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Res. No. 143-97-10113RESOLUTION NO.143-97-10113 A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY OF SOUTH MIAMI,FLORIDA,RELATING TO MEDIAN AND CONSTRUCTION ON SOUTHWEST 62ND AVENUE AUTHORIZING AN APPLICATION TO THE METRODADE OFFICE OF COMMUNITY AND ECONOMIC DEVELOPMENT (OCED)TO REQUEST AN AWARD OF COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG)FUNDS IN THE AMOUNT OF $250,000.00 TOWARD DESIGN AND CONSTRUCTION OF A MEDIAN FOR THE PURPOSE OF CALMING TRAFFIC. WHEREAS,The implementing recommendations of Charrette IIis an objective of the City;and WHEREAS,The design and construction of a median on SW 62nd Avenue between SW 64th Street and SW 70th Street will serve to calm traffic and provide a more pedestrian friendly environment; and WHEREAS,funding for this activity may be available through Community Development Block Grant fund; NOW THEREFORE BE IT RESOLVED BY THE COMMISSION OF THE CITY OF SOUTH MIAMI,FLORIDA: MAYOR AND CITY Section 1 the City of South Miami is submitting the application forfundingtotheOCEDforCDBGfundinginthe amount of$250,000.00 toward Median Design and Construction on SW 62nd Avenue between SW 64th Street and SW 70th Street; Section 2 This resolution shall take effect immediately upon approval. PASSED AND ADOPTED this 29th day of July,1997 ATT tLCcmn ITY CLERK READ AND APPROVED AS TO FORM: CITY ATTORNEY CON Mayor Price: ViceMayor Robaina: Commissioner Oliveros Commissioner Bethel: Commissioner Young: 5-0 Yea Yea Yea Yea Yea ACTIVITY APPLICATION SUBMISSION FORM FY 1998 1.Description (Activity No,l of 3 ) This twojiage formls tote filled out for each activity and ' each funding source requested,ifthis form is incomplete, the application will bexonsiderrednonresponsive. n^udaettand^DecfficmeasurahlA obiectiveyare required foreach activity: Agency: Contact City of South Miami William Pratt Agency Address:6130 sunset Drive Clty;South Miami ZipCode:33143 Activity Title:Median Design and Construction Activity Description:To design and construct a median on SW 62 Ave'between SW 64th and 70th Street."" %Funding Information Funding Source Requested:£]CDBG 98 QHOME 98 n^G 98 Last Year's FY 98 Requested Amount:$250,000.00 (FY 97)Funding:$70-00 Is funding being received for this activity from other sources?If so,list sources and amounts. Attach letterfs)of commitment if available. 3.Geographic Information Activity Address:s.W.62nd Avenue City of South Miami HIP 98D8 QSURTAX 98 Total Project Cost:$250,000.00 If a street address is unavailable,please provide crossroads information. Folio Number between SW 64th Street &SW 70th Street Census Tract 76.03 Block Group:76 .033 ,76 .03 Is this activity located inanEligible Block Group or Focus Area?If not,isitinan Entitlement City,Non-Focus Area, Countywide or State of Florida Small Cities CDBG Program activity?Pick only one. ^Countywide "Entitlement City HNon-Entitlement City Focus Areas: ^HLeisure City ""TCoconut Grove ^]Goulds Eligible Block Groups: ^[Atlantic Blvd. ""Biscayne Boulevard "TBiscayne Lake Gardens HBunche Park ^]Carol City "Dolphin IndustrialPark ^jFlagami Elementary HFIagami Park ^]FMC/St.Thomas "TGolden Glades HMulti-Focus Area HNon-Focus Area "TMelrose ^]Model City "HOpa-locka 0Golden Pond Lake Lucerne "HLakeview "HMiami Gardens Drive "HNaranja "[Norland "jNorth Central Dade "HOIympia Heights ~~]Pinewood/Kennel Club Page 33 [""Florida Small Cities-Homestead ["Florida Small Cities-Florida City ~penine xjSouth Miami ^]West Little River 'aimer Lake led Road Manor ichmond Heights "HSierra Estates ~~|South Miami Heights outhland Pines urfside ~]Vista Verde "jWestchester SUMMARY APPLICATION SUBMISSION FORM FY 1998 Instruction Sheet 2.Funding Information FundingSource:Check fundingsourcerequested.(Oneper activity). FY98 Requested Amount Specify amount requested forFY98. FY 97 Funding:If funded inFY 97,specify amount TotalProjectcost:Specify total amount requiredto complete theproject. Leveraging:Specify source andamountofother funding.Attachletter(s)of commitment. 