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Is your company registered and licensed to do business in Memphis? ______Yes No______
Is your company a member of the Better Business Bureau? _____Yes _____No
Is your company a Minority Owned Business? _____Yes _____No
Is your company a Female Owned Business? _____Yes ______No
How long has your company been in business? _______________________________
Can your company meet the insurance requirements specified in the RFQ? ___Yes ____No
Can your company meet the timing requirements specified in the RFQ? ____Yes ____No
Can your company meet all of the grass mitigation specifications in the RFQ? ____Yes ____No
Are you certified as MBE/WBE?

Certifying Agency:


II. OWNERSHIP OF FIRM:


Type of Ownership

Individual







Partnership







Corporation






Name and address of Owner, all Partners or all Stockholders (use back if necessary):
Name/Title Address % Ownership

Interest

_____________________ ____________________________________ ________________
_____________________ ____________________________________ ________________
_____________________ ____________________________________ _______________

Experience
Describe your company’s length of experience performing grass mitigation?

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Describe your company’s experience performing grass mitigation on right of ways?

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Identify the site supervisor who will be overseeing all grass mitigation services. As part of the qualifications evaluation, the City may conduct an in person interview with him/her.

________________________________________________________________________________________________________________________________________________________________________________________________________________________­­­­­­­­­__________________


In the event of the need for an emergency grass mitigation requirement, how quickly could you mobilize a crew?

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________



  1. COMPANY PERSONNEL AND RESOURCES


Supervisory Personnel


Name




Years Experience




Responsibilities















































Administrative Staff


Name




Position





























List all Subcontractors


Company Name




Trade




Contact Person




Phone #

































































Trade References (Please list all materials. Suppliers with whom you have open accounts.)



NAME




PHONE #




CONTACT PERSON

















































  1. PROJECT REFERENCES




NAME/ADDRESS




PHONE/FAX #




AMOUNT














































  1. ACTIVE PROJECTS (In Progress)




NAME/ADDRESS




PHONE #




DESCRIPTION




AMOUNT



































































  1. FINANCIALS




Name of Bank and Branch




Name of Back Officer

(Familiar with Contractor)


















Is there any pending litigation with which your company is engaged? If so, please list and state the nature of this litigation: ______________________________________________________________________________



______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


By my signature, I make legal affirmation that all representation included by me in this application form are true and factual to the full extent of my knowledge. I also agree to the release of any business or credit information required by the Division of Community Enhancement for the processing of this application.











DATE




SIGNATURE OF PRINCIPAL

NUMBERS REQUIRED:

SOCIAL SECURITY NUMBER:










IRS FEDERIAL IDENTIFICATION NO.:

62-



CITY OF MEMPHIS

Ground Maintenance Department
CONFLICT OF INTEREST DISCLOSURE FORM

Conflict of Interest Regulation: No person who exercise or have exercised any functions or responsibilities with respect to activities assisted with CIP Funds or who are in a position to participate in a decision making process or gain inside information with regard to these activities, may obtain a financial interest or benefit from an assisted activity, or have an interest in any contract, subcontract or agreement with respect thereto, or the proceeds there under, either for themselves or those with whom they have family or business ties, during their tenure or for one year thereafter.



Name:




Program Name:




Address:




Program RFQ #:




City, State, Zip:




Vendor #

(If any):





The purpose of this document is to assist in the determination of whether additional restrictions, oversight or other conditions might be advisable prior to execution of any contract, funding or providing assistance. The term 'Conflict of Interest" refers to situations in which financial or other personal considerations may compromise, or have the appearance of compromising professional judgment in the following rules and regulations of the program. Please Mark the appropriate box for each question and complete the attachment if indicated. This form (with Attachments, if required) must be completed and returned to your Program Representative.




  1. Family Relationships: Do you have a family member directly or indirectly involved or employed with the City of Memphis that creates a conflict of interest or the appearance of a conflict under the Conflict of Interest Regulation provided above?


