DiFranza Law. P.A. - RFP 16-02TAB I
Tide Page/Cover Letter/Table of Contents
LEGAL SERVICES FOR CITY ATTORNEY-FIRM
Request for Proposal No. 16-02
Date of Proposal• February 22, 2016
Submitting Law Firm:
DiFranza Law, P.A.
P.O. Box 51403
1824 Tanglewood Road
Jacksonville Beach, Florida 32250
Firm Contact: Lisa A. DiFranza, Esq.
Telephone: (904) 372-0216
Facsimile: (904) 372-0858
Email: Lisa@DiFranzaLaw.corn
Tab 1 1 of 9
Tab 1 2 of 9
CITY OF ATLANTIC BEACH REQUEST FOR PROPOSAL 16-02
LEGAL SERVICES FOR CITY ATTORNEY-FIRM
TABLE OF CONTENTS
Tab Description Page(s)
Tab 1 Title Page, Cover Letter and Table of Contents ---------------------------------------- 1-3
Tab 2 Experience of the law firm ------------------------------------------------------------------- 4
Tab 3 Experience of Attorney -------------------------------------------------------------------- 5-7
Tab 4 Fee Proposal ------------------------------------------------------------------------------------ 8
Tab 5 References -------------------------------------------------------------------------------------- 9
Tab 6 Required Forms
Sincerely,
isa A. DiFranza, Esq.
iFranza La P A.
2/21/2016
City of Atlantic Beach
City Hall
800 Seminole Road
Atlantic Beach, Florida 32233
Thank you for the honor to respond to Request for Proposal 16-02 for Legal Services for City Attorney-
Firm.
DiFranza Law, P. A. is a 100% woman owned, solo practitioner law firm, established on November 3, 2014
in Jacksonville Beach, Florida. Offices are located at 1824 Tanglewood Road, Jacksonville Beach, Florida
32250 and a downtown location at 1301 Riverplace Blvd, Jacksonville, FL 32207. Lisa A. DiFranza is the
sole practitioner and meets the Florida Bar license to practice and good standing requirements required by
the Request for Proposal. The firm web site can be found at http://www.difranzalaw.com .
It is proposed that services to the firm will utilize all of the resources of the firm required of the City. The
firm's lawyer has combined legal practice experience in excess of 20 years, with over 18 of those years
being Florida experience. The attorney is supported by a competent staff. It is proposed that Lisa A.
DiFranza would serve the City as City Attorney.
Lisa DiFranza's practice is substantially dedicated to general practice. Ms. DiFranza's background includes
extensive work in government agencies, experience multiple facets of municipal law, representation of law
enforcement agencies in forfeiture proceedings; Florida's Sunshine and Public Records Law, law
enforcement, tort claims from both claimant and defense perspectives, drafting statutes; administrative
hearings, advising local government officials in matters relating to official duties, contract drafting, civil
litigation, legal research, and providing opinions on questions of law relating to duty of agencies.
Enclosed with this response to the Request for Proposal are descriptions of the experience of the Firm and
its Attorney, Fee Proposal, References and the Required Forms. To the extent that this writing and its
enclosures omits addressing any requirement, leaves open any issue expected to be addressed, or begs
further supplement or response, please advise by contacting Lisa DiFranza at (904) 372-0216 office. Each
element of the proposed engagement is open to discussion, negotiation and resolution in the best interest of
the City of Atlantic Beach and the Firm.
Thank you for your favorable consideration and the opportunity to present before the City Council.
For the Firm
P.O. Box 51403
Attorney Email Lisa@DiFranzaLaw.com
Jacksonville Beach, Florida 32240-1403 Lisa A. DiFranza Webs te: http://www.DiFranzaLaw.com
Telephone: (904) 372-0216
Facsimile: (904) 372-0858
Tab 2
Experience of Law Firm
DIFRANZA LAW, P.A.
DiFranza Law, P.A. is a 100% woman-owned solo practice law firm, which opened its doors in
Jacksonville Beach, Florida in November of 2014.
The Firm's legal advice to its clients in zoning has been tested and found compliant from governing
agencies. The firm is a member of the Jacksonville Chamber, specifically, the Beaches Division
and has attended City Commission meetings. The Firm's attorney has drafted legislation to amend
statute sections within Florida's Public Records Law, Chapter 119.
