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HomeMy WebLinkAboutCompensation SummaryEXHIBIT C — COMPENSATION AND I3UDGET SUMMARY A. The CITY shall pay the SUBRECIPIENT, as maximum compensation for the services required pursuant to this Agreement the sum of $ e ' B. During the term hereof and for a period of three (3) years following the date of the last payment made hereunder, the CITY shall have the right to review and audit the time records and related records of the SUBRECIPIENT pertaining to any payments by the CITY. C. Requests for payment should be made at least on a monthly basis in a form provided by the Department. Reimbursement requests should he submitted to the CITY within thirty (30) calendar days after the indebtedness has been incurred in a form provided by the Department. D. The SUBRECIPIENT must submit the final request for payment to the CITY within 30 calendar days following the expiration date or termination date of this Agreement in a form provided by the Department. If the SUBRECIPIENT fails to comply with this requirement, the SUBRECIPIENT shall forfeit all rights to payment and the CITY shall not honor any request submitted thereafter. E. Any payment due under this Agreement may be withheld pending the receipt and approval by the CITY of all reports due from the SUBRECIPIENT as a part of this Agreement and any modifications thereto. <Eve Director's Name> Date 11 Exe(ltive Director (3) C ERT TICA T KP H REGARD 3 LOBSY G Certification for Contracts, Grants; Limns, aa€i Cooperative f;.ueements 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 any person for influencing or attempting to influence an officer or employee of an agency a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the uttering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an off er or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. This undersigned shall require that the language of this certification be included in the award documents for "All" sub -awards at all tiers (including subcontracts, sub -grants, and contracts under grants, loans, and cooperative 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 made or entered into. Submission of this certification is a pre -requisite for making or entering into this transaction imposed by Section 1352, Title 31, U. S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Name of Applicant j "066 4.- Mf ri." Print name of Certifying Official Sig of Certifying Official Dale 47 City of STATE OF FLORIDA The foregoing instrument was acknowledged before me this by • 't (nanie oPperson whose signature is being notarized) produced (Type of Identification) rts ' l'el?TARWJBLIC: r day of •es-‘1. , . 200 who is personalty known to the or who as identification, and who did/did not take an oath. c tfrt (Print Name) Aillill •-: ' I} c ---.--_,.. .e.,..`, tc"tcoFt'c6,... \ -.•::' .....: , ---;. -'-e,'' ;• ,, .,, • ....„ • .....c.. .,...:: ''',•< ".00‘•!: .. ....-..• ' 7,,, "7///11$11'1‘'s 48 CER E 1FICAflON REGARDING DEBARMENT, SUS•PEis SiON OMER RESPONSIBILITY MATTERS PRIMARY COVERED T RANEACT6ONS 1. The applicant certifies to the best of its knowledge and belief, that it and its principals: a. Are not presently debarred. suspended, proposed for debarment, declared ineligible. or voluntarily excluded from covered transactions by any Federal departmnent or agency. b. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them 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 for or otherwise criminally or civilly charged by a government entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph t .b of this certification; and d. Have not within a three-year period preceding this application; proposal had one or snore public transactions (Federal, State, or local) terminated for cause or default. 2. 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. ®IVE Aar, 47v • Applicant/Agency Print Name of Certifying Official Sit ture of Certifying Official Date 49 City of STATE OF FLORIDA • The foregoing instrument was acknowledged before me this c."- day f by (name of person whose signature is being notarized) • produced v (Type of Identification) NQTAR Y. PUEILIC: Lf. attire)`,3 ----" ‘N. • it .1% ; . 200 c- who is personally known to me or who as identification; and who did/did not take an oath. 