Loading...
HomeMy WebLinkAbout2020 04 13 Consent 306 - Advisory Selection Committee Recommendation for RFQ #07-19 LR "Professional Engineering Services for Water Plants and Distribution System Improvements" CONSENT AGENDA ITEM 306 1959 CITY COMMISSION AGENDA I APRILI3, 2020 REGULAR MEETING TITLE Advisory Selection Committee Recommendation for RFQ #07-19 LR "Professional Engineering Services for Water Plants and Distribution System Improvements" SUMMARY Request for Qualifications (RFQ) #07-19 LR was advertised from December 20, 2019 - January 31, 2020 for professional engineering services for water plants and distribution system improvements. The RFQ outlined the services requested, submittal requirements, and evaluation criteria (Attachment 1). Five (5) submittals were received from the following firms: • Besh,lnc. • Carollo Engineers, Inc. • Kimley-Horn • McKim and Creed, Inc. • Reiss Engineering, Inc. A Selection Committee comprised of City and Veolia staff evaluated the submittals based on the following criteria: -Experience of the firm and proposed project team with taste and odor as well as hydrogen sulfide issues. - Ability to provide cost effective planning services and solutions. - Ability to provide the necessary resources and effective project management to meet project time requirements. - Experience in providing a well-coordinated project with City Management, Utility Operators, and others. Based on the Selection Committee's review of the written RFQ responses, the following three (3) firms were short-listed and selected for interviews with the Selection Committee: • Carollo Engineers, Inc. • Kimley-Horn • Reiss Engineering, Inc. The short-listed firms were interviewed on February 28, 2020. Based on the interviews and written PFQ responses, the Selection Committee is recommending two (2) firms be awarded engineering continuing services agreements for water plants and distribution system improvements: • Carollo Engineers, Inc. • Kimley-Horn The recommended term of the agreement is three (3) years, with the option to extend the term for an additional (3) years based on satisfactory performance. The agreement will be the City's standard continuing services agreement prepared by the City Attorney, subject to any updates and modifications as determined by the City Attorney. Both firms will enter into the same agreement. Work will be accomplished under the agreements on a "task basis," similar to the way in which work has been assigned in the past to continuing services consultants. A written task order will be prepared for each project assignment and submitted for City Commission approval (as applicable). No funding is required to execute the engineering services contracts with the selected firms. Funding for the project assignments performed under these agreements will follow the City's normal budgeting and approval process. RECOMMENDATION The City's Advisory Selection Committee for PFQ 07-19 LP recommends the City Commission authorize City Manager and City Attorney to enter into engineering continuing services agreements for Water Plants and Distribution System Improvements with Carollo Engineers, Inc. and Kimley-Horn. Attachment 1 t • 1 Incorporated 1959 Mi City of Winter Springs, Florida REQUEST FOR QUALIFICATIONS RFQ#07-19 LR for Professional Engineering Services for Water Plants and Distribution System Improvements City of Winter Springs, Florida 1126 East SR 434 Winter Springs, FL 32708 407-327-1800 City of Winter Springs, FL REQUEST FOR QUALIFICATIONS RFQ#07-19 LR Professional Engineering Services for Water Plants and Distribution System Improvements TABLE OF CONTENTS 1. INTRODUCTION ? 11. SERVICES REQUESTED 5 -------------------------------------------------------------------------------------------------- 111. EVALUATION CRITERIA 6 IV. SUBMITTAL REQUIREMENTS 7 --------------------------------------------------------------------------------------- V. REFERENCE DOCUMENTS 8 V1. REQUIRED FORMS 9 1 City of Winter Springs, Florida REQUEST FOR QUALIFICATIONS RFQ#07-19 LR Professional Engineering Services for Water Plants and Distribution System Improvements I. INTRODUCTION The City of Winter Springs, Florida invites the submittal of a Letter of Response from professional engineering consultants for Professional Engineering Services for Water Plants and Distribution System Improvements. This Request for Qualifications (RFQ) has been issued to provide firms with information to prepare and submit a detailed response, which must satisfy all requirements and criteria established in this RFQ to qualify for consideration. Qualified firms who are interested in providing these services may download the RFQ from http://www.winterspringsfl.org/EN/web/gov/bids purchasing.htm and DemandStar. By responding to this RFQ, Respondent certifies, represents, and warrants that all information contained in Respondent's RFQ submittal is accurate and truthful and that the City will rely on said information during the RFQ process. Further, the Respondent represents and warrants to the City that they have read, understand, and agree to abide by all the terms and conditions set forth in the RFQ Package and all subsequently issued addendums. Respondent further understands and agrees that misleading, fraudulent, untruthful, and deceitful information, whether presented to the City in writing or verbally, shall be grounds for immediate disqualification. Additionally, Respondent agrees that the City shall have the sole discretion to rank Respondents to