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REQUEST FOR PROPOSALS
RFP NO. 10-10-02
INSTALLATION, OPERATION AND
MAINTENANCE OF ELECTRIC
VEHICLE CHARGING STATIONS
CITY OF SUNNY ISLES BEACH
MIAMI-DADE COUNTY, FLORIDA
T ABLE OF CONTENTS
RFP
Public Notice........................................................................................................................... ............... 1
Section 1.1 Introduction...................................................................................................................... . 3
Section 1.2 Scope of Services................................................................................................................ 3
Section 1.3 -Submittal Requirements................................................................................................. 4
Section 1.4 - Submission Date and Mandatory Pre-RFP Submission Conference......................... 5
Section 1.5 - Additional Information or Clarification ...................................................................... 6
Section 1.6 - Selection, Award, and Protest Procedures ...................................................................6
Section 1.7 - Contract Execution......................................................................................................... 7
Section 1.8 - Instructions..................................................................................................................... 7
Section 1.9 - Changes! Alterations....................................................................................................... 7
Section 1.10 - Discrepancies, Errors, and Omissions ........................................................................ 7
Section 1.11 - Disqualifications........................................................................................................... 7
Section 1.12 - Submission Receipt....................................................................................................... 8
Section 1.13 - Capital Expenditures.................................................................................................... 8
Section 1.14 - Hold Harmless and Indemnification........................................................................... 8
Section 1.15 - Reservation of Rights................................................................................................... 8
Section 1.16 - Additional Information................................................................................................ 9
Section 1.17 - Exhibit........................................................................................................................... 10
Public Entity Crime Affidavit (Attachment "A") .............................................................................. 11
Non-Collusive Affidavit (Attachment "B") ........................................................................................ 14
Questionnaire (Attachment "C")......................................................................................................... 16
PUBLIC NOTICE
NOTICE IS HEREBY GIVEN that the CITY OF SUNNY ISLES BEACH is seeking proposals
seeking proposals from qualified electric vehicle charging station
distributors/operators/manufacturers to install, operate, and maintain electric vehicle charging
stations for the City of Sunny Isles Beach.
Interested firm/individuals ("Proposer (s)") may pick-up a copy of Request for Proposals ("RFP") No.
10-10-02 to be issued on Monday, October 25, 2010 at Sunny Isles Beach Government Center, 18070
Collins Avenue, City Clerk's Office, Fourth Floor, Sunny Isles Beach, Florida, 33160. RFP No. 10-
10-02 is also available from DemandStar by calling (800) 711-1712 or by accessing their website at
www.demandstar.com. The RFP contains detailed and specific information about the scope of
services, Submission requirements and selection procedures.
One (1) original, four (4) copies of the completed and executed Submissions must be delivered to the
following address no later than Tuesday, November 23, 2010 at 10:00 a.m.:
Sunny Isles Beach Government Center
18070 Collins Avenue, City Clerk
First Floor Meeting Room
Sunny Isles Beach, Florida, 33160
The City reserves the right to accept or not accept late submitted bids in the sole discretion of the City
Manager or his designee.
The envelope containing the sealed Submission must be clearly marked as follows:
"SEALED BID"
RFP NO. 10-10-02 Install, Operate, and Maintain Electric Vehicle Charging Stations for the
City of Sunny Isles Beach.
OPENING DATE AND TIME: Tuesday, November 23,2010 at 10:00 a.m.
A mandatory Pre-RFP Submission Conference is scheduled for Tuesday, November 9, 2010 at
1:30 p.m. at the Sunny Isles Beach Government Center, 18070 Collins Avenue, First Floor
Meeting Room, Sunny Isles Beach, Florida 33160. All Proposers planning to submit Submissions
are required to attend this meeting. Proposers should allow sufficient time to ensure arrival prior to the
indicated time, those arriving after the discussion has begun will not be considered to be in attendance.
Submissions from those who have failed to attend will not be accepted.
The City of Sunny Isles Beach (the "City") intends to enter into an agreement with the successful
Proposer to install, operate, and maintain electric vehicle charging stations for the City of Sunny
Isles Beach.
