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Plant Professionals RFP PW2014-11Proposal 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 N/A Proposal/Bid Bond NIA N/A Performance Bond (As a Condition of Award; Not Required With the Submittal) NIA X Respondents Qualification Statement X Non - Collusion Affidavit X V Public Entity Crimes and Conflicts of Interest X Drug Free Workplace X Acknowledgement of Conformance with OSHA Standards X V/ List of Proposed Subcontractors and Principal Suppliers X Related Parry Transaction Verification Form V/ X Indemnification and Insurance Documents X Signed Contract Documents (All — including General Conditions and Supplementary Conditions) + 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 50 Thomas F. Pepe 9.10 -14 BID FORM THIS PROPOSAL IS SUBMITTED TO: Steven Alexander City Manager City of South Miami 6130 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 ail of the terms and conditions of the RFP, Invitation for Proposals and instructions to Respondents, including without limitation those dealing with the disposition of Proposal /Bid Bond. This Proposal will remain subject to acceptance for 180 calendar days after the day of the Proposal Opening. Respondent agrees to sign and submit the Contract, if not already submitted, the Bonds, required insurance documents, 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: 10) C JzC ILI T7 "' Addendum No. Dated: IZG °! 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. d. 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 this paragraph 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 ana 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. The failure of the Respondent to request a pre -bid marking of the construction site by any or all utility companies shall create an irrefutable presumption that the Respondent's bid, or proposal price, has taken into consideration all possible underground conditions and Respondent, if awarded the contract, shall not be entitled to a change order for any such condition discovered thereafter. Page I I of SO Thoma-w F_ Pena Qr 1 (614 ii. 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. iii. 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 or conditions at or contiguous to the site and assumes responsibility for the accurate location of all Underground Facilities and conditions that may affect the Work_ No additional examinations, investigations, explorations, tests, reports or similar information or data in respect to any Underground Facilities or conditions 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 unless the Proposal specifically states that the contract price is subject to adjustment for future discovery of underground facilities and /or conditions that affect the cost of the Work and unless the respondent makes a written request to the City for additional information prior to submitting the bid or proposal as required in subsection ii above, e. 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 Cary, that such resolution is acceptable to Respondent and that the Respondent waives any claim regarding the conflicts, errors or discrepancies. f_ 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 of: LUMP SUM BASE PRICE: dollars and PRICE PER LIGHT STRAND, PER SCOPE OF SERVICES: dollars and Thnmm F. App 4a I ffi 14 $CNF- N -tom 5VXT 'Q 7 -NOL.' '')rvZ�) iVJ�W7- ' -fiyi- y , cents $11 L,, .C2-` -Q1Q ? V-i1C' cents Page 13 of 50 COST ESTIMATE FOR REMOVAL OF LIGHT STRANDS AFTER 36 MONTHS, PER SCOPE OF SERVICES: dollars and —21F'11�0 cents $ 7 0. S. The ENTIRE WORK shall be completed, in full, within 30 Calendar 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. 6. Communications concerning this Proposal shall be addressed to: RESPONDENT: Address: Telephone: Facsimile: Attention: LEO Z.i''TTF :? 7. 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 I f 3 DAY OF y ;D►- i SE- 20j PROPOSAL SUBMITTED BY: Company LEC� '�U T «lam Name of Person Authorized to Submit Proposal ignature 5i' Qq7 Title Telephone Number Fax Number Email Address END OF SECTION Page 13 of 30 Thomas F. Pepe 9.10.14 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 In the past 5 years On Schedule b) In the past 10 years In the past 10 years On Schedule 2. Exist the last three (3) completed similar projects. a) b) Thomas F. Pepe 4 -10 -14 5 100 Project Name: C FlIyi ` ZFIF 1 It ;I Owner Name: Cj�C .