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Home My WebLink AboutR-03-0194J-03-147 2/18/03 RESOLUTION NO. 03— 194 A RESOLUTION OF THE MIAMI CITY COMMISSION ACCEPTING THE BIDS OF AERO PRODUCTS CORP. D/B/A AMERICAN LAFRANCE MEDIC MASTER, EMERGENCY MEDICAL PRODUCTS, INC., PHARMED CORP, SUNBELT MEDICAL SUPPLY, INC. AND TRI-ANIM HEALTH SERVICES, INC. FOR THE PROVISION OF INTRAVENOUS (IV) FLUIDS AND ADMINISTRATION SETS FOR THE DEPARTMENT OF FIRE -RESCUE, ON AN ITEM -BY -ITEM, AS -NEEDED CONTRACT BASIS, FOR TWO YEARS WITH THE OPTION TO RENEW FOR AN ADDITIONAL ONE-YEAR PERIOD, AT AN ESTIMATED ANNUAL AMOUNT OF $50,800, FOR A TOTAL CONTRACT AMOUNT NOT TO EXCEED $152,400; ALLOCATING FUNDS FROM THE BUDGET OF THE DEPARTMENT OF FIRE -RESCUE, ACCOUNT CODE NO. 001000.280601.6.714. BE IT RESOLVED BY THE COMMISSION OF THE CITY OF MIAMI, FLORIDA: Section 1. The bids of Aero Products Corp. d/b/a American Lafrance Medic Master, Emergency Medical Products, Inc., Pharmed Corp, Sunbelt Medical Supply, Inc. and Tri-Anim Health Services, Inc. for the provision of intravenous (IV) fluids and administration sets, for the Department of Fire -Rescue are accepted, on an item -by -item, as -needed contract basis, for two years with the option to renew for an additional one-year period, at an estimated annual amount of $50,800, for a total contract RBWMMD REPEALED AMP-11DRD BY: - CITY CODWSSION MEETING OF, FES ?. 7 ?_P03 Resolution No. 03- 194 amount not to exceed $152,400, with funds allocated from the budget of the Department of Fire -Rescue Account Code No. 001000.280601.6.714. Section 2. This Resolution shall become effective immediately upon its adoption and signature of the Mayor.11 PASSED AND ADOPTED this 27th day of February , 2003. el MANUEL A. DIAZ, OR ATTEST: �.A. PRISCILLA A. THOMPSON CITY CLERK APPROVED_X_S0'TOA,/RM AND CRRRECTNESS 6 39:tr:AS:BSS 1� If the Mayor does not sign this Resolution, it shall become effective at the end of ten calendar days from the date it was passed and adopted. If the Mayor vetoes this Resolution, it shall become effective immediately upon override of the veto by the City Commission. Page 2 of 2 CITY OF MIAMI, FLORIDA INTER -OFFICE MEMORANDUM CA -8 TO: Honorable Md DATE : FILE : FM-012.doc mbers o the City Co is ion SUBJECT: Accepting bids for IV Fluids and Administration Sets; �� Dept. of Fire -Rescue FROM: Joe Arriola REFERENCES: Bid No. 02-03-019 �ythief Administrator/City Manager 4 J ENCLOSURES: RECOMMENDATION It is respectfully recommended that the City Commission adopt the attached Resolution accepting the bids of Aero Products Corp d/b/a American LaFrance Medic Master, 3705 St. Johns Parkway, Sanford, FL (Non-Minority/Non-Local vendor), Emergency Medical Products, Inc., 1711 Paramount Court, Waukesha, WI (Non-Minority/Non-Local vendor), Pharmed Group, 3075 N.W. 107 Avenue, Miami, FL (Hispanic/Miami-Dade vendor), Sunbelt Medical Supply, Inc., 20 Capital Drive, Hilton Head, SC (Non-Minority/Non-Local vendor), and Tri-Anim Health Services, Inc., 13170 