02-20-07 Item 13South Miami
AII-AmmdcaCft
CITY OF SOUTH MIAMI 111111
INCORPORATE � ^
o 27 OFFICE OF THE CITY MANAGER
INTER - OFFICE MEMORANDUM, 2001
To: The Honorable Mayor Feliu and Members of the City Commission
Via: Yvonne S. McKinley, City Manager
From: W. Ajibola Balogun, REM, CFEA, Dire for
Public Works & Engineering Department
Date: February 20, 2007 Agenda Item No.:
Subject: Authorizing the City Manager to execute "gr'an't agreement with Miami -
Dade County Office of Community & Economic Development for the
Gibson- Bethel Community Center.
Resolution: A RESOLUTION OF THE MAYOR AND, CITY COMMISSION OF THE
CITY OF SOUTH MIAMI, FLORIDA, ''AUTHORIZING THE CITY
MANAGER TO EXECUTE FISCAL YEAR 2007 GRANT AGREEMENT
WITH MIAMI -DADE COUNTY OFFICE OF COMMUNITY AND
ECONOMIC DEVELOPMENT (OCED) FOR EMERGENCY GENERATOR
FOR THE GIBBON- BETHEL (MULTI- PURPOSE) COMMUNITY
CENTER; PROVIDING FOR AN EFFECTIVE; DATE
Request: Authorizing the City Manager to execute fiscal year 2007 grant agreement
with Miami -Dade County OCED.
Reason /Need: We have just received the attached -`.FY 2007 Final Award Letter
from OCED for a $100,000.00 grant -to provide an emergency
generator for the Gibson- Bethel Community Center. Upon
execution of the grant contract with OCED, we intend to commence
the project activities immediately and;complete by December 2007.
Cost:
$100,000.00
Funding Source: Miami -Dade County . Office of Community & Economic
Development, Fiscal Year 2007 grant..
Backup Documentation:
• Proposed Resolution
• Final Award Letter from OCED
• OCED Documents Required to Execute Agreement
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RESOLUTION NO.: .
A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE
CITY OF SOUTH MIAMI, FLORIDA, AUTHORIZING THE CITY MANAGER
TO EXECUTE FISCAL YEAR 2007 GRANT - AdREEMENT WITH MIAMI -
DADE COUNTY OFFICE OF COMMUNITY AND ECONOMIC
DEVELOPMENT (OCED) FOR EMERGENCY GENERATOR FOR THE
GIBSON- BETHEL (MULTI- PURPOSE) COMMUNITY CENTER;
PROVIDING FOR AN EFFECTIVE DATE
WHEREAS, the Mayor and City Commission wishes to ' "accept a grant from Miami -Dade
County OCED; and
WHEREAS, this grant agreement is for an emergency generator for the Gibson - Bethel
Community Center in an amount of $100,000.
NOW, THEREFORE, BE IT RESOLVED /ORDAINED BY THE MAYOR AND CITY
COMMISSION OF THE CITY OF SOUTH MIAMI, FLORIDA THAT:
Section 1. That the Mayor and City Commission , authorize the City Manager to
execute the grant agreement for an emergency generator' with Miami -Dade County Office of
Community & Economic Development.
Section 2. The attached exhibit is incorporate by reference into this resolution.
PASSED AND ADOPTED this
ATTEST:
READ AND APPROVED AS TO FORM:
CITY ATTORNEY
Include File Name and Path
day of , 2007.
APPROVED:
MAYOR
COMMISSION VOTE:
Mayor Feliu:
Vice Mayor Wikambe:
Commissioner Palmer:
Commissioner Birts:
Commissioner Beckman:
MIAMI-ODADE
ADA Coordination
Agenda Coordination
Animal Services
Art in Public Places
Audit and Management Services
Aviation
February 1, 2007
City of South Miami
6130 SUNSET DR
S MIAMI, FL 33143
Community & Economic Development
140 West Flagler Street • Suite 1000
Miami, Florida 33130
T 305 -375 -3422 F 305 - 375 -3428
Building
Subject: FY 2007 Final Award Letter
Building Code Compliance
Business Development
Capital Improvements
Activity Title:
Generator for Multi- Purpose Center
Citizens' Independent Transportation Trust
Activity ID:
20071030
Commission on Ethics and Public Trust
Category:..
Capital Improvement
Communications
Source:.
CDBG
Community Action Agency
BCC Approval:
$100,000.00
Community & Economic Development
Community Relations
Consumer Services
Corrections & Rehabilitation
Cultural Affairs
Elections
Emergency Management
Employee Relations
Empowerment Trust
Enterprise Technology Services
Environmental Resources Management
Fair Employment Practices
Finance
Fire Rescue
General Services Administration
Historic Preservation
Homeless That
Housing Agency
Housing Finance Authority
Human Services
Independent Review Panel
International Trade Consortium
Juvenile Services
Medical Examiner
Metro-Miami Action Plan
miamidade.gov
On January 25, 2007, the Board of County Commissioners (BCC) approved the 2007
Action Plan. The Plan, whose recommendations include funding allocations for your
agency, describe those projects funded through the Community Development Block
Grant (CDBG), the HOME Investment Partnership Program and the Emergency
Shelter Grand (ESG) Program. Noted above is the final FY 2007 funding
allocation for your request, which was approved by the BCC.
,Applications were received seeking a total of approximately $84.2 million in funding,
as part of this consolidated application and planning process; however, only. about
$39.4 million was available to fund these needed activities. As a result, not all
activities could be funded.
To prevent any delays in the initiation of the funded activities and to expedite the
processing of your agency's agreements, our district teams will schedule meetings
with you during the period of February 5 through February 16 to discuss the
completion of forms and the other items necessary to process your agreements. This
will ensure not only the expeditious development of your agency's agreements but
also the implementation and the completion of your activities within the time frames
specified in the FY 2007 Action Plan.
Metropolitan Planning Organization Please contact Jonathan Johnston , your Contracts Officer, at 305 - 375 -3447, if you
Park and Recreation
Planning and Zoning have any questions about the required documents.
Police
Procurement Management . Sincerely,
Property Appraisal
Public Library System
Public Works
Safe Neighborhood Parks Jose Cintron
Seaport }..
Director
Solid Waste Management
Strategic Business Management
Team Metro
Transit
r
JC /ZNA. .
C:
Task Force on Urban Economic Revitalization C:
izcaya Museum And Gardens
Water & Sewer
Building
Building Code Compliance
Business Development
City of South Miami
Capital Improvements
6130 SUNSET DR
Cilizens' Independent Transportation Trust
S MIAMI, FL 33143
Commission on Ethics and Public Trust
Communications
Subject: Contract Development Process for FY 2007
Community Action Agency
-
Community &Economic Development
Activity Title: Generator for Multi- Purpose Center
Community Relations
Activity ID: 20071030
Consumer Services
Category: Capital Improvement
Corrections & Rehabilitation
Source: CDBG
Cultural Affairs
BCC Approval: $100,000.00
Elections
Emergency Management
Employee Relations
Empowerment Trust
Enterprise Technology Services
On February 1, 2007, the Director of Office of Community and Economic
Environmental Resources Management
Development (OCED) advised you of your funding award for the above
Fair Employment Practices
mentioned project.
U
Finance
Fire Rescue
Please find attached the documents required to execute your agreement with
General Services Administration
Miami -Dade County. Our district teams will schedule meetings with you
Historic Preservation
Homeless Trust
during the weeks of F=ebruary 5 through February 16 to discuss the
Housing Agency
completion of those forms and of the other items necessary to process that
Housing Finance Authority
agreement.
Human Services
Independent Review Panel
Please contact Jonathan Johnston, your Contracts. Officer, at 305 - 375 -3447,
International Trade Consortium
if you have any questions about the required documents.
juvenile Services
Medical Examiner
Sincerely
Metro -Miami Action Plan
Metropolitan Planning Organization
Park and Recreation
Planning and Zoning
Police
Procurement Management
Zafar N. Ahmed
Property Appraisal
Director
Public Library System
Community Development Division
Public Works
Safe Neighborhood Parks
ZN A /1. dl
L� V/'V VU
Seaport
Solid Waste Management
Attachments
Strategic Business Management
Team Metro
Transit
Task Force on Urban Economic Revitalization
Vizcaya Museum And Gardens
Water & Sewer
CONTRACT DEVELOPMENT WORKSHOP
LIST OF CONTENTS
• SAMPLE OF BOARD OF DIRECTOR'S RESOLUTION APPROVING
THE. FUNDED AMOUNT AND AUTHORIZING EXECUTION OF
THE CONTRACT" WITH OCED .
• AUTHORIZED SIGNATURE FORM
• MIAMI -DADE COUNTY AFFIDAVITS
• AFFIDAVIT OF FINANCIAL AND CONFLICTS OF INTEREST
• RELATED PARTIES DISCLOSURE STATEMENT
• STATE OF FLORIDA PUBLIC ENTITY CRIMES AFFIDAVIT
• MIAMI -DADE COUNTY FAIR SUBCONTRACTING POLICIES
• MIAMI -DADE COUNTY LIVING WAGE AFFIDAVIT
• CODE OF BUSINESS ETHICS AFFIDAVIT
• CERTIFICATION REGARDING LOBBYING
• SAMPLE OF ACTION STEPS, SCOPE OF SERVICES, AND
BUDGET FOR NON - CONSTRUCTION RELATED ACTIVITIES
• SAMPLE
OF
ACTION STEPS, SCOPE
OF SERVICES, AND
BUDGET
FOR
CONSTRUCTION RELATED
ACTIVITIES
• LIST OF REQUIRED DOCUMENTS TO BE SUBMITTED BY THE
AGENCY
C: /Contract Development Workshop /List of Contents /Brianna
G
RESOLUTION AUTHORIZING EXECUTION OF A CONTRACT WITH
MIAMI -DADE COUNTY AND
FOR THE PROVISION
WHEREAS, this Board desires to accomplish the objectives as outlined in the scope of
service of the contract with Miami -Dade County.
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF DIRECTORS of
with Miami -Dade County for the maximum amount of $
the provision of
authorizes
to execute same for and on behalf of
The foregoing resolution was offered by
adoption, the motion was seconded by
upon being put to a vote was as follows:
approves one (1) contract
for
services for the Fiscal Year 2007 and
and
who moved its
, and
The Chairperson /President thereupon declared this resolution duly passed and adopted
this
day of
Signature- Chairperson or Secretary Agency Seal
L
o I
AUTHORIZING SIGNATURES
CONTRACTOR:
DATE:
This form certifies the names, titles and signatures of individuals authorized by the contractor's by -laws or
board resolution to sign contracts, checks, budget revision requests, payment requests and any other
requests, (e.g. purchase requisitions, purchase orders, receiving reports, direct bills) that are required by
the Office of Community and Economic Development (OCED) for disbursement of funds.
