HomeMy WebLinkAboutSuperSports of BrowardQUALIFICATION REQUEST
INCLUDE WITH YOUR BID
Contractor must list projects of similar project scope fulfilling the following qualification requests:
1. List Project Management Personnel. Personnel cannot be changed without written approval.
Project Manager h ,(^� k, sa"�
2. How many years has your organization been in business as a Contractor?
4. Will you subcontract any part of this work?
City of Sunny Isles Beach I ITB 22-12-02
5. The,�usiness is a,(sole proprieyrship) (partnership) (corporRtion) and name of owner:
6. Has your company ever been debarred or terminated for default on a government contract?
7. Firm must list any exceptions taken to the terms and condition in this ITB.
���t}OF SU41 Ntl�'
8. Describe the submitter's attributes, which make the submitter best -suited for this proiect.
END OF SECTION
City of Sunny Isles Beach I ITB 22-12-02
REASON FOR "NO BID"
For firms choosing ® to bid/propose on this opportunity, the city appreciates your
response using this form.
Please return via email to Purchasing(cDsibfl.net.
Why did your firm choose not to respond to this opportunity?
Circle all that apply from below list:
a. We do not offer these services or equivalent.
b. Insufficient time to respond to the solicitation.
c. Our project schedule would not permit us to perform.
d. Unable to meet requirements.
Other:
N�Ik
City of Sunny Isles Beach I ITB 22-12-02
fry of SOO Pi
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000
VALID OCTOBER 1, 2022 THROUGH SEPTEMBER 3o, 2023
DBA: SUPERSPORTS OF BROWARD COUNTY INC Receipt e:AL L OTHERS (REFEREE ASSI
-20655
Business Name: Business Type:
Owner Name: ROBERT H SEGAL Business Opened:06/01/1988
Business Location: 11873 SW 8TH CT State/County/Cert/Reg:
DAVIE Exemption Code:
Business Phone: 954-475-1528
Rooms Seats Employees Machines Professionals
1
For Vending Business Only
Number of Machines: Vanda— T-
Tax Amount
Transfer Fee
NSF Fee
Penalty
PriorYears
Collection Cost
Total Paid
33.00
0.00
0.00
6:60
0:00
25.00
64.60
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is
non -regulatory in nature. You must meet all County and/or Municipality planning
WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business location. This receipt does not indicate that the business is legal or that
it is in compliance with State or local laws and regulations.
Mailing Address:
ROBERT H SEGAL Receipt #04A-22-00002550
16401 STONEHAVEN RD Paid 12/15/2022 64.60
MIAMI LAKES, PL
33014-6052
DELIVER TO: INVITATION TO BID
City of Sunny Isles Beach SECTIONS A.M.
M
.
A
OPENING: 111:00 .00
City Clerk BID SUBMITTAL FORMS 01112/2023A.M.
18070 Collins Avenue
Sunny Isles Beach, FL 33160
PLEASE QUOTE PRICES FURNISHED & INSTALLED, LESS TAXES, PROVIDED TO
CITY OF SUNNY ISLES BEACH, FLORIDA
NOTE: City of Sunny Isles Beach is exempt from all taxes (Federal, State, and Local). Bid price should be
less all taxes. Tax Exemption Certificate furnished upon request.
Issued by: Purchasing Manager: Date Issued: This ITB Submittal Consists of
Genesis Cuevas December 22, 2022 this ITB, Attachments and
Exhibits
Sealed bids are subject to the Terms and Conditions of this INVITATION TO BID and the accompanying
Bid Submittal. Such other contract provisions, specifications, drawings or other data as are attached or
incorporated by reference in the Bid 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 Bid Submittal Requirement.
