97-22371 RESO
RESOLUTION NO. 97-22371
A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY
OF MIAMI BEACH, FLORIDA, AUTHORIZING THE MAYOR AND CITY.
CLERK TO EXECUTE THE FIRST AMENDMENT TO THE
PROFESSIONAL SERVICES AGREEMENT BETWEEN THE CITY OF
MIAMI BEACH AND DR. DAVID SANTISTEBAN, FOR JOB ANALYSIS
AND DEVELOPMENT AND VALIDATION OF PERMANENT SELECTION
PROCEDURES FOR FIREFIGHTER I AND POLICE OFFICERITRAINEE;
SAID AMENDMENT EXPANDING THE AGREEMENT TO INCLUDE
DEVELOPING OR REVISING, PILOT TESTING, AND VALIDATING A
MULTI-MODAL SCREENING TEST, PSYCHOLOGICAL, MEDICAL, AND
BACKGROUND PROCESS AND DEVELOPING AN APPLICANT
ORIENTATION PROGRAM IN AN AMOUNT NOT TO EXCEED $124,500,
AND AUTHORIZING THE CITY MANAGER TO EXERCISE THE OPTION
OF EXTENDING SAID AGREEMENT IN AN AMOUNT NOT TO EXCEED
$50,000, TO MEET ANY ADDITIONAL DEPARTMENT OF JUSTICE
REQUIREMENTS.
WHEREAS, the Consent Decree, entered by the Federal District Court, betweer tI e
Department of Justice (DOJ) and the City of Miami Beach, prohibits continued use of the Cit} 's
previous written tests for Firefighter I and Police OfficerlTrainee and allows the City to de\ielcp
alternative validated selection procedures for these entry-level classifications; and
WHEREAS, the Consent Decree requires that new Firefighter I and Police OfficerlTraime
tests and selection procedures must be developed in conjunction with the DOJ and provides th~t
the City will contract with recognized experts and that the method of test validation used by :;u( h
experts shall be approved by the DOJ; and
WHEREAS, the City retains the ultimate responsibility for the development ar d
administration of lawful examinations for entry-level Firefighter I and Police OfficerlTrainees; ar d
WHEREAS, under the Consent Decree, any test and selection procedure development shall
include the preparation of written job analyses; and
WHEREAS, the DOJ had no objections to the City's Request For Proposal (RFP) and tt e
proposal and methodology submitted by Dr. David Santisteban (Consultant); and
WHEREAS, the Consultant submitted the only response to the RFP issued by the City; ar d
WHEREAS, the Consultant is considered to be an expert and has extensive experience n
conducting job analyses and developing and validating civil service tests, oral boards, phy:)ic~1
ability tests, and other selection procedures (both entry-level and promotional) for uniforlled
positions, including Fire and Police; and
WHEREAS, the City, through a competitive bidding process, entered into contracts with Dr.
David Santisteban as low bidder, on June 1, 1990, for written test development for the Serg'3ant
of Police classification; and, on October 10, 1990, for the Lieutenant of Police classification; and
PalJe 2
WHEREAS, under the original Agreement, the Consultant already completed the! jc b
analyses and completed draft physical ability and oral tests; and
WHEREAS, the Consultant has initiated substantial work on the multi-modal screening teft,
as well as the psychological, medical, background process, and applicant orientation program; ar d
WHEREAS, through his work under the original Agreement, the Consultant has obtainEd
DOJ approval on his methodologies, techniques, procedures, and work products; in this proc es;,
he has gained invaluable knowledge about the City, about working with DOJ, and about the Cit~ s
classifications of Firefighter I Police OfficerlTrainee; and
WHEREAS, all work will be completed in accordance with the Consent Decree and will he' p
insure the administration of fair job-related select procedures, to select a diverse group of the m05t
qualified Firefighters I and Police OfficerlTrainees and help protect the City against litigation uld,~r
Title VII of the Civil Rights Act; and
WHEREAS, the Consultant is willing to perform these tasks not included in his orinin31
Agreement; and
WHEREAS, funding for this contract is available from the Police Department and Fi e
Department Professional Services budgets.
