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CITYWORKS CONSTRUCTION LLC5.2. FINAL PAYMENT. upon Final Completion ind acceptance of the Work in accordance with paragraph 14.07.8.1 of the General Conditions, OM NER shall pay the remainder of the Contract Price as recommended -by CONSULTANT as provided i Article 14 of the general Conditions. Article 6. INTEREST. Not Applicable Article 7. CONTRACTOR'S REPRESENTATION . 7,1. In order to induce OWNER to e ter into the Contract, CONTRACTOR makes -the following representations: CONTRACTOR has thoroughly and to its full atisfaction familiarized himself with the nature and extent of the Contract Documents, Work, locality, an with all local conditions and federal, state and local laws, ordinances, rules and regulations that in a y manner may affect oast, progress or performance of the Work.. CONTRACTOR has; (a) examined th Contract Documents, Project Specifications and Drawings thoroughly to its full satisfaction and has un ertaken the responsibility to determine, within the scope of CONTRACTOR's competence as a licensed G neral Contractor, that the Project Specifications and Drawings are fit and proper for the performance of t e Work and to the best of CONTRACTOR's knowledge are: (i) free from material errors, omissions, and/ r inconsistencies; and (ii) are in compliance with applicable laws, statutes, building codes, ordinances, r les and regulations; recognizing however, that CONTRACTOR is not responsible for the design of the roject; (b) visited the site to familiarize himself with local conditions that may in any manner affect c st, progress or performance of the Work; (c) examined the Project Site to its full satisfaction, including any existing work or improvements in place, and has determined that the same are fit and pr per to receive the Work in their present condition and CONTRACTOR waives all claims that same ar not in accordance with all data and information with respect to the Project as specified in the Drawings nd Project Specifications and /or as provided by OWNER and CONSULTANT; (d) familiarized himself with federal, state and _local laws, ordinances, rules, policies, and regulations that may in any manner affect cost; progress or performance of the Work; (e) studied and carefully correlated CONTRACTOR's observa ions with the Contract Documents; and (f) at CONTRACTOR's own expense, made or obtained any add tional examinations, investigations, explorations, tests and studies and obtained any additional info mation and data which pertain to the physical conditions (surface, sub - surface and underground facil ies) at or contiguous to the Project or otherwise which may affect cost, progress, performance or furnis ing of the Work and which CONTRACTOR deems necessary to determine its Contract Price for performing nd furnishing the Work in accordance with the time, price and other terms and conditions of the Contract ocuments. 7.2, !CONTRACTOR has studied carefully all repo s of investigations and tests of subsurface and latent physical conditions at the site or otherwise affecting cost, progress or performance of the Work which were relied capon by CONSULTANT in the preparation of he Drawings and Specifications. 7¢. CONTRACTOR has made or caused to be m de examinations, investigations and tests and studies of such reports and related data in addition to thus referred to in paragraph 7.2 as he deems necessary for the performance of the Work at the Contract Pr ce, within the Contract Time and in accordance with the other terms and conditions of the Contract Docu eats; and no additional examinations, investigations, tests, reports or similar data are or will be require by CONTRACTOR for such purposes. 