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Home My WebLink About24787AGREEMENT INFORMATION AGREEMENT NUMBER 24787 NAME/TYPE OF AGREEMENT THE LIBERTY CITY OPTIMIST CLUB OF FLORIDA, INC. DESCRIPTION SOCIAL SERVICES GAP PROGRAM AGREEMENT/YOUTH SERVICES PROGRAM/FILE ID: 14781/R-23-0479/MATTER ID: 23-3200 EFFECTIVE DATE ATTESTED BY TODD B. HANNON ATTESTED DATE 2/1/2024 DATE RECEIVED FROM ISSUING DEPT. 2/6/2024 NOTE DOCUSIGN AGREEMENT BY EMAIL CITY OF MIAMI DOCUMENT ROUTING FORM ORIGINATING DEPARTMENT: HOUSING AND COMMUNITY DEVELOPMENT DEPT. CONTACT PERSON: MONICA GALO NAME OF OTHER CONTRACTUAL PARTY/ENTITY: EXT. 1976 Liberty City Optimist Club of Florida, Inc. IS THIS AGREEMENT AS A RESULT OF A COMPETITIVE PROCUREMENT PROCESS? TOTAL CONTRACT AMOUNT: $ 25,203.00 TYPE OF AGREEMENT: ❑ MANAGEMENT AGREEMENT ❑ PROFESSIONAL SERVICES AGREEMENT ® GRANT AGREEMENT ❑ EXPERT CONSULTANT AGREEMENT ❑ LICENSE AGREEMENT OTHER: (PLEASE SPECIFY): N/A FUNDING INVOLVED? ❑ YES 0 NO YES ❑ NO ❑ PUBLIC WORKS AGREEMENT ❑ MAINTENANCE AGREEMENT ❑ INTER -LOCAL AGREEMENT ❑ LEASE AGREEMENT ❑ PURCHASE OR SALE AGREEMENT PURPOSE OF THE ITEM (BRIEF SUMMARY): Contract in the amount of in SSG fundingto LibertyCityOptimist Club of Florida,Inc. for $25,203.00 p the implementation of Youth Services. For additional information please see Resolution attached.. COMMISSION APPROVAL DATE: 10/26/2023 FILE ID: 14781 IF THIS DOES NOT REQUIRE COMMISSION APPROVAL, PLEASE EXPLAIN: N/A ENACTMENT No.: R-23-0479 Date PLEASE PRINT AND SIGN ROUTING INFORMATION APPROVAL BY DEPARTMENTAL DIRECTOR January 9, 2024 I 10:51:32 PRINT: ROBE EST SIGNATURE: PRINT: ANN-*EfiltWOEE.. SIGNATURE o1 by. C_ FratA,� i � SUBMITTED TO RISK MANAGEMENT January 9, 2024 I 11:00:51 EST SUBMITTED TO CITY ATTORNEY January 26, 2024 I 13:03:41 EST ._7335C63I1n PRINT: VICTORIA RP # 23-3200 SIGNATURE: ^F �'FPSCG.ignedby: 14 E7... �"�� APPROVAL BY ASSISTANT CITY MANAGERJanuary 31, 2024 I 12:18:09 PRINT: LARRY EST SIGNATURE: S e EF9oAF6FEoas7... d by: ' ,I,�, ("" y S.p6 RECEIVED BY CITY MANAGER February 1, 2024 I 05:40:03 EST PRINT: ART SIGNATURE: N�&9i igne sby: �!.1 igned by: a I'T w' NOVitom, �85OCF-sC 1) ONE ORIGINAL TO CITY CLERK, February 1, 2024 2) ONE COPY TO CITY ATTORNEY"S OFFICE, 3) REMAINING ORIGINAL(S) TO ORIGINATING DEPARTMENT I 17:49:48 ES -PRINT: SIGNATURE: 72�-a2A,... (—DocuSigned by: PRINT: SIGNATURE: PRINT: SIGNATURE: '—E46D7560DCF1459... PLEASE ATTACH THIS ROUTING FORM TO ALL DOCUMENTS THAT REQUIRE EXECUTION BY THE CITY MANAGER CITY OF MIAMI, FLORIDA DEPARTMENT OF HOUSING & COMMUNITY DEVELOPMENT SOCIAL SERVICES GAP PROGRAM ("SSG") AGREEMENT This Agreement (hereinafter the "Agreement") is entered into this day of , 20, between the City of Miami, a municipal corporation of the State of Florida (hereinafter the "CITY"), & The Liberty City Optimist Club of Florida, Inc. a Florida not for profit corporation (hereinafter referred to as the "RECIPIENT"). FUNDING SOURCE: CFDI # (Ifapplicable): AMOUNT: TERM OF AGREEMENT: PROJECT NUMBER: Social Services Gap Program N/A $ 25,203.00 Effective date of this agreement is October 1, 2023 to September 30, 2024 UEI (SAM#): SLALG9AGGX44 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 Exhibit C Exhibit D Exhibit E Exhibit F Exhibit G Work Program Compensation and Budget Summary Certification Regarding Lobbying Form Certification Regarding Debarment, Suspension and other Responsibility Matters (Primary Covered Transactions Form) Crime Entity Affidavit 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, 2023 to September 30, 2024 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 ofthis 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 Department 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 