Agreement with Salvation Army lq /11 t oil -- d 7?c2 1 V
CRIMNAL
AGREEMENT BETWEEN THE CITY OF MIAMI BEACH
AND THE SALVATION'ARMY, A GEORGIA CORPORATION,
FOR EMERGENCY SHELTER SERVICES
THIS AGREEMENT made and entered into this /O da of a �eV4b*. , 2011, b
Y Y
and between the CITY OF MIAMI BEACH, FLORIDA (hereinafter referred to as City),
having ifs principal offices - at 1700 Convention Center Drive, Miami Beach, Florida,
33139 and THE SALVATION ARMY, A GEORGIA. CORPORATION, (hereinafter
referred to as Contractor), whose address is 1.907 NW.38 STREET, MIAMI, FL 33142
SECTION 1
DEFINITIONS -
Agreement: This Agreement between the City and Contractor.
City Manager.: The Chief Ad min istrative Officer of the ;City.
Contractor: For the purposes of this Agreement, Contractor shall be.deemed to _.
be an. independent contractor, and not an agent or employee of the
City.
Services. All services, work and actions by the Contractor performed
- pursuant to or undertaken under this Agreement, as' described in
Section 2 and Exhibits "A" and "B" hereto.
Fee: Amount paid to the Contractor to cover the costs of the Services.
Risk Manager: The Risk Manager of the City;. with offices at 1700 Convention
Center Drive, Third Floor, Miami Beach, Florida 33139 telephone
number (305) 673- 7000, Ext.. 6435, and fax number (305) 673-
7023.
SECTION.2
SCOPE'OF WORK
The scope of work to be performed by Contractor is set forth in Exhibit "A,'' and "B ",
each entitled "Scope of Services" and "Service Deliverables ".
SECTION 3
COMPENSATION
3.1 FIXED FEE
For the term of this Agreement, the City agrees to pay a fixed fee of $20 per
bed, per day, for a minimum of thirty -one (31) beds, totaling Two Hundred and
Twenty Six. Thousand Three Hundred Dollars ($226,300) annually, to be used
by Contractor to provide Emergency Shelter Services (such Services as set
forth in Exhibit "A" and "B" hereto).
3.2 INVOICING
Contractor shall submit an invoice, which. includes a description of the
Services provided including the number of beds provided, and a copy of the
latest Monthly Progress Report as generated through the Homeless
Management Information System.
3.3 METHOD OF PAYMENT
Payments shall be. made within thirty. (30). days of the .date of invoice, in a
manner satisfactory to and as approved and received the City. Contractor
shall mail all invoices to:
City of Miami Beach
Homeless Services
Attention: Katherine Martinez, MSW
555 17 Street
Miami Beach, Florida 33139
With copies to to:
City of Miami Beach
Office of Real Estate Housing & Community Development
Attention: Anna Parekh
1700 Convention Center Drive
Miami Beach, Florida 33139
.- 2
SECTION 4
GENERAL PROVISIONS
4.1 RESPONSIBILITY OF THE CITY
With respects to the performance of the -Services; . the Contractor shall
exercise that degree of skill, care efficiency and diligence normally exercised
by recognized professionals with respect to the performance of comparable
Services. In it's performance of the Services, the Contractor shall comply with
- all applicable laws, ordinances, and. regulations of the city, Miami- Dade, the
State of Florida, and the federal government, as applicable.
4.2 PUBLIC ENTITY CRIMES
A State of Florida. Form PUR 7068 Sworn - Statement under Section
287.133(3) (a) Florida Statute on Public Entity Crimes shall be filed with the
City's Procurement Division, prior to commencement of the Services herein.
4.3 DURATION AND EXTENT OF AGREEMENT
The term of this Agreement shall commence on October 1 2011, the effective
date, and shall terminate on September 30, 2013.
