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2THE CITY OF PLEASANT LIVING To: FROM: DATE: SUBJECT: BACKGROUND: Amount: Account: ATTACHMENTS: CITY OF SOUTH MIAMI OFFICE OF THE CITY MANAGER INTER-OFFICE MEMORANDUM The Honorable Mayor & Members of the City Commission Steven Alexander, City Manager Agenda Item No.: d--January 3,2017 A Resolution authorizing the City Manager to purchase fifty (50) active shooter first aid kits and training from Grit Born LLC. The Police Department has been looking for solutions to provide first aid applications during hostile encounters. Officers responding to active shooter scenarios and/or other scenarios which fire rescue cannot respond due to an active scene, Police Officers will need the ability to provide medical attention to victims suffering traumatic injuries. These kits and training will provide military field grade medical kits to allow officers to provide medical attention which will dramatically increase the possibility of survival of victims. The first aid kits will be issued to all police officers and training will be provided by certified medical professionals. These kits were also recommended in the President's Task Force on 21 st Century Policing final report issued in May 2015. This purchase is being made. pursuant to Invitation to Quote (ITQ) #PD2016-24 which Grit Born LLC was the only vendor who participated. Grit Born LLC is a locally owned company. Total cost of this purchase will be $13,000. Not to exceed $13,000 $11,500 for the active shooter first aid kits will be charged to account number 608-1910-521-5210, State Forfeiture (Supplies), current balance $30,000; $1,500 for training will charged to account number 001-1910- 521-4080 current balance $26,050. Resolution ITQ Bid Opening PD2016-24 Grit Born Proposal Scope of Service-Active Shooter Kits Grit Born Sun Biz Demand Star Results Signed Written Certification 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 RESOLUTION NO. _______ _ A Resolution authorizing the City Manager to purchase fifty (50) active shooter first aid kits and training from Grit Born LLC. WHEREAS, the Mayor and City Commission wish to purchase fifty (50) active shooter first aid kits for the Police Department; and WHEREAS, the President's Task Force on 21 sT Century Policing final report of May 2015 recommends that all individual officers be equipped with tactical first aid kits and training; and' WHEREAS, Grit Born LLC participated in the invitation to quote # PD20 16-24 and was the only vendor to submit a quote for services requested; and WHEREAS, all products provided for the tactical first aid kits will be of military grade and all officers will be provided with the training to utilize said.equipment; and WHEREAS, the cost of the fifty (50) active shooter first aid kits will be $11,500; will be charged to account 608-1910-521-5210, State Forfeiture (Supplies) with a current balance of $30,000 and the cost of the training $1,500; will be charged to account 001-1910-521-4080 Training & Education with a current balance of $26,050 NOW, THEREFORE, BE IT RESOLVED BY THE MAYOR AND CITY COMMISSION OF THE CITY OF SOUTH MIAMI, FLORIDA: Section I: The City Manager is authorized to purchase fifty (50) active shooter first aid kits and training from Grit Born LLC, based on ITQ # PD20 I 6-24. . Section 2. Severability: If any section, clause, sentence, or phrase of this resolution is for any reason held invalid or unconstitutional by a court of competent jurisdiction, this holding shall not affect the validity of the remaining portions of this resolution. Section 3: This resolution shall take effect immediately upon approval. PASSED AND APPROVED this __ day of ______ , 2017. ATTEST: APPROVED: CITY CLERK READ AND APPROVED AS TO FORM, LANGUAGE, LEGALITY AND EXECUTION THEREOF CITY ATTORNEY MAYOR COMMISSION VOTE: Mayor Stoddard: Vice Mayor Welsh: Commissioner Liebman: Commissioner Edmond: Commissioner Harris: I. BACKGROUND: ATTACHMENT A Scope of Services "ACTIVE SHOOTER KITS & TRAINING" ITQ #PD2016-24 The City of South Miami is seeking quotations from experienced and capable parties to provide the South Miami Police Department "Active Shooter Kits" containing the materials specified in the Scope of Services, "11. Active Shooter Kit Specifications." In addition, respondents shall also provide Training & Familiarization Workshop courses: Note: Please refer to the "111. Training" section in the Scope of Services for course content. The work and materials specified in this solicitation shall consists of furnishing all goods, materials, supplies, and services, including but not limited to all activity and instructions per the specifications and all necessary materials. The City estimates a quantity of 50 kits will be required, which is an estimate only and not a firm commitment and, should be used for planning purposes only. II. ACTIVE SHOOTER KIT SPECIFICATIONS: Active Shooter Kits shall include the following materials, products and quantities. Respondents may submit alternate manufacturers but those alternates must be an approved equal. The City will make the sole decision and determination if alternate products and materials are "approved equals." The City estimates a quantity of 50 kits will be required, which is an estimate only and not a firm commitment and, should be used for planning purposes only. The contents of the Active Shooter Kits are listed below: A. ACTIVE SHOOTER KIT POUCH SPECIFICATIONS: 1 Custom 500 Denier Cordura® Nylon, 4 pouch system 10.5" long, 3.5" Wide, 1" Deep, Loop Velcro® in both Inner (Carries 4 x (30 round) .223 mags, 4 x (20 rounds) .308 mags, or 4 x (10 round) shotgun shell trays. Includes an Outer Lined Loop Velcro® for Police Identification Patches with/or blood type specification patches. Fully Adjustable to officer's length and width, with Ambidextrous access points on . each individual pouch within the 4 pouch system, also having large zip pull features for gloved hands access. Material must be in Black. Black zippers/Velcro/pulls/thread/etc. 2 B. KIT CONTENTS: • 1 each Mojo MARCH System Celox Rapid Gauze 3"x5' Z-fold Hemostatic Agent • 1 each Mojo MARCH System Battle Bandage • 1 each Mojo MARCH System Mojo Gauze • 1 each Mojo MARCH System Foxseal Chest Seal • leach Mojo MARCH System Nasal Trumpet w/ Surgical lube Size 28 French lumen • 1 each SWAT-T'"M Tourniquet • 2 Pairs Curaplex® TritonGrip TpM low Modulus Formulation Gloves • 1 each Mojo Trauma Shears • 1 each Durapore Surgical Tape 1" X 10 Yd. Hypoallergenic-latex Free-Water Resistant Edition • 1 each Sharpie® Durable Fine Point Permanent Marker • 1 each C.A.T.S Combat Application Tourniquet System (Color: Black, Generation 7 minimurt;l or latest up to date version available) • 1 each Military Grade Snap light developed by Cyalume Technologies for night time deployment and use of trauma kit. TRAINING REQUIREMENTS: A. Training Familiarization Workshop and Active Shooter Kit 1m plementation: Respondents shall provide training and Active Shooter Kit familiarization workshops for designated department personnel. The lIYorkshop shall include the actual training products and Active Shooter Kit contents in each kit and . provide attendees familiarization with the kit and contents, and how kit contents can be applied in the field. Respondents shall quote a per attendee rate, with a maximum of 10 per training session. Trainers shall be licensed and/or certified or active EMT (Emergency Medical Technician)or trauma center field and/or be fully competent to teach and certify BlS. (Basic life Support), AClS/PAlS (Advanced Cardiac life Support/Pediatric Advanced life Support). Workshop duration sessions shall be from 4-6 hours, each session. • These workshops shall include usage and familiarization of the product contained in the kits, handouts, power point demonstrations, etc., mock scenarios for performance under stress application for officers. Note: All course contents shall be pre-approved by the South Miami Police Department. 3 ATTACHMENT B PRICE PROPOSAL SHEET "ACTIVE SHOOTER KIT & TRAINING" ITQ #PD2016-24 NOTE: The City estimates a quantity of 50 kits will be required, which is an estimate only and not a firm commitment and, should be used for planning purposes only. I. ACTIVE SHOOTER KITS ACTIVE SHOOTER KITS COST PER UNIT A. TOTAL COST Based on Estimated $ $ Quantity, 50 Kits II. TRAINING FAMILAIRAZATION WORKSHOP & ACTIVE SHOOTER IMPLEMENTATION COST PER UNIT B. TRAINING MAXIMUM 10 PER TOTAL COST FOR FAMILARIZATION TRAINING SESSION MAXIMUM 10 PER WORKSHOP & ACTIVE TRAINING SESSION SHOOTER IMPEMENTATION $ $ III. TOTAL COST: ACTIVE SHOOTER KITS AND TRAINING (A+B) ACTIVE SHOOTER KITS + TRAINING $ _____ _ 4 Member Name Bid Number Bid Name 2 Document(s) found for this bid 307 Notified 17 Planholder(s) found. Supplier Name Advanced Starlight International American Safety Associates, LLC Bob Barker Company Inc Bound Tree Medical Central Lake Armor Express, Inc. Central Lake Armor Express, Inc. Chief Law Enforcement Supply Dana Safety Supply I Operating as Southern Public Safety Equipment & Southern Firearms Ever Ready First Aid & Medical Supply Fisher Scientific -Safety Henry Schein, Inc. Link Systems LLC MG Contracting & Sons inc. Safariland Southeastern Emergency Equipment Southern Police Equipment United Shield International, LLC City of South Miami ITQ-ITQ #PD2016-24-0-2016/SK ACTIVE SHOOTER KITS AND TRAINING Address 1 113 SW 5th Avenue 1470 SE 18 Terr Po Box 429 5000 Tuttle Crossing Blvd 8604 Cliff Cameron Drive 5221 West Market St 101-01 Foster Ave. 4709 Beachmont Drive PO Box 3227 5870 Hummingbird Court 22 Elm Gray Road Po Box 1097 7609 Midlothian Turnpike City Portland Homestead Fuquay·varina Dublin Charlotte Greensboro BROOKLYN Valrico Irmo Titusville Torrance Youngsville Richmond State Zip Phone Fax Attributes OR 97205 5032225718 5032225700 1. Hispanic 2. Small FL 33035 8773228248 9546355580 NC 27526 8003349880 8003227537 OH 43016 8005330523 8773112437 AB AB NC 28269 8138851310 8138857787 1. Small NC 27409 3368545536 3368543884 Business NY 11236 7183875700 7183879310 33549- FL 5902 8137899378 8134369898 SC 29063 8008453550 8005334793 1. Small FL 32780 4074010031 1111111111 Business CA 90503 3234702122 0000000000 AB 27596-1. Small NC 1097 9194355931 9194355961 Business 1. Small Business 2. Woman VA 23235 8043231855 8043235067 AB Kulick, Steven P From: Sent: To: Cc: Subject: Attachments: Good Afternoon Steven, Brown, Tim <Tim.Brown@Sarnova.com> Wednesday, December 07, 20164:04 PM Kulick, Steven P Brown, Tim RE: City of South Miami ITQ#PD2016-24 -Active Shooter Kit South Miami FL PD2016-24 Kits Due 12092016.pdf After reviewing the specs of the City of South Miami ITQ#PD2016-24 it has been decided that Bound Tree will not be able to quote this opportunity. We want to emphasize our continued commitment to provide the most complete offering of products and services therefore please keep us informed of any upcoming future bids or quotes. We thank you for the opportunity to provide all your EMS equipment and information needs. If you require additional information, our contact information is below. * Please verify the receipt of this message. Thank You, Tim Brown Bround Tree Medical I Pricing Analyst Direct 614.760-5352 I Fax 877.311.2437 Tim.Brown@Sarnova.coml www.boundtree.com Sarnova, a family of companies: Tri-anim Health Services, Bound Tree Medical & EMP PRIVILEGED AND CONFIDENTIAL: The information contained in this electronic message and any attachments are confidential property and intended only for the use of the addressee. Any interception, copying, accessing, or disclosure or distribution of this message is prohibited, and sender takes no responsibility for any unauthorized reliance on this message. If you have received this message in error, please notify the sender immediately and purge the message you received. DISCLAIMER REGARDING ELECTRONIC TRANSACTIONS: If this communication relates to the negotiation of a contract or agreement, any so-called electronic transaction or electronic signature statutes shall not be deemed to apply to this communication; contract formation in this matter shall occur only upon the mutual delivery or exchange of manually-affixed original Signatures on original documents. 1 ) BID OPENING REPORT Bids were opened on: Friday, December 9, 2016 after: 10:00am For: ITO # PD 2016-24 Active Shooter Kits & Training COMPANIES THAT SUBMITTED PROPOSALS: AMOUNT: 1. Grit Born, LLC .................. . $13,000.00 THE ABOVE BIDS HAVE NOT BEEN CHECKED. THE BIDS ARE SUBJECT TO CORRECTION AFTER THE BIDS HAVE BEEN COMPLETELY REVIEWED. City Clerk: tili<trI~ Ou . Hw ne p,mtN. § J( Witness: Jie. v J? ~ J~ ~ Print Name Witness: ___________ _ Print Name Signature TIIfnIYOfPIf.\<;,\/'.;lIIVI:>''(; OlYOFrouTH MIAMI INVITAllON TO QUOTE 1TQ#PD2016-24 SJBMITIIDTO: OtyOerk A'n8:f: ~ my/srATE Is:lJEDATE E-MAIl..: AcnVE~KI~&~NING NAMe Maria Menendez, (MC 6130 8.mset D'ive AOOR3:S 6130 8.mset [)ive OTYlsrATE ~M~lam~I,~R~on~d~a~33~1~34~-------------------SJuth Miami, R 33143 FHJNe 305-663-6339 MANDATQR(~~;;:;::::;M;;:s:n:;:;:;;NG;~--""--:NON:-;;:, :>:, ::=ESJ-EtX.J=-;=-~LID::;:::-, ...,.,....~ skulid<@southmiamifl.gov. DUEDAlE QUOJESJBMIs:lON FmUIR:MENlS (R:FmTO 8<HIBlT2" SJBMIs:iON FmUIR:MENlS') Quotessubmitted after 10 AM on the due date will not be a<mpted unless otherwise llJedfied in the quote dowment of a time change. All quotes will be submitted to the Oty OerksOffioe In a sealed envelope. The label on the on the envelope must read asfollows: Oty of SJuth Miami Maria M. Menendez, CMC 6130 8.mset [)ive SJuth Miami, R. 33143 .FID.E6rNAMe,';;A6nIJE~Kl1SANp"JRl\iNING' Mustlnfnrt'p~~ject nam~.lf label does not have alliiuo~ation above your quote will itot be a<mpted. INSJRANCEFm!JIR:MEN1S: ,The OlYSlnsuranoe requirements are attached (Bdlibit 1). Asa oondition of award, the awarded vendor must provide a alrtlficate of insuranoe naming the dty as additional insured. AFFIDAVl1S& OCMRACffmjlmlWllHSJBMITTAI..: (Bdllblt 2) R!sjlondentsmust oomplete and submit with your quote affidavits provided In Bdllbit 2. QUE5I1ONS AnY~~~fQr.!iddltional inforniati~n orqu~ionsilJlJ5t Ile In wrlti~ elnaile(lby 1oN~loqar thna Oil l)lmmber, 6,2016 tO,the . attei1t.iciri~f Mr)~e~ Kuli~;~nil!iS!.1l9 Man!lQGf,a,t 5k1i1id<@So~hnii8lllift99V; ",' ' '" " " . ' SXlPEOf S3'MCESa:s::RPIlON (mtRTOS3::J1ON 11): DES:RlPIlON OFVVClR<TO BEPEIVORtAID BYro-JSJLTANT: Item Number Item Description TOTAL R:FmTO ATTACH'v18\IT A "SX)fEOFS3'MCES SJl3MITQUOlEON ATTACHlil8\lTB "ffilCE mJFOS\Ls-EEI" :,,",'i, ::.,,/;,,)', ';;.;·: •. ·i.>,: .••• "."",,"> ,.' ,',' ,:",.""",.:'.