1 REQUEST FOR QUOTE (RFQ) Project Name: Disaster Recovery Hosting Service RFQ Number: IT-2013-RFQ-019 OUR KIDS CONTACT INFORMATION Project Manager: Contract Manager: Submission Address: Patrick Travers Leslie Glazer Our Kids of Miami-Dade/Monroe, Inc. 401 NW 2 nd Avenue, Suite S-10 th Floor Miami, Florida Florida-Based Businesses, Minority Business Enterprises (MBE), Small Businesses Enterprises (SBE) and Women s Business Enterprises (WBE) are encouraged to participate.
2 1. STATEMENT OF NEED Our Kids of Miami-Dade/ Monroe, Inc. has completed an analysis of existing business application and determined those which are critical in nature and would need to be supported at an alternate facility in the event of a disaster. Our Kids has made a determination of the facility requirement and system configuration, which we feel, is adequate to provide necessary backup for these critical applications. Our Kids has issued this Request For Quote for Disaster Recovery Services and is seeking responsive quotes. The intent of this document is to define the parameters and requirements of the desired disaster recovery services. We are seeking a quote for: 1 Full Cabinet at least 40U 20A x 120V(A+B) 10 Megs of Internet Cross connect costs for POTS/T-1/Fiber Ethernet/Copper Ethernet Cost for Remote Hands per hour/monthly Any additional fees not included in Service Order 2. COMPANY BACKGROUND About Us Our Kids is the non-profit Lead Agency for Community Based Care in Miami-Dade and Monroe counties. We contract with the Florida Department of Children & Families to provide foster care and related services to abused and/or neglected children. Our Kids promotes our Community s Values and Beliefs that were created as part of the Casey Family Programs Innovation Site Project with the Department of Children and Families. Miami, Gainesville and Pensacola were designated state innovation sites and each team had to develop a plan to improve their System of Care's approach to Family Centered Practice. Our Community s Values and Beliefs was the result of almost a year's worth of meeting and planning with all Dependency stakeholders. Our Kids vision is that the at-risk children of Miami-Dade and Monroe counties grow up in safe, permanent Families Guiding Principles Customer Service: Ensure that customer needs are met in a manner that is both child and family focused and in a manner that demonstrates commitment to being responsive and respectful to cultural diversity, transparency, and accountability. System and Process: Ensure services are seamless, cohesive, comprehensive, and collaborative within and across vendors and stakeholders. Performance: Require performance throughout the system of care, utilizing ongoing performance quality improvement and adopting best practices, in order to realize the highest quality of service. Fiscal Fiduciary Responsibility: Maximize existing resources, pursue additional funding sources, create operating efficiencies, and effectively manage costs to reinvest in continually improved quality of service. Innovation: Develop new resources and new business practices designed to maximize success.
3 Customer Satisfaction: Engage all key stakeholders, especially children, families and caregivers, in the planning, delivery, monitoring and continuous improvement of the system. Leadership and Stewardship: Maintain an independent board of community leaders that oversees the system of care. The Board s primary focus is to establish a strategic direction, advise on policy, advocate for system enhancements and innovations and facilitate relationships. The mission of Our Kids is to oversee and lead a coordinated system of care delivering excellence to abused, abandoned, and neglected children and their families in Miami-Dade and Monroe counties 3. Requirements Primary Requirements: Location: South East United States Power: Redundant 30A * 3 Phase 240V circuits with a usable power density of 8.6KB per enclosure. The site should have power redundancy systems that are adequate and well maintained at a minimum of N+1. Must have power filtering. Fuel: Must have at least four days at full capacity. Building: Must have a Cat 5 roof if located in Florida. Must have flood sensors and monitoring under raised floors and in other critical areas. Contract Terms: Contract with direct maintainer of Data Center no resellers. Must be amendable to contract negotiation. No automatic renewal. Building Security: 24/7 Certificates: SSAE 16 compliance or equivalent document, HIPPA certified Cooling: Redundant cooling is required with hot isle and cold isle temperature of 65-80F and 40-60% relative humidity. On Site Support: 24/7 on site electrical and in-house engineering staff. Fire Systems: Must be zoned. Insurance: Facility must carry adequate insurance and provide documentation. Secondary Requirements: Data Feeds: Please provide a list of carriers inside the facility and services they can provide and how they are brought in SLA: Provide alarm and notification SLAs Spare Parts: Should be kept on site Anticipated Start Date: Feb 3, 2014 Building: Minimum 24 raised floor environment and all critical infrastructure equipment such as chillers and generators on site must be behind protective walls and accessible during an event.