Services have been provided to individuals and companies in matters concerning administratively
governed issues, such as Funeral and Cemetery under Chapter 497, Florida Statutes, Zoning issues,
which included coordinated compliance with multi-agency governance over business activity by
State agencies and municipal agencies. The firm has also provided legal services in contract
drafting, breach of contract settlements and litigation.
The Firm is active in the Beaches community as a member of the Jacksonville Chamber, Beaches
Division, serving on the membership committee and public policy committee. The Firm principal
office is located in Jacksonville Beach and within minutes of City of Atlantic Beach. The City
may be assured there will be continuing accessibility and responsiveness of the Firm to the City's
needs.
There are no judgments or lawsuits against any attorney or this firm.
No lobbyists are employed by DiFranza Law, P.A.
Tab 2 Experience of Law Firm 4 of 9
Tab 3
Experience of Attorney
ATTORNEY: LISA A. DIFRANZA
Lisa A. DiFranza, Esq. will be the attorney assigned as City Attorney for the City of Atlantic
Beach. She is a member in good standing of the Florida Bar, admitted on January 10, 2011. She
is a member of the Jacksonville Bar Association (JBA), Jacksonville Beach Bar Association and
serves on the following committees: Florida Bar Consumer Protection Law Committee, JBA Pro
Bono Committee, JBA Referral Committee, and the JBA Elder Law Committee.
The legal experience of Lisa A. DiFranza, Esq. spans over two decades. Her background includes
extensive experience in Florida's Public Records Law, preparation and drafting of state statutes
and advising governmental entities of the application of state and federal law to the agencies'
activities, representation of Jacksonville Sheriff's Office and Neptune Beach Police Department
in forfeiture proceedings as an Assistant State Attorney, and training agencies in Florida Public
Records Law, including Duval County Clerk of Court, Jacksonville Sheriff's Office, and the
Fourth Judicial Circuit's State Attorney's Office. A detailed description of the attorney's
experience and education follows below.
CURRENT
DIFRANZA LAW, P.A.
Attorney/Owner (November 2014 — Present). Representing corporate clients and individuals in a wide range
of legal matters including but limited to general civil litigation, labor law, guardianships, probate, consumer
law, administrative law, custody issues, business law, criminal law, commercial transactions, business
formation, driver license issues, DUIs, landlord/tenant disputes, contracts drafting and contract litigation.
EXPERIENCE
DUVAL COUNTY CLERK OF THE CIRCUIT AND COUNTY COURTS, Jacksonville, FL
Compliance Officer/Internal Auditor (April 2014 — October 2014)
• Identified and reviewed legal authorities applicable to departments within the office of the Clerk of the
Circuit and County Courts in Duval County and identified potential areas of compliance vulnerability
and risk
• Developed corrective action plans for resolutions of problematic issues and provided general guidance to
avoid or manage similar situations in the future
• Reviewed departments as directed by the Clerk and report to the Clerk to apprise inform him of the
operation, compliance status, recommendations concerning compliance efforts
• Coordinated compliance activities of other departments to remain abreast of the status of all compliance
activities and identify trends
• Researched and advised the Clerk and management on issues related to local, state, and federal law
Tab 3 Experience of Attorney 5 of 9
STATE ATTORNEY'S OFFICE, FOURTH JUDICIAL CIRCUIT, Jacksonville, FL
Assistant State Attorney (January 2011 — April 2014)
• Managed the Public Records Division, which included an annual workload and flow of over 1700 public
records requests
• Represented law enforcement agencies, conducting research, discovery and factual investigations and
appearing at hearings and trial for forfeiture proceedings
• Developed office policies concerning retention of agency documents and public records requests for
