Fill - Free fillable DeKalb County Department of Purchasing and Contracting INVITATION (DeKalb County Government) PDF form

DeKalb County

Department of Purchasing and Contracting

Maloof Administration Building, 1300 Commerce Drive, 2

Floor,

Decatur, Georgia 30030

February 3, 2020

INVITATION TO BID (ITB) NO. 19-101200

FOR

QUICK INSERTION VALVES

(ANNUAL CONTRACT WITH 2 OPTIONS TO RENEW)

DEKALB COUNTY, GEORGIA

Procurement Agent:

Angel Frazier

Phone:

404-371-0814

Email:

amfrazier@dekalbcountyga.gov

Mandatory DeKalb First LSBE Meeting:

(Bidders must attend 1 meeting on either

of the dates listed in person or via video

conference.)

February 5, 2020 & February 12, 2020

4572 Memorial Drive, Decatur, Georgia 30032

Main Conference Room - A

(Meetings are held at 10:00 a.m. and 2:00 p.m.)

Video Conference: Utilize the link supplied on our webpage

labeled “DeKalb First LSBE Video Meeting”

Pre-Bid Conference and Site Visit:

N/A

Deadline for Submission of Questions:

5:00 P.M. ET, February 19, 2020

Bid Opening:

3:00 P.M. ET, March 4, 2020

Price Schedule Opening:

3 – 5 Business days after Bid Opening

FIRM’S NAME AND ADDRESS:

(Street, City, State and Zip Code. Type or print):

Federal Tax ID No. ______________________________

ARE YOU A DEKALB COUNTY FIRM? Yes ____ No ____

TELEPHONE AND FAX NUMBERS WITH AREA

CODE:

Phone: ________________________________________

Fax: __________________________________________

E-mail: ________________________________________

SIGNATURE OF PERSON AUTHORIZED

TO SIGN BID AND DATE:

_______________________________________________

SIGNER’S NAME AND TITLE (Type of Print):

_______________________________________________

THE RESPONSIBILITY FOR SUBMITTING A RESPONSE TO THIS BID TO THE

DEPARTMENT OF PURCHASING AND CONTRACTING OF DEKALB COUNTY

GOVERNMENT ON OR BEFORE THE STATED DATE AND TIME WILL BE SOLELY AND

STRICTLY THE RESPONSIBILITY OF THE BIDDER.

Crystal

Creekmore

Digitally signed by Crystal

Creekmore

Date: 2020.01.23

11:35:20 -05'00'

click to sign

signature

click to edit

Page 2 of 45

Revised 04/18/2019 P&C

TABLE OF CONTENTS

FOR

INVITATION TO BID NO. 19-101200

INVITATION TO BID OVERVIEW ............................................................................................... 3

INVITATION TO BID PROCEDURES .......................................................................................... 5

GENERAL TERMS AND CONDITIONS ....................................................................................... 9

MINIMUM SPECIFICATIONS ..................................................................................................... 21

PRICE SCHEDULE ......................................................................................................................... 24

BID ACKNOWLEDGEMENT FORM .......................................................................................... 26

Page 3 of 45

Revised 04/18/2019 P&C

INVITATION TO BID OVERVIEW

A. PURPOSE:

DeKalb County Government (the County) is soliciting bids for ITB No. 19-101200 Quick Insertion

Valves (Annual Contract with 2 Options to Renew) from responsible bidders.

B. GENERAL INFORMATION:

1. BID TIMETABLE:

The anticipated schedule for the bid process is as follows:

Date Issued:

February 3, 2020

Mandatory DeKalb First LSBE Meeting:

(Bidders must attend 1 meeting on either

of the dates listed.)

February 5, 2020 & February 12, 2020

4572 Memorial Drive, Decatur, Georgia 30032 Main

Conference Room - A

(Meetings are held at 10:00 a.m. and 2:00 p.m.)

Pre-Bid Conference and Site Visit:

N/A

Deadline for Submission of Questions:

5:00 P.M. ET, February 19, 2020

Bid Opening:

3:00 P.M. ET, March 4, 2020

Price Schedule Opening:

3 – 5 Business days after Bid Opening

Bids Valid Until:

Bids shall be valid for 90 days from and including the

bid opening date.

Sealed bids are to be addressed and delivered to:

DeKalb County Department of Purchasing and Contracting

Maloof Administration Building

1300 Commerce Drive, 2

Floor

Decatur, Georgia 30030, not later than 3:00 P.M. ET, March 4, 2020.

***NEW–PRICE SCHEDULE MUST BE SUBMITTED IN A SEPARATE SEALED

ENVELOPE OR BIDDER WILL BE DEEMED NON-RESPONSIVE AND WILL

NOT BE CONSIDERED FOR AWARD***

Submit one original bid package (inclusive of the entire Invitation to Bid document and

required documents with the exception of the price schedule) stamped “Original” and two

sealed identical copies stamped “Copy” of the bid package to the address listed above.

2. CONTACT PERSON:

The contact person for this bid is Angel Frazier, Procurement Agent. General inquiries

concerning the meaning or interpretation of this Invitation to Bid (ITB) may be requested from

the contact person via telephone at 404-317-0814 or via email at

amfrazier@dekalbcountyga.gov. Questions and requests for information or clarification

concerning the specifications in this ITB must be submitted to the above listed contact person

via email no later than the date and time listed in the bid timetable. Questions and requests

received after the above stated time or sent to anyone other than the listed contact person will

not receive a response or be the subject of addenda.

Page 4 of 45

Revised 04/18/2019 P&C

3. QUESTIONS:

All requests must be in writing. Any explanation desired by a bidder regarding the meaning

or interpretation of the Invitation to Bid, drawings, specifications, requirements, etc., must be

requested in writing and with sufficient time allowed for a reply to reach bidders before the

submission of their bids. If any statement in the bidding documents, specifications, plans, etc.,

appear ambiguous to the Bidder, Bidder is specifically instructed to make a written request to

the Department of Purchasing and Contracting as outlined in the preceding sentence. Any

information given to a prospective bidder concerning an Invitation to Bid will be furnished to

all prospective bidders, as an addenda to the Invitation, if such information is necessary to

bidders in submitting bids on the Invitation or if the lack of such information would be

prejudicial to uninformed bidders. Oral explanations or instructions given before the award of

the contract will not be binding. Questions must be submitted no later than 5:00 pm EST

on “February 19, 2020.”

4. ADDITIONAL INFORMATION/ADDENDA:

The County will issue responses to inquiries and any other corrections or amendments it deems

necessary in written addenda issued prior to the bid opening date. Bidders should not rely on

any representations, statements or explanations other than those made in this ITB or in any

addendum to this ITB. Where there appears to be a conflict between the ITB and any addenda

issued, the last addendum issued will prevail. It is the responsibility of the Bidder to ensure

awareness of all addenda issued for this solicitation. Please acknowledge the addenda and

submit to the DeKalb County Department of Purchasing and Contracting as requested. Bidders

may contact the above listed contact person to verify the number of addenda prior to

submission. Addenda issued for this ITB will be posted on DeKalb County’s website,

www.dekalbcountyga.gov/formalbids. Bidder should regularly check the County’s website for

addenda.

Page 5 of 45

Revised 04/18/2019 P&C

INVITATION TO BID PROCEDURES

BIDDER INFORMATION:

1. FAILURE TO SUBMIT THE PRICE SCHEDULE IN A SEPARATE SEALED

ENVELOPE SHALL DEEM THE BID NON-RESPONSIVE. INCLUDING THE

PRICE SCHEDULE IN ANY AREA OUTSIDE OF ITS SEPARATE, SEALED

ENVELOPE WILL RESULT IN BIDDER’S BID BEING DEEMED NON-

RESPONSIVE.

2. Failure to return all pages of this Invitation to Bid may result in bid being deemed non-

responsive.

3. Minimum specifications are intended to be open and non-restrictive. Contractors are

invited to inform the DeKalb County Department of Purchasing and Contracting whenever

specifications or procedures appear not to be fair and open. Such information should be

supplied as early in the procurement process as possible. Information received in less than

five (5) days prior to the scheduled bid opening will not be acted upon unless the DeKalb

County Department of Purchasing and Contracting rules that it is in the best interest of the

County to consider.

4. Brand names and numbers when provided in solicitations are for reference and to establish

a quality standard. Any reference to a brand name shall not be construed as restricting

Bidders to that manufacturer (unless “no substitutes” is stated). Bids on equal items will

be considered, provided the bid clearly describes the article offered and it is equal or

better in quality and function and fully compatible with this requirement.

5. By submitting a bid, Bidder warrants that any goods or services supplied to DeKalb

County Government meet or exceed the specifications set forth in this solicitation.

6. If any supplies, materials, and equipment are provided to the County under this

solicitation, then such items shall be new and in first-class condition unless the

solicitation specifically allows offers of used, reconditioned, or remanufactured items. If

newly manufactured products are specified, such products shall be of recent origin and

not previously used. No equipment of any type is acceptable if serial numbers or any other

manufacturer’s identification labels or marks have been removed, obliterated, or changed

in any way. A Contractor delivering any such equipment to the County will be deemed to

have breached the contract and appropriate action will be taken by the DeKalb County

Government Purchasing and Contracting Department.

7. Time of delivery is a part of the solicitation and an element of the contract that is to be

awarded. If the Bidder cannot meet the required service delivery dates, a bid should not

be submitted. Failure to deliver in accordance with the contract could result in the

Contractor being declared in default.

8. Bid Withdrawal

Bids may be withdrawn at any time prior to the bid opening. After bids have been publicly

opened, withdrawal of bids shall be based upon Part 3, Section IV, F. within the DeKalb

County Purchasing Policy.

Page 6 of 45

Revised 04/18/2019 P&C

9. Expenses of Preparing Responses to this ITB

The County accepts no responsibility for any expenses incurred by Bidders who submit

bids in response to this ITB. Such expenses are to be borne exclusively by the Bidders.

10. It is the responsibility of each Bidder to ensure that its submission is received by 3:00 p.m.

on the bid due date. The time/date stamp clock located in the Department of Purchasing

& Contracting shall serve as the official authority to determine lateness of any bid. The bid

opening time shall be strictly observed. Be aware that visitors to our offices will go

through a security screening process upon entering the building. Bidders should plan

enough time to ensure that they will be able to deliver their submission prior to our deadline.