Department'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 Department 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 finally 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 Department, the RECIPIENT shall provide all Agreement Records to the Department. The requested Agreement Records shall become the property of the Department 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 findings. The RECIPIENT will rectify all deficiencies cited by the Department 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 -party 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 RECLPIENT'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 PR©VISIONS 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 financial 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 2-1 1-1) and the State of Florida (Chapter 1 I2, 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. 8.1 1 GENERAL CONDITIONS. 8.1 1.1 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 I5t Avenue, Second Floor Miami, FL 33132 RECIPIENT The Liberty City Optimist Club of Florida, Inc. 4900 N W 12TH AVENUE Miami, FL 33127 R.1 1.2 Title and paragraph headings are for convenient reference and are not a part of this Agreement. 8.1 1.3 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 it 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. DocuSigned by: rivutk Ge Ati5 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. AUTHORIZED REPRESENTATIVE: 16?;A Name: .)"( (r,rirpate: I t IS 123 Name: sKi l presk2-1 Date tiO l Z3 Title: QQIi2 Title: Ea d Reiff bra.,/ Corporate Seal: DocuSigned by: RECIPIENT The Liberty City Optimist Club of Florida, Inc. 4900 NW 12TH AVENUE Miami, FL 33127 a Florida not -for -profit corporation ATTEST: CITY OF MIAMI, a municipal Corporation of the State of Florida DocuSigned by: c Wit lA 850CF37DB#2AFebruary 1, 2024 I 05:40:03 E ... Arthur Noriega V Date: City Manager ATTEST: DocuSigned by: Ea6R756fDCF145Q Todd l Lannon City Clerk February 1, 2024 1 17:49:48 EST Date: APPROVED AS TO INSURANCE APPROVED AS TO FORM AND REQUIREMENTS CORRECTNESS: ,-DocuSigned by: January 9, 2024 I 11:00:51 =S t o+ret_- 5uary 26, 2024 I 13:03:41 EST 271te 1-8214E7... Ann -Marie Sharpe Risk Management Date: 15 F 46F90AF-6.FEg467.. Victoria Mendez Date: City Attorney RP #23-3200 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 BRITTANY. SHARPTON EURECA COULANGES Executive Director LUTHER CAMPBELL SAMUEL K. JOHNSON* * Founders ***Deceased The k& Children'sTrrust itIiami I'ark� S R4creatiooi here 15�hcre Magic Happens The Liberty City Optimist Club Of Florida'Inc. FM4/D/!f Oarit 610' bst)‘ AUTHORIZED SIGNATURE FORM DATE: November 7, 2023 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 Community Development Block Grant (CDBG) 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) Luther Campbell Eureca Coulanges Kenyada Jefferson TITLE (please type) SIGNATURE Presi dent Executive Director 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 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 November 7, 2023, and the same have not been revoked, canceled, annulled or amended in any manner and are in full force and effect on the date hereof: WHEREAS, the Corporation has been awarded $25,203.00 in City of Miami Social Services Gap Program (SSG) for the period of October 1, 2023 through September 30, 2024. 