Ranger Constructionti
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SECTION II
PW 05-10-09-20
SUBMISSION REQUIREMENTS
The bidder shall submit two (2) oriqinal clearlv identified oriqinals and one copv of
the followinq:
x 1. Bid Documentation Form (Section III)
x 2. Minimum Qualifications for Bidders Form (Section IV) and three (3)
references (Attachment H)
x 3. Bid Bond
x4. Bid Unit Price Schedule (Section VII, Exhibit B)
In addition to the above, please complete the following forms that must be returned
with your bid:
x Attachment A— No Lobbying Affidavit
x Attachment B— Anti Collusion Statement and No Gifts Statement
x Attachment C— Proposer's Certification
x Attachment D— Sworn Statement Pursuant to Section 287.133(3)(a),
FL Statutes on Public Entity Crimes
x Attachment E— Conflict of Interest Disclosure
x Attachment F— Immigration Law Certification
x Attachment G— Drug Free Workplace Certification
x Attachment H— Reference Form
x Attachment I— FDOT State-Funded Agreement FPN 440372-1
City of Okeechobee Project No. PW 05-10-09-20
Public Works Department 3
SECTION III
PW 05-10-09-20
BID DOCUMENTATION
Ranger Construction Industries, Inc.
(BIDDER'S COMPANY NAME)
Clty COUf1Cll
City of Okeechobee
55 S.E. 3rd Avenue
Okeechobee, FL 34974
I have received the documents titled SOUTHEAST 3RD AVENUE PAVEMENT
IMPROVEMENTS, Project No. PW 05-10-09-20. I have also received addendum
number 1 through 1 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:
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.
�
3
4
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:Ranger Construction Industries, Inc.
City of Okeechobee
Public Works Department
Date: 10/22/2020
Project No. PW 05-10-09-20
om an i Name)
By: Title: Vice President
re)
steve.skubal@rangerconstruction.com
F Scott Fowler elena.arango@rangerconstruction.com
E►'pal �:estimating@rangerconstruction.com
(Printed Name)
Mailing Address: 4510 Glades Cutoff Road, Ft Pierce, FI 33
Office Number: �772) 464-6460
Fax Number: �772� 466-9559
City of Okeechobee
Public Works Department
Project No. PW 05-10-09-20
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.
1.2 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 at 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 bid 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
r
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.
Bidder: Ranger Construction Industries, Inc. Date: 10/22/2020
e)
By: Title: Vice President
ture)
steve.skubal@rangerconstruction.com
F Scott Fowler elena.arango@rangerconstruction.com
ECTIa I �: estimatina(a)rancaerconstruction.com
(Printed Name)
Mailing Address: 4510 Glades Cutoff Road, Ft Pierce, FL 34981
Office Number:
City of Okeechobee
Public Works Department
(772) 464-6460 Fax Number: �772� 466-9559
7
Project No. PW 05-10-09-20
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we, Rancter Construction Industries, Inc. as
PI'IC1CIpaI alld Travelers Casuaity and Surety Company ofAmerica , as Surety, are �iel�! and �irrr�ly bound
unto the City of Okeechobee (the "City"), in the penal sum of $ TheTotalR�i��S/o�o �awful
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 20,
for the Contract Documents:
Contract Title
Contract 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, p�ovides 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 ofthe Contract Documents, enters
into a written contract with the City, in accordance with the Bsd, 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 october2z , 20 20 .
F�SS ! �
FOR NON-CORPORATE BIDDERS:
(Witness)
By:
(Signature of Principal)
(Print Name)
(Print Name and Title)
(Witness)
(Print Name)
FOR CORPORATE BIDDERS:
ATTE T:
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Secreta ry
Business Address
Ranqer Construction Industries, Inc.
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4-�f !
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� � �T�✓ '� � �,
(Signature of�G , �orate Principal)
Scott Fowler, Uce President
(Print Name and Title)
1200 Elboc Way. Winter Garden. FL 34787
Business Address
,
�Ul���'Y: � ' ��
TravelerS �asualtv and Sur�fy Company of America
AZTE �T: — l' .
(Cor�aqrate Seal,� ,,�,
E
�''� ���� % ��: �i'' � �' �, �' U� �" � ;
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`Wit ess to Surcty -
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(Cor�`�rate�ur�ty)
Wlliam Phelps Attornev-In-Fact and FL Resident Aqent
; ,{Print Name and Title)
,
One Tower Square Hartford CT 06183
Business Address
447 Montreal Ave. Melbourne FL 32935
Florida Address for Service of Process
500-842-5075
Telephone Number
(Surety shall provide evidence of signature authority such as a certified copy of
Power of Attorney.
City of Okeechobee Project No. PW p5-10-09-20
Public Works Department 17
TR'AYELERS�
Travelers Casualty and Surety Company of America
Travelers Casualty and Surety Company
St. Paul Fire and Marine Insurance Company
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St.
Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the
"Companies"), and that the Companies do hereby make, constitute and appoint William Phelps of Meibourne, Florida their true and lawful
Attorney-in-Fact tosign, execute, seal and acknowledge any and all bonds,recognizances, conditional undeRakings and other writings obligatory in the
nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and
executing or guaranteeing bonds and under[akings required or
permitted in any actions or proceedings allowed by law.
IN WITNESS WHEREOF, the Companies have caused this instrument to be signed, and their corporate seals to be hereto affixed, this 3rd day of February,
2017.
1M�e��pry �a,G�r.vrd�m
�i�a G9�.e � '� �
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'ti.ww�" . �yM ,4i'O lY 'A
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State of Connecticut �,� va , w� �,v �
City of Hartford ss.
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B 'r%;.,�i:d"c.;�r�„_,�."?:�.!�-•�--".".
Y�
Robert L. Raney, Se or Vice President
On this the 3rd day of February, 2017, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of
Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, and
that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations
by himself as a duly authorized officer.
In Witness Whereof, I hereunto set my hand and o�cial seal.
My Commission expires the 30th day of June, 2021
w�
� � _��- � ��
*�q�,p * Marie C. Tetreault, Notary Pubiic
This Power of Attorney is granted under and by the authority of the following resoiutions adopted by the Boards of Directors of Travelers Casualty and
Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, which resolutions are now in
full force and effect, reading as follows:
RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any
Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and
Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with
the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a
bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may rernove any such appointee and revoke
the power given him or her; and it is
FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice
President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation
is in writing and a copy thereof is filed in the office of the Secretary; and it is
FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional
undeRaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior
Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant
Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by
one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more
Company o�cers pursuant to a written delegation of authority; and it is
FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice
President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power
of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys-in-Fact for purposes only
of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or ce�tificate bearing
such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile
signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached.
I, Kevin E. Hughes, the undersigned, Assistant Secretary of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety
Company, a�d St. Paul Fire and Marine Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of the Power of
Attorney executed by said Companies, which remains in full force and effect.
Dated this zznd day of octobe� , zozo
�pp •`a vr a,yo yb�'j
�� 4pY +�; � �
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� • � '�f ...w� �a�� � � �
(/`^- � •
Kevin E. Hughes, Assi tant Secretary
To v�r•'fy the aJthenticity of this Power ofAtto�ney, p/ease ca// us at 1-800-421-3880.
P/ease refer to the above-named Attorney-in-Fad and the detai/s of the bond to which the pawer is attached.
EXHIBIT B
BID UNIT PRICE SCHEDULE
PW 05-10-09-20
SOUTHEAST 3RD AVENUE PAVEMENT IMPROVEMENTS
UNIT ESTIMATED UNIT
ITEM NO. DESCRIPTION MEASURE QUANTITY PRIC AMOUNT
E
1 MOBILIZATION / DEMOBILIZATION S�MP 1 ��,eoo.00 $11,500.00
2 MAINTENANCE OF TRAFFIC S�MP 1 $g,soo.00 $9,600.00
3 INLET PROTECTION SYSTEM EACH 10 $�os.00 $1,090.00
MILL EXISTING ASPHALTIC SQUARE
4 PAVEMENT, YARD 8742 $2.z5 $19,669.50
1" AVERAGE DEPTH
SUPERPAVE ASPHALTIC
5 CONCRETE, TON 750 $112.65 $84,487.50
TRAFFIC C SP-9.5
6 REMOVAL OF EXISTING LUMP � �6,s2s.00 �6,825.00
SIDEWALK, CURB AND GUTTER SUM
� SIDEWALK CURB AND RAMP, EACH 10 ��,095.00 $10,950.00
FDOT INDEX 304, CR-F
$ DETECTABLE VWVARNING MAT - SQUARE 200 �46.00 $9,200.00
BRICK RED FOOT
TOTAL BID AMOUNT
Based on Bid Unit Prices & Estimated Quantities $153,322.00
City of Okeechobee Project No. PW 05-10-09-20
Public Works Department
42
Bidders Company Name Ranger Construction Industries, 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.
Bidder: Ranger Construction Industries, Inc. Date: 10/22/2020
� e
By: Title: Vice President
( � � )
steve.skubal@rangerconstruction. com
F Scott Fowler elena.arango@rangerconstruction.com
Efilal�: estimatinq�ranqerconstruction.com
(Printed Name)
Mailing Address: 4510 Glades Cutoff Road, Ft Pierce, FL 34981
Office Number: �772) 464-6460
Fax Number: �772� 466-9559
City of Okeechobee
Public Works Department
Project No. PW 05-10-09-20
43
SECTION VIII
PW 05-10-09-20
MISCELLANEOUS
A. No Lobbying: 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 Entiiy Crime AfiFidavit: 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 for 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 applicable 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 05-10-09-20
NO LOBBYING AFFIDAVIT
STATE OF FLORIDA
COUNTY OF Oranqe
This 22 day of October , 20 20 , F Scott Fowler being first duly sworn,
deposes and says that he/she is the authorized representative of
Ranqer Construction Industries, Inc. (Name of Contractor, Firm or Individual)
respondent to the attached request for Bid, or qualifications and/or any other solicitation released
by City of Okeechobee, and that the Bidder and any of its agents agrees to abide by the City of
Okeechobee no lobbying restrictions in regard to this solicitation.
Affian /
The foregoing instrument was acknowledged before me by means of I� physical presence or ❑
online notarization, this 22 day of October , 20 20 , by F Scott Fowler , who is
personally known to me or produced Personally Known as identification.
.��. �
:�����P�'••. STACYLBARBER Notary P lic Signature
_� • 1�' Notary Public - State oi Florida
=. �' P: Commission # GG 942423
`�••'.�'or F�°�` My Comm. Expires Apr 19, 2024
�������BondedthroughNationalNotaryAssn. COI'T1171 ion No. GG942423
City of Okeechobee Project No. PW 05-10-09-20
Public Works Department
46
e �
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:
By (printed/typed):
By (signature):
Title:
Mailing Address:
Ranger Construction Industries, Inc.
F Scott Fowler
City, State, Zip: Ft Pierce, Florida 34981
Telephone No.: �772) 464-6460
City of Okeechobee
Public Works Department
Project No. PW 05-10-09-20
47
vice rresiaent
4510 Glades Cutoff Road
ATTACHMENT C
PW 05-10-09-20
PROPOSER'S CERTIFICATION
I have carefully examined this Request for Bid (BID)/Request for Proposals (RFP)/ Request for
Qualifications (RFQ), which includes scope, requirements for submission, general information
and the evaluation and award process.
I acknowledge receipt of the following addenda.
Addendum # 1 Date: 10/15/2020 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 agree 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 grafuities, 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 agent of City of Okeechobee or of any other Company is
interested in said Bid; and that the undersigned executed this Proposer's Certification with full
knowledge and understanding of the matters therein contained and was duly authorized to do so.
Ranger Construction Industries, Inc.
Name of Business
i / /
/�
�'%��//
� • �• • � r '-
F Scott Fowler
Name & Title, Typed
4510 Glades Cutoff Road
Mailing Address
Ft Pierce, Florida 34981
City, State & Zip Code
(772) 464-6460
Telephone Number/Fax Number
steve. sku ba I@rangerconstruction. com
elena.arango@rangerconstruction.com
esti matint�ran�err.onstrur.tion _rom
Email Address
STATE OF FLORIDA
COUNTY OF Orange
The foregoing instrument was acknowledged before me by means of�l physical presence or ❑
online notarization, this 22 day of October , 2p 20 , by F Scott Fowler , who
is personally known to me or produced Personall Known as identification.
_`�'_"" �
: •'�i�ti� �r� `•,, STACV L BARBER
'_° �'���"� y Notary P lic Signature
� Notar Public - SUte of Florida
='a` o': Cammission N GG 942423 (�OiTI S on No. GG942423
�'�'.!"oF F��` My Comm. Expires Apr 19, 202�
������ Bonded throu4h National Notary Assn.
City of Okeechobee Project No. PW 05-10-09-20
Public Works Department
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:
F Scott Fowler (print Individual's name and title) for:
Ranger Construction Industries, Inc.
(print name of entity submitting sworn statement) whose business address is
4510 Glades Cutoff Road, Ft Pierce, Florida 34981 and (if
applicable) its Federal Employer ldentification Number (FEIN) is: 59-2098662
(If the entity has no FEIN, include the Social Security Number of the Individual signing this
sworn statement: NA _ _ �
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, 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 other 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 entity crime, with or
without an adjudication of guilt, in any federal or state trial court of record relating to
charges brought by indictment or information after July 1, 1989, as a result of a jury verdict,
non-jury trial, or entry of a plea of guilty or nolo contendere.
4. 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 of 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).
� 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 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.
❑ 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 IS VALID THROUGH DECEMBER 31 OF THE
CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO
INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF
THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES FOR
CATEGORY TWO O �N THE INFORMATION CONTAINED IN THIS FORM.
Signature
STATE OF FLORIDA
COUNTY OF Orange
The foregoing instrument was acknowledged before me by means of ❑ physical presence or ❑
online notarization, this 22 day of October , 20 20 , by F Scott Fowler , who
is personally known to me or produced Person II Known as identification.
,,�1eyi'r6�••., STACYLBARBER otary P lic Signature
:: •�'�� Notary Public - State of Florida
:'a' '` Commission q GG 942423
�`~'.?'ot v�°���� My Comm. Expires Apr 19, 2024 COtll ion No. GG942423
������ Bonded through National Notary Assn.
City of Okeechobee Project No. PW 05-10-09-20
Public Works Department
50
ATTACHMENT 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.
YES
NO X
Name(s) Position(s)
f�F_1
Firm Name: Ranqer Construction Industries, Inc.
By (Printed):
By (Signature):
Title:
vice rresicaen�
Address: 4510 Glades Cutoff Road
Ft Pierce, FL 34981
Phone Number: (772) 466-9559
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
("I NA")).
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 of Okeechobee.
Respondent attests that it is fully compliant with all applicable immigration laws, specifically
relating to the 1986 immigration act and subsequent amendments.
Ran er Co ru 'on Industries Inc.
ame
S i rra���
Vice Pr s' nt
Title
10/22/2020
Date
STATE OF FLORIDA
COUNTY OF Orange
The foregoing instrument was acknowledged before me by means of � physical presence or ❑
online notarization, this 22 day of October , 20 20 , by F Scott Fowler , who
is personally known to me or produced Personall Known as identification.
.• 'rv�••. STACYLBARBER Notary P lic Signature
':�,� ��: Notary Public - State of Florida
4 CommissionliGG942A23 Commission No. � G�2:�'��
���'.?'oF �°P`�' My Comm. Expires Apr 19, 2021
������� Bonded through National Notary Ass�.
City of Okeechobee Project No. PW 05-10-09-20
Public Works Department
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:
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
�
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 continue to maintain a drug-free workplace through
implementation of this section.
As the person authorized to sign this statement, I certify that this Firm complies fully with the
above requirements.
