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Home My WebLink AboutAPPENDIX AFFIDAVITSAPPENDIX AFFIDAVITS FORMAL BIDS MIAMI-DADE COUNTY BID NO.: 7543-5/14 MIAMI-DADE COUNTY BID AFFIDAVITS • DISABILITY NONDISCRIMINATION AFFIDAVIT (Resolution R-385-95) I, being duly first sworn, state that this 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 contract 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. The Americans with Disabilities Act of 1990 (ADA), Pub. L. 101-336, 104 Stat 327, 42 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 • MIAMI-DADE COUNTY DEBARMENT DISCLOSURE AFFIDAVIT (Ordinance 93-129) See Section 1 (1.3H) I, being duly first sworn, upon oath deposes and says that the bidder of this contract or his agents, officers, principals, stockholders, subcontractors or their affiliates are not debarred by Miami -Dade County. • MIAMI-DADE COUNTY COLLECTION OF TAXES, FEES AND PARKING TICKETS AFFIDAVIT (Ordinance 95-178) Section 1 (1.3 E) 1, being first duly sworn state that in compliance with the procedures contained in Section 2-8.1(c) of the Code of Miami -Dade County, and as amended by Ordinance 95-178, this firm hereby certifies that the foregoing statements are true and correct. That all delinquent and currently due fees or taxes (including, but not limited to, real and personal property taxes, convention and tourist development taxes, utility taxes, and occupational license taxes) collected in the normal course by the Miami -Dade County Tax Collector and County issued parking tickets for vehicles registered in the name of the above firm, have been paid. • AFFIDAVIT RELATING TO INDIVIDUALS AND ENTITIES ATTESTING BEING CURRENT IN THEIR OBLIGATIONS TO MIAMI-DADE COUNTY (Ordinance 99-162) See Section 1 (1.3 N) I, being first duly sworn state that in compliance with County Ordinance 99-162, the bidder is not in arrears in any payment under a contract, promissory note or other loan document with the County, or any of its agencies or instrumentalities, including the Public Health Trust (hereinafter referred to as "County"), either directly or indirectly through a firm, corporation, partnership or joint venture in which the individual or entity has a controlling financial interest as that term is defined in Section 2-11.1(b)(8) of the County Code. Page 1 of 8 Revised 10/24/01 MIAMI-DADE COUNTY BID NO.: 7543-5/14 MIAMI-DADE COUNTY DOMESTIC VIOLENCE LEAVE AFFIDAVIT (Ordinance 99-5 & Resolution R-185-00) That in compliance with Ordinance No 99-5, Resolution No. R-185-00 and the Code of Miami -Dade County, Florida, the following information is provided and is in compliance with all items in the aforementioned legislation. As an employer having, 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 preceding calendar year, do hereby certify to be in compliance with the Domestic Leave Ordinance, codified at 11A-60 et. Seq., of the Miami - Dade -County Code, and that the obligation to provide domestic `violence leave to employees shall be a contractual obligation. BY SIGNING AND NOTARIZING THIS PAGE YOU ARE ATTESTING TO AFFIDAVITS ON PAGES 1 AND 2 ..�:... ti:....lat8TVIT�iIMZC : .I.,,r"i su ws' SZLV S '. ."i'riar�. �`:.0 ,Nrato r • ,,1,,, .,: ..+`T'.. i"`9'wYWATZEE,. sn. t""ITZ.". _A:,^ x""4'.'. MIAMI-DADE COUNTY AFFIDAVITS SIGNATURE PAGE 1 . "7 F!'-T.tl"4=eAWAT'j^YY .:Y7F.?CVMS4`VVIN.MT'.3:c:;:.,« Z.1.:,t2,.'.F,',T^9`i'.".%,V.V,,,170k: %_"..a", .R ".,".. .^Y7v-:lrf.r,r,'" *.,: rr47<..a.,... ra`$Frai'""?:?: #C .". 