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 undersigned has hereunto set his hand and affixed the Corporation's corporate seal as of the ' , day of pbt/l° 4'yil23. Printed Name: Shirley Presley Signature: Title: Board Member (Corporate Seal City of Miami Resolution R-23-0479 Legislation City Hall 3500 Pan American Drive Miami, FL 33133 www.miamigov.com File Number: 14781 Final Action Date: 10/26/2023 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 $487,422.00 TO THE AGENCIES SPECIFIED IN EXHIBIT "A," ATTACHED AND INCORPORATED, FOR PUBLIC SERVICE ACTIVITIES FOR PROGRAM YEAR 2023-2024 FROM THE SOCIAL SERVICE GAP PROGRAM FUNDS, ACCOUNT NO. 14010.910199.481000; AUTHORIZING THE CITY MANAGER TO NEGOTIATE AND EXECUTE ANY AND ALL NECESSARY DOCUMENTS, IN A FORM 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 2023-2024 from the Social Service Gap Program fund, Account No. 14010.910199.481000; and WHEREAS, the City's Administration recommends the allocation of funds in the amount of $487,422.00 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 if 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 $487,422.00 to the Agencies for public service activities for program year 2023-2024 with said funds being allocated from the Social Service Gap Program, Account No. 14010.910199.481000. Section 3. The City Manager is authorized' to execute any and all necessary documents, in a form acceptable to the City Attorney, for said purpose. Section 4. This Resolution shall become effective immediately upon its adoption. 1 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: 14781 (Revision:) Printed On: 10/30/2023 File ID: 14781 Enactment Number: R-23-0479 APPROVED AS TO FORM AND CORRECTNESS: ndez, ity Attar ey , 10/16/2023 City of Miami Page 2 of 2 File ID: 14781 (Revision:) Printed on: 10/30/2023 City of Miami Department of Housing and Community Development Social Service Gap (SSG) Funding Allocation FY2023 Exhibit "A" Agency Description of Services Social Service Gap (SSG) A Leap of Faith Foundation, Inc. Health Services $ 15,000.00 Art Forever Miam, Inc. Youth Services $ 15,000.00 Catholic Charities of the Archdiocese of Miami, Inc. - Myers Center Elderly Meals $ 149,500.00 Centro Mater Child Care Services, Inc. Child Care Services $ 59,670.00 Coconut Grove Cares, Inc. Child Care Services $ 49,500.00 Ti Ayiti Preparedness And Relief Institution, Inc. Nutritional Meal Distribution Service $ 50,000.00 Greater Miami Service Corps Youth Services $ 20,000.00 St. Alban's Day Nursery, Inc. Child Care Services $ 9,049.00 The Association for Development of the Exceptional, Inc. Handicapped, Mental Health Services $ 20,800.00 The Boys and Girls Clubs of America Youth Services $ 25,000.00 The Liberty City Optimist Club of Florida, Inc. Youth Services $ 25,203.00 The Sundari Foundation, Inc. Homeless Services for Women $ 21,500.00 Thelma Gibson Health Initiative, Inc. Elderly Services & Services for the Disabled $ 27,200.00 Total Social Service Gap (SSG) Allocation: $ 487,422.00 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, 2023, to September 30, 2024 with funding from the 2023-2024 SSG Program Year. 2. SUBRECIPIENT will provide youth services to eligible program participants on the following days and time: 4 Monday, K— Tuesday, Wednesday, <Thursday, -1( Frir. for a total of Age program days between 4.. (CAM 'M d $ :DOA to ZO eligible participants, at the following site(s): 1350 NW 50th 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 1.3 to 141, 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 . Also include the following print outs from the below two links: a. https://www.miamidade.govlpa/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) i i i. 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 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 g. 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 final Close -Out (financial report) and inventory report. c. A final performance report. Authorized Representative Signature: Print Name: eui .