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Jeb T. BranhamP ,t y y r r , RECEIVED MAR 1 4 2019 PURCHASING DEPARTMENT Code Enforcement:Special Magistrate 19-02 City of Atlantic Beach - February 15, 201) Jeb T. Branham, P.A. Original 1 et,r1‘,t_. p e S JEB T. BRANHAM Attorney at Law March 15,2019 City of Atlantic Beach Attn: Procurement Manager 800 Seminole Road Atlantic Beach, FL 32233 Re: Request for Proposal No. 19-02— Code Enforcement Special Magistrate To Whom it May Concern: Enclosed please find Jeb T. Branham,P.A.'s response to the Request for Proposal No. 19-02,Code Enforcement Special Magistrate for the City of Atlantic Beach, Florida. In compliance with the request for proposal please, find the following: Tab 2 Experience of the Attorney/Law Firm Page 2 Tab 3 Fee Proposal Page 6 Tab 4 References Page 7 Tab 4 Required Forms Page 8 Tab 5 Certificates of Insurance Page 29 The firm's current professional liability insurance is included.Additional professional liability, general liability,and workers compensation insurance will be obtained if the applicant is selected. The firm has maintained offices at the following locations for the specified dates: 166 A1A North Ponte Vedra Beach, Florida from 2002-05; 1400 Marsh Landing Parkway, Suite 103,Jacksonville Beach, Florida from 2006-07; 333 1st Street North, Suite 305,Jacksonville Beach, Florida from 2008-11; 3500 3rd Street North,Jacksonville Beach,Florida from 2012-17; and 419 3rd Street North,Jacksonville Beach, Florida from 2018-present. I am happy to speak with you should there be any questions concerning the information contained within this proposal. 1Sincerel T. Branham JTB/jag Enclosures 419 3rd Street North, Jacksonville Beach, Florida 32250 jeb@jebbranham.com 1 (904) 339-0500 telephone i (904) 339-0501 facsimile I www.jebbranham.com City of Atlantic Beach Response to Request for Proposal 19-02 1 Code Enforcement Special Magistrate j City of Atlantic Beach Response to Request for Proposal t Code Enforcement Special MagistrateI;;J33lT,r FIRM QUALIFI CATIONS 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 &Company, Novartis Pharmaceuticals, and 3M combined with individual, personalized attention. QUALITY 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 17 years and as the Town Attorney for Baldwin for 15 years. The Ocean Highway and Port Authority, Nassau County recently retained Mr. Branham as its counsel. Mr. Branham previously served as Atlantic Beach's special magistrate for dangerous dog proceedings. 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 . BRANHAM Attorney at Law 2 City of Atlantic Beach Response to Request for Proposal Code Enforcement Special Magistrate n4' u1 -. RESUME - JEB T. BRANHAM 419 3rd Street North --Jacksonville Beach, Florida 32250 lc 904) 339-0500;jeb@jebbranham.com www.jebbranham.com f' LICENSES AND COURT ADNIISSIONS 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 (1/2002- present). Sole practitioner or partner in small firm from 2002 to 2019, practicing in commercial and municipal law, emphasizing litigation, both trial and appellate. Representative matters include Attorney for Ocean Highway and Port Authority, Nassau County, 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 - 12/2001). Commercial litigation department representing both 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 1"' 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 (5/I 998 - 1211 999). Tort litigation team defending automobile and medical device manufacturers and commercial litigation team defending Coca-Cola in PepsiCo v. Coca-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 aiiilh, utomotive products liability cases. J E B T . BRANHAM Attorney at Law 3 City of Atlantic Beach Response to Request for Proposal Code Enforcement Special Magistrate 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 Phonnoceugcifs Corp., 226 Ga. App. 547, 487 S.E.2d 70 0997). 