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2297 PBA 20/21-03 Public Protection Uniforms piggyback w/Plexus MktgSXKFOPM qq ❑ FINANCE DEPARTMENT p The item(s) noted below is/are attached and forwarded to your office for the following action(s): F-1 Development Order F-1 Mayor's signature F-1 Final Plat (original mylars) F-1 Recording F-1 Letter of Credit F-1 Rendering F] Maintenance Bond Z Safe keeping (Vault) F-1 Ordinance F-1 Deputy City Manager F-1 Performance Bond F-1 Payment Bond F-1 Resolution F-1 City Manager Signature F-1 F-1 City Clerk Attest/Signature F-1 City Attorney/Signature Once completed, please: F-1 Return originals to Purchasing- Department ❑ Return copies Special Instructions I ih13oja&zi4e,-v- F9Mes I SharePoiiit—l'iiiance—Ptirchasing_Forms - 2018.doc 11412-02-1 Date Plexus Marketing, Inc. Piggyback Contract (PBA 20/21-03) (Public Protection Uniforms) The City of Sanford ("City") enters this "Piggyback" Contract with Plexus Marketing ly Inc., a Florida corporation (hereinafter referred to as the "Vendor"), whose principal n= address 118 West New York Avenue, Deland, Florida 32720, under the terms and`'w conditions hereinafter provided. The City and the Vendor agree as follows: (1). The Purchasing Policy for the City of Sanford allows for "piggybacking" contracts. Pursuant to this procedure, the City is allowed to piggyback an existing government contract, and there is no need to obtain formal or informal quotations, proposals or bids. The parties agree that the Vendor has entered a contract with the government of Volusia County, Florida, said contract being identified as "Master Agreement NO. 540 70287-1 ", as may have been amended, in order for the Vendor to provide goods and services relating to the City's need for public protection uniforms (said original contract being referred to as the "original government contract" which is based upon procurement activity conditions). (2). The original government contract documents are incorporated herein by reference and attached as Exhibit "A" to this Contract. All of the terms and conditions set out in the original government contract are fully binding on the parties and said terms and conditions are incorporated herein; provided, however, that the City will negotiate and enter work orders/purchase orders with the Vendor in accordance with City policies and procedures for particular goods and services. (3). Notwithstanding the requirement that the original government contract is fully binding on the parties, the parties have agreed to modify certain technical 11 P a g e provisions of the original government contract as applied to this Contract between the Vendor and the City, as follows: (a). Time Period ("Term") of this Contract: (state N/A if this is not applicable). N/A. (b). Insurance Requirements of this Contract: (state N/A if this is not applicable). N/A. (c). Notwithstanding anything in the original government contract to the contrary, the City's terms and conditions relating to the issuance of purchase orders or work orders, or referenced in such documents, shall prevail over any inconsistent provisions of the original government contract. (d). Address change for the City: Notwithstanding the address and contact information for the government entity as set out in the original government contract, the Vendor agrees that he/she/it shall send notices, invoices and shall conduct all business with the City to the attention of City Manager, at: City of Sanford, 300 North Park Avenue; Sanford, Florida 32771. The City Manager's designated representative for this Contract is Marisol Ordohez, Purchasing Manager, Finance -Purchasing Division, 300 North Park Avenue; Sanford, Florida 32771, telephone number (407) 688-5028 and whose e-mail address is Marisol.ordonez@sanfordfl.gov. (e). Notwithstanding anything in the original government contract to the contrary, the venue of any dispute will be in Seminole County, Florida. Litigation between the parties arising out of this Contract shall be in Seminole County, Florida in the Court of appropriate jurisdiction. The law of Florida shall control any dispute between the parties 2 1 P a g e arising out of or related to this Contract, the performance thereof or any products or services delivered pursuant to such Contract. (f). Notwithstanding any other provision in the original government contract to the contrary, there shall be no arbitration with respect to any dispute between the parties arising out of this Contract. Dispute resolution shall be through voluntary and non-binding mediation, negotiation or litigation in the court of appropriate jurisdiction in Seminole County, Florida, with the parties bearing the costs of their own legal fees with respect to any dispute resolution, including litigation. (g). Notwithstanding any other provision in the original government contract to the contrary, the Vendor shall provide the City with most favored nation pricing. (h). All the services to be provided or performed shall be in conformance with commonly accepted industry and professional codes and standards, standards of the City, and the laws of any Federal, State or local regulatory agency. (i). Public Records Requirements. (1). IF THE CONTRACTORIVENDOR HAS 119, FLORIDA STATUTES, TO THE CONTRACTOR'S grr;:Mli I 93NM RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT (407) 688-50121 TRACI HOUCHIN, CMC, FORM, CITY CLERK, CITY OF SANFORD, CITY HALL, 300 NORTH PARK AVENUE, 31 Page SANFORD, FLORIDA 327711 TRACI. HOUC H I N@SAN FORDF L.GOV. (11). In order to comply with Section 119.070 1, Florida Statutes, public records laws, the Vendor must: (A). Keep and maintain public records that ordinarily and necessarily would be required by the City in order to perform the ��--T"Be4 (B). Provide the public with access to public records on the same terms and conditions that the City would provide the records and at a cost that does not exceed the cost provided in Chapter 119, Florida Statutes, or as otherwise provided by law. (C). Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law. (D).Meet all requirements for retaining public records and transfer, at no cost, to the City all public records in possession of the Vendor upon termination of this Contract and destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. All records stored electronically must be provided to the City in a format that is compatible with the information technology systems of the City. 41 Page (III). If the Vendor does not comply with a public records request, the City shall enforce the provisions of this Contract in accordance with the terms and conditions of this Contract. (IV). Failure by the Vendor to grant such public access and comply with public records requests shall be grounds for immediate unilateral cancellation of this Agreement by the City. The Vendor shall promptly provide the City with a copy of any request to inspect or copy public records in possession of the Vendor and shall promptly provide the City with a copy of the Vendor's response to each such request. All other provisions in the original government contract are fully binding on the parties and will represent the agreement between the City and the Vendor. Entered on the last date of a signatory hereto as set forth below. Attest: Authorized Signatory Printed Name: Attest: Plexus Marketing, Inc., a Florida corporatij n. BY: Caro e L. Tattrie Sole Cor rate Office Date: —30,Tlil—) City Of Sanford OULU Q9,'2-L(JJLN , VIM6 f 111- Jq Traci Houchin, City Clerk, MMC, FCR -,g1,ArT'1 _, �d %,tate Approved as to form and gal suffici n William L. Colbert City Attorney 51 Page Exhibit "A" [Attach original government contract] Master Agreement TERM: 2020-04-21 to 2023-04-20 Volusia County FLORIDA Date Issued: 05/05/2020 NO. 540 70287 - I Page I of 2 Vendor contact: Commodity County contact: Description Bill To: Name: GEORGE OR CAROLE TATTRIE Name: CHRISTINE JARVIS County of Volusia Phone: 386-736-1244 Ext.: Phone: 386-736-5953 Ext.: 6742 AS REQUIRED BY E-mail: E-mail: ejarvis@volusia.org USING DEPARTMENT I VOLUSIA COUNTY, FL 32720 Vendor Name: Vendor No. 01071600050 Ship To: PLEXUS MARKETING INC AS REQUIRED BY PLEXUS, INC. USING DEPARTMENT 118 WEST NEW YORK AVE VOLUSIA COUNTY, FL 32720 DELAND, FL 32720 Purchasinq MEGHAN CHESTNUT Solicitation Number: 20-B-26MC Phone: 386-626-6624 Ext: 16624 E-mail: mchestnut@volusia.org Award Date: 2020-04-21 Payment Terms: Net 45 Days, FOB Dest, Freight allowed Award Authorization: COUNCIL Document Description: Public Protection Uniforms Line Commodity Unit Description Unit Price or Item Code Contract Amount 1 20085 EA Pricing in accordance with ITB 20-B-26MC. 0.000000 P.I�n, Pam Wilsky, CPPD, CPPB Purchasing & Contracts Director Remainder of page is blank County of Volusia Sales Tax Exemption Number 85-8012622393C-9 A delivery order is required for the release of items / services from the referenced Master Agreement, If a solicitation number is referenced then the terms and conditions of said solicitation become part of the Master Agreement. Deviation from prices stated is not permitted without a signed corrected Change Order. If vendor terms and conditions conflict with Count of Volusia Terms and Conditions, the County's Terms and Conditions prevail. See reverse side for terms and conditions. Purchase Order (PO) or Master Agreement (MA) Terms and Conditions Providing any good or service constitutes acceptance of this entire PO or MA without exception. In the event this document is issued based on a solicitation or quote, the terms and conditions of the solicitation or quote prevail. Acceptance. Products/Services purchased as result of this PO or MA may be tested for compliance with specifications. Items delivered not in conformance with the specifications may be rejected and returned at the Provider's expense. Those items and items not delivered by the delivery date specified in the accepted offer and/or PO or MA may be purchased on the open market. Cancellation of Order. A request by either party to PO to cancel the order at no cost. Delivery. Title and risk of loss shall pass when items have been received, inspected, and accepted by County of Volusia ("County"). All associated shipping, insurance, and other related costs shall be bome by Provider. Discontinued. Provider shall give County 30 (thirty) days advance notice of a discontinued item(s) so that County can purchase additional quantities of discontinued item(s). County must give written approval of replacement(s) if they exceed previous price or fail to meet quality, form, fit, or function of the discontinued item. Time is of the essence regarding Performance of Services and this PO or MA can be terminated by the County for convenience, non -appropriation of funds, or non-performance. Disputes. If such dispute arises under this PO or MA and is not resolved informally by the parties within five (5) business days, the party bringing a claim ("Disputing Party') shall deliver to the first level representative of the other party a written statement ("Dispute Notice") describing the dispute. If the respective representatives cannot resolve the dispute within ten (10) days, the dispute shall be escalated through two higher levels of management. If the dispute has not been resolved within 25 (twenty- five) calendar days after delivery of the Disputing Party3@TMs notice, either party may give written notice to the other party declaring the resolution process terminated and pursue other legal recourse or initiate formal non-binding mediation before a single mediator, which shall be completed within 30 (thirty) days of initiation, in accordance with rules of practice and procedure adopted by the Supreme Court of Florida for court-ordered mediation, Rule 1.700, at seq., of the Florida Rules of Civil Procedure, and Chapter 44, Florida Statutes. If the dispute remains unresolved after conducting such mediation, then either party may proceed to finalize such termination remedies and commence litigation in a court of competent jurisdiction. Compliance with FEMA 2 CFR 200.318-326 and Appendix II Contract Provisions. This Agreement and the products/services provided may be utilized in the event of declared State/Federal Emergency and Contractors shall be prepared to comply with the requirements of the FEMA Super Circular CFR 200.318-326 and Appendix II Contract Provisions as amended. These documents can be found on the Internet at: https:/Avww.gpo.gov/fdsys/granule/CFR-2014-title2-voll/CFR-2014-title2-volt-sec200.318 Governing Law/,Jurisdiction/Venue. This PO or MA shall be governed by the laws of the State of Florida and venue for any litigation arising from this PO or MA shall be in the County of Volusia, Florida, and any trial shalt be non -jury. Provider shall comply with all applicable taws and regulations. Insurance. For goods and services delivered or performed by Provider on County premises, Provider certifies it maintains comprehensive general liability insurance and auto insurance in the amounts identified in the solicitation and/or contract and any amendments thereto pertaining to this PO or MA, or from an A.M. Best "A " or better rated insurance firm authorized by the State of Florida Insurance Commissioner. The County reserves the right to require the "County of Volusia" be named as additional insured for projects when deemed necessary. For services performed off County premises and goods delivered by third party carriers, the Provider shall use such carriers that maintain such insurance coverage as set forth above. Intellectual Property. Provider agrees to protect, defend, indemnify, and save the County, its agents, officials, including elected officials, and employees of the County harmless from and against any and all claims, demands, actions, and causes of action which may arise asserting that a copyright, trademark, trade secret, or patent ("Intellectual Property"), as provided under this PO or MA, infringes or misappropriates any third party's Intellectual Property. If Provider must pay a third party any license, royalty, or other such