(1_,C) GIle Title: "i•14-. D r r---Je. 7 Date 1zc23 STATE OF FLORIDA COUNTY OF MIAMI-DADE The foregoing instrument was acknowledged before me by means of ❑ physical presence or E online notarization, thi !3 day of N D&J1' 20 Z' S by b.meca. Ca of Liberty City Optimist Club of Florida, Inc., a Florida Not For Profit Corporation, on e alf of the corporation. He/she is personally known to me or has produced as identification. [Notary Seal]: MYRLINE NOEL MY COMMISSION # HH 195746 EXPIRES: November 7,2025 F�°; ° Bonded Thru Notary Public Underwriters Signature of Notary EXHIBIT C COMPENSATION AND BUDGET SUMMARY YOUTH SERVICES PROGRAM A. The maximum compensation under this Agreement shall be $ 25,203.00. 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 10'h of the following month to the following email address hcdrequest a,rniamigov.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. 1. 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: k 2.61-1 Print Name: 0) CA eitvL C%rtlP t Date Tit le: isAk12 CITY OF MIAMI DEPARTMENT OF HOUSING & COMMUNITY DEVELOPMENT ITEMIZED BUDGET NARRATIVE Agency: The Liberty City Optimist Club of Fl. Inc Contract Period: October , 2023 - September 30. 2024 Funding Source: Social Services Gap Program (SSG) LINE ITEM DESCRIPTION AMOUNT 200 PROFESSIONAL SERVICES $3,500.00 507 MEMBERSHIP(S) S3,500.00 510 LOCAL TRAVEL $4,607.00 511 OUT OF TOWN TRAVEL $6,750.00 522 PROGRAM SUPPLIES $2,750.00 r521 COMPUTER/OFFICE SUPPLIES $4,096.00 GRAND TOTAL: $25,203.00 BUDGET FORM 11 OF CITY OF MIAMI DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT COST ALLOCATION PLAN Agency: The Liberty City Optimist Club of FI, Inc Per October 1, 2023 - September 30, 2024 y Example Effective Date(s): 1011/2023-09/30/2024 10/112023-09/30/2024 10/112023-9/30.12024 v 1 1}23-7l31/2024 Example Line -Item Description CDBG % SSG OMB TCT-YD K-12 % % Toted Example 100Rent , ,(nn s00 soon ;/3ur,ri, Effective Date(s): Line -Item Description % CDBG % SSG OMB % TCT YAS % % Total I00 STAFF SALARIES 0% 0% to% 35847 90 % 309865 0% 100% $345,712.00 101 STAFF FICA 0% 0% IS°% 5032 82°r% 23701 0% 100% $28,733.00 102 STAFF MICA o% 0% o% 0% 0% 0% $0.00 103 STAFF WORKERS COMP. 0% 0% 0% ioo 1667 0% 100% $1,667.00 104 STAFF UNEMPLOYMENT COMP 0°% 0% 0% 0% 0% 0% $0.00 105 STAFF GROUP HEALTH INS. 0%e 0% 0% 0% 0% 0% $0.00 200 PROFESSIONAL SERVICES 0% 5% 3500 95% 65694 0% 0% 100% $69,194.00 203 AUDIT COST 40% 4700 0% 17% 2000 43% 5000 0% 100% S11,700.00 300 GEN. & AUTO LIABILITY INS. 100% 585 0% 0% 0% 0% 100% $585.00 350 TELEPHONE/INTERNET 100% 1838 0% 0% 0% 0°% 100% S1,838.00 360 ELECTRICITY 0% 0% 0% 0% 0% 0% $0.00 380 WATER & SEWER AND GARBAGE 0% 0% 0% 0% 0°% 0% $0.00 410 EQUIPMENT MAINT. o% 0% 0% 0% 014 0% $0.00 411 BLDG. MAINTENANCE. 0% 0% 0% 0% 0% 0%0 $0.00 450 EQUIPMENT RENTAL _ 0% 0°% 0% 0% 0% 0% $0.00 460 SPACE RENTAL 0% 0% o^% 0% 0% 0% $0.00 501 POSTAGE 0% 0% 0%° 0% 0% 0%' $0.00 502 PRINTING OUTSIDE 0% 0% 0% 0% o% 0% $0.00 504 ADVERTISING 0% 0% 0% 0% 1 0°i o°i $0.00 507 MEMBERSHIP(S) 62% 5704 38% 3500 0% 0% 0% 100% S9,204.00 510 LOCAL TRAVEL 0% 5% 4607 9% 9000 86% 81160 0% 10034 S94,767.00 511 OUT OF TOWN TRAVEL 2i% 6000 23% 6750 56% 16500 0°% 0% 100% $29,250.00 521 OFFICE SUPPLIES 0% 52% 4096 0% 48% 3800 0% 100% S7,896.00 522 PROGRAM SUPPLIES 3% 1000 _7% 2750 40% 15183 51% _ 19420 0% 100°% S38,353.00. 