The contract will be awarded by the City to the Proposer whose proposal best serves the interests of,
and represents the best value to, the City in accordance with the criteria set forth in Section 62-8 of the
City Code. The City reserves the right to reject any or all proposals, with or without cause, to waive
technical errors and informalities, and to accept the proposal which best serves the interest of the City.
Any questions regarding RFP No. 10-10-02 are to be directed in wntmg to Rick Conner, City
Manager, at the following address: 18070 Collins Ave., Fourth Floor, Sunny Isles Beach, Florida
33160. Alternatively, any questions may be sent via email to:rconner@sibfl.net.
Any questions or clarifications concerning the proposal specifications must be received by Rick
Conner, City Manager, at least seven (7) business days prior to the date of the proposal opening.
For further information, please contact Rick Conner, City Manager, at 305-792-1701.
Jane A. Hines, CMC, City Clerk
City of Sunny Isles Beach
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CITY OF SUNNY ISLES BEACH, FLORIDA
REQUEST FOR PROPOSAL NO. 10-10-02
INSTALLATION, OPERATION, AND MAINTENANCE OF ELECTRIC
VEHICLE CHARGING STATIONS FOR THE CITY OF SUNNY ISLES BEACH
1.1 INTRODUCTION
The City of Sunny Isles Beach, Florida, (the "City") a municipality located in Miami-
Dade County, Florida, requests qualified Proposers ("Proposers") to submit proposals for
the installation, operation and maintenance of electric vehicle charging stations
throughout various locations in the City.
The City is dedicated to providing environmentally friendly service programs, and
towards that end, the City intends to provide electric vehicle charging stations at
various municipal parking facilities. The City's goals and objectives are to promote a
vision to make electric vehicles a part of daily life for City residents and visitors. This
electric charging station program is to be accessible to the maximum number of
people in the most cost-efficient manner.
Self-service electric vehicle charging stations facilitate the use of electric vehicles
("EVs") due to the limited range of current EVs and their need to recharge periodically.
The availability of strategically placed charging stations throughout the City provides a
greater convenience and further promotes the use of EV s. Benefits to the City include
improved air quality, quieter and more livable streets, and decreased dependency on
fossil fuels.
Firms that provide electric vehicle charging stations should propose a business model
that is advantageous to both users and the City. In return, the firm may use municipal
parking spaces to provide their services, assess a fee for the use of electric vehicle
charging stations, and revenue share with the City.
1.2 SCOPE OF SERVICES
The successful Proposer must provide an electric vehicle charging station program
which includes the following networking capabilities and benefits:
. Electric vehicle charging station infrastructure that is open to all drivers
without requiring subscriptions.
. A revenue stream to pay for electricity, capital equipment, operation, and
maintenance.
· Ability for drivers to find charging stations via web enabled cell phones.
. Notification by SMS, text, or e-mail when charging is complete.
· Authenticated access to eliminate energy theft.
. Remote monitoring and diagnostic for superior quality of service.
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. Smart Grid integration for utility load management with future V2G capabilities.
. Green House Gas savings calculations per driver and per fleet.
. Fleet vehicle management.
. Comply with Miami Dade County and City of Sunny Isles Beach Building codes
and electrical codes.
The successful Proposer shall propose business model(s) that are advantageous to
the end users as well as the City and promotes the use of electric vehicles.
The City wishes to preserve flexibility for itself in entering into an EV charging
station program. Accordingly, we will adhere to the following sequence:
The successful Proposer shall initially be responsible for installing, operating, and
maintaining an electric vehicle charging station, Monday through Sunday, including
holidays and during special events. Upon completion of this initial installation,
operation and maintenance, and at the City's sole discretion and option, the City may:
. Elect to terminate the EV Charging Stations program; or
. Continue the EV charging station program, with the successful
Proposer, and identify additional parking garages from among other
City parking facilities; or
. Issue a new competitive solicitation.
