Douglas Hedstrom Cossey, P.A.- RFP 16-02 DH DOUGLAS
HEDSTROM
COSSEY, P.A.
PROPOSAL FOR LEGAL SERVICES TO
CITY OF ATLANTIC BEACH
RFP 16-02
February 24, 2016
Directed to:
Catherine Berry, J.D.
Director of Human Resources
800 Seminole Road
Atlantic Beach, FL 32233
Primary Contact: Joshua A. Cossey - Shareholder
JoshuaoDDHClawyers.com
TAB 1 - TITLE PAGE/ COVER LETTER/TOC
PROPOSAL FOR LEGAL SERVICES TO
THE CITY OF ATLANTIC BEACH
RFP 16-02
TABLE OF CONTENTS
Tab 1 —Table of Contents/Title Page/Cover Letter 2
Tab 2—Experience of the Law Firm 5
Tab 3 —Experience of Attorneys 7
Tab 4—Fee Proposal 10
Tab 5 —Professional References 11
Tab 6—Required Forms 12
Tab X—Miscellaneous 21
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TITLE PAGE
THE CITY OF ATLANTIC BEACH RFP 16-02/CITY ATTORNEY
LEGAL SERVICES FOR CITY ATTORNEY-FIRM
Response to Request for Proposal No. 16-02
Attn: Human Resources Director
800 Seminole Road
Atlantic Beach, FL 32233
RESPONDENT: DOUGLAS HEDSTROM COSSEY,P.A./JOSHUA A. COSSEY, ESQ.
10245 Centurion Parkway N.Jacksonville,FL 32256
Office: (800) 369-6657/Fax: (386) 385-5916
Overview: The firm of Douglas Cossey Hedstrom, P.A. was founded in 2013 as a Professional
Association. Our firm established an office within Putnam County, located at 601 St. Johns
Avenue, Palatka, Florida. Since then, our firm has opened offices in Jacksonville, St. Augustine,
Ocala, and Fleming Island. We can be reached at 1(800)369-6657. There are twelve attorney's
total who can assist the City of Atlantic Beach, seven who would be designated or available for
various committees and divisions as desired by the City. See Tab 3. Additionally, there are four
paralegals available to assist the attorneys in matters relating to the City of Atlantic Beach, along
with Law Clerks, and administrative staff. All attorneys are members of the Florida Bar, in good
standing. None have been disciplined or publicly reprimanded by the Florida Bar.
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Douglas Hedstrom Cossey, P.A.
IT75-----1 DOUGLAS
H EDSTR( M
COSSEY, P.A.
February 24, 2016
Sent Via Courier Service
Human Resources Director
800 Seminole Road
Atlantic Beach, FL 32233
Attn: Catherin Berry, J.D.
IN RE: The City of Atlantic Beach/RFP 16-02/City Attorney—Legal Services
Our Firm is honored to be considered for the RFP referenced above. We believe our Firm will be
a compliment to the City of Atlantic Beach's history of high standards and quality of life. There
are three (3) core value propositions that we believe distinguish our proposal as provided herein.
❖ Diversity and depth of practice areas.
While we may not have a board certified municipal lawyer, our attorneys provide the necessary
expertise and experience in such areas as employment, urban planning, and contracts. Whether
it is a discrimination claim,code enforcement, and/or procurement,our firm is poised to address
the full spectrum of issues that arise in local government.
❖ Emphasis on process and technology.
From our cloud based management systems, client interaction process, web conferencing
applications, to our use of data rooms with proper encryption, our firm is accessible,
approachable, and efficient.
❖ A balance of seasoned hands and up-and-comers.
Our firm has a strong balance of new lawyers, those approaching their prime, and those who
have several decades of experience in various areas, to include local government. This balance
allows for a blended rate that optimizes the value received by our clients.
We look forward to addressing any questions that may arise throughout the course of this process,
and in working toward the interests of the City of Atlantic Beach.
Respectfully submitted:
Joshua A. Cossey, Esq.
Encl/(6) Copies & (1)Thumb drive
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Douglas Hedstrom Cossey,P.A.