\,"',':.:: :-", . ". " .. /, '" .... " ", Rlspondent shall furnish all materials and equipment neoossary to serure oompletlon of the work. R:!spondent shall be oompensated a<XXlrding to the quote submitted. Rlspondent is responsible to serure all permits, If my, and should be reflected In the Rlspondentsquote. ~ondentsshall submit pndng on ATTAQ-IM8\lTB "ffilCE~s-EEr." Deadline to submit is: Derember 9,2016 at 10AM. PrintIType Name: Phone: Signature: Date: E-mail: Fax: Finn Name: F.E.I.N. No.: Address: City: ro iQrol State: EL, 33 IX) lHEe<BlJ1l00 0"1HISFI:B1 roNSIll\Jl1:SlHEUNEQUlIIOO\LOfERO"FlUClS:RlOBEOOUNDBVlHE1m>1SO"nsFroRlS\L I1\IW~lOSGl iHlSOCAJOTAliCt-l WimEINDlQI,lIDt>roJEBV AN Al11liC'f'I2EDREmEEENTAlIlIESWl.Rl:NIJER1HE~NCN-RES'GSVEIIiJl.EOlVMAV.1OI\eIER, IN nss::tEDls:R3ICt-l. ACXB'J'ANY~ 1HATINCI.U!lESAN EXBJJIB)IXXlJMENTWlOl Lt/EQUlVOO\LLYElNOSlHEFlUClS:R101HE1ImISO"nsOOIR lHEOlVSIRlUESI'FmQUOJ1BISFmlHElOMSI' ANDMosr~IIEFRCE lHEOlVlmRllESlHERiGiTlOAWArolHE Fro.B::flOlHEA~ CXNlDmDlHEEl:SflOfERllElHEOlVSINJERBr. 1tEOlVlmRllESlHERiGiTlOAWAFfJlHEFRl.E:rlO1l£FBmI WlH1l£lOMSr, MOOI'ImUISVI; ImUlSEl.EFrofOSIJ.. ASIlEItR.IINBJ BV1tEOlVlOWAIVEANYIRImJiARIlVIN 1HE m::ro&.lSOUOIJOTAliCt-l m:xBJUREANDSJIUcrAlIDlOlHERlGfTO"lHEOlVlOAWAFfJlHEFR:U3::f, ANDElmJlEAro/IRAcrWlHA fm'UIDENTOO~ OIIiI:R1HANlOlHE aE'MiO m:M!JB)1HELOMErFR:S\l.OOFRCEOR, IFlHESXFEO"IMlRI<ISDlIII!JB) INlODlsnNCrSJEIlIIISQN& lOAWfJro Ei\0l SJEIlVlSCt-llOA S3¥.RAlERefO'IDfNT. Rl:ERJNDENT Ao::EPISAlLO"1HE1m>1SAND(X)IIDllICt-lSCFlHEOCAJOTAliCt-l ANDOUOIESJEMIESCt-l REOUIIlSI.1ENlS 1liIS~ WLlIlSl.1A1N SJlUcrlOACXB'J'ANCEFm 1BOO\IBI~oo.'IS AFTERlHEFRRlS\l.<JFelING lHERefO'IDfNT.BVSGlINGANDSJEMI11INGlHS~A<!H'fBlOAlLlHE1m>1SAND(X)IIDllIONSO"lHE~o::MRAcr1HATISAPARTCF1HEs:xJOTAlI()IJ A>.O<AG:WlHAPFRlFlAlECWlNG:SlOo.:»IR:R.1lOlHEINR:ft',IAliCt-l IDITAiNBlIN lHSINIIITAliCt-llOOUOIE I. BA.O<GRJUND: ATTAa-tM~TA Sx>pe of ~rvices "AcnVEs-tOOTERKlTS& TRAINING' ITQ#A)2016-24 The aty of Sruth Miani is seeking quotations from experiena!d CIld capable parties to provide me Slu[HJ Miami Fbli~ lRparllBenOOPc.l1V.e SlooIIiil ~11ID oonrlhing the materials spedfied in the S::ope of ~rvires, "II. Active S100ter ~t ~fications." In addition, respondents shall also provide Training & Familiarization VVorkshop oourses: Note: Rease refer to the" III. Training" sadion in the S:x>pe of Swli~ for oourse oontent. The work and materials spedfied in this solidtation shall oonsists of furnishing all goods, materials, supplies, CIld services, induding but not limited to all activity and instructions per the specifications and all n~ materials. The aty estimates a quantity of 50 kits will be required, whidl is an estimate only and not a firm oommitment and, should be used for planning purposes only. II. AcnVEs-tc:XJrm.KlT s::HlACAllONS .Active Sloater ~ts shall include the following materials, products and quantities. Fe!pondents may submit alternate manufacturers but those alternates must be a1 approved equal. The aty will rna<e the SJle decision and determinaion if alternate productillhi rnc:iiIialCIi-e "approved equal!IlThe aty estimates a quantity of 50 kits will be required, whim is an estimate only and not a firm oommitment and, should be used for planning purposes only. The c:ontentsof thePdiveS100ter ~tsare listed below: A ACllVE&IOOTER KIT FOJO-I smACAllOOS 1 ClJstom 500 D3nier OJrdura®Nylon, 4 poudl system 10.5" long, 3.5" VVide, 1" Deep, Loop Velao®in both Inner (Olrries4 x (30 round) .223 mags, 4 x (20 rounds) .308 mags, or 4 x (10 round) shotgun shell trays. Indudes an CUter Uned Loop Velao®for Fbli~ Identification Patches with! or blood type specification patdles. RJII~juamle lJIhffj~'GiiLng:Kand wid[fil[ili(l'fl6mbidexl:tBu~inom, eadl individual poudl within the 4 poudl system, also having large lip pull features for gloved hands acxBSS. Material must be in Bad<. Bad< li pper&'Velaol pull &,threadl etc. 2 B. KIT CONTENTS: [IT] 1 each Mojo MA~CH System Celox Rapid Gauze 311 xS' Z-fold Hemostatic Agent ill] 1 each Mojo MARCH System Battle Bandage !ill 1 each Mojo MARCH System Mojo Gauze [ill 1 each Mojo MARCH System Foxseal Chest Seal ill11each Mojo MARCH System Nasal Trumpet w/ Surgical Lube Siie 28 French Lumen ill] 1 each SWAT-T'M Tourniquet [ill 2 Pairs Curaplex® TritonGrip TpM Low Modulus Formulation Gloves [IT] 1 each Mojo Trauma Shears illJ 1 each Durapore Surgical Tape 111 X 10 Yd. Hypoallergenic-Latex Free-Water Resistant Edition WJ 1 each Sharple® Durable Fine Point Permanent Marker [ill 1 each CAT.S Combat Application Tourniquet System (Color: Black, Generation 7 minimum or latest up to date version available) [[J 1 each Military Grade Snap light developed by Cyalume Technologies for night time deployment and use of trauma kit. TRAINING REqUIREMENTS: A. Training Familiarization Workshop and Active Shooter Kit Implementation: Respondents shall provide training and Active Shooter Kit familiarization workshops for designated department personnel. The workshop shall include the actual training products and Active Shooter Kit contents in each kit and provide attendees familiarization with the kit and contents, and how kit contents can be applied in the field. Respondents shall quote a per attendee rate, with a maximum of 10 per training session. Trainers shall be licensed and/or certified or active EMT (Emergency Medical Technician)or trauma center field and/or be fully competent to teach and certify BLS (Basic Life Support), ACLS/PALS (Advanced Cardiac Life Support/Pediatric Advanced life Support). Workshop duration sessions shall be from 4-6 hours, each session. [IT] These workshops shal include usc:ge a1d fanilicrizaion of the product contcined in the kits, hmdouts, power point demonstraions, etc., mock s:encrios for perforlTlalCe under &r~ spplicaion for officers. Note: All course contents shall be pre-approved by the So~h Miami Pollee Department. 3 AlTAa-IMENTB PRICE PROf()St\l 8-IEEf " ACllVE s-IOOT'ffi KIT f1fiRt\JNING' ITQ#PD2016-24 NOlE The aty estimates a quantity of 50 kits will be required, whidl is an estimate only and not a firm oommitment and, should be used for planning purposes only. I. AcnVEs-tOOlffiKlTS ACllVE&I()()Tffi KITS <X>Sr PER UNIT A TOTALOOSI" Based on EStimated $ i?JO .Dt> $ ').60 C) Quantity, 50 Kits II. 1R\JNING FAM ILAlRAZAl10N VVOR<S-lOP & AcnVEs-tOOlffi IMA..EIVI ENTAl10N <X>SrPER UNIT B. TRAINING MAXIMUM 10 A:R TOTAL <X>Sr FOR FAMILARlZAl10N TRAlNINGs:s:iON MAXIMUM 10 PER ~OP&ACllVE TRAlNINGs:s:iON S-OO"l'm 1M P8'v1ENTAl10N $ ~a·nt) $1,50D III. TOTALOOSf: AcnVESiOOlffiKlTSANDTFWNING (A+B) AcnVEs-JC)()l"ffiKlTS + TRAINING $ l'a,OOO 4 1.01 losurroce EXHIBIT 1 Active Shooter Kits and Training ITQ #PD2016-24 Insurance & Indemnification Requirements A. Without limiting its IiclJility, the contra::tor, consultalt or consulting firm (hereinater referred to a; • RRM" with reg:rd to Insura1re mel Indelmiflca:ion requirements) shal be required to procure end mantan ct its own expense during the life of the Contra::t, insurmce of the types a1d in the minimum anounts acted below a; will protect the RRM, from dams which rmv a-ise out of or result from the contra::t or the performmoe of the contra::t with the City of S:luth Miani, whether such dam is ag:inst the RRM or my sub-contra::tor, or by enyone directly or indirectly employed by Sly of them or by myone for whose a::ts my of them Il1af be lici)/e. B. No insurcme required by the CITY shal be iSQJed or written by a surplus lines C8'rier unless arthorized in writing by the CITY Sld such arthorizaion shal be ct the CITY's mle mel 8Jsllute discretion. The RRM shEIl purc::ha!le insur81Ce from mel shSl mantan the insurcnoe with a compcny or compcnies ISNfuIly arthorized to sell insuralOEl in the acte of Rorida, on forms cpproved by the aete of Rorida, as will protect the RRM, ct a minimum, from ail dams a; set forth below which may a-ise out of or result from the ARM's operctions under the Contra::t end for which the ARM may be 191y 1i8lle, whether such operetions be by the ARM or by a 8Jboontra::tor or by myone directly or indirectly employed by my of them, or by myone for whose a::ts my of them rmv be lieille: (a) dams under workers compensction, dimlity benefit end other simila-employee benefit a::tswhich a-e ~icaJle to the Work to be performed; (b) dams for danl:ges becaIse of bodily injury, oCQJpctiona sickness or disease, or deeth of the RRM's employees; (c) dams for cIancges beca.ISe of bodily injury, sickness or disease, or deeth of my permn other thal the ARM's employees; (d) dams for daTlCglS insured by usua permna injury liaiJility oover~; (e) dams for cIana,;Jes, other then to the Work itself, becaJse of injury to or destruction of t819b1e property, induding loss of use resulting there from; (t) dams for cIancges beca.Jse of bodily injury, deeth of a penDn or property ~ a-ising out of ownership, mantena1Ce or use of a motor vehide; (w dams for bodily injury or property cIal1cge a'ising out of completed operetions; end (h) dams involving contra::tua liaiJility insurcnoe ~iccble to the RRM's obligctions under the Contra::t. 1.02 Rrm's 11'!SJfa)Ce Generaly. The ARM shail provide Sld mantan in force Sld effect until ail the Work to be performed under this Contra::t has been completed ald ctX:epted by CITY (or for such dur aion a; is otherwise specified hereinSter), the insura1Ce cover~ written on Rorida cwroved forms Sld a; set forth below: 1.03 Workers Co~ion Insurax:e et the stetutory anount a; to al employees in OOmplia1Ce with the "Worker~ Compensction LaN" of the aete of Rorida induding Chcpter 440, Rorida aetutes, a; presently written or hereater anended, mel al CWIicaiJle federa lavs. In aklition, the policy (ies) must include: 8npIoyers Uctility ct the aetutory cover~ anount. The ARM shal further insure thct ail of its SJbcontra::tors mantan cwropriete levels of Worker's Compensction Insuratce. 1.04 Convnercia Comgre/1ensive Genera USlility insurSlce with bros:! form endorsement, a;well CB aJtomobile liailility, completed operctions ald products liaiJility, oontra::tua IiSJility, sewerSJility of interest with aossliaiJility pro\lision, Sld persona injurya1Cl property ~ JiclJilitywith lirrits of $1,000,000 combined singe limit per occurrence a1d $2,000,000 c:g;reg:te, including • Persona Injury: $1,000,000; • Medica InsurSlce: $5,000 per permn; • A"operty D~: $500,000 each occurrence; 1.05 Umbrella Commercia COl'QXehensive Genera Ucpjlity insurSlce shail be written on a Rorida cwroved form with the sane OOWl'S!J' as the pri/11a'y insura10El policy but in the anount of $1,000,000 per dam S1d $2,000,000 AnM AgJegte. Cover~ must be Sforded on a form no more restrictive then the letest edition of 5 the Comprehenave Genera Uci>ility policy, without restrictive endorsements, as filed by the Insurcnce S:rvices Offire, a1d must include: (a) A'emises end Opera ion (b) Independent Contredors (c) A'oducts aldIor Completed Opera ions Haza-d (d) 8cploaon, ColI~end Undergound HSZS'dCover~ (e) Broed Form A-operty Danc:g:! (1) Broed Form Contra::tual Cover~ ~icc:ble to this specific Contred, including my hold ha"mless a1dIor inclemnificction ~eement. (g) A:lrmna Injury Covercge with BllJIoyee a1d Contredual Exclusions removed, with minimum limits of covercge equal to those required for Bodily Injury Uci>ility end A'operty Danc:g:! Uci>ility. 1.06 SUsiness Automobile Ucbjlity with minimum limits of One Million Dollers ($1 ,000,000.00) plus m cdditiona One Million Doller ($1,000,000.00) umbrella per occurrenre combined ange limit for Bodily Injury Us,i1itya1d A'operty Dcrncge USlility. Umbrella cover~ must be awrdecl on a form no more restrictive thcrt the laest edition of the &JSness Automobile Uct:lility policy, without restrictive endorsements, as filed by with the stae of Aorida, end must include: (a) Owned Vehicles. (b) Hired a1d Non-Owned Vehicles (c) Bl1JIoyers' Non-Ownership 1.07 . a,1ecONTRACTS The ARM ~ees tlla: if my pert of the Work under the Contred is sublet, the suboontra::t shal oonlan the sane insurcnce provison as set forth in section 5.1 Slove a1d 5.4 below Sld substituting the word SJboontredor for the word ARM a1d substituting the word ARM for CITY where ~icable. 1.08 Are ax:! Extended Coverg InsuraK2 (EkJilders' Risk), IFAFfUCAet.e A. In the event thct this contred inwlves the construction of a structure, the CONTRACTOR shall mantan, with mlnsurcnce COmpaly or Insurcnce COlll>31ies a::oeptS>le to the CITY, "Broa:l" form/All Risk Insurcnce on buildings a1d structures, including VSldaisn & Malicious Mischief cover~, while in the course of construction, including founclctions, cdditions, ata::hments a1d al permment fixtures belongng to a1d constituting a pert of sad buildings or structures. The policy or policies shal am cover ma::hinery, if the cost of na:hinery is included in the Contra::t, or if the ma::hinery is loccted in a building tlla: is being renovcted by reason of this contred. The anount of insurcnce must, a al times, be a least . equa to the repla::elJlent a1d edual catI vaue of the insured property. The policy shall be in the name of the CITY a1d the CONTRACTOR, as their interest rnctj Eppea', a1d Iilal am cover the interests of al 8.tboontredors performing Work. B. All of the provisons set forth in Sldion 5.4 herein below Iilal cppIy to this cover~ unless it would be clecrly not ~icS>le. 1.09 Miecellcneous: A. If my notice of ca'ICeIlaion of insura1ce or cha1ga in cover~ is issued by the insura1ce compa1y or should my insuralce hale an expiraion dcte tlla: will occur during the period of this rontred, the ARM !!hal be responeible for seruring other a:oeptEble insurance prior to such anceIlaion, cha1ge, or expiraion 9) as to provide rontinuous covercge as specified in this section and m as to mantan cover~ during the life of this Contra::t. B. All deductibles roost be declered by the ARM a1d must be ~oved by the CITY. At the option of the CITY, either the ARM shall e1imincte or reduce such deductible or the ARM sheil procure a Bond, in a form sctisf'idory to the CITY covering the sane. C. The polldes sheil rontan waver of subrog:tlon 8JJinst CITY Where ~lcS>Ie, shal expressly prOvide tha such policy or policies ere primcry over my other collectible inSJrcnce thct CITY Ill8f have. The CITY reserves the rigrt a my time to request a ropy of the required polities for review. All policies sheil contan a • severct:lility of interest" or • aoss lici>ility" claJSEl without obligaion for premium ~ of the CITY as well as rontredua IiSlility provison coWll'ing the Contra::tors duty to indemnify the City as provided in this Ag-eement. D. Before sta1:ing the Work, the ARM shal deliver to the CITY and CON SJLTANT certificctes of ruch insurCl'lOEl, a::oeptEble to the CITY, as well as the insura1ce binder, if one is issued, the insurCl'lOEl policy, including the decleraion pcge a1d al ~icc:ble endorsements a1d provide the naTIe, cddress a1d telephone number of the insurance cgri or broker throug, whom the policy was obtaned. The irl9.Jrer 6 shal be reted A.VlI or better per A.M. Best's Key Raing Guide, letest edition a1CI aJthorized to issue insurmre in the Sete of Rorida All insurmce polides must be written on forms ~oved by the Scte of Rorida crtd they must reman in full force a1CI effect for the durction of the contra:t period with the CITY. The RRM ~ be required by the CITY, et its ~Ie discretion, to provide a" certified copy" of the R>licy (as defined in Article 1 of this document) which shal include the decla-aion pcg9 a1d al required endorsements. In aidition, the RRM shal deliver, a the time of delivery of the insurmce certifica:e, the following endorsements: (1) a policy provision or m endorsement with substaltialy simila-provisions as follows: "The City ofSluth Miani ism additiona imured. The insurer shal PCPJ all sumsthct the City of Sluth Miani becomes legally oblig:ted to ~ as danages becaJse of 'bodily injury", 'property ~, or "per~na a1CI a:lvertising injury" a1CI it will provide to the City al of the coverega thct Is typically provided under the stcnda"d Rorida cpproved forms for cornmerda g:II1erai lici>ility covercge A a1d covercge B'; (2) a policy provision or m endorsement with substaltially simila-provisions as follows: "This policy shall not be CSlCeIled (including ca'lCeIlaion for norr~ of premium), terminaed or maerially modified without first gvingthe City of Sluth Miani ten (10) dais a:fvcnced written notice of the intent to maerially modify the policy or to cmceI or termincte the policy for my reason. The notificction shal be delivered to the City by certified mail, with proof of delivery to the City." E If the RRM is providing professiona services, such as would be provided by m a-chitect, engneer, atorney, or a:oountmt, to nana a few, then in such event SlCI in a:Jdition to the aIlove requirements, the RRM sheil also provide R-ofessional Uallility Insurmoe on a Rorida ~oved form in the anount of $1,000,000 with deductible per clam if my, not to exceed 5% of the limit of liallility providing for all sums which the RRM shal become legally oblig:ted to ~ as dancg:Is for dams a-ising out of the services or work performed by the RRM Its ~s, representaives, am Contra::tors or assiglS, or by my per~n employed or retaned by him in connection with this Ageemern. This insurmce shall be maintained for four yea-s ater completion of the construction 81d moeptmoe of my A"oject covered by thlsAg-eement. However, the ARM ~ purchcEe ~fic A"oject A"ofessional UalJility Insurmce, In the anount mel under the terms specified aIlove, which is also a:x:epteble. No insurmce shall be iSSJed by a surplus lines ca-rier unless authorized in writing by the city a the city's ~Ie, ct>s:llute and unfettered discretion. 7 Indemnification Requirement A. The Contrcdor ax:epts a1d volunta-ily incurs sl risks of frIIJ injuries, ~ or ha'm which migrt a-ise during the work or event tllet is occurring on the CITY's property due to the negigence or other fallt of the Contr~or or myone ~ing throug, or on behsf of the Contrcdor. B. The Contrcdor shSl inde!mify, defend, save S1d hold CITY, its officers, afilictes, employees, suooessors mel assiglS, ha'mless from frIIJ a1d sl daJ'la9!!8, dams, lict>ility, losses, dams, cIema1ds, suits, fines, judgnents or oost md expenses, including rea:ornille cttorney's fees, pcrSegEj fees end investigctive oosts incidents there to 31d inrurred prior to, during or following frIIJ litigction, mediaion, a-bitrction md ct sl ~Icte levels, which may be suffered by, or axrued C9inst, cha'ged to or recoverc:tlle from the City of Sluth Mlani, Its officers, c:ffIlictes, employees, ~rs end assigns, by rea:on of frIIJ caJses of cdions or daim of my kind or Mure, including daims for injury to, or de<th of frIIJ person or persons md for the loss or clan9 to my property a-ising out of a negigent error, omission, mi&lOnduct, or my goss negigence, intentionS cd or ha"mfuI oonduct of the Contra:tor, its oontra:torlsuboontra:tor or frIIJ of their officers, directors, cgents, representctives, employees, or assiglS, or frIIJone a:ting throug, or on behalf of my of them, a-ising out of this Ageement, incident to it, or resulting from the perforrTla'lOe or non-performcnoe of the Contra:tor's obligctions under this AGREBIII8'JT. C. The Contrcdor shSl ~ Sl daims, losses mel expenses of my kind or Mure whctsoever, in oonnection therewith, including the expense or loss of the CITY mdlor its arected officers, Slilictes, employees, suooessors mel assiglS, including their cttorney's fees, in the defense of fnI a::tion in IaN or equity brougrt C9inst them md a-ising from the negigent error, omission, or a::t of the Contra:tor, its SJb..Contra:tor or my of their agents, repreeentctives, employees, or agns, B'ldIor S'ieingout of, or incident to, this Ageement, or inddent to or resulting from the performa1Ce or non-perforl11Cl'lOe of the Contra::tor's obligctions under thisAGREEM8\lT. D. The Contra:tor cvees md recognizes tllet neither the CITY nor its officers, afilictes, employees, suooessors mel assigns S1SI be held IimJe or responsible for frIIJ dams, induding the oosts md expenses of defending such daims which ~ result from or a-ise out of a:tions or omissions of the Contra:tor, its oontra:torlsubcontra::tor or my of their ~s, representaives, employees, or assigns, or frIIJone a::ting throug, or on behaf of the them, a1d a-ising out of or ooncerning the work or event tllet is occurring on the CITY's property. In reviewing ~oving or rejecting frIIJ submissions or a:ts of the Contra::tor, CITY in no waJ assumes or mes responsibility or licbility for the a::ts or omissions of the Contra:tor, its oontra::torlsubcontra::tor or my of their ~s, representctives, Efll>/oyees, or assiglS, or myone a::ting throug, or on behalf of them. E The Contra::tor has the duty to provide a defense with m atorney or IaN firm ~oved by the City of Sluth Miani, which ~ova will not be unrea:onc:tlly withheld. F. However, asto design professions oontra::ts, end pursuart to Sactlon 725.08 (1), AoridaSctutes, none of the provisions set forth herein Ebow thct a-e in oonflict with this subpa'cv~ shSl ~y end this subpS'cv~ shSl set forth the sole responsibility of the design professiona oonc:erning indernnificction. Thus, the design professions's obligctions as to the City end its cg:!I1Cies, as well as to its officers 31d employees, is to indermify md hold them ha-mlessfrom IiWilities, da'nc:g:!s, losses, md ooats, induding but not limited to, rea:onc:tlle cttorneys' fees, to the extent caJsed by the negigenoo, rec:kJess1ess, or intentionaly wrongul oonduct of the design professiona end other persons employed or utilized by the design professional In the perfor~ of the oontra::t. 8 EXHIBIT 2 INVITATION TO QUOTE AFFIDAVITSAND FORMS SUBMISSION REQUIREMENTS This listing indiccies the forms a1CI documents required to be submitted for this s>lidtction ald to be presented by the dea:lline set for within the &>lidtction. Fulfillment of al &>lidtaion requirements listed is maldctory for considerction of response to the &>lidtction. Additiona documents may be required end, if &>, they will be identified in al a:fdendum to this ITQ. The response shal include the following items: 1. Non-Collusion Affidavit 2. R.Jblic artity Crimes end Conflicts of Interest 3. Drug Free Workpla:e 4. Acknowledgement of Conformcnce with Os-JA Saldcrds 5. Federa a1d Seta Vendor Usting 6. Relcted Arty Tra1Si:dion Verificciion Form 7. R"esentction Tean Decia-ctionlAffidavit of Rspresentetion 8. Sgted Contrai Document (A1I-including Genera Conditions cnd SJpplementa-y Conditions if cttEdled. EXH IBIT 3 9 NON COLLUSION AFFIDAVIT SfATEOFR.ORlDA ) ) COUNTY OF MIAMI-DADE ) 6abt\e..\ D· Fi.gvuoa beingfirst duly sworn, deposesaldstaestha: (1) HelS1eIThey is'erethe Qwn" (Owner, Pcrtner, Oflicer-,~Repr~O:;esent~::::a~ive=-o-r""":A:-!JW--::):-M=------------ _~c "u.Ja.IIc:I\u.:\-..!oo~rDoW!a.u..n-'-'-1 ..JL",L~C4--_____ the Respondent tha has submitted the ata:hed Roposal; (2) . HeiSlelThey is'ere fully informed concerning the prepa-aion ald contents of the atailed A'opog 81d of sl pertinent circumstmces concerning such A'oposal; (3) 9Jch A'oposal is genuine md Is not a collusive or shan A'oposa; (4) Neither the said Respondent nor my of its officers, pcrtners, owners, £gents, representaives, employees or perties in interest, including this Slimt, have in my wflJ colluded, conspired, connived or ~eed, directly or indirectly, with my other Respondent, firm, or person to submit a collusive or shan A'oposa in connection with the Work for which the atatled A'oposal has been submitted; or to refi'an from Bidding or proposing in connection with such Work; or hale in Sly mmner, directly or indirectly, sougrt by Eg"eement or collusion, or communlcctlon, or conference with my Respondent, firm, or person to fix my overheat, profit, or cost elements of the Roposa! or of Sly other Respondent, or to fix my overheai, profit, or cost elements of the A'oposal A'ice or the A'oposal Rice of Sly other Respondent, or to secure throug, Sly collusion, conspir~, connivance, or unlaNfuJ Eg"eement SlY a:Iva1ta;,ye Ev,inst (Recipient), or any person interested in the proposed Work; (5) The price or prices quoted in the ata:hed Roposal ere far and proper 8ld ere not tanted by my collusion, conspir~, connivance, or unlaNful Eg"eement on the pert of the Respondent or my other of its ~s, representaives, owners, employees or perties of interest, including this Sliri. 9gned, seaed 8ld delivered in the presence of: SfIl'iJ.ureF¥ #/~ G aQ'£ltA D. flSveeoq I PUsidtn+ Rint Nane md Title iz-}O'lIWllP Dae ACKNOWIJ3)GEMENT SfATEOFR.ORlDA COUNTY OF MIAMI-DADE Thomas F. Pepa 02-23-15 ) ) ) 10 WITNe:Bmy hald crtd official sea. NOTARY RJ8lIC: s=ALOFOFRCE Thomas F. Pepa 02-23-15 11 Per~nally known to me, or Per~naI identificction: Type of Identlficction A"oduc:ed Did ta<e crt olth, or Did Not ta<ecrt olth. PUBLIC ENTITY CRIMESAND CONFLICTSOF INTEREST A.lrSlJa1t to the provisions of PcrCV~ (2) (a) of Slction 287.133, Rorida Sae Sautes -" A person or affiliae who has been pla;ed on the convicted vendor list follOwing a conviction for a public entity crime ~ not submit a R"oposa or bid on a Contra to provide my gJods or services to a public entity, rmv not submit a Bid or proposa for a Contred with a public entity for the construction of repcir of a public building or public work, may not submit bids or proposas on 1eageS or rea property to a public entity, IllC¥ not be aNa-ded to perform Work as a REEFONDENT, SJb-oontra::tor, supplier, SJb-consultant, or ConsultEllt under a Contred with any public entity, and may not transa::t business with any public entity in excess of the threshold anount CaegJry Two of Slction 287.017, Rorida Saut~ for thirty six (36) months from the dae of being pla;ed on the convicted vendor list" . The aNa-d of any contra::t hereunder Is subject to the provisions of Chcpter 112, Rorida Sae Sautes. Respondents must disclose with their A"oposas, the nane of cny officer, director, pa-tner, 8.'BJciae or ~ who is ~so 81 officer or employee of the City of S:luth Micmi or Its ¥I1cies. SNORN srATEMENT RJRSJANT TO 8:CTION 287.133 (3) (a), B..ORlDA srATUTES ON FUBLIC ENTITY CRIMES THISFORM MUsr BE SGN ED AND SNORN TO IN THEFREEENCEOFA NOTARY FUBLlC OR OTHm OFFICIAL AUTHORIZe) TO ADMINlsrm OATHS 1. This sworn staement is submitted to (\' \ . (\ 5 ~ . ~\j\..tne0't' _Omu '(blOml [print of the public entity] ~-40~~~~pr~i~~r~~\~ivi~d~~~~~I~'~~d~tW~~e~~~~I ~P~U~5~ld~&Jd~~ __________________ __ for __ ~h~~_;~t~B~O~~~O~I~L~L~C~ ________ ~ ___________________ ___ [print nane of entity submitting sworn staement] whose business a:ldress is );>4CLP sw 1]2 5-\1u,eJ tniam\ I EL 33' iJ and (if i:pplicS>le) its Feder~ Bnployer IdentifiCEtion Number (FaN) is .,.-51 0026 VJ (If the entity has no FEN, include the S:lci~ Slcurity Number of the individual sigling this sworn staement: ------------------------------------,~ 2. I understcnd tha a ·public entity crime" as defined in PcI"C~r~ 287.133 (1)(g), RQrida Saut§, Il1ealS a violalon of any stae or feders IaN by a person with respect to cnd directly relaed to the transa::tlon of business with any public entity or with an .,cy or politi~ subdivision of my other stae or of the United Sa~ including, but not limited to , any bid, proposcj or contred for gJods or services to be provided to any public entity or an cg3I1cy or politi~ subdivision of any other stae or of the United Saes a1d inVOlving antitrust, fraJd, theft, bribery, collUsion, ra::keteering, conspira::y, or maeris misrepresentalon. 3. I understand tha ·convicted" or "conviction" as defined In Pa"~~h 287.133 (1) (b), BQr.iruI Saut§, means a fi~ing of 9.Iilt or a conviction of a public entity crime, with or without cn a:ljudica:ion of 9Jllt, in any feder~ or stae tri~ court of record relaing to cha"ges brougrt by indictment or informalon aler JJly 1, 1989, as a result of a jury verdict, non-jury tri~, or entry of a plea of 9.Iilty or nolo contendere. 4. I understand tha an· ctfiliae" as defined In PcrCV~h 287.133 (1) (a), Rorjda Sctut§, means: (a) A predecessor or ~r of a person convicted of a public entity crime; or (b) An entity under the control of any naur~ person who is a::tive in the ~ of the entity and who has been convicted of a public entity crime. The term" ctfilicte" includes those Officers, directors, exeaJtives, pa-tners, shareholders, employees, members, and ~s who a-e edlve in Thomas F. Papa 02-23-15 12 the mal~ of m ctfiliae. The ownership by one person of sha-es constituting a controlling interest in my person, or a pooling of equipment or income anong persons when not for fair rnS'ket vaue under m a-m's Ieng:h CU"eement, shall be a prima fa:ie case thct one person controls S'IOther person. A person who knowingy enters into a joint venture with a person who ha; been convicted of a public entity aime in Rorida during the preceding 36 months shall be considered al aJiliae. . 5. I understClld tha a "person" as defined in PcrCU"~ 287.133 (1) (e), Rorida Setutes, meS'lS my Mural person or entity orgmized under the laNS of my stae or of the United aetes with the lega power to enter into a binding contrEd and which bids or proposal or ~ies to bid or proposal on contrBis for the provision of ~ods or services let by a public entity, or which otherwise trmsa::ts or cpplies to trmw business with a public entity. The term "person" includes those officers, directors, executives, pa-tners, sha"eholders, employees, members, md cgems who a-e Edive in malcg3l11ent of m entity. 6. I3a;ed on informaion md belief, the staement which I have ITlCI'ked below is true in relaion to the entity submitting this sworn stetement. [Indical:e which stetement CWies.] 