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Home My WebLink AboutSnack Time LLC . () o . () . . () . () . . . . . () . . Ie ea . (J () . . <l () let ~ . . . () :. (t () ~ ... . 3 . ,t ") ~ SNACK 11ME LLC. l-ttECE'VEDt'~QCA .""" ~ \ IJ ,\ R 2' "011 ,:;~i.; L. '- I. ~-l;\' c' Sun:)~ lsleli Bead1 . I __ L":'...~'~" t1<& C!~. Clerk .. Quality Food Service & Catering 149 NW 70th St. Boca Raton, FL 33487. Ph. (561) 674-6160. email:snacktime4u@gmail.com RFP 11-02-0 1 CONCESSIONAIRIE SERVICES FOR SAMSON OCEANFRONT PARK . . . . . . . . . . . . . ~ . () () . . . 'e '() () . () . \t . ,(t ~ .. . . I. ~) I() . \'l . I~) . . I) SNACK TIME LLC. Quality Food Service & Catering 149 NW 70th St. Boca Raton, FL 33487. Ph. (561) 674-6160. email:snacktime4u@gmail.com TABLE OF CONTENTS Company Introduction State of Florida Business License Food Service Manager Certificate Sample Menu Past and Current References Bank Reference Certificate of Insurance Proposed Monthly Rental Rate Company Photos Non-Collision Affidavit Public Entity Crimes Equal Opportunity Statement Conflict of Interest Statement Dispute Disclosure Form Anti - Kickback Affidavit Acknowledgment of Addenda Bid Submittal Form 1 2 3 4 5-8 9 10 11 12-15 16 17-18 19 20 21 22 23 24 . . . . . . . . . " . . <t . . () . . I(} Q () . () I. . . . I. . :') . . I. , c..). . . 't . () . . 'f) SNACK TIME LLC. Quality Food Service & Catering 149 NW 70th St. Boca Raton, FL 33487. Ph. (561) 674-6160. email: snacktime4u@gmail.com March 15,2011 We are pleased to introduce Snack Time LLC. and submit our proposal for Concessionaire Services at Samson Oceanfront Park. Snack Time LLC. (formerly Esther & David Company) is a family owned and operated Catering Company that has over 15 years of experience in South Florida's many different food service settings. Amongst these settings have been Food Service Operations at several Health Care Facilities, the Broward County Sherriff's Office Cafeteria, and many concession stands at recreational parks. Snack Time LLC.' s long history of excellence speaks for itself. Throughout the years, we have earned the solid reputation for being an extremely loyal, hard-working, and customer-service oriented company. Our high level of experience, staff, flexibility, cleanliness, and expertise has been the basics of all our retail and institutional endeavors. Our company embraces keeping close contact with customers and facility's management, so that we can tailor our services to meet any special needs that may arise. Therefore, operating the Concessionaire Services at Samson Oceanfront Park would be very similar to what we have done for the past 15 years. That is, our customers would be leisure-seeking patrons who would like to enjoy a quick and delicious bite during their stay at the park. Our company knows that the park's patrons want very simple things: good service, regular hours of operation, quality food at reasonable prices, and a clean, well-kept area to eat. If awarded this contract, we are confident that the City of Sunny Isles Beach and its residence will soon consider our company a part of its prestigious community. We guarantee that both the City and the Samson Oceanfront Park patrons will be greatly pleased with our services. We look forward to serving them soon. Sincerely, Judith Tauszik Snack Time LLC. Owner . . . . . . ct . . II . . . . . () . () . . ~ . ,) . ~ () . . . ~ . . . . (t "l . .