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2007-087 Lakeside Park Shelter Contract• RESOLUTION 2007-87 A RESOLUTION OF THE VILLAGE COUNCIL OF THE VILLAGE OF NORTH PALM BEACH, FLORIDA ACCEPTING THE BID SUBMITTED BY JAW CONSTRUCTION INC. FOR THE CONSTRUCTION OF THE LAKESIDE PARK SHELTER AND AUTHORIZING THE MAYOR AND VILLAGE CLERK TO EXECUTE AN AGREEMENT RELATING TO SUCH SERVICES; AND PROVIDING FOR AN EFFECTIVE DATE. WHEREAS, the Village issued an Invitation for Sealed Bids for the Lakeside Park Shelter; and WHEREAS, upon opening and reviewing the bid received, Village Administration recommended accepting the bid submitted by JAW Construction Inc. at a total cost not to exceed $28,000.00; and WHEREAS, the Village Council determines that the acceptance of the bid recommended by Village Administration is in the best interests of the Village. NOW, THEREFORE, BE IT RESOLVED BY THE VILLAGE COUNCIL OF THE VILLAGE OF NORTH PALM BEACH, FLORIDA as follows: Section 1. The foregoing recitals are ratified as true and incorporated herein. Section 2. The Village Council hereby accepts the bid submitted by JAW Construction Inc. for the Lakeside Park Shelter at a total cost of $28,000, with funds to be expended from V illage Account Numbers U8023-49006 and A5540-49952. Section 3. The Village Council authorizes the Mayor and Village Clerk to execute an agreement with JAW Construction, lnc. for the construction of the Lakeside Park Shelter, a copy of which is attached hereto and incorporated herein by reference. Section 4. This resolution shall take effect immediately upon adoption. PASSED AND ADOPTED THIS 13th DAY OF SEPTEMBER, 2007. (V illage Seal ATTEST: VILLAGE CLERK CONTRACT FOR LAKESIDE PARK SHELTER PROJECT This Contract is made as of the ~3 day of E Jlp , 2007, by and between the VILLAGE OF NORTH PALM BEACH, a municipal corporation organized and existing under the laws of the State of Florida, hereinafter referred to as VILLAGE, and JAW Construction Inc. a Florida corporation authorized to do business in the State of Florida, hereinafter referred to as the CONTRACTOR, whose Federal LD. is 90-0131514. In consideration of the promises and mutual covenants herein contained, it is hereby agreed that the CONTRACTOR shall provide to the VILLAGE all goods and services requested under Request for Proposals for Lakeside Park Shelter Project ("RFP" hereafter) and as further stated in CONTRACTOR'S responsive proposal to the RFP and pursuant to [he terms and conditions of this Contract. SECTION 1-SERVICES OF THE CONTRACTOR A. The CONTRACTOR shall provide all goods and services as stated in RFP and CONTRACTOR'S proposal (hereinafter referred to as "Work"), which are both incorporated herein by reference, to that degree of care and skill ordinarily exercised, under similar circumstances, by reputable members of its profession practicing in the same or similar locality at the time the Work is provided. B. The Work provided by the CONTRACTOR shall be commenced subsequent to the execution and approval of this Contract and upon written notice from the VILLAGE to proceed. SECTION 2 -PERIOD OF SERVICE. A. This Contract and the provision of all Work hereunder shall be completed by the CONTRACTOR within thirty (301 days of a notice to proceed or for such other period of time agreed to in writing by the parties in accordance with the terms and conditions of this Contract from the date of a Notice to Proceed from the VILLAGE. B. The CONTRACTOR shall not be considered in default by reason of any failure in performance of the Work if such failure arises out of causes reasonably beyond the control of the CONTRACTOR or its subcontractors and without their fault or negligence. Such causes include, but are not limited to: acts of God; natural or pubhc health emergencies; labor disputes; freight embargoes; unreasonable utility provider delays, unreasonable permitting delays and abnormally severe and unusual weather conditions. C. Upon the CONTRACTOR'S request, the VILLAGE shall consider the facts and extent of any failure to perform the Work and, if the CONTRACTOR'S failure to perform was without it or its subcontractor's fault or negligence, the Contract schedule and/or any other affected provision of this Contract shall be revised accordingly; subject to the VII,LAGE's rights to change, terminate, or stop any or all of the work at any time. D. Notwithstanding the foregoing, the CONTRACTOR shall not be entitled to an increase in the agreed to compensation in this Contract or payment or compensation of any kind from the VILLAGE for duet[, indirect, consequential, impact or other costs, expenses or damages, including but not limited to costs of acceleration or inefficiency, arising because of delay, disruption, interference or hindrance from any cause whatsoever. Provided, however, that this provision shall not preclude recovery or damages by the CONTRACTOR for hindrances or delays due solely to fraud, bad faith or active interference on the part of the VILLAGE or its agents. Otherwise, the CONTRACTOR shall be entitled only to extensions of the schedule in this Contract as the sole an exclusive remedy for such resulting delay, in accordance with and to the extent specifically provided above. SECTION 3: VILLAGE'S REPRESENTATIVE. Unless otherwise specified by the VILLAGE, the VILLAGE'S representative shall be Robert Phoenix, Deputy Building Official. SECTION 4: COMPENSATION AND METHOD OF PAYMENT. A. The VILLAGE agees to compensate the CONTRACTOR in accordance with CONTRACTOR'S proposal to the RFP. The total and cumulative amount of this Contract shall not exceed Twenty-eight thousand dollars and no cents ($28,000.00). B. CONTRACTOR shall invoices the VILLAGE on the form provided as Exhibit "A" and include such information as requested in Exhibit "A". Invoices received from the CONTRACTOR pursuant to this Contract will be reviewed and approved by the VILLAGE'S representative, indicating that the Work has been provided and rendered in conformity with the Contract and then will be sent to the Finance Department for payment. CONTRACTOR will invoice the VILLAGE in advance for each payment period. Invoices will normally be paid within thirty (30) days following the VILLAGE representative's approval. C. Work undertaken or expenses incurred that exceeds an amount set forth in this Contract without prior written authorization from the VILLAGE shall be the liability of the CONTRACTOR. D. CONTRACTOR waives consequential or incidental damages for claims, disputes or other matters in question arising out of or relating to this Contract. E. In order for both parties herein to close their books and records, CONTRACTOR will clearly state "final invoice" on the CONTRACTOR'S finaUlast billing to the VILLAGE. This certifies that all Work has been properly performed and all charges have been invoiced to the VILLAGE. Since this account will thereupon be closed, any and other further charges if not properly included in this final invoice are waived by the CONTRACTOR. The VILLAGE will not be liable for any invoice from the CONTRACTOR submitted thirty (30) days after the provision of the Work. F. The VILLAGE shall retain five percent (5 %) of the invoices received from CONTRACTOR for the provision of the Work under this Contract. Said retainage will be released by the VILLAGE upon final completion and inspection of the CONTRACTOR'S work. G. If the VILLAGE fails to make any payment due the CONTRACTOR for the Work under this Contract within forty-five (45) days after the CONTRACTOR's transmittal of its invoice to the VILLAGE, the CONTRACTOR may, after giving notice to the VILLAGE, suspend the Work under this Contract until it has been paid in full all amounts due. H. If the VILLAGE disputes any invoice or part of an invoice, VILLAGE shall notify CONTRACTOR of such dispute within fifteen (15) days of receipt of the invoice. VILLAGE reserves the right to off-set, reduce or withhold any payment to CONTRACTOR in accordance with the terms and conditions of this Contract. SECTION 5. USE OF DOCUMENTS. A. All documents, including but not limited to drawings, specifications, plans, reports, other items and data or programs stored electronically (collectively referred to as "Documents" hereafter), prepared by the CONTRACTOR and CONTRACTOR'S sub-contractors under this Contract shall be considered a "Work for Hire" and the exclusive property of the VILLAGE. To the extent such Documents may not be deemed a "Work for Hire" under applicable law, CONTRACTOR and CONTRACTOR'S sub-contractors will assign to VILLAGE all right, title and interest in and to CONTRACTOR's and/or CONTRACTOR'S sub-contractors' copyright(s) for such Documents. CONTRACTOR shall execute and deliver to VILLAGE such instruments of transfer and take such other action that VILLAGE may reasonable request, including, without limitation, executing and filing, at VILLAGE'S expense, copyright applications, assignments and other documents required for the protection of VILLAGE'S right to such Documents. The CONTRACTOR shall retain copies of the Documents for a period of three (3) years from the date of completion of the Project. The VILLAGE grants to the CONTRACTOR and CONTRACTOR'S sub-contractors the right and/or limited license to use a portion of the Documents prepared by the CONTRACTOR or the CONTRACTOR'S sub-contractors in future projects of the CONTRACTOR or the CONTRACTOR'S sub-contractors with said right and/or limited license to use a portion at CONTRACTOR'S or CONTRACTOR'S sub-contractor's own risk and without any liability to VILLAGE. B. Any modifications made by the VILLAGE to any of the CONTRACTOR'S Documents, or any use, partial use or reuse of the Documents without written authorization or adaptation by the CONTRACTOR will be at the VILLAGE'S sole risk and without liability to the CONTRACTOR. Any electronic files not containing an electronic seal are provided only for the convenience of the VILLAGE, and use of them is at the VILLAGE'S sole risk. SECTION 