ITB 22-12-02
Sports Officiating and Scorekeeping Services for Youth Athletic Leagues
A Performance Bond in the amount of 0% of the total amount of the bid will be required upon execution
of the contract by the successful firm and City of Sunny Isles Beach
Firm Name:
RETURN ONE ORIGINAL. THREE COPIES AND ONE USB RESPONSE IN A SEALED ENVELOPE
City of Sunny Isles Beach I ITB 22-12-02
y�y of Slo'
SECTION 6
BID SUBMITTAL FOR:
ACKNOWLEDGEMENT OF ADDENDA
INSTRUCTIONS: COMPLETE PART I OR PART II, WHICHEVER APPLIES
PART 1:
LIST BELOW ARE THE DATES OF ISSUE FOR EACH ADDENDUM RECEIVED IN CONNECTION
WITH THIS BID
Addendum #1, Dated
Addendum #2, Dated
Addendum #3, Dated
Addendum #4, Dated
Addendum #5, Dated
Addendum #6, Dated
Addendum #7, Dated
Addendum #8, Dated
PART II:❑ NO ADDENDUM WAS RECEIVED IN CONNECTION WITH THIS BID
FIRM NAME:
AUTHORIZED SIGNATURE: /,i/ DATE:
TITLE OF OFFICER:
City of Sunny Isles Beach I ITB 22-12-02
BID SUBMTITAL FORM
Bid Title: Sports Officiating and Storekeeping Services for Youth Athletic Leagues
The undersigned Bidder proposes and agrees, if this Bid is accepted, to enter into an agreement with The
City of Sunny Isles Beach to perform and furnish all Work as specified or indicated in the Contract
Documents for the Contract Price and within the Contract Time indicated in this Bid and in accordance with
the other terms and conditions of the Contract Documents.
The Bidder accepts all of the terms and conditions of the Advertisement or INVITATION TO BID and
Instructions to Proposers, including without limitation those dealing with the disposition of Bid Security.
This Bid will remain subject to acceptance for 90 days after the day of Bid opening. The Proposer agrees
to sign and submit the Agreement with the Bonds and other documents required by the Bidding
Requirements within ten days after the date of the City's Notice of Award.
In submitting this Bid, 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 Bid 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 Bid; the Proposer has not solicited or induced any person, firm or
corporation to refrain from Bidding; and Proposer has not sought by collusion to
obtain for itself any advantage over any other Proposers or over the City.
The Proposer understands and agrees that the Bid is for unit prices to furnish and install individual Work
Items for maintenance and/or repair work, complete in place. Estimates are provided for the purposes of
Bid Evaluation and to establish unit prices for individual Work to be contracted by the City under individual
Purchase Orders, based on the unit prices established under this Bid.
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 individual Purchase Orders and/or Notice to Proceed.
City of Sunny Isles Beach I ITB 22-12-02
4I �.of 51;OPia
Firm Name:
Street Address:
Mailing Address (if different):
�3'3c) ►4
Telephone No. Q 5 L— K_73 -56,4q Fax No.
Email Address: Y" 6n 9A2 MIN No.
* "By signing this document the bidder agrees to all Terms and conditions of this
INVITATION TO BID.
Signature:
(Signature of authorized agent) C
Print Name: )T2b�+ A WSJ
Title: TVv_-_,>AAk' .. &u A)'A QZc
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.
City of Sunny Isles Beach I ITB 22-12-02
ATTACHMENT A - PRICE SHEET
I. Bidder must use the Bid Price Sheet to submit Bidder's price for this Project.
II. Bidder shall hold the unit Bid Prices firm throughout the Contract period. Bidder
guarantees response time necessary to have a crew return to correct unfinished or
unsatisfactory services.
III. The City reserves the right to increase, decrease, and/or choose the items and quantities
below for the Project to meet its available budget using the unit prices provided below.
IV. Bidder must completely fill out each column below, i.e., unit price and total.
V. Not applicable or "N/A" is not acceptable and will cause Bidder to be determined non-
responsive. An authorized officer per the Bidders Sunbiz, must sign the Total Bid Price
Sheet.
