4To:
CITY OF SOUTH MIAMI
OFFICE OF THE CITY MANAGER
INTER-OFFICE MEMORANDUM
The Honorable Mayor & Members of the City Commission
South Miami
bOd!
;IUf'
2001
From: Hector Mirabile, PhD, City Manager /f Ll
Date: September I I, 2012 Agenda Item No.:~
SUBJECT: A Resolution authorizing the City Manager to award Maggolc, Inc. a
Purchase Order for the sidewalk upgrade at Dante Fascell Park Tennis
Center for a fee not to exceed $9,990.
BACKGROUND: An Invitation to Quote (ITQ) was previously issued for this project. Sealed bids
were opened on July 17, 2012, however staff was concerned with the low bid
price. A meeting was held with the low bidder to clarify their quotation and
ensure they fully understood the scope of work. Based on that meeting, all bids
were rejected and the ITQ was re-issued.
EXPENSE:
The ITQ was sent to 21 contractors complied from internal listings and a Miami-
Dade County contractor listing. Sealed bids were opened on September 7, 2012
with four proposals received:
Maggolc, Inc. $9,990
Quality Paving Corp. $13,500
JV A Engineering $14,814
Custom Homes, Inc. $15,005
Customs Homes was rejected; their bid was received late and they did not comply
with submitting the required affidavits and Related Parties Transaction form.
Based on their low bid and compliance with the ITQ, Maggolc, Inc. was
determined to be the most responsive and responsible vendor for this project.
The new ITQ form includes affidavits that are included with all formal RFP's and a
Related Parties Transaction form recently revised by the City Attorney.
$9,990 to account number 001-1750-519-3450 with a balance of $13,250
Page 10f2
SUPPORT: Resolution
Bid Opening Report, July 17, 2012
ITQ Re-issued: Vendor Solicitation Email dated August 24, 2012.
Bid Opening Report, September 7, 2012
Maggolc, Inc. proposal
Page 2 of2
1 RESOLUTION NO.: _________ _
2
3 A Resolution authorizing the City Manager to award Maggolc, Inc. a Purchase Order
4 for the sidewalk upgrade at Dante Fascell Park Tennis Center for a fee not to exceed
5 $9,990.
6
7 WHEREAS, the City accepted sealed quotations, including a quotation from Maggolc Inc.
8 for the sidewalk repair at Dante Fascell Park Tennis Center; and
9
10 WHEREAS, Maggolc, Inc. was a responsive and responsible vendor who provided the
11 lowest bid; and
12
13 WHEREAS, Capital Improvements analyzed the quotations received and determined
14 Maggolc's Inc. quotation as conforming to the scope of work; and
15
16 WHEREAS, Maggolc Inc. will perform the work requested for a fee not to exceed $9,900.
17
18 NOW, THEREFORE, BE IT RESOLVED BY THE MAYOR AND CITY COMMISSION OF THE
19 CITY OF SOUTH MIAMI, FLORIDA:
20
21 Section 1. The City Manager is authorized to award Maggolc Inc. a Purchase Order for
22 the sidewalk repair at Dante Fascell Park Tennis Center for a fee not to exceed $9,990.
23
24 Section 2. Severability. If any section, clause, sentence, or phrase of this resolution is
25 for any reason held invalid or unconstitutional by a court of competent jurisdiction, this holding
26 shall not affect the validity of the remaining portions of this resolution.
27
28 Section 3. Effective Date: This resolution shall take effect immediately upon approval
29 by the City Commission.
30
31 Section 4. The expenditure to be charged to the Public Works Contractual Services
32 Account Number 001-1750-519-3450.
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PASSED AND APPROVED this __ day of _____ ., 2012.
ATIEST:
CITY CLERK
READ AND APPROVED AS TO FORM,
LANGUAGE, LEGALITY AND
EXECUTION THEREOF
CITY ATIORNEY
APPROVED:
MAYOR
COMMISSION VOTE:
Mayor Stoddard:
Vice Mayor Liebman:
Commissioner Harris:
Commissioner Newman:
Commissioner Welsh:
BID OPENING REPORT
Bids were opened 011: Tuesday. July 17. 2012 after: 10:00 a.m.
For: SIDEWALK UPGRADE AT DANTE F ASCELL PARK
B\tb \,...)Qf(. O~.L " ('\ -th.t. ~+~ cJ .. U'k..\~ oCt, c..t b:"cOMx...l.k E.t.ff> If\e:e"'i~wo..!o. 6ei"\htl~ ;~iha.
