JEFFERSON COUNTY COMMISSION
PURCHASING DIVISION
ROOM 830 COURTHOUSE
BIRMINGHAM, ALABAMA 35203-0009
OFFICE: (205)325-5381/FAX: (205)325-5221
PRINCIPAL BUYER: DEBORAH SCALES
JULY 14, 2010
RFP NO: 141-10R
Prospective Offerors
141-10R
(Full document can be viewed and downloaded at http://paca.jccal.org)
COST ACCOUNTING SERVICES
SEALED PROPOSAL FOR:
Deborah Scales, Principal Buyer
REQUEST FOR PROPOSALS WILL
Room 830, 716 Richard Arrington Blvd North
BE RECEIVED BY:
Birmingham, AL 35203
***IMPORTANT SOLICITATION DATES***
PROPOSAL DUE DATE:
PROPOSAL OPENING DATE:
JULY 27, 2010 by 5:00 PM
JULY 28, 2010 at 2:00 PM
(Central Standard Time)
(Central Standard Time)
Return responses to this Request for Proposal in a sealed envelope marked:
“RFP #141-10R FOR COST ACCOUNTING SERVICES”
REQUEST FOR PROPOSAL OPENING WILL BE HELD AT:
Jefferson County Courthouse
Purchasing Department, Room 830
716 Richard Arrington Jr. Blvd North
Birmingham, Alabama 35203-0009
TO:
REQUEST FOR PROPOSAL NO.:
NOTIFICATION OF INTENT:
All recipients of this solicitation notice must indicate intent to submit a proposal. Those vendors submitting a Notification
of Intent will be sent a complete copy of any related addendum, answers to inquiries, etc. pertaining to this RFP.
Notification of intent must be faxed to (205) 325-5221 or e-mailed to Deborah Scales at scalesd@jccal.org no later than
JULY 21, 2010. Full document can be viewed and downloaded at http://paca.jccal.org
TELEPHONE INQUIRIES – NOT ACCEPTED:
Telephone inquiries with questions regarding clarification of any and all specifications of the RFP will not be accepted. All
questions must be written and faxed to (205)325-5221or e-mailed to Deborah Scales at scalesd@jccal.org no later than the
end of business, JULY 21, 2010, 2:00 p.m. CST
Submissions may be withdrawn, modified, and resubmitted prior to the formal proposal opening due date. Any submission
modification(s) submitted after the “Proposal Opening Due Date” will not be considered.
The County reserves the right to accept or reject any or all proposals, or any part of any proposal, and to waive any
informalities or irregularities in the proposal.
All costs incurred by the company to respond to this solicitation will be wholly the responsibility of the Offeror. All copies
and contents of the proposal, attachments, and explanations thereto submitted in response to this RFP, except copyrighted
material, shall become the property of the Jefferson County Commission regardless of the Consultant selected.
Response to this solicitation does not constitute an agreement between the Offeror and the County.
The County is not responsible for delays occasioned by the U.S. Postal Service, the internal mail delivery system of
the County, or any other means of delivery employed by the offeror. Similarly, the County is not responsible for,
and will not open, any bid responses which are received later than the date and time indicated above. Late bid
responses will be retained in the bid file, unopened.
Released by:
_____________________________________________________________
REQUEST FOR PROPOSAL
# 141-10R
“COST ACCOUNTING SERVICES”
Deborah Scales, Principal Buyer
Room 830*716 Richard Arrington Jr. Blvd North
Birmingham, Alabama 35203
Phone: (205) 325-5381
Email: scalesd@jccal.org
JEFFERSON COUNTY COMMISSION
PURCHASING DEPARTMENT
ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N
BIRMINGHAM, AL 35203
(205) 325-5381
PRINCIPAL BUYER: DEBORAH SCALES
JULY 14, 2010
RFP NO: 141-10R
REQUEST FOR PROPOSAL
Sealed Proposals, one (1) original and two (2) copies, marked “COST ACCOUNTING SERVICES” will be received by
the Purchasing Manager, Room 830 * 716 Richard Arrington Jr. Blvd North, Birmingham, Alabama.