4 Tertiary Information Needed: Company: Facility : Financials Mission Statement Is Data Center Core Business? Location(Elevation/Flood Zone) Building Type(Windows/Protection/Year built/purpose built) Infrastructure: Age of components/schedule of maintenance Emergency lock down procedure(hurricane) and power preparations Internal dimensions of cabinet and accessories o How many U s and how deep? Right of first refusal of adjacent space and conditions Outline parking, including where the lot is in relation to access to facility and how many spaces Outline in great detail generator setup along with fuel capacity Number of tanks, day and how long will each support generators Refuel contracts Diagram of power infrastructure o Each circuit connected to its each generator/ups/ats switch and PDU Do we have access to power utilization reports and how are they provided Is PDU supplied by facility, and if so does it allow for remote monitoring Describe how temperature and humidity is monitored and ranges Describe how chilled water is routed 4. GENERAL CONDITIONS A. Independent Contractor The vendor shall act in the capacity of an independent contractor and not as an officer, member or employee of Our Kids. Vendor, its agents, employees, subcontractors and/or assignees shall not represent to others that it has the authority to bind Our Kids unless specifically authorized in writing to do so. B. Our Kids Obligation Our Kids is not obligated to accept the lowest priced quote or any other particular quote. Our Kids at its discretion may refuse to accept any non-conforming quote; and may ask any vendor to supply further information after the closing date or cancel this RFQ at any time. Any decision regarding the awarding of this RFQ shall be final. C. Cone of Silence During the competitive process, no vendor contact is allowed with any Our Kids personnel, except the designated contact listed in Section 5.A.
5 5. RFQ PROCESS A. Contact Persons Technical, administrative, and legal questions including clarification regarding administrative aspects of the bid process arising from this Request for Quote, must be forwarded in writing via , and submitted to: Responses to written inquiries submitted timely by bidders will be posted on Our Kids website at It is the responsibility of all potential bidders to monitor this site for any changing information prior to submitting your quote. B. Limitations On Contacting Our Kids Personnel Vendors are required to any questions to the address listed above in Section 5.A. Vendors are not permitted to contact Our Kids personnel directly regarding this RFQ. All questions or comments must be directed to the address provided. Violation of these limitations may result in the disqualification of the proposer. C. Posting This RFQ solicitation will be posted to the Our Kids website on Tuesday, November 26, 2013 and will remain on the website for a minimum of ten (10) business days. All subsequent announcements and/or notices will be promptly posted on the website. D. Oral Instructions/ Changes To The Request For Quote (Addenda) No negotiations, decisions, or actions will be initiated or executed by a bidder as a result of any oral discussions with an Our Kids employee or representative. Only those communications, which are in writing from Our Kids, will be considered as a duly authorized expression on behalf of Our Kids. Notices of changes (addenda) will be posted on Our Kids website at It is the responsibility of all potential bidders to monitor this site for any changing information prior to submitting your quote. Any RFQ revisions will be issued in the form of an addenda and will be posted on the Our Kids website prior to the quote due date. If it is judged that several Vendors submit similar issues or questions, or many questions remain unanswered, a Proposer conference may be arranged at the offices of Our Kids or via conference call. ITN responders will not be required to attend. However, attendance is encouraged as the responder will find it highly beneficial. (Remainder of page intentionally left blank)
6 E. Procurement Schedule The following is a list of critical dates and actions. These dates are subject to change. Notices of changes (addenda) will be posted on Our Kids website at It is the responsibility of all potential bidders to monitor this site for any changing information prior to submitting your quote. Milestone Scheduled Date & Time (All times are denoted in Eastern Standard Time.) Release of RFQ Tuesday, November 26, 2013 Final date and time deadline written questions will be accepted Friday, December 6, 2013 (5:00PM) Anticipated date that answers to written questions will be posted Monday, December 9, 2013 on the website Quotes due Wednesday, December 11, 2013 (5:00PM) Anticipated Provider - Selection Date Thursday, December 12, 2013 Anticipated date of posting