Backup Documents 06/10/2025 Item #16K 3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 6 K 3
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
** ROUTING SLIP**
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2. (Enter your Dept here)
3. County Attorney Office County Attorney Office
032 P3
4. BCC Office Board of County BS by MB
Commissioners [s] 4113
5. Minutes and Records Clerk of Court's Office 7/4.t?
/ q;d�ztk
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above may need to contact staff for additional or missing information.
Name of Primary Staff Madison Bird Phone Number 2939
Contact/Department
Agenda Date Item was 00/Z5
Agenda Item Number
Approved by the BCC I 6k 3
Type of Document(s) p Number of Original
Attached R.t4FenFioh A yiee,elf Documents Attached '
PO number or account
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A" in the Not Applicable column,whichever is Yes N/A (Not
appropriate. (Initial) Applicable)
]. Does the document require the chairman's signature?(stamped unless otherwise stated) MB
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
provide the Contact Information(Name; Agency;Address; Phone)on an attached sheet.
3. Original document has been signed/initialed for legality. (All documents to be signed by MB
the Chairman,with the exception of most letters, must be reviewed and signed by the
Office of the County Attorney.)
4. All handwritten strike-through and revisions have been initialed by the County Attorney MB
Office and all other parties except the BCC Chairman and the Clerk to the Board.
5. The Chairman's signature line date has been entered as the date of BCC approval of the MB
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's MB
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip N/A
should be provided to the County Attorney Office at the time the item is uploaded to the
agenda. Some documents are time sensitive and require forwarding to Tallahassee within a
certain time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 61/a and all changes made during N/A is not
the meeting have been incorporated in the attached document. The County Attorney Sk/h% an option for
Office has reviewed the changes, if applicable. this line.
9. Initials of attorney verifying that the attached document is the version approved by the N/A is not
BCC, all changes directed by the BCC have been made,and the document is ready for the I an option for
Chairman's signature. / this line..
l:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04;Revised 1.26.05;2.24.05; 11/30/12;4/22/16;9/10/21
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RETENTION AGREEMENT WITH
JACKSON LEWIS P.C.
This Retention Agreement is made by and between the Board of County Commissioners
of Collier County, Florida (the "County"), and the law firm of Jackson Lewis, P.C., 100 South
Ashley Drive,Suite 2200,Tampa,FL 33602 ("Jackson Lewis") .
Whereas, Jackson Lewis has special expertise and resources on a wide range of legal
matters, with particular expertise in cyber security, data privacy, and security compliance and
also provides a wide-range of legal services concerning employee benefits compliance,labor and
employment law;and
Whereas,the County from time to time has a requirement and need for legal services that
is particularly within the expertise of Jackson Lewis.
Now, therefore, in consideration of the premises contained herein, the County hereby
hires and retains Jackson Lewis and Jackson Lewis hereby agrees to provide legal services to the
County.
ARTICLE 1
COMPENSATION: METHOD OF PAYMENT
1.1 Compensation shall be paid to Jackson Lewis in accordance with the terms set forth in
Exhibit "A" attached hereto and made a part hereof. Requirements for reimbursable expenses
are set forth in Exhibit "B," attached hereto and made a part hereof. Expenses other than
automobile expenses must be documented by copies of paid receipts or other evidence of
payment. The Certificate contained in Exhibit "C" must be included with every invoice
submitted for payment that involves a request for reimbursement of out-of-pocket expenses
incurred but is not required to be submitted if the invoice submitted for payment only involves
billable hours at the rates set forth herein.
1.2 The rates set forth in Exhibit"A"shall remain in effect without change for a minimum of
two (2) years from the effective date of this Agreement. In the subsequent years of the
Agreement,upon the request of Jackson Lewis,the County Attorney is authorized to negotiate to
increase the hourly rate up to a maximum of ten (10) percent without approval by the Board of
County Commissioners. In the negotiation process, Jackson Lewis must substantiate the reason
the request is being made(i.e. market conditions,increase in CPI,etc.)
1.3 Multiple Attorney Assignments. The County acknowledges that, from time to time, it
may be advisable for Jackson Lewis to assign more than one attorney to a project or case.
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Nevertheless, in order to ensure that such multiple attorney assignments are efficient and cost-
effective for the County, Jackson Lewis agrees to the following procedures and billing
limitations for multiple attorney assignments.
