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<br />11/13/1998 13:48 <br /> <br />31215-9474385 <br /> <br />SUNNY ISLES BEACH <br /> <br />PAGE 04 <br /> <br />Thc filII k:;al 1l:JII1CS :ll,d bll5l:ICliS addiCSS of ;)II~ ollll;:r II1dl\ Idu:'ll (olhcr Ihall subcol1(raclors m.llcn:I:1l1CI1. <br />slIppllers. laborers. or lendcrs) \\ho 1I:1\'c. or \\llIl\:I\C:. an~ II1lerC:Stllc:gJI. l:QulIablc beneficIal or olher\IISc) ,,' Ih.: <br />COl1tr:'lcl or bUSlncSS lrnnS41l:1I0n \\ 1111 Dadc COllll!) arc I Post Office: :lddrcsscs arc nOI acceplable) <br /> <br />N/A <br /> <br />, An~ pc:~n who \';llfully fails 10 disclose lhe informauon n:quircd hcn:in. or who kno\\ingly di~10~5 false: <br />in{onnallon in this regard. sh.illl be punished ~ a line of up to fi\'e hundrc4 dollars (SS()() (0) or lInpnsomnent In <br />the Coun~. jail ror up \0 Sl~ry <"el) d.a~'s 0:- both. <br /> <br />II. ~O-D^DE COU'NTY EMPLOYMENT DISCLOSURE AFFIDAVIT (Cololnry Ordinance No. \)U-Ll:i. Amcnc1ing <br />SC'C:. 2.M-I: Subseclion (dl(2) of thc COU\ll~ CIXie::). <br /> <br />E~ccpt where precluded by federal or 51:111: iaws or rcl"lalions. ~ch c:ontroct or bWlncss transaclion or rcnc'\\"allhen:cf <br />w!lIeh ill\'ohes Ihe c~pcndilure of le:n Iho\l..'lo!nd collars ($ I C).()OO) or mOR shall requin: lhe enllt'i conlractmg or <br />tr:lnsaclin~ business 10 disclose the follOWing ItUonnOlllon. The foregoing disclosure rc:qultcmc:nLS do ""I apply 10 <br />l"~r:'~e;s with the: Uni:c:c1 Sl:lr~s or art'. dC?3.:1lncnl 0:- ;:~ency .hereof. :!'le S13:e or 3n\' pclll:C::! So.l~1\'l5:cn ~r :lgc:'.=:: <br />Ihc:~or or 3n~ In\lnll:ipillil~ of Ihis SLate::. <br /> <br />J. <br /> <br />Oocs ~'our firm ha\'1: a colleclive bargaining agreement ......ilh Its em"lo~'ecs? <br /> <br />y ~ ....x.. III 0 <br /> <br />., <br />J.. <br /> <br />Docs your rirm pro'l.'lde p<tlci hcailh c:1M: benelits fot ils cmplo~'ees'7 <br /> <br />..!... Ye:s <br /> <br />No <br /> <br />} <br />~ <br /> <br />3. Pro',ide a CUrTenl bn:ait.down (nu:nbtr of p::rsons) of ~'our firm's work for~ and ownel'!hlp as to r.lct!:. national <br />origin nnd gender: <br /> <br />While: <br />Blade: <br />HispaniCS: <br /> <br />~ Males <br />~ Males <br />....l.3.. M a I es <br />Males <br /> <br />~ Femalcs <br />4 Fcrnalc:s <br />_-1. F~m.ales <br />F~ln.:ll=s <br /> <br />ASIan: <br />Amenc:.,n Indian: <br />Aleut tEskilno): <br /> <br />-1.. Males <br />Males <br />Males <br />Males <br /> <br />Females <br />Females <br />Females <br />Fe1T\i11~ <br /> <br />[[I, METRO-DADE COUNTY CRlMINAL RECORD AfFTOA VlT cSccllon 2-!l.(1 of .he Coun~' Code) <br /> <br />The indh'idual or emit'.' Cf\lCnng imo a ContraCt or n-c;:,:iving funding from lhc County _ has ...L. has not as of lhe <br />d.ate of Ilus affid.a\'u been eon'Vt(,:t~ of a fr;:~cmy during the past ten ( Ill) YC3r5. <br /> <br />An officer. director. or execulive of the cnt:ty entering into a contract or l"I:'CI:iving funding from Ihe Coumy _ 1\iiS <br />.....x.. has not as of the d:au: gf this aJlidavit ba:n con\lu:tcd of a fclon" durine the past ICft ( IIlI )'C:ln. <br /> <br />IV. METRQ..O..oE COUNTY ClJ'BA AFFILlA V1T (Coun~ Resolutions R-2112-YF, and R-20(.-~(,) <br /> <br />ThaI ncuher the firm (individual. organil.iltion. corporalion. etc:.) submilllng this bid or p~pg58l or n:l::e:I,,'ing this <br />c:onlmC:lllward or lIny of its owners. :oubsicf:,:mcs. or affili.uai or related firms has: <br /> <br />I. engaged in the purchase. lranspon. imponation or pilnic:ipalion in an~' lransaction In\'olvlng Inerc:handise Ihat: <br /> <br />:1. is of Cub..n origin: or <br /> <br />b. is or has bc:r:n lo.::oltc:d in or tran~ponc:d from or through Cuba: or <br />- ;. .__..l. -- ..-....,_~ ;~ ".I.~I. -r;~ .,""" of a"" "ni"'~ \\.1.1"" or ..... ft....,...... ..-.......,.,. ,n"nu(aClun: of Cuba: <br />.... '~'I'''W~ WI w~.,....... '" .. 1.......- :.. ,..U.L ".' U _.. I' _.t.... "I.... e'---O'h ,...__..- - <br /> <br />Page: :2 of .5 <br /> <br />II v. <br />I tWit '.~""("'/II" ....11 <br />