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Florida Blacktop, Inc.BID BOND KNOW ALL MEN BY THESE PRESENTS, that we, Florida Blacktop, Inc. as PrillCipal and United States Fire Insurance Company , as Surety, are held and firmly bound unto the City of Okeechobee (the "City"), in the penal sum of $ 5% of Amount Bid lawful money of the United States, for the payment of which sum, well and truly to be made, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally, firmly by these presents. THE CONDITION OF THE OBLIGATION IS SUCH, that whereas the Principal has submitted the accompanying bid, dated october22 , 20� for the Contract Documents: Contract Title: SOUTHEAST 3RD AVENUE PAVEMENT IMPROVEMENTS Contract Number: PW 05-10-09-20 NOW, THEREFORE, 1. If the Principal, a. Within seven (7) business days after the date of the Notice of Apparent Low Bidder, provides a Statutory Payment Bond and a Common Law Performance Bond as specified in the General Terms & Conditions or, in lieu of the Statutory Payment Bond or Common Law Performance Bond, provides an alternate form of security as specified in the Contract Documents; and provides the insurance certificate required under the Contract Documents, completed by a lawfully authorized insurance agent; and b. Within seven (7) business days of receipt of the Contract Documents, enters into a written contract with the City, in accordance with the Bid, as accepted, then the above obligations of the Principal and Surety shall be null and void. 2. However, should the Principal fail to fully comply with the conditions of paragraph 1 above, then the Principal and Surety, jointly and severally, shall be liable to the City for the full penal sum of this Bond which shall be forFeited to the City as liquidated damage, but not a penalty, as a result of the Principal's failure to comply with the bid instructions and conditions, regardless of whether the City ultimately decides to change the project requirements or resolicit bids. 3. The remedies provided herein are not to be construed as the City's exclusive remedies for the Principal's failure to enter into a contract with the City but shall be deemed supplemental to all remedies available to the City at law or otherwise. City of Okeechobee Project No. PW 05-10-09-20 Public Works Department 16 DATED ON October 22 I��1 FOR NON-CORPORATE BIDDERS: (Witness) By: (Signature of Principal) (Print Name) (Print Name and Title) (Witness) (Print Name) FOR CORPORATE BIDDERS: Blacktop, Inc. �_� As per Attached Power of Attorney Secretary Business Address (Sig.r�fure of Corpor te Princ�pal) i, r / v�J/�J Il E�Jii � `� • (Print Name and Title) 1287 West Atlantic Boulevard Pompano Beach, FL 33069 Business Address Unit ta s Fire Insurance Company � �J, �!�!a orporate Surety) � � �� Jarrett Merlucci, Attorney In Fact %� �� (Print Name and Title) "+�� 305 Madison Avenue Morristown, NJ 07960 Business Address 8000 Governors Square Blvd., Suite 101 Miami Lakes, FL 33016 Florida Address for Service of Process (305)722-2663 Telephone Number (Surety shall provide evidence of signature authority such as a certified copy of Power of Attorney. City of Okeechobee Project No. PW 05-10-09-20 Public Works Department 17 SURETY: ATTEST: % ,,(�Corporate Seal) POWCROTATTORNEY UNITED STATES FIRE [NSi1RANCE COMPANY PR[NCIPAL OFF[CC-MORRISTOWN, NEW JCRSEY KNOW ALL MEN BY THESE PRESENTS: That United States Fire Insurance Company, a corporation duly organi-r�ed and existing under the laws of thestate of Delawaze, has made, constituted a�id appointed, �id does hereby make, constitute and appoint: /nn A. Nipper, Davit! Russell Koover, Joseph Penichet Nielson, Chnrles Dnvi�! Nielson, Chnr/es Jackson Nielson, Shawn Alan Burton, Jarrett Merlucci each, its true and lawful Attomey(s}In-Fact, with fidl power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver: Any and all bonds and undertakings of surery and other documents that the ordinary course ofsurety business may require, and to bind United States Fire Insurance Company thereby as fully and to the same extent as if such bonds or undertakings had bcen duly executed a�id acknowledged by the regularly elected o�icers of United States Fire Insurance Company at its principal oflice, in a�nounts or penalties not exceeding: Seven Million, �ive Hundred Thousand Dollars ($7,500,000). This Power ofAttorney limits the act ofthose na�ned therein to the bonds and undertakings specifically named therein, and they have no authority to bind United States Fire Insura�ice Company except in the ma�mer and to the extent therein stated. This Power ofAttomey revokes all previous Powers ofAttomey issued on behalfofthe Attomeys-In-Fact named above and expires on January 31, 2021. This Power of Attomey is granted pursuant to Article N ofthe By-Laws of United States �ire Insurance Company as now in full force and efTect, and consistent with Article ID thereo� which Articles provide, in pertinent part: Article IV, Execution of Instruments - Except as the Boazd ofDirectors may authorize by resolution, the Chainnan ofthe Board, President, any Vice-President, a�iy Assistant Vice President, the Secretary, or any Assistant Secretary shall have power on behalf ofthe Coiporation: (a) to execute, atHx the wrporate seal manually or by ficsimile to, acknowledge, verify and deliver any