Signature: Date: 10/22/2020
Company: Ranger Const�rGction Industries, Inc. Name: F Scott Fowler
Address: 4510 Glades Cutoff Road
Ft Pierce, FL 34981
City of Okeechobee
Public Works Department
Title: Vice President
Phone Number: �772� 464-6460
Project No. PW 05-10-09-20
53
ATTACHMENT H
CITY OF OKEECHOBEE
SOUTHEAST 3RD AVENUE PAVEMENT IMPROVEMENTS
I��il�F�i[a��'b��7
1��=1:T=fr[�] �
Client Name: City of Port St. Lucie
Client Phone Number: (772) 871-5187
Client E-mail: tsalvador@cityofpsl.com
Service Dates: Beginning April 2019 End April 2022
Estimated Annual Contract Amount: �4,8982,166.10
Description of the services perFormed as they directly relate to the work of this Request
for Bid:
Job Name: Furnish and Install Asphaltic Concret Paving 200+ Ton
Description: Resurfacing of various areas within the city
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: Palm Beach County
Client Phone Number: (561)-233-3956
Client E-mail: afaustin@pbcgov.org
Service Dates: Beginning 2015 End 2021
Estimated Annual Contract Amount: $13,000,000
Description of the services performed as they directly relate to the work of this Request
for Bid:
Job Name: Palm Beach County yearly paving and resurFacing contract
Description: Paving and Resurfacing of various areas within the city as needed
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: St Lucie West Motorcoach PH1
Client Phone Number: (772) 336-1135
Client E-mail: tiffany@signaturepropertymgmt.com
Service Dates: Beginning 09/2020 End 09/2020
Estimated Annual Contract Amount: $206,367
Description of the services performed as they directly relate to the work of this Request
for Bid:
Job Name: St Lucie West Motorcoach PH1
Description: Rehabilitation of asphalt pavement including but not limited to approximately 4,000 SY of mill and overlay
with SP9.5 asphalt surface course, full depth asphalt repairs, remove and replace concrete curb, install new striping,
remove and replace whell stops and utility valve adjustments.
City of Okeechobee
Public Works Department
Project No. PW 05-10-09-20
54
ATTACHMENT I
CITY OF OKEECHOBEE
SOUTHEAST 3RD AVENUE
PAVEMENTIMPROVEMENTS
PW 05-10-09-20
"�••
- .�
�x� �
�� �� � ���� �
� �� �
�..` � z_._f r--�
�'l�rrc�cl �e�crr���e��t �+f �'�c���sportc�tio�a
u�ch scori' 605 Suwannee Street
co�FHtv�k Tallahassee, FL 32399-0�50
February 7, 201$
Dauid Allen
Public Wo�ks Director
City of Okeechobee
55 5outheast 3�d Avenue
Okeechobee, FL 34974
RE: N(]TICE TO PROCEED — DESIGH SERVIC�S
�M #: 44Q372-1-54-01
Agency: City of Okeechobee
Contract #: G0T44
Description: SE 3`d A�enue from SR 70 to SE 4th Street
Dear Mr. Allen
1ilKF. DF.1i�
SECRETARI'
In accordance with the State Funded Grant Agreement, executed on January 10, 2018
between the �lorida Department vf Transportation and City of (7keechobee for resurfacing of SE
3fd A�enue from SR 70 to SE 4th Street. You are hereby authorized to procesd wifh fhe
desrgn phase of this project. Once the Department has re�iewed and approved the �inal
Design Plans, a separate Notice to Proceed will be issued for the bidding phase of the project.
If I can be of further assistance, please contact me at (863} 519-2324 or Rick Arico at (239} 225-
1973.
5incerely,
Jobin Abraham
Local Program Coordinator
Cc: File
Lisa R. Brinson, Local Program Administrator
Rick Arico, Senior Roadway �ngineer
Charles R. Reed II, LAP Construction PM
ww�,�,�. fdoi, s;ov
55
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
SiATE-FUNDED GRANT AGREEMENT
FPN: 440372-1-54-01 Fund: SCRC FLAIR Category:
Org Code: 55014010106 FLAIR Obj:
FPN: Fund: FLAIR Category:
Org Code: FLAIR Obj:
FPN
Fund: _
Org Code:
FLAIR Category:
FLAIR Obj:
525-010-60
PROGR,4M MANAGEMENT
osn �
County No:91 Contract No: GOT44 Vendor No: F596000393001
THIS STATE-FUNDED GRANT AGREEMENT ("Agreement") is entered into on c.lAy���y /�'`� ,�o% ,
(This date to be entered by DOT only)
by and between the State of Florida Department of Transportation, ("DepartmenY'), and the Citv of Okeechobee,
("Recipient"). The
Department and the Recipient are sometimes referred to in this Agreement as a"Party" and collectively as the "Parties".
NOW, THEREFORE, in consideration of the mutuai benefits to be derived from joint participation on the Project, the Parties
agree to the following:
1. Authority: The Department is authorized to enter into this Agreement pursuant to Sections 334.044, 334.044(7),
and (select the applicable statufory authority for the program(s) below):
❑ Section 339.2817 Florida Statutes, County Incentive Grant Program (CIGP), (CSFA 55.008)
� Section 339.2818 Florida Statutes, Small County Outreach Program (SCOP), {CSFA 55.009)
❑ Section 339.2816 Florida Statutes, Small County Road Assistance Program (SCRAP), (CSFA 55.016)
❑ Section 339.2819 Florida Statutes, Transportation Regional Incentive Program (TRIP), (CSFA 55.026)
❑ Insert Leqal Authoritv , Insert Fundinp Proqram Name , Insert CSFA Number
The Recipient by Resolution or other form of official authorization, a copy of which is attached as Exhibit "E",
Recipient Resolution, and made a part of this Agreement, has authorized its officers to execute this Agreement
on its behalf.
2. Purpose of Agreement: The purpose of this Agreement is to provide for the Department's participation in
construction for the resurfacinq of SE 3�d Avenue from SR 70 (Park St) to SE 4th Street, as further described in
Exhibit "A", Project Description and Responsibilities, attached to and incorporated into this Agreement
("ProjecY'); to provide Department financial assistance to the Recipient; state the terms and conditions upon which
Department funds will be provided; and to set forth the manner in which the Project will be undertaken and
completed.
3. Term of the Agreement, Commencement and Completion of the Project: This Agreement shall commence
upon full execution by both Parties and the Recipient shall complete the Project on or before Mav 15�, 2021. If the
Recipient does not complete the Project within this time period, this Agreement will expire on the last day of the
scheduled completion as provided in this paragraph unless an extension of the time period is requested by the
Recipient and granted in writing by the Department prior to the expiration of this Agreement. Expiration of this
Agreement will be considered termination of the Project. The Recipient acknowledges that no funding for the Project
will be provided by the State under this Agreement for work on the Project that is not timely completed and invoiced
in accordance with the terms of this Agreement. The cost of any work performed prior to full execution of the
Agreement. Notwithstanding the expiration of the required completion date provided in this Agreement and the
consequent potential unavailability of any unexpended portion of State funding to be provided under this Agreement,
Page 1 of 14
STATE OF FLORIOA DEPARTMENT OF TRANSPORTATION 525-010-60
STATE-FUIVDED GRANT AGREEMENT PROGRAM MANAGEMENT
osn �
the Recipient shall remain obligated to complete all aspects of the Project identified in Exhibit "A" in accordance
with the remaining terms of this Agreement, unless otherwise agreed by the Parties, in writing.
Execution of this Agreement by both Parties shall be deemed a Notice to Proceed to the Recipient for the design
phase or other non-construction phases of the Project. If the Project involves a construction phase, the Recipient
shall not begin the construction phase of the Project until the Department issues a written Notice to Proceed for the
construction phase. Prior to commencing the construction work described in this Agreement, the Recipient shall
request a Notice to Proceed from the Department.
4. Amendments, Extensions and Assignment: This Agreement may be amended or extended upon mutual
written agreement of the Parties. This Agreement shall not be assigned, transferred or otherwise encumbered by
the Recipient under any circumstances without the prior written consent of the Department.
5. Termination or Suspension of Project: The Department may, by written notice to the Recipient, suspend any or
all of the DepartmenYs obligations under this Agreement for the Recipient's failure to comply with applicable law or
the terms of this Agreement until such time as the event or condition resulting in such suspension has ceased or
been corrected. The Department may also terminate this Agreement in whole or in part at any time the interest of
the Department requires such termination.
a. If the Department terminates the Agreement, the Department shall notify the Recipient of such termination
in writing within thirty (30) days of the Department's determination to terminate the Agreement, with
instructions as to the effective date of termination or to specify the stage of work at which the Agreement is
to be terminated.
b. The Parties to this Agreement may also terminate this Agreement when its continuation would not produce
beneficial results commensurate with the further expenditure of funds. In this event, the Parties shall agree
upon the termination conditions through mutual written agreement.
c. If the Agreement is terminated before performance is completed, the Recipient shall be paid only for that
work satisfactorily performed for which costs can be substantiated. Such payment, however, may not
exceed an amount which is the same percentage of the contract price as the amount of work satisfactorily
completed is a percentage of the total work called for by this Agreement. All work in progress on the
Department right-of-way will become the property of the Department and will be turned over promptly by
the Recipient.
d. Upon termination of fhis Agreement, the Recipient shall, within thirty (30) days, refund to the Department
any funds determined by the Department to have been expended in violation of this Agreement.
6. Project Cost:
a. The estimated cost of the Project is $123.531.00. This amount is based upon the Schedule of Financial
Assistance in Exhibit "B", attached and incorporated in this Agreement. The Schedule of Financial
Assistance may be modified by execution of an amendment of the Agreement by the Parties.
b. The Department agrees to participate in the Project cost up to the maximum amount of $123,531.00 and,
additionally the Department's participation in the Project shall not exceed 100% of the total cost of the
Project, and as more fully described in Exhibit "B", Schedule of Financial Assistance. The DepartmenYs
participation may be increased or reduced upon a determination of the actual bid amounts of the Project by
the execution of �n amendment. The Recipient agrees to bear all expenses in excess of the amount of the
Department's participation and any cost overruns or deficits incurred in connection with completion �f the
Project.
c. The Department's participation in eligible Project costs is subject to, but not limited to:
i. Legislative approval of the DepartmenYs appropriation request in the work program year that the
Project is scheduled to be committed;
Page 2 of 14
STATE Of FLORIDA DEPARTMENT OF TRANSPORTATION 525-010-60
STATE-FUNDED GRANT AGREEIVIENT PROGRAM MANAGEMENT
osn �
ii. Approval of all plans, specifications, contracts or other obligating documents and all other terms of
this Agreement; and
iii. Department approval of the Project scope and budget at the time appropriation authority becomes
available.
7. Compensation and Payment:
The Department shall reimburse the Recipient for costs incurred to perform services described in the
Project Description and Responsibilities in Exhibit "A", and as set forth in the Schedule of Financial
Assistance in Exhibit "B".
b. The Recipient shall provide quantifiable, measurable, and verifiable units of deliverables. Each deliverable
must specify the required minimum level of service to be performed and the criteria for evaluating successful
completion. The Project and the quantifiable, measurable, and verifiable units of deliverables are described
more fully in Exhibit "A", Project Description and Responsibilities. Any changes to the deliverables shall
require an amendment executed by both parties.
c. Invoices shall be submitted no more often than monthly and no less than quarterly by the Recipient in detail
sufficient for a proper pre-audit and post-audit, based on the quantifiable, measurable and verifiable
deliverables as established in Exhibit "A". Deliverables and costs incurred must be received and approved
by the Department prior to reimbursements. Requests for reimbursement by the Recipient shall include an
invoice, progress report and supporting documentation for the period of services being billed that are
acceptable to the Department. The Recipient shall use the format for the invoice and progress report that
is approved by the Department.
d. Supporting documentation must establish that the deliverables were received and accepted in writing by
the Recipient and must also establish that the required minimum standards or level of service to be
performed based on the criteria for evaluating successful completion as specified in Exhibit "A" has been
met. All costs invoiced shall be supported by properly executed payrolls, time records, invoices, contracts
or vouchers evidencing in proper detail the nature and propriety of charges as described in Attachment F
— Contract Payment Requirements.
e. Travel expenses are not compensable under this Agreement.
f. Payment shall be made only after receipt and approval of deliverables and costs incurred unless advance
payments are authorized by the Chief Financial Officer of the State of Florida under Chapters 215 and 216,
Florida Statutes or the DepartmenYs Comptroller under Section 334.044(29), Florida Statutes.
❑ If this box is selected, advance payment is authorized for this Agreement and Exhibit "G",
Alternative Advance Payment Financial Provisions is attached and incorporated into this
Agreement.
If the Department determines that the performance of the Recipient is unsatisfactory, the Department shall
notify the Recipient of the deficiency to be corrected, which correction shall be made within a time-frame to
be specified by the Department. The Recipient shall, within thirty (30) days after notice from the Department,
provide the Department with a corrective action plan describing how the Recipient will address all issues of
contract non-performance, unacceptable performance, failure to meet the minimum performance levels,
deliverable deficiencies, or contract non-compliance. If the corrective action plan is unacceptable to the
Department, the Recipient will not be reimburs.ed to the extent of the non-performance. The Recipient will
not be reimbursed until the Recipient resolves the deficiency. If the deficiency is subsequently resolved, the
Recipient may bill the Department for the unpaid reimbursement request(s) during the next billing period. If
the Recipient is unable to resolve the deficiency, the funds shall be forFeited at the end of the Agreement's
term.
Recipients receiving financial assistance from the Department should be aware of the following time
frames. Inspection and approval of deliverables and costs incurred shall take no longer than 20 days
from the DepartmenYs receipt of the invoice. The Department has 20 days to deliver a request for
Page 3 of 14
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 525-0'10-60
STATE-FUNDED GRANT AGREEMENT PROGRAM MANAGEI�IENT
osin
payment (voucher) to the Department of Financial Services. The 20 days are measured from the latter of
the date the invoice is received or the deliverables and costs incurred are received, inspected, and
approved.
If a payment is not available within 40 days, a separate interest penalty at a rate as established pursuant
to Section 55.03(1), Florida Statutes, will be due and payable, in addition to the invoice amount, to the
Recipient. Interest penalties of less than one (1) dollar will not be enforced unless the Recipient requests
payment. Invoices that have to be returned to a Recipient because of Recipient preparation errors will
result in a delay in the payment. The invoice payment requirements do not start until a properly
completed invoice is provided to the Department.
A Vendor Ombudsman has been established within the Department of Financial Services. The duties of
this individual include acting as an advocate for Recipient who may be experiencing problems in obtaining
timely payment(s) from a state agency. The Vendor Ombudsman may be contacted at (850) 413-5516.
g. The Recipient shall maintain an accounting system or separate accounts to ensure funds and projects are
tracked separately. Records of costs incurred under the terms of this Agreement shall be maintained and
made available upon request to the Department at all times during the period of this Agreement and for five
years after final payment is made. Copies of these documents and records shall be furnished to the
Department upon request. Records of costs incurred include the Recipient's general accounting records
and the project records, together with supporting documents and records, of the contractor and all
subcontractors performing work on the project, and all other records of the contractor and subcontractors
considered necessary by the Department for a proper audit of costs.
h. Progress Reports. Upon request, the Recipient agrees to provide progress reports to the Department in
the standard format used by the Department and at intervals established by the Department. The
Department will be entitled at all times to be advised, at its request, as to the status of the Project and of
details thereof.
i. If, after Project completion, any claim is made by the Deparkment resulting from an audit or for work or
services performed pursuant to this Agreement, the Department may offset such amount from payments
due for work or services done under any agreement which it has with the Recipient owing such amount if,
upon demand, payment of the amount is not made within 60 days to the Department. Offsetting any amount
pursuant to this paragraph shall not be considered a breach of contract by the Department.
j. The Recipient must submit the final invoice on the Project to the Department within 120 days after the
completion of the Project. Invoices submitted after the 120-day time period may not be paid.
k. The Department's performance and obligation to pay under this Agreement is contingent upon an annual
appropriation by the Legislature. If the Department's financial assistance for this Project is in multiple fiscal
years, a notice of availability of funds from the Department's project manager must be received prior to
costs being incurred by the Recipient. See Exhibit "B" for funding levels by fiscal year. Project costs
utilizing any fiscal year funds are not eligible for reimbursement if incurred prior to funds approval being
received. The Department will notify the Recipient, in writing, when funds are available.