NAME TITLE SIGNATURE
(Type or Print) (Type or Print)
1. Prime Contracts Subcontracts
11. Checks (List Amount Limits)
M. Budget Revision Requests
MIAMI -pADE COUNTY AFFIDAVITS
C: /Contract Development Workshop /List of Contents /Brianna
MIAMI -DADE COUNTY AFFIDAVITS
The contracting individual or entity (government or otherwise) shall indicate by an "X" all affidavits that pertain
to this contract and shall indicate by an "N /A" all affidavits that do not pertain to this contract. All blank spaces
must be filled.
The MIAMI -DADE COUNTY OWNERSHIP DISCLOSURE AFFIDAVIT; MIAMI -DADE COUNTY
EMPLOYMENT DISCLOSURE AFFIDAVIT; MIAMI -DADE CRIMINAL RECORD AFFIDAVIT; DISABILITY
NO'N- DISCRIMINATION AFFIDAVIT; and the PROJECT FRESH START AFFIDAVIT shall not pertain to
contracts with the United States or any of its departments or agencies thereof, the State or any political
subdivision or agency thereof; it shall however, pertain to municipalities of the State of Florida. All other
contracting entities or individuals shall read carefully each affidavit to determine whether or not it pertains to t
this contract.
1, , being first duly sworn state
Affiant
The full legal name and business address of the person(s) or entity contraction or transacting business with
Miami -Dade County are (Post Office addresses are not acceptable):
Federal Employer Identification Number (If none, Social Security)
Name of Entity,'Individual(s), Partners, or Corporation
Doing Business As (if same as above, leave blank)
Street Address City State Zip Code
1. MIAMI -DADE COUNTY OWNERSHIP DISCLOSURE AFFIDAVIT (Sec. 2 -8.1 of the County Code)
1. If the contract or business transaction is with a corporation, the full legal name and business address
shall be provided for each officer and director and each stockholder who holds directly or indirectly five
percent (5 %) or more of the corporation's stock. If the contract or business transaction is with a
partnership, the foregoing information shall be provided for each partner.' It the contract or business
transaction is with a trust, the full legal name and address shall be provided for each trustee and each
:beneficiary. The forgoing requirements shall not pertain to contracts with publicly- traded corporations or
to contracts with the United States or any department or names and addresses are (Post` Offices
addresses are not acceptable):`
Full Legal Name Address Ownership
Page 1 of 5
2. The full legal names and business address of any other individual (other than subcontractors, material
men, supplies, laborers, or lenders) who have, or will have, any interest (legal, equitable beneficial or
otherwise) in the contract or business transaction with Dade County are (Post Office addresses are not
acceptable):
3. Any person who willfully fails to disclose the information required herein, or who knowingly discloses
false information in this regard, shall be punished by a fine of up to five hundred dollars ($500.00) or
imprisonment in the County jail for up to sixty (60) days or both.
II. MIAMI -DADE COUNTY EMPLOYMENT DISCLOSURE AFFIDAVIT (County Ordinance No. 90 -133,
amending Sec. 2.8 -1; Subsection (d)(2) of the County Code).
Except where precluded by federal or State laws or regulations, each contract or business transaction or
renewal thereof which involves the expendituree of ten thousand dollar ($10,000) or more shall require the
entity contracting or transacting business to disclose the following information. The foregoing disclosure
requirements do not apply to contracts with the United States or any department or agency thereof, the
State or any political subdivision or agency or any municipality of this State.
1. Does your firm have a collective bargaining agreement with its employees?
Yes No
2. Does your firm provide paid health care benefits for its employees?
Yes No
3. Provide a current breakdown (number of persons) of your firm's work force and ownership as to race,
national origin and gender.
White:
Males:
Females:
Asian:
Males:
Females:
Black:
Males:
Females:
Indian:
Males:
Females:
Hispanics:
Males:
Females:
Aleut (Eskimo):
Males:
Females:
Males:
Females:__ Males: Females:
III. AFFIRMATIVE ACTION /NON - DISCRIMINATION OF EMPLOYMENT, PROMOTION AND
PROCUREMENT PRACTICES (County Ordinances 98 -30 codified at 2 -8.1.5 of the County Code)
In accordance with County Ordinance No. 98 -30, entities with annual gross revenues in excess of
$5,000,000 seeking to contract with the County shall, as condition receiving a County contract, have 1) a
written affirmative action plan which sets forth the procedures the entity utilizes to assure that it does not
discriminate in its employment and promotion practices; and ii) a written procurement policy which sets
forth the procedures the entity utilizes to assure that it does not discriminate against minority and women -
owned businesses in its own procurement of goods, supplies and services. Such affirmatives action plans
and procurement policies shall provide for periodic review to determine their effectiveness in assuring the
entity does not discriminate in its employment, promotion and procurement practices. The foregoing
notwithstanding, corporate entities whose boards of directors are representatives of the population make-
up of'the nation shall be presumed to have non - discriminatory employment and procurement policies, and
shall not be required to have written affirmative action plans and procurement policies in order to receive a
County contract. The foregoing presumption may, be rebutted.
The requirements of County Ordinance No. 98-30 may be waived upon the written recommendation of the
County Manager that it is in the best interest of the County to do so and upon approval of the Board of
County Commissioners by majority vote of the members present.
Page 2 of 5
The firm does not have annual gross revenues in excess of $5,000,000.
The firm does have annual revenues in excess of $5,000,000; however, its Board of Directors
is representative of the population make -up of the nation and has submitted a written, detailed
listing of its Board of Directors, including the race of ethnicity of each board member, to the
County's Department rnent of Business Development, 175
NW 1 st Avenue 28th Floor Miami,
Florida 33128.
The firm has annual gross revenues in excess of $5,000,000 and the firm does have a written
affirmative action plan and procurement policy as described above, which includes` periodic
review to determine effectiveness, and has submitted the plan and policy to the County's
Department of Business Development, 175 NW 1st Avenue, 28th Floor, Miami, Florida 33128.
The firm does not have an affirmative action plan and/or a procurement policy as described
above, but has been granted a waiver.
IV. MIAMI -DADE COUNTY CRIMINAL RECORD AFFIDAVIT (Section 2 -8.6 of the County Code)
The individual or entity entering into a contract or receiving funding from the County
has has not of the date of this affidavit been convicted of 'a felony during the past ten
(10) years.
V. -MIAMI -DADE EMPLOYMENT DRUG -FREE 'WORKPLACE AFFIDAVIT (County Ordinance
no. 92 -15 codified as Section 2 -8.1.2 of the County Code)
That in compliance with Ordinance No. 92-15 of the Code of Miami -Dade County, Florida, the
above named person or entity is providing a drug free workplace. A written statement to each
employee shall, inform the employee about:
1. Danger of drug abuse in the workplace
2. The firm's policy of maintaining a drug -free environment' at all workplaces
3. Availability of drug counseling, rehabilitation and employee assistance programs
4. Penalties that may be imposed upon employees for drug abuse violations
The person or entity shall also require' an employee to sign a statement, as a condition of ,
employment that the employee will abide by the terms and notify the employer of any criminal
drug conviction occurring no later than five (5) days after receiving notice of such conviction
and impose` appropriate' personnel action against the employee up to and including
termination.
Compliance with Ordinance No. 92 -15 may be waived if the special characteristics of the
product or service offered' by the person or entity make it necessary for the operation of the
`County or for the health, safety, welfare, economic benefits and well - being of the public.
Contracts involving funding which is provided in whole or in part by the United States of the
State of Florida shall be exempted from the provisions of this ordinance in those instances
where those provisions are inconfiict with the requirements of those government entities.
:I
UI. MIAMI -DADE EMPLOYMENT FAMILY LEAVE AFFIDAVIT (County Ordinances No. 142 -91
codified as Section 11A -29 et. EMPLOYMENT, of the County Code)
That in compliance with ordinance No. 142 -91 of the Code of Miami -Dade County, Florida, an
employer with fifty (50) or more employees working in Dade County for each working day
during" each of twenty (20) or more calendar workweeks, shall provide the following
information in compliance with all items in the aforementioned ordinance:'
Page 3 of 5
An employee who has worked for the above firm at least one (1) year shall be entitled to
ninety (90) days of family leave during any twenty -four (24) month period, for medical reasons,
for the birth or adoption of a child, or for the care of a child, spouse or other close relative who
has serious health condition without risk of termination of employer retaliation.
The foregoing requirements shall not pertain to contracts with the United States or any
department or agency thereof, or the State of Florida or any political subdivision or agency
thereof. It shall, however, pertain to municipalities of. this State.
Vll. DISABILITY NON - DISCRIMINATION AFFIDAVIT (County Resolution R385 -95)
That the above names firm, corporation or organization is in compliance with the agrees to
continue to comply with and assure that any subcontractor, or third party contractor under this
project complies with all applicable requirements of the laws listed below including, but not
limited to, those provisions pertaining to employment provisions of programs and services,
transportation, communications, access to facilities, renovations, and new construction in the
following laws: The Americans with Disabilities Act of 1990 (ADA), Pub. L. 101 -336, 104 Stat
327.42 U.S.C. 12101 -12213 and 47 U.S.C. Section 1612; The Fair Housing Act as amended,
42 U.S.C. Section 3601 -3631. The foregoing requirements shall not pertain to contracts with
the United States or any department or agency thereof, the State or any political subdivision
or agency thereof or any municipality of this State.
VIII. MIAMI -DADE COUNTY REGARDING DELIQUENT AND CURRENTLY DUE FEES OR
TAXES (Sec. 208.1 (c) of the County Code)
Except for small purchase orders and sole source contracts, that above named firm,
corporation, organization or individual desiring to transact business or enter a contract with the
County Verifies that all delinquent and currently due fees or taxes — including but not limited to
real and property taxes, utility taxes and occupational licenses — which are collected in the
normal course by the Dade County Tax Collector as well as Dade County issued parking
tickets for vehicles registered in the name of the firm, corporation, organization or individual
have been paid.
IX. CURRENT OR ALL COUNTY CONTRACTS, LOANS AND OTHER OBLIGATIONS
The individual entity seeking to transact business with the County is current in all its
obligations to the County and is not otherwise in default or any contract, promissory note or
other loan documents with the County or any of its agencies or instrumentalities.
X. PROJECT FRESH START (Resolution R- 702 -98 and 358 -99)
Any firm that has a contract with the County that results in actual payment of $500,000 or
more shall contribute to Project Fresh Start, the County's Welfare to Work Initiative. However,
if five percent (5 %) of the firm's work force consists of individuals who reside in Miami -Dade
County and who have lost or will loose cash assistance benefits (formerly Aid to Families with
dependent Children) as a result of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, the firm may request waiver from the requirement of R- 702098 and
R- 358 -99 by submitting a waiver request affidavit. The foregoing requirement does not pertain
to government entities, not for profit organizations or recipients of grant awards.
Page 4of5
XI. DOMESTIC VIOLENCE LEAVE (Resolution 185 -00 99 -5 Codified at 11 A-60 Et. Seq. of the
Miami -Dade County Code).
The firm desiring to do business with the County is in compliance with Domestic Leave
Ordinance, Ordinance 99 -5, coded at 11A -60 et. Seq. of the Miami-Dade, County Code,
which requires an employer which has in the regular course of business fifty (50) or more
employees working in Miami -Dade County for each working day during each of twenty (20) or
more calendar work weeks in the current or proceeding calendar, years, to provide Domestic
Violence Leave to its employees.
