Loading...
Res. No. 002-04-11781RESOLUTION NO.2-04-11781 A RESOLUTION OFTHE MAYOR AND CITY COMMISSION OF THE CITY OF SOUTH MIAMI, FLORIDA,AUTHORIZING THE CITY MANAGER TO EXECUTE A GRANT AGREEMENT WITH MIAMI-DADE COUNTY FOR THE CHURCH STREET IMPROVEMENTS -PHASE II GRANT AWARD OF $95,000 THROUGH THEOFFICEOF COMMUNITY &ECONOMIC DEVELOPMENT;PROVIDING AN EFFECTIVE DATE. WHEREAS,theMayorandCityCommissionwishtoacceptFY2004grantfundsfromMiami-Dade County Office of Community &EconomicDevelopmentand; WHEREAS,thegrantwill partially fundtheChurchStreet Improvements PhaseII,ana1;, WHEREAS,the Mayor andCityCommission authorize theCity Manager to execute thegrant contractforFY2004CommunityDevelopmentBlockGrant(CDBG)withMiami-DadeCountyOffice of Community &Economic Development. NOW THEREFORE,BE IT RESOLVED BY THE MAYOR AND CITY COMMISSION OF THE CITY OF SOUTH MIAMI,FLORIDA: Section 1:The city wishes to accept theFY2004 CDBG from Miami Dade County Office of Community &Economic Development. Section 2:That the Mayor andCity Commission authorize the City Manager to execute theFY 2004grant contract with Miami-Dade County Office of Community Development. Section 3:This resolution shall be effective immediately upon adoption. PASSED ANDADOPTEDthis 6th day of January ,2004. APPROVED:ATTEST: City Clerk READ ANOA2RRQYED AS TO FORM: C Commission Vote:4-0 Mayor Feliu:yea Vice Mayor Russell:out of room Commissioner Bethel:yea Commissioner Wiscombe:Yea Commissioner McCrea:Yea CITY OF SOUTH MIAMI Inter-office Memorandum South Miami fcxdad AMmericaCfty miir 2001 TO:Honorable Mayor,Vice Mayor &City Commission DATE:January 6,2004 FROM:Maria V.Davis City Manager X/^J&ir AGENDA ITEM No._ RE:Authorizing the City Manager to execute a grant contract with Miami-Dade County Office of Community and Economic Development RESOLUTION: A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY OF SOUTH MIAMI,FLORIDA,AUTHORIZING THE CITY MANAGER TO EXECUTE A GRANT AGREEMENT WITH MIAMI-DADE COUNTY FOR THE CHURCH STREET IMPROVEMENTS -PHASE II GRANT AWARD OF $95,000 THROUGH THE OFFICE OF COMMUNITY &ECONOMIC DEVELOPMENT;PROVIDING AN EFFECTIVE DATE. BACKGROUND &ANALYSIS: Following the grant application we submitted for funding last summer,Miami-Dade County has awarded $95,000 tothe City towards the Church Street Improvements Phase II project.The grant is funded through the Miami-Dade County Community Development Block Grant (CDBG)forthe Fiscal Year 2004. The phase II improvements along Church Street,between SW 68th Street and SW 69th Street,will include widening ofthe sidewalk,installation of electrical conduits for new street lights,landscaping with irrigation system,street furniture with pre-fabricated bus shelter,roadwayre-constructionandpavementmarking. RECOMMENDATION: Itis recommended thattheCity Commission approve the resolution. ATTACHMENTS: • a Proposed Resolution Copy of Required Documents for Contract Development received from OCED Miami-dade: community and economic development 140 w.flagler street,suite 1000 MIAMI,FL 33130-1561 November 14,2003 OFFICE OF COMMUNITY AND ECONOMIC DEVELOPMENT Director's Office PHONE:305-375-3848 FAX:305-375-3428 kfinnie@miamidade.gov www.miamidade.gov/ced/ Ms.Silvia Jarquin Grants Admin. City of SouthMiami 6130 SUNSET DR S MIAMI,FL 33143 RE:Contract Development Processfor FY 2004 DearMs.Jarquin: On November 12,2003,the Board of County Commissioners heldapublic hearing to discuss the proposed funding allocations for the 2004 Action Plan.Those recommendations,which include funding allocations for your agency,describe those projects that may be funded through the Community Development Block Grant (CDBG),the HOME Investment Partnership Program, the Emergency Shelter Grant (ESG),and the Documentary Surtax Program.The Board will considerthefinalversion of the2004ActionPlanonThursday,December 4,2003. Atthis point,staff cannot ensure youthatthe Board willnotalterthe funding recommendations.However,weare asking youto complete the required documents that accompany thisletterto expedite the processing ofyour agency's agreements. Our districtteamswillschedule meetings withyouduringtheweek of November 17-21 to discuss the completion ofthose forms and ofthe other items necessary to process your agreements.This will ensure not only the expeditious development of your agency's agreements but also the implementation and the completion of your activities within the time frames specified intheFY 2004 Action Plan. Please contact Richard Hoberman,your contracts officer,at (305)375-3472,ifyou have any questions abouttherequired documents. Sincerely, FelipeM.Rivero,III Supervisor ContractsManagementandMonitoringSection C:\Documents and Settings\ronsan\Desklop\FY 2004 REQUIRED DOCUMENTS LETTERmcrge2.doc Las!saved by Miami-Dade OCED 11/14/03 12:38 PM CONTRACT DEVELOPMENT WORKSHOP LIST OF CONTENTS •SAMPLE OF BOARD OF DIRECTOR'S RESOLUTION APPROVING THE FUNDED AMOUNT AND AUTHORIZING EXECUTION OF THE CONTRACT WITH OCED. AUTHORIZED SIGNATURE FORM. MIAMI-DADE COUNTY AFFIDAVITS. AFFIDAVIT OF FINANCIALAND CONFLICTS OF INTEREST. RELATED PARTIES DISCLOSURE STATEMENT. STATE OF FLORIDA PUBLIC ENTITY CRIMES AFFIDAVIT. CODEOF BUSINESS ETHICS AFFIDAVIT. SAMPLEOF ACTION STEPS FOR SCOPE OF SERVICES. SAMPLE