of Notice of Intent to Award. Friday, December 13, 2013 Anticipated Contract Start date Monday, February 3, 2014 Our Kids reserves the right to modify the schedule as circumstances warrant. F. Quote Deadline Quotes must be received via at no later than Wednesday, December , 5:00 PM, Eastern Standard Time. Vendors are solely responsible for ensuring that quotes are delivered on time. Delays caused by delivery service will not necessarily be grounds for a waiver of the deadline requirement. Quotes submitted after the deadline may be rejected. G. General Instructions for Preparation of the Quote The instructions for this RFQ have been designed to help ensure that all quotes are reviewed and evaluated in a consistent manner, as well as to minimize costs and response time. INFORMATION SUBMITTED IN VARIANCE WITH THESE INSTRUCTIONS MAY NOT BE REVIEWED OR EVALUATED. The quote package shall address all the Primary, Secondary and Tertiary Requirements listed above along with a copy of the proposed contract terms, SLA and pricing terms. H. Mandatory Requirements The following requirements must be met by the prospective Vendor to be considered responsive to this RFQ. Failure to meet these requirements will result in a proposal not being evaluated and rejected as non-responsive. It is MANDATORY that the prospective Vendor submits its proposal within the time frame specified in the Procurement Schedule. It is MANDATORY that the prospective Vendor includes the following information and documentation in the proposal response submitted to Our Kids: Affidavit of Service Vendor Standards (Exhibit A) Certification Regarding Lobbying (Exhibit B) W-9 Form (Exhibit C) Certification Regarding Debarment (Exhibit D)
7 Conflict of Interest Questionnaire (Exhibit E) Three (3) Customer References (Exhibit F) I. Right To Reject Or To Waive Minor Irregularities Statement Our Kids offers this RFQ as a competitive bid. Our Kids, at its sole discretion, may select or reject any or all quotations for any reason, may waive any informality in the quotes received, and may waive minor deviations from the specifications and shall be the sole judge thereof. Selection of a Vendor shall not be construed as a contract award. Our Kids may award a contract on the basis of information in addition to that received in a quotation. Therefore, it is emphasized that all quotations should be complete and submitted with the most favorable financial terms. J. Notice of Intent to Award The Notice of Intent to Award will be posted on the Our Kids website ( for 72 hours (Saturday, Sunday and State holidays excluded). If no written notice of protest is submitted to the Our Kids Contract Manager, the Intent to Award becomes final. Please Note: The Notice of Intent to Award shall not be construed as a contract with Our Kids of Miami- Dade/Monroe, Inc. K. Protests And Disputes Any person who is adversely affected by the terms, conditions and specifications contained in this solicitation, including any provisions governing the methods for ranking bids, quotes, or replies, awarding contracts, reserving rights of further negotiation, or modifying or amending any contract, shall submit a written notice of protest within 72 hours (Saturdays, Sundays and State holidays excluded) of Notice of Intent to the address identified above. FAILURE TO FILE A PROTEST WITHIN 72 HOURS OF THE POSTING SHALL CONSTITUTE A WAIVER OF VENDOR S RIGHT TO PROTEST. L. Reference Checks Our Kids may conduct reference checks on prospective Vendors throughout the procurement process. Our Kids may also contact any person(s) or organization(s) for information regarding a Vendor, regardless of the references provided by the Vendor. The Vendor may include any references or letters of support to be used in consideration for this RFQ. M. Quote Disposition All materials submitted in response to this RFQ shall become the property of Our Kids. N. Vendor Clarifications, Questions And Contact Information Our Kids reserves the right to obtain clarification of any point in the quote submitted by the Vendor or to obtain additional information necessary to properly evaluate a quote. If required, qualifying Vendors will be asked to further demonstrate their qualifications or the qualifications of the organization to provide the products and/or services requested in this RFQ. Failure of a Vendor to respond to a request for additional information or clarification may result in rejection of the quote. Our Kids' retention of this right shall in no way reduce the responsibility of Vendors to submit complete, accurate, and clear quotes. The quotation must include the name of the specific individual who will act as the primary Vendor contact during quote evaluation. The quotation must identify the contact's company, position in the company, address, telephone number, fax number, and e- mail address.
