VENETIAN PARC COMMUNITY DEVELOPMENT DISTRICT

MIAMI-DADE COUNTY REGULAR BOARD MEETING MARCH 25, 2021
6:00 P.M.

Special District Services, Inc.
6625 Miami Lakes Drive, Suite 374 Miami Lakes, FL 33014

www.venetianparccdd.org 561.630.4922 Telephone 877.SDS.4922 Toll Free 561.630.4923 Facsimile

AGENDA
VENETIAN PARC COMMUNITY DEVELOPMENT DISTRICT
Venetian Parc Community Clubhouse Meeting Room 15351 SW 175th Street
Miami, Florida 33187
REGULAR BOARD MEETING
March 25, 2021
6:00 p.m.

Call to Order
Proof of Publication…	Page 1
Establish Quorum
Additions or Deletions to Agenda
Comments from the Public for Items Not on the Agenda
Approval of Minutes
February 4, 2021 Special Board Meeting…	Page 2
Old Business
Update Regarding Additional Parking Spaces – Caltran Engineering, Inc.
Update Regarding Water & Sewer No-Objection Letter/Easement – Miami-Dade County
Public Schools…	Page 7
New Business
Discussion Regarding Sidewalk Pressure Cleaning…	Page 10
Discussion Regarding Sidewalk Milling/Cutting.	Page 13
Consider Resolution No. 2021-03 – Adopting a Fiscal Year 2021/2022 Proposed Budget…	Page 26
Consider Resolution No. 2021-04 – E-Verify Memorandum of Understanding…	Page 34
Administrative & Operational Matters
Office of Records Update
Board Member & Staff Closing Comments
Adjourn

MIAMI DAILY BUSINESS REVIEW
Published Daily except Saturday, Sunday and Legal Holidays
Miami, Miami-Dade County, Florida

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.._lro,;;.. l! Expires Novern r 19, 2022
...,,.	Bonded Thru Troy Fain lflsur.rn:e 800-385-701 9

f•:	- Commission# GG 277771

Before the undersigned authority personally appeared GUILLERMO GARCIA, who on oath says that he or she is the DIRECTOR OF OPERATIONS, Legal Notices of the Miami Daily
Business   Review   f/k/a   Miami   Review,    a   daily

Saturday,	Sunday	and	Legal	Holidays)

(except
newspaper,

published at Miami in Miami-Dade County, Florida; that the attached   copy   of advertisement, being   a Legal Advertisement of Notice in the matter of

VENETIAN PARC COMMUNITY DEVELOPMENT DISTRICT· FISCAL YEAR 2020/2021 REGULAR MEETING SCHEDULE

in the XXXX Court,
was published in said newspaper in the issues of 10/14/2020
Affiant further says that the said Miami Daily Business Review is a newspaper published at Miami, in said Miami-Dade County, Florida and that the said   newspaper   has   heretofore been continuously published in said Miami-Dade County, Florida each day (except Saturday,   Sunday   and Legal Holidays)   and has been entered as second class mail   matter   at   the   post office in Miami in said Miami-Dade County, Florida,   for a period of one year next preceding the first publication of the attached copy of advertisement; and affiant further   says that he or she has neither   paid nor promised any person,   firm or corporation any discount, rebate, commission or refund for the purpose of
securing    this    advertisement     for    publication     in    the    said

GUILLERMO GARCIA personally known to me

STATE OF FLORIDA COUNTY OF MIAMI-DADE:

VENETIAN PARC COMMUNITY DEVELOPMENT DISTRICT SPECIAL BOARD MEETING
FEBRYARY 4, 2021

CALL TO ORDER

District Manager Nancy Nguyen called the February 4, 2021, Special Board Meeting of Venetian Parc Community Development District (the “District”) to order at approximately 6:10 p.m. in the Venetian Parc Community Clubhouse Meeting Room located at 15351 SW 175th Street, Miami, Florida 33187.

PROOF OF PUBLICATION

Ms. Nguyen presented proof of publication that notice of the February 4, 2021, Special Board Meeting had been published in the Miami Daily Business Review on January 27, 2021, as legally required.

ESTABLISH A QUORUM

Ms. Nguyen stated that the attendance of Chairman Sergio Valdes, Vice Chairman Eugene Collings- Bonfill, and Supervisors Rachel Hernandez, Aaron Heinrich and Ariel Ogen constituted a quorum and it was in order to proceed with the meeting.

Staff in attendance included: District Manager Nancy Nguyen of Special District Services, Inc.; and General Counsel Ginger Wald of Billing, Cochran, Lyles, Mauro & Ramsey, P.A. (via phone).

Also in attendance via phone were: Erick Laventure and Ailsa Simon of Miami-Dade County Public Schools; Nobel Valencia of Avino & Associates; and Juan Alvarez of Alvarez Engineers.

CONSIDER RESOLUTION NO. 2021-01 – DECLARING VACANCIES

Ms. Nguyen presented Resolution No. 2021-01, entitled:

RESOLUTION NO. 2021-01

A RESOLUTION OF THE BOARD OF SUPERVISORS OF THE VENETIAN PARC COMMUNITY DEVELOPMENT DISTRICT DECLARING VACANCIES ON THE BOARD OF SUPERVISORS PURSUANT TO SECTION 190.006(3)(b), FLORIDA STATUTES; AND PROVIDING AN EFFECTIVE DATE.

Ms. Nguyen advised that the 4-year terms of office for Seats #3 (currently held by Ariel Ogen) and #4 (currently held by Aaron Heinrich) had expired in November 2020. She further explained that no elector had qualified for Seats #3 or #4. Pursuant to Section 190.006(3)(b), Florida Statutes, the District is required to declare the seats vacant and appoint a qualified elector to fill each vacancy within 90 days of the second Tuesday following the General Election. Until such appointment, the incumbent Board Member in said seats shall remain in office.

A motion was made by Mr. Valdes, seconded by Mr. Collings-Bonfill and unanimously passed declaring Seats #3 and #4 as vacant, effective November 17, 2020, and authorizing incumbent Board Members in these seats to remain in office until the appointment of a qualified elector to said seats.

Page 1 of 5

APPOINTMENT OF OFFICERS TO VACANT SEATS

Ms. Nguyen stated that vacancies had been declared in Seats #3 and #4, effective as of the second Tuesday of November (November 17, 2020) following the November General Election (November 3, 2020). Pursuant to Section 190.006(3)(b), Florida Statutes, incumbents (holdover Board Members) will serve no longer than ninety (90) days (from November 17, 2020) or until appointments to the vacancies have been made. A discussion ensued after which:

A motion was made by Mr. Valdes, seconded by Mr. Collings-Bonfill and unanimously passed appointing Ariel Ogen to Seat #3, and Aaron Heinrich to Seat #4; and each term of office will expire in November 2024.

ADMINISTER OATH OF OFFICE AND REVIEW NEW BOARD MEMBER DUTIES AND RESPONSIBILITIES

Ms. Nguyen, Notary Public in the State of Florida, administered the Oaths of Office to Mr. Ogen and Mr. Heinrich.

ELECTION OF OFFICERS

Ms. Nguyen indicated that as a result of the appointments to the vacant seats, it would be in order to elect officers to the District Board of Supervisors (the “Board”). Ms. Nguyen provided the following names for election:

Chairperson – Sergio Valdes
Vice Chairperson – Eugene Collings-Bonfill
Secretary/Treasurer – Nancy Nguyen
Assistant Secretaries – Rachel Hernandez, Aaron Heinrich, Ariel Ogen, Armando Silva and Gloria Perez

A motion was made by Mr. Ogen, seconded by Mr. Heinrich and unanimously passed electing the officers of the District Board of Supervisors, as listed above.

ADDITIONS OR DELETIONS TO AGENDA

There were no additions or deletions to the agenda.

COMMENTS FROM THE PUBLIC FOR ITEMS NOT ON THE AGENDA

There were no comments from the public for items not on the agenda.

APPROVAL OF MINUTES
1. October 22, 2020, Special Board Meeting

Ms. Nguyen presented the minutes of the October 22, 2020, Special Board Meeting and stated that she would like to make a change on Page 6 in the meeting book (remove Seat #2, currently held by Rachel Hernandez as a seat up for re-election at the General Election of November 3, 2020). She further explained that the copy of the minutes for execution at today’s meeting already reflected this change.
Page 2 of 5

Ms. Nguyen asked if there were any other changes. There being no additional comments or changes, a motion was made by Ms. Hernandez, seconded by Mr. Ogen and unanimously passed approving the minutes of the October 22, 2020, Special Board Meeting, as amended.

OLD BUSINESS
Update Regarding Monument Signs and Lighting

Ms. Nguyen advised that the monument sign lighting project had been completed. No additional information was required regarding this item at this time.

Discussion Regarding Additional Parking Space – Caltran Engineering, Inc.

Ms. Nguyen advised that the District site plan survey was still under review by the County. More information will be provided regarding this matter at a future meeting.

NEW BUSINESS
Discussion Regarding Water & Sewer Easement – Miami-Dade County Public Schools (MSCPS)

NOTE: This item was discussed prior to Item D.

Ms. Nguyen explained that representatives from Miami Dade County Public Schools were present via phone to discuss a water and sewer easement request.

Mr. Laventure of MSCPS advised the Board that construction of the public school on the southeast corner of SW 157 Avenue and SW 174 Street had commenced. He further explained that after requesting a permit from Miami-Dade Water and Sewer Department (WASD) for the construction of the water and sewer lines to the public school, WASD requested that MDCPS seek the approval from the District to run the water and sewer lines through the District owned tracts located on SW 174 Street and SW 155 Court.

