1. Introduction
The City of Starke, Florida ("City"), is seeking Statements of Qualifications ("SOQ") from qualified firms and individuals to provide continuing professional planning and zoning consulting services on an as-needed basis. The City intends to establish a pool of qualified firms and individuals through nonexclusive continuing professional services agreements with multiple consultants to assist City staff, the Planning and Zoning Board, and the City Commission with planning, zoning, land development, development review, comprehensive planning, code interpretation, and related municipal planning and zoning matters. The selected consultant(s) may be requested to provide professional planning and zoning services associated with current and future development, redevelopment, land-use planning, regulatory compliance, development applications, code amendments, long-range planning, and other planning-related initiatives identified by the City. Respondents may submit qualifications for all or selected service areas identified in Section 3. A Respondent is not required to provide every listed service to be considered. The City may qualify and select different consultants for different service areas, based on demonstrated qualifications and capacity. Selection does not guarantee an agreement or any minimum amount of work or compensation. The City does not guarantee equal distribution of assignments among selected consultants.
2. City Background
The City of Starke serves as the county seat of Bradford County and provides a full range of municipal services, including electric, water, wastewater, natural gas, public safety, recreation, planning and zoning, and public works services. The City is responsible for administering and implementing its comprehensive planning and land development regulations and for reviewing development proposals, zoning matters, land- use issues, and other planning-related requests within the City's jurisdiction. The City seeks experienced planning and zoning professionals capable of providing timely, technically sound, and practical assistance to City staff and decision-making bodies. The selected consultant(s) should be familiar with Florida's local government planning and zoning framework and capable of assisting the City with development review, comprehensive planning, zoning administration, land development regulations, code amendments, public meetings and hearings, and related planning initiatives.
The City anticipates using the selected consultant(s) on an as-needed basis to supplement existing City resources and provide specialized professional expertise when requested.
3. Scope of Services
The selected consultant(s) may be requested to provide professional planning and zoning services on an as-needed basis. Services may include, but are not limited to, any combination of the following:
A. Development Review and Planning Services
● Review development applications, site plans, subdivisions, plats, rezonings, conditional uses, variances, special exceptions, and other development-related requests.
● Conduct application completeness reviews; prepare consolidated deficiency comments; review resubmittals; and assist City staff with tracking application status, applicable statutory deadlines, and hearing schedules.
● Review applications for consistency with the City's Comprehensive Plan, Land Development Regulations, zoning regulations, and other applicable requirements.
● Provide written staff reports identifying applicable approval criteria, relevant facts, consistency findings, recommended action, and proposed conditions of approval, as appropriate to the assignment.
● Assist City staff with development review coordination and application processing.
● Evaluate proposed developments for consistency with applicable land-use, zoning, site-design, transportation, infrastructure, environmental, and other regulatory requirements.
● Attend development review meetings, pre-application meetings, technical review meetings, and other meetings as requested.
● Provide professional planning recommendations regarding proposed development and redevelopment projects.
● Assist with interpretation and application of applicable development standards and regulations.
B. Comprehensive Planning and Land Use
● Review and assist with annexations and related future land-use and zoning assignments, including supporting planning analyses and coordination with affected agencies.
● Review applicant-provided surveys, legal descriptions, maps, and supporting materials for annexation, future land-use, and zoning applications for consistency with applicable planning requirements.
● Assist with amendments to the City's Comprehensive Plan.
● Prepare or assist with evaluations, updates, and amendments to goals, objectives, policies, future land-use elements, and other comprehensive planning components.
● Assist with long-range land-use planning and growth-management strategies.
● Evaluate proposed land-use changes and future development patterns.
● Assist with required planning studies, assessments, and supporting documentation.
● Provide recommendations concerning land-use compatibility, growth, redevelopment, and community planning.
● Assist with coordination of planning activities with applicable regional, state, and local agencies.
● Assist with periodic reviews, updates, and other comprehensive planning activities as requested by the City.
C. Zoning and Land Development Regulations
● Review, interpret, and administer the City's zoning and land development regulations.
● Assist with zoning map and text amendments.
● Draft or assist with amendments to zoning regulations, land development regulations, and related ordinances.
● Evaluate existing regulations and recommend updates to address current planning needs and development trends.
● Assist with development of standards for permitted uses, conditional uses, setbacks, density, intensity, dimensional requirements, site design, parking, landscaping, signage, and other regulatory matters.
