Fort Walton Beach Council agenda — 07-23-13--special---alconese rezoning — reading text

any violation of Chapter 893 or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five ( 5) days after such conviction. 5. Impose a sanction on, or require the satisfactory participation in a drug assistance or rehabilitation program if such is available in the employee's community, by any employee who is so convicted. 6. Make a good faith effort to continue to maintain a drug -tiee workplace through implementation of Paragraphs I through 5. Check on As the person authorized to sign this statement, I cerlify that this firm complies fully with above requirements. As the person authorized to sign this statement, this firm does not comply fully with the above requirements. nt NAMEOF USINESS S e 13' f SIGNATURE T NAME & TITLE, TYPED OR PRINTED: c %s Gaa vii+ ll Page 9 of 26  uadoamg asunoo 1IoO Ho- lit. 81110 puemtl : 4- E J0i) sounluaA 1100 - ! esodoad P! 8 l l0-£f 911 guawgaelly m u Golf Course Turf S,, eeper Machine ITB 13 - 011 a Y U a PUBLIC ENTITY CRIME FORM - 1TR 13. 011 SWORN STATEMENT UNDER SECTION 287. 133 ( 3) ( A) FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS. pp 7 This sworn statement is submitted with Proposal, Proposal or Contract M This sworn statement is submitted by ; te- whose business address is G c v Lc lZ-- and ( if applicable) Federal Employer Identification Numbe ( FEIN) isfig- 3'/,? K If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement). My name is ' ( % e and my relationship to the entity named above i I understand that a " public entity crime" as defined in Paragraph 287. 133( axg), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or with the United States, including, but not limited to, any proposal or contract for goods or services to be provided to any public entity or any agency or political subdivision of any outer state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. I understand that " convicted' or " conviction" as defined in paragraph 287. 133( a)( b), Florida Statutes, means finding of guilt or a conviction of a public entity crime with or without an adjudication of guilt, in any federal or state trial court of records relating to charges brought by indictment or information after July I, 1989, as a result of a jury verdict, non -jury trial, or entry of a plea of guilty or note contendere. I understand that an " affiliate" as defined in Paragraph 287. 133( I)( a), Florida Statutes, means: A predecessor or successor of a person convicted of a public entity crime ( or) 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 of shares constituting a controlling income among persons when not for fair interest in another person, or a pooling of equipment or income among persons when not for fair market value under a length agreement, shall be a prima facie case that one person controls another person. A person who was knowingly convicted of a public entity crime, in Florida during the preceding 36 months shall be considered an affiliate. Rrec 111 of 6  jadaamg asan031100 1. 1, 0- Cl. 81110 puemtl : tr- E lOZ) saanluaA 1100 - lesodoad PEI 1. 1, 0- Cl. 811 quawgaelltl M m s Gol[ QmrsCnur lWecper Meohitk 1, 11113- 011 a I understand that a " person" as defined in Paragraph 287. 133( Ixe), Florida Statutes, means any natural person or entity organized under the laws of the state or of the United Slates with the legal power to enter into a binding contract for 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, directors, executives, partners, shareholders, employees, members, and agents who am active n management of an entity. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this swom statement. ( Please indicate which statement applies.) Xither the entity submitting this sworn statement, nor any officers, directors, executives, partners, shareholders, employees, members, or agents who are active in management of the entity, nor affiliate of the entity have been charged with and convicted of a public entity crime subsequent to July 1, 1989. The entity submitting this sworn Statentemi. or one or more of the officers, directors, executives, partners, shareholders, employees, members, or agents who are active in management of the entity or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. ( Please attach a copy of the final order.) The person or affiliate was placed on the convicted vendor list There has been a subsequent proceeding before a hearing officer of the State of Florida, Division of Administrative Bearings. The final order entered by the hearing officer determined that it was in public interest to remove the person or affiliate from the convicted vendor list. ( please attach a copy of the final order) The person or affiliate has not been placed on the om' icted vendor list. ( Please describe any action taken bv, or pending with, the Department of ener ervicoy}'^ Si to ure) J7 Date STATE OF: e C; rr COUNTY OF: PERSONALLY APPEARED BEFORE ME. the undersigned authority, who, oiler first being U swum affixed his /her signature at the space provided above on this . S day of I'-/- 2013, and is personally known to me, or has provided Lra. tj -rw-_ as identification. My Commission expires  aadoamS asanoplloE) lLO- EL B1Uo paemy: p- £ L0Z) saanluaA1100- lesodoad PIS LLO-£ L Bit: luamyoelltl N( a INVITATION TO BID ISSUE DATE: JANUARY 29. 2013 City of Fort Walton Beach, Florida BID NO: ITT 13 -011 Purchasing Department 105 Miracle Strip Pkwy SW OPENING DATE: February 26. 2013 Fort Walton Beach, Florida 32548 Telephone: ( 850) 833 -9523 OPENING TIME 2: 30 PM CST Fax: ( 850) 833- 9643 Website: httm11www. fwh.ore BID REQUESTED: GOLF COURSE TURF SWEEPER MACHINE The City of Fort Walton Beach invites bids for a GOLF COURSE TURF SWEEPER MACHINE. Bids will he opened and publicly read aloud at City Hall Annex Building —Conference Room, City of Fort Walton Beach, 105 Miracle Strip Parkway SW, Fort Walton Beach, Florida at 2: 30 PM ( CST) on February 26, 2013. Bids must be SUBMITTED ON THE FORMS FURNISHED BY THE CITY and in accordance with specifications and the list of quantities desired. Respondents are advised that from the date of release of this solicitation until award of the contract, no contact with City personnel related to this solicitation is permitted. All communications are to be directed to the Purchasing Representative and sole contact listed below. It is the intent and purpose of the City of Fort Walton Beach that this Invitation to Bid promotes competitive bidding. It shall be the bidder's responsibility to advise the Purchasing Department at the address noted in the Special Conditions, if any language, requirements, etc, or any combination thereof, inadvertently restricts or limits the requirements stated in this Invitation to Bid to a single source. Stich