Loading...
HomeMy WebLinkAboutR-2000-071 RESOLUTION NO. 2000-071 A RESOLUTION OF THE CITY OF DANIA BEACH, FLORIDA APPROVING THAT CERTAIN AGREEMENT NO. 00-11 B-1620- SYETP-18 BETWEEN THE ("CONTRACTOR") AND THE BROWARD EMPLOYMENT AND TRAINING ADMINISTRATION ("BETA"), A GOVERNMENTAL CONSORTIUM CREATED TO CONDUCT MANPOWER TRAINING AND EMPLOYMENT PROGRAMS IN BROWARD COUNTY AND THE CITY OF DANIA BEACH; FURTHER, PROVIDING AN EFFECTIVE DATE. WHEREAS, after due consideration, the City of Dania Beach, Florida hereinafter designated as ("CONTRACTOR") deems it in the public interest to execute a continuing Agreement between the Broward Employment and Training Administration in accordance with the terms and conditions contained in said Agreement No. NO. 00-11 B-1 620-SYETP-1 8. BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF DANIA BEACH, FLORIDA Section 1: That that certain Agreement No. NO. 00-11 B-1 620-SYETP-1 8 between the • Broward Employment Training Administration, a Governmental Consortium created to conduct Manpower Training and Employment Programs in Broward County and the City of Dania Beach, a copy of which is attached to and made a part of this Resolution as Exhibit"A", is approved and the appropriate City officials are hereby directed to execute same; provided, however, that the City Manager and City Attorney are authorized to make minor revisions to such Agreement as are deemed necessary and proper for the best interests of the City. Section 2: That this resolution shall be in force and take effect immediately upon its passage and adoption. PASSED AND ADOPTED this 23`d day of May, 2000. ® C.K. MICELYC MAYOR - COMMISSIONER RESOLUTION NO. 2000-071 ATTEST: ROLL CALL: MAYOR McELYEA - YES VICE-MAYOR BERTINO- YES SHERYL CHAPMA COMMISSIONER CALI - YES ACTING CITY CLERK COMMISSIONER ETLING - YES APPROVED AS TO FORM AND CORRECTNESS: BY: &I - THOM J. AY4sgPb CITY ATTORNEY RESOLUTION NO. 2000-071 AGREEMENT NO. 00-IIB-1620-SYETP-18 BETWEEN THE BROWARD EMPLOYMENT AND TRAINING ADMINISTRATION. • AND THE CITY OF DANIA EXHIBIT "All • AGREEMENT NO. 00-IIB-162 - -0 SYETP 18 This AGREEMENT, entered into this day of , 2000, by and between the Broward Employment and Training Administration, a consortium of the Cites of Fort Lauderdale and Hollywood, and Broward County, existing under and by virtue of the laws of the state of Florida as a Council of Governments, having its principal offices at 3800 Inverrary Boulevard, Suite 400, Lauderhill, Florida 33319 and the City of Dania, hereinafter referred to as CONTRACTOR existing under and by virtue of the laws of the State of Florida as a governmental entity having its principal office at 100 West Dania Beach Boulevard, Dania, FL 33004, to begin June 19, 2000, and to be completed by August 25, 2000, in accordance with Article 2, Section 208. WITNESSETH THAT WHEREAS, the Broward Employment and Training Administration has , entered into an Agreement with the Governor of the state of Florida and the United States Department of Labor for a grant for the execution and implementation of youth program services; AND WHEREAS, the Broward Employment and Training Administration and CONTRACTOR are desirous of providing meaningful employment for economically disadvantage youths, ages fourteen (14) through twenty-one (21), AND NOW THEREFORE, in consideration of the premises and the mutual covenants and obligations herein contained, and subject to the terms and conditions hereinafter stated, the parties hereto agree and understand as follows: ARTICLE I AGREEMENT PURPOSE AND DEFINITIONS 100. PURPOSE It is the purpose of this Agreement to state the covenants and conditions under which BETA and the Contractor will implement and provide training and employment services, specifically summer work experience opportunities to eligible youths as described herein, to be funded under the guidelines of WIA, and under the contracting powers of BETA. RM-MyDoc:Agreement SYETP 2006 Paee 2 of 17 101. DEFINITIONS 101.1 "BETA" shall mean the Broward Employment and Training Administration. 101.2 "BWDB/WAGES Coalition" shall mean the Broward Workforce Development Board/WAGES Coalition. 101.3 "Collective Bargaining Agents" shall mean a union or union representatives. 101.4 "Contractor" shall mean the participating governmental unit or nonprofit agency. 101.5 "DOL" shall mean the United States Department of Labor. 101.6 "Economically Disadvantaged" shall mean that income level as determined by the Governor and/or DOL as being below the poverty guidelines. • 101.7 "Job Order" shall mean the Summer Youth Program JOB ORDER form (and attachments) used as an application for requesting work sites/job slots for SYETP participants and which is incorporated into and made a part of this Agreement. 101.8 "Job Site/Worksite" shall mean the physical location and the department of the participating Contractor to which the youth has been assigned. 101.9 "Labor Union Concurrence" shall mean a union's consent to SYETP placements. 101 .10 "Participant" shall mean a WIA eligible youth referred, by BETA its agents or designees which for purposes of this Agreement shall be the Urban League of Broward County for placement, to a Contractor and who is fourteen (14) through twenty-one (21) years of age. 101.11 "Program" shall mean the activities and services to be provided by the Contractor under this Agreement. • RJD;MyDoc:Agreement SYETP 2000 Paee 3 of 17 101.12 "SYETP" shall mean Summer Youth Employment and Training Program. 101.13 "Urban League" shall mean the agency selected by the BETA Council and the BWDB/WAGES Coalition to be responsible for the development of summer worksites, eligibility determination of the youths, assignment of the youths to the worksites, and collection and verification of participant timesheets and payroll. 101.14 "WIA" shall mean the Workforce Investment Act of 1998. 101.15 "Worksite Aide" shall mean a youth who is eighteen (18) through twenty-one (21) years of age and who serves as an aide to the worksite supervisor or who performs as an administrative aide as directed by BETA or its agents or designees. 101.16 "Worksite Supervisor" shall mean Contractor's personnel designated by Contractor to provide continuos on-site supervision and direction to SYETP participants at Contractor's worksite(s) and who will be responsible for verifying SYETP participants' time sheets. • 101 .17 "Youth" shall mean a person who is fourteen (14) through twenty- one (21) years of age. 101 .18 "Youth Worksite Assistant" shall mean an Urban League/SYETP staff person who shall serve as a liaison. END OF ARTICLE I RJD;MyDoc:Agreement SYETP 2000 Paae 4 of 17 ARTICLE II PROGRAM OPERATIONS 200. PROGRAM 200.1 The program to be provided shall be a work experience, wherein a youth referred to Contractor by the Urban League of Broward County, is given job functions to perform under the guidance and leadership of the Contractor in accordance with the WIA regulations. 