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Item C18' CM ounty of onroe BOARD OF COUNTY COMMISSIONERS  Mayor Heather Carruthers, District 3 Mayor Pro Tem George Neugent, District 2 TheFloridaKeys Danny L. Kolhage, District 1 David Rice, District 4 Sylvia J. Murphy, District 5 County Commission Meeting April 20, 2016 Agenda Item Number: C.18  Agenda Item Summary #1551 BULK ITEM: DEPARTMENT: Yes Budget and Finance TIME APPROXIMATE:STAFF CONTACT: Kevin Madok 305-292-4480 N/A AGENDA ITEM WORDING: Approval to advertise a Request for Proposal for a Direct Loan Agreement in an amount not to exceed $16,300,000. ITEM BACKGROUND: Monroe County adopted a five-year capital plan as part of the budget, approved September 26, 2013. As part of the adopted capital plan, five construction projects as well as the refunding of the Infrastructure Sales Surtax Revenue Bond, Series 2003 were to be financed through the issuance of a 20 year debt obligation in the amount of $32 million. The debt issuance of 2014 included both a term loan in the amount of approximately $32 million and a two-year Line of Credit in the amount of $16 million. The original project budgets have increased and staff has now determined the line of credit should be replaced with permanent financing. The RFP will include pricing for a fixed term obligation in the amount of up to $16.3 million for a term of 10 years. PREVIOUS RELEVANT BOCC ACTION: Adoption of the Five Year Capital Plan along with the Budget on September 26, 2013. BOCC approval for Issuance of $16 million Line of Credit October 17, 2014. CONTRACT/AGREEMENT CHANGES: N/A DOCUMENTATION: RFP Loan April 2016-km FINANCIAL IMPACT: Effective Date: N/A 4EGOIX4K ' Expiration Date: N/A Total Dollar Value of Contract: Advertising $800 Total Cost to County: Advertising $800 Current Year Portion: $800 Budgeted: Yes Source of Funds: 304 Infrastructure Sales Surtax CPI: No Indirect Costs: No Estimated Ongoing Costs Not Included in above dollar amounts: None Revenue Producing: No If yes, amount: N/A Grant: No County Match : No Insurance Required: No Additional Details: 04/20/16 304-22004 · COUNTY ENGINEER CONSTR M $800.00 304 Infrastructure Sales Surtax STAFF RECOMMENDATION: Approval to advertise REVIEWED BY: Tina Boan Skipped 04/05/2016 9:23 AM Cynthia Hall Completed 04/05/2016 10:08 AM Maria Slavik Completed 04/05/2016 10:16 AM Kathy Peters Completed 04/05/2016 10:36 AM Board of County Commissioners Pending 04/20/2016 9:00 AM 4EGOIX4K 'E 13263)'3928= 6)59)78*36463437%07 *36 DIRECTLOANAGREEMENT (NBQ), SERIES 2016 (AMOUNT NOT TO EXCEED $16.3MILLION) BOARD OF COUNTY COMMISSIONERS MayorHeather Carruthers, District 3 Mayor Pro Team George Neugent, District 2 CommissionerDanny L. Kolhage, District 1 Commissioner David Rice, District 4 Commissioner Sylvia Murphy, District 5 CLERK OF THE CIRCUIT COURTSTRATEGIC PLANNING AmyL.HeavilinKevin Madok, Sr. Director %TVMP 4EGOIX4K Page | 1 'E 2SXMGISJ6IUYIWXJSV'SQTIXMXMZI7SPMGMXEXMSR 238-')-7,)6)&=+-:)2that on .YRIEX41the Monroe County Purchasing Office will receive and open sealed responses for the following: (-6)'803%2%+6))1)28 2&5 7)6-)7 %1392823883)<'))(1-00-32 Requirements for submission and the selection criteria may be requested from DemandStar by Onvia at [[[HIQERHWXEVGSQ [[2085,764,2174,821][12][,,][Arial]]OR [[[QSRVS [[586,821,800,878][12][,,][Arial]]IGSYRX] [[777,821,1003,878][12][,,][Arial]]FMHWGSQ [[1028,821,1311,878][12][,,][Arial]]or call toll [[1272,821,1322,878][12][,,][Arial]]- [[1288,821,1353,878][12][,,][Arial]]fr [[1319,821,1527,878][12][,,][Arial]]ee at 1 [[1505,821,1555,878][12][,,][Arial]]- [[1522,821,1627,878][12][,,][Arial]]800 [[1605,821,1655,878][12][,,][Arial]]- [[1622,821,1727,878][12][,,][Arial]]711 [[1705,821,1755,878][12][,,][Arial]]- [[1722,821,2210,878][12][,,][Arial]]1712. The Public Record is available at the Monroe County Purchasing Office located at The Gato Building, 1100 Simonton Street, Room 2-213, Key West, Florida. All Responses must be sealed and must be submitted to the Monroe County Purchasing Office. 