8 O. Vendor Costs Our Kids shall not be liable for any costs incurred by a prospective Vendor for preparing or submitting a quotation to Our Kids or for any subsequent demonstrations required by Our Kids. Quotations should be prepared simply and economically, providing a straightforward, concise description of Vendor capabilities to satisfy the requirements. P. Period Of Validity Of Quotes The Vendor must certify that its quote will remain in effect for sixty (60) days after Vendor s submission. Q. Quote Confidentiality By participating in this solicitation, process and submitting a response, Vendor acknowledges the requirements of the Florida Public Records law found in Chapter 119, Florida Statues and s. 24(a), Art. I of the Florida Constitution, and agrees to the provisions set forth in the section. Our Kids is an entity subject to the Florida Public Records laws. All Vendor responses and written communications regarding this RFQ become public records upon receipt by Our Kids and therefore are subject to public disclosure. If a Vendor asserts that any portion of its response or written communication is exempt from disclosure under the Public Records laws, the Vendor must clearly identify each portion of its quote that contains exempt information and provide an explanation of the statutory support for the exemption. If a request is made for the entire un-redacted quote, then Our Kids will promptly notify Vendor of the request. Vendor must take immediate and affirmative action to seek legal protection of its protected records at issue. Our Kids will not defend Vendor s claim in this regard. Failure by the Vendor to take action in accordance with this section shall constitute a waiver of its assertion that the protected records are exempt from disclosure. Notwithstanding the provisions of this section, in accordance with Federal or State law, Our Kids will comply with any court order to produce a protected record. R. Authorized to Do Business in the State Of Florida In accordance with sections , , and , Florida Statutes, foreign corporations, foreign limited liability companies, and foreign limited partnerships must be authorized to do business in the State of Florida. Such authorization should be obtained by the bid due date and time, but in any case, must be obtained prior to posting of the intended award of the contract. For authorization, contact: Florida Department of State Tallahassee, Florida (850) S. Other Conditions Other conditions which may cause rejection of bids include, evidence of collusion among bidders, obvious lack of experience or expertise to perform the required work, failure to perform or meet financial obligations on previous contracts, or in the event an individual, firm, partnership, or corporation is on the United States Comptroller General's List of Ineligible Contractors for Federally Financed or Assisted Projects. T. Contractual Obligations The Vendor will be required to ensure that each individual, partnership, firm, corporation or subcontractor that performs on this contract, will be subject to, and comply with the contractual requirements.
9 U. Unauthorized Aliens The employment of unauthorized aliens by any Vendor is considered a violation of Section 274A(e) of the Immigration and Nationality Act. If the Vendor knowingly employs unauthorized aliens, such violation shall be cause for unilateral cancellation of the contract. Vendor is required to enroll in the E-Verify program within 30 calendar days of being awarded a contract. V. Minority Business Enterprise (MBE) Utilization Our Kids encourages MBE firms, Certified Minority and Women s Business Enterprises to compete for contracts, and also encourages non-mbe and other minority Vendors to use MBE firms as subcontractors. Our Kids, it s Vendors, suppliers, and consultants should take all necessary and reasonable steps to ensure that minority businesses have the opportunity to compete for and perform contract work for Our Kids in a nondiscriminatory environment. W. Final Vendor Selection This procurement will be awarded to the responsible and responsive vendor who is determined to have the best knowledge, skill, ability and price; however, Our Kids reserves the right to reject any or all quotes received or to withdraw this RFQ, even after award, if it is determined to be in the best interest of Our Kids to do so. Unsuccessful vendors will not be notified; however, Our Kids reserves the right to reselect. 6. DESCRIPTION OF EVALUATION CRITERIA Vendor quotes will be evaluated based on the merits described in this section. The vendor response will be rated on the following criteria: Consideration 1: Total price (Available Points 40) Consideration 2: Installation (Available Points 5) Consideration 3: Facilities (Available Points 35) Consideration 4: Security/Certification (Available Points 20)
10 Affidavit of Service Provider Standards Agency Name: Phone: Address: City, State, Zip Code: Before me this day personally appeared, who, being duly sworn deposes and says: Name I,, as an authorized agent for, Name Agency Name swear that the following is true: : Agency Name Is Is not barred, suspended, or otherwise prohibited from doing business with any government entity, or has been barred, suspended, or otherwise prohibited from doing business with any government entity within the last 5 years; Is Is not Is Is not under investigation or indictment for criminal conduct, or has been convicted of any crime which would adversely reflect on their ability to provide services to vulnerable populations, including, but not limited to, abused or neglected children, or which adversely reflects their ability to properly handle public funds; currently involved, or has been involved within the last 5 years, with any litigation, regardless of whether as a plaintiff or defendant, which might pose a conflict of interest to Our Kids, the state or its subdivisions, or a federal entity providing funds to the department; Has had a contract terminated by the department for a failure to satisfactorily perform or for cause; or Has not Has Has not failed to implement a corrective action plan approved by Our Kids or any other governmental entity, after having received due notice. Signature Title Sworn to and subscribed before me this day of, 20. My Commission Expires NOTARY PUBLIC, State of Florida My signature, as a Notary Public, verifies the affiant s identification has been validated by:
11 CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS The undersigned certifies, to the best of his or her knowledge and belief, that: 1. No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or an employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into any cooperative agreement, and the extension, continuation, renewal, amendment, or modification for any federal contract, gran, loan or cooperative agreement. 2. If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with this federal contract, grant loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, Disclosure Form to Report Lobbying, in accordance with its instructions. 3. The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. 4. This certification is material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Signature Date Name of Authorized Individual Name and Address of Organization
