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HomeMy WebLinkAbout24417AGREEMENT INFORMATION AGREEMENT NUMBER 24417 NAME/TYPE OF AGREEMENT THE LIBERTY CITY OPTIMIST CLUB OF FLORIDA, INC. DESCRIPTION SOCIAL SERVICES GAP PROGRAM AGREEMENT/YOUTH SERVICES PROGRAM/FILE ID: 10914/R-22-0016/MATTER ID: 22-253/#23 EFFECTIVE DATE February 23, 2022 ATTESTED BY TODD B. HANNON ATTESTED DATE 2/17/2022 DATE RECEIVED FROM ISSUING DEPT. 5/10/2023 NOTE CITY OF MIAMI DOCUMENT ROUTING FORM all ORIGINATING DEPARTMENT: HOUSING AND COMMUNITY DEVELOPMENT DEPT. CONTACT PERSON: MONICA GALO EXT. 1976 NAME OF OTHER CONTRACTUAL PARTY/ENTITY: THE LIBERTY CITY OPTIMIST CLUB OF FLORIDA, INC. IS THIS AGREEMENT AS A RESULT OF A COMPETITIVE PROCUREMENT PROCESS? ❑YES ®NO TOTAL CONTRACT AMOUNT: $ 12,524.00 FUNDING INVOLVED? ® YES 0 NO TYPE OF AGREEMENT: ❑ MANAGEMENT AGREEMENT ❑ PROFESSIONAL SERVICES AGREEMENT ❑ GRANT AGREEMENT ❑ EXPERT CONSULTANT AGREEMENT ❑ LICENSE AGREEMENT OTHER: (PLEASE SPECIFY): N/A PURPOSE OF THE ITEM (BRIEF SUMMARY): ❑ PUBLIC WORKS AGREEMENT ❑ MAINTENANCE AGREEMENT ❑ INTER -LOCAL AGREEMENT ❑ LEASE AGREEMENT ❑ PURCHASE OR SALE AGREEMENT Contract in the amount of $ 12, 524.00 in SSG funding to THE LIBERTY CITY OPTIMIST CLUB OF FLORIDA, INC. for the implementation of Public Service Activities. For additional information please see resolution attached. COMMISSION APPROVAL DATE: January 13, 2022 FILE ID: 10914 IF THIS DOES NOT REQUIRE COMMISSION APPROVAL, PLEASE EXPLAIN: N/A ENACTMENT No.: R-22-0016 ROUTING INFORMATION Date ( EAS I AND SIGN APPROVAL BY DEPARTMENTAL DIRECTOR 2/4/2022 PRINT: R'bBERTO T ' E SIGNATURE: — SUBMITTED TO RISK MANAGEMENT PRINT: ANN-MARIE SHARPE signed by Gomez, Gomez, Frank SIGNATURE: Frank 08:2:3o224-0A25'00',04 08:203 SUBMITTED TO CITY ATTORNEY PRINT: VICTORIA MENDEZ 'a- a L. SIGNATURE: APPROVAL BY ASSISTANT CITY MANAGER PRINT: FERNANDO CASAMAYOR SIGNATURE: RECEIVED BY CITY MANAGER `' PRINT: ART NORIEGA, V. SIGNATURE: 1) ONE ORIGINAL TO CITY CLERK, 2) ONE COPY TO CITY ATTORNEY"S OFFICE, 3) REMAINING ORIGINAL(S) TO ORIGINATING DEPARTMENT N/A PRINT: TODD B. HANNON SIGNATURE: PRINT: „ SIGNATURE: PRINT:' SIGNATURE: PLEASE ATTACH THIS ROUTING FORM TO ALL DOCUMENTS THAT REQUIRE EXECUTION BY THE CITY MANAGER City of Miami Office of the City Attorney Legal Services Request To: Office of the City Attorney Date: February 3, 2022 From: Monica Galo Housing & Community Dev Contact Person Requesting Client Administrative Aide 305-416-1976 Title Telephone Legal Service Requested: HCD- 2022 -0014 Enclosed please fmd a contract for Public Service to be funded with Social Service Gap (SSG) for your review. Complete form and forward to the Office of the City Attorney or e-mail to Legal Services. Do not assume that the Office of the City Attorney knows the background of the question and/or issue, such as opinions on the same or similar issues, the existence of relevant memos, correspondence, etc. Please attach to this form and/or e-mail all pertinent information relating to the subject. Once your request has been assigned, an e-mail will be sent to you with the Assigned Attorney's name and the issued matter identification number. All attorneys in the Office of the City Attorney shall fully comply with the Rules Regulating The Florida Bar. For Legal Services requesting an opinion from the Office of the City Attorney: ❑ Iss . ion in writing. ❑ Pub h opim er issuance. Authorized by: ' o erto Tazoe Date response requested by: as soon as possible BELOW PORTION TO BE COMPLETED BY THE OFFICE OF THE CITY ATTORNEY Assigned Attorney: Date: File No. Approved by: Ultimate Client: Comments: D / R Date: Type: Matrix: Category: Copy returned to Requesting Client Copy to Ultimate Client rev. 06/17/2011 CITY OF MIAMI, FLORIDA DEPARTMENT OF HOUSING & COMMUNITY DEVELOPMENT SOCIAL SERVICES GAP PROGRAM ("SSG") AGREEMENT This Agreement (hereinafter the "Agreement") is entered into this , 9 day of lze .„U ' , 20 1, ;etween the City of Miami, a municipal corporation of the State of Florida (herei fter the "CITY"), & The Liberty City Optimist Club of Florida, Inc. a Florida not for profit corporation (hereinafter referred to as the "RECIPIENT"). FUNDING SOURCE: Social Services Gap Program CFDI # (If applicable): N/A AMOUNT: $ 12,524.00 TERM OF AGREEMENT: Effective date of this agreement is October 1, 2021 PROJECT NUMBER: to September 30, 2022 DUNS® NUMBER: 96-789-7109 AGENCY'S ADDRESS: 4900 NW 12TH AVENUE Miami, FL 33127 NOW, THEREFORE, in consideration of the mutual covenants and obligations herein set forth, the parties understand and agree as follows: ARTICLE I EXHIBITS AND DEFINITIONS 1.1 EXHIBITS. Attached hereto and forming a part of this Agreement are the following Exhibits: Exhibit A Corporate Resolution Authorizing Execution of this Agreement 1 Exhibit B Work Program Exhibit C Compensation and Budget Summary Exhibit D Certification Regarding Lobbying Form Exhibit E Certification Regarding Debarment, Suspension and other Responsibility Matters (Primary Covered Transactions Form) Exhibit F Crime Entity Affidavit Exhibit G Insurance Requirements 1.2 DEFINED TERMS. As used herein the following terms shall mean: Agreement Records: Any and all books, records, documents, information, data, papers, letters, materials, and computerized or electronic storage data and media, whether written, printed, computerized, electronic or electrical, however collected or preserved, which is or was produced, developed, maintained, completed, received or compiled by or at the direction of the RECIPIENT or any subcontractor in carrying out the duties and obligations required by the terms of this Agreement, including, but not limited to, financial books and records, ledgers, drawings, maps, pamphlets, designs, electronic tapes, computer drives and diskettes or surveys. SSG Program: Social Services Gap Program ("SSG") Department: The City of Miami Department of Housing & Community Development. Award: Any funds received by the RECIPIENT from any source during the period of time in which the RECIPIENT is performing the obligations set forth in this Agreement. Low -and -Moderate A member of a low- or moderate -income household whose Income Person: income is within specific income levels set forth by U.S. HUD. ARTICLE II BASIC REQUIREMENTS The following documents must be approved by the CITY and must be on file with the Department prior to the CITY's execution of this Agreement: 2.1 The Work Program submitted by the RECIPIENT to the CITY which shall become attached hereto as Exhibit `B" to this Agreement and shall include the following: 2.1.1 The description section shall detail the activities to be carried out by the RECIPIENT. It should specifically describe the activities to be carried out as a result of the expenditure of Funds. Where appropriate it should list measurable 2 objectives, define the who, what, where and when of the project, and in general detail how these activities will ensure that the intended beneficiaries will be served. 2.1.2 The schedule of activities and measurable objectives play an essential role in the grant management system. The schedule should provide projected milestones and deadlines for the accomplishment of tasks in carrying out the Work Program. These projected milestones and deadlines are a basis for measuring actual progress during the term of this Agreement. These items shall be in sufficient detail to provide a sound basis for the CITY to effectively monitor performance by the RECIPIENT under this Agreement. 2.2 The Budget Summary attached hereto as Exhibit "C", including the RECIPIENT's Itemized Budget, Cost Allocation, Budget Narrative, Staff Salaries Schedule and a copy of all subcontracts. 2.3 A list of key staff person (with their titles) who will carry out the Work Program. 2.4 Completion of an Authorized Representative Statement. 2.5 Job description and resumes for all positions funded in whole or in part under this Agreement. 2.6 The following corporate documents: (i) Bylaws, resolutions, and incumbency certificates for the RECIPIENT, certified by the RECIPIENT' s Corporate Secretary, authorizing the consummation of the transactions contemplated hereby, all in a form satisfactory to the CITY. 2.7 All other documents reasonably required by the CITY. ARTICLE III TERMS AND PROCEDURES 3.1 CITY AUTHORIZATION. For the purpose of this Agreement, the Department will act on behalf of the CITY in the fiscal control, programmatic monitoring and modification of this Agreement, except as otherwise provided in this Agreement. 3.2 3.2 EFFECTIVE DATE AND TERM: The Effective date of this agreement is October 1, 2021 to September 30, 2022 3.3 OBLIGATIONS OF RECIPIENT. The RECIPIENT shall carry out the services and activities as prescribed in its Work Program, which is attached and incorporated herein and made a part of this Agreement, in a manner that is lawful, and satisfactory to the CITY, and in accordance with the policies, procedures, and requirements as prescribed in this Agreement, and as set forth by the CITY. 3 3.4 POLICIES AND PROCEDURES MANUAL. The RECIPIENT is aware of and accepts the Policies and Procedures Manual, as applicable, for Community Development Block Grant ("CDBG") sub -recipients as the official document which outlines the fiscal, administrative and other guidelines which shall regulate the day-to-day operations of the RECIPIENT. The Policies and Procedures Manual for CDBG sub -recipients is incorporated herein and made a part of this Agreement. The City of Miami reserves the right to update this Policies and Procedures Manual via Program Directives. These Program Directives and updated versions of this Policies and Procedures Manual shall be incorporated and made a part of this Agreement. 