RFP SM-FN 2010-16 ACTUARIAL CONCEPTSACTUARIAL CONSULTING SERVICES
RFP NO.SM-FN 2010-16
CITY OF SOUTH MIAMI
ACTUARIAL CONCEPTS
2950 HALCYON LANE,SUITE 402
904-262-3020
MICHAEL J.TIERNEY
OCTOBER 18,2010
Concepts
ACTUARIAL CONCEPTS
ACTUARIAL CONSULTING SERVICES
RFP NO.SM-FN 2010-16
CITY OF SOUTH MIAMI
Table of Contents
RFP Checklist 1
Letter of Transmittal 2
Profileof Proposer 3
Summary of Proposer's Qualifications 5
Project Understanding 9
References 9
Project Time Schedule 9
Fee Proposal 9
Hold Harmless Indemnity Clause 11
Declaration 12
Non-Collusion Affidavit
Public Entity Crimes and Conflicts of Interest
Drug Free Workplace
Acknowledgement of Conformance with OSHA Standards
Concepts
RFP Checklist
XI verify that the signature on page 3 is the signature of the person authorized
to bind the agreement.
XIacknowledgereadingandsigningtheHoldHarmlessStatement.
XI have included all information,certificates,licenses and additional
documentationasrequiredbytheCityinthis RFP document.
XIhave checked forany addendums tothisRFP,andwill continue tocheckfor
any addendums up tothe due date and timeofthisRFP.
XIhavesubmittedone (1)original,ten (10)copies oftheentireproposalwith
addenda,andone (1)electroniccopyoforiginal proposal.
XIhaveverifiedthattheoutsideaddresslabelofmy RFP packageisclearly
marked to include my company's name,address,RFP number and date of
RFP opening.
XIncludea completed copyoftheFeeProposalPage with Amounts.
XIam aware thataNoticeofIntentto award thisbidshallbe posted onthe
City's website at www.cityofsouthmiami.net and onthe RFP/Bids Section,
andthatitismy responsibility tocheckforthis posting.Also,Ihave provided
myemail address,astheCity,atitsdiscretion,may provide me information
bysuch means regarding this procurement process.
N/A I have submitted all supporting documentation forlocal preference eligibility,
which must be received with thebid package prior tothebid opening date
and time(if applicable).
ACTUARIAL CONCEPTS
MICHAEL J.TIERNEY
PROPOSER'S AUTHORED SIGNAT
OCTOBER 18,2010
ac@actuarialconcepts.com
Concepts
Concepts Management Advisors
Benefit Specialists
October 18,2010
Cityof South Miami
Attn:City Clerk
6130 Sunset Drive
South Miami,Florida 33143
Gentlemen:
This letter and related attachments are submitted in reply to your request for proposal
dated September 27,2010,with regard to proposals for actuarial services to the City of
South Miami pertaining to its two defined benefit plans (General and Police plans).
Actuarial Concepts'staff,by reason of extensive experience of its principal in all facets
of public pension plans,including services as actuarial consultanttotheStateof Florida
Retirement System and many Florida cities,is well suited to provide actuarial services
totheCityof South Miami.
We understand that the client relationship will be with the City who is seeking
professional services toprovide general advice and counsel onthePlansand benefit
structures on possible plan changes and improvements;calculate and report the
estimated cost of changes in benefit structure based on applicable employee data and
payroll records;meet with Pension Ad Hoc Committee and City Staff to explain
changes to Plans andactuarial assumptions.
Michael J.Tierney,President,2950 Halcyon Lane,Suite 402,Jacksonville,Florida,32223,
904-262-3020,is authorized to make representations for Actuarial Concepts.
We at Actuarial Concepts appreciate the opportunity to present our firm's consulting
capabilities.