usage fee in order to deliver the items) under this PO or MA, such third party and usage fee must be specified in the Provider's offer to sell to the County. Indemnification. The Contractor shall indemnify, defend and hold harmless the County and its employees, officers, elected and appointed officials, agents, attorneys, representatives, volunteers, divisions, departments, districts, authorities, and associated entities from and against all claims, damages, losses, and expenses, including, but not limited to attorney's fees, arising out of or resulting from the performance of this Agreement to the extent that any such claim, damage, loss and expense is caused by any negligent act or omission of the Contractor, anyone directly or indirectly employed by Contractor. Modification & Assignment. County may unilaterally change, at no additional cost, the quantity and receiving point within the County for items not yet shipped. All other items must be mutually agreed upon in writing. County is not required to pay for defective items, back -orders, late deliveries, those quantifies exceeding the PO or MA quantity, or items shipped at a higher price than stated on the PO or MA. Neither this PO or MA nor any interest herein shall be assigned, transferred, or encumbered by Provider except as authorized in writing by the County. Notices. All notices given by one party to the other party under this PO or MA shall be delivered to the receiving party's address set forth on this PO either by hand, qualified courier, or e-mail and shall be deemed received the day after it is transmitted. For the County, it shall be addressed to the Purchasing and Contracts Department, 123 West Indiana Avenue, 3rd Floor, DeLand, Florida, 32720 or purchasing@volusia.org. No Waiver. Except as expressly set forth herein, no failure or delay on the part of County in exercising any right, power, or remedy hereunder shall operate as or be deemed a waiver thereof, nor shall any single or partial exercise of any right, power, or remedy preclude any other or further exercise thereof, or the exercise of any other right, power, or remedy. Order of Precedence. In the event of conflict between this PO or a Master Agreement (MA), the originating Volusia County contract and amendments thereto shall be controlling. This control shall pertain to all specifications and scopes of work included in the originating Volusia County contract and any amendments thereto. Payment. Except for construction services, which shall be paid pursuant to the Florida Prompt Payment Act, County shall pay Provider within 45 (forty-five) days after receipt of an accurate and undisputed invoice, unless the County accepts a prompt payment discount from Provider and the goods or services are not defective. Invoice, packing slip, delivery receipt, order acknowledgement, and correspondence shall clearly indicate the PO or MA number. Any additional or different terms and conditions on Providers documents shall be considered null and void. The County may deduct amounts it is due from Provider's payment or not pay disputed invoices until such dispute is resolved. Nothing in this PO or MA shall create any obligation on the part of the County to pay directly to any subcontractor of Provider any monies due to such subcontractor or claims of such subcontractor for amounts owed by Provider to subcontractor for goods or services provided under this PO or MA. Sovereign Immunity. The County expressly retains all rights, benefits and immunities of sovereign immunity in accordance with Section 768.28, Florida Statutes. Notwithstanding anything set forth in any section of the Agreement, Master Agreement, and/ or this Purchase Order to the contrary, nothing in any such documents shall be deemed as a waiver of immunity or the limitations of liability of the County beyond any statutory limited waiver of immunity or limits of liability which may have been or may be adopted by the Florida Legislature, and the cap on the amount and liability of the County for damages regardless of the number or nature of claims in tort, equity, or contract shall not exceed the dollar amount set by the legislature for tort. Nothing in the Agreement, Master Agreement, or this Purchase Order shall inure to the benefit of any third party for the purpose of allowing any claim against the County, which would otherwise be barred under the doctrine of sovereign immunity or by operation of law. Taxes. County is exempt from Manufacturers' Federal Excise Tax (Exemption# 49-6000-885) and Florida sales tax (Exemption# 85-8012622393C-9). Certificates are available at www.volusia.org/purchasing. After accessing the foregoing website, select, "Doing Business with Volusia County" and "Consumer Certificate of Tax Exemption" from the available menu screens to see a copy of the certificates. Termination for Convenience. The County may cancel the PO or MA in whole or part when it is in the best interest of the County with thirty (30) days notice. UCC. In addition to any rights or remedies contained in this P.O., each party shall have rights, duties, and remedies available through the Uniform Commercial Code (UCC). Warranty. Provider warrants that all Work or Services performed under this PO or MA shall be performed in a good and competent workmanlike manner to the satisfaction of the County, and materials shall be of good quality (unless otherwise stated on PO or MA), and free from defects and pursuant to specifications and requirements of the contract related to this PO or MA. Volusia County Purchasing & Contracts Division, (rev. 09-19-17 apprvd CHJJ) SUBMIT TO: COUNTY OFVOL08kA PURCHASING &C0NTRACTS 123 W. INDIANA AVE.,RM. 3Q2 DELA0K],FL32/2D~4GDB ANEQUAL OPPORTUNITY EMPLOYER CONTACT PERSON: MeghanChaatnu ----'3O6-626-O824 Emmil:-----' mg| DELAND:... ....... ___ .......... 38G -73O-5935 D/A'7ONABEACH ---'3OO-257-60OO Volusia County FLORIDA TITLE: NUMBER: SUBMITTAL DEADLINE: Public Protection Uniforms 20-B-26MC Wednesday, March 11, 2020, DO NOT RESPOND TO THIS SOLICITATION ON LINE — SEE SECTION 2.5, DELIVERY OF BIDS PRE BID DATE, TIME AND LOCATION: SUBMITTALS RECEIVED AFTER Ap[e-bid conference will not be held with this solicitation. I BE CONSIDERED ABOVE DwrsAND TIME WILL NOT WM'S NAME: MAILING ADDRESS: CITY - STATE - ZIP: / -t~�/| \ \�� ^ E-MAIL ADDRESS: ^ The vendor acknowledges that information provided in this Bid istrue and correct and agree to allhm nd conditions contained inthis Bid and related Exhibits. a4_11& ), -7 Author12 'Date Printed Name NUMBER: I FEDERAL |D.mSOCIAL SECURITY NUMBER: 3 / 15'1'- 36__I\/ i/ b THIS FORM MUST BECOMPLETED AND RETURNED WITH YOUR RESPONSE CONTENT OF INVITATION/RESPONSE: The contents of this IT8, all hanms, oonditiono, opeuificadions, and requirements included herein and the accepted and awarded response thereto may be incorporated into anagreement topurchase and become legally binding. Any terms, conditions, specifications, and/or requirements specific to the item or service requested in this invitation to bid mhmU supersede the requirements ofExhibit | "GENERAL CONDITIONS AND INSTRUCT0NS.