1.3.1 A primary attorney will be identified for such projects or cases and that attorney will be
the contact attorney for the County except in the case of an emergency or the County's written
pre-approval. In practice, this means that generally only the primary attorney will meet or
communicate directly with County personnel or attend meetings, court, arbitrations,mediations,
or other proceedings on behalf of the County.
1.3.2 Attorneys assigned to a project or case shall have demonstrated expertise that will
demonstrably enhance the value and efficiency of the legal services being provided to the
County.
1.3.3 Jackson Lewis agrees that internal or in-house conferences among multiple attorneys
assigned to a project or case shall be kept to the minimum reasonably necessary for the provision
of the legal services in question. To the extent internal or in-house conferences among multiple
attorneys assigned to a project or case are necessary, each such attorney may bill his or her
customary rate for up to thirty (30) minutes for any such conference. To the extent such a
conference exceeds thirty (30) minutes in length, Jackson Lewis agrees that it will discount the
total billings for all attorneys involved in the conference by forty-five(45)percent.
1.4 Jackson Lewis may submit invoices for hourly work assignments pursuant to Exhibit"A"
only after the services for which the invoices are submitted have been completed or expenses
incurred. An original invoice plus one copy is due within fifteen (15) days of the end of the
month, except the final invoice which must be received no later than sixty (60) days after the
work is completed or the expiration of this Agreement.
1.5 To be deemed proper, all invoices must comply with the requirements set forth in this
Agreement and must be submitted on the form and pursuant to the instruction prescribed by the
County. Payment may be withheld for failure of Jackson Lewis to comply with a term,
condition,or requirement of this Agreement.
1.6 Payment shall be made to Jackson Lewis at:
Jackson Lewis P.C.
100 South Ashley Drive
Suite 2200
Tampa,FL 33602
or electronically,upon submission of electronic payment instructions provided by Jackson Lewis.
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ARTICLE 2
INSURANCE
2.1 Jackson Lewis shall as a minimum, provide, pay for, and maintain in force at all times
during the term of this Agreement, professional liability insurance in an amount not less than
Two Million Dollars ($2,000,000.00) Per Occurrence, Combined Single Limits. If any liability
insurance obtained by Jackson Lewis to comply with the insurance requirements contained
herein is issued on a "claims made" form as opposed to an "occurrence" form, the retroactive
date for coverage shall be no later than the commencement date of the assigned work to which
this Agreement applies, and such insurance shall provide, in the event of cancellation or
non-renewal, that the discovery period for insurance claims (tail coverage) shall not be less than
three years following the completion of the assigned work and acceptance by the County.
2.2 Such policy or policies shall be issued by United States Treasury approved companies
authorized to do business in the State of Florida, and having agents upon whom service of
process may be made in Collier County,Florida.
2.3 Jackson Lewis shall furnish to the Collier County Risk Management Director Certificates
of Insurance or endorsements evidencing the insurance coverages specified by this Article prior
to beginning performance of work under this Agreement.
ARTICLE 3
TERM AND TIME OF PERFORMANCE
3.1 The term of this Agreement shall be for a period of two years to begin May 27,2025 and
to end on May 26, 2027, unless terminated earlier in accordance with the provisions of this
Agreement. Absent notice of intent to terminate, the Agreement may be renewed upon mutual
consent of the parties for three additional terms of one year each. In the event the term of this
Agreement extends beyond a single fiscal year of County, the continuation of this Agreement
k beyond the end of any fiscal year shall be subject to the availability of funds from County in
accordance with Chapter 129,Florida Statutes.
3.2 Time shall be deemed to be of the essence in performing the duties, obligations, and
responsibilities by this Agreement.
3.3 Any amendments, alterations, variations, modifications, or waivers of provisions of this
Agreement shall only be valid when they have been reduced to writing, duly signed by both
parties hereto,and attached to the original of this Agreement.
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ARTICLE 4
TERMINATION
4.1 This Agreement may be terminated by either party for cause upon ten days' notice or by
either party for convenience upon no less than thirty (30) days' advance written notice in
accordance with the"NOTICES"section of this Agreement.
4.2 Termination of this Agreement for cause shall include, but not be limited to, failure to
suitably perform the work, failure to continuously perform the work in a manner calculated to
meet or accomplish the objectives of the County as set forth in this Agreement, or multiple
breach of the provisions of this Agreement notwithstanding whether any such breach was
previously waived or cured.
