HomeMy WebLinkAboutAttachments A-E
ATTACHMENT A
ATTACHMENT B
ATTACHMENT C
ATTACHMENT D
ATTACHMENTDl
ATTACHMENTD2
ATTACHMENT D3
ATTACHMENTE
SUMMARY OF ATTACHMENTS
Program Narrative - Scope of Service
Program Budget
Quarterly Program Perfonnance Report & Invoice
Miami-Dade County Affidavits
Code of Business Ethics
Miami-Dade County Debarment of Disclosure Affidavit
State Public Entities Crime Affidavit
Provider's Disclosure of Subcontractors and Suppliers
ATTACHMENT A
Program Narrative - Scope of Service
PROGRAM NARRATIVE
Jurisdiction Name: MIAMI BEACH Police Department
Contact Person: Lt, Lynda Veski
Address: 1100 Washington Avenue, Miami Beach, FL 33139
673-7933 PH - 673-7867 FX
Program Area: COMMUNITY POLICING
Program Dates: 101l/01 - 09130/02
Program Name: Lincoln Rd Bicycle Enhancement Program
Target Population: City Residents and
Visitors
Problem Identification
Lincoln Rd on Miami Beach is an outdoor pedestrian Mall that extends approximately seven blocks in length.
Through city efforts, this road has gone from a virtual ghost town to now having numerous restaurants, shops,
theaters and art galleries along both sides of Lincoln Rd. It is gaining national reputation and is an attractive spot
for residents and tourist alike. In addition, the scheduled opening ofa new 18 screen movie complex will have a
significant impact on Lincoln Rd. and the surrounding neighborhood, definitely increasing the flow of traffic by
several thousand persons every weekend. Although the Miami Beach Police Department's Bike Patrol Unit has
an established presence on Lincoln Rd., they are under increasing pressure from residents and business owners to
provide additional police presence.
Prol!ram Description
The Miami Beach Police Department has an existing Bike Patrol Unit that patrols Lincoln Rd. and surrounding
areas. Officers work during the morning and afternoon hours, walking riding and in some cases roller blading.
Several officers are as_signed to the Lincoln Rd. beat whose main philosophy is to establish police/public
interactions with city residents and business merchants. These officers work closely with the Lincoln Rd.
business Association, the city sanitation department and Code Enforcement to improve the quality of life in this
popular Miami Beach area. Bike Patrol officers are responsible for all service calls and each is given a pager that
allow business owners to call them when necessary.
The Miami Beach Police Department would like to expand their Bike Patrol Unit on Lincoln Rd. to respond to
the increase of pedestrians and the impact of the new 18 screen movie complex. They will expand their patrol
hours to include nights. Two of the existing Bike Patrol officers will work two nights a week which will add
continuity of their services. Because the current unit does not have enough bikes for the number of officers, grant
funds will be used to support the additional work hours of two officers and for the purchase of three bikes for the
patrol unit.
Year One Accomplishments! Unmet Needs (1999-2000)
The increase in the police presence on Lincoln Road has been received well by local business owners. There has
been a significant reduction in crime as reported by the department along with an improved relationship with
business owners. Business owners have also began to take a proactive approach to dealing with issues that
concern there businesses. The Lincoln Road Mercantile Assoc. meets monthly to discuss strategies on making
their community safer.
In the second year of programming, Miami Beach's Bike Patrol Unit will participate in the monthly business
association meetings to assist in the planning for their business districts. They will deal with issues such as
trying to promote the new mall on Lincoln Road and address parking and security concerns. Grant funds will be
used to support additional over;ime for the officers on Lincoln Rd. and to purchase an electric car that is now the
newest way of patrolling small areas such as the beach.
Year Two Activitiesl AccomDlisbmenb & Unmet Needs (2000-2001)
According to quarterly data, the Miami Beach Bike Patrol unit has provided over 700 hours of service to Lincoln
Road's merchant area. As a result, there has been a considerable decrease in complaints and reports. During
the first grant year, there was only one store in the area, whereas now there are four with two scheduled to open
in a few months. It is also reported that there has been an increase in the pedestrian traffic in this very popular
tourist area. including an increase in the number of families on weekends. Officers continue to meet monthly
with the Merchants Association and the Lincoln Road Visionary committee. In the third year of programming,
the department plans to continue it's policing efforts for the high traffic area of Lincoln Road. Grant funds will
be used to provide the greatly needed manpower during the busiest times of the day,
Jurisdiction Name: MIAMI BEACH Police Department
Contact Person: Lt. Lynda Veski
Address: 1100 Washington Avenue, Miami Beach, FL 33139
673-7933 PH - 673-7867 FX
Program Area: COMMUNITY POLICING
Program Dates: 101110 I - 09/30/02
Program Name: Lincoln Rei Bicycle Enhancement Program
Target Population: City Residents and
Visitors
Proposed Activities Planned Measures Monitoring Plan
4.B.02. To enhance/expand 2 Officers to work additional Copies of invoices for materials
Bike Patrol services to Lincoln (overtime) hours in the evenings purchased.