^ xo-B-2eMC,Public Protection Unnvnma.duc Page 1of31 State of Florida Department of State I certify from the records of this office that PLEXUS MARKETING, INC. is a corporation organized under the laws of the State of Florida, filed on November 15, 1995. The document number of this corporation is P95000088204. I further certify that said corporation has paid all fees due this office through Decemb&r 31, 2020, that its most recent annual report/uniform business report, was filed on February 17, 2020, and that its status is active. I further certify that said corporation has not filed Articles of Dissolution. Given tinder my hand and the Great Seal of the State of Florida at Tallahassee, the Capital, this the Seventeenth day of February, 2020 Number: 2404261038CC Seeretury of State To authenticate' this certificatevisit the following siteenter this number, and then follow the instructions displayed. bttpsl://services.suhbi7-org/Filings/Certific.ateOfStatus/CertificateAuthentication a. -I — 12020 5.0 BID SUBMITTAL FORM TO: County of Volusia, Florida Office of Director of Purchasing and Contracts 123 W. Indiana Avenue, Room 302 Deland, FL 32720-4608 The undersigned hereby declare(s) that [firm name] P)a C' NC:A Xws (n* has carefully examined the specifications to furnish Public Protection Uniforms, for which Bid Submittals were advertised to be received no later than 3:00 p.m., EST, on Wednesday, March 11, 2020, and further declares that the firm will furnish the Public Protection Uniforms according to specifications. See Exhibits Ill-V11for technical specifications. Prices shall be SUbnflfted on Attachmerit A -- Pricing Sheet. Ensure aH six (6) tabs are reviewed and completed pror to submittal. The County reserves the right to negotiate with the awarded vendor for additional services similar in nature not known at the time of Bid closing. Sole Proprietor W/yes C1 No Total number employees ............... 4. F.O.B. Destination, freight allowed The following information is required in order to be granted a price redetermination. Assuming that the prices quoted include costs for vehicles, maintenance, repair, insurance, fuel, wages, insurances and other employee benefits, materials, overhead, operating expenses, etc., what percentage of the rate is directly attributed to the cost of fuel? ............................ _j _0 0/. Which does the firm use: El Diesel fuel or Q Gasoline? Assuming that the prices quoted include costs for vehicles, maintenance, repair, insurance, fuel, wages, materials, overhead, operating expenses, etc., what percentage of the rate is directIV attributed to the cost of wages? .............................. ...................................................... �C�10 Assuming that the prices quoted include costs for vehicles, maintenance, repair, insurance, fuel, wages, insurances and other employee benefits, materials, overhead, operating expenses, etc., what percentage of the rate is directIV attributed to the cost of materials? ................... —.20 % Delivery / Availability: 1 L gz�c- Prompt payment discount, if applicable: Do you accept electronic funds transfer (EFT)? N %, A Days; Net 45 Days Do you offer a discount for electronic funds transfer (EFT)? 2/YES L3 NO Q YES, -X. M-11101" 20-B-26MC, Public Protection Uniforms.docx Page 18 of 31 The County nfVo|umio raaenxea the rightbJ rejecteny or all proposg|a, to waive informalities, and to accept all or any part of any proposal as may be deemed to be in the best interest of the County. | hereby certify that | have read and understand the requirements and terms and conditions of this Invitation to Bid No. 20'B-26K8C' "Public Protection Uniforms", including all exhibits and attachments (as amended) and that 1, as the Bidder, will comply with all requirements, and that I am duly authorized to execute this proposal/offer document and any Agreement(s) and/or other transactions required byaward Vfthis ITB. Fudher, as attested to by below signature, | will provide the required inoVnanoa. per Exhibit U. Insurance, upon notification of recommendation of award. The vendor acknowledqes that information Drovided in this Bid is true and correct: T�tle Date Company Name '� .� Full Address Telephone Fax E-mail Address # Federal I.D. 20-B-26Mc.pumn pmtemmnunmmnn.dnvm Page 1Suf31 6.0 REFERENCES Agency #1 rINN RO-<'- Address City, state, ZIP Contact Person E-mail*7 �A I i,� M 0 00-sfo 0 Phone: 7--)7—,.Sq7 7 1 Date(s) of Service �Oo4- )-c)-19' Type of Service (,,,, I *;')n_ C� Comments: ry)eAtss-01.. Agency #2 k"e- .0a r Address Uje.51- Oaoko,3 City, State, ZIP ()_J Contact Person 81_0_�kcj�/ E-mail '.e' orw,Phone: 40:7 Date(s) of Service0 o Type of Service ry)6 Comments: Agency #3 -Fo to 0— E 6 re Address L C) 'rn a rd sz brt V_e, City, State, ZIP Contact Person E-mail Phone: L3 Date(s) of Service �oo-7- 22rc6c,3-t- Type of Service V Comments: 20-8-26MC, Public Protection Uniforms.docx Page 20 of 31 Volusia County Business rax' Receipt Issued pursuant to F.S. 205 and Volusia County Code of Ordinances Chapter 114-1 by: Volusia County Revenue Division -123 W Indiana Ave, Room 103, Deland, FL 32720 — (386) 736-6938 Account# 199504060016 Expires: September 30, 2020 Business Location: 118 W NEW YORK AV Business Name: PLEXUS MARKETING INC Owner Name: CAROLE TATTRIE Volusia County Mailing Address: 118 W NEW YORK AV FLORIDA DELAND, FL 32724 BUSINESS TYPE REQ DOC # CODE COUNT TAX Retail / Wholesale Sales 482 4 $30.00 x This receipt indicates payment of a tax, which is levied for the privilege of doing the tYpe(s) of business listed above within Volusia County. This receipt is non -regulatory in nature and is not meant to be a certification of the holder's ability to perform the service for which he is registered. This receipt also does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. ® The business must meet all County and/or Municipality planning and zoning requirements or this Business Tax Receipt may be revoked and all taxes paid would be forfeited. a The information contained on this BusinessTax Receipt must be kept up to date. Contact the Volusia County Revenue Division for instructions on making changes to your account. PLEXMAR-01 BLE ON oAT3/212 OJYYYY) 3/2/2020 CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(iss) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER C ACT Lane -Lennon Commercial Insurance, LLC PO Box 11 Deland, FL 32721 PHONE FAX Arc, No. Ed). 