RES 2022-0434 - PO to Jensen Gardens for 2022 Fontenelle Park Green Infrastructure Maintenance Services City Clerk Office Use Only:
/1 •7 4 i / Publication Date (if ppli able):
RESOLUTION Na�L-L�- LJ�- ' t�
Agenda Date: 21)Lz
Department: L b)1 Irk
Submitter: (,IQJSz Pthe,lc
CITY OF OMAHA
LEGISLATIVE CHAMBER
Omaha, Nebraska
RESOLVED BY THE CITY COUNCIL OF THE CITY OF OMAHA:
WHEREAS, the Environmental Quality Control Division of the Public Works Department is in
need of 2022 Fontenelle Park Green Infrastructure Maintenance Services; and,
WHEREAS; bids were received on March 23, 2022, for the procurement of 2022 Fontenelle
Park Green Infrastructure Maintenance Services to be utilized by the Environmental Quality
Control Division; and,
WHEREAS, Jensen Gardens, Inc. submitted the lowest and best bid to Douglas County
Purchasing for the attached bid named City of Omaha, Green Infrastructure Maintenance -
Fontenelle Park (2022), which by this reference, is made a part hereof; and,
WHEREAS, the cost of this procurement, totaling $26,050.00, will be paid from the Sewer
Revenue Fund 21121, Combined Sewer Overflow & Stormwater Program Organization 116714
NOW, THEREFORE, BE IT RESOLVED BY THE CITY.COUNCIL OF THE CITY OF OMAHA:
THAT, as recommended by the Mayor, the Purchasing Agent be authorized to issue a
Purchase Order to Jensen Gardens, Inc. for the procurement of 2022 Fontenelle Park Green
Infrastructure Maintenance Services to be utilized by the Environmental Quality Control Division in
the amount of$26,050.00.
BE IT FURTHER RESOLVED:
THAT, the Finance Department is authorized to pay the cost of this procurement from the
Sewer Revenue Fund 21121, Combined Sewer Overflow & Stormwater Program Organization
116714.
1121cvr APPROVED AS TO FORM
I?�
CITY ATTORNEY DATE
Adopted:
MAY 0 3 262 1'0
Attest: _ --
City Clerk
Approved:
Mayor
BID BOND: 5% NC
Douglas County Purchasing
TABULATION OF BIDS ON: CITY OF OMAHA
Green Infrastructure Maintenance - Fontenelle Park Nebraska's Best Lawn
(2022) Garret's Lawn Service Jensen Gardens, Inc.
& Landscape
Page 1
Date of Opening Department
Wednesday, March 23,2022 PUBLIC WORKS- ENVIRONMENTAL
Quantity DESCRIPTION UNIT UNIT UNIT
PRICE PRICE B PRICE C
Green Infrastructure Maintenance -
Fontenelle Park(2022)
LUMP SUM BID PRICE: $9,500.00 $26,050.00 $27,500.00
Bid Bond Received: Yes Yes
Terms: 30% / 100
Delivery: 30 calendar days
NC
DOUGLAS COUNTY
REQUEST FOR BID AND BID SHEET
BID ON: CITY OF OMAHA Green Infrastructure Maintenance Fontenelle Park 2022
RETURN BIDS TO: Published: March 9,2022
CITY CLERK Page 1
1819 Farnam Street BID BOND OR CERTIFIED CHECK REQUIRED IN THE AMOUNT OF 5%
LC-1 Omaha-Douglas Civic Center IF THE TOTAL AMOUNT FOR THE ITEM OFFERED IS$20,000 OR MORE.
Omaha,NE 68183 BID BOND OR CERTIFIED CHECK SHALL BE MADE PAYABLE TO
"CITY OF OMAHA"
NOT AN ORDER Bid Opening Time&Date: 11:00 a.m.CT on Wednesday,March 23,2022
IMPORTANT
1. Bid must be in the office of the CITY CLERK,1819 Famam Street,LC-1, 4 Right is reserved to accept or reject any or all bids in their entirety and the bidders shall
Omaha-Douglas Civic Center,Omaha,NE 68183 have the right to appeal any decision to the Omaha City Council and/or the Douglas County
by the opening date and time indicated in a sealed envelope marked: Board of Commissions.
