Item F4
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: JANUARY 17.2002
Division:
TDC
Bulk Item: Yes~ No
Department:
AGENDA ITEM WORDING:
Approval of an Amendment to Agreement with Prange & O'Hearn's Insights,
Inc. to extend Agreement for one (1) additional year and a monetary increase.
ITEM BACKGROUND:
Original Agreement allows for a one (1) year extension to Agreement and a
monetary increase.
TOe to approve same at their meeting of January 8, 2002.
PREVIOUS REVELANT BOCC ACTION:
soee approved original Agreement at their meeting of April 20, 2000.
soee approved FY 2002 budget at their meeting of September 19, 2001.
CONTRACT/AGREEMENT CHANGES:
Amendment for one (1) additional year and monetary increase.
STAFF RECOMMENDATIONS:
Approval
TOTAL COST: $60,037.50 per year
BUDGETED: Yes -L No
COST TO COUNTY:_$60.037.50 per vearfTOURIST PAY
REVENUE PRODUCING: Yes --X- No
AMOUNT PER MONTH_ Year _X_
APPROVED BY: County Atty ~ OMB/Purchasing ~
Risk Management X I,) ,\C. .
DIVISION DIRECTOR APPROVAL:
) .... /:;/ . ~
"///L;:':>C?L_<~~ '-'
(Lynda Stuart)
DOCUMENTATION:
Included X
To Follow_
Not Required_
DISPOSITION:
AGENDA ITEM # ~ -.r:y
Revised 2/27/01
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract with:
Prange & O'Hearn's
Insights, Inc.
Contract #
Effective Date:
Expiration Date:
6/1/02
5/31/02
Contract Purpose/Description:
Approval of an Amendment to Agreement with Prange & O'Hearn's
Insights, Inc. to extend Agreement for one (1) additional year and
monetary increase.
Contract Manager: Maxine Pacini
(Name)
3523
(Ex 1. )
TDC#3
(Department/Stop #)
for BOCC meeting on
1/17/02
Agenda Deadline: 1/2/02
CONTRACT COSTS
Total Dollar Value of Contract: $ 60,037.50
Budgeted? Yes~ No D Account Codes:
Grant: $
County Match: $
Current Year Portion: $
116-76065-530340- T26G-250X 530340
- - -
----
- - -
----
ADDITIONAL COSTS
Estimated Ongoing Costs: $_/yr For:
(Not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, etc.)
- - -
----
CONTRACT REVIEW
Changes Date Out
Date In Needed Reviewer
Division Director h9! ,:9;{.7 I YesD NcG -----/?7P1l~;~..A:.~, 7/
Risk Man~g~m;nt (21I1r\ d( YesO NoITY.c, ,l~(~\->---< ~~"
O.M.B.IPu~g 12.\nIOl YesONo[;;:Y ~ 0 p
County Attorney YesD NoD S.Hutton
Comments:
OMB Form Revised 2/27/01 Mep #2
JAN-03-02 11,46 FROM,HCTOC
10,3062980788
PAGE 1/1
ADDI!NDUU TO AGREEMENT
THIS ADDENDUM 1& emeNd InfO Chis day of T . 2002, by and between
the BOARD OF COUNTY COMMISSIONERS. Monroe County, Aorida. hereinafter referred to as 1he
COUNTY and Prange & O'Hearn's Insights. Inc. Marketing and Research Group, hereinafter refamtd
to as Firm.
WrrNESSETJ.4
WHEREAS, the parties entered Into an agreement on Aprtl 20. 2000: and
WHEReAS, the agreement "'ows for an extension for one (1) addltionel yur; and
WHEREAS, the monetary compensation needs to be revised per paragraph 10:
NOW THEREFORE, in consideration of the mutual covenants contalnecl herein, the parties
agree to hereby amend the agreernem en18red into on Aprtl 20, 2000. 8S fOllows:
1. Paragraph 1. TERM, shall be amended by adding the fOfIOwing:
This agreement is extended ror one (1) additionaJ )'Bar commencing June 1.
