FLORIDA CROWN WORKFORCE BOARD
REQUEST FOR PROPOSAL
PROFESSIONAL EMPLOYER ORGANIZATION
(PEO)
RELEASE DATE: OCTOBER 8, 2013
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REQUEST FOR PROPOSAL
SECTION 1: INTRODUCTION
1.1 STATEMENT OF NEED
The Florida Crown Workforce Board (FCWB) is the designated administrative entity and sub
state grantee for the Region 7 area and has been chartered by the Governor as the regional
workforce development board.
As such, the FCWB oversees the planning and
implementation of a variety of welfare reform and workforce development programs in
Columbia, Dixie, Gilchrist and Union Counties.
The FCWB delivers all programs and services to customers through its One Stop System.
This system is both physical and technological and includes connectivity between various
partners and service providers. The goal of the One Stop System is to provide full-service,
staffed sites, offering a full array of services to residents of the four counties which we serve
which will assist individuals to obtain employment through an individual mix of activities.
Our One Stop System is developed through two Universal Centers located one each in Lake
City and Trenton.
At this time, the FCWB is announcing its interest in securing responses from qualified
Professional Employer Organizations (“PEOs”), who can demonstrate written evidence of
past performance and business endeavors that align with the purpose, values, and vision of
the FCWB, to provide exemplary cost-effective human resource solutions and manage
employee risks as described within this Request for Proposals (“RFP”).
The purpose of this RFP is to allow the FCWB to identify the most qualified Proposer who,
after full Board approval, will be invited to negotiate a contract with the FCWB to provide
exemplary cost-effective human resource solutions and manage employee risks as described
in Section 3 of this RFP.
The FCWB will be entering into one contract for these services for the period of one (1) year
with an option to renew annually for up to two (2) additional one (1) year periods subject to:
1) Exemplary performance evaluations by the FCWB and other qualified entities;
2) Availability of funds as determined by the FCWB; and
3) Changes in programmatic or service related needs as determined in the sole discretion
of the FCWB.
The contract may also be affected by any changes in statute or rule that may arise during the
contract period or by amendments to the FCWB’s annual Workforce Services Plan as
approved by the Department of Economic Opportunity (DEO). Said limitations, however, do
not render the contract illusory because the FCWB is a legislatively created entity that relies
on state and federal funding and as such the contract will delineate the notice that the FCWB
will provide the Contractor to prevent issues of reliance. The FCWB issues this RFP with
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the explicit understanding that minor and major changes may be made, up to and including
the option to rescind this RFP in its entirety, if such is in the best interest of the FCWB.
1.2 ELIGIBLE PROPOSERS
All public or private not-for-profit corporations, local education agencies, governmental
units, public agencies, or private-for-profit corporations properly organized in accordance
with State and Federal law and in business for at least one year may submit a Proposal for
provision of services as defined within this RFP. Minority operated businesses, faith-based,
and community-based organizations are encouraged to submit a Proposal. No Proposer will
be considered for funding if:
1) The Proposer has been placed on the discriminatory vendor list pursuant to Section
287.134, F.S.
2) The Proposer has been debarred or suspended or otherwise determined to be
ineligible to receive federal and/or state funds by an action of any governmental
agency.
3) The Proposer’s previous contract(s) with the FCWB or any other State of Florida or
state affiliated agency has been terminated for cause.
4) The Proposer has not complied with an official order to repay disallowed costs
incurred during its conduct of programs or services.
5) The Proposer’s name appears on the convicted vendor list.
6) For any cause for which the Proposer is determined non-responsive or nonresponsible.
1.3 HISTORICAL BACKGROUND
The Florida Crown Workforce Board (FCWB) is the designated administrative entity and sub
state grantee for the Region 7 area and has been chartered by the Governor as the regional
workforce development board.
As such, the FCWB oversees the planning and
implementation of a variety of welfare reform and workforce development programs in
Columbia, Dixie, Gilchrist and Union Counties.
The FCWB is a private non-for-profit corporation registered under Section 501c(3) of U.S.
Internal Revenue Code. The FCWB is governed by a board of directors comprised of
volunteers from all four counties in the region who represent private sector business,
economic development, education, organized labor, community based organizations, veterans
and state and local government agencies. Joint oversight is provided through an agreement
with the Board of County Commissioners from each of the four counties in Region 7. The
mission of the FCWB is to deliver all programs and services to customers through its One
Stop System. This system is both physical and technological and includes connectivity
between various partners and service providers.
The goal of the One Stop System is to provide full-service, staffed sites, offering a full array
of Workforce Investment Act (WIA), Welfare Transition (WT), Wagner Peyser (WP),
Supplemental Nutrition Assistance Program (SNAP), Priority Re-Employment Planning
(PREP), Reemployment & Eligibility Assessment (REA), ACCESS, and Veteran’s services
to our area residents, which will assist individuals to obtain employment. The One Stop
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System has been developed through two Universal Centers located on each in Lake City and
Trenton.
1.4 AUTHORITIES
This Request for Proposal is being issued under the terms and requirements of the current
federal Workforce Innovation Act regulations.
1.5 FURTHER CONDITIONS
The FCWB has the responsibility to ensure contracted costs are necessary, reasonable, and
allowable as defined by State and Federal standards.
It is essential to the administration, coordination, availability, and delivery of FCWB services
that the Proposer be impartial in all matters. Therefore, the FCWB reserves the right to reject
a Proposal where there will be a continuing or frequently recurring conflict between the
Proposer’s private interests and the performance of the Proposer’s duties in the public’s
interest.
This RFP does not commit or obligate the FCWB to award a contract, to commit any funds
identified in this RFP document, to pay any costs incurred in the preparation or presentation
of a Proposal to this RFP, to pay for any costs incurred in advance of the execution of a
contract, or to procure or contract for services or supplies.
Payment for the provision of services from any award resulting from this RFP is contingent
upon annual appropriation by the State of Florida Legislature and availability of any and all
applicable federal funds.
The FCWB furthermore reserves the right to:
1) Reject any and/or all Proposals in whole or in part as the FCWB deems is in its best
interest.
2) Change or waive any provisions set forth in this RFP.
3) Return non-responsive Proposals without review.
4) Waive informalities and minor irregularities in Proposals received, as the FCWB
deems appropriate.
5) Request additional data, technical or price revisions, or oral presentations in support
of the written Proposal.
6) Independently determine that an arms-length agreement exists between the Proposer
and any sub-contractors or vendors they might choose to use.