4.3 In the event this Agreement is terminated for convenience, Jackson Lewis shall be paid
for any services performed to the date the Agreement is terminated; however, upon notice by
either party to terminate, Jackson Lewis shall refrain from performing further services or
incurring additional expenses under the term of this Agreement. Jackson Lewis' obligations to
the County as provided for hereunder shall cease upon termination,except for participating in an
orderly and professional transfer of such responsibilities and files or copies of files to the County
or its designee.
ARTICLE 5
RECORD AUDIT AND INSPECTION
5.1 The County shall have the right to audit the books and records of Jackson Lewis pertinent
to the funding under this Agreement. Jackson Lewis shall preserve and make available, at
reasonable times for examination and audit by the County, all financial records, supporting
documents,and other documents pertinent to this Agreement for a period of three(3)years after
termination of this Agreement or,if any audit has been initiated and audit findings have not been
resolved at the end of the three years,the books and records shall be retained until resolution of
the audit findings.
5.2 If the Florida Public Records Act(Chapter 119, Fla. Stat.)is determined by the County to
be applicable to Jackson Lewis' records, Jackson Lewis shall comply with all requirements
thereof,however, no confidentiality or non-disclosure requirement of either federal or State law
shall be violated by Jackson Lewis.
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ARTICLE 6
CONFLICT OF INTEREST
6.1 Jackson Lewis states that it is familiar with and will comply with the terms and
conditions of Chapter 112,Part III,Florida Statutes(Code of Ethics).
6.2 It is important that Jackson Lewis be independent and impartial in order to properly
conduct its services to the County. Jackson Lewis shall not act as counsel in any lawsuit or other
adversary proceeding in which the County is named as an adversary party or in which Jackson
Lewis takes an adverse position to the County.
6.3 Neither Jackson Lewis nor its employees shall have or hold any continuing or frequently
recurring employment or contractual relationship that is substantially antagonistic or
incompatible with Jackson Lewis' loyal and conscientious exercise of judgment related to its
performance under this Agreement.
6.4 In the event Jackson Lewis is permitted to utilize subcontractors, herein, to perform any
services required by this Agreement, Jackson Lewis agrees to prohibit such subcontractors, by
written contract,from having any conflicts as within the meaning of this section.
6.5 If Jackson Lewis' firm represents a client in matters having to do with Collier County
government, whether it be before the Board of County Commissioners or any other agency or
division of Collier County government,Jackson Lewis will contact the County Attorney's Office
before undertaking such representation so that it can be determined whether a conflict of interest
exists.
ARTICLE 7
INDEMNIFXCATION
7.1 Jackson Lewis acknowledges and agrees that Ten Dollars ($10.00) of the compensation
to be paid by the County, the adequacy of which is hereby acknowledged by Jackson Lewis, is
given as specific consideration to Jackson Lewis so that Jackson Lewis shall at all times
hereafter indemnify, hold harmless and, at the County's option, defend or pay for an attorney
selected by the County to defend the County,its officers,agents,servants,and employees against
any and all claims, losses, liabilities,and expenditures of any kind, including attorney fees, court
costs, and expenses, caused by the negligent act or omission of Jackson Lewis, its employees,
agents, servants, or officers, or accruing, resulting from, or related to the subject matter of this
Agreement including, without limitation, any and all claims, demands or causes of action of any
ii.
nature whatsoever resulting from injuries or damages sustained by any person or property. The
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provisions of this section shall survive the expiration or earlier termination of this Agreement.
To the extent considered necessary by the County, any sums due Jackson Lewis under this
Agreement may be retained by the County until all of the County's claims for indemnification
pursuant to this Agreement have been settled or otherwise resolved; and any amount withheld
shall not be subject to payment of interest by the County.
ARTICLE 8
OWNERSHIP OF DOCUMENTS
8.1 Any and all reports, photographs, surveys, and other data and documents provided or
created in connection with this Agreement are and shall remain the property of the County. In
the event of termination of this Agreement, any reports,photographs, surveys,and other data and
documents prepared by Jackson Lewis, whether finished or unfinished, shall become the
property of the County and shall be delivered by Jackson Lewis to the County within seven (7)
days of termination of this Agreement by either party. Any compensation due to Jackson Lewis
shall be withheld until all documents are received as provided herein.
