HomeMy WebLinkAboutLarimer & Co. _ Affidavits & Submittal FormsDELIVER TO: Request for Proposal
City of Sunny Isles Beach SECTION 6
City Clerk PROPOSAL SUBMITTAL OPENING: 2:30 P.M.
18070 Collins Avenue August 13, 2019
Sunny Isles Beach, FL 33160 FORMS
PLEASE QUOTE PRICES F.O.B. DESTINATION, LESS TAXES, DELIVERED IN
CITY OF SUNNY ISLES BEACH, FLORIDA
NOTE: City of Sunny Isles Beach is exempt from all taxes (Federal, State, and Local). Proposal price
should be less all taxes. Tax Exemption Certificate furnished upon request.
Issued by: Purchasing Agent Date Issued: This Proposal Submittal
Genesis Cuevas July 15, 2019 Consists of Pages 25+
Sealed Proposals are subject to the Terms and Conditions of this Invitation to Proposal and the
accompanying Proposal Submittal. Such other contract provisions, specifications, drawings or other data
as are attached or incorporated by reference in the Proposal Submittal, will be received at the office of
the City Clerk at the address shown above until the above stated time and date, and at that time, publicly
opened for furnishing the supplies or services described in the accompanying Proposal Submittal
Requirement.
RFP 19-07-02
Citywide Re -Branding Services
A Proposal Deposit in the amount of 0% of the total amount of the Proposal shall accompany all
Proposals
A Performance Bond in the amount of 0% of the total amount of the Proposal will be required upon
execution of the contract by the successful Proposer and City of Sunny Isles Beach
Procurement Agent: Firm Name:
Genesis Cuevas i
Commodity Code(s):
RETURN ONE ORIGINAL AND FOUR COPIES, AND ONE ELECTRONIC FILE OF PROPOSAL
SUBMITTAL PAGES AND AFFIDAVITS
FAILURE TO SIGN PAGE 26 OF SECTION 6 PROPOSAL SUBMITTAL WILL RENDER YOUR
PROPOSAL NON-RESPONSIVE
REQUEST FOR PROPOSAL NO. 19-07-02
ACKNOWLEDGEMENT OF ADDENDA
INSTRUCTIONS: COMPLETE PART I OR PART II, WHICHEVER APPLIES
I:7_1Afi;
LIST BELOW ARE THE DATES OF ISSUE FOR EACH ADDENDUM RECEIVED IN
CONNECTION WITH THIS PROPOSAL
PART II:
Addendum #1, Dated ��3/. /i
Addendum #2, Dated e, 5-- / 9
Addendum #3, Dated
Addendum #4, Dated
Addendum #5, Dated
Addendum #6, Dated
Addendum #7, Dated
Addendum #8, Dated
❑ NO ADDENDUM WAS RECEIVED IN CONNECTION WITH THIS PROPOSAL
FIRM NAME: .C,,9/1/i��,L �� LorxoAy� ��,•
AUTHORIZED SIGNATURE: DATE:
TITLE OF OFFICER:M� &o-f—
REQUEST FOR PROPOSAL N0. 19-07-02 w I
PROPOSAL SUBMITTAL FORM
The undersigned Proposer proposes and agrees, if this Proposal is accepted, to enter into an agreement
with the City of Sunny Isles Beach to perform and furnish all Services as specified or indicated in the
Contract Documents for the Contract Price and within the Contract Time indicated in this Proposal and in
accordance with the other terms and conditions of the Contract Documents. The Proposer accepts all of the
terms and conditions of the Advertisement or Invitation to Proposal and Instructions to Proposers, including
without limitation those dealing with the disposition of Proposal Security. This Proposal will remain subject
to acceptance for 90 days after the day of Proposal opening. The Proposer agrees to sign and submit the
Agreement and other documents required by the Proposal Requirements within ten days after the date of
the City's Notice of Award.
In submitting this Proposal, the Proposer represents, as more fully set forth in the Agreement, that:
The Proposer has familiarized himself/herself with the nature and extent of the
Contract Documents, work, site, locality, and all local conditions and Law and
Regulations that in any manner may affect cost, progress, performance, or
furnishing of the Work.
The Proposer has given the City written notice of all conflicts, errors,
discrepancies that it has discovered in the Contract Documents and the written
resolution thereof by City is acceptable to the Proposer.