200.2 The Urban League of Broward County shall be responsible for participant eligibility certification and recruitment. The Urban League of Broward County shall assess each participant to determine their suitability for Contractor's program. 201. RESPONSIBILITIES OF CONTRACTOR 201.1 Contractor shall supervise all participants at the job sites and may require participants' conformance with the Contractor's • personnel rules. 201.2 Contractor shall plan and direct participant work activities in accordance with the applicable Federal and State Child Labor Law Acts, rules and regulations, and other applicable state and local laws. 201.3 Contractor shall direct participant(s) work activities in accordance with their job order(s) and/or job description(s), which are hereby incorporated by reference and made a part of this Agreement. 201.4 Contractor shall comply with WIA and the regulations promulgated thereunder especially as they relate to Youth. 201.5 Contractor shall ensure that all of the Contractor's personnel, including any alternate staff, who will be involved in supervising the Summer Youth Employment and Training Program participants shall attend the SYETP Worksite supervisor's Training Meeting conducted by the Urban League of Broward County, which will be held during the months of May and June. RID;MyDoc:Agree ment SYETP 2006 Pate 5 of 17 201.6 Contractor shall allow their work site supervisors time off upon the Urban League of Broward County's written request so that they may attend the Worksite Supervisor's Orientation Workshops. 201 .7 Contractor shall orient and train their Worksite Supervisory personnel directly responsible for the supervision of SYETP participants, as to the Contractor's responsibilities and obligations under this Agreement by providing each worksite supervisor with a copy of this Agreement, as well as a copy of the worksite Supervisors Handbook, and assuring the availability and review of the training handbook and materials with any assigned alternate supervisors. 201.8 Contract shall immediately notify the Urban League of Broward County of any temporary and/or ongoing changes in the designation of personnel who will be supervising the youth. 201 .9 Contractor shall be accountable for maintaining SYETP participant time sheets by keeping accurate work time attendance rosters and timesheets, recording time in segments of fifteen minutes, assuring and supervising the proper • completion of SYETP participant time sheets consistent with instructions furnished by BETA and/or the Urban League of Broward County and certifying/signing participant time sheets if all the prior requirements are met. 201.10 Contractor shall not require participants to work more than the hours reflected in the Job Order and in no event may hours worked exceed thirty (30) hours per week unless expressly authorized in writing by BETA. BETA shall be responsible for participants' wages only up to 30 hours a week. Participants shall only be paid for time actually worked. BETA will not pay for time not worked, overtime, holidays, vacation, sick or other leave or time off from the job. Contractor shall be responsible for any wages due participants beyond thirty (30) hours a week, including wages due for any over-time worked by participants under Contractor's supervision, as well as for wages due and/or paid for holidays, vacation, sick or other leave or time off from the job. • RJD;MyDoc:Agree nient SYETP 2000 PaEe 6 of 17 201.11 Contractor agrees not to knowingly refer for eligibility determination any youths who have a wife, husband, son, daughter, mother, father, brother, brother-in-law, aunt; uncle, niece, nephew, stepparent, or stepchild who are employed in an administrative capacity for the Contractor, BETA, the Urban League, or another of BETA's Contractors. 201.12 If Contractor is a not for profit entity Contractor warrants that no youth will be involved in a work experience activity that contributes or could be expected to contribute to additional sales or income of the Contractor or which will otherwise result in the subsidization of wages for the Contractor's organization. In the event that the Contractor unknowingly realizes income, such income shall be payable to BETA. 201 .13 Contractor assures that all sites where participants will be assigned have the capability and facilities to provide services to summer youth in a sanitary and safe environment. 201.14 Contractor's worksite shall conform to normal routines and functions befitting a reasonable business establishment, including, but not limited to, appropriate supervision on the premises at all times, developing • positive work habits, working conditions, and attire. 201.15 Contractor shall assure it will have supervisory personnel who will act as worksite supervisors for each of the Contractor's worksites so as to provide for continuos on-site supervision of participants. 201 .16 Contractor shall allow BETA, its designated representative or the Urban League of Broward County to visit Contractor's training sites for the purpose of monitoring Contractor's operations to ensure compliance with this Agreement or Amendment hereto . 201 .17 The Contractor shall allow BETA, its designated representative or the Urban League of Broward County to conduct on-site evaluations of participants for the purpose of monitoring participants' work activities in accordance with their training plan/job order(s) and/or job description(s). 201 .18 Contractor understands that the program it is operating is a single site work experience program, which means that all job sites at which youth are to be located must be part of the Contractor's organization. Under no circumstances shall a participant be placed at a site other than Contractor's designated worksite, unless prior written permission is • granted by the Urban League of Broward County for outstationing, and in such instances, under no circumstances shall the outstationing site be a private-for-profit agency. RJD;MyDoc:Agreement SYETP 2000 Page 7 of 17 201.19 Contractor shall maintain accordingto sound management procedures, 9 records and files, containing, but not limited to, time sheets, attendance records, supervisor assignments, and personnel changes, relating to the Contractor's operation of the SYETP program. 