HomeMy Public PortalAboutPRR 16-2339Renee Basel
From: Chris O'Hare <chrisoharegulfstream@gmail.com>
Sent: Wednesday, October 12, 2016 7:52 AM
To: Bill Thrasher; Rita Taylor; Renee Basel; edward.nazzaro@gmail.com;
joconnor@jonesfoster.co m
Subject: Public Record Request - hiring Nazzaro
Dear Custodian of Records,
I request to inspect certain public records* in the custody of the Town of Gulf Stream Florida** or in the custody of its agents
or associated entities.
I request to inspect any public record*created in the past 60 days, the subject of which is
wholly or partly regarding the hiring of Mr. Edward C. Nezzaro as an employee of the Town of
Gulf Stream.
Responsive records may include but not be limited to request for proposals, request for
qualifications, letters of inquiry, letters of reference, letters of recommendation, letters of acceptance,
employment application, background checks concerning financial, criminal, social media etc.), W2 form, resume, salary
and/or benefits negotiations and any other public record responsive to this request.
Inspection of any responsive records may be essential to my ability to make informed comments regarding agenda
items in an upcoming regular meeting and public hearing scheduled to be held by the Town Commission this next
Friday, Oct 14. The production of any responsive records is therefore urgent and must be acted upon in compliance
with Florida Statutes and established case law as soon as possible.
Before making this public record request, I first searched online and in the public records portion of
your agency's website hoping I could locate the public records I seek without having to write you
directly. Unfortunately I cannot find the records I wish to inspect. Therefore I am writing you now and
requesting you make every effort as required by law to produce these public records without delay.
The public records I seek to inspect may be in the custody of an entity currently or previously
associated with your agency. As a courtesy to you and that entity, and to assist in expediting my
access to inspect records responsive to this request I am notifying the Town Attorney and Mr.
Nazzaro of this request by copy of this email. I am NOT requesting the Town Attorney or Mr.
Nazzaro produce responsive records directly to me. Rather I am alerting them to my request to you so that they may prepare to
assist you, if they choose to, in timely producing responsive records. Do not assume my act of copying the Town Attorney or Mr.
Nazzaro with this request relieves you of any of your duties under Florida Statute. I ask that you contact the Town
Attorney and Mr. Nazzaro in order to obtain all Public records responsive to this request.
I make this request pursuant to Article 1, Section 24 of the Florida Constitution and Chapter 119 of
the Florida Statutes. I hereby reserve all rights granted to me under the Florida
Constitution and Florida Statutes.
I ask that you take the following action:
• Read this entire request carefully and respond accordingly.
• If you are not the custodian of the public records described herein please determine who that person is and
notify me immediately in order that I may make this request to the appropriate person without delay.
• Reference Florida Statutes and appropriate case law when responding to this record request.
• Do NOT produce any records other than records responsive to this request.
• Identify by name the person or persons responding to this request if that person is not the Custodian of
Records for your agency as required by 119.07(1)(b).
• Respond to this public record request in a singular manner and do not combine this request with any other
public record requests when responding to this request.
• Once you have determined that you do or don't have any records in your custody responsive to this request,
immediately act to obtain any responsive records that may be in the custody of your contractor(s) or other
parties.
• Provide only those records for inspection that do not require extensive use of information technologies or
extensive staff time or both in excess of 15 minutes.
• If records responsive to this request are not presently available but you expect that they will soon be available
I request that you produce the records as soon as they are available.
I ask you to take note of §119.07(1)(c) Florida Statues and your affirmative obligation to (1)
promptly acknowledge receipt of this public records request and (2) make a good faith effort which
"includes making reasonable efforts to determine from other officers or employees within the agency
whether such a record exists and, if so, the location at which the record can be accessed." I am,
therefore, requesting that you notify every individual and entity in possession of records that may be
responsive to this public records request, including individuals and entities under contract with your
agency, to preserve and produce all responsive records on an immediate basis.