1.3 SUBMITT AL REQUIREMENTS
Proposals shall be as thorough and detailed as possible so that the City may properly
evaluate the capabilities of respective firms to provide the required services. All
submittals by Proposers shall contain no more than fifteen (15) pages specifically
addressing the following issues. Items number 8, 9 and 10 below will not be considered a
part of the fifteen (15) pages. Any Proposer wishing to provide the services described in
this RFP shall submit one (1) original and four (4) additional complete copies that
include, at a minimum, the following documentation: Name, address and company,
including, but not limited to, a business overview, financial state of the business, annual
revenue for past two years, and names and addresses of persons having financial interest
in the firm.
1. Provide a narrative description of current and previous experience for the
past five (5) years in successfully providing self-service vehicle charging
station services. The proposal must identify the primary individuals
responsible for supervising the work and include the resumes of the
primary individuals.
2. Provide a detailed cost proposal which shall include all costs associated
with the services described in this RFP.
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..
3. The successful Proposer must provide evidence of sufficient financial
stability to provide self-service electric vehicle charging station services to
meet the City's needs.
4. The successful Proposer must demonstrate a level of expertise, technical
knowledge, innovation and overall capacity to provide self-service electric
vehicle charging station services during variable periods of demand,
including any unforeseeable circumstances.
5. Proof of authorization to transact business in Florida from the Florida
Secretary of State, from the prime as well as any supporting firm( s).
6. The name, title, qualifications, experience, and all contact information of
the proposed contact person.
7. Provide copies of all licenses and certifications of the Proposer.
8. Sworn statement pursuant to Section 287.133(3)(A), Florida Statutes,
regarding Public Entity Crime, a copy of which is attached hereto.
9. Non-collusive and Public Entity Crime Affidavits, copies of which are
attached hereto as Attachments "A" and "B".
1 O. Questionnaire attached hereto as Attachment "C"
1.4 SUBMISSION DATE AND MANDATORY PRE-RFP SUBMISSION
CONFERENCE
Proposals must be received by the City Clerk's Office no later than 10:00 a.m. on
Tuesday, November 23, 2010, at the Sunny Isles Beach Government Center, Attn: City
Clerk, First Floor Conference Room, 18070 Collins Avenue, Sunny Isles Beach, FL
33160. One (1) original, and four (4) copies of the completed and executed proposal
must be delivered by this deadline. Proposals will be opened publicly and read aloud at
this time. The City reserves the right to accept or not accept late submitted proposals
based on the sole discretion of the City Manager or his designee.
The envelope containing the sealed Proposal must be clearlv marked as follows:
"SEALED PROPOSAL"
RFP NO. 10-10-02 INSTALLATION, OPERATION, AND MAINTENANCE OF
ELECTRIC VEHICLE CHARGING STATIONS FOR THE CITY OF SUNNY
ISLES BEACH
OPENING DATE AND TIME: Tuesday, November 23,2010 at 10:00 a.m.
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A mandatory Pre-RFP Submission Conference is scheduled for Tuesday. November
9. 2010, at 1:30 p.m., at the Sunny Isles Beach Government Center, 18070 Collins
Avenue, First Floor Conference Room, Sunny Isles Beach, Florida. All Proposers
planning to submit a Proposal shall be required to attend this meeting. Attendance at this
mandatory Pre-RFP Submission Conference is required in order to submit a proposal for
this RFP. Proposers should allow sufficient time to ensure arrival prior to the
indicated time; those arriving late will NOT be considered to be in attendance.
1.5 ADDITIONAL INFORMATION OR CLARIFICATION
Requests for additional information or clarifications must be made in wrItmg and
received by Rick Conner, City Manager, specified in the Public Notice Section of this
RFP, in accordance with the deadline for receipt of questions also specified in the Public
Notice Section of this RFP. The request for additional information and clarification must
contain the RFP number and title, Proposer's name, name of Proposer's contact person,
address, phone number, and facsimile number.
Electronic facsimile requesting additional information must be received by Rick Conner,
City Manager, at facsimile number (305) 792-1561. Facsimiles must have a cover sheet
which includes, at a minimum, the Proposer's name, name of Proposer's contact person,
address, number of pages transmitted, phone number, facsimile number, and RFP number
and title.