201.20 Contractor shall make original and/or certified copies of any reports, plans, surveys, information, documents, maps, or other data produced or developed by Contractor in execution of the project covered by this Agreement, available to BETA, the Governor of the State of Florida, the Comptroller General of the United States, and/or the Department of Labor (DOL), at any time upon reasonable notice, for the purpose of program audit, examination, excerpts and transcripts, even though the Contractor may at the time of the request no longer be operating programs for BETA. 201.21 Contractor shall keep copies of all records pertaining to the operation of this Agreement and any Amendment hereto for five (5) years following the expiration of this Agreement. 201.22 If Contractor, is an agency as defined in Chapter 768.28, Florida ® Statutes, Contractor agrees to be fully responsible to the limits set forth in Section 768.28, Florida Statutes, for acts of negligence of its agents or employees when acting within the scope of their employment or agency, and agrees to be liable to the limits set forth in Section 768.28, Florida Statutes for any damages caused by said negligence. Nothing herein is intended to serve as a waiver of sovereign immunity by any party to which sovereign immunity may be applicable. Nothing herein shall be construed as consent by a state agency or political subdivision of the State of Florida to be sued by third parties in any matter arising out of any contract.. 201 .23 Contractor shall cooperate with the Urban League in making youth available for SYETP Vocational Skills/Life Skills Orientations. 201 .24 Contractor shall inform BETA and the Urban League of Broward County SYETP staff immediately should an accident or injury occur at the job site, affecting or involving a participant. 201 .25 Contractor shall notify SYETP staff of any problem concerning participant's performance at a worksite. 201 .26 Contractor understands and agrees that no qualified disabled individual shall be on the basis of disability, be excluded from participation in, be denied the benefits of, or otherwise be subject to discrimination under this SYETP program. RJD;MyDoc:Agreement SYETP 2000 Paee 8 of 17 201.27 Contractor agrees to obtain written concurrence from the appropriate g bargaining agent if a collective bargaining Agreement is in force in Contractor's organization covering the occupations in which the Summer Youth participants are going to be employed. 201.28 Contractor shall provide insurance coverage for participants under the Contractor's general or public liability insurance policy, or if the Contractor is self-insured to indemnify BETA against third party claims involving participants under this Agreement. 201.29 Contractor Assurance To assure maintenance of effort the program funded by this Agreement: (a) Shall result in an increase in employment and training opportunities over those which would otherwise be available. (b) Shall not result in the displacement of currently employed workers by either a participant or an individual employed to • carry out the obligations under this Agreement, including partial displacement such as a reduction in the hours of non overtime work, wages or employment benefits. (c) Shall not impair current contracts for services or collective bargaining Agreements or result in the substitution of federal funds made available by this Agreement to subsidize work that would otherwise be performed by the Contractor. (d) Shall not create a job in a promotional line for either a participant or an individual employed to carry out the obligations under this Agreement, which will infringe in any way upon the promotional opportunities of a currently employed individual. 201.30 Participant Placement No participant shall be employed or job opening filled with an individual whose salary is funded by this Agreement: (a) when any other individual is on lay-off from the same or any substantially equivalent job; or (b) when the employer/Contractor has terminated the employment of any regular employee or otherwise reduced RJD;MyDoc:Agree nient SYETP 2000 Nee 9 of 17 its workforce with the intention of filling the vacancy so created by hiring a participant or employee whose wages are subsidized by the WIA or paid for with WIA funds. 201 .31 Compliance with Laws, Non Discrimination, Equal Employment Opportunity, and Americans with Disabilities Act a. Contractor shall comply with all federal, state, and local laws, codes, ordinances, rules, and regulations, in performing its duties, responsibilities and obligations pursuant to this Agreement. b. Contractor shall comply with the prohibitions against discrimination in, the Age Discrimination Act of 1975, Section 504 of the Rehabilitation Act, in Title IX of the Education Amendments of 1972, and under Title VI of the Civil Rights Act of 1964 with respect to the performance of their obligations under this Agreement, and shall comply with the physical and programmatic accessibility and reasonable accommodations requirements of Section 504 of the Vocational Rehabilitation Act of 1973, as amended, and the Americans with Disabilities Act of 1990. • c. Contractor shall not unlawfully discriminate against any pers on in its operations and activities in its use or expenditure of the funds or any portion of the funds provided by this Agreement and shall affirmatively comply with all applicable provisions of the Americans with Disabilities Act (ADA) in the course of providing any services funded in whole or in part by BETA, including Titles I and II of the ADA (regarding nondiscrimination on the basis of disability), and all applicable regulations, guidelines, and standards. In addition, Contractor shall take affirmative steps to ensure nondiscrimination in employment against disabled persons. Such actions shall include, but not be limited to, the following: employment, upgrading, demotion, transfer, recruitment or recruitment advertising, layoff, termination, rates of pay, other forms of compensation, terms and conditions of employment, training (including apprenticeship), and accessibility. d. Contractor's decisions regarding delivery of services under this Agreement shall be made without regard to or consideration of race, age, religion, color, gender, sexual orientation (Broward County Code, Chapter 16'/z), national origin, marital status, political affiliation, or physical or mental disability political RJD;MyDoc:Agreenlent SYETP 2000 Paee 10 of 17 affiliation, or any other factor which cannot be lawfully used as a basis for service delivery. e. Contractor shall not engage in or commit any discriminatory practice in violation of the Broward County Human Rights Act (Broward County Code, Chapter 16'/2) in performing the Scope of Services or any part of the Scope of Services of this Agreement. 