Telfair Avenue, Sylmar, CA (Non-Minority/Non-Local vendor) for the provision of intravenous (IV) fluids and administration sets, on an as needed contract basis, for two years with the option to extend for one additional one-year period, for the Department of Fire -Rescue, in an estimated annual amount of $50,800, for a total contract award not to exceed $152,400. Funds for this purchase will be allocated from the Department of Fire -Rescue Account Code No. 001000.280601.6.714, subject to availability of funds. BACKGROUND The Department of Fire -Rescue has a need to acquire intravenous (IV) fluids and administration sets on an as needed contract basis. This requested item is essential and is used by the Fire - Rescue emergency personnel to administer medications to patient suffering from medical and trauma related illness or injuries. Intravenous (IV) fluids are used to re -hydrate patients and the administration sets are the tubing system that deliver the medications. For the safety and well being of our citizens and visitors of the City of Miami, it is imperative that the Department of Fire -Rescue is fully eauinned by assuring that a reliable source for intravenous (IV) fluids and administration sets be secured. The Department of Fire -Rescue has analyzed the bids received pursuant to Bid No. 02-03-019. Bids submitted by Aero Products Corp d/b/a American LaFrance Medic Master, Emergency Medical Products, Inc., Pharmed Group, Sunbelt Medical Supply, Inc., and Tri-Anim Health Services, Inc. were deemed as the lowest responsible and responsive bids meeting specifications and are therefore recommended for award. Fiscal Impact: None — Budgeted Item JA/ / LK/TF/jam FM.012.doc 93- 194 1. Department Fire -Rescue Budgetary Impact Analysis Division: Emergency Response Division 2. Agenda Item # (if available) 3. Title and brief description of legislation or attach ordinance/resolution: Resolution accepting the bids of Aero Products d/b/a American LaFrance Medic Master, Emergency Medical Products, Inc., Pharmed Group, Sunbelt Medical Supply, Inc., and Tri-Anim Health Services, Inc., for the acquisition of IV fluids and administration sets, on an as needed contract basis, for two years with OTR for one additional one-year period, for the Devartment of Fire -Rescue, in an estimated annual amount of $50,800, for a total contract award not to exceed $152,400. Is this item related to revenue? NO: X YES ! (If yes, skip to item #7.) 5. Are there sufficient funds in Line Item? YES: X Index Code 280601 Minor Obj. Code 714 Amount: $50,800 NO: _ Complete the following questions: 0 Source of funds: Amount budgeted in the Line Item $ Balance in Line Item $ Amount needed in the Line Item $ Sufficient funds will be transferred from the following line items: ACTION ACCOUNT NUMBER ACCOUNT NAME TOTAL Index/Minor Object/Project No. Verifie y: Transfer done by: From $ From $ From $ To $ 7. Any additional comments? 