1425 CDBG Roof Replacement & Repairs14ZS
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PURCHASING DEPARTMENT
T I T'T A L MEMO RANDUM
To: r & City Clerk
RE: CDBG Funds Work Order No. 1 -171 for Meals on Wheel for $45,000 RFP 10/11- 171F
The item(s) noted below is /are attached and forwarded to your office for the following action(s):
❑
Development Order
❑
Mayor's signature
❑
Final Plat (original mylars)
❑
Reco ~~ �`''
❑
Letter of Credit
ndering
❑
Maintenance Bond
afe keeping (Vault)
❑
Ordinance
❑
❑
Performance Bond
ay men r go
❑
Resolution
®
City Manager Signature
❑
®
City Clerk Attest/Signature
Once completed, please:
® Return originals to Purchasing
❑ Return copies
El
Special Instructions:
This work order was processed before the new City Manager began with the City.
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TADept_ forms \City Clerk Transmittal Memo - 2009.doc
EXHIBIT A
WORK ORDER FORM
Work Order Number 1 - 171
CITY OF SANFORD FLORIDA
Master Agreement/Contract Number: NA J Dated:
Sept. 6, 2011
Contract/Project Title CDBG Project Roof Replacement and Repairs and other Weaterization and Energey Efficienc
Solicitation No: RFP 10/11 -171F ISanford Project No. NA
Purchase Order No.
Consultant/Contractor: Meals on Wheels
Consultant/Contractor's Business Address, Phone Number, Fax Number and E -mail Address:
2801 S. Financial Ct.; Sanford, FL 32773 Contact: Sherry Fincher, Executive Director; Phone: 407 - 333 -8877
Fax: 407 - 829 -2468
ATTACHMENTS TO THIS WORK ORDER METHOD OF COMPENSATION
DRAWINGS /PLANS /SPECIFICATIONS IFIXED FEE BASIS
SCOPE OF SERVICES
ITIME BASIS -NOT TO EXCEED AMOUNT
SPECIAL CONDITIONS
TIME BASIS- LIMITATION OF FUNDS
PRICING IINFORMATION
UNIT PRICE BASIS -NOT TO EXCEED AMOUNT
WO TERMS AND CONDITIONS
SUBMISSION INCLUDING SCOPE AND PRICING
TIME FOR COMPLETION: 180 Days of the effective date to this Work Order
Effective date- this Work Order: Date of Execution by City
Time for completion: The services to be provided by the Consultant/Contractor shall commence upon execution
of this Work Order by the parties and shall be completed within the time frame indicated above. Failure to meet
the stated completion requirement may be grounds for termination for default.
Work Order Amount: Dollars Expressed in Numbers: $ $45,000.00
Dollar Amount Written Out: Forty five thousand dollars and no /100
In Witness Whereof, the parties hereto have made and executed this Work Order on the respective dates under each
signature: The City as delegated through its City Manager and the Consultant/Contractor by and through its duly
authorized corporate officer having the full and complete authority to execute same.
CONSULTANT /CONTRACTOR
ATTEST: EXECUTION:
s
nature, Corporate Officer Signature, Corporate President
q}l'-* D irprtnr 9li3(1
Corporate Officer Printed Name, Title and Date Corporate President, Printed Name and Date
CITY OF SANFORD
nat re, P asing Manager
F. Willia Smith _ 20
Purchasin Mana er, Prin ed Name and Date
Signature, City Clerk City Manag
C ✓` � c, 1 o r7 Y C) _ 2 2 Tom George, P - it Mana erq' / I
City Clerk, Printed Name and Date City Manager, Printed Name and Date
Revised: 1 -42011
RE LLI V LU SEP 0 9 2011
Work Order (page 2) WORK ORDER
TERMS AND CONDITIONS
Execution of this Work Order by the CITY and the issuance of a notice to proceed, shall serve as authori-
zation for the CONSULTANT /CONTRACTOR to provide goods and /or services for the above project as set out in the
Scope of Services which is attached as Exhibit "A," as well as all other exhibits attached to that certain Agreement cited
on the face of this Work Order all of which are incorporated herein by reference as if they had been set out in its entirety
and as further delineated in the specifications, conditions and requirements stated in the listed documents which are
attached hereto and made a part hereof. The CONSULTANT /CONTRACTOR shall provide said goods and /or services
pursuant to this Work Order, its attachments and the above - referenced Agreement and its exhibits. If this Work Order
conflicts with said Agreement or exhibits, the Agreement and exhibits shall prevail provided, however, that the
CONSULTANT /CONTRACTOR shall not proceed with work until directed to do so by the CITY
TERM: This Work Order shall take effect on the date of its execution by the CITY and expires upon final delivery,
inspection, acceptance and payment unless terminated earlier in accordance with the Termination provisions herein=
provided however, that the CONSULTANT /CONTRACTOR shall not proceed with work until directed to do so by the
CITY
METHOD OF COMPENSATION:
(i) FIXED FEE BASIS. If the compensation is based on a "Fixed Fee Basis," then the
CONSULTANT /CONTRACTOR shall perform all work required by this Work Order for the Fixed Fee
Amount indicated as the Work Order Amount. The fixed feel is an all- inclusive Firm Fixed Price binding the
CONSULTANT /CONTRACTOR to complete the work for the Fixed Fee Amount regardless of the costs
of performance. In no event shall the CONSULTANT /CONTRACTOR be paid more than the Fixed Fee
Amount.