Green Infrastructure Maintenance Fontanelle
BID ON:CITY OF OMAHA Park 2022 5 When submitting bid on items listed,bidder may on a separate sheet,make
2. As evidence of good faith a bid bond or certified check must be submitted with bid. suggestions covering reduction in costs wherever this is possible through
Bid bond or certified check shall be made payable to"City of Omaha" redesign,change of material or utilization of standard items or quantity change.
FAILURE TO DO SO IS CAUSE FOR REJECTION. 6 Bid tabulation are available on the Douglas County Purchasing website:
3 The City of Omaha and Douglas County are tax exempt.Tax exempt certificates www.douglascountypurchasing.org. DO NOT CALL FOR THIS INFORMATION.
will be provided upon request.
Bid your lowest price,best delivery and terms,F.O.B.delivery point on the Item(s)listed below:
QUANTITY DESCRIPTION UNIT PRICE EXTENSION
Green Infrastructure Maintenance Fontenelle Park 2022
as per the attached specifications.
LUMP SUM BID: $26.050.00
There will be a non-mandatory pre-bid meeting on Wednesday,March (5%Bid Bond is to be
16,2022 at 10:30 A.M.at the following location: Fontenelle Park based upon this amount,if
parking lot,N 48th St.&Boyd St.Vendors are strongly encouraged to $20,000.00 or more)
attend.
Questions regarding this bid should be sent via email to bidquestions@douglascounty-ne.gov. Vendor must include the bid
title in the subject line.
The deadline to submit questions on this bid is 11:00 a.m. on the Thursday before the bid opening date. Answers to
questions will be posted via an addendum no later than the Friday before bid opening at www.douglascountypurchasing.org.
(I'LEA6E I'KIN I LI(.1bLY UK I YF't)
Payment Terms % Firm:Jensen Gardens,Inc Incorporated In:2001
Delivery(or completion) Name:Eric Gustafson Signature: 2LC'i ITi
calendar days following awe Title:Estimator Phone:402-253 8880 Fax: 2-25
Address:20714 S Hwy 50, Springfield NE, 68059
Street/P.O.Box City State Zip
Email Address:enc@jensengardens.com
DOUGLAS COUNTY REQUEST FOR BID
Green Infrastructure Maintenance Fontenelle Park 2022
NOT AN ORDER Page 2
BID CLAUSES-TERMS AND CONDITIONS
Requirement for Bid Bond: The surety company issuing the bid bond should be licensed by the State of Nebraska and listed on
the current edition of Circular 570 of the United States Department of the Treasury. A certified check,an official bank check, or
cashier's checks drawn on a national bank or a bank chartered under the laws of the state, payable to the City of Omaha,or lawful
money of the United States,or a United States Government Bond (negotiable)are acceptable substitutes for bond requirements.
LETTERS OF CREDIT AND COMPANY CHECKS ARE NOT ACCEPTABLE SUBSTITUTES FOR A BID BOND AND WOULD BE
CAUSE FOR REJECTION OF BID. If a bidder submits more than one bid,only one bid bond is required; however,the 5%bid bond
must be calculated using the highest bid amount of all submitted bids.
Conflict of Interest: Pursuant to all state and local rules,CONTRACTOR assures the City of Omaha(CITY)that no elected Official
or any officer or CITY employee shall have a financial interest,direct or indirect,in any CITY agreement. In the performance of this
agreement, CONTRACTOR will avoid all conflicts of interests or appearances of conflict of interest. CONTRACTOR will report any
conflict of interest immediately to the CITY. CONTRACTOR did not and will not provide any money or other benefit of any kind to
any CITY employee in the procuring of,facilitation of,and execution of or during the duration of this Agreement.
Communication with Staff: From the date this bid is issued until a contract is awarded, communication regarding this solicitation
between potential vendors and individuals employed by the City of Omaha. Only written communication via email to
bidquestions@douglascounty-ne.gov is permitted. Once an award is made the vendor will be permitted to speak with person(s)
participating in contract negotiations. Violation of these conditions may be considered sufficient cause to reject a vendor's
bid and/or selection irrespective of any other condition. The following exceptions to these restrictions are permitted: (1)
Contacts made pursuant to any pre-existing contracts or obligations; (2)City staff and/or vendor staff present at a Pre-Proposal
Conference,if scheduled,when recognized by the City as staff facilitating the meeting for the purpose of addressing questions;and
(3)Presentations, key personnel interviews,clarification sessions or discussions to finalize a contract,as requested by the City of
Omaha.
