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HomeMy WebLinkAboutExhibit 111 ATTACHMENT 1 MIAMI-DADE COUNTY AFFIDAVITS The contracting individual or entity (govemmental or otherwise) shall indicate by an "X" all affidavits that pertain to this contract and shall indicate by an "N/A" all affidavits that do not pertain to this contract. All blank spaces must be filled. The MIAMI-DADE COUNTY OWNERSHIP DISCLOSURE AFFIDAVIT; MIAMI -DARE COUNTY EMPLOYMENT DISCLOSURE AFFIDAVIT; MIAMI-DADE CRIMINAL RECORD AFFIDAVIT; DISABILITY NONDISCRIMINATION AFFIDAVIT; and the PROJECT FRESH START AFFIDAVIT shall not pertain to contracts with the United States or any of its departrnents or agencies thereof, the State or any political subdivision or, agency thereof or any municipality of this State. The MIAMI-DADE FAMII,Y LEAVE AFFIDAVIT shall not pertain to contracts with the United States or any of its depart-rients or agencies or the State of Florida or any political subdivision or agency thereof; it shall, however, pertain to municipalities of the State of Florida. All other contracting entities or individuals shall read carefully each affidavit to determine whether or not it pertains to this contract and initial to the left of the statement, if applicable; or "N/A" if not applicable; and/or provide the information requested. I Joe Arriola , being first duly sworn state: Affiant The full legal name and business address of the person(s) or entity contracting or transacting business with Miami -Dade County are (Post Office addresses are not acceptable): Federal ID# 59-6000375 Federal Employer Identification Number (If none, Social Security) City of Miami Name of Entity, Individual(s), Partners, or Corporation Doing Business As (if same as above, leave blank) 444 S.W. 2nd Avenue Miami, Florida 33130 Street Address City State Zip Code I. MIAMI DADE COUNTY OWNERSHIP DISCLOSURE AFFIDAVIT (Sec. 2-8.1 of the County Code) If the contract or business transaction is with a corporation, the full legal name and business address shall be provided for each officer and director and each stockholder who holds directly or indirectly Five percent (5%) or more of the corporation's stock. If the contract or business transaction is with a partnership, the foregoing information shall be provided for each partner. If the contract or business transaction is with a trust, the full legal name and address shall be provided for each trustee and each beneficiary. The foregoing requirements shall not pertain to contracts with publicly traded corporations or to contracts with the United States or any department or agency thereof, the State or any political subdivision or agency thereof or any municipality of this State. All such names and addresses are (Post Office addresses are not acceptable): lof 5 j Full Legal Name Address Ownership N/A 2. The full legal names and business address of any other individual (other than subcontractors, material men, suppliers, laborers, or lenders) who have, or will leave, any interest (legal, equitable beneficial or otherwise) in the contract or business transaction with Dade County are (Post Office addresses are not acceptable): N/A 3. Any person who willfully fails to disclose the information required herein, or who knowingly discloses false information in this regard, shall be punished by a fmc of up to five hundred dollars ($500.00) or imprisonment in the County jail for up to sixty (60) days or both. N.L& Il. MIAMI -DARE COUNTY EMPLOYMENT DISCLOSURE AFFIDAVIT (County Ordinance No, 90- I33, Amending sec. 2.8-1; Subsection (d)(2) of the County Code). Except where precluded by federal or State laws or regulations, each.contraet or business transaction or renewal thereof which involves the expenditure of ten thousand dollars ($10,000) or more shall require the entity contracting or transacting business to disclose the following information. The foregoing disclosure requirements do not apply to contracts with the United States or any department or agency thereof, the State or any political subdivision or agency thereof or any municipality of this State. Does your firm have a collective bargaining agreement with its employees? Yes _ No Does your firm provide paid health care benefits for its employees? Yes _ No Provide a current breakdown (number of persons) of your firrn's work force and ownership as to race, national origin and gender: White: Males Females Asian: Males Females Black: Males Females American Indian: Males Females Hispanics: Males Females Aleut (Eskimo): Males Females Males Females: Males Females N/A III. AFFIRMATIVE ACTION/NONDISCRINIINATION OF EMPLOYMENT, PROMOTION AND PROCUREMENT PRACTICES (County Ordinance 98-30 codified at 2-8.1.5 of the County Code.) In accordance with County Ordinance No. 98-30, entities with annual gross revenues in excess, of $5,000,000 seeking to contract with the County shall, as a condition of receiving a County contract, have: i) a wTitten affirmative action plan which sets forth the procedures the entity utilizes to assure that it does not discriminate in its employment and prornotion practices; and ii) a written procurement policy which sets forth the procedures the entity utilizes to assure that it does not discriminate against minority and women -owned businesses in its own procurement of goods, supplies and services. Such affirmative action plans and procurement policies shall provide for periodic review to determine their effectiveness in assuring the entity does notdiscriminate in its employment, promotion and procurement practices. The foregoing notwithstanding, corporate entities whose boards of directors are representative of the population make-up of the nation shall be presumed to have non-discriminatory employment and procurement policies, and shall not be. required to have written affirmative action plans and procurement policies in order to receive a County contract. The foregoing presumption may be rebutted. 2of5 The requirements of County Ordinance No. 98-30 may be waived upon the written recommendation of - the County Manager that it is in the best interest of the County to do so and upon approval of the Board of Courity Cormnissioners by majority vote of the members present. N/A The firm does not have annual gross revenues in excess of $5,000,000. The firm does have annual revenues in excess of 55,000,000; however, its Board of Directors is representative of the population make-up of the nation and has submitted a written, detailed listing of its Board of Directors, including the race or ethnicity of each board member, to the County's Department of Business Development, 175 N.W, lst Avenue, 28th Floor, Miami, Florida 33128, NIA The firm has annual gross revenues in excess of $5,000,000 and the firm does have a written affirmative action plan and procurement policy as described above, which includes periodic rcviews to determine effectiveness, and has submitted the plan and policy to the County's Department of Business Development 175 N.W. I' Avenue, 28th Floor, Miami, Florida 33128; NIA The firm does not have an affirmative action plan and/or a procurement policy as described above, but has been granted a waiver. N/9 IV. MIAMI -DARE COUNTY CRIIvfNAL RECORD AFFIDAVIT (Section 2-8.6 of the County Code) The individual or entity entering into a contract or receiving funding from the County has has not as of the date of this affidavit been convicted of a felony during the past ten (10) years. An officer, director, or executive of the entity entering into a contract or receiving fundg from the County has has not as of the date of this affidavit been convicted of a felony during the past ten (10) years. N/A V. MIAMI -DARE EMPLOYMENT DRUG-FREE WORKPLACE AFFIDAVIT (County Ordinance No. 92-15 codified as Section 2-8.1.2 of the County Code) That in compliance with Ordinance No. 92-15 of the Code of Miami -Dade County, Florida, the above named person or entity is providing a drug-free workplace. A written statement to each employee shall inform the employee about: 1. danger of drug abuse in the workplace 2. the firm's policy of maintaining a drug-free environment at all workplaces 3. availability of drug counseling, rehabilitation and employee assistance programs 4. penalties that may be imposed upon employees for drug abuse violations The person or entity shall also require an employee to sib a statement, as a condition of employment that the employee will abide by the terms and notify the employer of any criminal drug conviction occurring no later than five (5) days after receiving notice of such conviction and impose appropriate personnel action against the employee up to and including termination. Compliance with Ordinance No. 92-15 may be waived if the special characteristics of the product or service offered by the person or entity make it necessary for the operation of the County or for the health, safety, welfare, economic benefits and well-being of the public. Contracts involving funding which is provided in whole or in part by the United States or the State of Florida shall be exempted from the provisions of this ordinance in those instances where those provisions are in conflict with the requirements of those governmental entities. 3 of 5 :XVI. MIAMI -DARE EMPLOYMENT FAMILY LEAVE AFFIDAVTr (County Ordinance No. 142-91 codified as Section 11A-29 et. seq of the County Code) That in compliance with Ordinance No. 142-91 of the Code of Miami -Dade County, Florida, an employer with fifty (50) or more employees working in Dade County for each working day during each of twenty (20) or more calendar work weeks, shall provide the following information in compliance with all items in the aforementioned ordinance: An employee who has worked for the above firm at least one (1) year shall be entitled to ninety (90) days of family leave during any twenty-four (24) month period, for medical reasons, for the birth or adoption of a child, or for the care of a child, spouse or other close relative who has a serious health condition without risk of termination of employment or employer retaliation. The foregoing requirements shall not pertain to contracts with the United States or any department or agency thereof, or the State of Florida or any political subdivision or agency thereof. It shall, however, pertain to municipalities of this State. N/A VII. DISABILITY NON-DISCREYMZATION AFFIDAVIT (County Resolution R.