Late submissions, for whatever reason, will not be evaluated. Bidders should plan their

deliveries accordingly. Telephone or fax bids will not be accepted.

11. Price Schedule openings shall be conducted in the Department of Purchasing and

Contracting three (3) to five (5) days after the bid opening. Only the Price Schedules of

responsive bidders shall be opened. The County reserves the right to decide which bid(s)

will be deemed responsive and said determination shall be made in accordance with the

requirements stated in this solicitation.

12. Federal Work Authorization

Pursuant to O.C.G.A. §13-10-91, the County cannot enter into a contract for the physical

performance of services unless the Contractor, its Subcontractor(s) and sub-

subcontractor(s), as that term is defined by state law, register and participate in the Federal

Work Authorization Program to verify specific information on all new employees. The

Bidder certifies that he/she has complied and will continue to comply throughout the

contract term with O.C.G.A. §13-10-91 and any related and applicable Georgia

Department of Labor Rule. Contractor agrees that in the event it employs or contracts

with any Subcontractor(s) in connection with this contract, Contractor will secure from

each Subcontractor an affidavit that certifies the Subcontractor’s current and continuing

compliance with O.C.G.A. §13-10-91 throughout the contract term. Each Subcontractor

agrees that in the event it employs or contracts with any sub-subcontractor(s), each

Subcontractor will secure from each sub-subcontractor an affidavit that certifies the sub-

subcontractor’s current and continuing compliance with O.C.G.A. §13-10-91 throughout

the contract term.

13. LSBE Information

a. It is the objective of the Chief Executive Officer and Board of Commissioners

of DeKalb County to provide maximum practicable opportunity for all

businesses to participate in the performance of government contracts. The

current DeKalb County List of Certified Vendors may be found on the County

website at http://www.dekalbcountyga.gov/purchasing/pdf/supplierList.pdf

b. It is required that all responding Bidders attend the mandatory LSBE meeting

within two-weeks of the solicitation’s advertisement, and comply, complete and

submit all LSBE forms with the Bidder’s response in order to remain

responsive. Attendance can be in person, via video conference and

teleconference. Video conferencing is available

through Skype/Lync. Instructions for attendance via video conference can be

found on the County’s website at https://www.dekalbcountyga.gov/purchasing-

contracting/dekalb-first-lsbe-program.

Page 7 of 45

Revised 04/18/2019 P&C

c. For further details regarding the DeKalb First Local Small Business Enterprise

Ordinance, contact the LSBE Program representative, Felton Williams at

fbwilliams@dekalbcountyga.gov or (404) 371-6312.

14. First Source Jobs Information

The DeKalb County First Source Jobs Ordinance requires contractors or beneficiaries

entering into any type of agreement with the County, including purchase orders,

regardless of what they may be called for the procurement or disposal of supplies,

services, construction projects, professional or consultant services, which is funded in

whole or part with County funds or County administered funds in which the contractor

is to receive $50,000 or more in County expenditures or committed expenditures and

recipient of urban redevelopment action grants or community development block funds

administered in the amount of $50,000 or more make a good faith effort to hire

DeKalb County residents for at least 50% of jobs using the First Source Registry

(candidate database). The work to be performed under this contract is subject to the

provisions of the DeKalb County First Source Jobs Ordinance.

For more information on the First Source Jobs Ordinance requirement, please contact

WorkSource DeKalb at www.dekalbworkforce.org or 404-687-3400.

15. Attention to General Terms and Conditions

Bidders are cautioned to thoroughly understand and comply with all matters covered

under the General Terms and Conditions section of this ITB. The successful Bidder(s)

will enter into a contract approved by the County. The County’s ITB document and

attachments, subsequent County addenda, and the Bidder’s response documents are

intended to be incorporated into a contract. All Bidders should thoroughly review this

document prior to submitting a bid. Any proposed revisions to the terms or language of

this document must be submitted in writing with the bid. Since proposed revisions may

result in a bid being rejected if the revisions are unacceptable to the County, bidders

should review any proposed revisions with an officer of the firm having authority to

execute the contract. No alterations can be made in the contract after award is made.

16. Required Signatures

Bids must be signed by an officer or agent of the firm having the authority to execute

contracts.

17. Ethics Rules

Bidders are subject to the Ethics provision within the DeKalb County Purchasing Policy;

the Organizational Act, Section 22A, the Code of DeKalb County; and the rules of

Executive Order 2014-4. Any violations will be addressed, pursuant to these policies and

rules.

To the extent that the Organizational Act, Section 22A, the Code of DeKalb County, and

the rules of Executive Order 2014-4 allow a gift, meal, travel expense, ticket, or anything

else of value to be purchased for a CEO employee by a contractor doing business with

the County, the contractor must provide written disclosure, quarterly, of the exact nature

and value of the purchase to the Chief Integrity Officer, if created, or the Finance

Director or his/her designee. Every contractor conducting business with the County

will receive a copy of these ethical rules at the time of execution of the contract.

Page 8 of 45

Revised 04/18/2019 P&C

18. Business License

Bidders shall submit a copy of its current, valid business license with its Bid or upon award.

Georgia companies are to submit a valid county or city business license. Contractors that

are not Georgia companies are to provide a certificate of authority to transact business in

the State of Georgia and a copy of a valid business license issued by its home jurisdiction.

If Bidder holds a professional certification which is licensed by the state of Georgia, then

Bidder may submit a copy of its valid professional license with Bidder’s bid or upon award

unless the Minimum Specifications require submittal with the bid. Any license submitted

in response to this ITB shall be maintained by the Contractor for the duration of the

contract.

BID SUBMITTAL:

1. All bids should be completed in ink or typewritten. Errors should be crossed out and

corrections entered in ink or typewritten adjacent to the error. The person signing

the bid should initial corrections in ink.

2. Bidders shall complete and submit Attachment A - Required Documents Checklist and all

documents responsive to this requirement with the bid submittal.

3. If applicable, provide evidence that the Bidder is a DeKalb County Firm.

4. Bids must be submitted in a sealed envelope(s) or box(es) with the Bidder’s name and

“ITB No. 19-101200 Quick Insertion Valves” on the outside of each envelope or box.

All Bidders delivering submittals via delivery services, please place the sealed bid

envelope(s) or box(es) inside the delivery service envelope(s) or box(es). Bidders are

responsible for informing any delivery service of all delivery requirements. No

responsibility shall attach to the County for the premature opening of a submission not

properly addressed and/or identified. The Decatur postmaster will not deliver certified

or special delivery mail to specific addresses within DeKalb County Government.

C. Contract Award:

1. Bids submitted will be evaluated and recommended for award to the lowest, responsive,

and responsible Bidder(s).

2. The intent of this bid is to make an all-award; however, the County reserves the right to

award by line item or multiple awards. The County may accept any item or group of items

on any bid, whichever is in the best interest of DeKalb County.

3. The County reserves the right to reject any and all bids, to waive informalities, and to re-

advertise.

4. The judgment of DeKalb County Purchasing and Contracting on matters, as stated above,

shall be final. The County reserves the right to decide which Bid will be deemed lowest,

responsive and responsible.

Page 9 of 45

Revised 04/18/2019 P&C

GENERAL TERMS AND CONDITIONS

A. In the event of a conflict between any provisions contained in any of the documents

governing this transaction, the following shall be the order of precedence: Change

Orders or modifications; the Bidder’s accepted bid; and the County’s ITB.

B. The Bidder’s services shall include all things, personnel, and materials necessary to provide

the goods or services that are in compliance with the specifications as authorized by the

County.

C. Bidder extends to the County the option to renew the contract for two (2) additional one

year terms, under the same price(s), terms and conditions, and in accordance with

Paragraph L, Term.

D. DELIVERY:

Delivery of services or goods will commence within (3) calendar days upon request.

Bidder state agreement: Yes_____________ No______________

Contact Person:

Telephone Number: ____________________Cellular Phone Number: ________________

Address:

Alternate delivery time may be considered provided it is so stated. Bidder state alternate

terms for delivery or services below.

All prices are to be firm, F.O.B. Destination, Freight Prepaid and Allowed. Delivery shall

include delivered, unloaded, and placed in designated area. Delivery must be made between

9:00 A.M. and 2:30 P.M. Monday through Friday, unless otherwise required. The successful

bidder shall give a 24-hour prior Notice of Delivery to Department or Division calling in the

order, and must ask for caller’s telephone number as well as Purchase Order form and

address. The County will unload after prior notice.

E. DELIVERIES BEYOND THE CONTRACTUAL PERIOD:

This contract covers all requirements that may be ordered, as distinguished from delivered,

during the contract term. This is for the purpose of providing continuity of supply by

permitting the County to place orders as requirements arise in the normal course of supply

operations. Accordingly, any order mailed (or received, if forwarded by other means than

through the mail) to the Contractor on or before the expiration date of the contract, and

providing for delivery within the number of days specified in the contract, shall constitute

a valid order.

age 10 of 45

Revised 04/18/2019 P&C

F. FOREIGN PRODUCTS:

DeKalb County prefers to buy items produced and/or manufactured in the United States of

America; however, foreign products may be considered provided it is so stated. Bidder

certifies that items offered on this bid is/are manufactured and produced in the United States.

Yes ______ No _____

If “No”, state the exact location of plant or facility where items will be produced:

G. COUNTY REQUIREMENT:

The contract will be an “Indefinite Quantity” type with County requirements to be satisfied

on an “as ordered” basis. The County makes no promise, real or implied, to order any

quantity whatsoever. This invitation and resulting contract will provide for the normal

requirements of DeKalb County, and contracts will be used as primary sources for the

articles or services listed herein. Articles or services will be ordered from time to time in

such quantities as may be needed. As it was impossible to determine the precise quantities

of items described in this invitation that will be needed during the contract term, each

contractor is obligated to deliver all articles and services that may be ordered during the

contract term.

H. WARRANTY AND/OR GUARANTY:

Contractor warrants that its services under this Agreement shall be free of defects in materials

and workmanship for a period of 1 year. The Contractor shall not be liable for indirect,

special, or exemplary damages. The Contractor shall be liable for direct damages.

