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CITY OF SUNNY ISLES BEACH
18070 Collins Avenue
Sunny Isles Beach, Florida 33160 t„"" " 1.
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SS 305.947.0606
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BID FORM 1
BID COVER OCT 1 4` 2016� �¢
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rin
Bid Title: EVENT RIDES RENTAL al,at .'7yl c'Berrti
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 Services 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 this Invitation to Bid and Instructions to Bidders. This Bid
will remain subject to acceptance for 90 days after the day of Bid opening. The Bidder agrees to sign and submit
the Agreement with 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 Bidder represents, as more fully set forth in the Agreement, that:
• The Bidder 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 Bidder 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 Bidder.
• 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 Bidder has not directly
or indirectly induced or solicited any other Bidder to submit a false or sham Bid; the
Bidder has not solicited or induced any person,firm or corporation to refrain from Bidding;
and Bidder has not sought by collusion to obtain for itself any advantage over any other
Bidders or over the Gty.
Exact Legal Company Name: YkP. l 2 IP brarRevt _ oi-t r'r e ,T MC.
Business Name(dba), if any: Cep I., ro -1L rev, Snit rt`Y' e I
Street Address: o 9 �� i�✓ 1 (/ P P T t Ft o f ir f W Ooi, FL 3 30 1g
Mailing Address(if different)):
Telephone No.: q sq- q aJ- 3C 3 i3
City of Sunny Isles Beach I Invitation to Bid No. 16-08-02 17
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CITY OF SUNNY ISLES BEACH
SC_ 18070 Collins Avenue
-'- Sunny Isles Beach, Florida 33160 s,"" ',;
�.l. 305.947.0606
www.sibfl.net C n
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C„t OF SUS i'149
Fax No.: 9 S4{ - 0i3 -02308
Email Address: F8l 6). r I& Qr'attov,rSor-rc•e_, /'L9vr1
FEINNo.: (p5- J (72ag10
*By signing this document the bidder agrees to all Terms
Authorized Signature:
Print Name: Pahl l-!grin!
Title: V ice Pres I--
THE
THE EXECUTION OF THIS FORM CONSTITUTES THE UNEQUIVOCAL OFFER OF BIDDER 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 BIDDER TO THE TERMS
OF ITS OFFER.
City of Sunny Isles Beach I Invitation to Bid No. 16-08-02 -187.7-
CITY OF SUNNY ISLES BEACH
irs
18070 Collins Avenue
Sunny Isles Beach, Florida 33160 ti�� 'Fc;
305.947.0606 .o
C'''al su"e
BID FORM 2
ADDENDA ACKNOWLEDGEMENT
INSTRUCTIONS: COMPLETE PART I OR PART II, WHICHEVER APPLIES
PART I:
UST 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:
VNO NO ADDENDUM WAS RECEIVED IN CONNECTION WITH THIS BID
COMPANY NAME: C 9 (e l rez (mTYI Sot.0 CC.a
AUTHORIZED SIGNATURE: 9iz/et 77-7—t2;(�2i DATE: MIMIq/a!')J6,
Sec OF OFFICER: re+Q ry
City of Sunny Isles Beach I Invitation to Bid No. 16-08-02