7.4. CONTRACTOR has correlated and consid red the results- of all such observations, examinations; investigations; tests, reports and data with the terms and conditions of the Contract Documents and in reaching the Contract Price and Contract Tirr e, 14 m2» No assignment by a party hereto of any right under or interests in the Contract Documents will be binding on another party hereto without the written consent of the party sought to be bound; and specifically but without limitation, moneys that may becom due and moneys that are due may not be assigned without such consent (except to the extent that the effect of this restriction may be limited by law), and unless specifically stated to the contrary in any wri ten consent to an assignment, no assignment will release or discharge the assignor from any duty or resp nsiblity under the Contract Documents: 9.3. OWNER and CONTRACTOR each binds hims If, his partners, successors, assigns and legal representatives to the ether party hereto, his partners, <su cessrars, assigns and legal representatives in respect to all covenants, agreements and obligations coat fined in the Contract Documents: ' n , This Contract may be executed in counterpa s: ,5 The OWNER shall retain the ownership of al shop drawings and design drawings once payment therefore is made. .6 OWNER and CONTRACTOR hereby knowingly, irrevocably, voluntarily and intentionally waive any right either may have to a trial by jury in respect to any action or proceeding based upon the contract documents or arising out of, under, or in con iection with the work or the project._ .7 The law of the State of Florida shall gove n the contract between the City of South Miami and the successful bidder and any action shall be br ught in Miami -Dade County, Florida. In the event of litigation to settle issues arising hereunder, the prevai ing party in such litigation shall be entitled to recover against the other party its costs and expenses, inclu ing reasonable attorney fees, which shall include any fees and costs attributable to appellate proceedings "a ising on and of such litigation, .R INDEMNIFICATION. The parties agree that % of the total compensation paid to the Contractor for the performance of this agreement shall r present the specific consideration for the Contractor's indemnification of the City as set forth in this Section and in the Terms and Conditions,. To the fullest extent permitted by Laws and egulations, Contractor shall indemnify and hold harmless the City and their consultants, agents and employees from and against all claims, damages, losses and expenses, direct, indirect or consequential li eluding but not limited to fees and charges of attorneys and rather professionals and court costs) arising ut of or resulting from the performance of the work, provided that any such claim, damage; loss or expens (a) is attributable to bodily injury, sickness, disease or death, or to injury to or destruction of tangible p operty (other than the work itself) including the loss of use resulting there from and (b) is caused in h le or in part by any willful and wanton or negligent or gross negligent acts or omission of Contract r, any subcontractor, any person or organization directly or indirectly employed y any of them to perfo m or furnish any of the work or anyone for whose acts any of them may be liable, regardless of whether r not it is caused in part by a party indemnified hereunder or arises by or is imposed by Law and Regi lations regardless of the negligence of any such party. In any and all claims against the City or any f their consultants, agents or employees by any employee of Contractor, any Subcontractor, any person or organization directly or indirectly employed by any of them to perform or furnish any of the work o anyone for whose acts any of them may be liable, the indemnification obligation under the above aragraph shall not be limited in any way by any limitation on the amount or type: of damages, compens tion or benefits payable by or for Contractor or any such Subcontractor' or other person or org nization under workers or workman's compensation acts, disability benefit acts or other employee ben 2fit acts. 16 [END 0 SECTION] 18 GTION 4 BIDDER'S EPRESENTATION SCHEDULE OF BID ITEMS AND THE DETA LED SPECIFICATIONS, THE DETAILED P.F IFICATI NS WILL PREVAIL. The Bidder further proposes and agrees to cc m ply -in all respects with the time limits for commencement and completion of the Work as stated in Agreement. The Bidder agrees to execute the Agreement and furnish the executed ,Agreement, all required bonds, insurance certificates, and other requ red information to City within ten (10) ten calendar days after written notice of the Award of con Tact; Failure on the part of the Bidder to timely comply with this provision shall give City all ri hts and remedies set forth in