REQUEST FOR PROPOSALS YOUTH TRAINING GRANTS

RFP-CSP-13-YTG-01 Issue Date: March 25, 2014

Reissued: March 26, 2014 4:00 pmMandatory Proposers’ Conference: April 2, 2014

Proposals Due: April 15, 2014

I. GENERAL

The POLK COUNTY WORKFORCE DEVELOPMENT BOARD, INC. d.b.a. CareerSource Polk (hereinafter, CareerSource Polk), is soliciting proposals for Summer Youth Training Programs. Grants will be awarded through a competitive process to support teen pregnancy prevention and workforce readiness activities. The grants are intended to address the workforce challenges facing youth in our community ages 14-19.

While all programs are to be concluded by August 1, 2014, approved programs may run between May 1, 2014 (if contract is executed) and August 1, 2014. Programs should be designed to provide long term benefits to Summer Youth participants. The maximum award is $25,000. Eligible applicants must be local Polk County organizations, including community and faith-based nonprofit organizations.

II. POLK COUNTY WORKFORCE DEVELOPMENT BOARD, INC.

The mission of the CareerSource Polk is to be “the innovative leader to ensure and to sustain a quality workforce for today and the future.” CareerSource Polk is a private, nonprofit corporation governed by a volunteer Board of Directors. Board members represent business, education, social service agencies, community-based organizations, and state agencies.

CareerSource Polk serves as the grant recipient and administrative entity for an array of programs supported, in part by Temporary Assistance for Needy Families (TANF) funds. Programs serve a wide range of Polk County residents including those who are employed, unemployed, under-employed, dislocated, or have barriers to employment. Various employment and training related educational services and programs are provided to residents through the use of contractual agreements with area entities. Accordingly, funds made available through this grant solicitation are TANF funds which are intended, in part, to reduce non-marital pregnancies (teen pregnancy prevention) and encouraging the formation and maintenance of two parent families and preparing youth to participate in the workforce.

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III. SOLICITATION

Responses to this Request for Proposals (RFP) must be submitted by 12:00 p.m. (noon), Eastern Time, on April 15, 2014.

Proposals are to be submitted to: 2013 Summer Youth Grant Proposal

Attention: Luz M. Heredia, V.P. OperationsCareerSource Polk

600 North Broadway Avenue, Suite BBartow, Florida 33830

Proposals received after the specified time and date will not be considered for any reason. The respondent is solely responsible for assuring that the proposal is submitted in accordance with this RFP by the time designated. Similarly, the respondent assumes the responsibility that its proposal meets all the requirements as set forth in this RFP. Incomplete proposals are considered non responsive and will be disqualified.

April 2, 2014 Mandatory RFP pre‐proposal conference. The pre‐proposal conference starts at 11:00 a.m. The Pre‐proposal conference will be held at CareerSource Polk Administrative offices at 600 N. Broadway Avenue, (Third Floor ‐ Training Room) Bartow Florida, 33830

April 15, 2014 Proposals Due by 12:00 NoonJune 30, 2014 Funding for Projects End

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IV. MANDATORY PROPOSER’S CONFERENCE

There will be a Mandatory Proposer’s Conference held on April 2, 2014 at 11:00 A.M., at 600 North Broadway Avenue, Bartow Florida 33830, (Third Floor Training Room). This Conference is mandatory and attendance is required in order to be considered for funding. Proposers’ questions will be addressed during the solicitation period. All questions shall be submitted in writing via e-mail to: RFP_Questions@careersourcepolk.com prior to the proposer’s conference no later than April 1, 2014 at 11:00 A. M. Questions will be answered during the mandatory Proposer’s Conference. No later than April 4, 2014, questions and answers will be posted for review at CareerSource Polk’s web site: www.careersourcepolk.com by clicking on <Public Notices>, then clicking on <RFP’s/Procurements> and the link “2013 Summer Youth Proposals – Questions.”

All potential respondents are required to attend the mandatory Proposer’s Conference and ask questions regarding any aspects of the solicitation, as it will be the only method for having technical and other concerns addressed.