- . ') J . rt ,,>....',.....,~ ~...-,~.,. . ~ v~ . 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THE NATIONAL REGISTRY OF FOOD SAFETY PROFESSIONALS@ CERTIFIES JUDITH TOROCSIK HAS SUCCESSFUU- Y SATISFIED THE REQUlREMENI'S FOR THE FOOD SAFETY MANAGER CER11FICATION ExAMINATION President: 'I )/ ./" h ~'( ),J()/,,(L - , / J..-rwnmn! 1. 1..1 Tleh ISSUE DATE: MARCH 6, 2009 CERTIFICATE No: XE20350373 TEsT FORM: XEI Thil certificate is not valid for more tbaa fhre yean fro. date of issue.. o . . ~. () . . () rt I. . <l 3 . . . . ~. . . . . . . . \l . . {} . '. Ie Ie) .. I. I') . :) a \'l It . 3 . It .. . ~. '3 . . . ,'l '. I~t . SNACK TIME LLC. Quality Food Service & Catering 149 NW 70th St. Boca Raton, FL 33487. Ph. (561) 674-6160. emaiI: snacktime4u@gmail.com SAMPLE MENU FOR SAMSON OCEANFRONT PARK ~ lb. Hebrew National Hot Dog Grilled Italian Sausage on Hogi Roll Grilled Chicken Breast on Bun Jumbo Soft Pretzel $3.00 $4.00 $5.00 $2.50 Condiments: Ketchup, Mustard, Sauer kraut, Relish, Onion, Mayo. Lays Potato chips $1.00 Jumbo Muffin Assorted $2.50 Oreo Cookies $1.00 Peanuts $1.00 Assorted Candies $1.00 Snow Cone $2.00 Soda $1.00 Bottled Water $1.00 Fresh Fruit Cups $3.00 *Combo Meals and Specials will be offered daily * it . . . . ,) .- . , . . . . \J . . () . . ~ () . . :) . . (t . .. . - . . . . <l :l . . . ,. . (I . Paul E. Roman 2000 Glades Road Boca Raton, Florida 33431 September 11, 1997 Re: Judith Tauszik To Whom it May Concern: For the past 5 years I was the president of SCORES, which is the organization which operates the recreational youth soccer program in West Boca. For the last 3 of those years, I had the pleasure of working with Judith Tauszik, who managed our concession stands. The concessions were always well-stocked with a variety of items which constantly changed in response to the requests of players and parents, from whom she constantly solicited comments and suggestions_ The concessions were also kept in spotless condition, which is no easy job in an outdoor setting. I also frequented her "bakery" in Oaks Plaza, which went far beyond being a bakery, and offered a large variety of hot and cold prepared foods. Like the concession stands, the bakery was always spotless. Our financial arrangement with Judith was on the honor system, and I was always satisfied that she went beyond honorable in accounting to us for the income and expenses of the stands. I found Judith to be a tireless worker who was never satisfied with the status quo. Rather, she constantly looked for ways to improve things. I would recommend for employment in any aspect of the food service industry. If you need any additional information, do not hesitate to contact me (394-0500). VeryJfU1y you5S, // Y;. / /1 ~ /7. , );tti/)/ t/Z~_ I Paul YRoman PERf dIe Copy to: 79340_1 Mrs. Judith Tauszik b . . . . . . . . . . . . . . . 3 . . 'e Cl '. I. . .