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HomeMy WebLinkAboutEnvirowaste ServicesRECEIVED - MAY 252011b� DELIVER TO: CRy of smmy isles Beach City of Sunny Isles Beach INVITATION TO BID nmce of the c!-4 clerk City Clerk SECTION 4 OPENING: 10:00 A.M. 18070 Collins Avenue BID SUBMITTAL FORMS May 2S, 2011 Sunny Isles Beach, FL 33160 PLEASE QUOTE PRICES F.O.B. DESTINATION, LESS TAXES, DELIVERED IN CITY OF SUNNY ISLES BEACH, FLORIDA NOTE: City of Sunny Isles Beach is exempt from all taxes (Federal, State, and Local). Bid price should be less all taxes. Tax Exemption Certificate furnished upon request. Issued by: Purchasing Agent Date Issued: This Bid Submittal Consists of April 29, 2011 Pages 23 through 27 Sealed bids are subject to the Terms and Conditions of this Invitation to Bid and the accompanying Bid Submittal. Such other contract provisions, specifications, drawings or other data as are attached or incorporated by reference in the Bid Submittal, will be received at the office of the City Clerk at the address shown above until the above stated time and date, and at that time, publicly opened for furnishing the supplies or services described in the accompanying Bid Submittal Requirement. IFB 11 -04 -03 STORM WATER CATCH BASIN CLEANING & LINE JETTING A Bid Deposit in the amount of 0% of the total amount of the bid shall accompany all bids A Performance Bond in the amount of % of the total amount of the bid will be required upon execution of the contract by the successful bidder and City of Sunny Isles Beach Procurement Aaent: Firm Name: Marcanthony Tulloch V Commodity Code(s): �4 890-66 RETURN ONE ORIGINAL AND FOUR COPIES OF BID SUBMITTAL PAGES AND AFFIDAVITS FAILURE TO SIGN PAGE 27 OF SECTION 4 BID SUBMITTAL WILL RENDER YOUR BID NON- RESPONSIVE PAGE 23 of 28 BID No. 11 -01 -01 BID FORM Pump Out Services Item# Est. Qty Description Unit Price Extended Price 1 598 Storm water catch basins ao 202 � � Per Basin , 2 37,400 Jetting Per linear Foot Grand Total: Page 24A of 28 Bid No. 11 -01 -01 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 PART II: Addendum #1, Dated Addendum #2, Dated �z,L0 w & Addendum #3, Dated Addendum #4, Dated lu D z o� Dk�i Addendum #5, Dated Addendum #6, Dated Addendum #7, Dated Addendum #8, Dated ❑ NO ADDENDUM WAS RECEIVED IN CONNECTION WITH THIS BID r) v,it� was A_p I�..Q.v, -/,C�f 4 too P. -�I� . - FIRM NAME: cl AUTHORIZED SIGNATURE. DATE: TITLE OF OFFICER: l�� C'.0 a PAGE 25 of 28 BID No. 11 -01 -01 H .dry'. .;,•. BID SUBMITTAL FORM Bid Title: STORM WATER CATCH BASIN CLEANING & LINE JETTING The undersigned Proposer 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 Proposer accepts all of the terms and conditions of the Advertisement or Invitation to Bid and Instructions to Proposers, including without limitation those dealing with the disposition of Bid Security. This Bid will remain subject to acceptance for 90 days after the day of Bid opening. The Proposer agree 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 studied carefully all reports and drawings of subsurface conditions and drawings of physical conditions. The Proposer has obtained and carefully studied (or assumes responsibility for obtaining and carefully studying) all such examinations, investigations, explorations, tests and studies which pertain to the subsurface or physical conditions at the site or otherwise may affect the cost, progress, performance, or furnishing of the Work at the Contract Price, within the Contract Time and in accordance with the other terms and conditions of the Contract Documents, and no additional examinations, investigations, explorations, tests, reports or similar information or data are or will be required by Proposer for such purposes. • The Proposer has given the City written notice of all conflicts, errors, discrepancies that it has discovered in the Contract Documents and the written resolution thereof by City is acceptable to the Proposer. This Bid is genuine and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization, or corporation; the Proposer has not directly or indirectly induced or solicited any other Proposers to submit a false or sham Bid; the Proposer has not solicited or induced any person, firm or corporation to refrain from Bidding; and Proposer has not sought by collusion to obtain for itself any advantage over any other Proposers or over the City. The Proposer understands and agrees that the Bid is for unit prices to furnish and install individual Work Items for maintenance and /or repair work, complete in place. Estimates are provided for the purposes of Bid Evaluation and to establish unit prices for individual Work Items for maintenance and /or repair work PAGE 26 of 28 BID No. to be contracted by the City under individual Purchase Orders, based on the unit prices established under this Bid. The City and the successful Proposer will establish completion times for each individual Work Item and the successful Proposer agrees that the work will be completed within the time frames agreed upon and stipulated in the individual Purchase Orders and /or Notice to Proceed. FIRM NAME: C N V r A I'VaS )t; Se- V I 'C_e..S Street Address: 41 156- FL Mailing Address (if different): 305- 4, 3 ? - q1, &5 3U-5 -- G37-�g65� Telephone No. Fax No. Email Address: e° y - !tea vh6) ,*, � liI r iYQwa� 5°j , CGw► EIN No. * °SY SIGNING THIS DOCUMENT THE BIDDER AGREES TO ALL TERMSAND CONDITIONS OF THIS INDENTATION TO BID, SIGNATURE: (SIGNATURE OF AUTHORIZED AGENT) PRINT NAME: `� ytdi� 13,,,A1;'4 TITLE: _ ' 9, c no THE EXECUTION OF THIS FORM CONSTITUTES THE UNEQUIVOCAL OFFER OF PROPOSER TO BE BOUND BY THE TERMS OF ITS PROPOSAL. FAILURE TO SIGN THIS SOLICITATION WHERE INDICATED ABOVE BY AN AUTHORIZED REPRESENTATIVE SHALL RENDER THE PROPOSAL NON - RESPONSIVE. PACE 27 of 28 BID No. "414Y /s, � FJ NON COLLUSION AFFIDAVIT - .i 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 A tAr; �� ) 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, iC-h v% r0W 4S lac g.,"G¢.S �l✓0'Zt rJ / (Name of Corporation, Partnership, Individual, etc.) {/ a, �vp�d f—f a h , formed under the laws of f-1 ov d\ (Tyl3e of Business) (State) of which he is U I C! A-e j--- f (Sole Owner, Partner, President, etc.) Neither the undersigned nor any person, firm, or corporation named in above Paragraph 10.2, nor anyone else to the knowledge of the undersigned, have themselves solicited or employed anyone else to solicit favorable action for this Bid by the City, also that no head of any department or employee therein, or any officer of the City of Sunny Isles Beach, Florida is directly interested therein. This Bid is genuine and not collusive or a sham; the person, firm or corporation named above in Paragraph 10.2 has not colluded, conspired, connived or agreed directly or indirectly with any proposers or person, firm or corporation, to put in a sham Bid, or that such person, firm or corporation, shall refrain from Bidding, and has not in any manner, directly or indirectly, sought by agreement or collusion, or communication or conference with any person, firm or corporation, to fix the prices of said Bid or Bids of any other proposers; and all statements contained in the Bid or Bids described above true; and further; neither the undersigned, nor the person, firm or corporation named above in Paragraph 10.2, has directly or indirectly submitted said Bid or the contents thereof, or divulged information or data relative thereto, to any association or to any member or agent thereof. F.1 L.