6: INDEMNIFICATION A. The CONTRACTOR shall indemnify and hold harmless the VILLAGE, and its officers and employees, from liabilities, damages, losses, and costs, including but not limited to, reasonable attorney's fees (at the trial and appellate levels), to the extent caused by the negligence, recklessness, or intentionally wrongful conduct of the CONTRACTOR and other persons employed or utilized by the CONTRACTOR in the performance of the Work. B. Nothing contained in this Contract shall create a contractual relationship with or a cause of action in favor of a third party against either the VILLAGE or CONTRACTOR, nor shall this Contract be construed a waiver of sovereign immunity beyond the waiver provided in § 768.28, Florida Statutes. SECTION 7: PERSONNEL. A. The CONTRACTOR represents that it has, or will secure at its own expense, all necessary personnel required to perform the Work under this Contract. Such personnel shall not be employees of or have any contractual relationship with the VILLAGE. B. All of the Work required hereunder shall be performed by the CONTRACTOR or under its supervision, and all personnel engaged in performing the Work shall be fully qualified and, if required, authorized or permitted under state and local law to perform such Work. C. All of the CONTRACTOR'S personnel (and all sub-contractors) while on VILLAGE premises, will comply with all VILLAGE requirements governing conduct, safety, and security. SECTION 8: TERMINATION. A. This Contract may be cancelled by the CONTRACTOR upon ten (10) days prior written notice to the VILLAGE's representative in [he event of substantial failure by the VILLAGE to perform in accordance with the terms of this Contract through no fault of the CONTRACTOR. It may also be terminated, in whole or in part, by the VILLAGE, with or without cause, upon ten (10) days written notice to the CONTRACTOR Unless the CONTRACTOR is in breach of this Contract, the CONTRACTOR shall be paid for Work rendered to the VILLAGE'S satisfaction through the date of termination. After receipt of a Termination Notice and except as otherwise directed by the VILLAGE, the CONTRACTOR shall: 1. Stop work on the date and to the extent specified. 2. Temunate and settle all orders and subcontracts relating to the performance of the terminated work. 3. Transfer all work in progress, completed work, and other materials related to the terminated work to the VILLAGE. 4. Continue and complete all parts of the work that have not been terminated. SECTION 9: FEDERAL AND STATE TAX. The VILLAGE is exempt from payment of Florida State Sales and Use Tax. The CONTRACTOR shall not be exempted from paying sales tax to its suppliers for materials used to fill contractual obligations with the VILLAGE, nor is the CONTRACTOR authorized to use [he VILLAGE'S Tax Exemption Number in securing such materials. SECTION 10: INSURANCE. Prior to commencing any Work, the CONTRACTOR shall provide certificates evidencing insurance coverage as required in the RFP. All insurance, other than Worker's Compensation, to be maintained by the CONTRACTOR shall specifically include the VILLAGE as an Additional Insured. SECTION 11: SUCCESSORS AND ASSIGNS. The VILLAGE and the CONTRACTOR each binds itself and its partners, successors, executors, administrators, and assigns to the other party of this Contract and to the partners, successors, executors, administrators and assigns of such other party, in respect to all covenants of this Contract. Except as above, neither the VILLAGE nor the CONTRACTOR shall assign, sublet, convey or transfer its interest in this Contract without the written consent of the other. Nothing herein shall be construed as creating any personal liability on the part of any officer or agent of the VILLAGE which may be a party hereto, nor shall it be construed as giving any rights or benefits hereunder to anyone other than the VILLAGE and the CONTRACTOR. SECTION 12: GOVERNING LAW. VENUE AND REMEDIES. A. This Contract shall be governed by the laws of the State of Florida. Any and all legal action necessary to enforce the Contract will be held in Palm Beach County. 4 B. No remedy herein conferred upon any party is intended to be exclusive of any other remedy, and each and every such remedy shall be cumulative and shall be in addition to every other remedy given hereunder or now or hereafter existing at law or in equity or by statute or otherwise. No single or partial exercise by any party of any right, power, or remedy hereunder shall preclude any other or further exercise thereof. SECTION 13: INDEPENDENT CONTRACTOR RELATIONSHIP. The CONTRACTOR is, and shall be, in the performance of all Work under this Contract, an Independent CONTRACTOR, and not an employee, agent, or servant of the VII,LAGE. All persons engaged in any of the Work performed pursuant to this Contract shall at all times, and in all places, be subject to the CONTRACTOR'S sole direction, supervision, and control. The CONTRACTOR shall exercise control over the means and manner in which it and its employees perform the Work. SECTION 14: ACCESS AND AUDITS. The CONTRACTOR shall maintain adequate records to justify all charges, expenses, and costs incurred in estimating and perfomvng the Work for at least three (3) years after completion of this Contract. The VILLAGE shall have access to such books, records, and documents as required in this section for the purpose of inspection or audit during normal business hours, at the CONTRACTOR'S place of business. In no circumstances will CONTRACTOR be required to disclose any confidential or proprietary information regarding its products and service costs. SECTION 15: NONDISCRIMINATION. The CONTRACTOR warrants and represents that all of its employees are treated equally during employment without regard to race, color, religion, disability, sex, age, national origin, ancestry, marital status, or sexual orientation. SECTION 16: ENFORCEMENT COSTS. If any legal action or other proceeding is brought for the enforcement of this Contract, or because of an alleged dispute, breach, default or misrepresentation in connection with any provisions of this Contract, the successful or prevailing party or parties shall be entitled to recover reasonable attorney's fees, court costs and all expenses (including taxes) even if not taxable as court awarded costs (including, without limitation, all such fees, costs and expenses incident to appeals), incurred in that action or proceeding, in addition to any other relief to which such party or parties may be entitled. SECTION 17: AUTHORITY TO PRACTICE. The CONTRACTOR hereby represents and warrants that it has and will continue to maintain all licenses and approvals required to conduct its business and provide the Work under this Contract, and that it will at all times conduct its business and provide the Work under this Contract in a reputable manner. Proof of such licenses and approvals shall be submitted [o the VILLAGE'S representative upon request. SECTION 1S: SEVERABILITY. If any term or provision of this Contract, or the application thereof to any person or circumstances shall, to any extent, be held invalid or unenforceable, to remainder of this Contract, or the application of such terms or provision, to persons or circumstances other than those as to which it is held invalid or unenforceable, shall not be affected, and every other term and provision of this Contract shall be deemed valid and enforceable to the extent pemutted by law. SECTION 19: MODIFICATIONS OF WORK. 5 A. The VILLAGE reserves the right to make changes in the Work, including alterations, reductions therein or additions thereto. Upon receipt by the CONTRACTOR of the VILLAGE'S notification of a contemplated change, the CONTRACTOR shall, in writing: (1) provide a detailed estimate for the increase or decrease in cost due to the contemplated change, (2) notify the VILLAGE of any estimated change in the completion date, and (3) advise the VILLAGE if the contemplated change shall effect the CONTRACTOR'S ability to meet the completion dates or schedules of this Contract. B. If the VILLAGE so instructs in writing, the CONTRACTOR shall suspend work on that portion of the work affected by the contemplated change, pending the VILLAGE'S decision to proceed with the change. C. If the VILLAGE elects to make the change, the VILLAGE shall initiate a Contract Amendment and the CONTRACTOR shall not commence work on any such change until such written amendment is signed by the CONTRACTOR and approved and executed by the Village of North Palm Beach. SECTION 20: PUBLIC ENTITY CRIMES. CONTRACTOR acknowledges and agrees that a person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, sub-contractor, 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 Statues, for CATEGORY TWO for a period of 36 months following the date of being placed on the convicted vendor list. The CONTRACTOR will advise the VILLAGE immediately if it becomes aware of any violation of this statute. SECTION 21: PROTECTION OF WORK AND PROPERTY. A. The CONTRACTOR shall continuously maintain adequate protection of all Work from damage, and shall protect the VILLAGE's property from injury or loss arising in connection with the Contract. Except for any such damage, injury, or loss, except that which may be directly due to errors caused by the VILLAGE or employees of the VILLAGE, the CONTRACTOR shall provide any necessary materials to maintain such protection. B. Until acceptance of the Work by the VILLAGE, the VILLAGE'S property shall be under the charge and care of the CONTRACTOR and the CONTRACTOR shall take every necessary precaution against injury or damage to the work by the action of elements or from any other cause whatsoever, and the CONTRACTOR shall repair, restore and make good, without additional Work occasioned by any of the above causes before its completion and acceptance. C. The CONTRACTOR will also take every necessary precaution to ensure the safety of the VILLAGE, public and