If you contend that any of the records I am seeking, or any portion thereof, are exempt from
inspection or disclosure please cite the specific exemption as required by §119.07(1)(e) of the Florida
Statutes and state in writing and with particularity the basis for your conclusions as required
by §119.07(1)(f) of the Florida Statutes. Produce for my inspection all responsive records and ONLY
redact that portion of the record that you consider exempt. To be clear, if you consider an entire
record to be exempt, produce that record in its entirety with all portions redacted that you consider
exempt. I specifically ask you to do this in order that I may inspect fully redacted records for the
purpose of challenging a particular redaction or establishing a reference for a future request of a
record that is only temporarily exempt, as in the case of a public record that was prepared by an
agency attorney exclusively for litigation and is only exempt from disclosure until the conclusion of the
litigation.
If the public records being sought are maintained by your agency or contactors for your agency, in an
electronic format please produce the records in the original electronic format in which they were
created or received. See §119.01(2)(f), Florida Statutes.
Again I ask that you provide only those records for inspection that do not require extensive use of
information technologies or extensive staff time or both in excess of 15 minutes. Take note
of §119.07(4)(a)3.(d) Florida Statues and if you anticipate that any records exist, the production for
inspection of which will require extensive use of information technologies or extensive staff time or
both in excess of 15 minutes, then please provide those records that can be produced within the first
15 minutes and advise me of the cost you anticipate to be incurred by your agency for the remaining
records prior to incurring this cost. Please do not incur any costs on my behalf without first obtaining
my written authorization to proceed. If you produce only a portion of all existing responsive records,
please tell me that your response includes only a portion of all existing records responsive to this
request.
If you anticipate the need to incur any costs that I would be statutorily required to pay in order to
inspect these public records which would exceed $1.00 please notify me in advance of your incurring
that cost with a written estimate of the total cost. Please be sure to itemize any estimates so as to
indicate the total number of pages and/or records, as well as to distinguish the cost of labor and
materials. Again, please do not incur any costs on my behalf without first obtaining my written
authorization to proceed.
A record that does not exist because of its disposition requires the creation of a disposition record. In
all instances where you determine a record does not exist please determine if the record once existed
and in its replacement provide the disposition record for my inspection.
*The term public records, as used herein, has the same meaning and scope as the definition of
Public records adopted by the Florida Legislature as Statutes Chapter 119.
**The phrase Town of Gulf Stream when used herein refers to the Town in its entirety and all entities
of the Town including all employees, appointees, officials, assignees, counsel and consultants
including Town Manager, Town Clerk, Town Police Chief, Town Commissioners, Town Mayor, Town
Departments, Town Police Officers, Town Employees, Town Engineer, the law firm (Jones Foster
Johnston & Stubbs P.A.) that claims to be the Town Attorney including all attorney, partner and
employee members of that firm; the Town Counsel of Sweetapple, Broeker & Varkus including all
attorney, partner and employee members of that firm, the Town Counsel of Richman Greer, P.A.
including all attorney, partner and employee members of that firm and any other entity associated
with the Town and subject to public records law.
If you do not understand any part of this request or if you need clarification about this request, notify me as
soon as possible so I may further describe or clarify this request.
All responses to this public records request should be made in writing to the following email address:
chrisoharegulfstream@gmaii.com
TOWN OF GULF STREAM
PALM BEACH COUNTY, FLORIDA
Delivered via e-mail
October 12, 2016
Chris O'Hare [mail to: chrisoharegulfstreamOgmail.coml
Re: GS #2339 (hiring Nazzaro)
I request to inspect any public record *created in the past 60 days, the subject of which is wholly
or partly regarding the hiring of Mr. Edward C. Nezzaro as an employee of the Town of Gulf
Stream.
Responsive records may include but not be limited to request for proposals, request for
qualifications, letters of inquiry, letters of reference, letters of recommendation, letters of
acceptance, employment application, background checks concerning financial, criminal, social
media etc.), W2 form, resume, salary and/or benefits negotiations and any other public record
responsive to this request.
Inspection of any responsive records may be essential to my ability to make informed comments
regarding agenda items in an upcoming regular meeting and public hearing scheduled to be held
by the Town Commission this next Friday, Oct 14. The production of any responsive records is
therefore urgent and must be acted upon in compliance with Florida Statutes and established case
law as soon as possible.
