Agenda 01/27/2026 Item #16F 2 (Grant agreement with the Florida State Courts System, Office of the State Courts Administrator)1/27/2026
Item # 16.F.2
ID# 2025-5118
Executive Summary
Recommendation to approve and execute the grant agreement with the Florida State Courts System, Office of the State
Courts Administrator, reimbursing the County up to $1,000,000 for the renovation and expansion of the existing
switchgear and automatic transfer switch at the “Courthouse Annex Building L1” (Project 33979).
OBJECTIVE: To renovate and expand the existing switchgear and automatic transfer switch at the “Courthouse Annex
Building L1” project (the "Project") with grant funding assistance from the Florida State Courts System, Office of the
State Courts Administrator.
CONSIDERATIONS: On August 6, 2025, the Board received notice of appropriated grant-in-aid funding through
Chapter 2025-198, Laws of Florida. This grant agreement with the Florida State Courts System, Office of the State
Courts Administrator, will be utilized for the renovation and expansion of the existing switchgear and automatic transfer
switch at the Courthouse Annex Building. The goals to be achieved in this grant agreement are the following:
1. Engage the appropriate professional services firm to make any necessary recommendations and to advise or manage
subcontractors; and
2. To the extent feasible within existing funding, engage necessary professionals and contractors to complete the
renovation.
The Courthouse Annex Building L1 was completed in 2008 as part of the Collier County Courthouse complex. The
Courthouse Annex Building L1 has operated with limited emergency power coverage since its construction. Currently,
only one of the building’s three main electrical panels is connected to the backup generator, resulting in partial service
during power outages.
In 2024, the Facilities Management Division commissioned a power study, which concluded that the existing generator
has sufficient capacity to support the entire building. To achieve full backup power, a switchgear expansion is required.
The grant agreement with the Florida State Courts System Office of the State Courts Administrator expires on June 30,
2028.
This item is consistent with the Responsible Governance, Quality of Place, and Infrastructure and Asset Management
strategic focus areas of the Collier County Strategic Plan.
FISCAL IMPACT: A budget amendment is required to recognize grant funding in the amount of $1,000,000 in the
Specialized Grants Fund, 1831 project 33979. The source of the funding is the Florida State Courts System, Office of
the State Courts Administrator. There is no required match.
GROWTH MANAGEMENT IMPACT: There is no Growth Management Impact associated with this Item.
LEGAL CONSIDERATIONS: This item is approved as to form and legality and requires a majority vote of the Board
for approval. – CLD
RECOMMENDATION(S): To approve and execute the grant agreement with the Florida State Courts System, Office
of the State Courts Administrator, reimbursing the County up to $1,000,000 for the renovation and expansion of the
existing switchgear and automatic transfer switch at the “Courthouse Annex Building L1” (Project 33979).
PREPARED BY: Tim Rygiel, Supervisor - Project Management, Facilities Management
ATTACHMENTS:
1. Grant Agreement001
2. BA_Courthouse Annex Building L1 - 33979
Page 4671 of 5261
1/27/2026
Item # 16.F.2
ID# 2025-5118
Page 4672 of 5261
Agreement Number
FLORIDA STATE COURTS SYSTEM
OFFICE OF THE STAIE COURTS ADMINISTRATOR
THIS AGREEMENT is entered into between the State Court System of Florida. Offlce of the State Coufts Administrator,
hereinafter referred to as "OSCA," and the Collier County Board of County Commissioners, hereinafter referred to as the
Recipient'
I. THE RECIPIENT AGREES:
A, Agreement Oocument
1. To provide commodities and services indicated on Attachment A in accordance with the terms and conditions
specified in this Agreement.
2. That th€ Agreement document consasts of all attached documents identilied in Section Ill(l).
B. Governing Law and Venue
That this Agreement is executed and entered into in the State of Florida, and shall be construed, performed and enforced in
all respects in accordance with Florida law including Florida provisions for conflict of laws. Venue shall be Tallahassee, Florida.
C. lnvoicing and Travel
That funds provided n this Agreement may not be used for travel expenses ofRecipientor Recipient's staff lnvoices and all
necessary supporting documentaUon shall be submitted to the following address:
Office of the State Court Administrator
General Services Unit
Grants Administrator
500 S Duval Street
Tallahassee. FL 32399-1900
O, Records and Retention
1. To establish and maintain books, records, and documents (including electronic storage media) sufficient to reflect all
income and expenditures of funds provided by the OSCA under this Agreement in accordance with Rules2 430 and 2 440.
Floida Rules of General Practice and Judicial Admnislration
2 To retain, at no additional cost to the OSCA. all records, software and service records, flnancial records. supporting
documents, statistical records, and any other documents (including electronic storage media) pertinent to this Agreement
for a psriod of ten ('10) years after completion of the Agreement, or if an audit has been initiated and audit flndings have
not been resolved at the end of ten (10) years, the records and documents shall be retained until resolution of the audit
findings or any litigation which may be based on the terms of this Agreement. lf any such records are eligible for destruction
under applicable record retention schedules before ten (10) years after completion of the Agreement the records may be
destroyed with the prior written approva of the OSCA Grant N,4anager.
3 Upon demand and at no additiona I cost to the OSCA the Recipient will facilitate the duplication a nd transfer of any records
or documents during the required retention period
E. Public Records, Audlts, lnspections, lnvestigations and Monitoring
1. To allow public access to all documents, papers, letters, or other public records as defined in Rule 2.420, Florida Rules of
General Practice and Judicial Administration, Chapter 119, Floida Statutes and the DFS Reference Guide to State
Expenditures made or received by the Recipient in coniunction with this Agreement except that public records which are
made confldential by law must be protected from disclosure. lt is expressly understood that the Recipient's failure to
comply with this provision shall constitute an immediate breach of this Agreement for which the OSCA may unilaterally
termrnate the Agreement
2 To assure that these records shall be sublect at all reasonable times to inspection, review, copying. or audit by Federal,
State or other personnel duly authorized by OSCA.
3 To permit persons d!ly authorized by the OSCA to inspect and copy any records, papers, documents facilities. goods
and servrces of the Recpient which are relevant to this Agreement; and to interview any clients employees and sub-
reclpient employees of the Recipient to ass!re OSCA of the satisfactory performance of the terms and conditions of this
Agreement Following such review, OSCA will deliver to the Recipient a writton report of its findings and where
appropriate, a request for the Recipient to submit a corrective action plan in accordance with Attachment A Section D of
this Agreement
4. To comply and cooperate immediately with any inspections, reviews, investigations, or audits deemed necessary by the
Office of the lnspector General pursuant to section 20.055, Florida Statutes, and the Auditor General of Florida
5 To include the aforementioned audit, inspections, investigations and record keeping requirements in all subcontracts and
assrgnments.
