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HomeMy WebLinkAboutadditional forms• CERTIFICATION REGARDIV DEBOMENT, SUSPENSION AND OTHER ° RESPONSIBILITY IYIATTEIIS PRIMARY COVERED TRANSACTIONS The Proposer certifies to the best of its knowledge and belief, that it and its principals: 1 a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily, excluded from covered transactions by any Federal department or agency. b. Have not within a three.year period preceding this Proposal been convicted of or had a civil: judgement rendered against thent for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or falsification or destruction of records, making false statements, or receiving stolen property; c. Are not presently indicted fdror otherwise criminally or civilly charged by a government entity_ (Federal, State, or local) with commission of any of the offenses enumerated in paragraph 1.b of this certification; and d. Have not within a three-year period preceding this application/Proposal had one or more pub14[ transactions (Federal, State, or tool) terminated for cause or default. Where the prospective primary participant -is unable to certify to any of the statements in this certification, such prospective participant shall submit an explanation to the City of Miami. Pt eforp,,s PR.OPOSEIVAGENtY ()f....t (t PRINT NAME OF CERTIFYING OFFICIAL -g- Q -es)- e".SIGNATURE OF CERT FYING OFFICIA DATE City of Miami - 50A Bid N. 04-05-o1 1 CERTIFICATIJN REGARDING LOBBYING Certification for Contracts, Grants, Loans, and Cooperative Agreements The undersigned certifies to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid, or will be paid, by or on behalf of the undersigned, to a person for influencing or attempting to influ4nce an officer or employee of an agency a Member of Congress, a officer o_ r employee of Congress, or an employee of a Member of Congress in connection with the awarding of an Federal contract, the malting of any Federal grant, the making of any Federal loan, the entering into of a cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Feder contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid to any person for influencing or attempti to influence an officer or employee of any a- ency,-a Member of Congress, an officer or employee of Congress, an employee of a Member of Congress ii connection with this Federal contract, grant, loan, or cooperate agreement,the undersigned shall complete and submit Standard Form-1;.LL, "Disclosure Form to Repo Lobbying," in accordance with its instructions; (3) This undersigned shall require that the=language of this certification be included in the award documents tj "Ail" sub -awards at all tiers (including subcontracts, sub -grants, and contracts under grants, loans, and coaperati4 agreements) and that all sub -recipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was ma or entered into. Submission of this certifidation is a pre -requisite for making or entering into this transact' n imposed by Section 1352, Title 31, U.S. Code Any person who fails to file the required certification shall e subject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure. PRI TENArME OF CERTIFYING OFFICIAL r _ ) ky{ 1°- SIGNATURE OF CERTIFYING OFFICIAL DATE. * Note: In these instances, "All" in the Final Rule is expected to be clarified to show that it applies':-• covered contract/grant transactions over $100,000 (per QMB). City of Miami • 1 DISABILITY NON-DISCRIMINATION CERTIFICATION Certification for Contracts, Grants, Loans and Cooperative Agreements • The undersigned certifies that it is in compliance with and agrees to continue to comply with, and assure that any subcontractor, or third party contractor under this project complies with all applicable requirements of the laws listed above including, but not limited to, those provisions pertaining to employment, provision of programs and services, transportation, communications, access to facilities, renovations, and new construction in the following laws: • The Americans