contracts, obligations, instruments and documents whatsoever in connection with its business including, without limiting the toregoing, any bonds, guarantees, undertal:ings, recogni-rances, powers ofattomey or revocations ofany powers ofattomey, stipulations, policies ofinsurance, dceds, leases, mortgages, releases, satis&ctions and agency agreements; (b) to appoint, in writing, one or more persons for any or all ofthe purposes mentioned in the preceding paragraph (a), including affixing the seal ofthe Co�poration. Article III, Ofiicers, Section 3. ] I, Facsimile Signatures. The signature of any o(ficer authorized by the Corporation to sign any bonds, guazantees, undertakings, recognizances, stipulations, powers of attorney or revocations of any powers ofattomey and policies ofinsurance issued by the Corporation may be printed, lacsimile, lithographcd or othenvise produced. In addition, if and as authorized by the Boazd of Directors, dividend wamar�ts or checks, or other nwnerous instruments similar to one another in form, may be signed by the tacsimile signature or signatures, Iithographed or otherwise produced, oY'such officer or otiicers of the Corporation as from time to time may be authorized to sign such instruments on behalf of the Corporation. The Corporation may continue to use for the purposes herein stated the facsimile signature of any person or persons who shall have been such olTcer or officers ofthe Corporation, notwithstanding the fact that he may have a;ased to be such at the time when such instruments shall be issu�i. IN WITNESS WHEREOF, United States Fire Insurance Company has caused these presents to be signed and attested by its appropriate ot6cer and its corporate seal hereunto aifixc� this 22"� day ofAugust 2019. �� State of Pennsylvania } Cowrty of Philadelphia } UNITED STATES FIRE INSL�RANCE COMPANY � ,. /� � �/�, . \ � Anthony R. Slimowicz, Executive Vice President 00927402020 On this 22"d day of August 2019, before me, a Notary public of the State of Pennsylvania, came the above named officer of United States Fire Insurance Company, to mc personally known to be the individual and officer described herein, and acknowledged that he executed the foregoing instrument and affixed the seal of United States Fire [nsurance Company thereto by the authority of his office. Commonwealth oi Pen nsylvan ia — Nota ry Seal Tamara Wutkins, Notary Public Philadelphia County My commission ex pims August 22, 2023 Commission number 1348843 ✓ / Ah'YIAJ�-P� �^' � "_ """"Y Tamara Watkins (Notary Public) l, the undersigned officer of United States Fire Insivance Company, a Delaware corporation, do hereby certify that the original Power ofAttorney of which the foregoing is a full, true and correct copy is still in foroe and effect and has not been revoked. 22ud Oct. 20 IN �YITNFSS W FICREO F, 1 have hereunto set my liandand affixedthe corporate seal of United States Pire [nsurance Company on tl�e day of 20 C� � �` �� .� UNI'[ED STATFS FIRE INSURANCECOMPANY i I I.'�{ . l,',i`\ � , �� ` `�� ` ' . AI Wright, Senior Vice President EXHIBIT B BID UNIT PRICE SCHEDULE PW 05-10-09-20 SOUTHEAST 3RD AVENUE PAVEMENT IMPROVEMENTS UNIT ESTIMATED UNIT ITEM NO. DESCRIPTION MEASURE G2UANTITY PRIC AMOUNT E 1 MOBILIZATION / DEMOBILIZATION S M 1 ��GQ�. � � (% ' , 2 MAINTENANCE OF TRAFFIC LUMP � �, � S�M � �r ��r� �5-� -�� 3 INLET PROTECTION SYSTEM EACH 10 ��,:�� •,y•� . MILL EXISTING ASPHALTIC SQUARE 4 PAVEMENT, YARD 8742 � �j� � � 1" AVERAGE DEPTH 7 �/�'��' �� SUPERPAVE ASPHALT�C 5 CONCRETE, TON 750 l�d. � �5-Q�� y TRAFFIC C SP-9.5 � REMOVAL OF EXISTING LUMP 6 SIDEWALK, CURB AND GUTTER SUM � �� 5�� <vo� SIDEWALK CURB AND RAMP, 7 FDOT INDEX 304, CR-F EACH 10 fs"�� r�/�. t��j 8 DETECTABLE VWVARNING MAT - SQUARE 200 ��'.' ' t BRICK RED FOOT �� I � �� TOTAL BID AMOUNT �1 Based on Bid Unit Prices & Estimated Quantities �S� 17�� City of Okeechobee Project No. PW 05-10-09-20 Pubiic Works Department 42 Bidders Company Name Florida Blacktop, Inc. NOTE: This Bid is on a unit price basis. The total estimated amount is for Bid comparison purposes only. The Contractor should field verify the actual site conditions prior to time of bidding and before submitting the Bid proposal. The Contractor should read the special conditions and the requirements for insurance before submitting a Bid proposal. The Contractor should verify the quantities to be included in the construction contract. The Contractor shall furnish the City of Okeechobee with a Payment and Performance Bond in 100 percent (100%) of the total estimated amount of the contract. The Payment and Performance Bond shall continue in effect for one (1) year after completion and acceptance of the work as guarantee against construction defects. The Contractor in his Bid shall include the cost of said bond. I have attached the required 5 percent (5%} Bid Security to this Bid. c. rida Blacktop, I Date:10/22/2020 ny Name) : Elias Shaouy — (Printed Name) Title: President Emai1: leeshaouy@gmail.com Mailing Address: 1287 West Atlantic Blvd. Pompano Beach, FL 33069 Office Number: 954-943-9700 City of Okeechobee Public Works Department Fax Number: 954-943-�222 Project No. PW 05-10-09-20 43 BID BOND KNOW ALL MEN BY THESE PRESENTS, that we, Florida Biacktop, Inc. as PrinCipal and United States Fire Insurance Company , as Surety, are held