202 ADDITIONAL RESPONSIBILITIES 202.1 The Urban League of Broward County as BETA's youth services provider, shall assist the job site supervisor in resolving any problems concerning the youths' performance on the job by responding to the Contractor's notice as per Section 201.25 above. 202.2 The Urban League of Broward County shall hear all grievances concerning program participants' performance at the job site. 202.3 BETA shall be responsible for participants' wages. 202.4 BETA shall provide Workers' compensation for all Summer Youth Employment and Training Program (SYETP) participants. 202.5 The Urban League of Broward County shall provide counseling and supportive services to SYETP participants as needed. 202.6 The Urban league of Broward County shall be responsible for picking up participant time sheets and distributing participant paychecks dependent on Contractor's submission of properly certified time sheets. 203 MONITORING Contractor shall allow BETA, the Urban League of Broward County, the Governor of the State of Florida, or any of its agents, and the DOL to visit Contractor's work sites, and monitor, report problems, require corrective action within specified time periods or close work sites without prior notice other than a written notification to be delivered to the Contractor at the time of the closing of the work sites. 204 NOTICE RJD;MyDoc:Agreenient SYETP 2000 Pate 11 of 17 204.1 Other than as provided herein, notice required to be given to BETA under this Agreement, shall be sufficient when hand delivered or mailed to BETA at its office at 3800 Inverrary Boulevard, Suite 400, Lauderhill, Florida 33319. 204.2 All notices required to be given to the Contractor under this Agreement shall be sufficient when hand delivered or mailed to Contractor at its office located at the address identified in paragraph one, page one, of this Agreement. 205 TERMINATION 205.1 This Agreement may be terminated as follows: a. BETA or the Contractor may terminate this Agreement for convenience upon fifteen (15) days prior written notice to the other party. b. BETA and/or the Urban League of Broward County may transfer or terminate participants at any time without written notice to the Contractor whereupon termination shall become effective immediately. c. BETA may terminate this Agreement immediately upon twenty- four (24) hours written notice to the Contractor in the event that BETA's funding source cease to provide the grants under which the program or services to be provided under the contract is funded, or that the Grant under which this program is funded is terminated. d. BETA may terminate this Agreement at any time that the BETA authorized representative, who shall be the BETA Executive Director determines that: 1. Contractor has failed to comply with any of the provisions contained in this Agreement or any Amendment hereto; or 2. Contractor has failed to perform in whole or in part under this Agreement or has failed to take corrective action after receiving oral or written requests to do so within an appropriate time period as may be stipulated by BETA and/or the Urban League of Broward County. e. This Agreement shall be automatically terminated in the event that the Urban League of Broward County is unable to, or does RJD;MyDoc:Agreement SYETP 2000 Paee 12 of 17 not refer eligible and/or suitable participants to Contractor's program. 206 INTERGRATION 206.1 The following documents are hereby incorporated into and made a part of this Agreement: a. Child Labor Laws (29 USC 203): Employment of Minors Between Fourteen (14) and Sixteen (16) Years of Age (Subpart C), Occupations Particularly Hazardous for the Employment of Minors Between Sixteen (16) and Eighteen (18) Years of Age or Detrimental to Their Health or Well-being (subpart E). b. WIA Rules and Regulations c. Summer Youth Employment and Training Program Worksite Supervisor's Handbook. d. Completed Job Orders/Training Plans to be incorporated into this Agreement. Items a and b are public laws, items c and d are available from BETA. 207 PROHIBITED ACTIVITIES 207.1 Contractor shall comply with the federal Hatch Act and WIA Regulations which prohibit political activities under any WIA programs. Participants are prohibited from engaging in any political activity during hours paid for with WIA funds. Nor may any participant engaging in political activity represent himself or herself as a spokesperson of any WIA program. 207.2 WIA funded programs and activities may not be used to support any religious or anti-religious activity. WIA participants may not perform functions which provide direct religious education services. 208 AGREEMENT TERM 208.1 This Agreement shall begin on the date that it is signed by the parties and shall end on the date the last child referred completes the period of participation in accordance with their employment plan. RJD;MyDoc:Agreement SYETP 2000 Page 13 of 17 208.2 Youth participation may vary from 6 — 10 weeks dependent upon fund availability. 208.3 Contractor agrees to coordinate with BETA's designee the Urban League in order to confirm youth start and end dates and to assure youth do not remain in training beyond their training plan dates. END OF ARTICLE II RJD;MyDoc:Agreement SYETP 2000 Page 14 of 17 ARTICLE III 300 CONTRACTOR OBLIGATIONS TO ADHERE TO PUBLIC ENTITY CRIMES POLICY Pursuant to 287.133, Florida Statutes, a person or affiliate who has been placed on the convicted list for a public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with public entity for the construction or repair of a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to a public entity, may not be awarded or perform work as a Contractor, supplies, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity, and may not transact business with any public entity in excess of the threshold amount of $15,000 as provided in section 287.017, Florida Statutes for a period of 36 months from the date of being placed on the convicted vendor list. END OF ARTICLE III RJD;MyDoc:Agreement SYETP 2000 Patze 15 of 17 ARTICLE IV 400 MISCELLANEOUS: 400.1 The following documents as appropriate shall be attached as Exhibits A-E and are incorporated herein by reference: a. Exhibit A - Certification Regarding Lobbying b. Exhibit B - Public Entities Crimes Form C. Exhibit C - Vendor Information/Taxpayer Identification Verification Form d. Exhibit D - Certification Regarding Debarment e. Exhibit E - Insurance Certificate 400.2 This Agreement shall be interpreted and construed in accordance with and governed by the laws of the State of Florida. Any controversies or legal problems arising out of this Agreement and any action involving the enforcement or interpretation of any rights hereunder shall be submitted to the jurisdiction of the State courts of the Seventeenth Judicial Circuit of Broward County, Florida. By entering into this Agreement, BETA and the Contractor hereby expressly waive any rights either party may have to a trial by jury of any civil litigation related to or arising out of the Project. 