2376 RFQ 20/21-23 Prof Consulting Gp - (KEITH, Tetra Tech, Madrid Eng Gp)CITY OF
SANFORD
FINANCE DEPARTMENT
Wednesday, October 27, 2021
PURCHASING DEPARTMENT
TRANSMITTAL MEMORANDUM
To: City Clerk
RE: RFQ 20/21-23 Professional Consulting Services (KEITH, Tetra Tech,
Madrid Engineering Group)
The item(s) noted below is/are attached and forwarded to your office for the following action(s):
❑
Development Order
❑
Mayor's signature
❑
Final Plat (original mylars)
❑
Recording
❑
Letter of Credit
❑
Rendering
❑
Maintenance Bond
®
Safe keeping (Vault)
❑
Ordinance
❑
Deputy City Manager
❑
Performance Bond
❑
Payment Bond
❑
Resolution
❑
City Manager Signature
❑
❑
City Clerk Attest/Signature
❑
City Attorney/Signature
Once completed, please:
❑ Return originals to Purchasing- Department
❑ Return copies
Special Instructions:
OC a/
% From Date
TADept_forms\City Clerk Transmittal Memo - 2009.doc
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jjCITY OF
J
&kNFORD
FST. 1� •.,,
CITY COMMISSION MEMORANDUM 21.220.0
OCTOBER 25, 2021 AGENDA
To:
PREPARED BY:
SUBMITTED BY:
SUBJECT:
W S _ RM X
Item No.
Honorable Mayor and Members of the City Commission
Marisol Ordonez, Purchasing Manager
Norton N. Bonaparte, Jr., ICMA-CM, C
RFQ 20/21-23; Professional Consulting
Competitive Consulting Negotiation Ace
STRATEGIC PRIORITIES:
❑ Unify Downtown & the Waterfront
❑ Promote the City's Distinct Culture
Update Regulatory Framework
Redevelop and Revitalize Disadvantaged Communities
SYNOPSIS:
KIM
Services;
Approval for the procurement under RFQ 20/21-23 for professional engineering consulting
services procured under the Competitive Consulting Negotiation Act (CCNA) for various vendors
is requested.
FISCAL/STAFFING STATEMENT:
Funding for the procurement of CCNA professional engineering consulting services will be
provided based on a department's request for services.
BACKGROUND:
The City processed a new solicitation (RFQ 20/21-23) for professional engineering consulting
services under the CCNA with 19 submissions of qualifications being received; however, only 11
proposals were evaluated and scored by the City's CCNA selection committee as the remaining
eight proposals were presented and approved by the City Commission on September 27, 2021 as
renewal contracts. Thus, the City will have procured a wide array of uniquely talented engineering
firms to serve the needs of the City under continuing contract engagements under the terms of the
CCNA.
The rankings by scores of the selection committee for the 11 firms follows:
Firm Name: Score:
1. Tetra Tech, Inc. 419
2. Madrid Engineering, Inc. 410
3. Keith Engineering Inspired Design 390
4.
Bentley Architects & Eng. Inc.
382
5.
KMA Design Grp. LLC
292
6.
Nadic Engineering Srvc. Inc.
352
7.
Dedging & Marine Consultants
368
8.
JHS Environmental Engineering
312
9.
Metro Consulting Grp. LLC
346
10.
OM Engineering Srvc. Inc.
321
11.
Traffic Engineering Data
315
The following are the three firms that the City's CCNA selection committee recommends be
engaged in continuing contracts with the City in order to provide professional engineering
consulting services in addition to the array of firms currently under continuing contracts with the
City:
1. Tetra Tech, Inc.
2. Madrid Engineering, Inc.
3. Keith Engineering Inspired Design
LEGAL REVIEW:
The Assistant City Attorney has reviewed and has no legal objection with the procurement being
implemented as proposed. The Assistant City Attorney will draft the appropriate contracts upon
action by the City Commission.
RECOMMENDATION:
City staff recommends that the City Commission approve the procurement of the three additional
professional engineering consulting firms to provide professional engineering consulting services
to the City under continuing contracts under solicitation RFQ 20/21-23 and the provisions of the
CCNA.
SUGGESTED MOTION:
"I move to approve the selection of the three additional professional engineering consulting firms
and the award of continuing contracts, as proposed."
Attachments: (1). Bid opening certification minutes, etc.
(2). RFQ Evaluation Matrix (scoring form).
CITY OF SANFORD, FLORIDA - PURCHASING DIVISION
SOLICITATION OPENING CERTIFICATION AND MINUTES (Section 255.0518, Florida Statutes)
A. Solicitation Title Professional Consulting Services-CCNA (Engineering Services)
Number RFQ 20/21-23 Opening Date April 6, 2021 Time
2.00PMLmalTim Solicitation Documents Including
Announcement of This Opening Are Available for Viewing or Downloading at www.myvendorlink.com
Location of Opening: Commission Chamber & RingCentral https://v.ringcentral.com/join/29022169�
1. On this date the opening of the solicitation response identified above is hereby verified and the public
announcements recorded below regarding the solicitations received were duly made. It is noted that no other
business was conducted, there were no discussions and no input was received from anyone in attendance.
There was no attendance record made.
❑ IFB- Announced the name of each bidder and the amount of their bid.
❑ RFP- Announced the name of each respondent.
oRFQ- Announced the name of each respondent.
❑ If any submission was not opened and/or announced: check this item and indicate on tabulation below
specific information as to why the submission was not opened or announced.
W]All submissions were one
2. Name of City0e
Certification (1 B .
Sig
Certification (2) By:
d read. The tabulation below reflects the information read.
nced the bids: Marisol Ordonez
April 6, 2021 Marisol Ordonez, Purchasing Manager
date printed name and title
Signature date printed name and title
3. The public notice indicated by § 286.0105 and 286.011 Florida Statutes is not required because no rule, resolution,
or formal action has taken place or considered at this opening. Therefore, a verbatim record of the solicitation
specifically identified above is not required if a person, in accordance with City of Sanford Policy Number 15., elects
to file a protest or appeal an action associated with the identified solicitation.