� �.;�a.,�i K C C0 i1AM �i1j, Try Owner Address: DW,4 vi�F kl1- y r',4 fL Owner Telephone: ) - JL- 7- LCI 43 Original Contract Completion Time —7 (Days):'] J a Original Contract Completion Date: t C : `7 ZC] r Actual f=inal Contract Completion , Date:�G Original Contract Price: -$ Vi 3x. 6.0 Actual final Contract Price; I Z i >01 , 0 1 Project Name: Owner Name: l517EK 5Lx]ry-1� C.i.,l -ft1Wk; TY 451�oci47rt -W%) Owner Address: Page 20 of 50 33, C `1 Owner Telephone: 3 l ' S - 'b Original Contract Completion Time , (Days): `I -DA Y D — Original Contract Completion Date: 1Joj Z 2-613 Actual Final Contract Completion Date: ' GLV . Lc- Original Contract Price: q q�) - ! m Actual Final Contract Price . c�� �1 . C) Project Name: Owner Name: i T-y CY �°i' ;' Owner Address: 2 Z2 t' Owner Telephone: 3(fj _ `I L-xD.-- 5L -09 Original Contract Completion Time (Days): Original Contract Completion Date: N o'v Actual Final Contract Completion i J 0� Date: Original Contract Price: Actual Final Contract Price: Page 21 of 50 Thomas F. Pepe 9 -10-14 3. Current workload 4. The following information shall be attached to the proposal. a) RESPONDENT's home office organization chart" b) RESPONDENrs 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 5. Government References: List other Government Agencies or Quasi - government Agencies for which you have done business within rhw pair five (5) xpart Name of Agency: C Y Lett L- b413 , Page ZZ of 50 Thomas P. Pepe 9-16-14 17_�C-F y (� ` Z r 1 PiA1_�L—> i �L' 1�ir�t v "v . %y }�S`.aia -,� H T�c,•a HC -te iO - P,)Z,� ! I (i WZr3�v ��f�1liL`�! �[�J' Lit �� -- CJiIE� S ) 7 Nliff;nt Ctalz�LE,�'� Hvb-Pifill_ HfWk Cc�rL;zi,�'S T6 9' (%Z OF 3 50 %�voZ.fitiC1 i7fZf ;a,� �1c G } f I� �j i I L-t..j LJ� t M 1 l C)41 r 'Nl l � Li�JGf j `J= JJ`j�7lUC3 t, q, j. �J� B:3i I`jiY✓� '�G'U�T�GY� 78`v .. 188 1600/ f 4. The following information shall be attached to the proposal. a) RESPONDENT's home office organization chart" b) RESPONDENrs 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 5. Government References: List other Government Agencies or Quasi - government Agencies for which you have done business within rhw pair five (5) xpart Name of Agency: C Y Lett L- b413 , Page ZZ of 50 Thomas P. Pepe 9-16-14 Address: ZC C C, SLJ '72 1 44 �MJ IUI 1 FL 3"5615 Telephone No. :�� Contact Person: CO Type of Project: U c7mriiQu Name of Agency: t qJ , � ri:aejlT�t%,� lid i:Vi4 Address: L icO �L4 4Z Avi yAMI '-L L Telephone No.: 5Ui lo` -7360 Contact Person: If�v�` Type of Project: ��j � L~.� i "j U (-rNTS A-Nib Name of Agency: C J f OF DUIz )4L Address: �, q 0 A% 411 ��, f r-a a - -�)ce-1`i t- iL ;5-,� ) �, cc Telephone No.: Contact Person: ko -r Type of Project: tN ci Thomas F. Pease 9 -10. 14 T.e a Is Home Office Organization Chart Including Project Organization Chart 1. Sales associate/designer meets with possible client to review scope of work. 2. Sales associate/designer generates proposal based off specifications provided by possible client at meeting. 3. Proposal is sent to possible client for review. 4. Possible client signs contract and sends back to sales associateldesigner. 5. Sales associate /designer forwards signed contract to financing department to generate deposit invoice. 6. Financial department sends deposit invoice to client to be paid. 7. Financing department receives deposit payment and files client as partially paid. 8. Sales associate/designer sends signed contract to office manager. 9. Office manager orders all product needed per signed contract. 10. Office manager contacts client to finalize installation dates. 11. Office manager adds new client to master calendar for installation. 12. All product is received by warehouse supervisor. 13. Warehouse supervisor stores all product appropriately. 14. Warehouse manager sends all product that needs additional work, (including but not limited to, decorating, sorting, testing, wrapping) to decorating supervisor. 15. All finalized product is stored in warehouse in one location until installation date. 16. Office manager prepares work order for installation crew. 17. Office manager generates work order for warehouse supervisor to prepare all product for installation crew. 18. Warehouse supervisor will prepare all product for installation the night before installation crew is scheduled to install and leave installation work order with product. 19. Installation crew loads all product on truck(s) to be taken to installation site. 20. Installation crew installs all product and confirms 100% functioning of all product before leaving site for the last time. 21. Installation supervisor signs that work order is complete and gives to office manager. 