01-06-04 Item 5TO: Honorable Mayor, Vice Mayor DATE: January 6, 2004
& City Commission
FROM: Maria V. Davis
City Manager
AGENDA ITEM No.
RE: Authorizing the City Manager to
execute a grant contract with Miami -Dade
County Office of Community and Economic
Development
RESOLUTION:
A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY OF
SOUTH MIAMI, FLORIDA, AUTHORIZING THE CITY MANAGER TO EXECUTE
A GRANT AGREEMENT WITH MIAMI -DADE COUNTY FOR THE CHURCH
STREET IMPROVEMENTS — PHASE II GRANT AWARD OF $95,000 THROUGH
THE OFFICE OF COMMUNITY & ECONOMIC DEVELOPMENT; PROVIDING AN
EFFECTIVE DATE.
BACKGROUND & ANALYSIS:
Following the grant application we submitted for funding last summer, Miami -Dade
County has awarded $95,000 to the City towards the Church Street Improvements Phase
II project. The grant is funded through the Miami- Dade County Community
Development Block Grant (CDBG) for the Fiscal Year 2004.
The phase II improvements along Church Street, between SW 68th Street and SW 69th
Street, will include widening of the sidewalk, installation of electrical conduits for new
street lights, landscaping with irrigation system, street furniture with pre- fabricated bus
shelter, roadway re- construction and pavement marking.
RECOMMENDATION:
It is recommended that the City Commission approve the resolution.
ATTACHMENTS:
❑ Proposed Resolution
❑ Copy of Required Documents for Contract Development received from OCED
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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 A GRANT AGREEMENT WITH
MIAMI -DADE COUNTY FOR THE CHURCH STREET IMPROVEMENTS — PHASE II GRANT AWARD
OF $95,000 THROUGH THE OFFICE OF COMMUNITY & ECONOMIC DEVELOPMENT; PROVIDING
AN EFFECTIVE DATE.
WHEREAS, the Mayor and City Commission wish to accept FY 2004 grant funds from Miami -Dade
County Office of Community & Economic Development and;
WHEREAS, the grant will partially fund the Church Street Improvements Phase II, and;
WHEREAS, the Mayor and City Commission authorize the City Manager to execute the grant
contract for FY 2004 Community Development Block Grant (CDBG) with Miami -Dade County Office of
Community & Economic Development.
NOW THEREFORE, BE IT RESOLVED BY THE MAYOR AND CITY COMMISSION OF THE CITY OF
SOUTH MIAMI, FLORIDA:
Section l: The city wishes to accept the FY 2004 CDBG from Miami Dade County Office of
Community & Economic Development.
Section 2: That the Mayor and City Commission authorize the City Manager to execute the FY
2004 grant contract with Miami -Dade County Office of Community Development.
Section 3: This resolution shall be effective immediately upon adoption.
PASSED AND ADOPTED this
APPROVED:
City Clerk
READ AND APPROVED AS TO FORM:
CITY ATTORNEY
day of , 2004.
ATTEST:
Horace G. Feliu, Mayor
Commission Vote:
Mayor Feliu:
Vice Mayor Russell:
Commissioner Bethel:
Commissioner Wiscombe:
Commissioner McCrea:
OFFICE OF COMMUNITY AND
MIAMI- ECONOMIC DEVELOPMENT
Director's Office
COMMUNITY AND ECONOMIC DEVELOPMENT PHONE: 305-375-3848
FAX: 305 - 375 -3428
140 W. FLAGLER STREET, SUITE 1000 kfinnie miamidade.gov
MIAMI, FL 33130 -1561 www.miamidade.gov /ced/
November 14, 2003
Ms. Silvia Jarquin
Grants Admin.
City of South Miami
6130 SUNSET DR
S MIAMI, FL 33143
RE: Contract Development Process for FY 2004
Dear Ms. Jarquin:
On November 12, 2003, the Board of County Commissioners held a public hearing to discuss the
proposed funding allocations for the 2004 Action Plan. Those recommendations, which include
funding allocations for your agency, describe those projects that may be funded through the
Community Development Block Grant (CDBG), the HOME Investment Partnership Program,
the Emergency Shelter Grant (ESG), and the Documentary Surtax Program. The Board will
consider the final version ofthe 2004 Action Plan on Thursday, December 4, 2003.
At this point, staff cannot ensure you that the Board - will not alter the funding
recommendations. However, we are asking you to complete the required documents that
accompany this letter to expedite the processing of your agency's agreements.
Our district teams will schedule meetings with you during the week of November 17 -21 to
discuss the completion' of those forms and of 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 2004 Action Plan.