the Instructions to Bidders The undersigned agrees to accept as full com ensation therefore the total of the lump sum prices and extended unit prices items named in the following schedule. It is understood that the unit prices quoted or established for a parts lar item are to be used for computing the amount to be paid to the Contractor, based on the W rk actually performed as determined by the Agreement and the City. However, in utilizin the schedule, the Bidder agrees that in no event shall compensation paid to the Bidder under he Agreement exceed the dollar amount of the Bidder's Bid amount, as set forth in the attar ed Bid. It is intended that all Work to be performed under this Bid shall commence approximately thirty (3) days after Agreement execution. In no event shall City be obligated to pay for Vork not performed or materials not furnished. Bidder's Certificate of Competency No.—,— Bidder's Occupational License No. WITNESS: Y: Signat e uthorized Agent (SEAL] 20 ID FORM . DATE.(PAM)DDJYYYYj m— . — OzIO��zo PRODUCER (854) 966 -9993 THIS CERTIFICATE IS ISSUED AS A 'MATTER OF INFORMATION ONLY ANU CONFERS- NO RIGHTS UPON THE CERTIFICATE Gulfstream- Insurance Agency, Inc. HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 5833 Johnson Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hod 1 cod FI 33 3 I- INSURERS AFFORDING COVERAGE _.._ IN AIC _ INSURELS. _ INSURER: A, Mid— Continent Casualty _ Citlrworks Construction, LLC- INsURERB.Comner e & Indust 20356 N,E� 16th Place INSURERC: Miami FL 33179- INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INISURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVVITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOGU ENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISS4I17,D OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS S BJECT TO ALL THE TERMS EXCLUSIONS AND i ONDTTIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID 'CLAIMS. 'INSR L R ADLYL INSRO 7YFt OF INSURANCE: POLICY NUMBER POLICY EFFECTIVE DATE yMM?DD1YYj POLICY EXPIRATION RATE M1xuDD LIMITS A X GENERALLIABILITY 09—GL- 000867135 01/15/2013 01/15/2014 EACH OCCURRENCE ;. 11000,000 X COMMERCIAL GENERAL L"fLITY 6AI4AUETO8FNTEU < 10O,.flOO PREMISES Ea o.c ,rerca) 3 CLAIMS MADE I 't I OCCUR I % / !` / MED TXP (Aly c:ae p2ts®n) 5 PERSONAL & ACV INJURY % ... / GENERAL AGGREGATE ... , 2,000,000 GENT AGGREGATE LLvbT APPLIES PER: PRQOUgjS,.COMPYOPAGG S 2,000,000 X POLICY .JET ,,.,...}. LOC AUTOMOBILE LiABILtIrY / J? tF .� � COMBINED SINGLE LIMIT S t (Ea acrcide'ii) ANY AUTO ALL ..OWNED AUTOS $ (Per IA,A sort) SG 1P�ttLtrl AUTOS ...,.�,.,.._. HIRED AUTOS BODILY INJURY S (pa" acGden4r. NON- OV"E?AUTOS / f f PROPERTY DAMAGE ;. (Per accident) BAR GEUABILITY AUTO ONLY EA1WCDENI T __.. ANY AUTO ' OTHER T:iR ^1. :_..� AUTO ONLY .AGO EXCESSIJMBRELLALIABL17Y � � / EACH OCCURRENCE '$ ... OCCUR CiAIMSMADE q I AGGR�GAT $ DEDUCTIBLE. RETENTION :$ . a WORKERS COMPENSATION AND WC009 -87- 0866:. 45, 27 2032 I O5: 27/2013 X yy TT�I,,.��. I 7CR MITE OLT EMPLOYERS' LIABILITY 1=.L EACH ACCIDENT $ 1,000,000 ANY FROPRILTOWPARTNERIEXECUTIVE CFRCERWEMBEREXCLUDED", f..... !r El DISEASE - PAEMPLOYEE.S 1,000.:r.000 _...�. if y9s, describe under SPECIAL PROVISIONS, below E.L, DISEASE - POLICY LIMIT $ :1 , 000 G O0 OTHER DESCRIPTION OF t PF RATIONS ILOCAT$ONSNEflIGLESIEXCLUS(ONS ADDEO RY ENDORSE[ ENTISPECIAL PROVISIONS. CERTIFICATE MOLDER CANCELLATION — — SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, . THE ISSUING INSURER. WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE: TO THE OFRTIPICATE.IIOLDER NAMED 70 THE LEFT, BUT PROOF OF INSURANCE CE FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION. OR LIABILITY Or ANY KIND UPON: THE INSURER,: ITS AGENTS OR R". RESENTA "IVES AUTHORIZED REPRESENTATIVE I f AC ORE 25 (2001108) fl ACORD CORPORATION 1088 IF 502 t 1 ea> Page 1 of 2 AIADocument ; 01,',,,,VFT0RNEY KNOW ALL AI N BYTH ESE PR'a ";°s ,NIA, That %CAPnTL do IERI ITYI IMPh RNFION. <a s,Clataraati,axi aa� �[.c r Ic c,: �•'iMCa,n.:irs, �t ct`v, ats } rincipa@ nfficcs in the ('it,, of Nfdkii=. hN!W(M,,it'a- (10CS 111,Rke CM-AWR,,,vsJ appoint' -- ---- `--_— -------- _ — ° - ----------- ---- -- WARRF ALTER: DAVID be utle atsd�ttaas"fcif . trs;iTn }'fsi -i ? "ac:d, 10 a,aa.ike Cx oute. u_tal and t cl ver ror and