22. Office manager files completed work order. Plant Professionals, Inc 12027 SW 114 Place, Miami, FL 33176 www.plantprofessionals.com 305 - 259 -0503 Office 305 - 259 -5289 Fax maria@plantprofessionals.com 23. Financing department generates final payment invoice and sends to client to be paid. 24. Financing department receives final payment and clears contract as paid in full. 25. Sales associate /designer keeps contact with client throughout season and handles all service calls by generating work orders for maintenance crew. 26. Office manager generates take down schedule. 27. Take down crew removes all product. 28. Warehouse crew stores all product by client in warehouse. Plant Professionals, Inc 12027 SW 114 Place, Miami, FL 33176 www, plantprafen nionsin. cam 305 -259 -0503 Office 305-259 -5289 Fax maria @plantprafcc a ianala . corn Key Project Personnel Maria Drotar • Foliage by Flora • August 1993 - 1998 • Holiday Manager • Flora Green 772- 342 -332 • TruGreen 0 1998-2001 o Holiday Manager • Ambius /Rentokil O 2001-2002 o Holiday Manager o Paul Essek • Plant Professionals, Inc 0 2002 - Present o Owner General manager for the holiday department. Job duties included ordering all product, scheduling install and takedown, managing decorating team, managing install and takedown team. Design. Coordinating installs of up to 20 -30 different locations in one day with up to 5 trucks going out every day for 2 -3 weeks. Leo Rutter • Foliage by Flora a January 1993 -1998 o Account Executive o Flora Green 772- 342 -332 • TruGreen o 1998-2001 n Arrniint FYRrijflvR • Ambius /Rentokil 0 2001-2002 o Account Executive o Paul Essek Plant Profooeionale, Inn 12027 5W 114 Place, Miami, FL 33176 www.plantprofessionals.com 3nFL?5Q-nFim nffirra 305- 259 -5289 Fax maria@plantprofessionals.com F Plant Professionals, Inc 0 2002 - Present o Owner Account executive for the interior plant and holiday divisions. Sales in the holiday division reaching 1,000,000 annually. Including City of Coral Gables (Merrick Park), all of Baptist Health Systems, Miami International Airport, City of Miami Beach, Ocean Reef Club, Williams Island and Fisher Island. Responsible for quality control and liaison between clients and holiday team. Mario Castro s Plant Professionals, Inc 0 2012 - Present o Site Supervisor Site supervisor for all holiday lighting installation accounts. Manages all crew members on site to make sure all work is completed smoothly, professionally, and in a timely manner. Handles all work orders to be completed for installation, maintenance, and take down generated by office manager and sales associates /designers. Plant Professionals, Inc 12027 SW 114 Place, Miami, FL 33176 www.plantprofesslonaIs.com 305 - 259 -0503 Office 305 - 259 -5289 Fax maria@plantprofessionals.com NON COLLUSION AFFIDAVIT STATE OF FLORIDA COUNTY OF MIAMI -DADE ) being first duly sworn, deposes and states that: (1) He /She/They is /are the DA ,&2 LA (',Y-- — -- (Owner, Partner, Officer, Representative or Agent) of 1 e LC i [ �;f-�,e espondent that has submitted the attached Proposal; (2) HelShe/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, employees or parties of interest, including this affiant. Signed, sealed and delivered in the presence of BY Witness Signa f UAC Witness Print Name and Title l k I Datk Page 24 of 50 Thomas F. Pepe 9 -10-14 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 STATUTES, 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. is submitted to [print name of the public entity) by [print individ I's ,me and,title] for f. [print name of entity submitting sworn statement] whose business address is b Q aQ �j UL i I 1� P1(} C and (if applicable) its Federal Employer Identification Number (FEIN) is - CF5 t i (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 11 19$91 as a result of a jury Yerdic, nan -fury trial, or qn�r of a Plea Qf guilty yr nolo contendere. 4. 1 understand that an "affiliate" as defined in Paragraph 287.133 (1) (a), Florida Sntut�s, means: (a) A predecessor or successor of a person convicted of a public entity crime; or (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, Page 26 of 50 Thomas F. Pepe 9.10 -14 ACKNOWLEDGEMENT STATE OF FLORIDA COUNTY OF MIAMI -DADE n On this the V day of 120 before me, the undersigned Notary Public of the State of Florid ersonall a Bare islame(s) of individual(s who appeared before notary} v and whose name(s) is/are Subscribed to the within instrument, and he/she /they acknowledge that helshe/they executed it. WITNESS my hand and official seal. NOTARY PUBLIC: SEAL OF OFFICE: R Not- Notary Public State of Rorida Maria C DrOtar My Commission FF082673 Fxptres0411 012 01 5 �4! 