Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Joe Payne Inc.
DELIVER TO; City of Sunny Isles Beach City Clerk 18070 Collins Avenue Sunny Isles Beach, FL 33160 REQUEST FOR QUALIFICATIONS SECTION 6 BID SUBMITTAL FORMS OPENING: 10:00 A.M. 05/01/2012 Issued by: Purchasing Agent Date Issued: This Bid Submittal Consists of 04/02/2012 Pages 27 through 31 Sealed bids are subject to the Terms and Conditions of this Request for Qualifications 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. RFQ 12 -04 -01 Continuing Professional Architectural & Engineering Services Individuals Only (CCNA) 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 Aaent; Firm Name. Marcanthony Tulloch 'Jo (f a 4,1e, 47c Commodity Code(s); RETURN ONE ORIGINAL ONE COPYAND ONE ELECTRONIC COPY ON CD OR DVD OF BID SUBMITTAL PAGES AND AFFIDA VITS FAILURE TO SIGN PAGE 30 OF SECTION 6 BID SUBMITTAL WILL RENDER YOUR BID NON- RESPONSIVE City of Sunny Isles Beach I Request for Proposal No. 12 -04 -01 1 0 JOE PAYNE, INC. 9629 GRETNA GREEN DRIVE TAMPA, FL 33626 Members of the Selection Committee: Thank you for the opportunity to submit as an INDIVIDUAL for the CCNA Professional Services. I am ideally suited for this role in that I am an individual that currently works in this same capacity for two continuing contracts. I work as an individual reviewing plans and cases for the Florida Board of Engineers. I work remotely from my Tampa office and communicate weekly and monthly with the Board's compliancy officials. In addition, I complete engineering and inspection work in support of the Citizen's Insurance Wind Hazard Mitigation insurance program. I complete this work as an Individual. I have no employees and complete this work by myself, so I feel ideally suited for this work for Sunny Isles Beach. Relevant experience, qua lifications, and past performance As noted, I have current experience working as an individual performing contract work. I have served as a consultant for the Florida Board of Engineers since 2006 and receive an hourly rate for my services for assignments that range between 4 -16 hours. In addition, I serve as an inspector on a contract with Citizen's Insurance and have completed approximately 140 projects in Dade County consisting of Wind Hazard Mitigation Inspections. I worked extensively in Hialeah. I have completed this work from my home office in Tampa, FL. My office is my home address as 9629 Gretna Green Drive, Tampa, FL. I feel that this meets the essence of this advertisement. Relevant experience and qualifications of key personnel I am the only person employed by the company. I carry all of the required general, professional, and miscellaneous insurance required by the State under Joe Payne, Inc. I am a 20 year professional engineer with 13 years of experience in Florida. I have served as an engineer of record for over 200 municipal and private development projects. My key specialties are drainage, roadway, civil, and geotechnical engineer. I have vast experience in depositions and as a court engineer. Proposers; approach methodology to providing the services requested in this solicitation I have the unique ability to provide hands -on service through remote operations. I regularly communicate with professionals in Tallahassee for my Board of Engineers work. In addition, I communicate with an out of state office to service my Citizen's Insurance inspection work. I will meet with the project manager in Sunny Isles Beach, develop a relationship, and then complete work either in your office or in my office. I can work in your office on short notice and perform contract work as needed for the City. Proposers approach methodology to providing the services requested in this solicitation My operations are currently setup to serve clients in multiple locations. I do this by working on your site with my technology or working remotely. It will be important to establish scope, set goals, and then set schedule to continue this relationship. I am very strong at serving as an outside consultant or a neutral consultant as I currently operate in this capacity. In addition, my inspection work for Citizen's Insurance places me in Dade County regularly, so I can regularly visit your office. Civill Environmental Engineering I am a licensed civil engineer in Florida. I am the sole employee and will complete services. I will utilize mentors and specialty engineers for quality control and quality assurance. I do this on my current work. I have 20 years of civil engineering experience on civil, site development, utilities, stormwater, roadways, and other infrastructure projects. I will serve as the Team Project Manager and as stated have completed about 140 inspection cases in Dade County. I am very familiar with the area and the public works needs. The remainder of this letter responds to the format requirements in the RFQ. Joe Payne, Inc. RFQ 12 -04 -01 JOE PAYNE, INC. 9629 GRETNA GREEN DRIVE TAMPA, FL 33626 1. Company Information • In response to this Proposal, all Proposers must provide the following: • Name of Agency /Company (including any "Doing Business As" names) Joe Payne, Inc. • Company Locations Tampa, FL • Internet Web Site Address (if any) None • Details of Entity Business Structure (Corporation, Partnership, LLC) Corporation • Date Founded 2010 • Home office address, telephone number, and local address and phone number 9629 Gretna Green Drive, Tampa,FL 33626 813.731.1501 • List of any outstanding litigation that would threaten the viability of the Individual or the performance of this contract. None • Proof of insurance See attached • Indication of how long it would take to implement service after authorized to begin. I can begin office work immediately and be on -site within three business days. 2. Qualifications Proposer's relevant experience, qualifications and past performance ■ An explanation of why the Proposer is the best qualified to perform the contract and demonstrate its qualifications including an item -by -item disclosure outlining how the Individual meets or exceeds the requirements of this RFQ. I am an Individual that currently holds similar contracts with State Agencies. I can hit the ground running with tasks that are too small for corporations. I provide a lot of value to my clients through my low overhead and operations costs. My home is my office so my rate only needs to pay for my labor and benefits. My company does not have any debt. I am an expert engineer for the Florida Board of Engineers in Drainage, Geotechnical, Sinkhole evaluation, Roadway, Utilities, and Civil Engineering Disciplines. I am a hard worker and I am an Individual. ■ A schedule of proposed services. The schedule should include the Proposer's understanding of the issues and tasks of the project at hand. I understand that I will receive task assignments that will likely range from 16 -80 hours at a time or more. I am ideally suited for these small assignments as I currently complete work of this nature on my current contracts. In addition, I work remotely from Tampa and service clients statewide. ■ Must explain how the Individual meets the minimum qualifications, provide evidence such as copy of license and proof of relevant experience. I am a licensed engineer and Joe Payne, Inc. is a licensed corporation. Please see sunbiz.org. ■ Proposers are not required to submit a price proposal in its initial response to this RFQ Joe Payne, Inc. RFQ 12 -04 -01 JOE PAYNE, INC. 9629 GRETNA GREEN DRIVE TAMPA, FL 33626 I work for the Board at a rate of $100 /hr. I work for Citizen's at a rate that varies between $50- $60/hr. Rates are negotiable based on work and my ability to complete work with minimal expenses. 