3.5 LEVEL OF SERVICE. Should start-up time for the Work Program be required or in the event of the occurrence of any delays in the activities thereunder, the RECIPIENT shall immediately notify the Department in writing, giving all pertinent details and indicating when the Work Program shall begin and/or continue. It is understood and agreed that the RECIPIENT shall maintain the level of activities and expenditures in existence prior to the execution of this Agreement. Any activities funded through or as a result of this Agreement shall not result in the displacement of employed workers, impair existing agreements for services or activities, or result in the substitution of funds allocated under this Agreement for other funds in connection with work which would have been performed in the absence of this Agreement. ARTICLE IV SSG PROGRAM FUNDING AND DISBURSEMENT REQUIREMENTS 4.1 COMPENSATION. The amount of compensation payable by the CITY to the RECIPIENT shall be pursuant to the rates, schedules and conditions described in Exhibit "C" attached hereto and incorporated into this Agreement. 4.2 INSURANCE. At all times during the term hereof, the RECIPIENT shall maintain insurance acceptable to the CITY. Prior to commencing any activity under this Agreement, the RECIPIENT shall furnish to the CITY original certificates of insurance indicating that the RECIPIENT is in compliance with the provisions described in Exhibit "G" attached hereto, and incorporated into this Agreement. 4.3 FINANCIAL ACCOUNTABILITY. The CITY reserves the right to audit the records of the RECIPIENT at any time during the performance of this Agreement and for a period of five (5) years after its expiration/termination. The RECIPIENT agrees to provide all financial and other applicable records and documentation of services to the CITY. Any payment made shall be subject to reduction for amounts included in the related invoice which are found by the CITY, on the basis of such audit/review and at its sole discretion, not to constitute reasonable and necessary expenditures. Any payments made to the RECIPIENT are subject to reduction for overpayments on previously submitted invoices. 4 4.4 RECAPTURE OF FUNDS. The CITY reserves the right to recapture funds in the event that the RECIPIENT shall fail: (i) to comply with the terms of this Agreement, or (ii) to accept conditions imposed by the CITY. 4.5 CONTINGENCY CLAUSE. Funding pursuant to this Agreement is contingent on the availability of funds and continued authorization for SSG Program activities, and is also subject to amendment or termination due to lack of funds or authorization, reduction of funds, and/or changes in regulations. ARTICLE V RECORDS AND REPORTS 5.1 The RECIPIENT shall establish and maintain sufficient records to enable the CITY to determine whether the RECIPIENT has met the requirements of the SSG Program. At a minimum, the following records shall be maintained by the RECIPIENT: 5.1.1 Records providing a full description of each activity assisted or undertaken with SSG Program Funds, including its location (if the activity has a geographical locus), the amount of SSG and non -SSG Program Funds budgeted, obligated and expended for the activity. 5.1.2 Equal Opportunity Records containing: (i) Data on the extent to which each racial and ethnic group and single -headed households (by gender of household head) have applied for, participated in, or benefited from, any program or activity funded in whole or in part with SSG Program Funds. Such information shall be used only as a basis for further investigation relating to compliance with any requirement to attain or maintain any particular statistical measure by race, ethnicity, or gender in covered programs. 5.2 RETENTION AND ACCESSIBILITY OF RECORDS: 5.2.1 The Depai talent shall have the authority to review the RECIPIENT' s records, including project and programmatic records and books of account, for a period of five (5) years from the expiration/termination of this Agreement (the "Retention Period"). All books of account and supporting documentation shall be kept by the RECIPIENT at least until the expiration of the Retention Period. All records and reports required herein shall be retained and made accessible as provided thereunder. The RECIPIENT further agrees to abide by Chapter 119, Florida Statutes, as the same may be amended from time to time, pertaining to public records. The RECIPIENT shall ensure that the Agreement Records shall be 5 at all times subject to and available for full access and review, inspection and audit by the CITY and any other personnel duly authorized by the CITY. 5.2.2 The RECIPIENT shall include in all the Depaitiuent's approved subcontracts used to engage subcontractors to carry out any eligible substantive project or programmatic activities, as described in this Agreement and defined by the Department, each of the record -keeping and audit requirements detailed in this Agreement. The Depaituient shall, in its sole discretion, determine when services are eligible substantive project and/or programmatic activities and subject to the audit and record -keeping requirements described in this Agreement 5.2.3 If the CITY or the RECIPIENT has received or given notice of any kind indicating any threatened or pending litigation, claim or audit arising out of the activities pursuant to the project, the activities and/or the Work Program or under the terms of this Agreement, the Retention Period shall be extended until such time as the threatened or pending litigation, claim or audit is, in the sole and absolute discretion of the Department fully, completely and fmally resolved. 5.2.4 The RECIPIENT shall notify the Department in writing, both during the term of this Agreement and after its expiration/termination as part of the final closeout procedure, of the address where all Agreement Records will be retained. 5.2.5 The RECIPIENT shall obtain the prior written consent of the Department to the disposal of any Agreement Records within one year after the expiration of the Retention Period. 5.3 PROVISION OF RECORDS: 5.3.1 At any time upon request by the Depaitnient, the RECIPIENT shall provide all Agreement Records to the Department. The requested Agreement Records shall become the property of the Depth tuient without restriction, reservation, or limitation on their use. The Department shall have unlimited rights to all books, articles, or other copyrightable materials developed in the performance of this Agreement. These rights include the right of royalty -free, nonexclusive, and irrevocable license to reproduce, publish, or otherwise use, and to authorize others to use the Work Program for public purposes. 5.4 MONITORING. The RECIPIENT shall permit the Department and other persons duly authorized by the Department 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 Department. If a monitoring visit occurs, following such inspection or interviews, the Department will deliver to the RECIPIENT a report of its fmdings. The RECIPIENT will rectify all deficiencies cited by the Depaltuuent within the specified period of time set forth in the report or provide the Department with a reasonable justification for not 6 correcting the same. The Department will determine, in its sole and absolute discretion, whether or not the RECIPIENT' s justification is acceptable. 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. The CITY may carry out monitoring and evaluation activities, including visits and observations by CITY staff. The RECIPIENT shall ensure the cooperation of its employees and its Board members in such efforts. Any inconsistent, incomplete, or inadequate information, either received by the CITY or obtained through monitoring and evaluation by the CITY, shall constitute cause for the CITY to terminate this Agreement. 5.5 RELATED PARTIES: The term "related -parry transaction" includes, but is not limited to, a for -profit or nonprofit subsidiary or affiliate organization, an organization with an overlapping Board of Directors and an organization for which the RECIPIENT is responsible for appointing memberships. Upon forming the relationship or if already formed, before of at the time of execution of this Agreement, the RECIPIENT shall report such relationship to the Department. Any supplemental information shall be promptly reported to the Department. The RECIPIENT shall report to the Department the name, purpose for and any and all other relevant information in connection with any related -party transaction. ARTICLE VI OTHER SSG PROGRAM REQUIREMENTS 6.1 NON-DISCRIMINATION: The RECIPIENT shall not discriminate on the basis of race, color, national origin, sex, religion, age, marital or family status or handicap in connection with the activities and/or the Work Program or its performance under this Agreement. Furthermore, the RECIPIENT agrees that no otherwise qualified individual shall, solely by reason of his/her race, sex, color, creed, national origin, age, marital status or handicap, be excluded from the participation in, be denied benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance. 6.2 REVERSION OF ASSETS. Upon expiration/termination of this Agreement, the RECIPIENT must transfer to the CITY any unused SSG Program Funds at the time of expiration/termination and any accounts receivable attributable to the use of SSG Program Funds. 