● Provide technical assistance concerning interpretation and application of City regulations.
● Identify inconsistencies, gaps, or conflicts within applicable planning and zoning regulations and recommend corrective measures.
● Assist with preparation of proposed ordinances, resolutions, amendments, and supporting documentation.
● Assist City staff with maintaining consistency between the Comprehensive Plan, zoning regulations, and land development regulations.
D. Planning and Zoning Board and City Commission Support
● Attend Planning and Zoning Board and City Commission meetings, public hearings, and workshops when assigned by the City; present planning reports, explain recommendations, and respond to questions.
��� Assist with preparation of proposed findings, conditions, and development orders for review by City staff and legal counsel, as appropriate.
● Assist with public hearing procedures and preparation of supporting documentation.
● Respond to questions from City Staff concerning planning and zoning matters.
● Assist with coordination of public notices and hearing materials as directed by the City.
E. Planning Studies and Special Projects
● Conduct planning studies, demographic analyses, land-use analyses, development assessments, and other special planning projects.
● Assist with neighborhood, corridor, downtown, redevelopment, and community planning initiatives.
● Assist with transportation and mobility planning activities as related to land use and development.
● Provide technical assistance concerning economic development and redevelopment planning.
● Assist with geographic information system (GIS) analysis and mapping, when applicable.
● Prepare maps, exhibits, presentations, reports, and other planning materials.
● Provide planning-related training and technical assistance to City staff.
● Develop planning and zoning procedures, policies, checklists, and administrative materials.
● Assist with planning-related grant or funding opportunities when such services are directly related to planning projects.
● Provide other related professional planning and zoning services as requested by the City.
F. Ongoing Planning and Zoning Consultation
The selected consultant(s) may also be requested to serve as an ongoing professional resource to City staff by:
• Responding to planning and zoning questions.
• Providing technical guidance regarding development proposals and regulatory matters.
• Assisting with planning and zoning strategies.
• Reviewing proposed projects and development concepts.
• Providing recommendations regarding land-use and development issues.
• Providing other professional planning and zoning consultation as requested by the City.
G. Service Responsibilities and Coordination
The consultant shall provide planning and zoning review and recommendations based on applicable City regulations and materials submitted by applicants. The consultant shall work with designated City staff and other City professionals as needed. The City retains final decision-making and approval authority except as lawfully delegated in writing. Services under this RFQ do not include preparing surveys, engineering or architectural designs, Florida Building Code plan review, building inspections, or legal representation.
4. Contract Term
The City anticipates entering into continuing professional services agreements with one or more qualified firms for an initial term of three (3) years. Upon mutual agreement of the parties and approval by the City Commission, the agreement may be renewed for up to two (2) additional two-year terms under the same terms and conditions, subject to any negotiated adjustments in compensation. Renewal shall be contingent upon satisfactory performance by the consultant and the continued need for services by the City. Nothing herein shall obligate the City to renew any agreement. The City reserves the right to re-solicit qualifications at any time it determines such action to be in its best interest. The City does not guarantee any minimum amount of work under any resulting agreement.
5. Statements of Qualifications Requirements
Respondents shall submit one (1) original and two (2) copies of their Statements of Qualifications. Statements of Qualifications must include the following:
A. Cover Letter
The Cover Letter shall identify the Respondent and provide a brief statement of the firm's interest in providing continuing professional planning and zoning services to the City. The Cover Letter should identify the person authorized to represent the Respondent during the selection and contract negotiation process. The Cover Letter should also include a statement confirming the Respondent's willingness and ability to provide services on an as-needed basis during the anticipated contract term
B. Firm or Individual Overview
References to a firm or Respondent include qualified individuals, sole proprietors, and other eligible business entities, as applicable. Each Respondent shall identify the Section 3 service areas for which qualification is requested, describe its qualifications for each area, and identify any limitations or services requiring subconsultants. Provide the following information:
• Organization name.
• Name and contact information.
• Physical address of the firm's principal office and the location of the office that will primarily serve the City of Starke, if different.
• Experience and qualifications of the firm.
• Length of time the firm has been providing professional planning and zoning services.
• Description of the firm's experience with municipal and other governmental clients.
• Staff bios and resumes for key personnel who may be assigned to the City.
• Identification of the proposed lead planner, backup contact, subconsultants, and services each will perform.