I. In the event this Agreement is in excess of $25,000 and has a term for a period of more than one year, the
provisions of Section 339.135(6)(a), Florida Statutes, are hereby incorporated:
"The Department, during any fiscal year, shall not expend money, incur any liability, or
enter into any contract which, by its terms, involves the expenditure of money in excess of
the amounts budgeted as available for expenditure during such fiscal year. Any contract,
verbal or written, made in violation of this subsection is null and void, and no money may
be paid on such contract. The Department shall require a statement from the comptroller
of the Department that funds are available prior to entering into any such contract or other
binding commitment of funds. Nothing herein contained shall prevent the making of
contracts for periods exceeding 1 year, but any contract so made shall be executory only
for the value of the services to be rendered or agreed to be paid for in succeeding fiscal
years, and this paragraph shall be incorporated verbatim in all contracts of the Department
Page 4 of 14
STATE OF FLORIDA DEPARTM=NT OF TRANSPORTATION 525-010-60
STATE-FUfVDED GRANT AGREEMENT PROC�RAM MANAGE�v1ENT
os,n
which are for an amount in excess of $25,000 and which have a term for a period of more
than 1 year."
m. Any Project funds made available by the Department pursuant to this Agreement which are determined by
the Department to have been expended by the Recipient in violation of this Agreement or any other
applicable law or regulation, shall be promptly refunded in full to the Department. Acceptance by the
Department of any documentation or certifications, mandatory or otherwise permitted, that the Recipient
files shall not constitute a waiver of the Department's rights as the funding agency to verify all information
at a later date by audit or investigation.
n. In determining the amount of the payment, the Department will exclude all Project costs incurred by the
Recipient prior to the execution of this Agreement, costs incurred prior to issuance of a Notice to Proceed,
costs incurred after the expiration of the Agreement, costs which are not provided for in the latest approved
Schedule of Financial Assistance in Exhibit "B" for the Project, costs agreed to be borne by the Recipient
or its contractors and subcontractors for not meeting the Project commencement and final invoice time
lines, and costs attributable to goods or services received under a contract or other arrangements which
have not been approved in writing by the Department.
8. General Requirements:
The Recipient shall complete the Project with all practical dispatch in a sound, economical, and efficient manner,
and in accordance with the provisions in this Agreement and all applicable laws.
The Recipient must obtain written approval from the Department prior to performing itself (through the
efforts of its own employees) any aspect of the Project that will be funded under this Agreement.
❑ If this box is checked, then the Agency is permitted to utilize its own forces and the following
provision applies: Use of Agency Workforce. In the event the Agency proceeds with any phase
of the Project utilizing its own forces, the Agency will only be reimbursed for direct costs (this
excludes general overhead).
b. The Recipient shall provide to the Department certification and a copy of appropriate documentation
substantiating that all required right-of-way necessary for the Project has been obtained. Certification is
required prior to authorization for advertisement for or solicitation of bids for construction of the Project,
including if no right-of-way is required.
The Recipient shall comply and require its contractors and subcontractors to comply with all terms and
conditions of this Agreement and all federal, state, and local laws and regulations applicable to this Project.
d. The Recipient shall have the sole responsibility for resolving claims and requests for additional work for the
Project by the Recipient's contractors and consultants. No funds will be provided for payment of claims or
additional work on the Project under this Agreement without the prior written approval of the claim or request
for additional work by Department.
9. Contracts of the Recipient
a. The Department has the right to review and approve any and all third party contracts with respect to the
Project before the Recipient executes any contract or obligates itself in any manner requiring the
disbursement of Department funds under this Agreement, including consultant or construction contracts or
amendments thereto. If the Department exercises this right and the Recipient fails to obtain such approval,
the Department may deny payment to the Recipient. The Department may review the qualifications of any
consultant or contractor and to approve or disapprove the employment of such consultant or contractor.
b. It is understood and agreed by the parties hereto that participation by the Department in a project that
involves the purchase of commodities or contractual services or the purchasing of capital equipment or the
equipping of facilities, where purchases or costs exceed the Threshold Amount for CATEGORY TWO per
Chapter 287.017 Florida Statutes, is contingent on the Recipient complying in full with the provisions of
Chapter 287.057 Florida Statutes The Recipient shall certify to the Department that the purchase of
Page 5 of 14
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 525-010-60
STATE-FUNDED GRANT AGREEMENT PROGRAM MANAGEMENT
09/17
commodities or contractual services has been accomplished in compliance with Chapter 287.057 Florida
Statutes It shall be the sole responsibility of the Recipient to ensure that any obligations made in accordance
with this Section comply with the current threshold limits. Contracts, purchase orders, task orders,
construction change orders, or any other agreement that would result in exceeding the current budget
contained in Exhibit "B", or that are not consistent with the Project description and scope of services
contained in Exhibit "A" must be approved by the Department prior to Recipient execution. Failure to
obtain such approval, and subsequent execution of an amendment to the Agreement if required, shall be
sufficient cause for nonpayment by the Department.
c. Participation by the Department in a project that involves a consultant contract for engineering, architecture
or surveying services, is contingent on the Recipient's complying in full with provisions of Section 287.055,
Florida Statutes, Consultants' Competitive Negotiation Act. In all cases, the Recipient shall certify to the
Department that selection has been accomplished in compliance with the Consultants' Competitive
Negotiation Act.
d. If the Project is procured pursuant to Chapter 255 for construction services and at thetime of the competitive
solicitation for the Project 50 percent or more of the cost of the Project is to be paid from state-appropriated
funds, then the Recipient must comply with the requirements of Section 255.0991, Florida Statutes.
10. Design and Construction Standards and Required Approvals: I� the event the Project includes construction
the following provisions are incorporated into this Agreement:
a. The Recipient is responsible for obtaining all permits necessary for the Project.
b. In the event the Project involves construction on the DepartmenYs right-of-way, the Recipient shall provide
the Department with written notification of either its intent to:
i. Award the construction of the Project to a Department prequalified contractor which is the lowest
and best bidder in accordance with applicable state and federal statutes, rules, and regulations.
The Recipient shall then submit a copy of the bid tally sheet(s) and awarded bid contract, or
ii. Construct the Project utilizing existing Recipient employees, if the Recipient can complete said
Project within the time frame set forth in this Agreement. The RecipienYs use of this option is subject
to approval by the Department.
c. The Recipient shall hire a qualified contractor using the RecipienYs normal bid procedures to perform the
construction work for the Project. For projects that are not located on the Department's right-of-way, the
Recipient is not required to hire a contractor prequalified by the Department unless the Department
notifies the Recipient prior to letting that they are required to hire a contractor prequalified by the
Department.
d. The Recipient is responsible for provision of Construction Engineering Inspection (CEI) services. The
Department reserves the right to require the Recipient to hire a Department pre-qualified consultant firm
that includes one individual that has completed the Advanced Maintenance of Traffic Level Training.
Administration of the CEI staff shall be under the responsible charge of a State of Florida Licensed
Professional Engineer who shall provide the certification that all design and construction for the Project
meets the minimum construction standards established by Department. The Department shall have the
right to approve the CEI firm. The Department shall have the right, but not the obligation, to perform
independent assurance testing during the course of construction of the Project. Subject to the approval of
the Department, the Recipient may choose to satisfy the requirements set forth in this paragraph b.y either
hiring a Department prequalified consultant firm or utilizing Recipient staff that meet the requirements of
this paragraph, or a combination thereof.
e. The Recipient is responsible for the preparation of all design plans for the Project. The Department reserves
the right to require the Recipient to hire a Department pre-qualified consultant for the design phase of the
Project using the RecipienYs normal procurement procedures to perform the design services for the Project.
All design work on the Project shall be performed in accordance with the requirements of all applicable laws
and governmental rules and regulations and federal and state accepted design standards for the type of
Page 6 of 14
STATE OF FIORIDA DEPARTMENT OF TRANSPORTATION 525-0'10-60
STATE-FUNDED GRANT AGREEMENT PROGRAM MANAGEMENT
09117
construction contemplated by the Project, including, as applicable, but not limited to, the applicable
provisions of the Manual of Uniform Traffic Control Devices (MUTCD) and the AASHTO Policy on
Geometric Design of Streets and Highways. All design work for any portion of the Project to be located on
Department right-of-way shall conform to all applicable standards of the Department, as provided in Exhibit
"F", Terms and Conditions of Construction, which is attached to and incorporated into this Agreement
if a portion of the Project will be located on FDOT's right of way.
f. The Recipient shall adhere to the Department Conflict of Interest Procedure (FDOT Topic No. 375-030-
006) or Conflict of Interest Procedure for State Funded Grant Programs (FDOT Topic No. 750-000-002).
g. The Recipient will provide copies of the final design plans and specifications and final bid documents to the
DepartmenYs Construction Project Manager prior to commencing construction of the Project. The
Department will specify the number of copies required and the required format.
h. The Recipient shall require the RecipienYs contractor to post a payment and performance bond in
accordance with applicable law.
i. The Recipient shall be responsible to ensure that the construction work under this Agreement is performed
in accordance with the approved construction documents, and that it will meet all applicable Recipient and
Department standards.
Upon completion of the work authorized by this Agreement, the Recipient shall notify the Department in
writing of the completion of construction of the Project; and for all design work that originally required
certification by a Professional Engineer, this notification shall contain an Engineers Certification of
Compliance, signed and sealed by a Professional Engineer, the form of which is attached hereto and
incorporated herein as Exhibit "C", Engineers Certification of Completion. The certification shall state
that work has been completed in compliance with the Project construction plans and specifications. If any
deviations are found from the approved plans, the certification shall include a list of all deviations along with
an explanation that justifies the reason to accept each deviation.
k. The Recipient shall provide the Department with as-built plans of any portions of the Project funded through
the Agreement prior to final inspection.
11. Maintenance Obligations: In the event the Project includes construction then the following provisions are
incorporated into this Agreement:
a. The Recipient agrees to maintain any portion of the Project not located on the State Highway System
constructed under this Agreement for its useful life. If the Recipient constructs any improvement on
Department right-of-way, the Recipient
� shall
❑ shall not
maintain the improvements located on the Department right-of-way made for their useful life. If the Recipient
is required to maintain Project improvements located on the Department right-of-way beyond final
acceptance, then Recipient shall, prior to any disbursement of the State funding provided under this
Agreement, also execute a Maintenance Memorandum of Agreement in a form that is acceptable to the
Department. The Recipient has agreed to the foregoing by resolution, and such resolution is attached and
incorporated into this Agreement as Exhibit "E". This provision will survive termination of this Agreement.
12. State Single Audit: The administration of resources awarded through the Department to the Recipient by this
Agreement may be subject to audits and/or monitoring by the Department. The following requirements do not limit the
authority of the Department to conduct or arrange for the conduct of additional audits or evaluations of state financial
assistance or limit the authority of any state agency inspector general, the Auditor General, or any other state official.
The Recipient shall comply with all audit and audit reporting requirements as specified below.
a. In addition to reviews of audits conducted in accordance with Section 215.97, Florida Statutes, monitoring
procedures to monitor the RecipienYs use of state financial assistance may include but not be limited to on-
Page 7 of 14
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 525-010-60
STATE-FUNDED GRANT AGREEMENT PROGRAM MANAGEMENT
09/17
site visits by Department staff and/or other procedures including, reviewing any required performance and
financial reports, following up, ensuring corrective action, and issuing management decisions on
weaknesses found through audits when those findings pertain to state financial assistance awarded through
the Department by this Agreement. By entering into this Agreement, the Recipient agrees to comply and
cooperate fully with any monitoring procedures/processes deemed appropriate by the Department. The
Recipient further agrees to comply and cooperate with any inspections, reviews, investigations, or audits
deemed necessary by the Department, the Department of Financial Services (DFS) or the Auditor General.
b. The Recipient, a nonstate entity as defined by Section 215.97(2)(n), Florida Statutes, as a recipient of state
financial assistance awarded by the Department through this Agreement is subject to the following
requirements:
In the event the Recipient meets the audit threshold requirements established by Section 215.97,
Florida Statutes, the Recipient must have a State single or project-specific audit conducted for such
fiscal year in accordance with Section 215.97, Florida Statutes; applicable rules of the Department
of Financial Services; and Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and
for-profit organizations), Rules of the Auditor General. Exhibit "D" to this Agreement indicates
state financial assistance awarded through the Department by this Agreement needed by the
Recipient to further comply with the requirements of Section 215.97, Florida Statutes. In
determining the state financial assistance expended in a fiscal year, the Recipient shall consider
all sources of state financial assistance, including state financial assistance received from the
Department by this Agreement, other state agencies and other nonstate entities. State financial
assistance does not include Federal direct or pass-through awards and resources received by a
nonstate entity for Federal program matching requirements.
ii. In connection with the audit requirements, the Recipient shall ensure that the audit complies with
the requirements of Section 215.97(8), Florida Statutes. This includes submission of a financial
reporting package as defined by Section 215.97(2)(e), Florida Statutes, and Chapters 10.550 (local
governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor
General.
iii. In the event the Recipient does not meet the audit threshold requirements established by Section
215.97, Florida Statutes, the Recipient is exempt for such fiscal year from the state single audit
requirements of Section 215.97, Florida Statutes. However, the Recipient must provide a single
audit exemption statement to the Department at FDOTSingleAudit@dot.state.fl.us no later than
nine months after the end of the Recipient's audit period for each applicable audit year. In the event
the Recipient does not meet the audit threshold requirements established by Section 215.97,
Florida Statutes, in a fiscal year and elects to have an audit conducted in accordance with the
provisions of Section 215.97, Florida Statutes, the cost of the audit must be paid from the
Recipient's resources (i.e., the cost of such an audit must be paid from the RecipienYs resources
obtained from other than State entities).
iv. In accordance with Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit
organizations), Rules of the Auditor General, copies of financial reporting packages required by
this Agreement shall be submitted to:
Page 8 of 14
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 525-010-60
STATE-FUP�IDED GRANT AGREEMEIVT PROGRAM MANAGEMENT
osn �
Florida Department of Transportation
Office of Comptroller, MS 24
605 Suwannee Street
Tallahassee, FL 32399-0405
Email: Ff�O�'Sinc�leAudit@.dot.statQ.fl.us
And
State of Florida Auditor General
Local Government Audits/342
111 West Madison Street, Room 401
Tallahassee, FL 32399-1450
Email: flaudqen localqovt(c�aud.state.fl.us
v. Any copies of financial reporting packages, reports or other information required to be submitted to
the Department shall be submitted timely in accordance with Section 215.97, Florida Statutes, and
Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations),
Rules of the Auditor General, as applicable.
vi. The Recipient, when submitting financial reporting packages to the Department for audits done in
accordance with Chapters 10.550 (local governmental entities) or 10.650 (nonprofit and for-profit
organizations), Rules of the Auditor General, should indicate the date the reporting package was
delivered to the Recipient in correspondence accompanying the reporting package.
vii. Upon receipt, and within six months, the Department will review the Recipient's financial reporting
package, including corrective action plans and management letters, to the extent necessary to
determine whether timely and appropriate corrective action on all deficiencies has been taken
pertaining to the state financial assistance provided through the Department by this Agreement. If
the Recipient fails to have an audit conducted consistent with Section 215.97, Florida Statutes, the
Department may take appropriate corrective action to enforce compliance.
viii. As a condition of receiving state financial assistance, the Recipient shall permit the Department, or
its designee, DFS or the Auditor General access to the Recipient's records including financial
statements, the independent auditor's working papers and project records as necessary. Records
related to unresolved audit findings, appeals or litigation shall be retained until the action is
complete or the dispute is resolved.
c. The Recipient shall retain sufficient records demonstrating its compliance with the terms of this Agreement
for a period of five years from the date the audit report is issued and shall allow the Department, or its
designee, DFS or the Auditor General access to such records upon request. The Recipient shall ensure
that the audit working papers are made available to the Department, or its designee, DFS or the Auditor
General upon request for a period of five years from the date the audit report is issued unless extended in
writing by the Department.
