HomeMy WebLinkAboutRequired AttachmentsREQUIRRED ATTACHMENTS
THE SCHOOL BOARD OF MIAMI-DADE COUNTY, FLORIDA
PROCUREMENT MANAGEMENT SERVICES
1450 N.E. 2ND AVENUE, MIAMI, FLORIDA 33132
REQUEST FOR PROPOSALS NO. 056-G G 10
SUPPORTED EMPLOYMENT SERVICES FOR THE EDUCATION OF STUDENTS
WITH DISABILITIES
Sealed proposals will be accepted in Procurement Management, at the above location,
until 2:00 P.M. (Local Time) May 3, 2007, and may not be withdrawn for one hundred-
twen ty (120) days from that date.
ANTI -COLLUSION STATEMENT
THE UNDERSIGNED PROPOSER HAS NOT DIVULGED TO, DISCUSSED, OR
COMPARED HIS PROPOSAL WITH OTHER PROPOSERS AND HAS NOT COLLUDED
WITH ANY OTHER PROPOSER OR PARTIES TO THE PROPOSAL WHATSOEVER.
PROPOSER ACKNOWLEDGES THAT ALL INFORMATION CONTAINED HEREIN IS
PAR T OF THE PUBLIC DOMAIN AS DEFINED BY THE STATE OF FLORIDA SUNSHINE
LAW.
CERTIFICATION AND DENTIFICATION FOR PROPOSERS SUBMITTING PROPOSALS.
1 certify that this proposal is made without prior understanding, agreement or
connection with any corporation, firm or person submitting a proposal for the same
service, and is in all respects fair and without collusion or fraud. 1 agree to abide by
all conditions of these proposal specifications and 1 certify that I am authorized to
sign this proposal.
(Please Type or Print Below)
LEGAL. NAME OF AGENCY OR
CONTRACTOR SUBMITTING PROPOSAL: Easter Seals South Florida, Inc.
MAILING ADDRESS: 1475 NW 14th Avenue
CITY STATE, ZIP CODE: Miami, FL 33125
TELEPHONE NUMBER: 305.325.0470
BY: SIGNATURE
BY: TYPED Wayne Morgan
TITLE: Vice President/CFO
SUPPORTED..EMMPLO.YMENT SERVICES;FOR...T.FIREDUCATION:::
OF STUDENTS. WITH DISABILIT ES'
r
ATTACHMENT B
PROPOSER'S FEE AND CERTIFICATION OF HOURS OF SERVICES
PROPOSER'S FEE
Hourly Fee . 35 _ Qfl
LEGAL NAME OF AGENCY OR CONTRACTOR SUBMITTING PROPOSAL:
Easter Seals South Florida Ino
AUTHORIZED SIGNATURE:
NAME.TYFEI}:, Wayne Morgan
Pier:
N:: Vice President/CFO
Evelys Miura,.Coordinator..
ProjectACCEPr`:''
Miami Dade College
InteaMmerican. Campus,. Room.1112.
627 SIN 27.Avenue,
Miami, FL 33135
(305) 237-6649 Phone: (305)237-6651 Fax
Email: Projectaccept@a aolcom
April 24, 2007
Re: Easter Seals Supported Employment Services
To whom it may concern,
This is a letter of supporton behalf of Easter Seals Supported Employment Program's cooperative
agreement with Miami Dade County Public Schools. I have been involved with Easter Seals for the
past 10 years through their job coach services. My students have gained a wealth of information and
have benefited trememdously by their efforts to make employment a part of their daily lives. I am a
belkverthatalkindi4idualwith,andiwithoutudisabilities,needsuppc0 i uthei ; j;obs, antiwithoutthe•heI .
of seer Segill v env'.. r :-pc sr1 s.. ,Ms T :.; •P fk, oh ' j ani a
true pa ck of p seh s eess and rn stude to $ : e+c a as; possibIe;. i° .t t
my students have received ,adequate and, satisfactory. services.from Easter Seals.an& therefore• is support
them: in their quest to- continue serving. our students°;.
As always it will be be my pleasure to answer any questions in support of Easter Seals Supported
Employment program.
Sincerely,
Evelys P. Ubiera
PthjectAGt FT' Teacher-
Apri124, 2007.
To. Whom It May Concern:
The Job Coach Program provided through Eastern Seals is of great benefit to our
students. The staff is wonderful to work with. They are always willing to provide the
best assistance to our students.