and firmly bound unto the City of Okeechobee (the "City"), in the penal sum of $ 5% of Amount Bid lawful money of the United States, for the payment of which sum, well and truly to be made, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severaily, firmly by these presents. THE CONDITION OF THE OBLIGATION IS SUCH, that whereas the Principal has submitted the accompanying bid, dated October 22 , 20� for the Contract Documents: Contract Title: Con#ract Number: NOW, THEREFORE, 1. If the Principal, SOUTHEAST 3RD AVENUE PAVEMENT IMPROVEMENTS PW 05-10-09-20 a. Within seven (7) business days after the date of the Notice of Apparent Low Bidder, provides a Statutory Payment Bond and a Common Law Performance Bond as specified in the General Terms & Conditions or, in lieu of the Statutory Payment Bond or Common Law Performance Bond, provides an alternate form of security as specified in the Contract Documents; and provides the insurance certificate required under the Contract Docurnents, completed by a lawfully authorized insurance agent; and b. Within seven (7) business days of receipt of the Contract Documents, enters into a written contract with the City, in accordance with the Bid, as accepted, then the above obligations of the Principal and Surety shall be null and void. 2. However, should the Principal fail to fully comply with the conditions of paragraph 1 above, then the Principal and Surety, jointly and severally, shall be liable to the City for the full penal sum of this Bond which shall be forfeited to the City as liquidated damage, but not a penalty, as a result of the Principal's failure to comply with the bid instructions and conditions, regardless of whether the City ultimately decides to change the project requirements or resolicit bids. 3. The remedies provided herein are not to be construed as the City's exclusive remedies for the Principal's failure to enter into a contract with the City but shall be deemed supplemental to all remedies available to the City at law or otherwise. City of Okeechobee Project No. PW 05-10-09-20 Public Works Department 16 DATED ON October 22 FOR NON-CORPORATE BIDDERS: (Witness) (Print Name) (Witness) (Print Name) FOR CORPORATE BIDDERS: z SURETY: ATTEST' - ;: (Corporate Seal) As per Attached Power of Attorney Secretary �► � By: (Signature of Principai) (Print Name and Titie) Business Address FIoP'tda Blacktop, Inc. ,� ,, .�%, _.% 1 '(�.�aafure of Corpor te Princ,�pal) � � r� � :" /i%—•"� .�''^, r..�•:..''�,�'iv%� .,d_t,. � ( s (Print Name and Title) 1287 West Atlantic Boulevard Pompano Beach, FL 33069 Business Address Unit ta s Fire h�sura� nrt ce Com�an� � �sr� �� orporate Surety) � �� Jarrett Merlucci, Attorney In Fact (Print Name and Title) �''�a�..,�.•* 305 Madison Avenue Morristown, NJ 07960 Business Address 8000 Governors Square Blvd., Suite 101 Miami Lakes, FL 33016 Florida Address for Service of Process (305)722-2663 Telephone Number (Surety shall provide evidence of signature authority such as a certified copy of Power of Attorney. City of Okeechobee Project No. PW 05-10-09-20 Public Works Department 17 PO�i'F.R OF:ITTOR\1:1' UNITF.DS7'A'PES FIRE IVSt�RANCE COMPANY PRWCIPAI. OI'FICF. - �IORRIS'1'O�Vti, NEW JERSEI' KNOW ALL MEA� SY THESE PRESENTS: That United States Pire Insur.uic� Cumpam. a corporation duly orgmii�d and existing under thc la��_5 of thastate of Delaw�aza, has made, constituted a�id appointed, and does hereby mal:e, constituteand appoint: Inn A. Nrpper, Drevid Russell Hoo��er, Josepl� Penicl:d Nielson, Charles Dnvid Nrelson, Chnrles Jackson Nelson, Shnw�r Alan Burlou, Jnrret� Merlucci each, its true and lawlid Attomey(s}G�-Pact, rvith fuil power and authority hereby conferred in its name, piace and stead, to exe�utz, acknowledge and deliver: Any and all bonds ;md midertal:ings of surary and other documents that the ordinary wurse ofsurety business may require, and to bind United States Fire Insurance Company thereby as fuUy and to the sa�ne extent as if such bonds or undertai:ings had boen duly e�ecuted and acknowledged by the regulazly elected oflicers of Unifed Statcs Pire Insurance Company at its principal of�ce, in �vnounts or penalties not excceding: Seven Million, Five Hundred Thousand Dollars ($7,500,000). "f his Po�ver of Attorney timits the act of those name�cl therein to the bonds �nd undertal:ings specific:aily na�ned therein, and they have no authority to bind United States Pire Insuruue Compa�ry except in the manner and to the e�tent therein statc�l. "I'his Power ofAttorney revokes all previous Powers ofAttorncy issuecl on behalfofthe Attorneys-Li-Fact named above a�id expires on January 31, 2021. This Power oYAttomey is granted pursuant to Article IV of the Br�-Laws of United States Fira Insurance Company as no�v in full force and ef%ct, and consistent with Article 1(! therw� �a�hich Articies provide, in pertinent part: Artide IV, Esecution of Instruments - Except as the Board ofDirecrors may authori-rc by rc�olution, [he Cliairman ofthe 13oard, Prc�sident. �my Vice-President, any Assistant Vice President, the S��cretary, or a��y Assista�it Sc;cretary shall have power on behatf ofthe Cor�wration: (a) to e�ecute, aHix the corporate seal manualty or by facsimile to, acknowiedge, verify and deliver any contmcts, obligations, instruments and documents �vhatsoever in conn��ction