Attention All Bidders s1

JEFFERSON COUNTY COMMISSION PURCHASING DEPARTMENT ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N BIRMINGHAM, ALABAMA 35203-0009 (205) 325-5381(OFC) /(205) 214-4034(FAX)

CARMEN JONES, PRINCIPAL BUYER APRIL 24, 2015 MICHAEL MATTHEWS, PURCHASING AGENT ITB: 91-15

TO: Prospective Bidders INVITATION FOR BID NUMBER: 91-15 (contact principal buyer for a complete copy of bid package) SEPARATE SEALED BIDS FOR: ELECTRIC HOT WATER BOILER Carmen Jones, Principal Buyer INVITATION TO BID RESPONSES 716 Richard Arrington Jr. Blvd North WILL BE RECEIVED BY: Room 830 Courthouse Birmingham, AL 35203-0009 ***IMPORTANT SOLICITATION DATES*** BID DUE DATE: BID OPENING DATE: MAY 12, 2015 by 5:00 PM MAY 13, 2015 at 10:00 AM (Central Standard Time) (Central Standard Time) Return responses to this Invitation to Bid in a sealed envelope marked: “ITB #91-15 FOR ELECTRIC HOT WATER BOILER ” BID OPENING WILL BE HELD AT: Jefferson County Courthouse Purchasing Department, Room 830 Courthouse 716 Richard Arrington Jr. Blvd North Birmingham, Alabama 35203-0009

NOTIFICATION OF INTENT: All recipients of this solicitation notice must indicate intent to submit a bid. Those vendors submitting a Notification of Intent will be sent a complete copy of the bid, any related addendum, answers to inquiries, etc. pertaining to this ITB. Notification of intent must be faxed to (205) 214-4034 or e-mailed to Carmen Jones at [email protected].

TELEPHONE INQUIRIES – NOT ACCEPTED: Telephone inquiries with questions regarding clarification of any and all specifications of the ITB will not be accepted. All questions must be written and faxed to (205)214-4034 or e-mailed to Carmen Jones at [email protected].

Submissions may be withdrawn, modified, and resubmitted prior to the formal bid opening due date. Any submission modification(s) submitted after the “Bid Opening Due Date” will not be considered.

The County reserves the right to accept or reject any or all bids, or any part of any bid, and to waive any informalities or irregularities in the proposal.

All costs incurred by the company to respond to this solicitation will be wholly the responsibility of the Bidder. All copies and contents of the bid, attachments, and explanations thereto submitted in response to this ITB, except copyrighted material, shall become the property of the Jefferson County Commission regardless of the Consultant selected. Response to this solicitation does not constitute an agreement between the Bidder and the County.

The County is not responsible for delays occasioned by the U.S. Postal Service, the internal mail delivery system of the County, or any other means of delivery employed by the bidder. Similarly, the County is not responsible for, and will not open, any bid responses which are received later than the date and time indicated above. Late bid responses will be retained in the bid file, unopened.

Released by:

______JEFFERSON COUNTY COMMISSION PURCHASING DEPARTMENT ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N BIRMINGHAM, ALABAMA 35203-0009 (205) 325-5381(OFC)/(205) 214-4034(FAX)

CARMEN JONES, PRINCIPAL BUYER APRIL 24, 2015 MICHAEL MATTHEWS, PURCHASING AGENT ITB: 91-15 INVITATION TO BID

“ELECTRIC HOT WATER BOILER”

BID NO. 91-15

Carmen Jones, Principal Buyer 716 Richard Arrington Jr. Blvd North, Room 830 Birmingham, Alabama 35203 Phone: (205) 214-8583 Email: [email protected]

of 15 JEFFERSON COUNTY COMMISSION PURCHASING DEPARTMENT ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N BIRMINGHAM, ALABAMA 35203-0009 (205) 325-5381(OFC)/(205) 214-4034(FAX)

INVITATION TO BID

Sealed bids marked ELECTRIC HOT WATER BOILER” will be received by the Purchasing Manager, Room 830 * 716 Richard Arrington Jr Blvd North, Birmingham, Alabama 35203.

