HomeMy WebLinkAboutComposite Exhibit ACity of Miami
Anti -Poverty Initiative Program Guidelines
Background:
On September 23, 2014, the Miami City Commission approved Resolution No. 14-0362
establishing the Anti -Poverty Initiative ("API") program. The following Anti -Poverty Initiative
guidelines are established to ensure the program meets the intent of Resolution No. 15-0106 and
Resolution No. 16-0044 as well as anti -poverty related Sunshine meetings held in 2014. Funding
allocation is based on poverty rates for each commission district.
Purpose:
The purpose of the Anti -Poverty Initiative is to reduce poverty within the City of Miami
communities and funding shall be utilized to meet the needs of poor residents. The City of Miami
created the Anti -Poverty Initiative to address poverty based on a strategy of focusing the
provision of support towards the City's residents achieving self-sufficiency.
Anti -Poverty Initiative focuses on projects and programs providing direct services to
disadvantaged City of Miami residents in the following priority areas:
• Educational Programs for children, youth and adults
• Crime Prevention
• Elderly meals, transportation, recreational and health/wellness related activities
• At -risk youth or youth summer job programs
• Transportation services and programs
• Job development, retention and training programs
• Homeless Services
The expenditure of Anti -Poverty funds allocated under this Initiative shall only be expended to
benefit the interest of disadvantaged residents of the City of Miami.
Eligible Entities and Organizations:
Anti -Poverty Initiative fund recipients must be (1) tax-exempt and (2) registered and active State
of Florida entities:
• Not -for profit organizations {501(3)(c)}
• Governmental units
• Educational and academic institutions
• City of Miami departments, agencies and boards
Additional Program Guidelines and Requirements
• Any organization considered for or selected to receive Anti -Poverty Initiative funds must
comply with any and all local, state and federal laws, rules, regulations, or guidelines
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Anti -Poverty Initiative Program Guidelines
associated with the programs funded, and such allocations may be revoked at the sole
discretion of the City Commission.
• Organization must complete an Anti -Poverty Initiative funding request form
• API program is subject to commission approval and funding availability
• API fund recipients will use funds for a program or initiative that reaches a significant
number of individuals or significantly impacts Miami's disadvantage communities
• Recipients will be required to enter into a grant agreement with the City of Miami prior
to any funding being disbursed. Said agreement shall include program/activity
information and language regarding:
o Resolution stating who is authorized to execute agreement with City of Miami
o Scope of Services including but not limited to number of residents being served,
City of Miami District/Location where services are being provided, program
focus/priority area, frequency of service, performance measures and any other
performance metric deemed relevant to the program priority area
o Budget detailing how funding will be utilized to provided services to
disadvantaged City/District residents as described in the Scope of Services
o Invoicing for activities and services provided and residents assisted or served
o Conflict of Interest
o Insurance as required by the City of Miami
o Any other material terms deem applicable to ensure appropriate use of public
funds
• Recipients will be required to complete an end of program close-out report summarizing
the services provided, performance metrics, location of services and timeline for the
provision of API related services. The City, from time to time, will conduct on -site
monitoring and/or audits of the API funded program/activity/service.
• Funds cannot be used to pay expenditures such as:
o Lobbying Activities
o Traveling for non -program participants
o Meals for non -program participants
o Pay bad debt
o Defense and prosecution of criminal and civil proceedings
o Donations or fund raising activities
o Individual or Personal expenses
o Pay same expense charged to other funding source (e.g. CDBG funds)
o Sponsorship of events and activities
o Any other expenditures deemed ineligible by the City of Miami
• Organizations that discriminate based on race, color, sex, religion, national origin, age or
disability will not be recommended for funding.
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City of Miami
Anti -Poverty Initiative Program
CONTACT INFORMATION:
Contact Person:
Title:
Phone number:
Email Address:
Name of Person completing this form:
Legal Name of Organization:
Address (Street, City, State, Zip Code):
Executive Director of Organization:
Executive Director email:
Executive Director Contact Phone Number:
Is the organization a registered and active State of Florida (select one):
Not -for profit organization {501(3)(c)}
Local or state governmental units
Educational and academic institution
City of Miami department, agency and board
For -profit organization
City of Miami
Anti -Poverty Initiative Program
ORGANIZATION AND PROGRAM/PROJECT INFORMATION
Organization History and Background Information:
Please Select one:
Is your program/project providing direct services to residents of the City of Miami? Yes/No
Number of residents being served:
Frequency of service:
Age group Served:
Is your program/project impacting one of Miami's disadvantaged communities? Yes/No
Geographic Area Served (specific to this project/program)
District Served (1, 2, 3, 4, 5, Citywide)
Neighborhood/Community being served:
Program/Project Priority area (Select one):
Educational Programs for children, youth and adults
Crime Prevention
Elderly meals, transportation, recreational and health/wellness related activities
At -risk youth or youth summer job programs
Transportation services and programs
Job development, retention and training programs
Homeless Services
Improving housing opportunities and complete minor housing repairs and ADA upgrades
for low income elderly and veterans
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Anti -Poverty Initiative Program
Program/Project Title:
Project/Program Description:
Program Start Date: Program End Date:
Please describe how this program/project and funding will alleviate poverty within the City of
Miami?
IMPACT AND PERFORMANCE:
Describe overall expected outcomes and performance measures for this project/program:
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Anti -Poverty Initiative Program
FUNDING REQUEST INFORMATION:
Amount Requested: $
Explain how API funding will be utilized:
Itemize API funding related to expenditures below:
Personnel Salaries & Wages: $
Personnel Benefits $
Space: $
Utilities (Electricity, Phone, Internet): $
Supplies: $
Marketing: $
Transportation (Participants): $
Meals (Participants): $
Professional Services (List each):
Other (please describe):
Other (please describe):
Other (please describe):
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City of Miami
Anti -Poverty Initiative Program
To be completed by District Commissioner/Mayor's Office
Recommended for funding: Yes/No
Funding Recommendation:
Commission Meeting Date:
Additional Comments:
Completed by (Print & Sign):
Date:
CITY OF MIAMI
ANTI -POVERTY INITIATIVE
FUNDING AGREEMENT
This ANTI -POVERTY INITIATIVE AGREEMENT ("Agreement") is entered into
this day of , 20 by and between the CITY OF MIAMI, a municipal
corporation of the State of Florida, located at 444 SW 2nd Avenue, Miami, FL 33130 ("CITY"),
and , a Florida not for profit corporation, located at
("RECIPIENT"). The CITY and the RECIPIENT may each
be referred to as a "Party" and may collectively be referred to as the "Parties."
WHEREAS, the City created the Anti -Poverty Initiative ("API") to address poverty based
on a strategy of focusing the provision of support towards the City's residents achieving self-
sufficiency; and
WHEREAS, the RECIPIENT submitted a Request for API Funding to the City; and
WHEREAS, the CITY adopted Resolution No. R-_- on , 20_,
wherein the CITY approved providing funds to the RECIPIENT in the not to exceed amount of
dollars ($ .00) ("Funds"), attached and incorporated as Exhibit
"A"; and
WHEREAS, the CITY agrees to enter into this Agreement with the RECIPIENT to set
forth the terms and conditions relating to the use of the Funds by the RECIPIENT.
NOW, THEREFORE, in consideration of the mutual covenants and promises herein
contained, the Parties agree as follows:
TERMS
1. RECITALS: The recitals are true and correct and are hereby incorporated into and made
a part of this Agreement.
2. TERM: The term of this Agreement shall commence on , 20 and
shall continue until , 20 .