Alternatively, any questions may be sent via email to:rconner@sibfl.net. Any questions
or clarifications concerning the proposal specifications must be received by Rick Conner,
City Manager at least seven (7) business days prior to the date of the proposal opening.
The City will issue responses to inquiries and any other corrections or amendments it
deems necessary in written addenda issued prior to the Submission deadline. Proposers
should not rely on any representations, statements or explanations other than those made
in this RFP or in any written addendum to this RFP. Where there appears to be conflict
between the RFP and any addenda issued, the last addendum issued shall prevail.
1.6 SELECTION. AWARD. AND PROTEST PROCEDURES
The City will select the most qualified Proposer whose proposal best serves the interests
of and represents the best value to the City based on the criteria set forth in Section 62.8
of the City Code. The City will act, at its sole discretion, in what it considers to be in the
best interest of the City. The City will evaluate the comparable experience, capability,
project management, workload, financial strength, and other factors the City deems
pertinent and will select the Proposer that it deems to be most qualified. The City will be
the sole judge in determining the most qualified firm in accordance with the criteria set
forth in Section 62-8 of the City Code.
Any protests or objections to the City's Request for Proposals and/or the selection of the
selected Proposer must be submitted in writing in accordance with Section 62-15 of the
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City Code. If the City and selected Proposer are unable to negotiate a mutually
acceptable contract, the City may terminate the contract negotiations and begin
negotiations with the other qualified firms. This process may continue until a contract
has been executed or all Proposals have been rejected. No Proposer shall have any rights
in the subject project or against the City arising from such negotiations.
1.7 CONTRACT EXECUTION
The successful proposer will be required to enter into a contract satisfactory to the City.
The successful operation of this contract requires that the selected Proposer act in good
faith in all matters relating to carrying out the project and the interpretation of the
contract documents.
1.8 INSTRUCTIONS
Careful attention must be given to all requested items contained in this RFP. Proposers
are invited to submit Proposals in accordance with the requirements of this RFP.
PLEASE READ THE ENTIRE SOLICITATION BEFORE SUBMITTING A
PROPOSAL. Proposers shall make the necessary entry in all blanks provided for the
responses. The entire set of documents, together with all attachments hereto, constitutes
the RFP. Each Proposer must return these documents with all information necessary for
the City to properly analyze the response in total and in the same order in which it was
issued. Proposer's notes, exceptions, and comments may be rendered on an attachment,
provided the same format of this RFP text is followed. All responses to this RFP shall be
returned in a sealed envelope or package with the RFP number and opening date clearly
noted on the outside of the envelope. Proposers must provide a response to each
requirement of the RFP. Responses should be prepared in a concise manner with an
emphasis on completeness and clarity.
1.9 CHANGES/ALTERATIONS
Proposers may change or withdraw a response at anytime prior to the submission
deadline; however, no oral modifications will be allowed. Written modifications shall
not be allowed following the submission deadline.
1.10 DISCREPANCIES. ERRORS. AND OMISSIONS
Any discrepancies, errors, or ambiguities in the RFP or addenda (if any) should be
reported in writing to Rick Conner, City Manager. Should it be necessary, a written
addendum will be incorporated to the RFP. The City will NOT be responsible for any
oral instructions, clarifications, or other communications.
1.11 DISQUALIFICATION
The City reserves the right to disqualify responses before or after the submission
deadline, upon evidence of collusion with intent to defraud or other illegal practices on
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the part of the Proposer. The City also reserves the right to waive any immaterial defect
or informality in any responses to this RFP; to reject any or all responses in whole or in
part; or to reissue an RFP for the services described herein.
1.12 SUBMISSION RECEIPT
Sealed responses will be accepted in accordance with the instructions detailed on the
cover of this RFP. The Proposer shall file all documents necessary to support its
response and shall include them with its Proposal. Each Proposer shall be responsible for
the actual delivery of responses during business hours to the exact address indicated in
this RFP. The City reserves the right to accept or not accept late submitted proposals in
the sole discretion of the City Manager or his designee.