other guests and invitees thereof at or near the areas where work is being accomplished during and throughout the completion of all work. SECTION 22: NOTICE. All notices required in this Contract shall be sent by certified mail, return receipt requested, and if sent to the VILLAGE shall be mailed to: Village of North Palm Beach 6 Attn: Robert Phoenix Village Hall 501 US Highway One North Palm Beach, FL 33408 and if sent to the CONTRACTOR shall be mailed to: JAW Construction Inc. Attn: Joel Wieder. President 1000 Stinson Way #205 West Palm Beach, FL 33411 The foregoing names and addresses may be changed if such change is provided in writing to the other party. SECTION 23: ENTIRETY OF CONTRACTUAL AGREEMENT. The VILLAGE and the CONTRACTOR agree that this Contract sets forth the entire agreement between the parties, and that there are no promises or understandings other than those stated herein. None of the provisions, terms and conditions contained in this Contract may be added to, modified, superseded or otherwise altered, except by written instrument executed by the parties hereto. SECTION 24: TERMINOLOGY AND CAPTIONS. All pronouns, singular, plural, masculine, feminine or neuter, shall mean and include the person, entity, firm or corporation to which they relate as the context may require. Wherever the context may require, the singular shall mean and include the plural and the plural shall mean and include the singular. The term "Contract" as used herein, as well as the terms "herein", "hereof', "hereunder", "hereinafter" and the like mean this Contract in its entirety and all exhibits, amendments and addenda attached hereto and made a part hereof. The captions and paragraph headings are for reference and convenience only and do not enter into or become a part of the context of this Contract, nor shall such headings affect the meaning or interpretation of this Contract. SECTION 25: WAIVER. Failure of a party to enforce or exercise any of its right(s) under this Contract shall not be deemed a waiver of that parties' right to enforce or exercise said right(s) at any time thereafter. SECTION 26: PREPARATION. This Contract shall not be construed more strongly against either party regardless of who was more responsible for its preparation. SECTION 27: MATERIALITY. All provisions of the Contract shall be deemed material. In the event CONTRACTOR fails to comply with any of the provisions contained in this Contract or exhibits, amendments and addenda attached hereto, said failure shall be deemed a material breach of this Contract and VILLAGE may at its option and without notice terminate this Contract. SECTION 28: EXHIBITS AND CONTRACT DOCUMENTS. Each exhibit and other contract documents referred to in this Contract forms an essential part of this Contract. The exhibits and other contract documents, if not physically attached, should be treated as part of this Contract and are incorporated herein by reference. SECTION 29: CONTRACT DOCUMENTS AND CONTROLLING PROVISIONS. This Contract consists of the RFP, the CONTRACTOR'S proposal to the RFP, this Contract and any and all exhibits thereto. The CONTRACTOR agrees to be bound by all the terms and conditions set forth in the aforementioned documents. To the extent that there exists a conflict between this Contract and the remaining contract documents, the terms, conditions, covenants, and/or provisions of this Contract shall prevail with the RFP taking precedence over CONTRACTOR'S proposal. Wherever possible, the provisions of such documents shall be construed in such a manner as to avoid conflicts between provisions of the various documents. SECTION 30: LEGAL EFFECT. This Contract shall not become binding and effective until approved by the Village Council of the Village of North Palm Beach. SECTION 31: SURVNABILITY. Any provision of this Contract which is of a continuing nature or imposes an obligation which extends beyond the term of this Contract shall survive its expiration or earlier termination. SECTION 32: DEFAULT. A. Notwithstanding anything contained in this Contract to the contrary, the parties agree that the occurrence of any of the following shall be deemed a material event of default and shall be grounds for [emanation: The Filing of a lien by any sub-CONTRACTOR, sub-contractor or third tier sub- contractor including, but not limited to materialmen, suppliers, or laborers, upon any property, right of way, easement or other interest in land or right to use within the territorial boundaries of the VILLAGE which lien is not satisfied, discharged or contested in a court of law within thirty (30) days from the date of notice to the CONTRACTOR; 2. The Filing of any judgment lien against the assets of CONTRACTOR related to the performance of this Contract which is not satisfied, discharged or contested in a court of law within thirty (30) days from the date of notice to the CONTRACTOR; or The filing of a petition by or against CONTRACTOR for relief under the Bankruptcy Code, or for its reorganization or for the appointment of a receiver or trustee of CONTRACTOR or CONTRACTOR'S property; or an assignment by CONTRACTOR for the benefit of creditors; or the taking possession of the property of CONTRACTOR by any goverrunental officer or agency pursuant to statutory authority for the dissolution or liquidation of CONTRACTOR; or if a temporary or permanent receiver or trustee shall be appointed for CONTRACTOR or for CONTRACTOR's property and such temporary or permanent receiver or Trustee shall not be discharged within thirty (30) days from the date of appointment. 4. Due to circumstances within the control of the CONTRACTOR, CONTRACTOR fails to provide the Work under this Contract on schedule as agreed to by CONTRACTOR in this Contract. 8 B. CONTRACTOR shall provide written notice to the VILLAGE of the occurrence of any event of default within five (5) days of CONTRACTOR'S receipt of notice or knowledge of any such default. SECTION 33: WARRANTY. CONTRACTOR warrants that all Work, including goods and services, provided under this Contract will be free of defects in material and workmanship for a period of one (1) year following completion of the Work and successful final inspection. Should any Work fail to comply with this warranty during the warranty period of one (1) year, upon written notification from the VILLAGE, CONTRACTOR shall immediately repair or replace said defective materials and/or workmanship at CONTRACTOR'S sole expense. SECTION 34: WAIVER OF SUBROGATION. CONTRACTOR hereby waives any and all rights to Subrogation against the VILLAGE, its officers, employees and agents for each required policy. When required by the insurer, or should a policy condition not permit an insured to enter into apre- loss agreement to waive subrogation without an endorsement, then CONTRACTOR shall agree to notify the insurer and request the policy be endorsed with a Waiver of Transfer of Rights of Recovery Against Others, or its equivalent. This Waiver of Subrogation requirement shall not apply to any policy, which a condition to the policy specifically prohibits such an endorsement, or voids coverage should CONTRACTOR enter into such an agreement on a pre-loss basis. SECTION 35: REPRESENTATIONSBINDING AUTHORITY. Each party represents that the person executing this Contract has full power, authority and legal right to execute and deliver this document and perform all its obligations under this Contract. fTHE REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANKI IN WITNESS WHEREOF, the VILLAGE and CONTRACTOR hereto have made and executed this Contract for Lakeside Park Shelter Project as of the day and year first above written. /~ JAW BY: Position: /lam P~.'o~"~ VILLAGE OF NORTH PALM BEACH BY: ~. ';$D, ,BARD M. -14tAYbR ATTEST: A MELISSA TEAL, VILLAGE CLERK APPROVED AS TO FORM AND LEGAL SUFFICIENCY BY~~ s, VILLAGE ATTORNEY 10 EXHIBIT °°A" INVOICE FORM AND REQUIREMENTS (FORM ATTACHED) 11 APPLICATION FOR PAYMENT NO. To: VILLAGE OF NORTH PALM BEACH (OWNER) From: Contract: Lakeside Pazk Shelter Project OWNER's RFP for Lakeside Pazk Shelter Project For Work accomplished through the date of , 2007. 1. Original Contract Price: 2. Net change by Change Orders and Written Amendments (+ or 3. Current Contract Price (1 plus 2): 4. Total completed and stored to date: 5. Retainage (per Agreement): Five percent (5%) of completed Work, material and equipment purchased: 6. Total completed and stored to date less retainage (4 minus 5): 7. Less previous Application for Payments: 8. DUE THIS APPLICATION (6 MINUS 7): $ Accompanying Documentation: CONTRACTOR'S Certification: The undersigned CONTRACTOR certifies that (1) all previous progress payments received from OWNER on account of Work done and goods purchased under the Contract referred to above have been applied on account to discharge CONTRACTOR'S legitimate obligations incurred in connection with Work, materials and equipment covered by prior Applications for Payment numbered 1 through inclusive; (2) title of all Work, materials and equipment incorporated in said Work or otherwise listed in ar covered by this Application for Payment will pass to OWNER at time of payment free and clear of all Liens, security interests and encumbrances, and (3) all Work, materials and equipment covered by this Application for Payment aze in accordance with the Contract Documents and not defective. Dated Contractor State of County of Subscribed and sworn to before me this day of , 2007 Notary Public My Commission expires: Payment of the above AMOUNT DUE THIS APPLICATION is recommended. Dated By. Owner -Village of North Palm Beach 12 7/ 8/31/2007 11:40 LION INSURANCE COMPANY LYONS INSURANCE COMPANY-JAW Construction, Inc- 1/1 ~v~ ,M CERTIFICATE OF LIABIL ITY INSUR °a`e Plroduoer: Lidn Insurance Camparry ANCE 6/31/07 This Lereflcale Is issued as a matter of In(o tl 2738 U.S. Highvray 1 B N. nna on only and confers no nghb upon the CerBflcaee Folder. Thls Certlflraee d Holiday, FL 34891 oes not