8. Approved by: Department Director/Designe Date FOR DEP MENT OF MANAGEMENT AND BUDGET USE ONLY Verified by: Verifie y: Transfer done by: cam. C/L� Budget Analyst Budget Analyst Chief of Strategic Planning, Budgeting, and Performance Director/Designee Date Date — 1 ' Date 03_ 194 AWARD RECOMMENDATION AND APPROVAL FORM Date: January 13, 2003 Department/Division: FIRE -RESCUE Department Contact Name/Phone Number:JULIA MARTIN/ 305-416-1672 Bid/Contract Number: 02-03-019 Sr. Buyer: Terry Byrnes, CPPB Summary/Description of Purchase: IV FLUIDS & ADMINISTRATION SETS Justification for Award/Contract: Intravenous (IV) fluids and administration sets are necessary to be used by the Fie -Rescue emergency personnel to administer medications to patient suffering from medical and trauma related illnesses or injuries This requested item is used to re -hydrate patients and the administration sets are the tubing system that deliver the medications. `Type of Contract: Method of Purchase: ❑Single Purchase ®Formal Bid (include bid tabulation) ❑Short -Term Contract ❑Competitive Negotiated Purchase (include documentation) ❑Lease ❑Other Governmental Contracts (include documentation) ®Term Contract Contract Period: TWO YEARS OTR: One Additional One -Year Period (if applicable) Recommended Vendor(s): MWBE/Location Status: Award/Contract Value: See Attached Award Sheet $50,800 Year Total Value of Award/Contract (including Award Recommended By: -,I"' -'' /, Source(s) of Funds: Account Code(s):_ with potential OTR): $152,400 Department Director/Designee Signature Department of Fire -Rescue General Funds 001000.280601.6.714 Funding Approva - Certified By: DMB Director/Designee Chief Procurement Officer/Designee AWARDRECOMANDAPPROVALFORM Date 03- 194 AWARD SHEET IV FLUIDS ADMINISTRATION SETS FOR FIRE/RESCUE 02-03-019 IMm Descriiotion 1 Solution Administration Set with injection site, flashball device regular drip and 70" long, 10 drops approximately 1m1. Baxter No. 2C5417, 48/CS OR APPROVED EQUAL 2 Solution Administration Set with injection site, and "Y" medication site, 70" long, mini drip, 60 drops approximately Iml. Baxter No. 2C5418, 48/CS OR APPROVED EQUAL 3 Lactated Ringers injection USP, 1000 ml Baxter No. 2B2324, 12/CS OR APPROVED EQUAL 4 D5W Dextrose Injection USP, (5% Dextrose in Water) 250 ml. Baxter No. 2B0062Q, 36/CS OR APPROVED EQUAL 5 0.4% Lidocaine Hydrochloride and 5% Dextrose Injection (4mg/ml), 250 ml. Baxter No. 2B0972, 24/CS OR APPROVED EQUAL 6 Lactated Ringers Injection, UPS 500 ml per bag, 24 bags per case Baxter No. 2B2323Q OR APPROVED EQUAL 7 Furosemide Injection, USP; 40mg (10 mg/ml) 4ml prefilled syringe with male luer lock adapter MFG. Abbott Lab., NDC # 0074-9631-04 OR APPROVED 8 2% Lidocaine HCI Injection., USP (100 mg/5 ml) 5 ml prefilled syringe with male luer lock adapter and 20 gauge protected needle MFG Abbott Lab., NDC # 0074-4903-34 OR APPROVED EQUAL 9 0.90% Sodium Chloride Inhalation Solution USP 5 ml unit -dose vial, 100 per box; MFG. Dey; NDC # 49502-830-05 OR APPROVED EQUAL 10 1 ml Diphenhydramine HCI Injection, USP; 50 mg min -i jet prefilled syringe