Amendment No. 1 to the Agreement with Miami-Dade County Emergency Hotel/Motel Placement Program 2o1 C0- 2924E
THE CITY OF MIAMI BEACH
EMERGENCY HOTEL/MOTEL PLACEMENT PROGRAM CONTRACT#: PC-1617-HTMT-3
I ?HMIS STAFFING PROGRAM CONTRACT#PC-1617-STAFF-2
(
AMENDMENT#1 OF THE AGREEMENT
BETWEEN
MIAMI-DADE COUNTY AND
THE CITY OF MIAMI BEACH
EMERGENCY HOTEL/MOTEL PLACEMENT PROGRAM CONTRACT#: PC-1617-HTMT-3
HMIS STAFFING PROGRAM CONTRACT#: PC-1617-STAFF-2
THIS AMENDMENT #1 OF THE AGREEMENT (the "Agreement Amendment #1") is made as of
Swat Z?�ZD17by and between Miami-Dade County, through the Miami-Dade County Homeless Trust
(the "County") and The City of Miami Beach, (the "Provider), a recipient of grant funds to serve homeless
individuals.
WITNESSETH:
WHEREAS, on January 19, 2016, the County and the Provider entered into a Grant Agreement ("Agreement")
which provides funding for the provision of emergency housing and supportive services to homeless individuals
and families in Miami-Dade County.
WHEREAS,the Agreement provides for certain rights and responsibilities of the County; and
WHEREAS,the Agreement allows for amendments and extensions at the sole discretion of the County; and
WHEREAS, the County is desirous of extending and amending the Agreement for one (1) additional year
pursuant to the terms of the Agreement;
NOW, THEREFORE, BE IT RESOLVED, for and consideration of the mutual agreements between the
County and the Provider, which are set forth in this Amendment#lof the Agreement, the receipt and sufficiency
of which are acknowledged,the County and the Provider amend this Agreement as follows:
ARTICLE I—Recitals
The foregoing recitals are true and correct and constitute a part of this Amendment#1 of the Agreement.
ARTICLE II—Amendments
The Agreement is hereby amended as follows:
Article 2 is replaced as follows:
ARTICLE 2. AMOUNT PAYABLE.
Subject to available funds, the maximum amount payable for services rendered under this contract shall not
exceed:
• HOTEL/MOTEL PLACEMENT PROGRAM $ 10,000.00
• HMIS STAFFING PROGRAM $ 12,333.00
TOTAL $ 22,333.00
r '
THE CITY OF MIAMI BEACH. P`
EMERGENCY HOTEL/MOTEL PLACEMENT PROGRAM CONTRACT#: PC-1617-HTMT-3
HMIS STAFFING PROGRAM CONTRACT#PC-1617-STAFF-2
Both parties agree that should available Miami-Dade County funding be reduced, the amount payable under this
Contract may be proportionately reduced at the sole discretion and option of the County.
All services undertaken by the Provider before the County's execution of this Contract shall be at the Provider's
risk and expense.
It is the responsibility of the Provider to maintain sufficient financial resources to meet the expenses incurred
during the period between the provision of services and payment by the County.
The County, at its sole discretion,may allow Provider an advance of N/A once the Provider has submitted an
appropriate request and submitted an invoice in the form required by the County.
Article 4 is replaced as follows:
ARTICLE 4. BUDGET SUMMARY
The Provider agrees that all expenditures or costs shall be made in accordance with the revised
2016-2017 Budget,which is attached hereto and incorporated herein as Attachment B.
The parties agree that the Provider may, with the County's prior written approval, revise the line item
budget, and such revision shall not require an amendment to this Contract.
Pursuant to Board of Miami-Dade County Commissioners' Resolution Number R-630-13, the Provider will
submit a detailed project budget, and sources and uses statement as Attachment B, which shall be sufficiently
detailed to show (i) the total project cost, (ii) the amount of funds to be used for administrative and overhead
costs, (iii) whether the County funds will be 'gap' funds meaning that they would be the last remaining funds
needed to ensure funding for the total project cost, (iv)any profit to be made by the Provider, and(v)the amount
of funds devoted toward the provision of the desired services or activities.
The County Mayor or Mayor's designee may make unannounced, on-site visits during normal working hours to
the Provider's headquarters and any location or site where the services contracted for under this Agreement are
performed.
