HomeMy WebLinkAbout2006 Furniture PurchaseCITY OF SEBASTIAN
ATTENTION FINANCE DEPARTMENT
1225 Main Street
Sebastian, Florida 32958
Tel: (772) 589-5330 Fax: (772) 589-5570
PURCHASE
ORDER# 00(-)0523()---03 FY 20(w,
Pag(-- NL(mbei-
IMPORTANT
PURCHSE ORDER NUMBER MUST APPEAR ON ALL SHIPPING
NOTICES BILLS OF LADING, PACKAGES, PACKING LISTS,
INVOICES: FREIGHT BILLS AND CORRESPONDENCE CONCERNING
THIS ORDER.
TAX EXEMPT #41-04-012831-54C
IMPORTANT: THIS PURCHASE ORDER IS SUBJECT TO THE TERMS AND CONDITIONS ON THE FACE AND REVERSE SIDE HEREOF,
ACCEPTANCE IS LIMITED TO TERMS OF THIS ORDER.
At 1
The H,--kn Company s 1 Ci try of Sebastian
c/cnW,.-k i- ksc apes SLILtth H Attri". Municipal Airport
200 Oak: Street P 20c
c ? Airport. Drive East
• Muscatine. 1A 52761 T Sebas-t..J.an, FL.
L 0
L L Sp
VENDOR: IF,PRICES WHICH APPEAR ABOVE AKE NOT CORRECT CALL PURCHASING AGENT AND DELAY FURTHER ACTION
ICE.
PENDING INV --meWls'"on
66ZE-2)(l6 2 06 /21 /06 RPORT ADMT.NISTRAT10N
LN DESCRIPTION/PART NO. QTY COST EA. EXT. PRICE
or) Sebastian.Airport.HONI GSA Order 1 0 45922. 97000 45, ?22. -7
Evntry State of FloriJa #425-001-06-1 Each
CITY OF PO Total 45, 922 � 9
"I T -Iv
Ac co u ri t
455050-6064,,00-
2
A
jt,L0ME'0E-PEL CI -IN IS
ACCOUNT NUMBER
AMOUNT
PURCHASING
0
PURCHASING AGENT
El
CITY OF SEBASTIAN
ATTENTION FINANCE DEPARTMENT:
1225 Main Street
Sebastian, Florida 32958
' Tel: (772) 589-5330 Fax: (772) 589-5570
PURCHASE
ORDER# 00005229--01 FY 2x_;06
Pace Numbers 1
IMP_ ORTANT
PURCHSE ORDER NUMBER` MUST APPEAR ON ALL SHIPPING
NOTICES, BILLS OF LADING, PACKAGES, PACKING LISTS,
INVOICES,.FR,EIGHTBILLS AND CORRESPONDENCE CONCERNING
THIS ORDER.
TAX EXEMPT #41-04-012831-54C
{:[Ft.
Wor-kseapes South, LLC City of Sebastian
622 S. Federal Highway :Attrt:. MLtnic:ipa.l AirportP-02 Airport Drive East
Lauderdale, FL 33301 Sebastianq FL
VENDOR:. IF
_TPI
ABOVE ARE NOT CORRECT CALL PURCHASING AGENT AND DELAY FURTHER ACTION
AGENT
PURCHASING
CITY OF
SKIMLSTIM
HOME OF PELICAN ISLAND
1225 MAIN STREET • SEBASTIAN, FLORIDA 32958
TELEPHONE: (772) 589-5330 • FAX (772) 589-5570
June 15, 2006
Cindy Moeller
Workscapes
632 S. Federal Highway
Ft. Lauderdale, FL 33301
Dear Ms. Moeller:
This is to advise that on June 14, 2006 at the Regular City Council Meeting, members of
the Sebastian City Council awarded Workscapes, Inc., Ft. Lauderdale, FL., the Airport
Administration furniture bid in the amount of $61,155.60.
We look forward to meeting with you on Friday, June 16, 2006 to finalize our order. In
the meantime, if you should have any questions please feel free to contact me at 772-388-
8203.
Sincerely,
Jean M. Tarbell
Executive Assistant
U1Y OF
SIBAST NJ
HOME OF PELICAN ISLAND
1225 MAIN STREET • SEBASTIAN, FLORIDA 32958
TELEPHONE: (772) 589-5330 • FAX (772) 589-5570
ADDENDUM #1
AIRPORT FURNITURE
DATE: May 2, 2006
TO: All Bidders
This Addendum hereby becomes an integral part of the RFP under consideration by you as a
respondent. The City of Sebastian deems all sealed RFP's to have been proffered in recognition
of the entire RFP package — including all issued addenda.
This Addendum is being sent to you via "fax". Should you have any questions pertaining to this
Addendum #1, please contact Jason Milewsk, Airport Director at 1-772-388-8208.
ADDENDUM MESSAGE
1. Exhibit "E" was inadvertently left out of the RFP Package. Please find the attached Exhibit "E"
to be included as supplemental information for this RFP.
2. Please note that this does NOT reflect a change or addition to the proposal, it is only included
for clarification and supplemental information.
3. ALL OTHER TERMS AND CONDITIONS REMAIN THE SAME,
4. This page must be submitted signed, as acknowledgement of receipt, with your RFP.
Receipt acicnowle , Bidders Signature
Jason i, Airport Director
Firm Name
ADDMIN
ASSIST
306
WAGER'S
OFFICE
305
PILOT
LOUNGE
308
AIRPORT
EM
EXHIBIT "E"
STAFF
OFFI CE
304
STAFF
OFFICE
303
FLIGHT
PLANNING
107
r/Am
G
Cliff OF
SFORASTIM
HOME Of PELICAN ISLAND
1225 MAIN STREET • SEBASTIAN, FLORIDA 32958
TELEPHONE: (772) 589-5330 • FAX (772) 589-5570
REQUEST FOR PROPOSAL "RFP"
FURNITURE
FOR
SEBASTIAN MUNICIPAL
AIRPORT ADMINISTRATION BUILDING
Prepared by:
Jason Milewski, C.M.
City of Sebastian
Airport Director
Sebastian Municipal Airport
Contact. Jason Milewski, 772-388-8208, e-mailjmilewski@cityofsebastian.org
NOTICE OF REQUEST FOR PROPOSAL "RFP"
THE CITY OF SEBASTIAN, FLORIDA IS SEEKING PROPOSALS FROM
COMMERCIAL FURNITURE DEALERS FOR CASE GOODS, FILING SYSTEMS,
SEATING AND ACCESSORIES FOR THE SEBASTIAN MUNICIPAL AIRPORT
ADMINISTRATION BUILDING.