I
CAO
Page 4673 of 5261
6. To provide a flnancial and compliance audit to OSCA as specified in Attachment D, Parl 1 and to ensure that all related
party transactions are disciosed to the audltor.
F. lndemniflcation
Pursuant to section 768.28(19), Florida Statutes, nerther the Recipient nor the OSCA waive sovereign immunity nor do the
parties agree to indemnrfy each other for the other party s neg|gence.
G. lnsurance
To provide continuous adequate liability insurance coverage during the existence of this Agreement and any renewal(s) and
extension(s)
H. Assignments and Subcontracts
L To be responsible for all work performed and for all products produced pursuant to this Agreement
2. Any sub-contracts shall be evidenced by a written document. The Recipient further agrees that OSCA shall not be liable
to the sub-contractors in any way or for any reason The Recipient, at its expense, will defend the OSCA against such
claims.
3 That the OSCA shall at all times be entitled to assign or transfer ts rights. duties, or obligations under this Agreement to
another governmental entity in the State of Flofda, upon giving prior written notice to the Recipient
l. Return of Funds
To return to OSCA any overpayments due to unearned funds or funds for disallowed expenditures pursuant to the terms and
conditions of this Agreement that were disbursed to the Recipient by OSCA. ln the event that the Recipient or its independent
auditor discovers that an overpayment has been made, the Recipient shall repay said overpayment within thirty (30) business
days of discovery ln the event that OSCA first discovers an overpayment has been made, the Grant l,Ianager, on behalf of
OSCA, will notify the Recipient by letter of such findings. Should repayment not be made within forty-five (45) calendar days
of the notification by the OSCA, the Recipient will be charged at the laMul rate of interest on the outstanding balance after the
OSCA notification or Recipient discovery.
J. Compllance with Statutss, Laws, Regulations, and Rules
I That the Recipientshall. without exception. be aware ofand complywith ali State and Federai laws, rules, and regulations
relating to this Agreement as they may be enacted or amended from time-to-time, as well as any court or administrative order.
judgement, settlement, or comphance agreement involving the OSCA which by its nature affects this Agreement
2. That the Recipient will comply with the Americans with Disabilities Act. the Civil Rights Act of '1964, as amended, the Florida
Civil Righls Act of 1992, and any other federal or state law that prohibits discrimination on the basis of age, race, religion,
color disability, national origin, marital status, sex, or genetic information. The Recipient further assures that all sub-recipients
and sub-contractors, or others with whom it arranges to provide services under this Agreement will comply with these
requirements.
K. Employment of Unauthorized Aliens and Use of the E.Verify System
That unauthorized aliens shall not be employed by the Recrpient. The OSCA shall consider the employment of unauthorized
aliens a violation of section 2744 of the lmmigration and Nationality Act (8 U.S.C. 1324 a). Such violation shall be cause for
unilateral cancellation of this Agreement by OSCA.
PulSuant to sections 448.09 and 448 095, Florida Statutes, the Recipient, and all subcontractors or subrecipients must:
1. Be in full compliance wlth sections 488.09 and 488.095 Flo(da Statutes, regarding the use of the Depaftment of
Homeland Security's (DHS) E-Verify System (httos //www e-verifv.oov/) to veriiy the employment eligibility of each new
employee hired as required by I C.F.R. s. 274a The Recipient shall also include the requirement from this paragraph in
all subcontracts.
lf the Recipient is unable to register to utilize DFIS's E-Veriry system because they are a sole proprietor or business entity
with no employees, the Recipient must complete a registration waiver certrfication (Attachment E) certifying the reason for
non-registration which must be submitted for approval along with the required signed Agreement documents.
Confirm that all subcontractors/subrec pients with twentyJive (25) or more employees were registered with and have been
utlrzng the E-Verty system to verfy the employment eLigbiity of al new empoyees hired by the
subcontractor/subrecipient since Jr y 1 , 2423 as described in number 1 above. Subcontractors/subrec oients who were
2
3
non-comoliant with the statutorv reouirement for at least the ix 16) months oeriod orior to the anticioated effecUve date of
the subcontract are not elrorble to orovrde serv ces !nder this Aoreement
Priorto allowing any subcontractor/subrecipient to provide any services contemplated underthis Agreement. the Recipient
shall provide the OSCA'S Grant lvlanager a completed Subcontractor E-Verity Atfidavit (Attachment F) and proof of
registration to use the E-Verify system, if applicable.
4
trAo
Agreement Number
Page 4674 of 5261
Ag reement Number
5. Violation of the provisions in this section by the Recipient or a subcontractor/subrecipient may result in the penalties
prescribed by section 448.09 and 448 095, Florida Statutes, being applied to the Recipient and the
subcontractor/subrecipient and will constitute grounds for immediate termination of the Agreement by the OSCA.
6. Pu rsuant to section 448.095(5XcX3). Florida Statutes the Reclpi€nt is llable for any additional costs lncurred by the OSCA
as a result of the termination of the Agreement for a violation of the provisions contained in these paragraphs
L. Contracting with Entities of a Foreign Country of Concern
1. Pursuantto section 287.138, Florida Statutes, governmentai entities ofthe State of Florida are prohibited from entering
into contracts or agreements with entitres owned by a foreign country of concern, as defined in section 287 138( 1Xc),
Florida Statutesi where a foreign country ofconcern possesses a controlling interest in the entity; orwith entities organized
under the laws of, or with its principai place of bus ness in a foreign country of concern.
M. Contracting with Entities Engaged in Forced Labor or Human Trafficking
1. Pursuant to sections 287'1346 and 787 06, Florida Statutes, governmental entities of the State of Florida are prohibited
from accepting a bid, proposal or reply to any solicitation, entering into contracts or agreements with, or Vansacting
business with entities thatengage in forced labor as defined by section 287.1346, Florida Statues, orhuman trafficking,
as defined in section 787.06, Florida Statutes
N. Sponsorship
That if the Recipient is a non-governmental organization whlch sponsors a program financed wholly or in part by state funds,
ncluding any funds obtained through th s Agreement, it sha I in publicizing, advertising, or describing the sponsorship of the
program. state: "Sponsored by (Recipient 's name), the Florida Legislature and the Florida State Court System. lf the
sponsorship reference is in written material, the words "Florida Legislature and Florida State Court System" shall appear in the
same size letters or type as the name of the organization. Such sponsorship is sublect to the prior written approval of the
OSCA Grant l\4anager.