Article 5 is replaced as follows:
ARTICLE 5. EFFECTIVE TERM
Both parties agree that the Effective Term of this Contract shall continue to commence on
October 1,2016 and terminate at the close of business on September 30,2017. Contingent on the existence of
sufficient funding, the provider's performance and the approval of the County may be extended for one (1)
additional one(1)year term, at the County's sole discretion.
2
` THE CITY OF MIAMI BEACH
EMERGENCY HOTEL/MOTEL PLACEMENT PROGRAM CONTRACT#: PC-1617-HTMT-3
HMIS STAFFING PROGRAM CONTRACT#PC-1617-STAFF-2
Article 10 is replaced as follows:
ARTICLE 10. CIVIL RIGHTS
The Provider agrees to abide by Chapter 11A of the Code of Miami-Dade County ("County Code"), as
amended, which prohibits discrimination in employment, housing and public accommodations on the basis of
race, color, religion, color, sex, familial status, marital status, sexual orientation, pregnancy, age, ancestry,
national origin, disability, gender identity, gender expression or actual or perceived status as a victim of
domestic violence, dating violence or stalking; Title VII of the Civil Rights Act of 1968, as amended, which
prohibits discrimination in employment and public accommodation; the Age Discrimination Act of 1975, 42
U.S.C. §6101, as amended, which prohibits discrimination in employment because of age; the Rehabilitation
Act of 1973, 29 U.S.C. §794, as amended, which prohibits discrimination on the basis of disability; the
Americans with Disabilities Act, 42 U.S.C. §12101 et seq., which prohibits discrimination in employment and
public accommodations because of disability; the Federal Transit Act, 49 U.S.C. §1612, as amended; and the
Fair Housing Act, 42 U.S.C. §3601 et seq. It is expressly understood that the Provider must submit an affidavit
attesting that it is not in violation of the Acts. If the Provider or any owner, subsidiary, or other firm affiliated
with or related to the Provider is found by the responsible enforcement agency, the Courts or the County to be in
violation of these acts,the County will conduct no further business with the Provider.
Any contract entered into based upon a false affidavit shall be voidable by the County. If the Provider violates
any of the Acts during the term of any contract the Provider has with the County, such contract shall be voidable
by the County, even if the Provider was not in violation at the time it submitted its affidavit.
The Provider agrees that it is in compliance with the Domestic Violence Leave, codified as § 11A-60 et seq. of
the Miami-Dade County Code, which requires an employer, who in the regular course of business has fifty (50)
or more employees working in Miami-Dade County for each working day during each of twenty (20) or more
calendar work weeks to provide domestic violence leave to its employees.
Failure to comply with this local law may be grounds for voiding or terminating this Contract or for
commencement of debarment proceedings against Provider.
ARTICLE III—Ratification of the Agreement
Other than expressly modified or amended herein, all other terms and conditions of the Agreement shall remain
in full force and effect.
SIGNATURES APPEAR ON THE FOLLOWING PAGE
3
THE CITY OF MIAMI BEACH. ' ,
EMERGENCY HOTEL/MOTEL PLACEMENT PROGRAM CONTRACT#: PC-1617-HTMT-3
HMIS STAFFING PROGRAM CONTRACT#PC-1617-STAFF-2
IN WITNESS WHEREOF, the parties have caused this four (4) page Amendment#1 of the Agreement to be
executed by their respective and duly authorized officers the day and year first above written.
THE CITY OF t IAMI B' ACH MIAMI-DADE COUNT /
By: _o" By:
Name: i MY L. uloR Q1--ES Name: _4_4 !' d
Title: C.i MANAGER Title: �L,/ _II
V , I1.4 r
Date: 2, t 3( (7 Date: 3 _ 1
Attest: /I do Attest: HARVEY RUVIN, Clerk
Al<1°uthorized Person OR Notary Board of County Commissioners
Public
Print Name: By:
t"���L6(1. AN tt 11 CJ
Title: Cr17 C l erik Print Name: 110--w-der.-
Corporate
ZwcatrCorporate Seal OR Notary Seal/Stamp: ,......—•••..�
/•car°M�11s •t
,r`� n IN7Y
L-2';. ,-''''' 2'i 4 s✓b .t •.
t _ • li r t ...........