(ii) TIME BASIS WITH A NOT TO EXCEED AMOUNT. If the compensation is based on a "Time Basis Method"
with a Not -to- Exceed Amount, then the CONSULTANT /CONTRACTOR shall perform all work required
by this Work Order for a sum not exceeding the amount indicated as the Work Order Amount. In no event
is the CONSULTANT /CONTRACTOR authorized to incur expenses exceeding the Not -To- Exceed
Amount without the express written consent of the CITY. Such consent will normally be in the form of an
amendment to this Work Order. The CONSULTANT /CONTRACTOR'S compensation shall be based
on the actual work required by this Work Order and the Labor Hour Rates established in the Master
Agreement.
(iii) TIME BASIS WITH A LIMITATION OF FUNDS AMOUNT. If the compensation is based on a "Time Basis
Method" with a Limitation of Funds Amount, then the amount identified as the Work Order Amount
becomes the Limitation of Funds amount which shall not be exceeded without prior written approval of the
CITY. Such approval, if given by the CITY, will indicate a new Limitation of Funds amount. The
CONSULTANT /CONTRACTOR shall advise the CITY whenever the CONSULTANT /CONTRACTOR
has incurred expenses on this Work Order that equals or exceeds eighty percent (80 %) of the Limitation of
Funds amount. The CONSULTANT /CONTRACTOR'S compensation shall be based on the actual work
required by this Work Order and the Labor Hour Rates established in the Master Agreement.
(iv) UNIT PRICE BASIS WITH A NOT TO EXCEED AMOUNT. If the compensation is based on a "Unit Price
Basis," then the CONSULTANT /CONTRACTOR shall perform all work required by this Work Order for the
amount resulting from computing the quantity(ies) of defined units and agreed upon unit pricing to establish
amount of CONTRACTOR'S compensation. All adjustments to quantities shall be approved by the Project
Manager. Prior written approval by the City is required to adjust the not to exceed amount.
The CITY shall make payment to the CONSULTANT /CONTRACTOR in strict accordance with the payment terms
of the above - referenced Agreement.
It is expressly understood by the CONSULTANT /CONTRACTOR that this Work Order, until executed by the
CITY, does not authorize the performance of any services by the CONSULTANT /CONTRACTOR and that the CITY,
prior to its execution of the Work Order, reserves the right to authorize a party other than the
CONSULTANT /CONTRACTOR to perform the services called for under this Work Order if it is determined that to do
so is in the best interest of the CITY.
The CONSULTANT /CONTRACTOR shall execute this Work Order first and the CITY second. This Work
Order becomes effective and binding upon execution by the CITY and not until then. A copy of this executed Work Order
along with a Purchase Order will be forwarded to the CONSULTANT /CONTRACTOR at the completion of that action.
It is noted that the Purchase Order Number must be indicated on all invoices germane to the Work Order.
WORK ORDER TERMS AND CONDITIONS
1. By accepting this Work Order (WO) the ContractorNendor /Contractor accepts all of the Terms and
Conditions included herein. The Buyer is the City of Sanford, Florida, hereinafter referred to as the
"City ". The term "City" is used in a broad sense to include its employees, directors, officers, agents,
volunteers, etc.
2. All information referenced is hereby incorporated into the WO. These Terms and Conditions may be
varied only by written amendment signed by the parties. All modifications in performance, including but
not limited to, extensions of time, renewal, or substitution are void absent dually signed amendment by
the parties. Time is of the essence of the lawful performance of the duties and obligations contained in
the Work Order. The Vendor /Contractor agrees that Vendor /Contractor shall diligently and expeditiously
pursue Vendor /Contractor's obligations.
3. Cancellation rights reserved by the City. The City may cancel this WO in whole or in part at any time for
default by written notice to the Vendor /Contractor. The City shall have no liability to the
Vendor /Contractor beyond payment of any balance owing for Material purchased hereunder and
delivered to and accepted by the City prior to the Vendor /Contractor's receipt of the notice of
termination.
4. Terms of shipping are F.O.B. the City's delivery location unless otherwise noted within the terms of this
WO. Regardless of the indicated F.O.B. point, the City does not accept title until the delivery is
acknowledged by an authorized City representative"
5. Prices stated on this WO are firm, all inclusive and consistent with applicable negotiations, bid(s) and /or
quotations. The City is exempt from the Florida Sales and Use Tax and will furnish the
Vendor /Contractor with proof of tax exemption upon request. Extra charges for any purpose will not be
allowed unless explicitly indicated on the WO. This order is hereby cancelled, if pricing is omitted.
6. The Vendor /Contractor warrants that any material or equipment supplied hereunder is new, unused
condition and free from defects in title, workmanship, defects in design and in full compliance with the
specifications defined by the City in the order. The goods or services furnished under this WO are
covered by commercial warranties for such goods or services and that the rights and remedies
provided therein are in addition to and do not limit those available to the City. A copy of these
warranties and all applicable manufacturer's warranties shall be furnished at the time of delivery.
