ADMINISTMT

SUMMARY FORM

City Primary Contact: Julio Brea Vendor: Diversified Group Consulting

Secondary Contact: Contact: Neal de Jesus
Public Works & Engineering Address: 5722 S.flamingo Roa Suite 416
Department:
Phone Number: 305 -224 4842
- City: Cooper City State: FL Zi
33330

Dept. Fax: 305 -224 4789

- Phone: 954-699 0588
-
Primary Email: jbrea @cityofhomestead.com Fax:

Secondary Email: E mail:

- nealdj @comcast.net

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

2. Does this agreement replace an existing contract: Yes * No *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 Seminole Theater

4. Is Insurance required?K!
[ Yes [: k No * Ifyes, lvho is required to have it?vendor
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 : City IKI Vendor

7. Monies are due: Circle

( Ole) i Monthly II Quarterly 1JJ Annually other: upon invoice

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

9. Account Number(s): 3%- — ' VS `}

000 ' rJ' 7oQ( CPo1
10. If monies are paid to City, does Vendor pay Sales Tax (7 %): j
[ Yes It No
11. Do Late Fees Apply? [ 2 Yes [ li No Percentage of Late Fees/ How much:

12. All agreements involving payment to vendor must be accompanied by a requisition. Req. # /
r-

107 !
U/ns AvAa ih G cif
- MI 0 T' SS
City of Homestead * 650 N.E. 22 Terrace, Homestead, FL 33033
 David Wolpin
13. Was this agreement drafted/ reviewed by a City Attorney? U No [ KYes: If yes, whom?
Right to Audit"clause included: Q No IM 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 ther any othe dates that you want to be notified by e mail
-
on? : I Yes No; if yes, please list dates and reason on 11 es below:

15. Was this item approved by Council? Yes 0

If yes, please provide complete package.

16. Would you like the agreement sent out by regular egular Mail
If by FedEx please provide account number.

Form Prepared By: sherry Ader Date:

Dept. Head Approval: Date:

HR Dept. Approval (Employee related contracts): j Date:

Risk Management: Off, // Date:

I.
ST.Approval (for Technology Contracts Date: —

7
Procurement & Contracts Date:

For Official Use Only

L4 I l5
Completed & Appropriate Packet Submitted to Procurement on: off-
I.;)-
Prepared & Reviewed By: NqA 64U " Contract No. 1 5"P W — 0 t(Q

2nd Review: Waelw-c Date:

Final Revie - - Date: ALIIIrs

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