4.4 [INTENTIONALLY OMITTED]
4.5 INDEMNIFICATION
Contractor agrees to indemnify and hold harmless the City of. Miami Beach
and its officers, employees and agents, from and against any and all actions,
claims, liabilities, losses, and expenses, including, but not Limited to, attorneys'
fees, for personal, economic or bodily, injury, wrongful death, Loss of or
damage to property, at law or in equity, which may arise or ,be alleged 'to have
arisen from the negligent acts, errors, omissions or other wrongful conduct of
the Contractor, its employees, agents, sub - contractors, or any other person or
entity acting under Contractor's control, in connection with the Contractor's
performance of the Services pursuant to this Agreement; and to that extent,
the Contractor shall pay all such claims and losses and shall pay all such
costs and judgments which . may issue from any lawsuit arising from such
claims and losses, and shall pay all costs and attorneys'. fees expended by the
City in the defense of such claims and losses, including appeals:
The Contractor's obligation under . this Subsection shall not include the
obligation to indemnify the City of Miami Beach and its officers employees
and agents, from and against any actions or claims which arise or are alleged
to have arisen from negligent acts. or omissions or other wrongful conduct of
the City and its officers, employees and agents. The parties each agree to
give the other party prompt notice of any claim coming to its knowledge that in.
any way directly or. indirectly affects the other party.
4.6 TERMINATION, SUSPENSION AND SANCTIONS
4.6.1 Termination for Cause
If the Contractor shall fail to fulfill in a timely manner, or otherwise.
violate any of the covenants, agreements,. or stipulations material to this
Agreement, the City shall thereupon have the right to terminate the
Services then remaining to be performed. Prior to exercising its option
to terminate for cause, the City shall notify the Contractor of its violation
of the particular terms of this Agreement and shall grant Contractor
seven (7) days to cure such default. If such default remains uncured
after seven (7) days, the City, upon three (3) days notice to Contractor,
may terminate this Agreement and the -City shall be fully discharged
from any and all liabilities, duties and terms arising out of /or by virtue of
this Agreement.
Notwithstanding the above, the Contractor shall not be relieved- of
liability to the City for damages sustained by the City by any breach of
the Agreement by the Contractor. The City, at its sole option and
discretion, shall additionally be entitled to bring any and all
legal /equitable actions that it deems to be in its best interest in order to
enforce the City's right and remedies against the defaulting party. The
City shall be entitled to recover all costs of such actions, including
reasonable attorneys' fees. To the extent allowed by law, the defaulting
party waives its right to jury trial and its right to bring permissive counter
claims against the City in any such action.
.4.6.2 Termination for Convenience of City
The City May also, for its convenience and without cause, terminate the
services then remaining to be performed at any time during the term
hereof by giving . written notice. to Contractor of such termination, which
shall become effective five (5) days following receipt -by the Contractor
of the written termination notice. In that event, all finished or unfinished
documents and other materials, as described in Section 2 and in Exhibit
"A" shall be properly assembled and delivered to the City at
Contractor's sole cost and expense. If the Agreement is terminated by
the City as provided in this subsection,- Contractor shall be paid for any
services satisfactorily performed, as determined by the City at its
discretion, up to the date of termination. If contract is terminated without
cause as described in Section 2, City shall pick -up all finished and
4 .
unfinished documents "and other materials from Contractor at its
expense.
4.6.3 Termination for Insolvency
The City also reserves the right to terminate the remaining Services- to
be performed in the event the Contractor is placed either in voluntary
or involuntary bankruptcy or makes an assignment for the benefit of
creditors. In such event, the right and obligations for the parties shall
be the same as provided for in Section 4.6.2.,
4.6.4 for Noncompliance with Nondiscrimination.Provisions
In Sanctions the event of the Contractor's noncompliance with the
nondiscrimination provisions of this Agreement, as applicable, the City
shall impose such sanctions as the City,or the State .Florida may
determine to be appropriate, including but not limited to, withholding of
payments to the Contractor under the Agreement until the Contractor
complies and /or cancellation, termination or suspension of the Services.
In the event the City .cancels or terminates the Services pursuant -to this
Subsection the rights and obligations of the parties shall be the same as
provided in Section 4.6.2.
4.7 CHANGES AND
Each such. change /addition shall be directed by a written Notice signed by
the duly authorized representatives of the Contractor. Said Notices shall
provide an equitable adjustment in the time of performance, a reallocation of
the task budget and, if applicable, any provision of this Agreement, which is
affected by, said Notice. The City shall not reimburse the Contractor for the
cost of preparing Agreement change documents, written Notices to Proceed,
or other documentation in this regard..