Dear Chris O'Hare [mail to: chrisoharegulfstreamna,gmail.coml:
The Town of Gulf Stream has received your public records requests dated October 12, 2016. The
original public record request can be found at the following link:
htty://www2.gulf-stream.ore/weblink/O/doc/102392/Pagel.mx
Please be advised that the Town of Gulf Stream is currently working on a large number of
incoming public records requests. The Town will use its very best efforts to respond to you in a
reasonable amount of time with the appropriate response or an estimated cost to respond.
Sincerely,
prR""r uld " 9"
As requested by Rita Taylor
Town Clerk, Custodian of the Records
TOWN OF GULF STREAM
PALM BEACH COUNTY, FLORIDA
Delivered via e-mail
October 13, 2016
Chris O'Hare [chrisohare¢ulfstream@srnail.com]
Re: GS #2339 (hiring Nazzaro)
I request to inspect any public record *created in the past 60 days, the subject of which is wholly
or partly regarding the hiring of Mr. Edward C. Nezzaro as an employee of the Town of Gulf
Stream.
Responsive records may include but not be limited to request for proposals, request for
qualifications, letters of inquiry, letters of reference, letters of recommendation, letters of
acceptance, employment application, background checks concerning financial, criminal, social
media etc), W2 form, resume, salary and/or benefits negotiations and any other public record
responsive to this request.
Inspection of any responsive records may be essential to my ability to make informed comments
regarding agenda items in an upcoming regular meeting and public hearing scheduled to be held
by the Town Commission this next Friday, Oct 14. The production of any responsive records is
therefore urgent and must be acted upon in compliance with Florida Statutes and established
case law as soon as possible.
Dear Chris O'Hare[chrisohare¢ulfstream(&arnail.coml:
The Town of Gulf Stream has received your original record requests dated October 12, 2016.
Your original public records request and response to your request can be found at the following
link:
htty://www2.gulf-stream.or2/weblink/O/doc/102392/Pagel .asnx
We consider this request closed.
Sincerely,
14wei ROW"
As requested by Rita Taylor
Town Clerk, Custodian of the Records
Employment Eligibility Verification USCIS
t
Form I-9
Department of Homeland Security
U.S. Citizenship and Immigration Services Exp s 03/31/2017
6
to-START HERE. Read Instructions carefully before completing this form. The Instructions must be available during completion of this form.
ANTI -DISCRIMINATION NOTICE: It is illegal to discriminate against work -authorized individuals. Employers CANNOT specify which
document(s) they will accept from an employee. The refusal to hire an individual because the documentation presented has a future
expiration dale may also constitute illegal discrimination.
Section 1. Employee Information and Attestation (Employeesmustcomplete andsign Section 1 of Form 1-9 no later
than the first day of employment but not before accepting a job offer.)
Last Name (Family Name) First Name (Given Name) Middle Initial
alta. -D G
Other Names Used (if any)
re
Address (Street Number
Number and Name) ^ 1
VS110 f L�k-�..in�.�rc(20orf
Apt. Number
City or Tawn
(,VQ��rN frM
Slate
FL-
Zip Code
?3'//4/
Date of Birth (mm/dd/yyyy)
0716-51179)
I am aware that federal law provides for Imprisonment and/or fines for false statements or use of false documents in
connection with the completion of this form.
I attest, under penalty of perjury, that I am (check one of the following):
KA citizen of the United States
❑ A noncitizen national of the United States (See instructions)
❑ A lawful permanent resident (Alien Registration Number/USCIS Number):
❑ An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy) . Some aliens may write "N/A" in this field.
(See instructions)
For aliens authorized to work, provide your Alien Registration Number/USCIS Number OR Form 1-94 Admission Number.'
1. Alien Registration Number/USCIS
OR
2. Form 1-94 Admission Number.
If you obtained your admission number from CBP in connection with your arrival in the United
States, include the following:
Foreign Passport Number.
Country of Issuance:
3-D Barcode
Do Not Write In This Space
Some aliens may write "N/A" on the Foreign Passport Number and Country of Issuance fields. (See instructions)
Signature of Employee: �� Date (mmydd/yyyy): 07 /301,7610
Preparer and/or Translator Certification (To be completed and signed if Section 1 is prepared by a person other than the
employee.)