-,4 6 U.P e.eo. AFFIANT'S NAME AFFIANT'S TITLE TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this � day of / " I 20tfL. Personally Known �_ or Produced Identification Type of identification (Affix seal here) JELEANY VALOMA '~ , t': MY COMMISSION # EE041823 EXPIRES November 15, 2014 308-0163 MorMalloleryservke.00m Q)a� �ak�& 00 U TARY PUB (name printed or typed) DECEMBER 28,2010 1 of 7 NNYr PUBLIC ENTITY CRIMES City of Sunny Isles Beach '\ ", 18070 Collins Avenue C OPT o Sunny Isles Beach, FL 33160 so. '~ Telephone: (305) 947 -0606 Fax: (305) 949 -3113 SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a) FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES PUBLIC ENTITY CRIMES Pursuant to the provisions of paragraph (2) (a) of Section 287.133, Florida State Statutes - "A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a Bid on a Contract to provide any goods or services to a public entity, may not submit a Bid on a Contract with a public entity for the construction or repair of a public building or public Work, may not submit Bids on leases of real property to a public entity, may not be awarded to perform Work as a Contractor, supplier, Sub - Contractor, or Consultant under a Contract with any public entity, and may not transact business with any public entity in excess of the threshold amount Category Two of Sec. 287.017, FS for thirty six months from the date of being placed on the convicted vendor list ". THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. 11.1. This sworn statement is submitted to City of Sunny Isles Beach by P for 0-_h tl 1 ro wa< .P c`7. e ✓t/rCsS f �-( /� C [print name of entity submitting sworn staternentj whose business address is: E 1,( k s /y and (if applicable) its Federal Employer Identification number (FEIN) is (�', :�-- 0824620 (If the entity had no FEIN, include the Social Security Number of the individual signing this sworn statement: ) 11.2. 1 understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or with the United States, including, but not limited to, any Bid or Contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 11.3. 1 understand that "convicted" or "conviction" as defined in Para. 287.133(1)(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trail court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non -jury trial, or entry of a plea of guilty or nolo contendere. 11.4. 1 understand that an "affiliate" as defined in Para. 287.133(1)(a), Florida Statutes, means: a.) predecessor or successor of a person convicted of a public entity crime-, or b.) Any entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executors, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair DECEMBER 28, 2010 2 of 7 market value under an arm's length agreement, shall be a prime facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. 11.5. 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 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.) (i' 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 (SIgneft e') (Printed Nam 7) (Title) :EGor tq and subscribed before me this � day of t1�1�y , 20 � 1 , by (AFFIX NOTARY STAMP HERE) JELEANY VALDIVIIA MY COMMISSION # EED41823 EXPIRES November 15, 2014 Personally Known Type of Identification Produced OR Produced Identification 10/1998 3 of 7 otary Pyblic =State of Florida nt or Type Cbmmissioned Name EQUAL OPPORTUNITY / AFFIRMATIVE ACTION 1!'c9')• F -S O��'"a ,�' City of Sunny Isles Beach �. SUN 18070 Collins Avenue Sunny Isles Beach, FL 33160 Telephone: (305) 947 -0606 Fax: (305) 949 -3113 EQUAL OPPORTUNITY /AFFIRMATIVE ACTION STATEMENT The contractors and all subcontractors hereby agree to a commitment to the principles and practices of equal opportunity in employment and to comply with the letter and spirit of federal, state, and local laws and regulations prohibiting discrimination based on race, color, religion, national region, sex, age, handicap, marital status, and political affiliation or belief. Signed: Title: �%.� •d v Ch y i 1ro w #4 �a.•r ✓ %Ca. Firm: � S �iOZ.✓f%� Address: Y 5,5- DECEMBER 28,2010 4 of 7 ;13—NY +44FJ CONFLICT OF INTEREST i. City of Sunny Isles Beach ', ➢�` _ �' 18070 Collins Avenue sr ! F l01' o . Sunny Isles Beach, FL 33160 r� o, su" '� Telephone: (305) 947 -0606 Fax: (305) 949 -3113 CONFLICT OF INTEREST STATEMENT The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes. Proposers must disclose with their Bids, the name of any officer, director, partner, associate or agent who is also an officer or employee of the City of Sunny Isles Beach or its agencies. STATE OF FLORIDA COUNTY OF "" .d:,• BEFORE ME, the undersigned authority, personally appeared �`�a -� �JB,h� who was duly swom, deposes, and states: 18.1. 1 11 m the (J. C, a s of i►� S, WAS lt <cr�i�, with a local office in lilLk r 4 LA k k and principal office in "^ r. L- 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. �' x%-03 described as: Landscape Maintenance Services. The Affiant has made diligent inquiry and provides the information contained in this Affidavit based upon his own knowledge. 18.3 The Affiant states that only one submittal for the above Bid is being submitted and that the above named entity has no financial interest in other entities submitting Bids for the same project. 18.4 Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, participated in any collusion, or otherwise taken any action in restraints of free competitive pricing in connection with the entity's submittal for the above Bid. This statement restricts the discussion of pricing data until the completion of negotiations if necessary and execution of the Contract for this project. 18.5 Neither the entity nor its affiliates, nor any one associated with them, is presently suspended or otherwise ineligible from participation in contract letting by any local, State, or Federal Agency. 18.6 Neither the entity, nor its affiliates, nor any one associated with them have any potential conflict of interest due to any other clients, contracts, or property interests for this project. 18.71 certify that no member of the entity's ownership or management is presently applying for any employee position or actively seeking an elected position with the City of Sunny Isles Beach. 18.81 certify that no member of the entity's ownership or management, or staff has a vested interest in any aspect of the City of Sunny Isles Beach. 18.9 In the event that a 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. I Dated this 24 day of 201. ,'PLC_?C) AFFIANT Print or Type Name and Title Swom to and subscribed before me this 24 Personally Known O Produced Identification NOTARY PUBLIC STATE OF FLORIDA day of 2010. OR Type of dentifcation •k�+Y ;'- JELEANY VALDIVIA zz •" MY COMMISSION # EE041823 EXPIRES November 15, 2014 DECEM BER 28, 2010 NOT)398 -0i!i3 RoddallotaryServiee.com 5 of 7 S"A N Y IS, i .: t Tr Or SUN �N DISPUTE DISCLOSURE City of Sunny Isles Beach 18070 Collins Avenue Sunny Isles Beach, 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 tom' 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? V, 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._ C v ,r. p w� SAP `�f/VtC -E5 Firm Date (Cja" i34-1-, Authorized Signature Print or Type Name and Title DECEMBER 28, 2010 6 of 7 O� '"My +St f f l ot 01 su" a �^ u�. z STATE OF FLORIDA ) COUNTY OF i/ ) ANTI - KICKBACK City of Sunny Isles Beach 18070 Collins Avenue Sunny Isles Beach, FL 33160 Telephone: (305) 947 -0606 Fax: (305) 949 -3113 ANTI - KICKBACK AFFIDAVIT I, the undersigned, hereby duly sworn and deposed say that no portion of this sum herein Bid will be paid to any employees of the City of Sunny Isles Beach or its elected officials as a commission, kickback, reward or gift, directly or indirectly by me or any member of my firm or by an officer of the corporation. The foregoing instrument 20 l , by of per on], as E r--,v i rte W lo,_:-5te � I ees 4 executed]. AFFIX NOTARY STAMP HERE: �K JELEANY VALDMA *: MY COMMISSION # EED41823 EXPIRES November 15, 2014 too 3g8 -0153 FlorklMoterySevyloo.corn Personally Known �k Type of Identification Produced By: -- —� Title: y,P C.