386) 734-0800 AIC, No :(386) 738-3221 M doni@lanelennon.com INSURER(S) AFFORDING COVERAGE NAIC q 1127/2020 INSURERA -Old Dominion Insurance Co. 40231 EACH OCCURRENCE S 1,000,000 INSURED INSURER B: Travelers Casualty & Surety Co. 19038 INSURERC: Plexus Marketing, Inc. 118 W. New York Avenue Deland, FL 32720 INSURER D INSURERE: INSURERF: COVERAGES CFRTIFIr_ATF NrrMRFR- DCII#Qtr1t\i KitIMRCD- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. #NSR J.MMM TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP YYI LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X BPG7415M 1127/2020 1127/2021 EACH OCCURRENCE S 1,000,000 DAMAGETORENC TED n Cal S MED EXP An one ersan S10,000 PERSONAL &ADV INJURY S� 1,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: POLICY ❑ ippa r-1 LOC OTH -GENERAL AGGREGATE S 2'000,000 PRODUCTS -COMPIOPAGG S 2,000,000 S AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOOS ONLY AIJTO� OR1LY COMBINED SINGLE LIMIT S B019LY INJURY Perperson) S BODILYBODILY INJURY Per accident S PROaERd n# AMAGE $ S UMBRELLA LIABOCCUR EXCESS LIAB HCLAJMS-MAOE EACHOCCURRENCE S AGGREGATE S DED I I RETENTIONS S B WORKERS COMPENSATION AND EMPLOYERS' LUIBILrrYER ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFIdE EXCLUDED9 � i ands o 1 It yes, describe under DESCRIPTION OF OPERATIONS Wow NIA UB-OK404114-20 42 1127/2020 1127/2021ISTATUTET PER OTH- E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE -EA EMPLOYE S 100,000 EL. DISEASE - POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is requln:d) Workers compensation exemption, Carole Tattne Certificate holder is additional insured under general liability, subject to policy terms and conditions, as respects activities of named insured. County of Volusia Purchasing & Contracts 123 West Indiana Avenue, Room 302 3rd Floor Deland, FL 32720 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 16.0 HOLD HARMLESS AGREEMENT -e- 1, GarbLe_ —Fc,+�rt (Print owner's mine), am the owner of (print company name), an incorporated unincorporated business operating in the State of Florida. As such, I am bound by all laws of the state of Florida, including but not limited to those regarding the workers' compensation law. I hereby affirm that I or [the above-named business] employs fewer than four employees, all of whom are listed below, including myself, and therefore, the business is exempt from the statutory requirement for workers' compensation insurance for its employees. I certify that 1. will provide the County of Volusia with the name of each new employee together with all required waivers and releases for each prior to any employee being allowed to work to provide services under the contract set forth below. If any such employee is allowed to work without a signed waiver and release, such action will be a material breach of this Agreement. All signed waivers and releases shall be furnished before the commencement of any work by an employee or the undersigned to the County Project Manager or designated county representative. On Fc -,6 0-4 202�, the County of Volusia and I or [the above-named business) entered into a contract for (please insert name of contraci), (hereinafter "Agreement') which is incorporated by reference herein. On behalf of myself, my business, and the employees listed below, I and they hereby agree to waive and release any and all workers' compensation claims or liens under Chapter 440, Florida Statutes, against the County of Volusia and its agents, officials and employees, arising from any work or services provided under the Agreement whether or not it shall be alleged or determined that the art was caused by intention, or through negligence or omission of the County of Volusia or its agents, officials and employees or subcontractors. In the event that a workers' compensation claim or lien is made against the County of Volusia and/or its agents, officials or employees by myself or my employees or agents as a result of any work or services performed under the Agreement, I agree to indemnify, keep and hold harmless the County of Volusia, Florida, its agents, officials and employees, against all injuries, deaths, losses, damages, claims, liabilities, judgments, costs and expenses, direct, indirect or consequential (including, but not limited to, fees and charges of attorneys and other professionals) arising out of the Agreement with the County of Volusia, whether or not it shall be alleged or determined that the act was caused by intention or through negligence or omission of the County of Volusia or its employees, agents, or subcontractors. lorthe above- named business shall pay all charges of attorneys and all costs and other expenses incurred in connection 20-B-26MC, Public Protection Uniforms.doex Page 30 of 31 with the indemnity provided herein, and if any judgment shall be rendered against the County of Volusia in any action indemnified hereby, I or the above-named business shall, at my or its own expense, satisfy and discharge the same. The foregoing is not intended nor should it be construed as, a waiver of sovereign immunity of the COUNTY OF VOLUSIA under Section 768.28, Florida Statutes. Owner name) ( i �Jn, t re) Employee 1: (print name) (signature) Employee 2: (print name) (signature) Employee 3: (print name) (signature) STATE OF Cluqt8CA COUNTY OF _QD l C , Sworn to and subscribed before me this 2-4day of Fe- 6 u N , 20 LD, by who islare),rsonally known tome or who has/have produced \ Karen J. Hawes Notary Public State of Florida My Commission Expires 10/31/2020 Commission No. GG 43569 (Seal) as identification. NOTARY PUBLIC —STATE OF Type or print name: Commission No.: j Le Commission Expires: 3 L) -2— 0 I 20-B-26MC, Public Protection Uniforms.docx Page 31 of 31 7.0 CONFLICT OF INTEREST FORM I HEREBY CERTIFY that 7C- 1, (printed nam, 0--a M [ C' -Fa++Y-1 1 am the (title) D W me-(- --- and the duly authorized representative of the firm of (Firm Name) e> 4U lfy\ark-6i 64!' 'ZWC-,, whose address is 'rle-lc a W-- x-744 , and that I possess the legal authority to make this affidavit on behalf of myself and the firill for which I am acting; and, 2. Except as listed below, no employee, officer, or agent of the firm have any conflicts of interest, real or apparent, due to ownership, other clients, contracts, or interests associated with this project; and, 3. This Bid Submittal is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a Bid for the same services, and is in all respects fair and Without collusion or fraud. EXCEPTIONS to items above (List): Printed Name: ( '/,-, e-- I —(,,i *-f -n IP- Firm Name: k'Y\4,A, ricp-4x Date: -o-0 STATE OF 1 4' COUNTY OFL=c Sworn to and subscribed before , 20 Z -Q, by _Z�4 (� me this day of KU 0-Y C) � e, �- �'� e-- ------------ , who is/are personal gown to me or who has/have produced 7D Le , CC YA S [..,.-as iden4fication. Karen J. Hawes NOTA ty=P-=LIC t Notary VUDIIC State of Florida Type or print name: - kv My Commission Expires 10/31/2020 )/I Ck - �r -P- 0 1 1 .. \4 Commission No. GG 43569 Commission No.: G-27 (s- Ll S�.