1.13 CAPIT AL EXPENDITURES
The selected Proposer understands that any capital expenditures that the selected
Proposer makes, in order to perform the services required in this RFP is a business risk.
The City, however, is not and shall not payor reimburse any capital expenditures or any
other expenses, incurred by any Proposer, in anticipation either of a contract award or to
maintain the approved status of the selected Proposer if a contract is awarded.
1.14 HOLD HARMLESS AND INDEMNIFICATION
All Proposers shall hold the City, its officials and employees harmless and covenant not
to sue the City, its officials and employees in reference to their decisions to reject, award,
or not award a RFP, as applicable. Additionally, the selected Proposer shall indemnify,
defend and save harmless the City, its officers, agents and employees, from or on account
of any injuries or damages, received or sustained by any person or persons during or on
account of the Proposer's performance of its services under this RFP, or by or in
consequence of any negligence (excluding the sole negligence of City), in connection
with the same; or by use of any improper materials or by or on account of any act or
omission of the said selected Proposer or his Sub-Proposer, agents, servants or
employees. The selected Proposer shall indemnify, defend and hold harmless the City and
their agents or employees from and against all claims, damages, losses and expenses
including attorneys' fees arising out of or resulting from the performance of the work
described in the RFP, provided that any such claim damage, loss or expense (a) is
attributable to bodily injury, sickness, disease or death, or to injury to or destruction of
tangible property (other than work itself) including the loss of use resulting wherefrom
and (b) is caused in whole or in part by any negligent act or omission of the selected
Proposer, Sub-Proposer, anyone directly or indirectly employed by any of them or
anyone for whose acts any of them may be liable, regardless of whether or not it is caused
by a party indemnified hereunder.
1.15 RESERVATION OF RIGHTS
While pursuing this RFP process, the City reserves the right to:
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· Accept any or all responses, and the right, in its sole discretion, to accept the
Proposer who will best serve the interests of, and represent the best value to, the
City in conformity with the criteria set forth in Section 62-8 of the City Code.
· Reject any and all qualifications and to seek new qualifications when such a
procedure is reasonably in the best interest of the City.
· Investigate the financial capability, integrity, experience, and quality of
performance of each Proposer, including officers, principals, senior management,
and supervisors, as well as staff identified in the response to RFP.
· Investigate the Proposer's qualifications or any of its agents, as it deems
appropriate
· Conduct personal interviews of any or all Proposers prior to selection (the City
shall not be liable for any costs incurred by the Proposer(s) in connection with
such interviews).
· Waive any of the conditions or criteria set forth in this RFP.
· The City reserves the right on any advertised selection process to decide whether
to select a firm based on submission received in response to this RFP or whether
to hold interviews with the firms the City deems best qualified for the project.
1.16 ADDITIONAL INFORMATION
· The Submission must clearly be marked on the front of the envelope:
"SEALED PROPOSAL"
RFP NO. 10-10-02 INSTALLATION, OPERATION, AND MAINTENANCE OF
ELECTRIC VEHICLE CHARGING STATIONS FOR THE CITY OF SUNNY
ISLES BEACH
OPENING DATE AND TIME: Tuesday, November 23, 2010 at 10:00 a.m.
· Questions regarding this RFP must be directed, no later than seven (7) calendar
days before the opening of the RFP, to:
Rick Conner
City Manager
City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, FL 33160
Telephone: (305) 792-1701
Email: rconner@sibfl.net
· Responses to this RFP must be delivered by the stated deadline to:
Attn: Jane A. Hines, CMC
City Clerk
Sunny Isles Beach Government Center
18070 Collins Avenue
First Floor Conference Room,
Sunny Isles Beach, FL 33160
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. The opening of the Proposals will be in the First Floor Conference Room, 18070
Collins Avenue, Sunny Isles Beach, Florida 33160 at the stated time.
. Proposals will be opened publicly and read aloud at this time.
. The City is under no obligation to return the Proposals.
. The City will not be liable for any cost incurred in the preparation of the response
to RFP.
· The Proposals shall be prima facie evidence that the Proposer has full knowledge
of the scope, nature, quantity and quality of work to be performed; the detailed
requirements of the specifications; and the conditions under which the work is to
be performed.