with Disabilities Act of 1990 (ADA), Pub. L. 101-3.36, 104, Stat. 327, 42 U.S.C. 12101 12213 and 47, U.S.C. Sections 325 and 611= including Title I, Employment; Title I1, Public Services; Title III, .Public Accommodations and Services Operated by Private Entities; Title IV, Telecommunications, and Title V,• Miscellaneous Provisions; The Rehabilitation Act of 1973, 29 U.S.C, Section 794; The. Federal Transit Act, as amended 49 U.S.C; Section 1612; The Fair Housing Act as amended 42 U.S.C. Section 360.1.3631. The foregoing requirements shall not pertain to contracts with the United States or any department or; agency thereof, the State of any political subdivision or agency thereof or any municipality of this State. (13i der Signature) STATE OF , 1a f; COUNTY OF Q eo°- The foregoing instrument was acknowledged before me this day of 3—`w`+-az.e.,-, 2a7by � € (ca (\ Tec- 4)� .,r° as Pry i t l.e /..$' (title) (name of person whose signature is being notarized) of _ _ to E`1( 121eS r,it- known to me to be the person described herein, (name of corporation/company) or who produced as identification, and who did/did not take an oath. (Print Vendor Name) NOTARY PUBLIC: (Signature) RaddfOLO. rint Name) �l• tuy caflmiS1 n No; nrdmuNll>Ill.I - My commission expires City of Miami 50C Bid No. 04-05-011 SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(A). FLORIDA STATUES ON PUBLIC ENTITY CRIME THIS FORM MUST BE SIGNED AND SWORN TO. IN THE PRESENCE OF A NOTARY PUBLIC OR OTHEI OFFICIAL AUTHORIZED TO'ADMINISTIR OATHS. This sworn statement issubmittedto By -e D • r Ls 0 (print this individual's name and title) for � �- A- co y-. ct-4241 c • D i i�4tN41' 1 'Pees\ (print name of entity submitting statements) whose business address is �aS� g 1`� i�l. � s� l c (L" _. and if applicable is Federal Employer Identification Number (FEIN) is t- If the entity has no FEIN, include the Social Security Number of the individual signing this sworn Statemen 6 I understand that a "public entity crime" as defined in paragraph 287.133(1)(a), Florida Statutes, mean violation of any state or federal law 1}y a person with respect to and directly related to the transactions business with any public entity or with An agency or political subdivision of any other state or with the Unit States including, but not limited to any bid or contract for goods or services to be provided to any publ entity or any agency or political subdivision of any other state or of the United States and involving:antitru fraud, theft, bribery, collusion; -racketeering, conspiracy, or material -misrepresentation. -. - i understand that "convicted" or "convection'' as defined in Paragraph.287.133(1)(b), Florida Statutes mea a finding of guilt or a conviction of a public entity crime, with or without adjudication of guilt, in any fede or state trial court of record relating tcocharges' brought by indictment or information after July 1, 1989, as result of a Jury verdict, nonjury trial, of entry of a plea of guilty or nolo contendere. I understand that an "affiliate" as defined in paragraph 287.133(1)(a), Florida Statutes, means: 1. A predecessor or successor of a person convicted of public entity crime; or 2. An entity under the control of any -natural person who is active in the management of the entity and w has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executiv partners, shareholders, employees, members, and agents who are active in the management of an affilia The ownership by one person of share; constituting a controlling interest in another person, or a pooling' equipment or income among persons when not for fair market value under an arm's length agreement, sh' I be a prima facie case that one person controls another person. A person who knowingly enters into a 3o' venture with a person who has been Convicted of a public entity crime in Florida during the preceding 6 months shall be considered an. affiliate. I understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statutes, means any natu person or entity