HomeMy WebLinkAbout2009 10 07 Regular 600 Foster & FosterDefined Benefit Plan and Trust
for
Employees of the City of Winter Springs
REQUEST FOR PROPOSAL
FOR ACTUARIAL SERVICES
September 16, 2009
1 I Foster Foster, Inc.
Table of Contents
SUBMITTAL COVER LETTER 3
LETTER OF INTEREST 4
PROFILEOF PROPOSER 6
OVERVIEW.................................................................... 6
OUR MISSION, VISION VALUES
7
WHYCHOOSE US?
7
CLIENT RETENTION GRAPH
9
REFERENCES...............................................................
10
CLIENTLIST
11
SUMMARY OF QUALIFICATIONS
18
FORMS.....................................................................................
19
VENDOR RATE /FEE SCHEDULE
19
FEES................................................................
20
DISPUTES DISCLOSURE FORM
23
INSURANCE REQUIREMENTS FORM
24
FLORIDA STATUES ON PUBLIC ENTITY CRIMES FORM
25
DRUG -FREE WORK PLACE FORM
28
CONFLICTS OF INTEREST STATEMENT
29
CERTIFICATION OF NON- SEGREGATED FACILITIES FORM
31
PUBLIC RECORDS FORM
32
2 1 Foster Foster, Inc.
SUBMITTAL COVER SHEET
Submit proposal to:
Purchasing Department
CITY OF WINTER SPRINGS
1126 East State Road 434
Winter Springs, Florida 32708
407 -327 -5959
September 16, 2009 3:00 p.m.
REQUEST FOR PROPOSAL (RFP)
#021109/JD
PENSION PLAN ACTUARIAL SERVICES
I hereby certify that the information contained herein is true. I agree and understand that any
misstatement or misrepresentation or falsification of facts shall be cause for disqualification of
the submittal, immediate cancellation of any contract with the City that might arise from the
representations contained herein, and forfeiture of rights for further consideration for work in the
City of Winter Springs.
VENDOR NAME: finuff �RS-cr
MAILING ADDRESS: Gg20 Rv41/ (Worm Oyi,s�. (6q
City:
Name/Title:
Authorized Signature /D
Email Address: Jnb
State: FL
Zip: �Sg
Phone Fax (;3`))
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1 Vj L
Actuarial Consultants for Retirement Programs
September 16, 2009
Ms. Joanne Dalka, Information Services Director
City of Winter Springs
1126 East State Road 434
Winter Springs, FL 32708
Re: Actuarial Services for the Defined Benefit Plan and Trust for Employees of the City of Winter Springs
Dear Ms. Dalka:
I am writing in response to the request for proposal that we received regarding the Defined Benefit Plan and Trust
for Employees of the City of Winter Springs, Florida. This letter is our effort to emphasize what a pleasure it
would be to serve as the City's actuary.
As you may recall, I drove to Winter Springs about one year ago at no charge to the City. I spoke to the City
Council regarding the pros /cons of complying with Chapter 175/185. As evidenced by this trip, we strive to
educate as many clients or non clients as possible.
Foster Foster Consulting Actuaries, Inc. d/b /a Foster Foster, Inc., a Florida corporation, is an independent
actuarial consulting firm that was founded in 1979 and is structured to provide actuarial services to Florida public
pension programs. As the consulting actuaries to more than 180 public retirement programs throughout the State
of Florida, we are well qualified to perform the services required of the City. Additionally, for the past thirty
years, our firm has been the contract actuary for the Division of Retirement, State of Florida. In this capacity, we
have assisted the State in the development of procedures for determining compliance with the "extra benefits"
requirements set forth in amendments to Chapters 175 and 185, Florida Statutes.
It is our opinion that we are uniquely qualified and would be the best applicant to perform the services requested
for the following reasons:
Firm's Expertise Accountability Foster Foster, Inc. is an actuarial consulting firm originating in
1979 that only provides actuarial services of this nature to the public sector in Florida. Unlike other
firms, we agree to be a fiduciary to the Fund and act in the best interests of the Plan members.
Consultant's Credentials We will devote a Fellow of the Society of Actuaries (FSA) to perform the
valuations and provide consulting expertise. This is the highest designation that an actuary can obtain.