2002 and terminating an May 31,2003, pursuant to paragraph 10.
2. Paragraph 4. COMPENSATION. shall be amended by adding tne fOllowing:
For the period June 1,2002 tluough May 31, 2003, the FIRM's annual fee shalf'be
'56,437.50, with an additional amount of no more than $3.800 per year for approved
e1CP8neea.
3. Paragraph 5. BILLINGS, shaU be amended by adding the following;
For the period June 1,2002 through May 31,2003. the FIFW shall submit to the TOC
Adminislr'ltMt Office an initial billing for 26% ($14.109.42) of the C'4I1tract price. due
upon receipt of the project deSign document and swvey Instrument. followed by 12
equat monthly bilings of $3.527.34 for centrad selVices. ana up to $300 per monlh for
aU other appmvBd cha'1J8S IncurTed dUring the pl8VtOus month for WhiCh payment is
due from the COUN1Y as authorized under this Agreement.
4. The remaining provIiiona of the agreement dated April 20. 2000 Shall remain in 11.111
force enca 8ffect
Attest: DANNY L KOLHAGE. CJeIk Board of County Cammiaaloner.s of
Monroe County
BY:
Deputy Clerk
MayorlChairm8n
(CORPORATE SEAL)
Attest:
Prange & O'Heam's Insights, Inc. MartuJting and
Research Gmup
Witness
BY:
President
VISITOR PROFILE SURVEY AGREEMENT
THIS AGREEMENT is entered into this 2/J,t4 day of ~ ,2000, by
and between the BOARD OF COUNTY COMMISSIONERS, Mo roe County, Florida,
hereinafter referred to as the COUNTY and PRANGE & O'HEARN'S INSIGHTS, INC.
MARKETING AND RESEARCH GROUP, hereinafter referred to as FIRM;
WITNESSETH
WHEREAS, FIRM is qualified to provide services, and;
WHEREAS, the Monroe County Tourist Development Council (TDC) has recommended
this contract be entered into provide services, and;
WHEREAS, the COUNTY wishes to enter into this Agreement for services with the
FIRM,
1. TERM: The term of this Agreement is for a periOd of twenty-four (24) months
commencing June 1, 2000 and terminating May 31, 2002 subject to Section 10 herein.
2. SERVICES: In consideration of the base monthly contractual amount, the FIRM
shall provide the following services on behalf of the Florida Keys & Key West:
A. Survey Design -- Develop survey instrument, restricting the number of
questions so that the interview can be completed in a 3-5 minute time frame. Pretest
questionnaire to ensure validity of response and timing requirements.
B. Field Set-Up -- Identify key locations for interview sites. Develop a rotation plan
for the locations selected, to provide alternates to unproductive sites as well as to
broaden the reach of the field interviewing crew. Recruit interviewers from local labor
pool from various locations in the Keys. Instruct interviewers in respondent selection
techniques to be used, qualification criteria, and survey instrument administration.
Supervise interviewers in the field.
C. Datq Collection -- Develop project schedule to provide a guide for interview
completion. Conduct intercept interviews with visitors at selected locations throughout
the five regions of Monroe County (Key Largo, ISlamorada, Marathon, Lower Keys, and
Key West). Achieve a quota of 250 completed interviews (approXimately 50 per month)
in each region during each season, for a total interview base of 3,000 per year. Rotate
schedule so that days of the week are covered and a variety of visitors are interviewed.
1
o. Data Cleaning and Input -- Review each questionnaire for completeness and
legibility. Input survey responses and deliver to ToC monthly survey data on diskette,
in a format compatible with ToC's computer software.
3. REPORTS: The FIRM shall provide to ToC Administrative Office (1201 White
Street, Suite 102, Key West, FL 33040) reports and documentation of results of services.
- -- -- -- u -- -RepQrts-shall--shGw, -at-a-minimbJm:--- - - -- - - __ __ __ _ __ __ __ __ _ ___ _____ HU_ _ __h __ _m__ __ __ _
Monthly survey data on diskette, in a format compatible with ToC's computer software.