4YFPMGEXMSRHEXIW 'MXM^IR1SRCCCCCCCC /I]RSXIV;IHCCCCCCCC 6ITSVXIV*VMCCCCCCCCCCC Page | 2 4EGOIX4K 'E 7)'8-3232)-27869'8-3283463437)67 3&.)'8-:)3*8,)6*4 Public Financial Management, Inc., serving in its capacity as Financial Advisor, on behalf of Monroe County, FL, is requesting interested parties to submit proposals for a direct loan to the County. The Bank (the “Bank” or “Lender”) selected will agree toa direct loan in the form of the purchase of an Infrastructure Sales Surtax Bond, to be issued by Monroe County, Florida (the “County”) in the proposed principal amount not to exceed $16,300,000 subject to the following terms and conditions set forth in the Request for Proposals (the “RFP”). The Bank agrees to be legally bound to such terms from the date of the Form of Proposal to the Closing Date of the Loan. The Loan will replace the outstanding amount of the County’s Series 2014 Line of Credit,currently in the outstanding amount of $16 million. '%0)2(%6 A tentative calendar for the review of responses is as follows: %TVMP6*4GMVGYPEXIH 1E]0EWXHE]XSMWWYIUYIWXMSRW .YRI0EWXHE]XSMWWYIEHHIRHYQMJ RIGIWWEV] .YRI6IWTSRWIWHYI .YRI'SYRX]WXEJJVIZMI[WVIWTSRWIW .YRI7IPIGXIHJMVQRSXMJMIH .YP]'SYRX]'SQQMWWMSRQIIXMRKz ETTVSZEPSJWIPIGXIHFEROMRKJMVQERH PSEREKVIIQIRXHSGYQIRXW 7ITXIQFIV###0SERGPSWMRK TVIPMQMREV]WYFNIGXXS GLERKI The County specifically reserves the right to accept or reject all proposals, to waive irregularities and informalities in any or all proposals, and to re-advertise for proposals, and to award or negotiatea contract in the best interest of the County. Proposals must remain valid until September 1, 2016, to allow time for negotiation of a contract and execution of loan documentation. 79&1-77-326)59-6)1)287 Page | 3 4EGOIX4K 'E By no later than 3:00 p.m. on .YRI,interested respondents must submit one (1) original plus one (1) copyin electronic form (disk or thumb drive) to: 1SRVSI'SYRX]&SEVHSJ'SYRX]'SQQMWWMSRIVW 3JJMGISJ(MVIGXSVSJ4YVGLEWMRK 7MQSRXSR7XVIIX 7YMXI /I];IWX*0 4LSRI   *E\   Proposals received by the Purchasing Department after the deadline will be rejected and will not be considered. Please also send a copy of your response (via email) to Monroe County’s Sr. Director of Strategic Planning Kevin Madok at Madok-kevin@monroecounty-fl.govand to the County’s Financial Advisor, Public Financial Management, Inc., addressed to Pedro Varona (varonap@pfm.com) and Sergio Masvidal (masvidals@pfm.com)byRSPEXIV XLERTQSR.YRI.  /)=8)617 (1)Term: The Loan shall have a final maturity of April 1, 2025, withthe first principal payment to be due on April 1, 2017. The average life on the transaction is approximately 6.7 years. (2)Purpose: To refinance the County’s outstanding Line of Credit. (3)Principal Payments: The principal of the Loan shall be fully amortized over the term of the loan in an amount and in the manner as set forth on the attached preliminary amortization schedule (4)Interest Rate: Interest on the Loan shall be calculated on the basis of a three hundred sixty (360) day year comprised of twelve (12) thirty (30) day months, payable semiannually on April 1 and October 1, commencing on October 1, 2016 at a rate set forth in the Form of Proposal. (5)Security: The 2016 Loan shall be secured forthwith equally and ratable by a pledge of and lien upon (i)all amounts received by the County from the Discretionary Sales Surtax Clearing Trust Fund referred to in Section 212.054(4)(B), Florida Statutes, including but not limited to, the proceeds of the one cent local government infrastructure sales surtax levied pursuant to Section 212.055(2), Florida Statutes, and the proceeds of the tax levied pursuant to Section 202.19(5), Florida Statutes (the “Infrastructure Sales Surtax Revenues”), and (ii) until applied in accordance with the provisions of the Resolution, all moneys, including investments thereof, in certain funds and accounts Page | 4 4EGOIX4K 'E established pursuant to the Resolutions (collectively, the “Pledged Funds”). The 2016 Loan will be on parity with the County’s other Infrastructure Sales Surtax Bonds. (6)Interestto be Tax-Exempt: The County will enter into such covenants as shall be necessary, in the opinion of Bond Counsel, to assure compliance by the County with the Internal Revenue Code of 1986, as amended (the "Code"), and to qualify interest on the Loan for exclusion from gross income for federal income tax purposes as set forth in the opinion of Bond Counsel hereinafter mentioned.8LI'SYRX][MPPRSXEGGITXER]SJJIV [MXLGETMXEPEHIUYEG]SVSXLIVMRXIVIWXVEXIEHNYWXQIRXPERKYEKI[MXLVIWTIGXXS GLERKIWXSXE\PE[. The only interest rate adjustment provision the County will consider is one imposed by final judgment of the IRS and due from the holder which