l City of Sunny Isles Beach 2017 Rides
l.•yr....,-
x-' r.l * Prices are based on an up to 4 hour rate unless otherwise specified *
* All necessary Power,Attendants and/or Delivery fees are included *
Item Specs Play Space Ages Capacity Cost City
BellaTor Electric Train 38'Lx2'W driving area all ages (ADA) 26 $1,500 1
Bumper Cars w/Arena 40'x40' hard surface only 11 and up 8 $1,800 1
Bungee Jump-2 Station 25'x25' same 5 and up 2 $1,100 1
Bungee Jump-3 Station 30'x30' same 5 and up 3 $1,300 1
Bungee Jump-4 Station 30'x30' same 5 and up 4 $1,500 3
Carousel Mini 20'X15' same 7 and under 10 $850 1
Ferris Wheel Large 30'Lx25'Wx50'H same 48" 24 $5,500 1
Ferris Wheel Mini 20'x20' same under 48" 10 $1,195 1
Fiberglass Super Slide 90'Lx20'Wx35'H same 5 and up 3 $1,500 4
Flying Helicopters 40'x40' same 3 and up 24 $2,500 1
G-force/Twin Spin 20'x20' same 7 and up 4 $750 1
Go-Gator Coaster 60'x60' same 12 and under 18 $2,500 1
Merry Go Round 30'x30' same all ages 20 $5,500 1
Mindwinder Swings 40'x40' same 48" 16 $1,500 1
Pirate Ship 25'x25' same 3 and up 12 $1,200 1
Rock Climbing Wall 15'Dx15'Wx28'H 20'x20' 5 and up 4 $750 2
Spaceball 15'x15' same 48" 1 $750 1
Tubs of Fun 30'x30' same 3 and up 18 $1,200 1
State of FL Inspection Rates if Required:
Kiddie: $35.00
Non-Kiddie: $70.00
Super: $140.00
Late Charge (15 days): $100.00
Weekend: $100.00
I I
i I i —I i_ I i I
City of Sunny Isles Beach 2017 Interactives
a;`l !'4_,
. r * Prices are based on an up to 4 hour rate unless otherwise specified *
c. * All necessary Power,Attendants and/or Delivery fees are included *
Item Specs Play Space Ages Capacity Cost Qty
Airbots 35'Lx30'Wx9'H same 11 and up 2 $1,500 1
Airhockey 81 x 4W same all ages 4 $450 10
Armchair QB 15'W x 20'D x15'H same 11 and up 1 $995 1
Baseball Pitch 15'Dx14'Wx14'H same all ages 1 $595 2
Big Bailer 40Lx21Wx15H same 7 and up 1 $1,295 1
Bouncy Boxing 2011 x 20'W same 11 and up 1 $695 1
Bungee Run 25'Lx15'Wx7'H same 7 and up 2 $695 1
Cannon Blaster 25'Lx15'Wx15'H same 7 and up 4 $1,500 1
Cash Cube 3'L x 3'W x 7'H 10'x10' 7 and up 1 $495 1
Corn Hole 20'Lx10'W all ages 4 $175 10
Corn Hole -Glow same all ages 4 $375 10
Derby Horses w/Track 35'Lx25'W same all ages 3 $950 1
Dome Hockey 8'1.x4'W 10'x5' 7 and up 4 $595 1
Electronic Basketball 10'D x 5'W 10'x10' 7 and up 2 $375 5
Electronic Football 10'D x 5'W 10'x10' 7 and up 2 $375 2
First Down Challenge 16'Lx14'Wx17'H same 7 and up 2 $675 1
Floating Ball Gallery 12'Dx10'Wx10'H same all ages 2 $575 1
Floating Ball Relay 12'Dx10'Wx10'H same all ages 8 $575 1
Floating T-Ball 12'Dx10'Wx10'H same all ages 1 $575 2
Foosball 6'Lx4.5'W 10'x6' 7 and up 4 $275 5
Giant Twister 20'x20' same all ages $695 2
Gladiator Joust 20'x20' same 7 and up 2 $695 2
Glow Volleyball standard same 7 and up 12 $895 5
Golf Chip Shot 25'Dx15'Wx13'H 30'D all ages 1 $595 1
Hermit Crab Races 10'x10' 15'x15' 7 and up 8 $1,500 1
Human Billiards 30'1x17'Wx3'H same 7 and up 4 $995 1