4.8 ADDITIONAL CONDITIONS
It is expressly understood and agreed by the parties hereto that monies to be
used by Contractor, as contemplated by this Agreement, may originate from
City of Miami Beach Resort Tax, General Fund and /or Community
Development Block (CDBG) Grant funds from the US Department of Housing
and Urban Development (HUD) and must be implemented in full compliance
with all of HUD's rules and regulations. It is expressly understood and agreed
that in the event of curtailment or non - production of said federal grant funds,
the financial sources necessary to continue to pay the Contractor all or any.
portions of the funds contemplated herein will not be available, and that this
Agreement will thereby terminate effective as of the time that it is determined
by the City, in its sole discretion and judgment, that said funds are no longer
available. In the event of determination, the Contractor agrees that it will
not look to, nor seek to hold liable, the City nor any individual member of the
City Commission and /or City Administration thereof personally for the
performance of this Agreement and all of the parties hereto shall be released
from further liability each to the other.under the terms of this Agreement.
The Contractor agrees to comply with all applicable federal regulations as
they may apply. to program administration and .to carry out each activity in
compliance with the laws and regulations as described in 24 CFR 576, as
same may be amended from time to time. Additionally, the Contractor will
comply with all state and local (City and County) laws and ordinances hereto
applicable. It shall be Contractor's sole and absolute responsibility to
continually familiarize itself with any and all such applicable federal
regulations, as well as any and all applicable state and. local Laws and
ordinances. .
4.9 Religious Organization or Owned Property
As applicable, Emergency Shelter Grant funds may be used by religious
organizations or on property owned by religious organizations only with the
prior written approval from the City and only in accordance with requirements
set in 24 CFR 576.23.
4.10 Conformity to HUD Regulations
The Contractor agrees to abide by guidelines set forth by the US Department
of Housing and Urban Development for the administration and
implementation of the, Emergency Shelter Grants (ESG) Program, including
all applicable federal - regulations as they may apply. to program
administration and to carry out each activity in compliance with the laws and
regulations as described in 24 -CFR 576. The Contractor shall comply with
the requirements and standards of: 24 CFR 85 (codified pursuant. to OMB
circular No. A -102), OMB Circular No. A -87, OMB Circular No. A -122, OMB
Circular A -110 (implemented as 24 CFR part, 84), and /or the related ESG
provision as they relate to the acceptance and use of Emergency Shelter
Grant amounts, as applicable. The Contractor agrees to comply with all of
the provisions of 24 CFR 576.57. In this regard, the Contractor agrees that
duly authorized representatives of the US Department of Housing and Urban
.Development shall have access to any books, documents, papers and
records of the Contractor that. are directly pertinent to this Agreement for�the
purpose of making audits, examinations, excerpts and transcriptions.
4.11 Audit and Inspections
With 24 -hour written notice, the City and /or such representatives as the City
may deem to act on its behalf, may, during normal business hours, audit,
6
examine and make audits of all contracts, invoices, materials, payrolls,
records of personnel, conditions of employment and other data relating to all
matters covered by this Agreement.' Contractor shall maintain any and all
records necessary to document compliance with the provisions of this
Agreement:
4.12 Access to Records
Contractor agrees to allow, access during normal business hours to all
financial records to the City and /or such authorized .representatives as it may
deem to act on its behalf, 'and agrees. to provide such assistance as may be
necessary to facilitate financial audit by the City or its representatives when
deemed'. -necessary to insure compliance with applicable accounting and
financial standards. Contractor shall allow access during normal business
hours to all other records forms, . files, and documents which have been
generated in performance of this Agreement, to those personnel as may be
designated by the City.
4.13 Assignment, Transfer or Subcontracting
The Contractor shall not subcontract, assign, or transfer any work under this
Agreement without the prior written consent of the City.
4.14. Sub- contractors
The Contractor shall be liable, for the Contractor's services, responsibilities
and liabilities under this Agreement. and the services, responsibilities and
liabilities of sub - contractors, and any other person or entity acting under the
direction or.controls of the Contractor. When the term "Contractor" is used in
this Agreement, it .shall be deemed to include any sub- contractors and any
other person or entity acting under the direction or control of Contractor. All
sub- contractors must be approved of in writing prior to their engagement by
Contractor.