I attest, under penalty of perjury, that I have assisted in the completion of this form and that to the best of my knowledge the
Information Is true and correct.
Signature of Preparer or Translator: Dale (mm/dd/yyyy):
Last Name (Family Name) First Name (Given Name)
Address (Street Number and Name) City or Town State Zlp Code
Employer Completes Next Page
Form 1-9 03/08/13 N Page 7 of 9
Section 2. Employer or Authorized Representative Review and Verification
(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You
must physically examine one document from List A OR examine a combination of one document from List B and one document from List C as listed on
the "Lists of Acceptable Documents" on the next page of this form. For each document you review, record the following information: document title,
issuing authority, document number, and expiration date, if any.)
Employee Last Name, First Name and Middle Initial from Section 1: ei zz zt-01 rd w $,r d G
List A OR List B AND List C
Identity and Employment Authorization Identity Employment Authorization
Document Title:
Document Title: ,
�IrI Vf_ri fee
Document Title:
e— S c Saavrf* Ca4
Issuing Authority:
Document Number.
Issuing Ag1horti
S'12I2- d� �uri�8
Document Number:
240 -2x3 -82-Z 45
Issuing Authority:
/}
Document Number.
Expiration Date (if any)(mm/ddyyyy):
Document Title:
Expiration Dale (If any)(mm/ddyyyy):
Expiration Date (d any)(mm/ddyyyy):
3-D Barcode
Do Not Write In This Space
Issuing Authority:
Document Number.
Expiration Date (if any)(mm/dd/yyyy):
Document Title:
Issuing Authority:
Document Number:
Expiration Date (if any)(mm/ddyyyy):
Certification
I attest, under penalty of perjury, that (1) 1 have examined the document(s) presented by the above-named employee, (2) the
above -listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the
employee is authorized to work in the United States.
The employee's first day of employment (mm/ddfyyyy): 10, Oq— 2 v 16 (See Instructions for exemptions.)
Signal f Employeerr!r Authodzed Representative
r(n
Date (=767)
- - 0
0:3
Title of Employer or/Authorized Representative
Last Name Fatuity Name) First N 1ve
e Gn Name) Employees Business or Organization Name
own o� Gul S7rea
Employers Business or 0 an1ton Address (Street Number and Name)
ado Se-&- 4,
City or Town
C -0-F S5e� �
State Zip Code
�1 33Yffl3
Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative)
A. New Name (if applicable) Last Name (Family Name) First Name (Given Name) Middle Initial
B. Date of Rehire (if applicable) (mm/ddyyyy):
C. If employee's previous grant of employment authorization has expired, provide the Information for the document from List A or List C the employee
presented that establishes current employment authorization In the space provided below.
Document Title:
Document Number:
Expiretlon Date (i/any)(mm/ddy)yyJ:
I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and If
the employee presented document(s), the documents) I have examined appear to be genuine and to relate to the individual.
Signature of Employer or Authorized Representative: Dale (mm/ddyyyy): Print Name of Employer or Authorized Representative:
Form 1-9 03/08/13 N Page 8 of 9
stub with your personal records. The other side contains important
m.
e: The date we issued this card is shown below the signature line.
IIdlit, 11o1111Ern11ul11J11nIf111111rn11u11uu19J„1111
EDWARD CHRISTY NAZZARD
8504 WATER GAY
NEST PALM BEACH FL 33411-5556
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ALSINHO
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YOUR SOCIAL SECURITY CARD
ADULTS: Sign this cart in ink immediately.
CHILDREN: Do not sign until age lS or your first job,
whichever is earlier.
Keep your card in a safe place to prevent loss or theft.
DO NOT CARRY THIS CARD WITH YOU.
Do not laminate.
`M S Hr,
THIS NIIN P H�5�9��E�ST SHED
17 — . — U 111M.,
3
Form W-4 (2016)
Purpose. Complete Form W-4 so that your employer
can withhold the correct federal Income tax from your
pay. Consider completing a new Form W-4 each year
and when your personal or financial situation changes.