NOW, THEREFORE, BE IT DULY RESOLVED BY THE MAYOR AND CITY
COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, that the Mayor and City Commis sic n
hereby authorize the Mayor and City Clerk to execute the attached First Amendment to tt e
Professional Services Agreement between the City and Dr. David Santisteban; said amendrnelt
expanding the Agreement to include developing or revising, pilot testing, and validating a mul i-
modal screening test, psychological, medical, and background process and developing an applicalt
orientation program in an amount not to exceed $124,500, and authorizing the City Managl~r '0
exercise the option of extending said agreement in an amount not to exceed $50,000, to meet ar y
additional department of justice requirements.
PASSED AND ADOPTED this ~ day of
,1997
ATTEST:
R.l~ Bu~
CITY CLERK
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APPROVED AS TO
FORM & tANGUAGJE
& FOR EXECUTION
~~
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CITY OF
rVlIAMI BEACH
CITY HALL 1700 CONVENTION CENTER DRiVE MIAMI BEACH FLORIDA 33139
COMMISSION MEMORANDUM NO. ~
TO:
Mayor Seymour Gelber and
Memben of the City Commission
DATE:
May 7, 1997
FROM:
Jose Garcia-Pedrosa
City Manager
SUBJECT:
FIRST AMEND T TO FIREFIGHTER I AND POliCE OFFICER/TRAlrJE.:
PERMANENT ELECTION PROCEDURES PROFESSIONAL SERVIC .:
AGREEMENT WITH DR. DAVID SANTISTEBAN, EXPANDING AGREEMENT TO
INCLUDE DEVELOPING OR REVISING OTHER SELECTION PROCEDUHEi
AND DEVELOPING AN APPLICANT ORIENTATION PROGRAM, NOT TO
EXCEED $124,500; AND AUTHORIZING CITY MANAGER TO EXTEND
AGREEMENT NOT TO EXCEED $50,000, TO MEET ANY ADDITIOr~A_
DEPARTMENT OF JUSTICE REQUIREMENTS
ADMINISTRATION RECOMMENDATION:
It is recommended that the Mayor and the City Commission adopt the Resolution to execute th .~
attached First Amendment to the Professional Service Agreement with Dr. David Santisteban. Th .~
original Agreement was for Job Analysis and Development and Validation of Permanent Selectio 1
Procedures for Firefighter I and Police OfficerlTrainee. The Amendment will expand th.~
Agreement to include developing or revising, pilot testing, and validating a multi-modal screenin)
test, psychological, medical, and background process and developing an applicant orientatio 1
program for an amount not to exceed $124,500, and authorize the City Manager to exercise th.~
option of extending the Agreement for an amount not to exceed $50,000, to meet any addition( I
Department of Justice (DOJ) requirements.
CONTRACT AMOUNT AND FUNDING:
Not to exceed $124,500, and an option for the City Manager to extend the Agreement for up t,)
$50,000. Funds are available from the Fire Department's and Police Department's Profession<: I
Services budgets, subject to OMB approval.
BACKGROUND:
The Federal District Court entered the Consent Decree between the City of Miami Beach and thl!
DOJ, and includes the following items:
· Alleges that the City engaged in a pattern or practice of discrimination and that the writtell .
examinations previously used by the City did not meet the criteria established under Title V I
of the Civil Rights Act and the EEOC Uniform Guidelines on Employee Selection ProcedL rei
· Prohibits continued use of the City's previous written tests for Firefighter I and Police Off ce I"
· Allows the City to develop new tests and selection procedures
· Requires that the City conduct a job analysis and that new procedures be validated
· Requires that new procedures be developed in conjunction with DOJ and that the Cit "
contract with recognized experts
t4 '].V
AGENDA ITEM ~ ~
DATE 5-1.-!iJ-
Pa~lle 2
. Requires that DOJ approve the experts the City uses; the method of job analysis, validaHor I,
and test and selection procedure development and administration; the types of tests an:l
selection procedures
Outside legal counsel and DOJ reviewed and approved the Request For Proposals (RFP) befor~
it was issued to 24 agencies. The only proposal response was from Dr. David Santisteban. DC J
had no objections to Dr. Santisteban, his proposal, and the methodologies for job analysis, te:!it
development, and test validation.
Through competitive bidding, the City had entered into other successful Agreements with D'.
David Santisteban as low bidder. On June 1, 1990, the City contracted with Dr. Santisteball fer
testing services for Sergeant of Police and, on October 10, 1990, for Lieutenant of Police.