V. PROPOSAL REVIEW AND AWARD PROCESS

CareerSource Polk may act to award a contract under this solicitation based solely on the proposal as submitted. Submission of a proposal shall be taken as prima facie evidence that the respondent has familiarized itself with the contents of the RFP. Therefore, proposals should describe all aspects of services proposed in the most favorable terms from both price and performance of the objectives stated herein. CareerSource Polk reserves the right to request additional data in support of the proposal and/or to ask the respondent to make an oral presentation about its proposal. CareerSource Polk requires a successful respondent to participate in negotiations and submit any budget or other technical revisions to the proposal prior to final award of a contract. Further, CareerSource Polk reserves the right to reject any and all proposals submitted and/or to negotiate with all qualified sources. Receipt of a proposal does not commit CareerSource Polk to award a contract, pay any of the costs associated with preparation of the proposal, or to reimburse a respondent for any costs incurred prior to the signing of a contract agreement.

Contract award will be based on the review and rating of the proposals received in relation to amount and the type of funding available. All contracts will contain provisions relating to nondiscrimination, equal opportunities provisions as required by law and the anticipated funding sources in addition to prohibitions against subcontracting without prior written approval and lobbying. A team of CareerSource Polk representatives, using the rating criteria and guidelines contained in the Proposal Review Criteria, will review and rate the proposals.

Final award of a contract is contingent upon: successful negotiation of an agreement; acceptance by the respondent of the contract terms and conditions; and acceptance by the respondent of the responsibility for achieving contract and program

objectives.

Any entity that submits a proposal to CareerSource Polk for funding will receive fair and unbiased consideration. Should such entity not receive funding for its proposal and contends that the procurement process was flawed, that entity may protest the funding decision to the

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Board’s President/CEO within ten (10) days of the full Board’s decision. The President/CEO will attempt to resolve the dispute in a reasonable manner. If the dispute cannot be resolved with the President/CEO, then the protesting entity can seek and may be granted an opportunity to appeal to the Executive Committee of the Board. The Executive Committee of the Board’s decision on all such matters is final.

VI. FUNDS AVAILABLE

CareerSource Polk has selected the Request for Proposal (RFP) process to determine the reasonable price for these services. For planning purposes, the Board estimates that a total of $250,000 will be available for this grant solicitation. The maximum amount of each award is $25,000.

VII. PROPOSAL INSTRUCTIONS

All proposals must: Answer all requests for data or information in the format as provided in Section XIII. All responses must be typed or word-processed and numbered accordingly. Address all requests for information or mark as “not applicable.” Attach all requested documentation to the back of the proposal and mark accordingly. Complete and return only the proposal response pages. Retain all other information.

All proposals must consist of an original and four (4) copies. The original copy must contain original signatures in blue ink and be clearly identified as the “original copy” on its cover page. Incomplete proposals, (i.e. proposals that do not address all of the questions in this RFP), proposals submitted by fax or other electronic means, and proposals received after the above stated deadline will not be considered. Brochures or other presentations beyond that which is sufficient to present a complete and effective proposal are not desired. Elaborate artwork, expensive paper, and bindings are neither necessary nor wanted. Proposals may be “bound” by staples, binder clips, or contained in three-ring notebooks. When preparing the proposal, clear, thorough, and concise answers are better than a flowery or rambling narrative. Get to the point as quickly and completely as possible. Do not respond by referencing material presented elsewhere. The responses provided immediately after the question shall be considered complete and stand on its own merits. A response of "will comply" or "see above" or a similar statement shall receive zero (0) points for scoring purposes. Failure to respond to any questions may result in disqualification of the proposal as non-qualified and the proposal not being scored.

It is preferred that written material be single side, single-spaced, in 12-point font and 1” margins. For ease in translating the successful proposal into a contractual statement of work, all proposals are to be written in the indicative (“will, shall”) rather than the subjunctive (“may, could”) case. Pages must be numbered at the bottom. Legibility, clarity, and completeness are essential.

The Board will not return proposals, binders, or exhibits to proposals. All proposals become the property of the Board and will be a matter of public record subject to the provisions of Chapter 119, Florida Statutes. In submitting a proposal, the proposer acknowledges that CareerSource Polk will have the right to use all ideas or adaptations of those ideas contained in any proposal received in response to this RFP without the necessity of paying a fee, license, or royalty. Selection or rejection of the proposal will not affect this right.

