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Agenda 01/08/2019 Item #16D 201/08/2019 EXECUTIVE SUMMARY Recommendation to award Invitation to Bid (ITB) No. 18-7461 “Benches and Bleachers” to Southeastern Seating, Inc., and authorize staff to issue purchase orders totaling $119,562.48. OBJECTIVE: The purpose of this project is to replace thirty-one (31) Bleachers and five (5) Benches at various park facilities damaged by Hurricane Irma. CONSIDERATIONS: On September 20, 2018, the Procurement Services Department released ITB No. 18-7461 to 3071 vendors for the purchase of Benches and Bleachers. Interested bidders downloaded sixty-six (66) bid packages, and the County received six (6) bids by the October 19, 2018 deadline, as summarized below. Respondents: Company Name City County State Amount Responsive/Responsible Southeastern Seating, Inc. Tampa Hillsborough FL $119,562.48 Y/Y Swartz Associates, Inc. Naples Collier FL $124,699 Y/Y Bliss Products & Services, Inc. Lithia Springs Douglas GA $124,930.40 Y/Y Corvus Industries d/b/a Charron Sports Services, Inc. Liberty Pickens SC $135,148 Y/Y BSN Sports/US Games Jenkintown Montgomery PA $142,859.47 N/N Park Warehouse Boca Raton Palm Beach FL $155,483.16 N/N Staff reviewed the bids and determined that two (2) bidders, BSN Sports/US Games and Park Warehouse, were non-responsive for failing to provide the required line item prices and documentation. Staff is recommending to award to Southeastern Seating, Inc., the lowest, responsive, and responsible bidder. FISCAL IMPACT: Sufficient funds are available in Parks and Recreation Division Capital Fund (306), Project No. 50154. GROWTH MANAGEMENT IMPACT: There is no Growth Management impact associated with this Executive Summary. LEGAL CONSIDERATIONS: This item is approved as to form and legality and requires majority vote for Board approval. -SRT RECOMMENDATION: To award Invitation to Bid (ITB) No. 18-7461 “Benches and Bleachers” to Southeastern Seating, Inc., and authorize staff to issue purchase orders totaling $119,562.48. Prepared By: Matthew Catoe, Operations Analyst, Parks and Recreation Division ATTACHMENT(S) 1. 18-7461 Solicitation (DOCX) 16.D.2 Packet Pg. 1352 01/08/2019 2. 18-7461 Addendum #1 (DOC) 3. 18-7461 Bid Tabulation (XLSX) 4. 18-7461 Notice of Recommended Award (PDF) 5. (linked) 18-7461 Southeastern Seating_Submittal (PDF) 6. 18-7461 SoutheasternSeating_InsuranceGL (PDF) 7. 18-7461 SoutheasternSeating_InsuranceWC (PDF) 16.D.2 Packet Pg. 1353 01/08/2019 COLLIER COUNTY Board of County Commissioners Item Number: 16.D.2 Doc ID: 7493 Item Summary: Recommendation to award Invitation to Bid (ITB) No. 18-7461 “Benches and Bleachers” to Southeastern Seating, Inc., and authorize staff to issue purchase order(s) totaling $119,562.48. Meeting Date: 01/08/2019 Prepared by: Title: Operations Analyst – Parks & Recreation Name: Matthew Catoe 12/04/2018 11:02 AM Submitted by: Title: Division Director - Parks & Recreation – Parks & Recreation Name: Barry Williams 12/04/2018 11:02 AM Approved By: Review: Parks & Recreation Ilonka Washburn Additional Reviewer Completed 12/04/2018 11:14 AM Procurement Services Opal Vann Level 1 Purchasing Gatekeeper Completed 12/04/2018 12:22 PM Procurement Services Ted Coyman Additional Reviewer Completed 12/11/2018 9:14 AM Parks & Recreation Barry Williams Additional Reviewer Completed 12/11/2018 10:02 AM Procurement Services Swainson Hall Additional Reviewer Completed 12/12/2018 4:51 PM Procurement Services Kristofer Lopez Additional Reviewer Completed 12/13/2018 10:10 AM Procurement Services Sandra Herrera Additional Reviewer Completed 12/13/2018 10:19 AM Public Services Department Kimberley Grant Level 1 Reviewer Completed 12/13/2018 3:45 PM Public Services Department Todd Henry Level 1 Division Reviewer Completed 12/14/2018 7:57 AM Public Services Department Steve Carnell Level 2 Division Administrator Review Completed 12/18/2018 8:54 AM County Attorney's Office Scott Teach Level 2 Attorney Review Completed 12/20/2018 1:13 PM Grants Erica Robinson Level 2 Grants Review Completed 12/20/2018 2:47 PM Office of Management and Budget Laura Wells Level 3 OMB Gatekeeper Review Completed 12/20/2018 4:20 PM County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 12/21/2018 8:47 AM County Attorney's Office Emily Pepin CAO Preview Completed 12/21/2018 10:37 AM Budget and Management Office Ed Finn Additional Reviewer Completed 12/26/2018 12:20 PM 16.D.2 Packet Pg. 1354 01/08/2019 Grants Therese Stanley Additional Reviewer Completed 12/27/2018 9:02 AM County Manager's Office Nick Casalanguida Level 4 County Manager Review Completed 12/27/2018 2:44 PM Board of County Commissioners MaryJo Brock Meeting Pending 01/08/2019 9:00 AM 16.D.2 Packet Pg. 1355 COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS INVITATION TO BID (ITB) FOR Benches and Bleachers SOLICITATION NO.: 18-7461 KRISTOFER LOPEZ, PROCUREMENT STRATEGIST PROCUREMENT SERVICES DIVISION 3295 TAMIAMI TRAIL EAST, BLDG C-2 NAPLES, FLORIDA 34112 TELEPHONE: (239) 252-8944 Kristofer.lopez@colliercountyfl.gov (Email) This solicitation document is prepared in a Microsoft Word format. Any alterations to this document made by the Consultant may be grounds for rejection of proposal, cancellation of any subsequent award, or any other legal remedies available to the Collier County Government. 16.D.2.a Packet Pg. 1356 Attachment: 18-7461 Solicitation (7493 : Award Invitation to Bid (ITB) 18-7461 Benches and Bleachers) SOLICITATION PUBLIC NOTICE INVITATION TO BID (ITB) NUMBER: 18-7461 PROJECT TITLE: Benches and Bleachers PLACE OF BID OPENING: PROCUREMENT SERVICES DIVISION 3295 TAMIAMI TRAIL EAST, BLDG C-2 NAPLES, FL 34112 All proposals shall be submitted online via the Collier County Procurement Services Division Online Bidding System: https://www.bidsync.com/bidsync-cas/ INTRODUCTION As requested by the Parks and Recreation Division (hereinafter, the “Division or Department”), the Collier County Board of County Commissioners Procurement Services Division (hereinafter, “County”) has issued this Invitation to Bid (hereinafter, “ITB”) with the intent of obtaining bid submittals from interested and qualified vendors in accordance with the terms, conditions and specifications stated or attached. The vendor, at a minimum, must achieve the requirements of the Specifications or Scope of Work stated. The results of this solicitation may be used by other County departments once awarded according to the Board of County Commissioners Procurement Ordinance. The intent of this solicitation is for a one time purchase of the required benches and bleachers according to Attachment A specifications. TERM OF CONTRACT The contract term, if an award(s) is/are made is intended to be for current needs. Prices shall remain firm for the term of this contract. Surcharges will not be accepted in conjunction with this contract, and such charges should be incorporated into the pricing structure. The County Manager, or designee, may, at his discretion, extend the Agreement under all of the terms and conditions contained in this Agreement for up to one hundred eighty (180) days. The County Manager, or designee, shall give the C ontractor written notice of the County's intention to extend the Agreement term not less than ten (10) days prior to the end of the Agreement term then in ef fect. All goods are FOB destination and must be suitably packed and prepared to secure the lowest transportation rates and to comply with all carrier regulations. Risk of loss of any goods sold hereunder shall transfer to the COUNTY at the time and place of delivery; provided that risk of loss prior to actual receipt of the goods by the COUNTY nonethe less remain with VENDOR. AWARD CRITERIA ITB award criteria are as follows:  The County’s Procurement Services Division reserves the right to clarify a vendor’s submittal prior to the award of the solicitation.  