5. By: 20 Signature of Affiant Date / - / / / / / / / Printed Name of Affiant and Title Federal Employer Identification Number Printed Name of Firm Address of Firm SUBSCRIBED AND SWORN TO (or affirmed) before me this day of , 20_ He/She is personally known to me or has presented as identification. Type of identification Signature of Notary Print or Stamp Name of Notary Notary Public — State of Serial Number Expiration Date 1,4 Page 2 of 8 Revised 10/24/01 MIAMI-DADE COUNTY BID NO.: 7543-5/14 LIVING WAGE AFFIDAVIT (County Ordinance 99-44) I, being first duly sworn hereby state and certify that in compliance with Section 2-8.9 of the Miami -Dade County Code, by accepting award of this contract,' the bidder or proposer agrees to pay the living wage required by County Ordinance 99-44 to all employees assigned to this contract. The bidder or proposer further understands that the current living wage applied to this contract is $9.81 per hour plus health benefits as described in the ordinance, or $11.23 per hour without health benefits. The Living Wage required by Ordinance 99-44 is subject to indexing as set -forth in Section "C" (Indexing). By: 20 Signature of Affiant Date / - / / / / / / / Printed Name of Affiant and Title Federal Employer Identification Number Printed Name of Firm Address of Firm SUBSCRIBED AND SWORN TO (or affirmed) before me this day of , 20_ He/She is personally known to me or has presented as identification. Type of identification Signature of Notary Serial Number Print or Stamp Name of Notary Expiration Date Notary Public — State of Page 3 of 8 8/15/.05 MIAMI-DADE COUNTY BID NO.: 7543-5/14 A14'14IRMATIVE ACTION PLAN/PROCUREMENT POLICY AFFIDAVIT (Code. of Miami -Dade County. Section 2-8.1.5) (Ordinance No. 98-30) I, being duly first sworn, hereby state that the bidder of this contract: ❑ has a current Affirmative Action Plan and Procurement Policy, as required by Section 2-8.1.5 of the Code of Miami -Dade County, processed and approved for filing with the Miami -Dade County Department of Business Development (DBD) under the file No. "and the`' expiration date of ❑ had annual gross revenues in excess of $5,000,000.00 for the previous year and does not have a current Affirmative Action Plan and Procurement Policy as required by Section 2-8.1.5 of the Code of Miami -Dade County, processed and approved for filing with the Miami -Dade County DBD. I will contact DBD at 305-375- 3111 regarding this requirement. ❑ had annual gross revenues less than $5,000,000.00 for the previous year; therefore Section 2-8.1.5 of the Code of Miami -Dade County is not applicable. However, I will contact DBD at 305-375-3111 in order to submit the required affidavit and exemption request. Witness: Si., •u re Signature Witness: By: Signature Legal Name and Title The foregoing instrument was acknowledged before me this day of , 20 FOR AN INDIVIDUAL ACTING IN HIS OWN RIGHT: By: FOR A CORPORATION, PARTNERSHIP OR JOINT VENTURE: By: having the title of with ❑ a corporation ❑ partnership ❑ joint venture PLEASE NOTE: Section 2-104(4)(a) of the Code of Miami -Dade County (Ordinance No. 82-37) requires that all properly licensed architedura1 engineering, landscape architedurak and land surveyors have an affirmative action plan on file with the County. Section 2-& L 5 of the Code of Miami -Dade County requires that firms that have annual grass revenues in excess of five (5) mullion dollars have an affirmative action plan and procurement policy on file with the County. Finns that have a Board of Directors that are representative of the population make-up of the nation may be exempt For questions regarding these requirements, please contact the Miami -Dade County Department of Business Development at 305-375-3111. Page 4 of 8 Revised 11/8/04 MIAMI-DADE COUNTY BID NO.: 7543-5/14 CODE OF BUSINESS ETHICS Code of Miami -Dade County Section 2-8.1(i) I, being duly sworn, hereby state and certify that this firm has adopted a Code of Business Ethics that is fully complaint with the requirements of Section 2-8.1(i) of the Code of Miami -Dade County as amended. I further acknowledge that failure to comply with the adopted Code of Business Ethics shall render any contract with Miami -Dade County voidable, and subject this firm to debarment from County work pursuant to Section 10-38(h)(2) of the Code of Miami -Dade County as amended. I further acknowledge that failure to submit this affidavit shall render this firm ineligible for contract award. By: 20 Signature of Affiant Date / - / / / / / / / Printed Name of Affiant and Title Federal Employer Identification Number Printed Name of