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Home My WebLink AboutKEMP Group DELIVER TO: City of Sunny Isles Beach City Clerk 18070 Collins Avenue Sunny Isles Beach, FL 33160 INVITATION TO BID SECTION 4 BID SUBMITTAL FORMS ,"'- d .1:': ~ '~:rt a: ~ J 1 Ifl - '~.~7, ,....., " 1\. . lI..,.I l MAY ~ is!\111 City of SUMY lsl6s Beadl Office o! tho CIN Clqrk OPENING:.l0:00'A-;M. OS/25/11 I 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: 05/09/11 This Bid Submittal Consists of 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 11-05-03 School Crossing Guard Services 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 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 AQent: Marcanthony Tulloch Firm Name: Commodity Code(s): 990-27 .I~ e tn r Ct VOlt P ern -fl'r'ha I-;OY'/l I {lOY pp ra..A DO I RETURN ONE ORIGINAL AND FOUR (4) 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 School Crossing Guard Services # Description Est. Hours / Hourly Rate Extended Price Annually 1 School Crossing Guard Supervisor 1,080 $ 13. oD $ I If, 0 40. 00 2 School Crossing Guard 7,776 $I?J. vO $ , D', 0 S'6' 00 Annual Grand Total: $ I I SI I d..'t.. [i) PAGE 24 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 Addendum #1, Dated 5"/JO I" 5/ :}O II , 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: \(f~"V',f ~ "'0 IIp ~), f--P{ rlLh'O~( Co "'pll }'"lL-". L')Vj AUTHORIZED SIGNATURE: CC~ ' '" DATE: JI:J 'I/. I TITLE OF OFFICER: 1y-e~', d,p j,,,+ PAGE 25 OF 28 BID No. 11-01-01 BID SUBMITTAL FORM Bid Title: School Crossing Guard Services The undersigned Proposers proposes and agrees, if this Bid is accepted, to enter into an agreement with The City of Sunny Isles Beach and 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. This Bid will remain subject to acceptance for 90 days after the day of Bid opening. The Proposer agrees to sign and submit the and other documents required by the Bidding Requirements within ten days after the date of the City's Notice of Award. In submitting this Bid, the Proposer represents, as more fully set forth in the Agreement, that: · The Proposer has familiarized himself/herself with the nature and extent of the Contract Documents, Work, site, locality, and all local conditions and Law and Regulations that in any manner may affect cost, progress, performance, or furnishing of the Work. · The Proposer has given the City written notice of all conflicts, errors, discrepancies that it has discovered in the Contract Documents and the written resolution thereof by City is acceptable to the Proposer. · This Bid is genuine and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization, or corporation; the Proposer has not directly or indirectly induced or solicited any other Proposers to submit a false or sham Bid; the Proposer has not solicited or induced any person, firm or corporation to refrain from Bidding; and Proposer has not sought by collusion to obtain for itself any advantage over any other Proposers or over the City. The 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: l.(~vY". p ~YOLlf ~+.fVn<:d~DV\O l ~v' '(XJYV--h'()1J Street Address: 8--1\\ ~ LO ~O LC)tLt) I hli v-a.rnCIl/ PL. 2.:>?:>O,J-6 Mailing Address (if different): --PO R::,o 'f- Jf '111f11 t.J. I 1-1,' a /VJ ~ Fi" ~3 'd-L/l PAGE 26 OF 28 BID No. Telephone No. q S l/_ Lf~ 1- 7?-Ct l{ Email Address: K~rr.p1Yl"'t.L p J hl--J (:) aOJ.lom Fax No. qs,t/- 4 ~ 1- <;A s ~ FEIN No. h5:-.J)j1JQj2J2J!1JJ... * "BY SIGNING THIS DOCUMENT THE BIDDER AGREES TO ALL TERMS SI~~ (S~~NA~~t,;T)- !h \ PRINT NAME: o.hy; s,'-h' htL. A-J fyj Ilil klU1 TITLE: '"Vrt'~: cl f J,- +- THE EXECUTION OF THIS FORM CONSTITUTES THE UNEQUIVOCAL OFFER OF PROPOSER TO BE BOUND BY THE TERMS OF ITS PROPOSAL. FAILURE TO SIGN THIS SOLICITATION WHERE INDICATED ABOVE BY AN AUTHORIZED REPRESENTATIVE SHALL RENDER THE PROPOSAL NON-RESPONSIVE. THE CITY MAY, HOWEVER, IN ITS SOLE DISCRETION, ACCEPT ANY PROPOSAL THAT INCLUDES AN EXECUTED DOCUMENT WHICH UNEQUIVOCALLY BINDS THE PROPOSER TO THE TERMS OF ITS OFFER. .. PAGE 27 OF 28 BID No. KEMP PO Box 471614, Miami FL 33247 References 1. City of Cooper City PO Box 290910 Cooper City, FL 33329-0910 Contact: Kerri-Anne Fisher Phone: (954) 434-4300 ext 268 (9090 SW 50 Place, 33328-4227) 2. City of North Miami Beach Police Department PO Box 60000M North Miami Beach FL 33160-1078 Contact: Sgt Rick Knowles Phone: (305) 948-2921 (16901 NE 19 Ave) 3. City of Miramar 2300 Civic Place Miramar FL 33025 Contact: Indra Sarju Phone: 954-602-3065 4. City of West Park Florida PO Box 5710 West Park FL 33083-5710 Contact: Russell Benford Phone: (954) 963-5955 Fax: (954) 831-0393 5. City of Sunny Isles Beach 18070 Collins A venue Sunny Isles Beach FL 33160 Contact: Priscilla Walker, CMC, Phone: 305-792- I 703 6. Somerset Academy 1260 I Somerset Blvd Miramar FL 33027 Contact: Shannine Sadesky-Hunt, Phone: 305-829-2406 7. City of Pembroke Pines 10100 Pines Boulevard Pembroke Pines FL 33026 Contact: Judith Neugent, CMC, Phone: 954-435-650 I Contact: Sgt Pazienza, 954-558-8898 8. City of Hollywood Police Department PO Box 229045 Hollywood FL 33022-9045 Contact: Ian Superville, Phone: 954-921-3552 9. The DeMoya Group Inc 14600 SW 136 St Miami FL 33186 Contact: Alisa DeMoya, Phone: 305-255-57 I 3 10. Town of Davie Police Department 1230 SNob Hill Road Davie FL 33324 Contact: Lori Lysfjord Phone: (954) 693-8268 11. Broward County Florida PO Box 14740 Ft Lauderdale FL 33302-4740 Contact: M Kadzinski Phone: (954) 357-6064 2/16/04 - present School Crossing Guard 3/1 /04 - present School Crossing Guard 8/05 - present School Crossing Guards 10/8/05 - present School Crossing Guard 8/1 8/08 - present School Crossing Guards 10/20/2008 - present School Crossing Guards I 1/08 - present School Crossing Guards 8/24/09 - present School Crossing Guards 10/07 - 12/2009 School Crossing Guards 8/06 - 6/09 8/03 - 7/06 1/95 - 8/03 School Crossing Guards 2/06 - present Temporary Warehouse Laborer J06CWIM Mailing: PO Box 471614*Miami FL 33247 2111 SW 60 Way*Miramar FL 33023 KEMP GROUP INTERNATIONAL CORPORATION Proposer's Qualification Statement Christina Aderinokun has over fifteen years experience dealing with school crossing guards. She is certified by the State of Florida Department of Transportation as a School Crossing Guard Trainer. Ms. Aderinokun also has experience as a security officer and security officer manager. Joe Faluade has over fifteen years experience dealing with school crossing guards. He is certified by the State of Florida Department of Transportation as a School Crossing Guard Trainer. Mr. Faluade also has experience as a security officer and security officer manager. Our company has been in business for over ten years, providing school crossing guards and temporary personnel services to various governmental agencies. We also provide armed and unarmed guards. At this present time, we are providing School Crossing Guards to the City of Cooper City, City of North Miami Beach, City of Miramar, City of West Park, City of Sunny Isles Beach, Somerset Academy, City of Pembroke Pines and the City of Hollywood. We have also provided school crossing guards to the Town of Davie, The DeMoya Group, City of A ventura and the City of Miami Gardens. Our supervisors have been trained and are also certified as school crossing guard trainers. The management staff here at Kemp Group International Corporation is well qualified. We have the experience and expertise to provide the best service. Weare a reputable company and have been conducting business in accordance with all local laws and regulations. We have an office located in Broward County. The office in Broward is 2111 SW 60 Way in Miramar, FL 33023. .... PHONE: (954) 437-7294 FAX: (954) 437-8952 ....... ...... ... .......... r r .~. :~:':-:". ' ---...... ..~::.; :::,~ru~<J;~,c/" ,;..>;, t~Ti t' ~ 'z;i;: ".. -\., ~~~ 2\' v'< ;~;:'i,~ ',: 1;:'/' ~ I ~,..,: . . .:..:t~\\~: ;:::. .)',:'. ;,~ ;~:~::.,. "-'.y+ \.~,-- . ;;: k L-./ '-,f 1" I / ' _..~:~: 4t( (:;'~i\: \:Z. Nk i~;<S<~\!i \. .,. '. ~'~l:1 1.1-L~\!i :;/ ".; ,~,i;: ,~::.:~:..,.. '-.:... '.. ,-~'I:i ':,;;:,:: ,~: i,: .,.....~:-. l, p: /.:~ '~'\'\; t :.....,' . .J, . (.{~t/,. '~. ::':"~~!l \.. . ,..\" ~t>~: · '~l\! )" . 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Y...~.,... ~ ,~;~ ,~1 .':-'it i' AFFIDAVITS PAGE 28 OF 28 BID No. OF NON-COLLUSION AFFIDAVIT Of SU'" 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 'BY/:\'.( }1(t ) 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, of which he is a, (' /'I (l~{) YC')...t7 0 r) (Ty e of Business) ~("t'S.;d.p~.-y (Sole Owner, Partner, President, etc,) , formed under the laws of Flo,iJtt.. (State) 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, A~ /)(" -f.s i J -t' 1'- ..