4, 1 Lj r No ublic, State of Florida C. LroAalel_ (Name of Notary Public: Print, Stamp or type as commissioned.) Personally known to me, or Personal identification: Type of Identification Produced Did take an oath, or Did Not take an oath. Page 25 of 50 Tharnas F. Pepe 9 -10 -I4 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.] 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 I, 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 ONLY, AND THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES. FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM_ [Signature] Sworn to and subscribed before me this day of _j _ _ _ _ _ _ 20 1 Personally known 111 OR Produced identification Notary Public – State of (Type of identification) Form PUR 7068 (Rev.06 /1 1192) Thomas F. Pepe 9 -10 -14 My commission expires f L yi ,d (f— (Printed, typed or stamped commissioned name of notary public) EKE blic State of Florida Nil 37 9f §9 Drmr ission EE082673 4/10/20 t5 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 small 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 Bld, 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 (S) business days after such conviction. 5) Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program, if such is available in the employees community, by any employee who is so convicted. 6) (`'lake a good faith effort to continue 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. RESPONDENTS Signatur. Print Name: L- 0 �UT 1t-1� Date: 101.0 Page 28 of 50 Thomas F. Pepe 4 -14-14 ACKNOWLEDGEMENT OF CONFORMANCE WITH OSHA STANDARDS TO THE CITY OF SOUTH MIAMI We, V kk T,� `L 3 i D �� (Name of CONTRACTOR), hereby acknowledge and agree that as CONTRACTOR for the Downtown 13usiness District LED Lighting 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 MIA (Consultant) against any and all liability, claims, damages, losses and expenses they may incur due to the failure of (Sub - contractors names): to comply with such act or regulation. ONT CT R , Name I � I i � Title Page 29 of SO Thomas F. Pepe 9 -10 -14 �k Wi 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- Landscape fi Sodding and Turf Work Electrical d�° A- irrigation Paving a Park Amenities r } J-� y� I Graphics J.4 Utilities j Excavation Building z Structures Plumbing��} Painting ,,, g �� r Testing Laboratory Soil Fumigator Signs } i 6 1 Other:_ Thie licr shall K, nrnvirl,-A rn the-, City of Snuth Miami by the apparent lowest responsive and responsible Bidder ]Mu 116461IWI no ■lf11 sum ow nl■ 7111 71 renal, 1 TIP— within five (5) business days after Bid Opening. Page 30 of 50 Thomas F. Pepe 9-10-14 Le-10 RELATED PARTY TRANSACTION VERIFICATION FORM I i-_£-10 c: individually and on behalf of ' &LIni�5, v is�Etics. ( "Firm ")have Name of Representative CompanylVendorlEntSty read the City of South Miami ( "City ")'s Code of 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: (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 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 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, 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 agengActing 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: IV I (if necessary, use a separate sheet to supply additional inf rmation 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). 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: N C (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 member's 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 (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 r ago 3 I of in Thomas F. Pepe 9 -10.14 before any board, commission or {agency of the City within the past two years other than as (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 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 emplo ee; or (iii) any member of any board or agency of the City other than as follows: _ N { _(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 (7) shall be based solely on the signatory's personal knowledge and helshe 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 S% in the Firm, or any member of those persons' immediate family (i.e_ spouse, parents, children, brothers and sifters) have also responded, other than the following N � j (if necessary, use a separlite 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 of the maximum fine