Very truly yours,
ACTUARIAL CONCEPTS
By:/n'lAQuJ-'/yUAyVL^c
Michael J.Tierney
ASA,MAAA,FCA,EA #08-01337
2930 Halcyon Lane.Suite 402,Jacksonville.FL 32223
Phone:(904)262-3020.Fax:(904)268-3374
E-mail:ac@actuarialconcepts.com
Profileof Proposer
a.Actuarial Concepts was established in Jacksonville,Florida,on January 3,1989,
andiswholly owned byMichael J.Tierney.
b.Work willbeperformed from our office located at 2950 Halcyon Lane,Suite 402,
Jacksonville,Florida,32223.
c.Actuarial Concepts'professional staffhasservednumerouspublicandprivate
sector clients throughout the United States,and extensive involvement with the
publicsectorhasincludedassignmentsfortheStateofFloridaandmanyFlorida
municipalities.ActuarialConcepts'staffhas maintained long-term consulting
relationships that have survived prior affiliations,and the firm's tradition ofa
high quality work ethicand innovative problem solving has extended overmany
years.
Our principal inventory isthe talents,expertise and experience ofthe
professionals on our staff.Thereare,at present,seven employees,of whom four
are professional actuarial staff.Mr.Tierney isan enrolled actuary under ERISA,
aswellasa member oftheSocietyof Actuaries.Mr.Tierney is licensed to qualify
plans with the Internal Revenue Service.The remaining staff members are
experts in such related disciplinesaslegal research,computer systems,data
management,editing and general management and administration.Actuarial
Concepts hasits own actuarial software.All actuarial work is performed byin-
house staff,and no portion of actuarial projects is sublet to outsiders.
Actuarial Concepts currently has working relationships with theCity'slegal
advisors on labor and pension,Mr.James Crossland and Mr.James Linn.
Wehave extensive experience in thedesignand valuation ofbothpublicand
privateretirementplans,includingactuarialvaluationsandspecialstudies,and
drafting of plan documents and summary plan descriptions.
ActuarialConceptshasservedasconsultantstocity management (asopposedto
workingforpensionboards)formany years,assistingwiththe following:
•Union negotiations involvingchangestopoliceofficer and firefighter
benefits.
•How besttocomplywith minimum benefit andextrabenefit
provisions of Chapters 175/185,Florida Statutes.
•Consideration of alternative plan structures that would lowercitycosts
and/or lessen exposure tocost fluctuations.
•Projections of current planand alternative plan costs.
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Servingasacity actuary,weworkinthecity'sbest interests and are independent
ofthe police and general pension boards or their interests (that are often not the
same).A significant majority of our current practice is working directly forcities
asthecity actuary providing second opinions of pension board actuarial
valuations,special studies of potential benefit changes,and negotiation
assistance.
d.List and description of similar engagements within past 2 years
Cityof Coral Gables
405 Biltmore Way,1st Floor
Coral Gables,Florida 33134
Pat Salerno,City Manager
(305)460-5201
Assist with police negotiations;studies of alternative setsofplanchanges,
testimony at impasse hearing regarding City proposal.
City of Palm Bay
120 Malabar Road SE
PalmBay,Florida 32907
JonLewis,Deputy City Manager
(321)952-3411
Assistwithfirefighternegotiations;studiesof alternative planchanges,
projections of costs;testimony at impasse hearingregardingCity
proposal.
Cityof Hollywood
P.O.Box 229045
Hollywood,Florida 33022-9045
Gail Reinfeld,Director,Human Resources and Risk Management
(954)921-3218
Assist with police and firefighter negotiations;studies ofplan
restructuring,2 tier systems.
Cityof Altamonte Springs
225 Newburyport Avenue
Altamonte Springs,Florida 32701-3697
Mark B.DeBord,Director of Finance
(407)571-8090
Concepts
Assistwithhowtocomplywith Chapter 185 premium taxestobeusedfor
"extrabenefits";assistwithterminationoffirefighterplan.