� (Seal) Commission Expires: \ C) )l -;,, � --L- a '- (-) 20-B-26MC, Public Protection Uniforms.docx Page 21 of 31 February 28, 2020 t,v Volusla County FLORIDA Addendum No. I Purch'isingand collinacts 123 West Indiana Avenue, Room 302 diel -and, FL 32720-4608 (386) 736-5935 * Fax (386) 736-5972 wl"v. volusia. org Subject: ADDENDUM NO. I to IT13, 20-B-26MC, Public Protection Uniforms This addendum is being iSSLIC(I to 111,1ke changes to the IT13. This document and all changes, as listed below, shall become an integral part ofthe IT13 and shall take precedence over what was previously stated in the 11T document. ***NOTICE*** 1. Can Bidders submit a bid for it portion of the items, things they specialize in, or do Bidders need to submit for the entire bid? Yes, Bidders nlay bid on a portion of the items. Fill in a "No Bid" or "N/A" for items the bidder does not wish to bid on. Please sign and attach this addendum to your Bid submittal. ff"yotihave any questions regarding this information, please Contact mcghan Chestnut at 386-626-6624 or c -nail _g All other terms an(] conditions remain unchanged. END Oli'ADDENDUM NO. I Total Page(s): I Ka by William , IBA, CPPO, CP1311 Procurement a ager Purchasing and Contracts Division Vendor: Authoriz Please sign and return entire Addendum with Bi(I submittal. PrititedNaiiie&Title ol'Above:-'--�,r'OICL,1j_1-HTje_ Phone No. FAILURE TO RETURN ENTIRE FORM WITH THE BID SUBMITTAL MAY CAUSE THE SUBMITTAL TO BE RENDERED NON-RESPONSIVE Pau I of I Protection Uniforms Addendum No kJoe W-9Request for Taxpayer Give Form to the Form (Rev. October 2018) Identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service b- Go to www.irs.gov/FormW9 for instructions and the latest information. 1 Na ( s shown on your income tax return). Name is requiredthis line; do not leave this line blank. -o}}n�� 2 Business na ie/disregarded entity name, it different from -Wove ` mperson w 3 Check appropriate box for federal tax classification of the whose name is entered on Tina i. Check only one of the 4 Exemptions (codes apply only to c following seven boxes. certain entities, not individuals; see a ❑ lndividualtsole proprietor or ❑ C Corporation ol Corporation ❑ Partnership ❑ TrusUestate instructions on page 3): c single -member LLC Exempt payee code (f any) c. o �+ ❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) p Note: Check the appropriate box in the fine above for the tax classification of the single -member owner. Do not check Exemption from FATCA reporting H LLC if the LLC is clan ilfled as a single -member LLC that is disregarded from the owner unless the owner of the LLC is is from for code if any) C another LLC that not disregarded the owner U.S, federal tax purposes. Otherwise, a single -member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner. u a [, Other (see Instructions) 0-(Apoas to aCCo its awt+nlm§tt§tW do tho V.SJ 5 Address tuber, street, and apt. or suite no.) See instructions. Requester's name and address (optional) y 8 City, state, and ZIP code r� 7 List account numbers here (optional) Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid social security number _ m — backup withholding. sole For individuals, this is generally your social security number (SSNr However, fora resident alien, sale proprietor, or disregarded entity, see the instructions for Parti, Tater. For other entities, it is your employer identification number (EiN). If you do not have a number, see How to qet a TIN, later. or Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and I Employer ident ficatfon number Number To Give the Requester for guidelines on whose number to enter. 14s 4 T q7,1 f' t Under penalties of perjury, i certify that: 1. The number shown on this form is my correct taxpayer identification number (or 1 am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) i have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for part 11, later. Herlui r I pre of t �� �� ;�.tif�'r ! l �t " vV" ^S 4� Were U.S.t1.s. person ► Date ► Genera! Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.lrs.gov1F6rmW9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer Identification number (ITIN), adoption taxpayer Identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099 -INT (interest earned or paid) • Form 1099 -DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or grass proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TiN. !f you do not return Form W-9 to the requester with a TiN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 10-2018) 11.0 CERTIFICATION AFFIDAVIT BY CONTRACTOR AS LOCAL BUSINESS This form must be signed and sworn to in the presence of a notary public or other- official authorized to administer oaths. A. This sworn statement is submitted to County Of VOILlsia, FL, Purchasing and Contracts; By: C)QN� (Authorized individuals name and title) For: fnar-kx-,h-NS -.1\i C-' (Name of Company/Individual submitting swornstatement) B. Local Preference Eligibility I Vendor has been in business for a minimum of six (6) months prior to the date of Bids or quote 9111yes 0 No 2. Vendor has proof of local business in the form of a business tax receipt fi, m a local jurisdiction per Volusia County Local Preference ordinance �;Yles 71 No I understand that the submission of this form to the contracting officer for Volusia County, Florida, is valid through the end of term of the awarded Agreement. I also understand that failure to notify the County of Volusia of a change in address out of the local area may result in breach of Agreement. (Signature) SM 7E OF' i J) c, COUNITOF Sivorn to and subscribed before tire this day Of E4e�Wi(�A 20 U) I by CL C 0 0.e— who is/are person j -'known to me or who has/have produced 42O&L,as identification. Karen J. Hawes Notary Public State of Florida My Commission Expires 10/3112020 (sea/) Commission No. GG 43569 N IARYPUBLIC- ST,4TEOF-FL--o.tCdc:,c- 7ype or print name: N AConnnission No.: Commission Expires: 20-B-26MC, Public Protection Uniforms.docx Page 25 of 31 12.0 CERTIFICATION AFFIDAVIT BY SUB CONTRACTOR AS LOCAL BUSINESS This form must be signed and sworn to in the presence of a notary public or other official authorized to administer oaths. A. This sworn statement is submitted to County of Volusia, FL, Purchasing and Contracts; By: 0-,a rt, (.✓ 0 (Authorized individuals name and title) For: rr,6V(- (Name of Company/Individual submitting sworn statement) B. Local Preference Eligibility I Vendor has been in business for a minimum of six (6) months prior to the date of Bids or quote M/yes Cl No 2. Vendor has proof of local business in the form of a business tax receipt fro a local jurisdiction per Volusia County Local Preference ordinance z CJ No I understand that the submission of this form to the contracting officer for Volusia County, Florida, is valid through the end of term of the awarded Agreement. I also understand that failure to notify the,"unty of Volusia of a change in address out of the local area may result in breach of Agreement. (Signature) S T1 1 TE of COUNTY OF Sivorn to and subscribed before me this dqv qfa'►7-0 � by 20 ivho is/are personall known to me or it,hoha,vlhavepl-oclitced__�L- -Dr',QC�(S LCe-rlSe-asidentification. Karen J, Hawes ;�Notay Public NOItR YPCJBII -ST State of Florida 7YN' or print nt name: MY Commission Expires 10/31/2020 Commission Na, GG 43569 Commission No.: _Gllcr, (Seal) Cointi7issionExpires: _..__-,Ic,,._3kV 7-jQ�:z--6 20-B-26MC, Public Protection Uniforms.docx Page 26 of 31 8.0 DRUG-FREE WORK PLACE The undersigned firm, in accordance with Florida statute 287.087, hereby certifies that 0 n�Ncdoes: (Name ofFirm) I. 