Rd. during the grant period on Lincoln Rd, .
Copies of Payroll records and
4.B04. To hold 10 meetings 1 Officer to participate in overtime slips
with community leaders for the monthly business association
purpose of identifying problems. meetings. Program Plan and Activity
Schedule.
- Meeting announcements,
attendance records, etc.
Participant list and meeting
attendance records
Lt. Lynda Veski, MBPD Vaughn Tooley, DHS
ATTACHMENTB
Program Budget
PROGRAM BUDGET
Jurisdiction Name:
MIAMI BEACH
Program Area: COMMUNITY POLICING
Program Name: BICYCLE ENHANCEMENT PROGRAM
Target Population: Residents and Visitors of Miami BCIdI
Salaries and Benefits, Total
I Pol ice Officers X 14 hours per week X 52 weeks
X $40.70 (Overtime)
I Sergeant X 4 hours per month X 12 months
X $40.70 (Overtime)
Contractual Services. Total
Expenses. Total
Bike maintenance and repair
Total Budget
Dade County will reimburse an amount not to exceed:
The 25% CASH MATCH for this grant is:
The SOurce of the CASH MATCH is:
Law Enforcement Trust Fund. City of Miami Beach
I
05/30/01. Mb$02.wk4
$24,177
$8,059
ConllCt Person: Lt. Lynda Vcski
(305) 673-7933 ex!. 5385 PH - (305) 673-7864 FX
Program Dues; 10/1101 - 9130102
531,583
$29,630
$1,954
$0
5653
653
532,236
ATTACHMENT C
Quarterly Program Performance Report & Invoice
Quarterly Project Performance Report
Drug Control and System Improvement Formula Grant Program
COMMUNITY POLICING PROJECT
PURPOSE AREA 4B
(Jurisdiction Name)
(Project Name)
(Name of Person Completing Fonn)
(Title)
(Phone)
STATE CONTRACT ID NUMBER: 2002-CJ-2H-II-23-01-198
2 January 1 - March 31 April 15
.., April 1 - June 30 July 15
;)
4 July 1 - September 30 October 15
1* October 1 - December 31 January 15
.For example, if your project began in October, this is Report Number 1.
Record Number, Period, and Date below:
NOTE: All jurisdictions must complete Sections I through 5. Section 6 must be completed following each jurisdiction's
noted instructions. PROJECT NARRA TlYE must be completed by all jurisdictions following this section's instructions.
Any Report not received by April 16; July 16; October 16; and/or January 16 will result in that jurisdiction being
"Out of Compliance" and their Reimbursement Request will be delayed.
Miami Dade Department of Human Services Fonn Revised 7/01
4B.Ol Coral Gables, Hialeah, Hialeah Gardens, Homestead, Miami, Sweetwater, West Miami, Miami
Dade PAL
1)
During this reporting period, how many community service events, including
neighborhood clean ups were conducted? (list the type and/or setting of the event)
4B.02 Biscayne Park, Hialeah Gardens, Homestead, Miami Beach, Pinecrest, Sunny Isles, Virginia
Gardens
2) During this reporting period, were Bicycle Patrols conducted?
a. No. of officers
b. No. of hours
4B.03 EI Portal, Golden Beach, Key Biscayne, Miami Springs, North Miami, Sunny Isles, Miami Dade
PAL
3) During this reporting period, how many alternative drug free events were conducted?
(List the names of these events)
4B.04 Miami Beach, Miami Dade Burglary
4) During this reporting period, how many meetings with community leaders for the
purpose of identifying neighborhood problems
4B.05 Hialeah, Miami, Miami Shores, North Bay Village, North Miami, North Miami Beach,
Sweetwater, Miami Dade; All Projects
5) During this reporting period, how many crime prevention education classes were
presented? (list names of the groups to which these presentations were made)
4B.06 Hialeah, Miami Dade TAP
6) During this reporting period, how many individuals were provided crisis intervention
or counseling services?
