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Jeb T. Branham, Esq.
City of Atlantic Beach`. ` " ; Response to Request for Proposal } -- Special Magistrate for Dangerous Dog Enforcement „``� / REPRESENTATION PROPOSAL SUBMITTED BY JEB T. BRANHAM, ESQ. , lq" i ,v , t . i k V I II , 4 . , 1 , ' k '..* A ; 11 4 ,---Tr- ..i .ti..: , n ii .a 0 i { 1 ORIGINAL JEB T. BRANHAM City of Atlantic Beach Response to Request for Proposal Special Magistrate for Dangerous Dog Enforcement FIRM QUALIFICATIONS THE BENEFIT OF EXPERIENCE DEVELOPED AT TWO OF THE NATION'S BEST AND LARGEST LAW FIRMS COMBINED WITH 1 0 YEARS OF REPRESENTING MUNICIPAL GOVERNMENTS My goal is to bring every client the benefit of experience developed at two of the nation's best and largest law firms - McGuireWoods and King & Spalding - with the personal attention you can only get from a small practice. We deliver the legal sophistication gained from working in a big firm environment for some of the world's largest corporations like the Coca -Cola Company, General Motors, Eli Lilly Sc Company, Novartis Pharmaceuticals, and 3M combined with individual, personalized attention. QUAUTY OF LEGAL SERVICES: Practicing at the best firms and working for the most demanding clients in the world puts an attention to quality in our work that most lawyers never have the opportunity or need to develop. SERVICE AS TOWN ATTORNEY FOR TWO MUNICIPALITIES & OTHER GOVERNMENTAL EXPERIENCE: Jeb Branham has the honor and benefit of working as the Town Attorney for Callahan for ten years and as the Town Attorney for Baldwin for nine years. There are few attorneys in the area with this experience handling the legal matters unique to municipalities and government, combined with sophisticated, broad -based litigation expertise. My service as a town attorney includes the responsibility for prosecuting code enforcement violations, handling all land use and zoning matters and the conduct of quasi - judicial proceedings. I have conducted dozens of quasi - judicial proceedings, including numerous rezonings, annexations, and comprehensive plan amendments. During my tenure, the Town of Callahan had a zoning matter proceed to Fla. Stat. s. 70.51 special magistrate proceedings and a subsequent appeal to the Circuit Court. The Circuit Court upheld the Town's decision. On occasion, I represent private clients in land use and code enforcement matters, both before city councils, in the state trial courts, and on appeal. As the attorney for two Towns, I understand the importance of maintaining a thorough knowledge of and ensuring full compliance with state public records, public meetings, and ethics laws. Drafting legislation and regularly conducting hearings in which a municipality renders judgments affecting citizens' rights has given me the experience necessary to effectively balance the sometimes competing interests of the government, individuals, property owners, neighbors, and the citizenry as a whole. JEB T. BRAN HAM City of Atlantic Beach r ".404. A rj Response to Request for Proposal r J � �� Special Magistrate for Dangerous Dog Enforcement l ��ss*��' PERSONAL EXPERIENCE: I have been a dog owner- for 13 years. I also lived next door to a dog that was eventually designated a dangerous dog and destroyed. The next door neighbors' dog tried to bite both my father and my wife, as well as other neighbors. I had to physically prevent the dog from biting my wife. These incidents caused me to learn the laws applicable to aggressive animals. After the owners moved away, the dog injured someone, leading to the dog's destruction. Despite the dog's aggression towards others, the dog's owners loved it and considered it a gentle pet for their son. The experience of being both a long-term dog owner and a neighbor to an aggressive dog gives me a unique perspective to bring to the decision- making process required of the Special Magistrate. GOVERNMENTAL LITIGATION EXPERIENCE: • Began representing the Town of Callahan in 2003 to resolve numerous claims from prior administration's misconduct. • Resolved proceedings instituted against the Town of Callahan by the Florida Department of Transportation for utility relocation charges at a six - figure savings over FDOT's demands. • Resolved administrative proceedings instituted against the Town of Callahan for misconduct by a grant administrator at a six- figure savings over the Department of Community Affair's demands. • Resolved inverse condemnation and trespass litigation filed against the Town of Callahan resulting from retentior pond constructed illegally