BUDGET. LIST OF REQUIRED DOCUMENTS TO BE SUBMITTED BY THE AGENCY CVCbntroct Development Workshop/Listof Contents/Brianna REQUIRED DOCUMENTS FOR CONTRACT DEVELOPMENT TO BE PROVIDED BY THE AGENCY Project ID/ Local ID 0006 4010SMIAMI U.S.Department of Housing &Urban Development CPD Consolidated Plan ListingofProposedProjects Project Iitle/Priority/ Objective/Description HUbwiairixuodeyiitlei Funding Sources Citation/Accomplishments CITY OF S.MIAMI CHURCH STREET,59 PL IMPMTS 03K Street Improvements Infrastructure 570.201(c) 8216People (General) RECONSTRUCTION OF2,000 LF OF SIDEWALK BIKE LANE TRFP PLANTING AND OTHER STREET IMPROVEMENTS ' CDBG ESG HOME HOPWA TOTAL TotalOtherFunding Help the Homeless? Help those with HIVorAIDS? Eligibility: Subrecipient: Location(s): No No Start Date:01/01/04 CompletionDate:12/31/04 570.208(a)(1)-Low/Mod Area Local Government Addresses $95,000 $0 $0 $0 $95,000 $0 CONTRACT DEVELOPMENT WORKSHOP LIST OF CONTENTS •SAMPLE OF BOARD OF DIRECTOR'S RESOLUTION APPROVING THE FUNDED AMOUNT AND AUTHORIZING EXECUTION OF THE CONTRACT WITH OCED. •AUTHORIZED SIGNATURE FORM. •MIAMI-DADE COUNTY AFFIDAVITS. •AFFIDAVIT OF FINANCIAL AND CONFLICTS OF INTEREST. o RELATED PARTIES DISCLOSURE STATEMENT. •STATE OF FLORIDA PUBLIC ENTITY CRIMES AFFIDAVIT. •CODE OF BUSINESS ETHICS AFFIDAVIT. •SAMPLE OF ACTION STEPS FOR SCOPE OF SERVICES. •SAMPLE BUDGET. •LIST OFREQUIRED DOCUMENTS TO BE SUBMITTED BYTHE AGENCY C:/Controct Development Workshop/Ust of Contents/Brianna RESOLUTION AUTHORIZING EXECUTION OFA CONTRACT WITH l-DADE COUNTY AND FOR THE PROVISION WHEREAS,this Board desires to accomplish the objectives as outlined in the scope of serviceofthecontract with Miami-Dade County. NOW,THEREFORE,BEITRESOLVEDBY THE BOARD OF DIRECTORS of approves one (1)contract with Miami-Dade County for the maximum amount of$for theprovision of.services forthe Fiscal Year 2004 and authorizes and to execute same forandonbehalfof . The foregoing resolution was offeredby ,who moved its adoption,the motion was seconded by _,and upon being put toa vote was as follows: The Chairperson/President thereupon declared this resolution duly passed and adopted this day of ,. Signature-Chairperson or Secretary Agency Seal CONTRACTOR: DATE: AUTHORIZING SIGNATURES This form certifies the names,titles and signatures of individuals authorized by the contractor's by-laws or board resolution to sign contracts,checks,budget revision requests,payment requestsandany other requests,(e.g.purchase requisitions,purchase orders,receiving reports,direct bills)thatare required by theOfficeofCommunityandEconomicDevelopment (OCED)fordisbursementoffunds. NAME TITLE SIGNATURE (TypeorPrint)(Type or Print) I.Prime Contracts Subcontracts II.Checks (List Amount Limits) III.Budget Revision Requests NAME TITLE SIGNATURE (TypeorPrint)(Typeor Print) IV.Payment Requests V.Other Administrative Matters (e.g.Status Reports,Purchase Orders,Travel Requests) These signatures authorized are retained by OCEDfor auditing purposes. You are required to submit updates to this list as it becomes necessary. ililllilll^^ -DADE COUNTY/AFFIDAVITS The contracting individual or entity (government or otherwise)shall indicate by an "X"all affidavits that pertain to this contract and shall indicate by an "N/A"aii affidavits that do not pertain to this contract.All blank spaces must be filled. The MIAMI-DADE COUNTY.OWNERSHIP DISCLOSURE AFFIDAVIT;MIAMI-DADE COUNTY EMPLOYMENT DISCLOSURE AFFIDAVIT;MIAMI-DADE CRIMINAL RECORD AFFIDAVIT;DISABILITY NON-DISCRIMINATION AFFIDAVIT;andthe PROJECT FRESH START AFFIDAVIT shallnot pertain to contracts with the United Statesor any of its departments or agencies thereof,the Stateorany political subdivision or agency thereof;it shall however,pertainto municipalities oftheStateofFlorida.All other contracting entities or individuals shall read carefully each affidavit to determine whether ornotit pertains to this contract. ,being firstduly sworn state: Affiant The full legal name and business address ofthe person(s)orentitycontractionor transacting business with Miami-Dade County are (Post Office addresses are not acceptable): Federal Employer Identification Number (If none,Social Security) Name of Entity;Individual(s),Partners,or Corporation Doing Business As (If same as above,leave blank) Street Address City State Zip Code I.MIAMI-DADE COUNTY OWNERSHIP DISCLOSURE AFFIDAVIT (Sec.2-8.1of the County Code) 1.If the contract or business transaction iswitha corporation,the full legal name and business address shallbeprovidedfor each officer and director and each stockholder whoholdsdirectly or indirectlyfive percent(5%)ormoreofthe corporation's stock.If thecontractor business transaction is with a partnership,the foregoing informationshallbeprovidedfor each partner.Itthe contract or business transaction iswitha trust,the full legal name and address shall be provided for each trustee and each beneficiary.The forgoing requirements shallnotpertainto contracts withpublicly-traded corporations or to contracts with the United States or any department or names and addresses are (Post Offices addresses are not acceptable): Full Legal Name Address Ownership % Page 1of5 2.The full legal names and business address ofanyother