ITB-2026-02_Tree_Trimming_and_Removal_Services_-_Exhibits_B_thru_H_-_2026-02.pdf

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Attached to
Trimming and Removal Services
Solicitation number
ITB-2026-02
Issued by
Santa Rosa County, Florida

About this file

This document comprises Exhibits B through H of an Invitation to Bid (ITB-2026-02) issued by the City of Milton, Florida for tree trimming and removal services. The City seeks qualified contractors to provide as-needed tree trimming, pruning, removal, stump grinding, debris hauling, and related vegetation management services on an on-call basis. All services must be expressly authorized in writing by the City through purchase orders, work orders, or other written directives before work commences. The contract encompasses three primary service categories: whole tree removal with unit-based pricing, hourly services for non-removal work, and emergency/after-hours services. Each work authorization will specify the applicable pricing structure, which contractors must follow without substitution or combination of methods unless explicitly approved by the City in writing.

Compensation is structured through three distinct pricing mechanisms detailed in Exhibit B. Whole tree removal pricing is all-inclusive and varies by tree condition (healthy or dead), size (small, medium, or large), and site accessibility (open with good access, open with poor access, restricted with good access, or restricted with poor access), with unit prices covering mobilization, complete removal, stump grinding, site cleanup, debris hauling, and demobilization. Hourly service rates apply to limb removal, trimming, pruning, and vegetation management work, with separate classifications for supervisors/crew leads and laborers. Emergency and after-hours services command higher hourly rates and apply only when expressly authorized by the City for services performed outside normal business hours or under emergency conditions. All applications for payment must comply with Exhibit H requirements, including submission via email in searchable PDF or Word format to designated City representatives, and must be accompanied by City-issued work authorizations and supporting documentation. Contractors must certify under penalty of perjury that services were authorized, performed per contract standards, accurately priced, not previously billed, and that all subcontractors and suppliers have been paid.

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City of Milton

EXHIBIT B – SCHEDULE OF RATES AND UNIT PRICING

PURPOSE AND APPLICABILITY

This Exhibit B establishes the sole and exclusive rates and unit prices for Services performed under the Agreement. All compensation payable to the Contractor shall be based solely on the rates and unit prices set forth herein and only for Services expressly authorized in writing by the

City in accordance with the Agreement.

This Exhibit B contains multiple pricing structures applicable to different categories of Services, including: (1) all-inclusive unit pricing for whole tree removal Services; (2) hourly service rates for Services not involving whole tree removal; and (3) emergency and after-hours service rates.

The City shall designate, in each written work authorization, the applicable pricing structure. The

Contractor shall invoice the City only in accordance with the pricing structure expressly authorized by the City and shall not substitute, combine, or mix pricing methods for the same tree, work activity, or Service unless expressly authorized in writing by the City.

All Applications for Payment shall itemize Services performed using the applicable rates and unit prices set forth in this Exhibit B and shall comply with Exhibit H – Application for

Payment and Invoice Requirements.

1. WHOLE TREE REMOVAL UNIT PRICING

The following unit pricing schedules apply to whole tree removal Services authorized by the City pursuant to Section 9.2 of the Agreement.

Unit pricing is based on tree condition (healthy or dead), tree size, and site accessibility, as identified by the City in the applicable work authorization. For pricing purposes, Healthy Tree

Removal applies to trees with no dieback and/or no visible trunk deficiencies. Dead Tree

Removal applies to trees with more than 25% dieback, visible trunk, or limb deficiencies. Tree condition classifications used for pricing purposes shall be subject to City approval.

Each unit price is all-inclusive and includes mobilization, complete tree removal, stump grinding

(unless otherwise directed in writing by the City), site cleanup, debris hauling and lawful disposal, and de-mobilization, unless otherwise expressly stated. No additional compensation shall be due for such activities.

Tree Trimming and Removal Services

Contract No.:

Contract No.:

2. HOURLY SERVICE RATES (NOT INVOLVING WHOLE TREE REMOVAL)

The following hourly service rates apply to Services not involving whole tree removal that are authorized by the City pursuant to Section 9.3 of the Agreement, including limb removal, trimming, pruning, vegetation management, clearance work, and related Services.