ARTICLE 9
INDEPENDENT CONTRACTOR
9.1 Jackson Lewis is an independent contractor under this Agreement. Services provided by
Jackson Lewis shall be subject to the supervision of Jackson Lewis, and such services shall not
be provided by Jackson Lewis as officers, employees, or agents of the County. The parties
expressly acknowledge that it is not their intent to create any rights or obligations in any third
person or entity under this Agreement.
ARTICLE 10
NONDISCRIMINATION,EQUAL OPPORTUNITY
AND AMERICANS WITH DISABILITIES ACT
10.1 Jackson Lewis shall not unlawfully discriminate against any person in its operations and
activities in its use or expenditure of the funds or any portion of the funds provided by this
Agreement and shall affirmatively comply with all applicable provisions of the Americans with
Disabilities Act(ADA) in the course of providing any services funded in whole or in part by the
County, including Titles I and II of the ADA (regarding nondiscrimination on the basis of
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disability), and all applicable regulations, guidelines, and standards in performing any Scope of
Services under this Agreement.
10.2 Further, Jackson Lewis' decisions regarding the delivery of services under this
Agreement shall be made without regard to or consideration of race, age, religion, color, gender,
national origin, marital status, physical or mental disability, political affiliation, or any other
factor which cannot be lawfully or appropriately used as a basis for service delivery.
ARTICLE 11
NOTICES
11.1 Whenever either party desires to give notice to the other, such notice must be in writing:
(1) sent by registered or certified United States Mail, postage prepaid, return receipt requested,
(2)by hand-delivery,addressed to the party for whom it is intended at the place last specified,or
(3)by email at the below email addresses designated by each party. The place for giving notice
shall remain the same as set forth below until changed in writing in the manner provided in this
section. For the present,the parties designate the following:
FOR COLLIER COUNTY:
Jeffrey A.Klatzkow,County Attorney
Government Center
3299 Tamiami Trail East
Suite 800
Naples,Florida 34112
Jeff.Klatzkow®colliercountyfl.gov
FOR JACKSON LEWIS: P.C.
Joseph Lazzarotti,Esq.
Jackson Lewis,P.C.
100 South Ashley Drive
Suite 2200
Tampa,FL 33602
Joseph.L azzarottig acksonlewi s.com
ARTICLE 12
MISCELLANEOUS
12.1.1 WAIVER OF BREACH AND MATERIALITY Failure by the County to enforce any
provision of this Agreement shall not be deemed a waiver of the provision or modification of this
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Agreement. A waiver of any breach of a provision of this Agreement shall not be deemed a
waiver of any subsequent breach and shall not be construed to be a modification of the terms of
this Agreement.
12.1.2 COMPLIANCE WITH LAWS Jackson Lewis shall comply with all federal, State, and
local laws,codes,ordinances,rules,and regulations in performing its duties,responsibilities,and
obligations related to this Agreement.
12,3 SEVERANCE In the event a portion of this Agreement is found by a court of
competent jurisdiction to be invalid, the remaining provisions shall continue to be effective
unless the County and Jackson Lewis elect to terminate this Agreement. The election to
terminate this Agreement based upon this provision shall be made within seven (7)days after the
finding by the court becomes final.
12.4 APPLICABLE LAW AND VENUE This Agreement shall be interpreted and construed
in accordance with and governed by the laws of the State of Florida. Venue for litigation
concerning this Agreement shall be in Collier County,Florida,
12.5 PRIOR AGREEMENTS This document supercedes all prior negotiations,
correspondence, conversations, agreements, and understandings applicable to the matters
contained herein and the parties agree that there are no commitments, agreements or
understandings concerning the subject matter of this Agreement that are not contained in this
document. Accordingly, the parties agree that no deviation from the terms hereof shall be
predicated upon any prior representations or agreements, whether oral or written. It is further
agreed that no modification, amendment or alteration in the terms or conditions contained herein
shall be effective unless contained in a written document in accordance with Article 3 above.
12.6 INCORPORATION BY REFERENCE The truth and accuracy of each "Whereas"
clause set forth above is acknowledged by the parties. The attached Exhibits"A,""B,""C," and
"D" ("Affidavit Regarding Labor and Services") are incorporated into and made a part of this
Agreement.
