts stated in it are true.
/ //1 J
(Signature of u horized representative) Date
STATE OF New Jersey
COUNTY OF Somerset
Sworn to(or affirmed)and subscribed before me,by means of El physical presence or❑online notarization this
7th day of January ,20 by Robert J.Vander Meulen (Name of Affiant),who produced their
as identification or are personally known to me.
/tk. - {\
Notary Public(not required when digital) ':ter !
FITSUM A TESFAYE
f e i i / D, c;)E1)c r` 4 Nc ary Public,State of New Jersey )
( i tty Commission Expires May 10,2029
Commissl Q n Expires
Personally Known t\OR Produced Identification ❑
Type of Identification Produced:
CONTRACT RENEWAL OR EXTENSION REQUEST FORM Version:2025.1
43
C)5