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HomeMy WebLinkAboutItem D4 BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: FEBRUARY 17.2010 Division: TDC Bulk Item: Yes....K.- No Department: Staff Contact Person/Phone #: Maxine Pacini 296-1552 AGENDA ITEM WORDING: Approval to advertise the FY 2011 Monroe County Tourist Development Council Bricks and Mortar/Capital Projects Request for Funding Application. ITEM BACKGROUND: TDC approved same at their meeting of February 9,2010 PREVIOUS RELEVANT BOCC ACTION: CONTRACT/AGREEMENT CHANGES: STAFF RECOMMENDATIONS: Approval TOTAL COST: $ BUDGETED: Yes ~ No COST TO COUNTY: $ SOURCE OF FUNDS: TDC REVENUE PRODUCING: Yes....K.- No AMOUNTPERMONTH_ Year APPROVED BY: County Atty ~ OMB/Purchasing N/ A Risk Management N/ A DOCUMENTATION: Included X Not Required_ DISPOSITION: AGENDA ITEM # Revised 11/06 NOTICE OF REQUEST FOR APPLICATIONS This Request for Application is subject to change prior to its issuance should there be a change in policy by the Board of County Commissioners or the Tourist Development Council ("TDC"). NOTICE IS HEREBY GIVEN TO PROSPECTIVE APPLICANTS that on , 2010 the Monroe County Purchasing Office, the Board of County Commissioners of Monroe County, Florida will receive sealed applications until 5:00 p.m for the following: BRICKS AND MORTAR/CAPITAL PROJECTS RFA-TDC- -PUR/CV (Please note that individuals and for-profit organizations are not eligible to apply for Capital Project funds.) This application is funded as a fifty percent (50%) reimbursement of funds expended by any individual organization. The applicant must show that all funds (100%), excluding TDC funds, are available for the proiect at the time of application so that there is no delay in the progress of the proiect, and that TDC funding is not used as "matching" funds. The following is a list of district boundaries in which funds will be allocated: District 1: Key West - (shall encompass the City Limits of Key West) District II: Lower Keys - (city limits of Key West to West end of Seven Mile Bridge) District III: Marathon - (west end of Seven Mile Bridge to Long Key Bridge) District IV: Islamorada - (between Long Key Bridge and Mile Marker 90.939) District V: Key Largo - (from Mile Marker 90.940 to the Dade/Monroe County line and any portions of mainland Monroe County) The respective districts wish to solicit applications for consideration within the parameters for such expenditures as outlined in F.S. 125.0104 - paragraph (5) (a) 1. thru 4. - Tourist Development Tax. Requirements for submission and the selection criteria may be requested from DemandStar by Onvia at www.demandstar.com or call toll-free at 1-800-711-1712. The Request for Applications and all supporting documentation are public record and may be obtained from the Monroe County Purchasing Office, located at 1100 Simonton St., Key West, FL 33040. Technical questions should be directed, via e-mail, to the Administrative Office of the Tourist Development Council at adminasst@fla-keys.com. Any addenda to this Request for Monroe County Tourist Development Council FY 2011 Capital Project Application 1 Applications (RFA) shall be distributed to vendors on the list of DemandStar distributees for this RFA. Respondents must submit two (2) signed originals and nine (9) complete copies of the application (total=11) in a sealed envelope clearly marked on the outside, with the applicant's name and "Sealed Application for Bricks and Mortar/Capital Projects Funding" addressed to: Monroe County Purchasing Office 1100 Simonton Street, Room 1-213 Key West, FL 33040 Phone: (305) 292-4466 Fax: (305) 292-4465 All Applications must be received by the County Purchasing Office before 5:00 P.M. on Tuesday, , 2010. Any applications received after this date and time will be automatically rejected. Materials may be delivered by certified mail, return receipt requested, hand-delivered or couriered. Faxed or e-mailed applications will be automatically rejected. Applicants delivering applications by hand may request a receipt. If sent by mail or by courier, the above-mentioned envelope shall be enclosed in another envelope addressed to the entity and address stated above. Applicants should be aware that certain "express mail" services will not guarantee specific time delivery to Key West, Florida. It is the sole responsibility of each applicant to ensure their application is received in a timely fashion. Monroe County's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Monroe County Board of County Commissioners (County). All applications must remain valid for a period of ninety (90) days from the date of the deadline for submission stated above. The County will automatically reject the response of any person or affiliate who appears on the convicted vendor list prepared by the Department of Management Services, State of Florida, under Sec. 287.133(3)(d), Florida Statutes. All or portions of the documents and work papers and other forms of deliverables pursuant to this request shall be