3. GRANT OF FUNDS: Subject to the terms and conditions set forth herein and
RECEIPIENT'S compliance with all of its obligations hereunder, the CITY hereby agrees to make
available to the RECIPIENT the Funds to be used for the purpose(s), program(s), initiative(s), and
activity(ies) (as defined in Exhibit "B"), and as disbursed in the manner hereinafter provided.
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4. USE OF FUNDS: The Funds shall be used by the RECIPIENT as described in the
Scope of Work, attached and incorporated herein as Exhibit "B" and the Budget, attached and
incorporated herein as Exhibit "C" submitted by the RECIPIENT to the CITY.
DISBURSEMENT OF FUNDS:
A. The CITY shall provide Funds to the RECIPIENT in the not to exceed amount of
dollars ($ .00).
B. Payment shall be made in accordance with the schedule as set forth in Composite
Exhibit "D".
C. The RECIPIENT shall provide the CITY with a copy of a valid and executed W-9
form, a completed City of Miami Supplier Direct Deposit (ACH) Authorization Form and City of
Miami Request for Payment Form, attached and incorporated as Composite Exhibit "D" prior to
any disbursement of funds by the CITY.
D. The RECIPIENT shall provide the CITY a Close -Out Report, incorporated herein
as Exhibit "F", summarizing the services, programs and/or activities described in the Scope of
Work as Exhibit "B" and included in the Budget as Exhibit "C".
5. COMPLIANCE WITH POLICIES AND PROCEDURES: RECIPIENT understands
that the use of the Funds is subject to specific reporting, record keeping, administrative and
contracting guidelines, audit, and other requirements affecting the activities being funded by the
API Funds for the Scope of Work. RECIPIENT covenants and agrees to comply with such
requirements, and represents and warrants to the CITY that the Funds shall be used in accordance
with all of the requirements, terms and conditions contained therein, as the same may be amended
during the term hereof. Without limiting of the foregoing, RECIPIENT represents and warrants
that it will comply with, and the Funds will be used in accordance with, all applicable federal,
state, and local codes, laws, rules and regulations.
6. RECORDS, INSPECTIONS, REPORTS/AUDITS AND EVALUATION: To the
extent required by law, the Inspection and Audit provisions set forth in Sections 18-101 and 18-
102 of the Code of the City of Miami, Florida, as amended ("City Code"), are deemed as being
incorporated by reference herein and additionally apply to this Agreement. The CITY shall have
the right to conduct audits of RECIPIENT'S records pertaining to the Funds and that RECIPIENT
shall cooperate with the CITY in the performance of these activities. The CITY may, at reasonable
times, and for a period of up to three (3) years following the termination of this Agreement, audit,
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or cause to be audited, those books and records of the RECIPIENT which are related to
RECIPIENT'S performance under this Agreement. RECIPIENT agrees to maintain all such books
and records at its principal place of business for a period of three (3) years after final payment is
made under this Agreement. The CITY may also, and the RECIPIENT shall permit, the CITY and
other persons duly authorized by the CITY to inspect all Agreement records, facilities, goods, and
activities of the RECIPIENT which are in any way connected to the activities undertaken pursuant
to the terms of this Agreement, and/or interview any clients, employees, subcontractors or
assignees of the RECIPIENT as requested by the CITY. At the request of the CITY, the
RECIPIENT shall transmit to the CITY written statements of the RECIPIENT's official policies
on specified issues relating to the RECIPIENT's activities.
RECIPIENT understands, acknowledges, and agrees that:
a) The CITY must meet certain record keeping and reporting requirements with regard to the
Funds and that in order to enable the CITY to comply with its record keeping and reporting
requirements, RECIPIENT shall maintain all records as required by the CITY; and
b) At the CITY's request, and no later than thirty (30) days thereafter, RECIPIENT shall
deliver to the CITY such reports and written statements relating to the use of the Funds as
the CITY may require from time to time; and
c) All costs and expenses of the activities described in Exhibit "C" shall be at actual cost
with no markups; and
d) RECIPIENT'S failure to comply with these requirements or the receipt or discovery (by
monitoring, evaluation, or audit) by the CITY of any inconsistent, incomplete, or
inadequate information shall be grounds for the immediate termination of this Agreement
by the CITY and the immediate reimbursement to the CITY of any and all funds or amounts
disbursed pursuant to this Agreement.
RECIPIENT represents and warrants to the City that: (i) it possesses all qualifications,
licenses and expertise required for the performance of the Scope of Work; (ii) it is not delinquent
in the payment of any sums due to the City, including payment of permit fees, occupational
licenses, etc., nor in the performance of any obligations to the City; and (iii) all personnel assigned
to perform the Scope of Work are and shall be, at all times during the term hereof, fully qualified
and trained to perform the tasks assigned to each.
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Any inconsistent, incomplete, or inadequate information, either received by the CITY or
obtained by the CITY, shall constitute cause for the CITY to terminate this Agreement.
7. AWARD OF AGREEMENT: RECIPIENT represents and warrants to the CITY
that it has not employed or retained any person or company employed by the CITY to solicit or
secure this Agreement and that it has not offered to pay, paid, or agreed to pay any person any fee,
commission, percentage, brokerage fee, or gift of any kind contingent upon or in connection with,
the award of this Agreement.
8. COMPLIANCE WITH FEDERAL, STATE AND LOCAL LAWS: RECIPIENT
understands that agreements between private entities and local governments are subject to certain
laws, codes, rules and regulations, including, without limitation, laws pertaining to public records,
conflict of interest, record keeping, etc. The Parties agree to comply with and observe all applicable
laws, codes and ordinances as they may be amended from time to time.
9. INDEMNIFICATION: RECIPIENT shall indemnify, defend and hold harmless the
CITY and its officials, employees (collectively referred to as "Indemnitees") and each of them
from and against all loss, costs, penalties, fines, damages, claims, expenses (including attorney's
fees) or liabilities (collectively referred to as "Liabilities") by reason of any injury to or death of
any person or damage to or destruction or loss of any property arising out of, resulting from, or in
connection with (i) the negligent performance or non-performance of the Services contemplated
by this Agreement (whether active or passive) of RECIPIENT or its employees or subcontractors
(collectively referred to as "RECIPIENT') which is directly caused, in whole or in part, by any
act, omission, default or negligence (whether active or passive or in strict liability) of any of them,
or (ii) the failure of the RECIPIENT to comply materially with any of the requirements herein, or
the failure of the RECIPIENT to conform to statutes, ordinances, or other regulations or
requirements of any governmental authority, local, federal or state, in connection with the
performance of this Agreement even if it is alleged that the CITY, its officials and/or employees
were negligent. RECIPIENT expressly agrees to indemnify, defend and hold harmless the
Indemnitees, or any of them, from and against all liabilities which may be asserted by an employee
or former employee of RECIPIENT, or any of its subcontractors, as provided above, for which the
RECIPIENT's liability to such employee or former employee would otherwise be limited to
payments under state Workers' Compensation or similar laws. RECIPIENT further agrees to
indemnify, defend and hold harmless the Indemnitees from and against (i) any and all Liabilities
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imposed on account of the violation of any law, ordinance, order, rule, regulation, condition, or
requirement, related directly to RECIPIENT's negligent performance under this Agreement,
compliance with which is left by this Agreement to RECIPIENT, and (ii) any and all claims, and/or
suits for labor and materials furnished by RECIPIENT or utilized in the performance of this
Agreement or otherwise. This provision shall survive the termination or expiration of this
Agreement, as applicable.