3. Staffing Relevant experience and qualifications of key personnel, including key personnel of subconsultants, that will be assigned to this project well as experience and qualifications. I have included my curriculum vitae with this response package. I am an Individual which is why I replied to this advertisement. I am the President and the Chief Engineer. 4. Approach / Methodology Proposer's approach methodology to providing the services requested in this solicitation ■ Suitability of the methodologies and approaches used in achieving tasks I currently work remotely to service my contracts as an Individual. I speak with my clients daily or weekly as needed and conduct on -site and off -site meetings. I am very responsive and offer a lot of value with my rates as I have very little overhead. I am an Individual that works from my home. ■ Overall organization to completing the project I receive work requests and develop a scope with a fee estimate. After completion, I usually begin work within a few business days. I balance my work with schedules of projects and essentially work as many hours as needed to finish the work. I am an Individual, so there is no other assistance. I have mentors that provide quality control and assurance reviews who have over 40 years of experience. ■ Ability to meet desired timelines and deadlines Describe your Individual's understanding of the following types of projects and your Individual's Strengths in designing these types of projects: Architecture • Community centers I currently provide bid administration for a pool construction project at a community center. In addition, we are completing building permits for door construction. Previously, I provided engineering plans for an expansion project at a community center. Parking Garages I am not familiar with parking garages. Landscape Architecture I am not familiar with Landscape Architecture. Site master planning I completed master plans for residential subdivisions and small commercial properties. I completed approximately 20 of these projects. Urban design plans Most of my urban design experience occurred when I lived in Philadelphia and New Jersey. I completed urban design plans for station renovations along transit facilities. Park design Joe Payne, Inc. RFQ 12 -04 -01 JOE PAYNE, INC. 9629 GRETNA GREEN DRIVE TAMPA, FL 33626 I am not familiar with park design. Median design I am familiar with access management. I have completed about 15 projects dealing with and assessing an Access Management Plan. Civil / Environmental Engineering I am an expert drainage engineer for the Florida Board of Engineers. I am one of only three in the State that they use to review complaint cases in drainage. • Drainage System Designs I am an expert in drainage system designs. I have completed about 200 projects dealing with stormwater collection and stormwater management. • Force Main Analysis I am not an expert in this area. • Storm water I am an expert drainage engineer for the Florida Board of Engineers. I am one of only three in the State that they use to review complaint cases in drainage. 5. References Each Proposer must submit a list of three (3) public sector clients' references of current and past customers of which they have provided services within the past five (5) years of similar scope and size of those described herein. • Each Reference must be supplied on client's letterhead. • Each Reference letter must be signed with contact person and phone number. 6. Contract Forms All completed contract forms. City of Sunny Isles Beach Request for Proposal No. 12 -04 -01 DELIVER TO: City of Sunny Isles Beach City Clerk 18070 Collins Avenue Sunny Isles Beach, FL 33160 Sincerely, Jo ph Payne, PE (INDIVIDUAL) President of Joe Payne, Inc. Joe Payne, Inc. RFQ 12 -04 -01 f SECTION 6 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 3d 1� PART II: Addendum #2, Dated Addendum #3, Dated Addendum #4, Dated Addendum #5, Dated Addendum #6, Dated Addendum #7, Dated Addendum #8, Dated ❑ NO ADDENDUM WAS RECEIVED IN CONNECTION WITH THIS BID FIRM NAME: Jo Y i e .41oloe A.', , { AUTHORIZED SIGNATURE: TITLE OF O 10ER: Iles i �A f, DATE: �4 City of Sunny Isles Beach I Request for Proposal No. 12 -04 -01 `14 or suµ W, "'Y of suo Pr BID SUBMITTAL FORM Bid Title: Continuing Professional Architectural & Engineering Services Individuals Only (CCNA) The undersigned Proposers proposes and agrees, if this Bid is accepted, to enter into an agreement with the City of Sunny Isles Beach to perform and furnish all Work as specified or indicated in the Contract Documents and in accordance with the other terms and conditions of the Contract Documents. The Proposers accepts all of the terms and conditions of this or Request for Qualifications. This Bid will remain subject to acceptance for 90 days after the day of Bid opening. The Proposers agrees to sign and submit the Agreement with the 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. City of Sunny Isles Beach I Request for Proposal No. 12 -04 -01 ' ""I' or SUN Pr_ Firm Name: vX1 P C/o jo (51 Peal Im Street Address: 96 2 q Gee 47u P ��l Mailing Address (if different): Telephone No. 913 731 is U I Fax No. Email Address: T,7, y �FEIN No. E/P/, Zc.a, r/ Pf * "By signing this document the bidder agrees to aii Terms Signature: (Sign ti!iay v utthorized agent) Print Name: "/' SP�� ' �111�i'e Title: 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. City of Sunny Isles Beach I Request for Proposal No. 12 -04 -01 0 C,/ T Y /NNY FLO� SUN , OF .CAP City of Sunny Isles Beach I Request for Proposal No. 12 -04 -01 of SUN Pao SUNNY rS�F � n • }q P r SF 99�' FL�oR 5� C�Fy OF SUN PNO STATE OF FLORIDA i COUNTY OF x-101 q ) NON - COLLUSION AFFIDAVIT City of Sunny Isles Beach 18070 Collins Avenue Sunny Isles Beach, Fl- 33160 Telephone: (305) 947 -0606 Fax: (305) 949 -3113 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, (Name of Corporation, Prartnership, Individual, etc.) a, Ca/ 1r'o�'R /. c, formed under the laws of (Ty�iness) (State) of which he is //11 3i/ f,', �� Jd /P OW,7 (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 2002, Personally Known or Produced Identification >� Type of identification (Affix seal here) f^' '("\) DECEMBER 28, 2010 1 of 7 ,��P(yY PUA• RICHARD S MARTIN Notary Public - State of Florida « _ My Comm. Expires Apr 2, 2014 ;?• o. '9r•i'i,i 1•�`, Commission # DD 972545 Bonded Through National Notary Assn, DECEMBER 28, 2010 1 of 7 O� SVNNY ;S 4 P PUBLIC ENTITY CRIMES City of Sunny Isles Beach 18070 Collins Avenue 'S"p iD9)'• FL00.�0 .,'�� Sunny Isles Beach, FL 33160 c''� o. sus " 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 Cii by J� �� g ye7P 171 8. for A7,-, ----Tp*7n name ot entity su5mitting sworn statementJ �/ / T whose business address is: IT 11, ,/�G/ 1�L 5� � and (if applicable) its Federal Employer Identification number (FEIN) is & 616 ¢ 0 1�Z0 . (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.) 