__________________________________________________________________________

I. SAMPLES & TESTING:

Samples of items, when required, must be submitted within the time specified, and unless

otherwise specified by the County, at no expense to the County. If not destroyed by testing,

samples will be returned at bidder's request and expense, unless otherwise specified by the

Invitation to Bid. Since tests may require several days for completion, the County reserves

the right to use a portion of any supplies before the results of the tests are known, without

prejudice to any final adjustments, rejecting the unused portion of the delivery and payment

will be made on an adjusted basis for the used portion. The costs of inspections and tests of

any item which fails to meet the advertised specifications shall be borne by the bidder.

age 11 of 45

Revised 04/18/2019 P&C

J. LITERATURE:

When the bidder proposes to furnish another product, he is required to furnish, with his bid,

literature describing the item(s) being offered. Failure to furnish this literature may result in

the bid being deemed non-responsive.

K. SILENCE OF SPECIFICATIONS:

The apparent silence of these specifications and any supplemental specifications as to any

details, or the omission from it of a detailed description concerning any point, shall be

regarded as meaning that only the best commercial practices are to prevail and that only

materials of first quality and correct type, size and design are to be used. All workmanship

is to be first quality. All interpretations of this specification shall be made upon the basis

of this statement, with County interpretation to prevail.

L. TERM:

The Contractor shall commence the Work under this Contract within ten (10) days from the

acknowledgement of receipt of the Notice to Proceed (“Commencement Date”). The Initial

Term of this Agreement shall be for twelve (12) calendar months, beginning on the

Commencement Date. This annual contract comes with two (2) options to renew. Prior to

the expiration of the Initial Term, the parties have the option to renew this agreement for a

First annual Renewal Term of twelve (12) calendar months. Prior to the expiration of the

First annual Renewal Term, the parties have the option to renew this Agreement for a

Second annual Renewal Term of twelve (12) calendar months. Without further action by

either party, this Agreement will terminate at the end of the Initial Term or at the end of

each annual Renewal Term. Each option to renew must be exercised prior to the beginning

of each annual Renewal Term and, is only effective upon adoption and approval by the

DeKalb County Governing Authority and the Contractor in accordance with the terms of

this Contract.

age 12 of 45

Revised 04/18/2019 P&C

M. PRICING:

Alterations to the Price Schedule may result in the Bidder being deemed non-responsive and

its bid may be rejected.

1. Price Reductions: If at any time after the date of award, the Contractor makes a

general price reduction in the comparable price of any article or service covered by

the contract to customers generally, an equivalent price reduction based on similar

quantities and/or considerations shall apply to the contract for the duration of the

contract period (or until the price is further reduced). Such price reduction shall be

effective at the same time and in the same manner as the reduction in the price to

customers generally. An occasional sale at a lower price, or sale of distressed

merchandise at a lower price, would not be considered a general price reduction

under this paragraph. For purposes of this paragraph, a general price reduction shall

mean any reduction in the price of an article or service offered:

• To Contractor's customers.

• In the Contractor's price schedule for the class of customers; i.e.,

wholesalers, jobbers, retailers, etc., which was used as the basis for

bidding on this contract.

The Contractor shall invoice the County at such reduced price indicating on the

invoice that the reduction is pursuant to General Terms and Conditions, paragraph I.

as stated within the ITB.

2. Price Escalation Clause: During the life of the contract, the awarded bidder shall

furnish price lists to the County for increases, and those of the bidder’s supplier (e.g.

factory) increases, as prices change. The bidder must also provide a list of the

supplier’s (e.g. factory’s) previous price(s) to the County for purposes of

comparison. Price changes will be in effect only after receipt and approval by the

Director of the Department of Purchasing and Contracting. Price lists and changes

thereto are to be furnished under the contract and without charge to the County.

Catalogue(s) or Price List(s) must be submitted to the Department of Purchasing and

Contracting, Maloof Administration Building, 1300 Commerce Drive, 2

Floor,

Decatur, Georgia 30030.

3. By submission of this bid, the bidder certifies, and in the case of a joint bid each

party thereto certifies as to its own organization that in connection with this

procurement:

The prices in this bid have been arrived at independently, without

consultation, communication, or agreement, for the purpose of restricting

competition, as to any matter relating to such prices with any other bidder or

with any competitor,

Unless otherwise required by law, the prices which have been quoted in this

bid have not been knowingly disclosed by the bidder and will not knowingly

be disclosed by the bidder prior to opening, directly or indirectly to any other

bidder or to any competitor: and

Page 13 of 45

Revised 04/18/2019 P&C

No attempt has been made or will be made by the bidder to induce any other

person or firm to submit or not to submit a bid for the purpose of restricting

competition.

N. PAYMENT:

1. The County shall pay the Contractor based upon the accepted bid prices

submitted by Bidder. Invoices should be signed by the Bidder or authorized

delegate and must contain the authorizing DeKalb County Purchase Order (PO)

and/or Contract Purchase Agreement (CPA) Number in order for payment to be

processed. PO Number must also be on the delivery ticket.

A Contract Purchase Agreement is being issued in lieu of a formal contract. Any

reference to a

contract refers to the CPA.

2. Invoice(s) must be submitted as follows:

Vendor invoices:

Accounts Payable

DeKalb County Department of Finance

1300 Commerce Drive, 3

Floor

Decatur, GA 30030

For notices:

Chief Financial Officer

DeKalb County Department of Finance

1300 Commerce Drive, 6

Floor

Decatur, GA 30030

a. Upon award, Prime Contractor(s) with Local Small Business Enterprise

(LSBE) Subcontractor(s) shall enter utilization reports electronically at

www.dekalblsbe.info. Proof of payment to the LSBE Subcontractor must be

uploaded and submitted. LSBE Subcontractors shall confirm receipt of

payment from the Prime, electronically also, at www.dekalblsbe.info.

3. The County’s official payment terms are Net 30. Payment dates that fall on a

weekend or on a holiday will be issued on the County’s next business day.

O. ACCURACY OF WORK:

The Contractor shall be responsible for the accuracy of the Work and any error and/or

omission made by the Contractor in any phase of the Work under this Agreement.

Page 14 of 45

Revised 04/18/2019 P&C

P. ADDITIONAL WORK:

The County shall in no way be held liable for any work performed under this section which

has not first been approved in writing by the County in the manner required by applicable

law and/or the terms of this Contract. The County may at any time order changes within

the scope of the Work without invalidating the Contract upon seven (7) days written notice

to the Contractor. The Contractor shall proceed with the performance of any changes in the

Work so ordered by the County unless such change entitles the Contractor to a change in

Contract Price, and/or Contract Term, in which event the Contractor shall give the County

written notice thereof within fifteen (15) days after the receipt of the ordered change, and

the Contractor shall not execute such changes until it receives an executed Change Order

from the County. No extra cost or extension of time shall be allowed unless approved

by the County and authorized by execution of a Change Order. The parties’ execution of

any Change Order constitutes a final settlement of all matters relating to the change in the

Work which is the subject of the Change Order. The County shall not be liable for payment

for any work performed under this section which has not first been approved in writing

by the County in the manner required by applicable law and/or the terms of this Contract.

Q. OWNERSHIP OF DOCUMENTS:

All documents, including drawings, estimates, specifications, and data are and remain the

property of the County. The Contractor agrees that the County may reuse any and all

plans, specifications, drawings, estimates, or any other data or documents described herein

in its sole discretion without first obtaining permission of the Contractor and without any

payment of any monies to the Contractor therefore. Any reuse of the documents by the

County on a different site shall be at its risk and the Contractor shall have no liability where

such documents are reused.

R. RIGHT TO AUDIT:

The County shall have the right to audit all books and records, including electronic records,

relating or pertaining to this contract or agreement, including but not limited to all financial

and performance related records, property, and equipment purchased in whole or in part with

County funds and any documents or materials which support whose records, kept under the

control of the Contractor, including but not limited to those kept by the Contractor’s

employees, agents, assigns, successors and subcontractors. The County also has the right to

communicate with Contractor’s employees related to the audited records.

The Contractor shall maintain such books and records, together with such supporting or

underlying documents and materials, for the duration of this contract and for seven (7) years

after termination or expiration, including any and all renewals thereof. The books and

records, together with supporting documents and materials shall be made available, upon

request to the County or its designee, during normal business hours at the Contractor’s office

or place of business. In the event that no such locations is available, then the books, records

and supporting documents shall be made available for audit at a time and location which is

convenient for the County.

Page 15 of 45

Revised 04/18/2019 P&C

S. SUCCESSORS AND ASSIGNS:

The Contractor agrees it shall not sublet, assign, transfer, pledge, convey, sell, or otherwise

dispose of the whole or any part of this Contract or his right, title, or interest therein

to any person, firm, or corporation without the previous written consent of the County.

If the County consents to any such assignment or transfer, then the Contractor binds

itself, its partners, successors and assigns to all covenants of this Contract. Nothing

contained in this Contract shall create, nor be interpreted to create privity, or any other

relationship whatsoever, between the County and any person, or entity or than

Contractor.

T. REVIEWS AND ACCEPTANCE:

Work performed by the Contractor shall be subject to review and acceptance in stages as

required by the County. Acceptance shall not relieve the Contractor of its professional

obligation to correct, at his own expense, any errors in the Work.

U. TERMINATION OF AGREEMENT:

The Contractor understands and agrees that the date of the beginning of Work, rate of

progress, and time for completion of the Work are essential conditions of this Contract.

Both parties may, for its own convenience and at its sole option, without cause and

without prejudice to any other right or remedy of the party, elect to terminate the Contract

by delivering to the other party, at the address listed in the Notices article of this

Contract, a written notice of termination specifying the effective date of termination.

Such notice shall be delivered to the other party at least thirty (30) days prior to the

effective date of termination. If Contractor’s services are terminated by the County, the

termination will not affect any rights or remedies of the County then existing or which

may thereafter accrue against Contractor or its surety. In case of termination of this

Contract before completion of the Work, Contractor will be paid only for the portion of

the Work satisfactorily performed through the effective date of termination as determined

by the County. Neither party shall be entitled to recover lost profits, special, consequential

or punitive damages, attorney’s fees or costs from the other party to this Contract for any

reason whatsoever. This Contract shall not be deemed to provide any third-party with

any remedy, claim, right of action, or other right. The parties’ obligations pursuant to

this Section shall survive any acceptance of Work, or termination or expiration of this

Contract.