RECIPIENT understands and agrees that any and all liabilities regarding the use of any
subcontractor for Services related to this Agreement shall be borne solely by the RECIPIENT
throughout the duration of this Agreement and that this provision shall survive the termination or
expiration of this Agreement, as applicable.
10. REVERSION OF ASSETS: Upon the expiration, termination, or cancellation of this
Agreement, any unspent API Grant funds shall immediately revert to the possession and ownership
of the CITY and RECIPIENT shall transfer to the CITY all unused API Grant funds at the time of
such expiration, termination, or cancellation.
11. DEFAULT: If RECIPIENT fails to comply with any term or condition of this
Agreement, or fails to perform any of its obligations hereunder, then RECIPIENT shall be in
default. Upon the occurrence of a default hereunder the CITY, in addition to all remedies available
to it by law, may immediately, upon written notice to RECIPIENT, terminate this Agreement
whereupon all payments, advances, or other compensation paid by the CITY to RECIPIENT while
RECIPIENT was in default shall be immediately returned to the CITY. RECIPIENT understands
and agrees that termination of this Agreement under this section shall not release RECIPIENT
from any obligation accruing prior to the effective date of termination. Should RECIPIENT be
unable or unwilling to commence to perform the Services within the time provided or
contemplated herein, then, in addition to the foregoing, RECIPIENT shall be liable to the CITY
for all expenses incurred by the CITY in preparation and negotiation of this Agreement, as well as
all costs and expenses incurred by the CITY in the procurement of the Services, including
consequential and incidental damages.
12. CITY'S TERMINATION RIGHTS: The CITY shall have the right to terminate
this Agreement, in its sole discretion, at any time, by giving written notice to RECIPIENT at least
five (5) business days prior to the effective date of such termination. In such event, the CITY shall
pay to RECIPIENT compensation for services rendered and expenses incurred prior to the
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effective date of termination. In no event shall the CITY be liable to RECIPIENT for any
additional compensation, other than that provided herein, or for any consequential or incidental
damages.
13. REMEDIES FOR NONCOMPLIANCE: The CITY retains the right to
terminate this Agreement at any time prior to the completion of the services required pursuant to
this Agreement without penalty to the CITY. In that event, notice of termination of this
Agreement shall be in writing to the RECIPIENT, who shall be paid for those services performed
prior to the date of its receipt to the notice of termination. In no case, however, shall the CITY
pay the RECIPIENT an amount in excess of the total sum provided by this Agreement.
It is hereby understood by and between the CITY and the RECIPIENT that any payment
made in accordance with this Agreement to the RECIPIENT shall be made only if the
RECIPIENT is not in default under the terms of this Agreement. If the RECIPIENT is in default,
the CITY shall not be obligated and shall not pay to the RECIPIENT any sum whatsoever.
If the RECIPIENT fails to comply with any term of this Agreement, the CITY may take
one or more of the following courses of action:
(1) Temporarily withhold cash payments pending correction of the deficiency by
the RECIPIENT, or such more severe enforcement action as the CITY
determines is necessary or appropriate.
(2) Disallow (that is, deny both the use of funds and snatching credit) for all or part
of the cost of the activity or action not in compliance.
(3) Wholly or partially suspend or terminate the current API Program Funds
awarded to the RECIPIENT.
(4) Withhold further API Program funding for the RECIPIENT.
(5) Take all such other remedies that may be legally available.
14. MARKETING: RECIPIENT shall consult with the City Manager, or his or her
designee, regarding all uses and displays of the recognition of the CITY. The CITY shall have the
right to approve the form and placement of all acknowledgements, which approval shall not be
unreasonably withheld.
15. INSURANCE: The required Insurance, as approved by the City of Miami
Department of Risk Management shall be provided by the RECIPIENT and all such proof shall be
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attached as an Exhibit to this Agreement. Those entities/individuals required to be listed as
additional insured by the Department of Risk Management shall be included on all insurance
certificates and furnished by the RECIPIENT.
RECIPIENT shall, at all times during the term hereof, maintain insurance coverage in
accordance with Exhibit "E" attached and incorporated by this reference. All such insurance,
including renewals, shall be subject to the approval of the City for adequacy of protection and
evidence of such coverage shall be furnished to the City on Certificates of Insurance indicating
such insurance to be in force and effect and providing that it will not be canceled during the
performance of the services under this contract.
Execution of this Agreement is contingent upon the receipt of proper insurance documents.
16. NONDISCRIMINATION: RECIPIENT represents and warrants to the City that
RECIPIENT does not and will not engage in discriminatory practices and that there shall be no
discrimination in connection with RECIPIENT's performance under this Agreement on account
of race, color, sex, religion, age, handicap, marital status or national origin. RECIPIENT further
covenants that no otherwise qualified individual shall, solely by reason of his/her race, color, sex,
religion, age, handicap, marital status or national origin, be excluded from participation in, be
denied services, or be subject to discrimination under any provision of this Agreement.
17. ASSIGNMENT: This Agreement shall not be assigned by RECIPIENT, in whole or
in part, without the prior written consent of the CITY, which may be withheld or conditioned, in
the CITY'S sole discretion.
18. CERTIFICATIONS REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS: RECIPIENT 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, State, or local
agency.
b) Have not within a three (3) year period preceding the adoption of the Resolution,
attached and incorporated as Exhibit "A" been convicted of or had a civil judgement
rendered against them for the 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
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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 16.b of this certification; and
d) Have not within a three (3) year period preceding the adoption of the Resolution,
attached and incorporated as Exhibit "A" had one or more public transactions
(Federal, State, or local) 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 and the
CITY shall have the right to, in the CITY's sole discretion, to not enter into or terminate this
Agreement.
19. NOTICES: All notices or other communications required under this Agreement shall
be in writing and shall be given by hand -delivery or by registered or certified U.S. Mail, return
receipt requested, addressed to the other party at the address indicated herein or to such other
address as a party may designate by notice given as herein provided. Notice shall be deemed given
on the day on which personally delivered; or, if by mail, on the fifth day after being posted or the
date of actual receipt, whichever is earlier.
RECIPIENT
[Entity Name]
[Street Address, Suite/Floor]
[City, State, Zip Code]
Attn: [INSERT NAME]
CITY
City of Miami
Office of Grants Administration
444 SW 2"d Avenue, 5th Floor
Miami, FL 33130
Attn: Lillian Blondet, Director
With copies to:
Office of the City Attorney
444 SW 2"d Avenue, Suite 945
Miami, FL 33130
Attn: Victoria Mendez, City Attorney
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20. PUBLIC RECORDS: Pursuant to the provisions of Section 119.0701. Florida
Statutes, RECIPIENT must comply with the Florida public records laws, specifically the
RECIPIENT must:
A. Keep and maintain public records that ordinarily and necessarily would be required
by the public agency in order to perform the service.
B. Provide the public with access to public records on the same terms and conditions
that the public agency would provide the records and at a cost that does not exceed the cost
provided in this chapter of the Florida Statutes or as otherwise provided by law.
C. Ensure that public records that are exempt or confidential and exempt from public
records disclosure requirements are not disclosed except as authorized by law.
D. Meet all requirements for retaining public records and transfer, at no cost, to the
CITY all public records in possession of the RECIPIENT upon termination of the contract
and destroy any duplicate public records that are exempt or confidential and exempt from
public records disclosure requirements.
E. All records stored electronically must be provided to the CITY in a format that is
compatible with the information technology systems of the CITY.
IF THE RECIPIENT HAS QUESTIONS REGARDING THE
APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE
RECIPIENT'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO
THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS
AT (305) 416-1800, PUBLICRECORDS@MIAMIGOV.COM, AND 444 S.W.