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7) Verify any factual information as it is presented within the Proposal.
8) Require the establishment of escrow accounts for a Proposer that currently has
outstanding debts to the FCWB as a result of audits or monitoring reviews.
9) Conduct an analysis that may include, but is not limited to, a review of the Proposer’s
record keeping procedures, management systems, accounting and administrative
systems, personnel qualifications, program materials, customer satisfaction levels,
previous contract performance records and adherence to current budget/contracting
requirements.
10) Use additional or de-obligated grant funds or newly acquired supplemental revenues
to increase the same or similar services without regard to further procurement when a
Contractor is performing satisfactorily.
11) Change specifications and modify contracts as necessary to facilitate compliance with
legislation, regulations and policy directives, to manage funding, and/or to meet the
needs of children, families, and caregivers.
12) Conduct analysis of the budget and projected costs submitted by the Proposer in
response to this RFP, to be submitted to the FCWB as part of the review process.
13) To make any and all determinations exclusively which it deems necessary to protect
the best interests of the FCWB and either directly or indirectly through any of its
Contractors. The absence of the FCWB setting forth a specific reservation of rights
does not subject other areas of any contract resulting from this RFP to mutual
agreement.
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SECTION 2: RFP PROCESS
2.1 PROCUREMENT SCHEDULE
The FCWB’s RFP process will generally adhere to the following procurement schedule. The
dates and locations listed below are subject to change. Proposers will be notified of any
changes made to the procurement schedule. All times are Eastern Time.
ACTIVITY
DATE
Request for Proposals Released
10/8/13
Notice of Intent to submit a Proposal
due to the FCWB
10/10/13 @ 4:00
P.M. ET
Last day for submission of
inquiries
10/10/13 @ 4:00
P.M. ET
FCWB response to inquiries
LOCATION*
Posted on the web and sent
via email
1389 US Highway 90 West,
Suite 170
Lake City, FL 32055
1389 US Highway 90 West,
Suite 170
Lake City, FL 32055
Responses will be posted on
the web and sent via email
10/12/12
1389 US Highway 90 West,
Suite 170
Proposals due
Lake City, FL 32055
1389 US Highway 90 West,
10/16/13 @ 9:00 Suite 170
Initial opening of Proposals
A.M. ET
Lake City, FL 32055
Posted on the web and sent
Posting of awards
10/17/13
via email
*Locations subject to change. Notification of any changes will be made to all interested
parties as well as posted at the www.floridacrown.org website.
10/15/13 @ 4:00
P.M. ET
2.2
CONTACT PERSON
The Florida Crown Workforce Board, Inc., representing Columbia, Dixie, Gilchrist, and
Union Counties, issues this RFP. The person listed below is the contact for this RFP:
Robert Jones
Florida Crown Workforce Board, Inc.
1389 US Highway 90 West, Suite 170
Lake City, FL 32055
(386) 755-9026, Ext. 3218
rljones@flcrown.org
Note: Florida has a very broad public records law. Most written communications to or from
state officials or appointed councils regarding state business are public records available to
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the public and media upon request. E-mail communications may therefore be subject to
public disclosure.
2.3 LIMITATIONS ON CONTACTING FCWB PERSONNEL
Proposers are prohibited from contacting FCWB personnel or Board members regarding this
solicitation other than the contact person identified in Section 2.2 of this document. Any
violation may result in the disqualification of the Proposer. Please refer to Section 2.6 for
instructions regarding inquiries.
2.4
INTENT TO SUBMIT A PROPOSAL
Interested Proposers must sign and submit Intent to Submit (Appendix A) no later than
October 10, 2013 @ 4:00 P.M. ET to:
Robert Jones
Florida Crown Workforce Board, Inc.
1389 US Highway 90 West, Suite 170
Lake City, FL 32055
(386) 755-9026, Ext. 3218
FAX: (386) 487-1218
EMAIL: rljones@flcrown.org
Submission of Intent to Submit document does not obligate a prospective Proposer to submit
a Proposal. Failure to submit Intent to Submit document by the due date and time will
disqualify the Proposer from further consideration. The Intent to Submit document may be
delivered via mail services, in person or by facsimile or electronic transmission. Information
regarding any addenda to the RFP and copies of written responses to questions resulting in
clarifications or addenda to the RFP will only be sent to those Proposers submitting the Intent
to Submit document.
2.5 PROPOSER’S PRE-PROPOSAL CONFERENCE
This section intentionally omitted.
2.6 INQUIRIES
All inquiries requesting clarification regarding this RFP must be made in writing to the
identified contact person and received no later than October 10, 2013 @ 4:00 P.M. ET.
INQUIRIES MAY BE SUBMITTED IN PERSON OR VIA CERTIFIED MAIL,
FACSIMILE, OR ELECTRONICALLY. It is the responsibility of the Proposer to ensure
that facsimiles and electronic information has been received by the FCWB.
Written inquiries received no later than October 10, 2013 @ 4:00 P.M. ET will be provided
electronically to all Proposers who have submitted the Intent to Submit a Proposal document.
The response to written inquiries will be posted on the website, distributed by email, and
available at the FCWB office no later than October 12, 2013.
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Information regarding any addenda to the RFP and copies of written FCWB responses to
questions resulting in clarifications or addenda to the RFP will be posted on
www.floridacrown.org.
2.7 ACCEPTANCE OF PROPOSALS
A complete Proposal must be received in the FCWB office no later than October 15, 2013
@ 4:00 P.M. ET to the following address:
Robert Jones
Florida Crown Workforce Board, Inc.
1389 US Highway 90 West, Suite 170
Lake City, FL 32055
FACSIMILES OR ELECTRONIC TRANSMISSIONS WILL NOT BE ACCEPTED
The Proposal will be submitted in a sealed package containing the original and four (4)
hard copies of the Proposal for the purpose of review by the FCWB:
1) Fatal Criteria; and
2) Scope of Work Response; and
3) Completeness of all Required Forms and Timeliness of all Required Submissions
(Refer to Section 7 for Instructions on Submission of RFP documents)
Any Proposal submitted shall remain a valid offer for at least 180 days after the Proposal
submission date. No changes, modifications or additions to the submitted Proposal will be
accepted by or be binding on the FCWB after the October 15, 2013 deadline for submitting
Proposals has passed.