Public Sector Databank With plan experience for over 180 Florida public entities, we are best
equipped to set assumptions as to future demographic behavior. We are able to provide reports showing
how the Winter Springs fund is performing relative to other Florida pension funds in over 20 different
categories.
Relationship with the State of Florida, Department of Management Services (DMS) It is the job of
the DMS to review the work of the Fund actuary each year or any time a change to the ordinance is made.
The DMS reviews work of all actuaries practicing in this market. The DMS is also charged to hire an
actuarial firm to perform valuations for the Chapter 175/185 plans and represent them by being their
actuarial voice at their pension conferences. They have selected Foster Foster for each of the last 25
years.
13420 Parker Commons Blvd., Suite 104 Fort Myers, FL 33912 (239) 433 5500 Fax (239) 481 0634 www.foster foster.com
4 I Foster Foster, Inc.
Ms. Joanne Dalka
September 16, 2009
Page Two
I, Bradley R. Heinrichs, FSA and Consulting Actuary, will be the lead actuary and principal contact for purposes of this
proposal, and I commit to exceeding each City's expectations for quality and timeliness. I can be reached at the mailing
address and telephone number printed below. My email address is brad @foster foster.com.
We would consider it a privilege to serve the City Commission as their pension actuary. If you have any questions
regarding this proposal response, our firm, or the services we are prepared to provide, please don't hesitate to contact us.
Sincerely,
Bradley R. Heinrichs, F.S.A, E.A., M.A.A.A.
Authorized Officer
5 1 Foster Foster, Inc.
Profile of Pronoser
Overview
Foster Foster Consulting Actuaries, Inc. d/b /a Foster Foster, Inc., a Florida corporation, is an
independent actuarial consulting firm that was founded in 1979 and is structured to provide actuarial services
exclusively to public retirement and other post employment benefit programs.
Our firm currently employs fifteen (15) consultants, of which (7) have obtained actuarial credentials. Brad
Heinrichs, Jason Franken, John Bartz and Michael Merlob are Fellows of the Society of Actuaries, the
highest distinction an actuary can obtain.
Our office of primary contact is located in Fort Myers, FL at the following address:
Foster Foster, Inc.
13420 Parker Commons Blvd., Suite 104
Fort Myers, Florida 33912
Telephone: (239) 433 -5500
Facsimile: (239) 481 -0634
Email: data @foster foster.com
www.fioster-
foster.com
Foster Foster, Inc. is currently providing ongoing support to more than 180 local ordinance plans
throughout the State, along with an additional 18 Police Officers' and Firefighters' Trust Funds through a 20+
year contract with the Division of Retirement. We work almost exclusively with public retirement and other
post employment benefit (OPEB) plans and consider ourselves to be experts in all phases of the design and
administration of these programs.
We have committed to educating trustees by being a corporate sponsor and featured speaker for the Florida
Public Pension Trustees Association (FPPTA). We are also keynote speakers at the Division of Retirement
conferences and Brad is on the Executive Board for the Statewide Public Pension Organizational Network.
We firmly believe that better educated clients make the best decisions.
With that said, however, it is very difficult for a lay person to differentiate one actuarial firm from another.
On the following pages, we will attempt to point out a few distinguishing factors that separate Foster
Foster from the rest of the pack.
6 1 Foster Foster, Inc.
Profile of Pronoser
Our Mission, Vision Values
Mission: Provide municipal clients with unparalleled service by generating meaningful results, exceeding
expectations, and making each client feel as though they are our top priority.
Vision: To become the actuarial consulting firm the public sector holds in the highest regard.
Values: We are committed to being an organization that acts with integrity, honesty, respect and
professionalism. We embrace such attributes as innovation, peak performance and strong discipline that,
when combined with our mission, will help us realize our vision.
Why Choose Us?
Being strictly involved with the public sector, our consultants have a very firm grasp on the wants and needs
of our clients. Whether proposing a benefit improvement that best suits both the desires of the membership
and the constraints of the plan sponsors or making presentations, our consultants are easily understood,
experienced, professional, and accessible.
We agree to be a fiduciary to the Fund, unlike other actuarial firms.
We believe that there are four principal ways in which actuarial consulting firms are evaluated:
Accuracy
Timeliness /Responsiveness
Communication Ability
Cost
Accuracy
There are a couple of ways that we ensure accuracy in our work.