2" AVENUE, SUITE 945, MIAMI, FL 33130.
21. CONFLICT OF INTEREST: RECIPIENT has received copies of, and/or is familiar
with, the following provisions regarding conflict of interest in the performance of this Agreement
by RECIPIENT. RECIPIENT covenants, represents and warrants that it will comply with all such
conflict of interest provisions including, but not limited to:
(a) the Code of the City of Miami, Florida, Chapter 2, Article V; and
(b) Miami -Dade County Code, Section 2-11.1.
22. GOVERNING LAW, VENUE, AND FEES: This Agreement shall be construed
and enforced according to the laws of the State of Florida. Venue in all proceedings shall be in
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Miami -Dade County, Florida and the parties explicitly agree to the use of this venue. The term
"proceedings" shall include, but not be limited to, all meetings to resolve the dispute, including
voluntary arbitration, mediation, or other alternative dispute resolution mechanism. The parties
both waive any defense that venue in Miami -Dade County is not convenient. In any civil action or
other proceedings between the parties arising out of the Agreement, each party shall bear its own
attorney's fees.
23. WAIVER OF JURY TRIAL: Neither the RECIPIENT, nor any assignee,
successor, heir or personal representative of the RECIPIENT, nor any other person or entity, shall
seek a jury trial in any lawsuit, proceeding, counterclaim or any other litigation procedure based
upon or arising out of any of the Agreement and/or any modifications, or the dealings or the
relationship between or among such persons or entities, or any of them. Neither the RECIPIENT,
nor any other person or entity will seek to consolidate any such action in which a jury trial has
been waived with any other action. The provisions of this paragraph have been fully discussed by
the parties hereto, and the provisions hereof shall be subject to no exceptions. No party to this
Agreement has in any manner agreed with or represented to any other party that the provisions of
this paragraph will not be fully enforced in all instances.
24. MISCELLANEOUS PROVISIONS:
A. Title and paragraph headings are for convenient reference and are not a part of this
Agreement.
B. No waiver or breach of any provision of this Agreement shall constitute a waiver
of any subsequent breach of the same or any other provision hereof, and no waiver shall be
effective unless made in writing.
C. In the event of conflict between the terms of this Agreement and any terms or
conditions contained in any attached documents, the terms of this Agreement shall control.
D. Should any provision, paragraph, sentence, word or phrase contained in this
Agreement be determined by a court of competent jurisdiction to be invalid, illegal or otherwise
unenforceable under the laws of the State of Florida or the City of Miami, such provision,
paragraph, sentence, word or phrase shall be deemed modified to the extent necessary in order to
conform with such laws, or if not modifiable, then same shall be deemed severable, and in either
event, the remaining terms and provisions of this Agreement shall remain unmodified and in full
force and effect or limitation of its use.
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25. NON-DELEGABILITY: The obligations undertaken by the RECIPIENT pursuant to
this Agreement shall not be delegated or assigned to any other person or firm, in whole or in part,
without the CITY'S prior written consent, which may be withheld in the CITY'S sole discretion.
26. SUCCESSORS AND ASSIGNS: This Agreement shall be binding upon the parties
hereto, their heirs, executors, legal representatives, successors, or assigns.
27. INDEPENDENT CONTRACTOR: RECIPIENT, its contractors, subcontractors,
employees, and agents shall be deemed to be independent contractors, and not agents or employees
of the CITY, and shall not attain any rights or benefits under the civil service or pension programs
of the CITY, or any rights generally afforded its employees; further, they shall not be deemed
entitled to Florida Workers' Compensation benefits as employees of the CITY.
28. NO THIRD -PARTY BENEFICIARY RIGHTS: No provision of this Agreement shall,
in any way, inure to the benefit of any third parties so as to constitute any such third party a
beneficiary of this Agreement, or of anyone or more of the terms hereof, or otherwise give rise to
any cause of action in any party not a party hereto.
29. CONTINGENCY CLAUSE: Funding for this Agreement is contingent on the
availability of funds and continued authorization for program activities and the Agreement is
subject to amendment or termination due to lack of allocated and available funds, reduction or
discontinuance of funds or change in laws, codes, rules, policies or regulations, upon thirty (30)
days' notice.
30. RECIPIENT CERTIFICATION: The RECIPIENT certifies that it possesses the legal
authority to enter into this Agreement pursuant to authority that has been duly adopted or passed
as an official act of the RECIPIENT'S governing body, authorizing the execution of this
Agreement, including all understandings and assurances contained herein, and directing and
authorizing the person identified as the official representative of the RECIPIENT to act in
connection with this Agreement and to provide such information as may be requested. The
aforementioned authorization for the RECIPIENT is attached and incorporated as Exhibit "G"
31. AUTHORITY: Each person signing this Agreement represents and warrants that he
or she is duly authorized and has legal capacity to execute and deliver this Agreement. Each party
represents and warrants to the other that the execution and delivery of the Agreement and the
performance of such party's obligations and the certifications hereunder have been duly authorized
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and that the Agreement is valid and legal agreement binding on such party and enforceable in
accordance with its terms.
32. CONSTRUCTION: Should the provisions of this Agreement require judicial or arbitral
interpretation, it is agreed that the judicial or arbitral body interpreting or construing the same shall
not apply the assumption that the terms hereof shall be more strictly construed against one party
by reason of the rule of construction that an instrument is to be construed more strictly against the
party which itself or through its agents prepared same, it being agreed that the agents of both parties
have equally participated in the preparation of this Agreement.
33. ENTIRE AGREEMENT: This instrument and its attachments constitute the sole and
entire agreement between the parties relating to the subject matter hereof and correctly sets forth
the rights, duties, and obligations of each to the other as of its date. Any prior agreements,
promises, negotiations, or representations not expressly set forth in this Agreement are of no force
or effect. No modification or amendment hereto shall be valid unless in writing and executed by
properly authorized representatives of the parties hereto.
[Remainder intentionally left blank; Signature page to follow]
Page 12
City of Miami
API Funding Agreement
{INSERT RECIPIENT}
IN WITNESS WHEREOF, the parties hereto have caused this instrument to be executed
by their respective officials thereunto duly authorized, this the day and year above written.
"CITY"
CITY OF MIAMI, a municipal
ATTEST: corporation of the State of Florida
By:
Todd B. Hannon, City Clerk Emilio T. Gonzalez, Ph.D., City Manager
APPROVED AS TO FORM AND APPROVED AS TO INSURANCE
CORRECTNESS: REQUIREMENTS:
Victoria Mendez
City Attorney
Ann -Marie Sharpe, Director
Risk Management
"RECIPIENT"
ATTEST: [ENTITY],
A Florida Not -For -Profit Corporation
By:
Print Name: Print Name:
Title: Title:
Page 13
ANTI -POVERTY INITIATIVE
FUNDING AGREEMENT
EXHIBIT A - CITY OF MIAMI RESOLUTION
ANTI -POVERTY INITIATIVE
FUNDING AGREEMENT
EXHIBIT B — SCOPE OF WORK
Insert Pages 2 & 3 from Anti -Poverty Funding Request Form
ANTI -POVERTY INITIATIVE
FUNDING AGREEMENT
EXHIBIT C — BUDGET
Insert Page 4 from Anti -Poverty Funding Request Form
ANTI -POVERTY INITIATIVE
FUNDING AGREEMENT
COMPOSITE EXHIBIT "D"
2019 API AGREEMENT
COMPOSITE EXHIBIT "D"
1. The CITY shall pay the RECIPIENT, as maximum compensation for the services required
pursuant to this Agreement, the sum of $
2. Request for Payments should be submitted to the CITY in a form provided by the City and
included in this Exhibit as 2019 Request for Payment Form.