with its busin��ss inciuding, without limiting the foregoing, any bonds, guar�rtee5, underttil:ings, recognizances, powers ofattomey or re�-ocations ofany poH�ers ofattomey, stipulations, policies ofinsur<mce, deeds, Ic:ases, mortgages, releases, saus�actions and agency agr�ments: (U) to appaiiit, in �+�riiing, one or more persons tor any or all ofthe puiposes mentioned in che preceding paragrapli (a), induding at6xing the seal ofthe Corporation. Article IIt, ONicers, Section 3.1 I, ['1�imilc Signatures. The signature of any olficer authorized by the Corporation to sign any bonds, guatantees, undertakiugs, r��cogni7ances, stipulations, �owers of �ttomey or revocations ofany powers ofattomey and policies ofinsura�ice issueci by the Corporation may be pnnted, lacsimile, lithograph�l or othenvise produced. In addition, il and as authori-r�d by tl�e Boazd of Directors, dividend warrNus or checks, or other numerous instruments similar to one another in bnn; may be signeci by the �esimile signature or signatur��s, ]ithographed or othenvise produced, ofsuch o�icer or ot6ars ofthe Corporation as from time to time may be authorizzd to sign such instruments on behalfofthe Corporation. The Corporation may continue to use Sor the purposes herein stated the �csimile signature of any person or persons �+ho shall have been sudi olRcer or otiicers ofthe Corporation, notwitl�standing the 4�ct that he may have ceas�ci to be such at the time when such instruments shail be issucct. IN WITNF.SS �VHGREOT, Unitui States Fire Insurance Compa�iy has caused these presents to Ue siened and attested by its appropriate o119cer and its wrporate seal hereunto aflix� this 22"� day ofAugust 2019. U\ITED STATES F1RE IhSI!RANCE COMPAIYY s°i�''�`,�,��,, a s °"n4r ,�` w.,..• StateoCPennsylva�iia J Cowrty of I'hiladelphia ; J� . ,.�:,, Anthony R. Slimowicz, Executivc Vice President 00927402020 On this 22°`� day of Augus[ 2019, before me, a Notary pubGc of the State of Pennsylvania, came the above named of6cer of United States Fire Insurance Company, to me personally kno�tin to be the individual snd oPficer described lierein. and ackno�vledged tliat he esecuted the foregoing instrument and affixed the seal of United States Fire ]nsivance Company thereto by tlte authority of his office. Commonwealth ofPennsylvania—NotsirySeal Tamarn Watkins, Notary 1'ublic Philadelphia County My commission ex pires August 22, 2023 Commission numbcr 1348843 <��A-VVt.�U-e�— -ul ��`-'-"� Tamara Watkins (Notary Public) I, the undersigned oft7cer o f UnitcdStates Pirc Insurance Company, a Del��vare corporalion, do l�ereby certiFy thaYthe ori�inal Povys;r oFAttorney of �d�ich the foregoing is a f'ull, true and correct copy is still in force and ePf'ect and has not been revoked. 22nd Oct 20 ►y W 17NL:SS VVFIERP:O F, [ have herewito set my handand affixedthe corporate seal of United States Fire tasurance Company on the day of 20 ��,� UN17ED S'IA7�S FIRE INSURANCECO1�iP.4NY %, / , 1 i, �� %� i {l i 1 �. -J : ', 9'. _ r't'� ' Al Wright,Senior Vicc Presideni SECTION III PW 05-10-09-20 BID DOCUMENTATION Florida Blacktop, Inc. (BIDDER'S COMPANY NAME) City COUt1Cil City of Okeechobee 55 S.E. 3rd Avenue Okeechobee, FL 34974 I have received the documents titled SOUTHEAST 3RD AVE(VUE PAVEMENT IMPROVEMENTS Pro'ect No. PW 05-10-09-20. I have also received addendum number through �_ and have included these provisions in my Bid. I have examined both the Bid documents and the construction site and submit the following Bid in which I agree: �� 3 � To hold my Bid open until an agreement has been executed between the City of Okeechobee and accepted Bidder, or until ninety (90) days after Bids are opened, whichever is longer. Regarding the Disposition of Bid Security: to accept the provisions of the Instructions to the Bidders. To accomplish the work included in, and in accordance with the Contract Documents, if this Bid is accepted. To start work within 30 calendar days from the Notice to Proceed and there after completing the work within 30 calendar days of commencement of work. 5. Regarding Compensation for the proposed work: if this Bid is accepted, I will construct this project on a unit price basis as reflected in the Bid Unit Price Schedule, Exhibit B of this agreement. Payment will be made upon invoice after completion of all work. NOTE: The City shall not be liable to pay interest on any unpaid balance. Vendor is solely responsible for all taxes, withholding, or social security obligations. 6. Regarding the Award of the Contract: if I am awarded a contract for this project, I understand that the award may be for all or any portion thereof, of the items listed under the Bid Unit Price Schedule. Bidder:Florida Blacktop, Inc. City of Okeechobee Public Works Department Date:10/22/2020 Project No. PW 05-10-09-20 � (Printed Name) Title: President Email: leeshaouy@gmail.com Mailing Address:1287 West Atlantic Blvd. Pompano Beach, FL 33069 Office Number: 954-943-9700 City of Okeechobee Public Works Department Fax Number: 954-943-9222 Project No. PW 05-10-09-2Q Elias Shaouy SECTION IV PW 05-10-09-20 MINIMUM QUALIFICATIONS FOR BIDDERS Minimum Qualifications: 1.0 Experience 1.1 Bidder must have at least 3 years of experience in providing commercial asphalt roadway resurFacing services and concrete sidewalk improvements. 