Proposals will be accepted until 5:00 P.M. Central Time (standard or daylight savings time, as applicable) on July 27, 2010.
Proposals submitted after this date may not be considered.
Proposals will be opened at 2:00 P.M. on July 28, 2010.
TERM OF CONTRACT
Any contract resulting from this RFP will become effective upon bid award or within 30 days of award notification, approval
of the County Commission and purchase order is issued. Contract will expire on Sept 30, 2011. However, the contract
may be extended, at the County’s option, for a period of up to two (2) additional years, not to exceed a total of three (3)
years.
STATEMENT OF PURPOSE
This RFP provides interested parties with sufficient information to enable them to prepare and submit a response for
consideration by the Jefferson County Commission. By submitting a response, you are affirming that you (in the case of
individuals) and/or your organization are interested in contracting with the County to provide services covered herein.
INQUIRIES
Questions about this RFP should be directed in writing, via e-mail to Deborah Scales at the address shown below, no later
than the end of business JULY 21, 2010. Correspondence with individuals other than those listed herein will not be allowed:
Deborah Scales, Principal Buyer
E-Mail: scalesd@jccal.org
INTERPRETATIONS AND ADDENDA
No interpretation or modification made to any respondent as to the meaning of the RFP shall be binding on the Jefferson
County Commission unless submitted in writing and distributed as an addendum by the Jefferson County Purchasing
Department. Interpretations and/or clarifications shall be requested in writing and directed to Deborah Scales,
Jefferson County Purchasing Division, 830 Courthouse, 716 Richard Arrington Jr. Blvd. North, Birmingham, AL
35203, (Fax 205 325-5221) or (e-mail: scalesd@jccal.org) Verbal information obtained otherwise will not be considered
in awarding of contract. All addenda shall become part of the RFP.
NOTIFICATION OF INTENT
All recipients of this RFP are asked to return a letter of Notification of Intent indicating that they intend to submit a proposal.
Only those vendors submitting the Notification of Intent will be advised of any clarifications, addendum, answers to
inquiries, etc. pertaining to this RFP. Notification of intent must be e-mailed no later than JULY 21, 2010 to
scalesd@jccal.org.
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JEFFERSON COUNTY COMMISSION
PURCHASING DEPARTMENT
ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N
BIRMINGHAM, AL 35203
(205) 325-5381
PRINCIPAL BUYER: DEBORAH SCALES
JULY 14, 2010
RFP NO: 141-10R
REQUEST FOR PROPOSAL (CONTINUED)
STATEMENT OF PURPOSE: This RFP provides interested parties with sufficient information to enable them to prepare
and submit a response for consideration by the Jefferson County Commission. By submitting a response, you are affirming
that you (in the case of individuals) and/or your organization are interested in contracting with the County to provide services
covered herein.
SCOPE OF WORK: Jefferson County, Alabama d/b/a Jefferson Rehabilitation & Health Center desires to enter into a
contract with an Offeror who can supply the following cost accountant services:
Prepare an annual cost report – Medicare
Prepare an annual cost report – Medicaid
Provide cost reimbursement consultation on an as-needed basis
OFFEROR SPECIFICATIONS:
1. Offeror must have been in business for a minimum of the last 3 years.
2. Offeror must be licensed to do business in the State of Alabama, if required by Alabama law, and
licensed to do business in Jefferson County if located here or required by law.
