Fort Walton Beach Council agenda — 03-12-13--regular — reading text

No. NIA Addendum No. FAILURE TO SUBMIT ACKNOWLEDGMENT OF ANY ADDENDUM THAT AFFECTS THE SCOPE OF WORK IS CONSIDERED A MAJOR IRREGULARITY AND WILL BE CAUSE FOR REJECTION OF THE PROPOSAL. The Sound Council LLC ( rSC Productions) NAME OF BUSINESS BY 9 v Brandon Signature Grimes, Owner NAME & TITLE (type or print) PO Box 758 MAILING ADDRESS Fort Walton Beach, FL 32540 CITY, STATE, ZIP CODE 850 -621 -2437 TELEPHONE NUMBER 950- 226 -7886 4 February, 2013 DATE 6 of 28  watsRS punoS BulpueI 01,0- U ddN PJEMV : OZZZ) suoitonpo' d OSl - 01,0-£ L ddb : IuawyoetlV e RFP #13 - 010 am i Fort Walton Lellding Sound S s4 Yu REFERENCES RFP 13 -010 a Bidder shall submit as a part of the bid package, four (4) Customer references with name of the customer, address, contact person, and telephone number. REGARDING PROPOSER: Brandon Grimes, The Sound Council LLC (TSC Name: Emerald Coast Conference Center Name: AI Copeland Investmenk! Menchies Contact: Doug Ahern COntactMi= h Moore Address: 1250 Miracle Strip Parkway Address: 5916 Golden Pheasant Court Okaloosa Island, FL 32548 Baton Rouge, LA 70817 Telephone: 850609 -3800 Telephone: 225-772 -9730 Facsimile: Facsimile 8506096095 225 -612 -6724 Name: Name: Fart Walton Beach, Chamber of Comma The Block Club Contact: Contact: Ted Corwrcan Mark Hawkins Address: Address: 113 Eglin Parkway BE 34 Miracle Strip Parkway Fort Walton Beach, FL 32548 Fort Walton Beach, FL 32548 Telephone: 850 -2446191 Telephone: 850665-0660 Facsimile: Facsimile 850301 -9393 850 -244 -1935 7 of28  wels/.S Punog BUIPue3 01,0- El, d=1H PJemy : OZZZ) suoilonpord 351- 01, 0- Eli dd21 4uewg3ellV a N Fod Welt L= di. g Sood S DRUG -FREE WORKPLACE FORM The undersigned vendor, on t 5 Febmary , RFP 13 -010 RFP 473A10 2013, in accordance with Section 287.087, a u o.m does: Florida Statutes, certifies that [ company] The Sound Council LLC 1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees forviolations ofsuch prohibition. 2. Inform employees about the dangers ofdmg abuse in the workplace, the business's policy of maintaining a drug -free workplace, any available drug counseling, rehabilitation, employee assistance programs and the penalties that may be imposed upon employees for drug abuse violations. 3. Give each employee engaged in providing the commodities or contractual services that are under bid a copy ofthe statement specified in Paragraph 1. 4. In the statement specified in Paragraph 1, notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer ofany conviction of, or plea of guilty or nolo contendere to, 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 -free workplace through implementation of Paragraphs 1 through 5. Check one: x As the person authorized to sign this statement, I certify 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. The SoundSound Council LLC ( TSC Productions) F. BUSINES S: NAME O.. y BY: / t7/ 1/ I/ — SIGNATURE Brendon Grimes, Owner NAME & TITLE, TYPED OR PRINTED 8 of 28  mals6S punoS 6uipuel Ol0 -£l dJU PJ9mV: OZZZ) suollnnpold DSl - OlO-£ L d=IH : luaw43e11V UP #13. 010 a( N F rt Wan land' S d S" ] a PUBLIC ENTITY CRIME FORM —RFP 13 -010 Y auA 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. This sworn statement is submitted with Proposal, Proposal or Contract # RFP 13-010 whose business address This sworn statement is submitted by Brandon crimes is 405 Lovejoy Road, Unit CBD, Fort Walton Beach FL 32W and ( if applicable) Federal Employer Identification Number ( FEIN) is 264804129 ( If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement). My name is 1 7 elon v ( -,,. 7: m x and my relationship to the entity named above is_ I understand that a " public entity crime" as defined in Paragraph 287. 133( a)( g), 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 orwith an agency orpolitieal subdivision ofany 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 other 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 1, 1989, as a result of ajury verdict, nonjury trial, or entry ofaplea ofguilty or nolo comendere. I understand that an " affiliate" as defined in Paragraph 287. 133( 1)( 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 ofequipment 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. 9 of28  wats6S punoS 6uipuel Ol0-EL d=1M PJemV : OZZZ) suoponpold OSl- Ot0-£ L ddil : IuawgoeliV r I( FY 913- 0 IV Fort Walton l.andin Sounds Icm Nsi a m I understand that a ' person' as defined in Paragraph 287. 133( 1)( e), Florida Statutes, means any o. natural person or entity organized under