PROPOSALS SHALL BE SUBMITTED TO, CITY OF SEBASTIAN, AIRPORT
ADMINISTRATION, 1225 MAIN STREET, SEBASTIAN, FLORIDA 32958, UNTIL 2:00
P.M. ON WEDNESDAY, MAY 17, 2006. SEALED ENVELOPES ARE TO BE CLEARLY
MARKED AS FOLLOWS:
RFP: SEBASTIAN MUNICIPAL AIRPORT ADMINISTRATION
BUILDING FURNITURE. OPEN: MAY 17, 2006
Respondents may obtain a copy of the "RFP" package with instructions and
specifications from the City of Sebastian, Airport Administration, at the address stated
above, or call 772-388-8208.
Questions regarding this RFP should be directed to Jason Milewski, Airport
Director, 772-388-8208.
A mandatory pre -proposal meeting is scheduled for Monday, May 8, 2006 at 2:00 p.m.,
in Sebastian City Hall, 2"d Floor Conference Room, 1225 Main Street, Sebastian, FL
32958. Asite visit of the Airport Administration Building will be conducted at that time.
Drug Fee Workplace Form must be signed and submitted with your proposal. Any person
or affiliate who has been placed on the convicted vendor list following conviction for a
public entity crime may not submit a proposal as proscribed by Section 287.133, F.S. A
Public Entity Crime Form must be submitted signed and notarized with your proposal.
Proposals duly submitted will be publicly received at the date and time specified above at
Sebastian City Hall. The City of Sebastian reserves the right to reject or accept any or all
proposals, waive any irregularities, make an award to any respondent whose proposal or
portion thereof is deemed by the City to be in the best interest, cancel this RFP at will,
and/or will extend date or time deadline stated here.
Jason Milewski, C.M.
Airport Director
PROJECT OVERVIEW AND INSTRUCTIONS
All case goods, filing, seating and accessories must be at least the same or comparatively
equal to the items as set forth in the product specifications provided. Preferably, all case
goods must have potential future availability.
Please see attached proposed Exhibits A, B, C, & D layouts, and product specification
pages numbered 1-22. Approved equivalent manufacturers and components will be
accepted at the sole discretion of the City of Sebastian. No design modifications to
space/floor plan.
All proposals must include pictures/brochures of all proposed furnishings, product
specifications, warranties, color/finish suggestions, and price broken down by room
number as indicated on the plans.
Offers by e-mail, telephone, telegram or facsimile will not be accepted.
The city may issue written addenda to all recipients to clarify, comment, correct or as
other wise required to facilitate the selection process.
COST SUMMARY FORM
CATEGORY TOTAL PRICE COMMENTS/NOTES
CASE GOODS
CHAIRS
FILING
MISC ACCESSORIES
DELIVERY
INS TALLA TION
GRAND TOTAL
Authorized Signature
Printed Name
Firm Name and Address Title
Phone Number
Date Signed
FLIGHT
PLANNING
107
EXHIBIT "A"
0 PILOT
( LOUNGE
308
EMPLOYEE F
LOUNGE 2
O104
0
<1O
MA
EXHIBIT "B"
EXHIBIT "C"
EXHIBIT "Dn
DEVEL PINTEMENr
STUDIO
502
PRODUCT SPECIFICATIONS
SEBASTIAN AIRPORT 1 0f 22
ItemMf Cat
1
Qty PartNumber Part Description
Alias 1
Sell�Rxt
CAR CAR
4 674-1
Monique Lounge Chair
X103
Lobby
Honey maple
ii
Arc Com
Gramercy Park
GRADE 4
#AC -67013
COLOR
RAN STORM #4
'
2 CAR CAR
1 674-2
Monique Sofa
..._I
X103
Lobby
Honey Maple
Arc Com
Gramercy Park
�
GRADE 4
#AC -67013
3 HAW HAE
COLOR "— RAN STORM#4Tµ_..._..._..._..___.____._103
1 EM231-1842
MB
$
M`K
jTASK,W/FAB
H.E.,PNEU,HA,
Lobby
$
II
I()
(HARD CASTERS
!STANDARD VERSION
,1R-
CHR FAB - SQUARZ GRAD...
i
I
1002
HOPSCOTCH
I,TR-
SURFACE 2
I
10_0F
BLACK
4 OFS OFS
3 C06-2424CT 24WX24DX22H SQUARE
$
L$
END TABLE CALYPSO
Lobby
IMHM
HONEY MAPLE
5 OFS OFS
1 C06-40MT
X17H ROUND
I $
140
MAGAZINE TABLE
CALYPSO
q$
MHM
'HONEY MAPLE
sub_.__..._.__..__._.._____.._.
Lobb 103Subtotal
._._..
`$"
HAW HAK
1 4TLC-3660-
TABLE,4
104
$
W4S0000
LEG,RECTANGULAR 36"D
Loung
f
X 60"W
e
(W4S0000)
WD EDG,29"H,STAT
(2)
LAMINATE SURFACE 1
OH-
LAMINATE
OAE
MAPLE
,KP-
MAPLE (KINETICS)
OMA
MAPLE
,TR-
SURFACE 2
__
7
OAA
PUTTY
HAW HAS 4 1200-2100
STACKER,POLY .__.__ _ _
104 $
$
SHELL,W/O ARMS
Loung
NON -GANGING
e
,TR-
SHELL
003
PEBBLE GRAY
(2)
TRIM FRAME
,TR-
FRAME
_
OOF
BLACK___
sub__.
Lounge 104 Subtotal 104 L...
ZZ 10 Z IHOdl:IIV NVIISV93S
kund
Wok
t, 3odd8ns
81
Allnd
Wo
£ 3odz8ns
-82
HSdO 31883d
Lool
8 30H8J 1338
-nd'l
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L00
8 30V80 1338
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(8)
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SEBASTIAN AIRPORT
8
19
sub
20
21
4 of 22
HAW
HAF
1
JSPY-0542-
X SERIES,STORAGE
Aims i
202
sell
$
Ext
Si
CABINET,5X42
Copy
$
Subtotal _ __
202 C...
(S1)
PTD DRW,ELL PULL
X SERIES,STORAGE _. -
202 -
CABINET,SX42
Storag
,TR-
SURFACE 1
e
i
OAA
PUTTY
SURFACE 1
PUTTY
,TR-
SURFACE 2
SURFACE 2
PUTTY
(j
OAA
PUTTY
CHROME (BRIGHT NICKE...
T-3 STANDARD LOCK PLUG &
,LR-
LOCK PLUG & RING COLO...