results solely from actions or inactions of the County. (7)Documents: Documents, including the form of Bond embodying the terms hereof and of the accepted proposal, shall be prepared by Bond Counsel (Nabors Giblin & Nickerson, P.A.) for the County, who shall provide the Lender and its Counsel with drafts thereof for reviewand comment at least one week prior to closing. (8)Closing Documents: As a condition of closing the County shall deliver to the Lender the following: A. An Opinion of Bond Counsel, substantially to the effect that: 1) the County is duly authorized and empowered under the laws of Florida to issue the Loan evidencing the loan; 2) the Resolution under which the Loan is issued and secured is a valid and enforceable instrument of the County; 3) interest on the Loan is not includable in gross income for Federal income tax purposes under Section 103(a) of the Code; and 4) the Loan is a valid and binding obligation of the County and is enforceable in accordance with terms thereof; B. Such other documents, certificates and instruments as shall be required by Bond Counsel, to evidence compliance with, or to comply with, the provisions of the Code, and applicable regulations thereunder, with respect to the exclusion of interest payable on the Loan from gross income for federal income tax purposes. (9)Closing: It isanticipated that closing for the Loan shall occur on or after May 27, 2016. Closing shall occur at a time and place mutually acceptable to the County and the Lender. (10)Fees and Expenses: The County shall pay all financing related costs and shall pay for the preparation and printing of the loan documents and for the filing of any required financing statements. The County shall also pay the Lender’s Bank Counsel fees as specified on the form of proposal. Page | 5 4EGOIX4K 'E (11)Continuing Compliance: The County shall remit, when available, annual audited financial statements to the Lender, and any other information that the Lender shall reasonably request. (12)Rejection of Proposals: The County expressly reserves the right to reject any and all proposals received in connection with this request for proposals and thereafter to negotiate with any proposer or other bank. The basis for acceptance of any proposal shall be that which is in the best interest of the County as determined solely by the County. (13)Amendment: The County reserves the right to amend or modify this Request for Proposals by depositing in the United States mail or fax or email, addressed to each proposer which at the time has its name and address on file with the Financial Advisor, a copy of a written amendment or modification hereto. (14)Additional Information: The County has one additional Series of Infrastructure Sales Surtax Revenue Bonds outstanding, the Infrastructure Sales Surtax Revenue Bonds, Series 2007 (the “Series 2007 Bonds”). The Series 2007 Bonds are outstanding in the amount of $15,985,000. The County’s Infrastructure Sales Surtax Revenue Bonds currently maintain credit ratings of “A1,” “A+,” and “AA” from Moody’s, Standard & Poor’s and Fitch, respectively. Below please find pertinent links for your evaluation of the credit. x 2014 Financing Resolution, including relevant terms/covenants under which the 2016 loan will be issued. x 2013 CAFR: https://gov.propertyinfo.com/fl- monroe/other/CAFR_Report_2013.pdf x 2014 CAFR:https://gov.propertyinfo.com/fl- monroe/other/CAFR_Report_2014.pdf x 2016 Adopted Budget: http://www.monroecounty- fl.gov/ArchiveCenter/ViewFile/Item/1613 (15)Preliminary Loan Amortization Schedule* 04/01/2017100,000 04/01/2018100,000 04/01/20191,520,000 04/01/20201,570,000 04/01/20211,620,000 04/01/20221,670,000 04/01/20231,720,000 04/01/20241,765,000 04/01/20256,100,000 *Final amortization shall be set when the actual interest rate has been determined. 