It is the intent of Collier County to award to the lowest, responsive and responsible vendor(s) that represents the best value to the County.  For the purposes of determining the winning bidder, the County will select the vendor with the lowest price as outlined below:  Total of items 1-5 on bid schedule 18-7461  Collier County reserves the right to select one, or more than one suppliers, award on a line item basis, establish a pool for quoting, or other options that represents the best value to the County; however, it is the intent to:  Identify a single awardee  The County reserves the right to issue a formal contract, standard County Purchase Order, or utilize the County Purchasing Card for the award of this solicitation. DETAILED SCOPE OF WORK 16.D.2.a Packet Pg. 1357 Attachment: 18-7461 Solicitation (7493 : Award Invitation to Bid (ITB) 18-7461 Benches and Bleachers) *See Attachment A* VENDOR CHECKLIST ***Vendor should check off each of the following items as the necessary action is completed (please see, Form 2: Vendor Check List): The Solicitation Submittal has been signed. The Solicitation Pricing Document (Bid Schedule/Quote Schedule/Proposal Pricing/etc.) has been completed and attached. All applicable forms have been signed and included, along with licenses to complete the requirements of the project. Any addenda have been signed and included. Affidavit for Claiming Status as a Local Business, if applicable. Division of Corporations - Florida Department of State – http://dos.myflorida.com/sunbiz/ (If work performed in the State). E-Verify/Immigration Affidavit (Memorandum of Understanding). 16.D.2.a Packet Pg. 1358 Attachment: 18-7461 Solicitation (7493 : Award Invitation to Bid (ITB) 18-7461 Benches and Bleachers) Addendum #1 Date: 9/21/2018 From: Kristofer Lopez, Procurement Strategist To: Interested Bidders Subject: Addendum # 1 18-7461 Benches and Bleachers The following change is made to the above mentioned Collier County solicitation: 1. Delivery locations for the Benches and Bleachers. Benches and Bleachers Site Name Delivery Address Bench 1 Row x 21' w/bench legs Bleacher 5 Row x 21' Bleachers 8 Row x 21' Bleacher 5 Row x 15' Bleacher 10 Row x 21' Corkscrew Middle School 3300 Santa Barbara Blvd, Naples, FL 34116 . 2 . . . Eagle Lakes Community Park 11565 Tamiami Trail E, Naples, FL 34113 . . 1 8 . East Naples Community Park 3500 Thomasson Dr, Naples, FL 34112 . . . . 1 Golden Gate Community Park 3300 Santa Barbara Blvd, Naples, FL 34116 . 3 . 3 . Immokalee Sports Complex Park 505 Escambia St, Immokalee, FL 34142 . 2 2 1 . Max Hasse Community Park 3390 Golden Gate Blvd W, Naples, FL 34117 . 1 . . . North Collier Regional Park Athletics 15000 Livingston Rd, Naples, FL 34109 3 . . . . Osceola Elementary School 3300 Santa Barbara Blvd, Naples, FL 34116 . 2 . . . Sabal Palm Elementary School 3300 Santa Barbara Blvd, Naples, FL 34116 . 2 . . . Veterans Community Park 1895 Veterans Park Dr, Naples, FL 34109 . . . 1 . Vineyards Community Park 6231 Arbor Blvd W, Naples, FL 34119 2 2 . . . Total: 5 14 3 13 1 If you require additional information, please post a question on the Online Bidding site or contact me at the information noted above. C: Matt Catoe Email: Kristofer.lopez@colliercountyfl.gov Telephone: (239) 252-8944 16.D.2.b Packet Pg. 1359 Attachment: 18-7461 Addendum #1 (7493 : Award Invitation to Bid (ITB) 18-7461 Benches and Bleachers) Please sign below and return a copy of this Addendum with your submittal for the above referenced solicitation. (Signature) Date (Name of Firm) 16.D.2.b Packet Pg. 1360 Attachment: 18-7461 Addendum #1 (7493 : Award Invitation to Bid (ITB) 18-7461 Benches and Bleachers) Item Description Qty Price Total Price Total Price Total Price Total Price Total Price Total 1 Bench 1 Row x 21' w/bench legs PG Style - Portable Bench with Back - BE-PG21 5 $510.00 $2,550.00 $677.92 $3,389.60 $851.98 $4,259.90 $775.00 $3,875.00 $0.00 $0.00 $0.00 $0.00 Bleacher 5 Row x 15' Non-Elevated Aluminum Angle Frame NB-0515APRF 13 $2,448.96 $31,836.48 $2,911.81 $37,853.53 $2,952.00 $38,376.00 $3,149.00 $40,937.00 $0.00 $0.00 $0.00 $0.00 3 Bleacher 5 Row x 21' Non-Elevated Aluminum Angle Frame NB-0521APRF 14 $4,095.00 $57,330.00 $3,772.00 $52,808.00 $3,761.00 $52,654.00 $4,124.00 $57,736.00 $0.00 $0.00 $0.00 $0.00 4 Bleachers 8 Row x 21' Non-Elevated Aluminum Angle Frame NB 0821APRF 3 $6,552.00 $19,656.00 $6,997.16 $20,991.48 $6,792.50 $20,377.50 $7,440.00 $22,320.00 $0.00 $0.00 $0.00 $0.00 5 Bleacher 10 Row x 21' Non Elevated Aluminum Angle Frame NB-1021APRF 1 $8,190.00 $8,190.00 $9,656.39 $9,656.39 $9,263.00 $9,263.00 $10,280.00 $10,280.00 $0.00 $0.00 $0.00 $0.00 $119,562.48 $124,699.00 $124,930.40 $135,148.00 $142,859.47 $155,483.16 Form 1: Vendor’s Non-Response Statement Yes Yes Yes Yes No No Form 2: Vendor Check List Yes Yes Yes Yes No No Form 3: Conflict of Interest Affidavit Yes Yes Yes Yes No No Form 4: Vendor Declaration Statement Yes Yes Yes Yes No No Form 5: Immigration Affidavit Certification Yes Yes Yes Yes No No Form 6: Vendor Substitute W – 9 Yes Yes Yes Yes No No Grant Provisions Yes Yes Yes Yes No No Insurance and Bonding Requirements Yes Yes Yes Yes No No Opened by: Kristofer Lopez, Procurement Strategist Witnessed by: Viviana Giaramustas, Procurement Strategist BSN Sports/US Games Park Warehouse Non-Responsive Non-ResponsiveBenches and Bleachers Award Total Southeastern Seating, Inc Swartz Associates, Inc Bid Tabulation 18-7461 Bliss Products & Services, Inc Corvus Industries dba Charron Sports Servcies Ltd 16.D.2.c Packet Pg. 1361 Attachment: 18-7461 Bid Tabulation (7493 : Award Invitation to Bid (ITB) 18-7461 Benches and Bleachers) 16.D.2.d Packet Pg. 1362 Attachment: 18-7461 Notice of Recommended Award (7493 : Award Invitation to Bid (ITB) 18-7461 Benches and Bleachers) ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS 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 holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD GIRDLERS Debbie Day 12/13/2018 SOUTSEA-07 C BE0017724742013000 B 4928290400 A CA00001885605 0 3,000,000 2,000,000 1,000,000 2,000,000 1,000 100,000 1,000,000 1,000,000 X X X X X X License # 0E67768 02/09/2018 02/09/2019 09/26/2018 09/26/2019 02/09/2018 02/09/2019 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: FEMA project # 4337DRFLP0000001/DEM Contract # 18-7461 Collier County Board of County Commissioners, OR, Board of County Commissioners in Collier County, OR Collier County Government, OR Collier County are named as an Additional Insured on a Primary and Non-Contributory basis with respects to the General Liability policy as per written contract for any and all work performed on behalf of Collier County. 