individual (otherthan subcontractors,material men,supplies,laborers,orlenders)whohave,or will have,anyinterest (legal,equitable beneficial or otherwise)inthe contract or business transaction with DadeCountyare(PostOffice addresses arenot acceptable): 3.Anypersonwho willfully fails todisclosethe information required herein,orwhoknowinglydiscloses false information in this regard,shall be punished bya fine ofupto five hundred dollars ($500.00)or imprisonment inthe County jail foruptosixty(60)daysorboth. II.MIAMI-DADE COUNTY EMPLOYMENT DISCLOSURE AFFIDAVIT (CountyOrdinance No. 90-133, III.Amending Sec.2.8-1;Subsection (d)(2)ofthe County Code). Except where precluded by federal or State lawsor regulations,each contract or business transaction or renewal thereofwhichinvolvestheexpenditureoftenthousand dollar ($10*000)ormoreshall require the entitycontractingortransacting business todisclosethe following information.Theforegoingdisclosure requirementsdonotapplyto contracts withtheUnited States orany department or agency thereof,the State or any political subdivision or agency oranymunicipalityofthis State. 1.Does your firm have a collective bargaining agreement withits employees? 'Yes '.'"•No 2.Does your firm providepaid health care benefits forits employees? Yes No 3.Provideacurrent breakdown (number of persons)ofyourfirm'sworkforceand ownership as torace, national origin and gender. White:Males Females Asian:Males Females Black:Males Females American Indian:Males Females Hispanics:Males Ferriales Aluet (Eskimo):Males Females :Males Females :Males Females II AFFIRMATIVE ACTION/NON-DISCRIMINATION OF EMPLOYMENT,PROMOTION AND PROCUREMENT PRACTICES (County Ordinances 98-30codifiedat 2-8.1.5 ofthe County Code) In accordance with County Ordinance No.98-30,entities withannual gross revenues in excess of $5,000,000seekingtocontractwiththeCounty shall,as condition receiving aCountycontract,have I)a writtenaffirmativeactionplan which sets forththe procedures the entity utilizes to assure that it does not discriminate inits employment andpromotion practices;and ii)awritten procurement policywhich sets forth the procedures theentityutilizesto assure thatit does notdiscriminate against minorityand women- owned businesses initsown procurement ofgoods,suppliesandservices.Such affirmativesactionplans andprocurementpoliciesshallprovidefor periodic review todeterminetheir effectiveness inassuringthe entity does notdiscriminateinits employment,promotionand procurement practices.The foregoing notwithstanding,corporate entities whose boards ofdirectorsare representatives of the population make upofthe nation shallbe presumed tohave non-discriminatory employmentandprocurement policies,and shallnotberequiredtohavewrittenaffirmativeactionplansand procurement policiesin order to receive a County contract.The foregoing presumption may be rebutted. The requirements of County Ordinance No.98-30 may be waived upon the written recommendation ofthe County Managerthatitisin the best interest oftheCountytodosoanduponapproval of the Boardof County Commissioners by majority vote of the members present. Page 2of5 The firm does nothaveannualgrossrevenuesin excess of$5,000,000. The firm does haveannual revenues in excess of$5,000,000;however,itsBoardofDirectors is representative ofthe population make-up ofthe nation andhas submitted a written,detailed listing ofits Board of Directors,including the race of ethnicity ofeach board member,tothe County's Department ofBusiness Development,175NW 1st Avenue,28th Floor,Miami Florida 33128. The firm has annual gross revenues in excess of $5,000,000 and the firm does have awritten affirmative action plan and procurement policy as described above,which includes periodic review to determine effectiveness,and has submitted the plan and policy tothe County's Department ofBusiness Development,175 NW 1st Avenue,28th Floor,Miami,Florida 33128. The firm does nothavean affirmative action plan and/oraprocurementpolicyasdescribed above,but has been granted awaiver. _IV.MIAMI-DADE COUNTY CRIMINAL RECORD AFFIDAVIT (Section2-8.6of the CountyCode) The individual orentityentering into acontractor receiving funding from the County hashasnotofthedateofthis affidavit been convictedofafelonyduringthepastten (10)years. _V.MIAMI-DADE EMPLOYMENT DRUG-FREE WORKPLACE AFFIDAVIT (County Ordinance no.92-15 codified as Section 2-8.1.2 of the County Code) That in compliance with Ordinance No.92-15 of the Code ofMiami-Dade County,Florida,the above named person or entity isprovidinga drug-free workplace.Awritten statement to each employee shall,inform the employee about: 1.Danger of drug abuse in the workplace 2.The firm'spolicyof maintaining a drug-free environment atall workplaces 3.Availabilityof drug counseling,rehabilitation and employee assistance programs 4.Penalties that may be imposed upon employees fordrug abuse violations The person orentityshallalsorequirean employee tosigna statement,as aconditionof employment that the employee will abidebythe terms andnotify the employer ofany criminal drugconvictionoccurringnolaterthanfive(5)days afterreceivingnoticeof such conviction and impose appropriate personnel action against the employee upto and including termination. Compliance