1 have carefully read this entire five (5) page document entitled Miami -Dade County Affidavits and have
indicated by an "X" all affidavits that pertain to his contract and have indicated by an "N /A" all affidavits that do
not pertain to this contract.
By:
(Signature ture of Affian
t (Date)
SUBSCRIBED AND SWORN TO (or affirmed) before me this day of
20 by He /She is personally known tome or has
presented as identification.
(Type of Identification)
t
(Signature o Notary) a (Serial. Number)
ry
N m r
(Print of Stamp of Notary) (Expiration Date)
Notary Public — State of
(State)
Page 5 of 5
AFFIDAVIT OF FINANCIAL AND
CONFLICTS OF INTEREST
C: /Contract Development Workshop /List of Contents /Brianna
AFFIDAVIT OF FINANCIAL AND CONFLICTS OF INTEREST
1. Do you have any past due financial obligations with Miami -Dade County?
YES NO
Single Family House Loans
Multi - Family Housing Rehab
CDBG Commercial Loan Project
U.S HUD Section 108 Loan
Other HUD Funded Programs
Other (liens, fines, loans, Occupational licenses, etc.)
If YES, please explain:
2. Do you have any past due financial obligations with Miami -Dade County?
YES ' NO
If YES, please explain:
3. Are you a relative of or do you have any business or financial interests with any elected Miami -Dade County official,
Miami -Dade County Employee, or Member of Miami -Dade County's Advisory Boards?
YES NO
If YES, please explain:
Any false information provided on this affidavit will be reason for rejection and disqualification of your project- funding request
to Miami-Dade County.
The answers to the foregoing questions are correctly stated to the best of my knowledge and belief. `.
By:
(Signature of Applicant) (Date)
SUBSCRIBED AND SWORN TO (or affirmed) before me this day of 20
By . He /She is personally known to me or has presented
as identification.
(Type of Identification)
(Signature of Notary) (Serial Number)
(Print or Stamp of Notary) (Expiration Date)
Notary Public - 'Stamp of
(State) Notary Seal
,I
RELATES PARTIES DISCLOSURE
STATEMENT
C: /Contract Development Workshop /List of Contents /Brianno
STATE OF FLORIDA PUBLIC ENTITY
CRIMES AFFIDAVIT
C: /Contract Development Workshop /List of Contents /Brionna
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
1. This form statement is submitted to
by
(Print individual's name and title)
for
(Print name of entity submitting sWom statement)
whose business address is
and if applicable its Federal Employer Identification Number (FEIN) is If the entity has
not 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 Statues,
-- means a violation of any state or federal law by a person with respect to an directly related to
the transactions of business with any public entity or with an agency or political subdivision of
any other state or with the United States, including, but not limited to any bid or contract for
'goods or services to be provided to public entity or agency or political subdivision of any other
state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering,
conspiracy, or material misinterpretation.
3. l 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 an federal or state trial court of record relating to charges brought by
indictment or information after July 1, 1989, as a result of a jury verdict, non jury trial, or entry of
a plea of guilty or nolo contendere.
4. 1 understand that an "Affiliate" as defined in paragraph 287.`133(1)(a), Florida Statutes means:
1. A predecessor or successor of a person convicted of a public entity crime, or
2. 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 °afFillate" 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 another 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 Statues, means, any
natural person or entity organized under the laws of any state or of the United States within. the
legal power to enter into a binding contract and which bids or applies to bid on contracts for the
provision of goods or entity. The term "person" includes those officers, executives, partners,
shareholders, employees, members, and agents who are active in management of an entity
6. Based on information and belief, the statement which 1 have marked below is true in relation to the
entity submitting this sworn statement. (Please indicate which statement applies.)
Neither the entity submitting sworn statement, nor any of its officers, director, 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, or an affiliate of the entity had been charged
with and convicted of a public entity crime subsequent to July 1, 1989, AND (please indicate which
additional statement applies.
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, nor any affiliate of the entity has been charged with and convicted of a
public entity crime subsequent proceeding before a Hearing Officer of the State 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 IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC
ENTITY ONLY AND THAT THIS FORM IS VALID THROUGH DECEMBER 31 OR THE
CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO
INFORM THAT PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE
THRESHOLD AMOUNT PROVIDED IN . SECTION 287.017 FLORIDA STATUTES FOR A
CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.
(Signature)
Sworn to and subscribed before me this day of , 20
Personally known
Or produced identification Notary Public -State of
(Type of identification)
My commission expires
(Printed, typed or stamped commissioned
name of notary public)
MIAMI DADE COUNTY, FLORIDA RFP No.
Form A -7.2
FAIR SUBCONTRACTING POLICIES
(Ordinance 97 -35)
FAIR SUBCONTRACTING PRACTICES
In compliance with Miami -Dade County Ordinance 97 -35, the Proposer submits the following detailed
statement of its policies and procedures for awarding subcontracts:
I hereby certify that the foregoing information is true, correct and complete.
Signature of Authorized Representative:
Title:
Firm Name:
Address:
Telephone:
Form A -7.2 Rev. 2113101
Date:
Fed. ID No.
City /State /Zip:
Fax: (___�
I C: /Contract Development Workshop /List of Contents /Brianna
LIVING WAGE REQUIREMENT (Miami -Dade County Ordinance 99 -44)
Effective November 11, 1999 the provisions of Miami -Dade County Ordinance 99 -44 and
Section 2 -8.9 of the Code of Miami -Dade County shall apply to all service contracts involving
the expenditure of over $100,000 per year for "Covered Services."
"Covered Services" are the type of services purchased by the County that are subject to the
requirements of the Living Wage Ordinance which are one of the following:
(1) County Service Contracts
(i) food preparation and /or distribution
(Ii) security services
routine maintenance services such as custodial, cleaning, refuse removal, repair,
refinishing and recycling
(iv) clerical or other non - supervisory office work, whether temporary or permanent
(v) transportation and parking, services, including airport and seaport services
(A) printing and reproduction services
(vii) landscaping, lawn and /or agricultural services
In accordance with Miami -Dade County Ordinance 99-44, all Service Contractors entering
into a contract with Miami -Dade County to provide Covered Services as described above
shall pay to all of its employees providing such Covered Services to the County a Living
Wage of no less than $8.81 per hour plus Health Insurance as described in the
aforementioned ordinance, or $10.09 per hour without Health Insurance.
Such Health Benefits shall consist of payment of at least $1.28 per. hour towards the
provision of health care benefits for employees and their dependents. Proof of the provision
of Health Insurance must be submitted to the County to qualify for the wage rate for
employees with health benefits. The Service Contractor shall also agree to produce all
documents and records relating to payroll and compliance with this Ordinance prior to award
of a contract as a result of this solicitation upon request by the County.
"If records reflect that the Service Contractor is in violation of this Ordinance, the County has
the right to sanction the Service Contractor to include but not limited to termination, fine and
suspension.
This Ordinance encompasses various responsibilities that must be accomplished by the
successful proposer such as record keeping, posting and reporting. Upon the award of this
contract, the successful proposer must be prepared to comply with these requirements as
outlined in Ordinance 99-44.
FORMA -11
MIAMI -DADE COUNTY, FLORIDA
MIAMI -DARE COUNTY LIVING WAGE AFFIDAVIT
(Ordinance and Section 2 -8.9 of the Miami -Dade County Code)
�
n
u►a ce 99
Solicitation No.:
Title:
being first duly sworn hereby
state and certify that in compliance with Miami -Dade County Ordinance 99 -44 and Section 2 -8.9 of
the Miami -Dade County Code, by accepting award of this contract, the bidder or proposer agrees to
pay the living wage required by Miami -Dade County Ordinance 99 -44 to all employees assigned to
this contract. The bidder or proposer further understands that the current living wage applied to this
contract is $8.81 per hour plus health benefits as described in the ordinance, or $10.09 per hour without
health benefits.
By. 20
Signature of�ant Date
Printed Name of Affiant and Title Federal Identification Number
Printed Name of Firm
Address of Firm
SUBSCRIBED AND SWORN TO (or affirmed) before me this day of .20
by He/She is personally known to me or has presented
Affiant
as identification.
Type of identification
Signature of Notary Serial Number
Print or Stamp Name of Notary Expiration Date
Notary Public — State of Notary Seal
Rev. 3126102
CODE OF BUSINESS ETHICS AFFIDAVIT
C: /Contract Development Workshop /List of Contents /Brianna
FORM A -12
CODE OF BUSINESS ETHICS
In accordance with Section2- 8.1(1) of the Miami -Dade County Code, each person or
entity that seeks to do business with the County shall adopt a Code of Business Ethics
("Code") and shall, prior to execution: of any contract between the contractor and the
County, submit an affidavit stating that the contractor has adopted a Code that complies
with the requirements of Section .2 -8.1 (i) of the Miami -Dade County Code. Any person
or entity that fails to submit the required affidavit shall be ineligible for contract award.'
The Code of Business Ethics shall apply to all business that the contractor does with the
County and shall, at a minimum, require that the contractor:
• Comply with all applicable governmental rules and regulations including, ;among
others, the Miami -Dade County Conflict of Interest and Code of Ethics Ordinance
and the False Claims Ordinance.
• Comply with all applicable rules and regulations regarding Disadvantaged
Business Enterprises, Black Business Enterprises, Hispanic Business
Enterprises and Women Business Enterprises (hereinafter collectively Minority
Business Enterprises, "MBEs ") and Community Small Business Enterprises
(CSBEs) and shall specifically prohibit the following practices:
o Pass-through Requirements. The Code shall prohibit pass - throughs ;
whereby the prime fire requires that` the MBE or CSBE firm accept
payments as a MBE or CSBE and pass through those payments or a
portion of those payments to another entity including, but not limited to the
owner /operator of the prime firm;
o Rental Space Eau{pment or Flat Overhead Fee Requirements. The Code
shall proh• bit rental space requirements, e _
q ui merit requirements, is and/or
flat overhead fee requirements, whereby th e prime .
firm
requires ires the MBE
or CSBE firm to rent space or equipment from the prime firm or charges a
flat overhead fee for the use of space, equipment, secretary, etc;
0
Staffing g Requirements.
The Code
shall prohibit the prime firm from
the project, that a MBE or CSBE
mandating, as a condition to inclusion in p � ,
mand g._
hire, fire, or � rom ote certain . individuals not employed by the
rime firm, or
,-
utilize staff employed or previously employed by the prime firm.
o MBE or CSBE Staff Utilization. The Code shall prohibit the prime firm
from requiring the MBE or CSBE' firm to provide more staff than is
necessary and then utilizing the MBE or CSBE' staff for other work to be
performed by the prime firm.
o Fraudulently creating operating or representing MBE or CSBE. The Code
shall prohibit a prime firm including, but not limited to, the
owners /operators thereof from fraudulently creating, operating or
representing an entity as a MBE or CSBE for purposes of qualifying for
certification as a MBE or CSBE.