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to form and legal sufficiency. See memorandum dated IZ/l(-1/iso. .
This Agreement is approved as g Y
APPROVED AS TO
FORM & LANGUAGE
& O E ELUTION
City Attorney ----Date-
4
THE CITY OF MIAMI BEACH
HOTEL/MOTEL PLACEMENT PROGRAM PC-1617-HTMT-2
HMIS STAFFING PROGRAM PC-1617-STAFF-2
THE CITY OF MIAMI BEACH
EMERGENCY HOTEL/MOTEL PLACEMENT PROGRAM
GRANT#: PC-1617-HTMT-2
The Provider agrees to provide emergency hotel/motel placement of homeless families, transgendered
individuals, chronically homeless individuals or individuals who have a high vulnerability index score on
an as-needed basis.
Clients may be provided with food vouchers on an as-needed basis of up to $20.00 per person, per day.
Reimbursement will only be made for properly documented disbursement of food vouchers.
All reimbursement must be submitted to the County by the 10th day of each month following the month of
service. All reimbursement requests must be approved by the County prior to the disbursement of funds.
THE CITY OF MIAMI BEACH
HMIS STAFFING
GRANT#: PC-1617-STAFF-2
The Provider shall provide a dedicated HMIS Outreach staff person. The purpose of this staff position is
to maintain data current in the HMIS and includes, but is not limited to input of client data upon intake,
updates of client files, compilation of reports and entering data for statistical purposes. Failure to
maintain this data current, as evidenced by HMIS generated Monthly Progress Reports submitted to the
County each month under the United States Department of Housing and Urban Development (HUD)
Agreement between the City of Miami Beach and the Miami-Dade County Homeless Trust may result in
the termination of this Agreement.
ATTACHMENT F
Miami-Dade County Homeless Trust
Invoice For Services
NAME OF AGENCY: The City of Miami Beach
SERVICE PERIOD: TO
NAME OF GRANT: HMIS Staffing Program
GRANT NUMBER: PC-1617-STAFF-2
TOTAL AWARD AMOUNT: $12,333.00
AMOUNT OF FUNDS REQUESTED
THIS MONTH: $
AMOUNT OF FUNDS RECEIVED TO DATE: $
BALANCE REMAINING ON GRANT: $
(following payment of this request)
Signature of Executive Director or Date
Authorized Agency Representative
Printed Name of Executive Director or
Authorized Agency Representative
ATTACHMENT F
Miami-Dade County Homeless Trust
Invoice For Services
NAME OF AGENCY: The City of Miami Beach
SERVICE PERIOD: TO
NAME OF GRANT: Emergency Hotel/Motel Placement
Program
GRANT NUMBER: PC-1617-HTMT-3
TOTAL AWARD AMOUNT: $ 10,000.00
AMOUNT OF FUNDS REQUESTED
THIS MONTH: $
AMOUNT OF FUNDS RECEIVED TO DATE: $
BALANCE REMAINING ON GRANT: $
(following the payment of this request)
Signature of Executive Director or Date
Authorized Agency Representative
Printed Name of Executive Director or
Authorized Agency Representative
•
ATTACHMENT L
MIAMI-DADE COUNTY HOMELESS TRUST
ANNUAL ACTUAL EXPENDITURE REPORT
HMIS STAFFING PROGRAM
CITY OF MIAMI BEACH-GRANT NUMBER#: PC-1617-STAFF-2
OCTOBER 1, 2016—SEPTEMBER 30,2017
Name of Agency: The City of Miami Beach
$ 12,333.00
Month of Services Amount Paid
Oct-16
Nov-16
Dec-16
Jan-17
Feb-17
Mar-17
Apr-17
May-17
Jun-17
Jul-17
Aug-17
Sep-17
Total Requested $ 0.00
Balance Remaining $ 12,333.00
,
ATTACHMENT L
MIAMI-DADE COUNTY HOMELESS TRUST
ANNUAL ACTUAL EXPENDITURE REPORT
HOTEL/MOTEL PLACEMENT PROGRAM
CITY OF MIAMI BEACH- GRANT NUMBER#: PC-1617-HTMT-3
OCTOBER 1,2016—SEPTEMBER 30, 2017
Name of Agency: The City of Miami Beach
$ 10,000.00
Month of Services Amount Paid
Oct-16
Nov-16
Dec-16
Jan-17
Feb-17
Mar-17
Apr-17
May-17
Jun-17
Jul-17
Aug-17
Sep-17
Total Requested $ 0.00
Balance Remaining $ 10,000.00
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Miami-Dade County's Affidavits and Declarations
MIAMI=
COUNTY
Miami-Dade County requires each party desiring to enter into a contract with Miami-Dade County to;
(1) sign an affidavit as to certain matters and (2) make a declaration as to certain other matters. This
form contains both an Affidavit form for matters requiring the entity to sign under oath and a Declaration
form for matters requiring only an affirmation or declaration for other matters.
