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HARTZELL CONSTRUCTION, INCCity of"South Miami 1110, 'V "I 14A Request for Proposal for South Miami Al- CHY l I I I I F 2001 Window Restoration, Repair or Replacement for the Sylva Martin Bung RFP # SM 1115 13 7 ,,Z 11MM11= ff ZM i Y i Iq This checklist indicates the forms and documents required to 6e submitted for this solicitation and to be presented by the deadline set for within the solicitation. Fulfillment of all solicitation requirements listed b mandatory for consideration of response to the solicitation. Additional documents may be required and, if sp, they will be identified inan addendum tn this RFP. The response shall include the following items: X Bid Form N/A Proposal Bond N/A x Performance Bond (As a Condition o( Award; Not Required *See Note (U) With the Submittal) Below x Respondents Qualification StatememdKeferenccs X � Non-Collusion Affidavit � *(I) Performance Bond: Required as a Condition of Award and Prior to the Contractor Receiving a Notice to Proceed. Not Required with Submittal. and/or documents. Pege11of69 �Tnvmu zpv�.zm/|�m/sxuno�oou�,eo. Steven Alexander City Manager City nf South Miami 6|30 Sunset Drive South Miami, FL33|43 V, K this Proposal baccepted, the undersigned Respondent agrees to enter into aContract with the City of South Miami in the form included in this RFPPuckage and to perform and furnish all work ns specified or indicated in this RFP for the Proposed Pdce, within the Contract Time and in accordance with the other terms and conditions o[ the RFPPackage. 2. Respondent accepts all of the terms and conditions of the Advertisement, KFP. Invitation for Proposals and Instructions to Respondents, including without limitation those dealing with the disposition of Proposal Bond/Security. This Proposal will remain subject co acceptance for 9O calendar days after the day of the Proposal Opening. Respondent agrees to sign and submit the Contract, the Bonds, Insurance Policy with appropriate endorsements, Insurance Certi6cate, and other documents required by the RFP. within ten (|0 calendar days after the date of the City's Notice ofAward. 3. |n submitting this Proposal, Respondent represents that: n. Respondent has examined copies of all the RFP Documents and of the following Addenda, ifany (receipt mf all which is hereby ucknovv|e6geJ.) Addendum No. Dated: Addendum No. Dated: Addendum No. 0.* Dated: Addendum No. Dated: Addendum No. Dated: Addendum No. Dated; b. Respondent has familiarized himself with the nature and extent of the Contract Documents, the proposed work, site, locality, and all local conditions and laws and regulations that in any manner may affect cost, progress, performance or furnishing of the Work. c. Subsurface conditions: |f applicable to this RFP\ the Respondent represents that: i. Respondent has studied carefully all reports and drawings, if upp|ica6|e, of subsurface conditions and drawings of physical conditions. ii. Respondent has obtained and carefully studied (or assumes responsibility for obtaining and carefully studying) all such exuminations, invesdgationo, exp|omtiuns, tests and studies in addition to or to supplement those referred to in (c) above which pertain to the subsurface or physical conditions at the site or otherwise may affect the cost, prpgreon, performxnce, or the furnishing of the Work at the Contract Pricc, within the Contract Time and in accordance with the other terms and conditions of the Contract Documents. The Respondent hereby acknowledges that no additional exuminorions, investigoions, explorations, tests, reports or similar information or data arc, or vviU. be required by Respondent for any reason in connection with the Proposal. iii. Respondent has correlated the results of all such observations, exuminctions, investigadons, cxp|unaiono, teom, reports and studies with the terms and conditions of the Contract Documents. ��ge12of0Q Cnmmo ep�vxu|1�mo,m/usxu,�omou Project Name: Window Restoration, Repair or Replacement for the Sylva Martin Building RFP NO. SMI 11513 Date: December 3, 2013 Sent: Fax/E-mail/webpage This addendum submission is issued to clarif% suigiolement Wrnmwr��_i Kequest for Qualifications (RFQ) Documents, and is hereby made part 'of the Documents. All requirements of the Documents not modified herein shall remain in full force and effect as originally set forth, It shall be the sole responsibility of the bidder to secure Addenclums that may be issued for a specific solicitation. The following is provided to clarify comments and question raised during the pre. bid meeting regarding the applicability of the Florida Building Code requirements znd this project. I . Successful bidder must apply for a "building permit" at the City of South Miami bef6i�! proceeding with the work. Applicant must be a licensed contractor in the State of Florida and must provide at least copies of licensure certification, liability and workmen's compensation insurance policies, and occupational license from any municipality in Miami-Dade County. 2. All work must be in compliance with the "Existing Building 20 10 Florida Building Codu, which specifically outlines in Section 402 the definition of 'repairs' and Section 404 which specifically defines 'replacement' of selected building components, in both cases as modified by provisions for historical buildings as noted in Chapter I I and Appendix • of same code. 3. Chapter 5 outlines the requirements for 'repairs.' Chapters 6 and 7 outline requirements for 'replacement.' Page 1 of 2 4. Appendix B of the "Existing Building 2010 Florida Building Code" outlines suggested standards for rehabilitation and guidelines for rehabilitating historic buildings developed by the Preservation Assistance Division of the U.S. Department of the Interior. Comment at the top of page B. 16 is of particular relevance to this project, S. Cones of these documents are available on the City's (�8Lvv\y.southnILiamfl oy) or directly from the Florida Building Commission at The preceding items indicate that if a licensed contractor repairs existing windows, the requirements of the code's High Velocity Hurricane Zone guidelines do not apply. But if the windows are replaced, in order to comply with the 2010 FBC Chapter 24, the requirements will apply. Either alternative is allowed with modifications as permitted for historical M. AM, 'A 1 *11111 - IWJA 0,11103 IM WS1 j:*4 W*01,41 L4001fiNt M, Page 2 of 2 961:191!11 Project Name: Window Restoration, Repair or Replacement for the Sylva Martin Building TIMER #ate: December 5, 2013 Sent: Fax/E-mail/webpage This addendum submission is issued to clarify, supplement and/or modify the previously issued Request for Qualifications (RFQ) Documents, and is hereby made part of the Documents. All requirements of the Documents not modified herein shall remain in full force and effect as originally set forth. it shall be the sole responsibility of the bidder to secure Addenclums that may be issued for a specific solicitation. Mease provide me with the type of paint and type of wood is required to use for either restoration or replacement of the windows. 6 1: The type of paint and wood used in either the restoration or replacement ♦ the windows is -at the discretion of the proposer. Proposals, as well as, the repair, restoration and replacement methods submitted will be evaluated by the Selection Committee and the City's Historic Preservation Board. F-11,001:110 Page 1 of 1 Date: Decem ber 2, 2013 RFP Title: Window Restoration, Repair or Replacement for the S.Iva Mart4i RFP No.: SM I 11. 513 Y- b' 5 1 C) C-'2' 3 `4 9 to C:%Usc.r,;\skuhck,CSNI i J)ocuments,\'Soath �Nliaiiii',Tety)plates�,Pi-e-f3i(i Meeting Sign-111 Sfieel,doc LI t- Project Name: Window Restoration, Repair or Replacement for the Sylva Martin Building MW Date: December 6, 20 IE Sent: Fax/E-mail/webpag,; This addendum submission is issued to clarify, supplement and/or modify the previously issued Request for Qualifications (RFQ) Documents, and is hereby made part of the Documents. All requirements of the Documents not modified herein shall remain in full force and effect as originally set forth. It shall be the sole responsibility of the bidder to secure Addendums that may be issued for a specific solicitation. I � I I �� p � � III W�I « F.MaTATM-T21 s 6 Proposers that recommend to restore the windows, shall provide an "Option" for the windows to be Operational that "Open and Close" or, for the windows to be Non- operational (Fixed) that results in the windows "NOT Opening and Closing." Total cost for these options, along with the expected time to complete the project for each Option, must be provided. Use the format below: X]a ms »m\ $---/ z�0 Eli ?roject Completion '36) Days Project Completion Days F—Al 6101:4 1! 