Backup Documents 01/27/2026 Item #16F 2 16F2
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s)(List in routing order) Office Initials Date
1. County Attorney Office CAO NA 1l6
2. Board of County Commissioners Office BOCC
_N Lit 10,1
3. Minutes and Records Clerk of Court's Office
2,4 260
4. Send via email to:
Joshua.Thomas@collier.gov
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees
above,may need to contact staff for additional or missing information.
Name of Primary Staff Joshua Thomas,Grants Coordinator I
2885 S. Horseshoe Dr 252-6048
Contact/ Department
Agenda Date Item was January 27, 2�26 Agenda Item Number 16.F2
Approved by the BCC ry
Type of Document Number of Original
Attached Florida State Court Systems Grant Agreement Documents Attached 1
PO number or account
number if document is N/A
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
I. Does the document require the chairman's original signature STAMP NOT OK JT
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be J.I.
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the I.l.
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's JT
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip
should be provided to the County Attorney Office at the time the item is input into SIRE. JT
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 01/27/26 and all changes made during
the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable. V ++JJ
9. Initials of attorney verifying that the attached document is the version approved by the /�
BCC,all changes directed by the BCC have been made,and the document is ready for the Cam*'
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
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Agreement Number
FLORIDA STATE COURTS SYSTEM
OFFICE OF THE STATE COURTS ADMINISTRATOR
. THIS AGREEMENT is entered into between the State Court System of Florida. Office of the State Courts 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 Document
1 Tc provide commodities and services indicated on Attachment A in accordance with the terms and condleons
specified in this Agreement
2 That the Agreement document consists of all attached documents identified in Section 111(1)
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. Invoicing and Travel
That funds provided in this Agreement may not be used for travel expenses of Recipient or Recipient's staff Invoices and aui
necessary supporting documentation 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
D. Records and Retention
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 Rules 2 430 and 2 440.
Florida Rules of Genera!Practice and Judicial Administration.
2. To retain. at no additional cost to the OSCA, all records, software and service records, financial records. supporting
documents,statistical records, and any other documents(including electronic storage media)pertinent to this Agreement
for a period of ten(10)years after completion of the Agreement,or if an audit has been initiated and audit findings have
not been resolved at the end of ten (10)years. the records and documents shalt be retained until resolution of the audit.
findings or any litigation which may be based on tee terms of this Agreement If 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 approval of the OSCA Grant Manager
3 Upon demand and at no additional cost to tee OSCA,the Recipient will facilitate the duplication and transfer of any recorcs
Or documents during the required retention period.
E. Public Records,Audits,Inspections, Investigations 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, Florida Statutes and the DFS Reference Guide to State
Expenditures made or received by the Recipient in conjunction with this Agreement except that public records which are
made confidential by law must be protected from disclosure It 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
terminate the Agreement
2 To assure that these records shall be subject at ail reasonable times to inspection, review, copying. or audit by Federal,
State, or other personnel duly authorized by OSCA
3 To permit persons duly authorized by the OSCA to inspect and copy any records, papers documents, facilities. goods
and services of the Recipient which are relevant to this Agreement: and to interview any clients, empioyees and sub-
recipient employees of the Recipient to assure OSCA of the satisfactory performance of the terms and conditions of this
Agreement Following such review. OSCA will deliver to the Recipient a written 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 Inspector 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
assignments
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6. To provide a financial and compliance audit to OSCA as specified in Attachment 0, Part 1 and to ensure that all related
party transactions are disclosed to the auditor
F. Indemnification
Pursuant to section 768 28(19). Florida Statutes neither the Recipient nor the OSCA waive sovereign immunity nor dc the
parties agree to indemnify each other for the other party s negligence
G. Insurance
To provide continuous adequate liability insurance coverage during the existence of this Agreement and any renewal(s) and
extension(s)
H. Assignments and Subcontracts
I. 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 sha0 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 its rights duties or obligations under this Agreement to
another governmental entity in the State of Florida upon giving prior written notice to the Recipient
I. 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 In 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. In the event that OSCA first discovers an overpayment has been made, the Grant Manager 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 lawful rate of interest on the outstanding balance after the
OSCA notification or Recipient discovery
J. Compliance with Statutes, Laws, Regulations,and Rules
1. That the Recipient shall without exception. be aware of and comply with all State and Federal 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 compliance agreement involving the OSCA which by its nature affects this Agreement
2 That the Recipient will comply with the Americans with Disablities Act,the Civil Rights Act of 1964,as amended, the Fonda
Civil Rights Act of 1992, and any other federal or state iaw 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 Recipient The OSCA shalt consider the employment of unauthorized
aliens a violation of section 274A of the Immigration and Nationality Act(8 U S C 1324 a) Such violation shall be cause for
unilateral cancellation of this Agreement Dy OSCA.
