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Res No 001-17-14802RESOLUTION NO.001-17-14802 AResolutionauthorizing the CityManagertopurchase fifty (50)active shooter firstaidkits andtrainingfrom Grit Born LLC. WHEREAS,theMayorandCityCommissionwishtopurchase fifty (50)active shooter firstaidkits for the Police Department;and WHEREAS,the President's TaskForceon 2Ist Century Policing final report of May 2015 recommends that all individual officersbeequippedwithtacticalfirstaidkitsandtraining;and WHEREAS,Grit Born LLC participated in the invitation to quote #PD20I6-24 andwas the only vendor to submit a quote for services requested;and WHEREAS,all products providedfor the tacticalfirstaidkitswillbeofmilitarygradeandallofficers willbe provided with the training to utilizesaid equipment;and WHEREAS,the cost of the fifty (50)active shooter firstaidkitswillbe $l 1,500;willbecharged to account 608-1910-521-5210,State Forfeiture (Supplies)witha current balanceof $30,000 and the cost of the training $1,500;willbe charged to account 001-1910-521-4080 Training&Educationwitha current balanceof $26,050 NOW,THEREFORE,BE IT RESOLVED BY THE MAYOR AND CITY COMMISSION OF THE CITY OF SOUTH MIAMI,FLORIDA: Section I:The CityManageris authorized to purchase fifty(50)active shooter firstaidkitsand trainingfrom Grit Born LLC,basedon ITQ #PD20I6-24. Section 2.Severability:Ifanysection,clause,sentence,or phrase ofthis resolution isforany reason held invalid or unconstitutional bya court of competent jurisdiction,thisholdingshall not affect the validityof the remaining portions ofthis resolution. Section 3:This resolution shalltakeeffectimmediatelyuponapproval. PASSED AND APPROVED this 3rd dayof January 2017. APPROVED: READ AND APPROVED AS TO FORM, LANGUAGE,LEGALITY AND. EXECUIION^MEREOF COMMISSION VOTE: Mayor Stoddard: ViceMayor Welsh: Commissioner Liebman: Commissioner Edmond: Commissioner Harris: 5-0 Yea Yea Yea Yea Yea tWVkAlSoutW1Miami THE CITY OF PLEASANT LIVING CITY OF SOUTH MIAMI OFFICE OF THE CITY MANAGER INTER-OFFICE MEMORANDUM To: From: Date: Subject: Background: Amount: Account: Attachments: The Honorable Mayor &Members of the City Commission Steven Alexander,City Manager January 3,2017 Agenda Item No.: A Resolution authorizing the City Manager to purchase fifty(50)active shooter first aidkits 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. Thefirstaidkitswillbeissued to allpolice officers and training willbe provided by certified medical professionals.These kits were also recommended inthe President's Task Force on 21st Century Policing final report issued in May 2015. This purchase isbeing made pursuant toInvitationto Quote (ITQ) #PD2016-24 whichGritBorn LLC was the only vendor who participated. GritBorn LLC isalocally owned company.Total cost of this purchase will be $13,000. Not to exceed $13,000 $11,500 for the active shooter firstaidkits will bechargedto account number 608-1910-521-5210,State Forfeiture (Supplies),current balance $30,000;$1,500fortraining will chargedtoaccount 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 I.BACKGROUND: ATTACHMENT A Scope of Services "ACTIVE SHOOTER KITS&TRAINING" ITQ#PD2016-24 TheCityof South Miamiis seeking quotations from experienced and capable parties to provide the South MiamiPolice Department "Active Shooter Kits"containing the materials specified in the Scope ofServices,"//.Active Shooter Kit Specifications."In addition,respondents shallalsoprovideTraining&Familiarization Workshop courses: Note:Please refer to the "III.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. TheCity estimates a quantity ofSOkits will be required,whichisan estimate only and not a firm commitment and,should be used for planning purposes only. II.ACTIVE SHOOTER KIT SPECIFICATIONS: Active Shooter Kitsshall include the following materials,products and quantities.Respondents may submit alternate manufacturers but those alternates must bean approved equal.TheCity willmake the soledecisionand determination if alternate products and materials are "approved equals."TheCity estimates a quantity ofSOkits will be required,whichisan estimate only and not afirm 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: 1Custom500Denier Cordura®Nylon,4pouchsystem 10.5"long,3.5"Wide,1" Deep,Loop Velcro®inbothInner (Carries 4x(30round).223mags,4x(20rounds) .308mags,or4x(10round)shotgunshelltrays.Includesan Outer LinedLoop Velcro®forPolice Identification Patches with/or blood type specification patches. Fully Adjustable to officer's lengthand width,with Ambidextrous access points on eachindividualpouchwithin the 4pouchsystem,alsohavinglargezippull features for gloved hands access.Material must bein Black.Black zippers/Velcro/pulls/thread/etc. B.KIT CONTENTS: •1 each Mojo MARCH System Celox RapidGauze 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 FoxsealChestSeal leach Mojo MARCH SystemNasal Trumpet w/SurgicalLubeSize28French Lumen 1 each SWAT-T™Tourniquet 2PairsCuraplex®TritonGrip TE™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 minimum 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 Implementation: Respondents shall provide training and Active Shooter Kit familiarization workshops for designated department personnel.The vyorkshop 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 10per training session.Trainers shallbe licensed and/or certified or active EMT (Emergency Medical Technicianjor trauma center field and/or befully competent to teach and certify BLS (Basic Life Support),ACLS/PALS (Advanced Cardiac Life Support/Pediatric Advanced Life Support).Workshop duration sessions shallbe from 4-6 hours,each session. •These workshops shallincludeusageand familiarization ofthe product containedinthekits,handouts,power point demonstrations,etc.,mock scenarios for performance under stress application forofficers. Note:All course contents shall be pre-approved by the South Miami Police Department ATTACHMENT B PRICE PROPOSAL SHEET "ACTIVE SHOOTERKIT&TRAINING" ITQ#PD2016-24 NOTE:The Cityestimatesaquantityof50kitswillbe required,which isan estimate onlyandnotafirmcommitmentand,shouldbeusedfor planning purposes only. I.ACTIVE SHOOTER KITS ACTIVE SHOOTER KITS COST PER UNIT A. TOTALCOST Based on Estimated Quantity,50 Kits $S II.TRAINING FAMILAIRAZATION WORKSHOP &ACTIVE SHOOTER IMPLEMENTATION TRAINING FAMILARIZATION WORKSHOP &ACTIVE SHOOTER IMPEMENTATION COST PER UNIT MAXIMUM 10 PER TRAINING SESSION B. TOTAL COST FOR MAXIMUM 10 PER TRAINING SESSION s S III.TOTAL COST:ACTIVE SHOOTER KITS AND TRAINING (A+B) ACTIVE SHOOTER KITS +TRAINING s Member Name Bid Number Bid Name 2 Document(s)found for this bid 307 Notified 17 Planholder(s)found. Cityof South Miami ITQ-ITQ #PD2016-24-0-2016/SK ACTIVE SHOOTER KITS AND TRAINING Supplier Name Address 1 City State Zip Phone Fax Attributes Advanced Starlight International 113 SW 5th Avenue Portland OR 97205 5032225718 5032225700 American Safety Associates,LLC 1470 SE 18 Terr Homestead FL 33035 8773228248 9546355580 1.Hispanic 2.Small . Bob Barker Company Inc Po Box 429 Fuquay-varina NC 27526 8003349880 8003227537 Bound Tree Medical 5000 Tuttle Crossing Blvd Dublin OH 43016 8005330523 8773112437 Central Lake Armor Express,Inc.AB Central Lake Armor Express,Inc.AB ChiefLaw Enforcement Supply 8604 Cliff Cameron Drive Charlotte NC 28269 8138851310 8138857787 Dana Safety Supply |Operating as Southern Public Safety Equipment &Southern Firearms 5221 West Market St Greensboro NC 27409 3368545536 3368543884 1.Small Business Ever Ready FirstAid&Medical Supply 101-01 Foster Ave.BROOKLYN NY 11236 7183875700 7183879310 Fisher Scientific -Safety 4709 Beachmont Drive Valrico FL 33549- 5902 8137899378 8134369898 Henry Schein,Inc.PO Box 3227 Irmo SC 29063 8008453550 8005334793 Link Systems LLC 5870 Hummingbird Court Titusville FL 32780 4074010031 1111111111 1.Small Business MG Contracting &Sonsinc.22ElmGrayRoad Torrance CA 90503 3234702122 0000000000 Safari land AB Southeastern Emergency Equipment Po Box 1097 Youngsville NC 27596- 1097 9194355931 9194355961 1.Small Business Southern Police Equipment 7609 Midlothian Turnpike Richmond VA 23235 8043231855 8043235067 1.Small Business 2.Woman United Shield International,LLC AB Kulick,Steven P From:Brown,Tim <Tim.Brown@Samova.com> Sent:Wednesday,December 07,2016 4:04PM To:Kulick,Steven P Cc:Brown,Tim Subject:RE:Cityof South Miami ITQ#PD2016-24 -Active Shooter Kit Attachments:South MiamiFLPD2016-24KitsDue 12092016.pdf Good Afternoon Steven, After reviewing the specs of the Cityof South MiamiITQ#PD2016-24ithas been decided that Bound Tree will not be abletoquotethisopportunity.Wewanttoemphasizeourcontinuedcommitmenttoprovidethemost complete offering of products andservices therefore please keepusinformedofanyupcoming future bidsor quotes. We thank youfor the opportunity toprovideallyour EMS equipment and information needs.Ifyou require additional information,our contact information is below. *Please verify the receipt ofthis message. Thank You, Ttm Brown Bround Tree Medical |PricingAnalyst Direct 614.760-5352 |Fax 877.311.2437 Tim.Brown@Sarnova.com I www.boundtree.com Sarnova,afamilyof companies: Tri-anim Health Services,Bound Tree Medical &BMP PRIVILEGEDAND CONFIDENTIAL:The information contained inthis electronic message andany attachments are confidential propertyand intended onlyforthe use of the addressee.Any interception,copying,accessing,or disclosure ordistributionofthis message isprohibited,and sender takes no responsibility forany unauthorized reliance onthis message.Ifyou have received this message inerror,please notifythe sender immediately and purge the message you received. DISCLAIMERREGARDINGELECTRONIC TRANSACTIONS:If this communication relates tothe negotiation ofa contract or agreement,any so-called electronic transaction or electronic signature statutes shallnotbe deemed toapplytothis communication;contract formationinthis matter shall occur onlyuponthemutual delivery or exchange ofmanually-affixedoriginal signatures onoriginal documents. / 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: Witness: Print Name Witness: Print Name Signature Soutfr Miami li if «:hy e»piwanj mwc SUBMITTEDTO QtyQerk NAME ADDRESS CITY/STATE PHONE __ M/M^TOrVPFBQUdTEMBEnNGt Maria Menendez,CMC 6130 Sunset Drive Miami,Florida33134 305^63-6339 CITYOFSOUTHMIAMI INVlTATlONIOQUaiE nd#PD20l6-24 NONESCHBXJIJBD.. PR0J33T:Actye*^^ ADDRESS 6130 SUnset Drive anystate Sbuth Miami,R 33143 IS8UEDATE •.?•;;:>£:^X.jr^ EMAIL skulickOsouthmiamlfl.aov. DUEDATE >;.£ip©qem^9;;^iei^10AM •- QUaiESUBMISaONRBaUiRBvlBna (RB^TPB<rTOT2wSUBMiS30NRBaUiRSv1SsnS>> Quotessubmitted after10 AM ontheduedate will notbe aoo^ ofatimechange.All quoteswlll besubmittedtothe atyOerks Office inasealedenvelope.Thelabel on theonthe envelope must read asfoilows: tity of South Miami MariaM.Menendez,CMC 6130 SUnset Drive SbuthMiami,R.33143 ^•RQJB^I'.'.';rr :.\-j:.pf-\r::.:"•,;':";';; Must inputproject name,iflabeldoesnothaveallinformation aboveyourquote will notbeaccepted. INSURMvfCERgRJIRBVIBnB: .TheOTYSmsurance requirements areattached (Bmlbit 1).Asacondition of award,the awarded vendormust provide a certificateofinsurancenamingthe cityasadditionalinsured. AfflDAVrP3&aKTRftCTrHXilFBDVvlTH SUBMITTAL (Bchlblt 21 Ftespondentsmust completeandsubmitwithyourquote affidavits provided in Bdiibit 2. QUESTIONS $rij^^|^r^^timfeini Ded^fer;6,^i6^tihe ||e$^^.'v"';v'•=••;•-";';T •'/•;'V.'/•-'..-Jy; SfXPEOf a^MCE5De9CRPnON (RffgnOSBCnON ll>: r RffBRTO ATTACHMBvn-A,,SC30PEOFSBnMCBSi"OOP/ATTACHH) DBSCRfflONOFWOKTOBEPm^^ Item Number ItemDescription TOTAL raWTOA7TACHMBsrrAMS00PEOFSBRMCBS SUBMITQU0nnEONATrA(HvlBvITBnPRCE FTOFOSVLSrer K>;S;;;MS;^ Rssporident shall furnish all materials and equipment necessary tosecure completion ofthework.Respondent shall be compensated according tothequote submitted.Respondent isresponabteto secureallpermits,Ifany,andshouldbe reflected in thefespondentscjuote.RKpondentsshall submit pricing onATTACH\/IBsn,BHFW(EPROPOS^LSHSEr.w Print/Type Name: Signature: E-mail: Firm Name: Address: Deadlineto submit is:December.9,2016 at10 AM. Phone: Date: Fax: F.E.I.N.No.:__^filt^^U city:mmm\8te*"FL i33tn ^e-Wl~UWLjS\t\M\2A\U THEBmJTICWOFrHSroRM CCNSTmn^THEUNHMVOO^C^raiaJRETOSGNTHSSaiOTATlCNV^^ AUTHC*ffi>RB:raeBWATl\/ESHAlLf©^HOWB/B*INnSSOEDISCREnCN,AOCH^A^FR0POSM.TmTINCUJDeSAN B<BQLrrmDCCUMBrrVVHCH UfflWOmYBftreTHEROTSgrTO^ RtoBXlOTKEfiRM O0N3D8S)lFE8ESnOS3WIHEaTYSINrB3S3T. THEQTYBHBW^THERCa^TDAVWroTi£PRDUBUnDT>€rWSON WITHTHElCWfiST,M0STRB3>0N3V5 RSaaO^BUHRRCTOSU,ASOeTHWINBDBYTl^QTYTOWAJVEAWlRREBULARrTYlNTHE raOTOSALSCRSOUOrrATICWrTOCe^^ANDBmnEACOWCT\MTHAFffi<M3BW^^CmCtfHANTOTHE CtEWHO FRCMDffi)-rHEUC>AffirPF30QM.CRFRCEOH IFT^ESXPEOFVUORKISaVIOSD imDD)STINCT3iSOiViSONSTOAWARDE40XSUB0(V190NTOA SffftRATERSCNDB^T. RSCNDB4TACCEHSAUXH)£TBMS^ AFrmiHEFROROSALCFBIlhfG TKERBSRONDBir,BYaGraNGANDSJBMlTnNGTHSRROTOSAl,AGRBB3TOAU.