6.3 ENFORCEMENT OF THIS AGREEMENT. Any violation of this Agreement that remains uncured thirty (30) days after the RECIPIENT's receipt of notice from the CITY (by certified or registered mail) of such violation may, at the option of the CITY, be addressed by an action for damages or equitable relief, or any other remedy provided at law or in equity. In addition 7 to the remedies of the CITY set forth herein, if the RECIPIENT fails to comply with the terms of this Agreement, the CITY may suspend or terminate this Agreement. ARTICLE VII REMEDIES, SUSPENSION, TERMINATION 7.1 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: 7.1.1 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. 7.1.2 Disallow (that is, deny both the use of funds and matching credit) for all or part of the cost of the activity or action not in compliance. 7.1.3 Wholly or partially suspend or terminate the current SSG Program Funds awarded to the RECIPIENT. 7.1.4 Withhold further SSG Program funding for the RECIPIENT. 7.1.5 Take all such other remedies that may be legally available. Notwithstanding any other provision of this Agreement, if the RECIPIENT fails to comply with any term of this Agreement, the RECIPIENT, at the sole discretion of the City, shall pay to the City an amount equal to the current market value of any real property, under the RECIPIENT's control, acquired or improved in whole or in part with SSG Program Funds (including SSG Program Funds provided to the RECIPIENT in the form of a loan and/or grant), less any portion of the value attributable to expenditures of non -SSG Program funds for the acquisition of, or improvement to, the property. The payment is program income to the City. 7.2 SUSPENSION: 7.2.1 The Department may, for reasonable cause, temporarily suspend the RECIPIENT' s operations and authority to obligate funds under this Agreement or withhold payments to the RECIPIENT pending necessary corrective action by the 8 RECIPIENT, or both. Reasonable cause shall be determined by the Department in its sole and absolute discretion, and may include: (i) Ineffective or improper use of the SSG Program Funds by the RECIPIENT; (ii) Failure by the RECIPIENT to comply with any term or provision of this Agreement; (iii) Failure by the RECIPIENT to submit any documents required by this Agreement; or (iv) The RECIPIENT' s submittal of incorrect or incomplete documents. 7.2.2 The Department will notify the RECIPIENT in writing of any action taken pursuant to this Article by electronic mail, certified mail, return receipt requested, or by in person delivery with proof of delivery. The notification will include the reason(s) for such action, any conditions relating to the action taken, and the necessary corrective action(s). 7.3 TERMINATION. 7.3.1 Termination Because of Lack of Funds. In the event the CITY does not have the funds to finance this Agreement, or in the event that the CITY de -obligates the funds allocated to fund this Agreement, the Department may terminate this Agreement upon not less than twenty-four (24) hours prior notice in writing to the RECIPIENT. Said notice shall be delivered by electronic mail, certified mail, return receipt requested, or by in person delivery with proof of delivery. In the event that the CITY' s funding is reduced for SSG Program, the CITY shall determine, in its sole and absolute discretion, the availability of funds for the RECIPIENT pursuant to this Agreement. 7.3.2 Termination for Breach. The Department may terminate this Agreement, in whole or in part, in the event the Department determines, in its sole and absolute discretion, that the RECIPIENT is not compliant with any term or provision of this Agreement. The Department may terminate this Agreement, in whole or in part, in the event that the Department determines, in its sole and absolute discretion, that there exists an event of default under and pursuant to the terms of any other agreement or obligation of any kind or nature whatsoever of the RECIPIENT to the CITY, direct or contingent, whether now or hereafter due, existing, created or arising. 7.3.3 Unless the RECIPIENT's breach is waived by the Department in writing, the Department may, by written notice to the RECIPIENT, terminate this Agreement upon not less than twenty-four (24) hours prior written notice. Said notice shall be delivered by electronic mail, certified mail, return receipt requested, or by in person delivery with proof of delivery. Waiver of breach of any provision of this Agreement shall not be deemed to be a waiver of any other breach and shall not be construed to be a modification of the terms of this Agreement. The provisions hereof are not intended to be, and shall not be, construed to limit the Department's right to legal or equitable remedies. 9 ARTICLE VIII MISCELLANEOUS PROVISIONS 8.1 INDEMNIFICATION. The RECIPIENT shall indemnify, hold harmless, and defend the City, its officers, agents, directors, and/or employees, from liabilities, damages, losses, judgments, and costs, including, but not limited to reasonable attorney's fees, to the extent caused by the negligence, recklessness, negligent act or omission, or intentional wrongful misconduct of RECIPIENT and persons employed or utilized by RECIPIENT in the performance of this Contract. RECIPIENT shall, further, hold the City, its officials and/or employees, harmless for, and defend the City, its officials and/or employees against, any civil actions, statutory or similar claims, injuries or damages arising or resulting from the permitted work, even if it is alleged that the City, its officials and/or employees were negligent. These indemnifications shall survive the term of this Contract. In the event that any action or proceeding is brought against the City by reason of any such claim or demand, the RECIPIENT shall, upon written notice from the City, resist and defend such action or proceeding by counsel satisfactory to the City. The RECIPIENT expressly understands and agrees that any insurance protection required by this Agreement or otherwise provided by the RECIPIENT shall in no way limit the responsibility to indemnify, keep and save harmless and defend the City or its officers, employees, agents and instrumentalities as herein provided. The indemnification provided above shall obligate the RECIPIENT to defend, at its own expense, to and through appellate, supplemental or bankruptcy proceeding, or to provide for such defense, at the City's option, any and all claims of liability and all suits and actions of every name and description which may be brought against the City whether performed by the RECIPIENT, or persons employed or utilized by RECIPIENT. This indemnity will survive the cancellation or expiration of the Agreement. This indemnity will be interpreted under the laws of the State of Florida, including without limitation and interpretation, which conforms to the limitations of §725.06 and/or §725.08, Florida Statutes, as applicable. The RECIPIENT shall require all Sub -contractor agreements, if applicable, to include a provision that they will indemnify the City. The RECIPIENT agrees and recognizes that the City shall not be held liable or responsible for any claims which may result from any actions or omissions of the RECIPIENT in which the City participated either through review or concurrence of the RECIPIENT's actions. In reviewing, approving or rejecting any submissions by the RECIPIENT or other acts of the RECIPIENT, the City in no way assumes or shares any responsibility or liability of the RECIPIEN or Sub - RECIPIENT under this Agreements. 8.2 AMENDMENTS. No amendments to this Agreement shall be binding unless in writing and signed by both parties hereto. Budget modifications shall be approved by the Department in writing. 10 8.3 OWNERSHIP OF DOCUMENTS. All documents developed by the RECIPIENT under this Agreement shall be delivered to the CITY upon completion of the activities required pursuant to this Agreement and shall become the property of the CITY, without restriction or limitation on their use, if requested by the City. The RECIPIENT agrees that all documents maintained and generated pursuant to this Agreement shall be subject to all provisions of the Public Records Law, Chapter 119, Florida Statutes. It is further understood by and between the parties that any document, which is given by the CITY to the RECIPIENT pursuant to this Agreement, shall at all times remain the property of the CITY and shall not be used by the RECIPIENT for any other purpose whatsoever without the prior written consent of the CITY. 8.4 AWARD OF AGREEMENT. The RECIPIENT warrants that it has not employed or retained any person 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 employed by the CITY any fee, commission, percentage, brokerage fee, or gift of any kind contingent upon or resulting from the award of this Agreement. 