ENGINEER OF RECORD FOR PUBLIC WORKS PROJECTS
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AGREEMENT
FOR
PROFESSIONAL SERVICES
~
This AGREEMENT is made and entered into on this (~t day of Bu..(j jt- , 19.:IK
by and between the City of Clearwater, Florida (CITY) and Parsons Engineering Science, Inc.
(ENGINEER)
WITNESSETH:
WHEREAS the CITY desires to engage the ENGINEER to perform certain professional services
pertinent to such work in accordance with this Agreement; and
WHEREAS the ENGINEER desires to provide such professional services in accordance with this
Agreement, and
WHEREAS the CITY selected the ENGINEER in accordance with the competitive selection
process described in Section 281.055 of the Florida Statutes, and based on information and
representations given by the ENGINEER in a proposal dated March 30, 1998.
NOW, THEREFORE, in consideration of the premises and the mutual benefits which will accrue
to the parties hereto in carrying out the terms of this Agreement, it is mutually understood and
agreed as follows:
1. GENERAL SCOPE OF TffiS AGREEMENT
The relationship of the ENGINEER to the CITY will be that of a professional consultant, and the
ENGINEER will provide the professional and technical services required under this Agreement in
accordance with acceptable engineering practices and ethical standards.
ENGINEER must have a fully staffed and operating office located within Pinellas County, and
preferably in the City of Clearwater or be willing to commit to "subcontracting" rninimwn 40% -
maximwn 49% (if job subcontracted) of the work to companies located within Pinellas County. The
selected company shall not necessarily be the only Fngineer-of-Record for the City.
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2. PROFESSIONAL TECHNICAL SERVICES
2A. It shall be the responsibility of the ENGINEE~ to work with and for the CITY toward
solutions to engineering problems and the approach or technique to be used toward
accomplishment of the CITY's objective for each project or assignment. The ENGINEER's
services shall include developing and presenting advisory opinions regarding the usefulness
and continued profitability of Water, Sewer and Stormwater Utility System facilities, the
sufficiency of the rates and charges for the System services, the proper maintenance of the
elements of the System and the design of capital improvements thereto; roads, drainage,
structural analysis, transportation, traffic, environmental and gas systems. Representative
assignment areas are expected to include, but not be limited to, planning, studies or design
services as listed below:
1. Preparation of construction drawings, specifications and bid documents for public works
projects, including but not limited to:
. structural engineering elements
. streets and roadways, including intersection improvements
. parking facilities
. utility infrastructure, including water, wastewater, natural gas, storm water and
reused water
2. land surveying activities, including title search, aerial target placement, topographic
surveys, right-of-way surveys, preparation of right-of-way control surveys, preparation
of right-of-way mapping/parcel descriptions/parcel sketches
3. architectural services
4. transportation improvement planning and studies, including Project Development &
Environment (PD&E) studies
5. appraisals of land under consideration for acquisition by the CITY
6. traffic operations activities, including traffic signal warrant analysis, safety studies,
preparation of traffic signal construction documents, preparation of pavement marking
and signing plans, assistance as needed with the implementation of timing plans for and
the operation of the City's Urban Traffic Signal Computer System
7. hazardous materials investigations, mitigation/remediation plans and associated tasks
8. management of construction contracts
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9. review and assessment of the applicability ofdesignlCITY improvements
10. development/preparation of grant applications for CITY projects
11. preparation of permit application packages, including water, wastewater, surface water
management, National Pollution Discharge Elimination System (NPDES), and wetland
impacts: assistance in meeting regulatory and grant requirements, permitting and
preparation of permit documents and representation of the CITY before appropriate
regulatory bodies
12. environmental audits, including evaluation of hazardous materials potential,
archeological or historical resources, impacts to threatened or endangered species
13. hydrauliclhyclrologic modeling ofstrearns, watersheds, etc.