CO~is" ill"-~\:it..."l •.
CONTRACTORS: BID AMOUNTS:
----------... _ .. _._._--_ .. __ ._----_._-----,
1. JV A ENGINEERING CONTRAC:;LQR, IN~ ______________ $_14...:..,_81._4_.0_0 _______ _
2. QUALITY P ~ VINO CORP. _____________________ ......:$----'7,_99_0_.0_0 ___
1
3. ROCK POWER PAVING $ 15,677.70 _.----------.-------------~-~~~--------
---------.-----.. ---.... -----.--------------.. -.. -.-------l
---------------------------_._-
_._--._-----'-----._---_ ... _-_ .. _._--------
1--------.-----.-----.----------.. ---.. -----... ---.--------.--------1
_ .... _-_ ... _. __ ... _-_ ...... _ .... __ ... _-_._---_._-------------.----------------.-
1-------_··_-----------_·_·_--_·_----_·_·_-----------------I
._. __ .... __ ....... _ ....... _._ ..... _._ .... _---_._------. ------------------------._----_._-.-
1----_._------_ .. _--_ .. _------_._----------------------------
(-------------.... ---...... --------.-..... -...... ---.... ---.. -.--.. -..... -... ---.. ---.---------.---1
THE ABOVE BID AMOUNTS HAVE NOT BEEN CHECKED.
THE BID TOTALS ARE SUBJECT TO CORRECTION AFTER THE BIDS HAVE BEEN COMPLETELY
REVIEWED. ()
City Clerk:J~~~ ~ 0vU~ ___ .____ .__ \ A 1. ~--'.~\\-" ----;-_ p~~~ ~ ~~r~\~/ . ~i .. -.. -/ \<::.f:j~\-) I rJCil·~··,·"/)! "7 Witness:' -1, .. {\ :;1--
.--Print Naill' ) / ._.---SignaP~-·----··---·
Witness:-=.J~c? 4/}._ kJtbS; 7 f /" _~=~:~= __ ._. ___ ._. _____ ~_-. __ ._ .. __ .... _ ....
Print Name Signature
BID OPENING REPORT
Bids were opened on: Friday, September 7,2012 after: 10:00 a.m.
For: SIDEWALK UPGRADE AT DANTE FASCELL PARK -TENNIS CENTER
CONTRACTORS: BID AMOUNTS:
--~-
l. JV A ENGINEERING CONTRACTOR, INC. $/4 gJY~ 00
2. QUALITY PAVING CORP. $ 13 • SOb ,lXJ
3. MAGGOLCINC $ q;qCO,co
4. DAVIDJ.SANGUESA/CLL'"JtDM UDHES INL $ IS Oaf. 6(\ ,
THE ABOVE BID AMOUNTS HAVE NOT BEEN CHECKED.
THE BID TOTALS ARE SUBJECT TO CORRECTION AFTER THE BIDS HAVE BEEN COMPLETELY
REVIEWED.
CUyCI .. k: ~lLf~
Prit~t ~ame ,
Witness: ~+-el/~ /(JA
Print Name
Witness:
--~--------------------Print Name Signature
CllY OF SOUTH MIAMI
PUBLIC WORKS/CAPITAL IMPROVEMENTS AND CENTRAL SERVICES
INVITATION TO QUOTE
LUMP SUM PROPOSAL
SUBMllTED TO:Qty Clerk', OffiCll
NAME: Marla Menendez, CMe
PROJECT: Sidewalk Upgrade at pante fascell
l~£!l.!!.f~~lIL....-_
ADDRESS: 8600 Red Road
ADDRESS: &130 Sunset Drive CllY/STATE:
CllY/STATE, Miami, Florida 3.313,4.:. ________ _
PHONE: 305-663-6339
MANDATORY pRE-;fi:;QUiiOTE~.;;Mii::EET1~N;-;G;:-: ',I\!lI!~.-~!1.';"""' .. e""t-""ii1-.
DATE:
E-MAIL:
DUE DATE:
"BIDDERS ARE ENCOURAGED TO VISIT THE PROJECT SITE PRIOR TO THE QUOTE DUE DATE.
QUOTE SUBMISSION REQUIREMENT
Quotes submitted after 10:00am on the due date will not be accepted unless otherwise specified in the quote document of a
time change. All quotes will be submitted to the City Clerks Office in a sealed envelope. The label on the envelope needs
to read as follows:
City of Sauth Miami
Marla M. M~nendez, CMC
6130 Sunset Drive
South Miami, Fl. 33143
PraJect Name: "SIdewalk UPsrade Dante Faseen Park -Tennis Center"
Must input project name. If label and envelop does not have all information above your quote will not be accepted,
1. INSURANCE REQUIREMENTS:
The CITV'S insura nee requirements are attached (Exhibit 1). As a condition of award, the awarded vendor must provide a
certificate of Insurance naming the city as additional Insured.