II:
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IN WITNESS WHEREOF, the Parties have made and entered into this Agreement by
an authorized person or agent on this day of , 2025.
BOARD OF COUNTY COMMISSIONERS
ATTEST: OF COLLIER COUNTY,FLORIDA
Crystal K.Kinzel, Clerk of Courts
& Comptroller
•
By: 1 mp" By: •...44-1-401044"
Deputy Clerk urt L. Saunders, Chairman
AIM 1111 to ChaIrmata
flgnatur^
Approved as to form and
ality'
Scott . ach
Deputy County Attorney
J CKSON i:WIS P.C.
By:
int me• �J��i-- 1 � . fh'U
Its: Ot'tl���\
First Witness: `j-Q
Print Name: (fl6l,‘c\ -dV
Jf
Second Witness:
Print Name: ) 1
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EXHIBIT A
For professional services rendered, Jackson Lewis' fee shall be based on the following hourly
rates:
Attorney Office Position Hourly Billing Hourly Billing
Rate for Insured Rates for
Cyber/Privacy Uninsured Legal
Legal Services Services,which
reflects a 15%
discounted rate
Cyber/Privacy/AI
Joe Lazzarotti Tampa Principal $395.00 $752.25
Ryan Soscia Tampa Associate $395.00 $331.50
Employee Benefits
Joe La?.7arotti Tampa Principal $752.25
John Burgess Tampa Principal $573.75
Natalie Nathanson Miami Principal $697.00
Labor
Rey Velazquez Miami Principal $641.75
General Employment
Pedro Ferment Miami Principal $709.75
Chris Cavaliere Tampa Principal $501.50
Amy Recla Tampa Principal $493.00
Emily Chase-Sosnoff Tampa Principal $467.50
Audrey-Jade Salbo Miami Associate $450.50
Adam Schultz Miami Associate $450.50
Ranjiv Sondhi Miami Of Counsel $539.75
Hourly Billing Rate for Paralegals&Law Clerks: $150.00
Jackson Lewis' fee shall not exceed $200,000.00 per new matter assigned without the approval
of the Board of County Commissioners. Any expenditure beyond the initial $200,000.00
approval by the Board of County Commissioners must have Board approval prior to work being
performed. (Where appropriate a "not to exceed" sum shall be agreed to when each assignment
is made to Jackson Lewis.)
In the event that Jackson Lewis is required or requested to perform any additional or
extraordinary services not herein contemplated, Jackson Lewis shall be entitled to apply for
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additional compensation,the amount of which shall be subject to the approval of the County and
no such additional compensation in excess of the amount herein stated shall be paid unless
specifically authorized in advance by the County in its sole discretion.
Jackson Lewis shall provide, at no cost to the County, the annual response to the County's
auditors regarding pending or threatened litigation. The auditors typically request information
regarding all litigation, claims and assessments considered to be material. The response should
include the nature of the litigation,the progress of the case to date, an estimate of the amount or
range of potential loss, and any other information considered necessary to explain the case.
Jackson Lewis shall provide said response within 30 days of receipt of the request.
Departments, or Divisions within such Departments, shall be responsible and pay for legal
counsel services relating to litigation and outside counsel specifically for cases,matters or issues
relating to such Department or Division.
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EXHIBIT B
1. In addition to the charges for professional fees set forth in Exhibit"A,"and the Schedules
attached hereto, the County shall reimburse Jackson Lewis for out-of-pocket expenses
reasonably incurred in the course of rendering such legal services, including costs of printing,
costs of reproduction, and necessary travel expenses incurred in accordance with the
requirements of Chapter 112, F.S.
2. When incurred, Jackson Lewis shall submit invoices on a monthly basis for the payment
of out-of-pocket expenses. Each invoice shall include a signed Certificate(see Exhibit C) listing
all costs, expenses, vouchers, invoices and other documentary evidence that will describe in
reasonable detail the basis for expenditures for which reimbursement is sought. If no out-of-
pocket expenses are being sought for reimbursement, the submission of the certificate is not
necessary, and Jackson Lewis' itemized invoice of its billable hours will suffice.
3. REQUIREMENTS
The following represents Collier County's payment requirements for legal costs:
➢ Your federal employee identification number must be on all invoices submitted.
➢ The applicable Purchase Order number must be on all invoices submitted.