THE PROPOSER IS SOLELY RESPONSIBLE FOR ASSURING THAT ANYTHING
SENT TO THE FCWB ARRIVES SAFELY AND ON TIME. ANY SUBMISSION TO
THE FCWB, INCLUDING
INQUIRIES REGARDING THE RFP, AND/OR
PROPOSALS NOT RECEIVED AT EITHER THE SPECIFIED PLACE AND/OR BY
THE SPECIFIED DATE AND TIME WILL BE REJECTED AND RETURNED
UNOPENED TO THE PROPOSER BY THE FCWB.
2.8 WITHDRAWAL OF PROPOSAL
A written request for withdrawal, signed by the Proposer, may be considered if received by
the FCWB prior to the Proposal opening time and date indicated in the Procurement
Schedule in Section 2.1 of this RFP.
2.9 NOTICE TO AWARD
Through completion of the Proposal review process described in Section 8 of this RFP, a
Committee of the FCWB will review and score Proposals that have met the Fatal Criteria.
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The Proposer with the highest Total Proposal Score will be presented to the FCWB’s Board
of Directors for approval to negotiate a contract. Approval will also be requested from the
Board to negotiate with the next highest scored proposal in the event agreement cannot be
reached with the highest scored proposal. The Proposal scores will be posted on the date
specified in the Procurement Schedule in Section 2.1 of this RFP at the following location:
Florida Crown Workforce Board, Inc.
1389 US Highway 90 West, Suite 170
Lake City, FL 32055
www.floridacrown.org
2.10 SURETIES
Please provide the FCWB with evidence of Surety Bonds designed to provide assurance of
the timely and appropriate performance of key employer services. The Proposer is required
to add the Florida Crown Workforce Board, Inc. as a named insured in the bonds.
The bond must be issued by a surety company authorized to do business in the State of
Florida by the Department of Insurance and signed by a Florida licensed agent pursuant to
Section 287.0935, F.S.
2.11 INSURANCE
The Proposer shall maintain continuous adequate liability insurance coverage on a
comprehensive basis including, but not limited to, Commercial General Liability, Workers’
Compensation, Employer Practices Liability, and Professional Liability, and hold such
liability insurance at all times during the existence of the contract and any renewal(s) and
extension(s) of it as follows:
Coverage
Minimum Limits
Commercial General Liability to include a Broad $1,000,000 combined single limit
Form Property Damage Endorsement and occurrence $2,000,000 Aggregate
Contractual Liability
Workers' Compensation
Statutory
Employer Practices Liability
$1,000,000 per occurrence
Professional Liability
$1,000,000 per claims made as applicable
per
** The FCWB reserves the right to require additional insurance
All insurance policies shall be with insurers who are qualified and doing business in Florida.
Upon execution of the contract, the Proposer shall furnish the FCWB written verification
supporting the determination and extent of the types of insurance and written proof of
coverage of insurance by certificates of insurance accompanying the contract documents and
each policy shall name the FCWB as additional insured.
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The Proposer shall not commence any work in connection with the contract until the FCWB
has approved its insurance coverage. The FCWB shall be exempt from, and in no way liable
for, any sums of money that may represent a deductible in any insurance policy. The
payment of such deductible shall be the sole responsibility of the Proposer.
The FCWB may withhold payments or terminate the contract if the Proposer fails to maintain
or provide evidence of current insurance. Every insurance policy must provide the FCWB
with a thirty (30) day prior written notice of intent not to renew, or reduction in the policy
coverage, as well as a minimum of forty-five (45) days notice of cancellation.
2.12 PROTEST OR DISPUTES
Any organization that submits a response to the FCWB will receive fair and unbiased
consideration. In accordance with the FCWB regulations, respondents who are denied
funding have the right to appeal. The following steps must be taken for organizations to
appeal funding decisions.
Submit a letter of protest within ten (10) days of the final decision address to:
Jennie Reed, Chair
Florida Crown Workforce Board, Inc.
1389 US Highway 90 West, Suite 170
Lake City, FL 32055
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SECTION 3: SCOPE OF WORK
3.1 GENERAL STATEMENT
The FCWB is seeking responses from qualified Professional Employer Organizations (PEOs)
who can demonstrate written evidence of past performance and business endeavors that align
with the purpose, values, and vision of the FCWB, to provide exemplary cost-effective
human resource solutions and manage employee risks as outlined in this Section of the RFP.
Proposers should note that partial responses to proposed services, as determined by the
FCWB, will be deemed non-responsive and will disqualify the Proposer from further
consideration. To ensure full coverage of all required service components and to promote
collaboration among qualified organizations, Proposers may propose written sub-contracting
arrangements with other qualified partners as long as the qualifications and costs associated
with such proposed sub-contracts are clearly identified in the Proposal, and there is sufficient
justification for the sub-contract.
The FCWB is the designated administrative entity and sub state grantee for the Region 7 area
and has been charted by the Governor as the regional workforce development board. As
such, the FCWB oversees the planning and implementation of a variety of welfare reform
and workforce development programs in Columbia, Dixie, Gilchrist, and Union Counties.
The FCWB delivers all programs and services to customers through its One Stop System.
This system is both physical and technological and includes connectivity between various
partners and service providers. The goal of the One Stop System is to provide full-service,
staffed sites, offering a full array of services to residents of the four counties which we serve
which will assist individuals to obtain employment through an individual mix of activities.
Our One Stop System is developed through two Universal Centers located one each in Lake
City and Trenton.
3.2 PROPOSER’S QUALIFICATIONS
[A] Qualified Proposers shall provide a written summary demonstrating exemplary past
experience in expeditiously and efficiently providing the services of a Professional
Employer Organization (PEO) to include:
1. Written evidence of past performance and business endeavors that align with the purpose,
values, and vision of the FCWB.
2. Number of years the PEO has been in business in the United States and in Florida.
Indicate if the PEO is a State of Florida based corporation and does it have an office in
the FCWB’s service area of Columbia, Dixie, Gilchrist, and Union counties. Provide a
copy of your State License. Indicate your Federal Employer Identification Number and if
the PEO has been certified as a Minority Business Enterprise for the purposes of doing
business with state government, include a copy of Minority Business Enterprise
Certification.
3. Membership in a National Association or Organization to assure the FCWB that the PEO
is current with industry developments. If not a member of a National Association or
Organization you must explain how you stay abreast of industry developments.
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4. Membership in Employer Services Assurance Corporation (ESAC), or provide
information allowing the FCWB to assure the FCWB that its employees and employment
taxes will be paid and benefit payments will be assured in the event of payment default
by the PEO.