'i Neither the entity submitting this sworn staement, nor my of its officers, directors, executives, ~s, sha"eholders, employees, members, or cgents who a-e a:tive in the ~ of the entity, nor my aJiliete of the entity has been cha-gec\ with md convicted of a public entity aime subsequent to .lily 1, 1989. _ The entity submitting this sworn staernent, or one or more of its officers, directors, executives, pa-tners, sha-eholders, employees, members, or cgents who a-e a:tive in the mmcgement of the entity, or m atiliae of the entity ha; been cha-gec\ with CIld convicted of a public entity crime subsequent to ..lily 1,1989. __ The entity submitting this sworn staernEllJt, or one or more of its officers, directors, executives, pa-tners, shcreholders, employees, members, or cgents who a-e a:tive In the ~ of the entity, or a1 atiliae of the entity has been cha-gec\ with md convicted of a public entity alme subsequent of .lily 1, 1989. However, there has been a subsequent proceeding before a Hea-ing Officer of the Sae of Rorida, Division of Administretive Hea-ings CIld the Rnal 'Order entered by the Hea-ing Officer determined thct it Was not in the public interest to pl;:m the entity submitting this sworn stctement on the convicted vendor list. [ctta:h a copy of the final order.J I UNDffiSfAND THAT THESJENI~ON OFTHISFOFWI TO THE CONTRACTING OFRCERFORTHEFUBLIC BIITITY INDENTIRID IN PARAGRAAi 1 (ONE) ABOVE IS FOR THAT FUBLlC ENTITY ONLY, AND THAT THIS FORM ISVAUD THROUGH DB::8VlBER 31 OF THE CAlB'JDAR YEAR IN WHICH IT IS RLID. I AUD UNDERSI'AND THAT I AM REQUIRID TO INFORM THE FUBLlC BIJTITY FRlOR TO ENTERING INTO A CONTRACT IN EXCEES OF THE THRE&lOLD AMOUNT FROVIDID IN ETION 287.017, R.ORlDA srATUTES FOR CATB30RY TWO OF ANY CHANGEIN THEINR:lRMATlON CONTAINB) IN THlSR:lRM. ~-J;:i2 ~sgtCtureJ tf7 SNorn to .... subscribed before me this () ;> dI!I of ~ ,20,& Personallyknown ><=~-[;CUe-/Z~& I . OR Produced identificction Nota-y AJblic-Sae of F'1vCJJ!.1 plJ.. My oonmJssion expires bi,~#//;,o 1"7 ' (Type of identifical:ion) (Printed, typed or stanped commissi Form FUR 7068 (Rev.06/11/92) nane of nota-y public) J. e!7f M P ~M&~/l- Thomas F. Pepa 02·23·15 13 ii~~W~.. LEYDA P. ESC~. ;.: ~·i MY COMMISSION IFF241481 \, .ft.. • EXPIAES~ii~~~:·.· .~OI 3'111,(,'53 I' rWIt._ DRUG FREE WORKPLACE Whenever two or more Bids or A'oposas which a-e equ~ with respect to price, q~ity end service a-e received by the Sete or by my poUtiat subdivisions for the procurement of commodities or contrai~ services, a Bid or A'oposa received from a business thct certifies thet it has implemented a drug.free workpla::e progan shall be gven preferenoe in the aNa"d process. EStetJlished procedures for processing tie Bids or A'oposas sh~1 be followed if none of the tied vendors have a drug.free workpla::e progan. In order to hale a drug-free workpla::e progan, a business shal: 1) F\JbIish a stetement notifying employees thet the unlawful nmufa:ture, distribution, dispensing, possession, or use of a oontrolled substmce Is prohibited in the workpla::e end specifying the ailons thct shal be ta<en cgainst employees for violet Ions of such prohibition. 2) Inform employees S>out the dS1gel"s of drug cbuse in the workpla::e, the business' policy of mantaning a drug-free workpla::e, my avaletJle drug oounseling, rehmilitetion, end employee assistmce progans. md the peOOties thet nlaJ be imposed upon employees for drug ctluse violet ions. 3) Give ea::h employee eng:ged in providing the commodities or oontra::tu~ services thet a-e under Bid a copy of the steternent specified in SJbsection (1). 4) In the stetement specified in SJbsec:tion (1), notify the employees, thet, as a condition of working of the commodities or oontra::tu~ services thct a-e under Bid, he employee sh~1 ct>ide by the terms of the steternent md shal notify the employee of my oonviction of, or plea of 9lilty or 000 c:mten:lere to, my violetion of Chc:pter 893 or of my controlled substmce IaN of the United aetes or fIIy stEte, for a violEt ion occurring in the workpla:e no IEter thm five (5) business days after such conviction. ' 5) Impose a sa1Ction on, or require the saisfa::tory pcrticipaion in a drug ct>use assistfllce or rehct>ilitaion progam, if such is avalable in the employee's oommunity, by my employee who is a> convicted. 6) Ma<e a good fath effort to continue to maintan a drug.free workpla::e throug, implementetlon of this section. As the pera>n ruthorized to sign the stet this firm oomplies fully with the S>ove requirements. REs:ONDB\lT's Sgnaure: __ 4~rttL~L-';;'~~:"--_- A'int Name: C. .,abtid Dete: \'2..\ G~ 1 ~()\ \.Q Thomas F. Pepe 02-23-15 14 ACKNOWLEDGEMENT OF CONFORMANCE WITH OSHA STANDARDS TO THECITYOFs)UTH MIAMI We, (;)¢:W Botto. lL. t, . (Ncrne of CONTRACTOR), hereby a:knowledge Sld vee tlla: as CONTRACTOR for the Invitation Quote project as specified in the FOlicitaion documents have the FOle responsibility for COmpllSlte with al the requirements of the Federa Occupctlona Siety Sld Health Ad. of 1970, Sld al Saeald Iota sctetya1d health r~Iaions, atd cg-eeto Indemnify md hold hS'mlesstheCity of South Miam I Sld.lUL(Conl'UltSlt).nst SlY Sld al 1iB>ility, dams, danages, losses S'ld expenses they Il1af incur due to the fiilure of (9Jb-contra::tor's nanes): to comply with such cd or r~Ia:ion. CONTRACTOR' B LJ (\ E1e;,t O'tl-n! v,"- BY: fJabticl D. n,gvwCt Nane eU5ideot Title Witness 15 AFFIDAVIT CONCERNING FEDERAL AND STATEVENDORLlSTINGS . The person, or entity, who is responding to the City's a>licitaion, hereinSter referred to as· Respondent", must certify tha the Respondent's nane Does Not Eppea' on the Sae of Rorida, Depatment of Mal¥ment S3rvices, "CONVICTID, SJs=&.IDID, DI9:RlMINATORY FIDERAL EXCLUDID PARTIESmd COMRAINTSVe.JDOR UsrINGS'. . If the Respondent's nane Does cppea-on one or al the • UstingS' sul11/11a"ized below, Respondents must • Check if ApplieS' next to the ~iccble • Usting." The· UstingS' Cal be ax:essed throUdl the following link to the Rorida Depcrtment of M~ S:Jrvices website: http://www.dms.myfloridacomlbusiness operationslstae purchasing/vendor informaion/convicted suw ended discrimimtorl( complcints vendor lists DECLARATION UNDER PENALTY OF PERJJRY I, OObe\ e\ 0 .1='I~O oo(hereinater referred to as the" Decla-a'lt") stae, under penaty of perjury, tha the following staements e true ald correct: (1) I represent the Respondent whose nane is 01ZJ± eOt.O, U..c. . (2) I hale the following re/aionship with the Respondent pU$(cieor (Owner (if Respondent is a sole proprietor), A'esident (if Respondent is a corporaion) A:rtner (if Respondent is a pcrtnership), Genera A:rtner (If Respondent Is a Umited PcTtnershlp) or Mancgng Member>(lf Respondent is a Umited Ucbility Compmy). (3) I have revieNed the Aorida Depa'tment of Menc.gementS:lrvices website a the following URL a:ldress: http://www.dms.myfloridacomlbusiness_operaionslstae-purchasing'vendoUnformaion/convicted_SUspended_di scriminaory_compicints_vendorJists (4) I hale entered al • X' or a check mark beside ean listingca:egory set forth below if the Respondent's nana cwecrs in the list found on the Rorida Depa-tment of Mal¥ffienl S3rvices website for tha cctegory or listing. If I did not enter a mark beside a listingca:egory it IllealS tha I an atesting to the fa:t tha the Respondent's nane does not qlpea' on the listing for tha ca:egory in the Rorlda Depcrtrnent of Mal~ S:Jrvices website as of the dae of this affidavit. Check if Appliccble Convicted Vendor Ust SJspended Vendor Ust Discriminaory Vendor Ust Federa B<cluded A:rties Ust Vendor Complcint Ust ACKNOWLEDGEMENT STATE OF FLORIDA ) COUNTY OF MIAMI-DADE ) OlJ.,tt3is the ~ dClJ of ~o.L..k..-, before me, the undersigled arthorlty, pera>naly Eppea'ed 4z1hfJ/U11:k D ~ _ _ . who is pera>naly know to me or who provided the following Identificction ald who took al oah or affirmed thct thct helshelthey executed the foregoing Affidavit as the Declarant. W ITN ESS my hald and officia sea. NOTARY PUBLIC: ThomasF. Pepa 02-23-15 SEAL 16 Notary A.lblic, Sae of orida ,I., e.f) . § ~ eolJJlfll- (Name f Notary Rlblic: A'int, Samp or type as commissioned.) '~"'M~~=~!::::96 • . .eXPIRES AligUat.17:20it: . '1oriIIINoI rke.IlGIII·· ". RELATED PARTY TRANSACTION VERIFICATION FORM ~u~~~~e~aSd~~~=~~~~ bf~f~i~y£?~i M~f.Q})~~SeOfahl~ S3ctlon SA-1 of the City's Code of Ordincnces md I hereby certify, under penaty of perjury thct to the best of my knowledge, Informalon end belief: (1) neither I nor the Rrm have cny conflict of interest (as defined in section BA-1) with regc:rd to the contrai or busness thct I, end/or the Rrm, an(CI'e) mout to perform for, or to tralSCd with, the City, end (2) neither I nor eny employees, officers, directors of the Rrm, nor enyone who has a fincncia interest gecter thm 5% in the Rrm, has eny relctive(s), as defined in section 8A-1, who is en employee of the City or who is(a-e) m qJpointed or elected officia of the City, or who is(a-e) a member of my public body erected by the City Commission, i.e., a boCl'd or committee of the City, [while the ethics code still cppIies, if the person executing this form is doing so on behaf of a firm whose stock is publicly trmed, the staement in this section (2) shSl be based solely on the siglctory's persona knowl~ md helme Is not required to mcke S1 independent investig:tion as to the relctionship of employees or those who have a fincncla interest in the Rrm.]; md (3) neither I nor the Rrm, nor myone who has a finma interest gecter thm 5% in the Rrm, nor my member of those persons' immedicte fanily (i.e., spouse, pa"ents, children, brothers S1d sisters) has trmscded or entered into eny contract(s) with the City or has a fincncia interest, direct or indirect, in any business being trmsacted with the city, or with CI'rf person or agency aiingfor the city, other thm as follows: _(use (if necessa-y, use a sepcrcte sheet to supply mditiona informction thct will not fit on this line; however, you must mcKe reference, on the move line, to the mditiona sheet end the alditiona sheet must be signed under oah). [while the ethics code still qJplies, if the person executing this form is doing so on beIlaf of a firm whose stock is publicly trmect, the stctement in this section (3) &hal be based solely on the siglctory's persona knowledgs md helehe is not required to mcKe m independent investig:tion as to the relaionehip of those who hate a fincncia interest in the Rrm.]; md (4) no elected mdlor cppointed officia or employee of the City of SJuth Miani, or eny of their immedicte fanny members (i.e., spouse, pa"ents, children, brothers a1d sisters) has a fincncia interest, directly or indirectly, in the contract between you mdlor your Rrm a1d the City other thm the following individuas whose interest is set forth following their use a sepcrcte nanes:._~:---:-:-~~_~--::::--~_~-::---:-__ _ (if n~y, use a sepcrcte sheet to supply mditiona informaion thct will not fit on this line; however, you must ma<e reference, on the a.>ove line, to the mditiona sheet md the mditiona sheet must be sigled under oah). The na"neS of al City employees a1d thct of al elected mdlor ~inted city officias or boCl'd members, who own, directly or indirectly, m interest of five percent (5°~ or more of the tota assets of cepita stock in the firm a-e as follows: (if neoessa-y, use a sepcrcte sheet to supply mditiona informaion thct will not fit on this line; however, you must mcKe reference, on the ct>ove line, to the mditiona sheet a1d the additiona sheet must be sigled under octh). [while the ethics code still ~plies, if the person exeruting this form is doing so on beIlaf of a firm whose stock is publidy trmed, the staement in this section (4) shal be bmed solely on the sig1Ctory's persona knowledge and helehe is not required to mcKe m independent investig:tion as to the finma interest in the Rrm of city employees, ~inted officias or the immedicte fanily members of elected cndIor cwointed officia or employee.] (5) I md the Rrm further agee not to use or cttempt to use eny knowledge, property or resource which Il1C¥ corne to us throLJgl our position of trust, or throLJgl our perfor/l1a1Ce of our duties under the terms of the contract with the City, to secure a speda privilege, benefit, or exemption for ourselves, or others. We ~ee tha we Il1C¥ not di~ose or use informaion, not availEble to members of the genera public, for our persona g:in or benefit or for the persona gan or benefit of my other person or business entity, outside of the norma g:in or benefit anticipaed throug, the performmce of the contract. (6) I a1d the Rrm hereby a;knowledge tha we have not contraied or trmsacted cny business with the City or any person or aJf3I1CY acting for the City, md thct we have not cppecred in representction of any third pa"ty before eny boCl'd, commission or cgancy of the City within the past two yea's other thm as Thomas F. Pepe 02-23-15 17 follows: 'Uf SOld 4-swcrr TI'Ct01 )£",,"'5 on ()f,)05~Z()\\O (if necesscry, use a sepa-ae sheet to supply a:kIitiona Informction tha will not fit on t is hne; however, you must ma<e reference, on the Itlove line, to the a:lditiona sheet a1d the a:lditiona sheet must be sigted under oah). X:\RJrchasing\Vendor Re9straion\12.28.12 R8.A TED PARTY TRAN s\CTION V81IACATION FORM [3].docx (7) N either I nor my employees, officers, or directors of the Rrm, nor aly of their immediae fanily (i.e., as a spouse, s:m, daJgrter, pa'ent, brother or sister) is relaed by blood or mcrri~ to: (i) my member of the City Commission; (ii) my city employee; or (iii) my member of my boa-d or ¥I'1CY of the City other that as follows: ~_-,-~~~~~ __ ~~ _____ ,(if necesscry, use asepa-ae sheet to supplya:lditlona informaion tllet will not fit on this line; however, you must ma<e reference, on the Itlove line, to the a:lditiona sheet a1d the a:lditiona sheet must be sigted under oah). [while the ethics code still £WIies, If the person executing this form Is doing so on beIlaf of a firm whose stock Is publldy trated, the staement in this section (7) shal be based solely on the sipory's persona knowledge a1d he/she is not required to ma<e m Independent investigetion as to the relaionship by blood or mS'ri~ of employees, officers, or directors of the Rrm, or of my of their immediae fanily to my ~inted or elected officias of the City, or to their immediae fanily members]. (8) No Other Rrm, nor my officers or directors of tha: Other Rrm or alyone who hcs a finmda interest greaer thal5%in tha Other Rrm, nor fIIY member of those personS immediae fanily (i.e., spouse, pa-ents, children, brothers a1d sisters) nor fIIY of my Immediae fanily members (hereinater referred to as" Relited Pa'ties") has responded to a solicitaion by the City in which I or the Rrm tha I represent or fIIyone who has a finmda interest greaer that 5% in the Rrm, or my member of those personS Immediae fanily (i.e. spouse, pa'ents, children, brothers a1d sisters) have aso responded, other thal the following: ___________ --.,.. ___ -----------,-------(If necesscry, use a sepa-ae sheet to supply a:lditiona informction tha: will not fit on this line; however, you must lllC'ke reference, on the Itlove line, to the a:lditiona sheet a1d the a:lditiona sheet must be sigted under oah). [while the ethics code still cpplies, if the person executing this form is doing so on beIlaf of a firm whose stock is publidy tra:led, the staement in this section (8) shal be based solely on thelligtaory's persona knowledge fIId helshe is not required to l'Tv:ke fII independent investigetion into the Other