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Attachment C
ATTACHMENT C CONSULTANTS RESPONSE TO THE (ITB) Detail by FEI/EIN Number Page 1 of 2 Honda Department of State DIVISION OF CORPORATIONS it)Q DI`ILJcn I of �v -_'rfri► 1 rut uI/lciu!,;tate of Ronda»einire Department of State I Division of Corporations I Search Records / Detail By Document Number I Detail by FEI/EIN Number Florida Profit Corporation CRITICAL PATH SERVICES, INC. Filing Information • Document Number P98000028931 FEI/EIN Number 65-0828408 Date Filed 03/27/1998 State FL Status ACTIVE Principal Address 3305 SW 37th Avenue Unit B MIAMI, FL 33133 Changed:04/29/2016 Mailing Address P.O. BOX 330429 MIAMI, FL 33233 Changed:04/30/2012 Registered Agent Name&Address Marx Rosenthal PLLC One Southeast Third Avenue Suite 2900 MIAMI, FL 33131 Name Changed:04/29/2016 Address Changed:04/29/2016 Officer/Director Detail Name&Address Title P Schaffer,Craig I 3305 SW 37th Avenue Unit B MIAMI, FL 33133 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inq... 7/23/2018 Detail by FEI/EIN Number Page 2 of 2 Annual Reports Report Year Filed Date 2016 04/29/2016 2017 04/28/2017 2018 04/04/2018 Document Images 04/04/2018--ANNUAL REPORT View image in PDF format 04/28/2017--ANNUAL REPORT View image in PDF format 04/29/2016--ANNUAL REPORT View image in PDF format 05/01/2015--ANNUAL REPORT View image in PDF format 06/11/2014--ANNUAL REPORT View image in PDF format 03/28/2013--ANNUAL REPORT View image in PDF format 04/30/2012—ANNUAL REPORT View image in PDF format 04/29/2011—ANNUAL REPORT View image in PDF format 02/19/2010—ANNUAL REPORT View image in PDF format 03/16/2009—ANNUAL REPORT View image in PDF format 02/25/2008—ANNUAL REPORT View image in PDF format 06/29/2007—ANNUAL REPORT View image in PDF format 08/22/2006—Req.Agent Change View image in PDF format 04/26/2006—ANNUAL REPORT View image in PDF format 04/28/2005—ANNUAL REPORT View image in PDF format 01/26/2004—ANNUAL REPORT View image in PDF format 02/26/2003—ANNUAL REPORT View image in PDF format 04/29/2002—ANNUAL REPORT View image in PDF format 04/16/2001—ANNUAL REPORT View image in PDF format 03/15/2000—ANNUAL REPORT View image in PDF format • 04/14/1999—ANNUAL REPORT View image in PDF format 03/27/1998--Domestic Profit View image in PDF format Florida Department of State,Divw on of Corporations http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?incl... 7/23/2018 ' 1 . 1 . Identification Page and oi,.. .. . Table of Contents . 1111 111 1 PI . . mow ir,. I f, I I • .- ,., . II i iel N 11 Pt ., , ,.. .. , v • - n I . 1 ,. .,. • . • ; ,;, ,..., . ...,z..,,,,. \\%\c,, lks :It, t• • "i'', . - ..„. •'.. . ...: \. 1 . . •.. _.. ------ --- . . '" ..' - t- .. " .... . V1/4\ ii k • I "Ill „ I il ' r 1 1 • - i. ' - o il , , i I -, "::• , t :, I I tt. I •I ' fl • ,_ .. ' , .: -••- . //• , x.-\\ t 01 ...1,0--",,h.- . ;&'.• . 1/ ' . ,,, '-...--...., . . •Av - . .... ...... . A e _ i', : N.-. .,./ • . •. II , . .• i ;\.\.,, ., %, • •W 1 i. ' /1111 ,it. , •••-• 1 .. • . 0, '10 1 f,* / 4. .1 •'''''(.. Or." ... . • , A .... ' i ;1, ).,. ,,,p I, td• . ..... V, . .• / t-, .N.„, , ,\ i . \- .... - , .;• ,•,' ,• :` .: ', .. • al. . . .„L,.• VI' ANk `4,\ .., \,, f dr, , .`,,,-,.1 , % ‘• . _—_-- , y -% 7 .,‘4•*3••• I ' . '• 6 i . I ri,• N-.• '% " -...,-; `-- ' 1 • 1 ; • ... . • • eigi. ••1• 111111 * 'Illifiiii/ • Oil MO „ I I Wil , . mmi sal; •.% . ll. lik 111111.111. i•1111 ..6 1111 --4 1". 7 t • ; ... 1 , It , . . .. , 1, , , .0 • r is..w • • ,,, ,- ,,• .11 -.., a. . . . 11'' I ... ' ; I Tab A, 1 ' . ' ,,,....„..., ., •... .„.. ... . ... . , ,. . i ki , , ...... . . . • .. ...... r 1 "IA ----- • ilaININNOMarie 1' --_ Identification Page • Critical Path Services Inc. • 3305 SW 37th Ave. Miami, Fl. 33133 • cschaffer@criticalpathconstruction.com • Phone #: 305-856-3919 • Fax #: 305-856-3921 • Tax ID: 65-0828408 • Sub. S Corporation • Signature of officer w/ authority to bind bidder (see below) • Printed name of officer: Craig Schaffer • Title of authorized signing officer: President • Date of signature: 6-28-18 • Signature: , . .. ,, • k . _ . . _. _ _ . .. , , ,. .... _ _ .__ �Y. _ . . .. ._ ,rte V. •\ �-% ` e. yr r � c_ ..,,,,:„;:1,,44.... Z yam'; ' .` az,- �- \\ _ \\. •4 ,1 1 y,Yl�' ': `��t1. •.'�.- • ' ` .-.r.-;V;-', --:- •---,..:AL4IP.— , '‘‘\% 'I'-1..'''‘-----..' II'•4,11',4 , c..' .41...t'11,.ii•lAt ‘ 1(--. :‘, ;it!'ll.T.I.,„ ‘, A\\\\\\\\\ ' ` i ?,..p�y : 511 '' .12 r^y. S •�. —',1 A I ~ r 7 .r_ ` � � '-f I te .yam .._�..) , .. ` t i41 i. . s �{ - •,Yit ,h . . .v ••••` 1 i .. .tet a• _ .. wp Vt~ fie. ` - Table of Contents s - _ ._ . Tab B. Minimum Qualifications and Submittal Requirements Tab C. Financial Statements Tab D. Previous Experience and Key Personnel Tab E. Bid Price and Forms ) .41 . ., . . . /11 \ • inimum Qualifications and . ..,, Submittal Requirements ..„. i ' • . ir 0 . 'a i . , :,, ..7. --" Fir i . 0 .- . , -, . ---- . „ , itli 1..-.1 I, ; 1:4 - di 4 wi,le)4;,....:. , , - 4. . ... . .. . . . . . .. , . .,.....,.... ... • .:k. , , . , 4.-------..0 , .. ?-mems. . . . A -- -- - - ' 'ipio5' . - i ite- _ RI , tannin: ,, i . . • • %km. ' 4 ' *% ...01111111k 1. ... 1 W-- 47:1; ,514... ....._ --imm. . . . ,_ -Al ,.. . ... . ..... ._ . , . . . . . _ 7,10„ , 'I 0 A Ta b Ili 1.. • , ,._.,. . .,„ ..__ . ,_... ..... ..,. :., . .• _ , 7. J. Bid Guaranty Document A310TM — 2010 Conforms with The American Institute of Architects AIA Document 310 Bid Bond CONTRACTOR: SURETY: (Name,legal status and address) (Name,legal slates and principal place e jhncines:e) QBE Insurance Corporation 55 Water Street.20th Floor, Critical Path Services, Inc. 06E-Sarery.US-60X@us.gbe.con This document has important 578 NE 64 Street, Unit 2 New York, NY 10041 legal consequences.Consultation Miami, FL 33138 Mailing Address for Notices with an attorney is encouraged with respect to its completion or OWNER' Same as above modification. (NVame,legal status and address) Any singular reference to Cit of Miami Beach Contractor,Surety,Owner or City other party shall be considered 1755 Meridian Avenue, 3rd Floor plural where applicable. Miami Beach, FL 33139 BOND AMOUNT: 5% Five Percent of Amount Bid PROJECT: (Name.location or address.and Project'umber ifanv) Carl Fisher Clubhouse Restoration - Bid no. 2018-125-ZD The Contractor and Surety arc bound to the Owner in the amount set forth above.for the payment of which the Contractor and Surety bind themselves,their heirs,executors,administrators,successors and assigns,jointly and severally,as provided herein.The conditions of this Bond arc such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents,or within such time period as may be agreed to by the Owner and Contractor,and the Contractor tither(1)enters into a contract with the Owner in accordance with the terms of such bid,and gives such bond or bonds as may be specified in the bidding or Contract Documents,with a surety admitted in the jurisdiction of the Project and otherwise acceptable to the Owner,for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof,or(2)pays to the Owner the difference,not to exceed the amount of this Bond,between the amount specified in said bid and such larger amount for which the Owner may in good faith contract with another party to perform the work covered by said hid,then this obligation shall he null and void,otherwise to remain in full force and effect.The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend lime lime Jr which the Owner may accept the hid.Waiver of notice by the Surety shall not apply to any extension exceeding sixty(60)days in the aggregate beyond the time lir acceptance of bids specified in the bid documents,and the Owner and Contractor shall obtain the Surety's consent Iiran extension beyond sixty(60)days. If this Bond is issued in connection with a subcontractor's bid to a Contractor,the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project,any provision in this Bond conflicting witli said statutory or legal requirement shall he deemed deleted hcretrrm and provisions onfomung to such statutory or other legal requirement shall be deemed incorporated herein.When so furnished,the intent tha this Bond shall be construed as a statutory bond and not as a common law bond, 7 / Signed and se - ' i day of June, 2018. Critical Path Ser,ices. AFM. (Principal) I (Seal) (11'itness) By: I , 4 / (Title) 'I QBE Ipsgance Corporation (.tie 't3) (Sett/) (Irmlec l (70—Chart ' JJ Nielson . Attorney-in-Fact Surety Phone No. S-0054/AS 8/10 WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE BLUE BORDER QBEPOWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS,that QBE Insurance Corporation(the'Company"),a corporation duly organized and existing under the laws of the State of Pennsylvania,having its principal office at 55 Water Street 20th Floor,New York,NY 10041,has made. constituted and appointed, and does by these presents make, constitute and appoint David R Hoover,Charles J Nielson, Charles D Nielson,and Shawn Alan Burton of Nielson,Hoover&Company,Inc.of Miami Lakes.FL its true and lawful Attorney- in-Fact, to sign its name as surety only as delineated below and to execute, seal, acknowledge and deliver any and all bonds and undertakings, with the exception of financial guaranty insurance, to the same extent as if such bonds had been duly executed and acknowledged by the regularly elected officers of the Company at its principal office in their own proper persons. This Power of Attorney shall be construed and enforced in accordance with, and governed by, the laws of the State of New York, without giving effect to the principles of conflict of laws. This Power of Attorney is granted pursuant to the following resolutions,which were duly and validly adopted at a meeting of the Board of Directors of the Company with effect from June 30,2014: RESOLVED, that the Chief Executive Officer,any President,any Executive Vice President,any Senior Vice President,any Vice President,the Corporate Secretary or any Assistant Corporate Secretary is authorized to appoint one or more Attorneys- in-Fact and agents to execute on behalf of the Company, as surety, any and all bonds, undertakings and contracts of suretyship,or other written obligations in the nature thereof; to prescribe their respective duties and the respective limits of their authority;and to revoke any such appointment at any lime; FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance,or conditional undertaking will be valid and binding upon the Company when-(a)signed by any of the aforesaid authorized officers;or(b)duly executed(under seal,if required)by one or more Attorneys-in-Fact and agents pursuant to the power prescribed in his/her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority;and FURTHER RESOLVED,that the signature of any authorized officer and the seal of the Company may be drawn on or affixed by facsimile or electronically transmitted by email to any power of attorney or certification thereof authorizing the execution and delivery of any bond,undertaking,recognizance,or other suretyship obligation of the Company,and such signature and seal when so used shall have the same force and effect as though manually affixed. The Company may continue to use for the purposes herein stated the facsimile or electronically reproduced signature of any person or persons who shall have been such officer or officers of the Company,notwithstanding the fact that they may have ceased to be such at the time when such instruments shall be issued. IN WITNESS WHEREOF, the Company has caused these presents to be signed and attested by its appropriate officers and its corporate seal hereunto affixed this December 15,2017. Attest: QBE INSURANCE CORPORATION (Seal) By: ---'`-- - 4VBy Brett Halsey Matt Curran Senior Vice President Senior Vice President STATE OF NEW YORK )SS.: COUNTY OF NEW YORK On this December 15, 2017, before me personally appeared Brett Halsey and Malt Curran. both to me known to be Senior Vice Presidents of QBE Insurance Corporation, and that each,as such, being authorized to do,execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporation by each as a duly authorized officer. Hatpreet Kaur Manu Notary Public.Stan of New York By: •w No.02MA633i099 Harpre= • Kaur Mann,Notary Public Qualified is New Yodc County Commifeioa - °ber 28'2019 CERTIFICATE I,Jose Ramon Gonzalez,Jr.,the undersigned.Corporate Secretary of QBE Insurance Corporation do hereby certify that the foregoing is a true,correct and complete copy of the original Power of Attorney;that said Power of Attorney has not been revoked or rescinded and that the authority of the Attorney-in-Fact set forth herein,who executed the bond or undertaking to which this Power of Attorney is attached,is in full force and effect as of this date. Given under my hand and seal of the Company,this 20th June day of 2018. (Seal) By: J :. R• A '--� Jose Ramon Gonzalez,Jr..Corporate Secretary 5' Lt ,-..z.:1. STATE OF FLORIDA '- -.::..- DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION �� :'..• • V'j CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 `'...�•�` 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 SCHAFFER, CRAIG IAN CRITICAL PATH SERVICES INC 2200 SOUTH DIXIE HWY SUITE 701 MIAMI FL 33133 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range K- STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque ' ;) DEPARTMENT OF BUSINESS AND restaurants, and they keep Florida's economy strong. x,or� PROFESSIONAL REGULATION Every day we work to improve the way we do business in order CGC052781 ISSUED: 09/04/2016 to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more CERTIFIED GENERAL CONTRACTOR 'formation about our divisions and the regulations that impact SCHAFFER, CRAIG IAN uu, subscribe to department newsletters and learn more about CRITICAL PATH SERVICES INC the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly.We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.469 FS. and congratulations on your new license! Expiration date: AUG 31,2078 L1600040002439 DETACH HERE RICK SCOTT, GOVERNOR KFN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER i'%r .d ' CGC052781 :II .' ,: ,. r The GENERAL CONTRACTOR �- Named below IS CERTIFIED v'�%Iv " ' Under the provisions of Chapter 489 FS. `F ` Expiration date: AUG 31, 2018 SCHAFFER, CRAIG IAN -" ?