Asset Works Appraisal (2)PRICE PROPOSAL SHEET
Inventory and Valuation Services RFP
Proposers must include the Price Proposal Sheet with their submittal. Failure to do so will
render your proposal non - responsive and will be rejected from further consideration.
PRICE PROPOSAL SHEET
Annual
Year Amount
Year I
Year 2
Year 3
Year 4
Year 5
TOTALS See Proposal
ATTACHMENT #3 No CONFLICT OF INTERESTMON-COLLUSION
CERTIFICATION
Inventory and Valuation Services RFP
Submitted this 10 day of July
20 12
The undersigned, as Bidder /Proposer, declares that the only persons interested in this RFP are named
herein; that no other person has any interest in this RFP or in the Contract to which this RFP pertains;
that this response is made without connection or arrangement with any other person; and that this
response is in every respect fair and made in good faith, without collusion or fraud.
The Bidder /Proposer agrees if this response /submission is accepted, to execute an appropriate CITY
document for the purpose of establishing a formal contractual relationship between the Bidder /Proposer
and the CITY, for the performance of all requirements to which the response /submission pertains.
The Bidder /Proposer states that this response is based upon the documents identified by the following
number: Bid /RFP
The full -names and residences of persons and firms interested in the foregoing bid /proposal, as
principals, are as follows:
32
Continuation of Attachment #4No Conflict of inter /Non - Collusion Certification
NOTARY PUBLIC:
STATE OF Pennsylvania
COUNTY OF Bucks
The foregoing instrument was acknowledged before me this 10 day of
July 111,2012 by Christopher Krier (name of
person whose signature is being notarized) who is
X Personally known to me, or
Personal identification:
Type of Identification Produced
Did take an oath, or
Did Not take an oath.
SEAL
Sylvia Kelley
(Name of Notary Public: Print, Sump
or type as commissioned.)
FAILURE TO COMPLETE SIGN. & RETURN THIS FORM MAY DISQUALIFY YOUR RESPONSE
rr•
33
ATTACHMENT #2 DRUG FREE WORKPLACE
Inventory and Valuation Services RPP
Whenever two or more Bids which are equal with respect to price, quality and service are
received by the State or by any political subdivisions for the procurement of commodities or
contractual services, a Bid received from a business that certifies that it has implemented a
drug -free workplace program shall be given preference in the award process. Established
procedures for processing tie Bids will be followed if none of the tied vendors have a drug -free
workplace program. In order to have a drug -free workplace program, a business shall:
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'
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 under Bid 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.
S. 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, I certify that this firm complies fully with the
above requirements.
PROPOSER's
Signature:
Print Name: Christopher Krier
Date: 7/10/12
31
ATTACHMENTM PUBLIC ENTITY CRIMES AND CONFLICTS OF INTEREST
inventory and Valuation Services RFP
Pursuant to the provisions of Paragraph (2) (a) of Section 287.133, Florida State Statutes — "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 on a Contract to provide any goods or services to a
public entity, may not submit a Bid on a Contract with a public entity for the construction or
repair of a public building or public work, may not submit bids on leases of real property to a
public entity, may not be awarded to 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 Category Two of Section 287.017, Florida
Statutes, for thirty six (36) months from the date of being placed on the convicted vendor list'.
The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State
Statutes. BIDDERS must disclose with their Bids, the name of any officer, director, partner,
associate or agent who is also an officer or employee of the City of South Miami or it's
agencies.
SWORN STATEMENT PURSUANT TO SECTION 287.133 (3)(a),
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY
PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
I. This sworn statement is submitted to City of South Miami
[print name of the public entity]
by Christopher Krier, Regional Director a
[print individual's name and title]
for AssetWorks Inc.
[print name of entity submitting sworn statement]
whose business address is 101 Lakeside Drive
Southampton PA 1966
and (if applicable) its Federal Employer Identification Number (FEIN) is46.0521049
(If the entity has no FEIN, include the Social Security Number of the individual signing this
sworn statement: )
2. 1 understand that a "public entity crime" as defined in Paragraph 287.133 (1)(g), Florida
Statutes, means a violation of any state or federal law by a person with respect to and
directly related to the transaction of business with any public entity or with an agency
or political subdivision of any other state or of the United States, including, but not
limited to , any bid or contract for goods or services to be provided to any public entity
or an agency or political subdivision of any other state or of the United States and
involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material
misrepresentation.
3. 1 understand that "convicted" or "conviction" as defined in Paragraph 287.133 (1)(b),
Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or
W,
without an adjudication of guilt, in any federal or state trial court of record relating to
charges brought by indictment or information after July I, 1989, as a result of a jury
verdict, non -jury trial, or entry of a plea of guilty or nolo contendere.
4. 1 understand that an "affiliate" as defined in Paragraph 287.133 (1)(a), Florida Statutes,
means:
(a) A predecessor or successor of a person convicted of a public entity crime; or
(b) 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 any person, or a
pooling of equipment or income among persons when not for 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. 1 understand that a "person" as defined in Paragraph 287.133 (1)(e), Florida Statutes,
means any natural person or entity organized under the laws of any state or of the
United States with the legal power to enter into a binding contract and which bids or
applies to bid on contracts for the provision of goods or services led by a public entity,
or which otherwise transacts or applies to transact business with a public entity. The
term "person" includes those officers, directors, executives, partners, shareholders,
employees, members, and agents who are active in management of an entity.
6. Based on information and belief, the statement which I have marked below is true in
relation to the entity submitting this sworn statement. [Indicate which statement
applies.]
Neither the entity submitting this sworn statement, nor any of its officers,
directors, executives, partners, shareholders, employees, members, or agents who are
active in the management of the entity, nor any affiliate of the entity has been charged
with and convicted of a public entity crime subsequent to July I, 1989.
The entity submitting this sworn statement, or one or more of its officers,
directors, executives, partners, shareholders, employees, members, or agents who are
active in the management of the entity, or an affiliate of the entity has been charged with
and convicted of a public entity crime subsequent to July I, 1989.
The entity submitting this sworn statement, or one or more of its officers,
directors, executives, partners, shareholders, employees, members, or agents who are
active in the management of the entity, or an affiliate of the entity has been charged with
and convicted of a public entity crime subsequent of 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.]
29
Continuation of Attachment #2 Public Entity Crimes and Conflicts
I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING
OFFICER FOR THE PUBLIC ENTITY INDENTIFIED IN PARAGRAPH I (ONE) ABOVE IS
FOR THAT PUBLIC ENTITY ONLY, AND THAT THIS FORM IS VALID THROUGH
DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND
THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A
CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION
287.017, FLORIDA STATUTES, FOR CATEGORY TWO OF ANY CHANGE IN THE
INFORMATION CONTAINED IN THIS FORM.
Sworn to and subscribed before me this
X Personally known or
Produced identification
t - '��
[signatur
10 day of
Notary Public — State of
My commission expires
July 24.12
Pennsylvania
1/24/16
(Type of identification)
(Printed, typed or stamped commissioned name of notary public)
Form FUR 7068 (Rev.06 /11/92)
30