Rrm, or the Rrm he/she represents, as to their officers, directors or fIIyone haJlng a finalcla Interest In those Rrms or fIIY of their fIIy member of those persons' immediae fanily.] (9) I a1d the Rrm ~ee tha we a-e obJigeted to supplement this Verificction Form a1d inform the City of fIIy chfllge in cirrumsta1CeS tha would chfIIge our fIIswers to this dorument. ~fically, ater the opening of fIIy responses to a solicitaion, I a1d the Rrm have fII obligetion to supplement this Verificction Form with the nana of al Relaed Pa'ties who have aso responded to the sane sollcitaion a1d to dis::lose the relaionship of those pS'ties to me mel the Rrm. (10) A violaion of the City's Bhlcs Code, the 9ving of fIIy false informction or the failure to supplement this Verificction Form, may subject me or the Rrm to immediae terminaion of my ag'eernent with the City, fIId the Imposition of the macimum fine fIId/or fIIY penaties alowed by lew. Additionaly. viola Ions I11EtI be considered by a1d subject to a;tion by the Miani·Dade County Commission on Bhies. Under penaty of perjury, I deda-e thlt I have ma:le a diligent effort to investigetethe rnatersto which I an atesting hereinsbove a1d tha the staements ma:le hereinltlove a-e true corr. 0 the best of my knowledge, informaion fIId belief. ( Spure:_~~~~£;~~:p- A'int Nane& Dae: f-z.JO<6JZOty ThomasF. Pepe 02-23-15 18 Sec. 8A-1. -Conflict of interest and code of ethics ordinance. (a) Designation. This section shal be clesiglCted and known as the "City of Sluth Miani Conflid of Interest and Code of Bhies Ordinmce." This section shal be E4lPIicctJle to al city perronnel as defined below, and shal aso constitute a standa-d of ethica conduct and behavior for al artonomous personnel, quasi-judicia personnel, ajvig)ry personnel and depa-tmenta perronnel. The provisions of this section mal be ~ied in a cumuletive Il1alner. ~ wCfJ of exanple, and not as a limitaion, subsections (c) and (d) IMf be cwIied to the sane contra:t or transa:tion. (b) Definitions. For the purposes of this section the following definitions WIll be effective: (1) The term "commission members' mal refer to the mcvor and the membersofthe city commission. (2) The term "artonomous perronnel" mal refer to the members of artonornous arthorities, boa-ds and c:gencies, such as the city community redevelopment C99f1CY and the heath fa::ilities arthority. (3) The term "quasi-judicia personnel" mal refer to the members of the planning boa-d, the environmenta review and preservction boa-d, the code enforcement boa-d and such other individuas, boa-ds and <:g3I1cies of the city as perform quasi-judicia functions. (4) The term "a:!visory personnel" sheil refer to the members of those city a::Mg)ry boa-ds and cgencies whose role or prima-y responsibility is to recommend legsletion or gve a::Mce to the city commission. (5) The term "clepcrtmenta perronnel" sheil refer to the city clerk, the city rtlCI'lCger, depa-tment hea:is, the city ettorney, and al assistants to the city clerk, dty ~ and city ettorney, however titled. (6) The term "employeeS' mal refer to all other perronnel employed by the city. (7) The term "compensction" shall refer to any money, gft, favor, thing of vaue or financial benefit conferred, or to be conferred, in return for services rendered or to be rendered. (8) The term "controlling financial interest" shal refer to ownership, directly or indirectly, of ten percent or more of the outstanding ~ta stock in my corporetion or a direct or indirect interest of ten percent or more in a firm, pcrtnership, or other business entity et the time of transa:ting business with the dty. (9) The term "jmmediete fanily" shall refer to the spouse, pa-ents, children, brothers and sisters of the person involved. (10) The term "transa:t any business" sheil refer to the purchase or sae by the city of specific !pods or services for consideretion and to submitting a bid, a proposa in response to a RFP, a steternent of quaificaions in response to a request by the city, or entering into contra:t neg:>tietions for the provision on my !pods or services, whichever first occurs. (c) Prohibition on transacting businesswith the city. No perron included in the terms defined in pa-cgaphs (b)(1) throug, (6) and in pa-cgaph (b)(9) shal enter into any contrC¥i or transa::t any business in which thet person or a rnernber of the immecliete fa'nily has a financial interest, direct or indirect with the dty or any perron or ~ a:ting for the dty, a1d any such contra:t, . cg-eement or business ~ entered in violetion of this subsection shal render the transa:tion voidctlle. Willful violet ion of this subsection shal constitute rnafeasance in office and shall aIfect forfeiture of office or position. Nothing in this subsection mal prohibit or mcKe iIIega: (1) The ~ of taces, special assessments or fees for services provided by the city !pvernment; (2) The purchase of bonds, antidpction notes or other securities thct I11aJ be issued by the city throug, underwriters or directly from time to time. Wsdver of prctil:4tial. The requirements of this subsection Il1af be waved for a pa-ticula-trmmion only by four c:tfirrnaive votes of the city commission Ster public hearing upon finding tlla: (1) An open-to-al seaed competitive proposa has been atbmitted by a city person as defined in pa-cgaphs (b) (2) , (3) and (4); (2) The proposa has been submitted by a person or firm offering services within the ro:>pe of the pra:tice of a-chitecture, professiona engneering, or regstered land surveying, as defined by the IaN'S of the stete and pursuant to the provisions of the Consultmts Competitive N eg:>tietion Ad, and when the proposa has been submitted by a city person defined in pa-cg~s(b)(2), (3) and (4); (3) The property or services to be involved in the proposed transa::tion a-e unique and the city cannot CPJaiI itself of such property or services without entering a transcaion which would violae this subsection but for waiver of its requirements; and (4) TIla the proposed tranmion will be in the best interest of the city. This subsection shall be ~icable only to prospective transa:tions, a1d the city commission Il1af in no case retify a transa:tion entered in violetion of this subsection. R"o.4sC1lS amJative. This subsection mal be tcken to be cumuletive and mal not be construed to anend or repea ffl'J other IaN pertaining to the sane subject metter. (d) Further prohibition on transacting bUsiness with the city. Thomas F. Pepe 02-23-15 19 No person included in the terms defined in pcrq~ (b)(1) throug, (6) a1d in pcrq~ (b)(9) mal enter into 'MY contra::t or tra1Sl:t my business throug, a firm, corporetion, pcrtnership or business entity in which thct person or any member of the immediete fanily has a controlling financial interest, direct or indirect, with the dty or any person or a.J:lOCY a::ting for the city, and 'MY such contra::t, qeement or business ~ entered in violet ion of this subsection mal render the transa::tion voidct>le. The remaning provisions of subsection (c) will also be ~lic3:lle to this subsection as thoug, incorporeted by recittiion. Additionally, no person included in the term defined in pcrq""h (b)(1) shall vote on or pcrtidpcte in my w2IJ in my metter presented to the dty commission if thct person has 'MY of the following reletionships with my of the persons or entities which would be or migrt be directly or indirectly ctfectecl by any a::tion of the dty commission: (1) Officer, director, pcrtner, of counsel, consultmt, employee, fiduciery or benefidery; or (2) Sockholder, bondholder, debtor, or creditor, if in any instance the transcaion or metter would afect the person defined in pcrq~ (b}(1) in a mmner distinct from the mmner in which it would ctfect the public generally. Any person included in the term defined in pcrq~ (b)( 1) who has any of the specified reletionships or who would or mig,t, directly or indirectly, reaize a profit by the a::tion of the dty commission mal not vote on or pcrticipcte in any wClf in the metter. (E) Gifts. (1}Defilition. The term "gft" mal refer to the transfer of mything of economic vaue, whether in the form of money, service, loan, traJel, entertanment, hospitality, item or promise, or in any other form, without a:fequcte ancIlaNful consideretion. (2}Exa:ptions. The provisions of P<l'evCl'h (e)(1) shall not ""ply to: a Fblitical contributions specifically arthorized by stete IaN; b. Gifts from reletives or members of one's household, unless the person is a conduit on behalf of a third pcrty to the delivery of a gft thct Is prohibited under pcrevCl)h(3); c. Awerds for professional or dvic a::hievernent; d. Mal:erial such as books, reports, periodicals or pcrnphlets which ere solely informetional or of an a:lvertising ncture. (3) A'dibitions. A person des:ribed in pcrqCl)hs (b)(1) throtJgl (6) shall neither solidt nor demand my gft. It is also unlaNful for any person or entity to offer, gva or qee to gva to my person included in the terms defined in pcrqCl)hs (b)(1) throug, (6), or for my person included in the terms defined In pcrq""hs (b)(1) throug, (6) to a::cept or evee to a::cept from another person or entity, my 9ft for or becaJse of: a An official public a::tion tal<en, or to be tal<en, or which could be tal<en, or m omission or failure to tal<e a public aiion; b. A legal duty performed or to be performed, or which could be performed, or m omission or falure to perform a legal duty; c. A legal duty violal:ed or to be violeted, or which could be violeted by any perron included in the term defined in pcrqCl)h (b)(1); or d. Attendmce or absence from a public meeting et which offidal a::tion is to be tal<en. (4) Dis;:iosure. Any person included in the term defined in pcrq""hs (b)(1) throug, (6) shall di~ose my 9ft, or series of gfts from anyone perron or entity, having a value in excess of $25.00. The di~osure shall be ma:fe by filing a copy of the di~osure form required by chCl>ter 112, Rorida Setutes, for "local officers' with the city derk simultaneously with the filing of the form with the derk of the county and with the Rorida ~etary of Sal:e. (f) Compulrory dis;losure by employees of firms doing business with the city. Slould my perron included in the terms defined in parq~ (b)(1) throug, (6) be employed by a corporetion, firm, pcrtnership or business entity in which thct person or the immediete fanily does not have a contrOlling financial interest, md should the corporetion, firm, pcrtnership or business entity have substmtial business commitments to or from the city or any city ~, or be subject to direct reg.detion by the city or a city C99I'lcy, then the perron shall file a SNorn stal:ement di~osing such employment and interest with the clerk of the city. (g) Exploitation of official position prohibited. No person included in the terms defined in P<l'ev~ (b )(1) throug, (6) shcjl corruptly use or al:ternpt to use m official position to secure special privileges or exemptions for thet person or others. (h) Prohibition on use of confidential information. No person included in the terms defined in pcrq~ (b)(1) throug, (6) shall a:cept employment or ~ in my busin8$ or professional a::tivity which one mig,t recB:lnablyexpect would require or induce one to di~ose confidential informction a:quired by reason of an official position, nor shall thet perron in fa::t ever di~ose confidential informction garnered or g:ined throug, an official position with the city, nor shall thct perron ever use such inforrnction, directly or indirectly, for per~naI !Jin or benefit. Thomas F. Pape 02-23-15 20 (i) Conflicting employment prohibited. No per~:m included in the terms defined in pa-q~(b)(1) throug, (6) shal a::oept other employment which would impar independence of judgnent in the performmce of my public duties. (j) Prohibition on outside employment. (1) No penon included in the terms defined in pa-q~ (b)(6) shal receive my compensction for services as m officer or employee of the city from my 9:)urce other tha1 the city, except as may be permitted as follows: a Q:nera!ly prdlibited. No fuJI-time city employee SlaII a::oept outside employment, either incidenta, occa;jonaJ or otherwise, where city time, equipment or meteris is to be used or where such employment or my pat thereof is to be performed on city time. b. Wha1 pemitted. A fuJI-time city employee may ax:ept incidents or occasiana outside employment 9> long as such employment is not contra-y, detrimenta or a:lverse to the interest of the city or my of its depa-tments end the Cllprova required in subpa"qi:ph c. is obtaned. c. Approva of clepa"tment heal required. Any outside employment by my full-time city employee must first be CllPfoved in writing by the employee's depcrtment heaj who shal mantan a complete record of such employment. d. RlrBty. Any per9>n convicted of violaing my provision of this subsection shal be puniS1ed as provided in section 1-11 of the Code of Micmi·Da::Ie County end, in a::Idition SlaII be Qlbject to disnissa by the CllPOinting arthority. The city may a9:) assess ~nst a vioh:tor a fine not to exceed $500.00 end the costs of investig;tion incurred by the city. (2) All full-time city employees et1g':99d in my outside employment for my pef9>n, firm, corporction or entity other thm the city, or my of its C'9lIlcies or instrumentaities, shal file, under oeth, m mnua report indiccting the 9>urce of the outside employment, the ncture of the work being done WId any allOunt of money or other consideraion received by the employee from the outside employment. City employee reports shal be filed with the city derk. The reports shal be arcilctlle et a rea9Jnltlle time end pla:e for inspection by the public. The city mmcger may require monthly reports from individua employees or goups of employees for $Pod cause .. (k) Prohibited investments. No per9:)n included in the terms defined in pa-q~ (b)(1) throug, (6) or a member ofthe immediete family SlaII hate perrona investments in my enterprise which will aeae a substmtis conflict between privcte interests end the public interest. (I) Certain appearances and payment prohibited. (1) No person induded in the terms defined in pa-qi:phs (b)(1), (5) WId (6) shal Cllpea' before my city boa-d or c.gency and rnci<e a presentetion on behaf of a third per~m with respect to my metter, license, contract, certificcte, ruling, decision, Opinion, rete schedule, fra1chise, or other benefit 9:)ugu by the third person. Nor SlaII the per9:)n receive my compensction or 9ft, directly or indirectly, for services rendered to a third per9>n, who has cppIied for or is seeking some benefit from the dty or a city ~, in connection with the pa1icula-benefit sougu by the third person. Nor shal the person Cllpea' in my court or before my a::Iministretive tribuna as counselor lega a::Ivisor to a pa-ty who seeks lega relief from the city or a city coency throlJStl the suit in question. (2) No person induded in the terms defined in pa-C'g'~ (b)(2), (3) end (4) shal