DQ 24-012

NOTICE

October 2, 2023

Polk County, a political subdivision of the State of Florida, requests the submittal of quotes

for DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

Questions may be faxed to the Procurement Division, (863) 534-6789 or emailed to Mike

Baselice at [email protected] and must be received prior to 10:00 a.m.,

Wednesday, October 11, 2023. Questions received after the stated date and time will not be

considered.

Quotations may be faxed to the Procurement Division, (863) 534-6789 or emailed to Mike

Baselice at [email protected] and must be received prior to 10:00 a.m.,

Wednesday, October 18, 2023. Quotations received after the stated date and time will not be

considered.

Contractors are required:

➢ To attend a Mandatory site visit on Wednesday, October 4, 2023, at 9:00 a.m.

prior to submitting their quote.

➢ Read the Quote Specification thoroughly for any changes or special instructions.

➢ All requirements and deadlines provided in this package must be upheld. Failure to

comply may result in suspension as provided within this document and the

Procurement Procedures.

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

INSTRUCTIONS

1. The County shall consider awarding a quote to the Contractor that submits the overall

lowest price for demolition services, to include asbestos containing material described

more fully in the attached Asbestos Survey. If the structure has been deemed unsafe

by the Building Official, all material shall be considered to be Regulated Asbestos

Containing Material (RACM) and removed, transported, and disposed of according to

Department of Environmental Protection (DEP) regulations.To obtain a copy of the

Asbestos Surveys & Photos for DQ 24-012, 610 Cameron Road and 7 Grove Park

Lane, Eagle Lake demolition project please go the following FTP site: https://ftp3.polk-

county.net, you will be prompted for a User ID and Password. The User ID is

procurevendor and the password is solicitation. After you have logged in to the FTP

site, double click on the file folders “DQ 24-012, 610 Cameron Road – Asbestos

Surveys” and “DQ 24-012, 7 Grove Park Lane – Asbestos Survey”, select “Open” or

“Save As” to download the quote documents. If you need assistance accessing this

website due to ADA or any other reason, please email Mike Baselice at

[email protected]

2. The Procurement Director reserves the right to accept or reject any or all quotes

and/or to award on an individual item basis or an overall low, whichever is deemed to

be in the best interest of the County.

3. All Contractors shall submit prices on County quotation forms provided in this quote

package. Failure to do so may cause your quote to be considered non-responsive.

4. Procurement staff will verify licensure and insurance is up to date and meets all

requirements prior to award.

5. When asbestos material is present or structure has been deemed unsafe by the Polk

County Building Official, the Contractor MUST hold a State of Florida Asbestos

Contractor’s license, licensure type CJC. This portion of the scope of work shall

not be subcontracted. Contractor must note Asbestos Contractor license number on

the Quote Sheet provided in this package. Procurement staff will verify licensure is up

to date and active prior to award.

6. A Mandatory site visit will be held on Wednesday, October 4, 2023, at 9:00 a.m.

7. Receiving date is Wednesday, October 18, 2023, prior to 10:00 a.m.

8. The Successful Bidder must register in our new Vendor Database if you have not

already done so prior to award of this bid. A purchase order cannot be issued to a

vendor until they have registered. You may register by going to the following

link:https://www.polk-county.net/procurement/vendor-registration. Registered vendors

will receive a User ID and Password to access their company information. All

registered vendors must provide their owner gender, owner ethnicity, corporate status,

and a minimum of one (1) commodity code to be considered registered. It is the

responsibility of all vendors to update their vendor information. Only registered

vendors will receive notifications of future bids and quotes.

9. All prices quoted shall be good for thirty (30) days

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

10. If it becomes necessary to revise or amend any part of this quote, an addendum will

be issued and will be posted on the County’s website at https://www.polk-

county.net/procurement/bids. It is the sole responsibility of the bidders to check the

website to ensure that all available information has been received prior to submitting a

quote.

11. MISTAKES: Contractors are required to examine the specifications, delivery

schedule, quote prices and all instructions pertaining to the requirements of this quote.

Failure to do so shall be at Contractor’s risk. No change orders will be granted for

failure to fully inspect the entire parcel to accurately quote the project. Any questions

regarding work incorporated into project MUST be addressed prior to opening of quote

submittals. Questions shall be directed to the Procurement staff member noted on the

cover page of this package.

12. INDEMNIFICATION: Contractor, to the extent permitted by law, shall indemnify,

defend (by counsel reasonably acceptable to County), protect and hold the County,

and its officers, employees and agents, harmless from and against any and all, claims,

actions, causes of action, liabilities, penalties, forfeitures, damages, losses, and

expenses whatsoever (including, without limitation, attorneys’ fees, costs, and

expenses incurred during negotiation, through litigation and all appeals therefrom)

including, without limitation, those pertaining to the death of or injury to any person, or

damage to any property, arising out of or resulting from (i) the failure of Vendor to

comply with applicable laws, rules or regulations, (ii) the breach by Contractor of its

obligations under any Agreement with the County entered into pursuant to this

solicitation, (iii) any claim for trademark, patent, or copyright infringement arising out of

the scope of Contractor’s performance or nonperformance of the Agreement, or (iv)

the negligent acts, errors or omissions, or intentional or willful misconduct, of

Contractor, its professional associates, subcontractors, agents, and employees;

provided, however, that Contractor shall not be obligated to defend or indemnify the

County with respect to any such claims or damages arising out of the County’s sole

negligence. The obligations imposed by this Section shall survive the expiration or

earlier termination of the Agreement.

13. PUBLIC ENTITY CRIME: A person or affiliate who has been placed on the convicted

vendor list following a conviction for a public entity crime may not submit a bid on a

contract, provide any goods or provide any services to a public entity; may not submit

a bid on a contract with a public entity for the construction or repair of a public building

or public works; may not submit bids on leases of real property to a public entity; may

not be awarded or perform work as a contractor, supplier, subcontractor or consultant

under a contract with any public entity; and may not transact business with any

public entity in excess of the threshold amount provided in Section 287.017, for

CATEGORY TWO for a period of 36 months from the date of being placed on the

convicted vendor list. (Florida Statutes Section 287.012(a), (16), Section 287.058,

paragraph (2)(a) of Section 287.133). The person signing the Quote Sheet hereby

certifies that they have complied with said statute.

14. TERMINATION/SUSPENSION: The Procurement Director reserves the right to

terminate or suspend a vendor, in whole or in part, when it is in the best interest of the

County to do so. The Procurement Director, or their designee, shall notify the vendor,

in writing, of any such action with notice of the effective date of termination or

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

suspension. This notice shall also specify the state of the work at the time of

termination or suspension. Actions that will cause a vendor to be suspended include,

but are not limited to:

• Quality of work

• Repeated inspections

• Not completing jobs within the time given

• Lack of current insurance on file

• Vandalism

• Safety

• Any act of fraud

• Repeated incomplete or incorrect document submissions

Initial suspension will be a minimum of six months; continued deficiencies will result in

termination and deactivation from the County’s vendor database, in accordance with

Procurement procedures.