TAB 2 - EXPERIENCE OF THE LAW FIRM
Before going through the various aspects of our Firm's experience, it is worth noting that one of
Douglas Hedstrom Cossey, P.A.'s founding attorneys, retired judge Ed Hedstrom, was the City
Attorney for Palatka for over 20 years. It is his commitment to building stronger communities that
challenges and inspires our Firm to serve the public sector. While our firm provides services for
businesses, non-profits, and individuals, we are focused on continuing a tradition of service to
those tackling the ever growing complexities local government. Our commitment is to practice
with integrity, providing insights and solutions to local leaders. The following expounds upon
those topics and services referenced in RFP 16-02.
Ratings and recognition. From "AV Preeminent" to "Super Lawyer" designations, many of the
attorneys at Douglas Hedstrom Cossey, P.A., have received ratings and recognition on a national
level. In particular, Joshua A. Cossey("Joshua") has an "AV Preeminent" rating from Martindale-
Hubbell, a 10 out 10 ("Superb") rating by Avvo.com, received the 40 under 40 Award from the
Business Journal, was selected as one of the Top 100 Lawyers in America by The International
100, recognized as one of North Florida's top Business Lawyers by 904 Magazine, and recently
won the title of `Best In House Counsel Services —USA" by Acquisitions International. He is a
member of the ABA, JBA, and admitted to both State and Federal jurisdictions.
Knowledge of public finance: Our firm has handled issues with distressed properties through
eminent domain and acquisitions, issues surrounding assessments and self-insurance programs,
forfeiture,public private partnerships,and the use of foundations for program development. Public
finance covers a broad range of areas, to include procurement, fines, and exactions. Our firm has
litigated these matters and advised public entities regarding the application of Florida's
Administrative Code and Florida Statute.
Preparation and drafting of ordinance and advising governmental entities: Joshua Cossey has been
working on the drafting of laws since 1999, when he received his first position with the lobbying
firm McCloud & Associates in Tallahassee, FL. He later went to work for a lobbyist focused on
promoting apple products in Florida's education system. In law school, Joshua provided analysis
on such issues as citrus canker, the application of greenbelt code to the equestrian industry, and
the publication of a digest on Florida's boundary & fence laws. See Tab X. He presently works
on issues surrounding amendments for county noise ordnances, foliage requirements, and
permitting administration. Joshua has learned from Ed Hedstrom, who served as the City Attorney
for Palatka, FL, as well as Marion Radson, who served as the City attorney for Gainesville, FL.
The Firm presently advises the Boards of Save Rodman's Reservoir, Putnam County School
Board, and works with the City of Ocala on a variety of matters.
Knowledge of land use, zoning,real property and community development issues,comprehensive
plan amendments, utilities, and public works issues. It is likely that our firm is the only one with
an attorney who possesses a PhD in Urban and Regional Planning AND another attorney with an
LLM in Real Estate Development. To top it off, our retired Judge, Ed Hedstrom, has handled just
about every conceivable real estate matter under the sun, and teaches for The Attorney's Title
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Douglas Hedstrom Cossey, P.A.
Insurance FUND. Joshua Cossey has prevailed at trial on issues of boundary disputes, and co-
( authors a boundary law digest with the University of Florida. Joshua has also dealt with issues
surrounding the Public Service Commission, access to public works, utility service agreements,
and assessment disputes.
Florida Sunshine and public records laws: Joshua Cossey,Rocco Carbone, Charlie Douglas, Steve
Shaw, and Ed Hedstrom have experience advising public entities, to include the City of Palatka,
Putnam County School Board,Planning and Zoning Committees in Delray Beach,and other public
entities how to publish, notice, administer, and respond to issues surrounding Florid Sunshine
Laws and public records requests. Also, Joshua Cossey has successfully litigated public records
request matters for private parties. These issues include time computation, records custodian
issues, chain of custody issues, proper notice requirements, etc.