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, Temessee 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 1970, 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. Ruling elder 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 Attorney at Lew 4 City of Atlantic Beach ut Response to Request for Proposal x ci 6 Code Enforcement Special Magistrate r ~ EXPERIENCE-RELATED SPECIFIC INQUIRIES: Mr. Branham previously served on the Board of Governors for the State Bar of Georgia. Although he has practiced in local government law for 17 years, Mr. Branham is not board-certified nor does he hold specific ratings from rating agencies. Mr. Branham and his firm were counterclaim defendants when he and co-counsel sued a former client for fees owed. The case was resolved by settlement. Neither- Mr. Branham nor his firm have otherwise been sued, had judgments rendered against them, or had any bar- complaints lodged in the last five years. They do not employ lobbyists. 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 retention 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 over 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 aformer 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 with the City of Neptune Beach. Obtained multiple court orders authorizing the demolition of nuisance structures in code enforcement proceedings. JEB T. BRAN HAM Attorney et Law 5 City of Atlantic Beach J''' S A yfResponsetoRequestforProposal Code Enforcement Special Magistrate M 9- OUTLINE OF FEE OPTIONS 200 per hour is the hourly rate option.This includes hearing time,time spent preparing hearing materials,and time spent writing decisions and orders. Hearings can be handled at a flat rate of $500. This includes preparing for and conducting the hearing. issuing any necessary subpoenas,and preparing written decisions. A monthly flat rate option is available at $2,000 per month. If two or fewer hearings are held in a month, hearings will be billed at$500 each.If six or more hearings are held in a month,hearings above five will be billed at $500 each. Additionally,the proposal requires unusually high professional liability limits for a position that is covered by sovereign immunity. As long as the current professional liability limits are in place,an additional annual payment of$1 ,000 is required to partially offset the cost of procuring additional insurance. 1611\ JEB T. BRANHAM Attorney at Law 6 City of Atlantic Beach Response to Request for Proposal Code Enforcement Special Magistrate REFERENCES The Honorable Martin Fontes The Honorable Sean Lynch Mayor, Town of Callahan Mayor; Town of Baldwin 542300 U.S. Highway 1 10 U.S. Highway 90 West Callahan, Florida 3201 1 Baldwin, Florida 32234 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 Dates of Representation:Dates of Representation: 2002 to present 2004 to present klhIL JEB T. BRANHAM Attorney et Lew 7 RFP 19-02 City of Atlantic Beach Code Enforcement Special Magistrate CITY OF ATLANTIC BEACH Request for Proposals Special Magistrate Services RFP#19-02 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 5,Required forms: on V Signed copy of the Document Requirements Checklist Signature Sheet acknowledging addendums E-Verify Statement VDrug Free Workplace,if appropriate Public Entity Crimes Statement Non-Collusion Affidavit 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 V New Vendor Information Form Proposer Acknowledgements and Agreements Conflict of Interest Statement Disputes Disclosure Form Public Records 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 of this bid. SIGNATURE: A-PST: 3 -L C cz.r 1-\ -t1N. COMPANY: c S. (. (Z?^tnt,o,rn elk ADDRESS: ill 3 r-°(Oo„-1-1, PHONE: 011 33'i Os O 0 FAX: GI O 4 33 ci a SO EMAIL: DATE: 7/13/19- 01098179-I RFP 19-02 City of Atlantic Beach Code Enforcement Special Magistrate Special Magistrate Services RFP#19-02 SIGNATURE SHEET Proposer: Jeb .r'c c,rh Firm: 3 e-6 T. s3 2wN hQ n,., ( h• Address: it t/ '3C' 31-c-ct4 A) •, 3 c-L. Sat-v dl L G, Z 32z-S U Telephone Number: G'j 6q 32ci 0 .co 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. I Date Issued: .2I (5 I i q Addendum No. Date Issued: Addendum No. Date Issued: Addendum No. Date Issued: AUTHORIZED SIGNATURE: i - TITLE: Att01 Print/type name as signed above):JQ.2)h(,lf! DATE: 3I (3 I I q RFP 19-02 City of Atlantic Beach Code Enforcement Special Magistrate E-VERIFY ISTATEMENT Bid/Proposal Number: I - Project Description: l ODSl C, fl1 )CC 1 WI Spo c(1.0. S+fc COMPANY/FIRM/CONTRACTOR acknowledges and agrees to the following: The awarded COMPANY/FIRM/CONTRACTOR shall utilize the U.S. Department of Homeland Security's E-Verify system, in accordance with the terms governing use of the system,to confirm the employment eligibility of: 1. All persons employed by the SPECIAL MAGISTRATE/FIRM during the term of the Contract to perform employment duties within Florida; and 2. All persons assigned by the SPECIAL MAGISTRATE/FIRM to perform work pursuant to the contract with the Department. P)1LfbCompany/Firm: J O.J) T Q m P. P . Authorized Signature: Title: Date: 4O 1 n Q Date:j(3jI 0109an9-4 RFP 19-02 City of Atlantic Beach Code Enforcement Special Magistrate DRIJG-FREE WORKPI ACE 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 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) Infonn 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. 