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HomeMy WebLinkAboutCertificationCERTIFICATION 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 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 entering 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 officer 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. 3) 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. Catholic Charities of the Archdiocese of Miami, Inc. Name of Applicant Rev. Dea. Richard Turcotte, Ph.D Print name of Certifying Official ignature 'fCertifying Official City of t c'L i l 1 STATE OF FLORIDA Date The fyregoing instrument was c nowledged before me this / `-, ay by % kart' 1-1 t.. i— C C' t l who i personally known j o e or who (name of person whose signature is being notarized) --� Produced as identification, and who did/did not take an oath. (Type of Identificat NO' Y PUBLIC: (Signature) (Print N SEAL ,q 'v B TTINA UNOZ- MY ;OMMi$$IQN tf DD575967 Ex PiRE0 21: 2011 (407 358=..,,5 . _.t:)*NO sNcsary+crwas.coo'� CERTIFICATION REGARDING DEBARMENT, SUSPENSION & OTHER RESPONSIBILITY MATTERS PRIMARY COVERED TRANSACTIONS 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 department 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 1.b of this certification; and d. Have not within a three-year period preceding this application/proposal had one or more 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. Catholic Charities of the Archdiocese of Miami, Inc. Name of Applicant Rev. Dea. Richard Turcotte, Ph.D Print name of Certifying Official ature o Cerfifying Official J— City of -tyyI STATE OF FLORIDA The fo goirw inst en .. yas ackno dged before me this 1� � d t 1+, 200? by A c _ f l Lk_ 1 C0 �.Q who i personally known Ale or who (name of person whose signature is being notarized) Produced as identification, and who did/did not take an oath. (Type of Identification NOT - PUBLIC: Date (Signature) (Print SEAL • wilts i0N DD76987 } E.X.PtRE i Kv 21, 2011 (4077)39B-01. ',o;lils Motorv$croa:a.coT My commission expires SWORN STATEMENT PURSUANT TO SECTION 287.133 (3) (a), FLORIDA STATUTES. ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS 1. This sworn statement is submitted tol City of Miami by (Print name of the public entity) Deacon Richard Turcotte, Ph.D. Chief Executive Officer (Print individual's name and title) for Catholic Charities of the Archdiocese of Miami, Inc (Print name of entity submitting sworn statement) whose business address is 9401 Biscayne Boulevard, 2"a Floor Miami Shores, Florida 33138 and (if applicable) its Federal Employer Identification Number (FEIN) is 59-1279497 (If the entity has no FEIN, include the Social Security number of the individual signing this sworn statement: N/A ). 2. I understand that a "public entity crime" as defined in Paragraph 287.133 (1) (g). Florida Statutes. means a violation of any state or federal law by it person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state of the United States, including, but not limited to, any bid or contract for goods or services to be provided to any public entity or an 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 "conviction" as defined in Paragraph 287.133 (1) (b), Florida Statutes, means a fording of guilt or a conviction of a public entity crime, with or without an adjudication of -guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non jury trial, or entry or 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 a 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 agent who are active in the management of an affiliate. The ownership by one person of shares constituting controlling interest in another person, pooling of equipment or Income among persons when not for fair market value under as arm's length agreement. shall be a prima facie one that one person controls another person. A person who knowingly enters into a joint Venture with aperson who has been convicted of public entity crime in Florida during the preceding 36 months shall be considered as 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 contacts for the provision of goods or services let by a public entity , or which otherwise transacts or applies to transact business with a public entity. The te�ui "person" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity. 6. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. (Please indicate which statement applies) Neither the entity submitting this sworn statement, nor any of its officers, directors, executives, partners, shareholders, employees, members or agents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1,1989. 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, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. However, there has been a subsequent proceeding before a Hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convictedvendor list. (attach acopyof 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 THAT PUBIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALE NDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THAT PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUES FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. Signal -Lire Rev. Dea. Richard Turcotte, Ph.D. Sworn to and subscribed before me this 14 day of 200`2''> Identification (Type of Identification) My commission expires Notary Public- State of 0° SETTBll. .c,:i,! . ,': MY COMM1SSiON ti Q33375907 EXPIRES Ma', '5 2il I veto,11 - . ""` " iinted-typed or stamped co notary public) e OR Produced