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ADMINISTRATOR USE ONLY

CONTRACT SUMMARY FORM

City Primary Contact: Julio Brea Vendor: Diversified Group Consulting


Secondary Contact: Contact: Neal de Jesus
Public Works & Engineering Address: 572 S.fl Road, Suite 416
Department:
Phone Number., 305 -224 4842
- City: Cooper CityState: FL. Zip: 33330
Dept. Fax: 305 -224 4789
- Phone: 954-6 0588
-
Primary Email: jbrea @cityofhomestead.com Fax:

Secondary Email: E mail:


- nealdj @comcast.net

Professional Services
1. Type of Agreement (Ex:Maintenance, Consultin etc.):

2. Does this agreement replace an existing contract: YesNo *Ifyes prior Contract #:

3. Briefly explain the purpose or description of the scope of service of this Contract:

Fire consultina services as needed for the New Police Department

vendor
4. Is Insurance required?K'
[ Yes Q! No * Ifyes, who is required to have it?

Please note it is the Departments responsibility to acquire Risk Approval)

5. Term of Contract: Start Date: upon execution End Date: upon completion

6. Total Value of Contract: $ 00


24999.
, Paid to : [jj City X Vendor

7. Monies are due: Circle


( One) V-
Monthly U Quarterly i Annually Other: upon invoice

8. How much money is due or owed per circled item above: $ per Invoice

9. Account Nulnber(s):

10. If monies are paid to City, does Vendor pay Sales Tax (7 %): Yes No

11. Do Late Fees Apply? [_I Yes No Percentage of Late Fees/ How much:
TBD
12. All agreements involving payment to vendor must be accompanied by a requisition. Req. #

City of Homestead * 650 N.E. 22 Terrace, Homestead, FL 33033


David Wolpin
13. Was this agreement drafted/reviewed by a City Attorney? [:j No VYes: If yes, whom?
Right to Audit"clause included: U No V Yes: If not,please obtain City Manager's
authorization. The "Right to Audit"clause is included in the RFQ201307 agreement.
City Manager's Authorization: Finance Authorization:

Please note it is the Departments responsibility to acquire Legal approval)

14. Other than the expiration of this agreement; are there any other dates that you want to be notified by e m
- ail
on? :0 Yes No; if yes, please list dates and reason on lines below:

15. Was this item approved by Council? Yes 0 No


If yes, please provide complete package.

16. Would you like the agreement sent out 1 or by FedEx. Regular Mail
If by FedEx please provide account

Form Prepared By: sherry Ader

Dept. Head Approval: Q

HR Dept. Approval (Employee r ted contracts): A Date:

Risk Management: 5ee— CcheM eV 6LG l


0,++ Date: 41 a0 (5

I.
ST.Approval (for Technology Contracts) Date:
e

Procurement &
Contracts Date:

For Official Use Only

Completed & Appropriate Packet Submitted to Procurement on: : I


Q a L1 I 16
Prepared & Reviewed By: l./) dh"6a rcu. Contract No. 15' PW - 01

Fnd RevieA" Date: D7 51


'

Final Revie Date:'

City of Homestead * 650 N.E.22 Terrace, Homestead, FL 33033

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