Exemption from withholding. Ifyou are exempt,
complete only lines 1, 2, 3, 4, antl 7 and sign the form
to validate it. Your exemption for 2016 expires
February 15, 2017. See Pub. 505, Tax Withholding
and Estimated Tax.
Nate: If another person can claim you as a dependent
on his or her tax return,you cannot claim exemption
from withholding If your Income exceeds $1,050 and
includes more than $350 of unearned Income (for
example, Interest and dividends).
Exceptions. An employee may be able to claim
exemption from withholding even It the employee is a
dependent, If the employee:
• Is age 65 or alder,
• Is blind, or
• Will claim adjustments to Income; tax credits; or
itemized deductions, an his or her tax return.
The exceptions do not apply to supplemental wages
greater than $1,000,000.
Basic Instructions. If you are not exempt, complete
the Personal Allowances Worksheet below. The
worksheets on page 2 further adjust your
withholding allowances based on Itemized
deductions, certain credits, adjustments to Income,
or two-eamem/muhiple jobs situations.
Complete all worksheets that apply. However, you
may claim fewer (or zem) allowances. For regular
wages, withholding must be based on allowances
you claimed and may not be a flat amount or
percentage of wages.
Head of household. (1enwally, you can claim head
of household filing status on your tax return only If
you are unmanned and pay more than 50% of the
costs of keeping up a home for yourself and your
dependenils) or other qualifying Individuals. See
Pub 501, emptions, Standard Deduction, and
Filing Information, for Information.
Tax credal. You can take projected tax credits into account
In figuring your allowable number of withholding allowances.
Credits for child or dependent care expenses and the child
tax credit may be claimed using the Personal Allowances
Worksheet below. See Pub. 505 for Information on
converting your other credits Into withholding allowances.
Nonwage Income.11 cu have a large amount of
nonwage Income, such as Interest or dividends,
consider making estimated tax payments using Form
1040 -ES, Estimated Tax for Individuals. Otherwise, you
may awe additional tax. If you have pension or annuity
Income, see Pub. 505 to find out If yyoou should adjust
your withholding on Form W-4 or WdP.
Two eamers or multiple jobs. If you have a
working spouse or more than one job, fi ure the
total number of allowances you are entitled to claim
on all jobs using worksheets from only one Form
W-4. Your withholding usually will be most accurate
when all allowances are claimed on the Form W-4
for the highest paying job and zem allowances are
claimed on the others. See Pub. 505 for details.
Nonresident alien. If you are a nonresident alien,
sea Notice 1392, Supplemental Form W-4
Instructions for Nonresident Aliens, before
completing this forth.
Check your withholding. Aker your Forth W-4 takes
effect, use Pub. 505 to see how the amount you are
having withheld corn area to your projected total tax
for 2016. See Pub. 505 especially if your earnings
exceed $130,000 (Single) or $160,000 (Married).
Personal Allowances Worksheet (Keep for your records.)
A Enter "1" for yourself H no one else can claim you as a dependent . . . . . . . . . . . . . . . . . . A
( • You are single and have only one job; or 1
B Enter 1" if; `l • You are marded, have only one job, and your spouse does not work; or J} B
• Your wages from a second job or your spouse's wages (or the total of both) are $1,500 or less.
C Enter "1" for your spouse. But, you may choose to enter "-0--" if you are marded and have either a working spouse or more
than one job, (Entering "-0-" may help you avoid having too little tax withheld.) . . . . . . . . . . . . . . C
D Enter number of dependents (other than your spouse or yourself) you will claim on your tax return . . . . . . . . D
E Enter "1" if you will file as head of household on your tax return (see conditions under Head of household above) . . E
F Enter "1" if you have at least $2,000 of child or dependent care expenses for which you plan to claim a credit . . . F
(Note: Do not Include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.)
G Child Tax Credit (including additional child tax credit). See Pub. 972, Child Tax Credit, for more information.
• If your total Income will be less than $70,000 ($100,000 if marded), enter 02" for each eligible child; then less "1" if you
have two to four eligible children or less "2" if you have five or more eligible children.