'frfl-My commission expires is4 (Print Name) SE SWORN STATEMENT PURSUANT TO SEMFtOM 2t . E33 (). FLORIDA STATUTES ON PUBLIC ENTITY' CRAVE THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADD- MINISTER OATHS. /� 1. This sworn statement is submitted to 1 a. czt- c - Y` `i � rA'' r for {tk' \-- % A - X CL c e--- �-r (Print this individual's name and title) Cvim& bp_ 61‘,- (Print name of entity submitting statements) r whose business address is 1 i �� � t Gt t&4 s I"7'V� 3C0 and whose Federal Employer Identification Number (FEIN) is 51 19 Z 7' 3 If the entity has no FEIN, include the Social Security Number of the individual signing this sworn Statement: 2. I understand that a "public entity crime" as defined in paragraph 287.133(1)(a), Florida Statutes. mean a violation of any state or federal law by a person with respect to and directly related to the transactions 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 any agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 3. I understand that "convicted" or "convection" as defined in Paragraph 287.133(1)(b), Florida Statutes means a finding of guilt or a conviction of a public entity crime, with or without adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July I, 1989, as a result of a Jury verdict, nonjury trial, or entry of a plea of guilty or nolo contendere. 4. I understand that an "affiliate" as defined in paragraph 287.133(1)(a), Florida Statutes. means: a. A predecessor or successor of a person convicted of public entity crime; or b. An 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, executives, 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 market value under an arm's length agreement, shall be a prima 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. 5. I understand that a "person" as defined in Paragraph 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 51 provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. 't'he term "person" includes those officers, executives, partners, shareholders, employees, members, and agents who are active in management of an entit _ 6. Based on information and belief, the statement which I have marked below is true in a relation to he entity submitting this sworn statement. (Please indicate which statement applies). .(.. Neither the entity submitting this sworn statement, nor any of its officers, directors_ xecutives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or any affiliate of the entity has been charged with and convicted of a public entity crime within the past 36 months. 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 within the past 36 months. AND (Please indicate which additional statement applies). 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 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 within the past 36 months. However, there has been a subsequent proceeding before a Hearing Officers of the State of Florida, Division of Administrative Hearings and the Final Order 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. (Attached is 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 1 (ONE) ABOVE IS FOR THE PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED AND FOR THE PERIOD OF THE CONTRACT ENTERED INTO, WHICHEVER PERIOD IS LONGER. 1 ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES, FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. City of •rS) t STATE OF FLORIDA Sworn and subscribed before me thisA day ofr -. .Q• ;�? F , 200 f y r; t �+ C' t `r P t' who is Personally known to me Or wfo produced identification - (Type of Identification) h d staff, .. '45 2 4 S:' 52 EXHIBIT G INSURANCE REQUIREMENTS FOR SUB- RECIPIENT PUBLIC FACILITIES & IMPROVEMENTS I. Commercial General Liability A. Limits of Liability Bodily Injury and Property Damage Liability Each Occurrence S300,000 General Aggregate Limit S600,000 Personal and Adv. Injury $300,000 Products/Completed Operations S300,000 Endorsements Required City of Miami included as an Additional Insured Contractual Liability II. Business Automobile Liability A. Limits of Liability Bodily Injury and Property Damage Liability Combined Single Limit/Split Limits Owned/Scheduled Autos S50,000i 100,000/50,000 Hired and Non Owned Autos S50.000/100,000 B. Endorsements Required City of Miami included as an Additional insured • An agency may request in writing the Waiver of this coverage in part or as a whole if: a) The agency does not own any vehicles b) The agency does not hire the services of a company to perform services for which the agency is being awarded the funding, and c) The agency does not allow employees to use their personal vehicle for business purposes. III. Worker's Compensation A. Limits of Liability Statutory -State of Florida B. Employer's Liability Limits of Liability S100,000 for bodily injury caused by an accident, each accident S100,000 for bodily injury caused by disease, each employee S.500,000 for bodily injury caused by disease, policy limit • NOTE: All certificates of insurance must be provided for review and approval prior to the effective date of the agreement. The above policies shall provide the City of Miami with written notice of cancellation or material change from the insurer not less than (30) days prior to any such cancellation or material change. Companies authorized to do business in the State of Florida, with the following qualifications, shall issue all insurance policies required above: The company must be rated no less than "A" as to management, and no less than "Class V" as to Financial Strength, by the latest edition of Best's Insurance Guide, published by A.M. Best Company, Oldwick, New Jersey, or its equivalent. All policies and /or certificates of insurance are subject to review and verification by Risk Management prior to insurance approval. EXHIBIT H INSURANCE REQUIREMENTS GENERAL CONTRACTOR PUBLIC FACILITIES & IMPROVEMENTS I. Commercial General Liability A. Limits of Liability Bodily Injury and Property Damage Liability Each Occurrence General Aggregate Limit Products/Completed Operations Personal and Advertising Injury B. Endorsements Required S 1.000,000 $ 2,000,000 $ 1,000,000 $1,000,000 City of Miami included as an Additional Insured Sub-recipient/agency included as an Additional Insured Employees included as insured Independent Contractors Coyerage Contractual Liability Explosion, Collapse and Underground Hazard Loading and Unloading II. Business Automobile Liability A. Limits of Liability Bodily Injury and Property Damage Liability Combined Single Limit Any Auto/Scheduled Autos Hired & Non -Owned Autos B. Endorsements Required S 1,000,000 S 1,000,000 City of Miami included as an Additional Insured Sub-recipient/agency included as an Additional Insured III. Worker's Compensation A. Limits of Liability Statutory -State of Florida Waiver of subrogation B. Employer's Liability Limits of Liability $$1,000,000 for bodily injury caused by an accident, each accident. $1,000,000 for bodily injury caused by disease, each employee $1,000,000 for bodily injury caused by disease, policy limit V. Umbrella Policy A. Limits of Liability Bodily Injury and Property Damage Liability Each Occurrence $ 1,000,000 Aggregate $ 1,000,000 VI. Payment and Performance Bond- City of Miami and Sub-recipient/agency included as obligees. VII. Builders' Risk Causes of Loss: All Risk -Specific Coverage Project Location Valuation: Replacement Cost Deductible: $2,500 All other Perils 5% maximum on Wind City of Miami and Sub-recipient/agency included as an Additional Insured A. Limit/Value at Location or Site $ B. Coverage Extensions: • Materials, supplies and similar property owned by others fcr which you are responsible. • Full coverage up to policy limits for equipment breakdown. • Temporary storage/transit coverage. • Full coverage up to policy limits for site preparation, re - excavation, re -preparation and re -grade in the event of a loss. • Fences, scaffolding, construction forms coverage and signs • Valuable papers coverage for blueprints, site plans and similar documents. • Trees, shrubs, sod, plants while at premises. • Flood, including inundation, rain. seepage and water damage. • Earthquake • Business Interruption • Subsidence o Nev ordinance or law; reimbursement for any resulting loss of value to the undamaged portion, and required demolition expenses, including construction necessary to repair, rebuild or re -construct damaged parts. • Escalation clause in the event of a total loss up to 5% of policy limit. • Temporary stnictures, cribbing and false work built or erected at construction site. • Unintentional errors and omissions in reporting clause • Full coverage up to policy limits for testing including physical loss caused by pneumatic and hydrostatic testing. • Debris Removal. NOTE: CERTIFICATES OF INSURANCE MUST BE SUBMITTED BY THE GC FOR REVIEW AND APPROVAL PRIOR TO START OF THE PROJECT • The above policies shall provide the City of Miami with written notice of cancellation or material change from the insurer not less than (30) days prior to any such cancellation or material change. Companies authorized to do business in the State of Florida, with the following qualifications, shall issue all insurance policies required above: The company must be rated no Tess than "A" as to management, and no less than "Class V" as to Financial Strengtb, by the latest edition of Best's Insurance Guide, published by A.M. Best Company, Oldwick, New Jersey, or its equivalent. All policies and /or certificates of insurance are subject to review and verification by Risk Management prior to insurance approval.