subject to reuse by the County. The County reserves the right to reject any and all applications, to waive informalities in any or all applications, to re-advertise for applications; and to separately accept or reject any item or items and to award and/or negotiate a contract in the best interest of the County. Contract(s) will be awarded to those applicants whose application(s) are/is deemed by the County, upon recommendation of the Monroe County Tourist Development Council, to be in the best interest of Monroe County. Dated at Key West this _ day of 2010. Monroe County Purchasing Department Monroe County Tourist Development Council FY 2011 Capital Project Application 2 OVERVIEW AND INSTRUCTIONS INQUIRIES AND CORRESPONDENCE All questions pertaining to this solicitation should be directed to: Maxine Pacini or Lynda Stuart at (305) 296-1552 (AdminAsst@fla-keys.com) All applications submitted in response to this solicitation should be addressed to and received no later than 5:00 p.m. (close of business day) , 2010 Purchasing Department of Monroe County 1100 Simonton Street, 1st Floor, Room 1-213 Key West, Florida 33040 Attention: CAPITAL PROJECT FUNDING APPLICATION CAPITAL PROJECT APPLICATION FUNDING PROCEDURE The Monroe County Tourist Development Council (TDC) administers the four (4) cent bed tax collected for the purpose of promoting the Florida Keys as a tourist destination. Each year, the TDC invites organizations registered to do business in Florida, to apply for funding for Bricks and Mortar/Capital Improvement projects in the Florida Keys. All applications will be reviewed by the appropriate District Advisory Committees (DAC's), who shall make recommendations on funding the project to the TDC. Upon approval of recommended funding allocation by the TDC, the administrative office will coordinate with the project coordinator to establish a contract for the project, and will present the proposed contract to the County for final approval. This application will be funded as a fifty percent (50%) reimbursement of funds expended bv any individual oraanization. The applicant must show that all funds (100%) are available for the proiect at the time of application so that there is no delav in the proaress of the proiect. and that TDC fundina is not used as "matchina" funds. APPLICANT RESPONSIBILITIES AND IMPORTANT INFORMATION TO KNOW PRIOR TO FILLING OUT THE APPLICATION . Prior to filling out application, please go to www.sunbiz.oro to ensure that your organization is registered to do business in the state of Florida. Only applicants that are duly registered will be accepted. . Applicant shall complete, copy, sign (by an authorized officer) and submit the correct number of copies of the application to the Monroe County Purchasing Department. (Please DO NOT use three (3) ring HARD binders - soft binders/spiral binding/or no binders are preferred.) . Applicant shall familiarize itself with referenced online materials noted in this application (sample agreement): http://www.monroecounty-fl.oov/paoes/MonroeCoFL TDC/index. . Cost of preparation and submission of the application is the responsibility of the applicant. . All information furnished or disclosed as part of the application process is considered public record by the laws of the State of Florida. . The applicant shall not lobby, solicit or act to influence the outcome of the competition, discussion or negotiations leading to the award of the contract. Monroe County Tourist Development Council FY 2011 Capital Project Application 3 . All attachments should be noted as such in the top right hand corner of each sheet - please do not use tab inserts. . Be advised that if your organization is awarded funding you will be required to enter into a contract which delegates you to maintain accurate and complete documentation of the project. You will be required to obtain a signed amendment to the contract before making any substantive changes to the project or you may nullify the County's obligation to pay. You will be required to comply with the following reimbursement procedures outlined in the sample agreement which can be found at http://www.monroecounty- fl.aov/paoes/MonroeCoFL TDC/index. . Any applicant who intends to utilize volunteer labor or in-kind donations of property shall provide in the application a schedule of values for each unit of in-kind services and/or goods (property). Should funding be allocated, CountylTDC reserve the right to deny the application of certain in-kind services and goods for match purposes and to negotiate a revised schedule of values for permissible items. For example, County will not accept as in-kind match the waiver of permit fees. . An applicant cannot apply only for funds to cover the cost of design plans. Design plans are an acceptable expense, however, this expense must be part of the overall project application request. . The recipient of TDC capital project funding shall designate a project manager if no licensed architect, engineer or general contractor is involved