All completed questionnaires and other hard copy from field work.
4. COMPENSATION: The FIRM's annual fee shall be $53,750, with an additional
amount of no more than $3,600 per year for approved expenses. Miscellaneous expenses
may include travel, lodging, printing, mailing, couriers, postage, respondent incentives (if
required), etc. Miscellaneous expenses must be approved in advance and billed separately.
Monroe County's performance and obligation to pay under this contract is contingent upon an
annual appropriation by the BOCC.
5. BILLINGS: The FIRM shall submit to the TOC Administrative Office an initial
billing for 25% ($13,437.50) each contract year, due upon receipt of the project design
document and survey instrument, followed by 12 equal monthly billings of $3,359.37 for
contract services, and up to $300 per month for all other approved charges incurred during the
previous month for which payment is due from the COUNTY as authorized under this
Agreement. The COUNTY shall be responsible for payment of all authorized fees and costs
due the FIRM while this Agreement is in force which fees and costs are described and limited
in paragraph 4. Said payments shall be sent by mail by COUNTY directly to Prange &
O'Hearn's Insights, Inc., 43 East Ocean Boulevard, Stuart, FL 34994.
6. LICENSES AND QUALIFICATION: The FIRM warrants that it is qualified to
perform the services under this agreement and holds any licenses necessary for same.
2
7. INDEMNIFICA TION AND HOLD HARMLESS: The Contractor Covenants and
agrees to indemnify and hold harmless Monroe County Board of County Commissioners from
any and all claims for bodily injury (including death), personal injury, and property damage
(including property owned by Monroe County) and any other losses, damages, and expenses
(including attorney's fees) which arise out of, in connection with, or by reason of services
provided by the Contractor or any of its Subcontractor(s) in any tier, occasioned by the
negligence, errors, or other wrongful act or omission of the Contractor or its Subcontractors in
any tier, their employees, or agents.
In the event the completion of the project (to include the work of others) is delayed or
suspended as a result of the Contractor's failure to purchase or maintain the required
insurance, the Contractor shall indemnify the County from any and all increased expenses
resulting from such delay.
The first ten dollars ($10.00) of remuneration paid to the Contractor is for the
indemnification provided for above.
The extent of liability is in no way limited to, reduced, or lessened by the insurance
requirements contained elsewhere within this agreement.
8. INSURANCE: Insurance requirements are in Exhibit A, attached hereto
and incorporated herein by reference.
9. APPROVALS AND CHANGES OF SPECIFICATIONS OF SERVICES: The
TOC shall have the sole and exclusive right to approve, modify, reject, or cancel any and all
plans, proposals, submissions and other work in process, in which event the TOC's directions
shall be immediately implemented. However, nothing in this Agreement shall be construed as
requiring the FIRM to violate any contractual commitments to vendors contracted on TOC's
behalf. All contractual commitments to contracted vendors require the TOG's prior written
approval. The COUNTY shall only be liable for charges approved in writing prior to the FIRM's
entering into such contractual commitment. If any modifications to the specifications become
substantial, the FIRM may elect to re-negotiate the cost of deliverables under the revised
specifications.
The performance of all services between FIRM as described and otherwise provided
under this Agreement will be in full cooperation with and under the direct supervision of the
TOC. Whenever approval is required from the TOG, said approval shall be in writing from the
TOC Administrative Director or a designee, according to TOG policy.
3
10. TERMINATION; RENEWAL: Either party shall have the right to cancel this
Agreement at its sole discretion upon sixty (60) days written notice to the other party. FIRM
shall deliver to TDC and COUNTY all papers and other materials related to the work
performed under this Agreement upon termination thereof. County shall pay FIRM only for
such reimbursable expenses authorized prior to termination. If, for any reason, funds are not
appropriated in any fiscal year, FIRM will be given fifteen (15) days notice of termination, and
FIRM will not be required to continue services or produce deliverables after the termination
date.