For Firefighter and Police Officer, Dr. Santisteban's original Agreement included:
STATUS
Complete
Concept rejected by DOJ
Final draft
Final draft
In Progress
TASK
. Conduct Job Analyses
. Develop Written Tests
. Develop Physical Abilities Tests
. Develop Oral Board Test (Fire)
. Validate the Tests
ANAL YSIS:
DOJ REQUIREMENTS: Due to DOJ requirements, the following items must be added to th3
Agreement: develop, tape, and validate the multi-modal ("MST" video) screening tests ($75,000 I;
analyze, revise, and validate the psychological, medical, and backgrounds processes ($29,500 I;
and conduct much more extensive pilot testing ($10,000). The original Agreement inclLded
previous Commission authorization for the City Manager to expand the original Agreement t y
$10,000 for the development of an applicant orientation program. The orientation prograll s
included in the attached expanded Agreement. In order to contain the costs of test administra-:ioll,
The City has worked with the Consultant to develop the most cost effective quality test posslbhl.
MST: Originally, DOJ had agreed to allow the City to use a written test, but later said that we c,)u d
not use this form of testing, primarily due to the adverse impact usually associated with wr tte n
tests. Dr. Santisteban proposed a compromise which DOJ accepted, a MST screening test. Tt'3
MST is far less expensive than DOJ's proposals. The MST is very similar to a typical written ':es t,
but much of the information is presented via video.
ORIENTATIONITEST PREPARATION PROGRAM: The orientation will help to level the playirg
field for all applicants and reduce adverse impact due to differences in test-taking experience. D-.
Santisteban's proposal stated, "Given the City's concern about increasing the diversity of the \VOl k
force, the nature of the Consent Decree, and the possibility that the different ethnic/gender grc1ur s
may have very different backgrounds with respect to exposure to testing programs .. c n
orientation program [will] provide information to prospective applicants about the entire selectic n
process, the requirements of the position, and the do's and don'ts of test taking".
COMPLETION OF PERMANENT HIRING PROCEDURES: With Dr. Santisteban's help, the Ci y
is very close to completing the permanent selection procedures for Firefighter and Police OffcE".
It is estimated that these processes will be developed by September 1, 1997. The attached
expanded Agreement is necessary to comply with DOJ's requirements, to finish this project, ar d
to bring the Consent Decree to an end.
Pa~lle 3
Dr. Santisteban is the best choice to finish this project in the final, but crucial stages, if we are t J
stay on tract and avoid costly delays. This is based on several factors including:
The Consultant has been accepted by DOJ
. He is the only person intimately knowledgeable of this project due to the many hours he has
spent developing and negotiating proposals with DOJ
. He knows the history of what DOJ is willing to approve and what they will not approve
. He developed the concepts and details of the types of selection procedures the City want s jJ
use which have been accepted by DOJ
He is extremely familiar with the City's Firefighter and Police Officer jobs since he conducte:!
the job analyses
He has been an expert witness and been successful in local litigation regarding his work an:!
the work of others
The Consultant was the only one to respond to the original RFP
He has initiated substantial work on the MST, psychological, medical, and backgrOLncs
processes
CONCLUSION:
Through his work under the initial Agreement, the Consultant has negotiated successfully with DC J
and obtained DOJ approval on his methodologies, techniques, procedures, and work product:;.
In this process, Dr. Santisteban has gained invaluable knowledge about the City, about wor><.:inq
with DOJ, and about the City's classifications of Firefighter and Police Officer.
It is recommended that the Mayor and City Commission adopt the Resolution to expand th3
Agreement with Dr. Santisteban to proceed with the work DOJ requires but which was not a pat
of the initial Agreement. This will allow proceeding with the development of permanent selectic1
procedures for Firefighter and Police Officer. It is also recommended that the Mayor and Cit y
Commission authorize the City Manager to exercise the option to expand the Agreement up 1 J
$50,00~ to ~t any additional DOJ requirements.