- . (t . . . '. I. . ~ .. . . . . .. f. . . . Parkland Parks and Re,cre.a'Uon Department 6600 Unjv,ersi'ly Drive Parxland, Borida 33{)61 Phone 1954)-7:57-1.909 fax (954)- 341-5161 August 16, 2005 To Whom It May Concern: It is with pleasure that I write this letter of recommendation for Judith Tauszik owner of the Snack Time Inc. (formerly the Esther & David Company.) For the past 8 years, I have been the Parks & Recreation Director of the City of Parkland. During those years, I have had the pleasure of working with this company, who has been providing excellent food and beverage services in all of our parks. They also operate the snack bar in our Equestrian Center .. Especially important, is their work ethic, loyalty, commitment, and high standards. They always cheerful, cooperative, and willing to help each of their customers. Sometimes customers have special food requirements due to allergies, religious requirements, or other preferences. They handle everyone with unbelievable skill. Our concession stands are considered by the Department of Health as being one of the cleanest, safest, and best organized in the county. They offer more than just what is in their contract. Year after year they organize and provide their food service during our biggest events, such as Parkland Days, Concerts, and many Tournaments as well. They also volunteer to help and donate beverages during such events as Build-a-Park, or on the City's Egg Hunt, and on the 4th of July celebration, which are greatly appreciated. Indeed, anyone fortunate enough to have the Snack Time Inc. as a Food Service Provider should be very grateful. Having been a Park & Recreation Director for 15 years, I can honestly say that I do not lightly give out such an outstanding reference. Please feel free to contact me if you require any additional information at (561)452-1909. S' CerelY,~ es M. Cowen irector G . . . . <J . . . . . . . . . . . . . . . . . . I. . . . . '. . . \l . . . . . . . ,:) . . . ~ to) TheTreatmentCenter WE RESTORE HOPE June 22, 2009 TO: City of B?ynton Beach FROM: Bill Russell, CEO SUBJ: Links Golf Course Snack Bar Request for Proposal (RFP) I am writing in support of Judith Tauszik's company, Snack Time, LLC, RFP application to be the operator of the snack bar at the Links Golf Course. I have known Judy since 1999 when she was the Food Service Manager at The Watershed Treatment Programs in Boca Raton. Judy has also helped me as the interim Chef at The Treatment Center. Judy is exceptionally professional and capable. She is committed to providing the best in quality and taste for her customers, at the most reasonable cost. For example, her home-made soups and sandwiches are legendary. She consistently demonstrates excellent customer service. She maintains positive relations with her suppliers. She ensures her kitchen and serving areas are spotlessly clean. Judy's style is family-oriented. She will have her children, Esther and David, as part of her team. The Links patrons will feel like they are being treated like family by Judy's family. In these days of commercial concessions it is refreshing to recommend an "old-fashioned" family to provide tasty snacks to the golfers and guests. Please give Judy the opportunity to make a full presentation as your review her RFP application. Very truly yours, Bill Russell CEO P.O. Box 541119 · Greenacres, Florida 33454 · Phone: 561.253.6790 www.thetreatmentcenter.com 7 . . . . . . . . . " ~ (J . () (t () . . . . . . . '. . .