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VIII. PERIOD OF PERFORMANCE

Services funded under this solicitation are to be provided following the signing of the contract and ending June 30th, 2014. Any activities that begin before the contract is signed will be determined as an unallowable cost and not be reimbursed. Cash advances will not be available; therefore, the successful respondent must have sufficient cash resources for initial program start-up expenditures and await reimbursement from CareerSource Polk, usually within 2-3 weeks of an invoice submitted with proper documentation.

IX. PROPOSAL SOLICITATION

A Request for Proposals (RFP) is being used as the method of solicitation to assure the greatest degree of opportunity as well as open competition and to achieve the best possible outcomes based on the objectives stated herein. Public notice of this RFP has been published in the local newspaper designated by the Polk County Board of County Commissioners as the official instrument of such notices. All known entities recognized as being involved in the provision of the services solicited shall be sent a notification of this RFP. All requests for copies of this RFP will be referred to the appropriate link on the Board’s web site: www.careersourcepolk.com, click on <Public Notices> then click on <RFP’s/Procurements>. After the published deadline for receipt of proposals, all proposals become public information and are available for inspection to any interested party. Duplication of any part or of an entire proposal will be subject to the appropriate fees established by CareerSource Polk.

No changes, modifications, or additions can be made to proposals after the submission deadline unless required by the Board of all proposers. CareerSource Polk reserves the right to waive any minor technical irregularity. After the submission deadline, no proposer will discuss any proposal with CareerSource Polk staff member unless the discussion is in response to CareerSource Polk staff request for additional information. CareerSource Polk reserves the right to reject the proposal of any proposer who fails to comply with this provision.

X. PUBLIC ENTITIES CRIME STATEMENT

A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract for the construction or repair of a public building or public work, may not submit a bid on leases of real property to a public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with a public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, F.S. for CATEGORY TWO for a period or 36 months from the date of being placed on the convicted vendor list.

XI. DEBARMENT AND SUSPENSION

Proposals will only be accepted that address all service components of this RFP. No parties debarred or suspended from doing business with the state of Florida or the Federal government will be eligible to do business with Polk County Workforce Development Board, Inc.

XII. Anti-Lobbying Prohibition

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CareerSource Polk will not reimburse for any activity that can be considered as lobbying activity.

XIII. TECHNICAL ASSISTANCE PROVIDED BY THE BOARD

CareerSource Polk staff will be available to provide technical assistance with the provision of information needed to conduct program and fiscal monitoring and oversight reporting. CareerSource Polk staff will coordinate with award grantees to schedule visits, respond to requests for information, and provide other technical assistance as may be deemed necessary during the course of proposal preparation, program execution and follow-up reporting.

XIV. PROPOSAL PREPARATION INSTRUCTIONS

FORMAT FOR PREPARING PROPOSAL All proposals must be assembled according to the following outline with all pages numbered in sequential order: 1. Letter of Transmittal--prepare a cover letter on the organization’s letterhead signed by the

individual who is legally authorized to submit the proposal for the organization. The name, title, address, and telephone number of the individual who has the authority to negotiate on behalf of and contractually bind the offeror must be provided. The proposal should also list a contact person who is generally available to answer questions about the proposal.

2. Organizational History Describe the history and purpose of the organization (including mission statement)

3. Executive Summary--Include a brief summary outlining the proposer’s program, individuals to be served, amount of funds requested, and projected outcomes. This section should be limited to no more than ½ page. CareerSource Polk staff may include this Executive Summary as part of their recommendation to the Board.

4. The Proposal - This portion of the proposal should demonstrate the organization understands the scope and intent of this solicitation and their capability to implement their proposed programs by answering the following questions:

Complete Project Description: Proposals should be written to cover the items in the order presented. A summary page presenting the information in items a-e below must be included. A detailed description of the information must be further described throughout the proposal:

a. Project Name b. Amount Requestedc. Number and age of youth to be served d. Location: Describe when primary training will take place (address of location)e. Program Timeline - Define the timetable for implementation of activities--when will it

begin and when will it end? Include the number of hours of direct service to Summer Youth participants.

i. Date Project begins ii. Date Project ends iii. Total number of weeksiv. Days of the week the program will operate v. Hours of the day the program will operate

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vi. Total number of training hours per participant

f. Outreach and Recruitment Activities – Describe how participants will be recruited and selected for the program.

g. Project components – The proposal must at least include the following two (2) topics. Describe in detail what topics will be covered during the project. (Topics must include Teen Pregnancy Prevention and work readiness skills training.). Describe the daily schedule of program activities.