15. Vendors must possess a Polk County Local Business Tax Receipt (f/k/a Occupational

License) in order to do business with the Polk County Board of County

Commissioners. Procurement staff will verify that the successful Contractor possesses

a valid Business Tax Receipt prior to award.

16. This document and any resulting purchase orders shall be governed in all respects by

the laws of the State of Florida and any litigation with respect thereto shall be brought

only in the Courts of Polk County, Florida or the United States District Court, Middle

District of Florida located in Hillsborough County, Florida.

17. Safety Requirements: The Contractor shall take all necessary precautions for the

safety of and shall provide the necessary protection to prevent damage, injury or loss

to: all employees on the project and other persons who may be affected by it; all of the

project work; and all materials or equipment to be incorporated, whether in storage on

or off the site. The Contractor shall assume all risk of loss for stored equipment or

materials, irrespective of whether the Contractor has transferred the title of the stored

equipment or materials to the County. Other property at the site or adjacent to it,

including trees, shrubs, lawns, walks, pavements, roadways, structures and utilities

not designated for removal, relocation or replacement in the course of demolition shall

be the responsibility of the Contractor. Any questions regarding compliance with the

safety requirements/regulations provision shall be directed to the Polk County Safety

and Regulatory Manager, Risk Management Division, (863) 534-5267.

18. The Contractor is responsible for observing all, DEP and OSHA regulations and shall

self-inspect to ensure that this is accomplished. The Contractor shall ensure that all

personnel are properly trained and shall be able to provide documentation for their

personnel that have attended training courses. Examples of such training courses are:

Hazard Communications; Traffic Work Zone Safety; Personal Protective Equipment;

First Aid/CPR; Permit Required Confined Space; and Lock Out/Tag Out of Hazardous

Energy. All contractors are required to comply with OSHA Standards regardless of the

number of employees they may have.

19. A County representative may periodically monitor work site safety. Should there be

safety and/or health violations, classified as Serious, Willful or Criminal/Willful

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

Violations, the County’s representative may have the authority, but not the duty, to

require the Contractor to correct the violation in an expeditious manner. Inspections

shall be based on requirements contained in law. The definitions of serious, willful and

criminal/willful violations are as follows:

Serious Violation: A serious violation shall be deemed to exist in a place of

employment if there is a substantial probability that death or serious physical harm

could result from a condition which exists, or from one or more practices, means,

methods, operations, or processes which have been adopted or are in use, in such

place of employment unless the employer did not, and could not, with the exercise

of reasonable diligence, know of the presence of the violation.

Willful violation: May exist where evidence shows that the employer committed

an intentional and knowing violation of the Act.

Criminal/Willful violation: A repeat violation of a previously-cited willful violation.

Violation of Serious, Willful or Criminal violation may have the following

consequences:

First violation: correction may be a verbal warning and the correction shall be

done the same day. Written documentation may be maintained by the County. This

violation may result in work stoppage until the violation is corrected. The work

stoppage shall not entitle the Contractor to additional contract time or

compensation.

Second violation: this may constitute a breach of contract for safety violations

and may result in termination of the contract at the sole discretion of the County.

This could also be grounds for suspension or termination.

Note: The County Safety and Regulatory Manager or their designee may stop any

job to ensure the safety of all concerned.

Should the work site be a hazardous area, the Contractor must provide the County

with a copy of the Contractor’s Safety Plan to include information concerning hazards

such as type or identification of known toxic material, machine hazards, Material

Safety Data Sheets (MSDS) or any other information that would assist the Contractor

in the planning of a safe work site.

The Contractor shall be aware that while working for the County, representatives from

agencies such as the United States Department of Labor (DOL), Occupational Safety

and Health Administration (OSHA) and the Division of Safety, State of Florida, DEP

are invitees and need not have warrants or permission to enter the work site. These

agencies, as well as the County Safety and Regulatory Manager or their designee,

enter at the pleasure of the County.

The Contractor shall designate a competent person of its organization whose duty

shall be the prevention of accidents at the site. This person shall be the Contractor’s

Superintendent unless otherwise designated, in writing, by the Contractor to the User

Division. All communications to the Superintendent shall be as binding as if given to

the Contractor.

20. Quotes should include pricing for the removal of all structures, footers, plumbing

below grade, and debris, as well as any shrubs, trees, or vegetation in which removal

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

is necessary for the safe demolition of the structure, and any other obstructions

associated with the property that fall within the lot dimensions given. Lot should be

cleared and raked, and any man-made items removed, unless otherwise specified in

the quote package.

21. PERFORMANCE OF WORK: All or portions of the work required under this quote

may be performed by Subcontractors, exclusive of removal of asbestos containing

material, regulated or unregulated. If the successful Contractor plans to use

Subcontractor(s) the Contractor must provide a list of ALL Subcontractor(s) and the

division of work to be performed by each Subcontractor to the Procurement Division

for approval prior to award of the quote. Proof of insurance and all applicable

licensing required to safely perform the scope of work will be required from the

Subcontractor(s) prior to the issuance of the Notice to Commence Services. It will be

the responsibility of the Prime Contractor to submit this documentation to the

Procurement Division after the recap has been issued and prior to award. It is the

Prime Contractor’s responsibility to inform and provide job specifications to any/all

Subcontractor(s) of the job. Any rework required due to negligence or inability of any

Subcontractor(s) shall be the responsibility of the Prime Contractor.

The Contractor or their designee must be on site during the performance of this quote

and will be fully responsible for all acts and omissions of their Subcontractor(s) and of

any persons directly or indirectly employed by them. No changes to Subcontractor(s)

used will be allowed after submittal of quote unless otherwise approved by the

Procurement Director in advance of any work to be performed. Any Prime Contractor

that defaults on this requirement may be suspended as allowed within the

Procurement Procedures.

Only duly authorized employees of the Prime Contractor or Subcontractor are allowed

to be present on the demolition site. Violations of this requirement will result in a stop

work order being issued by the User Division.

Any work performed by the successful Contractor or their Subcontractor(s) must meet

all environmental regulations and deadlines stated in the Notice to Commence

Services.

Delays as a result of weather events may be cause for an extension of time to the

Completion Date established within the Notice to Commence Services. The length of

delay and comparable number of days shall be determined by the County.

Extension(s) of time shall be on a one-to-one basis.

A delay due to a weather event is defined as an inability to complete any portion of the

scope of work due to inclement weather. If the weather prevents outside activity from

occurring but the Contractor is able to perform another portion of the scope, a delay is

not justified. The Contractor must request an extension of time to the Completion

Date immediately upon the conclusion of the weather event causing the delay. This

request may be sent electronically via email.