► a 'a CRITICAL PATH SERVICES INC Ai---;, & • x 578 NE 64TH STREET _ _ ' + _: •. SUITE 701 5 _f MIAMI FL 33138 •j ,o. ISSUED oq/04/2o16 DISPLAY AS REOUIRED BY LAW SEQ# L1609040002439 00cn Ir" a D M N � a, o � o o : } Cl) !— N IMMIIVl O ami U W J N rs"_O 03 m e W >- O N- I U c � � � U QI W X p u d 07== COo' CI. c 0 c � 1 cD ( � , 0 cr) cu �; Q r _ .N a) 0:I W � n my _ W � � � 0 � CD a) in_ 0 t=-a 0 lommil P-, v, I- ..o 0 .o U F- c, E c Ell c- = i I- z cn .. H I c h CU = N O CU'II.2 d C N U E O CO v C Cr—' a J m • C m C CJS Z Q Z Z ti .. 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LSl < o CU ---J C < S 1 = +=0' c CO - UJ _ C- - 0 000 ' N _ L a CUJ M ,_ .0 CV - i o < cV) 0 U — u_ d) V ....1 CO (J) d w Lu 0 0 0 LL z � _.. Q z z '� .. o 0 O ~' v Z c° 3 ui L o Cl) Cl) W c) ccs J 2 cco o 06 r . U M U U ,L LJ- 0UJ ` — ;7 co Ci) CL ¢ (l) a_ CO Cl) >"' (f) _ Z Q S o ' _ _ �_ _Z ( F- cn C.) w F- H- woz G Q Li-. Q Q 2 W 0 00z � = . J Q (a t— � � x wQ Q 0 W 4,4--, >. U F- M 0 0 (q Z Q W — C) N F- H o Z .-� > (0 _ Q Q :•+NM V ti rte?' stU0N a u_ a) W `" - O 0 m m V t? o zW ~ s I— O z z m >. O o z 1' LL O W 0 � s W w � n- ° CeZO U O W in < Li.1 W Q C Z a U) H I- �'.."4 CRITI-3 OP ID:J A��R� CERTIFICATE OF LIABILITY INSURANCE OATE(MM/DD/YYYY) 06/29/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED `EPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. .IPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT BROWN &BROWN OF FLORIDA INC PHOS: Jake Scaduto 14900 NW 79th Court Suite#200 _(ALc xo Ext):305-364-7800 ra,No):305-7144401 Miami Lakes, FL 33016-5869 E-MAIL Jake Scaduto ADDRESS; INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Kinsale Insurance Company 38920 INSURED Critical Path Services,Inc. INSURER a:Economy Preferred Ins.Co. 38067 Attn:Craig Schaffer P O Box 330429 INSURER c:Lloyds of London Miami, FL 33233 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. -INSR1 IADDUSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IINSD'WVn POUCY NUMBER (MMIDDMYYYI (MWODmIYY) LIMITS A X 1 COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ _ 1,000,0 CLAIMS-MACE 1 X OCCUR 01000433280 11/05/2017 DAMAGE TO RENTED 100,0 11/05/2018 PREMISES(Ea occurrence) $ X Ded$5,000 Per Oc MED EXP(My one person) S 5,0 PERSONAL&ADV INJURY $ 1,000,0 GEM AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,0 '�POLICY I.X 1 PRo I JECT LOC I PRODUCTS-COMP/OP AGG S 2,000,0 I OTHER: Emp Ben. S 1,000,0 AUTOMOBILE LIABILITY COMe��la SINGLE LIMIT 1$ 1,000,0 (Eaf ANY AUTO CA006661P2017 10/01/2017 10/01/2018 BODILY INJURY(Per person) S 10,0 1 ALL AUTOS OWNED X E SCHEDULED i BODILY INJURY(Per accident) S X I HIRED AUTOS X NOV-OWNED Perr�TY DAMAGE S tL 1 ( $ UMBRELLA UAB X OCCUR EACH OCCURRENCE S_ 5,000,0 A X EXCESS UAB i CLAIMS-MADE 01000513950 11/05/2017 11/0512018 AGGREGATE $ 5,000,0 I OEO 1 RETENTION S S WORKERS COMPENSATION 1 PER OTH- AND EMPLOYERS'UA8IUTY j STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y!N I EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ NIA --- (Mandatory in NH) E.L.DISEASE-EA EMPLOYE$ K s,describe under DESCRIPTION OF OPERATIONS below ' E.L.DISEASE-POLICY LIMIT $ C Pollution Liab ANE193768717 05/15/2017 05/15/2018 Aggregate 1,000,0 Retention:$10,000 RETRO DATE:5115/17 EachClaim 1,000,0 DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION MIAMIBE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Miami Beach THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. C/O Procurement Department 1700 Convention Center Drive AUTHORIZED REPRESENTATIVE Miami Beach,FL 33139 Brown and Brown of Florida,Inc. I 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD _____..—.4,1 CRITI-3 OP ID: .4CO1213, CERTIFICATE OF LIABILITY INSURANCE DATE(M MJDDlYYW �"'f 06/14/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THI: CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIE: BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE[ REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject t. the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to th; certificate holder in lieu of such endorsement(s). PRODUCER CONTACT BROWN& BROWN OF FLORIDA INC NAME: Jake Scaduto 14900 NW 79th Court Suite#201PHONE i _Eat).305-364-7800 ILac Noe 305414-4401 Miami Lakes, FL 33016-5869 E-MAIL Jake Scaduto ADDRESS, INSURER(S)AFFORDING COVERAGE _ _ NAIC p INSURER A:Kinsale Insurance Company 38920 INSURED Critical Path Services,Inc. INSURERB:Economy Preferred Ins.Co. _ 38067 Attn:Craig Schaffer INSURER[:Lloyds of London P O Box 330429 Miami,FL 33233 INSURER 0: INSURER E: INSURER F: 4 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: f THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOE INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI: CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM; EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TN I TYPE OF INSURANCEADDLI SU8 POLICY EFF POLICY EXP INSQ.J Ytt POLICYNUMOER {Iw,00(YYYYl!lMujuorYYYt LIMITS A I X COMMERCIAL GENERAL LIABILITY T I 1I F-- EACH OCCURRENCE $ 1,000, I CLAIMS-MADE I X OCCUR i 101000433280 11/05/2017 11/05/20181 OAMAGETORENTED X Ded 55,000 Per Oc ! PREMISEs(Ea oxunerca) I s 100, ,--- --. ( 1 MED EXP(Any one person) I S 5. PERSONAL&ADV INJURY 5 1,000, GENT.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 2,000, POLICY X JECT 17 LOC I `PRODUCTS-COMPIOP AGG I S 2,000, OTHER: I I Emp Ben. I$ 1,000, AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) I5 1,000, BI {_ANY AUTO CA006661P2017 10/01/2017 10/01/2018 i BODILY INJURY(Per penon) 15 10, ALL_ AUTOS OWNED I X AU OS SCHEDJLED D 1 BODILY INJURY(Per accident)I S - - X HIRED AUTOS t-X^ NCN-CWNED I PROPERTY DAMAGE122_ I$ ALTOS (Per*ceder:I r I$ UMBRELLA una I X occuR LEACH OCCURRENCE I$ 5,000, A ;X I EXCESS UAB ( I CLAIMS.MAOE 01000513950 11/05/2017 1110512018 I AGGREGATE 1 s 5,000, 1-1 DED I I RETENTION$ I I$ WORKERS COMPENSATION I PER ER I _ AND EMPLOYERS'LIABILITY 1 ANY PROPRIETOR/PARTNER/EXECUTIVE YEL.EACH ACCIDENT I S OFF10ERIMEMBER EXCLUDED? TiI N/A 1----- — (Mandatory in NH) EL DISEASE-EA EMPLOYES S If yes descnbo.,nder —- i DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT I S C Pollution Liab ANE193768717 05/15/2017 05/15/2018 Aggregate 1,000, Retention:$10,000 'RETRO DATE:5/15117 EachClaim 1,000, I I I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101.Additional Remarks Schedule.may be attached if more spat•is required) Ref: Bid-Carl Fisher Clubhouse Renovation CERTIFICATE HOLDER CANCELLATION CRITICA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Critical Path Services Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED II ACCORDANCE WITH THE POLICY PROVISIONS. P.O.Box 330429 Miami,FL 33233 AUTHORIZED REPRESENTATIVE Brown and Brown of Florida.Inc. ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD • A O" CEI T1IFIICA'�E Of LABILITY►IDTi Y LNS CE: "�'�' 1'�`�"�' TIIISt CE7+C1}FI *1E IS:ISSUED XV A 110. 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CANCEILATT041. sMis_Y ANY dr TNE+I DE5CORE0 c * 3E:GAME!. ENCORE 71,E ele"".IY esscio es-re STERE%. NOT IM *ILL esZ DEI NERS0 If7 /tC00R17.NOV W AT4 Tr1E:Palo( :MS'i. AUTIi(XiIZIEIsfD1rE3EAf1/t7SYF<``744 cxt/rs3ee? I fa 198S201-5 ACM,CORPORATIOte. Al:xifltifs restate'. ACCRD 2$value.% . The ACetAto..rime mid logo arc revisierect masks of A I 1. J k . , , vious Experience of Bidder ( Firm ) J • :l a �+e,. 1 .1: , v / `f - - '� l'''::-‘:',,,. ,.:1C'1! .i' .I^ -_y j . `,. it*, 'f, ' v_. i._ , _ ., •+...--_,AL,:___ I • itn- , 1 _ : bk at.'!:.,A471 i',1' -- - - '1(--' .:4l'-'-'-' ._1.. .--:-.7:, i i,4 0. , :i ,_, , - 47. .,:): .._ -3 •f:_--,r4. -e..4--:_ .,,,ki. ‘,i.ti.,31.--. 1.: ..v_. _ rj ; L..... r .-, -, ,;.,--, , __._-.;- 1-- .-... . 'E '-- ' _ . :- -_ 7. I. I.. tiI_.a „ -— ` - .`_ 1 Project: Retail Building Rehabilitation, 845 Lincoln rd., Miami Beach ..tient: Jenel Management Rep: Mr. David Dushey Address: 275 Madison Ave., suite 1100, NY, NY Phone#: 212-889-6405 Email: ddushey@Jenel.net Narrative: This project entailed complete structural remediation of this 1930's era building including complete interior gut out to the structure, underpinning the existing foundations with helical piles, steel jacketing of existing timber load bearing columns, sistering & reinforcing all diaphragms , rebuilding the original rotted single hung wood windows to full operation, full base building M.E.P.'s for Urban Outfitters and vanilla boxing for other tenant's and all work was done on a bay by bay sequence, while the building was occupied and operating as old tenant's left to make way for the new _tenants. Contract: $1,250,000 Completed: 12/2013 Vintage: 1925 (Med. Revival) 3. .3. ri UJeLL ttL - } IWO I. Y ,,,_.,v N N A R ilkis .r // . tali //row owl am.sill I. m:.. I,•si S. iworPOI lig pm tog 0 _- HDAWM PIM NO 1111111 • •• . El gm um j%%� ice/ °, u■� !li! ■/110 mml 11111 ma NMI illiF■"�� ~ _ swum ■'.■ _. ! ., i-ilicS sEctrr— :-._. . - ... — _ '' r �- L lir: : 7 ?"1 ' i I -1--- � , - 4.4.4.4 i , IN _ . . . i.i.4.r.n 1 1 ., , ,, ,.., . , .., .... -. A-4-.1 maw am ,111111111111111111111111r Project: Lynmar Hotel Reconstruction, 735 Collins Ave., Miami Beach Client: Jenel Management Rep: Mr. David Dushey Address: 275 Madison Ave., suite 1100, NY, NY Phone#: 212-889-6405 Email: ddushey@Jenel.net Narrative: This Project included front and back façade remediation, structur stabilization, & cut-off from the middle of the building, while the balance of the existing 1930's era Art Deco hotel was demolished and rebuilt from the ground up in between the existing facades. I 7. J. rI uje I. ttJ - i • .. 4' n 77.11 !,.!4 1 Alt 111 Int KIR t Ii ! 69+1. is ;23 --3 s6a a=� _=4� 1111111711.7: 1111Irri2 LJEL g,..1g.A 'IMI1KW iii-----":: :C .‘ ow.. mammon rie mom i MINA 6\IIII 6\M .a' I II }t' I•MM� � �� � B J. moi minim• �_ M1aEII• MN MIN 31>•9� INN NM MCI M0 II • } • aa 4111111"W" •1111111111111111 Inn ME NMI MIMI Mimi imis ' ! 3 in --r it 7 .mIli Mil Mil IMM NM NMI MIMI NMI UMW 1 - iiIIiI:iIiIIINUN MIMI NM IMmi NMI NMI MN Illm 110 ;, _"`4 ,: 1 11 - - f 1-.f!....•- , ,_ 4 1 go:_it Orb f}{{ 7 '-, i �' mai Project: London Arms Hotel Rehabilitation, 727 Collins Ave., Miami Beach Client: Aria Development Group ep: David Ardite Address: 2800 Biscayne Blvd., #100, Miami, Fl. 33137 Phone: (305) 576-1340 Email: David@ariadevelopmentgroup.com Narrative: This project consisted of complete demolition of the 1st floor to grade, lowering of the floor elevation and installation of new foundations an( 1st floor slab and white boxing for a future commercial tenant, window replacements on the 1st floor, gut out of 2nd, 3rd, 4th floor units, vertical & horizontal structural remediation, and replacement of all finishes in the units and common areas, new M.E.P. systems throughout. This project was the recipient of the City of Miami Beach's "Best Facade Award" as given by the Design Preservation League, circa 1993 (see the bronze plaque to follow.) -ontract: $2,200,000 Completed: 8/2015 Vintage: 1930 .1111. e 1I t.- •fiit 4 ,�:``- _jet __ _41 -0.....,...,„.s 4 - `\ '. * i . Alit ,, +1 _ 'tom " e 4 ill ,, � � ;c ,; \ r. ' `may AK '' ; , meq, •! 71►�z .4C a;• I = , = ;gym !,fig 4'F -1„'•, ; ; P. ` �� ,,. .:4,re• - 2 err";' .. r f� y • v • \ , �" 1 ,. I i ' �► - r oI'ti o �, i ,• R i ` ; t - •R''' i ,c.i dp - ( -,_ , : ,:,... :-': t:' ' -.'' ! . , --- .,... MTH - CRITICAL PATH Vagabond Motel AERIAL CONSTRUCTION 1 PHOTOS 06-09-14 Project: Vagabond Motel Restoration, 7301 Biscayne Blvd., Miami Client: Vagabond Hotel Group Rep: Avra Jain Address: 7301 Biscayne Blvd., Miami Phone: (305) 400-8420 Email: Jainavra@gmail.com Narrative: Complete gut out and reconstruction of this vintage "Mid-Century Modern" specimen of a project. Complete structural remediation, rooms restored to original finishes but in new condition including refinishing terrazzo floors, restoring Dade County Pine wood floors, reconstruction of the Olympic size pool and pool deck with cabana bar, restoring original mosaic tile mermaid motif in the swimming pool, as well corner fountain and original neon signs throughout. We also shored up the East wing of the 2 story sections and excavated a new basement through limestone rock, 12' below Biscayne Boulevard elevation and 50' long. Rebuilt the entire site which was 1.25 acres i encompassing an entire city block. This project is a Nationally Registered Historic Structure. Contract: $6,500,00 Completed: 7/2014 Vintage: 1953 (Mid-Century Modern) 511101111.IIIIIIIIIk'- ' ^n lo" •i 1 .,„...% i - . , ig _. . cia,..•i-Q. Li ,. . .------- Ili i it <- .1 ‘, _, _ _ , , . -.....„, ....... km pir ,,„ ,-,....„. ., ,4 I . , , , ,jam+• r '1e/4f'" Oh , IL ' )),dityl,Y f. _� im1 �� —ii, - ‘ i A• ; , N : ..,.,,,,,,, ,. of ,i :,•1, ,..A , vn __ 1 , L :ito ‘—' : 4 :. i ' f;,;:. FR i ii , 11—i ----: I ' ! I ,tP, :,. . ._, .1_ ' 'Ili- 1:441if ii IL 1 - , "ra '!,=. irgiii it: ! I I - • — ' ` _ -.r.er, -►r` Project: Franklin Hotel Restoration, 830 Client: United Box Inc. Rep: Antonio Andolfato Address: 350 Fifth Ave., NY,NY Phone: (305) 538-5170 Email: www.replay.IT Narrative: Complete gut out and reconstruction of this Art Deco hotel, complete structural remediation, new doors & windows, added new elevator shaft, brought up to current codes with complete new MEP systems, 1st floor converted to retail for Replay Jeans flagship location, 2nd & 3rd floors built out with new extended stay hotel rooms complete with kitchens to serve European client base Contract: $3,500,000 Completed: 10/2010 Vintage: 1934 (Art Deco) J. -r Previous Expeni-rceof • Bidder P( Lead Manager) • Lead Project Manager: 1. Dana Stunkel (See Resume in Tab D) Project experience, among other work, includes projects seen in B.3: • Lincoln Rd . retail, P. M . ) • Lynmar Hotel, P. M . • London Arms Hotel, P. M . • Vagabond Hotel, P. M . 2. Eva Romero (See Resume in Tab D) Project experience, among other work, includes projects seen in B.3: • Vagabond Hotel, A. P. M . S ...' (11 11 ill . -.._ 4 I- * It • . ..... . li , . , ........ , ,...., _ OMB MINN , . . _ ... ...., . . 11E, I -kar. • 40-- • 'ar- s .. .... ... . ..._ P... ... " jir ' -grit 0-- Inv a iii a ! IP RP i I itit ' e-N1 iLr . . . . ilk.. , I" ..04 oniumwer.. j1111111 _ Pr 0. 