VI. The award will be to the lowest responsive responsible Bidder for Total Bid Amount.
NY
F L 0
OF s01 �
IJ
City of Sunny Isles Beach I ITB 22-12-02
AFFIDAVITS
SONY
* FL0�
OF $uN P
City of Sunny Isles Beach I ITB 22-12-02
Sa�NY rs�
Off'`
NON -COLLUSION AFFIDAVIT
City of Sunny Isles Beach
18070 Collins Avenue
F F 60R y Sunny Isles Beach, FL 33160
C/TY OF 5 t3 ANO Telephone: (305) 947-0606 Fax: (305) 949-3113
STATE OF FLORIDA )
COUNTY OF l"OW64
The undersigned being first duly swom 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,
-r✓ 06 1,- V1%rcrs' 'TF U 0 k)AA,r" Co. -1—LA C
(Name of Corporation, Partnership, Individual, etc.)
a, _5*d? CA.T.'J 0 rPi4t4 )i%AC , formed under the laws of
I (Type of Business) (State)
of which he is S4LB Q. its i,—
(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.
I. '0 l�uss5 D.rw
AFFIANT'S NAME AFFIANT'S TITLE
TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this C r1at, of C' • on2
Personally Known �/� or Produced Identification
Type of identification _ >l D/ '
(Affix seal here)
------------
Y v ANGELA PAULINO
Notary Public - State of Florida
Commission # HH 233411
„•oF "'' My Comm, Expires Feb 27, 2026
DECEMBER 28, 2010
SJp1NY �S�F
SOF
PUBLIC ENTITY CRIMES
U z
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 City of Sunny Isles Beach
by Ra ftlx e ' W .EMS L Tab5tID%4:J
iprint individual s name and huej
for +r5 oris �A A-�
ipnn -% e o entity su 'rs sworn s emen
whose business address is:
t f_ k'73 _rui Sc yf 6-1—
and (if applicable) its Federal Employer Identification number (FEIN) is 63= d L36P1f7
(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 2B, 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.)
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.
(Signature)
Q % J 1k
(Printed Nam
(fr la S4",
(Title)
Sorn to nd s scribed before me this 34day of Z Z by
c. JLt' T �J
(AFFIX NOTARY S E
ot►ar OOe�• ANGELA PAULINO
Signature:
�l s- Notary Public - State of Florida g
a6: Commission # HH 233411
My Comm. Expires Feb 27, 2026
Personally Known OR Produced Identification F -L- L �--
SUNNY es��
CONFLICT OF INTEREST
x
City of Sunny Isles Beach
k l
18070 Collins Avenue
zF aye y f aR�o sw� Sunny Isles Beach, FL 33160
or su1+ 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 FLOI>j�Dq�Q`d
COUNTY OF QQjj''��
BEFORE ME, the undersigned authority, personally appearedUae+ �4 'SeOaj who was duly sworn,
deposes, and states: ---
18,1. 1 am the Nov b, -f-T— of
S",,;. --c r-1 Bet *#d with a local office in ,�,�„ �.,ar� and principal office in
18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. described
as: Golden Shores Street Lighting. 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.
18A 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.
Dated this 0 " day of Pe_ , 2022.
AFFIANT22 r,l
Print or Type Name and Title
Sworn to and subscribed before me this dCAday of )49C ;202,.
❑ Personally Known OR
❑ Produced Identification ✓ ; Type of Iden IcaIon
NOTARY PUBLIC STATE OF FLORIDA
;;oY roa`•; ANGELA PAULINO
Notary Public - State of Florida
Commission # HH 233411
°F1fldt • My Comm. Expires Feb 27, 2026
DECEMBER 28, 2010
SUNNY 15�F�
v� tix
CONTRACTOR ANTI -BOYCOTT CERTIFICATION
0
P
M1� � • F L O \ y\'
[PURSUANT TO FLORIDA STATUTE § 215.47251
LQtt+ -H SPA, on behalf of
Print Name tomOny Name
certifies that - IS `& "es not:
Company Name
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
/ Rno
Title
�v
Date
4uNN
-'"CRs
� A
DISPUTE DISCLOSURE
u ;R
City of Sunny Isles Beach
PSv
18070 Collins Avenue
p
F ti o
Sunny Isles Beach, FL 33160
c TY or suw PNo
Telephone: (305) 947-0606 Fax: (305) 949-3113
DISPUTE DISCLOSURE FORM
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
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
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 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
Signature
DECEMBER 28, 2010
—..
