Professional Engineering Services for Panacea Inflow & Infiltration Project Addendum No. 1

RFQ 2026-13
PROFESSIONAL ENGINEERING SERVICES FOR PANACEA
INFLOW & INFILTRATION PROJECT
Required Forms, Documents, and Certifications
The following forms must be fully completed and signed by a person with
authority to bind the Proposer.

RFQ 2026-13 PROFESSIONAL ENGINEERING SERVICES FOR PANACEA INFLOW & INFILTRATION
PROJECT
PROPOSAL FORMS
CHECKLIST OF REQUIRED FORMS, DOCUMENTS, AND CERTIFICATIONS:
Please submit the items on the following list and any other items required by any section of this
RFQ. The checklist is provided as a courtesy and may not be inclusive of all items required
within this RFQ.
Form No. 1 Proposal Transmittal Form
Form No. 2 Qualifications Application and Questionnaire
Form No. 3 References
Form No. 4 Indemnification and Hold Harmless Statement
Form No. 5 Public Entity Crimes Sworn Statement
Form No. 6 Equal Employment Opportunity/Affirmative Action Statement
Form No. 7 Drug Free Workplace Certification
Form No. 8 Conflicts of Interest Disclosure
Form No. 9 Non-Collusion Affidavit
Form No. 10 Ethics Clause & Certification Regarding Lobbying for Contracts,
Grants, Loans, and Cooperative Agreements
Form No. 11 List of Proposed Sub-Contractors
Form No. 12 Certification Regarding Debarment, Suspension, and Other
Responsibility Matters -Primary Covered Transactions
Form No. 13 E-Verify Compliance Certification
Form No. 14 Insurance Certification
Form No. 15 Comments on Proposed Contract

RFQ 2026-13 PROFESSIONAL ENGINEERING SERVICES FOR PANACEA INFLOW & INFILTRATION
PROJECT
PROPOSAL FORMS
FORM 1
PROPOSAL TRANSMITTAL FORM (TO BE ON FIRM'S LETTERHEAD)
The Board of County Commissioners, Wakulla County, reserves the right to accept or reject any
and/or all proposals in the best interest of Wakulla County.
Ralph Thomas
Chairman
This proposal is submitted by the below named firm/individual by the undersigned authorized
representative.
(Firm Name)
BY
(Authorized Representative)
(Printed or Typed Name)
ADDRESS
TELEPHONE
FAX
FEID #______________________________
UEI#_________________________(REQUIRED FOR THIS PROJECT)
ADDENDA ACKNOWLEDGMENTS: (IF APPLICABLE)
Addendum #1 dated __________ Initials ______
Addendum #2 dated __________ Initials ______
Addendum #3 dated __________ Initials ______
Addendum #4 dated __________ Initials ______
Addendum #5 dated __________ Initials ______
Addendum #6 dated __________ Initials ______

RFQ 2026-13 PROFESSIONAL ENGINEERING SERVICES FOR PANACEA INFLOW & INFILTRATION
PROJECT
PROPOSAL FORMS
Attach a copy of the webpage(s) from http://www.sunbiz.org here:

RFQ 2026-13 PROFESSIONAL ENGINEERING SERVICES FOR PANACEA INFLOW & INFILTRATION
PROJECT
PROPOSAL FORMS
FORM 2
QUALIFICATION APPLICATION AND QUESTIONNAIRE
All qualification packages must be submitted with the proposal to be considered for
qualification. No exceptions.
PURPOSE: To provide Wakulla County with reasonable assurance that the prospective proposer
has the financial assets, resources, work force, and work experience to successfully complete
the agreement with the County.
FIRM NAME: _________________________________________________________
BUSINESS ADDRESS:
CITY - STATE - ZIP___________________________________________________
PHONE NUMBER: ______
EMAIL:
The undersigned warrants the truth and accuracy of all statements and answers herein
contained. Include additional sheets if necessary.
1. What is the firm's current Florida General Business Number?
2. How many years has your organization been in business?
3. Describe and give contact information of current projects that you have underway. Do
you have a project(s) underway which might interfere with the start of this Work and
completion on schedule?