12 Bidder has successfully completed at least 12 asphalt resurfacing projects including at least three projects including concrete sidewalk improvements. 2.0 References 2.1 Bidder must provide afi least 3 verifiable references of similar work as referenced in section 1.0 above. 2.2 For each reference, Bidder shall submit a completed Reference Form provided in Attachment H. provide the client name, client phone number, and client e- mail address. 2.3 Bidder shall provide a written description of the services performed in sufficient detail as they directly relate to the work of this Request for Bid. The description shall include the dates of the period that the Bidder provided the services as well as the contractual amount of the services provided. 2.4 The City, in its sole discretion, may reject any and all bids if the City is not able to verify the references provided. 3.0 Discriminatory Vendor List 3.1 In accordance with Section 287.134, Florida Statutes, an entity or affiliate who has been placed on the Discriminatory Vendor List, kept by the Florida Department of Management Services, may not submit a bid on a contract to provide goods or services to a public entity; may not submit a�id on a contract with a public entity for the construction or repair of a public building or public work; may not submit bids on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor or consultant under a contract with any public entity; and may not transact business with any public entity. 4.0 FDOT Certificate of Qualification 4.1 An entity or affiliate who has had its Certificate of Qualification suspended, revoked, denied or have further been determined by the Florida Department of Transportation to be a non-responsible contractor may not submit a bid or perform work for the construction or repair of a public building or public work on a contract with the Recipient. 5.0 Bidder certifies that 5.1 Bidder meets the qualifications listed in Section IV, 1.0 above. 5.2 Bidder has never failed to complete work awarded under a contract due to circumstances that were under Bidder's control. City of Okeechobee Project No. PW 05-10-09-20 Public Works Department 6 5.3 The Bidder has not been placed on the Discriminatory Vender List kept by the Florida Department of Management Services as listed in section 3.0 above. 5.4 The Bidder has not had its Florida Department of Transportation Certificate of Qualification suspended, revoked or denied as listed in section 4.0 above. Ftorida Blacktop, Inc. Bidde � ompany Name) By: Si ure) Date: 10/22/2020 Title: President Elias Shaouy (Printed Name) Email �eeshaouy@gmail.com Mailing Address:1287 West Atlanfic Blvd. Pompano Beach, FL 33069 Office Number:954-943-9700 Fax Number: 954-943-9222 City of Okeechobee Public Works Department Project No. PW 05-10-09-20 SECTION Vill PW 05-10-09-20 MISCELLANEOUS A. No Labbying: All respondents are hereby placed on notice that any communication, whether written or oral, with City of Okeechobee elected officials or any City staff or outside Individuals working with the City in respect to this request (with the exception of the General Services personnel designated to receive requests for interpretation or corrections or technical questions), is prohibited. These persons shall not be lobbied, either individually or collectively, regarding any request for Bid, qualifications and/or any other solicitations released by the City. To do so is grounds for immediate disqualification from the selection process. All respondents must submit the attached No Lobbying Affidavit with their submittal stating that they and their Subcontractor, sub- consultants and agents agree to abide by the no lobbying restrictions in order to be considered for this request. Any respondent that does not submit the required No Lobbying Affidavit will be automatically disqualified from further consideration. NOTE: For respondents' convenience, this certification form is attached and made a part of the procurement package. See Attachment A B. Collusion, Gratuities and Kickbacks: It shall be unethical for any respondent to collude with any other respondent or offer, give or agree to give any City Council member, City employee or City representative (including selection committee members) a gift, gratuity or an offer of employment in connection with any decision, approval, disapproval, recommendation or preparation of any part of the procurement process. NOTE: For respondents' convenience, this certification form is attached and made a part of the procurement package. See Attachment B C. Modifications: The City reserves the right to modify, alter or change the scope or other aspects of this solicitation. D. Level Playing Field: The contents of this solicitation are intended to provide a level playing field on which Firms or Individuals may base their responses. E. Public Enfity Crime Affidavit: As required by Florida Statute 287.133(2)(a), 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 on a contract with a Public Entity for the construction or repair of a public building or a 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, supplier, Subcontractor, or consultant under a contract with any Public Entity, and may not transact business with any Public Entity in excess of the threshold amount provided in F.S. 287.017 for Cateqory Two