This Proposal is genuine and not made in the interest of or on behalf of any
undisclosed person, firm or corporation and is not submitted in conformity with
any agreement or rules of any group, association, organization, or corporation;
the Proposer has not directly or indirectly induced or solicited any other
Proposers to submit a false or sham Proposal; the Proposer has not solicited or
induced any person, firm or corporation to refrain from Proposing; and Proposer
has not sought by collusion to obtain for itself any advantage over any other
Proposers or over the City.
The City and the successful Proposer will establish completion times for each individual Work Item and
the successful Proposer agrees that the work will be completed within the time frames agreed upon and
stipulated in the. Notice to Proceed.
i
FIRM NAME:%�R� � _6z t-P4A1t1
Street Address: /
I_3S_I-J._6ENv-aAL 3L✓D Su r
Mailing Address (if different):
Telephone No. G_y�7 �DD= 5Fax No. _--/—------- _---------
Email Address: SMAA✓aIJDL.494;MEKCoM_PiAlq.FEIN No.
. eorlt—
REQUEST FOR PROPOSALS N0. 19-07-02 •
*BY SIGNING THIS DOCUMENT THE PROPOSER AGREES TO ALL TERMS AND CONDITIONS OF THERFP
SIGNATURE:
------------------------------------------------------------------
(SIGNATURE OF AUTHORIZED AGENT)
PRINT NAME:�Irt�oA�_1
TITLE:_, bL"idN(�R-
DATE: 6' 1*5 - /
THE EXECUTION OF THIS FORM CONSTITUTES THE UNEQUIVOCAL OFFER OF PROPOSER TO
BE BOUND BY THE TERMS OF ITS PROPOSAL. FAILURE TO SIGN THIS SOLICITATION WHERE
INDICATED ABOVE BY AN AUTHORIZED REPRESENTATIVE SHALL RENDER THE PROPOSAL
NON-RESPONSIVE. THE CITY MAY, HOWEVER, IN ITS SOLE DISCRETION, ACCEPT ANY
PROPOSAL THAT INCLUDES AN EXECUTED DOCUMENT WHICH UNEQUIVOCALLY BINDS THE
PROPOSER TO THE TERMS OF ITS OFFER.
REQUEST FOR PROPOSALS N0. 19-07-02
PRICE PROPOSAL
Provide a detailed cost statement for providing the services indicated in Section 3.0 Scope of Services. All
expense reimbursements will be charged against the total all-inclusive maximum price submitted by the
firm. The project fee(s) shall include all labor, equipment, materials, transportation, overhead, travel,
insurance, sales and other taxes, licenses, incidentals, and all other related cost necessary to meet the
work requirements.
Phase 1: Market Research and Investigation
Item
Description
Estimated Hours
Not -to -Exceed
Lump Sum
1
All Inclusive Cost
lod0
TV,
1
for Scope of Services Requested in
g oep
Section 3.0
Phase 2: Brand Development and Execution
Item
Description
Estimated Hours
Not -to -Exceed
Lump Sum
1
All Inclusive Cost for Scope of
al00
li S0, p0O
Services Requested in Section 3.0
�IGNATURE:
WNWE OF AUTHORIZED AGENT AND FIRM NAME)
PRINT NAME: d7�/t�t/O� RIHi
TITLE :1" �,✓Rft/,.V�- �k 1��� ------
DATE:
REQUEST FOR PROPOSALS N0. 19-07-02
REQUEST FOR PROPOSALS NO. 19-07-02 '
Florida's Riviera:
F l o r i d a' s R i v i e r a
CITY OF SUNNY ISLES BEACH
�.S r�cer�
1p{ 1UNNY 'f�ft r
CITY OF SUNNY ISLES BEACH cs r�cerdi
Department Logo:
CuItura16CommunityServices
Park Logos:
Affiliate Logos:
SIB,,
CLEAN WATER CAMPAIGN
SUNNY ISLES BEACH
Other Logos:
1
SUNNY ISLES
MOVING FOR'W'ARD TOGETIIER BEACH
AM a
YEEE'VIS10N
-IBi*
MW *1 F Oil
H O T S P O T
S' Bl"formation
SUNNY ISLES BEACH
SlotANY Isl
F Loi
OF sub
REQUEST FOR PROPOSALS NO. 19-07-02
O� b�O N Y-IS<��,8
NON -COLLUSION AFFIDAVIT
„
City of Sunny Isles Beach
18070 Collins Avenue
yF
O
CD➢l• F�OR`9 `+�f Sunny Isles Beach, FL 33160
c�Ty op SUN 'o Telephone: (305) 947-0606 Fax: (305) 949-3113
STATE OF FLORIDA J
COUNTY OF OLM4&e—)
The undersigned being first duly sworn as provided by law, deposes, and says:
This Affidavit is made with the knowledge and intent that it is to be filed with the City of Sunny Isles Beach City Commission and that it will be
relied upon by said County, in any consideration which may give to and any action it may take with respect to this Bid.