3.Geographic Information Activity Address:Specify Street Address. Location:If street address isunavailable,pleaseprovidecrossroads. Area:Check appropriateoption. EnterpriseZone:If applicable,pleasecheck appropriate option. District Check appropriate option.If a multi-district,specifywhich districts. Census Tract Specify census tract. BlockGroup:Specify blockgroup. Folio Number Please provide the folio number for proposedsite. 4.HUD Information HUD Code:See following pages 3,4 and5 directly afterthis form.Check HUD activity typeand activity code. NationalObjective:Check appropriateoption. Proposed Accomplishment Type:Check appropriateoption. Proposed No.of accomplishments:Please specify. Totalunits:For housing activitiesonly,please specify the total number ofunitsto be constructed. 5.Metro -Dade Information Metro-Dade Category:Check appropriateoption. Agency Type:Check appropriateoption. Special needs groups:If applicable,please check appropriate option. Please check the State Enterprise Zone or Federal Enterprise Community in which this activity is iocated. [ajNot Applicable Qvliami Beach [^Federal Enterprise Community QNorth Central[jHomestead/Florida City For Economic Development activities only,please indicate the Targeted Urban Area whichthe proposed activity will serve. [""Richmond Heights [""|Carol City [""jLittle Haiti [""jNW 27 Ave.Corr.[""{Coconut Grove [""[Leisure City QPerrine [TGoutds pppa-Locka [""prownsville [""West Uttle River ["TSouth Miami QModel City/Uberty City fTOvertown QWV183 St.Corr.[""jHmstd/FL City rTPrinceton/Naranja Which Commission District does this activity serve?Check only one. Exception:if Multi-District check appropriate District box(es). ^Countywide ^District 01 rpistrict 02 [""[District 03 rpistrict 04 [""pistrict °5 pxpistrict06 fpistrict 07 ^District 08' [^District 09 ^District 10 |HDistrict11 [""pistrict 12 [""jDistrict 13 4.HUD Information HUD Code and Eligibility Citation:Check the appropriate box on the next pages. National Objective: Notethat 570.208 (c)UrgentNeedisaveryrestrictivecategorythatisnotapplicableto most proposedactivities.Please confer with OCED staff in order to determine the appropriate use of this category for your proposed activity. Q570.208(a)(1)L/M Area Benefit Q570.208(a)(2)L/M Limited Clientele Q570.208(a)(3)L/M Housing Benefit Proposed Accomplishment Type: [""{Businesses QEIderly PJEIderly Households PJFeet ofPublic Utilities Proposed No.of Accomplishments: (Recipients) Q570.208(a)(4)L/M Jobs Benefit Q]570.208(b)(1)S/B Area Benefit Q570.208(b)(2)S/B Spot Benefit [~|Households (General) [""jHousing Units riLarge Households ^Organizations 5.Metro-Dade Information Funding Category: [HCapital Improvement ^Historic Preservation [""[Economic Develoment Agency Type: rTCounty Department ^Municipality [""^Housing [HPublic Service Provider-501(c)(3) riPublic Service Provider -For Profit Is the proposed project utilizing propertyidentifiedin the OCED LandandPublic Housing Disposition List? If yes,is this a premium site? Areany of these special needs groups benefitting fromthis activity? QJEIderiy p]Mentally and Physically Disabled [""[Farmworker AgenciesandServices [""persons with Aids [""{Homeless Agencies and Services [""[Persons withDrug or Alcohol Addictions Page 34 Q570.208(b)(3)S/B Urban Renewal Q570.208(c)Urgent Need Ppeople (General) EHPublic Facilities FTSmall Households Qfouth Total Units: (Housing Only) [""[Administration {""{Public Service ppeveloper -501(c)(3) [""peveloper -For Profit es es pg[No pT[Public Housing Residents [""[Welfare/Wages COMMUNITY DEVELOPMENT BLOCK GRANT ELIGIBILITY ACTIVITY FORM (Check onlv one for each activity /application.') CHECK ^CODE iACTIVITY DESCRIPTION i)1 Acquisition ofReal Property 1D2 1Disposition !03 1Public Facilities and Improvements (General) 03A Senior Centers 03B Handicapped Centers 03C Homeless Facilities (notoperatingcosts) 03D