^^E^HWSA^IOOO^aynCNSa^HEFCfM OONTmCTTKMfSAPARTCFTIEaOUQTATlON FttCKAGEVVlTHAlWDmTEOHAlKSTO I.BACKGROUND ATTACHMBMTA Soope ofServices uAcnvESHOore?Kns&training1 ITQ#PD201&-24 The Oty of South Miami is seeking quotations from experienced and capable parties to provide lie SouE]Miami Fblice DeparQBendAcQife ShooID MuHconHhing the materials specified in the Scope of Services,"II.Active Shooter Kit Specifications."In addition,respondents shall also provide Training &familiarization Workshop courses: Note:Please refer to the"III.Training"section inthe Soope of Services for course content. Theworkand materials specified inthis solicitation shall consists of furnishing all goods, materials,supplies,and services,including butnot limited to all activity and instructions per the specificationsand all necessarymaterials TheOtyestimatesa quantity of50kitswill be required,which isan estimate only and nota firm commitment and,shouldbeusedforplanningpurposesonly. ACnVESHOC3TgiKITS?B3nCATIONS Artive Shooter Kits shall include the following materials,products and quantities.Ftespondents may submit alternate manufacturers butthose alternates mustbean approved equal.TheQty will make the sole decision and determination if alternate productGlnd matSialClre "approved equaldl TheOtyestimatesa quantity of50kits will be required,which isan estimate onlyandnota firm commitment and,should beused for planning purposes only. The contentsof the Active Shooter Kits are listed below: A ACnVESHOOTBR KITPOUCH SPB3FICATIONS 1 Custom 500 Denier Cbrdura®Nylon,4 pouch system 10.5"long,3.5"Wide,1" Deep,loop \felcro®in both Inner (Carries4 x(30 round).223 mags,4x(20 rounds) .308 mags,or4x(10 round)shotgun shell trays.Includes an Outer lined Loop Velcro®for Fblice Identification Patcheswith/or blood type specification patches. Rjl&juGaietSbfficer'Q^gil^^ each individual pouch within the4 pouch system,also having large ap pull features forgloved hands access.Material must be in Back.Back zippers/Vfelcro/pulls/thread/etc. B.KIT CONTENTS: CD 1 each Mojo MARCH System Celox Rapid Gauze 3"x5'Z-fold Hemostatic Agent El 1 each Mojo MARCH System Battle Bandage GD 1 each Mojo MARCH System Mojo Gauze ED 1 each Mojo MARCH System Foxseal Chest Seal 03 leach Mojo MARCH System Nasal Trumpet w/Surgical Lube Size 28 French Lumen ED 1 each SWAT-T™Tourniquet GD 2 Pairs Curaplex®TritonGrip TE™Low Modulus Formulation Gloves El 1 each Mojo Trauma Shears GD 1 each Durapore Surgical Tape 1"X10 Yd.Hypoallergenic-Latex Free-Water Resistant Edition GD 1 each Sharpie®Durable Fine Point Permanent Marker GD 1 each C.A.T.S Combat Application Tourniquet System (Color:Black, Generation 7 minimum or latest up to date version available) ED 1 each Military Grade Snap light developed by Cyalume Technologies for night time deployment anduseof trauma kit. TRAINING REQUIREMENTS: A.Training Familiarization Workshop and Active Shooter Kit Implementation: Respondents shall provide trainingandActive Shooter Kit familiarization workshopsfor designated department personnel.The workshop shallinclude the actual training products andActive Shooter Kit contents in each kitand provide attendees familiarization with the kitand contents,and how kit contents can be applied in the field. Respondents shall quote a per attendee rate,with a maximum of 10pertraining session.Trainers shall be licensed and/or certified or active EMT (Emergency MedicalTechnician)or trauma center field and/or befully competent to teach andcertify BLS (Basic Life Support),ACLS/PALS (AdvancedCardiac Life Support/Pediatric Advanced Life Support).Workshop duration sessions shallbe from 4-6 hours,each session. El These workshops shall include usage and familiarization of the productcontainedin the kits,handouts,powerpoint demonstrations*etc.,mock scenariosforperformanceunder stress applicationfor officers Note:Allcourse contents shallbe pre-approved by the SouthMiamiPolice Department ATTACHMBMTB PRCEPROPOSOd-SHET •ACnVEaHOOIfflKITOaRMNINGr ITQ#PD2016-24 NOTE TheOtyestimatesa quantity of50kits will be required,which isanestimate onlyandnotafirmcommitmentand,shouldbeusedfor planning purposesonly. I.ACTIVESHOOTERKITS ACTIVESHOOTBRK1TS Based on Estimated Quantity,50Kits OOSTPBRUNIT siao.oo A TOTALOOSr $nt6oo II.TRAINING FAMILAIRAZATION WORKSHOPS AOlVESHOOTm IMPLa/IBITATlON TRAINING RAMILAF82AT10N WORKSHOPS ACTIVE a*x>Tm IMPa/IBsTTATION OOSTPBRUNIT MAXIMUM 10 PER TRAJNINGSESaON $flQ.Qfr B. TOTALOOSTFOR MAXIMUM 10 PER TRAININGS^ON $ltf?PO TOTALOOST:AOlVESHOOTmiOTSANDTRAINING (A+B) ACnVESHOOTmKITB+TRAINING $13,000 EXHIBIT 1 Active Shooter Kitsand Training ITQ #PD2016-24 Insurance &Indemnification Requirements 1.01 insurance A.Without limiting its liability,the contractor,consuttart or consulting firm (hereinafter referredtoas "FIRM"with regard to Insurance and Indemnification requirements)shall berequiredtoprocureand maintain atitsownexpenseduringthe lifeof the Contract,insurance of the types aid intheminimum amountsstatedbelowaswillprotectthe FIRM,from claims whichmayariseoutoforresultfrom the contractor the performanceof the contractwith the CityofSbuth Mart,whethersuch dam is against the RRM or anysubcontractor,orby anyone directly or indirectly employed byanyofthemorby anyone forwhoseactsanyofthemmaybe liable. B.No insurance required by the CITY shall beissuedorwrittenbyasurpluslinescarrier unlessauthorized inwritingbytheCITYandsuch authorization shall beattheCITY'Ssoleandabsolute discretion.The RRM shall purchase insurance fromand shall mantan the insurance witha company or companies lawfully authorized to sell insurance inthe 3ate of Florida,onforms approved by the 3ate of Florida,as willprotect the RRM,ataminimum,from all claimsassetforthbelowwhichmayariseoutoforresult fromthe RRM's operations underthe Contract art for which theRRMmaybe legally liable,whether suchoperationsbebytheRRMorbya Subcontractor orbyanyone cfirectly or indirectly employedby anyofthem,orby anyone forwhoseactsanyofthemmaybe liable:(a)claims under workers? compensation,disability benefit andother similar employeebenefit actswhich are applicable tothe Work tobe performed;(b)claims for damages because of bodily injury,occupational sicknessor disease,or death of the RRMs employees;(c)claims for damages because of bodily injury,sicknessor disease,or deathofanypersonother thai the RRM'semployees;(d)dams for damages insured by usual personal injury liability coverage (e)claimsfor damages*otherthantothe Work itself,becauseof injury toor destruction of tangble property,including loss of use resulting there from;(0claimsfordamagesbecause of bodily injury,deathofapersonor property damage arising out of ownership,maintenance oruse of a motor vehicle;{$claims forbodily injury orproperty danage aristag outofcompleted operations;and (h)dams involving contractual liability insurance applicable tothe RRMs obligations underthe Contract. 1.02 Rrm's Insurance Generally.TheRRM shall provideandmantaninforceandeffectuntil all the Work to beperformedunder this Contracthasbeencompletedand accepted byCITY(orforsuch duration asisotherwise spedfied hereinafter),the insurance coverage writtenonRoridaapproved forms and assetforth below: 1.03 Workers?Compensation Insurance atthestatutoryamountastoallemployeesincompliancewith the "Workers?Compensation Law"ofthe Sate of RoridaindudingChapter 440,RoridaSetutes,as presently written or hereafter amended,and ett applicable federal lava In addition,the policy (ies)must indude:Employers?Liability at the statutorycoverageamount.The RRM shell furtherinsurethat all of its aibcontractors mantan appropriate levels of Worker's Compensation Insurance. 1.04 Commerdal ComprehensiveGeneral Liability insurance withbroadformendorsement,aswellas automobile liability,completedoperations and products liability,contractual liability,severability of interest with aoss liability provision,and personal injuryandproperty damage liability withlimitsof $1,000,000 combinedsinge limit peroccurrenceand $2,000,000 aggregate,induding •Ffersonal Injury:$1,000,000; •Medical Insurance:$5,000per person; •R-operty Damage:$600,000each occurrence; 1.05 Umbrella Commerdal Comprehensive General Liability insuranceshallbewrittenonaRoridaapproved formwiththesamecoverageastheprimaryInsurance policybut Intheamountof $1,000,000 per daim and $2,000,000 Annual Agyegate.Covergge mustbe afforded on aform nomorerestridivethan the latest edition of the Comprehensive General Liability policy,without restridive endorsements,asfiled bythe Insurance Services Office,andmustindude: (aj)Remises andOperation (b)Independent Contractors (c)Roduds and/or CompletedOperations Hazard (d)Bcpiosion,CollapseandUndergroundHazardCoverage (e)Broad Form Roperty Damage (f)Broad form Contradual Coverage applicable tothisspedfic Contract,induding any hold harmless andfor indemnification ag-eement. (gO Personal Irgury Coverage with BnployeeaxJ Contractual Bcdusions removed,with minimum limitsof ooverage equal tothose required for Bodily Injury Liability and Roperty Damage Liability. 1.06 Business Automobile UafaHity withminimumlimitsofOne Nfillion Dolla-s ($1,000,000.00)plusan additional One Million Dollar ($1,000,000.00)umbrella per occurrence combined singe limit for Bodily Injury Liability andRoperty Damage Liability.Umbrella coverage mustbe afforded onaformnomorerestridivethan the latest edition ofthe Business AutomobileUability policy,without restrictive endorsements,as filed bywiththe state of Rorida,andmust indude: (a)Owned Vehides. (b)HiredandNon-Owned Vehides (c)Employers?Non-Ownership 107SUBCONTRACTSTheRRM sgrees thatifany part ofthe Work under the Contrad issub!et,the subcontract shall contain the same insurance provisionassetforthin sedion 5.1aboveand5.4belowand substitutingtheword Subcontractor for the wordRRMand substituting the wordRRMforCITYwhere applicable. 1.08 Rrggnd tended Coverage Insurarre (Polders?rj§k),IFAFFUCABU& A.In the eventthat this contrad involves the construdion of a structwe,the CONTRACTOR stall maintain,withan Insurance Companyor Insurance Companies acceptable to the CITY,"Broad"form/All Risk Insurance on buildings andstructures,induding Vandalism &Malicious Mischief coverage,whilein the oourseofconstrudion,induding foundations,additions,attachmentsand all permanent fixturesbelongng to andconstitutingapart of said buildingsorstructures.The policyorpoliciesshallalsocover machinery,ifthecostof machinery is inducted intheContrad,orifthe machinery is located ina building thatisbeingrenovatedbyreasonofthiscontrad.Theamountof insurance must,at all times,beat least equal to the replacement and actual cadi valueoftheinsuredproperty.Thepolicy shall beinthenameof the CITYandthe CONTRACTOR,astheirinterestmay appear,and shall also covertheinterestsof ail SubcontractorsperformingWork. B.Allofthe provisions set fort hin Section 5.4 herein below shall apply tothis coverage unlessitwouldbe dearlynot applicable. 1.09 MiecdterreQus A.If any noticeof cancellation of insurance or change in coverage is issued bythe insurance compary or should any insurance hai/e an expiration datethat will occur during the periodofthiscontrad,theRRM shall be responsible for securing other acceptable insurance prior tosuch cancellation,change,or expiration soas to providecontinuousooverage asspedfiedinthissectionandsoasto maintain coverage duringthe lifeofthis Contrad. B.All dedudibles mustbe dedaed bythe RRM and must be approved bythe CITY.Atthe option ofthe CITY,eithertheRRM shall eliminate or reduce suchdedudible ortheRRM shall procure a Bond,ina form satisfactory tothe CITY covering the same. C.The polldes shall contain waiver of subrogstlon against CITYwhere applicable,shall expressly provide thatsuch policy orpolidesare primary overanyothercolledibleinsuranoe thatCITY m^hawe.The CITY reserves the right at any timeto request a copy ofthe required polidesfor review.All polides shall contain a "severability of interest"or "aoss liability dausewithout obligation for premium payment ofthe CITY aswell as contractual liability provision covering the Contractors duty to indemnify theCityas provided inthis Ag-eement. D.Beforestartingthe Work,theRRM shall deliver totheCITYand CONSULTANT certificatesofsuch insurance,acceptable tothe CITY,aswell asthe insuranoe binder,ifoneis issued,the insurance policy, induding the dedaration page and all applicable endorsementsand provide the name,addressand telephonenumber ofthe insurance agent or broker through whomthe policy was obtained.The insurer shall be rated AA/II orbetterper AM.Best'sKey Rating Guide,latest editionand authorized toissue insurance inthe Sate ofRoridaAll insurance polides mustbe written on forms approved bythe Sate of Rorida and theymust remain in foil force and effect forthe duration ofthecontrad period with the CITY.The RRM maybe required bythe CITY,atitssole discretion,to provide a "certified copy"of the Fblicy (asdefined inArtide1ofthis document)which shall indudethe dedaration page and all required endorsementsIn addition,theRRM shall deliver,atthetimeof delivery ofthe insurance certificate,the following endorsements: (1)a policy provision oran endorsement with substantially similar provisions as follows: "The Cityof Sbuth Itfartisan additional insured.The insurer shall p^all sumsthattheCityof Sbuth Miami becomeslegally obligated to pay as damages because of 'bodily injury",'property damage',or "personal andadvertising injury"and it will provide totheCity all ofthe coverage that l8typlcally providedunder the standard Roridaapprovedformsfor conrcnerdal general liability coverageAand coverage B*; (2)a policy provision oran endorsement with stf&antially a'milar provisions as follows: "This policy shall notbe canoelled (indudng cancellation for non-payment of premium), terminated or materially modified without first gvingtheCityofSbuth Miami ten (10)days advanced writtennoticeoftheintentto materially