lwhka$f, as ,tare�:y�, and as A act mW dm! m A al d. irkrmk, t?7nfCiLak4gs, and cantr;aets arf �,urctes,hip. prcavido'9 trot no bond or in tlnttak.ing or cotimult of Su x,:ship ,t.kk�utcd undcr (Ins aufl n-it^k= dull a'°uacci in, W110LIAL the SLUT, of --------------------------- — -- — ----- ALL WRITTEN INSTRUMENTSITN AN AN40UNT NOT TO EXCEED: 20,000,000.00 - - -- --- - - - - -- --- ---- -- --- -- -- -- I'liis lauwa, €`orAttna.trr: is Waa;atecl un d 5 raped and scaled by kc r, i , iteder also l by th,� a€ lhor ity ofibe, rulirru ha^ Rc, cUuiiata ackww� c lJo- forme of'Diacctnrs of CAPIT01, Ida lase MITI' CORP TI,k110N ,t o noel n., l..!y call2d azntl hold on the 15di day (if vttak,, 2N2, "RESOLVED. dial Me PresidmW Peec=ki a Vke Presitia,atf, VVe Pre s dm at. IScemutry or I w a rk s as t„ 9 hdisaacSmHy csr ath.,a, r .e, It atacl then sta;r�Q% are r°rcatted he Po%V(rL anti asrrihcritatscaii t".r ,al;;a Q,t h a Power- of At: rrat.a year Te puspoves ortls of exoculing sud ziu sLirtd bonds and uradeank aaag,s. and aaffaer attidIp ubli Tatar, itl bin n aturc tlaereoC mw uc`tazt p €n icl,, °at a i -Lt.��aav ar[ , aa�,asPaila acrz tts3ak s at d atCrraraey r) tarAkr. a nch alsl ai,riun to h"e I; laowun`s and dunks La;ilas} taa a,trt # offices 8o tfac 1 aasita s caf s mrinaaiy, Nks ;��a,t ac ta# udi aaffice , and scaef lffv, -b nctrh'p aii a ray lie <afraxcd Ca>'anys such: post or of altos nqy or to any certrt3cke rchdri , We 7 k f,c:,iari`Ic. yd " ,ti ch Iro"Tr rr1 "r;a;Eunney or cerAnytz %b A;ng . nA I S,a7AI ts.rf_atattattts or fre:rinarle seal shall be inhd and hkdin.g "on Eire CoinIsmy, hd my su h power ,c executed and Ica .r.a d lax ti:ekhrvilk "raiifmn aaml af. hulle sul shall Its valid and iaita2lhig utsun the Cun,pany in Me i aWee with reyvet io any I'saaraei or undk ritalchg tai- oler w3rrhd'a9l3ir;lctrry is the nmure ders tsf to which A is raeianhed Any suds upp7a. }aaatrrurt ni" her rc.olx , tc.r e ause. trt- tyiahom cause, hy any op'-:Ad dllawn& at any tar c:' IN 'WITNESS t1'FIE;k EOF, the CAPIT(H. INDEMNI "I V CORPO ATIhyN tau cnzmdMesn prk., nB on be Qno d by 0 eel #"seer unde siyned and U coo- imratc S aI ua kn (rcreVn aaI`ftk. d aixaGya awacd, llo~ "tad date csf e4l r 2011. tsBC,t. CAPITOLI�dl)I +r'k�I'I'Y 4IkIIIIIIt: I'IIIy 1Ir I m �•" r ar Rkha hAA AHm HI _'resitic°ni n, 0 2.. David F. P'tudy M„ IS tidcfai,3 flEreatraans TO 4 President EFF, OF O i',I'0NSIN COUNTY 01' DANE j y Fi:r l` e4„ (1ta to 2nd day oaf Vlay, 2011 f:cIm mcz pa is ou ire ca me t "Id f . Pr €rI rn me € Yt.l,hm who Sing by rue du Q s woni did tdcrm so orarl stag, thiit lie resides in the Co apt" Dan - State af''WiscollSiIn that h0 r. 1 "ac°;1.3,,a.k tWC A PITOL I%kDLM N ITY COR11011 AT ION' Bite C iirpo ration des, .ribol 6aercin lied aaii'sa It onumed IV til,na°e itashun ritt t m he Inri*,ts Mc war A Me w d caartatas'- afas'q itixa. Me WA ta!1,jxe I'to said im traaa en1, 1s ,ri h cgrl omit sca,` iita. it vvjs su ttf ud by ordu of * v lf;tattl s'a9 Ldirct,Iait< ant oera'Pc4a• =Lassa a anti that lace sl#ofbk nme trr.a-cstaa by HE „rdgq „oar l�rra&" I�rta,gur i,4T rtYh WISCONSIN Nolur Ptn:llis. Dane ('ta.. `ri'I P;{I!.°kw'9i ? E2AN , tkrfll`it::16h' lv onatrr: Isar =, 1s P.;rnaanent I, be tts cbmi necl, duty Acted to 'Ira 4_Rke dated FFotrm rutty hev jultiatloent iit C,hPFIFIIL I'eI)I +MNIT9' COIII$I RiVITON a `,t`tsr:arnin t Cron +r;aBsarra; oaathorieed to niuke this certnictatc, CtI) HEREBY C'EII`I MY Am the feafi «;iaau ntlachct} Power of,"kit:ans..o' tcnnaLins, in fult f'orc:c`iatrcd has ncsi: been mvo kM: and ttirii,es'atict o tdtEtt?41ae Rest lutiarn aaFdw Ilesurd r f I")dccu-icts, "firth in the Power of 'Nstorttey is nuo, in I'mcc.'. SiY;md zt d seat d ai 10 CO Cif "k'Bialziic r, U, fEZ e tsf 5,",`ik,+,°cita n= fln, 17th day c,E May 7 013 REAL M.�.�,, smmm y r �+ Tfdln L3CC'UMl,,,NT I;� "k,C'i"I '`/Lo la UNLESS l "r°,E, I ED f YI"I tsl�` -1� -c` `iIr"kF)ED 3" aACKC;C?�11i`'iS? "Ia�II'fifxs Sft�I'I SIi Rfs`� ^ata"�'IL%LR EN, 11.1;: �1!FI'd,.R PIIIII'I" @frt \F} t °C l ikf3l;. II' 't``OU HAVE .rf`w:h'tdf;If,f,TPII ,S f' «D r ",aP �fNl.i THE Al 111x, s':110 IN M VHS S')C1I'I MENT CAV `sM "6. " =' d l: n. CTI N 12 SUPPLE ENTTO BID TENDER FOR THIS FORM MUST BE SUBMITTED W TH BID FOR BID TO BE DEEMED RESPONSIVE QUALIFIC TION STATEMENT 8. How many years has your organization been i i business? 