RFQ 2026-13 PROFESSIONAL ENGINEERING SERVICES FOR PANACEA INFLOW & INFILTRATION
PROJECT
PROPOSAL FORMS
4. List projects and provide a brief description that you have completed similar in type,
size, and nature as the one proposed. Note: Projects may be larger than this project.
a. Name of Project:
Owner/Engineer: Telephone No.:
Address:
Date Started: Date Completed: Contract Value:
Team Members:
Description of Project:
b. Name of Project:
Owner/Engineer: Telephone No.:
Address:
Date Started: Date Completed: Contract Value:
Team Members:
Description of Project:
c. Name of Project:
Owner/Engineer: Telephone No.:
Address:
Date Started: Date Completed: Contract Value:
Team Members:
Description of Project:
5. List any additional references you would like to include outside of projects similar in
scope to this one:

RFQ 2026-13 PROFESSIONAL ENGINEERING SERVICES FOR PANACEA INFLOW & INFILTRATION
PROJECT
PROPOSAL FORMS
Name of Project:
Owner/Engineer: Telephone No.:
Address:
Name of Project:
Owner/Engineer: Telephone No.:
Address:
Name of Project:
Owner/Engineer: Telephone No.:
Address:
6. List the projects completed within Wakulla County in the past (3) years.
7. Have you ever failed to complete work awarded to you? If so, where and why?
8. List all past project conflicts, litigations, arbitrations, mediations, informal settlement
discussions, or disputes involving your company for the past (3) years and outcome.
Fully describe the circumstances (use additional sheets if necessary).

RFQ 2026-13 PROFESSIONAL ENGINEERING SERVICES FOR PANACEA INFLOW & INFILTRATION
PROJECT
PROPOSAL FORMS
________________________________________________________________________
________________________________________________________________________
9. State the true and exact, correct, and complete name under which you do business.
BIDDER IS:
SOLE PROPRIETORSHIP
(SEAL)
(Individuals Signature)
(Individuals Name)
Florida Business License No. and Expiration Date ________________________________
Business Address:
Phone No.:
A PARTNERSHIP
(SEAL)
(Partnership Name)
(General Partner's Signature)
(General Partner's Name)
Florida Business License No. and Expiration Date ________________________________
Business Address:
Phone No.:
A CORPORATION

RFQ 2026-13 PROFESSIONAL ENGINEERING SERVICES FOR PANACEA INFLOW & INFILTRATION
PROJECT
PROPOSAL FORMS
(SEAL)
(Corporation Name)
(State of Incorporation)
By (Name of person authorized to sign)
(Title)
(Authorized Signature)
Florida Business License Number and Expiration Date
(Corporate Seal)
Attest _______________________________________________________________________
(Secretary)
Business address: _______________________________________________________________
Phone No.: ____________________________________________________________________
10. LIST ALL PRINCIPALS OF ORGANIZATION: (President, Vice-President, Secretary-Treasurer,
Partner, etc.)
_______________________________________________________________________
______________________________________________________________________
_______________________________________________________________________
______________________________________________________________________
________________________________________________ _____________________
Signature and Title of Person Submitting Application Date

RFQ 2026-13 PROFESSIONAL ENGINEERING SERVICES FOR PANACEA INFLOW & INFILTRATION
PROJECT
PROPOSAL FORMS
STATE OF
COUNTY OF ______________
The foregoing instrument was acknowledged before me this ______ day of _______________,
20__, by
_______________________, as ____________________of ____________________________
on
(Name) (Title) (Company)
behalf of the company. He/she is personally known to me or has produced
____________________ __
(DL or ID Number)
as identification.
_______________________________________ Notary Public, State of _____ __
(Signature of Notary)
Name: __________________________________
(Legibly Printed)
________________________________
(AFFIX OFFICIAL SEAL)
Commission No.: ________________________ My Commission Expires: _________________