HomeMy WebLinkAboutPremiere Design Solutions, Inc (PDS)NO CONTINGENT FEES
STATE OF FLORIDA }
COUNTY OF MIAMI-DADE )
I, the undersigned, hereby duly sworn and deposed say not to have employed or retained any
company or person, other than a bona fide employee working solely for the respondent to
solicit or secure this agreement and not to have paid or agreed to pay any person, company,
corporation, individual or firm, other than a bona fide employee working solely for the
respondent, any fee, commission or percentage, gift or othernsideration contingent upon or
I
resulting from award or making of this agreement. I
Title:
LUIS J. JURADO
PRESIDENT
The foregoing instrument was acknowledged before me this
_ -- Aujgust 20 20 , by LUIS J. JURADO
of person], as PRESIDENT [type of
PREMIERE DESIGN SOLUTIONS, INC. [name of party on behalf of whom
executed].
AFFIX NOTARY STAMP HERE:
�`*�`•Y'A�e��ti Ana L. Salazar
Comm.#GG956638
,
s Expires: Feb. 9, 2024
�Booded Thro Aaron Notary
6th day of
[name
authority], for
instrument was
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No ary Public -- State of Florida
ANA L. SALAZAR
Print or Type Commissioned Name
Personally Known x OR Produced Identification
Type of Identification Produced
STATE OF FLORIDA )
COUNTY OF MIAMI-DADE )
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 rhe or any member of nay firm or
by an officer of the corporation. I f
By:
Title:
PRESIDENT
J. JURADO
The foregoing instrument was acknowledged before me this _ 6th - day of
August 1 Zp 20 f by LUIS J. JURADO [name
of person], as PRESIDENT _ [type of authority], for
PREMIERE DESIGN SOLUTIONS, INC, [name of party on behalf of whom instrument was
executed].
AFFIX NOTARY STAMP HERE:
t 1111Y1A�eY'�1y Ana L. Salazar
.y Comm. I GG956638
Expires, Feb, 9, 2024
Bonded Thru Aaron Notary
4ak*&91111
N Lary Public — State of Florida
ANA L. SALAZAR
Print or Type Commissioned Name
Personally Known X OR Produced Identification
Type of Identification Produced
DLCEMBER 28, 2010
pror fs
45
CONFLICT OF INTEREST
V :fir City of Sunny Isles Beach
18070 Coffins Avenue
f i0A os°Y 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 MIAMI-DADE
BEFORE ME, the undersigned authority, personally appeared LUIS J. JURADO , who was duly sworn,
deposes, and states:
18.1. 1 am the PRESIDENT of
PREMIERE DESIGN SOLUTIONS, INC. with a local office in North Miami, Florida and principal office in
Miramar, Florida
18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, RFO No. 20-07-01 described
as: RFQ Professional 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 co flict of ' terest is identified in the provision of services, I, on behalf of the above named entity, will
immediately notify the Cityf Sun Isles Beach.
Dated thisy of August _2020.
_ LUIS J. JURADO, President _
AFFIANT Print or Type Name and Title
Sworn to an subs ibed before me this 0th day of August 2020.
___1
ill Personail Known X OR
0 Produced Identification ; Type of Identification
AokuJcr4Q,),l,
NOTARY PUBLIC STATE OF FLORIDA
Mtclu+rp
- y P& Ana L. Salazar
Comm.W95,6638
GG956638
Expires: Feb. 9, 2024
Bonded Thru Aaron Notary
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.)
X 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 INF RM/THE PUBLIC ENTITY PRIOR TO ENTERING INTO
A CONTRACT IN EXCESS OF THE THRESHOLD AMO NT PROVIDED IN SECTION 287.017, FLORIDA
STATUTES, FOR CATEGORY TWO OF ANY, CHAN E If�yy//THE INFORMATION CONTAINED IN THIS FORM.
By:
(Signature)
(Printed Ne
(Title)
S J. JURADO
PRESIDENT
Sworn to and subscribed before me this 6th day of August , 20 20 , by
(AFFIX NOTARY STAMP HERE) ANA L. SALAZAR
`a�uYP pyi
Arta L. Salazar
Comm.#GG956638 Signature:
•. ... ,` Expires: Feb. 9, 2024
Bonded Thru Aaron Notary
Personally Known X OR Produced Identification
O�;
' e
PUBLIC ENTITY CRIMES
c,
City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, FL 33160
r'' o• s=,= .* Telephone: (305) 947-0606 Fax, (305) 949-3113
SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(x)
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 SIGP
OFFICIAL AUTHORIZED TO
11.1. This sworn
by
ANP SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
AMSTER OATHS.
to. City of Sunny Isles Beach
LUIS J. JURADO
for PREMIERE DESIGN SOLUTIONS, INC.
whose business address is:
1065 NE 125th St, Suite # 211 B, North Miami, Florida, 33161
and (if applicable) its Federal Employer Identification number (FEIN) is # 26-0571068 _
(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
DECEMeER 28, 2010
�J
STATE OF FLORIDA
COUNTY OF MIAMI -RADE t
NONCOLLUSION AFFIDAVIT
City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, FL 33160
Telephone: (305) 947-4606 Fax: (305) 949-3113
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,
of which lie is
PREMIERE DESIGN SOLUTIONS, INC.
(Name of Corporation, Partnership, Individual, etc.)
a, 5 CORPORATION formed under the laws of FLORIDA
(Type of Business) (State)
PRESIDENT
(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 d�ecn bed above true; and further; neither the undersigned, nor the person, firm or corporation named above in Paragraph
10.2, hasidirectlyindirectly submitted said Bid or the contents thereof, or divulged information or data relative thereto, to any association or
to any m mber ogent thereof.
PRESIDENT
AFFIANT'$ TITLE
TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this _ 6th day of August , 20 20
Personally Known X or Produced Identification
Type of identification
(Affix seal here)
Ana L. Salazar
ys Comm.#GG956638
• Expires; Feb. 9, 2024
Banded Thru Aaron Notary
DECEMBER 28, 2010
�"64W'Vr
ANA L. SALAZAR
OTARY PUBLIC (name printed or typed)