13. Restrictions, Prohibitions, Controls and Labor Provisions:
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 to provide any goods or services to a public entity; may not
submit a bid 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 in excess of the threshold amount provided in Section 287.017,
Florida Statutes, for CATEGORY TWO for a period of 36 months from the date of being placed on the
convicted vendor list.
b. 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 bid on a contract with a public
Page 9 of 14
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 525-0'10-60
STATE-FUNDED GRANT AGREEIVIENT PROGRAM MANAGEMENT
os„ �
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.
c. An entity or affiliate who has had its Certificate of Qualification suspended, revoked, denied or have further
been determined by the Department 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.
d. No funds received pursuant to this Agreement may be expended for lobbying the Florida Legislature, judicial
branch, or any state agency, in accordance with Section 216.347, Florida Statutes.
e. The Department shall consider the employment by any contractor of unauthorized aliens a violation of
Section 274A(e) of the Immigration and Nationality Act. If the contractor knowingly employs unauthorized
aliens, such violation will be cause for unilateral cancellation of this Agreement.
f. The Recipient shall:
i. Utilize the U.S. Department of Homeland Security's E-Verify system to verify the employment
eligibility of all new employees hired by the Recipient during the term of the contract; and
ii. Expressly require any subcontractors performing work or providing services pursuant to the
state contract to likewise utilize the U.S. Department of Homeland Security's E-Verify system to
verify the employment eligibility of all new employees hired by the subcontractor during the contract
term.
g. The Recipient shall comply and require its contractors and subcontractors to comply with all terms and
conditions of this Agreement and all federal, state, and local laws and regulations applicable to this Project.
14. Indemnification and Insurance:
It is not intended by any of the provisions of any part of this Agreement to create in the public or any member
thereof, a third party beneficiary under this Agreement, or to authorize anyone not a party to this Agreement
to maintain a suit for personal injuries or property damage pursuant to the terms or provisions of this
Agreement. The Recipient guaranties the payment of all just claims for materials, supplies, tools, or labor
and other just claims against the Recipient or any subcontractor, in connection with this Agreement.
Additionally, to the extent permitted by law and as limited by and pursuant to the provisions of Section
768.28, Florida Statutes, the Recipient agrees to indemnify and hold harmless the Department , including
the DepartmenYs officers and employees, from liabilities, damages, losses and costs, including, but not
limited to, reasonable attorney's fees, to the extent caused by the negligence, recklessness or intentional
wrongful misconduct of the Recipient and persons employed or utilized by the Recipient in the performance
of this Agreement. This indemnification shall survive the termination of this Agreement. Nothing contained
in this paragraph is intended to nor shall it constitute a waiver of the State of Florida and the Recipient's
sovereign immunity. Additionally, the Recipient agrees to include the following indemnification in all
contracts with contractors/subcontractors and consultants/subconsultants who perform work in connection
with this Agreement:
"To the fullest extent permitted by law, the Recipient's contractor/consultant shall indemnify and hold
harmless the Recipient and the State of Florida, Department of Transportation, including the Department's
officers and employees, from liabilities, damages, losses and costs, including, but not limited to, reasonable
attorney's fees, to the extent caused by the negligence, recklessness or intentional wrongful misconduct of
the contractor or consultant and persons employed or utilized by the contractor or consultant in the
performance of this Agreement.
This indemnification shall survive the termination of this Agreement. Nothing contained in this paragraph
is intended to nor shall it constitute a waiver of the State of Florida or the RecipienYs sovereign immunity."
Page 10 of 14
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 525-010-60
STATE-FUNDED GRANT AG6�EEMENT PROGRAM MANAGEMENT
osn �
b. The Recipient shall provide Workers' Compensation Insurance in accordance with Florida's Workers'
Compensation law for all employees. If subletting any of the work, ensure that the subcontractor(s) and
subconsultants have Workers' Compensation Insurance for their employees in accordance with Florida's
Workers' Compensation law. If using "leased employees" or employees obtained through professional
employer organizations ("PEO's"}, ensure that such employees are covered by Workers' Compensation
insurance through the PEO's or other leasing entities. Ensure that any equipment rental agreements that
include operators or other personnel who are employees of independent contractors, sole proprietorships
or partners are covered by insurance required under Florida's Workers' Compensation law.
c. If the Recipient elects to self-perForm the Project, and such self-performance is approved by the Department
in accordance with the terms of this Agreement, the Recipient may self-insure and proof of self-insurance
shall be provided to the Department. If the Recipient elects to hire a contractor or consultant to perform the
Project, then the Recipient shall, or cause its contractor or consultant to carry Commercial General Liability
insurance providing continuous coverage for all work or operations performed under the Agreement. Such
insurance shall be no more restrictive than that provided by the latest occurrence form edition of the
standard Commercial General Liability Coverage Form (ISO Form CG 00 01) as filed for use in the State
of Florida. Recipient shall, or cause its contractor to cause the Department to be made an Additional Insured
as to such insurance. Such coverage shall be on an "occurrence" basis and shall include
Products/Completed Operations coverage. The coverage afforded to the Department as an Additional
Insured shall be primary as to any other available insurance and shall not be more restrictive than the
coverage afforded to the Named Insured. The limits of coverage shall not be less than $1,000,000 for each
occurrence and not less than a$5,000,000 annual general aggregate, inclusive of amounts provided by an
umbrella or excess policy. The limits of coverage described herein shall apply fully to the work or operations
performed under the Agreement, and may not be shared with or diminished by claims unrelated to the
Agreement. The policy/ies and coverage described herein may be subject to a deductible and such
deductibles shall be paid by the Named Insured. No policy/ies or coverage described herein may contain
or be subject to a Retention or a Self-Insured Retention unless the Recipient is a state agency or subdivision
of the State of Florida that elects to self-perform the Project. Prior to the execution of the Agreement, and
at all renewal periods which occur prior to final acceptance of the work, the Department shall be provided
with an ACORD Certificate of Liability Insurance reflecting the coverage described herein. The Department
shall be notified in writing within ten days of any cancellation, notice of cancellation, lapse, renewal, or
proposed change to any policy or coverage described herein. The DepartmenYs approval or failure to
disapprove any policy/ies, coverage, or ACORD Certificates shall not relieve or excuse any obligation to
procure and maintain the insurance required herein, nor serve as a waiver of any rights or defenses the
Department may have.
d. When the Agreement includes the construction of a railroad grade crossing, railroad overpass or underpass
structure, or any other work or operations within the limits of the railroad right-of-way, including any
encroachments thereon from work or operations in the vicinity of the railroad right-of-way, the Recipient
shall, or cause its contractor to, in addition to the insurance coverage required above, procure and maintain
Railroad Protective Liability Coverage (ISO Form CG 00 35) where the railroad is the Named Insured and
where the limits are not less than $2,000,000 combined single limit for bodily injury and/or property damage
per occurrence, and with an annual aggregate limit of not less than $6,000,000. The railroad shall also be
added along with the Department as an Additional Insured on the policy/ies procured pursuant to the
paragraph above. Prior to the execution of the Agreement, and at all renewal periods which occur prior to
final acceptance of the work, both the Department and the railroad shali be provided with an ACORD
Certificate of Liability Insurance reflecting the coverage described herein. The insurance described herein
shall be maintained through final acceptance of the work. Both the Department and the railroad shall be
notified in writing within ten days of any cancellation, notice of cancellation, renewal, or proposed change
to any policy or coverage described herein. The Department's approval or failure to disapprove any
policy/ies, coverage, or ACORD Certificates shall not relieve or excuse any obligation to procure and
maintain the insurance required herein, nor serve as a waiver of any rights the Department may have.
e. When the Agreement involves work on or in the vicinity of utility-owned property or facilities, the utility shall
be added along wifh the Department as an Additional Insured on the Commercial General Liability policy/ies
procured above.
15. Miscellaneous:
Page 11 of 14
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 525-010-60
STATE-FUNDED GRANT AGREEMENT PROGRAM MANAGEMENT
osn �
a. In no event shall any payment to the Recipient constitute or be construed as a waiver by the Department
of any breach of covenant or any default which may then exist on the part of the Recipient and the making
of such payment by the Department, while any such breach or default shall exist, shall in no way impair or
prejudice any right or remedy available to the Department with respect to such breach or default.
b. If any provision of this Agreement is held invalid, the remainder of this Agreement shall not be affected. In
such an instance, the remainder would then continue to conform to the terms and requirements of
applicable law.
c. The Recipient and the Department agree that the Recipient, its employees, contractors, subcontractors,
consultants, and subconsultants are not agents of the Department as a result of this Agreement.
d. By execution of the Agreement, the Recipient represents that it has not paid and, also agrees not to pay,
any bonus or commission for the purpose of obtaining an approval of its application for the financing
hereunder.
e. Nothing in the Agreement shall require the Recipient to observe or enforce compliance with any provision
or perform any act or do any other thing in contravention of any applicable state law. If any of the provisions
of the Agreement violate any applicable state law, the Recipient will at once notify the Department in writing
in order that appropriate changes and modifications may be made by the Department and the Recipient to
the end that the Recipient may proceed as soon as possible with the Project.
f. This Agreement may be executed in one or more counterparts, each of which shall be deemed an original,
but all of which shall constitute the same Agreement. A facsimile or electronic transmission of this
Agreement with a signature on behalf of a party will be legal and binding on such party.
g. The Department reserves the right to unilaterally terminate this Agreement for failure by the Recipient to
comply with the provisions of Chapter 119, Florida Statutes.
h. The Recipient agrees to comply with Section 20.055(5), Florida Statutes, and to incorporate in all
subcontracts the obligation to comply with Section 20.055(5), Florida Statutes
i. This Agreement shall be governed by and construed in accordance with the laws of the State of Florida. In
the event of a conflict between any portion of the contract and Florida law, the laws of Florida shall prevail.
The Recipient agrees to waive forum and venue and that the Department shall determine the forum and
venue in which any dispute under this Agreement is decided.
j. This Agreement does not involve the purchase of Tangible Personal Property, as defined in Chapter 273,
Florida Statutes.
16. Exhibits.
a. Exhibits A, B, D, and E, and Attachment F are attached to and incorporated into this Agreement.
b. � The Project will involve construction, therefore, Exhibit "C", Engineer's Certification of Compliance is
attached and incorporated into this Agreement.
c. ❑ A portion or all of the Project will utilize the Department's right-of-way and, therefore, Exhibit F, Terms
and Conditions of Construction in Department Right-of-Way, is attached and incorporated into this
Agreement.
d. ❑ The following Exhibit(s), in addition to those listed in 16.a. and 16.b., are attached and incorporated into
this Agreement:
e. Exhibit and Attachment List
Page 12 of 14
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 525-010-60
STATE-FUNDED GRANT AGREEMENT PROGRAM MANAGEMENT
09/17
Exhibit A: Project Description and Responsibilities
Exhibit B: Schedule of Financial Assistance
`Exhibit C: Engineer's Certification of Compliance
Exhibit D: State Financial Assistance (Florida Single Audit Act)
Exhibit E: Recipient Resolution
''Exhibit F: Terms and Conditions of Construction in Department Right-of-Way
�Exhibit G: Alternative Pay Method
Attachment F— Contract Payment Requirements
"Additional Exhibit(s):
�Indicates that the Exhibit is only attached and incorporated if applicable box is selected.
The remainder of this page intentionally left blank.
Page 13 of 14
pSTA7E OF nFnLnO�RIDA DEPARTMENpT O�F TpR4�NaSPORTAT�I�O7N p�y
��lh�����11111C1��� ���U'Cl� W�A.9���I1C711�9V �1
525-070£0
PROGRAM MANAGEMENT
09/17
IN W9iNESS WHEREOF, the Parties have executed this Agreement on the day and year written above.
RECIPILNT CITY OF �KEECHOBEE
�
, �'� '�� r � �' ,
By: / j f
Name: ��'"IinglR. Watford, Jr.
Title: Mayor
STAiE OF FLORIDe4,
DEP,4RiMENi OF lRANSPOI�TATI�iV
l� %�
By: �" �y►/� ,,�--�;
�
N me: r`� ' �. � I �
Title: �__Dire tor of Trans�ortation Develonmant i
ATTES : ' �/
,
: _ � iif��C�
Lane Gamiotea, CMC, City Clerk
REVIEW�D FOR L\Gl�,L SUFFI�ENCY
`' � �..'� ••�" � �— lJ�'
—� l. V �.
John R. Cook, City Attorney
Legal Review: .
` -; ,� .i
B�: ��. „� r �/�� �',.�•�/�
Name: /� . �N°`''`�
Page 94 of 14
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 525-010-60
STATE-FUIVDED GRANT AGREEIVIENT PROGRAM MANAGEMENT
09/17
Page 1 of 2
EXHIBIT "A"
PROJECT DESCRIPTIOiV AfdD RESPONSIBILITIES
FPN: 440372-1-54-01
This exhibit forms an integral part of the State-Funded Grant Agreement between the State of Florida, Department of
Transportation and
City of Okeechobee (the Recipient)
PROJECT LOCATION:
❑ The project is on the National Highway System.
❑ The project is on the State Highway System.
PROJECT LENGTH AND MILE POST LIMITS: 0.258 Miles - SE 3RD AVENUE FROM SR 70 (PARK ST) TO SE 4TH
STREET
PROJECT DESCRIPTION: The purpose of this Exhibit is to describe the scope of work and the responsibilities of the City
of Okeechobee in connection with the resurfacing of SE Third Avenue from SR 70 (Park Street) to SE Fourth Street,
approximately 1,250 feet. The project will also include sidewalk repair to meet ADA compliance, as appropriate. The general
objective is for the City of Okeechobee to provide contract administration, management services, construction engineering
inspection services and quality acceptance reviews of all work associated with the design and construction of the resurfacing
and associated improvements.
Specifically and non inclusive, the following are included in the Scope of Services:
• Milling and Resurfacing the existing travel lanes according to City specifications.
• Signing and pavement markings to meet the latest MUTCD standards, as appropriate.
• The plans shall include an appropriate provision for maintenance of traffic.
• Construct or reconstruct, as appropriate, sideroad and driveway turnouts.
• Construct or reconstruct adequate drainage facilities to accommodate the roadway improvements, as appropriate.
• Provide for the preparation of the Roadway Plans Package.
• Identifying and obtaining any geotechnical investigation, analysis, and design dictated by the project needs. All
geotechnical work necessary shall be performed in accordance with the governing regulations.
• Construction Plans and Documentation provided for FDOT review at 60% and 100% completeness.
• Plan Specifications and bid packages, to be provided by 100% Plan review.