and/or any penalties allowed by law. Additionally, violations may be considered by and subject to action by the Miami -Dade County Commission on Ethics. Under penalty of perjury, I declare that 1 have made a diligent effort to investigate the matters to which I am attesting hereinabove and that the statements ma ereinabove a �truend Correct to the best of my knowledge, information and belief. Signal Print Name & Title: ' 'V b ll (f CE A%' At I(, Date: ATTACHED: Sec. 8A -I - Conflict of interest and code of ethics ordinance. Municode Page i0f4 Page 32 of 50 Thomas F. Pepe 9 -10 -14 Sec. 8A -1. - 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. (6) 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. .a (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 (t) 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); NTI14 VT'VFr.I L)r VT WUIYicc7 LV UIZ IIIYVIYrd m dIV pfV}7V7GLi LFU0121FUVTV Inv. UnIlqur. and Lhc GIL?' c-annVE 3Yall IL=lf 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. 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. Rage 33 of 50 Thamas F. Pene 4 -10-14 (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. (!)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)(I ) 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)(I) through (6) to Y 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 fling 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) Rimhibition on urn n f rnn fidantinl in fnmmntinn_ 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 Page 34 of 50 Thomas F. Pepe 9 -10-14 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 employees 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 l -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 tile, 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 in 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 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. (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 wnen Cute person believes or lia3 w 6J1«c drat tl,_ f­ ;-I Page 35 of 50 Thomas F. Pepe 9 -10 -I4 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 pro fessionai 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, RFR 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. (Card. 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), I (I A -2) adopted Jan. i I, 1969. END OF SECTION Page 36 of 50 1 nomas r. Pepe 9.10.14 PLANT04 OP ID: CP CERTIFICATE OF LIABILITY INSURANCE °ATE(MWDUNYYY) 11/1812014 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: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER FILER INSURANCE, INC. 9440 S.W. 77 Avenue Miami„ FL 33156 Keith R. Miller CONTACT NAME: PHONE FAX Arc Nn Ezt : Arc, No)! AADDRDDR ESS: ACPGLZ05954001402 05/25/2014 0512512015 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Nationwide Ins Co of America 25453 MEO EXP (Any one person) INSURED Plant Professionals, Inc. INSURER B: Allied P&C Insurance CO 42579 12005 SW 114 Place Miami, FL 33176 INSURER C: Mapfre Ins. Co. 34932 $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC PRODUCTS - COMPIOPAGG INSURER D : INSURER E C AUTOMOBILE LIABILITY X ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS INSURER F: 4150120007112 COVFRAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, 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 BEEN REDUCED BY PAID CLAIMS. INSR T TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM!©DIYYYY POLICY lYYXYPY U�Ts A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FV-7 OCCUR CHRISTINE PIERSOL- =733D11 ACPGLZ05954001402 05/25/2014 0512512015 EACH OCCURRENCE $ 100,00 PREMISES Ea occu erica $ 100,0fl MEO EXP (Any one person) 5,00 _ PERSONAL & ADV INJURY_ _3 $� 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC PRODUCTS - COMPIOPAGG $ 2,000,00 $ C AUTOMOBILE LIABILITY X ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS 4150120007112 11119/2013 11/1912014 COMSINPD SINGLE LIMIT Ea accident 5flfl 00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE, CPERACCIDEN T $ e X UMBRELLA e LEAK X EXCESS LIAR OGGUR CLAIMS -MADE ACPCAPS954001402 05!2512014 0512512015 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 OED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY YIN ANY PROPRIETOwPARTNERIEXECUTIVE OFFICERIMEM13ER EXCLUDED? ❑ (Mandatary in NH) If yes, describe under I DESCRIPTION OF OPERATIONS below NIA WCSTATU- OTH- TOY LIMITS I I ER E.L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE ' $ E. L. DISEASE - POLICY LIMIT $ i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES {Attach ACORD 101, Additional Remarks Schedule, it more apace Is required) f`roTrrrf`Atr 11Pf1 r1rD [`AWCFI I ATI[frd CITYO50 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of South Miami THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 6130 Sunset Drive South Miami, FL 33143 AUTHORIZED REPRESENTATIVE CHRISTINE PIERSOL- =733D11 O 1988 -2010 ACORD CORPORATION. Ali rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AC�RQa CERTIFICATE OF LIABILITY INSURANCE DATE (MWDDlYYYY) 11/18/2014 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: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Bouchard Insurance for CoAdvantage 101 Starcrest Drive Clearwater, FL 33758 CONTACT NAME: PHONE I FAX Arc No): E -MAIL ADDRESS: INSURER S AEEORDING COVERAGE NAIC # rNSURERA: American Zurich Insurance Company 40142 INSURED CoAdvantage Corporation Alt Emp: PLANT PROFESSIONALS, INC. 3350 Buschwood Park Drive #120D ENSURER 8 $ INSURER C: INSURER D MED EXP (Any one person) Tampa, FL 33618 INSURER E : INSURER F: GOVERAGES CERTIFICATE NUMBER: 14FLO77863701 RFVIRIAN NI]MRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, 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 BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SU R POLICY NUMBER POLICY EFF MMfD4 POLICY EXP MMrVDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE D OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence)$ MED EXP (Any one person) $ Y PERSONAL & ApV INJURY $ GFN'L AGGREGATE LIMIT APPLIES PER: POLICY 1:1 JET D LOC GENERALAGGREGATE $ PROpUCTS - GOMPIOP AGG $ $ OTHER: AUTOMOBILE LIAa1LrrY COMBINED 5 N LE LIMIT �a acclaem BODILY INJURY (Per persort) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS Per accident BODILY INJURY ( ) $ NON -OWNED HIRED AUTOS AUTOS j per ac 'I)IAMAGE $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND AND EMPLOYERS' LIABILrfY YIN [PER OTH- I STATUTE ER E.L. EACH ACCIDENT — $ 1,000,000 A ANY PROPRIETORIPARTNERlEXECUTIVE OFFICFR)MEMBEREXCLUDED? NIA WC 56 -11- 942 -00 04/01/2014 04/01/2015 E.L. DISEASE - EA EMPLOYE $ 1,000,000 (Mandatory in NH) If yes, describe under pESCRi PTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 Location Coverage Period: 04/01/2014 04/01/2015 Client# 19830 -FL DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is (equired) PLANT PROFESSIONALS, INC. Coverage is provided for 12027 SW 114 Place only those employees Miami, FL 33176 teased to but not subcontractors of: V.=MI lrl{.AI= MULUerc I ANC:tLLAI IUN City Of Miami 6130 Sunset Drive South Miami, FL 33143 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 All riahts reserved ACORD 25 (20141011 The ACORD name and logo are registered marks of ACORD CITY OF SOUTH MIAMI INDEMNITY AGREEMENT This indemnity agreement made this day of NC"m' • 1 20 I1' by and between the City of South Miami (City) and ..PL w- i -,1 C sSIGr- LS�A(whose Name of Entity address i 2a o-7 acv /1 � L )ml f oil / } . ( Indemnitor). �7C WITNESSETH 1. City hereby permits Indemnitor to use the following described property in the City of South Miami (Premises), commencing on ( r'� 2011 q on the following day(s) beginning at C3 a.n /p.m. and ending at 7 c) C) [legal description and street address are attached as App. I] 2. Use: tndemnitor shall use the premised solely for the purpose of: ( -i2) L 1 (-7 r-1 l 1 nJ (? aN, 7-9&43- 14t P7ij" -� 3. Exculpation and Indemnification Clause: Indemnitor agrees that it will indemnify, bold and save the City its officers, agents, contractors and employees whole and harmless, and at City's option defend them, from and against all claims, demands, actions, damages, loss, cost, liabilities, expenses and judgments of any nature recovered from or asserted against City on account of injury or damage to person or property to the extent that any damage or injury may be incident to, arise out of, or be caused, either proximately or remotely, wholly or in part, by an act. omission, negligence or misconduct on the part of Indemnitor or any of its agents, servants, employees, contractors, patrons, guests, licensees or invitees or of any other person entering upon the Premises, or when any such injury or damage is the result. proximate or remote, of the violation by Indemnitor or any of its agents, servants, employees, contractors, patrons, guests, licensees or invitees of any law, ordinance or governmental order of any kind, or when any such injury or damage may in any other way arise from or out of the use by Indemnitor, its agents, servants, employees, contractors, patrons, guests, licensees