4.15 Equal Employment'Opportunity
rand only in accordance with In connection with the performance of this Agreement, the Contractor shall applicable
not discriminate against any employee or applicant for employment because federal law,
of race, color, religion, ancestry, sex, age, and national origin, place of birth,
marital status, or physical handicap. The Contractor shall take affirmative
action. to ensure that- applicants. are employed and that employees are
treated during their employment without regard to their race, color, religion,
ancestry, sex, age, national origin, place of birth_, marital status, - disability, as
applicable. Such action shall include, but not be limited to the following:
employment, upgrading, demotion, or termination; recruitment or recruitment
-- advertising; ' . layoff or termination; rates. of pay, or other forms of
compensation; and selection for training, including apprenticeship.
4.16 Conflict of Interest
The Contractor agrees to adhere to and be governed by the Metropolitan
Miami -Dade County Conflict of Interest Ordinance (No. 72 -82), as amended;
and by the City of Miami Beach Charter and Code, which are incorporated by
reference herein as. if fully set forth herein, in connection with the - Agreement
conditions hereunder.
The Contractor covenants that it presently has no interest and shall not
acquire any interest, direct or indirectly which should conflict in any manner
or degree with the performance of the Services. The Contractor further
covenants that in the performance of this Agreement, no person having any
such interest shall knowingly be employed by the Contractor. No member of
or delegate to the Congress of the United States shall be admitted to any
share or part of this Agreement or to any benefits arising there from.
4.17 Patent Rights; Copyrights; Confidential Findings
Any patentable result arising out of this Agreement, as well as all information,
design specifications, processes, data and findings, shall be made available
to the City for public use.
No reports, other documents, articles or devices produced in whole or -in part
under this Agreement shall be the subject of any application for copyright or
patent by or on behalf of the Contractor or its employees or subcontractors.
4.18 Notices
Ali notices and communications relating to the day -to -day activities shall be
exchanged between the Project Manager appointed by the Contractor and
the Program Coordinator designated by the City. The Contractor's Project
manager and the City's Program Coordinator shall be designated promptly
upon- commencement of services.
All other notices and communications in writing required or permitted
hereunder may be delivered personally to the representatives of the
f Contractor and the City listed below or may be mailed by registered mail.
Until changed by notice in writing,.all such notices and communications shall
be addressed as follows:
TO CONTRACTOR:
The Salvation Army — Miami Area Command
8
Attn: Major Fernando Martinez
1907 NW 38 Street
Miami, Florida 33142
(305)637 -6721
TO CITY: .
City of Miami . Beach
Attn: Hilda Fernandez /Office of the City Manager
1700 Convention Center Drive
Miami Beach, Florida 33139
(305) 673 -7077
WITH COPIES TO:
Homeless Services Program
Attn: Katherine Martinez; MSW
City of Miami Beach
.555 17" Street
Miami Beach, Florida 33139
Office of Real Estate, Housing & Community Development
Attn: Anna Parekh
City of Miami Beach
1700 Convention Center Drive
Miami Beach,, Florida 33139
4.19 Litigation and Jurisdiction Venue
This Agreement shall be enforceable in Miami -Dade County, Florida, and if
legal action is necessary by either party with respect to the enforcement of any
or all of the ,terms or conditions herein, exclusive venue for the enforcement of
same shall lie in Miami -Dade County, Florida.
4.20 Entirety of Agreement
This writing and the Services embody the entire Agreement.and understanding
between the parties hereto, and there are no other agreements and
understandings, oral or written with reference to the subject matter hereof that'
are not merged herein and superceded hereby.
4.21 Insurance Requirements
The Contractor shall not commence any work pursuant to this Agreement until
all insurance required under this Section has been obtained . and such
insurance has been approved by the City's Risk Manager. The Provider .shall
maintain and carry in full force during the term of this Agreement and
throughout the duration of this project the following insurance:
a. Workers Compensation & Employers Liability as required pursuant to
Florida statute.
b. Thirty (30) days written notice of cancellation or substanti
modification in the insurance coverage must be given to the City's Risk
Manager by the Contractor and his insurance company.
c. The insurance must be furnished by insurance companies authorized
to do business in -the State of Florida and approved by the City's Risk
Manager.
d. Original certificates of insurance for the above coverage must be
submitted to the City's. Risk Manager for approval prior to any work
commencing. These certificates will be kept on file in the Office of the
Risk Manager, Third Floor, City. Hall.
e. The Contractor is responsible for obtaining and submitting all
insurance certificates for their. Contractors.