h. Project Objectives – Describe in detail what objectives from each topic covered you hope to accomplish.

i. Administrative Capacity i. Describe your organization’s administrative capacity to undertake the program as

described in the proposal. ii. Describe your organization’s staffing plan for this project. iii. Describe your organization’s experience with administering similar youth

programs or initiatives using local, state or federal funds. iv. Describe the qualifications of key individuals planned for assignment to this

project. j. Measurable Outcomes - All proposals should include a description of measurable

outcomes. The measurable outcomes must be directly attributed to services provided, outcomes that can be achieved during the contract period.

k. Program Evaluation – How will you determine if your program has been successful?

5. Budget – Provide a detailed budget to include an itemization of costs (e.g. staff salaries, facility rental, printing, materials, supplies, software costs for field trips, transportation, etc.)The budget should utilize an appropriate line item budget and include program costs supported by proposal award and leveraged resources provided by proposer as well as a brief budget narrative. All proposal costs must be necessary for the operation the program in accordance with Federal and State guidelines. Any questions about allowable costs should be submitted in accordance with the procedures herein described under “Proposers Questions.”

6. Bonus Points – Bonus points will be awarded for leveraging resources (e.g. food and beverage, facilities costs, speakers, etc.) Bidders will earn points for in-kind costs that are arranged and provided to the students. The in-kind costs must be costs which could have been paid by grant funds but which are not paid because they have been contributed by some other source. The in-kind costs must also be costs which contribute to the delivery of the program or contribute to the effectiveness of the program. The bidder can earn up to 20 points based on the following:

$0 to $500 In Kind = 6 Points $501 to $1000 = 12 Points $1001 and more = 20 Points.

7. Mandatory Attachments – In addition to all documents and information requested above, failure to provide any of the following mandatory requirements may also render the proposal as non-responsive and will not be scored:

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A copy of the agency designation (as a private, non-profit, public corporation, etc.) as granted by the US Internal Revenue Service.

A copy of the proposer’s Board of Directors list including affiliations. A signed Proposer Guarantees and Proposer Warranties (Attachment A) List of references with Contact information Statement of Assurances (Attachment B) Nondiscrimination & Equal Opportunity Assurance (Attachment C) Debarment and Suspension Certification (Attachment D) Drug-Free Workplace Certification (Attachment E) Public Entities Crimes Certification (Attachment F)

The following criteria will be used to evaluate the proposals. The value of each element is listed next to the criteria. All proposals will be evaluated up to 140 total points.

Project Name:Amount Requested:

CRITERIA POINTS AVAILABLE RATINGProject Components 30Project Objectives 15Administrative Capacity 20Program Evaluation 5Measurable Outcomes 20Detailed Budget 30Total (w/out Bonus points) 120Bonus Points (Leveraged Resources) 20Final Total 140

Proposals will be evaluated by a Review/Ranking Committee consisting of up to 4 individuals. The individual scores will be added and an average score tabulated for the proposal.

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Attachment A PROPOSER GUARANTEES AND PROPOSER WARRANTIES

I. PROPOSER GUARANTEES The proposer certifies it can and will provide and make available, at a minimum, all services as requested in this Request for Proposals.

II. PROPOSER WARRANTIES A. Proposer warrants that it is willing to defend, indemnify and hold harmless CareerSource

Polk, its Board members, jointly or severally, and its staff for any third-party claims which may arise from services programs initiated as a result of this proposal.

B. Proposer warrants that it is willing, if necessary, to provide insurance policy providing a prudent amount of coverage for the willful or negligent acts or omissions of any of its officers, employees, or agents.

C. Proposer warrants that it will not delegate or subcontract its responsibilities under an agreement without the prior written permission of the Board.

D. Proposer warrants that all the information provided by it in connection with this proposal is true and accurate.

III. The respondent’s:

Federal Tax ID Number

Signature of Official Date

Typed Name of Official

Organization

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Attachment B STATEMENT OF ASSURANCES & CERTIFICATIONS

CareerSource Polk does not award a contract where the Contractor has failed to accept the ASSURANCES AND CERTIFICATIONS contained in this section. In performing its responsibilities under this Proposal, the Contractor hereby certifies that it will fully comply with the following (if a contract is awarded):

1. Assurances 2. Nondiscrimination & Equal Opportunity Assurance (29 CFR Part 37) 3. Debarment and Suspension Certification (29 CFR Part 98) 4. Drug Free Workplace Certification (29 CFR Part 98) 5. Public Entity Crimes (FS 287.133(3)(a)

By signing the Agreement (upon awarding of a contract), the Contractor is providing the above assurances and certifications as detailed below:

A. ASSURANCES – NOTE: Certain of these assurances may not be applicable to your contract. If you have questions, please contact CareerSource Polk.