Ice Hockey Slap Shot 15'Dx14'Wx14'H 20'D 7 and up 1 $695 1
Ice Skating Rink 48'Lx24'Wx4'H 25'x50' all ages 10 $3,500 1
Hi-Striker- Large 16'H 10'X10' 11 and up 1 $695 2
Hi-Striker- small Kiddie all ages 1 $275 2
Human Foosball 45'Lx20'Wx7'H same 7 and up 8 $1,500 1
Kapow 30'x30' same 7 and up 2 $2,500 1
Log Roller 20'Lx16'Wx8'H same 7 and up 2 $895 2
Laser Tag 30'Dx25'Wx15'H same 7 and up 6 $1,295 1
Mechanical Bull 20'x20' same 7 and up 1 $1,295 2
Meltdown 30'x30' same 48" 8 $1,500 1
Miniature Golf-9 Holes 30'x30' same all ages 36 $1,800 1
Mini Golf Hole -Glow minimum of 3 15'x15' 7 and up 12 $375 18
Monster Trikes w/Track 35'Lx25'W same 11 and up 3 $950 3
Movie Screen 24'Lx20'Hx15'D 30'D all ages 100 $995 2
Photobooth-SnapShot $995 2
Photobooth-iGo $995 3
y�/�l� City of Sunny Isles Beach 2017 Interactives
a;-j-`1, ,�,a
. II
•
Photobooth-Classic $995 2
Photobooth-FacePlace $1,500 1
Photobooth-HD $1,295 1
Pop Noggins Music Videos 20'x20' same all ages 6 $1,500 1
Pool Table 8'Lx4.5'W 10'x10' all ages 4 $550 8
Quarterback Throw 15'Dx14'Wx14'H same all ages 1 $595 1
Robo Surfer 15'1x10'Wx10'H same 7 and up 1 $895 2
Rock Climbing Wall 15'Dx15'Wx28'H 20'x20' 5 and up 4 $750 2
Rodeo Calf Roper 25'Lx10'W same all ages 1 $895 1
Rope Ladder 10'Lx15'W same all ages 2 $750 1
Soccer Goal 15'Dx14'Wx14'H same all ages 1 $595 1
Sports Bungee 25'Lx15'Wx7'H same 7 and up 2 $695 1
Tap The App 5'Lx3'W same 7 and up 4 $395 1
The lump Off 56'Lx14'Wx16'H same 48" 1 $1,500 1
Triple Play 18'Dx20'Wx12'H same all ages
Velcro Wall 20'Dx12'Wx16'H same 7 and up 1 $750 1
Volleyball Set standard same 7 and up 16 $275 10
Video Game Station 50" HD Screen standard 7 and up 4 $375 10
World Sports Games 37'Lx28'Wx21'H same all ages 6 $995 1
Wrecking Ball 25'x25'X16'h same 7 and up 4 $795 1
Zip Line - 100' 100'L x 20'W 120'L 48" 2 $3,500 1
Zip Line - 200' 200'L x 20W 250'L 48" 2 $5,500 2
Zorbs 75'Lx25'W same all ages 2 $1,250 1
City of Sunny Isles 2017 Combo's and Obstacles
_i:,,,..:,r
s:�� * Prices are based on an up to 4 hour rate unless otherwise specified *
�1, * All necessary Power, Attendants and/or Delivery fees are included *
Item I Specs IPlay Space' Ages Capacity I Cost I Qty
Adrenaline Extreme Obstacle 43'Lx42'Wx16'H same 7 and up 8 $1,295 1
Amazon Olympics Obstacle - 38' 38'Lx12'Wx14'H same 7 and up 4 $695 2
Amazon Olympics Obstacle -82' 82'Lx12'Wx16'H same 7 and up 6 $895 1
Amazon Olympics Obstacle- 120' 120'Lx12'Wx16'H same 7 and up 8 $1,100 1
Big Top Toddler Combo 21'Lx16'Wxll'H same 5 and under 8 $795 1
Bounce Climb Slide Combo 30'Lx15'Wx15'H same 11 and under 8 $495 1
Buccaneer Combo 271x16'Wx17'H same 11 and under 6 $695 1
Circus Animals Toddler Combo 20'x20' same S and under 8 $595 1
Dash &Splash Combo-Dry 17'Lx17'Wx22'H same 11 and under 6 $695 1
Double Trouble Olympics Obstacle 75'Lx15'Wx16'H same 7 and up 8 $995 1
Frozen Club Combo 22'Lx19'Wx15'H same 11 and under 6 $695 1