(If YES, please complete Part A of the Attachment)


  1. Program Relationships: Are you involved in any other activity directly or indirectly with the City of Memphis that may create a conflict of interest or the appearance of a conflict under the Conflict of Interest Regulation provided above?


(If YES, please complete Part B of the Attachment)


  1. Business Relationships: Are you or a family member (spouse, child, stepchild, parent, sibling, or domestic partner) involved as an investor, owner, employee, consultant, contractor, or board member with an entity that has a contractual relationship with the City of Memphis to provide goods or services, sponsor development activities and/or receive referrals from the City of Memphis?


(If YES, please complete Part C of the Attachment)


  1. Gifts of Personal Use:

To the best of your knowledge, have you or your family members accepted gratuity gifts, or special favors from someone that is doing business with or proposing to do business with the City of Memphis?
(If YES, please complete Part D on Attachment)
To the best of your knowledge, have you or your family members made any donations or gifts, or provided special favors to the City of Memphis or any employee of the City of Memphis who exercises or may exercise any functions or responsibility with respect to the activities involving your award, contract or program assistance?
(If YES, please complete Part D on Attachment)


  1. Legal Proceedings and Debarment Have you been involved in any fraud, antitrust or criminal proceedings as a defendant (other than a minor traffic offense) or been debarred, suspended or otherwise excluded by a duly authorized regulatory agency or had a transaction with any such agency terminated for any reason?


(If YES, please complete Part D on Attachment)
I have read and understand the Conflict of Interest Disclosure Form and have disclosed all information required by this disclosure, if any, in an attached statement. I agree to comply with any conditions or restrictions imposed by the agency to reduce or eliminate actual and/or potential conflicts of interest. I will update this disclosure form promptly if relevant circumstances change. I understand that this Disclosure Form is not a confidential document.



Print Name:




Date:




Signature:



Date:






CITY OF MEMPHIS

Ground Maintenance Department

CONFLICT OF INTEREST DISCLOSURE FORM

ATTACHMENT PARTS A - E



Conflict of Interest Regulation: No person who exercise or have exercised any functions or responsibilities with respect to activities assisted with CIP Funds or who are in a position to participate in a decision making process or gain inside information with regard to these activities, may obtain a financial interest or benefit from an assisted activity, or have an interest in any contract, subcontract or agreement with respect thereto, or the proceeds there under, either for themselves or those with whom they have family or business ties, during their tenure or for one year thereafter.


Name:




Program Name:




Address:




Program Client #:




City, State, Zip:




Contractor Vendor #:



If you answered YES to any questions on the previous page, please complete the relevant section(s) below. If you answered NO to All questions, you may discard this attachment. Give your complete form to your Program Representative.



PART A: FAMILY RELATIONSHIPS


  1. Name of your family member(s) directly or indirectly involved or employed at City of Memphis:



  1. Do any of your family members work in the program area? ________________________________________________________________________________________________________________________________________________________________________________________________________________________




  1. Are any of your family members elected officials or members of any City of Memphis Board of Commissions? ________________________________________________________________________




  1. Relationship to you: _______________________ Position: ______________________

Department: _____________________________ Supervisor: ____________________



PART B: PROGRAM RELATIONSHIPS


  1. Activities: Name and describe the activity and/or program that you are directly or indirectly involved with:




  1. Have you used the name of the City of Memphis, or their resources (facilities, personnel, or equipment), or confidential information in connection with the activity and/or program?


(If YES, describe the resource used):
PART C: BUSINESS RELATIONSHIPS
Please provide this section for each business relationship, or attach a separate explanation of business and research activities.