~ . ~ . . . Cl (t . () . . . :t . . . \) VENETIAN ISLES COMMUNITY ASSOC., INC. C/O G.R.S. MANAGEMENT ASSOC., INC. 3900 WOODLAKE BLVD., STE. 309 LAKE WORTH, FL. 33463 (561) 735-9168 March 16,2011 To Whom It May Concern: Judith Tauszik, Snack Time LLC has been providing food services to the Venetian Isles Community for the past year. This has been our community's first venture in offering tIllS type of service to our residents. Weare very pleased with the service and food offered by Snack Time and look forward to continued success in this venture. Judith is very cooperative with residents who have made recommendations in the types of food, drinks and snacks they would like offered. She always responds in a positive and friendly manner, which can be difficult at times. It is my pleasure to recommend Judith and Snack Time LLC to any community or organization that would like to employ them. Please feel free to contact me if any additional infonnation is needed. ~ Herb Friedman President Venetian Isles Master Association 2 . , . . . . ) '. . .. . , . .. "t .. . :t .. l :) . a . . . . t J . ... 1 ) ~ >> l . >> J ) . . . cffibank~} BOCA VIA MIZNER 998 S FEDERAL HWY BOCA RATON, FL 33432 03/15/2011 Reference Letter To Whom It May Concern: This is to certify that the title of the following account(s) reflects SNACK TIME, LLC of 149 NW 70TH ST APT 302 BOCA RATON, FL 33487 as an account holder. Account Type Account Number Balance Date Opened CB STREAMLINED 9115153151 $20,800.53 06/26/2009 CHKG The above mentioned balance(s) represents the accumulation of successive deposits. JASON WESTFORT PERSONAL BANKER P 4637001 BOCA MIZNER / BR#92 (561J 347-3231 Client Financial Analyst Citibank, N.A.,Member FDIC g . . . . . . . . . . . . . ~ . a . . . . . . . . . . . (t . . . ~.l . . I. . . ,e . .(l . . . DATE (MMIDDIYV) 3f1Sl20i 1 ACORD CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONL.Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND, OR AL.TER THE COVERAGE AFFORDED BY THE POLICIES BEL.OW INSURERS AFFORDING COVERAGE NAIC # PRODUCER Phone. 954 583-5444 Fax - 954-583-2820 Pelican Insurance Agency 6950 Cypress Rd Ste 208/7 Plantation, FI ~.3~17 INSURER A: nvc:.I'OC''' INSURER B: Snack Time LLC 149 NW 70 St. #302 Boca Raton. FL 33487 INSURER c: -...--------------.----...-.-- INSURER 0, INSURER E: COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L1STE,D BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS ..__._ ._n_.__u._.__--.- Pending i jPOLlCY EFFECTIVE POLlCV EXPIRATIONl DATE (MMIODIYYI DATE IMM/DDIYY) : , I . ---r. ~~':iri,?~~.I;- i::~~ \ \ 'MEO ~XP (An'{ ere oc:son) , S S5.000 Ii I ~:::;::::;" .. j:.. i~:.:: \ PROD~~~S-~OV.P~~~i3? . .\.~~.- S2,OOO,OQQ I LIMITS INSF L TR TYPE OF INSURANCE POLICV NUMBER I- ____._.... ........ -'. .._--.--1----. GENERAL LIABILITY !XI COMMERCV-.L GE~ERAL L1AB!L1TV ~___[] CLAMS WAllE Ci OCCUR -1 GEN'L AGGREGATE LIMiT APPLIES PER I 1----\ POLICY 1-1 ~~T II LaC i AUTOMOTIVE LIABILI1Y C\Af<V AUTO I AU. OWNED AUTOS R~\SCHEDULED AUTOS HIRED AUTOS __: """.m"," """' I GARAGE LIABILITY ~IO ANY AUTO PCESS UABILITY I OCCUR II CLAIMS \lADE -I I DEDUCnIlL~ II RETENTION $ VlORKER'S CO~\PENSATION AND EMPLOYERS' LIABILITY ANY PROPR,ETORi?I,RTNERiEXECUTIVE OFFICERilAEMBER EXCLUDED? It y<!s. cescnoo cflde' SPECIAL PROVISIONS below \ $ COIABlNED SINGLE LIMIT (Ea acdc6'lt) 1-...--...- .