3. The RECIPIENT 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 CITY. If the RECIPIENT fails to comply with this requirement, the RECIPIENT shall
forfeit all rights to payment and the CITY shall not honor any request submitted thereafter.
4. Schedule of payments to RECIPIENT will be as follows:
5. Any payment due under this Agreement may be withheld pending the receipt and approval by
the CITY of all reports and information due from the RECIPIENT as a part of this Agreement
and any modifications thereto.
2019 API Request for Payment Form
Date: Invoice Number:
Send to:
City of Miami
Office of Grants Administration
444 SW 2nd Ave., 5th Floor
Miami, FL 33130
Program/Project Title:
Recipient's Name:
Recipient's Address:
I hereby request payment in the amount of $ for expenses incurred in relation to the
2019 City of Miami Anti -Poverty Initiative Activity/Program/Services provide below.
Number of People
Served/Location of
Services
Service Description
Rate
Amount
TOTAL: $
I certify that the Program/Service was provided in accordance to the approved Program/Project as
described in the API Funding Request Form and that expenses were incurred in the provision of said
Program/Service.
Signature
Type Name
Date Title:
CITY OF MIAMI SUPPLIER DIRECT DEPOSIT (ACH) AUTHORIZATION
Supplier Number (if known)
Name of Supplier
Address
FEIN/TIN/SSN
Phone Number Fax Number
Email address
Direct Deposit/ACH Action Request (check one):
Start
Change ❑ Stop 0
CHECKING ACCOUNT INFORMATION
Name of Financial Institution
Address
Phone Number
Account Number
Routing Number
VOIDED CHECK ATTACHED
Signature Date
Signature above signifies agreement with the terms and conditions on the back of this form
INSTRUCTIONS
This authorization form for Direct Deposit/ACH Deposit must be completed and signed by an authorized
representative of the Supplier requesting deposit. You must attach a copy or original (marked void) of your
bank check. If you are unable to provide a void or canceled check, a statement from your bank (on bank
letterhead) listing your account information may be substituted. To indicate the action requested, and
account type, place a check mark or an "X" to the left of the appropriate choice. After the form is completed,
signed and the appropriate documents attached, it should be returned to the Finance Department of the City
of Miami, 444 SW 2nd Ave, 6th Floor, Miami, FL, 33130 or faxed to 305-416-1987 or e-mailed to
payables@miamigov.com.
AUTHORIZATION
I hereby authorize and request the City of Miami to initiate credit entries, and if necessary, debit entries and
adjustments for any credit entries in error, to my account at the financial institution named. This authorization
is to remain in effect until withdrawn by me in writing with sufficient notice to the City to allow adequate time
to effect termination.
Form
(Rev. November2017)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
Identification Number and Certification
a Go to www.irs.gov/FormW9 for instructions and the latest information.
Give Form to the
requester. Do not
send to the IRS.
Print or type.
See Specific Instructions on page 3.
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
2 Business name/disregarded entity name, if different from above
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the
following seven boxes.
❑ Individual/sole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate
single -member LLC
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) a
4 Exemptions (codes apply only to
certain entities. not individuals: see
instructions on page 3):
Exempt payee code (if any)
Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check
LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that
Exemption from FATCA reporting
code (if any)
NI
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
Other (see instructions) a
(Applies to accounts maintained outside the U.S.)
5 Address (number, street, and apt. or suite no.) See instructions.
Requester's name and address (optional)
6 City, state, and ZIP code
7 List account number(s) here (optional)
Part I Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities. it is your emolover identification number (EIN). If you do not have a number. see How to aet a
Social security number
-
-
TIN, later.
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and
Number To Give the Requester for guidelines on whose number to enter.
or
Employer identification number
Part II
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); arid
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
Sign
Here
Signature of
U.S. persona
Date.
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
- Form 1099-INT (interest earned or paid)
- Form 1099-DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
Cat. No.10231X
Form W-9 (Rev_ 11-2017)
Form W-9 (Rev. 11-2017) Page 2
By signing the filled -out form, you:
1. Certify that the TIN you are giving is correct (or you are waiting for a
number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt
payee. If applicable, you are also certifying that as a U.S. person, your
allocable share of any partnership income from a U.S. trade or business
is not subject to the withholding tax on foreign partners' share of
effectively connected income, and
4. Certify that FATCA code(s) entered on this form (if any) indicating
that you are exempt from the FATCA reporting, is correct. See What is
FATCA reporting, later, for further information.
Note: If you are a U.S. person and a requester gives you a form other
than Form W-9 to request your TIN, you must use the requester's form if
it is substantially similar to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
• An individual who is a U.S. citizen or U.S. resident alien;
• A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United States;
• An estate (other than a foreign estate); or
- A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or
business in the United States are generally required to pay a withholding
tax under section 1446 on any foreign partners' share of effectively
connected taxable income from such business. Further, in certain cases
where a Form W-9 has not been received, the rules under section 1446
require a partnership to presume that a partner is a foreign person, and
pay the section 1446 withholding tax. Therefore, if you are a U.S. person
that is a partner in a partnership conducting a trade or business in the
United States, provide Form W-9 to the partnership to establish your
U.S. status and avoid section 1446 withholding on your share of
partnership income.
In the cases below, the following person must give Form W-9 to the
partnership for purposes of establishing its U.S. status and avoiding
withholding on its allocable share of net income from the partnership
conducting a trade or business in the United States.
- In the case of a disregarded entity with a U.S. owner, the U.S. owner
of the disregarded entity and not the entity;
• In the case of a grantor trust with a U.S. grantor or other U.S. owner,
generally, the U.S. grantor or other U.S. owner of the grantor trust and
not the trust; and
• In the case of a U.S. trust (other than a grantor trust), the U.S. trust
(other than a grantor trust) and not the beneficiaries of the trust.
Foreign person. If you are a foreign person or the U.S. branch of a
foreign bank that has elected to be treated as a U.S. person, do not use
Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see
Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign
Entities).
Nonresident alien who becomes a resident alien. Generally, only a
nonresident alien individual may use the terms of a tax treaty to reduce
or eliminate U.S. tax on certain types of income. However, most tax
treaties contain a provision known as a "saving clause." Exceptions
specified in the saving clause may permit an exemption from tax to
continue for certain types of income even after the payee has otherwise
become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception
contained in the saving clause of a tax treaty to claim an exemption
from U.S. tax on certain types of income, you must attach a statement
to Form W-9 that specifies the following five items.
1. The treaty country. Generally, this must be the same treaty under
which you claimed exemption from tax as a nonresident alien.
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that contains the
saving clause and its exceptions.
4. The type and amount of income that qualifies for the exemption
from tax.
5. Sufficient facts to justify the exemption from tax under the terms of
the treaty article.
Example. Article 20 of the U.S.-China income tax treaty allows an
exemption from tax for scholarship income received by a Chinese
student temporarily present in the United States. Under U.S. law, this
student will become a resident alien for tax purposes if his or her stay in
the United States exceeds 5 calendar years. However, paragraph 2 of
the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows
the provisions of Article 20 to continue to apply even after the Chinese
student becomes a resident alien of the United States. A Chinese
student who qualifies for this exception (under paragraph 2 of the first
protocol) and is relying on this exception to claim an exemption from tax
on his or her scholarship or fellowship income would attach to Form
W-9 a statement that includes the information described above to
support that exemption.
If you are a nonresident alien or a foreign entity, give the requester the
appropriate completed Form W-8 or Form 8233.