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 A HANGE IN THE INFORMATION CONTAINED IN THIS FORM. By: ,/( 'g turb) / q Printed NWe / (Title) Sworn to and subscribed before me this day of 20�, by (AFFIX NOTARY STAMP HERE) � RICHARD S MARTIN Notary Public - of Florida Si ature: to Pu 6ic 'o7offidW- State My Comm. Expires Apr 2, 2014 Commission # DD 972545 rent or Type Commissio ed ame 9 P ........... ' Bonded Through National Notary Assn. Pers P W Identification Type of Identification Produced L 10/1998 3 of 7 tio� SUNNY ,S(���r EQUAL OPPORTUNITY / AFFIRMATIVE ACTION • �` - P yF pEOP 5' City of Sunny Isles Beach 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: Firm: 1�C- Address: `/6 1 GiP�ir� G /�+-'i ,�.so� e DECEMBER 28, 2010 4 of 7 O� SVt4NY IS(�'�q CONFLICT OF INTEREST City of Sunny Isles Beach ` r 18070 Collins Avenue se 99�. FL°R + Sunny Isles Beach, FL 33160 o, $uN ' 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 G� COUNTY OF j BEFORE ME, the undersigned authority, personally appeared J� P �7Gi � who was duly sworn, deposes, and states: / 18.1. 1 am the / l �5/ P ,"t of J C') P e01 V4 (' Tel (• with a local office in ray and principal office in T�� 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. 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. 18.8 1 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. ' & _ day of Print or Type Name and 2R1 Sworn to and subscribed before me this C� day of M n 2016.)— O Personally Known OR Produced Identification ; Ty of Ide tification NOTARY PUBLIC STATE OF FLORIDA --- -------- �av'P RICHARD S MARTIN Notary Public - State of Florida E My Comm. Expires Apr 2, 2014 Commission # DD 972545 5 DECEMBER 28, 2010 •! j °r �� °P`' Bonded Through National Notary Assn. SJNNY �S�F Y U x P � hF '99�• FLO C,ty of $ UN PNO 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 19.2. Has your firm, or any member of your firm, been declared in default, terminated or removed from a contract or job related to the services your firm provides in the regular course of business within the last five (5) years? YES NO 19.3. Has your firm had against it or filed any requests for equitable adjustment, contract claims, Bid protests, or litigation in the past five (5) years that is related to the services your firm provides in the regular course of business? YES NO If yes, state the nature of the request for equitable adjustment, contract claim, litigation, or protest, and state a brief description of the case, the outcome or status of the suit and the monetary amounts of extended contract time involved. I hereby certify that all statements made are true and agree and understand that any misstatement or misrepresentation of falsification of facts shall be cause for forfeiture of rights for further consideration of this Bid for the City of Sunny Isles Beach. Dat V/0 v Print or Typ Name and T Ale DECEMBER 28, 2010 6 of 7 °�SJNNy /SC��9 � F P hF CD9�. FL�O" 4E iy Of S � N STATE OF FLORIDA ) COUNTY OF ) 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�, by of persE44, as executed]. AFFIX NOTARY STAMP HERE: By: )OP Title: //P was acknowledged before me this day of p«y [name [type of authority], for [nammg-of —party on behalf of whom instrument was 91 A 11 ri Print or Type Commissioned Name Personally Known OR Produced Identification Type of Identification Produced rL- �b C__ DECEMBER 28, 2010 7 of 7 RICHARD S MARTIN Notary Public - State of Florida My Comm. Expires Apr 2, 2014 ••i� F' Vii , i�P �. Commission # DD 972545 Bonded Through National Notary Assn. 91 A 11 ri Print or Type Commissioned Name Personally Known OR Produced Identification Type of Identification Produced rL- �b C__ DECEMBER 28, 2010 7 of 7 To Whom It May Concern: Joe Payne through Joe Payne, Inc. provided 1099 services for me since August 2009. I can attest that his work is excellent and completed with professionalism and upmost quality. I highly recommend Joe for Individual Contracts such as RFQ 12- 04 -01. Sincerely, Brad Foran, PE Principal Lighthouse Engineering, Inc. 727.365.3616 (Phone) 727.683.9848 (Fax) bforan @lighthouseenginc.com A :QOM May 2, 2012 RE: REFERENCE FOR JOE PAYNE To Whom It May Concern: AECOM 813- 630 -2500 tel 10210 Highland Manor Dr 813- 621 -2300 fax Suite 350 Tampa, FL 33610 www.aecom.com Joe Payne through Joe Payne, Inc. provided 1099 services for my company related to traffic counts and traffic studies. He also completed drainage studies. I can attest that his work is excellent and completed with professionalism and upmost quality. I highly recommend Joe for Individual Contracts such as RFQ 12- 04 -01. Sincerely, 71,011-11 PV9,t7— Todd Potter, PE Transportation Engineer To Whom It May Concern: Joe Payne through Joe Payne, Inc. provided 1099 services for Lighthouse Engineering during my tenure. I can attest that his work is excellent and completed with professionalism and upmost quality. I highly recommend Joe for Individual Contracts such as RFQ 12- 04 -01. Sincerely, Ewald Frank Foran, PE Quality Control and Assurance Officer Lighthouse Engineering, Inc. 727.365.3616 (Phone) 727.683.9848 (Fax) Bid Details - Onvia DemandStar Page 1 of 2 User: Payne, Joe Organization: joe payne, inc Logout i Help DEMANDSTAR by ONVIA My DemandStar Suppliers Account Info [View Bids] View Orders View Responses Bid Details Bid Information Agency City of Sunny Isles Beach Bid Type Request For Qualifications Bid Number RFQ- 12- 04- 01- 0- 2012/mb Fiscal Year 2012 Bid Writer Mauricio Betancur Bid Name Continuing Professional Architectural & Engineering Services Individuals Only CCNA) Bid Status Active Bid Status Text None Due Date /Time 5/4/2012 10:00 AM Eastern Broadcast Date 4/2/2012 Bid Bond Project Estimated Budget Plan (blueprint) None Distribution Options Distribution Method Download and Mail Distributed By Onvia DemandStar Distribution Notes None The objective of this solicitation is to solicit proposals for the qualifications and selection of Scope of Work individual professionals to provide Architecture, Landscape Architecture, Civil / Environmental Engineering, Planning & Urban Design, Traffic Engineering & Transportation Consulting professional services. E- Bidding No Legal Ad Pre -Bid Conference Publications Documents Please select either the View or Edit button to manage legal ad. Miami Daily Business Review 4/2/2012 RFQ Specifications (38 Pages, Complete) Bid Package Request for Clarification No. 1 (2 Pages, Complete) Addendum No. 1 (1 Page, Complete) Commodity Codes VIEW VIEW http: / /www.demandstar.com /supplier/ bids /Bid_Detail. asp ?_PU= %2Fsupplier %2Fbids %2F... 5/1/2012 Bid Details - Onvia DemandStar SRV- 918 -16 - Architectural Consulting SRV- 918 -32 - Consulting Services (Not Otherwise Classified) SRV- 918 -42 - Engineering Consulting SRV- 918 -43 - Environmental Consulting SRV- 918 -73 - Landscaping Consulting SRV- 918 -92 - Urban Planning Consulting SRV- 918 -94 - Traffic Consulting SRV- 918 -96 - Transportation Consulting j « Return I DemandStar is a product of Onvia, Inc. (c) 1997 -2012. All rights reserved. I Terms of Use I Privacy Page 2 of 2 http:// www. demandstar .comisupplierlbidsIBid_Detail. asp ?_PU= %2Fsupplier %2Fbids %2F... 5/1/2012 ARCHITECT - ENGINEER QUALIFICATIONS PART I - CONTRACT - SPECIFIC QUALIFICATIONS A. CONTRACT INFORMATION 1. TITLE AND LOCATION (City and State): City of Sunny Isles Beach, FL 2. PUBLIC NOTICE DATE: May 2012 3. SOLICITATION OR PROJECT NUMBER B. ARCHITECT - ENGINEER POINT OF CONTACT 4. NAME AND TITLE: Joe Payne, PE President 5. NAME OF FIRM: Joe Payne Inc. 6. TLEPHONE NUMBER: 813.731.1501 7. FAX NUMBER: 727 - 683 -9848 8. E -MAIL ADDRESS: joepaynel973 @verizon.net C. PROPOSED TEAM (Complete this section for the prime contractor and all key subcontractors.) 