with Ordinance No.92-15 may be waived if the special characteristics of the productor service offered by thepersonor entity make it necessary forthe operation of the Countyorfor the health,safety,welfare,economic benefits andwell-beingof the public. Contracts involving fundingwhichisprovidedin whole orinpart by the United States of the State ofFloridashall be exempted fromthe provisions ofthis ordinance in those instances where those provisions areinconflictwiththe requirements of those government entities. VI.MIAMI-DADE EMPLOYMENT FAMILYLEAVEAFFIDAVIT (County Ordinances No.142-91 codified as Section 11A-29 et.Seq ofthe County Code) That in compliance with ordinance No.142-91of the Code of Miami-Dade County,Florida,an employer withfifty(50)or more employees workinginDade County for each working day during each of twenty (20)ormore calendar workweeks,shall provide the following information in compliance withall items in the aforementioned ordinance: Page 3or5 Anemployeewhohas worked for theabove firm atleastone(1)yearshallbe entitled to ninety (90)days of family leave during any twenty-four (24)month period,for medical reasons, for the birth or adoption ofa child,or for thecareofa child,spouseorother close relative who hasserious health condition without risk of termination of employer retaliation. The foregoing requirements shall not pertain to contracts with the United States or any department or agency thereof,or the State of Florida or any political subdivision or agency thereof,itshall,however,pertain to municipalities ofthis State. VII.DISABILITY NON-DISCRIMINATION AFFIDAVIT (County Resolution R385-95) Thatthe above names firm,corporation or organization is in compliance with the agrees to continuetocomply with andassurethatany subcontractor,or third party contractorunderthis project complies with all applicable requirements ofthe laws listed below including,butnot limited to,those provisions pertaining toemployment provisions ofprogramsand services, transportation,communications,access tofacilities,renovations,and new construction in the following laws:TheAmericans with Disabilities Actof1990 (ADA),Pub.L 101-336,104Stat 327.42 U.S.C.12101-12213and47U.S.C.Section 1612;The Fair Housing Act asamended, 42U.S.C.Section3601-3631.Theforegoingrequirementsshallnotpertain to contracts with theUnited States oranydepartmentor agency thereof,theStateorany political subdivision or agency thereof or any municipalityofthis State. .IX.CURRENT OR ALL COUNTY CONTRACTS,LOANS AND OTHER OBLIGATIONS The individual entity seeking to transact business with the County is current in all its obligationstotheCountyandisnototherwiseindefaultoranycontract,promissory noteor other loan documents with the Countyor any ofits agencies or instrumentalities. X.PROJECT FRESH START (Resolution R-702-98 and 358-99) Any firm that has a contract withthe County that results inactual payment of $500,000 or more shall contribute toProjectFresh Start,the County's Welfare to Work Initiative.However, iffive percent (5%)of the firm'sworkforce consists ofindividuals who reside in Miami-Dade County and who have lostor will loose cash assistance benefits (formerlyAid to Families with dependent Children)asaresultof the PersonalResponsibilityand Work Opportunity Reconciliation Actof 1996,the firm may request waiver from the requirement of R-702098 and R-358-99 by submitting awaiver request affidavit.The foregoing requirement does not pertain to government entities,notforprofit organizations or recipients of grant awards. XI.DOMESTICVIOLENCELEAVE(Resolution185-00;99-5Codifiedat 11A-60 Et.Seq.ofthe Miami-Dade County Code). The firm desiring todo business with the County isin compliance with Domestic Leave Ordinance,Ordinance 99-5,codifiedat 11A-60 et.Seq.oftheMiami-Dade County Code, whichrequiresan employer which has intheregular course of business fifty(50)ormore employees workingin Miami-Dade County for each workingdayduring each of twenty (20)or more calendar work weeks inthecurrentor proceeding calendar years,to provide Domestic Violence Leave to.its employees. Page 4 of 5 I havecarefullyreadthis entire five (5)pagedocumententitled Miami-Dade CountyAffidavits andhave indicatedbyan "X"allaffidavitsthatpertainto his contractandhave indicated byan "N/A"allaffidavitsthatdo not pertain to this contract. By: (Signature ofAffiant)(Date) SUBSCRIBED AND SWORN TO(or affirmed)before me this day of 20 by, presented _ ..He/She is personally known to me or has as identification. (Type ofIdentification) (Signature ofNotary)(SerialNumber) (Printof Stamp ofNotary)(Expiration Date) NotaryPublic-State of (State) Page 5 of 5 AFFIDAVITOF FINANCIAL ANDCONFLICTSOF INTEREST 1.Do you have any past due financial obligations with Miami-Dade County? YES NO Single Family House Loans Multi-Family Housing Rehab CDBG Commercial Loan Project U.S.HUD Section 108 Loan Other HUD Funded Programs Other (liens,fines,loans, Occupationallicenses,etc.) IfYES,please explain: 2.Do youhaveanypastdue financial obligations with Miami-Dade County? YES NO IfYES,please explain: 3.Are youa relative ofordo you haveanybusinessor financial interests with any elected Miami-Dade County official, Miami-Dade CountyEmployee,orMemberof Miami-Dade