Youth Centers 03E Neighborhood Facilities 03F Parks,Recreational Facilities 03G ParkingFacilities 03H SolidWaste Disposal Improvements 031 FloodDrainImprovements 03J Water/Sewer Improvements X 03K Street Improvements 03L Sidewalks 03M Child Care Centers 03N TreePlanting 030 Fire Station/Equipment 03P Health Facilities 03Q AbusedandNeglected Children Facilities 03R Asbestos Removal 03S Facilities for AIDS Patients(notoperatingcosts) 03T Operatmg Costs ofHomeless/AIDS Patients programs 04 Clearance and Demolition 04A Clean-up ofContaminated Sites 05 PublicServices (General) 05A Senior Services 05B HandicappedServices 05C LegalServices 05D Youth Services 05E Transportation Services tf> City of South Miami FY 1998 Scope of Services National Objective:Low and Moderate Area Benefit CDBG Eligible Activity and Regulation Subsection #:Public Facilities Improvements 570.201(C) Title of Activity:MedianDesignand Construction Goal:To modify thetrafficpatternandtrafficflowonSW62nd Avenue. Objective:To improve SW 62nd Avenue between SW 64th and SW70th Street by construction of a raised median. Action Steps: a.Advertiseforqualified(architect/engineer). Timeline:January-February 1998 b.Select architect/engineer foralterations. Timeline:February 1998 c.Complete preliminarydesignand presentations. Timeline:March-April 1998 d.CompleteandpresentfinaldesigntoCityCommission Timeline:May 1998 e.Meet OCED pre-bid requirements. Timeline:April-June 1998 f.Prepare construction bidpackage. Timeline:June 1998 g.Selectqualified contractor. Timeline:July1998 h.Conduct preconstruction conference. Timeline:July1998 I.Complete median construction. Timeline:July-December 1998 j.Contract completion/closeout Timeline:December 1998 CITY OF SOUTH MIAMI MEDIAN DESIGN & CONSTRUCTION TOTAL ALL NON-OCED OCED SOURCES Personnel '04010 Program Director $55,438.00 $10,000.00 $65,438.00 allocated 10%time '04010 Secretary $18,248.00 $3,000.00 $21,248.00 @ 10%time '04010 Accounting Maria Munro $40,000.00 $3,000.00 $43,000.00 Sub-Total Salaries $113,686.00 $16,000.00 $129,686.00 Fringe-Benefits '04012 MICA/FICA @7.65%$7,237.00 $1,224.00 $8,461.00 Total Fringes $7,237.00$1,224.00 $8,461.00 Total Personnel Services $120,923.00 $17,224.00 $138,147.00 Operating Expenses '31010 Telephone-Regular $2,500.00 $100.00 $2,600.00 '31530 Travel $1,500.00 $200.00 $1,700.00 •31611 Postage $0.00 $100.00 $100.00 Total Operating Expenses $4,000.00 $400.00 $4,400.00 Contractual Services '20101 Audit $0.00 $500.00 $500.00 •31410 Legal Ads $0.00 $2,000.00 $2,000.00 •23220 Liability $0.00 $500.00 $500.00 '21411 Consulting Architect $0.00 $15,000.00 $15,000.00 Contractual Services $0.00 $18,000.00 $18,000.00 Commodities Commodities Total $0.00 $0.00 $0.00 Capital Outlay '99031 Improvements made to $0.00 $184,376.00 $184,376.00 street '99023 Design $0.00 $30,000.00 $30,000.00 Capital Outlay Total $0.00 $214,376.00 $214,376.00 GRANPTOTAU $124,923.00$250,000.00 $374,923,00 City of South Miami MEDIAN DESIGN &CONSTRUCTION January 01,1998 December 31,1998 Budget Summary Categories Total Personnel $17,224.00 Operating Expenses $400.00 Contractual Services $18,000.00 Commodities $0.00 Capital Outlay $214,376.00 TOTAL OCED COST $250,000.00 FORM 12 METRO-DADE COUNTY AFFIDAVITS The contracting individual or entity (govcmmcnul or otherwise)shall indicate by an "X"all affidavits that pertain to this contract and shall indicate by an "N/A"all affidavits that do not pertain to this contract.All blank spaces must be filled. The METRO-DADE COUNTY OWNERSHIP DISCLOSURE AFFIDAVIT:MCTWJMDBCO^DISCLOSURE AFFIDAVIT:METRO-DADE CRIMINAL RECORD AFFIDAVIT:and WSABIWTY.NOWI^^AinON AFFIDAVIT shall not-pertain id contracts VStiTrtie Uhltetf States ^'^-^SS^^^^^^^JSd^SmpoliticalsubdivisionoragencythereoforanymunicipalityofthisState.The METRO-DADE FAMILY ^^^^WHOMSmtuSTiocontractswiththeUnitedStatesoranvofitsdepartmentsoragenciesortheStateofFlondaorampoliticalEI£a^JcS.It shall,however,pertain to municipalities of the State