9a. PRIME (CHECK HERE): Joe Payne, Inc. 9a. JOINT - VENTURE PARTNER (CHECK HERE): 9a. SUBCONTRACTOR (CHECK HERE): 9a. FIRM NAME: 9a. IF BRANCH OFFICE CHECK HERE: 10a. ADDRESS 11a. ROLE IN THIS CONTRACT: Prime 9b. PRIME (CHECK HERE): 9b. JOINT - VENTURE PARTNER (CHECK HERE): 9b. SUBCONTRACTOR (CHECK HERE): 9b. FIRM NAME: 9b. IF BRANCH OFFICE CHECK HERE: 10b. ADDRESS 11b. ROLE IN THIS CONTRACT STANDARD FORM 330 (6/2004) PAGE 2 9c. PRIME (CHECK HERE): 9c. JOINT - VENTURE PARTNER (CHECK HERE): 9c. SUBCONTRACTOR (CHECK HERE): 9c. FIRM NAME: 9c. IF BRANCH OFFICE CHECK HERE: 10c. ADDRESS 11c. ROLE IN THIS CONTRACT 9d. PRIME (CHECK HERE): 9d. JOINT - VENTURE PARTNER (CHECK HERE): 9d. SUBCONTRACTOR (CHECK HERE): 9d. FIRM NAME: 9d. IF BRANCH OFFICE CHECK HERE: 10d. ADDRESS 11d. ROLE IN THIS CONTRACT 9e. PRIME (CHECK HERE): 9e. JOINT - VENTURE PARTNER (CHECK HERE): 9e. SUBCONTRACTOR (CHECK HERE): 9e. FIRM NAME: 9e. IF BRANCH OFFICE CHECK HERE: 10e. ADDRESS 11e. ROLE IN THIS CONTRACT 9f. PRIME (CHECK HERE): 9f. JOINT - VENTURE PARTNER (CHECK HERE): 9f. SUBCONTRACTOR (CHECK HERE): 9f. FIRM NAME: 9f. IF BRANCH OFFICE CHECK HERE: 10f. ADDRESS 1 if. ROLE IN THIS CONTRACT D. ORGANIZATIONAL CHART OF PROPOSED TEAM (Staffing is in proposal) STANDARD FORM 330 (612004) PAGE 3 E. RESUMES OF KEY PERSONNEL PROPOSED FOR THIS CONTRACT (Complete one Section E for each key person.) 12. NAME: Joe Payne, PE 13. ROLE IN THIS CONTRACT: Project Director/ Engineer 14a. YEARS EXPERIENCE - TOTAL: 20 14b. YEARS EXPERIENCE -WITH CURRENT FIRM: 3 15. FIRM NAME AND LOCATION (City and State): Joe Payne Inc., Tampa, FL 16. EDUCATION (DEGREE AND SPECIALIZATION):MBA Finance and Management (USF), BS Civil Engineering (Drexel University), MS Studies Geotechnical Engineering (New Jersey Institute of Technology). SPECIALIZATION (Civil Engineering). Hillsborough County Public Works Project Management (Previous Superior and Excellent CAPE scores) 17. CURRENT PROFESSIONAL REGISTRATION (STATE AND DISCIPLINE): FL, GA, DE. Civil Engineering 18. OTHER PROFESSIONAL QUALIFICATIONS (Publications, Organizations, Training, Awards, etc.): Forensic Engineer, Case Reviewer for the Florida Board of Engineers. Volunteer Hillsborough County Government (Plumbing Licensing and Examination Board, Land Use Appeals Board). 19a(1) RELEVANT PROJECT - TITLE AND LOCATION (City and State): Hillsborough County General Civil Services Contract 2005 -2007. Renewed 2007. 19a(2) RELEVANT PROJECT - YEAR COMPLETED - PROFESSIONAL SERVICES: 2007 19a(2) RELEVANT PROJECT - YEAR COMPLETED - CONSTRUCTION (If applicable): 19a(3) RELEVANT PROJECT - BRIEF DESCRIPTION (Brief scope, size, cost etc.) AND SPECIFIC ROLE: Project Director and Project Manager for several General Civil Engineering contracts. The Gen Civ contract was capped at $3M and I completed approximately $1 M of work. 19a(3) RELEVANT PROJECT - BRIEF DESCRIPTION - Check here if project performed with current firm: No, project was with TYLIN. 19b(1) RELEVANT PROJECT - TITLE AND LOCATION (City and State): Hillsborough County TTF -2a. Project Manager for the award of the Broadway Avenue and Falkenburg Road project. Project Manager into the first phase of design. 19b(2) RELEVANT PROJECT - YEAR COMPLETED - PROFESSIONAL SERVICES: 2009 19b(2) RELEVANT PROJECT - YEAR COMPLETED - CONSTRUCTION (If applicable): 19b(3) RELEVANT PROJECT - BRIEF DESCRIPTION (Brief scope, size, cost etc.) AND SPECIFIC ROLE: Project Manager for the intersection Improvement at Broadway Avenue and North Falkenburg Road. $1 M estimated fee. 19b(3) RELEVANT PROJECT - BRIEF DESCRIPTION - Check here if project performed with current firm: No, project was completed with Greenhorne & O'mara. 19c(1) RELEVANT PROJECT - TITLE AND LOCATION (City and State):Meadowpointe 2 CDD, Wesley Chapel, FL. 19c(2) RELEVANT PROJECT - YEAR COMPLETED - PROFESSIONAL SERVICES: 2011 19c(2) RELEVANT PROJECT - YEAR COMPLETED - CONSTRUCTION (If applicable): Continuing 19c(3) RELEVANT PROJECT - BRIEF DESCRIPTION (Brief scope, size, cost etc.) AND SPECIFIC ROLE: Engineering Consultant for Meadowpointe CDD in Wesley Chapel, FL. Completed site inspection, permit inspections, bid evaluations, construction administration, litigation support, and other professional services required by the community. Project Manager for the contract. 19c(3) RELEVANT PROJECT - BRIEF DESCRIPTION - Check here if project performed with current firm: YES. 19d(1) RELEVANT PROJECT - TITLE AND LOCATION (City and State): Haben Boulevard resurfacing in Manatee County. FDOT District One Bartow 19d(2) RELEVANT PROJECT - YEAR COMPLETED - PROFESSIONAL SERVICES: 2010 19d(2) RELEVANT PROJECT - YEAR COMPLETED - CONSTRUCTION (If applicable): 19d(3) RELEVANT PROJECT - BRIEF DESCRIPTION (Brief scope, size, cost etc.) AND SPECIFIC ROLE: Engineering Consultant for a Design -Build Project that resurfaced a collector road in Manateee County. $700k construction budget. 19d(3) RELEVANT PROJECT - BRIEF DESCRIPTION - Check here if project performed with current firm: YES 19e(1) RELEVANT PROJECT - TITLE AND LOCATION (City and State): Consultant for Board of Engineers 19e(2) RELEVANT PROJECT - YEAR COMPLETED - PROFESSIONAL SERVICES: 2006 19e(2) RELEVANT PROJECT - YEAR COMPLETED - CONSTRUCTION (If applicable): 19e(3) RELEVANT PROJECT - BRIEF DESCRIPTION (Brief scope, size, cost etc.) AND SPECIFIC ROLE: Engineering Consultant for depositions, Case reviews, and case reports 19e(3) RELEVANT PROJECT - BRIEF DESCRIPTION - Check here if project performed with current firm: YES STANDARD FORM 330 (6/2004) PAGE 4 E. RESUMES OF KEY PERSONNEL PROPOSED FOR THIS CONTRACT (Complete one Section E for each key person.) F. EXAMPLE PROJECTS WHICH BEST ILLUSTRATE PROPOSED TEAM'S QUALIFICATIONS FOR THIS CONTRACT (Present as many projects as requested by the agency, or 10 projects, if not specified. Complete one Section F for each project.) D. EXAMPLE PROJECT KEY NUMBER: 1 E. TITLE AND LOCATION (City and State): Meadowpointe 2 CDD, Wesley Chapel, FL F. YEAR COMPLETED - PROFESSIONAL SERVICES: ONGOING G. YEAR COMPLETED -CONSTRUCTION (Ifapplicable):N /A 23a. PROJECT OWNER'S INFORMATION - PROJECT OWNER: Meadowpointe 2 CDD and Severn Trent 23b. PROJECT OWNER'S INFORMATION - POINT OF CONTACT NAME: Linda Straw (11112), Andy Mendenhall (Severn Trent) 23c. PROJECT OWNER'S INFORMATION -POINT OF CONTACT TELEPHONE NUMBER: Linda (813.991.5016) Andy (813- 781 -7330) 24. BRIEF DESCRIPTION OF PROJECT AND RELEVANCE TO THIS CONTRACT (Include scope, size, and cost): Provide engineering consulting Services to Meadowpointe 2. Scope includes meeting attendance, permit inspections, construction administration, and litigation support. For a a rate of $731 hr. 25. FIRMS FROM SECTION INVOLVED WITH THIS PROJECT (1) FIRM NAME (2) FIRM LOCATION (City and State) (3) ROLE Joe Payne, Inc. Tampa, FL Prime Consultant H. EXAMPLE PROJECT KEY NUMBER: 2 I. TITLE AND LOCATION (City and State): Haben Boulevard Resurfacing, Manatee County, FL J. YEAR COMPLETED - PROFESSIONAL SERVICES: 2010 K. YEAR COMPLETED - CONSTRUCTION (If applicable): 2010 23a. PROJECT OWNER'S INFORMATION - PROJECT OWNER: FDOT District One Bartow 23b. PROJECT OWNER'S INFORMATION - POINT OF CONTACT NAME: James Wooten 23c. PROJECT OWNER'S INFORMATION - POINT OF CONTACT TELEPHONE NUMBER: 863.519.2300 24. BRIEF DESCRIPTION OF PROJECT AND RELEVANCE TO THIS CONTRACT (Include scope, size, and cost): Resurfacing Design a collector road between US301 and SR 64. Size of each project approached to 1.2 miles. This was a design -build project in which our design was placed in construction plans that was utilized by our partner AJAX Paving to construct the project. $700K project. 