Mr. Collings-Bonfill explained, after reviewing the Traffic Operation Plan (the “TOP”), he would like to request that MDCPS address certain items prior to the Board approving the construction of the water and sewer lines for the public school. Mr. Collings-Bonfill further explained that he was concerned with the traffic impact that the school will have and that the TOP had not been approved by the County as of yet.

Mr. Laventure indicated that there was already an Access Easement Agreement in place for MDCPS to use these tracts (this document was received by the District Manager and District Counsel eight (8) minutes prior to the commencement of today’s Special Board Meeting). The Board requested that MDCPS provide a County approved traffic study and TOP. Additionally, the Board requested that MDCPS consider the construction of an additional lane on SW 174 Street for the sole purpose and use by the public school as well as the installation of a traffic signal at the intersection of SW 157 Avenue and SW 174 Street.

Ms. Simon explained that time was of the essence for the installation of the water and sewer lines and requested that the Board approve the construction. Mr. Collings-Bonfill stated that the Board would like to receive the documents requested prior to any approval. Because of MDCPS’s need to receive the approval quickly, the Board requested that MDCPS provide a letter of non-objection or an easement
Page 3 of 5

agreement to the Board with specific language of what was being requested. In order to facilitate the approval of such document:

A motion was made by Mr. Valdes, seconded by Ms. Hernandez and unanimously passed appointing Mr. Collings-Bonfill as the District representative; and authorizing Mr. Collings-Bonfill to approve and execute any documents received by Miami Dade County Public Schools.

The MDCPS representatives thanked the Board for their time and indicated that they would send the requested information to the Ms. Nguyen, Mr. Collings-Bonfill and Ms. Wald.

Discussion Regarding Procedures for Completion of a Constriction Project - Alvarez Engineers

NOTE: This item was discussed prior to Item H.

Ms. Nguyen explained, at the request of the Board, that she had invited Juan Alvarez to attend today’s meeting to discuss the procedures after an engineer completes a construction project.

Mr. Alvarez greeted the Board and stated that he would gladly answer any questions they may have. Mr. Valdes requested information regarding the second and final lift of asphalt for the roads in Phase 2 (also known as the areas which are Luxcom’s responsibility to complete). Mr. Alvarez explained that he was in communication with Oscar Barbara of Luxcom regarding the streets and was informed that Luxcom was currently looking for proposals for the final lift of asphalt for the roads. He further explained that once a project has been completed, Alvarez Engineers does an inspection of the work. A discussion ensued after which: Mr. Alvarez explained that once the final lift project has been completed, he will contact District Staff so that they can be present for the engineering inspection of the project. More information will be provided regarding this item at a later date.

Note: At approximately 7:13 p.m., Mr. Alvarez excused himself from the meeting and hung up.

ADMINISTRATIVE & OPERATIONAL MATTERS
Consider Resolution No. 2021-02 – Ratifying Actions Taken Pursuant to E.O. No. 20-69

Ms. Nguyen presented Resolution No. 2021-02, entitled:

RESOLUTION NO. 2021-02

A RESOLUTION BY THE BOARD OF SUPERVISORS OF THE VENETIAN PARC COMMUNITY DEVELOPMENT DISTRICT RATIFYING AND APPROVING ACTIONS TAKEN BY THE BOARD OF SUPERVISORS AT MEETINGS HELD VIA MEDIA COMMUNICATIONS TECHNOLOGY PURSUANT TO EXECUTIVE ORDER NO. 20-69, AS AMENDED AND EXTENDED, AS A RESULT OF THE COVID-19 PANDEMIC

Ms. Nguyen explained, due to the COVID-19 pandemic, Governor DeSantis’ Executive Order 20-69 allowed for District meetings to be held using media communications technology and it would be in order to ratify the actions taken by the Board during the May 26, 2020, July 23, 2020, August 27, 2020, and October 22, 2020, District meetings held via Zoom. A discussion ensued after which:

Page 4 of 5

A motion was made by Mr. Collings-Bonfill, seconded by Mr. Heinrich and unanimously passed approving and adopting Resolution No. 2021-02, as presented, ratifying the actions taken by the District Board during the May 26, 2020, July 23, 2020, August 27, 2020, and October 22, 2020 meetings held via Zoom.

BOARD MEMBER & STAFF CLOSING COMMENTS

Ms. Nguyen reminded the Board that the next District meeting would be held on March 25, 2021.

ADJOURNMENT

There being no further business to come before the Board, a motion was made by Mr. Collings-Bonfill, seconded by Mr. Heinrich and unanimously passed to adjourn the Special Board Meeting at approximately 7:25 p.m.

Secretary/Assistant Secretary	Chairperson/Vice Chairperson

Page 5 of 5

LAW  OFFICES
BILLING, COCHRAN, LYLES,  MAURO  & RAMSEY,  P.A.
ESTABLISHED 1977

DENNISE. LYLES JOHN W. MAURO
KENNETH W. MORGAN , J R. BRUCE M. RAMSEY
RIC HARD T. WOULFE CAROL J . HEALY GLASGOW MIC HAEL J . PAWELCZYK ANDREW A. RIEF
MANUEL R. COMRAS SHIRLEY A. DELUNA MARK A. RUTLEDGE GINGER E. WALD JEFFERY R. LAWLE Y DONNA M. KRUSB E SCOTT C. COCHRAN SHAWN B. McKAMEY

LAS OLAS SQUARE. SUITE 600
515 EAST LAS OLAS BOULEVARD FORT LAUDERDALE. FLORIDA 33301
(9 5 4 ) 764-7150
FAX: (954) 764-7279

CENTURION TOWER
1601 FORUM P L AC E . SUITE 400 WEST PALM B EAC H . FLORIDA 33401
(5 6 1) 659-5970
FAX: (5 6  1)  659-6173 WWW.BILLINGCOCHRAN.COM
PLEASE REPLY TO: FORT LAUDERDALE

March 15, 2021

CAMILLE E. BLANTON CHRISTINE A. BROWN BRAD J . KIMBER VANESS A T. STEINERTS JOHN C. WEBBER

OF COUNSEL
CL ARK J . COCHRAN, J R. SUSAN F. DELEGAL GERALD L. KNIGHT

STEVEN F. BILLI NG. 1947-1998
HAYWARD D. GAY, 19 4 3 -20 0 7

Ana Craft
Assistant School Board Attorney Miami-Dade County Public Schools 1450 N.E. 2nd Avenue
Suite 430
Miami, Florida 33132 ACra ft@dadeschools .net

RE:		Venetian Pare Community Development District - School Board of Miami-Dade County request for letter of no objection

Dear Ms. Craft:

I am in receipt of your letter dated March 6, 2021 and your request for the Venetian Pare Community Development District ("District") to execute a form letter of no objection regarding an easement over District owned property.

In your March 6, 2021 letter, you outlined your position that The School Board of Miami-Dade County ("School Board") has a perpetual, non-exclusive easement in, to, upon and over all of the Common Areas for the installation of utilities. In fact, you and the School Board's representatives have stated that such an easement exists. Originally, the School Board requested from the District a "letter of no objection" to the utilization of an existing easement over District property for the School Board to connect to the water and sewer as required by Miami-Dade County (WASD). In the special meeting of the District, which was held only at the request of the School Board, it was repeatedly asked whether the School Board was requesting an actual grant of easement or only a letter of no objection . The answer was only a letter. Yet, a review of the draft "non-objection letter" attachment to your March 6, 2021 correspondence extends beyond a mere letter of no objection and could be interpreted as an agreement that the District will execute a grant of easement to WASD. Since this is substantially more than previously requested, this request for a grant of easement has been provided to

Assistant School Board Attorney March 15, 2021
Page 2

the District Engineer for review and comment prior to proceeding with the execution of same.

Your letter outlines only certain portions of the Declaration for Venetian Pare (the "Declaration") in your analysis that the School Board already maintains an easement over District Property for installation of utilities. A further review of the Declaration provides certain exclusions. I direct your attention to page 2 of the Declaration and the definition of Common Areas, which specifically provides that "certain areas that would otherwise be Common Areas shall be conveyed to the District and comprise part of the Facilities". Additionally, I would direct your further attention to Section 10 of the Declaration, which explains the existence of the District and the possible ownership of property within the District. Specifically, in Section 10.1, the language of the Declaration is clear that the final determination of Common Areas "may not occur until the completion of all development". Section
10.4 provides that the Developer may convey portions of the Community to the District and therefore these portions will not be Common Areas of the Association. Therefore, your analysis that the School Board as the successor in interest to the Developer, benefits from a perpetual, non-exclusive easement upon and over all of the Common Areas, does not necessarily apply to District-owned property which is excluded from the definition of Common Areas in the Declaration.

While the District has been accommodating with the School Board's request, the District Board of Supervisors also has an obligation to have the new request for the grant of an easement properly reviewed by the District Engineer prior to proceeding with the proposed letter of no objection . This has already been undertaken by the District. There is a concern that the request by the School Board is more than initially contemplated. The District shall continue to proceed with the new request by the School Board after the full review and report from the District Engineer.