Each section of this form must be read, and initialed indicating acceptance and/or compliance with the
County's policy related to the particular affidavit. For affidavit sections that you do not believe are
applicable to your organization,please indicate this by placing"x" in the box next to N/A.
•
ALL SECTIONS MUST BE COMPLETED
THE FOLLOWING MATTERS REQUIRE THE ENTITY TO SIGN AN AFFIDAVIT UNDER OATH:
STATE OF ( Ft RII A )
COUNTY OF (t41 A M r — DA DC
COUNTRY OF (USA )
Before me the undersigned authority appeared
(Print Name), l N1'I L . M O RA�„��S who is personally known to me or who has provided
as identification and who did swear to the following:
That he or she is the duly authorized representative of(Name of Entity) Cm"' O M I A til► gEA 0%4
(Address of Entity) 1-4<x) CON V NT'I CD N CEN r E K TDR IV E Post Office
addresses are not acce table.
9 --G0003 2
Federal Employment Identification Number
C. �-y OF t`413EACI-1 (hereinafter referred to as the contracting
"entity"), and that he or she is the entity's (Sole Proprietor)(Partner)(President or Other Authorized Officer)
ai-r'1 MA'.JAcc �
That he or she has full authority to make this affidavit, and that the information given herein and the documents
attached hereto are true and correct; and
That he or she says as follows:
Miami-Dade County's Affidavits and Declarations
1. MIAMI-DADE COUNTY OWNERSHIP DISCLOSURE AFFIDAVIT(SECTION 2-8.1 Pertains O
OF THE COUNTY CODE) N/A 154.
If the contract or business transaction is with a corporation,the full legal name and business address shall be
provided for each officer and director and each stockholder who holds directly or indirectly five percent(5%) or
more of the corporation's stock.
If the contract or business transaction is with a partnership,the foregoing information shall be provided for
each partner.
If the contract or business transaction is with a trust,the full legal name and address shall be provided for each
trustee and each beneficiary. The foregoing requirements shall not pertain to contracts with publicly traded
corporations or to contracts with the United States or any department or agency thereof,the State or any
political subdivision or agency thereof or any municipality of this State. All such names and address are outlined
below:Post Office addresses are not acceptable.
(Full Legal Name,Address,%Ownership) (Full Legal Name,Address,%Ownership)
(Full Legal Name,Address,%Ownership) (Full Legal Name,Address,%Ownership)
The full legal names and business address of any other individual(other than subcontractors,material person,
suppliers,laborers, or lenders)who have, or will have, any interest(legal, equitable beneficial or otherwise) in
the contract or business transaction with Miami Dade County are:
Post office addresses are not acceptable
Any person who willfully fails to disclose the information required herein, or who knowingly discloses false,
information in this regard,shall be punished by a fine of up to five hundred dollars ($500.00) or imprisonment
in jail for up to sixty(60) days or both.
........`.�rw�...rm ��i �r n , .+ •rte , fir.- -'---'------ ll-..-.- fl ,-.C9n
Miami-Dade County's Affidavits and Declarations
2. MIAMI-DADE COUNTY EMPLOYMENT DISCLOSURE AFFIDAVIT(COUNTY pertains )
ORDINANCE 90-133,AMENDING SECTION 2.8-1; SUBSECTION (d)(2) OF THE N/A D
COUNTY CODE)
Except where precluded by Federal or State laws or regulations, each contract or business transaction or
renewal thereof which involves the expenditure of then thousand dollars ($10,000) or more shall require the
entity contracting or transaction business to disclose the following information: The foregoing disclosure
requirements do not apply to contracts with the United States or any department or agency thereof,the State or
any political subdivision or agency thereof or any municipality of this State.