in the project. If the project is performed by County or City personnel, the project manager shall be the Engineer, Building Official or Construction Manager of that local government. . Any part of the project the applicant wishes to seek reimbursement from the County for, must NOT commence prior to the date of County approval. . Maintenance: The applicant shall be responsible for all maintenance and operational costs of the premises improved or constructed with the use of funding from the TDC/County. The applicant shall be responsible to the TDC/County for the safekeeping and proper use of the property entrusted to applicant's care, to include any and all insurance for the value of the equipment and any maintenance or service contracts relating to such equipment for its service life. Any disposal of assets procured through funding under this agreement shall comply with chapter 274, F.S. or chapter 617, F.S., dependent upon the type of entity funded under this agreement. . Permits: Applicant shall be responsible for securing all federal, state and local development approval and permits necessary to complete the project. Award of funds under this application do not indicate any development approval by the County and applicant shall be required to comply with all County concurrency requirements under land use laws of the County and State. . Taxes: The TDC/County is exempt from Federal, Excise and State of Florida Sales Tax. . Performance Guarantee: A successful applicant shall warrant, by signing this application, that applicant has the financial capability of completing the project as planned without the need to request further funding from TDC/County for same. Applicant shall warrant by signing this application and confirm in writing (in the form of bank statements; signed letter from the bank stating that funds are in the bank for the specified project; documentation provided by a financial institution of a line of credit assigned to the specific project within the application) that applicant has the funds in place at the time of the application for grant funds to be able to complete the project prior to seeking Monroe County Tourist Development Council FY 2011 Capital Project Application 4 . reimbursement of TDC funds. A governmental applicant shall provide a line item budget for the project in question, and proof that the budget has been adopted by the governing board of that entity. The applicant by signing the application certifies that: applicant, its principals, and any previously owned business is/are not and have never been in default to Monroe County under the terms of any contract. (Default means failure to fulfill contractual obligations where County had to take legal action to obtain remedy or where a bonding company had to make good for applicant.) . Construction and Other Contracts: Applicant, by signing the application, warrants that, if awarded funds for the project, all contracts, for construction or otherwise, to complete the project shall be let in compliance with all applicable laws and County purchasing policy and to comply particularly with F.S. Chapter 255, Chapter 274 and Chapter 287. Applicant further agrees to provide TDC/County and their designated representatives with: a) access to the project premises for inspection of the progress of the project; b) documentation including copies of all sub-contracts/Request For Bids verifying compliance with purchase/construction/architectural contract requirements of the County [Notice to owner, list of sub-contractors, and release of liens must be provided to County]; and c) access to all records concerning the project. These records must be retained by applicant for a minimum of four (4) years after the termination date of agreement. This requirement may be for a different time period than that required by other government agencies. All records must be kept in accordance with Generally Accepted Accounting Principles. . Termination for Default/Convenience: The TDC/County reserves the right to terminate any contract and agreement if, in its opinion, there shall be a failure at any time, to properly perform faithfully any portion of the project as funded by TDC/County according to the plan presented with the application, or as modified and accepted in writing by TDC/County. Further, TDC/County reserves the right to terminate payments under this agreement should the anticipated funding become unavailable for any reason. Should termination occur under this provision, TDC/County shall give applicant thirty (30) days notice prior to termination. . Payments: Applicant shall submit all documentation required by the County Finance Department in accordance with instructions from said department, prior to payment of any funds awarded. The TDC Application for Payment forms provided in the TDC reimbursement packaQe shall be used. Ten percent (10%) of every prooress payment shall be withheld by County until certification of completion of proiect. . Contractor and Sub-Contractor Bonding: Applicant