on private property for market value of property. • On behalf of the Town of Hilliard, successfully resolved litigation between the Town and building contractor ove conversion of church into new Town Hall. • Served as lead negotiator for the Town of Baldwin on union contract with Teamsters. • Obtained a dismissal with prejudice of a lawsuit filed against the Town of Baldwin by a former employee when prior litigation attorneys representing the Town were unsuccessful. • Obtained a temporary injunction for the Town of Baldwin to stop the operation of an unauthorized borrow pit. • Obtained a temporary injunction for the Town of Callahan to stop unpermitted construction. • Successfully defended the Town of Callahan's denial of a site plan in certiorari proceedings. • Obtained defense verdict for private corporation in code enforcement action in which the City of Jacksonville sought over $400,000 in fines. • Appealed denial of variance for private landowner via writ of certiorari and obtained agreed -upon resolution witl the City of Neptune Beach. • Obtained multiple court orders authorizing the demolition of nuisance structures in code enforcement proceedings. JEB T. BRAN HAM 2 City of Atlantic Beach Response to Request for Proposal Special Magistrate ..or Dangerous Dog Enforcement PERFORMANCE OF JOB REQUIREMENTS EXPERIENCE APPROACH I will use my years of municipal and quasi - judicial experience to conduct rock -solid code enforcement hearings on dangerous dog cases. I understand dangerous dog cases involve cricitcal issues of public safety and draw out strong emotions and serious concerns on all sides. I will balance the interests of the City of Atlantic Beach, dog owners, and neighbors to ensure fundmental fairness for all and due process for the alleged violator. I will develop written guidelines and basic procedures to provide advance notice to alleged violators, code enforcement officers, witnesses, and others about how hearings will be conducted to ensure fairness and minimize in- hearing disruptions and controversies. I will incorporate any similar guidelines currently in use by Atlantic Beach into our materials to insure continiuity. We will prepare agendas that include all cases set for hearing on a hearing day. I anticpate the City Attorney or a member of Atlantic Beach's administrative staff will present the cases to me for decision in accordance with Fla. Stat. s. I62.07(2). We will require sworn testimony and will provide opportunities for cross examination. After hearings, I will prepare written findings of fact, conclusions of law, and an order to effectuate all decisions. I anticipate using court reporters to transcribe proceedings to meet the recording requirements of Fla. Stat. s. 1 62.07(3) and to create effective records if decisions are appealed to the Circuit Court. I will be the only attorney handling the special magistrate duties. I have practiced law since 1 995 and am licensed in Georgia and Florida. I was recently elected to the State Bar of Georgia Board of Governors. I always pay careful attention to the public's budgetary concerns and routinely deliver services to government clients under budget. I bring a practical approach to my firm's work. As a special magistrate that means conducting fair, transparent hewarings, issuing prompt decisions that will withstand appeal, and spending only the minimum hours necessary to achieve those results. My experience in municipal law, litigation, and quasi- judicial iraliN proceedings will allow me to prepare, conduct hearings, and write decisions efficiently. My goal is to use my experience to perform the job well while minimizing billable hours. J EB T. BRAN HAM 3 Ilk •� .a Y City of Atlantic Beach (; • Response to Request for Proposal Special Magistrate for Dangerous Dog Enfo rcement RESUME — JEB T. BRANHAM 3500 3rd Street South— Jacksonville Beach, Florida 32250 (904) 339 -0500; jeb @jebbranham.com www.jebbranham.com 3 1 j S l LICENSES AND COURT ADMISSIONS Florida Bar, September 2000. Also admitted to U.S.D.C., Middle District of Florida and the Eleventh Circuit Court of Appeals. Georgia Bar, November 1995. Also admitted to Georgia Supreme Court and Court of Appeals and U.S.D.C., Northern District of Georgia. Authorized by the State of Georgia to appear as sole or lead counsel at trials and depositions. LEGAL EXPERIENCE Jeb T. Branham, Esq. Jacksonville Beach, Florida (112002 — present). Sole practitioner or partner in small firm from 2002 to 2010, practicing in commercial and municipal law, emphasizing litigation, both trial and