Other cities that Actuarial Concepts hasservedasconsultantto management
include Boca Raton,Daytona Beach,FortMyers,Miami,Miami Beach,Panama
City,Sanibel,Sunrise.
e.ActuarialConceptshasnotbeeninvolvedinlitigation within thelastfive (5)
years,andthereisno pending litigationarising out of our performance.
f.Actuarial Concepts currently isnot providing anyservicestotheCityofSouth
Miami Employees Retirement Fund.
g.Actuarial Concepts is not involved in any litigation that directly affects services
provided totheCityof South Miami.
Summary of Proposer's Qualifications
a.-c.Michael J.Tierney
Title:Project Manager
Yearsof Service with Actuarial Concepts:21
Yearsof Experience:35+
Professional Registration:ASA,MAAA,FCA,EA08-01337
Education:See resume below
Work Experience:See resume below
Mr.Tierney,an actuary withover35yearsof consulting andactuarialexperience
inpensionsandemployee benefits,andpresidentofthe firm,wouldhaveoverall
responsibility forthe account,includingavailabilityforconsultationand
attendanceatmeetingswhenrequested.Mr.Tierneywouldtobe responsible for
policysettingandstrategicplanningassignmentsrelatedtoplandesign,
including interpretation ofresults,framingof recommendations and preparation
ofrelatedreports.Mr.Tierney's resumeis provided onthefollowingpages.
Estimated hours.Currently unknown;depends on scope of alternatives and
studies involved.
Anne Solaun
Title:Actuarial Analyst
Yearsof Service with Actuarial Concepts:21
Yearsof Experience:24
Education:BachelorofScienceDegreewithmajorin mathematics fromCollege
ofNewRochellein!983
Concepts
Work Experience:
Ms.Solaunhas24 years ofexperiencein actuarial valuation analysis.Ms.Solaun
would be responsible for running the valuation systems applied totheplansand
interfacing with the database.
Estimated hours.Currently unknown;depends onspecific studies performed.
Barbara J.Wilkerson
Title:Actuarial Assistant
Yearsof Service with Actuarial Concepts:21
Yearsof Experience:25
Education:Graduated fromMacclenny High School,Salutatorian in 1985;
attended FCCJ in mathematics
Work Experience:
Ms.Wilkerson has 25 years of experience in data management and has worked
asdata manager forplansforthepast 20.Ms.Wilkerson would beresponsible
for management and maintenance ofthe database.
Estimated hours,20.
Concepts
MICHAEL J.TIERNEY
ASA,MAAA,FCA,EA 08-01337
MichaelJ.Tierneyisa consulting actuary specializinginpensionsand other employee benefits.Heserves
asanadvisortomanagementinboththepublicandprivatesectors,and supervises astaffwithactuarial,
teclinical compliance,communicationandcomputerexpertisethatassistsinthedesign,pricingand
administration of employee benefit plans.
ACTUARIAL ACCREDITATIONS
—Associate in the Society of Actuaries
Mr.Tierney studied forandtook actuarial exams sponsored bythe Society of Actuaries.He successfully
completed therequired examinations to become an Associate intheSocietyof Actuaries in 1967.
—Member,American Academy of Actuaries
Membership in the American Academy of Actuaries requires three years'experience in responsible actuarial
work,aswellaspassingthe required exams.Mr.Tierney wasacceptedasamemberin 1976.
—Enrolled Actuary (IRS)
Mr.Tierney was licensed to practice actuarial science in dealings with the Internal Revenue Service by the
JointBoardforthe Enrollment of Actuaries,becominganEnrolledActuaryin1976.
—Fellow in the Conference of Consulting Actuaries
Mr.Tierney completed the necessary requirements to become a Fellow in the Conference of Consulting
Actuaries,being accepted in 1979.Candidates for Conference membership must have twelve years'
experience in responsible actuarial work,hold a position of substantial actuarial responsibility,and meet
educational requirements.
EMPLOYMENT HISTORY
After a six-year development program at Northwestern Mutual Life Insurance Company,in 1970 Mr.
Tierney joined a midwestern pension consulting firm,where he changed his focus to the field of pensions.