400.3 This Agreement incorporates and includes all prior negotiations correspondence, conversations Agreements, and understandings applicable to the matter contained herein, and the parties agree that there are no commitments, Agreements, or understandings concerning the subject matter of this Agreement that are not contained in this Agreement. END OF ARTICLE IV RJD;MyDoc:Agreenient SYETP 2000 Nee 16 of 17 EXECUTION PAGE IN WITNESS THEREOF, the parties hereto have made and executed this document on the respective dates under each signature: Beach THE CITY OF DANIA signing by and through its Commission , following Board action on the 23 day of May , 2000, and the Broward Employment and Training Administration signing by and through its Executive Director, following Board Action on the th day of , 2000. Mayor • AS TO CITY OF DANIA BEACH By: f of C .K. Mc WI ES ED BY: A a'rlw� L.S. BY: ( Signa r y -fn g ,( L.S. NAM Michael Smith ery apman, TIT City Manager Actinq City C erk Approved as to f m & correctness : D TE: _ By: T ' Thomas Ansbro, Ci y Attorney AS TO TH BROWA D EMPLOYMENT AND TRAINING ADMINISTRATION • WITNESSED BY: L.S. BY: (Signature) L.S. Mason C. Jackson TITLE: Executive Director DATE: Approved as to form by the Office of the County Attorney for Broward County, Florida EDWARD A. DION,County Attorney Governmental Center 115 South Andrews Avenue Ft. Lauderdale, FL 33301 BY-. - Rochelle J. Daniels Assistant County Attorney RJD;MyDoc:Agreement SYETP - 2000 - - _f 1, • SYETP CHECKLIST FORM The following items must be returned to BETA's Legal Department at 3800 Inverrary Boulevard, Suite 400, Lauderhill, FL 33319 with your executed Agreements. 1. THREE (3) SYETP AGREEMENTS 2. LABOR UNION CONCURRENCE 3. RESOLUTION 4. VENDOR/TAXPAYER ID VERIFICATION 5. FEDERAL DEBARMENT 6. CERTIFICATE OF LOBBYING 7. PUBLIC ENTITIES CRIME 8. *CERTIFICATE OF INSURANCE (THIRD PARTY LIABILITY) 9. *ARTICLES OF INCORPORATION *YOUR AGENCY MUST PROVIDE A COPY OF YOUR CERTIFICATE OF INSURANCE AND ARTICLES OF INCORPORATION. • SAMPLE INSURANCE FORM LETTER Dear Insurance Carrier: We currently have volunteers who are helping out at our agency under the -:.;,;_.-_Community.-=Work--Experience--Program-,-(C.WEP), a federally funded program administered by the Broward Employment and Training Administration (BETA). Because these volunteers are participating in the Community Work Experience Program at our agency, BETA has requested to be included on our insurance coverage. Please issue a Certificate of Insurance that includes BETA as a named insured under our policy. A copy of the Certificate of-Insurance, which names BETA as an additional insured should be forwarded to the BETA Legal Department at 3800 Inverrary Boulevard, Suite 400, Lauderhill, FL 33319. Thank you for your assistance. 5 1 r LABOR UNION CONCURRENCE FORM NAME OF ORGANIZATION: Name of Union(s): (a) For Organization with a Labor Union 1, Representative/Agent of the above named labor union hereby declare that the placement of participants at the worksites operated by ` __., .__... . ,:_... does nbt- and wilC not infringe on the rights of others to employment in the (Organization) Signed: Date: Union Representative/Delegate (b) For Organization Without a Labor Union 1, position held of (organization) hereby declare that our workers are not unionized nor are they represented by or affiliated with any labor union. Sinned: Cate: President, Secretay, Director, Principal, etc. A RESOLUTION OF HEREINAFTER DESIGNATED AS THE CONTRACTOR, AUTHORIZING CONTRACTOR TO ENTER INTO A'EMPLOYMENT AND TRAINING CONTRACT AND FURTHER AUTHORIZING A CERTAIN OFFICER OR ADMINISTRATOR OF THE CONTRACTOR TO EXECUTE THE AGREEMENT BETWEEN THE BROWARD EMPLOYMENT AND TRAINING ADMINISTRATION (BETA),A GOVERNMENTAL CONSORTIUM CREATED TO CONDUCT WORKFORCE DEVELOPMENT, WELFARE AND SOCIAL SERVICE PROGRAMS IN BROWARD COUNTY, FLORIDA,AND THE CONTRACTOR, IN ACCORDANCE WITH THE TERMS AND CONDITIONS CONTAINED IN SAID AGREEMENT. WHEREAS,after due consideration, the (Contractor)deems it in the public interest to execute a Agreement between BETA and the Contractor in accordance with the tetztts.a•nd:conditions contained in>said-Agreement Iv'o: = "~ a copy of which is attached hereto and made a pan hereof. NOW THEREFORE,BE IT RESOLVED BY THE CONTRACTOR: Section l: That the pertinent official(s) is/are herebv authorized to execute Agreement No. benreen The Broward Employment and Training Administration and the Contractor. ADOPTED this day of 19 Signature Authorized Official • Corporate Seal or Governmental Seal (if applicable) VENDOR INFOR_XATION/TAXPAYER IDENTIFICATION VERIFICATION Date Part 1 - Please make any corrections necessary: Part 2 - TAX I .D. Number: TIN Check one : Federal Employer Identification Number (FEIN) Social Security Number (SSN) Part 3 - Minority Business Information : (ex: Female, Asia: AfroAmerican, N/A) 1 . Minority Owned/Operated - Part 4 - Business Desiqnation. Please CIRCLE appropriate number: 1 . CORPORATION, PROFESSIONAL ASSOCIATION OR PROFESSION. CORPORATION (a corporation formed under the laws of a state within the U.S . ) 2 . NOT FOR PROFIT CORPORATION (Section 501 ( c) ( 3 ) ) 3 . PARTNERSHIP, JOINT VENTURE, ESTATE OR TRUST 4 . SOLE PROPRIETORSHIP OR SELF EIMPLOYED (TIN must Social Security No. ) 5 . NONCORPORATE RENTAL AGENT 6 . GOVERNIENTAL ENTITY (City, County, state or U. Government) • & . FOR7 7 GN CORPORATION OR FORE I GN NATIONAL OR OT:: FOREIGN ENTITY (A corporation or other foreign enti formed under the laws of a coon try other than the U. cr an ind; dual temporarily in TT, S . Who pays ta, as a citizen of a country other than the U. S . ) NOTE . Failure to complete and return this form may subject you backup withholding in the amount of 20% of future payments purse- to Section 3406 , Internal Revenue Code . Linder Penalties of Perjury, I declare that I have examined ti request and to the best of my knowledge and belief, it is tri correct and complette . AUTHORIZED SIGNATURE DATE TITLE TELEPHONE ' 1 • Instruction for Certification 1. By signing and submitting this proposal, the prospective recipient of Federal assistance funds is providing the certification set out below. 