modify the policy orto cancel orterminate the policy forany reason.The notification shall be delivered totheCityby certified mail,with proofof deliverytothe City." Ifthe RRM is provicfing professional services,suchaswouldbe provided byan architect,engneer, attorney,oraccountant,tonameafew,theninsucheventandinadditionto the aboverequirements, the RRMshall alsoprovide Rofesstanal Liability Insuranoe onaRoridaapproved formintheamountof $1,000,000 withdeductibleper daim If any,nottoexceed 5%of the limit of liability providing for all sumswhichtheRRM shall become legally obligated topayas danagesfor dams arising outof the services orworkperformedbytheRRMIts agents,representatives,SUb Contradorsor assign orby any person employedorretanedbyhimin oonnedion withthisAg-eement.This insurance shall be mantained forfouryearsalter completion oftheconstrudionand acceptance ofanyRojectcoveredby this Ag-eement.However,theRRM may purchase ^edfic Roject R-ofessional Liability Insuranoe,Inthe amountandunder the termsspedfied above,whichisalso acceptable.No insurance shall beissuedbya surplus lines carrier unless authorized in writing bythedtyatthe tit/s sole,absolute andunfettered discretion. Indemnification Requirement A.The Contrador accepts and voluntarily incurs all risksof any injuries^damages,or harm which might arise during theworkor event that is occurring onthe CITYs property due tothe negligence or other fault ofthe Contractororanyoneactingthroucfi oronbehalfoftheContractor. BTheContrador shall indemnify,defend,save andhold CITY,its officers*affiliates,employees, successors and assign harmless from any and all damage*daims*liability,losses*dams,demands,suits,fines* judgments or cost and expenses,induding reasonable attorney's fees,paralegal fees and investigative costs inddental thereto and incurred prior to,during or following any litigation,mecfiation,arbitration and at all appellate levels,which may be suffered by,or accrued against,charged toor recoverable from the City of &uth Miami,its officers,affiliates,employees,sucoessors and assign by reason of any causes of actions or claim ofany kind or nature,induding daims for injury to,or death of any person or persons aid for thelossor damage to any property aris'ng outofa negligent error,omission,misoondud,or any goss negligence,intentional ador harmful condud of theContrador,itsoontrador/subcontrador oranyoftheir officers*diredors*agents,representatives* employees,or assigns*or anyone adingthroujji oron behalf of any ofthem,arising outofthis Ageement, inddenttoit,or resulting from the performance or non-performaiceof the Contrador's obligations underthis AGRfflMBMT. C.TheContrador shall payail daims,lossesand expensesofanykindornaturewhatsoever,in connedion therewith,induding theexpenseorlossoftheCITY and/or its affeded officers;affiliates,employees, successors and assigns*induding their attorney's fees,inthe defense of any adioninlavorequitybroujjit against themandariang from the negligent error,omission,or act oftheContrador,its SUb-Contrador oranyoftheir agents,representatives*employees*or assigns,and/or arising outof,orinddentto,thisAgeement,orinddentto or resulting fromthe performance or non-performanoe ofthe Contrador's obligations under thisAGRra/IBNT. D.TheContrador ggees andreoogiizesthatneither the CITYnorits officers*affiliates,employees, successorsand a9Sigis shall beheld liable or responsible for anydaims,indudingthe costsandexpenses of defendingsuch daims which ma/resultfromorariseoutof adions oromissionsof the Contrador,its contractor/subcontractor oranyoftheir agents*representatives*employees*or asagps,oranyoneactingthrou^i oron behalf ofthethem,and alsing outofor concerning theworkoreventthatis occurring onthe CITTs property.In reviewing,approving or rejecting any submissions or ads oftheContractor,CITY innowayassumes orshares responsibility or liability forthe ads oromissionsoftheContrador,itsoontrador/subcontrador orany of their agents,representatives,employees*or assign or anyone acting throucfi oron behdf of them. EThe Contrador has the duty to provideadefensewithanattorneyorlavfirmapprovedby the City of South Miami,whichapprovalwill notbeunreasonablywithheld. F.However,astodesigi professional oontracts,and pursuant toSection725.08 (1),RoridaSalutes, noneofthe provisions setforthhereinabovethatarein conflict withthis subparagraph shall apply andthis subparagraph shall setforththesole responsibility ofthe design professional concerning indemnification.Thus, the design professional's obligationsasto the Cityandits qgendes,aswellastoitsofficersandemployees,isto indemnify andholdthemharmlessfrom liabilities*damages,losses,aid costs*indudingbutnot limited to, reasonable attorneys'fees*to the extentcausedbythe negligence,recklessness,or intentionally wron^ul oondudofthedesigi professional andotherpersonsemployedor utilized by the desigi professional in the performanceoftheoontrad. EXHIBIT 2 INVITATION TO QUOTE AFFIDAVITS AND FORMS SUBMISSION REQUIREMENTS This listing indicates the formsanddocumentsrequiredtobesubmittedforthis solicitation and to bepresentedby the deadlinesetforwithin the solicitation.Fulfillment of all solicitation requirementslistedismandatory for consideration ofresponseto the solicitation.Additional documentsmaybe required and,ifso,they will be identified inanaddendumtothisITQ.The response shall include the following items: 1.Non-Collusion Affidavit 2.Fublic Entity Crimes andConflicts of Interest 3.DrugFree Workplace 4.Acknowledgement of ConformancewithOSHA aandards 5.Federal andStateVendor Listing 6.Related Farty Transaction Verification Form 7.Presentation Team Dedaration/Affidavit of Representation 8.Sgned Contract Document (All-including General Conditions and Supplementary Conditionsif attached.EXHIBIT 3 NON COLLUSION AFFIDAVIT STATEOF FLORIDA ) ) COUNTY OFM1AMI-DADE ) foflb&id D-Hff U££OCt beingfirst duly sworn,deposes and statesthat: (1)He/aieTThey isferethe QlPndfc._ (Owner,ftrtner,Officer,Representative or Agent)df QltiW ftj^Kln f LLC the Respondent that has submitted the attached Roposal; (2).He/SheTThey istere fully informed concerning the preparation and contents ofthe attached Roposal and of all pertinentcircumstancesconcerning suchRoposal; (3)SUch Roposalis genuine andisnota collusive orsham Roposal; (4)Neither the saidRespondentnoranyof its officers*partners*owners^agents*representatives* employees or parties in interest,induding this affiant,hat/e inanyway colluded,conspired,connived or ggreed,directly or indirectly,with any other Respondent,firm,or person to submit a collusive or sham Roposalin connection with theWorkforwhichthe attached Roposalhasbeen submitted;or to refrain from Bidding or proposing in connection with such Work;or have inany manner,directly or indirectly,soucfrt by ag-eement or collusion,or communication,orconference with any Respondent,firm,or person to fix any overhead,profit,orcost elements oftheRoposalorofany other Respondent,ortofix any overhead,profit,orcostelementsoftheRoposalRiceor the Roposal Rice of aiy other Respondent,ortosecure through any collusion,conspiracy,connivance, or unlawful agreement any advantage against (Recipient),orany person interested inthe proposed Work; (5)Thepriceorpricesquotedinthe attached Roposalare fair and proper and arenot tainted byany collusion,conspiracy,connivance,or unlawful agreement on the partoftheRespondentor aiy other ofits agents*representatives,owners*employeesor parties ofinterest,induding this affiant. Sgied,sealedanddeliveredin the presence of By: Sgiature nt MamAanH TitlP \JWitfiess^\L/^Rint Name and Title \i\w\to\u Date ACKNOWLEDGB/IBMT STATEOF FLORIDA ) ) COUNTYOF MIAMI-DADE ) On this the Off day of J/jfo&prt Jw/.20/£>.before me,the undersigied Notary Ftiblic of the Sate ofRorid^persona(!y notary)Q=*tMU^ (Na^s)of individual(s)who appeared before i &(Jfrryb£>)£>*and whose name(s)isfare Subscribed to the within instrument,and he/she/they acknowledge thathe/she/theyexecutedit. Thomas F.Pepe 02-23-15 1Q WITNESSmy handand official seal. NOTARY RJBUC: ffiMOFOFRCE 4ft Thomas F.Pepe 02-23-15 UEVDA P.ESCOBAR g MY COMMISSION #FF246496 EXP1RE8 Auou*tA7.201»: 11 ^&0jt?#-ifl me o^Notary RjWIc:Rrtat,aa(Nameo^Notary RjHIc:Print,aampor typeascommissioned) V^Rsrsonally known to me,or ftrsonal identification: TypeofIdentification Reduced Did take anoath,or Did Not take anoath. PUBLIC ENTITY CRIMES AND CONFLICTSOF INTEREST Rjrsuant tothe provisions of Raragraph (2)(a)of Section 287.133,Florida 3ate aatutes -u A person or affiliate who has been placed onthe convicted vendor list following a conviction for a public entity crime may not submit a Roposal or bid ona Contract to provide any goods or services toa public entity,m^not submit a Bid or proposal for a Contract witha public entity for the construction of repair ofa public building or public work,m^ not submit bids or proposals on leases or real property toa public entity,may notbe awarded to perform Work asa RESFONDBMT,SUb-contractor,supplier,SLib-consultant,or Consultant under a Contract withany public entity,and may not transact business with any public entity inexcessofthe threshold amount Category Twoof Sfection 287.017,Rorida Salutes*for thirty sx (36)months from the date ofbang placed onthe convicted vendor list". The award ofany contract hereunder is subject tothe proviaons of Chapter 112,Rorida Sate Satutea Respondents must disdosewiththeir Roposals*the name of any officer,director,partner,assoriate or agent who isalsoanofficeror employee of the City of Sbuth Miami oritsagencies SWORN STATB/IBMT RJRSUANTTO SBCTION 287.133 (3)($, FLORIDA STATUTES ON PUBLIC BMTITY CRIMES THISFORM MUST BESGNED AND SWORN TO IN THEPRE9BNCEOFA NOTARY FUBUC OROTHBR OFRCIAL AUTHORIZE)TO ADMINISTER OATHS 1.This sworn statement is submitted to Mm of ftorth miflvn'i [printname of the publicentity] by ftfltaftd o.nqjMM ,?<^f>iden+ {pint individual'snamWsnd title] for faflf ftftgn iLLC. [printname of entitysubmittingswornstatement] whosebusinessaddressis )646ll SbO KYL S\d^eA and (if applicable)its Federal Bnployer Identification Number (FBN)is ^l*-&)hb7jSu>(If the entityhasno FBN,includethe Sbcial Security Numberof the individual agiing thisswornstatement: J 2.I understand that au public entity crime"asdefinedin Paragraph 287.133 (1)(g),Rorida Sstutea meansaviolation of anystateorfederallawbyapersonwithrespect to anddirectlyrelatedto the transaction of business with any public entityorwithan agency or political subdivision of any otherstate orofthe United Sates*including,butnot limited to,any bid,proposal orcontract for goodsor services tobe provided toany public entityoran agency or political subdivision ofanyotherstateorofthe United Sates and Involving antitrust,fraud,theft,bribery,collusion,racketeering conspiracy,or material misrepresentation. 3.I understaidthat "convicted"or "conviction"as defined in Ffersgraph 287.133 (1)(b),Rorida Statutes^meansa finding of guilt ora conviction ofa public entity crime,withorwithoutan adjudication of guilt,inany federal orstate trial courtofrecord relating to charges brougit by indictment or information after JUIy 1,1989,asa result ofajury verdict,non-jury trial,orentryofa plea of guilty or nolo contendere. 4.I understand thatan "affiliate"as defined in ftragaph 287.133 (1)(a),Horida Sautes,means: (a)A predecessor or successor ofa person convicted ofa public entity crime;or (b)Anentity under the control of any natural person whois active inthe management ofthe entity andwhohasbeenconvicted of a public entity crime.The term"affiliate"includes those officers* directors*executives,partners,shareholders,employees*members*aid agents whoare active In Thomas F.Pepe 02-23-15 12 the management ofan affiliate.The ownership byone person of shares constituting a controlling interestinany person,ora pooling of equipment or inoome amongpersonswhennotfor fair market value under an arm's length agreement,shall bea prima facie casethatoneperson controlsanother person.A person who knowingly entersintoajointventurewithaperson whohasbeen convicted ofa public entitycrimein Rorida during the preceding 36months shall be considered ai affiliate 5.I understand thata "person"as defined in Rarag-aph 287.133 (1)(e),Honda Statutes,meansany natural person orentity organized under thelawsofanystateorofthe United Sates withthe legal powertoenterintoa binding contract and whichbidsor proposal or applies tobidor proposal on contracts forthe provision ofgoodsor services letbya public entity,orwhichotherwisetransactsor applies to transact business witha public entity.Theterm "person"includes those officers*directors, executives*partners*shareholders*employees*members*and agents whoare active in management ofan entity. 6.Based oninformationandbelief,thestatementwhich I havemarkedbelowis true inrelation to the entity submitting thissworn statement.