14. development of wetland mitigation plans, including compliance monitoring
15. water quality monitoring, including report preparation
16. preparation and implementation of public involvement programs, including graphics
(presentation boards, slides, handouts, etc.)
17. studies related to stonnwater management, master planning, design and financing,
including stonnwater utility feasibility and implementation
18. studies related to rates, user charges and impact upon various agreements between the
CITY and its customers, suppliers and consultants
19. studies of recreational facility improvements, including expansion or improvements to
existing facilities as well as development of new facilities: includes possible preparation
of construction documents (including permits) and construction management
20. aviation services, including master planning and design of planned improvements
21. other work as may be reasonably required under the general scope of professional and
technical engineering services in connection with the CITY's public works/engineering
system.
2B. The ENGINEER's services under this Agreement will be provided under work Orders.
Generally, each Work Order will include the services for a single project or assignment, and
it will contain a mutually agreed-upon detailed scope of work, fee, invoicing method, and
schedule of performance in accordance with applicable fiscal and budgetary constraints.
Total. compensation for all services shall not exceed $10,00.0 per work Order unless
specifically authorized by the City Commission.
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2C. The ENGINEER shall maintain an adequate and competent staff of professionally qualified
personnel available to the CITY for the purpose of rendering the required engineering
services hereunder, and shall diligently execute the work to meet the completion time
established. .
2D. The CITY reserves the right to enter into contracts with other engineering firms for similar
services. The ENGINEER will, when directed to do so by the CITY, coordinate and work
with other engineering firms retained by the CITY.
3. PERIOD OF SERVICE
3A. The ENGINEER shall begin work promptly after receipt of a fully executed copy of each
Work Order, in accordance with Paragraph 2B above. Receipt of a fully executed Work
Order shall constitute written notice to proceed.
3B. If the ENGINEER's services called for under any Work Order are delayed for reasons
beyond the ENGINEER's control, the time ofperfonnance shall be adjusted as appropriate.
3C. It is the intent of the parties hereto that this Agreement continue in force until five (5) years
from the date of execution, subject to the provisions for termination contained herein.
Assignments that are in progress at the Contract termination date will be completed by the
ENGINEER unless specifically tenninated by the CITY.
4. INSURANCE REOUlREMENTS
4A. Workers Compensation and Employers Liability. The ENGINEER shall procure and
maintain, for the life of this Agreement, Workers Compensation Insurance covering all
employees with limits meeting all applicable state and federal laws. This coverage shall
include Employers Liability with limits meeting all applicable state and federal laws.
4B. General Liability. The ENGINEER shall procure and maintain, for the life of this
Agreement, General Liability Insurance. This coverage shall be on an "Occurrence" basis.
Coverage shall include Premises and Operations; Independent Contractors; Products and
completed Operations and Contractual Liability. Coverage shall be no more restrictive than
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the latest edition of the Commercial General Liability polices of the Insurance Services
Office (ISO).
This policy shall provide coverage for death. bodily injury, personal injury or property
damage that could arise directly or indirectly from the perfonnance of this Agreement.
The minimum limits of coverage shall be $500,000 per Occurrence Combined Single Limit
for Bodily Injury Liability and Property Damage Liability.
The CITY shall be included and identified as an Additional Insured under the
policy/certificate of insurance.
4C. Business Automobile Liability. The ENGINEER shall procure and maintain. for the life of
the Agreement, Business Automobile Liability Insurance.
The minimum limits of coverage shall be $500,000 per Occurrence Combined Single Limit
for Bodily Injury Liability and Property Damage Liability. This coverage shall be an "Any
Auto" type policy. Coverage shall be no more restrictive than the latest edition of the
Business Automobile Practices of the Insurance Services Office (ISO).
The CITY shall be included and identified as an Additional Insured under the
policy/certificate of insurance.
4D. Professional Liability Insurance. The ENGINEER shall procure and maintain for the life of
this Agreement, Professional Liability Insurance. This insurance shall provide coverage
against negligent acts, errors or omissions by the ENGINEER in the perfonnance of this
contract. The minimum limits of coverage shall be $1,000,000.