organized under the laws of any state or of the United States with the legal power to en into a binding contract and which bidsor applies to bid on contracts for the provision of goods or services by a public entity, or which otherwise transacts or applies to transact business with a public entity. The tee "person" includes those officers, execives, partners, shareholders, employees, members, and agents whoa e active in management of an entity. r City of Miami 50D Bid N REMINDER ALL• BIDDERS MUST SUBMIT AN ECONOMIC OPPORTUNITY PLAN CONFORMING TO THE REQUIREMENTS LISTED 4SUPPLIMENTARY CONDITIONS EXHIBIT 2" SECTION 3 EMPLOYMENT AND ECONOMIC OPPORTUNITY" LISTED IN THIS =BID. 2. ANY SECTION 3CERTIFIED CONTRACTOR THAT INTENDS TO CLAIM A PREFERENCE MUST INCLUDE A CURRENT SECTION 3 CERTIFICATION LETTER WITH IT'S BID. SEE SECTION "00920 ADDITIONAL ARTICLES" FOR MORE INFORMATION. City of Miami _ 50E Bid No. 04-05-011 AC#1438388 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SEQ#L04c 60701485 BATCH NUMBER LICENSE NBR 06/07/2004 030706522 CGC050965 The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2006 TRASOBARES, DELIO ALBERT METRO EXPRESS INC 3594 SW 143 CT MIAMI FL 33175 JEB BUSH GOVERNOR DISPLAY AS REQUIRED BY LAW DIANE CARR SECRETARY Ac#0932378 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SEQ#LC3C60501440 BATCH NUMBER LICENSE NBR 06/05/20031200456684 QB0011827 The BUSINESS ORGANIZATION Named below IS QUALIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2005 (THIS IS NOT A LICENSE TO PERFORM WORK. THIS ALLOWS COMPANY TO DO BUSINESS ONLY IF IT HAS A QUALIFIER.) METRO EXPRESS INC 3594 SW 143 COURT MIAMI FL 33175 JEB BUSH GOVERNOR • DISPLAY AS gECLlIRED BY LAW DIANE CARR SECRETARY • No: OCCUPATIONAL LICENSE 1611-103 Amount: 150.00 CITY OF HIALEAH, FLORIDA Raul L. Martinez Mayor The person, firm or corp. listed hereon is hereby Licensed to engage in the business specified subject to the regulations and restrictions of the City of Hialeah, Florida. HIGHWAY/STREET CONSTRUCTION METRO EXPRESS I Nc. e095 W 21 LN HIALEAH, EL 33016 E095 W 21 LN VALIDATING No. 0000 EXPIRES SEPTEMBER 30, 2005 MIAMI DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 14th FLOOR MIAMI, FL 33130 2004 OCCUPATIONAL LICENSE TAX 2005 MIAMI-DADE COUNTY - STATE OF FLORIDA EXPIRES CEPT. 30, 2005 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER BA - ART. 9 & 10 ac FIRST-CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 23- THIS IS NOT A BILL-00 NOT PAY 409216-9 * HOME OFFICE * RENEWAL BUSINESS NAME 1 LOCATION LICENSE NO. 4 272 57 -1 METRO EXPRESS INC STATE #CGC050965 3594 SW 143 CT 33175 UNIN DADE COUNTY OWNER METRO EXPRESS INC Sec. Type of Business 196 GENERAL BUILDING CONTRACTOR THIS IS AN OCCUPATIONAL TAX ONLY. IT GOES NOT PERMIT THE LICENSEE TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE LICENSEE FROM ANY OTHER LICENSE OR PERMIT REQUIRED EV LAW. THIS f5 NOT A CERTIFICATION OF THE LICENSEE'S OUALIFICA. 'NON. PAYMENT RECEIVED MIAMI.DADE COUNTY TAX COLLECTOR. 08/05/2004 00200000069 0000753.40 SEE OTHER SIDE • WORKER/S 10 DO NOT FORWARD METRO EXPRESS INC BLANCA R TRASOBARES PRES 3594 SW 143 CT MIAMI FL 33175 Illilll,lllllllll,III,I11111IIIIlIIIIIIIIlIIII1lIIlflI1111111E AL:UKU,,, CERTIFICATE OF LIABILITY INSURANCE PRODUCER ALLSTATE INSURANCE 6500 WEST 4TH AVE..STE #42 TALEAH, FL 33012 J05)819-4999 0:3/18/2004 THIS CERTIFICATE '15 ISSUED AS A MATTER OF INFORCIAT10N` ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER_ THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED SY THE POLICIES BELOW URED 'tETRO EXPRESS INC 3594 SW .143 C:1' MIAMI, FL 33175 COVERAGES INSURER A. INSURER 3' INSURERS AFFORDING COVERAGE' ALLSTATE INDEMNITY CO INSuFIER INSURER D• INSURER E. . • B { {ANY P yiE } g A OV 1 HE P LICY PERIODINDICATE NC C. N ITIIONpOF� ANY CONTRACT OR �OTHHpER DOCUMENT HOWN �r , E-1Acilrig V1 i SlJCtDCBY PAID Euilk? NOTWITHSTANDING- — WITH RESPECT I O 4�iH(CH SUBJECT TO ALL THiz TERMS, I R�ERQUIR ��{{NEE M R ESTAGG"EGAa L{�tiTS INSR LTR TYPE OF .4.131.1R-104E PCUCY NUMBER POUCY EFFECTIVE CATE(Mmscc:Yr', PCUCY EXPIRATION oArLkiK-Cerra `" `—____— UMITS GENERAL uA31uTY CCr.IM!RCI?L-GENER.