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CITY OF MIAMI BEACH
FIRST AMENDMENT TO PROFESSIONAL SERVICES AGREEMENT
BETWEEN THE CITY OF MIAMI BEACH (CITY)
AND DR. DAVID SANTISTEBAN (CONSULTANT)
FOR JOB ANALYSIS, SELECTION PROCEDURE DEVELOPMENT, AND
VALIDATION FOR FIREFIGHTER I AND
POLICE OFFICER/TRAINEE CLASSIFICATIONS
THIS FIRST AMENDMENT TO THE PROFESSIONAL SERVICES AGREEMENT BETWEiEN
THE CITY OF MIAMI BEACH (CITY) AND DR. DAVID SANTISTEBAN (CONSULTANT) FOR'
JOB ANALYSIS, SELECTION PROCEDURE DEVELOPMENT, AND VALIDATION FOR
FIREFIGHTER I AND POLICE OFFICERlTRAINEE CLASSIFICATIONS, dated April 20,1994. is
made this ~ day of May , 1997, by and between the CITY OF MIAMI BEACH,
a Florida municipal corporation, hereinafter called the "City", which term shall include its officictls,
successors, legal representatives, and assigns, and DR. DAVID SANTISTEBAN, an individLal,
hereinafter called the "Consultant".
GOAL OF SERVICES
The purpose of the project is to continue to increase the diversity of the City's work force and
to comply with the terms of the Consent Decree entered into with the United States Department
of Justice (DOJ) by performing the following functions: develop a fair, valid, defensible, customized
selection process; score and analyze the results of the selection procedures; respond to applicant
challenges; establish a cutting point; produce an ordered register of results; and validate the entire
selection process. The Consultant will perform these services in a valid, reliable manner consistEmt
with sound, currently accepted professional and legal methodologies. The above services will be
provided for the entry-level Firefighter I and the sworn entry-level Police OfficerlTrain 3e
classifications.
All aspects of the project will be completed in a manner which complies with the terms of tl1e
Consent Decree and which meets with the approval of the DOJ and the court. The specifics of tlhe
<.
1
project are subject to change to incorporate DOJ and court requirements.
The results of this process will be utilized by the City to select the most qualified and suitabl" ~
individuals for the noted classifications.
SCOPE OF WORK AND SERVICES REQUIRED
The conditions of the original Agreement will still be in effect and will apply to the work bednq
performed under this Amendment.
The Scope of Work covered by this First Amendment, to be performed by the Consulj art
includes, but is not limited to: developing or revising, pilot testing, and validating multimodc:l
screening tests (MST), psychologicals, medicals, and background processes and developinu
applicant orientation programs for Firefighter I and Police OfficerlTrainee.
TASK A - CONSTRUCT MULTIMODAL SCREENING TESTS (MSTs): Utilizing the concept:,
which have been approved by DOJ, develop MSTs which will screen applicants using a multimcdai
approach which combines different manners of stimulus presentation: video, audio, written. Thi:
multimodal approach will seek to enhance the fidelity of the testing instrument while at the samE
time make it a viable screening device for a large number of applicants. The MSTs will bE
developed to represent typical work on the job. All test items will involve materials and situatiom
common to Firefighter II Police Officer work, so that the candidates will readily see the relevance
of the test. The exam will not require any prior knowledge of the job, instead it will assess the
abilities and knowledge which according to the respective job analysis are required for succes:ifu
completion of the respective training academy and eventual performance of the duties of:he
position. The MSTs will:
Be developed so that they may be easily administered in a large group format with a proctol
and a number of test monitors
Consist of approximately 40-60 multiple choice questions. The primary form of presentat or
will be through videos with a written test booklet being used to supplement the vie ec
presentations
Have content validity which will be established through the use of Subject Matter Expert (SIVIE;
panels
The Consultant will:
Develop, analyze, interpret results, and validate based upon the job analysis
Ensure that no person(s), other than those designated by the City Manager, shall have acce!ss
2
.