All insurance policies must be issued by companies authorized to do business
under the Laws of the State of Florida. The companies must be rated no less
than "B +" as to management and not less than "Class IV" as to strength by the
latest edition of Best's Insurance Guide, published by A.M. Best Company,
Oldwick, New Jersey, or its equivalent, subject to the approval of the City's
Risk Manager.
Compliance with the foregoing requirements shall not relieve the Contractor of
liabilities.and obligations under this Section or under any other portion of this
Agreement, and the City shall have the right to obtain from the Contractor
specimen copies of the insurance policies. in the event that submitted
certificates of insurance are inadequate to ascertain compliance with required
coverage.
4.22 Endorsements
All of- the Contractor's certificates', above., shall contain endorsements
providing, that written notice shall be given to the City at least thirty (30) days
prior to termination, cancellation or reduction in coverage in the policy.
4.23 Certificates
Unless directed by the City otherwise, the Contractor shall not commence any
services pursuant to this Agreement until the City has received and approved,
in writing, certificates of insurance showing that the requirements of this
- Section (in its entirety) have been met and provided for.
4.24 LIMITATION OF CITY'S LIABILITY
The City desires to enter into this Agreement only if in so doing the City can
place a limit on the City's Liability for any cause of action for money damages due to
. 10
an alleged breach by the City of this Agreement, so that its liability .for any such
breach never exceeds the sum of $1,000. Contractor hereby expresses its
willingness to enter into this Agreement with Contractor's recovery from the City for
any damage action for breach of contract to be limited to a maximum amount of
$1,000.
Accordingly, and notwithstanding 'any other term or condition of this
Agreement, Contractor hereby agrees that the City shall not be liable to the
Contractor for damages in an amount in excess of $1,000.00 for any action or claim
for breach of contract arising out of the performance or non- performance of any.
obligations imposed upon the City by this Agreement. Nothing contained in this
paragraph or elsewhere in this Agreement is in any way intended to be a waiver of
the limitation placed upon the City's liability as set forth in Section 76828, Florida
Statutes.
[REMAINDER OF PAGE INTENTIONALLY. LEFT BLANK]
.. 11
9
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to
be executed by their appropriate officials, as of the date first entered above.
FOR CITY: CITY OF MIAMI BEACH, FLORIDA
ATTEST:
By: ov
.City Clerk it ) nager
FOR CONTRACTOR THE SALVATION ARMY, A GEORGIA CORPORATION
ATTEST:
By:
w
• l
N • L jA T Secretary P Iident
MELANIE MATHIS BRAC JOHN R. 'ONE TREASURER
���scz� �c�r.�FT�
Print Name /Title - Print Name /Title
Corp
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� ,,.
I S
APPROVED AS TO
R t FORM & LANGUAGE
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& FO EXECUTION
City Atto Date
12
EXHIBIT "All
SCOPE OF SERVICES
Emergency Shelter Services for Miami Beach Clients
The Contractor agrees to provide a minimum of thirty -one (31) guaranteed,
emergency care beds per day, seven (7) days a week, twenty -four (24) hours per day
for homeless individuals (males or females) and families referred exclusively by the,
-City of Miami Beach Homeless Services Program.
- Emergency beds include the following elements that most be incorporated in the
delivery of services under this Agreement:
1. Clients will be referred exclusively by the City of Miami Beach Homeless
Services Program.
2. Emergency housing is limited to a period not to exceed ninety (90) days per
client unless expressly authorized by the City. Requests for extensions beyond
the 90 days must be submitted in advance to the City for approval.
3. At least three (3) prepared and nutritious meals daily with one of these meals
being a hot meal. Bagged lunches will be provided upon request for clients
without income, attending employment or educational appointments.
4. On site supervision.
5. Testing for tuberculosis within forty -eight (48) business hours of admittance to
shelter.
6. Clients will receive an intake assessment for needed services within 72 hours
of admittance into shelter.
7. Case Management staff will be bilingual and should have some social service
experience working with homeless populations or preferably a Bachelor of Arts
degree in Psychology, Social Work or Sociology.
8. Clients will receive case management services with an emphasis on obtaining
stability, entitlements, and housing, this includes:
a. ®evelopm,ent of a Service Plan and documentation of contacts.