The weather event shall be of a duration that prevents the Contractor from performing

work for a significant portion of the day or that leaves the job site in such a state that

the Contractor is unable to continue to work. The County shall be the sole

determination of whether the weather event meets the stated criteria contained within

this document.

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

Nothing in the quote document shall create any contractual relationship between any

subcontractor and the County or any obligation to pay or facilitate the payment of any

monies due any subcontractor, except as may otherwise be required by law.

The Closure Package, which shall include all necessary documentation to complete

the demolition project must be submitted to the User Division within five (5) business

days of the Completion Date stated within the Notice to Commence Services. Any

Contractor that does not abide by this timeframe may be subject to suspension as

noted within this document and the Procurement Procedures.

Items to be submitted in the Closure Package:

➢ Final Invoice (original)

➢ Certificate of Completion (original)

➢ Checklist (from quote document)

➢ Final closed permits noted under Section 3., Submittal Requirements After

Demolition

o Final Building Permit

o Final Septic Tank Abandonment Permit showing confirmation of removal

of septic tank

o Tire invoices showing disposal at authorized tire disposal site.

o Household hazardous waste (i.e., paints, insecticides) invoice showing

disposal at authorized disposal site.

➢ Scaled Landfill tickets. Tickets must be completely filled out and include

property address. (original)

➢ Final Unconditional Release of Lien from all Subcontractor(s) (original)

➢ Picture of completed project, date and time stamped

For purposes of the Closure Package, “scaled” means that all material delivered to an

approved landfill must be weighed on the landfill’s scale for accurate measurement of

material.

22. LOCAL PREFERENCE: It is the policy of the Board of County Commissioners to

afford local preference to Polk County entities in the award of bids. Preference shall

be administered in accordance with the following:

When written quotations are received, and the lowest price is offered by an entity

located outside of Polk County, and the next lowest price is offered by an entity

located in Polk County, and is within 5% of the lowest price offered, then the Polk

County entity shall be given the opportunity to match the lowest price offered, and if

agreement to match the lowest price is reached, the Polk County entity will be

awarded the quote if the Polk County entity is otherwise fully qualified and meets all

County requirements.

For purposes of this provision the term "Polk County entity" means any business having

a physical location within the boundaries of Polk County, Florida, at which employees

are located and business activity is managed and controlled on a day to day basis.

Additionally, the business must have been located within the boundaries of Polk

County for a minimum of 12 months prior to the date the applicable solicitation is

issued. This requirement may be evidenced through a recorded deed, an executed

lease agreement, or other form of written documentation acceptable to the County.

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

The County shall have the right, but not the obligation, to verify the foregoing

requirements.

If a contract is being funded in whole or in part by assistance of any federal, state or

local agency which disallows local preference, the County will adhere to those

requirements by not applying this section.

23. VENDOR PREFERENCE: It is the policy of the Board of County Commissioners to

afford vendor preference to women and minority owned entities in the award of

quotes. Preference shall be administered in accordance with the following:

When written quotations (less than $50,000.00) are received, and the lowest price is

offered by a non-women or minority owned entity located outside of Polk County, and

a price is offered by a women or minority owned entity that is within 5% of the lowest

price offered, then the women or minority owned entity shall be given the opportunity

to match the lowest price offered, and if agreement to match the lowest price is

reached, the women or minority owned entity will be awarded the quote if the women

or minority owned entity is otherwise fully qualified and meets all county requirements.

The term “Women or Minority Owned Entity” means any business having at least 51%

ownership by women or minority group members who independently control the

management and day-to-day operations of the firm. Group members are Females,

African Americans, Hispanic Americans, Asian-Pacific Americans, Native Americans,

and Asian-Indian Americans.

If a contract is being funded in whole or in part by assistance of any federal, state or

local agency which disallows this form of preference, the County will adhere to those

requirements by not applying section.

This policy in no way supersedes the Local Preference Policy.

24. The Closure Package and all required documentation for this project are to be sent via

regular mail or hand-delivered to the following address:

REGULAR MAIL ADDRESS:

HAND DELIVERY:

R. Wade Allen, Administrator, Polk

County Board of County Commissioners

Post Office Box 9005, Drawer RE01,

Bartow, Florida 33831-9005

Phone: 863-534-2580

515 East Boulevard Street Bartow,

Florida 33830

Phone: 863-534-2580

25. Unauthorized Alien(s): The vendor agrees that unauthorized aliens shall not be

employed nor utilized in the performance of the requirements of this solicitation. The

County shall consider the employment or utilization of unauthorized aliens a violation

of Section 274A(e) of the Immigration and Naturalization Act (8 U.S.C. 1324a). Such

violation shall be cause for unilateral termination of this Agreement by the County. As

part of the response to this solicitation, the successful vendor will complete and submit

the attached form “Affidavit Certification Immigration Laws.

26. Employment Eligibility Verification (E-Verify)

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

A. Unless otherwise defined herein, terms used in this Section which are defined in

Section 448.095, Florida Statutes, as may be amended from time to time, shall have

the meaning ascribed in said statute.

B. Pursuant to Section 448.095(5), Florida Statutes, the contractor hereto, and any

subcontractor thereof, must register with and use the E-Verify system to verify the work

authorization status of all new employees of the contractor or subcontractor. The

contractor acknowledges and agrees that (i) the County and the contractor may not

enter into this Agreement, and the contractor may not enter into any subcontracts

hereunder, unless each party to this Agreement, and each party to any subcontracts

hereunder, registers with and uses the E-Verify system; and (ii) use of the U.S.

Department of Homeland Security’s E-Verify System and compliance with all other

terms of this Certification and Section 448.095, Fla. Stat., is an express condition of this

Agreement, and the County may treat a failure to comply as a material breach of this

Agreement.

C. By entering into this Agreement, the contractor becomes obligated to comply with

the provisions of Section 448.095, Fla. Stat., "Employment Eligibility," as amended from

time to time. This includes but is not limited to utilization of the E-Verify System to verify

the work authorization status of all newly hired employees, and requiring all

subcontractors to provide an affidavit attesting that the subcontractor does not employ,

contract with, or subcontract with, an unauthorized alien. The contractor shall maintain

a copy of such affidavit for the duration of this Agreement. Failure to comply will lead to

termination of this Agreement, or if a subcontractor knowingly violates the statute or

Section 448.09(1), Fla. Stat., the subcontract must be terminated immediately. If this

Agreement is terminated pursuant to Section 448.095, Fla. Stat., such termination is not

a breach of contract and may not be considered as such. Any challenge to termination

under this provision must be filed in the Tenth Judicial Circuit Court of Florida no later

than 20 calendar days after the date of termination. If this Agreement is terminated for

a violation of Section 448.095, Fla. Stat., by the contractor, the contractor may not be

awarded a public contract for a period of 1 year after the date of termination. The

contractor shall be liable for any additional costs incurred by the County as a result of

the termination of this Agreement. Nothing in this Section shall be construed to allow

intentional discrimination of any class protected by law.