8.5 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 granted or withheld in the CITY's sole discretion. 8.6 CONSTRUCTION OF AGREEMENT. This Agreement shall be construed and enforced according to the laws of the State of Florida. 8.7 CONFLICT OF INTEREST. 8.7.1 The RECIPIENT covenants that no person under its employ who presently exercises any functions or responsibilities in connection with SSG Program funded activities has any personal fmancial interest, direct or indirect, in this Agreement. The RECIPIENT further covenants that, in the performance of this Agreement, no person having such a conflicting interest shall be employed. Any such interest on the part of the RECIPIENT or its employees must be disclosed in writing to the CITY. 8.7.2 The RECIPIENT is aware of the conflict of interest laws of the City of Miami (City of Miami Code Chapter 2, Article V), Dade County, Florida (Dade County Code Section 2-11-1) and the State of Florida (Chapter 112, Florida Statutes), and agrees that it shall comply in all respects with the terms of the same. 8.8 PROCUREMENT. The RECIPIENT shall comply with the procurement standards set by the City of Miami Purchasing Department. 11 8.9 NO OBLIGATION TO RENEW. Upon expiration of the term of this Agreement, the RECIPIENT agrees and understands that the CITY has no obligation to renew this Agreement. 8.10 ENTIRE AGREEMENT. This instrument and its attachments constitute the only agreement of the parties hereto relating to the SSG Program Funds and sets forth the rights, duties, and obligations of each of the parties hereto 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. 8.11 GENERAL CONDITIONS. 8.11.1 All notices or other communications which shall or may be given pursuant to this Agreement shall be in writing and shall be delivered by in person delivery or by registered mail addressed to the other party at the address indicated herein or as the same may be changed from time to time, upon notice in writing. Such notice shall be deemed given on the day on which personally served, or, if by mail, on the fifth day after being posted or the date of actual receipt, whichever is earlier. CITY OF MIAMI George Mensah, Director Department of Housing & Community Development One Flagler Building 14 NE 1st Avenue, Second Floor Miami, FL 33132 RECIPIENT The Liberty City Optimist Club of Florida, Inc. 4900 NW 12TH AVENUE Miami, FL 33127 8.11.2 Title and paragraph headings are for convenient reference and are not a part of this Agreement. 8.11.3 In the event of conflict between the terms of this Agreement and any terms or conditions contained in any attached documents, the terms in this Agreement shall control. 12 8.11.4 No waiver of 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. 8.11.5 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 to conform with such laws, then same shall be deemed severed, and in either event, the remaining terms and provisions of this Agreement shall remain unmodified and in full force and effect. 8.12 INDEPENDENT CONTRACTOR. The RECIPIENT and its 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 Ordinances of the CITY or any rights generally afforded classified or unclassified employees; further, they shall not be deemed entitled to the Florida Worker's Compensation benefits as employees of the CITY. 8.13 SUCCESSORS AND ASSIGNS. This Agreement shall be binding upon the parties hereto, and their respective heirs, executors, legal representatives, successors, and assigns. 8.14 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 required. 8.15 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. 8.16 CLOSE OUT. When the City determines that all required work under the Agreement has been completed or upon the expiration or termination of the RECIPIENT Agreement, the CITY 13 shall require the RECIPIENT to provide final versions of all financial, performance, and other reports. These reports may include, but are not limited to: • A final performance or progress report. • A financial status report (including all program income). • A final request for payment. • A final inventory of property in the RECIPIENT's possession that was acquired or improved with SSG funds. 8.17 COUNTERPARTS AND ELECTRONIC SIGNATURES. This Agreement may be executed in any number of counterparts, each of which so executed shall be deemed to be an original, and such counterparts shall together constitute but one and the same Agreement. The parties shall be entitled to sign and transmit an electronic signature of this Agreement (whether by facsimile, PDF or other email transmission), which signature shall be binding on the party whose name is contained therein. Any party providing an electronic signature agrees to promptly execute and deliver to the other parties an original signed Agreement upon request. 14 IN WITNESS WHEREOF, the parties hereto have caused this instrument to be executed by their respective officials thereunto duly authorized on the date above written. RECIPIENT The Liberty City Optimist Club of Florida, Inc. AUTHORIZED REPRESENTATIVE: 4900 NW 12TH AVENUE Miami, FL 33127 a Florida not -for -profit corporation ATTEST: Name: k4tj Date: t 1312sazZ Name: Title: E-Ke ...)h -- G ar Title:Foci Corporate Seal: CITY OF MIAMI, a municipal Corporation of t tate of Florida Arthur oriega City Manager Date: APPROVED AS TO INSURANCE REQUIREMENTS Digitally signed by Gomez, Gomez, Frank Date: 2022.0204 Frank 082058 Ann -Marie Sharpe Risk Management Date: 15 ATTEST: Todd Hannon City Clerk D to o aa2.. 1s7 APPROVED AS TO FORM AND CORRECTNESS: 3evataAL a Victoria dez Date: City Attorney REA *22-253 City of Miami Legislation Resolution: R-22-0016 City Hall 3500 Pan American Drive Miami, FL 33133 www.miamigov.com File Number: 10914 Final Action Date: 1/13/2022 A RESOLUTION OF THE MIAMI CITY COMMISSION, WITH ATTACHMENT(S), PURSUANT TO SECTION 18-72 OF THE CODE OF THE CITY OF MIAMI, FLORIDA, AS AMENDED, ALLOCATING FUNDS IN THE AMOUNT OF $131,473.88 TO THE AGENCIES SPECIFIED IN EXHIBIT "A", ATTACHED AND INCORPORATED, FOR PUBLIC SERVICE ACTIVITIES FOR PROGRAM YEAR 2021-2022 FROM THE SOCIAL SERVICE GAP PROGRAM FUNDS, ACCOUNT NO. 14010.910101.882000; FURTHER AUTHORIZING THE CITY MANAGER TO NEGOTIATE AND EXECUTE ANY AND ALL NECESSARY DOCUMENTS, ALL IN FORMS ACCEPTABLE TO THE CITY ATTORNEY, FOR SAID PURPOSE. WHEREAS, due to the continuous decrease of available Community Development Block Grant funds, Public Service agencies' funding allocations have been reduced, resulting in a reduction of services to City of Miami ("City") residents; and WHEREAS, pursuant to Section 18-72 of the Code of the City of Miami, Florida, as amended ("City Code"), the City Commission wishes to allocate funding to cover Public Service program shortfalls for program year 2021-2022 from the Social Services Gap Program fund, Account No.14010.910101.882000; and WHEREAS, on September 23, 2021, the City Commission approved a contribution from General Funds for Public Service activities; and WHEREAS, the City's Administration recommends the allocation of funds in the amount of $131,473.88 from the Social Service Gap Program to the agencies specified in Exhibit "A", attached and incorporated ("Agencies"), for Public Service activities; NOW, THEREFORE, BE IT RESOLVED BY THE COMMISSION OF THE CITY OF MIAMI, FLORIDA: Section 1. The recitals and findings contained in the Preamble to this Resolution are adopted by reference and incorporated as fully set forth in this Section. Section 2. The City Manager is authorized' pursuant to Section 18-72 of the City Code to allocate funds in the total amount of $131,473.88 to the Agencies for Public Service activities for program year 2021-2022 with said funds allocated from the Social Services Gap Program, Account No. 14010.910101.882000. ' The herein authorization is further subject to compliance with all legal requirements that may be imposed, including but not limited to those prescribed by applicable City Charter and City Code provisions. City of Miami Page 1 of 2 File ID: 10914 (Revision:) Printed On: 1/14/2022 File ID: 10914 Enactment Number: R-22-0016 Section 3. The City Manager is authorized' to negotiate and execute any and all necessary documents, all in forms acceptable to the City Attorney, for said purpose. Section 4. This Resolution shall become effective immediately upon its adoption. APPROVED AS TO FORM AND CORRECTNESS: 11/8/2021 City of Miami Page 2 of 2 File ID: 10914 (Revision:) Printed on: 1/14/2022 City of Miami Department of Housing and Community Development Social Service Gap (SSG) Funding Allocation FY2021 "Exhibit A" SOCIAL SERVICE GAP (SSG) FUNDING FY2021 Agency Description of Services SSG Funding FY2021 Centro Mater Child Care Sevices, Inc. Child Care Services $ 22,670.00 Family Action Network Movement, Inc. Youth Services $ 29,000.00 Girl Power Rocks, Inc. Youth Service $ 2,325.00 Greater Miami Service Corps Youth Services $ 9,500.00 The Association for Development of the Exceptional, Inc. Handicapped, Mental Health, Elderly Services $ 24,182.00 The Liberty City Optimist Club of Florida, Inc. Youth Services $ 12,524.00 The Sundari Foundation, Inc. Homeless Services for Women $ 26,849.88 Thelma Gibson Health Initiative Elderly Services & Services for the Disabled $ 4,423.00 Total Allocation: $ 131,473.88 CERTIFICATE OF CORPORATE RESOLUTIONS, CORPORATE STATUS AND INCUMBENCY OF The Liberty City Optimist Club of FL, Inc , a Florida Not for Profit Corporation The undersigned, as Executive Director of The Liberty City Optimist Club of FL, Inc , a Florida not -for -profit Corporation (the "Corporation"), hereby certifies that: 1. The Corporation is a duly formed, validly existing corporation in good standing under the laws of the State of Florida. 