Hourly service rates shall apply only where expressly authorized by the City and shall not be used for whole tree removal Services unless otherwise authorized in writing by the City. The

City shall designate, in each written work authorization, the applicable hourly service category.

WHOLE TREE REMOVAL CHART

HEALTHY TREE REMOVAL

TREE SIZE SITE CONDITION ACCESSIBILITY UNIT UNIT RATE

Small Open GA – Good Access EA $

Small Open PA – Poor Access EA $

Small Restricted GA – Good Access EA $

Small Restricted PA – Poor Access EA $

Medium Open GA – Good Access EA $

Medium Open PA – Poor Access EA $

Medium Restricted GA – Good Access EA $

Medium Restricted PA – Poor Access EA $

Large Open GA – Good Access EA $

Large Open PA – Poor Access EA $

Large Restricted GA – Good Access EA $

Large Restricted PA – Poor Access EA $

DEAD TREE REMOVAL

Small Open GA – Good Access EA $

Small Open PA – Poor Access EA $

Small Restricted GA – Good Access EA $

Small Restricted PA – Poor Access EA $

Medium Open GA – Good Access EA $

Medium Open PA – Poor Access EA $

Medium Restricted GA – Good Access EA $

Medium Restricted PA – Poor Access EA $

Large Open GA – Good Access EA $

Large Open PA – Poor Access EA $

Large Restricted GA – Good Access EA $

Large Restricted PA – Poor Access EA $

Contract No.:

Unless otherwise expressly stated, hourly service rates shall be deemed to include all labor, supervision, equipment, tools, vehicles, materials, mobilization, overhead, profit, and incidentals necessary to perform the authorized Services. No additional compensation shall be due when

Services are compensated on an hourly basis. Minimum service charges apply only when expressly authorized by the City.

HOURLY SERVICE RATES

Service Classification Unit Unit Rate

Supervisor/Crew Lead Hour $

Laborer Hour $

Minimum Service

Charge/Time

Hour $ for hour(s), including mileage

3. EMERGENCY AND AFTER-HOURS HOURLY SERVICE RATES

The following emergency and after-hours hourly service rates apply to Services authorized by the City pursuant to Section 9.4 of the Agreement and performed outside of normal business hours, as defined in Section 1.10, or under emergency conditions requiring immediate response.

Emergency and after-hours hourly rates shall apply only when expressly activated and authorized in writing by the City and only for the duration of the City-authorized emergency or after-hours service period. Routine Services performed outside normal business hours shall not be compensated at emergency or after-hours rates absent express City authorization.

Unless otherwise expressly stated, emergency and after-hours hourly service rates shall be deemed to include all labor, supervision, equipment, tools, vehicles, materials, mobilization, overhead, profit, and incidentals necessary to perform the authorized Services. No additional compensation shall be due for standby time, idle time, travel time, or mobilization time unless expressly authorized in writing by the City.

EMERGENCY AND AFTER-HOURS HOURLY SERVICE RATES

Service Classification Unit Unit Rate

Supervisor/Crew Lead Hour $

Laborer Hour $

Minimum Service

Charge/Time

Hour $ for hour(s), Company Name Page 12 of 20

SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(A).

FLORIDA STATUTES ON PUBLIC ENTITY CRIME

THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL

AUTHORIZED TO ADMINISTER OATHS.

1. This sworn statement is submitted to

By

(print this individual’s name and title) for (print name of entity submitting statements) whose business address is and if applicable whose Federal Employer Identification Number (FEIN) is

If the entity has no FEIN, include the Social Security Number of the individual signing this sworn Statement:

2. I understand that a “public entity crime” as defined in paragraph 287.133(1)(a), Florida Statutes, mean a violation of any state or federal law by a person with respect to and directly related to the transactions of business with any public entity or with an agency or political subdivision of any other state or with the United States including, but not limited to any bid or contract for goods or services to be provided to any public entity or any agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.

3. I understand that “convicted” or “convection” as defined in Paragraph 287.133(1)(b), Florida Statutes means a finding of guilt or a conviction of a public entity crime, with or without adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a Jury verdict, nonjury trial, or entry of a plea of guilty or nolo contendere.