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 proposal, the employee will propose by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contender 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. As the person authorized to sign the statement, requirements. Name and Title Signature Firm Street address City, State, Zip I certify that this firm complies fully with the above M Date 20-B-26MC, Public Protection Uniforms.docx Page 22 of 31 9.0 CERTIFICATION REGARDING DEBARMENT Certification Regarding; Debarment, Suspension, And Other Responsibility Matters Primary Covered Transactions TO BE COMPLETED BY CONTRACTOR. A. The prospective primary participant (contractor) certifies to the best of its knowledge and belief, that it and its principals (subcontractors and suppliers): 1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; 2. Have not within a three (3) year period preceding this bid proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (A) (2) of this certification; and 4. have not within a three-year period preceding this bid proposal had one or more public transactions (Federal, State, or local) terminated for cause or default. B. Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this bid proposal. {WWW Nagle and Title Si ature 6 c� Firm Street address City, State, Zip Date 20-B-26MC, Public Protection Unifomms.docx Page 23 of 31 10.0 CERTIFICATION REGARDING DEBARMENT (SUB) Certification Regarding Debarment, Suspension, Ineligibility And Voluntary Exclusion TO BE COMPLETED BY ALL SUB -CONTRACTORS A. The prospective participant (sub -contractor) certifies to the best of its knowledge and belief, that it and its principals (subcontractors and suppliers): I Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; 2. Have not within a three (3) year period preceding this bid proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property. 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (A) (2) of this certification; and 4. Have not within a three-year period preceding this bid proposal had one or more public transactions (Federal, State, or local) terminated for cause or default. B. Where the prospective participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this bid proposal. ar-6c'-ramrocl Name and Title 00V Al. Y"/ A Signature P tC,AA-<- CYV,-CVJAiii 4-4-4c-1 Firm I 1� I L)p—bnk Street address �e Arm, City, State, Zip *' Date 20-B-26MC, Public Protection Uniforms.doex Page 24 of 31 13.0 NOTIFICATION REGARDING PUBLIC ENTITY CRIME & DISCRIMINATORY VENDOR LIST REQUIREMENTS & DISQUALIFICATION PROVISION A. Pursuant to Florida Statutory requirements, potential Bidders are notified: 287.133(2)(a) A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a Bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a Bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit Bids, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount provided in s. 287.017 for CATEGORY TWO for a period of 36 months following the date of being placed on the convicted vendor list. 287.133(2)(b) A public entity may not accept any Bid, proposal, or reply from, award any contract to, or transact any business in excess of the threshold amount provided in s. 287.017 for CATEGORY TWO with any person or affiliate on the convicted vendor list for a period of 36 months following the date that person or affiliate was placed on the convicted vendor list unless that person or affiliate has been removed from the list pursuant to paragraph (3)(f). A public entity that was transacting business with a person at the time of the commission of a public entity crime resulting in that person being placed on the convicted vendor list may not accept any Bid, proposal, or reply from, award any contract to, or transact any business with any other person who is under the same, or substantially the same, control as the person whose name appears on the convicted vendor list so long as that person's name appears on the convicted vendor list. 287.134(2)(a) An entity or affiliate who has been placed on the discriminatory vendor list may not submit a Bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a Bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit Bids, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity; and may not transact business with any public entity, 287.134(2)(b) A public entity may not accept any Bid, proposals, or replies from, award any contract to, or transact any business with any entity or affiliate on the discriminatory vendor list for a period of 36 months following the date that entity or affiliate was placed on the discriminatory vendor list unless that entity or affiliate has been removed from the list pursuant to paragraph (3)(f). A public entity that was transacting business with an entity at the time of the discrimination resulting in that entity being placed on the discriminatory vendor list may not accept any Bid, proposal, or reply from, award any contract to, or transact any business with any other entity who is under the same, or substantially the same, control as the entity whose name appears on the discriminatory vendor list so long as that entity's name appears on the discriminatory vendor list. B. By submitting a proposal, the Bidder represents and warrants that the submission of its proposal does not violate Section 287.133, Florida Statutes (2005), nor Section 287.134, Florida Statutes (2005). C. In addition to the foregoing, the Bidder represents and warrants that Bidder, Bidder's subcontractors and Bidder's implementer, if any, is not under investigation for violation of such statutes. D. Bidder should read carefully all provisions of 287.133 and 287.134, Florida Statutes (2005). 20-B-26MC, Public Protection Uniforms.docx Page 27 of 31 14.0 PROOF OF EXEMPTION Volusia County FLORIDA BUSINESS SERVICES REVENUE DIVISION 123 W. INDIANA AVE. * RooNi 103 * Dr..I.AND, FL 32720-4602 PHONE: 386-736-5938 * FAX: 386-822-5729 inviv. vo1LYia.-()r,1revG,nye g__ I certify that the business known as (business name) _ If, &(-YX Ovee-+ L "Ji providing 01(\11 �00k-"s services, which is located at (street address) (Citi) falls under the business tax exemption described in: U Florida Statute 205.063 L3 Florida Statute 205.065 13 Florida Statute 205. 191 13 Florida Statute 205. 064 L) Florida Statute 205, 162 U Florida Statute 205. 192 U Florida Statute 205. 171 llwla�dmmf)col± e conl/fl/volsl OR is the type of business indicated below: L3 Child Care- Residential L3 Insurance Adjuster, Agent, Radio/Television Station U Commercial Rentals or Company Religious Institution U Door to Door/Peddler Sales L3 Pharmacist/Pharmacy U Residential Rentals over 6nionths (Prescription Drugs Only) U Sale of Alcoholic Products only (Authorized SignatureA)" (Printed Name) S 7:4 T1, OF R E:rl 'I, A Ok COUNTY OF 01 N Sworn to and subscribed bgfore me this day of C--eN 11-1J Vst� —, 20 -2-0, by who is/are pe,-,,o,�y known to me or who haslhave produced �{ Qi4t pp as idenlificatiom Karen J. Hawes Notary Public State of Florida My Commission Expires 10/31/2020 Commission No. GG 43569 (.Sea!) NOT AIRY PUBLIC - STATE OF J:7 7yl�e or print name: iA Commission No.: Li :5 5 In 1) ..........