[Indicate which statement applies,] X Neither the entitysubmittingthisswornstatement,noranyofits officers*directors*executives* pothers,shareholders*employees*members*or agents who are active in the management ofthe entity, nor any affiliate of the entityhasbeen charged withand convicted of a public entitycrimesubsequentto JUly 1,1989. .Theentitysubmittingthisswornstatement,oroneor more ofits officers,directors*executives, partners*shareholders*employees,members*or agents who are active inthe management ofthe entity, or ai affiliate oftheentityhasbeen charged with and convicted ofa public entitycrime subsequent to JUly 1,1989. .Theentity submitting thisswornstatement,oroneormoreofits officers*directors*executives* partners*shareholders*employees,members*oragentswhoareactive in the management oftheentity, oran affiliate oftheentityhasbeen charged with and convicted ofa public entitycrime subsequent of JUly 1,1989.However,there has been a subsequent proceeding before a Hearing Officer ofthe State of Rorida,Divison of Administrative Hearings andthe final Orderenteredbythe Hearing Officer determined thatitwasnotinthe public interest to place theentity submitting thissworn statement on the convicted vendor list,[attach acopyofthe final order.] I UNDERSTAND THAT THESUBMISSON OFTHISFORMTO THECONTRACTlNGOFRCmFORTHEPUBLIC BslTiTY INDBJTIRBE)IN FftRAGRAPH 1 (ON§ABOVE ISFORTHAT RJBUC BITITY ONLY,ANDTHAT THISFDRM iSVAUD THROUGH D&BMBSR 31 OF THE CALENDAR YBKR IN WHICH IT IS RLBD.i ALSO UNDERSTAND THAT I AM RK>U1RED TO INFORM THE RJBUC BITITY PRIOR TO ENTERING INTO A CONTRACT IN BCCBSS OF THE THRESHOLD AMOUNTPROVIDE)IN SBCTION 287.017,FLORIDA STATUTES R}R CATB30RY TWO OF ANY CHANGEIN THEINFORMATION CONTAINED IN THISRDRM. ^^A^y n<0 A Ia9^ure]^3nott\to and subscribed before me this &*day of JJ<&Z'erZ4J&&&.20/^. Personallyknown >£C?f9&2sjvgx,^>-r/<Z.U&2#& OR Roduced identification Notary Public-3ate of f^A*0l£l&/% My commission expires Su (Typeof identification)(Rinted,typedor stamped oommissieFormPUR7068(Rev.06/11/92)name of notary public)£&T//lrf p £^/*#&#/Jisstened' Thomas F.Pepe 02-23-15 13 #i%,LEYDA P.ESCOBAR %J|J^MY COMMISSION #FF24S48I ^^^EXWRESAugi^UaOHK. DRUG FREE WORKPLACE Whenever twoormore Bids or Roposals which are equal with respect to price,quality and service arereceived bythe aate or by any political subdivisionsfor the procurement ofcommodities or contractual servioes*a Bid or Roposai received from a business that certifies that it has implemented a drug-free workplace prog-am shall be gven preference in the award prooesa Established procedures for processing tie Bids or Roposals shall be followed if none ofthetied vendors have a drug-free workplace program.In orderto have a drug-free workplace prog-am,a business shall: 1)Riblish a statement notifying employees that the unlawful manufacture,distribution,dispensing, possession,oruseofa controlled substance is prohibited inthe workplace and specifying the actions that shall betaken against employees for violations of such prohibition. 2)Inform employees about the dangers of drug abuse inthe workplace,the buanessf policy of maintaining a drug-free workplace,any available drug counseling rehabilitation,and employee assistance programs*and the penalties that may be imposed upon employees for drug abuse violations 3)Give each employee engaged in providing the commodities or contractual services thatareunder Bidacopyofthestatement specified in Subsection (1). 4)In the statement spedfied in Subsection (1),notify the employees*that,asa condition ofworking of thecommoditiesor contractual servicesthatare under Bid,heemployeeshall abide by the termsofthe statement and shall notify the employee ofany conviction of,or plea of guilty or ndo contendere to,anyviolation of Chapter 893orof any controlled substance law oftheUnited Statesor any state,fora violation occur ring inthe worktfaceno later thanfive(5)business days after such conviction. 5)Impose a sanction on,or require the satisfactory participation inadrugabuse assistance or rehabilitation prog-am,if such is a/alable inthe employee's community,byanyemployee whois so convicted. 6)Make a good faith effortto continue to maintain a drug-free workplace througi implementation of this section. Asthepersonauthorized to agn the steemont.I certifythatthisfirm complies fully with the above requirements. RESFONDBMT'sagisture: Rint Nane:(hctold D^ty y^p Date:^JQ^|Z^VP Thomas F.Pepe 02-23-15 14 ACKNOWLEDGEMENT OF CONFORMANCE WITH OSHA STANDARDS TO THECITYOFSOUTH MIAMI We Gnfl-VV SOUln,LLC .(NameofCONTRACTOR),herebyacknowledgeaidag-eethat» CONTRACTORfor theInvitation Quote project as spedfied inthe solidtation documents hawe the sole responsibility for compliaice with ail the requirements ofthe Federal Occupational S-fety and Health Actof 1970, and all aate aid local safety and health regulations*and agree to indemnify andhold harmlessthe Cityof South Miam i andjy^JConsultant)against any and ail liability,daims*damages*losses and expenses they may incur due to the failure of(Sib-contractor's names): to complywithsuchactor regulation. CONTRACTOR fofcVir fioftn.tL(L Witness by:Cnnhuld D.Vjawtack Title 15 AFFIDAVIT CONCERNING FEDERAL AND STATEVENDORLISTINGS The person,or entity,whois responding tothe City's solicitation,hereinafter referred to as"Respondent",must certify that the Respondent's name Does Not appear onthe 3ate of Rorida^Department of Management Services* "CONVICTED,SUSPENDED,DISCRIMINATORY FEDERAL EXCLUDED PARTIESand COMFLAINTSVBMDOR LISTINGS'.> Ifthe Respondent's nane Does appear ononeor all the"Ustlngsf summarized below,Respondents must"Check if Applies?next tothe applicable "listing"Thett UstingsT can be accessed through the following link tothe Rorida Departmentof Management Serviceswebsite: http://www.dm&myfloridacom/business^operationsfetate_purchasingft/endor information/convicted susp endecLdiscriminatory^complaints vendorji^s DECLARATION UNDER PENALTY OF PERJURY I,foflWtll D.Pi<^fl^(hereinafter referred to as the "Dedarant")state,under penalty of perjury, that the following statements are true andcorrect: (1)Irepresent the Respondent whose name Is fryfcH"G>Qi&nf LLC. (2)I have the following relationship withthe Respondent PiL&yiAenlr (Owner (ifRespondent isa sole proprietor),Resident(if Respondent isa corporation)ftrtner (if Respondent isa partnership),General Partner (if Respondent isa Limited Partnership)or Managng Member>(if Respondentisa Limited Liability Company). (3)I hare reviewed the RoridaDepartmentof Management Serviceswebste atthe following URL address: http://www.dm&myfioridacontf^ scriminatoi7_cx)m^aints_vendorJists (4)I have entered an"x"ora check mark beside each listingfcategory set forth below ifthe Respondent's name appears inthe list found onthe Rorida Department of Management Services websiteforthat category or listing If I did notentera mark beside a listingfcategory it means that I amattesting tothe fact thatthe Respondent's name does notappearon the listing forthatcategoryin the RoridaDepartment of Management Sfervioes website as ofthe date of this affidavit. Check if Applicable ConvictedVendorUst Suspended VendorList Discriminatory VendorList Federal Bcduded Forties List VendorComplaint List FURTHER DECLARANT SAYETH NOT (R-lntr ACKNOWLEDGEMENT STATE OFFLORIDA) COUNTY OFMIAMI-DADE) Dnftlsthe_&£da/ofJ1^^^$C&1§/(?.before me,the undersigied authority,personally&??&>/)J&r^D y7^i<£O6z&0/$*whoii On followingidentification foregoing Affidavit as the Dedarant. WITN ESS myhandand offidal seal. NOTARY PUBLIC: SEAL Thorn asF.Pepe 02-23-15 16 is personally knowtomeorwhoprovidedthe andwho took anoathoraffirmedthatthat he/she/they executed the rU?fi<i&f)' Notary FWic,3ate ofRorida (Nameof Notary F\jblicx Bint, Samp or type as commissioned.) LEVDA P.ESCOBAR S MYCOMMISSION#FF246496 EXPIRES Au^t 17,20 Id RELATED PARTY TRANSACTION VERIFICATION FORM I (hfltottd D-FifrMEtifl individually and on behatfof foflR &0&n,LlC (ttRrmB)have Namecf Rfcfesentative OorrparyAfcnda/B%read the City of Sbuth Miami ("City7sCodeof Shies* Section 8A-1 ofthe CitysCode of Ordinances and I hereby certify,under penalty of perjury that tothebestofmy knowledge,information and belief. (1)neither I nor the firm have any conflict of interest (as defined in section 8A-1)with regard tothe contract or businessthat I,and/or the Rrm,am(are)abouttoperformfor,orto transact with,the City,and (2)neither I nor any employees;officers;directors ofthe Rrm,nor anyone who hasafinandal interest greater than5%inthe Rrm,hasany relative(s),asdefined in section 8A-1,whoisan employee oftheCityorwho is(are) an appointed or elected offidal ofthe City,orwho is(are)a member of any public bodycreated bytheCity Commission,i.e.aboard or commltteeof the City,[while theethicscode still applies,ifthe person executing this form is doingso on behalf ofafirm whose stockis publidy traded,the statement inthis section (2)shall be based solely onthe sgnator/spersonal knowledge and he/she Isnot requiredtomakean independent investigation asto the relationship of employees orthosewho haveafinandal interest inthe Rrm.];and (3)neither I northeRrm,noranyonewho hasafinandal interest g-eater than5%intheRrm,noranymemberof those persons?immediate family (i.e.,spouse,parents,children,brothers and asters)hastransacted orentered into ay contract(s)with theCityor has afinandal interest,direct or indirect,inany business bang transacted withthe dty,orwithanypersonor agency actingfor the cHy,otherthanas follows _(use Ofnecessary,usea separate sheetto supply additional information that will not fit onthis line;however,you mustmake reference,on the above line,to the additional sheetand the additional sheetmustbe signed under oath),[while theethicscode still applies;ifthe person executing thisformis doing soon behalf of afirm whose stockis publidy traded,the statement inthis section (3)shall be based solely onthe agnator/s personal knowledge and he/she isnot required tomakean independent investigation astothe relationship ofthosewho have a financial interestin the RrmJ;and (4)noelected and/or appointed offidal oremployeeoftheCityof a>uth Miami,oranyoftheir immediate family members(i.e,spouse,parent^children,brothersandasters)hasafinandal interest,directly or indirectly,inthe contract betweenyou and/or yourRrmand the Cityotherthan the following individuals whose interest isset forth follpwingtheir usea separate names: (if necessary,usea separate sheetto supply additional information that will notfitonthis line;however,youmust make reference,ontheabove line,tothe additional sheetandthe additional sheetmustbe signed underoath). Thenamesof all Cityemployeesandthatof all elected aid/or appointed dty offidais or board members,who own,directly or indirectly,aninterestof five percent (5°/Q ormoreofthetotalassetsof capital stockinthe firm are as follows: (if necessary,usea separate sheetto supply additional information that will not fit onthis line;however,youmust make reference,onthe above line,totheadditional sheet and the additional sheet must be agied under oath), [while the ethics code still applies;ifthe person executing this form isdoing soon behalf ofa firm whose stock is publidy traded,the statement inthis section (4)shall be based solely onthe a'giator/s personal knowledge and he/sheisnot required tomakean independent investigation asto the finandal interestintheRrmof dty employees;appointed offidaisorthe immediate family members of elected and/or appointed offidal or employee.] (5)I andtheRrm further agree nottouseorattempttouseany knowledge,propertyor resource which ma/ cometous through pur positionoftrust,orthroughour performance ofour duties underthetermsof the contractwiththeCity,tosecureaspedai privilege,benefit,orexemptionforourselves,or other*We agreethat we maynotdisdoseoruse information,not available tomembersofthe general public,forour personal gain or benefit orforthe personal ganor benefit ofanyother person or business entity,outsideofthe normal gain or benefit antidpated throucji the performance of the contract. (6)I and the Rrmherebyacknowledgethat we havenotcontractedor transacted anybusinesswith the Cityor anypersonor agency actingfor the City,andthat we hare notappearedinrepresentationofanythirdparty beforeany board,commission or agency of the City within thepasttwoyearsotherthanas Thomas F.Pepe 02-23-15 17 follows:utf ^\d 4 ^iocrti?iflrn iFKttA An l\fi)06)2W (if necessary,usea separate shedto supply additional information that will not fit onthis line;however,youmust make reference,on the above line,tothe additional sheetandthe additional shed mustbe agied under oath). X:\FUrchain^Vendor Regstration\12.28.12 RELATE)PARTY TRANSITION VB3RCATION FORM[3].docx (7)Neither I norany employees;officers;or directors oftheRrm,nor any of their immediate family (La,asa spouse,son,daughter,parent,brother or sister)is related by Wood or marriage to:(i)any member oftheCity Commission;(ii)anydty employee;or (iii)anymember ofany board or agency oftheCityotherthanasfollows (if necessary,usea separate sheetto supply additional information thatwill not fit onthis line;however,youmustmake reference,ontheaboveline,tothe additional sheet and the additional shedmustbe sigied under oath),[while the ethics code still applies,ifthe person executing this form is doing soon behalf ofa firm whosestock Is publidy traded,the statement in this section(7) shall be based solely onthe signatory's personal knowledge and he/sheisnot required tomakean independent investigation astothe relationship by Wood or marriage of employees^officers^or directors oftheRrm,orofany oftheir immediate fanily toany appointed orelectedoffidaisoftheCity,orto their immediate family members]. (8)NoOtherRrm,noranyofficers or directors ofthatOtherRrmoranyonewho hasafinandal interest greater than5%inthatOtherRrm,noranymemberofthose persons'immediate family (i.e.,spouse;parents;children, brothers