In 1975,Mr.Tierney joined Tillinghast,a specialty actuarial consulting firm headquartered in Atlanta,
Georgia.Tillinghast merged with Towers Perrin.a large,multi-faceted consulting firm,in 1986.In 1989,
Mr.Tierney formed Actuarial Concepts,a specialty actuarial consulting firm,located in Jacksonville,
Florida.
Mr.Tierney has worked continuously full-time in the actuarial field since 1964 and has over 30 years of
experience in actuarial work pertaining to insurance and pension plan analysis.
PROFESSIONAL ACTIVITIES
—Board Member of Conference of Consulting Actuaries
Mr.Tierney was elected to the Board of Directors of the Conference of Consulting Actuaries in 1995.Mr.
Tierney has served on the Executive Committee as Secretary,and previously served two years as Vice
President of Pensions for the CCA.
—National Committees
Mr.Tierney has served on several national committees for the actuarial organizations previously mentioned.
Among other assignments he has served as a member of the American Academy of Actuaries'Pension
PracticeCouncil,aswellastheCouncilonProfessionalism.
Mr.Tierney has also served three years as Chairman of the Society of Actuaries'Committee on Pension
Terminology.
—Panel Speaker
Mr.Tierney has participated as a speaker on numerous panels on pension issues before the Society of
Actuaries,the American Academy of Actuaries,the Conference of Consulting Actuaries and the Southeast
Actuaries Club.He has also participated on panel presentations for the Enrolled Actuaries annual meeting
Concepts
8
and served as guest speakerfor several conventions,including the Southern Gas Association andthe
American Institute of Steel Construction Workers.
—Articles Written
Mr.Tierney has written several published articles on pension issues,including articles forthe actuarial
magazine Enrolled Actuaries Report;andan article on employee benefit trends published in Resource,the
magazine of theLifeOfficeManagementAssociation (LOMA).
—Guest Lecturer
Mr.Tierneyservedasguestlectureras pan of theannualFloridaBarLaborRelationsForum,wherehis
presentation wastitled"Unisexing Benefit Payouts and Retirement System Regulations."Thelecture
outlinewas published bythe Florida Barin October 1985.
—Expert Witness
Mr.Tierneyhasservedasanexpertwitnessinseveralcourtproceedings.Hehastestifiedasanexpertin
pensionsystemsandactuarialissuesrelatedtothosesystems,includingactuarialmethodsforallocating
benefitsbeforeandafteradatecertain.Mr.TierneyservedastheStateofFlorida'sexpertwitness in
pensionsforthe 1985 reversediscriminationpensionlitigation,State of Floridavs.HughlanLong,which
was reviewed bythe Supreme Court.
GOVERNMENT CLIENT EXPERIENCE
Mr.Tierneyhasservedas consulting actuarytomanycitiesintheState of Florida(usuallyreferredtoas
"City Actuary")pertaining toissuesrelatedtotheir General,Policeand Firefighter pension plans,including
assistance withunion negotiations,and compliance withFL Statutes 175&185.Clients includeCity of
Sunrise,City of Miami.City of MiamiBeach,City of Hollywood,City of Oakland Park,City of Boca
Raton,andCity of Coral Gables.
Mr.Tierney has served asan advisor totheFlorida Independent Retirement Commission onissues relating
topublicdefinedpensionannuityplanconversionstosingle-sumaccountbalanceplansfor 200,000 public
school employees in Florida.
Mr.TierneyhassubstantialexperiencewithpublicplansinFloridahavingservedastheactuaryorco-
actuary of recordfortheFloridaRetirement System andtheplans of DadeCountySchoolSystem,St.Johns
RiverPowerPark,City of FortWaltonBeach,CityofGainesville,City of Jacksonville,City of LakeCity,
City of DeltonaandCity of St.Augustine.
EDUCATION
Mr.TierneyearnedaBachelorof Science degree,withamajorinmathematics,fromCarleton
Collegein1964.