appellate. Representative matters include Town Attorney for Baldwin and Callahan, Florida, settling administrative law matters with the State of Florida $500,000 under State's demand, litigating the fleet -wide failure of marine engines for Costa Rican fishing lodge and subsequent nation -wide class action, general counsel representation of national auto painting franchisor, litigating easement rights between regional restaurant and land developer, and trademark registration for state and national surfing organizations. McGuireWoods, Jacksonville, Florida (1/2000 - 1212001). Commercial litigation department representing bot institutional and closely -held businesses in disputes from banking procedures to business torts. Representative matters include litigation arising from the sale of multi - million dollar companies, distributorship termination, the fleet wide failure of marine engines, and — at trial and I Ith Circuit appellate level — the termination of physicians from an insurance network. Responsible for all aspects of litigation including coordinating and drafting discovery, taking and defending depositions, and court appearances. King & Spalding, Atlanta, Georgia (511 998 - 17./1999). Tort litigation team defending automobile and medical device manufacturers and commercial litigation team defending Coca -Cola in Pepsico v. Coco - Cola antitrust litigation. Defended high exposure and nationwide litigation matters (both pending and potential), with extensive experience addressing document production logistics and privilege issues. Start -to- finish case handling responsibility for General Motors automotive products liability cases. JEB T. BRANHAM 4 City of Atlantic Beach to Request for Proposal A Special Magistrate for Dangerous Dog Enforcement RESUME, CONTINUED Hawkins & Parnell, Atlanta, Ga (9/1995 - 4/1998). Products liability defense for prescription pharmaceuticals, medical devices, clothing and textiles, and industrial products. Broad range of litigation experience representing insurers and insureds in commercial disputes and personal injury defense. Start -to- finish case handling and billing responsibility with extensive client contact. Developed and implemented document retention policy for international medical device manufacturer. Published opinion: Presto v. Sandoz Pharmaceuticals Corp., 226 Ga. App. 547, 487 S.E.2d 70 (I 997). PROFESSIONAL ASSOCIATIONS • Elected to the Board of Governors of the State Bar of Georgia in 2013 • Member of Florida Bar (member of City, County, and Local Government Law Section and Business Law Section) • Member of the State Bar of Georgia • Member of the Jacksonville Bar Association EDUCATION University of Tennessee College of Law Emory University Knoxville, Tennessee Atlanta, Georgia Juris Doctor, cum laude, May, 1995 B.A. English 1992 Honors and Achievements. Top 15% of law school class, dean's list all semesters; University of Tennessee Law Review; Am. Jur. awards in Con Law II and Criminal Procedure. Merit scholarship from Southeastern Bankruptcy Law Institute. BACKGROUND Born 1 970, Knoxville, Tennessee. Married to Michelle for 12 years with one five -year old son. Civic activities include former Board Member for Frum the Ground Up and Surfrider Foundation, First Coast Chapter. Member of and Sunday school teacher for Palms Presbyterian Church and served on the search committee for a new pastor. Member of the legal committee of the Ocean Cay Homeowner's Association. JEB T. BRANHAM 5 City of Atlantic Beach ; Response to Request for Proposal ~ �. • l"' 1 Special Magistrate for Dangerous Dog Enforcement P4Inii9V FIRM OUTLINE OF FEES & ESTIMATE OF EXPENSES The fee for my services is $ 175 per hour. This includes hearing time, time spent preparing hearing materials, and time spent writing decisions and orders. The only anticipated expenses are court reporter fees. I anticipate using Powers Reporting for most hearings.At my request, Powers Reporting has agreed to a flat -fee discounted rate of $75 for hearings. Preparation of hearing transcripts will cost $4.50 per page, and copeis of transcripts will cost $2.00 per page.Transcripts are likely to be prepared only when convicted violators appeal. In such instances, the violator must pay for the transcript. In many instances, the $75 flat fee will be the only fee incurred by Atlantic Beach. CONTACT INFORMATION I can speak about the items described in this proposal. I may be reached at: 3500 3rd Street South Jacksonville Beach, Florida 32250 (904) 339 -0500 POSITIVE REFERENCES The Honorable Shirley Graham The Honorable Stan