Z. AFFIDAVITS TO BE COMPLETED BY BIDDER: (Exhibit #2)
3. SCOPE OF WORK DESCRIPTION (TO BE COMPLETED BY CITV):
Upgrade Sidewalk area located at Dante Fascell's Tennis Center. Remove and dl~posp. existing asphalt Sidewalk. backfill.
regrade and compact to LBR·40, Install new 1" asphalt sidewalk (S:-11J) and comeact. Regrade and sod swale between sidewalk
arid tennis clay courts. backfill and re@rade6feetfromsouthedge of ~!dewalk arld harmonize to exlstlng..,Il"'r"'ad.;;.e"', _____ .
4. DESCRIPTION OF WORK TO BE PERFORMED BY CONTRACTOR:
Item N4mber -Item Description -Qtv .... Unit
101-1 Barricade and secure work areas lS 1
102:1 Remove and dispose asphalt.(200'xS') SY 111
110·1·2 Install 4" of lBR-40 (200'.7') backflll on exlsUn!! sidewalk foomrlnt SV 160
120-1 Install 1 " of Type 5-111 surface miK to excavated area and co·meact -SY 1~~ .. -.. ---'-
160·4 Regrade and extend backfill 6 feet from onile to , Sy 135
285;706 Aegradeexlstlng swafe co~rt and sJ.tlewalk Sy 135.
337-7-32 Install Flofatam sod (from south edRe a slde~~ __ SY 270
425·1-311 Remove and haul away any related debris ~rom sne __ LS 1
LUMP SUM TOTA~ ._--$9 f:!}ClJO.";,1>
Contractor ;hall furnish all materials and ~ulpment nct!lS'iiJry to secure completion of the work~:.:tr::.act=of:..;s;:-h:::a::.lI;:.b::.e------
compllnsated according to the quote submitted. Blddersareel1~t() viSit the site prior to the quote due date. •
100"" Performance and Payment Bond relJ\lfred. Contractor Is .-.pbmlllle to secure all permits and bonds and reflected in LS quote.
Contractor m~y choose to submit a qUQte,on (Omi/IIIlY letterhead but must be at1ached with this form.
Deadline to submit 1$ FRIDAYiS4!PtembQf 7, 2012 at 10 am -Clerk's office at 6130 Sunset Drive/South Mla~ __ _
~'-----.. --" '--'-J mE llXEC:UlION OF THIS FORM CONSTITUTES THE UNEQUIVOCAL OFFER OF PROPOSER TO 8E BOUND BY THE TERMS OF ITS PROPOSAL FAILURE TO SIGN THIS
$(I ... utfI'AIION WHERE INDICATED ABOVE BY A. N. AU. THORIZED REPRESENTATIVE SHALL RENDER THE PROPOSAL NON·RESPONSIVE. THE CITY MAY, HOWEVER, IN ITS .
SOU, IlISCRET1ON, ACCEPT ANY PROPOSAL THAT INCLUDES AN EKECUTED DOCUMENT WHICH UNEQUIVOCALLY BINDS THE PROPOSER TO THE TERMS OF ITS OffER.
TH£ CITV'S REQUEST FOR QUOTES IS fOR THE LOWEST AND MOST RESPONSIVE PRICE. THE CITY RESERVES THE RIGHT TO AWARD THE PROJECT TO THE FIRM
tONSI!)I1R£O THE IEs~.:r2 SERIIE THECITY'S Imtill£$T, ____ . __ _
Exhibit# I
Insurance and Indemnification
I. Insurance and Indemnificatio?
Without limiting its liability. the proposing firm shall be required to procure and
maintain !it its own expense during the life of the Contract, insurance of the types
and in the minimum amounts stated below as will protect the proposing firm, from
claims which may arise out of or result from the proposing firm's execution of a
contract with the City of South Miami for Performance Based Audits. whether such
execution by the firm or by any sub-consultant. or by anyone directly or indirectly
employed by any of them or by anyone for whose acts any of them may be liable.