© a was acknowledged before me this day of F [name [type of authority], for (Wname of party on behalf of whom instrument was tary Pub — State of Florida JN , a dylyu(I I� Print or Typ ommissioned Name OR Produced Identification DECEMBER 28, 2010 7 of 7 DELIVER TO: City of Sunny Isles Beach INVITATION TO BID City Clerk SECTION 4 OPENING: 10:00 A.M. 18070 Collins Avenue BID SUBMITTAL FORMS May 25, 2011 Sunny Isles Beach, FL 33160 PLEASE QUOTE PRICES F.O.B. DESTINATION, LESS TAXES, DELIVERED IN CITY OF SUNNY ISLES BEACH, FLORIDA NOTE: City of Sunny Isles Beach is exempt from all taxes (Federal, State, and Local). Bid price should be less all taxes. Tax Exemption Certificate furnished upon request. Issued by: Purchasing Agent Date Issued: This Bid Submittal Consists of April 29, 2011 Pages 23 through 27 Sealed bids are subject to the Terms and Conditions of this Invitation to Bid and the accompanying Bid Submittal. Such other contract provisions, specifications, drawings or other data as are attached or incorporated by reference in the Bid Submittal, will be received at the office of the City Clerk at the address shown above until the above stated time and date, and at that time, publicly opened for furnishing the supplies or services described in the accompanying Bid Submittal Requirement. IFB 11 -04 -03 STORM WATER CATCH BASIN CLEANING & LINE ]ETiTNG A Bid Deposit in the amount of 0% of the total amount of the bid shall accompany all bids A Performance Bond in the amount of % of the total amount of the bid will be required upon execution of the contract by the successful bidder and City of Sunny Isles Beach Procurement Agent: Firm Name: Marcanthony Tulloch v Lk., o-r ttc aV t°f re's Commodity Code(s): 890 -66 RETURN ONE ORIGINAL AND FOUR COPIES OF BID SUBMITTAL PAGES AND AFFIDAVITS FAILURE TO SIGN PAGE 27 OF SECTION 4 BID SUBMITTAL WILL RENDER YOUR BID NON- RESPONSIVE PACE 23 of 28 BID No. 11 -01 -01 1111111161 Pump Out Services Item# Est. Qty Description Unit Price Extended Price 1 598 Storm water catch basins �� r � � Per Basin 2 I 37,400 Jetting $ O l $ om 37( , Per linear Foot Grand Total: $ Page 24A of 28 Bid No. 11 -01 -01 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 PART I1: Addendum #1, Dated ya �- IC-0 ✓ Addendum #2, Dated X/,�4 (- `-, Addendum #3, Dated Addendum #4, Dated 1� o Ne� Addendum #5, Dated Addendum #6, Dated Addendum #7, Dated Addendum #8, Dated ❑ NO ADDENDUM WAS RECEIVED IN CONNECTION WITH THIS BID FIRM NAME: 4: Y-) y , v C) °-- a AUTHORIZED SIGNATURE: —C-7- DATE: TITLE OF OFFICER: -r PAGE 25 of 28 BID No. 11-01 -01 NNV %S NON- COLLUSION AFFIDAVIT City of Sunny Isles Beach 18070 Collins Avenue sFr9°i;'6-oa• °a Sunny Isles Beach, FL 33160 Telephone: (305) 947 -0606 Fax: (305) 949 -3113 STATE OF FLORIDA J COUNTY OF (A,- P4- 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, C_rj V/ ro LV cc 4.0- 'S:a � (/r -CIC.t' C (Name of Corporation, Partnership, Individual, etc.) a, l: 6 V- Po"_ " -( a formed under the laws of 1 oyr ,I, (Tyl3e of Business) (State) of which he is vice Aes ;JA (Sole Owner, Partner, President, etc.) Neither the undersigned nor any person, firm, or corporation named in above Paragraph 10.2, nor anyone else to the knowledge of the undersigned, have themselves solicited or employed anyone else to solicit favorable action for this Bid by the City, also that no head of any department or employee therein, or any officer of the City of Sunny Isles Beach, Florida is directly interested therein_ This Bid is genuine and not collusive or a sham; the person, firm or corporation named above in Paragraph 10.2 has not colluded, conspired, connived or agreed directly or indirectly with any proposers or person, firm or corporation, to put in a sham Bid, or that such person, firm or corporation, shall refrain from Bidding, and has not in any manner, directly or indirectly, sought by agreement or collusion, or communication or conference with any person, firm or corporation, to fix the prices of said Bid or Bids of any other proposers; and all statements contained in the Bid or Bids described above true; and further, neither the undersigned, nor the person, firm or corporation named above in Paragraph 10.2, has directly or indirectly submitted said Bid or the contents thereof, or divulged information or data relative thereto, to any association or to any member or agent thereof. 'EJ ui•:& 8416 ().1') 0 C . 4, AFFIANT'S NAME AFFIA� NT'S TITE TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this � day of ! " 1 204L. Personally Known �_ or Produced Identification Type of identification (Affix seal here) TARY PUB I (name printed or typed) L JELEANY YALDMA MY COMMISSION # EE041823 EXPIRES November 15, 2014 3D8 -0153 Florldallotaryservice.com DECEMBER 28,2010 1 of 7 NNb7 PUBLIC ENTITY CRIMES V *�Z City of Sunny Isles Beach • ! ' 18070 Collins Avenue _$ t_11. O Sunny Isles Beach, FL 33160 or s01 �" °% Telephone. (305) 947 -0606 Fax: (305) 949 -3113 SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(x) FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES PUBLIC ENTITY CRIMES Pursuant to the provisions of paragraph (2) (a) of Section 287.133, Florida State Statutes - "A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a Bid on a Contract to provide any goods or services to a public entity, may not submit a Bid on a Contract with a public entity for the construction or repair of a public building or public Work, may not submit Bids on leases of real property to a public entity, may not be awarded to perform Work as a Contractor, supplier, Sub - Contractor, or Consultant under a Contract with any public entity, and may not transact business with any public entity in excess of the threshold amount Category Two of Sec. 287.017, FS for thirty six months from the date of being placed on the convicted vendor list ". THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. 11.1. This sworn statement is submitted to City of Sunny Isles Beach tprint individual s name an e /� for �-►)t! J t'UtarQ+; x 1,e,✓V,Ca.i �y t C [print name name of entity submitting sworn statement] whose business address is: S E and (if applicable) its Federal Employer Identification number (FEIN) is 08Z, -ro (if the entity had no FEIN, include the Social Security Number of the individual signing this sworn statement: ) 11.2. 1 understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or with the United States, including, but not limited to, any Bid or Contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 11.3. 1 understand that "convicted" or "conviction" as defined in Para. 287.133(1)(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trail court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non jury trial, or entry of a plea of guilty or nolo contendere. 11.4. 1 understand that an "affiliate" as defined in Para. 287.133(1)(a), Florida Statutes, means: a.) predecessor or successor of a person convicted of a public entity crime; or b.) Any entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executors, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair DECEMBER 28, 2010 2 of 7 market value under an arm's length agreement, shall be a prime facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. 