• A Professional Engineer, registered in the State of Florida, in responsible charge of the projecYs design shall professionally
endorse (sign, seal and certify) the record plans, the special provisions and all reference and support documents.
• Construction of the Project will not commence until FDOT has approved the construction plans and specifications and all
required right-of-way has been properly obtained and certified (if applicable).
• Coordination with utility owners during design and construction will be required to determine and avoid potential impacts.
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 525-010-60
STATE-FUNDED GRANT AGREEMENT PROGRAM MANAGEMENT
09f17
Page 2 of 2
EXHIBIT "A"
PROJECT DESCRIPTIOiV AMD RESPONSIBILITIES
Where unavoidable, disposition of the utility conflicts should be coordinated.
• Acquisition of all applicable stormwater and environmental permits in accordance with Chapter 62-25, Regulation of Storm
water Discharge, Florida Administrative Code; Chapter 373 and 403, Florida Statutes; Chapters 40 and 62, Florida
Administrative Code; Rivers and Harbors Act of 1899; Section 404 of the Clean Water Act; and parts 114 and 115, Title 33,
Code of Federal Regulations. In addition, permitting required by local agencies shall be prepared in accordance with their
specific regulations. Acquisition includes all associated permit fees.
• Provide Construction Engineering and Inspection (CEI) and Quality Assurance Engineering.
• Upon completion of construction, Final As-built Construction Plans, signed and sealed by a Professional Engineer,
registered in the State of Florida, will be provided.
• Coordinate construction activities with other projects that are impacted by this project. This includes projects under the
jurisdiction of local governments or other regional and state agencies.
SPECIAL CONSIDERATIONS BY RECIPIENT:
The Agency is required to provide a copy of the design plans for the Department's review and approval to coordinate
permitting with the Department, and notify the Department prior to commencement of any right-of-way activities.
The Recipient shall commence the project's activities subsequent to the execution of this Agreement and shall perform in
accordance with the following schedule:
a) Design plans contract to begin on or before June 1, 2018.
b) Design plans to be completed by June 1, 2019.
c) Actual Construction shall begin no later than December 1, 2019.
d) Construction shall be completed by December 1, 2020.
e) Closeout documents shall be completed by May 1, 2021.
If this schedule cannot be met, the Recipient will notify the Department in writing with a revised schedule or the project is
subject to the withdrawal of funding.
SPECIAL CONSIDERATIONS BY DEPARTMENT:
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
STATE-FUNDED GRANT AGREEIVIENT
EXHIBIT "B"
525-0�0-60
PROGRAM MANAGEMENT
09/17
Page 1 of 2
SCHEDULE OF FINANCIAL ASSISTANCE
RECIPIENT PdAME & BILLING ADDRESS: FIidAF1CIAL PROJECT NUMBER:
55 S.E. Third Avenue
Okeechobee. Florida 34974
440372-1-54-01
I. PHASE OF WORK b Fiscal Year: FY FY FY TOTAL
Design- Phase 34 $ o.00 $ o.00 � o.00 �o.00
% % °�o %
Maximum Department Participation -(Insert Proqram Name) or or or or
$ $ $ $ 0.00
% % % %
Maximum Department Participation -(Insert Proaram Name) or or or or
$ $ $ $ 0.00
% % % %
Maximum Department Participation -(Insert Proqram Name) or or or or
$ $ $ $ 0.00
% % % %
Local Participation (Any applicable waiver noted in Exhibit "A") or or or or
$ 0.00 $ 0.00 $ 0.00 $0.00
In-Kind Contribution $ $ $ $ 0.00
Cash $ $ $ $ 0.00
Combination In-Kind/Cash $ $ $ $ 0.00
Right of Way- Phase 44 � o.00 � o.00 $ o.00 $o.00
% % % %
Maximum Department Participation -(Insert Proqram Name) or or or or
$ $ $ $ 0.00
% % % %
Maximum Department Participation -(Insert Program Name) or or or or
$ $ $ $ 0.00
% % % %
Maximum Department Participation -(Insert Proqram Name1 or or or or
$ $ $ $ 0.00
Local Participation (Any appiicable waiver noted in Exhibit "A") % % % %
or or or or
$ 0.00 $ 0.00 $ 0.00 $0.00
In-Kind Contribution $ $ $ $ 0.00
Cash $ $ 0.00 $ $ 0.00
Combination In-Kind/Cash $ $ $ $ 0.00
Construction/CEl - Phase 54 $ 123,531.00 $ 0.00 $ 0.00 $123,531.00
°�o ��o % %
Maximum Department Participation -(� or or or or
$ $ $ $ 0.00
% % % %
Maximum Department Participation -(SCRC) or or or or
$ 123,531.00 $ $ $ 123,539.00
% % % %
Maximum Department Participation -(Insert Proqram Namel or or or or
$ $ $ $ 0.00
Local Participation (Any applicable waiver noted in Exhibit "A") % % % %
or or or or
$ 0.00 $ 0.00 $ 0.00 $0.00
In-Kind Contribution $ $ $ $ 0.00
Cash $ $ $ $ 0.00
Combination In-Kind/Cash $ $ $ $ 0.00
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 525-010-60
STATE-FUNDED GRANT AGREEMENT PROGRAMMANAGEMENT
osn �
EXHIBIT "B" Page 2 of 2
SCHEDULE OF FINANCIAL ASSISTANCE
Insert Phase and Number (if applicablej $ o.00 $ o.00 $ o.00 $o.00
% % % %
Maximum Department Participation -(Insert Proaram Name) or or or or
$ $ $ $ 0.00
% % % %
Maximum Department Participation -(insert Program Name) or or or or
$ $ $ $ 0.00
% % % %
Maximum Department Participation -(Insert Program Name) or or or or
$ $ $ $ 0.00
% % % %
Local Participation (Any applicable waiver noted in Exhibit "A")
or or or or
$ 0.00 $ 0.00 $ 0.00 $0.00
In-Kind Contribution $ $ $ $ 0.00
Cash $ $ $ $ 0.00
Combination In-Kind/Cash $ $ $ $ 0.00
II. TOTAL PROJECT COST: ��23,53i.00 $o.00 �o.00 $123,531.00
COST ANALYSIS CERTIFICATION AS REQUIRED BY SECTION 216.3475, FLORIDA STATUTES:
I certify that the cost for each line item budget category has been evaluated and determined to be allowable, reasonable, and necessary as required by
Section 216.3475, F.S. Documentation is on file evidencing the methodology used and the conclusions reached.
.�e�B/N ,�4BIQldN�i+l
District Grant Manager Name
�%� ��. 1 //O/9o�R
Signature ��— —" ate
STATE OF FLORIDA DEPARTh7cNT OF TRANSPORTATION 525-010-60
STATE-FUNDED GRANT AGREEIVIENT PROGRAM MANAGEMeNT
osn �
Page � of 1
EXHIBIT "C"
ENGINEER'S CERTIFICATION OF COMPLIANCE
Engineer's Certification of Compliance. The Recipient shall complete and submit the following Notice of
Completion and, if applicable, Engineer's Certification of Compliance to the Department upon completion
of the construction phase of the Project.
NOTICE OF COMPLETION
STATE-FUNDED GRANT AGREEMENT
Between
THE STATE OF FLORIDA, DEPARTMENT OF TRANSPORTATION
and THE CITY OF OKEECHOBEE
PROJECT DESCRIPTION:SE 3RD AVENUE FROM SR 70 (PARK ST) TO SE 4TH STREET
F P I D#: 440372-1-54-01
In accordance with the Terms and Conditions of the State-Funded Grant Agreement, the undersigned
provides notification that the work authorized by this Agreement is complete as of , 20_.
By:
Name:
Title:
ENGINEER'S CERTIFICATION OF COMPLIANCE
In accordance with the Terms and Conditions of the State-Funded Grant Agreement, the undersigned
certifies that all work which originally required certification by a Professional Engineer has been completed
in compliance with the Project construction plans and specifications. If any deviations have been made
from the approved plans, a list of all deviations, along with an explanation thatjustifies the reason to accept
each deviation, will be attached to this Certification. Also, with submittal of this certification the Recipient
shall furnish the Department a set of "as-built" plans certified by the Engineer of Record/CEI.
By:
SEAL: Name:
Date:
STATE OF FLORIDA DEPAP,T2dENT OF TRANSPORTATION
STATE-FUNDED GRANT AGREEMENT
EXHIBIT D
STATE FINAPlCIAL ASSISTANCE (FLORIDA SIfVGLE AUDIT ACT)
525-0'10-60
PROGRAM MANAGEMENT
osn �
Page 1 of t
THE STATE RESOURCES AWARDED PURSUANT TO THIS AGREEMENT CONSIST OF THE FOLLOWING•
Awarding Agency: Florida Department of Transportation
State Project Title ❑ County Incentive Grant Program (CIGP), (CSFA 55.008)
and CSFA � Small County Outreach Program (SCOP), (CSFA 55.009)
Number: ❑ Small County Road Assistance Program (SCRAP), (CSFA 55.016)
❑ Transportation Regional Incentive Program (TRIP), (CSFA 55.026)
❑ Insert Program Name, Insert CSFA Number
*Awrard Amount: $123,531.00
*The state award amount may change with supplemental agreements
Specific project information for CSFA Number is provided at: https://apps.fldfs.com/fsaa/searchCataloq.aspx
COiVIPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS
AGREEMENT:
State Project Compliance Requirements for CSFA Number are provided at:
https://apps.fidfs.com/fsaa/searchCompliance aspx
The State Projects Compliance Supplement is provided at: https://apps.fldfs.com/fsaa/compliance.aspx
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 525-010-60
STATE-FUNDED GRAiVT AGREEMENT PROGRAM MANAGEMENT
osn �
Page 1 of 1
EXHIBIT "E"
RECIPIENT RESOLUTION
The Recipient Resolution, or other official authorization, authorizing entry into this Agreement is
attached and incorporated into this Agreement.
RESOLUTION N0. 2017-12
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF OKEECHOBEE, FLORIDA,
AUTHORIZING THE EXECUTION OF A SMALL COUNTY OUTREACH AGREEMENT WITH
THE FLORIDA DEPARTMENT OF TRANSPORTATION PROVIDING FOR PARTIAL
PROJECT FUNDING IN AN AMOUNT NOT TO EXCEED $123,531.00; PROVIDING FOR
CONFLICT; PROVIDING FOR SEVERABILITY; AND PROVIDING FOR AN EFFECTIVE
DATE.
WHEREAS, the City Council for the City of Okeechobee, Florida, approved the execution of a Smali County
Outreach Program Agreement (SCOP) with the Florida DepartmentofTransportation (FDOT) provitling
for funding by FDOT of certain improvements to Southeast Third Avenue from State Road 70 (Park
5treet) to Southeast Fourth Street under Financial Project Number (FPN) 440372-1-54-01 on the below
date; and
WHEREAS, the FDOT has programmed up to $123,531.00 to reimburse the City of Okeechobee for the
construction of work under the SCOP Agreement; and
WHEREAS, the FDOT required the City of Okeechobee to provide a Resolution memorializing and confirming
the City's aforementioned affirmative vote to approve the SCOP Agreement and authorizing its Mayor
or designee to execute the Agreement; and
WHEREAS, it is in the public interest that the parties enter in to the SCOP Agreement.
NOW, THEREFORE, be it resoived before the City Council for the City of Okeechobee, Florida; presented at a
duly adveriised public meeting; and passed by majority vote of the City Couneil; and properly executed
by the Mayor or designee, as Chief Presiding Officer for the City:
SECTION 1: On the below date, the City Council for the City of Okeechobee, Florida, approved by majority
vote the Small County Outreach Program Agreement for FDOT FPN 440372-1-54-01 and
authorized its Mayor or designee to execute the Agreement.
SECTION 2:
SECTION 3:
The City Clerk of the City of Okeechobee, shall forward.a certified copy of this Resolution to
FDOT along with the Executed Agreement.
Conflict. All Resolution or parts of Resolutions in conflict herewith are hereby repealed.
SECTION 4: Severability. If any section, subsection, sentence, clause, phrase or portion of this Resolution,
or application hereof, is for any reason held invalid or unconstitutional by any court of
competentjurisdiction, such porfion or provision and such holding shall not affect the validity of
the remaining portions or applications here.
SECTION 5: Effective Date. This Resolution shall take effect immediately upon its adoption.
INTRODUCED AND ADO.PTED in Regular Session this 19�h day of December, 2017.
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ATTEST: � Dowling R. �. tford, r., �ayor
��? � LG�I . ' .-�
Lane Gamioiea, C C, City Clerk
REVIEWED FOR LEGAL SUFF�
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John R. Cook, City Attorney
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RESOLUTION NO. 2017-12 PAGE 1 OF 1 �"°�� ����d���
Cet�! �'I�i
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 525-010-60
STATE-FUNDED GRANT AGREEMENT PROGRAM MANAGEMENT
osn �
Page 1 of 1
ATTACHMENT F
CONTRACT PAYMENT REQUIREINIENTS
Florida Deparfinent of Financial Services, Reference Guide for State Expenditures
Cost Reimbursement Contracfs
Invoices for cost reimbursement contracts must be supported by an itemized listing of expenditures by
category (salary, travel, expenses, etc.). Supporting documentation shall be submitted for each amount for
which reimbursement is being claimed indicating that the item has been paid. Documentation for each
amount for which reimbursement is being claimed must indicate that the item has been paid. Check
numbers may be provided in lieu of copies of actual checks. Each piece of documentation should clearly
reflect the dates of service. Only expenditures for categories in the approved agreement budget may be
reimbursed. These expenditures must be allowable (pursuant to law) and directly related to the services
being provided.
Listed below are types and examples of supporting documentation for cost reimbursement agreements:
(1) Salaries: A payroll register or similar documentation should be submitted. The payroll register
should show gross salary charges, fringe benefits, other deductions and net pay. If an individual
for whom reimbursement is being claimed is paid by the hour, a document reflecting the hours
worked times the rate of pay will be acceptable.
(2) Fringe Benefits: Fringe Benefits should be supported by invoices showing the amount paid on
behalf of the employee (e.g., insurance premiums paid). If the contract specifically states that fringe
benefits will be based on a specified percentage rather than the actual cost of fringe benefits, then
the calculation for the fringe benefits amount must be shown.
Exception: Governmental entities are not required to provide check numbers or copies of checks
for fringe benefits.
(3) Travel: Reimbursement for travel must be in accordance with Section 112.061, Florida
Statutes, which includes submission of the claim on the approved State travel voucher or electronic
means.
(4) Other direct costs: Reimbursement will be made based on paid invoices/receipts. If
nonexpendable property is purchased using State funds, the contract should include a provision
for the transfer of the property to the State when services are terminated. Documentation must be
provided to show compliance with Department of Management Services Rule 60A-1.017, Florida
Administrative Code, regarding the requirements for contracts which include services and that
provide for the contractor to purchase tangible personal property as defined in Section 273.02,
Florida Statutes, for subsequent transfer to the State.
(5) In-house charges:Charges which may be of an internal nature (e.g., postage, copies, etc.) may
be reimbursed on a usage log which shows the units times the rate being charged. The rates must
be reasonable.
(6) Indirect costs:lf the contract specifies that indirect costs will be paid based on a specified rate,
then the calculation should be shown.
Contracts between state agencies, and or contracts between universities may submit alternative
documentation to substantiate the reimbursement request that may be in the form of FLAIR reports
or other detailed reports.
The Florida Department of Financial Services, online Reference Guide for State Expenditures can be found
at this web address http://www.myfloridacfo.com/aadir/reference auide/.