3. Offeror must have experience working with Medicare and Medicaid reimbursement issues
4. Offeror must provide a qualified CPA with Medicare/Medicaid cost reimbursement experience and
provide a current resume
5. Offeror must furnish references of customers utilizing similar services.
OTHER BENEFITS AND COMPENSATION: There are no other benefits or compensation except as listed in Method of
Payment below
EVALUATION CRITERIA
The evaluation criterion for this RFP will be based on, but not limited to the following:
A. Quality of work plan submitted
B. Experience in providing similar services
C. Pricing
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JEFFERSON COUNTY COMMISSION
PURCHASING DEPARTMENT
ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N
BIRMINGHAM, AL 35203
(205) 325-5381
PRINCIPAL BUYER: DEBORAH SCALES
JULY 14, 2010
RFP NO: 141-10R
REQUEST FOR PROPOSAL (CONTINUED)
SUBMISSION INSTRUCTIONS
All costs incurred by the company to respond to this solicitation will be wholly the responsibility of the Offeror. All copies
and contents of any proposal, attachment, and explanation thereto submitted in response to this RFP, except copyrighted
material, shall become the property of the Jefferson County Commission regardless of the Vendor selected. Any materials
submitted in response to this solicitation shall not be returned.
Submittals should include one (1) original (“marked original”) and (2) copies, arranged in the following format:
A. Introduction: provide a brief letter of introduction on the firm’s letterhead identifying the proposal contents;
B. Experience: provide a profile of experiences including resume that the individual has performed work on
similar projects in accordance with the scope of services;
C. Delivery: Offeror must describe in detail in their proposal how they can fulfill the requirements as described in
the scope of services in this RFP;
D. References: provide contact information for three (3) references for the most recent projects your company has
been awarded similar to the scope of services to be provided;
E. Examples of Work from other projects (if available)
F. Required Forms (price structure, non-collusion affidavit, and signature page). The forms may not be
altered or substituted. Offerors that do not use the forms within this RFP may be deemed as
nonresponsive. However, Offerors may include additional data to provide explanation as needed.
INVOICING
All invoices must agree with the purchase order in description and price and include the following information: 1) Purchase
Order Number; 2) Ship-to Department name and address.
In order to ensure prompt payment, ALL ORIGINAL INVOICES * MUST BE SENT TO:
Jefferson County Commission
Finance Department
Room 820, Courthouse
716 Richard Arrington Jr. Blvd, North
Birmingham, AL 35203
*If invoice does not agree with purchase order, credits or a corrected invoice will be required in order for the County to
process payment. Invoices that do not reference an authorized Purchase Order will be returned to the vendor.
THIRD-PARTY “REMIT-TO”
If Offeror has a third-party “remit-to” company, that information must appear on the Offeror’s response. Jefferson County
will send payment to the company designated by Offeror on its response, but will not be responsible for resolving payment
issues, should the Offeror change payment processing companies after a payment has been mailed or without forty-five (45)
days written notification to the Purchasing and Accounting division of Jefferson County.
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JEFFERSON COUNTY COMMISSION
PURCHASING DEPARTMENT
ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N
BIRMINGHAM, AL 35203
(205) 325-5381
PRINCIPAL BUYER: DEBORAH SCALES
JULY 14, 2010
RFP NO: 141-10R
REQUEST FOR PROPOSAL (CONTINUED)
CANCELLATION
Failure to deliver as specified and in accordance with the bid submitted, including promised delivery, will constitute
sufficient grounds for cancellation of the order at the option of the County Commission.
SOLE CONTRACTOR/IMPLEMENTER
The Jefferson County Commission intends to award the contract to a sole contractor. The successful Offeror shall assume
total responsibility for all Deliverables whether a sub-contractor or third-party produces them in whole or in part. Further,
the County will consider the successful Offeror to be the sole point of contact with regard to contractual matters, including
payment of all charges resulting from the Contract. The successful Offeror will be fully responsible for any default by a subcontractor, just as if the successful Offeror will be solely responsible for the success of the entire Project
TERMINATION OF CONTRACT
This contract may be terminated by the County with a thirty (30) day written notice to the other party regardless of reason.
Any violation of this agreement shall constitute a breach and default of this agreement. Upon such breach, the County shall
have the right to immediately terminate the contract and withhold further payments. Such termination shall not relieve the
contractor of any liability to the County for damages sustained by virtue of a breach by the contractor.
GUARANTEE
Offeror certifies by bidding, that he is fully aware of the conditions of service and purpose for which item(s) included in this
bid are to be purchased, and that his offering will meet these requirements of service and purpose to the satisfaction of the
Jefferson County Commission and its agent.