4B.07 Coral Gables, Sweetwater
7) Did the project create or expand one or more community or neighborhood recreation
center programs?
a. Did the center activities include arts and crafts?
b. Did the center activities include music activities?
c. Did the center activities include drama and theater activities?
d. Did the center activities include academic tutoring?
e. Did the center activities include table games?
f. Did the center activities include drug awareness and prevention education? _
g. Did the center activities include sports? (list sporting activities)
4B.09 Hialeah Gardens, South Miami
8) During this reporting period how many neighborhood watch meetings were
conducted?
4B.I0 Florida City, Hialeah Gardens, Homestead, South Miami, Sunny Isles, West Miami
9) During this reporting period, how many households were provided with Operation ID
services?
Project Narrative
(Please include a brief narrative detailing your progress in meeting your program objectives.)
Miami-Dade County
Community Policing
Resolution R-737-01
Grant HSB422
QINVCP
Revised 06/12/00
QUARTERLY PROJECT PERFORMANCE REPORT & INVOICE
[To Be Typed on Jurisdiction's Letterhead]
City:
Date of Claim:
Project Name:
Claim Number:
Costs Incurred During the Period of:
FIRST QUARTER
SECOND QUARTER
THIRD QUARTER
FOURTH QUARTER
October I - December 31
January I - March 31
April 1 - June 30
July I - September 30
Report Due January 15
Report Due April IS
Report Due June 15
Report Due October IS
1. Total Federal Budget $
2. Amount This Invoice $
(75%)
3. Amount Previous Invoices $
4. Remaining Balance $
(Sub1nCt Lines 2& 3 from Line 1)
. Budget
Categories
Line Item
Disallowed
Exceeds
Budget
Federal
Funds
(75%)
Local
Match
(25%)
Total
Funds
(100%)
I. Salaries & Benefits
2. Other Personnel
Services (Temporary
Employees/Contractual )
3. Expenses
4. Total Claim Costs
We request payment in accordance with our contract agreement in the amount of 75% of Total Costs for this
Claim $ (75%), the balance of costs, $ (25%), to be recorded as our
in-kind contribution to comply with the local cash match requirement.
Attached please fmd the records which substantiate the above expenditures. I certify that all of the costs have been
paid and none of the items have been previously reimbursed, all of the expenditures comply with the authorized
budget and fall within the contractual scope of services and all of the goods and services have been received for
which reimbursement is requested.
Respectfully submitted,
Chief of Police/Other City Official
Payment Approved, Miami-Dade County
Miami-Dade County
Community Policing
Resolution R-737-01
Grant HSB422
Page 2 00
QUARTERLY PROJECT PERFORMANCE REPORT & INVOICE - Payroll Expenses
City:
Date of Claim:
Project Name:
Claim Number:
Costs Incurred During the Period of:
FIRST QUARTER
SECOND QUARTER
THIRD QUARTER
FOURTH QUARTER
October I - December 31
January 1 - March 31
April I - June 30
July 1 - September 30
Report Due January 15
Report Due April 15
Report Due June 15
Report Due October 15
OfficerlStaffName
Date of Activity
Type of Activity.
Total Hours
"(Presentation, Parent Meeting, Field Trip. etc.)
TOTAL HOURS
AT$
PER HOUR = $
I CERTIFY THAT PA YMENT FOR THE AMOUNT OF $
IS CORRECT.
OFFICER/STAFF SIGNATURE
OFFICER/STAFF SOCIAL SECURITY #
CHIEF OF POLICE/CITY OFFICIAL SIGNATURE
I VERIFY THAT THE ABOVE SERVICES WERE PROVIDED:
School Principal's Signature
NOTE: Bookkeeping report documenting payroll expenses must be attached to process payment,
Miami-Dade County
Community Policing
Resolution R-737-01
Grant HSB422
Page 3 of3
QUARTERLY PROJECT PERFORMANCE REPORT & INVOICE
(Equipment, Supplies, Material Expenses)
City:
Date of Claim:
Project Name:
Claim Number:
Costs Incurred During the Period of:
FIRST QUARTER
SECOND QUARTER
THIRD QUARTER
FOURTH QUARTER
October I - December 31
January 1 - March 31
April 1 - June 30
July I - September 30
Report Due January 15
Report Due April 15
Report Due June 15
Report Due October 15
Vendor
Item Description
Date Paid
Check No.
Amount
TOTAL AMOUNT EXPENSES
NOTE: Copies of all invoices and checks for this request must be attached to process payment.