O. Publicity
That without limitation, the Recipient and its employees, agents, and representatives will not, without prior written consent in
each instance, usetheStateof Florida's the State Court System's or the OSCA'S name or seal in advertising, publicity, or
any other promotional endeavor. The Recipient will not represent that any product or service provided by the Recipient has
been approved or endorsed by the State of Florida. the State Court System, or the OSCA or refer to the existence of this
Agreement in press releases, advertising or materials distributed to the Recipient's prospective customers.
P. Lobbying
To nol expend and of the funds provided under this Agreement for the purpose of lobbying the Legislature, judicial branch, or
a state agency.
Q. Final R6imbursement REquest Process
To submit the final reimbursement request for payment by the OSCA by the last business day in July after the end of the (State
Fiscal Year) SFY or within thirty (30) calendar days after the Agreement expires or is terminated. lf the Recipient fails to do so,
all nghls to payment are forfeited and the OSCA will not honor any requests submitted after the aforesaid time period Any
payment due under the terms of this Agreement may be withheld until all reports, deliverables, and tasks due from the Recipient
pursuant to this Agreement and necessary adjustments thereto have been approved by the OSCA.
II. OSCA AGREES:
A. Agreement Amount
To pay for commodities and services according to the terms and conditions of this Agreement in an accordance with
Attachment B to this Agreement sublect to the availability of funds Any costs or services pajd for under any other Agreement
or from any other source are not eligible for payment under this Agreement.
B. Payment
Pursuant to section 2'15.422, Florida Statutes, the OSCA has fifteen (15) business days to inspect the documentation regarding
the delivery of the goods and services provided by the Recipient, unless a different period has been agreed to by the parties
C, Payment Inquiries and Vendor Ombudsman
1. That issues regarding the inspectlon, acceptance and payment for foods and services provided under this Agreement will
be handled by the Grant Administrator at (850) 922-1184.
2 That a Vendor Ombudsman has been established within the Oepartment of Financial Services. The duties of this offlce
are found in section 215.42217), Florida Statutes, which include disseminating information relative to the prompt payment
of this state and assisting vendors in receiving their payments in a timely manner from a state agency. The Vendor
Ombudsman may be contacted at (850) 410-9724 An automated payment history line (850) 4'13-7269 is available for
payment history and pending payment information
3
CAO
Page 4675 of 5261
Agreement Number
III. THE RECIPIENT AND OSCA MUTUALLY AGREE:
A. Effectlve and Ending OatEB
That thrs Agreement shall begin on the date on which the Agreement has been signed by the last party required to sign it. lt
shall end at midnight. Eastern Time on June 30, 2028 The State of Florida's performance and obligation to pay under this
Agreement is contingent upon an annual appropflation by the Legislature and spending allocation by the Chief Justice
B. Renewal
That upon continued appropriations by the Florida Legislature. the OSCA and the Recipient may renew the Agreement, in
whole or in part. for a period that may not exceed three (3) years or the term of the original Agreement, whichever penod is
longer. The renewal may be divided into increments. may be for a complete term, or any combination thereof The renewal
must be in writ ng and signed by both parties, and is contingent upon satisfactory performance and sub,ect to availability of
funds for this Agreement.
C. Termination
1 That this Agreement may be terminated by the OSCA without cause upon no less than a sixty (60) calendar day notice in
v/riUng to the other party unless a shorter tlme rs mutually agreed upon in writing.
2. ln the event funds for payment pursuant to this Agreement become unavailable, the OSCA may terminate this Agreement
upon no less than a twentyjour (24) hour notice in writing to the Recipient. The OSCA shall be the final authority as to
the availability and adequacy of funds
3. ln the event the Recipient fails to fully comply with the terms and conditions of this Agreement, the OSCA may terminate
the Agreement upon no less than twenty-four (24) hours'notice in writing to the Recipi€nt, excluding Saturday, Sunday,
and Holidays. Such notice may be issued without providing an oppodunity for cure if it specifies the nature of the
noncompliance and states that provision for cure would adversely affect the interests of the State or is not perm tted by
law or regulation. Otherwise, notice of termination will be issued after the Recipient's failure to fully cure such
noncomplrance within the time specified in the written notice of noncompliance issued by the OSCA specifylng the nature
of the noncompliance and the actions requrred to cure such noncompliance The OSCAs failure to demand performance
of any prov sion of thrs Agreement shall not be deemed a waiver of such performance. The OSCA'S waiver of any one
breach of any provision of this Agreement shaLl not be deemed to be a waiver of any other breach and neither event shall
be construed to be a modification of lhe terms and conditions of this Agreement. The provisions hereln do not limlt the
OSCA's right to remedies at law or rnequity.
4. Ihe following shall be sufficient cause for termination by the OSCA upon no less than twenty-four (24) hours' notice in
writing to the Recipient. To be terminated under this prov sion, the Recipient must have
Committed a violation of or non-compliance with Chapter 435, Florida Statutes.
Commrtted a violation of or non-compliance with section 448.09, Florida Statutes.
Committed a violataon of or non-compliance with section 448.095, Florida Statutes.
Been declared a business entity ineligible to contract with the State of Florida pursuant to Section 287.138, Florida
Statutes.
Been declared a Convicted Vendor pursuant to Section 287.133, Florida Statutes.
Been declared a Suspended Vendor pursuant to Section 287.1351, Florida Statues.
Engage in forced labor practices as defined by Section 287.1346, Florida Statutes.
Engage in human trafficking prachces as defined by Section 787.06, Florida Statutes.
Previously failed to satisfactorily perform in a contract or agreement with any division of the State Courts System,
been notlfied of the unsatisfactory perfomance and failed totimely correct the unsatisfactory performance: or
Had a contract or agreement terminated for cause by any division of the State Courts System
5. ln the event of termination under sections C(1) or C(2), the Recipient will be compensated for any work satisfactorily
completed lhrough the date of termination or an earlier date of suspension of work.
6. That written notice of terminatlon shall be delivered by U.S. Postal Service or any expedited delivery service that provides
verification of delivery or by hand delivery to the Grant Manager or the representative of the Recipient responsible for
administration of the program as appropriate
D. RenegotiationsorModifications
1. That, with the exception of modifying the Budget in Attachment B, modifications of all other prov sions of this Agreement
shall be valid only when they have been reduced to writing and duly signed by both parties.
2. The rate of payment and the total dollaramountmay be adjusted retroactively to reflect price level increases and changes
in the rate of payment when these have been established through the appropriations process and subsequently identrfied
in OSCA's operating budget, without said price level increases being approved in writing by the parties.
3 That the parties agree to renegotiate this Agreement if there are any revrsions of any applicable state laws. or regulations
that make changes in this Agreement necessary.
