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Roadway Construction Proposal SwaleProposal Submittal Checklist Form This checklist indicates the forms and documents required to be submitted for this solicitation and to be presented by the deadline set for within the solicitation. Fulfillment of all solicitation requirements listed is mandatory for consideration of response to the solicitation. Additional documents may be required and, if so, they will be identified in an addendum to this RFP. The response shall include the following items: X Bid Form ✓ NIA Proposal (Bid) Bond NIA X Performance Bond (As a Condition of Award; Not Required *See Note (1) With the Submittal) Below X Respondents Qualification Statement V/ X Non - Collusion Affidavit Y X Public Entity Crimes and Conflicts of Interest X Drug Free Workplace X Acknowledgement of Conformance with OSHA Standards V X List of Proposed Subcontractors and Principal Suppliers ./ X Related Party Transaction Verification Form X Indemnification and Insurance Documents ✓ *(I) Performance Bond: Required as a Condition of Award and Prior to the Contractor Receiving a Notice to Proceed. Not Required with Submittal. Submit this checklist along with your proposal indicating the completion and submission of each required forms and/or documents. END OF SECTION Page 10 of 69 ® Thomas F. Pepe, 2011 -2013. All rights reserved. 919113 BID FORM THIS PROPOSAL IS SUBMITTED TO: Steven Alexander City Manager City of South Miami 5130 Sunset Drive South Miami, FL 33143 I. If this Proposal is accepted, the undersigned Respondent agrees to enter into a Contract with the City of South Miami in the form included in this RFP Package, and to perform and furnish all work as specified or indicated in this RFP for the Proposed Price, within the Contract Time and in accordance with the other terms and conditions of the RFP Package. 2. Respondent accepts all of the terms and conditions of the Advertisement, RFP, Invitation for Proposals and Instructions to Respondents, including without limitation those dealing with the disposition of Proposal Bond /Security. This Proposal will remain subject to acceptance for 90 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 Certificate, and other documents required by the RFP, within ten (10) calendar days after the date of the City's Notice of Award. 3. In submitting this Proposal, Respondent represents that: a. Respondent has examined copies of all the RFP Documents and of the following Addenda, if any (receipt of all which is hereby acknowledged.) Addendum No. Dated: Addendum No. Dated: Addendum No. 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: If applicable to this RFP, the Respondent represents that: i. Respondent has studied carefully all reports and drawings, if applicable, 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 examinations, investigations, explorations, 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, progress, performance, or the furnishing of the Work at the Contract Price, within the Contract Time and in accordance with the other terms and conditions of the Contract Documents. The Respondent hereby acknowledges that no additional examinations, investigations, explorations, tests, reports or similar information or data are, or will, be required by Respondent for any reason in connection with the Proposal. W. Respondent has correlated the results of all such observations, examinations, investigations, explorations, tests, reports and studies with the terms and conditions of the Contract Documents. Page 11 of fig ® Thomas F. Pepe, 2011-2013. All rights reserved. 9/9/13 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 examinations, investigations, explorations, tests, reports or similar information or data in respect to any Underground Facilities are, or will be, 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. d. Respondent has given the City written notice of all conflicts, errors or discrepancies that it has discovered in the Contract Documents and, if any conflicts, errors or discrepancies have been found and notice given, the Respondent represents, by 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 or discrepancies. 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. 