MFG. by IMS; NDC # 0548-1390-00 OR APPROVED EQUAL 11 10% Calcium Chloride injection, usp 1 gram (100 mg/ml); 10 ml unit of use syringe with male Luer Lock Adapter and 20 -gauge protected needle; mfg. by Abbott Lab. NDC No. 0074-4928-33 OR APPROVED EQUAL Prepared by: Terry Bymes, CPPB 01/17/03 EsLAnnual Unit Quantity U!M Price Vendor 300 Case $ 38.65 AERO PRODUCTS 200 Case $ 52.32 TRI-ANIM HEALTH SERVICE (BAXTER 119-205418) 1000 Case $ 12.14 PHARMED GROUP Case $ 26.20 PHARMED GROUP 30 Case $ 72.93 TRI-ANIM HEALTH SERVICE (BAXTER118-2B0972) 25 Case $ 20.64 EMERGENCY MEDICAL PRODUCTS 2400 Ea $ 1.56 SUNBELT MEDICAL SUPPLIES 2400 Ea $ 1.33 SUNBELT MEDICAL SUPPLIES Ea $ 0.085 PHARMED GROUP Ea $ 1.31 EMERGENCY MEDICAL PRODUCTS 600 Ea $ 1.33 SUNBELT MEDICAL SUPPLIES - 194 1 2 3 4 5 6 7 8 9 TABULATION OF BIDS IV FLUIDS ADMINISTRATION SETS FOR FIRE/RESCUE 02-03-019 I VWR International Alliance Medical Moore Medical Corp. a624 RL C .American LaFronce Medic Master Lohman, MO 66063 7705 SLJohns Pkwir5anford, FL32771 NIA Non -Local EstAnnual Item Description Quantity Unit Ulm Eft Total Solution Administration Set with injection site, 300 Case $ 43.36 s 17,0011.00 Bashball device regular drip and 70" long, 16766 S 65.81 5 19,143.00 10 drops approximately Iml. $ 108.00 $ 72,400.00 11,59s.eo Baxter No. 2C5417, 48/CS OR APPROVED EQUAL Solution Administration Set with injection site, 200 Case S 54.91 $ 10,982.00 and "Y" medication site, 70" long, mini drip, 1666B S 122.40 $ 24,460.00 60 drops approximately Iml. Baxter No. 2C5418, 48/CS OR APPROVED EQUAI. S 14.55 s 14,550.00 NO BID Lactated Ringers injection USP, 1000 ml 1000 Case $ 22.75 $ 22,750.00 Baxter No. 282324, 12/CS OR APPROVED EQUAL 0856A S 52.92 $ 13,230.00 DS W Dextrose Injection USP, (5% Dextrose 250 Case $ 31.97 $ 7,992.50 in Water) 250 ml. 0936A Baxter No 2130062Q, 36/CS OR APPROVED EQUAL 0.4% Lidocaine Hydrochloride and 5% 30 Case S 97.65 $ 2,929." Dextrose Injection (4mg/ml), 250 ml. 7455A Baxter No. 2B0972, 24/CS OR APPROVED EQUAL Lactated Ringers Injection, UPS 25 Case $ 37.50 $ 937.30 500 ml per bag, 24 bags per case 2641A Baxter No. 2B2323Q OR APPROVED EQUAI. Furosemide Injection, USP; 40mg (10 mg/ml) 2400 Ea S 2.61 $ 6,264.00 4ml prefilled syringe with male lucr luck adapter 7039 MFG. Abbott Lab., NUC 6 0074-9631-04 OR APPROVED EQUAL 2% Lidocaine HCl Injection., USP (100 mg/5 ml) 2400 Ea $ 2.30 $ 5,520.00 5 ml prefilled syringe with male luer lock adapter and 20 gauge protected needle 4968 MFG Abbott Lab., NDC # 0074.4903-34 OR APPROVED EQUAL 0.96/o Sodium Chloride Inhalation Solution USP 2400 Ea NO BID #VALUE[ 5 ml unit -dose vial, 100 per box; MFG. Dey; NDC b 49502-830-05 OR APPROVED EQUAL I VWR International Aero Products Corp DaYA Moore Medical Corp. 1050 Satellite Blvd. NW .American LaFronce Medic Master 706 J. Downey or. Suwannee, UA 70024 7705 SLJohns Pkwir5anford, FL32771 New Britain, CT 06050 NIA INon-Local I WA/Non-Local I WA/Non-Local Unit Total Unit Total Unit Total rice Price Price S 65.81 5 19,143.00 $ 