523 COMPUTER SOFTWARE 100% 4900 0% 0% 0°% 0% 100% $4,900.00 600 LICENSE & PERMITS 100% 70 0% 0% 0% 0% 100% $70.00 700 TRAINING _ 0% 0% 54% 3765 46% 3200 o% 100% $6,965.00 800 CAPITAL OUTLAY EQUIP. _ 0% 0% 0% 100% 4950 0% 100% $4,950.00 OTHER - INDIRECT COST 0% 0% 34% 24765 66% 48859 0% 100% $73,624.00 OTHER - PROFESSIONAL SERVICES 0% 0^;, 0% 100% 68505 070 100% $68,505.00 OTHER 0% o°-„ 82814 27% L'087= 0% 100% $112,687.00 GRAND TOTAL: 524,797.00 S25,203.00 $260,600.00 S600,000.00 S910,600.00 BUDGET FORM III 1 OF 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 Tess than $10,000 and not more than $100,000 for each such failure. Authorized Representative Signature: Print Name: Title: r STATE OF FLORIDA COUNTY OF MIAMI-DADE The foregoing instrument was ac owledged before me by means of fapThysical presence or ❑ .nline notarization, this day of 20 2,1 by a >Mr o oration, on behalf of the corporation. He/she is personally known to as identification. me or has produu`ed [Notary Seal]: MYRLINE NOEL MY COMMISSION # HH 195746 EXPIRES: November 7, 2025 Bonded Thru Notary Public underwriters 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 I .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: Print a e: c,Y eC U e_1.,x (C+ /1x c Title: (� �., T L� f" Date STATE OF FLORIDA COUNTY OF MIAMI-DADE The foregoing instrument was anowledged before me l cans of P-(gsical presence or Eday of 20 by a oty)-- ft( Corp ration, on behalf of the corporation. He/she is personally known to me or has produced nline notariz talon, [Notary Seal]: this vlav MYRLUNE NOEL MY COMMISSION # HH 195746 EXPIRES: November 7, 2025 F Banded Thru Notary Public Underwriters as identification. Signature of Notary 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 j Q,, e by el) (e-e '( 01�1 kct vt j eS (P ' t this individual's name and title) M i'Q n l EK(20AikcLpirecAd for tirdC., Uked-i, C- Dei; nlb"I- ek)6 csi FLIfre (Print name of entity submitting statements) whose business address is 49D P LA3 \ Z tvwP , H ;c1 rn1 l F( �33 3 -1 and if applicable is Federal Employer Identification Number (FEIN) is (Dg' D 2 L9 b({U If the entity has no FEIN, include the Social Security Number of the individual signing this sworn Statement: 2, 1 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. I 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 ofa 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(1)(a), Florida Statutes, means: 1. A predecessor or successor ofa 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 ofa 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 arm'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 ofa 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. (Please indicate with an "X" which statement applies). (.. Neither the entity submitting this sworn statement, nor any of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, 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 1 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: J� f�"a l Gi ci(t Title: E e ate STATE OF FLORIDA COUNTY OF MIAMI-DADE The foregoing instrument was acknowledged before me y means of 17-15Tiysical presence or ❑ nline notarization this day of 20by CV,_ of `t`YIQ.. L+ O Nev,Ar ; a ()C•- l 1144 cor oration, on behalf of the corporation. He/she is personally known to me or has produced as identification. Signature of Notary [Notary Seal]: THY P� MYRLINE NOEL . MY COMMISSION ifNH 195746 =�•�` a3 •• EXPIRES: November 7, 2025 ''•'•'Fadi:L°'�� Bonded Thre Notary Public Underwriters Exhibit C INSURANCE REQUIREMENTS PUBLIC SERVICE AND ECONOMIC DEVELOPMENT PROGRAMS FOR COMMUNITY DEVELOPMENT I. Commercial General Liability (Primary & Non Contributory) A. Limits of Liability Bodily Injury and Property Damage Liability Each Occurrence $300,000 General Aggregate Lirnit $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 Requ ired) Explosion, Collapse, & Underground Hazard (If Applicable) Contingent Liability/Contractual Liability Premises & Operations Liability 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 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 $500,000 for bodily injury caused by disease, policy limit IV. Professional Liability (If Applicable) Each Claim $250,000 Policy Aggregate $250,000 '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" 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. A� p® CERTIFICATE OF LIABILITY INSURANCE DATE(MMDDIYYYY) O6/05/2023 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(les) 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 7850 Northwest 146th Street Suite 200 Miami Lakes FL 33016 CONTACT Jane Warren NAME: PHONE (305) 558-1101 FAx () 305 822-4722 WC No, EMI: (A/C, No): E-MAIL Jwarrentkbinco.