7. The City reserves the right to conduct any inspection or investigation to verify compliance of the goods
and /or services with the requirements of this Work order and to reject any delivery not in compliance If
any deficiency is not visible at the time of delivery the City reserves the right to take and /or require
appropriate corrective action upon the discovery of any deficiency, non - compliance, or defect
8. All tools or property furnished to the Vendor /Contractor by the City shall remain the property of the City,
be subject to removal upon the City's demand, be used only on behalf of the City, be maintained in
good order, and be clearly identified as property of the City. The Vendor /Contractor assumes any and
all liability of whatsoever type or nature for loss or damage to such property.
9. The Vendor /Contractor agrees to comply with all Federal, State of Florida, Seminole County, City laws,
ordinances, regulations, authority and codes and authority having jurisdiction over the purchase.
10. To the fullest extent permitted by law, the Vendor /Contractor shall indemnify, hold harmless and defend
the City, its agents, servants, officers, officials and employees, or any of them, from and against any
and all claims, damages, losses, and expenses including, but not limited to, attorney's fees and other
legal costs such as those for paralegal, investigative, and legal support services, and the actual costs
incurred for expert witness testimony, arising out of or resulting from the performance or provision of
services required under this Agreement, provided that same is caused in whole or in part by the error,
omission, act, failure to act, breach of contract obligation, malfeasance, officers, officials, employees, or
agents. Additionally, the Vendor /Contractor accepts responsibility for all damages resulting in any way
related to the procurement and delivery of goods or services contemplated in this Work order. Nothing
herein shall be deemed to affect the rights, privileges, and immunities of the City as set forth in Section
768.28, Florida Statutes.
11. The Vendor /Contractor shall not assign this WO, any rights under this WO or any monies due or to
become due hereunder nor delegate or subcontract any obligations or work hereunder without the prior
written consent of the City.
WORK ORDER TERMS AND CONDITIONS -Page 2
12. The Vendor /Contractor shall not disclose the existence of this WO without prior written consent of the
City except as may be required to perform this WO.
13. All Material purchased hereunder must be packaged to ensure its security and delivery in accordance
with the City's shipping and packaging specification and good commercial practice. Each package shall
be labeled indicating the addressee of each package or shipment and the applicable WO number. All
shipments shall comply with HAZMAT requirements including, but not limited to, (DOT) regulations
published in 49CFR 1399, OSHA regulations 29 CFR 4999.
14. The Vendor /Contractor shall perform the obligations of this WO as an independent contractor and
under no circumstances shall it be considered as agent or employee of the City.
15. The Vendor /Contractor ensures that its personnel shall comply with reasonable conduct guidelines and
City policies and procedures.
16. After each delivery, the Vendor /Contractor shall provide to the "bill to address" an original, "proper
invoice" (single copy) which includes: a) Vendor /Contractor's name(dba), telephone number, mailing
address; b) City's P.O. Number; c) Date of invoice; d) Shipping date; e) Delivery date; f) Payment
terms; g) Description of goods /services; h) quantity; i) Unit price; j) Extended price; k) Total. The City
has the right to reconcile invoice with the WO and adjust payment accordingly to comply with the WO.
Payment will be made only to the Vendor /Contractor identified on the WO and for received and
accepted goods /services. The City shall have right at any time to set -off any amounts due to the
Vendor /Contractor against any amounts owed to the City by the Vendor /Contractor and shall in the
case of Vendor /Contractor default retain the right to further adjust payments as consistent with the best
interests of the City.
17. Payment of invoices will be in compliance with Chapter 218, Part VII of Florida Statutes, City Ordinance
No. 3029, Purchasing Policy of the City and the stipulations, terms and conditions of this WO. Any cash
discount period will date from receipt of invoice, receipt of actual delivery or date of invoice, which ever
is later.
18. If this WO involves the Vendor /Contractor's performance on the City's premises or at any place where
the City conducts operations, the Vendor /Contractor shall request information from the Purchasing
Manager regarding insurance coverage requirements. In circumstances where insurance is required,
Vendor /Contractor shall provide proofs of insurance required by the City, or City reserves the right to
cancel this Work Order, immediately suspend performance by the Vendor /Contractor at
Vendor /Contractor's expense and prohibit access to City premises until such proofs of insurance is
verified Noncompliance with this item shall place the Vendor /Contractor in default and subject to
disbarment from the City's Vendor /Contractor List.
19. The failure of the city to enforce any provision of this WO, exercise any right or privilege granted to the
City hereunder shall not constitute or be construed as a waiver of any such provision or right and the
same shall continue in force.
20. The Vendor /Contractor shall notify the Purchasing Manager of any inherent hazard and applicable
precautions, protective measures and provide any additional relevant information, including MSDS,
related to the Material being purchased herein.
21. The City shall have the right at no additional charge to use all or portions of material found in the
Vendor /Contractor's applicable literature relevant to the purchase. The Vendor /Contractor agrees to
advise the City of any updated information relative to the foregoing literature and documentation with
timely written notice.