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OKeechobee Public Works
PW 05-10-09-20
FDOT FPN 440372-1
SOUTHEAST 3rd AVENUE PAVEMENT IMPROVEMENTS
Addendum 1
October 15. 2020
uestion: Is striping included in this project?
Answer: Striping is not included in the scope of this project.
L=1=-'���
�llAill/.!' Vyr�J�l�S
David Allen
Public Works Oirector
Clarification: All millings produced during the project are the property of the City. Millings are
to be delivered to the City's Public Works Facility located at 500 NW 11th Avenue, Okeechobee
FL 34974. The Public Works Facility is approximately 1.5 miles from the project location. The
facility is normally open from 6:30 am to 5:00 pm Monday — Thursday. Arrangements for the
facility to be open at other times can be made by contacting the Public Works Department.
Okeechobee Public Works
PW 05-10-09-20
FDOT FPN 440372-1
SOUTHEAST 3rd AVENUE PAVEMENT IMPROVEMENTS
Pre-bid meeting, October 14, 2020
Agenda
1. Introduction
2. Project Scope
a. Pavement improvements including milling, resurfacing, and concrete sidewalk
ADA ramp construction on SE 3rd Avenue from Park Street (SR 70j to SE 4th
Street.
3. FDOT Funded Project
a. Governing Specifications for the project are the current FDOT the overriding
specifications for the project.
b. The conditions in the Grant Funded agreement included in the appendix to the
bid document are the overriding conditions for the project.
4. Bonding requirements
a. Bid bond will be required for the project.
b. Performance and other bonds are based on the criteria as outlined in section V
of the bid document.
Mailing address: 55 SE 3'd Ave, Facility Address 500 NW 11�h Avenue • Okeechobee FL 34974 • 863-763-3926
Form w��
(Rzv. October2018)
Departmen! of the Treasury
Internal flevenue Service
Request for Taxpayer
Identification Number and Certification
► Go to www.irs.gov/FormW9 for instructions and the iatest information.
Give Form to the
requester. Do not
send to the IRS.
1 Name (as snouvn on your income tax return). Name is required on this line; do not
Ranger Construction Industries, Inc.
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2 Business name/disregarded entity name, if different from above
3 Check appropriate box for federal fax classification of the person whose name is entered on fine 1. Check onfy one of the 4 Exemptions (codes apply onty to
following seven boxes. certain entities, noc individuals; see
instructions on page 3):
❑ Individualisole proprietor or ❑✓ C Corporation ❑ S Corporation ❑ Partnership ❑ TrusVesta[e
single-rtiernber LLC Exempt payee code (if anyj
❑ Limited liabillry company. Enter [he tar, classification (G-C corporation, S=S corporation, P=Partnership) ►
Note: Check the appropriate bor in the line above for the tax classifica!ion of the singlz-member owner. Do not check Exemption from FATCA reportirg
LLC if tne LLC is classi`ied as a single-me;nber LLC that is disregarded from the ovrner unless the owrer of tne LLC is code fif any)
anotner LLC tnat is not disregarded from �he owner for U.S. federai tax purposes. O[herwise, a single-member LLC that
is disregarded from the o��iner should check the appropriale box for the tax classification of its owner.
Lf Otrer (see instructions) ►
5 Address (rumber, sireet, and apl. or suite no.) See ins[ructions.
101 Sansbury's Way
6 City. state. and ZIP code
/nppbes !o arco��nls ma�nta�ne�J oulside Ihr U.S./
Requester's name and address (optionaq
West Palm Beach, FI 33411
7 List accourt n�moer(sj i,are (eotionaq
Taxpayer ldentification Number �
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup witiiholding. For individuals, this is generalfy your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entitias, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN. later.
Note: If the accouni is in more than one name, see tne instructions for line 1. Also see N/hat Name and
Number To Give the Requester for guidelines on whose number to enter.
or
number
0�00�0����
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subj2ct to backup uvithholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup wifhholding as a result of a(ailure to report aIl interest or dividends, or (c) the IRS has notified me that f am
no longer subject to backup withholding; and
3 I an� a U.S. ciiizen or oti�er U.S. per5on (defined below); and
:. The FATCA code(s) enter?d on this form (if any) mdicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out !tem 2 above if you have been notified by the IRS that you are currontly subject to backup withholding because
you have failed to report all interesl and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisit�vn or abandonment of secured property, cancellation of debt, caitributions to an individual retirement arrangement (!RA}, and generally, payments
otner [nan interest and dividends, you are not reqwred to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
Sign Signature ot
Here U.S. person ►
�-� i`:! � `'%�'d`i
General Instructions
t�
Section references are to the Internal Revenua Code unless otherwise
noted.
Future developments For the latest information about developments
related to Form W-9 and its instructions, such as Iegislation enacted
after tney were published, go to www.i�s.gov/Fo�mW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
inforination return with the IRS must obtain your correct taxpayer
identi(ication number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification numoer (ATIN), or employer identification number
(EINI, to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099-INT (interest earned or paid)
. oate ► OCtObe� 21, 2020
• Form 1099-DIV (dividends, including those from stocks or mutual
f�nas>
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds frorn real estate transactions)
• Form 1099-K (merchant card and third party rtetwork transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
CaL No. 10231X Form W-9 (Rev. 10-2018)
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�'�o�i�ir� l�epc��°tme�¢t of 1'�c�nsp��t�xta�n
RON DGSANTIS 605 Suwannee Street KEVIN J. TIIILiAULT, P.E.
GOVERYOR Tallahassee, FL 32399-0450 SCCRCTARY
hlay 12, 2020
RA�IGER CODISTROCTION If1DUSTRIES, ID(C.
101 SAD�SBURY'S WAY
WEST PALh] BEACH, ELORIDP. 33411
RE: CERTIE'ICATE Oe QURLIFICATIODI
Dear Sir/2�iadam:
The Department of Transpertatior has qualified your company for tne type of work
indicated belo�a. Unless your company is notified ctherwise, this Certificate of
Quali.fication �•iill expire 6/30/2021. However, the new application is ciu2 4/30/2021.
In accordaiice with S.937.14 (1) F.S. your next application must be filed o�ithin (4)
months of the ending date of the applicant's audited annual financial statements.
If your company's maximum capacity has been revised, you can access it by logging into
the Contractor Prequalification Application System via the following link:
HTTPS://fdotwpl.dot.state.fl.us/ContractorPreQualification/
Once logged in, select "View" for the most recently approved application, and then
click the "Manage" and "Application Summary" tabs.
FDOT APPROVED WORiC CLASSES:
DEBRIS RE�fOVAL (Eh:ERGENCY) , DRAINAGE, FENCIDIG, FLEXIBLE PAVIDIG, GRADID]G, GRASSING,
SEEDIDiG A^1D SODUING, GUARDRAIL, HOT PLADIT-hIIXED BITUh1. COURSES, iD1TERMEDIATE BRIDGES,
hIID10R BRIDGES, PORTLAND CEM�NT CONCRETE ROAD�AAY PAVING, ROAD;VAY SIGNIDiG, SIDE4VALK,
U�IDERGROUND UTILITY AND RIP RAP.
You may apply �or a Revised Certificate of Qualification at any time prior to the
e:�oiraticn date of this certificate according to Section 19-22.0091(3), Florida
Administrative Code (F.A.C.), by accessing your most recently approved application as
shown above and choosina "Update" instead of "View." If certification in additional
classes of work is desired, documentation is needed to show that your company has done
such �aork with your own forces and equipment or that ex�erience �aas gained :aith
another contractor and that you have the necessary equipment for each additional class
of work requested,
All prequalified contractors are required by Section 19-22.00E(3), F.A.C., to certify
their work undercaay monthly in order to adjust maximum bidding capacity to available
bidding capaci.ty. You can find the link to this report at the website shown above.
Sincerely,
� T ��c.v9v f/ . �c y �
Alan Autry, Manager
Contracts Administration Office
AA:cg
�vtivrv.fdot.gov
Ron DeSantis, Governor
Halsey Beshears, Secretary .
; Florida
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Sl'ATE O� F�OR�Da4
�EP�4RT1�/iENT OF �USIIVESS �aND PROFESS��6�A� REGU��'�pN
CONSiRUCTION �I-N�`UST�RY ;L�C,E9�S9�G �OAR�
THE GENERAL CON�TRAGTO:R. FiEREIf�,fS CERTIFIED UNDER THE
_ _„ __ ;, ,,,
PROVISIONS O�,F CHAPTER 489, FLOR'IDA S,TATUTES
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�ER CONSTRU_CTI(ON INDUSTRIES;��IN'C'.
' ' =; 1'01_ SANSBURY'S W�AY= � � �?''+' � � ��'
WEST`PALM'BEACH FL' 3341�1-_ � "�
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LgCENSE �lUOv1�E��' 'CGC031554 _ ��
E)CPI62�.T90N DATE:� AUG4.�ST 31, 2022
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Do not alter this document in any form.
This is your license. It is unlawful for anyone other than the licensee to use this document.
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�d_.._ __S T. L U C I E_ CO U N T Y ��. Lu�ie Co�nty Local Bu�i�te�s T'�x Re�eipg
Facilities or machines # Roams # Seats # Employees #100 Receipt #1799-00900009
Type of business 1799 MISC/SPECIALIY CONTRACTOR
(SPECIALTY)
DBA name Ranger Construction Industries Business Michael B. Kracunas
Expires SEPTEMSER 30, 2021
Malling address: Ranger Construction Industries Business location: 4510 Glades Cut Off Rd
1Q1 Sansbury's Way Fort Pierce, FL 34981
West Palm Beach, FL 33411
RENEWAL St Lucie County CU-CQ56779
Original tax: $27.55 F40180
Penalty:
Collection cost:
Total: �2�,55 Paid 07/06/2Q20 27.55 0025-20200706-031444
Law requires this Local Buslness Tax Receipt to be displayed conspicuously at the place of buslness In such a manner that it can be open to the
view of the public and subject to Inspection by all duly authorized officers of the county, Upon failure to do so, the locai business taxpayer shall
be subject to the payment of another Local Buslness Tax for the sam� business, professfon or occupation.
Pursuant to Florida law, all Local Business Tax Receipts shall be sold by the Tax Collector beg!nning July 1 of each year and shali expire on
September 30 of the succeeding year, Those l.ocaf Bustness Tax Receipts renewed beginning October 1 shali be delinquent and subject to a
delinquency penalty of 10 percent for the month of October. An additional 5 percent penalty for each month of delinquency is added until paid,
provided that the totaf delinquency penalty shall not exceed 2S percent of the Local Business Tax far the deflnquent establlshm�nt.
In addition to the pertalty, the Tax Collector Is entitfed to a collection fee of �1 to $5. Thls fee is based on the amount of Local Business Tax,
which aviil be collected from delinquent taxpayers a£ter September 30 of the business year.
This receipt fs a Loca( 8usiness 7ax only, It does noi permlt the local buslness taxpayer to violate any exlsting regulatory or zoning laws of the
state, county or clty, It also does not exempt the locai business taxpayer from any other taxes, licenses or permits that may be required by
iaw,
Pursuant to Florida law, Local Buslness Taxes are subject to change.
Ranger Construction Industries
101 Sansbury's Way
West Palm Beach, FL 33411
City of Fort Pierce, Florida
' 100 N. US Highway 1
Fort Pierce, FL 34950
{772) 467-3065
Amount Paid: $25.00 Issued: August 16, 2019
Comp Card Expires:
State License Expires;
Worker's Comp Expires
Liability Ins. Expires:
September 30, 2020
C�5807821719 04/01/20
CGC031554 08/31/20
17-24820 09/30/17
City of Fort Pierce, Florida
Certificate of Competency
GENERAL CONTRACTOR (CERTIFIED}
Control #4044684 License # 20-QQ026841
RANGER CONSTRUCTION INQUSTRfES
KRACUNAS, MICHAEL B
101 SANSBURY'S WAY
WEST PALM BEACH FL 33411
RANGER CONSTRUCTION INDUSTRIES
101. SANSBURY'S WAY
WEST PAi.M BEACH FL 33411
��� �� � CERTIFICATE OF LIAB�LITY 1�1SURARlCE DATE(MM/DD/YYYY)
�� 3/25/2020
TH1S CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate hoider in lieu of such endorsement(s).
PRODUCER CONTACT
George H. Friedlander Company PHONE Kristen LaPlante F�
1566 Kanawha Blvd. E. �vc r,o e:t: 321-254-8477 aic No:321-988-0209
E-MAIL
Charleston VW 25311 a�nRFsc kristenlanlantelcr�friedlandercomoanv.com
INSURED
Ranger Construction
industries, inc.
4510 Glades Cut-Off Road
Fort Pierce FL 34981
iNsuReR,n: Travelersindemnit Co
RANG002 �NSURER B: CI121'ief O2I( Flf@ II1SUf211CB
iNsurteR c: Travelers Pro ert & Casu�
INSURER D :
NAIC #
25658
25615
25674
COVERAGES CERTIFICATE NUMBER: 1599030832 REVISI�iV NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LlSTED BELO�N HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERiOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY COiVTRACT OR OTHER DOCUMEtiT WITH RESPECT TO N/HICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT Tp ALL THE TER�dS,
EXCLUSIONS AND CONDlTIONS OF SUCH POLICIES. LIv11TS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR � 7YPE OF INSURANCE ADOLISUBR� � POLICY EFF POLICYEXP
LTRI INSD.WVO POLICYNUMBER I MM/DD/YYYY MM/DD/YYYY LIMITS
B�X COMMERCIALGENERALLIABILITY � CO-58076217-20 4/1/2020 4/'i/2021 �
EACHOCCURRENCE $1,000,000
�I I DA�bIAGE TO RENTED
� J CLAI:bIS-f�lADe LJ OCCUR PREMISES (Ea occurrence $ 500,D00
X �
Contractual Liab i i titED EXP (Any one person) $ 10,000
I_____ __________ I PERSONAL & ADV INJURY $ 000,000 ___
GEN'L AGGREGATE LIL11T AFPLIES PER: GENER,4L AGGREGATE I$ 2,000,000
I� POLICY `n jE� � LOC ; PRODUCTS-COMP/OPAGG I 82,000,000
� OTHER: i � I S
A AU70MOBILELIA8ILITV CAP-58078?86-IND-20 4/1/2020 4/1I2021 COib181NEDSLVGLELINiIT $7,000,000
�Ea accident _____
X ANY AUTO 80DILY INJURY (Per person) }I $
ObVNED SCHED'JLED BODILY INJURY (Per accident) I$
AUTOS ONLY __� AUTOS i
' X HIRED X NON-OWNED I PROPERTYDA�IAGE � �
_ AUTOS ONI.Y AUTOS ONLY ! Per accident) ___._ �
I� I — I '" -------�---
C X UMeRELLALIAB X� pCCUR CUP-1N297872-20-25 I 4/1/2020 4/'1f2021 Ep,CHOCCURRENCE $5,000,000
EXCESS LIAB CLAItv1S-tviADE � —�—J
__ AGGREGATE $5,000,000
DED X RETENTION $ f � $
g WORKERSCOMPENSATION UB-SL888782-20-25-D 4/1/2020 4/112021 X PER OTH-
I AND EMPLOYERS' LIABILITY y� N I I STATUTE I ER _____
A�YPROPRIETOR/PARTNER/EXECUTIVE I E.L. EACHACCIDENT $ 1,000,000
OFFICER/McY18EREXCIUDED7 � N�A -- —
(MandatoryinNHj E.L.OISEASE-EAEMPLOYEE' $1,000,000
If yes, describe under - - —
DESCRIPTION OF OPERATIONS below � E.L. DISEASE - POLICY LIL11T i$ 1,000,000
I
I I
DESCRIPTION OF OPERATIONS / LOCAT(ONS / VEHICLES (ACORD 101, Additianal Remarks Schedule, may be attached if more spaee is required)
Per Project Aggregate appiies when required by written contract.