9. What similar zagements is your coo any recently working on? 10. Have you ever failed to complete any work awarded to you? if so, where and why? 11. Give names, addresses and telephone numb rs of three individuals, corporations, agencies, or institutions or which you have performed si t � ilar work both in scope and cost: m 1 gt a escib (name) (ad 'tom N — Tess hone #) 11.2. � (na } (ad bani ress) (ph e # 1.. k - - Ij (name) (ad a (phone #) 12. List the fallowing information concerning all contracts in progress as of the date of submission of this bid. (In case of co- venture, list the information 'f r all co- ventures.) PERCENT OF NAME OF TOTAL CONTRACT CONTRACTED DATE OF OWNER COMPLETION TO PROJECT VALUE COMPLETION GATE tir " .6 Gin ?BAS OLOiD QCA,-45Q nCI34 26 15 9q I R C.- i (Continue list on Insert sheet, if necessary. 33 1. Has the Bidder or his or her representative inspected the proposed project and does the Bidder have a complete plan for its performance? 14. Will you subcontract any art of this work? If so include a list of subcontractors and task performed by each subcontractor, `�" The foregoing list of subcontractor(s) may not be amended after award of the contract without the prior written approval of the Contract ,Administrator, whose apps val shall not be unreasonably withheld, 15, What equipment do you own that is availabl for the wore t 1. What equipment will you purchase for the proposed work 17. What equipment will you rent for the propos d work? 18, State the name of your proposed project manager and give details of his or her qualifications and experience in managing similar work, 19. State the true, exact, correct and complete name of the partnership, corporation or trade name under which you do business and the address of th place of business, (If a corporation, state the name of the president and secretary, If a partnership, nam s of the individuals who do business un ate the names of all partners. if a trade ame, state the er he trade name.) Q1 L f 7 34 Ire € bilia is Constructora Armont S.A Controller Lima, Peru March 2003 — December 2005 Seminaries Sencico: Training and Investigation in Construction Industr Project Schedule "S Project Planner" Dec 2003 Seminarium Lima -Pero "Cost Evaluation: Modem Tools ° July 1997 School of usiness;ESA "Financial Management" Oct. - Dec. 1999 "Accounting Management" July —Sep. 1959 19.7. List all claims, arbitrations, adminis rative hearings and lawsuits brought by or against the Bidder or its predecessor organization(s) during the last five (5) years. The list shall include all case names; case, arbitration or hearing identification numbers; the name of the project over which the dispute arose; and a description of the subject matter of the dispute. NAME RELATIONSHIP Sign ture oaf ei - uImitting supplement forma STATE OF FLORIDA j )SS. COUNTY OF MIAMI-DADS ) The foregoing i strurnent was acknowledge before me this 4V,, _LZ day of 2013, by t who is pees nail known to mef or who has produced as identi icatio and who did /did not take an oath. WITNESS my hand and official seal, this day of � �� 201:3. s � i€ !� 4fla [NOTARY 5 t9re �, sw���17s �`'c r" del a Sri 4 D 94369 xS iiF (Signature' person taking ackn wledgment) [END OF SECTION] 36 S CTIN 11 SWORN STATE EN ON PUBLIC ENTITY CRIMES SECTION 287.133 3 a FLORIDA STATUTES' THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL 30 omrission expires /r imped-ComiVissioned Nauss otary Pubic) .ff [c (t_' f 4Yh ipp8 i.bi � � ^3tri {� 3.d�4�4�i £ s} Doc 943696 OF SECTION] 31 ANTI-{ III ardor gift, directly or indirectly y me or any member of my By: 5 Title: Kczs' Ab>.. , 44 042696 � n 1, W SECTION) 27 SUCTION 10 NON- t?E USIVE AFFIDAVIT State of Tloi& } SS: County of being first duly sworn, deposes and says that: a) he is the RAU _ (Owner, Partner„ Officer, Representative or Agent) the Bidder that has submitted the attached Proposal; b) He/shJ is fully informed respecting the prep ration and contents of the attached Proposal and of all pertinent circumstances respecting such Proposal; c) Such Proposal is genuine and is not collusive r a sham Proposal; d) Neither the said Bidder nor any of its officer , partners, owners, agents, representatives, employees or parties in