V. INDEMNIFICATION AGREEMENT:

The Contractor shall be responsible from the execution date or from the time of the

beginning of the Work, whichever shall be the earlier, for all injury or damage of any

kind resulting from the Work, to persons or property, including employees and property

of the County. The Contractor shall exonerate, indemnify, and save harmless the County,

its elected officials, officers, employees, agents and servants, hereinafter collectively

referred to in this Section as “the County Indemnitees,” from and against all claims or

actions based upon or arising out of any damage or injury (including without limitation

any injury or death to persons and any damage to property) caused by or sustained in

connection with the performance of this Contract or by conditions created thereby or

arising out of or any way connected with Work performed under this Contract, as well as

Page 16 of 45

Revised 04/18/2019 P&C

all expenses incidental to the defense of any such claims, litigation, and actions.

Furthermore, Contractor shall assume and pay for, without cost to the County Indemnitees,

the defense of any and all claims, litigation, and actions suffered through any act or omission

of the Contractor, or any Subcontractor, or anyone directly or indirectly employed by or

under the supervision of any of them. Notwithstanding any language or provision in this

Contract, Contractor shall not be required to indemnify any County Indemnitee against

claims, actions, or expenses based upon or arising out of the County Indemnitee’s sole

negligence. As between the County Indemnitees and the Contractor as the other party, the

Contractor shall assume responsibility and liability for any damage, loss, or injury, including

death, of any kind or nature whatever to person or property, resulting from any kind of

claim made by Contractor’s employees, agents, vendors, Suppliers or Subcontractors

caused by or resulting from the performance of Work under this Contract, or caused by or

resulting from any error, omission, or the negligent or intentional act of the Contractor,

vendors, Suppliers, or Subcontractors, or any of their officers, agents, servants, or

employees. The Contractor shall defend, indemnify, and hold harmless the County

Indemnitees from and against any and all claims, loss, damage, charge, or expense to which

they or any of them may be put or subjected by reason of any such damage, loss, or injury.

The Contractor expressly agrees to provide a full and complete defense against any claims

brought or actions filed against the County Indemnitees, where such claim or action

involves, in whole or in part, the subject of the indemnity contained in this Contract,

whether such claims or actions are rightfully or wrongfully brought or filed. The County

has the sole discretion to choose the counsel who will provide the defense. No provision of

this Contract and nothing herein shall be construed as creating any individual or personal

liability on the part of any elected official, officer, employee, agent or servant of the

County, nor shall the Contract be construed as giving any rights or benefits hereunder

to anyone other than the parties to this Contract. The parties’ obligations pursuant to this

Section shall survive any acceptance of Work, or termination or expiration of this Contract.

W. INSURANCE:

Insurance must meet the County’s requirements and will be furnished by the successful

Bidder(s) upon award.

1. Successful Bidder(s) will advise their insurance agent of the County’s requirements as

listed below and that they may not proceed with any work until insurance is provided

that is in compliance with these requirements.

2. Contractor’s insurance company or agent must mail, email, or bring an original

certificate of insurance and applicable declarations or endorsements to the DeKalb

County address listed within this Insurance provision. Insurance must be from

companies able to do business in Georgia and acceptable to the County as follows:

a. Certificates must cover:

i. Statutory Workers Compensation

(1) Employer’s liability insurance by accident, each accident $1,000,000

(2) Employer’s liability insurance by disease, policy limit $1,000,000

(3) Employer’s liability insurance by disease, each employee $1,000,000

ii. Business Auto Liability Insurance with a minimum $500,000

Page 17 of 45

Revised 04/18/2019 P&C

Combined Single Limit/Each Occurrence (Including operation of

non-owned, owned, and hired automobiles).

iii. Commercial General Liability Insurance

(1) Each Occurrence - $1,000,000

(2) Fire Damage - $250,000

(3) Medical Expense - $10,000

(4) Personal & Advertising Injury - $1,000,000

(5) General Aggregate - $2,000,000

(6) Products & Completed Operations - $1,500,000

(7) Contractual Liability where applicable

b. DeKalb County, GA shall be named as Additional Insured under any General

Liability, Business Auto and Umbrella Policies. Coverage shall apply as

Primary and non-contributory with Waiver of Subrogation in favor of DeKalb

County, Georgia. Such additional insured coverage shall be endorsed to

Contractor’s policy by attachment of ISO Additional Insured Endorsement

forms CG 20 10 10 01 (ongoing operations) and CG 20 37 10 01 (products-

completed operations), or form(s) providing equivalent coverage.

c. This insurance for the County as the additional insured shall be as broad as the

coverage provided for the named-insured Contractor. It shall apply as primary

insurance before any other insurance or self-insurance, including any

deductible, non-contributory, and waiver of subrogation provided to the

County as the additional insured.

d. Contractor agrees to waive all rights of subrogation and other rights of recovery

against the County and its elected officials, officers, employees or agents, and

shall cause each Subcontractor to waive all rights of subrogation for all

coverages.

e. Certificates shall state that the policy or policies shall not expire, be

cancelled or altered without at least sixty (60) days prior written notice to

the County.

f. Contractor understands and agrees that the purchase of insurance in no

way limits the liability of the Contractor.

g. The insurance carrier must have a minimum A.M. Best rating of not less than

“A” (Excellent) with a Financial Size Category of VII or better.

h. Certificates to contain policy number, policy limits and policy expiration date

of all policies issued in accordance with this contract.

i. Certificates to contain the location and operations to which the insurance applies.

Page 18 of 45

Revised 04/18/2019 P&C

j. Certificates to contain successful contractor’s protective coverage for any

subcontractor’s operations. If this coverage is included in General Liability,

please indicate on the Certificate of Insurance.

k. Certificates to contain successful contractor’s contractual insurance

coverage. If this coverage is included in the General Liability, please

indicate this on the Certificate of Insurance.

l. Certificates shall be issued and delivered to the County and must identify

the “Certificate Holder” as follows:

DeKalb County, Georgia

Director of Purchasing and

Contracting

Maloof Administration Building

1300 Commerce Drive, 2nd Floor

Decatur, Georgia 30030

m. The successful contractor shall be wholly responsible for securing

certificates of insurance coverage as set forth above from all subcontractors

who are engaged in this work.

X. GEORGIA LAWS GOVERN:

The laws of the State of Georgia shall govern the construction of this Contract without

regard for conflicts of laws. Should any provision of this Contract require judicial

interpretation, it is agreed that the court interpreting or construing the same shall not apply

a presumption that the terms hereof shall be more strictly construed against one party, by

reason of the rule of construction, that a document is to be construed more strictly against

the party who itself or through its agent prepared same; it being agreed that the agents of

all parties have participated in the preparation hereof, and all parties have had an

adequate opportunity to consult with legal counsel. In interpreting this Contract in its

entirety, the printed provisions of this Contract, and any additions written or typed

hereon, shall be given equal weight, and there shall be no inference by operation of law

or otherwise; that any provision of this Contract shall be construed against either party

hereto.

Y. VENUE:

This Agreement shall be deemed to have been made and performed in DeKalb County,

Georgia. For the purposes of venue, all suits or causes of action arising out of this

Agreement shall be brought in the courts of DeKalb County, Georgia.

Z. COUNTY REPRESENTATIVE:

The County may designate a representative through whom the Contractor will contact the

County. In the event of such designation, said representative shall be consulted and his

written recommendation obtained before any request for extra work is presented to the

County. Payments to the Contractor shall be made only upon itemized bill submitted to and

approved by said representative.

Page 19 of 45

Revised 04/18/2019 P&C

AA. CONTRACTOR’S STATUS:

The Contractor will supervise and direct the Work, including the Work of all

Subcontractors. Only persons skilled in the type of work which they are to perform shall

be employed. The Contractor shall, at all times, maintain discipline and good order among

his employees, and shall not employ any unfit person or persons or anyone unskilled in the

work assigned him. The relationship between the County and the Contractor shall be that

of owner and independent contractor. Other than the consideration set forth herein, the

Contractor, its officers, agents, servants, employees, and any Subcontractors shall not be

entitled to any County employee benefits including, but not limited to social security,

insurance, paid annual leave, sick leave, worker's compensation, free parking or

retirement benefits. All services provided by Contractor shall be by employees of

Contractor or its Subcontractors and subject to supervision by Contractor. No officer

or employee of Contractor or any Subcontractor shall be deemed an officer or employee of

the County. Personnel policies, tax responsibilities, social security payments, health

insurance, employee benefits and other administrative policies, procedures or

requirements applicable to the Work or services rendered under this Contract shall be those

of the Contractor, not the County.

BB. SOLE AGREEMENT:

This Contract constitutes the sole contract between the County and the Contractor. The

terms, conditions, and requirements of this Contract may not be modified. No verbal

agreement or conversation with any officer, agent, or employee of the County, either before

or after the award of the Contract, shall affect or modify any of the terms or obligations

herein contained. No representations, oral or written, shall be binding on the parties unless

expressly incorporated herein.

CC. SEVERABILITY:

If any provision of this Contract or the application thereof to any person or circumstance

shall to any extent be held invalid, then the remainder of this Contract or the application of

such provision to persons or circumstances, other than those as to which it is held invalid,

shall not be affected thereby, and each provision of this Contract shall be valid and enforced

to the fullest extent permitted by law.

DD. NOTICES:

Any notice or consent required to be given by or on behalf of any party hereto to any other

party hereto shall be in writing and shall be sent to the Director of the Department of

Purchasing and Contracting or to the Contractor or his authorized representative on the

work site by (a) registered or certified United States mail, return receipt requested, postage

prepaid, (b) personal delivery, or (c) overnight courier service. All notices sent to the

addresses listed below shall be binding unless said address is changed in writing no less

than fourteen days before such notice is sent. Future changes in address shall be

effective upon written notice being given by the Contractor to the Director of the

Department of Purchasing and Contracting or by the County to the Contractor’s authorized

representative via certified first class U.S. mail, return receipt requested. Such notices will

be addressed as follows:

Page 20 of 45

Revised 04/18/2019 P&C

If to the County:

Chief Procurement Officer

Department of Purchasing and Contracting

Maloof Administration Building

1300 Commerce Drive, 2

Floor

Decatur, Georgia 30030

If to the Contractor:

Notices shall be sent to the contact information that is listed in

the Bidder’s Response to the ITB.