12 Form W-9 (Rev. December 2011) Department of the Treasury Internal Revenue Service Name (as shown on your income tax return) Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. Print or type See Specific Instructions on page 2. Business name/disregarded entity name, if different from above Check appropriate box for federal tax classification: Individual/sole proprietor C Corporation S Corporation Partnership Trust/estate Exempt payee Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) Other (see instructions) Address (number, street, and apt. or suite no.) Requester s name and address (optional) City, state, and ZIP code List account number(s) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on the Name line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. Social security number Employer identification number Part II Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. I am a U.S. citizen or other U.S. person (defined below). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 4. Sign Here Signature of U.S. person General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners share of effectively connected income. Date Note. If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester s form if it is substantially similar to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: An individual who is a U.S. citizen or U.S. resident alien, A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, An estate (other than a foreign estate), or A domestic trust (as defined in Regulations section ). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners share of income from such business. Further, in certain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income. Cat. No X Form W-9 (Rev )
13 Form W-9 (Rev ) Page 2 The person who gives Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States is in the following cases: The U.S. owner of a disregarded entity and not the entity, The U.S. grantor or other owner of a grantor trust and not the trust, and The U.S. trust (other than a grantor trust) and not the beneficiaries of the trust. Foreign person. If you are a foreign person, do not use Form W-9. Instead, use the appropriate Form W-8 (see Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities). Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a saving clause. Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes. If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items: 1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien. 2. The treaty article addressing the income. 3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions. 4. The type and amount of income that qualifies for the exemption from tax. 5. Sufficient facts to justify the exemption from tax under the terms of the treaty article. Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption. If you are a nonresident alien or a foreign entity not subject to backup withholding, give the requester the appropriate completed Form W-8. What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS a percentage of such payments. This is called backup withholding. Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return. Payments you receive will be subject to backup withholding if: 1. You do not furnish your TIN to the requester, 2. You do not certify your TIN when required (see the Part II instructions on page 3 for details), 3. The IRS tells the requester that you furnished an incorrect TIN, 4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or 5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only). Certain payees and payments are exempt from backup withholding. See the instructions below and the separate Instructions for the Requester of Form W-9. Also see Special rules for partnerships on page 1. Updating Your Information You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account, for example, if the grantor of a grantor trust dies. Penalties Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty. Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties. Specific Instructions Name If you are an individual, you must generally enter the name shown on your income tax return. However, if you have changed your last name, for instance, due to marriage without informing the Social Security Administration of the name change, enter your first name, the last name shown on your social security card, and your new last name. If the account is in joint names, list first, and then circle, the name of the person or entity whose number you entered in Part I of the form. Sole proprietor. Enter your individual name as shown on your income tax return on the Name line. You may enter your business, trade, or doing business as (DBA) name on the Business name/disregarded entity name line. Partnership, C Corporation, or S Corporation. Enter the entity's name on the Name line and any business, trade, or doing business as (DBA) name on the Business name/disregarded entity name line. Disregarded entity. Enter the owner's name on the Name line. The name of the entity entered on the Name line should never be a disregarded entity. The name on the Name line must be the name shown on the income tax return on which the income will be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a domestic owner, the domestic owner's name is required to be provided on the Name line. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on the Business name/disregarded entity name line. If the owner of the disregarded entity is a foreign person, you must complete an appropriate Form W-8. Note. Check the appropriate box for the federal tax classification of the person whose name is entered on the Name line (Individual/sole proprietor, Partnership, C Corporation, S Corporation, Trust/estate). Limited Liability Company (LLC). If the person identified on the Name line is an LLC, check the Limited liability company box only and enter the appropriate code for the tax classification in the space provided. If you are an LLC that is treated as a partnership for federal tax purposes, enter P for partnership. If you are an LLC that has filed a Form 8832 or a Form 2553 to be taxed as a corporation, enter C for C corporation or S for S corporation. If you are an LLC that is disregarded as an entity separate from its owner under Regulation section (except for employment and excise tax), do not check the LLC box unless the owner of the LLC (required to be identified on the Name line) is another LLC that is not disregarded for federal tax purposes. If the LLC is disregarded as an entity separate from its owner, enter the appropriate tax classification of the owner identified on the Name line.