25. FIRMS FROM SECTION INVOLVED WITH THIS PROJECT (1) FIRM NAME (2) FIRM LOCATION (City and State) (3) ROLE Joe Payne, Inc. Tampa, FL Prime Consultant STANDARD FORM 330 (6/2004) PAGE 5 L. EXAMPLE PROJECT KEY NUMBER: 3 M. TITLE AND LOCATION (City and State): Board of Engineers Consultant -Drainage N. YEAR COMPLETED - PROFESSIONAL SERVICES: 2006 -2008 O. YEAR COMPLETED - CONSTRUCTION (If applicable): 2006 -2008 23a. PROJECT OWNER'S INFORMATION - PROJECT OWNER: FBPE 23b. PROJECT OWNER'S INFORMATION - POINT OF CONTACT NAME: John Rimes 23c. PROJECT OWNER'S INFORMATION - POINT OF CONTACT TELEPHONE NUMBER: (850) 5210500 24. BRIEF DESCRIPTION OF PROJECT AND RELEVANCE TO THIS CONTRACT (Include scope, size, and cost):Completed case reviews in drainage Only. 25. FIRMS FROM SECTION INVOLVED WITH THIS PROJECT (1) FIRM NAME (2) FIRM LOCATION (City and State) (3) ROLE Joe Payne, Inc. Tampa, FL Prime Consultant P. EXAMPLE PROJECT KEY NUMBER: 4 Q. TITLE AND LOCATION (City and State): Citizen's Inspector R. YEAR COMPLETED - PROFESSIONAL SERVICES: 2011/2012 S. YEAR COMPLETED - CONSTRUCTION (If applicable):current 23a. PROJECT OWNER'S INFORMATION - PROJECT OWNER: Citizen's c/o Mueller Services 23b. PROJECT OWNER'S INFORMATION - POINT OF CONTACT NAME: Mike Bucelli 23c. PROJECT OWNER'S INFORMATION - POINT OF CONTACT TELEPHONE NUMBER: (813) 7311501 24. BRIEF DESCRIPTION OF PROJECT AND RELEVANCE TO THIS CONTRACT (Include scope, size, and cost): Complete Wind Hazard mitigation Inspections for citizen's insurance 25. FIRMS FROM SECTION INVOLVED WITH THIS PROJECT (1) FIRM NAME (2) FIRM LOCATION (City and State) (3) ROLE Joe Payne, Inc. Tampa, FL Prime Consultant STANDARD FORM 330 (6/2004) PAGE 6 T. EXAMPLE PROJECT KEY NUMBER: 5 U. TITLE AND LOCATION (City and State): Greenace Properties V. YEAR COMPLETED - PROFESSIONAL SERVICES: 2009 W. YEAR COMPLETED - CONSTRUCTION (If applicable):2009 23a. PROJECT OWNER'S INFORMATION - PROJECT OWNER: Greenacre Properties 23b. PROJECT OWNER'S INFORMATION - POINT OF CONTACT NAME: Jeff Greenacre 23c. PROJECT OWNER'S INFORMATION - POINT OF CONTACT TELEPHONE NUMBER: (813) 7311501 26. BRIEF DESCRIPTION OF PROJECT AND RELEVANCE TO THIS CONTRACT (Include scope, size, and cost): Completed Drainage Improvement And construction administration activities for condo associations 24. FIRMS FROM SECTION INVOLVED WITH THIS PROJECT (1) FIRM NAME (2) FIRM LOCATION (City and State) (3) ROLE Joe Payne, Inc. Tampa, FL Prime Consultant X. EXAMPLE PROJECT KEY NUMBER: 6 Y. TITLE AND LOCATION (City and State): Hillsborough County Transportation Task Force 2a — Broadway Avenue and Falkenburg Road. Z. YEAR COMPLETED - PROFESSIONAL SERVICES: TBD AA. YEAR COMPLETED - CONSTRUCTION (If applicable): 23a. PROJECT OWNER'S INFORMATION - PROJECT OWNER: Hillsborough County Public Works 23b. PROJECT OWNER'S INFORMATION - POINT OF CONTACT NAME: Hank Schneider, HNTB GEC 23c. PROJECT OWNER'S INFORMATION - POINT OF CONTACT TELEPHONE NUMBER: 813.402.4150 25. BRIEF DESCRIPTION OF PROJECT AND RELEVANCE TO THIS CONTRACT (Include scope, size, and cost):Major intersection improvement in East County. Improve the Falkenburg Road northbound turn movement and turning movements on to Broadway Avenue. Improve Level of Service of the intersection. Cost approaches $1 M 26. FIRMS FROM SECTION INVOLVED WITH THIS PROJECT (1) FIRM NAME (2) FIRM LOCATION (City and State) (3) ROLE Joe Payne, Inc. Tampa, FL Joe Payne worked on this project at a previous employer. STANDARD FORM 330 (6/2004) PAGE 7 BB. EXAMPLE PROJECT KEY NUMBER: 7 CC. TITLE AND LOCATION (City and State): City of Tallahassee — Joe Louis St. DD. YEAR COMPLETED - PROFESSIONAL SERVICES: 2009 EE. YEAR COMPLETED - CONSTRUCTION (If applicable):2009 23a. PROJECT OWNER'S INFORMATION - PROJECT OWNER: City of Tallahassee 23b. PROJECT OWNER'S INFORMATION - POINT OF CONTACT NAME: William Woolery 23c. PROJECT OWNER'S INFORMATION - POINT OF CONTACT TELEPHONE NUMBER: 850.891.8197 24. BRIEF DESCRIPTION OF PROJECT AND RELEVANCE TO THIS CONTRACT (Include scope, size, and cost): Roadway and Safety Enhancement project along a rural collector road in Tallahassee. Our design included sidewalk, slope, handrail, and other miscellaneous safety enhancements The project included construction plans which our partner Semper Fi utilized to complete this Design -Build project. Cost = $100k. 25. FIRMS FROM SECTION INVOLVED WITH THIS PROJECT (1) FIRM NAME (2) FIRM LOCATION (City and State) (3) ROLE Joe Payne, Inc. Tampa, FL Prime Consultant FF. EXAMPLE PROJECT KEY NUMBER: 8 GG. TITLE AND LOCATION (City and State): Florida Friendly Landscaping HH. YEAR COMPLETED - PROFESSIONAL SERVICES: 2009/2010 11. YEAR COMPLETED - CONSTRUCTION (If applicable): 23a. PROJECT OWNER'S INFORMATION - PROJECT OWNER: Westchase Association 23b. PROJECT OWNER'S INFORMATION - POINT OF CONTACT NAME: Jeff Greenacre/ MaryJo Locascio 23c. PROJECT OWNER'S INFORMATION - POINT OF CONTACT TELEPHONE NUMBER: (813) 926 -6404 24. BRIEF DESCRIPTION OF PROJECT AND RELEVANCE TO THIS CONTRACT (Include scope, size, and cost): Landscape Architecture and Technical Writing. Wrote amended guidelines to the Westchase Association guidelines for the new Florida Friendly Landscaping Statutes. $5k. 25. FIRMS FROM SECTION INVOLVED WITH THIS PROJECT (1) FIRM NAME (2) FIRM LOCATION (City and State) (3) ROLE Joe Payne, Inc. Tampa, FL Prime Consultant STANDARD FORM 330 (612004) PAGE 8 JJ. EXAMPLE PROJECT KEY NUMBER: 9 KK. TITLE AND LOCATION (City and State): Florida Board of Engineers/ Florida Engineering Management Corporation. Tallahassee, FL LL. YEAR COMPLETED - PROFESSIONAL SERVICES:2005- current MM. YEAR COMPLETED - CONSTRUCTION (If applicable): 23a. PROJECT OWNER'S INFORMATION - PROJECT OWNER: Florida Engineering Management Corporation 23b. PROJECT OWNER'S INFORMATION - POINT OF CONTACT NAME: John Rimes 23c. PROJECT OWNER'S INFORMATION - POINT OF CONTACT TELEPHONE NUMBER: 850.521.0500 24. BRIEF DESCRIPTION OF PROJECT AND RELEVANCE TO THIS CONTRACT (Include scope, size, and cost):Mr. Payne serves as one of the Board's senior case reviewers in Central Florida. Review cases involving potential law and rules violations in conjunction with efforts of the probable Cause panel. Work includes forensic engineering, case review, depositions, and if necessary, expert witness work. Mr. Payne has reviewed cases in the practices of site engineering, utility engineering, geotechnical engineering, permitting, drainage, transportation, and water resources. Professional Service work performed at a cost of $100 1hr. 25. FIRMS FROM SECTION INVOLVED WITH THIS PROJECT (1) FIRM NAME (2) FIRM LOCATION (City and State) (3) ROLE Joe Payne, Inc. Tampa, FL Prime Consultant NN. EXAMPLE PROJECT KEY NUMBER: 10 00. TITLE AND LOCATION (City and State): Spring Ridge CDD PP. YEAR COMPLETED - PROFESSIONAL SERVICES: 2012 QQ. YEAR COMPLETED - CONSTRUCTION (If applicable): 2012 23a. PROJECT OWNER'S INFORMATION - PROJECT OWNER: Spring Ridge CDD 23b. PROJECT OWNER'S INFORMATION - POINT OF CONTACT NAME: Sandra Manual 23c. PROJECT OWNER'S INFORMATION - POINT OF CONTACT TELEPHONE NUMBER: 8137311501 24. BRIEF DESCRIPTION OF PROJECT AND RELEVANCE TO THIS CONTRACT (Include scope, size, and cost): District Engineer for the Spring Ridge CDD 25. FIRMS FROM SECTION INVOLVED WITH THIS PROJECT (1) FIRM NAME (2) FIRM LOCATION (City and State) (3) ROLE Joe Payne, Inc. Tampa, FL Prime Consultant STANDARD FORM 330 (6/2004) PAGE 9 H. ADDITIONAL INFORMATION 29. PROVIDE ANY ADDITIONAL INFORMATION REQUESTED BY THE AGENCY. ATTACH ADDITIONAL SHEETS AS NEEDED: See enclosure 9. AUTHORIZED REPRESENTATIVE The foregoing is a statement of facts. 