Pursuant to sections 448 09 and 448 095 Florida Statutes, the Recipient,and all subcontractors or subrecipients must.
1 Be in full compliance with sections 488 09 and 488 095: Florida Statutes, regarding the use of the Department of
Homeland Security's (OHS) E-Verify System (http .I/www e-verify govi) to verify the employment eligibility of each new
employee hired as required by 8 C F R s 274a The Recipient shall also include the requirement from this paragraph in
all subcontracts.
2 If the Recipient is unable to register to utilize DHS's E-Verify system because they are a sole proprietor or business entity
with no employees,the Recipient must complete a registration waiver certification(Attachment E)certifying the reason for
non-registration,which must be submitted for approval along with the required signed Agreement documents
3. Confirm that all subcontractors/subrecipients with twenty-five(25)or more employees were registered with and have been
utilizing the E-Verify system to verify the employment eligibility of all new employees hired by the
subcontractorisubrecipient since July 1,2023, as described in number 1 above. Subcontractors/subreciplents who were
non-compliant with the statutory requirement for at least the six(6)months period prior to be anticipategg,ffective date of
the subcontract are not eliaCle toaarovide services under this Agreement.
4. Prior to allowing any subcontractorisubrecipient to provide any services contemplated under this Agreement,the Recipient
shall provide the OSCA's Grant Manager a completed Subcontractor E-Verify Affidavit (Attachment Fi and proof of
registration to use the E-Verify system, if applicable.
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5. Violation of the provisions in this section by the Recipient or a subcontractorlsubrecipient may result in the penal(es
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. Pursuant to section 448.095(5)(c)(3),Florida Statutes.the Recipient is liable for any additional costs incurred 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 Pursuant to section 287.138. Florida Statutes, governmental entities of the State of Florida are prohibited from entering
into contracts or agreements with entities owned by a foreign country of concern, as defined in section 287 138(1)(c),
Florida Statutes:where a foreign country of concern possesses a controlling interest in the entity:or with entities organized
under the laws of. or with its principal place of business 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 transacting
business with entities that engage in forced labor as defined by section 287.1346, Florida Statues, or human trafficking,
as defined in section 787.06, Florida Statutes.
N, Sponsorship
That if the Recipient is a non-governmental organization which sponsors a program financed wholly or in part by state funds:
ncluding any funds obtained through this Agreement. it shall, 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' If the
sponsorship reference is in written material:the words"Florida Legislature and Florida State Court System"shalt appear in the
same size letters or type as the name of the organization Such sponsorship is subject to the prior written approval of the
OSCA Grant Manager.
0, Publicity
That without limitation. the Recipient and its employees; agents,and representatives will not. without prior written consent in
each instance use the State of Florida's. the State Court Systems, 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 not expend and of the funds provided under this Agreement for the purpose of lobbying the Legislature,judicial branch,or
a state agency
Q. Final Reimbursement 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 If the Recipient fails to do so.
all rights 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
it. 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 subject to the availability of funds Any costs or services paid for under any other Agreement
or from any other source are not eligible for payment under this Agreement.
B. Payment
Pursuant to section 215 422.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 inspection,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 Department of Financial Services The duties of this office
are found in section 215.422(7), 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) 413-7269 is availab'ie for
payment history and pending payment information.
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III. THE RECIPIENT AND OSCA MUTUALLY AGREE:
A. Effective and Ending Dates
That this Agreement shall begin on the date on which the Agreement has been signed by the last party reovred to sign it It
shall end at midnight. Eastern Time. on June 30, 2028 The State of Florida's performance and obiigation to pay under this
Agreement is contingent upon an annual appropriation 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 perod that may not exceed three i3)years or the term of the original Agreement,whichever period
longer. The renewal may be divided into increments, may be for a complete term, or any combination thereof The renewal
must be in writing and signed by both parties, and is contingent upon satisfactory performance and subject 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
writing to the other party unless a snorter time is rnutu&Iy agreed upon in writing
2 In the event funds for payment pursuant to this Agreement become unavailable,the OSCA may terminate this Agreement
upon no less than a twenty-four (24) hour notice in writing to the Recipient. The OSCA shall be the final authority as to
the availability and adequacy of funds
3 In 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 Recipient, excluding Saturday Sunday.
and Holidays Such notice may be issued without providing an opportunity 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 permitted by
law or regulation Otherwise, notice of terminator MI be issued after the Recipients failure to fully cure such
noncompliance within Me time specified in the written,notice of noncompliance issued by the OSCA specifying the nature
of the noncompliance and the actions required to cure such noncompliance. Tne OSCA's failure to demand performance
of any provision of this Agreement shall, not he 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 the terms and conditions of this Agreement. The provisions herein do not omit the
OSCA's right to remedies at law or inequity
4 The 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 provision. the Recipient must have:
4 1 Committed a violation of or non-compliance with Chapter 435, Florida Statutes.