22. A person or affiliate who has been removed from the City's Vendor /Contractor List may not submit a bid
or transact business with the City in excess of Category Two for a period of thirty -six (36) months from
the date of being removed from the City's Vendor /Contractor List.
23. In compliance with 8 U.S.C. Section1324a(e) [Section 274A(e) of the Immigration and Nationality Act
(INA)], the City will not intentionally make an award or upon discovery of a violation will unilaterally
cancel this WO with any contractor who knowingly employs unauthorized alien workers.
WORK ORDER TERMS AND CONDITIONS -Page 3
24. This WO shall be governed by and interpreted in accordance with the laws of the State of Florida. In
any action or proceeding required to enforce or interpret the terms of this Agreement, venue shall be of
the Eighteenth Judicial Circuit in and for Seminole County, Florida
REQUEST FOR PROPOSALS (INFORMAL)
CITY OF SANFORD, FLORIDA
Return Proposal(s) To:
Telephone: (407) 688 -5028
DATE OF REQUEST.
F. William Smith, Purchasing Manager
FAX: (407) 688 -5021
May 31, 2011
P.O. Box 1788
Email: bill.smith @sanfordfl.gov
Sanford FL 32772 -1788
REQUEST NO.
RESPOND BY
1. Proposals may be submitted via FAX, Mail or Hand Delivery
RFP 10111 -171F
Date: June 14, 2011
2. Proposals received after date indicated above will not be
Time: 2:00 p.m.
considered
3. Informal Response(s) may be opened by the City at the
time it is received
Respondent Information:
Company Name and Address:
Meals on Wheels, Etc.
2801 S. Financial Ct.
Sanford FL 32773
T elephone No: 407 - 333 -8 FAX No.: 4 829 -2468
Contact Person: Sherry Fi ncher Title: Ex ecutiv e Directo
TERMS AND CONDITI
1. The City of Sanford reserves the right to reject any and all bids and /or proposals in entirety or in part, to waive informalities and to
make the award which is in its best interests.
2. Terms and or conditions indicating a time frame(s) for payment other than in accordance to Chapter 218, part VII of the Florida
Statutes are objected to and shall not be accepted unless agreed to, in writing, by the City of Sanford.
3. All pricing quoted shall be F.O.B. Destination, if so i n d i ca ted by the City, prior notification of delivery shall be required.
4. These terms and conditions, the quotation /proposal, and any resulting Purchase Order, Work Order, and /or Contract shall constitute
the entire agreement of any order resulting thereof, unless agreed upon, in writing, by the Purchasing Manager of the City of Sanford.
Also, N this bid involves service, the bidder warrants that If awarded the project he/she will provide an insurance certificate in
compliance with the attached requirements.
5. The City of Sanford shall be responsible only for items which are actually ordered, via a City of Sanford Purchase Order, regardless
of quantities or estimates indicated herein.
6. Time is of the essence with regard to delivery of this quotation and any goods or services ordered as a result of this response. Also,
the City of Sanford will consider only timely quotations/proposals received. Timely delivery to the correct destination is the
responsibility of the Pro poser.
7. The Proposer/bidder is responsible to identify exactly what is being offered for delivery and /or performance.
LINE ry DESCRIPTION AND SPECIFICATIONS QTY UNIT AND EXTENDED COST
ITE UNIT PRICE
City of Sanford CDBG (Community Development Block
Grant) Senior's Home Rehabilitation Program. Also,
requirements for MWBE and Davis Bacon considerations
apply.
1
To assist seniors in the Goldsboro and Georgetown areas
8
4,875
39 , 000.00
with needed roof replacement and repairs and other minor
weatherization and energy efficiency repairs
2
Program Delivery Fee
1
6,000
6,000.00
The City of Sanford hereby requests proposals from
qualified firm(s) to provide services as provided herein.
Total
45,000.00
Signature of Person u Ftesponse Primed Name
Sherry Fincher
This form including signatures must be included with your response
City of Sanford CDBG Seniors Home Rehabilitation Program
Program Grant Amount: $45,000
Program Goal: If awarded, this project will assist seniors in the areas of
Goldsboro and Georgetown with needed roof replacements or repairs and will
work in conjunction with the agency's Weatherization Assistance Program to
provide energy savings and efficiency for low income and high priority
individuals.
Program Objectives, Qualifications and Resume of Applicant: For the past three
years, Meals on Wheels, Etc. has been providing home weatherization services
in Seminole County. This is made possible through funding from the United
States Department of Energy and the Department of Community Affairs, State of
Florida. The agency also contracts with the Senior Resource Alliance
(Department of Elder Affairs, State of Florida) for a variety of services which
enable seniors in Seminole County to remain living in their own homes for as
long as possible.
The agency is a 501 (c)(3) nonprofit agency based in Sanford, and has been
providing senior services since 1973. Meals on Wheels, Etc. is experienced in
contracting with local, state and federal governments.