Unavailability of Funding: Due to possible future reductions including but not limited the City of Omaha (CITY), State and/or
Federal appropriations,the CITY cannot guarantee the continued availability of funding for this Agreement, notwithstanding the
consideration stated in this Agreement. In the event funds to finance this Agreement become unavailable either in full or in part due
to such reduction in appropriations,the CITY may terminate the Agreement or reduce the consideration upon notice in writing to
Contractor. The notice shall be delivered by certified mail,return receipt requested,or in person with proof of delivery. The CITY
shall be the final authority as to the availability of funds. The effective date of such Agreement termination or reduction in
consideration shall be specified in the notice as the date of service of the notice or the actual effective date of the CITY,State
and/or Federal funding reduction,whichever is later. Provided,that reduction shall not apply to payments made for services
satisfactorily completed prior to the effective date. In the event of a reduction of consideration,Contractor may cancel this
Agreement as of the effective date of the proposed reduction upon the provision of advance written notice to CITY.
Assignment and Delegation: This Agreement is exclusive to the Parties and rights may not be assigned nor duties delegated by
either Party except on prior written consent of the other. Any attempted assignment or delegation without such approval shall be
void and shall constitute a material breach of contract. Any and all additional fees,charges,costs or expenses,which result from an
approved assignment or delegation,shall be paid by the assigning/delegating Party.
Termination: The City of Omaha may terminate the awarded contract at any time if the vendor fails to carry out the terms or fails to
make substantial progress toward the fulfillment of the contract obligations. In such event,the City shall provide the vendor with
thirty(30)days written notice of conditions which endanger contract performance. If after such notice the vendor fails to remedy
these conditions,the City may send a certified letter to the vendor for immediate cancellation of the contract. In such event,the City
would receive a pro-rated portion of the value of the performance bond depending on the value of the remaining portion of the
contract. The City will give the vendor sixty(60)days'notice of termination of contract if appropriations cease.The City of Omaha
may also terminate the agreement for any reason upon 30 days'notice.
Payment Terms: Net 30 payment terms shall apply to all invoices billed to the City of Omaha. Payment of invoice amount will occur
within 30 days following receipt of invoice or receipt of goods/services,whichever is later.
Drug Free Policy: CONTRACTOR assures the City of Omaha that CONTRACTOR has established and maintains a drug free
workplace policy.
SIGN ALL COPIES Firm Jensen Gardens,Inc
By Eric Gustafson
Title Estimator
CONTINUATION SHEET
DOUGLAS COUNTY REQUEST FOR BID
Green Infrastructure Maintenance Fontenelle Park 2022
NOT AN ORDER Page 3
BID CLAUSES-TERMS AND CONDITIONS
FEDERAL DEBARMENT OR SUSPENSION
Has bidder or its principals been debarred or suspended from Federal contracts?
YES x NO (failure to provide a response may be cause for rejection of bid)
Bidder certifies by submission of this bid that neither it nor its principals are presently debarred or suspended from participation
in Federal contracts. If during the term of the agreement the awarded bidder or any person engaged in performing this
agreement becomes debarred or suspended such Party shall notify the City of Omaha immediately.
Form CC-1: All bidders awarded a City contract in the amount of$10,000 or more must comply with the Contract Compliance
Ordinance by having a current Contract Compliance Report(Form CC-1)on file with the Human Rights&Relations
Department. This report shall be in effect for 24 months from the date received by the Human Rights&Relations Department.
Any questions regarding the Contract Compliance Ordinance should be directed to the Human Rights&Relations Department
at(402)444-5055. Bidders are encouraged to use the following weblink to determine if they have a current Form CC-1
on file(search by company name): https:/lhumanrights.cityofomaha.org/cc-1-search
Equal Employment Opportunity: In accordance with the Nebraska Fair Employment Practice Act,Neb.Rev.Stat.§48-1122,
the Contractor agrees that neither it nor any of its subcontractors shall discriminate against any employee,or applicant for
employment to be employed in the performance of this Agreement,with respect to hire,tenure,terms,conditions,or privileges
of employment because of the race,color,religion,sex,disability,or national origin of the employee or applicant.