4. Florida Statute 119.071: Sealed bids, proposals, or replies received by an agency pursuant to a competitive
solicitation are exempt from s. 119.07(1) and s. 24(a), Art. I of the State Constitution until such time as the agency
provides notice of an intended decision or until 30 days after opening the bids, proposals, or final replies, whichever
is earlier. Note -City of Sanford Procurement Procedure 6-500 mandates that as applicable to an IFB: the name of each
bidder and the specific amount of the bid will be shared at the opening, for an RFP or RFQ the name of each person
or firm will be shared at the opening. (Florida Statues may be found at. hitp:Uww)v.teg state fl.us/statutesl)
Bidder/Proposer I Bid Base Alternate Bid
/ Wi-+nitiai here if tabulation is attached in lieu of using the above tabulation or if additional pages are
attached. It is noted that this is page one of % pages.'
' Page 1 of 1 City of Sanford Doc
April 6, 2021
Bid Opening Date: April 6, 2021 at 2:OOPM Local Time
Location: Commission Chambers -
Solicitation: RFQ 20/21-23 Professional Consulting Services- CCNA (Engineering
Services)
RingCentral Meeting was available on April 6, 2021 at 2:OOPM Local Time
https:Hv.rinfzcentral.com/ioin/290221695
Bid Tabulation Sheet
1. Bentley Architects and Engineers, Inc.
2. CPH Inc.
3. John D Hermann/Arminimus Consultants
4. SMW GeoScience Inc.
5. Madrid Engineering Inc.
6. KEITH Engineering Inspired Design
7. KMA Design Group, LLC
8. NADIC Engineering Services Inc.
9. Professional Services Inc.
10. Reiss Engineering Inc.
11. AVCON Inc.
12. Dedging & Marine Consultants
13. JHS Environmental Engineering
14. Ardaman and Associates Inc.
15. Tetra Tech, Inc.
16. METRO Consulting Group, LLC
17. OM Engineering Services, Inc.
18. Traffic Engineering Data Solutions, Inc.
19. Terracon Consultants, Inc.
Art Woodruff Sheena Britton terry S. Wiggins, Sr. Patrick Austin Patty Mahany Norton N. Bonaparte, Jr.
Mayor District 1 District 2 District 3 District 4 City Manager
City Hall, 2nd Floor • 300 N. Park Avenue • Sanford, FL 32771-1244 • PO Box 1788 • Sanford FL, 32772-1788
p. 407.688.5020 • f. 407.688.5021 o sanfordfl.gov
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AGREEMENT BY AND BETWEEN
THE CITY OF SANFORD, FLORIDA AND TETRA TECH INC. FOR SOLICITATION
NUMBER: RFQ 20/21-23/CCNA MASTER AGREEMENT
THIS CCNA ASTER 4PREEMENT (hereinafter the "Agreement") is made and
entered into this Oday of , 2021, by and between the City of Sanford,
Florida, a Florida municipality, (hereinafter referred to as the "City"), whose mailing
address is 300 North Park Avenue, Sanford, Florida 32771, Tetra Tech Inc., a Delaware
corporation, ("Tetra Tech" throughout) whose principal and mailing address is 3475 East
Foothill Boulevard, Pasadena, California 91107. The City and Tetra Tech may be
collectively referenced herein as the "Parties".
WITNESSETH:
IN CONSIDERATION of the mutual covenants, promises, and representations
contained herein and other good and valuable consideration, the receipt and sufficiency
of which is hereby acknowledged, the Parties hereto agree as follows:
Section 1. Recitals. The above recitals are true and form a material part of
this Agreement upon which the Parties have relied.
Section 2. Authority. Each party hereto represents to the other that it has
undertaken all necessary actions to execute this Agreement, and that it has the legal
authority to enter into this Agreement and to undertake all obligations imposed on it.
The persons executing this Agreement for each party certify that they are authorized to
bind the party fully to the terms of this Agreement.
Section 3. Scope of Agreement. This Agreement is for the consulting and
engineering services as set forth in the Consultant's Competitive Negotiation Act (the
"CCNA" as set forth in Section 287.055, Florida Statutes) and the procurement
solicitation documents relating hereto, the responses thereto from Tetra Tech and the
work orders and documents related thereto as issued by the City (all of which are
incorporated herein as if fully set forth herein verbatim) and it is recognized Tetra Tech
shall perform services as otherwise directed by the City all of such services to include
all labor and materials that may be required including, but in no way limited to, the
goods and services provided by subconsultants as may be approved by the City within
the amount of compensation to be paid to Tetra Tech This is a continuing services
contract under the provisions of the CCNA and within the scope of the professional
service of engineering as defined in Section 471.005(7), Florida Statutes, or its
successor provisions.
Section 4. Effective Date and Term of Agreement. This Agreement shall
take effect on the date that this Agreement is fully executed by the Parties hereto. This
Agreement shall remain in effect until the services provided under all City work orders
have been fully performed in accordance with the requirements of the City; provided,
however, that, the indemnification provisions and insurance provisions of the City's
�' t
standard contractual terms and conditions shall not terminate and the protections
afforded to the City shall continue in effect subsequent to such services being provided
by Tetra Tech No services have commenced prior to the execution of this Agreement
that would entitle Tetra Tech for any compensation therefor.
Section 5. Compensation. The Parties agree to compensation as set forth
in the City's work orders as issued from time -to -time.
Section 6. Standard Contractual Terms and Conditions. All "Standard
Contractual Terms and Conditions", as provided on the City's website, apply to this
Agreement. Such Terms and Conditions may be found at the City's website; which can
be reached at: (https://www.sanfordfl.gov/departments/finance/purchasing/contract-
terms-and-conditions or www. SanfordFL.gov), or a successor link. The Parties shall
also be bound by the purchasing policies and procedures of the City as well as the
controlling provisions of Florida law. Work orders shall be used, in accordance
therewith, in the implementation of this Agreement to the extent deemed necessary by
the City in its sole and absolute discretion. Additionally, the Parties agree that the
provisions of all Federal rules and procedures, and any other matters required to be
incorporated herein are incorporated into this Agreement (such as, but not limited to,
any and all required contract clauses by agencies such as the Federal Emergency
Management Agency and the Florida Department of Economic Opportunity or their
successor agencies). All services shall be subject to the provisions of the CCNA and all
controlling requirements of Federal law.