Backup Withholding
What is backup withholding? Persons making certain payments to you
must under certain conditions withhold and pay to the IRS 28% of such
payments. This is called "backup withholding." Payments that may be
subject to backup withholding include interest, tax-exempt interest,
dividends, broker and barter exchange transactions, rents, royalties,
nonemployee pay, payments made in settlement of payment card and
third party network transactions, and certain payments from fishing boat
operators. Real estate transactions are not subject to backup
withholding.
You will not be subject to backup withholding on payments you
receive if you give the requester your correct TIN, make the proper
certifications, and report all your taxable interest and dividends on your
tax return.
Payments you receive will be subject to backup withholding if:
1. You do not furnish your TIN to the requester,
2. You do not certify your TIN when required (see the instructions for
Part II for details),
3. The IRS tells the requester that you furnished an incorrect TIN,
4. The IRS tells you that you are subject to backup withholding
because you did not report all your interest and dividends on your tax
return (for reportable interest and dividends only), or
5. You do not certify to the requester that you are not subject to
backup withholding under 4 above (for reportable interest and dividend
accounts opened after 1983 only).
Certain payees and payments are exempt from backup withholding.
See Exempt payee code, later, and the separate Instructions for the
Requester of Form W-9 for more information.
Also see Special rules for partnerships, earlier.
What is FATCA Reporting?
The Foreign Account Tax Compliance Act (FATCA) requires a
participating foreign financial institution to report all United States
account holders that are specified United States persons. Certain
payees are exempt from FATCA reporting. See Exemption from FATCA
reporting code, later, and the Instructions for the Requester of Form
W-9 for more information.
Updating Your Information
You must provide updated information to any person to whom you
claimed to be an exempt payee if you are no longer an exempt payee
and anticipate receiving reportable payments in the future from this
person. For example, you may need to provide updated information if
you are a C corporation that elects to be an S corporation, or if you no
longer are tax exempt. In addition, you must furnish a new Form W-9 if
the name or TIN changes for the account; for example, if the grantor of a
grantor trust dies.
Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN to a
requester, you are subject to a penalty of $50 for each such failure
unless your failure is due to reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. If you
make a false statement with no reasonable basis that results in no
backup withholding, you are subject to a $500 penalty.
Form W-9(Rev .11-2017) Page 3
Criminal penalty for falsifying information. Willfully falsifying
certifications or affirmations may subject you to criminal penalties
including fines and/or imprisonment.
Misuse of TINs. If the requester discloses or uses TINS in violation of
federal law, the requester may be subject to civil and criminal penalties.
Specific Instructions
Line 1
You must enter one of the following on this line; do not leave this line
blank. The name should match the name on your tax return.
If this Form W-9 is for a joint account (other than an account
maintained by a foreign financial institution (FFI)), list first, and then
circle, the name of the person or entity whose number you entered in
Part I of Form W-9. If you are providing Form W-9 to an FFI to document
a joint account, each holder of the account that is a U.S. person must
provide a Form W-9.
a. Individual. Generally, enter the name shown on your tax return. If
you have changed your last name without informing the Social Security
Administration (SSA) of the name change, enter your first name, the last
name as shown on your social security card, and your new last name.
Note: ITIN applicant: Enter your individual name as it was entered on
your Form W-7 application, line 1 a. This should also be the same as the
name you entered on the Form 1040/1040A/1040EZ you filed with your
application.
b. Sole proprietor or single -member LLC. Enter your individual
name as shown on your 1040/1040A/1040EZ on line 1. You may enter
your business, trade, or "doing business as" (DBA) name on line 2.
c. Partnership, LLC that is not a single -member LLC, C
corporation, or S corporation. Enter the entity's name as shown on the
entity's tax return on line 1 and any business, trade, or DBA name on
line 2.
d. Other entities. Enter your name as shown on required U.S. federal
tax documents on line 1. This name should match the name shown on the
charter or other legal document creating the entity. You may enter any
business, trade, or DBA name on line 2.
e. Disregarded entity. For U.S. federal tax purposes, an entity that is
disregarded as an entity separate from its owner is treated as a
"disregarded entity." See Regulations section 301.7701-2(c)(2)(iii). Enter
the owner's name on line 1. The name of the entity entered on line 1
should never be a disregarded entity. The name on line 1 should be the
name shown on the income tax return on which the income should be
reported. For example, if a foreign LLC that is treated as a disregarded
entity for U.S. federal tax purposes has a single owner that is a U.S.
person, the U.S. owner's name is required to be provided on line 1. If
the direct owner of the entity is also a disregarded entity, enter the first
owner that is not disregarded for federal tax purposes. Enter the
disregarded entity's name on line 2, "Business name/disregarded entity
name." If the owner of the disregarded entity is a foreign person, the
owner must complete an appropriate Form W-8 instead of a Form W-9.
This is the case even if the foreign person has a U.S. TIN.
Line 2
If you have a business name, trade name, DBA name, or disregarded
entity name, you may enter it on line 2.
Line 3
Check the appropriate box on line 3 for the U.S. federal tax
classification of the person whose name is entered on line 1. Check only
one box on line 3.
IF the entity/person on line 1 is
a(n)...
THEN check the box for ...
• Corporation
Corporation
• Individual
• Sole proprietorship, or
• Single -member limited liability
company (LLC) owned by an
individual and disregarded for U.S.
federal tax purposes.
Individual/sole proprietor or single-
member LLC
• LLC treated as a partnership for
U.S. federal tax purposes,
• LLC that has filed Form 8832 or
2553 to be taxed as a corporation,
or
• LLC that is disregarded as an
entity separate from its owner but
the owner is another LLC that is
not disregarded for U.S. federal tax
purposes.
Limited liability company and enter
the appropriate tax classification.
(P= Partnership; C= C corporation;
or S= S corporation)
• Partnership
Partnership
• Trust/estate
Trust/estate
Line 4, Exemptions
If you are exempt from backup withholding and/or FATCA reporting,
enter in the appropriate space on line 4 any code(s) that may apply to
you.
Exempt payee code.
• Generally, individuals (including sole proprietors) are not exempt from
backup withholding.
• Except as provided below, corporations are exempt from backup
withholding for certain payments, including interest and dividends.
• Corporations are not exempt from backup withholding for payments
made in settlement of payment card or third party network transactions.
• Corporations are not exempt from backup withholding with respect to
attorneys' fees or gross proceeds paid to attorneys, and corporations
that provide medical or health care services are not exempt with respect
to payments reportable on Form 1099-MISC.
The following codes identify payees that are exempt from backup
withholding. Enter the appropriate code in the space in line 4.
1—An organization exempt from tax under section 501(a), any IRA, or
a custodial account under section 403(b)(7) if the account satisfies the
requirements of section 401(f)(2)
2—The United States or any of its agencies or instrumentalities 3—
A state, the District of Columbia, a U.S. commonwealth or
possession, or any of their political subdivisions or instrumentalities
4—A foreign government or any of its political subdivisions, agencies,
or instrumentalities
5—A corporation
6—A dealer in securities or commodities required to register in the
United States, the District of Columbia, or a U.S. commonwealth or
possession
7—A futures commission merchant registered with the Commodity
Futures Trading Commission
8—A real estate investment trust
9—An entity registered at all times during the tax year under the
Investment Company Act of 1940
10—A common trust fund operated by a bank under section 584(a) 11—
A financial institution
12—A middleman known in the investment community as a nominee or
custodian
13—A trust exempt from tax under section 664 or described in section
4947
Form W-9 (Rev. 11-2017)
Page4
The following chart shows types of payments that may be exempt
from backup withholding. The chart applies to the exempt payees listed
above, 1 through 13.