• Disclosure of current or anticipated private-client work or other relationships that may create a conflict involving City assignments, and the proposed process for identifying and managing conflicts.
• Proof of current registration with the Florida Division of Corporations (Sunbiz) or other documentation demonstrating the firm's legal authority to conduct business in the State of Florida.
• Identification of any applicable professional licenses or registrations.
• Description of the firm's availability and ability to respond to City requests on an as-needed basis.).
C. Relevant Experience
Provide examples of successful planning and zoning assignments performed by the Respondent. Examples should include municipal, county, state, federal, or other public- sector clients whenever possible:
• Client Name
• Client Location
• Project Description
• Scope of Services
• Services Provided by the Respondent
• Project Duration
• Key Personnel Involved
• Project Outcome
• Contract or Project Value, if available
• Current Client Contact Information, if permitted
Relevant experience may include, but is not limited to:
• Comprehensive planning
• Comprehensive Plan amendments
• Land-use planning
• Zoning administration
• Zoning map and text amendments
• Land Development Regulations
• Development review
• Site-plan review
• Subdivision and plat review
• Rezoning applications
• Conditional uses and special exceptions
• Variances
• Planning and Zoning Board support
• City Commission support
• Public hearings
• Planning studies
• Community planning
• Redevelopment planning
• Transportation and mobility planning
• GIS and mapping
• Ordinance and code development
• Growth-management planning
• Economic development and land-use planning
D. Approach to Services
Respondents shall describe their proposed approach to providing continuing professional planning and zoning services to the City. The response shall address the following items to the extent applicable to the service areas offered. Identify any item not offered or not applicable:
1. Development Review and Planning Services - Describe the Respondent's approach to reviewing development applications and applicant-provided materials, evaluating consistency with applicable planning and zoning requirements, and preparing written comments, findings, and recommendations.
2. Comprehensive Planning and Land Use - Describe the Respondent's approach to comprehensive planning, plan amendments, annexations, future land-use changes, and long-range planning.
3. Zoning and Land Development Regulations -- Describe the Respondent's approach to interpreting and applying zoning and land development regulations, reviewing zoning amendments, and preparing proposed code updates
4. Planning and Zoning Board and City Commission Support - Describe the Respondent's approach to preparing hearing materials and staff reports, presenting recommendations, and responding to questions at public hearings, meetings, and workshops.
5. Planning Studies and Special Projects - Describe the Respondent's approach to conducting planning studies, analyses, and special projects and preparing supporting reports, exhibits, and recommendations.
6. Ongoing Planning and Zoning Consultation - Describe how the Respondent will provide routine technical assistance to City staff, evaluate development concepts, and address planning and zoning questions.
7. Communication and Responsiveness - Describe the Respondent's capacity to provide ongoing planning and zoning assistance to the City, including how it will communicate with City staff, respond to questions and requests, and complete reviews and recommendations within applicable deadlines.
8. Quality Control - Describe the Respondent's procedures for ensuring the accuracy, consistency, and regulatory compliance of its work products and recommendations.
E. References
Provide at least three (3) recent governmental or public-sector references, including:
• Organization Name
• Contact Person
• Title
• Telephone Number
• Email Address
• Description of services provided
• Approximate dates of services
• Brief description of the project or assignment
References should, when possible, be for clients for whom the Respondent has provided municipal planning, zoning, comprehensive planning, development review, or related professional services.
F. Compensation
Compensation will be negotiated with selected consultants following the qualifications evaluation and selection process, in accordance with applicable law and City procurement requirements. Respondents shall not include fee schedules or compensation proposals in their Statements of Qualifications.
G. Credentials
Provide information regarding:
• Professional certifications
• Applicable business licenses
• Professional registrations
• Relevant memberships or affiliations
• Any disclosures required by applicable law
• Any other credentials demonstrating the Respondent's qualifications to perform the requested services
H. Required Forms
Include completed Attachments A through D with the Statement of Qualifications. Attachment A is the Respondent Certification, including certification of eligibility under section 287.133, Florida Statutes. Attachment B is the Business Entity Disclosure Affidavit. Attachment C is the certification regarding use of City funds for diversity, equity, and inclusion materials. The City requests Attachment C with this solicitation in anticipation of agreements extending beyond January 1, 2027; this submission requirement does not change the statutory effective date or applicability described in Section 8. Attachment D is the Human Trafficking Affidavit. Selected consultants shall provide updated forms if information changes before execution. A current human trafficking affidavit is required at contract execution, renewal, or extension. Any certification required by section 287.139, Florida Statutes, must be provided before award of an applicable contract or renewal.