interest, including this aff ant, have in an way colluded, conspired, connived or agreed, directly or indirectly, with any other Bidder, firer, or person to ubmit a collusive or sham Proposal in connection with the Work for which the attached Proposal has been su mitted; or to refrain from proposing in connection with such work; or have in any manner, directly or ind rectly, sought by person to fix the price or prices in the attached Proposal or of any other Bidder, or to fix a y overhead, profit, or cast elements of the Proposal price or the Proposal price of any other Bidder, or to ecure through any collusion, conspiracy, connivance, or unlawful agreement any advantage against (Recipe ),or any person interested in the proposed work; e) The price or prices quoted in the attached Proposal 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 in int rest; including this affiant Signed, seal d livered in the pres r r f By: Witness AD Witne (P, °rated Nafne State of (Title) ) County of i BEFORE ME, the undersigned authority, perso ally appeared _ l to me well known and known by me to be the person d scribed herein and who executed the foregoing Affidavit and acknowledged to and before me that executed said Affidavit for the purpose therein expressed; E WITNESS, my hand and official seal this day f 2013: lUty missioeEre t � t �f ��_�. "t T" L Notary Public Stat f F orida t Large y5 f {f if �Z i1 f r�n1 � y [ �a: m, C�,pbc:s 00w t r =. [END O ECTION] �u % � , ,�.n russ oss � 1� s 369 ;• S CTION 15 DRUG-FRE WORKPLACE FOR T e ndersign d v ndor ac;co dance � 5ectoon sr.vo/, rsonua .3taLnerUuy `Xro+sies Uldt does. (Jame of Business} 1� Publish a statement notifying employees that t e 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 prohibi ion: 2) Inform employees about the dangers of drug a use in the workplace, the business's policy of maintaining a drug -free workplace, any available drug coups Iling, rehabilitation; and employee assistance programs, and the penalties that may be imposed upon emplo ees for drug abuse violations. 3) Give each employee engaged in providing the mmodities -or contractual services that are under bid a copy of the statement specified in subsection (1). l In the statement specified in subsection (1), rotify 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 are conviction of, or plea of guilty or nolo contendere tot any violation of chapter $93 or of any controlled SL bstance 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 satisfact ry participation in a drug abuse assistance or rehabilitation program if such is available in the employee's c mmunity, by any employee who is so convicted. 6) Make a good faith effort to continue to rnai tain a drug -free workplace through implementation of this section. As the person authorized to ig tate ent, I ce �a. ify that this firm complies fully with the above requirements. Proposers Sigma re _ Gate [END OF SECTION] 4 S CTION 1. RELATED PARTY TRANSACTION VERIFICATION FOR individually and on behalf of irm") ("Firm") have read the City of South Miami ( "City ")'s Code of Ethics, Section 8A-1 of the City's Code of ordinances and I hereby certify, under penalty of perjury that to the est of my knowledge, information and belief: (1) neither I nor the Firm have any conflict of interes (as defined in section 8 -1) with regard to the contract or business that 1 and/or the Firm, am(are) about to p rform for, or to transact with, the City, and (2) neither I nor any employees, officers, directors 'o the Firm, nor anyone who has a financial interest greater than 5% in the firm, has any'relative(s), as defined i section 8A -1, who is an employee of the City or who is(are) an appointed or elected official of the City; or who i (are) a member of any public body created by the City Commission, i.e., a board or committee of the City, nd (3) neither I nor the Firm, nor anyone who has a fin neial interest greater than 5% in the Firm; nor any member of those persons' immediate family (i.e., spouse, pare ts, children, brothers and sisters) has transacted or entered into any contract(s) with the City or has a financial i terest, direct or indirect, in any business; being transacted with the city, or with any person or agency acting fo the city, other than as follows: use a