30. SIGNATURE OF AUTHORIZED REPRESENTATIVE: 31. DATE SIGNED: 32. NAME AND TITLE OF SIGNER: Joe Payne, PE President STANDARD FORM 330 (6/2004) PAGE 11 ARCHITECT - ENGINEER QUALIFICATIONS PART II - GENERAL QUALIFICATIONS (If a firm has branch offices, complete for each specific branch office seeking work.) 1. SOLICITATION NUMBER (If any): 2a. FIRM (OR BRANCH OFFICE) NAME: Joe Payne, Inc. 2b. FIRM (OR BRANCH OFFICE) STREET: 9629 Gretna Green Drive 2c. FIRM (OR BRANCH OFFICE) CITY: Tampa 2d. FIRM (OR BRANCH OFFICE) STATE: FL 2e. FIRM (OR BRANCH OFFICE) ZIP CODE: 33626 3. YEAR ESTABLISHED: 2007 4. DUNS NUMBER: 5a. OWNERSHIP - TYPE: 5b. OWNERSHIP - SMALL BUSINESS STATUS: 6a. POINT OF CONTACT NAME AND TITLE: Joe Payne 6b. POINT OF CONTACT TELEPHONE NUMBER: 8137311501 6c. POINT OF CONTACT E -MAIL ADDRESS: joepaynel973 @verizon.net 7. NAME OF FIRM (If block 2a is a branch office): 8a. FORMER FIRM NAME(S) (If any) 8b. YR. ESTABLISHED 8c. DUNS NUMBER STANDARD FORM 330 (6/2004) PAGE 12 9. EMPLOYEES BY DISCIPLINE a. Function Code b. Discipline c(1). No. of Employees c(2). No. of - Firm Employees - Branch 8 12 15 16 18 23 Firm 1 26 32 34 39 47 48 6061 62 Other Employee STANDARD FORM 330 (6/2004) PAGE 13 10. PROFILE OF FIRM'S EXPERIENCE AND ANNUAL AVERAGE REVENUE FOR LAST 5 YEARS a. Profile Code b. Experience c. Revenue Index C06 C15 D04 F05 16 Design Build projects in transportation engineering 1 L03 P06 R04 R11 Forensic Engineering for the Board of Engineers S13 T03 V01 W02 Construction and traffic control permitting W03 Z01 Florida Friendly Landscaping Guidelines CDD and HOA experience PROFESSIONAL SERVICES REVENUE INDEX NUMBER 1. Less than $100,000 6. $2 million to less than $5 million 2. $100,000 to less than $250,000 7. $5 million to less than $10 million 3. $250,000 to less than $500,00 8. $10 million to less than $25 million 4. $500,000 to less than $1 million 9. $25 million to less than $50 million 5. $1 million to less than $2 million 10. $50 million or greater 11. ANNUAL AVERAGE PROFESSIONAL SERVICES REVENUES OF FIRM FOR LAST 3 YEARS (Insert revenue index number shown above) 11 a. Federal Work:O 11 b. Non - Federal Work: $80k 11 c. Total Work: $80k 12a. SIGNATURE: 12b. DATE SIGNED: 12. AUTHORIZED REPRESENTATIVE. The foregoing is a statement of facts. STANDARD FORM 330 (6/2004) PAGE 14 List of Disciplines (Function Codes) Code Description Code Description 01 Acoustical Engineer 32 Hydraulic Engineer 02 Administrative 33 Hydrographic Surveyor 03 Aerial Photographer 34 Hydrologist 04 Aeronautical Engineer 35 Industrial Engineer 05 Archeologist 36 Industrial Hygienist 06 Architect 37 Interior Designer 07 Biologist 38 Land Surveyor 08 CADD Technician 39 Landscape Architect 09 Cartographer 40 Materials Engineer 10 Chemical Engineer 41 Materials Handling Engineer 11 Chemist 42 Mechanical Engineer 12 Civil Engineer 43 Mining Engineer 13 Communications Engineer 44 Oceanographer 14 Computer Programmer 45 Photo Interpreter 15 Construction Inspector 46 Photogrammetrist 16 Construction Manager 47 Planner: Urban /Regional 17 Corrosion Engineer 48 Project Manager 18 Cost Engineer /Estimator 49 Remote Sensing Specialist 19 Ecologist 50 Risk Assessor 20 Economist 51 Safety /Occupational Health Engineer 21 Electrical Engineer 52 Sanitary Engineer 22 Electronics Engineer 53 Scheduler 23 Environmental Engineer 54 Security Specialist 24 Environmental Scientist 55 Soils Engineer 25 Fire Protection Engineer 56 Specifications Writer 26 Forensic Engineer 57 Structural Engineer 27 Foundation /Geotechnical Engineer 58 Technician /Analyst 28 Geodetic Surveyor 59 Toxicologist 29 Geographic Information System Specialist 60 Transportation Engineer 30 Geologist 61 Value Engineer 31 Health Facility Planner 62 Water Resources Engineer STANDARD FORM 330 (6/2004) PAGE 6 OF INSTRUCTIONS List of Experience Categories (Profile Codes) Code Description Code Description A01 Acoustics, Noise Abatement D01 Dams (Concrete; Arch) A02 Aerial Photography; Airborne Data and Imagery D02 Dams (Earth; Rock); Dikes; Levees Collection and Analysis D03 Desalinization (Process and Facilities) A03 Agricultural Development; Grain Storage; D04 Design -Build - Preparation of Requests for Farm Mechanization Proposals A04 Air Pollution Control D05 Digital Elevation and Terrain Model Develop - A05 Airports; Navaids; Airport Lighting; ment Aircraft Fueling D06 Digital Orthophotography A06 Airports; Terminals and Hangars; Freight D07 Dining Halls; Clubs; Restaurants Handling D08 Dredging Studies and Design A07 Arctic Facilities A08 Animal Facilities E01 Ecological and Archeological A09 Anti - Terrorism /Force Protection Investigations A10 Asbestos Abatement E02 Educational Facilities; Classrooms All Auditoriums and Theaters E03 Electrical Studies and Design Al2 Automation; Controls; Instrumentation E04 Electronics E05 Elevators; Escalators; People- Movers B01 Barracks; Dormitories E06 Embassies and Chanceries B02 Bridges E07 Energy Conservation; New Energy Sources C01 Cartography E08 Engineering Economics CO2 Cemeteries (Planning and Relocation) E09 Environmental Impact Studies, CO3 Charting; Nautical and Aeronautical Assessments or Statements C04 Chemical Processing and Storage E10 Environmental and natural Resource C05 Child Care /Development Facilities Mapping C06 Churches; Chapels Ell Environmental Planning C07 Coastal Engineering E12 Environmental Remediation C08 Codes; Standards; Ordinances E13 Environmental Testing and Analysis C09 Cold Storage; Refrigeration and Fast Freeze F01 Fallout Shelters; Blast- Resistant Design C10 Commercial Building (Low Rise); F02 Field Houses; Gyms; Stadiums Shopping Centers F03 Fire Protection C11 Community Facilities F04 Fisheries; Fish Ladders C12 Communications Systems; TV; Microwave F05 Forensic Engineering C13 Computer Facilities; Computer Service F06 Forestry and Forest Products C14 Conservation and Resource Management G01 Garages; Vehicles Maintenance Facilities; C15 Construction Management Parking Decks C16 Construction Surveying G02 Gas Systems (Propane; Natural, Etc.) C17 Corrosion Control; Cathodic Protection G03 Geodetic Surveying: Ground and Air - Electrolysis borne C18 Cost Estimating; Cost Engineering and G04 Geographic Information System Analysis; Parametric Costing; Services: Development, Forecasting Analysis, and Data Collection C19 Cryogenic Facilities STANDARD FORM 330 (6/2004) PAGE 7 OF INSTRUCTIONS Code Description Code Description G05 Geospatial Data Conversion: Scanning, M08 Modular systems Design; Digitizing, Compilation, Pre - Fabricated Structures or Attributing, Scribing, Drafting Components G06 Graphic Design N01 Naval Architecture; Off -Shore H01 Harbors; Jetties; Piers, Ship Platforms Terminal Facilities NO2 Navigation Structures; Locks H02 Hazardous Materials Handling and NO3 Nuclear Facilities; Nuclear Shielding Storage H03 Hazardous, Toxic, Radioactive 001 Office Buildings; Industrial