6. Evaluation Criteria
The City will evaluate Statements of Qualifications to determine whether each Respondent is qualified to provide the service areas identified in its submission. Respondents may be considered for one or more service areas and are not required to offer every service listed in this RFQ. The City will consider the following criteria:
• Relevant Experience - Demonstrated experience providing municipal planning, zoning, development review, comprehensive planning, or other services relevant to the service areas offered.
• Personnel Qualifications - Education, experience, professional credentials, and qualifications of the individuals proposed to perform the services.
• Approach to Services - Understanding of the City's needs and a practical approach to providing accurate, consistent, and technically sound services.
• Capacity and Responsiveness - Capacity to provide ongoing assistance, communicate with City staff, respond to questions and requests, and complete assignments within applicable deadlines.
• References and Past Performances - Demonstrated quality of work, reliability, responsiveness, and satisfactory performance on similar assignment.
• Completeness of Submission - Submission of the information and forms required by this RFQ sufficient to demonstrate qualifications for the services offered.
The City may select any or all Respondents determined to be qualified for one or more service areas. There is no predetermined limit on the number of consultants that may be selected. Respondents will be evaluated for inclusion in the consultant pool rather than ranked for a limited number of positions.
Selection is subject to successful negotiation of a mutually acceptable agreement and approval by the appropriate City officials. The City reserves the right to decline any submission that does not adequately demonstrate the qualifications or capacity necessary to provide the services offered. Qualification or execution of an agreement does not guarantee an assignment, minimum compensation, or equal distribution of work.
7. Submission Instructions
Respondents shall submit one (1) original and two (2) copies of their Statements of Qualifications in a sealed envelope clearly marked: RFQ No. 2027-01 Continuing Professional Planning and Zoning Consulting Services
Submittals shall be delivered to:
City of Starke
Attn: Stephanie Mann
209 North Thompson Street
Starke, Florida 32091
Contact Information
Contact Person: Stephanie Mann
Email: smann@cityofstarke.org
Phone: (904) 964-5027
Qualifications Due: December 10, at 2:00 PM Eastern Time
All submittals must be received by the date and time specified in this RFQ. Electronic submissions will not be accepted. Late submissions will not be considered. Respondents are solely responsible for ensuring that their SOQs are received by the City before the submission deadline.
Questions and Addenda
Submit questions in writing to Stephanie Mann at smann@cityofstarke.org no later than ten (10) calendar days before the submission deadline. Oral statements do not modify this RFQ. Clarifications or changes will be issued by written addendum through the City's designated solicitation distribution method. Respondents are responsible for obtaining and acknowledging all addenda in Attachment A. If an addendum materially affects preparation of a response, the City may extend the deadline.
8. Terms and Conditions
• The City reserves the right to reject any or all Statements of Qualifications.
• The City may enter into nonexclusive continuing services agreements with multiple qualified firms or individuals for all or selected service areas.
• Consultants shall disclose conflicts before accepting assignments and promptly disclose any conflict arising during performance. The City may require mitigation, reassign work, or decline an assignment because of a conflict.
• Replacement of designated lead personnel or material changes in assigned subconsultants require prior written City approval.
• Resulting agreements shall address appropriate insurance, public records responsibilities, termination, transition of pending assignments, and delivery of City work products, including editable reports, source documents, and GIS data where applicable. Preexisting proprietary materials and third-party licensing shall be identified and addressed in the agreement.
• All work products prepared specifically for the City under any resulting agreement shall become the property of the City, subject to applicable law and the terms of the executed agreement.
• The City may conduct interviews or discussions to determine a Respondent's qualifications.
• The City reserves the right to negotiate the final scope of services and compensation with the selected consultant(s).
• The City reserves the right to waive informalities and minor irregularities in any Statements of Qualifications received.
• The City does not guarantee any minimum amount of work, assignments, or compensation under any resulting agreement.
• The City reserves the right to request additional information or clarification from Respondents as permitted by applicable law.
• The City reserves the right to cancel, modify, suspend, or reissue this RFQ when determined to be in the City's best interest and as permitted by applicable law.