EE. Georgia Open Records Act:

Without regard to any designation made by the person or entity making a submission, DeKalb

County considers all information submitted in response to this invitation or request to be a

public record that will be disclosed upon request pursuant to the Georgia Open Records Act,

O.C.G.A. §50-18-70 et seq., without consulting or contacting the Responder person or entity

making the submission, unless a court order is presented with the submission. Bidders or

Responders may wish to consult an attorney or obtain legal advice prior to making a

submission.

FF. Cooperative Procurement

The County through the Department of Purchasing & Contracting may permit piggybacks to

this contract from other city, county, local authority, agency, or board of education if the

vendor will extend the same prices, terms, and conditions to the city. Piggybacking shall only

be available where competition was used to secure the contract and only for a period of 12-

months following entry, renewal or extension of the contract. This provision shall not apply to

any contract where otherwise prohibited or mandated by state law.

Page 21 of 45

Revised 04/18/2019 P&C

MINIMUM SPECIFICATIONS

GENERAL REQUIREMENTS:

I. QuikValve™ VALVE INSERTION MACHINE

A. General

The insertion machine must be a Transmate QuikValve™ Insertion machine or approved

equal. If an equal product is bid, Bidder must prove the machine is capable of inserting the

Transmate QuikValve™.

B. The Transmate QuikValve™ Insertion machine, or approved equal shall have the

following components:

1. Be of light-weight construction with a manual feed and integral travel scale.

Be provided with a suitable storage box will be provided.

2. Capable of making 3” to 12” lateral cuts, as well as inserting 4”, 6” and 8”

QuikValve™ inserts in both pressurized and unpressurized mains.

3. Shell Cutter

The shell cutters shall:

a. Be provided with carbide teeth.

b. Be 4”, 4.275”, 5.5”, 6.0”, 6.325”, 7.5”, 8.0” and 8.425” provided with this

equipment.

c. Thread onto the main shaft.

d. Have the number of teeth a minimum of three (3) times the nominal outside

diameter of the cutter.

4. Pilot Drill

The pilot drill shall:

a. Incorporate a Spade bit.

b. Be removable, with only one (1) pilot drill needed for all cuts under 10” inches.

c. Be provided with an extension for 10” inch and 12” inch cuts.

d. Thread into the main shaft of the QuikValve™ Insertion machine.

5. Travel

Travel shall:

a. Use both a quick travel and a threaded travel method into and out of the cut.

b. Be provided by a sliding square tube mechanism and allow about 14” inches of

fast travel.

c. Have threaded travel provided by a ductile iron feed nut traveling on a threaded

tube.

d. Have the threaded tube case hardened and corrosion protected.

e. Have the threaded travel 13 ½” inches long.

f. Have a travel scale, marked in inches shall be cut into the top of the threaded tube.

6. Shaft

The shaft shall:

a. Be constructed of 4140 turned, ground, and polished steel alloy.

b. Be case hardened and corrosion protected.

c. Have a 3/4" square at the rear of the shaft for the power drive connection.

Page 22 of 45

Revised 04/18/2019 P&C

d. Have the tip of the shaft threaded with 1 ¼” to 7” inch threads to allow

attachment of shell cutters.

e. Have the tip of the shaft drilled and tapped with a 5/8” to 11” hole for the

attachment of either of the two (2) pilot drills.

7. Adapters

All adapters shall:

a. Be constructed of ductile iron or aluminum.

b. Thread on to the end of the threaded tube.

c. Have a set screw to lock the adapters on the threaded tube.

d. Be made of aluminum for use with the QuikValve™ insertion.

e. Have a bolt circle that mates with the QuikValve™ slide valve mechanism.

8. Hydraulic Drive System

The hydraulic drive system shall:

a. Be self-contained and available as an option.

b. Have a hydraulic drive pump mechanism that is powered by a 14-horse power

(HP), 4-cycle gasoline engine.

c. Have a drive pump that is surrounded by a metal frame with rubber pads on the

bottom.

d. Have a hydraulic drive motor with an on-off valve.

e. Be provided with all hoses and connectors.

9. Slide Valve

A slide valve shall:

a. Be provided to isolate the insertion machine during a QuikValve™ installation.

b. Be capable of withstanding up to 150 psi water pressure.

c. Be capable of mating to the QuikValve™ Insertion sleeve and the QuikValve™

insertion machine.

d. Take no more than 44 turns to open and close.

10. Pipe Reamers

The pipe reamers shall:

a. Be provided, one for 4” installations, one for 6” installations, and one for 8”

installations.

b. Be provided complete with a sizing ring.

c. Have cutting blades constructed out of high-speed steel tool steel, the reamer

body shall be constructed out of aluminum alloy.

d. Be capable of threading onto the end of the main shaft of the Quik Valve Insertion

machine.

11. Drilling Bushings

The drill bushings shall be:

a. Provided one each for 4”, 6”, and 8” insertions.

b. Capable of mating to the inside diameter of the lower flange on the slide valve

provided.

c. Be constructed of mild steel with a bronze alloy bushing.

Page 23 of 45

Revised 04/18/2019 P&C

II. QuikValve™ TAPPING SLEEVE

A. General

The sleeve shall be:

1. Designed to accommodate the equipment and fixtures necessary to drill and ream

the pipe and install the QuikValve insertion valve without any interruption in water

service.

2. Fabricated to assure a 360°seal around the pipe under working pressures up to 150

psi.

(Test pressure: 225 psi.)

3. American Standard Testing Methods (ASTM) A-36 steel.

B. Neck

The neck shall be manufactured to precision tolerances that assure proper alignment,

support, and sealing of the QuikValve insert.

C. Bolts and Nuts

The bolts and nuts shall:

1. Be high strength, low alloy steel (Corten).

2. Meet American Water Works Association (AWWA) standard mechanical joints

and gaskets.

3. Be Type 304 stainless steel bolts. The stainless-steel specialty nuts are optional.

D. Gaskets

The gaskets shall:

1. Be made of Styrene Butadiene Rubber (SBR) compounded for potable water

service in accordance with ASTM D2000 3 BA715.

2. Provide a positive 360° seal on the pipe.

3. Assure a tight, durable, and resilient seal at the pipe sleeve - valve insert junction.

III. PRICING

Bidder shall provide pricing that is all inclusive of equipment, labor, and delivery to provide

Quick Insertion Valves and Sleeves as listed in Items Numbered 1 through 11 on the Bid

Schedule, and in accordance with the attached Minimum Specifications as listed on pages 21-

23 of this solicitation.

IV. DELIVERY

Delivery shall be Free on Board (F.O.B.) to:

DeKalb County Watershed Management Warehouse Facility

ATTN: John Mann

1580 Roadhaven Drive

Warehouse Facility

Stone Mountain, Georgia 30083

Page 24 of 45

Revised 04/18/2019 P&C

PRICE SCHEDULE MUST BE SUBMITTED IN A SEPARATE SEALED

ENVELOPE OR BIDDER WILL BE DEEMED NON-RESPONSIVE AND WILL

NOT BE CONSIDERED FOR AWARD. INCLUDING PRICE IN ANY AREA

OUTSIDE OF THE SEPARATE SEALED ENVELOPE WILL RESULT IN THE BID

BEING DEEMED NON-RESPONSIVE.***

PRICE SCHEDULE

ITEM

NO.

DESCRIPTION

ESTIMATED

QUANTITY

UNIT OF

MEASURE

UNIT PRICE AMOUNT

Quick Insert Valve, 6-inch

Manufacturer Brand Name &

Number or Equal:

Each

$ ___________

Quick Insert Valve , 8-inch

Manufacturer Brand Name &

Number or Equal:

Each

$ ___________

Quick Insert Valve, 10-inch

Manufacturer Brand Name &

Number or Equal:

Each

$ ___________

Quick Insert Valve, 12-inch

Manufacturer Brand Name &

Number or Equal:

10 Each

$ ___________

Sleeve, 6-inch

Valve Insertion Range 6.81 –

7.00

Manufacturer Brand Name &

Number or Equal:

15 Each

$ ___________

Page 25 of 45

Revised 04/18/2019 P&C

Sleeve, 6-inch

Valve Insertion Range 7.21 –

7.40

Manufacturer Brand Name &

Number or Equal:

5 Each

$ ___________

Sleeve, 8-inch

Valve Insertion Range 8.95 –

9.15

Manufacturer Brand Name &

Number or Equal:

10 Each

$ ___________

Sleeve, 8-inch

Valve Insertion Range 8.16 –

9.35

Manufacturer Brand Name &

Number or Equal:

10 Each

$ ___________

Sleeve, 8-inch

Valve Insertion Range 9.36 –

9.55

Manufacturer Brand Name &

Number or Equal:

10 Each

$ ___________

10.

Sleeve, 10-inch

Valve Insertion Range 10.85-

11.25

Manufacturer Brand Name &

Number or Equal:

8 Each

$ ___________

11.

Sleeve, 12-inch

Valve Insertion Range 12.90-

13.20

Manufacturer Brand Name &

Number or Equal:

Each

$ ___________

Total (Lines 1-11)

$ ___________

Page 26 of 45

Revised 04/18/2019 P&C

BID ACKNOWLEDGEMENT FORM

I, the undersigned, acknowledge that I have read the Bid Document in its entirety and agree to conform

to its every requirement. I further acknowledge that failure to prepare, submit, or execute this bid in

the exact manner requested will be just cause to reject my entire bid.

Name of Business Entity Submitting Bid Print Name and Title of Authorized Signer

Business Entity Street Address Authorized Signature

Business Entity City, State and Zip Code Contact Person’s Phone Number

Business Entity County Contact Person’s E-mail Address

• Bidder acknowledges addendum(s): No. 1__, No. 2__, No. 3__ (

If Applicable

) ________(

Initial

)

• Bidder acknowledges that this bid is valid for 90 days from and including ________ (

Initial

)

the bid opening date.

• Bidder acknowledges that bid meets or exceeds minimum specifications. ________ (

Initial

)

Any deviation from minimum specifications must be explained, in detail,

by bidder as to how the bid does not meet the exact specifications.