Please contact Richard Hoberman, your contracts officer, at (305) 375 -3472, if you have any
questions about the required documents.
Sincerely,
A,
Felipe M. Rivero, III
Supervisor
Contracts Management and Monitoring Section
C Tocuments and Set ingskonsan\Desktop\FY 2004 REQUIRED DOCUMENTS LETTERmerge2.doc -
Last saved by Miami -Dade OCED.11 /14/03 12:38 PM
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.
• CODE OF BUSINESS ETHICS AFFIDAVIT.
SAMPLE OF ACTION STEPS FOR SCOPE OF SERVICES.
• SAMPLE BUDGET.
• LIST OF REQUIRED DOCUMENTS TO BE SUBMITTED BY THE
AGENCY
C: /Contract Development Workshop /List of Contents /Brionnn
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CONTRACT DEVELOPMENT WORKSHOP
LIST OF CONTENTS
RESOLUTION AUTHORIZING EXECUTION OF A CONTRACT WITH
MIAMI =OA®E 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 2004 and
authorizes and
to execute sane for and on behalf of
The foregoing resolution was offered by who moved its
adoption, the motion was seconded by , and
upon being put to a vote was as follows:
The Chairperson /President thereupon declared this resolution duly passed and adopted
this day of
Signature- Chairperson or Secretary Agency Seal
-
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)
I. Prime Contracts Subcontracts
II. Checks (List amount Limits)
III. Budget Revision Requests
1
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 f ®r auditing purposes.
• You are required to submit updates to this list as it becomes necessary.
MIAMI -DADS COUNTY AFFIDAVIT
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.
I, 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 Elntity; Individual(s), Partners, err- Corporation
e s above, blank
Su �ir9ess
As If same a
Doing � ( )
i
Street Address City State Zip Code
lm 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 l 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 � egal 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.
11. MIAMI -DADE COUNTY EMPLOYMENT DISCLOSURE AFFIDAVIT (County Ordinance No.
90- 133,
III. 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 Aluet (Eskimo): Males Females
Males Females Males Females
tl AFFIRMATIVE ArTlflhl /nlflhl_rllCt'I Ill.. I�I�'i'1W nc EMPLOYMENT, ®nnRnr„ -,r,AB dr•
_ /NO r IQr 1KAI NATION vl L.-M LO I ME \9 1 , FRO lI�IC CM ON
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 1st Avenue, 28th Floor, Miami,
Florida 33128.
The firm has annual gross revenues in excess of $5,400,000 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 1 st 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. banger of drug abuse in the workplace
2. The firm's policy of maintaining a drug -free environment at all workplaces
3. Availability of drug counseiing, 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
.J Uru g 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 11 A -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 or 5
i
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.
Vil DISABILITY NON - DISCRIMINATION AFFIDAVIT (County Resolution 8385 -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 lusted 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. 1 21 01 -1 221 3 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.
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
n -3eu -99 tea ray Submitting a waiver request affidavit. The foregoing requirement does not pertain
to government entities, not for profit organizations or recipients of grant awards.
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.
Page 4of5
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 "NiK' all affidavits that do
not pertain to this contract.
By,
(Signature of Affiant) (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 of Stamp of Notary) (Expiration Date)
Notary Public ® State of
(State)
Page 5of5'
AFFIDAVIT OF FINANCIAL AND CONFLICTS OF INTEREST
1. Da 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:
A„y false InJorrination 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 Notary Seal
(State)
SWORN STATEMENT PURSUANT TO SECTION 287.133 (3) (a)
FLORIDA STATUES 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 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. I 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 287.1 33(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)
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
flan 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 _10 Oln plv�rled or pl eviou.7ly employed'by ti 1W pr ItI1 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 Cade
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: 20
Signature of Affiant Date
Printed Name and Title of Affiant Federal Employer Identification Number
Printed Name of Firm
Address of Firm
SUBSCRIBED AND SWORN TO (of affirmed) before me this day of ,20
He /Sheds personally known to or has presented as identification.
Type of identification
Signature of Notary Serial Number
Print or Stamped Name of Notary Expiration Date
Notary Public, State of
SAMPLE SCOPES OF SERVICES
e SAMPLE I — Public Service Activity with new clients eves
quarter
SAMPLE II - Public Service Activity with same clients
every quarter.
e SAMPLE III Economic Development activity.
e SAMPLE IV — Construction/Housing activity.
Aleency Name
2002. FY
Scope ofServices
January 1, 2002 December 31, 2 .002
I.- AC E;
Employment and Training Program
2.- ACTTVITY DESCRIPTION:
Employment training for 100 people countywide in FY 2002
3.- APPROVED BY BCC:
$50,000
4.-SOURCE
CDBG 2002
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:
570.20B(a)(2) - Low / Mod. Income Ciientele (LMC) .