30 day Notice of Cancellation applies except for 10 day notice for non-payment of premium in accordance with policy provision. Insurance Office of America, Inc. 4915 West Cypress Street Tampa, FL 33607 (813) 637-8484(813) 262-2311 22527 Collier County Board of County Commissioners 3295 Tamiami Trail East Naples, FL 34112 Southeastern Seating Inc 903 E. 17th Ave Tampa, FL 33605 Admiral Insurance Company Auto-Owners Insurance Company AIG Specialty Insurance Company 24856 18988 26883 X Debbie.Day@ioausa.com 16.D.2.f Packet Pg. 1363 Attachment: 18-7461 SoutheasternSeating_InsuranceGL (7493 : Award Invitation to Bid (ITB) 18-7461 Benches and Bleachers) Item Description Qty Total 1 Bench 1 Row x 21' w/bench legs PG Style - Portable Bench with Back - BE-PG21 5 $2,550.00 Bleacher 5 Row x 15' Non-Elevated Aluminum Angle Frame NB-0515APRF 13 $31,836.48 3 Bleacher 5 Row x 21' Non-Elevated Aluminum Angle Frame NB-0521APRF 14 $57,330.00 4 Bleachers 8 Row x 21' Non-Elevated Aluminum Angle Frame NB 0821APRF 3 $19,656.00 5 Bleacher 10 Row x 21' Non Elevated Aluminum Angle Frame NB-1021APRF 1 $8,190.00 $119,562.48Award Total Bid Schedule 18-7461 Benches and Bleachers Page 1 of 17 E-Verify MOU for Employers | Revision Date 06/01/13 Company ID Number: THE E-VERIFY MEMORANDUM OF UNDERSTANDING FOR EMPLOYERS ARTICLE I PURPOSE AND AUTHORITY E-Verify is a program that electronically confirms an employee’s eligibility to work in the United States after completion of Form I-9, Employment Eligibility Verification (Form I-9). This Memorandum of Understanding (MOU) explains certain features of the E-Verify program and describes specific responsibilities of the Employer, the Social Security Administration (SSA), and DHS. Authority for the E-Verify program is found in Title IV, Subtitle A, of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (IIRIRA), Pub. L. 104-208, 110 Stat. 3009, as amended (8 U.S.C. § 1324a note). The Federal Acquisition Regulation (FAR) Subpart 22.18, “Employment Eligibility Verification” and Executive Order 12989, as amended, provide authority for Federal contractors and subcontractors (Federal contractor) to use E-Verify to verify the employment eligibility of certain employees working on Federal contracts. ARTICLE II RESPONSIBILITIES A. RESPONSIBILITIES OF THE EMPLOYER 1.The Employer agrees to display the following notices supplied by DHS in a prominent place that is clearly visible to prospective employees and all employees who are to be verified through the system: a.Notice of E-Verify Participation b.Notice of Right to Work 2.The Employer agrees to provide to the SSA and DHS the names, titles, addresses, and telephone numbers of the Employer representatives to be contacted about E-Verify. The Employer also agrees to keep such information current by providing updated information to SSA and DHS whenever the representatives’ contact information changes. 3.The Employer agrees to grant E-Verify access only to current employees who need E-Verify access. Employers must promptly terminate an employee’s E-Verify access if the employer is separated from the company or no longer needs access to E-Verify. 325170 The parties to this agreement are the Department of Homeland Security (DHS) and the Southeastern Seating, Inc. (Employer). The purpose of this agreement is to set forth terms and conditions which the Employer will follow while participating in E-Verify. Page 2 of 17 E-Verify MOU for Employers | Revision Date 06/01/13 Company ID Number: 4. The Employer agrees to become familiar with and comply with the most recent version of the E-Verify User Manual. 5. The Employer agrees that any Employer Representative who will create E-Verify cases will complete the E-Verify Tutorial before that individual creates any cases. a. The Employer agrees that all Employer representatives will take the refresher tutorials when prompted by E-Verify in order to continue using E-Verify. Failure to complete a refresher tutorial will prevent the Employer Representative from continued use of E-Verify. 6. The Employer agrees to comply with current Form I-9 procedures, with two exceptions: a. If an employee presents a "List B" identity document, the Employer agrees to only accept "List B" documents that contain a photo. (List B documents identified in 8 C.F.R. § 274a.2(b)(1)(B)) can be presented during the Form I-9 process to establish identity.) If an employee objects to the photo requirement for religious reasons, the Employer should contact E-Verify at 888-464-4218. b. If an employee presents a DHS Form I-551 (Permanent Resident Card), Form I-766 (Employment Authorization Document), or U.S. Passport or Passport Card to complete Form I-9, the Employer agrees to make a photocopy of the document and to retain the photocopy with the employee’s Form I-9. The Employer will use the photocopy to verify the photo and to assist DHS with its review of photo mismatches that employees contest. DHS may in the future designate other documents that activate the photo screening tool. Note: Subject only to the exceptions noted previously in this paragraph, employees still retain the right to present any List A, or List B and List C, document(s) to complete the Form I-9. 7. The Employer agrees to record the case verification number on the employee's Form I-9 or to print the screen containing the case verification number and attach it to the employee's Form I-9. 8. The Employer agrees that, although it participates in E-Verify, the Employer has a responsibility to complete, retain, and make available for inspection Forms I-9 that relate to its employees, or from other requirements of applicable regulations or laws, including the obligation to comply with the antidiscrimination requirements of section 274B of the INA with respect to Form I-9 procedures. a. The following modified requirements are the only exceptions to an Employer’s obligation to not employ unauthorized workers and comply with the anti-discrimination provision of the INA: (1) List B identity documents must have photos, as described in paragraph 6 above; (2) When an Employer confirms the identity and employment eligibility of newly hired employee using E-Verify procedures, the Employer establishes a rebuttable presumption that it has not violated section 274A(a)(1)(A) of the Immigration and Nationality Act (INA) with respect to the hiring of that employee; (3) If the Employer receives a final nonconfirmation for an employee, but continues to employ that person, the Employer must notify DHS and the Employer is subject to a civil money penalty between $550 and $1,100 for each failure to notify DHS of continued employment following a final nonconfirmation; (4) If the Employer continues to employ an employee after receiving a final nonconfirmation, then the Employer is subject to a rebuttable presumption that it has knowingly 325170 Page 3 of 17 E-Verify MOU for Employers | Revision Date 06/01/13 Company ID Number: employed an unauthorized alien in violation of section 274A(a)(1)(A); and (5) no E-Verify participant is civilly or criminally liable under any law for any action taken in good faith based on information provided through the E-Verify. b. DHS reserves the right to conduct Form I-9 compliance inspections, as well as any other enforcement or compliance activity authorized by law, including site visits, to ensure proper use of E-Verify. 