11.5. 1 understand that a "person" as defined in Para. 287.133(1)(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding Contract and which Bids or applies to Bid on Contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "persons" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of any entity. 11.6. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. (Indicate which statement applies.) C/ 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 (Printed Nam (/.? ) (Title) 17.L I Sworn tq and subscribed before me this day of M(A V 20 1 by n. (AFFIX NOTARY STAMP HERE) JELEA14Y VAL011M MY COMMISSION # EED41823 EXPIRES November 15, 2014 Personally Known Type of Identification Produced OR Produced Identification 9011998 3 of 7 is = State of Florida nt or Type Cbmmissioned Name O� Svc `N Y "rS� Fed �n EQUAL OPPORTUNITY / AFFIRMATIVE ACTION City of Sunny Isles Beach rr Q so,, 18070 Collins Avenue Sunny Isles Beach, FL 33160 Telephone: (305) 947 -0606 Fax: (305) 949 -3113 EQUAL OPPORTUNITY /AFFIRMATIVE ACTION STATEMENT The contractors and all subcontractors hereby agree to a commitment to the principles and practices of equal opportunity in employment and to comply with the letter and spirit of federal, state, and local laws and regulations prohibiting discrimination based on race, color, religion, national region, sex, age, handicap, marital status, and political affiliation or belief. Signed: ----� — Title: 4 •d y Firm: Ch V� Iro w��, %�y ✓i�S �rrrtel� Address: DECEMBER 28, 2010 4 of 7 SJNNV �S�F n CONFLICT OF INTEREST •`� City of Sunny Isles Beach s•� r 18070 Collins Avenue r ion o° Sunny Isles Beach, FL 33160 Telephone: (305) 947 -0606 Fax: (305) 949 -3113 CONFLICT OF INTEREST STATEMENT The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes. Proposers must disclose with their Bids, the name of any officer, director, partner, associate or agent who is also an officer or employee of the City of Sunny Isles Beach or its agencies. STATE OF FLORIDA COUNTY OF - ,4,. a.4 BEFORE ME, the undersigned authority, personally appeared ' -d`��� / �e,`��i who was duly swom, deposes, and states: 18.1. 1 m the (1. P C, a d of s! Was �c'� < <n Ca..,n with a local office in 1,0 L" t. t and principal office in 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. `° O C�4 --03 described as: Landscape Maintenance Services. The Affiant has made diligent inquiry and provides the information contained in this Affidavit based upon his own knowledge. 18.3 The Affiant states that only one submittal for the above Bid is being submitted and that the above named entity has no financial interest in other entities submitting Bids for the same project. 18.4 Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, participated in any collusion, or otherwise taken any action in restraints of free competitive pricing in connection with the entity's submittal for the above Bid. This statement restricts the discussion of pricing data until the completion of negotiations if necessary and execution of the Contract for this project. 18.5 Neither the entity nor its affiliates, nor any one associated with them, is presently suspended or otherwise ineligible from participation in contract letting by any local, State, or Federal Agency. 18.6 Neither the entity, nor its affiliates, nor any one associated with them have any potential conflict of interest due to any other clients, contracts, or property interests for this project. 18.71 certify that no member of the entity's ownership or management is presently applying for any employee position or actively seeking an elected position with the City of Sunny Isles Beach. 18.81 certify that no member of the entity's ownership or management, or staff has a vested interest in any aspect of the City of Sunny Isles Beach. 18.9 In the event that a conflict of interest is identified in the provision of services, I, on behalf of the above named entity, will immediately notify the City of Sunny Isles Beach. Dated this 2'°f day of 201 lb. Y L C-0 C) AFFIANT JJPrint or Type Name and Title Swom to and subscribed before me this day of 201411. Personally Known OR O Produced Identification ; Type ofLdentification NOTARY PUBLIC STATE OF FLORIDA JELEANY VALDIVIA *: • *: MY COMMISSION # EE041823 EXPIRES November 15, 2014 DECEMBER 28, 2010 (407) 398 -0153 FlandaNctaryService.com 5 of 7 DELIVER TO: City of Sunny Isles Beach INVITATION TO BID City Clerk SECTION 4 OPENING: 10:00 A.M. 18070 Collins Avenue BID SUBMITTAL FORMS May 25, 2011 Sunny Isles Beach, FL 33160 PLEASE QUOTE PRICES F.O.B. DESTINATION, LESS TAXES, DELIVERED IN CITY OF SUNNY ISLES BEACH, FLORIDA NOTE: City of Sunny Isles Beach is exempt from all taxes (Federal, State, and Local). Bid price should be less all taxes. Tax Exemption Certificate furnished upon request. Issued by: Purchasing Agent Date Issued: This Bid Submittal Consists of April 29, 2011 Pages 23 through 27 Sealed bids are subject to the Terms and Conditions of this Invitation to Bid and the accompanying Bid Submittal. Such other contract provisions, specifications, drawings or other data as are attached or incorporated by reference in the Bid Submittal, will be received at the office of the City Clerk at the address shown above until the above stated time and date, and at that time, publicly opened for furnishing the supplies or services described in the accompanying Bid Submittal Requirement. IFB 11 -04 -03 STORM WATER CATCH BASIN CLEANING & LINE JETTING A Bid Deposit in the amount of 0% of the total amount of the bid shall accompany all bids A Performance Bond in the amount of % of the total amount of the bid will be required upon execution of the contract by the successful bidder and City of Sunny Isles Beach Procurement Agent: Marcanthony Tulloch Commodity Code(s): 890 -66 Firm Name: RETURN ONE ORIGINAL AND FOUR COPIES OF BID SUBMITTAL PAGES AND AFFIDAVITS FAILURE TO SIGN PAGE 27 OF SECTION 4 BID SUBMITTAL WILL RENDER YOUR BID NON- RESPONSIVE PAGE 23 of 28 BID NO. 11 -01 -01 BID FORM Pump Out Services Item# Est. Qty Description Unit Price Extended Price 1 598 Storm water catch basins 00 ��2 � Per Basin) 2 37,400 Jetting 3/ Per linear Foot Grand Total: $ S-1� .,5-7� � Page 24A of 28 Bid No. 11 -01 -01 SECTION 4 BID SUBMITTAL FOR: ACKNOWLEDGEMENT OF ADDENDA INSTRUCTIONS: COMPLETE PART I OR PART II, WHICHEVER APPLIES PART 1: LIST BELOW ARE THE DATES OF ISSUE FOR EACH ADDENDUM RECEIVED IN CONNECTION WITH THIS BID PART II: Addendum #1, Dated y0 �— �,,— IC70 F Addendum #2, Dated`' Addendum #3, Dated Addendum #4, Dated N Addendum #5, Dated Addendum #6, Dated Addendum #7, Dated Addendum #8, Dated ❑ NO ADDENDUM WAS RECEIVED IN CONNECTION WITH THIS BID J: r7 v, 2 C) A_p �-lc v r o u t� . FIRM NAME: Uy AUTHORIZED SIGNATURE. zY /i TITLE OF OFFICER: 12 : PAGE 25 of 28 BID No. 11 -01 -01 0 1� bJ S`F�O NON - COLLUSION AFFIDAVIT V' �3 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 [M �y ; Y4k 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, L- i t-0 W 4f i-f L/i cc Ur 0 Z., P �u► C (Name of Corporation, Partnership, Individual, etc.) a, �y �% dV' f2Ov-0• -�I 6 formed under the laws of (Ty0e of Business) (State) of which he is v ICf !