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 of: LUMP SUM BASE PRICE: dollars and Alternates: #1 #2 #3 #4 ThritV Seven Thousand zero #5 #6 #7 #8 cents $ 37,000.00 A fee breakdown, if applicable, for each task must be completed in the table shown above. Failure to complete this information shall render the proposal non- responsive. S. The ENTIRE WORK shall be completed, in full, within 45 days from the date stipulated in the NOTICE TO PROCEED. Failure to complete the entire work during the described time period shall result in the assessment of liquidated damages as set forth in the Contract. Page 12 of 69 ® Thornas F. Pepe, 2011 -2013. All rights reserved. 919113 6. Communications concerning this Proposal shall be addressed to: RESPONDENT: Roadway Construction, LLC Address: 6750 North Andrews Ave Suite 200 Fort Lauderdale FL 33309 Telephone: 305- -200 -7873 Facsimile: 954-417-3677 Attention: Silvio Rubi The terms used in this Proposal which are defined in the Contract shall have the same meaning as is assigned to them in the Contract Documents, unless specifically defined in this RFP Package. SUBMITTED THIS 30 DAY OF October PROPOSAL SUBMITTED BY. Roadway Construction, LLC Company Silvio Rubi me of Person Authorized to Submit r sal Si re MGMR C Thomas F. Pepe, 2011 -2013. All rights reserved. 919113 305 -200 -7873 Telephone Number 954 - 417 -3677 Fax Number 2013 silvi.o @roadway- construction.com Email Address END OF SECTION Page 13 of 69 RESPONDENT QUALIFICATION STATEMENT 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 17 In the past 5 years On Schedule 17 b) in the past 10 years 17 In the past 10 years On Schedule 17 2. List the last three (3) completed similar projects. a) Project Name: Riverside Swale Owner Name: City of Fort Lauderdale Owner Address: 100 N. Andrews Ave, Fort Lauderdale, FL Owner Telephone: 954 - 828 -5678 Original Contract Completion Time (Days): 60 Days Original Contract Completion Date: 8/1/2013 Actual Final Contract Completion Date: 7/11/2013 Original Contract Price: $31,555.00 Actual Final Contract Price: $27,721.38 b) Project Name: Traffic Calmimg Project Owner Name: City of West Park Page 20 of 69 0 Thomas F. Pepe, 2011 -2013. Alf rights reserved. 919113 Owner Address: 1965 S. State Road 7, West Paris Owner Telephone: 954-889-4162 Original Contract Completion Time 60 days (Days): Original Contract Completion Date: 9/06/2013 Actual Final Contract Completion 8/15/2013 Date: Original Contract Price: $24,550.70 Actual Final Contract Price $24,550.70 Project Name: 66 Units of Hialeah Owner Name: Caribe Utilties of Florida Owner Address: 11110 SW 88 St, Miami, FL Owner Telephone: 305-596-0141 Original Contract Completion Time (Days): 30 Original Contract Completion Date: 10/30/2013 Actual Final Contract Completion Date: 10/13/2013 Original Contract Price: $23,555.50 Actual Final Contract Price: $23,555.50 Page 21 of 69 C Thomas F. Pepe, 2011 -2013. All rights reserved. 919113 3. Current workload Project Name Red Reef Park Owiier Natile Telephoiie Number City Of 561- 393 -7871 Boca Raton C011tricr Price $106,462.13 Shadow Wood City Of Coral Springs 954- 344 -1001 $ 67,091.60 Drainage Miami -Dade Count 305 -375 -2930 $202,649.10 -Improvements 4. The following information shall be attached to the proposal. a) RESPONDENTS home office organization chart. b) RESPONDENTS 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, b) 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: City of Fort Lauderdale Address: 100 N. Andrews Ave, Fort Lauderdale, FL Page 2-2 of 69 ® Thomas F. Pepe, 2011 -2013. All rights reserved. 919113 Telephone No.: 954 -828 -5678 Contact Person: Sayd Hussain Type of Project Swale, Curbs, Asphalt Name of Agency: City of West Park Address: 1965 S. State Road 7, West Park, FL Telephone No.: 954- 889 -4162 Contact Person: Dan Millien Type of Project Traffic Calming Name of Agency: Miami -Dade County Address: 6601 NW 72 Avenue, Miami, FL Telephone No.: 305 - 889 --6702 Contact Person: Angel Martinez Type of Project: Renovation Page 23 of 69 O Thomas F. Pepe, 201 1 -2613. All rights reserved. 