· The Proposers shall furnish the City with such additional information as the City
may reasonably require.
· Under no circumstance should any prospective Proposer or anyone acting on their
behalf, seek to influence or to gain the support of any member of the City
Commission or City Staff favorable to the interest of the prospective Proposer.
Likewise, contact with the City Commission or City Staff against the interest of
other prospective Proposers is prohibited. Any such activities may result in the
exclusion of the prospective Proposer from consideration by the City.
1.17 ATTACHMENTS
The Exhibits to this RFP are as follows:
Attachment "A"
Public Entity Crime Affidavit
Attachment "B"
Non-Collusive Affidavit
Attachment "C"
Questionnaire
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...
SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a)
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY
PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
1. This sworn statement is submitted
to
by
for
whose business address is
and (if applicable) its Federal Employer Identification Number (FEIN)
(If the entity had no FEIN, include the Social Security Number of the individual signing this
sworn statement:
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 of 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 or of the United States and involving antitrust, fraud, theft,
bribery, collusion, racketeering, conspiracy, or material misrepresentation.
3. I understand that "convicted" or "conviction" as defined in Paragraph 287.l33(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 trial court of record relating to charges brought by
indictment or information after July 1, 1989, as a result of a jury verdict, nonjury trial, or
entry of a plea of guilty or nolo contenders.
4. I understand that an "affiliate" as defined in Paragraph 287. 133(1)(a), Florida Statutes, means:
a. A predecessor or successor of a person convicted of a public entity crime; or
b. An 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 come. The term "affiliate" includes those
officers, directors, executives, 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 market value under an arm's length agreement, shall be a prima 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.
5. I understand that a "person" as defined in Paragraph 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
Attachment "A"
11
applies to transact business with a publi9 entity. The term "person" includes those officers,
directors, executives, partners, shareholders, employees, members, and agents who are active
in management of any entity.
6. Based on information and belief, the statement which I have marked below is true in a
relation to the entity submitting this sworn statement. (Please indicate which one (1) of the
following three (3) statements is applicable.)
_ (1) Neither the entity submitting this sworn statement, nor any of its officers, directors,
executives, partners, shareholders, employees, members, or agents who are active in the
management of the entity, or any affiliate of the entity has been charged with and convicted of a
public entity crime within the past 36 months.
_(2) 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 any affiliate of the entity has been charged with and convicted of a
public entity crime within the past 36 months.
_(3) 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 agents who are active in management of the entity, or any affiliate
of the entity has been charged with and convicted of a public entity crime within the past 36
months. However, there has been a subsequent proceeding before a Hearing Officer of the State
of Florida, Division of Administrative Hearings and the Final Order 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. (Attached is 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 1 (ONE) ABOVE IS
FOR THE PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH
DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED AND FOR THE
PERIOD OF THE CONTRACT ENTERED INTO, WHICHEVER PERIOD IS LONGER. 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 THE
CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS
FORM.
SIGNATURE OF AFFIANT
(Printed or Typed Legal Name of Affiant)
12
ST ATE OF FLORIDA )
)ss.
COUNTY OF MIAMI-DADE)
The foregoing Form was acknowledged before me this_ day of , 2010, by
~ cl
, a Florida corporation, on behalf of said corporation and limited
partnership. He/She personally appeared before me and is personally known to me.
{NOTARY SEAL}
Notary:
Print Name
Notary Public, State of Florida
My Commission Expires:
13
NON-COLLUSION AFFIDAVIT
STATE OF FLORIDA
COUNTY OF MIAMI-DADE
The undersigned being first duly sworn as provided by law, deposes, and says:
1.1. 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 City, in any
consideration which may give to and any action it may take with respect to this proposal.
1.2. The undersigned IS authorized
to make this Affidavit on behalf of,
(Name of Corporation, Partnership, Individual,
existing under the laws of the State of
(Sole Owner,
etc.), a corporation duly organized and
of which he is
Partner, President, etc.)