• Bidder acknowledgement of Revisions to the above Terms and Conditions:

• No revisions ________ (

Initial

)

• There are revisions and they are included with the bid submittal ________ (

Initial

)

The above acknowledgment must be properly signed and firmly attached to your bid. The

acknowledgment becomes a part of your bid and without it your bid is not be complete and will be

subject to rejection.

THIS PAGE MUST BE RETURNED WITH YOUR BID. FAILURE TO SUBMIT THIS

COMPLETED FORM WILL RESULT IN YOUR BID BEING DEEMED NON-

RESPONSIVE.

Page 27 of 45

Revised 04/18/2019 P&C

ATTACHMENT A

REQUIRED DOCUMENTS CHECKLIST

Bidder shall complete and submit the following documents with their bid:

Bid Page No. Title

Check This Box If

Included With Bid

26 Bid Acknowledgement Form*

27 Required Documents Checklist

28 Contractor Reference and Release Form*

29 Subcontractor Reference and Release Form, if applicable**

31 Contractor Affidavit*

32 Subcontractor Affidavit, if applicable**

33-41 LSBE - Exhibits A and/or B of Attachment G*

42 First Source Jobs Acknowledgement Form

43 New Employee Tracking Form

*If these mandatory forms are not completed and submitted with the bid, the bidder

will be deemed non-responsive.

**These forms are applicable if a subcontractor will be utilized to fulfill the

requirements of this contract. If these forms are applicable, they must be completed

and submitted along with the bid. Failure to submit these forms, if applicable, will

result in the bidder being deemed non-responsive.

I, the undersigned, acknowledge that I have included the requested documents as listed above.

________________________________

Printed Name Signature

Page 28 of 45

Revised 04/18/2019 P&C

ATTACHMENT B

CONTRACTOR REFERENCE AND RELEASE FORM

List below at least three (3) references, including company name, contact name, address, email address,

telephone numbers and contract period who can verify your experience and ability to perform the type(s)

of product(s)/ service(s) listed in the solicitation.

Company Name

Contract Period

Contact Person Name and Title

Telephone Number (include area code)

Complete Primary Address

City

State

Zip Code

Email Address

Fax Number (include area code)

Project Name and Description

Company Name

Contract Period

Contact Person Name and Title

Telephone Number (include area code)

Complete Primary Address

City

State

Zip Code

Email Address

Fax Number (include area code)

Project Name and Description

Company Name

Contract Period

Contact Person Name and Title

Telephone Number (include area code)

Complete Primary Address

City

State

Zip Code

Email Address

Fax Number (include area code)

Project Name and Description

REFERENCE CHECK RELEASE STATEMENT

You are authorized to contact the references provided above for purposes of this ITB.

Signed_______________________________________ Title___________________________

(Authorized Signature of Bidder)

Company Name _____________________________________Date ____________________

Page 29 of 45

Revised 04/18/2019 P&C

ATTACHMENT C

SUBCONTRACTOR REFERENCE AND RELEASE FORM

List below at least three (3) references, including company name, contact name, address, email address,

telephone numbers and contract period who can verify your experience and ability to perform the type(s)

of product(s)/ service(s) listed in the solicitation.

Company Name

Contract Period

Contact Person Name and Title

Telephone Number (include area code)

Complete Primary Address

City

State

Zip Code

Email Address

Fax Number (include area code)

Project Name and Description

Company Name

Contract Period

Contact Person Name and Title

Telephone Number (include area code)

Complete Primary Address

City

State

Zip Code

Email Address

Fax Number (include area code)

Project Name and Description

Company Name

Contract Period

Contact Person Name and Title

Telephone Number (include area code)

Complete Primary Address

City

State

Zip Code

Email Address

Fax Number (include area code)

Project Name and Description

REFERENCE CHECK RELEASE STATEMENT

You are authorized to contact the references provided above for purposes of this ITB.

Signed_______________________________________ Title___________________________

(Authorized Signature of Bidder)

Company Name _____________________________________Date ____________________

Page 30 of 45

Revised 04/18/2019 P&C

ATTACHMENT D

CONTRACTOR & SUBCONTRACTOR EVIDENCE OF COMPLIANCE:

(1)

County contracts for the physical performance of services within the state of Georgia shall

include the following provisions:

a. the contractor has registered with and is authorized to use the federal work authorization

program to verify information on all newly hired employees or subcontractors;

b. by affidavit, the contractor must attest to the contractor’s name, address, user

identification number, date of authorization, and verification of the continual

participation throughout the contract period, and

c. the affidavit shall become a part of the covered contract and must be attached.

(2) No contractor or subcontractor who enters into a contract with the County shall enter into such

a contract or subcontract in connection with the physical performance of services within

Georgia unless the contractor or subcontractor registers and participates in the federal work

authorization program to verify information of all newly hired employees. Any employee,

contractor, or subcontractor of such contactor or subcontractor shall also be required to satisfy

the requirements of O.C.G.A. § 13-10-91, as amended.

(3) Upon contracting with a new subcontractor, a contractor or subcontractor shall, as a condition

of any contract or subcontract entered into pursuant to O.C.G.A. § 13-10-91, as amended,

agree to provide the County with notice of the identity of any and all subsequent subcontractors

hired or contracted by the contractor or subcontractor. Such notice shall be provided within

five (5) business days of entering into a contract or agreement for hire with any subcontractor.

Such notice shall include an affidavit from each subsequent contractor attesting to the

subcontractor’s name, address, user identification number, and date of authorization to use the

federal work authorization program.

(4) An affidavit shall be considered an open public record; provided, however, that any

information protected from public disclosure by federal law or by Article 4 of Chapter 28 of

Title 50 shall be redacted. Affidavits shall be maintained by the County for five years from

the date of receipt.

(5) To verify compliance, the contractor agrees to participate in random audits conducted by the

Commissioner of the Georgia Department of Labor. The results of the audits shall be

published on the www.open.georgia.gov website, and on the Department of Labor’s website

no later than December 31 of each year.

(6) Any person who knowingly and willfully makes a false, fictitious, or fraudulent statement in

an affidavit submitted pursuant to O.C.G.A. § 13-10-91 shall be guilty of a violation of Code

§ 16-10-20 and, upon conviction, shall be punished as provided in such section. Contractors

and subcontractors convicted for false statements based on a violation of such section shall be

prohibited from bidding on or entering into any public contract for twelve (12) months

following such conviction.

_______________________

O.C.G.A. § 13-10-91, as amended

Page 31 of 45

Revised 04/18/2019 P&C

ATTACHMENT E

CONTRACTOR AFFIDAVIT

By executing this affidavit, the undersigned verifies its compliance with O.C.G.A. § 13-10-91, as

amended, stating affirmatively that the individual, firm or corporation which is contracting with DEKALB

COUNTY, GA, a political subdivision of the State of Georgia, has registered with and is participating in a

federal work authorization program* [any of the electronic verification of work authorization programs

operated by the United States Department of Homeland Security or any equivalent federal work authorization

program operated by the United States Department of Homeland Security to verify information of newly hired

employees, pursuant to the Immigration Reform and Control Act of 1986 (IRCA), P.L. 99-603, in accordance

with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91, as amended]. The affiant

agrees to continue to use the federal work authorization program throughout the contract period.

The undersigned further agrees that, should it employ or contract with any subcontractor(s) in

connection with the physical performance of services pursuant to this contract with the COUNTY, contractor

will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91, as

amended, on the Subcontractor Affidavit form. Contractor further agrees to maintain records of such

compliance and provide a copy of each such verification to the COUNTY, within five (5) days from when the

subcontractor(s) is retained to perform such service.

BY: Authorized Officer or Agent Federal Work Authorization

(Bidder’s Name) Enrollment Date

Title of Authorized Officer or Agent of Bidder Identification Number

Printed Name of Authorized Officer or Agent

Address (* do not include a post office box)

SUBSCRIBED AND SWORN

BEFORE ME ON THIS THE

_______________ DAY OF _______________________, 20__

____________________________________________________

Notary Public

My Commission Expires: _______________________________

Page 32 of 45

Revised 04/18/2019 P&C

ATTACHMENT F

SUBCONTRACTOR AFFIDAVIT

By executing this affidavit, the undersigned verifies its compliance with O.C.G.A. § 13-10-91, as

amended, stating affirmatively that the individual, firm, or corporation which is engaged in the physical

performance of services under a contract with _________________________________name of contractor) on

behalf of DEKALB COUNTY, GA, a political subdivision of the State of Georgia, has registered with and is

participating in a federal work authorization program* [any of the electronic verification of work authorization

programs operated by the United States Department of Homeland Security or any equivalent federal work

authorization program operated by the United States Department of Homeland Security to verify information

of newly hired employees, pursuant to the Immigration Reform and Control Act of 1986 (IRCA), P.L. 99-603,

in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91, as amended].

The affiant agrees to continue to use the federal work authorization program throughout the contract period.]

______________________________________________ ____________________________

BY: Authorized Officer or Agent Federal

Work Authorization

(Bidder’s Name) Enrollment Date

______________________________________________ ____________________________

Title of Authorized Officer or Agent of Bidder Identification Number

______________________________________________

Printed Name of Authorized Officer or Agent

______________________________________________

Address (* do not include a post office box)

SUBSCRIBED AND SWORN

BEFORE ME ON THIS THE

_______________ DAY OF _______________________, 20__

____________________________________________________

Notary Public

My Commission Expires: _______________________________

Page 33 of 45

Revised 04/18/2019 P&C

ATTACHMENT G

DEKALB FIRST LSBE INFORMATION

WITH EXHIBITS A – B

SCHEDULE OF LOCAL SMALL BUSINESS ENTERPRISE PARTICIPATION

OPPORTUNITY TRACKING FORM

The Chief Executive Officer and the Board of Commissioners of DeKalb County believe that it is important

to encourage the participation of small and local businesses in the continuing business of County

government; and that the participation of these types of businesses in procurement will strengthen the

overall economic fabric of DeKalb County, contribute to the County’s economy and tax base, and provide

employment to local residents. Therefore, the Chief Executive Officer and the Board of Commissioners

have made the success of local small businesses a permanent goal of DeKalb County by implementing the

DeKalb First Local Small Business Enterprise Ordinance.