ATTACHMENTD
Miami-Dade County Affidavits
ATTACHMENT D
DEPARTMENT OF HUMAN SERVICES
BYRNE GRANT ADMINISTRATION
MIAMI-DADE COUNTY AFFIDAVITS
The contracting individual or entity (governmental ot otherwise) shall indicate by an "X" all affidavits
that pertain to this contract and shall indicate by an "N/A" all affidavits that do not pertain to this contract. AIl
blank spaces must be filled.
The MIAMI-DADE COUNlY OWNERSHIP DISCLOSURE AFFIDAVIT; MIAMI-DADE COUNlY
EMPLOYMENT DISCLOSURE AFFIDAVIT; MIAMI-DADE CRIMINAL RECORD AFFIDAVIT;
DISABILllY NONDISCRIMINATION AFFIDAVIT; and the PROJECT FRESH START AFFIDAVIT shaIl
not pertain to contracts with the United States or any of its departments or agencies thereof, the State or any
political subdivision or agency thereof or any municipality of this State. The MIAMI-DADE FAMILY LEAVE
AFFIDAVIT shall not pertain to contracts with the United States or any of its departments or agencies or the
State of Florida or any political subdivision or agency thereof; it shall, however, pertain to municipalities of the
State of Florida. All other contracting entities or individuals shall read carefully each affidavit to detennine
whether or not it pertains to this contract.
I,
Niesen Kasdin
Affiant
, being first duly sworn state:
The full legal name and business address of the person(s) or entity contracting or transacting business with
Miami-Dade County are (Post Office addresses are not acceptable):
F59-6000372
Federal Employer Identification Number (If none, Social Security)
City of Miami Beach
Name of Entity, Individual(s), Partners, or Corporation
Doing Business As (if same as above, leave blank)
1700 Convention Center Dr. 4th floor. Miami
Street Address City State
Beach. Florida 33139
Zip Code
NLA- I. MIAMI-DADE COUNlY OWNERSHIP DISCLOSURE AFFIDAVIT (Sec. 2-8.1 of the County Code)
I. 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 infonnation shall be provided for each partner. If the contract or business
transact.ion 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
addresses are (Post Office addresses are not acceptable):
Full Legal Name
Address
Ownership
%
%
%
10f5
2. The full legal names and business 'Ilddress of any other individual (other than subcontractors.
material men, suppliers, laborers, or lenders) who have, or will have, any interest (legal, equitable
beneficial or otherwise) in the contract or business transaction with Dade County are (Post Office
addresses are not acceptable):
N/A
N/A_II.
3. Any person who willfully fails to disclose the infonnation required herein, or who knowingly
discloses false infonnation in this regard, shall be punished by a fine of up to five hundred dollars
($500.00) or imprisonment in the County jail for up to sixty (60) days or both.
MIAMI-DADE COUNTY EMPLOYMENT DISCLOSURE AFFIDAVIT (County Ordinance No. 90-
133, Amending sec. 2.8-1; Subsection (dX2) of the County Code).
Except where precluded by federal or State laws or regulations, each contract or business transaction .or
renewal thereof which involves the expenditure often thousand dollars ($10,000) or more shall require
the entity contracting or transacting business to disclose the following infonnation. 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.
1. Does your finn have a collective bargaining agreement with its employees?
Yes No
2. Does your finn provide paid health care benefits for its employees?
Yes No
3. Provide a current breakdown (number of persons) of your finn's
work force and ownership as to race, national origin and gender:
White:
Black:
Hispanics:
Males
Males
Males
Males
Females
Females
Females
Females:
Asian:
American Indian:
Aleut (Eskimo):
Males
Males
Males
Males
Females
Females
Females
Females
N/A Ill. AFFIRMATIVE ACTIONINONDlSCRIMINATION OF EMPLOYMENT, PROMOTION AND
PROCUREMENT PRACTICES (County Ordinance 98-30 codified at 2-8.1.5 of the County Code.)
In accordance with County Ordinance No. 98-30, entities with annual gross revenues in excess of
$5,000,000 seeking to contract with the County shall, as a condition of receiving a County contract,
have: i) a written affinnative action plan which sets forth the procedures the entity utilizes to assure that
it does not discriminate in its employment and promotion practices; and ii) 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 affinnative
action plans and procurement policies shall provide for periodic review to detennine their effectiveness
in assuring the entity does not discriminate in its employment, promotion and procurement practices.
The foregoing notwithstanding, corporate entities whose boards 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 written affinnative action plans and procurement
policies in order to receive a County contract. The foregoing presumption may be rebutted.
20f5
The requirements of County Ordinance No. 98-30 may be waived upon the written recommendation of
the County Manager that it is in the best interest of the County to do so and upon approval of the Board
of County Commissioners by majority vote of the members present.
