REQUEST FOR STATEMENTS OF QUALIFICATIONS FLORIDA DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES DIVISION OF ANIMAL INDUSTRY

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1 I. PURPOSE REQUEST FOR STATEMENTS OF QUALIFICATIONS FLORIDA DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES DIVISION OF ANIMAL INDUSTRY SPECIAL TERMS, CONDITIONS AND SPECIFICATIONS The Florida Department of Agriculture and Consumer Services (FDACS or Department) seeks to obtain the professional services of licensed general contractors who wish to compete for construction management (CM) at risk services (i.e., the Negotiated Fee-Guaranteed Maximum Price Construction Contracting Method, as defined by Rule 60D-5.002(12) Florida Administrative Code) on the following project: Bronson Animal Diagnostic Disease Laboratory Expansion 2700 John Young Pkwy, Kissimmee, Florida II. SCOPE OF PROJECT The selected CM firm will work with the design firm Reynolds, Smith and Hills, Inc., Deerwood Park Boulevard, South Jacksonville, Florida The initial study includes an 18,768 sf new office/lab facility to be built on the forested site adjacent to the existing laboratory complex. Included are new utilities and parking, new storm water provisions, new covered walkways, possible phased design for future expansion to the west, emergency vehicle storage, laboratory designs compatible with BSL-2 guidelines. The laboratory includes Virology, Bacteriology, Serology, Histology, IHC, Clinical Pathology and lab equipment. ESTIMATED CONSTRUCTION BUDGET: Current funding is approximately $7.35 million with additional funding expected but contingent upon future appropriation by the Legislature. Construction costs are expected to be approximately $7.5 million. III. SERVICES TO BE PROVIDED A. Design Phase: The CM shall be paid a fixed fee for pre-construction services to include critical assessment of design and recommendation; value engineering; market/constructability analysis; preliminary schedules; cost estimates for each item or proposal package at completion of design development stage and at 100% construction documents stage and development of a guaranteed maximum price (GMP). B. Construction Phase: If a GMP is agreed on, the CM shall fully and satisfactorily manage the project to completion. The CM is responsible to provide appropriate staff and oversight, bonding, quality controls, permitting, advertising and competitively bid trade contracts in accordance with Florida Administrative Code 60D-5. Failure to negotiate a fixed fee for the design phase services, or to arrive at an acceptable GMP within the time provided in the agreement, may result in the termination of the construction manager's contract. The selected CM shall demonstrate that they can bring multiple qualified and competitive subcontractors to all related construction trades for successful project delivery. The CM must be capable of supplying workers that meet Florida Department of Law Enforcement criminal history background checks. 1

2 IV. GENERAL INFORMATION - TERMS AND CONDITIONS A. Calendar of Events Listed below are the important actions and dates/times by which the actions must be taken or completed. If the Department finds it necessary to change any of these fixed dates/times, an addendum will be issued. DATE/TIME September 14, 2016 September 23, 2016 September 28, 2016 October 13, 2:00 p.m. October 24, 2016 (on or about) October 28, 2016 (on or about) November 2, 2016 (on or about) November 7, 2016 (on or about) ACTIVITY SOQ advertised on the Vendor Bid System and advertised in the Florida Administrative Weekly. Written questions due to Department's purchasing director by 3:00 p.m. Questions can be faxed to (850) , or ed to Christie.Hutchinson@FreshFromFlorida.com. No questions shall be received/answered after this date. The Department's written response to any questions reviewed shall be posted as an addendum. Proposals must be received by the Department. Proposals shall be opened at the Department's purchasing office, SB-8, Mayo Building, 407 South Calhoun Street, Tallahassee, Florida, Oral presentations from selected firms will be conducted in person at the Department s purchasing office, 407 S. Calhoun Street, SB-8 Mayo Building, Tallahassee, Florida Final selection results posted on the Vendor Bid System at click on Business, Doing Business with the State of Florida, Everything for Vendors and Customers, Vendor Bid System, Search Advertisements. Tabulations will remain posted for a period of seventy-two (72) hours. Failure to file a protest within the time prescribed in Section (3), Florida Statutes, shall constitute a waiver of proceedings under Chapter 120, Florida Statutes. Failure to file the proper bond at the time of filing the formal protest will result in denial of the protest. Negotiations with selected firm begins. Expected date that contract will officially begin. 2