this RFQ. The final ranking of the qualifications of all Respondents by the City does not guarantee that any of the highest ranked Respondents will be selected to perform the services required by this RFQ. The City may elect, at its sole discretion, to initiate negotiations to enter into one or more written agreements with selected Respondents pursuant to this RFQ. Said agreements shall be approved separately by, and at the sole discretion of, the City Commission of Winter Springs, and shall depend on numerous factors such as any successful Respondent offering fair, competitive and reasonable prices for their services and the Respondent's ability to accept the terms and conditions required by the City. Further, Respondent agrees that the City has the right to reject, for any reason and without penalty, any and all submittal packages prior to and after the rankings are made by the City, and that the City has the right, for any reason and without penalty,to terminate any contract negotiations commenced under this RFQ with any Respondent at any time. In addition, the City reserves the right to both waive any minor informality in responses and to determine, in its sole discretion, whether or not a particular informality is minor. Respondent shall bear all costs associated with preparing, responding, interviewing or presenting in connection with this RFQ. The City of Winter Springs will not be liable or pay for any such cost. During the RFQ process, Respondent consents to the City of Winter Springs conducting credit and corporate background checks on the Respondent. Further, the Respondent hereby consents and authorizes the City to contact any and all previous clients, and references, of Respondent to inquire about the Respondent's past or current performance on any other project that the City deems to be relevant to the services requested under this RFQ. 2 Firms shall not contact any City officials or staff members regarding this RFQ except as provided under this RFQ related to the pre-submittal tour and written comments or questions regarding the meaning or intent of the RFQ shall be submitted to the City Controller, Holly Queen, CPA at hqueen@winterspringsfl.org. ANY INDIRECT OR DIRECT COMMUNICATIONS AND LOBBYING REGARDING THIS RFQ MADE TO MEMBERS OF THE CITY COMMISSION, MEMBERS OF THE SELECTION COMMITTEE, OR ANY OTHER CITY OFFICIAL ARE STRICTLY PROHIBITED AND SHALL CONSTITUTE GROUNDS FOR IMMEDIATE DISQUALIFICATION. Only questions answered by formal written addenda issued by the City will be binding. Oral and other interpretations or clarifications will be without legal effect and may not be relied upon by Respondents in submitting their response. Note: Respondents shall familiarize themselves with the provisions of the Florida Public Records Law, especially section 119.071, Florida Statutes. Unless deemed exempt or confidential by law, all information submitted by Respondents to the City will become a public record subject to the provisions of the Florida Public Records Law. A pre-submittal tour of the City's water plants will be held on Wednesday,January 8, 2020, at 9:00 AM. The tour will start at WTP #1 located on 851 Northern Way, Winter Springs, FL 32708. This will be the only time available for interested firms to tour the facilities and to ask any questions in person regarding the RFQ. Attendance at the pre-submittal tour is MANDATORY for ALL firms interested in pursuing this work. Each Respondent is limited to three (3) participants per tour. All attendees shall be required to sign-in and provide their own transportation to/from the facilities and provide their own safety equipment appropriate for touring the facilities. All other questions regarding this RFQ shall be submitted in writing to the City Controller, Holly Queen, CPA at hqueen@winterspringsfl.org. Submittal responses shall include four (4) originals in a sealed package marked "RFQ #07-19 LR- PROFESSIONAL ENGINEERING SERVICES FOR WATER PLANTS AND DISTRIBUTION SYSTEM IMPROVEMENTS" and 1 CD/DVD containing all documents in Adobe PDF electronic format. Submittals must be received in City Hall's Utility Billing Department, 1126 East State Road 434, Winter Springs, Florida 32708, no later than 12:00 PM EST Friday, January 31, 2020. All proposals received after the established deadline will not be accepted. The City will not be responsible for mail delays, late, or incorrect deliveries. The clock located in the lobby of City Hall will be the official authority for determining the time that packages are received and for determining late responses. The City reserves the right to amend the RFQ. If it becomes necessary to revise any part of the RFQ, an addendum shall be provided to firms who are recorded with the City as having received a copy of this RFQ. In the event of addenda, firms shall include acknowledgment of all addenda as part of their submittal. Failure to acknowledge addenda may be grounds for disqualification of the submittal. Respondents who are preparing a submittal are expected to examine this request including all relevant forms, terms, conditions, and instructions. All costs associated with preparation and submittal of qualifications shall be borne entirely by the Respondent. Submittals will become the property of the City and will become part of the public record, subsequent to award of the contract(s) or rejection of all submittals. INDEMNIFICATION STATEMENT— By submitting a response document signed by an authorized agent of the Respondent, Respondent