4E. Indemnify. In consideration of the sum of One Hundred Dollars ($100.00), the receipt and
sufficiency of which is acknowledged, payable as part of the first payment for services, the
ENGINEER agrees to defend, save and hold the CITY, its agents, assigns and employees,
harmless from all claims or causes of action, including costs and attorney's fees, and all
judgments whatsoever, involving personal injury, bodily injury, death, or property damage,
arising out of any negligent act or omission, or the violation of any federal, state or local law
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or regulations by the ENGINEER, its subcontractors, agents, assigns, invitees or employees
in connection with this Agreement. The ENGINEER agrees to indenmify and hold hannless
the City from losses, damages or lawsuits resulting from the ENGINEER's intentional
misconduct or intentional torts committed during the perfonnance of this contract.
4F. Hazardous Substances. It is understood and agreed that in seeking the professional services
of the ENGINEER under this Agreement, the CITY does not request the ENGINEER to
undertake uninsurable or potentially uninsurable obligations for the CITY's benefit involving
or related in any manner to hazardous substances. Therefore, the ENGINEER undertakes no
such obligation hereunder, and the CITY agrees to hold hannless, indemnify, and defend the
ENGINEER from and against any and all claims, losses, damages, liability, and costs
arising out of or in any way connected with the presence, discharge, release, or escape of
contaminants or hazardous substances of any kind, or environmental liability of any nature,
in any manner related to services perfonned by the ENGINEER under this Agreement.
4G. Supplemental Provisions. The insurance coverages and conditions afforded by the above-
mentioned policies shall not be suspended, voided, canceled or coverage reduced except after
thirty (30) days prior written notice by certified mail return receipt requested has been given
to both the City Engineer and the Risk Management Offices of the CITY.
Certificates of Insurance meeting the specific required insurance provisions specified within
this Contract/Agreement shall be forwarded to both the City Engineer and Risk Management
offices of the CITY and approved prior to the start of any work. After review, the
Certificate will be filed with the City Clerk as a part of the official contract file.
Receipt and acceptance of the ENGINEER Certificate of Insurance, or other similar
document does not constitute acceptance or approval of amounts or types of coverages which
may be less than required by this Agreement.
The City may, at its option, require a copy of the ENGINEER's Insurance Policy(s).
All insurance policies required within this contract shall provide full coverage from the first
dollar of exposure unless otherwise stipulated. No deductible will be accepted without prior
approval from the CITY.
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4H. Safety and Health Requirements. It is the ENGINEER'S sole duty to provide safe and
healthful working conditions to its employees on and about the site of Agreement
performance. The CIlY assumes no duty for supervision of the ENGINEER. The
ENGINEER will provide a "Drug Free" workplace in accordance with Section 287-987,
Florida Statutes.
The CIlY may, without any liability to ENGINEER, order that the work stop at the site of
Agreement Performance if a condition of inuned.iate danger to CIlY employees, CITY
equipment, citizens, or if property damage exists. This provision shall not shift
responsibility for any risk of loss for injuries or damage sustained from the ENGINEER to
the CI1Y, and the ENGINEER shall remain solely responsible for compliance with all safety
requirements and for the safety of all persons and property at the site of Agreement
Performance until the beginning of construction, which arise out of the ENGINEER"s
negligence.
The ENGINEER shall comply with the standards and regulations set forth by the
Occupational Safety and Health Administration (OSHA), the Florida Department of Labor
and Employment Security, and all other appropriate federal, state and local regulations or
City safety and health standards.
5. GENERAL CONSIDERATIONS
5A. All documents including field books, drawings, specifications, calculations, etc. supplied by
the ENGINEER shall become the property of the CI1Y. The CIlY acknowledges that such
documents are not intended or represented to be suitable for use by the CITY or others for
purposes other than those for which the documents are prepared. Any reuse of these
documents without written verification or adaptation by the ENGINEER for the specific
purpose intended will be at the CI1Y's sole risk without liability or legal exposure to the
ENGINEER.