  1. Name of business:




  1. Categorize the business' relationship with the City of Memphis:









Briefly describe the business or licensing activity:


  1. Who is involved with the business? Check all that apply:




:
Describe the position or involvement (check all that apply):







:


  1. Are you receiving any type of compensation? If YES, describe _______________________________________________________________________________________________________________________________________




  1. Who at City of Memphis oversees the relationship with this business?

Name: __________________________________ Title: _______________________


Department: _____________________________ Phone: ______________________

PART D: GIFTS FOR PERSONAL USE


  1. What was the dollar value of the gift(s) you or your family member received or donated? _______________________________________________________________________________________________________________________________________




  1. Who was the donor or donee of the gift? _______________________________________________________________________________________________________________________________________




  1. What is the donor's or donee's relationship with City of Memphis? ____________________________________________________________________________________________________________________________________________________________________________________________________________


PART E: LEGAL PROCEEDINGS AND DEBARMENT
Describe any legal proceedings or debarment situation: ______


Print Name:




Date:




Signature:




Date:




GENERAL CONDITIONS OF THE CONTRACT
Master Grass Mitigation Agreement

For Privately Owned Lots and

Designated Right of Ways

For the

Division of Public Works

Ground Maintenance Department

Grass Mitigation for properties as designated by the Division of Community Enhancement, Ground Maintenance Department





  1. LOCATION

All locations shall be identified and assigned by the City of Memphis Grounds Maintenance Department.



II. SCOPE AND GENERAL CONDITIONS
A) Provide weed cutting and clean up services for privately owned vacant property (with or without residential or commercial buildings) and right of ways, all within the City limits of Memphis, Tennessee.
B) The Contractor shall provide service for a period covering Twelve (12) months based upon the need as determined by the Ground Maintenance Department.
C) Although there are no set boundaries, work assignments will be made using geographically convenient considerations. Volume may be based on production. This contract does not grant an exclusive right to the contractor. The City reserves the right to supplement weed cutting as necessary. The approximate hours in the Bid Section are a probability rather than a guarantee of work volume. Service charges are not to be greater than $15.00 each.
III. SPECIFICATIONS:
A). Mitigation of Private Lots
1. Yards shall be cut with commercial lawnmowers, push mowers, tractor with a bush hog and/or whatever equipment necessary to properly cut grass according to the City’s standards. Line trimmers and hand blades might be necessary in hard to reach areas such as steep slopes, utility poles, sidewalk areas, and some borders.
2. Contractor shall remove litter and debris before cutting and take said debris to curbside (large items or a large amount of trash). Contractor shall contact Ground Maintenance after placing it on curbside for location of pickup. Contractor shall cut grass (over 12” tall), hedges, clearing of fence lines. Mowing shall be a maximum height of 1" (one inch) for improved property (with vacant structures) and the height of 3" (3 inches) for unimproved property (vacant lots). Sidewalks and driveways shall be cleared of grass and/or shrubbery to permit clear pedestrian and vehicular passage. All clippings shall be blown, swept or raked from streets, curbs, gutters, sidewalks, and adjoining properties.
3. Contractor shall take good before and after pictures displaying on a cardboard (or an equivalent signage) showing the ward, block and parcel number and the street name of the property where applicable. Print out all before and after pictures and attach to cutting card. Where permitted by the City, the pictures may be submitted on a CD. Pickup and return all cutting cards to the designated personnel daily. Before and after pictures are to be taken using a digital camera labeled date and time should be stamped on the photos together with the invoice. The before and after pictures should be taken from the same views. If there is a building, the picture should show as much as possible of the building. If the location has no building, choose a landmark.