4 2 Committed a violation of or non-compliance with section 448 09, Florida Statutes
4 3 Committed a violation of or non-compliance with section 448 095, Florida Statutes
4 4 Been declared a business entity ineligible to contract with the State of Florida pursuant to Section 287 138, Florida
Statutes
4 5 Been declared a Convicted Vendor pursuant to Section 287 133, Florida Statutes
4.6 Been declared a Suspended Vendor pursuant to Section 287 1351. Florida Statues.
4 '7 Engage in forced labor practices as defined by Section 287 1346. Florida Statutes
4 8 Engage in human trafficking practices as defined by Section 787.06. Florida Statutes.
4.9 Previously failed to satisfactorily perform in a contract or agreement with any division of the State Courts System,
been notified of the unsatisfactory performance,and failed to timely correct the unsatisfactory performance,or
4,10 Had a contract or agreement terminated for cause by any division of the State Courts System.
5 In the event of termination under sections C(1) or Ct2). the Recipient will be compensated for any work satisfactorily
completed through the date of termination or an earlier date of suspension of work
6 That written notice of termination shall be delivered by U.S Postai 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. Renegotiations or Modifications
1 'That with the exception of modifying the Budget in Attachment B, modifications of all other provisions 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 dollar amount may 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 subsecuently identified
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 revisions of any applicable state laws, or regulations
that make changes in this Agreement necessary
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E. Third-Party Beneficiaries
The terms and conditions of this Agreement are intended to be solely for the benefit of the Parties and their respective
successors or permitted assigns.and ills not the intention of tne Parties for the Parties to confer third-party beneficiary rights.
interest or claims to another party
F. Execution in Counterparts
This Agreement may be executed in counterparts each of which will be an original and all of which we constitute but one and
the same;nstrument,A signed copy of the Agreement or counterpart transmitted via facsimile,email or other electronic means
will be deemed to nave the same legal effect as delivery of an original executed copy
G. Notice
That any notice, that is required under this Agreement shall be in writing and sent by U S Postal Service or any expedited
delivery service that provides verification 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 ;n 111.11 3
and by the Recipient to OSCA's Grant Manager indicated in III H 4.
H. Official Payee and Representatives(Names,Addresses,and Telephone Numbers):
1 The Recipient name as shown on page 1 of this Agreement, and mailing address of the official payee to whom the
payment snail be made]s
Collier County Board of County Commissioners
3299 Tarniami Trail East. Suite 700
Naples FL 34112
(239)252-7513
2 The name of the Recipient's contact person and street address where financial and administrative records are maintained
is:
Suzanne Boothby
Office of the Clerk of the Circuit Court
&Comptroller of Collier County
3299 Tarniami Trait East: Suite 403
Naples. FL 34112
239-252-7825
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 Tarniami Trail East Suite 101
Naples FL 34112
(239)252-8239
Tim Rygiel@collier gov
4 The name address, and telephone number of the Grant Manager for OSCA for this Agreement is.
Jessica Mitcheii. General Services Analyst
Office of the State Courts Administrator
500 South Duval Street
Tallahassee FL 32399-1900
(850)488-3738
mitchellk@flcourts gov
5 The name, address, and telephone number of the Project Monitor/Circuit Liaison for this Agreement is:
Ms Kern Hixson
AOC Operations Division Manager—Collier County
Twentieth Judicial Circuit of Florida
3315 Tarniami 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 pal.y, notice
shall be provided in writing to the other party Updates or changes to information in this section do not require a written
contract amendment and may be effective upon receipt of the other party
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I. All Terms and Conditions Included
This Agreement and its attachments,and any exhibits referenced in said attachments,together with any documents
incorporated by reference. contain all the terms and conditions agreed upon by the parties. There are no provisions terms,
conditions, or obligations other than those contained herein, and this Agreement shall supersede all previous
communications,representations,or Agreements,either verbal or written between the parties If any term or provision of this
Agreement is 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(Z):
Applicable attachments: 7' indicates the attachment applies to this Agreement.
