SCHOOL BOARD OF BREVARD COUNTY, FLORIDA
(Training and Advisory Services Less than $25,000.00)
Enter Name of Consultant(s)Enter SSN or EIN Number
Name of Person Rendering ServicesSocial Security or EIN Number
Check here if W-9 Form has been provided (Required)
Enter Name of Company (if applicable)Check here if Vita has been provided
Name of CompanyCheck here if services are to be provided by a Corp.
Enter Address Line 1
Enter Address Line 2
Enter City, State and Zip Code
This is a contract between the School Board of Brevard County and Enter Name of Consultant or Firm for the following consultant services in accordance with Board Policy 6540 (Invoice for services is required for payment):
Enter description of services to be provided. Be specific.
Date(s) services are to be provided and charges:
Date(s):Total No. Hrs.Hourly RateTotal Cost
Enter Date(s) Enter Total Number Hrs. $0.00 $0.00
Estimated Reimbursable Expenses: $0.00
Estimated Total Cost for Professional Services: $0.00
List expenses, if any, that are to be reimbursed: (Note: Reimbursement for travel, per diem and/or meals, and mileage are to be paid based on Board rules using Board forms and shall not exceed Board adopted rates.)
Enter description of expenses, if any, to be reimbursed.
This agreement may be cancelled by either party, upon written notice of not less than ten (10) days prior to the date the service is to commence. Said notice shall be by certified mail and the date of posting shall constitute date of receipt. Consultant is not authorized to provide any services herein without an approved purchase order from the Board.
______PLEASE SIGN IN BLUE INK
School or Department Name
Signature of RequestorDateSignature of Consultant/Corp. AgentDate
Signature of Principal/Dept. HeadDateSignature of Associate/Area/Assistant Supt.Date
Signature of Superintendent/DesigneeDate
Signature of Chairman/Board (if required) Date
INSTRUCTIONS FOR CONSULTANT SERVICES AGREEMENT
See School Board Policy #6540
- School/Department initiates request for contracted (consultant) services and signs the agreement as “requestor”. The requestor is usually the project coordinator, or other school or department employee responsible for the coordination of the services to be provided.
- Consultant completes required information and signs the agreement.
- Principal or department head signs the agreement and forwards to the Assistant Superintendent for approval. This approval is required prior to the performance of professional services.
- The following additional approval signatures must be obtained prior to any services being performed:
A) Agreements in excess of $50.00 per hour ($400.00 per day) up to $100.00 per hour ($800.00 per day), which total less than $25,000.00, must be approved by the Superintendent or Associate Superintendent of Financial Services.
B) Agreements in excess of $100.00 per hour ($800.00 per day), which total $25,000.00 or more, must be approved by the Board.
*FAILURE TO OBTAIN APPROVALS BEFORE SERVICES BEGIN IS A VIOLATION OF BOARD POLICY.
- After all authorized signatures are obtained; the Agreement is to be returned to the originating school or department. Provide a copy of the signed agreement to the Consultant. Once received, a Purchase Order (PO) request must be prepared and the original signed contract must be sent to Purchasing for PO approval. Purchasing will then forward the original signed contract to Accounting Services to verify invoice documentation and retention. The purchasing department will send the Vendor copy of the Purchase Order to the consultant, and the receiving copy to the originating department. Consultant is not authorized to begin services without a signed agreement and approved Purchase Order.
- After satisfactory performance of the services, the requesting department completes receiving information in CrossPointe and submits the invoice from the consultant to accounting for payment.
INSURANCE FOR CONTRACTS LESS THAN $50,000:
Insurance. The Contractor/vendor will provide before commencement of work, and attach to this agreement, a certificate(s) evidencing such insurance coverage to the extent listed in 8.1 to 8.5 below. The following applies to the insurance requirements below for products or services from Contractor/vendors when all products, services, or work performed when totaled together will pay the contractor/vendor less than $25,000 during the fiscal year. The insurance requirements are as follows:
- Insurance listed in 8.1 below is required of all contractor/vendors: The School Board shall be named as an additional insured to the insurance policy. If the School Board is not listed as an additional insured then the School Board reserves the right terminate this agreement.