1 • Pending award of contract and CMB request I) r. G • 2 years reviewed financials available upon written request. J 0 a it . • •, ,--' iV t..w�'• , ..-kkti.,..7',.. ._.--V-.•-, 4 . , ' . • , . , .., • ID lll \, v y w — �.• .eel Ar J r. T .......--__ /.... ,,,1 . , . . — . .::ie..y...• • - Ir.] ..-,:...., ::::„, t ,, ,,,. ,.;:ri.:..7,;•1.,,:-.‘•'.,..71.-,\I.-x*k,,-- ''••••••-• ' •V. ' ••,' •":..,. ;•-_,-.2:... „4; ., i 1 . :L • as _' i •� = +q��. . _•j� 4_ \ - • !t t'1f .f 'f• 1 ►-`• , . r. _ `� - -• ��• a .',i..• 4. S +. �, ,j �,L% -i 1 ..I !t •a: 4b• - - ' `, i a.•. _- 1i • �"'•A•44..:,,,....•Jr•` �i • - `� • ......\.�...yrl.gj { "�►...•..^�M}mow• ' ♦ to N / . . , . : : ...,______ ______ \.- Tab D London Arms Hotel J. J. Bidder (Business Entity) shall demonstrate the contractors team's ability to execute the type of work within the contract documents: Our plan for execution of this project is to ONLY utilize staff members from the general contractor's roster who have participated in one of the projects , ,own in preceding section B.3, or who've had similar experience in a prior job assignment. Similarly, it is our plan to only utilize subcontractor talent who've worked with us previously on one of the five projects we've listed in section B.3, or have similar experience which they can prove on another project of similar size, scope, and specifics. VII 410• L an ea Organizati 0 on Chart iii ci r _ co '' 0 c A q L. V co 0 2 o N c ` C V •4, ft2oLL W O C E c O A 3 V O [7 O F- V Qr d V, V1 W LL - 1 1 c OO .413 Y u m O ` Y O c ,o N d j M c L d V > p C O 2 T O o c O: Am o i''' '‘E' oS d £ C = Q 01 m 0 0 0- L K V, Q W—____—. c W L W d 1— (7 N C LL I .i -- ---4 4— Y O m m O OOD C to To m 7 • Y M 4! C C y �_ A q N n 3 •O' t 2 O .c tel O V c N V, pp C T m v - ,0 A A C O G V 0 Q� d Q o 7 O. ,es rJ c 0 0 0 O L CU L 1— d Y 1 N • V m v d C • c /0ns c E r - o o ,o VI N Q V (11 CC C Q O Cul• Z .m A CU £ O • • X V, W V 0. J VI V LL -?---T - C) • co a LC u 4,.. r32 2 1 C V a r Eo �I' ., i.) . -O c c m 120 • to m m T. 2 2 Q c u C N J O V O Y K CD r 2 - I ;--.1 to O Zr m Q u c ` o s - V, c — d v v o1 7 Q u > V O co V O Qi a _N -c F O aar a Ol• o3,:. CJ 5- ,o m y a = -cs 0 a- .— N ? C Y O 0 j v m 3 m Y .e m CJ I .n N C 6/ o E aJ CO E a) E Russel B. Hitchins Senior Pre-Construction Manager 38 Years Construction Experience iISkIIIS . . Specializing in the development and implementation of cost and project engineering systems geared to individual projects. Attentive to detail and the ability to meet both long term and short term assignments. Solid resourceful talents, combining high energy and conceptual skil demanded by organization and planning factors. '_f Present Critical Path Services, Inc. - Sr. Pre-construction Manager '.011- 2017 Richter Incorporated - Partner !006-2011 RBH Industries - Construction Consulting '.000-2006 Structure Tone Inc., Director of Estimating L997-2000 Pavarini Construction Company Inc., Director of Estimating !992-1977 Structure Tone Inc., Director of Estimating L985-1992 Structure Tone Inc., Chief Estimator _982-1985 Structure Tone Inc., Senior Estimator • L' 1-1982 Structure Tone Inc., Staff Estimator Dana Stunkel senior Project Manager 17 Years Construction Experience Construction/ Demolition Projects Infrastructure Improvement Projects Environmental Remediation Projects Site Safety/OSHA Compliance QA/QC/ Field Engineering Change Order Management Budgeting& Cost Controls Bidding/ Estimating/ Proposals Subcontractor/ Crew Supervision Recruiting/Training Team Members Microsoft Projects, Bluebeam, Word, Excel, Outlook, UDA, QuickBooks, Procore and Primavera Deane- Sr. Project Manager October 2012 — Present Critical Path Services, Inc., Miami Fl. Sr. Project Manager LP Cook Construction Company Inc., Miami, FL May 2007 — October 2012 Project Supervisor: March 2004 — Feb 2007 Weaver & Weaver General Contractors, Miami, FL Property & Project Manager: Feb 2002 — Dec 2004 Denver Property Management & Construction, Denver, CO Evamila Romero Project Manager 14 Years Construction Experience wrirr. • General Contracting Professional • Subcontractor Management • Construction Safety Controller • OSHA 10 hour Certified • Interior and Exterior Renovator • Project Scheduling • Excellent Customer Relations erience Critical Path Services, Inc. 2017-present Project Manager American Rebar 2015-2017 Project Manager Critical Path Construction 2013-2015 Assistant Project Manager Steel Works 2010-2013 Sales Manager Titan Reinforcing/Baker Concrete 2008-2010 Project Engineer Suncoast Prestress 2004-2007 Project Coordinator Gary Tichacek Project Superintendent 25 Total Years Construction Experience • General Contracting Professional • Subcontractor Management • Construction Safety Officer • OSHA 10 hour Certified • Interior and Exterior Renovator • Project Scheduling Critical Path Services, Inc., Superintendent 2014-present Ditocco Construction, Superintendent 2009-2014 DK Kallabrative, Superintendent 2002-2009 Charland Rury Construction, Superintendent 1993-2001 Robert Seabrook Project Superintendent 34 Years Construction • General Contracting Professional • Subcontractor Management • Construction Safety Controller • OSHA 10 hour Certified • Interior and Exterior Renovator • Project Scheduling • Excellent Customer Relations D Critical Path Services, Inc., Superintendent 2016 - Present Modular Contractors, Supervisor 2008-2016 Link Construction, Supervisor 2005 -2007 Ditocco Construction, Supervisor 2000-2005 Perrine Brother Construction, Supervisor 1984-2004 Angel Rivera Estimator/ Cost Engineer 12 Total Years Experience • Planswift • On Screen Take off • Vu360 • AutoCAD • Draftsight • Sketchup • Ground Penetrating Radar (GPR) • ArcGIS ) Photoshop • Lighthouse • Microsoft Office Suite Critical Path Services, Inc. 05/2017 - Present Estimator Skyline Construction & Restoration Corp. 06/2012— 03/2017 Project Estimator Design Build Inter-American 05/2008 —01/2011 Project Estimator .-e-Ri Construction Inc. I San Juan, PR 05/2003 -05/2005 Project Estimator and Safety Coordinator t David Solero Accountant/ Controller 27 Total Years Experience , :RITICAL PATH SERVICES, Miami, FL 2015- Present ccountant/Controller 1 KINMETICS, INC. 2014-2015 4 ►irector of Finance & Operations IEW ART MIAMI LLC, Miami, FL 2009-2014 'ontroller ,MICON DEVELOPMENT GROUP, Miami, FL 2005-2009 'ontroller VNOVATIVE SURVEILLANCE TECHNOLOGY, Coral Springs, FL 2004-2005 .ontroller RODSON CONSTRUCTION, INC., Miami, FL 2001-2003 'FO/IT Manager )XYGENE INC., Bal Harbor, FL 1993-2001 )perations/Accounting Manager AQUILA CONSTRUCTION CORP., Brooklyn, NY{SE_P] 1991-1992 ull Charge Bookkeeper/Payroll Manager INITED LIGHTING AND ENERGY, New York, NY{sEP 1986-1990 'ontroller/Operations Manager[sEP]:;EP; i• v A. Key elements of proposed organizational structure. The planned staff for this project will be Executive 15% time, Senior PM 25% time, PM 100% time, Superintendent 100%, Foreman 50% time. B. Availability of personnel for project. The individuals being considered for assignment to this project are ) highlighted on the preceding organizational chart, the ultimate start date for the project will govern availability of a particular staff level employee. The Executive, Sr. PM, and Senior Precon Manager are involved in all our projects. C. Name of individual(s) who will serve as primary contact with the city: 1. Project level issues: Dana Stunkel, S.P.M. 2. Executive level issues: Craig Schaffer, President D. Sub-contractor roles: (See tab D. 1) T . if\ 00 i • 1 1 ' , • —' ..,:-.....-....,,..—' , , . j — ) J__- _ I _to-. • lie • x--.1 --- -" '.. - I 4 i . i t0119 - if.: ' 11 N , . ,,, L I ft r / 1 1 III s4 ' -- I I i I . — lit 1 , ... I, 1 ,i. -.1.•': ' ... ) i 5 i I , 4„ i f.. i 1 1 , .1 . 1 I 1 i i I l , 1 1 a 1 i 1 i I 4 i 1 II I, ........ .,-,... . -4.*.k.•,...44.44.H. ..,—.. 1,—. •. I ........1, I .. _ " • 1 <9...J .L.•,.', 1- . - / - r _ _ _. 0 APPENDIX A Price Form, Bid Tender Form, & Supplements ATTACHMENT A-1: ITB Price Form & Unit Price Breakdown form ATTACHMENT A-2: Bid Tender Form ATTACHMENT A-3: Supplement to Bid Tender Form: Contractor Qualification Statement ATTACHMENT A-4: Supplement to Bid Tender Form: Non-Collusion Certificate ATTACHMENT A-5: Supplement to Bid Tender Form: Drug Free Workplace Certification ATTACHMENT A-6: Supplement to Bid Tender Form: Equal Benefits Ordinance ATTACHMENT A-7: Supplement to Bid Tender Form:Trench Safety Act ATTACHMENT A-8: Supplement to Bid Tender Form: Recycled Content Information Failure to submit the attached ITB Price Form shall render proposal non-responsive. and said non-responsive proposal shall not be considered by the City. Jl BID NO: 2018-125-2D CITYOF MIAMI BEACH VI,A,i,A1 BEACH A-1 City of Miami Beach ''/�` !TB Price Form I The TOTAL BASE BID amount Includes the all-indusive total cost M the wad specified in this bid,consisting of furnishing all materials,labor,equipment, �/ :hoar,supervision,mobilization,demobilisation,overhead and profit,Insurance,permits,and taxes to complete the work to the full Intent as shown or Indicated in the contract documents.Any or all alternates,If applimble,may be selected at M.Litys sok dkaeW n and based on funding availability. BIDDER MUST SUBMIT THIS ITB PRICE FORM FULLY COMPLETED, INCLUDING SECTIONS 1 AND 2, AS PART OF THE BID RESPONSE. FAILURE TO DO SO SHALL DEEM THE BIDDER NONRESPONSIVE. In the event of arlthmetkal errors between the division totals and the total base bid,the Bidder agars that the total base bid shall govern. In the event of a discrepancy between the numerical total base bid and t a wtiaen total base bid,the written total base bid shall govern.In absence of totals submitted for any d klsion cost,the City shall interpret as no bid for the division,which may disqualifybidder. SECTION A-BIDDERSPRICE(BUILDING): PROJECT TITLE:ITB NO. 2018-125-ZD CARL FISHER CLUBHOUSE RESTORATION(BUILDING) Cost 01-General Requirements $ g3G SSZ v! 02-Site Construction(Demolition) $ 7,? S 73 9Z 03-Concrete $ /AS 7QC2 04- Masonry $ 05-Metals $ 2 g-, GJ,2"i 06-Wood and Plastics $ /22, crio6, r% 07•Thermal and Moisture Protection $ ZSZ GG/ 08-Doors and Windows $ ?j 5T 787 09-Finishes $ 2/2, 5-S77V 10-Specialties $ 0 15-Mechanical $ ysga t/7 b 15-Mechanical-Kitchen Hood System $ X29.747 16-Electrical $ 1 , - 4/. ' SECTION A-BUILDING SUBTOTAL $ 36 a i6 SECTION B-BIDDERS PRICE(SITE) CARL FISHER CLUBHOUSE EXTERIOR IMPROVEMENTS 4 16-Exterior Improvements Electrical(Light Pole Installation, FPL Conduit Install,Site Work Electrical) $ 2�f, 31-Earth Moving-(Final Grading and Soils) $ ?,/� SSG Si 32-Exterior Improvements(Landscape) $ 74', gfGj, St- 32-Exterior Improvements(Irrigation) $ fl, o$Z 32-Exterior Improvements(Hardscape-Sidewalks, Precast Steps, $ ," Deo q9 Retaining Walls, etc.) /e 32-Exterior Improvements-(Site Furnishings-Bike Racks,Plaques, $ 7ya S�bG etc-) 33-Stormwater Utilities-Drainage $ 3 G/7.£ SECTION B -EXTERIOR IMPROVEMENTS SUBTOTAL $ s' / Bond 37 t-pc..) Insurance at: e1/3 Allowance for City Indemnification $25.00 • Permit Allowance $5,000.00 BID NO:2018-125-ZD CITYOF MIAMI BEACH MIAMI BEACH 53 'LUMP SUM GRAND TOTAL (TOTAL BASE BID FOR SECTION A+ B) $ i��— * \_l _ ALTERNATE 1 (ADD) Provide and Install Kitchen Equipment $ 6 Zcc ALT ERN ATE I TOTAL ilirrEa ALTERNATE 2(ADD Provide and Install wood Doors and Windows in lieu of CGI alum.doors $ owgi t and windows s•ecifled O ALTERNATE 2 TOTAL $ / yG Z PROJECT SHALL BE AWARDED TO THE LOWEST,RESPONSIVE, RESPONSIBLE BIDDER OFFERING THE LOWEST LUMP SUM GRAND TOTAL(TOTAL BASE BID) Continued on Next Page... a 0 BID NO:2018-125-ZD CITYOF MIAMI BEACH MIAMI BEACH 54 A-1 ITB Price Form Supplement- Unit Prices C) For Division 3 (Concrete) only, bidders shall provide a schedule of values indicating the unit cost for those structural repair items (wall spall, column spall, wall crack, and beam spall) Identified in the schedule titled Estimated Repair Quantities on drawing 51.03. Item Description Unit Unit Price (b) 01 Wall,Spall Cu. In. $ 7 02 Column, Spall In. $ 03 Wall, Crack In. $ Z.- 04 Beam,Spall Cu. In. S e 71- Section SSection 2-Bidder's Affirmation: Company: S it rrc.AL PAtH rGN51-171-7C1-Ita-2 Address Line 1: 3o Sc' 5W 37rw nitrAXAC AddressLine2: I`'IEAw r rto¢arA9 Telephone: aces-.. 3419 Email: C:56(4.41=- se. G CZrr Al / — 06rscxo , CoH Signature: Name: l .C-E Q G n �: r FAILURE TO SUBMIT THIS FORM FULLY EXECUTED AND BID BOND (IF APPLICABLE) WITH BID SUBMITTAL SHALL RESULT IN BEING DEEMED NONRESPONSIVE. Balance of Page Intentionally Left Blank o BID NO:2018-125-ZD CITYOF MIAMI BEACH MIAMI BEACH 55 A-2 City of Miami Beach,Florida - 1700 Convention Center Drive Miami Beach, Florida 33139 The undersigned, as Bidder, hereby declares that the only persons interested in this bid as principal are named herein and that no person other than herein mentioned has any interest in this bid or in the Contract to be entered into; that this bid is made without connection with any other person, firm, or parties making a bid; and that it is, in all respects, made fairly and in good faith without collusion or fraud. The Bidder further declares that it has examined the site of the Work and informed itself fully of all conditions pertaining to the place where the Work is to be done; that it has examined the Contract Documents and all addenda thereto furnished before the opening of the bids, as acknowledged below; and that it has satisfied itself about the Work to be performed; and all other required information with the bid; and that this hid is submitted voluntarily and willingly. The Bidder agrees, if this bid is accepted, to contract with the City, a political subdivision of the State of Florida, pursuant to the terms and conditions of the Contract Documents and to furnish all necessary materials, equipment, machinery, tools, apparatus, means of transportation, and all labor necessary to construct and complete within the time limits specified the Work covered by the Contract Documents for the Project entitled: INVITATION TO BID (ITS) No. 2018-125-ZD Carl Fisher Clubhouse Restoration The Bidder also agrees to furnish the required Performance Bond and Payment Bond or alternative form of security, if permitted by the City, each for not less than the total bid price plus alternates, it any, provided in the ITB Price Form in Section 00408 and to furnish the required Certificate(s)of Insurance. In the event of arithmetical errors between the division totals and the total base bid in the ITS Price Form, the Bidder agrees that the total base bid shall govern. In the event of a discrepancy between the numerical total base bid and the written total base bid, the written total base bid shall govern. In absence of totals submitted for any division cost, the City shall interpret as no bid for the division, which may disqualify bidder. BID NO:2018-125ZD CITYOF MIAMI BEACH MIAMI BEACH 56 A-2 Acknowledgment is hereby made of the following addenda (identified by number)received since issuance of this Solicitation: Amendment 1 Sv.w 6l Amendment 8 Amendment 2 � Amendment 7 Amendment �V-C.