Totman Mayor,Town of Callahan Mayor,Town of Baldwin Telephone: (904) 879 -3801 Telephone: (904) 266 -5031 Facsimile: (904) 879 -6151 Facsimile: (904) 266 -4220 Email: mayor @townofcallahan -fl.gov Email: baldwinmayor @comcast.net Lisa Purvis Clerk,Town of Hilliard Telephone: (904) 845 -3555 Facsimile: (904) 845 -1221 Email: Ipurvis@townofhilliard.com • JEB T. BRAN HAM 6 City of Atlantic Beach `,-,, r Response to Request for Proposal r Special Magistrate for Dangerous Dog Enforcement Submitted: August 30, 2013 By: /i' / > ri1iiii ll JEB T. BRANHAM, P.A. 3500 3RD STREET SOUTH JACKSONVILLE BEACH, FLORDIA 32250 TEL: (904) 339 -0500; FAX: (904) 339 -0501 JEB @JEBBRANHAM.COM I . ii - - .. .. Y ,) \ ..... 4 0por x. ��� ._ fi. \ _________„„ .iiimor--......-.„ ,, . , kwr . . , f . 7 ,, l i it'''' - ' - --- . 111111111 , N i hiov ,,,,,,,c,,- - „ i ...,,s s:. - 4 --iii, . i i 1 - l :41111,.. 04 N \ JEB T. BRANHAM \ \ 7 °C O Rl dq �� . . 3 s �� 7950 The Florida Bar 651 EAST JEFFERSON STREET JOHN F. HARKNESS, JR. TALLAHASSEE, FLORIDA 32399 -2300 850/561 -5600 EXECUTIVE DIRECTOR wwW.FLORIDABAR.ORG State of Florida ) County of Leon ) In Re: 296030 Jeb T. Branham Jeb T. Branham, P.A. 3500 3rd St. S Jacksonville Beach, FL I HEREBY CERTIFY that I am the duly appointed custodian of membership records of The Florida Bar. I FURTHER CERTIFY that the records in the office of the Clerk of the Supreme Court of Florida indicate that said attorney was admitted to practice law in the State of Florida on September 14, 2000. I FURTHER CERTIFY that the records in the office of The Florida Bar indicate that the above attorney is an active member of The Florida Bar in good standing. Dated this /2- 11-1day of August, 2013. 61 .0* 44144Q P4m Gerard Supervisor, Membership Records The Florida Bar PG /LK/KLCF1:R10 DATE (MOONY) ACORDTM CERTIFICATE OF INSURANCE O!2913 PRODUCER: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Coastal insurers. Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6434 I s, Avenue North HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR St. Petcrsbum FL 33710 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A -- INSURED: COMPANY Job T. Branham. P.A. B I 3500 3" I Street South COMPANY 1 Jacksonville Beach, FL 37250 C COMPANY D Medmarc Casualty Insurance Company [ COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT IMTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE (MMIDDIYY) , DATE (M. IDDfYY) A GENERAL LIABILITY GENERAL AGGREGATE COMMERCIAL GENERAL LIABILITY .PRODUCTS - COMPIOP AGG n CLAIMS MADE © OCCUR PERSONAL & ADV INJURY IA! _'S & CONTRACTOR'S PR OT EACH OCCURRENCE _La'..yers Professional Liability Damage to Rented Premises MED EXP (Any one person) AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO _ ALL OWNED AUTOS !BODILY INJURY (Per person) _SCHEDULED AUTOS _HIRED AUTOS 'BODILY INJURY (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE ' GARAGE LIABILITY I AUTO ONLY • EA ACCIDENT ANY AUTO I OTHER THAN AUTO ONLY: — EACH ACCIDEN — AGGREGATE -. B EXCESS LIABILITY 'EACH OCCURRENCE / UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM SELF- INSURED RETENTION C WORKER'S COMPENSATION AND LSTATUTORY LIMITS EMPLOYERS' LIABILITY EACH ACCIDENT itiE Rri :TP-:w 0R! Q INCL DISEASE • POLICY LIMIT oaRTr;ERSECUi s :'E I I OFFICERS ARE/ EXCL . DISEASE - EACH EMPLOYEE OTHER 12MCFL00795 • I1 /5 ;'2012 i 11!52013 Each Claim S500,0001Aggreggate 51,000,000 6 Professional Liabilit \' DESCRIPTION OF OPERATIONSLOCATIONS1VEHICLES /SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION City of Atlantic Beach, Florida SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE R00 Seminole Road THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO Atlantic Beach. FL 32233 THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY N,ND .' • ►. THE CI • - Y, _TS AGENTS OR REPRESENTATIVES. / , AUTHORIZED REPRESENTATIVE ,.a a 1 , • ACORD 25-S (3193) 1 of 1 G' ACORD CO •ORATION 1993 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 bidlproposal 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 (t). 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 VE T' S SIGNATURE DAZE 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 Jeb Branham, President (print individual's name and title) for Jeb T. Branham, P.A. (print name of entity submitting sworn statement) whose business address is 3500 3rd Street South Jacksonville Beach, Florida 32250 and (if applicable) its Federal Employer Identification Number (FEIN) is 20 - 3316715 (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. 