6)59)787*36%((-8-32%0-2*361%8-32 Page | 6 4EGOIX4K 'E Anyinquiriesor requests for clarification or additional information must be delivered in writing via e-mailto the County and the County’s financial advisor (PFM) no later than May 30, 2016 atall three of the following email addresses: Madok-Kevin@MonroeCounty-FL.Gov;masvidals@pfm.com;varonap@pfm.com. All inquiries will be answered via an addendum, uploaded to DemandStar.All addenda are a part of the contract documents and each Proposer will be bound by such addenda, whether or not received by him/her. It is the responsibility of each Proposer to verify that he/she has received all addenda issued before responses are opened. '328)283*79&1-77-32 Each proposalshallinclude the following: x Proposal Response Form (Attachment A). x Contact information:State the legal name of the financial institution or firm, the principal business address, name of the contact person, telephone and facsimile numbers, e-mail address. x Other County Forms (Attachment B): Lobbying and Conflict of Interest Ethics Clause ¾ Non-Collusion Affidavit ¾ Drug Free Workplace Form ¾ Public Entity Crime Statement ¾ Local Preference Form (if applicable) ¾ x Litigation:To comply with Section 2-347(h) of the Monroe County Code, each Proposalmust provide the following information: (1)A list of the personsor entity’s shareholders with five (5) percent or more of the stock or, if a general partnership, a list of the general partners; or, if a limited liability company, a list of its members; or, if a solely owned proprietorship, name(s) of owner(s); (2)A list of the officers and directors of the entity; (3)The number of years the person or entity has been operating and, if different, the number of years it has been providing the services, goods, or construction services called for in the bid specifications (include a list of similar projects); (4)The number of years the person or entity has operated under its present name and any prior names; (5)Answers to the following questions regarding claims and suits: a.Has the person, principals, entity, or any entity previously owned, operated or directed by any of its officers, major shareholders or Page | 7 4EGOIX4K 'E directors, ever failed to complete work or provide the goods for which it has contracted? If yes, provide details; b.Are there any judgments, claims, arbitration proceeding or suits pending or outstanding against the person, principal of the entity, or entity, or any entity previously owned, operated or directed by any of its officers, directors, or general partners? If yes, provide details; c.Has the person, principal of the entity, entity, or any entity previously owned, operated or directed by any of its officers, major shareholders or directors, within the last five (5) years, been a party to any lawsuit, arbitration, or mediation with regard to a contract for services, goods or construction services similar to those requested in the specifications with private or public entities? If yes, provide details; d.Has the person, principal of the entity, or any entity previously owned, operated or directed by any of its officers, owners, partners, major shareholders or directors, ever initiated litigation against the county or been sued by the county in connection with a contract to provide services, goods or construction services? If yes, provide details; e.Whether, within the last five (5) years, the owner, an officer, general partner, principal, controlling shareholder or major creditor of the person or entity was an officer, director, general partner, principal, controlling shareholder or major creditor of any other entity that failed to perform services or furnish goods similar to those sought in the request for competitive solicitation. ):%09%8-32'6-8)6-% Award shall be made to the responsible proposer whose proposal is determined to be the most advantageous to the County, taking intoconsideration the evaluation criteria set forth below: Overall borrowing cost50 points Compliance with other terms as stated in 30 points the RFP Ability to provide all required services10points Location of firm (local preference if 10 points applicable: up to 5 additional points) 8SXEPTSMRXWIEVRIHEVISREWGEPISJzTSMRXW !PS[IWX!LMKLIWX Page | 8 4EGOIX4K 'E %XXEGLQIRX% 463437%06)74327)*361 1SRVSI'SYRX]*PSVMHE -RJVEWXVYGXYVI7EPIW7YVXE\6IZIRYI0SER7IVMIW The Bank (the “Bank” or “Lender”) hereby agrees to the purchase of the Infrastructure Sales Surtax Revenue Bond, Series 2016 (the “Loan”), to be issued by Monroe County, Florida (the “County”) in the proposed principal amount not to exceed $16,300,000 subject to the terms and conditions set forth in the Request for Proposal dated April 7, 2016 (the “RFP”), which is attached hereto and incorporated hereby by this reference. The final aggregate principal amount and amortization of the Loan is subject to change dependent on actual interest rate. The Bank agrees to be legally bound to such terms from the date of the Form of Proposal to the Closing Date of the Loan. Interest Rate: The County shall only consider proposals which clearly express the rate of interest and/or the method of setting such rate of interest and the maximum rate of interest to be charged during the full term of the Loan. *M\IH6EXISJ-RXIVIWX A fixed rate, non-bank qualified, tax-exempt of interest for the term of the Loan equal to %____per annum. Such rate shall remain in effect through ______________, 2016. 