IF the payment is for ...
THEN the payment is exempt
for...
Interest and dividend payments
All exempt payees except
for 7
Broker transactions
Exempt payees 1 through 4 and 6
through 11 and all C corporations.
S corporations must not enter an
exempt payee code because they
are exempt only for sales of
noncovered securities acquired
prior to 2012.
Barter exchange transactions and
patronage dividends
Exempt payees 1 through 4
Payments over $600 required to be
reported and direct sales over
$5,0001
Generally, exempt payees
1 through 52
Payments made in settlement of
payment card or third party network
transactions
Exempt payees 1 through 4
1 See Form 1099-MISC, Miscellaneous Income, and its instructions.
2 However, the following payments made to a corporation and
reportable on Form 1099-MISC are not exempt from backup
withholding: medical and health care payments, attorneys' fees, gross
proceeds paid to an attorney reportable under section 6045(f), and
payments for services paid by a federal executive agency.
Exemption from FATCA reporting code. The following codes identify
payees that are exempt from reporting under FATCA. These codes
apply to persons submitting this form for accounts maintained outside
of the United States by certain foreign financial institutions. Therefore, if
you are only submitting this form for an account you hold in the United
States, you may leave this field blank. Consult with the person
requesting this form if you are uncertain if the financial institution is
subject to these requirements. A requester may indicate that a code is
not required by providing you with a Form W-9 with "Not Applicable" (or
any similar indication) written or printed on the line for a FATCA
exemption code.
A —An organization exempt from tax under section 501(a) or any
individual retirement plan as defined in section 7701(a)(37)
B—The United States or any of its agencies or instrumentalities
C—A state, the District of Columbia, a U.S. commonwealth or
possession, or any of their political subdivisions or instrumentalities
D—A corporation the stock of which is regularly traded on one or
more established securities markets, as described in Regulations
section 1.1472-1(c)(1)(i)
E—A corporation that is a member of the same expanded affiliated
group as a corporation described in Regulations section 1.1472-1(c)(1)(i)
F—A dealer in securities, commodities, or derivative financial
instruments (including notional principal contracts, futures, forwards,
and options) that is registered as such under the laws of the United
States or any state
G—A real estate investment trust
H—A regulated investment company as defined in section 851 or an
entity registered at all times during the tax year under the Investment
Company Act of 1940
I —A common trust fund as defined in section 584(a) J—
A bank as defined in section 581
K—A broker
L—A trust exempt from tax under section 664 or described in section
4947(a)(1)
M—A tax exempt trust under a section 403(b) plan or section 457(g)
plan
Note: You may wish to consult with the financial institution requesting
this form to determine whether the FATCA code and/or exempt payee
code should be completed.
Line 5
Enter your address (number, street, and apartment or suite number).
This is where the requester of this Form W-9 will mail your information
returns. If this address differs from the one the requester already has on
file, write NEW at the top. If a new address is provided, there is still a
chance the old address will be used until the payor changes your
address in their records.
Line 6
Enter your city, state. and ZIP code.
Part I. Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. If you are a resident alien and
you do not have and are not eligible to get an SSN, your TIN is your IRS
individual taxpayer identification number (ITIN). Enter it in the social
security number box. If you do not have an ITIN, see How to get a TIN
below.
If you are a sole proprietor and you have an EIN, you may enter either
your SSN or EIN.
If you are a single -member LLC that is disregarded as an entity
separate from its owner, enter the owner's SSN (or EIN, if the owner has
one). Do not enter the disregarded entity's EIN. If the LLC is classified as
a corporation or partnership, enter the entity's EIN.
Note: See What Name and Number To Give the Requester, later, for
further clarification of name and TIN combinations.
How to get a TIN. If you do not have a TIN, apply for one immediately.
To apply for an SSN, get Form SS-5, Application for a Social Security
Card, from your local SSA office or get this form online at
www.SSA.gov. You may also get this form by calling 1-800-772-1213.
Use Form W-7, Application for IRS Individual Taxpayer Identification
Number, to apply for an ITIN, or Form SS-4, Application for Employer
Identification Number, to apply for an EIN. You can apply for an EIN
online by accessing the IRS website at www.irs.gov/Businesses and
clicking on Employer Identification Number (EIN) under Starting a
Business. Go to www.irs.gov/Forms to view, download, or print Form W-
7 and/or Form SS-4. Or, you can go to www.irs.gov/OrderForms to
place an order and have Form W-7 and/or SS-4 mailed to you within 10
business days.
If you are asked to complete Form W-9 but do not have a TIN, apply
for a TIN and write "Applied For" in the space for the TIN, sign and date
the form, and give it to the requester. For interest and dividend
payments, and certain payments made with respect to readily tradable
instruments, generally you will have 60 days to get a TIN and give it to
the requester before you are subject to backup withholding on
payments. The 60-day rule does not apply to other types of payments.
You will be subject to backup withholding on all such payments until
you provide your TIN to the requester.
Note: Entering "Applied For" means that you have already applied for a
TIN or that you intend to apply for one soon.
Caution: A disregarded U.S. entity that has a foreign owner must use
the appropriate Form W-8.
Part II. Certification
To establish to the withholding agent that you are a U.S. person, or
resident alien, sign Form W-9. You may be requested to sign by the
withholding agent even if item 1, 4, or 5 below indicates otherwise.
For a joint account, only the person whose TIN is shown in Part I
should sign (when required). In the case of a disregarded entity, the
person identified on line 1 must sign. Exempt payees, see Exempt payee
code, earlier.
Signature requirements. Complete the certification as indicated in
items 1 through 5 below.
Form W-9 (Rev. 11-2017) Page 5
1. Interest, dividend, and barter exchange accounts opened
before 1984 and broker accounts considered active during 1983.
You must give your correct TIN, but you do not have to sign the
certification.
2. Interest, dividend, broker, and barter exchange accounts
opened after 1983 and broker accounts considered inactive during
1983. You must sign the certification or backup withholding will apply. If
you are subject to backup withholding and you are merely providing
your correct TIN to the requester, you must cross out item 2 in the
certification before signing the form.
3. Real estate transactions. You must sign the certification. You may
cross out item 2 of the certification.
4. Other payments. You must give your correct TIN, but you do not
have to sign the certification unless you have been notified that you
have previously given an incorrect TIN. "Other payments" include
payments made in the course of the requester's trade or business for
rents, royalties, goods (other than bills for merchandise), medical and
health care services (including payments to corporations), payments to
a nonemployee for services, payments made in settlement of payment
card and third party network transactions, payments to certain fishing
boat crew members and fishermen, and gross proceeds paid to
attorneys (including payments to corporations).
5. Mortgage interest paid by you, acquisition or abandonment of
secured property, cancellation of debt, qualified tuition program
payments (under section 529), ABLE accounts (under section 529A),
IRA, Coverdell ESA, Archer MSA or HSA contributions or
distributions, and pension distributions. You must give your correct
TIN, but you do not have to sign the certification.