4. I understand that an “affiliate” as defined in paragraph 287.133(1)(a), Florida Statutes, means:

1. A predecessor or successor of a person convicted of public entity crime; or

2. An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term “affiliate” includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm’s length agreement, shall be a prima facie case that one person controls another person.

A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate.

5. I understand that a “person” as defined in Paragraph 287.133(1)(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term “person” includes those officers, executives, partners, shareholders, employees, members, and agents who are active in management of an entity.

6. Based on information and belief, the statement which I have marked below is true in a relation to the

Company Name entity submitting this sworn statement. (Please indicate which statement applies).

_ Neither the entity submitting this sworn statement, nor any of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or any affiliate of the entity has been charged with and convicted of a public entity crime within the past 36 months.

_ The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime within the past 36 months. AND (Please indicate which additional statement applies).

_ The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime within the past 36 months. However, there has been a subsequent proceeding before a Hearing Officers of the State of Florida, Division of Administrative Hearings and the Final Order by the Hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list.

(Attached is a copy of the final order).

I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THE PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED AND FOR THE PERIOD OF THE CONTRACT ENTERED INTO, WHICHEVER PERIOD IS LONGER. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES, FOR CATEGORY TWO

OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.

(Signature)

City of

STATE OF FLORIDA

Sworn and subscribed before me this day of , 20 by who is Personally known to me

Or who produced identification - (Type of Identification)

(Signature) Notary Public—State of Florida

(Printed, typed or stamped commissioned name of notary public)

My commission expires (SEAL)

Company Name

NON-COLLUSION AFFIDAVIT

STATE OF

COUNTY OF

Owner, Partner or Officer of Firm Company

Name, Address, City and State

Being of lawful age, being first duly sworn, on oath says that he/she is the agent authorized by the bidder to submit the attached bid. Affidavit further states as proposer, that they have not been a party to any collusion among bidders in restraint of competition by agreement to bid at a fixed price or to refrain from bidding; or with any officer of the City of Milton or any of their employees as to quantity, quality or price in the prospective contract; or any discussion between bidders and any official of the City of Milton or any of their employees concerning exchange of money or other things of value for special consideration in submitting a sealed bid for:

FIRM NAME:

SIGNATURE:

TITLE:

The foregoing instrument was acknowledged before me this day of , 20 by the above signed acting on behalf of the organization/company.

He/she is personally known to me or has produced as identification and did (did not) take an oath.

Signature of Notary

SEAL

CONFLICT OF INTEREST DISCLOSURE FORM

For purposes of determining any possible conflict of interest, all bidders/proposers, must disclose if any City of Milton, employee(s), elected officials(s), of if any of its agencies is also an owner, corporate officer, agency, employee, etc., of their business.

Indicate either “yes” (a City employee, elected official, or agency is also associated with your business), or “no”. If yes, give person(s) name(s) and position(s) with your business.

YES NO

NAME(S) POSITION(S)

Firm Name By (Printed):

By (Signature): Title

Address Phone No.

E-Mail: _____________________________

Z:\Forms\CONTRACTOR FORMS\Conflict of Interest Disclosure Form.docx

VENDOR SCRUTINIZED COMPANIES LISTS ATTESTATION

Per section 287.135, Florida Statutes, agencies are prohibited from contracting with Vendors for commodities or contractual services valued at over $1,000,000 that are on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran

Petroleum Energy Sector List, or been engaged in business operations in Cuba or Syria, pursuant to section 215.473, Florida Statutes.

I, ____________________________________ am the ______________________________ of

(Authorized Representative’s Name) (Title)

_______________________________________, (the “Vendor”), and am authorized to represent and ____________________________ contractually bind Vendor.

(Vendor’s Legal Name)

Having been duly sworn, I do hereby attest, to the best of my knowledge and belief, the following:

The Vendor submitting this Response is not listed on any of the following lists:

• Scrutinized Companies with Activities in Sudan List

• Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List

• Scrutinized Companies that Boycott Israel List

I understand that, pursuant to section 287.135, Florida Statutes, the submission of a false certification may subject Vendor to immediate contract termination, civil penalties, attorney’s fees, and/or other costs.