919113 NON COLLUSION AFFIDAVIT STATE OF FLORIDA COUNTY OF MIAMI -DADE Silvio Rub i being first duly sworn, deposes and states that (1) He /ShelThey islare the MGRM (Owner, Partner, Officer, Representative or Agent) of Roadway Construction, LLC the Respondent that has submitted the attached Proposal; (2) He/She/They is /are fully informed concerning the preparation and contents of the attached Proposal and of all pertinent circumstances concerning such Proposal; (3) Such Proposal is genuine and is not a collusive or sham Proposal; (4) Neither the said Respondent nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affiant, have in any way colluded, conspired, connived or agreed, directly or indirectly, with any other Respondent, firm, or person to submit a collusive or sham Proposal in connection with the Work for which the attached Proposal has been submitted; or to refrain from Bidding or proposing in connection with such Work; or have in any manner, directly or indirectly, sought by agreement or collusion, or communication, or conference with any Respondent, firm, or person to fix any overhead, profit, or cost elements of the Proposal or of any other Respondent, or to fix any overhead, profit, or cost elements of the Proposal Price or the Proposal Price of any other Respondent, or to secure through any collusion, conspiracy, connivance, or unlawful agreement any advantage against (Recipient), or any person interested in the proposed Work; (5) The price or prices quoted in the attached Proposal are fair and proper and are not tainted by any collusion, conspiracy, connivance, or unlawful agreement on the part of the Respondent or any other of its agents, representatives, owners, employes or parties of interest, including this affiant Signed, sided and delivered in the presence of: By: A III i e Silvio Rubi -MGRM Print Name and Title 10 -30 -2013 Date C Thomas F. Pepe, 2011 -2013, All rights reserved. 919/13 Page 24 of 69 11142remVI A 4 B STATE OF FLORIDA COUNTY OF MIAMI -DADE On this the 3 0 day of October , 20 1 � before me, the undersigned Notary Public of the State of Florida, personally apppeared ( Name(s) of individual(s) who appeared before notary) Silvio RM and whose name(s) islare Subscribed to the within instrument, and he/shelthey acknowledge that helshehhey execu�t. WITNESS my hand and official seal. Notary Publi to of Florida NOTARY PUBLIC: SEAL OF OFFICE: AMA • GONZALEZ • FxPIREB Old W 31.2(M8 scam PW— - j Alga Gonzlaez (Name of Notary Public: Print, Scamp or type as commissioned.) Xxx Personally known to me, or Personal identification: Type of Identification Produced Xxx Did take an oath, or Did Not take an oath. Page 25 of 69 Thomas F. Pepe, 2011 -2013. All rights reserved. 419/13 PUBLIC ENTITY CRIMES AND CONFLICTS OF INTEREST 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 entity, 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 leases 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 287.017, Florida Statutes, for thirty six (36) months from the date of being placed on the convicted vendor list ". The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes. Respondents must disclose with their Proposals, the name of any officer, director, partner, associate or agent who is also an officer or employee of the City of South Miami or its agencies. SWORN STATEMENT PURSUANT TO SECTION 287.133 (3) (a), FLORIDA T , ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. I. This sworn statement is submitted to City Of South Miami [print name of the public entity] by Silvio Rubi —MGRM [print individual's name and title] for Roadway Construction, LLC [print name of entity submitting sworn statement] whose business address is 6750 North Andrews Ave, Suite 200 Fort Lauderdale, FL 33309 and (if applicable) its Federal Employer Identification Number (FEIN) is 4 5 — 4 7 6 7 314 (If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement: 2. 1 understand that a "public entity crime" as defined in Paragraph 287.133 (1)(g), Florida Statutes. means a violation of any state or federal law by a person with respect to and directly related to the 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 political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 3. 1 understand that "convicted" or "conviction" as defined in Paragraph 287.133 (1) (b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July I, 1989, as a result of a jury verdict, non -jury trial, or entry of a plea of guilty or polo contendere. 4. 1 understand that an "affiliate" as defined in Paragraph 287.133 (1) (a), Florida Statutes, means: (a) A predecessor or successor of a person convicted of a public entity crime; or Page 26 of 69 ® Thomas F. Pepe, 2011 -2013. All rights reserved. 9/9/13 (b) An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in any person, or a pooling of equipment or income among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. 5. I understand that a "person" as defined in Paragraph 287.133 (1) (e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which bids or proposal or applies to bid or proposal on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity. 6. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. [Indicate which statement applies] xxx Neither the entity submitting this sworn statement, nor any of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. 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 1, 1989. 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 of July 1, 1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer 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 order.] I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY INDENTIFIED IN PARAGRAPH I (ONE) ABOVE IS FOR THAT PUBLIC ENTITY LY, AND THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILE S UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A TRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FL RIDA A T CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. Sworn to and subscribed before me this 30 day of October Personally known xxx OR Produced identification (Type of identification) Form PUR 7068 (Rev.06 /11192) 0 Thomas F. Pepe, 2011-2013. All rights reserved 9/9/13 2013 Notary Public —State of Florida My commission expires 10 / 31 / 2 016 (Printed, typed or stamped commissioned name of notary public) 7 of 69 AMA III QOZq MY COMMISS M # EE81M 8 Odoba 31.2018 soso�n DRUG FREE WORKPLACE Whenever two or more Bids or Proposals which are equal with respect to price, quality and service are received by the State or by any political subdivisions for the procurement of commodities or contractual services, a Bid or Proposal received from a business 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 be 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: 1) 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 of the statement specified in Subsection (1). 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 note 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 a sanction 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 to continue to maintain a drug -free workplace through implementation of this section. As the person authorized to silp the statement, I certify that this firm complies fully with the above requirements. RESPONDENT's Signature Print Name: Silvio Rub Date: 10 -30 -2013 Page 28 of 69 ® Thomas F. Pepe, 2011 -2013. All rights reserved. 9/9113 ACKNOWLEDGEMENT OF CONFORMANCE WITH OSHA STANDARDS TO THE CITY OF SOUTH MIAMI We, Roadway Construction, LLC , (Name of CONTRACTOR), hereby acknowledge and agree that as CONTRACTORS for the SW 61 Avenue Swale Improvements project as specified have the sole responsibility for compliance with all the requirements of the Federal Occupational Safety and Health Act of 1970, and all State and local safety and health regulations, and agree to indemnify and hold harmless the City of South Miami and against any and ail liability, claims, damages, losses and expenses they may incur due to the failure of (Sub - contractor's names): to comply with suO.3 or regulation. CONTRACTOR i ess BY: Silvio Rubi Name MGRM Title C Thomas F. Pepe, 2011 -2013. All rights reserved, 919113 Page 29 of 69 LIST OF PROPOSED SUBCONTRACTORS AND PRINCIPAL SUPPLIERS BIDDER shall list all Proposed Subcontractors to be used on this project if they are awarded the Contract Other: This list shall be provided to the City of South Miami by the apparent lowest responsive and responsible Bidder within five (5) business days after Bid Opening- Page 30 of 69 ® Thomas F. Pepe, 2011 -2013. All rights reserved. 919113 ., Eniail Landscape N/A Sodding and Turf Work N/A Electrical N/A Irrigation IN /A Paving N/A Park Amenities N/A Graphics N/A Utilities N/A Excavation N/A Building N/A Structures N/A Plumbing N/A Painting N/A Testing Laboratory N/A Soil Fumigator N/A Signs N/A Other: This list shall be provided to the City of South Miami by the apparent lowest responsive and responsible Bidder within five (5) business days after Bid Opening- Page 30 of 69 ® Thomas F. Pepe, 2011 -2013. All rights reserved. 