'SWX )\TIRWIW The Bank shall request the reimbursement of its legal fees only, subject to a maximum of $__________. The Bank proposes to utilize _________________________________________ as bank counsel. 4VITE]QIRX3TXMSR Please specify prepayment terms below, and/or use additional pages as necessary: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ________________________ he Bank acknowledges that the County reserves the right to reject any and all T proposals received in connection with this request for proposals. Respectfully submitted, ______________________________________ [Name of Bank] This section to be filled-in by the County By/Date: ______________________________ ACCEPTED this ___ day of _________, 2014 Authorized Officer Monroe County, Florida ______________________________________ [typed or printed name of officer] By: ___________________________ Authorized Officer ContactInformation (Address, Tel, Email): ______________________________________ Page | 9 4EGOIX4K 'E %XXEGLQIRX&z3XLIV*SVQW The following forms must be signed and attached to each Proposal: 03&&=-2+%2('32*0-'83*-28)6)78'0%97) 7;36278%8)1)2892()636(-2%2')23 13263)'3928=*036-(% ETHICS CLAUSE “________________________________________________________________” (Company) “…warrants that he/it has not employed, retained or otherwise had act on his/her behalf any former County officer or employee inviolation of Section 2 of Ordinance No. 010- 1990 or any County officer or employee in violation of Section 3 of Ordinance No. 010- 1990. For breach or violation of this provision the County may, in its discretion, terminate this Agreement without liability and may also, in its discretion, deduct from the Agreement or purchase price, or otherwise recover, the full amount of any fee, commission, percentage, gift, or consideration paid to the former County officer or employee.” ___________________________________ (Signature) Date: ______________________________ STATE OF:______________________________ COUNTY OF:______________________________ Subscribed and sworn to (or affirmed) before me on ___________________________________ (date) by _______________________________________ (name of affiant). He/She is personally known to me or has produced __________________________________________ (type of identification) as identification. ____________________________________ NOTARY PUBLIC MyCommission Expires: ______________ Page | 10 4EGOIX4K 'E 232'30097-32%**-(%:-8 I, _______________________ of the city of _______________________ according to law on my oath, and under penalty of perjury, depose and say that 1.I am ______________________________________________ of the firm of _______________________________________________ the bidder making the Proposal for the project described in the Request for Proposals for _________________________________________ and that I executed the said proposal with full authority to do so; 2.The prices in this bid have been arrived at independently without collusion, consultation, communication or agreement for the purpose of restricting competition, as to anymatter relating to such prices with any other bidder or with any competitor; 3.Unless otherwise required by law, the prices which have been quoted in this bid have not been knowingly disclosed by the bidder and will not knowingly be disclosed by the bidder prior to bid opening, directly or indirectly, to any other bidder or to any competitor; and 4.No attempt has been made or will be made by the bidder to induce any other person, partnership or corporation to submit, or not to submit, a bid for the purpose of restricting competition; and 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. ___________________________________ (Signature) Date: ______________________________ STATE OF:______________________________ COUNTY OF:______________________________ Subscribed and sworn to (or affirmed) before me on ____________________________________ (date) by _______________________________________ (name of affiant). He/She is personally known to me or has produced __________________________________________ (type of identification) as identification. ____________________________________ NOTARY PUBLIC MyCommission Expires: ______________ Page | 11 4EGOIX4K 'E (69+*6));36/40%')*361 The undersigned vendor in accordance with Florida Statutes Section 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’ policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposedupon employees for drug abuse violations. 