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02/22/1995 Contract CONTRACT THIS AGREEMENT, made and entered into this 1995 , A . D., by and between MONROE COUNTY, first part (hereinafter sometimes called the party of the second part (hereinafter "Contractor"). 22nd day of February , FLORIDA, party of the "OWner"), and Toxikon, sometimes called the WITNESSED: That the parties hereto, for the consideration herein- after set forth, mutually agree as follows: SCOPE OF THE WORK The Contractor shall provide all laboJ;', equipment, and materials to: sample, analyze, and report on th~..County's ~ndfil~ ~ven (11) ground water monitoring wells 'and three (~_ !rurface ~ter moni toring locations. ~ ,., C) - all of the work d.~.,cribttcf i~ the ;::c. 1'1 CD C) .. a SPECIFICATION FOR GROUND WATER AND SURFACE WATER SAMPL~ A~ ANALYSIS AT KEY LARGO, LONG KEY AND CUD JOE KEY LANDFILLS The contractor shall perform Specification entitled: and their proposal, each attached hereto and incorporated as part of this Contract document. THE CONTRACT SUM The County shall pay to the Contractor for the faithful performance of said service. The Contractor shall invoice th~ County quarterly; two (2) quarters for $3,741.00 each, and two (2) quarters for $4,086.00 each. The yearly contract amount shall be a8 stated by the Contractor's proposal as follows: Fifteen thousand six hundred fifty four and 00/100 dollars ($15,654.00) 1 CONTRACTOR'S ACCEPTANCE OF CONDITIONS A. The Contractor hereby agrees that it has carefully examined the site and has made investigations to fully satisfy it..lf that the site is correct and sui table for this work and it assumes full responsibility therefore. The provisions of the Contract shall control any inconsistent provisions contained in the Specifications. All Specifications have been read and carefully considered by the Contractor, who understands the same and agrees to their sufficiency for the work to be done. Under no circumstances, conditions, or situations shall this Contract be more strongly construed against the Owner than against the Contractor and its Surety. B. Any ambiguity or uncertainty in the Specifications shall be interpreted and construed by the Owner, and its decision shall be final and binding upon all parti.s. C. The passing, approval, and/or acceptance of any part of the work or material by the Owner shall not operate as a waiver by the Owner of strict compliance with the terms of this Contract, and Specifications covering said work. Failure on the part of the Contractor, immediately after Notice to correct workmanship shall entitle the Owner, if it sees fit, to correct the same and recover the reasonable cost of such replacement and/or repair from the Contractor, who shall in any event be jointly and severally liable to the Owner for all damage, loss, and expense caused to the Owner by reason of the Contractor's breach of this Contract and/or its failure to comply strictly and in all things with this Contract and with the Specifications. HOLD HARMLESS The Contractor shall defend, indemnify and hold the County, its officials, employees and agents harmless, from any and all claims, liabilities, losses and causes of action which may arise out of the performance of the Contract except such claims, liabilities, losses and causes of action which may arise because of the County's negli- gent actions or omissions. Compliance with the insurance require- ments shall not relieve the Contractor from the obligations imposed by this article. 2 , . INDEPENDENT CONTRACTOR At all times and for all purposes under this Agreement the Contractor is an independent Contractor and not an employ.e of the Board of County Commissioners for Monroe County. No state..nt contained in this Agreement shall be construed so as to find the Contrac~or or any of its employees, contractors, servants, or agents to be employees of the Board of County Commissioners for Monroe County. ASSURANCE AGAINST DISCRIMINATION The Contractor shall not discriminate against any person on the basis of race, creed, color, .national origin, sex, age, or any other characteristic or aspect which ts not job related, in its recruiting, hiring, promoting, terminAting, or any other area affecting employment under this Agreem~rit or with the provision of services or goods under this Agreement. ASSIGNMENT The Contractor shall not assign this Agreement, except in writing and with the prior written approval of the Board of County Commis- sioners for Monroe County and Contractor, which approval shall be subject to such conditions and provisions as the Board and Contractor may deem necessary. This Agreement shall be incorporated by reference into any assignment and any assignee shall comply with all of the provisions of this Agreement. Unless expressly provided for therein, such approval shall in no manner or event be deemed to impose any obligation upon the Board in addition to the total agreed-upon price of the services/goods of the Contractor. COMPLIANCE WITH LAW In providing all services/goods pursuant to this Agreement, the Contractor shall abide by all statutes, ordinances, rules and regu- lations pertaining to, or regulating the provisions of, such services, including those now in effect and hereinafter adopted. Any violation of said statutes, ordinances, rules and regulations shall constitute a material breach of this Agreement and shall entitle the Board to terminate this Contract immediately upon delivery of written notice of termination to the Contractor. 