5B. When authorized, the ENGINEER shall prepare a final estimate of probable construction
costs, following CITY approval of the bid documents and other prebid activities. The CITY
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hereby acknowledges that estimates of probable construction costs cannot be guaranteed, and
such estimates are not to be construed as a promise that designed facilities will not exceed a
cost limitation. Should the lowest, responsive and acceptable bid price received by the CITY
within three (3) months from the date of the CITY's approval of the bid documents exceed
the ENGINEER's final cost estimate by more than ten percent (10%), the ENGINEER shall
perform a detailed evaluation of the low bid. The evaluation will review the bid prices on a
line item bases, identifying areas of disagreement and providing a rationale for the difference.
5C. The ENGINEER will provide expert witnesses, if required, to testify in connection with any
suit at law. A supplemental agreement will be negotiated between the CITY and the
ENGINEER describing the services desired and providing a basis for compensation to the
ENGINEER.
50. Upon the ENGINEER's written request, the CITY will furnish or cause to be furnished such
reports, studies, instruments, documents, and other information as the ENGINEER and
CITY mutually deem necessary.
5E. The CITY and the ENGINEER each bind themselves and their successors, legal
representatives and assigns to the other party to this Agreement and to the partners,
successors, legal representatives and assigns of each other party, in respect to all covenants
of this Agreement; and, neither the CITY nor the ENGINEER will assign or transfer its
interest in this Agreement without consent of the other.
SF. The ENGINEER hereby agrees to indemnify, defend, save and hold harmless the CITY from
all claims, demands, liabilities and suits caused by any negligent act, error or omission of the
ENGINEER, the ENGINEER's subcontractors, agents or employees in rendering the
professional services called for herein. It is specifically understood and agreed, however,
that this indemnification agreement does not cover or indemnify the CITY for its own
negligence. The ENGINEER hereby further agrees to indemnify, defend, save and hold
harmless the CITY from any and all fines, costs, and expenses caused by, directly or
indirectly, with the ENGINEER's failure to comply with any applicable laws, statutes,
ordinances, or government regulations.
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5G. 1be ENGINEER agrees not to engage the services of any person or persons in the employ of
the CITY to an allied capacity, on either a full or part-time basis, on the date of the signing
of this Agreement, or during its tenn.
5H. Key personnel assigned to City projects by the ENGINEER shall not be removed from the
projects until alternate personnel acceptable to the CITY are approved in writing by the
CITY. Key personnel are identified as:
. Walid Hatoum. P.E.
. David Jones. P.E.
. John Martin A.1C.P.
. Tom Jones. P.E.
. Julia Schulten
51 The ENGINEER shall execute the appropriate State of Florida sworn statement under
Section 287. 133(3)(a), Florida Statutes, Public Entity Crimes prior to the execution of this
Agreement.
51. The ENGINEER shall attach a brief status report on the project(s) with each request for
payment.
5K. The ENGINEER shall provide a Certificate regarding a "Drug Free Workplace" per the
requirements of State of Florida directive: City Memorandum No. 23 (90-91) dated
December 17,1990, from George C. Banks, CPPO, Director, Division of Purchasing.
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6. COMPENSATION
6A. The ENGINEER shall be compensated for all services rendered under this Agreement in
accordance with the provisions of each Work Order, upon presentation of ENGINEER's
invoice. An hourly rate schedule and typical methods of compensation are attached hereto as
Exhibit A.
6B. Except as may be addressed in the initiating Work Order, the compensation for services shall
be invoiced by the ENGINEER and paid by the CIlY once each month. Such invoices shall
be due and payable upon receipt.
6C. The ENGINEER agrees to allow full and open inspection of payroll records and
expenditures in connection with hourly rate and cost plus fixed fee work assignments upon
request of the CI1Y.