Section 7. Tetra Tech's Mandatory Compliance with Chapter 119, Florida
Statutes, and Public Records Requests.
(a). In order to comply with Section 119.0701, Florida Statutes, public records
laws, Tetra Tech must:
(1). Keep and maintain public records that ordinarily and necessarily
would be required by the City in order to perform the service.
(2). Provide the public with access to public records on the same
terms and conditions that the City would provide the records and at a
cost that does not exceed the cost provided in Chapter 119, Florida
Statutes, 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.
(4). Meet all requirements for retaining public records and transfer, at
no cost, to the City all public records in possession of Tetra Tech
upon termination of the contract and destroy any duplicate public
records that are exempt or confidential and exempt from public
21'
records disclosure requirements. All records stored electronically
must be provided to the City in a format that is compatible with the
information technology systems of the City.
(b). If Tetra Tech does not comply with a public records request, the City shall
enforce the contract provisions in accordance with this Agreement.
(c). Failure by Tetra Tech o grant such public access and comply with public
records requests shall be grounds for immediate unilateral cancellation of this
Agreement by the City. Tetra Tech shall promptly provide the City with a copy of any
request to inspect or copy public records in possession of Tetra Tech and shall promptly
provide the City with a copy of Tetra Tech's response to each such request.
(d). IF THE CONTRACTORIVENDOR HAS QUESTIONS
REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA
STATUTES, TO THE CONTRACTOR'S (VENDOR'S) DUTY TO
PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT,
CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT (407) 688-5012,
TRACI HOUCHIN, MMC, FCRM, CITY CLERK, CITY OF SANFORD,
CITY HALL, 300 NORTH PARK AVENUE, SANFORD, FLORIDA 32771,
TRACI.HOUCHIN@SANFORDFL.GOV.
Section 8. Time is of the Essence. Time is hereby declared of the essence
as to the lawful performance of all duties and obligations set forth in this Agreement.
Section 9. Entire Agreement/Modification. This Agreement and the
provisions thereof, together with all standard contractual terms and conditions, as
provided on the City's website and the controlling requirements of Federal law, and
including, without limitation, the documents attached hereto, constitute the entire
integrated agreement between the City and Tetra Tech and supersedes and controls
over any and all prior agreements, understandings, representations, correspondence
and statements whether written or oral in connection therewith and all the terms and
provisions contained herein constitute the full and complete agreement between the
Parties hereto to the date hereof. This Agreement may only be amended, supplemented
or modified by a formal written amendment of equal dignity herewith.
Section 10. Severability. If any term, provision or condition contained in this
Agreement shall, to any extent, be held invalid or unenforceable, the remainder of this
Agreement, or the application of such term, provision or condition to persons or
circumstances other than those in respect of which it is invalid or unenforceable, shall
not be affected thereby, and each term, provision and condition of this Agreement shall
be valid and enforceable to the fullest extent permitted by law when consistent with
equity and the public interest.
3 11 '
Section 11. Waiver. The failure of the City to insist in any instance upon
the strict performance of any provision of this Agreement, or to exercise any right or
privilege granted to the City hereunder shall not constitute or be construed as a waiver
of any such provision or right and the same shall continue in force.
Section 12. Captions. The section headings and captions of this Agreement
are for convenience and reference only and in no way define, limit, describe the scope
or intent of this Agreement or any part thereof, or in any way affect this Agreement or
construe any provision of this Agreement.
Section 13. Counterparts. This Agreement may be executed in any
number of counterparts, each of which shall be deemed an original, but all of which,
taken together, shall constitute one and the same document.
Section 14. Binding Effect. This Agreement shall be binding upon and
inure to the benefit of the successors in interest, transferees and assigns of the Parties.
Each party hereto represents to the other that it has undertaken all necessary actions to
execute this Agreement, and that it has the legal authority to enter into this Agreement
and to undertake all obligations imposed on it. The signatories hereof represent that
they have the requisite and legal authority to execute this Agreement and bind the
respective Parties herein.
Section 15. Remedies. The rights and remedies of the Parties, provided for
under this Agreement, are in addition to any other rights and remedies provided by law
or otherwise necessary in the public interest.
Section 16. Governing law, Venue and Interpretation. This Agreement is
to be governed by the laws of the State of Florida. Venue for any legal proceeding
related to this Agreement shall be in the Eighteenth Judicial Circuit Court in and for
Seminole County, Florida. This Agreement is the result of bona fide arms length
negotiations between the City and Tetra Tech, and all Parties have contributed
substantially and materially to the preparation of the Agreement. Accordingly, this
Agreement shall not be construed or interpreted more strictly against any one party.
than against any other party and all provisions shall be applied to fulfill the public
interest.
IN WITNESS WHEREOF, the City and Tetra Tech have executed this instrument
for the purpose herein expressed.
SIGNATURE BLOCKS FOLLOW:
41P
J
Attest: CITY OF SANFORD
Traci Houchin, MMC, FCRM r;.r ArtWoodruff
City Clerk ��'�""°� Mayor
,+a -Date:
r
Approved as to form and r
legal sufficiency. vk f''iis'
hey ��: �,,)^A� .r'".•
m40,J,J,.--
Colbert, CityoAttorrn
Air on
Attest: .4 C/9
L� rbnce<Jenkins
Vice President
Tetra Tech, Inc., a Delaware
Corporation.
By:
Jon F, P.E.
Vice President
Dated:
5�f',�
OTETRATECH
CERTIFICATE
TETRA TECH, INC.