/Ief %J-A- (Sole Owner, Partner, President, etc.) Neither the undersigned nor any person, firm, or corporation named in above Paragraph 10.2, nor anyone else to the knowledge of the undersigned, have themselves solicited or employed anyone else to solicit favorable action for this Bid by the City, also that no head of any department or employee therein, or any officer of the City of Sunny Isles Beach, Florida is directly interested therein. This Bid is genuine and not collusive or a sham; the person, firm or corporation named above in Paragraph 10.2 has not colluded, conspired, connived or agreed directly or indirectly with any proposers or person, firm or corporation, to put in a sham Bid, or that such person, firm or corporation, shall refrain from Bidding, and has not in any manner, directly or indirectly, sought by agreement or collusion, or communication or conference with any person, firm or corporation, to fix the prices of said Bid or Bids of any other proposers; and all statements contained in the Bid or Bids described above true; and further; neither the undersigned, nor the person, firm or corporation named above in Paragraph 10.2, has directly or indirectly submitted said Bid or the contents thereof, or divulged information or data relative thereto, to any association or to any member or agent thereof. AFFIANT'S NAME AFFIANT'S TITLE TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this � day of ! " 1 _, 20¢L Personally Known _X_ or Produced Identification Type of identification (Affix seal here) TARY PUB (name printed or typedl JELEANY VALDMA MY COMMISSION # EE041823 EXPIRES November 15, 2014 308 0163 FlorMaNciaryService.cm DECEMBER 28,2010 1 Of 7 OE SUNtav +sC Ff PUBLIC ENTITY CRIMES v r. City of Sunny Isles Beach r • 18070 Collins Avenue Sunny Isles Beach, FL 33160 Telephone: (305) 947 -0606 Fax: (305) 949 -3113 SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(x) FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES PUBLIC ENTITY CRIMES Pursuant to the provisions of paragraph (2) (a) of Section 287.133, Florida State Statutes - "A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a Bid on a Contract to provide any goods or services to a public entity, may not submit a Bid on a Contract with a public entity for the construction or repair of a public building or public Work, may not submit Bids on leases of real property to a public entity, may not be awarded to perform Work as a Contractor, supplier, Sub - Contractor, or Consultant under a Contract with any public entity, and may not transact business with any public entity in excess of the threshold amount Category Two of Sec. 287.017, FS for thirty six months from the date of being placed on the convicted vendor list ". THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. 11.1. This sworn statement is submitted to City of Sunny Isles Beach by PJ C.v,.✓ tpinn�r rcn .urns Warne e/nlu/*uue Gf� n � / y� /� for �" � if 1 UPI - L./.�C ✓V ! �,,Y..� 1 r� p '° f o C [print name of entity submitting sworn s emen whose business address is: and (if applicable) its Federal Employer Identification number (FEIN) is 00ZQC,-?Q (if the entity had no FEIN, include the Social Security Number of the individual signing this sworn statement: ) 11.2. 1 understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or with the United States, including, but not limited to, any Bid or Contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 11.3. 1 understand that "convicted" or "conviction" as defined in Para. 287.133(1)(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trail court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non jury trial, or entry of a plea of guilty or nolo contendere. 11.4. 1 understand that an "affiliate" as defined in Para. 287.133(1)(a), Florida Statutes, means: a.) predecessor or successor of a person convicted of a public entity crime; or b.) Any entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executors, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair DECEMBER 28, 2010 2 of 7 market value under an arm's length agreement, shall be a prime facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. 11.5. 1 understand that a "person" as defined in Para. 287.133(1)(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding Contract and which Bids or applies to Bid on Contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "persons" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of any entity. 11.6. Based on information and belief, the statement which I have marked below is true in relation to the entity / submitting this sworn statement. (Indicate which statement applies.) C/ 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' t + - - ---� (Signs s� K)c..4 (Printed a �) C.6.�. (Title) ,y ' Sworn t and subscribed before me this day of I�{%�V 20' f ; by (AFFIX NOTARY STAMP HERE) JELEANY VAL011M MY COMMISSION # EED41823 EXPIRES November 15, 2014 Personally Known Type of Identification Produced OR Produced Identification 1011998 3 of 7 in tore Notary P blic "State of Florida d I y nt or Type C mmissioned Name p�NY r SU -- vs�F1' EQUAL OPPORTUNITY / �3; AFFIRMATIVE ACTION sf� '• rLoF� og� City of Sunny Isles Beach rr a, SIGN •*' 18070 Collins Avenue Sunny Isles Beach, FL 33160 Telephone: (305) 947 -0606 Fax: (305) 949 -3113 EQUAL OPPORTUNITY /AFFIRMATIVE ACTION STATEMENT The contractors and all subcontractors hereby agree to a commitment to the principles and practices of equal opportunity in employment and to comply with the letter and spirit of federal, state, and local laws and regulations prohibiting discrimination based on race, color, religion, national region, sex, age, handicap, marital status, and political affiliation or belief. Signed: --- Title: t/./) •� v Firm: C�1 V ['Vow aS %.Y V, C-a-S Address: � 5t5- ¢"r=eaj�- IWA DECEMBER 28,2010 4 of 7 yV,ANY rS CONFLICT OF INTEREST v! s City of Sunny Isles Beach %4 ✓�^ 18070 Collins Avenue s� c'•' ^ io�'aa; Sunny Isles Beach, FL 33160 ry. er SUN '' Telephone: (305) 947 -0606 Fax: (305) 949 -3113 CONFLICT OF INTEREST STATEMENT The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes. Proposers must disclose with their Bids, the name of any officer, director, partner, associate or agent who is also an officer or employee of the City of Sunny Isles Beach or its agencies. STATE OF FLORIDA COUNTY OF -,14 BEFORE ME, the undersigned authority, personally appeared ul,- -4 / �g,hii who was duly swom, deposes, and states: 18.1. I m the (J. %� C. 0. Q of WAS �c'�<< _with a local office in r'a �t � I. and principal office in 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. l l "a 1/`03 described as: Landscape Maintenance Services. The Affiant has made diligent inquiry and provides the information contained in this Affidavit based upon his own knowledge. 18.3 The Affiant states that only one submittal for the above Bid is being submitted and that the above named entity has no financial interest in other entities submitting Bids for the same project. 18.4 Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, participated in any collusion, or otherwise taken any action in restraints of free competitive pricing in connection with the entity's submittal for the above Bid. This statement restricts the discussion of pricing data until the completion of negotiations if necessary and execution of the Contract for this project. 18.5 Neither the entity nor its affiliates, nor any one associated with them, is presently suspended or otherwise ineligible from participation in contract letting by any local, State, or Federal Agency. 18.6 Neither the entity, nor its affiliates, nor any one associated with them have any potential conflict of interest due to any other clients, contracts, or property interests for this project. 