2. By the unanimous written consent of the Board of Directors of the Corporation, the following resolutions were adopted as of January 31, 2022, and the same have not been revoked, .cancelled, annulled or amended in any manner and are in full force and effect on the date hereof: WHEREAS, the Corporation has been awarded $12,524.00 in City of Miami Social Services Gap Program (SSG) for period of October 1, 2021through September 30, 2022. WHEREAS, the Corporation desires to fulfill its contractual responsibilities and accomplish the objectives in the Contract's Work Program; WHEREAS, a quorum was present and voted for the passage of these resolutions, NOW THEREFORE, BE IT RESOLVED, that the Corporation, on its own behalf, approves the Contract. FURTHER RESOLVED, that the Corporation ratifies the execution of the Contract by and between the Corporation and the City of Miami. FURTHER RESOLVED, that the Corporation hereby authorizes the execution and delivery of the Contract and all attachments required to be executed and delivered by the Corporation in connection with the Contract, FURTHER RESOLVED, that the President, the Executive Director, the Secretary, any other officer of the Corporation or any other duly authorized representative employed by the Corporation listed below, acting alone in either case, with full power of substitution, be and hereby is authorized to execute and deliver, and the Secretary of the Corporation is hereby authorized to (but is not required to) affix the seal of the Corporation to and attest the same upon the Contract, but with such modifications and additional provisions as the officer of the Corporation executing the same may deem advisable. All of the documents executed and delivered as aforesaid shall be and constitute the acts and obligations of the Corporation. FURTHER RESOLVED, that the Corporation hereby ratifies and confirms the acts of its officer or duly authorized representative employed by the Corporation executing and delivering all such documents and instruments, including but not limited to: the Contract, any amendments, payments requests, and budget modifications attendant to the Contact, regardless of whether such acts were performed before or subsequent to the date of the adoption of this Resolution. FURTHER RESOLVED, that the Corporation directs its officers and employees to perform all of the Corporation's obligations and undertakings under the Contract, FURTHER RESOLVED, that these Resolutions shall continue in full force and effect and may be relied upon by the Corporation and the City of Miami, until receipt of written notice of any change therein. 3. The following person(s) are hereby authorized by the Corporation to execute and deliver all such documents and instruments related to the Contract, including but not limited to: any amendments, payments requests and budget modifications attendant to the Contract, regardless of whether such acts were performed before or subsequent to the date of the adoption of this Resolution. NAME TITLE SIGNATURE Eureca Coulanges Executive Director IN WITNESS WHEREOF, the under igned has hereunto set his hand and affixed the Corporation's corporate seal as of the ?1 day of jciV1ia. v'- 2022. Printed Name: Shirley Presley Signature: ,J Title: Board Member (Corporate •S LUTHER R CAMPBELL President NADEGE M. JASMIN Vice -President GENESSEE WATKINS Treasurer KENYADA S. JEFFERSON Secretary BOARD OF DIRECTORS GERALD L. DARLING DWIGHT L. JACKSON. SR. SHIRLEY PRESLEY PIERRE RUTLEDGE BRITTNEY TELLIS ADVISORY BOARD KRISTEN CAMPBELL GEORGE JOHNSON DEWEY W. KNIGHT, III BRITTAEY. SHARPTON EURECA COULANGES Executive Director LUTHER CAMPBELL SAMUEL K. JOHNSON* • Founders ***Deceased The Children's Trust The Liberty City Optimist Club Of Florida Inc. et � f,yieto11 Ap u� AUTHORIZED SIGNATURE FORM DATE: 01 /3 1 /2022 This form certifies the names, titles and signatures of individuals authorized by the Provider to sign contracts, checks, budget revisions, payment requests, and other requests that may be requested by the Department of Housing & Community Development for disbursement of Social Service Gap Program (SSG) funds. Attached hereto and incorporated herein is a certified copy of a duly authorized and executed resolution passed by the Provider's Board that provides for this authorization. These signature authorizations are retained by the Department of Housing & Community Development for auditing purposes. Should the Provider desire to change the information on this document, a certified and authorized and executed Resolution describing the desired changes should be submitted to the Department of Housing & Community Development. NAME (please type) TITLE (please type) SIGNATURE Luther Campbell President Eureca Coulanges Executive Director Kenyada Jefferson Secretary To Enhance the Growth and Development of our Youth and Community" 4900 NW 12 AV, Miami, FL 33142-Phone: (786) 220-0645 Fax: (786)-220-0648 —e-mail: Icocfl@yahoo.com EXHIBIT B WORK PROGRAM YOUTH SERVICES PROGRAM National Objective: 1. RECIPIENT understands that although these funds are not Community Development Grant (CDBG), this contract is governed by some of the guidelines set forth by HUD. Therefore, the objective for this activity is assistance to low to moderate income persons by serving a limited clientele as defined in 24 CFR 570.208(a)(2). The HUD matrix code associated with this activity is: 05D (Youth Services) is defined as services for teenagers (13 to 19) which include recreational services and teen counseling programs. Scope of Services: 1. SUBRECIPIENT will provide youth services to eligible program participants from October 1, 2021 to September 30, 2022 with funding from the 2021-2022 SSG Program Year. 2. SUBRECIPIENT will provide youth services to eligible program participants on the following days and time: )C.. Monday, X_ Tuesday, >'Wednesday, k- Thursday, k Frid for a total of 2t{0 program days between C.(; 00 A1V nd l3 ; C)O AMo 10 eligible participants, at the following site(s): 1350 NW 50"' Street, Miami, FL 33142 Other tasks to be performed by the SUBRECIPIENT in connection with the provision of childcare services include, but are not limited to, the following: 3. Perform eligibility determination: (24CFR 570.208(a)(1)(i) and 24CFR 570.506) A. Only children and family meeting the following criteria will be considered eligible program participants: a. Reside in the City of Miami b. A member of a low (extremely low to low) income household c. Ages =:� ,'. to i:icr years old B. SUBRECIPIENT must keep in file proof of the information listed below demonstrating that each program participant is eligible to receive program benefits: a. City of Miami Public Service Application b. Parent current picture identification c. Proof of Participant's Age i. Legible copy of a birth Certificate ii. School registrar information for active school year d. Proof of living in the city and the district i. School registrar information for active school year 1. Also include the following print outs from the below two links: a. https://www.miamidade.gov/pa/property search.asp i. Folio # must begin with 01- to be consider a City of Miami resident. e. Current HUD Income Limits Chart (At the time of client intake.) i. https://www.huduser.gov/portal/datasets/il.html f. Proof of Household Income (Any one of those documents will suffice.) i. School registrar information showing meal qualification status (for active school year) ii. Pay Stub (not older than 90 days- 3 months of paycheck stubs) iii. Bank Statement showing direct deposit amounts (not older than 90 days) iv. Employer Statement / Letter (not older than 90 days) v. Social Security Statement vi. Medicaid Cards vii. Section 8 certification viii. AFDC / Food Stamp Authorization Statement ix. Latest Income Tax Return g. Proof of Legal Residency: i. Last five (5) digits of clients SSN must be clearly written on application ii. If illegal aliens, application must indicate their legal status SUBRECIPIENT may replace program participants who stop receiving program benefits by providing the information required in items 4 a. and b. for the new participant. SUBRECIPIENT will not invoice the City of Miami until the proposed participant is certified as eligible by the City of Miami. 4. At all times, maintain facilities in conformance with all applicable codes, licensing, and other requirements for the operation of day care center and/or youth center. The facilities must be handicapped accessible. 5. Procure services and equipment in a manner that provides, to the maximum extent, practical, open and free competition and in compliance with 24 CFR 84.40-48. 6. As part of the programs, provide a range of structured social, educational and cultural enrichment activities appropriate to the age group being served. 