Code enforcement proceedings: Joshua Cossey and other members of the firm have experience in
litigating, interpreting, and revising municipal and county code on a number levels. The Firm has
provided representation to numerous private parties on issues such as noise ordinances, rezoning
issues, variances, building code enforcement, eminent domain,
Location and availability of staff: Joshua Cossey, his paralegal, law clerk, and other attorneys are
located in their offices located at 10245 Centurion Parkway N, Jacksonville, FL 32256. They are
available by cell and local lines full time, to serve and address any issues that may arise during the
course of normal operating hours, as well as meetings to address emergencies. Mr. Rocco Carbone
is based out of the Jacksonville office, and all other attorneys are available as needed.
Depth of Firm and ability to provide comprehensive services: Douglas Hedstrom Cossey, PA
provides a diverse and accomplished collection of professionals to address every aspect of local
government. From a retired Judge who served as City Attorney, PhD's in urban land use and
development, our attorneys have tackled the gamut of issues in employment and procurement, the
Firm. Douglas Hedstrom has five offices throughout NE Florida, with twelve (12) attorneys. The
firm has grown steadily over the last few years and is projected to stay on course. Given the unique
background and practice areas of the Firm, it is unlikely that outsourcing would be rarely
necessary.
Grant submission review experience: Mr. Cossey and other members of the firm are experienced
in assisting non-profits and private companies apply and pursue R Series, P Series, and other
federal,private, and non-profit grants. Ex: Our firm created an specialized educational foundation,
authorized by statute, for the purpose of benefiting children and families within a school district,
and continue to assist the Foundation pursue appropriate grants.
Disclosure: No lawsuits or judgments exist in the last five years against any of the attorneys in the
Firm at this time. There are presently no lobbyists employed by the Firm at this time.
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Douglas Hedstrom Cossey, P.A.
TAB 3 - EXPERIENCE OF ATTORNEYS
JOSHUA A.COSSEY,ESQ. (Primary Assigned Counsel -Partner)
Joshua A. Cossey ("Joshua") has an "AV Preeminent" rating from Martindale-Hubbell, a
10 out 10 ("Superb") rating by Avvo.com, received the 40 under 40 Award from the Business
Journal,was selected as one of the Top 100 Lawyers in America by The International 100,recently
recognized as one of North Florida's top Business Lawyers by 904 Magazine, and recently won
the title of "Best In House Counsel Services — USA" by Acquisitions International. His trial
experience includes business disputes, property disputes, and lending practices. Back in 2005,
Joshua began his familiarization with municipal law when he received a highly competitive
clerkship with the City of Gainesville. Under the tutelage of the longest standing City Attorney(at
that time), Marion Radson, Joshua received both training and exposure to the complexities that
riddle the day to day operations of managing local governments. Before joining the firm, Joshua
worked in-house for both Inc. 500 and publicly traded companies as General Counsel and other
executive roles, where he developed proficiencies in corporate governance, vendor managements
risk management, and employment law issues. Prior to his corporate capacities, Joshua ran his
own practice focused on both litigation and compliance issues, where he handled multi-million
dollar mergers, acquisitions, construction disputes, boundary disputes, franchise agreements,
greenbelt&agricultural matters,arbitration,creditor/debtor issues,and government affairs.Joshua
attended FSU for where graduated Summa Cum Laude with a degree in Psychology and Political
Science. In 2004 he attended the UF, Levin College of Law, where contributed to several
publications to include the University of Florida's Boundary Law Digest.Joshua was also inducted
as a member of Florida Blue Key. Going on 13 years, Joshua continues to serve in the Florida
Army National Guard, with MOSs in Engineering, Ordnance, and Logistics. His community
involvement includes service roles in Leadership Florida, and NE Region Board of Governors.
Joshua moved to Jacksonville in the Summer of 2008, and presently resides in a neighborhood off
of Hodges Blvd, approximately 10 minutes from the City of Atlantic Beach. Joshua has
successfully litigated Florida Sunshine laws for private parties, bid protests, writs of mandamus,
and ordinance violations for private companies & individuals. Mr. Cossey acts as general counsel
for numerous business across the state of Florida; has prepared in writing numerous instruments
and contracts, while revising several forms for functionality, process improvement, compliance,
and risk management.He has litigated civil and administrative complaints,represented community
associations, and handled arbitration. He's proffered opinions of law related to audits, conflicts of
interest, delegation of authority, and fiduciary responsibilities. He was admitted to the Florida Bar
in October 2008, is in good standing, and is rated nationally as described herein.