PRICES
Shall include all billable charges related to the successful performance of this contract.
METHOD OF PAYMENT
Offeror will be paid monthly after submission and approval of an itemized invoice showing date of service, name of resident,
staff member, etc. and legal or consultation service provided.
TAX
Jefferson County is exempt from all tax. Successful offeror is responsible for all Federal, State, and Local taxes that are due
as a result of this transaction. These taxes are not deducted from monthly payment.
INDEPENDENT CONTRACTOR
The Offeror acknowledges and understands that the performance of this contract is an independent contracting individual
and/or agency and, as such, the Offeror is obligated for all applicable taxes and neither the County nor the using department
will be obligated for same under this contract.
WORKMEN’S COMPENSATION
FICA taxes, Occupational Taxes, all applicable Federal, State and Local taxes:
The Offeror acknowledges and understands that the performance of this contract is an independent contracting
individual and/or agency and, as such, the Offeror is obligated for all applicable taxes and neither the County nor the
using department will be obligated for same under this contract.
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JEFFERSON COUNTY COMMISSION
PURCHASING DEPARTMENT
ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N
BIRMINGHAM, AL 35203
(205) 325-5381
PRINCIPAL BUYER: DEBORAH SCALES
JULY 14, 2010
RFP NO: 141-10R
REQUEST FOR PROPOSAL (CONTINUED)
NEGOTIATIONS
Jefferson County reserves the right to enter into contract negotiations with the selected offeror. If the County and the
selected offeror cannot negotiate a successful contract, the County may terminate negotiations and begin negotiation with the
next selected offeror. This process will continue until a contract has been executed or all proposals have been rejected. No
offeror shall have any rights against the County arising from such negotiations.
MODIFICATION OF CONTRACT
This contract may be modified only by a written amendment executed by all Parties hereto. All change orders, where
required, shall be executed in conformance with the policies and procedures of the Jefferson County Commission.
NON-DISCRIMINATION POLICY
The Jefferson County Commission is strongly committed to equal opportunity in solicitation of ITB’s and RFP’s. The
County encourages Offerors and proposers to share this commitment. Each Offeror submitting a proposal agrees not to
refuse to hire, discharge, promote, demote, or to otherwise discriminate against any person otherwise qualified solely because
of race, creed, sex, national origin or disability.
INSURANCE
The successful offeror will maintain such insurance as will protect him and the County from claim under Workmen's
Compensation Acts, and from claims for damage and/or personal injury, including death, which may arise from operations
under this contract. Insurance will be written by companies authorized to do business in Jefferson County, Alabama and
shall include Jefferson County, Alabama as Added Additional Insured By Endorsement including a thirty (30) day(s)
written cancellation notice. Evidence of insurance will be furnished to the Purchasing agent not later than seven (7) day(s)
after Purchase Order/contract date. Successful offeror is also required to include the RFP number on the evidence of
insurance.
Insurance Minimum Coverage
Contracting party shall file the following insurance coverage and limits of liability with the County's Human Resource
Department and Purchasing Department before beginning work with the County.
General Liability:
$1,000,000 - Bodily injury and property damage combined occurrence
$1,000,000 - Bodily injury and property damage combined aggregate
$1,000,000 - Personal injury aggregate
Comprehensive Form including Premises/Operation, Products/Completed Operations, Contractual, Independent
contractors, Broad Form property damage and personal injury.