compliance with applicable administrative and statutory law
• Developed a division policy and staff procedures for compliance with Florida's Public Records Law
• Drafted memoranda, pleadings, and motions and appear in court
• Trained, assisted and provided legal advice to office management, staff attorneys and staff concerning
compliance with Florida's Public Records Law, Chapter 119, Florida Statutes, and related state, federal,
and judicial law
• Supervised public records staff
• Managed an ongoing caseload of over 100 in diversion programs
OFFICE OF ATTORNEY GENERAL, ECONOMIC CRIMES DIVISION, Jacksonville, FL
Law Clerk (February 2009—December 2010)
• Analyzed and evaluated business practices in order to make determination of violations of state and
federal consumer protection laws
• Prepared economic crime cases for litigation through performing legal research, drafting motions,
subpoenas, as well as conduct discovery relating to Chapter 501, Part II, Florida Statutes and other state
and federal laws
• Drafted settlement agreements and consent judgments
• Investigated alleged economic crimes committed by individuals and corporate entities, review complaints
and supporting documents, and obtains documentary evidence
Participated with attorney and investigators in conducting interviews of fact witnesses
• Prepared records for public record requests pursuant to Florida's Public Records Law
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES, BUREAU OF ADMINISTRATIVE REVIEWS,
Tallahassee, FL
Operations Analyst II (February 2006 — July 2007)
• Developed and conducted administrative-hearing training
• Served as liaison during rules implementations in field offices
Drafted revisions to Florida Statutes and analyzed proposed bills for legislature
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES, BUREAU OF ADMINISTRATIVE REVIEWS,
IandatialeLakes, FL
Field Hearing Officer (January 2005 — February 2006)
• Conducted hearings regarding administrative suspensions and reinstatement of driver licenses
• Received evidence under oath or affirmation, determined the order of testimony, developed the hearing
record, controlled disruptive parties, ruled on objections to evidence, oral, and written motions, and
documented findings and rulings
• Investigated motorists' ability to operate a motor vehicle, and recommended appropriate action
Tab 3 Experience of Attorney 6 of 9
CHARLOTTE COUNTY AMERICAN RED CROSS, Port Charlotte, Florida
Health, Safety, Youth & Community Services Director (March 2003 — August 2004)
• Coordinated, implemented, and evaluated American Red Cross Health and Safety education services
• Developed policies and procedures for operations and recommended ways of improving management
practices and office operations to Board
• Conducted presentations to the public
• Communicated the directives of the National American Red Cross and coordinated with instructors, staff,
and volunteers to ensure compliance with said directives
CREDENTIALS
Admitted to practice
State Court: Florida
Federal Court: U.S. District Court, Middle District of Florida
EDUCATION
FLORIDA COASTAL SCHOOL OF LAW: Juris Doctor rum laude May 2010
Honors: Dean's Scholar
Teaching and Research Assistant: Constitutional Law, International Law, and International. Human
Rights
ST. THOMAS UNIVERSITY SCHOOL OF LAW: Juris Doctor Studies, August 2007-May 2008
Honors: Dean's List
AMERICAN INTERCONTINENTAL UNIVERSITY: Bachelor of Science summa cum laude, Criminal Justice,
November 2005
Tab 3 Experience of Attorney 7 of 9
Tab 4
Fee Proposal
The Fee Proposal of DiFranza Law, P.A. is as follows:
Hourly rate for attorney: $200.00 per hour.
Attorney: Lisa A. DiFranza, Esq.
Monthly rate for attorney: $8,000.00 per month
Attorney: Lisa A. DiFranza, Esq.
Rates for reimbursable expenses:
Copies: $0.05/page
Travel: The Firm will utilize the most economical class and method for necessary out of
area travel and only actual expenses will be charged to the City.
There is no charge for travel within the vicinity for required attendance or other services.
Expenses would be reimbursed consistent with the City's policies and the contract terms.