1 loll] z 1-M 9 In F211111AL EA—ViII11:1:8 &**0;2 #2 #f I < + 4611.1 4 Lag I 7!0! iv. Respondent has reviewed and checked all information and data shown or indicated in the RFP Package or in the Contract Documents with respect to existing Underground Facilities at or contiguous to the site and assumes responsibility for the accurate location of all Underground Facilities. No additional cxumin:tions, investigations, exp|orationo, u:o,z, reports or similar information nr data in respect to any Underground Facilities are, or will bc, required by Respondent in order to perform and furnish the Work at the Contract Price, within the Contract Time and in accordance with the other terms and conditions of the Contract Documents. 6 Respondent has given the City written notice of all conflicts, errors or discrepancies that it has discovered inthe Contract Documents and, kany conflicts, errors or discrepancies have been found and notice given, the Respondent represents, 6y submitting its proposal to the City, that the Respondent has received sufficient notice of the resolution thereof from the City, that such resolution is acceptable to Respondent and that the Respondent waives any claim regarding the conflicts, errors nrdiscrepancies. e. This Proposal is genuine and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted pursuant to any agreement or rules of any group, association, organization, or corporation; Respondent has not directly or indirectly induced or solicited any other Respondent to submit a false or sham Proposal; Respondent has not solicited or induced any person, firm or corporation to refrain from responding; and Respondent has not sought by collusion or otherwise to obtain for itself any advantage over any other Respondent or over the CITY. 4. Respondent understands and agrees that the Contract Price is the amount that it needs to furnish and install all of the Work complete and in place. The Schedule of Values, if required, is provided for the purpose of Proposal Evaluation and when initiated by the CITY, it shall form the basis for calculating the pricing of change orders. The Contract Price shall not be adjusted in any way so as to result in a deviation from the Schedule of Values, except to the extent that the CITY changes the scope of the Work after the Contract Date, As such, the Respondent shall furnish all labor, materials, equipment, tools, superintendence and services necessary to provide a complete, in place, Project for the Proposal Price #f- #Z #3 #4 #7 M cents 720 6 Communications concerning this Proposal shall b* addressed to: P�m13�GQ Cmvma �p�onu1�m/sxxnumom�m*� CONSTRUCTION, INC. Prpject ScheduleL Repair of existing windows Week 1- Remove (2) windows Board up and secure for safety and weather conditions. Take windows to our shop for repair, return 5 to 8 days later for install of repaired windows. Week 2- 3 Remove windows 3 & 4 board up and secure for safety and weather issues, take windows 3 & 4 to shop for repair and return 5 to 8 days later for install of repaired windows Week 3 - 4 Remove windows 5 &6, board up and secure for safety and weather issues, take windows 5 & Y #? our shop for repair and return 5 to 8 days later for install. Michael Goodwin Project Director 11 PHONE: 954-957-9762 FAX: 954-957-9766 ,, TOLL. FREE: 866-957-9762 ,d Court, 2301 N.W. 33 Suite 113 Pompano Beach, FL. 33069 AdMINEft, CONSTRUCTION, INC. kfillismill2i I 1 § « + +w? 111 1 111 1 1111111q�qrlilniiiii 11 i 1, 1 Week 4 — Removal of existing windows and install of new windows 2l ¥1 done on a *2±t# one basis, this process will take 2 days barring any weather issues 'LO avoid. MT-m- Michael Goodwin Project Director Mobile: 954-658-0515 PHONE: 954-957-9762 «r«% 954-9529766 - TOLL FREE: 866-957-9762 2301 N.W. 33'd Court, Suite 113 — Pompano Beach, FL. 33069 vvuoj M* *. � Company re tdd,e c..' Title phone Number qrLI , 9 9,746 Fax Number Odwln e 1.&d7ell rald" >'75 Email Address Page 14 of 69 Oc Thomas F. Pepe, 2011-2013, All fights reserved. 9/9/13 The response to this questionnaire shall be utilized as part of the CITY'S overall Proposal Evaluation and RESPONDENT selection. I - Number of similar construction projects completed, a) In the past 5 years In the past 5 years On Schedule b) In the past 10 years In the past 10 years On Schedule 2. List the last three (3) completed similar projects, a) Project Name: 1-,4V7 Owner Name: 44 Owner Address: -AA 0 11" I- 1 141, /44-11-0-, ,o t Actual Final Contract Price: (0 Thomas F. Pepe, 2011-2013. All rights reserved. 9/9/13 -213 (J logiP :-) "� , 'o — -S'o 4 19/1"'a ge'14it' Owner Telephone: Original Contract Completion Time (Days): Original Contract Completion Date: Actual Final Contract Completion Date: Original Contract Price: �- UT, I Owner Telephone: Original Contract Completion Time (Days): (/76- 93c-)' J 5-el, '77 1/ -ft/ Original Contract Completion Date: Actual Final Contract Completion Date: St 8 Original Contract Price: Actual Final Contract Price: C Thomas F. Pepe, 2011-2013. All rights reserved. 9/9/13 SCEM99M 3. Current workload Project Name Owner Name Telephone Number Contract Price �� I�i����l II � liI� wl ICI III .��� �il���� ,� �: ! �� ,� �� �� ��! �I,� ��I� II �I 111111 �I , I�IN uJ NIIIIII �� �,! ,INS �I ��� � � 4. The following information shall be attached to the proposal. a) RESPONDENT's home office organization chart. b) RESPONDENT's proposed project organizational chart. c) Resumes of proposed key project personnel, including on-site Superintendent. 5. List and describe any: a) Bankruptcy petitions filed by or against the Respondent or any predecessor organizations, '0) Any arbitration or civil or criminal proceedings, or Suspension of contracts or debarring from Bidding or Responding by any public agency brought c) against the Respondent in the last five (5) years 1. Government References: List other Government Agencies or Quasi-government Agencies for which you have done business within the past five (5) years. Name of Agency: GL41 01�( eye dpl� )0141 U Page 23 of 69 0 Thomas F. Pepe, 2011-2013, All rights reserved. 9/9/13 Address: () / 611 j2,� In-, , / 14 12 c/ tic �j OVa A K , -'e- Telephone Contact Person: 6��47 O&V S Type of Project: (C""54— C-4t) .4y � WrAO ale Name of Agency: -7-0 W4 a '4 t A" a Address: J7/0 &-'J st1 J Telepho • r Contact Person: /_ r4 iz a-, 1h e, (0 A" 4, Type of Project: Cone Name of Agency: Jep' Address: JI-7 V03 e 4,7 -),- x2. / & II/J -9, t) t&O t y 5 0 t_) /Z Telephone No.: Jkl- -7(//— Contact Person: Type of Project: C005 Alle fl'W Page 24 of 69 0 Thomas F. Pepe, 2011-2013, All fights reserved. 9/9/13 Hartzell Construction, Inc. 2301 N.W. 33rd Court, Suite 12 Pompano Beach, FL 33069 December 9, 2013 Resume - William Stecklow -Vice President- Restoration and City Division P William Stecklow's background is as a general contractor and a construction manager. He graduated from Long Island University in 1963 with a B.S. degree; prior to graduation; Mr. Stecklow worked part time as a mason apprentice and in 1964 became a United Stonemason. In 1965 he entered the Mechanics Institute, where he took courses in estimating and blueprint reading. Upon completion of these courses he entered his family construction business in the purchasing department. In 1967 he became the chief estimator and buyer for the corporation; THOMASON INDUSTRIES, In 1974, HARLOW RESTORATION was formed with William as president to handle the numerous specialty Bicentennial stone projects that were coming out for bid. Because of the hands on experience of William, as a mason and the 64 years of family construction work, Harlow was put on a special list of qualified contractors. The following are some of the historic, some negotiated and others bid projects that we did for various government agencies: United States Custom Houses, Boston, MA; Perry's Monument, Put in Bay, Ohio; Roger Williams Park, Providence, RI; Soldier's and Sailor's Monument, Prospect Park, NY; Old Federal Building, Cleveland, Ohio; Bethesda Terrace, Central Park, NY, Reception Center and Nurses Buildings, Ellis Island, NY; USMA, West Point (Restored 8 Buildings; Pier on liberty Island, NJ; and the Renwich Gallery of Art, Washington D.C. - which we were awarded as THE SECOND LOW bidder because we were considered as the most qualified low bidder. In 1989 he retired for 3 years. In 1992 Westchester Bonding Company called and asked William to review a masonry project and the claim by the Page 2 of 2 - Resume - William Stecklow - Project Manager general contractor that the mason - the bonded sub was delaying the project. Based upon William's review and recommendation, the bonding company allowed the mason contractor of record to complete the project under the supervision and guidance of William Stecklow. The project was completed within the contract costs AND SCHEDULED TIME. The project was the Hutchinson River Parkway Bridge. The main problem was access. A