-385-95) That the above named firm, corporation or organization is in compliance with and agrees to continue to comply with, and assure that any subcontractor, or third party contractor under this project complies with all applicable requirements of the laws listed below including, but not limited to, those provisions pertaining to employment, provision of programs and services, transportation, communications, access to facilities, renovations, and new construction in the following laws: The Americans with Disabilities Act of 1990 (ADA), Pub. L. 101-336, 104 Stat 327, 42 U.S.C, 12101-12213 and 47 U.S.C. Sections 225 and 611 including Title I, Employment; Title II, Public Services; Title III, Public Accommodations and Services Operated by Private Entities; Title IV, Telecommunications; and Title V, Miscellaneous Provisions; The Rehabilitation Act of 1973, 29 U.S.C. Section 794; The Federal Transit Act, as amended 49 U.S.C. Section 1612; The Fair Housing Act as amended, 42 U.S.C. Section 3601-3631. The foregoing requirements shall not pertain to contracts with the United States or any department or agency thereof, the State or any political subdivision or agency thereof or any municipality of this State. N/A VIII. MIAMI -DADS COUNTY Y REGARDING DELINQUENT AND CURRENTLY DUE FEES OR TAXES (Sec. 2-8.1(c) of the County Code) Except for small purchase order and sole source contracts, that above named trm, corporation, organization or individual desiring to transact business or enter into a contract with the County verifies that all delinquent and currently due fees or taxes -- including but not limited to real and property taxes, utility taxes and occupational licenses -- which are collected in the normal course by the Dade County Tax Collector as well as Dade County issued parking tickets for vehicles registered in the name of the firm, corporation, organization or individual have been paid. N/A LX. CURRENT ON ALL COUNTY CONTRACTS, LOANS AND OTHER OBLIGATIONS The individual entity seeking to transact business with the County is current in all its obligations to the County and is not otherwise in default of any contract, promissory note or other loan document with the County or any of its agencies or instrumentalities. 4 of 5 N/A X. PROTECT FRESH START (Resolutions R-702-98 and 358-99) Any firm that has a contract with the County that results in actual payment of $500,000 or more shall contribute to Project Fresh Start, the County's Welfare to Work Initiative. However, if five percent (5%) of the firm's work force consists of individuals who reside in Miami -Dade County and who have lost or will lose cash assistance benefits (formerly Aid to Families with Dependent Children) as a result of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, the firm may request waiver from the requirements of R-702-98 and R-358-99 by submitting a waiver request affidavit. The foregoing requirement does not pertain to government entities, not for profit organizations or recipients of grant awards. N/A XI. DOMESTIC VIOLENCE LEAVE (Resolution 185-00; 99-5 Codified At 11A-60 Et. Seq, of the Miami -Dade County Code). The firm desiring to do business with the County is in compliance with Domestic Leave Ordinance, Ordinance 99-5, codified at I IA -60 et. seq. of the Miami Dade County Code, which requires an employer which has in the regular course of business fifty (50) or more employees working in Miami - Dade County for each working day during each of twenty (20) or more calendar work weeks in the current or proceeding calendar years, to provide Domestic Violence Leave to its employees. I have carefully read this entire five (5) page document entitled, "Miami -Dade County Affidavits" and have indicated by an "X" all affidavits that pertain to this contract and have indicated by an "NIA" all affidavits that do not pertain -to this contract �, 6 r.�. ZYP,7 ;7� >,J —d i.— ignature of Affiant) e Arricla, City Manager SUBSCRIBED AND SWORN TO (or affirmed) before me this cp� day of _ ..2005 by known to me or has presented (Type of Identification) Jl (Signature of No iI (Print or Stamp of Notary) Notary Public — Stamp State of FlD/, ✓/ (�— (State) 5 of 5 (Date) "rel He/She is personally as identification, (Serial Number) (Expiration Date) Notary Seal Ofelia E. Pere <IRY.PLE4 R� Z Commission #DD221319 u. Expires: Jul 26, 2007 O. Bonded ThN111111, r Atlantic Bonding Co., Inc.