far a period of thirty-six (36) months from the date of being placed on the convicted vendor list. Any person must notify the City within thirty (30) days after a conviction of a Public Entity crime applicable to that person or to an affiliate of that person. NOTE: For respondents' convenience, this certification form is attached and made a part of the procurement package. See Attachment D City of Okeechobee Public Works Department Project No. PW 05-10-09-20 44 F. Conflict of Interest: The award hereunder is subject to the provisions of Chapter 112, Florida Statutes. All respondents must disclose with their submission the name of any officer, director, employee or agent who is also a public officer, employee or an agent of the City of Okeechobee City Council, or any of its agencies. Furthermore, all respondents must disclose the name of any City officer, employee or agent who owns, directly or indirectly, an interest of five percent (5 %) or more in the Firm or any of its parent companies or subsidiaries. NOTE: For respondents' convenience, this certification form is attached and made a part of the procurement package. See Attachment E G. Immigration Laws: Respondents must comply with all applicabfe immigration laws in their employment practices. NOTE: For respondents' convenience, this certification form is attached and made a part of the procurement package. See Attachment F H. Tie Bids: Preference shall be given to businesses with drug-free workplace programs. Whenever two or more bids which are equal with respect to quality and service are received by the City for the procurement of commodities or contractual services, a bid received from a business that certifies that it has implemented a drug-free workplace program shall be given preference in the award process. Established procedures for processing tie bids will be followed if none of the tied vendors has a drug-free workplace program. City of Okeechobee Public Works Department Project No. PW 05-10-09-20 45 ATTACHMENT A PW 05-10-09-2Q NO LOBBYING AFFIDAVIT STATE OF FLORIDA COUNTY OF Broward This 22 day of October 2�p Elias Shaouy deposes and says that he/she is the Florida Blacktop, Inc. (Name of respondent to the attached request for Bid, or qualifications a by City of Okeechobee, and that the Bidder and any of it� Okeechobee no lobbying restrictions in regard to this soli ta� being first duly sw , authorized represent ' of Contractor, Firm Individual) ad��,iy other s �citation released ients agrees t abide by the City of ion. Affiant The foregoing instrument was acknowledged before me by means of u physical presence or u online notarization, this 22 day of October , 2CQ0 , by Elias Shaouy , wh�o �is, personally known to me or produced r---- as identification. vv+� Notary Public State of Flonda a�� Maria l. Gonez My Commiu�on GG 978a70 � p� a� Expues 04It4/2024 - - - _ ' City of Okeechobee Public Works Department Notary Public Signature Commission No. Project No. PW 05-10-09-20 46 ATTACHMENT B PW 05-10-09-20 ANTI-COLLUSION STATEMENT AND NO GIFTS STATEMENT Date: 10/22/2020 Anti-collusion statement: The below-signed Bidder has not divulged to, discussed, or compared his/her Bid with other Bidders and has not colluded with any other Bidder or parties to a Bid whatsoever. No gifts statement: No premiums, rebates, gifts or gratuities are permitted with, prior to, or after submission of the Bid. Any such violation will result in rejection of the Bid and removal from the Bid list(s). Firm Name: Florida Blacktop, Inc. By (printed/typed) By (signature): Title: Mailing Address: City, State, Zip: Telephone No.: City of Okeechobee Public Works Department Shaouy President 1287 West Atlantic Blvd. Pompano Beach, FL 33069 954-943-9700 Project No. PW 05-10-09-20 47 ATTACHMENT C PW 05-10-09-20 PROPOSER'S CERTIFICATION I have carefully examined this Request for Bid (BID)/Request for Proposais (RFP)/ Request for Qualifications (RFQ), which includes scope, requirements for submission, general information and fihe evaluation and award process. I acknowledge receipt of the following addenda. Addendum # 1 Date: 10/15/2Q2p Addendum # Date: Addendum # Date: Addendum # Date: Addendum # Date: Addendum # Date: I hereby propose to provide the services requested in the City's BID/RFP/RFQ and, if awarded, to enter into the attached draft contract. I agree that the terms and conditions of the City's BID/RFP/RFQ shall take precedence over any conflicting terms and conditions submitted with my proposal and agres to abide by all conditions of the BID/RFP/RFQ, unless a properly completed Exceptions to BID/RFP/RFQ form is submitted. I acknowledge that the City may not accept the proposal due to any exceptions. I certify that all information contained in my proposal is truthful to the best of my knowledge and belief. I further certify that I am duly authorized to submit this proposal on behalf of the Company as its agent and that the Company is ready, willing and able to perform if awarded a contract. I further certify, under oath, that this proposal is made without prior understanding, agreement, connection, discussion or collusion with any other person, Company or Corporation submitting a proposal for the same product or service; no gratuities, gifts or kick-backs were offered or given by the Bidder or anyone on its behalf