of Florida.Ail other contracting enuue,or individuals shall read carefully each affidavit to determine whether or not it pertains to this contract. ,L.Dennis Whitt .being first duly sworn state: Affiant The full legal name and business address of the person(s)or entity contracting or transacting business with Mctro-Dade County are (Post Office addresses arcnot acceptable): 59-6000-431 , Federal Employer Identification Number (If none.Social Security) City of South Miami __. Name of Entity.Individual(s).Partners,or Corporation Doing Business As (if same as above,leave blank),6130 Sunset Drive South Miami Florida 3314.3 Street Address C^''=**** _I.METRO-DADE COUNTY DISCLOSURE AFFIDAVIT (Sec.2-8.1 of the County Code) I If the contract or business transaction is with a corporation,the foil legal name and business address shall beLtlS^ch Staid director and each stockholder who holds directly or indirectly five ^(WomooTthecorporation's stock.If the contract or business transaction is with *W"^**"^information shallbe provided for each partner,if the contract or business transaction is with atrust the Ml legalnaSaddressshallbeprovidedforeachtrusteeandeachbeneficiary.The foregoing "*""^**Jn°££fe»conu^s with publicly-traded corporations or to contracts with the United States ^y department or-—•S?teSte State Sr any political .»****»»2S«cy thereof or any *mnic.pahty of this State.All such names and addresses are (Post Office addresses are not acceptable): aaa~*.OwnershipFullLegalNameAddress */K * % % lOOf .1* The full legal names and business address of any other individual (other than subcontractors "Mm^nen.suppliers laborers,or lenders)who have,or will have,any interest (legal,equitable beneficial or othem.se)in the contract or business transaction with Dade County are (Post Office addresses are not acceptable): tf/A SrjS***"*-:*"nf'-•ii^t~rlif-"t"r "•*•' i Anv oerson who willfiillv rails to disclose the,information:required herwn.-ar;*fhoImowiiigly discloses false^SS-S^SS.shaU be punished *a fine of up to five hundred dollars ($500.00)or imprisonment « the Countv jail for uptosixty (60)days or both. FORM 13 II.METRO-DADE COUNTY EMPLOYMENT DISCLOSURE AFFIDAVIT (County Ordinance No.90-133.Amending sec.2.8-1:Subsection (d)(2)ofthe County Code). Exc^wh^precluded bv federal or Srate laws or regul^wS^e^elxpel^of ten thousand doUars ($10,000)or more shall require the enuty contracting orransactin^bSiness to disclose the following information.The foregoing disclosure requirements do not apply toco^trac^witMhe United States or any department or agency thereof,the State or any political subdivision or agency thereoforany municipality ofthis State. 1.Does your firm have acollective bargaining agreement with its employees?—Yes —No 2.Does your firm provide paid health care benefits for its employees?—Yes —No 3.Provide acurrent breakdown (number of persons)of your firm's work force and ownership as to race,national origin and gender: White:Males Females Asian:Males Females Black:Males Females American Indian:Males FemalesHispanics:~Males _Females Aleut (Eskimo):_Mate _Femate :Males Females *****FenuUes III.METRO-DADE COUNTY CRIMINAL RECORD AFFIDAVIT (Section 2*6 of the County Code)FORM 14 The individual or entity entering into acontract or reoerving fuiiding ftom the County hashas not as of the date ofthis affidavit been convicted ofa felony during the past ten (10)years. An office,director,or executive of the entity en^^has not as of the date of this affidavit been convicted of afelony during the past ten (10)years. IV METRO-DADE COUNTY CUBA AFFIDAVIT (County Resolution R-656-93)FORM 15 Art Of 1992. ttt CXOWUM !0<J FORM 16 —V METRO-DADE EMPLOYMENT DRUG-FREE WORKPLACE AFFIDAVIT (County Ordinance No.92-15 codified as Section 2-8.1.2 of the County Code) Thatin compliance with Ordinance No.92-15 ofthe Code of Metropolitan Dade County.Florida,the above named pcrsbn or entity is providing a drug-free workplace.A written statement to each