First, we require that credentialed actuaries review each item prior to it being sent to the client.
Nothing leaves our office without a minimum of two sets of eyes reviewing it.
Second, we use the best actuarial valuation software money can buy. ProVal was developed by
WinTech in Greenwich, CT., and is THE state -of- the -art in actuarial valuation software. This
software is entirely PC- based, which eliminates the time and expense associated with maintaining
and operating a mainframe system. The software creates an electronic audit trail that provides
excellent documentation. This allows for an easy transfer of information between actuaries and
ensures accuracy in valuation results.
Last, given that we have over 180 clients that submit valuation reports to the State for review, in our
25+ years we have never had a valuation report not be approved. In certain instances, a revision is
required for clarification purposes, but each report eventually is approved, and nearly all of them
upon the first reading.
7 1 Foster Foster, Inc.
Profile of Pronoser
Timeliness /Responsiveness
Our firm has over 180 public sector clients, yet part of our mission is to make each client feel like
they are our only client. Because of the specialized nature of our firm, we have developed
economies of scale in operations. This allows us to make the following promises to our clients:
Benefit calculations will be performed in no more than 10 business days.
Actuarial Valuations will be performed in no more than 60 -90 days following the receipt of all
necessary demographic and financial information. Because we perform our own asset reconciliation,
audited assets are typically not necessary for us to perform the valuation, so our clients are able to
receive their report shortly after the beginning of the fiscal year.
Communication Ability
Understanding an actuary can be like trying to figure out what Snoopy is saying in a Charlie Brown
Special. Our actuaries start by articulating the essential information that requires client attention,
such as the contribution requirements for the year and the funded status of the plans. Then, our task
is always to provide a sound explanation as to why the state of the plans are different than the year
before, as well as our forecast of how it will look next year. At that point, depending upon our
audience, we may delve deeper into the details of the report.
We feel that flooding a client with words is not effective communication. Being clear, concise and
articulate is a much better approach in our view. Our reports bear that out, as they are some of the
clearest and easiest to read.
Cost
The firm prides itself in being the lowest cost provider in the marketplace. The following attributes
make us somewhat unique among our competitors:
The structure of our organization is one that minimizes fixed overhead, allowing us to bill our
clients less than our competitors, while still maintaining our mission of providing unparalleled
service.
We split travel costs among clients whose meetings occur on the same trip, so scheduling your
meeting on the same day as the other cities in your area would save the plans money.
We give impartial advice as to whether or not performing a study might achieve the intended
results of the client.
Most of our work is a fixed cost, articulated clearly in advance, so there are no hidden charges.
Our hourly billing rates for other work are notoriously among the lowest in the industry.
We adhere to our core values of honesty, integrity, respect, and professionalism.
Client Retention
Ultimately, actuaries are hired and fired based upon their abilities to communicate accurate results in
a timely manner; but do so at a reasonable cost. The only true way of knowing this is to take the
firm for a "test- drive," but a strong indicator for overall performance is client retention. We have
been the actuary for over half of our clients for at around 15 years. Please find a Client Retention
Graph on the following page.
8 1 Foster Foster, Inc.
Client Retention Graph
9 1 Foster Foster, Inc.
More Than
15 Years
Less than
54%
5 Years
13%
5 -10 Years
15%
10 -15 Years
18%
More Than 15 Years
10 -15 Years
115-10 Years
Less than 5 Years
9 1 Foster Foster, Inc.