1
41
4.2
43
44
45
46
4.7
4.8
4.9
4.10
CAO
Page 4676 of 5261
Ag reement Number
E. Third-Parly Beneficiaries
The terms and conditions of this Agreement are intended to be solely for the benefit of th€ Parties and their respective
successors or permitted assigns, and it is not the intention of the Parlies for the Parties to confer third-party beneficiary rights,
interest, or claims to another party.
F. Execution in Counterparts
Thrs Agreement may be executed rn counterparts, each of which will be an original and all of which will constitute but one and
the same instrument. A signed copy of the Agreement or counterpart transmitted via facsimile, email, or other electronrc means
wlll be deemed to have the same legal effect as delivery of an original executed copy.
G. Notice
That any notic€, that is required under this Agreement shall be in writing and sent by U.S. Postal Servico or any expedited
delivery servlce that provides veriflcation of delivery or by hand delivery. Said notice shall be sent by the OSCA to the
representative of the Recipient responsible for administration of the program, at the designated address indicated in lll.H 3.
and by the Recipient. to OSCA'S Grant Manager indicated in lll.H.4.
H. Oflicial Payee and Representatives (Names, Addresses, and TelEphone Number3):
1. The Recipient name. as shown on page 1 of this Agreement, and mailing address of the official payee to whom the
payment shallbe made is:
Collier County Board of County Commissioners
3299 Tamiami Trail East Suite 700
Naples, FL 34112
(239) 2s2-7813
2. The name of the Recipient's contact person and street address where financial and administrative records are maintained
iS:
Suzanne Boothby
Off ce of the Clerk of the Circuit Court
& Comptroller of Collier County
3299 Tamiami Trail East. Suite 403
Naples. FL 341 12
239-252-7825
-(
CAO
3. The name, address, and telephone number of the Recipient's Project Manager responsible for administration of the
program under this Agreement is:
Tim Rygiel
Collier County Board of County Commissioners
3335 Tamiami Trail East Suite 10'1
Naples, FL 34112
(239) 252-8239
Tim. Rygiel@collier.gov
4. The name. address, and telephone numbsr of the Grant Manager for OSCA for this Agreement is:
Jessica Mitchell, General Services Analyst
Office of the State Courts Administrator
500 South Duval Street
Tallahassee, FL 32399-1900
(850)488-3738
mitchellj@flcourts.gov
5. The nam€, address, and telephone number of the Project Monitor/Circuit Liaison for this Agreement is
Ms. Keni Hixson
AOC Operations Oivision Manager - Collier County
Twentieth Judicial Circuit of Florida
3315 Tamiami Trail E
Naples, FL 34112
(239) 252-8124
KHixson@ca.cjis20 org
6. Upon change of representatives (names, addresses, telephone numbers and e-mail addresses) by either party, notice
shall be provided in writing to the other party. Updates or changes to information in this section do not require a written
contract amendm€nt and may be offective upon receipt of the other party.
Page 4677 of 5261
I.All Terms and Conditions Included
Agreement Number ______ _
This Agreement and its attachments, and any exhibits referenced in said attachments, together with any documents
incorporated by reference, contain all the terms and cond1t1ons agreed upon by the parties. There are no provis ions , terms,
conditions, or obligations other than those contained herein, and this Agreement shall supersede all previous
commu ni cations , representations, or Agreements, either verbal or written between the parties. If any term or provision of this
Agreement 1s legally determined unlawful or unenforceable, the remainder of the Agreement shall remain in full force and
effect and such term or provision shall be stricken. Attachments and exhibits to this Agreement which apply, and therefore
are incorporated by reference include (those indicated with a checked box(�):
Applicable attachments: [;g) indicates the attachment applies to this Agreement.
Attachment# Attachment Title
� Attachment A Scope of Work/Additional Provisions
� Attachment B State Fiscal Year Budget Document
� Attachment C Certification Regarding Lobbying
� Attachment D Compliance Monitoring and Auditing
� Attachment E Contractor/Subcontractor E-Verify Registration Proof or Waiver Affidavit
� Attachment F Subcontractor's E-Verify Registration Affidavit
D Attachment G Contractor's Statutory Compliance Affidavit
By signing this Agreement, the parties agree that they have read and agree to the entire Agreement, as described in
Paragraph Ill.I. above.
IN WITNESS THEREOF, the parties hereto have caused this six (6) page Agreement and any attachments or exhibits to be
executed by their undersigned officials as duly authorized.
THE COLLIER COUNTY FLORIDA BOARD
OF COUNTY COMMISSIONERS
SIGNED
BY:
NAME:
TITLE:
DATE:
Vendor#
Dan Kowal
Chairman
F596000558007
Approved as to fonn and legality
�lh�-Assistant County Attorney
6
THE FLORIDA STATE COURTS SYSTEM
OFFICE OF THE STATE COURTS ADMINISTRATOR
SIGNED
BY:
NAME: Eric Maclure
TITLE: State Courts Ad ministrator
DATE:
CAO
Page 4678 of 5261
The Florida Legislature, through Chapter 2025-198. Section 7, Line 2976A, Laws of Florida. appropriated funds as granFin-aid to the
Recipient, to be used to renovate and expand the existing switchgear and automatic transfer switch (ATS) located at the Courthouse Annex
Building at the Collier County Government Center. This Agreement provides the method for disbursement of the appropriated funds, ho,,y the
funds may be spent, sets forth requisrte deliverables, performance measures, financial consequences, reporling requirements, disbursement
and expenditure reconciliation, invoice terms and other conditions necessary for payment. The total appropriation amount, amounts set-aside
from the appropriation for specific purposes, any use restrictions and allocation requirements are identified in the Fiscal Year Budget,
Attachment B to this Agreement.
Section B - Obiective
The Recipient, in consultation with tho Chief Judge of the Twentieth Judicial Circuit Court of Florida, will use the funds provided under this
Agreement to make the necessary improvements to the Courthouse Annex Building at the Collier County Government Center
The goals to be achieved to meet this objective are:
l. Engage the appropriate professional services firm (architect, engineer, commercial general contractor) to make any necessary
recommendations and to advise or manage subcontractors.2. To the extent leasible within existing funding, engage necessary professionals and contractors to:a Complete renovation and expansion of the existrng switchgear and automatic transfer switch (ATS) located at the
Courthouse Annex Building
PART 2 - WORK REQUIREMENTS
SECTION A . PROJECT RESOURCES
The following professional servrces must be used on this project to ensure the objectives of the Agreement are achieved and that the state
funds provided under this Agreement are protected from loss:
1. Project Manager: A representative ofthe Recipient with the responsibility and authority to managethe project within the parameters
set forth by the governing body of the Recipient's organization. including review, inspection and acceptance of the work being
performed creation and/or the submission ofall reports and deliverables to the OSCA, approval ofall invoices. submission ofdraw
requests for funding from the OSCA and the financial accountrngofall project funds The Project Manager will also serve as the liaison
between the Reclpient, any vendors/contractors, the Twentieth Judicial Circuit, its Project Monitor, and the OSCA.