2. The certification in this clause is a material representation of fact upon which reliance was placed when BETA determined to enter into this transaction. If it is later determined that the prospective participant knowingly available, BETA may terminate this transaction for cause of default. 3. The prospective recipient of Federal assistance funds shall provide immediate written notice to BETA if at any time the prospective recipient of Federal assistance funds learns its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 4. The term "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant," "proposal," and "voluntarily excluded," as sued in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact BETA for assistance in obtaining a copy of those regulations. 5. The prospective recipient of Federal assistance fund agrees by submi Ling this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended., declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by BETA. . __ .. v S. The prospective recipient or f ;ederal"-assistance fund- s" furtn�t" aar�es submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion" — "Lower Tier Covered Transactions," provided by the Department of Labor, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of Its principals. Each participant may, but is not required to, check the List of Parties Excluded from Procurement or Non- Procurement or Non-Procurement Programs. • 8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 9. Except for transactions authorized under Paragraph 8 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available, BETA may terminate this transaction for cause or default. • - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ___ -.Certification Regarding,Debarment,_SuSpension,_.and,_Other: Responsibility Matters Lower Tier Covered Transactions - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - • This certification is required b the regulations implementing Executive order q Y 9 P 9 12549, Debarment and Suspension, 29 CFR Part 98, Section 98,510, Participants' responsibilities. The regulations were published as Part VII of the May 26, 1988 Federal Register (pages 19160-19211). Before signing this certification, read the attached instructions, Attachment A, which are an integral part of the certification. (1) The prospective recipient of Federal Assistance funds certifies, by submission of this proposal, that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by an Federal department or agency. (2) Where the prospective recipient of Federal assistance funds is unable to _ -- - certify to any of the-- statements- in_a.th-is-->certinc3tion;----,such--=p�r-©s ective- __,.__ participant shall attach an explanation of this proposal. Contractor Name Name and Title of Authorized Representative Signature Date A bbtR,,a. CertieaLion Instructions for Com2Ietion of SFI L rLobbuiric Actiz,* es • This dis--loturt form :hall be completed by the reporting ffitit?', whether st:bavrard" or p--L-nc Fcdcra rrcipicnt, at the i:i:a5on or rec-ipt of a covered Frdu-al action, or a Sat=-!al change to ra prn-lous filing pursuant to title 31 U.S.C.,vectioa 1352. The fiting of a farm is r quired for tA--h paymcnt or a rt:ment L, =Ake payment to sny lobbying =tsty for fnnuena.Zg or attempting to i iDueaoe an officer or =ployr. rncy, a 1�r:cmber of Cangresa, an o'� �pl� Of Coagscaa, cr an employre of a Mrmber of Coo is u tOnneC:ti= with a rnve*ed Fde.ral a.^-tjoa. Ube the SF•I1.LA Continuation Shen for additional i^,io-,.,ation i the apacx on the fo m is izsadeuatc. Complete all item: that a for both the initial ,film chn.ti o:natioato the.implcmcnting guuidsnx P?I} g and ag tc + puhliahed by the Dffi� of .'vagemcat and Bud et fc 1. Idc.^.tify the type of cavmd Fedesal az-bon for whjzb lobbying a-- ty is and/or has bc- c�eci:.-ed Lo inQuease Lhe out==e of a eowrd Fdergl ^lion 2. 3d:.ctify the Status of the eav=td Fed---al &:tion. 3• Idcr '} the approp-tale classiri;ttio:, of ta.'s report, If this is a foliow,.:p caused by,,, ial change to the :So Wation prr•.•iously reported, cat:r the year snd t�uacrter in L�: chLngc oeeurrtd Enter tit dLL of...the Jos•,,-__r,-cvious}y.--su. ..� -. y- _�_ W-i = . �» T=ro B cztity i this cow:^ed Fedt.-al 4 Enter Ltic full rt-ne, add.-rss, city, state and sip code of the zips yng ent7:J. =.:chid C--ng-etsional Dlt--net, if lmoRn. Check the tarp ap::ate ela:s ;.$5on of the 4,-ig emtir L?, designates if it is, or expc:ts to be, a prit or subaa-ard renpi:nt, Idcnti�J the tie the t:'�akg.-des, e.g, the h.--st s::ba»a:des of L �hc p: e is L,1c It, r c ti:r. S::`aa�$.tea i_zlud zrt not ii^it:d to a::bco:,L-acti, aubg..Lnis, and caaL-&ct az.-a._1s t ndrs gl an�.a. �• If the a'9E_^izzti.^.n f—,in Lhe rrzc'. -_", item 4 Che"�e? •� ti. {peo nLWc, addl•�st, ei y, s:att a--id zip code of the rime Fedt al Cc::g-cssional Dis�-ict, ir>�:o�-:. 5 Ent:r tic ramie of the Fedcral agen:y ^zj=j-ig the gus.^d ar i:a^. �_:;t 1.z:lude a 1:tS: Dnt orgy^.i:x .�o^al Ic,�l below ag:n� ramie, it L-nvv, . Fro'. Px—JL= ;., t>..- r..� Sta�tzt Cr.Lst Gus:d. 7. ...tcr Lie Federal nx_ne or det---:ptirn fo- the CC -red Fed--al &c anL-n (its lj. v--::, en2c: Lht full Catalog of Fed�-al D=estic Assist.a.ac- (CFDA) nu�bc fa: g:t;,ta 1r=ns, aM-d IZ4LM �-^...;-. cntt. Bate: the Sort app ,,r.4te Fd---C ideayfy:.ng nu=bo--- aNm able fx the Fedt-al a_-tjx i.d--=.wed in ite= 1 (e.g., Request for P;apes� (pr?) n.�..bc I:.v;t-Ltizn fcr7 Bi-d [L--3) n=ber V�L:.t a.ZaotM--=e:.nt ==bcr, the con--&--t, twit, srr ID.&M au-a.-d numr�, th, a;.pli zition/propoLai cont:-oI numbs asai�e�. by the Fr-de-al _'Y)• Ia.lude p-e::zet, e.g . 9. For a d Fedcal action whce :h.•-t'h&s b-= ass awz.-d = 10Ln — t by the Fed---e ag:ncy, titer the Federal smo,.=t of th-" a%-ard/lain =--j==t fx the pri= entry identified in item 4 x S. Ar'r�'oYd OMB t?36g-0t 5 A:.• o::_;l f::Local R_ro<::.• as S�adrd F=m LZI.-A Ja), zthCJuD-nA=e, a s s, city, g-,&tc-Wld-;Zr�-CVdc.of th-e 1pbb % ty engage by the rtP0,:-Lin =titY id=tiEt-d in itt= 4 to iriDut=t the covtrtd Federal action. (b) Enter the full aunts of the in di Vid u al(s) performing a eni ct s, and in c2 u d c full ad d re if different from 10 W. Enter Last Name, First Name, smd Middle L-litipi (MI). 