7. PROHIBITION AGAINST CONTINGENT FEES
The ENGINEER warrants that it has not employed or retained any company or person, other
than a bona fide employee working solely for the ENGINEER, to solicit or secure this
Agreement and that it has not paid or agreed to pay any persons, company, corporation
individual or firm, other than a bona fide employee working for the ENGINEER any fee,
commission, percentage, gift, or any other consideration, contingent upon or resulting from
the award or making of this Agreement.
8. TERMINATION
This Agreement may be terminated by either party with seven (7) days prior written notice,
in the event of substantial failure to perform in accordance with the terms hereof by the other
party through no fault of the terminating party. If this Agreement is terminated, the
ENGINEER shall be paid in accordance with the provisions of outstanding Work Orders for
all work performed up to the date of termination.
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9. SUSPENSION. CANCELLATION OR ABANDONMENT
If the project described in any Work Order is suspended, canceled or abandoned by the
CITY, without affecting any other Work Order or this Agreement, the ENGINEER shall be
given vie (5) days prior written notice of such action and shall be compensated for
professional services provided up to the date of suspension, cancellation or abandonment.
This Agreement shall be administered and interpreted under the laws of the State of Florida.
10. TERMINATION OF CONVENIENCE
Either the CITY of the ENGINEER may terminate the Agreement at any time by giving
written notice to the other of such termination and specifying the effective date of such
termination at least thirty (30) days before said termination date. If the Agreement is
terminated by the CITY as provided herein, the ENGINEER will be paid for services
rendered through the date or termination.
IN WITNESS WHEREOF, the parties hereto have made and executed this Agreement on the
date and year above written.
PARSONS ENGINEERING SCIENCE, INC.
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WITNESS:
Biff'~ff '
Countersigned:
CITY OF CLEARWATER
~-
City Attorney
BY:~"" -
City c.nager _.
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C1.t C~_rk. . _.
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EXlDBIT A
PROVISION OF PAYMENT
BASIS FOR PAYMENT
The OWNER shall pay ENGINEER and ENGINEER agrees to accept as full compensation for its
services (as established by Work Order) compensation as computed by one of the following
methods.
METHOD A - COSTS TIMES MUTIPLIER BASIS
Compensation in the form of actual costs times a multiplier as determined by the following
formula:
Actual Raw Salary Cost x Multiplier + Subconsultant Cost + Other Direct Costs
Multiplier 2.96 includes fringe benefit rate, overhead, operating margin and profit and is
subject to annual review.
Subconsultant Costs are actual costs incurred times a factor of 1.00. Actual costs shall be
based on billing rates for required labor classifications.
Other Direct Costs are actual costs incurred for travel outside of Tampa Bay area, printing,
copying, long distance telephone calls, etc., times a factor of 1.00.
METHOD B - LUMP SUM
Compensation in the form of "lump sum" shall be determined by mutual agreement between the
ENGINEER and the CIlY. The lump sum amount shall be negotiated based upon a scope of
services developed by the ENGINEER and approved by the CIlY.
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Aon Risk Services, Inc. of Southern California
707 Wilshire Boulevard, Suite 6000
Los Angeles, California 90017
(213) 630-3200
CODE SUB-CODE
INSURED
Parsons Engineering Science, Inc.