Company Name Signature

Authorized Representative Date

Name and Title

E-VERIFY STATEMENT OF COMPLIANCE

Contractor hereby certifies compliance with the following:

Pursuant to § 448.095(2) Florida Statutes (2020), Contractor shall register with and use the E-

Verify system operated by the United States Department of Homeland Security to verify the work authorization status of all new employees hired by Contractor while performing work or providing services for the City of Milton. Contractor shall also include in any related subcontracts a requirement that subcontractors performing work or providing services for the City of Milton on its behalf register with and use the E-Verify system to verify the work authorization status of all new employees hired by the subcontractor while performing work or providing services for the City of

Milton. Additionally, Contractor shall include in any related subcontracts a requirement that subcontractors performing work or providing services for the City of Milton on its behalf provide

Contractor with an affidavit stating that the subcontractor does not employ, contract with, or subcontract with any unauthorized alien as defined in 8 U.S.C. § 1324a(h)(3). Contractor shall maintain a copy of such affidavit for the duration of its contract with the City of Milton.

FIRM NAME

SIGNATURE

TITLE

P.0. Box 909 • 6738 Dixon Street • Milton, Florida 32572 Phone (850) 983-5400 • Fax (850)983-5415

Established 1844

EXHIBIT H – APPLICATION FOR PAYMENT AND

INVOICE REQUIREMENTS

Authority: Ch. 218, Part VII, F.S.

Tree Trimming and Removal Services

Contract No.:

1. PURPOSE AND APPLICABILITY

This Exhibit establishes the minimum content, documentation, and certification requirements for all Applications for Payment submitted by the Contractor under this Contract. These requirements are intended to ensure compliance with the Local Government Prompt Payment

Act, Ch. 218, Part VII, F.S., and applicable provisions of Florida law governing payment to contractors, subcontractors, and suppliers.

Receipt by the City of a complete Application for Payment that complies with this Exhibit constitutes submission of a Proper Invoice as defined in § 218.72(8), F.S. for purposes of the

Local Government Prompt Payment Act.

Services under this Contract are performed on an as-needed, on-call basis and are authorized solely through City-issued purchase orders, work orders, or other written directives. Applications for Payment shall be limited to Services expressly authorized by such City-issued instruments and satisfactorily performed in accordance with the Contract.

2. DEFINITIONS

For purposes of this Contract:

1. Invoice means the Contractor’s written request for payment for Services performed during the applicable billing period.

2. Proper Invoice means an invoice that meets the minimum content requirements of

§ 218.72(8), F.S. and Chapter 218, Part VII, F.S., and Section 4 of this Exhibit.

3. Application for Payment or Proper Invoice Package means a complete submission consisting of a Proper Invoice, required certifications, and all required supporting documentation, detailed in Section 5 of this Exhibit.

3. SUBMISSION METHOD AND RECEIPT

3.1 Submission Method

All Applications for Payment shall be submitted electronically by email in searchable PDF or

Word format, unless otherwise approved in writing by the City.

3.2 Submission Address

Applications for Payment shall be submitted by email to all of the following recipients:

Landscape Department Head, Lee Willingham: lwillingham@miltonfl.org, and City Contract

Coordinator, April Taylor: ataylor@miltonfl.org.

mailto:lwillingham@miltonfl.org mailto:ataylor@miltonfl.org

INVOICE REQUIREMENTS

Authority: Ch. 218, Part VII, F.S.

Tree Trimming and Removal Services

Contract No.:

The City may update submission email addresses by written notice, including by email, without requiring a formal amendment to the Contract.

3.3 Subject Line

The email subject line shall include the City’s Contract number and the phrase “Application for

Payment.”

3.4 Time of Receipt

An Application for Payment shall be deemed received by the City upon successful electronic delivery to all required submission addresses, provided the submission is not returned as undeliverable. Receipt alone does not constitute acceptance or confirmation that the submission is complete.

3.5 Proper Invoice Determination

An Application for Payment shall not be deemed a Proper Invoice and shall not trigger statutory payment timelines unless and until the City has reviewed the submission and provided written acknowledgment that the submission is complete and compliant with this Exhibit.