What Name and Number To Give the Requester
For this type of account:
Give name and SSN of:
1. Individual
2. Two or more individuals (joint
account) other than an account
maintained by an FFI
3. Two or more U.S. persons
(joint account maintained by an FFI)
4. Custodial account of a minor
(Uniform Gift to Minors Act)
5. a. The usual revocable savings trust
(grantor is also trustee)
b. So-called trust account that is not
a legal or valid trust under state law
6. Sole proprietorship or disregarded
entity owned by an individual
7. Grantor trust filing under Optional
Form 1099 Filing Method 1 (see
Regulations section 1.671-4(b)(2)(i)
(A))
The individual
The actual owner of the account or, if
combined funds, the first individual on
the account'
Each holder of the account
The minor'
The grantor -trustee"
The actual owner'
The owner'
The grantor*
For this type of account:
Give name and EIN of:
8. Disregarded entity not owned by an
individual
9. A valid trust, estate, or pension trust
10. Corporation or LLC electing
corporate status on Form 8832 or
Form 2553
11. Association, club, religious,
charitable, educational, or other tax-
exempt organization
12. Partnership or multi -member LLC
13. A broker or registered nominee
The owner
Legal entity°
The corporation
The organization
The partnership
The broker or nominee
For this type of account:
Give name and EIN of:
14. Account with the Department of
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
15. Grantor trust filing under the Form
1041 Filing Method or the Optional
Form 1099 Filing Method 2 (see
Regulations section 1.671-4(b)(2)(i)(B))
The public entity
The trust
'List first and circle the name of the person whose number you furnish.
If only one person on a joint account has an SSN, that person's number
must be furnished.
2 Circle the minor's name and furnish the minor's SSN.
'You must show your individual name and you may also enter your
business or DBA name on the "Business name/disregarded entity"
name line. You may use either your SSN or EIN (if you have one), but the
IRS encourages you to use your SSN.
° List first and circle the name of the trust, estate, or pension trust. (Do
not furnish the TIN of the personal representative or trustee unless the
legal entity itself is not designated in the account title.) Also see Special
rules for partnerships, earlier.
*Note: The grantor also must provide a Form W-9 to trustee of trust.
Note: If no name is circled when more than one name is listed, the
number will be considered to be that of the first name listed.
Secure Your Tax Records From Identity Theft
Identity theft occurs when someone uses your personal information
such as your name, SSN, or other identifying information, without your
permission, to commit fraud or other crimes. An identity thief may use
your SSN to get a job or may file a tax return using your SSN to receive
a refund.
To reduce your risk:
- Protect your SSN,
• Ensure your employer is protecting your SSN, and
• Be careful when choosing a tax preparer.
If your tax records are affected by identity theft and you receive a
notice from the IRS, respond right away to the name and phone number
printed on the IRS notice or letter.
If your tax records are not currently affected by identity theft but you
think you are at risk due to a lost or stolen purse or wallet, questionable
credit card activity or credit report, contact the IRS Identity Theft Hotline
at 1-800-908-4490 or submit Form 14039.
For more information, see Pub. 5027, Identity Theft Information for
Taxpayers.
Victims of identity theft who are experiencing economic harm or a
systemic problem, or are seeking help in resolving tax problems that
have not been resolved through normal channels, may be eligible for
Taxpayer Advocate Service (TAS) assistance. You can reach TAS by
calling the TAS toll -free case intake line at 1-877-777-4778 or TTY/TDD
1-800-829-4059.
Protect yourself from suspicious emails or phishing schemes.
Phishing is the creation and use of email and websites designed to
mimic legitimate business emails and websites. The most common act
is sending an email to a user falsely claiming to be an established
legitimate enterprise in an attempt to scam the user into surrendering
private information that will be used for identity theft.
Form W-9 (Rev. 11-2017) Page 6
The IRS does not initiate contacts with taxpayers via emails. Also, the
IRS does not request personal detailed information through email or ask
taxpayers for the PIN numbers, passwords, or similar secret access
information for their credit card, bank, or other financial accounts.
If you receive an unsolicited email claiming to be from the IRS,
forward this message to phishing@irs.gov. You may also report misuse
of the IRS name, logo, or other IRS property to the Treasury Inspector
General for Tax Administration (TIGTA) at 1-800-366-4484. You can
forward suspicious emails to the Federal Trade Commission at
spam@uce.gov or report them at www.ftc.gov/complaint. You can
contact the FTC at www.ftc.gov/idtheft or 877-IDTHEFT (877-438-4338).
If you have been the victim of identity theft, see www.IdentityTheft.gov
and Pub. 5027.
Visit www.irs.gov/ldentityTheft to learn more about identity theft and
how to reduce your risk.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your
correct TIN to persons (including federal agencies) who are required to
file information returns with the IRS to report interest, dividends, or
certain other income paid to you; mortgage interest you paid; the
acquisition or abandonment of secured property; the cancellation of
debt; or contributions you made to an IRA, Archer MSA, or HSA. The
person collecting this form uses the information on the form to file
information returns with the IRS, reporting the above information.
Routine uses of this information include giving it to the Department of
Justice for civil and criminal litigation and to cities, states, the District of
Columbia, and U.S. commonwealths and possessions for use in
administering their laws. The information also may be disclosed to other
countries under a treaty, to federal and state agencies to enforce civil
and criminal laws, or to federal law enforcement and intelligence
agencies to combat terrorism. You must provide your TIN whether or
not you are required to file a tax return. Under section 3406, payers
must generally withhold a percentage of taxable interest, dividend, and
certain other payments to a payee who does not give a TIN to the payer.
Certain penalties may also apply for providing false or fraudulent
information.
ANTI -POVERTY INITIATIVE
FUNDING AGREEMENT
EXHIBIT E - INSURANCE REQUIREMENTS
Commercial General Liability
A. Limits of Liability
Bodily Injury and Property Damage Liability
Each Occurrence $300,000
General Aggregate Limit $600,000
Personal and Adv. Injury $300,000
Products/Completed Operations $300,000
B. Endorsements Required
City of Miami listed as additional insured
Contingent & Contractual Liability
Premises and Operations Liability
Primary Insurance Clause Endorsement
II. Business Automobile Liability
A. Limits of Liability
Bodily Injury and Property Damage Liability
Combined Single Limit
Scheduled Autos
Including Hired, Borrowed or Non -Owned Autos
Any One Accident $ 300,000
B. Endorsements Required
City of Miami listed as an additional insured
III. Worker's Compensation
Limits of Liability
Statutory -State of Florida
Waiver of Subrogation
Employer's Liability
A. Limits of Liability
$100,000 for bodily injury caused by an accident, each accident
$100,000 for bodily injury caused by disease, each employee
$500,000 for bodily injury caused by disease, policy limit
IV. Professional Liability/Errors and Omissions Coverage (if applicable)
Combined Single Limit
Each Claim
General Aggregate Limit
Retro Date Included
$ 250,000
$ 250,000
The above policies shall provide the City of Miami with written notice of cancellation or
material change from the insurer in accordance to policy provisions.
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.
ANTI -POVERTY INITIATIVE
FUNDING AGREEMENT
EXHIBIT F - CLOSE-OUT REPORT
ANTI -POVERTY INITIATIVE
FUNDING AGREEMENT
EXHIBIT G - RECIPIENT'S CORPORATE RESOLUTION
City of Miami
2019 Anti -Poverty Initiative Program Close -Out Report
Date: Allocation Amount:
Program/Project Title:
Recipient's Name:
Recipient's Address:
Please provide the information in reference to all the services provided with the City of Miami Anti -Poverty
Initiative:
Program Start Date and End Date
Program/Project Priority Area
Description of Project/Activity/Service
District where Project/Activity/Service were
Provided
District 1, District 2, District 2, District 3, District 5 and/or
Citywide
Location of Project/Activity/Service (ie. Site,
neighborhood, area)
Total Number of People Served
Frequency of Project/Activity/Service
I certify that the Program/Service was provided in accordance to the City of Miami Anti -Poverty Initiative Program
Guidelines
Signature
Date
Type Name
Title:
Return to:
City of Miami
Office of Grants Administration
444 SW 2nd Ave., 5th Floor
Miami, FL 33130