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. 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. . - A r r i - (signature) August 30, 2013 (date) STATE OF Florida COUNTY OF Duval PERSONALLY APPEARED BEFORE ME, the undersigned authority, ,. ,-: _, , Jeb T. Branham who after first being sworn by me, affixed , (name of individual signing) 2 his /her signature in the space provided above on this 3© da of , 20 13 . *d !L / _ l ► �� 1 -- . .Si. • TARY PUBLIC - • - ' - c - I ' - � dO Y P % Notary Public State of Florida Denise LaBrie Woodard j My Commission DD949798 4 0f rti e* Expires 01/0412014 W-9 Request Rt for Taxpayer Give Form to the Form requester. Do not (Rev. January 2011) Identification Number and Certification send to the IRS. Department of the Treasury Internal Revenue Service Name (as shown on your income tax return) Jeb T. Branham, P.A. Business name /disregarded entity name, if different from above N ° 0) CO °- Check appropriate box for federal tax c o classification (required): ❑ Individual /sole proprietor ❑ C Corporation 0 S Corporation ❑ Partnership 0 Trust /estate co o. c ❑Exempt payee 3 ❑ Limited liability company. Enter the tax classification (C =C corporation, S =S corporation, P= partnership) ► Q 2 0 . 7 ; t Other (see instructions) ► E. A (number, street, and apt. or suite no.) Requester's name and address (optional) O 3500 3rd Street South m City, state, and ZIP code in Jacksonville Beach, Florida 32250 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 the "Name" line I Social security number to avoid backup withholding. For individuals, this is 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. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose Employer identification number number to enter. 2 0 - 13 3 1 6 7 1 5 Part 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) 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). 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 4. j Sign Signature of Z /2 Here U.S. person ►`- / ■ Date • 0/1 3 Note. If a requester gives you a form other than Form W -9 to request General Instructions your TIN, you must use the requester's form if it is substantially similar Section references are to the Internal Revenue Code unless otherwise to this Form W -9. noted. Definition of a U.S. person. For federal tax purposes, you are Purpose of Form considered a U.S. person if you are: A person who is required to file an information return with the IRS must • An individual who is a U.S. citizen or U.S. resident alien, obtain your correct taxpayer identification number (TIN) to report, for • A partnership, corporation, company, or association created or example, income paid to you, real estate transactions, mortgage interest organized in the United States or under the laws of the United States, you paid, acquisition or abandonment of secured property, cancellation • An estate (other than a foreign estate), or of debt, or contributions you made to an IRA. • A domestic trust (as defined in Regulations section 301.7701 -7). Use Form W-9 only if you are a U.S. person (including a resident Special rules for partnerships. Partnerships that conduct a trade or alien), to provide your correct TIN to the person requesting it (the business in the United States are generally required to pay a withholding requester) and, when applicable, to: tax on any foreign partners' share of income from such business. 1. Certify that the TIN you are giving is correct (or you are waiting for a Further, in certain cases where a Form W -9 has not been received, a number to be issued), partnership is required to presume that a partner is a foreign person, 2. Certify that you are not subject to backup withholding, or and pay the withholding tax. Therefore, if you are a U.S. person that is a 3. Claim exemption from backup withholding if you are a U.S. exempt partner in a partnership conducting a trade or business in the United If applicable, you are also certifying that as a U.S. person, our States, provide Form W -9 to the partnership to establish your U.S. payee. PP Y Y 9 P Y status and avoid withholding on your share of partnership income. 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. Cat. No. 10231X Form W -9 (Rev. 1 -2011) JEB T. BRANHAM, P.A. 3500 3RD STREET SOUTH JACKSONVILLE BEACH, FLORIDA 32250 PHONE: 904.339.0500: FACSIMILE: 904.339.0501 JEB @JEBBRANHAM .COM : WWW.JEBBRANHAM.COM JEB T. BRANHAM EB .BRANHAM 3500 Third Street South (acksonville Beach, FL 32250 City of Atlantic Beach 800 Seminole Road Atlantic Beach, FL 32233 VIA HAND DELIVERY C,P {EvH\ ,' 0 201 AUG 3 By Yrn