Profile of Pronoser
References
The following client contacts are familiar with our firm and its experience in the preparation of both the
actuarial valuations of their pension plans and the Governmental Accounting Standards Board disclosure
statements applicable to the public retirement programs they sponsor:
Client: Lakeland Police Officers' Supplemental Pension Board
Contact:
Jody Sisson
Address:
730 E. Main Street, Lakeland, FL 32175
Phone:
(863) 698 -0359
Email:
JSisson4 @tampabay.rr.com
Services provided:
Pension Actuarial Services
Client:
Lakeland Firefighters' Supplemental Pension Board
Contact:
Tim Spivey
Address:
730 E. Main Street, Lakeland, FL 32175
Phone:
(833) 661 -2366
Email:
timspivey @earthlink.net
Services provided:
Pension Actuarial Services
Client:
City of Winter Haven
Contact:
Cal Bowen
Address:
P.O. Box 2277, Winter Haven, FL 33883
Phone:
(863) 291 -5667
Email:
cbowen @mywinterhaven.com
Services provided:
Pension Actuarial Services, Administration, OPEB Consulting
Client: Kissimmee Utility Authority
Contact: Lisa Davis
Address: 1701 W. Carroll Street, Kissimmee, FL 34741
Phone: (407) 933 -9803
Email: Idavis@kua.com
Services provided: Pension Actuarial Services
Client: Palm Bay Police Officers' and Firefighters' Pension Board
Contact: Richard Adams
Address: 1501 Robert J Conlan Blvd NE, Ste 260, Palm Bay, FL 32905 -3567
Phone: (321) 508 -1731
Email: pbpfpf @msn.com
Services provided: Pension Actuarial Services
We perform annual actuarial valuations for the retirement programs sponsored by each of these clients, as
well as the preparation of the Governmental Accounting Standards Board disclosure information required for
the Comprehensive Annual Financial Reports.
We feel that each of our 180+ clients are satisfied with our services, so we encourage you to contact any of
our clients listed on the following pages as to the quality of our work product.
10 1 Foster Foster, Inc.
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Summary of Qualifications
The persons with the primary responsibility for completion of the work outlined herein are Bradley
Heinrichs, Douglas Lozen, Barbara Smith and Drew Ballard.
Mr. Heinrichs joined the firm in August 2005 and has many years of actuarial pension experience. Brad is
one of approximately 1,600 actuaries worldwide who is both a Fellow of the Society of Actuaries and an
Enrolled Actuary per ERISA. He is also a member of the Academy of Actuaries. Brad will manage the
project, deliver valuation results at meetings, and ensure that the work product adheres to the rules,
regulations, and guidelines set forth by the United States Government, the State of Florida, and the Actuarial
Standards of Practice. He has experience consulting as a lead actuary for clients ranging in size from 50 to
250,000 participants. He is a frequent speaker at the Division of Retirement Florida State Pension
Conference, as well as the Florida Public Pension Trustees Association (FPPTA). He also serves on the
Statewide Public Pension Organization Network (SPPON) Executive Board of Directors.
Mr. Lozen is an actuary who consult to many funds in the Orlando area. He is a graduate of Michigan Tech,
has been working at Foster Foster for 10 years, and will play a key role in the valuation production and
project coordination.
Additional staff personnel who would be providing actuarial and administrative support to the program are
the following:
Ms. Smith is the pension consultant who is responsible for the reconciliation of the activity of the trust funds
and coordinates office production. She has extensive knowledge of Florida and federal pension law and has
more than 19 years experience in the administration of qualified retirement programs.
Mr. Ballard joined our firm in 2009 after graduating from the University of Nebraska with a degree in
Actuarial Science. Drew is in the process of rapidly obtaining his actuarial credentials. He will work with
the valuation team to scrub and reconcile the personnel data, determine funding requirements and produce
valuation reports. He will also be responsible for assisting with the benefit calculations.
18 1 Foster Foster, Inc.
VEND RA TE/FEE SCHEDULE
Please include a breakdown of the dollar amount of and the basis for your fees as appropriate based on the
following categories (generally defined in Scope of Services):
Benefits Administration f=unctions `ice A �CL6
Annual Valuation and SPD Preparation 11
Ad hoc Calculations and General Analysis A7ACAM
Total proposed annual fee for base services as per scope of work 11 00
Fee /Rate Schedule for any additional services (above and beyond that stated in the base scope of
services) that may be requested:
For all additional work, vendor is requested to provide a proposal which shall
include a breakdown of the hourly rate which will be applicable, in determining the
cost of these services, by major category of employee (actuary, associate, clerical,
etc.); for these additional services, billing will be broken down into time per
category by major task. These fees will be fixed for the initial period of two years,
and negotiated thereafter. Prior to accepting an assignment for additional work,
you will be requested to provide a proposed fee for the task on a "not to exceed"
basis prior to receiving authority to proceed.
VI
Fees
Standard Valuation Work
The regular annual actuarial services that we are prepared to provide on behalf of the Plan are as follows:
Performance of the annual Actuarial Valuation and Report. In the course of the valuation, we
will determine the funding requirements and generally review the experience of the Plan.