Additionally, the District has requested through the District Manager to the School Board representative, a County approved Traffic Study and Traffic Operations Plan for the anticipated vehicular and pedestrian access to SW 174 Street and SW 155 Court set forth in the Access Easement Agreement between the School Board and Developer, Venetian Lennar, LLC ("Lennar") for Tract P. That Access Easement Agreement specifically stated that Lennar was to be provided with the design of the Easement Areas (the "Approved Working Drawings ") to assure proper ingress/egress to the School Parcel. The District Manager requested this information from Lennar and was informed that the School Board did not provide the "Approved Working Drawings" to Lennar. Lennar conveyed Tract P to the District. The District as the successor owner has the same interest as Lennar to ensure that the community and its residents will be safe from the use of community roadways by the proposed school. Therefore, this is a formal request that the "Approved Working Drawings" and any other traffic studies and traffic operations plan be provided to the District. Please provide this information

Assistant School Board Attorney March 15, 2021
Page 3

as soon as possible. The District anticipates meeting on March 25, 2021 and this information along with any further requests by the School Board should be addressed at this time.

Very truly yours,

Ginger E. Wald For the Firm

cc:	Nancy Nguyen, District Manager (via e-mail only)
Supervisor Collings -Banfill (via e-mail only)

 	I & M   P A I N T I N G   - INVOICE	

I & M PAINTING	
7259 Sw 22 St	
Miami, Fl 33155	
Phone: (786) 326-5357	
Mail:sales@impaintingllc.com	

INVOICE BILL TO	
Venetian Parc SDD	
Special Distric Services, Inc.	
2501 A Burns Road Palm Beach	
Gardens, FL 33410	

DATE	3/16/2021	
INVOICE #	909987	
Total	$7,063.33	

MATERIALS	DESCRIPTION	QUANTITY	PRICE	
				
	softwash with chemical to CDD sidewalks	150,000 sf	$4,840.00	
	softwash with chemical to County sidewalks	30,000 sf	$610.00	
	softwash with chemical to CDD sidewalks	50,000 sf	$1,613.33	
			$0.00	
			$0.00	
			$0.00	
			$0.00	

Total	$7,063.33

ADDITIONAL	
NOTE	
/	TERMS	&	
CONDITIONS	
DOWN PAYMENT OF 30% DUE UPFRONT. ONCE FINAL JOB IS COMPLETE, REMAINING BALANCE IS DUE.	

13476 SW 22nd Street Miramar, FL 33027
Thepressurecleaningman@gmail.com www.thepressurecleaningman.com Cell: (954)328-8964
License Dade County No. 14BS00064 License Broward County No. 11-RP-17299-X

ThePressureCleaningMan
Estimate

For: Venetian Parc CDD Jromero@sdsinc.org

Estimate
No:

1161

2501A Burns Road
Palm Beach Gardens, FL 33410 C/O Special District Services, Inc

Date: 03/16/2021

Description	Amount

Pressure Cleaning of:
1. Sidewalks (District)

$11,993.20

Pressure Cleaning of:
1. Sidewalks (County)

$2,387.28

Additional Pressure Cleaning of: 50,000 ft.²
1. Sidewalks (District)

$5,000.00

STIMAT

Subtotal	$19,380.48
Total	$19,380.48

Total	$19,380.48

Notes
Pricing may change if job specifications/materials change.

Pressure washing ground work does NOT remove any gum, rust stains, tire marks, or oil stains unless specified otherwise in estimate content. The above mention require to be treated with special chemicals/techniques.

Vendor will supply all labor, materials and water needed to complete the job in a professional manner. Timeframe of job 1 to 2 weeks weather

Date	Estimate #	
3/16/2021	539	

19525 SW 272 ST
HOMESTEAD, FL 33031

Venetian Parc CDD
C/o Special District Services, Inc.
2501A Burns Road
Palm Beach Gardens, FL 33410

Description	Quantity	Rate	Amount	
Pressure washing of sidewalk areas as outlined by District Manager.		0.00	0.00	
Sidewalks will be chemically post treated after pressure washing is				
completed.				
Sidewalks CDD Area	150,000	0.065	9,750.00	
County Sidewalks	30,000	0.065	1,950.00	
Additional Sidewalks	50,000	0.065	3,250.00	

TOTAL $14,950.00	

PH: 305-989-8446

Phone #

Trimscape@hotmail.com

E-mail

CORPORATION
6508 SW 33rd Street Miramar Florida 33023 U.S.A		Estimate
#1042	

Bill To				
Venetian Parc CDD				
2501A Burns Road		Estimate Date :	12/04/2020	
#	Item & Description	Qty		Amount	
1	Removal of sidewalk tripping hazards at 70 locations initially through all community sidewalks with the exclusion of newly built homes. After walking through the property	85	$7,200	
	we will add 15 locations to the estimate. For a total of 85 locations through the			
	community.			

JCC SERVICES

C/o Special District Services, Inc.

Palm Beach Gardens, FL 33410

JCC Services Corporation does not remove or replace sidewalks. Service will be provided only in Sidewalks noted on the estimate. The replacement of sidewalks is beyond the scope of our work and will not be done by JCC Services Corporation.
Any changes or additions are subject to change orders that must be approved in advance.
All the job will be conducted under the documents required by clienT. Certificate of Liability includes: General Liability=$2,000,000/General Aggregate=$2,000,000 / Worker’s Comp=$1,000,000

Sub Total

Discount	$7,200	
Total	$7,200	

Notes
JCC Services Corp, want to thank you for the opportunity to estimate the sidewalk maintenance job for your company.

Regards,

Juan Carlos Carabali

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CDD BOUNDARY

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COD OWNERSH P		
TRACTS "B, C, D, J, L, M, 0, AND P"	TRACTS "C, D, E, F, G, H, J, K, L, M, N,	TRACTS "A AND PORTION OF H"	TRACTS "A, I AND P" (PB 170, PG 33)	
(PB 170, PG 27)	0, QAND R" (PB 170, PG 33)	(PB 170, PG 27)	FOLIOS 30-5933-064-2130	
FO LIOS: 30-5933-035-3940	FOLIOS: 30-5933-064-2150	FOLIOS: 30-5933-035-3930	30-5933-064-2210	
30-5933-035-3950	30-5933-064-2170	30-5933-035-4000	30-5933-064-2280	
30-5933-035-3960	30-5933-064-2180	ORB 30197 , PG 3548	ORB 30296, PG 4779	
30-5933-035-4020	30-5933-064-2160	CATEGORY: INTERIOS ROADS	CATEGORY : INTERIOR ROADS	
30-5933-035-4070	30-5933-064-2240			
30-5933-035-4040	30-5933-064-2200			
30-5933-035-4050	30-5933-064-2190			
30-5933-035-4080	30-5933-064-2250			
ORB 30197, PG 3548	30-5933-064-2260			
CATEGORY: LANDSCAPING AND	30-5933-064-2230			
ENTRY FEATURES	30-5933-064-2270			
	30-5933-064-2290			
	30-5933-064-2220			
	30-5933-064-2300			

ORB 30296, PG 4779 CATEGORY: LANDSCAPING AND ENTRY FEATURES

ALVAREZ ENGINEERS, INC.
VENETIAN PARC C.D.D.
DISTRICT BOUNDARY

EXHIBIT 2

0 100'

I

300'	500'
I

--

I 1/ 4 / 2019  P:\070905  -  Venetian  Pare CDO\Year/y   Report\2019  Report\CADD\EXHIBIT-02.dgn	Page 14

Page 15

October 23, 2020

Venetian Parc HOA

Executive Proposal

15351 SW 175th St. Miami, FL 33187
C/O Special District Services, Inc.

 	SIDEWALK SAFETY EVALUATION	

The information in this summary is confidential and proprietary. It is owned by Florida Sidewalk Solutions and is to be used only in evaluating this project. This document is exempt from release under the Freedom of Information Act and may not be distributed under any circumstances.

Florida Sidewalk Solutions	FloridaSidewalkPSoalgueti1o6ns.com
Prepared by Becky Navia	Becky@FloridaSidewalkSolutions.com	Cell # 305 607-4859

Executive Proposal

Venetian Parc HOA
15351 SW 175th St. Miami, FL 33187
C/O Special District Services, Inc.

 	WHO WE ARE	

Florida Sidewalk Solutions (FSS) is an affiliate of Precision Concrete Cutting, the global leader in Sidewalk Asset Management. FSS has been servicing South Florida since 2005, utilizing six U.S. patents awarded for trip hazard removal, equipment and technique.

U.S. Pat. No. 6,827,074	U.S. Pat. No. 6,896,604 U.S. Pat. No. 7,000,606	U.S. Pat. No. 7,143,760 U.S. Pat. No. 7,201,644	U.S. Pat. No. 7,402,095

Florida Sidewalk Solutions assesses thousands of miles of sidewalk infrastructure each year for both cities and communities using our proprietary Geographical Information Systems Surveying Technology. This technology provides the insight and knowledge our clients need to make data driven, well-informed decisions about repairing their uneven
sidewalk trip hazards.

The information in this summary is confidential and proprietary. It is owned by Florida Sidewalk Solutions and is to be used only in evaluating this project. This document is exempt from release under the Freedom of Information Act and may not be distributed under any circumstances.

Page 17

The information in this summary is confidential and proprietary. This document is exempt from release under the Freedom of Information Act and may not be distributed under any circumstances.

Executive Proposal

Venetian Parc HOA
15351 SW 175th St. Miami, FL 33187
C/O Special District Services, Inc.

 	OUR PROMISE TO YOU…	

Our work is guaranteed to offer the following benefits:

Cost Savings - Remove trip hazards at a fraction of the cost of other methods

Proprietary and Patented Cutting Technology to repair trip hazards.