It is important that this program continue as it benefits the students at Miami Senior High
School.
Sincerely,
KiW
Keila L. Morales
SPED Departrnent.Chairperson
Miami Senior High School
2450 SW 1st Street
Miami, FL 33135
Ms. Coglin
1200 NW 6* ave
Miami, F1.33136
April 25, 2007
Dear Sir:
It is with great pleasure that I write a letter of acknowledgement for Easter Seals
Supported Employment Program's cooperative agreement with Booker T. Washington
High School.
Ms. Sanchez has always displayed a high degree of integrity, responsibility, and
ambition. She is definitely a leader; I have worked very close with her assisting my
studentsin job placement She is: also, a me st:dep ndable teanrplayer: Her good judgment-
and mature outlook ensure a Logical and practical approach to her endeavors. Ms.
Sanchez works diligently in placing students with various employers. For further
questions regarding Ms. Sanchez, feel free to contact me @ 305 324-8900 ext2276.
ially,
Ms. Coglin
April 24, 2007
t
To. Whom It May Concern.:
The Job Coach Program provided through Eastern Seals is of great benefit to our
students. The staff is wonderful to work with. They are always willing to provide the
best assistance to our students.
It is important that this program continue as it benefits the students at Miami Senior High
School.
oana Alvarez
SPED Department. Data Input Specialist
Miami Senior High School
2450 SW lst Street
Miami, FL 33135
April 24, 2007
r
To Whom It May Concern:.
The Job Coach Program provided through Eastern Seals is of great benefit to our
students. The staff is wonderful to work with. They are always willing to provide the
best assistance to our students.
It is important that this program continue as it benefits the students at Miami Senior High
School.
Sincerely,
ZH ika A. Santos -Gonzalez
SPED Program. Specialist;
Miami Senior High School
2450 SW 1s` Street
Miami, FL 33135
April 27,.20.07.
To Whom It May Concern:
This letter is to confirm that Mr. Reza Pourmashia visits our store at Pizza Hut on a regular basis
trying to assist and secure the job opportunities for his clients. Furthermore he has been
extremely generous with his time staying with his clients that are currently employed in our
establishment for long hours. Making certain to the best of his abilities that his clients as well as
store management team are mutually satisfied with their employee/employer relationship.
It is my honor and extreme pleasure to assist Mr. Pourmashia in his humanitarian and
professional efforts towards helping otheryoung men and womerr who are in need'of assistance.
It has been a wonderful experience during the past year that I have had the pleasure of associating
with Mr. Pourmashia and I must say that he is a rare example of tremendous work ethic,
sacrificing, compassion and kindness towards others.
Please feel free to contact me for any questions that you may have at (305) 247-6100.
incerely Yours,
) Anr Maiat:;
General' Manager
Pi77a Hut
Homesteadr_Fl.
u Y. ♦. + . • ......
14h iri-aide Cr.J itity Public Sc;i,00ls
S osrinlendent ottchoois:
Pido4ldh ff Crow, EdD.
Assl+ednK Superintendent
birds
Adrnlntsbadw Director
V !IY Gonfilto
Instructional Supervisor
J, Y B+rookner
April 27, 2007
To Whom This May Concern,
Mieml-o ds Cour t sahooI $os d
Agustin J. Bar►et% Chair
Dr. Mvbn Karp, Vice Char
Reeder Diu der is PordMa
Evelyn Lsootieb Gager,
Perm Tabsroe Hentrnen
Dr. Robert E. Ingram
Ane Rivas Logan
Dr. Mans Perez
Dr. Salomon C. Stinson
t am'writing° an beha of Mr: Reza Pot rrneeins Employment Speciai for E wasuSeelal Sabin > Serxiaes. t.fie.,
had the pleasure of waiting with Mr. Pourinasiha over the past live months in his position as a job coach for students
with significant cognitive disabilities as South Ridge Senior High School and Homestead Senior High School. During
this time, Mr. Pounnasiha has attended W,d vidual Educational Program (IEP) meetings for supported employment
candidates and provided an explanation of the Program b parents/guardians. In addition, Mr. Pourmaelha has
C• x �ji =-,arts.:: sxe i tine, a:: jpb:�;; .:.and: ,/t��ee�n supp�orti(v�e _ is .them due � ..atfe>-: in y��prvvws
f {dr yy .; 10R':i' �yji� is :1 jam, `amploy� rt Ot ' :R�k;>`r4i.a . ,y - Yft 11418"t.�e`;.`
suozessin
As a Transeba SUpportreactier +4igt Mist der COuntylkitielditiokthavistackthalopportixdpidkleirtic
Pounnaeitteinteract-with oYX` tudertts-artd'.IE:bthngs,-ms'gr+set=pleats,aas Atiehappineasatld,; :Ot,,
our students invchtteti rt: the .Suppot Empk ymar t..Ptt grams ,t to pleasurst tohaveW-pourrnaalhassamernber;
of our team ded{cated bwarda the education and success of our student
LatootwErocinkiZEOK
Transition Support Teacher,
Miami Dade County Pubic School
DMs on.at Sperm -Ede..