The COUNTY shall have the option of renewing this agreement for an additional one
(1) year under the same terms and conditions subject to negotiation of monetary terms and
provided the COUNTY provides FIRM prior written notice of its election of this option no later
than thirty days before this agreement expires.
11. DISCLOSURE OF FINANCIAL INTERESTS: The FIRM agrees to disclose any
existing financial interest in its business by its suppliers or providers utilized in fulfillment of this
Agreement and shall disclose said interests as they may arise from time to time.
12. APPLICABLE LAW; VENUE: This Agreement shall be governed by and
construed according to the laws of the State of Florida and all actions brought under or
pursuant to this Agreement shall be brought in a court of competent jurisdiction in Monroe
County, Florida.
13. ENTIRE AGREEMENT AMENDMENT: This writing embodies the entire
Agreement and understanding between the parties hereto, and there are no other agreements
or understandings, oral or written, with reference to the subject matter hereof that are not
merged herein and superseded hereby. Any amendment to this Agreement shall be in writing
and signed by both the COUNTY and FIRM.
14. LAWS AND REGULATIONS: It shall be understood and agreed that any and all
services, materials and equipment shall comply fully with all Local, State and Federal laws and
regulations.
15. TAXES: The Board of County Commissioners and TOG are exempt from
Federal Excise and State of Florida Sales Tax. State Sales Tax and Use Tax Certificate
Number is 03000210354.
4
16. FINANCE CHARGES: The COUNTY and TOC, shall not be responsible for any
finance charges.
17. ASSIGNMENT: The FIRM shall not assign, transfer, convey, sublet or otherwise
dispose of this Agreement, or of any or all of its right, title or interest therein, of his or its power
to execute such contract to any person, company or corporation without prior consent of the
COUNTY.
18. OWNERSHIP: All work performed under the Agreement shall be the property of
the TOC and COUNTY, for whatever use arid/or disposition the TOC and COUNTY may deem
appropriate. Such property shall include: a) all plans, documents and recommendations; b) All
manuscripts, copy, graphics, and videotapes. The TOC and COUNTY shall have the full right
to reproduce and/or use any products derived from the contractor's work under the Agreement
without payment of any royalties, or fees. No reproduction of said property shall be made by
FIRM or any other entity for purposes of resale.
19. COMPLIANCE WITH LAWS - NONDISCRIMINATION: The firm shall comply
with all federal, state and local laws and ordinances applicable to the work or payment for
work thereof, and shall not discriminate on the grounds or race, color, religion, sex, age, or
national origin in the performance of work under this Agreement. This Agreement shall be
subject to all federal, state, and local laws and ordinances.
20 NOTICE: Whenever notice is required by this Agreement to be give to either
party, said notice shall be delivered to:
For County: Ms. Lynda Stuart
Monroe County TOC
1201 White Street, Suite 102
Key West, FL 33040
For FIRM: Jack O'Hearn, President
Prange & O'Hearn's Insights, Inc.
43 East Ocean Boulevard
Stuart, FL 34994
21. SEVERABILITY: If any provision of this Agreement shall be held by a Court of
competent jurisdiction to be invalid or unenforceable, the remainder of this Agreement, or the
application of such provision other than those as to which it is invalid or unenforceable, shall
not be affected thereby; and each provision of this Agreement shall be valid and enforceable
to the fullest extent permitted by law.
22. The FIRM agrees to furnish the TOC with copies of bids of subcontractors.
5
23. ETHICS CLAUSE: The FIRM warrants that no person has been employed or
retained to solicit or secure this contract upon an Agreement or understanding for a
commission, percentage, brokerage, or contingent fee and that no member of the Monroe
County government or the TOC has any interest, financially or otherwise, in the FIRM or its
subcontractors.
IN WITNESS WHEREOF, the parties hereto have caused this instrument to be
executed in their names, and seals impressed hereon, by their proper officials, all as of the
daY"c1fi'(j'-Ye:ar,tirst above written.