• Any resulting agreement shall be subject to approval by the appropriate City officials and shall contain the terms and conditions determined by the City.
• Selected consultant(s) shall comply with all applicable federal, state, and local laws, ordinances, regulations, and professional requirements applicable to the services performed.
• Nothing in this RFQ shall be construed as creating a contractual relationship between the City and any Respondent prior to execution of a written agreement.
• Respondents shall bear all costs associated with preparation and submission of their Statements of Qualifications.
• The City's selection and contracting process shall be conducted in accordance with applicable Florida law and the City's applicable procurement requirements.
Human Trafficking Affidavit
Pursuant to section 787.06(14), Florida Statutes, a nongovernmental entity must provide the City, when a contract is executed, renewed, or extended, an affidavit signed by an officer or authorized representative under penalty of perjury attesting that the entity does not use coercion for labor or services as defined in section 787.06. Attachment D shall be submitted with the response and updated as required at execution, renewal, or extension.
Use of City Funds and Diversity Equity and Inclusion Materials
Chapter 2026-43, Laws of Florida, takes effect January 1, 2027. Section 287.139, Florida Statutes, applies to ordinary municipal contracts executed or renewed after January 1, 2027, and requires certification before award. Attachment C provides that certification. For each agreement to which the statute applies, the consultant shall not use City funds to require its employees, contractors, volunteers, vendors, or agents to ascribe to, study, or be instructed using diversity, equity, and inclusion materials as defined in sections 125.595(1) and 166.04971(1), Florida Statutes. Effective January 1, 2027, services and use of City funds shall also comply with section 166.04971, including its applicable exceptions. This provision does not prohibit compliance with state or federal antidiscrimination laws or the equal opportunity and equal employment opportunity informational materials excluded from the statutory definition.
Public Entity Crimes Notice
A person or affiliate placed on the convicted vendor list following a conviction for a public entity crime is subject to the restrictions in section 287.133(2)(a), Florida Statutes. For 36 months following placement on the list, the person or affiliate may not submit a bid, proposal, or reply to provide goods or services to a public entity; submit a bid, proposal, or reply for construction or repair of a public building or public work; submit a bid, proposal, or reply on a lease of real property to a public entity; be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with a public entity; or transact business with a public entity in excess of the Category Two threshold in section 287.017, Florida Statutes. Applicable statutory provisions and any removal from the list govern eligibility.
Public Records
Responses and resulting work products are subject to Florida public records law and applicable exemptions. A Respondent claiming an exemption shall identify the specific material and statutory basis; the City does not guarantee confidentiality beyond what the law allows.
Respondent Certification
City of Starke RFQ No. 2027-01
The undersigned is authorized to submit this response on behalf of the Respondent identified below. Respondent legal name: __________________________________________________
I certify that I have reviewed the RFQ and applicable addenda; the information submitted is true and accurate to the best of my knowledge; and the Respondent is ready, willing, and able to provide the services offered, subject to a mutually acceptable written agreement. The response will remain available for City consideration for 120 days following the submission deadline. I certify that this response was independently prepared without collusion or an agreement to restrain competition. Any actual or potential conflicts of interest involving City officials, employees, other clients, or proposed assignments are disclosed in an attachment. No undisclosed arrangement exists to improperly influence selection. The Respondent understands that qualification does not guarantee an agreement, work, exclusivity, or equal distribution of assignments. No work is authorized by submission or selection alone. I certify that the Respondent is eligible to contract with the City under section 287.133, Florida Statutes, and that neither the Respondent nor an affiliate is subject to a prohibition under that section that would prevent the proposed agreement. Any relevant conviction, convicted vendor list status, or order affecting eligibility is disclosed in an attachment. The Respondent will promptly notify the City of any change affecting eligibility before award or during an agreement. Addenda acknowledged by number and date (or "None"): _________________________
*** ** * ** ***
Address: ______________________________________________________________ Telephone: ______________________ Email: ________________________________ Conflict disclosure attached: [ ] Yes [ ] No conflicts identified Signature: ___________________________________ Date: __________________ Printed name: _________________________________________________________ Title or capacity: _______________________________________________________
Business Entity Disclosure Affidavit
City of Starke RFQ No. 2027-01
Provide the information below and attach additional pages as needed. Use business addresses. Do not include Social Security numbers in the response; any required tax information will be collected separately through vendor setup. Full legal name: ________________________________________________________ Business form (individual, corporation, LLC, partnership, other): ___________________ Doing business as, if applicable: ____________________________________________ Principal business address: ________________________________________________ Contract contact and email: _______________________________________________ Identify officers and directors; partners or managing members, as applicable; each owner holding directly or indirectly five percent or more; and, for a trust, trustees and beneficiaries. For an individual, identify the individual. Provide names, business addresses, roles, and ownership percentages, as applicable.