31 ,31 , (1VENDSIGNATUREDATE Q- 0D- CODE rIfocrem ctct,,LBid/RFP Number Bid/RFP Title Qq 1 raf e 01098179-1 RFP 19-02 City of Atlantic Beach Code Enforcement Special Magistrate 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. Thi sworn statwent is su itted to the Cit of Atlantic Beach by Leg -1" rap map, , P. f . print inJvidpal's Catty g] ami P. ETforbranfl print name of entity submittin l sword} emen ) whose business addr ss is • Ca 0 04 e SO t(fe M 1 t 3aa50 I X15and(if applicable)its Federal Employer Identification Number(FEIN)is 53 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. 01098179-I RFP 19-02 City of Atlantic Beach Code Enforcement Special Magistrate 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. Sirarr e1 STATE OF r z4 I€ 4 D A bate) COUNTY OF I WI A PERSONALLY APPEARED BEFORE ME,the undersigned authority, J EB Q R/rF4A- n who,after first being duly sworn by me,affixed name of individual signing) his/her signature in the space provided above on this 1lday ofcc/12019. NOTARY PU J.'S ( Iii6D—r------4 My commission pires: J.DIXON 7„;C s'ion##GG 196739 A•.w7•71 Expires April 8,2022 P' Bonded Nu Troy Fain Insurance 800-985-7019 01098179-I RFP 19-02 City of Atlantic Beach Code Enforcement Special Magistrate Non-Collusion Affidavit This sworn statement is submitted with Bid, Proposal or Contract for J QD . € anhC TI This sworn stateme t is submitted by (entity) JQy)1. 'C i((1 whose business address is 4(Q 510 St. K is.) Ci((Q, Nab and (if applicable) federal Employer Identification Number(FEIN) is tb 3 (p11 If a Sole Pro riet o r" and you have no FEIN, include the last four(4) digits of your Social Security Number: 0617 Jeb Branham My name is and my relationship to the entity named above is S4.-c- 1. The above named is fully informed respecting the preparation and contents of the attached proposal and of all pertinent circumstances respecting such proposal; 2. Such Proposal is genuine and is not a collusive or sham proposal; 3. Neither the said Proposer nor any of its officers, partners, owners, agents, representatives, employees, or parties in interest, including this affiant, has in any way colluded, connived, or agreed, directly or indirectly, with any other Bidder, firm or person to submit a collusive or sham Proposal in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other Bidder, firm, or person to fix the price or prices in the attached proposal or any other Bidder,or to fix any overhead, profit or cost element of the proposal price or the proposal price of any other Bidder, or to secure through any collusion,connivance, or unlawful agreement any advantage against the City of Atlantic Beach, Florida or any person interested in the proposed Contract; and 4. The price or prices quoted in the attached proposal are fair and proper and are not tainted by any collusion, conspiracy, connivance, or unlawful agreement on the part of the Bidder or any of its agents, representatives, owners, employees, or parties in interest, including this affiant. 7 /15 ature Date STATE OF FLORIDA COUNTY OF D u,v#q-L. PERSONALLY APPEARED BEFORE ME, the undersigned authority, who, after first being swooy} by me, affixed his/her signature at the space provided above on this '31/4"day of 2019, and is personally known to me, or has provided as ident' cation. 