Concepts
d.Municipal staffsupport.Generally minimal,otherthantosupplythe
necessary employee data and payroll records in usable electronic format.
Project Understanding
Thekeytopensionreformistodevelopthereformobjectivesfirst,takingintoaccount
thepredilectionsoftheCity Commission aswellasemploymentpolicypreferredby
management,alongwithadviceonemploymentfromtheCity'slaborattorneyand
legal restraintsasadvisedbytheCity'spensionattorney.Developmentof objectives are
basedon understanding ofthepossiblealternatives (e.g.,plan freezeandstartnewplan
versusplanmodification).Anexecutivesessiontodevelopthis understanding before
anyspecific studies are undertaken is highly recommended.
In general,any specificcostobjectivemaybe accomplished;the extent of reform isthe
only unknown.Many citiesset their cost reductions first and priorities on provision
adjustment.Then the studies needed maybe minimized.The studies are not the
objectiveofthe assignment;cost levels and cost control are.
References
Contact infoofan employee and pension board member or other non-government
related contact foreach entity.Wedonotknow any employees or pension board
members that could be used asreferences.Wedo,however,provide references by
representativesofotherFloridacitiesforwhomwehave completed similarassignments
in Section d.under Profile of Proposer.Also,your labor and pension attorneys,James
Crossland and James Linn,are offered as additional references.
Project Time Schedule
The project timeschedulefor specific services alongwiththeapproximatecostwillbe
providedatthetimeany specific service isrequested.Ingeneral,projectsetupand
valuationbaselinetake about 5weekstocompleteafterdataisreceived.Thetimeframe
forany specific study would be dependent uponthetypeof study requested.In
general,afterthebaselineisestablishedany specific studyshouldbecompletedwithin
2weeksoftherequest.Multiplestudiesrequestedatthesametimemaytakelonger.
Fee Proposal
a.WithregardtotheActuarialConsulting Services describedherein,the fixed
annualcost,payablemonthly.Weareunableto provide afixedcostuntilthe
services needed areexplicitlydefined.Seebillingrates below forthebasisofany
specific project quote.
Concepts
10
b.With respect to additional agreed upon services that may be best performed on
an hourly basis,the following hourly billing rates apply:
Strategic Consulting $290 per hour
Valuation Actuary $190 per hour
Compliance Specialist $105 per hour
Actuarial Analyst $95 per hour
Administration $50 per hour
c.Itemized Fee Proposal
a)Importing City Employee and Police data and payroll records.
Lump Sum Amount,$600.
b)Provide general adviceandcounselonthePlans and benefit structures on
possibleplanchangesandimprovements.See hourly rates.
c)Calculateand report thecostofchangesinbenefit structure forthe
purpose ofrunwaymodelsand projections.Dependson specific study
requested;generally ranges from $1,750 to $3,500 perstudyafter baseline
established.Totalfeesfor similar assignments for other Florida cities have
ranged from $15,000 to $30,000.
d)Meet,asnecessary,withthePensionAdHocCommitteeandCity Staff to
explain changes totheFundand actuarial assumptions.Based on certain
projectionsorchanges.Seehourlyrates.
e)Anticipated Expense Structure (i.e.,copyperpageamount,etc.).
Production expenses included inhourlyrates;travel expenses are actual
outofpocketexpenseswithnomarkup.
Concepts
HoldHarmlessandIndemnityClause
Actuarial Concepts
6/%U <2^Jm-l^i
Michael J.Tierney/
Contractor shall inderrrnify^clefend and hold harmless the City of South Miami,its
elected and appointed officials,employees and agents for any and all suits,actions,
legal or administrative proceedings,claims,damage,liabilities,interest,attorney's fees,
costs of any kind whether arising prior to the start of activities or following the
completion or acceptance andin any manner directly or indirectly caused,occasioned
or contributed toin whole orinpartby reason ofany act,erroror omission,fault or
negligence whether active or passive by the contract,or anyone acting under its
direction,control,or on its behalf in connection with or incident to its performance of
the contract.