Parks Waste Remediation 002 Oceanographic Engineering H04 Heating; Ventilating; Air 003 Ordnance; Munitions; Special Conditioning Weapons H05 Health Systems Planning H06 High -rise; Air - Rights -Type Buildings P01 Petroleum Exploration; Refining H07 Highways; Streets; Airfield Paving; P02 Petroleum and Fuel (Storage and Parking Lots Distribution) H08 Historical Preservation P03 Photogrammetry H09 Hospital and Medical Facilities PO4 Pipelines (Cross- Country - Liquid and H10 Hotels; Motels Gas) H11 Housing (Residential, Multi- Family; P05 Planning (Community, Regional, Apartments; Condominiums) Areawide and State) H12 Hydraulics and Pneumatics P06 Planning (Site, Installation and Project) H13 Hydrographic Surveying P07 Plumbing and Piping Design P08 Prisons and Correctional Facilities 101 Industrial Buildings; Manufacturing P09 Product, Machine Equipment Design Plants P10 Pneumatic Structures, Air - Support 102 Industrial Processes; Quality Buildings Control P11 Postal Facilities 103 Industrial Waste Treatment P12 Power Generation, Transmission, 104 Intelligent Transportation Systems Distribution 105 Interior Design; Space Planning P13 Public Safety Facilities 106 Irrigation; Drainage R01 Radar; Sonar; Radio and Radar J01 Judicial and Courtroom Facilities Telescopes R02 Radio Frequency Systems and L01 Laboratories; Medical Research Shieldings Facilities R03 Railroad; Rapid Transit L02 Land Surveying R04 Recreation Facilities (Parks, L03 Landscape Architecture Marinas, Etc.) L04 Libraries; Museums; Galleries R05 Refrigeration Plants /Systems L05 Lighting (Interior, Display; Theater, R06 Rehabilitation (Buildings; Structures; Etc.) Facilities L06 Lighting (Exteriors; Streets; R07 Remote Sensing Memorials; Athletic Fields, Etc.) R08 Research Facilities R09 Resources Recovery; Recycling M01 Mapping Location /Addressing Systems R10 Risk Analysis M02 Materials Handling Systems; Rl l Rivers; Canals; Waterways; Flood Conveyors; Sorters Control M03 Metallurgy R12 Roofing M04 Microclimatology; Tropical Engineering S01 Safety Engineering; Accident M05 Military Design Standards Studies; OSHA Studies M06 Mining and Mineralogy S02 Security Systems; Intruder and Smoke M07 Missile Facilities (Silos; Fuels; Detection Transport) S03 Seismic Designs and Studies STANDARD FORM 330 (6/2004) PAGE 8 OF INSTRUCTIONS Code Description SO4 Sewage Collection, Treatment and Disposal S05 Soils and Geologic Studies; Foundations S06 Solar Energy Utilization S07 Solid Wastes; Incineration; Landfill S08 Special Environments; Clean Rooms, Etc. S09 Structural Design; Special Structures S10 Surveying; Platting; Mapping; Flood Plain Studies S11 Sustainable Design S12 Swimming Pools S13 Storm Water Handling and Facilities T01 Telephone Systems (Rural; .Mobile; Intercom, Etc.) T02 Testing and Inspection Services T03 Traffic and Transportation Engineering T04 Topographic Surveying and Mapping T05 Towers (Self - Supporting and Guyed Systems) T06 Tunnels and Subways U01 Unexploded Ordnance Remediation UO2 Urban renewals; Community Development UO3 Utilities (Gas and Steam) Vol Value Analysis; Life -Cycle Costing W01 Warehouse and Depots W02 Water Resources; Hydrology; Ground Water W03 Water Supply; Treatment and Distribution W04 Wind Tunnels; Research/Testing Facilities Design Z01 Zoning; Land Use Studies STANDARD FORM 330 (6/2004) PAGE 1 OP ID: 4P .A4C°R° CERTIFICATE OF LIABILITY INSURANCE DAT 02123 DIYYYY) 02/23/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such -endorsement(s). PRODUCER 716 - 849 -8618 Lawley Service, Inc. 716 - 849 -8291 361 Delaware Avenue Buffalo, NY 14202 LSI / Kirk Lawley CONTACT NAME: PHONE Ext: L C' No: E -MAIL ADDRESS: CUSTOMER 1t.J0EP -01 INSURER(S) AFFORDING COVERAGE NAIC tt INSURED Joe Payne Inc 9629 Gretna Green Drive Tampa, FL 33626 INSURER A: Darwin Select Ins CO 1 INSURER B: INSURER C $ INSURER D: $ INSURER E: $ INSURER F: $ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR .LM TYPE OF INSURANCE ADDL SUBR POLICYNUMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY X1 CLAIMS -MADE F—I OCCUR 1 1 EACH OCCURRENCE $ D E (RENTED PREMI SES S Ea occurrence ) $ MED EXP (Anyone person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOG PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WCSTATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ A Professional 03065757 04/18/12 04118113 E Claim 500,00 Aggregate 500,00 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Inspector /Reinspector (Insurance) MUEL -01 Mueller Services Attn: Mike Beattie 63 Main Street Tonawanda, NY 14150 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD OP ID: SUHE CERTIFICATE OF LIABILITY INSURANCE 1 DAT04 /24//YYYY) 04/24112 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 716 - 849 -8618 Lawley Service, Inc. 716 - 849 -8291 361 Delaware Avenue Buffalo, NY 14202 CONTACT NAME: PHONE FAX t 'C' No E -MAIL ADDRESS: PRODUCER JOEP -01 CUSTOMER ID INSURER(S) AFFORDING COVERAGE NAIC # INSURED Joe Payne 9629 Gretna Green Drive Tampa, FL 33626 INSURER A: Travelers Property Casualty Co 001 INSURER B: 04/18/13 INSURER C $ 1,000,00 INSURER D: $ 500,00 INSURER E: $ 5,00 INSURFR F' $ 1,000,00 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS- INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1XI OCCUR 6608689X770 04/18/12 04/18/13 EACH OCCURRENCE $ 1,000,00 'REMISES Ea occurrence $ 500,00 MED EXP (Anyone person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER POLICY D PRO LOC PRODUCTS - COMP /OP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 6608689X770 04/18/12 04/18/13 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ UMBRELLA LIAB EXCESS LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Mueller Services 63 Main Street Tonawnada, NY 14150 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD Joseph Payne PE, MBA Curriculum Vitae Credentials Professional Engineer Florida License #55751 Delaware License #15439 Georgia License #33995 Home 9629 Gretna Green Drive Tampa, FL 33626 Phone Cell: 813.731.1501 Internet E- mail:joepa ne1973 verzion.net Education Masters of Business Administration University of South Florida, Tampa, Florida Bachelor of Science in Civil Engineering Drexel University, Philadelphia, Pennsylvania Graduate studies (Geotechnical Engineering- 1998) New Jersey Institute of Technology, Newark, New Jersey Continuing Education: 1802 Wind Hazard Mitigation Training — April 2011 FILE/ FDOT Bridge Hydraulics Course — July 2005 NHI Stream Stability Course — April 2005 NRCS SHWT Determination Course — 2003 Advanced MOT Work Zone — 2005 Amtrak Contractor Safety Training - 1999 OSHA 40 Hour Hazwoper —1997 Professional Associations Florida Board of Professional Engineers, Case Reviewer /Forensic Engineer Hillsborough County Plumbing Board of Adjustment, Appeals and Examiners (Engineer) Hillsborough County Land Use Appeals Board (2009 -2010) Westchase Association Board of Directors (2007 -2009) Areas of Concentration Transportation Project Management Public Sector Market Development/ Project Management Environmental Resource Permitting Pond Siting Reports D.O.T. Drainage Connection Permits Utility Design Site Engineering Water Resources Public Meetings Specialized Expertise FDOT and FHWA Design Policy Financial Management and Capital Budgeting State of Florida — Drainage Design Regulations State of Florida — Environmental Resource Permitting FDOT Drainage Connection Permits Professional Experience