Y. t.' wi " E7t' :r r •r-tiaffrk_ '. 131!. !it..
305'915.1796 • Fix 3059115:1FStYy-eses c erst
NOV-3-2004 10:26P FROM:
TO:3055474731 P.2/
Carlos S. Contreras, M.D.
1344 S.W.150 Avenue
Miami, Florida 33194
May 2, 2007
RE: Mrs. Azam Farzaneh
Employment spedalist
r
To whom it may concern,
We are writing this letter to commend Mrs. Farzaneh for the
magnificent Job she has done in her position as an employment specialist particularly with
respect to our son Joshua. Mrs. Farzaneh allayed our fears about allowing our son to work for
an hourly wage as a tax paying citizen. She has greatly helped our Down's Syndrome son,
Joshua E. Contreras from Braddock High School, by having assisted him in obtaining a job at
Pubkx Supermarket located on Miller Drive and 157t Avenue. He has been happily working
there for almost three years now. Mrs. Farzaneh was a very sweet, kind, and loving influence on
our son. Joshua loves his job, and he always looks forward to going to work. It is remarkable the
smooth, and professional way in which Mrs. Farzaneh performs her job. She has always been
on time in response to any of our queries, smiling and cooperative. Imagine, we shall never
forget her. Joshua always speaks about her. We are very happy we met her. She has been a
very special, and positive influence In our family, but particularly so in Joshua's life. We highly
recommend Mrs. Farzaneh.
Thank you. God bless you. Have a pleasant day.
0/, 7147 1/�r1�
rhos and at ��'-�
Miami -Dada County Public Schools
Prirfcipal Miami -Dade Col/my School Board
James R Haj .gus'trn J Barrera. Chair
Peria 7-abates Hantrnan Vice Chair
April 26.2007
To Whom It May Concern:
Frank „I. Bohai{os
Evelyn Langlieb Greer
Or Robert B Ingram
Cyr Martin Karp
Ana Rivas Logan
Dr. Marta Perez
Dr. Solomon C. Stinson
Superintendent of Schools
Rudolph F. Crew_ Ed D
I would like to express to you my appreciation of the work done by the
Employment Specialist for our school, Azam Farzaneh. She has worked hard to place our
students in supported employment throughout the year. When managers have stacks of
applications to consider, she gets our student's applications on top. It's not easy to
persuade employers to hire the handicapped, but she is able to do it. She was able to
explain our program and type of clients to gain empathy and acceptance from them. She
has gone out of her way to get our students the hours they prefer and the best job
locations to please both parents and employers.
She works well with parents also. She sets up interviews, trains new workers and
smooths out any trouble areas that may arise between employers, employees and parents.
We have parents waiting for their child to turn eighteen so that she can place their child
in a job, too. She has attended I.G. P. meetings to discuss future. job placements. She has
been there to answer questions from parents regarding how supported employment
works.
We are happy to have Ms. Azam as part of our team and look fomard to working
with her next year.
Sincerely,
Celeste C. Sadler
ESE Teacher, Southwest Miami Sr.
SOUTHWEST MIAMI SENIOR HIGH SCHOOL
RRW .5fth TPrrar:A. • Miami Florida 33165
.: , tirf a(,f/(i
Principal Miami -Dade County School 8o3rd
lames R. Ha) Agustin J. Barrera. Chair
Pena i abares Hantrnan. Vice Chair
Frank. l Bolar os
Evelyn Lariglieb Greer
Dr Robert B ingrain
Dr. Martin Karp
Ana Rivas Logan
Dr. Marta Perez
Dr Solomon C Stinson
Superintendent of Schools
Rudolph F Crew Ed C°
April 27. 2007
To whom it may concern,
l am writing this letter on behalf of Ms. Azam-Farzaneh for her role in training and
finding employment for our mentally handicapped students. Ms. Azam has had
success in matching students with an appropriate job. As a result of these jobs,
our students have good self esteem, improve their employment skills, and are
able to make money.