Storag
LOCK COLOR
e
CHROME
Subtotal _.._.......__...___ ...._
OBL
BLACK
.-.....__-____. ___.__. . __--
202 $ """'_.g"
H.E.,PNEU,HA,TASK,W/FAB
Techni
HAW
HAJ
1
LSET-3
ISTANDARD LOCK PLUG &
HOPSCOTCH
r
HAW
, LX-
OBP
2 `JSP
IS1
(Si)
JR -
OAA
,TR -
OAA
�6B
R-
P
1 E
LX-
OBP
sub
22 t
M23
1,1R-
002 R-
23 1HkW— HAF r1
(Si)
TR
OAA
,TR -
OAA
,LR -
KEY LOCK SET (QTY 3)
V4
Copy
$
LOCK COLOR
CHROME
Subtotal _ __
202 C...
Y-0542-
X SERIES,STORAGE _. -
202 -
CABINET,SX42
Storag
e
PTD DRW,ELL PULL
SURFACE 1
PUTTY
SURFACE 2
PUTTY
(j
LOCK PLUG & RING COLO...I
CHROME (BRIGHT NICKE...
T-3 STANDARD LOCK PLUG &
202
KEY LOCK SET (QTY 3)
Storag
LOCK COLOR
e
CHROME
Subtotal _.._.......__...___ ...._
202 S...
-1842 MB
.-.....__-____. ___.__. . __--
202 $ """'_.g"
H.E.,PNEU,HA,TASK,W/FAB
Techni
HARD. CASTERS
clans
STANDARD VERSION
CHR FAB - SQUARZ GRAD...
HOPSCOTCH
r
SURFACE 2
BLACK
-24-S1 X
202
SERIES, PED ESTAL,ATTAC
Techni
HED,BOX/BOX/FILE 24"D
clans
PTD FRT,ELLIPSE PULL
SURFACE 1
PUTTY
SURFACE
PUTTY i
LOCK PLUG & RING COLO...
CHROME (BRIGHT NICKE... I
SEBASTIAN AIRPORT
24
27
28
HAW
HAF
3
JPAJ-24-S1
X
202
$
SERIES,PEDESTAL,ATTAC
Techni
HED,FILE/FILE 24"D
clans
(Si)
PTD FRT,ELLIPSE PULL
,TR-
SURFACE 1
OAA
!PUTTY
,TR-
ISURFACE 2
OAA
PUTTY
LR -
LOCK PLUG & RING COLO...
"WAW
...__
—
OBP
CHROME (BRIGHT NICKE...
HAF
J_P_9-_1_8._-.S__1_
,X
202
$
SERIES,PEDESTAL,MOBILE
Techni
,BOX/BOX/FILE 18"D
clans
(Si)
JPTD
FRT,ELLIPSE PULL
,TR-
ISURFACE1
OAA
'PUTTY
,TR-
SURFACE 2
[j
OAA
PUTTY
,LR-
LOCK PLUG & RING COLO...
OBP
CHROME (BRIGHT N_ICKE_...
HAW
HAJ
3
LSET-6
STANDARD LOCK PLUG &
1202
Y -
IKEY LOCK SET (QTY 6)
i
�Techni
clans
'LX_
LOCK COLOR
OBP
CHROME
HAW HAN
2
NEB- —_
BASE FEED -RECEPTACLE
I
X202
$
CONNECTN POWER CORD
Techni
1clans
_ _.--
�?)
CANADA VERSION
HAW HAW 1
_
E2CC-90-21�
TOP CAP,4-WAY ��- —�
202
$
ITechn!
(21)
TWO-WAY, STRAIGHT
clans
,TR-
SURFACE 1
1
OAAPUTTY
I
_
1AW HAW 4
E2 -_46_-V
FC
_ _
202
POST,FABRIC,46"H
;Techni
Iciansj
(V)
VARIABLE HEIGHT
,FU-
REEL GRADE B
j
007
PEBBLE DASH
,TR-
SURFACE 2
OAA
PUTTY
,TR-
SURFACE 3
OAA
PUTTY
E2FS-16-N
_
180DEG FINISH
2p2
POST,VERTICAL COVER
Techni
7007
ONLY,FABRIC,16"H
clans
(N)
VERTICAL COVER ONLY
,FU-
REEL GRADE B
PEBBLE DASH
'1 $
5 of 22
SEBASTIAN AIRPORT
6 of 22
31
HAW
HAW
1
E2FS-62
ra10. KJC���� iion Anas Sell
180AEG FINISH 202 $
Ext Sell
f $
POST,FABRIC,62"H Techni
cians
()
STANDARD VERSION
,FU-
REEL GRADE B
007
PEBBLE DASH
,TR-
SURFACE 2
OAA
PUTTY
,TR-
SURFACE 3
OAA
PUTTY
MONO PANEL,SQ TOP —_ 202
32 HAW HAW
9 jE2MN-346-B
i
CAP,NO-POWER,36"W X Techni
46"H cians
(B)
POWER BASE
,FU-
REEL GRADE B
007
PEBBLE DASH
,FU-
REEL GRADE B
007
PEBBLE DASH
,TR-
SURFACE 3
°OAA
SJR-
PUTTY
SURFACE 4
OAA
PUTTY___
33 HAW HAW
_ _
6� _ E2MP-462-B
MONO PANEL,SQ TOP 202M___ -_. $" _._. _
__•__•___
F
CAP,W/POWER,48"W X Techni
62"H cians
(B)
POWER BASE
,FU-
REEL GRADE B
007
PEBBLE DASH
,FU-
REEL GRADE B
j
007
PEBBLE DASH
i,TR-
SURFACE 3
jj
OAA
PUTTY
,TR-
SURFACE 4
OAA
PUTTY___
REG. FLIPPER DOOR - ..._. 202 $ ---•--$---_..._____._.
34
HAW
HAW
6
_
FDRF-4
FABRIC 48"Techni
cians
(
WITH LOCK
FU-
REEL GRADE B
007
PEBBLE
DASH
1,TR-
SURFACE
2
OAA
PUTTY
,TR-
SURFACE
3
OAA_
PUTTY
-'_.__ _ 202 !$—
35 HAW
HAW
_.__J_
_
3 HGRY-3616 SLATWALL
ASSEMBLY,PLUNIGROUP,1
Techni
6X36"
cians
1
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SEBASTIAN AIRPORT
46
48
50
51
HAW
HAW
3
WUCE-3648-1CORNER,90DEG
202 i
$
LJSAL44
WRAP-AROUND EXTENDED
Techni
WORKSURFACE 36 X 48
clans
(LJSAL44)
LAM,EDGBND,STD,WRWA...
I
,01-1-
LAMINATE
OAE
MAPLE
,HP-
LAMINATE/T-MOLD
__
OAE
MAPLE
HAW
HAW
_
3
y
WUCE-3648-
CORNER,90DEG
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$"
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WRAP-AROUND EXTENDED
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WORKSURFACE 36 X 48
clans !
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MAPLE
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OAE
MAPLE
HAW
HAW
1
WUEC-5032-
_
CONFERENCE END
202 1
$
LJSC
WORKSURFACE 50 X 32
Techni
�
clans
(LJSC)
LAM,EDGBND,STD CORE,...