To The City of Sanford, Florida:
I hereby certify to you that I am the duly elected and qualified Senior Vice President, General
Counsel and Secretary of Tetra Tech, Inc., a Delaware corporation (the "Company"), and that as such, I
am authorized to execute this Certificate on behalf of the Company. I further certify to you on behalf of
the Company that:
Jon Fox, Vice President within the Company's Resilient and Sustainable Infrastructure Division of
the Government Services Group, is authorized and empowered, in accordance with the Company's
Signature Approval Authority Matrix, as approved by the Company's Board of Directors, to execute for
and on behalf of the Company, Solicitation Number: RFQ 20/21-23/CCNA Master Agreement between
the Company and the City of Sanford, Florida.
IN WITNESS WHEREOF, I have hereunto set my hand as of this 18th day of October, 2021.
Preston Hopscill
Senior Vice President, General Counsel
and Secretary
FEB
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Form
(liev. October 2018)
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3. i am a U.S. clizen or other U.S. n9. and
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Certifioatlon instruettons. You must cross out item 2 above if you have been notified by the IRS that you are currendYs ubject to back WhhltoUN because
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acquisition or abandonment of secured property, cancellation of debt, contributions apply, For mortgage interest
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General instructions
Section references are to the Internal Revenue Code unless Wtorwise
noted.
Futur'a developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/F0rmW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identifir tt on number (TTN) which may be your social security number
(SSM, Individual taxpayer identification number (MM, adoption
taxpayer identification number (ATIN), or employer Identificationtdoptidopti
t�M, to report on an information return the amount paid to ion number
you, or other
amount reportable on an information retort. Examples of Information
returns include, but are not limited to, the following.
• Form 1099 -INT (interest earned or paid)
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• Form 1og9-DIV r
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• Form 1099 -"SC (various types of income, prizes, awards. or gross
Proceeds)
• Form 1099-8 (stock or mutual fund sales and certain other
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Use Form W-9 only if you are a U.S. Person (including a resident
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it you do not return Form W-9 to the requester with a TIN, you might
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later.
Cat No. 10231x
Form tin -s (Rev. to -2018)
AGREEMENT BY AND BETWEEN
THE CITY OF SANFORD, FLORIDA AND MADRID ENGINEERING GROUP, INC.
FOR SOLICITATION NUMBER: RFQ 20/21-23/CCNA MASTER AGREEMENT
THIS CCNA I ASTER AGREEMENT (hereinafter the "Agreement") is made and
entered into this _41
day of _, 2021, by and between the City of Sanford,
Florida, a Florida municipality, (hereinafter referred to as the "City"), whose mailing
address is 300 North Park Avenue, Sanford, Florida 32771, Madrid Engineering Group
Inc., a Florida corporation, ("Madrid Engineering Group" throughout) whose principal
and mailing address is 2030 State Road 60 East, Bartow, Florida 338304268. The City
and Madrid Engineering Group may be collectively referenced herein as the "Parties".
WITNESSETH:
IN CONSIDERATION of the mutual covenants, promises, and representations
contained herein and other good and valuable consideration, the receipt and sufficiency
of which is hereby acknowledged, the Parties hereto agree as follows:
Section 1. Recitals. The above recitals are true and form a material part of
this Agreement upon which the Parties have relied.
Section 2. Authority. Each party hereto represents to the other that it has
undertaken all necessary actions to execute this Agreement, and that it has the legal
authority to enter into this Agreement and to undertake all obligations imposed on it.
The persons executing this Agreement for each party certify that they are authorized to
bind the party fully to the terms of this Agreement.
Section 3. Scope of Agreement. This Agreement is for the consulting and
engineering services as set forth in the Consultant's Competitive Negotiation Act (the
"CCNA" as set forth in Section 287.055, Florida Statutes) and the procurement
solicitation documents relating hereto, the responses thereto from Madrid Engineering
Group and the work orders and documents related thereto as issued by the City (all of
which are incorporated herein as if fully set forth herein verbatim) and it is recognized
Madrid Engineering Group shall perform services as otherwise directed by the City all of
such services to include all labor and materials that may be required including, but in no
way limited to, the goods and services provided by subconsultants as may be approved
by the City within the amount of compensation to be paid to Madrid Engineering Group
This is a continuing services contract under the provisions of the CCNA and within the
scope of the professional service of engineering as defined in Section 471.005(7),
Florida Statutes, or its successor provisions.
Section 4. Effective Date and Term of Agreement. This Agreement shall
take effect on the date that this Agreement is fully executed by the Parties hereto. This
Agreement shall remain in effect until the services provided under all City work orders
have been fully performed in accordance with the requirements of the City; provided,
however, that, the indemnification provisions and insurance provisions of the City's
I I Page
standard contractual terms and conditions shall not terminate and the protections
afforded to the City shall continue in effect subsequent to such services being provided
by Madrid Engineering Group No services have commenced prior to the execution of
this Agreement that would entitle Madrid Engineering Group for any compensation
therefor.
Section 5. Compensation. The Parties agree to compensation as set forth
in the City's work orders as issued from time -to -time.
Section 6. Standard Contractual Terms and Conditions. All "Standard
Contractual Terms and Conditions", as provided on the City's website, apply to this
Agreement. Such Terms and Conditions may be found at the City's website; which can
be reached at: (https://www.sanfordfl.gov/departments/finance/purchasing/contract-
terms-and-conditions or www. SanfordFL.gov), or a successor link. The Parties shall
also be bound by the purchasing policies and procedures of the City as well as the
controlling provisions of Florida law. Work orders shall be used, in accordance
therewith, in the implementation of this Agreement to the extent deemed necessary by
the City in its sole and absolute discretion. Additionally, the Parties agree that the
provisions of all Federal rules and procedures, and any other matters required to be
incorporated herein are incorporated into this Agreement (such as, but not limited to,
any and all required contract clauses by agencies such as the Federal Emergency
Management Agency and the Florida Department of Economic Opportunity or their
successor agencies). All services shall be subject to the provisions of the CCNA and all
controlling requirements of Federal law.