Actuarial Concepts
Qhccc<3dA-//J^uiAjj
MichaelJ.Tierney
further certifies that it will meet all insurance requirements of the City of South Miami
and agrees toproduce valid,timely certificates of coverage.
11
Concepts
12
Declaration
The undersigned,as Proposer (herein used in the masculine singular,irrespective of
actual gender and number),declares under oath that no other person has any interest in
this proposal or in any resulting agreements to which this proposal pertains,that this
proposal is not made with connection or arrangement with any other persons and
without collusion or fraud.
The Proposer further declares that he has complied in every respect with all the
instructions to Proposer,that he has read all addenda,if any,issued prior to the
opening of Proposals,andthathehas satisfied himself fully relative to all matters and
conditions with respect to the general conditions of the agreement and all relevant
information towhichthisproposal pertains.
Actuarial Concepts
MichaelJ.Tierney
Concepts
DRUG FREE WORKPLACE
Actuarial Consulting Services
Whenevertwoormore Bids which are equal withrespectto price,quality andservicearereceivedbytheState
or by any political subdivisions forthe procurement of commodities or contractual services,a Bid received from a
business thatcertifiesthatithas implemented a drug-free workplace program shall be given preferenceinthe
award process.Established procedures for processing tie Bids will be followed if noneofthe tied vendors have a
drug-free workplace program.In orderto have a drug-free workplace program,a business shall:
1)Publish astatement notifying employees thatthe unlawful manufacture,distribution,dispensing,
possession,or use ofa controlled substance is prohibited in the workplace and specifying the actions that will be
taken against employeesforviolationsofsuchprohibition.
2)Inform employees about the dangers of drug abuse in the workplace,the business'policy of
maintaining a drug-free 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 ofthestatement specified in Subsection (I).
4)In the statement specified in Subsection (I),notify the employees,that,as a condition of working
ofthe commodities orcontractualservicesthatareunder Bid,heemployee will abidebythetermsofthe
statement and will notify the employee of any conviction of,or plea of guilty or nolo contendere to.any violation
of Chapter 893 orof any controlled substance law of the United States or any state,for a violation occurring in
the workplace nolaterthan five (5)daysaftersuch 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 certify that this firm complies fully with the above requirements.
1 GbtL //\04/VLbBIDDER'S Signature:
Print Name:MICHAEL J.TIERNEY
Date-OCTOBER 18,2010
South Miami Actuarial Consulting Services RFP 2010-16 20of23
ACKNOWLEDGEMENT OFCONFORMANCEWITHOSHASTANDARDS
Actuarial Consulting Services
TO THE CITY OF SOUTH MIAMI
We,A^-TIIARTAT,r.ONCFPTS •(Name of Contractor),hereby acknowledge and agree that as
Contractors for the Pension Plan Administration Services,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 of South Miami and
Non-Applicable,against any and all liability,claims,damages,losses and expenses they may incur due to the failure
of (subcontractor's names):
NOT APPLICABLE
to comply withsuchactor regulation.