PROVISIONS OF DEKALB FIRST LOCAL SMALL BUSINESS ENTERPRISE (LSBE)

ORDINANCE

Percentage of LSBE Participation Required

20% of Total Award

Certification Designation

Request For Proposals

(RFP)

LSBE Within DeKalb (LSBE-

DeKalb)

Ten (10) Preference

Points

LSBE Outside DeKalb (LSBE-

MSA)

Five (5) Preference Points

Demonstrated GFE

Two (2) Preference Points

Certified Local Small Business Enterprises (LSBEs) located within DeKalb County and prime contractors

utilizing LSBEs that are locally-based inside DeKalb County shall receive ten (10) points in the initial

evaluation of their response to any Request for Proposal. Certified LSBEs located outside of DeKalb

County but within the nine (9) County Metropolitan Statistical Area (MSA) consisting of Cherokee,

Clayton, Cobb, Douglas, Fayette, Fulton, Gwinnett, Henry and Rockdale Counties shall receive five (5)

points in the initial evaluation of their response to any Request for Proposal. Prime Contractors who

demonstrate sufficient good faith efforts in accordance with the requirements of the ordinance shall be

granted two (2) points in their initial evaluation of responses to any Request for Proposal. Pro-rated points

shall be granted where a mixture of LSBE-DeKalb and LSBE MSA firms are utilized. Utilization of each

firm shall be based upon the terms of the qualified sealed solicitation.

Prime Contractor(s) deemed responsible and remains responsive to an Invitation to Bid (ITB) because they

are either a certified LSBE-DeKalb or LSBE-MSA firm or has obtained 20% participation of an LSBE-

DeKalb or LSBE-MSA firm, submits the lowest bid price shall be deemed the lowest, responsive and

responsible bidder.

Prime Contractor(s) deemed responsible and remains responsive to an Invitation to Bid (ITB) and

documented good faith efforts, submits a lower bid price than a Prime Contractor that achieved 20% LSBE

participation, or otherwise required benchmark, then the Prime Contractor who actually met the benchmark

will be given the opportunity to match the lowest bid price of the Prime Contractor who only made good

faith efforts. Prime Contractor(s) who choose not to match the lowest bid price, then the Prime Contractor

who made the good faith efforts will be deemed the lowest, responsive and responsible bidder.

Page 34 of 45

Revised 04/18/2019 P&C

For all qualified sealed solicitations, the Director of Purchasing and Contracting, DeKalb County

Government, shall determine if the bidder/proposer has included written documentation showing that at

least twenty percent (20%) of the total contract award will be performed by a certified LSBE. This written

documentation shall be in the form of a notarized Schedule of LSBE Participation (Attached hereto as

“Exhibit A”.) For all contracts, a signed letter of intent from all certified LSBEs describing the work,

material, equipment and/or services to be performed or provided by the LSBE(s) and the agreed upon

percentage shall be due with the bid or proposal documents and included with “Exhibit A”. The certified

vendor list establishes the group of Certified LSBE’s from which the bidder/proposer must solicit

subcontractors for LSBE participation. This list can be found on our website

https://www.dekalbcountyga.gov/purchasing

or obtained from the Special Projects LSBE Program team.

Prime Contractors failing to meet the LSBE benchmark must document and demonstrate Good Faith

Efforts in accordance with the attached “Checklist for Good Faith Efforts” portion of “Exhibit A.” The

notarized Schedule of LSBE Participation shall be due and submitted with each bid or proposal. Failure to

achieve the LSBE benchmark or demonstrate good faith efforts shall result in a bid or proposal being

rejected. Prime Contractors that fail to attend the mandatory LSBE meeting in person or via video

conference shall mean that the Prime Contractor has not demonstrated sufficient good faith efforts and its

bid or proposal if submitted, shall be deemed non-responsive without any further review.

Upon award, Prime Contractors are required to submit a report detailing LSBE Sub-Contractor usage with

each request for payment and not less than on a monthly basis. Prime Contractors shall ensure that all

LSBE sub-contractors have been paid within seven (7) days of the Prime’s receipt of payment from the

County. Failure to provide requested reports/documentation shall constitute a material breach of contract,

entitling the County to terminate the Contract for default or pursue other remedies. LSBE sub-contractors

must confirm payments received from the Prime(s) for each County contract they participate in.

For eligible bids/proposals valued over $5,000,000.00, the Mentor-Protégé provision of the Ordinance

shall apply. Prime Contractors must agree to become mentors and take on an LSBE protégé in an effort to

enhance the potential of future LSBEs. Qualifying projects shall be performed by both Mentor and Protégé

through a subcontract between both parties. This requirement is in addition to all other applicable sections

of the DeKalb First Ordinance. Please review the ordinance, section 2-214 or contact the LSBE Program

Representative for detailed information regarding this initiative.

Page 35 of 45

Revised 04/18/2019 P&C

EXHIBIT A

SCHEDULE OF DEKALB FIRST LOCAL SMALL BUSINESS ENTERPRISE PARTICIPATION

OPPORTUNITY TRACKING FORM

As specified, Bidders and Proposers are to present the details of LSBE participation below:

PRIME BIDDER/PROPOSER___________________________________________________________

SOLICITATION NUMBER: 19-101200

TITLE OF UNIT OF WORK – Quick Insertion Valves

1. My firm, as the prime bidder/proposer on this unit of work, is a certified (check all that apply):

____LSBE-DeKalb ____LSBE-MSA

2. If you are a Certified LSBE-DeKalb or MSA, please indicate below the percentage of that your

firm will carry out directly: ____________________________________.

3. If the prime bidder/proposer is a joint venture, please describe below the nature of the joint venture

and level of work and percentage of participation to be provided by the LSBE-DeKalb or MSA

joint venture firm.

________________________________________________________________________

4. List the LSBE-DeKalb or MSA subcontractors and/or firms (including suppliers) to be utilized in

of this contract, if awarded. No changes can be made in the subcontractors listed below without

the prior written approval of the County. Please attach a signed letter of intent from all certified

LSBEs describing the work, materials, equipment or services to be performed and/or provided and

the agreed upon percentage of work to be performed. A Letter of Intent form is attached hereto as

“Exhibit B”.

Name of Company

Address

Telephone

Fax

Contact Person

Indicate certification status and attach proof of

certification:

LSBE-DeKalb/LSBE-MSA

Description of services to be performed

Percentage of work to be performed

Page 36 of 45

Revised 04/18/2019 P&C

Name of Company

Address

Telephone

Fax

Contact Person

Indicate certification status and attach proof

of certification:

LSBE-DeKalb/LSBE-MSA

Description of services to be performed

Percentage of work to be performed

Name of Company

Address

Telephone

Fax

Contact Person

Indicate certification status and attach proof

of certification:

LSBE-DeKalb/LSBE-MSA

Description of services to be performed

Percentage of work to be performed

Name of Company

Address

Telephone

Fax

Contact Person

Indicate certification status and attach proof

of certification:

LSBE-DeKalb/LSBE-MSA

Description of services to be performed

Percentage of work to be performed

Name of Company

Address

Telephone

Fax

Contact Person

Indicate certification status and attach proof

of certification:

LSBE-DeKalb/LSBE-MSA

Description of services to be performed

Percentage of work to be performed

Please attach additional pages, if necessary.

Page 37 of 45

Revised 04/18/2019 P&C

EXHIBIT A, CONT’D

DEKALB COUNTY

CHECKLIST FOR GOOD FAITH EFFORTS

A bidder/proposer that does not meet the County’s LSBE participation benchmark is required to submit

documentation to support all “Yes” responses as proof of “good faith efforts.” Please indicate whether or

not any of these actions were taken:

Yes

Description of Actions

Prime Contractors shall attend a MANDATORY LSBE Meeting in

person or via video conference within two-weeks of advertisement

of the solicitation.

Provide a contact log showing the company’s name, contact person,

address, email and contact number (phone or fax) used to contact the

proposed certified subcontractors, nature of work requested for

quote, date of contact, the name and title of the person making the

effort, response date and the percentage of work.

Provide interested LSBEs via email, of any new relevant

information, if any, at least 5 business days prior to submission of

the bid or proposal.

Efforts made to divide the work for LSBE subcontracting areas

likely to be successful and to identify portions of work available to

LSBEs consistent with their availability. Include a list of divisions

of work not subcontracted and the corresponding reasons for not

including them. The ability or desire of a bidder/proposer to perform

the contract work with its own organization does not relieve it of the

responsibility to make good faith efforts on all scopes of work

subject to subcontracting.

Efforts were made to assist potential LSBE subcontractors meet

bonding, insurance, or other governmental contracting requirements.

Where feasible, facilitating the leasing of supplies or equipment

when they are of such a specialized nature that the LSBE could not

readily and economically obtain them in the marketplace.

Communication via email or phone with DeKalb First Program Staff

seeking assistance in identifying available LSBEs. Provide DeKalb

First Program Staff representative name and title, and date of

contact.

For all contracts, a signed letter of intent from all certified LSBEs

describing the work, materials, equipment or services to be

performed or provided by the LSBE(s) and the agreed upon LSBE

participation percentage shall be due with the bid or proposal

documents.

Other Actions, to include Mentor/Protégé commitment for

solicitations $5M and above (specify):

Please explain all “no” answers above (by number):

Page 38 of 45

Revised 04/18/2019 P&C

This list is a guideline and by no means exhaustive. The County will review these efforts, along with

attached supporting documents, to assess the bidder/proposer’s efforts to meet the County’s LSBE

Participation benchmark. If you require assistance in identifying certified, bona fide LSBEs, please contact

the Purchasing and Contracting Department - DeKalb First Program, Felton Williams, Procurement

Projects Manager at 404-371-6312.

click to sign

signature

click to edit

Page 39 of 45

Revised 04/18/2019 P&C

EXHIBIT A, CONT’D

DEKALB FIRST LOCAL SMALL BUSINESS ENTERPRISE SCHEDULE OF

PARTICIPATION

OPPORTUNITY TRACKING FORM

Bidder/Proposer Statement of Compliance

Bidder(s)/Proposer(s) hereby state that they have read and understand the requirements and

conditions as set forth in the objectives and that reasonable effort were made to support the County in

providing the maximum practicable opportunity for the utilization of LSBEs consistent with the

efficient and economical performance of this contract. The Bidder and any subcontractors shall file

compliance reports at reasonable times and intervals with the County in the form and to the extent

prescribed by the Director of DeKalb County Purchasing and Purchasing and Contracting Department.