2. Project Monitor (Circuit Representative). A representative of the Twentieth Judicial Circuitwiththe responsibility and authority to
workwlth the Project Managerto ensure the needs and rnterests ofthe Twentieth Judicial Circuitare met throughout the renovation The
Project l\,4on tor may assist in the review, inspectron and acceptance of the work being performed must review, prior to submission, all
reports and deliverables to the OSCA, approval ofall invoices submission of draw requests forfunding from the OSCA and the financial
accounting ofall project funds The Project Monrtorwill also serve as a Iiaison bet\rveen the Recipientandthe OSCA
s ECTION B - PROJECT PHASES
To ensure the security of the state funds provided for this project. the following tasks must be successfully completed to earn the mrlestone
payment associated vr'ith each task or phase under this Agreement. Upon completion of each task or phase, the funds advanced to the
Recipient will be deemed earned and the Recipient will be eligible for disbursement of the next advance, in accordance with the Attachment
B the Project Budget.
Renovation and expansion of the existing switchgear and automat c transfer switch at the Courthouse Annex Building at the to the Collier
County Government Center
1. Evaluation and Estimation - Review ofthe current conditions by a qualified and icensed professional appropriate forthework to be
completed to determine the extent ofthe issues and the necessary repairs or upgrades needed The Project Manager, Proiect lvlonitor
and the OSCA will be provided an estimate or other similar documentation outlining the work to be completed.
2. Engagement - Engaging an appropriately licensed and insured contractor(s), or other appropnate professional(s). Iicensed under the
provisions ofthe applicable Florida Statutes, to perform the repair or upgrades outlined above and in Attachment B The contract(s) with
the vendo(s) should include descripton of the work to be performed (incorporating the design and blueprints, if any. by reference),
proiect plan, milestones, due dates, minimum quality and performanc€ standards, progress payment amounts, liquidated damages,
flnancial consequences for failure to perform or meet minimum standards, warranty, and latent damages provisions.
3. Ex€cution of the Work - The engaged professional(s), and any necessary subcontractor(s), performs the repair and/or upgrade work
necessary and in accordance with the approved estlmate and scope of contract(s). Copies of all purchase orders or other procurement
documentation will be malntained and provided ln regular reporting to the OSCA.
4. lnspection and Acceptanco - All necessary rnspections wrll be conducted, pursuant to any applicable Florida Statute or other rule, as
well as rnspection by the Prolect Manager A "punch-list" of itemsthatfail to meet the acceptance ofthe lnspector or Recipient and a
7
Agreement Number
Attachment A
Scope of Work
PART 1 - GENERAL INFORMATION
Section A - Backqround and Purpose
Cr-\O
Page 4679 of 5261
Agreement Number
reasonable schedule for the vendor to coffect the deficiencies. Recipient should keep copies of all bills of lading, packing slips or other
slmllar documentat on received or generated and provide copies upon request
SECTION C - DELIVERABLES AND FINANCIAL CONSEQUENCES
The Recipient will ensure that only the following deliverables are submitted to the OSCA:
1. Project Plan - A document out ining itemssuch asthe phases, activities tasks, deliverables, deliverables acceptance plan, resources,
roles and responsibllities, performance measures, monitoring activities risk assessment and mltigation plan, procurement plan, contract
management plan. stakeholder communicaUon plan, and financial management plan (including the project budget). At a min mum, the
Recipient will provide a project plan that includes a high-level project schedule that sets the critical path for the project The project plan
is due to the OSCA within 45 days of the execution of this Agreement and will be updated and resubmitted with all requests for a
reimbursement 'Note: This deliverable must be approved by the Chief Judge and the Chair of the County Commission before it can be
approved by the OSCA Grant Manager. The initial project plan can outline what changes if any, to the project plan that may be
approved by the Pro.ject Manager and Project Monitor without requiring formal approval of the Chief Judge and the Chair of the Co!nty
Commission. Ensure that the necessary time to complete these reviews and approvals is factored into the Proiect Schedule
2. Prorect Schedule - A comprehensive document that outlines the critical path of the proJect (purchase and installatron of switchgear and
ATS)from start to completion. The schedule will lnclude begrn and end dates for all phases, subordinate activities and tasks for the
prolect. The schedule must be updated when a change occlrrs. The project schedule is due to the OSCA wrthin thirty (30) days of the
execution of the separate contract between the Recipient and the awarded contractors for thls project and resubmitted with all requests
for reimbursement
3. Monthly Project Report - The monthly report will be submitted to the OSCA by the 1sth calendar day of each month and will contain
the follo\,Ying:
3.1. An executive narrative of the current status of the project
3.2. Adetail report ofthe actvities and tasks completed during the priormonth
3.3. A detailed comparison of any changes made to the Prolect Plan during the prior month.
3.4. Update of the project budget, including cosl status expendrture status. obligated funds and fund balances Failure to submit this
deliverable by the due date will result n a I quldated damages assessment of $50 for each day it is late from the invo ce unless
additional time is granted by the OSCA Grant Adm nistrator.
4. Contract Package - A package containing the signed contract(s)with the General Contractor, Electrician, Archrtect, Engineer or other
Professional Services provider contracted to perform work associated with this Agreement This deliverable is due within fitteen (15)
calendar days of the last party signrng the contract. Failure to submit this deliverable by the due date will result in a liquidated damages
assessment of $50 for each day itis late from the invoice unless additional time is granted by the OSCA Grant Administrator.
5. lnspection Package - Copies of all final inspection reports issued bythe local building authority showing the approval ofthework The
delivery of this package will be within fifteen (15) calendar days of the issuance of each passed inspection. Failure to submit this
deliverable by the due date will result in a liquidated damages assessment of $50 for each day it is late from the invoice, unless
additional time is granted by the OSCA Grant Administrator
6. Acceptance Package - Copies of the flnal report issued by the Project Manager recommending acceptance of the work by the
Commissioners if necessary and the c ose-out letter issued to the Genera Contractor or other profess onal services provider
It is acknowledged that the funding provided in this Agreement is only part of the funds nec€ssary to complete the project. lt is anticipated
that these funds will be fully expended before the project is completed. lf all funds are expended prior to the end of the term of this
Agreement, the Recipient's monthly reporting requirements, and associated financial consequences, will cease once it has submitted all
deliverables and reports to the OSCA Grant Administrator following the final invoice. Should additional tunds be appropriated, this
Agreement will be amended to include those funds and further amend scope, deliverables, and other provisions
SECTION D - CORRECTIVE ACTION PLAN (CAP)
1. Should the OSCA identify any deficiency based on Contract requirements, which the OSCA, in its sole discretion, deems to be of
significant magnitude, the OSCA may notify the Recipient of the deficiency and of the need to submit a CAP.