CONTRACTOR
ACTUARIAL CONCEPTS
Witness
RY:MICHAEL J.TIERNEY
Name
PRESIDENT
Title
South Miami Actuarial Consulting Services RFP 2010-16 21 of 23
NQN-CQLLUSIQN AFFIDAVIT
STATE OF FLORIDA
)
COUNTY OF MIAMI-DADE
MICHAEL J.TIERNEY
Actuarial Consulting Services
beingfirstduly sworn,deposes andsaysthat:
(I)
(Owner,Partner,Officer,RepresentativeorAgent)of
ACTUARIAL CONCEPTS
He/She/They is/are the OWNF.T?-PRF.STnF.NT
the BIDDER that has submitted the attached Bid;
(2)He/She/They is/are fully informed respecting the preparation and contentsofthe attached Bid and of all
pertinentcircumstancesrespectingsuch Bid;
(3)Such Bid isgenuineandisnota collusive orsham Bid;
(4)Neither the said BIDDER nor any of its officers,partners,owners,agents,representatives,employees or
parties in interest,including this affiant,have in any way colluded,conspired,connived or agreed,directly or
indirectly,with any other BIDDER,firm,or person to submit a collusive or sham Bid in connection with the Work
for which theattached Bid hasbeensubmitted;ortorefrainfrom Bidding in connection withsuchWork;orhave
in any manner,directly or indirectly,sought by agreement or collusion,or communication,or conference with any
BIDDER,firm,or person to fix any overhead,profit,or cost elements of the Bid orof any other BIDDER,orto fix
any overhead,profit,orcost elements of the Bid Price or the Bid Price of any other BIDDER,orto secure
through any collusion,conspiracy,connivance,or unlawful agreement any advantage against (Recipient),or any
personinterestedintheproposedWork;
(5)The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion,
conspiracy,connivance,or unlawful agreement on the part of the BIDDER or any other of its agents,
representatives,owners,employees or parties of interest,including this affiant.
Signed,sealed and delivered in the presence of:
tnes
Witness
South Miami Actuarial Consulting Services
By:^AMjOjaJ^^
Signature
MICHAEL J.TIERNEY,OWNER-PRESIDENT
Print Name and Title
OCTOBER 18,2010
Date
RFP 2010-15 of 23
ACKNOWLEDGEMENT
STATE OF FLORIDA )
COUNTY OF-MIAMI DAP&^/^^C kHJ
On this the /&day of OO^f&S&Z-.,2007:before me,the undersigned Notary Public of the State of
Florida,personally appeared(Name(s)of individual(s)whoappearedbefore
notary)^V(g^^^rr^l^L^z>/and whose name(s)is/are Subscribed^totht
within instrument,and he/she/theyle/they acknowle<ledgethat he/she/they executed it.
WITNESSmyhandandofficialseal.G^^^
ic.State of Fl
NOTARY PUBLIC:
SEAL OF OFFICE:
4#¥%.JOSE A$ARRgR»ry p,bj
:JLJh_S MY COMMISSION #DD933432
^vfSlffi EXPIRES October 15,2013
(407)398-0153 FloridaNolarySGfvice.com
rf.^a^^e^>e^
(NameofNotary Public:Print,Stamportypeas
commissioned.)
Personally known tome.or
Personal identification:
Typeof Identification Produced
Did take an oath,or
Did Not take an oath.
South Miami Actuarial Consulting Services RFP20I0-I6 6 of 23
PUBLIC ENTITY CRIMES AND CONFLICTS OF INTEREST
Actuarial Consulting Services
Pursuant tothe provisions of Paragraph (2)(a)of Section 287.133,Florida StateStatutes-"Apersonor affiliate
whohasbeen placed onthe convicted vendorlist following a conviction fora public entitycrime may not submit a
Bid onaContracttoprovideanygoodsor services toa public entity,may notsubmita Bid onaContractwitha
public entity forthe construction of repair ofa public building or public work,may not submit bids on leases or
real propertytoa public entity,may notbe awarded to perform WorkasaContractor,supplier,Subcontractor,
orConsultantundera Contract withany public entity,and may nottransactbusinesswithany public entityin
excessofthethresholdamountCategoryTwoof Section 287.017,Florida Statutes,forthirtysix(36)months
fromthedateofbeingplacedontheconvictedvendorlist".
Theawardofanycontracthereunderissubjecttothe provisions ofChapter 112,Florida StateStatutes.
BIDDERS mustdisclosewiththeir Bids,thenameofany officer,director,partner,associateoragentwhoisalso
anofficer or employeeofSouth Miami or itsagencies.