amend, extend or al6er the wverege afforded by the policies below Phone: 727-838.5662 Fax: 727-937-2138 . Insurers Affording Coverage Insured: South Eest Personnel Leasing, Inc. Insurer A: Lion insurance Company NAIL Y x1075 2739 U.S. Highway 19 N. Insurer B: Holiday, FL 34691 Insurer C: Phone :(727)938-5562 Insurer D: rasped[ w xnich His careficete may be issued or may pertain, He insurance affbrde0 py He shomr may nave boon reduced by peitl claims. INSR ADDL LTR wsRD Type of Insurence Policy Number descnbad Herein is sud;ect to Date eM conddom of such policies. Aggregate limih Limits nmerciel General Liability Claims Made ~ Occur aggregate limit applies per: ~ ^ Project ^ LOC OBILE LUIBILITY Anv Arno All pwiled AiIIOs Schetluled AIR05 Hired ANOs NorvO,med ANO6 GARAGE LIABILRY Anv who Each Occurrence Damage N rented premses (EA occurrence) Med Exp Personal Adv Injury General Aggregate Products - Domp/pp Agg Combinetl Sing!a Limll (EA PCdideM) Bodiy lnpry (Par Person) Dolly Injury (Per ACCitlenll Property Damage (Per ACratlent) ~~ ANO Only - Ea Accident Offer Than FA PCC. Pltos Onry: AGG. EXCESS/UPoIBRELW LWBILITY Eecn occurrence Occur ^ Claims Made Dedactiele AgTegme Retention A Workers Compensation antl WC 71949 O1Po12007 01/012008 WO Ste- OTH- Employers' Llablliry X Cory Limbs ER Arty proprietorlparHer/executive of6cerhnember E.l. Each Accident St000000 exNUded7 If Ves, descdbe under special provisions below. E.L. Disease-Ea Employee $1000000 E.L. Disease- Paliq Limbs $1000000 other 0809006 JAW Construction, Inc. COVERAGE APPLIES ONLY TO THOSE EMPLOYEES LEASED, NOT TO SUBCONTRACTORS. Oesoipdons of ODerafions/LocationsNeniges/EOVluslons atldetl by Entlorsementry-pegal hovislons: COVERAGE APPLIES ONIV IN THE STATE OF FLORIDA TO THOSE EMPLOYEES LEASED TO BUT NOT SUBCONTRACTORS OF JAW Construc8on, Ina.' FAX; 661- 3336674 & 681-6266689 / ISSUE OB-31-07 (JOY) Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 LERi1FICAiE HOLDER VILLAGE OF NORTH PALM BEACH Should any of Ina above eescnbetl po!mies be cence!led before Ha efPVadon dale Hereof, the isswng insurer rtill endeamr to mai130 tlaye nnten nobw to He certificate ho'der named [o He left, but failure to Do so she!I impose no obAgaticn or Oedility of any kn0 upon He insurer, its agents or represarbatiws. 601 U6 HIGHWAY ONE NORTH PALM BEACH FL 33a0B /~~t // Anne M. Gannon, Tax Collector P.O. Box 3353 West Palm Beach, FL 33402-3353 www.pbcgov.comltax Tel:(561) 355-2272 JAW CONSTRUCTION INC WIEDER JOEL 1000 STINSON WAY #105 License Number: 2007-00294 WEST PALM BEACH FL 33411-3733 Dear Business Owner This is your new occupational license. Please keep the upper portion for your records and detach the bottom of this form. Verify the information and display it conspicuously at your place of business, open to the view of the public. This license is in addition to and not in lieu of any other license required by law or municipal -ordinance and is subjecf to regulations of zoning, health, and any other lawful au~tfiority (County Ordinance Number 72-7). Licenses may be transferred to a new owner when evidence of a sale is provided; the original license is surrendered and a transfer fee is paid. Licenses may be transferred to a new location when proof of zoning approval is provided; the original license is surrendered and a transfer fee is paid. Business name changes require a new license. This license expires on September 30, 2008. Renewal notices are mailed at the end of June. If you do not receive the notice by the end of July, please let us know. I hope you have a successful year. Tax Collector """" DETACH AND DISPLAY BOTTOM PORTION, AND KEEP UPPER PORTION FOR YOUR RECORDS """" 2007-00294 STATE OF FLORIDA OC-032 PALM BEACH COUNTY CLASSIFICATION OCCUPATIONAL LICENSE EXPIRES: SEPTEMBER - 30 - 2008 JAW CONSTRUCTION INC ** LOCATED AT CNTY 527.50 WIEDER JOEL 1000 STINSON WAY #105 WEST PALM BEACH FL 33411 TOTAL 527.50 Is hereby licensed at above address for the period beginning on the f THIS IS NOT ABILL - DO NOT PAY _~ first day of October and ending on the thirtieth day of September to ----- -' engage in the business, profession or occupation oF: GENERAL CONTRACTOR PAID. PBC TAX COLLECTOR 527.50 OCC 049 1469924 07-24-2007 CGC1507094 Anne M. Gannon THIS LICENSE VALID ONLY WHEN RECEIPTED BY rev rntlFCTnR.PALM BEACH COUNTY TAX COLLECTOR ~K~ STATE OF FLORIDA - DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 ~`°°~'°''~' TALLAHASSEEMONROE STRELT32399-0783 WIEDER, JOEL ALAN JAW CONSTRUCTION INC 1000 STINSON WAY IINIT 105 WEST PALM BEACB J SFAIE OK KLARIDA -~, A'(,~~IaQB~~f ~:~i DEPARTMENT OF BIISIN8S3 AND '--~PROFESSIONALREGULATION CGC1507094 ,..._:0'6/07/06 050805629 ~~CERTIFIED GBNERAL.CONTRACTOR "`WSBDER, JOEL''.ALAN -.. `:JAW CONSTRUCTION'INC." ~'SS'CHRTIFIHD under theHrwisione of Ch. 4,89 8S .' IDQiracton aace: AUG31; 2008 ~ nososo7o1is2~ FL 33411 DETACH HERE 2 6 O S 4~ 6 ?? `, ,STATE":OF, FLORIDi~"' DEPARTMENT OF BUSINES3:AND PROFESSIONAL REGULATION C.pNSTRUCTiON INl,7ITSTRY;,7,ICENS,'ING:80ARD SEQ#Ltr60607p1152,' 7/ 1/17/2007 16:27 LION INSURANCE COMPANY Lton Insurance coRyJany+ut7uyyu7 ,y, Dee ACORD re CERTIFICATE OF LIABILITY INSURANCE in7aoo7 Producer: Lien Insurance Cemparry This Certificate is issued as a matter of information only and confers no rights 19 N h ' 9 U S Hi upon the CertiRcate Holder. This Certificate does notamend, extend or alder . way 273 . . g e afforded by the policies below. the ra Holiday, FL 34691 cove g Phon¢: 727-93&5562 Fax: 727-937-2138 Insurers Affording Coverage NAIL # Inc l L i t P Insurer A: Lion Insurence Company 11075 . ersonne eas ng, Insured: South Eas 19 N Hi h Insurer B: way . g 2739 US. FL 34691 Insurer C: Holiday, 562 Insurer D: Phone : (727)9365 Insurer E: Coverages Tde pouees of inwrence lined below he+e been lssuedm He msuree named edove fpr He pol,ry pantie mmcated NonrHStennng eM re9mremem, tens or conemon ofeM Cmo-ect ar opnr documen[MH respect ttl which Aggregels Ilmits shown ma) hoe been reduced try and condidoRS pt such polices l n d 91 H t i HIS celeficate ma) be issued or may Oertein, Ne insurance atlorded byHe pd . ro e erms, exc us o s. ines descnbed herein Is sublo pad dalms_ Policy Effective Policy EXpirabon Dare Llrrllt5 INSR ADDL Type of Insurance Policy Number Date LTR wsRD (MMIDD/YY) (MM/DDNY) ENERAL LIABILITY Each occurrence 5 Commercial General Liability Damage to rented aemises cEA CI91ms Made ~ Occur occurrence) g Metl Exp $ Personal Adv Injury r eneral aggregate limit applies per: l A S Genera ggregate Polity ^ ProJatt ^ LOC P C /6 A 9 Omp p qq roducts- UTOMOBILE LIABILITY Combmetl Single Limit (EA Attidenr) S Arty AUro Badiy lrgvry All O.mad Aidos (Per Person) S Scheduled fwtas Bodiy Injury Hired AUtos $ meO gNOs N D (Per ACddenq orv + PropeM Damage (Per ACCidenr) $ GARAGE LIABILITY ANO Ony-Ea ACCidenr 8 Arty AU[o Offer Than EA ACC. T Autos OMy qGG. S EXCESS/UMBRELLA. LWBILITY Eecn Oauirence Occur ^Cleims Made Aggr¢gele Deduceeie Re[enlion X we sme. o7FF A Workers Compensation and ' WC 71949 01/012007 01/012008 tory Limits ER Llabllity Employers f b H E.L. Each Accident 81000000 cer nrem er Arty prpprietor/parfier/atracutive a exeluded7 E.L. Disease- Ea Employee 8160oga0 If Yes, describe under special provisions below. E.L. Disease-Policy Limits 51000000 OMe 0809004 COVERAGE APPLIES ONLY TO THOSE EMPLOYEES LEASED, NOT TO SUBCONTRACTORS. JAW Construction, Inc. pezcdptionz ar OpemtlonsrLOCetlonsNehide¢IExduslons atltletl by EnmrzementlSpedal Provisions: ADD ON Dglli: 1/9/2607 Y IN THE STATE OF FLORIDA TO THOSE EMPLOYEES LEASED TO BUT NOT SUBCONTRACTORS OF JAW Construction, Inc. • FAX 561-80& N L COVERAGE APPLIES O 8676! ISSUE 2-28-06 (PA) REISSUE 3606 (SFp I REISSUE 032406 (TD) I REISSUE 01-17-07 (NM) Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 CERTIFICgTE HOLDER CANCELLATION Should emyWtl~e abe.e descnoed polices be canc¢Iletl before Na PJOi20on date Hereof, Nelssmng insurarvnll _ _ _ endeo+orto mai130 dayswntten noucero He ceNM1Cale holtlernemed to Heleh,bN leilure fo do sosha!limpose no ' serlfa0ws. orrep re ob;igefion or liability of cry kntl upon He insurer, its egerrts -._..__ _ 1 '-- / / / K ../~I~^ ACORD CORPORAPON 1988 ACORD Zb 11061108) ACORD°, CERTIFICATE OF LIABILI TY INSI~~-`~~E DATE PRODUCER SAlpgp7 INSURANCE 95 3/16/2007 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 5 GRAND AvE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CARL$BAD, CA 92008 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 888 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ( )267-1127 INSURERS AFFORDING COVERAGE INSURED JAW CONSTRUCTION, ZNC 3COTTSDALE INSURANCE C~ANY INSURER A: JOEL WIEDER INSURER B: 1000 STINSON WAY DNIT 105 It1SURER C' WEST PALM BEACA, FL 33411 INSURER D: COVERAGES USURER E: THE POLICIFR nF IMtl TRANCE I ieren oo n..., ~.,,~ ...