- Insurance listed in 8.2 below: All contractor/vendors whose work for the School Board involves products or services and the value of their products or services for the Board is in excess of $5,000, but less than $25,000 are required to carry this insurance to the limit listed below.
- Insurance listed in 8.3 below: Any contractor/vendor transporting district employees, delivering or transporting district owned equipment or property, or providing services or equipment where a reasonable person would believe the School Board is responsible for the work of the contractor/vendor from portal to portal is required to carry this insurance to the limit listed below.
- Insurance as listed in 8.4 below: Any contractor/vendor that has one or more employees or subcontracts any portion of their work to another individual or company is required to have workers’ compensation insurance to the limits listed in 8.4 below. Contractor/vendors that are a sole owner and operator have two following options with regard to the requirement to have a workers’ compensation policy these are:
- The sole owner/operators that do not have workers’ compensation insurance, but whose business is a Limited Liability Company (LLC) or Corporation may submit a State of Florida, Division of Workers’ Compensation Exemption form, or:
- Sole owner/operators that do not have a workers’ compensation insurance policy or hold a State of Florida Workers’ Compensation Exemption form may still provide services for the School Board if they submit a completed “Request to be an Independent Contractor for Business or Self-Proprietors that Cannot Obtain a Workers Compensation Exemption Form.” The Office of Purchasing Services can provide the form to the applicant and will then determine if the sole owner/operator meets the definition as an independent contractor/vendor once the applicant submits the completed form.
- Insurance as listed in 8.5 below: All contractor/vendors providing professional services such as architects, engineers, attorneys, auditors, accountants, etc. are required to have this insurance to the limits listed below.
All Contractor/vendors will carry and maintain policies as described in numbers 1 to 5 above and as marked in the box to the left of each section 8.1 to 8.5 below as specifically indicated by a representative of the Office of Purchasing Services. All required insurance must be from insurance carriers that have an “A” rating or better and a financial size category of “VII” or higher according to the A. M. Best Company. Such certificates must contain a provision to notifiy the Board, thirty-days (30) in advance of any material change in coverage or cancellation. This is applicable for the procurement and delivery of products, goods, or services furnished to the School Board of Brevard County.
8.1. Commercial General Liability Insurance:
Negligence including Bodily Injury and Property Damage
Per Occurrence -$ 500,000
General Aggregate -$1,000,000
8.2. Product Liability and/or Completed Operations Insurance:
Negligence Including Bodily Injury and property damage -$ 250,000
Products – Completed Operations Aggregate - $ 500,000
8.3. Automobile Liability:
Negligence Including Bodily Injury and Property Damage:
Per Claim - $ 300,000
Combined Single Limit - $1,000,000
8.4. Workers’ Compensation/Employer’s Liability:
W.C. Limit Required* - Statutory Limits
E.L. Each Accident - $ 100,000
E.L. Disease – Each Employee$ 100,000
E.L. Disease – Policy Limit$ 500,000
8.5. Professional Liability Insurance (Errors and Omissions):
Each Claim - $ 250,000
Per Occurrence:$ 500,000
Professional Liability coverage must be maintained for a two-year period following completion of the contract.
All businesses (“VENDORS” or “VENDOR” of “VENDOR’S”) that wish to conduct business with Brevard Public Schools (“BPS”) must complete and return this form. Please note that all VENDORS are subject to the BPS Code of Ethics, which prohibits BPS employees, BPS consultants, and School Board members from having certain personal, business, or family relationships with persons or entities conducting (or proposing to conduct) business with BPS and which additionally prohibits the acceptance of gifts from VENDORS. The entire Code of Ethics may be viewed at The Code and its definitions are incorporated by reference into this Disclosure Form. If a VENDOR has a disclosable relationship, the VENDOR should assume that the relationship may pose a conflict of interest until notified to the contrary in writing by a BPS staff member authorized to confirm that a determination has been made that a conflict does not exist. A principle of the Code of Ethics is to ensure that relationships do not influence any official decision or judgment of BPS employees, BPS consultants or School Board members. Accordingly, disclosure also should be made for any such person connected with Vendor (e.g., officer, director, partner, shareholder, employee, sub‐contractor, consultant, agent) that is likely to: (i) materially contribute to VENDOR’S preparation, drafting, or presentation of a proposal or bid for services, (ii) materially contribute to VENDOR’S negotiation of a contract with BPS, or (iii) perform material services under a contract with BPS. Below, these persons are referred to as “Disclosable Persons.”