Sincerely,
Lourdes Luis
ESE Teacher
SOUTHWEST MIAMI SENIOR HIGH SCHOOL
ocgt; c IA.' Gntl. - AR:.,..,: Ct:..:, !-. 0424i:G
Principal
James R Ha]
April 26, 2007
To Whom It May Concern: -
Miami -Dade County School Board
Agustin J. Barrera, Char.
Peria Tabares Hantman Vice Char
Frank J. Botatio.s
Evelyn Langtieb Greer
Dr Robert B. Moran?
Dr. Martin Karp
Ana Rivas Logan
Dr. Marta Perez
Dr SolOnOn C Stinson
Superintendent of Schools
Rudolph F Crew. Ed D
Please allow this letter to serve as a formal commendation for Azam Farzaneh. Here at
Southwest Miami Senior High, Ms. Farzaneh has shown great dedication in obtaining
employment for students with disabilities. Her efforts have lead to the successful
placement of a number of students in the Special Education department at our school.
She goes beyond the normal call of duty by establishing and maintaining contact with
clients and their parents, in addition to the constant solicitation of employers to provide
job opportunities to those often left out of the job maket. Ms. Farzaneh's personal
compassion and love for those with disabilities is a key factor in her successes and
without her our program wouldn't be as successful as it is today.
Please let it be known that Ms. Azam Fa.rzaneh's services are greatly appreciated and
well needed here at our school.
Respectfully yours.
I
Molina Paraskeva Perez. Special .Education Program Specialist
Southwest Miami Senior High
Principal • Miami -Dade County School Board
James R Haj Agustin J Barrera. Charr
Perla TabaresHantman. Vice Chair
Frank J Bolarios
Evelyn Langlieb Greer
Dr Robert B Irngra.m?
Dr. Martin Karp
Ana Rivas Logan
Dr Marta Perez
Dr. Solomon C Strnson
Superintendent of Schools
Rudolph F Grey}, Ed 0
April 26. 2007
T'o Whom It May Concern:
I have had the opportunity to work with Mrs. Azam Farzaneh for four years. She
has worked hard to find jobs for our students and give them on -the _job training. The
students are happy at their_ jobs and are learning social skills and independent Ii8ving
skills. We see a growth in their maturity and a high level of self-esteem. The parents
appreciate the job she does because now they know what their child will do when they
complete their education. This is a great service to the community and an essential
element in our students all around development.
Sincerely,
r
Agustin Grana
S'i'El) "I.eachcr
r. A.I * ''I IN•/r OR RP. .<[ a ..e /fi r•. e. .... • .... —. ..— —.
Principal
James R Haj
April 26.2007
To Whom It May Concern:
Miami -Dade County Public
Miami -Dade County School Board
Agustin J Barrera. Chair
Perla Tabares Hantman. Vice Char
Frank J Balerlos
Evelyn Langtieb Greer
Dr Robert 8 Ingram
Dr Martin Karp
Ana Rivas Logan
Dr. Marta Perez
Dr Solomon C Stinson
Superintendent of Schools
Rudolph F Crew Ed C
Azam Farzaneh has been instrumental to Southwest Miami Senior special diploma
students. Through her endless efforts,.she has obtained entry level jobs for our students
and provides a liaison between employer, parents, student and school. Her determination
and persistence has assisted many of students finding employment.
We are extremely grateful for commitment and efforts.
Sincerely. /'
Marlene Espin
}
Cf)I Fri-11AI= T MI 1! API CCitties In LJSP'LI ts" e et A
April 27, 2007
To Whom It May Concern:
This is to inform that I know Mrs. Azam Farzaneh about three years. Mrs. Farzaneh is
Employment Specialist at H. G. Braddock Senior High School and her duties are to work
with kids that belongs to TMH Program "Trainable Mentally Handicap" - ESE Students
(Exceptional Students Education). Mrs. Farzaneh, helps these special students to get jobs
and follow up with students to give them support in the different activities that they may
have. When these ESE students have a job they joint and interact with their community
and the same job helps them to be more independent and grow up themselves.