and asters)nor any ofmy immediate family members (hereinafter referred toas"Related RartiesT)has responded to asolidtation bytheCityin which I ortheRrmthat I represent oranyonewhohas afinandai interest greater than5%intheRrm,oranymemberofthose persons'immediate family (i.e.spouse,parents^ children,brothers aid sisters)have alsoresponded,otherthan the following :,Of necessary,useaseparateshed to supply additional information thatwillnotfitonthis line;however,youmust makereference,on the aboveline,to the additional shed and the additional shed mustbe sigied under oath), [while theethicscode still applies;if the personexecutingthisformisdoingsoonbehalfofafirmwhosestockis publidy traded,the statementinthissection(8)shall bebasedsolelyonthe sigiator/s personal knowledgeand he/she isnotrequiredtomakeanindependent investigation into the OtherRrm,or the Rrm he/she represents;as totheir officers,directorsoranyone having a flnandal Interest in thoseRrmsorany of theiranymemberofthose persons?immediate family.] (9)I and the Rrm ggree that we ae obligated to supplement this Verification Form andinform the Cityofany change indrcumstancesthatwould change ouranswerstothis document.Jfcedfically,afterthe opening ofany responsestoasolidtation,I andtheRrmhavean obligation to supplement this Verification Formwith the name of all Related Rarties whohavealsorespondedtothesame solidtdion andtodisclosethe relationship ofthose parties to me and the Rrm. (10)A violation ofthe City's Ethics Code,the gving of any false information orthe falure to supplement this Verification Form,may subject meortheRrmtoimmediatetermination ofany agreement with the City,andthe Imposition ofthe maximum fine and/or any penalties allowed by law.Additionally,violations maybe considered by and subject to action bythe Miami-Dade County Commission on Bhica Under penalty of perjury,I dedarethat I havemadea diligent effortto investigate thematterstowhich I am attesting hereinabove andthatthe statements made hereinabove are true^hd correc^jto the best ofmyknowledge,information and belief. Sgnature:_ mntName&fl^h^f PgffJHgnf ThoniasF.Pepe 02-23-15 18 Sec.8A-1.-Conflict of interest and code of ethics ordinance. (a)Designation. Thissection shall be designated andknownasthe"Cityof Sbuth Miami Conflidof Interest andCodeofEthics Ordinance."This section shall be applicable to all dty personnel as defined below,and shall alsoconstitutea standard of ethical oondudand behavior for all autonomous personnel,quaa-judidal personnel,advisory personndand departmental personnel.The provisions ofthissedion shall be applied ina cumulative manner.By wa/of example,andnotasa limitation,subsections (c)and(d)ma/be applied tothesame contract ortransaction. (b)Definitions For thepurposes ofthissedionthe following definitions shall be effective: (1)Theterm "commission members!1 shall rdertothe mayor and the membersof the dty commission. (2)Theterm "autonomous personnel"shall rdertothemembersof autonomous authorities*boardsand agendes* suchasthe dty community redevelopment agency andthe health facilities authority. (3)Theterm "quasi-judidal personnel"shall rdertothe membersof the planning board,the environmental review andpreservationboard,the code enforcement boardandsuch other individuals,boardsand agendes of the dty asperform quasi-judidal fundions. (4)Theterm "advisory personnd"shall refer tothe members ofthosedty advisory boardsandagendeswhose soleor primary respona'WIity isto reoommend legslation orgveadviceto the citycommisaon. (5)Theterm "depatmental personnd"shall rdertothedtyderk,thedty manager,department heads,the dty attorney,and all assistants to the dty derk,dty manager and dty attorney,howevertitled. (6)The term "employees!'shall referto all other personnel employed bythedty. (7)Theterm "compensation"shall rderto any money,gft,favor,thingofvalueor finandal benefit conferred,or to be conferred,in rdurn for services renderedor to berendered. (8)The term "controlling finandal interest"shall referto ownership,diredlyorindirediy,often percentor more of the outstanding capital stockinany corporation oradiredor indirect interest often percentormoreina firm, partnership,orotherbusinessentityatthetimeof transacting businesswith the dty. (9)The term "immedlde family"shall rder tothespouse,parents^children,brothersandsistersoftheperson involved. (10)Theterm "transact aiy business!1 shall rdertothe purchase orsaleby the dtyof specific goodsorservices for consideration andtosubmittinga Wd,a proposal in response toa RFP,astatementof qualifications inresponse toa request bythe city,or enteringintocontrad negotiations for the provison onanygoodsor services;whichever first occurs (c)Prohibition ontransactingbusinesswith the dty. Noperson induded intheterms defined in parag-aphs (b)(1)through (6)andin paragraph (b)(9)shall enterinto anycontractor transact anybusinessinwhichthatpersonoramemberof the immediate family hasa finandal interest,directorindiredwith the dtyoranypersonor agency acting for the dty,andanysuchcontrad, agreement orbusinessengagement entered in violdion of this subsedion shallrender the transadion voidable. Willful violation of this subsection shall constitute malfeasance in office andshall affect forfeiture of office or position.Nothinginthissubsection shall prohibit ormake illegal; (1)The p^ment of taxes^spedal assessments orfeesfor services provided bythe dty government; (2)The purchase of bonds,antidpdion notesorother securities thatmaybe issued by the dty throucfi underwriters ordiredlyfrom time totime. Waiver of prohibition.Therequirementsofthissubsedionmaybewaivedfora particular transaction onlybyfour affirmative votes of the dty commissionafter public hearing upon finding that: (1)An open-to-all sealed compditive proposal hasbeen submitted byadtypersonasdefinedin paragraphs (b)(2), (3)and (4); (2)The proposal hasbeensubmittedbya person or firm offering serviceswithinthe soope ofthe practice of architecture,professional engneering,or regstered land surveying as defined bythelawsofthestate and pursuant tothe provisions of the Consultants!CompditiveNegotidion Ad,andwhen the proposal hasbeen submittedbyacitypersondefinedin parag-aphs (b)(2),(3)and (4); (3)Thepropertyorservicestobe involved intheproposedtransadionareuniqueand the dty cannot avail itself of suchpropertyorserviceswithoutenteringa transaction whichwouldviolatethis subsedion butforwaiverof itsrequirements;and (4)That the proposed transaction willbeinthebestinterestofthedty. This subsedion shallbeapplicableonlyto prospedive transadions,and the dty commission mayinnocase rdify a transaction entered in violdion of this subsedion. RcMsions cumutetivaThissubsection shall betaken to becumulativeand shall notbe construed toamendorrepeal anyother law pertaining tothesame subject matter. (d)Furtherprohibitionon transacting businesswith the dty. Thomas F.Pepe 02-23-15 19 No person induded inthe terms defined in paragraphs (b)(1)throu^i (6)and in paragraph (b)(9)shall enter into any contrad or transact any business through a firm,corpordion,patnership or business entity inwhich thd person or any member ofthe immediate family hasa controlling finandal interest,diredor indired,withthe dty or any person or agency adingfor thedty,and any such contrad,ageementor business engagement enteredin vioidion ofthissubsedion shall render the transaction voidaWe.Theremaning provisions ofsubsedion(c)will alsobe applicable tothissubsedionasthough incorporated byredtation. Additionally,no person induded intheterm defined in paragraph (b)(1)shdl voteonor partidpate in any wayin any mdter presented tothedty commission ifthd person has anyofthe following rddionshipswith anyof the personsor entities which wouldbeor might bediredlyor indirediy affeded by any adionofthedty commission: (1)Officer,diredor,partner,of counsd,consultant,employee,fidudary or benefidary;or (2)aockholder,bondholder,debtor,or creditor,ifin any instance the transaction or matter would affied the person defined in paragraph (b)(1)ina manner distinct from the manner In which itwould affed the public generally.Any person induded intheterm defined in paragraph (b)(1)whohasany ofthe spedfied rddionships orwho would or micjrt,diredly or indirediy,realize a profit bythe adion ofthedty commission shall notvoteon or partidpate inanywayin the mdter. (E)Gifts (l)Defirition Theterm"gft"shall rdertothe transfer of anything of economic value,whdherinthe form of money,service,loan,travd,entertanment,hospitality,itemor promise,orinanyother form,without adequde and la/rtul consideration. (2)Bccepticn&Theprovisionsof paragraph (e)(1)shall not apply to: a Fblitical contributionsspedficallyauthorizedbystate la/v; b.Giftsfrom reldivesor membersof one's household,unless the person isaconduit onbehalfofathirdparty to the deliveryofagft thd isprohibitedunder parag*aph(3); c.Awards for professional ordvic achievement; d.Material suchas books;reports,periodicals or pamphlets whicharesolely informational orofan advertising ndure. (3)Rdibitions Aperson described in perag-qphs (b)(1)through (6)shall neither solicit nor demand anygft.Itis also unlawful foranypersonorentitytooffer,gveorag-eeto gve toanyperson inducted inthe terms definedin parag-aphs (b)(1)through (6),orforanypersonindudedinthe terms definedin parag-aphs (b)(1)through(6)to acceptor agree toacceptfromanotherpersonorentity,anygftfororbecauseof: aAnoffidal public adion taken,ortobetaken,orwhichcouldbetaken,oranomissionor failure to take apublic action; b.A legal dutyperformedortobeperformed,orwhichcouldbeperformed,oranomissionor failure to perform a legal duty; c.A legal dutyviolatedortobe violated,orwhichcouldbeviolatedbyanypersonindudedinthe term definedin paragaph (b)(1);or d.Attendanceorabsencefromapublicmeding dwhichoffidaladionistobetaken. (4)Disdosue Anypersoninductedintheterm defined in parag-aphs (b)(1)throu^i (6)shall disdoseanygft,or series of gpfts fromanyonepersonorentity,having avalueinexcessof$25.00.Thedisdosure shall bemadeby filing acopyof the disdosure formrequiredbychapter 112,Florida Sdutes,for "local officer^'withthe dty derk simultaneously withthe filing oftheformwith the derkofthecountyandwiththe Rorida Sfecrdaryof ade. (f)Compulsory disdosure by employeesof firmsdoingbusinesswith the dty. Siould anyperson induded in the terms definedinparagaphs(b)(1)through (8)beemployedbyacorpordion, firm,partnership orbusinessentityinwhichthd person orthe immedide family doesnothavea controlling finandal interest,andshouldthecorpordion,firm,partnership orbusinessentityhave substantial business commitments toor from thedtyor any dty agency,orbesubjedtodired reguldion bythedtyoradty agency, thenthe person shall file asworn stdement disdosing such employment andinteredwiththederkofthedty, (g)Exploitation of offidal position prohibited. No person induded intheterms defined in paragaphs (b )(1)through (6)shall corruptly useor dtempt tousean offidalpositiontosecurespedal privileges orexemptionsfor thd personor others (h)Prohibitiononuse of confidential information. Nopersonindudedintheterms defined in paragaphs (b)(1)through (6)shall accept employment or engage in anybusinessor professional adivitywhichone mijjit reasonably expectwouldrequireorinduceonetodisdose confidential information acquired by reason ofan offidal position,nor shall thd personin fad everdisdose confidential informdion ga-nered or gained throughan offidal postionwiththedty,nor shall thd person ever use such informdion,diredlyor indirediy,for personal gainorbenefit. Thomas F.Pepe 02-23-15 2Q (i)Conflicting employment prohibited. Nopersonindudedin the terms defined in paragraphs (b)(1)through (6)shall acceptotheremploymentwhich wouldimpair independence of judgment in the performance of any public duties (j)Prohibitionon outside employment. (1)I No person induded in the terms defined in paragaphs (b)(6)shall receive any compensdion for servioes asan officer oremployeeof the dty fromanysourceotherthan the dty,exceptasmaybepermittedas follows: a Generally prohibited No full-time dtyemployee shall acceptoutsideemployment,either incidental,occaaond or otherwise,where dty time,equipmentor material istobeusedorwheresuchemploymentoranypart thereof Is tobeperformedon dty time. b.When permitted.A full-time dty employeemay acoept inddental or occasional outsideemploymentsolongas such employment isnot contrary,ddrimental or adverse tothe interest of the dty oranyofitsdepartmentsand the approval requiredin subparagraph c.isobtained. c.Approvalof department head required.Anyoutside employment by any full-time dtyemployeemust first be approvedinwritingby the employee'sdepartment head who shall maintain acompleterecord of such employment. d.Ftenalty.Anyperson convided of violating aiy provision of thissubsedion shall be punished asprovidedin sedion 1-11 oftheCode of Miami-Dade Countyand,in addition shall besubjectto dismissal by the appointing authority.Thecitymayalsoassess against a violator a fine nottoexceed$500.00andthecosts of investigation incurredby the dty. (2)All full-time dtyemployees engaged inanyoutsideemploymentfor any person,firm,corpordion orentity otherthanthedty,oranyofitsagendesor instrumentalities^shall file,under odh,an annual report indicating the source of the outsideemployment,the ndure oftheworkbeingdone and anyamountofmoneyorother consideration received by the