Section 7. Madrid Engineering Group's Mandatory Compliance with
Chapter 119, Florida Statutes, and Public Records Requests.
(a). In order to comply with Section 119.0701, Florida Statutes, public records
laws, Madrid Engineering Group must:
(1). Keep and maintain public records that ordinarily and necessarily
would be required by the City in order to perform the service.
(2). Provide the public with access to public records on the same
terms and conditions that the City would provide the records and at a
cost that does not exceed the cost provided in Chapter 119, Florida
Statutes, 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.
(4). Meet all requirements for retaining public records and transfer, at
no cost, to the City all public records in possession of Madrid
Engineering Group upon termination of the contract and destroy any
21Page
duplicate public records that are exempt or confidential and exempt
from public records disclosure requirements. All records stored
electronically must be provided to the City in a format that is
compatible with the information technology systems of the City.
(b). If Madrid Engineering Group does not comply with a public records
request, the City shall enforce the contract provisions in accordance with this
Agreement.
(c). Failure by Madrid Engineering Group to grant such public access and
comply with public records requests shall be grounds for immediate unilateral
cancellation of this Agreement by the City. Madrid Engineering Group shall promptly
provide the City with a copy of any request to inspect or copy public records in
possession of Madrid Engineering Group and shall promptly provide the City with a
copy of Madrid Engineering Group's response to each such request.
(d). IF THE CONTRACTORIVENDOR HAS QUESTIONS
REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA
STATUTES, TO THE CONTRACTOR'S (VENDOR'S) DUTY TO
PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT,
CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT (407) 688-5012,
TRACI HOUCHIN, MMC, FCRM, CITY CLERK, CITY OF SANFORD,
CITY HALL, 300 NORTH PARK AVENUE, SANFORD, FLORIDA 32771,
TRACI.HO00HIN@SANFORDFL.GOV.
Section 8. Time is of the Essence. Time is hereby declared of the essence
as to the lawful performance of all duties and obligations set forth in this Agreement.
Section 9. Entire Agreement/Modification. This Agreement and the
provisions thereof, together with all standard contractual terms and conditions, as
provided on the City's website and the controlling requirements of Federal law, and
including, without limitation, the documents attached hereto, constitute the entire
integrated agreement between the City and Madrid Engineering Group and supersedes
and controls over any and all prior agreements, understandings, representations,
correspondence and statements whether written or oral in connection therewith and all
the terms and provisions contained herein constitute the full and complete agreement
between the Parties hereto to the date hereof. This Agreement may only be amended,
supplemented or modified by a formal written amendment of equal dignity herewith.
Section 10. Severability. If any term, provision or condition contained in this
Agreement shall, to any extent, be held invalid or unenforceable, the remainder of this
Agreement, or the application of such term, provision or condition to persons or
circumstances other than those in respect of which it is invalid or unenforceable, shall
not be affected thereby, and each term, provision and condition of this Agreement shall
31 Pa!, c
be valid and enforceable to the fullest extent permitted by law when consistent with
equity and the public interest.
Section 11. Waiver. The failure of the City to insist in any instance upon
the strict performance of any provision of this Agreement, or to exercise any right or
privilege granted to the City hereunder shall not constitute or be construed as a waiver
of any such provision or right and the same shall continue in force.
Section 12. Captions. The section headings and captions of this Agreement
are for convenience and reference only and in no way define, limit, describe the scope
or intent of this Agreement or any part thereof, or in any way affect this Agreement or
construe any provision of this Agreement.
Section 13. Counterparts. This Agreement may be executed in any
number of counterparts, each of which shall be deemed an original, but all of which,
taken together, shall constitute one and the same document.
Section 14. Binding Effect. This Agreement shall be binding upon and
inure to the benefit of the successors in interest, transferees and assigns of the Parties.
Each party hereto represents to the other that it has undertaken all necessary actions to
execute this Agreement, and that it has the legal authority to enter into this Agreement
and to undertake all obligations imposed on it. The signatories hereof represent that
they have the requisite and legal authority to execute this Agreement and bind the
respective Parties herein.
Section 15. Remedies. The rights and remedies of the Parties, provided for
under this Agreement, are in addition to any other rights and remedies provided by law
or otherwise necessary in the public interest.
Section 16. Governing law, Venue and Interpretation. This Agreement is
to be governed by the laws of the State of Florida. Venue for any legal proceeding
related to this Agreement shall be in the Eighteenth Judicial Circuit Court in and for
Seminole County, Florida. This Agreement is the result of bona fide arms length
negotiations between the City and Madrid Engineering Group, and all Parties have
contributed substantially and materially to the preparation of the Agreement.
Accordingly, this Agreement shall not be construed or interpreted more strictly against
any one party. than against any other party and all provisions shall be applied to fulfill
the public interest.
IN WITNESS WHEREOF, the City and Madrid Engineering Group have executed
this instrument for the purpose herein expressed.
SIGNATURE BLOCKS FOLLOW:
41Paor e
Attest:
Traci Houchin, MMC, FCRM
City Clerk
CITY OF SANFORD
By:
Art Wood
Mayor
Approved as to form and
legal sufficiency.
,a ;r
iam L Colbert, City Att ne i
'/6
Attest: /I C/q Madrid Engineering Group, Inc., a
Florida corporation.
Stephen Tarte
CEO
Sheila Tarte
President /
Dated: / e21 ci/
51 �'
Form W-9 Request for Taxpayer Give Form to the
Re%, cc. ote- 2015" Identification Number and Certification requester. Do not
0--pan're"! of elle Tres:ix'f
10- Go to www irS,gOV1FOhmV1r9 for instructions and the latent inf—.+;— send to the IRS,
irorrie tc, "!fIlmi Narne lS f 1401`eZ 00 tNS oe, not leave, fills ii'le ofan
k.
2 Bus"r(?sss an a, ,:Ititv rfalne, if
to rb )�-p
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3 Crc-c�. aplyuptizil4p for M
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rty, W.'a, I ante ei i�
Bartow FL 3383.0.