108.00 $ 72,400.00 11,59s.eo 68000-748 VWR Brand $ 68.31 $ 13,662.00 S 53.30 $ 10,660.00 S 122.40 $ 24,460.00 68000-750 S 15.87 s 1s,e7o.00 S 14.55 s 14,550.00 NO BID 68000-420 S 58.65 s 14,662.50 68000 S 29.60 $ 7,400." S 52.92 $ 13,230.00 -132 S 106.10 $ 7,133.00 $ 68000-268 S 28.65 $ 716.25 $ 68000-418 NO BID I S NO BID NO BID E 78.50 $ 2,355.00 I NO BID 26.00 s 660.00 1 $ 41.28 $ 1,032.00 3.18 $ 7,632.00 1 NO BID 3.35 s 0,040.00 1 NO BID $ 0.1305 $ 313.20 [ NO BID Biomedical International 4696 SW 74 Ct Mlaml, FL 77166 HispanW Dada Unit Loyl Price EXEL S 44.00 s 13,200.00 Cs of 50 ea. EXEL S 54.00 6 101"0.00 Cs of 60 ea. S 25.00 s 25,000.00 S 92.00 6 23,000.00 NO BID S 38.00 $ 950.00 S 250 s 4,000.00 S 2.50 $ 6,000.00 $ 0.18 $ 432.00 Prepared by Terry Byrnes, Approvals 1'- 01/13/03 Department Director/Designee TABULATION OF BIDS IV FLUIDS ADMINISTRATION SETS FOR FIRE/RESCUE 02-03-019 10 1 ml Diphenhydramine HCI Injection, USP; 50 mg 2400 Ea $ 1.58 $ 3,792.00 NO BID $ 2.73 $ 6,662.00 $ 2.90 $ 6,960.00 $ 1.50 f 7,600.06 min -i jet prefilled syringe 625 MFG. by IMS; NDC k 0548-1390-00 OR APPROVED EQUA1, I 1 10% Calcium Chloride injection, usp 600 Ea S 2.60 f t,seo.00 NO BID $ 3.74 f 2,2".0o NO BID S 3.00 f 1,600.00 I gram (100 mg/ml); 10 ml unit of use syringe 5323 Aneyr Syringe needle with male Luer I.ock Adapter and 20 -gauge free lust look Bp protected needle; mfg. by Abbott Lab. NDC No. 0074.4928-33 OR APPROVED EQUAL pprov" / Prepared by Terry Byrnes, A 01/13/03 Department Director/Designee as 1 2 3 4 5 6 7 8 9 Item Description Est.Annual Quantity Ulm Solution Administration Set with injection site, 300 Case Bashball device regular drip and 70" long, Ballentine, SC 29002 10 drops approximately Intl. NIA INon-Local Baxter No. 2C5417.48/CS OR APPROVED EQUAL Unit Tots Solution Administration Set with injection site, 200 Case and "Y" medication site, 70" long, mini drip, S 72.00 t 21,600.00 60 drops approximately I ml. Baxter No 2('5418, 48/CS OR APPROVED EQUAL t Lactated congers injection USP, 1000 ml 1000 Case Baxter No 281324, 12.rCS OR APPROVED EQUAL $ D5W Dextrose Injection IISP, (5% Dextrose 250 Case in Waten 250 ml Baxter Na 2B0062Q, 36/CS OR APPROVED VOL AL Cs of 50 ea. 0.4% L idccaine Hydrochloride and 5"6 30 Case Dextms: Injection (4mg/ml). 250 ml. Baxtcr No. 2B0972, 24/CS OR APPROVED EQUAL Lactated Ringers Injection, UPS 25 Case 500 ml per bag, 24 bags per case Baxter No. 2B2323Q OR APPROVED EQUAL Furosemide Injection, USP; 40mg (10 mg/ml) 2400 Ea 4ml preftlled syringe with male luer lock adapter S 14.79 MFG. Abbott Lab., NDC N 0074-9631-04 OR APPROVED EQUAL 2% Lidocaine HCl Injection., USP (100 mg/5 ml) 2400 Ea 5 ml prefilled syringe with male luer lock adapter and 20 gauge protected needle MFG Abbott Lab., NDC N 0074.4903-34 OR APPROVED F.QUAL 09% Sodium Chloride Inhalation Solution USP 2400 Ea 5 ml unit -dose vial, 100 per box; MFG. Dey; NDC N 49502-830.05 OR APPROVED EQUAL Prepared by Terry Byrnes, 01/13/03 TABULATION OF BIDS IV FLUIDS ADMINISTRATION SETS FOR