shall require all contractors and sub-contractors to post such performance bonds as are required by such contractors/sub- contractors entering into contract with the TDC/County. . Acknowledgements: Applicant shall be required to display an appropriate public acknowledgment of the support of the Monroe County Tourist Development Council in a publicly prominent area of the project. Monroe County Tourist Development Council FY 2011 Capital Project Application 5 PERMISSIBLE USES FOR CAPITAL PROJECT FUNDS All capital projects funded by TDC shall be owned and operated by either a governmental entity or non-profit organization. Individuals and for-profit organizations are not eliaible to apply for Capital Projects funds. Tourist Development capital project funds may be used in Monroe County as follows: 1. To acquire, construct, extend, enlarge, remodel, repair, or improve one or more publicly owned and operated convention centers, sports stadiums, sports arenas, coliseums, or auditoriums within the boundaries of the taxing district in which the tax is levied. 2. To finance beach improvement, maintenance, re-nourishment, restoration, and erosion control. 3. To acquire, construct, extend, enlarge, remodel, repair, improve, or promote one or more museums, zoological parks or nature centers which are publicly owned and operated by non- profit organizations and open to the public. 4. To finance fishing piers. Monroe County Tourist Development Council FY 2011 Capital Project Application 6 APPLICATION FOR CAPITAL PROJECT FUNDING Please submit two (2) originals and nine (9) copies of the application APPLICANT ORGANIZATION: (Registered business name as it appears on www.sunbiz.oro). TYPE OF APPLICANT: D Non-Profit PROJECT TITLE: DGovernment Entity LOCATION OR ADDRESS OF PROJECT: Provide both physical (postal service) address, RE# and legal description (lot, block, subdivision) and attach map. WHICH OF THE FOLLOWING APPLIES TO YOUR PROJECT? DPublicly owned and operated DOwned and operated by a non-profit organization DPublicly owned and operated by a non-profit organization WHICH OF THE FOLLOWING BEST DESCRIBES YOUR PROJECT? DConvention Center DSports Stadium DSports Arena DColiseum DFishing Pier DAuditorium DMuseum DZoological Park DNature Center DBeach or Beach Park Facility Which of the following applies to your project? DAcquire DConstruct DRepair Dlmprove DExtend DEnlarge DRemodel If you checked the box for Beach or Beach Park Facility, which of the following applies? Dlmprovement DRe-nourishment DRestoration DErosion control If the TDC/County requires a Conservation Easement Deed or mortgage note requiring repayment of TDC monies in the event of transfer of ownership or change in use of the premises, would you be agreeable to executing same? DYes DNo Monroe County Tourist Development Council FY 2011 Capital Project Application 7 DESIGNATED PROJECT CONTACT PERSON Name & Title: Daytime Telephone/mobile no: Business Address: E-mail: Application is for % of total funds to be obtained from all sources. Has applicant received previous TDC assistance: DYes DNo If yes, please specify year, amount and nature of project. List any previous grant-in-aid assistance received by the applicant or for the property from any government agency. Indicate year of award, amount, division which awarded the grant, and a brief description of the project assisted by each. For purposes of this application no more than twenty-five (25%) percent of total project cost shall be of in-kind services and materials. TDC requires confirmation in writing that project funds are in place at the time of this application for grant funds (see Performance Guarantee on page 4). Payment is a 50% reimbursement of the total cost of each segment of the project, subject to the cap on expenditures for that segment as set forth in the agreement. Applicant must be prepared to pay the entire cost of segment in advance of seeking the 50% reimbursement. (The project may be broken down into 2 or 3 segments. When one segment is completed, reimbursement of 50% of that cost can be applied for through the TDC.) a) TDC funds Confirmed/Available requested: Hard-Dollar funds Confirmed In-kind Funds (Up to a maximum of 25% of project) Total Project Cost $ $ $ $ Monroe County Tourist Development Council FY 2011 Capital Project Application 8 b) State source of resources for the project specified in this application: (i) Hard-dollar: (ii) In-kind: Proiected in-kind services and ooods shall be allocated the followino values. subiect to neaotiation with TDC/County. List here all such anticipated values: In the space below, write a brief description of the overall project: In the space below write a list of specific items/services, and the dollar amount for each of those items/services that your requested TDC funds will be spent on. Monroe County Tourist Development Council FY 2011 Capital Project Application 9 PROJECT DESCRIPTION 1. Use: a) Original use of structure and date of construction: b) Modifications to the present