4. Invoices submitted with no pictures or pictures that are not clear or cannot be identified may result in no payment. If the property does not need to be cut, please take a picture to verify that fact for the City’s records.
5. The contractor shall be available to do the work when requested by the Division. Other work done shall not interfere with work agreed to herein. Weather permitting, the contractor shall complete the work scheduled by the Division within five (5) working days, and shall report progress of said work on a daily basis.
6. Work completed but not reported in a timely manner may result in nonpayment. For the purpose of this contract, Saturday will be considered a working day unless it is a nationally-recognized holiday.
7. It shall be the duty of the contractor to adequately communicate with the City personnel. The City of Memphis shall not be liable for: any injuries to contractors' employees, damage to the contractors' machines and equipment, any damage to the property cut or adjoining properties, damages and injuries to vehicles and their occupants, or injury to residents or pedestrians.
8. Accident Prevention: Precaution shall be exercised at all times for the protection of persons (including employees) and property. The safety provisions of applicable laws, building and construction codes shall be observed. Machinery, equipment and other hazards shall be guarded or eliminated in accordance with the safety provisions of the Manual of Accident Prevention in Construction published by the Association of General Contractors of America to the extent that such provisions are in contravention of State or local laws and ordinance.
9. Work shall be picked up on mornings and invoices shall be submitted as soon as available unless otherwise instructed. Invoices shall be submitted for payment as invoices are received and verified. Verification shall include matching the invoice with an existing work order, checking rates assigned, and visual inspection of work to determine the level of performance. Work determined to be below the standards set by the Division shall be rejected and the invoice deleted from payment. Upon notification the contractor has twenty-four (24) hours to correct the problem. All billings are subject to verification and the books of the contractor may be subject to audit insofar as items under this contract are concerned.
10. Contractors may arrive to cut property and find that the front is cut and not the back. Contractors are to cut uncut portions of property in taking before and after pictures showing what was cut and not cut. If the entrance to the backyard is not large enough or something is blocking the entrance, the cutting of backyard will have to be done by weed eating.
11. At time some cutting of right-of-way may be requested. The contractor must cut right-of-ways eight feet (8’) over from the edge of pavement where possible. Areas can be cut with either rear or side mounted bush hogs. When rear mounts are used on right-of-way the 8’ requirement must be met. Some roads have sections of extra-wide designated right-of-way up to ninety feet (90’). These must be cut to the line of private property where possible. Some street have curbed right-of-way which may require lawn mowers and hand trimming for example sidewalk grassy strips, ditches, utility poles, traffic signs, fire hydrants and the overhanging of tree limbs which may obstruct traffic, traffic signs, guardrails, and intersections which may require the use of a chainsaws.
12. The City reserves the right to audit the records of the contractor. The contractor shall make and keep as the same accrue, full and complete records and books of accounts of revenue and income, and costs and expenses that specifically relate to performance under this contract. Records and books of accounts, together with any or all other memoranda pertaining thereto that may be kept, maintained or possessed by the contractor, shall be open to examination during regular business hours, by the City or its representatives for the purposes of inspection, auditing, verifying, or copying the same, or making extracts. The Contractor shall make and keep said records and books of accounts in accordance with generally accepted accounting principles.
13. The City shall pay the contractor only for actual time spent cutting and/or cleaning with the minimum charge being 1 hour. Travel time to and from the job and breakdown time shall not be included. Lots found to be already cut or cannot be cut may be billed at a service charge rate only.
B). Mitigation of Right of Ways