The CONTRACTOR/COMPANY shall not commence WORK on this Agreement
until he has obtained all insurance required by the City. The
CONTRACTOR/COMPANY shall indemnify and save the City harmless from any and
all damages. claims, liability. losses and causes of actions of any kind or nature arising out
of a negligent error, omission. or act of the CONTRACTOR/COMPANY. its agents.
representatives, employees, Sub-Contractor, or assigns, incident to arising out of or
resulting from the performance of the CONTRACTOR/COMPANY'S professional
services under this Agreement. The CONTRACTOR/COMPANY shall pay all claims
and losses of any kind or nature whatsoever, in connection therewith, including the
City'S attorney's fees and expenses in the defense of any action in law or equity brought
against the City arising from the negligent error, omission, or act of the
CONTRACTOR/COMPANY, its agents, representatives. employees, Sub-Contractor.
or assigns, incident to, ariSing out of or resulting from the performance of the
CONTRACTOR/COMPANY'S professional services under this Agreement ..
The CONTRACTOR/COMPANY agrees and recognizes that the City shall not be held
liable or responsible for any claims, including the costs and expenses of defending such
claims which may result from or arise out of actions or omissions of the
CONTRACTOR/COMPANY, its agents, representatives, employees. Sub-Contractors,
sub-contractors, or assigns. In reviewing, approving or rejecting any submissions or acts
of the CONTRACTOR/COMPANY, the City in no way assumes or shares
responsibility or liability of the CONTRACTOR/COMPANYS, Sub-Contractors. their
agents or assigns.
The CONTRACTOR/COMPANY shall maintain during the term of this
Agreement the following insurance:
A. Professional liability Insurance on a Florida approved form in the amount of
$1,000.000 with deductible per claim if any, not to exceed 5% of the limit of liability
providing for all sums which the CONTRACTOR/COMPANY shall become legally
obligated to pay as damages for claims arising out of the services or work
performed by the CONTRACTOR/COMPANY its agents, representatives. Sub-
Insurance and Indemnification July 25,2012
Contractors or assigns, or by any person employed or retained by him in
connection with this Agreement This insurance shall be maintained for four years
after completion of the construction and acceptance of any Project covered by this
Agreement. However, the CONTRACTOR/COMPANY may purchase Specific
Project Professional Liability Insurance, in the amount and under the terms specified
above, which is also acceptable.
B. Comprehensive general liability insurance with broad form endorsement, on a
Florida approved form including automobile liability, completed operations and
products liability, contractual liability, severability of interest with cross liability
provision, and personal injury and property damage liability with limits of
$1,000,000 combined single limit per occurrence and $2,000,000 aggregate,
including:
• Personal Injury: $1,000,000;
• Medical Insurance $25,000 per person;
• Property Damage: $500,000 each occurrence;
• Automobile liability: $1,000,000 each accidentJoccurrence.
C. Umbrella Commercial General liability insurance on a Florida approved form with
the same coverage as the primary insurance policy but in the amount of $1,000,000
per claim.
The City must be named as additional "named" insured for all except Workers'
Compensation, and reflect the indemnification and hold harmless provision
contained herein. Policy must specify whether it is primary or excess/umbrella
coverage. City must receive 10 days advance written notice of any policy
modification and 30 days advance written notice of cancellation, including
cancellation for non-payment of premiums. All insurance must remain in full
force and effect for the duration of the contract period with the City. The
CONTRACTOR/COMPANY must provide not only a "certified copy" of the
Binder but also the Policy itself with the name, address and phone number of
the agent and agency procuring the insurance.
D. Workman's Compensation Insurance in compliance with Chapter 440, Florida
Statutes. as presently written or hereafter amended.
E. The policies shall contain waiver of subrogation against City where applicable, shall
expressly provide that such policy or policies are primary over any other collective
Insurance that City may have. The City reserves the right at any time to request a
copy of the required policies for review. All policies shall contain a "severability of
interest" or "cross liability" clause without obligation for premium payment of the
City.
Insurance and Indemnification July 25, 2012
F. All of the above insurance required to be provided by the
CONTRACTOR/COMPANY is to be placed with BEST rated A·8 (A.VIII) or
better insurance companies, qualified to do business under the laws of the State of
Florida on approved Florida forms.
The CONTRACTOR/COMPANY shall furnish certified copies of all "Binders" or
certificates of insurance to the City prior to the commencement of operations,
which "Binders" or certificates shall clearly indicate that the
CONTRACTOR/COMPANY has obtained insurance in the type, amount, and
classification as required for strict compliance with this Section and that no
reduction in limits by endorsement during the policy term, or cancellation of this
insurance shall be effective without thirty (30) days prior written notice to the
CITY.