acknowledges and accepts the terms and conditions of the following Indemnification Statement in the event of contract award: 3 "For other and additional good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the Respondent shall indemnify, hold harmless and defend the City of Winter Springs and its elected and appointed officers, agents, officials, attorneys, representatives and employees (hereinafter the "City") against any and all liability, loss, cost, damages, expenses, injuries (including death), claim or actions, of whatever type, including but not limited to attorney's fees in any legal proceeding through trial and appeal, which the City may hereafter sustain, incur or be required to pay, arising out of, wholly or in part, or due to any act or omission of Respondent, its agent(s), vendors, Respondents, representatives, servants, or employees in the execution, performance or non- performance or failure to adequately perform Respondent's obligations pursuant to this RFQ and any subsequent contract." LIMITATION OF LIABILITY STATEMENT — By submitting a response document signed by an authorized agent of the Respondent, Respondent acknowledges and accepts the terms and conditions of the following Limited Liability Statement in the event of contract award: "The City desires to enter into this contract only if in so doing the City can place a limit on the City's liability for any cause of action arising out of the contract, so that the City's liability for any breach never exceeds the sum of any contract amount that is owed by the City for services actually performed by the Respondent to the City's complete satisfaction. For other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, Respondent expresses its willingness to enter into this contract with the knowledge that the Respondent's recovery from the City to any action or claim arising from the contract is limited to a maximum amount of the sum of any contract amount that is owed by the City for services actually performed by the Respondent to the City's complete satisfaction. Nothing contained in this paragraph or elsewhere in this contract is in any way intended either to be a waiver of the limitation placed upon the liability of the City as set forth in Section 768.28 Florida Statutes, or to extend the liability of the City beyond the limits established in said Section 768.28 Florida Statutes; and no claim or award against the City shall include attorney's fees, investigative costs, expert fees, suit costs or pre-judgment interest." Submittals will be evaluated and ranked by a selection committee composed of City staff and its O&M vendor. Oral presentations of the short-listed firms may be requested at the discretion of the selection committee. A final determination of the rankings and selected firm will be made by the City Commission at a date and time to be determined. The City reserves the right to withdraw or amend the RFQ; reject any or all submittals in whole or in part; to re-advertise for any or all of the services; to negotiate for additional services or materials; and/or to accept the proposals, which, in its judgment best serves the interest of the City. Selection shall be made of the Respondent that demonstrates capability while most closely meeting the City's needs according to the requirements of this RFQ and the evaluation criteria and factors designated herein. Further, once the City Commission approves a ranking of the firms, the award will depend upon the successful Respondent negotiating acceptable terms under a Consulting Professional Services Agreement. While not part of the ranking part of the RFQ process, Respondents are hereby notified that should a Respondent be selected to negotiate a contract with the City, the City will be paying significant attention to cost of services being offered. If the City pursues competitive negotiations with your firm and the City cannot agree on fair, competitive, and reasonable rates, fees, and charges for services required by this RFQ, the City will cease negotiations with your firm. The City will then commence negotiations with the next ranked firm until the City has awarded a contract or rejected all the proposals at its sole discretion. 4 The submittal shall not exceed 25 pages in length, exclusive of a one-page cover letter, proposed staff resumes, and the standard forms. Resumes of proposed staff cannot exceed two (2) pages in length per staff member. The targeted schedule for this solicitation is as follows: RFQ Released for Advertisement December 20, 2019 Mandatory Pre-Submittal Tour January 8, 2020 Proposals Due January 31, 2020 Oral Presentations TBD II. SERVICES REQUESTED The Consulting Professional Services Agreement will be for an initial term of five (5) years with the option to extend by mutual agreement. However, the Consulting Professional Services Agreement shall be subject to termination for convenience by the City. Services provided to the City by the successful consultant will be on an individual task order basis. Task orders shall be assigned and approved at the City's sole discretion after the Consulting Professional Services Agreement is approved and executed by the parties. Generally, task orders shall be limited to a variety of professional and engineering services required by the City related to the City's water utility plants and distribution system. By way of example, such services may include, but are not limited to the following: 1) Water Treatment Plant No. 1—The water treatment plant located