8. AC'lMTY ADDRESS:
4343 W Flagler ST, STE 3QQ
Miami FL 33134
9: EOCAT ON:
Entitlement City (Miami)
CO.- Sonia Colon
PLANNER: A.B. Mumford
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NOTE: YOU MUST USE THE ACTION STEP FORMAT THAT IS DESCRIBED
ON THE FOLLOWING PAGE
INSTRUCTIONS
FOR CONSTRUCTIONi REHABILITATION, HOUSING AND
ADMINISTRATIVE COSTS
ACTION STEP FORMAT
AGENCY NAME
The legal name of your agency
ACTIVITY
The title of the activity being funded through OCED
FUNDING
SOURCE
The OCED funding source (CDBG, HOME, ESG, HATF, HDG)
AMOUNT
Indicate the amount of funding that you are seeking from OCED for the
activity
TOTAL ACTIVITY
COST
Indicate the total cost of the activity
TOTAL AVAILABLE
FUNDING
(ALL SOURCES)
Indicate the total funding that you have secured for the activity from non-
OCED and OCED funding sources.
ACCOMPLIS , N
UNITS
Indicate the total number of service units that your project will achieve
throughout the grant period.
Ind.icate the service unit type — housing, building, organization, etc.
COLUMN I
Indicate the quarter of operation
COLUMN 11
Identify in 3 -4 words each service that the project will conduct during
each quarter,
COLUMN HI
On the shaded line at the bottom of each quarterly interval, indicate the
year to date percentage of completion that the project will achieve each
quarter. NOTE: The total percentage of completion for the grant period
will consist of [AMOUNT +TOTAL AVAILABLE FUNDING (NON -
OCED ) /TOTAL ACTIVITY COSTS] X 100.
COLUMN IV
Indicate on each of the shaded lines for each quarter the total number of
service units that the project will accomplish year to date.
COLUMN V
Indicate on each of the shaded lines for each quarter the portion of the
project's total allocation that the project will expend year to date.
i
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— — - _ --
r
NOTE: . YOU MUST USE THE ACTION STEP FORMAT THAT IS DESCRIBED
ON THE FOLLOWING PACE
INSTRUCTIONS FOR PUBLIC SERNJCES AND ECONOARC DEVELOPMENT
ACTION STEP FORMAT
AGENCY NAME
The legal name of your agency
ACTIVITY
The title of the activity being funded through OCED
FUNDING
SOURCE.
The OCED funding source(CDBG, HOIE, ESG, HATF, HDG)
AMOUNT
Indicate the amount of funding that you are seeking for the activity
ACCOMPLISHMENT
UNITS
Indicate the total number of service units that your project will achieve
throughout the grant period.
TYPE
Indicate the service unit type — people, elderly, children, etc.
COLUMNI
Indicate the quarter of operation
COLUMN H
Identify in 3 -4 words each service that the project will conduct during
each quarter.
COLUMN III
Using only one of the following categories - quarterly, monthly, weekly,
daily - identify the frequency of the proposed service. If the project will
provide a specific service several times within a service interval, then
indicate so as part of Column II (eg. For counseling services that will
occur twice per week should be stated as "Counseling Services (2)
Weekly").
COLUMN IV
Indicate the number of persons out of the project's population that will
be affected by each action step.
COLUMN V
Indicate on each of the shaded lilies for each quarter the total number of
service units that the project will accomplish year to date.
COLU3Vq VI
Indicate on each of the shaded lines for each quarter the total number of
clients that the project will serve year to date.
COLUMN VII
Indicate on each of the shaded lines for each quarter the portion of the
project's total allocation that the project will expend year to date.
s
ABC PROGRAMAENG
CDD
FY 2002
SAY BUDGET
JANUARY 1, 2002- DECEMBER 31, 2002
CATEGORIES FY 2002
I. PERSONNEL. $ 11,788
H. CONTRACTUAL SERVICES $ 40,000
III. OPERATING SERVICES $ 4,000
IV. CG3 aDITTES $ 1,600
V. CAPITAL OUTLAW $ 65,579
TOTAL BUDGET s1:!5,967
AGENCY NAME, INC.
GDBG FY 2002
[PROJECT NAME]
DETAIL BUDGET
January 1, 2002 thru December 31, 2002
04010 Fringe Benefits
Fica:11;000x.0620= 628x100%
Mica:11,006x.0145 =160
Subtotal Fringe
OP
Pdon OCEF�
OCE�3
Total OCED
Total AH Sources
N010 PERSONNEL - Em do ee
0.00
2,500
$2,500.00
0
$0.00.