14 Form W-9 (Rev ) Page 3 Other entities. Enter your business name as shown on required federal tax documents on the Name line. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on the Business name/ disregarded entity name line. Exempt Payee If you are exempt from backup withholding, enter your name as described above and check the appropriate box for your status, then check the Exempt payee box in the line following the Business name/ disregarded entity name, sign and date the form. Generally, individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends. Note. If you are exempt from backup withholding, you should still complete this form to avoid possible erroneous backup withholding. The following payees are exempt from backup withholding: 1. An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2), 2. The United States or any of its agencies or instrumentalities, 3. A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or instrumentalities, 4. A foreign government or any of its political subdivisions, agencies, or instrumentalities, or 5. An international organization or any of its agencies or instrumentalities. Other payees that may be exempt from backup withholding include: 6. A corporation, 7. A foreign central bank of issue, 8. A dealer in securities or commodities required to register in the United States, the District of Columbia, or a possession of the United States, 9. A futures commission merchant registered with the Commodity Futures Trading Commission, 10. A real estate investment trust, 11. An entity registered at all times during the tax year under the Investment Company Act of 1940, 12. A common trust fund operated by a bank under section 584(a), 13. A financial institution, 14. A middleman known in the investment community as a nominee or custodian, or 15. A trust exempt from tax under section 664 or described in section The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 15. IF the payment is for... Interest and dividend payments THEN the payment is exempt for... All exempt payees except for 9 Broker transactions Exempt payees 1 through 5 and 7 through 13. Also, C corporations. Barter exchange transactions and patronage dividends Payments over $600 required to be reported and direct sales over $5,000 1 Exempt payees 1 through 5 Generally, exempt payees 1 through 7 2 Part I. Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer identification number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see How to get a TIN below. If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. However, the IRS prefers that you use your SSN. If you are a single-member LLC that is disregarded as an entity separate from its owner (see Limited Liability Company (LLC) on page 2), enter the owner s SSN (or EIN, if the owner has one). Do not enter the disregarded entity s EIN. If the LLC is classified as a corporation or partnership, enter the entity s EIN. Note. See the chart on page 4 for further clarification of name and TIN combinations. How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local Social Security Administration office or get this form online at You may also get this form by calling Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at and clicking on Employer Identification Number (EIN) under Starting a Business. You can get Forms W-7 and SS-4 from the IRS by visiting IRS.gov or by calling TAX-FORM ( ). If you are asked to complete Form W-9 but do not have a TIN, write Applied For in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester. Note. Entering Applied For means that you have already applied for a TIN or that you intend to apply for one soon. Caution: A disregarded domestic entity that has a foreign owner must use the appropriate Form W-8. Part II. Certification To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if item 1, below, and items 4 and 5 on page 4 indicate otherwise. For a joint account, only the person whose TIN is shown in Part I should sign (when required). In the case of a disregarded entity, the person identified on the Name line must sign. Exempt payees, see Exempt Payee on page 3. Signature requirements. Complete the certification as indicated in items 1 through 3, below, and items 4 and 5 on page Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during You must give your correct TIN, but you do not have to sign the certification. 2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form. 3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification. 1 See Form 1099-MISC, Miscellaneous Income, and its instructions. 2 However, the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup withholding: medical and health care payments, attorneys' fees, gross proceeds paid to an attorney, and payments for services paid by a federal executive agency.
15 Form W-9 (Rev ) Page 4 4. Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. Other payments include payments made in the course of the requester s trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations). 