employee shall inform the employee about: I.danger ofdmg abuseintheworkplace X the firm's policy of maintaining a drug-free environment atall workplaces 3.availability of dnig counseling,rehabi :- 4.penaltiesthatmaybeimposeduponemployees for drugabuseviolations ... The person orentity shall also require an employee to sign a statement as a condition of employment that the employee will abide by the terms and notify the employer of any criminal drug conviction occurring no later than five (5)days after receiving notice of such conviction and impose appropriate personnel action against the employee up to and including termination. Compliance with Ordinance No.92-15 may be waived if the special characteristics ofthe product or service offered by the person or entity make it necessary for the operation of the County or for the health,safety,welfare,economic benefits and well-being of the public.Contracts involving funding which is provided in whole or in part by the United States orthe State of Florida shall be exempted from the provisions ofthis ordinance in those instances where those provisions are in conflict with the requirements ofthose governmental entities.FORX/r VI.METRO-DADE EMPLOYMENT FAMILYLEAVE AFFIDAVIT (County Ordinance No.142-91 codified as Section 11A-29 a.5£fl of theCountyCode) Thatin compliance with Ordinance No.142-91 ofthe Code of Metropolitan Dade County.Florida,an employer with fifty (50)or more employees working in Dade County for each working day during each oftwenty (20)or more calendar work weeks,shall provide the following information in compliance withallitemsinthe aforementioned ordinance: An employee whohas worked for the above firm at least one (1)year shall be entitled to ninety (90)days of family leave during any twenty-four (24)monthperiod for medical reasons,for thebirthor adoption ofachildor for the care ofachild spouse or other close relative who has a serious health condition without risk of termination of employment or employer retaliation. The foregoing requirements shall not pertain to contracts with the United States or any department or agency thereof. orthe State of Florida orany political subdivision or agency thereof.It shall,however,pertain to municipalities ofthis State. Vn.DISABILITY NON-DISCRIMINATION AFFIDAVIT (County Resolution R-385-95)18 _Thatthe above named firm,corporation or organization isin compliance withand agrees to continue to comply with. ""•"'"dha Assure thatany subcontractor,or third ^fy contractor under this project complies with all applicabte^squirsinents of thelawslistedbelowincluding,butnotlimitedto.those provisions pertainingto employment provision of programs and services,transportation,communications,accessto facilities,renovations,andnewconstructioninthe following laws:The Americans with Disabilities Act of 1990 (ADA).Pub.L.101-336.104Stat327.42U.S.C.12101-12213and 47U.S.C.Sections225and 611 includingTitleI.Employment:TitleII.PublicServices:TitleIII.Public Accommodations andServicesOperatedbyPrivateEntities:TitleIV.Telecommunications:and Title V.Miscellaneous Provisions:The Rehabilitation Act of 1973.29 U.S.C.Section 794:The Federal Transit Act as amended 49 U.S.C. Section 1612:The Fair Housing Actasamended42 U.S.C.Section 3601-3631.The foregoing requirements shall not pertaintocontractswiththeUnitedStatesorany department oragency thereof,theStateorany political subdivision or agency thereoforanymunicipality of this State. (06 r*r*ri4W VIII. 19 by. rented FORM 19 METRO-DADE COUNTY REGARDING DELINQUENT AND CURRENTLY DUE-FEES OR TAXES (Sec. 2-8.1(c)oftheCountyCode) Exeeot for small purchase orders and sole source contracts,that above named firm,corporation,organization orSu^d^rinrS^saabusiness or enter into acontract with the County verifies that all delinquent andSSSSfdSTS^™*including but not limited to real and proper*taxes utility taxes and o^P^Smw-55 are collected in the normal course by the Dade County Tax Collector as well as Dade Countyj^^^.br vehicles registered in the name of the firm,corporation,orgamzauon or mdividua.have •/-been.paid.