2. Uponsuch notification, the Recipientshall submrtaformal written CAP within ten ('10) business days ofthe date ofthe letter from the
OSCA requiring submission of a CAP TheCAPshall be sent to the OSCA'S Grant Manager for review and approval
3. TheOSCAshall notity the Reciprent in writing ofthe acceptance or unacceptability ofthe CAPwrthin ten ('10) business days of receipt
oftheCAP lf theCAP s unacceptable, the OSCA shall provrde a written statement identifying in reason able detail astowhytheOSCA
8
Page 4680 of 5261
Agreement Number
believes the CAP will not result in correction of the cited deflciencies. The Recipient shall have ten ('10) business days from receipt of
the reiection letter to submit a revised CAP or letter of explanation
4. Upon acc€ptance of the CAP. the Recipient shall have atthe discretion of theOSCA, uptosixty(60) calendar days to implement and
successfully complete the agreed upon CAP. Acceptance of the CAP by the OSCA does not guarantee the implementation will result
r" eIn rrat,on of ruture def'crencres
5. TheCAPwill reman n effect until all deficiencies are corrected. updates on the status ofthe CAP will be required as determined by
the OSCA'S Grant Manager.
6. The Recapient's failure to respond to a request for a CAP or failure to implemeot and successfully complete the CAP may result in
termination of the Contract, pursuant to the termination provisions set forth in this Contract. The OSCA reserves the right to exercise
other remedies as permitted by law
Section E - Proqram Administration and Oversiqht
1. Grant Fund Manaqement
'1.1. All funds provided under this Agreement will be accounted for at all times.
1.2. Funds mustbe deposited into an accountata financial institution designated as a "Qualified Public Depository pursuantto
Chapter '136 and section 280.03(1Xb), Florida Statutes.
1.3. lnterest earned on advanced amounts will be treated as "program income" to be used only for program activities authorized bythis
Agreement.
'1.4. No handling or service charges shall be deducted from the advance amounts in the depository. Handling and service charges must
be paid by the Recipient pursuant to section 2'19.05, Florida Statutes.
1.5. Any advanced amounts not necessary for expenses incurred prior to June 30,2028, still in the possession ofthe Recipientmustbe
returned to the OSCA by September 30, 2028, for return to the Legislature's General Revenue Fund pursuant to Section I
ParagraphloftheAgreement.unlessotherwisespecifiedbytheOSCA. lf this Agreement is renewed or extended, the above
dates will be extended to match the new ending date of the Agreement.
'1.6. Maintain a separate cash book detailing all receipts and disbursements offunds advanced to the Recipient under this Agreement
pursuant to section 219.04, Flonda Statutes.
1.7. Reconcile all accounts according to Generally Acceptable Government Accounting Standards (GAAS) on adaily basis and retain
documentation of each reconciliation as required by section 219.04 Florida Statutes.
1.8. Ensure that all fund disbursements are made in accordance with applicable state grant laws and rules and retain documentation
suPPonrng all disbursements
'1.9. Expenses reimbursed from any other source are not elrgible for reimbursement under this Agreement
1.10. Administrative and indirect costs are not reimbursable under this Agreement.
1.11. Funds must be used in accordance with Collier County purchasing policies and rules.
2. Reclpient ReimburEement and lnvoicino
2.1. Funds are made available by the Florida Legislature to the OSCA in quarterly increments. lfthis Recipient has an identified need
for an advance of funds, a request may be made to the OSCA. Advances, up to 25ok, may be made for fiscally restrained counties
and when otherwise iustified. Prior to granting an advance, the OSCA must receive the necessary approval of the Department of
Financial Services OtheMise fundswill be paid tothe Recipient upon submission ofan invoice and proof of completion ofeach
task/phase. Funds are considered earned upon successful completion of each task/phase
2,2, Grant funds may only be used to provide the services identified in Attachment A to this Agreement.
2.3. lnvoices with all supporting documentation sufficient to perform a pre-audit and post audit must be submitted according to the
prolect schedule for the expenditures incurred durlng the prior month. lnvoices must includei
2.3.1. The reports identified in Section C ofthis attachment.
2.3.2, Details showing the quantity, unit cost and extended costs of the items or services purchased and proof of payment
2.3.3. A certification statement that the "Expenses being submitted for reimbursement are true and accurate expenditures incurred
while providing the services required under our Agreement. All services were provided in accordance with the terms and
conditions of the Agreemant and have not been and will not be reimbursed by any other source."
PART 3 - SUPPORTING INFORMATION
Section A - Dual/Multiple Funding Source Billing
No expense submitted for reirnbursement under this Agreement may also be submitted to any other funding source for reimbursement. The
OSCA reserves the right to verify thatthis practice is not being used bythe Recipient Dual or multiple billings will result in the expense being
drsallowed and the Recipient will be required to return any disallowed expenses Failure to repay the disallowed amountswill resultrnthe
I
Page 4681 of 5261
Agreement Number
OSCA filing a claim with the Department of Financial Services for an offuet of any future amounts disbursed to the Recipient, regardless of
the source
Section B - Pooled Funding
lf the Recipient receives funding for any services identified in this Agreement from multiple sources and intends to pool all funds to pay for
the delivery of services, in addition to the requirements identified n Part2, Section D, the Recipient m ust a lso subm it an expense allocation
plan that proportionally allocates the total cost of the service across all funding providers, based on the percentage of the funds provided by
each funding source.
SectionC-StateFunds
The funds for this Agreement are from an award of state funds provided by the Florida Legislature. A CSFA number for this Agreement will
be assigned and provided to the Recipient. Project Manager and Project Monitor.
UNTENTION ALLY LEFT BLANN
l0
CAO
Page 4682 of 5261
Agreement Number
ATTACHMENT B - AGREEMENT BUDGET-
Budget Summary
Funds Available Funds Expended Funds Balance
2025t2026 - 2027-
2028
Renovations/Expansion
$'1,000 000.00 $0.00 $1,000,000.00
Total $1,000,000.00 $0 00 s'1 000.000 00
Funds were appropriated in the fixed capital outlay category.
Detail of specific projects, task and work to be completed along with corresponding set-aside of the total Budget and
expenditures to date.