,01-1-
LAMINATE
OAE
MAPLE
,HP-
LAMINATE/T-MOLD
OAE
IMAPLE
HAW
HAW
4
WURA-2436-ERECT WORKSURFACE 24D
202
$
LJSA
�X 36W
Techni
clans
(LJSA)
LAM,EDGBND,STD CORE,...
,01-1-
LAMINATE
OAE
MAPLE
,HP-
ILAMINATE/T-MOLD
OAE
MAPLE
HAW
HHO
3
DTPR-3
MOXIE JUMP STUFF PAPER
202
$
SORTER
Techni
j
clans
,TR-
SURFACE 1
OLQ
FROST
,TR-
SURFACE 2
OMC
METALLIC CHAMPAGNE
HAW
HHO
3
DTPT-3
IPHONE SHELF,SLAT TILE
202
$
Techni
ISURFACE1
clans
,TR-
OLQ
FROST
,TR-
SURFACE 2
OMC
METALLIC CHAMPAGNE
iAW HHO
i
3
DTWC-2
jTOOL CLIP 202
$�
F Techni
I
,TR-
clans
SURFACE 1
I
$
$
8 of 22
SEBASTIAN AIRPORT
sub
53
56
58
sub
9 of ZZ
$
!
!
i Subtotal
202 T...
FOF
�FOF
1
17-2248BR
48WX22D BRIDGE - SMARTI
203
$
Manag
17-7222CRR
72WX2215 RIGHT PEDESTAl
203
$
FOF
FOF
1
CREDENZA - SMARTI
manag
FOF
FOF
1
17-7236LPD
72WX36D BOW SHAPED
er
203
� $
B
ILEFT PEDESTAL DESK -
Manag
ler
�
SMARTI
__
LST LST 1 92D13 'Exec High Back, Drb Arms 203i $
& Poylmer Resin Base, Manag
Mid -pivot Tilt er
F La -Z -Boy Fabric Price Grad...
(4) (La -Z -Boy) Alto
F496486 Deep Navy
— No Selection
042 Black
_
OFS OFS 1 CB -R _ 22" VENEER CYLINDER— 203 —~ �$
BASE CONF RM Manag
er
MATTE
MNM NATURAL MAPLE ON MAP...
X NO WIRE ACCESS DOOR
OFS OFS 1 CT -42-4G 42" RND 1-3116" STRAIGHT 203 $
GRAIN TABLE TOPS CONF Manag
RM er
1 MATTE
MNM NATURAL MAPLE ON MAP...
T EDGE PROFILE T
X NO POWER GROMMET
OFS
OST
4
23737
22WX22DX32H GUEST,
203
$
BRIO
Manag
NMM
NATURAL MAPLE
er
6
GRADE 6 FABRIC
ETC6
OTHER GRADE 6 TEXTILES
ARC COM... #AC
-67773 SEAFOAM #4
FOF
FOF
2 11-66BC
36WX14DX66H
BOOKCASE
203
$
-
OUESTI
Manag
MNM
er
AL MAPLE ON MAP...
al-� --�' 203
FOF FOF
1
D LEFT PEDESTAL 208
...
$
N - SMARTI Office
L MAPLE ON MAP...
CURVED
9 of ZZ
$
SEBASTIAN AIRPORT 10 of 22
item Mf Cat I Qtv
61
Part Number Part Descri tion Alias 1
Sell_ Ext Sell
FOF FOF 1
17-663ORPD 66WX30D RIGHT PEDESTAL 208
$ $
DESK - SMARTI Office
MNM NATURAL MAPLE ON MAP...
T REED
D BLACK CURVED
62 HAW HAE ._ 1.__.
_
M231-1842 MB-____.._.... _ .___._....___-...._....__..... 208 _..__..._$.._....
H.E.,PNEU,HA,TASK,W/FAB Office
HARD CASTERS
() STANDARD VERSION
,1R- iCHR FAB - SQUARZ GRAD...
002 HOPSCOTCH
,TR- SURFACE 2
OOF BLACK
63 OFS OST
BRIO Office
INMM NATURAL MAPLE
6 GRADE 6 FABRIC
�ETC6 OTHER GRADE 6 TEXTILES
ARC COM ...;#AC -67773 SEAFOAM #4
sub
—Su—btota—I --______._
_H
64 HAW HAF 2
_
— JFWA-42 X 209
$ $
SERIES,CONTERWEIGHT,4I-
File
I" FILE
1�5�i:i_AWHAF 2
JLPD-0542- IX SERIES,LF,5X42,PTD FRT 209
$
�S1 i File
$
� 3
(Si) (PTD FRT,ELLIPSE PULL
,TR- SURFACE 1
OAA PUTTY
,TR- SURFACE 2
OAA PUTTY
,LR- LOCK PLUG & RING COLO...
OBL JBLACK
66 HAW HAJ 1
LSET-3 STANDARD LOCK PLUG & 209
$ $
KEY LOCK SET (QTY 3) File
,LX- LOCK COLOR
OBL BLACK
sub
67
Subtotal _ 209 F...
$
FOF FOF 1
I
17-2248RPR 48WX22D RIGHT PEDESTA 304
$ $
RETURN - SMARTI Staff
MNM NATURAL MAPLE ON MAP...
T REED
D IBLACK CURVED T
SEBASTIAN AIRPORT
68
68
71
73
74
75
sub
76
11 of 22
FOF
FOF
1
17-3855LFC
38WX22DX55H 4 -DRAWER
304
$
JCI_I_-
$
LATERAL FILE - SMARTI
Staff
MNM
NATURAL MAPLE ON MAP...
T
REED
D
BLACK CURVED
FOF
FOF
1
17-663OLPD
66WX30D LEFT PEDESTAL
304
_ $
$-T
DESK - SMARTI
Staff
MNM
NATURAL MAPLE ON MAP...
T
REED
D
BLACK CURVED
FOF
OF
1
17-7543HD
751/8WX15DX42H—
304
$—$
HIGHBACK ORGANIZER -
Staff
SMARTI
MNM
NATURAL MAPLE ON MAP...
IT
REED
I
VO F
FOF
1FT-7318
73WX18H FABRIC
304
TACKBOARD FOR 7543HD
Staff
t6
GRADE 6 FABRIC
�ETC6
IARC COt36WX8D
OTHER GRADE 6 FABRICS
�
C-67773 SEAFOAM #4
1
FOF
FOF
1
FTL-1
TASK LIGHT
30
$ $
StaffHAW
HAE
1
}M231-1842
MB� - - -
304 ---
- -$ �" $' -
H.E.,PNEU,HA,TASK,W/FAB
Staff
j
HARD CASTERS
f
1�)
STANDARD VERSION
I
,113-
CHR FAB - SQUARZ GRAD...
002
HOPSCOTCH
TR-
SURFACE 2
OOF
BLACK
OFS
OST
2
23037
22WX22DX32H GUEST,
304
$
$`
I
BRIO
Staff
NMM
NATURAL MAPLE
i'6
GRADE 6 FABRIC
lETC6
OTHER GRADE 6 TEXTILES
ARC COM ...
