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<br />Full Legal Name <br /> <br />Address <br /> <br />Ownership <br /> <br />% <br /> <br />% <br /> <br />% <br /> <br />2. The full legal names and business address of any other individual (other than subcontractors, <br />material men, suppliers, laborers, or lenders) who have,or will have, any interest (legal, equitable <br />beneficial or otherwise) in the contract or business transaction with Dade County are (post Office <br />addresses are not acceptable): <br /> <br />3. Any person who willfully fails to disclose the information required herein, or who knowingly <br />discloses false information in this regard, shall be punished by a fine of up to five hundred dollars <br />($500.00) or imprisonment in the County jail for up to sixty (60) days or both. <br /> <br />~ R II. MIAMI-DADE COUNTY EMPLOYMENT DISCLOSURE AFFIDAVIT (County Ordinance No. 90- <br />133, Amending sec. 2.8-1; Subsection (d)(2) of the County Code). <br /> <br />im. <br /> <br />Except where precluded by fed~ral or State laws or regulations, each.contract or business transaction or <br />renewal thereof which involves the expenditure often thousand dollars ($10,000) or more shall require <br />the entity contracting or transacting business to disclose the following information. The foregoing <br />disclosure requirements do not apply to contracts with the United States or any department or agency <br />thereof, the State or any political subdivision or agency thereof or any municipality of this State. <br /> <br />1. Does your firm have a collective bargaining agreement with its employees? <br />Yes No <br /> <br />2. Does your firm provide paid health care benefits for its employees? <br />Yes . No <br /> <br />3. Provide a current breakdown (number of persons) of your firm's <br />work force and ownership as to race, national origin and gender: <br /> <br />White: <br />Black: <br />Hispanics: <br /> <br />Males <br />Males <br />Males <br />-Males <br /> <br />Females <br />Females <br />Females <br />Females: <br /> <br />Males ' <br />Males - <br />Males <br />Males <br /> <br />Asian: <br />American Indian: <br />Aleut (Eskimo): <br /> <br />Females <br />Females <br />Females <br />Females <br /> <br />AFFIRMATIVE ACTION/NONDISCRIMINATION OF EMPLOYMENT, PROMOTION AND <br />PROCUREMENT PRACTICES (County Ordiriance 98-30 codified at 2-8. L5 of the County Code.) <br /> <br />In accordance with County Ordinance No. 98-30, entities with annual gross revenues in excess of <br />$5,QOO,000 seeking to contract with the County shall,as a condition of receiving a County contract, <br />have: i) a written af:fmnative action plan which sets forth the procedures the entity utilizes to assure that <br />it does not discriminate in its employment and promotion practices; and ii) a written procurement policy <br />which Sets forth the procedures the entity utilizes to assure that it does not discriminate against minority <br />and women-ownedbtciinesses in its own procurement of goods, supplies and services. Such affinnative <br />action plans and procurement policies shall provide for periodic review to determine their effectiveness <br />in assuring. the entity does not .discriminate in its employment, promotion and procurement practices. <br />The foregoing notwithstanding, corporate entities whose .boards of directors are representative of the <br />population make.;.up of the nation shall be presumoo to have non-discriminatory employment and <br />procurement policies, and shall not be required to have written affirmative action plans and procurement <br />policies in order to receive a Cowity contract. The foregoing presumption may be reb"utted. <br /> <br />9 of 16 <br /> <br />vi!- <br />