Bids will be accepted until 5:00 P.M. central time (standard or daylight savings time, as applicable) on Tuesday, May 12, 2015. Bids submitted after this date and time will not be considered.

Bids will be publicly opened at 10:00 A.M. (Central Standard Time) on Wednesday, May 13, 2015.

The County is not responsible for delays occasioned by the U. S. Postal Service, the internal mail delivery system of the County, or any other means of delivery employed by the bidder. Similarly, the County is not responsible for, and will not open, any bid/proposal responses, which are received later than the date and time, indicated above. Late bids/proposals will be retained in the bid/proposal file, unopened.

TERMS OF CONTRACT Any contract resulting from this ITB will become effective upon bid award (or within 30 days of award notification, approval of the County Commission and purchase order is issued). However, the contract may be extended, at the County’s option and Commission approval, for a period of up to two (2) additional one (1) year terms, until 2018.

SUMMARY OF INVITATION TO BID This bid is for purchasing one (1) Precision Model “HW” Series II Electric Hot Water Boiler. No installation is required and the bidder will be selected based upon cost, ability and integrity to fulfill the contract obligations.

CERTIFICATION The bidder certifies that the bid has been arrived at by the bidder independently and has been submitted without any collusion designed to limit independent bidding or competition. The bidder further certifies that the materials, products, services and/or goods offered herein meet all requirements of the stated specifications and are equal in quality, value and performance with highest quality, nationally advertised brand and/or trade names.

BRAND NAMES The acceptable specified brand(s) are indicated in this bid document; however, bidders offering substitutions must get approval from the user department and include signed acceptance letter with bid document or bid submitted may not be considered for evaluation.

KEY CONTACT If additional information is required concerning this ITB or the procurement process, inquiries should be directed in writing to Carmen Jones via e-mail: [email protected] or Denaman Payton via e-mail: [email protected] Correspondence with individuals other than those listed herein will not be allowed.

NEGOTIATIONS Jefferson County reserves the right to enter into contract negotiations with the selected bidder. If the County and the selected bidder cannot negotiate a successful contract, the County may terminate negotiations and begin negotiation with the next selected bidder. This process will continue until a contract has been executed or all proposals have been rejected. No bidder shall have any rights against the County arising from such negotiations.

DELIVERY F.O.B. Destination via best way.

ADDITIONAL PURCHASES If mutually agreed upon within twelve (12) months from bid opening date, this bid may be used as the basis for additional purchases. JEFFERSON COUNTY COMMISSION PURCHASING DEPARTMENT ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N BIRMINGHAM, ALABAMA 35203-0009 (205) 325-5381(OFC)/(205) 214-4034(FAX)

INVITATION TO BID (CONT’D)

SPECIFICATIONS Use of specific names and numbers is not intended to restrict the bidding of any seller and/or manufacturer, but is solely for the purpose of indicating the type, size and quality of materials, products, service, or equipment considered best adapted to the County's intended use. Proprietary specifications may be waived for functional equivalents offered.

Electric Hot Water Boiler - Precision Model HW24D-800D-480-150

 150 psi pressure vessel built to ASME Code Section IV and National Board registered  800 KW/480 volt/3ph  Heating elements to be incoloy sheathed replaceable with standard tools  10 – steps by a solid state progressive sequencer  Full size structural steel base  Heavy duty steel boiler vessel housing  3” fiberglass insulation  ASME safety relief valve(s)  Pressure gauge with cock  Full port drain valve  NEMA 1 electric control panel with key locked door(s)  Integral branch circuit fusing  Magnetic contactors rated @ 500,000 cycles  Alarm buzzer with pilot & silence switch  Common alarm dry contact  Flow switch  3ph Ammeter  3pn Voltmeter  Safety door interlock  Aux float type LWCO  Local/remote switch  On/off switch with pilot light  Status pilot lights for each step/stage  Manual reset probe type low water cut off with pilot light and test circuit  Auto and manual reset high temperature safety

PRICE REDUCTION In the event of a general price reduction, the County will receive the benefit of such reduction on any undelivered portion of contract.

