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

does: Florida Statutes, certifies that o I. publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specit} ing the actions that will betaken against employees for violations of such prohibition. 2, Inform employees about the dangers or drug abuse in the workplace, the business' s policy of maintaining a drug-lice 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 of the statement specified in paragraph 1. q. In the statement specified in Paragraph I. 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 of any conviction of or plea of guilty, or polo contenders 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 live ( 5) days alter such com' iction. 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 N who is > o convicted. aC 6. Make a good faith etloit to continue to maintain a drug -free workplace through y intplen entatlon of Paragraphs I through 5- a Q Check one: 0 As the person authorized to sign this statement. I certify that this 0 firm complies fully with above requirements. a As the person authorized to sign this statement, this firm does not c comply fully with the above requirements. E NAML Of tSl) 5Yti EfS ti: F. P =, d inc dba All Pro.. Sound LUm Q 13Y;_ GN.4TLRE JQjn Fqgua - vice Presiden _._ NAME. & TITLE. TYPED OR PRINTED 9 of 29  F15 .2. c HfFpII- I' m P910 Sound s1slet =._ PUBLIC ENTITY CRIME FORM —RFP 13 -010 SWORN STATEMENT UNDER .WC1lON 287. 133 ( 3) ( A) FLORIDA S' l A] UTES, ON PUBLIC EN I I I -Y CRIMES THIS FORM MUST BE SIGNED IN " I' HE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMIN IS' I' ER OATHS. This sworn statement is submitted with Proposal, Proposal or Contract 4 RFP 13 - 010 whose business address This worn statement is submitted by John Fuqua and ( if applicable) Federal Employer is AP Sound, Inc_ dba All Pro _Sound Identification Number ( FEIN) is 27- 4564877 ( If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement). My name Is _ and ms relationship to the entity named ahove is V/C" n _. 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 kith any public entity or with an agency or political 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 an), other state or of the I Tined States and involving antitrust, fraud, theft, bribery. collusion, racketeering. conspiracy, or material misrepresentation. I understand that " convicted" or " cony iction" asdefined in paragraph 287. 1 33( 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 ) u1y I, 1989, as a result of ajury verdict. non -jury trial, or enus of a plea of guilty Or 11010 contcndere. 0 I understand that an " affiliate" as defined in Paragraph 287. 133( 1 )( a). Florida Statutes, means: 0 A predecessor or successor ofa person convicted of a public entity crime ( or) fYaLL An entity under the control of any natural person who is active in the management of the C entire and who has been convicted of a public entity crime. The term " affiliate" includes EE Those otlicers, directors, execattiveS. partners, shareholders, employees, members, and agents m who are active in the management of an affiliate. The ownership by one of shares constituting a controlling incomeamongpersonswhen not for fair interest in anotherperson. 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 that he considered an affiliate 9 of 29 acket P .  RPP d13 -010 F- 1 5.2. c Jun walem 1 ands g S d Ss,c __ u 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 the state or of the 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 business with a public entity. The term " person' includes those officers. directors, executives, partners, shareholders, employees, members, and agents who are 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 sworn statement. ( Please indicate which statement applies.) V 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 I, 1989. @ The entity submitting this sworn statement, or one or more of the officers, directors, - exccutives. partners_ shareholders, employees, members, or agents who are active in management of the entice or an affiliate of the entity has been charged with and convicted of a public entity crime ° 0 subsequent to .luly L 1989. ( Please attach a copy of the final order.) M a I he person or afti l i are was placed on the cony icted vendor list. There has been a subsequent v proceeding before a hearing officer ofthe 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) R 0N The person or affiliate has not been placed on the convicted vendor list. ( Please describe any action taken by. or pending with, the Denali ment o General S cry ice N0 Signature) ---` p- 0 Date) o SFA I F OF: COUNTY OF: " C0* 411,4- a fY PERSONALLY APPEARED BEFORF MF, the undersigned authority. who. after first being a a