CINDY MARVIN,ESQ. (Elder Affairs -Associate)
Admitted to practice in November 1, 1979, Cindy has dedicated her practice to serving in
a variety of matters from guardianship, probate, and criminal matters. Cindy has a vast amount of
litigation experience in civil and criminal law, having tried approximately one hundred cases. She is a
seventh-generation North Floridian, with a focus on community and philanthropy. She works
extensively with issues surrounding aging populations, and elder affairs.
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Douglas Hedstrom Cossey,P.A.
STEPHEN F. SHAW,ESQ. (Urban Planning -Partner)
Stephen F. Shaw ("Steve") grew up in Florida with a love of real estate development and
today focuses his practice in real estate, land use, and urban planning. He received an
undergraduate degree in Real Estate from the Florida State University College of Business, which
is ranked in the top ten in the country. Upon graduation, Steve passed five Appraisal Institute MAI
exams and performed over three hundred residential and commercial appraisal reports for major
lenders as well as becoming a licensed Florida Real Estate Broker. Steve went on to graduate with
a Master of Science in Urban and Regional Planning from the Florida State University, where he
not only studied how nuisances affect the value of real estate but he also built appraisal and
regression models to construct a study of the effect of a social NIMBY upon neighboring single-
family home values. Steve continued his education at the University of Florida College of Law.
He took the opportunity to take all available courses related to real estate, land use, and planning
as well as clerking with land use attorney C. David Coffey. After passing the Florida Bar, he
became an associate with the Fishback Dominick law firm in downtown' Orlando. Wanting to
complete his ultimate goal of a Doctor of Philosophy degree, Steve returned to the University of
Florida and was accepted into the highly ranked College of Design, Planning and Construction.
His Ph.D. dissertation topic centered upon municipal public school impact fees. The chairman of
his committee was joint-professor of Urban & Regional Planning/Law James Nicholas, the
preeminent expert on impact fees. Steve has represented clients throughout Florida - from small
claims to Federal District Court. He also has also prosecuted appeals in both state and federal
appeals courts. His experience includes municipality and county liability for drainage and
boundary disputes, as well as civil rights violations related to zoning and land use decisions.
Further, he has extensive experience in real estate, housing, tenant/landlord, quiet title,
condominium, time-share, and mobile home actions and transactions. Steve was admitted to the
Florida Bar in October 1997, is in good standing, holds no board certifications, and is recognized
nationally as described herein. He is also admitted to the South Carolina Bar.
Rocco J. CARBONE,III.,ESQ.(LABOR&COMPLIANCE-Associate)
Rocco concentrates his practice in education and administrative law.Since joining Douglas
Hedstrom Cossey in January of 2015 much of his practice focuses on education and administrative
law. Regarding education law, Rocco has experience advising and representing school board
members and district staff on various issues including bullying/harassment investigations, Due
Process Hearings, Expulsion Hearings, employee terminations, truancy, procurement laws, and
Florida's Sunshine Laws regarding public records and public meetings law. He is familiar with
DOAH procedures, ESE and IDEA matters as well as FERPA and student privacy related
issues. Prior to joining the firm, Rocco was an associate at a large law firm based in Philadelphia.
His practice focused on various civil litigation matters. Prior to entering private practice, Rocco
was a prosecutor with the State Attorney's Office in the 4th Judicial Circuit gaining extensive
litigation experience. Rocco graduated cum laude in the top 13% of his class in law school where hil
he was both a Dean's Scholar and on the Dean's List. While in law school, Rocco was a member
of the Executive Board on the Mock Trial team, and won several advocacy awards. Rocco was
admitted to the Florida Bar in October 1997, is in good standing,holds no board certifications, and
is recognized nationally as described herein. Rocco is also licensed and in good standing with the
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Georgia and New Jersey State Bar Associations. Rocco leads several programs, to include the
Truancy Division, for the Putnam County School Board.