or invitees of the Premises. Indemnitor covenants and agrees that in case City shall be made party to any litigation against Indemnitor, or in any litigation commenced by a party against any parry other than Indemnitor relating to this Agreement or to the Premises, then Indemnitor shall and will pay all costs and expenses including reasonable attorneys fees and court costs incurred by or imposed upon City by virtue or any such litigation. These terms of indemnification shall be effective unless damage or injury results from the sole negligence or willful misconduct of City. 4_ Ordinances and Regulations: lndemnitor shall comply with all applicable laws, statutes, ordinances and requirements. Indemnitor shall not admit to the premises a larger number of persons than the total number designated by the appropriate City Department_ 5. Responsibility for Damage: If the Premises, or any portion of the Premises, or any structure equipment, fixture, or other item on, in, under or attached to the Premises shall be destroyed, damaged, marred, altered, or physically changed in any manner whatsoever, then Indemnitor shall be responsible for restoring the property to its original condition, ordinary wear and tear excepted. Indemnitor is to properly care for all tools and equipment entrusted to Indemnitor during the terms of this Agreement and all such equipment so entrusted which is lost, stolen, damaged or disappears shall be the sole responsibility of Indemnitor and Indemnitor shall pay the full replacement costs of to City. & Insurance: As a condition precedent to being permitted to use the Premises, Indemnitor shall, at its own expenses, comply with all of the following insurance requirements of the City. It is agreed by the parties that the Indemnitor shall provide proof of the following insurance coverage to the City on or before using the Prolimi (a) Commercial general liability insurance, on an occurrence basis in the amount of Two Million ($2,000,000.00) Dollar per occurrence and in the aggregate for bodily injury, death, property damage and personal injury. The policy must include coverage for contractual liability. If the user's activities involve the sale of alcohol, then liquor liability in the same amount is also required. These policies must name the City of South Miami as additional insured. Page I af3 (b) It is understood and agreed that all coverage provided by the Indernnitor are primary to any insurance or self - insurance program the City has for these premises and the Iudemnitor and their insurance shall have no right of recovery or subrogation against the City_ (c) All policies must be issued by companies authorized to do business in the State of Florida and assigned a rating of A+ or better, per Bests Key Rating Guide, latest edition. (d) Alternate coverage to satisfy these requirements is subject to prior approval of the City's Risk Manager. Additional insurance coverage, as determined the City's Risk Manager, may be required for this Agreement or for any activities permitted on the Premises. 7. Other Terms and Conditions: The Indemnitor shall provide, at Indemnitor's sole cost and expense, off -duty City of South Miami police officers, as required by the City Manager, IN WITNESS WHEREOF, the Indemnitor has executed this Agreement this >! C- day of ,)iL� "[ 201. INDEMNITOR: 'PC_f) e T q LAgName of Entity/Individual) By: (Signature) VILE— (Print name and title of person signing) ATTEST: (Signature of Corporate Secrtary or Witness) Please check one of the following: ❑ Corporate Acknowledgment f ;l Partnership Acknowledgment ❑ Individual/Sole Proprietor Acknowledgment CORPORATESEAL (affix here) STATE OF FLORIDA COUNTY OF MIAMI -DADE Page 2 of 3 On this the ? C� day of K10 V x-1'3 20/'/ before me, the undersigned Notary Public of the State of Florida, the foregoing instrument was acknowledged by (print name and title of corporate officer) r C (print name of corporation and state or place on behalf of the corporation. Witness my hand and offici 1 seal. A �. Notary I3ublic State of Florida Print Name: -- R.r,rC� Ple e check one of the following: personally known to me Produced identification ;PAOY Notary Public State of Florida Maria C Drolar a v My Commission EE082 &73 (Type of identification produced) or s� Expires 04/10)12015 015 Please check one of the following: ❑ DID take an oath ,DID NOT take an oath_ CITY OF SOUTH MIAMI ATTEST: APPROVED AS TO FORM: CI'T'Y CLERK CITY MANAGER READ AND APPROVED AS TO FORM: CITY ATTORNEY Page 3 of 3