5. Workers’ Compensation Certification Program evidencing that the PEO’s risk
management program is meeting proven insurance industry risk management best
practices to reduce work-related accidents and control losses.
6. Any additional Industry Recognized Awards/Certifications.
7. Identify the PEO’s workers’ compensation carrier, the rating of the carrier, how long the
PEO has been with the carrier, and what coverage commitment the PEO has for the
future.
8. Credentials and experience of the PEO’s administrative, human resources, and risk
management staff and indicate the average staff tenure with the organization.
9. Professional and client references, including bank and credit references. The PEO shall
demonstrate that payroll taxes and insurance premiums have been paid consistently and
timely.
10. Identity how the employee benefits are funded, indicating if they are fully insured
(required for health benefits in Florida) or partially self-funded. Who the third party
administrator(s) or carrier(s) are and provide written evidence of the financial viability of
these organizations.
11. Indicate if the PEO offers a Client Defense Program and up to what dollar amount will
the PEO pay for legal fees for the defense of qualified employee lawsuits filed against the
FCWB.
12. Indicate if the PEO offers Employment Practices Liability Insurance (EPLI) coverage.
Identify the PEO’s insurance carrier, the coverage per claim and overall aggregate, the
deductible per claim. Indicate the type of claims included in the coverage.
[B] Qualified Proposers shall describe their organization’s financial viability with particular
attention given to the Proposer’s ability to continue in business for the duration of the
contract period(s). The description should include an analysis of operation data for the
last three (3) years and a trend analysis noting prospectively how the organization
believes operations will continue based on historical results. The description should
include the number of years in operation.
3.3 SERVICES TO BE PROVIDED
The following are the services to be provided by a qualified Professional Employer
Organization (PEO) for the FCWB for approximately 20 (twenty) employees receiving
payroll every two (2) weeks made through electronic deposits or through issuing checks:
A. Human Resource Management
The FCWB requires the Proposer to provide a detailed description of their human resource
management services to include:
1. Personnel Consultation and Assistance
2. Unemployment Claims Handling
3. Conflict Resolution
4. Employee Handbooks, Employment Forms, Policies
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5. Personnel File Maintenance
6. Compliance with Employment Laws and Regulations
7. Employee Background Checks
8. Drug Testing Program
9. Supervisory Training on Legal Compliance, Management
10. Pre-employment Screening/Skills Testing
11. Employee Hiring/Firing (Advice and Assistance)
12. Employee Discipline
B. Workers’ Compensation/Safety
The FCWB requires the Proposer to provide a detailed description of their workers’
compensation/safety services to include:
1. Workers’ Compensation Claims Handling
2. Compliance with Workers’ Compensation Laws
3. Investigation of Employee Claims
4. Fraudulent Claims Reward Program
5. Managed Care Program
6. Preparation/Compliance with OSHA Regulations
7. Safety Policies and Inspections
C. Benefits
The FCWB requires the Proposer to provide a detailed description of their benefits to
include:
1. Workers’ Compensation Insurance (mandatory)
2. Health Insurance
3. Dental Insurance, if available
4. Vision Insurance, if available
5. Life Insurance
6. Disability Insurance
7. 401 (K) Retirement Plan
8. Track Eligibility Dates for Benefits, Conduct Enrollments
9. Compliance with COBRA, HIPAA, ERISA
10. IRA and Savings Bond Plan
11. Employee Assistance Program
12. Tuition Reimbursement
13 Cafeteria Plan/Flexible Spending Account Plan
14. Adoption Assistance
15. Credit Counseling
16. Employee Entertainment and Services Discounts
D. Payroll
The FCWB requires the Proposer to provide a detailed description of their payroll services to
include:
1. Report Hours
2. Computation and Preparation of Payroll
3. Direct Deposit
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4. Deductions for Child Support, Levies, and Garnishments
5. Withhold Income Taxes and FICA
6. Complete Quarterly Tax Filings
7. Complete W-4s, I-9s, and W-2s,
8. Print/Deliver Checks
9. Employer Verification
10. Employee Earnings Records
11. Customized Reporting of Payroll Costs
E. Training Programs
The FCWB requires the Proposer to provide a detailed description of their training programs
to include:
1. Schedule of Trainings/Seminars Offered
2. Cost to the FCWB to Attend Trainings/Seminars
3. Supervisory Training on Legal Compliance, Management
4. Workers’ Compensation/ Safety Training
F. Online Services
The FCWB requires the Proposer to provide a detailed description of their online services to
include:
1. Timekeeping, Timesheets, and Timeclocks
2. Access – Reporting, Data Change Requests, New Hire Enrollment and Payroll Entry
3.4 PRICE FOR PROFESSIONAL EMPLOYER ORGANIZATION (PEO) SERVICES
The FCWB requires the Proposer to provide detailed, itemized pricing for each service
provided in Section 3.3 of this RFP to include all applicable costs and fees to the FCWB.
The Proposer shall indicate the thresholds for changes in costs and fees and whether it is an
increased or decreased cost/fee. The Proposer shall indicate if there are any other costs to the
FCWB.
Additionally, the FCWB requires the Proposer to provide a sample of their invoice, itemizing
applicable costs and fees to include:
1. Employer Taxes:
- Social Security
- Medicare
- Federal Unemployment
- State Unemployment
2. Administrative Fee
3. Workers’ Compensation Insurance (approximately 20 employees)
4. Combined Rates for Services Provided
5. Combined Rates for Services Provided After $7,000.00 State and Federal caps are
met.
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SECTION 4 - CONTRACTOR RESPONSIBIITIES AND SPECIFICATIONS
4.1 STAFFING LEVELS AND FUNCTIONS
The Contractor shall maintain sufficient staff to deliver the agreed upon Professional
Employer Organization (PEO) services as specified in the Contractor’s Proposal.
Upon execution of the contract, the Contractor must provide a current organizational chart
listing positions and lines of authority.
The Contractor must submit written notification, within five (5) working days, to the FCWB
of changes in key staff. When the position is filled, the FCWB shall be notified in writing of
the identity and qualifications of the new incumbent.
4.2 PROFESSIONAL QUALIFICATIONS
The Contractor will ensure that all staff are appropriately qualified and participate in a
professional development plan.
4.3 SUBCONTRACTORS
Within each component of the Proposal, the Proposer may include the subcontracting of
specific services. However, awarding the contract to the Proposer does not commit nor
require the FCWB to accept any proposed sub-contractor, nor does it relieve the Proposer
from responsibility for full performance under any contract that may result from this RFP.