County's Advisory Boards? YES NO ifYES,please explain: Anyfalseinformationprovidedonthisaffidavit will bereasonforrejectionand disqualification ofyour project-funding request toMiami-DadeCounty. The answers to the foregoing questions are correctly stated to the best ofmy knowledge and belief. By: (Signature ofApplicant)(Date) SUBSCRIBED AND SWORNTO(oraffirmed)beforemethisdayof 20 By .He/She ispersonallyknowntomeor has presented ;as identification. (Typeof identification) (Signature ofNotary)(Serial Number) (Printor Stamp ofNotary)(ExpirationDate) NotaryPublic-Stamp of -Notary Seal (State) SAMPLE AGENCY NAME DISCLOSURE ABOUT RELATED PARTIES (DATE) THERE ARE NO BOARD MEMBERS OFTHE (AGENCY NAME) WHO HAVE ANY RELATIONSHIP OR HAVE MADE ANY TRANSACTION WITH OTHER ENTITIES THAT MIGHT RESULT INA CONFLICT WITH (AGENCY NAME)OPERATIONS. msm®3?mmmiMmmm>$mMwmm%z SWORN STATEMENT PURSUANT TO SECTION 287.133 (3)(a) FLORIDA STATUES ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED.AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS 1.This form statement is submitted to by (Printindividual's name andtitle) for (Print name ofentitysubmittingsworn statement) whose business address Is and If applicable its Federal Employer Identification Number (FEIN)is If the entityhas not FEIN,include theSocial Security Numberofthe individual signingthissworn statement. 2.I understandthata "public entity crime"asdefinedin paragraph 287.133(1 )(g),Florida Statues, means a violation ofanystateor federal lawbyaperson with respecttoandirectlyrelatedto thetransactionsof business withany public entityorwithan agency or political subdivisionof anyotherstateor with the United States,including,butnot limited toany bid or contract for goods or services tobe provided to public entity or agencyor political subdivision ofany other stateoroftheUnited States and involving antitrust,fraud,theft,bribery,collusion,racketeering, conspiracy,or material misinterpretation. 3.I understand that "convicted"or "conviction"asdefinedinParagraph 287.133(1 )(b),Florida Statutes,meansa finding of guilt ora conviction ofa public entity crime,with or without an adjudication of guilt,in an federal or state trial court of record relating to charges brought by indictment or information afterJuly 1,1989,asa result ofa jury verdict,non-jury trial,orentryof apleaof guilty ornolocontendere. 4.I understandthatan "Affiliate"asdefinedin paragraph 287.133(1 )(a),Florida Statutes means: 1.A predecessor or successor ofa person convicted ofa public entity crime,or 2.An entity under the control ofany natural person who is active in the management ofthe entity and who hasbeen convicted ofa 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 ofshares constituting a controlling interest inanotherperson,ora pooling ofequipment or income among personswhennot for fair market value under anarm's length agreement,shall bea prima facie case that one person controls another person.A person who knowingly enters into a joint venture with a person who hasbeen convicted ofa public entity crime in Florida during the preceding 36 months shall be considered an affiliate. 5.I understandthata "person"asdefined in Paragraph 287.133(1 )(e),Florida Statues,meansany natural personor entity organized under the laws ofanystateorofthe United States within the legal power to enter into a binding contract and which bids or applies to bid on contracts for the provision of goods or entity.The'term "person"'includes those officers,executives,partners, shareholders,employees,members,and agents who are active in management of an entity 6.Basedon information and belief,thestatement which I have marked below istrueinrelationtothe entity submitting this sworn statement.(Please indicate which statement applies.) Neither the entity submitting sworn statement,nor any of its officers,director,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 toJuly 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,or an affiliate of the entity had been charged with and convicted of a public entity crime subsequent to July 1,1989,AND (please indicate which additional statement applies. The entity submitting this sworn statement,or one or more of its officers,directors, executives,partners,shareholders,employees,members,or agents who are active in the management of the entity,nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent proceeding before a Hearing Officer of the State of the State of Florida,Division of Administrative Hearings and the Final Order entered by the Hearing Officer determined thatitwas not in the public interest to place the entity submitting this sworn statement ontheconvictedvendor list,(attachacopyofthe 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 OR THE CALENDAR YEAR IN WHICH IT IS FILED.I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THAT PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017 FLORIDA STATUTES FOR A CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. (Signature) Sworn toandsubscribedbeforeme this dayof.120_ Personally known Or produced identification _Notary Public-State of (Typeofidentification) My commission expires. (Printed,typedor stamped commissioned name of notary public) FORMA-12 CODE OF BUSINESS