Automobile Liability:
$1,000,000 - Bodily injury and property damage combined coverage
Any automobile including hired and non-owned vehicles
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JEFFERSON COUNTY COMMISSION
PURCHASING DEPARTMENT
ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N
BIRMINGHAM, AL 35203
(205) 325-5381
PRINCIPAL BUYER: DEBORAH SCALES
JULY 14, 2010
RFP NO: 141-10R
REQUEST FOR PROPOSAL (CONTINUED)
INSURANCE (CONTINUED)
Workers Compensation and Employers Liability:
$100,000 - Limit each occurrence
Umbrella Coverage:
$1,000,000 - Each occurrence
$1,000,000 - Aggregate
Added Additional Insured By Endorsement:
Jefferson County, Alabama
30 day(s) written cancellation notice
Under Description of Operations/Locations/Vehicles/Exclusions Added by Endorsement/Special
Provisions enter the BID/RFP Number, Project Number or Purchase Order Number Covered by
The Certificate of Insurance
MAINTENANCE OF RECORDS
Offeror shall maintain documentation of all charges against Jefferson County. The books, records, and documents of
Contract, insofar as they relate to work performed or money received under the contract, shall be maintained for a period of
three (3) full years from the date of the final payment and will be subject to audit, at any reasonable time and upon notice by
the County or its duly appointed representative. The records shall be maintained in accordance with generally accepted
accounting principles.
CONFLICT OF INTEREST
The Offeror declares that, as of the date of this contract, neither the County nor any County Commissioner nor any Director
nor any other Jefferson County Government official is directly or indirectly interested in this contract or any contract with the
Offeror for which compensation will be sought during the period of time this contract is being performed, and, furthermore,
the Offeror pledges that he/it will notify the Purchasing Manager in writing should it come to his/its knowledge that any
County official becomes directly or indirectly interested in the contract or any contract the Offeror for which compensation
will be sought during the aforesaid period. In addition, the Offeror declares that, as of the date of this contract, neither he/it
nor any of his/its officers or employees have given or donated or promised to give or donate, either directly or indirectly, to
any official or employee of the Jefferson County Commission, or to anyone else for the County’s benefit, any sum of money
or other thing of value for aid or assistance in obtaining this contract with the County under which compensation will be
sought during the period of time this contract is being performed and furthermore, that neither the Offeror nor any of his/its
officers or employees will give or donate or promise to give or donate, directly or indirectly, to any official or employee of
the Jefferson County Commission, or to anyone else for the County’s benefit, any sum of money or other thing of value, for
aid or assistance in obtaining any amendment to this contract with the Offeror for which compensation will be claimed during
the period of time this contract is being performed.
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JEFFERSON COUNTY COMMISSION
PURCHASING DEPARTMENT
ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N
BIRMINGHAM, AL 35203
(205) 325-5381
PRINCIPAL BUYER: DEBORAH SCALES
JULY 14, 2010
RFP NO: 141-10R
REQUEST FOR PROPOSAL (CONTINUED)
COUNTY FUNDS PAID
Successful Offeror must certify by the execution of Purchase Order Agreement that no part of the funds paid by the County
pursuant to this agreement nor any part of the services, products or any item or thing of value whatsoever purchased or
acquired with said funds shall be paid to, used by or used in any way whatsoever for the personal benefit of any member or
employee of any government whatsoever or family member of any of them, including federal, state, county and municipal
and any agency or subsidiary of any such government; and further certify that neither the Offeror nor any of its officers,
partners, owners, agents, representatives, employees or parties in interest has in any way colluded, conspired, connived, with
any member of the governing body or employee of the governing body of the County or any other public official or public
employee, in any manner whatsoever, to secure or obtain this Agreement and further certify that, except as expressly set out
in the scope of work or services of this Agreement, no promise or commitment of any nature whatsoever of any thing of
value whatsoever has been made or communicated to any such governing body member or employee or official as
inducement or consideration for this Agreement.
Any violation of this certification shall constitute a breach and default of this Agreement which shall be cause for
termination. Upon such termination, Offeror shall immediately refund to the County all amounts paid by the County
pursuant to this Agreement.