11. Enter the amount Of CO PenaRtion paid Or rrasonably expectA- to be pa3d by the rrpert- e=ity (item 4) to the lobbyir,& emtity (itrm 10). Indicate whetheT the pa),mtnt hl, (&=-,Al) or wU be made Check an boxes that appl mA. y. If this is a =t .� ch&, z rtpo.4 enter thLe Cu=u'&t*rft amount Of payment=LLde Or planned to be =&de. .12. Check the RPP-.v;r,-Ate box4es). Check all beams that apply. if payment is made through Contribution, vPccifY the nature and value of the in-kind payment 13. CSeck the approp7i&te box(ts). Check all bcLx_zl that apply. if eller,vpe=,f y t. natu,r 24. Provide a sPeCM.- a-rid detaBed dex=iption of the or-rek-its that the lobbyist has p.=fo�- .=td, '%-M be "'Pecte'd W PeTfOrin, and t2he date(&) Of any aezvices rendered. -r a:-& and related not just time spent Include e LE p p c in Actual contact withFederal OM,cljo&. Ide.n tify t Federal officials) OT C:nploycr(s) contacted Or the =ploytt(s), or.- Cong7tts thRt acre contacted. h th' -a-SF-=2.-A —1-----_: 15. The --70Y-ing OM:ir-I 9-'AB sC gn a-rid date the f=--, p-,Int h:tlh-- titIt, Rnd rtPC7-t'Ln9 bur den fD7 Lhis collection Of information is egrated to ave.-zgt 3:) =:ir.Utes ; time for rtNicV.-ing L*-Irt-ructions, stx:--h-ng c;ci;tLng data • =zillUdni-ng the d&ta needed, and c--=p)rt-,ng readle -i ng L colco-men:& regarding ic LI .1 of j:lfo—&tion. St.. ts*-4---A'L#4 or other arpezt of this =11t or =-4- r rtdu=Lng LI-1,:s burden, to tht office or V d Budg! P,-Dj t:1 (0348-DD45). W B.C. CERTIFICATION FOR CONTRACTS, GRA.>ti"I'S, LOANS, AND COOPERATIVE AGREEMENTS The undcrsignccd ccrtifiu,to the b= of his or bcr knowledge and belief,that: r (1) No Federal appropriated funds have be`n paid or will be paid, by or on b-half of the undersign-d, to any persDn for influencing or attcmpting to influence an Officer or Employe: of an Agency, a Member of Congress, an Officer or E.mployce of Congress, or an Employ= of a Member of Congress in connection with the awarding Of any Federal contract, the making of any Federal pant, the making of any Fcdcral loam the catering into zny coDperative ag;rmcn% and the ext=ion, continuation, rrn:wal, amendment, or modificaion of any Federal cone g *..at, loan, or cooperative E ^meat. iLr� ;ids ot}ie t1 -.Fr, :ral appropriated funds have been paid or �7I1 b` paid to any person for influencing or stte.rnpt,ng to influence an offic-r or cr.:ploye- of any agency, a Member of Congress, an Orijccr or Employee of Congress, or a.*t - ID Of a Member of Congr_ss in connection --,,-ith this Federal contract, grant., loa.^., or coDpera:ive agTYmcnt, the undersigned shall complete and submit Stsnda-d FDTP.- . T T T , "Disciosurc Form to Repo-Lobbying"in a_cord_-nc- V'it,J' its L�StIUCtlo�^.5. (3) The un3ers,igned shall regi.�ir.that �e IQ^�:pge of L^�s ce:-� be :�-� ,a.� the o ........._.. ::, award documents fDr all s,.tb-avrrds at all tics (including ss1xon:.-a�s, sub-g .-tts, and con:.-acts wader giants, loans, and coop, agrecm=nts) and&,It sub._cepienu sa:all ceiiify and disclose a=rdingly. This c-rtifI:Zt Dn is a material rerrestn arive of fact upon which relian wP.s placed v.•hen this =ars.action WES.-T,ade ar ent~•ed into. Submission of this ce-.iucation is a p.-rrcquisite for making or renting into this transaction imposed by Stction 1352, Title 31,U-S. Code- Any fails to file the rqui--d c-rntifi a ion Ate b` subj=to a civil p-ralry of not less than S10,000 and not nora than SI00,0D0 for r.z_-h such fail=-. Grant'-e.JCanziactor/prgR']•7R'lon 3Tt A Pro�,,Tltle Name of ceni�iny M=Bi Tati P:-int Na.-me and Sign `Note: In these inst:.nces, "aIl",in the Final Rule is -_xpected to be clarified to show that it applies to cov_r d contra_•-tlp-znt=r_-sar,ions over SI00,0D0 (per OMB). DISCLOSUI�£ OF LOBBYING ACTnrl=S Coctpir.c this form to discicsc lobbyLj activi�cs p:.^r,snt t.o 31 US.C. 1352 (src rry=st for public burdca di.srlc,;- c) - I.Type of Fcdy-al Anion: 2 S:aas of Fcdcal Anion 3.R.c po rt T ypc • i wr -t bidlof er/+,-r U=,icn b. g7ml faitiil filing s- coo'c=vt A;Ttc =l b isu:ul swi d d tauC:-W L`us�le d lots L Poo 4ww%l. For Marcia)Clanj, Qnly a ban F -=tsc ?' gw.ur f. h=irUU-=cc - t of,=ts;)ort — 4. Nr=wad A,dd.-=of Rcpo.^.irtf Sub"'873rc Tiff—if known: S. 1f Rcfa�Ers:iry it No.4 is"w&-dm Floc Nzmt an A o.Primc: Ca^f--.ssio ta!Disri:,If known: Co•^•gasianal Diz�i�tfk�►ow;^: 6. Fecal D=;-L.sscu�Agrny: 1. Fuca'Prog-a.-s Ns.'arJtJcs.--iptioa: C7rDA NL7nb% 9. Award A-mo=, if L"wn: l G. a. T:z-,:ar.'Addrers ofLt�5ying ^.ii,� b. lnd,ri::uls FcrforML-4 Scvixs (ir4L4=4 sir=if Of in ivi:::tl,las:flt^::,firs r.Z-,..M') difTc-;-:•from No. )Qs_) rz-4,f=nz:--,WoI (s)Sr' -A if ncxzsz^l) (A:s:h Caatirs:a ,or Sht:rj(s)SF.LLLA. if Psym.nt(chc-1 all L`.r apply): 13. Typu of Psy.enj(chtri afl s.L s,-p'ty): ems_sr.:::1 phrtncd;' :2 Fa t,of Piyr.:t;( i all t:s s;7h) b.o*4-;=c fa t rss, r-=""izzi= a_dcfarad e a;w i ochc,fig" l d. 5ricf "iptix of Sc-rixs Pcfor mx—,cc m be P-ewmgd sad Da:r(s)of 5c,-iac,in.:,s,,�..� (sue Costtinutix S'�'s)Sr-:1.I.,�!f>3�ry� Arrr-evt 6 by OMB 034t-0D46 tlt txiud fcr I.ccal R.-produt:iaa S:artdvd Form LIS-A DISCLOSURE OF LOBBYING Ar-nVIII,_,S (Continuation Sheet) Reporting Entity: Paz e,-- Page Approved by OMB 03e&4)U6 Avshacistd fc rLacal Fxp.--�mi= S=.,.AA"Fw=LLL-A .. .t..VB B YING.A CTl.VI,I'IE S . C pku the form to disclose lobbying s.ivi6es pursus."t to 31 US.0 1352 (sec nr for public burden disclosure) IS. Continu::ion Shect(s)SF•LL1.A touched: YES NO laformatios rsQvuled through this form h auWo rind by title 31 USC This disclosure e(labbrlag aczivit;c.s is a material disclosure of fad ps erhkb reG.sacs was Paced b7 tise tier abort its this trzas.setlo® bras made or eotcr� into. This 8isclosssrs t� retlulrt:d psrsagat to U.SG I332, 73is ha;ormstlos wM be rsporud is the Csagrsu s ml�ssanally aed Mtl be Qrallabk for public�spettlost. Amy person o►bc falls to tik tbt regakred dix-eksars ahaU be subject to a ei'rU pgaalry of not b=thsa S10,004 and set m•tx than SIDOPW for eneb nth falls+re.s _ = Signature Prins Na�c Title .1, . ,.._. Tdcphmx Ntra�cr -..- Dee _. t- --. i A;,prvvt. by OMB CU&-DO46 Authtxz=d fx I o=l Fv7o&=j= S=wd Fo.=LLLrA rLy �1llH JiHIUI-- b U-N eu=LIC ENTi'i'I L .K1!?L5 THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUSLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS . 1 . This sworn statement is submitted with Bid, Proposal or Contract No. for 2 . This sworn statement is submitted by (name of entity sub- whose business address is mitting sworn statement) an3 (if applicable) its Federal Employer Identification Number (FEIN) is ( If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement: 3 . My name is and my (please print name of individual signing) relationship to the entity named above is I understand that a "public entity crime" as defined in Paragraph 287 . 