The firm does not have annual gross revenues in excess of $5,000,000.
The firm does have annual revenues in excess of $5,000,000; however, its Board of Directors is
representative of the population make-up of the nation and has submitted a written, detailed
listing of its Board of Directors, including the race or ethnicity of each board member, t? th~
County's Department of Business Development, 175 N.W, 1st Avenue, 28th Floor, MIamI,
Florida 33128.
The firm has annual gross revenues in excess of $5,000,000 and the firm does have a written
affirmative action plan and procurement policy as described above, which includes periodic
reviews to determine effectiveness, and has submitted the plan and policy to the County's
Department of Business Development 175 N.W. I" Avenue, 28th Floor, Miami, Florida
33128;
The firm does not have an affirmative action plan and/or a procurement policy as described
above, but has been granted a waiver.
N/ A_IV. MIAMI-DADE COUNTY CRIMINAL RECORD AFFIDAVIT (Section 2-8.6 of the County Code)
xx _V.
The individual or entity entering into a contract or receiving funding from the 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 of the entity entering into a contract or receiving funding from the
County _ has _ has not as of the date of this affidavit been convicted ofa felony during the past
ten (I 0) years.
MIAMI-DADE EMPLOYMENT DRUG-FREE WORKPLACE AFFIDAVIT (County Ordinance No.
92-15 codified as Section 2-8.1.2 of the County Code)
That in compliance with Ordinance No. 92-15 of the Code of Miaini-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 may be 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.
30f5
XLVI.
MIAMI-DADE EMPLOYMENT FAMILY LEAVE AFFIDAVIT (County Ordinance No.
142-91 codified as Section IIA-29 et. 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 infonnation in
compliance with all items in the aforementioned ordinance:
An employee who has worked for the above finn 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 oftennination 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.
N/A. vn. DISABILITY NON-DISCRIMINA nON AFFIDAVIT (County Resolution R-385-95)
That the above named finn, 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 n, Public
Services; Title III, Public Accommodations 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, the State or any political
subdivision or agency thereof or any municipality of this State.
N/8....ym. MIAMI-DADE COUNTY REGARDING DELINQUENT AND CURRENTLY DUE FEES OR
TAXES (Sec. 2-8.I(c) of the County Code)
Except for small purchase orders and sole source contracts, that above named finn, 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 nonnal course by
the Dade County Tax Collector as well as Dade County issued parking tickets for vehicles registered
in the name of the finn, corporation, organization or individual have been paid.
N/ ~IX. CURRENT ON ALL COUNTY CONTRACTS, LOANS AND OTHER OBLIGA nONS
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.
4of5
N/ A _X.
PROJECT FRESH START (Resolutions R-702-98 and 358-99)
Any fIrm that has a contract with the County that results in actual payment of $500,000 or more shall
contribute to Project Fresh Start, the County's Welfare to Work Initiative. However, if fIve percent
(5%) of the firm's work force consists of individuals who reside in Miami-Dade County and who have
lost or will lose cash assistance benefits (formerly Aid to Families with Dependent Children) as a
result of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, the firm may
request waiver from the requirements of R-702-98 and R-358-99 by submitting a waiver request
affidavit. The foregoing requirement does not pertain to government entities, not for profit
organizations or recipients of grant awards.
N/A_Xl.
DOMESTIC VIOLENCE LEAVE (Resolution 185-00; 99-5 Codified At IIA-60 Et. Seq. of the
Miami-Dade County Code).
The fIrm desiring to do business with the County is in compliance with Domestic Leave Ordinance,
Ordinance 99-5, codified at l1A-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.
I have carefully read this entire five (5) page document entitled, "Miami-Dade County Affidavits" and
have indicated by an "X" all affidavits that pertain to this contract and have indicated by an "N/A" all affidavits
that do not pertain to this contract.
(Signature of Affiant (Date)
SUBSCRIBED AND SWORN TO (or affirmed) before me this L day of (") ct
~
200J by V'VlCfI'T\ l-\ I ~Ot.D~-'L . ~personallY
known to me or has presented K{\)()u---l ,...J as identification.
(Type ofIdentification)
IOllflof
By:
(Signature of Notal)')
~ l?1\~
(Print or Stamp of Notary)
CC 7Gq<-f[3
(Serial Number)
BI '2.- ~I 01-
(Expiration Date)
Notal)' Public - Stamp State of
P1 OiL1J '"
(State)
Notary Seal
:lPl/a.. Stacy E. Kilroy
I' ~ CollllL1ssIan # CC 769.128
<!1 ~ MJ6, 23. 2002
"-i I ~ IIONDEO THRU
If OF fl.'(/! ATLAN11C \iON04NG co..1NC.