Meals on Wheels, Etc. assists seniors with a number of home projects such as
minor home repairs, installation of grab bars, wheelchair ramps, railings, and
exterior painting of homes, and major yard clean -ups. Retired local contractors,
experienced volunteers, and YouthBuild participate in these activities. There is
some limited funding for supplies through the Older American Act (federal funds.)
YouthBuild, in particular, has been instrumental in helping elderly residents move
safely about their homes. Their projects have included the construction of
wheelchair ramps, the repair of porches, steps, and railings, and many yard jobs.
Meals on Wheels, Etc. will work with YouthBuild in providing rehabilitation of
homes in Goldsboro and Georgetown.
The Weatherization Assistance Program's goal is to lower the monthly energy
burden of low- income households through improvement of energy efficiency. A
thorough visual inspection and diagnostic tests are performed to determine what
can be done to reduce the energy cost of the residence within the budget allotted
each home ($5,000 - $5,600.) A priority list is utilized which includes the
following in order of importance: air sealing, attic and floor insulation, solar
window screens, smart thermostat, compact fluorescent light, sealing and
insulation of ducts, replacement of refrigerator, heat and air, and water heater.
Meals on Wheels, Etc. is proposing the provision of repairs and /or replacement
of roofs in the targeted areas which will then allow homeowners to be eligible for
weatherization services. To every extent possible, the agency will coordinate
other needed repairs with Youthbuild and other local groups. Approximately
eight roof replacements or repairs will be completed at an average cost of
$4,875.00 per home. The project delivery fee will be $6,000.00 for a total of
$45,000.00.
Meals on Wheels, Etc. will work with Sanford based contractors to provide this
service. The agency maintains adequate insurance and has the programmatic
and administrative capability to administer this project in a professional and
competent manner.
Overseeing this project are:
Executive Director (19 years experience)
Weatherization Manager (licensed contractor; experienced Weatherization
Provider)
Client intake clerk and volunteer group organizer; experienced in both
Weatherization and volunteer group projects.
Attached are certificates of insurance, Weatherization Information, 501 (c)(3)
certification, Independent Audit, and agency organizational chart.
Disputes Disclosure Form 435 -1
Answer the following questions by answering "YES" or "NO ". If you answer "YES ", please explain in the
space provided, please add a page(s) if additional space is needed.
1. Has your firm, or any of its officers, received a reprimand of any nature or been suspended
by the Department of Professional Regulation or any other regulatory agency or professional
association within the last five (5) years? No
2. Has your firm, or any member of your firm, been declared in default, terminated or removed from
a contract or job related to the services your firm provides in the regular course of business within
the last five (5) years? No
3. Has your firm had filed against it or filed any requests for equitable adjustment, contract claims or
litigation in the past five (5) years that is related to the services your firm provides in the regular
course of business? No If yes, the explanation must state the nature of the request for
equitable adjustment, contract claim or litigation, a brief description of the case, the outcome or
status of suit and the monetary amounts or extended contract time involved.
i hereby certify that all statements made are true and agree and understand that any misstatement or
misrepresentation or falsification of facts shall be cause for forfeiture of rights for further consideration of
the project identified.
Meals on Wheels, Etc.
Firm
June 6-2011
Authorized Signature Date
Sherry Fincher, Executive Director
Printed or Typed Name and Title
FORM NO. DSPT 12.204
THIS FORM MUST BE SUBMITTED WITH BID
RFP 10111 -17 IF
Drug -Free Work Place 436 -2
The undersigned, in accordance with Florida Statute 287.087 hereby certifies that the company named
below does:
1. Publish a statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession, or use of a controlled substance is prohibited in the workplace and
specifying the actions that will be taken against employees for violations of such prohibition.
2. Inform employees about the dangers of drug abuse in the workplace, the business's policy
of maintaining a drug -free workplace, any available drug counseling, rehabilitation, and
employee assistance programs, and the penalties that may be imposed upon employees for
drug abuse violations.
3. Give each employee engaged in providing the commodities or contractual services that are
proposed a copy of the statement specified in subsection (1).
4. In the statement specified in subsection (1), notify the employees that, as a condition of
working on the commodities or contractual services that are under bid, the employee will abide
by the terms of the statement and will notify the employer of any conviction of, or plea of guilty
or nolo contendere to, any violation of Chapter 893 or of any controlled substance law of the
United States or any state, for a violation occurring in the workplace no later than five (5) days
after such conviction.
5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or
rehabilitation program if such is available in the employee's community, by any employee who
is so convicted.
6. Make a good faith effort to continue to maintain a drug -free workplace through implementation
of this section.
Meals on Wheels, Etc.
Firm
June 6, 2011
Authorized Signature Date
Sherry Fincher, Executiv Director
Printed or Typed Name and Title
FORM NO. DFWP 14.204
THIS FORM MUST BE SUBMITTED WITH BID
RFP 10/11 -171F
Florida Statutes On Public Entity Crimes 435 -3
THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
This sworn statement is submitted to The City of Sanford
by
Sherry Fi ncher on behalf of Meals on Wheels, Etc.
whose business address is: 2801 S Financial Ct Sanford FL 32773
and (if applicable) its Federal Employer Identification Number (FEIN) is 59 2977907 (If the entity has
no FEIN, include the Social Security Number of the individual signing this statement: ) .