The Contractor shall be responsible for service delivery, monitoring and quality assurance of
all subcontracts. The Contractor shall have written procedures for monitoring of
subcontracts; including corrective action plans and follow-through to ensure implementation
of required improvements.
Subcontractors known at the time of Proposal submission and the amount of the subcontract
shall be identified in the Proposer’s response to this RFP. Subcontracts shall be approved in
writing by the FCWB prior to the effective date of any subcontract. No subcontract, which
the Contractor enters into with respect to performance under a contract resulting from this
RFP, shall in any way relieve the Contractor of any responsibility for performance of its
duties. Payments to subcontractors shall be the responsibility of the Contractor. No
payments to the Contractor, with respect to subcontracts, will be processed until all
subcontracts are approved, in writing, by the FCWB.
4.4 RECORDS AND DOCUMENTATION
During the term of the contract, the Contractor shall maintain accurate records and any
documentation required by the State and/or Federal regulations. The Contractor shall
provide copies of all such documentation and records as determined by the FCWB. After
termination of the contract, the Contractor shall be required to keep all records a period of
five (5) years from the time of service as well as five (5) years from the close of an audit.
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The Contractor agrees to maintain the confidentiality of all records required by law or
administrative rule to be protected from disclosure. The Contractor further agrees to hold
harmless, defend, and indemnify the FCWB from any claim or damage, including reasonable
attorney's fees and costs or from any fine or penalty imposed as a result of an improper
disclosure by the Contractor of confidential records at its expense. The Contractor shall
maintain all records required to be maintained pursuant to the resulting contract in such
manner as to be accessible by the FCWB upon demand. Where permitted under applicable
law, access by the public shall be permitted without delay.
4.5 MONITORING AND PERFORMANCE REQUIREMENTS
Contractors must comply with the requirements of the FCWB's contract with reference to
monitoring by the FCWB. The FCWB will monitor for compliance on an ongoing basis
during the fiscal year. The Contractor also agrees to fully cooperate with the FCWB in the
conduct of performance audits as applicable.
The Contractor agrees to include the applicable monitoring and performance requirements in
all approved subcontracts and assignments that result from this RFP.
The FCWB will conduct quality assurance reviews during the contract period for the
following purposes:
1)
2)
3)
4)
To assess the quality of services provided under this contract;
To determine compliance with FCWB requirements;
The extent to which key indicators of performance are being achieved; and
To validate internal quality improvement systems and findings.
4.6 FINANCIAL AUDIT REQUIREMENTS
Contractors must comply with the requirements of the FCWB’s contract with reference to
financial audits as applicable.
The Contractor agrees to include the audit requirements in all approved subcontracts and
assignments that result from this RFP.
This part is applicable if the Contractor is a state or local government or a non-profit
organization as defined in OMB Circular A-133, as revised. In the event that the Contractor
expends $500,000 or more in Federal awards in its fiscal year, the Contractor must have a
single or program-specific audit conducted in accordance with the provisions of the federal
Single Audit Act of 1996 and OMB Circular A0133, as revised.
The provisions of this part are applicable if the Contractor is a non-state entity as defined by
section 215.97, Florida Statutes (the Florida Single Audit Act). In the event that the
Contractor expends a total amount of state financial assistance equal to or in excess of
$500,000 in any fiscal year, the Contractor must have a state single or project-specific audit
for such fiscal year in accordance with section 215.97, Florida Statutes; applicable rules of
16
the Department of Financial Services and chapter 10,550 (local governmental entities) or
chapter 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General.
4.7 CONTRACTOR UNIQUE ACTIVITIES
The Contractor and the FCWB, in the performance of the contract, shall be considered coemployers of those employees covered in Section 3.3 of this RFP.
The Contractor shall hold confidential all information relating to FCWB personnel, which is
obtained by the Contractor under the resulting contract and shall not use the information
obtained in any manner except as permitted by law.
The Contractor shall be knowledgeable of and in full compliance with all state and federal
laws, rules, and regulations as amended from time to time that affects or may affect the
subject areas of this contract including, but not limited to, the authorities listed in the
applicable sections of this RFP. The Contractor shall request technical assistance from the
FCWB when deemed necessary to facilitate compliance with these authorities. The FCWB's
failure to provide such technical assistance does not relieve the Contractor of its
responsibilities to ensure compliance with all state and federal laws, rules and regulations or
performance under the terms of the contract.
4.8 FCWB DETERMINATIONS
The FCWB reserves the right to make any and all determinations exclusively which it deems
are necessary to protect the best interests of the FCWB, its employees, and the customers
who are served by the FCWB either directly or through any one of its Contractors. The
absence of the FCWB setting forth a specific reservation of rights does not subject other
areas of the contract resulting from this RFP to mutual agreement.
4.9 REQUIRED REPORTS
Contractors must comply with the requirements of the FCWB's contract with reference to
reporting requirements by the FCWB. The FCWB will monitor for compliance on an
ongoing basis during the fiscal year. All Proposers should note the FCWB requires that
reporting be timely. As such, it is expected that 100% of required reports are submitted on or
before the due date unless approved in writing by the FCWB’s Executive Director.
The Contractor agrees to include the applicable reporting requirements in all approved
subcontracts and assignments that result from this RFP.
17
SECTION 5 - FINANCIAL SPECIFICATIONS
5.1 FUNDING SOURCES
The FCWB is a sub-recipient of Federal Funds as well as State General Revenue funds.
Accordingly, the contract will require fiscal and compliance audits as mandated by State and
Federal regulations.
5.2 LOCAL MATCH REQUIREMENTS
This section intentionally omitted
5.3 COST ALLOCATION, ALLOWABLE COSTS, AND DISALLOWANCES
The FCWB has the responsibility to ensure contracted costs are necessary, reasonable, and
allowable as defined by State and Federal standards.
5.4 INVOICING AND PAYMENT OF INVOICES
Payment of invoices by the FCWB to the Contractor is governed by section 215.422, Florida
Statutes.
18
SECTION 6- TERMS AND CONDITIONS
6.1 TERMS AND CONDITIONS
The final terms and conditions will be negotiated with the highest scored Proposer and as
approved by the FCWB’s Board of Directors.