As the duly authorized representative of the Contractor, I certify that the Contractor: 1. Will give CareerSource Polk, the Comptroller General of the United States , and if

appropriate, the State, through any authorized representative, access to and the right to examine all books, records, databases, papers, or documents related to the award of this contract; and will establish proper accounting system in accordance with generally accepted accounting standards or CareerSource Polk directives.

2. Is in compliance with Title VII of the 1964 Civil Rights Act, as amended, the Florida Civil Rights Act of 1992, as amended, and Polk County Ordinances, in that the Participating Employer does not, on the grounds of race, color, sex, religion, handicap, age, marital status, or national origin, discriminate in any form or manner against said the Participating Employer’s employees or applicants for employment.

3. Is in substantial compliance with the Americans with Disabilities Act of 1990, P.L. 109-336, as applicable.

4. Will comply fully with the nondiscrimination and equal opportunity provisions of the following laws: a. Section 188 of the WIA, which prohibits discrimination against all individuals in

the United States on the basis of race, color, religion, sex, national origin, age, disability, political affiliation or belief, and against beneficiaries on the basis of either citizenship/status as a lawfully admitted immigrant authorized to work in the United States or participate in any WIA Title I-financially assisted program or activity;

b. Title VI of the Civil Rights Act of 1964, as amended, which prohibits discrimination on the basis of race, color, and national origin;

c. Section 504 of the Rehabilitation Act of 1973, as amended, which prohibits discrimination against qualified individuals with disabilities;

d. The Age Discrimination Act of 1975, as amended, which prohibits discrimination on the basis of age; and

e. Title IX of the Education Amendments of 1972, as amended, which prohibits discrimination on the basis of sex in educational programs.

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5. Is in compliance with 29 CFR Part 37 and all other regulations implementing the laws listed above.

6. Is in compliance with other applicable Federal and State laws, Executive Orders, and regulations prohibiting discrimination as herein above referenced and are included by this reference. This statement of assurance shall be interpreted to include Vietnam Era Veterans and Disabled Veterans within its protective range of applicability.

7. Is in compliance with Section 654 of the Omnibus Budget Reconciliation Act of 1981 as amended, 42 U.S.C. 9849, which prohibits discrimination on the basis of race, creed, color, national origin, sex, handicap, political affiliation or beliefs.

8. Certifies, through signature on Attachment C, that it is in compliance with the Equal Employment Opportunity (EEO): Executive Order No. 11246 as amended by EO No. 11375 and as supplemented in the Department of Labor regulation 29 CFR parts 33 & 37 as well as 41 CFR, part 60 and 45 CPR part 80, if applicable.

9. Certifies, through signature on Attachment D that it is in compliance with the Debarment and Suspension Executive Orders 12549 and 12689.

10. Certifies through signature on Attachment E, that it is in compliance with the Drug Free Workplace Laws.

11. Has included a signed sworn statement Attachment F under Section 287.133(3) (a), Florida Statutes, on Public Entity Crimes.

Proposer’s printed name Organization’s name

Proposer’s signature Date

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Attachment C NONDISCRIMINATION & EQUAL OPPORTUNITY ASSURANCE

As a condition to the Grantee the Grantee assures that it will comply fully with the nondiscrimination and equal opportunity provisions of the following laws:

1. Title VI of the Civil Rights Act of 1964, as amended, which prohibits discrimination on the basis of race, color and national origin;

2. Section 504 of the Rehabilitation Act of 1973, as amended, which prohibits discrimination against qualified individuals with disabilities;

3. Title IX of the Education Amendments of 1972, as amended, which prohibits discrimination on the basis of sex in educational programs;