EDWARD E.HEDSTROM,ESQ. (Senior Attorney -Partner)
Ed is a retired Circuit Court Judge who joined the firm in June of 2014. A graduate of the
University of Florida College of Law,Ed has been a member of the Florida Bar for nearly 50 years.
He served Putnam County as partner at Hedstrom & Smith from 1977 to 2000. Ed served as
Counsel for the City of Palatka from 1979 until 2000. Additionally, Ed served as Counsel for the
Putnam County Clerk of Court from 1974 until 2000. In 2000, Ed was appointed to the bench as
Circuit Court Judge,Seventh Circuit. Ed retired from the bench in 2010 but remained an extremely
active Senior Judge and also became a board-certified civil mediator.Ed officially retired from the
bench in June of 2014 and joined Douglas Hedstrom Cossey, P.A.. where he now provides an
unrivaled wealth of knowledge and experience.
CHARLES T.DOUGLAS,JR.,ESQ. (TORTS &LIABILITY-Partner)
Charlie is co-founder and shareholder of the firm that he founded in 2013. Since 2014,
Charlie has been the School Board Attorney for Putnam County School District. In this role he has
overseen all of the Putnam County School District's legal issues, including, but not limited to
Florida's Sunshine Law, employee termination hearings, disposal of school property, and bullying
and harassment investigations. Since his selection as the School Board Attorney he has gained
extensive experience related to school law and constitutional law. Charlie graduated Valedictorian
of Palatka High School in 2000. One year later,Charlie received his Associate in Arts degree from
St. Johns River State College and transferred as a Junior to the University of Florida. In 2003,
Charlie graduated, summa cum laude, with a degree in Business Administration. Charlie attended
the University of Florida Levin College of Law, where he served as Editor-in-Chief of the Florida
Law Review and graduated second in his class of 211 students. Prior to founding Douglas
Hedstrom Cossey, P.A., Charlie practiced civil litigation with a Jacksonville law firm from 2006
until 2013 with the firm of Harrell & Harrell, P.A.
JEREMIAH BLOCKER,ESQ. (CONSTRUCTION&ENFORCEMENT-Associate)
Jeremiah has experience in handling zoning disputes, construction issues and land use
transactions. He has worked extensively in the area of political consulting and election law,having
advised candidates in several local and state campaigns. He is also a board member of the Florida
Bar Committee on Military Law and is certified in Veterans Benefits Appeals. Before working in
private practice, Jeremiah served as a prosecutor with the State Attorney's Office in both
Jacksonville and Palatka, Florida. He is an experienced litigator with having tried over thirty jury
trials ranging from DUIs to violent felony cases. As a prosecutor, he served as the Drug Court
liaison, managing all Drug Court diversion cases and worked with community leaders to assist
substance-abuse defendants successfully reintegrate into the community. After passing the Florida
Bar,Jeremiah continued his legal studies at the University of Miami School of Law in Coral Gables
to focus on zoning disputes, commercial real estate litigation and land use transactions. He
graduated with a Masters of Law in Real Property Development, LLM.
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Douglas Hedstrom Cossey, P.A.
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TAB 4 - FEE PROPOSAL
The following includes, but is not limited to, Douglas Hedstrom Cossey, PA.'s hourly rate
option, a monthly retainer fee option, and a combination of these options. Unless strictly a
monthly retainer, the hourly rate option is mandatory.
A.Hourly rates for the attorneys and costs:
City Attorney (Joshua A. Cossey) bill rate: $250.00 p/hr
Senior Attorney (All other Shareholders) bill rate: $250.00 p/hr
Asst. City Attorney (All Associates) bill rate: $200.00 p/hr
Labor Attorney (Rocco Carbone): $250.00 p/hr
Law Clerks $125.00 p/hr
Paralegals $75.00 p/hr
Admin No Charge
B. The rates for reimbursable and/or out-of-pocket expenses, including,but not limited to, word
processing, photocopying, faxing, etc.:
Copies (B&W/Color): $0.05 p/page
Faxes: No Charge
Litigation files: $50.00 per file
Mileage: Pursuant to: IR-2015-137
C. The proposed rates for all other fee proposals or arrangements outside the standard hourly
rates, if proposed by you or your law firm:
Option 1: The Firm would accept a flat fee of$12,500.00 a month to cover all issues and services
outside of litigation, providing fulltime support 40 hours a week. Litigation would then receive a
20 % discount from the hourly rates proposed.