The undersigned is authorized to make this Affidavit on behalf of,
(Name of Corporation, Partnership,
Individual, etc.)
a, M V;%,4"sty CGCG) formed under the laws of
(Type of Business) (Slate)
of which he is M./A34 MEA"Ai4t-.
(Sole Owner, Partner, President, etc.)
Neither the undersigned nor any person, firm, or corporation named in above Paragraph 10.2, nor anyone else to the knowledge of the
undersigned, have themselves solicited or employed anyone else to solicit favorable action for this Bid by the City, also that no head of any
department or employee therein, or any officer of the City of Sunny Isles Beach, Florida is directly interested therein.
This Bid is genuine and not collusive or a sham; the person, firm or corporation named above in Paragraph 10.2 has not colluded, conspired,
connived or agreed directly or indirectly with any proposers or person, firm or corporation, to put in a sham Bid, or that such person, firm or
corporation, shall refrain from Bidding, and has not in any manner, directly or indirectly, sought by agreement or collusion, or communication
or conference with any person, firm or corporation, to fix the prices of said Bid or Bids of any other proposers; and all statements contained in
the Bid or Bids described above true; and further; neither the undersigned, nor the person, firm or corporation named above in Paragraph
10.2, has directly or indirectly submitted said Bid or the contents thereof, or divulged information or data relative thereto, to any association or
to any member or agent thereof.
AFFIANT'S NAME AFFIANTS TITLE
TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this P� day of 1 V 01 k%+ Aq
Personally Known or Produced Identification �–; J
/l
Type of identifications
1
(Affix seal here) \/ p 1 '�-b 10
If
fir, R 0
NOTARY PUBLIC (name printed or typed)
`
EVELYN SOLORZANO
' j. ; . •`
Notary Public State of Florida
�i'.pi
Commission # GG 288836
My Comm. Expires Jan 6, 2023
DECEMBER 28, 2010
PUBLIC ENTITY CRIMES
City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, FL 33160
Telephone: (305) 947-0606 Fax: (305) 949-3113
SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a)
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
PUBLIC ENTITY CRIMES
Pursuant to the provisions of paragraph (2) (a) of Section 287.133, Florida State Statutes - "A person or affiliate
who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a
Bid on a Contract to provide any goods or services to a public entity, may not submit a Bid on a Contract with a
public entity for the construction or repair of a public building or public Work, may not submit Bids on leases of
real property to a public entity, may not be awarded to perform Work as a Contractor, supplier, Sub -Contractor, or
Consultant under a Contract with any public entity, and may not transact business with any public entity in excess
of the threshold amount Category Two of Sec. 287.017, FS for thirty six months from the date of being placed on
the convicted vendor list".
THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
11.1. This sworn statement is submitted to
by .�h°/1-N'6 /tel LAS/ r�ZE,l2 /�'(/F�ukG i�tl6,
—[pnn i—r'ndiv ua sof named 111
for Zf1;ae2 S'inc�,tN S(. LLC .
n name o entitysubmitting swom staternritir
whose business address is:
��ia ✓tio 7:z . 3Z S o /
and (if applicable) its Federal Employer Identification number (FEIN) is 7/QS
(If the entity had no FEIN, include the Social Security Number of the individual signing this sworn
statement: )
11.2. 1 understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, means a
violation of any state or federal law by a person with respect to and directly related to the transaction of
business with any public entity or with an agency or political subdivision of any other state or with the
United States, including, but not limited to, any Bid or Contract for goods or services to be provided to any
public entity or an agency or political subdivision of any other state of the United States and involving
antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.
11.3. 1 understand that "convicted" or "conviction" as defined in Para. 287.133(1)(b), Florida Statutes, means a
finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any
federal or state trail 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.
11.4. 1 understand that an "affiliate" as defined in Para. 287.133(1)(a), Florida Statutes, means:
a.) predecessor or successor of a person convicted of a public entity crime; or
b.) Any 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, executors, 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
DECEMBER 28, 2010
market value under an arm's length agreement, shall be a prime 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.
