Statement of No Proposal Submittal Form
RFP 14-07-001 Executive Search Services
If your company does not intend to propose on this procurement, please complete and return this form
prior to the date shown for receipt of proposals to:
RFP 14-07-001 Executive Search Services
Attn: Larry Millholland, Purchasing Manager
Pasco-Hernando State College
10230 Ridge Road
New Port Richey, Florida 34654
Failure to submit either a Proposal or a Statement of No Proposal Submittal shall be cause for
removal from future mailing lists.
We, the undersigned, have declined to propose on the above referenced Request for Proposal for the
following reason(s):
Scope of Work or Terms and Conditions are too "restrictive." (Please explain below)
Unable to meet requirements
RFP was unclear (please explain below)
Insufficient time to respond
We do not offer this type of service or equivalent
Our employee man loading would not permit us to perform
Unable to meet bond or insurance requirements
Other (please explain:
Remove us from your “Proposers List”
Company:
Signature:
Title:
Address:
City / State:
Zip code:
Telephone #:
Fax #:
E-Mail:
Website:
RFP 14-07-001 for Executive Search Services
Checklist
This checklist is provided to assist each Proposer in the preparation of its proposal. Included in this check
list are important requirements which are the responsibility of each Proposer to submit with its response in
order to make its proposal response fully compliant.
Tab 1: Minimum Requirements
Letter of intent
Proposal submission (form)
Acknowledgment of addendum (if applicable)
Proposer Information (form)
W9 Taxpayer (form)
Drug-Free Work Place (form)
Basic Questions (form)
Minority/Woman Owned/Service-Disabled Veteran Business Enterprise Designation Business
Declaration (form)
Corporate Information: Copy or evidence of authorization or registration with Florida to conduct
business in the State (For foreign companies, this is called a nexus).
Subsidiaries
History of Firm
Proof of insurance and licenses
Certification Regarding Debarment (form)
Non-Collusion Certificate (form)
Consultant Responsibility Questionnaire (form)
Negotiators List (form)
Tab 2: Firm & Staff Qualifications & Past Experience
Information described in instructions for Tab 2
Contracted Services Questionnaire (Parts 1 & 2)
RFP 14-07-001 for Executive Search Services
Tab 3: Proposed Executive Search Process/ Elements/ Timeline
Information described in instructions for Tab 3
Tab 4: References
Information described in instructions for Tab 4
References (Form)
Tab 5: Total Fees / Proposed Cost Sheet
Price proposal (form)
OTHER:
Proposal envelope/box is marked accordingly
Required number of proposal submittals: (8) Hardcopies w/ Labeled Tabs and (1) electronic
copy of RFP submittals (PDF Format with electronic Tabs)
(1) copy of Financial Statements (separate or sealed/enclosed envelope marked confidential)
RFP 14-07-001 for Executive Search Services
Proposal Submission Form
Tab 1
This is to certify that I (Proposer) have read and understood the terms, conditions, specifications
and other instructions contained in this request, and further, that the items of materials and/or
services rendered do meet minimum specifications set forth in this invitation.
I further certify that this proposal is made without prior understanding, agreement, or connection
with any corporation, firm, or persons submitting a proposal for the same materials, supplies, or
equipment and is in all respect fair and without collusion or fraud. I agree to abide by all conditions
of this request and certify that I am authorized to sign this proposal for the Proposer.