PRICES Bidders must honor their bid price for sixty (60) days from the date of sealed bid opening.

TAX Jefferson County is exempt from all Federal Tax, and sales and use tax, except Alabama tax on oils, lubricants and fuels specifically bought for over-the-road transportation use.

PRE-PAYMENTS No prepayments of any kind will be made prior to shipment. JEFFERSON COUNTY COMMISSION PURCHASING DEPARTMENT ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N BIRMINGHAM, ALABAMA 35203-0009 (205) 325-5381(OFC)/(205) 214-4034(FAX)

PUBLIC DISCLOSURE Subject to applicable law or regulations, the content of each Bidder’s submission shall become public information upon the effective date of any resulting contract.

GUARANTEE Bidder certifies by bidding, that he is fully aware of the conditions of service and purpose for which item(s) included in this bid are to be purchased, and that his offering will meet these requirements of service and purpose to the satisfaction of the Jefferson County Commission and its agent.

INVOICING All invoices must agree with the purchase order in description and price and include the following information: 1) Purchase Order Number; 2) Ship-to Department name and address.

In order to ensure prompt payment, ALL ORIGINAL INVOICES* MUST BE SENT TO: Jefferson County Commission Finance Department Room 820, Courthouse 716 Richard Arrington Jr. Blvd, North Birmingham, AL 35203

*If invoice does not agree with purchase order, credits or a corrected invoice will be required in order for the County to process payment. Invoices that do not reference an authorized Purchase Order will be returned to the vendor.

THIRD-PARTY “REMIT-TO” If Bidder has a third-party “remit-to” company, that information must appear on the Bidder’s response. Jefferson County will send payment to the company designated by Bidder on its response, but will not be responsible for resolving payment issues, should the Bidder change payment processing companies after a payment has been mailed or without forty-five (45) days written notification to the Purchasing and Accounting division of Jefferson County.

Purchase orders will be issued as deliveries are required.

CANCELLATION Failure to deliver as specified and in accordance with the bid submitted, including promised delivery will constitute sufficient grounds for cancellation of the order at the option of the County Commission.

TERMINATION OF CONTRACT This contract may be terminated by the County with a thirty (30) day written notice to the other party regardless of reason. Any violation of this agreement shall constitute a breach and default of this agreement. Upon such breach, the County shall have the right to immediately terminate the contract and withhold further payments. Such termination shall not relieve the contractor of any liability to the County for damages sustained by virtue of a breach by the contractor.

PROTECTION DAMAGE Contractor will be responsible for any damage to property of the county or others caused by him, his employees or subcontractors, and will replace and make good such damage. The contractor will maintain adequate protection to prevent damage to his work and property of others, and take all necessary precautions for the safety of his employees and others. The contractors will comply with all safety laws and regulations in effect in the locality. JEFFERSON COUNTY COMMISSION PURCHASING DEPARTMENT ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N BIRMINGHAM, ALABAMA 35203-0009 (205) 325-5381(OFC)/(205) 214-4034(FAX)

BUSINESS LICENSE In the event you receive a notification of intent to award letter, you will be required to provide your Jefferson County business license within 7 days of receipt of notice of intent to award. If you are not currently registered with Jefferson County Revenue Department, and do not have a business account number, applications may be obtained by logging on to http://jeffconline.jccal.org/revenue. Once you have logged on, click on Business License and then **New Applicants. Failure to submit the requested information may result in the notice of intent to award being revoked.

INSURANCE The successful bidder will maintain such insurance as will protect him and the County from claim under Workmen's Compensation Acts, and from claims for damage and/or personal injury, including death, which may arise from operations under this contract. Insurance will be written by companies authorized to do business in Jefferson County, Alabama and shall include Jefferson County, Alabama as Added Additional Insured By Endorsement including a thirty (30) day(s) written cancellation notice. Evidence of insurance will be furnished to the Purchasing agent not later than seven (7) day(s) after Purchase Order/contract date. Successful bidder is also required to include the bid number on the evidence of insurance.

Insurance Minimum Coverage: Contracting party shall file the following insurance coverage and limits of liability with the County's Human Resource Department and Purchasing Department before beginning work with the County.

General Liability: $1,000,000 - Bodily injury and property damage combined occurrence $1,000,000 - Bodily injury and property damage combined aggregate $1,000,000 - Personal injury aggregate Comprehensive Form including Premises/Operation, Products/Completed Operations, Contractual, Independent contractors, Broad Form property damage and personal injury.

Automobile Liability: $1,000,000 - Bodily injury and property damage combined coverage Any automobile including hired and non-owned vehicles

Workers Compensation and Employers Liability: $100,000 - Limit each occurrence

Umbrella Coverage: $1,000,000 - Each occurrence $1,000,000 – Aggregate

Added Additional Insured By Endorsement: Jefferson County, Alabama 30 day(s) written cancellation notice

Under Description of Operations/Locations/Vehicles/Exclusions Added by Endorsement/Special Provisions enter the BID/RFP Number, Project Number or Purchase Order Number Covered by the Certificate of Insurance

HOLD HARMLESS AND INDEMNIFICATION JEFFERSON COUNTY COMMISSION PURCHASING DEPARTMENT ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N BIRMINGHAM, ALABAMA 35203-0009 (205) 325-5381(OFC)/(205) 214-4034(FAX)

CARMEN JONES, PRINCIPAL BUYER APRIL 24, 2015 MICHAEL MATTHEWS, PURCHASING AGENT ITB: 91-15 Contracting party agrees to indemnify, hold harmless and defend Jefferson County, Alabama, its elected officers and employees (hereinafter referred to in this paragraph collectively as “County”), from and against any and all loss expense or damage, including court cost and attorney’s fees, for liability claimed against or imposed upon County because of bodily injury, death or property damage, real or personal, including loss of use thereof arising out of or as a consequence of the breach of any duty or obligations of the contracting party included in this agreement, negligent acts, errors or omissions, including engineering and/or professional error, fault, mistake or negligence of Integrator, its employees, agents, representatives, or subcontractors, their employees, agents or representatives in connections with or incident to the performance of this agreement, or arising out of Worker’s Compensation claims, Unemployment Compensation claims, or Unemployment Disability compensation claims of employees of company and/or its subcontractors or claims under similar such laws or obligations. Company obligation under this Section shall not extend to any liability caused by the sole negligence of the County, or its employees. Before beginning work, contract party shall file with the County a certificate from his insurer showing the amounts of insurance carried and the risk covered thereby. Liability insurance coverage must be no less than $1,000,000. During performance the company must effect and maintain insurance from a company licensed to do business in the State of Alabama. Coverage required includes 1) Comprehensive General Liability; 2) Comprehensive Automobile Liability; 3) Worker’s Compensation and Employer’s Liability.

WARRANTY The Awarded contractor must provide Jefferson County with Standard Manufactures Warranty covering materials and workmanship.

NON-DISCRIMINATION POLICY The Jefferson County Commission is strongly committed to equal opportunity in solicitation of ITB’s and RFP’s. The County encourages bidders and proposers to share this commitment. Each bidder/contractor submitting a proposal will not discriminate against any employee or applicant for employment because of race, color, religion, sex, national origin, age, disability or veteran status. The Bidder/Contractor will ensure that qualified applicants are employed, and that employees are treated during employment, without regard to their race, color, religion, sex, national origin, age, disability or veteran status. Such action shall include, but not be limited to the following: employment, promotion, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship.

AWARD Award will be made to the lowest responsible bidder provided that all conditions and specifications required by the County are met. County may award contract based on the needs of the County.

GENERAL The Jefferson County Commission expressly reserves the right to reject any or all bids, or parts of bids, and to make the award or awards as the best interest of the County appears.

CORRECTIONS/AUTHORIZED SIGNATURE Bids having any erasures or corrections must be initialed in ink. Bid must be signed in ink by an official authorized representative.

GOVERNING LAW/DISPUTE RESOLUTION Any contract agreement that is issued based on this ITB, the parties shall agree that the contract agreement is made and entered into in Jefferson County, Alabama, and that all services, materials and equipment to be rendered pursuant to said contract agreement are to be delivered in Jefferson County, Alabama. The interpretation and enforcement of this contract agreement will be governed by laws of the State of Alabama. The parties agree that jurisdiction and venue over all disputes arising under this contract agreement shall be the Circuit Court of Jefferson County Alabama, Birmingham Division.

SINGLE BID If a single bid response is received for this ITB, the bid will be rejected in accordance with Title 41-16-50-a-1 of the Alabama Code. The bid will be opened, but will not be read publicly. We will proceed with negotiations for a lower price with the rejected bidder and other bidders by means of sealed quotes. The rejected bidder’s initial offer will not be disclosed to other bidders, prior to the awarding JEFFERSON COUNTY COMMISSION PURCHASING DEPARTMENT ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N BIRMINGHAM, ALABAMA 35203-0009 (205) 325-5381(OFC)/(205) 214-4034(FAX)

CARMEN JONES, PRINCIPAL BUYER APRIL 24, 2015 MICHAEL MATTHEWS, PURCHASING AGENT ITB: 91-15 of a contract. The award will be made to the company offering the lowest negotiated quotation, provided that all conditions and specifications required by the County are met.

BID ACCEPTANCE/REJECTION Jefferson County expressly reserves the right to reject any or all bids, or parts of bids, and to make the award on merit and/or features of design and quality, delivery, and availability of parts and service as the best interest of the County appears.

STATEMENT OF COMPLIANCE WITH ALABAMA CODE SECTION 31-13-9 By signing this contract, the contracting parties affirm, for the duration of the agreement, that they will not violate federal immigration law or knowingly employ, hire for employment, or continue to employ an unauthorized alien within the State of Alabama. Furthermore, a contracting party found to be in violation of this provision shall be deemed in breach of the agreement and shall be responsible for all damages resulting therefrom.

Carmen Jones Principal Buyer

STATEMENT OF COMPLIANCE WITH ALABAMA CODE SECTION 31-13-9

By signing this contract, the contracting parties affirm, for the duration of the agreement, that they will not violate federal immigration law or knowingly employ, hire for employment, or continue to employ an unauthorized alien within the State of Alabama. Furthermore, a contracting party found to be in violation of this provision shall be deemed in breach of the agreement and shall be responsible for all damages resulting therefrom.

______Printed Name of Authorized Representative Title

______Signature of Authorized Representative Date Signed

______Name of Business JEFFERSON COUNTY COMMISSION PURCHASING DEPARTMENT ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N BIRMINGHAM, ALABAMA 35203-0009 (205) 325-5381(OFC)/(205) 214-4034(FAX)

BID (Bidder must use this form. Fill in all spaces.)

A BID BOND OR CASHIER'S CHECK IN THE AMOUNT OF 5% OF BID MUST ACCOMPANY ANY BID $25,000 OR MORE. BIDS SUBMITTED WITHOUT THE BID BOND WILL NOT BE CONSIDERED.

QUANTITY COST TOTAL COST

Item 1. Precision “HW” Series II Electric Hot Water Boiler Model HW24D-800D-480-150 or Approved equal One (1) $______EA $______

Grand Total for Item 1………………………………………………$______

Delivery is guaranteed not later than ______days after order date.

Bidder must submit a copy of their Jefferson County business license within 7 days of receipt of notice of intent to award. Failure to submit the requested information will result in the notice of intent to award being revoked. JEFFERSON COUNTY COMMISSION PURCHASING DEPARTMENT ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N BIRMINGHAM, ALABAMA 35203-0009 (205) 325-5381(OFC)/(205) 214-4034(FAX)

Attach a letter stating differences between County specifications and specifications of item(s) offered.