employeefromtheoutsideemployment.Cityemployeereports shall be filed with thedtyderk.Thereports shall be amiable da reasonable time and place for inspection bythe public.Thedty mangger may require monthlyreportsfrom individual employees or groups of employees for good cause. (k)Rrohibited investments Nopersonindudedin the terms definedin parag-aphs (b)(1)through(6)oramemberofthe immedide family shall have personal investmentsinanyenterprisewhich will createa substantial conflict betweenprivateinterests and the publicinterest. (I)Certain appearances and payment prohibited. (1)Nopersonindudedintheterms defined in paragaphs (b)(1),(5)and (6)shall appear beforeany dty board or agency andmakea presentdion onbehalfof athird person withrespedtoany mdter,license,oontract, certificde,ruling,dedsion,opinion,rde schedule,franchise,orother benefit 90Ugit bythethirdperson.Nor shall the personreceiveanycompensdionor cpft,diredlyorindirediy,forservicesrenderedtoathirdperson,who has applied fororisseekingsome benefit fromthedtyoracity agency,in connedion withthe particular benefit soughtby the thirdperson.Nor shall the person appear inanycourtorbeforeanyadministrdive tribunal as counselor legal advisor toapartywho seeks legal rdid fromthe dty ora dty agency throughthe suitin question. (2)Noperson induded in the termsdefinedin parag-aphs (b)(2),(3)and(4)shall appear bdore the dty commissionor agency onwhich the person serves,either diredly or througi an assodde,andmakea presentdion onbehalfof athird personwithrespectto aiy mdter,license,contract,certificde,ruling,dedsion, opinion,rde schedule,franchise,orotherbenefit sougit by the third person.Nor shall suchpersonreceiveany compensdion or g|ift,diredly or indirediy,for services rendered to athird party who has applied for oris seeking somebenefitfrom the dty commissionoragencyonwhich the personservesin connedion with the particular benefit soughtbythethird party.Nor shall the person appear inanycourt or bdore anyadministrdive tribunal as counselor legal advisor toathird party whoseeks legal relieffromthedtycommissionor agency onwhich such person serves through the suit inquestion. (m)Actions prohibited when finandal interests involved. Noperson inducted intheterms defined inparagaphs(b)(1)through (6)shdl participate inanyoffidaladion diredlyorindirediy affecting abusinessinwhich thd personoranymemberof the immedide family hasa finandal interest.Afinandal interest isdefinedinthis subsedion to indude,but notbelimited to,any dired or indiredinterestinany invedment,equity,ordebt. (n)Acquiringfinancial intereda Nopersonindudedin the terms defined in paragraphs (b)(1)through(6)shdl acquire a finandal interestina projed,business entity or propertyda time when the personbelievesorhasreason to believe thd the financial interestmaybediredly dfeded by offidal actionsorby offidal actions by the dty ordty agency ofwhichthe personisanoffidal,officeroremployee. (0)Recommending professional services. Thomas P.Pepe 02-23-15 21 Nopersoninduded intheterms defined in paragraphs (b)(1)throu^i (4)mayrecommend the services ofany lawyer or law firm,archited or architedural firm,public rddionsfirm,oranyother person or firm,professional orotherwise,toassidinanytransadion involving the dty oranyofits agendes^provided thd a recommenddion ma/properly bemadewhen required tobe made bythedutiesof officeandin advance da public meetingattendedbyother dty officials,officersoremployees. (p)Continuing application after dty service. (1)No person inducted intheterms defined in paragaphs (b)(1),(5)and (6)shall,for aperiod oftwo years after his orherdty service or employment hasceased,lobby any dty offidal [as defined in paagraphs (b)(1)through (6)]In oonnedion with any judicial or other proceeding applicdion,RR3,RFQ,bid,request for ruling orother ddermindion,contrad,daim,controversy,charge,aocusdion,arrest orother particular subject matterin which thedtyoroneofits agendas isa party orhasanyinterest whdever,whdherdiredorindirect. Nothing contained inthissubsedion shall prohibit anyindividual from submitting a routine administrdive requed or applicdion toadty department or agency during the two-year period after hisor her service hasceased. (2)The provisions ofthesubsedion shall not apply to persons whobecome employed by governmental entities, 501(c)(3)non-profit entities or educdional institutions or entities;and who lobby on behalf ofthose entities in theiroffidal capacities, (3)The provisions ofthissubsedion shall apply to all persons described in parggaph (p)(1)whose dty serviceor employmentceasedafter the effedive dde ofthe ordinance fromwhichthis sedion derives. (4)No person described in parqgaph (p)(1)whosedty service or employment ceased within twoyearsprior to the effedive dde ofthisordinance shall foraperiodoftwoyearsafterhisorherserviceoremployment enter intoa lobbying contract tolobbyanycity offidal inconnedionwithanysubjed described in parag-aph (p)(1)in which the dtyoroneofitsagendesisapartyorhasanydiredand substantial interest;andinwhichheorshe partidpded diredlyorindirectlythroughdedsion,approval,disapproval,recommendation,the rendering of advice,investigation,orotherwise,duringhisorhercityserviceoremployment.A person partidpded "directly" whereheorshewas subdantially involved inthe particular subjed mdter throughdedsion,approval,disapproval, reoommenddion,the renderingof advioe,investigation,orotherwise,duringhisorher dty serviceor employment.Apersonpartidpded "indirediy"whereheorshe knowingly partidpdedinanywayinthe particula* subject mdter throughdedsion,approval,disapproval,recommendation,the renderingof advice,investigation,or otherwise,during hisorher dty serviceor employment.Allpersonscoveredbythis paragraph shall executean affidarvit onaform approved bythe dty attorney prior to lobbying any dty offidalattestingthd the requirements ofthissubsediondonotpredudethe person from lobbying dty offidais (5)Any personwhoviolatesthis subsedion shall besubjed to the penaltiesprovidedin sedion 8A-2(p). (q)City attorney torender opinions onrequest. Whenever any personindudedintheterms defined in paragaphs (b)(1)through (6)and paragaph (b)(9)isin doubtastotheproper interprddion orapplicdion of this conflid of intered andcodeof dhics ordinance,or wheneveranypersonwho rendersservicestothedtyisindoubt astothe applicability of the ordinancethd person,ma/submit to the dty dtomey a full written stdement of the fadsandquestionsThe dty attorney shall then renderanopiniontosuchpersonand shall publish theseopinions without use of thenameof the person advisedunless the person permits the use of aname. (Ord.No.649-1680,§2,3-2-99) Bitot's nde-Ord.No.6-9&-1680,§1,adopted 3-2-99,repealed g 8A-1 and8A-2in their entirdyand replaced them withnew§§ 8A-1 and 8A-2.Former <§8A-1 and8A-2pertanedtodedardionof policy and definitions,respedivdy,and derived fromOrd.No.634,<§1 (1A-1),1 (1A-2)adopted Jn.11,1969. BJDOFfflCTION Thomas F.Pepe 02-23-15 _ PRESENTATION TEAM DECLARATION/AFFIDVAIT OF REPRESENTATION Thisaffidavitisnotrequiredforcompliancewith the City's Solicitation;however,itmaybeusedtoavoid theneedtoregistermembersofyourpresentationteamas lobbyists.Pursuant to City Ordinance 28-14- 2206 (c)(9),anypersonwhoappearsasarepresentativeforan individual or firm foranoral presentation beforea City certification,evaluation,selection,technicalrevieworsimilar committee,shalllist on an affidavitprovidedbytheCitystaff,allindividualswhomaymakea presentation.Theaffidavitshallbe filed bystaffwiththe Clerk's office atthetimethecommittee^proposal issubmittedtothe City Manager.For the purposeofthissubsectiononly,thelistedmembersofthepresentationteam,with the exception ofany person otherwise required to register asa lobbyist,shall notbe required topayany registrationfees.Nopersonshallappearbeforeanycommitteeonbehalfofananyoneunlesshe or she hasbeenlistedaspartofthe firm's presentationteampursuanttothisparagraphorunlessheorsheis registeredwiththe City Clerk's officeasa lobbyist andhaspaidall applicable lobbyist registration fees. Pursuant to '92,525(2),Florida Statutes,the undersigned,6flvV BofrhiUXL makes the following declaration under penaltyofperjury: Listedbelowareall individuals whomaymakeapresentationonbehalfof the entity that the affiant represents.Pleasenote;Nopersonshall appear beforeanycommitteeonbehalfofanyoneunlesshe orshehasbeenlistedas part ofthefirm'spresentationteampursuanttothisparagraphorunlesshe orsheis registered with the Clerk'sofficeasa lobbyist andhaspaidallapplicablelobbyist registration fees. NAME TITLE Mirtw,Milldn,VcftoCbcr^te For the purposeofthis Affidavit ofRepresentationonly,thelisted members of the presentationteam, with the exception ofany person otherwise required to register asalobbyist,shallnotbe required to payany registration fees.The Affidavitof Representation shallbefiledwith the CityClerk'soffice at the time the committee's proposalis submitted to the City aspartof the procurement process. Under penalties ofperjury,I declare that I havereadtheforegoing declaration and that the facts stated initare true andspecificallythat the persons listedaboveare the members of the presentation team of the entity listed below Executed thjs %day of D/(frpnfafl£20|(<? Signature of Representative hrioffell TV Fta\mtoa,9u$\dorAr pgrt florin,HC Print Name and Title7 Print name of entity being represented Thomas F.Pepe 02-23-1S END OF SECTION 23 EXHIBIT 3 CONTRACT FOR ACTIVE SHOOTER KITS AND TRAINING ITQ#PD2016-24 THIS CONTRACT,entered into this _g_day of pffirnfyif .20 IU .by the CITY OF SOUTH MIAMI through itsManager,bothofwhomshall be hereinafter referredtoas the "CITY"where applicable;located at 6130SunsetDrive,SouthMiami,FL,E-mail: salexander@southmiamifl.govand foUl-V PjOCHj |J,C mri^anofficeand principal place of business located atlS4ftU?gyjp hlfr IWort^y'Pmall address of ftflfrbflfrnj le&nypnW.^and Facsimile transmission number of (hereinafter called the ^CONTRACTOR")^ WITNESSETH: WHEREAS,the CITY is in need of ft^sfg..fortjrfrtf.UAS^Tuk**:and WHEREAS,the CITY desires to retain CONTRACTOR to provide We required goods and/or services based on CONTRACTOR'S representations whichreflect that CONTRACTOR is qualifiedand capable ofprovidingsaidgoods and/or servicesina professional and timely manner and in accordance with the ClTY's goalsand requirements;and WHEREAS,CONTRACTOR has agreed toprovide the required goods and/or servicesin accordance with the terms and conditions set forth herein. NOW,THEREFORE,in consideration of the mutual covenants and agreements herein contained,the parties agree asfollows: 1)Engagement of Contractor:Basedon 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 forthinsaidproposal,quote or response tosolicitation, whichever is applicable,as modified by the Contract Documents,orasis otherwise set forth in the Contract Documents definedbelow(allofwhichis hereinafter referred to as the Work"). (Checkthebox immediately precedingthedocumentdescribedbelowtoindicatethatsuch document ispartofthis Contract) VContractor's response tothe ClTY's written solicitation;or VContractor's proposal or quote,orif none, dAs described in paragraph 2 below. 2)Contract Documents:The Contract Documents shall include this Contract and the following "checked documents",as well asany attachments or exhibits that are made a part of any of the "checked documents". (Check theboximmediately preceding thedocument described belowtoindicatethatsuchdocumentispartofthis Contract) d General Conditions to Contract, a Supplementary Conditions, V "Other Documents"referring to in this Contract and signed by the parties, V Solicitation documents ("hereinafter referred toas "Bid Documents" includingany request forbid,requestforproposalorsimilarrequest) V Scope of Services, V Contractor's response tothe ClTY's Bid Documents, V Contractor's proposal or quote, V ClTY's Insurance &Indemnification Requirements, d Bonding ofEmployees (the term "employee",as used in this Contract,shall include volunteers)-$1,000,000 d Payment Bond, •Performance Bond, This Contract and the GeneralConditionsto Contract,Supplementary Conditions,the Solicitation,ScopeofServicesand "Other Documents",ifanyare"checkeddocuments",shall take precedent over the responsetothe ClTY's Bid Documents,ifany,orthe proposal orthe Thomas F.Pepe2016 07/29/16 24 quote,ifany.The "checked documents"are attached hereto and made apart hereof by reference. 3)Date of Commencement:CONTRACTOR shall commence the performance of the Workunderthis Contract on TBD oradatetobespecifiedinaNotice to Proceed,or Purchase Order,(hereinafter referred toas the "Work Commencement Date"),andshall complete the performance hereunder within TBD daysorthelengthoftime set forthinthe Contract Documents,whichever Is the shorter periodoftime.TimeIsof the essence. 4)Primary Contacts:ThePrimaryContactPersoninchargeofadministeringthis Contractonbehalfof the CITY is the CityManager("Manager"),assistant Manager,or the Manager's designee,whoshallbe designated inawriting signed by the Manager.The Primary Contact Personfor CONTRACTOR and his/her contact information Isasfollows:Name: GuJQWX D'fffti^teP-mall:qili^bfl^U^Qy^ir:^n\&Street Address: 5)Scope of Services:Thegoods and/or services tobeprovided are as set forth in the "checked documents". 