Non-Discrimination: Both Parties agree that in accordance with 42 USCS 12101 et seq.,the Nebraska Fair Employment
Practice Act-Neb.Rev.Stat.§48-1122,and Omaha Municipal code 13-89,they will not discriminate against any employee or
applicant for employment,to be employed in the performance of this Agreement,with respect to hire,tenure,terms,conditions,
or privileges of employment because of the age,race,color,religion,sex,disability,or national origin of the employee or
applicant. None of the Parties shall,in the performance of this Agreement,discriminate or permit discrimination in violation of
federal or state laws or local ordinances.
E-Verify: New Employee Work Eligibility Status(Neb.Rev.Stat.§4-108-114)
The Contractor is required and hereby agrees to use a federal immigration verification system to determine the work eligibility
status of new employees physically performing services within the state of Nebraska. A federal immigration verification system
means the electronic verification of the work authorization program authorized by the Illegal Immigration Reform and Immigrant
Responsibility Act of 1996,8 U.S.C. 1324a,known as the E-Verify Program,or an equivalent federal program designated by the
United States Department of Homeland Security or other federal agency authorized to verify the work eligibility status of a newly
hired employee. If the Contractor is an individual or sole proprietorship,the following applies:
1, The Contractor must complete the United States Citizenship Attestation Form,available on the Department of
Administrative Services website at www.das.state.ne.us.
2. If the Contractor indicates on such attestation form that he or she is a qualified alien,the Contractor agrees to provide the
US Citizenship and Immigration Services documentation required to verify the Contractor's lawful presence in the United
States using the Systematic Alien Verification for Entitlements(SAVE)Program.
3. The Contractor understands and agrees that lawful presence in the United States is required and the Contractor may be
disqualified or the contract terminated if such lawful presence cannot be verified as required by Neb.Rev.Stat.§4-108.
Joint Governmental Purchases:The City of Omaha has been authorized to join with other public corporations or units of
government within the State of Nebraska in the cooperative procurement of materials,equipment,work,or services. With the
consent of the successful bidder the City may use the public competitive bid secured herein for the procurement of future
materials,equipment,work,or services under the same terms,conditions,and prices offered by the bidder herein. Bidders are
requested to indicate below if they are willing to extend the pricing,terms,and conditions of this bid to other City of Omaha
departments,Douglas County departments,or other government agencies,If the bidder is the successful bidder. If the
successful bidder replies Yes to this provision,other City of Omaha departments,Douglas County departments,and other
government agencies may enter into a contract with the successful bidder for the purchase of the goods and/or services
described herein based on the terms,conditions,and prices offered by the successful bidder to the City of Omaha.
x YES NO
SIGN ALL COPIES Firm Jensen Gardens, Inc
By Eric Gustafson
Title Estimator
CONTINUATION SHEET
DOUGLAS COUNTY REQUEST FOR BID
Green Infrastructure Maintenance Fontenelle Park 2022
NOT AN ORDER Page 4
BID CLAUSES-TERMS AND CONDITIONS
INSURANCE: Each bidder must provide a Certificate of Insurance with their bid documents which details their current
levels of coverage.
FOLLOWING AWARD OF CONTRACT: For City projects where the scope of work will be less than$200,000.00,it is
required that the awarded contractor provide a Certificate of Insurance meeting or exceeding the following levels of
insurance:(1)adequate workers'compensation(statutory);(2)commercial general liability in an amount not less than
$250,000 for any person for any number of claims arising out of a single occurrence and not less than$500,000 for all
claims arising out of a single occurrence;and(3)property damage insurance in an amount not less than$500,000;and
naming CITY OF OMAHA as an additional insured,except for Workers'Compensation policies/certificates,for the term of
the agreement.Certificates of Insurance are required before service begins.
FOLLOWING AWARD OF CONTRACT:For City projects where the scope of work will exceed$200,000.00,it is required
that the awarded contractor provide a Certificate of Insurance meeting or exceeding the following levels of insurance:(1)
adequate workers'compensation(statutory);(2)commercial general liability in an amount not less than$1,000,000 for
any person for any number of claims arising out of a single occurrence and not less than$5,000,000 for all claims arising
out of a single occurrence;and(3)property damage insurance in an amount not less than$500,000;and naming CITY
OF OMAHA as an additional insured,except for Workers'Compensation policies/certificates,for the term of the
.agreement.Certificates of Insurance are reauired before service begins.