Eppecr before the city commission or ~ on which the person serves, either directly or throug, m associete, WId rnS<e a presentaion on behaf of a third per9>n with rel1{)Elct to my metter, license, contra::t, certificcte, ruling, decision, opinion, rae !dledule, frcnchise, or other benefit soug,t by the third perron. Nor shal such per9:)n receive my col'l1pElllSC:tion or 9ft, directly or indirectly, for services rendered to a third pa-ty who has cppiied for or is seeking some benefit from the citycommiSliion or c.gency on which the per9:)n serves in connection with the pa-ticula- benefit 9:)ug,t by the third pa-ty. Nor shal the person cppea-in my court or before my a::Iministraive tribuna as counselor lega a::Ivisor to a third pa-ty who seeks lega relief from the city commiSliion or cgency on which such person serves throug, the suit in question. (m) Actions prohibited when financial interests involved. No person induded in the terms defined in pa-q~ (b) (1) throug, (6) shal pa-tidpcte in my offids action directly or indirectly ctfecting a business in which thct person or my member of the immediete fanily has a finalCia interest. A fincncia interest is defined in this Qlbsection to indude, but not be limited to, my direct or indirect interest in my investment, equity, or debt. (n) Acquiring financial interests. No person induded in the terms defined in pa-q~ (b)(1) throu!tl (6) shal a:quire a finmcia interest in a project, business entity or propertyet a time when the per9:)n believes or has reason to believe thct the finmcia interest ~ be directly cifected by officia a::tions or by officis actions by the city or city cgency of which the person is a'I officia, officer or employee. (0) Recommending profeSliional services. Thomas F. Pepe 02-23-15 21 No person included in the terms defined in pcrcgq')hs (b)(1) throug, (4) may recommend the services of Sly laNyer or lav firm, a-dlitect or a-dlitectural firm, public relctions firm, or my other person or firm, professiona or otherwise, to assist in Sly trEi"1&dion involving the city or my of its cgencies, provided thct a recommendction may properly be lTIiiIie when required to be lTIiiIie by the duties of office CTld in a:Iva1ce ct a public meeting cttended by other city officials, officers or employees. (p) Continuing application after city service. (1) No person included in the terms defined in pcrcg~ (b}(1), (5) CTld (6) shall, for a period oftwo yea-s after his or her city service or employment hcB ceased, lobby SlY city official [as defined in pcrcg~ (b)(1) throug, (6)] in connection with my judidal or other proceeding, ~icction, RFP, RFO, bid, request for ruling or other c1eterminction, contrai, daim, controversy, char~, a:cusaion, crrest or other pcrticulcr subject metter in whidl the dty or one of its ~es is a pcrty or hcB my interest whctever, whether direct or indirect. Nothing contained in this subsection shall prohibit my individual from submitting a routine a:lministrctive request or ~icction to a city depcrtment or CV3f1CY during the two-yea-period clter his or her service hcB ceased. (2) The provisions of the subsection shall not ~ply to persons who become employed by governmental entities, 501(c)(3} non-profit entities or educctional institutions or entities, 81d who lobby on behalf of those entities in their official ~ties. (3) The prOvisions of this subsection shall c:wIy to all persons des::ribed in pCTcg~ (p}(1) whose city service or employment ceased after the effective dcte of the ordincnce from which this section derives. (4) No person d~ibed in pcrcgcph (p)(1) whose city service or employment ceased within two yecrs prior to the effective dale of this ordincnce shal for a period of two yecrs after his or her service or employment enter into alobbyingcontrai to lobby my city official in connection with my subject d~ibed in pcrcg~ (p}(1) in which the city or one of its ~es is a pcrty or hcB Sly direct CTld substmtial interest; 81d in which he or she pcrticipcted directly or indirectly throug, decision, ~ova, dise.,proval, recommendalion, the rendering of a:Mce, investigtion, or otherwise, during his or her dty service or employment. A person pcrticipcted "directly" where he or she was substantially involved in the pcrticulcr subject metter throug, decision, ~oval, discpprova, recommendction, the rendering of a:lvice, investig:tion, or otherwise, during his or her dty service or employment. A person pcrticipcted "indirectly" where he or she knowingy pcrticipcted in SlY Wat in the pcrticula- subject metter throug, decision, ~oval, discpprova, recommendction, the rendering of a:lvice, investig:tion, or otherwise, during his or her city service or employment. All persons covered by this pcrcgcph shall execute m ctfidavit on a form ~proved by the city cttorney prior to lobbying Sly city official cttesting thct the requirements of this subsection do not pradude the person from lobbying city officials. (5) Any person who violctes this subsection shall be subject to the penalties provided in section SA-2(p}. (q) City attorney to render opinions on request. Whenever my person included in the terms defined in pcrcg~ (b)(1) throug. (6) md pcrcg~ (b)(9) is in doubt as to the proper interpretction or CllP/icction of this conflict of interest 81d code of ethics ordinmce, or whenever Sly person who renders services to the city is in doubt as to the c:wIiccbility of the ordin81ce thct person, mat submit to the city cttorney a full written stctement of the fa::ts and questions. The city cttorney shall then render 81 opinion to such person 81d shall publish these opinions without use of the ncrne of the person a:Msed unless the person permits the use of a nCTne. (Ocl. No. 6-99-1680, §2, 3--2-99) 8:ita's nete-Ord. No. 6-99-1680, § 1, a:lopted 3--2-99, repealed §§ 8A-1 md 8A-2 in their entirety 81d replaced them with new §§ aA·1 CTld SA-2. Former §§8A-1 81d 8A-2 pertained to dada-ction of polic..y 8ld definitions, respectively, and derived from Ord. No. 634, §§ 1 (1A-1), 1 (1A-2) a:Iopted JI1.11, 1969. Thomas F. Pepa 02-23-15 END OF8:CTION 22 PRESENTATION TEAM DECLARATION/AFFIDVAIT OF REPRESENTATION This affidavit is not required for compliance with the City's Solicitation; however, it may be used to avoid the need to register members of your presentation team as lobbyists. Pursuant to City Ordinance 28-14- 2206 (c)(9), any person who appears as a representative for an individual or firm for an oral presentation before a City certification, evaluation, selection, technical review or similar committee, shall list on an affidavit provided by the City staff, all individuals who may make a presentation. The affidavit shall be filed by staff with the Clerk's office at the time the committee's proposal is submitted to the City Manager. For the purpose of this subsection only, the listed members of the presentation team, with the exception of any person otherwise required to register as a lobbyist, shall not be required to pay any registration fees. No person shall appear before any committee on behalf of an anyone unless he or she has been listed as part of the firm's presentation team pursuant to this paragraph or unless he or she is registered with the City Clerk's office as a lobbyist and has paid all applicable lobbyist registration fees. Pursuant to '92.525(2), Florida Statutes, the undersigned, baH" Bca.h I LLC. makes the following declaration under penalty of perjury: Listed below are all individuals who may make a presentation on behalf of the entity that the affiant represents. Please note; No person shall appear before any committee on behalf of anyone unless he or she has been listed as part of the firm's presentation team pursuant to this paragraph or unless he or she Is registered with the Clerk's office as a lobbyist and has paid all applicable lobbyist registration fees. \?uslck:n± For the purpose of this Affidavit of Representation only, the listed members of the presentation team, with the exception of any person otherwise required to register as a lobbyist, shall not be required to pay any registration fees. The Affidavit of Representation shall be filed with the City Clerk's office at the time the committee's proposal is submitted to the City as part of the procurement process. Under penalties of perjury, I declare that I have read the foregoing declaration and that the facts stated in it are true and specifically that the persons listed above are the members of the presentation team of the entity listed below Thomas F. Pepe 01·13·15 Ofl-i+ BOA1, LLC, Print name of entity being represented END OF SECTION 23 EXHIBIT 3 CONTRACT FOR ACTIVE SHOOTER KITS AND TRAINING ITQ #PD2016·24 THIS CONTRACT, entered Into this -1L day of DtC<rob.OL ' 20l!L, by the CITY OF SOUTH MIAMI through its Manager, both of whom shall be hereinafter referred to as the "CITY" where applicable; located at 6130 Sunset Drive, South Miami, FL. , E-mail: salexander@southmiamifl.gov and C1~.H Boro I l ( l C with an office and principal place of business located at 1540lP ~ 111. 51: Inlaml/,cftJ'tP'f?mail address of ~ei!b4tnIIt'.@~rnajl.~and Facsimile transmission number of __ (hereinafter called the CONTRACTO "). I'l') WITNESSETH: WHEREAS, the CITY is in need of ActN'f.. fib 00+01« Jt.it~ ~ TU!r~ ; and WHEREAS, the CITY desires to retain CONTRACTOR to provide e required goods and/or services based on CONTRACTOR's representations which reflect that CONTRACTOR is qualified and capable of providing said goods and/or services in a professional and timely manner and in accordance with the CITY's goals and requirements; and WHEREAS, CONTRACTOR has agreed to provide the required goods and/or services in accordance with the terms and conditions set forth herein. NOW, THEREFORE, in consideration of the mutual covenants and agreements herein c.ontained, the parties agree as follows: 1) Engagement of Contractor: Based on the representations of CONTRACTOR as set out in the following "checked" documents the CITY hereby retains CONTRACTOR to provide the goods and/or services set forth in said proposal, quote or response to solicitation, whichever is applicable, as modified by the Contract Documents, or as is otherwise set forth in the Contract Documents defined below (all of which is hereinafter referred to as the Work"). (Check the box immediately preceding the document described below to indicate that such document is part of this Contract) " Contractor's response to the CITY's written solicitation; or " Contractor's proposal or quote, or if none, o As described in paragraph 2 below. 2) Contract Documents: The Contract Documents shall include this Contract and the following "checked documents", as well as any attachments or exhibits that are made a part of any of the "checked documents". (Check the box immediately preceding the document described below to Indicate that such document is part of this Contract) o General Conditions to Contract, o Supplementary Conditions, . " "Other Documents" referring to in this Contract and signed by the parties, " Solicitation documents ("hereinafter referred to as "Bid Documents" including any request for bid, request for proposal or similar request) " Scope of Services, " Contractor's response to the CITY's Bid Documents, " Contractor's proposal or quote, " CITY's Insurance & Indemnification Requirements, o Bonding of Employees (the term "employee", as used in this Contract, shall include volunteers) -$1,000,000 o Payment Bond, o Performance Bond, This Contract and the General Conditions to Contract, Supplementary Conditions, the Solicitation, Scope of Services and "Other Documents", if any are "checked documents", shall take precedent over the response to the CITY's Bid Documents, If any, or the proposal or the Thomas F. Pepe 2016 07/29/16 24 quote, if any. The "checked documents" are attached hereto and made a part hereof by reference. 3) Date of Commencement: CONTRACTOR shall commence the performance of the Work under this Contract on TOO or a date to be specified in a Notice to Proceed, or Purchase Order, (hereinafter referred to as the "Work Commencement Date"), and shall complete the performance hereunder within TOO days or the length of time set forth in the Contract Documents, whichever is the shorter period of time. Time Is of the essence. 4) Primary Contacts: The Primary Contact Person in charge of administering this Contract on behalf of the CITY is the City Manager ("Manager"), assistant Manager, or the Manager's designee, who shall be designated in a writing signed by the Manager. The Primary Contact Person for CONTRACTOR and his/her contact information is as follows: Name: ~f>ltfp' g\~~Stm~f~1~~lt~~~m .01R Street Address: 5) Scope of Services: The goods and/or services to be provided are as set forth in the "checked documents". 6) Compensation: The CONTRACTOR's compensation for CONTRACTOR's performance under the terms and provisions of this Contract, or CONTRACTOR's payments in the event CONTRACTOR is paying the City for the uses of the CITY's property or services, (hereinafter referred to as the Contract Price) shall be one of the following, as indicated by one of the following checked box, c $ I~ I 000 or as set forth in c CONTRACTOR's response to the CITY's written solicitation, If any, or, if none, then as set out In CONTRACTOR's proposal or quote, the Scope of Services, or as set forth in, or modified by, one of the Contract Documents, whichever is applicable. 7) Hours of Work: In the event that this Contract requires the performance of services, it is presumed that the cost of performing the Work after regular working hours, and on Sunday and legal holidays, is included in the Contract Price. However, nothing contained herein shall authorize work on days and during hours that are otherwise prohibited by ordinance unless specifically authorized or instructed in writing by the City Manager, the Manager's assistant or designee. 8) Time Provisions: The term of this Contract shall commence on the Work Commencement Date and shall continue for one (1) year or until it expires on _____ -', or unless earlier terminated according to the Contract Documents. Notwithstanding the foregoing, this Contract may be extended by an additional N/A period if the extension is in writing and signed by the City Manager. An extension of the term of this Contract is at the CITY's sole and absolute discretion. 9) Termination: This Contract may be terminated without cause by the CITY with 30 days of advanced written notice. This provision supersedes and takes precedence over any contrary prOVisions for termination contained in the Contract Documents. 10) Applicable Law and Venue: Florida law shall apply to the interpretation and enforcement of this Contract. Venue for all proceedings shall be in Miami-Dade County, Florida. 