to any information regarding the selection device, the selection device items, developmen:
materials, desired performancelresponseslanswers, or any related materials
Ensure that the test items have not been used and will not be used in whole nor in part by ,,:In:'
,other past, present, or future client or any other agency or individual without express writter
agreement between the City and the Consultant
Construct the selection devices with weights in proportion to the relative importance of KSA~
or behaviors to be sampled or measured as determined by the job analysis
Develop selection device components for each KSA or behavioral content area and documen
that the components are an adequate and representative sample of the KSA or behaviCira
content area to be measured or sampled, ensuring complete coverage of all major element~
of each KSA or behavioral content area
Develop components which will discriminate among applicants' levels of competency c.nc
which would differentiate among levels of job performance
Avoid redundancy and confounding of measurement
Review and edit items to insure freedom from misspelling or grammatical, typographical, or
other errors and freedom of ethnic, gender, or other bias - and to insure that all items are
properly prepared in accordance with accepted testing criteria, are reliable and valid, are
directly related to performance of the job, and are reasonable and defensible
Provide written documentation linking each component with the appropriate KSA or job
behavior
Develop desired performancelresponses for each component andlor standardslcriteria and a
form by which performance is to be evaluated, scored, analyzed, and interpreted
Produce and evaluate descriptive selection device statistics and analyses including adverse
impact statistics
Review and respond in writing to each applicant challenge, including justification of correct
(desired) performancelresponse
Determine appropriate cutting point (or passing score)
Provide the City with an ordered register of the selection device results of each participant
Prepare complete detailed report documenting entire process including, but not limited to, all
methodologies, rationales, and procedures
.
TASK B - DEVELOP APPLICANT ORIENTATION PROGRAM: Consultant will develop a
thorough orientation program to be given to each applicant. The program will include an orientation
3
booklet which will include detailed information on the format and content of each one of thE
selection instruments. Consultant will also develop an orientation presentation designed to ansM/e .
questions that the applicants may have regarding the selection process.
TASK C - CONDUCT PILOT TESTING: Pilot administrations of the tests will be conduC':ec
using proper ethnic and gender representation. The results of which will be evaluated with respec
to such factors as psychometric properties of the test (e.g., reliability, average scores, standarc
deviation, standard error of measurement), possible biases, and impact by ethnicity and genaer
TASK D - REVIEW, REVISE, AND VALIDATE BACKGROUND PROCESSES: Consultanl
will take into consideration the requirements of the State of Florida Statutes and the Florida
Department of Law Enforcement while reviewing and revising current and proposed background
processes. Documentation of the appropriateness of the background processes will utilize- a
content validity approach to demonstrate that the chosen areas for investigation are related to
performance of the job.
TASK E - REVIEW, REVISE, AND VALIDATE THE PSYCHOLOGICAL EVALUATIONS:
Consultant will review and analyze the test battery and interpretation of results of the curre!nt
psychological evaluations. Review and analysis will include, but not be limited to available
literature, validity studies, technical reports, local studies, etc. Consultant will revise psychological
evaluation where indicated and will validate the appropriateness of the instruments. Consultcnt
will establish a linkage between the areas covered by the psychological evaluation and tile
knowledgeslabilities found by the job analyses to be required prior to selection for the job.
TASK F - REVIEW, REVISE, AND VALIDATE THE MEDICAL EVALUATIONS: Consultant
will consider State of Florida Statutes and Florida Department of Law Enforcement standards wh Ie
reviewing and analyzing the current medical evaluation processes. Documentation of the
appropriateness of the medical processes will utilize a content validity approach to demonstrate
that the chosen areas for evaluation are related to performance of the job.
TASK G - DOCUMENTATION, FOLLOW-UP, AND GENERAL SERVICES: Will include, but
will not be limited to:
Prepare and deliver such presentations and participate in such discussions, proceedings, etc:. ,
4
as may be requested to comply with DOJ and court requests and requirements
Remain available on an as-needed basis to answer any questions or clarify or interpret th ~
results of any individual's results
Provide supplemental written material and training to City personnel to facilitate the use of thl'!
selection device results and reports
Defend andlor represent the City and testify on the City's behalf if any claims or allegations an!
made regarding the services provided including, but not limited to, the validity of the ':est
battery or evaluation methods or results
Maintain all raw test results and notes with respect to each individual evaluated for the timE!
period set forth in Florida records retention or other applicable laws or as specified by the City
whichever is greater
Submit a report summarizing evaluation and test results, including an analysis b~
ethnicitylrace, gender, and age showing adverse impact, if any, of each component and 0:
entire selection process and giving recommendations for future reduction of any adversE
impact
LAWS AND REGULATIONS
It shall be understood and agreed that any and all services, materials and equipment sl1al
comply fully with all local, state and Federal laws, ordinances, codes, and regulations clnc
acceptable professional industry standards applicable to the services contemplated herein. Thi~
shall include, but not be limited to, the Americans with Disabilities Act, Title VII of the Civil Riglt~
Act, the EEOC Uniform Guidelines, all other EEO regulations and guidelines, and Americar
Psychological Association guidelines.