Compliance reports filed at such times as directed shall contain information as to the employment

practices, policies, programs and statistics of Contractors and their subcontractors.

1. Non-Discrimination Policy

a. During the performance of this agreement, Contractor agrees to conform to the

following Non-Discrimination Policy adopted by the County.

b. Contractor shall not discriminate against any employee or applicant for employment

because of race, color, religion, sex, national origin, or disability. The Contractor will

take action to ensure that applicants are employed, and the employees are treated during

employment without regard to their race, color, religion, sex, national origin, or

disability. Such action shall include, but not be limited to, the following:

(1) Employment, upgrading, demotion or transfer; recruitment or recruitment

advertising; layoff or termination; rates of pay or other forms of compensation;

and selection for training, including apprenticeship. Contractor agrees to post

in conspicuous places available to employees and applicants for employment,

notices to be provided setting forth provisions of this non-discrimination clause.

(2) Contractor shall, in all solicitations or advertisements for employees placed by

or on behalf of Contractor, state that all qualified applicants will receive

consideration for employment without regard to race, color, religion, sex,

national origin, or disability.

c. Without limiting the foregoing, Contractor shall not discriminate on the basis of

disability in the admission or access to, or treatment or employment in, the programs

and activities, which form the subject of the contract. The Contractor will take action

to ensure that applicants for participation in such programs and activities are considered

without regard to disability. Such action shall include, but not be limited to, the

following:

(1) Contractor agrees to post in conspicuous places available to participants in its

programs and activities notices to be provided setting forth the provisions of

this non-discrimination clause.

(2) Contractor shall, in all solicitations or advertisements for programs or activities,

which are the subject of the contract, state that all qualified applicants will

receive consideration for participation without regard to disability.

2. Commitment

The undersigned certifies that he/she has read, understands, and agrees to be bound by the bid

specifications, including the accompanying Exhibits and other terms and conditions of the

Invitation to Bid and/or Request for Proposal regarding LSBE utilization. The undersigned

click to sign

signature

click to edit

Page 40 of 45

Revised 04/18/2019 P&C

further certifies that he/she is legally authorized by the bidder or responder to make the

statements and representations in Exhibit A and that said statements and representations are

true and correct to the best of his/her knowledge and belief. The undersigned will enter into

formal agreement(s) with the LSBE(s) listed in this Exhibit A, which are deemed by the owner

to be legitimate and responsible LSBEs. Said agreement(s) shall be for the work and contract

with the Prime Contractor. The undersigned understands and agrees that if any of the

statements and representations are made by the Bidder knowing them to be false, or if there is

a failure of the successful Bidder (i.e., Contractor) to implement any of the stated agreements,

intentions, objectives, goals and commitments set forth herein without prior approval of the

County, then in any such events the contractor’s act or failure to act, as the case may be, shall

constitute a material breach of contract, entitling the County to terminate the Contract for

default. The right to so terminate shall be in addition to, and not in lieu of, any other rights

and remedies the County may have for other defaults under the Contract. Additionally, the

Contractor will be subject to the loss of any future contract awards by the County for a period

of one year.

Firm Name (Please Print):

_________________________________________________________________

Firm’s Officer:

_________________________________________________________________

(Authorized Signature and Title Required) Date

Sworn to and Subscribed to before me this ____ day of_______________, 201__.

_________________________________________________________________

Notary Public

My Commission Expires:_____________________________________________

Page 41 of 45

Revised 04/18/2019 P&C

EXHIBIT B

LETTER OF INTENT TO PERFORM AS A SUBCONTRACTOR

PROVIDING MATERIALS OR SERVICES

Instructions:

1. Complete the form in its entirety and submit with bid documents.

2. Attach a copy of the LSBE’s current valid Certification Letter.

To:______________________________________________________________________________

(Name of Prime Contractor Firm)

From: ________________________________________  LSBE –DeKalb  LSBE –MSA

(Name of Subcontractor Firm) (Check all that apply)

ITB Number: 19-101200 ______________

Project Name: Quick Insertion Valves_________________________________________________

The undersigned subcontractor is prepared to perform the following described work or provide

materials or services in connection with the above project (specify in detail particular work items,

materials, or services to be performed or provided).

Description of Materials or Services

Project/Task Assignment

% of

Contract

Award

Prime Contractor Sub-contractor

Signature:_________________________ Signature:______________________________

Title:_____________________________ Title:__________________________________

Date:_____________________________ Date: __________________________________

Page 42 of 45

Revised 04/18/2019 P&C

FIRST SOURCE JOBS ORDINANCE

INFORMATION (WITH EXHIBITS 1 – 4)

EXHIBIT 1

FIRST SOURCE JOBS ORDINANCE ACKNOWLEDGEMENT

The DeKalb County First Source Ordinance requires contractors or beneficiaries of eligible projects entering

into any type of agreement with the County, including purchase orders, regardless of what they may be called,

for the procurement or disposal of supplies, services, construction projects, professional or consultant services,

which is funded in whole or part with County funds or County administered funds in which the contractor is to

receive $50,000 or more in County expenditures or committed expenditures and recipient of urban

redevelopment action grants or community development block funds administered in the amount of $50,000 or

more to make a good faith effort to hire DeKalb County residents for at least 50% of jobs created using the First

Source Registry (candidate database) within one hundred twenty (120) days of contract execution. The work to

be performed under this contract is subject to the provisions of the DeKalb County First Source Jobs Ordinance.

All contractors will be asked to submit an Employment Roster and/or copies of active payroll registers on a

monthly basis to verify compliance. The undersigned acknowledges and agrees to comply with the provisions

of the DeKalb County First Source Jobs Ordinance.

CONTRACTOR OR BENEFICIARY INFORMATION:

Contractor or Beneficiary Name (Signature)

Contractor or Beneficiary Name (Printed)

Title

Telephone

_______________________________________

Name of Business

Please answer the following questions:

1. How many job openings do you anticipate filling related to this contract? _____

2. How many incumbents/existing employees will retain jobs due to this contract?

DeKalb Residents: _____ Non-DeKalb Residents: _____

3. How many work hours per week constitutes Full Time employment? ______

Please return this form to WorkSource DeKalb, (404)687-3900 or email to

fkadkins@dekalbcountyga.gov, malee@dekalbcountyga.gov, vlnicksion@dekalbcountyga.gov, or

jmjones@dekalbcountyga.gov

WorkSource DeKalb (WSD) is an EEO/M/F/D/V employer/program. Auxiliary aids/services are available upon request to individuals

with disabilities. Persons with hearing impairments may call 1-800-255-0135 or 711 TTY for assistance. WSD is 100% funded by the

U. S. Department of Labor and is a proud partner of the American Job Center Network. Revised March 2018

Page 43 of 45

Revised 04/18/2019 P&C

FIRST SOURCE JOBS ORDINANCE

INFORMATION

EXHIBIT 2

NEW EMPLOYEE TRACKING FORM

Name of Bidder______________________________________________________________________

Address_____________________________________________________________________________

E-Mail______________________________________________________________________________

Phone Number_______________________________________________________________________

Fax Number_________________________________________________________________________

Do you anticipate hiring from the First Source Candidate Registry? Y or N (Circle one)

If so, the approximate number of employees you anticipate hiring: _____________________________

Type of Position (s) you anticipate hiring:

(List position title, one position per line)

Attach job description per job title:

The number you

anticipate hiring:

Timeline

Please return this form to WorkSource DeKalb, fax (404) 687-4099 or email to

FirstSourceJobs@dekalbcountyga.gov.

Page 44 of 45

Revised 04/18/2019 P&C

FIRST SOURCE JOBS ORDINANCE INFORMATION

EXHIBIT 3

BUSINESS SERVICE REQUEST FORM

Please note: We need one form completed for each position that you have available.

DATE: FEDERAL TAX ID:

COMPANY NAME: WEBSITE:

ADDRESS:

(WORKSITE ADDRESS IF DIFFERENT):

CONTACT NAME:

CONTACT PHONE: CONTACT FAX:

CONTACT E-MAIL ADDRESS:

Are you a private employment agency or staffing agency? YES NO

JOB DESCRIPTION: (PLEASE INCLUDE A COPY OF JOB DESCRIPTION)

POSITION TITLE:

NUMBER OF POSITIONS AVAILABLE:_________ TARGET START DATE:__________

WEEKLY WORK HOURS: 20-30 hours 30-40 hours Other

SPECIFIC WORK SCHEDULE:

SALARY RATE(OR RANGE):

PERM TEMP TEMP-TO-PERM SEASONAL

PUBLIC TRANSPORTATION ACCESSIBILITY YES NO

IF SCREENINGS ARE REQUIRED, SELECT ALL THAT APPLY:

CREDIT DRUG MVR BACKGROUND OTHER

__________________________

Please return form to: Business Solutions Unit (First Source)

774 Jordan Lane Bldg. #4

Decatur, Ga. 30033

Phone: (404) 687-3400

FirstSourceJobs@dekalbcountyga.gov

Page 45 of 45

Revised 04/18/2019 P&C

FIRST SOURCE JOBS ORDINANCE INFORMATION

EXHIBIT 4

EMPLOYMENT ROSTER

DeKalb County

Contract Number: ______________________

Project Name:________________________

Contractor: ___________________________ Date: _______________________

Name

Position:

Start

Date

Hourly

Rate of

Pay

Hired

for this

Project?

(yes/no)

Anticipated

Length of

Employment

(Months)

% of

Time

Dedicated

to the

Project

Full or

Part

Time?

(No. of

Hours)

Georgia

County of

Residency

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

DeKalb County Department of Purchasing and Contracting INVITATION (DeKalb County Government)

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank DeKalb County Department of Purchasing and Contracting INVITATION (DeKalb County Government) Form

Related forms

Fillable DeKalb County Department of Purchasing and Contracting INVITATION (DeKalb County Government)

Fill Online, Printable, Fillable, Blank DeKalb County Department of Purchasing and Contracting INVITATION (DeKalb County Government) Form

Related forms

First 20 documents completely FREE!