7 Lis! ac, -Our;'
1Mre iopzicw,l i
aixpayer Ident fication Number (TfNj
Enter your TIN in the appropriate box. Tre TIN wovided mu,,I rriatch the raire giver, an firte I to a Social security number
backup wilhh;.)Iding, For ilidividuals• this is generally your s( tat security ;,,b(�, void
resident ilsen Sole propffetor, Oe ' disregarded entity. . hr- lowever. for a
entities. it is YOV er!'PlOyer iden see I , inStfUctions for Part 1. later. For other
identification fluo'be, (EIN), if you do mot have ljk,rlb,
TIN, later .see Fiow to gel
or
Note: It the accCulll is r.•: thar one POrne. Set- the instructions for I'lle 1, Also see lWitig Mifne, aro Employerentification number
%1mbilt To Give the R&Quesler for guidelines (In vvhost� nurf tber to enter , ------
5'9-;31115'617 1
-!311151617 212'
order) of pejuj (,,,tlfy that:
1 TIie nunit,&, Shruywr, of,
,,)is form is f `Y IZJAPTyi.r iderlitication n rnl).r for I art veelltirlg fora nurribet to be issued to inn l; arid
2 1 am not subject to, backup Vithholding because: ,ai i dill fiaxPfnpt from bnckupl withholding. Or (bt 1 have not I:feen rectified by file Interral Revenue
Service i , IRS) that I ani subject to back�,,p vi;thholding.afia resol of a laillire to alt Ortel est ! w diVdellds. cr fell the IRS has rotififA me that I am.
ro longer subject to backup withholding; arid
1 1 am , U.S. citizen or other (,i.S.person idel,tred telovj. i, -d
t. The FA -'--A co-jclseo,t,.eej of! thistlorrnI
,f lny: ind atairi tvat 1 &M exempt from FATCA reporting is correct.
Certification instructions, yuj niust c
,rnss ouitem 2 above ;f you have beer noifir,,d by the IRS that you 3le cueren!;y subject to ba(,kjp withholding
you have %jilej to rel.10,1 Z�.Il lillfyel Decause
-it illid dividw,�ii; of,, vrur For real �-,,tate trarf!;ac*.w)r,,�,, lt�-irt 2 does riot apply,
acqut ilOn Or abandonment of secii-ere -.top Y. �;dlf.t!!13110-iof debt. corldhiAnns to a,- rp re
.s _ pit rly. For frior%jage interest caid.
Other the n interest and cividerics. vol. are n( I, mell, arTangern-en? ilRAI, and generally, payments
•gn the cortifi"arICn tt;t "'kr" q
h't Parr It, later,
-Signature -cf—
Here I U.S. person 1--4 10/19/2021
, Date!
Genera'I Instructions
Ser"Or te'c-e--, -' to tile internal Revl,Vue Code otfa r-
se
noted.
Future developments. or file
WX
Xit developments
related to Fulfil W-9 and its Instructions, Sue 1, ,)s lec islatioll f�lj I
I published. go to www.; Ittey Wert VV9, a( Oct
Purpose of Form
An irldividUal Or L -lit"; Form, tiV 9 requpste,�,, rpfIui,pfj , the an
rin
i"f0alicill 'the IPS Must Obta:n your correct I 1,paytj
identification rumbe! il IN) which stay be ycl it social security cumber
ISM, irdivi&al laxpavet idewtificalionI
'liumbe, rITIN)adoption
taxPaYer 04WItificalion number to I IN3. or et,10o,
wer identification titnibef,
,lEIN), to report on ar information return th*+ ,lnlotivl paid Ire you. or Other
3mO-'.nt rePOIJbIle 0a all inforr!i-jtjori ?L.IL.rfl. Exam,), s of 1 0,
I matior
-etums ir�dLjde, b— are rot limited to- the following.
- Form 1099 -INT tinterest earned or paid]
Oaf ^40 10:>:ttx
• Form 1099-01V (dividends. including those frot-,l stocks or mutual
wes. a,,ivards. or q,�,ss
i'larious lype,� of il c jrne
• Form 1090-8 Ist ock or mutual ft,nd Siles bred certain other
ransactiuns by brc*ers±
• Pon-ri Trwi-S (proce.ec is front T-Ral estate trarsactionsl
• f tflu", pall-, fransacturs)
F,';Fr" 1098 lhorrne mQrtgage wte,,!stl, ity98-t. Ica, zt,re
1098-T itotfor"i - I .
• Form 1099-C (Canceled debt)
• "Orin I099 -A Orab,1nfjoqf-:lc,-1 .)o r f,,rp S I _id prcpe y
thse Fo,rn Vj-y oniy j; yo, area U,S, PelsonEincludino a residont
10 Prc-vide TIN,
return FOMI W-9 to flip rrRjaester ",th a TW, you rn;gfn
DocuSign Envelope ID: 15B38439-9860-41CF-BA90-85C1D8B88FF7
AGREEMENT BY AND BETWEEN
THE CITY OF SANFORD, FLORIDA AND KEITH AND ASSOCIATES, INC. FOR
SOLICITATION NUMBER: RFQ 20/21-23/CCNA MASTER AGREEMENT
THIS CCNA MASTER AGREEMENT (hereinafter the "Agreement") is made and
entered into this p4 day of . -, 2021, by and between the City of Sanford,
Florida, a Florida municipality, (hereinafter referred to as the "City"), whose mailing
address is 300 North Park Avenue, Sanford, Florida 32771, Keith and Associates Inc., a
Florida corporation doing business as "KEITH", ("Keith and Associates" throughout)
whose principal and mailing address is 301 East Atlantic Boulevard, Pompano Beach,
Florida 33060. The City and Keith and Associates may be collectively referenced herein
as the "Parties".
WITNESSETH:
IN CONSIDERATION of the mutual covenants, promises, and representations
contained herein and other good and valuable consideration, the receipt and sufficiency
of which is hereby acknowledged, the Parties hereto agree as follows:
Section 1. Recitals. The above recitals are true and form a material part of
this Agreement upon which the Parties have relied.