TASK
A. Develop, pilot, validate MST
B. Applicant orientation program
C. Conduct extensive pilot testing
D. Developl revise, validate background
E. psychological
F. medical
TOTAL
COST BREAKDOWN
FIREFIGHTER POLICE OFFICER
$37,500 $37,500
$5,000 $5,000
$5,000 $5,000
$14,750 $14,750
TOTAL
$75,CIOC
$10,CiOC
$10,COO
$29,WO
$62,250
5
$62,250
$124,fiOO'
',.
COMPENSA TION
The Consultant shall be compensated for the services performed herein in an amount net to
exceed One Hundred Twenty-Four Thousand, Five Hundred Dollars ($124,500). The City Manage"
may exercise the option to extend the Agreement in an amount not to exceed Fifty Thousand
Dollars ($50,000) to meet any additional DOJ requirements.
IN WITNESS WHEREOF, the parties hereto have caused this First Amendment Agreemen:
to be executed by their appropriate officials, as of the date first entered above.
WITNESS:
j/LIiJ~'v;
,/ /
By:
,-""""
FOR CITY:
ATTEST:
By:
e~6~
CITY CLERK
FOR CONSULTANT:
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APPROVED AS TO
FORM & LANGUAGE
& FOR EXECUTION
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6
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 AUTHORL:ED TO
ADMINISTER OATHS.
1. This sworn statement is submitted to
by J)~v(b S tiNTI ~ Ie. tJ~^-.J
(print individual's name and title)
for
(print name of entity submitting sworn statement)
whose business address is
10 (
,
c.e; ~l....
M A::r-P R..c....1()
b #/01..--12.5\
1Ur/F-
PI
3~ / "'> 'f
and (if applicable) its Federal Employer Identification Number (FEIN) is
(If the entity has no FEIN, inc~d~_t~SD~jat Security Number of the individual signing
statement: I ?:>" 3 ~lS J J ...J .)
this. SI,lom
2. I understand that a "publ ic entity crime" as defined in Paragraph 287.133(1 )(g), Florida Statl.:W..
means a violation of any state or federal law by a person with respect to and directly related :0 he
transaction of business with any public entity or with an agency or political subdivision of any ot,er
state or of the United States, including, but not limited to, any bid or contract for goods or servi:es
to be provided to any public entity or an agency or political subdivision of any other state or If 'he
United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspira,:y, or
material misrepresentation.
3. I understand that "convicted" or "conviction" as defined in Paragraph 287.133(1)(b), Florida Sta'n.:L.
means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of
gui l t, in any federal or state trial court of record relating to charges brought by indictml!nt or
information after July 1, 1989, as a result of a jury verdict, non-jury trial, or entry of a p.ea of
guilty or nolo contendere.
4.
understand that an "affi l iate" as defined in Paragraph 287.133(1 )(a), Florida
Statutes. nlear s:
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 Ilf he
entity and who has been convicted of a publ ic entity crime. The term "affi l iate" includes th lse
officers, directors, executives, partners, shareholders, employees, members, and agen:s ,Iho
are active in the management of an affi l iate. The ownership by one person of .ha'es
consti tuting a controll ing interest in another person, or a pool ing of equipment or inclme
among persons when not for fair market value under an arm's length agreement, shall be a pr ma
facie case that one person controls another person. A person who knowingly enters into a jo nt
venture with a person who has been convicted of a public entity crime in Florida duril1ghe
preceding 36 months shall be considered an affiliate.
5. I understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statutes. mems my
natural person or entity organized under the laws of any state or of the United States with the legal pc~er
to enter into a binding contract and which bids or applies to bid on contracts for the provis' on of
goods or services let by a public entity, or which otherwise transacts or applies to transact business w th
a public entity. The term "person" includes those officers, directors, executives, par:ne's,
shareholders, employees, members, and agents who are active in management of an entity.
6.
entity
Based on information and belief, the statement which I have marked is true in relation to
submitting this sworn statement. (indicate which statement applies.)