Preparation of information required for the Bureau of Local Retirement Systems per Chapter 112
Florida Statutes
Preparation of disclosure information for auditors per Governmental Accounting Standards
Board Statements No. 25 and 27.
Preparation of individual Member Certificates that set forth the projected, accrued, and vested
benefits, along with a statement of accumulated Member contributions on the valuation date.
This will be done within 60 days of Plan fiscal year end.
Review of Plan mortality tables used to calculate actuarially- equivalent benefit options.
Respond to any inquires by the State of Florida regarding issues derived by their review of the
Valuation and obtaining State acceptance.
One meeting with the City to discuss the valuation results and to answer any pending questions.
There will be no charge for time or travel for this meeting, just out -of- pocket expenses.
Additional meetings will incur a charge for time, 1 /2 the hourly rate for travel and out -of- pocket
expenses.
The services outlined above will be completed within 60 -90 days of receipt of all of the necessary
information required to complete the project.
All valuation work will be performed using ProVal, the most state -of- the -art actuarial valuation software
available on the market today.
Our fees will be guaranteed for a period of three (3) years from the date that the contract is approved. The
entire fee will be billed upon delivery of the report to the Board. The fees associated with the standard
valuation work will be as follows:
October 1, 2009 Valuation $11,000
*Subsequent reports will incur a 5% increase
20 1 Foster Foster, Inc.
Fees
Other Products Services
In addition to the regular annual services outlined on the previous page, we are also prepared to perform the
following special services:
Calculate monthly retirement benefits for retiring and terminating members. Our fee for the
calculation and certification of the normal form of payment and all optional forms is $300, provided
that the information is submitted using our standardized form. Information provided by any other
means will incur a $400 charge. These calculations will be performed and the results provided to the
City within 5 working days of receipt of all necessary employee and financial information.
Calculations of monthly benefits due to disability, death, or those benefits to terminated vested
members who left under prior plan provisions will be provided within the same timeframe, although
hourly rates will apply due to the complexity of the calculations.
Determine eligibility, benefits, and vesting for Plan participants
Perform contribution analysis and review for Plan participants
Perform "buy- back" calculations for $100.
Update quarterly DROP Accounts, if any, for $60 per account, per quarter.
Update the Summary Plan Description for $2,000 or fees in accordance with our hourly rate, if
lower.
Prepare supplemental actuarial and financial information for inclusion in the required Summary Plan
Description for $500.
Preparation of required Actuarial Impact Statements to describe the costs associated with the
implementation of alternative benefit improvements or changes in actuarial assumptions and
methods. The fee for this work is $1,000 per Statement.
Conduct meetings with the City to deliver reports or to answer questions.
Prepare the Annual Report to the Department of Management Services for $2,000.
Analyze funding trends to predict future contribution requirements.
Perform experience studies to help provide the City with historical data to use when selecting
actuarial assumptions.
Calculate refunds of employee contributions for $100.
Perform other general consulting services via telephone, email, or facsimile outside of what is
previously stipulated.
Calculate and report the cost of changes in benefit structure as a result of change of direction in City
policy or changes in Federal or State laws impacting upon the Plan.
Review current plan design to ensure the retirement program is meeting the goals of the City in
benefits provided and cost control.
Consult with City's financial advisors and/or legal counsel in the implementation and administration
of the plan.
21 1 Foster Foster, Inc.
Fees
The charges for the work not explicitly stated would be based upon the amount of time required to complete
each task. Additionally, travel will be charged at 1 /2 of the hourly rate. We will provide a firm fee quotation
prior to commencing any work at the City's request. Our hourly charges are as follows:
Hourly
Senior Actuarial Consultant
$250
Actuarial Consultant
$200
Actuarial Analyst
$150
Administrative /Clerical
65
In addition to providing the services outlined in the proposal herein, Foster Foster, Inc. has created online
benefit calculation software that will enable participants to perform benefit calculation estimates at their
leisure. This software is invaluable in helping participants understand how the provisions of the plan affect a
participant's benefit on a personal level, as well as how retiring at different dates impacts their pension. This
software also helps takes the strain off of the pension administrator because participants can obtain
instantaneous estimates on their own.
Foster Foster, Inc. would be happy to implement this product for Winter Springs for $16 per member per
year. It would allow for instantaneous benefit calculation estimates to be performed by the members in the
privacy of their own home and could lower benefit calculation expenses to the fund. The estimates show all
of the available optional forms of payment as well.