<....,'\;.;:::>.;':~...:~"i' ;~':~\
kSEAL)' .'.,,,.... ,,'
'~ri~~~:l~
(~L~puty Clerk
Board of County Commissioners
of Monroe County
~~+-~
(CORPORATE SEAL)
Attest:
Prange & O'Hearn's Insights, Inc. Marketing and
esearch Group
By
Secretary
By
OR
Witness
6
EXHIBIT , A
RISK MANAGEMENT
POLICY AND PROCEDURES
CONTRACT ADMINISTRA nON
MANUAL
1996 Edition
General Insurance Requirements
for
Other Contractors and Subcontractors
As a pre-requisite of the work gov~med, or the goods supplied under this contract (including the
pre-staging of personnel and matenal), the Contractor shall obtain., at hislher own expense~
insurance as specified in any attached schedules, which are made part of this contract. The
Contractor will ensure that the insurance obtained will extend protection to all Subcontractors
engaged by the Contractor. As an alternative, the Contractor may require all Subcontractors to
obtain insurance consistent with the attached schedules.
The Contractor will not be permitted to commence work governed by this contract (including
pre-staging of personnel and material) until satisfactory evidence of the required insurance has
been furnished to. the County as specified below. Delays in the commencement of work,
resulting from the failure of the Contractor to provide satisfactory evidence of the required
insurance~ shall not extend deadlines specified in this contract and any penalties and failure to
perform assessments shall be imposed as if the work commenced on the specified. date and time,
except for the Contractor's failure to provide satisfactory evidence. .
The Contractor shall maintain the required insurance throughout the entire term of this contract
and any extensions specified in the attached schedules. Failure to comply v.ith this pro\oisian
may result in the immediate suspension of all work until the required insurance has been
reinstated or replaced.. Delays in the completion of work resulting from the failure of the
Contractor to maintain the required insurance shall not extend deadlines specified in this contract
and any penalties and failure to perform assessments shall be imposed as if the work had not
been suspended, except for the Contractor's failure to maintain the required insurance.
The Contractor shall proyide, to the County, as satisfactory evidence of me required insurance,
ei ther.
. Certificate of Insurance
or-
. A Certified copy of the actual insurance policy.
The County, at its sole option. has the right to request a certified copy of any or all insurance
policies required by this contract.
All insurance policies must specify that they are not subject to cancellation, non-renewal,
material change, or reduction in coverage unless a minimum oftbirty (30) days prior notification
is given to the County by the insurer.
The acceptance and/or approval of the Contractor's insurance shall not be constrUed as relieving
the Contractor from any liability or obligation assumed under this contract or imposed by law.
Adminimtion Instruction
#4709.1
14
The Monroe County Board of County Commissioners, its empk _ _es and officials will be
included as "Additional Insured" on all policies, except for Workers' Compensation.
Any deviations from these General Insurance Requirements must be requested in writing on the
County prepared fonn entitled "Request for Waiver of Insurance Requirements" and
approved by Monroe County Risk Management.
Administr.Uion InStruction
#4709.2
"
15
1996 cdlLJon
GENERAL LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY~ FLORIDA
AND
Prior to the commencement of work governed by this contra~ the Contractor shall obtain
General Liability Insurance. Coverage shall be maintained throughout the life of the contract and
include, as a minimum: ..
. Premises Operations
. ProductS and Completed Operations
. Blanket Contractual Liabilitv
. Personal Injury Liability .
. Expanded Definition of Property Damage
The minimum limits acceptable shall be:
$300,000 Combined Single Limit (CSL)
If split limits are pro'l,ided, the minimum limits acceptable shall be:
$100,000 per Person
$300,000 per Occurrence
$ 50,000 Property D<m1age
.An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its
provisions should include coverage for claims filed on or after the effective date ofmis contract.
In addition, the period for which claims may be reported should extend for a minimum of twelve
(12) months folIo\..ing the acceptance of work by the County.
The Monroe County Board of County Commissioners shall be named as Additional Insured on
all policies issued to satisfy the above requirements.