2. 1 understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes means a
violation of any state or federal law by a person with respect to and directly related to the transaction of
business with any public entity or with an agency or political subdivision of any other state or with the
United States, including, but not limited to, any bid or contract for goods or services, any lease for real
property, or any contract for the construction or repair of a public building or public work, involving antitrust,
fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.
3. 1 understand the "convicted" or "conviction" as defined in Paragraph 287.133(1)(b), Florida Statutes, means
a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any
federal or state trial court of record relating to charges brought by indictment or information after July 1,
1989, as a result of a jury verdict, non jury trial, or entry of a plea of guilt or nolo contendere.
4. 1 understand that an "affiliate" as defined in Paragraph 287.133(1)(a), Florida Statutes. means:
1. A predecessor or successor of a person convicted of a public entity crime: or
2. An entity under the control of any natural person who is active in the management of the entity and
who has been convicted of a public entity crime. The term "affiliate" includes those officers,
directors, executives, partners, shareholders, employees, members, and agents who are active in
the management of an affiliate. The ownership by one person of shares constituting a controlling
interest in another person, or a pooling of equipment or income among persons when not fair
market value under an arm's length agreement, shall be a prima facie case that one person
controls another person. A person who knowingly enters into a joint venture with a person who has
been convicted of a public entity crime in Florida during the preceding 36 months shall be
considered an affiliate.
I understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statutes_ means any natural
person or entity organized under the laws of any state or of the United States with the legal power to enter
into a binding contract and which bids or applies to bid on contracts let by a public entity, or which
otherwise transacts or applies to transact business with a public entity. The term "person" includes those
officers, directors, executives, partners, shareholders, employees, members, and agents who are active in
management of an entity.
Based on information and belief, the statement which I have marked below is true in relation to the entity
submitting this sworn statement. (Please indicate which statement applies.)
X Neither the entity submitting this sworn statement, nor any of its officers, director, executives,
partners, shareholders, employees, members, or agents who are active in the management of the entity,
nor any affiliate of the entity were charged with and convicted of a public entity crime after July 1, 1989.
The entity submitting this sworn statement, or one or more of the officers, directors, executives,
partners, shareholders, employees, members, or agents who are active in the management of the entity, or
any affiliate of the entity was charged with and convicted of a public entity crime after July 1, 1989.
RFP 10/11 -17 1F
The entity submitting this sworn statement, or one of its officers, directors, executives, partners,
shareholders, employees, members, or agents who are active in the management of the entity, or any
affiliate of the entity was charged with and convicted of a public entity crime subsequent to July 1, 1989.
However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida,
Division of Administrative Hearings and the Final Order entered by the Hearing Officer determined that it
was not in the public interest to place the entity submitting this sworn statement on the convicted vendor
list. (Attach a copy of the final order.)
I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE
PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND,
THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I
ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A
CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA
STATUTES FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.
S
(signature)
June 6, 2011
(date)
State of Florida
County of Semi nol e
On this 6th day of June , 20 11, before me, the undersigned Notary Public of the State of
Florida, personally appeared
Sherry Fincher and
(Name(s) of individuals who appeared before notary)
whose name(s) is/are Subscribed to the within instrument, and he /she/they acknowledge that he/she/they executed
it.
WITNESS my hand
and official seal.
NOTARY PUBLIC, STATE OF FLORIDA
NOTARY PUBLIC
SEAL OF OFFICE: Brenda K. Dri nnan
(Name of Notary Public: Print, Stamp, or Type as Commissioned.)
nr
. ` 0 44� 6 Notary Public State of Florida
Brenda K Drinnan
My Commission DD902807
��►oi �o Expires 07/26/2013
FORM NO. PEC 15.204
X Personally known to me, or
Produced identification:
(Type of Identification Produced)
_ DID take an oath, or
X DID NOT take an oath.
THIS FORM MUST BE SUBMITTED WITH BID
RFP 10/11 -17 IF
00436-4
Certification of Non - Segregated Facilities 436 -6
By affixing his signature to this form, the Bidder certifies that he does not maintain or provide for
his employees any segregated facilities at any of his establishments, and that he does not
permit his employees to perform their services at any location, under his control, where
segregated facilities are maintained. The Bidder certifies further that he will not maintain or
provide for his employees any segregated facilities at any location under his control where
segregated facilities are maintained. The Bidder agrees that a breach of this certification will be
a violation of the Equal Opportunity clause in any contract resulting from acceptance of this Bid.
As used in this certification, the term "segregated facilities" means any waiting rooms, work
areas, restrooms and washrooms, restaurants and other eating areas, time clocks, locker rooms
and other storage and dressing areas, parking lots, drinking fountains, recreation or
entertainment area, transportation and housing facilities provided for employees which are
segregated by explicit directive, or are in fact segregated on the basis of race, color, religious
disability or national origin, because of habit, local custom, or otherwise. The Bidder agrees that
(except where he has obtained identical certifications from proposed subcontractors for specific
time periods) he will obtain identical certifications from proposed subcontractors prior to the
award of subcontracts exceeding $10,000 which are not exempt from the provisions of the
Equal Opportunity clause, and that he will retain such certifications in his files.