5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), IRA, Coverdell ESA, Archer MSA or HSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification. What Name and Number To Give the Requester For this type of account: Give name and SSN of: 1. Individual The individual 2. Two or more individuals (joint The actual owner of the account or, account) if combined funds, the first individual on the account 1 3. Custodian account of a minor The minor 2 (Uniform Gift to Minors Act) 4. a. The usual revocable savings The grantor-trustee 1 trust (grantor is also trustee) b. So-called trust account that is The actual owner 1 not a legal or valid trust under state law 5. Sole proprietorship or disregarded The owner 3 entity owned by an individual 6. Grantor trust filing under Optional The grantor* Form 1099 Filing Method 1 (see Regulation section (b)(2)(i)(A)) For this type of account: Give name and EIN of: 7. Disregarded entity not owned by an The owner individual 8. A valid trust, estate, or pension trust Legal entity 4 9. Corporation or LLC electing The corporation corporate status on Form 8832 or Form Association, club, religious, The organization charitable, educational, or other tax-exempt organization 11. Partnership or multi-member LLC The partnership 12. A broker or registered nominee The broker or nominee 13. Account with the Department of The public entity Agriculture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program payments 14. Grantor trust filing under the Form The trust 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulation section (b)(2)(i)(B)) Note. If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed. Secure Your Tax Records from Identity Theft Identity theft occurs when someone uses your personal information such as your name, social security number (SSN), or other identifying information, without your permission, to commit fraud or other crimes. An identity thief may use your SSN to get a job or may file a tax return using your SSN to receive a refund. To reduce your risk: Protect your SSN, Ensure your employer is protecting your SSN, and Be careful when choosing a tax preparer. If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter. If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at or submit Form For more information, see Publication 4535, Identity Theft Prevention and Victim Assistance. Victims of identity theft who are experiencing economic harm or a system problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAS by calling the TAS toll-free case intake line at or TTY/TDD Protect yourself from suspicious s or phishing schemes. Phishing is the creation and use of and websites designed to mimic legitimate business s and websites. The most common act is sending an to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft. The IRS does not initiate contacts with taxpayers via s. Also, the IRS does not request personal detailed information through or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts. If you receive an unsolicited claiming to be from the IRS, forward this message to You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration at You can forward suspicious s to the Federal Trade Commission at: or contact them at or IDTHEFT ( ). Visit IRS.gov to learn more about identity theft and how to reduce your risk. 1 List first and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person s number must be furnished. 2 Circle the minor s name and furnish the minor s SSN. 3 You must show your individual name and you may also enter your business or DBA name on the Business name/disregarded entity name line. You may use either your SSN or EIN (if you have one), but the IRS encourages you to use your SSN. 4 List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.) Also see Special rules for partnerships on page 1. *Note. Grantor also must provide a Form W-9 to trustee of trust. Privacy Act Notice Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information.
16 Page 1 of 2 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION CONTRACTS/SUBCONTRACTS This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, signed February 18, The guidelines were published in the May 29, 1987 Federal Register (52 Fed. Reg., pages ) Terms of Agreement 1. Each vendor whose contract/subcontract equals or exceeds $25,000 in federal and/or State of Florida moneys must sign this certification prior to execution of each contract/subcontract. Additionally, vendors who audit federal programs must also sign, regardless of the contract amount. Our Kids of Miami-Dade/Monroe, Inc. ( Our Kids ) cannot contract with these types of vendors if they re debarred or suspended by the federal government or by the State of Florida. 2. This certification is a material representation of fact upon which reliance is placed when this contract/subcontract is entered into. If it is later determined that the signer knowingly rendered an erroneous certification, Our Kids may pursue any or all available remedies. 3. The vendor shall provide immediate written notice to the contract manager at any time the vendor learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 4. The terms debarred, suspended, ineligible, person, principal, and voluntarily excluded, as used in this certification, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order You may contact Our Kids contract manager for assistance in obtaining a copy of those regulations. 5. The vendor agrees by submitting this certification that, it shall not knowingly enter into any subcontract with a person or business who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this contract/subcontract unless authorized by the Federal Government and/or State of Florida. 6. The vendor further agrees by submitting this certification that it will require each subcontractor of this contract/subcontract, whose payment will equal or exceed $25,000 in federal and/or State of Florida moneys, to submit a signed copy of this certification. 7. Our Kids may rely upon a certification of a vendor that is not debarred, suspended, ineligible, or voluntarily excluded from contracting/subcontracting unless it knows that the certification is erroneous. 8. This signed certification must be kept in the Our Kids contract manager s file. Subcontractor s certification must be kept at the vendor s business location.
