Fort Walton Beach Council agenda — 04-24-12 regular — reading text

3 4. 1 understand that a " public entity crime' as defined in Paragraph 287. 133( a)( g). Florida Statutes, 0 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 9m or with the United States, including, but not limited to, any bid or contract for goods or services to be u0 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 mc misrepresentation. U Y 5. I understand that " convicted' or " conviction" as defined in paragraph 287.133( a)( b), Florida 3 Statutes, means finding of guilt or a conviction of a public entity crime with or without an adjudication of N guilt, in any federal or state trial court of records relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non -jury trial, or entry of a plea of guilty or nolo 0 r comendere. Mr 6. I understand that an " affiliate' as defined in Paragraph 287. 133( 1)( a), Florida Statutes, means: I. A predecessor or successor of a person convicted of a public entity crime; or caE isN 2. An entity under the control of any natural person who is active in the management of the entity Q and who has been convicted of a public entity crime. The term " affiliate" includes those officers, directors, executives, partners, shareholders, employees, I Packet P9. 37  8. 2. b ti ITBN 12 -015 Public Entity Crimes Statement— Pg 2 of 3 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 0 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. NV2 UO 7. 1 understand that a " person' as defined in Paragraph 287. 133( 1)( e), Florida Statutes, means any m natural person or entity organized under the laws of the state or of the United States with the legal power a to enter into a binding contract for provision of goods or services let by a public entity, or which otherwise W 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 are active n Rc c management of an entity. 8. Based on information and belief, the statement which I have marked below is true in relation to the NON entity submitting this sworn statement. ( Please indicate which statement applies.) in Neither the entity submitting this sworn statement, nor any officers, directors, executives, partners, shareholders, employees, members, or agents who are active in management of N r the entity, nor affiliate of the entity have been charged with and convicted of a public c entity crime subsequent to July 1, 1989. E The entity submitting this sworn statement, or one or more of the officers, directors, 00 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 am of a public entity crime subsequent to July I, 1989. ( Please attach a copy of the final order) u0 N The person or affiliate was placed on the convicted vendor list. There has been a U subsequent proceeding before a hearing officer of the State of Florida, Division of Y Administrative Hearings. The final order entered by the hearing officer determined that 3 it was in public interest to remove the person or affiliate from the convicted vendor list. Please attach a copy of the final order) aw The person or affiliate has not been placed on the convicted vendor list. ( Please describe NOr any action taken by, or pending with, the Department of General Services.) mr c Signature) E LVN Date'. 1 Packet Pg. 38  8. 2. b TFB# 12 -015 Public Entity Crimes Statement— Pg 3 of 3 STATE OF FLORIDA COUNTY OF PERSONALLY APPEARED BEFORE ME, the undersigned authority, who, after first being swom by 2012, day of , me, affixed his /her signature at the space provided above on this _ driver' s and is personally known tome, or has provided _ ( license/ military id) as identification. Notary Public My Commission expires:_ 1 Packet P9. 39  8. 2. b is r . m od SECTION 2 - GENERAL CONDITIONS 2. 1 EXECUTION OF BID: Bid must contain a manual signature of an authorized representative in the space provided. Florida law requires that when a municipality enters into a contractual agreement with a corporation licensed to do business in the State of Florida, such agreement shall be signed by two ( 2) Corporate Officials ( i. e., President, Vice President, Secretary, Treasurer) with the corporate seal affixed. It is also required that such execution be acknowledged before a Notary Public with Notary Seal affixed. If neither the aforementioned corporate officers nor the corporate seal are readily available, a letter of authorization can be submitted in lieu of these requirements. Such letter of authorization must be on the corporate stationery, must clearly state that the person who signed the referenced agreement is duly authorized to enter into such agreement on behalf of the corporation, and must be signed by the corporate officials designated above. Failure to submit letter of authorization within two ( 2) weeks after notification of award may result in award to the next apparent low bidder. 2. 1. 1 In the case of a partnership, the agreement must be signed by a general or managing partner and notarized as outlined above. 2. 1 , 2 In the case of a sole proprietorship, the owner must sign the agreement and have such execution notarized. 2. 1. 3 If you have any questions regarding the execution of the signature page, please feel free to contact the Purchasing Division at ( 850) 833 -9523 for further clarification. 2. 2 SUBMITTAL OF BIDS: Bids shall be submitted utilizing the bid form( s) provided by the City. All bids shall be properly executed with all blank spaces filled in. The signatures of all persons signing shall be in longhand. Erasures, interlineations, or other corrections shall be authenticated by affixing in the margin immediately opposite the correction the initials of a person signing the bid. If the unit price and the total amount named by a bidder for any item are t in agreement the ' t once alone shall be considered as remesentine the bidder' s intention and the totals shall be corrected. 2. 3 AMENDMENT OF THE INVITATION TO BID: It is the bidder' s responsibility to contact the Purchasing Department prior to submitting a bid to ascertain if any addenda have been issued, to obtain all such addenda, and return executed addenda with the bid (or complete and sign addenda acknowledgement form.) The failure of a bidder to submit acknowledgment of any addenda that affects the bid price(s), is considered a major irregularity and will be cause for rejection of the bid. 2A BIDDER' S CERTIFICATION FORM: Each bidder shall complete the " bidder' s certification" form included with this invitation to bid, and submit the form with the bid. The failure of a bidder to submit this document will be cause for