+.L LIASILTY N/A tT/A tT/A EACH CCCliRRENCE I s tT / A 1 FIRE Catil.=Gc(Any ane lee) 3 tf /A h ' I CLAIMS MACE OCCUR �` ME7 _JCP (Any ort.e perxrt} 3 t'r / `. 1 N/A PF.RsoIULLACV! IN:U.RY TsN/ .�`` GENERAL ACGREOATE 5 t'r / =. v ri'L A3C.REGA. _ uhlr AP?,.J ES PER: PRCOuCS • C.'7m?.•Ca AGO 3 td / ,:a- ;�F POLICY n PR„ n LCC _ A 'AUTOMOBILEUABIUTY ANY AU-O ALi_ CwNE7 AUTOS SC;-E=ULEO AUTOS - rlrRcoAuros NC..- vr!IEOAUTOS 048653804 03/15/04 03/15/05 CmairiE7 3ING...1 u.vri saccdtr., r1 .�.., 000 , 00 0 3CCILY [s:4RY (Per pers:.nl 5 N /.!^, X X accLYIrI. RY (Par acctm: - s tr /+-. PRCF'E..R Y CA!.IAyc - . s (Pe' ir_,C.M: NT / A I GARAGE IANY AL'-O I NI /:. NT/A N/A. N/A AUTOQ!IL"'•-^ACC`Oc'N? `'3tr/i-. 07,-"RT4,L,; =;a c 15tT/ AUTO ONE'• AGO I i IN /.. ' EXCE3S LIASIUTY tr/A . r/A - Nr/A EACH CC:,'LRRE.`C_ 1 5 IN/A' CCCJP.. ... CL;i1,3 MAC_ AGO.REGA-c S t'T/,.. IDE7UCTIEL_E • I R-'_`+T:ON 5 N/A I5N/1.. N/A 15 tr /,-. N/A- I s WORKERS CCMPE,ssAI'ON Aso EMPLOYEERS'uaaLirr tr/A tT/A t'T/A j N,f, s-Ai1 . { CT.y., I TCRY 2....i.5 1 I E�R 1 ,. , T E L. DISEASE • A. EMPLOYEE 1 5 tT / -. E.L. crsEA.sE • POLICY LIMIT SN /,-. OTHER N/A tT/A N/A. N/A - N/A OER.RIP TION CPBR.1T:ONS.LOCA1',CNS,Ye-1C'LES+cACLU 51CN$ A cozo 3Y ENCORBIKakTiSFECiAL PR Ov15i OYS CERTIFICATE HOLDER I X ACCITICNAL IN5L?PED. INSURER LE"E.R: X CANCELLATION • S+.CULD ANY OF THE AECv CESCRI3e'C POLICIcS 35 CANOE.-=7 aSPCR:: r-i; i:.= PATTCH CATE THEREOF, THE !SSL:ISO INSURER WIL'.. E,. CEA'vCP. TO SIAIL 3 0 ma's rr Rlr"-N NOTICE TO THE CERTIFICATE HCLDEP NAMED TO FAILURE 7C CO S.^. SAAL'- IMPOSE NC CaLICAT:CN CR 1:A31L!'r( CF ANY IONC'JPON THE INSURE?, ITS AC=.YT3 CR REPRESENTATIVES. AUTHORL'ED REPRESENTATIVE .\ ACORD 25S (7/97) '�J C ACORD CORPORATION ACCRD,, CERTIFICATE OF LIABILITY INSURANCE• PRODUCER NORTH STARR INS. —no WEST 4TH AVE 443 LEAH, FL. 33012 (305)828-7451 DATE;ti,.wao~YYy~ 03/].'.5/2004 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED dY THE POLICIES BELOW ENSURERS AFFORDING COVERAGE INsuRE° METRO EXPRESS INC. 3594 SC1 143 COURT MIAMI FL 33175 FIRST COMi34ERCIAL M"+3TUTAL INS ,.NS'1RE.R 3 INSURER C •IINSLIRE.R E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PF.R1OD INDICATED. NOT WWVITHSTA'IDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO'r:HICH.THIS CERTIFICATE MAY 9<: ISSi.'_D OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED 9Y PAID CLAIMS. NSR LTR TYPE OF INSURANCE POLICY NUMBER POL,CY EFFE"TINE DATE IMM/DDrYY1 POLICY EXPIRATION ❑ATE ruMIOOIYYI LIMITS ' - GENERAL ■ LIABILITY 00l.I7'ECIA'. G!N! AIL! 1 .31LIr N/A N/A 1 N/A = CM OCCURRENCE: 5 NiA ;a:. �:R- DLG: ..,, :ra �iri1 5 N/^�� A CLSL15'.IA°? GCCL'R i-p m30 ExP , :re :arson; S M/A ==_R3CN LS- :I.NJURY SN/A G_ .ER.:. :_-;,: __ — sN/A GE`JL AGCFi=GA c LIMIT APPLES ?ER PROCUCTS • CCA,P'CP A..,G - $ N/A 'CGCY I 11ET _wC• El ?C AUTOMOBILE LIABILITY .. AIU TO -'t,'r:N"e7 AUTOS _., ?DL'LEC A•-TCS r.:nEoA„Tas NON -OWNED AUTC5 - N/A N/A - N/A :,1.I3INE] S:!NOI-a -'+I T ±3 a:GC}^ ' ' Lu /A C°l'' :N. Rv ,,Par:eat - -N/A scciLY;n,:_Re0 ,r 3r 3C: ea rl, SN/A �_ I PRCPE.RTY ` ...AGE =ar 3G:.t^ ;N/A GARAGE LIABILITY AN „ ., . - N/A N/A N/A C :N'..Y -.11. ACCIOEN7" 5 _:P. - ,c . SN/A -0�, AGG sN/A EXCESS LIABILITY N/A N/A N/A C� :CvLR .�_. � (�! _En,c,:;-_ sN/A :N1/A ski /:; . A WORKERS COMPENSATION ANC EMPLOrsRS'LIABILITY • 17017-1 03/24/04. - 03/24/05. X h T'^5,, S.;I=j f -;R E_L.cAC 4s:Z_.'7 s3.00, 000 ELCEEASE E E'hL;,'-_E 5500,000 EL.CSE•:.-=CS'C''LI..T 5100, 000 . . oTrra c DESCRIPTIn, C;. OPERATIONS:LOCATIONSw=_;HICLEEEXCLU510NS AOOEO BY ENOORSEmENTlSPECIAL PROvi510NS 1r� CERTIFICATE HOLDER ADDITIONAL INSURED: INSURER LETTER: CANCELLATION SHOULD ANY OF THE A30VE OESCP:SED POLICIES BE CA,NCELLEO 8E-S�._ _-xPl•A""�' °ATE THEREOF, THE ISSUING INSURER WILL ENOEAVCR TO MAIL ri O c-Ys �'''•: =� NOTICE TO THE CERTIFICATE HCLOEP NAMED TO THE t!