Attachment# Attachment Title
Attachment A Scope of Work/Additional Provisions
Attachment B State Fiscal Year Budget Document
® l 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
0 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 111.1.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 THE FLORIDA STATE COURTS SYSTEM
OF COUNTY COMMISSIONERS OFFICE OF THE STATE COURTS ADMINISTRATOR
SIGNED SIGNED
BY: BY:
NAME: Dan Kowal NAME: Eric Maclure
TITLE: Chairman TITLE: State Courts Administrator
DATE: 27/2 DATE:
Vendor# F59 0005 8007
M•
Approved as to form and legality `! �..; `�r
AT i Ex;T. �;,
i1 CR;STA
--•,CLEW:
Assistant County Attorney .• w
Attest rapt beet.& Clerk
{1.. sig4rpOn .._...• 'C;��
G ,(h,4J1
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Agreement Number
Attachment A
Scope of Work
PART 1 -GENERAL INFORMATION
Section A-Background and Purpose
The Florida Legislature,through Chapter 2025-198 Section 7. Line 2976A, Laws of Florida, appropriated funds as grant-in-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, how the
funds rray be spent, sets forth requisite deliverables.performance measures, financial consequences reporting 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 Objective
Tne Recipient, in consultatein with the 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 acreeved to meet this objective are.
1. Engage the appropriate professional services Irv,.(architect, engineer. commercial general contractor)to make any necessary
recommendations and to advise or manage subcontractors.
2. To the extent feasible within existing funding, engage necessary professionals and contractors to
a Complete renovation and expansion of the existing switchgear and automatic transfer switch(ATS)located at the
Courthouse Annex Building.
PART 2-WORK REQUIREMENTS
SECTION A-PROJECT RESOURCES
The following professional services must be used on this project to ensure the objectives of the Agreement are achieved and that the state
funds provided uneer this Agreement are protected from loss:
1. Project Manager A representative of the Recipient with the responsibility and authority to manage the project within the oarameters
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 of all reports and deliverables to the OSCA, approval,of all invoices,submission of draw
requests for funding from the OSCA and tne financial accounting of all project funds The Project Manager will also serve as the liaison
between the Recipient,any vendors/contractors the Twentieth Judicial Circuit, its Project Monitor. and the OSCA
2. Project Monitor(Circuit Representative) A representative of the Twentieth Judicial Circuit with the responsibility and authority to
work with the Project Manager to ensure the needs and interests of the Twentieth Judicial Circuit are met throughout the renovation. The
Project Monitor may assist in the review, inspection and acceptance of the work being performed; must review, prior to submission.all
reports and deliverables to the OSCA. approval of all invoices, submission of draw requests for funding from the OSCA and the financial
accounting of ail project funds The Project Monitor will also serve as a liaison between the Recipient and the OSCA.
SECTION B-PROJECT PHASES
To ensure the security of the state funds provided for this project the following tasks must be successfully completed tc earn the milestone
payment associated with 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 eeth the Attachment
B, the Project Budget
Renovation and expansion of the existing switchgear and automatic transfer switch at the Courthouse Annex Building at the to the Collier
County Government Center.
1. Evaluation and Estimation-Review of the current conditions by a qualified and licensed professional appropriate for the work to be
completed to determine the extent of the issues and the necessary repairs or upgrades needed The Project Manager Project Monitor
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 appropriate professional(s). icensed under the
provisions of the applicable Florida Statutes. to perform the repair or upgrades outlined above and ii Attachment B The contract(s) wan
the vendorts)should include description of the work to be performed(incorporating the design and blueprints, if any by referencei,
project plan, milestones, due dates minimum quality and performance standards. progress payment amounts liquidated damages,
financial consequences for failure to perform or meet minimum standards warranty. and latent damages provisions.
3. Execution 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 estimate and scope of contract(s). Copies of all purchase orders or other procurement
documentation will be maintained and provided in regular reporting to the OSCA
4. Inspection and Acceptance-All necessary inspections will be conducted pursuant to any applicable Florida Statute or other rule as
well as inspection by the Project Manager A"punch-list"of items that fail to meet the acceptance of the Inspector or Recipient and a
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Agreement Number
reasonable schedule for the vendor to correct the deficiencies, Recipient should keep copies of all bills of lading, packing slips or other
similar documentation received or generated and provide copies upon request
SECTION C—DELIVERABLES ANC FINANCIAL CONSEQUENCES
The Recipient will ensure that only the following deliverables are isebrnitted to the OSCA
1. Project Plan-A document outlining items such as the phases: activities, tasks, deliverables.deliverables acceptance plan, resources.