50f5
ATTACHMENT Dl
Code of Business Ethics
. MIAMI-DADE COUNTY, FLORIDA
AT'l'ACBHENT Dl
Form A-12
Code of Business Ethics
In accordance with Resolution R-994-99 each person or entity that seeks to do'business with Miami-Dace
County shall adopt the Miami-Dade County/Greater Miami Chamber of Commerce Code of Business Ethics
as follows:
The Miami-Dade COl,Jnty/Greater Miami Chamber of Commerce seeks to create and sustain an ethical
business climate for its members and the community by adopting a Code of Business Ethics. Miami-Dade
County/Greater Miami Chamber of Commerce encourages its members to incorporate the principles and
practices outlined here in their individual codes of ethics, which will guide their relationships with customers,
clients and suppliers. This Model Code can and should be prominently displayed at all business locations
and may be incorporated into marketing materials. Miami-Dade County/Greater Miami Chamber of
Commerce believes that its members should use this Code as a model for the development of their
organizations' business codes of ethics.
This Model Code is a statement of principles to help guide decisions and actions based on respect for the
importance of ethical business standards in the community. Miami-Dade County/Greater Miami Chamber
of Commerce believes the adoption of a meaningful code of ethics is the responsibility of every business
and professional organization.
By affixing a signature in the Proposal signature page, Form A-12, the Proposer hereby agrees to
comply with the principles of Miami-Dade County/Greater Miami Chamber of Commerce Code of
Business Ethics. If the Proposer firm's code varies in any way the Proposer must identify the
difference(s) on a separate documents attached to Form A-12.
Comoliance with Government Rules and Reaulations
. We the undersigned Proposer will properly maintain all records and post all licenses and certificates in
prominent places easily seen by our employees and customers;
· In dealing with government agencies and employees. we will conduct business in accordance with all
applicable rules and regulations and in the open;
· We. the undersigned Proposer wiii report contract irreguiarities and other improper or uniawfui business
practices to the Ethics Commission. the Office of Inspector General or appropriate law enforcement
authorities.
Recruitment. Selection and Comoensation of Contractors Consultina. Vendors. and Suooliers
. We, the undersigned Proposer will avoid conflicts of interest and disclose such conflicts when identified;
. Gifts that compromise the integrity of a business transaction are unacceptable; we will not kick back
any portion of a contract payment to employees of the other contracting party or accept such kickback.
Business Accountina
. All our financial transactions will be properly and fairly recorded in appropriate books of account, and
there will be no .off the books. transactions or secret accounts.
Promotion and Sales of Products and Services
. Our products will comply with all applicable safety and quality standards;
5/01 1 of 3
Jr)U'lJr'JJ.UJ'tUJ:. LVlJi" J I, r LURlDA
RFP.\o./III/'
. We, the undersigned Proposer will promote and advertise our business and its products or services In a
manner that is not misleading and does not falsely disparage our competitors:
. We. the undersigned Proposer will conduct business with govemment agencies and employees In ,
manner that avoids even the appearance of impropriety. Efforts to curry political favoritism are
unacceptable;
. Our proposal will be competitive. appropriate to the request for proposals/qualifications documents and
arrived at independently;
. Any changes to contracts awarded will have a substantive basis and not be pursued merely because we
are the successful Proposer.
. We, the undersigned Proposer will; to the best of our ability, perform govemment contracts awarded at
the price and under the terms provided for in the contract. We will not submit inflated invoices for goods
provided or services performed under such contracts, and claims will be made only for work actually
performed. We will abide by all contracting and subcontracting regulations.
. We, the undersigned Proposer will not, directly or indirectly, offer to give a bribe or otherwise channel
kickbacks from contracts awarded, to govemment officials, their family members or business
associates.
. We. the undersigned Proposer will not seek or expect preferential treatment on proposals based on our
participation in political campaigns.
Public Life and Political Camoaions
. We. the undersigned Proposer encourage all employees to participate in community life, publiC service
and the political process to the extent permitted by law;
. We. the undersigned Proposer encourage all employees to recruit. support and elect ethical and
qualified public officials and engage them in dialogue and debate about business and community issues
to the extent permitted by !a\,v;
. Our contributions to politicai parties, committees or individuais wiii be made oniy in accordance with
applicable laws and will comply with all requirements for pUblic disclosure. All contributions made on
behalf of the business must be reported to senior company management;
. We, the imdersigned Proposer will not contribute to the campaigns of persons who are convicted felons
or those who do not sign the Fair Campaign Practices Ordinance.