Mrs. Farzaneh is a very responsible, cooperative and professional, I think she will be an
asset for any person who requires her services.
Sincerely,
La7aro . Buchillon
ESE T acher
April 25, 2007
'Po whom it may concern:
I woad like to thank our employment specialist, Azam Farzaneh, for her work with
our ESE students. She is continuously helping our students find employment in the
community and making sure they are successful. It is not an easy task to find jobs for our
students but Ms. Azam gets the job done. She is there with our students every step of the
way until they are placed at a work site. She is always in communication with the
parents, teachers, and managers in order to provide our students with a smooth transition
into the work world.
She makes sure to meet with the parents and explain how supported employment
works and how it benefits their young adult. She is also present at I.E.P. meetings to
discuss future job placements. Thanks to her efforts and dedication, our students acquire
the work skills needed to maintain a job and gain a sense of independence and self-worth.
Sincerely,
asmina Rios
ESE Teacher
Braddock Senior High
April 25, 2007
To Whom It May Concern:
Ms. Azam Farzaneh and I have worked together for the past 17 years. She is a person who has always been
patient and she has worked patiently with the students and their parents. She has worked very hard to make sure
that the Moderately Mentally Handicapped young adults at Braddock, Killian and Southwest Senior High
Schools are placed into the community for employment. Ms. Farzaneh is a person who always follows through
and she makes an effort to make sure that the young adults are trained properly for employment. Throughout
the years she has been a great asset to these programs.
Should you require further information, please feel free to contact me.
Sincerely,
N 1_
Rua Ingram
Transition Support Teacher
r
To Whom it May Concern:
Miami 04/26/2007
Publix Supermarkets
7805 SW 40 ST
Miami Florida
Mrs Azam Farzaneh, an employment specialist, for the Supported
Employment Program has been directly working with me for the last four years.
In the years that I have worked with her, Mrs. Farzaneh has brought to my store
excellent associates. She has been able to adapt each associates strengths with the
needs of the store by placing them in the proper job classes. Throughout the time
that the associates have been working with us she has consistently checked up and
made sure that each associate is doing what Publix stresses, mainly providing
premier Customer Service. Mrs. Farzaneh is always available for any questions or
concerns and deals with any situation in a very professional and correct manner.
Mrs Farzaneh is not only an asset to the company, but she cares a lot about
her students/associates, always willing to go the extra mile for her company and
for Publix.
Any questions or concerns you may contact me at (305)266-1950.
SirfberelyZ
Store Manager
Store # 44
t,
305.27 ;-82G2
litiogdo awe 7/(4414 Z. Roor.guep
9103.Soadaaeae 7Q ,7
iayu, e0 da -33r73
May 1, 2007
Re: Mrs. Azam
Employment Coordinator
-To WHOM IT MAY CONCERN:
Our twin boys, Keith and Kenny entered Southwest High School as freshmen. They
AI be graduating this year. Before meeting Mrs. Azam, and entering the program, both
goys had fears, worries and insecurities about working. After speaking to Mrs. Azam, she
was able to provide accurate and necessary information regarding the current job market,
and other information regarding' the program. Mrs. Azam was successful in placing our
boys in the right job for them with Publix. Since they have been employed at Publix the
boys have become responsible, they now have a sense of duty and have demonstrated
a desire to continue working. This could not have been possible without Mrs. Azam's
guidance, expertise and help. Mrs. Azam is a skillful professional. She provides the
children with step-by-step advice from the point of filling out an application, -through the
interview process. She counsels the children as to what is precisely expected of them at
their jobs, and the manner in which they are to conduct themselves.
. I believe that Mrs. Azam is responsible for having prepared my boys for the real
world by placng them with a job that they are able to do. She has contributed to building
the foundation to assist in making the children feel productive and confident. The job
interview process and getting a job for the first time is a very difficult process for anyone,
but especially so for children with disabilities. Mrs. Azam possesses the skill, knowledge
and dedication to carry out her responsibilities which produces successful results.
As parents of twins with disabilities, we urge that this program continues for
purposes of assisting other students and other families. Mrs. Azam's expertise and
dedication makes this program a success. Our family is an example of such success and
we are very grateful to the program, and especially to Mrs. Azam.