17 Page 2 of 2 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION CONTRACTS/SUBCONTRACTS Certification 1. The prospective vendor certifies, by signing this certification, that neither the business nor principals of business is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this contract/subcontract by any federal department or agency or State of Florida department or agency. 2. Where the prospective vendor is unable to certify to any of the statements in this certification, such prospective vendor shall attach an explanation to this certification. Signature Date Name Title
18 Conflict of Interest Questionnaire Name of Vendor: 1. Do you, your immediate family, business partner or organization have financial or other interests in any Our Kids Board Members or Employees? (See attached list) 2. Have gratuities, favors, or anything of monetary value been offered to you or accepted by you from any of Our Kids Board Members or Employees? (See attached list) 3. Have you been employed by any of Our Kids Board Members or Employees within the last 6 months? (See attached list) 4. Are there any other conditions which may cause a conflict of interest? Yes No If you answered yes to any of the above questions, please explain. All disclosures shall include a description of the relationship or interest causing the conflict, the role in the arrangement or transaction played by the person having the conflict of interest, and the benefits and detriments accruing to the Organization and to the person having the conflict of interest. I DECLARE ALL OF THE ABOVE QUESTIONS ARE ANSWERED TRUTHFULLY AND TO THE BEST OF MY KNOWLEDGE. Name (print) Signature Date
19 Board Members Abess, Leonard Dominguez, Carmen Martinez, Charlie Adorno, Hank Eables, Patricia A. Priegues Sproul, Rebecca Arriola, Joe Elam, Joyce J. Ruga, Raimundo L. Avael, RaiEtte Ferzli, Alain Russ, Gina Benitez, Sonia Friedman, David Silver, Ron Blecke, Berta Goldstein, Adam M. Smith Jackson, Vickie Bohrer, Sandy Goodman, Laura B. Smith, H.T. Cobb, Charles C. Greer, Evelyn L. Tegnalia, Anthony Colson, Dean E. Halsey, Douglas M. Turkel, Bruce de la Cruz Jr., Carlos Kadre, Manny Ward, Keith Deas, Richard Kauranen, Donna A. William Walker, H. Deas, Richard R. Licko, Carol A. Wurm, Gwen
20 Allegra, Frances P Andre, Alison E Ayala, Elaine M Balladares, Norma E Barreto, Luis M Benyard, Tricia N Black, Katie R Bocanegra, Sasha Bofill, Bree N Bonilla Alvarez, David I Brillinessite Ii, Hugh O Bryant, Nellie W Butterfield, Bridget Cadenas, Maria T Campos, Rafael Canals, Helene L Cardo, Sylvia A Caricchio, Elizabeth M Castillo, Jacqueline De Faria, Gabriela E Diaz, Cecilia E Diaz, Tomas R Edwards, Tonia Z Ferdinandy, Jorge J Garcia, Alejandra Garcia, Marelys N Garcia, Zaira M George, Elena Z Gonzalez, Edgar L Gonzalez, Francisco R Gonzalez, Jose L Gonzalez, Stephanie M Granados, Sonia Gutierrez, Damian Harland, David E Hayes, Reginald L Henry, Petal B Hernandez, Danielle L Herrera, Edgart Y Employees Hinestroza, Christian G Hosein, Issa K Howard, Monik N Jacobson, Lisa T Janssens, Ana I Jimenez, Marisol D Junco, Anabel Kerr, Michael G Kirwan, Stacy G Kitchens, Claudia C Kunuji, Viavon M Ledesma, Luis A Lemos, Carmen R Lewis, Kadiya T Lindo, Rebecca P Lopez, Widlyne Machacon, Donald G Martinez, Anne Martinez, Mario A Matos, David J Mcarthur, Denise R Mcgillis, Nicole C Meltz, Evelin I Mendez, Andrea L Molan, Robin M Molina, Adriana Montano, Jariel Montero Caicedo, Michelle T Moore, Natralia A Moreno, Griselda Morgan, Gila C Nadeau, Michael J Naylor, Utoepia J Nelson, Kevin J Olivera, Aimer Ortega, Julia E Pardinas, Islem Pena, Odalys Penn, Gregory L Peralta, Veronica Perdomo, Carlos A Perez, Beatriz Pino, Nelida R Planas, Carlos A Poveda, Agnes Quintana, Rebekah L Ramos, Merannies Ramos, Nathan C Reaney, Lisa M Rihl, Alba D Roberts, Gail D Robledo, Maria P Rodriguez, Maria E Ruiz, Lourdes J Samuels, Michelle Sanchez, Jennifer A Sanchez, Karen Y Sanchez, Nubia Sanchez, Sashi M Sanfiel, Carina Y Scoff, Jennifer C Silva, Lissette S Simmons, Saudia A Smith, Patricia K Soto, Helen Sotomayor, Nayibe Stayduhar, Rosemary Stefanoni, Luis A Stephen, Renee M Stewart Barrett, Sandra A Taube, Taya E Taylor, Denise L Taylor, Timothy Toledo, Miriam B Tolmos, Hortensia F Torres, Amalia Torres, Yvonne J Travers, Patrick C Twensey, Cassamia L
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Vendor Set up Instructions This document must be completed in accordance with the following procedures: PLEASE READ CAREFULLY 1. A vendor number will only be issued upon the request and approval of the
(NOT CURRENTLY LICENSED WITH THE HARTFORD) Hartford Standard Flood Program - WYO Federal Flood Insurance through The Hartford Standard Flood Program WRITE-YOUR-OWN PROGRAM Highly Competitive Commission
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LME, INC appreciates the opportunity to serve you. We will make every effort to provide you with the finest transportation services. New Account Set-up Packet: - Application - References (Ok to use your
WHOLESALE BROKER REGISTRATION PROCESS A. Overview: Thank you for considering becoming a registered broker with Cherrywood Commercial Lending, LLC ("CCL"). Our registration process is outlined below. Please
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