11.5. 1 understand that a "person" as defined in Para. 287.133(1)(e), Florida Statutes, means any natural
person or entity organized under the laws of any state or of the United States with the legal power to
enter into a binding Contract and which Bids or applies to Bid on Contracts for the provision of goods or
services let by a public entity, or which otherwise transacts or applies to transact business with a public
entity. The term "persons" includes those officers, directors, executives, partners, shareholders,
employees, members, and agents who are active in management of any entity.
11.6. Based on information and belief, the statement which I have marked below is true in relation to the entity
% submitting this sworn statement. (Indicate which statement applies.)
V Neither the entity submitting this sworn statement, nor any of it's officers, directors, executives, partners,
shareholders, employees, members, or agents who are active in the management of the entity, nor any
affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1,
1989.
The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners,
shareholders, employees, members, or agents who are active in the management of the entity, or an
affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1,
1989.
The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners,
shareholders, employees, members, or agents who are active in the management of the entity, or an
affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1,
1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of
Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer 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 11.1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND,
THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I
ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO
A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA
STATUTES, FOR CATEGORY TWO OF ANY, CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.
By:
Si nature)
(Printed Name)
' (Title)
Sworn to and subscri,>pd before me this day of PRjo,1,`5-� 20 by
mann (n . �v� �
(AFFIX O S
1►Ar Pug"••., EVELYN SOLORZANO
Notary Public - State of Florida Signature: Notary Public - State of Florida
i Commission p GG 288836
My Comm. Expires Jan 6, 2023 roduced
Personally Known OR Produced Identification FZ OL LAP -1 l %-� 0 10/1998
O� SVyNY IS
a �
n
or t
'S'f C'➢7• FLOP\ oy�
TY OF SUN
EQUAL OPPORTUNITY /
AFFIRMATIVE ACTION
City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, FL 33160
Telephone: (305) 947-0606 Fax: (305) 949-3113
EQUAL OPPORTUNITY/AFFIRMATIVE ACTION STATEMENT
The contractors and all subcontractors hereby agree to a commitment to the principles and
practices of equal opportunity in employment and to comply with the letter and spirit of
federal, state, and local laws and regulations prohibiting discrimination based on race,
color, religion, national region, sex, age, handicap, marital status, and political affiliation or
belief.
Signed:
Title:
Firm:
Address:
DECEMBER 28, 2010
�NNY IS,
a F
y
n
u x
0 A\ yW
1
f�T` of SVN
CONFLICT OF INTEREST
City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, FL 33160
Telephone: (305) 947-0606 Fax: (305) 949-3113
CONFLICT OF INTEREST STATEMENT
The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes. Proposers must
disclose with their Bids, the name of any officer, director, partner, associate or agent who is also an officer or employee of the
City of Sunny Isles Beach or its agencies.
STATE OF FLORIDA
COUNTY OF /yll6E QQ �/ Z#4yP-11n
BEFORE ME, the undersigned authority, personally appeared /aA.�lO� �"Cwho was duly sworn,
deposes, and states:
18.1. 1 am the EAA-8of
(��, LLG , with a local office in 15,g -Din i=A7 4XebA- and principal office in
4�1)4 Z jo.mo .1
18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. described
as: Landscape Maintenance Services. The Affiant has made diligent inquiry and provides the information contained in this
Affidavit based upon his own knowledge.
18.3 The Affiant states that only one submittal for the above Bid is being submitted and that the above named entity has
no financial interest in other entities submitting Bids for the same project.
18.4 Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, participated in
any collusion, or otherwise taken any action in restraints of free competitive pricing in connection with the entity's submittal for
the above Bid. This statement restricts the discussion of pricing data until the completion of negotiations if necessary and
execution of the Contract for this project.
18.5 Neither the entity nor its affiliates, nor any one associated with them, is presently suspended or otherwise ineligible from
participation in contract letting by any local, State, or Federal Agency.
18.6 Neither the entity, nor its affiliates, nor any one associated with them have any potential conflict of interest due to any
other clients, contracts, or property interests for this project.
18.71 certify that no member of the entity's ownership or management is presently applying for any employee position or
actively seeking an elected position with the City of Sunny Isles Beach.
18.81 certify that no member of the entity's ownership or management, or staff has a vested interest in any aspect of the City
of Sunny Isles Beach.
18.9 In the event that a conflict of interest is identified in the provision of services, I, on behalf of the above named entity, will
immediately notify the City of Sunny Isles Beach. q �
D ed t ' v day of �lA� 20�
L r ! M. hc1�c� n ana ( (I
AFFIANT Print or Type Nam6 and Title
Sworn to and subscribed before me this day of 2018.
