Pest control

BID PURPOSE AND REQUIREMENTS ALABAMA PORT AUTHORITY PEST CONTROL SERVICES CONTRACT The Alabama Port Authority (APA) will accept sealed bids for Pest Control Services to be performed at the following restricted (R) and nonrestricted (NR) locations (see specific details for each location): MONTHLY: A. Pier E Pier 2 (R) B. Container Yard: Offices & Outer Areas (R) C. APA Administration Building (R) D. Warehouse B (R) E. Central Garage (R) F. Terminal Railroad: Diesel Shop (NR) G. Terminal Railroad: Maintenance of Way (NR) H. Truck Control Building (NR) I. Mud Lakes Office (NR) J. Housekeeping Office (R) K. Central Maintenance Trailers (R) L. McDuffie Coal Terminal; Multiple Locations (R) QUATERLY: M. APA Administration Building (R) N. Buildings 50 & 55 (R) O. International Trade Center (R) P. McDuffie Coal Terminal Beach House (R) Q. Blakely Island Warehouse & Guard House (R) R. Pinto Terminal Building & Guard House(R) S. Mobile Middle Bay Port: Building 100 & Guard House (NR & R) T.

Port Police: Building, Annex & 2 Guard Houses (R) U. Marine Liquid Bulk Terminal Guard House (R) Alabama Port Authority Port of Mobile Invitation to Bid Requested by: Approved by: Joy Lang Fixed Assets & Service Contracts Date Judith Adams V.P. of Internal & External Affairs Date Approved by: Approved by: Linda K. Paaymans, C.P.M., CPE Chief Financial Officer Date John C. Driscoll Director & Chief Executive Officer Date 2 BID PURPOSE AND REQUIREMENTS This Pest Control Service contract shall be for a period of five (5) years effective October 1, 2022 and ending September 30, 2027. The Alabama Port Authority reserves the sole right to renew the contract in one (1) year increments at no cost to the APA for a period of up to five (5) years, with the first renewal year contract beginning October 1, 2027. The APA may cancel this contract at its sole discretion for any reason, including but not limited to non-performance of service, by providing a 30-day written notice of termination to Contractor. The APA also reserves the right to amend this contract at any time without penalty. The Alabama Port Authority reserves the right to reject any and all bids deemed for the interest of the APA and to strike out any item or items in the proposals, and to waive any defect or irregularity not a violation of law or to make any modification in the several conditions herein stipulated that are deemed to be in the best interest of the APA, including the separation of items of a class in making awards. In general, awards will be made at the sole discretion of the APA to the lowest satisfactory and responsible bidder. The APA reserves the right to reject, at will, any employees of the Contractor to perform work on APA property. No allowance will be made for errors, either of omission or commission, on the part of the bidders. It must be assumed that bidders have fully informed themselves as to all conditions, requirements, and specifications before submitting proposals and they cannot expect to be excused or relieved from the responsibility assumed by their proposals on the plea of error. In case of error in extension of prices, the unit price will govern. Prospective bidders must attend a MANDATORY Pre-bid Meeting and Tour of the facilities on Monday, August 29, 2022 at 9:00 am CST. The meeting will begin on the 4th floor of the International Trade Center; 250 North Water Street; Mobile, AL 36602. Due to TWIC escort regulations, only one person per company is allowed to attend the pre-bid tour. The Pre-Bid Meeting & Tour may last up to three (3) hours. Confirm your attendance at the mandatory pre- bid meeting to Joy Lang at Joy.Lang@alports.com no later than noon, Wednesday, August 24, 2022. Failure to confirm your attendance will result in you not being able to attend the mandatory pre-bid meeting and tour, which is required in order to bid. Face masks are required in the van. The purpose of the meeting and tour is to give prospective bidders the opportunity to carefully examine the sites of the proposed work prior to submission of a bid proposal. Each Bidder shall satisfy oneself as to the character, quality, and quantities of work to be performed, and as to the requirements of the proposed contract. The submission of a proposal shall be proof that the bidder has made such examination and is satisfied as to the conditions to be encountered in performing the work and as to the requirements of the proposed contract. Prospective bidders must have a valid photo ID issued by a city, state or federal agency in order to attend