Tab 4 Fee Proposal
8 of 9
Tab 5
References
DIFRANZA LAW, P.A. REFERENCES
References for similar services, attesting to the firm's knowledge, integrity, quality of work,
timeliness, diligence, and flexibility are:
PAT GLEASON, AAG
Special Counsel for Open Government
Attorney General Office
400 S Monroe St # PL-01
Tallahassee, FL 32399-6536
Telephone: (850) 245-0179
Email: bat.gleason@myfloridalegal.com
MICHAEL VON EIFF, DETECTIVE
Jacksonville Sheriff's Office
501 East Bay Street
Jacksonville, Florida 32202
Telephone: (904) 588-0088
Michael.VonEiff@jaxsheriff org
RICHARD MANTEI, ASA, DIRECTOR
State Attorney's Office, 4th Judicial Circuit
311 West Monroe Street
Jacksonville, FL 32202
Telephone: 904-630-2400
Email: RMantei@coj.net
VANESSA MOORE, ASA/LEGAL ADVISOR
Assigned to Jacksonville Sheriffs Office
State Attorney's Office, 4th Judicial Circuit
311 West Monroe Street
Jacksonville, FL 32202
Telephone: 904-630-2104
Email: Vanessa.Moore@jaxsherifforg
LARRY SCHMITT, CHIEF OF HUMAN RESOURCES
Jacksonville Sheriff's Office
501 East Bay Street
Jacksonville, Florida 32202
Telephone: (904) 630-2125
Tab 5 References 9 of 9
CITY OF ATLANTIC BEACH
Request for Proposals
Attorney Services
RFP #16-02
DOCUMENT REQUIREMENTS CHECKLIST
ALL REQUIRED DOCUMENTS, AS LISTED BELOW, MUST BE INCLUDED WITHIN YOUR PROPOSAL PACKAGE. ONE (1) ORIGINAL AND
SIX (6) COPIES, PLUS AN ELECTRONIC FILE (CD OR FLASH DRIVE) WITH ALL REQUIRED DOCUMENTS SHOULD BE SENT TO THE CITY
AND SHOULD BE IN THE SAME ORDER AS LISTED BELOW.
Proposals, and ALL required documents, submitted as complete packages (one original and six copies plus one digital copy)
to include the following under Tab 6, Required forms:
q Signed copy of the Document Requirements Checklist
q Signature Sheet acknowledging addendums
q Drug Free Workplace, if appropriate
q Public Entity Crimes Statement
q Non-Collusion Affidavit of Prime Respondent
q Completed Form W-9 Request for Taxpayer Identification Number and Certification (form may be obtained from
the IRS website https://www.irs.gov/pub/irs-pdf/fw9.pdf
q New Vendor Information Form
The above requirements have been noted and are understood by, bidder. I understand that failure to submit an item
listed above may resu in re "d.
SIGNATUR PRINT: Lisa A. DiFranza
P.O. Box 51403, 1824 Tanglewood Road
COMPANY: Lisa A. DiFranza ADDRESS: Jacksonville Beach, Florida 32250
PHONE: (904) 372-0216 FAX : (904) 372-0858
E-MAIL: Lisa@DiFranzalaw.com DATE: 2/21/16
16 'Page
City of Atlantic beach
RFP# 1 6 - 0 2
City Attorney Services
RFP-16-02
SIGNATURE SHEET
Proposer: Lisa A. DiFranza
Firm: DiFranza Law, P.A.
Address: P.O. Box 51403, 1824 Tanglewood Road,Jacksonville Beach 32250
Telephone Number: (904) 372-0216
ADDENDUM ACKNOWLEDGEMENT
The proposer shall acknowledge obtaining all addenda issued to this formal solicitation from the City's web site
by completing the blocks below. Failure to acknowledge all addenda may be cause for rejection of the bid
response.
Addendum No. 1
Addendum No. Date Issued:
Addendum No. Date Issued:
Addendum No. Date Issued:
AUTHORIZED SIGNATUR
TITLE: President
Date Issued: 02/11/2016
(print/type name as signed above): Lisa A. DiFranza
DATE: 02/21/2016
17IPage
City of Atlantic Beach
RFP#16-02
DRUG-FREE WORKPLACE CERTIFICATION
Section 287.087, Florida Statues, effective January 1, 1991, specifies that preference must be given to vendors submitting a
certification with their bid/proposal certifying they have a drug-free workplace. This requirement affects all public entities
of the State and is as follows:
IDENTICAL TIE BIDS - Preference shall be given to business with drug-free workplace
programs. Whenever two or more bids which are equal with respect to price, quality and service are received by the State or
by any political subdivision for the procurement of commodities or contractual services, a bid received from a business that
certifies that it has implemented a drug-free workplace program. In order to have a drug-free workplace program, a business
shall:
1) Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a
controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for
violations of such prohibition.
2) Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug-free
workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be
imposed upon employees for drug abuse violations.
3) Give each employee engaged in providing the commodities or contractual services that are under bid a copy of the
statement specified in subsection (1).