CERTIFICATE HOLDER _ CANCELLATION
SHOULD ANY OF TNE ABOVE DESCRIBEI� POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WI7H THE POLICY PROVISIONS.
Generic Certificate
ACORD 25 (2016/03)
REPRESENTATIVE
O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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DIVISION OF CORPORATIONS
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Department of State / Division of Corporations / Search Records / Search by Entity Name /
����3� �� E��6'��9 R��9��
Florida Profit Corporation
RANGER CONSTRUCTION INDUSTRIES, INC.
Filing Information
Document Number F40180
FEUEIN Number 59-2098662
Date Filed 06/10/1981
Effective Date 06/OS/1981
State FL
Status ACTIVE
Last Event CORPORATE MERGER
Event Date Filed 12/27/2010
Event Effeciive Date 12/31/2010
Principal Address
101 SANSBURY'S WAY
WEST PALM BCH, FL 33411
Changed: 01 /27/2009
Nlailing Address
101 SANSBURY'S WAY
WEST PALM BCH, FL 33411
Changed: 01 /27/2009
Registered Agent Name & Address
BROWNING, DOUGLAS
101 SANSBURY'S WAY
WEST PALM BEACH, FL 33411
Name Changed: 08/25/2010
Address Changed: 01/27/2009
Officer/Director Detail
Name & Address
Title ST
BROWNING, f�OUGLAS J I
101 SANSBURYS WAY �
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WEST PALM BEACH, FL 33411
Title President
SCHAFER, ROBERT
101 SANSBURYS WAY
WEST PALM BEACH, FL 33411
7itle VP
FRANK, SCOTT
101 SANSBURY'S WAY
WEST PALM BEACH, FL 33411
Titfe Chairman, CEO
VECELLIO JR, LEO A
101 SANSBURY'S WAY
WEST PALM BEACH, FL 33411
Title VP
Foavler, Frank Scott
101 SANSBURY'S WAY
WEST PALM BCH, FL 33411
Title VP
Vecellio, Michael A
101 SANSBURY'S WAY
WEST PALM BCH, FL 33411
Titie VP
Vecellio, Christopher S
101 SANSBURY'S WAY
WES7 PALM BCH, FL 33411
Titte VP
Vecellio, Kathryn C
1b1 SANSBURY'S WAY
WEST PALM BCH, FL 33411
Title Sr Vice President-Finance
Smith, Robert D
101 SANSBURY'S WAY
WEST PALM BCH, FL 33411
Title Chief Estimator, Asst Secretary
Skubal, Steve
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I
101 SANSBURY'S WAY
WEST PALM BCH, FL 33411
Title Asst Secrefary
Fowler, Richard
101 SANSBURY'S WAY
WESi PALM BCH, FL 33411
Title Asst Secretary
Yoder, William
101 SANSBURY'S WAY
WEST PALM BCH, FL 33411
Titie Asst Treasurer, Asst Secretary
Gwinn, L.L.
101 SANSBURY'S WAY
WEST PALM BCH, FL 33411
Title Asst. Secretary
Kracunas, Michael
1Q1 Sansburys Way
West Palm Beach, FL 33411
Tifle VP
Moretz, James W
101 SANSBURY'S WAY
WEST PALM BCH, FL 33411
Title Branch Operations Manager
Flynn, Patrick
101 SANSBURY'S WAY
WEST PALM BCH, FL 33411
Titie Chief Estimator-South, Asst Secretary
Eliis, Brian
101 SANSBURY'S WAY
WEST PALM BCH, FL 33411
Annual Reports
Report Year Filed Date
2018 04/23/2018
2019 01 /30/2019
2�2p 05/15/2020
v,�.l�'� u;' L�It�ly Ivalllc
IDocument Images
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ue!2�i by tntity Name
OS/15/2020 -- ANNUA� REPORT
01(30/2019 --ANNUAL REPORT
04l23/2018 -- ANNUAL REPORT
08/02/2017 --AMENDED ANNUAL REPORT
01/18/2017 --ANNUAL REPORT
01/23/2016 --ANNUAL REPORT
03l26/2015 --ANNUAL REPORT
01/OS/2014 --ANNUAL REPORT
01/28/2013 --ANNUAL REPORT
04/30/2012 -- ANNUAL REPORT
02/24/2011 -- ANNUAL REPORT
12/27/2010 -- Merger
08/25/2010 -- P,eg. Agenf Change
01/08/2010 --ANNUAL REPORT
01l27/2009 -- ANNUAI REPORT
03/03/2008 --ANNUAL REPORT
03/26/2007 --ANNUAL REPORT
02l22/2007 --AhNUAL REPORT
02/17/2006 --ANNUAL REPORI'
02/16/2005 --ANNUAL REPORT
03/01/2004 --ANNUAL REPOP,T
02/19/2003 -- ANNUAL REPORT
02/19/2002 -- ANNUAL REPORT
01/31/2001 -- ANNUAL REPORT
02/14/2000 -- ANNUAL REPORT
�3�22�1999 --ANNUAL REPORT
03/12/199g _- ANNUAL REPORT
02/11/1997 --ANNUA� REPORT
03/07/1996 -- ANNUAL REPORT
03/22/1995 -- ANNUAL REPORT
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Re: ic+., Dep�r;,r.er; n� 5:.�:^.. Gi��:sior af !.o rura:.ic.�s
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I h2 Company is commi�i�d to a Drug Free Workplace Program and �vil� a�gressively pursua the nrogram
to elimina�e drug a�us� from our v�iork environmeni. We hav� devzlo.�e� a plan ror acnievina ii�at goal.
Pleasc re�ar to ^,;o�endix A for tn� tex� oi our Drug Free Workolace ProGr2m. ao hclo acnieve ihis goal,
em;olo��cs are ,orohi.bited fror�: � �
� Poss2ssing, CIISi(I011ilfl9, selling, manu�aciuring, or being under �� in�1uence o� any illegal drug;
� Consuming alconolic beverages ��ihil� on com�ary ,oremis=s, cus��mer pre,mises, i�i company
v�hid�s or �vni;� on com�any busin�ss or iime (including luncn o� oih�r brca!�s); and
E�'�using inhala��ts or prescripfiion drugs or poss�ssing piesc�i;o�o;� drugs that hava not been
p�escribed for t,7e employee by a physician.
�n ym;�!oY�� ��>>ho viola`es tnis policy is subj�ci to correciive aciio� ur ;o and including i2rminaiion oi
em��0�m�ni- US2 Oi SOille druas is dccec�a:olc i0� ScV2i8i Ci3�S. ��icCIICi1 Oi SUCiI d(UGS 01 �if2ScilC2 Oi
alconol v+iiil b� considarzd oei�g "und�r tne in�1uencz".
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CIII�J;U�'�.GJ u3iiiy N;�SCi;� upi� '�'��y� ?rrnrrljn� ip � ph�lSlCi2�l'S IilS�t IJC?i7T1S Of CISI�9 OV�f-ific-COU�i2i'
d(uy^� �•��' � ii2u6�ii;�i uUi pv'S^� '" ' " . � •
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drugs �,�iould im�pair tn�lf �Jf1 fSIC2!, m�nial, E;�-,o�ional or o�he� raculil2S. V
Th� Compar�y's suosiance-a�use program includcs snverai componen�s to su�por i�s eiiors to remain
driag-f�e�, includina:
e Suoervisory training; __ __.
e Cip��l�,y�.�.. A�I�I��c��J'S p�U914��5�
6 Ci U`51 ic iiiig fl� qi� a�J�il�ai`1�5�
� Drug t�s`ing a��e� accidants involving injury and/o� properiy darn::�e;
� Drug t:.siino v�i;�an a supefviso� susp�cts t7a� an employ:e is "und.rtne in1u�nce" tluring v��o�king
hou rs;
a Drug tes�;ng on a random basis; and
� An EmployeeAssis�anc� Program (tA�')
All iniorma�io7 reia`ir�g to drug ai�d/oi Clcohol screens is to b� kapi s�.rcin/ con id2n�al. Th� information
avi�f b� ke�� in 'the e�nploy�e's m�dical file, w�ilici� yvili be ma�ntainc�! s��arai2ly Trorn tn2 emaloy��'s
p�;sonnel �le. These m�dica! files �vill be keo't lock�d and s�cured and access wili be IimiTed to c2rain
individucis in tne o-ganization. Under no circui�s�ances snould the resul�s oi a drug and/o� alcohol
screen be discussed �vi�n i��dividua!s v��ho do not hav� a �vork-rela�ed nee� io �no�r�.
cmploy�eg IflUOiVcd ifl 8fi aCCldent or injury Iil�/O�Vif1Q G�2fflc3t�2 i0 Giu�c'�j Of til2i I'�."�U!Ce8 tll?�IC2i
attentio� a�niay from tne premis�s wiil be scr�en�d to detemin� �vheth�rtn� employze t�s�s positive for
drugs and/or alcohol.
I� a supervisor susoects that an individual is at v�rork and unde� tn� influ�nce of alcohol and/or drugs, the
supervisor snouid notiy tne Sarety Deoar`�ment and/or i;�e H�aman Rssources Departrnent to seek
auL�orization to t�s� the em.oloyee. The supervisor �vill be granted permission to test the employae i;
sufiicien� objective symotoms exist to indicate th2 employee may be ��d�r th� inluenc� o` drugs and/or
alconol. Symptoms wiould includz slurred soeech uneven gait, imoair�d m2n'tal functions, e�tr�mely
dila�ed puoils, smell oT alcohol evidence of drugs and/or alcohol about tne emolayee's person or in the
ernploye�'s vvork vicinit�, negative performance pat�erns, excessiv� cr un2x�lained absenteeism or
tardi�ass, etc. '
While tne Comoany does not condone the abusQ oi alcohal, presc��i�filon drugs, and/or use of ill�ga!
divgs, the Company does recognize that addiciion to drugs and/or alcoho'I can be treaied. If an
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em�loyee r�cog�izes a p2rsonal acldic5on o� a.buse oroblem and seeks assisiznc� frorn managemen� in
advance oi d�ieciion, ih� Comoany may assis't fhe employez in sael<ing ir2atma��t Th� con idential
naiure o� ine employee's counszling and reha.biliia�ion Tordrug and/oralca��ola�uszNiill b� pr�s�rved.
���3r-�P�� ��:�fl��PLA�� F�L'Cl'
I. �'i3�,'0��.
Thz Corn;oany is commi�t=d to mainiaii�ing an alconol-iree and drug-ir=e ���orko!ac� to proi�ct ti'12 i1221�h
2f1CI S2T�iJ Oi� em;oloyaes and tne pu.blic. i ha', commi�m�ni is jEoo�rdizza ,��en an em,oloye� ill�gally
us;.s drugs in tne ti�rork;olace, o� us�s alcohol on �na job. There;or�, fne Cornaany has 2do�'ted th�
fo;lo�,ving �rug-;=re� �Vor�;olace Policy (th � "Policy"):
� Th� unla�;��iul use, possession, trad�, dis�.; iou��o� or salc of iilegai drugs, orconsoll�d su'osiances
is proi�i�it�d.
� Presence inn tn� body, o`iliegal drugs or con�rolled subs�ances, ia� znon-�nedicai rzason is
L.� ..
�Ji Oi iI.01i2�.
� Reooriing to v��ork and/or tivorking �mde� tne iniluence o� aico�iol ai� proni�ii�u.
I1. AS���;Cr,�l�`�� ;v
i he Polic� a;o�lies to ali a�plic2nts, eno!oye�s (salaried and hourl�), NII-ti��n�, pari-tima, seasonal,
cas:..ial, pro�ationa�� or ��moorary.
�3l. L1'�ir"..'p3�S'� Y �'�J�u.�J
M', A:CdilO�
Alcon�l is d� ined as eu�, i alconol, 2 IIf�L11C �`l�i IS tflc lil`OY.IC2iing ayent ir, f�m�n't�d a��d distiil2d lic�uors.
I� includ�s, bu: is noi limi�zd to, becr, �,vine, and liquo:.
[3, Druc�
"Drug" is any pnysical or mind-alie�ing subsiance. This includ�s, bui is na� limi��d to, a"con�rol�zd
subscance" or a"controll�d dar,g�rous subs�ance " as de�in�d by iederal and s:ate sta�.ui�s; marjuana or
cannabiiioids (poi, wie�d, grass); cocaine (coke, Crack); o�iaies (haroi�, mor�nii���, cod�in2);
amohatafnines (speed, "uo�ers", �eth, ice); pn2ncyclidine (PC�'); bat'oitura��s (barbs, do���mers);
m�ihaqua;on� (Quaalud�s); me�;�adone; b2n?odiazeain�s (Valium, Librium, Xanax); pro�o;���� ���e
(Darvon); a�y deriv2Cl Of COI11fJl�l�d suostance; or any prescrib�d drug tnat is a'ous�d or noi usad in
accordance �vi�h a pnysician's eval�ation and pr�scriotion.
�, l.ln��r t��� 9��a�1�,���r���
�aing und�r tne inrluence oi alco�iul is de ir�zd as a 8iood-,�;Icoho! Co�ie�i: ("��C') u� A� or hig� �:,r, c��
being undsr the in�uence o� G drug is d2fined as a posilive drug t�st resul�andlor v��her� an employze's
a;opearance, ac�ions or mannerisms indicate f�a� th� emoloyee is under t�a in1ue��c� o� alconol or a d�ug.
i�J. P�O�iI�;��J �0�d�3iJ�3
Any emoloy2e oi the Comaany found to be unde� fine influence of aiconol oiusing, manufacturing, s�llit�g,
trading, disiJibuting, dispensing, possessing any drug as herein darined tivhile oerorming services for or
on be�aif of the Company will be in viola�ion of this Policy. With res�ect to tne use o� alconol, the
prohi'�ition does not aoply to a Comoany sponsored and or sanciioned activi�y which may include the
seNing of alcoholic baverag�s, such use being governed by la�,v.
4�. F�1�.�8 ��'2�. ���C���1��! E'� GO+��Dl�'�T
The fo!lowing conduct also constitutes a violation of this °olicy:
1. refusing �o consent to a s�azch, inspeciion, test, or refusing to subrnitspecimen fo� testing;
2
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2. s��viiching, aliai ing, o� in any oih�� �,�iay mai�i;oulaiing any br�aih, blood, unne or ofner spccime�
collecied in conneccion �nii�� 't,`�is Policy;
3. ra�using to suo�nit co a s�aicn or insoeccion in conneciion v,�i�a �is Policy, including, bu� not
limiiad to, personal venicles park�d on a Company siie;
-^.. b�ing convicted oi oi pleading no coniest ro an� criminal drug c� alcahol o`ens� for a viola�:io��
occurring in the tivorkolace or occurring ��ihile conduciing th� G�mpany's busin�ss ar failina to
immediac�ly no'ti�y tne Company abou't sucn action;
5. for cnos� employees in sa�=cy-s�nsi�iv= posiiions, failure to notiiy a superviso� o� managcr o� th�
us� o� a pr2scria�ion or ov2r-tne-counc�r drug tivhicn may alt-r t�: en,��oY��'` Pn'l��cal or m�n�al
a:oili�y to p�rom his or h�r sa�ety-sensiiive iunc�.ions.