floating barge system was designed to work with the tides. Material was then able to be loaded and moved from barge to barge and the final barge was used for scaffolding. From 1992 -1996 he consulted for several bonding companies on the following projects: Epcot Center - Completion of Fiberglass Railings; Winter Haven Airport Fuel Farm- Avgas Tanks; Pointe Verde Complex- a single family subdivision; Sawgrass School- Enunciator Panels; Hampton Beach Condo - Exterior Restoration; Stranahan House - historic restoration; Neptune Power Plant. From end of 1997 to beginning of 1999, he was the Construction Manager for The Aruba Airport's $120,000,000.00 project. In 1995, William started working with Hartzell Construction as a consultant for city projects. William had an Asbestos Supervisor's license which expired in 2004. He was a trustee for his alma mater, Long Island University: a board of director for AHRC and HIAS, Architectural Review Committee - Half Hollows Hills School District; Chairmen Architectural Review Bord of The Polo Club, Boca Raton FL, President of Dix Hills Village Association of Dix Hills, NY and Huntington Homeowners' Association of The Polo Club.. Awards. Humanitarian Award - Association for retarded Children; Distinguished Alumni Award, C.W. Post; Community Service Award - Dix Hills Civic Association; Women's American Ort Golden Circle Award. Main Fax Number (954) 957 -9766 Main Phone Number (954) 957 -9762 WSS Fax Number (561) 482 -9078 WSS Cell Phone Number (561) 239 -4711 HQRTZELL qww Been in Business for over 64 years in South Florida William Stecklow — 21404 Shannon Ridge Way, Boca Raton Florida 33428 (561) 239-4711 bqq@Atqg��� Page 2 Prior to 1991 — President of Harlow Restoration and Waterproofing; Completed /restored the following projects- United States Custom House; Boston, MA, Perry's Monument- Put -in -Bay, Ohio; Bethesda Terrace, Central Park, NYC; Reception Center and Nurses Buildings, Ellis Island, NY, Holland Tunnel, NYC, waterproofed numerous projects in 6 states; Brooklyn Borough Hall, Brooklyn, NY; Restoration of the Brooklyn Bridge Park; NY, NY. Old Federal Building, Cleveland, Ohio; State Capital Buildings — Lansing, MI; Farley P.O. — New York City, Renwich Gallery of Art, DC; West Point Moat bridges and infrastructure. Formal Education BS — C.W. Post College 1963 Mechanics Institute- Drafting and Construction Estimating 1961 Asbestos Handler's License 1986 Asbestos Supervisor's License 2004 Other: Trustee — Long Island University; Board of Director- Association for Help of Retarded Children Board of Director- HIAS; President of Dix Hills Village Association; President of Huntington Homeowner's Association. Awards: Humanitarian Award —AHRC; Distinguished Alumni Award — C.W. Post College; Women's ORT Golden Circle Award. References Available F - -1 i �.;1� r .('�+ r\ Edward Holman President William Stecklow Senior Vice President Mark Conley Bill Butzbach Robert Mosley Vice President Mike Goodwin V.P. of sales & Marketing Director of Operations Project Manager li=MM-= UMMMM-7y". Moll M � �-' f M" I AN MM - wl, CONSTRUCTION,I . W—Mr-WOMM, l7r, PHONE: 954-957-9762 2 FAX: 954-957-9766 TOLL FREE: 866-957-9762 2301 NN, Sad Court, Sui2 113 i Pompano Beach, FL. 33069 MM i i I �Wd 6 -'* N. IdWIqed volvh.-7 being first duly sworn, deposes and states that: (1) He/She/They is/are the j (Owner, Partner, Officer, Representative or Agent) of Hiqft�"11 the Respondent that has submitted the attached Proposal; Page 25 of 69 C Thomas F. Pepe, 2011-2013. All rights reserved. 9/9/13 On this the /0 day of &C- —, 20L3 , before me, the undersigned Notary Public of the State of Florida, personally appeared (Name(s) of individual(s) who appeared before notary) Jw' /3 fed and whose name(s) is/are Subscribed to the within instrument, and he/she/they acknowledge that he/she/they executed it. ffiffom mp Notary Public State Of Florida Carly 13iftlingmeyer MY COMMission EE 187219 � yal'; Expires 08/26/2016 (Name of Notary Public: Print, Stamp "or 'type as commissioned.) Personally known to me, or Type of dentification Produced Did take an oath, or Page 26 of 69 C Thomas F, Pepe, 2011-2013. All rights reserved. 9/9/13 Pursuant to the provisions of Paragraph. (2) (a) of Section 287.133, Florida State Statutes — 'A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a Proposal or bid on a Contract to provide any goods or services to a public pndty, may not submit a Bid or proposal for a Contract with a public entity for the construction of repair of a public building or public work, may not submit bids or proposals on |eomeo or real property to a public entity, may not be awarded to perform Work as a RESPONDENT, Sub-contractor, supplier, Sub-consultant, or Consultant under a Contract with any public entity, and may not transact business with any public entity in excess of the threshold amount Category Two of Section 287017. Florida 8tatuues, for thirty six (36) months from the date of being placed on the convicted vendor The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statute, Res ondents must disclose with their Pro osals, the name! THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. [print name mf entity submitting sworn statement] � \ whose business address is and (if applicable) its Federal Employer Identification Number (FEIN) is 65— —/019 _ _ (if the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement: JL | understand that o "public entity crhna' as defined in Paragraph 287133 (|)(g), Florida Statutes means u violation of any state or federal law bya person with respect to and directly related mthe transaction of business with any public entity or with an agency or political subdivision of any other state or of the United States, including, but not limited to , any bid, proposal or contract for goods or services to be provided to any public entity or an agency or 9o|idco| subdivision of any other state or of the United States and involving antitrust, fraod, theft, bribery, co||usion, racketeering, conspiracy, or material misrepresentation. � \ understand that "convicted" or "conviction" as defined in Paragraph 287.133 (\) (b). Florida Statutes, means u finding of guilt orx conviction o/a public entity crime, with or without nnadjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non-jury trial, or entry of a plea of guilty or no|ncontendere. 4` | understand that an'affiUete�'uu defined in Paragraph 287|33(|)(a). Florida Statutes, means: (a) A predecessor or successor o{a person convicted ofu public entity crime; or Page 27of0S C Thomas r. Pepe, zu\}-2o|y, All rights reserved. (b) An entity under the control of any natural person who is active in the management of the entity and who has been convicted nfu public entity crime. The term ^mffi|kate' includes those officers, uirectom, mxecudves, partners, shareholders, employees, members, and agents who are active in the management ofanaffi|iate. The ownership by one person of shares constituting acontrolling interest in any person, or pooling of equipment or income among persons when not for fair market value under an arm's length agreement, ahuU be u prima facie case that one person controls another person. A person who knowingly enters into o joint venture with o person who has been convicted of public entity crime in Florida during the preceding 36 months shall be considered undfi|izte. I | understand that a "person" as defined in Paragraph 287.133 (|) (e)` Florida Statutes, means any natural person or entity organized under the kuvo of any state orofthe United States with the |eQo pv,,cr to enter into u binding contract and which bids or proposal or applies to bid or proposal on contracts for the provision of goods or services let by m public endty, or which otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers, 6irectom, cxccudves, partmcrm, shareholders, emp|oyeeo, mcmbmn, and agents who are active in management of an entity. 6 Based on information and belief, the statement which | have marked below is true in relation to the entity submitting this sworn statement. [indicate which statement appies] _,+._ Nek6artho entity submitting this sworn statement, nor any ofits officco. 6ircctoo, executives, partners, shareholders, employees, membeo, or agents who are active in the management of the entity' nor any affi|iatemf the entity has been charged with and convicted oJx public entity crime subsequent =z July 1, 1 9W The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July Thc entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, vragents who are active in the management of the entity, urmnaffi|iateof the entity has been charged with and convicted ufo public entity crime subsequent mfJuly |. 