roles and responsibilities, performance measures,monitoring activities, risk assessment and mitigation plan, procurement plan,contract
management plan, stakenolder communication plan, and financial management plan(including the project buoget).At a minimum,the
Recipient will provide a project plan that includes a high-level project schedule that sets the critical path for the proxist The project plan
is due to the OSCA within 45 days of the execution of this Agreement and will be updated arid 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 car 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 Project Manager and Project Monitor without requiring formal approval of the Chief Judge and the Chair of the County
Commission Ensure that the necessary time to complete these reviews and approvals is factored into the Project Schedule
2, Project Schedule—A compreeensive document that outlines the critical path of the project(purchase and installation of switchgear aria
A TS)from start to completion The schedule will include begin and end dates for all phases, subordinate activities and tasks for the
project The schedule must be updated when a change occurs, The project schedule is due to the OSCA within thirty(30)days of the
execution of the separate contract between the Recipient and the awarded contractors for this project and resubmitted with all requests
for reimbursement
3. Monthly Project Report—Tee monthly report will be submitted to the OSCA by the 15th calendar day of each month and will contain
the loliowing'
3.1. An executive narrative of the current status of the project.
3,2. A detail report of the activities and tasks completed dung the prior month.
3.3. A detailed comparison of any changes made to the Project Plan during the prior month
3.4. Update of the project budget, including cost status.expenditure states,obligated funds and fund balances 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 tr'e invoice, unless
additional time is granted by the OSCA Grant Administrator
4. Contract Package-A package containing the signed contract(s)with the General Contractor, Electrician. Architect, Engineer or other
Professional Services provider contracted to perform work associated with this Agreement This deliverable is due within fifteen(15)
calendar days of the last party signing the contract. 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
5. Inspection Package—Copies of all final inspection reports issued by the local building authority showing the approval of the work 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 final report issued by the Project Manager recommending acceptance of the work by the
Commissioners, if necessary. and the close-out letter issued to the General Contractor or other professional services provider
It is acknowledged that the funding provided in this Agreement is only part of the funds necessary to complete the project It is anticipated
that these funds will be fully expended before the project is completed if all funds are expended prior to the end of the term of this
Agreement.the Recipients monthly reporting requirements. and associated financial consequences, will cease once it nas submitted all
deliverables and reports to the OSCA Grant Administrator following the final invoice. Should additional funds be appropriated this
Agreement will be amended to include those funds and further amend scope: deliverables,and other provisions.
SECTION 0—CORRECTIVE ACTION PLAN(CAPI
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. Upon such notification. the Recipient shall submit a formal written CAP within ten (10)business days of the date of the letter from the
OSCA requiring submission of a CAP The CAP snall be sent to the OSCA s Grant Manager for review and approval
3. The OSCA shall notify the Recipient in writing of the acceptance or unacceptability of the CAP within ten(10)business days of receipt
of the CAP If the CAP is unacceptable.the OSCA shall provide a written statement identifying in reasonable detail as to why the OSCA
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Agreement Number ,
believes the CAP will not result in correction of the cited deficiencies The Recipient shall have ten(10)business days from receipt of
the rejection letter to submit a revised CAP or letter of explanation.
4. Upon acceptance of the CAP,the Recipient shall have at the discretion of the OSCA, up to sixty(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
ir,elimination of future deficencies
5. The CAP will remain in effect until al!deficiencies are corrected Updates on the status of the CAP will be required as determined by
the OSCA's Grant Manager
6. The Recipient's failure to respond to a request for a CAP or failure to implement 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—Program Administration and Oversight
1. Grant Fund Management
1.1. Als funds provided under this Agreement wit be accounted for at all times.
1.2. Funds must be deposited into an account at a financial institution designated as a"Qualified Public Depository`pursuant to
Chapter 136 and section 280.03(1)(b), Florida Statutes
1.3. Interest earned on advanced amounts will be treated as 'program income"to be used only for program activities authorized by this
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 219.05, Florida Statutes
1.5. Any advanced amounts not necessary for expenses incurred prior to June 30. 2028. still in the possession of Me Recipient must be
returned to the OSCA by September 30,2028,for return to the Legislature's General Revenue Fund pursuant to Section I
Paragraph I.of the Agreement, unless otherwise specified by the OSCA If 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 of funds advanced to the Recipient under this Agreement
pursuant to section 219.04, Florida Statutes.