18.71 certify that no member of the entity's ownership or management is presently applying for any employee position or actively seeking an elected position with the City of Sunny Isles Beach. 18.81 certify that no member of the entity's ownership or management, or staff has a vested interest in any aspect of the City of Sunny Isles Beach. 18.9 In the event that a conflict of interest is identified in the provision of services, I, on behalf of the above named entity, will immediately notify the City of Sunny Isles Beach. Dated this �`� day of ► " n � , 201 �. „ v P c � AFFIANT Print or Type Name and Title Swom to and subscribed before me this 2 day of '�lQ,\( 2010. '� Personally Known OR 0 Produced Identification ; Type of dentification NOTARY PUBLIC STATE OF FLORIDA JELEANY VALDIVIA *c MY COMMISSION # EE041823 EXPIRES November 15, 2014 DECEMBER 28, 20110 (40'r7 398.0153 FlondaNctaryServlce.com 5 of 7 DELIVER TO: City of Sunny Isles Beach City Clerk 18070 Collins Avenue Sunny Isles Beach, FL 33160 INVITATION TO BID SECTION 4 OPENING: 10:00 A.M. BID SUBMITTAL FORMS May 25, 2011 PLEASE QUOTE PRICES F.O.B. DESTINATION, LESS TAXES, DELIVERED IN CITY OF SUNNY ISLES BEACH, FLORIDA NOTE: City of Sunny Isles Beach is exempt from all taxes (Federal, State, and Local). Bid price should be less all taxes. Tax Exemption Certificate furnished upon request. Issued by: Purchasing Agent Date Issued: This Bid Submittal Consists of April 29, 2011 Pages 23 through 27 Sealed bids are subject to the Terms and Conditions of this Invitation to Bid and the accompanying Bid Submittal. Such other contract provisions, specifications, drawings or other data as are attached or incorporated by reference in the Bid Submittal, will be received at the office of the City Clerk at the address shown above until the above stated time and date, and at that time, publicly opened for furnishing the supplies or services described in the accompanying Bid Submittal Requirement. IFB 11 -04 -03 STORM WATER CATCH BASIN CLEANING & LINE JETTING A Bid Deposit in the amount of Qom°/ of the total amount of the bid shall accompany all bids A Performance Bond in the amount of Q% of the total amount of the bid will be required upon execution of the contract by the successful bidder and City of Sunny Isles Beach Procurement Agent: Firm Name: Marcanthony Tulloch v 6_r ti Commodity Code(s): 890 -66 RETURN ONE ORIGINAL AND FOUR COPIES OF BID SUBMITTAL PAGES AND AFFIDAVITS FAILURE TO SIGN PAGE 27 OF SECTION 4 BID SUBMITTAL WILL RENDER YOUR BID NON- RESPONSIVE PAGE 23 of 28 BID No. 11 -01 -01 BID FORM Pump Out Services Item# Est. Qty Description Unit Price Extended Price 1 598 Storm water catch basins $ Per Basin)2 2 37,400 Jetting $ $ Per linear Foot Grand Total: $ S"9' ��` at Page 24A of 28 Bid No. 11 -01 -01 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 PART II: Addendum #1, Dated Addendum #2, Dated Addendum #3, Dated Addendum #4, Dated /v Addendum #5, Dated Addendum #6, Dated Addendum #7, Dated Addendum #8, Dated ❑ NO ADDENDUM WAS RECEIVED IN CONNECTION WITH THIS BID FIRM NAME: 4; n v ►2 C-) w a S �. �-lc v v r`Cg -S 91, ro U P. -� t.-, .- AUTHORIZED SIGNATURE. DATE: TITLE OF OFFICER: /: -T PAGE 25 of 28 BID No. 11 -01 -01 �O4 4UxN,v rs[�SeT 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 I COUNTY OF (M( PA) 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, G ri V/ r o IV 4.17 1 4 1pw (/r CX—S (Name of Corporation, Partnership, Individual, etc.) a, � �f a , formed under the laws off olydt (Ty of Business) (State) of which he is U (C! Plei ;oL r (Sole Owner, Partner, President, etc.) Neither the undersigned nor any person, firm, or corporation named in above Paragraph 10.2, nor anyone else to the knowledge of the undersigned, have themselves solicited or employed anyone else to solicit favorable action for this Bid by the City, also that no head of any department or employee therein, or any officer of the City of Sunny Isles Beach, Florida is directly interested therein. This Bid is genuine and not collusive or a sham; the person, firm or corporation named above in Paragraph 10.2 has not colluded, conspired, connived or agreed directly or indirectly with any proposers or person, firm or corporation, to put in a sham Bid, or that such person, firm or corporation, shall refrain from Bidding, and has not in any manner, directly or indirectly, sought by agreement or collusion, or communication or conference with any person, firm or corporation, to fa 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. F un2 Q 1114, bA U• P C .e' a AFFIANT'S NAME AFFIANT'S TITLE TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this o-� day of / " 1 20¢L Personally Known �_ or Produced Identification Type of identification (Affix seal here) TARY PUB (name printed or typed) JELEANY VALDIVIA '~ MY COMMISSION # EE041823 EXPIRES November 15, 2014 i&153 RorMallotsrySerWeo.com DECEMBER 28, 2010 1 of 7 jyNY F'J� StFf 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 perform Work as a Contractor, supplier, Sub - Contractor, or Consultant under a Contract with any public entity, and may not transact business with any public entity in excess of the threshold amount Category Two of Sec. 287.017, FS for thirty six months from the date of being placed on the convicted vendor list ". THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. 11.1. This sworn statement is submitted to City of Sunny Isles Beach by e j for c-n if t ►'U wQS f1X [print name of en sum ing swo whose business address is: C,v, 6 istatement] t and (if applicable) its Federal Employer identification number (FEIN) is & — (If the entity had no FEIN, include the Social Security Number of the individual signing this sworn statement: ) 11.2. 1 understand that a 'public entity crime as defined in Paragraph 287.133(1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or with the United States, including, but not limited to, any Bid or Contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 11.3. 1 understand that "convicted" or "conviction" as defined in Para. 287.133(1)(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trail court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non jury trial, or entry of a plea of guilty or nolo contendere. 11.4. 1 understand that an "affiliate" as defined in Para. 287.133(1)(a), Florida Statutes, means: a.) predecessor or successor of a person convicted of a public entity crime; or b.) Any entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executors, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair DECEMBER 28,2010 2 of 7 market value under an arm's length agreement, shall be a prime facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. 11.5. 1 understand that a "person" as defined in Para. 287.133(1)(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding Contract and which Bids or applies to Bid on Contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "persons" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of any entity. 11.6. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. (Indicate which statement applies.) L/ 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: (Printed a .7 ) C.6.U. (Title) Sworn tQ and subscribed before me this � day of 20 f t by (AFFIX NOTARY STAMP HERE) JELEA14Y VALDIVIA MY COMMISSION # EE041823 EXPIRES November 15, 2014 Personally Known Type of Identification Produced OR Produced Identification 1011998 3 of 7 Notary or Type of Florida Name bVtiy hlY +S�F EQUAL OPPORTUNITY / AFFIRMATIVE ACTION City of Sunny Isles Beach o {ti Sol. .