Proposer:
Signature:
Proposing as:
Title:
Corporation
Sole Proprietor
Other(explain):
Address:
City/State
Zip:
Telephone:
Fax:
E-Mail:
Website:
RFP 14-07-001 for Executive Search Services
Proposer Information Form
Tab 1
Proposer Name:
Formerly:
Mailing Address:
City, State, Zip:
Street Address:
City, State, Zip:
Contact Person:
Title:
E-mail Address:
Website Home Page:
Type of Business: (Check one)
Incorporated in the State of:
Date:
Corporation (S or C)
# of Years:
Proposer is a M/WBE/SDVBE:
Yes
No
Sole-Proprietorship
Partnership (Standard or Limited)
Federal Employer Identification Number:
__ __ - __ __ __ __ __ __ __
Joint Venture
Limited Liability Corporation
SSN (if Sole-Proprietorship or Partnership):
__ __ __- __ __- __ __ __ __
Only required if FEIN is not provided
Telephone Number:
(
)
Toll Free Telephone Number:
(
)
Fax Number:
(
RFP 14-07-001 for Executive Search Services
)
W-9 Taxpayer Form
Tab 1
http://www.irs.gov/pub/irs-pdf/fw9.pdf
RFP 14-07-001 for Executive Search Services
Drug Free Workplace Form
Tab 1
The undersigned proposer in accordance with Florida Statute 287.087 hereby certifies that
does:
(Name of Business)
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
proposed 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 proposal, 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
contend ere 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.
Proposer's Signature
Date
RFP 14-07-001 for Executive Search Services
Basic Questions Form
Tab 1
Complete the following items and submit with your proposal:
a. In what Year did your company incorporate, and in what State?
/
b. Length of time in business
Years
c. National executive search experience within higher education
Years
c. How many clients are you currently contracted with?
#
d. How many clients have you contracted with of similar type/size over the last five
(5) years?
#
e. How many staff does your company directly employ?
Staff
f.
Staff
How many of the staff identified in (e.) above are employed/staffed in Florida?
Has your firm successfully placed a President within an institution similar in mission to PHSC in
the past 60 months and where the individual has been in place for at least 2 years and is
continuing their role?
YES
NO
(If yes, define below the dates and names of the similar institutions your firm conducted successful national College
President executive searches for where the President has been in place for at least two years and is continuing in their
role.
Has your firm successfully placed a President within a Florida institution of higher education
within the past 60 months?
YES
NO
(If yes, define below the dates and names of the institutions your firm conducted successful national College President
executive searches for where the President has been in place for at least two years and is continuing in their role.
My firm has demonstrable knowledge and familiarity with Florida’s Sunshine and Open Records
Law?
YES
NO
(If yes, define demonstrate your knowledge and familiarity below).
RFP 13-01 for Contracted Custodial Services
8
Minority, Woman Owned, and
Service-Disabled Veteran Business Enterprise Designation
Business Declaration Form
Tab 1
Proposer hereby declares that it is a Minority/Woman Owned/Service-Disabled Veteran Business
Enterprise Designation Business Enterprise by virtue of the following:
Type of Business: Check applicable block(s)
“African-American” includes persons having origins in any of the black racial groups of Africa.
“Hispanic American” includes persons of Mexican, Puerto Rican, Cuban, Central or South
American, or other Spanish cultures or origins, regardless of race.
“Native American” includes American Indians, Eskimos, Alaskan Indians, Aleuts and Native
Hawaiians.
“Asian-Pacific Americans” includes persons whose origins are from Japan, China, Taiwan,
Korea, Southeast Asia, the Philippines, Samoa, Guam, the U.S. Trust Territories of the Pacific,
and Northern Marianas.
“Asian-Indian Americans” includes persons whose origins are from India, the Indian SubContinent and Pakistan.
“Woman-Owned Business Enterprise”
“Service-Disabled Veteran Business Enterprise Designation (SDVBE)”
Note:
MBE and WBE are defined by Federal Register 49 CFR, Part 23, as a business firm which as at least
fifty-one percent (51%) owned by minority or women group members, or in the case of a publicly owned
business, at least fifty-one percent (51%) of the stock of which is owned by the minority or woman. The
minority or woman ownership must exercise actual day to day management and control of the business.
Florida Statute 287.094 states that it is unlawful for any individual to falsely represent any entity as a
minority business enterprise. A person in violation of 287.094 is guilty of a felony of the second degree.
SDVBE are defined in the Florida Service-Disabled Opportunity Act located in Florida Statute Section
295.187.