1. The contractor may be required to cut City right-of-ways as well as City owned lots.


2. All cuttings done under the contract for right of ways will be a maximum height of four inches (4”).
3. The contractor must cut right-of-ways eight feet (8’) over from the edge of pavement where possible. Areas can be cut with either rear or side mounted bush hogs. When rear mounts are used on right-of-way the 8’ requirement must be met. Some roads have sections of extra-wide designated right-of-way up to ninety feet (90’). These must be cut to the line of private property where possible. Some street have curbed right-of-way which may require lawn mowers and hand trimming for example sidewalk grassy strips, ditches, utility poles, traffic signs, fire hydrants and the overhanging of tree limbs which may obstruct traffic, traffic signs, guardrails, and intersections which may require the use of a chainsaws.
4. Before and after pictures are to be taken of right-of-ways using a digital camera labeled and submitted with the invoice. Where permitted by the City, the pictures may be submitted on a CD. Pictures shall have a sign showing the location of the right-of-ways. Before and after pictures are to be taken using a digital camera labeled date and time should be stamped on the photos together with the invoice. Both the before and after pictures should have the same viewing. If there is a building, the picture should show as much as possible of the building. If the location has no buildings choose a landmark where possible for identification.
5. City owned lots shall be cut with a bush hog. Sidewalk grassy strips, ditches, utility poles, slopes, and otherwise hard-to-reach areas shall be clipped with line trimmers or hand held blades. The operator is required to move any obstructions, i.e. limbs, trees, etc. to the curb.
6. All clippings that result from any work performed under the contract must be blown, swept or otherwise removed from streets, sidewalks, or any other paved surface. Under no circumstances is the contractor to blow or allow clippings, leaves, and other debris from the work performed to be left in the street or blow into the storm drains, catch basins, or inlets in violation of City Ordinance # 4538.
7. The contractor shall be available to do the work when requested by the City. Other work (including City contracts) shall not interfere with work agreed to herein. The contractor shall complete the assignment within the stated period of time as noted in the contract.
8. It shall be the duty of the contractor to adequately communicate with the Division. The Contractor must respond to communication attempts within twenty-four (24) hours. Contractor shall furnish proof of local business communications, capable of personnel contact within one hour, i.e. personal pagers, mobile phones, radios, etc.
9. The Contractor will provide proof of having available for immediate use, any of the described equipment listed below (or its equivalent) :
a. Two tractors with bush hogs – one must be side-mount type. (Successful bidders must have one additional tractor and one additional side-mount bush hog for each additional area awarded.)


  1. Two commercial type lawnmowers.




  1. Manual tools – two blowers, two hand blades, two commercial line trimmers, two chainsaws and other equipment that may be needed to perform task.




  1. Excavator or front-end loader

10. Hourly rates shall be used for indescribable right-of-ways and city owned lots. These work orders shall be completed within five days from issue unless otherwise specified. The City shall pay the contractor only for actual time spent cutting and/or cleaning. Travel time to and from the job and breakdown time are not included. The contractor must have a work order from the City prior to the work commencing.


11. Payment shall be made within 30 days as invoices are received and verified by the Grounds Maintenance Department. Verification shall include matching the invoice with an existing work order, checking rates with prices bid, and visual inspection of work to determine the level of performance. Work determined to be below the standards set by the Division shall be rejected and the invoice deleted from payment. Upon notification the contractor has forty-eight hours to correct the problem. The successful bidder shall submit all invoice to:
City of Memphis

Grounds Maintenance Department

281 E. Parkway N.

Memphis, TN 38112
11. The City of Memphis is not responsible for any injuries to persons including contractor’s employees, nor damage to private vehicles, nor the contractor’s machinery and equipment, nor be liable for damage to properties the contractor mows, such as ornamental shrubbery, flowers, damaged sidewalk, etc. Damage claims must be efficiently processed and legally satisfied by the contractor.
12. Accident Prevention: Precaution shall be exercised at all times for the protection of persons (including employees) and property. The safety provisions of applicable laws, building and construction codes shall be observed. Machinery, equipment and other hazards shall be guarded or eliminated in accordance with the safety provisions of the Manual of Accident Prevention in Construction published by the Association of General Contractors of America to the extent that such provisions are in contravention of State or local laws and ordinances.
13. The City reserves the right to audit the records of the contractor. The contractor shall make and keep as the same accrue, full and complete records and books of accounts of revenue and income, and costs and expenses that specifically relate to performance under this contract. Records and books of accounts, together with any or all other memoranda pertaining thereto that may be kept, maintained or possessed by the contractor, shall be open to examination during regular business hours, by the City or its representatives for the purposes of inspection, auditing, verifying, or copying the same, or making extracts there from. The contractor shall make and keep said records and books of accounts in accordance with generally accepted accounting principles.
III. TERM
The initial term of this contract shall include services rendered for a period ending June 30, 2014. The term of this agreement shall remain in effect for the entire period unless otherwise abbreviated upon mutual agreement of the parties, and following execution of an appropriate documentation evidencing the modification. The City may extend this Agreement for additional two (2) one-year periods, renewable on an annual basis, under the same terms and conditions. The City shall serve notice of the time extensions in writing to the Contractors by regular mail at least thirty (30) calendar days prior to the expiration of the original term of this Agreement, or any renewal term, in order for such extension to be effective.