separate sheet to supply, additional information that will not fit on this line but make reference to the additi nal sheet which must be signed under oath). (4) no elected and /or appointed official or employe of the City of Miami, or any of their immediate family members (i.e. , spouse, parents, children, brothers a id sisters) has a financially interest, directly or indirectly, in the contract between you and /or your Firm and the City other than the following individuals whose interest is set forth fallowing their names: use a separate sheet to supply additional information that will not fit on this line but make reference to the additi nal sheet which must be signed under oath). The names of all City employees and that of all elected and /tor appoi ted city officials or board members, who own, directly or indirectly, an interest of five percent (5%) or more f the total assets of capital stock in the firm are as follows: (use a separate heet'to supply additional information that will not fit on this line but make reference to the additional sheet whi h must be signed under oath). (5) 1 and the Firm further agree not to use or attem t to use any knowledge, property or resource which may come to us through our position of trust, or throng our performance of our duties under the terms of the contract with the City, to secure a special privilege, enefit, or exemption for ourselves, or others. We agree that we may not disclose or use information, not availa le to members of the general public, for our personal gain or benefit or for the personal gain or enefit of any other person or business entity, outside of the normal gain or benefit anticipated through the perf rmance of the contract. (5) 1 and the Firm hereby acknowledge that we hav not contracted or transacted any business with the City or any person or agency acting for the City, and that e have not appeared in representation of any third party before any board, commission or agency of the Cit within the past two years other than as follows: (use a s partite 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 l nor any 43 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 rnarri ge to: (i) any member of the City Commission; (ii) any city employee; or (iii) any member of any board or agenc of the City other than as follows: (use a separates eet to supply additional information that will not fit on this dine but make reference to the additional sheet whit must be signed under oath), (7) No Other Firm, nor any officers or directors of th t Other Firm or anyone who has a financial interest greater than 5% in that Other Firm, 'nor any ember of those persons' immediate family (i.e., spouse, parents, children, brothers and sisters) nor any of rn immediate family members (hereinafter referred to as "`Related Parties"") has responded to solicitation by he City in which I or the Firm that I represent or anyone who has a financial interest greater than % in the Firm, or any member of those persons' immediate fancily (i.e. spouse, parents, children, brothers and sisters) have also responded, other than the fallowing: (use a separa e sheet to supply additional information that will not fit on this line but make reference to the additional sheet hick must be signed under oath):- (8) I and the Firm agree that we are obligated to sup lenient this Verification Form and inform the City of any change in circumstances that would change our ans ers to this document. Specifically, after the opening of any responses to a solicitation, I and the Firm have an ob igation 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, ( ) A violation of the City's Ethics Coate, the giving of any false information or the failure to supplement this Verification Form, may ;subject me or the Firm to im ediate termination of any agreement with the City, and the imposition of the maximum fine and/or any penaltie allowed bylaw. Additionally, violations maybe considered by and subject to action by the Miami -trade County ommission on Ethics. Under penalty of perjury, I d e I h e made diligent effort to investigate the matters to which I am attesting hereinabove and to pits made hereinabove are true and correct to the best of my s knowledge, information e . 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