~...., ANY REQUIREMENT, TERM OR CONDITION~OF ANY CONTRACT OR OTHER DOC E T T I D T I UMENT WITH RESPEC O WHICH TH S CERT IFICA TE MAY BE ISSUED MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN OR POLICIES. AGGREGATE LIMITS SHOWN MAV HAVE BEEN REDUCED BY PAID IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH INSR CLAIMS. R TYPEOFINSURANCE POIICYNUMBER DRVE PD LTCYM P L EY PIpRON GENERAL LIABILRY M O D M LIM BS j~ COMMERCIAL GENERAL L CLS1371510 EACH OCCURRENCE g1, 000, 000 IABILITY 3/15/2007 3/15/2008 100 0 CLAIMS MODE ®OC FIFE DAMAGE (Any one tire) , 00 $ CUR MED EXP (Any one permn) g 5 , 000 PERSONALBADV IWURY gl, GOO, 000 C~NL AGGREGATE UM T ' GENERAL AGGREGATE E1, 000, 000 I APPLIES PER: POLICY ~ PRODUCTS-CQ.1P/OP AGG $1,000,000 LOC E AU TOMOBILE LU1BIlRY qNy AUTO COMBINED SINGLE LIMIT (Ee attiEelry E ALL OWNED AUTOS ' BCHEDUIED AULC6 BODILY INJURY (Per person) E HIRED AUr05 NONOWNED AULCG BODILY I W UM E (Per ecciEerrt) PROPERLY DAMAGE (Per ecciEem) E GAR AGE LIABRITY ANV AlJrO Al7TO0NLY-EA ACCIDEM E OTHER TITAN EA ACC $ AUfOONLY: AGG $ E%CESS LUU3IDTY OCCUR CLAIMS MADE EACHOCCURRENCE E AGGREGATE g DEDUCTIBLE E RETENTION E E WORKERS COMPENSATION AND S EMPLOYERS' LUIBILLTY WC BTATLL OT1t E. L. EACH ACCIDENT $ E.L. DISEASE-EA EMPLOYEE S OTHER E.L. DISEAEE-POLICY LIMIT E DESCRIPTION OF OPERATgNS/LOCATIONSNEHICLES~EXCLUSION$ ADDED BY ENDORSEMENT/SPECIAL pROV1510NS CERTIFICATE HOLDER ADOLIIONAL INSURED; INSURER LETTER: CANCELLATION VILLAGE OF NORTB PALM BEACB 501 U$ H SHOULD ANY OF THE ABOVE DESCRIBED PO B6 NCELlEO BEFORE THE E%PIRAAON IGHWAY ONE DATE THEREOF,"THE ISSUING IN R WILL ENDEAV 30 OR T MA DAYS WRRTEN NORTH PALM BEACH, FL 33408 NOTICE TO THE CERIIFK:AT OLDER NAMED TO THE L , BUT F URE TO DO 50 SHALL 561 626 5869 IMPOSE NO OBLIGATON A UPON T NSURER, ITS AGENTS OR REPRESENTATNES. AUTNORD:EO REPRESENTATIVE Arnon ~e c nrnr. __ V V ., T ~~/ ©ACORD CORPORATION 7988 JAW CONSTRUCTION, INC. General Contractor CGC #1507094 1000 Stinson Way Unit #105, West Palm Beach, Florida 33411 Phone: (561) 333-6738, Fax: (561) 333-6674 Joel Wieder -President Email: joel@jawconstructioninc.com Website: www.jawconstructioninc.com • JAW CONSTRUCTION, INC. is a General Contractor that is Licensed and Insured • Over 25 years Hands-On Commercial and Residential Experience • Committed to Quality, Schedules and Professionalism with Extensive Construction Knowledge • Able to run complete Build Out Projects • We are qualified to provide all goods and services requested in this RFP and will comply with all rule and regulations of the Village, Palm Beach County, State of Florida and the United states if selected. PROFESSIONAL WORK EXPERIENCE INCLUDES: DEMOLITION ROUGH AND FINISH CARPENTRY FRAMING AND DRYWALL FLOORING ALL FINISHES CONCRETE SHELL WORK SHINGLE ROOFING HURRICANE PROTECTION (Accordion Shutters, Generators, Impact Windows and Doors) REFERENCES Florida Community Health Centers, Inc. -Complete Remodel of Pahokee Facility $50,000 Mike O'Mara-4450 S. Tiffany Drive, West Palm Beach, FL 33407 561-844-9443 School District of Palm Beach County -Clinic Renovation at Logger's Run Middle School $130,000 Butch Gifford - 3300 Summit Blvd. West Palm Beach, FL 33406 561-687-7019 Macy's -Interior Remodeling of various stores $3,000 - $13,000 Ron Rodriguez - 22 E Flagler Drive, Miami, FL 33131 305-577-2093 Lake Clarke Shores -Police Department temporary office trailer $5,500 Barbados Road, West Palm Beach, FL 33406 Lt. Shaw 561-964-0685 Tiki Huts -Built for non government customers CERTIFICATIONS General Contractor, Building Trades Association, Better Business Bureau, National Hurricane Protection Association, Guardian Generator Dealer, OSHA - 4 Hour, OSHA -Course #510 ~~ D PROPOSAL FOR THE SHELTER JAW Construction, Inc. proposes to build an open sided wooden 25' x 30' "Chickee Style" shelter. Pressure treated marine quality pilings will be used for uprights Upper structure will be northern yellow pine, and Roof to be made of green cabbage palms Class B Fire retardant will be applied 30-35 days after completion JAW Construction, Inc. will sub-contract with Tiki Huts from Miami Florida. They were founded in 2000 and have grown to be a leader in the creation of tropical themed environments. JAW Construction, Inc. will provide all supervision, permitting and quality control from start to finish. 2-3 days will be necessary to complete the project once approved by the Village. COSTS: Pressure treated wood and thatching $24,500 Class B Fire Retardant $3,500 Total Proposal $28,000.00 ADVERTISEMENT Sealed proposals will be received by the Village of North Palm Beach, Florida, at the Village Manager's office, Village Hall, North Palm Beach, Florida, until: 3:00 P.M. Aueust 29, 2007 Time Date at which time they will be opened and read in public in the Village Manager's office. Such proposals to provide for the famishing o£ Lakeside Park Shelter Project (Chickee-Style Hut) The resulting contract shall be awazded to the responsible proposer that best meets the needs of the Village, taking into consideration, among other things, the financial responsibility of the proposer, proven skill and experience, abilities to timely perform the contract, previous satisfactory performance and such other abilities of the proposer that the Village, in its sole discretion, determines will enable them to perform effectively and efficiently the contract being proposed upon. The envelope containing the proposal shall be mazked as follows: SEALED PROPOSAL Lakeside Park Shelter Project PROPOSER'S NAME ~)/~'lli ([>/~ STY<'UC~ ~ /J / A% C . TO BE OPENED 3:00 P.M. Aueust 29, 2007 Time Date No proposer may withdraw his or her proposal for a period of sixty (60) days after submission by the date set for the opening thereof. 1'he Village reserves the right to reject any or all proposals, in whole or in part, and/or make awards either as individual items or as a total combined proposal, whichever it considers in the best interest of the Village, and to waive any informality in any proposal. The complete Request for Proposals including specifications and proposal forms may be obtained by bona fide proposers upon application at the office of the Village Pazks & Recreation Director, 501 U_S. Highway 1, North Palm Beach, FL 33408-4906 or from the Village website at: www_villaee-nnb.org. PUBLISH: PALM BEACH POSTDATE: ALM BEACH J' y fight, Village M er ASAP Page: 2 RFP EXHIBIT "B" PUBLIC ENTITY CRIMES STATEMENT UNDER & 287.133. FLORIDA STATUTES THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS. 1. This swom ,statement is submitted to the Village of North Palm Beach ("Owner") by +~~~ I ft.}IP.F(E.f (print individual's name and title) for V~I:.J ~OJ1S'i"Jl?I:C~Lt)R.? ~N<_. (print name of entity submitting swom statement) whose business address is iob6 Si'Inscn Line # 1 b~ > in accordance with the RFP for goods and services related to Lakeside Park Shelter Construction (Project). 2. 1 understand that a "public entity crime" as defined in Paragraph 287.133(I)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or of the United States, including, but not limited to, any proposal or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 3. 1 understand that "convicted" or "conviction" as defined in Paragraph 287.133(]xb), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non jury trial, or entry of a plea of guilty or nolo contenders. 4. I understand that an "affiliate" as defined in Paragraph 287.133(I)(a), Florida Statutes, means: (I) A predecessor or successor of a person convicted of a public entity crime; or (2) An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among' persons when not for fair market value under an arm's length agreement, shall bi; a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. 5. I understand that a "person" as defined in Paragraph 287.133(1 x e), Florida 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 which submits proposals or applies to submit a proposal on contracts 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 [hose officers, directors, executives, partners, shazeholders, employees, members, and agents who are active in management of an entity. 6. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. (Please indicate which statement applies.) Neither the entity submitting this sworn statement, nor one or more of the officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of Page: I I the entity, nor any affiliate of the entity, has been charged with and convicted of public entity crime subsequent to July 1, 2003. _ There has been a proceeding concerning the conviction before a hearing officer of the State of Florida, Division of Administrative Hearings. The final order entered by the hearing officer did not place the person or affiliate on the convicted vendor list. (Please attach a copy of the Final Ober.] _ The person or affiliate was placed on the convicted vendor list. There has been a subsequent proceeding before a hearing officer of the State of Florida, Division of Administrative Hearings. The final order entered by the hearing officer determined that it was in the public interest to remove the person or affiliate from the convicted vendor list. (Please attach a copy ofthe Final Order.] _ The person or affiliate has been placed on the convicted vendor list. [Please describe any action taken by or pending with the Department of General Services.] 1 UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE OWNER FOR THE OSBORNE PARK REMODELING CONSTRUCTION PROJECT IDENTIFIED IN PARAGRAPH 1 (ONE) AND WILL BE SUBMITTED TO THE PROJECT OWNER AND THAT THIS FORM IS VALID HROUGH PROJECT COMPLETION. 1 ALSO UNDERSTAND THAT I AM REQUIRED TO O M T OWNER OF ANY CHANGE IN THE INFORMATION CONTAINED fN THIS FO D RIN TH PROJECT. ~~ OF FLORIDA ss OF ~L}uri t')jLAL~ ) BEFORE ME the undersigned authority, an ~o;fficer duly authorized to administer oaths and take acknowledgments, this day personally appeared • IC~.i (titP~f/r who is~ersonally know to me or produced identification (form of identification produced) to me to be the person described herein and who executed the foregoing instrument, this _~ day of LL , 2007. CAROLINA CALDEROR Nopry WD9e - &W of ibA09 ~~MrE~gtMMa+NOVt.POt CanmisHOn 0 DD 8109 n Notary Public Page: [ 2 RFP EXHIBIT "C" PROPOSER'S ACKNOWLEDGMENT SUBMIT ONE ORGINAL AND L2, COPIES OF YOUR PROPOSAL TO: Village of North Palm Beach Attn: Village Manager Village Hall 501 US Highway 1, North Palm Beach, FL 33408 RFP TITLE: LAKESIDE PARK SHELTER CONSTRUCTION PROJECT RFP NO: # Proposal must be received PRIOR TO 3 p.m.. Weduesdav. Aueust 29.2007, at which time Proposals will be opened. Proposer's Name: ~.~ fYW L.p ~S'(~ UL T I D N (Please specify if a corporation, partnership, other en Fed. ID# or SSN: c't> ~ G ~ ~j ~ -j ~ Address: ~~ or individual) Telephone No.: J~ I - 3 3~- (; ~ 73 if Fax Number: ~U~- ~j~j ~ - (y a-]t} Contact representative: ~Oi ' ~ (Jv I ~ ~(" The undersigned authorized representative of the Proposer agrees to all terms and conditions stated in the RFP, and proposes and agrees that if this proposal is accepted by the Village, the Proposer ~yill,negotiate with the Village in order to enter into a standard Village contract to provide l go ds ~d services as stated in this proposal and in accordance with the terms and wuuiu u~ ui ~c rr. ~~ ~ ~"" A o zed Representative's Signature ame: p /~~~1 Date ~r^~Sid.