Sincerely,
Maria E. Rodriguez
04/30/2007 13:52 305-643-7618 ST FL VOC REHAB
PAGE 02
FLORIDA DEPARTMENT OF EDUCATION
STATE BOARD OTmUCAT1O11
T.WeZt.ARQTAIR,Oralry w
Aar
DQTYA CILCALLAWAY
t1LAZIWYDUIM
AO11O1MAR71,EZ
flBC*IAu mor
KA7appr1lli1KAMIK
LIMA Llanelli
May I, 2007
To Whom it May Concern:
Jambe lamikat
Coorialiihoper •rr
The Division of Vocational Rehabilitation has fired with Taster Seals South Florida for many
years to deliver supported employment services to developmentally disabled students and recent
graduates. This relationship has resulted in the successful placement of may developmentally
disabled individuals and will, hopefully, be responsible for many more in the years to come.
Sincerely,
Vocational Rehabilitation Consultant
1nArrALOPR
Director. rad ion R habrampon ..
2002 Okl Said Augustine Road, Building A • Tallahassee, PL. 32301.48e62
Toll Free: 1-800- 451-4327 (Vos a or TTY) • In TNhhassee: 8504245.3398 (Voice or TrY) • FAX 850-245-3302
Florida Relay Service: 1-804-055-8771 (TTY) • 1-800-955-8770 (Vote) • www.rehebwori s,org
April 26, 2007
Easter Seals
To whom it may concern:
By this means, I would like to recommend Reza Pourmasiha for any future
professional opportunities. During the 2006-2007 school year, he was our
job coach at Homestead Senior High. He has assisted over six students in
the initial employment process. He also trained many of our students at the
job site. We currently have two students that are holding paying jobs in the
community. Reza closely monitors their progress and is in touch with the
managers. He informs me of any difficulties or progress of the student at
their employment site.
He is very dedicated to the acquisition of jobs within our community for our
mentally handicapped population.
If you should have any questions, please contact me at 305-245-7000 ext.
2279.
Sincerely,
00-111.L
Ms. Elaine Abreu
Homestead Senior High
TMH Teacher
Principal Miami -Dade County School Board
James R. Haj Agustin J Barrera. Chair
Perla Tabares Hantman. Vice Chair
Frank J Botanos
Evelyn Langl,eb Greer
Dr Robert B. ingrarn
Dr Martin Karp
Ana Rivas Looan
Dr. Marta Pere.
Jr Solomon C Stinson
Superintendent of Schools
Rudolp?? F EC
April 25. 2007
To Whom It May Concern:
The Southwest Miami High School TMH Program is happy with the work that Mrs.
Azam Farzaneh is doing for us. Mrs. Farzaneh always finds employment for our students
and makes sure there is a link between the employer. the home and the school. She is
always asking about new students to find employment for and is concerned about their
well being.
Mrs. Farzaneh is a great asset to our program and the students it serves.
Sincerely.
John P, Woodward
Special Education Teacher
(SPED)
SOUTHWEST MMIAMI SENIOR HIGH SCHOOL
OOS t, C SA, j:rlth ?'2144
Dr. A. Cielesz
TMH Teacher
Braddock Senior High
3601 S. W. 147t Avenue
Miami, FL 33185
April 25, 2007
To Whom It May Concern:
r
Re: Mrs. Azam Farzaneh—Employment Specialist
I have known Ms. Farzaneh and worked with her these past three years at Braddock
Senior High. She has successfully placed Trainable Mentally Handicapped students in
part-time jobs at Publix.
If there are any questions, or if I can provide any further information, please call me at
Braddock Senior High 305-225-9729.
Sincerely,
IYZ�.
Dr. A. Cielesz
TMH Program
Van
CIA. 590722783
419
4
nformaatio r . ee ,. .
Federal Employer Identification Number
Or
Owner's Social Security Number
Easter Seals South Florida, Inc.
Name of Firm, Individual(s), Partners or Corporation
1475 NW 14th Avenue
Street Address
Miami, FL 33125
City
State Zip Code
3. Ownership Disclosure
ATTACHMENT C
2. Telephone/Fax/Contact Person
305.325.0470
Telephone number
305.325.0578
Fax number
Wayne Morgan
Contact Person
wmorgan@sfl.easterseals.com
E-mail address
If the contract or business transaction is with a corporation, partnership, sole proprietorship,or joint venture, the full legal name
and business address shall be provided for the chief officer, director, or owner who holds, directly or indirectly the majority of the
stock or ownership. 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.. Post Office; addresses are not acceptable.
-
Name
Title
--r-
Address Gender
Race, •
ethnicity', :Steck Ownership.