3 B. Contact Persons If additional information is required, please contact: Christie Hutchinson Florida Department of Agriculture and Consumer Services - Purchasing Office 407 South Calhoun Street, SB-8 Mayo Building Tallahassee, Florida Telephone: (850) Christie.Hutchinson@FreshFromFlorida.com C. Number of Copies Required One (1) original and five (5) copies of the SOQ proposal must be completed and submitted to the purchasing office in accordance with the proposal deadlines stated herein. The original must contain an original signature of an official of the potential service provider who is authorized to bind the service provider to the proposal (in blue ink). D. How to Submit a Proposal Proposals must be submitted in a sealed envelope to the address listed on the proposal form by the time and date listed on the form. In addition to the address, the face of the envelope shall be marked with the date and time of the proposal opening and the proposal number. NOTE: Proposals received by the Department after the proposal opening time and date shall be rejected as untimely and shall not be opened. A late proposal notice shall be sent to the proposing firm upon posting of award notice with instructions for its return. Unclaimed late proposals shall be destroyed after forty-five (45) days. Offers from contractors listed on the Department's posted award notice are the only offers received in accordance with the Department's proposal opening time and date. E. Cost of Preparation The Department is not liable for any costs incurred by a proposer in response to this SOQ, including any oral presentations. F. Standard Solicitation Terms and Conditions INDEPENDENT CAPACITY OF CONTRACTOR The contractor, its officers, agents and employees, in performance of this contract, shall act in the capacity of an independent contractor and not as an officer, employee or agent of the state. PUBLIC ENTITY CRIMES 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 proposal on a contract to provide any goods or services to a public entity; may not submit a proposal on a contract with a public entity for the construction or repair of a public building or public work; may not submit proposals 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 3

4 Section , Florida Statutes, for category two, for a period of 36 months from the date of being placed on the convicted vendor list. AUDITING DUTIES The contractor will comply with section , Florida Statutes. EMPLOYMENT OF UNAUTHORIZED ALIENS Pursuant to Executive Order , effective October 1, 1996, the following standard provision shall apply to any contract awarded as a result of this ITB: The employment of unauthorized aliens by any contractor is considered a violation of section 274A(e) of the Immigration and Nationality Act. If the contractor knowingly employs unauthorized aliens, such violation shall be cause for unilateral cancellation of the contract. DISCRIMINATION An entity or affiliate, who has been placed on the discriminatory vendor list, may not submit a proposal on a contract to provide goods or services to a public entity; may not submit a proposal on a contract with a public entity for the construction or repair of a public building or public work; may not submit proposals on leases of real property to a public entity; may not award or perform work as a contractor, supplier, subcontractor or consultant under contract with any public entity and may not transact any business with any public entity. ANNUAL APPROPRIATIONS The state of Florida's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Legislature DISQUALIFICATION OF RESPONDENTS More than one proposal from an individual, firm, partnership, corporation or association, under the same or different names, will not be considered. Reasonable grounds for believing that a respondent is interested in more than one proposal for the same work will cause the rejection of all proposals in which such respondents are believed to be interested. If there is reason to believe that collusion exists among the respondents, any or all proposals will be rejected. No participants in such collusion will be considered in future proposals for the same work. Falsifications of any entry made on the respondent s offer will be deemed a material irregularity and will be grounds for rejection. REJECTION OF RESPONSES The Department reserves the right to reject any and all proposals, when such rejection is in the interest of the state of Florida, and to reject the proposal of a respondent who the Department determines is not in a position to perform the contract. LATE RESPONSES Proposals received by the Department after the opening time and date will be rejected as untimely and will not be opened. A late proposal notice will be sent to the respondent upon the posting of award notice with instructions for its return. Unclaimed late proposals will be 4