The nondiscriminatory guidelines as promulgated in Section 202, Executive Order 11246, and as
amended by Executive Order 11375 and as amended, relative to Equal Opportunity for all persons and
implementations of rules and regulations prescribed by the United States Secretary of Labor are
incorporated herein.
NOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. 1001.
Date: June 6, 2011
BY;
Sherry Fincher Executive Director
Print Name Title
Official Address:
2801 S. Financial Ct.
Sanford, FL 32773
FORM N0. SFAC 16.204
THIS FORM MUST BE SUBMITTED WITH BID
RFP 10/11 -17 ff
Conflict of Interest Statement 435 -6
1. Sherry Fi ncher of Meals on Wheels, Etc. deposes and states that
Name of Affiant Name of Company
2. The above named entity is submitting an Expression of Interest for the City of Sanford project
identified below.
3. The Affiant has made diligent inquiry and provides the information contained in this Affidavit based
upon his own knowledge.
4. The Affiant states that only one submittal for the above project is being submitted and that the above
named entity has no financial interest in other entities submitting proposals for the same project.
5. Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement,
participated in any collusion, or otherwise taken any action in restraint of free competitive pricing in
connection with the entity's submittal for the above project. This statement restricts the discussion of
pricing data until the completion of negotiations and execution of the Agreement for this project.
6. Neither the entity nor its affiliates, nor any one associated with them, is presently suspended or
otherwise ineligible from participating in contract lettings by any local, state, or federal agency.
7. Neither the entity, nor its affiliates, nor any one associated with them have any potential conflict of
interest due to any other clients, contracts, or property interests for this project.
8. 1 certify that no member of the entity's ownership, management, or staff has a vested interest in any
aspect of or Department of the City of Sanford.
9. 1 certify that no member of the entity's ownership or management is presently applying for an
employee position or actively seeking an elected position with City of Sanford.
10. In the event that a conflict of interest is identified in the provision of services, I, on behalf of the above
named entity, will imru_ej ately notify the City of Sanford in writing.
June
, 2011
Date
Signature of Affiant
Sherry Fincher Executive Director
Typed or Printed Name of Affiant Title
State of Florida, County of Semi nol e
On this 6th day of ,hint 20 _U, before me, the undersigned Notary Public of the State of
Florida, personally appeared
Sherry Fincher and
(Name(s) of individuals who appeared before notary)
whose name(s) is/are Subscribed to the within instrument, and he/she /they acknowledge that he/she/they executed
it.
WITNESS my hand
and official seal.
NOTARY PUBLIC, STATE OF FLORIDA
NOTARY PUBLIC
SEAL OF OFFICE: Brenda K. Dri nnan
(Name of Notary Public: Print, Stamp, or Type as Commissioned.)
X Personally known to me, or
.0 Notary Public state of Florida _Produced identification:
Brenda K Drinnan
cz E+q My Commission DD902807 (Type of Identification Produced)
OF �d' Expires 07/26/2013
_ DID take an oath, or
X DID NOT take an oath.
FORM NO. CFI 18.204
THIS FORM MUST BE SUBMITTED WITH BID
RFP 10/11 -171F
Non - collusion Affidavit of Offeror /Bidder 435 -7
The undersigned, by signing this document hereby certifies that the company named below hereby is or
does:
1. States that the entity named below and the individual signing this document has submitted
the attached bid or proposal:
2. He is fully informed respecting the preparation and contents of the attached proposal and of
all pertinent circumstances respecting such proposal;
3. Said bid or proposal is genuine and is not a collusive or sham bid or proposal;
4. Neither the said bidder or proposer nor any of its officers, partners, owners, agents,
representatives, employees or parties in interest, including this affiant, has in any way
colluded, conspired, connived or agreed, directly or indirectly with any other bidder,
proposer, firm or person to submit a collusive or sham bid or proposal in connection with the
Contract for which the attached bid or proposal has been submitted or to refrain from bidding
or proposing in connection with such Contract, or has in any manner, directly or indirectly,
sought by agreement or collusion or communications or conference with any other bidder,
proposer, firm or person to fix the price or prices in the attached bid or proposal or of any
other bidder of proposer, or to fix any overhead, profit or cost element of the bid or proposal
price or the bid or proposal price of any other bidder or proposer, or to secure through any
collusion, conspiracy, connivance or unlawful agreement any advantage against the City
of Sanford or any person interested in the proposed Contract.
5. The price or prices quoted in the attached bid or proposal are fair and proper and are not
tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the
bidder or proposer or any of its agents, representatives, owners, employees, or parties in
interest, including the individual signing this document.
6, 2011
Signature of Afflant Date
Sherry Fincher Executiye, Director
Typed or Printed Name of Afruant Title
State of Florida, County of Semi nol a On this 6th day of June , 20 11, before
me, the undersigned Notary Public of the State of Florida, personally appeared
Sherry Fincher and
( Name(s) of individuals who appeared before notary)
whose name(s) is /are Subscribed to the within instrument, and he/she /they acknowledge that he /she/they executed
it. WITNESS my hand and official seal.