27. CODE OF ETHICS: If any vendor violates or is a party to a violation of the code of

ethics of Polk County or the State of Florida, with respect to this quote, such vendor

may be disqualified from performing the work described in this quote or from

furnishing the goods or services for which the quote is submitted and shall be further

disqualified from quoting on any future quotes for work, goods, or services for the

County.

28. CONE OF SILENCE: Bidders and any prospective bidders shall not contact,

communicate with or discuss any matter relating in any way to this quote with any

member of the Polk County Board of County Commissioners or any employee of Polk

County other than the County Procurement Director or the individual designated in the

Procurement Division. This prohibition begins with the issuance of the quote and ends

upon award or execution of the final contract. Any such communication initiated by a

bidder or prospective bidder shall be grounds for disqualifying the offender form

consideration for an award pursuant to this qoute and for bids or contracts to be

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

awarded pursuant to RFPs, or Requests for Bid that the County may issue in the

future.

29. ATTORNEY’S FEES AND COSTS: Each party shall be responsible for its own legal

and attorney’s fees, costs and expenses incurred in connection with any dispute or

any litigation arising out of, or relating to this Agreement, including attorney’s fees,

costs and expenses incurred for any appellate or bankruptcy proceedings.

30. PUBLIC RECORD LAWS

(a) The Contractor acknowledges the County’s obligations under Article I, Section

24, of the Florida Constitution and under Chapter 119, Florida Statutes, to release

public records to members of the public upon request and comply in the handling of

the materials created under this Agreement. The Contractor further acknowledges

that the constitutional and statutory provisions control over the terms of this

Agreement. In association with its performance pursuant to this Agreement, the

Contractor shall not release or otherwise disclose the content of any documents or

information that is specifically exempt from disclosure pursuant to all applicable laws.

(b) Without in any manner limiting the generality of the foregoing, to the extent

applicable, the Contractor acknowledges its obligations to comply with Section

119.0701, Florida Statutes, with regard to public records, and shall:

(1) keep and maintain public records required by the County to perform the

services required under this Agreement;

(2) upon request from the County’s Custodian of Public Records or his/her

designee, provide the County with a copy of the requested records or allow the

records to be inspected or copied within a reasonable time at a cost that does not

exceed the cost provided in Chapter 119, Florida Statutes, or as otherwise

provided by law;

(3) ensure that public records that are exempt or confidential and exempt from

public records disclosure requirements are not disclosed except as authorized by

law for the duration of the term of this Agreement and following completion of this

Agreement if the Contractor does not transfer the records to the County; and

(4) upon completion of this Agreement, transfer, at no cost, to the County all

public records in possession of the Contractor or keep and maintain public records

required by the County to perform the service. If the Contractor transfers all public

records to the County upon completion of this Agreement, the Contractor shall

destroy any duplicate public records that are exempt or confidential and exempt

from public records disclosure requirements. If the Contractor keeps and maintains

public records upon completion of this Agreement, the Contractor shall meet all

applicable requirements for retaining public records. All records stored

electronically must be provided to the County, upon request from the County’s

Custodian of Public Records, in a format that is compatible with the information

technology systems of the County.

APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE

CONTRACTOR’S DUTY TO PROVIDE PUBLIC RECORDS RELATING

TO THIS AGREEMENT, CONTACT THE COUNTY’S CUSTODIAN OF

PUBLIC RECORDS AT:

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

RECORDS MANAGEMENT LIAISON OFFICER

POLK COUNTY

330 WEST CHURCH ST.

BARTOW, FL 33830

TELEPHONE: (863) 534-7527

EMAIL: RMLO@POLK-COUNTY.NET

31. SCRUTINIZED COMPANIES AND BUSINESS OPERATIONS CERTIFICATION;

TERMINATION.

A. Certification(s).

(i) By its execution of this Agreement, the Vendor hereby certifies to the County

that the Vendor is not on the Scrutinized Companies that Boycott Israel List,

created pursuant to Section 215.4725, Florida Statutes, nor is the Vendor engaged

in a boycott of Israel, nor was the Vendor on such List or engaged in such a

boycott at the time it submitted its bid, proposal, quote, or other form of offer, as

applicable, to the County with respect to this Agreement.

(ii) Additionally, if the value of the goods or services acquired under this

Agreement are greater than or equal to One Million Dollars ($1,000,000), then the

Vendor further certifies to the County as follows:

(a) the Vendor is not on the Scrutinized Companies with Activities in

Sudan List, created pursuant to Section 215.473, Florida Statutes; and

(b) the Vendor is not on the Scrutinized Companies with Activities in the

Iran Petroleum Energy Sector List, created pursuant to Section 215.473,

Florida Statutes; and

defined in Florida Statutes, Section 287.135) in Cuba or Syria; and

(d) the Vendor was not on any of the Lists referenced in this subsection

A(ii), nor engaged in business operations in Cuba or Syria when it

submitted its proposal to the County concerning the subject of this

Agreement.

(iii) The Vendor hereby acknowledges that it is fully aware of the penalties that

may be imposed upon the Vendor for submitting a false certification to the County

regarding the foregoing matters.

B. Termination. In addition to any other termination rights stated herein, the County

may immediately terminate this Agreement upon the occurrence of any of the

following events:

(i) The Vendor is found to have submitted a false certification to the County

with respect to any of the matters set forth in subsection A(i) above, or the

Vendor is found to have been placed on the Scrutinized Companies that

Boycott Israel List or is engaged in a boycott of Israel.

(ii) The Vendor is found to have submitted a false certification to the County with

respect to any of the matters set forth in subsection A(ii) above, or the Vendor is

found to have been placed on the Scrutinized Companies with Activities in Sudan

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

List, or the Scrutinized Companies with Activities in the Iran Petroleum Energy

Sector List, or has been engaged in business operations in Cuba or Syria, and the

value of the goods or services acquired under this Agreement are greater than or

equal to One Million Dollars ($1,000,000).

32. UNCONTROLLABLE FORCES (FORCE MAJEURE): Either party hereunder may be

temporarily excused from performance if an Event of Force Majeure directly or

indirectly causes its nonperformance. An “Event of Force Majeure” is defined as any

event which results in the prevention or delay of performance by a party of its

obligations under this Agreement and which is beyond the reasonable control of the

nonperforming party. It includes, but is not limited to fire, flood, earthquakes, storms,

lightning, epidemic, war, riot, civil disturbance, sabotage, and governmental actions.

Neither party shall be excused from performance if non-performance is due to forces

which are reasonably preventable, removable, or remediable and which the non-

performing party could have, with the exercise of reasonable diligence, prevented,

removed, or remedied prior to, during, or immediately after their occurrence. Within

five (5) days after the occurrence of an Event of Force Majeure, the non-performing

party shall deliver written notice to the other party describing the event in reasonably

sufficient detail, along with proof of how the event has precluded the non-performing

party from performing its obligations hereunder, and a good faith estimate as to the

anticipated duration of the delay and the means and methods for correcting the delay.