Compliance with the foregoing requirements shall not relieve the
CONTRACTOR/COMPANY of his liability and obligations under this Section or
under any other portion of this Agreement.
CONTRACTOR/COMPANY agrees to supply copies of certificates of insurance
to the City verifying the above-mentioned insurance coverage.
CONTRACTOR/COMPANY agrees to list City as an Additional Insured of the
CONTRACTOR/COMPANY's General liability insurance and shall provide the
City quarterly reports concerning any and all claims.
Insurance and Indemnification July 25,2012
EXHIBIT 2
AFFIDAVITS AND FORMS
SUBMISSION REQUIREMENTS
I", Respondent's Sworn Statement Under Section 287.133(3)(A), Florida Statutes, on
Attachment #1 "Public Entity Crimes and Conflicts of Interest Affidavit,"
shall be completed and provided with the proposal submittal.
2. Neither the individual(s)/firm, nor any of his/her/its employees shall be permitted
to represent any client before the Commission or any Committee, department or
agency of the City, and shall agree not to undertake any other private
representation which might create a conflict of interest with the City. The
individual(s)/firm may not represent any Commission member, individually, or, any
member of their family or any business in which the Commission member of their
family has an interest.
3. All proposals received will be considered public records. The City will consider all
quotations using such criteria as the Commission or City Manager may adopt at
either of their sole discretion. The individual(s)/firm selected will be required to
enter into a formal agreement with the City in a form satisfactory to the City, prior
to the execution of which the City shall reserve all rights, including the right to
change its selection.
4. Respondent's Attachment #2 '"Drug Free Workplace" form shall be
completed and provided with the proposal submittal.
5. Respondent's Attachment #3 "No Conflict of Interest/Non Collusion
Affidavit," shall be completed and provided with the proposal submittal. "
6. Respondent's Attachment #4 uAcknowledgement and Conformance with
OSHA Standards," shall be completed and provided with the proposal submittal.
7. Respondent's Attachment #5 "Related Party Transaction Verification
Form" shall be completed and provided with the proposal submittal.
Page 1 oflO
ATTACHMENT #1 PUBLIC ENTITY CRIMES AND CONFLICTS OF INTEREST
Pursuant to the provisions of Paragraph (2) (a) of Section 287.133, Florida State Statutes -"A
person or affiliate who has been placed on the convicted vendor list following a conviction for a
public entity crime may not submit a Bid on a Contract to provide any goods or services to a
public entity, may not submit a Bid on a Contract with a public entity for the construction or
repair of a public building or public work. may not submit bids on leases of real property to a
public entity. may not be awarded to perform work as a Contractor, supplier, Subcontractor.
or Consultant under a Contract with any public entity, and may not transact business with any
public entity in excess of the threshold amount Category Two of Section 287.017, Florida
Statutes. for thirty six (36) months from the date of being placed on the convicted vendor list",
The award of any contract hereunder is subject to the provisions of Chapter I 12, Florida State
Statutes. BIDDERS must disclose with their Bids, the name of any officer, director, partner,
associate or agent who is also an officer or employee of the City of South Miami or its agencies.
SWORN STATEMENT PURSUANT TO SECTION 287.133 (3)(a),
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY
PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
I. This sworn statement is'submitted to t!1 '-& Or ";;Qul--~ Mr 'a eA.~· ! j [print nafiu!f the public entity]
by C:!./.flr"'r'O GONz--o.Je V L P~fcle-J
[print individual's name and title] I
for MIl66't2 LC ::r~-,
[print name of entity submitting sworn statement]
L!O~() ~W >'is ¢;( IL~
)
whose business address is
312/1).£'
and (if applicable) its Federal Employer Identification Number (FEIN) is ZO -:3.3 45? r .$~
<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 < I )(g), Florida
Statutes, means a violation of any state or federal law by a person with respect to and
directly related to the transaction of business with any public entity or with an agency
or political subdivision of any other state 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 (I)(b),
Florida Statutes. means a finding of guilt or a conviction of a public entity crime, with or
Page 2 ofl0
without an adjudication of guilt, in any federal or state trial court of record relating to
charges brought by indictment or information after July I, 1989. as a result of a jury
verdict, non-Jury trial, or entry of a plea of guilty or nolo contender.
4. I understand that an "affiliate" as defined in Paragraph 287.133 (I )(a), Florida Statutes,
means:
(a) A predecessor or successor of a person convicted of a public entity crime; or
(b) An entity under the control of any natural person who is active in the
management of the entity and who has been convicted of a public entity crime. The
term "affiliate" includes those officers, directors, executives, partners. shareholders,
employees, members, and agents who are active in the management of an affiliate. The
ownership by one person of shares constituting a controlling interest in any 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.