4 My Commission expires: Notary Signature CARLA J.DIXON A, Commission#GG 19619 P01098179-1 r . Expires April 8,2022 f Q Bonded Tins Troy fain Insura.ae 80G-5o5-i 019 Request for Taxpayer Give Form to the Form W 9 Identification Number and Certification requester. Do not Rev.October 2018) send to the IRS. Departs Revenueent f the Treasury Go to www.irs.gov/FormW9 for instructions and the latest information.Internal Service 9 1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank. Jeb T.Branham, P.A. 2 Business name/disregarded entity name,if different from above 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1.Check only one of the 4 Exemptions(codes apply only to rn following seven boxes. certain entities,not individuals;see ctsinstructions on page 3): a o Individual/sole proprietor or C Corporation S Corporation Partnership Trust/estate n single-member LLC Exempt payee code(if any) ci ca. o 3 Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership) o 2Note:Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting c c LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is code(if any) Otherwise,— another LLC that is not disregarded from the owner for U.S.federal tax purposes. a single-member LLC that Il is disregarded from the owner should check the appropriate box for the tax classification of its owner. g Other(see instructions) Applies to accounts maintained outside the U.S) a 5 Address(number,street,and apt.or suite no.)See instructions. Requester's name and address(optional) cn 419 Third Street North 6 City,state,and ZIP code Jacksonville Beach, Florida 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 instructions for Part I,later.For other entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TIN, later. or Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and Employer identification number Number To Give the Requester for guidelines on whose number to enter. 2 0 - 3 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);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 for Part II,later. Sign Signature of 3/1 3 A CHereU.S.person Date 1 General Instructio s Form 1099-DIV(dividends,including those from stocks or mutual funds) Section references are to the Internal Revenue Code unless otherwise Form 1099-MISC(various types of income,prizes,awards,or gross noted. proceeds) Future developments.For the latest information about developments Form 1099-B(stock or mutual fund sales and certain other related to Form W-9 and its instructions,such as legislation enacted transactions by brokers) after they were published,go to www.irs.gov/FormW9. Form 1099-S(proceeds from real estate transactions) Purpose of Form Form 1099-K(merchant card and third party network transactions) An individual or entity(Form W-9 requester)who is required to file an Form 1098(home mortgage interest),1098-E(student loan interest), information return with the IRS must obtain your correct taxpayer 1098-T(tuition) identification number(TIN)which may be your social security number Form 1099-C(canceled debt) SSN),individual taxpayer identification number(ITIN),adoption Form 1099-A(acquisition or abandonment of secured property)taxpayer identification number(ATIN),or employer identification number EIN),to report on an information return the amount paid to you,or other Use Form W-9 only if you are a U.S.person(including a resident amount reportable on an information return.Examples of information alien),to provide your correct TIN. returns include,but are not limited to,the following. If you do not return Form W-9 to the requester with a TIN,you might Form 1099-INT(interest earned or paid) be subject to backup withholding.See What is backup withholding, later. Cat.No.10231X Form W-9(Rev.10-2018) RFP 19-02 City of Atlantic Beach Code Enforcement Special Magistrate CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FLORIDA 32233-5445 TELEPHONE(904)247-5880 FAX: (904)247-5819 1V1V'1V.COAB.US NEW VENDOR INFORMATION REQUEST FORM Please complete and return with all other bid documents Ji2i0 `_T, &o n hap) P. . Vendor Name (as it should appear on Purchase Orders and u heck Payments) tq 31:d 1- WQm-h, Jaakcomitte &aL 3 as5O Remit to Address Physical Address (if different from remittance) Company Phone: Q 04 -3sq - 0500l0 Company Fax: q 04 -L33Q -05 01 Company Website: 12_10b( hQIYI . CDr1\ Point of Contact Information: Name: jeb ( ia.nhojc Email Address: Jeb (® jabboi hwi .COM Phone: q04- ` 0 50 0 Fax:C102+-9)3C1-050 Should Purchase Orders be faxed or emailed? Provide correct information for either choice. eiflut b Com RFP 19-02 City of Atlantic Beach Code Enforcement Special Magistrate PROPOSER ACKNOWLEDGEMENTS AND AGREEMENTS The undersigned, as an employee or agent of the Proposer,having the authority to sign a binding agreement on behalf of the corporation, company, or firm presenting this submittal, confirms understanding and/or agreement and/or takes exception with any statement in the following sections of this RFP document. 