FIRE/RESCUE 02-03-019 Tri-Anim Health Services Inc. MATRX Medical Inc. 13170 Tenair Av. 200 Gates Rd. Sylmar, CA 91342 Ballentine, SC 29002 NIA Non -Local NIA INon-Local Unit Total Unit Tots Price Price S 40.70 f 12,210.00 S 72.00 t 21,600.00 Baxter 118-2C5417 118-X5418 10,464.00 II $ 124.80 9 24,960.00 S 12.70 s 12,700.00 Baxter 118-28234 S 29.40 f 7,35000 Baxter I IB -0062Q Baxter t 2,187.90 Baxter 118-280972 $ 28.23 t 709.751 Baxter 118-2B2323Q S 2.24 t 5,376.00 ABBOTT 043-9631-04 NO BID NO BID S 14.64 s 14,640.00 $ 4248 s 1o,sm.00 I NO BID PHARMED GROUP Sunbelt Medical Supply Inc Emergency Medical Products Inc 3075 NW 107 Av 20 Capital Dr. 11711 Paramount Ct Miami, FL 33172 Hilton Head, SC 29926 Waukesha, 9N 63166 Hispanic/ Dads WA/Non-Local NIA/Non-Local Unit Total Unit im Unit Total Price Price Price Anslno $ 38.70 f 11,610.00 $ 71.00 $ 21,300.00 S 41.76 s 1262600 .' a Is 31.92 t 798.00 1 $ NO BID 1 $ NO BID Is NO BID Ce of 50 ea. Anginal 52.86 t 10,572.00 $ 77.00 9 19,400.00 $ 42.72 s 6,544.00 Cs of 50 ea. Abbott 12.14 It 12,140.00 S 14.79 4 14jilo.0o S 12.24 6 12,240.00 Abbott 5 td 60. 6,600 $ 26.00 5 6.500.00 S 26.64 s 6,660.00 - .73ea. Csof24 @ $1.08 ea. Abbott 78.86 $ 2,355.80 S 110.00 It 3.300.00 S 89.28 s 2,676.40 Abbott 21.35 t $33.76 $ 32.00 t 600.00 LS 20.64 t 41s.0o Abbott 2.60 t 6,240.00 S 1.56 t 3,7".00 S 1.85 it 4,440.00 c Abbott 2.04 t 4,696.00 $ 1.33 t 3,192.00 $ 1.34 t 3,216.00 - Day IMS 204.00 S 0.0900 t 214.00 $ 0.1250 t 300.00 0548.2190-00 Approval: Department Director/Designee 10 1 ml Diphenhydramine HCI Injection, USP; 50 mg 2400 min-i-jel prefillcd syringe MFG. by IMS; NDC 4 0548-1390.00 OR APPROVED EQUAI. I 1 10% Calcium Chloride injection, usp 600 1 gram ((00 mg/ml); 10 ml unit of use syringe with mal; Luer Lock Adapter and 20 -gauge protected needle; mlg. by Abbott Lab. NDC No. 0074-492833 OR APPROVED EQUAI. Prepared by Terry Byrnes, 01/13/03 TABULATION OF BIDS IV FLUIDS ADMINISTRATION SETS FOR FIRE/RESCUE 02-03-019 Ea $ 1.64 $ 3,939.00 386-1390-OOEA Ea $ 1.70 s 1,020.00 IMS386-2004-00 IMS NO BID $ 1.86 $ 4,464.00 $ 1.46 s 3,604.00 $ 1.31 $ 3.1".00 A o IMS NO BID $ 3.80 $ 2,260.00 $ 1.33 $ r9e.00 $ 1.34 $ 604.00 0548-2004-00 Approval Department Director/Designee 12ITY OF MIAMI— OF THE CITY CLERK BLD SECURITY LIS& NOMT11TISTIZAT10N SETS IV 1.11LUIDS BID ITEM: BID NO: :j 02-03-019 j!i DATE BID(S) OPENED:- - WEUIESPhy, jANUARY 8, 2003 TIME 2:00 FM dpi TOTAL BID AMOUNT BID BOND (ER) CASHIER'S CHECK BIOMEDICAL INTERWIONL. OMP. Wi wan ir- SUN BELT MEEIML/a:WZG- :C -SOURCE /Nonbc& PHAR-M PHA MED GKW (PMG) bA MTRX MEDICAL, INQ- TRI-ANIM HEALTH SERVICE, IW- PI/ a /tiontaw L AM PMU= MP1Pr,:,/AME]:"ICM LA MWE VWIC MMTER w1h LAb�I- � VW INTERNATIONAL 4,*Jwcw40e4'— ALLIANCE MEDICAL, INC. VMPE MEDICAL CORP . . (0t -E COPY) #1A 7WWWO-141, EWYaENCY MEDICAL PMDE-CM, UC -Pi 1A, /rcnLW34(d- No BID: DOWNrCM MEDICAL EXVIR'� + fier 4"S bo no0 "Offers from the TIMclors Us ted herein a's am eel BM received bnely :: CLS Of 020 abO110 OPOfting O&W can, tw*medll 'm mmo-me to tho me hereby reJected as late:f =4 Ume 0 AU 7- .