5. I understand that a "person" as defined in Paragraph 287.133 (I)(e), Florida Statutes,
means any natural person or entity organized under the laws of any state or of the
United States 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 led 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 entity submitting this sworn statement. [Indicate which statement
apZ']
Neither the entity submitting this sworn statement, nor any of its officers.
directors, executives. partners, shareholders, employees, members, or agents who are
active in the management of the entity, nor any affiliate of the entity has been charged
with and convicted of a public entity crime subsequent to July I, 1989.
___ The entity submitting this sworn statement, or one or more of its officers,
directors, executives, partners, shareholders, employees, members, or agents who are
active in the management of the entity, or an affiliate of the entity has been charged with
and convicted of a public entity crime subsequent to July I, 1989.
___ The entity submitting this sworn statement, or one or more of its officers,
directors, executives, partners, shareholders. employees, members, or agents who are
active in the management of the entity, or an affiliate of the entity has been charged with
and convicted of a public entity crime subsequent of July I, 1989. However. there has
been a subsequent proceeding before a Hearing Officer of the State of Florida, Division
of Administrative Hearings and the Final Order entered by the Hearing Officer
determined that it was not in the public interest to place the entity submitting this
sworn statement on the convicted vendor list. {attach a copy of the final order.]
Page 3 of10
Continuation of Attachment #2 Public Entity Crimes and Conflicts
I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING
OFFICER FOR THE PUBLIC ENTITY INDENTIFIED IN PARAGRAPH I (ONE) ABOVE IS
FOR THAT PUBLIC ENTITY ONLY. AND THAT THIS FORM IS VALID THROUGH
DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND
THAT I AM REQUIRED TO INFORM 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 O~NY v\NGE IN THE
INFORMATION CONTAINED IN THIS FORM.
--,-'7 I
Sworn to and subscribed before me this
Personally known or
,_L Pr~uced identification
~~4 ~'\}~5\-k~~
(Type of identification)
----1l-....-._
day of ,20 i'd--
Notary Public -State of . ~/1m hl~-,_---
My commission expires 6?) ~ :L:1-::., ~,O i {
(Printed. t>(p~d or si' ed commissioned name of notary public)
Form PUR 7068 (Rev.06111192) ~\\~i\\"" l'Q1\a. _"', .. ,'''', .. ,''''-------~u,fl." ' PATRICIA A, RIVERA
, ' , MY COMMISSION #EEl3340
Page 4 ofl0
EXPIRES: MAR 13, 2015
Bonde1 through 1st Slale Insurance
ATTACHMENT #2 "DRUG FREE WORKPLACE"
Whenever two or more Bids which are equal with respect to price, quality and service are
received by the State or by any political subdivisions for the procurement of commodities or
contractual services, a Bid received from a business that certifies that it has implemented a
drugMfree workplace program shall be given preference in the award process. Established
procedures for processing tie Bids will be followed if none of the tied vendors have a drugMfree
workplace program. In order to have a drugMfree workplace program. a business shall:
I. Publish a statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession, or use of a controlled substance is prohibited in the workplace
and specifying the actions that will be taken against employees for violations of such
prohibition. '
2. Inform employees about the dangers of drug abuse in the workplace, the business'
policy of maintaining a drugMfree workplace, any available drug counseling, rehabilitation,
and employee assistance programs, and the penalties that may be imposed upon
employees for drug abuse violations.
3. Give each employee engaged in prOViding the commodities or contractual services that
are under Bid a copy of the statement specified in Subsection (I).
4. In the statement specified in Subsection (I), notify the employees, that, as a condition of
working on the commodities or contractual services that are under Bid, the employee
will abide by the terms of the statement and will notify the employer of any conviction
of, or plea of guilty or nolo contender to, any violation of Chapter 893 or of any
controlled substance law of the United States or any state, for a violation occurring in
the workplace no later than five (5) days after such conviction.
5. Impose a sanction on. or require the satisfactory participation in a drug abuse assistance
or rehabilitation program, if such is available in the employee's community, by any
employee who is so convicted.
6. Make a good faith effort to continue to maintain a drug-free workplace through
implementation of this section.
As the person authorized to sign the statement, I tify that this firm complies fully with the
above requirements.