1.3. Neither the undersigned nor any person, firm, or corporation named in above Paragraph
1.2, nor anyone else to the knowledge of the undersigned, have themselves solicited or employed
anyone else to solicit favorable action for this proposal 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.
1.4. This proposal is genuine and not collusive or a sham; the person, firm or corporation
named above in Paragraph 1.2 has not colluded, conspired, connived or agreed directly or
indirectly with any Proposer or person, firm or corporation, to put in a sham proposal, or that such
person, firm or corporation, shall refrain from Proposing, 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 proposal or proposals of any other Proposer; and all
statements contained in the proposal or proposals described above are true; and further; neither
the undersigned, nor the person, firm or corporation named above in Paragraph 1.2, has directly
or indirectly submitted said proposal or the contents thereof, or divulged information or data
relative thereto, to any association or to any member or agent thereof.
AFFIANT'S NAME
AFFIANT'S TITLE
Attachment "B"
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The foregoing Affidavit was acknowledged before me this_ day of , 2010, by
as of
, a Florida corporation, on behalf of said corporation and limited
partnership. He/She personally appeared before me and is personally known to me.
{ NOTORIAL SEAL }
Notary:
Print Name:
Notary Public, State of Florida
My Commission Expires:
\
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Ouestionnaire
Contractor's Name:
Principal Office Address:
Individual
Partnership
Corporation
(Circle One)
If a Corporation. answer this:
When incorporated:
In what State:
If a Foreien Corporation:
Date of Registration with Florida Secretary of State:
Name of Resident Agent:
Address of Resident Agent:
President's Name:
Vice-President's Name:
Treasurer's Name:
Members of Board of Directors:
If a Partnership:
Date of Organization:
Date of Limited Partnership:
Name and Address of Each Partner:
Name
Address
Attachment "C"
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Designate general partners in a Limited Partnership
1. Number of years of relevant experience in operating business:
2. Have any agrements held by Contractor for a project ever been canceled?
Yes () No ( )
3. Has the Contractor or any principals of the applicant organization failed to
qualify as a responsible Bidder, refused to enter into a contract after an award has
been made, failed to complete a contract during the past five (5) years, or been
declared to be in default in any contract in the last five (5) years?
Yes ( )
No ( )
If yes, please explain:
4. Has the Contractor or any of its principlals ever been declared bankrupt or
reorganized under Chapter 11 or put into receivership?
Yes ( )
No ( )
If yes, give date, court jurisidiction, action taken, and other explanation deemed
necessary on separate sheet.
5. List all pending lawsuits or judgments involving the corporation, partnership
or individuals with more than ten perscent (10%) interest in the business entity:
A. List all pending lawsuites:
B. List all judgments from lawsuits in the last five (5) years:
C. List any criminal violations and/or convictions of the Contractor and/or any
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of its principals:
6. Conflicts of Interest. The following relationships are the only potential,
actual, or perceived conflicts of interest in connection with this proposal: (If none,
state none.)
7. Public Disclosure. In order to determine whether the Contractor or its
principals have any association or relationships with the City which would
constitute a conflict of interest, either actual or percieved, and in an attempt to
ensure full and complete disclosure regarding this contract, all Proposers are
required to disclose all persons and entities who may be involved with this Proposal.
This list shall include public relation firms, lawyers and lobbyists. The City
Manager or his designee shall be notified in writing if any person or entity is added
to this list after receipt of proposals.
8. Are there any pending discussions relative to mergers, acquisitions,
partnerships, or assignment of contract?
The Proposer understands that information contained in this Questionaire will
relied upon by the City in awarding the proposed contract, and such information is
warranted by the Proposer to be true and accurate. The Proposer agrees to furnish
such additioanl information, pior to acceptance of any proposal relating to the
qualifications of the Proposer, as may be required by the City Manager or his
designee.
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Proposer
IF INDIVIDUAL:
Witness:
Signature
Signature
Print Name
Print Name
IF PARTNERSHIP:
Witness:
Signature
Name of Firm
By:
General Partner
Print Name
IF CORPORATION:
Attest:
Secretary
Name of Corporation
Print Name
Address
By:
President
(Corporate Seal)
Print Name
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