Referrals for specialized health, substance abuse, mental - health
screening and treatment will be made for clients based on need or
their request.
C. Referral to other entitlement agencies including, but not limited to,
VA, Food Stamps, and Medicaid.
d. Referral to educational and vocational training.
e. Referral to permanent housing-
13
9, Clean clothing and hygiene products, if available.
10. Contractor will provide a monthly client progress report to the City which will
include services /referrals provided to clients placed in emergency care beds
by the City.
11. Daily notification of availability of beds under this agreement will be
communicated to the City via electronic mail or facsimile by 9 AM Monday
through Friday excluding legal holidays.
12. Contractor retains the right to immediately dismiss clients who fail to adhere to
contractor's rules or regulations. The, contractor must notify the City in writing
of such dismissals within 24 hours of termination and provide an incident
report.
13. Random drug and alcohol tests will be conducted monthly and /or at shelter
staff's discretion with test results included in client's case file.
14. The City reserves the right to conduct periodic audits of client files to ensure
adherence to service benchmarks.
14
EXHIBIT "B"
"SERVICE DELIVERABLES"
The following benchmarks will be utilized to measure the program's
accomplishments:
1. Placement will be available seven (7) days per week, twenty -four (24) hours
per day.
2. Contractor will provide daily bed availability status via electronic mail or
facsimile by 9 AM, Mondays through Friday, excluding legal holidays.
3. Within seventy -two (72) business hours. of program admission:
a. Client will have completed intake, assessment and formulated a service
plan with Contractor.
b. Contractor will provide needed referrals to address medical needs',
including tuberculosis test, physical exam,* and mental health
assessment, as appropriate.
4. Within seven (7) days of program admission:
a. Client will have applied for financial. entitlements, if appropriate, via
Contractor.
b. Client will meet with on -site job developer to schedule job interviews.
c. if appropriate, client will meet with drug and alcohol counselor provided
by contractor..
5 Within ninety (90) days of program admission:
a. Client will be transitioned to appropriate transitional or permanent
housing.
b. , Documentation of client transition will be forwarded to the City.
6. City reserves the right to conduct periodic audits of client files to ensure -
adherence to service benchmarks, including, but not limited to, case plan
timelines, provision of referrals, and submission of monthly progress reports.
7. Contractor will provide the City with a monthly. prog ress report for each client
at the end of each month tracking client's progress and services received while
in shelter.
15 .
THE SALVATION ARMY POLICY STATEMENT
ON RELATIONSHIPS WITH OTHER GROUPS AND ORGANIZATIONS
The Salvation Army in the United States works cooperatively with many groups -
governmental, social service, civic, religious, business, humanitarian, educational,
health, character building, and other groups - in the pursuit of its mission to preach the
Christian Gospel and meet human need.
Any agency, governmental or private, which enters into a contractual or cooperative
relationship with The Salvation Army should be advised that: p
1 • The Salvation Army is an international reli ions and charitable m -
g movement,
organized and operated on a quasi- military pattern, and is a branch of the
Christian church.
2 All programs of The Salvation Army are administered by Salvation Army
Officers, who are ministers of the Gospel.
3 • The motivation of the organization is love of God and a ractical concern
oncern
for the needs of humanity.
4. The Salvation Army's provision of food, shelter, health services counseling,,
and other physical, social, emotional, psychological and spiritual aid, is
-given on the basis'of need, available resources and established program
policies.
Organizations contracting and/or cooperating with The Salvation Army may be assured
that because The -Salvation Army is rooted in Christian compassion and is governed b y
Judeo- Christian ethics, The Salvation Army will strictly observe all provisions of its
contracts and agreements.
Commissioners Conference:
May -96
:r
SECTION 00045 FORM PUR 7068
Bid or Contract No.
SWORN STATEMENT PURSUANT TO SECTION 287:133(3)(x),
FLORIDA STATUTES ON PUBLIC ENTITY CRIMES
(This form must be signed and sworn to in the presence of a Notary. Public or other
official. authorized to administer oaths.)