4. PROPER INVOICE MINIMUM CONTENT REQUIREMENTS

Each Proper Invoice shall include, at a minimum:

1. Contractor’s legal name, address, and remittance information;

2. City Contract number;

3. Unique invoice number and invoice date;

4. Description of Services performed during the billing period, organized by applicable pay items and unit rates set forth in Exhibit B – Schedule of Rates and Unit Pricing;

5. Dates of Service;

6. Location(s) where services were performed;

7. Contractor Certification Statement (Section 6.1); and

8. Subcontractor and Supplier Certification Statement (Section 6.2).

5. APPLICATION FOR PAYMENT MINIMUM CONTENT REQUIREMENTS

A complete Application for Payment shall consist of the following items submitted together:

1. A Proper Invoice meeting the requirements of Section 4 of this Exhibit;

2. City-Issued Purchase Order(s), Work Order(s), or other written authorization for Services invoiced; and

3. Material Invoices, if any.

INVOICE REQUIREMENTS

Authority: Ch. 218, Part VII, F.S.

Tree Trimming and Removal Services

Contract No.:

If the City determines that an Application for Payment is incomplete or non-compliant, the City shall notify the Contractor in writing of the deficiencies. Such submission shall not constitute a

Proper Invoice and shall not trigger statutory payment timelines.

6. REQUIRED CERTIFICATIONS

Each Application for Payment shall include the following certifications executed by an authorized representative of the Contractor:

6.1 Contractor Certification:

The undersigned Contractor hereby certifies, under penalty of perjury under the laws of the State of Florida, that this Application for Payment is true, correct, and complete, and that:

1. The Services for which payment is requested were expressly authorized in writing by the

City, were actually performed in accordance with the Contract, and were completed in conformity with applicable performance standards;

2. The amounts requested are accurately calculated in accordance with the applicable unit rates, hourly rates, or pricing structure set forth in Exhibit B – Schedule of Rates and

Unit Pricing, as authorized by the City;

3. No amounts included in this Application for Payment duplicate amounts previously billed or paid under this Contract; and

4. The Contractor maintains records supporting the Services performed and amounts billed, which were created and kept in the ordinary course of business and are available for inspection or audit by the City in accordance with the Contract.

6.2 Subcontractor and Supplier Payment Certification

The undersigned Contractor further certifies, under penalty of perjury under the laws of the State of Florida, that all subcontractors and suppliers utilized by the Contractor in the performance of the Services invoiced herein have been paid all undisputed amounts due for Services performed or materials supplied in connection with such invoiced Services, except for amounts subject to a bona fide dispute or lawful withholding.

This certification is made as a contractual representation and is not intended to invoke or incorporate Ch. 255, F.S., which does not apply to this Contract.

Submission of this certification is a condition precedent to the City’s obligation to process payment for the amounts requested in this Application for Payment.

Contractor Signature: ________________________________

Name: __________________________

INVOICE REQUIREMENTS

Authority: Ch. 218, Part VII, F.S.

Tree Trimming and Removal Services

Contract No.:

Title: ___________________________

Date: ___________________

7. EMERGENCY AND AFTER-HOURS SERVICES

Emergency or after-hours Services shall be invoiced only if authorized by the City in accordance with the Contract and shall be separately identified and itemized in the Application for Payment using the applicable rates set forth in Exhibit B – Schedule of Rates and Unit Pricing.

8. OPTIONAL PROPER INVOICE TEMPLATE (REFERENCE ONLY)

For convenience only, the City may provide an illustrative Proper Invoice Template. Use of any

City-provided template is optional. Regardless of format, the Contractor remains solely responsible for ensuring that each Application for Payment complies with this Exhibit and applicable Florida law.