ADA Compliance - Approved and Compliant with ADA standards

Mapping Services - GPS mapping integrated with Google Earth Map

Clean - No mess left behind = Reduced resident complaints

Safety - Decrease liability on your pedestrian SIDEWALKs by increasing safety

Low Impact - Average removal time is less than 20 minutes per repair

Minimum Disruption  - No sidewalk closures or incidental costs

Full-Service Contractor - Sidewalk Maintenance Program and Consultation Services

The information in this summary is confidential and proprietary. It is owned by Florida Sidewalk Solutions and is to be used only in evaluating this project. This document is exempt from release under the Freedom of Information Act and may not be distributed under any circumstances.

The information in this summary is confidential and proprietary. This document is exempt from release under the Freedom of Information Act and may not be distributed under any circumstances.

Page 18

The information in this summary is confidential and proprietary. This document is exempt from release under the Freedom of Information Act and may not be distributed under any circumstances.

Executive Proposal

Venetian Parc HOA
15351 SW 175th St. Miami, FL 33187
C/O Special District Services, Inc.

 	TRIP HAZARD REPAIR MAP	

The information in this summary is confidential and proprietary. It is owned by Florida Sidewalk Solutions and is to be used only in evaluating this project. This document is exempt from release under the Freedom of Information Act and may not be distributed under any circumstances.

Page 19

The information in this summary is confidential and proprietary. This document is exempt from release under the Freedom of Information Act and may not be distributed under any circumstances.

Executive Proposal

Venetian Parc HOA
15351 SW 175th St. Miami, FL 33187
C/O Special District Services, Inc.

 	GRINDING VS. SAW CUT TECHNOLOGY	

CONVENTIONAL GRINDING

The biggest contrast between grinding and the Florida Sidewalk Solutions repair method is the quality, aesthetics, and ADA Compliance our patented saw-cutting offers.
Grinding Limitations:
Damages the concrete, breaks edges, knocks out aggregate
Looks rough, unfinished, and highlights the uneven scarring
Does not meet ADA slope requirements
FSS Advantage:
Our finish is the finest
Our slope meets ADA specifications
Our sidewalks are the safest

FSS
SAW CUTTING

Our technique is the fastest
Our service is the best

The information in this summary is confidential and proprietary. It is owned by Florida Sidewalk Solutions and is to be used only in evaluating this project. This document is exempt from release under the Freedom of Information Act and may not be distributed under any circumstances.

The information in this summary is confidential and proprietary. This document is exempt from release under the Freedom of Information Act and may not be distributed under any circumstances.

Page 20

The information in this summary is confidential and proprietary. This document is exempt from release under the Freedom of Information Act and may not be distributed under any circumstances.

Executive Proposal

Venetian Parc HOA
10/23/20
Property Snapshot

 	TRIP HAZARD REPAIR MAP	

The information in this summary is confidential and proprietary. It is owned by Florida Sidewalk Solutions and is to be used only in evaluating this project. This document is exempt from release under the Freedom of Information Act and may not be distributed under any circumstances.

Page 21

The information in this summary is confidential and proprietary. This document is exempt from release under the Freedom of Information Act and may not be distributed under any circumstances.

Executive Proposal

10/23/20
Venetian Parc HOA
15351 SW 175th St. Miami, FL 33187
C/O Special District Services, Inc.

 	SIDEWALK OVERVIEW	

Complete Survey Results :
Trip Hazards Listed: 70
Lineal Feet of Corrections: 351
Repair Location: Venetian Parc HOA
Trip Hazard Repair Quote: $7,382.70
The above quote reflects a 10% discount detailed on the following page

FSS Recommended Corrective Actions:
Remove 70 Trip Hazards Correcting 351 Lineal Feet of Displaced, Heaved Sidewalk Currently Not Meeting ADA Sidewalk Safety Specifications

October 23, 2020

Venetian Parc HOA

Executive Proposal

15351 SW 175th St. Miami, FL 33187
C/O Special District Services, Inc.

 	Quick Approval Discount Option	
Proposed Sidewalk Trip Hazards Corrections - 70

Repair Quote
$8,203.00
Pricing valid 90-days

*Quick Approval Incentive Offer
$7,382.70
10% Discount = $820.30 Off
To approve by March 31, 2021

*DISCOUNT OFFER:
To take advantage of the $820.30 SAVINGS approval must be received by March 31, 2020.

The information in this summary is confidential and proprietary.  It is owned by Florida Sidewalk Solutions and is to be used only in evaluatPingatgheis p2r4oject.

This document is exempt from release under the Freedom of Information Act and may not be distributed under any circumstances.

Executive Proposal

 	What’s Next?	

Where are we at? Recap of free work delivered to date and next steps:

Executive Summary

Venetian Parc HOA
15351 SW 175th St. Miami, FL 33187
C/O Special District Services, Inc.

 	Florida Sidewalk Solutions	

ABOUT OUR WORK:
Please note this survey in no way constitutes or guarantees the identification of every trip hazard on site. Therefore, the final determination of the work to be performed shall be the sole responsibility of the customer. Florida Sidewalk Solutions (FSS) removes only those trip hazards specifically requested by customers and therefore makes no guarantee or representation that the property is free of trip hazards after the project is completed.
ALL jobs require a Florida Sidewalk Solutions signed Notice to Proceed / Contract for Patented – Saw Cutting Trip Hazard Removal in order to be scheduled. Any changes or additions are subject to contract document legal fees.
Our work requires the use of generators; therefore, we cannot work in rainy conditions or with wet concrete.
Florida Sidewalk Solutions does not remove or replace sidewalks. This property has zero locations that are beyond our scope of work and in need of replacement. Areas noted for replacement are recommendations only and are not included in this proposal. A list of replacement addresses / locations will be provided upon project approval. Replacements are the sole responsibility of the customer.
Town of Davie Occupational license: #41998 /Broward County Occupational license: #329-30464
Miami-Dade County Occupational license: #607999-0 /Certificate of Competency: E0600786 / Federal Tax ID: #56-2520955
Certificate of Liability includes: General Liability=$2,000,000/General Aggregate=$2,000,000 / Automobile=$1,000,000/ Worker’s Comp=$1,000,000 / Please let us know in advance if you need to be listed as a Certificate Holder on our policy.

The information in this summary is confidential and proprietary. It is owned by Florida Sidewalk Solutions and is to be used only in evaluating this project. This document is exempt from release under the Freedom of Information Act and may not be distributed under any circumstances.

The information in this summary is confidential and proprietary. This document is exempt from release under the Freedom of Information Act and may not be distributed under any circumstances.

Page 25

The information in this summary is confidential and proprietary. This document is exempt from release under the Freedom of Information Act and may not be distributed under any circumstances.

RESOLUTION NO. 2021-03

A RESOLUTION OF THE BOARD OF SUPERVISORS OF THE VENETIAN PARC COMMUNITY DEVELOPMENT DISTRICT APPROVING A PROPOSED BUDGET AND NON-AD VALOREM SPECIAL ASSESSMENTS FOR FISCAL YEAR 2021/2022; AND PROVIDING AN EFFECTIVE DATE.

WHEREAS, the Board of Supervisors (the “Board”) of the Venetian Parc Community Development District (the “District”) is required by Section 190.008(2)(a), Florida Statutes, to approve a Proposed Budget for each fiscal year; and,

WHEREAS, the Proposed Budget including the Assessments for Fiscal Year 2021/2022 has been prepared and considered by the Board.

NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF SUPERVISORS OF THE VENETIAN PARC COMMUNITY DEVELOPMENT DISTRICT, THAT:

Section 1. The Proposed Budget including the Assessments for Fiscal Year 2021/2022 attached hereto as Exhibit “A” is approved and adopted by the Board.

Section 2. A Public Hearing is hereby scheduled for May 27, 2021 at 6:00 p.m. in the Venetian Parc Community Clubhouse Meeting Room located at 15351 S.W. 175th Street, Miami, Florida 33187, for the purpose of receiving public comments on the Proposed Fiscal Year 2021/2022 Budget.

PASSED, ADOPTED and EFFECTIVE this 25th day of March, 2021.

ATTEST:	VENETIAN PARC
COMMUNITY DEVELOPMENT DISTRICT

By:			By:		 Secretary/Assistant Secretary			Chair/Vice Chair

Venetian Parc Community Development District

Proposed Budget For Fiscal Year 2021/2022
October 1, 2021 - September 30, 2022

CONTENTS

PROPOSED BUDGET

DETAILED PROPOSED BUDGET

DETAILED PROPOSED DEBT SERVICE FUND BUDGET (AREA ONE) IV           DETAILED PROPOSED DEBT SERVICE FUND BUDGET (AREA TWO) V	ASSESSMENT COMPARISON

PROPOSED BUDGET
VENETIAN PARC COMMUNITY DEVELOPMENT DISTRICT FISCAL YEAR 202 /2022
OCTOBER 202  - SEPTEMBER 30 2022

REVENUES	
FISCAL YEAR 202 /2022 BUDGET	

                           	       	
                           	       	
  h R      	 	

TOTAL REVENUES	   0      	
		
E PENDITURES		
ADMINISTRATIVE E PENDITURES		
           F   	 	

     	      	
           R   	      	
      F   	     	

             	     	
       	   	
 ff            	   	

          R     F -         	   	
          R     F -         	   	
        F -         	     	
        F -         	     	
                      F -         	   	
                      F -         	   	
                          	     	
TOTAL ADMINISTRATIVE E PENDITURES	       	
		
MAINTENANCE E PENDITURES		
                        	      	
F                          	     	
                                      	     	
       R                  	     	
                           	     	
                   R                 	     	

                       	      	
                  	     	