• The Code shall also require that on any, contract where MBE or CSBE
participation is purported, the contract shall specify essential terms including, but
not limited to; a specific statement regarding the percent of participation planned
for MBEs or CSBEs, the timing of payments and when the work is to be
performed.
• The failure of a contractor to comply with its Code of Business Ethics shall render
any contract between the contractor and the County voidable, and subject
violators to debarment from future County work pursuant to•Section 10- 38(h)(2)
of the Code. The Inspector General shall be authorized to investigate any alleged
violation by a contractor of its Code of Business Ethics.
By:
Signature of Affiant
Printed Name and Title of Affiant
Printed Name of Firm
Address of Firm
20
Date
Federal Employer Identification Number
SUBSCRIBED AND SWORN TO (of affirmed ) before me this day of ,20,
He /She is personally known to me or has presented as identification.
Type of Identification
Signature of Notary
Print or Stamped Name of Notary
Notary Public, State of
Serial Number
Expiration Date
CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief, that:
1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or
employee of an agency, a Member of Congress, an officer or employee of Congress,
or an employee of a Member of Congress in connection with the awarding of any
Federal contract, the making of any Federal grant, the making of any Federal loan,
the entering into of any cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any Federal contract, grant, loan, or
cooperative agreement.
2. If any of the funds other than Federal appropriated funds have been paid or will be
paid to any person for influencing or attempting to influence an officer or employee
of any agency, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with this Federal contract, grant,
loan, or cooperative agreement, the undersigned shall complete and submit Standard
Form LLL, "Disclosure Form to Report Lobbying," in accordance with its
instructions.
3. The undersigned shall require that the language of this certification be included in
the award documents for all subawards at all tiers (including subcontracts, subgrants,
and contracts under grants, loans, and cooperative agreement in excess of $100,000)
and that all subrecipients shall certify and disclose accordingly.
4. This certification is a material representation of fact upon which reliance was placed
when this transaction was made or entered into. Submission of this certification is a
prerequisite for making or entering into this transaction imposed by section 1352,
title 31, U.S. Code. Any person who fails to file the required certification shall be
subject to a civil penalty of not less than $10,000 and not more than $100,000 for
each such failure.
By:
(Signature of Authorized Representative)
Print:
(Print Name of Firm and Authorized Representative)
Title:
Date:
COUNTY
Agency Name
FY 2007
Scope of Services
January 1, 2007 — December 31, 2007
1. - ACTIVITY TITLE: Employment and Training Program
2. - ACTIVITY DESCRIPTION: Employment training for 100 people countywide in FY 2007
3. - APPROVED BY BCC: $50,000
4. - SOURCE: CDBG 2007
5. - HUD INFORMATION:
5a. — HUD matrix code: 0511 `
5b. — Title: Employment Training
5c. — Eligibility 570.201(e)
6. - ACCOMPLISHMENTS:
6a. — Number of Units: 100
6b. — Type: People
7. -NATIONAL OBJECTIVE: 570.208(A)(2) — Low/Mod. Income Clientele (LMC)
8. - ACTIVITY ADDRESS: 4343 W. Flagler Street, Ste. 300
Miami, Florida 33134
9. - LOCATION: Entitlement City (Miami)
➢ CO: Sonia Colon PLANNER: A.B. Mumford '
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SAMPLE BUDGET SUMMARY
FOR NON- CONSTRUCTION RELATED PROJECTS
NAME OF AGENCY, INC.
ABC PROGRAMMING
CDBG
IFY 2007
SUMMARY BUDGET
JANUARY 1, 2007 — DECEMBER 31, 2007
CATEGORIES Non -OCED CDBG 2007 TOTAL ALL
SOURCES
I. PERSONNEL 119,236 23,169 $ 142,405
11. CONTRACTUAL SERVICES
9,500
9,500
$ 19,000
III. OPERATING SERVICES
6,750
6,750
$ 13,500
IV. COMMODITIES
800
800
$ 1,600
V. CAPITAL OUTLAY
0
0
$ 0
TOTAL BUDGET
$136,286
$40,219
$176,505
OTHER FUNDING SOURCES (Non- OCED):
ABC Grant $50,000
BL Grant $86,286
Total $136,286
g fit
040 1 D F
nn a v s
Fica :11,000 x.0620 = 628 x 100%
PP
Non OCED
OCED
TOTAL OCED
TOTAL ALL SOURCES
04010 PERSONNEL • Employee
$800
1,530
11.43
297
$1,827
Regular - Salaries
Executive Director
26
38,000
Bi -Week)
0
0
$38,000
Deputy Director,
26
47,000
" 0
0
$47,000
Case Manager
26
12,500
480.77
12,500
$25,000
Tutor
26
8,000
307.69
8,000
' $16,000
Subtotal Salaries
105,500
788.46
20,500
$126,000
g fit
040 1 D F
nn a v s
Fica :11,000 x.0620 = 628 x 100%
6,541
48.88
1,271
$7,812
Mica: 11,000x.0145=160
$800
1,530
11.43
297
$1,827
Worker's Compensation
$0.00
5,665
42.34
1,101
$6,766
Subtotal Hinge
$800
$1,600
13,736
107.66
2,669
$16,405
25330 Rent Copier
1,500
0.00
1,500
$3,000
Total Personnel
119,236
891.12
23,169
$142,405
C f ct 15 rvices
on ra ua e
21011 External Audit
2,000
0.00
2,000
$4,000.
21020 Accounting Services
$800
0
0.00
0°
$0.00
21030 Other Professional Svc.
$0.00
0
0.00'
0.00
$0.00
22350 Bottled Water
$800
$1,600
0
0.00
0
$0.00
25330 Rent Copier
1,500
0.00
1,500
$3,000
25511 Building Rental
6,000
0.00
6,000,`
$12,000
Total Contractual
91500
0.00
9,500
$19,000
0 t• Ex �
era m ense
22010 Electrical Services
2,000
0.00
2,000
$4,000'
23210 General Liability Insurance
23220 Automobile Liability Insurance
$800
1,500
1,250
0.00
0.00
1,500
1,250
$3,000
$2,500'
31011 Telephone Re ular
$0.00
1,250
0.00
1,250
$2,500
31011 Telephone Lon Distance
$800
$1,600
150
0.00
150
$300
31610 Postage
600
0.00
600
$1,200
31420 Advertising Radio
0.00
0.00
0.00
$0.00
Total Operafing Operating Expense
6,750
0.00
6,750 ;
_ $13,500
Commodities
31510 Outside Prinfing
400
0.00
400
$800
95020 Computer Purchase
0
0.00
0 '
$0.00
47010 Office Supplies/Outside Vendors
Total` Commodities
400
800
0.00
0.00
400
800
$800
$1,600
Capital Outla
0.00
0.00
0.00:
0.00'
Total Capital Outlay
0.00
0.00
0.00
0.00
TOTAL BUDGET $136,286 0.00 $40,219 $176,505
List of all other funding sources and corresponding amounts as indicated below:
ABC Grant $50,000
BL Grant $86.286
Total $136,286
SAMPLE OF ACTION STEPS,
SCOPE OF SERVICES, AND BUDGET
FOR CONSTRUCTION RELATED
ACTIVITIES
C: /Contract Development Workshop /List of Contents/Brianno
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EXAMPLES OF ACTION STEPS
FOR
CONSTRUCTION PROJECTS (HOUSING, CAPITAL IMPROVEMENT, OR ECONOMIC DEVELOPMENT)
ACTION STEPS
YES
I NO
NOTES ! COMMENTS
PRE-DEVELOPMENT PHASE (DESIGN PHASE
ENVIRONMENTAL CLEARANCE (OCED APPROVAL REQUIRED)
COMPLETE ENVIRONMENTAL REVIEW FORM & SUBMIT TO OCED FOR
REVIEW /APPROVAL
SOLICITATION RFP / RFQ FOR ARCHITECTURAL SERVICES
REQUIRES WRITTEN APPROVAL FROM OCED PRIOR TO PUBLICATION
3
EVALUATION OF RFP / RFQ RESPONSES
4
RECOMMENDATION, SELECTION / AWARD
EXECUTE CONTRACT FOR ARCHITECTURAL SERVICES
REQUIRES WRITTEN APPROVAL FROM OCED PRIOR TO EXECUTION
6
ISSUE NOTICE TO PROCEED
7
COMMENCE & COMPLETE DESIGN DRAWINGS/
SPECIFICATIONS/ RFP
$
MONITOR MANAGEMENT
FINAL DRAWINGS / SPECIFICATIONS / RFP
CONSTRUCTION PLANS & SPECIFICATIONS REQUIRE OCED APPROVAL PRIOR
TO IMPLEMENTATION
10
SEEK AND OBTAIN FIRM FINANCING COMMITTMENTS
SUBSIDY LAYERING. REVIEW / ANALYSIS
REQUEST FROM OCED
PRE -BID PHASE
ENVIRONMENTAL CLEARANCE (OCED APPROVAL REQUIRED
COMPLETE ENVIRONMENTAL REVIEW FORM & SUBMIT TO OCED FOR
REVIEW /APPROVAL °
2
APPRAISAL /MARKET ANALYSIS / PRO FORMA ANALYSIS
SUBSIDY LAYERING REVIEW/ ANALYSIS
REQUEST FROM OCED
BID / RFP PACKAGE FOR GENERAL CONTRACTOR GC
REQUIRES WRITTEN APPROVAL FROM OCED PRIOR TO PUBLICATION
DAVIS -BACON WAGE DETERMINATION
MUST BE REQUESTED FROM OCED & BE INCLUDED IN THE OCED APPROVED
BID PACKAGE
6
ADVERTISEMENT
7
PRE -BID CONFERENCE,
POST -BID PHASE
1
BID / RFP OPENING
2
RECOMMENDATION, SELECTION /AWARD
3
VERIFY GC IS NOT ON DEBARMENT LIST
4
OBTAIN EVIDENCE OF GC CURRENT LICENSE & CURRENT
OCCUPATIONAL LICENSE
5
PAYMENT AND PERFORMANCE BOND
PAGE 1 OF 2
EXAMPLES OF ACTION STEPS FOR CONSTRUCTION RELATED ACTIVITIES
REVISED 7j27106
ACTION STEPS
YES
NO
NOTES / COMMENTS
&
CERTIFICATES OF INSURANCE (REFERENCE ATTACHMENT B -1 OF
CONTRACT)
EXECUTE CONTRACT FOR GENERAL CONTRACTOR
REQUIRES WRITTEN APPROVAL FROM OCED PRIOR TO EXECUTION
CONSTRUCTION PHASE
1
MDHA HOME LOAN CLOSING
PRE- CONSTRUCTION CONFERENCE (INCLUDE WORK SCHEDULE`
AND MAINTENANCE OF TRAFFIC)
CONTACT & COORDINATE WITH,OCED PRIOR TO SCHEDULING`'
3
RELEASE NOTICE TO PROCEED
4
OBTAIN PERMITS
5
'COMM'ENCE CONSTRUCTION
6
CONSTRUCTION MANAGEMENT & MONITORING
WEEKLY PAYROLLS & PAYMENT CERTIFICATIONS
(,LABOR COMPLIANCE)
REQUIRES OCED REVIEW 'AND APPROVAL
8
SECTION 3 PLANS, COMPLIANCE, MONTHLY REPORTS
MONTHLY SUBMITTAL OF CONSTRUCTION RELATED
PAYMENT REQUESTS / REIMBURSEMENT REQUESTS
REQUIRES 0CED REVIEW 'AND APPROVAL '- r
10
'SUBMITTAL OF QUARTERLY PROGRESS REPORTS AND
:ANNUAL REPORT
11
RELEASE OF LIENS (OBTAIN RELEASE / WAIVER OF LIENS FROM ALL
CONTRACTORS AND SUPPLIERS)
12
CONDUCT FINAL "WALK -THRU"
13
CERTIFICATE OF COMPLETION
14
"AS BUILT" DRAWINGS
15
OBTAIN CERTIFICATION OF OCCUPANCY
16
;PROJECT COMPLETION FORM
-- OTHER --
ADDITIONAL CONSTRUCTION RELATED ITEMS THAT REQUIRE PRIOR WRITTEN APPROVAL FROM OCED
ADDITION OF ANY POSITION NOT SPECIFICALLY LISTED IN
THE APPROVED BUDGET
MODIFICATION OR ADDITION OF ALL JOB DESCRIPTIONS
DISPOSITION OF ALL REAL, EXPENDABLE PERSONAL AND .