1.7. Reconcile all accounts according to Generally Acceptable Government Accounting Standards(GAAS)on a daily 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
supporting all disbursements
1.9. Expenses reimbursed from any other source are not eligible 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. Recipient Reimbursement and Invoicing
2.1. Funds are made available by the Florida Legislature to the OSCA in quarterly increments. If this Recipient has an identified need
for an advance of funds,a request may be made to the OSCA_Advances, up to 25%, may be made for fiscally restrained counties
and when otherwise justified Prior to granting an advance, the OSCA must receive the necessary approval of the Department of
Financial Services. Otherwise,funds will be paid to the Recipient upon submission of an invoice and proof of completion of each
taskiphase.Funds are considered earned upon successful completion of each tasklphase
2.2. Grant funds may only be used to provide the services identified in Attachment A to this Agreement
2.3. Invoices with ail supporting documentation sufficient to perform a pre-audit and post audit must be submitted according to the
project schedule for the expenditures incurred during the prior month. Invoices must include.
2,3.1. The reports identified in Section C of this 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 be rig 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 Agreement and have not been and will not be reimbursed by any other source '
PART 3—SUPPORTING INFORMATION
Section A—DualiMultiple Funding Source Biting
No expense submitted for reimbursement under this Agreement may also be submitted to any other funding source for reimbursement The
OSCA reserves Me right to verify that this practice is not being used by the Recipient. Dual or multiple billings will result in the expense being
disallowed and Me Recipient will be required to return any disallowed expenses Failure to repay the disallowed amounts wit result in the
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Agreement Number
OSCA filing a claim with the Department of Financial Services for an offset of any future amounts disbursed to the Recipient, regardless of
the source
Section B--Pooled Funding
If 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 in Part 2, Section D the Recipient must also submit 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
Section C—State Funds
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.
[INTENTIONALLY LEFT BLANK]
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Agreement Number
ATTACHMENT B-AGREEMENT BUDGET*
Budget Summary
State Fiscal Year Funds Available Funds Expended Funds Balance
51.000.000.00 $MO $1000.00000
2028
i Total Si0UU.000�O0 | $O�OO $1.00O�O00,00 |
�������
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 tndate,
Project/Task Total Estimated Cost Expenditures to Date
/
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| |
|
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MonthlyExpendxums 8obeupdm�d and expanded oe needed)
� ---- T - -- }
| Mon�� Ex�enoeAmound Total Expenditures |
January 2026
February 2026
March 2026
April 2026
^The Budget will beupdated
May 2026
— ..........-_ ........ monthly and wm become part of
June 2026 ' | this Agreement without the need
----' / for e formal amendment. The
July 2025
_ Recipient may modify the form
August 2025
and format n('tie Budget\obest
reflect the pro'
�n�wo� 0nbo
September zouu completed: with prior approval mf
/ October 2025 i | | the OSCA. The initial Budget and
' - xubooquentupdates require
November |
2025 . approval of both the County
-- | Commission Chair and Chief
December 2025
-- ` Judge.
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Agreement Number,,,,
Attachment
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR RECIPIENTS,GRANTS, LOANS,AND COOPERATIVE AGREEMENTS
Theundersignud omrtif|es to the best nf his or her knowledge and belief, that,
(1) No appropriated funds have been paid or will be pmid, by or on behalf of the underuiQnod, to any person for
mMuencmg or attempting to influence an off icoror an emp|nyee of any agency,o member o/the Florida Leg|n|eoue
an officer or employee of the Leg|u|a\ono, or an employee of member of the Legislature in connection with the
awarding of the any funds for this Agreement.
(2) If any funds other than the appropriated *undo have been paid or will be paid to any person for m0uenci*g or
attempting to influence on officer or employee of any aQency, a member of the Florida Leg|u|atu,e, on officer or
employee of the Legislature. or an employee ofo member ofthe Legislature in connection with this Agreement.
the undersigned shall enter the name of the Lobbying Registrant(s) in the space provided below,
<3) The undersigned uhaH require that the language of this certification be included in the award documents for all
aubewardoat all tiers (including subcontractors, nuhQnants, and Recipients under grants. ioens, arid cooperative
agreements)and that all nubrecip|ento shall certify and disclose accordingly,
This certification is a material representation of fact upon which reliance was placed when this transaction was
made o/entered into Submission of this certification is a prerequisite for making or entering into this transaction
imposed bysection 1352. Title 31. US. Code.Any person who fails to file the required certification shaUbp
subject toa civil penalty of not less than$1O.DOOand not more than
S1O0000 for each such failure.