919113 RELATED PARTY TRANSACTION VERIFICATION FORM I Silvio Rubi ' individually and on behalf of Roadway Construction, LLC ( "Firm')have Name of Representative CompanylVendorlEntity read the City of South Miami ( "City ")'s Code of Ethics, Section BA -I of the City's Code of Ordinances and i hereby certify, under penalty of perjury that to the best of my knowledge, information and belief: (t) neither I nor the Firm have any conflict of interest (as defined in section BA -1) with regard to the contract or business that I, and/or the Firm, am(are) about to perform for, or to transact with, the City, and (2) neither I nor any employees, officers, directors of the Firm, nor anyone who has a financial interest greater than 5% in the Firm, has any relative(s), as defined in section BA -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, i.e., a 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., spouse, parents, children, brothers 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: _(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) 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 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, on the above line, to the additional sheet and the additional sheet must be signed under oath). The names of all City employees and that of all elected and/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 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) 1 and the Firm further agree not to use or attempt to use any knowledge, property or 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 31 of 69 ® Thomas F. Pepe, 2011 -2013. All rights reserved. 919/13 (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 party before any board, commission or agency of the City within the past two years other than as follows: I (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:IPurchasing\Vendor Registration\ 12.28.12 RELATED PARTY TRANSACTION VERIFICATION FORM 13].docx (7) Neither I nor any employees, officers, or directors of the Firm, nor any of their immediate family (i.e., as a spouse, son. daughter, parent, brother or sister) is related by blood or marriage to: (i) any member of 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 a separate sheet to supply additional information that will not ft 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 based solely on the 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 I or the Firm that I represent or anyone who has a financial 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 foflowing. (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 (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) 1 and the Firm agree that we are obligated to supplement this Verification Form and inform the City of any change in circumstances that would change our answers to this document. Specifically, after the opening of any responses to a solicitation, I and the Firm have an obligation to supplement this Verification Form with the name of all Related Parties who have also responded to the same solicitation and to disclose the relationship of those parties to me and the Firm. (10) A violation of the City's Ethics Code, the giving of any false information or the failure to supplement this Verification Form, may subject me or the Firm to immediate termination of any agreement with the City, and the imposition the maximum fine and /or any penalties allowed by law. Additionally, violations may be considered by and subjec t tion by the Miami -Dade County Commission on Ethics. Under penalty of perjury, I declare that ! have made gent effort to investigate the matters to which I am attesting hereinabove and that the statements made here! ve are true and correct to the best of my knowledge, information and belief. Signature: Print Name Silvio Rubi —MGRM Date: 10 -30 -2013 ATTACHED: Page 32 of 69 C Thomas F. Pepe, 2011 -2013. All rights reserved. 919113 Sec. 8A -i - Confl ict of interest and code of ethics ordinance. Municode Page I OR 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. (S) 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: (1) 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 scaled 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 33 of 69 C Thomas F. Pepe, 2011 -2013. All rights reserved. 919113 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. (f)Definidon. 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 34 of 69 0 Thomas F. Pepe, 2011 -2013. All rights reserved. 919113 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. 0) 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. Penahy. Any person convicted of violating any provision of this subsection shall be punished as provided in section I -1 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. (1) 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 parry 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 35 of 69 ® Thomas F. Pepe, 2011 -2013. Ail rights reserved. 