#AC -67773 SEAFOAM #4
I
FOF FOF
1
11-666C
i-----
36UUX14DX66H BOOKCASE 304 $
- QUESTI Manag
er
MNM_--- NATURAL MAPLE_ ON MAP...
Subtotal-�-�_ 304 S...I
FOF FOF 1 17-2248BR 48WX22D BRIDGE - SMARTI 305 $
Manag I
er i
SEBASTIAN AIRPORT
77 FOF FOF 1
- 17-7222CRR 72WX22D RIGHT'PEDESTA r3015 s 1
CREDENZA - SMARTIManag
78 FOF 1
17-7236RPD 72WX36D BOW SHAPED 1305 _ !$"
B
LEFT PEDESTAL DESK - JManag�
SMART!
_
79 L§—T- LST
___
— 92113
_ _Jer
Exec High Back, Drb Arms 1305 $
& Poylmer Resin Base, !Manag
Mid -pivot Tilt ;er
F
La -Z -Boy Fabric Price Grad...
(4)
(La -Z -Boy) Alto I
F496486
Deep Navy
No Selection
042
Black
80 OFS OFS 1
CB -R
22" VENEER CYLINDER 305 $
BASE CONF RM Manag
1
er
MATTE l
MNM
NATURAL MAPLE ON MAP...
_ _
81 -1-
- __ X_ ___ .
-- NO WIRE ACCESS DOOR
OFS OF
CT -42-4G
42" RND 1-3116" STRAIGHT- 305
GRAIN TABLE TOPS CONF Manag
RM er
1
MATTE
MNM
NATURAL MAPLE ON MAP...
T
EDGE PROFILE T
X
NO POWER GROMMET
_
82 OFS OST 4
23737 - �-
22WX22DX32H GUEST,- - y 305 1 $_.
BRIO Manag
NMM
er
NATURAL MAPLE
6
GRADE 6 FABRIC
ETC6
OTHER GRADE 6 TEXTILES
ARC COM ...
# AC -67773 SEAFOAM #4
83 FOF FOF 2
11-66BC
36WX14DX66H BOOKCASE 203
�r $�
- QUEST! Manag ;
MNM
er
NATURAL MAPLE ON MAP...
sub
84
__
Subtotal 305...
FOF FOF 1
_ _ _
17-22T848WX22D RIGHT PEDESTA 306
RETURN - SMART! Admin
MNM
NATURAL MAPLE ON MAP... i
T
REED
D
BLACK CURVED
85 FOF FOF 1
17-3855LFC
38WX22DX55H 4 -DRAWER 306 �$
LATERAL FILE SMARTI
- Admin
MNM
NATURAL MAPLE ON MAP...
T
REED
D
BLACK CURVED
12 of 22
a
06
68
L8
98
ZZ Io £ I. 1HOdHIV NVIISVI33S
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$__........_..
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_ 9£-VMd(`
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__..._.
$ 90£ _1H_Jll XSV1 a8XM9£ __ ___L-�1.._.
:10.4 30d
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S0188V.l 9 30V219 N3H10
9013
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9
ulwPV aH£bSL 2lOd a21V08H3V1
90E 3INSVd H8LXMEL
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WNW
!121VWS
u!wpV - 213ZINVE)NO NOVSH01H
$ 90£ HZtiXaSLXM8/LSL aHEtiS1-LL
—
L dOd d03
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1
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WNW
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$
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$ 1 90£ 1V1S3a3d J.:131 a0£XM99 adl0£99-LL
lies L Seud unn „���„ ,.s . .__..._...-_
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06
68
L8
98
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SEBASTIAN AIRPORT
Item T-
gfg Cat Q Part Number Part Description Alias 1
o
94 HAW HAF 2 JLPD-0536- X SERIES,LF,5X36,PTD FRT 306 $
S1 Admin
95
sub
97-
98
sub
99
100
�6 GRADE 6 FABRIC
ETC6 OTHER GRADE 6 TEXTILES
1 _ CONTACT OFS FOR ORD...
CAR C
-��— �
__A _ _ Subtotal
R _...__� ______ _._.._..... 306 A..
2
$
14 of 22
1659-S AMIGO SLEEPER CHAIR 308 $ $
w
j Pilot f
GRADE 4
1(S1)
PTD FRT,ELLIPSE PULL
-WS1--i
,TR-
SURFACE 1
OFS
{0AA
PUTTY
308
1,TR-
SURFACE 2
Pilo
OAA
PUTTY
,LR-
10BP
LOCK PLUG & RING COLO...
308
FOF
FOF
1
17-2248LPR
CHROME (BRIGHT NICKE...
404
AW
HAJ
1
LSET-3
STANDARD LOCK PLUG &
_
306
#
KEY LOCK SET (QTY 3)
Admir
f,LX-
LOCK COLOR
-1—
D
CHROME
FS
OST
1
123037
22WX22DX32H —GUEST—,—'—
306
BRIO
Admin
NMM
NATURAL MAPLE
�6 GRADE 6 FABRIC
ETC6 OTHER GRADE 6 TEXTILES
1 _ CONTACT OFS FOR ORD...
CAR C
-��— �
__A _ _ Subtotal
R _...__� ______ _._.._..... 306 A..
2
$
14 of 22
1659-S AMIGO SLEEPER CHAIR 308 $ $
w
j Pilot f
in
GRADE 4
ARC COM ...
AC -67759
-WS1--i
COLOR
SLATE #10
OFS
C06-24CT
24WX24DX22H ROUND END
308
TABLE CALYPSO
Pilo
MINIM
NATURAL MAPLE
Subtotal
308
FOF
FOF
1
17-2248LPR
48WX22D LEFT PEDESTAL
404
RETURN - SMARTI
Ad
MINIM
NATURAL MAPLE ON MAP...
T
REED
D
BLACK CURVED
FOF
FOF
1
17-663ORPD
66WX30D RIGHT PEDESTAL404
DESK-SMARTI
Adm
MINIM
NATURAL MAPLE ON MAP...
T
REED
D
BLACK CURVED
in
SEBASTIAN AIRPORT
15 of 22
Item
Mf
Cat
I Qty
10art Number
Part Description
Alias 1
Sell Ext Sell._
$ $
101
HAW
HAE
1
M231-1842
MB
404
H.E.,PNEU,HA,TASK,WIFAB
Admin
HARD CASTERS
O
STANDARD VERSION
JR-
CHR FAB - SQUARZ GRAD...
002
HOPSCOTCH
,TR-
SURFACE 2
SOOF
BLACK
102
OFS
OST
-2
23037
22WX225X32H GUEST,
404
.$ $
BRIO
Admin
1
NMM
NATURAL MAPLE
6
GRADE 6 FABRIC
ETC6
OTHER GRADE 6 TEXTILES
�
Skipped Option
sub
Subtotal
72WX22D RIGHT PEDESTAL305
4_04A...