5 destroyed after 45 days. Offers from vendors listed on the Department's posted award notice are the only offers received timely in accordance with the Department's opening time and date. POSTING OF SOLICITATION TABULATIONS Tabulations with recommended award(s) will be posted for review by interested parties on the Florida Bid System located at click on Business, Doing Business with the State of Florida, Everything for Vendors and Customers, Vendor Bid System, Search Advertisements. Tabulations will remain posted for a period of seventy two (72) hours. Failure to file a protest within the time prescribed in Section (3), Florida Statutes, shall constitute a waiver of proceedings under Chapter 120, Florida Statutes. Failure to file the proper bond at the time of filing the formal protest will result in denial of the protest. V. STANDARD QUALIFYING DATA AND FORMS REQUIRED In order to be considered responsive, and on or before the response due date listed below, firms interested in being considered for this project must submit their response with a table of contents and tabbed sections in the following order: A, A brief letter of interest detailing the firm's qualifications to meet the above referenced criteria (include firm name, address, contact person, telephone number and address). B. APPENDIX I, CM01 EXPERIENCE QUESTIONNAIRE AND CONTRACTOR S FINANCIAL INFORMATION, shall be completed and submitted in order for respondents to be deemed responsive. This form may be obtained from anagement/building_construction/forms_and_documents. Responses that are incomplete will be rejected as non-responsive and will not be evaluated by the Department. Failure to submit any of the listed requirements shall result in rejection of that response. The project listed herein shall be administered directly by FDACS. C. Project listing of relevant experience (including name of client, architect and phone number). D. Resumes of proposed staff and staff organizations, for both pre-construction and construction phases. E. Contractors License: A reproduction of the firm s current contractor(s) license is required for the services offered and shall be in the name of the firm offering said services. Firms must be properly registered at the time of application to practice their profession in the state of Florida and with the appropriate state board governing the services offered. A verification of the current status with the appropriate state board is made before the recommendation and approval of a firm s selection is finalized. F. Corporate Registration: If the firm offering services is a corporation, it must be properly registered with the Department of State to operate in Florida and provide a copy of the firm s current Florida corporate registration. G. Description of effective project management systems utilized to successfully complete relevant projects. 5

6 H. APPENDIX II, DRUG-FREE WORKPLACE REQUIREMENTS. Preference shall be given to proposals certifying a drug-free workplace has been implemented in accordance with Section , Florida Statutes. Whenever two or more equal proposals are received by the state or by any political subdivision for the procurement of commodities or contractual services, the proposal received from a business that certifies it has implemented a drug-free workplace program shall be given preference in the award process. Established procedures for processing tie proposals will be followed if none of the tied vendors have a drug-free workplace program (APPENDIX II, DRUG-FREE WORKPLACE PROGRAM - BIDDER CERTIFICATION). If applicable, please sign and return with your response. I. APPENDIX III, CERTIFICATION REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS FOR EXPENDITURE OF FEDERAL FUNDS. Any person submitting a response to this proposal MUST execute the enclosed form FDACS-01522, CERTIFICATION REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS FOR EXPENDITURE OF FEDERAL FUNDS, and enclose it with his/her bid or proposal (APPENDIX III, CERTIFICATION REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS FOR EXPENDITURE OF FEDERAL FUNDS). The Certification for Lobbying is required by 7 CFR Part 3018 for expenditures $100,000 and above. The Certification for Debarment and Suspension and Other Responsibility Matters is required by 7 CFR Part 3017 for expenditures $25,000 and above. V. SELECTION PROCEDURES A. A selection committee appointed by the Commissioner of the Florida Department of Agriculture and Consumer Services or designee will review each application in depth and rate the applicants. B. Preliminary Screening 1. Proposed Office Distance to Site (10 points) 2. Financial Capability to Project Scope (5 points) 3. Relevant Project Type Experience (20 points) 4. Proposed Preconstruction Phase Staff (15 points) 5. Proposed Construction Phase Staff (15 Points) 6. Project Management Systems Utilization (10 points) 7. Location: The proximity (highway distance) of the applicant (applicants with multiple offices shall list the office where the work will be performed) in relation to the project will be rated. The Selection Committee shall use the following rating table: Miles From Project Rating

7 The selection committee may adjust the scores indicated by the table above based on additional written commitments by an applicant to place personnel on site or in close proximity to the site during appropriate portions of the design or construction phases or if a firm makes arrangements with a local professional firm for assistance and support where appropriate. C. The selection committee shall rate/rank firms under consideration based on the above factors. D. Oral Interviews - Oral interviews may be conducted if the selection committee deems necessary. The selection committee may review and assess the previous rating evaluations of each firm and rate each firm additionally in the following categories: (no more than 3 highest ranked firms) 1. References for Relevant Projects: Obtain and explain the significance of three or more client letterhead references for relevant projects. 2. Preconstruction Services: Explain accuracy and extent of probable cost estimates, constructability review and cost containment efforts. 3. Bid Marketplace Effort: Explain the knowledge of local marketplace to obtain competitive bids. 4. Construction Site Mobilization: Define likely site mobilization approach. 5. Construction Phase Scheduling: Project overall construction schedule example. 6. Overall Approach and Method: Explain how the firm s best practices yield successful outcomes. E. Based on the above Oral Interviews, the selection committee will recommend the three firms (minimum) most qualified to accomplish the work, in priority order according to the final totals on the evaluation form. The Department will enter negotiations with the highest ranked firm. VI. DISABILITY ACCESS: Pursuant to the provisions of the Americans with Disabilities Act according to Florida Statutes, any person requiring special accommodations to participate in this meeting is asked to advise the agency at least 48 hours before the meeting by contacting Christie Hutchinson, If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800) (TDD) or 1(800) (Voice). 7

8 APPENDIX I DEPARTMENT OF MANAGEMENT SERVICES DIVISION OF REAL ESTATE DEVELOPMENT AND MANAGEMENT CONTRACTOR EXPERIENCE QUESTIONNAIRE AND FINANCIAL INFORMATION INSTRUCTIONS PAGE The information listed is required to be filed with the Department of Management Services (DMS) prior to award of Competitive Bid or shall be included with Construction Management (CM) at Risk Request for Qualifications (RFQ). The identified Contractor or Bidder is required to complete all Items If the bidder or contractor is a Joint Venture, then each entity that is a party to the Joint Venture must individually complete this Questionnaire. Project Information: Project Number - Use DMS project number as shown in the contract documents or RFQ advertisement Project Name - Use project name as shown in the contract documents or RFQ advertisement Project Location - Use location as indicated in the contract documents or RFQ advertisement 1. Provide contractor corporate name as listed with the Department of State, Division of Corporation Listing on or sunbiz.org 2. Provide requested Business Structure information. 3. Provide Annual Construction Gross Revenue for previous five (5) years. 4. Provide firm s Current Bonding Capacity. 5. Provide Business Name information. 6. List number of full-time personnel within your organization. 7. Provide Subsidiary or Affiliated companies financial involvement information. 8. Identify construction management personnel experience for your organization. 9. Identify your organization or predecessor organizations failure to complete a project contract. 10. Identify if your organization has been involved in litigation. 11. List the most recent ten (10) contracts completed by your organization. 12. Explain the differences in final contract price and/or scheduled completion dates. 13. Identify any liquidated damages, penalties, liens, defaults or cancellations imposed or filed. 14. Provide contract information currently under construction. DIRECTIONS: Items1 through 14 must be fully completed or marked Does Not Apply for any non-pertinent Item(s). For CM at Risk the evaluators which are comprised of up to five (5) committee members will independently score category Financial Capacity to Project Scope listed under preliminary screening based upon information provided in Items 1-14, however, if needed, the Owner reserves the right to request your firm s most recent Financial Statement. If additional space is required, please attach supplementary pages. 8 DMS form CM01 Rev. 7/16

9 DEPARTMENT OF MANAGEMENT SERVICES DIVISION OF REAL ESTATE DEVELOPMENT AND MANAGEMENT CONTRACTOR EXPERIENCE QUESTIONNAIRE AND FINANCIAL INFORMATION (Continued) Project Number: Project Name: Project Location: 1. Firm Name: Firm Address: Contact Name and Telephone Number: Contact Address: The contractor acknowledges that this Contractor Experience Questionnaire and Financial Information are made for the express purpose of inducing the Department of Management Services (DMS) to award a contract to the contractor. Further, the contractor acknowledges that the agency may at its discretion, by means which the Owner may choose, determine the truth and accuracy of all statements made by the contractor herein. If needed, the Owner reserves the right to request your most recent Financial Statement. 2. Business Structure: (List firm names if Partnership or Joint Venture) Proprietorship ( ) Corporation ( ) Joint Venture ( ) Partnership ( ) Please provide copy of State of Florida Corporate Registration: If Corporation answer below: Date of Incorporation: In what State: If Joint Venture or Partnership, answer below: Date of organization: Firms Involved: Name of Corporate Officers: President: Vice President: Secretary: Treasurer: 3. Annual Construction Gross Revenue for Previous Five (5) Years: Year $ Year $ Year $ Year $ Year $ 9 DMS form CM01 Rev. 7/16

10 DEPARTMENT OF MANAGEMENT SERVICES DIVISION OF REAL ESTATE DEVELOPMENT AND MANAGEMENT CONTRACTOR EXPERIENCE QUESTIONNAIRE AND FINANCIAL INFORMATION (Continued) 4. Firm s Current Bonding Capacity: Per Project Limit: Per Aggregate Limit: 5. How many years has your organization been in the construction business? B. How many years under your present business name: C. How many years under previous business name: (List other names): Number of full time personnel within your organization: Current A. Executive Administrators B. Preconstruction Managers and Estimators C. Construction Project Managers D. Field Superintendents and Foremen E. Other Field Construction Employees F. Administrative Assistants G. Total number of full time personnel 7. Subsidiary or affiliated companies which Principal(s) have financial interest and list nature of business: DMS form CM01 Rev. 7/16

11 DEPARTMENT OF MANAGEMENT SERVICES DIVISION OF REAL ESTATE DEVELOPMENT AND MANAGEMENT CONTRACTOR EXPERIENCE QUESTIONNAIRE AND FINANCIAL INFORMATION (Continued) 8. Identify construction management personnel experience for your organization. (Highlight personnel likely to be assigned to project being bid or solicited) Name: Title: Years with firm / years in construction 9. Within previous five (5) fiscal years has your organization or predecessor organizations ever failed to complete a project. If so, state name of organization and reason thereof Within previous five (5) fiscal years has your organization been involved in litigation with your client? If so, please list and explain nature and current status DMS form CM01 Rev. 7/16

12 CONTRACTOR EXPERIENCE QUESTIONNAIRE AND FINANCIAL INFORMATION (Continued) 11. List the most recent ten (10) contracts completed by your organization: Construction Duration Completion Dates Owner of Project Project Name and Location Building Type Name of Design Professional Final Contract Price Commenceme nt Completio n Months a 12 DMS form CM01 Rev. 7/16

13 DEPARTMENT OF MANAGEMENT SERVICES DIVISION OF REAL ESTATE DEVELOPMENT AND MANAGEMENT CONTRACTOR EXPERIENCE QUESTIONNAIRE AND FINANCIAL INFORMATION (Continued) With reference to ten (10) most recently completed contracts, as listed on Page 5, answer the following questions: 12. Explain the differences in final contract price and/or scheduled completion dates. 13. Were there any liquidated damages, penalties, liens, defaults or cancellations imposed or filed? If so, list the name and location of the project and why rejected from bidding? 14. Provide contract information currently under construction as requested below. (Use seven largest dollar value) A B C D E Project Description Location & Owner Design Professional Total Contract Amount Uncomplete d Contract Amount Scheduled Substantial Completion Date Total 13 DMS form CM01 Rev. 7/16

14 APPENDIX II ADAM H. PUTNAM COMMISSIONER Florida Department of Agriculture and Consumer Services Bureau of General Services DRUG-FREE WORKPLACE PROGRAM - BIDDER CERTIFICATION IDENTICAL TIE BIDS - Preference shall be given to businesses with drug- free workplace programs. Whenever two or more bids, which are equal with respect to price, quality, and service are received by the state or by any political subdivision for the procurement of commodities or contractual services, a bid received from a business that certifies that it has implemented a drug-free workplace program shall be given preference in the award process. Established procedures for processing tie bids will be followed if none of the tied vendors have a drug-free workplace program. In order to have a drug-free workplace program, a business shall: 1) Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2) Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3) Give each employee engaged in providing the commodities or contractual services that are under 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, or plea of guilty or nolo contendere to, any violation of chapter 893 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. FDACS /12 VENDOR'S SIGNATURE 14

15 APPENDIX III ADAM H. PUTNAM COMMISSIONER Florida Department of Agriculture and Consumer Services Division of Administration CERTIFICATION REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS FOR EXPENDITURE OF FEDERAL FUNDS LOBBYING As required by 7 CFR Part 3018, for persons entering into a contract, grant or cooperative agreement over $100,000 involving the expenditure of Federal funds, the undersigned certifies for itself and its principals that: (a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the making of any Federal grant, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal grant or cooperative agreement; (b) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress or an employee of a Member of Congress, in connection with this Federal grant or cooperative agreement, the undersigned shall complete and submit Standard Form - LLL, Disclosure Form to Report Lobbying, in accordance with its instructions; and (c) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subgrants, contracts under grants and cooperative agreements, and subcontracts) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. PRINTED NAME/TITLE OF REPRESENTATIVE CONTRACT / PURCHASE ORDER NUMBER SIGNATURE OF REPRESENTATIVE / DATE DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS As required by 7 CFR Part 3017, for persons entering into a contract, grant or cooperative agreement over $25,000 involving the expenditure of Federal funds, the undersigned certifies for itself and its principals that: (a) (b) (c) (d) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; Have not within a three-year period preceding this application been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; Are not presently indicted for or otherwise criminally or civilly charged by a Government entity (Federal, State, or local) with commission of any offenses enumerated in paragraph (b) of this certification; and Have not within a three-year period preceding this application had one or more public transaction (Federal, State, or local) terminated for cause or default; and Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach an explanation to this application. PRINTED NAME/TITLE OF REPRESENTATIVE SIGNATURE OF REPRESENTATIVE / DATE CONTRACT / PURCHASE ORDER NUMBER FDACS /12 15