• If your total Income will be between $70,000 and $84,000 ($100,000 and $119,000 if married), enter "1" for each eligible child G
H Add lines A through G and enter total here. (Note: This may be different from the number of exemptions you claim on your tax return.) ► H
• ifyou plan to Itemize or claim adjustments to Income and want to reduce your withholding, see the Deductions
For accuracy, and Adjustments Worksheet on page 2.
complete all • If you are single and have more than one job or are married and you and your spouse both work and the combined
worksheets samings from all jobs exceed $50,000 ($20,000 if married), see the Two-Eamers/Multiple Jobs Worksheet on page 2
that apply. to avoid having too little tax withheld.
• If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below.
Separate here and give Form W4 to your employer. Keep the top part for your records- ----------------------------------
Employee's Withholding Allowance Certificate OMB No. 1545-0074
Farm 4 X016
Internal mere Treasury ►whether you are entitled to claim a certain number of allowances or exemption from withholding is
Internal W. aewke aubjeet to review by the IRS. Your employer may be required to send a copy o1 this form to the IRS.
1 Your first name and ml dle initial Last name 2 Your social security number
dulokrck G. ct.Z. aAr o �/
Home address (number and street or rural mute) 3 LlSingle Married LJ Marred, but withhold at higher Single rate.
S0oV (J kc J e Cov rTl Note: "married, but legally separated, or spouse Its nonresident ellen, check the'smille' l ax.
/ COityar town, state, and ZIP code 4 N your last name differs from that shown on your social security card,
V ` It, EJ fen L 3 3 N / q check here. You must call 1-500.772-1213 for a replacement card. 111-
5
5 Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2) 5 O
6 Additional amount, if any, you want withheld from each paycheck . . . . . . . . . . . . . . 6 $
7 1 claim exemption from withholding for 2016, and I certify that I meet both of the following conditions for exemption.
• Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and
• This year I expect a refund of all federal Income tax withheld because I expect to have no tax Ilabili
If you meet both conditions, write "Exempt" here . . ► 7
Under penalties of perjury, I declare that I have examined this Vftificate and, a best of my knowledge and belief, It is true, correct, and complete.
Employee's signature
(This form is not valid unless you sign ft.) ► Date P-
8
6 Employer's name and address (Employer: Complete lines%@ anlo 10 only if sending to the IRS.) 1 a Office code (optional 1 10 Employer Identification number (EIN)
For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 102200 Form
EMPLOYEE ACKNOWLEDGEMENT FORM
The Town of Gulf Stream Personnel Policy Handbook revised October 10, 2007 (the
handbook), describes important information about the Town, and I understand that I should
consult the Town Manager, Police Chief or Town Clerk regarding any questions not answered in
the handbook.
I have entered into my employment relationship with the Town voluntarily and
acknowledge that there is no specified length of employment. Accordingly, either I or the Town
can terminate the relationship at will, with or without cause, at any time, so long as there is no
violation of applicable federal or state law.
Since the information, policies, and benefits described here are necessarily subject to
change, I acknowledge that revisions to the handbook may occur, except to the Town's policy of
employment -at -will. All such changes will be communicated through official notices, and I
understand that revised information may supersede, modify, or eliminate existing policies. Only
the Town Commission or the Town Manager has the ability to adopt policies that amend this
handbook.
Furthermore, I acknowledge that this handbook is neither a contract of employment nor a
legal document. I have received the handbook, and I understand that it is my responsibility to
read and comply with the policies contained in this handbook and any revisions made to it.
Qf 1--�
EMPLOYEE' NATURE DATE
9w0.�J lUaZLarc7
EMPLOYEE'S NAME (TYPED OR PRINTED)
ov,-zi0-&jam
Town of Gulf Stream, Florida, Personnel Policy Handbook 43
Section I - Town of Gulf Stream's Commitment and Involvement
The management of the Town of Gulf Stream is committed to providing employees with a safe and healthful
workplace. It is the policy of the Town that employees report unsafe conditions and do not perform work
tasks if the work is considered unsafe. Employees must report all accidents, injuries, and unsafe conditions
to their supervisor immediately. Such reports will not result in any retaliation, penalty, or other disincentive.