} AFFIANT'S TITLE TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this ~ day of t11l1 , 200U Personally Known or Produced Identification V ' Aor-j dtv dnV/l"S I)OI....c.-L Type of identification i~1 ~'" ~~i "t Of fl.!!' Notary Public Slale of Florida Pamela L James My Commission DD908709 Expires 08/17/2013 e printed or typed) (Affix seal here) DECEMBER 28, 2010 1 of 7 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. by .t't---I- for Cb I' D ytLti tYl whose business address is: \ S I d II Lv lOD [uO{) I rn i YO rrt a. ( pc, ~~D d-..6 and (if applicable) its Federal Employer Identification number (FEIN) is b ~ -01 0 ~ ~ er d- . (If the entity had no FEIN, include the Social Security Number of the individual signing this sworn statement: ,) 11.2. I understand that a "public entity crime" as defined in Paragraph 287,133(1 )(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or with the United States, including, but not limited to, any Bid or Contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation, 11.3. I understand that "convicted" or "conviction" as defined in Para, 287.133(1 )(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trail court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non~jury trial, or entry of a plea of guilty or 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 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. I 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,) 11.6. 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. B. (Signa ure C:hyi c;. . J'"'A- Ad PYI h D ~u t\ (Priqted Name) -H'"-/"Sl d Pl'- + (Title) Sworn to and subscribed before me this / ~ day of , 201L-, by (AFFI 4th"'" Signature: Notary Public - Print or Type Commissioned Name OR Produced Identification v Personally Known Type of Identification Produced F70 ri da... d Y'IY-Irl~ Il'ul\.u 10/1998 3 of 7 EQUAL 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. Firm: c--~~, l>(-fS', df.... + \( ~m~ ~ yD L( t> -zr 1'"'1+-11' IlCL-h' C"a.. i COf ~f,()n 1>0 ~l>X L-I'1JlJltf ~(,' a)Y\ i pc, ~ 3?-Ln Signed: Title: Address: DECEMBER 28, 2010 4 of 7 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 /rl COUNTY OF _Fro ~ yO BEFORE ME, the undersigned authority, personally appeared Lh ri5J7l1tL- deposes, and states: 18.1. I am tbe ~('6/cl(JJ'-';' I!...~f 8ttlIJ.f 'iIA..JN",diOfV1./ (!or'fJ with a local office in '(hi ~/'Y'\,tr lrn~ . 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No, \ 1- ot;.......O:? described as: Landscape Maintenance Services, The Affiant has made diligent inquiry and provides the information contained in this Affidavit based upon his own knowledge, Ad t ri /lp ~/) who was duly sworn, of and principal office in 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 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. 18.7 I 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. 18.91n 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 b It{CL , 2~t-o.....:}q II . ~ ' -,yi hD K.I.'-11 ( A--c".sidpd Print or Type Name and Title Sworn to and subscribed before me this 1L day of Il tt.~l o Personally Known OR ~ Produced Identification V' ; Type of Ide 'fication ,2019' O(L/ dOli yiVe..)'1~ /.'Of\S,.l. DECEMBER 28, 2010 5 of 7 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? NO / YES 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 a,ny 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. Keh'\f> ~rt)U.f Lrr--i-.er00--+1onal Co(poro.h\~ ~i~, Autho ' I' re '-'\, s1 / (P fell Da e Ch l'i~ 'hnCA..; AJ f VI' 1\0 ~r.I1t- ~ ~ d-t'h..+ Print or Type Name and Title DECEMBER 28. 2010 6 of 7 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 STATE OF FLORIDA ) COUNTY OF ~OlOCtvc!- ~ 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: ~~\ Title: l\'-e~ cl-el---Y . J The foregoing instrument was acknowledged before me this lie day of J:j (.,V\ , 20~, by rJ,,(jS.+i~ 'Ad-Pri /"'In ~n [name of p~rson], as ~~<;')d.pw- [type of authority], for K-P~ R. 10 f.t. P Cfr,-+~r ntl 'I,'cnc< f COr f' [name of party on behalf of whom instrument was executed] . ~~ p~ Notary Public State of Florida R~'" Pamela L James ~ ; My Commission 00908709 "'~o,,,,rP Expires 08/17/2013 tV1~ tate of Florida AFFIX NOTARY STAMP HERE: Print or Type Commissioned Name Personally Known OR Produced Identification ~ Type of Identification Produced dVi-VfY'~ \\'ClMSe- DECEMBER 28, 2010 7 of 7