4) In the statement specified in subsection (1), notify the employees that, as a condition of working on the commodities or
contractual services that are under bid, the employee will abide by the terms of the, statement and will notify the employer of
any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893 or of any controlled substance law of
the United States or any state, for a violation occurrence in the workplace no later than five (5) days after such conviction.
5) Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such
is available in the employee's community, by any employee who is so convicted.
6) Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section.
AS THE PERSON AUTHORIZED TO SIGN THE STATEMENT, I CERTIFY THAT THIS FIRM COMPLIES FULLY
WITH TH ABO E MENTS.
DOR'
air h
181Page
City of Atlantic Beach
RFP#16-02
PUBLIC ENTITY CRIMES
SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(A), FLORIDA STATUTES, ON PUBLIC ENTITY
CRIMES.
THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
1. This sworn statement is submitted to the City of Atlantic Beach
by Lisa A. DiFranza
(print individual's name and title)
for DiFranza Law, P.A.
(print name of entity submitting sworn statement)
whose business address is 1824 Tanglewood Road
Jacksonville Beach, Florida 32250
and (if applicable) its Federal Employer Identification Number (FEIN) is 47-2209906
2. I understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida
Statutes, means a violation of any state or federal law by a person with respect to and
directly related to the transaction of business with any public entity or with an agency or
political subdivision of any other state or of the United States, including, but not limited to, any bid or contract for goods or
services to be provided to any public entity or an agency or political subdivision of any other state or of the United States
and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.
3. I understand that "convicted" or "conviction" as defined in Paragraph 287.133(1)(b), Florida Statutes, means a finding
of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of
record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, nonjury trial,
or entry of a plea of guilty or nolo contendere.
4. I understand that an "affiliate" as defined in Paragraph 287.133(1)(a), Florida Statutes, means:
1. A predecessor or successor of a person convicted of a public entity crime; or
2. An entity under the control of any natural person who is active in the management of the entity and who has been
convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners, shareholders,
employees, members, and agents who are active in the interest in another person, or a pooling of equipment or income
among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person
controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a
public entity crime in Florida during the preceding 36 months shall be considered an affiliate.
5. I understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statutes, means any natural person or entity
organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which
bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts
or applies to transact business with a public entity. The term "person" includes those officers, directors, executives, partners,
shareholders, employees, members, and agents who are active in management of an entity.
6. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this
sworn statement. (Indicate which statement applies.)
X Neither the entity submitting this sworn statement, nor any of its officers, directors, executives, partners, shareholders,
employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity has been
charged with and convicted of a public entity crime subsequent of July 1, 1989.
19 I Pa ,
City of Atlantic Beach
RFP#16 02
signature)
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X The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders,
employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged
with and convicted of a public entity crime subsequent to July 1, 1989.
X The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders,
employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged
with and convicted of a public entity crime subsequent to July 1, 1989. However, there has been a subsequent proceeding
before a Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by the
Hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the
convicted vendor list. (Attach a copy of the final order)
I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE
PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY
AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS
FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO
ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION
287.017, FLORIDA STATUTES FOR CATEGORY TWO 0 t AN N THE INFORMATION
CONTAINED IN THIS FORM.
(date)
STATE OF FLORIDA
COUNTY OF DUVAL
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
Lisa A. DiFranza who, after first being sworn by me, affixed
(name of individual signing) 1 c‘c- his/her signature in the space provided above on day of February , 20 16 .
NOTARY PUBLIC
My commission expires:
ZOIFIge
City of Atlantic BeaOh
RFP#16-02
NON-COLLUSION AFFIDAVIT OF PRIME RESPONDENT
STATE OF FLORIDA
COUNTY OF DUVAL
LISA A. DIFRANZA , being duly sworn, deposes and says that:
(1) He/she is President of DiFranza Law, P.A.
Title Firm/Company
the respondent that has submitted the attached response.
(2) He/she is fully informed respecting the preparation and contents of the attached solicitation and of
all pertinent circumstances respecting such solicitation.
(3) Such solicitation is genuine and is not a collusive or sham solicitation.