HOLD HARMLESS AND INDEMNIFICATION
Contracting party agrees to indemnify, hold harmless and defend Jefferson County, Alabama, its elected officers and
employees (hereinafter referred to in this paragraph collectively as “County”), from and against any and all loss expense or
damage, including court cost and attorney’s fees, for liability claimed against or imposed upon County because of bodily
injury, death or property damage, real or personal, including loss of use thereof arising out of or as a consequence of the
breach of any duty or obligations of the contracting party included in this agreement, negligent acts, errors or omissions,
including engineering and/or professional error, fault, mistake or negligence of Integrator, its employees, agents,
representatives, or subcontractors, their employees, agents or representatives in connections with or incident to the
performance of this agreement, or arising out of Worker’s Compensation claims, Unemployment Compensation claims, or
Unemployment Disability compensation claims of employees of company and/or its subcontractors or claims under similar
such laws or obligations. Company obligation under this Section shall not extend to any liability caused by the sole
negligence of the County, or its employees. Before beginning work, contract party shall file with the County a certificate
from his insurer showing the amounts of insurance carried and the risk covered thereby. Liability insurance coverage must
be no less than $1,000,000. During performance the company must effect and maintain insurance from a company licensed
to do business in the State of Alabama. Coverage required includes 1) Comprehensive General Liability; 2) Comprehensive
Automobile Liability; 3) Worker’s Compensation and Employer’s Liability.
BID BOND
Each Offeror will furnish, with its bid response, a bid bond or cashier’s check of $500.00 made out to Jefferson County,
Alabama.
GENERAL
The Jefferson County Commission expressively reserves the right to reject any and all RFP’s, or parts of RFP’s, and to make
the award or awards as the best interest of the county appears.
_____________________________
Deborah Scales
Principal Buyer
9
JEFFERSON COUNTY COMMISSION
PURCHASING DEPARTMENT
ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N
BIRMINGHAM, AL 35203
(205) 325-5381
PRINCIPAL BUYER: DEBORAH SCALES
JULY 14, 2010
RFP NO: 141-10R
REQUEST FOR PROPOSAL (CONTINUED)
The contract for “Cost Accountant Services” is to prepare the Medicare cost report year ending 09/30/2010 and
for the Medicaid cost report year ending 06/30/2010 and provide cost reimbursement consultation on an asneeded basis. The Jefferson Rehabilitation and Health Center, Cost Accountant Services will be awarded upon
consideration of the following:
1. Offeror must have experience working with Medicare and Medicaid reimbursement issues
2. Offeror must provide a qualified CPA with Medicare/Medicaid cost reimbursement experience and
provide resume.
3. Offeror must furnish references of customers utilizing similar services
4. Pricing
Please indicate the Rate, in the space below, at which the Offeror will provide Cost Accountant Services to the
JRHC or attached a fee schedule to this form and submit it.
$ ______________________________ per _________________________________
Note: Final selection of candidate will be at the sole discretion of Jefferson County.
ATTACH A LETTER STATING DIFFERENCES BETWEEN COUNTY SPECIFICATIONS AND
SPECIFICATIONS OF SERVICES RENDERED.
10
JEFFERSON COUNTY COMMISSION
PURCHASING DEPARTMENT
ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N
BIRMINGHAM, AL 35203
(205) 325-5381
PRINCIPAL BUYER: DEBORAH SCALES
JULY 14, 2010
RFP NO: 141-10R
Non-Collusion Affidavit
I, ___________________________________________________, an authorized agent/representative of
________________________________attest that the proposal is not made in the interest of, or on behalf of, any
undisclosed person, partnership, company, association, organization, or corporation; that the Proposal is genuine and
not collusive or sham; that the Offeror has not directly or indirectly induced or solicited any other Offeror to put in a
false or sham RFP, and has not directly or indirectly colluded, conspired, connived or agreed with any Offeror or
anyone else to put in a sham RFP, or than anyone shall refrain from proposing; that the Offeror has not in any manner,
directly or indirectly sought by agreement, communication or conference with anyone to fix the RFP of the Offeror or
any other Offeror, to fix any overhead profit, or cost element of the RFP price or of that of any Offeror, or to secure
any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all
statements contained in the RFP are true; and further, that the Offeror has not, directly or indirectly submitted his/her
RFP price or any breakdown thereof or the contents thereof, of divulged information or data relative thereto, or paid,
and will not pay any fee to any corporation, partnership, company, association, organization, RFP depository, or to any
member or agent thereof, to effectuate a collusive or sham RFP.