1. This sworn statement is submitted to
[print name of the public entity].
by
[print individual's name and title]
for
[print name of entity submitting sworn statement]
whose business address is
and (if applicable) its Federal Employer Identification Number (FEIN) is
58- 06606[)7 (If the;.entity. has no FEIN,
include the Social` Security Number of the individual signing this sworn statement:
2.. 1 understand that a "public entity crime' as defined in Paragraph 287.133(1)(g),
Florida Statutes means a violation of any state or federal law, by a person with
respect to and directly related to the transaction of business with any public entity
or with an agency or. political subdivision of any other state or of. the United
States, including, but not limited to, any bid or contract for goods or services to
be provided to any public entity or an agency. or political subdivision of any other
state or of the Untied States and involving antitrust, fraud, theft, bribery,
collusion, racketeering, conspiracy, or material misrepresentation
3. I understand that "convicted' or "conviction as defined' in Paragraph
Florida Statutes means a finding of guilt or a conviction of a
public entity crime, with or without an' adjudication of guilt, in any federal or state
trial court of record relating to charges 'brought by indictment or information after
July 1, 1989, as a result of a jury verdict, nonjury trial, or entry a plea- of guilty
or polo contendere.
4. 1' understand that an "affiliate" as defined in Paragraph 287.133(1)(a), Florida
Statutes means:
1. A predecessor or successor•of a person convicted of a public entity crime;
_ or
54320.03. FORM 7068 00045 -1
o
M .
2. An entity under the. control of any natural person who is active in :the
management-of the entity 'and who. has been convicted of a public entity
crime. The term "affiliate'' includes those officers, directors; executives,
partners., shareholders, employees,. members, and agents who are active
in the management of an affiliate.. The ownership by one. person'of shares
constituting a controlling interest in another person, or a pooling of
equipment .or income among persons when not for fair market value under
an arm's length agreement, shall be a prima facie case that one person
controls. another person. A . person, who knowingly enters into' a joint
venture with a person who has been convicted of a public entity crime in
Florida during the preceding 36 months shall.be considered. an affiliate.
5. I understand that a "person" as defined in Paragraph 287:133(1)(e), Florida
Statutes means any natural person or entity organized under the laws 'of any
T state or of the United States with the legal power to enter into. a binding contract
and which bids or applies, to bid on contracts for the provision of goods or
services let by a public entity, or which otherwise transacts or applies to transact
business with a public entity. The term "person" includes those officers,. directors,
executives, partners, . shareholders,> employees, members; and agents who are
active in management of an entity.
6. Based on. information and belief, the statement which I have marked below is
true "in relation to the entity submitting this sworn statement. [Indicate which
statement applies.]
Neither the entity submitting. this sworn statement, nor any of its officers,
directors, executives, partners; shareholders, employees, members or agents
who are active in the management of the entity, nor any affiliate of the entity, has
been charged with and convicted :of, a public: entity crime subsequent to July 1,
1989.
The entity submitting this sworn statement, or one or more of its officers,
directors, executives; partners shareholders, employees, members, or agents
who are active in the management of the entity or an affiliate of the entity has
been charged with and convicted of a public entity crime subsequent to July 1,
1989:
The entity submitting this sworn statement, or one or more of its officers,
directors, executives; partners, share holders, employees., members, or agents
who are active in the management of the entity, or an affiliate of the entity has
been charged with and convicted of ar public entity crime subsequent to July 1,
1989. However, .there has. been a subsequent proceeding before a Hearing
Officer of the State of Florida, Division of Administrative Hearings and the Final.
Order entered by the Hearing .Officer determined that it was not in the public
interest to place the entity submitting this sworn statement on the convicted
vendor list. [Attach a copy of the final order:]
UNDERSTAND. THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING
OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 1 (ONE) ABOVE
54320.03 FORM 7068 : 00045 -2
r
IS FOR THAT PUBLIC ENTITY ONLY AND THAT THIS FORM IS .VALID THROUGH
DECEMBER 31 OF THE CALENDAR YEAR IN WHICH. IT IS FILED. I ALSO
UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO
ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT
PROVIDED IN SECTION 287:017, FLORIDA STATUTES FOR CATEGORY TWO OF
ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.
[signature]
Sworn to and subscribed 'before me this day of 1 2005.
Personally known
OR Produced identification Notary Public -State of
My Commission expires _
(Type bf identification)
(Printed, typed or stamped
Commissioned name of notary public).
END SECTION 00045
54320.03 FORM 7068 00045 -3