TREE SIZE SITE CONDITION ACCESSIBILITY UNIT QTY UNIT RATE

EXTENDED AMOUNT

Small Open GA – Good Access EA $ $

Small Open PA – Poor Access EA $ $

Small Restricted GA – Good Access EA $ $

Small Restricted PA – Poor Access EA $ $

Medium Open GA – Good Access EA $ $

Medium Open PA – Poor Access EA $ $

Medium Restricted GA – Good Access EA $ $

Medium Restricted PA – Poor Access EA $ $

Large Open GA – Good Access EA $ $

Large Open PA – Poor Access EA $ $

Large Restricted GA – Good Access EA $ $

Large Restricted PA – Poor Access EA $ $

Small Open GA – Good Access EA $ $

Small Open PA – Poor Access EA $ $

Small Restricted GA – Good Access EA $ $

Small Restricted PA – Poor Access EA $ $

Medium Open GA – Good Access EA $ $

Medium Open PA – Poor Access EA $ $

Medium Restricted GA – Good Access EA $ $

Medium Restricted PA – Poor Access EA $ $

Large Open GA – Good Access EA $ $

Large Open PA – Poor Access EA $ $

Large Restricted GA – Good Access EA $ $

Large Restricted PA – Poor Access EA $ $

Service Classification Unit Qty (Hours) Unit Rate

Supervisor/Crew Lead Hour $

Laborer Hour $

Minimum Service Charge, including mileage Hour $

Service Classification Unit Qty (Hours) Unit Rate

Supervisor/Crew Lead Hour $

Laborer Hour $

PROPER INVOICE TEMPLATE

(Reference Only)

Contract No.:

Invoice No.:

Invoice Date:

Dates of Service: From _________ To _________

PROJECT INFORMATION

EMERGENCY AND AFTER-HOURS HOURLY SERVICE RATES

Extended Amount

TOTAL HOURLY SERVICES THIS APPLICATION: $

Extended Amount

HOURLY SERVICE RATES

1.3 Emergency and After-Hours Service Rates

Note: Minimum Service Charge applies only when expressly authorized by the City.

Phone No.:

1.2 Hourly Service Rates

1.1 Whole Tree Removal

1. Services All rates and unit prices in section 1.1, 1.2, and 1.3 correspond to Exhibit B – Schedule of Rates and Unit Pricing.

WHOLE TREE REMOVAL CHART

HEALTHY TREE REMOVAL

TOTAL WHOLE TREE REMOVAL THIS APPLICATION:

DEAD TREE REMOVAL

Project Name (if applicable):

CONTRACTOR INFORMATION

Email:

Legal Name:

Remittance Address:

Minimum Service Charge, Hour $

1. City-Issued Purchase Order, Work Order, or other written authorization for authorized Services;

2. Material Invoices, if any.

The undersigned Contractor hereby certifies, under penalty of perjury under the laws of the State of Florida, that this Application for Payment is true, correct, and complete, and that:

1. The Services for which payment is requested were expressly authorized in writing by the City, were actually performed in accordance with the

Contract, and were completed in conformity with applicable performance standards;

2. The amounts requested are accurately calculated in accordance with the applicable unit rates, hourly rates, or pricing structure set forth in Exhibit B

– Schedule of Rates and Unit Pricing, as authorized by the City;

3. No amounts included in this Application for Payment duplicate amounts previously billed or paid under this Contract; and

4. The Contractor maintains records supporting the Services performed and amounts billed, which were created and kept in the ordinary course of business and are available for inspection or audit by the City in accordance with the Contract.

2. Contractor Certification

Note: Minimum Service Charge applies only when expressly authorized by the City.

TOTAL EMERGENCY AND AFTER-HOURS HOURLY SERVICES THIS APPLICATION: $

DATE:

TITLE:

NAME:

CONTRACTOR'S SIGNATURE:

Required Additional Items (if applicable) :

3. Subcontractor and Supplier Payment Certification

The undersigned Contractor further certifies, under penalty of perjury under the laws of the State of Florida, that all subcontractors and suppliers utilized by the Contractor in the performance of the Services invoiced herein have been paid all undisputed amounts due for Services performed or materials supplied in connection with such invoiced Services, except for amounts subject to a bona fide dispute or lawful withholding.

This certification is made as a contractual representation and is not intended to invoke or incorporate Ch. 255, F.S., which does not apply to this

Contract.

Submission of this certification is a condition precedent to the City’s obligation to process payment for the amounts requested in this Application for

Payment.

EXHIBIT B - Schedule of Rates and Unit Pricing
EXHIBIT C - Public Entity Crimes
EXHIBIT D - Non-Collusion Affidavit
EXHIBIT E - Conflict of Interest Disclosure Form 2016
Exhibit F - Scrutinized Companies List
Exhibit G - E-Verify Affidavit
EXHIBIT H - APPLICATION FOR PAYMENT AND INVOICE REQUIREMENTS
TEMPLATE - APPLICATION FOR PAYMENT TEMPLATE - Tree Trimming and Removal

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