11) Duties and Responsibilities: CONTRACTOR shall comply with all applicable laws, ordinances, codes, rules, regulations, and health and safety standards of any governmental body having jurisdiction over any matter related to this Contract or the goods and/or services to be performed hereunder, and shall commit no trespass on any private property in performing any of the work embraced by this Contract. Each and every provision and/or clause required by law to be inserted in this Contract shall be deemed to be inserted herein and this Contract shall be read and enforced as though such provisions and/or clauses were included herein. 12) Change Orders: No additional Work or extras shall be done unless the same is duly authorized in writing and in advance of the work by appropriate action by the City Manager and in accordance with the Contract Documents. Thomas F. Pepe 2016 07129/16 25 13) Ucenses and CBtifications: Qmtractor shall secure all necessary business S1d profesSonai licenses at its ~Ie expense prior to executing this Q>ntract or oommendng the Work. 14) Insuranoo, Indemnification & Bonding: o::M'RA.CfCR shall oomply with the insurance, indemnification and bonding requirementsset forth in the O:>ntract Documents. 15) Uquidated Damages: In the event that CXNfR4\CJtR shall fail to romplete the Work within the time limit set forth in the O:>ntract Oxuments, or the extended time limit agreed upon, in amrdanoo with the procedure as more pcrtia.dcrly set forth in the O:>ntract [))ajrnents, liquidated danages shall be paid at the rate of $ NI A dollars WI" day until the Work is rompleted. 16) .1Jry Trial Waiver: The paiieswaivetheir ridlt to jury trial. 17) 81tire Agreement, Modification, and Non-waiver: The O:>ntract Qx:uments oonstitute the entire ~eement of the paties and supersedes any prior ~eements, written or oral. The O:>ntract Qx:uments may not be modified or anended except in writing, signed by both pCl"ties hereto md if this O:>ntract is required to be approved by the aty O:>mmission, all an1endments thereto must be approved in the same manner and with the same formality as this O:>ntract. The O:>ntract Oxuments, in general, and this pa-~aph, in patirular, shall not be modified or anended by any acts or omissions of the pmies. No failure to exerdse and no delay in exerdsing any ridlt, power or privilege shall operate as a waiver. No waver of the Q>ntract ilx:uments, in whole or part, including the provisions of this par~aph, may be implied by any act or omission. 18) A.lblic R3oords: o::M'RA.CfCRand all of its suboontractors are required to oomply with the public reoords IaN (s.119.0701) while providing goods and! or services on behalf of the OlY and the a:NJRA.CrOR, under such ronditions, shall inoorporate this paragaph in all of its suboontracts for this A"oject and shall: (a) K'eep and mantan public reoords required by the public agenOJ to perform the servioo; (b) Upon request from the public agency's rustodian of public reoords, provide the public agenOJ with a oopy of the requested reoords or allow the reoords to be inspected or oopied within a reasonable time at a oost that does not exceed the oost provided in this chapter or as otherwise provided by law; (c) Ehsure that public reoords that are exempt or oonfidential and exempt from public reoords disclosure requirements are not ditdosed except as authori2Bd by IaN for the duration of the O:>ntract term S1d follOWing completion of the O:>ntract if o::NTRACrCR does not tralsfer the reoords to the public agenc.y; and (d) Upon rompletion of the O:>ntract, transfer, at no rost, to the publicagenc.y all public reoords in possession of o::NTRACrCRor keep S1d maintain public reoords required by the public agenOJ to perform the servioo. If o::NTRACrCR transfers all public reoords to the public agenOJ upon oompletion of the O:>ntract, CXl'-JlRA.CT<R shall destroy any duplicate public reoords that are exempt or confidential and exempt from public records dis::losure requirements. If o::NTRACrCR keeps a1d maintans public records upon oompletion of the O:>ntract, o::NTRACrCRshail meet all applicable requirements for retaining public reoords. ,AJI records stored electronically must be provided to the public agenc.y, upon request from the public agency's rustodiS1 of public reoords, in a format thct is oompatible with the informction technology systems of the public agenOJ. IF CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO TIllS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT 305-663-6340; E-mail: mmenendez@southmiamifl.gov; 6130 Sunset Drive, South Miami, FL .33143. 19) Background S::reening. All per~nnel and volunteersthat will provide any servi~ with vulnerable permns, asdefined in S!d:ion 435.02, Ra SaI:., involving the Oty or its Thomas F. Pepe 2016 07129/16 26 Agency in such related activity or who may have access to secure or sensitive areas of the City, must be in compliance with Levell! Background Screening and fingerprinting requirements as per, Florida Statute Ch. 435 prior to the scheduled start of any employee or volunteer. CONTRACTOR shall prevent any and all of its personnel, including volunteers, from engaging in any such related activities without having passed a background screening to the satisfaction of the City. A violation of this requirement shall constitute a substantial breach of this Contract. 20) Drug Free Workplace. CONTRACTOR shall comply with the Drug Free Workplace policy set forth in the City of South Miami's Personnel Manual which Is made a part of this Contract by reference. 21) Transfer and AsSignment. None of the work or services under this Contract shall be subcontracted or assigned without prior written consent from the CITY which may be denied without cause. 22) Notices. All notices given or required under this Contract shall be deemed sufficient if sent by a method that provides written evidence of delivery, including e-mail and facsimile transmission and delivered to CONTRACTOR or his designated contact person. Return of mail, sent to the address contained herein for the parties or their contact persons, as not deliverable or for failure to claim the mail shall be deemed received on the date that the mail is returned to sender. IN WITNESS WHEREOF, the parties, have executed this Contract, on or before the date first above written, with full knowledge of its content and significance and intending to be legally bound by the terms hereof. :v~ne~'2 ATIESTED: By: ______ _ Maria Menendez City Clerk Read and Approved as to Form, Language, Legality and Execution Thereof: By: ________ _ City Attorney Thomas F. Pepe 2016 07129/16 27 [IndiVidual or entity's name] CITY OF SOUTH MIAMI By: ________ _ Steven Alexander City Manager Insurance Addendum To whom it may Concern, In good faith we, Grit Born, have provided quotes from the insurance company we are working with in order to show that we will have the provisions of insurance at the time of the project initiation. This industry is new to the insurance company and they are taking a little longer than usual to determine the liabilities at hand. As our act of transparency Grit Born plans to provide all completed insurance documents and binder as soon as the insurance company provides the final documentation. Thank you for your patience and understanding to this unique situation. Feel free to contact us if any questions should arise. AMERICAN INSURANCE PO BOX 66-7955 MIAMI, FL 33166 GRIT BORN, LLC 15406 SW 172 STREET MIAMI, FL33187 Commercial Auto Insurance Quote PROGRESSIVE" COMMERCIAL Underwritten by: Progressive Express Ins Company December 1, 2016 Policy Period: Dec 1, 2016 -Dec 1,2017 Page 1 of2 Customer Phone number: 1-305-725-7512 Thank you for contacting me about your auto insurance needs. I am pleased to provide you with a quote from Progressive Express Ins Company, a company that offers competitive rates and many outstanding services. Progressive gives you access to your policy information through progressiveagent.com, your customized Web site. Claims service is available 24 hours a day, 7 days a week by calling 1-800-274-4499. policy information Business type: Retail Trade Operations Sub business type: Other Retail Trade Operations Other: ONLINE RETAILER OF FIRST AID KITS Quote for 12 month policy period If you pay your premium in full, you will receive a discount as shown. !~.~~.I. P.~!!~¥.p.~~~!~~ ........................................................................................................................... J.5.,.~.~.~:~~. Paid in full discount -875.00 ........................................................................ , ....................................................... , .......................................... .. Policy premium if paid in full $5,028.00 Payment plans Payment Method: 10 payments Electronic Funds Transfer (EFT) assures that your payment is on time. Each payment includes a $1.00 service charge. Payment plan Total premium Initial payment Payments l'Cj 'p~'y~~~t;,' 2o:0~i~ 'D~;';;~"'''''' $S)303'.00 .. · .. · .. ········ .. ··· $'; ·,·18il.'6o· ...... ······ .... ·· .... ·· 9 'ijayme'rii~' ~i$5i'5: 7'2" ...................... .. 6 'p~y; ·5~~~·~~~i:·io:o~io· 6~~~'" '$'s~90ioo""'''''''''''''''' '$'; ~·1·iio·.60···"·"·····""···""·5 'p'ayme'rii~'of'$9'45:48""'''''''''''''''''''''' i·o .. p~·y~~~t~·,· 25':6~i~ 'D~;';;~"""" $5',903'.00······ .. ···· ...... ·· '$'; ','475'.75'" ....................... 9 'paymeiii~'of'$49i:9'2"""'''''''''''''''''''' 4 'p~'y; '5~~~'~~~i; '2'5:00/0' 6~~~"" $'s~90ioo"""""'"'''''''' $', ~'4 7'5'. 75···· .. ······· ...... ·· .. ··· 3 'paymeiii~' ~f' $ i ',4 76.'75·· .. ··· .. · ........ ·· .. · . Make payments by mail or at progressiveagent.com. Each payment includes a $3.00 service charge. Payment plan Total premium Initial payment Payments i'o'p~y~~~i~','2ii"6~i~'D~;';;~"" .... $·5·,90ioo .. · .. · .... ······ .. ·· '$', :;·80·.60······· .. ··· .. · .. · .. ·· .. · 9 'pay'meiiis'of' $sii :7'2'· .. · ................... .. 6 'p~y; 's~~~'~~~i:'io:o~io' 6~~~"" $S·,903'.00 .. ··· .. · .. ····· .... · '$'; ~·1·80·.60·""·"····""···""··5 'pay'meiiis'of' $9'47 :48" ....................... . "0' 'p~'y~~~t~',' 25'''0~i~ 'D~;';;~"""" $'s', 90ioo············ ........ ·$·,:'475'.75··· .... ·· ................ 9 'pay'meiii~' of' $·494:9·2 .. · .... · .. · .......... ·· .. · 4 'p~y; ·s~~;~~~i;·2·5·.ooio· '6~~~"" $S·,903'.00 .. ········· .. ···· .. · 'i; :'47·5'.75··· .. ···· .. ·· ...... ······:3 'pa y'meiiis' of' $ '·,478.'75 .. · .... ·· .. ·· .. ····· .. · 4 'p~y: 'Q~arte~iy:' i5·.ooi~ '6'~~ii"" $·5·,903'.00·· .. · .. ···· .. ··· .... '$'i :'475'.75· .. ···· .. ··· .. ·· .. ···· .. ·:3 'p'ay'meiiis'o't'$ i'.478.'75 .... ·····,···· .. ·· .. · .. ,. ·Payment···· .... · ...... ······· .. · .. ·· $ s·,02il.00··· .. ··· .. ···· .. · .. ·· i'5',02S'.CiCi .. · .. · .. ···· .. · .. · .. · .. · N·one··· .... · .. · .. · .. ···· .. · .. · .. · .. ·· .. ···· .. · .. ··· .. · To purchase insurance I Continuoo GRIT BORN. LLC Page2 of 2 Please review the information on your quote for accuracy; incomplete and inaccurate information could affect your rate. These rates are subject to verification of information. If you have any questions or would like to purchase a Progressive policy, please call me at 1-305-715-9956. Your coverage will begin once your initial payment has been received. Thanks again for the opportunity to work with you. Rated drivers Failure to accurately and completely report all driver information may result in premium differences and service delays. Marital Additional ~.~I)'!~ ............................................ l\g~ .............. s.til!~.s ..................... }9i~!~ ................ i~r9(I)l~li~.~ ........................ '" .............. . GABRIEL FIGUEROA 33 Married 0 KATIRIA FIGUEROA 33 Married o Outline of coverage The policy limits shown for a vehicle may not be combined with the limits for the same coverage on another vehicle unless the policy contract or endorsements indicate otherwise. ~.~s.c!~~~i?~ ............. : .............................................. ~i~i.t~ ................................................................. ~.e.~~~i.~I.~ ............ ~~:~i.~~ liability To Others $4.196 ... ~?~.i!y.! ~)~~¥. ?~~ .~~?~.~~¥. ~?~?~~ .~i.~~i.'!~¥ .............. ~ .1. '.~.~~'.~.~~ .~~~~i.~~.~. ~.i~~.I~ .I!~.i~ ......................................................... .. Hired Auto liability To Others 266 ... ~~~.i!y.!~)~~¥.?~~.~~?~.~~¥.~?~?~~.~i.~~i.I!~¥ .............. tl!.9.q~ •. 9.q~.~~.':'!~in~.~.~.i~g.I~.!!~!! .......................................................... . Employer Non-Owned Auto Liability To Others 194 " .~.~?i!y. !~J.~~¥. ?~~ ?~?~.~~¥. ~?~?~~ .~i.~~i.I!~¥ ............ J.1!.9.q~~9.q~ .~~~~i.~~~. ~!~g!~. !!~!! .......................................................... . Basic Personal Injury Protection 296 " .~!~~ .. ~?~~. ~?~~.-.~.~~.~~ .I.~?~~~.~. ~~.Iy' .................. 11.~ .. q~q .~?~~. P'~!.s.9~ .......................................... ~~ ............................ . Comprehensive 259 ... ~~.~.~~.t? .S~Y.~~~.~~ .~~.~~.~~I.~ ................................ ~i.,:,!!~ .9f.1.i~?!!i.tY. .'.~~~. ~~.~~~i.~!~ .............................................................. .. Collision 692 See Auto Coverage Schedule Limit of liability less deductible Total 12 month policy premium Number of Employees: (0-10) Cost of Hire: $5,000 or less (if any) $5,903.00 Auto coverage schedule 1. 2016 HONDA PILOT Actual Cash Value (plus $2,000.00 Permanently Attached Equip) VIN: 5FNYF5H52GB040476 Garaging Zip Code: 33187 Territory: 71 Radius: 100 miles Personal use: Y Body type: SUV Use class: S Liability Premium ~!~~!I.i~ ............ ~!