the pre-bid tour. Bidders must furnish with the sealed bids all insurance and a list of chemicals by manufactures name with MSDS sheets, which must be approved by the Environmental Protection Agency and the State of Alabama Agriculture & Industries and appropriate certificates as received from federal, state and/or local agencies (to include, but not limited to, current Department of Agriculture and Industries permit), which verify qualifications to do such work listed in the bid. Bidders should also include a brief company history reflecting experience in the services listed in this bid and provide three (3) commercial references. mailto:Joy.Lang@alports.com 3 When submitting your proposal, please include a copy of your City of Mobile Business license. Non-residents of the State must show evidence of having qualified with the Secretary of State to do business in Alabama. Where applicable, also include evidence of holding a current license from the State Licensing Board for General Contractors, Montgomery, Alabama, as required by Chapter 8 of Title 34 of the Code of Alabama, 1975. Also, bidders must return a signed and notarized copy of the attached STATE OF ALABAMA DISCLOSURE STATEMENT as required by Alabama Act 2001-955. Failure to enclose the aforementioned signed and notarized form in the sealed bid submission will invalidate the bid entirely. Bids will be awarded on an all or none basis unless otherwise stated. Questions or comments pertaining to the bid must be presented in writing and sent via email only to Joy Lang, ASPA Fixed Assets Manager, at Joy.Lang@alports.com no later than 12:00 pm CST, Wednesday, August 31, 2022 or question(s) will be forever waived. Sealed bid proposals must be delivered via mail courier to the Alabama State Port Authority, 250 N. Water Street, Suite 330, Mobile, AL 36602 any time prior to bid opening. Bids must be sealed and must state the Bid Title (Alabama State Port Authoritys Pest Control Services Bid) on the outside of the envelope. Failure to mark and/or seal the Bid Package with the Bid Title may invalidate the bid. Sealed bid proposals may also be hand delivered to aforementioned address any time prior to the bid opening. All submitted bids will be publicly opened at 9:00 AM CST on Wednesday, September 7, 2022, on the 4th floor of the International Trade Center; 250 North Water Street, Mobile, AL. 36602. THE ALABAMA PORT AUTHORITY WILL NOT ACCEPT BIDS VIA EMAIL OR FAX. PAYMENT: All invoices shall contain the APA issued Purchase Order Number and shall be mailed to: Alabama State Port Authority Attn: Accounts Payable P. O. Box 1588 Mobile, AL 36633-1588 or sent via email to accountspayable@alports.com w/Joy Lang at joy.lang@alports.com in copy. -Invoices should indicate work performed at the location in the contract and date(s) worked. Invoices should be received no later than the fifth (5th) business day of each month and net thirty (30) days payment. Itemization of each item is for the APAs internal purposes only. Prospective bidders should consider all costs associated with this bid, including, but not limited to APA credentials, TWIC cards, travel time, travel expenses, materials and warranty and insurance, as the APA will award all items listed in the bid as one contract. Pursuant to the Code of Alabama, 1975, Title 40-23-4 (A) (11), the Alabama State Port Authority is exempt from paying taxes. An exemption letter will be furnished upon request. IMPORTANT NOTICE TO BIDDERS REGARDING ACCESS TO RESTRICTED FACILITIES: Successful bidders requiring access to the Alabama Port Authoritys restricted facilities to fulfill any obligations set forth in this bid must comply with the Authoritys Access Policy found in its entirety at https://www.alports.com/port-access/ It is the policy of the APA that all persons seeking unescorted access to restricted APA facilities obtain an APA issued photo ID badge, an APA vehicle decal and a Transportation Worker Identification Credential (TWIC), no exceptions. Information about the Transportation Workers Identification Credential is available online at www.tsa.gov/twic or by calling 1-855-347-8371. The local TWIC Enrollment Center is located at IdentoGo at 3761 Government Blvd.; Suite E1; Mobile, AL 36693. Information on MANDATORY APA Security Awareness Training classes can be found at https://www.alports.com/port-access/ mailto:Joy.Lang@alports.com mailto:accountspayable@alports.com mailto:joy.lang@alports.com https://www.alports.com/port-access/ http://www.tsa.gov/twic https://www.alports.com/port-access/ 4 IMPORTANT