6)Compensation:The CONTRACTOR'S compensation for CONTRACTOR'S performance under the terms andprovisionsofthis Contract,or CONTRACTOR'S payments in the event CONTRACTOR ispaying the Cityfor the usesof the ClTY's property or services, (hereinafter referredtoas the ContractPrice)shallbeoneofthe following,asindicatedby oneof the following checked box,o Sl^.QflCi oras set forthIn o CONTRACTOR'S response to the ClTY's written solicitation,ifany,or,if none,then as set out in CONTRACTOR'S proposalor quote,the Scope of Services,oras set forthin,ormodifiedby,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 costofperformingtheWorkafterregularworkinghours,and onSundayandlegalholidays,isincludedin the Contract Price.However,nothing contained hereinshallauthorizeworkondaysandduringhours that are otherwise prohibitedby ordinance unlessspecifically authorized or instructed inwritingby 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 (11 year or untilit expires on ,or unless earlier terminated according to the Contract Documents. Notwithstanding the foregoing,thisContractmaybe extended byanadditionalN/A periodif the extensionisinwritingandsignedby the CityManager.Anextensionof the term of this Contract is at the ClTY's sole and absolute discretion. 9)Termination:This Contract maybe terminated without cause by the CITY with30 daysofadvanced written notice.Thisprovision supersedes andtakes precedence over any contrary provisions for termination contained in the Contract Documents. 10)Applicable Lawand Venue:Floridalawshallapplyto the interpretation and enforcement ofthisContract.VenueforallproceedingsshallbeInMiami-DadeCounty, Florida. 11)DutiesandResponsibilities:CONTRACTOR shallcomplywithallapplicablelaws, ordinances,codes,rules,regulations,andhealthand safety standards ofany governmental bodyhavingjurisdictionoverany matter relatedtothisContractor the goods and/or services tobeperformed hereunder,andshallcommitno trespass onanyprivate property in performinganyof the workembracedbythisContract.Eachandeveryprovision and/or clause required bylaw to be inserted inthis Contract shall be deemed to be inserted herein andthis Contract shall be read and enforced as though suchprovisions and/or clauses were included herein. 12)ChangeOrders:No additional Work or extras shallbe done unless the same is dulyauthorizedinwritingandinadvanceoftheworkby appropriate actionby the City Manager andin accordance with the Contract Documents. Thomas F.Pepe2016 07/29/16 25 13)Licenses and Certifications Contractor shall secure all necessary business and professional licenses atits soleexpense prior to awaiting tNs Contract or commencing the Work. 14)Insuranoe,Indemnification &Bonding:G0N1RU3OR shell comply withthe insurance,indemnification and bcmdirg retirements set forth inthe Contract Documents. 15)Liquidated Damages In theeventthat CONTRACTOR shall fall to complete the Workwithin the time timit setforthinthe Contract Documents,or the extendedtimelimit agreed upon,in accordance withthe procedure as rrxxeparticulariy set forth inthe Contract Documents,liquidated damagasshaH be paid atthe rate rf llJkkdjtala!^until the Workis completed 16)Jury Trial Waiver:Theparties waivetheir right to jurytrial. 17)Brtire Agreement,Modification,andNon-waiverThe Contract Documents constitute the entire agreement ofthe parties andsupersedes any prhx agreements,written cford.lheGortfractDocumertsrnaynctben^ both parties hereto and ifthis Contract isrequired tobe approved bytheCtyConmiflslon,all amendments thereto must be approved inthe samernannerarKlwtththeaerrBfonnafflyas this Contract.The Contract Documents,In general,and tNs paragraph,in particular,shall not temofifiedoramancWrjyaryattswo^^NofefluretoeHarctaeandno delay in exercising any rigjit,prjwar<»-pn^No waiver ofthe Contract Documents,in whole or part,induding the provisions of this paragraph,may be implied byanyactor omission. 18)PlrbTicRBCixcteCCWTWaa?arKlallof'to withthe public records law (a11ft0701)whfle provkfing goods arKVwaarwicfiSOTbeharf of the OTY and the CCKTFWCTOR under such oarelftlor^atialliricorDCcate this paragraphing of itsaibcortractsfor tHsftoject and diaH:(a)Map ard maintain pubfcreccHTto required by the pubHcagancy to perform the service;(b)Upon request from the pubOcagamyscustodian tfpufaticreooro^provide the publte^ recordstobeinspected orcopiedwitMnareaeonabretiinsataooalthatdoaBmtexoBedthe coat provided inthischapter orasotherwise rjroviaed by law;(c)&sure that puHte records that are exempt orconfidential and exempt from rxiblterieaardsdadcaLre requirements are notoxdoaad except asauthorized by law for tte duration ofthe Cortratltenn and fdlowmg completion ofthe Contract if CGNIROOR does not transfer the records tothe public agency;and(d)L^eompteticoc*the Contra*,transfer,atno coat,tothe public agency all pubfic records in posseajon of OONTFBCTORor toepardmamtahpubfcreoordsrea^ftedby the pubUc agancy to perform the aarvioa IfCENTR<03Rtrarefere all puWte records tothe public agency upon completion ofthe Contract,ODNTfVCTOR ahaD destroy any duplicate pubSc records that are exempt or confidential and exempt from public records disclosure recrements.If CCtfrwOCR heaps art Contract,CONTWCTORshall meet all appicabterequireniarTtstorretairrlr^ records stored eleetroniceBy must be provided tothe public agency,upon request from the public agency's custodian of public records,in a format that is compatible with the irrforTrrtiontec*inc<c^syaernsoftherjublteaEjawy. IF CONTRACTOR HASQUESTIONS REGARDING THE APPUCATIONOF CHAPTER 119,FLORIDA STATUTES,TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO TfflCS CONTRACT,CONTACT THECUSTODIAN OFPUBUC RECORDS AT 305-663-6340;E-mail: mmenendez@southmiamifLgov;6130 Sunset Drive,South Miami,FL 33143. 19)Background Screening.Allp«rscxineiandvolurteersthatwnipccvideanys9rvk» with vulnerable persons,asdeflned in Sedion435.02,Haaat.,irrvorvingtheatyorit8 Than F.Pepe 2016 maa/u as Agency in such related activity or who may have access to secure or sensitive areas ofthe City, must be in compliance with Level II Background Screening and fingerprinting requirements as per,Florida Statute Ch.435 prior tothe scheduled start of any employee or volunteer. CONTRACTOR shall prevent any and all ofits personnel,including volunteers,from engaging in any such related activities without having passed a background screening to the satisfaction of the City.Aviolation of this requirement shall constitute a substantial breach of this Contract. 20)Drug Free Workplace.CONTRACTOR shall comply vuith the Dmg Free W policy setfort*i!in the Qty of South Miami's Personnel Manual which is made a part ofthis Contractby reference. 21)Transfer and Assignment.None ofthe work or sen/ices under this Contract shall be subcontracted or assigned without prior written consent firbmthe CITY which may be denied without cause. 22)Notices.All notices given or required under thisContract shall bedeemed sufficient ifsent by amethod that provides written evidence of delivery,including e-mail and facsimile transmission and delivered toCONTRACTOR or his designated contact person. Return of mail,sent tothe address contained herein for the parties ortheir contact persons, asnotdeliverable prior feilii^to claim the mail shall bedeemed received on the date that the mailis returned to sender. IN WITNESS WHEREOF,the parties,have executed this Cortract,on or before the date first above Written,with lull knowledge of its content and significance and intending to be legally boundbythetermshereof. ^^[Individual or entity's name] Witnessed:^^-^ By:^^^^^^^Bii±^LM^CL nam Menendez CityClerk Read and Approved asto Form,Language, Legalityand Execution Thereof: By:_^>3%^> City Attorney ThomasF.Pepe2016 07/29/16 y£^ 27 Steven Alexander CityManager Insurance Addendum To whom it may Concern, In good faith we,Grit Born,have provided quotes from the insurance companyweareworkingwithin ordertoshowthatwewillhavetheprovisions of insuranceatthetimeof the projectinitiation.This industry isnewtotheinsurancecompanyandthey are takinga little longerthan usual todeterminethe liabilities at hand. Asouractof transparency Grit Born plans to provide all completed insurance documentsandbinderas soonastheinsurance company provides the final documentation.Thankyouforyourpatienceand understandingtothisuniquesituation.Feel freetocontactusifany questions shouldarise. AMERICAN INSURANCE POBOX 66-7955 MIAMI,FL 33166 GRITBORN,LLC 15406 SW172STREET MIAMI,FL 33187 PROGRESSIVE COMMERC/AL Underwritten by: Progressive Express Ins Company December 1,2016 Policy Period:Dec 1,2016-Dec 1,2017 Pagel of2 Customer Phone number.1-305-725-7512 Commercial Auto Insurance Quote 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 policyperiod If you pay your premium in full,you will receive a discount as shown. Total policy premium Paidinfull discount Policy premium ifpaidin full $5,903.00 '-875.00 $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 10 Payments,20.0%Down $5,903.00 $1,180.60 9 payments of$525.72 6 Pay,Seasonal,20.0%Down $5,903.00 $1,180.60 5 payments of$945.48 10 Payments,25.0%Down $5,903.00 $1,475.75 9 payments of$492.92 4 Pay,Seasonal,25.0%Down $5,903.00 Make payments by mail orat progressiveagent. Payment plan Total premium $1,475.75 com.Each payment includes Initial payment 3 payments of$1,476.75 a $3.00 service charge. Payments 10 Payments,20.0%Down $5,903.00 $1,180.60 9 payments of $527.72 6 Pay,Seasonal,20.0%Down $5,903.00 $1,180.60 5 payments of $947.48 10 Payments,25.0%Down $5,903.00 $1,475.75 9 payments of $494.92 4 Pay,Seasonal,25.0%Down $5,903.00 $1,475.75 3 payments of$1,478.75 4 Pay,Quarterly,25.0%Down $5,903.00 $1,475.75 3 payments of$1,478.75 1 Payment $5,028.00 $5,028.00 None To purchase insurance Continued 6RIT BORN,LLC Page2 of2 Please review the information on your quote for accuracy;incomplete and inaccurate information could affea your rate. These rates are subjea 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 Name Age status Points !n!?[m.3tjon gabriel RGUEROA 7777.'^77^^777777^7777777777 '.7.77 KAT imA fVgUEROA 33:Married 0 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 contraa or endorsements indicate otherwise. Description ,Limits Deductible Premium Liability To Others $4,196 Bodily Injury and Property Damage Liability $1,000,000 combined single limit Hired Auto Liability To Others 266 Bodily Injury and Property Da mage Ua bility $l,00q,0M^ Employer Non-Owned Auto Liability To Others 194 Bodily Injury and Property Damage Liability $1,000,000 combined single limit Basic Personal Injury Protection 296 With Work Comp-Named Insured Only $10,000 each person $0 Comprehensive 259 See Auto Coverage Schedule Urn it of liability less deductible Collision 692 See Auto Coverage Schedule Limit of liability less deductible Total12 month policy premium $5,903.00 Number of Employees:(0-10) Cost of Hire:$5,000 or less (if any) 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 Usedass:S Liability Liability PIP Premium $41%$2% ...Comp Comp Collision Collision Physical Damage Deductible Premium Deductible Premium Auto Total Premium $V#000 $259 $1,000 $692 $5,443 Premium discounts Policy Package Vehide 2016 HONDA PILOT Anti-Theft Standard,Air Bag and Anti-lock Brakes Form QTE ft(05/08) AmWINS Access Quote Number: Date: Quote Type: Insured Name: Policy Term: ♦Home State: AMW00041907 12/8/2016 New Grit Born LLC 12/8/2016 to 12/8/2017 FL From: Underwriter Email: AmWINS-Orlando,FL (407)541-5Q07 COMMERCIAL QUOTE Jaclyn DePasquale jaclyn.depasquale@amwins.co m Quote Is valid until 2/6/2017. Carrier:Covington Specialty Insurance Company A.M.Best Rated:A+XIII We are pleased toofferthe following Termsand Conditions based on information received.Please reviewcarefullyascoveragemay not be exactly asrequestedontheapplication. Commercial Quote Coverage Premium without Terrorism Commercial General Liability $2,750.00 (MP) Terrorism Premium Excluded Annual Minimum and Deposit $2,750.00 Total Estimated Policy Premium $2,750.00 Commission:10%Terrorism may be added for $110.00 +taxes. Minimum Earned Premium A minimum earned premiumof25%of thepremium,willbe retained ifthepolicyis canceled attheinsured's request.All fees are fully earnedandnon-refundable.Flatcancellationswillnotbe honored. Underwriting Requirements Subject to: Where possible,suppliersshouldnametheapplicantasadditionalinsured Fill in forms: CG 2133?Exclusion-DesignatedProducts "Smoke Grenades" GBA 104016?Limitation -Designated Products "FirstAidandTraumaResponseKitsand Supplies" GBA 105.006 AdditionalInsured-Vendors -Primaryand Noncorttributory "City of South Miami" CG2404?Waiver of Transfer of Rights of RecoveryAgainst OtherstoUs "City of SouthMiami" RSUI Quote Number:AMW00041907 Page 1 This quotation for coverage is strictly conditioned upon nomaterial change inthe risk occurring between the date ofthis proposal and the inception date ofthe proposed policy.It is subject to modification or withdrawal ifanynew,correctedorupdated information becomes known which relatestoanyproposed Insured's claimshistoryorriskexposureor which could otherwise changethe underwritingevaluationofany proposed Insured. Insured Name:Grit Born LLC Favorable Inspectionper Company Guidelines Signed &CompletedACORDApplication Signed &Completed Supplemental Application Signed TRIA Selection/Rejection Form Commercial General Liability Limits of Insurance General Aggregate Limit (other than Products Comp/Ops) Products-Completed.Operations Aggregate Limit Personal and