Firm Address of Firm SUBSCRIBED AND SWORN TO (or affirmed) before me this day of , 20 He/She is personally known to me or has presented as identification. Type of identification Signature of Notary Serial Number Print or Stamp Name of Notary Expiration Date Notary Public — State of Notar ' eF I Page 5 of 8 Revised 08/23/01 MIAMI-DADE COUNTY BID NO.: 7543-5/14 FAIR SUBCONTRACTING PRACTICES (Ordinance 97-35) In compliance with Miami -Dade County Ordinance 97-35, the Bidder shall submit with the bid proposal a detailed statement of its policies and procedures (use separate sheet if necessary) for awarding subcontractors in accordance with Section 1, Paragraph 1.15 ❑ NO SUBCONTRACTORS WILL BE UTILIZED FOR THIS CONTRACT Signature Date Page 6 of 8 Revised 01/15/04 MIAMI-DADE COUNTY BID NO.: 7543-5/14 SUBCONTRACTOR/SUPPLIER LISTING (Ordinance 97-104) Firm Name of Prime Contractor/Respondent: Bid No.: Title: This forms, or a comparable listing meeting the requirements of Ordinance No. 97-104 MUST be completed, signed and submitted by all bidders and respondents on County contracts for purchases of supplies, materials or services, including professional services which involve expenditures of $100,000 or more, and all bidders and respondents on County or Public Health Trust construction contracts which involve expenditures of $100,000 or more. A bidder or respondent who is awarded the contract shall not change or substitute first tier subcontractors or direct suppliers or the portions of the contract work to be performed or materials to be supplied from those identified, except upon written approval of the County. This form, or a comparable listing meeting the requirements of Ordinance No. 97-104, MUST be completed, signed and submitted even though the bidder or proposer will not utilize subcontractors or suppliers on the contract. The bidder or proposer should enter the word "NONE" under the appropriate heading of sub form 100 in those instances where no subcontractors or suppliers will be used on the contract. Business Name and Address of First Tier Subcontractor/Subconsultant Principal Owner Scope of Work to be Performed by Subcontractor/Subconsultant (Principal Owner) Gender Race Business Name and Address of Direct Supplier Principal Owner Supplies/Materials/Services to be Provided by Supplier (Principa Gender Owner) Race I certify that the representations contained in this Subcontractor/Supplier Lb is are to the est f knowledge omy true an Prime Contractor/Respondent's Signature Page 7 of 8 Print Name (Duplicate if additional space is needed) Print Title Revised 01/15/04 FORM 100 Date MIAMI-DADE COUNTY BID NO.: 7543-5/14 MIAMI-DADE COUNTY CERTIFICATION OF RECYCLED ENVIRONMENTALLY ACCEPTABLE PACKAGING 1110 PRODUCT CONTENT RESOLUTION (R-738-92) MINIMUM CERTIFIED CONTENT Bid Item Number RECYCLED PRODUCTS RECOVERED MATERIALS RECYCABLE PRODUCTS % Composition Type of Material % Composition " Type of Material % Composition Type of Material • DEFINITIONS "Recycled Material" shall be defined as any waste material or by-products that have been recovered or diverted from solid waste. "Recycled Product" shall be defined as any product which is in whole or in part composed of recovered materials. "Recyclable Product" shall be defined as ,the ability of a product and its packaging to be reused, reconditioned for use, or recycled through existing recycling collection programs. "Waste Reducing Product" shall be defined as any product which will result in less waste generated due to its use rather than another product designed to serve the same function with a greater waste, generation rate. This shall include, but not limited to those products that can be reused, refilled or have a longer life expectancy and contain a lesser amount of toxic constituents. 1 have the knowledge to certify and do so by certify that the Minimum Materials Content in our product(s) are as specified on this form and conform with the definitions as shown above. NAME . ADDRESS CITY STATE. ZIP SIGNATURE TITLE Page 8 of 8 Revised 08/23/01