REQUIREMENTS FOR PERFORMANCE BOND: The successful vendor shall provide a performance bond equal to the
vendor's bid within ten(10)calendar days from award of the contract. The surety company issuing the performance bond
should be licensed by the State of Nebraska and listed on the current edition of Circular 570 of the United States
Department of the Treasury.
INDEPENDENT VENDOR: Both parties understand and agree that(vendor)is an independent vendor under the
provisions of this Agreement and not employed by or otherwise affiliated with Douglas County(COUNTY)or the City of
Omaha(CITY). Employees of vendor(If any)are not employees of COUNTY/CITY. Each Party shall pay all wages,
salaries and other amounts due its employees and shall be responsible for all reports,obligations,and payments
pertaining to social security taxation,income tax withholding,workers'compensation,unemployment compensation,group
insurance coverage,collective bargaining agreements or any other such similar matters. Both parties understand and
agree that vendor is solely responsible for acquiring and maintaining,for the term of this Agreement,adequate general
and special liability insurance,including but not limited to workers'compensation insurance,sufficient to protect vendor's
ability to complete performance under this Agreement.Neither Party shall have any authority to bind the other by or with
any contract or agreement,nor to impose any liability upon the other.All acts and contracts of each shall be in its own
name and not in the name of the other.
EXTRAORDINARY EVENTS: in the event of a pandemic,natural disaster,terroristic attack,or closure of a facility due to
construction,remodeling or sale or any other extraordinary event which results in one,some or all of the listed facilities in
this Agreement being closed for two weeks or more,the City may discontinue services upon immediate notice.
Solid Waste Disposal: Pursuant to an Interlace]agreement between the City of Omaha(Res.124)and Douglas County
(Res.85)dated January 31,2012,all solid waste collected and/or processed pursuant to City or County contracts is
required to be taken to the Douglas County Pheasant Point Landfill. This includes trash,rubbish,construction,and other
solid waste.This is a requirement that will not be waived. C&D,hazardous waste,untreated medical waste,asbestos and
recycled materials are exempt from this directive.
No SEB Reserve:This bid does not have an SEB reserve. Please see the SEB utilization and disclosure forms included
with this bid. These documents must be completed and returned with bid submission. If your company is qualified Tier 1
/Tier 2 ESB/SB,then please disclose this on the disclosure form. If your company is not qualified,then please put"N/A"
on the disclosure form.
CONSUMER PRICE INDEX CLAUSE:Following the initial contract term,the awarded bidder may propose price
increases for any contract extensions offered by the City. Price Increases must be requested 30 days prior to proposed
increase and must be justified with documentation(e.g.reports,manufacturer statements,invoices,etc.). Proposed price
increases will be reviewed by the City,who at their sole discretion will either approve or reject the proposed increase.
SIGN ALL COPIES Firm Jensen Gardens, Inc
By Eric Gustafson
Title Estimator
CONTINUATION SHEET
Responsible Contractor Compliance Form
RC-1
AHA,/v4.rotA .
... .
Wi1�lt rto)'a)t ' n
1. Regulation: �41'8n polo'
A.Article IV,Division I of Chapter 10 of the Omaha Municipal Code thereon require:
1.That all contractors who submit a bid to City of Omaha shall designate a representative who on
behalf of the Contractor,shall fill out completely a Responsible Contractor Compliance Form
(RC-1). An incomplete or unsigned RC-1 form will make your bid null and void.
2. Filing this Report(please initial in the boxes below):
Contractor agrees that Contractor will not knowingly employ or hire an employee not lawfully
EG authorized to perform employment in the United States and that the Contractor and all sub-
contractors shall use E-Verify to determine work eligibility.
EG Contractor agrees that Contractor will not knowingly violate Nebraska's Misclassification of
Employee law(Neb.Rev.Stat.Section 48-2901 et seq.).
EG Contractor agrees that Contractor will not knowingly violate Nebraska's Fair Labor Standards
Law(Neb.Rev.Stat.Section 73-104 et seq.).
EG Contractor has not been convicted of any tax violations(local,State and Federal)within the last
three years from the date this bid is submitted.
Contractor has not,upon final determination by the Occupational Safety and Health
EG Administration,been convicted of a criminal,repeat,or willful violation of the Occupational
Safety and Health Act(OSHA)or been convicted of 3(three)separate"serious"OSHA violations
within the past three(3)years.