~ .......................................................................................................................................... . $4196 $296 Physical Damage Premium Camp Deductible $1.000 Premium discounts Policy Vehicle 2016 HONDA PILOT Form QTE Fl (05/08) Comp Premium $259 Collision Deductible $1.000 Collision Premium $692 Package Anti-Theft Standard. Air Bag and Anti-lock Brakes Auto Total $5,443 *bWINS" Quote Number: Date: Quote Type: Insured Name: Policy Term: .:. Home State: Access AMW00041907 12/8/2016 New Grit Born LLC 12/8/2016 to 12/8/2017 FL Quote is valid until 2/6/2017. AmWINS -Orlando, FL (407) 541-5007 COMMERCIAL QUOTE From: Jaclyn DePasquale Underwriter Email: jaclyn.depasquale@amwins.co m Carrier: Covington Specialty Insurance Company A.M. Best Rated: A+ XIII We are pleased to offer the following Terms and Conditions based on information received. Please review carefully as coverage may not be exactly as requested on the application. Commercial Quote Coverage Commercial General Liability Terrorism Premium Annual Minimum and Deposit Total Estimated Policy Premium Commission: 10% Minimum Earned Premium Premium without Terrorism $2,750.00 (MP) Excluded $2,750.00 $2,750.00 Terrorism may be added for $110.00 + taxes. A minimum earned premium of25% of the premium, will be retained if the policy is canceled at the insured's request. All fees are fully earned and non-refundable. Flat cancellations will not be honored. Underwriting Requirements Subject to: Where possible, suppliers should name the applicant as additional insured Fill in fOlms: CG 2133? Exclusion -Designated Products "Smoke Grenades" GBA 104016? Limitation -Designated Products "First Aid and Trauma Response Kits and Supplies" GBA 105.006 Additional Insured -Vendors ~Primary and Noncontributory "City of South Miami" CG 2404? Waiver of Transfer of Rights of Recovery Against Others to Us "City of South Miami" RSUI Quote Number: AMW00041907 Page 1 This quotation for coverage is strictly cOnditioned upon no material change in the risk occurrIng between the date of thIs proposal and the inception date of the proposed pol/cy, Ills subject to modification or withdrawal il any new, corrected or updated information becomes known which relates to any proposed Insured's claims history or risk exposure or which could otherwise change the underwriting evaluation of any proposed Insured, Insured Name: Grit Born LLC Favorable Inspection per Company Guidelines Signed & Completed ACORD Application Signed & Completed Supplemental Application Signed TRIA Selection/Rejection Form Commercial General Liability limits of Insurance General Aggregate Limit (other than Products Comp/Ops) Prodlicts-CompletedOperations AggrE3gate Limit Personal and Advertising Injury Limit Each Occurrence Limit Damage to Premises Rented to You Limit Medical Expense Limit Deductible Location Schedule Address Premises No. 1 15406 Southwest 172nd Street, Miami, FL, 33187 Class Prm. Code Description Basis Amount Rate Products #1 54444 Manufacturers NOC Sales $B,OOO $7.500 #1 99999 -GBA 105006 Additional E Insured -Vendors - Primary and Noncontributory "The City of South Miami" Terrorism Coverage Rate All Other $1.250 $250.00 Terrorism Coverage Acceptance • Add Form GBA909003 Terrorism Coverage Rejection • Add Form GBA906005 • Add Form RSG99018 RSUI Quote Number: AMW00041907 Quote Number: AMW00041907 $2,000;OQO $2,000;000 $1,000,000 $1,000,000 $100,000 • NOT COVERED •• •• NO DEDUCTIBLE -- Premium Premium All Products Other $2,143 (MP) $357 (MP) $250 Page 2 This quotation for coverage Is striclly conditioned upon no material change in the risk occurring between the date of this proposal and the Inception date of the proposed policy. It is subject to mod/flcallon or withdrawal if any new, corrected or updated information becomes known which relates to any proposed Insured's claims history or risk exposure or which could otherwise change the underwriting evaluallon of any proposed Insured. Insured Name: Grit Born LLC Form Number • GBA 901001 • GBA 900016 • GBA 900002 • GBA 909008 • GBA 909022 • GBA 904010 • GBA 906011 • GBA 909001 • IL 0017 • IL 0021 • GBA 100001 • CG 0001 • CG 2133 • CG 2135 • CG 2404 • GBA 104014 • GBA 104016 • GBA 105006 • GBA 106010 • GBA 106025 • GBA 106059 • GBA 106070 • GBA 106092 • GBA 106099 • GSA 106109 • GSA 903001 Applicable Policy Forms Schedule Title Insurance Policy Jacket Florida Common Policy Declarations Schedule of Endorsements Florida Important Notice to Policyholders State Fraud Statement Minimum Earned Premium Retained Quote Number: AMW00041907 Exclusion of Other Nuclear, Biological, Chemical or Radiological Acts of Terrorism Service of Suit Common Policy Conditions Nuclear Exclusion Commercial General Liability Coverage Part Declarations Commercial General Liability Coverage Form Exclusion M Designated Products Exclusion M Coverage C M Medical Payments Waiver of Transfer of Rights of Recovery Against Others To Us Basis of Premium Limitation • Designated Products Additional Insured M Vendors M Primary and N.oncontributory Exclusion M Assault and Battery Exclusion M Firearms and Weapons Exclusions and Limitations Amendatory Exclusion M Prior Products or Completed Operations Products M Completed Operations Included In General Aggregate Exclusion M Intellectual Property Hazard Exclusion M Access or Disclosure of Confidential or Personal Information and Data M Related Liability Florida Changes· Cancellation and Nonrenewal Supplemental Applications • Products Liability Supplemental Application RSUI Quote Number: AMW00041907 Page 3 This quo/atlon for coverage is s/rictly condllloned upon no rna/erial change in Ihe risk occurring belween Ihe dale of /hls proposal and Ihe Inception dale of Ihe proposed policy. It Is subjecllo modification or wi/hdrawalff any new, corrected or updated information becomes known which rela/es /0 any proposed Insured's c/alms hls/ory or risk axposure or which could o/helWise change the underwriting evaluation of any proposed Insured. . Insured Name: Grit Born LLC Quote Number: AMW00041907 .:. The term "Home State" means, with respect to an insured ~ (i) The state in which an insured maintains its principal place of business or, in the case of an individual, the individual's principal residence; or (ii) If 100 percent of the insured risk is located out of the State referred to in subparagraph (A), the state to which the greatest percentage of the insured's taxable premium for that insurance contract is allocated. RSUI Quote Number: AMW00041907 Page 4 This quotalion for coverage is strictly conditioned upon no material change in the risk occurring between the date of this proposal and the Incepl/on date of the proposed policy. Ills subject to modifical/on or withdrawal if any new. corrected or updated information becomes known which relates to any proposed Insured's claims history or risk exposure or which could otherwise change the underwril/ng evaluation of any proposed Insured. RSUI Group, Inc. 945 East Paces Ferry Road Suite 1800 Atlanta, GA 30326-1125 Phone (404) 231-2366 Fax (404) 231-3755 Policy Number: _T.;;..;B~D _______________ _ Insurer: COVINGTON SPECIALTY INSURANCE COMPANY Named Insured: OFFER OF TERRORISM COVERAGE In accordance with the Terrorism Risk Insurance Act, we are required to offer the insured coverage for losses resulting from an act of terrorism, not otherwise excluded by this policy, and as covered by the Terrorism Risk Insurance Act. All other policy provisions will apply to coverage for such act of terrorism. The insured must choose whether or not to pay the premium described below under DISCLOSURE OF PREMIUM for coverage for acts of terrorism that are certified by the Secretary of the Treasury as covered acts under the Terrorism Risk Insurance Act, or not to pay the premium, and reject this offer of coverage at the time of binding. If the premium shown in the DISCLOSURE OF PREMIUM is not collected and the insured does not reject coverage for terrorism this policy will be issued excluding acts of terrorism. DISCLOSURE OF PREMIUM If you accept this offer, the portion of your premium for the policy term attributable to coverage for all acts of terrorism covered under this policy including terrorism acts certified under the Act is $ __ . DISCLOSURE OF FEDERAL PARTICIPATION IN PAYMENT OF TERRORISM LOSSES The United States Government, Department of the Treasury, will pay a share of terrorism losses insured under the federal program. Under the formula, the United States Government generally reimburses 85% through 2015; 84% beginning on January 1, 2016; 83% beginning on January 1, 2017; 82% beginning on January 1,2018; 81% beginning on January 1, 2019 and 80% beginning on January 1, 2020, of covered terrorism losses that exceed the applicable insurer retention. However, if aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $100 billion in a calendar year, the Treasury shall not make any payment for any portion of the amou nt of such losses that exceeds $100 billion. CAP INSURER PARTICIPATION IN PAYMENT OF TERRORISM LOSSES If aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $100 billion in a calendar year and we have met our insurer deductible under the Terrorism Risk Insurance Act, we will not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion, and in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of Treasury. o I hereby elect to purchase certified terrorism coverage and pay the premium shown above under DISCLOSURE OF PREMIUM. o I hereby reject the purchase of certified terrorism coverage. Insured's Signature Date If you do not respond to our offer and do not return this notice to the Company, you will have no Terrorism Coverage under this policy. RSUI Indemnity Company Landmark American Insurance Company Covington Specialty Insurance Company A member of Alleghany Insurance Holdings LLC ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/vYYY) ~. 12108/2016 THIS CERTIFICATE IS ISSUED AS A MAnER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). . PRODUCER AMERICAN INSURANCE BROKER I ~~~~~CT PATRICIA PEREZ 3650 N.W. 82ND. AVE. H;HONE (305) 715·9956 1fM ,,",.(305) 715-7316 AIC..Na,..Exl)· PH 504 . ~;,Mn';l~~~. DPLA@AMERICANINSURANCEBROKERS.COM DORAL FL 33166 INSURER/SI AFFORDING COVERAGE NAIC# INSUAFRA :COVINGTON SPECIALTY INSURED INSURER B: Gritborn LLC INSURER c· 15406 SW 172 8T . INSIIAERD' Miami FL 33187-INSURERE' i INSURERF: COVERAGES CERTIFICATE NUMBER' REVISION NUMBER' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I~M TYPE OF INSURANCE I~~~; ~~ POllev NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY X X PLA 115030161208-001 12/08/2016 12/08/2017 EACH OCCURRENCE $ 1,000,000 I--tJ CLAIMS-MADE 0 OCCUR ~~~6~~r9,,~:~!,~~on"" I--$ 300,000 MED EXP (Anv one oerson I $ 0 I-- I--PERSONAL & ADV INJURY $ 1,000,000 ~'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 0 ~r8T 0 LOC PRODUCTS -COMP/OP AGG $ 2,000,000 OTHER, $ AUTOMOBILE LIABILITY r,,~~~l\'!.~~,~INGLE LIMIT $ - -ANY AUTO ,.-SCHEDULED BODILY INJURY (Per person) $ ALL OWNED I--AUTOS f--AUTOS BODILY INJURY (Per aeeldenl) $ NON·OWNED rD~?~~},~,T"~,?AMAGE $ I--HIRED AUTOS f--AUTOS $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ I--EXCESS LIAB CLAIMS·MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION I ~!f~T1IT" I I gJH- AND EMPLOYERS' LIABILITY U ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $ I g~~~~rtirg~ 'ir~gPERATIONS holow E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addlllonal Remarks Schedule, may be aHached If more space Is required) Online retailer who's sells first aid kits of all sorts to any consumer in need, focus on Police, Fire and Military personnel, also offer product familiarization workshops. CERTIFICATE HOLDER NAME AS ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION AI 011567 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN "SAMPLE CERTIFICATE ONLY" ACCORDANCE WITH THE POLICY PROVISIONS. ~ ./7'\ - AUTHORIZED REPRESENTATIVE l-r ~ I \ © 1988·2014 ACORD CORPORATION, All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Detail by Entity Name Florida Limited Liability Company GRIT BORN, LLC Filing Information Document Number FEIIEIN Number Date Filed State Status Principal Address 15406 SW 172 STREET MIAMI, FL 33187 Mailing Address 15406 SW 172 STREET MIAMI, FL 33187 L15000158038 47-5100256 09/16/2015 FL ACTIVE Registered Agent Name & Address NELSON & ASSOCIATES, CPA PA 1867 NW 97 AVENUE SUITE 102 MIAMI, FL 33172 Aythorized Person(s) Detail Name & Address Title MGR FIGUEROA, GABRIEL 15406 SW 172 STREET MIAMI, FL 33187 Title MGR FIGUEROA, KATIRIA 15406 SW 172 STREET MIAMI, FL 33187 Annual Reports Report Year 2016 Document Images Filed Date 04/29/2016 04/29/2016 --ANNUAL REPORT 09/16/2015 --Florida Limited Liability View image in PDF format View image in PDF format LI'QLQII uy L.IILUY l"IIi:1l1ltt http://search.sunbiz.orgllnquiry/CorporationSearch/SearchResultDetail?inQuirvtvoe=EntitvName&directionTvoe=lnitial&searchNameOrder=GRITBORN%201 ... '213 2016 FLORIDA LIMITED LIABILITY COMPANY ANNUAL REPORT DOCUMENT# L 15000158038 Entity Name: GRIT BORN, LLC Current Principal Place of Business: 15406 SW 172 STREET MIAMI, FL 33187 Current Mailing Address: 15406 SW 172 STREET MIAMI, FL 33187 US FEI Number: 47·5100256 Name and Address of Current Registered Agent: NELSON & ASSOCIATES. CPA PA 1867 NW 97 AVENUE SUITE 102 MIAMI, FL 33172 US FILED Apr 29,2016 Secretary of State CC8337754586 Certificate of Status Desired: No The above named entity submits this statement for the purpose of changing Its registered office or registered agent. or both. In the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Authorized Person(s) Detail : Title Name Address MGR FIGUEROA, GABRIEL 15406 SW 172 STREET City-State-Zip: MIAMI FL 33187 Title Name Address MGR FIGUEROA, KATIRIA 15406 SW 172 STREET City-State-Zip: MIAMI FL 33187 Date J hereby certify that the Information Indicated on this report or supplemental report is true and accurate and that my elecfranic signature shall have the same legal effect as If made under oath; that I am a managing member or manager of the limited liability company or the receIver or trustee empowered to execute this report as required by Chapter 605, Florida Statutes; and that my name appears above, or on an attachment with a/l other like empowered. SIGNATURE: KA TIRIA FIGUEROA MGR 04/29/2016 Electronic Signature of Signing Authorized Person(s) Detail Date CONTRABAND FORFEITURE ACT Forfeiture Expenditure Certification I, Rene Landa, am the Chief of Police for the City of South Miami and I am requesting the expenditure of $1 1,500 for Active Shooter First Aid Kits from account 608-1910-521- 5210 that has been appropriated to the Police Department for City of South Miami's by the City Commission. I hereby certify, pursuant to § 932.0755(d)(b)', that the expenditure requested complies with the provisions of subsection 932.7055(5)(a) which states: § 932.7055 (5)(a) If the seizing agency is a ... municipal agency, the ... proceeds shall be deposited in a special law enforcement trust fund established by the ... municipality. Such proceeds and interest earned therefrom shall be used for school resource officer, crime prevention, safe neighborhood, drug abuse education and prevention programs, or for other law enforcement purposes, which include defraying the cost of protracted or complex investigations,. providing additional equipment or expertise, purchasing automated external defibrillators for use in law enforcement vehicles, and providing matching funds to obtain federal grants. The proceeds and interest may not be used to meet normal operating expenses of the law enforcement agency. Pursuant to §92.525(2) 2, Florida Statutes and under penalties of peljury, I declare that I have read the foregoing Forfeiture Expenditure Certification and that the facts stated therein are true. Executed this 15' day of [)ecern&ec ,201~ I 932.7055(5)(b) Forfeiture funds may be expended upon request by the ... the chief of police to the .:. municipality, accompanied by a written certification that the request complies with the provisions of this subsection, and only upon appropriation to the ... police department by ... the municipality. 2 NOTE: When the verification on information or belief is permitted by law, in which case the words "to the best of my knowledge and belief' may be added. From: 2012 Fla. Statutes, Section 95.525(2).