The non-performing party’s obligations, so far as those obligations are affected by the

Event of Force Majeure, shall be temporarily suspended during, but no longer than,

the continuance of the Event of Force Majeure and for a reasonable time thereafter as

may be required for the non-performing party to return to normal business operations.

If excused from performing any obligations under this Agreement due to the

occurrence of an Event of Force Majeure, the non-performing party shall promptly,

diligently, and in good faith take all reasonable action required for it to be able to

commence or resume performance of its obligations under this Agreement. During

any such time period, the non-performing party shall keep the other party duly notified

of all such actions required for it to be able to commence or resume performance of its

obligations under this Agreement.

33. NO CONSTRUCTION AGAINST DRAFTER. The Parties acknowledge that this

Agreement and all the terms and conditions contained herein have been fully

reviewed and negotiated by the Parties. Accordingly, any rule of construction to the

effect that ambiguities are to be resolved against the drafting party shall not apply in

interpreting this Agreement

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

SPECIFICATIONS

1. The Contractor shall begin work after Notice to Commence Services has been issued

by the Procurement Division. Work shall only be authorized Monday through Friday

between the hours of 7:00 a.m. and 5:00 p.m., excluding County holidays. If the

Contractor desires to work outside of the regular hours, a request must be made 48

hours prior to the planned work. The Contractor shall have twenty (20) business days

from the date Notice to Commence Services is issued to complete the demolition

(Completion Date). All paperwork noted as a part of the Closure Package must be

submitted no later than five (5) business days of the Completion Date stated in the

Notice to Commence Services.

2. The Contractor must notify Polk County via email with the specific start day.

3. Demolition services must be provided utilizing the “wet demo” method regardless of

the presence of hazardous material. If asbestos material is present, a State licensed

Asbestos Contractor must perform the work in accordance with established guidelines

for the type of material present. Removal of asbestos containing material must be

performed by the Prime Contractor only. This work will not be subcontracted

out.

4. Should asbestos be found during demolition when (i) the asbestos survey, if

performed, indicates no asbestos is present within the structure, or (ii) an asbestos

survey was not required or performed in accordance with applicable federal and state

rules and regulations, the Contractor MUST immediately stop work and report the

finding to the County and this demolition quote shall terminate. The Contractor shall

be paid for all work completed prior to the discovery of asbestos. The County shall

issue a new demolition quote solicitation to complete the demolition which shall

indicate that asbestos material is present within the structure.

5. The Contractor shall be required to submit copies of all DEP Notices for asbestos

abatement and demolition activity. Work dates on the notices must reflect actual work

dates for in progress inspections. Any changes to notices must be sent in writing to

the DEP and the County before work for that specific notice commences.

6. The Contractor shall remove all debris, trash, man-made items, or building material

from site. All utility poles, unless they are marked that they are owned by a utility

company; or located in a right-of-way, must be removed. All man-made items should

be removed at the completion of the demolition.

7. The Contractor is responsible for observing all federal, state, and county

environmental regulations associated with the structure(s) being demolished and

cleared from the site.

8. The Contractor must pull all necessary permits for the demolition of the structure(s).

As of August 25, 2006, demolition permits are also required for mobile homes. Final

closed permits must be submitted as part of the Closure Package described in

Instructions, Item 20.

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

9. The Contractor is responsible for utility disconnects. All underground plumbing must

be removed. The Contractor shall contact the appropriate power company so that they

may disconnect the power source.

10. Septic tanks, lift stations, and raised drain fields shall be removed: If there is a septic

tank on premises, the Contractor shall submit a copy of their Septic System

Abandonment Permit and the Completion Form that is signed by a Health Department

official as instructed on the Checklist with their Closure Package. Chapter 64E-6.011

and 64E-6.019 of the Florida Administrative Code sets the rules for the proper

procedure of abandonment of septic tanks.

11. Unless otherwise specified, the Contractor shall remove all structures on the property.

This includes the primary structure and secondary structures, such as sheds, garages,

doghouses, etc. Any questions regarding structures to be demolished and removed

must be addressed prior to the Quote Receiving date and time.

12. The Contractor shall remove all slabs, underground plumbing, pillars and/or footers

associated with the structure to be demolished.

13. The Contractor shall remove all fences, except those which divide the property from

an adjoining property.

14. Taggable items (such as cars, boats, car trailers, etc.) are not to be removed unless

otherwise specified.

15. The Contractor MUST use authorized landfills with scales only in disposing of

construction materials associated with the demolition process. Load weight must be

printed on scaled landfill ticket. No materials may be buried on site. Should this be

found, the Contractor will be subject to suspension as outlined in this solicitation and

the Procurement Procedures. Scaled landfill tickets must include the project address

and the name of Contractor/Hauler.

16. Unless otherwise noted, the site should be brought to a raked site basis. This shall

include bringing in “clean” fill dirt (i.e., no organic matter, debris or large rocks), if

necessary. Also, the Contractor shall use fill dirt to level any ruts or machine cuts.

17. All abatements and special considerations associated with the demolition are the

responsibility of the Contractor.

18. No area shall remain that retains or detains water at the close of the project.

19. It is the responsibility for the Contractor to dispose of all household hazardous waste,

including but not limited to paint, paint cans, and recyclables at an authorized landfill

and submit authorized landfill receipts. Contractors should include the disposal costs

in their quote. Scaled landfill tickets with the actual cost from an authorized landfill

must be submitted within the Contractor’s Closure Package. Labor for removal of

household hazardous waste should also be included in the quote and will not be

allowed as an additional charge.

20. Tires must be taken to an authorized tire disposal site. Contractors should incorporate

tires into quote price. This cost will NOT be reimbursed via separate invoice on this

demolition. The contractor must include landfill tickets for the tires with request for

payment before payment for demolition will be rendered.

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

21. The Certificate of Completion is to be executed when the scope of work is complete,

all permits have been inspected and finalized by the respective agencies that issued

the permits, all Subcontractors have been paid, and unconditional lien releases(s)

have been obtained. This shall be the final action required of the Contractor prior to

assembly of the Closure Package for submittal to the County.

22. Contractors should not assume that items located on the property while submitting a

quote will remain on the property at the time of demolition. The County may not own

the property(ies) being demolished; therefore the property owner may remove items

from their property at any time prior to the demolition.

23. If the project site is left unattended, it is the responsibility of the Contractor to secure

the site before leaving. This includes, but is not limited to, energized power lines,

covering open pools, septic tanks, and holes from excavation.

24. The Contractor MUST contact the Real Estate Services Division to request an

inspection after the demolition project has been completed. Multiple inspections by

County personnel after completion deadline may subject the Contractor to suspension

as outlined within this document and the Procurement Procedures.