in the east part of the City and its distribution system have been the source of taste and odor complaints by residents. A contributing factor is the hydrogen sulfide in the wells. The City is in the process of chemical testing utilizing hydrogen peroxide for treatment. In 2017, the City added an anionic ion exchange (IEX) system for the removal of total organic carbon and bromide to limit the formation of total trihalomethanes (TTHMs) after chlorination. This project would follow up on that initial study to determine the treatment process and equipment needed to remove the hydrogen sulfide. It is anticipated the plant will need new chemical feeds, additional treatment vessels, and other changes. There are also hydraulic improvements that could be made between the two groundwater storage tanks to improve the pumping out of the plant. The facility should have a vulnerability study performed and safety improvements made. The engineering work would include the analysis, design of improvements, bid services and construction observation. Because of the interest by the public, this project needs to be done as quickly as practical. Recommendations and references by the engineer to their experience in fast tracking projects are requested. 2) Water Wells at Water Treatment Plant No. 1—The four water wells at Water Treatment Plant No. 1 are in need of inspection and rehabilitation. The engineer will make recommendations on necessary rehabilitation after the inspections and provide field oversight of the repairs. This effort will need to be coordinated with the operations staff to assure adequate flow from WTP No. 1 or the other two plants during that time period. 5 3) Water Treatment Plant No. 2—This is a pump and treat facility located in the northwest part of the City. The work at that facility will be phased in after the changes at WTP No. 1 have been successfully completed. The two wells at the plant will be inspected and rehabilitated based on the findings of the inspection. A test of chemical treatment of the hydrogen sulfide will be undertaken to provide potential options for treatment followed by design, biding services and construction observation. 4) Water Treatment Plant No. 3—This is a pump and treat facility located in the southwest part of the City. The work at that facility will be phased in after the changes at WTP No. 1 have been successfully completed. The two wells at the plant will be inspected and rehabilitated based on the findings of the inspection. A test of chemical treatment of the hydrogen sulfide will be undertaken to provide potential options for treatment followed by design, biding services and construction observation. 5) Water Quality Evaluation — The engineer will be expected to evaluate the current well and water sampling information to assess the compliance with lead, PFAS, TTHM and other emerging contaminants. 6) Water Distribution System Modeling and Analysis — The water distribution system has a current hydraulic model that has indicated problems with dead-end lines. The City may require updates to the model and construction of solutions to the dead-end lines. 7) Other Tasks—Other professional and engineering services assigned by the City related to the City's water treatment plants and water distribution system. III. EVALUATION CRITERIA All responses will be subject to a review and evaluation process under the terms, conditions and procedures set forth in the RFQ. It is the intent of the City that all Respondents responding to this RFQ who meet the minimum requirements contained in this RFQ shall be ranked, at the selection committee's and City Commission's sole and absolute discretion, in accordance with the evaluation criteria and factors established in the RFQ. The City will consider all responsive and responsible responses received in its evaluation and award process. Contracts will be awarded to a successful Respondent deemed the most qualified, and in the City's best interests as determined in the sole and absolute discretion of the City Commission of the City of Winter Springs. Respondents shall submit information for evaluation in the categories listed below. Submittals will be scored and weighted using the evaluation rating range table and cumulative point system (the maximum attainable score is 100 points) as follows: ■ Experience of the firm and proposed project team with taste and odor as well as hydrogen sulfide issues. (40 points) ■ Ability to provide cost effective planning services and solutions. This should include references of practical solutions to water system issues. (30 points) ■ Ability to provide the necessary resources and effective project management to meet project time requirements. A proven track record of fast response to projects such as WTP No 1. This should include project references. (20 points) 6 ■ The City expects a collaborative approach to the project. Please provide your approach and experience in providing a well-coordinated project with City Management, Utility Operators, and others. (10 points) The City may, at its discretion, seek clarification of any aspect of a Respondent's submittal. IV. SUBMITTAL REQUIREMENTS Letters of Response, at a minimum, shall include the following information: 1. Cover Letter containing the following information: a. Project Name b. Consultant's name and address c. Proposed responsible office for consultant d. Contact person, phone number, and e-mail address e. List of subconsultants and their roles on the project 2. Experience of the firm and proposed project team (provide description of sample projects with Owner references) 3. Ability to provide cost effective services and solutions 4. Ability to provide the necessary resources and effective project management to meet project time requirements 5. Proposed key personnel and their proposed project roles 6. Resumes for proposed key personnel (SEPARATE FROM THE 25 PAGE LIMITATION). 