NOTICE TO BIDDERS REGARDING EMPLOYMENT PRACTICES: Effective October 1, 2011, the Beason-Hammon Alabama Taxpayer & Citizen Protection Act requires that any business entity contracting with or approving any grant or incentives to the state, including the APA, certify compliance with the Act. Alabamas law requires business entities conducting business with the state register with E-Verify on or before January 1, 2012. E-Verify is an Internet-based system that allows an employer to determine the eligibility of that employee to work in the United States. The E-Verify system is operated by the Department of Homeland Security in partnership with the Social Security Administration. E-Verify is available in Spanish. All bidders must certify such compliance by executing the enclosed Certificate of Compliance with the Beason-Hammon Alabama Taxpayer & Citizen Protection Act and returning it to the APA with your bid package. The Certificate must be witnessed. For more information about this system, please log on to http://www.dhs.gov/files/programs/gc_1185221678150.shtm. CONTRACTORS RESPONSIBILITY: The Contractor shall be responsible for all damages to persons or property that occur on Alabama Port Authority property, as a result of the contractors fault or negligence, as well as that resulting from acts of the Contractors employees, agents and subcontractors. The Contractor shall also save and keep harmless the APA against any or all lost cost, damage claims expenses or liability in connection with the performance of this contract. PROTECTION OF THE ALABAMA PORT AUTHORITYS BUILDINGS AND EQUIPMENT: The Contractor shall provide reasonable service to avoid damaging existing buildings and/or equipment on Alabama Port Authority property. If the Contractor fails to do so and damages any such buildings or equipment, the Contractor shall replace or repair the damage at no expense to the APA. If the Contractor fails or refuses to make such repair or replacement, the Contractor shall be liable for the cost thereof, which may be deducted from the contract price. PROJECT DECRIPTION & SCOPE OF WORK TO BE PERFORMED: The scope of services for this project includes, but is not limited to furnishing all labor, equipment, insurance, supervision and incidentals necessary to provide pest control service to the locations listed in this bid. The successful bidder must have complete knowledge of pest control maintenance. The successful bidder must demonstrate, in the bid submittal, evidence of a qualified and experienced staff. Bidder shall submit a list of the number of employees and include their years of experience in commercial pest control. Most facilities can be serviced between the hours of 8:00 am 5:00 pm CST, Monday-Friday; however, some facilities must be scheduled with APA representatives in advance. Some facilities can only be serviced between 7:00 am - 3:00 pm CST, Monday Friday. Successful bidder will be given a list of department contacts to schedule service arrangements. Services will consist of monthly and/or quarterly extermination and effective control of ants, roaches, spiders, flying insects, mosquitos, rodents, wasps, etc. within the referenced facilities and along other perimeters through systematic chemical applications. Services may include re- service calls as requested by the APA, at no additional charge and shall be performed as soon as possible and not exceed a twenty-four (24) hour period, with the exception of items A & B, as these are high priority areas and must receive same day service when requested by the APA. Service does not include bird or termite control. There shall be between 10 18 bait stations per pier and up to six (6) per building, serviced monthly Upon completion of each service and/or re- service, a representative from that location shall sign a service ticket from the Pest Control technician that will, in turn, submit the ticket to Joy Lang at Joy.Lang@alports.com http://www.dhs.gov/files/programs/gc_1185221678150.shtm mailto:Joy.Lang@alports.com 5 For mosquito control only: Type of Application - Prescription Larval Control will be performed with VectoLex (Bacillus sphaericus), VectoBac (Bacillus Thuringiensis Israelensis - BTI), Abate, Natular, and/or Altosid mosquito larvicide or approved equivalent for ditches and catch basins and an extended residual slow-release insecticide for up to 90-day control. The contractor shall only use pesticides registered by the U.S. Environmental Protection Agency. Mosquito control will be performed only when requested by the APA and there