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC M INSURER A: Fortegra Speciality Insurance Company 16823 INURED Liberty City Optimist Club of Florida, Inc., DBA: Liberty City Warriors 1350 NW 50 Street Miami FL 33142 INSURER B : Berkley Life and Health Insurance Co. 64890 INSURER C INSURER 0 INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 23I24 GLIAUTOIACC 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 POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL.SUBR INSD WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP IMMIDDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY KSG1000001-01-000622 06/09/2023 06/09/2024 EACH OCCURRENCE 1,000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300,000 X ABUSE/MOLESTATION MED EXP (Any one person? $ 5,000 x $1MOCC1$2MAGG PERSONAL &ADV INJURY s 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER. PRO- GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP/OPAGG $ 2,000,0 00 Participant Liability $ 1,000,000 A AUTOMOBILE X — LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY — _ se /,,,_,� SCHEDULED AUTOS NON -OWNED AUTOS ONLY KSG1000001-01-000622 06/09/2023 06/09/2024 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ — UMBRELLA LIAB EXCESS LIAB — OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE 5 DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, nasarlee under DESCRIPTION OF OPERATIONS below N 1A PER STATUTE QTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ EL. DISEASE - POLICY LIMIT $ B PARTICIPANT ACCIDENT DEDUCTIBLE $259 PAI L014001150103 06/09/2023 06/09/2024 EXCESS COVERAGE AD&D $100,000 $10,000 DESCRIPTtON OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) 1 The City of Miami is listed as an additional insured with respect to general liability and auto liability arising out of the operations of the named insured. Coverage is afforded for contingent and contractual exposures, and the general liability shall be 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 CANCELLATION I 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 J ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD / A� o® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/08/2022 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 policy, 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 7850 Northwest 146th Street Suite 200 Miami Lakes FL 33016 CONTACT Jane Warren NAME: (q/C,NE Ext): (305) 558-1101 FAX No): (305) 822-4722 E-MAIL Jwarren@kbmco.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Fortegra Speciality Insurance Company 16823 INSURED Liberty City Optimist Club of Florida, Inc. 1350 NW 50 Street Miami FL 33142 INSURER B : Lloyds of London 15642 INSURER C: INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 22/23 GL/Prof 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY KSG1000001-00-C10031 06/09/2022 06/09/2023 EACH OCCURRENCEDAMAGE $ 1,000,000 CLAIMS -MADE X OCCUR TO RETED PREMISES (Ea occurrence) $ 300,000 X Abuse/Molestation MED EXP (Any one person) $ 5,000 X $1M OCC/$2M AGG PERSONAL&ADVINJURY $ 1,000,000 GENIIAGGREGATE X POLICY OTHER: LIMIT APPLIES JECT PRO-LOC PER: GENERAL AGGREGATE $ 3'000'000 PRODUCTS - COMP/OPAGG $ 2,000,000 Participant Liability $ 1,000,000 A AUTOMOBILE X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY �/ /• SCHEDULED AUTOS NON -OWNED AUTOS ONLY KSG1000001-00-C10031 06/09/2022 06/09/2023 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILYINJURY(Peraccident) $ PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N /A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ B Professional Liability PSL0039576487 12/07/2022 12/07/2023 Limit of Liabiity Deductilbe per claim $250,000 $1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Miami is listed as an additional insured with respect to general liability and auto liability arising out of the operations of the named insured. Coverage is afforded for contingent and contractual exposures, and the general liability shall be 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 CANCELLATION 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 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CONFIRMATION OF INSURANCE THE TERMS AND CONDITIONS OF THIS CONFIRMATION OF INSURANCE MAY NOT COMPLY WITH THE SPECIFICATIONS SUBMITTED FOR CONSIDERATION. PLEASE READ THIS CONFIRMATION CAREFULLY AND COMPARE IT AGAINST THE QUOTE PROVIDED & SUBMISSION DOCUMENTS. PLEASE REVIEW THE POLICY FORMS FOR THE ACTUAL COVERAGE'S PROVIDED. IN THE EVENT OF DIFFERENCE, THE POLICY WILL PREVAIL. IN ACCORDANCE WITH YOUR INSTRUCTIONS, AND IN RELIANCE UPON THE STATEMENTS MADE BY THE RETAIL BROKER IN THE APPLICATION/SUBMISSION, THE INSURER HAS BOUND COVERAGE AS FOLLOWS: DATE ISSUED: PRODUCER: INSURED: December 8, 2022 Wendy Drake Keen Battle Mead & Company 7850 Northwest 146th St., #200 Miami Lakes, FL 33016 Liberty City, Miami Optimist Club of Florida, Inc 1350 NW 50 Street Miami, FL 33142 INSURER: Lloyd's of London Non -Admitted A.M. BEST RATING: A XV POLICY NO.: PSL0039576487 COVERAGE: Professional Liability POLICY PERIOD: 12/7/2022 TO 12/7/2023 12:01 A.M. STANDARD TIME AT THE LOCATION ADDRESS OF THE NAMED INSURED. THIS INSURANCE BINDER WILL BE TERMINATED AND SUPERSEDED UPON DELIVERY OF THE POLICY(IES) ISSUED TO REPLACE IT, 60 DAYS OF THE DATE OF THIS BINDER OR EFFECTIVE DATE OF COVERAGE. LIMITS OF LIABILITY: INSURING CLAUSE 1: PROFESSIONAL LIABILITY $250,000 $250,000 $250,000 $250,000 $250,000 $250,000 $250,000 $250,000 $250,000 $250,000 $100,000 $100,000 ALL SECTIONS COMBINED SECTION A: ERRORS AND OMISSIONS SECTION B: BREACH OF CONTRACT SECTION C: SUB -CONTRACTOR VICARIOUS LIABILITY SECTION E: INTELLECTUAL PROPERTY RIGHTS INFRINGEMENT SECTION F: POLLUTION LIABILITY SECTION G: REGULATORY COSTS AND FINES SECTION H: DISHONESTY OF EMPLOYEES SECTION I: PAYMENT OF WITHHELD FEES INSURING CLAUSE 6: LOSS MITIGATION INSURING CLAUSE 7: COURT ATTENDANCE COSTS INSURING CLAUSE 8: REPUTATION AND BRAND PROTECTION DEDUCTIBLE: $1,000 Insuring Clause 1 $0 Insuring Clause 6-8 RETROACTIVE DATE: 12/7/2022 PREMIUM: $1,000.00 Flat Annual Premium, plus FL Surplus Lines Taxes and Fees. SURPLUS LINES TAXES/FEES: $64.22 Surplus Lines Tax $0.78 Stamping Office Fee THE FILING OF SURPLUS LINES TAXES & FEES IS THE RESPONSIBILITY OF: ECC Insurance Brokers, LLC FEES: Broker Fee $200.00 Carrier Policy Fee $100.00 Note that a fee is being charged in addition to the commission TOTAL: $1,365.00 COMMISSION: 10% TERMS AND CONDITIONS / ENDORSEMENTS AND EXCLUSIONS; INCLUDES BUT NOT LIMITED TO: BUSINESS ACTIVITIES: The professional services of a non-profit organization LEGAL ACTION: Worldwide TERRITORIAL SCOPE: Worldwide OPTIONAL EXTENDED REPORTING PERIOD: 12 months for 100% of applicable annualized premium WORDING: Professions (US) v3.2 ENDORSEMENTS: Complaints Notice (USA) Abuse and Molestation Exclusion Clause Bodily Injury Exclusion Amendatory Clause THIS CONFIRMATION OF INSURANCE IS SUBJECT TO THE FOLLOWING INFORMATION BEING RECEIVED WITHIN 10 DAYS OF THE EFFECTIVE DATE: None For