Does your firm have a collective bargaining agreement with its employees? Yes D No
Does your firm provide paid health care benefits for its employees?`1]Yes D No
Provide a current breakdown(number of persons) of your firm's work force and ownership [below):
White: Males 2.c-13 Females i U®
Black: Males 2e6 Females i cz
Hispanic: Males B i . Females 3 14.
Asian: Males 5 Females 5
American Native: Males Z Females tv
Aleut(Eskimo): Males is? Females
Miami-Dade County's Affidavits and Declarations
3. MIAMI-DADE COUNTY AFFIRMATIVE ACTION/
NONDISCRIMINATION OF EMPLOYMENT,PROMOTION AND Pertains ❑
PROCUREMENT PRACTICES (COUNTY ORDINANCE 98-30 CODIFIED N/A ❑
AT 2-8.1.5 OF THE COUNTY CODE)
Pursuant to Miami-Dade County's Ordinance No. 98-30,Section 2-8.1.5, entities with annual gross revenue in
excess of$5,000,000 seeking to contract with the County shall,as a condition of receiving a County contract,have:
1) a written affirmative action plan which sets forth the procedures the entity utilizes to assure that it does not
discriminate in its employment and promotion practices and 2) a written procurement policy which sets forth the
procedures the entity utilizes to assure that it does not discriminate against minority and women-owned
businesses in its own procurement of goods,supplies and services.Such affirmative action plans and procurement
policies shall provide for periodic review to determine their effectiveness in assuring the entity does not
discriminate in its employment,promotion and procurement practices.The foregoing,not withstanding, corporate
entities whose board of directors are representative of the population make-up of the nation shall be presumed to
have non-discriminatory employment and procurement policies, and shall not be required to have a written
affirmative action plan and procurement policy in order to receive a County contract.The foregoing presumption
maybe rebutted.The requirements of this section maybe waived upon written recommendation of the County
Manager that it is in the best interest of the County to do so and approval of the County Commission by majority
vote of the members present. Based on the above,please complete the affidavit as directed and return the
completed affidavit along with a cover letter on your company's letterhead,listing the company's address, phone ,
and fax numbers, and any required documents,to:Miami-Dade County,Department of Procurement
Management Affirmative Action Plan Unit 111 NW 1st Street, 13th Floor Miami,FL 33128
Yes No ❑ My company has an affirmative action plan and procurement policy and is
available for review.
My company has annual gross revenues in excess of$5,000,000.
Yes C l No ❑ Therefore, our company's affirmative action plan and procurement policy
is available for review.
Yes ❑ No N My company has annual gross revenues less than$5,000,000.
If at any time the Miami Dade County has reason to believe that any person or firm has willfully and knowingly
provided incorrect information or made false statements,the County may refer the matter to the State Attorney's
Office and/or other investigative agencies.The County may initiate debarment and/or pursue other remedies in
accordance with Miami-Dade County policy and/or applicable federal,state and local laws.
4. MIAMI-DADE COUNTY CRIMINAL RECORD AFFIDAVIT Pertains
(SECTION 2-8.6 OF THE COUNTY CODE) N/A ❑
The individual or entity entering into a contract or receiving funding from Miami-Dade County ❑ has ❑ has not,
as of the date of this affidavit,been convicted of a felony during the past ten (10) years.
An officer, director, or executive officer of the entity entering into a contract or receiving funding from Miami-Dade
County❑ has ❑has not as of the date of this affidavit been convicted of a felony during the past ten (10) years.
Miami-Dade County's Affidavits and Declarations
5. PUBLIC ENTITY CRIMES AFFIDAVIT(SECTION Pertains l]
287.133(3)(a),FLORIDA STATUTES) N/A O
The individual or entity entering into a contract or receiving funding from Miami-Dade County understands the
following: 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 of the United States of America,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 of the United States of America and involving antitrust,fraud,theft,bribery,
collusion,racketeering, conspiracy,or material misrepresentation.
That"Convicted" or"conviction"as defined in Paragraph 287.133 (1) (b) 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 state trial court of
record relating to charges brought by indictment or information after July 1,1989, as a result of a jury verdict,non-
jury trial, or entry of plea of guilty or nolo contendere.