Frozen Stage Coach 31'Lx14'Wx16'H same 11 and under 6 $795 1
Hello Kitty Club Combo 22'Lx19'Wx15'H same 11 and under 6 $695 1
Mickey Park Toddler Combo 20'x20' same 5 and under 8 $695 1
Military Olympics Obstacle 75'Lx15'Wx16'H same 7 and up 8 $1,200 1
Module Combo-30 Themes 21'Dx18'Wx17'H same 11 and under 6 $595 1
Space Camp Comb 21'Lx19'wx15'H same 11 and under 6 $595 1
Stage Coach Combo 31'Lx14'Wx16'H same 11 and under 6 $795 1
Strawberry Garden Combo 28'Lx15'Wx18'H same 11 and under 6 $695 1
This Place Is A Zoo Combo 21'Lx19'wx15'H same 11 and under 6 $595 1
Toxic Drop Wipeout Obstacle 78'Lx15'Wx16'H same 7 and up 6 $1,295 1
Toy Town Toddler Combo 20'x20' same 5 and under 8 $595 1
Wall-E 4inl Combo 21'Dx18'Wx17'H same 11 and under 6 $595 1
Winter Wonderland Combo 22'Lx13'Wx17'H same 11 and under 8 $695 1
Xtreme Gator Adrenaline Obstacle 36'Lx28'Wx17'H same 7 and up 8 $995 1
' City of Sunny Isles 2017 Dry Slides
b. rt * Prices are based on an up to 4 hour rate unless otherwise specified *
* All necessary Power, Attendants and/or Delivery fees are included *
Item I Specs Play Space Ages Capacity Cost qty
Amazon Combo Slide 44'Lx15'Wx16'H same 5 and up 2 695 1
Bass Pro Slide 45'Lx26'Wx33'H same 48" 2 1250 1
Coconut Falls 33'Lx26'Wx25'H same 5 and up 2 850 1
Dual Lane Slide 30'Lx15'Wx24'H same 5 and up 2 695 1
Fiberglass Super Slide 901x20'Wx35'H same 5 and up 3 1500 1
Kongo Krazy 45'Lx30'Wx35'H same 48" 2 1500 1
Paradise Slide 35'Lx21'Wx27'H same 5 and up 2 850 1
Raptor Slide 42'Lx44'Wx25'H same 48" 3 1250 1
Screamer Slide 30'Lx17'Wx26'H same 5 and up 2 695 1
Tidal Wave Slide 35'Lx21'Wx27'H same 5 and up 2 850 1
Vertical Rush Slide 32'Lx13'Wx30'H same 7 and up 2 1250 1
y City of Sunny Isles 2017 Bouncers
s-. * Prices are based on an up to 4 hour rate unless otherwise specified *
* All necessary Power,Attendants and/or Delivery fees are included *
e
Item ms, a Specs Play Space Ages 'Capacity ICost ICfty
Atlantis 131x13' same 11 and under 6 325 1
Backyardigans 15'x15' same 11 and under 6 350 1
Batman 15'x15' same 11 and under 6 350 1
Blues Clues 15'x15' same 11 and under 6 350 1
Candy Land 15'x15' same 11 and under 6 350 1
Cars 15'x15' same 11 and under 6 350 1
Curious George 15'x15' same 11 and under 6 350 1
Disney Princess 15'X15' same 11 and under 6 350 1
Dora Explorer 15'x15' same 11 and under 6 350 1
Farm 15'x15' same 11 and under 6 350 1
Fairies 15'x15' same 11 and under 6 350 1
Finding Nemo 15'x15' same 11 and under 6 350 1
Firemen 15'x15' same 11 and under 6 350 1
Frankie Foot Bouncer 18'Lx11'Wx18'H same 11 and under 6 475 1
Girl Thing 15'x15' same 11 and under 6 350 1
Go Diego 15'x15' same 11 and under 6 350 1
Ice Castle 15'x15' same 11 and under 6 350 1
Incredibles 15'x15' same 11 and under 6 350 1
Incredible Hulk 15'x15' same 11 and under 6 350 1
Knights & Dragons 15'x15' same 11 and under 6 350 1
Madagascar 15'X15' same 11 and under 6 350 1