NONEXPENDABLE PERSONAL PROPERTY
DISPOSITION OF PROGRAM INCOME
r
CONTRACT RECORDS
MODIFICATION OF PROPOSED GROSS RENTS FOR HOME
ASSISTED UNITS
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LIST OF REQUIRED DOCUMENTS TO BE
SUBMITTED BY THE AGENCY
C: /Contract Development Workshop /List of Contents /Brianno
i
CONTRACT DEVELOPMENT WORKSHOP
LIST OF CONTENTS
• SAMPLE OF BOARD OF DIRECTOR'S RESOLUTION APPROVING
THE FUNDED AMOUNT AND AUTHORIZING EXECUTION OF
THE CONTRACT WITH OCED.
• AUTHORIZED SIGNATURE FORM
• MIAMI -DARE COUNTY AFFIDAVITS
• AFFIDAVIT OF FINANCIAL AND CONFLICTS OF INTEREST
• RELATED PARTIES DISCLOSURE STATEMENT
• STATE OF FLORIDA PUBLIC ENTITY CRIMES AFFIDAVIT
• MIAMI -DADE COUNTY FAIR SUBCONTRACTING POLICIES
• MIAMI -DADE COUNTY LIVING WAGE AFFIDAVIT
• CODE OF BUSINESS ETHICS AFFIDAVIT
• CERTIFICATION REGARDING LOBBYING
• SAMPLE OF ACTION STEPS, SCOPE OF SERVICES, AND
BUDGET FOR NON - CONSTRUCTION RELATED ACTIVITIES
• SAMPLE OF ACTION STEPS, SCOPE OF SERVICES, AND
BUDGET FOR CONSTRUCTION RELATED ACTIVITIES
• LIST OF REQUIRED DOCUMENTS TO BE SUBMITTED BY THE
AGENCY
C: /Contract Development Workshop /List of Contents /Brianna
Q,
SAMPLE OF BOARD OF DIRECTOR'S
RESOLUTION APPROVING THE
FUNDED AMOUNT AND AUTHORIZING
EXECUTION OF THE CONTRACT WITH-
OCED
C: /Contract Development Workshop /List of Contents /Brianno
C
RESOLUTION AUTHORIZING EXECUTION OF A CONTRACT WITH
MIAMI -DADS COUNTY AND
FOR THE PROVISION
WHEREAS, this Board desires to accomplish the objectives as outlined in the scope of
service of the contract with Miami - -Dade County.
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF DIRECTORS of
approves one (1) contract
with Miami -Dade County for the maximum amount of $ for
the provision of services for the Fiscal Year 2007 and
authorizes
to execute same for and on behalf of
The foregoing resolution was offered by
adoption, the motion was seconded by
upon being put to a vote was as follows:
and
who moved its
, and
The Chairperson /President thereupon declared this resolution duly passed and adopted
this day of
Signature- Chairperson or Secretary
Agency Seal
AUTHORIZED SIGNATURE FORM
C: /Contract Development Workshop /List of Contents /Brionna
AUTHORIZING SIGNATURES
CONTRACTOR:
DATE:
This form certifies the names, titles and signatures of individuals authorized by the contractor's by -laws or
board resolution to sign contracts, checks, budget revision requests, payment requests and any other
requests, (e.g. purchase requisitions, purchase orders, receiving reports, direct bills) that are required by
the Office of Community and Economic Development (OCED) for disbursement of funds.
NAME TITLE SIGNATURE
(Type or Print) (Type or Print)
I. Prime Contracts Subcontracts
11. Checks (List Amount Limits)
111. Budget Revision Requests
NAME TITLE SIGNATURE
(Type or Print) (Type or Print)
IV. Payment Requests
V. Other Administrative Matters
(e.g. Status Reports, Purchase Orders, Travel Requests)
* These signatures authorized are retained by OCED for auditing purposes.
* You are required to submit updates to this list as it becomes necessary.
MIAMI -DADE COUNTY AFFIDAVITS
C: /Contract Development Workshop /List of Contents /Brianna
MIAMI -DADE COUNTY AFFIDAVITS
The contracting individual or entity (government or otherwise) shall indicate by an "X" all affidavits that pertain
to this contract and shall indicate by an "N /A" all affidavits that do not pertain to this contract. All blank spaces
must be filled.
The MIAMI -DADE COUNTY OWNERSHIP DISCLOSURE AFFIDAVIT; MIAMI -DADE COUNTY
EMPLOYMENT DISCLOSURE AFFIDAVIT; MIAMI -DADE CRIMINAL RECORD AFFIDAVIT; DISABILITY
NON - DISCRIMINATION AFFIDAVIT; and the PROJECT FRESH START AFFIDAVIT shall not pertain to
contracts with the United States or any of its departments or agencies thereof, the State or any political
subdivision or agency thereof, it shall however, pertain to municipalities of the State of Florida. All other
contracting entities or individuals shall read carefully each affidavit to determine whether or not it pertains to
this contract.
1, Affiant ^, being first duly swom state:
The full legal name and business address of the person(s) or entity contraction or transacting business with
Miami -Dade County are (Post Office addresses are rot acceptable):
Federal Employer Identification Number (If none, Social Security)
Name of Entity, Individual(s), Partners, or, Corporation
Doing Business As (If same as above, leave blank)
Street Address City State Zip Code
1. MIAMI -DADE COUNTY OWNERSHIP DISCLOSURE AFFIDAVIT (Sec. 2 -8.1 of the County Code)
1. If the contract or business transaction is with a corporation, the full legal name and business address
shall be provided for each officer and director and each stockholder who holds directly or indirectly five
percent (5 %) or more of the corporation's stock. If the contract or business transaction is with a
partnership, the foregoing information shall be provided for each partner. It the contract or business
transaction is with a trust, the full legal name and address shall be provided for each trustee and each
beneficiary. The forgoing requirements shall not pertain to contracts with publicly - traded corporations or
to contracts with the United States or any department or names and addresses are (Post Offices
addresses are not acceptable):
Full Legal Name Address Ownership
Page 1 of 5
2. The fill legal names and business address of any other individual (other than subcontractors,. material
men, supplies, laborers, or lenders) who have, or will have, any interest (legal, equitable beneficial or
otherwise) in the contract or business transaction with Dade County are (Post Office addresses are not
acceptable):
3. Any person who willfully fails to disclose the information required herein, or who knowingly discloses
false information in this regard, shall be punished by a fine of up to five hundred dollars ($500.00) or
imprisonment in the County jail for up to sixty (60) days or both.
11. MIAMI -DADE COUNTY EMPLOYMENT DISCLOSURE AFFIDAVIT (County Ordinance No. 90 -133,
amending Sec. 2.8 -1; Subsection (d)(2) of the County Code).
Except where precluded by federal or State laws or regulations, each contract or business transaction or
renewal thereof which involves the expenditure of ten thousand dollar ($10,000) or more shall require the
entity contracting or transacting business to disclose the following information. The foregoing disclosure
requirements do not apply to contracts with the United States or any department or agency thereof, the
State or any political subdivision or agency or any municipality of this State.
1. Does your firm have a collective bargaining agreement with its employees?
Yes No
2. Does your firm provide paid health care benefits for its employees?
Yes No
3. Provide a current breakdown (number of persons) of your firm's work force and ownership as to race,
national origin and gender.
White: Males:
Females:
Asian: Males:
Females:
Black: Males:
Females:
American Indian: Males:
Females:
Hispanics: Males:
Females:
Aleut (Eskimo): Males:
Females:
Males:
Females:
Males:
Females:
111. AFFIRMATIVE ACTION /NON- DISCRIMINATION OF EMPLOYMENT, PROMOTION AND
PROCUREMENT PRACTICES (County Ordinances 98 -30 codified at 2 -8.1.5 of the County Code)
In accordance with County Ordinance No. 98 -30, entities with annual gross revenues in excess of
$5,000,000 seeking to contract with the County shall, as condition receiving a County contract, have 1) a
written affirmative action plan which sets forth the procedures the entity utilizes to assure that it does not
discriminate in its employment and promotion practices; and ii) a written procurement policy which sets
forth the procedures the entity utilizes to assure that it does not discriminate against minority and women-
owned businesses in its own procurement of goods, supplies and services. Such affirmatives action plans
and procurement policies shall provide for periodic review to determine their effectiveness in assuring the
entity does not discriminate in its employment, promotion and procurement practices. The foregoing
notwithstanding, corporate entities whose boards of directors are representatives of the population make-
up of %the nation shall be presumed to have non - discriminatory employment and procurement policies, and
shall not be required to have written affirmative action plans and procurement policies in order to receive a
County contract. The foregoing presumption may be rebutted.
The requirements of County Ordinance No. 98 -30 may be waived upon the written recommendation of the
County Manager that it is in the best interest of the County to do so and upon approval of the Board of
County Commissioners by majority vote of the members present.
Page 2 of 5
The firm does not have annual gross revenues in excess of $5,000,000.
The firm does have annual revenues in excess of $5,000,000; however, its Board of Directors
is representative of the population make -up of the nation and has submitted a written, detailed
listing of its Board of Directors, including the race of ethnicity of each board member, to the
County's Department of Business Development, 175 NW 15' Avenue, 28th Floor, Miami,
Florida 33128.
The firm has annual gross revenues in excess of $5,000,000 and the firm does have a written
affirmative action plan and procurement policy as described above, which includes periodic
review to determine effectiveness, and has submitted the plan and policy to the County's
Department of Business Development, 175 NW 15' Avenue, 28"' Floor, Miami, Florida 33128.
The firm does not have an affirmative action plan and/or a procurement policy as described
above, but has been granted a waiver.