Remainder of Page Intentionally Left Blank
19
SECTION 7: THE PROPOSAL
7.1 GENERAL INSTRUCTIONS FOR SUBMISSION OF THE PROPOSAL
This section sets forth the manner in which the proposal is to be compiled. The Proposal
shall be submitted in a sealed package containing the original and four (4) hard copies of
the Proposal as follows:
(A) Package Contents (compiled in this order):
1) Page 1 - Fatal Criteria Checklist (Appendix B)
**Failure to comply with all Fatal Criteria will render a Proposal non-responsive
and ineligible for further evaluation.
2) Scope of Work Written Response:
a. Proposer’s Qualifications (Section 3.2 of this RFP))
b. Services to be Provided (Section 3.3 of this RFP)
c. Price for Professional Employer Organization (PEO) Services (Section 3.4 of this
RFP)
3) Required Signed Documents and Certifications:
(i) Request for Proposal Acknowledgement Form (Appendix C)
(ii) Acceptance of Contract Terms and Conditions (Appendix D)
(iii) Statement of No Involvement (Appendix E)
(iv) Statement of Assurances (Appendix F)
(v) Certification Regarding Debarment, Suspension, and other Responsibility Matters
Primary Covered Transactions (Appendix G)
(vi) Sworn Statement Pursuant to Section 287.133(3) (A), Florida Statutes on Public
Entity Crimes (Appendix H)
(vii) Statement of Non-Discrimination (Appendix I)
(viii) Certification Regarding Lobbying (Appendix J)
(ix) Certification Regarding Drug-Free Workplace (Appendix K)
**The Package Contents shall not exceed forty (40) pages in total.
The narrative information is to be presented single sided on 8.5 by 11 paper using a 1-inch
top, bottom and left/right margin and minimum 12-point font in either Arial or Times New
Roman.
All Required Forms and Certifications must be signed by the designated official in BLUE ink
as an indicator of “original signature”.
Proposers should not submit additional documents such as Annual Reports, Brochures, etc.
Proposers should note that partial responses to proposed services will be deemed nonresponsive and will disqualify the Proposer from further consideration.
20
(B) Electronic Copy:
After the Initial Opening of Proposals at 9:00 A.M. on October 16, 2013 the Proposer
acknowledges and agrees upon request by the FCWB, to submit one (1) electronic copy of
the Package Contents of the Proposal to:
rljones@flcrown.org
7.2 COST OF PREPARATION OF PROPOSAL
The FCWB is not liable for any costs incurred by a Proposer in responding to this Request
for Proposal.
Remainder of Page Intentionally Left Blank
21
SECTION 8: PROPOSAL REVIEW PROCESS
8.1 OVERVIEW OF THE PROPOSAL REVIEW PROCESS
The FCWB will review and score each Proposal submitted in response to this RFP. As
outlined within this section, the FCWB will follow a Proposal review process to score
Proposals, and all proposals that are scored will be presented to the full FCWB Board along
with the recommendation that the Board approve the start of negotiations with the highest
scoring proposal. If terms and conditions cannot be successfully negotiated within a
timeframe set by the FCWB, then the second highest scored proposal will be contacted and
the negotiations begin with that entity. The Proposal review process will be conducted as
follows and in the order listed below:
Step
1. Determination of
meeting RFP fatal
criteria
Process
Prior to Proposals being
forwarded to the Committee,
FCWB staff will conduct a
review of submitted Proposals
to determine that fatal criteria
as outlined in the RFP have
been met.
2. Review of scope
response of
Proposals
Members of the Committee
will independently review and
score the scope response of
each Proposal meeting all
mandatory fatal criteria
requirements as outlined in
Section 3.
The highest scoring Proposal Proposals are ranked by score.
is recommended to the full
FCWB Board for Contract
Award.
3. Total Score
Scoring
Points are not awarded for this
section. Proposals that do not
meet all fatal criteria are
disqualified, and no further
review is conducted.
The Proposer that didn’t meet
the fatal criteria will be notified
and the Proposal will not be
returned to the Proposer.
Points are awarded for this section.
8.2 TOTAL PROPOSAL SCORE
The highest scoring Proposal is recommended to the full FCWB Board for award; however,
the Board shall select the proposal they determine to be in the best interest of the board.
8.3 FINAL DETERMINATION
After completion of the Proposal review and scoring process, the Review Committee will
present a summary of all proposals that were scored to the Board and recommend approval to
begin contract negotiations with the highest scored proposal. The Committee shall also ask
the Board for approval to begin contract negotiations with the next highest scored proposal if
22
a contract cannot be successfully negotiated within a timeframe as set by the FCWB. The
Notice of Intent to Award will be posted on the date specified in the Procurement Schedule in
Section 2.1 of this RFP at the www.floridacrown.org website.
Remainder of Page Intentionally Left Blank
23
APPENDICES
24
Appendix A
INTENT TO SUBMIT
Title of Proposal
Proposer’s Name
Proposer Contact Person
Title
Proposer Address
City
State
Zip
Telephone
Fax
E-mail
Signature of Authorized Official
Date
Name (Print)
Title (Print)
25
Appendix B
FATAL CRITERIA CHECKLIST
TITLE OF PROPOSAL
PROPOSER’S NAME
CONTACT PERSON AND TITLE
ADDRESS
TELEPHONE
FAX
EMAIL
FATAL CRITERIA CHECKLIST
1. Was the Proposal received by the time and date specified in the
RFP?
2. Original and four (4) hard copies and one (1) electronic of the
Proposal?
3. Was the Intent to Submit form received by the time and date
specified in the RFP? (Appendix A)
4. Was the Fatal Criteria Checklist submitted as Page1? (Appendix B)
5. Was the Scope of Work Response included?
6. Original signed and dated Request for Proposal Acknowledgement
form? (Appendix C)
7. Original signed and dated Acceptance of Contact Terms and
Conditions? (Appendix D)
8. Original signed and dated Statement of No Involvement? (Appendix
E)
9. Original signed and dated Statement of Assurances? (Appendix F)
10. Original signed and dated Certification Regarding Debarment,
Suspension, and other Responsibility Matters Primary Covered
Transactions? (Appendix G)
11. Original signed and dated Sworn Statement Pursuant to Section
287.133(3) (A), Florida Statutes on Public Entity Crimes?
(Appendix H)
12. Original signed and dated Statement of Non-Discrimination?
(Appendix I)
13. Original signed and dated Certification Regarding Lobbying?
(Appendix J)
14. Original signed and dated Certification Regarding Drug-Free
Workplace? (Appendix K)
26
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
15. Were all accompanying forms requiring signature signed by a duly
authorized officer of the applying organization, and was proof of
authorization included, if needed?