Section 2. Authority. Each party hereto represents to the other that it has
undertaken all necessary actions to execute this Agreement, and that it has the legal
authority to enter into this Agreement and to undertake all obligations imposed on it.
The persons executing this Agreement for each party certify that they are authorized to
bind the party fully to the terms of this Agreement.
Section 3. Scope of Agreement. This Agreement is for the consulting and
engineering services as set forth in the Consultant's Competitive Negotiation Act (the
"CCNA" as set forth in Section 287.055, Florida Statutes) and the procurement
solicitation documents relating hereto, the responses thereto from Keith and Associates
and the work orders and documents related thereto as issued by the City (all of which
are incorporated herein as if fully set forth herein verbatim) and it is recognized Keith
and Associates shall perform services as otherwise directed by the City all of such
services to include all labor and materials that may be required including, but in no way
limited to, the goods and services provided by subconsultants as may be approved by
the City within the amount of compensation to be paid to Keith and Associates This is a
continuing services contract under the provisions of the CCNA and within the scope of
the professional service of engineering as defined in Section 471.005(7), Florida
Statutes, or its successor provisions.
Section 4. Effective Date and Term of Agreement. This Agreement shall
take effect on the date that this Agreement is fully executed by the Parties hereto. This
Agreement shall remain in effect until the services provided under all City work orders
have been fully performed in accordance with the requirements of the City; provided,
I I pa g e
DocuSign Envelope ID: 151338439-9860-41 CF-BA90-85C1D8B88FF7
however, that, the indemnification provisions and insurance provisions of the City's
standard contractual terms and conditions shall not terminate and the protections
afforded to the City shall continue in effect subsequent to such services being provided
by Keith and Associates No services have commenced prior to the execution of this
Agreement that would entitle Keith and Associates for any compensation therefor.
Section 6. Compensation. The Parties agree to compensation as set forth
in the City's work orders as issued from time -to -time.
Section 6. Standard Contractual Terms and Conditions. All "Standard
Contractual Terms and Conditions", as provided on the City's website, apply to this
Agreement. Such Terms and Conditions may be found at the City's website; which can
be reached at: (https://www.sanfordfl.gov/departments/finance/purchasing/contract-
terms-and-conditions or www. Sanford FL.gov), or a successor link. The Parties shall
also be bound by the purchasing policies and procedures of the City as well as the
controlling provisions of Florida law. Work orders shall be used, in accordance
therewith, in the implementation of this Agreement to the extent deemed necessary by
the City in its sole and absolute discretion. Additionally, the Parties agree that the
provisions of all Federal rules and procedures, and any other matters required to be
incorporated herein are incorporated into this Agreement (such as, but not limited to,
any and all required contract clauses by agencies such as the Federal Emergency
Management Agency and the Florida Department of Economic Opportunity or their
successor agencies). All services shall be subject to the provisions of the CCNA and all
controlling requirements of Federal law.
Section 7. Keith and Associates' Mandatory Compliance with Chapter
119, Florida Statutes, and Public Records Requests.
(a). In order to comply with Section 119.0701, Florida Statutes, public records
laws, Keith and Associates must:
(1). Keep and maintain public records that ordinarily and necessarily
would be required by the City in order to perform the service.
(2). Provide the public with access to public records on the same
terms and conditions that the City would provide the records and at a
cost that does not exceed the cost provided in Chapter 119, Florida
Statutes, 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.
(4). Meet all requirements for retaining public records and transfer, at
no cost, to the City all public records in possession of Keith and
Associates upon termination of the contract and destroy any
21P i e
DocuSign Envelope ID: 15B39439-9860-41CF-BA90-85C1D8B88FF7
duplicate public records that are exempt or confidential and exempt
from public records disclosure requirements. All records stored
electronically must be provided to the City in a format that is
compatible with the information technology systems of the City.
(b). If Keith and Associates does not comply with a public records request, the
City shall enforce the contract provisions in accordance with this Agreement.
(c). Failure by Keith and Associates to grant such public access and comply
with public records requests shall be grounds for immediate unilateral cancellation of
this Agreement by the City. Keith and Associates shall promptly provide the City with a
copy of any request to inspect or copy public records in possession of Keith and
Associates and shall promptly provide the City with a copy of Keith and Associates'
response to each such request.
(d). IF THE CONTRACTOR/VENDOR HAS QUESTIONS
REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA
STATUTES, TO THE CONTRACTOR'S (VENDOR'S) DUTY TO
PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT,
CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT (407) 688-5012,
TRACI HOUCHIN, MMC, FORM, CITY CLERK, CITY OF SANFORD,
CITY HALL, 300 NORTH PARK AVENUE, SANFORD, FLORIDA 32771,
TRACI.HOUCHIN@SANFORDFL.GOV.
Section 8. Time is of the Essence. Time is hereby declared of the essence
as to the lawful performance of all duties and obligations set forth in this Agreement.
Section 9. Entire Agreement/Modification. This Agreement and the
provisions thereof, together with all standard contractual terms and conditions, as
provided on the City's website and the controlling requirements of Federal law, and
including, without limitation, the documents attached hereto, constitute the entire
integrated agreement between the City and Keith and Associates and supersedes and
controls over any and all prior agreements, understandings, representations,
correspondence and statements whether written or oral in connection therewith and all
the terms and provisions contained herein constitute the full and complete agreement
between the Parties hereto to the date hereof. This Agreement may only be amended,
supplemented or modified by a formal written amendment of equal dignity herewith.
Section 10. Severability. If any term, provision or condition contained in this
Agreement shall, to any extent, be held invalid or unenforceable, the remainder of this
Agreement, or the application of such term, provision or condition to persons or
circumstances other than those in respect of which it is invalid or unenforceable, shall
not be affected thereby, and each term, provision and condition of this Agreement shall
be valid and enforceable to the fullest extent permitted by law when consistent with
equity and the public interest.