- ass �,,r5," Amendment8 Amendment 4 Amendment 9 Amendment 5 Amendment 10 Attached is a Bid Bond ,28c, Cash 0, Money Order 0, Unconditional Letter of Credit 0, Treasurer's Check 0, Bank Draft 0, Cashier's Check O, or: Certified Check 0 No. Bank of for the sum of Dollars ($ ). The Bidder shall acknowledge this bid by signing and completing the spaces provided below. Name of Bidder: C rz rrc,L Pa4-w -(141Z Vie-tilt ZNt Address Line 1: 33p15w 37tH AyBNvC" Address Line 2: J''trA kr, 1/vart9 33fl:3 Telephone Number: Jos-t5"-er tI CI E-mail Address: C ScMa Fret e C Zrrrc.e& Birk GaA.ntrzcacr)o,._) Cor.4 Social Security Number: OR Federal I.D. Number: 66-opfg'j - Dun & Bradstreet No.: oil-Z53-o3c If a partnership, names and addresses of partners: (Sign below if not incorporated) /a7-crv_nLPeak X 2Nac_AXIL/. WITNESSES: (Type or Print Name • iidr/d/. ) 1V et Lit' (Type or • int Name Signed Above) BID NO:2018-125-ZD CITYOF MIAMI BEACH MIAMI 57 a-z (Sion below if incorporated) G2arrest ATTEST: (Type or Print Name of Corporation) _1111/I/ / tary ar/aii /dir (7i. ' ure an Title) ((CORPORATE SEAL) / "57/ gg (Type or Pr t Name Signed Above) Incorporated under the laws of the State of: i �• 0 i l BID NO:2018-125-ZD CITYOF MIAMI BEACH MIAMI BEACH 58 A-3 SUPPLEMENT TO BID/TENDER FORM: CONTRACTOR QUALIFICATION STATEMENT 0 THIS COMPLETED FORM SHOULD BE SUBMITTED WITH THE BID; HOWEVER, ANY ADDITIONAL INFORMATION NOT INCLUDED IN THE SUBMITTED FORM AS DETERMINED IN THE SOLE DISCRETION OF THE CITY, SHALL BE SUBMITTED WITHIN TWO (2) BUSINESS DAYS OF THE CITYS REQUEST. The undersigned authorized representative of the Bidder certifies the truth and accuracy of all statements and the answers contained herein. 1. Please list all Licenses, Certifications, and/or Registrations your organization may possess. Please also indicate the number of years your organization has been in possession of these licenses, certifications, and/or registrations. (4ee/C�ert0ific�t ?gGgistration# #]ems MO 2. Attach a list of the Key Personnel, the intended role /for this Project, and resumes for each individual. �+ /� // ,per y/^ 3. What business are you in? G� tette7S, /reef !Ns 4. Please indicate the last project of similar scope and volume that your organization has completed and its completion date. Grwff l�J get_An ler y©� N ✓2! 0 AN, l 5. Have you ever failed to complete any work awarded to you? If so, where and why? A/O 6. List owner names, addresses and telephone numbers, and surety and project names, for all projects for which you have performed work, where your surety has intervened to assist in completion of the project,whether orr/not a claim was made. NSF 7. References & Past Performance. Bidder shall submit at least three (3) references for whom the proposer has completed work similar in size and nature as the work referenced in solicitation. SUBMITTAL REQUIREMENT: Proposer shall submit a minimum of three (3) references, including the following information: 1) Firm Name, 2) Contact Individual Name & Title, 3) Address, 4)Telephone, 5) Contact's Email and 6) Narrative on Scope of Services Provided. O BID NO:2018-125-ZD CITYOF MIAMI BEACH MIAMI BEACH 59 References:. 1. Jenel Management David Dushey, President 275 Madison Ave.,#1100,NY, NY 212-889-6405 ddushev@jenel.net 845 Lincoln Rd.& Lynmar Hotel (see Tab B.3, project#1) 2. Vagabond Hotel Group Avra lain, Principle 7301 Biscayne Blvd., Miami, Fl. 305-400-8420 jainavra@amail.com 0 Vagabond Motel(see Tab B.3, project#4) 3. Sklarchitecture Ari Sklar,President 2310 Hollywood Blvd., Hollywood, FI.33020 954-925-9292 ari@sklarchitec.com 845 Lincoln Rd.(see Tab B.3,project#1) l Critical Path Service,Inc. 3305 SW 37t Ave, Miami, FL 33133 7: 305.8563919 F: 305-856-3921 A-3 8. Attach a list including the following information concerning all contracts in progress as of the date of submission of this bid. In case of co-venture, list the inflation for all Q co-venturers): kayo/fai�q ia,,,k ) a. Name of Project ''G d" G j b. Owner and Point of Contact Minimum of Phone Number&E-mai Address) c. Original Contract Value d. Current Contract Value e. Projected Date of Completion per Contract f. Percent (%) Completion to Date of Bid Submittal 9. Has a representative of the Bidder completely inspected the proposed project and does the Bidder have a complete plan for its performance? ig.Yes 0 N 10. State the true, exact, correct and complete name of the partnership, corporation or trade name under which you do business and the address of the place of business. (If a corporation, state the name of the president and secretary. If a partnership, state the names of all partners. If a trade name, state the names of the individuals who do business under the trade name). Additional Sheets may be attached as necessary. A. The correct name of the Bidder's: C&I TCAI_ Air £e2veM T.'& . B. The business is a: 0 Sole Proprietorship a ❑ rtnership Corporation Porporation C. The address of principal place of bust ess is. 33©S c� 3 'hm 6 M . .1/4u/, FL-. 33/ 37 D. The names of the corporate officers, or partners, or individuals doing business under a trade name, are as follows: frit, bat P//` �.pA4tAJj ry l/ jl` Val ' /entev/1e2 0 BID NO:2018-125-ZD CITYOF MIAMI BEACH (\MA:01 BEACH g O E X M X X g 0 x 9 m n - $ $ a 2 e § 8 Y 8 8 $ fi y E I ;IR Y org co- ° hi k 9 aL & c a $`3i ie 6 9 `o fr I .13 E a. 4 a ° x — ., 2 a a u 3 • A-3 E. List all organizations which were predecessors to Bidder or in which the principals or officers of the Bidder were principals or officers. 0 F. List and describe all bankruptcy petitions (voluntary or involuntary) which have been filed by or against the Bidder, its parent or subsidiaries or predecessor organizations during the past five (5) years. Include in the description the disposition of each such petition. 214 G. List and describe all successful Performance or Payment Bond claims made to your surety(ies) during the last five (5) years. The list and descriptions should include claims against the bond of the Bidder and its predecessor organization(s). - I H. List all claims, arbitrations, administrative hearings and lawsuits brought by or against the Bidder or its predecessor organization(s) during the last five (5) years. The list shall include all case names; case, arbitration or hearing identification numbers; the name of the project over which the dispute arose; a description of the subject matter of the dispute; and the final outcome of the claim. .sfll�w,�� I. List and describe all criminal proceedings or hearings concerning business related offenses in which the Bidder, its principals or officers or predecessor organization(s) were defendants. r) BID NO:2018-125-ZD CITYOF MIAMI BEACH BEACH 61 O Litigation History Present—2013 (5 years) 1. 2016, CA-013641, Bay Carpets V.Critical Path Services Inc.,Payment Dispute,Casty Residence,Dismissed. 2. 2014,016232-CA-01,David Benson V.Critical Path Services, Inc., Design Defect issue, Benson Residence,Settled. 3. 2016-02601-CA-01, Daiza Corrles Et.Al.V.Critical Path Construction Services,LLC, Personal Injury claim,Stanton Marriott Hotel, Pending. 1:17-CV-23467 Nautilus Insurance Company V. Critical Path Construction 0 Services, LLC, see above case, Dismissed. 4. 2014-019991-CA-01, East Coast Metal Structures Corp.V.735 Collins LLC&Critical Path Construction Services,LLC,Payment Dispute, Lynmar Hotel, Dismissed. 5. 2014-0070-SP-25,Stone Brokers of America V.Critical Path Construction Services,LLC, Payment Dispute,Diamond Residence, Dismissed J Critical Path Service, Inc. 3305 SW 37t Ave,Miami, FL 33133 T: 305.8563919 F: 305-656-3921 A-3 J. Has the Bidder, its principals, officers or predecessor organization(s) been debarred or suspended from bidding by any government during the last five (5) years? If yes, please provide details. K. Under what conditions does the Bidder request Change Orders? 0 4-QX62 � © i I' &vi'4I4/t w �r� At � ' . L. Provide the names of all individuals or entities (including your sub-consultants) with a controlling financial interest and the percentage of ownership. The term "controlling financial interest" shall mean the ownership, directly or indirectly, of 10% or more of the outstanding capital stock in any corporation or a direct or indirect interest of 10% or more in a firm. The term "firm" shall mean any corporation, partnership, business trust or any legal entity other than a natural person. a A./ A M. Individuals or entities (including our sub-consultants) with a controlling financial interest: have have not contributed to the campaign either directly or indirectly, of a candidate who has been elected to the office of Mayor or City Commissioner for the City of Miami Beach. Please provide the name(s) and date(s) of said contributions and to whom said contribution was made. /Ji N. Has the Corporation, Officers of the Corporation, Principal Stockholders, Principals of the Partnership or Owner of Sole Proprietorship ever been indicted, debarred, disqualified or suspended from performing work for the Federal Government or any State or Local Government or subdivision or agency thereof? ❑Yes *a O. Are any indictments, debarments, disqualifications, or suspensions referenced on the previous page//current? ❑Yhs No If the an wer to either number N or 0 is yes, attach a written detailed explanation. BID NO:2018-125-ZD CITYOF MIAMI BEACH - fJ�IA A:BEACH 62 A-3 P. Is the business entity owned by a certified service-disabled veteran, and or a small business owned and controlled by veterans, as defined on Section 502 of the Veteran 0 Benefit Health, and Information Technology Act of 2006, and cited in the Database of Veteran-owns Business? ❑Yes No Q. Non-Discrimination. Pursuant to City Ordinance No.2016-3990, the City shall not enter into a contract with a business unless the business represents that it does not and will not engage in a boycott as defined in Section 2-375(a) of the City Code, including the blacklisting, divesting from, or otherwise refusing to deal with a person or entity when such action is based on race, color, national origin, religion, sex, intersexuality, gender identity, sexual orientation, marital or familial status, age or disability. SUBMITTAL REQUIREMENT: No additional submittal is required. By virtue of executing this affidavit document, Proposer agrees .it is and shall remain in full compliance with Section 2-375 of the City of Miami Beach City Code. R. Moratorium on Travel to and the Purchase of Goods or Services from North Carolina and Mississippi. Pursuant to Resolution 2016-29375, the City of Miami Beach, Florida, prohibits official City travel to the states of North Carolina and Mississippi, as well as the purchase of goods or services sourced in North Carolina and Mississippi. Proposer shall agree that no travel shall occur on behalf of the City to North Carolina or Mississippi, nor shall any product or services it provides to the City be sourced from these states. SUBMITTAL REQUIREMENT: No additional submittal is required. By virtue of Q executing this affidavit document, Proposer agrees it is and shall remain in full compliance with Resolution 2016-29375. S. Fair Chance Requirement. Pursuant to Section 2-376 of the City Code, the City shall not enter into any contract resulting from a competitive solicitation, unless the proposer certifies in writing that the business has adopted and employs written policies, practices, and standards that are consistent with the City's Fair Chance Ordinance, set forth in Article V of Chapter 62 of the City Code ("Fair Chance Ordinance"), and which, among other things, (i) prohibits City contractors, as an employer, from inquiring about an applicants criminal history until the applicant is given a conditional offer of employment; (ii) prohibits advertising of employment positions with a statement that an individual with a criminal record may not apply for the position, and (iii) prohibits placing a statement on an employment application that a person with a criminal record may not apply for the position. SUBMITTAL REQUIREMENT: No additional submittal is required at this time. By virtue of executing this affidavit, Proposer certifies that it has adopted policies, practices and standards consistent with the Citys Fair Chance Ordinance. Proposer agrees to provide the City with supporting documentation evidencing its compliance upon request. Proposer further agrees that any breach of the representations made herein shall constitute a material breach of contract, and shall entitle the City to the immediate termination for cause of the agreement, in addition to any damages that may be available at law and in equity. 0 BID NO:2018-125-20 CITYOF MIAMI BEACH pf,lAMI BEACH 63 A-3 CONTRACTOR QUALIFICATION STATEMENT VALIDATION: 0 The undersigned certifies that the information provided in this questionnaire is correct and accurate. IF PARTNERSHIP: Signature Print Name of Firm Print Name Address Title: CONTINUED ON FOLLOWING PAGE IF CORPORATION: / Ghnc AL- 17ArN SZP✓/G,..-The; t -°'re 4 71 Print Name of Corporation 1, Oret 3tpS Sw 37 r*. AIM A.XJE Print Nam=ft Address / 1ULAr�� P/o¢chA -Wan WITNE 0 Title: - S ALA/ Signature nn eAr os AtAicA Print Name // Title: ps5%rye/ /vroaed! /f rM� pro (CORPORATE SEAL) Attest: _ ar, Secretary • 0 BID NO:2018-125-2D CITYOF MIAMI BEACH MIAMI BEACH 64 A-4 SUPPLEMENT TO BID/TENDER FORM: NON-COLLUSION CERTIFICATE THIS FORM MUST BE SUBMITTED PRIOR TO AWARD FOR BIDDER TO BE DEEMED RESPONSIBLE. �Q Submitted this d(% day of 1114/i/ , 201 . The undersigned, as Bidder, declares that the only persons interested in this Bid are named herein; that no other person has any interest in this Bid or in the Contract to which this Bid pertains; that this Bid is made without connection or arrangement with any other person; and that this Bid is in every respect fair and made in good faith, without collusion or fraud. The Bidder agrees if this Bid is accepted, to execute an appropriate City of Miami Beach document for the purpose of establishing a formal contractual relationship between the Bidder and the City of Miami Beach, Florida, for the performance of all requirements to which the Bid pertains. The Bidder states that this Bid is base/ upon the documents identified by the following number: Bid No. 2018-125-ZD. IRNA SIGNATURE I,/ //AWL- PRINTED NAM TITLE (IF CO It41.0/t/ir PORATION) 0 BID NO:2016-125-2D CITYOF MIAMI BEACH IIVIl,AM1 BEACH 65 A-5 SUPPLEMENT TO BID/TENDER FORM: DRUG FREE WORKPLACE CERTIFICATION 0 The undersigned Bidder hereby certified that it will provide a drug-free workplace program by: (1) Publishing a statement notifying its employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the offeror's workplace, and specifying the actions that will be taken against employees for violations of such prohibition; (2) Establishing a continuing drug-free awareness program to inform its employees about: (i) The dangers of drug abuse in the workplace; (ii) The Bidder's policy of maintaining a drug-free workplace; (iii) Any available drug counseling, rehabilitation, and employee assistance programs; and (iv) The penalties that may be imposed upon employees for drug abuse violations occurring In the workplace; (3) Giving all employees engaged in performance of the Contract a copy of the statement required by subparagraph (1); (4) Notifying all employees, in writing, of the statement required by subparagraph (1), that as a ^ condition of employment on a covered Contract, the employee shall: l� (i) Abide by the terms of the statement; and (ii) Notify the employer in writing of the employee's conviction under a criminal drug statute for a violation occurring in the workplace no later than five (5) calendar days after such conviction; (5) Notifying the City in writing within ten (10) calendar days after receiving notice under subdivision (4) (ii) above, from an employee or otherwise receiving actual notice of such conviction. The notice shall include the position title of the employee; (6) Within thirty (30) calendar days after receiving notice under subparagraph (4) of a conviction, taking one of the following actions with respect to an employee who is convicted of a drug abuse violation occurring in the workplace: (i) Taking appropriate personnel action against such employee, up to and including termination; or (ii) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a federal, state, or local health, law enforcement, or other appropriate agency; and (7) Making a good faith effort to maintain a drug-free workplace program through implementation of subparagraphs(1)through (6). 0 BID NO:2018-1252D CITYOF MIAMI BEACH MIAMI BEACH 66 A-5 SUPPLEMENT TO BID/TENDER FORM: DRUG FREE WORKPLACE CERTIFICATION / �� i Is / (Bidd- ign-'Y/) (Print Ven••rName) STATE OF COUNTY OF The f regoing ijppstrument wa acknowleptged before me this day oft. )r,( 11-6 ,20 , by l5M.Jr-ihCLi"1"1:� as (name of person whose signature is being notarized) (title)of c_parm L.f�Ar1 c:1j2 n 4fi• (name of corporauu,uk.5,,,,,ony) k own to m be the person described herein, or who produced as _ i e n, and who did/did not take an oath. NOTARY PUBLIC-. 't (S .nature) �r�)J�/� /� � V .�•rwDdaNPdnSelmPenaet m e bim o4 I Fzi;r3 8012 188676 (Print Name) My commission expires: 0340/��22 J BID NO:2018-125-ZD CITYOF MIAMI BEACH MIAMI BEACH 67 A-6 SUPPLEMENT TO BID TENDER FORM: EQUAL BENEFITS ORDINANCE SUMMARY 0 The foregoing analysis provides a summary of the major points of the proposed Ordinance: 1) What is the intent of the Ordinance? The proposed Ordinance will require certain contractors doing business with the City of Miami Beach, who are awarded a contract pursuant to competitive bids, to provide "Equal Benefits" to their employees with Domestic Partners, as they provide to employees with spouses. 2) How are "Equal Benefits" defined and what kind of"Benefits" does the Ordinance cover? "Equal Benefits" means that contractors doing business with the City who are covered by the Ordinance shall be required to provide the same type of benefits that they offer to employees and their spouses, to employees with Domestic Partners. The type of "Benefits" defined by the Ordinance and which may be offered by a contractor include: sick leave, bereavement leave, family medical leave, and health benefits. The "Benefits" defined in the Ordinance are the same type of benefits that the City provides to Domestic Partners of City employees, pursuant to Section 62-XXX of the City Code]. Notwithstanding the definition of "Benefits" in the Ordinance, to comply with the Ordinance a Contractor is not required to provide all the above-described benefits. Contractors are only required to offer the same type of Benefits they offer to their employees with spouses, to employees with Domestic Partners. Additionally, a 0 Contractor who offers no benefits to employees or their spouses, would not be required to offer any benefits to employees with Domestic Partners (and would still be in compliance with the Ordinance)] 3) Who is considered a "Domestic Partner" under the Ordinance? A "Domestic Partner' shall mean any two (2) adults of the same or different sex who have registered as domestic partners with a government body pursuant to state or local law authorizing such registration, or with an internal registry maintained by the employer of at least one of the domestic partners. 4) What type of Contracts and/or which Contractors are covered by the Ordinance? The Ordinance only applies to the following: • Competitively bid City contracts(bids, RFP's, RFQ's, RFLI's, etc.), • Contracts valued at over$100,000, • Contractors who maintain 51 or more full time employees on their payrolls during 20 or more calendar work weeks in either the current or the preceding calendar year, • Contractors covered by the Ordinance are only required to comply as to employees who: 1) either work within the City limits of the City of Miami Beach; or 2) the contractors employees located in the United States, but outside of the City limits, only if those employees are directly performing work on the,City contract(covered by the Ordinance). l ✓BID NO:2018-125-ZD CITYOF MIAMI BEACH hPJAMJ BEACH 68 A-6 5) In what cases does the Ordinance not apply? The provisions of the Ordinance do not apply where: • The City contract has been has been entered into prior to the effective date of the Ordinance (including renewal terms contained in such contracts); • The City contract is not competitively bid; • The City contract is valued at less than $100,000; • The contractor has less than 51 employees; • The contractor does not provide Benefits either to employees' spouses or to employees' Domestic Partners; • The contractor is a religious organization, association, society or any nonprofit charitable or educational institution or organization operated, supervised or controlled by or in conjunction with a religious organization, association or society; • The contractor is another government entity. The following City contracts are not covered by the Ordinance: • Contracts for sale or lease of City property; • Development Agreements; • Contracts/grants for CDBG, HOME, SHIP, and Surtax funds administered by the City's Office of Community Development; • Cultural Arts Council grants; • Contracts for professional NE, landscape NE, or survey and mapping services procured pursuant to Chapter 287.055, Florida Statutes ("The Consultants Competitive Negotiation Act"; • Contracts for the procurement of life, health, accident, hospitalization, legal ( ) expense, annuity insurance, or any and all other kinds of insurance for the officers and employees of the City and their dependents, from a group insurance plan. The Ordinance provides, upon written recommendation of the City Manager, that the City Commission may, by 5/7ths vote, waive application of the Ordinance for the following: • Emergency contracts; • Contracts where only one bid response is received; • Contracts where more than one bid response is received, but none of the bidders can comply with the requirements of the Ordinance. The City's ability to apply the Ordinance may also be preempted in instances where the Ordinance impacts health, retirement, or pension program which fall within the jurisdiction of the Employee Retirement Income Security Act (ERISA), and may under certain circumstances be held invalid under Federal preemption. 6) How is the Ordinance enforced by the City? • City contracts that are covered by the Ordinance shall notify potential bidders/proposers of the Ordinance and its requirements in the ITB documents; • At the time of entering into the contract with the City, the proposed City contractor shall certify to the City that it intends to provide Equal Benefits, along with the description of its employee benefds plan, which needs to be delivered to 11) the Procurement Director prior to entering into the contract; BID NO:2018.125-ZD CITYOF MIAMI BEACH MIAMI BEACH 69 A-6 • The City has the ongoing right to investigate/audit contracts for compliance with the provisions of the Ordinance; • The contractor is required to post notice to its employees at its place of business that it provides Equal Benefits. 7) Is there another way for a Contractor who does not provide Equal Benefits to comply with the Ordinance? If a contractor covered by the Ordinance has made a reasonable yet unsuccessful effort to provide Equal Benefits, it can still comply with the Ordinance by providing an employee with the "Cash Equivalent" of the similar benefit(s) offered to the contractor's employees and their spouses. B) What are the penalties for non compliance? Failure of a contractor to comply with the requirements of the Ordinance may result in the following: • Breach/default under the contract; • Termination of the contract; • Monies due under the contract may be retained by the City until compliance is achieved; • Debarment of contractors from City work, as prescribed by the City Code. 0 Balance of Page Intentionally Left Blank BID NO:2018.125-ZD CITYOF MIAMI BEACH MIAMI BEACH 70 A-6 MIAMIBEACH DECLARATION: NONDISCRIMINATION IN CONTRACTS AND BENEFITS Section 1.Vendor Information Name of Company: Crjy+Tc.gt<Rc---a{ S_ ) �U& Name of Company Contact Person; G2nyr) Sol/F FeZq'/ E-mail:Phone Number. 3ps=Qs-e—3171 t_Fax Number.�OJ 6-5[Lf GS����P�� cirr*r«a—NaTt'r eoxvsrrzrsrsc,. ea N Vendor Number(if known): Federal ID or Social G.urity Number. 6$tC?2S°/ot Approximate Number of Employees in the U.S.: •If 50 or less, ip to Section 4,date and sign) Are any of your employees covered by a collective bargaining agreement or union trust fund? Yes/.No Union name(s): ! `' Section 2.Compliance Questions Question 1.Nondiscrimination-Protected Classes A. Does your company agree to not discriminate against your employees, applicants for employment, employees of the City, or members of the public on the basis of the fact or perception of a person's membership in the categories listed below? Please note: a NES" answer means your company agrees it will not discriminate; a "NO" answer means your company refuses to agree that it will not discriminate. Please answer yes or no to each category. Race _Yes_No I Sex _Yes_No Color Yes No Sexual. Orientation Yes No Creed _Yes_No I Gender Identity(transgender status) _Yes_No r Religion _Yes_No r Domestic partner status _Yes_No National origin _Yes_No I Marital status _Yes_No Ancestry _Yes_No I Disability _Yes_No .Age _Yes_No AIDS/HIV status _Yes_No Height _Yes_No Weight _Yes_No B. Does your company agree to insert a similar nondiscrimination provision in any subcontract you enter into for the performance of a substantial portion of the contract you have with the City? Please note:you must answer this question,even if you do not intend to enter into any subcontracts. _Yes_No BID NO:2018-125ZD CITYOF MIAMI BEACH MIAMI BEACH 71 A-6 Question 2.Nondiscrimination-Equal Benefits for Employees with Spouses and Employees with Domestic Partners. O When awarding competitively solicited contracts valued at over $100,000 whose contractors maintain 51 or more full time employees on their payrolls during 20 or more calendar work weeks, the Equal Benefits for Domestic Partners Ordinance 2005-3494 requires certain contractors doing business with the City of Miami Beach, who are awarded a contract pursuant to competitive bids, to provide "Equal Benefds" to their employees with domestic partners, as they provide to employees with spouses. The Ordinance applies to all employees of a Contractor who work within the City limits of the City of Miami Beach, Florida; and the Contractor's employees located in the United States, but outside of the City of Miami Beach limits, who are directly performing work on the contract within the City of Miami Beach. A. Does your company provide or offer access to any benefits to employees with spouses or to spouses of employees? YES NO B. Does your company provide or offer access to any benefits to employees with (same or opposite sex)domestic partners*or to domestic partners of employees? YES NO C. Please check all benefits that apply to your answers above and list in the "other' section any additional benefits not already specified. Note: some benefits are provided to employees because they have a spouse or domestic partner, such as bereavement leave; other benefits are provided directly to the spouse or domestic partner, such as medical 0 insurance. BENEFIT Firm Provides Firm Provides Firm does not for Employees for Employees Provide Benefit with Spouses with Domestic Partners Health Sick Leave Family Medical Leave Bereavement Leave If Proposer cannot offer a benefit to domestic partners because of reasons outside your control, (e.g., there are no insurance providers in your area willing to offer domestic partner coverage) you may be eligible for Reasonable Measures compliance. To comply on this basis, you must agree to pay a cash equivalent and submit a completed Reasonable Measures Application (attached) with all necessary documentation. Your Reasonable Measures Application will be reviewed for consideration by the City Manager, or his designee. Approval is not guaranteed and the City Manager's decision is final. Further information on the Equal Benefits requirement is available at www.miamibeachfl.aovlorocurementf LJ BID NO:2019-1252D CITYOF MIAMI BEACH MIAMI BEACH 72 A-6 Section 3.Required Documentation - YOU MUST SUBMIT SUPPORTING DOCUMENTATION to verify each benefit marked in Question 2C. Without proper documentation,your company cannot be certified as complying with the City's Equal Benefits Requirement for Domestic Partner Ordinance. For example, to document medical insurance submit a statement from your insurance provider or a copy of the eligibility section of your plan document;to document leave programs,submit a copy of your company's employee handbook.If documentation for a particular benefit does not exist,attach an explanation. Have you submitted supporting documentation for each benefit offered? _Yes No Section 4. Executing the Document I declare under penalty of perjury under the laws of the State of Florida that the foregoing is true and correct, and that I am authorized to bind this entity contractually. Executed this 21 day of lll}^rnt ,In the year 10 I g at _ t/%/ 23o5-- 5c.o 3771- Avo Signa Tire � Mailing Address /I i / i/ /'II LEI IN791-1r ,[Dern 33ZY3 Nammee/off Sig /�arttory�, City,State,'Zip Code TitleU(.(/N l aer BID NO:2018-125-ZD CITYOF MIAMI BEACH MIAMI BEACH 73 A-6 MIAMIBEACH 0 REASONABLE MEASURES APPLICATION Declaration: Nondiscrimination in Contracts and Benefits Submit this form and supporting documentation to the City's Procurement Department ONLY IF you: A. Have taken all reasonable measures to end discrimination in benefits; B. Are unable to do so; and C. Intend to offer a cash equivalent to employees for whom equal benefits are not available. You must submit the following information with this form: 9 The names, contact persons and telephone numbers of benefits providers contacted for the purpose of acquiring nondiscriminatory benefits; 10 The dates on which such benefits providers were contacted; 11 Copies of any written response(s)you received from such benefits providers,and if written responses are unavailable, summaries of oral responses; and 12 Any other information you feel is relevant to documenting your inability to end discrimination in benefits, including, but not limited to, reference to federal or state laws which preclude the ending of discrimination in benefits. I declare (or certify) under penalty of perjury under the laws of the State of Florida that the foregoing is true d correct,an hat 1 am authorized to bind this entity contractually. &,) / , / , t- rG l T-t Po. &,,, 3301/21 Name of Company(ple "e print) Mailing Address of Company l ,1,411 , rt . g32,3)Signature / Cl Sta Ip � � &t1(6 — 3 '1 Namof Sign ory(please print) Telephone Numb r Title Date 0 BID NO:2018-125-ZD CITYOF MIAMI BEACH MIAMI BEACH 74 A-6 Definition of Terms C.1) A. Reasonable Measures The City of Miami Beach will determine whether a City Contractor has taken all reasonable measures provided by the City Contractor that demonstrates that it is not possible for the City Contractor to end discrimination in benefits. A determination that it is not possible for the City Contractor to end discrimination in benefits shall be based upon a consideration of such factors as: 1. The number of benefits providers identified and contacted, in writing, by the City Contractor, and written documentation from these providers that they will not provide equal benefits; 2. The existence of benefits providers willing to offer equal benefits to the City Contractor; and 3. The existence of federal or state laws which preclude the City Contractor from ending discrimination in benefits. B.Cash Equivalent "Cash Equivalent"means the amount of money paid to an employee with a Domestic Partner(or spouse, if applicable) in lieu of providing Benefits to the employees' Domestic partner (or spouse, if applicable). The Cash Equivalent is equal to the employer's direct expense of providing Benefits to an employee for his or her spouse. Cash Equivalent.The cash equivalent of the following benefits apply: A. For bereavement leave, cash payment for the number of days that would be allowed as paid O time off for death of a spouse. Cash payment would be in the form of wages of the domestic partner employee for the number of days allowed. B. For health benefits,the cost to the Contractor of the Contractors share of the single monthly premiums that are being paid for the domestic partner employee, to be paid on a regular basis while the domestic partner employee maintains the such insurance in force for himself or herself. C. For family medical leave, cash payments for the number of days that would be allowed as time off for an employee to care for a spouse that has a serious health condition. Cash payment would be in the form of wages of the domestic partner employee for the number of days allowed. BID NO:2018-125-2D CITYOF MIAMI BEACH ,MMI AM1 BEACH 75 Critical Path Services,Inc. 0 NHP Medical Plans NHP medical plans • Requires a primary care doctor to be selected and used for all primary care type of services • No referrals needed to see a specialist • HMO Plan does not have out of network benefits(AVN9) • LabCorp is the in network lab Instructions for selecting the primary care doctor(PCP): www.mvuhc.com Select"Find a Physician"(on right hand side of screen under links and tools) Next screen you will choose the 1"box"All United Healthcare Plans" 0 The plan selection will be NHP HMO/POS Access The next page you will enter zip code location or city and state where you want to search The next page will allow you to search for different doctors,hospitals and facilities. Please make sure you are choosing a doctor that is a primary care doctor. Once you are enrolled in a medical plan you can go to www.mvuhc.com and register as a member to view benefits,claims or print duplicate ID cards. Presented by:Mario Birk 954-775-0275 954-775-0889 Fax g mario(W bickinsuranceconsulta nts.com 0 • 0 i 2 a • I a a ! | 6. | O : ili I I { ' I a I I 0 ! ) ] )! ! z � | \ } } kk! ! ! II ( \ 1011 | | k A 811 It : » ! ! _ i } ■ § ! ! ■ . ) . ) i | ! ! ■ ali 1 eiz _ IEa .4 | f • g9 .. ' | : ` ` � ! | § / { k \| ) ) | ) | ) a > | Ii , s ! { ! ! ! ! ! ! ! | . | | a !| \2 0 Help with your out-of-pocket medical costs TransConnect"for Florida Supplemenlal Medical Expense Insurance I Underwritten by Transamerica Life Insurance Company h x r k�w Andrea was 33 weeks along when she was involved in a car Product highlights accident, immediately putting her into pre-term labor. After the whirlwind of the ambulance ride. ER. emergency c-section, and • Guaranteed issue hospital stay, she's nervous about how much her major medical insurance will pay. It's a relief to remember that she signed up • Nu pre '.:imp rardrions. for TransConnec6'al her employer's last open enrollment. • Pre.senl a Tran<Connecl which can pay for out-of-pocket expenses like deductibles, I0 card along crier your co-insurance, and co-payments. (roup medical ID cam ro me Inpatient Hospital Benefit's $4000 me Os al service p'oy'C r Your poky pays benefits for inpatient hospital stays,inpatient procedures. • Review Uams online Inpatient physician chaiges,and even routine nursery care for dependent children.Your employer determines your calendar year maximum benefit (multiplied by three for an insured family). Canted infcwn nation Outpatient Hospital Benefits $2000 Your policy also pays benefits(separate from the inpatient hospital ccr/' transamericabene`its com benefits)for. > radiological diagnostic testing ors83- 63-7 9 9 nq performed in a hospital outpatient 7-888-763-7474 facility or a magnetic resonance imaging(MRI)facility > radiation therapy or chemotherapy authorized by a radiologist. _ chemotherapist,or an oncologist tar outpatient cancer bealment > outpatient surgery performed in a hospital facility.free-standing surgery center,or physician's office > MRIs,CT scans. PET scans, diagnostic ultrasounds. electrocardiogram(EKG) tests performed in a physician's office(x-rays and lab fees are not Included) > cardiac cauterizations and stress tests > accident injury or emergency condition treatment In a hospital ER or urgent care center > ER charges for illness it admitted to the hospital Accident-Only Ambulance Benefit $1000 This benefit is payable when ambulance transportation(ground or air)is required to a hospital or emergency center for inluries sustained in an accident.Ambulance transportation must be within 72 hours of the accident and must be provided by a licensed professional ambulance company. TRAIN SAM ERICA Help with your out-of-pocket medical costs I TransConnect"for Florida Supplemental Medical Expense Insurance Eligibility J You must be actively employed qualifying as an eligible ensured(defined by the employer)and have an employer's basic,major medical.or comprehensive medical plan. Important Policy Provisions Your employer selects benefit amounts,paid only for deductibles.co-insurance,and co-pays Incurred when your major medical plan pays for specified trealrnelts and care. How to Submit a Claim The ID card you'll receive after enrollment should be presented at time of sundce so providers are paid directly alter your major medical carrier determines what you owe. If you don't do so at time of service,simply suhmil a TransComlecr•claim form, U692 or HCFA(the itemized service provider's bill),and the Expbnalion of Benefits(EOB)from the major medical carrier showing what you owe alter what they paid. Exclusions • No benefits are payable under this policy/certificate for any expenses incurred: > Lale enrollees ate subject le a 30 day waiting period. > For any lass 4suned wl die ler ache duty sl utue in the armed > During any period the insured person does not have coverage forces of, country.II •el.+notify us of such active any uY f ) dbe we under another udan plan. arerefundr any dray a re ult o furls a ceripd fico wdich no t+OMlils > As Ilse result of suicide or any ollempled sriaJa, aro provided as a result of this exclusion. white sane or insane. > For pregnancy of a depeale it chili). > For any intentionsly self-/acted'gay cc sickness. > For sex changes. > For resit care or rehadlilative care and treatment. > For expemlrenlal lreabnenl,procedural.devices.drugs > For vvlumary abortion except,with respect to the Insured Cr surgery.lExcept mat bone wenn:)lrancplants v.uh:ol be insured spouse where Ila insured a Ism Owuredk dapeldenl considered experimetel is Ihn Imaln:rnl cl G naval. spo(eea ere would be endangered if the fetus were carried to > Fel al:6tielll Or sidu+( s:uer;t Out of awl ri the course of any tarn;or where medkal complications have arisen from abortion. occupaden for comperRalin wage or i otit:(Doesnit apply to sole > As a result of commission of a felony. prateaters Cr partners al onset by w::Fo,:i compelirialknit > Asa result of peticjxation In a riot,dA corm nab],civil > For mental tlaiess or ltmclbrna+x umiak:a>sv^nu thwarters, (7lsobedence.a unlawful assembly.ExcludesbssucctmryT while regardless of the care,..,if the obern>clie:.al plan does not.river acting in a beard manrwill'in the scope ofauthurih; these cerM.lions. > As a result el palicipallon in a contest of speed ii pa.er driven > Fa ddnik or N:Jpn Scneces.inducting.In rl not!meet In velkdes,parachuting Cr hang gliding. treatment.sagely exlrachxrs Cr xi rays.unless res(,tliny kW'?:c+ > As a see of air bevel except as a frepayirg passenger m a accident owlninn vAle'he burned meson's insurance Order convnerciai to on a mutiny 5d:edd'iel reheard a pass:Alger this policy Is Si force Nod 11 iniad hart will len 17 Alae%of 1ho for lraSperlatientry andnol as apaol a crewlueaLj. fake ofsuch Jeddah t'r file to a'iigeilia dunces a'enemas. > Asarastt of nteAcation as delerniMerf edde@fed by the laws d sl insured newlxrnchikl;and JO:INSwo tho sale Winery of and futci Gen of the geogroplliad ma it whist theice9 metered, rnecessar;dental care paraded to an iLhmal Fxxsrrl Mealmj > For alcohotsm ex drug us0.unless such drugs ware taken al catrwl criteria. the advice of a physician and taken as prescribed time hostilal > For Toone physiCN examrmlians and roes curs. confined as an inpatient. Termination of Insurance Insurance on an insured will end on the Insurance on a dependent will end on earliest of the following dates: the earliest of the following dates: The Cornpwry may end rho insolence if: > The end of the last period lor which > The i strredt insurance lennblales. > Any loomed person Sub lsU premium has been pard > The end of the last period for,dliCh fraudulent daim. > The pokey Is terminated. premium has boot Part > Parlb(allunr nnlvrIS are ani nap. > The insured relies. coot > The dependentionofdno ens. meets the > orenp)yn any tn andstain waren 110tIe«maysy > The ksuredceases rage in urlces'yg4p, dhrdep nd ntsctna in Winner:ItW RAIllg innnar:F.d'j rAm9 > The in$URd's coverage in the urnrleifyitg > The dependents awaa;pa roam in Winner:rrawxslilg rvnmalrl. medoal plan ends. underlying medical plan ends. > If the a dedyb'g me;(del rtYi lOnena les. > The potty is mairdiesi so as to exdid& dependent insurance Up-to-dale INOmlalion regarding our compensation practicescan be found in the Disclosures section of 0urwoasile'.kbcs.com Thin a Isidnimmaly orbraCcm-t: 9pv:t p mGb en. nsun .n pWnn:r,ann l?T+>n.uns<aur.:Irmaryx u+nini Ccdaraapds Paley Nen crus CeGAn2Ft.ad Crb',e2FL FealiSDol%31a n:w+Sna nrarvr;.1101 iprfx,city 11 ht smkder in Al I,ytb:il v: Lmllaraeinnrckd,lc apply.PtWIu:Ixnxlty rxNE(erwni(k:lx wean tut. L`li, TRANSAMERICA. Critical Path Services,Inc. Employee Benefits Enrollment Form 2018-2019 0 1. NHP HMO Pan AVN9/AA ❑ Employee only ❑ Employee/spouse ❑ Employee/child ❑ Employee/family NHP Primary Care Doctor Name and city of location: ❑ Waive coverage (provide reason for waiving) Spousal Coverage Individual Coverage Medicare No Coverage • O2. Transamerica GAP($4,000) Inpatient Benefit ❑ Employee only ❑ Employee/spouse ❑ Employee/child ❑ Employee/family ❑ Decline coverage Employee Full Name: Date of Hire Date of Birth Gender: Email address: Street address: Social security tt. City,State,Zip Phone# Signature: Date: J If adding dependents to any coverage, please complete the dependent page. Dependents cannot be added unless all information is complete. Employee Full Name: Dependent information(all Information must be fully completed to add dependents) Dependent Full Name Relationship Date of Birth Gender Social Security# to insured 1. NHP Primary Care Doctor Name and city of location: 2. NHP Primary Care Doctor Name and city of location: 3. NHP Primary Care Doctor Name and city of location: 4. NHP Primary Care Doctor Name and city of location: 5. NHP Primary Care Doctor Name and city of location: J A-6 MIAMIBEACH SUBSTANTIAL COMPLIANCE AUTHORIZATION FORM Declaration: Nondiscrimination in Contracts and Benefits This form, and supporting documentation, must be submitted to the Procurement Department by entities seeking to contract with the City of Miami Beach that wish to delay ending their discrimination In benefits pursuant to the Rules of Procedure, as set out below. Fill out all sections that apply. Attach additional sheets as necessary. A. Open Enrollment Ending discrimination in benefits may be delayed until the first effective date after the first open enrollment process following the date the contract with the City begins, provided that the City Contractor submits to the Procurement Department evidence that reasonable efforts are being undertaken to end discrimination in benefits.This delay may not exceed two years from the date the contract with the City is entered into, and only applies to benefits for which an open enrollment process is applicable. Date next benefits plan year begins: Date nondiscriminatory benefits will be available: O Reason for Delay: Description of efforts being undertaken to end discrimination in benefits: 2 BID NO:2018-125-ZD CITYOF MIAMI BEACH MIAMIBEACH BEACH 76 A-6 B. Administrative Actions and Request for Extension Ending discrimination in benefits may be delayed to allow administrative steps to be taken to incorporate nondiscriminatory benefits into the City Contractor's infrastructure. The time allotted for these administrative steps shall apply only to those benefits for which administrative steps are necessary and may not exceed three months. An extension of this time may be granted at the discretion of the Procurement Director, upon the written request of the City Contractor. Administrative steps may include, but are not limited to, such actions as computer systems modifications, personnel policy revisions, and the development and distribution of employee communications. Description of administrative steps and dates to be achieved: If requesting extension beyond three months, please explain basis: C. Collective Bargaining Agreements (CBA) Ending discrimination in benefits may be delayed until the expiration of a City Contractors Current 0 collective bargaining agreement(s)where all of the following conditions have been met: 1. The provision of benefits is governed by one or more collective bargaining agreement(s); 2. The City Contractor takes all reasonable measures to end discrimination in benefits either by requesting that the Unions involved agree to reopen the agreements in order for the City Contractor to take whatever steps necessary to end discrimination in benefits or by ending discrimination in benefits without reopening the collective bargaining agreements; and 3. In the event that the City Contractor cannot end discrimination in benefits despite taking all reasonable measures to do so, the City Contractor provides a cash equivalent to eligible employees for whom benefits are not available. Unless otherwise authorized in writing by the Procurement Director, this cash equivalent payment must begin at the time the Unions refuse to allow the collective bargaining agreements to be reopened, or in any case no longer than three (3)months from the date the contract with the City is entered into. For a delay to be granted under this provision, written proof must be submitted with this form that: • The benefits for which the delay is requested are governed by a collective bargaining agreement; • All reasonable measures have been taken to end discrimination in benefits (see Section C.2, above); and • A cash equivalent payment will be provided to eligible employees for whom benefits are not available. U BID NO:2018-125-Z0 CITYOF MIAMI BEACH MIAMI BEACH 77 A-6 I declare (or certify) under penalty of perjury under the laws of the State of Florida that the fore.oing is trued orrect,a at I am authorized to bind this e I contractually. , fri !/� 'T�%C- �/ a ` ® - � ��C Name of Company i•le.se print) Mailing �Ad/dress ofQf oo�mpany / '/4' ' / C- . 33� Signature NW City,State,Zip CA ; F(6 - 29/9 Name of Sig ory(plese p int) Telephone Nu mbe hofle Title Date O O BID NO:2018-125-ZD CITYOF MIAMI BEACH j f 1GM1 BEACH 78 A-7 SUPPLEMENT TO BID/TENDER FORM: TRENCH SAFETY ACT IF APPLICABLE, THIS FORM MUST BE SUBMITTED WITH BID FOR BID TO BE DEEMED RESPONSIVE. (SEE SECTION 00407) On October 1, 1990 House Bill 3181, known as the Trench Safety Act became law. This incorporates the Occupational Safety&Health Administration (OSHA) revised excavation safety standards, citation 29 CFR.S.1926.650, as Florida's own standards. The Bidder, by virtue of the signature below, affirms that the Bidder is aware of this Act, and will comply with all applicable trench safety standards. Such assurance shall be legally binding on all persons employed by the Bidder and subcontractors. The Bidder is also obligated to identify the anticipated method and cost of compliance with the applicable trench safety standards. BIDDER ACKNOWLEDGES THAT INCLUDED IN THE VARIOUS ITEMS OF THE BID AND IN THE TOTAL BID PRICE ARE COSTS FOR COMPLYING WITH THE FLORIDA TRENCH SAFETY ACT. THESE ITEMS ARE A BREAKOUT OF THE RESPECTIVE ITEMS INVOLVING TRENCHING AND WILL NOT BE PAID SEPARATELY. THEY ARE NOT TO BE CONFUSED WITH BID ITEMS IN THE SCHEDULE OF PRICES, NOR BE CONSIDERED ADDITIONAL WORK. The Bidder further identified the costs and methods summarized below: Q Description Unit Quantity UnitPrice Price Extended Method 3,OCO �s 3"0 m � W f l of l 5005e - S /C 000 Set&sada/ P42 ( i a cQ /00 rel,ve -jo neo Total $ Olr/ 6� V ,{ lid" Cve.e. Name of Bi..er / Authorrgna /re .f U.der BID NO:2018-125-ZD CITYOF MIAMI BEACH ;.MIAM,!BEACH 79 A-7 CONSIDERATION FOR INDEMNIFICATION OF CITY 0 Consideration for Indemnification of City $25.00 Cost for compliance to all Federal and State requirements of the Trench Safety Act* [NOTE: If the box above is checked, the Bidder must fill out the foregoing Trench Safety Act Form (Attachment A-7) in order to be considered responsive.] O 0 BID NO:2018-125-ZD CITYOF MIAMI BEACH MIAMI BEACH 80 A-8 RECYCLED CONTENT INFORMATION In support of the Florida Waste Management Law, Bidders are encouraged to supply with their bid, any information available regarding recycled material content in the products bid. The City is particularly interested in the type of recycled material used (such as paper, plastic, glass, metal, etc.); and the percentage of recycled material contained in the product. The City also requests information regarding any known or potential material content in the product that may be extracted and recycled after the product has served its intended purpose. Cr; \- -& AO:MA/4 el. 0 a BID NO:2018-125-ZD CITYOF MIAMI BEACH MIAMI BEACH 81 a 0 W APPENDIX B List of Plans and Specifications w BID NO: 2018-125-ZD CITYOF MIAMI BEACH ;'.I�' BEACH 82 MIAMIBEACH B OD LIST OF PLANS & SPECIFICATIONS CONTRACT DOCUMENTS AS DEVELOPED BY Ri HEISENBOTTLE ARCHITECTS,DATED May 17,2017 Page Sheet No./Spec. No. Title/Description ITB 2018-125-2D:Carl Fisher Clubhouse Restoration- Specifications 1 1 Division 1 Specifications(Div.2 through 16 has been included in drawings) 2 2 Geotechnical Report 3 3 Pre-Renovation Asbestos Survey 4 4 Lead Based Paint Report 5 5 Kitchen Equipment Cut Sheets ITB 2018-125-ZD:Cad Fisher Clubhouse Restoration- DRAWINGS O 1 60.00 Cover Sheet 2 G0.01 Index and General Notes 3 60.02 Specifications 4 60.03 Specifications 5 G0.04 Specifications 6 LS.01 Life Safety Plan and Code Analysis 7 A0.01 Architectural Demolition Site Plan 9 A0.02 Architectural Site Plan 10 A1.01 Demolition First Floor Plan 11 A1.02 Demolition Clerestory Floor Plan 12 A1.03 Demolition Roof Plan 13 A1.04 Demolition Reflected Ceiling Plan 14 A1.05 North and South Demolition Elevations 15 A1.06 East and West Demolition Plans 16 A2.01 First Floor Plan 17 A2.02 Clerestory Floor Plan 18 A2.03 Roof Plan 19 A2.04 Reflected Ceiling Plan 20 A2.05 Finish Floor Plan J-- 21 A3.00 North and South Exterior Elevations BID NO:2018-125-ZD CITYOF MIAMI BEACH 83 7,1.1,'id BEACH 22 A3.01 East and West Exterior Elevations 23 A3.02 A3.02—G0.01—Index and General Notes 24 A4.O0 Building Sections 25 A4.01 Building Sections 26 A4.O2 Building Sections 27 A5.00 Wall Sections 28 A5.01 Wall Sections 29 A5.02 Wall Sections 30 A5.03 Wall Types 31 A6.00 Enlarged Restroom Plans and Elevations 32 A6.01 Enlarged Annex Restroom Plans and Elevations 33 A6.02 _ Interior Elevations 34 A6.03 Interior Elevations 35 A7.0D Door Schedule and Types 36 A7.01 Door Details 37 A7.02 Door Details 38 A7.03 Door Details 39 A7.04 Window Types 40 A7.05 Window Details 41 A7.06 Window Details 42 A8.0O Details 43 A8.01 Details 44 A8.02 _ Details ^ 45 A9.00 Roof Details �J1 46 A9.01 Roof Details 47 A9.02 Roof Details 48 A10.00 Enlarged Kitchen Equipment Plan 49 5.100 General Structural Notes 50 5.101 General Structural Notes and Abbreviation Legend 51 5.102 Schedules and Typical Details _ 52 S.103 Concrete Repairs, Legend,Quantity and Schedule 53 S.104 Typical Concrete Repair Details 54 5.105 Typical Concrete Repair Details 55 5.200 First Floor and Foundation Plan 56 5.20OA Equipment Enclosure Floor and Foundation Plan 57 5.201 Lower Roof Framing Plan 58 5.202 Upper Roof Framing Plan 59 5.300 Sections and Details 60 5.301 Sections and Details 61 S.302 Sections and Details 62 5.303 Sections and Details 63 5.304 Sections and Details 64 S.305 Sections and Details 65 5.306 Sections and Details 66 5.400 Building Elevations Concrete Repairs .-I67 5.500 Design Wind Pressures for Doors and Windows J BID NO:2018-125•ZD CITYOF MIAMI BEACH %Al "LIBEACH 84 1 68 5.501 Design Wind Pressures for Doors and Windows 69 5.502 Design Wind Pressures for Doors and Windows 70 P0.O1 General Notes,Legend and Schedules 71 P2.01 First Floor Plumbing Plan 72 P4.01 Enlarged Bathroom Plans and Isometrics 73 P402 Enlarged Kitchen Sanitary Plan and Isometric 74 P4.03 Enlarged Kitchen Domestic Water Plan and Isometric 75 P5.01 Domestic Water Isometric Diagram 76 P5.O2 Sanitary Isometric Diagram 77 P6.01 Plumbing Details 78 M0.01 General Notes, Legend and Schedules 79 M0.02 HVAC Schedules 80 M2.01 First Floor HVAC Plan 81 M2.02 HVAC Roof Plan 82 M3.01 HVAC Details 83 M4.01 HVAC Controls 84 E0.01 General Notes,Legend and Schedules 85 E2.01 First Floor Lighting Plan 86 E2.O2 Clerestory Lighting Plan 87 E3.01 First Floor Power and Systems Plan 88 E4.O1 Enlarged Plans 89 E5.O1 Electrical Panel Schedules 90 E5.O2 Electrical Panel Schedules ,---` 91 E6.O1 Electrical Riser Diagrams p, 92 E7.O1 Electrical Details ITS 2018-125-ZD:Carl Fisher Clubhouse Restoration-Exterior Improvement Documents 1 C2.O2 DEMOLITION PLAN(PHASE 1) 2 C2.O8 EROSION CONTROL LAN (EXISTING SITE) 3 C2.13 EROSION CONTROL PLAN (PROPOSED IMPROVEMENTS) 4 C2.17 EROSION CONTROL AND SEDIMENT CONTROL DETAILS 5 C4.02.O1 RUCTURAL GENERAL OTES AND KEY PLANS 6 C4.02.O2 STRUCTURAL CTIONS AND DETAIL 7 C4.02.03 STRUCTURAL CTIONS AND DETAIL 8 C4.O7 DRAINAGE PLAN (PHASE 2) 9 L-103A LAYOUT PLAN 10 L-117 LAYOUT ENLARGEMENT PRECAST SEAT EDGE 11 L-203 MATERIALS PLAN 12 1-303 GRADING PLAN 13 L-403 SOILS PLAN 14 L-503A PLANTING PLAN 15 L-5038 UNDERSTORY PLANTING LAYOUT PLAN 16 L-505 PLANTING SCHEDULE 17 L-513 PLANTING LAYOUT ENLARGEMENT 18 L-603 FURNISHING PLAN 19 L-605 FURNISHING PLAN BID NO:2018-125-ZD CITYOF MIAMI BEACH !A:id BEACH 85 20 L-901 HARDSCAPE DETAILS 21 L-904 HARDSCAPE DETAILS 22 L-961 LANDSCAPE DETAILS 'J 23 L-962 LANDSCAPE DETAILS 24 L-963 LANDSCAPE DETAILS 25 U-103 IRRIGATION SPRAY&ROTOR LAYOUT PLAN 26 LI-107 IRRIGATION BUBBLER LAYOUT PLAN 27 LI-109 IRRIGATION SPECIFICATION DETAILS 28 E3013 ENLARGED SITE LIGHTING EAST 29 Class II Permit Storm- Expires on 5-5-18 30 Phase II Environmental Site Assessment-2015-02-03-E Sciences- Final 31 Soil Management Plan—Final 32 Job sketch for FPL conduit layout for customer-Model-Transformer Conduit Routing 33 Precast Shop Drawings-Precast Steps 34 Convention Center Pump Station-As Built-Rev 1 ITB 2018.125-ZD:Carl Fisher Clubhouse Restoration Exterior Improvement-Specifications 1 3 4500-Architectural Precast Concrete 2 321313-Concrete Walks and Curbs 3 321373-Concrete Paving Joint Sealants 4 32 8400-Irrigation Systems 5 32 9115-Soil Preparation 6 329300-Plants and Planting—Copy 7 329300-Plants and Planting 8 32 9643-Temporary Tree and Plant Protection Note: Site scope associated with this project is described in the Exterior Improvement Documents and Specifications. Building scope associated with this project is described in the Carl Fisher Clubhouse Restoration Drawings and Specifications. BID NO:2018-125ZD CITYOF MIAMI BEACH ' '!A ild BEACH 86 3 0 J 0 APPENDIX C Required Forms for Bid Submittal (Note:Attachments below only apply if the adjacent box is checked) Z ATTACHMENT C-1: Prevailing Wage and Local Workforce Participation Program Requirements Z ATTACHMENT C-1A: Responsible Contractor Affidavit Farm (PART A) y ATTACHMENT C-1B: Responsible Contractor Affidavit Form (PART B) E ATTACHMENT C-2: Bid Guaranty Form; Unconditional Letter Of Credit E ATTACHMENT C-3: Statement Of Compliance: Prevailing Wage Rate Ordinance E ATTACHMENT C-4: Statement Of Compliance: Davis Bacon Wages 0 BID NO:2018-125-ZD CITYOF MIAMI BEACH MIAMI l BEACH 87 C-1 The Requirements of the Prevailing Wage and Local Workforce Participation Programs shall apply to the award of this project. The purpose of this appendix is to summarize, for clarity, the requirements of the City's Prevailing Wage and Local Workforce Program Requirements. In the event of any omissions or conflicts,the requirements of the City Code,with respect to these programs,shall prevail. I. MINIMUM WAGES AND BENEFITS 1. Employee Compensation. The rate of wages and fringe benefits, or cash equivalent, for all laborers, mechanics and apprentices employed by the contractor or subcontractor on the work covered by the contract, shall be not less than the prevailing rate of wages and fringe benefit payments or cash equivalence for similar skills or classifications of work as established by the Federal Register last published by the United States Department of Labor prior to the date of issuance of this solicitation. (reference: Sec 31-27). 2. Notice Requirement. On the date on which any laborer or mechanic commences work on a construction contract to which this article applies, the contractor shall be required to post a notice in a prominent place at the work site stating the requirements of this article. (reference: Sec 31-29). O3. Certified Payrolls. With each payment application, Contractor shall submit a copy of all payrolls, including (at a minimum)the name and zip code for the covered employee,to the City accompanied by a signed "Statement of Compliance" indicating that the payrolls are correct and complete and that each laborer or mechanic has been paid not less than the proper prevailing wage rate for the work performed. Beginning,January 30, 2018, all payroll submittals shall be completed electronically via the City's electronic compliance portal, LCP Tracker. No payment application shall be deemed accepted until such time as the Procurement Department has confirmed that a certified payroll for the applicable payment application has been accurately submitted in LCP Tracker. a. LCP Tracker Training.The Procurement Department offers ongoing training in LCP Tracker to all contractors.To schedule a training session, contact Allan Gonzalez at AlianGonzalez@MiamlBeachFL.gov or at 305-673-7490. a BID NO:2018-125-2D CITYOF MIAMI BEACH MIAMI BEACH 88 C-1 II. LOCAL WORKFORCE PARTICIPATION GOALS 1. Responsible Contractor Affidavit. As a condition of being responsive to the 0 requirements of the solicitation and eligible to be considered for award,the bidder shall submit a Responsible Contractor Affidavit.The Responsible Contractor Affidavit (RCA) is comprised of two (2) forms — RCA-Part A and RCA-Part B. Both forms are required to be submitted with the bid or within 48 business hours of being notified by the Procurement Contracting Officer for the solicitation. Failure to submit the RCA shall result in the bid being disqualified and deemed non-responsive. a. Part A—Commitment to Promote Local Workforce Participation.The contractor, and each subcontractor, shall submit RCA-Part A affirming that it will make its best reasonable efforts to promote employment opportunities for Miami-Dade County residents by seeking to achieve a project goal of having thirty percent (30%) of all construction labor hours performed by Miami-Dade County residents. The contractor shall also affirm that it will make its best reasonable efforts to promote employment opportunities for Miami Beach residents. To download RCA-Part A affidavit, visit miamibeachfl.gov/procurement/local workforce. b. Part B — Position / Employee Data. The contractor, and each sub-contractor shall submit RCA-Part B with the following sections completed: • Section 1 — Indicate the number of positions required to complete the contract work, and the minimum qualification(s)for each position. 0 • Section 2—For the positions indicated in Section 1,specify the name,address, and position of each current employee of the contractor or subcontractor. • Section 3 -For the positions indicated in Section 1, not indicated in Section 2, each contractor or subcontractor shall specify the number of positions, and the minimum qualifications)for each position,that the contractor or subcontractor shall seek to hire to supplement the current employees listed in Section 2. To download RCA-Part B form,visit miamibeachfl.gov/procurement/local workforce. 3. Workforce Performance Report. Before its final application for payment,the contractor shall submit its final Certified Payroll in LCP Tracker, which shall be deemed its final Workforce Performance Report. If the project goal of thirty percent(30%) of all construction labor hours to be performed by Miami-Dade County residents is not met, the Contractor shall submit supporting documentation verifying reasonable efforts to promote employment opportunities for Miami Beach and Miami-Dade County residents. No final payment application may be approved without this information. BID NO:2018-125-ZD CINOF MIAMI BEACH (Vl',AfJ,I BEACH 89 c-1 Ill. PROCESS FLOW The following graphic outlining the major steps of the Prevailing Wage and Local Workforce OParticipation programs is provided illustrative purposes only. 6.Contractor submits Workforce Performance 1.Bidder submits Report prior to bid or proposal. submittal of final payment application. dek lit 2.With is bid or proposal, 5.Projecct bidder submits Responsible Completed. Contractor Affidavit-Parts A and B. 11/4 4.Prior to submitting 41 0 every payment application, 3.Project Contractors submits Awarded. Certified Payrolls in LCP Tracker. Balance of Page Intentionally Left Blank a BID NO:2018-125-ZD CITYOF MIAMI BEACH MIAMI BEACH 90 C-1 A LOCAL WORKFORCE PARTICIPATION PROGRAM Responsible Contractor Affidavit Form 0 Part A— Commitment to Promote Local Workforce Participation In accordance with Article III,Section 31-40 of the Miami Beach Code,all contractors and subcontractors of any tier performing on a city contract valued in excess of$1,000,000 for(I)the construction,demolition, aeration and/or repair of city buildings or city public works projects. or(II) a contract valued in excess of$1,000000 which provides for privately-funded construction, demolition, alteration andfor repair of buildings or Improvements located on city-owned land, and which are subject to Section 31-40 of the Miami Beach Code shall comply with the requirements of the Local Workforce Participation Program. The undersigned Contractor affirms that, should it be awarded the contract pursuant to this solicitation, it shall comply with the following: I. The contractor will make its best reasonable efforts to promote employment opportunities for local Miami- Dade County residents and seek to achieve a project goal of having thirty percent (30%) of all construction labor hours performed by Miami-Dade County residents. ii. The contractor will also make its best reasonable efforts to promote employment opportuniti-. for Miami Beach residents. o verify workers' residency, contractor(s) shall provide the reside ad• ess of each wper. Print Name .1Affiant Print Title of Affiant /�/� '•nat re 4 Affiant 6asrrCAt— para . 2r/�/55:Ve, d2,9 ;1 0 Name of Firm Date 5Z CC st.. 31r' 41SAwt> fu0A.4>=, r%torI ,4, 33Z33 /J/o¢tnq 33233 _ Address of Firm State Zip Code Notary Public Information yy� -bode Notary Public—State of CIbrid � County of`IryllIR/Y?l (� Subscribedbriand"ss�wontto((or ',affirmed) before me this 2..,PA f dayayof, , JLLI I"f 20 LU. by U1t.UQ c nkVe e)or she i personally known to m t or has produced identification 0 Type of identificati n produced Sig ature of NotaryubliP c Serial Number 03/io42D2- -`- d P nt,gF• • nnan®a';�gWlGda Expir tion ate Notary Public Seal ;4 ter. Dianna Lynne Pint ado My Comm nGG t008>e /�f dry Expires 03n0.2022 `✓ BID NO:2018.125-ZD CITYOF MIAMI BEACH I\A]A (BEACH 91 \ \ \ \ \ o \ / I J �� / mm D61 v. ~ : % ! \ oll. :2' In a CO : - c ( I n r § a \ - ` / , \ \ / J ( \ _ $ § -f 2 ] 2 { - Cq _ 0 c \ \ . - 0 & %ITI el is \ 3 = in 5 FL \ �� } MI. 13 0 } o Co _ � k § � ! \ _ 0 $ � { _ ` © ke °Z. Dec Cu ' 13 13at } ko. q — � o i \ 2 co n _ � ! § - 222 I } ` � in % � R I'll" ( g | % ; ( io ) ` \ a ^ ` osmcia ( _ \ [ ! II, / : (.1 er 0 III ® e � 0 \ � ~ � } \ § 3 = / Carl Fisher Clubhouse Bid CMB ITB#:2018-125-ZD Local Workforce Participation ROsterC-IB Critical Path Services, Inc.Staff Name Address Position 1. Craig Schaffer, 5660 Collins Ave. 11B, Miami Beach Executive 2. Joseph Castellano, 8620 SW 44th St., Miami Foreman 3. Daniella Fonseca, 11800 SW 18th St.,#517, Miami Estimator 4. Dianna Pintado, 12862 SW 203`a St., Miami Office Manager 0 5. Robert W. Seabrooke, 1100 W 20151St., Miami Supervisor 6. David Solero, 2700 N. Miami,Ave., Miami Accounting Manger 7. Carlos Araica, 94215W 154th Ct., Miami Project Manager 8. Jandui Barreros, 6630 SW 4th Ct., Miami Project Manager ;J Critical Path Construction 3305 SW 37th Ave., Miami, FL 33133 T: 305-856-3919 F: 305-856-3921 C--. 1(4. P 17 I It\ 1.99/41-\ c-z AMI : - AC • CO❑ BID GUARANTY FORM UNCOND • 'AL LETTER OF CREDIT Date of Issue Issuing Bank's No. Beneficiary: Applicant: City of Miami Beach Amount: 1700 Convention Center Drive in 'nited States Funds Miami Beach, Florida 33139 Expiring: Date - Bid/Contract Number We hereby authorize you to draw on (Bank, ssuer name) at by or•.er of and for the account (branch address) of (contractor, applicant, cus •mer) up to an aggregate amount, in United States Funds, of available by your drafts at sight, accompanied by: A signed statement from the City Manag r of the City of Miami Beach, or his authorized representative, that the drawing is due t. default in performance of obligations on the part of agreed upon by and (contractor, applicant, custo er) between City of Miami Beach, Florid. and (contractor, applicant, customer) pursuant to the Bid/Contract No. for (name of project) Drafts must be drawn and negotiated 'of later than (expiration date) Drafts must bear the clause: "Drawn under Letter of Credit No. of dated (Bank na e) This Letter of Credit sets forth n full terms of our undertaking, and such undertaking shall not in any way be modified, amended, •r amplified by reference to any documents, instrument, or agreement referred to herein or to whi this Letter of Credit is referred or this Letter of Credit relates, and any such reference shall not be •eemed to incorporate herein by reference any 0 document, instrument, or -•reement. BID NO:2018-125-2D CITYOF MIAMI BEACH MIAMI BEACH 93 C-2 We hereby agree with the drawers, endorsers, and bona fide holders of all drafts drawn under . d in O.compliance with the terms of this Letter of Credit that such drafts will be duly honor-.. upon presentation to the drawee. The execution of the Contract and the submission of the required Performance and Pa nt Guaranty and Insurance Certificate by the shall be a elease of all obligations. (contractor, applicant, customer) This Letter of Credit is subject to the "Uniform Customs and Practice for D.cumentary Credits," International Chamber of Commerce (1993 revision), Publication No. 500 •.d to the provisions of Florida law. If a conflict between the Uniform Customs and Practice for Documentary Credits and Florida law should arise, Florida law shall prevail. If a conflict between e law of another state or country and Florida la-+w should arise, Florida law shall prevail. .-zed Signature 0 I / -410 0 BID NO:2018-125-ZD CITYOF MIAMI BEACH MAM.BEACH LI STATEMENT OF COMPLIANCE: C-3 PREVAILING WAGE RATE ORDINANCE NO. 94-2960 No. Zrfs No;�1cJSC-IzS-z' OContractNo. Project Title ca .,- r---i-snitoz CIO I-loo,c- fZnrsvA+ra" The undersigned CONTRACTOR hereby swears under penalty of perjury that, during the period covered by the application for payment to which this statement is attached, all mechanics, laborers, and apprentices, employed or working on the site of the Project, have been paid at wage rates, and that the wage rates of payments, contributions, or costs for fringe benefits have not been less than those required by City of Miami Beach Ordinance No. 94-2960 andnjhe applicable conditions of the Contract. Dated �/2k7 , 20/8 arrrc.ec-pnr:, S1$!Zl/) ✓}-�L- • 111(( ( o tr ctor) By: St e) By: G.la I I (Print Na 'e an• Title) STATE OF ) SS COUNTY OF ) �The foregoing instrument war$ acknowledd9e_d befor me this day of _ LLI-)-C , 20�, by ( '.-0J6 if- who is Qersonally known to me or who has produced as identification and who did/did not take an oath. n//�� WITNESS my hand and official seal, this /2U 051hdaf.117-in--e 20)s.,f/,,� (NOTARY SEAL) a-4/ L1,l-QJ (_ e''v (Sign ture of person king acknledgment) . II _ I/1 ' PI • 4O ,Jfl\, Notary pual nrig nda (Name of officer takin. acknowledgment) Dianna Lynne Pinlado -Y) My.n's 'onGG2886ra (typed, printed or stamped) f\li+a bI1 ( .1-CCI- Of - - n'.1)mj(Title ` z iinto1(0 (Serial number, if any) My commission expires: 6540022_ 0 BID NO:2018-125-ZD CITYOF MIAMI BEACH MIAMI BEACH ❑ STATEMENT OF COMPLIANCE: C-4 DAVIS BACON ACT N0. -20R- %2S-•f7 Contract No. Project Title`G�A ,*g- ' t c./01SFbCSG /Lrncv4t.ti-t The undersigned Contractor hereby swears under penalty of perjury that, during the period covered by the application for payment to which this statement is attached, all mechanics, laborers, and apprentices, employed or working on the site of the Project, have been paid at wage rates, and that the wage rates of payments, contributions, or costs for fringe benefits have not been less than those required by the Davis Bacon Act and the applicable conditions of the Contrac n q.� 'o Dated ��, 20 /'S G2.I.rx- SS,`//�if`�51{9C Co :acey n By: (Print Name and Title STATE OF ) SS COUNTY OF ) nn//�� The foregoing strume w s ac�a0wikgd� d efore me this G7}}�"1 day of 0 f g , 20k, by O J �(�n eQ _, who is personally known to me or who has produced J as identification and who did/did not take an oath. WITNESS my hand and official seal, this 20th da o , A if 20) 40 (NOTARY SEAL) 1/4" rii�//,/ _ /_.4L' ' I de \5./nature of person t.king ackno dgment) I a , _ IA '//i ' f ,,.. NoLa Pubacs,,eFIOOde (Name of officer taking acknowledgment) zr '1: Dianna Lynne P'ntado (typed printed or stamped) My COmrg;GG 198576 • 8r „a+° Evpoea ovtonbn 1 `may &bl j(' S .�d—/I/7tr/ d a__(T le or rank), Unmet ' - &7(o (Serial number, if any) My commission expires: t s k /2022 0 BID NO:2018-125-ZD CITYOF MIAMI BEACH %JiIA )IBEACH a D