ETHICS In accordance with Section2-8.1(i)oftheMiami-Dade County Code,each person or entitythat seeks todo business withtheCountyshalladoptaCodeof Business Ethics ("Code")andshall,prior to execution ofanycontract between thecontractorandthe County,submit anaffidavitstatingthatthecontractor has adopted a Code that complies with the requirements of Section 2-8.1 (i)oftheMiami-DadeCounty Code.Any person orentitythatfailsto submit the required affidavit shall be ineligible for contract award. The Code of Business Ethicsshallapplyto all business that the contractor does with the County and shall,ata minimum,requirethat the contractor: •Complywith all applicablegovernmentalrulesandregulationsincluding,among others,the Miami-Dade County ConflictofInterestand Code ofEthics Ordinance and the False Claims Ordinance. •Complywith all applicablerulesandregulations regarding Disadvantaged Business Enterprises,Black Business Enterprises,Hispanic Business Enterprisesand Women Business Enterprises(hereinaftercollectively Minority Business Enterprises,"MBEs")andCommunitySmall Business Enterprises (CSBEs)andshallspecifically prohibit the following practices: o Pass-through Requirements.The Code shallprohibit pass-throughs whereby the prime fire requiresthatthe MBE orCSBE firm accept payments as a MBE orCSBEand pass through those payments ora portion of those paymentstoanotherentity including,butnotlimitedtothe owner/operator of the prime firm; o Rental Space.Equipment orFlat Overhead Fee Requirements.The Code shall prohibit rental space requirements,equipmentrequirements,and/or flat overhead fee requirements,whereby the prime firm requires the MBE or CSBE firm torent space or equipment fromtheprime firm or charges a flat overhead fee for the use of space,equipment,secretary,etc; o Staffing Requirements.The Code shallprohibit the primefirmfrom mandating,asa condition to inclusion in the project,thata MBE orCSBE hire,fire,orpromote certain individuals not employed bytheprime firm,or utilize staff employed or previously employedbytheprime firm. oMBEor CSBE Staff Utilization.The Code shall prohibit the prime firm from requiring the MBE orCSBE firm to provide morestaffthanis necessary andthen utilizing the MBE orCSBEstaff for otherworktobe performed by the prime firm. o Fraudulently creating,operating or representing MBEor CSBE.The Code shall prohibit a prime firm including,butnot limited to,the owners/operatorsthereof from fraudulently creating,operating or representing anentityasa MBE orCSBE for purposesof qualifying for certification as a MBE or CSBE. •The Code shall also require thatonanycontractwhere MBE orCSBE participation is purported,the contract shall specifyessentialterms including,but notlimitedto;a specific statement regarding the percent of participation planned forMBEsor CSBEs,the timingof payments and when the workisto be performed. The failure of a contractor to compiy with its Code of Business Ethics shall render any contract between the contractor and the County voidable,and subject violators to debarment fromfuture County work pursuant to Section 10-38(h)(2) of the Code.The Inspector Generalshall be authorized to investigate any alleged violationbya contractor ofits Code of Business Ethics. By:20. Signature ofAffiant Date Printed Name andTitleofAffiant Federal Employer Identification Number Printed Name of Firm Address of Firm SUBSCRIBED AND SWORN TO (of affirmed)before me this day of ,20, He/She is personally known tomeor has presented as identification. Type of Identification Signature of Notary Serial Number Printor Stamped Name ofNotary Expiration Date Notary Public,State of SAMPLE SCOPES OF SERVICES •SAMPLE I-Public Service Activity with new clients every quarter •SAMPLE II-Public ServiceActivitywithsame clients every quarter. •SAMPLE HI -Economic Development activity. •SAMPLE IV -Construction/Housing activity. REQUIRED DOCUMENTS FOR CONTRACT DEVELOPMENT TO BE PROVIDED BY THE AGENCY REQUIRED DOCUMENTS FOR CONTRACT DEVELOPMENT TO BE PROVIDED BY THE AGENCY 1.MOST CURRENT ARTICLES OF INCORPORATION 2.MOST CURRENT BYLAWS 3.MOST CURRENTBOARDOFDIRECTOR'S ROSTER 4.MOST CURRENT IRS TAX EXEMPT STATUS DETERMINATION LETTER 5.MOST CURRENT IRS FORM 990 6.MOST CURRENT STATE OF FLORIDA CORPORATE CERTIFICATE 7.CERTIFICATE OF ©OOD STANDING FROM DEPARTMENT OF STATE !Z* MUM. COKRUHtlYAWD KCONOMtCOEVBLDTOBRT Agency Name FY 20.02. Scope;ofServices January 1,2002-December 31,2002 1.-ACTIVITY TTELE: 2.-ACTIVITY DESCRIPTION: 3.-APPROVED BY BCC: 4.-SOURCE 5.-HDD INFORMATION: 5a.-HUD matrix code: 5b.-Title: 5c-Eligibility: 6.ACCOMPLISHMENTS: 6a.-Number ofUnits: 6b.-Type: 7.-NATIONAL OBJECTIVE: 8.-ACTIVITY ADDRESS: 9.-LOCATION: ^CO:Sonia Colon Employment and Training Program Employmenttrainingfor100peoplecountywideinFY2002 $50,000 CDBG 2002 05H Employment Training 570.201(e) 100 People 570.208(a)(2)-Low/Mod,income Clientele (LMC) 4343 W Flagler ST,STE300 Miami FL 33134 Entitlement City(Miami) PLANNER:A3.Mumford SA M P L E A C T I O N S T E P F O R M A T F O R P U B L I C S E R V I C E S A N D E C O N O M I C D E V E L O P M E N T A C T I V I T I E S QU A R T E R - A G E N C Y N A M E : AC T I V I T Y : F U N D I N G S O U R C E : AM O U N T : A C C O M P L I S H M E N T U N I T S : T Y P E ; .' • - - . 