· We. the undersigned Proposer will not knowingly disseminate false campaign information or support
those who do.
Pass-throuoh Reauirements
· This Code prohibits pass-through payments whereby the prime firm requires that the MBE firm accepts
payments as an MBE and passes through those payments to another entity;
2 of 3
MIAMI-DADE COUNTY. FLORIDA
RFP '''. fiOO
Rental Soace. Eauioment and Staff Reauirements or Flat Overhead Fee Reauirements
· This Code prohibits rental space requirements, equipment requirements, staff requirements and/or fiat
overhead fee requirements, whereby the prime firm requires the M8E firm. to rent space. equipment
and/or staff from the prime firm or charges a flat overhead fee for the use of space. equipment.
secretary. etc;
M8E Staff Utilization
· This Code prohibits the prime firm from requiring the M8E firm to provide more staff than is necessary
and then utilizing the M8E staff for other work to be performed by the prime firm.
This Code also requires that on any contract where M8E participation is purported. the contract shall
specify essential terms including, but not limited to, a specific statement regarding the percent of
participation planned for M8Es, he tim. g of payments and when the work is to be performed.
Oate
.20_
By:
Neisen Kasdin
Printed Name of Affiant and rrtle
Li..L .L1J0LtJ!.-,L/..L./~
Federalldentific:ation Number
City nrl Mi~mi Rp~ch
17nn Cnnvpntion Center
M . ..Printed Na.,.,of Filll'l 33139
Dr. laml Beacn, r lonoa
Address of F"mn
SUBSCRIBMNDSWORNIT~(Or~melhisll-daYOf Oc...-.T .20..l..
by Ct111 n. ~. HelShe is personally known to me or has presented
~ ....
'"'-^-"
Type of identification
S>1"ffi. Signature of r.z: \ ~
P'rint o~p Name of Natar;
P1 O1-;.J <;
as identification.
~L I & Cf7tct53
~/ Se7al Number
U LS O"L.
Ex;:irabon Date
Notary Public - State of
New 4/25/00
Notary Seal
AP'I~ StaCy E. Kilroy
~ '"O'~ (omnIIssIon # CC 769428
~ ElcpIreS HJG. 23. 2002
~-tOfvo.'1 A~~~~.IMC
3 of 3
ATTACHMENT D2
Miami-Dade County Debarment Disclosure Affidavit
Attathment D2
MIAMI-DADE COUNTY DEBARMENT DISCLOSURE AFFIDA VII
(Ordinance 93-129, Section 1)
I, being duly first sworn, upon oath deposes and says that the bidder of this
contract or his agents, officers, principals, stockholders, subcontractors or their
affiliates are not debarred by Miami-Dade County.
By:
(Signature of Affiant)
(Date)
SUBSCRIBED AND SWORN TO (or affirmed) before me this
day of
200_ by
, He/She
is personally known to me or has presented
(Type of Identification)
as identification.
(Signature of Notary)
(Serial Number)
(Print or Stamp of Notary)
(Expiration Date)
Notary Public - Stamp State of
Notary Seal
(State)
5/01
Attachment D2
MIAMI-DADE COUNTY DEBARMENT DISCLOSURE AFFIDAVIT
(Ordinance 93-129, Section 1)
I, being duly first sworn, upon oath deposes and says that the bidder of this
contract or his agents, officers, principals, stockholders, subcontractors or their
affiliates are not debarred by Miami-Dade County.
By ~.a&.; ~ L?"~ 1011110 (
(Signature or Affian (Date)
SUBSCRIBED AND SWORN TO (or affirmed) before me this J \ day of 0 G
200_ by YV/ &cnl tt-. f?:, (yv.J ~
is personally known to me or has presented r..N ~
(Type of Identification)
. He/She
as identification.
~
(Signature of Notary)
c ~ I (j q 4tf3
(Serial Number)
~ /c;, fkA-
(Print or Stamp of Notary)
8/2- sid I
(Expiration Date)
Notary Public - Stamp State of
ptOttiJer
(State)
Notary Seal
--
5/01
ATTACHMENT D3
State Public Entities Crime Affidavit
Attachment D3
SWORN STATEMENT PURSUANT TO SECTION 287.133 (3) (a),
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 Miami-Dade County
by Neisen Kasdin, Mayor
(print individual's name and title)
fur City of Miami Beach
(print Name of entity submitting sworn statement)
whose businessaddress is 1700 Conventi on Center Dr., Mi ami Beach, Fl. 33139
and ifapplicable its Federal Employer Identification Number (FEIN) is F59-6000372
If the entity has no FEIN, include the Social Security Number ofthe individual signing
this sworn statement:
2. I understand that a "public entity crime" as defined in paragraph %87.133 (I)(g), Florida Statutes,
means a violation of any state or federal law by a person with respect to and directly related to the
transactions of business with any public entity or with an agency or political subdivision of any other
state or with the United States, including, but not limited to, any bid or contract for goods or services
to be provided to public entity or agency or political subdivision of any other state or of the United
States and involving antitrust, fraud, theft, bribery, colIusion, racketeering, conspiracy, or material
misinterpretation.