TOTAL MAINTENANCE E PENDITURES	      0	
		
TOTAL E PENDITURES	        	
		
REVENUES LESS E PENDITURES	  2     	
		
              -         	         	
              -         	         	
		
BALANCE	     2 	
		
                                 F  	        	
          F                 	        	
		
E CESS/ (S ORTFALL)	 0	
		
          F          Y   	 	
		
NET E CESS/ (S ORTFALL)	  	

DETAILED PROPOSED BUDGET
VENETIAN PARC COMMUNITY DEVELOPMENT DISTRICT FISCAL YEAR 202 /2022
OCTOBER 202  - SEPTEMBER 30 2022

REVENUES	
FISCAL YEAR
20 /2020
ACTUAL	
FISCAL YEAR 2020/202 BUDGET	
FISCAL YEAR 202 /2022 BUDGET	

COMMENTS	

                           	       	       	       	                 	
                           	       	       	       	                 	
  h R      	     	 	 		
               	   	   	   	                         h	
					
TOTAL REVENUES	   0 3 8 0	   0  88	   0      		
					
E PENDITURES					
ADMINISTRATIVE E PENDITURES					
           F   	 	 	 	           F   	
                        	 	 	 	           F           	
          	      	      	      	              	
     	      	      	      	    h     F                    	
           R   	      	      	      	               	
      F   	     	     	     	                F                  	
         	     	     	     	                  	
                    	     	   	   	              F                    	
             	     	     	     	    h     F                    	
       	   	   	   	             F                    	
 ff            	   	   	   	    h     F                    	
                    	   	   	   	    h     F                    	
                  	     	     	     	    h      F                    	
          R      F -         	   	   	   	    h     F                    	
          R      F -         	   	   	   	    h     F                    	
        F -         	     	     	     	    h     F                    	
        F -         	     	     	     	    h     F                    	
                      F -         	   	   	   	    h      F                    	
                      F -         	   	   	   	    h      F                    	
                          	 	     	     	                          	
TOTAL ADMINISTRATIVE E PENDITURES	       	    3  	       		
					
MAINTENANCE E PENDITURES					
                        	      	      	      	    h     F                    	
F                          	     	     	     	    h      F                    	
                                      	     	     	     	                F                    	
       R                  	   	     	     	    h     F                    	
                           	     	     	     	    h      F                    	
                   R                 	     	     	     	                F                    	
                                                  	 	 	      	                                                  	
                   	     	     	     	    h      F                    	
                       	     	      	      	                 F                    	
                  	 	     	     	    h      F                    	
TOTAL MAINTENANCE E PENDITURES	 3 3 	     38	      0		
					
TOTAL E PENDITURES	        	     30 	        		
					
REVENUES LESS E PENDITURES	  32 2  	  2 83	  2     		
					
              -         	         	         	         	                                        	
              -         	         	         	         	                                        	
					
BALANCE	  8 03	     32	     2 		
					
                                 F  	        	        	        	             f                              R   	
          F                 	        	        	        	F                f                              R   	
					
E CESS/ (S ORTFALL)	     8 	 0	 0		
					
          F        Y   	 	 	 	          F        Y   	
					
NET E CESS/ (S ORTFALL)	     8 	  	  		

DETAILED PROPOSED DEBT SERVICE FUND (AREA ONE) BUDGET
VENETIAN PARC COMMUNITY DEVELOPMENT DISTRICT FISCAL YEAR 202 /2022
OCTOBER 202 - SEPTEMBER 30 2022

REVENUES	
FISCAL YEAR

20 /2020

ACTUAL	FISCAL YEAR 2020/202 BUDGET	FISCAL YEAR 202 /2022 BUDGET	

COMMENTS	

     	

                   F            	

       	

                               	

Total Revenues	
     23 	
  30 82	
  30 0 		

E PENDITURES					

      	

                             	

       	

                             	

     R         	

      	

Total Expenditures	
     22 	
  30 82	
  30 0 		

Excess/ (Shortfall)	
 2 00 	
 0	
 0		

Series 20 3 Bond Information - Area One

                    =	          	                              =	            	
         R  =	      -      	                             =	                      	
           =	            			
              =

               f      =	             

DETAILED PROPOSED DEBT SERVICE FUND (AREA TWO) BUDGET
VENETIAN PARC COMMUNITY DEVELOPMENT DISTRICT FISCAL YEAR 202 /2022
OCTOBER 202 - SEPTEMBER 30 2022

REVENUES	
FISCAL YEAR
20 8/20 ACTUAL	FISCAL YEAR 2020/202 BUDGET	FISCAL YEAR 202 /2022 BUDGET	

COMMENTS	

     	

                   F            	

       	

                               	

      	

Total Revenues	
     8  	
  28 3  	
  28 0  		

E PENDITURES					

      	

                             	

       	

                             	

     R         	

     	

Total Expenditures	
      3 	
  28 3  	
  28 0  		

Excess/ (Shortfall)	
  3 2  	
 0	
 0		

Series 20 3 Bond Information - Area Two

                    =	          	                              =	            	
         R  =	       -       	                             =	                      	
           =	            			
              =

               f      =	             

Venetian Parc Community Development District Assessment Comparison

	F     Y   	F     Y   	F     Y   	Fiscal Year	
	         	         	         	202 /2022	
	          	          	          	Projected Assessment	
	    f             	    f             	    f             	 	Before Discount*		

       	

  3 .  	
           	      	      	       	    .0 	
    	         	         	         	   2 .  	
      F                     h    	      .8 	      .  	      .  	      . 2	

       	

  3 .  	
           	      	      	       	    .0 	
    	         	         	         	    22.3 	
      F                        F      U    	   823.  	   823.  	    23.  	    23. 0	

       	

  3 .  	
           	      	      	       	    .0 	
    	         	         	         	   2 .  	
      F                     h    	      .8 	      .  	      .  	      . 2	

       	

  3 .  	
           	      	      	       	    .0 	
    	         	         	         	    22.3 	
      F                        F      U    	   823.  	   823.  	    23.  	    23. 0	

*                                     h F          			
            f                 			
                        F  			
                             F  			

            f         			
                F      H       f        	
             h    	  		      U    	   	
                F      U    	   		           	 	
               U    	   		       F       	   	

             h    	  			
                F      U    	   			
               U    	   			

               U    	   			
               U    	   			
      U    	   			

                  	

RESOLUTION NO. 2021-04

A RESOLUTION OF THE BOARD OF SUPERVISORS OF THE VENETIAN PARC COMMUNITY DEVELOPMENT DISTRICT DIRECTING THE DISTRICT MANAGER TO REGISTER THE DISTRICT WITH AND USE THE E- VERIFY SYSTEM PURSUANT TO THE REQUIREMENTS OF SECTION 448.095, FLORIDA STATUTES; AUTHORIZING EXECUTION OF THE E-VERIFY MEMORANDUM OF UNDERSTANDING FOR EMPLOYERS BETWEEN THE DISTRICT AND THE DEPARTMENT OF HOMELAND SECURITY (DHS); PROVIDING FOR SEVERABILITY; AND PROVIDING FOR AN EFFECTIVE DATE

WHEREAS, Section 448.095, Florida Statutes, requires public employers, like the Venetian Parc Community Development District (the “District”), to register with and use the E- Verify system of the United States Department of Homeland Security (the “E-Verify system”) to verify the work authorization status of newly hired employees; and

WHEREAS, Section 448.095, Florida Statutes, also mandates that the District may not, on or after January 1, 2021, enter contracts with a contractor unless the contractor and its subcontractors have registered with and are utilizing the E-Verify system; and

WHEREAS, in order to register with the E-Verify system, the District is required to enter into the E-Verify Memorandum of Understanding for Employers with the Department of Homeland Security (OHS), a copy of which is attached hereto and made a part hereof as Exhibit “A” the (“E-Verify MOU”); and

WHEREAS, in accordance with the requirements of Section 448.095, Florida Statutes, the District Board of Supervisors finds it to be in the best interest of the District to register with the E-Verify system, authorize execution of the E-Verify MOU, and utilize the E-Verify system in connection with its hiring practices and for new and renewed agreements entered into on or after January 1, 2021 with contractors, service providers, and others providing labor, supplies or services to the District.

NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF SUPERVISORS OF THE VENETIAN PARC COMMUNITY DEVELOPMENT DISTRICT, THAT:

Section 1.       The above recitals are true and correct and incorporated herein as if set forth in full herein.

Section 2.     In accordance with the requirements of Section 448.095, Florida Statutes, the District Manager shall register the District with and utilize the E-Verify system, and shall administer agreements entered into on or after January 1, 2021 with contractors, service

1

providers, and others providing labor, supplies, or services to the District to monitor and enforce E-Verify compliance.

Section 3. The District Manager is authorized to execute the E-Verify MOU on behalf of the District.

Section 4. The District Manager of the District is hereby directed to take other action(s) necessary and consistent with the intent of this Resolution, including but not limited to, completing the tasks needed to otherwise comply with the provisions of Section 448.095, Florida Statutes and the terms, conditions, and requirements of the District as set forth in the E-Verify MOU.

Section 5. All sections, or parts thereof, which conflict herewith, are, to the extent of such conflict, superseded and repealed. In the event that any portion of this Resolution is found to be unconstitutional or improper, such portion shall be severed herein and shall not affect the validity of the remaining portions of this Resolution.

Section 6.	This Resolution shall take effect immediately upon its adoption.

PASSED AND ADOPTED this 25th day of March, 2021, by the Board of Supervisors of the Venetian Parc Community Development District.

