Fort Walton Beach Council agenda — 01-24-12 regular — reading text

oV 6. 1 understand that an " affiliate" as defined in Paragraph 287. 133( 1)( a), Florida c Statutes means: m 1. A predecessor or successor of a person convicted of a public entity crime; or V m0 2. An entity under the control of any natural person who is active in the 2 management of the entity and who has been convicted of a public entity crime. The term " affiliate" includes those officers, directors, executives, partners, u shareholders, employees, members, and agents who are active in the t management of an affiliate. The ownership by one of shares constituting a m controlling income among persons when not for fair interest in another person, a 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 Page 10 of 27 Packet Pg: 101  8. 3. e 1 con Jii " I' vI • ud R" i6o, D ITB# 12 -008 Public Entity Crimes Statement —Pg 2 of 3 controls another person. A person who was knowingly convicted of a public entity 0N0 crime, in Florida during the preceding 36 months shall be considered an affiliate. Nd m 7. 1 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 the state or of the a United States 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 S0 business with a public entity. The term " person" includes those officers, directors, 0 executives, partners, shareholders, employees, members, and agents who are active n management of an entity. oN 8. Based on information and belief, the statement which I have marked below is true m in relation to the entity submitting this sworn statement. ( Please indicate which statement a03a applies.) Neither 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 swom statement, 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 Hearings. 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 convicted vendor list. Please describe any action taken by, or pending with, the Department of General Services.) Signature) Company) Date: Page 11 of 27 Packet Pg. 102  8. 3. e rrw n) nos t -, "' I' d I I naa , i.,= RJ uon._... _- ITB# 12 -008 Public Entity Crimes Statement— Pg 3 of 3 N00 STATE OF FLORIDA Na0 COUNTY OF c_ 0K PERSONALLY APPEARED BEFORE ME, the undersigned authority, who, after first a being sworn by me, affixed his /her signature at the space provided above on this a day of , 2011, and is personally known to me, or has provided driver' s license /military id) as identification. 0N_ Notary Public Lr a My Commission expires: Q 3 nmN OQN f- m OYO PM tcLuAQE Page 12 of 27 Packet Pg: 703  8. 3. 0 tl b i] nr. GENERAL CONDITIONS N 1. EXECUTION OF BID: Bid must contain a manual signature of an authorized ` oo o 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 m agreement shall be signed by two ( 2) Corporate officials ( i. e., President, Vice President, c 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 v submitted in lieu of these requirements. Such letter of authorization must be on the corporate t stationery, must clearly state that the person who signed the referenced agreement is duly p 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) c weeks after notification of award may result in award to the next apparent low bidder. n m 1. 1 In the case of a partnership, the agreement must be signed by a general or F E managing partner and notarized as outlined above. 3 1. 2 In the case of a sole proprietorship, the owner must sign the agreement and have m such execution notarized. 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. r SUBMITTAL OF BIDS: Bids shall be submitted utilizing the bid forms) provided by rn 2. the City. All bids shall be properly executed with