Option 2: The Firm shall provide a prorated bucket of 50 hours for a monthly flat fee of
$9,000.00 a month to cover all issues and services outside of litigation. After the 50 hours, the
standard hourly rate shall apply for all services with a 10 % discount on all rates.
D. Proposed provision for rate increases in future years:
The Firm proposes an annual rate increase of 5% per year after the first year, and each year
thereafter.
ill
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Douglas Hedstrom Cossey, P.A.
TAB 5 - REFERENCES
Nikki Cummings
Putnam County School Board
216 Lakeview Dr.
Satsuma, Florida 32189
(386) 649 4870
Joe Pickens
President of St. Johns River State College
P.O. Box 1374
Palatka, Florida 32178
(386) 937-1563
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Douglas Hedstrom Cossey, P.A.
TAB 6 - REQUIRED FORMS
Attestation: To our knowledge the appointment as City Attorney will not result in a conflict of
{ interest with respect to current or anticipated clients of the law firm. If a conflict is deemed to
possibly exist, the prospective City Attorney or law firm shall state the nature of such conflict,
and a proposal to resolve the same prior to appointment as City Attorney.
All other required forms, affidavits, and checklists are enclosed herein.
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Douglas Hedstrom Cossey, P.A.
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:
/Signed copy of the Document Requirements Checklist
1 Signature Sheet acknowledging addendums
Drug Free Workplace, if appropriate
Public Entity Crimes Statement
/Non-Collusion Affidavit of Prime Respondent
37 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
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 result in rejection o this bid.
SIGNATURE: PRINT: Joshua A Cossey
COMPANY: Douglas Hedstrom Cossey,P.A. ADDRESS: 10245 Centurion Parkway N Jacksonville, FL
32256
PHONE: 800-369-6657 FAX: 386-385-5916
E-MAIL: info@DHClawyers.com DATE: 02/23/16
City Attorney Services
RFP-16-02
SIGNATURE SHEET
Proposer: Joshua A Cossey
Firm: Douglas Hedstrom Cossey, P.A.
Address: 10245 Centurion Parkway N Jacksonville, FL 32256
Telephone Number: 800-369-6657
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. One (1) Date Issued: February 11, 2016
Addendum No. Date Issued:
Addendum No. Date Issued:
Addendum No. Date Issued:
AUTHORIZED SIGNATURE:
TITLE: Partner
(print/type name as signed above): Joshua A Cossey
DATE: 2/23/16
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 effects 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 drugfree 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
contenders 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 THE ABOVE REQUIREMENTS.
Z 3 /6
VENDOR'S SIGNATURE DAT
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
(print name of the public entity)
by Joshua A. Cossey,Esq. - Shareholder
(print individual's name and title)
for Douglas Hedstrom Cossey, P.A.
(print name of entity submitting sworn statement)
whose business address is 10245 Centurion Parkway N
• Jacksonville, FL 32256
and(if applicable)its Federal Employer Identification Number (FEIN)is 46-3582182
(If the entity has no FEIN, include the Social Security Number of the individual signing
this sworn statement: •)
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
.he 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. 1 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.)
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.
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.
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 OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.
;ac' `N.‘, STACEY C LAWRENCE
„ j *I MY COMMISSION#FF168985
EXPIRES October 15,2018 (signs e)
(407)398-0153 FloridallotaryService.com rj z 2:///
(dat
STATE OF "
COUNTY OF t1AV,°(4
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
Ana 1)JJ 1 who, after first being sworn by me, affixed
(name of individual s' ning) 2r�
his her signature in the space provided above on this Z J day of Fel'. , 20 I .
NOTARY PUBLIC
My commission expires: l 0l ICJ I`e
NON-COLLUSION AFFIDAVIT OF PRIME RESPONDENT
STATE OF FLORIDA
COUNTY OF DUVAL )
Joshua A. Cossey , being duly sworn, deposes and says that:
(1) He/she is Shareholder of Douglas Hedstrom Cossey, 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 conference with 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 of interest, including affiant.