--
�$
103
FOF
FOF
_
1 _
___
17-7222CRR
CREDENZA - SMARTI
Manag
48WX22D BRIDGE -SMART!
er
406
104
FOF
FOF
__
1
17-22486R
Manag
er
MNM
NATURAL MAPLE ON MAP.,.
T
REED
D
BLACK CURVED
105
FOF
FOF
1
17- 7236RPD
72WX36D BOW SHAPED _
406
$' $
B
RIGHT PEDESTAL DESK -
Manag
SMARTI
er
MNM
NATURAL MAPLE ON MAP...
T
REED
D
BLACK CURVED
$ $
106
LST
LST
1
921313
Exec High Back, Drb Arms
406
& Poylmer Resin Base,
Manag
Mid -pivot Tilt
er
F
La -Z -Boy Fabric Price Grad...
(4)
(La -Z -Boy) Alto
F496486
Deep Navy
No Selection
042
Black
107
OFS
OFS
1
CB -R
22" VENEER CYLINDER
406
BASE CONF RM
Manag
er
1
MATTE
s
MNM
NATURAL MAPLE ON MAP...
X INO
WIRE ACCESS DOOR
■
SEBASTIAN AIRPORT
16 of 22
Item
--Mfl
Cat
Q
Part Numbee
Part Description
Alias 1
Sell
Ext Sell
108
OFS
OFS
1 !CT -42-4G
42" RND 1-3116" STRAIGHT
406
$ $
i
GRAIN TABLE TOPS CONF
Manag
RM
er
!
1
MATTE
!!
i
MNM
NATURAL MAPLE ON MAP...
1T
EDGE PROFILE T
__
OFS
OST
_ X _
4. _ 23737
NO POWER GROMMET_
22WX22DX32H GUEST, T�
_
____
109
BRIO
Manag
j
er
NMM
NATURAL MAPLE
6
GRADE 6 FABRIC
�ETC6
OTHER GRADE 6 TEXTILES
1
CONTACT OFS FOR ORD...
110
FOF
FOF
2'11-66BC
i
36WX14DX66H BOOKCASE'406$
- QUESTI
Manag
{
EMNM
er
NATURAL MAPLE ON N MAP...
sub
Subtotal
406...
111
FOF
FOF
1 E17-2248LPR
48WX22D LEFT PEDESTAL
407
$ �$
RETURN - SMARTI
Staff
MNM
NATURAL MAPLE ON MAP...
T
REED
D
BLACK CURVED
112
__
FOF -
FOF
_ __ __
1 17-6630RPD
66WX30DuRIGHT PEDESTA
407 _^�
DESK - SMARTI
Staff
(MNM
NATURAL MAPLE ON MAP...
IT
REED
D
BLACK CURVED
113
FOF
FOF
1 17-7543HD
i
751/8WX15DX42H
HIGHBACK ORGANIZER -
407
Staff
SMARTI
MNM
NATURAL MAPLE ON MAP...
T
REED
$ $
114
FOF
FOF
1
FT -7318
73WX18H FABRIC
407 1
TACKBOARD FOR 7543HD
Staff
6
GRADE 6 FABRIC
ETC6
OTHER GRADE 6 FABRICS
!
1
1
CALL OFS FOR
115
FOF�
FOF
7L-1
_O_R_D_ERIN...
36WX8D TASK LIGHT _____
_
407 _
Staff
SEBASTIAN AIRPORT
17 of 22
Item
--Mfg
Cat I Qtv Part Numbe
. Part -Description Alias 1
Sell
Ext Sell -
116
HAW
HAE 1 M231-1842
IMB 407
$
$
H.E.,PNEU,HA,TASK,W/FAB Staff
C
HARD CASTERS
()
STANDARD VERSION
JR-
CHR FAB - SQUARZ GRAD...
002
HOPSCOTCH
,TR-
ISURFACE 2
OOF
BLACK
117
OFS
OST 2� 23037
22WX22DX32H GUEST,l� 407
BRIO Staff
NMM
NATURAL MAPLE
6
GRADE 6 FABRIC
ETC6
OTHER GRADE 6 TEXTILES
1
CONTACT OFS FOR ORD...
j
sub
118
FOF
FOF
1
Subtotal___^_
17-2248LPR 48WX22D LEFT PEDESTAL
407 S...
Toy–
$' -4—$$_
'
$$
RETURN - SMARTI
Staff
MNM NATURAL MAPLE ON MAP...
4
T REED
_ __
D BLACK CURVED_
}38WX22DX55H
,
119
FOF
FOF
1
17-3855LFC
4 -DRAWER
408
LATERAL FILE - SMARTI
Staff
MNM
NATURAL MAPLE ON MAP...
T
REED
D
BLACK CURVED
120
FOF
FOF
1
17-663ORPD
66WX30D RIGHT PEDESTA
408
$
$
DESK -SMART!
Staff
MNM
NATURAL MAPLE ON MAP...
T
REED
D
BLACK CURVED
$ y
$
121
FOF
FOF
1
17 -7543RD
751/8WX15DX42H —.
_408—+
HIGHBACK ORGANIZER -
Staff
SMARTI
i
MNM
NATURAL MAPLE ON MAP...
T _
REED
_
j
122
FO
FOF
1
FT -7318
73WX18H FABRIC
408
$
TACKBOARD FOR 7543HD
Staff
6
GRADE 6 FABRIC
ETC6
OTHER GRADE 6 FABRICS
1
CALL OFS FOR ORDERIN... ,
!
123FOF
FOF
1
TL -1 36WX8D
TASK LIGHT
408
$
Staff
i
SEBASTIAN AIRPORT
18 of 22
Item
Mf
Cat
Q
Part Number
Part Descri tion
Alias 1 Sell
Ext Sell
124
HAW
HAE
1 1
M231-1842
MB
408 $
$
H.E.,PNEU,HA,TASK,W/FAB
Staff
II
HARD CASTERS
()
STANDARD VERSION
1R-
CHR FAB - SQUARZ GRAD...
++
002
HOPSCOTCH
I
,TR-
SURFACE 2
OOF
BLACK
I
408 --r-^$
$
125
OFS
OST
2
23037
_
22WX22DX32H_ GUEST,
BRIO
Staff
j
NMM
NATURAL MAPLE
!j
6
GRADE 6 FABRIC
f
ETC6
OTHER GRADE 6 TEXTILES
CONTACT OFS FOR ORD...
I
sub
FOF
FOF
__--
1
--_ ______.
17-2248RPR
biota___ ___ --.1
Subtotal ._..__---.--.----.-___-...._J409
48WX22D
-
408 S..
'
.__.__..._...