9. The Employer is strictly prohibited from creating an E-Verify case before the employee has been hired, meaning that a firm offer of employment was extended and accepted and Form I-9 was completed. The Employer agrees to create an E-Verify case for new employees within three Employer business days after each employee has been hired (after both Sections 1 and 2 of Form I-9 have been completed), and to complete as many steps of the E-Verify process as are necessary according to the E-Verify User Manual. If E-Verify is temporarily unavailable, the three-day time period will be extended until it is again operational in order to accommodate the Employer's attempting, in good faith, to make inquiries during the period of unavailability. 10. The Employer agrees not to use E-Verify for pre-employment screening of job applicants, in support of any unlawful employment practice, or for any other use that this MOU or the E-Verify User Manual does not authorize. 11. The Employer must use E-Verify for all new employees. The Employer will not verify selectively and will not verify employees hired before the effective date of this MOU. Employers who are Federal contractors may qualify for exceptions to this requirement as described in Article II.B of this MOU. 12. The Employer agrees to follow appropriate procedures (see Article III below) regarding tentative nonconfirmations. The Employer must promptly notify employees in private of the finding and provide them with the notice and letter containing information specific to the employee’s E-Verify case. The Employer agrees to provide both the English and the translated notice and letter for employees with limited English proficiency to employees. The Employer agrees to provide written referral instructions to employees and instruct affected employees to bring the English copy of the letter to the SSA. The Employer must allow employees to contest the finding, and not take adverse action against employees if they choose to contest the finding, while their case is still pending. Further, when employees contest a tentative nonconfirmation based upon a photo mismatch, the Employer must take additional steps (see Article III.B. below) to contact DHS with information necessary to resolve the challenge. 13. The Employer agrees not to take any adverse action against an employee based upon the employee's perceived employment eligibility status while SSA or DHS is processing the verification request unless the Employer obtains knowledge (as defined in 8 C.F.R. § 274a.1(l)) that the employee is not work authorized. The Employer understands that an initial inability of the SSA or DHS automated verification system to verify work authorization, a tentative nonconfirmation, a case in continuance (indicating the need for additional time for the government to resolve a case), or the finding of a photo mismatch, does not establish, and should not be interpreted as, evidence that the employee is not work authorized. In any of such cases, the employee must be provided a full and fair opportunity to contest the finding, and if he or she does so, the employee may not be terminated or suffer any adverse employment consequences based upon the employee’s perceived employment eligibility status 325170 Page 4 of 17 E-Verify MOU for Employers | Revision Date 06/01/13 Company ID Number: (including denying, reducing, or extending work hours, delaying or preventing training, requiring an employee to work in poorer conditions, withholding pay, refusing to assign the employee to a Federal contract or other assignment, or otherwise assuming that he or she is unauthorized to work) until and unless secondary verification by SSA or DHS has been completed and a final nonconfirmation has been issued. If the employee does not choose to contest a tentative nonconfirmation or a photo mismatch or if a secondary verification is completed and a final nonconfirmation is issued, then the Employer can find the employee is not work authorized and terminate the employee’s employment. Employers or employees with questions about a final nonconfirmation may call E-Verify at 1-888-464- 4218 (customer service) or 1-888-897-7781 (worker hotline). 14. The Employer agrees to comply with Title VII of the Civil Rights Act of 1964 and section 274B of the INA as applicable by not discriminating unlawfully against any individual in hiring, firing, employment eligibility verification, or recruitment or referral practices because of his or her national origin or citizenship status, or by committing discriminatory documentary practices. The Employer understands that such illegal practices can include selective verification or use of E-Verify except as provided in part D below, or discharging or refusing to hire employees because they appear or sound “foreign” or have received tentative nonconfirmations. The Employer further understands that any violation of the immigration-related unfair employment practices provisions in section 274B of the INA could subject the Employer to civil penalties, back pay awards, and other sanctions, and violations of Title VII could subject the Employer to back pay awards, compensatory and punitive damages. Violations of either section 274B of the INA or Title VII may also lead to the termination of its participation in E-Verify. If the Employer has any questions relating to the anti-discrimination provision, it should contact OSC at 1-800-255-8155 or 1-800-237-2515 (TDD). 15. The Employer agrees that it will use the information it receives from E-Verify only to confirm the employment eligibility of employees as authorized by this MOU. The Employer agrees that it will safeguard this information, and means of access to it (such as PINS and passwords), to ensure that it is not used for any other purpose and as necessary to protect its confidentiality, including ensuring that it is not disseminated to any person other than employees of the Employer who are authorized to perform the Employer's responsibilities under this MOU, except for such dissemination as may be authorized in advance by SSA or DHS for legitimate purposes. 