4. The Age Discrimination Act of 1975, as amended, which prohibits discrimination on the basis of age;

5. The American with Disabilities Act of 1990, P.L. 101-336, prohibits discrimination in all employment practices, including job application procedures, hiring, firing, advancement, compensation, training, and other terms, conditions, and privileges of employment. It applies to recruitment, advertising, tenure, layoff, leave, fringe benefits, and all other employment related activities;

6. Section 188 of the Workforce Investment Act of 1998 (WIA) which prohibits discrimination against all individuals in the United States on the basis of race, color, religion, sex national origin, age, disability, political affiliation, or belief, and against beneficiaries on the basis of either citizenship/status as a lawfully admitted immigrant authorized to work in the United States or participation in any WIA Title I financially assisted program or activity; and

7. Executive Order 11246, as amended by Executive Order 11375, requires that Federal contractors and subcontractors not discriminate against any employee or applicant for employment because of race, color, religion, sex, or national origin. It also requires the contractor/subcontractor to take affirmative action to ensure that applicants are employed and that employees are treated during employment, without regard to their race, color, religion, sex, or national origin.

The Grantee also assures that it will comply with 29 CFR Part 37 and all other regulations implementing the laws listed above. This assurance applies to the grant applicant’s operation of the WIA Title I – financially assisted program or activity, and to all agreements the grant applicant makes to carry out the WIA Title I – financially assisted program or activity. The Grantee understands that DEO and the United States have the right to seek judicial enforcement of the assurance.

Name of Authorized representative Title

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Signature of Authorized representative Date

Attachment D 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 May 26, 1988 Federal Register (pages 19160-19211). (BEFORE SIGNING CERTIFICATION, READ ATTACHED INSTRUCTIONS WHICH ARE AN INTEGRAL PART OF THE CERTIFICATION)

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 Agreement 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 proposal 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 criminal or civil charges 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 this application/Agreement had one or more public transactions (Federal, State or local) terminated for cause or default.

Where the prospective primary participant is unable to certify any of the statements in this certification, such prospective participant shall attach an explanation to this Agreement and submit to: Stacy Campbell-Domineck, President/CEO, CareerSource Polk

Name of Authorized representative Title

Signature of Authorized representative Date

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Attachment E DRUG-FREE WORKPLACE CERTIFICATION

Preference shall be given to businesses with drug-free workplace programs. Pursuant to Section 287.087, Florida Statutes, whenever two or more competitive solicitations that are equal with respect to price, quality, and service are received by the State or by any political subdivision for the procurement of commodities or contractual services, a response received from a business that certifies that it has implemented a drug-free workplace program shall be given preference in the award process. Established procedures for processing tie responses will be followed if none of the tied providers has a drug free workplace program. In order to have a drug-free workplace program, a business shall:

1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition.

2. Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations.

3. Give each employee engaged in providing the commodities or contractual services that are under proposal a copy of the statement specified in Subsection (1).

4. In the statement specified in Subsection (1), notify the employees that, as a condition of working on the commodities or contractual services that are under proposal, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 894, Florida Statutes, or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction.

5. Impose a sanction on any employee who is so convicted or require the satisfactory participation in a drug abuse assistance or rehabilitation program as such is available in the employee's community.

6. Make a good faith effort to continue to maintain a drug-free workplace through implementation of applicable laws, rules and regulations.

As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements.

Business Name Provider’s Signature

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Attachment F 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 toPrint name of the public entity

byPrint individual’s name and title

forPrint name of entity submitting sworn statement

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 or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or of the United States, including, but not limited to, any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.

3. I understand that “convicted” or “conviction” as defined in Paragraph 287.133(1) (b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or 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, nonjury trial, or entry of a plea of guilty or nolo contendere.

4. I understand that an “affiliate” as defined in Paragraph 287.133(1)(a), Florida Statutes, means:

a. A predecessor or successor of a person convicted of a public entity crime; or b. An entity under the control of any natural person who is active in the management of the

entity and who has been convicted of a public entity crime. The term “affiliate” includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm’s length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate.

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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 or 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 in management of an entity.

6. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. (Indicate which statement applies.)

_____Neither the entity submitting this sworn statement, nor any of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent of 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.

_____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 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.

Signature Date

STATE OF COUNTY OF

PERSONALLY APPEARED BEFORE ME, the undersigned authority,

who, after first being sworn by me, affixed his/her

signature in the space provided above on this day of

2014.

NOTARY PUBLIC

My commission expires:

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