ProjecVTask Total Estimated Cost Expenditures to Date
Monthly Expenditures (to be updated and expanded as needed)
-The Budget will be updated
monthly and will become part of
this Agreement without the need
for a formal amendment. The
Recipient may modify the form
and format of the Budget to best
reflect the project and work to be
completed, with prior approval of
the OSCA. The initial Budget and
subsequent updates require
approval of both the County
Commission Chair and Chief
J udge
Per od Monthly Expense Amount Total Expenditures
Januaty 2026
February 2026
March 2026
April 2026
May 2026
June 2026
July 2025
August 2025
September 2025
October 2025
November 2025
December 2025
ll
State Fiscal Year
Page 4683 of 5261
(1)
Agreement Number
Attachment C
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR RECIPIENTS, GRANTS, LOANS, AND COOPERATIVE AGREEMENTS
The undersigned cedifies, to the best of his or her knowledge and belief, that:
No appropriated funds have been paid or wil! be paid, by or on behalf ol the undersigned, to any person for
influencing or attempting to influence an officer or an employee of any agency, a member of the Florida Legislature,
an officer or employee of the Legislature, or an employee of a member of the Legislature in connection with the
awarding of the any funds for this Agreement.
lf any funds other than the appropriated funds have been paid or will be paid to any person for influencing or
attempting to influence an officer or employee of any agency, a member of the Florida Legislature, an officer or
employee of the Legislature, or an employee of a member of the Legislature in connection with this Agreement,
the undersigned shall enter the name of the Lobbying Registrant(s) in the space provided below.
The undersigned shall require that the language of this certification be included in the award documents for all
subawards at all tiers (including subcontractors, subgrants. and Recipients under grants, loans, and cooperalive
agreements) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was
made or entered into Submission of this certification is a prerequisite for making or entering into this transaction
imposed by section 1352, Title 31 U.S. Code. Any person who fails to file the required certification shall be
subject to a civil penalty of not less than $10,000 and not more than
$100,000 for each such failure.
By Date
(2)
(3)
Name of Authorized lnd ivid ual
ll
Name and Address of Lobbvinq Reqistrant(s)
CAO
Page 4684 of 5261
Ag reement Number
COMPLIANCE MONITORING AND AUDITING
ln addition to reviews of audits conducted, monitoring procedures may include, but not be limited to, on-site visits by OSCA
staff, limited scope compliance, financial or performance audits, and/or other monitoring methods. By entering into this
Agreement, the Recipient agrees to comply and cooperate with any monitoring procedures/processes deemed appropriate by
OSCA. ln the event OSCA determines that a limited scope audit of the Recipient is appropriate, the Recipient agrees to
comply with any additional instructions provided by OSCA staff to the Recipient regarding such audit. The Recipient further
agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the OSCA, the
Supreme Court lnspector General. the Chief Financial Officer (CFO) or the Auditor General.
AUDITS
PART I: STATE FUNOED AGREEMENTS
ln the event that the Recipient expends a total amount of state funds equal to or in excess of $1,000,000.00 in any fiscal
year of such Recipient, the OSCA requires the Recipient to have a State single or projeclspecific audit for such fiscal year
in accordance with section 215.97, Florida Statutes; applicable rules of the Department of Financial Services, and chapters
1 0.550 (local governmental entities) or 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General.
Attachment A, Part 3, Section D and Attachment E, Exhibit 1 to this Agreement indicates state funds awarded by the
Florida Legislature through OSCA by this Agreement. ln determining the state funds expended in its fiscal year, the
Recipient shall consider all sources of state funds, including state funds received from OSCA, other state agencies, and
other non-state entities. State funds do not include federal direct or pass{hrough awards and resources received by a non-
state entity for federal program matching requirements
2. ln connection with the audit requirements addressed in Part l, paragraph '1, the Recipient shall ensure that the audit
complies with the requirements of section 215.97(8), Florida Statutes. This includes submission of a financial reporting
package as specified in section 215.97(2), Florida Statutes, and chapters 10.550 (local governmental entities) or 10.650
(nonprofit and for-profit organizations), Rules of the Auditor General.
3. lf the Recipient expends less than $1,000,000.00 in state funds in its fiscal year, an audit conducted in accordance with the
provisions of section 215.97, Florida Statutes, is not required. ln the event that the Recipient expends less than
$1,000,000.00 in state funds in its fiscal year and elects to have an audit conducted in accordance with the provisions of
section 215 97, Florida Statutes. the cost of the audit must be paid from the non-state entity's resources (i e.. the cost of
such an audit must be paid from the Recipient's resources obtained from other than State entities).
PART ll: REPORT SUBMISSION
Copies of financial reporting packages required by PART I of this Agreement shall be submitted by or on behalf of the
Recipient directly to each of the following:
The OSCA at the following address:
Office of the State Courts Administrator
General Services Unit
Supreme Court Building
500 S. Duval Street
Tallahassee, Florida 32399-1900
l-j
Attachment D
The administration of resources awarded by the Florida Legislature, administered by the Office of the State Courts
Administrator, to the Recipient will be subject to audits and/or monitoring by OSCA, as described in this section Although the
OSCA is not a state awarding agency under the Florida Single Audit Act (Act), the state funds awarded under this Contract will
be treated as state financial assistance subject to the provisions of the Act as outlined herein.
MONITORING
cpCI
Page 4685 of 5261
Agreement Number
The Auditor General's Oftice at the following address
Auditor General's Office
Room 401 , Pepper Building
1 11 West Madison Street
Tallahassee. Florida 32399-1450
PART V: RECORD RETENTION
The Recipient shall retain sufficient records demonstrating its compliance with the terms of this Agreement for a period of five
(5) years from the date the audit report is issued, and shall allow OSCA, the Supreme Court lnspector General, CFO, Auditor
General, or a duly authorized designee access to such records upon request. The Recipient shall ensure that audit working
papers are made available to OSCA, the Supreme Court lnspector General, CFO, Auditor General, or a duly authorized
designee upon request for a period of five (5) years frorn the date the audit report is issued, unless extended in writing by
OSCA,
B
t:
l{
Page 4686 of 5261
Agreement Number
|,-'amtheoWnerorauthorizedrepresentatiVeofthebusineSSentityShownbe|ow.
I hereby acknowledge on behalf of my business or business entity that I am aware of the requirement in sections 448.09 and
448.095, Florida Statutes, that every public employer. contractor, and subcontractor shall register with and use the E-Verify
system to verify the work authorization status of all newly hired employees.
Business or Business Entity Legal Address
Business or Business Entity Taxpayer ldentafication
Number:
I hereby certify that my business
ls not engaged as an "employer" who hires individuals as an "employee" to perform labor or services in exchange
for a salary, wages or other renumeration requiring the completion and submission of the U.S. Citizenship and
lmmigration Services Form l-9, "Employment Eligibility Verification", does not pay employee salaries or wages,
does not collect federal withholding taxes from any salaries or wages and submit them to the lnternal Revenue
Service, has no power to dictate or control an individual's work duties and obligations, and does not supervise
emplovees ol subcgnt?ctors.
ls organized outside the United States and its territories and does not have any physical locations within the United
States, and is not considered an "employer", as described in the paragraph above.