(Signed)
/7 i=-4
The foregoing instrument was acknowledged before me this Z J day of COY-'' , 2016, by
J 01'1 �U Co to
'L- , who is personally known tde or who has produced
as identification and who did /did not take an oath,
NOTARY PUBLIC
(t;;STACEY C LAWRENCE
MY COMMISSION#FF168985
n.cpe EXPIRES October 15,2018
(407)398-0153 FlondallotaryService corn
Form W-9 i Request for Taxpayer Give Form to the
ter.Do not
(Rev.December2014) identification Number and Certification send requester.
the IRS.
Department of the Treasury
Internal Revenue Service
1 Name(as shown on your Income tax return).Name is required on this line;do not leave this line blank.
C1n o-r 1 es —r. rpei c.e.$ C.5 3r
csi 2 Business name/disregarded entity name,if dl-rent frdm above
4 c i a-s -I. 14 4 r-f o fY i Rik
3 Check appropriate box for federal tax classification;check only f the following seven boxes: 4 Exemptions(codes apply only to
ccertain entitles,not individuals;see
❑Individual/sole proprietor or ❑ C Corporation S Corporation ❑ Partnership ❑Trust/estate instructions on page 3):
B single-member LLC Exempt payee code(if any)
❑Limited liability company.Enter the tax classification(C�corporation,S=S corporation,P=partnerahlp)►
o Note.For a single-member LLC that is disregarded,do not check LLC;check the appropriate box In the line above for Exemption from FATCA reporting
the tax classification of the single-member owner. code(if any)
E- ❑Other(see Instructions)► Mp°°to i°iieii°lned 01tsid•""US)
E 5 Address(number,street,and apt.or suite no.) Requester's name and address(optional)
I,O i 54. Ic'rIirt5 kVQ_.rti,�.'Z.
e City,state,and ZIP code
A i'ooa_vka- FL. 3 iii
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 fine 1 to avoid j 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 — —
entitles,it Is your employer Identification number(EIN).If you do not have a number,see How to get a -
77N on page 3. or
Note.If the account Is in more than one name,see the instructions for line 1 and the chart on page 4 for Employer identification number
guidelines on whose number to enter.
"Pair II Certification
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)t'r,bt 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 l to backup withholding;and
3. I am a U.S.cithen or other U.S.person(defined below);and
4.The FATCA cocas)entered on this form(if any)indicating that I am exarnpt 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,acq_!attion 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.
Sign Signature of
Here u.s.penton • Data► /—1 /G
General Instructions /•Form 1098(home mortgage Interest),1098-E(student loan Interest),1098-T
(tuition)
Section references sic to the Internal Revenue Code unless otherwise noted. •Form 1099-C(canceled debt)
Future developments.information about developments affecting Form W-9(such •Form 1099-A(acquisition or abandonment of secured property)
as legislation enacted after we release it)Is at www.lrs.gov/fw9.
Use Form W-9 only If you are a U.S.person(Including a resident alien),to
Purpose of Fti rm provide your correct TIN.
An individual or nntii (Form W-9 requester)who is required to file an information If you do not return Form W-9 to the requester with a TiN,you might be subject
return with the IRS rural obtain your correct taxpayer identification number(TIN) to backup withholding.See What is backup withholding?on page 2.
which may be your nncial security number(SSN),individual taxpayer Identification By signing the filled-out form,you:
number(MN),adoption taxpayer Identification number(ATIN),or employer 1.Certify that the TIN you are giving is correct(or you are waiting for a number
Identification number(EIN),to report on an information return the amount paid to to be Issued),
you,or other amount reportable on an Information return.Examples of information 2.Certify that you are not subject to backup withholding,or
returns Include,but are not limited to,the following: �Y P g.