3.Gives each employee engaged in providing the commodities or contractual services that are under bid 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 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 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. ___________________________________ (Signature) Date: ______________________________ STATE OF:______________________________ COUNTY OF:______________________________ Subscribed and sworn to (or affirmed) before me on _______________(date) by _______________________________________ (name of affiant). He/She is personally known to me or has produced __________________________ (type of identification) as identification. ____________________________________ NOTARY PUBLIC MyCommission Expires: ______________ Page | 12 4EGOIX4K 'E 49&0-')28-8='6-1)78%8)1)28 “A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or CONTRACTOR under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, Florida Statutes, for CATEGORY TWO for a period of 36 months from the date of being placed on the convictedvendor list.” I have read the above and state that neither ______________________ (Respondent’s name) nor any Affiliate has been placed on the convicted vendor list within the last 36 months. ___________________________________ (Signature) Date: ______________________________ STATE OF:______________________________ COUNTY OF:______________________________ Subscribed and sworn to (or affirmed) before me on _________________________________ (date) by ___________________________(name of affiant). He/She is personally known to me or has produced ______________________________________________ (type of identification) as identification. ____________________________________ NOTARY PUBLIC MyCommission Expires: ______________ Page | 13 4EGOIX4K 'E 03'%046)*)6)2')*361 A. Vendors claiming a local preference according to Ordinance 023-2009 must complete this form. Name of Bidder/Responder______________________________Date:_______________ 1. Does the vendor havea valid receipt for the business tax paid to the Monroe County Tax Collector dated at least one year prior to the notice or request for bid or proposal? __________ (Please furnish copy.) 2. Does the vendor have a physical business address located within Monroe County from which the vendor operates or performs business on a day to day basis that is a substantial component of the goods or services being offered to Monroe County?_______________ List Address: ____________________________________________________________ Telephone Number:_______________________________________________________ B. Does the vendor/prime contractor intend to subcontract 50% or more of the goods, services or construction to local businesses meeting the criteria above as tolicensing and location? ____________ If yes, please provide: 1. Copy of Receipt of the business tax paid to the Monroe County Tax Collector by the subcontractor dated at least one year prior to the notice or request for bid or proposal. 2. Subcontractor Address within Monroe County from which the subcontractor operates: __________________________________________Tel. Number _____________________ _________________________________________Print Name:______________________ Signature and Title of Authorized Signatory for Bidder/Responder STATE OF:______________________________ COUNTY OF:______________________________ Subscribed and sworn to (or affirmed) before me on _________________________________ (date) by___________________________(name of affiant). He/She is personally known to me or has produced ______________________________________________ (type of identification) as identification. ____________________________________ NOTARY PUBLIC MyCommission Expires: _______________ Page | 14 4EGOIX4K