16. The Employer agrees to notify DHS immediately in the event of a breach of personal information. Breaches are defined as loss of control or unauthorized access to E-Verify personal data. All suspected or confirmed breaches should be reported by calling 1-888-464-4218 or via email at E-Verify@dhs.gov. Please use “Privacy Incident – Password” in the subject line of your email when sending a breach report to E-Verify. 17. The Employer acknowledges that the information it receives from SSA is governed by the Privacy Act (5 U.S.C. § 552a(i)(1) and (3)) and the Social Security Act (42 U.S.C. 1306(a)). Any person who obtains this information under false pretenses or uses it for any purpose other than as provided for in this MOU may be subject to criminal penalties. 18. The Employer agrees to cooperate with DHS and SSA in their compliance monitoring and evaluation of E-Verify, which includes permitting DHS, SSA, their contractors and other agents, upon 325170 Page 5 of 17 E-Verify MOU for Employers | Revision Date 06/01/13 Company ID Number: reasonable notice, to review Forms I-9 and other employment records and to interview it and its employees regarding the Employer’s use of E-Verify, and to respond in a prompt and accurate manner to DHS requests for information relating to their participation in E-Verify. 19. The Employer shall not make any false or unauthorized claims or references about its participation in E-Verify on its website, in advertising materials, or other media. The Employer shall not describe its services as federally-approved, federally-certified, or federally-recognized, or use language with a similar intent on its website or other materials provided to the public. Entering into this MOU does not mean that E-Verify endorses or authorizes your E-Verify services and any claim to that effect is false. 20. The Employer shall not state in its website or other public documents that any language used therein has been provided or approved by DHS, USCIS or the Verification Division, without first obtaining the prior written consent of DHS. 21. The Employer agrees that E-Verify trademarks and logos may be used only under license by DHS/USCIS (see M-795 (Web)) and, other than pursuant to the specific terms of such license, may not be used in any manner that might imply that the Employer’s services, products, websites, or publications are sponsored by, endorsed by, licensed by, or affiliated with DHS, USCIS, or E-Verify. 22. The Employer understands that if it uses E-Verify procedures for any purpose other than as authorized by this MOU, the Employer may be subject to appropriate legal action and termination of its participation in E-Verify according to this MOU. B. RESPONSIBILITIES OF FEDERAL CONTRACTORS 1. If the Employer is a Federal contractor with the FAR E-Verify clause subject to the employment verification terms in Subpart 22.18 of the FAR, it will become familiar with and comply with the most current version of the E-Verify User Manual for Federal Contractors as well as the E-Verify Supplemental Guide for Federal Contractors. 2. In addition to the responsibilities of every employer outlined in this MOU, the Employer understands that if it is a Federal contractor subject to the employment verification terms in Subpart 22.18 of the FAR it must verify the employment eligibility of any “employee assigned to the contract” (as defined in FAR 22.1801). Once an employee has been verified through E-Verify by the Employer, the Employer may not create a second case for the employee through E-Verify. a. An Employer that is not enrolled in E-Verify as a Federal contractor at the time of a contract award must enroll as a Federal contractor in the E-Verify program within 30 calendar days of contract award and, within 90 days of enrollment, begin to verify employment eligibility of new hires using E-Verify. The Employer must verify those employees who are working in the United States, whether or not they are assigned to the contract. Once the Employer begins verifying new hires, such verification of new hires must be initiated within three business days after the hire date. Once enrolled in E-Verify as a Federal contractor, the Employer must begin verification of employees assigned to the contract within 90 calendar days after the date of enrollment or within 30 days of an employee’s assignment to the contract, whichever date is later. 325170 Page 6 of 17 E-Verify MOU for Employers | Revision Date 06/01/13 Company ID Number: b. Employers enrolled in E-Verify as a Federal contractor for 90 days or more at the time of a contract award must use E-Verify to begin verification of employment eligibility for new hires of the Employer who are working in the United States, whether or not assigned to the contract, within three business days after the date of hire. If the Employer is enrolled in E-Verify as a Federal contractor for 90 calendar days or less at the time of contract award, the Employer must, within 90 days of enrollment, begin to use E-Verify to initiate verification of new hires of the contractor who are working in the United States, whether or not assigned to the contract. Such verification of new hires must be initiated within three business days after the date of hire. An Employer enrolled as a Federal contractor in E-Verify must begin verification of each employee assigned to the contract within 90 calendar days after date of contract award or within 30 days after assignment to the contract, whichever is later. c. Federal contractors that are institutions of higher education (as defined at 20 U.S.C. 1001(a)), state or local governments, governments of Federally recognized Indian tribes, or sureties performing under a takeover agreement entered into with a Federal agency under a performance bond may choose to only verify new and existing employees assigned to the Federal contract. Such Federal contractors may, however, elect to verify all new hires, and/or all existing employees hired after November 6, 1986. Employers in this category must begin verification of employees assigned to the contract within 90 calendar days after the date of enrollment or within 30 days of an employee’s assignment to the contract, whichever date is later. d. Upon enrollment, Employers who are Federal contractors may elect to verify employment eligibility of all existing employees working in the United States who were hired after November 6, 1986, instead of verifying only those employees assigned to a covered Federal contract. After enrollment, Employers must elect to verify existing staff following DHS procedures and begin E-Verify verification of all existing employees within 180 days after the election. e. The Employer may use a previously completed Form I-9 as the basis for creating an E-Verify case for an employee assigned to a contract as long as: i. That Form I-9 is complete (including the SSN) and complies with Article II.A.6, ii. The employee’s work authorization has not expired, and iii. The Employer has reviewed the Form I-9 information either in person or in communications with the employee to ensure that the employee’s Section 1, Form