VENETIAN PARC COMMUNITY DEVELOPMENT DISTRICT

Print Name:		Print Name:   	
Secretary/Assistant Secretary	Chair/Vice Chair

2

Exhibit “A”

The E-Verify Memorandum of Understanding for Employers

3

Company ID Number:  	

THE E-VERIFY MEMORANDUM OF UNDERSTANDING
FOR EMPLOYERS

ARTICLE I PURPOSE AND AUTHORITY

The parties to this agreement are the Department of Homeland Security (DHS) and the
 	(Employer). The purpose of this agreement is to set forth terms and conditions which the Employer will follow while participating in E-Verify.

E-Verify is a program that electronically confirms an employee’s eligibility to work in the United States after completion of Form I-9, Employment Eligibility Verification (Form I-9). This Memorandum of Understanding (MOU) explains certain features of the E-Verify program and describes specific responsibilities of the Employer, the Social Security Administration (SSA), and DHS.

Authority for the E-Verify program is found in Title IV, Subtitle A, of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (IIRIRA), Pub. L. 104-208, 110 Stat.
3009, as amended (8 U.S.C. § 1324a note). The Federal Acquisition Regulation (FAR) Subpart 22.18, “Employment Eligibility Verification” and Executive Order 12989, as amended, provide authority for Federal contractors and subcontractors (Federal contractor) to use E-Verify to verify the employment eligibility of certain employees working on Federal contracts.

ARTICLE II RESPONSIBILITIES

RESPONSIBILITIES OF THE EMPLOYER

The Employer agrees to display the following notices supplied by DHS in a prominent place that is clearly visible to prospective employees and all employees who are to be verified through the system:
Notice of E-Verify Participation
Notice of Right to Work
The Employer agrees to provide to the SSA and DHS the names, titles, addresses, and telephone numbers of the Employer representatives to be contacted about E-Verify. The Employer also agrees to keep such information current by providing updated information to SSA and DHS whenever the representatives’ contact information changes.
The Employer agrees to grant E-Verify access only to current employees who need E- Verify access. Employers must promptly terminate an employee’s E-Verify access if the
Page 1 of 13 E-Verify MOU for Web Services Employers | Revision Date 06/01/13

employee is separated from the company or no longer needs access to E-Verify.
The Employer agrees to become familiar with and comply with the most recent version of the E-Verify User Manual.
The Employer agrees that any Employer Representative who will create E-Verify cases will complete the E-Verify Tutorial before that individual creates any cases.
The Employer agrees that all Employer representatives will take the refresher tutorials when prompted by E-Verify in order to continue using E-Verify. Failure to complete a refresher tutorial will prevent the Employer Representative from continued use of E-Verify.
The Employer agrees to comply with current Form I-9 procedures, with two exceptions:
If an employee presents a "List B" identity document, the Employer agrees to only accept "List B" documents that contain a photo. (List B documents identified in 8 C.F.R. § 274a.2(b)(1)(B)) can be presented during the Form I-9 process to establish identity.) If an employee objects to the photo requirement for religious reasons, the Employer should contact E-Verify at 888-464-4218.
If an employee presents a DHS Form I-551 (Permanent Resident Card), Form I-766 (Employment Authorization Document), or U.S. Passport or Passport Card to complete Form I-9, the Employer agrees to make a photocopy of the document and to retain the photocopy with the employee’s Form I-9. The Employer will use the photocopy to verify the photo and to assist DHS with its review of photo mismatches that employees contest. DHS may in the future designate other documents that activate the photo screening tool.

Note: Subject only to the exceptions noted previously in this paragraph, employees still retain the right to present any List A, or List B and List C, document(s) to complete the Form I-9.

The Employer agrees to record the case verification number on the employee's Form I-9 or to print the screen containing the case verification number and attach it to the employee's Form I-9.
The Employer agrees that, although it participates in E-Verify, the Employer has a responsibility to complete, retain, and make available for inspection Forms I-9 that relate to its employees, or from other requirements of applicable regulations or laws, including the obligation to comply with the antidiscrimination requirements of section 274B of the INA with respect to Form I-9 procedures.
The following modified requirements are the only exceptions to an Employer’s obligation to not employ unauthorized workers and comply with the anti- discrimination provision of the INA: (1) List B identity documents must have photos, as described in paragraph 6 above; (2) When an Employer confirms the identity and employment eligibility of newly hired employee using E-Verify procedures, the Employer establishes a rebuttable presumption that it has not violated section 274A(a)(1)(A) of the Immigration and Nationality Act (INA) with respect to the hiring of that employee; (3) If the Employer receives a final nonconfirmation for an employee, but continues to employ that person, the Employer must notify DHS and the Employer is subject to a civil money penalty between $550 and $1,100 for each failure to notify DHS of continued employment

Page 2 of 13 E-Verify MOU for Web Services Employers | Revision Date 06/01/13

following a final nonconfirmation; (4) If the Employer continues to employ an employee after receiving a final nonconfirmation, then the Employer is subject to a rebuttable presumption that it has knowingly employed an unauthorized alien in violation of section 274A(a)(1)(A); and (5) no E-Verify participant is civilly or criminally liable under any law for any action taken in good faith based on information provided through the E-Verify.
DHS reserves the right to conduct Form I-9 compliance inspections, as well as any other enforcement or compliance activity authorized by law, including site visits, to ensure proper use of E-Verify.
The Employer is strictly prohibited from creating an E-Verify case before the employee has been hired, meaning that a firm offer of employment was extended and accepted and Form I-9 was completed. The Employer agrees to create an E-Verify case for new employees within three Employer business days after each employee has been hired (after both Sections 1 and 2 of Form I-9 have been completed), and to complete as many steps of the E-Verify process as are necessary according to the E-Verify User Manual. If E-Verify is temporarily unavailable, the three-day time period will be extended until it is again operational in order to accommodate the Employer's attempting, in good faith, to make inquiries during the period of unavailability.
The Employer agrees not to use E-Verify for pre-employment screening of job applicants, in support of any unlawful employment practice, or for any other use that this MOU or the E-Verify User Manual does not authorize.
The Employer must use E-Verify for all new employees. The Employer will not verify selectively and will not verify employees hired before the effective date of this MOU. Employers who are Federal contractors may qualify for exceptions to this requirement as described in Article II.B of this MOU.
The Employer agrees to follow appropriate procedures (see Article III below) regarding tentative nonconfirmations. The Employer must promptly notify employees in private of the finding and provide them with the notice and letter containing information specific to the employee’s E-Verify case. The Employer agrees to provide both the English and the translated notice and letter for employees with limited English proficiency to employees. The Employer agrees to provide written referral instructions to employees and instruct affected employees to bring the English copy of the letter to the SSA. The Employer must allow employees to contest the finding, and not take adverse action against employees if they choose to contest the finding, while their case is still pending. Further, when employees contest a tentative nonconfirmation based upon a photo mismatch, the Employer must take additional steps (see Article III.B. below) to contact DHS with information necessary to resolve the challenge.
The Employer agrees not to take any adverse action against an employee based upon the employee's perceived employment eligibility status while SSA or DHS is processing the verification request unless the Employer obtains knowledge (as defined in 8 C.F.R. § 274a.1(l)) that the employee is not work authorized. The Employer understands that an initial inability of the SSA or DHS automated verification system to verify work authorization, a tentative nonconfirmation, a case in continuance (indicating the need for additional time for the government to resolve a case), or the finding of a photo mismatch, does not establish, and should not be interpreted as, evidence that the employee is not work authorized. In any of such cases, the employee must be provided a full and fair opportunity to contest the finding, and if he or she does so, the employee

Page 3 of 13 E-Verify MOU for Web Services Employers | Revision Date 06/01/13

may not be terminated or suffer any adverse employment consequences based upon the employee’s perceived employment eligibility status (including denying, reducing, or extending work hours, delaying or preventing training, requiring an employee to work in poorer conditions, withholding pay, refusing to assign the employee to a Federal contract or other assignment, or otherwise assuming that he or she is unauthorized to work) until and unless secondary verification by SSA or DHS has been completed and a final nonconfirmation has been issued. If the employee does not choose to contest a tentative nonconfirmation or a photo mismatch or if a secondary verification is completed and a final nonconfirmation is issued, then the Employer can find the employee is not work authorized and terminate the employee’s employment. Employers or employees with questions about a final nonconfirmation may call E-Verify at 1-888-464-4218 (customer service) or 1-888-897-7781 (worker hotline).
The Employer agrees to comply with Title VII of the Civil Rights Act of 1964 and section 274B of the INA as applicable by not discriminating unlawfully against any individual in hiring, firing, employment eligibility verification, or recruitment or referral practices because of his or her national origin or citizenship status, or by committing discriminatory documentary practices. The Employer understands that such illegal practices can include selective verification or use of E-Verify except as provided in part D below, or discharging or refusing to hire employees because they appear or sound “foreign” or have received tentative nonconfirmations. The Employer further understands that any violation of the immigration-related unfair employment practices provisions in section 274B of the INA could subject the Employer to civil penalties, back pay awards, and other sanctions, and violations of Title VII could subject the Employer to back pay awards, compensatory and punitive damages. Violations of either section 274B of the INA or Title VII may also lead to the termination of its participation in E-Verify. If the Employer has any questions relating to the anti-discrimination provision, it should contact the Immigrant and Employee Rights Section, Civil Rights Division, U.S. Department of Justice at 1-800-255-8155 or 1-800-237-2515 (TTY) or go to https://www.justice.gov/ier.
The Employer agrees that it will use the information it receives from E-Verify only to confirm the employment eligibility of employees as authorized by this MOU. The Employer agrees that it will safeguard this information, and means of access to it (such as PINS and passwords), to ensure that it is not used for any other purpose and as necessary to protect its confidentiality, including ensuring that it is not disseminated to any person other than employees of the Employer who are authorized to perform the Employer's responsibilities under this MOU, except for such dissemination as may be authorized in advance by SSA or DHS for legitimate purposes.
The Employer agrees to notify DHS immediately in the event of a breach of personal information. Breaches are defined as loss of control or unauthorized access to E-Verify personal data. All suspected or confirmed breaches should be reported by calling 1-888- 464-4218 or via email at E-Verify@dhs.gov. Please use “Privacy Incident – Password” in the subject line of your email when sending a breach report to E-Verify.
The Employer acknowledges that the information it receives from SSA is governed by the Privacy Act (5 U.S.C. § 552a(i)(1) and (3)) and the Social Security Act (42 U.S.C. 1306(a)). Any person who obtains this information under false pretenses or uses it for any purpose other than as provided for in this MOU may be subject to criminal penalties.
The Employer agrees to cooperate with DHS and SSA in their compliance monitoring and evaluation of E-Verify, which includes permitting DHS, SSA, their contractors and