--------- Commission A business that falls under one of the exempt classifications listed above is not required to have a Volusia County Business Tax Receipt. Revenue Director/Designee 20-B-26MC, Public Protection Uniforms.docx Page 28 of 31 16.0 CERTIFICATION REGARDING PROHIBITION AGAINST CONTRACTING WITH SCRUTINIZED COMPANIES I hereby certify that neither the undersigned entity, nor any of its wholly owned subsidiaries, majority-owned subsidiaries, parent companies, or affiliates of such entities or business associations, that exists for the purpose of making profit have been placed on the Scrutinized Companies that Boycott Israel List created pursuant to s. 215.4725 of the Florida Statutes, or are engaged in a boycott of Israel. In addition, if this solicitation is for a contract for goods or services of one million dollars or more, 1. hereby certify that neither the undersigned entity, nor any of its wholly owned subsidiaries, majority- owned subsidiaries, parent companies, or affiliates of such entities or business associations, that exists for the purpose of making profit are on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, created pursuant to s.215.473 of the Florida Statutes, or are engaged in business operations in Cuba or Syria as defined in said statute. I understand and agree that the County may immediately terminate any contract resulting from this solicitation upon written notice if the undersigned entity (or any of those related entities of respondent as defined above by Florida law) are found to have submitted a false certification or any of the following occur with respect to the company or a related entity: (i) it has been placed on the Scrutinized Companies that Boycott Israel List, or is engaged in a boycott of Israel, or (ii) for any contract for goods or set -vices of one million dollars or more, it has been placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or it is found to have been engaged in business operations in Cuba or Syria. Na, to (Authorized Signature) Title: Date: S 20-8-26MC, Public Protection Uniforms.docx Page 29 of 31 0 CD Pte' p� CLCD put - CD *mud �O.. C CD CD 14. 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Q�(��rnp|etedInvitation toBid Cover Page signed bvanauthorized agent nfthe firm, as listed on the Florida Department of State, Division of Corporations' Sunbiz report available atxvvvw.gunb/z.org(SuDbiz),shall berequired. |fanyone other than the officers listed oO the Sunbizwebsite will be signing this ITB, amemorandum ofauthority signed byanoff icer of the firm allocating authorization shall berequired. |ffirm ionot currently registered aa avendor inthe State mfFlorida (Sunbiz)' include documentation designation of contracting authority. The memorandum of authority shall be on the firm's letterhead and shall clearly state the name, title and contact information for the individual designated hvthe firm. U Requimmd Copies and Electronic Copy onCDorUSB drive (see Section 2.£0 /Provide a Florida Department ofState, Division of Corporations' Suubiz mepmdL i| b| t bbc 7References p|ated�y/d Subro�a|Form (use a�achodform Section 5.C). - List at least three (3) recent references where the proposed product has been provided within the past three (3)years. Use nfthe attached form (Section G.0)will aid inevaluation. Unless specifically asked bythe County, the County ofVo|ueiashall not bey listed aoareference. /BusinessTmx Receipt (BTR) To be responsive to this solicitation, each Bidder who is currently required to have o Business Tax Receipt (BTR)at the time of submittal shall provide ocopy Dftheir current QTFf in their response tothis solicitation. There are two exceptions tothis Bid submission requirement: 1. If Bidder's business does not have e physical location in Lake, (]ngOge\ Osceola, Sennino/e, VrVo|usia County, no submission is required` OR 2. If Bidder's business type is exempt, submit with proposal a Proof ofExemption approved bythe Vo|usiaCounty Revenue Director (see Section 14.0). For more information and toaccess Ch 114, Article 1, Sect. YY4-1[fthe VVuSia County Code VfOrdinances, see C�'|nsmranoe - (See Exhibit ||) Evidence of required insurance coverage or proof of insurability in the amounts indicated. If available, e properly completed ACOR[} Form is preferable. Final forms must contain the correct solicitation and/or project DU0be[ and Vo|uoig County contact person. Contractor shall provide the required insurance detailed in Exhibit || for the entire Term of the agreement. Regardless of anything submitted as proof ofinsurance, Contractor shall comply with all requirements of Exhibit ||. �6-26MC��P��no���� . � Page 16nf31 Firms that have owner/operators that have filed a "Notice of Election to be Exempt" shall submit a copy with the proposal. Incorporated and unincorporated firms that qualify for an exemption under the Florida Workers' Compensation law in Chapter 440, Florida Statutes, shall submit an executed Hold Harmless Agreement (see Section 16.0) relieving the County of liability in the event they and/or their employees are injured while providing goods and/or services to the V�C t . Conflict of Interest Form (use attached form Section 7.0) All Bidders shall properly complete, have notarized, and include with their Bid Submittal the attached statement disclosing any potential conflict of interest that the Bidder may have due to ownership, r clients, contracts, or interests associated with this project. ot7 LVAddenda issued subsequent to the release of this solicitation must be signed and returned with e firm's Bid. Failure to return signed addenda may be cause for the Bid to be op,co idered non-responsive. _9 1 -9 Include a completed W-9 form. If the firm is not registered with Volusia County, on- line registration is available at .volusia.org/purchasing under Vendor Self Service, which links to the registration site and the W-9 form can be accessed through this site as w . tification Affidavit by Local Business (use attached forms 11.0 and 12.0) All Zer-1 Bidders shall complete, have notarized, and include with their Bid Submittal the attached st tement(s) confirming Local Preference Eligibility. Drug -Free Work Place form (use attached form Section 8.0). 4/certification Regarding Debarment - Prime (use attached form Section 9.0). tom' Certification Regarding Debarment - Sub if applicable (use attached form Section it n. 0). CERTIFICATION IRTIFICATION REGARDING PROHIBITION AGAINST CONTRACTING WITH SCRUTINIZED COMPANIES (use attached form in Section 15.0) All Bidders shall be prepared to supply a financial statement upon request, preferably a certified audit, but a third party prepared financial statement and the latest D & B report will be accepted. [THE REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK] 20-B-26MC, Public Protection Uniforms.docx Page 17 of 31