1989. Hmwever, there has been o subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing (}tDrer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list. [attach a copy of the final onder] Sworn on and subscribed before me this A) day of {JR Produced identification Notary Public —State of (Type ofidentification) Form PUR7068(Ke.06/||/92) Ocruvmu c Pepe, zon-2oo. All rights reserved. My commission expires _____ (Printedtypedorstampedcommbdoned name of notary public) 28of8& 60Y Notary Public State of Florida Carly Bittlingmeyer "Y Commission EE 187219 or ExPirft 05/28/201 a Whenever two or more Bids ur Proposals which are equal with respect to price, quality and service are received hy the State orby any political au66ivisipnafortheprocoremeotpfoommoditiesorcootcmzuu]aervkes,oBNqr Proposal received from abusiness that certifies that it has implemented a drug-free workplace program shall be given preference in the award process. Established procedures for processing tie Bids or Proposals shall 6e followed if none of the tied vendors have a drug-free workplace program. In order to have a drug-free workplace program, a business shall: |) Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that shall be taken against employees for violations of such prohibition. 2) Inform employees about the dangers of drug abuse in the workplace, the business' policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3) Give each employee engaged in providing the commodities or contractual services that are under Bid a copy cf the statement specified in Subsection (|). 4) In the statement specified in Subsection (1), notify the employees, that, as a condition of working of the commodities or contractual services that are under Bid, he employee shall abide by the terms of the statement and shall notify the employee of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893 or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) business days after such conviction. S) Impose asanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program, if such is available in the employee's community, by any employee who is so convicted. 6) Make a good faith effort umcontinue to maintain a drug-free workplace through implementation of this section. As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. RESPONDENT's Signature: Print Name: Page 2Oof80 (0 Thomas F. Pepe, zu//-2no, All rights reserved, Page 31 of 69 C Thomas F. Pepe, 2011-2013, All rights reserved. 9/9/13 / I of ('Fmn') have Name ofRepresentative CompanylYendorlEntity read the City of South Miami ("City)'m Code mfEthics, Section 8A'|nf the City's Code of Ordinances and I hereby certify, under penalty of perjury that to the best of my knowledge, information and belief. (1) neither I nor the Firm have any conflict of interest (as defined in section 8A- 1) with regard to the contract or business that |. and/or the Firm, am(are) about to perform for, nrto transact with, the City, and CQ neither | nor any employees, officers, directors of the Firm, nor anyone who has o financial interest greater than 5% in the Firm, has any relative(s), as defined in section 8A- 1, who is an employee of the City or who is(are) an appointed or elected official of the City, or who is(are) a member of any public body created by the City Commission, ie..o board or committee of the City, [while the ethics code still applies, if the person executing this form is doing so on behalf of a firm whose stock is publicly traded, the statement in this section (2) shall be based solely on the signatory's personal knowledge and he/she is not required to make an independent investigation as to the relationship of employees or those who have a financial interest in the Firm.]; and (3) neither I nor the Firm, nor anyone who has a financial interest greater than 5% in the Firm, nor any member of those persons' immediate family (i.e., opousc, porents, children, brothers and sisters) has transacted or entered into any contmct(s) with the City qr has o financial interest, direct or indirect, in any business being transacted with the city, or with any person or agency acting for the city, other than as follows: _(use (if necessary, use a separate sheet to supply additional information that will not fit on this line; however, you must make reference, on the above line, to the additional sheet and the additional sheet must be signed under oath). [while the ethics code still applies, if the person executing this form is doing so on behalf of a firm whose stock is publicly traded, the statement in this section (3) shall be based solely on the signatory's personal knowledge and he/she is not required to make an independent investigation as to the relationship of those who have a financial interest in the Firm.]; and (4)m* elected and/or appointed official pr employee cf the City of South Miami, or any mJ their immediate family members (i.e., spouse, parents, children, brothers and sisters) has a financial interest, directly or indirectly, in the contract between you and/or your Firm and the City other than the following individuals whose interest is set forth following their use a separate names: (if necessary, use a separate sheet to supply additional information that will not fit on this line; however, you must make reference, un the above line, to the additional sheet and the additional sheet must 6a signed under oat6). The names of all City employees and that of all elected and/or appointed city officials or board members, who own, directly or indirectly, on interest of five percent (S%)or more cf the total assets of capital stock in the firm are as follows: (if necessary, use a separate sheet um supply additional information that will not fit on this line; however, you must make reference, nn the above line, co the additional sheet and the additional sheet must be signed under uud). [while the ethics code still applies, if the person executing this form is doing so on behalf of a firm whose stock is publicly traded, the statement in this section (4) shall be based solely on the signatory's personal knowledge and he/she is not required to make an independent investigation as to the financial interest in the Firm of city employees, appointed officials or the immediate family members of elected and/or appointed official or employee.] (5)| and the Firm further agree not to use or attempt m use any knowledge, property nr resource which may come to us through our position of trust, or through our performance of our duties under the terms of the contract with the City, to secure a special privilege, benefit, or exemption for ourselves, or others. We agree that we may not disclose or use information, not available to members of the general public, for our personal gain or benefit or for the personal gain or benefit of any other person or business entity, outside of the normal gain or benefit anticipated through the performance of the contract. Page 32of88 Dnmmmz Pepe, zm//ano.xx rights reserved. We, -g ��,I hell eC"f re'A)kl _, (Name of CONTRACTOR), hereby acknowledge and agree that as to comply with such act or regulation, " t BY: two ".1 Name — 00/leos/ Title Page 30 of 69 C Thomas F. Pepe, 2011-2013. All rights reserved. 9/9/13 (6) 1 and the Firm hereby acknowledge that we have not contracted or transacted any business with the City or any person or agency acting for the City, and that we have not appeared in representation of any third par-ty before any board, commission or agency of the City within the past two years other than as follows: if necessary, use a separate sheet to supply additional information that will not fit on this line; however, you must make reference, on the above line, to the additional sheet and the additional sheet must be signed under oath). X:\Purchasing\Vendor Registration\ 12.28.12 RELATED PARTY TRANSACTION VERIFICATION FORM [3].docx (7) Neither | nor any employees, officers, or directors of the Firm, nor any of their immediate family (ie,aou spouse, son, daughter, parent, brother or sister) is related by blood or marriage to: (0 any member o/the City Commission; (ii) any city employee; or (iii) any member of any board or agency of the City other than as follows: (if necessary, use u separate sheet to supply additional information that will not fit on this line; however, you must make reference, on the above line, to the additional sheet and the additional sheet must be signed under oath). [while the ethics code still applies, if the person executing this form is doing so on behalf of a firm whose stock is publicly traded, the statement in this section (7) shall be bused solely onthe signatory's personal knowledge and he/she is not required to make an independent investigation as to the relationship by blood or marriage of employees, officers, or directors of the Firm, or of any of their immediate family to any appointed or elected officials of the City, or to their immediate family members]. (8) No Other Firm, nor any officers or directors of