I hereby certify that, except as disclosed below, to VENDOR’S knowledge, there is no conflict of interest involving the VENDOR named below that would violate the BPS Code of Ethics, including that: (a) after inquiry, neither VENDOR nor any Disclosable Person is involved or engaged in any private business venture or enterprise, directly or indirectly, with any BPS employee, consultant, or Board member; (b) no BPS employee, consultant, or Board member or his or her family member owns or has a material personal financial interest (directly or indirectly) in VENDOR. I further certify that, during any period prohibited by an applicable solicitation, neither the VENDOR nor anyone acting on its behalf has requested that any employee, consultant, or Board member of BPS exert any influence to secure the appointment of VENDOR under a contract or proposed contract.
VENDOR INFORMATION:VENDOR Name: / ______
VENDOR Phone Number: / ______
VENDOR Address: / ______
Federal Identification Number: / ______
State of Incorporation or Domicile: / ______
DISCLOSURE STATEMENT:I BELIEVE THAT THE VENDOR REFERENCED ON PAGE 1 DOES have a potential conflict (or conflicts) of interest with a current or potential BPS employee(s), BPS consultant(s), or BPS School Board Member(s).
Yes, the above statement is true.
No, the above statement is not true.
If you checked “YES” above, please provide the following information:
LIST the name(s) of BPS employee(s), BPS School Board member(s), BPS consultant(s), or BPS employees’, BPS School Board members’, or BPS consultants’ family member(s) with whom there may be a conflict of interest:
PROVIDE A BRIEF DESCRIPTION of the nature of the potential conflict(s) of interest:
By my signature below, I certify that I am the Authorized Representative of the VENDOR named herein, and that all of the information I am providing is true and complete and to the best of my knowledge:Print the name of the VENDOR’S Authorized Representative
Print the Position/Title of the VENDOR’S Authorized Representative
VENDOR’S Authorized Representative’s Signature / Date
SCHOOL BOARD OF BREVARD COUNTY
OFFICE OF PURCHASING SERVICES
2700 JUDGE FRAN JAMIESON WAY
VIERA, FL 32940-6601
RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT
HOLD HARMLESS AGREEMENT
The Vendor agrees, by accepting award of this bid, contract, project, service and/or maintenance agreement to the following “Release, Indemnification and Hold Harmless Agreement”:
The Vendor shall indemnify and hold harmless the School Board of Brevard County, its elected officials and appointed officials, employees, and agents from any and all claims, suits, actions, damages, liability, and expenses (including attorney fees) in connection with loss of life, bodily or personal injury, or property damage including loss of use thereof, directly or indirectly caused by, resulting from, arising out of or occurring in connection with the operations of the Vendor or its officers, employees, agents, or independent contractors, excepting only such loss of life, bodily or personal injury, or property damage is solely attributable to the gross negligence or willful misconduct of School Board of Brevard County or its elected or appointed officials and employees. The above provisions shall survive the termination of this Agreement and shall pertain to any occurrence during the term of this Agreement, even though the claim may be made after the termination hereof. Nothing contained herein is intended nor shall be construed to waive School Board of Brevard County’s rights and immunities under the common law or Florida Statutes including, but not limited to, Florida Statutes 768.28, as amended from time to time.
The Vendor certifies they will comply with the requirements of the Jessica Lunsford Act (Section 1012.465, Florida Statutes) in regards to fingerprinting and level 2 background screenings of all employees and any subcontractors employees who will have access to any District school or property when students may be present, or will have direct contact with any student; or have access to or control of school funds. Vendor’s failure to comply with this requirement will constitute a material breach of contract.
Any questions as to the intent or meaning of any part of the above-required coverage should be brought to the Director of Risk Management of the School Board of Brevard County, Florida.
I certify that I am an Authorized Representative of the Vendor and have the authority to bind my company to this agreement:
Vendor/Company Name - PrintAuthorized Representative’s Name – Print
Revised 11/21/17Page 1 of 7