Florida Business only: A copy of the Surplus Lines Disclosure and Acknowledgement signed and completed by the Insured is required ALL OTHER TERMS AND CONDITIONS APPLY PER THE POLICY FORM CANCELLATION: THIS POLICY IS SUBJECT TO THE CANCELLATION PROVISIONS AS FOUND IN THE POLICY(IES) OR CERTIFICATE(S) CURRENTLY IN USE BY THE INSURER. THE INSURANCE EFFECTED UNDER THE INSURER'S BINDER CAN BE CANCELLED BY THE INSURER (SUBJECT TO STATUTORY REGULATIONS) BY MAILING, TO THE INSURED AT THE ADDRESS STATED ON THE FACE OF THIS CONFIRMATION OF INSURANCE, WRITTEN NOTICE STATING WHEN SUCH CANCELLATION SHALL BE EFFECTIVE. IN THE EVENT OF CANCELLATION BY THE INSURED, THE EARNED PREMIUM WOULD BE SUBJECT TO THE MINIMUM PREMIUM IF APPLICABLE. THIS CONFIRMATION OF INSURANCE IS ISSUED BASED UPON THE INSURER'S AGREEMENT TO BIND AND IS ISSUED BY ECC INSURANCE BROKERS, LLC. WITHOUT ANY LIABILITY WHATSOEVER AS AN INSURER. PREMIUM PAYMENT IS DUE WITHIN TWENTY (20) DAYS FROM EFFECTIVE DATE UNLESS OTHERWISE STIPULATED. AUTHORIZED REPRESENTATIVE Anthony Parise, Vice President INSURED: , Liberty City, Miami Optimist Club of Florida, Inc DATE ISSUED: December 8, 2022 Reference #:0672447 LUTHER R CAMPBELL President NADEGE M. JASMDN 'ice -President GENESSEE WATKINS Treasurer KENYADA S. JEE I~ E.RSON Secretary BOARD OF DIRECTORS GLRALD L DARLING DWIGHT L. JACKSON, SR. SHIRLEY PRESLEY PIERRE RUTLEDGE. BRITTNEY TELLIS ADVISORY BOARD KRISTEN CAMPBELL GEORGEJOHNSON DEWEY W, KNIGHT, III BRITTANY, SIIARPTON EURECA COULANGES Executive Director LUTHER CAMPBELL SAMUEL K. JOHNSON" Pounders "'Deceased The Chiktr+en's Trust MIAMI•DADE COUNTY IL. The Liberty City Optimist Club Of Florida, Inc. /56,iirti ati Od4 November 8, 2023 Department of Community & Economic Development Social Services Gap Program (SSG) 14 NE 1 AVE 2nd Floor. Miami, FI 33132 RE: The Liberty City Optimist _ Workers' Comp The Liberty City Optimist Club has less than 1 paid employee under the Community Development Block Grant for FY 2023-2024. Under Chapter 440 of State of Florida Statues, employers with three (3) or fewer employees can opt to operate without Workers Compensation Insurance. SSiiyn�c�errelly,,y, &t Lec4L Eureca Coulanges, Executive Director The Liberty City Optimist Club 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:info@Iibertycitvoptimist.org LUTHER R CAMPBELL President NADEGE M. JASMIN 'Vier -President GENESSEE WATKINS Treasurer KENYADA S. JEFFERSON Secretary BOARD OF DIRECTORS GERALD L. DARLING DW IGHT L. JACKSON, SR. SI IIRLEY PRESLEY Pi1:RRE RUTLEDGE HRI'FTNEY TELLIS ADVISORY BOARD KRISTEN CAMPBELL GEORGEJOHNSON DEWEY W, KNIGHT, III BRITTANY SHARPTON EURECA COULANGES Executive [)ireeter LUTHER CAMPBELL SAMUEL K. JOHNSON"' " Founders *'*Deceased The 4J Children'sTrust h9i.anei I'atl�. h P t tjIiun The Liberty City Optimist Club Of Florida Inc. �{ fPfa'o/ $at'i Ap. November 7, 2023 Department of Housing & Community Development 14 NE 1 AVE 2nd Floor Miami, FL 33132 RE: Contract Period: October 1st, 2023 — September 30, 2024 Dear George Mensah, This is to advise you that The Liberty City Optimist Club of Florida, Inc., has no company owned vehicles Sincerely, Eureca Coulanges Executive Director 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 Olivera, Rosemary From: Galo, Monica Sent: Tuesday, February 6, 2024 10:50 AM To: Lee, Denise; Olivera, Rosemary; Ewan, Nicole; Hannon, Todd; Pereira, Raymond Subject: Executed Agreement - Liberty City Optimist Club SSG Contract $25203 Attachments: Executed Agreement - Liberty City Optimist Club SSG Contract $25203.pdf Good morning, Please find attached the fully executed copy of an agreement from DocuSign that is to be considered an original agreement for your records. Thank you, Monica Galo i