=T, 8UT FAILURE TO'Df) SO Sr A' -'- IMPOSE NO OBLIGATION 0R LIABILITY OF ANY KIhO UPON THE INSURER, ITS A:,ENTS C3 ACORD 25-S (7197) REPRESENTATIVES. AUTHORIZED REPRESE.NTATIvE p ACORD CORPORATION ACORD CERTIFICATE OF LIABILITY INSURANCE PRODUCER Brown & Brown, Inc. 5900 N. Andrews Ave. #300 A r). Box 5727 Lauderdale FL 33310-5727 one:954-776-2222 Fax:954-776-4446 INSURED Metro Ex ress, Inc 8095 West 21st Lane Hialeah FL 33016 OP ID F 9 0,4TE [MM(DD/YYYy) METR-13 09 09 44 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAI C # INSURER A: Harleysville Insurance Company INSURER 8: Great American Ins .Do INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INOICATED. 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSH {pA•DP'u LTA INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMMIDD/YY) POLICY EXPIRATION DATE (MMJDD/YY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY GL8C6166 02/25/04 02/25/05 EACH OCCURRENCE 51000000 X UAMAGt I HtNIkU PREMISES (Ea occurence) 5:L00000 CLAIMS MADE 1 X j OCCUR MED EXP {Any one person) S 5 0 0 [3 X X,C,U Coverage PERSONAL & ADV INJURY S1000000 GENERAL AGGREGATE 52000000 N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/DP AGG S 200000 0 POLICY 7 PRD LO JECT n C ' . AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON•OW NED AUTOS - - COMBINED SINGLE LIMIT (Ea accident) S BODILY INJURY S (Per person) . BODILY INJURY " [Per accident) 5 PROPERTY DAMAGE (Per accident) GARAGE LIABILITY ANY AUTO - - AUTO ONLY -EA ACCIDENT i $ OTHER THAN EA ACC 15 AUTO ONLY: AGG 1I 5 EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE 1 5 OCCUR CLAIMS MADE AGGREGATE j$ DEDUCTIBLE RETENTION S I5 15 IS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? l( yyes. describe under SPECIAL PROVISIONS below rrL TI'MI u ni � TORY LIhIITS I ER _ E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE- POLICY LIMIT $ B OTHER Equipment Floater IMP1350498 03/05/04 03/05/05 Scheduled See Below Ded. $1,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS *10 days notice given for nonpayment of premium CERTIFICATE HOLDER CANCELLATION CITCORA City of Coral Gables 405 Biltmore Way Coral Gables FL 33134 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *3 0 DAYS WRITTEN "OTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, (T5 AGENTS OR REPRESENTATIVES. AUTHOR RES ATIVE © ACORD CORPORATION 19881988 ACORD 25 (2001108) ASSURANCE OF COMPLIANCE (SECTION 3, HUD ACT OF 1968) TRAINING, EMPLOYMENT, AND CONTRACTING OPPORTUNITIES FOR BUSINESS AND LOWER INCOME PERSONS A. The project assisted under this (contract) (agreement) is subject to the requirement s of Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 170u. Section 3 requires that to the greatest extent feasible opportunities for training and employment be given to lower income residents of the project area and contract for work in connection with the project be awarded to business concerns which are located in or owned in substantial part by persons residing in the area of the project, B. Notwithstanding any other provision of this (contract) (agreement), the (applicant) (recipient) shall carry out the provisions of said Section 3 and the regulations issued pursuant thereto by the Secretary set forth in 24 CFR Part 135(published in 38 Federal Register 29220, October 23, 1973), and all applicable rules and orders of the Secretary issued there under prior to the execution of this (contract) (agreement). The requirements of said regulations include but are not limited to development and implementation of an affirmative action plan for utilizing business concerns located within or owned in substantial part by persons residing in the area of the project; the making of a good faith effort as defined by the regulations, to provide training, employment and business opportunities required by Section3; and incorporation of the "Section 3 Clause" specified by Section 135.20 (b) of the regulations in all contracts for work in connection with the project. The (applicant) (recipient) certifies and agrees that it is under no contractual or other disability which would prevent it from complying with these requirements. C. Compliance with the provision of Section. 