~n~ Position: Page: l3 RFP EXHIBIT' "D" PROPOSAL FORM Iu accordance with the terms and conditions stated in the Request for Proposal (RFP) requesting all goods and services for the Lakeside Park Shelter Construction Project, the undersigned proposes the following to the Village otNort6 Palm Beach: ~/x1,~ CD(7S~ UC~IOSJ~ /(~• (Proposer's Legal Name) certifies that it is licensed to perform the requested services in the State of Florida and Palm Beach County. Applicable License number(s): ~ ~C 1 SU'7p°~y- Proposer agrees to provide the required goods and/or services stated in the RFP for an amount not to exceed: -fh,~`~Scv,~ coil Written Dollar Amount (~ ~~~ v~c~P o~ ~ Proposer ~ ~' °%or, r-----~ to provide all required goods and/or services stated in the RFP in days from the date of notice to proceed. Kepresentative's Signature G Date Position: Page: 14 ~, RFP EXHIBIT "E" CONFIRMATION OF DRUG-FREE WORKPLACE In accordance with Section 287.087, Florida Statutes, whenever two or more Proposals aze equal with respect to price, quality, and service which are received by any political subdivision for the procurement of commodities or contractual services, a proposal received from a business that certifies that it has implemented adrug-free workplace program shall be given preference in the awazd process. In order to have adrug-free workplace program, a business shall: (1) Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. (2) Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining adrug-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) Give each employee engaged in providing the commodities or contractual services that aze under proposal a copy of the statement specified in subsection (1). (4) In the statement specified in subsection (1), notify the employees that, as a condition of working on the commodities or contractual services that are under proposal, 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 or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than 5 days after such conviction. (5) Impose 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 by, any employee who is so convicted. (ti) Make a good faith effort to continue to maintain adrug-free workplace through implementation of this section. As the perso thorized to sign this statement on behalf of .T~ ~0lKTh'UGI /Uti ~ / n C I certify tl~,y-~`. CD~'lS-(`/{ UC i 1UaJ~ t t~(' complies fully with the above Representative's Signature Date ~~C'Si d~,r>~ Position: Page: I S SEALED PROPOSALS FOR Lakeside Park Shelter Project VILLAGE OF NORTH PALM BEACH 501 U.S. HIGHV/AY 1 NORTH PALM BEACH, FLORIDA 33408-4906 ADVERTISEMENT, INSTRUCTIONS TO PROPOSERS SPECIFICATIONS, PROPOSAL FORMS PROPOSALS TO BE OPENED August 29, 2007 3:00 P.M. Page: I ADVERTISEMENT Sealed proposals will be received by the Village of North Palm Beach, Florida, at the Village Manager's office, Village Hall, North Palm Beach, Florida, until: 3.00 P.M. August 29, 2007 Time Date at which time they will be opened and read in public in the Village Manager's office. Such proposals to provide for the furnishing of: Lakeside Fark Shelter Project (Chickee-Style Hut) The resulting contract shall be awarded to the responsible proposer that best meets the needs of the Village, taking into consideration, among other things, the financial responsibility of the proposer, proven skill and experience, abilities to timely perform the contract, previous satisfactory performance and such other abilities of the proposer that the Village, in its sole discretion, determines will enable them to perform effectively and efficiently the contract being proposed upon. The envelope containing the proposal shall be mazked as follows: SEALED PROPOSAL PROPOSER'S NAME. Lakeside Park Shelter Project TO BE OPENED 3:00 P.M. Aueust 29, 2007 Time Date No proposer may withdraw his or her proposal for a period of sixty (60) days after submission by the date set for the opening thereof. The Village reserves the right to reject any or all proposals, in whole or in part, and/or make awards either as individual items or as a total combined proposal, whichever it considers in the best interest of the Village, and to waive any informality in any proposal. The complete Request for Proposals including specifications and proposal forms may be obtained by bona fide proposers upon applicalivn at the office of the Village Parks & Recreation Director, 50l U.S. Highway 1, North Palm Beach, FL 33408-4906 or from the Village website at: www.village-npb_org_ PUBLISH: PALM BEACH POSTDATE: ALM AF,ACH J' y fight, Village M er ASAP Page: 2 REQUEST FOR PROPOSALS FOR LAKESIDE PARK SHELTER PROJECT 1. REQUEST FOR PROPOSALS: The Village of North Palm Beach, a Florida municipal corporation ("Village"), is accepting sealed proposals for the Lakeside Pazk Shelter Construction project ("Project") (as more fully described herein) until 3:OOum, local time, on Aueuat 29. 2007, at the Village Manager's office, Village Hall, 501 U.S. Highway One, North Palm Beach, 33408. Proposals received after the aforementioned date and time will be returned unopened. 2. PREPARATION OF PROPOSAL: 'This Request for Proposals ("RFP" hereafter) provides the complete set of terms and conditions, limited specifications and proposal forms for the required goods and/or services for the Project. The limited specifications for the Project are attached hereto and incorporated by reference as Exhibit "A". The proposal forms aze attached hereto and incorporated by reference as Exhibits "B" to "E" and are the following: Public Entity Crimes Statement Exhibit "B" Proposer's Acknowledgment Exhibit "C" Proposal Form Exhibit "D" Drug Free Workplace Exhibit "E" This RFP is available for review and printing from the Village's web site: village-npb.org. All proposal forms must be completed in full and include a manual signature, in ink, where applicable. The signature must be of an authorized representative who has the legal ability to bind the proposing entity in contractual obligations. Unsigned proposals will not be accepted. All proposals forms must be typed or legibly printed in ink. Use of erasable ink is not permitted. All corrections made by a Proposer to any part of a proposal form must be initialed in ink. ]t is a Proposer's sole responsibility to assure that his/her proposal is complete and delivered at the proper time and place of the proposal opening. The Village will not be responsible for any expenses incurred in connection with the prepazation and/or delivery of a proposal. An original of all proposal forms and (2) copies along with the other required information (as stated in Section 9 below) must be submitted in a sealed envelope to the address provided above via hand-delivery or mail. Faxed or e-mailed proposals are not acceptable. The face of the sealed envelope shall state "SEALED PROPOSAL" and contain the Proposer's name, return address, title of the proposal, proposal number (if applicable) and the date and time for proposal opening. Proposals not submitted in a sealed envelope or on the enclosed proposal forms may be rejected. Mark Hodekins at (5611 841-3384 is available to answer any non-technical questions regarding this RFP. Any technical questions regazding this RFP should be submitted in writing to Village Buildine Official at 501 U.S. HiP_hwav One, North Palm Beacb. FL 33408 for Page: 3 review and response. If any technical question requires a response which the Village in its sole discretion determines should be provided to all potential Proposers, the Village will issue an official addendum to this RFP. The Village will endeavor to make sure all potential Proposers receive such addendum by posting the addendum on the Village's website for the respective proposal solicitation; however, it is the sole responsibility of every Proposer to verify with the Village whether any addendum has been issued prior to submitting a proposal. The Village will not issue an addendum five (5) days yr less before proposal opening. 3. PROPOSAL EVALUATION AND AWARD: On the date and time specified in this RFP, the Village will open and announce aloud all proposals received on time. The evaluation of the proposals will occur soon thereafter. The proposal opening may be delayed if, at the sole discretion of the Village, it is considered to be in the Village's best interests. The Village Administration will evaluate the proposals in order to prepare a recommendation to the Village Council for selection of the top-ranked Proposer and award of a resulting contract. The selected Proposer will be selected on the basis of the responsiveness of its proposal, and the results of the Village's research and investigation of the information in each proposal. Upon selecting the successful Proposer who will best serve the interests of the Village, the successful Proposer shall be required to execute the Contract attached hereto as Exhibit "F," which will incorporate the terms and conditions of this RFP and the selected proposal. Minor variations in the terms and conditions of the Village contract may be authorized by the Village so long as such variations are consistent with this RFP and the selected respondent's proposal. Venue for any dispute regarding this RFP shall be in Palm Beach County, Florida. Any protest relating to this RFP must be submitted to the Village within five (5) calendar days of the day when the reason for such protest became known or should have become known or the respondent shall waive any and all right to such protest. The Village, in its sole discretion, reserves the right to waive all technicalities or irregularities, to reject any or all proposals or any part of a proposal, to award to a single Proposer or to divide the award between Proposers, and to re-solicit this RFP or any part of this RFP. The Village further reserves the right, in its sole discretion, to award a contract to the Proposer whose proposal best serves the interests of the Village. 