7. Attached Forms(SEPARATE FROM THE 25 PAGE LIMITATION) a. Disputes Disclosure Form (provided herein) b. Drug-Free Work Place Form (provided herein) c. Florida Statutes on Public Entity Crimes Form (provided herein) d. Certification of Non-Segregated Facilities Form (provided herein) e. Insurance Requirements Form (provided herein) f. Conflict of Interest Statement (provided herein) g. Vendor Certification Regarding Scrutinized Companies Lists (provided herein) 7 V. REFERENCE DOCUMENTS The City has compiled reference documents for review and use by Respondents in preparing their responses to this RFQ. Such reference documents will be available via online sharefile. The reference documents include the following: ■ Water Supply Plan,April 2017; ■ Water Treatment Plant No. 1 Process Evaluation, December 2018; and ■ Water Distribution System Map, August 2019. 8 City of Winter Springs, Florida REQUEST FOR QUALIFICATIONS RFQ#07-19 LR Professional Engineering Services for Water Plants and Distribution System Improvements DISPUTES DISCLOSURE FORM 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? 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? 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? 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 the statements contained herein are true. I agree and understand that any misstatement or misrepresentation or falsification of facts shall be cause for disqualification of the submittal, immediate cancellation of any contract with the City that might arise from the representations contained herein, and forfeiture of rights for further consideration for work in the City of Winter Springs. Firm: Name/Title: Authorized Signature/ Date: This Form Must Be Completed and Returned with your Submittal 9 City of Winter Springs, Florida REQUEST FOR QUALIFICATIONS RFQ#07-19 LR Professional Engineering Services for Water Plants and Distribution System Improvements DRUG -FREE WORK PLACE FORM 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. Firm: Name/Title: Authorized Signature/ Date: This Form Must Be Completed and Returned with your Submittal 10 City of Winter Springs, Florida REQUEST FOR QUALIFICATIONS RFQ#07-19 LR Professional Engineering Services for Water Plants and Distribution System Improvements FLORIDA STATUTES ON PUBLIC ENTITY CRIMES FORM THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. 1. This sworn statement is submitted to the City of Winter Springs by: on behalf of: whose business address is: Federal Employer Identification Number (FEIN) 2. I understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), F.S., 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. I understand the "convicted" or "conviction" as defined in Paragraph 287.133(1)(b), F.S., 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. I understand that an "affiliate" as defined in Paragraph 287.133(1)(a), F.S., means: A predecessor or successor of a person convicted of a public entity crime or 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. 5. I understand that a "person" as defined in Paragraph 287.133(1)(e), F.S., 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, 11 directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity. 6. 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.) 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. 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 City of Winter Springs is for the City of Winter Springs only. I also understand that I am required to inform the City of Winter Springs prior to entering into a contract in excess of$25,000 of any change in the information contained in this form. Signature Date State of Florida, County of On this day of 20___, before me, the undersigned Notary Public of the State of Florida, personally appeared: (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. Sworn to and subscribed before me this day of 20 Notary Public My Commission expires: Personally Known Produced Identification: (Type) Did take an Oath Did Not take and Oath 12 City of Winter Springs, Florida REQUEST FOR QUALIFICATIONS RFQ#07-19 LR Professional Engineering Services for Water Plants and Distribution System Improvements CERTIFICATION OF NON -SEGREGATED FACILITIES FORM By affixing his signature to this form, the consultant 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 consultant 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 consultant 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 consultant 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. By: Date: Print Name Title Official Address: This Form Must Be Completed and Returned with your Submittal 13 City of Winter Springs, Florida REQUEST FOR QUALIFICATIONS RFQ#07-19 LR Professional Engineering Services for Water Plants and Distribution System Improvements INSURANCE REQUIREMENTS FORM 1. The consultant shall be required to provide to the City, prior to signing a contract for or commencing any work,a Certificate of Insurance which verifies coverage in compliance with the requirements outlined below. Compliance of said certificate must be acknowledged by the Purchasing Coordinator prior to start of work. Any work initiated without completion of this requirement shall be unauthorized and the City of Winter Springs will not be responsible. 