is no minimum guarantee for service calls for mosquito control. The successful bidder must submit records (sanitation/service log report) on rodent activity in the General Cargo areas (Items A & B) showing any rodent activity and submit to the General Cargo Manager monthly. The successful bidder must also submit records as to the products used for extermination, location, application technique and the amount used. The APA will notify the successful bidder of all information required by the APA to be included in the sanitation/service log report. These items are also considered high priority areas and must receive SAME DAY service when requested by ASPA. The successful bidder shall alert proper APA personnel to specific areas, which may prevent a potential problem. Below are APA addresses & approx. sq. ft. (for some locations) to assist with the bidding process: LOCATION ADDRESS SQ. FT. MONTHLY A Piers E Pier 2 Alabama State Docks (ASD) Blvd. B Container Yard; Offices & Outer Areas C Administration Building (exterior rodent control) 1400 ASD Blvd. 16,000 D Warehouse B (rodent stations) E Central Garage 1301 ASD Blvd. F Terminal Railroad: Diesel Shop 126 Industrial Canal Rd. E. 3,000 G Terminal Railroad: Maintenance of Way 96 Dekle Road H Truck Control Building 90 Industrial Canal Rd. E. 1,281 I Mud Lakes Office 1758 Cochrane Causeway 850 J Housekeeping Office 1109, 1201 & 1203 ASD Blvd. K Central Maintenance Trailers 1100 ASD Blvd. L McDuffie Coal Terminal: Admin. Bldg., Training Bldg.; Maint. Bldg., Garage, Electrical Shop, Employee Breakroom-Labor Bldg., Shift & Electrical Foremans Office, TRR Breakroom, Guard Houses & Main Gate Guard Breakroom Yeend Loop & Ezra Trice Blvd. QUARTERLY M Administration Building (interior service) 1400 ASD Blvd. 16,000 N Buildings 50 & 55 1900 & 1901 13th Street 19,000 O International Trade Center 250 North Water Street 32,000 P McDuffie Coal Terminal Beach House 1768 Yeend Loop 7,000 Q Blakely Island Warehouse & Guard House 1767 Cochrane Causeway R Pinto Terminal Building & Guard House 910 Dunlap Drive S Mobile Middle Bay Port Building 100 & Guard House 7611 Lake Road South T Port Police: Building, Annex & 2 Guard Houses 900, 1105 & 1107 ASD Blvd. U Marine Liquid Bulk Terminal Guard House 7811 Rangeline Road 6 Bidders Submitted Price for Scope of Pest Control Services: Prospective bidders should consider all costs associated with this bid including APA credentials, TWIC cards, insurance, etc. as the ASPA will award all items listed in the bid as one contract. It is required that bidders list the annual prices for each item below: Bidders Total Annual Price for Item A $ ________ Bidders Total Annual Price for Item B $ ________ Bidders Total Annual Price for Item C $ ________ Bidders Total Annual Price for Item D $ ________ Bidders Total Annual Price for Item E $ ________ Bidders Total Annual Price for Item F $ ________ Bidders Total Annual Price for Item G $ ________ Bidders Total Annual Price for Item H $ ________ Bidders Total Annual Price for Item I $ ________ Bidders Total Annual Price for Item J $ ________ Bidders Total Annual Price for Item K $ ________ Bidders Total Annual Price for Item L $ ________ Bidders Total Annual Price for Item M $ ________ Bidders Total Annual Price for Item N $ ________ Bidders Total Annual Price for Item O $ ________ Bidders Total Annual Price for Item P $ ________ Bidders Total Annual Price for Item Q $ ________ Bidders Total Annual Price for Item R $ ________ Bidders Total Annual Price for Item S $ ________ Bidders Total Annual Price for Item T $ ________ Bidders Total Annual Price for Item U $ ________ Mosquito Control hourly rate on a call out basis only $ ________ per hour (no minimum call out guaranteed will be as requested only) By signing this bid, I affirm the stipulated services will begin on October 1, 2022, or two (2) days from receipt of written notification from the Alabama Port Authority. 7 _______________________________ Company _______________________________ Representative _______________________________ Phone ________________________________ Email FOR ALL BIDS $15,000 AND OVER STATE OF ______________________) COUNTY OF ____________________) On this __________ day of __________________ , 20_______, before me appeared ____________________, to me personally known, who, being by me duly sworn, did say that such person executed the foregoing instrument as the free act and deed of such person, having been duly authorized to execute such instrument in such capacity. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. _____________________________________ Notary Public, State of ___________________ _____________________________________ Print Name My commission expires: __________________ Receipt of following addendums is acknowledged: Addendum No. ________ Addendum No. ________ Addendum No. ________ ___________________________ Contractors Signature: __________________________ _______________________________ ________ Print Name Title Date 8 INSTRUCTIONS FOR BIDDERS ALABAMA PORT AUTHORITY This instruction sheet is provided as a guide to facilitate the bid process and highlight important points for consideration by bidders. Each bidder is responsible for fully reading and complying with the instructions on the Alabama Port Authority bid form. This instruction sheet is to be used as a guide ONLY. 1. Alternate bid proposals and/or suitable attachments may be rendered, with proper support. 2. If your company is not prepared to submit a bid, so state and sign to avoid being deleted from the prospective bidder's list. 3. The Alabama Port Authority reserves the right to reject any and all bids if deemed in the Alabama Port Authority's interest. 4. No allowance will be made for error, either omission or commission. 5. Unit price governs in errors relating to extension of prices. 6. Bids will not be accepted via FAX or EMAIL. All bids must be sealed and sent via mail courier or hand delivered to Joy Lang at the International Trade Center; 250 N. Water St.; Suite 330, Mobile, AL., 36602 before the specified date and time, with the bid title on the envelope. Bids received after the specified opening time will be returned to the bidder unopened. Bidders are requested to show a return address on the bid envelope. 7. The Alabama Port Authority accepts no responsibility for facilitating the receipt of bids. 8. Bids over $15,000 must be NOTARIZED. 10. Bid proposals must be filled out completely, including the name, address, telephone number, fax number (if possible), and signature of responsible person. 11. Questions or comments pertaining to the bid must be presented in writing and sent via email only to Joy Lang, ASPA Fixed Assets Manager, at Joy.Lang@alports.com no later than 12:00 pm CST, Wednesday, August 31, 2022, or question(s) will be forever waived. 12. Notarization not required on "SALE" BIDS. mailto:Joy.Lang@alports.com 9 ALABAMA STATE PORT AUTHORITY INSURANCE REQUIREMENTS FOR CONTRACT WORK INDEMNIFICATION The Contractor shall assume all liability for and shall indemnify and save harmless the State of Alabama and the Alabama State Port Authority, doing business as Alabama State Docks (ASD), and its officers and employees from all damages and liability for injury to any person or persons, and injury to or destruction of property, including the loss of use thereof, by reason of an accident or occurrence arising from operations under the contract, whether such operations are performed by himself or by any subcontractor or by anyone directly or indirectly employed by either of them occurring on or about the premises, or the ways and means adjacent during the term of the contract, or any extension thereof, and shall also assume the liability for injury and/or damages to adjacent or neighboring property by reason of work done under the contract INSURANCE REQUIREMENTS The Contractor shall not commence work under the contract until he has obtained all insurance required under the following paragraphs and until such insurance has been approved by ASD, nor shall the Contractor allow any subcontractor to commence work until all similar applicable insurance has been obtained by the subcontractor or the Contractor has provided coverage for the subcontractor. The Contractor shall provide, at his expense, insurance in accordance with the following: General Requirements (applicable to all policies) (Required for this project) All policies of insurance must be written with companies acceptable to ASD. The Contractor shall furnish to ASD certificates of insurance, signed by the licensed agent evidencing required coverages. ASD reserves the right to require certified copies of any and all policies. Each policy of insurance shall provide, either in body of the policy or by endorsement, that such policy cannot be substantially altered or cancelled without thirty (30) days written notice to ASD and to the insured. Except for Workers Compensation, said policies will identify Alabama State Port Authority, its officers, officials, agents, servants and employees as Primary and Non-contributory Additional Insureds in connection