NOTE: The information provided by the vendor on this form should be consistent with that provided on the "Vendor's
Application". All vendors must have a current vendor's application on file with M-DCPS, and have provided information and/or be
familiar with M-DCPS' policy regarding the following: (a) Employment Disclosure, (b) Drug Free Workplace, (c) Family Leave
Policy, (d) Code of Business Ethics, (e) Conflict of Interest, (f) Perception, (g) Gratuities, and (h) Business Meals. Failure to
provide M-DCPS a current vendor application may cause the vendor not to be awarded arty new business with M-DCPS.
Vendor applications can be downloaded at hilp:/fprocur•ement. dadeschoots.rLet
Occupational Category
President/CEO
President Asst
Human Resources
AFFIRMATIVE ACTION
EMPLOYMENT BREAKDOWN
ATTACHMENT D
Race/Ancestry
Non- Non- Am. Ind.]
Gender Hispanic Hispanic Alaska
Male Female White Black Hispanic Asian Native
Biller 3 1 2
Receptionist
Controller
Vice Pres Finance
HR Aide 1
Acct Payable 1
Acct Receivable
FM-4859 Rev_ (02-01)
Occupational Cate jory
ADC Director
ADC Prog Coord
ADC Activities Dir
ADC Activities Aide
AFFIRMATIVE ACTION
EMPLOYMENT BREAKDOWN
Race/Ancestry
Non- Non -
Gender Hispanic Hispanic
Male Female White Black Hispanic
1 1
ADC Clerk 1
ADC Clerical Aide
2 2
1
ADC Companion 6 1 5
ADC Driver
1 3
4
ADC LPN 2 1 1
ADC Nursing Asst
1 28
4 25
ADC Respite Wker 12 2 10
ADC Secretary 1 1 2
ADC Social Worker 2 1 1
ATTACHMENT D
Asian
Am. Ind./
Alaska
Native
FM-4869 Rev. (02-01)
v.rdy;Ow
Occupational Category
Development Dir
AFFIRMATIVE ACTION
EMPLOYMENT BREAKDOWN
ATTACHMENT D
Race/Ancestry
Non- Non- Any. ind.J
Gender Hispanic Hispanic Alaska
Male Female White Black Hispanic Asian Native
Development Rec 1 1
Event Coordinator
Out of Sch Dir
Tutor
2 2
Tutoring Coord 2 1 1
Greeter 1 1 1 1
Operations Dir
Operations Maint
OMR Director 1
OMR Off Mgr
OMR Reauth Coord 2 1 1
Speech Therapist 2 1 1
Occupational Therapist
1
FM-4869 Rev. 102-01)
���a� �auay�i3�;i sw'xerc
Occupational Category
OMR Receptionist
Voc Svs Dir
Voc Svs Asst Dir
Voc Case Manager
Voc Program Asst
AFFIRMATIVE ACTION
EMPLOYMENT BREAKDOWN
ATTACHMENT D
Race/Ancestry
Non- Non- Am. Ind./
Gender Hispanic Hispanic Alaska
Male Female White Black Hispanic Asian Native
2 1 1
Voc Evaluator 1 2 2 1
Employment Spec
Living Coach
2 5 1 1 3 2
SIS Counselor 2 2 4
Voc Technician 1
Voc Admin Asst 1 1 2
1
,11
FM-4859 Rev. (02-09 )
mkilf erData Co rrf y,t4714'.r'.;^ous
Occurmtionat Category
MEPS Lunch Worker
School Chef
AFFIRMATIVE ACTION
EMPLOYMENT BREAKDOWN
Race/Ancestry
ATTACHMENT D
Non- Non- Am.Ind./
Gender Hispanic Hispanic Alaska
Mate Female White Black Hispanic Asian Native
2 2 1 3
1- 1
School Drivers 7
School Teachers
3 4
6 1 1 4
Sch Teacher Asst 6 2 4
School Asst 4 2 2
School Aide 4
School Secretary 2
School LPN
Sch Social Wker
Sch Maintenance
Med Rec Secretary
Sch Principal
4
2
1 2 2 1
FM-4859 Rev. (O2-011
OccuDationni Category
President/CEO
President Asst
Human Resources
AFFIRMATIVE ACTION
EMPLOYMENT BREAKDOWN
ATTACHMENT D
Race(Ancesuy
Non- Non- Am. Ind./
Gender Hispanic Hispanic Alaska
Male Female White Black Hispanic Asian Native
1 1
Biller 3 1 2
Receptionist
Controller 1
Vice Pres Finance
HR Aide
Acct Payable
Acct Receivable
. ..«.0,.