Proposer:
Certified by (name of Public Entity, if applicable):
Certificate Number (attach copy):
Signature:
Date:
Non-WMBE/SDVBE
Signature:
Date:
RFP 13-01 for Contracted Custodial Services
9
Certification Regarding Debarment
Tab 1
THE UNDERSIGNED PROPOSER/OFFER/SUBCONTRACTOR (“ATTESTER”) CERTIFIES, TO THE
BEST OF ITS KNOWLEDGE AND BELIEF THAT:
The attester and/or any of its principals or sub-consultant:
Are not presently debarred, suspended, proposed for debarment, or declared ineligible for award
of contracts by any Federal Agency.
Have not for a three (3) year period preceding this offer, been convicted of or had a civil judgment
rendered against them for commission of fraud or criminal offences in connection with obtaining, or
attempting to obtain, or performing a public (Federal, State, or Local) contract or subcontract: violation of
Federal or State antitrust status relating to the submission of offers, or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen
property; and
Are not presently indicted for, or otherwise criminally or charged in any civil action by a
government entity with commission of any of these offenses enumerated above.
The Attester has not, within a three (3) year period preceding this offer, had one (1) or more
contracts terminated for default by any governmental agency.
“Principals”, for the purpose of this certification, means officers, directors, owners, partners, and
persons having a primary management or supervisory responsibilities within a business entity.
This certification concerns a matter which may be within the jurisdiction of an agency of the
United States and the making of false, fictitious, or fraudulent certification may render the maker subject
to prosecution under Section 1001, USC.
The Attester shall immediately notify the Procurement Department at any time the attester learns
that its certification was erroneous when submitted or has become erroneous.
A certification in which any of the items detailed above exists will not necessarily result in
withholding of an award under this solicitation. However, the certification will be considered in
connection with a determination of the Attester’s responsibility. Failure of the Attester to furnish a
certificate or provide such additional information as requested by College may render the Attester nonresponsive.
Nothing contained in the foregoing shall be construed to require establishment of a system of
records in order to render, in good faith, the certification required to exceed that which is normally
possessed by a prudent person in the ordinary course of business dealings.
If it is later determined that the Attester knowingly rendered an erroneous certification, in addition
to other remedies available to College, the College may terminate the contract resulting from this
solicitation for default.
If Attester is unable to certify to any of the statements in this certification, attach an explanation to
this certification.
Company Name TYPED
(Signature of Authorized Company Official)
(Title of Official, Including Name, Typed)
RFP 13-01 for Contracted Custodial Services
10
Non-Collusion Certificate
Tab 1
By submission of this certificate, each person signing certifies, and in the case of a joint response, each
party certifies as to its own organization, under penalty of perjury, that to the best of its knowledge and
belief:
1. The content of the party’s response has been arrived at independently without collusion, consultation,
communications, or agreement with any other party for the purpose of restricting competition as to any
matter relating to service or cost;
2. No attempt has been made or will be made by the party to induce any other person, partnership or
corporation to submit or not to submit a response for the purpose of restricting competition;
3. No employee, agent or consultant of Pasco-Hernando State College has received or will receive any
payment or any other form of compensation from the party as a result of a contract award or promise
of such an award to the party.
I swear and affirm, under penalties for perjury as specified by FL Statute 807.02 that the
information provided with this certificate is true.
Name:
Signature:
Title:
Company:
Date:
RFP 13-01 for Contracted Custodial Services
11
Consultant Responsibility Questionnaire
Tab 1
INSTRUCTIONS:
Please complete this form answering every question. A “Yes” answer to any question requires a written
explanation attached to the questionnaire and submitted on company letterhead signed by an officer of the
company.
All new mailing list applicants are required to complete this form at the time of application. Companies are
responsible for updating information in their Responsibility Questionnaire as changes occur. Any consultant
recommended for award on a Pasco-Hernando State College contract will be required to have this form on file
prior to the award date.
QUESTIONS:
Within the past five years, has your firm, any affiliate, any owner or officer or major stockholder (5% or more
shares) or any person involved in the bidding or contracting process been the subject of any of the following:
NO
YES
A judgment or conviction for any business-related conduct constituting a crime
under local, state or federal law including, but not limited to, fraud, extortion,
bribery, racketeering, price-fixing, or bid collusion?