date including date & description: c) Present use: d) Any other uses between original and present: e) Proposed use: f) Insert or attach photograph of existing site: Monroe County Tourist Development Council FY 2011 Capital Project Application 10 g) Historic designation: Indicate whether the property has been listed in the National Register, is located in a National Register district, is a locally designated historic landmark or is located in a locally designated historic district. If located within a historic district, provide the official name of the district. This information is available from the planning agency having jurisdiction over the property. All Capital projects funded by TDC shall be owned and operated by a governmental entity or non-profit organization. Applicant shall provide proof of property ownership or long-term lease for consideration of funding. 2. Ownership or other interest in property by applicant: a) Official records reference for ownership documentation b) If not owned by applicant, provide long-term lease of property c) If not owned by applicant, provide notarized consent letter from owner for use of property as outlined in this application 3. If proposed project calls for transfer of title of real property to County, two (2) current real estate appraisals and one (1) environmental assessment shall be provided. The TDC/County shall ascertain, prior to acceptance of any donation or prior to purchase, that the property will pose no environmental hazard, or liability for same, to County. The TDC/County must also ascertain permissible government interest in the transfer of title. Indicate any such proposed title transfers here. 4. *This paragraph applies only to an acquisition funding request, but you will still need to complete items 5 through 13, whether this is new construction or renovations, additions, or exhibits. The purchase amount shall not exceed the value of the property as determined by the average of two appraisals, or the average of the closest two appraisals if more than two are obtained. NOTE: The maximum grant amount from tourist development revenue for an acquisition project shall not exceed 50% of the purchase amount. Indicate the area of the property to be acquired in acres: In evaluating applications for acquisition funding, an important consideration is the appropriateness of the size of the site to be acquired. Determinations of the appropriateness of site size will be made on a case-by-case basis and will depend on the characteristics for which the property is considered to be significant. Sufficient property should be acquired to assure Monroe County Tourist Development Council FY 2011 Capital Project Application 11 that the historic relationship of a structure or archaeological site to its surrounding environment is preserved. However, it is important that no more property than is necessary to achieve established preservation objectives be included in the acquisition project application. As this factor is crucial to favorable consideration of your grant application and will have substantial impact on the cost of the required application documentation, we encourage prospective applicants to consult with the staff of the TDC Administrative Office prior to initiating the required documentation. 5. Protection of property: Indicate any type of state or federal protection currently afforded the property. It may be that more than one type may be applicable. Provide citations for applicable local protective ordinances. Include copies of property-specific restrictive legal instruments in an attachment. By signing and submitting this application, the proposer warrants that all restrictions are disclosed. Failure to include every restriction on the property may result in immediate termination of any agreement and demand for return of any monies paid thereunder. 6. Is the property threatened by imminent destruction, deterioration or other loss which may include demolition, vacancy, severe deterioration, loss of structural integrity, encroaching development, adverse environmental conditions, vandalism, etc.? Be specific regarding the nature of immediacy of the threat. If so, describe in detail: 7. a) Are there any building restrictions on the site? If so, describe. Attach copies of all recorded easement and restrictive covenants. By signing and submitting this application, the proposer warrants that all restrictions are disclosed. Failure to include every restriction on the property may result in immediate termination of any agreement and demand for return of any monies paid thereunder. Monroe County Tourist Development Council FY 2011 Capital Project Application 12 b) Is the proposed project compatible with the County's Concurrency Requirements under the existing and proposed Land Use Comprehensive Plan? How have you ascertained such compatibility? (Note: If your description does not provide information about existing permits and/or review by the County Planning Department, your application shall be rejected.) c) Does