Mickey& Friends 15'x15' same 11 and under 6 350 1
Noah's Ark 15'x15' same 11 and under 6 350 1
Outer Space 15'x15' same 11 and under 6 350 1
Paw Patrol 151x15' same 11 and under 6 350 1
Pirate Foot Bouncer 18'Lx11'Wx18'H same 11 and under 6 475 1
Princess and the Frog 15'x15' same 11 and under 6 350 1
Pocahontas 15'x15' same 11 and under 6 350 1
Power Rangers 155x15' same 11 and under 6 350 1
Race Cars 15'x15' same 11 and under 6 350 1
Scooby Doo 15'x15' same 11 and under 6 350 1
Sesame Street 15'x15' same 11 and under 6 350 1
Shrek 15'x15' same 11 and under 6 350 1
Spider Man 15'x15' same 11 and under 6 350 1
Sponge Bob 15'x15' same 11 and under 6 350 1
Sports 15'x15' same 11 and under 6 350 1
Superman 15'x15' same 11 and under 6 350 1
Toy Story 15'x15' same 11 and under 6 350 1
Tropical Luau 15'x15' same 11 and under 6 350 1
Winnie the Pooh 15'x15' same 11 and under 6 350 1
Winter Fun 15'x15' same 11 and under 6 350 1
Yo Gabba Gabba 15'x15' same 11 and under 6 350 1
4:il,l. City of Sunny Isles 2017 Water Fun
�.,
I, * Prices are based on an up to 4 hour rate unless otherwise specified
* All necessary Power, Attendants and/or Delivery fees are included *
err—
L Item _ Specs I Play Space Ages 'Capacity Cost IQty
Amazon Water Slide 44'Lx15'Wx16'H same 7 and up 2 $695 1
Amazon Olympics Obstacle - 38' 38'Lx12'Wx14'H same 7 and up 4 $695 2
Amazon Olympics Obstacle -82' 82'Lx12'Wx16'H same 7 and up 6 $895 1
Amazon Olympics Obstacle- 120' 120'Lx12'Wx16'H same 7 and up 8 $1,095 1
Blue Crush Combo Slide 65'Lx25'Wx27'H same 7 and up 2 $950 1
Canyon Rapids Water Slide 27'Lx24'Wx22'H same 5 and up 2 $695 1
Coconut Falls Water Slide 33'Lx26'Wx25'H same 5 and up 2 $850 1
Dash &Splash 17'Lx17'Wx22'H same 5 and up 6 $695 1
Dual Lane Slip 'n' Slide 33'Lx9'Wx8'H same 3 and up 2 $495 1
Dual Lane Slip w/Pool 33'Lx9'Wx8'H same 3 and up 2 $495 1
Dual Lane Surf'n' Slide 34'Lx16'Wx9'H same 3 and up 2 $695 1
Dunk Tank 5'Lx5'Wx8'H 10'x10' 5 and up 1 $495 1
Fire and Ice Water Slide 34'Lx17'Wx25'H same 5 and up 2 $795 1
Foam Party Arena 20'Lx20'Wx5'H same 3 and up 8 $1,195 2
Paradise Plunge Combo Slide 68'Lx21'Wx27'H same 5 and up 1 $950 1
Pitch Burst 5'Lx5'Wx8'H 10'x10' S and up 1 $495 1
Splash Island 18'Lx18'Wx13'H same 11 and under 5 $595 1
Wall-E Combo-Wet 21'Dx18'Wx17'H same 11 and under 6 $550 1
Water Balloon Battle 45'Lx13'Wx15'H same 5 and up 4 $795 1
Water Tag 28'Lx16'W same 5 and up 6 $650 1
Water Wars 30'Lx10'W 7 and up 2 $850 1
Wild Wave Mini 26'Lx12'Wx14'H same 3 and up 1 $495 1
Wipe Out Slide 36'Lx13'Wx19'H same 5 and up 1 $750 1
2015 Price List Food, Games and Artists
as 1;1',f•
* Prices are based on an up to 4 hour rate unless otherwise specified *
* All necessary Power,Attendants and/or Delivery fees are included *
Item mer Specs Play Space Ages !CapacityI Cost per I Qty
FUN FOODS:
Cotton Candy Machine $100 5
Old Fashioned Cart $50 2
Popcorn Machine 8 oz. $100 5
Old Fashioned Cart $50 2