126
RIGHT PEDESTA
RETURN - SMARTI
Staff
MNM
NATURAL MAPLE ON MAP...
T
REED
I
D
BLACK CURVED
$
127
FOF
FOF
1 _
17-3855LFC
_
38WX22DX55H 4 -DRAWER
409
LATERAL FILE - SMARTI
Staff
i
MNM
NATURAL MAPLE ON MAP...
I
T
REED
ID
BLACK CURVED
128
FOF
FOF
1
17-6630LPD
66WX30D LEFT PEDESTAL
DESK - SMARTI
Staff
I
MNM
NATURAL MAPLE ON MAP...
i
T
REED
D
BLACK CURVED
$ $
129
FOF
FOF €
1
17-7543HD
751/8WX15DX42H
409
HIGHBACK ORGANIZER -
Staff
SMARTI
MNM
NATURAL MAPLE ON MAP...
T
REED
"L
130
FOF
_
FOF
1
FT -7318
73WX18H FABRIC
409 {
$ $�
TACKBOARD FOR 7543HD
Staff j
6
GRADE 6 FABRIC
ETC6
OTHER GRADE 6 FABRICS
1
CALL OFS FOR ORDERIN...
131
FOF
_
FOF
1
TL -1
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t
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SEBASTIAN AIRPORT
20 of 22
Item
-Mf-q-Cat
I Oty
Part Number
Part Description
Alias 1
Self _ _ E)
$ v $
140
HAW
HAE
1
M231-1842
MB
410
H.E.,PNEU,HA,TASK,W/FAB
Staff
HARD CASTERS
()
STANDARD VERSION
,1R-
CHR FAB - SQUARZ GRAD...
002
HOPSCOTCH
,TR-
SURFACE 2
OOF
BLACK
141
OFS
OST
2
23037
_
22WX22DX32H GUEST, T
410
BRIO
Staff
NMM
NATURAL MAPLE
6
GRADE 6 FABRIC
ETC6
OTHER GRADE 6 TEXTILES
1
CONTACT OFS FOR ORD...
sub
Subtotal
410S...
�--''�
_-$--
142
HAW
HAF
3
JFWA-42
X
411
$
$
SERIES,CONTERWEIGHT,4
Storag
"_FILE
e
$
143
HAW
H—AF
3
_
JLPD_-0442_-
X SERIES,LF,4X42,PTD FRT
411
S2
Storag
e
(S2)
PTD FRT,RADIUS PULL
,TR-
SURFACE 1
OAA
PUTTY
,TR-
SURFACE 2
OMC
METALLIC CHAMPAGNE
,LR-
LOCK PLUG & RING COLO...
_
OBP
CHROME (BRIGHT NICKE...
sub
_
_ _
—
Subtotal
411 S...t
$
144
NAW
HA F
1
JSPY-0542-
X SERIES,STORAGE
411
S1
CABINET,5X42
Storag
(S1)
PTD DRW,ELL PULL
,TR-
SURFACE 1
OAA
PUTTY
,TR-
SURFACE 2
OAA
PUTTY
,LR-
LOCK PLUG & RING COLO...
OBP
CHROME (BRIGHT NICKE...
145
HAW
HAJ
1
LSET-6
STANDARD LOCK PLUG &
411 j
$ ,
$
KEY LOCK SET (QTY 6)
Storag
,LX-
LOCK COLOR
OBPCHROME
sub
Subtotal _____.-^
411
t Sell
SEBASTIAN AIRPORT
21 of 22
Item
-.-Mfg
Cat
Oty
Part Number
Part Description
Alias 11
SellEx+ Rall
$ $
146
HAW
HAE
6
M231-1842
MB
502
H.E.,PNEU,HA,TASK,W/FAB
Intern
HARD CASTERS
()
STANDARD VERSION
I
,1 R-jjCHR
FAB - SQUARZ GRAD...:
002
jHOPSCOTCH
,TR-
2
OOF
!!!SURFACE
!BLACK
$' $
147
HAW
HAK
6
45TC-3060-
450 TABLE, RECTANGLE,1
X502
4FO
BASE 30" X 60"
Intern
(C4FO)
FLAT WD,29"H,FOLD,GLD
i
(2)
LAMINATE TOP
i
,OH-
LAMINATE
OAE
MAPLE
,KP-
MAPLE (KINETICS)
OMA
MAPLE
(2)
;TRIM BASE
,TR-
BASE
OAA
PUTTY
sub
Subtotal
5021...
$
148
HAW
HAK
_
4 ~
4TLC-3672- TABLE,4
Confer
W4SOOGO LEG,RECTANGULAR 36"D
fence
X 72"W
(W4SOOGO) WD EDG,29"H,STAT,GNG
(2) iLAMINATE SURFACE 1
,OH- ILAMINATE
OAE MAPLE
,KP- MAPLE (KINETICS)
OMA MAPLE
,TR- SURFACE 2
OAA PUTTY
149
HAW
HAK
4
4TLH-3672- TABLE,4 LEG,D
HALF.
C
$"�
$ -
W4SOOGO 36"D X 72"W
ence
(W4SOOGO) WD EDG,29"H,STAT,GNG
(2) LAMINATE SURFACE 1
,OH- LAMINATE j
OAE MAPLE
,KP- MAPLE (KINETICS)
OMA MAPLE
,TR- SURFACE 2
OAA iPUTTY
"$�
$
150
HAW
HAE
24
M231-1441
__
.E
MB H.,PNEU,HA,TARM
iW/O
CAP,HARD
CASTERS,BACK LOCK
(
)
STANDARD VERSION
,1R-
CHR FAB - SQUARZ GRAD...
002
HOPSCOTCH
,TR-
SURFACE 2 I
OOF IBLACK
i
SEBASTIAN AIRPORT
22 of 22
Item
Mf
Cat
I Qtv
Part Number
Part Description
Alias 1
Sell Ext Sell
sub__
Subtotal _
1% FUEL CHARGE —
Conf...
$
$ $
151
CAR
CAR
1 _
FUEL —
SURCHARG
E
$
152
FOF
FOF
—i --'FUEL
1 % FUEL CHARGE--�
'—$
SURCHARG
E
$ $
158
OFS
UFS
--i—
FUEL
1% FUEL CHARGE
SURCHARG
FBI
FBI
1
E
__ ___ _..._...__....___
LABOR
_._._.._..___..___._..__._..___. _.____.
INSTALLATION
_......_..._.._......_...___
154
Grand Total
$
DRUG-FREE WORKPLACE FORM
The undersigned Contractor, in accordance with Florida Statute 287.087 hereby certifies
that
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' policy
of maintaining a drug free workplace, any available drug counseling, rehabilitation,
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 Paragraph 1.
4. In the statement specified in Paragraph 1, notify the employees that, as a condition of
working on the commodities or contractual services that the employee will abide by the
terms of the statement and will notify the employer of any conviction of, or plea of guilty
or nolo contendere to any violation of Chapter 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 Paragraph 1 through 5.