the site contain endangered or threatened species of flora or fauna? []Yes []No If so, describe: d) Are there facilities existing or planned to accommodate the physically disabled? DYes DNo Describe/Explain: e) Public accessibility and use: Indicate the extent to which the property is or is scheduled to be open to the public each year (hours per day, days per week and weeks per year) upon project completion. Indicate whether or not the property will be accessible to the handicapped per Chapter 553, Part V, Florida Statutes and the Americans with Disabilities Act, Public Law 1012-336. If not, provide a brief explanation. Estimate the number of persons who will use or visit the completed facility annually. For archaeological projects, if the site will not be accessible to the public, estimate the number of persons annually who will be exposed to the interpretive materials and reports resulting from the project. How was this estimate derived? Monroe County Tourist Development Council FY 2011 Capital Project Application 13 8. Describe present physical condition of site: (attach legal description per property tax records). Indicate, by checking the appropriate term, the present condition of the property. DExcellent: The property is habitable and occupied; no repairs are needed. All physical evidence indicates that the property is under continuous maintenance. Application is for expansion and enhancement. DGood: The property is habitable and occupied; only cosmetic repairs are needed (e.g., peeling paint, missing ornamental features, some deteriorated mortar, etc.) Property is maintained but in need of minor repair. DFair: The property is habitable but may be vacant. Both the structural integrity (foundation, framing, etc.) and weather tight integrity of the property (siding, walls, roofing, etc.) are in jeopardy because of prolonged neglect. DPoor: The property is uninhabitable and vacant. Major structural repairs are needed. Weather-tight integrity has been lost. The property is derelict, abandoned and not habitable without major rehabilitation work. Also, list any specific factors or problems which contribute to the present condition of the property. 9. List and describe all major work items included in the proposed project: Monroe County Tourist Development Council FY 2011 Capital Project Application 14 10. Status of Project Planning: D D D Not yet initiated Schematics complete Documents complete D D D Initiated Design development Construction documents completed 11. Name and Address of Project Consultant (architect, engineer, contractor, etc.). Enclose planning or architectural documents completed to date (1 set). 12. Has a contract for architectural services or constructional services been executed? DYes DNo If so, indicate the scope of services to be provided under this contract and whether these services were obtained through competitive negotiations, requests for applications or other process. 13. Describe the means by which the structure(s) affected by this project will be maintained subsequent to restoration/rehabilitation. Include sources and estimated amounts of funding for such maintenance. It is the County's policy not to fund operations and maintenance costs of organizations notwithstanding any tourism promotional value of a project. Monroe County Tourist Development Council FY 2011 Capital Project Application 15 PROJECT BUDGET AND TIMETABLE - ALL PROJECTS 1. Cost Estimates: List all major work items and the estimated costs of each. If the project is phased, segregate clearly those costs for the phase to be assisted by the TDC funds requested. All phases and total estimated cost of the entire project must be listed here. Total cost of phase/project for which funds are requested: a)Phase $ b)Project $ Amount of TDC funds requested: (Funds requested from TDC not to exceed 50% of the total project cost) a)Phase $ b)Project $ 1. Confirmation that signed, sealed bid process was utilized for acquiring architectural services, or that project does not require architectural services. Total confirmed In-kind funds: $ 2. Outline of expansion opportunity for acquiring further grants. Monroe County Tourist Development Council FY 2011 Capital Project Application 16 3. Tentative timetable. Indicate all major project activities and the anticipated time required to complete each stage of the project on the graph below. Project Timetable (in months) Project Activity 1 2 3 4 5 6 7 8 9 10 11 12 a). b). c). d). e). f). g). Please indicate any critical dates and explain why they are critical. 4. What is the total project cost: $ 5. Length of time for project completion (months and year(s): Monroe County Tourist Development Council FY 2011 Capital Project Application 17 PROJECT BENEFITS - ALL PROJECTS 1. Is the primary purpose of the project to promote tourism in Monroe County? 2. How will the project promote tourism in Monroe County? ADDITIONAL INFORMATION - ALL PROJECTS: 1. District in which the project is located. 2. Population of city/district where project activity will take place. 