Items that must be included within the Closure Package:

➢ Final Invoice (original)

➢ Certificate of Completion (original)

➢ Checklist (from quote document)

➢ Final closed permits noted under Section 3., Submittal Requirements After

Demolition

o Final Building Permit

o Tire invoices showing disposal at authorized tire disposal site.

o Household hazardous waste (i.e., paints, insecticides) invoice showing

disposal at authorized disposal site.

➢ Scaled Landfill tickets. Tickets must be completely filled out and include

property address. (original)

➢ Final Unconditional Release of Lien from all Subcontractor(s) (original)

25. Contractors shall NOT send individual items in to the User Division. ALL items listed

above MUST be submitted together, not later than five (5) business days of the

Completion Date noted in the Notice to Commence Services. Failure to follow these

instructions may subject the Contractor to suspension as outlined within this document

and the Procurement Procedures.

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

QUOTE SHEET

(SUBMITTAL PAGE)

Quotation Price for demolition services $_______________________________

Are Subcontractors being used in the performance of this demolition? (Mark only one)

[ ] Yes [ ] No

Name of Subcontractor(s):

____________________________________________________________________________

Work being performed by Subcontractor(s):

(List ALL subcontractors. Attach additional sheets if needed)

Firm Name: ____________________________________________________________

Authorized Signature_____________________________________________________

Printed Name & Title of Authorized Signer: ___________________________________

P.O. Box/Street Address: _______________________________________________________

City, State and Zip Code: ____________________________________________________

Telephone Number: ___________________ E-Mail Address: ___________________________

FL Asbestos Contractor License # (CJC): ___________________________________

COMPANY CLASSIFICATION (Must Circle One)

Caucasian

African American

Hispanic American

Asian-Pacific American

Native American

Asian-Indian American

If one of the above is circled please indicate whether ____Female ____Male

Publicly Traded Corporation

Employee Owned Company

RETURN ALL QUOTES TO PROCUREMENT VIA MAIL, FAX OR EMAIL:

Polk County Procurement Division

330 West Church Street, Room 150

Bartow, FL 33830

(863)534-6757

Fax: (863)534-6789

Email: procurement @polk-county.net

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

THE FOLLOWING SECTION SHOULD BE COMPLETED BY ALL BIDDERS:

(SUBMITTAL PAGE)

Company Name:

DBA/Fictitious Name (if applicable):

NOTE: COMPANY NAME MUST MATCH LEGAL NAME ASSIGNED TO TIN

NUMBER. CURRENT W9 SHOULD BE SUBMITTED WITH BID.

TIN #:

(Street No or PO Box Number) (Street Name)

(City)

(County) (State) (Zip Code)

Contact Person:

Phone Number:

Cell Phone Number:

Email Address:

Type of Organization:

Sole Proprietorship Partnership Non-Profit Sub-

Chapter

Joint Venture Corporation LLC LLP

Publicly Traded Employee Owned

State of Incorporation

The Successful vendor must complete and submit this section prior to award. The

Successful vendor must invoice using the company name listed above.

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

ADDRESS:

610 Cameron Road, Eagle Lake, FL 33839

7 Grove Park Lane, Eagle Lake, FL 33839 (A Portion of)

TAX ID #:

262906-672500-005602

262906-000000-022260 (A Portion Of)

OWNER:

Polk County

Directions:

From Bartow: Head East on U.S. 98/Van Fleet Dr. for 0.5 miles; Turn

left onto U.S. 17 N. for 8.4 miles; Turn right onto Cameron Road.

Continue for approximately 1,000 feet. The first address will be on

the right. For the second address continue following Cameron Road.

Turn Right onto Grove Park Lane. The second address will be on

the right about 80 feet south of Cameron Road.

1.) Demo IN PLACE Approximate 672 sq. ft. – 1975 Mobile

Home, Approximate 920 sq. ft. – 1972 Mobile Home,

Approximate 678 sq. ft. – 1972 Mobile Home.

2.) Remove Concrete Block Well House. Leave Well.

3.) Remove Metal Gate.

4.) Remove All Wood Frames/Posts and decks on the

Properties

5.) Remove Wood Porch with Stairs.

6.) Remove Concrete Steps.

7.) Remove all Sheds.

8.) Remove White Jeep VIN #NL1516945.

9.) Remove Propane Tanks.

10.) Remove any Tires found on the property.

11.) Do Not Crush Septic Tanks. Pump Out and Remove

Septic Tanks (three) and Drain Fields in accordance with

Florida Administrative Code Chapter 64E-6.011 and 64E-

6.019.

12.) Include a photo of the removed septic tanks on the

transport to the dump site or shown out of the ground.

13.) Remove all Debris. Fill Level and Rake upon Completion.

Photos available upon request.

Description:

WAHNETA FARMS PB 1 PG 82A 82B LOT 56

Metes and Bounds Description

Utilities:

Demo Contractor is responsible for all disconnects and permits with

any and all utilities, municipalities, etc. Electricity must be

disconnected from the structure prior to start. Must have required

permit(s) prior to start.

PLEASE NOTE: The County has requested that Tampa Electric

remove the meter and disconnect service to these properties.

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

However, it is still the Contractor’s responsibility to verity the

disconnect.

Demolition:

Demolition in place – Structures as described above and removal of

all debris. Demolition services must be provided utilizing the “wet

demo” method regardless of the presence of hazardous material.

Must demo per NESHAP Recommendations, asbestos survey

available upon request. If asbestos material is present, a State

licensed Asbestos Contractor must perform the work in accordance

with established guidelines for the type of material present.

NOTE: Incorporate tires and/or any chemicals into quote price.

This cost will NOT be reimbursed via separate invoice on this

demolition. The contractor must include landfill tickets for the

tires and/or chemicals with request for payment before

payment for demolition will be rendered.

NOTE: Do Not Crush Septic Tank. Pump Out and Remove

Septic Tank and Drain Field in accordance with Florida

Administrative Code Chapter 64E-6.011 and 64E-6.019. Include

a photo of the removed tank on the transport to the dump site

and copy of Septic System Abandonment Permit and

Completion Form signed by a Health Department Official for

verification of removal, when submitting Close Out

Package/Checklist.

Fill all areas as needed, level and rake.

NOTICE: If there is a well, do NOT remove or do anything to it.

Do not include well abandonment in the demolition quote. The

well is to remain, and the abandonment will be performed by

others.

NOTES:

Structure (check one):

Does not contain asbestos (see attached Asbestos Survey).

X Does contain asbestos (see attached Asbestos Survey).

An asbestos survey was not required or performed on the property in

accordance with applicable state and federal rules and regulations.

Exception(s): Do not include well abandonment in the demolition quote. The well

is to remain and the abandonment will be performed by others.

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

If submitting a "NO QUOTE", Bidder shall return this form to The Polk County Board of County

Commissioners Procurement Division, ATTN: Mike Baselice, 330 West Church Street, Room 150,

Bartow, Florida 33830; or via fax to (863) 534-6789.