O Personally Known OR V�� l�l�l J�{'��3/1� ��(�•
Produced Identification ; Type of I i�cation 11
NOTARY PUBLIC STATE OF FLORIDA
S►Rr "� =SOLORZANOANO�Notof Florida288836My n 6, 2023
DECEMBER28,2010
SVNNY rs(�f
DISPUTE DISCLOSURE
City of Sunny Isles Beach
18070 Collins Avenue
sf 'a� • , `o��C +`r Sunny Isles Beach, FL 33160
SO4 Telephone: (305) 947-0606 Fax: (305) 949-3113
I13P-11111 116,1411 � � OY.'Tu`l
Answer the following questions by placing a "X" after "Yes" or "No". If you answer "Yes", please
explain in the space provided, or on a separate sheet attached to this form.
19.1. Has your firm or any of its officers, received a reprimand of any nature or been suspended by the
Department of Professional Regulations or any other regulatory agency or professional associations within the last
five (5) years?
YES NO 2
19.2. Has your firm, or any member of your firm, been declared in default, terminated or removed from a
contract or job related to the services your firm provides in the regular course of business within the last five (5)
years?
YES NO A
19.3. Has your firm had against it or filed any requests for equitable adjustment, contract claims, Bid protests,
or litigation in the past five (5) years that is related to the services your firm provides in the regular course of
business?
YES NO X If yes, state the nature of the request for equitable adjustment, contract
claim, litigation, or protest, and state a brief description of the case, the outcome or status of the suit and the
monetary amounts of extended contract time involved.
I hereby certify that all statements made are true and agree and understand that any misstatement or
misrepresentation of falsification of facts shall be cause for forfeiture of rights for further consideration of this Bid
for the City of Sunny Isles Beach.
Firm
� Z --"t'
horized Signat e
DECEMBER 28, 2010
Date��
/f,do cJ 1"'10-1kemxof 0i, -
Print or Type Name and Title
SUNNY IS,
s
OF B�
a �
~ n
O r
yf i99' : F l o?. R
c�TY or VN 00
STATE OF FLORIDA )
COUNTY OF )
ANTI -KICKBACK
City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, FL 33160
Telephone: (305) 947-0606 Fax: (305) 949-3113
ANTI -KICKBACK AFFIDAVIT
I, the undersigned, hereby duly sworn and deposed say that no portion of this sum herein Bid
will be paid to any employees of the City of Sunny Isles Beach or its elected officials as a
commission, kickback, reward or gift, directly or indirectly by me or any member of my firm or
by an officer of the corporation.
By: "imf_lel
Title: 9-0e—
The foregoing instrument was acknowledged before me this day of
AV :3— , 20 ICI , by hanvr_ M • lL&'OW -PIr [name
of Verson],as (Ylr_tm�n nom, ,jr�-Xinr2- ' ' [type of authority], for
J4 [name of party on behalf of whom instrument was
executed].
AFFIX NOTARY STAMP HERE:
Notary Public — Sta of Florida
ad vt- PU1o(?,IR_(3-
Print
c;.Print or Ty�e Commissioned Name
t✓�
Personally Known OR Produced Identification
Type of Identification Produced iZ L QS(p 7G�'�-0
DECEMBER 28, 2010
:o1�xY'Pu'•..
^
?W Q
EVELYN SOLORZANO
Notary Public State of Florida
Commission p GG 288836
? a �!°'�•
My comm. Expires Jan 6, 2023
Notary Public — Sta of Florida
ad vt- PU1o(?,IR_(3-
Print
c;.Print or Ty�e Commissioned Name
t✓�
Personally Known OR Produced Identification
Type of Identification Produced iZ L QS(p 7G�'�-0
DECEMBER 28, 2010
4 SUNNY IS[Fr
O B
m
ti n
1=
CONTRACTOR ANTI -BOYCOTT CERTIFICATION
[PURSUANT TO FLORIDA STATUTE § 215.47251
i
,e,`,,,4 on behalf of,gtImee o�j,�/ Zle. ,
Print Name Company Name
certifies that,A,el,"* t9 f, //-e. does not:
Company ame
1. Participate in a boycott of Israel; and
2. Is not on the Scrutinized Companies that Boycott Israel list; and
3. Is not on the Scrutinized Companies with Activities in Sudan List; and
4. Is not on the Scrutinized Companies with Activities in the Iran Petroleum
Energy Sector List; and
5. Has not engaged in business operations in Cuba or Syria.
Signature
Title
Date