3. I understand that "convicted" or "conviction" as defined in Paragraph 287.133 (I)(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 or state trial court of record relating to charges brought by
indictment or information after July I, 1989, as a result of a jury verdict, non jury trial, or entry of a
plea of guilty or nolo contendere.
4. I 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 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, shalI be a prima facie case that one person
controls another person. A person wbo knowingly enters into a joint venture with a person who
bas been convicted of a public entity crime in Florida during the preceding 36 months shalI be
considered an affiliate.
10/2
5. I understand that a "person" as defined in Paragraph 287.133(I)(e), Florida Statutes, means any
natural person or entity organized under the laws of any state or of the United States within the legal
power to enter into a binding contact 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, executives, partners, shareholders,
employees, members, and agents who are active in management ofan 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. (please 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 I, 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, nor any affiliate of the entity has been charged with and convicted of a public entity crime
subsequent to July I, 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).
I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR
THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH I (ONE) ABOVE 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 THAT
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 INFORMA TION CONTAINED IN THIS FORM.
~7A' ;(~,,~
(Signature)
Swom to and subscrlbtd ~efore me this I (~ day of tJ ~
Personally known /Y 1Cf17J' fh I_~
OR Produced Identification ~ )~ Notary Public - State of
My commission expires
. 2oC!L.
Ffz/Vfd~
8 2-3102.
(Type of Identification)
~~
(printed typed or stamped commissioned name of notary
public)
a;.I~ P\, Stacy E. Kilroy
~ i"" Comllllsslon # CC 7690428
~ ,4 ElIplres HJG. 23, 2002
~ Iff' BONDED THRU
OF f\l ATtAImC BONDING CO.. INC.
2012
ATIACHMENTE
Provider's Disclosure of Subcontractors and Suppliers
ATIACHMENT E
MIAMI-DADE DEPARTMENT OF HUMAN SERVICES
BYRNE GRANT ADMINISTRATION
PROVIDER'S DISCLOSURE OF SUBCONTRACTORS AND SUPPLIERS
(Ordinance 97-104)
Name of Organization: City of Miami Beach
Address: 1700 Conventi on Center Dr.
Miami Beach, Fl. 33139
REQUIRED LISTING OF SUBCONTRACTORS ON COUNTY CONTRACT
..
In compliance with Miami-Dade County Ordinance 97-104, the Provider must submit the list of first tier
subcontractors or sub-consultants who will perform any part of the Scope of Services Work, if this
Contract is for $100,000 or more.
The Provider must complete this information. If the Provider will not utilize subcontractors, then the
Provider must state "No subcontractors will be used"; do not state "N/A".
NAME OF SUBCONTRACTOR OR SUB-CONSULTANT
ADDRESS
CITY AND STATE
N/A
No ~'^ '0 WyY\vJr,,, !Ai. \ \ be It. )e~
REQUIRED LIST OF SUPPLIERS ON COUNTY CONTRACT
In compliance with Miami-Dade County Ordinance 97-104, the Provider must submit a list of suppliers
who will supply materials for the Scope of Services to the Provider, if this Contract is $100,000 or
more.
The Provider must fill out this information. If the Provider will not use suppliers, the Provider must
state "No suppliers will be used", do not state "N/A".
NAME OF SUPPLIER
ADDRESS
CITY AND STATE
N/A ~O ,?"",~,t-r, ~'. \\ tfJ iAc,J,
I hereby certify that theforego;ng ;nfor11Ult;on is true, cor~ect aZd co rplete:
Signature of Authorized Representative: ~ P7'D >" . ..4 ##
Tille: Mayor L>ate: October 11,2001
Firm Name: City of Miami Beach
Fed. IL> No. F59-6000372
Address: 1700 Convention Center Dr. Ci~/State/Zip: Miami Beach, Fl. 33139
Telephone: (305) 673-7952 Fax: (3051 673-7854 E-mail: