National Foundation for Teaching Entrepreneurship for Youth Services Agreement~Oo ~ ~~ S_~ J-
PROFESIONAL SERVICES AGREEMENT
BETWEEN THE CITY OF MIAMI BEACH, FLORIDA
AND THE NATIONAL FOUNDATION FOR TEACHING ENTREPRENEURSHIP
FOR YOUTH SERVICES
RELATED TO THE CITY'S SERVICE PARTNERSHIP INITIATIVE
THIS AGREEMENT made and entered into this 1st day of December, 2007, by
and between the CITY OF MIAMI BEACH, FLORIDA (hereinafter referred to as City),
having its principal offices at 1700 Convention Center Drive, Miami Beach, Florida,
33139, and NATIONAL FOUNDATION FOR TEACHING ENTREPRENEURSHIP, a
New York Corporation, (hereinafter referred to as Contractor), whose address is 7210
Red Road, Suite 207, South Miami, Florida, 33143.
SECTION 1
1.1 DEFINITIONS
Agreement: This Agreement between the City and Contractor, and any
exhibits and/or attachments hereto.
City Manager: The Chief Administrative Officer of the City.
Contractor: For the purposes of this Agreement, Contractor shall be
deemed to be an independent contractor, and not an agent
or employee of the City.
Services: All services, work and actions by the Contractor performed
pursuant to or undertaken under this Agreement, as
described in Section 2 and Exhibit "A" hereto.
Fee (Compensation): Amount paid to the Contractor to cover the costs of the
Services.
Risk Manager: The Risk Manager of the City, with offices at 1700
Convention Center Drive, Third Floor, Miami Beach, Florida
33139, telephone number (305) 673-7000, Ext. 6435, and
fax number (305) 673-7023.
1
SECTION 2
SCOPE OF WORK (SERVICES)
The Contractor will provide entrepreneurship training in conjunction with UNIDAD,
Inc. for up to thirty (30) youths in accordance with The Children's Trust Miami Beach
Service Partnership Grant, dated December 1, 2007. The scope of work to be
performed by Contractor is further detailed in Exhibit "A," entitled "Scope of Services."
The Contractor shall report to the City of Miami Beach, Neighborhood Services
Department, Office of Community Services, Division Director.
SECTION 3
COMPENSATION
3.1 FIXED FEE
Contractor shall be compensated for the Services, as set forth in Section 2
and Exhibit "A", at Seven Hundred and Seventy One Dollars ($771) per youth (for up
to thirty (30) youths).
Contractor's compensation shall be further subject to and conditioned upon all
or any portion of the Services to be provided herein being allowable and within the
Scope of Services delineated in Exhibit "A".
Notwithstanding the preceding, Contractor's total compensation during the
term of this Agreement shall not exceed the maximum allowable sum of Twenty
Three Thousand One Hundred and Thirty Dollars ($23,130).
3.2 INVOICING
Contractor shall submit monthly invoices, a Monthly Progress Report, and
accompanying Monthly Progress Submissions Checklist & Summary Form, as set
forth in Exhibit "B", which includes an itemized, detailed description of the Services,
or portions thereof, provided (including the clients served) and cost(s) for same.
Invoices and supporting documentation shall be submitted to Maria L. Ruiz, Division
Director, Office of Community Services, 1700 Convention Center Drive, Miami
Beach, Florida, 33139.
3.3 METHOD OF PAYMENT
Payments shall be made within thirty (30) days of the date of invoice, in a
manner satisfactory to and as approved and received by the City Manager and/or his
designee, who shall be the Division Director, Office of Community Services.
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SECTION 4
GENERAL PROVISIONS
4.1 RESPONSIBILITY OF THE CONTRACTOR
With respect to the performance of the Services, the Contractor shall exercise
that degree of skill, care, efficiency and diligence normally exercised by recognized
professionals with respect to the performance of comparable services. In its
performance of the Services, the Contractor shall comply with all applicable laws,
ordinances, and regulations of the City, Miami-Dade County, the State of Florida, and
the federal government, as applicable.
4.2 PUBLIC ENTITY CRIMES
A State of Florida Form PUR 7068, Sworn Statement under Section
287.133(3)(a) Florida Statute on Public Entity Crimes shall be filed with the City's
Procurement Division, prior to commencement of the Services herein.
4.3 DURATION AND EXTENT OF AGREEMENT (TERM)
The term of this Agreement shall commence upon execution of this Agreement
by all parties hereto, and shall terminate on May 31, 2008.
4.4 TIME OF COMPLETION
The Services to be rendered by the Contractor shall be commenced upon
receipt of a written Notice to Proceed from the City subsequent to execution of the
Agreement by the parties, and shall be completed no later than May 31, 2008.
4.5 INDEMNIFICATION
Contractor agrees to indemnify and hold harmless the City of Miami Beach and its
officers, employees and agents, from and against any and all actions, claims,
liabilities, losses, and expenses, including, but not limited to, attorneys' fees, for
personal, economic or bodily injury, wrongful death, loss of or damage to property, at
law or in equity, which may arise or be alleged to have arisen from the negligent acts,
errors, omissions or other wrongful conduct of the Contractor, its employees, agents,
sub-consultants, or any other person or entity acting under Consultant's control, in
connection with the Contractor's performance of the Services pursuant to this
Agreement; and to that extent, the Contractor shall pay all such claims and losses
and shall pay all such costs and judgments which may issue from any lawsuit arising
from such claims and losses, and shall pay all costs and attorneys' fees expended by
the City in the defense of such claims and losses, including appeals.
The Contractor's obligation under this Subsection shall not include the obligation to
indemnify the City of Miami Beach and its officers, employees and agents, from and
3
against any actions or claims which arise or are alleged to have arisen from negligent
acts or omissions or other wrongful conduct of the City and its officers, employees
and agents. The parties each agree to give the other party prompt notice of any
claim coming to its knowledge that in any way directly or indirectly affects the other
party.
4.6 TERMINATION, SUSPENSION AND SANCTIONS
4.6.1 Termination for Cause
If the Contractor shall fail to fulfill in a timely manner, or otherwise
violate any of the covenants, agreements, or stipulations material to this
Agreement, the City shall thereupon have the right to terminate the
Services then remaining to be performed. Prior to exercising its option
to terminate for cause, the City shall notify the Contractor of its violation
of the particular terms of this Agreement and shall grant Contractor
seven (7) days to cure such default. If such default remains uncured
after seven (7) days, the City, upon three (3) days' notice to Contractor,
may terminate this Agreement and the City shall be fully discharged
from any and all liabilities, duties and terms arising out of/or by virtue of
this Agreement.
Notwithstanding the above, the Contractor shall not be relieved of
liability to the City for damages sustained by the City by any breach of
the Agreement by the Contractor. The City, at its sole option and
discretion, shall additionally be entitled to bring any and all
legal/equitable actions that it deems to be in its best interest in order to
enforce the City's right and remedies against the defaulting party. The
City shall be entitled to recover all costs of such actions, including
reasonable attorneys' fees. To the extent allowed by law, the defaulting
party waives its right to jury trial and its right to bring permissive counter
claims against the City in any such action.
4.6.2 Termination for Convenience of City
NOTWITHSTANDING SECTION 4.6.1, THE CITY MAY ALSO, FOR
ITS CONVENIENCE AND WITHOUT CAUSE, TERMINATE THIS
AGREEMENT AT ANY TIME DURING THE TERM HEREOF BY
GIVING WRITTEN NOTICE TO CONSULTANT OF SUCH
TERMINATION, WHICH SHALL BECOME EFFECTIVE SEVEN (7)
DAYS FOLLOWING RECEIPT BY THE CONSULTANT OF THE
WRITTEN TERMINATION NOTICE. IN THAT EVENT, ANY
FINISHED OR UNFINISHED DOCUMENTS AND OTHER
MATERIALS PREPARED AND OR OTHERWISE COMPILED BY
CONSULTANT PURSUANT TO ITS PROVISION OF THE SERVICES
CONTEMPLATED IN SECTION 2 AND IN EXHIBIT "A", SHALL BE
PROMPTLY ASSEMBLED AND DELIVERED TO THE CITY, AT
CONSULTANT'S SOLE COST AND EXPENSE. IF THE
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AGREEMENT IS TERMINATED BY THE CITY AS PROVIDED IN
THIS SUBSECTION, CONSULTANT SHALL BE PAID FOR ANY
SERVICES SATISFACTORILY PERFORMED, AS DETERMINED BY
THE CITY AT ITS SOLE DISCERTION, UP TO THE DATE OF
TERMINATION; .PROVIDED, HOWEVER, THAT AS A CONDITION
PRECEDENT TO SUCH PAYMENT, CONSULTANT SHALL HAVE
DELIVERED ANY AND ALL DOCUMENTS, MATERIALS, ETC, TO
CITY, AS REQUIRED HEREIN.
4.6.3 Termination for Insolvency
The City also reserves the right to terminate the remaining Services to
be performed in the event the Contractor is placed either in voluntary
or involuntary bankruptcy or makes an assignment for the benefit of
creditors. In such event, the right and obligations for the parties shall
be the same as provided for in Section 4.6.2.
4.6.4 Sanctions for Noncomaliance with Nondiscrimination Provisions
In the event of the Contractor's noncompliance with the
nondiscrimination provisions of this Agreement, as applicable, the City
shall impose such sanctions as the City or the State of Florida may
determine to be appropriate, including but not limited to, withholding of
payments to the Contractor under the Agreement until the Contractor
complies and/or cancellation, termination or suspension of the
Services and/or the Agreement. In the event the City cancels or
terminates the Services and/or the Agreement pursuant to this
Subsection the rights and obligations of the parties shall be the same
as provided in Section 4.6.2.
4.7 CHANGES AND ADDITIONS
Any changes and additions to the terms of this Agreement shall be by a written
amendment, signed by the duly authorized representatives of the City and Contractor.
No alteration, change, or modification of the terms of this Agreement shall be valid
unless amended in writing, signed by the parties hereto, and approved by the City.
4.8 OWNERSHIP OF DOCUMENTS
Any changes and additions to the terms of this Agreement shall be by a
written amendment, signed by the duly authorized representatives of the City and
Contractor. No alteration, change, or modification of the terms of this Agreement
shall be valid unless amended in writing, signed by the parties hereto, and
approved by the City.
5
4.9 AUDIT AND INSPECTIONS
Upon 24-hour's written notice, the City Manager (on behalf of the City) and/or
such authorized representatives as the City Manager may deem to act on the City's
behalf, may, during Contractor's normal business hours, audit, examine and make
audits of all contracts, invoices, materials, payrolls, records of personnel, conditions
of employment, and any and all other data and/or records and/or documents
relating to all matters covered by this Agreement. Contractor shall maintain any and
all such records, as necessary to document compliance with the provisions of this
Agreement.
4.10 ACCESS TO RECORDS
Contractor agrees to allow access during normal business hours to all
records including, without limitation, Contractor's financial records, to the City and/or
its authorized representatives, and agrees to provide such assistance as may be
necessary to facilitate audit by the City and/or its representatives, when and as the
City Manager, in his sole and reasonable discretion, may deem necessary to ensure
compliance with the provisions of this Agreement including, without limitation, as
they pertain to any financial audits (with applicable accounting and financial
standards). Contractor shall allow access during normal business hours to any and
all records, forms, files, and documents which have been generated in performance
of this Agreement, by the City and/or its authorized representatives.
4.11 INSURANCE REQUIREMENTS
The Contractor shall not commence any work and/or Services pursuant
to this Agreement until all insurance required under this Section has been obtained
and such insurance has been reviewed and approved by the City's Risk Manager.
Contractor shall maintain and carry in full force during the term of this Agreement the
following insurance:
1. Contractor General Liability, in the amount of $1,000,000.
2. Contractor Professional Liability, in the amount of $200,000.
3. Workers Compensation & Employers Liability, as required pursuant to Florida
Statutes.
All insurance required hereunder must be furnished by insurance companies
authorized to do business in the State of Florida.
Original certificates of insurance for the above coverage must be submitted to
the City's Risk Manager at the Office of the Risk Manager of the City of Miami Beach,
1700 Convention Center Drive, Miami Beach, Florida 33139.
The Contractor is solely responsible for obtaining and submitting all insurance
certificates for its sub-contractors.
6
All insurance policies must be issued by companies authorized to do business
under the laws of the State of Florida. The companies must be rated no less than
"B+" as to management and not less than "Class VI" as to strength by the latest
edition of Best's Insurance Guide, published by A.M. Best Company, Oldwick, New
Jersey, or its equivalent.
Compliance with the foregoing requirements shall not relieve the Contractor of
the liabilities and obligations under this Section or under any other portion of this
Agreement, and the City shall have the right to obtain from the Contractor specimen
copies of the insurance policies in the event that submitted certificates of insurance
are inadequate to ascertain compliance with required overage.
All of Contractor's certificates, as required in this Section 4.11, shall contain
endorsements providing that written notice shall be given to the City at least thirty
(30) days prior to termination, cancellation or reduction in coverage in the policy.
The Contractor shall not commence any work and/or Services pursuant to this
Agreement until the City's Risk Manager has received, reviewed and approved, in
writing, certificates of insurance showing that the requirements of this Section (in its
entirety) have been met and provided for.
4.12 ASSIGNMENT, TRANSFER OR SUBCONTRACTING
The Contractor shall not subcontract, assign, or transfer any work under this
Agreement without the prior written consent of the City Manager which consent, if
granted at all, shall be at the Manager's sole and absolute discretion.
4.13 SUB-CONTRACTORS
The Contractor shall be liable for Contractor's services, responsibilities and
liabilities under this Agreement, and the services, responsibilities and liabilities of
sub-contractors, and any other person or entity acting under the direction or control
of Contractor. When the term "Contractor" is used in this Agreement, it shall be
deemed to include any sub-contractors and any other person or entity acting under
the direction or control of Contractor. All sub-contractors must be approved, in
writing by the City Manager, or his designee, prior to their engagement by
Contractor (which approval, if granted at all, shall be at the Manager's sole
discretion and judgment).
4.14 EQUAL EMPLOYMENT OPPORTUNITY
In connection with the performance of this Agreement, the Contractor shall
not discriminate against any employee or applicant for employment because of
race, color, religion, ancestry, sex, age, and national origin, place of birth, marital
status, or physical handicap. The Contractor shall take affirmative action to ensure
that applicants are employed and that employees are treated during their
7
employment without regard to their race, color, religion, ancestry, sex, age, national
origin, place of birth, marital status, disability, or sexual orientation, as applicable.
4.15 NO CONFLICT OF INTEREST
The Contractor agrees to adhere to and be governed by the Metropolitan
Miami-Dade County Conflict of Interest Ordinance, as same may be amended from
time to time; and by City of Miami Beach Code, as same may be amended from
time to time.
The Contractor covenants that it presently has no interest and shall not
acquire any interest, direct or indirectly which should conflict in any manner or
degree with the performance of the Services. The Contractor further covenants that
in the performance of this Agreement, no person having any such interest shall
knowingly be employed by the Consultant. No member of or delegate to the
Congress of the United States shall be admitted to any share or part of this
Agreement or to any benefits arising there from.
4.16 PATENT RIGHTS; COPYRIGHTS; CONFIDENTIAL FINDINGS
Any patentable result arising out of this Agreement, as well as all information,
design specifications, processes, data and findings, shall be made available in
perpetuity to the City, for public use.
No reports, other documents, articles or devices produced in whole or in part
under this Agreement shall be the subject of any application for copyright or patent
by or on behalf of the Contractor or its employees or subcontractors.
4.17 NOTICES
All notices and communications relating to the day-to-day activities shall be
exchanged between a project manager appointed by the Contractor and the
program coordinator designated by the City Manager, who shall be Neighborhood
Services Department, Office of Community Services, Division Director. The
Contractor's project manager shall be designated following execution of this
Agreement by the parties and prior to commencement of the Services.
All other notices and communications in writing required or permitted
hereunder may be delivered personally to the representatives of the Contractor and
the City listed below or may be mailed by registered mail.
Until changed by notice in writing, all such notices and communications shall
be addressed as follows:
TO CONTRACTOR:
The National Foundation for Teaching Entrepreneurship
Attn: Alice Horn, Executive Director, South Florida
7210 Red Road, Suite 207
South Miami, Florida 33143
(305)665-1141
TO CITY:
City of Miami Beach
Office of Community Services
Attn: Maria L. Ruiz, Director
1700 Convention Center Drive
Miami Beach, Florida 33139
(305) 673-7491
4.18 LITIGATION JURISDICTION/VENUE
This Agreement shall be governed by, and construed in accordance with, the
laws of the State of Florida, both substantive and remedial, without regard to
principles of conflict of laws. The exclusive venue for any litigation arising out of the
Agreement shall be Miami-Dade County, Florida, if in State court, and the U.S.
District Court, Southern District of Florida, if in federal court.
BY ENTERING INTO THIS AGREEMENT,
EXPRESSLY WAIVE ANY RIGHTS EITHER PARTY
JURY OR ANY CIVIL LITIGATION RELATED TO,
AGREEMENT.
4.19 ENTIRETY OF AGREEMENT
CONTRACTOR AND CITY
MAY HAVE TO A TRIAL BY
OR ARISING OUT OF, THIS
This writing and any exhibits and/or attachments incorporated (and/or
otherwise referenced for incorporation) herein embody the entire Agreement and
understanding between the parties hereto, and there are no other agreements and
understandings, oral or written, with reference to the subject matter hereof that are
not merged herein and superseded hereby.
4.20 LIMITATION OF CITY'S LIABILITY
The City desires to enter into this Agreement only if in so doing the City can
place a limit on the City's liability for any cause of action for money damages due to
an alleged breach by the City of this Agreement, so that its liability for any such
breach never exceeds the sum of $1,000. Contractor hereby expresses its
willingness to enter into this Agreement with Consultant's recovery from the City for
any damage action for breach of contract to be limited to a maximum amount of
$1,000.
9
Accordingly, and notwithstanding any other term or condition of this
Agreement, Contractor hereby agrees that the City shall not be liable to the
Contractor for damages in an amount in excess of $1,000 for any action or claim for
breach of contract arising out of the performance or non-performance of any
obligations imposed upon the City by this Agreement. Nothing contained in this
paragraph or elsewhere in this Agreement is in any way intended to be a waiver of
the limitation placed upon the City's liability as set forth in Section 768.28, Florida
Statutes.
[REMAINDER OF THIS PAGE LEFT INTENTIONALLY BLANK]
10
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to
be executed by their appropriate officials, as of the date first entered above.
FOR CITY:
ATTEST:
R
I
By.
City Clerk
Robert Parcher
FOR CONTRACTOR:
ATTEST:
By:
Secretary
Print Name
Corporate Seal
CITY OF MIAMI BEACH, FLORIDA
Mayor
Matti Herrera Bower
NATIONAL FOUNDATION FOR
TEACHING ENTREPRENEURSHIP,
a New York Corporation
By:
President
S ~
Print Name
STATE OF 1~j~~ y
County of /V?%J~K~
Sworq to and subscribed before m~
this.day of b~/
Notary Public
AKA IK
Notary PuDGc, State of New York
No.O1Kii60915~0
Owlif ied in Kings County
Commission Expires Apri128, 201
CertNicate flied wOh New York Cou
11
APPROVED AS TO
FORM 8 LANGUAGE
EXHIBIT "A"
"SCOPE OF SERVICES"
The Contractor agrees to provide the following services.
Service Documentation of Service
Entrepreneurship Training Completed Training Attendance Sheets and copies of
certificates issued to participants(attached
The Contractor agrees that its Partner Performance Rating, the score awarded for
performance on the following measures, will be posted on the City's website:
• Timely and accurate submission of monthly, quarterly and annual progress
report
• Timely and accurate submissions of financial reports
• Delivery of contracted service units
• Promotion of the Miami Beach Service Partnership
• Attendance at Miami Beach Service Partnership Governing Board and related
City committee(s) meetings
In addition, the Contractor agrees to allow the City to post a link to the Contractor's
home website as well as enable a link from the Contractor's website to the City's
website.
Service Deliverables
f ~~ Service Unit of Service Service Location
Entrepreneurship Training Up to 90 hours for each of up
to 30 outh Miami Beach Senior High
School
12
EXHIBIT "B"
INVOICING
The Contractor agrees to provide the invoicing and services documentation as
indicated in the Monthly Progress Report and Monthly Progress Submissions
Checklist & Summary Form, as attached to this Exhibit.
13
ACORD
CERTIFICATE OF LIABILITY INSURANCE OP ID PD DATE (MM/DD/YYYY)
,.
NATLF-1 11 28 07
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wesfair Agency, Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
9 Hunts Lane HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO Box 215 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Chappaqua NY 10514
Phone : 914-238-3734 Fax :914-238-8402 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Th@ Hartford 084
INSURER 8: Philadelphia Indemnity Ins. Co
NAT' L FDN TEACHING ET AL INSURER C:
7210 Red Oad Ste' 207
South Miami F~ 33143 INSURER D:
INSURER E:
HVY
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 CONTRACTOR 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR NSR TYPE OF INSURANCE POLICY NUMBER DATEYMM/DD/YY E DATE MM/DDm LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
A X X COMMERCIAL GENERAL LIABILITY 16UUNAF1585 07/08/07 07/08/08 PREMISES (Eaoccurence> $ 300000
CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 10000
PERSONALBADVINJURY $ 1000000
GENERAL AGGREGATE $ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO PRODUCTS -COMP/OP AGG $ 2000000
-
POLICY
JECT LOC
AU TOMOBILE LIABILITY
A
ANYAUTO
16UUNAF1585
07/08/07
07/08/08 COMBINED SINGLE LIMIT
(EaacGdent) $ 1000000
ALL OWNED AUTOS
BODILY INJURY
$
SCHEDULED AUTOS (Per person)
][ HIRED AUTOS
X
NON-OWNED AUTOS BODILY INJURY
(Per accident) $
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO
OTHER THAN ~ ACC
$
AUTO ONLY: AGG $
EXCESS/UMBRELLALIABILITY EACH OCCURRENCE $jOQOOQO
A X OCCUR ~ CLAIMSMADE 16RHU AF1800 07/08/07 07/08/06 AGGREGATE $ 5000000
DEDUCTIBLE $
X RETENTION $10000 $
WORKERS COMPENSATION AND
EMPLOYERS' LUIBfLiTY TORY LII14lTS ER
A 16WEEL8716 07
0
ANY PROPRIETOR/PARTNERlEXECUTIVE /
8/07 07/08/08 E. L. EACH ACCIDENT $ 1000000
OFFICER/MEMBER EXCLUDED?
If yes, describe under _
E.L. DISEASE - EA EMPLOYEE
$ 1000000
SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 1000000
OTHER
DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT / SPECUIL PROVISION8
THE CITY OF MIAMI BEACH IS LISTED AS ADDITIONAL INSURED FOR GENERAL
LIABILITY ONLY
f`COTICIP ATC aJA~ non _ _ _. _
MIBEACH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF MIAMI BEACH DATE THEREOF, THE ISSUING INSURER WILL ~67W07~MAIL 3O DAYS WRITTEN
CITY RISK MANAGER NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT ii~ApQmOmp~SHALL
1700 CONVENTION CTR DR . 3RD FL IMPOSE NO OBLIGATION OR LWBILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
MIAMI BEACH FL 33139 REPRESENTATIVES.
AUTHORIZED REPRESENTAT
Harve Dann
ACARn ~S r~nn~rnm
U ACORD CORPORATION 7988
SWORN STATEMENT UNDER SECTION 287.133(3)(a),
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
OFFICER AUTHORIZED TO ADMINISTER OATHS.