- p -r, tto-4XA7,1 A;?4F�W64 received rerson receiApg bid(s) PURCHAS G DEPART_ an (City fit) Dep* clerk envelops an behalf of (Dati) 11 03- 194 FORM 813 MEMORANDUM OF VOTING CONFLICT FOR COUNTY, MUNICIPAL, AND OTHER LOCAL PUBLIC OFFICERS LAST NAME—FIRST NAME—MIDDLE NAME 5')q1)eNr_ -z� oe LQ . NAME OF BOARD, COUNCIL, COMMISSION, AUTHORITY, OR COMMITTEE t? iT aFP AM co tit/ ss/ ok) MAILING ADDRESS 3 5"o o PAA) 4► e.12 7 � A e) IS X21 v e— ��'JJCITY THE BOARD, dOUNCIL, COMMISSION, AUTHORITY OR COMMITTEE ON WHICH I SERVE IS A UNIT OF: CITY`, ` COUNTY L3 COUNTY L) OTHER LOCAL AGENCY NAME OF POLITICAL SUBDIVISION: DATE ON WHICH VOTE OCCURRED FF 6 0 TZ Q00 MY POSITION IS: ELECTIVE ❑ APPOINTIVE WHO MUST FILE FORM 813 This form is for use by any person serving at the county, city, or other local level of government on an appointed or elected board, council, commission, authority, or committee. It applies equally to members of advisory and non -advisory bodies who are presented with a voting conflict of interest under Section 112.3143, Florida Statutes. Your responsibilities under the law when faced with voting on a measure in which you have a conflict of interest will vary greatly depending on whether you hold an elective or appointive position. For this reason, please pay close attention to the instructions on this form before completing the reverse side and filing the form. INSTRUCTIONS FOR COMPLIANCE WITH SECTION 112.3143, FLORIDA STATUTES A person holding elective or appointive county, municipal, or other local public office MUST ABSTAIN from voting on a measure which inures to his or her special private gain or loss. Each elected or appointed local officer also is prohibited from knowingly voting on a mea- sure which inures to the special gain or loss of a principal (other than a government agency) by whom he or she is retained (including the parent organization or subsidiary of a corporate principal by which he or she is retained); to the special private gain or loss of a relative; or to the special private gain or loss of a business associate. Commissioners of community redevelopment agencies under Sec. 163.356 or 163.357, F.S., and officers of independent special tax districts elected on a one -acre, one -vote basis are not prohibited from voting in that capacity. For purposes of this law, a "relative" includes only the officer's father, mother, son, daughter, husband, wife, brother, sister, father-in-law, mother-in-law, son-in-law, and daughter-in-law. A "business associate" means any person or entity engaged in or carrying on a business enterprise with the officer as a partner, joint venturer, coowner of property, or corporate shareholder (w er the; ar rfIhe rati are not listed on any national or regional stock exchange).-:)U(��rM� ""e ��jqf°��)'n.