PROPOSER's
~~~ . . -~
Print Name: =-J!JI4X!~~.zL1 'fk~cLp -
Date: < __ ~~ ______ •
Page 5 of to
ATTACHMENT #3 "No CONFLICT OF INTEREST/NoN COLLUSION AFFIDAVIT"
Submitted this Lday ot--.f2-Ref:e~ ,20 I e?-___ J ,
The undersigned, as Bidder/Proposer, declares that the only persons interested in this RFP are named
herein; that no other person has any interest in this RFP or in the Contract to which this RFP pertains;
that this response is made without connection or arrangement with any other person; and that this
response is in every respect fair and made in good faith, without collusion or fraud.
The Bidder/Proposer agrees if this response/submission is accepted, to execute an appropriate CITY
document for the purpose of establishing a formal contractual relationship between the Bidder/Proposer
and the CITY, for the performance of all requirements to which the response/submission pertains.
The Bidder/Proposer states that this response is based upon the documents identified by the following
number: Bid/RFP
The full-names and residences of persons and firms interested in the foregoing bid/proposal, as
principals. are as follows:
,--
11t);JO,:;..(4) :75
Jj/a~ pC :J3!lf
The Bidder/Proposer further certifies that this response/submission complies with section 4(c) of the
Charter of the City of Miami, Florida, that, to the best of its knowledge and belief, no Commissioner,
Mayor, or other officer or employee of the CITY has an . terest directly or indirectly in the profits or
emoluments of the Contract, job, work or s ice to c the response/submission pertains.
Signature:
Printed Name: __ L/a.1'7" ~ 2--O-fJ e ~', __ _
Title: _.-.-1~.~J..e_.J-,-. _.~'-__ _
Telephone: _::t!(i -;;;-., I
Company Name ._~~
;;::.l:1.:1 __ _
:::t:~e.-~
Continuation of Attachment #3No Con~ict of inter/Non-Collusion Certification
Page 6 ofl0
NOTARY PUBLIC:
STATEOF_.ri:tcrnc!q. _
COUNTY OF ~ \rJllAAd' --~a. ole .
e fo going(nstrument was ac,;kn. OWledgeC\~,O~ me t~ 1-t.yof
.. \ ~A . 20 A jh . by . ~\lo iM~,( ~
perso whose signature is being notarized) who is
(name of
SEAL
Personally known to me, or
~~1' Personal identification:
t~~~~ ~~ \~~.ttJ~~_.
Type of Identification Produced
. __ .1_ Did take an oath, or
Did Not take an oath.
,,-... ~
(Name of Notary Public: Print. Stamp
or type as commissioned.)
fAIL.URE TO COMfLETE. SIGN. , RETURN THIS FORM MAY DISOUALIFY YOUR RESpONSE
Page 7oflO
ATTACHMENT #4 "ACKNOWLEDGEMENT AND CONFORMANCE WITH OSHA
STANDARDS"
TO THE CITY OF SOUTH MIAMI
We, d it!-r A.Jt::..--(Name of Contractor), hereby acknowledge and agree that
as Contractor the Janitorial Services RFP, as specified have the sole responsibility for compliance
with all the requirements of the Federal Occupational Safety and Health Act of 1970, and all State and
local safety and health regulations, and agree to indemnify and hold harmless the City of South Miami
against any and all liability, claims, damages, losses and expenses they may incur due to the failure of
(subcontractor's names):
tIo ..;5vtltaCk.J1 Y'O\<>rdrrr" t
to comply with such act or regulation.
Witness
fAUJ.JBE TO CQMPlEIe\~IGN. & RETURN II::!IS FQRMMAX DISQUAlIF.Y YOUR BfSRONSg
Page 8 oflO
ATTACHMENT #5 "RELATED PARTY TRANSACTION VERIFICATION FORM"
I-if-C1 ;rr (; ~,v uJ'el; IndMdwol1y and on be"'" of *Wifo ~"FI,,"")
Name of Representotive ComponyNendorlEntity
have read the City of South Miami (UCity")'s Code of Ethics, Section SA· I of the City's Code of Ordinances and I
hereby certify, under penalty of perjury that to the best of my knowledge, information and belief:
( I) neither I nor the Firm have any conflict of interest (as defined in section SA· I ) with regard to the
contract or business that I, and/or the Firm, am{are) about to perform for, or to transact with, the
City, and
(2) neither I nor any employees, officers, directors of the Firm, nor anyone who has a financial interest
greater than 5% in the Firm, has any relative(s), as defined in section SA.I, who is an employee
of the City or who is (are) an appointed or elected official of the City, or who is(are) a
member of any public body created by the City Commission, i.e., a board or committee of the
City, and
(3) neither I nor the Firm, nor anyone who has a financial interest greater than 5% in the Firm, nor any
member of those persons' immediate family (I.e., spouse, parents, children, brothers and sisters) has
transacted or entered into any contract(s} with the City or has a financial interest, direct
or indirect, in any business being transacte with the city. or With any person or agency acting
for the city, other than as follows: (use a
separate sheet to supply additional informa on that will not fit on this line but make reference to the
additional sheet which must be signed under oath).