SWORN STATEMENT PURSUANT TO SECTION 287.133 (3)(a),
FLORIDA STATUTES.ON PUBLIC ENTITY CRIMES
THISFORMMUSTBESIGNED AND SWORN TO INTHE PRESENCE OFA NOTARY PUBLICOROTHER
OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
I.This sworn statement is submitted to
CITYOF SOUTH MIAMI
for
[printnameofthepublicentity]
by
MICHAEL J.TIERNEY,PRESIDENT
[print individual's nameandtide]
ACTUARIAL CONCEPTS
[printnameofentity submitting sworn statement]
......2950HALCYON LANE,SUITE402whosebusinessaddressis!-—
JACKSONVILLE FL 32223
and (if applicable)its Federal Employer Identification Number (FEIN)is 59-2921222 (If the
entity has no FEIN,include the Social Security Number ofthe individual signing this sworn statement:
•)
2.I understand thata "public entity crime"as defined in Paragraph 287.133 (l)(g).Florida Statutes,
means a violation of any stateor federal law by a person with respect to and directly related tothe transaction of
business with any public entity or with an agency or political subdivision of any otherstateorofthe United States,
including,butnot limited to,any bid or contract for goods or services tobe provided to any public entity oran
agency or political subdivision of any other state orofthe United States and involving antitrust,fraud,theft,
bribery,collusion,racketeering,conspiracy,or material misrepresentation.
3.I understand that "convicted"or "conviction"as defined inParagraph 287.133(1 )(b),FloridaStatutes.
means a finding of guilt ora conviction ofa public entity crime,with or without an adjudication of guilt,in any
South Miami Actuarial Consulting Services RFP 2010-16 17 of23
federal or state trial court of record relating to charges brought by indictment or information after July I,1989,as
a result ofa jury verdict,non-jury trial,or entry ofa plea of guilty or nolo contendere.
4.I understandthatan "affiliate"asdefinedin Paragraph 287.133(1 )(a).FloridaStatutes,means:
(a)A predecessor or successor ofa person convicted ofa 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 ofa public entity crime.Theterm "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,ora 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 ofa public entity crime in Florida during the preceding 36
months shallbe considered an affiliate.
5.I understand thata"person"as defined in Paragraph 287.133 (l)(e),Florida Statutes,means any
natural person or entity organized under the laws of any state orofthe 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
whoareactivein management ofan entity.
6.Based on information and belief,the statement which I have marked below istrue in relation tothe
entity submitting this sworn statement.[Indicate which statement applies.]
X 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 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 ofthe entity,or an affiliate of the
entity has been charged with and convicted ofa 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 ofa public entity crime subsequent of July I.1989.However,there
has been a subsequent proceeding before a Hearing Officer ofthe State of Florida,Division of Administrative
Hearings and the Final Order entered by the Hearing Officer determined thatit 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 THATTHE 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
THATTHISFORM IS VALID THROUGH DECEMBER 31 OFTHECALENDARYEAR IN WHICH IT IS FILED.I
ALSO UNDERSTANDTHAT I AM REQUIRED TO INFORM THE PUBLIC ENTITYPRIORTO ENTERING
INTO A CONTRACT IN EXCESSOFTHETHRESHOLD AMOUNT PROVIDED IN SECTION 287.017,
FLORIDASTATUTES.FOR CATEGORY TWO OFANY CHANGE INTHE INFORMATION CONTAINED IN
THIS FORM.
UiLLa*!.It*
[Signature]
South Miami Actuarial Consulting Services RFP 2010-16 18 of23
Sworn to and subscribed beforeme this /7.
Personally known cS^-
OR Produced identification
(Typeof identification)
Form PUR 7068 (Rev.06/1 1/92)
South Miami Actuarial Consulting Services
dayof £&rf%>£>2-,201k
^
Notary Public-State of ^U^K^g-
My commission expires
(Printed,typedorstampedcommissioned
nameof notary public)
#Y%JOSE A BARRERA
!*(jnji MY COMMISSION #DD933432
VSfW exP!RHS October 15,2013
(407)398-0153 FlorldaNolaryScrvice.com
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