IV. MIAMI -DADE COUNTY CRIMINAL RECORD AFFIDAVIT (Section 2 -8.6 of the County Code)
The individual or entity entering into a contract or receiving funding from the County
has has not of the date of this affidavit been convicted of a felony during the past ten
(10) years.
V. MIAMI -DADE EMPLOYMENT DRUG -FREE WORKPLACE AFFIDAVIT (County Ordinance
no. 92 -15 codified as Section 2 -8.1.2 of the County Code)
That in compliance with Ordinance No. 92 -15 of the Code of Miami -Dade County, Florida, the
above named person or entity is providing a drug -free workplace. A written statement to each
employee shall, inform the employee about:
1. Danger of drug abuse in the workplace
2. The firm's policy of maintaining a drug -free environment at all workplaces
3. Availability of drug counseling, rehabilitation and employee assistance programs
4. Penalties that may be imposed upon employees for drug abuse violations
The person or entity shall also require an employee to sign a statement, as a condition of
employment that the employee will abide by the terms and notify the employer of any criminal
drug conviction occurring no later than five (5) days after receiving notice of such conviction
and impose appropriate personnel action against the employee up to and including
termination.
Compliance with Ordinance: No. 92 -•15 may be waived if the special characteristics of the
product or service offered by the person or entity make it necessary for the operation of the
County or for the health, safety, welfare, economic benefits and well -being of the public.
Contracts involving funding which is provided in whole or in part by the United States of the
State of Florida shall be exempted from the provisions of this ordinance in those instances
where those provisions are in conflict with the requirements of those government entities.
VI. MIAMI -DADE EMPLOYMENT FAMILY LEAVE AFFIDAVIT (County Ordinances No. 142 -91
codified as Section 11A -29 et. Seq of the County Code)
That in compliance with ordinance No. 142 -91 of the Code of Miami -Dade County, Florida, an
employer with fifty (50) or more employees working in Dade County for each working day
during each of twenty (20) or more calendar workweeks, shall provide the following
information in compliance with all items in the aforementioned ordinance:
Page 3 of 5
An employee who has worked for the above firm at least one (1) year shall be entitled to
ninety (90) days of family leave during any twenty -four (24) month period, for medical reasons,
for the birth or adoption of a child, or for the care of a child, spouse or other close relative who
has serious health condition without risk of termination of employer retaliation.
The foregoing requirements shall not pertain to contracts with the United States or any
department or agency thereof, or the State of Florida or any political subdivision or agency
thereof. It shall, however, pertain to municipalities of. this State.
VII. DISABILITY NON - DISCRIMINATION AFFIDAVIT (County Resolution R385 -95)
That the above names firm, corporation or organization is in compliance with the agrees to
continue to comply with and assure that any subcontractor, or third party contractor under this
project complies with all applicable requirements of the laws listed below including, but not
limited to, those provisions pertaining to employment provisions of programs and services,
transportation, communications, access to facilities, renovations, and new construction in the
following laws: The Americans with Disabilities Act of 1990 (ADA), Pub. L. 101 -336, 104 Stat
327.42 U.S.C. 12101 -12213 and 47 U.S.C. Section 1612; The Fair Housing Act as amended,
42 U.S.C. Section 3601 -3631. The foregoing requirements shall not pertain to contracts with
the United States or any department or agency thereof, the State or any political subdivision
or agency thereof or any municipality of this State.
VIII. MIAMI -DADE COUNTY REGARDING DELIQUENT AND CURRENTLY DUE FEES OR
TAXES (Sec. 208.1 (c) of the County Code)
Except for small purchase orders and sole source contracts, that above named firm,
corporation, organization or individual desiring to transact business or enter a contract with the
County Verifies that all delinquent and currently due fees or taxes — including but not limited to
real and property taxes, utility taxes and occupational licenses — which are collected in the
normal course by the Dade County Tax Collector as well as Dade County issued parking
tickets for vehicles registered in the name of the firm, corporation, organization or individual
have been paid.
_, IX. CURRENT OR ALL COUNTY CONTRACTS, LOANS AND OTHER OBLIGATIONS
The individual entity seeking to transact business with the County is current in all its
obligations to the County and is not otherwise in default or any contract, promissory note or
other loan documents with the County or any of its agencies or instrumentalities.
_X. PROJECT FRESH START (Resolution R- 702 -98 and 358 -99)
Any firm that has a contract with the County that results in actual payment of $500,000 or
more shall contribute to Project Fresh Start, the County's Welfare to Work Initiative. However,
if five percent (5 %) of the firm's work force consists of individuals who reside in Miami -Dade
County and who have lost or will loose cash assistance benefits (formerly Aid to Families with
dependent Children) as a result of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, the firm may request waiver from the requirement of R- 702098 and
R- 358 -99 by submitting a waiver request affidavit. The foregoing requirement does not pertain
to government entities, not for profit organizations or recipients of grant awards.
Page 4 of 5
XI. DOMESTIC VIOLENCE LEAVE (Resolution 185 -00; 99 -5 Codified at 11A -60 Et. Seq. of the
Miami -Dade County Code).
The firm desiring to do business with the County is in compliance with Domestic Leave
Ordinance, Ordinance 99 -5, codified at 11A -60 et. Seq. of the Miami -Dade County Code,
which requires an employer which has in the regular course of business fifty (50) or more
employees working in Miami -Dade County for each working day during each of twenty (20) or
more calendar work weeks in the current or proceeding calendar years, to provide Domestic
Violence Leave to its employees.
I have carefully read this entire five (5) page document entitled Miami -Dade County Affidavits and have
indicated by an "X" all affidavits that pertain to his contract and have indicated by an "N /A" all affidavits that do
not pertain to this contract.
By:
(Signature of Affiant)
SUBSCRIBED AND SWORN TO (or affirmed) before me this
20 by
presented _
(Type of Identification)
(Signature of Notary)
(Print of Stamp of Notary)
Notary Public — State of
(State)
Page 5 of 5
(Date)
day of
He /She is personally known to me or has
as identification.
(Serial Number)
(Expiration Date)
AFFIDAVIT OF FINANCIAL AND
CONFLICTS OF INTEREST
C: /Contract Development Workshop /List of Contents /Brionna
AFFIDAVIT OF FINANCIAL AND CONFLICTS OF INTEREST
I. Do you have any past due financial obligations with Miami -Dade County?
YES NO
Single Family House Loans
Multi- Family Housing Rehab
CDBG Commercial Loan Project
U.S. HUD Section 108 Loan
Other HUD Funded Programs
Other (liens, fines, loans, Occupational licenses, etc.)
If YES, please explain:
2. Do you have any past due financial obligations with Miami -Dade County?
YES NO
If YES, please explain:
3. Are you a relative of or do you have any business or, financial interests with any elected Miami -Dade County official,
Miami -Dade County Employee, or Member of Miami -Dade County's Advisory Boards?
YES NO
If YES, please explain:
Any false information provided on this affidavit will be reason for rejection and disqualification of your project - funding request
to Miami -Dade County.
The answers to the foregoing questions are correctly stated to the best of my knowledge and berief.
By:
(Signature of Applicant) (Date)
SUBSCRIBED AND SWORN TO (or affirmed) before me this day of 20
By He /She is personally known to me or has presented
(Type of identification) as identification.
(Signature of Notary) (Serial Number)
(Print or Stamp of Notary) (Expiration Date)
Notary Public — Stamp of
(State) Notary Seal
RELATED PARTIES DISCLOSURE
STATEMENT
C: /Contract Development Workshop /List of Contents /Brianna
At
AGENCY NAME
DISCLOSURE ABOUT RELATED PARTIES
THERE ARE NO BOARD MEMBERS OF THE (AGENCY NAME)
WHO HAVE ANY RELATIONSHIP OR HAVE MADE ANY TRANSACTION WITH
OTHER-ENTITIES THAT MIGHT RESULT IN A CONFLICT WITH (AGENCY
NAME) OPERATIONS.
STATE OF FLORIDA PUBLIC ENTITY
CRIMES AFFIDAVIT
C: /Contract Development Workshop /List of Contents /Brianno
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
1. This form statement is submitted to
by
(Print individual's name and title)
for
(Print name of entity submitting sworn statement)
whose business address is
and if applicable its Federal Employer Identification Number (FEIN) is If the entity has
not 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 Statues,
- - - - -- means a violation of any state or federal law by a person with respect town directly related to
the transactions of business with any public entity or with an agency or political subdivision of
any other state or with the United States, including, but not limited to any bid or contract for
goods or services to be provided to public entity or agency or political subdivision of any other
state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering,
conspiracy, or material misinterpretation.
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 an federal or state trial court of record relating to charges brought by
indictment or information after July 1, 1989, as a result of a jury verdict, non jury trial, or entry of
a plea of guilty or nolo contendere.
4. 1 understand that an "Affiliate" as defined in paragraph 287.133(1)(a), Florida Statutes means:
1. A predecessor or successor of a person convicted of a public entity crime, or
2. 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 another 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. 1 understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statues, means any
natural person or entity organized under the laws of any state or of the United States within the
legal power to enter into a binding contract and which bids or applies to bid on contracts for the
provision of goods or entity. The term "person" includes those officers, 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. (Please indicate which statement applies.)
Neither the entity submitting sworn statement, nor any of its officers, director, 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, or an affiliate of the entity had been charged
with and convicted of a public entity crime subsequent to July 1, 1989, AND (please indicate which
additional statement applies.
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, nor any affiliate of the entity has been charged with and convicted of a
public entity crime subsequent proceeding before a Hearing Officer of the State 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 IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC
ENTITY ONLY AND THAT THIS FORM IS VALID THROUGH DECEMBER 31 OR THE
CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO
INFORM THAT PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE
THRESHOLD AMOUNT PROVIDED IN . SECTION 287.017 FLORIDA STATUTES FOR A
CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.
(Signature)
Sworn to and subscribed before me this -___ day of , 20
Personally known
Or produced identification
Notary Public -State of
My commission expires
(Type of identification)
(Printed, typed or stamped commissioned
name of notary public)
MIAMI -DACE COUNTY FAIR
SUBCONTRACTING POLICIES
C: /Contract Development Workshop /List of Contents /Brianna
MIAMI -DADE COUNTY, FLORIDA REP No.
Form A -7.2
FAIR SUBCONTRACTING POLICIES
(Ordinance 97 -35)
FAIR SUBCONTRACTING PRACTICES
In compliance with Miami -Dade County Ordinance 97 -35, the Proposer submits the following detailed
statement of its policies and procedures for awarding subcontracts:
I hereby certify that the foregoing information is true, correct and complete.
Signature of Authorized Representative:
Title:
Date:
Firm Name: Fed. ID No.
Address: _ City /State /Zip:
Telephone: { ) Fax :: (
Form A -7.2 Rev. 2113101
MIAMI -DACE COUNTY LIVING WAGE
AFFIDAVIT
C: /Contract Development Workshop /List of Contents/Brianna
LIVING WAGE REQUIREMENT (Miami -Dade County Ordinance 99-441
Effective November 11, 1999 the provisions of Miami -Dade County Ordinance 99 -44 and
Section 2 -8.9 of the Code of Miami -Dade County shall apply to all service contracts involving
the expenditure of over $100,000 per year for "Covered Services."