•Form 1099-INT(interest earned or paid) 3.Claim exemption from backup withholding if you are a U.S.exempt payee.If
•Form 1098-DN(dividends, those from stocks or mutual funds) applicable,you are also certifying that as a U.S.person,your allocable share of
( including any partnership Income from a U.S.trade or business Is not subject to the
•Fein 1099-MISC\arious'ypes of income,prizes,awards,or gross proceeds) withholding tax on foreign partners'share of effectively connected Income,and
•Form 1099-B(etor k or mutual fund sales and certain other transactions by 4.Certify that FATCA code(s)entered on this form(if any)Indicating that you are
brokers) exempt from the FATCA reporting,Is correct.See What is FATCA reporting?on
•Form 1099-S(prornods from real estate transactions) page 2 for further information.
•Form 1099-K(merchant card and third party network transactions)
Cat.No.10231 X Form W-9(Rev.12-2014)
;-4111111101t'
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
Douglas Hedstrom Cossey,PA
Vendor Name (as it should appear on Purchase Orders and Check Payments)
10245 Centurion Parkway N Jacksonville,FL 32256
Remit To Address
i
ti Physical Address (if different from remittance)
Company Phone: 800-369-6657 Company Fax: 386-385-5916
Company Website: DHClawyers.com
Point Of Contact Information:
Name: Joshua A Cossey
E-Mail Address: info @DHClawyers.com
Phone: 800-369-6657 904-891-2507
Fax: 386-385-5916
Should Purchase Orders be faxed or e-mailed? Provide correct information for either choice.
Respones: Emailed.
How did you learn of this Bid/RFP (check one)? Financial News &Daily Record
X City's Website Faxed/E-mailed Announcement Other(please specify):
TAB X - MISCELLANEOUS
ADDITIONAL BACKGROUD
Douglas Hedstrom Cossey, P.A. has over 2600 sqft of office space conveniently located off of US
17 South, Orange Park,with regular office hours of 8:30 a.m.to 6:30 p.m.,Monday through Friday,
to provide legal services to the District. We have a 12 hour client call back policy to ensure that
clients receive immediate attention. All attorneys, paralegals, and secretarial staff have mobile e-
mail and document access. E-mail is checked frequently and our firm can respond quickly to
inquiries. We are available to meet with members of the board at our office or theirs, depending
upon preference.
Each assigned attorney would be responsible for logging detailed notes of all actions taken
and all communications made on District-related matters.That detailed log would be electronically
stored on a secured server which assigned attorneys could access both in and out of the office.
Weekly review meetings will serve to keep all assigned attorneys knowledgeable, involved, and
available to The District. The attorney assigned to the County shall keep office hours within the
Clay County School Board as requested or required.
CASE STUDY
Over the 2014-2015 school year, Douglas Hedstrom Cossey, P.A.'s education attorneys have
assisted in developing and implementing the Putnam County School District's Truancy Program.
We have had remarkable success in working with our partners at the Department of Juvenile
Justice ("D.J.J."), CDS Family and Behavioral Health Services ("C.D.S."), Juvenile Crime
Prevention Office ("J.C.P.O."), and Department of Children and Family Services ("D.C.F.") to
provide services for children in need, while also providing increased financial success for the
Putnam County School District.
Like all public school districts, Putnam County receives funding for each student who is actively
in school during October and February of the fiscal school year. During the 2014-2015 school
year,a total of 486 truancy cases were investigated. Out of the 486 truancy cases,not every truancy
case received funding; however, the estimated amount for those truancy cases the Truancy
Program was able to monitor and ensure were in school constitutes $2,900,875.24 of funding that
would not have been allotted to the Putnam County School District if these children were truant.
The Truancy Program continues to grow and provide much needed services to the students and
families of the District, and now Putnam County is becoming a model for other Districts. On
November 7, 2014, one of the Putnam County School District Resource Officers began assisting
Flagler County with its Truancy Program and other Districts are showing similar interest.
I
(
21
Douglas Hedstrom Cossey,P.A.
INSURANCE
Douglas &Hedstrom, P.A. maintains professional liability insurance through Attorney Protective,
a division of Berkshire Hathaway. The firm has coverage in the amount of $1,000,000.00 per
claim; $2,000,000.00 aggregate. Our policy number is RLPL100371-1. This policy expires on 9-
11-2016, but shall be renewed prior to expiration.
(Remainder intentionally blank)
22
Douglas Hedstrom Cossey,P.A.