Finally, we are currently helping entities comply with the new GASB 43/45 rules by providing actuarial
consulting services. These new rules are with regards to Other Postemployment Benefits (OPEB). This is
out of scope for purposes of this proposal, but it is a service that we are currently providing.
22 1 Foster Foster, Inc.
Answer the following questions by answering "YES" or "NO". If you answer "YES please
explain in the space provided, please add a page(s) if additional space is needed.
1. Has your firm, or any of its officers, received a reprimand of any nature or been suspended by the
Department of Professional Regulation or any other regulatory agency or professional association
within the last five (5) years? NQ
2. Has your firm, or any member of your firm, been declared in default, terminated or removed from
a contract or job related to the services your firm provides in the regular course of business within
the last five (5) years CS
�'C. 1 'VFW IKX•} t j -C. 1'�'L (Y per -Ir u. rcri
(i" VN, -�k- r
3. Has your firm had filed against it or filed any requests for equitable adjustment, contract claims or
litigation in the past five 5) years that is related to the services your firm provides in the regular
course of business? L t' If yes, the explanation must state the nature of the request for
equitable adjustment, contract claim or litigation, a brief description of the case, the outcome or
status of suit and the monetary amounts or extended contract time involved.
V �Uid. alt s_ trf C_ t. L� 't'�{Y'i` ii a t.r� 1I
F
v v, 1, �fi� d l l j i r iJ jvu" f e s r -�L f `,_j r(I
r
f �Pr* f
I hereby certify that the statements ontained herein are true. I agree and understand that any misstatement or
misrepresentation or falsification of facts shall be cause for disqualification of the submittal, immediate cancellation
of any contract with the City that might arise from the representations contained herein, and forfeiture of rights for
further consideration for work in the City of Winter Springs.
Firm: 6 4 bl kf4�
Name Title: PWA( .1 f t I V
Authorized Signature Da
tit r
t `it`_ fat ?(tt�Y c f_4 -k
This F Must B e Completed and Returned with your Submitta
INSURANCE REQUIREMENTS FORM
1. The vendor shall be required to provide to the Purchasing Coordinator, prior to signing a contract for or
commencing any work, a Certificate of Insurance which verifies coverage in compliance with the requirements
outlined below. Compliance of said certificate must be acknowledged by the Purchasing Coordinator prior to
start of work. Any work initiated without completion of this requirement shall be unauthorized and the City of
Winter Springs will not be responsible.
2. The City of Winter Springs reserves the right to require coverage and limits as considered to be in its best
interests. Insurance requirements shall be on a case by case basis determined by the project, conditions and
exposure.
3. Except for Professional Liability and Workers Compensation Policies, when required, all policies are to be
endorsed to include the City of Winter Springs as Additional Insured. In the cancellation clause the
number "30" shall be inserted into the blank space provided prior to the words "days prior notice... All
vendor policies are to be considered primary to City coverage and shall not contain co- insurance provisions.
4. In the event that the insurance coverage expires prior to the completion of services, a renewal certificate shall
be issued 30 days prior to said expiration date.
5. Subvendors or sub-contractors retained by the primary vendor are the responsibility of said primary
vendor in all respects.
6. Insurance requirements:
COVERAGE REQUIRED MINIMUM POLICY LIMITS
Statutory
1,000,000 Occurrence
1,000,000 CSL
Workers' Compensation
Commercial General Liability including Contractual Liability, Products and
Completed Operations, XCU and Owners and Contractors Protective
Comprehensive Auto Liability, CSL, shall include 'any auto"
Professional
$9,000,000 Occurrence
(NOTE: All limits are per occurrence and must include Bodily Injury and Property Damage. Deductibles and
self insured retentions must be approved by the City of Winter Springs, and all insurers must have an A.M. Best
rating of at least A: VII.)
7. Bonding Required: None This Submittal
8. Vendor will be required to provide a certificate of insurance in compliance with the above, within four (4) days of
notification of award with continuing coverage, without a break.
9. I hereby certify that the insurance and bonding requirements outlined above shall be met as required, if l am
awarded a contract for the services specified herein.