I-9 attestation has not changed (including, but not limited to, a lawful permanent resident alien having become a naturalized U.S. citizen). f. The Employer shall complete a new Form I-9 consistent with Article II.A.6 or update the previous Form I-9 to provide the necessary information if: i. The Employer cannot determine that Form I-9 complies with Article II.A.6, ii. The employee’s basis for work authorization as attested in Section 1 has expired or changed, or iii. The Form I-9 contains no SSN or is otherwise incomplete. Note: If Section 1 of Form I-9 is otherwise valid and up-to-date and the form otherwise complies with 325170 Page 7 of 17 E-Verify MOU for Employers | Revision Date 06/01/13 Company ID Number: Article II.C.5, but reflects documentation (such as a U.S. passport or Form I-551) that expired after completing Form I-9, the Employer shall not require the production of additional documentation, or use the photo screening tool described in Article II.A.5, subject to any additional or superseding instructions that may be provided on this subject in the E-Verify User Manual. g. The Employer agrees not to require a second verification using E-Verify of any assigned employee who has previously been verified as a newly hired employee under this MOU or to authorize verification of any existing employee by any Employer that is not a Federal contractor based on this Article. 3. The Employer understands that if it is a Federal contractor, its compliance with this MOU is a performance requirement under the terms of the Federal contract or subcontract, and the Employer consents to the release of information relating to compliance with its verification responsibilities under this MOU to contracting officers or other officials authorized to review the Employer’s compliance with Federal contracting requirements. C. RESPONSIBILITIES OF SSA 1. SSA agrees to allow DHS to compare data provided by the Employer against SSA’s database. SSA sends DHS confirmation that the data sent either matches or does not match the information in SSA’s database. 2. SSA agrees to safeguard the information the Employer provides through E-Verify procedures. SSA also agrees to limit access to such information, as is appropriate by law, to individuals responsible for the verification of Social Security numbers or responsible for evaluation of E-Verify or such other persons or entities who may be authorized by SSA as governed by the Privacy Act (5 U.S.C. § 552a), the Social Security Act (42 U.S.C. 1306(a)), and SSA regulations (20 CFR Part 401). 3. SSA agrees to provide case results from its database within three Federal Government work days of the initial inquiry. E-Verify provides the information to the Employer. 4. SSA agrees to update SSA records as necessary if the employee who contests the SSA tentative nonconfirmation visits an SSA field office and provides the required evidence. If the employee visits an SSA field office within the eight Federal Government work days from the date of referral to SSA, SSA agrees to update SSA records, if appropriate, within the eight-day period unless SSA determines that more than eight days may be necessary. In such cases, SSA will provide additional instructions to the employee. If the employee does not visit SSA in the time allowed, E-Verify may provide a final nonconfirmation to the employer. Note: If an Employer experiences technical problems, or has a policy question, the employer should contact E-Verify at 1-888-464-4218. D. RESPONSIBILITIES OF DHS 1. DHS agrees to provide the Employer with selected data from DHS databases to enable the Employer to conduct, to the extent authorized by this MOU: a. Automated verification checks on alien employees by electronic means, and 325170 Page 8 of 17 E-Verify MOU for Employers | Revision Date 06/01/13 Company ID Number: b. Photo verification checks (when available) on employees. 2. DHS agrees to assist the Employer with operational problems associated with the Employer's participation in E-Verify. DHS agrees to provide the Employer names, titles, addresses, and telephone numbers of DHS representatives to be contacted during the E-Verify process. 3. DHS agrees to provide to the Employer with access to E-Verify training materials as well as an E-Verify User Manual that contain instructions on E-Verify policies, procedures, and requirements for both SSA and DHS, including restrictions on the use of E-Verify. 4. DHS agrees to train Employers on all important changes made to E-Verify through the use of mandatory refresher tutorials and updates to the E-Verify User Manual. Even without changes to E-Verify, DHS reserves the right to require employers to take mandatory refresher tutorials. 5. DHS agrees to provide to the Employer a notice, which indicates the Employer's participation in E-Verify. DHS also agrees to provide to the Employer anti-discrimination notices issued by the Office of Special Counsel for Immigration-Related Unfair Employment Practices (OSC), Civil Rights Division, U.S. Department of Justice. 6. DHS agrees to issue each of the Employer’s E-Verify users a unique user identification number and password that permits them to log in to E-Verify. 7. DHS agrees to safeguard the information the Employer provides, and to limit access to such information to individuals responsible for the verification process, for evaluation of E-Verify, or to such other persons or entities as may be authorized by applicable law. Information will be used only to verify the accuracy of Social Security numbers and employment eligibility, to enforce the INA and Federal criminal laws, and to administer Federal contracting requirements. 8. DHS agrees to provide a means of automated verification that provides (in conjunction with SSA verification procedures) confirmation or tentative nonconfirmation of employees' employment eligibility within three Federal Government work days of the initial inquiry. 9. DHS agrees to provide a means of secondary verification (including updating DHS records) for employees who contest DHS tentative nonconfirmations and photo mismatch tentative nonconfirmations. This provides final confirmation or nonconfirmation of the employees' employment eligibility within 10 Federal Government work days of the date of referral to DHS, unless DHS determines that more than 10 days may be necessary. In such cases, DHS will provide additional verification instructions. ARTICLE III REFERRAL OF INDIVIDUALS TO SSA AND DHS A. REFERRAL TO SSA 1. If the Employer receives a tentative nonconfirmation issued by SSA, the Employer must print the notice as directed by E-Verify. The Employer must promptly notify employees in private of the finding and provide them with the notice and letter containing information specific to the employee’s E-Verify 325170 Page 9 of 17 E-Verify MOU for Employers | Revision Date 06/01/13 Company ID Number: case. The Employer also agrees to provide both the English and the translated notice and letter for employees with limited English proficiency to employees. The Employer agrees to provide written referral instructions to employees and instruct affected employees to bring the English copy of the letter to the SSA. The Employer must allow employees to contest the finding, and not take adverse action against employees if they choose to contest the finding, while their case is still pending. 