Snow Cone Machine $100 5
Old Fashioned Cart $50 2
Ice 100 lbs. $25
Fun Food Servings batch of 75 $25
Food Servers $15 per hour
Old Fashioned Shake Lemonade Cart ask for details
GAMES:
Kentucky Derby Midway 30'Lx8'Wx16'H 30'Lx16'Wx16'H 5 and up 14 $1500 no prizes 1
$500 add prizes
Wacky Water Race 30'Lx8'Wx16'H 30'Lx16'Wx16'H 7 and up 16 $1500 no prizes
$500 add prizes
Carnival Game Booths 10'x10' $250 15
Carnival Games:
Small $75 10
Medium ask for List $150 10
Deluxe $200-250 5
Attendant $15 per hour
Giant Lawn Games ask for List $150-$250
ARTISTS:
Airbrush Artist $150 per hour 10
Balloon Twister $150 per hour 10
Caricaturist $150 per hour 10
Clown $150 per hour 10
Clown w/Show $275 45 min. 1
Extreme Balloon Twister $275 per hour 5
Face Painter $150 per hour 15
Juggler $150 per hour 5
Juggling Show $350 per hour 1
Games Master $350 1.5 hrs 3
Glitter Tattoos $150 per hour 2
Hair Braider w/beads $175 per hour
Magician Strolling $275 per hour 5
Magic Show $275 40 min. 2
Ponies $150 per hour 10
Wild Animal Show $375 per hour 3
ANN♦IJ
Oi S 'b""\r\1
'_ NON - COLLUSION AFFIDAVIT
^I` I
City of Sunny Isles Beach
" 18070 Cams Avenue
b
se )10� a+' Sunny Isles Beach,FL 33160
a. sun'� Telephone:(305)907-0606 Fax(305)90?3113
STATE OF FLORIDA )
COUNTY OF BMurarrt)
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,
lhr0 Cekbritro i Source.. --fie.--.
(Name of Corporation,Partnership,Individual,etc.)
Evevrt- Honi d
a ,eo`1/i(�S ,formed under the laws ofa
(Type of Business) (State)
of which he is V rct Pre,jAeht"
(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,fire 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 fox 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. ..ent thereof.
111110 V,cc- Pres1 e1e pit
AFFIANTS NAME W-- . AFFIANTS TITLE
/ �/ n ae/6
W)
TAKEN.S RN AND SUBSCRIBED TO BEFORE ME this.1`'l day of (2G T 19 v' ..260—.--
Personally
26(I!Personally Known or Produced Identification
Type of identification F L C
(Affix seal here) ��
N• if Y R.:LIC(name printed or typed)
AA."'a JEXTOR AYALA
iLWIA MY COMMISSION t FF 911313
* *
EXPIRES:October 3,2019
°j+r of soreld1tn 3WpdNdaySNrffi
rrcai ata 2e.2010 1 of 7
PUBLIC ENTITY CRIMES
City of Sunny Isles Beach
16070 CcRns Avenue
\'•i 1 o`+Y"+` Sunny Isles Beach,FL 33160
''o. sus' Telephone:(305)947-0606 Fax(305)949-3113
SWORN STATEMENT PURSUANT TO SECTION 287.1.33(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` statementsttemis submitted to City of Sunny Isles Beach
by pa-_. _-'mean i �'pfi
for Thui that.py� zcteZ
whose business address is:
Esq. 4
-Tyler- Sree-t"
1-4-ony(,7erno, Fir 3-8019
and (if applicable) its Federal Employer Identification number(FEIN) is (S ' 108s 'I C7.
(If the entity had no FEIN, include the Social Security Number of the individual signing this sworn
statement: .)
11.2. I 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. I 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 nob contendere.