GLl
Administration Instruction
#4709.2
53
1 TTO c..uIUV'.
VEIDCLE LIABILITY
INSURANCE REQUIREMENTS
FOR
-- -
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Recognizing that the work governed by this contract requires the use ofyehicles, the Contractor,
prior to the commencement of work, shall obtain Vehicle Liability Insurance. Coverage shall be
maintained throughout the life of the contract and include, as a minimum, liability coverage for:
. Ov,l1e~ Non-O\\'11ed, and Hired Vehicles
The minimum limits acceptable shall be:
5100,000 Combined Single Limit (CSL)
If split limits are pro\ided, the minimum limits acceptable shall be:
5 50,000 per Person
5100,000 per Occurrence
5 25,000 Property Damage
The MonrOe County Bciard ofCountv Commissioners shall be named as Additional Insured on
all policies issued to satisfy die above requirements.
VLl
Administration Instruction
#4709.2
80
19% Edjuon
WORKERS' COMPENSATnJN
INSURANCE REQUlREl\1ENTS
FOR
CO NTRACT
BETWEEN
MONROE COUNlY, FLORIDA
AND
Prior to the commencement of work governed by this contract, the Contractor shall obtain
Workers' Compensation Insurance with liniits sufficient to respond to Florida Statute 440.
In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not less
than:
S100,OOO Bodily Injury by Accident
S500,OOO Bodily Injury by Diseasey policy limits
S100,000 Bodily Injury by Disease, each employee
Coverage shall be maintained throughout the entire term of the contract.
Coverage shall be provided by a company or companies authorized to transact business in the
state of Florida.
If the Contractor has been approved by the Florida's Department of Labor, as an authorized self-
insurer, the County shall recognize and honor the Contractor's status. The Contractor may be
required to submit a Letter of Authorization issued by the Departtnent of Labor and a Certificate
of Insurance, providing details on the Contractor's Excess Insurance Program.
lfthe Contractor participates in a self-insurance fund, a Certificate of Insurance will be required.
In additio~ the Contractor may be required to submit updated financial Statements from the fund
upon request from the County.
..,".:'
WCl
Administration Instruction
#4709.2
87
SWORN STATEMENT PURSUANT TO SEcnON Z87.1JJ(J) (a),
FLORIDA SfATUTFS1 ON PUBUC ENInY CRIMEs
THIS FO&."{ MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBUC OR OTHER
OFFICIAL AUTHORIZED TO ADMINISrER. OATHS. .
1. T'hi3 sworn statement i3 submitted to
by
[print name 0{ the pubUc entityj
for
[print Indlvtdll8h name and title]
[print name o( entity snbmitting SWorn statement]
w.hose bustIess address is
and (if applicable) its Federal Employer Identification Number (FEIN) i3
(If the entity has no FEIN, indtIde the-Social Sectuity Number o( the individual signing this
sworn statement:
.)
2. I understand that a .public entity crime. as defined in Paragraph 287.133(1)(g), Florida Statutes. means a
violation of any state or fcder.tI law by a person with respect to and directly related. to the transaction of
business with any public entity or with an agency or political subdivision of any other state or of the United.
States, including, but not limited to, any bid or contract for goods or seivices to be provided to any public
entiey or an agency or political subdivision of any other state or of the United States and involving antitrust,
fraud, theft, bn'bery, collDsion. racketeering. conspiracy, or material misrepresentation.
0"
3. I understand that .coIIViaed. or .conviction" as defined. in ParagIAlph Z87.133(1)(b), Florida Stntutes. means
a finding of guilt or a conviction of a public entity crime. with or without an adjudication at guilt, in any
federal or state trial coun ot record relating. to charges brought by indictment or information after July 1,
1989, as a result of a jury verdict, nonjury trial, or entry of a plea of guilty or nolo contendere.
4. I understand that an "affiliate" as defined in Paragraph 287.133(1)(a), Fronda Statutes, means:
.. ......