That an"affiliate" as defined in Paragraph 287.133 (1) (a) Florida Statutes means a) a predecessor or successor of a
person convicted of a public entity crime; or b) 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 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.
That a"person"as defined in Paragraph 287.133 (1) CO Florida Statutes means any natural person or entity
organized under the laws of any state or of the United States of America 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 the management of an entity.
Based on information and belief,the statement as marked below,is true in relation to the entity submitting this
sworn statement. (Please indicate which statement applies by applying the individual initials near the box).
O 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 an affiliate of the
entity has been charged with and convicted of a public entity crime within the past 36 months.
O 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 within the past 36 months; and
D yes an additional statement is applicable or D no an additional statement is not applicable.
O 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 has been charged
with and convicted of a public entity crime within the past 36 months. However,there have been subsequent
proceedings 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".
The individual or entity entering into a contract or receiving funding from Miami-Dade County understands that he
or she is required to inform the public entity prior to entering into a contract in excess of the threshold amount
provided in Section 287.017 Florida Statues for Category 2 of any change in the information contained in this form.
Miami-Dade County's Affidavits and Declarations
6.MIAMI-DADE EMPLOYMENT FAMILY LEAVE AFFIDAVIT pertains )
(County Ordinance No.142-91 codified as Section 11A-29 et. N/A
seq of the County Code)
That in compliance with Ordinance No. 142-91 of the Code of Miami-Dade County, Florida, an employer with fifty
(50) or more employees working in Dade County for each working day during each of twenty(20) or more
calendar work weeks,shall provide the following information in compliance with all items in the aforementioned
ordinance:
An employee who has worked for the above firm at least one (1)year shall be entitled to ninety(90) days of family
leave during any twenty-four (24) month period,for medical reasons,for the birth or adoption of a child, or for the
care of a`child,spouse or other close relative who has a serious health condition without risk of termination of
employment or employer retaliation.
The foregoing requirements shall not pertain to contracts with the United States or any department or agency
thereof, or the State of Florida or any political subdivision or agency thereof. It shall,however,pertain to
municipalities of this State.
7. MIAMI-DADE COUNTY DISABILITY NONDISCRIMINATION Pertains 1i7
AFFIDAVIT (County Resolution R-385-95) N/A D
That the above named firm,corporation or organization is in compliance with and agrees to continue to comply
with, and assure that any subcontractor,or third party contractor under this project complies with all applicable
requirements of the laws listed below including,but not limited to,those provisions pertaining to employment,
provision of programs and services,transportation,communications, access to facilities,renovations, and new
construction in the following laws:The Americans with Disabilities Act of 1990 (ADA),Pub.L. 101-336, 104 Stat.
327,42 U.S.C. 12101-12213 and 47 U.S. C. Sections 225 and 611 including Title I, Employment;Title II,Public
Services; Title III, Public Accommodation and Services Operated by Private Entities; Title IV,Telecommunications;
and Title V,Miscellaneous Provisions:The Rehabilitation Act of 1973, 29 U.S.C.Section 794:The Federal Transit
Act,as amended 49 U.S. C.Section 1612:The Fair Housing Act as amended,42 U.S.C.Section 3601-3631.The
foregoing requirements shall not pertain to contracts with the United States or any department or agency thereof,
or the State or any political subdivision or agency thereof or any municipality of this State.
8.MIAMI-DADE COUNTY REGARDING DELINQUENT AND CURRENTLY DUE Pertains ' ]
FEES OR TAXES (Sec.2-8.1(c) of the County Code) N/A O
Except for small purchase orders and sole source contracts,that above named firm, corporation,organization or
individual desiring to transact business or enter into a contract with the County verifies that all delinquent and
currently due fees or taxes--including but not limited to real and property taxes,utility taxes and occupational
licenses--which are collected in the normal course by the Dade County Tax Collector as well as Dade County
issued parking tickets for vehicles registered in the name of the firm, corporation,organization or individual have
been paid.
r
Miami-Dade County's Affidavits and Declarations
Pertains .70
9. CURRENT ON ALL COUNTY CONTRACTS,LOANS AND OTHER OBLIGATIONS N/A O
The individual entity seeking to transact business with the County is current in all its obligations to the County and •
is not otherwise in default of any contract,promissory note or other loan document with the County or any of its
agencies or instrumentalities.