11.4. I 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
CC-COMER 28,2010 2 of 7
market value under an arm's length agreement, shall be a prime fade 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. I understand that a "person" as defined in Pam. 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:
(Signature)
Pau ( Pa W. i
(Printed Name)
Via Prestde.nT
(The)
Sworn to and subscribed before me this /4/ day of 0G4 G e , 20 IL , by
(AFFIX NOTARY STAMP HERE)
,JEKTORAYALA
MYCONJJISSIONtFF911313 Signat5eNotary Puy", Sate of Florida
EXPIRES:October 3,2019 :Pct- r /q
BotdeE trJBolgetNotarySents Print or Type Commiss ned Name
Personally Known OR Produced Identification C//
Type of Identification Produced rc- 19 L
ureas 3 of 7
214"f<
\Fr EQUAL OPPORTUNITY /
AFFIRMATIVE ACTION
. City of Sunny Isles Beach
',a. ,v. 16070 Coons Avenue
Sunny Isles Be ,.adFL 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: i
� t Imo;
Title: Vie r 2 Presi,Lo h t
Firm: Th e. ale oratfc i t?oa r a -r-for.,
Address: 5?s"e} 7y/er- Stre2V
I4O/1yLOO I FL- 3 90 r9
c.,.213,2010 4017
,$N ,s,,
+•
CONFLICT OF INTEREST
G _
City of Sunny Isles Beach
13070 Collis Avenue
Sunny Isles Beach,FL 33160
u. ,us''' Telephone:(305)947-0606 Far.(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 $rnwfcrd
BEFORE ME, the undersigned authority, personally appeared Pau../ Cann i who was duly swom,
deposes, and states: P
18.1. I am [+ the VICe. Pre s;ei: f of
TAP �/a(� herr S'ixrce SnLith a local office in fir,I Iyw rL 3o,9 and principal office in
18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. M2-09-0 i described
as: L .r The Affiant has made diligent inquiry and provides the information contained in this
Affidavit based upon his own knowledge. E u ey,-f fes ROnot(
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.
18.8 I 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 his Q day of f)r+r)ot7 r .x.16
-5/ Poll r :wsir Ste Pres deh'"-
AFFIANT Print or Type Narial;rand Title
�(laker X0/6
Swom to and subscribed before me this /9 day of / /(
❑ / Personally Known OR —/ p(_
qy Produced Identification �;Type of Identifica'.n r
NOTARY PUBLIC STATE OF FLORIDA
.e B JEXTOR AYALA
ao'...ire,' MYCOUSSIONtFP911313
aUSA
EXPIRES:October 3,2019
"'..'a�' Bonded TtrukfolNGity Scrim
DECEMBER 23,2010 5 of 7
Vs"♦ it f
Ol "'T�f
' _, DISPUTE DISCLOSURE
i
•. City of Sunny Isles Beach
•• 18070 Carve Avenue
a•;----0°
•r v oo+` Sunny Isles Brach,FL 33160
'o.s��' Telephone:(305)947-0606 Far.(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 acsoriations within the last
five(5)years?
•
YES NO k7
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 17-
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
daim, 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.
11/e.- Cale bredion Sou,rte tyc /pi 14/ 9_o/40
Firm e� to
_> 'Vice Pres'
Authorized Signature Print or Type Name and Title
oece.ffa 2e,2010 6o17
SVNMY 1,,F
'_ ANTI - KICKBACK
City of Sunny Isles Beach
18070 Cain Avenue
'�`•r to''Y ..' Sunny Isles Beach.FL 33160
''o. ,uv' Telephone:(305)947-0606 Far(305)949-3113
ANTI-KICKBACK AFFIDAVIT
STATE OF FLORIDA )
)
COUNTY OF orD1v 4 )
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: \C-4?-2
,7a.
Title: V(CC { re5%den+
0 zit foregoing instrument was acknowledged before me this / y day of
G P V , 20 / b , by [name
of person], as Vire_ Presirled, f [type of authority], for
The_l'e/n lvratim,Strte Tie, [name of party on behalf of whom instrument was
executed].
AFFIX NOTARY STAMP HERE:
Y.:.-----
,P::tet JEKTORAYALA No • • •u . is— State of Florida
, ,-„ MYCOASOSSICNrfF911313
`1 - EXPIRES:Oct:09,3,2019 Z:9—fel.--40( 4 c
%pm,' Bu101011n kipONON SenFe Y'q
Print or Type Commissioned Name
Personally Known OR Produced Id ratification V
Type of Identification Produced F` . I)L-
CECE,mEa 28,2010 7 of 7