EG Contractor agrees to make a good faith effort to ensure all subcontractors employed on this project
comply with the provisions of the Responsible Contractor Compliance Form RC-1.
(T/. Q z 4.e 3/21/2022
Signature Date
By signing,I verify on behalf of the Contractor that the information above is true and correct. Filing false
information carries a penalty of up to a$500 fine or six months in jail. In addition,the contractor and sub-
contractors can be subject to immediate disqualification and prohibited from any future City of Omaha
contract for a period of 10 years.
EMPLOYEE CLASSIFICATION ACT:
Each contractor who performs construction or delivery service pursuant to this contract shall
submit with their bid submission an affidavit attesting that (I) each individual performing
services for such contractor is properly classified under the Nebraska Employee Classification
Act, 2010 LB 563 ("the Act"); (2) such contractor has completed a Federal 1-9 Immigration form
and has such form on file for each employee performing services; (3) such contractor has
complied with Neb. Rev. Stat. Section 4-114 (Federal Immigration Verification System--E-
Verify); (4) such contractor has no reasonable basis to believe that any individual performing
services for such contractor is an undocumented worker; and (5) as of the time of the contract,
such contractor is not barred from contracting with the state or any political subdivision pursuant
to the Act. The contractor shall follow the provisions of the Act. A violation of the Act by a
contractor is grounds for rescission of the contract by City of Omaha/Douglas County.
CONTRACTOR shall follow the provisions of the Employee Classification Act (Act). A
violation of the Act will be a material breach and, in addition to any other remedies, be grounds
for immediate contract rescission. If CONTRACTOR is performing construction or providing
delivery service, CONTRACTOR shall submit an affidavit that complies with the
Act. CONTRACTOR will also ensure that all subcontractors performing services for Contractor
will also complete affidavits that comply with the Act. Contractor may submit the affidavit(s)
with their bid submission. In all circumstances, Contractor shall provide the affidavits
before work or services are undertaken pursuant to this Agreement.
Following award, if CONTRACTOR changes or adds additional subcontractors,
CONTRACTOR shall ensure that the subcontractor provides an Employee Classification Act
affidavit to Douglas County Purchasing Department before that subcontractor begins work or
services.
All Employee Classification Act affidavits shall be sent to: Douglas County Purchasing Agent,
1819 Farnam Street, Room 902, Omaha NE 68183.
FAIR LABOR STANDARDS:
CONTRACTOR agrees to maintain FAIR LABOR STANDARDS as defined in Neb. Rev Stat §
73-104. CONTRACTOR has filed with Douglas County (City/County Purchasing) a statement
that it is complying with and will continue to comply with, fair labor standards as provided in
Neb. Rev. Stat. §§73-102 & 73-104. In addition, CONTRACTOR assures County that it will
continue to comply with statutory fair labor standards throughout its performance under this
contract.
AFFIDAVIT FOR EMPLOYEE CLASSIFICATION ACT& FAIR LABOR
STANDARDS
1, Eric Gustafson , being first duly sworn under oath, state and
depose as follows:
1. I am competent to testify to,and have personal knowledge of,the matters stated in
this affidavit.
2. I am (a contractor) or (the authorized agent of the contractor) for
Jensen Gardens, Inc Company, (hereinafter "Contractor"). I attest to the
following: (a) each individual performing services for Contractor is properly classified under
the Nebraska Employee Classification Act, ("the Act"), (b)Contractor has completed a federal I-
9 immigration form and has such form on file for each employee performing services, (c)
Contractor has complied with Neb. Rev. Stat. §4-114 (use of federal immigration verification
system), (d) Contractor has no reasonable basis to believe that any individual performing
services for Contractor is an undocumented worker, (e) as of the time of the contract, Contractor
is not barred from contracting with the state or any political subdivision pursuant to the Act, and
(f) Contractor is complying with and will continue to comply with, fair labor standards as
provided in Neb.Rev.Stat. §§73-102 & 73-104, as applicable and as amended hereinafter.
Contractor will also ensure that all subcontractors execute affidavits in compliance with the Act.
FURTHER AFFIANT SAYETH NAUGHT.