-- BODie V INJURY {Per persen: --'-- BODlL V INJURV {per a::ddcnti Is PROPERTY DAlMGE {Per accicen:j $ AUTO O'll Y - EAAC~.IDE"''T _._\ $ OTHER THAN EA ACC S AUTO 0'" Y- AGG EACH CCCUHENCE s AGGREGATE s s s ~L;';;0l:;:&L~~~ . -- I E.L. EACII ACCIDENT · ,E.L OISf~.S5~EAE~'~ S _ _ _ IEL DISEASE - POLICY LIMIT $ I I \mH" DESCRIPTION OF OPERATIONS,l.OCATIONSNEHICLESIEXCLUSIONS ADDED BV ENDORSEMENT/SPECIAL PROVISIONS COVERAGE PENDING THE AWARD OF THE CONTRACT Certificate holder named as an additional insured with regards to general liability. CERTIFICATE HOLDER I X !ADDITIONAL INSURED; INSURER LETTER: A CANCELLATION (See Belowl- City Of Sunny Isles Beach 18070 Collins Ave. 3rd Floor Sunny Isles Beach, FI. 33160 305-947-5107 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 10 EXPIRATION DA.T THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL BiJ1#~~J~~VJ~~I~~~J~~~i~~~[LCI~ITfO~~~~E~~tf~~IJ~ 6~EL:t:'DTY OF ANY KIND UPON THE COfAPANY,lTS AGENTS OR REPRESENT.}TIVES, /f //' ./ AUTHORIZED REPRESENTATIVE /// ~/ .,/ /t:-. S /" -~-~::--; / -t/"":~ amuel Jacks ;;:::--_'~:'-c:.~:"'~ 0ACORD CORPORATION 1988 ACORD 25 (2001/08) 1 of 2 (0 . . . . . . . . . . . . ~ . . . . (t . . . '. . () . . I. '. . . .~ . . . . . . . . ~ . . ,t SNACK TIME LLC. Quality Food Service & Catering 149 NW 70th St. Boca Raton, FL 33487. Ph. (561) 674'6160. email:snacktime4u@gmail.com PROPOSED MONTHLY RENTAL RATE TO THE CITY MONTHLY RENT FOR FIRST TWO (2) YEARS: $ 300.00 MONTHLY RENT FOR YEARS THREE (3) AND FOUR (4): $ 400.00 MONTHLY RENT FOR YEARS FIVE (5) AND SIX (6): $ 500.00 ADITIONAL 15% OF GROSS SALES AFTER ANY SPECIAL EVENT ORGANIZIDE BY THE CITY , ~ March 13,2011 II . . . . . ~ . . . ct' . . " . e {) . . . 'Q ~. . . ie .e '. . () . () . Ie . I. I. '. 'e ~) . () . . I. I , OceoV\ \Y\ \~+ SYlGck betr :3 0 '{ Vito 11\ lSeacJl - -!QI ."~"~,,,.~ ?Ot k \a f\d Wes+-'tb-r~ ... , I~ m ob( l fo oC( - cart - --'?arl{etv/o( --- lerromar J ~cn k CDlIlceS510V' ~- , l yO{ lle r: SLL5(/{( S~~~ ~CH~ ''boCOI 1b~r L3 . . .--- ~Our : +00 d - , : CoV\C\?,:hloil\ : Ty Q l '(ex'J . . . . 3 ~ _.~ T (~ r ~J (,I' I lCb I C.. ~ '~~ I .~ ~ 1('" , I r' ,. -Iff' - J r n!:~ ...... i {.. . Ot ~ , "l .. '~"t ,~ lit 1:,0':( f\-t- 0 VI IV\\ct 5f\OL~ j)aV N\j h uslJa Lt cJ =Pde VI O(a::-Sl'~ I I , I ,I - -..... .. !1cih Qee-f .cpa ( ~ tsQCM,MI \... l.s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,...... ~..,y, ...~."II.".. ~ NON-COLLUSION AFFIDAVIT City of Sunny Isles Beach 18070 Collins Avenue Sunny Isles Beach, FL 33160 Telephone: (305) 947-0606 Fax: (305) 949-3113 STATE OF FLORIDA ) COUNTY OF ~N)'\ ~ 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, ~nc{6!Ln VYte- LLC (Name of Corporation, Partnership. Individual, etc.) a, _GQ-t-er" Vl t1 _, formed under the laws of (Type of Business)~ FL (State) of which he is 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. ) ccd{fh raU5~(k. AFFIANT'S NAME rHClM.J1I1~ dZl-(vrer AFFIANT'S nTL V TAKEN, SWORN AND S~RIBED TO BEFORE ME this \C;-\\ day of Personally Known 1- or Produced Identification ___; MPMM ,20~L Type of identification (Affix seal here) JASON R. WESTFORT MY COMMISSION. DO 992109 EXPIRES: June 13,2014 Bonded Thru Notary Public Unde!Writers DECEMBER 28.2010 10f7 IG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,....,. PUBLIC ENTITY CRIMES City of Sunny Isles Beach 18070 Collins Avenue Sunny Isles Beach, Fl 33160 Telephone: (305) 947-0606 Fax: (305) 949-3113 SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a) FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES PUBLIC ENTITY CRIMES Pursuant to the provisions of paragraph (2) (a) of Section 287.133, Florida State Statutes - "A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a