2. The Employer agrees to obtain the employee’s response about whether he or she will contest the tentative nonconfirmation as soon as possible after the Employer receives the tentative nonconfirmation. Only the employee may determine whether he or she will contest the tentative nonconfirmation. 3. After a tentative nonconfirmation, the Employer will refer employees to SSA field offices only as directed by E-Verify. The Employer must record the case verification number, review the employee information submitted to E-Verify to identify any errors, and find out whether the employee contests the tentative nonconfirmation. The Employer will transmit the Social Security number, or any other corrected employee information that SSA requests, to SSA for verification again if this review indicates a need to do so. 4. The Employer will instruct the employee to visit an SSA office within eight Federal Government work days. SSA will electronically transmit the result of the referral to the Employer within 10 Federal Government work days of the referral unless it determines that more than 10 days is necessary. 5. While waiting for case results, the Employer agrees to check the E-Verify system regularly for case updates. 6. The Employer agrees not to ask the employee to obtain a printout from the Social Security Administration number database (the Numident) or other written verification of the SSN from the SSA. B. REFERRAL TO DHS 1. If the Employer receives a tentative nonconfirmation issued by DHS, the Employer must promptly notify employees in private of the finding and provide them with the notice and letter containing information specific to the employee’s E-Verify case. The Employer also agrees to provide both the English and the translated notice and letter for employees with limited English proficiency to employees. The Employer must allow employees to contest the finding, and not take adverse action against employees if they choose to contest the finding, while their case is still pending. 2. The Employer agrees to obtain the employee’s response about whether he or she will contest the tentative nonconfirmation as soon as possible after the Employer receives the tentative nonconfirmation. Only the employee may determine whether he or she will contest the tentative nonconfirmation. 3. The Employer agrees to refer individuals to DHS only when the employee chooses to contest a tentative nonconfirmation. 4. If the employee contests a tentative nonconfirmation issued by DHS, the Employer will instruct the 325170 Page 10 of 17 E-Verify MOU for Employers | Revision Date 06/01/13 Company ID Number: employee to contact DHS through its toll-free hotline (as found on the referral letter) within eight Federal Government work days. 5. If the Employer finds a photo mismatch, the Employer must provide the photo mismatch tentative nonconfirmation notice and follow the instructions outlined in paragraph 1 of this section for tentative nonconfirmations, generally. 6. The Employer agrees that if an employee contests a tentative nonconfirmation based upon a photo mismatch, the Employer will send a copy of the employee’s Form I-551, Form I-766, U.S. Passport, or passport card to DHS for review by: a. Scanning and uploading the document, or b. Sending a photocopy of the document by express mail (furnished and paid for by the employer). 7. The Employer understands that if it cannot determine whether there is a photo match/mismatch, the Employer must forward the employee’s documentation to DHS as described in the preceding paragraph. The Employer agrees to resolve the case as specified by the DHS representative who will determine the photo match or mismatch. 8. DHS will electronically transmit the result of the referral to the Employer within 10 Federal Government work days of the referral unless it determines that more than 10 days is necessary. 9. While waiting for case results, the Employer agrees to check the E-Verify system regularly for case updates. ARTICLE IV SERVICE PROVISIONS A. NO SERVICE FEES 1. SSA and DHS will not charge the Employer for verification services performed under this MOU. The Employer is responsible for providing equipment needed to make inquiries. To access E-Verify, an Employer will need a personal computer with Internet access. ARTICLE V MODIFICATION AND TERMINATION A. MODIFICATION 1. This MOU is effective upon the signature of all parties and shall continue in effect for as long as the SSA and DHS operates the E-Verify program unless modified in writing by the mutual consent of all parties. 2. Any and all E-Verify system enhancements by DHS or SSA, including but not limited to E-Verify checking against additional data sources and instituting new verification policies or procedures, will be covered under this MOU and will not cause the need for a supplemental MOU that outlines these changes. 325170 Page 11 of 17 E-Verify MOU for Employers | Revision Date 06/01/13 Company ID Number: B. TERMINATION 1. The Employer may terminate this MOU and its participation in E-Verify at any time upon 30 days prior written notice to the other parties. 2. Notwithstanding Article V, part A of this MOU, DHS may terminate this MOU, and thereby the Employer’s participation in E-Verify, with or without notice at any time if deemed necessary because of the requirements of law or policy, or upon a determination by SSA or DHS that there has been a breach of system integrity or security by the Employer, or a failure on the part of the Employer to comply with established E-Verify procedures and/or legal requirements. The Employer understands that if it is a Federal contractor, termination of this MOU by any party for any reason may negatively affect the performance of its contractual responsibilities. Similarly, the Employer understands that if it is in a state where E-Verify is mandatory, termination of this by any party MOU may negatively affect the Employer’s business. 3. An Employer that is a Federal contractor may terminate this MOU when the Federal contract that requires its participation in E-Verify is terminated or completed. In such cases, the Federal contractor must provide written notice to DHS. If an Employer that is a Federal contractor fails to provide such notice, then that Employer will remain an E-Verify participant, will remain bound by the terms of this MOU that apply to non-Federal contractor participants, and will be required to use the E-Verify procedures to verify the employment eligibility of all newly hired employees. 