DID PROPOSAL MEET ALL FATAL CRITERIA?
YES
NO
YES
NO
**Failure to comply with all Fatal Criteria will render a Proposal non-responsive and
ineligible for further evaluation.
27
Appendix C
Florida Crown Workforce Board, Inc.
REQUEST FOR PROPOSAL ACKNOWLEDGEMENT FORM
Proposer Name
Proposer Mailing Address
City
State
Zip
Telephone Number
Web Page
Email
Number of Pages in the Proposal: _____
I certify that this Proposal is made without prior understanding, agreement, or connection with
any corporation, firm, or person submitting an offer for the same material, supplies, equipment,
or services and in all respects fair and without collusion or fraud. I agree to abide by all
conditions of this Proposal and certify that I am authorized to sign this response and that the
offer is in compliance with all requirements of the Request for Proposals, including but not
limited to, certification requirements.
The Proposer offers and agrees that if this Proposal is awarded, the Proposer will convey, sell,
assign, or transfer to the Florida Crown Workforce Board, Inc. all rights, title and interest in and
to all causes of action it may now or hereafter acquire under the Anti-trust laws of the United
States and the State of Florida for price fixing relating to the particular commodities or services
purchased or acquired by the Florida Crown Workforce Board, Inc. At the FCWB’s discretion,
such assignment shall be made and become effective at the time the FCWB tenders final
payment to the Proposer.
Signature of Authorized Official
Date
Name (Print)
Title (Print)
28
Appendix D
ACCEPTANCE OF CONTRACT TERMS AND CONDITIONS
If___________________________________________________________________ should be
awarded this Contract, it will comply with all the terms and conditions specified in the RFP and
contained in Contract.
Signature of Authorized Official
Date
Name (Print)
Title (Print)
*An authorized official is an officer of the Proposer’s organization who has legal authority to
bind the Proposer to the provisions of the Proposal. This usually is the President, Chairman of
the Board, Executive Director, or owner of the entity. A document establishing delegated
authority must be included with the Proposal if signed by other than the President, Chairman,
Executive Director, or owner.
29
Appendix E
STATEMENT OF NO INVOLVEMENT
I, __________________________________________, as an authorized representative of
_____________________________________________, certify that no member of this firm nor
any person having interest in this firm has been awarded a Contract by the Florida Crown
Workforce Board, Inc. on a noncompetitive basis to:
1)
Develop this Request for Proposal
2)
Perform a feasibility study concerning the scope of work contained in this RFP; or
3)
Develop a program similar to what is contained in this RFP.
Signature of Authorized Official
Date
Name (Print)
Title (Print)
30
Appendix F
STATEMENT OF ASSURANCES
The Proposer assures the following itemized requirements and conditions will be met:
1) The Proposer has the ability to provide directly, or through sub-contract, all
products/services described in this RFP and resulting Contract.
2) The Proposer will accept accountability for meeting the performance standards
established by the FCWB and as may be required by the State and Federal government
related to the products/services described in this RFP.
3) The Proposer assures the establishment of sufficient working capital to meet and to
maintain product order volume.
4) The Proposer assures that there are no continuing or frequently recurring conflicts
between the Proposer’s private interests and the performance of the Proposer’s duties in
the public interest.
Signature of Authorized Official
Date
Name (Print)
Title (Print)
Witnessed By:
Witness
Date
Name (Print)
Title (Print)
Witness
Date
Name (Print)
Title (Print)
31
Appendix G
CERTIFICATION REGARDING
DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS
PRIMARY COVERED TRANSACTIONS
This certification is required by the regulations implementing Executive Order 12549,
Debarment and Suspension, 29 CFR Part 98, Section 98.510, Participants Responsibilities. The
regulations were published as Part VII of the October 26, 1988 Federal Register (pages 19160 –
19211).
1) The prospective primary participant certifies to the best of its knowledge and belief, that
it and its principals:
a. Are not presently debarred, suspended, proposed for debarment, and declared
ineligible or voluntarily excluded from covered transactions by any Federal
department or agency.
b. Have not within a three (3) year period preceding this Contract 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.
c. 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 1.b. of this certification.
d. Have not within a three (3) year period preceding Proposal had one or more public
transactions (Federal, State, local) terminated for cause or default.
2) 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 Proposal.
Signature of Authorized Official
Date
Name (Print)
Title (Print)
32
Appendix H
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.
1. This sworn statement is submitted by __________________________________ for
________________________________________.
whose
business
address
is
____________________________________________________ and (if applicable) its
Federal Employer Identification Number (FEIN) is ______________. (If the entity has no
FEIN, include the Social Security Number of the individual signing this sworn statement:
__________________________________.
2. I understand that a “public entity crime” as defined in Paragraph 287.133(1)(g), Florida
Statutes, means a violation of any state and 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 and services to be provided to any public entity or any agency
or political subdivision of any other state or of the United Stated and involving antitrust,
fraud, theft, bribery, collusion, racketeering, conspiracy or material misrepresentation.
3. I understand the “convicted” or “conviction” as defined in Paragraph 287.133(l) (b), Florida
Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an
adjudication of guilt, in any federal or state trial court of record relating to charges brought
by indictment or information after July 1, 1989, as a result of a jury verdict, non-jury trial, or
entry of a plea of guilty or nolo contendere.
4. I understand that an “affiliate” as defined in Paragraph 287.133(l) (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 who has been convicted of a public entity crime. The term “affiliate” included
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 for fair market value an arm’s length agreement, shall
be a prima facie case that one person controls another person. A person who knowingly
enters into a join 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), 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 and services let by a public entity, or which otherwise transacts or
applies to transact business with a public entity. The term “person” includes those officers,
directors, executives, partners, shareholders, employees, members, and agents who are active
33
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 or the entity has been charged with and
convicted of a public entity crime subsequent to July 1,1989.
_________ The entity 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 1, 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 1, 1989. However, there has been a
subsequent proceeding before a Hearing Officer of the State of Florida, Division of
Administrative Hearings and the Final Order entered by the Hearing Officer determined that
it was not in the public interest to place the entity submitting this sworn statement on the
convicted vendor list. [Attach a copy of the final order]
I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR
THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY
ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OR 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.
Signature
Sworn to and subscribed before me this
day of
, 20____.