1. This sworn statement is submitted to C'~ u~ ~ Aw\ t ~,4~
[print namennof public entity]
by ~Je Vvl~2~c~~ ~ 1~2e52c~Q•v t
[print individual' name and title]
for ' ~'a ,V ~IioNa- I 1tU~+~l tcih- `~ ,~eRNn ~'~C ~IK.e~;n~tie u.2 Sl~~ /~ ~ ~'1~CA i
\I {--- ,.c1 [print name of entity submitti sworn s atement]
u .~-
w ose business address is 12.U W,a-ll ~2Qel ag ~ r"~~ _ Ne ~ J ~ ~~ ~ `~~ / ~ 5
and (if applicable) its Federal Employer Ident~cation Number (FEIN) is ~ 3" ~y O ~ ? 31 (If the
entity has no FEIN, include the Social Security Number of the individual signing this sworn statement:
.)
2. I understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes.
means a violation of any state or federal law by a person with respect to and directly related to the
transaction of business with any business with any public entity or with an agency or political
subdivision of any other state or of the United States, including, but not limited to, any bid or contract
for goods or services to be provided to any public entity or an agency or political subdivision of any
other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering,
conspiracy, or material misrepresentation.
3. I understand that "convicted" or "conviction" as defined in Paragraph 287.133(1)(b), Florida Statutes.
means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt,
in any federal or state trial court of record relating to charges brought by indictment or information after
July 1, 1989, as a result of a jury verdict, nonjury trial, or entry of a plea of guilty or nolo contendere.
4. I understand that an "affiliate" as defined in Paragraph 287.133 (1)(a), Florida Statutes. means:
1. A predecessor or successor of a person convicted of a public entity crime; or
2. An entity under the control of any natural person who is active in the management of the entity and
who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors,
executives, partners, shareholders, employees, members, and agents who are active in the
management of an affiliate. The ownership by one person of shares constituting a controlling interest
in another person, or a pooling of equipment or income among persons when not for fair market value
under an arm's length agreement, shall be a prima facie case that one person controls another person.
A person who knowingly enters into a joint venture with a person who has been convicted of a public
entity crime in Florida during the preceding 36 months shall be considered an affiliate.
G:\WpflCONT ADM\PUR7068.doc
5. I understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statutes means any
natural person or entity organized under the laws of any state or of the United States with the legal
power to enter into a binding contract and which bids or applies to bid on contracts for the provision of
goods or services let by a public entity, or which otherwise transacts or applies to transact business
with a public entity. The term "person" includes those officers, directors, executives, partners,
shareholders, employees, members, and agents who are active in management of an entity.
6. Based on information and belief, the statement which I have marked below is true in relation to the
enti/ty submitting this sworn statement. [indicate which statement applies.].
Neither the entity submitting this sworn statement, nor any officers, directors, executives,
partners, shareholders, employees, members, or agents who are active in the
management of the entity, nor any affiliate of the entity has been charged with and
convicted of a public entity crime subsequent to July 1, 1989.
The entity submitting this sworn statement, or one or more of its officers, directors,
executives, partners, shareholders, employees, members or agents who are active in
management of the entity, or an affiliate of the entity has been charged with and convicted
of a public entity crime subsequent to July 1, 1989.
_ The entity submitting this sworn statement, or one or more of its officers, directors,
executives, partners, shareholders, employees, members, or agents who are active in the
management of the entity, or an affiliate of the entity has been charged with and convicted
of a public entity crime subsequent to July 1, 1989. However, there has been a
subsequent proceeding before a Hearing Officer of the State of Florida, Division of
Administrative Hearings and the Final Order entered by the hearing Officer determined that
it was not in the public interest to place the entity submitting this sworn statement on the
convicted vendor list. (attach a copy of the final order]
I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE
PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND,
THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I
ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO
A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA
STATUTES FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.
~ D~ ., ~ i ~
[signature]
Swom to and subscribed before me this '7 ~ day of ~~-'^^~~-W , 20~.
Personally known
OR Produced identification ~~ S ~ L
~5 S~ E~ ~-(~ I ~
(Type of Identification)
K K
7No~pt I(g6091570 ~~
Oualdied+nK'~Cour~y
C,Oe~nI~NCatstiledw~'dnt~Ya 'col
Notary Public -State of ~~,J ~,o~
My commission expires ~ ,r~ r! Z ~ ~ ~ ~~
(Printed typed or stamped Commissioned name of Notary Public)
G:1wpflCO NT_ADM~P U R7068. doc