As the person authorized to sign this statement, I certify that this firm complies fully
with the above requirements.
Date:
Signature
PUBLIC ENTITY CRIMES FORM
Any person submitting a quote, bid, or proposal in response to this invitation or
Agreement, must execute the enclosed form sworn statement under section 287.133(3)(a),
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES, including proper check(s), in the
space(s) provided, and enclose it with his quote, bid, or proposal. If you are submitting a quote,
bid or proposal on behalf of dealers or suppliers who will ship commodities and receive payment
from the resulting Agreement, it is your responsibility to see that copy(ies) of the form are
executed by them and are included with your quote, bid, or proposal. Corrections to the form
will not be allowed after the quote, bid, or proposal opening time and date. Failure to complete
this form in every detail and submit it with your quote, bid, or proposal may result in immediate
disqualification of your bid or proposal.
The 1989 Florida Legislature passed Senate Bill 458 creating Sections 287.132 - 133,
Florida Statutes, effective July 1, 1989. Section 287.132(3)(d), Florida Statutes, requires the
Florida Department of General Services to maintain and make available to other political entities
a "convicted vendor" list consisting of persons and affiliates who are disqualified from public
and purchasing process because they have been found guilty of a public entity crime. A public
entity crime is described by Section 287.133, Florida Statutes, as a violation of any State or
Federal law by a person with respect to and directly related to the transaction of business with
any public entity in Florida or with an agency or political subdivision of any other state or with
the United States, including, but not limited to, any bid or Agreement for goods or services to be
provided to any public entity or with an agency or political subdivision and involving antitrust,
fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.
By law no public entity shall accept any bid from, award any Agreement to, or transact
any business in excess of the threshold amount provided in Section 287.017, Florida Statutes, for
category two (currently $10,000) with any person or affiliate on the convicted vendor list for a
period of 36 months from the date that person or affiliate was placed on the convicted vendor list
unless that person or affiliate has been removed from the list pursuant to Section 287.133(3)(f),
Florida Statutes.
Therefore, effective October 1, 1990, prior to entering into an Agreement (formal
Agreement or purchase order) in excess of the threshold amount for category two, to provide
goods or services to THE CITY OF SEBASTIAN, a person shall file a sworn statement with
the Contract/Agreement officer or Purchasing Director, as applicable. The attached statement or
affidavit will be the form to be utilized and must be properly signed in the presence of a notary
public or other officer authorized to administer oaths and properly executed.
THE INCLUSION OF THE SWORN STATEMENT OR AFFIDAVIT SHALL BE
SUBMITTED CONCURRENTLY WITH YOUR QUOTE OR BID DOCUMENTS. NON-
INCLUSION OF THIS DOCUMENT MAY NECESSITATE REJECTION OF YOUR
QUOTE OR BID.
SWORN STATEMENT UNDER SECTION 287.133(3)(a),
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR
OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS.
2.
This sworn statement is submitted with Bid, Proposal or Agreement No.
for THE CITY OF SEBASTIAN.
This sworn statement is submitted by
(name of
sworn statement) whose business
its Federal Employer Identification (FEIN) is
no FEIN, include the Social Security Number of the
statement:
individual
entity submitting
address is
and (if applicable)
_ (If the entity has
signing this sworn
3. My name is (please print name of
individual signing) and my relationship to the entity named above is
4. I understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida
Statutes, means a violation of any state or federal law by a person with respect to and
directly related to the transaction of business with any public entity or with an agency or
political subdivision of any other state or with the United States, including, but not
limited to, any bid or Agreement for goods or services to be provided to any public entity
or an agency or political subdivision of any other state or of the United States and
involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material
misrepresentation.
5. I understand that "convicted" or "conviction" as defined in Paragraph 287.133(1)(b),
Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or
without an adjudication of guilt, in any federal or state trial court of record relating to
charges brought by indictment or information after July 1, 1989, as a result of a jury
verdict, nonjury trial, or entry of a plea of guilty or nolo contendere.
6. I understand that an "affiliate" as defined in Paragraph 287.133(1)(a), Florida Statutes,
means:
(1) A predecessor or successor of a person convicted of a public entity crime; or
(2) An entity under the control of any natural person who is active in the
management of the entity and who has been convicted of a public entity crime. The term
"affiliate" includes those officers, directors, executives, partners, shareholders,
employees, members, and agents who are active in the management of an affiliate. The
ownership by one person of shares constituting a controlling interest in another person, or
a pooling of equipment or income among persons when not for fair market value under
an arm's length agreement, shall be a prima facie case that one person controls another
person. A person who knowingly enters into a joint venture with a person who has been
convicted of a public entity crime in Florida during the preceding 36 months shall be
considered an affiliate.
7. I understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statutes,
means any natural person or entity organized under the laws of any state or of the United
States with the legal power to enter into a binding Agreement and which bids or applies
to bid on Agreements for the provision of goods or services let by a public entity, or
which otherwise transacts or applies to transact business with a public entity. The term
"person" includes those officers, directors, executives, partners, shareholders, employees,
members, and agents who are active in management of an entity.
8. Based on information and belief, the statement which I have marked below is true in
relation to the entity submitting this sworn statement. (Please indicate which statement
applies.)
Neither the entity submitting this sworn statement, nor any officers, directors,
executives, partners, shareholders, employees, members, or agents who are active in
management of the entity, nor any affiliate of the entity have been charged with and
convicted of a public entity crime subsequent to July 1, 1989.
The entity submitting this sworn statement, or one or more of the officers,
directors, executives, partners, shareholders, employees, members or agents who are
active in management of the entity, or an affiliate of the entity has been charged with and
convicted of a public entity crime subsequent to July 1, 1989, AND (Please indicate
which additional statement applies.)
There has been a proceeding concerning the conviction before a hearing officer of
the State of Florida, Division of Administrative Hearings. The final order entered by the
hearing officer did not place the person or affiliate on the convicted vendor list. (Please
attach a copy of the final order.)
The person or affiliate was placed on the convicted vendor list.
There has been a subsequent proceeding before a hearing officer of the State of Florida,
Division of Administrative Hearings.
The final order entered by the hearing officer determined that it was in the public interest to
remove the person or affiliate from the convicted vendor list. (Please attach a copy of the final
order.)
The person or affiliate has not been placed on the convicted vendor list. (Please
describe any action taken by or pending with the Department of General Services.)
Date:
STATE OF FLORIDA
COUNTY OF
(Signature)
The foregoing instrument was acknowledged before me this day of ,
2004 by
behalf of
known to me or has produced
take an oath.
, (title) on
(name of partnership), a partnership. He/she is personally
as identification and did ( ) did not ( )
Name:
My Commission Expires:
Commission Number: