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City of CharlotteEngineering & Property Management
REQUIRED FORMS
RFP 2018‐335Project Name: Emergency Mitigation Clean Up Services
Page 1
FORM 1 – EXECUTION OF PROPOSAL
The person executing the Proposal, on behalf of the Company, being duly sworn, solemnly swears (or affirms) that neither he, nor any official, agent or employee of the Company has entered into any agreement, participated in any collusion, or otherwise taken any action which is in restraint of full and open competition in connection with any proposal or contract, that the Company has not been convicted of violating North Carolina General Statute 133 24‐ within the last three years, and that the Company intends to do the work with its own bona fide employees or subcontractors and is not proposing for the benefit of another company.
Submission of a response to this RFP constitutes certification that the Company and all proposed team members are not currently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this Project by any State or Federal department or agency. Submission is also agreement that the City will be notified of any change in this status.
NC General Statute 133 32‐ and City Policy prohibit any gift from anyone with a contract with the City, or from any person seeking to do business with the City. By execution of this Proposal, you attest, for your organization and its employees or agents, that you are not aware that any such gift has been offered, accepted, or promised by any employees of your organization.
The information contained in this Proposal, including its forms and other documents, delivered or to be delivered to the City, is true, accurate, and complete. This Proposal includes all information necessary to ensure that the statements therein do not in whole or in part mislead the City as to any material facts.
Type of Company:(check 1 box) Sole Proprietor Partnership Joint Venture
Corporation (identify the State of incorporation)
(if joint venture, complete this “Proposal Submission” sheet for each joint venture company and identify the “Name of Joint Venture” on each sheet)
NAME OF JOINT VENTURE:
City of Charlotte Vendor Number:
ACKNOWLE DG EMENT O F ADDENDA: The undersigned acknowledges receipt of the following addenda:
No: Date: No: Date: No: Date:
Company Legal Name:
Mailing Address:
City/State/Zip:
Phone: Email:
Signature of Authorized Representative (or Designee)
(Print Name)
(Title)
Date
Proposal is valid for one hundre‐ d eighty‐ (180) days from the Proposal due date.
City of CharlotteEngineering & Property Management
REQUIRED FORMS
RFP 2018‐335Project Name: Emergency Mitigation Clean Up Services
Page 2
FORM 2 – SUBCONTRACTOR / SUPPLIER UTILIZATION PARTICIPATION PLAN
Project Name: EMERGENCY MITIGATION CLEAN UP SERVICES
Company Name:
Identify outreach efforts that w e re employed by the firm to maximize inclusion of M/WSBEs to be submitted with the firm’s proposal (attach additional sheets if needed):
Identify outreach efforts that will be emplo y ed by the firm to maximize inclusion during the contract period of the Project (attach additional sheets if needed):
List below all M/W/SBEs that you intend to use on this contract.
Subcontractor Name Description of work / materials
Indicate either“M”, “S”,
and/or “W”
CityVendor #
ProjectedUtilization ($)
Total MBE Utilization %
Total WBE Utilization %
Total SBE Utilization %
Aggregate M/W/SBE Utilization % $
Total Contract Amount $
City of Charlotte REQUIRED FORMS
RFP 2018‐335Project Name: Emergency Mitigation Clean Up Services
Page 3
Engineering & Property Management
FORM 3 – COMMERCIAL N O N ‐ DISCRIMINATION CERTIFICATION
Project Name: EMERGENCY MITIGATION CLEAN UP SERVICESCompany’s Name:
The undersigned Company hereby certifies and agrees that the following information is correct:
1. In preparing its bid/proposal, the Company has considered all bids/proposals submitted from qualified, potential subcontractors and suppliers and has not engaged in discrimination as defined in Section 2 below.
2. For purposes of this certification, discrimination means discrimination in the solicitation, selection, or treatment of any subcontractor, vendor, or supplier on the basis of race, ethnicity, gender, age, religion, national origin, marital status, familial status, sexual orientation, gender identity, gender expression, or disability or any other unlawful form of discrimination. Without limiting the foregoing, discrimination also includes retaliating against any person or other entity for reporting any incident of discrimination.
3. Without limiting any other remedies that the City may have for a false certification, it is understood and agreed that, if this certification is false, such false certification will constitute grounds for the City to reject the bid/proposal submitted with this certification and terminate any contract awarded based on such bid/proposal. It shall also constitute a violation of the City’s Commercial Non Discrim‐ ination Ordinance and shall subject the Company to any remedies allowed thereunder, including possible disqualification from participating in City contracts for up to two years.
4. As a condition of contracting with the City, the Company agrees to promptly provide to the City all information and documentation that may be requested by the City from time to time regarding the solicitation and selection of subcontractors and suppliers in connection with this Contract. Failure to maintain or failure to provide such information shall constitute grounds for the City to reject the bid/proposal submitted by the Consultant/bidder and to terminate any contract awarded on such bid/proposal. It shall also constitute a violation of the City’s Commercial Non Discrimination ‐ Ordinance and shall subject the Company to any remedies that are allowed thereunder.
5. As part of its bid/proposal, the Company shall provide to the City a list of all instances within the past ten years where a complaint was filed or pending against the Company in a legal or administrative proceeding alleging that the Company discriminated against its subcontractors, vendors or suppliers, and a description of the status or resolution of that complaint, including any remedial action taken.
6. As a condition of submitting a bid/proposal to the City, the Company agrees to comply with the City’s Commercial Non Discrimination‐ Policy as described in Section 2, Article V of the Charlotte City Code, and consents to be bound by the award of any arbitration conducted thereunder.
By: SIGNATURE OF AUTHORIZED OFFICIAL
Title:
Date:
City of CharlotteEngineering & Property Management
REQUIRED FORMS
RFP2018‐335Project Name: Emergency Mitigation Clean Up Services
Page 36
Form 4 – SERVICE PROVIDER QUESTI O N NAIRE
Project Name: EMERGENCY MITIGATION CLEAN UP SERVICES
Company Name:
1. When was your company established? How many years have you been in business providing Emergency Mitigation Clean Up Services?
Year established:
Number of years providing Emergency Mitigation Clean Up Services:
2. How many qualified employees are available to provide the services?
Number of employees:
3. How long have your employees worked for you?
How many employees have been with your company for less t ha n 3 years ?
How many employees have been with your company for more t h a n 3 years ?
City of CharlotteEngineering & Property Management
REQUIRED FORMS
RFP2018‐335Project Name: Emergency Mitigation Clean Up Services
Page 37
4. Are you able to provide on call‐ services 24 hours a day, 7 days a week and be at a project site within 1 hour for emergency calls?
Yes.
No.
5. Does your company have the capability to self perfo‐ rm all the Services? What percentage of the work/which tasks would you subcontract?
Yes.
No. What areas would you need to subcontract?
6. Has the company or any employee or agent/ subcontractor had a felony conviction within the past 15 years?
No.
Yes. Explain:
7. Are you willing to submit all proposed personnel for a strict CMPD background check?
Yes.
No.
City of CharlotteEngineering & Property Management
REQUIRED FORMS
RFP2018‐335Project Name: Emergency Mitigation Clean Up Services
Page 38
8. Have you been involved in any litigation in the past 5 years?
No.
Yes. Explain:
9. List 5 references on Form 6 for services performed by your company and proposed subcontractors that were similar in nature to the scope of services under this RFP. Provide Information on Form 6
City of CharlotteEngineering & Property Management
REQUIRED FORMS
RFP2018‐335Project Name: Emergency Mitigation Clean Up Services
Page 39
Form 5 – Key Personnel an d Other Re s ources (Make copies and attach additional sheets as necessary)
Project Name: EMERGENCY MITIGATION CLEAN UP SERVICESCompany’s Name:
List the Supervisor an d other k ey s t aff who will be assigned to this Project. Provide the information required for each.
Key Personnel 1 Key Personnel 2 Key Personnel 3
Name
Professional Certifications/Licenses(include Certification/License #)Proposed Role/Function for Projects Company Project Manager Site Superintendent
Office Location (City, State)
Number of Years with Company
Number of Years of RelevantExperienceAvailability to Provide Services forthis Project for the next 12 months
Describe Relevant Experience, include list of Projects where the Key Person was responsible for the same role/function.
City of CharlotteEngineering & Property Management
REQUIRED FORMS
RFP2018‐335Project Name: Emergency Mitigation Clean Up Services
Page 40
Project Name: EMERGENCY MITIGATION CLEAN UP SERVICES Company’s Name:
List the full names of all em ploye e s (except Supervisor and key staff) whom you intend to assign to this Project. Describe their specific role/responsibility and availability for this Project.
Employee Name Project Role/Responsibility Availability Education / Experience/ Certifications
City of CharlotteEngineering & Property Management
REQUIRED FORMS
RFP2018‐335Project Name: Emergency Mitigation Clean Up Services
Page 41
Project Name: EMERGENCY MITIGATION CLEAN UP SERVICES Company’s Name:
List the legal names of all S ubcont r a c tors whom you intend to use on this Project. Provide their specific role/responsibility and contact information.
Subcontractor Name Project Role/Responsibility Contact Person & Contact Information (Address, Phone, Email) Certifications
City of CharlotteEngineering & Property Management
REQUIRED FORMS
RFP2018‐335Project Name: Emergency Mitigation Clean Up Services
Page 42
Project Name: EMERGENCY MITIGATION CLEAN UP SERVICES Company’s Name:
List examples of e q uipm en t you intend to use for this project. Include Equipment Type, Brand, and Model, indicating whether the equipment is owned by your company or to be leased.
Equipment Type Brand Model Own or Lease?
□ Own□ Will Lease
□ Own□ Will Lease
□ Own□ Will Lease
□ Own□ Will Lease
□ Own□ Will Lease
□ Own□ Will Lease
□ Own□ Will Lease
□ Own□ Will Lease
City of CharlotteEngineering & Property Management
REQUIRED FORMS
RFP2018‐335Project Name: Emergency Mitigation Clean Up Services
Page 43
FORM 6 – REFERENCES Please type or print
REFERENCES
1
Company Name
Contact Name
Phone Number
E Mail‐ Address
Service Dates
Scope of Work
2
Company Name
Contact Name
Phone Number
E Mail‐ Address
Service Dates
Scope of Work
3
Company Name
Contact Name
Phone Number
E Mail‐ Address
Service Dates
Scope of Work
RFP2018‐335Project Name: Emergency Mitigation Clean Up Services
Page 44
City of CharlotteEngineering & Property Management
REQUIRED FORMS
REFERENCES
4
Company Name
Contact Name
Phone Number
E Mail‐ Address
Service Dates
Scope of Work
5
Company Name
Contact Name
Phone Number
E Mail‐ Address
Service Dates
Scope of Work
City of CharlotteEngineering & Property Management
REQUIRED FORMS
RFP2018‐335Project Name: Emergency Mitigation Clean Up Services
Page 45
Form 7 – Company Em plo y ee L i c ensi n g an d Certifi c ations Copy this Form as Needed.
Project Name: EMERGENCY MITIGATION CLEAN UP SERVICESCompany’s Name:
List staff with documented credentials:
1. NAME OF CERTIFICATION:
Name of Individual:
Working Title with Company:
Certification Issued By:
License/Registration/Certification #:
Effective Date / Expiration Date:
2. NAME OF CERTIFICATION:
Name of Individual:
Working Title with Company:
Certification Issued By:
License/Registration/Certification #:
Effective Date / Expiration Date:
3. NAME OF CERTIFICATION:
Name of Individual:
Working Title with Company:
Certification Issued By:
License/Registration/Certification #:
Effective Date / Expiration Date:
City of CharlotteEngineering & Property Management
REQUIRED FORMS
RFP2018‐335Project Name: Emergency Mitigation Clean Up Services
Page 46
Form 8 – Pricing
Project Name: EMERGENCY MITIGATION CLEAN UP SERVICES
Company’s Name:
UNIT PRICESThe uni t pric e s listed are bil l ing rates that inc l ude al l ov e rhead and pr o fit. Cleanup and decontamination of anyequipment used shall be included in unit pricing. There shall be no tr i p charges or f u el sur c harge s . Prices s h all remain u n ch a nged for o ne year following contract execution. For unusual circumstances not covered by one of the categories listed below, the City and the Company will negotiate rates applicable to remediation for the specific circumstances.
PRICE LISTCATEGORY UNIT REGULAR HOURS AFTER HOURSGENERALEmergency Service Call (Initial Assessment) Each (Hour)Service Technician HourlyService Vehicle/Van/Pickup HourlyWATER EXTRACTIONWater extraction from floor – Category 1 Square FootWater extraction from floor – Category 1 (Heavy) Square FootWater extraction from floor – Category 2 Square FootWater extraction from floor – Category 3 Square FootEQUIPMENT (include all Filter Changes and Equipment Cleanup as applicable)Air Mover (per day) Each (Day)Axial Fan (per day) Each (Day)Dehumidifier – Large (per day) Each (Day)Dehumidifier – Extra Large (per day) Each (Day)Negative Air Fan/Air Scrubber – Small (per day) Each (Day)Negative Air Fan/Air Scrubber – Large (per day) Each (Day)Extension Cord – 50’ (per day) Each (Day)Personal Protective Equipment (PPE) Each (Piece)Personal Respiratory Equipment (PRE) Each (Piece)Plastic Containment Barriers Square FootDEMOLITION AND CLEANUPTear out Trim/Base Linear FootTear out Ceiling Tile and bag for disposal Square FootTear out Drywall (1/2”) and bag for disposal Square FootTear out Drywall (5/8”) and bag for disposal Square FootTear out Carpet, cut and bag for disposal Square FootRemove and Dispose of Debris (per Cubic Yard) Each (CY)CLEANINGClean and Deodorize Carpet Square FootClean and Deodorize Fabric Modular Panel Square FootClean Vinyl Flooring Square FootClean Hardwood Flooring Square FootClean Laminate Flooring Square FootAntimicrobial Treatment Square FootBlock and Pad Furniture Each RoomMove and Reset Contents Each RoomMove and Reset Contents – Large Room Each Room
SAMPLE PROJECT #1 (Use Unit Pricing from Price List above) Plumbing Overflow
Quantity UnitUnitPrice
TotalCost
Emergency Service/Mobilization (After Hours) 1 EARestroom (8X10) Ceramic Tile FloorExtract black water, after hours, (Disposal on site) 80 SF
Antimicrobial Treatment 80 SF
Utility Room (5X10) Vinyl Sheeting Floor (not wet underneath)Extract black water, after hours, (Disposal on site) 50 SF
Antimicrobial Treatment 50 SF
Hallway (5X13) CarpetExtract black water, after hours, (Disposal on site) 65 SF
Antimicrobial Treatment 65 SF
Tear out Carpet, cut & bag for disposal 65 SF
Adjoining Cubicle (8X8) CarpetExtract black water, after hours (Disposal on site) 64 SF
Antimicrobial Treatment (Floor and Partial Partition Walls) 96 SF
Tear out Carpet, cut & bag for disposal 64 SF
Equipment RentalAir Mover (4 Units X 3 days) 12 EA
Dehumidifier, Large (1 Unit X 3 days) 3 EA
$
SAMPLE PROJECT #2 (Use Unit Pricing from Price List above) Major Roof Leak Storm‐ Water Damage Quantity Unit
UnitPrice
TotalCost
Emergency Service/Mobilization (After Hours) 1 EAWarehouse (30X70) Concrete Floor, partially flooded
Extract Category 1 water, after hours (Disposal on site) 1400 SF
Antimicrobial Treatment 1400 SF
Office Area (10 X 30) Carpet, substantially floodedExtract Category 1 water, after hours (Disposal on site) 300 SF
Tear out Carpet, cut and bag for disposal 300 SF
Antimicrobial Treatment 300 SF
Block and pad Furnishings: 7 loaded 6 drawer‐ solid base‐ file cabinets,4 double p‐ edestal (4 legs each) 72X36 desks, 2 (4 legs each) 72X24 credenzas, 1 with additional hutch), 1 center‐pedestal (solid base)96X48 conference/work table, 1 5 shelf ‐ 36X24X72 storage cabinet and 1 solid base 20X36. Assume 4 (5 wheels each) Desk chairs and 14 (4 legs each) Side chairs sustained no damage and can be stored on top of conference table.
LOT EA
Tear out Vinyl Base and bag for disposal 30 LF
Tear out Ceiling Tile and bag for disposal 60 SF
Equipment RentalAir Mover, Large (4 Units X 3 days) 12 EA
Dehumidifier, Large (2 Units X 3 days) 6 EA
$
City of Charlotte REQUIRED FORMSEngineering & Property Management
Sample Project #1 Total:
Sample Project #2 Total:
RFP2018‐335 Page 47Project Name: Emergency Mitigation Clean Up Services