A criminal investigation or indictment for any business-related conduct constituting
a crime under local, state or federal law including, but not limited to, fraud,
extortion, bribery, racketeering, price-fixing, or bid collusion?
An unsatisfied judgment, injunction or lien obtained by a government agency
including, but not limited to, judgments based on taxes owed and fines and
penalties assessed by any government agency?
An investigation for a civil violation by any local, state or federal agency?
A grant of immunity for any business-related conduct constituting a crime under
local, state or federal law including, but not limited to, fraud, extortion, bribery,
racketeering, price-fixing, or bid collusion?
A local, state, or federal suspension, debarment or termination from the contract
process?
A local, state or federal contract suspension or termination for cause prior to the
completion of the term of a contract?
A local, state, or federal denial of award for non-responsibility?
An agreement to a voluntary exclusion from bidding/contracting?
RFP 13-01 for Contracted Custodial Services
12
NO
YES
An administrative proceeding or civil action seeking specific performance or
restitution in connection with any local, state or federally funded or grant-recipient
agency or contract?
A state labor law violation deemed willful?
A firm-related bankruptcy proceeding?
A sanction imposed as a result of judicial or administrative proceedings relative to
any business or professional license?
A denial, decertification, revocation or forfeiture of Woman’s Business Enterprise,
Minority Business Enterprise or Disadvantaged Business Enterprise status?
A rejection of an offer on a local, state or federal contract for failure to meet
statutory affirmative action or M/WBE requirements on a previously held contract?
A consent order with the Florida Department of Environmental Protection, or a
federal, state or local government enforcement determination involving a violation
of federal, state or local government laws?
An occupational Safety and Health Act citation and Notification of Penalty
containing a violation classified as serious or willful?
A rejection of a bid on a Florida State contract for failure to comply with Fair
Employment Principles?
Any claims pending or in litigation?
Any legal judgment(s) against your organization?
A citation, notice, violation order, pending administrative hearing or proceeding or
determination for violations of:
- federal, state or local health laws, rules or regulations
- unemployment insurance or workers’ compensation coverage or claim
requirements
- ERISA (Employee Retirement Income Security Act)
- federal, state or local human rights laws
- federal or state security laws
- federal INS and Alienage laws
- Sherman Act or other federal anti-trust laws
RFP 13-01 for Contracted Custodial Services
13
NOTES:
Information on the following additional topics MUST also be submitted with this questionnaire. Check “none” if
topic does not apply.
Agency complaints or reports of contract deviation received within the past two
years for contract performance issues arising out of a contract with any federal,
state or local funded grant-recipient agency?
NONE
Amounts and dates of all judgment(s)/arbitrations against your company in the last
5-years?
NONE
Disputes within the past two years concerning your company’s failure to provide
commodities or services to political subdivisions within the past two years pursuant
to centralized contracts with the Florida Department of Management Services?
NONE
Employee Identification No., Social Security No., Name, DBA, trade name or
abbreviation previously or currently used by your business which is different from
that listed on your mailing list application form?
NONE
CERTIFICATION:
The undersigned: recognizes that this questionnaire is submitted for the express purpose of assisting PascoHernando State College make a determination regarding either an application for placement on mailing lists or
the status of an existing mailing list entry or to award a contract or approve a subcontract; acknowledges that
Pasco-Hernando State College may in its discretion, by means which it may choose, verify the truth and
accuracy of all statements made herein; acknowledges that intentional submission of false or misleading
information may constitute a misdemeanor under Florida Statute 807.02; and states that the information
submitted in this questionnaire and any attached pages is true, accurate and complete.