to gain favorable treatment concerning this procurement; no City Council member, employee or a of City of Okeechobee or of any other Company is interested in said Bid; and that undersigned executed this Proposer's Certification with full knowledge and understandi of the matters therein contained and was duly authorized to do so. Florida Blacktop, Inc 1287 West Atlantic Blvd. 1�ia ae of Busine Mailing Address Pompano Beach, FL 33069 City, State & Zip Code �54-943-9700/954-943-9222 Authorize Signat Telephone Number/Fax Number Elias Shaouy - President Name & Title, Typed IeeshaouvCa�qmail.com Email Address STATE OF FLORIDA COUNTY OFBroward The foregoing instrument was acknowledged before me by means of u physical presence or u online notarization, this 22 day of October , 2020 , by Elias Shaouy , who is personally known to me or produced as identification. =o,►R� "�'� Notary Publrc Stete of FlorWe N \,,;� . Maria l. Gonez ;�F 3� P� My Comm�ss�on GG 978q10 o; r,o° Exp�res 04/14/2024 ry Public Sic��a ure mission No. � City of OI<eechobee Public Worl<s Department Project No. PW 05-10-09-20 48 ATTACHMENT D PW 05-10-09-20 SWORN STATEMENT PURSUANT TO SECTION 287.133 (3)(a), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. This sworn statement is submitted to CITY OF OKEECHOBEE, FLORIDA by: Elias Shaouy - President (print Individual's name and title) for: Florida Blacktop, Inc. (print name of entity submitting sworn statement) whose business address is 1287 West Atlantic Blvd. Pompano Beach, FL 33069 and (if applicable) its Federal Employer ldentification Number (FEIN) is:59-2363756 (If the entity has no FEIN, include the Social Security Number of the Individual signing this sworn statement: - - .) 2. I understand that a"public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and direcfily related to the transaction of business with any public entity c,r with an agency or political subdivision of any other state or of the United States, including but not limited to, any Bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any ather state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentations. 3. I understand that "convicted" or "conviction" as defined in Paragraph 287.133(1)(b), Florida Statutes, means a finding of guilt or a conviction of a public �ntity 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. I understand that an "affiliate" as defined in Paragraph 287.133(1)(a), Florida Statutes, means: a. A predecessor or successor of a person convicted of a public entity crime; or b. 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 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 af a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. City of Okeechobee Public Works Department Project No. PW 05-10-09-20 49 5. 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 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 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 sworn statement. (Indicate which statement applies). f� Neither the entity submitting this sworn statement, nor any of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any 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 o�cers, directors, executives, partners, 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 affiliate of the entity has been charged with and convicted of a 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 final 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 list (attach a copy of the final order). I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND THAT THIS FORM fS HROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FIL =. LSO UNDERSTAND THAT I AM REQUIRED TO INFORM T LIC ENTITY P TO ENTERING INTO A CONTRACT IN EXCESS OF THE TH SHOLD AMOUN OVIDED IN SECTION 287.017, FLORIDA STATUTES FOR CATEGO NGE IN THE INFORMATION CONTAINED IN THIS FORM. Signature STATE OF FLO�'^-,�-- COUNTY OF BrOW3i"CI The foregoing instrument was acknowledged before me by means of u physical presence or u online notarization, this22 day of ��t�jpr , 2020 , ay Elias Shaouy , who is personally known to me or produced as identificati . �,r,�,�M„� - ary Public Signat e ��►r" � Notary Pub4c State of Flofida Maria l. Gonez Commission No. 14� My Commissiai GG 978410 �a ad` Exp�res U4/14/2024 City of Okeechobee Public Works Department Project No. PW 05-10-09-20 50 ATTAGHMENT E PW 05-10-09-20 CONFLICT OF INTEREST DISCLOSURE FORM For purposes of determining any possible conflict of interest, all Bidders must disclose if any City of Okeechobee employee(s), elected official(s), or any of its agents is also an owner, corporate officer, director, agent, employee, etc., of their business. Indicate either "yes" (a City employee, elected official or agent is associated with your business), or "no". If yes, give person{s) name(s) and position(s) with your business. 