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other agents, upon reasonable notice, to review Forms I-9 and other employment records and to interview it and its employees regarding the Employer’s use of E-Verify, and to respond in a prompt and accurate manner to DHS requests for information relating to their participation in E-Verify.
The Employer shall not make any false or unauthorized claims or references about its participation in E-Verify on its website, in advertising materials, or other media. The Employer shall not describe its services as federally-approved, federally-certified, or federally-recognized, or use language with a similar intent on its website or other materials provided to the public. Entering into this MOU does not mean that E-Verify endorses or authorizes your E-Verify services and any claim to that effect is false.
The Employer shall not state in its website or other public documents that any language used therein has been provided or approved by DHS, USCIS or the Verification Division, without first obtaining the prior written consent of DHS.
The Employer agrees that E-Verify trademarks and logos may be used only under license by DHS/USCIS (see M-795 (Web)) and, other than pursuant to the specific terms of such license, may not be used in any manner that might imply that the Employer’s services, products, websites, or publications are sponsored by, endorsed by, licensed by, or affiliated with DHS, USCIS, or E-Verify.
The Employer understands that if it uses E-Verify procedures for any purpose other than as authorized by this MOU, the Employer may be subject to appropriate legal action and termination of its participation in E-Verify according to this MOU.

RESPONSIBILITIES OF FEDERAL CONTRACTORS

If the Employer is a Federal contractor with the FAR E-Verify clause subject to the employment verification terms in Subpart 22.18 of the FAR, it will become familiar with and comply with the most current version of the E-Verify User Manual for Federal Contractors as well as the E-Verify Supplemental Guide for Federal Contractors.
In addition to the responsibilities of every employer outlined in this MOU, the Employer understands that if it is a Federal contractor subject to the employment verification terms in Subpart 22.18 of the FAR it must verify the employment eligibility of any “employee assigned to the contract” (as defined in FAR 22.1801). Once an employee has been verified through E-Verify by the Employer, the Employer may not create a second case for the employee through E-Verify.
An Employer that is not enrolled in E-Verify as a Federal contractor at the time of a contract award must enroll as a Federal contractor in the E-Verify program within 30 calendar days of contract award and, within 90 days of enrollment, begin to verify employment eligibility of new hires using E-Verify. The Employer must verify those employees who are working in the United States, whether or not they are assigned to the contract. Once the Employer begins verifying new hires, such verification of new hires must be initiated within three business days after the hire date. Once enrolled in E-Verify as a Federal contractor, the Employer must begin verification of employees assigned to the contract within 90 calendar days after the date of enrollment or within 30 days of an employee’s assignment to the contract, whichever date is later.
Employers enrolled in E-Verify as a Federal contractor for 90 days or more at the time of a contract award must use E-Verify to begin verification of employment

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eligibility for new hires of the Employer who are working in the United States, whether or not assigned to the contract, within three business days after the date of hire. If the Employer is enrolled in E-Verify as a Federal contractor for 90 calendar days or less at the time of contract award, the Employer must, within 90 days of enrollment, begin to use E-Verify to initiate verification of new hires of the contractor who are working in the United States, whether or not assigned to the contract. Such verification of new hires must be initiated within three business days after the date of hire. An Employer enrolled as a Federal contractor in E- Verify must begin verification of each employee assigned to the contract within 90 calendar days after date of contract award or within 30 days after assignment to the contract, whichever is later.
Federal contractors that are institutions of higher education (as defined at 20
U.S.C. 1001(a)), state or local governments, governments of Federally recognized Indian tribes, or sureties performing under a takeover agreement entered into with a Federal agency under a performance bond may choose to only verify new and existing employees assigned to the Federal contract. Such Federal contractors may, however, elect to verify all new hires, and/or all existing employees hired after November 6, 1986. Employers in this category must begin verification of employees assigned to the contract within 90 calendar days after the date of enrollment or within 30 days of an employee’s assignment to the contract, whichever date is later.
Upon enrollment, Employers who are Federal contractors may elect to verify employment eligibility of all existing employees working in the United States who were hired after November 6, 1986, instead of verifying only those employees assigned to a covered Federal contract. After enrollment, Employers must elect to verify existing staff following DHS procedures and begin E-Verify verification of all existing employees within 180 days after the election.
The Employer may use a previously completed Form I-9 as the basis for creating an E-Verify case for an employee assigned to a contract as long as:
That Form I-9 is complete (including the SSN) and complies with Article II.A.6,
The employee’s work authorization has not expired, and
The Employer has reviewed the Form I-9 information either in person or in communications with the employee to ensure that the employee’s Section 1, Form I-9 attestation has not changed (including, but not limited to, a lawful permanent resident alien having become a naturalized U.S. citizen).
The Employer shall complete a new Form I-9 consistent with Article II.A.6 or update the previous Form I-9 to provide the necessary information if:
The Employer cannot determine that Form I-9 complies with Article II.A.6,
The employee’s basis for work authorization as attested in Section 1 has expired or changed, or
The Form I-9 contains no SSN or is otherwise incomplete.

Note: If Section 1 of Form I-9 is otherwise valid and up-to-date and the form otherwise complies with Article II.C.5, but reflects documentation (such as a U.S. passport or Form I-551) that expired after completing Form I-9, the Employer shall

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not require the production of additional documentation, or use the photo screening tool described in Article II.A.5, subject to any additional or superseding instructions that may be provided on this subject in the E-Verify User Manual.

The Employer agrees not to require a second verification using E-Verify of any assigned employee who has previously been verified as a newly hired employee under this MOU or to authorize verification of any existing employee by any Employer that is not a Federal contractor based on this Article.
The Employer understands that if it is a Federal contractor, its compliance with this MOU is a performance requirement under the terms of the Federal contract or subcontract, and the Employer consents to the release of information relating to compliance with its verification responsibilities under this MOU to contracting officers or other officials authorized to review the Employer’s compliance with Federal contracting requirements.

RESPONSIBILITIES OF SSA

SSA agrees to allow DHS to compare data provided by the Employer against SSA’s database. SSA sends DHS confirmation that the data sent either matches or does not match the information in SSA’s database.
SSA agrees to safeguard the information the Employer provides through E-Verify procedures. SSA also agrees to limit access to such information, as is appropriate by law, to individuals responsible for the verification of Social Security numbers or responsible for evaluation of E-Verify or such other persons or entities who may be authorized by SSA as governed by the Privacy Act (5 U.S.C. § 552a), the Social Security Act (42 U.S.C. 1306(a)), and SSA regulations (20 CFR Part 401).
SSA agrees to provide case results from its database within three Federal Government work days of the initial inquiry. E-Verify provides the information to the Employer.
SSA agrees to update SSA records as necessary if the employee who contests the SSA tentative nonconfirmation visits an SSA field office and provides the required evidence. If the employee visits an SSA field office within the eight Federal Government work days from the date of referral to SSA, SSA agrees to update SSA records, if appropriate, within the eight-day period unless SSA determines that more than eight days may be necessary. In such cases, SSA will provide additional instructions to the employee. If the employee does not visit SSA in the time allowed, E-Verify may provide a final nonconfirmation to the employer.

Note: If an Employer experiences technical problems, or has a policy question, the employer should contact E-Verify at 1-888-464-4218.

RESPONSIBILITIES OF DHS

DHS agrees to provide the Employer with selected data from DHS databases to enable the Employer to conduct, to the extent authorized by this MOU:
Automated verification checks on alien employees by electronic means, and
Photo verification checks (when available) on employees.