4. INSURANCE REQUIREMENTS: A. Prior to the approval of a resulting contract, the selected Proposer shall provide to the Village certificates evidencing insurance coverage in the minimum amounts as required hereunder or as otherwise agreed to in the negotiated contract. All insurance policies shall be issued by companies authorized to do business under the laws of the State of Florida. The certificates shall clearly indicate that the selected Proposer has obtained insurance of the type, amount, and classification as required for strict compliance with this Section and that no material change or cancellation of the insurance shall be effective without thirty (34) days' prior written notice to the Village. Failure to comply with the foregoing requirements Page: 4 shall not relieve the selected Proposer of its liability and obligations under a resulting contract. B. The selected Proposer shall maintain, during the life of a resulting contract, commercial general liability, including contractual liability insurance in the amount of $500,000 per occurrence to protect the selected Proposer from claims for damages for bodily and personal injury, including wrongful death, as well as from claims of property damages which may arise from any operations under a resulting contract, whether such operations are caused by the selected Proposer or by anyone directly employed by or contracting with the selected Proposer. C. The selected Proposer shall maintain, during the life of a resulting wntract, comprehensive automobile liability insurance in the minimum amount of $500,000 combined single limit for bodily injury and property damages liability to protect the selected Proposer from claims for damages for bodily and personal injury, including death, as well as from claims for property damage, which may arise from the ownership, use, or maintenance of owned and non-owned automobiles, including rented automobiles whether such operations be by the selected Proposer or by anyone directly or indirectly employed by the selected Proposer. D. The parties to the resulting contract shall carry Workers' Compensation Insurance and Employer's Liability Insurance for all employees as required by Florida Statutes. Tn the event that a party does not carry Workers' Compensation Insurance and chooses not to obtain same, then such party shall in accordance with Section 440.05, Florida Statutes, apply for and obtain an exemption authorized by the Department of Insurance and shall provide a copy of such exemption to the other party. E. All insurance, other than Worker's Compensation, to be maintained by the selected Proposer shall specifically include the Village as an Additional Insured. 5. REGULATIONS. PERMITS AND FEES: "1"he selected Proposer will be required to obtain at their expense all permits, inspections and/or licenses required to provide the required goods and/or services to the Village under this RFP. The Village will waive any and all permit and inspection fees required to be obtained from the Village. The selected Proposer must comply with all Federal, State and local laws and regulations that may apply. 6. PUBLIC ENTITY CRIMES: In accordance with section 287.133, Florida Statutes, any person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a proposal, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a proposal, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded of perform work as a contractor, supplier, subcontractor, or consultant under a contract Page: 5 with any public entity; and may not transact business with any public entity in excess of $25,000 for a period of 36 months following the date of being placed on the convicted vendor list. Accordingly, if your proposal exceeds $25,000, a public entity crimes statement must be completed and signed by an authorized representative and be included with your proposal. A copy of the public entity crimes statement is attached to this RFP as Exhibit "B". 7. PUBLIC RECORDS: Upon receipt, all proposals and information submitted with each proposal become "public record", property of the Village and shall be subject to public disclosure consistent with Chapter119, h'lorida Statutes (Public Records Law). In order to possibly be exempt from disclosure, Proposers must invoke the specific exemptions to disclosure provided by law in their proposal by providing the specific statutory authority for the claimed exemption, identifying the data or other materials to be protected, and stating the reasons why such exclusion from public disclosure is necessary. Any resulting contract may be reviewed by any person after the contract has been executed by the Village. The Village has the right to use any or all information/rnaterial submitted in response to this RFP and/or any resulting contract from it. Disqualification of a Respondent does not eliminate this right. 8. PROPOSER'S CERTIFICATION: Each Proposer submitting a proposal acknowledges, agrees and certifies as follows: A. The Proposer and its proposal aze subject to all terms and conditions specified herein with no exceptions unless authorized in writing by the Village; B. The proposal constitutes an offer to the Village which shall remain open, irrevocable and unchanged for sixty (60) days after proposal opening; C. The Proposer has not given, offered nor intends to give or offer any economic opportunity, future employment, favor or gratuity in any kind to any employee of the Village in connection with this RFP; D. The Proposer has not divulged or discussed its proposal with other Proposers; E. The proposal is made based on independent determination of the Proposer without collusion with other Proposers in an effort to restrict competition; F. The Proposer has not made any attempt to induce any potential Proposer from submitting or declining to submit a proposal in response to this RFP; G. The Proposer is financially solvent and sufficiently experienced and competent to provide all goods and/or services required in this RFP; H. That the Proposer shall indemnify, defend and hold harmless the Village, its officers, employees and agents from any and all claims, damages, causes of action or liability related to or arising from this RFP; and, I.. That all information provided in the proposal is true and correct in all respects. Page: 6 if any Proposer or its proposal fails to comply with the foregoing certifications, said failure will include, but may not be limited to, grounds for rejecting that Proposer's proposal. 9. PROPOSAL FORMAT AND REOU[REMENTS: Each proposal shall be submit in a clear, concise format, on 8%z X 11 paper. Each proposal set shall contain all information requested herein to be considered for award. Omission of required information may be cause for disqualification. A. Cover Letter of Transmittal: The cover letter will summarize in a brief and concise statement the Proposer's qualifications, how it is organized, and ils location relative to the Village. Minimum qualifications should be stated and must include: 1. A statement that the Proposer is licensed and qualified to provide all goods and services requested under this RFP and as stated in the proposal to complete the Project; 2. A statement that the Proposer is able and will comply with all applicable laws, rules, regulations and ordinances of the Village, Palm Beach County, the State of Florida and the United States if selected by the Village Council; and, 3. A statement that the Proposer is able and will provide the required insurance as stated herein if selected by the Village Council. The following proposal forms should be attached to the Cover Letter: - Public Entity Crimes Statement RFP Exhibit "B" - Proposer's Acknowledgment RFP Exhibit "C" - Proposal Form RFP Exhibit "D" - Drug Free Workplace RFP Exhibit "E" B. Proposer's References: This section of the proposal must include a list of no more than six (ti) other municipalities, public entities or other entities which the Proposer has provided similar goods and/or services as those requested in this RFP to complete the Project. Proposer shall indicate a contact person's name, address and telephone number for each reference, and a general description of the Project, total Project cost and if the Project was completed on time and within budget. C. Proposer's Proposal for the Shelter: This section of the proposal shall include all goods and services to be provided by the Proposer to complete the Project as stated in this RFP including the specifications. The minimum requirements stated in the specifications shall be included and re-stated in this section of the proposal. A total price for all goods and services shall be provided in this section. The total price shall be broken down into cost components or line items of more than $10,000. This Page: 7 section shall also include the number of days necessary for the Proposer to complete all work upon receipt of a notification to proceed from the Village. D. Subcontractors: This section of the proposal shall identify all subcontractors the Proposer plans to utilize in the provision of all goods and services under this RF'P. F.. Conflict of Interest: All Proposers must disclose with their proposal the name(s) of any officer, director, agent, or immediate family member (spouse, parent, sibling, and child) who is also an employee or officer of the Village. Further, all Proposers must disclose the name of any Village employee or officer who, either directly or indirectly, owns a material interest in the Proposer's company, firm or group or in that of any of its affiliates. If no such conflict of interests exists, the Proposer should clearly state this in its proposal. ITNE REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANKI Page: 8 RFP EXHIBIT "A" These Specifications contain the minimum goods and services required by the Village to complete the Project. Proposers must be able to provide these goods and services at a minimum. Additional goods and services consistent with the Project must be proposed and must be separately identified in the proposal. The Project must be completed so as to be compliant with all applicable building codes (unless exempt), and other applicable local laws, ordinances and regulations. In addition, the Project shall be accomplished to create a unified, esthetically pleasing appearance for Lakeside Park. CONSTRUCTION SPECIFICATION Lakeside Park Shelter Chiekee Style PARTI-GENERAL I.01 WORK INCLUDED The contractor shall provWe all labor, rrratedals and appurtenances necessary jor construction oja Chickee Sryle sheUer at Lakeside Park 1.02 RELATED WORK SeGion - Earthwork Section -Concrete 1.03 SYSTEM DESCRIPTION The stracmre shall be an opened sided wooden 25' X 30' "Chtckee Sryle"sheker that has a thatched roojojpalm or palmetto or other as like materials and does not incrorporore any elecnlcal, phrmbing or other non-wood jeamres The shelter shall Mclude all components requLed 1.04 QUALITY ASSURANCE The contractor shall provkle laborers and sapervlrors who are lharough/y jamUlar wUh the type ajconstrucdon involved and materials and techniques speeded. I.OS SUBMITTAL The manujacnrre-'s lUereture shall be submided fo the Village jar review and approval prior !o installation. 