Bid on a Contract to provide any goods or services to a public entity, may not submit a Bid on a Contract with a public entity for the construction or repair of a public building or public Work, may not submit Bids on leases of real property to a public entity, may not be awarded to perfonn 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. whose business address is: {t.rq 170CA and (if applicable) its Federal Employer Identification number (FEIN) is {O { 72. cD q 2:3 (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 infonnation 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. 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 tenn "affiliate" includes those officers, directors, executors, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair DECEMBER 28, 2010 2 of 7 17 . . :t . . . . . . . . . . . . . . . . . . . . . . . . . (t o . . . . . . . . . . . . . - " market value under an ann'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. I 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 tenn "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. ~ ---tedl'-/--0 tauSZ--( ~ (Printed N~h l..-LCX- l'l...( t:1 tJ l{e~ (Title) -------~ S p----- Sworn to and subscribed before me this \S~ day of__~\-\. __ jj'l\1~ -1 r$ oCSi K. . (AFFIX NOTARY STAMP HERE JASON R. WESTFORT MY COMMISSION # DO 992109 PIRES: June 13.2014 . ded Thru Notary Public Underwnters Signature: Notary f Florida Print or Type Com OR Produced Identification Personally Known Type of Identification Produced __________________ 10/1998 30f7 18 - . :l . . . . . . . . . . !J . () . . . . . . . . o () . . . . . . . . . () . . . . . . Q () " EQU AL OPPORTUNITY / AFFIRMATIVE ACTION City of Sunny Isles Beach 18070 Collins Avenue Sunny Isles Beach, Fl 33160 Telephone: (305) 947-0606 Fax: (305) 949-3113 EQUAL OPPORTUNITY I 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: ~, '\\CtlV'0if\ Title: 0\ Ol VL~CZ5:' ~~ki vte/~ S V'\C(C/~ lI'Vv\~ LLC Address: ILt0 lJUj (0 sJ. #302- (pO~ Qo1JoV) ~L, 33Cf?7 Firm: DECeMBER 28, 2010 40f7 \q . . . . . . . . . . . . :t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '" CONFLICT OF INTEREST City of Sunny Isles Beach 18070 Collins Avenue Sunny Isles Beach, FL 33160 Telephone: (305) 947-<l606 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}IDA tl.1 COUNTY OF .{lIlJ'I u:t(K BEFORE ME, the undersigned authority, personally appeared ~rl~ 1.J.tocb \ ( deposes, and states: ' {) W V\.E: r- 18.1. I In-' am LL the of S hCLC-'(.... It "'-'< <::: L with a local office in -'1? c ~~V) I F L and principal office in rgcrCl. f' ~~L 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. II ... () Z- -O/described as: Land~a,re Ma~nce Services. The Affiant has made diligent inquiry and provides the information contained in this Affidavitnased upon his own knowledge. , who was duly sworn, 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 tree 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 anyone 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 anyone 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. Datef th~~_ day of ~Ji 201~.. I' . ./ ~l.-L . , \e-e&~" JtA.C(/I"1 Ta.C-{('u-t.t. wt4'L1a5 (4 r f,qJ 4e.v A ANT Print or Type Name and Title S ~to and subscribed before me this -lS- day of ~om I Personally Known OR a Produced Identification ; Type of Identifi .