100 West Walnut Street
Pasadena, CA 91124
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ISSUE DATE (MMlDDIYY)
7/2/98
..,,,,,~..,
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO
RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BElOW
COMPANIES AFFORDING COVERAGE
COfII'Nf'(
lETTER A National Union Fire Insurance Company
COfII'Nf'(
lETTER B Continental Casualty Company
COMPNf'( C
lETTER
COfII'Nf'(
lETTER D
~Nf'( E
lETTER ATTACHMENTS (IF ANY) ON SECOND PAGE
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOlVloffHSTANDING AtN REQUIREMENT, TERM OR CONDmON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS, AND CONDITIONS OF SUCH POLICIES. THE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
co TYPE OF INSURANCE POLICY NUMBER POllCYEFFECTlVE POUCYEXPIRATlON ALL LIMITS IN THOUSANDS
l TR DATE (MMIDDIYY) OA TE (MMIDDIYY)
A
GENERAL LIABILITY
Ii2I COMMERCIAl GENERAl UABllITY
o ClAIMS MADE !ill OCCURRENCE
o OIMlERS & CONtRACTORS PROTECT1\IE
RMGL83361 01 CLR
1/1/98
1/1/99
GaERAl AGGREGATE
PROOUCTS-COUPIOPS AGGREGATE
500
B
o
o
AUTOMOBILE LIABILITY
IilJ Nf'( AUTO
!ill AlL 0\M0lED AUTOS
IilJ SCHEDUlED AUTll6
IilJ HIRED AUTOS
IilJ ~AUTOS
o GARAGE UAIllllTY
o
EXCESS LIABILITY
o ~FORII
o OllER lHAN lMlRBJ.A FORM
BUA 188900387
BUA 188899435- TX
$
$
$
$
$
$
PeRSONAl & AD\IERT1SING INJURY
EACH OCCURRENCE
FRE DAMAGE (ANY ONE FIRE)
IEDlCAl EXPENSE (ANY ONE PERSON)
500
B
WORKERS' COt*ENSA TION
AND
EMPLOYERS'LIABILITY
WC188900356
WC188900339- WI & OR
1/1/98
1/1/99
CSL
500
A
OTHER
PROFESSIONAL UA8IUTY
RMGLCM8336102E
IIOOIl. Y INJURY
(l'ER PERSON)
IIOOIl. Y INJURY
(l'ER ACCIDENT)
PROPERTY DAMAGE
111/98
1/1/99
1,000 (EACH ACCIDENT)
1,000 (OISEASE POUCY UIMT)
1,000 (OISEASE EACH EMPlOYEE)
EACH AGGREGATE
OCCURRENCE
$ $
$
1{E~r". 1~":~>lj~
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~ .........;'0. ,~~ :"ov~~...~t:J
$
$
$
1/1/98
1/1/99
1,000
1,000
EACH CLAIM
AGGREGATE
DESCRIPTION OF OPERA TIONSlLOCA T1QNSNEHICLESlRESTRICTIONSlSPECIAL ITEMS:
Re: PES-Tampa - Professional Services.
See attached Additonallnsured (ops), Conlradual Uability (con), and Notice c:l Cancellation (30) clauses.
'C
City of Clearwater
City Engineers
100 S. Myrtle Avenue, 2nd Floor
Clearwater, FL33756-5520
Attn: Ms. Mashid Arasgeh
ACORD 25-5 (3/88) , ..
PES F0R220 2196
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES.
AUTHOR~DREPRESENTATlVE
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SPECIAL CLAUSES ATTACHING TO CERTIFICATE OF INSURANCE
(ACORD FORM 25-S)
Cerlificate Holder:
City of Clearwater
City Engineers
100 S. Myrtle Avenue, 2nd Floor
Clearwater, FL 33756-5520
PES FOR220 2196
Additional Insured (OPS):
Except as respects Workers' Compensation and solely as respects work performed by the named insured, the Certificate Holder is included as an
additional insured but only to the extent of the named insured's negligence.
Cancellation Notice (NOC):
It is agreed that, in the event of cancellation or material change in the aforementioned policy(ies), the Certificate Holder shall be given thirty (30)
days prior written notice except for non-payment of premium, ten (10) days prior notice shall be provided.
Contractual Liability (CON):
General Liability includes Contractual Liability (insurance is available only to the extent provided by the policy).
.- -or:.' .
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SWORN STATEMENT PURSUANT TO SEcrION 287.133(3)(8),
FLORIDA ~ATUTES.. ON PUBUC ENTI1Y CRIMES
THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBUC OR OTHER
OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
1.