1. GENERAL TERMS AND CONDITIONS Understands and agrees to all terms. 2. SCOPE OF SERVICES,MINIMUM REQUIREMENTS AND QUALIFICATIONS Understands and agrees to all terms. 3. PROPOSAL FORMAT Understands and agrees to all terms. Name: J Q l3M hOf1\ Title: kibiri\itSignature:V---aDate: 3I X31 (q Bid/RFP Title: 4—02- Bid/RFP No.: i q —0'' 01098179-1 RFP 19-02 City of Atlantic Beach Code Enforcement Special Magistrate CONFLICT OF INTEREST STATEMENT This sworn statement is submitted with Bid,Proposal or Contract for ....)Q.,6"—T. e Ar\ a f \ This swore tatetnent is submitte4 by (et) . t i2 Q, (Amwhose business address is t 4 3 QCJl 1VIlt a icable) Federal Employer Identification Number(FEIN) is JO 331(p""( 15 If a (&WO • for and you have no FEIN, include the last four(4)digits of your Soc§ riftVit al Security Number: My name isd tMA to the entity named above is if 1. The above nailed entity is submitting a d/Prgposal fo the.City of Atlantic Beach Bid/RFP No. 1 Q -Oa titled C_;O6 . mP11i el a k. S raf-e 2. The Affiant has made diligent inquiry and provides the information contained in the Affidavit based upon his/her own knowledge. 3. The Affiant states that only one submittal for the above proposal is being submitted and that the above named entity has no financial interest in other entities submitting proposals for the same project. 4. Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, participated in any collusion, or otherwise taken any action in restraints of free competitive pricing in connection with the entity's submittal for the above proposal. This statement restricts the discussion of pricing data until the completion of negotiations if necessary and execution of the Contract for this project. 5. Neither the entity not its affiliates, nor anyone associated with them, is presently suspended or otherwise ineligible from participation in contract letting by any local, State,or Federal Agency. 6. Neither the entity nor its affiliates, nor anyone associated with them have any potential conflict of interest due to any other clients,contracts,or property interests for this project. 7. I certify that no member of the entity's ownership or management is presently applying for an employee position or actively seeking an elected position with the City of Atlantic Beach. 8. I certify that no member of the entity's ownership or management, or staff has a vested interest in any aspect of the City of Atlantic Beach. 9. In the event that a conflict of interest is identified in the provision of services, I,on behalf of the above named entity,will immediately notify the City of Atlantic Bea A VIA 'i ature Date STATE OF FLO DA COUNTY OF J,Vi4'L PERSONALLY APPEARED BEFORE ME, the undersigned authority, who, after first being sworn b me, affixed his/her signature at the space provided above on this I g` ay of Q,rC. - , 20/ and is personally known to me,or has provided as identification. Notary Signature: ( 41J My Commission expires: CARLAJ.DIXON 01098179.1 R: , Commission#GG 19u739 b,,. o; Expires P,pril 8,2022 f,F°e'' Bonded Tru Troy Fain Insurance 800.335-1015 RFP 19-02 City of Atlantic Beach Code Enforcement Special Magistrate DISPUTES DISCLOSURE FORM Answer the following questions by placing as "X" after "YES" or "NO". If you answer YES", please explain in the space provided,or via attachment. Has your firm or any of its officers, received a reprimand of any nature or been suspended by the The Florida Bar or any other regulatory agency or professional association within the last five(5) years? YES NO Has your firm, or any member of your firm, been declared in default, terminated or removed from a contract or job related to the services your firm provides in the regular course of business within the last five(5)years? YES NO < Has your firm had filed against it or filed any request for equitable adjustment, contract claims, bid protest, or litigation in the past five(5) years that is related to the services your firm provides in the regular course of business? YES NO X If yes, state the nature of the request for equitable adjustment, contract claim, litigation, or protest, and state a brief description of the case, the outcome or status of the suit and the monetary amounts or extended contract time involved. I hereby certify that all statements made are true and agree and understand that any misstatement or misrepresentation or falsification of facts shall be cause for forfeiture of rights for further consideration of this proposal for the City of Atlantic Beach. J r,\hCtrn , p1131J0 q Him Date Joi) Exa.nhann Au orized Signature Printed or Typed Name and Title CODe P ecr r l a -0?