133 ( 1 ) ( g) , Florida Statutes means a violation of any state or federal law by a person with respect to and directly related to the transition of bus_ness with any public entity or with an agency or political subdivision of any other state or with the United States , including but not limited to, anv bid or contract for aDcds 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, co11L,sion, racketeering, conspiracy, or n-,ateria1 r,-. srepreser,tations . J I understandsthat "convicted" or "conviction" as defined in Paragraph 287 . 133 ( 1 ) (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, nonjury trial , or entry of a plea of guilty or nolo contendere . 5 . I understand that an "affiliate" as defined in Paragraph 267 . 133( l ) (a) , Florida Statutes , means : 1 . A predecessor or successor of a person convicted of a public entity crime; or • i 2 . An-.entity An- .6ntity under the" con�rol oLL 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 . per son,- 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 as an affiliate . i 7 . 'I understand that a "person" as defined in Paragraph 287 . 133 ( 1 ) ( c) , Florida Statutes , mears.....any .-.natura.1_.�.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 bids or applies to bid 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 Ithose officers , directors , executives , partners , shareholders, employees , members and agents who are active _. 1in- -the-- management of- an entity- 8. �Dased 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 a:-plies. ) ® Neither the entity submitting this Sworn S atement, nor any , nor any affiliate of the entity have � w :ti a stet a �: �� entity crime LJ�C11 A..11al�?u �'.1�..-1-_-a.l� �..�V�1�' ia. � subsequent to July 1 , 1969 . The entity submitting this sworn statement , or one or more of t_^.e officers , directors , executives , partner, si.arehclders e..:ployees , members , or agents who are active in management of the entity has been charged with or convicted of a public entity crime S'_IbDSe Ue:,t to July 1 , 1999, AND (Please indicate which additional statement applies . ) There has been a proceeding concerning the conviction before a hearing officer of she State of Florida, Division of Administrative Hearings . The final order entered by the hearing officer did not place the person cr affiliate on the convicted vendor list . (Please attach a copy of the final order. ) 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 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 not been placed on the convicted vendor list. (Please describe any action taken by or pending with the Department of General Services . ) ( signature) Date: STATE OF COUNTY OF PERSONALLY APPEARED BEFORE ME, the undersigned authority, who, after first being (name of individual signing) s_w,orn____by . me, _ affixed._._ hi_s/her sicnature, in _the_ space provided ._ . above on this day of i9 NOTARY P103LZC �`y com:Tission expl_"es Form PUR 7068 (Rev 11/89 ) OFFICE OF THE COUNTY ATTORNEY Please reply to: • Edward A. Dion BETA Legal Department County Attorney BROWARD COUNTY 3800 Inverrary Boulevard, Suite 400 Lauderhill, FL 33319 (954) 535-2341 • Fax (954) 535-2301 March 17, 2000 The Honorable Jim Cali, Mayor City of Dania 100 West Dania Beach Boulevard Dania FL 33004 Dear Mayor Cali: Enclosed please find: 1. Three (3) unexecuted copies of the summer youth program agreement between the Broward Employment and Training Administration and your organization or entity. 2. Federal Debarment Forms which when signed certify that your Sorganization or entity has not been barred from receiving federal funds or participating in a federally funded program. 3. Lobbying certificates, which when signed certify that the youth assigned to your organization or entity will not be engaged in partisan political activities while employed at your work sites. 4. A letter to be signed by your collective bargaining agent if your entity is a union shop indicating that the collective bargaining agent is aware of the summer program and that the assignment of the youth will not interfere with the collective bargaining agreements in place. Note that if your organization is not covered by collective bargaining then it is requested that the proper individual sign the letter indicating that the information requested is not applicable to your work site. 5. A resolution form indicating that the appropriate body for your organization has authorized entry into this agreement. This is a sample form. You are free to use your organization's resolution form or in the alternative to provide a copy of the minutes of the Board, Council, or Commission meeting at which entry into this agreement was authorized. Federal and State agencies do not need to provide a resolution form or minutes. BROWARD COUNTY BOARD OF COUNTY COMMISSIONERS—An Equal Opportunity Employer and Provider of Services Norman Abramowitz Scott I.Cowan Suzanne N.Gunzburger Kristin D.Jacobs Ilene Lieberman Lori Nance Parrish John E. Rodstrom,Jr. Visit us on the internet:www.broward.org/legal Transmittal Letter Summer Agreements 03/20/00 Page 2 The agreements should be signed, witnessed and dated. They should then be returned to the BETA Legal Department, at 3800 Inverrary Boulevard, Suite 400, Lauderhill, Florida 33319, along with one executed copy of the above listed forms. An original executed copy of the agreement will be returned to you after the authorized officials at BETA sign the agreement. Please be aware that no youth will be able to begin work until BETA and your organization have executed the documents. In addition to the above, the contract requires that organizations which are not self insured add BETA to their third party liability insurance policies as an additional insured. This generally does not result in any increase to the premium. A copy of a certificate of insurance indicating BETA has been added as an additional insured must be forwarded to the BETA Legal Department at the address provided on page one of this letter. Please feel free to direct any questions regarding the enclosed package to the BETA Legal Department at (954) 535-2341, or to rdaniels[cb-broward- workforce.org. Thank you for your attention to the above. We look forward to a productive and successful summer. Sincerely yours, Rochelle J. Daniels Assistant County Attorney RJD/vsu Attachments