7. Maintain program and financial records documenting the eligibility, attendance, provision of services, and SUBRECIPIENT expenses relative to the youth services as a result of the assistance the CDBG program. 8. SUBRECIPIENT will provide the following program reports to the City: a. A monthly report for the services provided to eligible participants in a form provided by the CITY. This report must include the date range when services were provided, the name of the participant, type of service provided (after school or full day), the last five digits of the participant's social security number and the number of days served. This form must be signed by the Program Manager and Executive Director. b. A fmal Close -Out (financial report) and inventory report. c. A final performance report. Authorized Representative Signature: zZ2Z Print Name: EuoreCc eipt,, ttVVeS ate Title: EkIPC.A-iv . Pi STATE OF FLORIDA COUNTY OF MIAMI-DADE , The foregoing instrument was acknowledged before me by mea s of Idl physical presence or O online nota 'zation, this 2 day of f 20 21.. by of Liberty City Optimist Cltib of Florida, Inc., a Florida Not For Profit Corporation, on behalf of the corporation. He/she is personally known to me or has produced as identification. [Notary Seal]: MATTHEW JOSEPH HATTEN MY COMMISSION # HH 195/35 a.� • EXPIRES: November7, 2025 ,dF Fioe Bonded Thu Notify Public Undenedters Signat re of Notary 0/0- EXHII3 IT C COMPENSATION AND BUDGET SUMMARY YOUTH SERVICES PROGRAM A. The maximum compensation under this Agreement shall be $ 12,524.00. B. SUBRECIPIENT's Budget Narrative, Staff Salary Schedule and Cost Allocation are attached hereto and made part of this Agreement. C. All payments shall be for services provided only during the term of this Agreement and in compliance with the previously approved Work Program (Exhibit B) and Program Budget. D. Requests for payment should be made at least on a monthly basis. Reimbursement requests should be submitted to the CITY by the 10th of the following month to the following email address hcdrequest(c�miamigov.com. After the indebtedness has been incurred in a form provided by the Department. Failure to comply with these time frames for requesting reimbursement/payment may result in the rejection of those invoices within the reimbursement package which do not meet these requirements. E. Each written request for payment shall contain a statement declaring and affirming that services were provided to certified program participants and in accordance with the approved Work Program and Program Budget. All documentation in support of each request shall be subject to review and approval by the CITY at the time the request is made. F. All expenditures must be verified with a copy of the original invoice and a copy of a check or other form of payment which was used to pay that specific invoice. In the event that an invoice is paid by various funding sources, the copy of the invoice must indicate the exact amount (allocation) paid by various funding sources equaling the total of the invoice. No miscellaneous categories shall be accepted as a line -item budget. G. The SUBRECIPIENT must submit the final request for payment to the CITY within ten (10) calendar days following the termination date of this Agreement. If the SUBRECIPIENT fails to comply with this requirement, the SUBRECIPIENT shall forfeit all rights to payment and the CITY shall not honor any request submitted thereafter. H. Any payment due under this Agreement may be withheld pending the receipt and approval by the CITY of all reports due from the SUBRECIPIENT as a part of this Agreement and any modifications thereto. I. During the term hereof and for a period of five (5) years following the date of the last payment made hereunder, the CITY shall have the right to review and audit the time records and related records of the SUBRECIPIENT pertaining to any payments by the CITY. Authorized Representative Signature: Print Name: EA.): eff4a t4-t Title: exe T"`+'e.? Z 1 Z2 ate STATE OF FLORIDA COUNTY OF MIAMI-DADE Thforegoing instrument was acknowledged before me by means of day of %t 20'2'2 by Optimist Club of Florida, Inc., a Florida Not For Profit personally known to me or has produced [Notary Se 'hysical presence or r online notarization, this of Liberty City Corpor ation, on behalf of the corporation. He/she is : 0:74:,,, MATTHEW JOSEPH HATTEN MY COMMISSION # HH 195735 a• .,.:�; EXPIRES: November 7, 2025 ?,,° a?.'' Bonded TMu Notary PuGtic U Vawnllrs as identification. Signature of Not CITY OF NIIANII DEPARTMENT OF HOUSING & COMMUNITY DEVELOPMENT ITEMIZED BUDGET NARRATIVE Agency:; The Liberty City Optimist Club of Fl, Inc Contract Period: OCTOBER 1, 2021 - SEPTEMBER 30.2022 Funding Source: SOCIAL SERVICES GAP (SSG) LINE ITEM DESCRIPTION AMOUNT 203 AUDIT COST $1,750.00 304 GENRAL LIABILITY & INSURANCE $1,170.00 350 TELEPHONE/INTERNET $920.00 507 MEMBERSHIP(S) $1,228.00 521 OFFICE SUPPLIES $1,500.00 522 PROGRAM SUPPLIES $1,500.00 523 COMPUTER SOFTWARE $1,300.00 600 LICENSE & PERMITS $70.00 700 TRAINING $1,200.00 800 CAPITAL OUTLAY EQUIP $1,886.00 GRAND TOTAL: $12,524.00 BUDGET FORM I 1 OF 1 CITY OF MIAMI DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT STAFF SALARY SCHEDULE Agency: The Liberty City Optimist Club of Fl Inc Period Covering: October 1, 2021 - September 30, 2022 Employee Name Position Title Social Security (Last . • Ethnicity Type of Employee " Pt/Ft Period Budgeted Pay Periods AnnuaI ` Gross Salary Total Salary Per Pay Period Percent of Salary Charged to 01 Total Amount Charged to City F +r� YOLANDA BELL PROGRAM DIRECTOR B FT 21/22 58000 08/21-07/22 0 0 ETHEL DAVIS SITE COORDINATOR B PT 21/22 33588 08/21-07/22 0 0 RONNIE JEFFERSON ACTIVITY LEADER B PT 21/22 12480 08/21-07/22 0 0 ANDREA JONES ACTIVITY LEADER B PT 21/22 12480 08/21-07/22 0 0 DARREYL BETHUNE FITNESS INST B PT 21/22 7280 08/21-07/22 0 0 TAMEIKA WILEY PROGRAM MANAGER B FT 21/22 50000 08/21-07/22 0 0 DEONDRA SMITH ACTIVITY LEADER B PT 21/22 10400 08/21-07/22 0 0 SABRINA JACKSON ACTIVITY LEADER B PT 21/22 10400 08/21-07/22 0 0 KENYA ESSIX CERTIFIED TEACHER B CONTRACT 21/22 15840 08/21-07/22 0 0 LADEMIA ALBURY CERTIFIED TEACHER B CONTRACT 21/22 10560 08/21-07/22 0 0 TEACHER ASST PT 21/22 10400 08/21-07/22 0 0 Total: $0.00 BUDGET FORM II 1 OF 1 Agency: The Liberty City Optimist Club of FI, Inc CITY OF MIAMI DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT COST ALLOCATION PLAN Period Being Cost Alla October 1, 2021- September 30, 2022 r Example /ffecthe ()ate(s): I0i1121-9/30/22 CDBG 10 I __I ') III 22 I() )I-')))) 7/1/21-6/1U/22 S/121-7/31/22 S/1/21-7/31/22 Example Line -Item Description % SSG ()NIB I SS % TCT-YAS TCT-YEN % Iota! 11vample inn Rent 500 ,Cull 'NO }0(Ili , l.•CIM 0U 17feetire Date(s): Line -item Description % CDBG SSG % 0:1IR USS TCT-YAS % TCT-YEN % Total 100 STAFF SALARIES 0% 0% 0% 0% 68% 147974 32% 69486 100% $217,460.00 101 STAFF FICA 0% o%%% 0% 0% 68% 11321 32% 5315 100%%% $16,636.00 102 STAFF MICA 0% 0% o% 0% o% o% 0% $0.00 103 STAFF WORKERS COMP. 0% 0% o% 0% 68% 799 32% 375 100% $1,174.00 104 STAFF UNEMPLOYMENT COMP 0% 0% o% 0% o% 0% 0% $0.00 105 STAFF GROUP HEALTH INS. o% 0% o% o% 0% o% 0% $0.00 200 PROFESSIONAL SERVICES 14% 4100 0% 86% 25000 0% o% 0% 86% $29,100.00 203 AUDIT COST 22% 1750 22% 1750 0% 0% 25% 2000 31% 2500 78% $8,000.00 300 GEN. & AUTO LIABILITY INS. o% 100% 1170 0% o% o% o% 100% $1,170.00 350 TELEPHONE/INTERNET 0% 100% 920 0% 0% 0% 0% 100% $920.00 360 ELECTRICITY o%%% 0% o% o%%% o% 0% 0% $0.00 380 WATER & SEWER AND GARBAGE 0% 0% 0% 0% 0% 0% 0% $0.00 410 EQUIPMENT MAINT. 100% 9404 0%%% o% 0% o% 0% 0% $9,404.00 411 BLDG. MAINTENANCE 0%/% 0% 0% 0% 0% 0% 0% $0.00 450 EQUIPMENT RENTAL 0% 0% 0% 0% 0% 0% 0% $0.00 460 SPACE RENTAL 0% 0% o% 0% o% 0% 0% $0.00 501 POSTAGE 0% 0% 0% o%%% o% 0% 0% $0.00 502 PRINTING OUTSIDE 33% 2500 0% 67% 5000 0% 0% 0•/% 67% $7,500.00 504 ADVERTISING 32% 1200 0%%% 0% o% 46% 1740 22% 846 68% $3,786.00 $7,850.00 507 MEMBERSHIP(S) 84% 6622 16% 1228 0%%% o%%% o% o%/% 16% 510 LOCAL TRAVEL 20% 8500 0% 71% 30000 0% 6% 2400 4% 1600 80% $42,500.00 511 OUT OF TOWN TRAVEL 34% 13000 0% 66% 25000 0%%% 0% 0% 66% $38,000.00 521 OFFICE SUPPLIES 46% 3000 23% 1500 0% 0% 15%%% 1000 15%%% 1000 54% $6,500.00 522 PROGRAM SUPPLIES 16%%% 3995 6% 1500 62% 15000 0% 8%i% 2000 8% 1842 84% $24,337.00 523 COMPUTER SOFTWARE 54% 1550 46% 1300 0%%% 0% 0% 0% 46% $2,850.00 600 LICENSE & PERMITS 70% 165 30% 70 0% 0%%% 0% 0% 30% $235.00 700 TRAINING 8%r% 500 19%%% 1200 64% 4000 0%%% 6% 350 3% 200 92% $6,250.00 800 CAPITAL OUTLAY EQUIP. 9% 3714 5% 1886 86% 35000 0% o% o%%% 91% $40,600.00 OTHER o%/% 0% 47% 95000 4% 7500 35% 70388 15% 29790 100% $202,678.00 GRAND TOTAL: "_� ' t $12,524.00 $234,000.00 $7,500.00 $239.972.00 S112,954.00 $666,950.00 BUDGET FORM III 1 OF 1 EXHIBIT D CERTIFICATION 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. * Note: In these instances, "All" in the Final Rule is expected to be clarified to show that it applies to cover Contract/grant transactions over $100,000 (per QMB). 