We have declined to bid on the above-mentioned quote for the following reasons:

Specifications too "restrictive". Insufficient time to respond.

Do not offer this product/service. Our schedule would not permit us to perform.

Unable to meet specifications. Unable to meet insurance requirements.

Specifications unclear. Other (please specify below).

We understand that if the "No Quote" form is not executed and returned, our name may be deleted

from the list of qualified bidders for the County for further demolition projects.

Signature Company

Typed Name and Title Address

Telephone Number City, State, Zip Code

E-Mail Address Date

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

SAFETY REQUIREMENTS/REGULATIONS FORM

(SUBMITTAL PAGE)

Bidder must sign and have notarized:

The undersigned bidder hereby certifies that they fully understand the safety

requirements/regulation provisions and will comply.

Dated this day of , 20__

Name of Firm

Title of Person Signing (SEAL)

STATE OF ________________

COUNTY OF ______________

The foregoing instrument was acknowledged before me by means of physical

presence or online notarization, this _____ day of ___________, 2023, by

___________________(name) as _______________ (title of officer) of

__________________ (entity name), on behalf of the company, who is personally

known to me or has produced ___________________________ as identification.

Notary Public Signature: ___________________________________

Printed Name of Notary Public: ______________________________

Notary Commission Number and Expiration: _______________

(AFFIX NOTARY SEAL)

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

Drug-Free Workplace Form

(Submittal Page)

The undersigned vendor in accordance with Florida Statue 287.087 hereby certifies

that, (Name of the Business): _________________________________________ does:

1. Publish a statement notifying employees that the unlawful manufacture,

distribution, dispensing, possession or use of a controlled substance is prohibited

in the workplace and specifying the actions that will be taken against employees

for violations of such prohibition.

2. Inform employees about the dangers of drug abuse in the workplace, the

business’s policy of maintaining a drug-free workplace, any available drug

counseling, rehabilitation programs, employee assistance programs and the

penalties that may be imposed upon employees for drug abuse violations.

3. Give each employee engaged in providing the commodities or contractual

services that are under bid a copy of the statement specified in subsection (1).

4. In the statement specified in subsection (1), notify the employees that, as a

condition of working on the commodities or contractual services that are under

bid, the employee will abide by the terms of the statement and will notify the

employer of any conviction of, plea of guilty or nolo contendere to, any violation

of Chapter 1893 or of any controlled substance law of the United States or any

state, for a violation occurring in the workplace no later than five (5) days after

such conviction.

5. Impose a sanction on or require the satisfactory participation in a drug abuse

assistance or rehabilitation program, if such is available in the employee’s

community, by any employee who is so convicted.

6. Make a good faith effort to continue to maintain a drug-free workplace through

implementation of this section.

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

the above requirements.

Vendor Signature: _______________________________________________________

Date: ________________________________

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

INSURANCE REQUIREMENTS

An original certificate of insurance must meet the following requirements:

1. Worker’s Compensation Insurance providing statutory benefits, including those

that may be required by any applicable federal statute. Any sole proprietor or

partner actively engaged in the construction industry and any corporate officer of

a construction or non-construction industry corporation who elects to be exempt

from the provisions of the worker’s compensation law must provide either a

worker’s compensation exemption certificate (construction industry) or a letter

stating the exemption status and number of employees (non-construction).

Admitted in Florida Yes

Employer’s Liability $100,000

All States Endorsement Statutory

Voluntary Compensation Statutory

Worker’s Compensation policy will contain waiver of subrogation in favor of Polk

County.

2. All contractors are required to provide the County with one original certificate of

insurance, which must include the following information:

a. Worker’s Compensation Insurance providing statutory benefits, including

those that may be required by any applicable federal statute. Any sole proprietor

or partner actively engaged in the construction industry and any corporate officer

of a construction or non-construction industry corporation who elects to be exempt

from the provisions of the Worker’s Compensation exemption certificate

(construction industry) or a letter stating the exemption status and number of

employees (non-construction industry).

b. Commercial General Liability Insurance, including County and Contractor

Protective, Contractual, Products and Completed Operations Liability coverage on

an occurrence Broad form policy in limits not less than those listed and deductible

amount not to exceed $25,000. XCU Property Damage exclusion must be removed

from the policy.

Each Occurrence: $1,000,000

Completed Operation $1,000,000

Pollution Liability $1,000,000

c. Automobile Liability Insurance. Coverage shall be maintained by the

Contractor as to the ownership, maintenance, and use of all of its owned, non-

owned, leased or hired vehicles with limits of not less than:

Bodily Injury & Property Damage Liability $1,000,000

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

Combined Single Limit Each Accident

d. Pollution Liability is required for all contractors that perform demolitions

involving asbestos. This coverage will be requested upon the initial award of a

project that contains asbestos material.

3. Polk County is to be named as an additional insured on both the General Liability

Policy and the Automobile Liability Policy as follows: “Polk County, a political

subdivision of the State of Florida, is named as additional insured with respect to

liability arising from any demolition quote for Automobile and General Liability

policies of insurance. All policies (except auto) contain a waiver of subrogation in

favor of Polk County.” All insurance coverage shall be written with a firm having an

A.M. Best Rating of at least the “A” category and financial size category of VIII.

The Certificate Holder must be stated as:

Polk County, a political subdivision of the State of Florida

PO Box 9005, Drawer AS05

Bartow, Florida 33831-9005

The County must be an additional named insured in regards to General and Automobile

Liability. Coverage must be provided by an insurer licensed to do business in the State

of Florida and must be rated “A VIII” or better by A.M. Best Rating Company for Class VIII

financial size category. Waiver of subrogation in favor of Polk County is required for

General Liability and Worker’s Compensation coverages.

Notation on the certificate reflecting the additional insured status and the waiver of

subrogation or copies of the endorsements must be provided to verify requirements. “All

work performed for Polk County” must be noted on the certificate.

The acceptable form of the certificate of insurance shall be the industry standard ACORD

certificate.

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

Affidavit Certification Immigration Laws

POLK COUNTY WILL NOT INTENTIONALLY AWARD COUNTY CONTRACTS TO

ANY CONTRACTOR WHO KNOWINGLY EMPLOYS UNAUTHORIZED ALIEN

WORKERS, CONSTITUTING A VIOLATION OF THE EMPLOYMENT PROVISIONS

CONTAINED IN 8 U.S.C. SECTION 1324 A(E) {SECTION 274A(E) OF THE

IMMIGRATION AND NATIONALITY ACT (“INA”)}.

POLK COUNTY MAY CONSIDER THE EMPLOYMENT BY ANY CONTRACTOR OF

UNAUTHORIZED ALIENS A VIOLATION OF SECTION 274A(E) OF THE INA. SUCH

VIOLATION OF THE RECIPIENT OF THE EMPLOYMENT PROVISIONS

CONTAINED IN 274A(E) OF THE INA SHALL BE GROUNDS FOR UNILATERAL

CANCELLATION OF THE CONTRACT BY POLK COUNTY.