Lighthouse Engineering, Tampa, FL Current Partner Partner in a civil /transportation engineering and project management firm. Senior Engineer and Project Manager for consulting services on 30 ARRA Design Build stimulus projects. Project Director for civil /site contracts for drainage improvements, construction management, and general engineering consultation. Project Engineer for a variety of sidewalk, pedestrian improvement, and milling and resurfacing projects. Provide General Engineering Services for Florida Board of Engineers, Community Development Districts, Homeowner's Association, and Property Management Companies. Completed consulting work on the I -595 P3 project in Ft. Lauderdale. Complete Traffic Control, Interdisciplinary Reviews, and Drainage Constructability reviews for AECOM. Attended meetings with FDOT, Turnpike, and DUSA. Complete Wind Hazard Mitigation Inspections for companies that serve Citizen's Insurance. The region for this work includes South Florida and West Florida. Greenhorne & O'Mara, Clearwater, FL 4108 to 8109 Project Director Instability in Office Manager role at TYLIN led me to approach Greenhorne & O'mara with ownership opportunities. Worked as a Project Manager and Technical Director for a nationally ranked general civil and transportation consulting firm located in Tampa Bay. Project Manager for professional service contracts in the one million to three million dollar range. Won the Hillsborough County TTF -2a contract at Broadway and Falkenburg which was the first Hillsborough County public works contract at the office. Closed FDOT Design -Build contracts for work in FDOT 2. Brought in construction permitting and dewatering contracts for work in Collier County. Set -up teaming agreements for contracts for FDOT Design -Build projects and shortlisted on D4 work. Project Director for Hillsborough County Public Works contracts. Assists the Office Manager in reaching $2.5 million dollar sales goal for public sector clients, primarily City, County, and alternate bid FDOT projects. Corporate restructuring led me to pursue a new home to continue my career. References: Brad Foran (Frmr. Office Manager) 727.365.3616 TYLin, Inc., Tampa, FL 7105 to 4108 Associate/ Project Manager Project Manager and Technical Lead Drainage Engineer for the Tampa Business Unit of an international structural and transportation engineering firm. Won the Hillsborough County General Civil Service contract for the office. Brought in several FDOT 1 DEMO assignments under prior contracts. Shortlisted on several Districtwide Drainage contracts and invited by FDOT 1 to present for them at the 2007 FICE conference. Project Manager for DOT reconstruction and County intersection improvement projects. Senior Drainage Engineer on multi -lane widening, new construction, and reconstruction highway projects. Engineer of Record for engineering work associated with Water Management District permitting of stormwater management facilities. Responsible for conformance to the FDOT Drainage Design Policy and the State of Florida regulatory standards and statutes. Senior Quality Control and Quality Assurance official for the Tampa Business Unit's Roadway Drainage Design activities. Represent clients at formal and informal Public Meetings. Reference: John Darling (Frmr. Office Manager) 813.205.4623 American Consulting Engineers of Fla, Inc., Land O' Lakes, FL 4104 to 7105 Senior Drainage Engineer/ Project Manager For family reasons, worked for a company closer to my Tampa home. Statewide Drainage Engineer for a national transportation engineering firm. Senior Drainage Engineer on multi -lane widening, new construction, and reconstruction highway projects. Engineer of Record for work associated with Water Management Districts. Project Manager for City and County municipal projects with construction costs under one million dollars. Represented clients at formal and informal Public Meetings. Pursued and won several CDD contracts. Considered ownership opportunities until TYLIN approached me with a more affordable stock ownership plan. Reference: John Kilgore (Office Manager) 813.927.0061 Coastal Engineering, Inc., Brooksville, FL 3103 to 4104 Assistant Director Assistant Director for a privately owned site and civil engineering firm. Won and closed approximately an average of $25 -50k of contracts per week with private clients during a very "hot" development market. Directed a 15 member technical staff completing residential and commercial construction plans for private developers. Engineer of Record for engineering work associated with Water Management District permitting, DOT Drainage Connection Permits, DOT Driveway Connection Permits, DOT Utility Permits, DOT R/W Permits, and DOT Access Management Connection Permits. Represented clients at Public Meetings. Reference: Tom Mountain (Office Manager) 352. 796 9423 Florida Department of Transportation, Tampa, 9101 to 3103 Assistant District Drainage Engineer Received a request from FDOT to work for their Tampa office. Worked as a Lead Permit Official for D.O.T. Drainage Connection Permit Reviews. Senior Engineer for engineering services completed by the Department for public services. Represented the State at formal and informal Public Meetings. Engineer of Record for engineering work associated with Water Management District permitting of stormwater management facilities. Reference: Dwayne Kile (Frmr. Office Manager), 727.572.7111 Dames & Moore/ URS, Inc., Tampa, 7/00 to 9101 Senior Drainage Engineer Received an opportunity for a full time position at Dames & Moore. Engineer of Record for Roadway Drainage Engineering services on public transportation projects. Engineer of Record for engineering work associated with Water Management District permitting of stormwater management facilities. Reference: Matt Fabrizio (Frmr. Project Manager), 727.423.0202 System One - 6199 to 7/00 Contract position — Drainage Engineer Relocated to Florida for a contract position for System One working at Bowyer- Singleton in Orlando, FL. Designer and Engineer for roadway drainage consultation on public transportation projects. Designer and coordinator for engineering work associated with Water Management District permitting of stormwater management facilities. Reference: Kevin Knudsen (Office Manager), Rob Garrigues (Frmr Supervisor) 813.289.5550 Frederic R.- Barris, Inc., Philadelphia, PA 8198 to 6199 Civil Designer Relocated back to Philadelphia to work for a major transportation company. Civil and Transportation Designer for a national-transportation and public infrastructure engineering firm. Stormwater Management Design on road widening projects. Reference: Timothy Gunner (Former Department Manager) McNally Engineering. Oakland, NJ 4/97 to 8198 Project Manager Brown Caldwell was in the process of acquiring Eckenfelder. Pursued a management opportunity with McNally Engineering for job stability. Managed the design of small site and civil engineering service contracts. Coordinated environmental permits for these activities. Reference: Mike McNally, Owner Eckenfelder /Brown Caldwell, Inc., Ramsey, NJ 8195 to 4/97 Project Designer Civil and Environmental Designer for a waste management division of a national environmental engineering firm. Completed a six month construction quality assurance assignment for a groundwater pump, treat, and reinjection system. Reference: Mike Monteleone (Former Office Manager)