••..---"'..:f'l';^::':~'~Z,^'^^"----•*»•-'•v....^.t..;.s.. Ihave carefully read this entire four (4)page document entitled,"Metro-Dade £0™*,^indicated by an "X"all affidavits that pertain to this contract and have indicated by an N/A all affidavits nut not pertain tothis contract. (Signature of Affiant) SUBSCRIBED AND SWORN TO (or affirmed)before me this day of. (Date) He/She is personally known to me or has as identification. (Typeof Identification) (Signature of Notary) (Print orStamp of Notary) Notary Seal (SerialNumber) (Expiration Date) Notary Public •State of. (State) 101 C*C4CSAH FORM 19A THIS FORM KOST .E •g-gRSK"'f ™"^^°'*""^?WUC ""^OFFICIAL AUTHORIZED.TO ADMINISTER OATHS. •.Metropolitan Dade County ' L ThiSfwomstttaneatiSinbmiaedlO (print n«»e of cbe pabUe catttrj ^t.nonn^whitt.Citv Manager _J ^(prist Dwdoal'a mom and tt3ej :itv of South Miami 4. ""^Tpetot name of entity •utomttttaf whosebusinessaddressis 6130 Sunset Drive South Miami/FL 33143 .ad (If applicable)its Federal Employer umma^Hnbmin^^^Sim=£2L. (Ifthe«tityl«.oFHN;ir<*-et* Iu*emand that.>*»c entity crimediSionofanystateorfedenltewtoy*person wfth^rapea^^J^^^^te OT 0f the United£££,w^^^S**,?^ff^cSS^S 2odt^tee7»?Vproved to any publicStates,mdudinf,^^SlJSSn^fSy^EefstSe o?of tic SXedStates indtoSvtog a*™*. STtneTb^?^-—--*——• Iundema«dth.t-co«^orW«ion-asde^^ strir.ss.tsffiCWJW w of .**or «>*«^ IttBderstand«hat.»^te-f»a^to^^ I.Ai«oec*»rortuce*n*oro<ai*rsoucon^ who haTb^lonvtoed of t public entity crime.The J^.'fPjJJS^^of ITaffliate/Tbe ownership toy one person of shares ~^™«ri_°7Shet value under an arm*teng* the"receding*moitthsshill be considered an affiliate. ,understand that a-persoa-as defined In ff^^^fSSBtXSt^^ ageouwbo ue «tiw in to»»nai!«ii or «i entJcy. FORM 19A Based on information and belief the statement which I have marked below btruein relation tothe eatitv submittingthis sworn statement.(Indicate which statement applies.] 'Neither theentity submitting this sworn statement,nor any of Its officer*,directors,executives partners,shareholders,employees,members,or agents who are active inthe management of the entity nor any affiliate of the entity has been charged with and convicted ofa public entity crime subsequent to Jury It 19o7« _The entity submitting this sworn statement,or one or more ofits officer*directors,executives, partners,shareholders,employees,members,or agents who are active inthe management ofthe entity,or an affiliate of the entity has been charged with and convicted ofa public entity crime subsequent to Jury _The entity submitting this sworn statement,oroneor more of to officers,directors,executives, partners,shareholders,employees,members,or agents who are active inthe management ofthe entity,or an affiliate of the entity has been charged with and convicted ofa pubtfc entity crime subsequent to July L1989.However,there has been a subseq^t proceeding betee a Hearmg Offiosr ctf tte Division of Administrative Hearings and the Final Order entered bythe Hearing Officer determined that it was notinthe public interest to place the endry submitting this sworn statement onthe convicted vendor list,(attachacopy of the finalorder] I UNDERSTAND THATTHE SUBMISSION OFTHIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDHmTnED Df PARAGRAPH 1 (ONE)ABOVE IS FOR THAT PUBLIC ENTRY ONLY AND, THATTHISFORMISVALIDTHROUGHDECEMBER 31 OFTHE CALENDAR YEAR D*WHICH IT IS FILED. IALSO UNDERSTAND THAT I AM REQUIRED TOINFORMTHE PUBLIC ENTRY PRIORTO ENTERING INTO A CONTRACT IN EXCESS OFTHE THRESHOLD AMOUNT PROVIDED JS SECTION 287417,FLOIMU STATUTES FORCATEGORYTWOOF ANY CHANGEINTHE INFORMATION CONTAINEDINTHIS FORM. Sworn to and subscribed before me this «___^_davaf 19. Personally known OR Produced identMeatioa Notary Public •State ©C (Type of identification) foci Form PUR 7068(Rev.06/18792) (Printed typed or stamped commissionedname of notary public)