IV. COMPENSATION:
1) CONTRACTOR shall be paid at a rate of Fifty Dollars ($50.00) per hour for mitigation of grass on private lots and One Hundred Dollar ($100) per hour for mitigation on right of ways. The total amount per lot assigned shall be decided by the Ground Maintenance Department upon by a review and walk through of the area to be cut. The total amount established by the City shall be reflective of any additional work required that is outside the normal process. Contractor agrees to accept such payment as full compensation for services to be performed under this agreement. Service Charge for lots already cut upon visit shall be at a flat rate of $15.00 per yard. A City Representative must verify that the property had already been mitigation
2). CONTRACTOR shall submit monthly statements to the City of Memphis Ground Maintenance Department, showing work performed in accordance with the City of Memphis Billing Guidelines and Procedures. CITY shall pay CONTRACTOR within thirty (30) calendar days after submission of an approvable invoice.
V. METHOD OF INVOICING AND PAYMENT

     

A). Invoices with proper documentation to support services completed will be submitted by Contractor to the City for payment. Contractor will include the designated City Contract Number on all invoice requests, reports, and correspondence. Upon receipt and approval of each invoice, the City shall pay the amount shown unless there are some discrepancies. If discrepancies occur, the Contractor will be contacted by the City and notified of the problem. Adjustment requests by the City are expected to be followed.


B). The original and one copy of all invoices or statements shall be submitted to the City by the Contractor.  Upon receipt and approval of each invoice, the City shall, within thirty (30) days, submit to the Contractor the amount shown to be due and payable. 
C). Upon the close of the contract period, the Contractor shall have thirty (30) days from the end date of this agreement to submit a payment request to the City; any requests received after this period will not be honored.

 

Invoices are to be sent to: Grounds Maintenance Department



281 E. Partway North, 2nd Floor

Memphis, Tennessee 38112


VI. INSURANCE REQUIREMENTS FOR SERVICE CONTRACTS
1.) The Contractor shall not commence any work under this contract until it has obtained and caused its subcontractors to procure and keep in force all insurance required. The Contractor shall furnish the City of Memphis Risk Manager a Certificate of Insurance and/or policies attested by a duly authorized representative of the insurance carrier evidencing that the insurance required hereunder is in effect. All insurance companies must be acceptable to the City of Memphis and licensed in the state of Tennessee.
2.) If any of the Insurance Requirements are non-renewed at the expiration dates, payment to the company may be withheld until those requirements have been met, or at the option of the City. The City may pay the renewal premiums and withhold such payments from any monies due the Contractor.
3.) The Contractor shall indemnify, defend, save and hold harmless the City, its officers, employees, and agents, from and against any and all claims, demands, suits, actions, penalties, damages, settlements, costs, expenses, or other liabilities of any kind and character arising out of or in connection with the breach of this Agreement by Contractor, its employees, subcontractors, or agents, or any negligent act or omission of Contractor, its employees, subcontractors, or agents, which occurs pursuant to the performance of this Agreement, and this indemnification shall survive the expiration or earlier termination of this Agreement. The provisions of this paragraph shall not apply to any loss or damage caused solely by the acts, errors, or omissions of the City, its officers, employees and agents.
4.) Each certificate or policy shall require and state in writing the following clauses:
a) “Should any of the described policies be cancelled or material changed before the expiration date thereof, notice will be delivered in accordance with the policy provisions to the City of Memphis Risk Manager” by registered mail, return receipt requested to the following address:
City of Memphis

Attn: Risk Management

2714 Union Extended, Suite 200

Memphis, TN 38112


The City of Memphis, its officials, agents, employees and representatives shall be named as additional insured on all liability policies.” The additional insured endorsements shall be attached to the Certificate of Insurance.
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