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DHS agrees to assist the Employer with operational problems associated with the Employer's participation in E-Verify. DHS agrees to provide the Employer names, titles, addresses, and telephone numbers of DHS representatives to be contacted during the E- Verify process.
DHS agrees to provide to the Employer with access to E-Verify training materials as well as an E-Verify User Manual that contain instructions on E-Verify policies, procedures, and requirements for both SSA and DHS, including restrictions on the use of E-Verify.
DHS agrees to train Employers on all important changes made to E-Verify through the use of mandatory refresher tutorials and updates to the E-Verify User Manual. Even without changes to E-Verify, DHS reserves the right to require employers to take mandatory refresher tutorials.
DHS agrees to provide to the Employer a notice, which indicates the Employer's participation in E-Verify. DHS also agrees to provide to the Employer anti-discrimination notices issued by the Immigrant and Employee Rights Section, Civil Rights Division, U.S. Department of Justice.
DHS agrees to issue each of the Employer’s E-Verify users a unique user identification number and password that permits them to log in to E-Verify.
DHS agrees to safeguard the information the Employer provides, and to limit access to such information to individuals responsible for the verification process, for evaluation of
E-Verify, or to such other persons or entities as may be authorized by applicable law. Information will be used only to verify the accuracy of Social Security numbers and employment eligibility, to enforce the INA and Federal criminal laws, and to administer Federal contracting requirements.
DHS agrees to provide a means of automated verification that provides (in conjunction with SSA verification procedures) confirmation or tentative nonconfirmation of employees' employment eligibility within three Federal Government work days of the initial inquiry.
DHS agrees to provide a means of secondary verification (including updating DHS records) for employees who contest DHS tentative nonconfirmations and photo mismatch tentative nonconfirmations. This provides final confirmation or nonconfirmation of the employees' employment eligibility within 10 Federal Government work days of the date of referral to DHS, unless DHS determines that more than 10 days may be necessary. In such cases, DHS will provide additional verification instructions.

ARTICLE III
REFERRAL OF INDIVIDUALS TO SSA AND DHS

REFERRAL TO SSA

If the Employer receives a tentative nonconfirmation issued by SSA, the Employer must print the notice as directed by E-Verify. The Employer must promptly notify employees in private of the finding and provide them with the notice and letter containing information specific to the employee’s E-Verify case. The Employer also agrees to provide both the English and the translated notice and letter for employees with limited English proficiency to employees. The Employer agrees to provide written referral instructions to employees and instruct affected employees to bring the English copy of

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the letter to the SSA. The Employer must allow employees to contest the finding, and not take adverse action against employees if they choose to contest the finding, while their case is still pending.
The Employer agrees to obtain the employee’s response about whether he or she will contest the tentative nonconfirmation as soon as possible after the Employer receives the tentative nonconfirmation. Only the employee may determine whether he or she will contest the tentative nonconfirmation.
After a tentative nonconfirmation, the Employer will refer employees to SSA field offices only as directed by E-Verify. The Employer must record the case verification number, review the employee information submitted to E-Verify to identify any errors, and find out whether the employee contests the tentative nonconfirmation. The Employer will transmit the Social Security number, or any other corrected employee information that SSA requests, to SSA for verification again if this review indicates a need to do so.
The Employer will instruct the employee to visit an SSA office within eight Federal Government work days. SSA will electronically transmit the result of the referral to the Employer within 10 Federal Government work days of the referral unless it determines that more than 10 days is necessary.
While waiting for case results, the Employer agrees to check the E-Verify system regularly for case updates.
The Employer agrees not to ask the employee to obtain a printout from the Social Security Administration number database (the Numident) or other written verification of the SSN from the SSA.

REFERRAL TO DHS

If the Employer receives a tentative nonconfirmation issued by DHS, the Employer must promptly notify employees in private of the finding and provide them with the notice and letter containing information specific to the employee’s E-Verify case. The Employer also agrees to provide both the English and the translated notice and letter for employees with limited English proficiency to employees. The Employer must allow employees to contest the finding, and not take adverse action against employees if they choose to contest the finding, while their case is still pending.
The Employer agrees to obtain the employee’s response about whether he or she will contest the tentative nonconfirmation as soon as possible after the Employer receives the tentative nonconfirmation. Only the employee may determine whether he or she will contest the tentative nonconfirmation.
The Employer agrees to refer individuals to DHS only when the employee chooses to contest a tentative nonconfirmation.
If the employee contests a tentative nonconfirmation issued by DHS, the Employer will instruct the employee to contact DHS through its toll-free hotline (as found on the referral letter) within eight Federal Government work days.
If the Employer finds a photo mismatch, the Employer must provide the photo mismatch tentative nonconfirmation notice and follow the instructions outlined in paragraph 1 of this section for tentative nonconfirmations, generally.
The Employer agrees that if an employee contests a tentative nonconfirmation based upon a photo mismatch, the Employer will send a copy of the employee’s Form I-551, Form I-766, U.S. Passport, or passport card to DHS for review by:

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Scanning and uploading the document, or
Sending a photocopy of the document by express mail (furnished and paid for by the employer).
The Employer understands that if it cannot determine whether there is a photo match/mismatch, the Employer must forward the employee’s documentation to DHS as described in the preceding paragraph. The Employer agrees to resolve the case as specified by the DHS representative who will determine the photo match or mismatch.
DHS will electronically transmit the result of the referral to the Employer within 10 Federal Government work days of the referral unless it determines that more than 10 days is necessary.
While waiting for case results, the Employer agrees to check the E-Verify system regularly for case updates.

ARTICLE IV SERVICE PROVISIONS

A. NO SERVICE FEES

1. SSA and DHS will not charge the Employer for verification services performed under this MOU. The Employer is responsible for providing equipment needed to make inquiries. To access E-Verify, an Employer will need a personal computer with Internet access.

ARTICLE V MODIFICATION AND TERMINATION

MODIFICATION

This MOU is effective upon the signature of all parties and shall continue in effect for as long as the SSA and DHS operates the E-Verify program unless modified in writing by the mutual consent of all parties.
Any and all E-Verify system enhancements by DHS or SSA, including but not limited to E-Verify checking against additional data sources and instituting new verification policies or procedures, will be covered under this MOU and will not cause the need for a supplemental MOU that outlines these changes.

TERMINATION

The Employer may terminate this MOU and its participation in E-Verify at any time upon 30 days prior written notice to the other parties.
Notwithstanding Article V, part A of this MOU, DHS may terminate this MOU, and thereby the Employer’s participation in E-Verify, with or without notice at any time if deemed necessary because of the requirements of law or policy, or upon a determination by SSA or DHS that there has been a breach of system integrity or security by the Employer, or a failure on the part of the Employer to comply with established E-Verify procedures and/or legal requirements. The Employer understands that if it is a Federal contractor, termination of this MOU by any party for any reason may negatively affect the

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performance of its contractual responsibilities. Similarly, the Employer understands that if it is in a state where E-Verify is mandatory, termination of this by any party MOU may negatively affect the Employer’s business.
An Employer that is a Federal contractor may terminate this MOU when the Federal contract that requires its participation in E-Verify is terminated or completed. In such cases, the Federal contractor must provide written notice to DHS. If an Employer that is a Federal contractor fails to provide such notice, then that Employer will remain an E-Verify participant, will remain bound by the terms of this MOU that apply to non-Federal contractor participants, and will be required to use the E-Verify procedures to verify the employment eligibility of all newly hired employees.
The Employer agrees that E-Verify is not liable for any losses, financial or otherwise, if the Employer is terminated from E-Verify.

ARTICLE VI PARTIES

Some or all SSA and DHS responsibilities under this MOU may be performed by contractor(s), and SSA and DHS may adjust verification responsibilities between each other as necessary. By separate agreement with DHS, SSA has agreed to perform its responsibilities as described in this MOU.
Nothing in this MOU is intended, or should be construed, to create any right or benefit, substantive or procedural, enforceable at law by any third party against the United States, its agencies, officers, or employees, or against the Employer, its agents, officers, or employees.
The Employer may not assign, directly or indirectly, whether by operation of law, change of control or merger, all or any part of its rights or obligations under this MOU without the prior written consent of DHS, which consent shall not be unreasonably withheld or delayed. Any attempt to sublicense, assign, or transfer any of the rights, duties, or obligations herein is void.
Each party shall be solely responsible for defending any claim or action against it arising out of or related to E-Verify or this MOU, whether civil or criminal, and for any liability wherefrom, including (but not limited to) any dispute between the Employer and any other person or entity regarding the applicability of Section 403(d) of IIRIRA to any action taken or allegedly taken by the Employer.
The Employer understands that its participation in E-Verify is not confidential information and may be disclosed as authorized or required by law and DHS or SSA policy, including but not limited to, Congressional oversight, E-Verify publicity and media inquiries, determinations of compliance with Federal contractual requirements, and responses to inquiries under the Freedom of Information Act (FOIA).
The individuals whose signatures appear below represent that they are authorized to enter into this MOU on behalf of the Employer and DHS respectively. The Employer understands that any inaccurate statement, representation, data or other information provided to DHS may subject the Employer, its subcontractors, its employees, or its representatives to: (1) prosecution for false statements pursuant to 18 U.S.C. 1001 and/or; (2) immediate termination of its MOU and/or; (3) possible debarment or suspension.
The foregoing constitutes the full agreement on this subject between DHS and the

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Employer.

To be accepted as an E-Verify participant, you should only sign the Employer’s Section of the signature page. If you have any questions, contact E-Verify at 1-888- 464-4218.

Approved by:

E-Verify Employer	
Name (Please Type or Print)	Title	
Signature	Date	
Department of Homeland Security – Verification Division	
Name (Please Type or Print)	Title	
Signature	Date	

Information Required for E-Verify

Information relating to your Company:	
Company Name:		
Company Facility Address:		
Company Alternate Address:		
County or Parish:		
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Employer Identification Number:		
North American Industry
Classification Systems Code:		
Parent Company:		
Number of Employees:		
Number of Sites Verified for:		
Are you verifying for more than one site?
If yes, please provide the number of sites verified for in each State:

State	Number of	Site(s) sites	

Information relating to the Program Administrator(s) for your Company on policy questions or operational problems:	
Name:		
Telephone Number:		
Fax Number:		
E-mail Address:		

Name:		
Telephone Number:		
Fax Number:		
E-mail Address:		

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