9/9113 (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)J 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 parry 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 f1 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 SA -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, § 1, 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 BA -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 Page 36 of 69 C� Thomas F. Pepe, 2011 -2013. All rights reserved. 919113 Dale CERTIFICATE OF LIABILITY INSURANCE 3/6/2013 Producer: Lion Insurance Company This Certificate is Issued as a matter of Information only and confers to rights 2739 U.S. Highway 19 N. inn the Certificate Holder. This Certificate does not amend, extend or alter the coverage afforded by the polides below. Holiday, FL 34691 (727) 938 -5562 Insurers Affording Coverage NAIL # Insured. insurer A: Lien Insurance Company 1ip75 South East Personnel Leasing, Inc. & Subsidiarie Insurer s: 2739 U.S. Highway 19 N. Insurer C: Holiday, FL 34691 Insurer D: Insurer E: Coverages TMpolcmB&IrmwamolWdbebwMwbmnMswdtofti.ou narnWabovelorftPollcypedodindicalad. rp any mcp r. no Wm tx sty conbud or reaped ID oft oahiriwle mey be issued or may pertain gte ittaisamn afbtdad by ate poieies dow0bed Dwelt is stMW b all tiro hems Och dons, and ooMibom of each prides. AWragare rmHs ehown may have been reduced by paid china. iNSR ADDL Policy Effective Policy E)Viration Date Limits LTR NSRD Type of Insurance Policy Number Date (MM /DDIYY) (MMIDD/YY) ENERAL LIABILfrY Each Occu once Commercial General Liability Daatege b rertlad prenises (EA Claims Made ❑ Occur Mod Exp Personal Adv I r4" eneral aggregate limit applies per: Getters{ Aggregate PoYsy ❑ Pn�d ❑ LOG Pmdu�- ComptCpAug UTOAAOBILE LWBIL lTY Combined Sirgle U:tel (EAAc kW* Any Auno Bodily Troy AM 0"ned Arlon (Per Person) SoWuled Ades Bodiy hIW Head Autos (PerAcddw) Non4>wwd Aube (Par Acdded) EXC ESSRI MBRELLA LIABILITY eadi oocunw `x Oocur Claims Made Ag9mgaYa Dedw" A Workers Compensation and WC 71949 01/01/2013 01/01/2014 x WC Statu. OTH- Employers' LiabNlty tory Limits ER E.L. Each Acciderl i1,000,000 Any proprietor /partner/emcttive offrcerfinember excluded? NO E.L. Disease - Ea Employee St,aoo,ogo If Yes, describe under special provisions below. E.L. Disease - Policy Limits $1,000,000 Other Lion Insurance Company is A.M. Best Company rated A- (Excellent). AM # 12616 Descriptions of Opera *xWLocations/VehichWExclusions added by Endorsamentispecial Provisions: client ID: 92-67 -075 Coverage only applies to active employee(s) of South East Employee Leasing Services, Inc. that are leased to the following "[gent Company": Roadway Construction, LLC Coverage only applies to Injuries incurred by South East Personnel Leasing, Inc. & Subsidiaries active employee(s) , while vxAdng In Florida. Coverage does not apply to statutory employee(s) or Independent contractor(s) of the Client Company or any other entity. A list of the active employees) leased to the Client Company can be obtained by faxing a request to (727) 937-2138 or by caging (727) 938 -5562. projlect Name: FOR BID PURPOSES ONLY ISSUE 03 -06-13 (TLD) Date: l 11 013 CERTIFICATE HOLDER CANCELLATION ROADWAY CONSTRUCTION LLC Should any oft o above described prides be rsroelled before the eV4adon dalethe:eof, the issuing irtatre WR endeavor to mail 30 days mdsn notice to the his tdder named to th Nett, bd tense to do so gal impose no obligation or IiaWdy of ary Idnd upon the hsuar, ifs egerla or reprsaetaatives. 6750 NORTH ANDREW AVE GTE 200 FT LAUDERDALE, FL 33909 �AI� --"ON ROADW -1 OP ID: TC ACOREP [am1lwMa mr' �. CERTIFICATE OF LIABILITY INSURANCE 09M012013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: 9 On cerWicale holder Is an ADDITIONAL INSURED, the pollcy(We) must be endorsed. M SUBROGATION IS WANED, subject to Ore isrms and condltlons of the policy, certain policies may require an endorsement. A abdo ent on Cris cwtlncals does not canter rights to Ors cm drum holder In Ow of such s . CONTACT rMODUCEIII Phone: 303 423403 , ISure Insurance Brokwai _..- ._.. - -- Z700 SW 137 AVE i Fax: 300 -2Z0 -0765 - - -- - - Miami, FL 33173: Teresa R. Ca;"a. Agent - s Arrolmrla covsRAOE -_ - -- YORAM Roadway Construction LLC'� Essex Insurance Silvio Ruble sec American Zurich Insurance Co 5750 N Andre" Ave # 200_:.; _._._ Ft Iaudardele, FL 33309 INeI�IS E a.e►tirn. n�a /tee2MC1NA7=unrree1]. RGVMTIN NJ WRFR• `THIS.IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOIWTHSTANDINO ANY REOUtREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. -- -- - - ._ ..-- - -- _ _ _._.