➢ No service, interest, or other charge of like nature is to be imposed with regard to
any item, invoice, or request. All firms doing business with Collier County must
have a current W-9 "Request for Taxpayer Identification Number and
Certification"on file.
➢ Services rendered must be specifically and concisely identified:
➢ Names of persons performing services,hourly rates, and dates must be listed. The
County agrees to reimburse Jackson Lewis for retention and utilization of
sub-consultants.
➢ Reimbursable expense must be verified by attached receipts or copies thereof,
along with the submission of the Certificate attached as Exhibit C.
➢ Claims for mileage and meals cannot exceed statutory allowance as provided for
under Chapter 112, F.S. Meals and mileage cannot be charged unless the
professional has traveled outside the county of the principal business location.
➢ Claims for lodging at single rate(actual cost) must be substantiated by paid bill or
charge,with a cap of no more than$150.00 per night.
➢ Car rentals required for travel should include compact or standard-size vehicles
only.
➢ Common carrier travel shall be reimbursable at tourist or coach class fares only.
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A The Accounting Division requires original receipts,or copies of receipts that have
been certified to be true copies of the originals, along with the completion of the
Certificate contained in Exhibit C,to accompany Jackson Lewis' invoice when it
is requesting payment for out-of-pocket expenses. The certifying person must
sign the Certification form and a description provided of the reimbursable items
that are being certified.
➢ Faxes shall not be reimbursed
➢ Legal Research costs(Lexis-Nexis, Westlaw, etc.)shall not be reimbursed
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EXHIBIT C
•
CERTIFICATE
IT IS HEREBY CERTIFIED that:
1, has been duly designated as special counsel to
render legal services or provider of services for or on behalf of Collier County;
2. Each of the documents hereinafter identified and attached is a true and correct copy of the
original record;
3, Expenditure(s) enumerated represent costs necessarily incurred during the course 'of
official business for which payment has not been received and for which documentation is
not available or reasonably retrievable;
4. Claims are in compliance with the applicable statutes and administrative orders, and with
the express provision that all other parties are barred from entitlement to any part of these
costs.
RE: Invoice No. ,Dated
Period Covered: :Amount
IN-HOUSE CHARGES:
Photocopies: copies®$0.15/each $
Mileage: miles @ /mile $
OTHER(Conies of invoices required):
Other: $
TOTAL: $
FOR THE FIRM
Signed:
Print Name:
Title:
Date:
CAC)
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EXHIBIT D
AFFIDAVIT REGARDING LABOR AND SERVICES
Effective July 1, 2024, pursuant to § 787.06(13), Florida Statutes, when a contract is executed,
renewed, or extended between a nongovernmental entity and a governmental entity, the
nongovernmental entity must provide the governmental entity with an affidavit signed by an
officer or a representative of the nongovernmental entity under penalty of perjury attesting that
the nongovernmental entity does not use coercion for labor or services.
Nongovernmental Entity's Name: r�t GCM/11 Pc_
Address: uU Sc A.t44►N bat Le SF 2-2-ciu ThorR-3r;1c;)2,
Phone Number: ,Q13 512 f 2-ft
Authorized Representative's Name: v;Mtn LP 2.V '1 utt
Authorized Representative's Title:
Email Address:
AFFIDAVIT
I, 01A (.dir22 h(Narnc of Authorized Representative), as authorized representative attest
that •'Mile .t)14 Lt tiv Pc (Name of Nongovernmental Entity) does not use
coercion for labor or services as defined in § 787.06,Florida Statutes.
Under penalt +f perjury, I declare that I have read the foregoing Affidavit and that the facts stated in it
_are true. ,
�`I,& PAI "2-o; 2o 2 s
(Si_nature\ aut b orized representative) Date
STATE OF nUlu(d n
COUNTY OF \(9O
• Sworn to (or affirm) and Subscribed before me, by means of physical presence or 0 online
not fzatior thi d• , by (Name of Affiant), who produced his Florida
Dr es L s id c t n. j o',cp\r 5. Lc1Uclvuf j
Notary Public not required when digital) NICOLE M.VILLA
f*: 14 MYCOMMISSIONgHH658967
O'VC�/�I �J cJ VO ▪ •�A'' EXPIRES:March 31,2029
: i ;?•••
Commission Expires
Personally KnownAbR Produced Identification 0
Type of Identification Produced:
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