"Covered Services" are the type of services purchased by the County that are subject to the
requirements of the Living Wage Ordinance which are one of the following:
(1) County Service Contracts
(i) food preparation and /or distribution
(ii) security services
(iii) routine maintenance services such as custodial, cleaning, refuse removal, repair,
refinishing and recycling
(iv) clerical or other non - supervisory office work, whether temporary or permanent
(v) transportation and parking services, including airport and seaport services
(vi) printing and reproduction services
(vii) landscaping, lawn and /or agricultural services
In accordance with Miami -Dade County Ordinance 99-44, all Service Contractors entering
into a contract with Miami -Dade County to provide Covered Services as described above
shall pay to all of its employees providing such Covered Services to the County a Living
Wage of no less than $8.81 per hour plus Health Insurance as described in the
aforementioned ordinance, or $10.09 per hour without Health Insurance.
Such Health Benefits shall consist of payment of at least $1.28 per. hour towards the
provision of health care benefits for employees and their dependents. Proof of the provision
of Health Insurance must be submitted to the County to qualify for the wage rate for
employees with health benefits. The Service Contractor shall also agree to produce all
documents and records relating to payroll and compliance with this Ordinance prior to award
of a contract as a result of this solicitation upon request by the County.
`If records reflect that the Service Contractor is in violation of this Ordinance, the County has
the right to sanction the Service Contractor to include but not limited to termination, fine and
suspension.
This Ordinance encompasses various responsibilities that must be accomplished by the
successful proposer such as record keeping, posting and reporting. Upon the award of this
contract, the successful proposer must be prepared to comply with these requirements as
outlined in Ordinance 99-44.
FORMA-11
MIAMI -DADE COUNTY, FLORIDA
MIAMI -DADE COUNTY LIVING WAGE AFFIDAVIT
(Ordinance 9944 and Section 2 -$.9 of the Miami -Dade County Code)
Solicitation No.:
Title:
I, being first duly sworn hereby
state and certify that in compliance with Miami -Dade County Ordinance 99 -44 and Section 2 -8.9 of
the Miami -Dade County Code, by accepting award of this contract, the bidder or proposer agrees to
pay the living wage required by Miami -Dade County Ordinance 99-44 to all employees assigned to
this contract. The bidder or proposer further understands that the current living wage applied to this
contract is $8.81 per hour plus health benefits as described in the ordinance, or $10.09 per hour without
health benefits.
By: _ , 20.
Signature of Affiant Date
Printed Name of Affiant and Title Federal Identification Number
Printed Name of Finn
Address of Finn
SUBSCRIBED AND SWORN TO (or affirmed) before me this day of .20__,
by He/She is personally known to me or has presented
Affiant
_ as identification.
Type of identification
Signature of Notary
Print or Stamp Name of Notary
Notary Public — State of
Rev. 3126102
Serial Number
Expiration Date
Notary Seal
CODE OF BUSINESS ETHICS AFFIDAVIT
C: /Contract Development Workshop /List of Contents /Brianna
FORM A -12
CODE OF BUSINESS ETHICS
In accordance with Section2- 8.1(i) of the Miami -Dade County Code, each person or
entity that seeks to do business with the County shall adopt a Code of Business Ethics
( "Code ") and shall, prior to execution of any contract between the contractor and the
County, submit an affidavit stating that the contractor has adopted a Code that complies
with the requirements of Section .2 -8.1 (1) of the Miami -Dade County Code. Any person
or entity that fails to submit the required affidavit shall be ineligible for contract award.
The Code of Business Ethics shall apply to all business that the contractor does with the
County and shall, at a minimum, require that the contractor:
• Comply with all applicable governmental rules and regulations including, among
others, the Miami -Dade County Conflict of Interest and Code of Ethics Ordinance
and the False Claims Ordinance.
• Comply with all applicable rules and regulations regarding Disadvantaged
Business Enterprises, Black Business Enterprises, Hispanic Business
Enterprises and Women Business Enterprises (hereinafter collectively Minority
Business Enterprises, "MBEs ") and Community Small Business Enterprises
(CSBEs) and shall specifically prohibit the following practices:
• Pass -through Requirements. The Code shall prohibit pass - throughs
whereby the prime fire requires that" the MBE or CSBE firm accept
payments as a MBE or CSBE and pass through those payments or a
portion of those payments to another entity including, but not limited to the
owner /operator of the prime firm;
• Rental Space, Equipment or, Flat Overhead Fee Requirements. The Code
shall prohibit rental space requirements, equipment requirements, and /or
flat overhead fee requirements, whereby the prime firm requires the MBE
or CSBE firm to rent space or equipment from the prime firm or charges a
flat overhead fee for the use of space, equipment, secretary, etc;
• Staffing Requirements. The Code shall prohibit the prime firm from
mandating, as a condition to inclusion in the project, that a MBE or CSBE
hire, fire, or promote certain individuals not employed by the prime firm, or
utilize staff employed or previously employed by the prime firm.
• MBE or CSBE Staff Utilization. The Code shall prohibit the prime firm
from requiring the MBE or CSBE firm to provide more staff than is
necessary and then utilizing the MBE or CSBE staff for other work to be
performed by the prime firm.
• Fraudulently creating, operating or representing MBE or CSBE. The Code
shall prohibit a prime firm including, but not limited to, the
owners /operators thereof from fraudulently creating, operating or
representing an entity as a MBE or CSBE for purposes of qualifying for
certification as a MBE or CSBE.
• The Code shall also require that on any contract where MBE or CSBE
participation is purported, the contract shall specify essential terms including, but
not limited to; a speck statement regarding the percent of participation planned
for MBEs or CSBEs, the timing of payments and when the work is to be
performed.
• The failure of a contractor to comply with its Code of Business Ethics shall render
any contract between the contractor and the County voidable, and subject
violators to debarment frorn future County work pursuant to•Section 10- 38(h)(2)
of the Code. The Inspector General shall be authorized to investigate any alleged
violation by a contractor of its Code of Business Ethics.
By:
Signature of Affiant
Printed Name and Title of Affiant
Printed Name of Firm
Address of Firm
20
Date
Federal Employer Identification Number
SUBSCRIBED AND SWORN TO (of affirmed ) before me this day of ,20
He /She is personally known to me or has presented as identification.
Type of Identification
Signature of Notary
Print or Stamped Name of Notary
Notary Public, State of
Serial Number
Expiration Date
CERTIFICATION REGARDING LOBBYING
C: /Contract Development Workshop /List of Contents /Srianna
CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief, that:
No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or
employee of an agency, a Member of Congress, an officer or employee of Congress,
or an employee of a Member of Congress in connection with the awarding of any
Federal contract, the making of any Federal grant, the making of any Federal loan,
the entering into of any cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any Federal contract, grant, loan, or
cooperative agreement.
2. If any of the funds other than Federal appropriated funds have been paid or will be
paid to any person for influencing or attempting to influence an officer or employee
of any agency, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with this Federal contract, grant,
loan, or cooperative agreement, the undersigned shall complete and submit Standard
Form LLL, "Disclosure Form to Report Lobbying," in accordance with its
instructions.
3. The undersigned shall require that the language of this certification be included in
the award documents for all subawards at all tiers (including subcontracts, subgrants,
and contracts under grants, loans, and cooperative agreement in excess of $100,000)
and that all subrecipients shall certify and disclose accordingly.
4. This certification is a material representation of fact upon which reliance was placed
when this transaction was made or entered into. Submission of this certification is a
prerequisite for making or entering into this transaction imposed by section 1352,
title 31, U.S. Code. Any person who fails to file the required certification shall be
subject to a civil penalty of not less than $10,000 and not more than $100,000 for
each such failure.
La
(Signature of Authorized Representative)
Print:
(Print Name of Firm and Authorized Representative)
Title:
Date:
SAMPLE OF ACTION STEPS,
SCOPE OF SERVICES, AND BUDGET
FOR NON - CONSTRUCTION RELATED
ACTIVITIES
C: /Contract Development Workshop /List of Contents /Brianna
M [A. M I- i.7�►,IC3r�
a►
Agency Name
FY 2007
Scope of Services
January 1, 2007 — December 31, 2007
1. - ACTIVITY TITLE: Employment and Training Program
2. - ACTIVITY DESCRIPTION: Employment training for 100 people countywide in FY 2007
3. APPROVED BY BCC: $50,000
4. - SOURCE: CDBG 2007
5. - HUD INFORMATION:
5a. — HUD matrix code: 05H -
5b. — Title: Employment Training
5c. — Eligibility 570.201(e)
6. - ACCOMPLISHMENTS:
6a. — Number of Units: 100
6b. — Type: People
7. - NATIONAL OBJECTIVE: 570.208(A)(2) — Low/Mod. Income Clientele (LMC)
8. - ACTIVITY ADDRESS: 4343 W. Flagler Street, Ste. 300
Miami, Florida 33134
9. - LOCATION: Entitlement City (Miami)
➢ CO: Sonia Colon PLANNER: A.B. Mumford
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SAMPLE BUDGET SUMMARY
FOR NON - CONSTRUCTION RELATED PROJECTS
NAME OF AGENCY, INC.
ABC PROGRAMMING
CDBG
FY 2007
SUMMARY BUDGET
JANUARY 1, 2007 — DECEMBER 31, 2007
CATEGORIES Non -OCED CDBG 2007 TOTAL ALL
SOURCES
1. PERSONNEL 119,236 23,169 $ 142,405
IL CONTRACTUAL SERVICES
Ill. OPERATING SERVICES
IV. COMMODITIES
V. CAPITAL OUTLAY
TOTAL BUDGET
9,500 9,500 $19,000
6,750 6,750 $ 13,500
800 800 $ 1,600
0 0 $ 0
$136,286 $40,219 $176,505
OTHER FUNDING SOURCES (Non- OCED):
ABC Grant $50,000
BL Grant $86,286
Total $136,286
SAMPLE BUDGET FOR NON-CONSTRUCTION RELATED PROJECTS
AGENCY NAME, INC.