2. The City of Winter Springs reserves the right to require coverage and limits as considered to be in its best interests. Insurance requirements shall be on a case by case basis determined by the project,conditions and exposure. 3. Except for Professional Liability and Workers Compensation Policies,when required,all policies are to be endorsed to include the City of Winter Springs as Additional Insured. In the cancellation clause the number"30"shall be inserted into the blank space provided prior to the words"days prior notice...". All consultant policies are to be considered primary to City coverage and shall not contain co-insurance provisions. 4. In the event that the insurance coverage expires prior to the completion of services,a renewal certificate shall be issued 30 days prior to said expiration date. 5. Subconsultants retained by the primary consultant are the responsibility of said primary consultant in all respects. 6. Insurance requirements: COVERAGE REQUIRED MINIMUM POLICY LIMITS Workers'Compensation Statutory Commercial General Liability including Contractual Liability, Products and Completed Operations,XCU and Owners and Contractors Protective $5,000,000 Occurrence Comprehensive Auto Liability,CSL,shall include"any auto" $500,000 CSL Professional $5,000,000 Claims-Made (NOTE:All limits are per occurrence unless noted otherwise and must include Bodily Injury and Property Damage. Deductibles and self insured retentions must be approved by the City of Winter Springs,and all insurers must have an A.M. Best rating of at least A:VII.) 7. Bonding Required: None This Submittal 8. Consultant will be required to provide a certificate of insurance in compliance with the above,within four(4)days of notification of award with continuing coverage,without a break. 9. I hereby certify that the insurance and bonding requirements outlined above shall be met as required, if I am awarded a contact for the services specified herein. Firm: Name/Title: Authorized Signature/Date: This Form Must Be Completed and Returned with your Submittal 14 City of Winter Springs, Florida REQUEST FOR QUALIFICATIONS RFQ#07-19 LR Professional Engineering Services for Water Plants and Distribution System Improvements CONFLICT OF INTEREST STATEMENT 1. of deposes and states that Name of Affiant Name of Company the above named entity is submitting qualifications to the City of Winter Springs for the project identified above. 2. The Affiant has made diligent inquiry and provides the information contained in this Affidavit based upon his own knowledge. 3. 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 qualifications for the same services. 4. 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. 5. 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. 6. 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 these services. 7. 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 Winter Springs. 8. 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 Winter Springs. 9. In the event that a conflict of interest is identified in the provision of services, 1, on behalf of the above named entity, will immediately notify the City of Winter Springs in writing. 15 Signature of Affiant Date Typed or Printed Name of Affiant Title State of Florida, County of On this day of 20_, before me, the undersigned Notary Public of the State of Florida, personally appeared 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: (Name of Notary Public:Print,Stamp,or Type as Commissioned.) This Form Must Be Completed and Returned with your Submittal 16 City of Winter Springs, Florida REQUEST FOR QUALIFICATIONS RFQ#07-19 LR Professional Engineering Services for Water Plants and Distribution System Improvements VENDOR CERTIFICATION REGARDING SCRUTINIZED COMPANIES LISTS Respondent Vendor Name: Vendor FEIN: Vendor's Authorized Representative Name and Title: Address: City: State: Zip: Phone Number: Email Address: Section 287.135, F.S. prohibits a company from bidding on, submitting a proposal for, or entering into or renewing a contract for goods or services of any amount if the company is on the Scrutinized Companies that Boycott Israel List, created pursuant to Section 215.475, F.S. or is engaged in a boycott of Israel. Section 287.135, F.S. also prohibits a company from bidding on, submitting a proposal for, or entering into or renewing a contract for goods or services of $1,000,000 or more, if the company is on either the Scrutinized Companies with Activities in Sudan List, or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector Lists which are created pursuant to s. 215.473, F.S. As the person authorized to sign on behalf of Respondent, I hereby certify that the company identified above in the section entitled "Respondent Vendor Name" is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or the Scrutinized Companies that Boycott Israel List. I further certify that the company is not engaged in a boycott of Israel. I understand that pursuant to section 287.135, Florida Statutes, the submission of a false certification may subject company to civil penalties, attorney's fees, and/or costs. Certified By: Who is authorized to sign on behalf of the above referenced company. Authorized Representative: Print Name and Title: Signature: Date: This Form Must Be Completed and Returned with your Submittal 17