Name and_Address ofLobbvinq ReqiutranVx>
By: Doha:
Name of Authorized |ndmidua|�
|�
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Agreement Number
Attachment ]
COMPLIANCE MONITORING AND AUDITING
The odmm'e/rauon olro»ourcos awarded by the Florida Lagim|ature, 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 nLa4o awarding agency under the Florida Single Audit Act (\ct), the state funds awarded under this Contract will
be treated as state financial assistance subject\o the provisions o(the Act axoutlined herein
MONITORING
In addition to reviews p/audits conducted, monitoring procedures may|no|ude, but not be limited to, on-site visits by OSCA
e1mf[ limited scope compliance, financial or performance mudito, 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. |n the event OSCA determines that a limited scope audit ufthe Recipient ioappropriate. the Recipient agrees to
comply with any additional instructions provided by OSCA staff to the Recipient regarding such audit. The Reoip/en(further
agrees tocomp/y and cooperate with any manod|onm. remewa, investigations, or audits deemed necessary oy the OSCA. the
Supreme Court Inspector General the Chief Financial Officer(CFO)or the Auditor General.
AUDITS
PART |: STATE FUNDED AGREEMENTS
1 In the event that the Recipient expends atota|amount of state funds equal to or in excess of$1,0OU.0UOOO in any fiaca|
year of such Recipient, the OSCA requires the Recipient to have a State single or project-specific audit for such fiaoa|year
in accordance with section 215.87. Florida Statutes. applicable rules of the Department of Financial Services and chapters
10,550(local governmental entities) or 10.650(nonprofit and for-profit organizations), Rules of the AuduorGeneral.
Attachment A. Part 3. Section Dand Attachment E. Exhibit 1 Ua this Agreement indicates state funds awarded by the
Florida Legislature through OSCA by this Agreement. In determining the state funds expended in its fiscal year, the
Rooip/e:t 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 orpaoo'thmugh awards and resources received by a non-
state entity for federal program matching requirements.
2 |n connection with the audit requirements addressed in Part | paragraph 1. the Recipient shall ensure that 'he audif
complies with the requirements of section 215.87(8) Florida Statutes. This includes submission cda financial reporting
package msspecified m section 21597(2) Florida Statutes, and chapters 1O55U(local governmental entities) o,1O.650
(nonprofit and for-profit organbationo)' Rules of the Auditor General.
l If the Recipient expends |asm than$1.000.000.00 in state funds in its fiscal year, an audit conducted in accordance with the
provisions nfsection 215.97. Florida Statutes, is not required. |n the event that the Recipient expends |enm than
$1800,000,00 in state funds in its fiscal year and elects to have an audit conducted in accordance with the pmv|mionm of
section 216Q7. Florida Statutes. the cost o/the audit must be paid from the non-state entity's resources (ie the cost of
Such ar. audit must be paid from the Recipient's resources obtained from other than State entities).
PART ||: REPORT SUBMISSION
1 Copies of financial reporting packages required by PART| of this Agreement aheU be submitted by or an hebsK of the
Recipient directly to each of the following:
A The OSCA ot the following mddnamm:
Office o(the State Courts Administrator
General Services Unit
Supreme Court 8ui|dinQ
5OOS Duval Street
Tallahassee, Florida 3230A'1AU0
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Agreement Number
B The Auditor General's Office at the following address:
Auditor Generals Office
Room 4O1. Pepper Building
111 Wno( Madison Street
Ta||ahaooem, Florida 323S9'1450
PART V: RECORD RETENTION
The Recipient shall retain sufficient records demonstrating 4s compliance with the terms of this Agreement for a period of five
(15) years from the do1e the audit napm1 is /noued, and ehu|| a!|m*OSCA. the Supreme Court|uopectorGenora|r CFO. Auditor
8enora| or duly authorized doai.nee uocemo to such records upon request. The Recipient xhoshallensure that audit working
�
papers are made available toOSCA. the Supreme Court Inspector General, CFO Auditor General. or duly authorized
designee upon request for a period of five(5)years from the date the audit report is issued, unless extended in writing by
O8CA,
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Agreement Number
Attachment
CONTRACTOR'S E'VERIF7 REGISTRATION CERTIFICATION
| .om the owner o/authorized representative o|the business entity shown below,
| hereby acknowledge on behalf of my business or business entity that | am ewena of the requirement in sections 44809 and
448095. Florida Statutes. that every public employer. uunkac(nr, and oubonndnactor shall register with and use the E'Vehfy
system to verify the work authorization status of all newly hired employees
Business or Business Entity Legal Name:
Business or Business Entity Legal Address
Business or Business Entity Taxpayer Identification
| hereby certify that mybusiness:
Is 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 I
Immigration Services Form 1-9, "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 Internal Revenue
Service, has no power to dictate or control an individual's work duties and obligations. and does not supervise
employees of subcontractors.
y physical locations within 4�0�'Fte'j
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 riot hire more than five (5) employees in I
a calendar year.