CDBG FY 2007
[PROJECT NAME]
DETAIL BUDGET
January 1, 2007 thru December 31, 2007
04010 Fringe Benefits
Fica:11,000 x .0620 = 628 x 100%
PP
Non OCED
OCED
TOTAL OCED
TOTAL ALL SOURCES
04010 PERSONNEL - Employee
$800
1,530
11.43
297
$1,827
Regular - Salaries
$0.00
5,665
Bi -Weekly
1,101
$6,766
Executive Director
26
38,000
0
0
$38,000
Deputy Director
26
47,000
0
0
$47,000
Case Manager
26
12,500
480.77
12,500
$25,000
Tutor
26
8,000
307.69
8,000
$16,000
Subtotal Salaries
105,500
788.46
20,500
$126,000
04010 Fringe Benefits
Fica:11,000 x .0620 = 628 x 100%
$50,000
6,541
48.88
1,271
$7,812
Mica: 11,000 x .0145 =160
$800
1,530
11.43
297
$1,827
Worker's Compensation
$0.00
5,665
42.34
1,101
$6,766
Subtotal Fringe
$800
13,736
102.66
2,669
$16,405
25330 Rent Copier
$1,600
1,500
0.00
1,500
$3,000
Total Personnel
119,236
891.12
23,169
$142,405
Contractual Services
21011 External Audit
$50,000
2,000
0.00
2,000
$4,000
21020 Accounting Services
$800
0
0.00
0
$0.00
21030 Other Professional Svc.
$0.00
0
0.00
0.00
$0.00
22350 Bottled Water
$800
0
0.00
0
$0.00
25330 Rent Copier
$1,600
1,500
0.00
1,500
$3,000
25511 Building Rental
6,000
0.00
6,000
$12,000
Total Contractual
9,500
0.00
9,500
$19,000
Operating Expense
22010 Electrical Services
$50,000
2,000
0.00
2,000
$4,000
23210 General Liability Insurance
$800
1,500
0.00
1,500
$3,000
23220 Automobile Liability Insurance
$0.00
1,250
0.00
1,250
$2,500
31011 Telephone Regular
$800
1,250
0.00
1,250
$2,500
31011 Telephone Long Distance
$1,600
150
0.00
150
$300
31610 Postage
600
0.00
600
$1,200
31420 Ad rtising Radio
0.00
0.00
0.00
$0.00
Total Operating Expense
6,750
0.00
6,750
$13,500
Commodities
$50,000
31510 Outside Pdnting
$86.286
400
0.00
400
$800
95020 Computer Purchase
0
0.00
0
$0.00
47010 Office Supplies/Outside Vendors
400
0.00
400
$800
Total Commodities
1
800
0.00
800
$1,600
Capital Outlay
$50,000
BL Grant
$86.286
0.00
0.00
0.00
0.00
Total Capital Outlay
0.00
0.00
0.00
0.00
TOTAL BUDGET $136,286 0.00 $40,219 1 $176,505
List of all other funding sources and corresponding amounts as indicated below:
ABC Grant
$50,000
BL Grant
$86.286
Total
$136,286
SAMPLE OF ACTION STEPS,
SCOPE OF SERVICES, AND BUDGET
FOR CONSTRUCTION RELATED
ACTIVITIES
C: /Contract Development Workshop /List of Contents/Brianna
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EXAMPLES OF ACTION STEPS
FOR
CONSTRUCTION PROJECTS (HOUSING, CAPITAL IMPROVEMENT, OR ECONOMIC DEVELOPMENT)
ACTION STEPS I YES I NO I NOTES /COMMENTS 1
PRE- DEVELOPMENT PHASE (DESIGN PHASE)
ENVIRONMENTAL CLEARANCE (OCED APPROVAL REQUIRED)
COMPLETE ENVIRONMENTAL REVIEW FORM & SUBMIT'f0 OCED FOR
SOLICITATION RFP / RFQ FOR ARCHITECTURAL SERVICES
REQUIRES WRITTEN APPROVAL FROM OCED PRIOR TO PUBLICATION
3 I EVALUATION OF RFP / RFQ RESPONSES
4 1 RECOMMENDATION, SELECTION/ AWARD
EXECUTE CONTRACT FOR ARCHITECTURAL SERVICES
REQUIRES WRITTEN APPROVAL FROM OCED PRIOR TO EXECUTION
6 ISSUE NOTICE TO PROCEED
7 COMMENCE & COMPLETE DESIGN DRAWINGS/
SPECIFICATIONS/ RFP
J8 MONITOR MANAGEMENT
FINAL DRAWINGS / SPECIFICATIONS / RFP
CONSTRUCTION PLANS & SPECIFICATIONS REQUIRE OCED APPROVAL PRIOR
TO IMPLEMENTATION
110 I SEEK AND OBTAIN FIRM FINANCING COMMITTMENTS I
SUBSIDY LAYERING REVIEW / ANALYSIS
REQUEST FROM OCED
PRE -DID PHASE
ENVIRONMENTAL CLEARANCE (OCED APPROVAL REQUIRED)
COMPLETE ENVIRONMENTAL REVIEW FORM & SUBMIT TO OCED FOR
Pr% /IC \A / /APPRr'N/nl -
1 2 I APPRAISAL/ MARKET ANALYSIS/ PRO FORMA ANALYSIS I I
SUBSIDY LAYERING REVIEW / ANALYSIS
REQUEST FROM OCED
61 BID / RFP PACKAGE FOR GENERAL CONTRACTOR (GC)
REQUIRES WRITTEN APPROVAL FROM OCED PRIOR TO PUBLICATION
DAVIS -BACON WAGE DETERMINATION
MUST BE REQUESTED FROM OCED & BE INCLUDED IN THE OCED APPROVED
BID PACKAGE
ADVERTISEMENT
7 I PRE -BID CONFERENCE,
POST -BID PHASE
1 BID / RFP OPENING
2 RECOMMENDATION, SELECTION / AWARD
3 VERIFY GC IS NOT ON DEBARMENT LIST
4 OBTAIN EVIDENCE OF GC CURRENT LICENSE & CURRENT
OCCUPATIONAL LICENSE
5 PAYMENT AND PERFORMANCE BOND
PAGE 1 OF 2
EXAMPLES OF ACTION STEPS FOR CONSTRUCTION RELATED ACTIVITIES
REVISEo 2127106
ACTION STEPS I YES I NO I NOTES / COMMENTS
6 I CERTIFICATES O OF INSURANCE (REFERENCE ATTACHMENT B -1 OF
EXECUTE CONTRACT FOR GENERAL CONTRACTOR
REQUIRES WRITTEN APPROVAL FROM OCED PRIOR TO EXECUTION
(CONSTRUCTION PHASE
1 MDHA HOME LOAN CLOSING
PRE - CONSTRUCTION CONFERENCE (INCLUDE WORK SCHEDULE
AND MAINTENANCE OF TRAFFIC)
CONTACT & COORDINATE WITH OCED PRIOR TO SCHEDULING
3 RELEASE NOTICE TO PROCEED
4 1 OBTAIN PERMITS
15 I COMMENCE CONSTRUCTION I I I I
6 I CONSTRUCTION MANAGEMENT & MONITORING I I I I
WEEKLY PAYROLLS & PAYMENT CERTIFICATIONS
(LABOR COMPLIANCE
REQUIRES OCED REVIEW AND APPROVAL
8 SECTION 3 PLANS, COMPLIANCE, MONTHLY REPORTS
MONTHLY SUBMITTAL OF CONSTRUCTION RELATED
PAYMENT REQUESTS / REIMBURSEMENT REQUESTS
REQUIRES OCED REVIEW AND APPROVAL
10 SUBMITTAL OF QUARTERLY PROGRESS REPORTS AND
ANNUAL REPORT
11 RELEASE OF LIENS (OBTAIN RELEASE / WAIVER OF LIENS FROM ALL
CONTRACTORS AND SUPPLIERS)
12 CONDUCT FINAL "WALK -THRU"
13 CERTIFICATE OF COMPLETION
14 1 "AS BUILT" DRAWINGS
1 15 1 OBTAIN CERTIFICATION OF OCCUPANCY
1 16 1 PROJECT COMPLETION FORM I I I
-- OTHER --
ADDITIONAL CONSTRUCTION RELATED ITEMS THAT REQUIRE PRIOR WRITTEN APPROVAL FROM OCED
ADDITION OF ANY POSITION NOT SPECIFICALLY LISTED IN
THE APPROVED BUDGET
PAGE 2 OF 2
EXAMPLES OF ACTION STEPS FOR CONSTRUCTION RELATED ACTIVITIES
REwsm 2127106
SAMPLE CONSTRUCTION BUDGET FOR HOME OR CDBG FUNDS
Agency Name
OCED FY 2007
January 1, 2007 - December 31, 2007
SUB OBJECT DESCRIPTION HOME or CDBG OTHER AMT TOTAL AMT
AMOUNT
Personnel expenses 01 Personnel
are not allowable for
Executive Director
$0
$23,077
$23,077
construction related
Housing Assistant
$0
$0
$0
projects.
FICA/MICA
$0
$1,883
$1,883
Total Personnel
$0
$24,960
$24,960
20 Contractual Services
21010
Audit External
$10,000
$0
$10,000
Accounting Services
$0
$3,600
$3,600
23210
General Liability Insurance
$1,000
$0
$1,000
23220
Auto Liability
$1,000
$0
$1,000
23620
Other Insurance Expense:
$1,000
$0
$1,000
Builders Risk
Flood
61613
Title Insurance
$5,000
$0
$5,000
21030
Construction Manager (Consultant)
$25,000
$0
$25,000
21420
Appraisal & Surveying Services
$7,000
$0
$7,000
24421
Property Maintenance
$5,000
$0
$5,000
21210
Attorney's Fees
$5,000
$0
$5,000
31420
Marketing
$10,000
$0
$10,000
Total Contractual
$70,000
$3,600
$73,600
Personnel expenses
30 Operating Expenses
are not allowable for
Electric/Telephone
$0
$7,400
$7,400
construction related
Water & Sewer Services
$0
$1,000
$1,000
projects.
Total Operating Expenses
$0
$8,400
$8,400
Personnel expenses
40 Commodities
are not allowable for
Office Supplies
$0
$1,400
$1,400
construction related
Office Equipment
$0
$5,000
$5,000
projects.
Rent
$0
$12,000
$12,000
Total Commodities
$0
$18,400
$18,400
90 Capital Outlay
91090
Purchase Price of Land
$75,000
$0
$75,000
91012
Environmental
$5,000
$0
$5,000
91021
Site Preparation
$5,000
$0
$5,000
91111
Fence Installation
$2,000
$0
$2,000
94210
Prime Contractor - Construction
$0
$0
$0
Property Taxes
$0
$5,000
$5,000
32250
Building Permits
$10,000
$0
$10,000
61626
Architect Fees
$13,000
$0
$13,000
26250
Impact Fees
$20,000
$0
$20,000
Total Capital Outlay
$130,000
$5,000
$135,000
TOTALS
$200,000
$60,360
$260,360
OTHER FUNDING SOURCES (Non -OCED)
ABC Grant $30,000
First Bank Loan $30,360
Total $60,360
LIST OF REQUIRED DOCUMENTS TO BE
SUBMITTED BY THE AGENCY
C: /Contract Development Workshop /List of Contents /Brianno
REQUIRED DOCUMENTS FOR CONTRACT DEVELOPMENT TO
BE PROVIDED BY THE AGENCY
1. LIST OF CURRENT BUSINESS ASSOCIATIONS
2. MOST CURRENT ARTICLES OF INCORPORATION
3. MOST CURRENT BYLAWS
4. MOST CURRENT BOARD OF DIRECTOR'S ROSTER
5. MOST CURRENT IRS TAX EXEMPT STATUS DETERMINATION LETTER
6. MOST CURRENT IRS FORM 990
7. MOST CURRENT STATE OF FLORIDA CORPORATE CERTIFICATE
8. CERTIFICATE OF GOOD STANDING FROM DEPARTMENT OF STATE