1.06 PRODUCT HANDLING AND STORAGE Upon receipt a1 the job sire, all mate~hds shag be checked by the selected connacfor ro ensure tha! no damage occurred during shipping or handling. Materials shall be stored M such a manner to ensure proper vent7latlon and d~ahrage, and to protect against damage, weather, vandal/sm and lheJt Pale: 9 PART 2 -MATERIALS 2.01 MATERIAL A. FR4ME: Nand-peeled Cyprea~ or Pine logs, wealher resistant timbers that are very strong and straight or like materials B. THATCH: Fresh-cut green fronds from Sabol, Cabbage or Date palms treated wish fire resistanl materials. C. FOUNDAT/ON: The shelter will be ballt on an existing concrete slab PART 3 -EXECUTION 3.01 PREPARA'I'lON A scalable Survey/site plan wil/ be provided by the Village showing setbacks from olher slrLCtures and property lines 3.02 PERMITTING Proposer will supply two complete sets: • Architect's or Engineer's Sealed plans that include floor plan and elevations showing dimensions and materials to be used, cross-sections showing all construction details for foundation, columns, walls, roof, etc. Construction details are to include fasteners, straps, anchors, etc. • Design Professional of record plans sre to be in compliance with 2004 Florida Building Code if the Proposer qualifies for the exemption contained in section 553.'73, Fla. Slat., that Proposer may be released from the requirements of section 3.02 above upon submission of an original contract with the Miccosukee "Tribe of Indians of Florida or the Seminole 'tribe of Florida. However, said Proposer will still be required to provide a floor plan and elevations showing all construction materials proposed for the Project. Page: 10 RFP EXHIBIT "B" PUBLIC ENTITY CRIMES STATEMENT UNDER & 287.133, FLORIDA STATUTES THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS. 1. This sworn statement is submitted to the Village of North Palm Beach ("C+wner") by (print individual's name and title) for (print name of entity submitting sworn statement) whose business address is , in accordance with the RFP for goods and services related to Lakeside Park Shelter Construction (Project). 2. 1 understand that a "public entity crime" as defined in Paragraph 287.133(])(8), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or of the United States, including, but not limited to, any proposal or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 3. I understand that "convicted" or "conviction" as defined in Paragraph 287.133(I)(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non jury trial, or entry of a plea of guilty or nolo contendere. 4. 1 understand that an "affiliate" as defined in Paragraph 287.133(1)(a), Florida Statutes, means: (I) A predecessor or successor of a person convicted of a public entity crime; or (2) An entity under the conVOl of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. 5. 1 understand that a "person" as defined in Paragraph 287.133(1 x e), Florida Statutes, means any natural person w entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which submits proposals or applies to submit a proposal on contracts 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, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity. 6. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this swom statement. (Please indicate which statement applies.) _ Neither the entity submitting this swom statement, nor one or more of the officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of Page: 1 1 the entity, nor any affiliate of the entity, has been charged with and convicted of public entity crime subsequent to July 1, 2003. There has been a procceding concerning the conviction before a hearing oflieer of the State of Florida, Division of Administrative Hearings. The final order entered by the hearing officer did nat place tfie person or affiliate on the convicted vendor list. [Please attach a copy of the Final Dreier.] The person or affiliate was placed on the convicted vendor list. There has been a subsequent pnxeeding before a hearing officer of the State of Florida, Division of Administrative Hearings. The fmal order entered by the hearing officer determined that it was in the public interest to remove the person or affiliate from the convicted vendor list. [Please attach a copy of the Final Order.] The person or affiliate has been placed on the convicted vendor list. [Please describe any action taken by or pending with the Department of General Services.] 1 UNDERS"LAND THAT THE SUBMISSION OF THIS FORM TO THE OWNER FOR THE OSBORNE PARK REMODELING CONSTRUCTION PROJECT IDENTIFIED IN PARAGRAPH 1 (ONE) AND WILL BE SUBMITTED TO THE PROJECT OWNER AND THAI' THIS FORM IS VALID THROUGH PROJECT COMPLETION. 1 ALSO UNDERSTAND THAT I AM REQUIRED TU INFORM THE OWNER OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM DURING THE PROJECT. (Signature) S"TA~I~F, OF FLORIDA COUNTY OF ) ss BEFORE MF, the undersigned authority, an of'Fccr duly authorized to administer oaths and take acknowledgments, this day personally appeared who is personally know to me or produced identification (form of identification produced) to me to be the person described herein and who executed the foregoing instrument, this day of , 2007. Notary Public Page: 12 RFP EXHIBIT "C" PROPOSER'S ACKNOWLEDGMENT SUBMIT ONE ORGINAL AND L2, COPIES OF YOUR PROPOSAL TO: Village of North Palm Beach Attn: Village Manager Village Hall 50] US Highway 1, North Palm Beach, FL 33408 RFP TITLE: LAKESIDE PARK SHELTER CONSTRUCTION PROJECT RFP NO: # Proposal must be received PRIOR TO 3 a.m., Wednesday. Aueust 29. 2007, at which time Proposals will be opened. Proposer's Name: (Please specify if a corporation, partnership, other entity or individual) Fed. ID# or SSN: Address: Telephone No.: Contact representative: Fax Number: The undersigned authorized representative of the Proposer agrees to all terms and conditions stated in the RFP, and proposes and agrees that if this proposal is accepted by the Village, the Proposer will negotiate with the Village in order to enter into a standard Village contract to provide all goods and services as stated in this proposal and in accordance with the terms and conditions of the RFP. Authorized Representative's Signature Name: Date Position: Page: 13 RFP EXHIBIT "ll" PROPOSAL FORM In accordance with the terms and conditions stated in the Request for Proposal (RFP) requesting all goods and services for the Lakeside Park Shelter Construction Project, the undersigned proposes the following to the Village of North Palm Beach: (Proposer's Legal Name) certifies that it is licensed to perform the requested services in the State of Florida and Palm Beach County. Applicable License number(s): Proposer agrees to provide the required goods and/or services slated in the RFP for an amount not to exceed: Written Dollar Amount ($ ) Proposer agrees to provide all required goods and/or services stated in the RFP in days from the date of notice to proceed. Authorized Representative's Signature Date Name: Position: Page: 14 RFP EXHIBIT "E" CONFD2MATION OF DRUG-FREE WORKPLACE [n accordance with Section 287.087, Florida Statutes, whenever two or more Proposals are equal with respect to price, quality, and service which are received by any political subdivision for the procurement of commodities or contractual services, a proposal received from a business that certifies that it has implemented adrug-free workplace program shall be given preference in the awazd process. In order to have adrug-free workplace program, a business shall: (1) Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. (2) Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining adrug-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) Give each employee engaged in providing the commodities or contractual services that are under proposal a copy of the statement specified in subsection (1). (4) In the statement specified in subsection (1), notify the employees that, as a condition of working on the commodities or contractual services that are under proposal, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or polo contendere to, any violation of chapter 893 or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than 5 days after such conviction. (5) Impose 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 by, any employee who is so convicted. (6) Make a good faith effort to continue to maintain adrug-free workplace through implementation of this section. As the person authorized to sign this statement on behalf of I certify that complies fully with the above requirements. Authorized Representative's Signature Name: Date Position: Page: 15