3, the regulations set forth in 24 CFR Part 135, and all applicable rules and orders of the Secretary issued thereunder prior to approval by the Government of the application for this (contract) (agreement), shall be a condition of the Federal financial assistance provided to the project, binding upon the (applicant) (recipient), its contractors and subcontractors, its successors; and assigns to the sanctions specified by this (contract) (agreement), and to such sanctions as are specified by 24 CFR Section 135.135. 1) t a 5 Dike, DATE APPLICANT 'PCS w, [•1- ADDRESS tL. Ft 77o(L AUTHORIZED SIGNATURE • METRO EXPRESS, INC. State Wide General & Engineering Contractors CGC050965 - E-201301 SECTION 3 ECONOMIC OPPORTUNITY PLAN LICENSED INSURED BONDED Question # 1 Identify individuals responsible for planning, implementing, and tracking the project's Section 3 training and employment goals. Describe their prior experience in this area. The individuals responsible for planning, implementing, and tracking the projects Section 3 training and employment goals is Dello A. Trasobares, of Metro Express Inc; hereafter referred to as "Contractor". He will obtain all pertinent information become thoroughly familiar and ensure contract compliance with the HUD Section 3 Regulation. Dello A. Trasobares has worked on many construction projects, and is qualified to administer contractor's Section 3 Economic Opportunity Plan. Question # 2 Describe efforts to be taken to recruit, solicit, encourage, facilitate and hire public housing and other low- income persons. Identify and private or public resources that will be used. Contractor will take the following steps to recruit, solicit, encourage, facilitate and hire public housing and other low-income persons, in the event any vacancies occur throughout the duration of the project: 1. Meet with resident associations and managers at the public housing site where work is to take place, first, and second, at other public housing sites. 2. Schedule a time and place for public housing residents to complete job applications. 3. Develop a list of "pre -qualified" Section 3 public housing and other low-income residents who could fill job vacancies that may later become available. 4. Contract Angel Alonso, at (305) 416-2094 for employment referrals. 5. Contact Don De Jamett, YWCA, at (305) 377-9922, Ext. 204, or Fax (305) 373-9922 for HUD Youth build employment referrals. 6. Send notices about Section 3 training and employment obligations and opportunities required for this project to labor organizations. 7. Establish a training program to provide public residents and other low income residents with the opportunity to learn basic skills and job requirements. 8. Advertise in major and community newspapers, and on job sites for workers who meet the definitions of a Section 3 resident Contractor will establish files to record and retain written documentation of all training and employment outreach effort and responses from agency representatives and job applicants. Question # 3 (ONLY APPLICABLE TO FIRMS THAT SUBCONTRACT) Describe the contractor's activities to be taken for recruiting, soliciting, encouraging, facilitating and selecting Section 3 subcontractors, where applicable, Contractor will take all feasible measures to recruit, solicit, encourage, facilitate, and select qualified Section 3 business subcontracting firms to perfom at least 10% of the project award amount (contract sum) for each City of Miami project for which Contractor is the successful bidder. 8095 W. 21st Lane - Hialeah, Florida 33016 - Telephone: (305) 459-8286 / Fax: (305) 459-8287 An equal opportunity employer METRO EXPRESS, INC. State Wide General & Engineering Contractors CGC050965 - E-201301 Firm Name Page 2 of 3 LICENSED INS1URED BONDED Contractor will request the organizations, listed below, to provide lists of firms, organized by trade category, that can perform required project work (in addition to these organitztions, Contractor may also contact other organizations that provide such listings): 1. Miami -Dade County Department of Business Development. 