Jensen Gardens, Inc '
Affiant(Contractor)
5
SUBSCRIBED AND SWORN TO before me this it }
day of f Vl tlD , 2022
XGE NI?IIAI.NOTAY State of Nebraska 1/"74a
Notary J OILLENWA7ER No Y Public
My Comm.Exp,December 26,2025
CCity` !%`
Of Omaha Small & Emerging Small Business Program
,,;. Te Participation Utilization Form
NOTE: It is the policy of the City of Omaha that Small and Emerging Small Businesses shall have the maximum practicable
opportunity to participate in City of Omaha projects. Consequently,the requirements of the Small and Emerging Small Business
Program ordinance apply to this solicitation. For questions on certification,including a listing of the SEB Program Participants,
please see the City of Omaha Human Rights&Relations website at: http://www.cityofomaha.org/humanrights/contract-compliance
or contact via phone: 402-444-5055.
With regard to this solicitation,the City has determined that a sufficient number of SEB Program
Participants exist within the following Certified Group(s):
[ ] Tier I Emerging Small Business [ ] Tier I Small Business
[ ] Tier II Emerging Small Business [ ] Tier II Small Business
To fulfill [ ] the entire scope of this contract/agreement.
[ ] a portion of this contract/agreement as defined below:
Comments/
Identified Scope Notes
No reserve
PLEASE NOTE: In order to be considered for this solicitation,potentially eligible participants MUST be certified in the above-
referenced category PRIOR TO the bid opening date of this solicitation.
The City of Omaha has given preference to the above-referenced category of participants in the preparation of these contract
documents according to the provisions of OMC 10-200.3(d). Failure to utilize a certified participant for the above-designated
portion of this contract/agreement shall be deemed non-responsive and rejected. Bidders must complete the Participation
Disclosure form and submit it with their bid/agreement documentation in order to be considered.
,- ? - City Of Omaha Small & Emerging Small Business Program
Participation Disclosure Form
THIS FORM MUST BE SUBMITTED WITH THE BID
NOTICE: This form must he submitted by the General Contractor/Lead Consultant at the time of bid/agreement submission,designating all companies utilized to complete the scopes
of work designated as reserved for Program Participants on the Participation Utilization Form attached to the project documentation. The General Contractor/Lead Consultant may
utilize SEB Program Participants for additional scopes of work not specified on the Participation Utilization Form,but they may not be substituted for scopes specifically identified by
the City on the Participation Utilization Form. Should the below listed SEB Program Participant be determined to be unable to perform successfully or is not performing satisfactorily,
the General Contractor/Lead Consultant shall obtain written approval from the Public Works Director or a designee before dismissal/substitution of the Participant. By submitting this
form.the General Contractor/Lead Consultant is certifying that it has afforded any/all applicable program participants the opportunity to submit bids/proposals on this project.
Identified Full Name of Projected start/ Percentage of total
Scope Participant completion date Agreed Price contract
N/A
TOTAL: 0.00
CERTIFICATION:
The undersigned certifies that he/she has read,understands,and agrees to be bound by small and/or emerging small business participation utilization requirements,and the other terms
and conditions of the Invitation for Bids/Request for Proposals. The undersigned further certifies that he/she is legally authorized to make the statements and representations as to the
Participation Utilization requirements and that said statements and representations are true and correct to the best of his/her knowledge and belief. The undersigned will enter into
formal agreement(s)with the Participating Companies listed in the above disclosure at the price(s)set forth in this disclosure,conditioned upon execution of a contract/agreement by
the undersigned company with the City of Omaha. The undersigned agrees that if any of the representations made regarding utilization of small and/or emerging small business by the
General Contractor/Lead Consultant,knowing them to be false,or if there is a failure by the undersigned company to implement the stated agreements,intentions,objectives,goals,and
comments set forth herein without prior approval of the Public Works Director or designee,such action shall constitute a material breach of the contract,entitling the City of Omaha to
reject the bid/proposal or to terminate the Contract/Agreement for default. The right to so terminate shall be in addition to,and not in lieu of,any other rights or remedies the City of
Omaha may have for other defaults under the Contract/Agreement,under City of Omaha's Contract Compliance Ordinance or otherwise.
Signed this 21 day of March in the year 2022
Signature: Cu Title: Estimator Printed Name: Eric Gustafson
Firm or Corporate N e: Jensen Gardens, Inc
Address: 20714 S Hwy 50, Springfield NE, 68059 Telephone No.: 402-253-8880