7�
Print or Type Name ands itle
ANNUAL PRICING PER GAME
Item
League
Estimated
Estimated Number of >
Price Per Official -
Total Price
No.
Annual Games
Official Per Game
Per Game
(A)
(B)
(C);
(D)
1
Soccer
160
2
$
$
4s,b b
2
Travel Soccer
9
2
$
$
r`
3
Volleyball
16
1
$
$
4
Travel Volleyball
8
1
$
1�
$
5
Basketball
96
1
$
1
4 j
$
p �1
`r
V
A� V
Grand Total:
The Grand Total shall be calculated using the following formula (A x B x C,= Dj
$
Name of authorized Officer Sunbiz a d/or legal documentation Title
of S -t , �nfi r-� ;C%t rAs Z> V "t �C 71 t 6,—,,r -A 0 �� a ➢ � a
Name of Finn as it adbears on Sunbiz and/or legal documentation hereby aktest that I have the
authority to sign this notarized certification and certify that the above referenced information is true,
complete and correct.
Signature
City of Sunny Isles Beach I ITB 22-12-02
SUNNY Ig��
-r EQUAL OPPORTUNITY /
a
' AFFIRMATIVE ACTION
y4
C1/— F 40 PLOP y4t City of Sunny Isles Beach
c'TY or sut+ PNv 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: fC4 0,41
Firm:
Address I "�
DECEMBER 28, 201 D
Florida Statute 448.095 directs all public employers, including municipal governments, to verify the
employment eligibility of all new public employees through the U.S. Department of Homeland Security's E -
Verify System, and further provides that a public employer may not enter into a contract unless each party
to the contract registers with and uses the E -Verify system.
Florida Statute 448.095 further provides that if a contractor enters into a contract with a subcontractor, the
subcontractor must provide the contractor with an affidavit stating that the subcontractor does not employ,
contract with, or subcontract with an unauthorized alien.
In accordance with Florida Statute 448.095, all contractors doing business with the City of Sunny Isles
Beach are required to verify employee eligibility using the E -Verify system for all existing and new
employees hired by the contractor during the contract term. Further, the contractor must also require and
maintain the statutorily required affidavit of its subcontractors. It is the responsibility of the awarded vendor to
ensure compliance with E -Verify requirements (as applicable). To enroll in E -Verify, employers should visit
the E -Verify website (https://www.e-verify.goy/emplovers/enrolling-in-e-verify) and follow the
instructions. The contractor must, as usual, retain the 1-9 Forms for inspection.
By affixing your signature below you hereby affirm that you will comply with E -Verify requirements.
"
Company Name 0
Offeror Signature
Rgag i Irl
Print Name
fir- dZwS-3
Federal Employer Identification Number (FEIN)
Date
,nn lss / c l
Title
Notary Public Information
2flLZ
f�
Sworn to and subscribed before me on this this ay of •V be
Byb'I T/ • �Ggal
❑ is to me G
produc a (cation (type of identification produced: )
ANGELA PAULINO
�vv :o►A °�;:
j <? Notary Public - State of Florida
Commission # HH 233411
Signa ure of Notary Public '''�oFF`4 My comm. Expires Feb 27, 2026
Arjoblo D 2 - L -V Zo Z.(,
Prin Stamp of Notary Public Expiration Date
STATE OF FLORIDA
COUNTY OF gWttlCld
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.
The foregoing instrument
2)& , 20Z -'Z, by
of person], as
executed].
AFFIX NOTARY STAMP HERE:
By:�
Title:
w s acknowledged before me this day of
[name
[type of authority], for
[name of party on horn instrument was
r1�
N tary Public —State of Florida
V,P� ANGELA PAULINO
� Notary Public - State of Florida r '
V` Commission # HH 233411
�•• My Comm. Expires Feb 27, 2026
Print4 Type Commissioned Name
Personally Known OR Pro¢ucec(,�d�ntification
Type of Identification Produced I -C— � r
DECEMBER28,2010