that Other Firm or anyone who has a financial interest greater than 5% in that Other Firm, nor any member of those persons' immediate family (i.e., spouse, parents, children, brothers and sisters) nor any of my immediate family members (hereinafter referred to as "Related Parties") has responded to a solicitation by the City in which | or the Firm that | represent or anyone who has afinancia| interest greater than 5% in the Firm, or any member of those persons' immediate family (i.e. spouse, parents, children, brothers and sisters) have also responded, other than the following: necessary, use a separate sheet to supply additional information that will not fit on this line; however, you must make reference, on the above line, to the additional sheet and the additional sheet must be signed under oath). [while the ethics code still applies, if the person executing this form is doing so on behalf of a firm whose stock is publicly traded, the statement in this section (8) shall be based solely on the signatory's personal knowledge and he/she is not required to make an independent investigation into the Other Firm, or the Firm he/she represents, as to their officers, directors or anyone having a financial interest in those Firms or any of their any member of those persons' immediate family.] (9)|and the Firm agree that we are obligated m supplement this Verification Form and inform the City of any change in circumstances that would change our answers co this document. SpecificuUyafterd`nppeniogofany, responses uou solicitation, } and the Firm have on obligation tmsupplement this Verification Form with the name pf all Related Parties who have also responded to the same solicitation and to disclose the relationship of those parties to me and the Firm. Print Name & Title: 'cdwav MCI t, l ' ATTACHED. Sec. 8A- I - Conflict of interest and code of ethics ordinance. Page 33 of 69 0 mvmas F. Pepe, zn//-mo. All rights reserved. Municode Page ION Sec. 8A -I. - Conflict of interest and code of ethics ordinance. (a) Designation. This section shall be designated and known as the "City of South Miami Conflict of Interest and Code of Ethics Ordinance." This section shall be applicable to all city personnel as defined below, and shall also constitute a standard of ethical conduct and behavior for all autonomous personnel, quasi - judicial personnel, advisory personnel and departmental personnel. The provisions of this section shall be applied in a cumulative manner. By way of example, and not as a limitation, subsections (c) and (d) may be applied to the same contract or transaction. (b) Definitions. For the purposes of this section the following definitions shall be effective: (1) The term "commission members" shall refer to the mayor and the members of the city commission. (2) The term "autonomous personnel" shall refer to the members of autonomous authorities, boards and agencies, such as the city community redevelopment agency and the health facilities authority. (3) The term "quasi- judicial personnel" shall refer to the members of the planning board, the environmental review and preservation board, the code enforcement board and such other individuals, boards and agencies of the city as perform quasi - judicial functions. (4) The term "advisory personnel" shall refer to the members of those city advisory boards and agencies whose sole or primary responsibility is to recommend legislation or give advice to the city commission. (5) The term "departmental personnel" shall refer to the city clerk, the city manager, department heads, the city attorney, and all assistants to the city clerk, city manager and city attorney, however titled. (6) The term "employees" shall refer to all other personnel employed by the city. (7) The term "compensation" shall refer to any money, gift, favor, thing of value or financial benefit conferred, or to be conferred, in return for services rendered or to be rendered. (8) The term "controlling financial interest" shall refer to ownership, directly or indirectly, of ten percent or more of the outstanding capital stock in any corporation or a direct or indirect interest of ten percent or more in a firm, partnership, or other business entity at the time of transacting business with the city. (9) The term "immediate family" shall refer to the spouse, parents, children, brothers and sisters of the person involved. (10) The term "transact any business" shall refer to the purchase or sale by the city of specific goods or services for consideration and to submitting a bid, a proposal in response to a RFP, a statement of qualifications in response to a request by the city, or entering into contract negotiations for the provision on any goods or services, whichever first occurs. (c) Prohibition on transacting business with the city. No person included in the terms defined in paragraphs (b)(1) through (6) and in paragraph (b)(9) shall enter into any contract or transact any business in which that person or a member of the immediate family has a financial interest, direct or indirect with the city or any person or agency acting for the city, and any such contract, agreement or business engagement entered in violation of this subsection shall render the transaction voidable. Willful violation of this subsection shall constitute malfeasance in office and shall affect forfeiture of office or position. Nothing in this subsection shall prohibit or make illegal: (I ) The payment of taxes, special assessments or fees for services provided by the city government; (2) The purchase of bonds, anticipation notes or other securities that may be issued by the city through underwriters or directly from time to time. Waiver of prohibition. The requirements of this subsection may be waived for a particular transaction only by four affirmative votes of the city commission after public hearing upon finding that: (1) An open -to -all sealed competitive proposal has been submitted by a city person as defined in paragraphs (b)(2), (3) and (4); (2) The proposal has been submitted by a person or firm offering services within the scope of the practice of architecture, professional engineering, or registered land surveying, as defined by the laws of the state and pursuant to the provisions of the Consultants' Competitive Negotiation Act, and when the proposal has been submitted by a city person defined in paragraphs (b)(2), (3) and (4); (3) The property or services to be involved in the proposed transaction are unique and the city cannot avail itself of such property or services without entering a transaction which would violate this subsection but for waiver of its requirements; and (4) That the proposed transaction will be in the best interest of the city. Page 34 of 69 © Thomas F. Pepe, 2011 -2013. All rights reserved. 9/9/13 This subsection shall be applicable only to prospective transactions, and the city commission may in no case ratify a transaction entered in violation of this subsection. Provisions cumulative. This subsection shall be taken to be cumulative and shall not be construed to amend or repeal any other law pertaining to the same subject matter. (d) Further -prohibition on transacting business with the city. No person included in the terms defined in paragraphs (b)(1) through (6) and in paragraph (b)(9) shall enter into any contract or transact any business through a firm, corporation, partnership or business entity in which that person or any member of the immediate family has a controlling financial interest, direct or indirect, with the city or any person or agency acting for the city, and any such contract, agreement or business engagement entered in violation of this subsection shall render the transaction voidable. The remaining provisions of subsection (c) will also be applicable to this subsection as though incorporated by recitation. Additionally, no person included in the term defined in paragraph (b)(1) shall vote on or participate in any way in any matter presented to the city commission if that person has any of the following relationships with any of the persons or entities which would be or might be directly or indirectly affected by any action of the city commission: (1) Officer, director, partner, of counsel, consultant, employee, fiduciary or beneficiary; or (2) Stockholder, bondholder, debtor, or creditor, if in any instance the transaction or matter would affect the person defined in paragraph (b)(1) in a manner distinct from the manner in which it would affect the public generally. Any person included in the term defined in paragraph (b)( 1) who has any of the specified relationships or who would or might, directly or indirectly, realize a profit by the action of the city commission shall not vote on or participate in any way in the matter. (E) Gifts. (I)Definition. The term "gift" shall refer to the transfer