(4) Neither the said respondent nor any of its officers, partners, owners, agent representatives,
employees or parties in interest including this affiant, has in any way, colluded, conspired, or agreed,
directly or
indirectly, with any other respondent, firm or person, to submit a collusive or sham response in
connection with the Agreement for which the attached response has been submitted or to refrain
from bidding in connection with such. Agreement, or has in any manner, directly or indirectly, sought
by Agreement or collusion or communication or conferenceswith any other responder, firm or person
to fix the price or prices in the attached solicitation or of any other respondent, or to fix any overhead,
profit or cost element of the proposed price or the proposed price of any other responder, or to
secure
through any collusion, conspiracy, connivance or unlawful Agreement any advantage against the City
of
Atlantic Beach, Florida, or any person interested in the proposed Agreement.
(5) The price or prices quoted in the attached response are fair and proper and are not tainted by
any collusion, conspiracy, or unlawful Agreement on the part of the proposer or any of its
agents, representatives, owners, employees, or parties du. affiant.
(Signe
The foregoing foregoing instrument was acknowledged before me this day of February
----Th , who is ersonally kno to me or who has produced
as identifica ion and who did /did not take an oath.
, 2016, by
Lisa A. DiFranza
4 6 0 9 9 0 2 2 7
Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for
guidelines on whose number to enter.
Employer identification number
Part II
Certification
Signature of
U.S. person 10.
Sign
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Form WaS
(Rev. December 2014)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
Identification Number and Certification
Give Form to the
requester. Do not
send to the IRS.
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1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
DiFranza Law, P.A.
2 Business name/disregarded entity name, if different from above
3 Check appropriate box for federal tax classification; check only one of the following seven boxes: 4 Exemptions
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Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in
the tax classification of the single-member owner.
0 Other (see instructions) Il►
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from FATCA reporting the line above for
maintained outside the U.S.)
5 Address (number, street, and apt. or suite no.)
1824 Tanglewood Road
Requester's name and address (optional)
6 City, state, and ZIP code
Jacksonville Beach, FL 32250
7 List account number(s) here (optional)
Part I Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN on page 3.
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage
interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and
generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the
instructions on page 3.
Or
Date IP.
General Instructions
Section references are to the Internal Revenue Code unless otherwise noted.
Future developments. Information about developments affecting Form W-9 (such
as legislation enacted after we release it) is at www.irs.gov/fw9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an information
return with the IRS must obtain your correct taxpayer identification number (TIN)
which may be your social security number (SSN), individual taxpayer identification
number (ITIN), adoption taxpayer identification number (ATIN), or employer
identification number (EIN), to report on an information return the amount paid to
you, or other amount reportable on an information return. Examples of information
returns include, but are not limited to, the following:
• Form 1099-INT (interest earned or paid)
• Form 1099-DIV (dividends, including those from stocks or mutual funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)
• Form 1099-B (stock or mutual fund sales and certain other transactions by
brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T
(tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident alien), to
provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might be subject
to backup withholding. See What is backup withholding? on page 2.
By signing the filled-out form, you:
1. Certify that the TIN you are giving is correct (or you are waiting for a number
to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt payee. If
applicable, you are also certifying that as a U.S. person, your allocable share of
any partnership income from a U.S. trade or business is not subject to the
withholding tax on foreign partners' share of effectively connected income, and
4. Certify that FATCA code(s) entered on this form (if any) indicating that you are
exempt from the FATCA reporting, is correct. See What is FATCA reporting? on
page, 2 for further information.
Cat. No. 10231X
Form W-9 (Rev. 12-2014)
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ATLANTIC BEACH, FLORIDA 32233-5445
TELEPHONE (904) 247-5880 FAX: (904) 247-5819
WWW.COAB.US
New Vendor Information Request Form
Please complete and return with all other bid documents
DiFranza Law, P.A.
Vendor Name (as it should appear on Purchase Orders and Check Payments)
P.O. Box 51403
Remit To Address
Jacksonville Beach, FL 32240-1403
1824 Tanglewood Road
Physical Address (if different from remittance)
Jacksonville Beach, Florida 32250
Company Phone: (904) 372-0216
Company Fax: (904) 372-0858
Company Website: http://www.DiFranzaLaw.com
Point Of Contact Information:
Name: Lisa A. DiFranza
E-Mail Address: Lisa@DiFranzalaw.com
Phone: (904) 372-0216
Fax: (904) 372-0858
Should Purchase Orders be faxed or e-mailed? Provide correct information for either choice.
faxed: (904) 372-0858