I, the undersigned, hereby certify that I have read and understand this Non- Collusion Affidavit and guarantee complete
compliance with all the terms, conditions and stipulations.
Subscribed and Sworn to
Before me this ________ day
of ___________ 20____.
BY: ___________________________________
Authorized Signature of Offeror
Date
_____________________________________
Print or Type Name of Offeror
___________________________________
Notary Public of
My Commission expires
11
JEFFERSON COUNTY COMMISSION
PURCHASING DEPARTMENT
ROOM 830 * 716 RICHARD ARRINGTON JR BLVD NO
BIRMINGHAM, AL 35203
(205) 325-5381
PRINCIPAL BUYER: DEBORAH SCALES
JULY 14, 2010
RFP NO: 141-10R
JEFFERSON COUNTY, ALABAMA
EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION FORM
Contractor/Vendor Name: _________________________________________________________________
Address:
_____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
The Contractor acknowledges receipt of Jefferson County’s Equal Employment Opportunity Contractor Compliance
Administrative Order (attached hereto) and certifies that it is an equal opportunity employer and agrees to the requirements of
the Policy and the Equal Employment Opportunity Clause therein. It further certifies that it will require all subcontractors to
execute an Equal Employment Opportunity statement and certification of compliance.
The Contractor will not discriminate against any employee or applicant for employment because of race, color, religion, sex,
national origin, age, disability or veteran status. The Contractor will ensure that qualified applicants are employed, and that
employees are treated during employment, without regard to their race, color, religion, sex, national origin, age, disability or
veteran status. Such action shall include, but not be limited to the following: employment, promotion, demotion, or transfer;
recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for
training, including apprenticeship. The Contractor agrees to post in conspicuous places, available to employees and
applicants for employment, notices setting forth the provisions of this non-discrimination clause.
The Contractor will furnish to the County, upon request, reports, notices, policies and/or information certifying compliance
with this policy.
In the event of the Contractor’s non-compliance with the equal employment opportunity clause of this contract, this contract
may not be awarded or may be cancelled, terminated or suspended in whole or in part and the Contractor may be declared
ineligible for further County contracts.
____________________________
Date
__________________________________________
Signature
__________________________________________
Title
12
JEFFERSON COUNTY COMMISSION
PURCHASING DEPARTMENT
ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N
BIRMINGHAM, AL 35203
(205) 325-5381
PRINCIPAL BUYER: DEBORAH SCALES
JULY 14, 2010
RFP NO: 141-10R
SIGNATURE PAGE
The Jefferson County Commission, or its Agent, shall have the right to waive any informality or irregularity.
Under certain limited conditions, the Purchasing Department may apply a local preference option in determining
the low proposal for purchases of personal property.
All provisions of this Proposal are accepted by Offeror as part of any contract or purchase resulting therefrom.
Please specify terms of payment below; otherwise, the terms will be Net 30.
Date: _______Company Name: ______________________________ Web Address:_____________
Terms: _______Address:_______________________________________City:__________________
County: _______________State: _____ Zip: ____________ Phone: (_____)____________________
If Jefferson County Business Licenses were issued to your company for the past twelve (12) months, please list
numbers: _____________________________________________.
Vendor's Federal I.D. Number: ____________________________
I certify that ___________________________ has ___ has not ___ been in operation for one
(Company Name)
(Check one)
year at location(s) zoned for the type of business conducted by my company at the address stated above.
______________________________
(Authorized Signature)
______________________________
(Print Name)
______________________________
(E-Mail Address)
Toll Free Phone: _____________________________Fax Number:____________________________
Return original proposal in sealed envelope. Authorized signature of Offeror must be in ink.
Proposals received in our office after the specified date and hour will not be considered.
INDICATE THE FOLLOWING ADDRESSES IF DIFFERENT FROM ABOVE:
1. BID AWARD NOTICE ADDRESS
2. PURCHASE ORDER ADDRESS
3. REMITTANCE ADDRESS (AND NAME IF DIFFERENT THAN ABOVE)
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