'A C T I O N ST E P CA T E G O R Y - ' IN T A K E AN D A S S E S S M E N T IN D I V I D U A L CO U N S E L I N G G R O U P C O U N S E L I N G TU T O R I A L S E R V I C E S S C H O O L V I S I T S W O R K S H O P -• • ; : Y ; : X ^ - - - ^ IN T A K E AN D A S S E S S M E N T IN D I V I D U A L C O U N S E L I N G G R O U P C O U N S E L I N G TU T O R I A L SE R V I C E S S C H O O L V I S I T S W O R K S H O P :: -; -' : '" • ' - . : • . ' •? . ' - \ V - > ; ' ~ i IN T A K E AN D A S S E S S M E N T IN D I V I D U A L C O U N S E L I N G G R O U P C O U N S E L I N G TU T O R I A L S E R V I C E S S C H O O L V I S I T S W O R K S H O P 'A £ P R p y E q 1 h - ' ; p , & K | j j | NO S T R O M O . IN C . Y O U T H S E R V I C E S P R O J E C T C D B G 2 0 0 3 T; ^ i * ; i 5 o . q q O v i . '• ' • ^ r^ ; - f . " - , - 2 3 0 ": . i YO U T H S ••• r . I• ; • • N U M B E R o r , : CL I E N T S . ' c u m u l a t i v e - - - i c u m u l a t i v e . >, - c u m u l a t i v e ^q u a r t e r l y ' . , . i nu m b e r • \> j -. p r o j e c t e d ' >! se r v i c e . u m i t s ; cf c l i e u i s ' pa y m e n t le v e l . ' ' ' • a p p r o v e d a p p r o v e d . , - a p p r o v e d . '• (S E R V I C E .F R E Q U E N C Y . .A P P R O V E D Q U A R T E R L Y WE E K L Y MO N T H L Y W E E K L Y Q U A R T E R L Y Q U A R T E R L Y Q U A R T E R L Y W E E K L Y M O N T H L Y W E E K L Y Q U A R T E R L Y Q U A R T E R L Y r j M S M & M S i M I Q U A R T E R L Y W E E K L Y M O N T H L Y WE E K L Y QU A R T E R L Y Q U A R T E R L Y '- . I - •: . ' '- > •. : 4 0 : - : - l - •.. • : : . ; : • • • '• ^0 : • r; \ - t r : . [ ••• .: $ 2 Q , 0 3 7 A ' . '••'• -'• •; : . i . . : - i 2 0 : - : - : . - : V : : - : \ . . v -1 2 0 v ; . • : - . . - . v s » i . 2 o i . - . . i •; : . . . ' . ' : '- . ' • - •: i - V : - v : ' ; . - , ; I S O ' - ;- • ; ' , : ; - • •:• '• 1 5 0 IN T A K E A N D A S S E S S M E N T IN D I V I D U A L C O U N S E L I N G G R O U P C O U N S E L I N G TU T O R I A L SE R V I C E S SC H O O L VI S I T S W O R K S H O P Q U A R T E R L Y W E E K L Y M O N T H L Y W E E K L Y Q U A R T E R L Y Q U A R T E R L Y - • B - J • - ' - '- - • • . - . . - • - • • • : • ' ••" •-• • • • ' . • • - ; : •: ' 2 3 0 . - : , - ; , - . " : : - - v . V- ~ 2 3 0 . r : : ' - 7 ; : - : : . V S . 1 5 0 . 0 0 0 j AT T A C H M E N T "A * Ac t u a l qu a r t e r l y ac c o m ' p ' l i s m m e n i s cu m m u l a t i v e . ' cu m m u l a t i v e j' ' .c u m m u l a t i v e ' pe r c e h t a g f ^ o f . '- " CQ M P I E T I O N t - SE R V I C E UN I IS RE J f . ' . ' n U R S C M E N T S ^ • a : : i y . - : ; - : : ^ : ; ••• • • • • • • - . •' • • • • • i ••• g .w - V •• • • - • - ^ ^ • • : V ^ : i r > - ^ : ; - ' : . U - - ^ ^ ; ;; : - •'• • • • ' : : , - : \ \ : : : ^ - ~ > : u 3 - . ; f- : - > i . - ^ - . - ; ~ - ; - > . - j L - i •• • - • • • • • ! -' - • • " • •' : • ! ' : & ^ : ^ i - : •: ^ . : r : r . . - ^ , - ^ j ^ ^ NOTE:YOU MUST USE THE ACTION STEP FORMAT THAT IS DESCRIBED ON THE FOLLOWING PAGE INSTRUCTIONS FOR CONSTRUCTION,REHABILITATTON,HOUSING AND ADMENISTRATTVE COSTS ACTION STEP FORMAT AGENCY NAME ACTIVITY FUNDING SOURCE AMOUNT TOTAL ACTIVITY COST Thelegalname of youragency Thetitle of theactivitybeingfundedthroughOCED The OCED funding source (CDBG,HOME,ESG,HATF,HDG) Indicate the amount of funding thatyou are seeking from OCED forthe activity Indicate thetotalcost of the activity TOTAL AVAILABLE FUNDING (ALL SOURCES)Indicate the total funding that you have secured for the activity from non- OCED andOCEDfundingsources. ACCOMPLISHMENT Indicate the total number of service unitsthatyourproject will achieve throughoutthe grant period. Indicate the service unittype-housing,building,organization,etc. Indicatethe quarter of operation Identify in 3-4 words each service that the project will conduct during eachquarter. Onthe shaded lineatthebottom of each quarterly interval,indicate the year to date percentage of completion that the project will achieve each quarter.NOTE:The total percentage of completion for the grant period will consist of [AMOUNT +TOTAL AVAILABLE FUNDING (NON- OCED )/TOTAL ACTIVITY COSTS]X 100. Indicateoneach oftheshadedlinesforeach quarter thetotal number of serviceunitsthatthe project will accomplish yeartodate. Indicateoneach of the shaded linesforeach quarter theportion of the project's total allocation that the project will expend yeartodate. UNITS TYPE COLUMN I COLUMN n column m COLUMN IV COLUMN V SAMPLESCOPEOFSERVICESFORCONSTRUCTION.REHABILITATION.HOUSING.ANDADMINISTRATIVECOSTS 1ST AGENCYNAME- ACTIVITY: FUNDINGSOURCE: AMOUNT: TOTALACTIVITYCOSTS: TOTALAVAILABLEFUNDING(NON- OCED): PROPOSEDACCOMPLISHMENT UNITS: ACCOMPLISHMENTUNITS: TYPE: IDENTIFYANDACQUIRE2HOUSES EXECUTECONTRACT- ARCHITECTURALSERVICES ENVIRONMENTALAPPROVAL DAVIS-BACONWAGE DETERMINATION OBTAINPERMITS-2HOUSES SELECTANDEXECUTECONTRACT FORGENERALCONTRACTOR ttgflRayjpm^S THEHAWKERCORPORATION YOUTHSERVICESCENTER CDBG2003 $900,000 $400,000 6 HOUSING 3S839i«Sg$S3Sre BEGINREHABILITATION•?&tZ\%?