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 S10,000 and not more than $100,000 for each such failure. Authorized Representative Signature: 2�. Print Name: Et...) Title: e * r• ate STATE OF FLORIDA COUNTY OF MIAMI-DADE The foregoing instrument was acknowledged before me by means of physical presence or ❑ online notarization. his day Lof .66 l C i t _120 by v aGl of �' a non fj'b corporation, on behalf of the rporati6n. He/ le is, rse known to me or has produced as identification. [Notary Seal]: Syt MATTHEW JOSEPH HATTEN r. '•.k; MY COMMISSION # HH 195735 :•r. . W EXPIRES: November 7, 2025 ,,,,,, F!,'"••• Bonded'tiuu NotalyPublioUndenvriter9 fYJ Signature of Notary EXHIBIT E CERTIFICATION REGARDING DEBARMENT, SUSPENSION & OTHER RESPONSIBILITY MATTERS PRIMARY COVERED TRANSACTIONS 1. Subrecipient certifies to the best of its knowledge and belief, that it and its principals: a. Are not presently debarred, suspended, proposed for debarment, and 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 judgement 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. Authorized Representative Signature: Pant Name: Title: E ppa,,.r+� Dc-recityr et2d Date STATE OF FLORIDA COUNTY OF MIAMI-DADE The foregoing instrument was acknowledged before me by means of physical presence or 0 online notarization, this 1,—day of Ft6 20 Z by E of C ales of / 1 a ►,Nein ert) C-"ar corporation, on behalf of th torpor Lion. e she is Personally known to me or has produced as identification. [Notary Seal]: 4iFk, MATTHEW JOSEPH HATTEN ts MY COMMISSION # HH 195735 '.. <' EXPIRES: November 7, 2025 .TrjCr o pp 4 Bonded Mu Notary Public Underwriters Signature of Notary a/0Q- EXHIBIT F SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(A). FLORIDA STATUTES ON PUBLIC ENTITY CRIME 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 to The, , CZ j O- J -(Cct yy j by EA) Ir G e..0k taVl P ���� ;Is--bl( (Print the individual's name and title) for lQ ,, LC KJ'Q -+ OZ-k ' m t 4 a L o t (Print name of entitysubmi#tin statements g ) whose business address is 49,00 Vti LC) 1 Z*%./ kCOLVYl. t 5N z -7 and if applicable is Federal Employer Identification Number (FEIN) is LO5 0 2-29 bLA If the entity has no FEIN, include the Social Security Number of the individual signing this sworn Statement: 2. l understand that a "public entity crime" as defined in paragraph 287.133(1)(a), Florida Statutes, mean a violation of any state or federal law by a person with respect to and directly related to the transactions of business with any public entity or with an agency or political subdivision of any other state or with the United States including, but not limited to any bid or contract for goods or services to be provided to any public entity or any agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 3. 1 understand that "convicted" or "convection" as defined in Paragraph 287.133(1)(b), Florida Statutes means a finding of guilt or a conviction of a public entity crime, with or without adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a Jury verdict, nonjury trial, or entry of a plea of guilty or nolo contendere. 4. I understand that an "affiliate" as defined in paragraph 287.133(I)(a), Florida Statutes, means: 1. A predecessor or successor of a person convicted of public entity crime; or 2. An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arnt's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. 5. I understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers, 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 a relation to the entity submitting this sworn statement. (Pleases"indicate ,with':ariwt►ich' tatement 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, or any affiliate of the entity has been charged with and convicted of a public entity crime within the past 36 months. The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime within the past 36 months. AND (Please indicate which additional statement applies). The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime within the past 36 months. However, there has been a subsequent proceeding before a Hearing Officers of the State of Florida, Division of Administrative Hearings and the Final Order by the Hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list. (Attached is a copy of the final order). I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THE PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED AND FOR THE PERIOD OF THE CONTRACT ENTERED INTO, WHICHEVER PERIOD IS LONGER. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES, FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. Authorized Representative Signature: Print Name: Title: STATE OF FLORIDA COUNTY OF MIAMI-DADE 2� 222- ate The foregoing instrument was acknowledged before me by means of hysical presence or ❑ onlinetarizr� this day of �e� 20 by c�)e 3 of r6 a in p f yp c,corporation, on behalf of the ine or has produced orporation. He/s e is ersonally known to as identification. MATTHEWJOSEPH HATTEN MY COMMISSION # HH 195735 [Notary S ��:;= EXPIRES: November 7, 2025 Vie,10 Bonded Thor NotaryPubfl Underwdterr Signature of Notary Exhibit G INSURANCE REQUIREMENTS PUBLIC SERVICE AND ECONOMIC DEVELOPMENT PROGRAMS FOR HOUSING & COMMUNITY DEVELOPMENT I. Commercial General Liability (Prima,y & Non Contributory) A. Limits of Liability Bodily Injury and Property Damage Liability Each Occurrence $300,000 General Aggregate Limit $600,000 Products/Completed Operations $300,000 Personal and Advertising Injury $300,000 B. Endorsements Required City of Miami included listed as additional insured (endorsement Required) Explosion, Collapse, & Underground Hazard (If Applicable) Contingent Liability/Contractual Liability Premises & Operations Liability Example. "The City of Miami is named additional insured on the general liability. On a primary and non-contributory basis. All policy and conditions apply." II. Business Automobile Liability A. Limits of Liability Bodily Injury and Property Damage Liability Owned Autos/Scheduled Autos Including coverage for Hired and Non -Owned Autos Combined Single Limit $ 300,000 B. Endorsements Required City of Miami included as an Additional Insured Example. "The City of Miami is named additional insured on the automobile liability. Note: If agency does not own any vehicles please submit this stamen on the agency's dated letterhead and signed by the authorized representative. III. Worker's Compensation Limits of Liability Statutory -State of Florida 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 [Notary Seal]: $500,000 for bodily injury caused by disease, policy limit IV. Professional Liability (If Applicable) Each Claim $250,000 Policy Aggregate $250,000 V. Certificate Holder Information should be listed as the following: City of Miami 444 SW 2°" Avenue Miami, FL 33130 'THE DEPARTMENT OF RISK MANAGEMENT RESERVES THE RIGHT TO SOLICIT ADDITIONAL INSURANCE COVERAGE AS MAY BE APPLICABLE IN CONNECTION TO A PARTICULAR RISK, OR SCOPE OF SERVICES/WORK PROGRAM" THE ABOVE POLICIES SHALL PROVIDE THE CITY OF MIAMI WITH WRITTEN NOTICE OF CANCELLATION IN ACCORDANCE WITH 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. Authorized Representative Signature: Print Name: t2 , (Ds) k tcirie Title: .iica,.a_,L \Q., ate STATE OF FLORIDA COUNTY OF MIAMI-DADE The foregoing instrument was acknowledged before me 1-,y means of Vphysical presence or DIonline notarization}, this Z_ day of 1-e6 20 /..2- by mecst ealagel of LJ G14�jj'' ✓ rVs� a icon Qyb c-,k- corporation, on behalf off t corperration. He/she is nown to me or has produ•ri - • •-• ....,.:�.� as identification. OSEPH HATTEN MY COMMISSION # HH 195736 . Bonded Noveymyb�er?,J2025 .:f BndedT,MYNavy PublicU dw 'iBls 0/2'2 Signature of Notary A 9 �® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 06/15/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the po icy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). . PRODUCER Keen Battle Mead & Company Northwest 146th Street Suite 200 Miami Lakes FL 33016 CONTACT Jane Warren NAME: PH NNo, Ext): (305) 558-1101 I FAX No): (305) 822-4722 (AI7850 E-MAIL Jwarren@kbmco.com ADDRESS: INSURER(s) AFFORDING COVERAGE NAIC # INSURER A: Houston Casualty Company 42374 INSURED Liberty City Optimist Club of Florida, Inc. 1350 NW 50 Street Miami FL 33142 INSURER B: Berkley Life and Health Insurance Co. 64890 INSURER C ; INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 21/22 GL/ACC/A&B/ACC REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE ADDLSUBR 1NSD WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MMIDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY • 21/7007391-11146 06/09/2021 06/09/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300,000 X ABUSE/MOLESTATION MED EXP (Any one person) $ 5,000 X $1M OCC/$2M AGG PERSONAL BADV INJURY $ 1,000,000 GEN'L X X AGGREGATE POLICY OTHER: Assault LIMIT APPLIES PER: PRO JECT LOC & Battery GENERALAGGREGATE $ 3,000,000 PRODUCTS-COMP/OPAGG $ 2,000,000 Participant Liability $ 1,000,000 A AUTOMOBILE ` X — LIABILITY ANYAUTO OWNED AUTOS ONLY HIRED AUTOS ONLY X _ SCHEDULED AUTOS NON -OWNED AUTOS ONLY 21f7007391-11146 06/09/2021 06/09/2022 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ' BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA L1AB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION , AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ B Accident Medical Excess Coverage PAI L014001150101 06/09/2021 06/09/2022 Maximum Benefit AD&D Decuctible - $250 $100,000 $10,000 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Activities - Youth