eIrroNirliWowilEVIPAP
1
Mow�,sr«��1
FM-4859 Rev. (02-01)
Miami -Dade County. Public. Schools
WORN STATEMENT - NEW CONTRACTS
ATTACHMENT E
SWORN STATEMENT PURSUANT TO SECTION 1012.465,
FLORIDA STATUTES AS AMENDED BY
HB 1877, THE JESSICA LUNSFORD ACT
THIS FORM MUST BE SIGNED AND SWORN TO IN 1I1E PRESENCE OF A NOTARY
PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
1. This sworn statement is submitted to The School Board of Miami -Dade County, Fl
(Hereinafter "Board" or "School Board") by Wayne Morgan
Vice President/CFO
(Print individual's name and title)
for Easter Seals South Florida, Inc.
(Print.Tarr : entity:subi g.swont..stat enti)
whasnbasimmsaddiessig 1475 NW 14th Avenue Miami, FL 33125
and its Federal Employer Identification Number (FEIN) is
590222783 . If the entity has no FEIN, include the Social Security
Number (SSN) of the individual signing this.. sworn.. statementand..so. indicate..
Wayne Morgan, Vice President/CFO it.
L .... d i£I`ikai..?�ii✓e'?l:k' `ir �!w`rSL"i rI:
(Print individual's name and title)
sworn statement on behalf of Easter Seals :South Florida, Inc.
(Print Name of entity submitting sworn statement)
3. I tuiderstandihatdMingthe2005 Legishtive.S sign ; libudeBINI877, TheiessicaLunsford,
Act fitereinafter"The Act'` or ":: -17y was; passeland?:a vo .by Go erimaF Phsh.onMay..
2, 2005, with: an, effective date• of September I,. 2005
Initials
Page 1 of 3
FM-6910 (08-05)
4. I understand that . the. Act amends the .background screening .requirements of section
1012.465, Florida Statutes (2004) for all non -instructional school district employees or
"contractual personnel" by requiring all non -instructional school district employees or
contractual personnel who are permitted access on school grounds when students are present
to undergo and pass "level 2 background screening," and furtherI understand the Act defines
"contractual personnel" to include any vendor, individual, or entity under contract with the
Board.
5. I understand that pursuant to section 1012.465, Florida Statutes as amended by the Act, non -
instructional school district employees or contractual personnel who are permitted access on
school grounds when students are present, who have direct contact with students or who
have access to or control of school funds must meet level 2 screening requirements as
described in sections 1012.32 and 435.04, Florida Statutes.
6. I understand that as a Non Profit (eg. a private bus
Type of entity
service contractor) all contractual personnel, as defined in section 1012.465, Florida
Statutes, must meet level 2 screening requirements as outlined in sections 1012.32
and 435.04, Florida Statutes in order to do business with The School. Board. of
Mann- :. Cc unty, Fliorirla W.:
7. I understanctiv&olewelt'` st-zeetiiiig.reepinMsPsot,277 as. + r i a >a& I.012 3-2..':°a .
435:04; FictridaStanttesmeansthat.friagerprintzrofatlznntraetaakperscsuaekmttstbeohtainetk,
and submitted.tottte-F-1.orrdaDepartmentafLawEnfacementotstate.processingand to :the
Federal Bureau ofliiuest gation.-for federalproeess g: ,
8. I understand that the School Board will implement local procedures to comply with level 2
screening requirements, as defined in sections 1012.32 and 435.04. I understand that my
company must comply with these local procedures as they are developed.
I ur erat :i; i. s .arr *i /W ', > � x aZ •
10. I understand that any personnel of the contractor found through fingerprint processing and
subsequent level 2 background screening to have been found guilty of, regardless of
adjudication, or entered a plea of nolo contendere or guilty to any offense outlined in Section
435.04, Florida Statutes (or any similar statute of another jurisdiction), shall not be permitted
to- come onto: school groulids.or.a lease&ses wh school- ti activities are
tal g•pll ~e.whemstudents are preserrk shalinotbe p tt tdi ct cr r ctwit steden
and shall not be permitted to have access. to school district -fiends°
kJ
Initials
Page 2 of 3
FM-6910 (08-05)