AdvertisingInjuryLimit Each Occurrence Limit Damage to Premises Rented toYouLimit Medical Expense Limit Deductible Location Schedule Premises No.Address 1 15406 Southwest 172nd Street,Miami,FL,33187 Quote Number:AMW00041907 $2,000,000 $2,000,000 $1,000,000 $1,000,000 $100,000 -NOT COVERED -- NO DEDUCTIBLE -- Prm. Class Code Description Basis Amount Rate Products Rate All Other Premium Products Premium AH Other #1 54444 Manufacturers NOC Sales $8,000 $7,500 $1,250 $2,143 (MP)$357(MP) #1 -GBA 105006 Additional E Insured -Vendors - Primaryand Noncontrlbutory "The City of South Miami" Terrorism Coverage Acceptance •Add Form GBA909003 RSUI Quote Number:AMW00041907 $250.00 Terrorism Coverage Terrorism Coverage Rejection •Add Form GBA906005 ♦AddFormRSG99018 $250 Page 2 This quotation for coverage Is strictly conditioned upon nomateriel change intherisk occurring between the dateofthis proposal and theInception dateoftheproposed policy.It issubject to modification orwithdrawal ifanynew.corrected orupdated information becomes known which relates toanyproposed Insured's claims history orrisk exposure orwhich could otherwise change the underwriting evaluation 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 IL0017 IL 0021 GBA 100001 CG 0001 CG 2133 CG2135 CG 2404 GBA 104014 GBA 104016 GBA 105006 GBA 106010 GBA 106025 GBA 106059 GBA 106070 GBA 106092 GBA 106099 GBA 106109 GBA 903001 Quote Number:AMW00041907 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 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 -Designated Products Exclusion -Coverage C-Medical Payments Waiver of Transfer of Rights of Recovery Against Others To Us Basis of Premium Limitation -Designated Products Additional Insured -Vendors -Primary and Noncontributory Exclusion -Assault and Battery Exclusion -Firearms and Weapons Exclusions and Limitations Amendatory Exclusion -Prior Products or Completed Operations Products -Completed Operations Included In General Aggregate Exclusion -Intellectual Property Hazard Exclusion -Access or Disclosure of Confidential or Personal Information and Data-Related Liability Florida Changes -Cancellation and Nonrenewal Supplemental Applications Products Liability Supplemental Application RSUI Quote Number:AMW00041907 Page 3 This quotation for coverage is strictly conditioned upon nomaterial change inthe risk occurring between the date ofthis proposal and the Inception date oftheproposed policy.It Is subject toThisquotationtorcoveragetsstrictlyconditioneduponnomaterialchangeintheriskoccurnngbetweenthedateoithisproposalanameinceptionaaieormeproposeapoucy.u is subjectto modification or withdrawal ifanynew,corrected orupdatedinformation becomesknown which relatea toanyproposed Insured's claims history orriskexposure or which couldotherwise change the underwritingevaluationofeny proposed Insured. Insured Name:Grit Born LLC Quote Number.AMW00041907 ♦The term "Home State"means,withrespecttoaninsured- (i)The state in which an insured maintains its principal place of business or,in the case ofan individual,the individual's principalresidence;or (ii)If 100 percent of the insured risk is located out of the State referred toin subparagraph (A),the state towhich the greatest percentage ofthe insured's taxable premium for that insurance contract is allocated. RSUI Quote Number:AMW00041907 Page 4 This quotation forcoverage is strictly conditioned upon no material changeintherisk occurring between thedateofthisproposal andtheInception dateoftheproposed poricy.ItIssubject to modification or withdrawal Ifanynew.correctedorupdatedinformation becomes known which relatestoanyproposed Insured's claimshistory orriskexposureor which couldotherwise change the underwriting evaluation ofany proposed Insured. RSUIGroup,Inc.Phone (404)231-2366 946EastPaces Ferry Road pax mq4)231-3755 Suite 1800 Atlanta,GA 30326-1125 Policy Number:TBD Insurer:COVINGTON SPECIALTY INSURANCE COMPANY Named Insured:__. OFFER OF TERRORISM COVERAGE In accordance with the Terrorism Risk Insurance Act,weare required to offer theinsuredcoverageforlosses resulting from anactof terrorism,not otherwise excludedbythis policy,andascoveredbytheTerrorism Risk Insurance Act.All otherpolicyprovisions will applytocoverageforsuch act ofterrorism.Theinsured must choose whetherornottopaythe premium described below under DISCLOSURE OF PREMIUM forcoverageforactsof terrorismthatare certified by the Secretary oftheTreasury ascoveredactsunderthe Terrorism RiskInsurance Act,ornottopaythepremium,andrejectthis offer ofcoverageatthetimeof binding. Ifthe premium shown inthe DISCLOSURE OF PREMIUM isnot collected andthe insured doesnotreject coverage forterrorismthispolicy will be issued excludingactsofterrorism. DISCLOSURE OF PREMIUM If you accept thisoffer,theportionofyourpremiumforthe policy termattributableto coverage forallactsof terrorismcoveredunderthispolicyincludingterrorism acts certified under theActis$. DISCLOSURE OF FEDERAL PARTICIPATION IN PAYMENT OF TERRORISM LOSSES The United States Government,Department oftheTreasury,will paya share ofterrorism losses insured under thefederal program.Undertheformula,the United States Government generally reimburses85%through 2015; 84%beginningon January 1,2016;83%beginningonJanuary1,2017;82%beginningon January 1,2018;81% beginningon January 1,2019and80%beginningonJanuary1,2020,ofcoveredterrorism losses thatexceed the applicable insurer retention.However,if aggregate insured losses attributableto terrorist acts certifiedunder the TerrorismRisk Insurance Act exceed $100 billion ina calendar year,the Treasury shallnotmakeany payment for any portionofthe amount 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 ina calendar yearandwehavemetourinsurerdeductibleundertheTerrorismRisk Insurance Act, we will notbeliableforthe payment ofanyportionoftheamountof such losses that exceeds $100 billion,andin such case insured losses upto that amount are subject topro rata allocationin accordance with procedures established bythe Secretary of Treasury. •I herebyelecttopurchase certified terrorism coverageandpaythe premium shownaboveunder DISCLOSURE OF PREMIUM. •I herebyrejectthepurchaseof 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 Amemberof Alleghany InsuranceHoldings LLC j\CORCf CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/08/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NORIGHTSUPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOESNOTAFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND ORALTERTHE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOESNOT CONSTITUTE A CONTRACT BETWEENTHEISSUING INSURER(S),AUTHORIZED REPRESENTATIVEOR PRODUCER,ANDTHE CERTIFICATE HOLDER. IMPORTANT:If thecertificateholderIsan ADDITIONAL INSURED,the pollcy(les)mustbeendorsed.If SUBROGATION IS WAIVED,subjectto the terms andconditionsofthepolicy,certainpoliciesmay require anendorsement.A statement onthiscertificatedoesnot confer rightstothe certificateholderinlieuofsuch endorsements). producer AMERICAN INSURANCE BROKER 3650 N.W.82ND.AVE. PH504 DORAL FL INSURED 33166 Gritborn LLC 15406 SW 172 ST Miami FL 33187- £ont*ct PATRICIA PEREZ (305)715-9956PHONE •{AfCMn,FxQ- E-MAIL ABDRESSJ 88.^(305)715-7316 DPLA@AMERICANINSURANCEBROKERS.COM INSURER'S)AFFORDING COVERAGE INSURER A:.COVINGTON SPECIALTY NA1C0 INSURERS: INSURER C: IN3URER D: INSURERS; INSURER F: COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: THIS IS TOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIOD INDICATED.NOTWITHSTANDINGANYREQUIREMENT.TERMOR CONDITION OFANYCONTRACT OR OTHERDOCUMENTWITH RESPECT TOWHICHTHIS CERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS, EXCLUSIONS ANDCONDITIONSOFSUCHPOLICIES.LIMITSSHOWNMAYHAVEBEENREDUCEDBYPAIDCLAIMS. INSR LIR TYPE OF INSURANCE ADDL iwsn SUBR wv/n POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP /MM/nn/YYYY)LIMITS A X COMMERCIAL GENERAL LIABILITY X X PLA11503Q161208-001 12/08/2016 12/08/2017 EACH OCCURRENCE %1,000,000 CLAIMS-MADE I *IOCCUR DAMAGE TO RENTED PRFMISFS (Ea nrmrrftnca)$300,000 MED EXP (Anv one oetson)$0 PERSONAL &ADVINJURY $1,000,000 GENt AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $2,000,000 X POLICY |jjRf°f ||lOC OTHER: PROOUCTS -COMP/OP AGG S 2,000,000 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea arnW^nt)$ ANY AUTO BODILYINJURY(Perperson)$ ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON-OWNEO AUTOS BODILYINJURY(Peraccident)$ PROPERTY DAMAGE (Per ardrfpnt)$ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE s DED RETENTION $$ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY y/N ANY PROPRIETOR/PARTNER/EXECUTIVE |~H OFFICER/MEMBER EXCLUDED?J (MandatoryinNH) If yes.describe under DESCRIPTION OF OPERATIONS below N/A I PER I STATUTE I OTH-Ifr E.L EACH ACCIDENT s E.L.DISEASE -EA EMPLOYEE $ E.L.DISEASE -POLICY LIMIT $ ' DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES {ACORO 101.AdditionalRemarks Schedule,maybeattachedIfmore space Isrequired) Onlineretailerwho'ssellsfirstaidkitsofallsortsto any consumer inneed,focusonPolice,Fire and Military personnel,alsoofferproduct familiarization workshops. CERTIFICATE HOLDER NAME AS ADDITIONAL INSURED Al 011567CERTIFICATEHOLDERCANCELLATION "SAMPLE CERTIFICATE ONLY" I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BEDELIVEREDIN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /jES%l^&£tf£%^Z+ ACORD 25(2014/01) ©1988-2014 ACORDCORPORATION.Allrights reserved. The ACORD name and logo are registered marks of ACORD Detail by Entity Name Florida Limited Liability Company GRIT BORN,LLC Fifing Information Document Number L15000158038 FEI/EIN Number 47-5100256 Date Filed 09/16/2015 State FL Status ACTIVE Principal Address 15406 SW 172 STREET MIAMI,FL 33187 Mailing Address 15406 SW 172 STREET MIAMI,FL 33187 Registered Agent Name &Address NELSON &ASSOCIATES,CPAPA 1867 NW 97 AVENUE SUITE 102 MIAMI,FL 33172 Authorized Personfcl 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 Filed Date 2016 04/29/2016 Document Images 04/29/2016 -ANNUAL REPORT j/iew image in PDF format 09/16/2015-Florida Limited Liability ViewimageinPDF format lschcui uy unuiy in cunt? http://search.sunbiz.orp;inq^2/3 2016 FLORIDA LIMITED LIABILITY COMPANY ANNUAL REPORT DOCUMENT*L15000158038 Entity Name:GRITBORN,LLC Current Principal Place of Business: 15406 SW 172 STREET MIAMI,FL 33187 FILED Apr 29,2016 Secretary of State CC8337754586 Current Mailing Address: 15406 SW 172 STREET MIAMI,FL 33187 US FEl Number:47-5100256 Name and Address of Current Registered Agent: NELSON &ASSOCIATES,CPA PA 1867 NW 97 AVENUE SUITE 102 MIAMI,FL 33172 US The above namedentitysubmitsthisstatementforthepurposeofchangingitsregisteredofficeorregisteredagent,orboth,intheStateof Florida. SIGNATURE: Electronic Signature of Registered Agent Authorized Person(s)Detail: Title MGR Name FIGUEROA,GABRIEL Address 15406 SW 172 STREET Ctty-State-Zip:MIAMIFL 33187 Certificate of Status Desired:No Title MGR Name FIGUEROA,KATIRIA Address 16406 SW 172 STREET City-State-Zip:MIAMI FL 33187 Date I hereby certifythattheinformationindicatedonthisreportorsupplementalreportistrueandaccurateandthatmyelectronicsignatureshallhavethe same legaleffectasifmadeunder oath;that I ama managing member or manager ofthelimitedliability company orthe receiver or trustee empowered to execute th/s reportas required by Chapter 605,FloridaStatutes:and that my name appears above,oronan attachment with aJIother like empowered. SIGNATURE:KATIRIA FIGUEROA MGR 04/29/2016 ElectronicSignatureofSigningAuthorized Person(s)Detail Date CONTRABAND FORFEITURE ACT ForfeitureExpenditureCertification I,Rene Landa,amthe Chief of Police for the City of South Miami and I am requesting the expenditure of $11,500 forActive Shooter FirstAid Kits from account 608-1910-521- 5210 thathas been appropriated tothe Police Department for City of South Miami's by the City Commission.1hereby certify,pursuant to§932.0755(d)(b)\thatthe expenditurerequested complies with the provisions of subsection 9327055(5)(a)which states: §9327055 (5)(a)If the seizing agency isa...municipal agency,the... proceeds shallbedepositedina special law enforcement trust fund established bythe...municipality.Such proceedsandinterestearned therefrom shall beusedforschoolresource officer,crime prevention,safe neighborhood,drugabuseeducationandprevention programs,orfor other law enforcement purposes,which include defraying thecostofprotractedor complex investigations,providing additional equipment or expertise, purchasing automated externaldefibrillatorsforuseinlaw enforcement vehicles,and providing matching funds to obtain federal grants.The proceeds and interest maynotbeusedtomeetnormaloperatingexpensesofthelaw enforcement agency. Pursuantto§92.525(2),Florida Statutes andunderpenaltiesofperjury,IdeclarethatI havereadtheforegoingForfeitureExpenditureCertificationandthatthefactsstated therein are true. Executed this /5 day of l^&a&yqfc&l ,201& ^anda :of Police 1932.7055(5)(b)Forfeiture funds maybe expended upon request bythe...thechiefof police tothe.:.municipality, accompanied by a written certification thattherequestcomplieswiththe provisions of this subsection,and only upon appropriation tothe...policedepartment by...themunicipality. 2 NOTE:Whenthe verification on information orbeliefis permitted by law,in which case the words "tothebestof mv knowledge and belief may beadded.From:2012 Fla.Statutes,Section95.525(2).