Does not have more than five (5) employees at any given time and does not hire more than five (5) employees in
a calendar year.
For the reasons stated above, my business or business entity is not eligible to register with and cannot use the Department
of Homeland Security E-Verify System.
By signing this certification, lagree not to hire employees who are not authorized to be employed in the United States pursuant
to8U.S.C. s. 1324a(h)(3) at the time of employment or at any time throughout the term of the employment. I fu rther acknowledge
that I will notify the Contract Manager within ten (10) calendar days of any change in the business entity status as an employer
or if any employees are hired. I further acknowledge that the failure to make the appropriate notifications will result in the
immediate termination of my contract.
I HEREBY CERTIFY THAT THE FOREGOING IS TRUE AND CORRECT
Sole Proprietor/Authorized Representative
Printed Name
I -,.
Attachment E
CONTRACTOR'S E.VERIFY REGISTRATION CERTIFICATION
Business or Business Entity Legal Name:
Page 4687 of 5261
Agreement Number
FLORIDA STATE COURTS SYSTEM
SUBCONTRACTOR'S E-VERIFY REGISTRATION AFFIDAVIT
l, _, am the owner or authorized representative of the business entity shown below.
I hereby acknowledge on behalf of my business or business entity that I am aware of the requirement in section 448.095(2)(a),
Florida Statutes, that every private employer with more than 25 employees and every public employer, contractor, and
subcontractor must be registered with and use the Department of Homeland Security's (DHS) E-Verify system to verify the work
authorization status of all newly hired employees.
Business or Business Entity Legal Name
Business or Business Entity Taxpayer ldentification
Number (TlN):
I hereby certify that my business or business entity
By signing this affidavit, I agree to maintain an active E-Verify registration and that I will notify the Contract lvlanager within ten
(10) calendar days of any change ln business entity status as an employer. I further acknowledge that the failure to comply with
section 448.095, Florida Statutes, can result in fines of $1,000 per day, prohibition of my business from entering into any
contracts with any government entity in the State of Florida for a period of 1-year, suspension or revocation of any business or
professional license issued to my business by any agency of the State of Florida and the immediate termination of my contract.
Will certify compliance on the first unemployment tax return submitted to the Department of Commerce, as required by section
448.095(3), Florida Statues.
I HEREBY AFFIRI\iI AND VERIFY THAT THE FOREGOING IS TRUE AND CORRECT
Sole Proprietor/Authorized Representative
ls registered with the DHS E-Verify system (https://www.e-verify.gov/) to verify the employment eligibility of each
new employee hired within three (3) business days after the employee begins working for pay, as required by 8
C.F.R s. 274a for contract\agreement eligibility purposes.
Does not have more than five (5) employees at any given time and does not hire more than five (5) employees in a
calendar year and is not eligible to register to use the OHS E-Verify system.
Ooes not hire and agrees not to hire employees who are not authorized to be employed in the United States pursuant
to 8 U.S.C. s. 1324a(h)(3).
Printed Name
l6
Attachment F
Business or Business Entity Legal Address:
Page 4688 of 5261
Agreement Number
STATE OF
COUNTY OF
Sworn to (or Affirmed) and Subscribed Before l\4e By
l\4eans of tr Physacal Presence or C Online Notarization
th is day ot _,202_,
by Who
tr ls Personally Known to Me or tr Produced ldentification
Type of ldentification Produced
Signature of Notary Public
Printed Name of Notary Public Administering Oath Pursuant to 51 17.'10, Florida Statutes
t7
Page 4689 of 5261
Agreement Number
l.,amanofficerorauthorizedrepreSentatiVeofthebuSinessentityshown
below. I hereby acknowledge on behalf of my business or business entity that I am aware that governmental entities of the
State of Florida are prohibited from entering into, amending, extending, and renewing certain contracts and agreements with
foreign countries of concern, pursuant to section 287.138, Florida Statutes, business entities that engage in forced labor and
human trafficking practices, pursuant to sections 287. '1 346, and 786.06( 1 3), Florida Statutes.
Business or Business Entity Legal
Name:
Business or Business Entity Legal Address
Business or Business Entity Taxpayer
ldentification Number:
. My business entity is not owned by a foreign country of concern, as defined by section 287.138, Florida
Statutes.
. No foreign country of concern has a controlling inlerest in my business entity, as defined by section
287. 1 38, Florida Statutes.
r My business entity is not organized under the laws of or has its principal place of business in a foreign
country of concern as defined by section 287.138, Florida Statutes.
. My business entity does not engage in forced labor practices, as defined by section 287.1346, Flo.ida
Statutes.
. My business entity does not engage in human trafficking, as defined by section 787.06, Florida Statutes.
o My business entity does not employ or engage any person who performs any of the activities in section
787.30, Florida Statutes.
I have been advised that, in addition to criminal penalties for perjury for providing false information on this affidavit, my failure
to comply with the requrrements of sections 287 1346 and 287 138, and chapter 787. Florida Statutes, may result in civil and
criminal penalties, prohibitions against doing business with any governmental entity of the State of Florida the suspension or
revocation of all business or professional licenses and certifications issued by the State of Florida.
CAO
iti
Attachment G
CONTRACTOR'S STATUTORY COMPLIANCE AFFIDAVIT
I hereby certify under penalty of perjury that:
Page 4690 of 5261
Agreement Number
By signing this affidavit, I agree that I will notify the Contract lvlanager within ten (10) calendar
days of any change in my business entity status that would make any statement made on this
affidavit untrue and within thirty (30) calendar days of gaining direct knowledge that any
subcontractor or vendor is in violation of any of the requirements of sections 287.1346 and787,
Florida Statutes. I further acknowledge that the failure to make the appropriate notification will
result in the immediate termination of my contract.
I HEREBY AFFIRIV AND VERIFY THAT THE FOREGOING IS TRUE AND CORRECT
Sole Proprietor/Authorized Representative
Printed Name
STATE OF
Sworn to (or Affirmed) and Subscribed
Before N4e By Means of ! Physical
Presence or D Online Nolarization this day ol _,202_,by , Who
E ls Personally Known to Me or tr Produced
ldentification. Type of ldentification Produced:
Signature of Notary Public
Printed Name of Notary Public Administering Oath Pursuant to S117.03, Florida Statutes
t9
CAO
COUNTY OF
Page 4691 of 5261