Personally known
or produced identification
Name of Notary:
Notary Public - State of
My commission expires:
_______________________________
(Printed typed or stamped
Commissioned name of notary public)
34
Appendix I
STATEMENT OF NON-DISCRIMINATION
Public Law 105-220, Sec. 188 Nondiscrimination
(a) In General.-(1) Federal financial assistance.—For the purpose of applying the prohibitions against
discrimination on the basis of age under the Age Discrimination Act of 1975 (42 U.S.C. 6101
et seq.), on the basis of disability under section 504 of the Rehabilitation Act of 1973 (29
U.S.C. 794), on the basis of sex under title IX of the Education Amendments of 1972 (20
U.S.C. 1681 et seq.), or on the basis of race, color, or national origin under title VI of the
Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), programs and activities funded or
otherwise financially assisted in whole or in part under this Act are considered to be
programs and activities receiving Federal financial assistance.
(2) Prohibitions of discrimination regarding participation, benefits, and employment. No
individual shall be excluded from participation in, denied the benefits of, subjected to
discrimination under, or denied employment in the administration of or in connection with,
any such program or activity because of race, color, religion, sex (except as otherwise
permitted under title IX of the Education amendments of 1972), national origin, age,
disability, or political affiliation or belief.
(3) Prohibition on assistance for facilities for sectarian instruction or religious worship.
Participants shall not be employed under this title to carry out the construction, operation, or
maintenance of any part of any facility that is used or to be used for sectarian instruction or
as a place for religious worship (except with respect to the maintenance of a facility that is
not primarily or inherently devoted to sectarian instruction or religious worship, in a case in
which the organization operating the facility is part of a program or activity providing
services to participants).
(4) Prohibition on discrimination on basis of participant status. No person may discriminate
against an individual who is a participant in a program or activity that receives funds under
this title, with respect to the terms and conditions affecting, or rights provided to, the
individual, solely because of the status of the individual as a participant.
(5) Prohibition on discrimination against certain noncitizens. Participation in programs and
activities or receiving funds under this title shall be available to citizens and nationals of the
United States, lawfully admitted permanent resident aliens, refugees, asylees, and parolees,
and other immigrants authorized by the Attorney General to work in the United States.
The undersigned has read and agreed to the statements described above.
Signature of Authorized Official
Date
Name (Print)
Title (Print)
35
Appendix J
CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief, that:
1) No federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or an
employee of any agency, a member of congress, an officer or employee of congress, or an
employee or member of congress in connection with the awarding of any federal contract,
the making of any federal grant, the making of any federal loan, the entering into any
cooperative agreement, and the extension, continuation, renewal, amendment, or
modification of any federal contract, grant, loan, or cooperative agreement.
2) If any funds other than federal appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency, a
member of congress, an officer or employee of congress, or an employee of a member of
congress in connection with this federal contract, grant, loan, or cooperative agreement,
the undersigned shall complete and submit Standard Form-LLL, “Disclosure Form to
Report Lobbying”, in accordance with its instructions.
3) The undersigned shall require that the language of this certification be included in the
award documents for all* subawards at all tiers (including subcontracts, subgrants, and
contracts under grants, loans, and cooperative agreements) and that all* subrecipients
shall certify and disclose accordingly.
This certification is material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for
making or entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any
person who fails to file the required certification shall be subject to a civil penalty of not less
than $10,000 and not more than $100,000 for each such failure.
Signature of Authorized Official
Date
Name (Print)
Title (Print)
*NOTE: - In these instances, “All” in the Final Rule is expected to be clarified to show that it
applies to covered Contract/Grant transactions over $100,000 (per OMB).
36
Appendix K
CERTIFICATION REGARDING DRUG-FREE WORKPLACE
Pursuant to the Drug-Free Workplace Act of 1988 and it’s implementing regulations codified at
29 CFR 98, Subpart F.
I, ____________, the undersigned, in representation
of___________________., the Contractor, attest and certify that the Contractor will provide a
drug-free workplace by the following actions.
A. Publishing a statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession or use of a controlled substance is prohibited in the Contractor’s
workplace and specifying the actions that will be taken against employees for violation of
such prohibition.
B. Establishing an ongoing drug-free awareness program to inform employees concerning:
1. The dangers of drug abuse in the workplace.
2. The policy of maintaining a drug-free workplace.
3. Any available drug counseling, rehabilitation and employee assistance programs.
4. The penalties that may be imposed upon employees for drug abuse violations occurring
in the workplace.
C. Making it a requirement that each employee to be engaged in the performance of the
Contract be given a copy of the statement required by paragraph 1.
D. Notifying the employee in the statement required by paragraph 1 that, as a condition of
employment under the Agreement, the employee will:
1. Abide by the terms of the statement.
2. Notify the employer in writing of his or her conviction for a violation of a criminal drug
statute occurring in the workplace no later than five (5) calendar days after such
conviction.
E. Notifying the agency in writing ten (10) calendar days after receiving notice under
subparagraph 4.b. from an employee or otherwise receiving actual notice of such conviction.
We will provide such notice of convicted employees, including position title, to every Grant
officer on whose grant activity the convicted employee was working. The notice shall
include the identification number (s) of each affected Contract/Grant.
F. Taking one of the following actions, within thirty (30) calendar days of receiving notice
under subparagraph 4.b., with respect to any employee who is so convicted.
1. Taking appropriate personnel action against such an employee, up to and including
termination consistent with the requirements of the Rehabilitation Act of 1973 as
amended.
37
2. Requiring such employee to participate satisfactorily in a drug abuse assistance or
rehabilitation program approved for such purposes by a Federal, State, or local, health,
law enforcement or other appropriate agency.
G. Making a good faith effort to continue to maintain a drug-free workplace through
implementation of paragraphs 1, 2, 3, 4, 5, and 6.
H. Notwithstanding, it is not required to provide the workplace address under the Agreement.
As of today, the specific sites are known and we have decided to provide the specific
addresses with the understanding that if any of the identified places change during the
performance of the Contract, we will inform the agency of the changes. The following are
the sites for the performance of work done in connection with the specific Contract including
street addresses, city, county, state and zip code:
Check ( ) if there are workplaces on files that are not identified here.
Check ( ) if any additional page was required for the listing of the workplaces.
CERTIFICATION
I declare under penalty of perjury under the laws of the United States and under the penalties set
forth by the Drug-Free Workplace Act of 1988, that this certification is true and correct.
Signature of Authorized Official
Date
Name (Print)
Title (Print)
38