&#$Tyx£-£;^a^mo:i£i!aga^^^$ioaooo^ IDENTIFYPOTENTIALRENTORSORSgjVS#3£?of«S*^ $e&£••Vz^&*&<\ 2ND PURCHASERS COMPLETE2HOUSES OBTAINCERTIFICATESOF OCCUPANCY PLACERENTORSORBUYERStN2 HOUSESTmm IDENTIFYANDACQUIRE3HOUSESS^^ EXECUTECONTRACT-S^G$K|SreW ARCHITECTURALSERVICESS&^W&vM ARCHITECTURALSERVICES ENVIRONMENTALAPPROVAL DAVIS-BACONWAGE DETERMINATION OBTAINPERMITS-2HOUSES SELECTANDEXECUTECONTRACT FORGENERALCONTRACTOR 3RD BEGINREHABILITATION*r:;?J&^«>^*^-ij@ 4TH IDENTIFYPOTENTIALRENTORSOR PURCHASERS COMPLETESHOUSES OBTAINCERTIFICATESOF OCCUPANCY PLACERENTORSORBUYERSIN3 HOUSES ^^^^^^^^^^l^^^^^^^^^^^^SlS^^^lSlMElM^i^i sliillllillt MSMmHE Mmrsm&Sfii 8*jgfesfetfj»^g5i ATTACHMENT"A" BsaswaeeaiJBgg •g&sasa^-geafc-a ma&t&smM PMtt&V&i&^'ptp ^MSiu^MU^ffyEft^ IITS^REIMBUMeMSNTS* im*®fi&ms?mii<tt gfeara^'c^.?,asfe :/.W^ViBra«&i?flo? w&wj::^&*wv.*aI NOTE:YOU MUST USE THE ACTION STEP FORMAT THAT IS DESCRIBED ON THE FOLLOWING PAGE INSTRUCTIONS FOR PUBLIC SERVICES AND ECONOMIC DEVELOPMENT ACTION STEP FORMAT AGENCY NAME ACTIVITY FUNDING SOURCE AMOUNT The legal name of your agency Thetitle of theactivitybeingfundedthroughOCED TheOCEDfundingsource (CDBG,HOME,ESG,HATP,HDG) Indicatetheamount of fundingmatyouareseekingforthe activity ACCOMPLISHMENT UNITS TYPE COLUMN I COLUMN H COLUMN HI COLUMN IV COLUMN V COLUMN VI COLUMN vn Indicate the total number of serviceunitsthat your project will achieve throughout thegrantperiod. Indicatetheserviceunittype-people,elderly,children,etc. Indicatethequarterof operation Identify in 3-4 words each service that the project will conduct during each quarter. Using onlyoneofthe following categories -quarterly,monthly,weekly, daily -identify the frequency ofthe proposed service.Iftheprojectwill provide a specific serviceseveraltimeswithinaservice interval,then indicate soaspartof Column II (eg.For counseling services thatwill occurtwiceper week should be stated as "Counseling Services (2) Weekly"). Indicate the number of persons outofthe project's population thatwill be affected by eachactionstep. Indicateoneachoftheshadedlinesforeachquarterthetotal number of service units thattheprojectwill accomplish yeartodate. Indicateoneach of theshadedlinesforeachquarterthetotal number of clients thattheprojectwillserve yeartodate. Indicate oneach of theshadedlinesforeachquarterthe portion of the project'stotal allocation thatthe project will expend yeartodate. CATEGORIES NAME OF AGENCY,INC. ABC PROGRAMMING CDBG FY 2002 SUMMARY BUDGET JANUARY 1,2002-DECEMBER 31,2002 FY 2002 I.PERSONNEL H.CONTRACTUAL SERVICES EL OPERATING SERVICES IV.COMMODITIES $11,788 $40,000 $4,000 $1,600 V.CAPITAL OUTLAY TOTAL BUDGET $68,579 $125^67 04O10 PERSONNEL «Employee Regular-Salaries Executive Director Deputy Director Office Mgr. Receptionist Subtotal Salaries AGENCY NAME,INC. CDBG FY 2002 [PROJECT NAME] DETAIL BUDGET January 1,2002 thai December 31,2002 PP Non OCED OCED Total OCED Bi-Week)y 26 38,000 26 26 47,000 423.08 11,000 26 65,000 400.00 11,000 Total All Sources $38,000.00 $47,000.00 S11,000.00 $0.00 $96,000.00 D4O10 Fringe Benefits :>.\>I .• Rca;11.000xi0620=628x100%0 0.00 628 $628.00 Mica:11.000x.0145=160 0 0.00 160 $160.00 Subtotal Fringe 0 0.00 788 $788.00 Total Personnel 0 0.00 11,788 $96,788,00 Contractual Services 21011 External Audit 0 0.00 4,000 $4,000.00 21012 Environmental Audit 0 0.00 0 $0.00 21030 Other ProfessionaJ-Svc.ConstMgm.0 0.00 30,000 $30,000.00 21030 Other Professional Svc..0 0.00 0 $0.00 22350 Bottled Water 0 0.00 0 $0.00 25330 Rent Copier 0 0.00 0 $0.00 25511 Building Rental 0 0.00 6,000 .$6,000.00 Total Contractual 0 0.00 40,000 $40,000.00 Operating Expense 31011 Telephone Regular 31011 Telephone Long Distance 31610 Postage 31420 Advertising Radio Total Operating Expense 0.00 0.00 0.00 0.00 0.00 2,500 300 1,200 4,000 $2,500.00 $300.00 $1,200.00 $0.00 $4,000.00 Commodities 31510 Outside Printing 0 0.00 400 $400.00 95020 Computer Purchase 0 0.00 0 $0.00 47010 Office supplies/Outside Vendors 0 0.00 1,200 $1200.00 Total Commodities 0 0.00 1,600 $1,600.00 Capital Outlay 61620 Basic Architectural fees 0 0.00 0 $0.00 61620 Prime Contractor 0 0.00 68,579 $68,579.00 Total Capital Outlay 0 0.00 68,579 568,579.00 TOTAL BUDGET 85,000 0.00 125,967 $210,967.00 Agency Name OCEDFY2002 January 1,2002 -December 31,2002 HOME SAMPLE BUDGET CHPO DESCRIPTION HOME AMT HOME AMT OTHER AMT TOTAL AMT 01 Personnel Executive Director $0 $32,308 $23,077 $55,385 Housing Assistant $0 $3,846 $0 $3,846 FICA $0 $3,846 $1,863 $5,729 .20 Contractual Services Audit External (2000.&2001)$10,000 $0 $0 $10,000 Accounting Services $0 $0 $3,600 $3,600 General Liability Insurance $3,000 $0 $0 $3,000 Title Insurance $5,000 $0 $0 $5,000 Construction Manager(Consuttant)$25,000 $0 $0 $25,000 Appraisaj &Surveying Services $7,000 $0 $0 $7,000 Property Maintenance $5,000 $0 $0 $5,000 Attorney's Fees $5,000 $0 $0 $5,000 Marketing $10,000 $0 •$0 $10,000 30 Operating Expenses Electric/Telephone $0 $0 $7,400 $7,400 Water &Sewer Services $0 $0 $1,000 $1,000 40 Commodities ~ Office Supplies $0 $0 $1,400 $1,400 Office Equipment $0 $0 $5,000 $5,000 Rent $0 $0 $12,000 $12,000 90Capital Outlay Purchase Price of Land $75,000 $0 $0 $75,000 Environmental $5,000 $0 $0 $5,000 Property Taxes $0 $0 $5,000 $5,000 Building Permits $10,000 $0 $0 $10,000 Architect Fees $10,000 $0 $0 $t0j000 Impact Fees $20,000 $0 $0 $20,000 Financing Cost $10,000 $0 $0 $10,000 Total $200,000 $40,000 $60,360 $300,360