~either the entity submitting this sworn statement, nor any of its officers, dire:to
- executives, partners, shareholders, employees, members, or agents who are active in
management of the entity, nor any affiliate of the entity have been charged with and conlic
of a public entity crime subsequent to July 1, 1989.
he
's,
he
ed
The entity submitting this sworn statement, or one or more of the officers, dire:to's,
executives, partners, shareholders, employees, members, or agents who are active in :he
management of the ent i ty, or an aft i l i ate of the ent i ty has been charged wi th and conli c:ed
of a public entity crime subsequent to July 1, 1989.
The entity submitting this sworn statement, or one or more of its officers, dire:to's,
executives, partners, shareholders, employees members, or agents who are active in :he
management of the entity, or an affiliate of the entity has been charged with and con/ic:ed
of a public entity crime subsequent to July 1,1989. However, there has been a subs~qu~nt
proceeding before a Hearing Officer of the State of Florida, Division of Administ"at ve
Hearings and the Final Order entered by the Hearing Officer determined that it was not in:he
public interest to place the entity submitting this sworn statement on the convicted lenJor
list. (attach a copy of the final order)
I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDEN-IF ED
IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMIIER 31
OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENT TY
PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, fj,.Q!LDA
STATUTES FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAIN D I THIS R.
STATE OF F ,--,,^,- '.0 A
COUNTY OF O~C
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
{)Av. D ,S.-4,.J T I ,"I"?c'/:>..,.,.~ , who, after first being sworn by me, affixed
signature
in the space provi ded above on th i s 2. day of 0-1,/-/ Y , 19<::; I .
his/,er
My Corrrnission Expires: _S/ ("I"" ",(,
FORM PUR 7068 (Rev. 12/21/95)
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NOTARY PU L
OH.kJi'j, TI;7:-:~T7sr:/\ (,
CAJ\:LJ InJH;,..',0D
NOTARY PUBLIC ~;J Ar: ('J. i'J 'A~:;);\
COMMISSION !':O, C'.";;".J::.:)
MY COMMISSION EX 1'. r.iil y "::!.0.~lg
DISABILITY NONDISCRIMINATION AFFIDAVIT
CONTRACT REFERENCE
NAME OF FIRM, CORPORATION, OR ORGANIZATION Ok//:; )~NrrJn."d::.;CLrt/
AUTHORIZED AGENT COMPLETING AFFIDAVIT:
POSITION
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PHONENUMBER6ot 'fl/JL-'f 7 /
I,
, being duly first sworn state:
That the above named firm, corporation or organization is in compliance with and agrees to contir ue
to comply with, and assure that any subcontractor, or third party contractor under this proj:ct
complies with all applicable requirements of the laws listed below including, but not limited to, th(,se
provisions pertaining to employment, provision of programs and services, transportatillll,
communications, access to facilities, renovations, and new construction.
The Americans with Disabilities Act of 1990 (ADA): Pub. L. 101-336, 104 Stat 327, 42 l.S C.
12101-12213 and 47 U.S.C. Sections 225 and 611 including Title I, Employment; Title II, Fuclic
Services; Title III, Public Accommodations and Services Operated by Private Entities; Title] V,
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.
r[;,1c
ate
SUBSCRIBED AND SWORN TO (or affirmed) before me on
,S /2 II,'.,
/ '
(Date)
,S P'1 AJ II ..)' T ,-:a~ , He/She is personally known to me or has
(Affiant)
by [) A Vi 0
presented F,--. v.? {L. '-- l C '
(Type of identification)
~ J(?~
(Si n re of Notary)
as identification.
C~L 'r KUl-IL-v<J/VJ
(Print or Stamp Name of Notary)
ce..) ~~ CL.Y
(Serial Number)
S / I ,./ Zt,,-~
tExpinltion Date)
r-oYPiCfAL ~':. 7j! 'fniST:AL
\ CARL I !<l:Ii ,""'>II)
NOTARY !'UBUC ~,r t:1 '-. OF n..:'il.11)A
L COMM1SS10i'. 7-' '. CCS';(,im,
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Notary Seal
Notary Public
~rL0'^-" . 0/1
(State)
The City of Miami Beach will not award a contract to any firm, corporation or organization that fails to complet~ m ,d
submit this Affidavit with the firm, corporation or organization's bid or proposal or fails to have this Affidavit on f Ie
with the City of Miami Beach.
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