with work performed for, on behalf of, or on the property of ASD, including a waiver of all rights of subrogation. General Liability (Required for this project) The Contractor shall take out and maintain during the life of the contract Commercial General Liability insurance, including Blanket Contractual and Completed Operations coverages, in an amount not less than $2,000,000 for any one occurrence for bodily injury, including death, and property damage liability. Coverage must be endorsed to include the following and copies of said endorsements must be provided prior to commencing work. 1.) Pesticide or Herbicide Applicator Endorsement CG22641185 stating that form CG2264 includes coverage for contamination or pollution as long as the insured neither intends nor expects to violate the statutes, ordinances, regulations or license requirements of any federal, state or local government which apply to those operations. 2.) Removal of the care, custody and control exclusion, Section I, subparagraph 2 exclusion J, sections (3) (4) and (5) as stated in From CG000010196. Automobile Liability (Required for this project) The Contractor shall take out and maintain during the life of the contract Business Automobile Liability insurance covering any auto in an amount not less than $1,000,000 for any one occurrence for bodily injury, including death, and property damage liability. Workers Compensation (Required for this project) The Contractor shall take out and maintain during the life of the contract Workers Compensation and Employers Liability insurance providing coverage under the Alabama Workers Compensation Act in an amount not less than that required by Alabama law. Where applicable, Contractor shall take out and maintain during the life of the contract insurance providing coverage as required by Federal statute, including but not limited to U.S. Longshoremen and Harborworkers Compensation Act (USL&H), Jones Act, and Railroad Federal Employers Liability Act (FELA). REL Joy Lang 2022 Pest Control 5-Year Service Contract KM 8-11-2022 INSURANCE REQUIREMENTS FOR CONTRACT WORK a ALABAMA STATE PORT AUTHORITY ee 10 State of _______________________________ County of ______________________________ CERTIFICATE OF COMPLIANCE WITH THE BEASON-HAMMON ALABAMA TAXPAYER AND CITIZEN PROTECTION ACT (ACT 2011-535, as amended by Act 2012-491) DATE: ________________________________ RE Contract/Grant/Incentive, (describe by number or subject): _______________________________________________________________ by and between _______________________________________________________ (Contractor/Grantee) and _________________________________________ (State agency, Department or Public Entity) The undersigned hereby certifies to the State of Alabama as follows: 1. The undersigned holds the position of _____________________ with the Contractor/Grantee named above, and is authorized to provide representations set out in this Certificate as the official and binding act of that entity, and has knowledge of the provisions of THE BEASON-HAMMON ALABAMA TAXPAYER AND CITIZEN PROTECTION ACT (Act 2011-535 of the Alabama Legislature, as amended by Act 2012-491) which is described herein as the Act. 2. Using the following definitions from Section 3 of the Act, select the initial either (a) or (b), below, to describe the Contractor/Grantees business structure. BUSINESS ENTITY. Any person or group of persons employing one or more persons performing or engaging in any activity, enterprise, profession or occupation for gain, benefit, advantage or livelihood, whether for profit or not for profit. Business entity shall include, but not limited to the following: a. Self-employed individuals, business entities filing articles of incorporation, partnerships, limited partnerships, limited liability companies, foreign corporations, foreign limited partnerships, foreign limited liability companies authorized to transact business in this state, business trusts and any business entity that registers with the Secretary of State. b. Any business entity that possesses a business license, permit, certificate, approval, registration, charter or similar form of authorization issued by the state, any business entity that that is exempt by law from obtaining such a business license and any business entity that is operating unlawfully without a business license. EMPLOYER. Any person, firm corporation, partnership, joint stock, association, agent, manager, representative, foreman or other person having control or custody of any employment, or of any employee, including any person or entity employing any person for hire within the State of Alabama, including a public employer. This term shall not include the occupant of a household contracting with another person to perform casual domestic labor within the household. ___ (a) The Contractor/Grantee is a business entity or employer as those terms are defined in Section 3 of the Act. ___ (b) The Contractor/Grantee is not a business entity or employer as those terms are defined in Section 3 of the Act. 3. As of the date of this Certificate, contractor/Grantee does not knowingly employ an unauthorized alien within the State of Alabama and hereafter it will not knowingly employ, hire for employment or continue to employ an unauthorized alien within the State of Alabama; 4. Contractor/Grantee is enrolled in E-Verify unless it is not eligible to enroll because of the rules of that program or other factors beyond its control. Certified this ______day of ______________20______. ______________________________________ Name of Contractor/Grantee/Recipient By: ______________________________________ Its: ______________________________________ The above certification was signed in my presence by the person whose name appears above, on This______day of ________________20______. WITNESS: ____________________________________ ____________________________________ Printed Name of Witness 11 State of Alabama Disclosure Statement (Required by Act 2001-955) This form is provided with Ci contract [1] Proposat C1] Request for Proposal invitation to Bid] Grant Proposal Have you of any of your partners, divisions, of any related business units previously performed work of provided goods to any State Agency/Depariment in the current or last fiscal year? O ves Ono It yes, identy below the State Agency/Department that received the goods or services, the type(s) of goods or services previously pro- vided, and the amount received forthe provision of such goods or services. Have you or any of your pariners, divisions, or any related business units previously applied and recelved any grants from any State Agency/Department in the current or last fiscal year? O ves On. It yes, identity the State Agency/Department that awarded the grant, the date such grant was awarded, and the amount ofthe grant. 1. List below the name(s) and address(es) ofall public officale/public employees with whom you, members of your Immediate family, or any of your employees have a family relationship and who may directly personally benefit financially from the proposed transaction Identity the State DepartmentvAgency for which the public offiials/public employees work. (Attach additional shes if necessary) 12 2. List below the name(s) and address(es) of all family members of public officials/public employees with whom you, members of your immediate family, or any of your employees have a family relationship and who may directly personally benefit financially trom the proposed transaction. Identity the public officlals/public employees and State Department/Agency for which the public offcials/public employees work. (Attach additional sheets if necessary.) roa I you Identified individuals in items one and/or two above, describe in detail below the direct financial benefit to be gained by the public officials, public employees, and/or their family members as the result of the contract, proposal, request for proposal, invitation to bid, or grant proposal. (Attach adcitional sheets if necessary.) Describe in detall below any indirect financial benefits to be gained by any public official, public employee, and/or family members of the public oficial or public employee as the result of the contract, proposal, request for proposal, invitation to bid, or grant proposal. (Attach additional sheets if necessary.) List below the name(s) and address(es) of all paid consultants andior lobbyists utilized to obtain the contract, proposal, request for pro- posal, invitation to bid, or grant proposal: By signing below, | certify under oath and penalty of perjury that all statements on or attached to this form are true and correct to the best of my knowledge. | further understand that a civil penalty of ten percent (10%) of the amount of the transaction, not to exceed $10,000.00, is applied for knowingly providing incorrect or misleading information. Signature Date Notary Signature Date Date Notary Expires Act 2001-965 requires the disclosure statement to be completed and filed with all proposals, bids, contracts, or grant proposals to the State of Alabama in excess of $5,000. \