BIDDER ATTEST THAT THEY ARE FULLY COMPLIANT WITH ALL APPLICABLE

IMMIGRATION LAWS (SPECIFICALLY TO THE 1986 IMMIGRATION ACT AND

SUBSEQUENT AMENDMENTS).

Company Name: ___________________________________________________

Signature: ________________________________________________________

Title: _____________________________________________________________

Date: _____________________________________________________________

State of: ____________________

County of: ___________________

The foregoing instrument was acknowledged before me by means of physical

presence or online notarization, this _____ day of ___________, 2023, by

___________________(name) as _______________ (title of officer) of

__________________ (entity name), on behalf of the company, who is personally

known to me or has produced ___________________________ as identification.

Notary Public Signature: ___________________________________

Printed Name of Notary Public: ______________________________

Notary Commission Number and Expiration: _______________

(AFFIX NOTARY SEAL)

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

EMPLOYMENT ELIGIBILITY VERIFICATION (E-VERIFY) CERTIFICATION

(Florida Statutes, Section 448.095)

PROJECT NAME:_______________________________________________________________

The undersigned, as an authorized officer of the contractor identified below (the “Contractor”),

having full knowledge of the statements contained herein, hereby certifies to Polk County, a political

subdivision of the State of Florida (the “County”), by and on behalf of the Contractor in accordance with

the requirements of Section 448.095, Florida Statutes, as related to the contract entered into by and

between the Contractor and the County on or about the date hereof, whereby the Contractor will provide

labor, supplies, or services to the County in exchange for salary, wages, or other remuneration (the

“Contract”), as follows:

1. Unless otherwise defined herein, terms used in this Certification which are defined in

Section 448.095, Florida Statutes, as may be amended from time to time, shall have the meaning ascribed

in said statute.

2. Pursuant to Section 448.095(5), Florida Statutes, the Contractor, and any subcontractor

under the Contract, must register with and use the E-Verify system to verify the work authorization status

of all new employees of the Contractor or subcontractor. The Contractor acknowledges and agrees that (i)

the County and the Contractor may not enter into the Contract, and the Contractor may not enter into any

subcontracts thereunder, unless each party to the Contract, and each party to any subcontracts thereunder,

registers with and uses the E-Verify system; and (ii) use of the U.S. Department of Homeland Security’s E-

Verify System and compliance with all other terms of this Certification and Section 448.095, Fla. Stat., is

an express condition of the Contract, and the County may treat a failure to comply as a material breach of

the Contract.

3. By entering into the Contract, the Contractor becomes obligated to comply with the

provisions of Section 448.095, Fla. Stat., "Employment Eligibility," as amended from time to time. This

includes but is not limited to utilization of the E-Verify System to verify the work authorization status of all

newly hired employees, and requiring all subcontractors to provide an affidavit attesting that the

subcontractor does not employ, contract with, or subcontract with, an unauthorized alien. The Contractor

shall maintain a copy of such affidavit for the duration of the Contract. Failure to comply will lead to

termination of the Contract, or if a subcontractor knowingly violates the statute or Section 448.09(1), Fla.

Stat., the subcontract must be terminated immediately. If the Contract is terminated pursuant to Section

448.095, Fla. Stat., such termination is not a breach of contract and may not be considered as such. Any

challenge to termination under this provision must be filed in the Tenth Judicial Circuit Court of Florida no

later than 20 calendar days after the date of termination. If the Contract is terminated for a violation of

Section 448.095, Fla. Stat., by the Contractor, the Contractor may not be awarded a public contract for a

period of 1 year after the date of termination. The Contractor shall be liable for any additional costs incurred

by the County as a result of the termination of the Contract. Nothing in this Certification shall be construed

to allow intentional discrimination of any class protected by law.

Executed this day of , 2023.

ATTEST: CONTRACTOR:

By: By:

PRINTED NAME: PRINTED NAME:

Its: Its:

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

CHECKLISTS

SECTION 1. SUBMITTAL REQUIREMENTS BEFORE DEMOLITION STARTS

____ 10-Day DEP Notice for Demolition Activities (Must indicate Wet Demo)

Suggested submittal within 8 calendar days from Notice to Proceed.

____ 10-Day DEP Notice for Asbestos Abatement (If Survey Determines Asbestos

Containing Materials) Suggested submittal within 3 calendar days from Notice to

Proceed.

____ Scaled Landfill Tickets for Asbestos Abatement (Must Use a Class 1 Landfill)

Scan and email before demo starts

____ Notify Polk County of Demolition Start Date Via Email at

[email protected]. Suggested submittal within 10 Calendar days

from Notice to Commence Services.

SECTION 2. PROJECT SITE POSTING REQUIREMENTS

____ 10-Day NESHAP Notice (Demo and Abatement if applicable)

____ Abatement Company Asbestos Certification (If applicable)

____ Building Permits

____ Copy of Asbestos Survey or Building Official Letter

SECTION 3. SUBMITTAL REQUIREMENTS AFTER DEMOLITION IS COMPLETED

(ALL ITEMS NOTED BELOW MUST BE SUBMITTED TOGETHER AT ONE TIME AS A

PACKAGE AND WITHIN 5 BUSINESS DAYS AFTER THE COMPLETION DATE

LISTED IN THE NOTICE TO COMMENCE SERVICES)

____ Original Invoice and Certificate of Completion

____ Scaled Landfill Tickets for C&D Material

____ Original Landfill Tickets for Hazardous Materials or Tires (If applicable)

____ FINAL Septic Tank Abandonment Permit (or Completion Form), if applicable.

(Or letter why tank was not abandoned. Letter must be on company letterhead

and signed by someone with signature authority for the company). Permit must be

signed by an official with authority to close permit.

____ FINAL Building Permit for Demolition Permit must be signed by an official with

authority to close permit.

____ Unconditional Release of Lien from All Subcontractors (originals) If, the

subcontractor listed is not used a letter on company letterhead signed by

someone with signature authority must be submitted for the company used (if

any).

____ Final Picture of Site

DQ 24-012, 610 Cameron Road and 7 Grove Park Lane, Eagle Lake

CERTIFICATE OF COMPLETION

DQ Number: 24-012 Case Number: N/A

Completion Date: _________________ Notice to Proceed Date: __________________

Address: 610 Cameron Road and 7 Grove Park Lane, Eagle Lake, FL 33839

The Work to which this certificate applies has been inspected by the authorized

representatives of the County and the permitting agencies and the Contractor; and that

Work is hereby declared to be complete in accordance with the scope of work contained

within the demolition quote package. This Certificate of Completion applies to all Work

under the awarded demolition.

Contractor:

By:

(Authorized Signature)

(Typed Name & Title)

Date:

County Division:

(Authorized Signature)

(Typed Name & Title)

Date: __________________