V�1. ��'13G A, �t� A� CO',-1�D1_ A E� � a;��G
Beio�� any ies't, an employ�e snould infiorm in� tes�.ing p=rsonnel a9ou�: any us� o� pr�scrip:ion o� non-
presc�io�ion mzdicir�es. Em�loy��s mGy be physically examined and/o; t��ced �orti�� presence o� alconol
or d�ugs in ih� follo�,�iirg circums�:ances: pos:-o��-r p�e-enoloym�n� t=s�.i�c; reasorabl� sus�icior iescing;
DOSi-aCC1�2�1t TcSilfl9; governneni required iesiing, including bu� noi lirri�ed io, regu(ations cro�uigated
b!� th2 Uf11iP.CI Sicic.'> ��oarn�n� o� i ransoora:ion (DO i); r�iu�n io ��vor�c a��erany a�s�nce greu��r th�n
fiA10 h�J��i(S CiU��BilOC1 ZCS�II�; Uilannounced ranci�ll'I i:�iiiiy; 8ii� U^u�]nnii�(:P.CIfOII04V-UO t�Silil� TO'i ti10��
8i11;0�0�2�5, ITa�y, ��icffEC� A`Jifl� GOi1l,0alf i0i8SSE�Si'il�n�:ana�or �rea��������
�J39. Gfl�zS��I�L�GiS;�i���,a���? ni�fl�� m� a;-�i� ��L9C�l
Viola`ion oi this Drug-Fre� VVor�piace Poiicy �vili r�suli in 'te�nina�ion oi emn!oyment or disqualr�ca�ion fior
ernploymcn' efgi�iiiiy ��ri�n tn;, Company. I he Go��oany r�s�rv„s tn� rign� and discre5on to de��rmin�
v�ih�'tner an e�r�ploya� �vno vio!ai�s th�s �oGcy a+rill be co�sidarad for r�--mployinen� ��ritn tne Comoany.
Furnar, fna Company r�s��ves th� right to dsi�rmin� v�ina;, i� any, 6en� i�s ��iiil be res?or:.d to an
individual Uil�o violairs thi� �olicy and is suosequen�ly re-2mployed. ih� Co�n,aany also resnrv�s �'ne
righi to inaose cer�in r�siric:ions, L�eatm�nt ��equi��m���is, and ies`in�;aquiremen�s as a condi'tion oi ��-
e�np!oym�n�.
'�,lll. ��i�;-1DLy i l�Lll Y
Ali i��iormation concer�ing drug and/or alcohol ies�ing re�2r�als and tesung resulis and(o� tr2a�meni and
re�a�iliiation oi an employ�e �vill be ke�i striccly confid2ntia! and r�leas�d ooly vvith t�'�e cons�ni o� tne
ernpioyee, or on a need-to-kno+�v basis, or as requir�d 6y la�.v.
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N17.i� D:���/
3zt.r..tz sf:t�� �' 60� 5u��a�7s�ee Street S�,z��T,s�a�'
G�V�,RN��3 Tallahassee, F'L 32399-0450
9/20/2018 - -
R�: DSE �F�lRi�ATIVE ACTi�N PL.AN APPROVAL
Thz Disadvantaged Business Enterprise Affirmaiive Action Pl�r� su�metied by:
(�.q,N�FR �0�!$TRUCTfON INDUSTRICS WC
has been a�p�o9�ed for a period of three years. Please upda�e ar�d submit a new plan
before the exparafion date shown befov�. If you do not plan ta wo�'�c on any Florida
Depariment of Transpor�ation Projec�s, it wili not be necessary for you to submit a new
plan.
(f you need any additionaf infiormation, please contact me at (850� �� �-4747.
Sincerely,
� ,�
Stefan Kulakoayski
State Contract Compliance Adminisirator
Equa! Opporiuniiy Office
AFFIRlV1Ai'IVE ACTION PLAN EXPIRATION:9l20I2021
..�^;_-�� I01 u1N92UFiY'9 WAY
� "i� Q�+ Wc-a"iPALM0Fr1CH,R33#11
1 ���% 1�J. OFftC£: �81J 793•8400
-.;� Constructton FAk(�61)760-d372
wwH.n�er�anawcdauwn
s�saaalia
EQlW1 OPPORiUWTY OFFICE
12112
Ftde } cf 2
Rae�q�r Consfrucfl�n 1ndu�.tri�s. tnc. hereafter ref t a" � C� �party" oc "this Co�re�ny" has
adopged fhis poticy a�d pla�a. �
Qdg�: 091�81201� By:u �. n S6gr�aSa�ae
Corparate F�I� Plo.: 69�2098�62 Rob�r� Scitafe� Pras��gr� Pri�t�d �a�ae � t(tle
DISADVANik�+��f� BUS1Pl�SS ENTERPRIS� (`�BE') ApFt�FAAT�VE ACTIC��9 P9�Pd
�OLtCY STAi'E�9E�tT
!i is the policy of fhis Carng�any tha� disadvanFaged businsss�s, as defned by 49 CFR P�r# ?�S, SubQa�k D and
Imp(emen#ed �nder Rul� Chapter 1478, F.A.C., shall have th� op�run!#y ���+p��� Gs su�c��i"aac�r� an� 5vp�(;ers
on all cAntracis a��rard�d by ihe Ftorida Department of Transpor�a6an (FflOT).
Tha raquiremenis af Rule Chap�er 1�-78, F,A.C., shail apply fa aN cont�c� enterad info b�:�ee� ��1aT at�af �e
Cornpany. Subcon.ractors andlor sup�l�ers to �te Com�any will also be bound byfhe r�quireme�ats Df Rule �hap�Er 14-78
F.A.C, and its su�contE�ct�r sh�6! take all neaessary and reasonabte ste�s � eccordance uri;h Cha��r 14-78, �.A.C., to
ensura that disadwant�ged busiraessEs have the opportunity to campete and per�arm r�flric ujni�c�d �rai�► FDOT. The
Cam�ny a�d its subcontractars shaii no� d+5criminata on the basis of rac�, �cola, �eligioa, natiana� origiR, dYsabilny, sex,
ar age in fha adr�inisfration of contr�cis with FD4T. ihe Com�rany has �e�i��at�d and appoin#�d a l�aison Ofif?cer Eo
d�v�lop, main#ain, and m�nftor f�e DBE Affim�ative Aciion Pian implemen�at�e�. Tf�e Lia;son Officer +r�'li be r�sponsibte f�r
dissar�inating Ynis policy staf�m�ni throughout the Company and to d��advanlaged con�ro�aed 6usir��s�s. Yf°is st�temEn`
is posted on nofice boards af ihe Company.
I. DESIG�I�TIOV OF LIAlSOi'3 OF�IC�R
The Company wlll aggressiveiy r�cru(t disadvantagc-d iwsinesses as subcor,tracio�s and suppliers for a!! ccmtracts vrith
FDOT. The Company has appo(nted a l.laison 0�[cer fo de�reiap and main�i� �is Affi�raiiE�: P.�tion P�an ir� eccordance
wi}h ihe requir�ments of Rul� Chapter �4-78, F.AC. The Liaisan OfFicer will have primary respansibilfty far de��loping,
maintainirig, and mvnitoring t�e Compan�e util'�zation of d+sadvantageti subcontradors in �dditlon t� t�e following s�ecinc
dufies:
(1j ihe Lfaison Q�cer shail aggressiveh,r sallcit bids irom dsadvant�ged business subconfr�cto�s faraii ._-_
FDOT contracts;
��� reccrds� for a per od of not e'ssithan�thsre� yea�rs, o�r as di cted by en'y sp cffio co�ntractualarequirera?e�� o`
FD{1T.
The fo�1o��Ing indiv(dual has been designated Liais�n 4�ncer wiih �asp�ns�bil'�Cj for Implemen�ing the Compa�ys
zifirmative action �rogram in ecco�dance with tt�e requirements af F�O7, Q �.�
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D�E LlAISON QF�ICER:
NAMEe Rob��t 5chafer
71TLE; Presldent
EMAlL: Bob,Ssha#��rangetconstru�tion.cazn
AI�LIRESS; 101 Sanst�u�y's Way, YVest Paim Beach, FL 33411
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275-070-118
EQUN-OFPORTUMTYO'� Z
Faga 2 of 2
18. RFFOR;V1ATiVE ttCTION NSETHODS
In order to formulate a realistic Affirmative Acfion Pfan, th� Company has identitied the following known bar�ers to
pa�icipation by disadvantaged subcontractors, before describing its proposeda`firm�tive acfion methods;
1. Lack of qualified disa�van#ag�d suhcontractors in our specific ge4g�p�+��1 areas of work;
2, Lack of certfied disadvantagRd subcontractor who se�k to perform FDOT work;
3. Lack of interest in perForming on FDOT contracts;
4. Lack oF response Nrhen requested to bid; •
5. Limited kno4,vledge Qf FDOT plans and specincatians to prepar� a rQs�onsible bid.
In vi��� of fne barriers to disadvaniagad busi�esses stated above, it shall be the policy of tha Company to pravide
apporfuniiy by utifizing the following affirmativ� acfion methods to ensura part;cipatiot► on ihe con#ra� with FDOT wili:
9. Providz writEen notice to a!I certified DBC subcontracfors in thegeagraphical araa where f�e �vork is ta be
subcontracted by the Company;
2. Adve�tise in minori�� fflcused media cancpming subcontract apper�unities with th� Company;
3. Select portions of work to be p�r�Orm2d by DBEs in or�er to insreas2 the �lke6hood of mQeting t�e sRa�'s
goafs (includirg, wheta a�propriafe, breaking dov�n contracts into economical;y faasibie unifs fa f��i�ifa� D��
parti�ipatian);
4, Provide adequata informaUon abaui t�e pfans, specificafions, ard xe�uirerr,en;s of t1�e contraci, nofre�ac&irrg
sui�confractors without sou�d reas�ns base� on a thorough Inuastiga6o� flf t�eir caPabilities;
5. Wave requirements o° per�omaance bonds v�here it is practical to do �;
6. Ai�end prs-bid meetings he(d bf FDDT to apprise di�zdvantaged subcontractar o` o�portunities ;vith the
Gompany;
7. Fonow u� or� initial so(icitatioru of int2rest to DBE subeontractors ta d�ten�ine with certainty wh2ther the D8E
company Is fntar�sted i� the sabcontract opcorfunity.
8. lJ�!i�e FaOT's D8E Suppo�ive Services provid2rs for assi�iance in id�rati#yirg and roti€��ng D��'s o�
cantraciing opportunities.
Th2 Company u�derstands that tnis list of atiirmati��e a�tion met�ods u not exhaust�ve and �vill incl�de addifional
appraaches a�sr having established familiarity wiih tFia disadvantaged subcontrcting communfty andlor determined t�a
stat�d apprcachea to be ineffactive.
IIL I+�i�'LEMERfiAT10N
The Company will make every efiort to
1. Me2t state gaals by uEilizing its affirmative actian methods.
2. Express good fafth by seeki�g to utilize D8E su�coniractors where work is to be subcontracted.
3. Ensurirtg ibat contracted DBE's perform a commereiallp usefuf funcEon as evidenced by their ex�c�ttion flf a
dis'�nct alement of work wii� its o��un workforce and tha carrying o4�F responsibilities by acfual[y per€arr�inS,
managing and supervisit�g the work involved.
N. R�9�Q�2TI�dG
The Company shall keep and m�intain such records as are neca�sary to de{armine the Comoany's compliance with its
DBE Afnrrnativa Actinn Pian. The Company wiil design ifs recard keeoing system to ind�ca%:
1. The num6er of QBE subcontractors and suppliers used by th� Cornpanp, identiA�ing fhe items af work,
materials and services provid�ed;
2. The efiorts and progress being made in obtaining DBE su�confradors through locaf and wmmunit�r sour�es;
3. Dacumentation of all contracis, to include correspondence, telephone calls, newsgaper advertisements, aic,,
io obtain D8� participation on all FDOT projects;
4. Ti�e Company shal! comply with FDOi's requirements regarding pay►nents t� suhcantractors including DSEs
for each month (estimate periadj in wt�ich the companies have worked.
V. D�� D1�E�TORY
fihe Comp2ny witl utilize the DBE Directory publisited by the FDOT
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if��s i�e�norar�d�am ag Unde�sia�di�g (�10�J) s�is fo�ifi� ihe..��ints o� agreemens b�r�en t�re
�epsrii��e�t of H�rneiand Security (Dk#S) a�� ]I�m���° Co���ic�ia� dnd�s�a'� Ine. ��m�loy�r)
rega�dir�g �h� Emp�oy�r's .pa�'ic��a�ior�. in t�e EmpPay�n�n� �{igibil�ty �Ver�cation, Program (�-
V�riiy). ihis M�ll .explai�is c�r�a�n fea�ures o� ihe E-Veri�y prograrn ar►� enumerafzs sp�ci�ic
responsi�i�i��s of Di�S, �he SocPaa 5ecurity A�m�nist�a#ion (SSA), and #he Employe`. �Ver�'ry is
a prfl���m iha# electror�icatl� efln��ms ar� employe�'s e99gz�if� to �vark in #he U�ited 5'�ates after
co�np(���n of fiie Empl�ym�nt Epig��ifiiy Varification Farm (�arm I-9). �or cov�rad gov�Pn�nent
con4raofars, E-Veriiy is usesi #o verify th¢ �mployment e�igibif�j of a!I nerv�y hirad e��Ioy��s and
al9 e�is�a�rg �tn�loye�s assigned ia �ed�ral contracfs or to veriiy the en4irz uvork3oree i� t�ie
contra�izi� so chooses. .
Rutnorifi� f�r� t�e E-Vari�r �rogra� is fo+�nd i� T�a IV, Su�titfe A, of #�e'I!leg�l Immigra�ioii
Refo�n ��d Immig�a�f Respans€b�li�r AcE of 9996 (iiR�i�l), Pu6, L. .104-2fl8, 990 Stai. 3009, as
arnende�# {S U.S.C. §�32�a nate). Aut�ori�y for as�:.oi ihe � Vaciiy program by Federal
c��tracf��s �nd subco�trac�ars co�rere�l by the te�rns oP Subpart 22.��, rc�mployrner�t E9agi�ildty
V�ri��i�t�n, �; the Fzderai Ac��isiiion R�gvlatio� .(FAR} (f�Erei�t���r refarted to in t��s MaLt as
a°F�ede�a� canirac�or:wi�th i�� FAR E�VEri?y cia�se") t� veri�y;ih� employme�# e�igibiliiy nf
certai� e�n�iflyees wor'�ti�g on Federa# con�racts is a�so #ormd in S�'npa�t 22.� 8 and in �x�cuiivv
��der 1�98�, as a,��nded. �
�4�T�
��d3��i'�t3�� T�} �� P�RF�����
A. �������9�9��`i��� t3� ���
�, SSA agr�s_ fo ptovide the Em�foyer uvii�r �vailabl�.iri�ormatio�i tha# allouus fhe Er�ployer ta
confirm #h� accuracp ot 3ocial.Seourify Numbers pr�v�de� by �1! e�ipfoyees ��'r�fied un��r ihis
M0�3 a�d ihe'�mpioymeni auihor�zatien of U.S. c�ti�ens. . ..
2. �SA agrees ta prqvid� tQ the �m�toy�r appro�riat� a�5i`tance wiih operatignai proble�s t�at
may aris� during th� Empioyer's,,pa�ticipation in t�e E-Veri�y program. 55A agrees to provide
f�e Employer w�th names, fitles, addresses, and tdephone n�mbe�s a€ 6SA repres�ntafives to
be contac�d during ine E-Ver�jr. p�ocess,
3.. SSA agrees fo safeguard the, inforrtiation p�avided 6y ihe Empfoyer through the E-Verify
program procedures, and to limit access fo sucf� informaiion, as is appropriate by law, fo
individuals respansible for the derification of ;Soa�a! Securi�y iVumbers and. for evaluafion of the
E Verify program or such other persans or en�fies wh� r�ay be a�athorize� by SSA as�gavemed
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