1't� Name(s) NO X Position(s) Firm Name: Florida Blacktop, Inc. By (Printed): By (Signature): _ Tit�e: President hao Address: 1287 West Atlantic Blvd. Pompano Beach, FL 33069 Phone Number:954-943-9700 City of Okeechobee Public Works Department Project No. PW 05-10-09-20 51 ATTACHMENT F PW 05-10-09-20 IMMIGRATION LAW CERTIFICATION City of Okeechobee will not intentionally award City contracts to any Contractor who knowingly employs unauthorized alien workers, constituting a violation of the employment provisions contained in 8 U.S.C. Section 1324 a(e) (Section 274a(e) of the immigration and nationality act ("INA")). City of Okeechobee may consider the employment by any Contractor of unauthorized aliens a violation of Section 274A(e) of the INA. Such violation by the recipient of the employment provisions contained in Section 274A(e) of the INA shall be grounds for unilateral cancellation of the contract by City af Okeechobee. Respondent attests that it is fully compliant with all applicable immigration �� specifically relating to the 1986 immigration act and subsequent amendments. Florida Blackto , c. �---5� any Name Si nat Presi 10/22/��0 Date STATE OF FLORIDA COUNTY OF BrOWaI"d The foregoing instrument was acknowledged before me by means of u physical presence or u online notarization, this �_ day ofOCtOb2t' , 2020 , by Elias Shaouy , who is personally known to me or produced as identification. Notary Public igna re Commission No. r��cvv - y�. • Notary PuW�c Ste� °t Fla�da aQ � Maria l. Gonez �! Expres 0411� 24 97�10 �«.ad' City of Okeechobee Public Works Department Project No. PW 05-10-09-20 52 ATTACHMENT G PW 05-10-09-20 DRUG-FREE WORKPLACE CERTIFICATION THE BELOW SIGNED Bidder/proposer CERTIFIES that it has implemented a drug-free workplace program. In order to have a drug-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 violation of such prohibition. 2. Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug-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 quote 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 quote, the employee will abide by the terms of the statement and will notify the employer of any conviction or plea of guilty or nolo contendere to any violation occurring in the workplace no later than five (5) days after such conviction. 5 � As the pe on authorized to s above re ireme Signature: Company: Florida Bla�Tctop, Inc. address:1287 West Atlantic Blvd. Impose a sanction on, or require the satisfactory participation in, drug abuse assistance or rehabilitation program if such is available in the employee's community, by an employee who is convicted. / Make a good faith effort to conti to maintain a drug-free workplace through implementation of this section. statement, I certify that this Firm complies fully with the Pompano Beach, FL 33069 City of Okeechobee Public Works Department �ate:October 22nd, 2020 Name:Elias Shaouy Titie: Presiden# Phone Number: 954-943-9700 Project No. PW 05-10-09-20 53 ATTACHMENT H CITY OF OKEECHOBEE SOUTHEAST 3RD AVENUE PAVEMENT IMPROVEMENTS PW 05-10-09-20 REFERENCE C�ient tvame: City of Coral Spring - Sherwood Forrest Park- Resufacing Client Phone Number: 954-345-2219 Client E-mai�: ggordon@coralsprings.org Glen Gordon Service Dates: Beginning ��d2�� End � � l�� Estimated Annual Contract Amount: 158,097.99 Description of the services performed as they directly relate to the work of this Request for Bid: Mill and Overlay City of Okeechobee Public Works Department Project No. PW 05-10-09-20 54 ATTACHMENT H CITY OF OKEECHOBEE SOUTHEAST 3RD AVENUE PAVEMENT IMPROVEMENTS PW 05-10-09-20 REFERENCE C�ient Name: George Sacks Hillsboro center Client Phone Number: 561-338-9950 C�ient E-mail: gsacks@commercialflorida.net Service Dates: Beginning 4/3/2018 End 5/21/2018 Estimated Annual Contract Amount: $290,167.71 Description of the services performed as they directly relate to the work of this Request for Bid: Mill and Overlay City of Okeechobee Public Works Department Project No. PW 05-10-09-20 54 ATTACHMENT H CITY OF OKEECHOBEE SOUTHEAST 3RD AVENUE PAVEMENT IMPROVEMENTS PW 05-10-09-20 REFERENCE Client Name: City of Tamarac Mainlands 16 (Forsythe Colony) Club House Parking Lot Renovation Client Phone Number: 9.54-597-3704 Client E-mai�: Bryan.Farrow@tamarac.org Service Dates: Beginning � �� End �02/,�li/� Estimated Annual Contract Amount: 83,055.57 Description of the services performed as they directly relate to the work of this Request for Bid: Parking Lot Renovation City of Okeechobee Public Works Department Project No. PW 05-10-09-20 54 ATTACHMENTI CITY OF OKEECHOBEE SOUTHEAST3RD AVENUE PAVEMENTIMPROVEMENTS PW 05-10-09-20 x�ch scorr covFxN�k Februan/ 7, 2d18 � �'loridc� �epurt�nent of �'rutasporta�ro�x 605 Suwannee Street Tallahassee, Fi. 32393-0450 David Ailen Public Works Di�ect�r City of Okeechobee 55 Southeast 3rd Avenue Okeechobee, FL 34974 ftE: NQTICE TO PROCEED — GIESIGN SERVICES Dear Mr. Allen FM #: 440372-1-54-01 Agency: City ofi Okeechobee Contract #: GOT44 Description: SE 3`d Avenue from SR 7I3 to SE 4"' Street �DKF. C1E\l sFcuFr:►u�° In accordance with the State Funded Grant Agreement, executed on January 10, 201$ between the Florida Department of Transpo�tation and City of Okeechobee for resurfacing of SE 3fd Avenue from SR 70 to SE 4t'' Street. You are hereby aufhorized to proceed with the design phase of this praject Once the Department has reviewed and approved the Finai Design Plans, a separate Notice to P�oceed will be issued for the bidding phase of the project. If 1 can be of further assistance, please contact me at (863} 519-2324 or Rick Arico at (239) 22�- 19�3. Sincerely, �� _.� Jobin Abraham Local Program Coordinator Cc: File Lisa R. Brinson, Local Program Administrator Rick Arico, Senior Roadway Engineer Charles R. Reed U, LAP Const�uction PM w�«�;.fdut.gov 55