Fot the reasons stated above, my business or business entity is not eligible to register with and cannot use trie Department
of Homeland Security E-Verify System.
By signing this certification, |agree not to hire employees who are not authorized tobaemployed in the United S\eton pursuant
oo8UBCo. 1I24a(h)(3)at\hehmeufemp|oymanto'atmny\im*throughouithetermuftheamp|qfmoni {funherecknmwiedge
that | will mddy the Contract Manager within ten (10) calendar days of any change in the business entity status as an employe
or if any employees are hied. | further acknowledge rno( the failure to make the appropriate notifications will romu|1 in the
immediate termination ufmycontract
| HEREBY CERTIFY THAT THE FOREGOING |8 TRUE AND CORRECT
8olepmphetoriAuthohzed Ropemmn!o\ma
Printed Name
|�
� � �� �
1 6 F 2
Agreement Number
Attachment F
FLORIDA STATE COURTS SYSTEM
SUBCONTRACTOR'S E-VERIFY REGISTRATION AFFIDAVIT
,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 Legal Address:
Business or Business Entity Taxpayer Identification
Number(TIN)_ _.__ 1
I hereby certify that my business or business entity.
Is 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 m equired 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 DHS E-Verify system
Does not hire and agrees not to hire employees who are not authorized to be employed in the United States pursuant
to8USCs 13244/. (3) .._.__.
By signing this affidavit. I agree to maintain an active E-Verify registration and that I will notify the Contract Manager within ten
(10) calendar days of any change in 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 AFFIRM AND VERIFY THAT THE FOREGOING IS TRUE AND CORRECT.
Sole Proprietor/Authorized Representative
Prnted Name
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Agreement
Number_
STATE OF
COUNTY OF
Sworn to tor Affirmed) and Subscribed Before K8eBy
Means mf[] Physical Presence o,O Online Notarization
this__ day of . 2O2__.
by Who
O Is Personally Known VuYNeorO Produced Identification.
Type ofIdentification Produced:
_
'Signature of Notary Public
Printed Name ofNotary Public Administering Oath Pursuant to§117.10. Florida 5Xa(uhan
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Agreement Number
Attachment G
CONTRACTOR'S STATUTORY COMPLIANCE AFFIDAVIT
enoan officer or authorized representative o(the business entity shown
below. | hereby acknowledge on behalf of my business or business entity that | am aware that governmental entities of the
State ofFlorida are Prohibited from entering into amending, extending. and renewing certain contracts and agreements with
foreign countries o|concern, pursuant*o section 287138 Florida Statutes. business entities that engage )n forced iabo,and
human trafficking practices, pursuant hx sections 2871348. and 788.O5(13). Florida Statutes
Business or Business Entity Legal
�
Business or Business Entity Legal Address:
Business or Business Entity Taxpayer
Identification Number,
----- -----'
| hereby certify Linder penalty cd perjury that:
w My business entity is not owned by a foreign country of concern, as defined by section 287 138, Florida
uoatuiau
^ No foreign country of concern has a controlling interest in my business on\ity, as defined by section
287138. Florida Statutes.
° M@ huoinmxu entity is not organized under the |aws of or has its principal plaoo of business in a foreign
country of concern as defined by section 287,138 Florida Statutes
° My business entity does not engage inforced labor practices. as defined by section 2871346, Florida
Statutes
• Axy business entity does not engage in human trafficking. as defined by section 787 00. Florida Statutes.
» My business entity does not employ or engage any person who performs any of the activities in section
787,30. Florida Statutes
| have been advised that, in addition tocriminal penalties for perjury for providing false information on this affidavit, my failure
m comply with the requirements of sections 387 1346 and 287l38. and chapter 787 Florida Statutes, may result incwiiand
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 bythe State ofFlorida,
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Agreement Number
By signing this affidavit, | agree that | will notify the Contract Manager within ten (10) calendar
days of any change in my business entity status that mwuk1 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 and 787,
Florida Statutes | further acknowledge that the failure to make the appropriate notification -will
mauK}n |he immediate termination nfmycontract
| HEREBY AFFIRM AND VERIFY THAT THE FOREGOING |STRUE AND CORRECT,
0o|e Prop,ietor/Auihonzed Representative
_______
Printed Name
STATE OF COUNTY OF
Sworn tu(or Affirmed)and Subscribed
Before K4eBy Means ofOPhysical
Presence orO Online Notarization this day of_. 202'
hy Who
LJ Is Personally Known to K8eorO Produced
Identification Type ofIdentification Produced:
3Iina1umofNcxa9Public
����....��� __..'
Printed Name of Notary Public Administering Oath Pursuant to§117 03, Florida Statutes
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