1. A predecessor or sua:essor of a person convicted of a public entity crime; or
2. An entity under the control of any natural person who is ac:tiYe in the management of the entity and
who has been convicted. of a public entity crime. The _term "atliIi.ate" includes those officers, directors,
.executives, panners, shareholdeI3, employees, members, and agents who are active in the .management of_
an affiliate. -~The_ ownership by on~.person of shares constituting a controlling interest in another person,
or-a-pOOIing of equipment or income among persons when not for fair market value under an arm's length
agreement, sh311 be a prima f1cie case that one person controls another person. A person wno knowingly
enters into a jomt venture with a person who has been convicted of a public entity crime in Florida during
the preceding 36 months shan be considered. an affiliate.
S. r understand that a .pez:son" as defined. in Paragraph 281.133(1)(e), IIonda Statutes. means any. natural
person or entity organized under the laws of any state or of the United. States with the legal power to enter
into a binding contract and wbich bids or applies to bid on cont:r.lct3 for the 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, direccor3, executives, partnc:r:s, 3hareholders, employees, members, and
agents who are active in management of an entity.
.-
6. B","" on info =a tio n anct beliet; the '''Hemeo t whie" [ have mar""" '-'ow is true in relation to '" e eell ~
submitting tbis.c- -m, Dent. [lndlalt.e wWeb !itJ:1tc:ment 'Ies
- Neither the eotity ,ubmitting this >wom ""tement, oor any of ita office",. directo",. a=oriv",.
pOmIe",. 'boreholde",. employ=. membe",. or agen~ who"", >ctive in the =gement of the eoticl. oar
any affili"te of the enticf has been cl1arged with and convicted of a public entity ctime ,ub,,,!uent to July
1, 1989.
Tne entirf ,ubmitting this swom ''''tement, or one or mtm: of its office",. directo",. ac<:uriv",.
panne",. 'lureholde",. employee.. membe",. or agen~ who are >ctive in the =gemenr of the entity. Or
an afllliHe of the entity has been cl1arged with and COnvicted of a publie entity crime ,ub''''luent to July
1, 1989.
- rne entity ,ubmitting this swom ''''tement, or one or mo~ of ita officer.;. directo",. aecuriv",.
parme",. 'barebolde",. employ=, membe",. or agents who are =Mo In the manngement of the entity. or
an afIllit,e of the entity has been c11arged with and convicted 0{ . P'Jblic entity crime ,ub,,,!uent to July
I. 1989. However. there has been a Subsequent Proceeding before a Heuring Officer of the Stare of Florida,
Divisioo of Administrntive Heuring> and the 0=1 Order entem1 by the Heuring Officer deternrined that
it was oot In the public interest to pmce the entity ,ubmitting this SWOm 'tatement on the convicted vendor
list. [attach a copy or the fInal order} _
I UNDERSTAND THAT TIlE SUBMIssroN OF THIS FOIll>tC TO THE CONTIlACI'ING OFFICER. FOR TIlE
PUllUC ENTITY !DEN tillED IN PARAGRAPH 1 (ONE) ABOVE IS 70R THAT PUllUC ENTITY ONLy AND,
THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED.
I ALSO UNDERstAND THAT I M>'1 REQIlIREIJ TO INFOR..\f TIlE PU!lUC ENTITY PRIOR TO ENTERJNG
INTO A CONTIlAcr IN EXCESs OF TIlE THREsHOLD AMOUNT PROVIDED IN SEcrrON 287.011, FLORm>!.
STA TTll:F.~ FOR CATEGORY TWO OF "'-'<Y CHANGE IN TIlE INFOR..'<AnON CONTAlNEIJ IN THIS FOR..\<L
(signature1
Sworn co and subscnoed before me this
day of
.19_.
Pe~onaIly known
OR Produced id.:ntificatiOil
NotaIy Public - Scate of
(!)'pc of identification)
My COmmission expires
(printed typed or stamped
co~oned name of notaIy public)
Form PUR 7068 (Rev. 06/11/92)