* ° , 18070 Collins Avenue Sunny Isles Beach, FL 33160 Telephone: (305) 947 -0606 Fax: (305) 949 -3113 EQUAL OPPORTUNITY/ AFFIRMATIVE ACTION STATEMENT The contractors and all subcontractors hereby agree to a commitment to the principles and practices of equal opportunity in employment and to comply with the letter and spirit of federal, state, and local laws and regulations prohibiting discrimination based on race, color, religion, national region, sex, age, handicap, marital status, and political affiliation or belief. Signed: Title: y�� 4 Firm: Ch V i too LV #-� %n -•Y y� S (� rc-u a Address: DECEMBER 28, 2010 4 of 7 Q�SUpror �SrFSs ui .wz CONFLICT OF INTEREST City of Sunny Isles Beach 18070 Collins Avenue Sunny Isles Beach, FL 33160 Telephone: (305) 947 -0606 Fax: (305) 949 -3113 CONFLICT OF INTEREST STATEMENT The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes. Proposers must disclose with their Bids, the name of any officer, director, partner, associate or agent who is also an officer or employee of the City of Sunny Isles Beach or its agencies. STATE OF FLORIDA COUNTY OF -4-1 .4n. 44 BEFORE ME, the undersigned authority, personally appeared ' d`Kp -� / �8.`�� who was duly swom, deposes, and states: 18.1. 1 {{ m the (�', C. 0.4 of 40 F. WAS ac ec -,(c C with a local office in r'L2 �� t and principal office in —K CrA �� r. 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. 0 "a x-03 described as: Landscape Maintenance Services. The Affiant has made diligent inquiry and provides the information contained in this Affidavit based upon his own knowledge. 18.3 The Affiant states that only one submittal for the above Bid is being submitted and that the above named entity has no financial interest in other entities submitting Bids for the same project. 18.4 Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, participated in any collusion, or otherwise taken any action in restraints of free competitive pricing in connection with the entity's submittal for the above Bid. This statement restricts the discussion of pricing data until the completion of negotiations if necessary and execution of the Contract for this project. 18.5 Neither the entity nor its affiliates, nor any one associated with them, is presently suspended or otherwise ineligible from participation in contract letting by any local, State, or Federal Agency. 18.6 Neither the entity, nor its affiliates, nor any one associated with them have any potential conflict of interest due to any other clients, contracts, or property interests for this project. 18.71 certify that no member of the entity's ownership or management is presently applying for any employee position or actively seeking an elected position with the City of Sunny Isles Beach. 18.81 certify that no member of the entity's ownership or management, or staff has a vested interest in any aspect of the City of Sunny Isles Beach. 18.9 In the event that a conflict of interest is identified in the provision of services, I, on behalf of the above named entity, will immediately notify the City 't H / of Sunny Isles Beach. ) Dated this — day of I " !(/� V _ 12010. AFFIANT Jl Print or Type Name and Title Sworn to and subscribed before me this �`'t day of 2010. �,Z_ Personally Known OR O Produced Identification ;Type =denfification NOTARY PUBLIC STATE OF FLORIDA JELEANY VALDIVIA *: MY COMMISSION # EE041823 EXPIRES November 15, 2014 DECEMBER 28, 2010 (407) 398.0153 Flor�dsNotoryServke.com 5 of 7 DELIVER TO: INVITATION TO BID City of Sunny Isles Beach City Clerk SECTION 4 OPENING: 10:00 A.M. 18070 Collins Avenue BID SUBMITTAL FORMS May 25, 2011 Sunny Isles Beach, FL 33160 PLEASE QUOTE PRICES F.O.B. DESTINATION, LESS TAXES, DELIVERED IN CITY OF SUNNY ISLES BEACH, FLORIDA NOTE: City of Sunny Isles Beach is exempt from all taxes (Federal, State, and Local). Bid price should be less all taxes. Tax Exemption Certificate furnished upon request. Issued by: Purchasing Agent Date Issued: This Bid Submittal Consists of April 29, 2011 Pages 23 through 27 Sealed bids are subject to the Terms and Conditions of this Invitation to Bid and the accompanying Bid Submittal. Such other contract provisions, specifications, drawings or other data as are attached or incorporated by reference in the Bid Submittal, will be received at the office of the City Clerk at the address shown above until the above stated time and date, and at that time, publicly opened for furnishing the supplies or services described in the accompanying Bid Submittal Requirement. IFB 11 -04 -03 STORM WATER CATCH BASIN CLEANING & LINE JETTING A Bid Deposit in the amount of Q°/q of the total amount of the bid shall accompany all bids A Performance Bond in the amount of 0% of the total amount of the bid will be required upon execution of the contract by the successful bidder and City of Sunny Isles Beach Procurement Agent: Firm Name: Marcanthony Tulloch I v ,,� t,,-,. mr t V �� C�c. s Crro -Y,/3 Commodity Code(s): 890 -66 RETURN ONE ORIGINAL AND FOUR COPIES OF BID SUBMITTAL PAGES AND AFFIDAVITS FAILURE TO SIGN PAGE 27 OF SECTION 4 BID SUBMITTAL WILL RENDER YOUR BID NON- RESPONSIVE PAGE 23 of 28 BID No. 11 -01 -01 BID FORM Pump Out Services Item# Est. Qty Description Unit Price Extended Price 1 598 Storm water catch basins 11 202 Per Basin 2 37,400 Jetting $ $ om Per linear Foot Grand Total: Page 24A of 28 Bid No. 11 -01 -01 SECTION 4 BID SUBMITTAL FOR: ACKNOWLEDGEMENT OF ADDENDA INSTRUCTIONS: COMPLETE PART I OR PART II, WHICHEVER APPLIES PART l: LIST BELOW ARE THE DATES OF ISSUE FOR EACH ADDENDUM RECEIVED IN CONNECTION WITH THIS BID Addendum #1, Dated 3,- Addendum #2, Dated`' Addendum #3, Dated Xjo N D Addendum #4, Dated Addendum #5, Dated Addendum #6, Dated Addendum #7, Dated Addendum #8, Dated PART II: ❑ NO ADDENDUM WAS RECEIVED IN CONNECTION WITH THIS BID FIRM NAME: G= n v ►2 c> w a S 4.p Il A/ v /,cf -S to u P. -� fig . AUTHORIZED SIGNATURE. __ DATE: TITLE OF OFFICER: PAGE 25 of 28 BID No. 11 -01 -01 NON - COLLUSION AFFIDAVIT I' City of Sunny Isles Beach 18070 Collins Avenue . F l Op 0 Sunny Isles Beach, FL 33160 r'r> Q, sari *11 % Telephone: (305) 947 -0606 Fax: (305) 949 -3113 STATE OF FLORIDA J COUNTY OF (Ar( P4JL 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, C— r1 V/ ro W Cr 14 ls:p ' tli 'Cf-S W U► (Name of Corporation, Partnership, Individual, etc.) g / a, V' f20v—a- -(S Yt , formed under the laws ofL (Tyl3e of Business) (State) of which he is V (Cf (Sole Owner, Partner, President, etc.) Neither the undersigned nor any person, firm, or corporation named in above Paragraph 10.2, nor anyone else to the knowledge of the undersigned, have themselves solicited or employed anyone else to solicit favorable action for this Bid by the City, also that no head of any department or employee therein, or any officer of the City of Sunny Isles Beach, Florida is directly interested therein. This Bid is genuine and not collusive or a sham; the person, firm or corporation named above in Paragraph 10.2 has not colluded, conspired, connived or agreed directly or indirectly with any proposers or person, firm or corporation, to put in a sham Bid, or that such person, firm or corporation, shall refrain from Bidding, and has not in any manner, directly or indirectly, sought by agreement or collusion, or communication or conference with any person, firm or corporation, to fix the prices of said Bid or Bids of any other proposers; and all statements contained in the Bid or Bids described above true; and