10. DOMESTIC VIOLENCE LEAVE (Resolution 185-00; 99-5 Codified At 11A- Pertains
60 Et.Seq.of the Miami-Dade County Code). N/A ❑
The firm desiring to do business with the County is in compliance with Domestic Leave Ordinance,Ordinance 99-
5,codified at 11A-60 et.seq.of the Miami Dade County Code,which requires an employer which has in the regular
course of business fifty(50) or more employees working in Miami-Dade County for each working day during each
of twenty(20) or more calendar work weeks in the current or proceeding calendar years,to provide Domestic
Violence Leave to its employees.
11. MIAMI-DADE COUNTY EMPLOYMENT DRUG-FREE WORKPLACE Pertains
AFFIDAVIT(County Ordinance No.92-15 codified as Section 2- N/A ❑
8.1.2 of the County Code)
That in compliance with Ordinance No. 92-15 of the Code of Miami-Dade County,Florida,the above named person
or entity is providing a drug-free workplace.A written statement to each employee shall inform the employee
about:
1. danger of drug abuse in the workplace;
2. the firm's policy of maintaining a drug-free environment at all workplaces;
3. availability of drug counseling,rehabilitation and employee assistance programs;
4. penalties that may be imposed upon employees for drug abuse violations.
The person or entity shall also require an employee to sign a statement,as a condition of employment that the
employee will abide by the terms and notify the employer of any criminal drug conviction occurring no later than
five (5) days after receiving notice of such conviction and impose appropriate personnel action against the
employee up to and including termination.
Compliance with Ordinance No. 92-15 maybe waived if the special characteristics of the product or service offered
by the person or entity make it necessary for the operation of the County or for the health,safety,welfare economic
benefits and well-being of the public.Contracts involving funding which is provided in whole or in part by the
United States or the State of Florida shall be exempted from the provisions of this ordinance in those instances
where those provisions are in conflict with the requirements of those governmental entities.
Miami-Dade County's Affidavits and Declarations
12. ATTESTATION REGARDING DUE AND PROPER ACKNOWLEDGEMENT OF Pertains Q
COUNTY FUNDING SUPPORT N/A O
By initialing this subsection and accepting County funds,the above named firm, corporation, organization or
individual agrees to abide by the grant contract requirement to recognize and acknowledge Miami-Dade County's
grant support in a manner commensurate with all contributorsand sponsors of its activities at comparable dollar
levels.
1 13.MIAMI-DADE COUNTY RESOLUTION NO.R-630-13 REQUIRING A DETAILED
PROJECT BUDGET,SOURCES AND USES STATEMENT,CERTIFICATIONS AS pertains
TO PAST DEFAULTS ON AGREEMENTS WITH NON-COUNTY FUNDING N/A
SOURCES,AND DUE DILIGENCE CHECK
Pursuant to Miami-Dade County Resolution No.R-630-13,requiring a detailed project budget, sources and uses
statement,certifications as to past defaults on agreements with non-county funding sources and due diligence
check prior to the County Mayor or County Mayor's designee recommending a commitinent of Miami-Dade County
funds to Social Services, Economic Development, Community Development,and Affordable Housing Agencies and
Providers.
The undersigned entity certifies,to the best of his or her knowledge and belief,that:
1. Within the past five (5)years,neither the Agency nor its directors,partners,principals,members or board
members:
(i) have been sued by a funding source for breach of contract or failure to perform obligations under a
contract;
(ii) have been cited by a funding source for non-compliance or default under a contract;
(iii) have been a defendant in a lawsuit based upon a contract with a funding source.
Please list any matters which prohibit the Agency from making the certifications required and explain how the
matters are being resolved(use separate sheet if necessary):
14.MIAMI-DADE COUNTY RESOLUTION No.R-478-12 NOT TO USE PRODUCTS Pertains X
OR FOODS CONTAINING"PINK SLIME" N/A O
Pursuant to Miami-Dade County Resolution No. R-478-12,the undersigned certifies,not to use meat products
containing"Pink Slime"in food provided or served as part any food program;urging all who provide food services
or operate a food program to immediately discontinue using meat products containing"pink slime" in food
provided or served in these programs.