of anything of economic value, whether in the form of money, service, loan, travel, entertainment, hospitality, item or promise, or in any other form, without adequate and lawful consideration. (2)Exceptions. The provisions of paragraph (e)(1) shall not apply to: a. Political contributions specifically authorized by state law; b. Gifts from relatives or members of one's household, unless the person is a conduit on behalf of a third party to the delivery of a gift that is prohibited under paragraph(3); c. Awards for professional or civic achievement; d. Material such as books, reports, periodicals or pamphlets which are solely informational or of an advertising nature. (3) Prohibitions. A person described in paragraphs (b)(1) through (6) shall neither solicit nor demand any gift. It is also unlawful for any person or entity to offer, give or agree to give to any person included in the terms defined in paragraphs (b)(1) through (6), or for any person included in the terms defined in paragraphs (b)(1) through (6) to accept or agree to accept from another person or entity, any gift for or because of: a. An official public action taken, or to be taken, or which could be taken, or an omission or failure to take a public action; b. A legal duty performed or to be performed, or which could be performed, or an omission or failure to perform a legal duty; c. A legal duty violated or to be violated, or which could be violated by any person included in the term defined in paragraph (b)(1); or d. Attendance or absence from a public meeting at which official action is to be taken. (4) Disclosure. Any person included in the term defined in paragraphs (b)(1) through (6) shall disclose any gift, or series of gifts from anyone person or entity, having a value in excess of $25.00. The disclosure shall be made by filing a copy of the disclosure form required by chapter 112, Florida Statutes, for "local officers" with the city clerk simultaneously with the filing of the form with the clerk of the county and with the Florida Secretary of State. (f) Compulsory disclosure by employees of firms doing business with the city. Should any person included in the terms defined in paragraphs (b)(1) through (6) be employed by a corporation, firm, partnership or business entity in which that person or the immediate family does not have a controlling financial interest, and should the corporation, firm, partnership or business entity have substantial business commitments to or from the city or any city agency, or be subject to direct regulation by the city or a city agency, then the person shall file a sworn statement disclosing such employment and interest with the clerk of the city. (g) Exploitation of official position prohibited. No person included in the terms defined in paragraphs (b )(1) through (6) shall corruptly use or attempt to use an official position to secure special privileges or exemptions for that person or others. (h) Prohibition on use of confidential information. Page 35 of 69 © Thomas F. Pepe, 2011 -2013. All rights reserved. 9/9/13 No person included in the terms defined in paragraphs (b)(1) through (6) shall accept employment or engage in any business or professional activity which one might reasonably expect would require or induce one to disclose confidential information acquired by reason of an official position, nor shall that person in fact ever disclose confidential information garnered or gained through an official position with the city, nor shall that person ever use such information, directly or indirectly, for personal gain or benefit. (i) Conflicting employment prohibited. No person included in the terms defined in paragraphs (b)(1) through (6) shall accept other employment which would impair independence of judgment in the performance of any public duties. (j) Prohibition on outside employment. (1) No person included in the terms defined in paragraphs (b)(6) shall receive any compensation for services as an officer or employee of the city from any source other than the city, except as may be permitted as follows: a. Generally prohibited. No full -time city employee shall accept outside employment, either incidental, occasional or otherwise, where city time, equipment or material is to be used or where such employment or any part thereof is to be performed on city time. b. When permitted. A full -time city employee may accept incidental or occasional outside employment so long as such employment is not contrary, detrimental or adverse to the interest of the city or any of its departments and the approval required in subparagraph c. is obtained. c. Approval of department head required. Any outside employment by any full -time city employee must first be approved in writing by the employee's department head who shall maintain a complete record of such employment. d. Penalty. Any person convicted of violating any provision of this subsection shall be punished as provided in section I - I I of the Code of Miami -Dade County and, in addition shall be subject to dismissal by the appointing authority. The city may also assess against a violator a fine not to exceed $500.00 and the costs of investigation incurred by the city. (2) All full -time city employees engaged in any outside employment for any person, firm, corporation or entity other than the city, or any of its agencies or instrumentalities, shall file, under oath, an annual report indicating the source of the outside employment, the nature of the work being done and any amount of money or other consideration received by the employee from the outside employment. City employee reports shall be filed with the city clerk. The reports shall be available at a reasonable time and place for inspection by the public. The city manager may require monthly reports from individual employees or groups of employees for good cause. (k) Prohibited investments. No person included in the terms defined in paragraphs (b)(1) through (6) or a member of the immediate family shall have personal investments in any enterprise which will create a substantial conflict between private interests and the public interest. (1) Certain appearances and payment prohibited. (I ) No person included in the terms defined in paragraphs (b)(1), (5) and (6) shall appear before any city board or agency and make a presentation on behalf of a third person with respect to any matter, license, contract, certificate, ruling, decision, opinion, rate schedule, franchise, or other benefit sought by the third person. Nor shall the person receive any compensation or gift, directly or indirectly, for services rendered to a third person, who has applied for or is seeking some benefit from the city or a city agency, in connection with the particular benefit sought by the third person. Nor shall the person appear in any court or before any administrative tribunal as counselor legal advisor to a party who seeks legal relief from the city or a city agency through the suit in question. (2) No person included in the terms defined in paragraphs (b)(2), (3) and (4) shall appear before the city commission or agency on which the person serves, either directly or through an associate, and make a presentation on behalf of a third person with respect to any matter, license, contract, certificate, ruling, decision, opinion, rate schedule, franchise, or other benefit sought by the third person. Nor shall such person receive any compensation or gift, directly or indirectly, for services rendered to a third party who has applied for or is seeking some benefit from the city commission or agency on which the person serves in connection with the particular benefit sought by the third party. Nor shall the person appear in any court or before any administrative tribunal as counselor legal advisor to a third party who seeks legal relief from the city commission or agency on which such person serves through the suit in question. (m) Actions prohibited when financial interests involved. No person included in the terms defined in paragraphs (b) (1) through (6) shall participate in any official action directly or indirectly affecting a business in which that person or any member of the immediate family has a financial interest. A financial interest is defined in this subsection to include, but not be limited to, any direct or indirect interest in any investment, equity, or debt. Page 36 of 69 © Thomas F. Pepe, 2011 -2013. All rights reserved. 