further; neither the undersigned, nor the person, firm or corporation named above in Paragraph 10.2, has directly or indirectly submitted said Bid or the contents thereof, or divulged information or data relative thereto, to any association or to any member or agent thereof. [: J (.ti42Q °'A � C .4 O AFFIANT'S NAME AFFIANT'S TITLE TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this � day of 200L Personally Known �_ or Produced Identification Type of identification (Affix seal here) JELEANY VALDMA MY COMMISSION # EE041823 EXPIRES November 15, 2014 388-0163 Fl0rWalloteryServlce.Can DECEMBER 28, 2010 1 of 7 �typed) TARY PUB (name printe NNbI 0 1k ` PUBLIC ENTITY CRIMES : City of Sunny Isles Beach •`ti /�• 18070 Collins Avenue Sunny Isles Beach, FL 33160 Telephone: (305) 947 -0606 Fax: (305) 949 -3113 SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a) FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES PUBLIC ENTITY CRIMES Pursuant to the provisions of paragraph (2) (a) of Section 287.133, Florida State Statutes - "A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a Bid on a Contract to provide any goods or services to a public entity, may not submit a Bid on a Contract with a public entity for the construction or repair of a public building or public Work, may not submit Bids on leases of real property to a public entity, may not be awarded to perform Work as a Contractor, supplier, Sub- Contractor, or Consultant under a Contract with any public entity, and may not transact business with any public entity in excess of the threshold amount Category Two of Sec. 287.017, FS for thirty six months from the date of being placed on the convicted vendor list ". THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. 11.1. This sworn statement is submitted to City of Sunny Isles Beach by F tpnrit individual's name an e c _ for �htf I. t'UUtQS X e✓uf6,S lY r &tf t,C [print name of entity submitting sworn statement] whose business address is: S E et kS l S Kint --3 and (if applicable) its Federal Employer Identification number (FEIN) is �S O82YG�y'0 (If the entity had no FEIN, include the Social Security Number of the individual signing this sworn statement: ) 11.2. 1 understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or with the United States, including, but not limited to, any Bid or Contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 11.3. 1 understand that "convicted" or "conviction" as defined in Para. 287.133(1)(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trail court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non jury trial, or entry of a plea of guilty or nolo contendere. 11.4. 1 understand that an "affiliate" as defined in Para. 287.133(1)(a), Florida Statutes, means: a.) predecessor or successor of a person convicted of a public entity crime; or b.) Any entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executors, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair DECEMBEB28,2010 2 of 7 market value under an arm's length agreement, shall be a prime facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. 11.5. 1 understand that a "person" as defined in Para. 287.133(1)(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding Contract and which Bids or applies to Bid on Contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "persons" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of any entity. 11.6. Based on information and belief, the statement which I have marked below is true in relation to the entity / submitting this sworn statement. (Indicate which statement applies.) C/ 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: (Printed a ) C.6.u. (Title) j Sworn t and subscribed before me this I day ofU 20 I< t by (AFFIX NOTARY STAMP HERE) • ': JELEANY VALDW MY COMMISSION # EED41823 EXPIRES November 15, 2014 Personally Known Type of Identification Produced OR Produced Identification 10 /im 3 of 7 otary or Type of Florida Name �oF Supnr'S`�rs� EQUAL OPPORTUNITY / •` AFFIRMATIVE ACTION �" • City of Sunny Isles Beach if '�7 . F t Off, ybr 18070 Collins Avenue Sunny Isles Beach, FL 33160 Telephone: (305) 947 -0606 Fax: (305) 9493113 EQUAL OPPORTUNITY /AFFIRMATIVE ACTION STATEMENT The contractors and all subcontractors hereby agree to a commitment to the principles and practices of equal opportunity in employment and to comply with the letter and spirit of federal, state, and local laws and regulations prohibiting discrimination based on race, color, religion, national region, sex, age, handicap, marital status, and political affiliation or belief. Signed: Title: y.� 4 �•� v Firm: Ch y! yo waS %ter vc1z.S �(pZr!!� Address: DECEMBER 28, 2010 4 of 7 J p1m Y CONFLICT OF INTEREST City of Sunny Isles Beach 18070 Collins Avenue Sr' i • j`yi15gk, �' Sunny Isles Beach, FL 33160 r�ry or SUS # ,.c Telephone: (305) 947 -0606 Fax: (305) 949 -3113 CONFLICT OF INTEREST STATEMENT The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes. Proposers must disclose with their Bids, the name of any officer, director, partner, associate or agent who is also an officer or employee of the City of Sunny Isles Beach or its agencies. STATE OF FLORIDA COUNTY OF .4i.• BEFORE ME, the undersigned authority, personally appeared '- �`�a-� e.h� who was duly swom, deposes, and states: 18.1. ► / m the P C. 49• d of G J;a Wank. �C,.,Cq th a local office in CO w> i � rC and principal office in V 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. .-- d IL-03 described as: Landscape Maintenance Services. The Affiant has made diligent inquiry and provides the information contained in this Affidavit based upon his own knowledge. 18.3 The Affiant states that only one submittal for the above Bid is being submitted and that the above named entity has no financial interest in other entities submitting Bids for the same project. 18.4 Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, participated in any collusion, or otherwise taken any action in restraints of free competitive pricing in connection with the entity's submittal for the above Bid. This statement restricts the discussion of pricing data until the completion of negotiations if necessary and execution of the Contract for this project. 18.5 Neither the entity nor its affiliates, nor any one associated with them, is presently suspended or otherwise ineligible from participation in contract letting by any local, State, or Federal Agency. 18.6 Neither the entity, nor its affiliates, nor any one associated with them have any potential conflict of interest due to any other clients, contracts, or property interests for this project. 18.71 certify that no member of the entity's ownership or management is presently applying for any employee position or actively seeking an elected position with the City of Sunny Isles Beach. 18.81 certify that no member of the entity's ownership or management, or staff has a vested interest in any aspect of the City of Sunny Isles Beach. 18.9 In the event that a conflict of interest is identified in the provision of services, I, on behalf of the above named entity, will immediately notify the City jjof Sunny Isles Beach. Dated this 2-4 day_ of I " / A � , 201 lb. I ,v P,-C-- AFFIANT Print or Type Name and Title Sworn to and subscribed before me this a4 U day of aQ 12010. CI_ Personally Known OR 0 Produced Identification ; Type of Identification 0 d , L, r, , I ( �n NOTARY PUBLIC STATE OF FLORIDA JELEANY VALDIVIA MY COMMISSION # EEG41823 EXPIRES November 15, 2014 DECEMBER 28, 2010 t40� 398 -0153 Flondallotoryservice.com 5 of 7