Regular - Salaries
26
38,0D.0
Bi -Vdeek
0
0
$38,000.00
Executive Director
Deputy Director
26
47400
0
0
$47,000.00
Office Mgr.
26
0
423.08
11,OOD
$11,000.00
Recepii Mist
26
0
' 400.00
0
$0.00
Subtotal Salaries
85,000
0
11,000
596,0f10.00
04010 Fringe Benefits
Fica:11;000x.0620= 628x100%
Mica:11,006x.0145 =160
Subtotal Fringe
01 0.00 0 $0.00
0
0
0
0.00
0.00
0.00
628
160
788
$628.00
$160.00
$788.00
21011 External Audit
0.00
2,500
$2,500.00
0
$0.00.
Total Personnel
300
0
0.00
11,788
$96:,788.00
Contractarad Services
01 0.00 0 $0.00
D
O.OQ
4.000
$4,000.00
21011 External Audit
0.00
2,500
$2,500.00
0
$0.00.
21012 Environmental Audit
300
0
0.00
0
0.00
21030 Other Professional -Svc. Const.M m.
$1,200.00.
0
0.00
30,000
$30,000.00
21030 Other Professional Svc.
$0.00
0
0.00
..: 0
$0.00
22350 Bottled Water
$4,000.00
0
0.00
0
$0.00
25330 Rent Copier
01
0.00
0
$0.00
25511 Building Rental
01
0.00
610001
.,$6,000.00
Total Contractual
0
0A0
40,0001__
540,000.00
2 rafdrq F S erase
01 0.00 0 $0.00
31510 Outside Pdnfin
125,987
0
31011 Telephone Regular
0
0.00
2,500
$2,500.00
31011 Telephone Long Distance
0
0.00
300
$300.00
31610 Postage
0
0.00
1200,
$1,200.00.
31420 Advertisin Radio
' -0
0.00
0
$0.00
Total Operating Expense
0
0.00
4,000
$4,000.00
commodities
01 0.00 0 $0.00
31510 Outside Pdnfin
125,987
0
0.00
400
$400.00
95020 Computer Purchase
0
0.001
2j.
$0.00
47010 Office supplies/Outside Vendors
0
0.001
1,2001
$1;200.00
Total Co¢rernodifries
0
0.001
1,6001
$1,600.00
Capital Outdo
61620 Basic Architectural fees
01 0.00 0 $0.00
61620 Prime Contractor
125,987
01
O.OGI
68,579F
$68,579.00
Total Capital Outlay
01
0.001
68,5791
$68,579.00
TOTAL BUDGET
85,000
0.0Q
125,987
5210,967.00
Agency Name
DOME SAMPLE BUDGET
OCED FY2DO2
January 1, 2002 - December
31, 2002
CHDO
I3ESCRIPTIOIV
HOME AMT
HOME AMT
OTHER AMT
TOTA!_ AIVIT
01 Personnel
Executive Director
$0
$32,308
$23,077
$55,385
Mousing Assistant
$0
$3;846
$0
$3,846
FICA
.$0
$3,846
.$1,883
$5,729
20 Contractual Services
Audit External (2000.,& 2001)
$10,060
$0
$0
$10,000
Accounting Services
$0
$0
$3,600
$3,600
General Liability Insurance
$3,000
$0
$0
$3;000
Title Insurance
$5,000
$0
_ $0
$5,000
Construction Manager(Consultant)
$26,000
$0
$0
$25,D00
;appraisal & Surveying Services
$7,000
$0
$0
$7,000
Property .:Maintenance
$5,000
$0
$O
$5,000
Attorney's Fees
$8,000
$0
$0
$5,000
Marketing
$10,OD®
$®
$0
$10,0D0
30 Operating Expenses
€iecMc/Teiephone
$0
$0
$7,400
$7,400
dater& Sewer Services
$0
$0
$1,000
$1,000
40 Commodities
Office supplies
$0
$0
$9,400
$1,400
(Office Equipment
$0
$0
$5,000
$S,ODO
Red
$0
$0
$12,000
$12,000
90 Capital Outlay
Purchase Price of Land
$75,000
$0
$0
$75,DDO
Enviromental
$5,000
$0
$0
$51;000
Property Taxes
$0
$0
$5,000
$5,000
Building Permits
$10,000
$0
$0
$10,000
Architect Fees
$10,000
$0
$0
$110;'00D
Impact Fees
$20.1000
$0
$0
$20;000
Financing Cast
$10;000
$0
$0
$16,000
Total
$200,ODO
$40,000
$50,360
$300,360