4. The Employer agrees that E-Verify is not liable for any losses, financial or otherwise, if the Employer is terminated from E-Verify. ARTICLE VI PARTIES A. Some or all SSA and DHS responsibilities under this MOU may be performed by contractor(s), and SSA and DHS may adjust verification responsibilities between each other as necessary. By separate agreement with DHS, SSA has agreed to perform its responsibilities as described in this MOU. B. Nothing in this MOU is intended, or should be construed, to create any right or benefit, substantive or procedural, enforceable at law by any third party against the United States, its agencies, officers, or employees, or against the Employer, its agents, officers, or employees. C. The Employer may not assign, directly or indirectly, whether by operation of law, change of control or merger, all or any part of its rights or obligations under this MOU without the prior written consent of DHS, which consent shall not be unreasonably withheld or delayed. Any attempt to sublicense, assign, or transfer any of the rights, duties, or obligations herein is void. D. Each party shall be solely responsible for defending any claim or action against it arising out of or related to E-Verify or this MOU, whether civil or criminal, and for any liability wherefrom, including (but not limited to) any dispute between the Employer and any other person or entity regarding the applicability of Section 403(d) of IIRIRA to any action taken or allegedly taken by the Employer. E. The Employer understands that its participation in E-Verify is not confidential information and may be disclosed as authorized or required by law and DHS or SSA policy, including but not limited to, 325170 Page 12 of 17 E-Verify MOU for Employers | Revision Date 06/01/13 Company ID Number: Congressional oversight, E-Verify publicity and media inquiries, determinations of compliance with Federal contractual requirements, and responses to inquiries under the Freedom of Information Act (FOIA). F. The individuals whose signatures appear below represent that they are authorized to enter into this MOU on behalf of the Employer and DHS respectively. The Employer understands that any inaccurate statement, representation, data or other information provided to DHS may subject the Employer, its subcontractors, its employees, or its representatives to: (1) prosecution for false statements pursuant to 18 U.S.C. 1001 and/or; (2) immediate termination of its MOU and/or; (3) possible debarment or suspension. G. The foregoing constitutes the full agreement on this subject between DHS and the Employer. To be accepted as an E-Verify participant, you should only sign the Employer’s Section of the signature page. If you have any questions, contact E-Verify at 1-888-464-4218. 325170 Page 13 of 17 E-Verify MOU for Employers | Revision Date 06/01/13 Company ID Number: Approved by: Employer Name (Please Type or Print) Title Signature Date Department of Homeland Security – Verification Division Name (Please Type or Print) Title Signature Date 325170 Southeastern Seating, Inc. Eugene J Freeman Electronically Signed 05/06/2010 USCIS Verification Division Electronically Signed 05/06/2010 Page 14 of 17 E-Verify MOU for Employers | Revision Date 06/01/13 Company ID Number: Information Required for the E-Verify Program Information relating to your Company: Company Name Company Facility Address Company Alternate Address County or Parish Employer Identification Number North American Industry Classification Systems Code Parent Company Number of Employees Number of Sites Verified for 325170 Southeastern Seating, Inc. 903 E. 17th Ave Tampa, FL 33605 HILLSBOROUGH 593640537 332 20 to 99 1 Page 15 of 17 E-Verify MOU for Employers | Revision Date 06/01/13 Company ID Number: Are you verifying for more than 1 site? If yes, please provide the number of sites verified for in each State: 325170 FLORIDA 1 site(s) Page 16 of 17 E-Verify MOU for Employers | Revision Date 06/01/13 Company ID Number: Information relating to the Program Administrator(s) for your Company on policy questions or operational problems: 325170 Name Cynthia R Collamore Phone Number (813) 273 - 9858 Fax Number (813) 273 - 9196 Email Address ccollamore@seseating.com Page 17 of 17 E-Verify MOU for Employers | Revision Date 06/01/13 Company ID Number: 325170 Page intentionally left blank CERTIFICATE OF LIABILITY INSURANCE Date Producer: Insured: This Certificate is issued as a matter of information only and confers no rights upon the Certificate Holder. This Certificate does not amend, extend or alter the coverage afforded by the policies below. Insurers Affording Coverage NAIC # Insurer A: Insurer B: Insurer C: Insurer D: Coverages The policies of insurance listed below have been issued to the insured named above for the policy period indicated. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions, and conditions of such policies. Aggregate limits shown may have been reduced by paid claims. INSR LTR ADDL INSRD Type of Insurance Policy Number Policy Effective Date (MM/DD/YY) Policy Expiration Date (MM/DD/YY) Limits GENERAL LIABILITY Commercial General Liability Claims Made Occur General aggregate limit applies per: Policy Project LOC Each Occurrence Damage to rented premises (EA occurrence) Med Exp Personal Adv Injury General Aggregate Products - Comp/Op Agg $ $ $ $ $ $ AUTOMOBILE LIABILITY Any Auto All Owned Autos Scheduled Autos Hired Autos Non-Owned Autos Combined Single Limit (EA Accident) Bodily Injury (Per Person) Bodily Injury (Per Accident) Property Damage (Per Accident) $ $ $ $ EXCESS/UMBRELLA LIABILITY Occur Claims Made Deductible Each Occurrence Aggregate Workers Compensation and Employers' Liability Any proprietor/partner/executive officer/member excluded? If Yes, describe under special provisions below. WC Statu- tory Limits E.L. Each Accident E.L. Disease - Ea Employee E.L. Disease - Policy Limits Other Descriptions of Operations/Locations/Vehicles/Exclusions added by Endorsement/Special Provisions: CERTIFICATE HOLDER CANCELLATION A OTH- ER X Should any of the above described policies be cancelled before the expiration date thereof, the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS 3295 TAMIAMI TRAIL E ISSUE 12-12-18(SS) Lion Insurance Company Insurer E: Plymouth Insurance Agency 2739 U.S. Highway 19 N. Holiday, FL 34691 12/12/2018 11075 Lion Insurance Company is A.M. Best Company rated A (Excellent). AMB # 12616 NAPLES, FL 34112 South East Personnel Leasing, Inc. & Subsidiaries 2739 U.S. Highway 19 N. Holiday, FL 34691 Client ID:92-70-753 BID NO. 18-7461 BENCHES AND BLEACHERS Coverage only applies to injuries incurred by South East Personnel Leasing, Inc. & Subsidiaries active employee(s) Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937-2138 or email certificates@lioninsurancecompany.com Coverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following "Client Company": Southeastern Seating, Inc. Begin Date:11/2/2016 WC 71949 01/01/2019 01/01/2020 $1,000,000 $1,000,000 $1,000,000 Project Name: , while working in: FL. (727) 938-5562 NO 16.D.2.g Packet Pg. 1364 Attachment: 18-7461 SoutheasternSeating_InsuranceWC (7493 : Award Invitation to Bid (ITB) 18-7461 Benches and Bleachers)