�p{to�p/��sp!,"'ye pubn ! k ! ! ! ♦ ! f i ! i • record Ii C*connecti • • it ELECTED OFFICERS: lac -a�`� 7 >? Priscilla A. Thom S( In addition to abstaining from voting in the situations described above, you must disclose the conflict:it, Cie PRIOR TO THE VOTE BEING TAKEN by publicly stating to the assembly the nature of your interest in the measure on which you are abstaining from voting; and WITHIN 15 DAYS AFTER THE VOTE OCCURS by completing and filing this form with the person responsible for recording the min- utes of the meeting, who should incorporate the form in the minutes. APPOINTED OFFICERS: Although you must abstain from voting in the situations described above, you otherwise may participate in these matters. However, you must disclose the nature of the conflict before making any attempt to influence the decision, whether orally or in writing and whether made by you or at your direction. IF YOU INTEND TO MAKE ANY ATTEMPT TO INFLUENCE THE DECISION PRIOR TO THE MEETING AT WHICH THE VOTE WILL BE TAKEN: • You must complete and file this form (before making any attempt to influence the decision) with the person responsible for recording the minutes of the meeting, who will incorporate the form in the minutes. (Continued on other side) CE FORM 8B - EFF. 1/2000 03- 194 PAGE 1 APPOINTED OFFICERS (continued) • A copy of the form must be provided immediately to the other members of the agency. • The form must be read publicly at the next meeting after the form is filed. IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING: • You must disclose orally the nature of your conflict in the measure before participating. • You must complete the form and file it within 15 days after the vote occurs with the person responsible for recording the minutes of the meeting, who must incorporate the form in the minutes. A copy of the form must be provided immediately to the other members of the agency, and the form must be read publicly at the next meeting after the form is filed. DISCLOSURE OF LOCAL OFFICER'S INTEREST _ 0 —`_ ` S /f -F _ hereby disclose that on _ -r _ C 20 3' (a) A measure came or will come before my agency which (check one) _ inured to my special private gain or loss; I 1� inured to the special gain or loss of my business associate, inured to the special gain or loss of my relative, — __ inured to the special gain or loss of—____ --_- --- by whom I am retained; or _— inured to the special gain or loss of — ,� which is the parent organization or subsidiary of a principal which has retained me. (b) The measure before my agency and the nature of my conflicting interest in the measure is as follows: -F14)1k0E,A /S /) Cy4,J1—=AJ - OF LeUc1lS �. F�2ee•��9� `� '4SSoq..4%S s„�, p.�k�il l;�$e.+a.e Ya4 �;,� �_l,'s.; E6o�•..j'''l�v record I0�w:: item Co -8Len - 59 q90 —� Imo/112— 2 L Date Filed NOTICE: UNDER PROVISIONS OF FLORIDA STATUTES §112.317, A I(A)LURE TO MAKE ANY REQUIRED DISCLOSURE CONSTITUTES GROUNDS FOR AND MAY BE PUNISHED BY ONE 0 MORE OF THE FOLLOWING: IMPEACHMENT, REMOVAL OR SUSPENSION FROM OFFICE OR EMPLOYMENT, DEMOTION, REDUCTION IN SALARY, REPRIMAND, OR A CIVIL PENALTY NOT TO EXCEED $10,000. CE FORM 88 - EFF. 112000 PAGE 2 03- 194