2. Contractor's Resource Center. 3. Small Business Administration. 4. Minority Business Development Center. Contractor understand that, in addition to awarding work to qualified Section 3 businesses, it is our responsibility to: 1.. use the City of Miami solicitation letter to advertise to the "greatest extent feasible" to all firms on lists provided to us by City of Miami and other organizations about the type of work needed to complete each City of Miami project, 2 advise firms of Contractor's obligation to seek and award work to qualified Section 3 businesses, whrere feasible, 3. clarify the definition of a Section 3 resident and business, 4. explain how to qualify as a Section 3 business in order to be elegible to receive a preference from Contractor when subcontractor work is to be awarded, and 5. provide Section 3 certified firms that are qualified to perform work with an opportunity to submit price quotations for City of Miami project work, and where financially feasible, hire such firms as subcontractors. Documentation of Outreach to find Eligible Section 3 Subcontracting Firms 1 Contractor will establish files to record and retain written documentation of all outreach efforts and responses received from organizations and subcontractors who are contacted. 2. Contractor will fax the City of Miami Solicitation Letter and business application to all firms that these organizations identify, based on each category of work required for each project. 3. Contractor will provide City of Miami with copies of its facsimile receipts to each of the organizations listed in its Plan and their responses. 4. Contractor will provide City of Miami with copies of its facsimile receipts and responses received from every firm that is faxed for each MDHA project. 5. Contractor will provide City of Miami with an outreach close-out letter for each project awarded that refers to an attached outreach summary report. If Contractor is unable to meet City of Miami's requirement to contract at least 10% of the award amount to Section 3 businesses, Contractor will include in its close-out letter an explanation as to why this requirement was not met. 6. The outreach summary report, referred to in No. 5, above, will list all contacts made to each organization or association, the individuals firms subsequently contacted, categorized by trade, and the bid amount or other type of responses received from each firm (similar to the sample outreach summary report attached to Contractor's Plan). 7. If a firm is non -responsive, Contractor agrees to make a second attempt at getting them to respond, failing which, Contractor will move on to another company, all of which will be faxed to City of Miami, and referred to in the outreach close-out letter and summary report. 8095 W. 21st Lane - Hialeah, Florida 33016 - Telephone: (305) 459-8286 / Fax: (305) 459-828'7 An equal opportunity employer METRO EXPRESS, INC. State Wide General & Engineering Contractors CGC050965-.E-201301 Firm Name Page 3 of 3 LICE'N SED INSURED BONDED Question # 4 (ONLY APPLICABLE TO FIRMS THAT SUBCONTRACT) Describe plans to structure project activities in ways to create opportunities for Section 3 firms to participate, where applicable. Contractor will make every effort to structure project activities to increase opportunities for Section 3 businesses.. This will be accomplished by sub -dividing the work into smaller amounts, or by using multiple firms to complete similar types of work. Submitted by: aCti)2,›.- President Name, President Submission Date: \ 1.teT06-- Attachment: Sample Outreach Table Outreach Form (to solicit subcontracting firms) Training and Employment Outreach Documentation Form (to solicit trainees/employees) 8095 W. 21st Lane - Hialeah, Florida 33016 - Telephone: (305) 459-8286 / Fax: (305) 459-8287 An equal opportunity employer