3 1 P a e
DocuSign Envelope ID: 151338439-9860-41CF-BA90-85C1 D81388FF7
Section 11. Waiver. The failure of the City to insist in any instance upon
the strict performance of any provision of this Agreement, or to exercise any right or
privilege granted to the City hereunder shall not constitute or be construed as a waiver
of any such provision or right and the same shall continue in force.
Section 12. Captions. The section headings and captions of this Agreement
are for convenience and reference only and in no way define, limit, describe the scope
or intent of this Agreement or any part thereof, or in any way affect this Agreement or
construe any provision of this Agreement.
Section 13. Counterparts. This Agreement may be executed in any
number of counterparts, each of which shall be deemed an original, but all of which,
taken together, shall constitute one and the same document.
Section 14. Binding Effect. This Agreement shall be binding upon and
inure to the benefit of the successors in interest, transferees and assigns of the Parties.
Each party hereto represents to the other that it has undertaken all necessary actions to
execute this Agreement, and that it has the legal authority to enter into this Agreement
and to undertake all obligations imposed on it. The signatories hereof represent that
they have the requisite and legal authority to execute this Agreement and bind the
respective Parties herein.
Section 15. Remedies. The rights and remedies of the Parties, provided for
under this Agreement, are in addition to any other rights and remedies provided by law
or otherwise necessary in the public interest.
Section 16. Governing law, Venue and Interpretation. This Agreement is
to be governed by the laws of the State of Florida. Venue for any legal proceeding
related to this Agreement shall be in the Eighteenth Judicial Circuit Court in and for
Seminole County, Florida. This Agreement is the result of bona fide arms length
negotiations between the City and Keith and Associates, and all Parties have
contributed substantially and materially to the preparation of the Agreement.
Accordingly, this Agreement shall not be construed or interpreted more strictly against
any one party. than against any other party and all provisions shall be applied to fulfill
the public interest.
IN WITNESS WHEREOF, the City and Keith and Associates have executed this
instrument for the purpose herein expressed.
SIGNATURE BLOCKS FOLLOW:
4
DocuSign Envelope ID: 15B38439-9860-41CF-BA90-85C1D8B88FF7
Attest:
Traci Houchin, MMC, FCRM
City Clerk
O
Approved as to form and
legal sufficiency.
icry 4A,
•�'l,:tr J'�•
f rl
I' o Bert, C(y Att rney
lk,o A//%J/C-; /L) X-�7
Attest: 19-<11k
FDocuSigned by:
F^JG�oI{�t uv,�,f,V�t/b4
--- oonsnoo•�s•�>.cr
Elizabeth Underwood
Secretary
CITY OF SANFORD
By:
Art Woodruff
Mayor
Date:
Keith and Associates, Inc., a Florida
corporation, doing business as
"KEITH".
ocuSigned by:
By: Fob",
d1L 1`t,titit,—�jbWA
e8+'^'BBB 4d A+8
Adolphine Keith-Lazowick
President/Treasurer
Dated: 10/18/2021
51Pa`e
DocuSign Envelope ID: B8DC1241-7144-4429-A95E-24723DOB D8D3
i axpayer Ioenuncation 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. ole For individuals, this is generally your social security number (SSNr. However, for a — m —
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 I Employer identification number
Number To Give the Requesterfor guidelines on whose number to enter. F__i___l
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. 1 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. 1 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�oj required sign the certification, but you must provide your correct TIN. See the instructions for Part 11, later.
Sign Signature of / (� a„
Here U.S. person► !' /�4 Date► i � ?� e
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FcrmW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099 -INT (interest earned or paid)
• Form 1099 -DIV (dividends, including those from stocks or mutual
funds)
a Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
e Form 1099-S (proceeds from real estate transactions)
o Form 1099-K (merchant card and third party network transactions)
o Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
e Form 1099-C (canceled debt)
a Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
Cat. No. 10231X Form W-9 (Rev. 10-2018)
W11111111119
Request for Taxpayer
Give
Form
Identification Number Certification
Form to the
(Rev. October
2018)
and
requester. Do not
Department of the Treasury
Internal Revenue Service
P Go to www.irs.gov/FormW9 for instructions and the latest information.
send to the IRS.
1 Name (as shown on your income tax return). Name Is required on this line; do not leave this line blank.
Keith and Associates, Inc.
2 Business name/disregarded entity name, If different from above
dba KEITH
m3
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
ro
following seven boxes.
certain entities, not individuals; see
a
o
❑ Individual/sole proprietor or 21 C Corporation ❑ S Corporation ElPartnership ❑ Trust/estate
instructions on page 3):
o
single member LLC
Exempt payee code (if any)
CL
❑ Limited liability company. Enter the tax classification (C --C corporation, S=S corporation, P=Partnership) ►
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Note; Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check
LLC
Exemption from FATCA reporting
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if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is
n
another LLC that Is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that
code (f any)
Is disregarded from the owner should check the appropriate box for the tax classification of its owner.
Other (see instructions b -m E]Oth)
oL c+M� to account. men5ined uuL:,fi the U.S,1
y
5 Address (number, street, and apt. or suite no.) See instructions.
Requester's name and address (optional
301 East Atlantic Boulevard
6 City, state, and ZIP code
Pompano Beach, FL 33060
7 List account number(s) here (optional)
i axpayer Ioenuncation 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. ole For individuals, this is generally your social security number (SSNr. However, for a — m —
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 I Employer identification number
Number To Give the Requesterfor guidelines on whose number to enter. F__i___l
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. 1 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. 1 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�oj required sign the certification, but you must provide your correct TIN. See the instructions for Part 11, later.
Sign Signature of / (� a„
Here U.S. person► !' /�4 Date► i � ?� e
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FcrmW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099 -INT (interest earned or paid)
• Form 1099 -DIV (dividends, including those from stocks or mutual
funds)
a Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
e Form 1099-S (proceeds from real estate transactions)
o Form 1099-K (merchant card and third party network transactions)
o Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
e Form 1099-C (canceled debt)
a Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
Cat. No. 10231X Form W-9 (Rev. 10-2018)