Firm: key v f1
Name Title: Rl/,trt
Authorized Signature Date:
h ?'rr
Zi/AM
This Form Must Be Completed and Returned with your Submittal
9
FLORIDA STATUTES ON PUBLIC ENTITY CRIMES FORM
THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC
OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
1. This sworn statement is submitted to the City of Winter Springs by:
dig LA—P- &n/fl f o s
on behalf of:
whose business address is:
ri pay- i
Federal Employer Identification Number FEIN f
or Social Security of the person signing this statement:
2. 1 understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), F.S., 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 with the United States, including, but not limited to, any bid or contract for goods or
services, any lease for real property, or any contract for the construction or repair of a public
building or public work, involving antitrust, fraud, theft, bribery, collusion, racketeering,
conspiracy, or material misrepresentation.
3. 1 understand the "convicted" or "conviction" as defined in Paragraph 287.133(1)(b), F.S.,
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 guilt
or nolo contendere.
4. 1 understand that an "affiliate" as defined in Paragraph 287.133(1)(a), F.S., means:
A predecessor or successor of a person convicted of a public entity crime or 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 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.
10
5. 1 understand that a "person" as defined in Paragraph 287.133(1)(e), F.S., 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 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. (Please indicate which statement applies.)
Neither the entity submitting this sworn statement, nor any of its officers, director,
executives, partners, shareholders, employees, members, or agents who are active in the
management of the entity, nor any affiliate of the entity were charged with and convicted of a
public entity crime after July 1, 1989.
The entity submitting this sworn statement, or one or more of the officers, directors,
executives, partners, shareholders, employees, members, or agents who are active in the
management of the entity, or any affiliate of the entity was charged with and convicted of a public
entity crime after July 1, 1989.
The entity submitting this sworn statement, or one of its officers, directors, executives,
partners, shareholders, employees, members, or agents who are active in the management of
the entity, or any affiliate of the entity was 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 City of Winter Springs is for the City of Winter
Springs only, and that this from is valid through December 31, 2007. 1 also understand that I am
requ' ed to inform the City of Winter Springs prior to entering into a contract in excess of $25,000
of r change in he information contained in this form.
A
State of Florida, County of On this day of be 206 7 before
me, the undersigned Notary Public of the State of Florida, personally appeared:
otac_Jley R. elf fi
(Name(s) of individuals who appeared before notary)
11
whose name(s) is/are Subscribed to the within instrument, and helshefthey acknowledge that
he/she/they executed it.
Sworn to and subscribed before me this
Jb tk day of kz�L— 20 Q
Notary B bl is
My Commission expires:
Personally Known
Produced Identification:
(Type)
Did take an Oath
Did Not take an Oath
KATHLEEN 141AF3fE EYMEN
My COMMISSION DD 48NIO
EXPIRES: OctoWr 12, 2D09
Banded Thru N*ry Pubk undv
s [Ojai
12
Firm: tc4V �S
Name 1 Title:
Authorized Signature Date:
DRUG-FREE WORK PLACE FORM
The undersigned, in accordance with Florida Statute 287.087 hereby certifies that the company named
below does:
1. Publish a statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession, or use of a controlled substance is prohibited in the workplace and
specifying the actions that will be taken against employees for violations of such prohibition.
2. Inform employees about the dangers of drug abuse in the workplace, the business's policy
of maintaining 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 proposed
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 bid, the employee will abide by the
terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo
contendere to, any violation of Chapter 893 or of any controlled substance law of the United States or
any state, for a violation occurring in the workplace no later than five (5) days after such conviction.
5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or
rehabilitation program if such is available in the employee's community, by any employee who is so
convicted.
6. Make a good faith effort to continue to maintain a drug -free workplace through implementation of this
section.
WO. ichS Pry l dent
1
13
This Form Must Be Completed and Returned with your Submittal
CONFLICT OF INTEREST S TATEMENT
of deposes and states that
Name of Affiant Name of Company
the above named entity is submitting a proposal to the City of Winter Springs for the project identified
above.
2. The Affiant has made diligent inquiry and provides the information contained in this Affidavit based
upon his own knowledge.
3. The Affiant states that only one submittal for the above project is being submitted and that the above
named entity has no financial interest in other entities submitting qualifications for the same services.
4. Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement,
participated in any collusion, or otherwise taken any action in restraint of free competitive pricing in
connection with the entity's submittal for the above project. This statement restricts the discussion of
pricing data until the completion of negotiations and execution of the Agreement for this project.
5. Neither the entity nor its affiliates, nor anyone associated with them, is presently suspended or
otherwise ineligible from participating in contract lettings by any local, state, or federal agency.
6. Neither the entity, nor its affiliates, nor anyone associated with them have any potential conflict of
interest due to any other clients, contracts, or property interests for these services.
7. 1 certify that no member of the entity's ownership, management, or staff has a vested interest in any
aspect of or department of the City of Winter Springs.
8. 1 certify that no member of the entity's ownership or management is presently applying for an
employ a position or actively seeking an elected position with City of Winter Springs.
9. In t ent that a co flict terest is identified in the provision of services, 1, on behalf of the above
rid egik,,Avill e i y notify the City of Winter Springs in writing.
Of
Date
Title Typed or Printed Name of Affiant
State of Florida, County of ez�
On this day of 20P` before me, the undersigned Notary Public of the
State of Florida, personally appeared
and
14
(Name(s) of individuals who appeared before notary)
whose name(s) is /are subscribed to the within instrument, and he/she /they acknowledge that he /she /they
executed it.
WITNESS my hand and official seal.
NOTARY PUBLIC, STATE OF FLORIDA NOTARY UBLIC
4
KATHLEEN MMJE OBRIEN
SEAL OFFICE: My COMMISSION# DD IG
EXPIRES: October 12,20M
�P,f;�;u 8 a�ladThmNafluyP�;icUndatw�itmts
(Name of Notary Public: Print, Stamp, or Type as Commissioned.)
This Form Must Be Completed and Returned with your Submittal
15
CERTIFICATION OF NON-SEGREGATED FACILITI
By affixing his signature to this form, the consultant certifies that he does not maintain or provide for his
employees any segregated facilities at any of his establishments, and that he does not permit his
employees to perform their services at any location, under his control, where segregated facilities are
maintained. The consultant certifies further that he will not maintain or provide for his employees any
segregated facilities at any location under his control where segregated facilities are maintained. The
consultant agrees that a breach of this certification will be a violation of the Equal Opportunity clause in
any contract resulting from acceptance of this Bid. As used in this certification, the term "segregated
facilities" means any waiting rooms, work areas, restrooms and washrooms, restaurants and other eating
areas, time clocks, locker rooms and other storage and dressing areas, parking lots, drinking fountains,
recreation or entertainment area, transportation and housing facilities provided for employees which are
segregated by explicit directive, or are in fact segregated on the basis of race, color, religious disability or
national origin, because of habit, local custom, or otherwise. The consultant agrees that (except where
he has obtained identical certifications from proposed subcontractors for specific time periods) he will
obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding
$10,000 which are not exempt from the provisions of the Equal Opportunity clause, and that he will retain
such certifications in his files.
The nondiscriminatory guidelines as promulgated in Section 202, Executive Order 11246, and as
amended by Executive Order 11375 and as amended, relative to Equal Opportunity for all persons and
implementations of rules and regulations prescribed by the United States Secretary of Labor are
incorporated herein.
NOTE: /THV penalty for making false statements in offers is prescribed in 18 U.S.C. 1001.
Date:
r007E P/
Print Name Title
Official Address: 1 3L/ 26 P L&y C&Y) MPrj ,c1� S�,r c Pr kl-f �(t_ 739/2_
1 1
This Form Must Be Completed and Returned with your Submittal
16
PUBLIC RECORDS FORM
All proposals are subject to the Florida Public Records Act, F.S. 119. The
submission of a proposal authorizes release of your firm's credit data to the City
of winter Springs. Responsive proposals are "public records" and shall be subject to
public disclosure consistent with Chapter 119.07(3) (o), Florida Statutes. Vendors must
invoke any exemptions to disclosure provided by law in the response to the proposal,
and must identify the data or other materials to be protected, and must state the
applicable statutory exemption for exclusion from public disclosure. Please list below
any exemptions to disclosure as provided by law and sign and date the form where
indicated.; If you are not claiming any Public Records Exemptions, please check the
box below and sign and date the form where indicated.
f
O Ne are claiming no exemptions
e I idor' SignaturefDate
This Form Must Be Completed and Returned with your Submittal
17