3. Federal Employer's Identification Number of applicant's organization. 4. Permitting: List all permits required to complete this project. 5. Outline of proposed program in which this project will promote tourism in Monroe County. 6. Applicant must demonstrate the ability to complete the project as proposed and to maintain and operate the project as a viable and long-term tourist attraction and is open to the public. Included in this demonstration should be a summary of the applicant's past grant experience, past two (2) year's financial statements, proposed operational budget and description of administrative resources available to applicant and committed to the project. Attach financial statements, budgetary and other documents. Monroe County Tourist Development Council FY 2011 Capital Project Application 18 NON-COLLUSION AFFIDAVIT and VERIFICATION I, , of the city of according to law on my oath, and under penalty of perjury, depose and say that: 1) I am , the applicant making the application for the project described as follows: 2) The prices in this application have been arrived at independently without collusion, consultation, communication or agreement for the purpose of restricting competition, as to any matter relating to such prices with any other applicant or with any competitor; 3) Unless otherwise required by law, the prices which have been quoted in this application have not been knowingly disclosed by the applicant and will not knowingly be disclosed by the applicant prior to application opening, directly or indirectly, to any other applicant or to any competitor; and 4) No attempt has been made or will be made by the applicant to induce any other person, partnership or corporation to submit, or not to submit, an application for the purpose of restricting competition; 5) The statements contained in this affidavit are true and correct, and made with full knowledge that Monroe County relies upon the truth of the statements contained in this affidavit in awarding contracts for said project. VERI FICA TION I HEREBY CERTIFY that I have read the forgoing application and that the facts stated herein are true and correct to the best of my knowledge and belief. President's/Mayor's Name Typed President's/Mayor's Signature Sworn to and subscribed before me this Day of r 20 personally appeared ,. and known to be the person named in and who executed the foregoing document. My commission expires: Notary Public State of Monroe County Tourist Development Council FY 2011 Capital Project Application 19 DRUG FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that: (Name of Business) 1. Publishes 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 for violations of such prohibition. 2. Informs employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Gives each employee engaged in providing the commodities or contractual services that are under application a copy of the statement specified in subsection (1). 4. In the statement specified in subsection (1), notifies the employees that, as a condition of working on the commodities or contractual services that are under application, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893 (Florida Statutes) 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. Imposes a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, or any employee who is so convicted. 6. Makes a good faith effort to continue to maintain a drug-free workplace through implementation of this section. As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. Applicant's Signature: Date: Monroe County Tourist Development Council FY 2011 Capital Project Application 20 ATTACHMENTS AND CERTIFICATIONS -ALL PROJECTS 1. The following supporting documents are attached. a) 0 (i) 0 (ii) 0 b) 0 c) 0 d) 0 Proof of ownership/consent of owner for use of property as outlined in this application: Official record reference for ownership documentation; or Consent letter from owner for use of property as outlined in this application Citations to applicable protective ordinance if applicable Copy of letter designating project supervisor Map showing location and boundaries of project area (for all types of projects involving specific site or area which cannot be identified by a street address) e) 0 Photographs of existing conditions of project site(s) or area - two sets of originals and 9 photocopies f) 0 g) 0 h) 0 i) 0 j) 0 k) 0 I) 0 Documentation of confirmed project funds Annual operating budget upon completion Plans and specifications, if completed (development projects only - one set) Criteria Fact Sheet All restrictive documents governing use of the property Non-Collusion Affidavit and Verification Form (notarized) Drug Free Workplace Form I certify that the information contained in this application is true and correct to the best of my knowledge, and that I am the duly authorized representative of the applicant. Signature: Title: Date: Monroe County Tourist Development Council FY 2011 Capital Project Application 21