*** ** * ** ***
Identify other persons with a legal, equitable, or beneficial interest in this proposed agreement, excluding ordinary subcontractors, suppliers, laborers, and lenders, or state "None."
*** ** * ** ***
Under oath, I certify that the foregoing and attached disclosures are true and complete to the best of my knowledge and that I am authorized to provide them. Signature: ___________________________________ Date: __________________ Printed name: _________________________________________________________ Title or capacity: _______________________________________________________ STATE OF _________________ COUNTY OF _______________ The foregoing instrument was acknowledged before me by means of � physical presence or � online notarization, this ____ day of ____________****, 20**** , by _********************************, as _________________________ on behalf of the company/corporation. They � are personally known to me or � have produced _________________ as identification. _________________________________________ Notary Public Signature (Affix Notary Stamp or Seal) Print, Type or Stamp Name of Notary:********** My commission expires:**********************
Certification Regarding Diversity Equity and Inclusion Materials
City of Starke RFQ No. 2027-01
For purposes of section 287.139, Florida Statutes. Requested with the response; required before award when the statute applies. Chapter 2026-43 takes effect January 1, 2027; for ordinary municipal contracts, the certification requirement applies to contracts executed or renewed after January 1, 2027. Respondent legal name: __________________________________________________ Authorized representative and title: _________________________________________ On behalf of the Respondent, I certify to the City of Starke that the Respondent does not and will not use City funds in requiring its employees, contractors, volunteers, vendors, or agents to ascribe to, study, or be instructed using materials relating to diversity, equity, and inclusion as defined in sections 125.595(1) and 166.04971(1), Florida Statutes. This certification concerns use of City funds and uses the statutory definitions and exclusions. It does not certify the absence of privately funded activities unrelated to City funds. It does not prohibit compliance with state or federal antidiscrimination laws or use of equal opportunity or equal employment opportunity materials designed to inform persons about prohibited discrimination, as excluded by the statutory definition. I am authorized to provide this certification. The Respondent agrees to comply with the applicable requirements during performance and to provide an updated certification before an applicable renewal. Signature: ___________________________________ Date: __________________ Printed name: _________________________________________________________ Title or capacity: _______________________________________________________
HUMAN TRAFFICKING AFFIDAVIT
In compliance with Section 787.06(14), Florida Statutes, this affidavit must be completed by an officer or representative of a nongovernmental entity that is executing, renewing, or extending a contract with the City of _______________ (the "Governmental Entity").
The undersigned, on behalf of the entity listed below (the "Nongovernmental Entity"), hereby
attests under penalty of perjury as follows:
1. I am over the age of 18 and I have personal knowledge of the matters set forth herein.
2. I am an officer or representative of_________________________, a non-governmental
entity and I am authorized to provide this affidavit on behalf of Nongovernmental Entity)
3. Nongovernmental Entity, and any of its subsidiaries or affiliates, do not use coercion for
labor or services, as those terms are defined in Section 787.06, Florida Statutes, as may be
amended from time to time.
4. If, at any time in the future, Nongovernmental Entity does use coercion for labor or
services, Nongovernmental Entity will immediately notify Governmental Entity and no contracts
may be executed, renewed, or extended between the parties.
5. I have read the foregoing affidavit and confirm that the facts stated in it are true, and are
made for the benefit of, and reliance by Governmental Entity.
Company: ___________________________________________
Authorized Signature: Date: _____________
Printed Name:
Title: _________________________________________________
STATE OF _________________
COUNTY OF _______________
The foregoing instrument was acknowledged before me by means of ☐ physical presence or ☐
online notarization, this ____ day of ________________, 20____, by
_________________________________, as _________________________ on behalf of the
company/corporation. They ☐ are personally known to me or ☐ have produced
_________________ as identification.
_________________________________________
Notary Public Signature
(Affix Notary Stamp or Seal) Print, Type or Stamp Name of Notary:__________
My commission expires:______________________
