Metro Express PART 1SCHEDULE OF EVENTS
Multiple Locations for Road Resurfacing Projects
P P 2 1 -08
13. Lobbying. All firms and their agents who intend to submit, or who submitted, bids or responses for this
RESPONDENT QUALIFICATION
Multiple Locations for Road Resurfacing Projects
RFlP I-
The response to this gUestionnaire shall be utilized as part of this CITY'S overall Proposal Evaluation an
RESPONDENT selection: _
I. Number of similar 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
List the last three (3) completed similar projects.
a) Project Name:
Owner Name:
Owner Address:..
_.w
Owner Telephone:��}�
Original Contract Completion Time
(Gays);
(
Original Contract Completion Gate:
Actual Final Contract Completion
Gate.
a
Original Contract Price.
� +
Actual Final Contract Price:
b) Project Name;
LO
Owner Name:
'
Owner Address.?
Owner Telephone;
- oo
Original Contract Completion Time
(Guys): C
Original Contract Completion Gate:
:Actual Final Contract Completion
Gate. �C 1
Original Contract Price:
Actual Final Contract Price
..._._
Thomas F. Pep
12110/2015
12
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NON COLLUSION AFFIDAVIT
PUBLIC
Pursuant to the provisions of Paragraph () (a) of Section 287.133, Florida State Statute — "A per -sort or affiliate
�s li^' i�® ®iii � ;�lE LI:� i *T`
Ma
« , � a �
RELATED I I E
1 > individually and can behalf of "
( "Firm ") have Name of Representative CompanylVendorlEntity read the City of Code N��hk'-s,
Section BA- I of the City's Code of Ordinances and I hereby certify, cinder 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 1, and /or the Firm, am(are) about to perform for, or to transact with, the
City, and
() neither l nor any employees, officers, directors of the Firm, near anyone who has a financial interest greater
than 5% in the Firm, has any relative(s), as defined in section 8A- 1, wh s is an employee of the City or when 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, i.e., a board or committee of the City, [while the ethics code still applies, if the person executing this
farm is doing so on behalf of a firm whose stock is publicly traded, the statement in this section () 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 near the Firm, nor anyone who has a financial interest greater than 5lyl in the Firm, nor any member of
these persons' immediate family (i.e., spouse, parents, children, breathers and sisters) has transacted or entered
into any contract(s) with the City or has a 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:
_ (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 farm is doing so on behalf of a firm whose
stack 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 snake an independent investigation as to the relationship of those who
have a financial interest in the Firma; and
(d) no elected and /or appointed official or employee of the City of South Miami, or any of 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 Bather than the following Individuals whose interest is set
forth fallowing their names:
(if necessary, use a separate sheet to supply additional information that will not fit on this line, however, you must
make reference, can the above line, to the additional sheet and the additional sheet roust be signed under oath).
The names of all City employees and that of all elected acrd /or appointed city officials or board members, who
own, directly or indirectly, an interest of five percent (5%) or more of the total assets of capital stock in the firm
are 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).
[while the ethics code still applies, if the person executing this farm is doing so on behalf of a firm whose stock is
publicly traded, the statement in this section () 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) 1 and the Firm further agree not to use or attempt to use any knowledge, property care resource which may
carne 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 ocher person or business entity, outside of the normal gain or
benefit anticipated through the performance of the contract.
() 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 party
before any board, commission or agency of the City within the past two years other than as
Thomas F. Pepe
1211012015
----------------------------------------
----------------------------------------
'----------------------------------------
Sec. SA-1. - Conflict of interest and code of ethics ordinance.
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 fern fly 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 gement 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)(l) 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 car:
participate in any way in the matter.
(!,) 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, items or promise„ or in any other farm, 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 (),
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)(l) 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 gilt fOi- or because of
a. An official public action takers, 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 terns defined in
paragraph (b)(1)tr or
d. Attendance or absence froin a public meeting at which official action is to be taken,
(4) Disclosure, Any person included in the terra defused in paragraphs (b)(l) through (6) shall disclose any gift, or
series of gifts from anyone person or entity, having a value in excess of $25:40. The disclosure shall be made by
filing a copy of the disclosure form required by chapter 112, Florida Statutes, for ° °Racal
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.
Compulsory disclosure by employees of fir s doing business with the city.
Should any person included in the terms defined in paragraphs (b)(I) through (6) be employed by a corporation,
firm, partnership or business entity in which that person or the irnrnediate family doses 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 tta direct regulation by the city of a city agency,
Then the person shall file a sworn staterttent disclosing such ernisioyment and interest with the clerk of the city.
(g) Exploitation of ial position prohibited.
No person included in the terms, defined in paragraphs (b)(I) through () .shall corruptly use or attempt to use an
official position to secure special privileges or exemptions for that person or others.
() Prohibition on use o f n f r+den ial infonniation.
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, near shall that persona 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.
Thomas F. Pepe
12/1012015