Employee recommendations to improve safety and health conditions will be given thorough consideration by
the Town Manager. The Town will give top priority to and provide the financial resources for the correction
of any condition deemed unsafe. Similarly, the Town will take disciplinary action against any employee who
willfully or repeatedly violates workplace safety rules. This action may include verbal or written reprimands
and may ultimately result in termination of employment.
The primary responsibility for the coordination, implementation, and maintenance of the Town of Gulf
Stream's workplace safety program has been assigned to Sergeant Edward Allen of the Police Department.
The title for this responsibility shall be "Safety Program Coordinator".
The Town Manager will be actively involved with employees in establishing and maintaining an effective
safety program. The Town will encourage and strive to:
Promote safety committee participation;
Provide safety and health education and training; and
Review and update workplace safety policies and procedures.
This policy is intended to complement other Town Policies (such as the Personnel Policy Handbook and the
Police Department General and Administrative orders.) Any perceived conflicts with other policies should
be referred to a supervisor for clarification. This Policy Statement serves to express the Town's commitment
to and involvement in providing our employees a safe and healthful workplace. This workplace safety
program will be incorporated as the standard of practice for the Town. Compliance with the safety rules will
be required of all employees as a condition of employment.
k2 �- k� I 0-/q4 I
William H. Thrasher, Town Manager Date
q4-�"O Io l
Employ s Signature Date
I.1
TOWN OF GULF STREAM
ACKNOWLEDGMENT OF RECEIPT &
UNDERSTANDING
I hereby acknowledge that I have received and read a summary of the Town's Drug -
Free Workplace policy, a summary of the drugs which may alter or affect a drug test
and a list of local Employee Assistance Programs and drug and alcohol treatment
programs. I have had an opportunity to have all aspects of this material fully
explained. I understand that the full text of the Drug -Free Workplace policy is available
upon request. I also understand that I must abide by the policy as a condition of
employment, and any violation may result in disciplinary action, up to and including
discharge.
Further, I understand that during my employment I may be required to submit to
testing for the presence of drugs or alcohol. I understand that submission to such
testing is a condition of employment with the Town, and disciplinary action up to and
including discharge may result if: 1) I refuse to consent to such testing, 2) I refuse to
execute all forms of consent and release of liability as are usually and reasonably
attendant to such examinations, 3) I refuse to authorize release of the test results to the
Town, 4) the tests establish a violation of the Towns Drug -Free Workplace policy, 5) I
otherwise violate the policy. If I am injured in the course and scope of my
employment and test positive, I forfeit my eligibility for medical and indemnity
benefits under the Workers' Compensation Act upon exhaustion of the remedies
provided in Florida Stature 440.102(5).
I ALSO UNDERSTAND THAT THE DRUG-FREE WORKPLACE POLICY AND
RELATED DOCUMENTS ARE NOT INTENDED TO CONSTITUTE A CONTRACT
BETWEEN THE TOWN AND ME.
THE UNDERSIGNED FURTHER STATES THAT HE OR SHE HAS READ THE
FOREGOING ACKNOWLEDGMENT AND KNOWS THE CONTENTS THEREOF
AND SIGNS THE SAME OF HIS OR HER OWN FREE WILL.
/N�zza f0 �/�� l61 //(-,
Naina�please print) Signatur Date
Witness Date
PUBLIC EMPLOYEE'S OATH
and
OATH OF OFFICE
1 c-IIInrO a citizen of the State of
Florida and of the United States of America, and being employed
by or being an officer of the Town of Gulf Stream, Florida and
a recipient of public funds as such employee or officer, do
hereby solemny swear (or affirm) that I will support the
Constitution of the United States and of the State of Florida.
I do solemnly swear (or affirm) that I will support,
protect, and defend the Constitution and Government of the
United States and of the State of Florida against all enemies,
domestic or foreign, and that I will bear true faith, loyalty,
and allegiance to the same, and that I am entitled to hold office
under the Constitution of the United States and the Constitution
of the State of 'Florida, and that I will faithfully perform all
the duties of the office of 5+c':C- 4440r,l!{ of the Town of
Gulf Stream, Florida, on which I am about teI enter, so help
me God.
Attested:
7,4 ` / L
gut�— -1--D (Witness)
Dated this Y day of 1/C fp�c� 01