- Bid/RFP Title nr t o Bid/RFP Number 01098179-1 RFP 19-02 City of Atlantic Beach Code Enforcement Special Magistrate PUBLIC RECORDS PROVISIONS FOR ALL CONTRACTS AND AMENDMENTS Effective as of July 1,2016 per Chapter 2016-20, Laws of Florida This is to confirm that we have been informed of,and will abide by,the Public Records Provisions regarding s. 119.0701 F Signed: Print: 1 ) Company: L J(2.12j 77 elan ham) PM • Phone: qo4—3Y4_' O O O Email:JQPe 4138f0(\hOJ l .COM Date: , I L3I I q Public Records Provisions,Page 2 01098179•I RFP 19-02 City of Atlantic Beach Code Enforcement Special Magistrate PUBLIC RECORDS PROVISIONS FOR ALL CONTRACTS AND AMENDMENTS Effective as of July 1,2016 per Chapter 2016-20, Laws of Florida Section 119.0701. Public Records a) IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT DONNA BARTLE, THE CITY CLERK AND THE CUSTODIAN OF PUBLIC RECORDS AT (904) 247-5809, dbartle(&coab.us, 800 SEMINOLE ROAD, ATLANTIC BEACH, FLORIDA 32233. b) The contractor shall comply with Chapter 119, Florida Statutes, in regards to public records laws, specifically to: 1. Keep and maintain public records required by the public agency to perform the service. 2. Upon request from the public agency's custodian of public records,provide the public agency with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law. 3. Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the contractor does not transfer the records to the public agency. 4. Upon completion of the contract, transfer, at no cost, to the public agency all public records in possession of the contractor or keep and maintain public records required by the public agency to perforin the service. If the contractor transfers all public records to the public agency upon completion of the contract, the contractor shall destroy any duplicate public records that are exempt or confidential and exempt for public records disclosure requirements. If the contractor keeps and maintains public records upon completion of the contract, the contractor shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the public agency, upon request from the public agency's custodian of public records, in a format that is compatible with the information technology systems of the public agency. c) Failure to provide the public records to the public agency within a reasonable time may subject the contractor to penalties under s. 119.10 and s. 119.0701(4),Florida Statutes. Public Records Provisions, Page 1 01098179-I IN ® DATE(MM/DD/YYYY) ACoRI CERTIFICATE OF LIABILITY INSURANCE 03/13/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Bill Hanaway Agency Marketing Services, Inc. A/cc.No.Ext): 727-384-1036 FAX No): 727-3434123 9800 4th Street N,Suite 400 ADDRESS: bhanaway@agencymarketing.com INSURER(S)AFFORDING COVERAGE NAIC# St.Petersburg FL 33702 INSURER A: Berkley Insurance Company 32603 INSURED INSURER B: Jeb T.Branham,P.A. INSURER C: 419 3rd Street North INSURER D: INSURER E: Jacksonville Beach FL 32250 INSURER F: COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: 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 WITH 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. INSR ADOLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY n PROT- n LOC PRODUCTS-COMP/OP AGG $JEC OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS _ AUTOS Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N N/A Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Lawyers Professional Liability 250,000 Each Claim PLP-1354927-P5 11/05/2018 11/05/2019 500,000 Aggregate DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) Deductible: $2,500 each claim Retroactive Date: 11/05/2012 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Jeb T.Branham, P.A. ACCORDANCE WITH THE POLICY PROVISIONS. 419 3rd Street North AUTHORIZED REPRESENTATIVE Jacksonville Beach FL 32250 i3111•1 r 4-'G. 1 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD JEB T. BRANHAM, P.A. 419 3RD STREET NORTH JACKSONVILLE BEACH, FLORIDA 32250 PHONE: 904.339.0500 FACSIMILE: 904.339.0501 JEB@JEBBRANHAM.COM WWW.J EBB RANHAM.COM JEB T . BRANHAM Attorney at Law