~-:;"\"fi;:"" JASON R. WESTFORT :~:'iJ\~ MY COMMISSION # DO 992109 ~"\ .~ EXPIRES: June 13,2014 '~i';;;'" .' Bonded Thru Notary Public Underwriters 'lfill'" NOTARY PUBLIC STATE OF FLORIDA DECEPoIBER 28. 2010 50f7 20 . . . . . . . . . . . . :) . . . . . . . . . . . . . . . . . . . . . . . . . . () . . . ~ ~ tJJ ':', .. DISPUTE DISCLOSURE City of Sunny Isles Beach 18070 Collins Avenue Sunny Isles Bead1, FL 33160 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. 5r1C(Ll'/Il''V\~ LL C Fi 3//3/2010 3~~ dl{-V) IctL/~i(l Print or Type Name and Title DECEMBER 26, 2010 60f7 .2J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . () . . . . . ,....,. ANTI-KICKBACK City of Sunny Isles Beach 18070 Collins Avenue Sunny Isles Beach, FL 33160 Telephone: (305) 947-1J606 Fax: (305) 949-3113 ANTI-KICKBACK AFFIDAVIT STATE OF FLORIDA COUNTY OF Q"LM ~ ) ) ) 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.cdr.}l.y - r au SL--(L- Title: V\ltCLvu:t0'~ ~ J/wef/" \ c::' ~~ D day of [name [type of authority], for [name of party on behalf of whom instrument was l^~he foregoing instrument was acknowledged before me this r'f\(l.Q.,\ , 20.1L-, by of person], as executed]. AFFIX NOTARY STAMP HERE: /;}-:;".\:r~~. JASON A. WESTFOAT g.: :.~ MY COMMISSION. DD 992109 1 .;~.... EXPIRES: June 13, 2014 "~iif. Bonded Thru Notary Public UnderwritelS ~ Print or Type Commissioned Name Personally Known ~R Produced Identification Type of Identification Produced DECEMBER 28, 2010 70f7 22 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ie :. SECTION 4 BID SUBMITTAL FOR: ACKNOWLEDGEMENT OF ADDENDA INSTRUCTIONS: COMPLETE PART I OR PART II, WHICHEVER APPliES PART I: LIST BELOW ARE THE DATES OF ISSUE FOR EACH ADDENDUM RECEIVED IN CONNECTION WITH THIS BID Addendum #1, Dated Ilet f-C h 3 I 1-0 (( l Addendum #2, Dated Addendum #3, Dated Addendum #4, Dated Addendum #5, Dated Addendum #6, Dated Addendum #7, Dated Addendum #8, Dated PART II: o NO ADDENDUM WAS RECEIVED IN CONNECTION WITH THIS BID FIRM NAME: 5' MUe l It \I\tle.. LLL- ~ AUTHORIZED SIGNATURE: ~~ ~1o~TE: -S 113 (.20 (( TIm OF OFFICER: rI\CA 1.-( Ct r.J ~idl1 ef PAGE 29 OF 32 BID No. 11-02-01 .- L3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . "" ..... -00 .~: ", Jz :..." "0 . .:- .' . ,. BID SUBMITTAL FORM Bid Title: CONCESSIONAIRE SERVICES FOR SAMSON OCEANFRONT PARK The undersigned Proposers proposes and agrees, if this Bid is accepted, to enter into an agreement with The City of Sunny Isles Beach in the form included in the Contract Documents 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 Proposers 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 Proposers 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, discrepandes 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. FIRM NAME: 3nClct 70+1 5+ . .~L, \ \'vy\ C LLc StrlLt0ressb W Mailing Address (if different): ~30L bDCA '~3LrJ> '7 a2ct-\-oVJ PAGE 30 OF 32 BID No. 11-02-01 2+ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ 67Lr- (Q 160Fax No. ~ . t. OJ@C/1'Y'YA t 'ErN No. JJO-JJ1J2::J93/1J3 C.oJ!)} * "BY S.lGNrNG THrs DOCUMENT THE BrODER AGREES TO ALL TERMS SIGNATURE: THE EXECUTION OF THIS FORM CONSTITUTES THE UNEQUIVOCAL OFFER OF PROPOSER TO BE BOUND BY THE TERMS OF ITS PROPOSAL. FAILURE TO SIGN THIS SOUCITATION 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. PAGE 31 OF 32 BID No, 11-02-01 J/.S