(4) no elected and/or appointed official or employee of the City of Miami, or any of their
Immediate family members (i.e., spouse, parents, children, brothers and sisters) has a financially
interest. directly or indirectly, in the contract between you andlor your Firm and the City
other than the foil wing individuals whose interest is set forth follOWing their names:
"="----J,..;;;,.,.."f-...:;j".---:: __ :----:-_--::::--_:::-_-:-:-::-_:--_-:-_--::-__ (use a separate
sheet to supply dditional information that will not fit on this line but make reference to the
additional sheet which must be signed under oath). The names of all City employees and that of all
elected and/or appointed city officials or board members, who own, directly or indirectly, an interest
of five percent (5%) r more of the total assets of capital stock in the firm are as follows:
""""'':''=~-:--~~y!.....l;~ _ __::__._-_·{use a separate sheet to supply additional information that will not fit on this ne but make reference to the additional sheet which must be signed under
oath).
(5) I and the Firm further agree not to use or attempt to use any knowledge, property or
resource which may come to us through our position of trust, or through our performance of our
duties under the terms of the contract with the City, to secure a special privilege, benefit. or
exemption for ourselves, or others. We agree that we may not disclose or use information, not
available to members of the general pUblic, for our personal gain or benefit or for the personal gain
or benefit of any other person or business entity, outSide of the normal gain or benefit anticipated
through the performance of the contract.
(6) I and the Firm hereby acknowledge that we have not contracted or transacted any
business with the City or any person or agency acting for the City. and that we have not appeared
in representation of any third party before any board. cs>mmisslon or agency of the City Within the
past two years other than as follows: P L4 (use a separate sheet
to supply additional information that will not fit on this line but make reference to the additional
sheet which must be signed under oath). Neither I nor any employees, officers, or directors of the
Firm, nor any of their immediate family (I.e .• as a spouse, son, daughter, parent, brother or sister) is
related by blood or marriage to: (i) any member of the City Commission; (Ii) any city employee; or
(iii) any member of any board or agency of the City other than as follows:
IVJ. ~ __ (use a separate sheet to supply additional information that w~lII:-n-o-t-;:fl:-t-o-n~th;-:l,J.s ~lin<-cl-f:b:-ut make reference to the additional sheet which must be signed under
oath).
(7) No Other Firm, nor any officers or directors of that Other Firm or anyone who has a financial
Page 9 of 10
interest greater than 5% in that Other Firm. nor any member of those persons' immediate family
(i.e .• spouse, parents, children, brothers and sisters) nor any of my immediate family members
(hereinafter referred to as "Related Parties'') has responded to a solicitation by the City in
which I or the Firm that I represent or anyone who has a financial interest greater than 5% in
the Firm. or any member of those persons' immediate family (i.e. spouse, parents. children.
~~~_~d ~tZ)J:av:.aJ~~~esponded. other than the following:
. _______ ._(use a separate sheet to supply additional information
that will not fit on this line but make reference to the additional sheet which must be signed under
oath).
(8) I and the Firm agree that we are obligated to supplement this Verification Form and inform the City
of any change in circumstances that would change our answers to this document. Specifically. after
the opening of any responses to a solicitation, I and the Firm have an obligation to supplement this
Verification Form with the name of all Related Parties who have also responded to the same
solicitation and to disclose the relationship of those parties to me and the Firm.
(9) A violation of the City's Ethics Code, the giving of any false information or the failure to
supplement this Verification Form. may subject me or the Firm to immediate termination of any
agreement with the City, and the imposition of the maximum fine and/or any penalties allowed
by law. Additionally, violations may be considered by and subject to action by the Miami-Dade
County Commission on Ethics.
Under penalty of perju
am attesting hereinabove nd
knowledge, information d e
ATTACHED:
clare that I have made a diligent effort to investigate the matters to which I
statements made hereinabove are true and correct to the best of my
Sec. 8A-1 -Conflict of interest and code of ethics ordinance.
Page lOoflO