Tackle Football Certificate Holder is listed as additional insured. Coverage is Primary and Non -Contributory. This insurance covers activities sponsored and supervised by the named Insurance for which an insurance premium has been paid. CERTIFICATE HOLDER CANCELLATIO City of Miami 444 SW 2 Avenue Miami FL 33130 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE � l ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD LUTHER R CAMPBELL President NADEGE M. JASMIN Vice -President GENESSEE WAIKINS Treasurer KENYADA S. JEFFERSON Secretary BOARD OF DIRECTORS GERALD L. DARLING DWIGHT L. JACKSON, SR. SHIRLEY PRESLEY PIERRE RUTLEDGE BRITTNEY TELLIS ADVISORY BOARD KRISTEN CAMPBELL GEORGEJOHNSON DEWEY W. KNIGHT, III BRITTANY. SHARPTON EURECA COULANGES Executive Director LUTHER CAMPBELL SAMUEL K. JOHNSON• • • Founders ...Deceased lien I Paris & Kerrcalfnn Where \I.Ve Harjmns TheZ. Children'sTrust The Liberty City Optimist Club _ _Of m Floridaa Inc. 1 f/4/(d o/ outs January 31, 2022 Department of Housing & Community Development 14 NE 1-AV 2 Floor Miami, FL 33132 RE: Contract Period: October 1, 2021—September 30, 2022 Dear George Mensah, This is to advise you that The Liberty City Optimist Club of Florida, Inc. has no company owned vehicles cue ly, Eureca Cobfanges0' Executive Director To Enhance the Growth and Development of our Youth and Community" 4900 NW 12 AV, Miami, FL 33127-Phone: (786) 220-0645 Fax: (786)-220-0648 —e-mail: Icocfl@yahoo.com o 1 Authorized Representative Statement City of Miami - Department of Housing and Community Development Provide the name(s) and telephone number of the person(s) who has been designated the responsibility within the following areas: Position Name Telephone # Chairman of the Board Executive Director Project Director Affirmative Action Officer Personnel Officer Fiscal Management Officer LA-) .r Ca ��a-ems{ 11 to -� ZA-Z)ta ti S." I. Persons Authorized to Sign Checks Name: Title: Phone: Signature: Name: ?fe5\€`t Title: (60c Y d. F-( - vrti be..t- Phone: gip{,' & - tato 3S Signature: II. Person(s) Authorized to Sign Reimbursement Packages Name: Title: Phone: Signature: --)t)io ?)T) a Name: Title: Phone: Signature: III. Persons Authorized to Sign Contracts Name: Title: Phone: Signature: —77) ;:-ateA Date: 1 30i'�u._ 1 Name: Title: Phone: Signature: Page 1 of 1 foRQ4 Certification of Sound Fiscal Management PAGE1 of2 City of Miami — Department of Housing & Community Development We, GG ", CrtYi (Full Name) As the Chief Financial Officer of As the Executive Director, and (Organization) Receiving funds from the City of Miami, have the need to establish and maintain sound financial and Fiscal controls and management systems. We hereby certify that l ,, (Abe i1- Ct. (Organizatibn) has established internal controls which are adequate to safeguard the assets of the agency, monitor the accuracy and reliability of accounting data, promote operating efficiency and insure compliance with prescribed policies and procedures. (Full Name) , acknowledge that as a condition of Executive Director Name: Date: Signature: Name: Date: Signature: Chief Financial Officer I am a duly licensed certified public accountant and have been engaged to review the accounting systems of , which is a private (_profit/ _non-profit) organization (Organization) that will operate programs for the City of Miami. I have reviewed the financial systems that this agency Has established. This review was completed on . At the time of review, the (date) Agency had established internal controls which were adequate to safeguard the assets of the agency, monitor the accuracy and reliability of accounting data, promote operating efficiency, and insure compliance with prescribed management policies. Name of Firm Typed Name of Accountant Date Signature of Accountant If any modifications are required to this certificate due to the nature of the engagement between the Agency and the C.P.A., attach a substitute report as explanation. Page 1 of 2 1,_111)4 Certification of Sound Fiscal Management PAGE 2of2 City of Miami — Department of Housing & Community Development STATE OF FLORIDA COUNTY OF MIAMI-DADE The foregoing instrument was acknowledged before me by means of physical presence or online notarization, this 2-- daJyV of Ftt� 20 29- by £9'4 J of 1_"6• i ,' 5' ®D7�f� , a ( r7 li'yp ?-,�- corporation, on behalf of the corporation./He/she/ is parscmally known to me or has produced as identification. [Notary Seal]: .a. MATTHEW JOSEPH FLATTEN MY COMMISSION # HH 195735 EXPIRES: November 7, 2025 ;?pf,r;;°. Bonded Thru Notary Pu'lc UndwwnTara de#-- i-/f7,7/(z- Signature of Notary Page 2 of 2 !ROO Disability Non -Discrimination Certification PAGE 1of1 Certification for Contracts, Grants, Loans, and Cooperative Agreements The undersigned certifies that it is in compliance with and agrees to continue to comply with, and assure that any subcontractor, or third party contractor under this project complies with all applicable requirements of the laws listed above including, but not limited to, those provisions pertaining to employment, provision of programs and services, transportation, communications, access to facilities, renovations, and new construction in the following laws: The Americans with Disabilities Act of 1990 (ADA), Pub. L. 101-336, 104, Stat. 327, 42 U.S.C. 12101-12213 and 47, U.S.C. Sections 325 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. The foregoing requirements shall not pertain to contracts with the United States or any department or agency thereof, the State of any political subdivision or agency thereof or any municipality of this State. Agency Name: '`riAl2, uo94_A-\ ql;fy1-4 c.,(A.36 Printed Name of Certifying Repfeientative Signature "i T Certifying Re STATE OF FLORIDA COUNTY OF MIAMI-DADE sentative �Gi�O i41 vk96c Title of Certifying Representative Date The foregoing instrument was ackno�wledged before me by means of physical presence or O online notarization, this '2-- day of 7•C 20 2 — by "*V(e- COC. S of , a In ai If)(1) t-corporation, on beha of the corporation. He/she is personally kn to me or has produced as identification. [Notary Seal M TTHEW JOSEPH HATTEN ? * MY COMMISSION # NH 195735 EXPIRES: November 7, 2025 Bondoehru Notary Pubec lhrdermilers Signature of Notary Page 1 of 1 fo OQ111 Drug Free Workplace Certification PAGE 1 of 2 Certification for Contracts, Grants, Loans, and Cooperative Agreements The undersigned certifies that it will provide a drug -free workplace program by: (1) Publishing a statement notifying its employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the offerors workplace, and specifying the actions that will be taken against employees for violations of such prohibition; (2) Establishing a continuing drug -free awareness program to inform its employees about: (i) The dangers of drug abuse in the workplace; (ii) The Bidder's policy of maintaining a drug -free workplace; (iii) Any available drug counseling, rehabilitation, and employee assistance programs; and (iv) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; Giving all employees engaged in the performance of the Contract a copy of the statement required by subparagraph (1); (4) Notifying all employees, in writing, of the statement required by subparagraph (1), that as a condition of employment on a covered Contract, the employee shall: (i) Abide by the terms of the statement; and (ii) Notify the employer in writing of the employee's conviction under a criminal drug statute for a violation occurring in the workplace no later than five (5) calendar days after such conviction; Notifying City of Miami government in writing within ten (10) calendar days after receiving notice under subdivision (4) (ii) above, from an employee or otherwise receiving actual notice of such conviction. The notice shall include the position title of the employee; (6) Within thirty (30) calendar days after receiving notice under subparagraph (4) of a conviction, taking one of the following actions with respect to an employee who is convicted of a drug abuse violation occurring in the workplace: (i) Taking appropriate personnel action against such employee, up to and including termination; or (ii) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a federal, state, or local health, law enforcement, or other appropriate agency; and (3) (5) (7) Making a good faith effort to maintain a drug -free workplace program through implementation of subparagraph (1) through (6). Agency Name: LLIGRA\ c_J\-1 Dosnnz(s4-- evneea, tA. �av�//� e_S Printed Name of Certifying Representative e)02,0 .. D � lv.e r Title of Certifying Representative 2/t2�22- Signature of Certifying Reprntative Date Page 1 of 2 !RQ10 Drug Workplace Work lace Certification PAGE 2af2 Certification for Contracts, Grants, Loans, and Cooperative Agreements STATE OF FLORIDA COUNTY OF MIAMI-DADE The foregoing instrument was acknowledged before me by means of ❑ physical presence or ❑ online notarization, this day of 20 by E �.�- (Q !A e_Dt�.t tr S of Q L c , es G i7Ql►'t"'is a ✓1b„— ,Yb corporation, on be If of the corporation. He/she is personally kno n to me or has produced as identification. [Notary S MATiHEW JOSEPH I{A1TEN MY COMMISSION # NH 195735 EXPIRES: November 7, 2�0�25 Bonded Notary N `r11deret" _ �g Signature of Notary Page 2 of 2 AL}IIl1