NAME OF YOUR COMPANY______

NON-COLLUSION AFFIDAVIT

I, ______, an authorized agent/representative of

______attest that the Invitation to Bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the Invitation to

Bid is genuine and not collusive or sham; that the Bidder has not directly or indirectly induced or solicited any other

Bidder to put in a false or sham ITB, and has not directly or indirectly colluded, conspired, connived, or agreed with any

Bidder or anyone else to put in a sham ITB, or that anyone shall refrain from proposing; that the Bidder has not in any manner, directly or indirectly sought by agreement, communication or conference with anyone to fix the ITB of the

Bidder or any other Bidder, or to fix any overhead, profit, or cost element of the ITB price or of that of any Bidder, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the ITB are true; and further, that the Bidder has not, directly or indirectly, submitted his/her ITB JEFFERSON COUNTY COMMISSION PURCHASING DEPARTMENT ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N BIRMINGHAM, ALABAMA 35203-0009 (205) 325-5381(OFC)/(205) 214-4034(FAX)

CARMEN JONES, PRINCIPAL BUYER APRIL 24, 2015 MICHAEL MATTHEWS, PURCHASING AGENT ITB: 91-15 price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay any fee to any corporation, partnership, company, association, organization, ITB depository, or to any member or agent thereof, to effectuate a collusive or sham ITB.

I, the undersigned, hereby certify that I have read and understand this Non- Collusion Affidavit and guarantee complete compliance with all the terms, conditions and stipulations.

Subscribed and Sworn to BY ______Before me this ______day Authorized Signature of Bidder Date of ______20____.

______Print or Type Name of Bidder

______Notary Public of My Commission expires

JEFFERSON COUNTY, ALABAMA EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION FORM

Contractor/Vendor Name: ______Address: ______

The Contractor acknowledges receipt of Jefferson County’s Equal Employment Opportunity Contractor Compliance Administrative Order (attached hereto) and certifies that it is an equal opportunity employer and agrees to the requirements of the Policy and the Equal Employment Opportunity Clause therein. It further certifies that it will require all subcontractors to execute an Equal Employment Opportunity statement and certification of compliance in accordance with Jefferson County Administrative Order 08-4 as follows:

1. The Contractor will not discriminate against any employee or applicant for employment because of race, color, religion, sex, national origin, age, disability or veteran status pursuant to the provisions of Title VII of the Civil Rights Act of 1964, 42 U.S.C. §§ 1981, 1983, 1986 and all amendments thereto relative to discriminatory employment JEFFERSON COUNTY COMMISSION PURCHASING DEPARTMENT ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N BIRMINGHAM, ALABAMA 35203-0009 (205) 325-5381(OFC)/(205) 214-4034(FAX)

CARMEN JONES, PRINCIPAL BUYER APRIL 24, 2015 MICHAEL MATTHEWS, PURCHASING AGENT ITB: 91-15 practices. The Contractor will ensure that qualified applicants are employed, and that employees are treated during employment, without regard to their race, color, religion, sex, national origin, age, disability or veteran status. Such action shall include, but not be limited to the following: employment, promotion, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship.

2. In the event of the Contractor’s non-compliance with the equal employment opportunity clause of this contract, this contract may not be awarded or may be cancelled, terminated or suspended in whole or in part and the Contractor may be declared ineligible for further County contracts.

3. The Contractor will include the provisions of paragraph (1) in every subcontract or purchase order.

4. The Contractor shall certify to the County its compliance with this policy prior to receipt of any contract or business with the County.

The Contractor will furnish to the County, upon request, reports, notices, policies and/or information certifying compliance with this policy. In the event of the Contractor’s non-compliance with the equal employment opportunity clause of this contract, this contract may not be awarded or may be cancelled, terminated or suspended in whole or in part and the Contractor may be declared ineligible for further County contracts.

______Date Signature

______Title

STATEMENT OF COMPLIANCE WITH ALABAMA CODE SECTION 31-13-9

By signing this contract, the contracting parties affirm, for the duration of the agreement, that they will not violate federal immigration law or knowingly employ, hire for employment, or continue to employ an unauthorized alien within the State of Alabama. Furthermore, a contracting party found to be in violation of this provision shall be deemed in breach of the agreement and shall be responsible for all damages resulting therefrom.

______Printed Name of Authorized Representative Title

______JEFFERSON COUNTY COMMISSION PURCHASING DEPARTMENT ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N BIRMINGHAM, ALABAMA 35203-0009 (205) 325-5381(OFC)/(205) 214-4034(FAX)

CARMEN JONES, PRINCIPAL BUYER APRIL 24, 2015 MICHAEL MATTHEWS, PURCHASING AGENT ITB: 91-15 Signature of Authorized Representative Date Signed

______Name of Business

AFFIDAVIT OF CONTRACTOR Alabama Act 2011-535

STATE OF ALABAMA JEFFERSON COUNTY

I affirm the following:

1. I will not knowingly employ, hire for employment, or continue to employ an unauthorized alien; and,

2. I affirm that the below listed Business Organization is enrolled in the E-Verify program, that the Business Organization listed below will remain enrolled in the E-Verify program during the term of the contract and that every employee that is required to be verified will be verified according to the applicable federal rules and regulations; and, JEFFERSON COUNTY COMMISSION PURCHASING DEPARTMENT ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N BIRMINGHAM, ALABAMA 35203-0009 (205) 325-5381(OFC)/(205) 214-4034(FAX)

CARMEN JONES, PRINCIPAL BUYER APRIL 24, 2015 MICHAEL MATTHEWS, PURCHASING AGENT ITB: 91-15 3. I acknowledge that §9(e) Alabama Act 2011-535 authorizes the County to terminate this contract for a first violation of §9(a) of said Act, and requires the County to terminate this contract for a second violation of §9(a) of said Act.

______Printed Name of Contractor (or Authorized Representative) Title

______Signature of Contractor (or Authorized Representative) Date Signed

______Name of Business Entity Phone Number

State of ______

County of ______

Sworn to and subscribed before me on this ____ day of ______, 20___.

______NOTARY PUBLIC

My Commission Expires: ______

SIGNATURE PAGE

The Jefferson County Commission, or its Agent, shall have the right to waive any informality or irregularity. Under certain limited conditions, the Purchasing Department may apply a local preference option in determining the low bid for purchases of personal property.

All provisions of this Invitation are accepted by bidder as part of any contract or purchase resulting therefrom.

Please specify terms of payment below;

Date: ______Company Name: ______Web Address: ______JEFFERSON COUNTY COMMISSION PURCHASING DEPARTMENT ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N BIRMINGHAM, ALABAMA 35203-0009 (205) 325-5381(OFC)/(205) 214-4034(FAX)

Terms: ______Address:______City:______

County: ______State: ____Zip: ______Phone: _____) ______

If Jefferson County Business Licenses were issued to your company for the past twelve (12) months, please list numbers: ______.

Vendor's Federal I.D. Number: ______

I certify that ______has ___ has not ___ been in operation for one year at (Company Name) (Check one) location(s) zoned for the type of business conducted by my company at the address stated above.

______(Authorized Signature) ______(Print Name) ______(E-Mail Address) Toll Free Phone: ______Fax Number: ______

Return original bid in sealed envelope. Authorized signature of bidder must be in ink.

Bids received in our office after the specified date and hour may not be considered.

INDICATE THE FOLLOWING ADDRESSES IF DIFFERENT FROM ABOVE:

1. BID AWARD NOTICE ADDRESS

2. PURCHASE ORDER ADDRESS

3. REMITTANCE ADDRESS (AND NAME IF DIFFERENT THAN ABOVE)

NOTIFICATION OF INTENT TO RESPOND

ITB #91-15

“ELECTRIC HOT WATER BOILER” JEFFERSON COUNTY COMMISSION PURCHASING DEPARTMENT ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N BIRMINGHAM, ALABAMA 35203-0009 (205) 325-5381(OFC)/(205) 214-4034(FAX)

( ) On behalf of myself/my firm/institution, I hereby certify that I/we intend to submit a response.

( ) On behalf of myself/my firm/institution, I hereby certify that I/we do not intend to submit a response.

______Authorized Signature Individual/Institution/Firm

______Title Date

***NOTE***

You may fax the notification of intent to respond to 205.214.4034 or by email to [email protected].