NOTARY PUBLIC, STATE OF FLORIDA
NOTARY PUBLIC
SEAL OF OFFICE:
N 2807 Notary Public State of Florida
Brenda K Drinnan
My Commission DD90
Expires 07 /26/2013
Brenda K. Drinnan
(Name of Notary Public: Print, Stamp, or Type as Commissioned.)
X Personally known to me, or _ Produced identification
(Type of Identification Produced)
_ DID take an oath, or
X DID NOT take an oath
RFP 10/11 -17 IF
FORM No. AC 5.908
THIS FORM MUST BE SUBMITTED WITH BID
Unauthorized (Illegal) Allen Workers 435 -8
The CITY will not intentionally award publicly- funded contracts to any contractor who knowingly employs
unauthorized alien workers, constituting a violation of the employment provisions contained in 8 U.S.C.
Section 1324a(e) Section 274A(e) of the Immigration and Nationally Act (INA). The CITY shall consider
the employment by the CONTRACTOR of unauthorized aliens, a violation of Section 274A(e) of the INA.
Such violation by the CONTRACTOR of the employment provisions contained in Section 274A(e) of the
INA shall be grounds for immediate termination of this Agreement by the CITY.
1. By executing this certification, the CONTRACTOR certifies that
Meals on Wheels, Etc. (name of company) does not and will not during the
performance of any contract resulting from the solicitation identified below employ illegal alien workers or
otherwise violate the provisions of the federal Immigration Reform and Control Act of 1986.
2. The Undersigned agrees to, upon request of the City, provide copies of Immigration Form 1 -9 for
each person associated with the above named company who has been or is present at the designated
jobsite associated with any work or project resulting from this solicitation.
CONTRACTOR: Meals on Wheels, Etc.
Signature: c5 Printed Name: Sherry Fi ncher
Title: Executive Director
Affix Corporate Seal
STATE OF Florida )
) ss
COUNTY OF Seminole )
Date: June 6, 2011
The foregoing instrument was acknowledged before me this _ 6t.h day of .i,me , 20 _J�L- ,
by Sherry Fi ncher of Meals on Wheels, Etc. firm), on behalf of the
firm. He /She is personally known to me or has produced
identification.
Print Name Brenda K. Dri nnan
Notary Public in and for the County
and State Aforementioned 1
My commission expires:
Form No. IM 0506.209
KFP 10/11 -17 IF
THIS FORM MUST BE SUBMITTED WITH BID
Americans With Disabilities Act Affidavit 436 -9
By executing this Certification, the undersigned CONTRACTOR certifies that the information herein
contained is true and correct and that none of the information supplied was for the purpose of defrauding
the City of Sanford (CITY).
the CONTRACTOR will not discriminate against any employee or applicant for employment because of
physical or mental handicap in regard to any position for which the employee or applicant for
employment is qualified. The CONTRACTOR agrees to comply with the rules, regulations and relevant
orders issued pursuant to the Americans with Disabilities Act (AFA), 42 USC s. 12101 et seq. It is
understood that in no event shall the CITY be held liable for the actions or omissions of the
CONTRACTOR or any other party or parties to the Agreement for failure to comply with the ADA. The
CONTRACTOR agrees to hold harmless and indemnify the CITY, its agents, officers or employees from
any and all claims, demands, debts, liabilities or causes of action of every kind or character, whether in
law or equity, resulting from the CONTRACTOR's acts or omissions in connection with the ADA.
CONTRACTOR:
Meals on Wheels, Etc.
Signature: Printed Name: Sherry Fi ncher
Title: Executive Director Date: June 6, 2010
Affix Corporate Seal
STATE OF Florida )
) ss
COUNTY OF Semi nol e )
The foregoing instrument was acknowledged before me this 6th day of June , 20 11 ,
by Sherry Fi ncher of Meals on Wheels, Etc. firm), on behalf of the
firm. He/She is personally known to me or has produced
identification.
Print Name Brenda K. Dri nnan
Notary Public in and for the County
and State Aforementioned �y
My commission expires: t
Form No. AWD 0512.209
THIS FORM MUST BE SUBMITTED WITH BID
RFP 10/11 -171F
RECYCLED CONTENT INFORMATION REPORT 435 -10
In support of the Florida Waste Management Law, bidders are encouraged to supply with their
bid, any information available regarding recycled material content in the products bid. The City is
particularly interested in the type of recycled material used (such as paper, plastic, glass, metal,
etc.); the percentage of recycled material contained in the product and the cost and product
performance impact of increasing the percentage of recycled content. The City also requests
information regarding any known or potential material content in the product that may be
extracted and recycled after the product has served its intended purpose.
Product bid contains recycled content?
_Yes X No
Percent of recycled content contained.
Percent of recycled content which is post end user material
Is your product packaged and /or shipped in material containing recycled content?
Yes X No.
Is your product recyclable after it has reached its intended end use?
Yes X No.
THIS FORM IS VOLUNTARY BUT HIGHLY ENCOURAGED
RFP 10/11 -17 IF