Name of Business
Signature of Officer
Address
Typed Copy of Signature
City, State, Zip
Title
RFP 13-01 for Contracted Custodial Services
14
Authorized Negotiators
Tab 1
The Proposer represents that the following persons are authorized to negotiate on its behalf with the
agency in connection with this solicitation:
Negotiator 1
Negotiator 2
Negotiator 3
Name
Title
Telephone
Fax
Email
RFP 13-01 for Contracted Custodial Services
15
Contracted Services Questionnaire
Tab 2 (Part 1 of 2)
Will your firm perform all of the work required, and as identified in Section 12 (Scope of Work)?
YES
NO
(If No, define below the names of the entities that will perform aspects of the work not performed by your firm)
<Task>
<Task>
<Task>
<Task>
Pursuant to Florida Statute 112.313(7) “Personnel Responsibilities Outside Scope of Employment" -“
No employee (including part time employees, or adjunct employees or Board member) shall sell any
product or service to the College Board except as may be specified in the employee's position
responsibilities at the College.”
Does your company have any employee that own > 5% of your company and is also a full
time/ part time or adjunct employee or Board member of the College?
YES
NO
(If Yes, Define below the name of the employee and or Board member as well as detail below their relationship
with your company and the College).
What is your firm’s candidate submission-acceptance rate of your applicant pool when
conducting similar searches / How many have been accepted vs. rejected?
RATIO
Based on your experience, what has been the average observed time to fill a Presidential/CEO
position within higher education?
Months
RFP 13-01 for Contracted Custodial Services
16
Contracted Services Questionnaire
Tab 2 (Part 2 of 2)
Provide the ratio in your typical pool of submitted candidates of employed to unemployed people.
RATIO
Have you ever placed a Presidential candidate in higher education who was later fired, asked to
resign, or resigned rather than be terminated due to inadequate or misleading credentials or
undisclosed background issues?
YES
NO
(If yes, provide the details surrounding the placement, title, length of employment and date of termination.)
My firm guarantees that the proposed list of staff will be utilized exclusively through the search
process and that it will not change personnel without the express written permission by the
College?
YES
NO
I certify and attest that all information submitted on the Contracted Services Questionnaire (TAB2) is
accurate to the best of my knowledge.
Name:
Signature:
Title:
Company:
Date:
RFP 13-01 for Contracted Custodial Services
17
Reference List
Tab 4
Proposers shall list below Five (5) related client references where your firm has provided similar
firm services as defined in this RFP.
Preference will be given to references that were for national executive searches for State of
Florida Public Community Colleges/other Public State institution of higher education conducted
within the past 36 months.
Client
Contact Name
Phone #/Email
Address
Years of
Providing
Defined
firm
Services
Summary of firm
Services Provided
*
* N= National Search, CP = College President Search, EX – Executive Search
I certify and attest that all information submitted on the Contracted Services Questionnaire (TAB2) is
accurate to the best of my knowledge.
Name:
Signature:
Title:
Company:
Date:
RFP 13-01 for Contracted Custodial Services
18
Proposed Fee Schedule
Tab 5
Price Proposal guidelines:
Define below your firm’s proposed all inclusive* fees to provide all Executive Search Services defined
herein based on:
A. No pre-payment or deposits are allowed.
B. Payment by the College will be on a net 30 day basis “following” satisfactory completion of each
mutually agreed-to deliverable.
C. The College timely completing its provision of support-specific services to the firm as defined
herein.
 *All inclusive fees defined below shall include all proposed firm labor, and support materials to
provide all services defined herein. The College will not be invoiced for any additional cost/fees
beyond those defined and pre-approved in writing.
D. For analytical purposes firms’ are not to include the cost of all travel and lodging for the work
accomplished. Travel will be handled in addition to the prices below and in accordance with
Section 13 above.
Phases/
↵ Milestones/
↵ Tasks
#
Lump Sum
Not to Exceed
$
$
$
$
$
$
$
TOTAL  $
** PAYMENT TERMS **
NET 30 DAYS OR PROMPT PAYMENT DISCOUNT OF
%,
DAYS OFFERED BY PROPOSER.
Name:
Signature:
Title:
Company:
Date:
RFP 13-01 for Contracted Custodial Services
19