9/9/13 (n) Acquiring financial interests. No person included in the terms defined in paragraphs (b)(1) through (6) shall acquire a financial interest in a project, business entity or property at a time when the person believes or has reason to believe that the financial interest may be directly affected by official actions or by official actions by the city or city agency of which the person is an official, officer or employee. (0) Recommending professional services. No person included in the terms defined in paragraphs (b)(1) through (4) may recommend the services of any lawyer or law firm, architect or architectural firm, public relations firm, or any other person or firm, professional or otherwise, to assist in any transaction involving the city or any of its agencies, provided that a recommendation may properly be made when required to be made by the duties of office and in advance at a public meeting attended by other city officials, officers or employees. (p) Continuing application after city service. (1) No person included in the terms defined in paragraphs (b)(1), (5) and (6) shall, for a period of two years after his or her city service or employment has ceased, lobby any city official [as defined in paragraphs (b)(1) through (6)] in connection with any judicial or other proceeding, application, RFP, RFQ, bid, request for ruling or other determination, contract, claim, controversy, charge, accusation, arrest or other particular subject matter in which the city or one of its agencies is a party or has any interest whatever, whether direct or indirect. Nothing contained in this subsection shall prohibit any individual from submitting a routine administrative request or application to a city department or agency during the two -year period after his or her service has ceased. (2) The provisions of the subsection shall not apply to persons who become employed by governmental entities, 501(c)(3) non - profit entities or educational institutions or entities, and who lobby on behalf of those entities in their official capacities. (3) The provisions of this subsection shall apply to all persons described in paragraph (p)(1) whose city service or employment ceased after the effective date of the ordinance from which this section derives. (4) No person described in paragraph (p)(1) whose city service or employment ceased within two years prior to the effective date of this ordinance shall for a period of two years after his or her service or employment enter into a lobbying contract to lobby any city official in connection with any subject described in paragraph (p)(1) in which the city or one of its agencies is a party or has any direct and substantial interest; and in which he or she participated directly or indirectly through decision, approval, disapproval, recommendation, the rendering of advice, investigation, or otherwise, during his or her city service or employment. A person participated "directly" where he or she was substantially involved in the particular subject matter through decision, approval, disapproval, recommendation, the rendering of advice, investigation, or otherwise, during his or her city service or employment. A person participated "indirectly" where he or she knowingly participated in any way in the particular subject matter through decision, approval, disapproval, recommendation, the rendering of advice, investigation, or otherwise, during his or her city service or employment. All persons covered by this paragraph shall execute an affidavit on a form approved by the city attorney prior to lobbying any city official attesting that the requirements of this subsection do not preclude the person from lobbying city officials. (5) Any person who violates this subsection shall be subject to the penalties provided in section 8A -2(p). (q) City attorney to render opinions on request. Whenever any person included in the terms defined in paragraphs (b)(1) through (6) and paragraph (b)(9) is in doubt as to the proper interpretation or application of this conflict of interest and code of ethics ordinance, or whenever any person who renders services to the city is in doubt as to the applicability of the ordinance that person, may submit to the city attorney a full written statement of the facts and questions. The city attorney shall then render an opinion to such person and shall publish these opinions without use of the name of the person advised unless the person permits the use of a name. (Ord. No. 6 -99 -1680, § 2, 3 -2 -99) Editor's note- Ord. No. 6 -99 -1680, § I, adopted 3 -2 -99, repealed §§ 8A -I and 8A -2 in their entirety and replaced them with new §§ 8A -I and 8A -2. Former §§ 8A -I and 8A -2 pertained to declaration of policy and definitions, respectively, and derived from Ord. No. 634, §§ I (I A -1), 1 (1 A -2) adopted Jan. 11, 1969. END OF SECTION © Thomas F. Pepe, 2011 -2013. All rights reserved. 9/9/13 Page 37 of 69 I 1 3 -r c o wo y = _ yb ° � — m rn c DO Z H S° < m 7 v�°i m In O `i a r O fA 0 c'o c ttii w m v 3 c n '' rn -. n n c°n 0 Di ch m ° o K d sup u, Ql x o-3 t" m a C� ? o !37 co W D� m 3 cc m D > O L N %� W Ln 0w0 x a N o r' oM GcD > n C ~� D� w m �O�c, t� pD� W '0 -i r+ 9 W w CO) 0 O O n m ° y n n_ mu w N nn� N 1 O_ S CA x H 'ryU m 1 Q N -a µ a m D �mr. omm m N y j �Ncn : X o _ o 3o3U „ o o r �A�� - 0 o z c O En (D O 'n �, F+ n v ^ - E i m m 3 0 m Ln W ?�0 - -3�� n m -�a s ° 3 c � a ° _ 0 ( CD n a m@ C z ra a C N m� `" �o <' C m C O o_°v��,y�� r ° � fp Ali � ° °m W o o CD X O w r m N ^ a Z W 3• ca Q C W omNrn°. u< ��t� N mW (/) k y 3 to O 2 c3i ` N W C6 m � a cn C m S tD a U) CD � Q ��! �._. Oro Q �_ o n N. n �c CD -.j `_°. o0 7 G �c' comwmCy W n m b� WcD c o _ z� m� CO y (D (m m �o � m cn M t Co m 0) X I m C> 03°�� 3 m Qw OA WCO �mo3Q -- n� zzo 10 CA mn I. N O= 6 0 .Q Ul N !7 r W ffk;•.1 ao m mod W H Ul - F� O N =r �. N C N O 0 O A 0) jB ° a rn m t'n 3 N w O ,- 2 o J D3UO m n o womo to a y is o QQ� w o� CC m m oco to �� to K N 0 a � o ' i 3 � N t � 'o o � i 0 i I � i � ° ° i CD v 0 0 T 0 CD O N 0 0 0 m O 3 O (7 O O N O 0 v N � a � �• O 0 i aV I" 1 t` L' X Q O1 h CD 0 N N O F. Uml O n rt Ci ^'1 zip N i V n� i Y r. n� n n rt I� O 3 O W J r N `J O 0 CD �o Imo` �r ley} ti ® R V. N C� c u b - a py tmmJ Q y v 11 w `ll • ai� L V v� Tam ( O J` DO C Jam• �1 n� i Y r. n� n n rt I� O 3 O W J r N `J O 0 CD �o Imo` �r ley} ti ® R V. N C� c u b - a py tmmJ Q y v 11 w `ll • ai� L V v� Tam ( O STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 MOSLEY, ROBERT JOHN HARTZELL CONSTRUCTION INC 2301 NW 33RD CT STE 12 POMPANO BEACH F% 31.1069 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. (850) 487 -1395 STATE of FLORIDA AC # DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CGCO61592 06/06/12 110415296 Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense.com. CERTIFIED GENERAL CONTRACTOR There you can find more information about our divisions and the regulations that MOSLEY, ROBERT JOHN impact you, subscribe to department newsletters and learn more about the HARTZELL CONSTRUCTION INC Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. IS CERTIFIED under the provisions of ch.489 Fs Thank you for doing business in Florida, and congratulations on your new license! Expiration date: AUG 31, 2014 L12060601335 DETACH HERE _ ?,j' ;T +TYi4 AC# r6l `5 / 41. STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SEQ# L12060601335 06/06/20121110415296 ICGCO61592 The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date; AUG 311 2014 MOSLEY, ROBERT JOHN HARTZELL CONSTRUCTION INC 2301 NW 33RD CT STE 12 POMPANO BEACH FL 33060 RICK SCOTT GOVERNOR DISPLAY AS REQUIRED BY LAW KEN LAWSON SECRETARY CERTIFICATE OF LIABILITY INSURANCE DATE 07/28 /28/2 2/Y01Y3 �d 3 PRODUCER STATE FARM MUTUAL INSURANCE COMPANY THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE KEVIN WELTLIN, AGENT HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 24011 HWY 27 N ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, O LAKE WALES, FL 33859 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: ' t 251%8 HARTZELL CONSTRUCTION COMPANY INSURER B: 2301 NW 33RD CT STE 112 INSURER C: POMPANO BEACH, FL 33069 -1000 ID 457158 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TEEM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD' POLICY NUMBER DATE MMIUDC/YYYY) DATE A MfDD TION LIMITS LTR INSR TYPE OF INSURANCE ( A GENERAL LIABILITY EACH -AG—M CUO R EN ED $ COMCLA MIS MADEE OBCCIJR PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY I $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ PRO- LOC $ POLICY JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ X ANY AUTO See Below 07/28/2013 01/28/2014 (Ea accident) it ALL OWNED AUTOS BODILY INJURY $ 1 100%000 SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ 190009000 NON -OWNED AUTOS 900 5897- A28 -59 0712812013 01/28/2014 (Per accident) X ENOL PROPERTY DAMAGE $ 15000,000 (Per accident) ' GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ $ TWO STATU- OTH WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN E.L. EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ (Mandatary In NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 893 4024- A28 -59 893 4029- A28 -59 893 4025 - A28 -59 893 4030 - A28 -59 EFFECTIVE DATE FOR ALL POLICIES 07/28/2013 - 01/28/2014 893 4027- A28 -59 893 4028 - A28 -59 CERTIFICATE HOLDER CANCELLATION For Bidding Purposes ACORD 25 (2009101) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCtLLtU BtrUKt r nt: enrlrt Inn. DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO so SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1002398 139020 08 -31 -2009 OP ID: TG DATE (M MIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 09/11/13 46 M THIS CERTGDOES NOT AFFIRMATIVELY RMAT VELYEOR NEGATIVELY AMENDYEXTEND OR ALTER TIHETCOVERAGE AFFORDED ABY THE POLICIES CERTIFICATE BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTS and It the conditions of the older I certain policies ALay INSURED, require endorsemenm A s atef endorsed. ent on this eriitiOGe does not WAIVED, bights to the the terms holder In lieu Of SUCK endOfSemBnt S . nnrnrneT PRODUCER INNOVATIVE INSURANCE CONSULTANTS, INC, 5461 UNIVERSITY DRIVE, #103 FL THOMAS Jo EFRANC0087 INSURED __ HARTZELL CONSTRUCTION, INC. 2301 NW 33RD COURT, STE 112 POMPANO BEACH, FL 33069 954- 340 -9551 HARTZ -2 ,STARR INDEMNITY & LIABILITY CO COMMERCE & INDUSTRY i CHARTIS ,BRIDGEFIELD EMPLOYERS INS CO 1 9410 OVERAGES CERTIFICATE NUiVltstK: OR THE POLICY INDICATED. CNOTTWITHSTANDING ANY I REQUIREMENT* TERM OR CONDITION VOF ANY CONTRACTT OR OTHER DOCUMENT WITH RESPECT TO WHICH PERIOD CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID C EX S• LIMITS TYPE OF INSURANCE GENERAL LIABILITY A X COMMERCIAL GENERAL. LIABILITY -M CLAIMSADE a OCCUR X BLKT ADDL INSURED X BL WAIVER LIMIT APPLIES PER: AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OW Nm AUTOS UMBRELLA LIAB X OCCUR X EXCESS LIAR CLAIMS B DEDUCTIBLE RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY C OFFCEMEEMBEREXCLU EXCLUDED? (Mandatory In NH) 1'.x10 YQIN /A1 x L NONCONTRIBUTORY -38373 I 1 EACH OCCURRENCE 7ERSONAL3t 07125/13 07/25114 e ersc INJUI GATE MPIOP $ 1 EACUt�CCIDENT 07/25113 07/25114 AGG09/13/13 09113114 E.L. E.L. DISEASE - EA OF OPERATIONS I LOCATIONS 1 VEHICLES (Aufkch ACORD 944, Additioria! Remarks Schadule, !f more space iE rewired) ATE HOLDER IS ALSO KNOWN AS ADDITIONAL INSURED WITH RESPECT TO LIABILITY. INSURANCE EVIDENCED BY THIS CERTIFICATE SHALL BE PRIMARY COOETTHEADDIITONALYINSUREDS WIITTHNRESPECTATO GENERAL LIABILITYAANDIE3 HARTZELL CONSTRUCTIONt INC. 2301 NW 33RD CT, SUITE 112 POMPANO BEACH, FL 33069 W 1 1 HARTZ -1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988.2009 ACORD CORPORATION. All rights reserved. COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per parson) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Peracctdent) $ EACUt�CCIDENT 07/25113 07/25114 AGG09/13/13 09113114 E.L. E.L. DISEASE - EA OF OPERATIONS I LOCATIONS 1 VEHICLES (Aufkch ACORD 944, Additioria! Remarks Schadule, !f more space iE rewired) ATE HOLDER IS ALSO KNOWN AS ADDITIONAL INSURED WITH RESPECT TO LIABILITY. INSURANCE EVIDENCED BY THIS CERTIFICATE SHALL BE PRIMARY COOETTHEADDIITONALYINSUREDS WIITTHNRESPECTATO GENERAL LIABILITYAANDIE3 HARTZELL CONSTRUCTIONt INC. 2301 NW 33RD CT, SUITE 112 POMPANO BEACH, FL 33069 W 1 1 HARTZ -1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988.2009 ACORD CORPORATION. All rights reserved. Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" line Social security number to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a �� resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other j` -�� I entities. it is your employer identification number (EIN). If you do not have a number, see HotA to o =t a I I TIN on page 3. Note. If the account is in more than one name, see the chart on page s for guidelines on whose number to enter. 1 -1 D 1 Ln ILK I3 Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. 1 am not subject to backup withholding because: (a) i am exempt from baCXUp .,vithholdln ^y, or Ib) I haviC i 10L becsn notifi` by t, ie internal ReVei sue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. 1 am a U.S. citizen or other U.S. person (defined below). Certification instructions. You must = you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report al Form 4 Request for Taxpayev For real estate transactions. item 2 does not apply. For mortgage Give Form to the (Rev. December 2011) F ° �F ° ° Bdenti g cation iefumbe and Certru ,. catDo9l debt. contributions to an individual retirement arrangement (IRA), and requester, Do not D=;artmentoi the Treasury not required to sign the certifir-.ation, but you must provide your correct TIN. Seethe send to the IRS. Internal Revenue Service 1023'!X Form W -9 (Rev. 12.2011) Name (as showir� on your income tax return; tttt Business name /d srogarded entity name, if different from above N m U) CU c ° c Check appropriate box for federal tax classification: m ❑ Individual/Sole proprietor ❑ C Corporation 2050 Corporation ❑ Partnership f i ruscres =ate j CL o nY (- rp rp _pannershi D. ❑Limited liability company. Enter the tax classification C =C corporation, S=S corporation, P- p) �❑ Exempt payee o C th tL` c ❑ Other (see instructions) U Address (number, street, and apt. or suite no.) �j Requester's name and address (optional) W ti m Ci , state, and ZIP code List account umber(s) here (optional; Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" line Social security number to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a �� resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other j` -�� I entities. it is your employer identification number (EIN). If you do not have a number, see HotA to o =t a I I TIN on page 3. Note. If the account is in more than one name, see the chart on page s for guidelines on whose number to enter. 1 -1 D 1 Ln ILK I3 Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. 1 am not subject to backup withholding because: (a) i am exempt from baCXUp .,vithholdln ^y, or Ib) I haviC i 10L becsn notifi` by t, ie internal ReVei sue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. 1 am a U.S. citizen or other U.S. person (defined below). Certification instructions. You must ross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report al as a U.S. person, your erest and dividends on your tax return. For real estate transactions. item 2 does not apply. For mortgage interest paid, acquisition or abandpfient of secured property, cancellation of debt. contributions to an individual retirement arrangement (IRA), and generally, payments other than rest and divic you are not required to sign the certifir-.ation, but you must provide your correct TIN. Seethe instructions on page 4. Cat. No. 1023'!X z5ign Signature of Here U.S. person D Date © i / y General IiiSB"uCBO S Note. If a requester gives you a form other than Fo. t W-9 to re quest your TIN, you must use the requesters form it it is substantially similar Section references are to the Internal Revenue Code unless otherwise to this Form W -9. noted. Definition of a U.S. person. For federal tax, Purposes. you are Purpo$e of Form considered a U.S. person if you are: A person who is required to file an information return with the IRS must a An individual who is a U.S. citizen or U.S. resident alien, obtain your correct taxpayer identification number fTIN) to report. for e A partnership, corporation, cornp =ny, or association created or example, income paid to you, real estate transactions, mortgage interest organized in the United States or under the laws of the United States, you paid, acquisition or abandonment of secured property, cancellation a An estate (other than a foreign estate), or of debt, or contributions you made to an IRA. a A domestic trust (as defined in Regulations s ec-tion 301.7701 -7i. Use Form W -9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the Special rules for partnerships. Partnerships that conduct a trade or requester) and, when applicable, to: business in the United States are generally required to pay a withholding tax on any foreign partners' ;hare of income from Sup , business. i. Certify that the TIN you are giving is correct for you are eraiting .or a Further, in certain cases `.':'here a Form W-9 has riot been received, a number to be issued), partnership is required to presume that a partner is a foreign person, 2. Certify that you are not subject to backup withholding. or and pay the withholding tax. Therefore, if you are a U.S. person that is a 3. Claim exemption from backup withholding if you are a U.S. exer^pt partner in a psrtne ship conducting a trade or business in tha Unitec payee. If applicable, you are also certifying that as a U.S. person, your States, provide Fonn VV-9 to the partnership to establish your U.S. allocable share of any partnership income from a U.S. trade or business status and avoid withholding on your share of partnership income. is not subject to the withholding tax on foreign pa ttnei:,' share of effectively connected income. Cat. No. 1023'!X Form W -9 (Rev. 12.2011)