- - _- - -- --- — LTR TYPE OF INiUTANCE wjiiigiiiit 111111212=1 L ihm QlJIERAL LlAaLL1TY EACH OCCURRENCE S B X RAL LIABILITY IAD"570 01!31#2013 OW31IM14 PR BMpSES� ommrios s 100 CLA/AS -MADE X OCCUR x BLANKET AWL INSURED 01/31/2013 ON31/2014 nERSOnsL a A3V INJURY : 1 000 , GENERAL AGGREGATE f 2,000, GEN'L AGGREGATE LMT APPLIES PER: PROpl1CT5 - C IMPIOP AGG S 1,000, ' I f POLICY ET LOC AUrpMOeU t IAaalTY COMBINI :D SINGLE llEM w— i_-- _ -____ A ANY AUTO X t i8A 3C7ODSW 0!1121=13 09M12014 BODILY IN.RIRY lw Pon& s - X LTUSMINED X i SC A ! BODILY KAJKY der aam*Al $ AUOS TIDF1.01ATBD PRObEitiY OAMFZiE . . >: X HREAAUiOS x - - _-_._ -_ —__ . -_-.- PIP s 10, UYRII[L.LA LlAa OCCUR El1CRULMS CLAMS�MOE; AGGREGATE : OE RETMnQNS _ - - -- - -- s YYOIetaRe CO1M1iATIOw VC 3YATU- QTH- AND E1111FLOYEW LJIA4111TY YIN ANY PROPR1ETORIPARTNERIEXECUTtVE I' El. EACH ACCIDENT S ............ OFFI(;F Y MBER EXCLUDEIr ❑ �N! A ( T M W _ _ _. .... - - - - - -_ - E.L. DISEASE - EA EMPLOYEE' $ SCIePTt011 T)pfS E.L. DISEASE - POLICY LOW f C 'Equipment Floater iECO3025M 0904P2013 ON W2014 EQUIIPMENT 35, DpCr11P nON OF OMMTOW I LOCATMO I VEI M21 (ARneh ACORD 101. Ad M" Rlnlrhi Sdw01f, N neon ff� Is m0*6 l FOR BID PURPOSES ONLY Mn�,r,w.•er. fie non f*AWd CI I ATIfW W IIi36 MU AGVKU LARO- JKA I RANI. AN rtgms reserves. ACORD 25 (2010(05) The ACORD name and logo are ragisb"ad marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POUCKS BE CANCELLED BEFORE ROADWAY CONSTRUCTION, LLC THE ExPIRATION DATE THEREOF, NOTICE WH.L BE DELIVERED IN ACCORDANCE WITH THE POLICY PRIARSIONS, 6750 NORTH ANDREWS AVE, SUITE 200 AUTHOR0D11lI11211BrTATHE VZ4f-.0 FORT LAUDERDALE, FL 33309 W IIi36 MU AGVKU LARO- JKA I RANI. AN rtgms reserves. 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M d OJ or W m N d 7 �^ N 7 m -� 4A N 000 000 W W W to m V 0 01 O O 0 Ln In 00 i.n U n 01 T j iZ In LU W 00 DO N L N N Z w w ''' a) � � w � m v+ t}+ 000 O00 M V V Ln Ln Lei 00 00 N C NA Vr (A 0 0 0 a o 0 0 n Z 3 M rt 0 0 M d 6l N rye G1 r r N n 0 @ e+ PO 1+ d 03 i�1Z rt 0 e* 0 � 0 0 0 0 � 0 0 0 � r- g8 °0 0 0 0 0 0 0 ae ae M „ 0 z 0 0 7V1Ei i Carlos Tejas 17875 SW 156 Ave ♦ Miami, FL 33187 ♦ Phone: (786) 298 -1685 ♦ Email: MIFOC;:iz 10 Construction Superintendent ➢ Dynamic, qualified and highly ethical Superintendent with over ten years of extensive experience in general construction operations. Demonstrated leader experienced in supervising and coordinating activities engaged in safety. ➢ Strong communicator with effective interpersonal skills, building good rapport with individuals in the work process, and providing a sense of commitment and contribution to the overall success of team objectives. ➢ Responsible for the on -site management and coordination of all subs and trades, schedule, inspections, walk- throughs and similar job -site duties. ➢ Highly motivated self- starter with a tireless drive and energy; leads by example with a sound professional attitude, strong work ethic, and pride in personal performance. AREAS OF EXPERTISE ■ Client Relationships • Issue Resolution ■ Timeline Management ■ Customer Service ■ Computer Skills/ MS Office • Quality Control • Supervision and Training • Safety Supervision • Permits • Scheduling PROFESSIONAL EXPERIENCE • Project Planning • Team Coordination • Installations • OSHA Regulations • Underground Utilities General Superintendent Roadway Construction, LLC Fort Lauderdale, FL 2012- Present • Supervise and coordinate several projects in underground utilities and earthwork construction. • Obtain permits for projects. • Coordinate shop drawings and submittals. • Manage the project planning and scheduling. • Handle material buy -out and submittal of payment requisitions. • Conduct project meetings with the engineer and city officials. • Oversee subcontractors. Project Manager Conquest Engineering Group, Co., Miami, FL 2007 to 2010 • Supervised the project and handled daily operations for underground utilities and earthwork construction projects. • Coordinated subcontractors. Utilities Foreman/ Supervisor Downrite Engineering, Miami, FL 2002 to 2007 • Mainline foreman in charge of installing water, sewer, and drainage systems from 4 inches to 48 inches. • Tested and inspected utilities lines. • Supervised the punch out crews. Crew Leader/ Pipe Layer/ Operator The DeMoya Group, Miami, FL ■ Installed waterlines, sewer, and storm drainage. 1998 to 2002 EDUCATION High School Diploma Miami High, Miami, FL lot 0 n Pt wi on N rh 0 w •C N cn rh 0 0 r r n wj ONE&• N pi 0 zi r) PU rt z CL PU lk� 0 a N ka CA rh 0 0 tMol rmol n