This swom statement is submined to
City of Clearwater
[print name or the public entity)
by
[print IDdh1dual's name and title)
for Parsons Engineering Science, Inc.
[print name or endt)' submitting sworn s~temeDt]
whose business address is
2901 W. Busch Boulevard, Suite 905
Tampa, FL 33618
and (if applicable) its Federal Employer Identification Number (FEIN) is
(If the entity has no FEIN, include the Soda! Security Number of the individual signing this
95-3047593
swom statement:
.) .
2 I understand that a -public entity crime- as defined in Paragraph 287.133(1)(g), Florida Statutes. means a
violation of any state or 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, includiilg, but not limited to, any bid or contract Cor 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, bn1>ery, collusion, racketeering, conspiracy, or material misrepresentation.
3. I understand that -convicted- or -collViction- 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 enuy of a plea of guilty or nolo contendere.
4. I understand that an -affiliate- as defined in Paragraph 287.133(1)(a), Florida Statutes. means:
1. A predecessor or successor of a person convicted of a public entity aime; 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 ot a public entity crime. The term -atfiliate- 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 constitu.ting a conttolling 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 fade case that one person conttols another person. A person who knowingly
enters into a joint venture with a person who bas been oonvic:ted of a public entity crime in Rorida during
the preceding 36 months shall be oonsidered an affiliate. .
s. I understand that a -person- as defined in Paragraph 287. 133(1) (e), Florida Statutes. means any natural
person or entity organized under the laws ot any state or of the United States with the legal power to enter
into a binding oontract and which bids or applies to bid on contracts for the provision of goods or servi~
let by a public entity. or which otherwise transacts or applies to transact business with a public entity. The
term -person- includes those officers, direc:tOn, executives, panners, shareholders, employees, members, and
agents who are active in management ot an entity. .
6. Based on information and belief, the statement which I:havc marked below is true in relation to the entity
submitting this sworn statTent. . [indicate which statement appUes.] ~ .
xx Neither the entity submitting this sworn statement, nor any of its officers, directors, cxecuth-e:s,
partners, shareholders, employees, members, or agents who are active in the management of the entity, nor
any affiliate at the entity bas been charged with and convicted of a public entity crime subsequent to July
1, 1989.
_ The entity submitting this sworn statement, Qr one or more of its officers, directors, executives,
panners, shareholders, employees, members, or agents who are active in the management of the entity, or
an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July
1, 1989.
_ The entity submitting this sworn statement, or one or more of its officers, directors, executives,
partners, shareholders, employees, members, or agents who are active in the management of the entity, or
an affWate of the entity has been charged with and convicted of ~ public entity crime subsequent to July
1, 1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida,
Division of Administrative Hearings and the Fmal Order entered by the Hearing Officer determined that
it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor
Ust. [attach a cop)' of the tIDal order]
I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACl1NG OFFICER FOR THE
PUBUC ENTITY m~n!ilJ:ill IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBUC ENTITY ONLY AL"ffi,
THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED.
I ALSO UNDERSTAND THAT I AM REQurREn TO INFORM THE PUBUC ENTIn PRIOR TO ENTERING
INTO A CONTRACl" IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SEcrION 287.011, FLORIDA
STATUTES FOR CATEGORY 'lW0 OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORr.'\f.
.cr Q[~
Sworn to and subscribed before me this
~f)-IIJ day of
;tuJ~~
71)LLI1ih)fl';jIlbJiIJ {!MC/Mf
.1998 .
Personally known
%
(Type of identification)
Nowy .~. .
l !*: ~ MY COMMISSION , CC 5ll6021
f EXPIRES: June 30. 3lOO
My co TIInI NoWy PubIc lhIIrwlllIllI
/ll1t.#ELE E/IZA6€77.J C/I,mjJbell
(Printed typed or stamped
commissioned name of nowy public)
OR Produced identification
Form PUR 7068 (Rev. 06/11J92)