3 INSURANCE Upon execution of this Agreement, the Contractor shall furnish the Owner Certificates of Insurance indicating the minimum coverage limitations as indicated by an "X" on the attached forms identified as INSCKLST 1-4, as further detailed on forms WC1, GL1, VL1, PROl, GIRl and GIR2, each attached hereto and incorporated as part of this Contract document. FUNDING AVAILABILITY In the event that funds are partially reduced or cannot be obtained or cannot be continued at level sufficient to allow for the purchase of the services/goods specified herein, this Agreement may then be terminated immediately at th~ option of the Board by written notice of termination delivered in person or by mail to the Contractor. The Board shall not be>6bligated to pay for any services provided by the Contractor after the Contractor has received written notice of termination. PROFESSIONAL RESPONSIBILITY The Contractor warrants that it is authorized by law to engage in the performance of the activities encompassed by the project herein described. The provider shall at all times exercise independent, professional judgement and shall assume professional responsibility for the services to be provided. Continued funding by the Board is contingent upon retention of appropriate local, state, and/or federal certification and/or licensure of Contractor. TERM OF CONTRACT/RENEWAL A. This contract commencing on parties. shall be for a period of three (3) years, the day in which it has been executed by both B. The Owner shall have the option to renew this Agreement after the third year for one additional three-year period. The contract amount agreed to herein may be adjusted annually in accordance with the percentage change in the Con$umer Price Index (CPI) for Wage Earners and Clerical Workers in the Miami, Florida area index, and shall be based upon the annual average CPI computation from January 1 through December 31 of the 4 previous year. Increases in the contract amount during each option period shall be extended into the succeeding years. C. Either of the parties hereto may cancel this Agreement with or without cause by giving the other party sixty (60) days written notice of its intention to do so. NOTICE REQUIREMENT Any notice required or permitted under this Agreement shall be in writing and hand delivered or mailed, postage prepaid, to the other party by Certified mail, returned receipt requested, to the following: FOR COUNTY FOR CONTRACTOR Monroe County Environmental Management 5100 College Road . Key West, FL 33040 Toxikon 1860 Old Okeechobee Road Suite 401 West Palm Beach, FL 33409 5 IN WITNESS WHEREOF the parties hereto have executed this Agreement on the day and date first above written in four (4) counterparts, each of which shall, without proof or accounting for the other counterparts, be deemed an original Contract. COUNTY OF MONROE, STATE OF FLORIDA By ct~-F~ Mayor/C irman i<r: _....-......*....~~ Attest: DANNY L. KOLHAGE, Clerk ~8pQJ~~~41) erk By Attest: WITNESS WITNESS By__ r 6 . . ^rril22, 199.1 11Il1'rinlinc MONROE COUNlY, FLORIDA INSURANCE CHECKLIST FOR VENDORS SUBMI1TING PROPOSALS FOR WORK To assist in the development of your proposal, the insurance coverages marked with an "X" will be required in the event an award is made to your firm. Please review this form with your insurance agent and have him/her sign it in the place provided. It is also required that the bidder sign the form and submit it with each proposal. WORKERS' COM PENSA TION AND EMPLOYERS' LIABILITY wel We2 WC3 weusu 1 WelA x Workers' Compensation Employers Liability Employers Liability Employers Liability US Longshoremen & Harbor Workers Act Federal Jones Act , Statutory Limits $100,000/$500,000/$100,000 $500,000/$500, OOO/$SOO~ooO $1,000,000/$1,000,000/$1,000,000 Same as Employers' Liability Same as Employers' Liability ^dlllini'1I1llive Jnstn'<1iu" INSCKLST J. 1/470901 6 ^'" if 21. '<)'J.l ,.. 1,",11;"1 GENERAL LIABILITY As a minimurn. the required general liability coverages will include: · Premises Operations · Blanket Contractual · Expanded Definition of Property Damage . Products and Completed Operations Personal Injury . Required Limits: GLI x $100,000 per Person; $300,000 per Occurrence $50,000 Property Damage or $300,000 Combined Single Limit $250,000 per Person; $500,000 per Occurrence $50,000 Property Damage or $500,000 Combined Single Lin;1it $500,000 per Person; $1,000,000 per OccUlTence I $100,000 Property Damage or $1,000,000 Combined Single Limit GL2 GL3 Required Endorsement: GLXCU Underground, Explosion and Collapse (XCU) G LLl Q Liquor Liability All endorsements are required to have the same limits as the basic policy. Admini'1Illth.c Instru<.1ion INSCKLST l. 11.1709.0 I 7 l\priI22. 1<J<J.1 IlIlIlhlllin" .Y.E!.UCLE LJABlLJT'( As a minimum, coverage should extend to liability for: · Owned; Nonowned; and Hired Vehicles Required Umits: VLJ )( VL2 VLJ BRI MVC PRO] PR02 PROJ x POLl POL2 POLJ EDI ED2 GKJ GK2 GKJ MEDI M ED2 MED3 ^dnlini<tralivc l!~muc1ion 114709.01 $50,000 per Person: $ 100,000 per Occurrence $25,000 Property Damage or SIOO,OOO Combined Single Limit SIOO,OOO per Person; $300,000 per Occurrence $50,000 Property Damage or $300,000 Combined Single Limit 1 S500,000 per Person; $1,000,.000 per Occurrence SIOO,OOO Property Damage, '';.. or. $1,000,000 Combined Single Limit MISCELLANEOUS COVERAGES Builders' Risk Motor Truck Cargo Professional Liability Pollution Liability Employee Dishonesty Garage Keepers Medical Profossional INSCKLST :3 Limits equal to the completed project. Limits equal to the maximum value of anyone shipment. S 250,000 per Occurrence/$ 500,000 Agg. $ 500,000 per Occurrcnce/$ I ,000,000 Agg. $/ ,000,000 per Occurrencel$2,OOO,OOO Agg. $ 500,000 per Occurrence/S I ,000,000 Agg. $1,000,000 per Occurrencel$2,000.OOO Agg. $5,000,000 per OccurrencelSI 0,000,000 Agg. $ 10,000 S/OO,OOO $ 300,000 ($ 25,000 per Vel!) $ 500,000 ($100,000 per Veh) SI,OOO,OOO ($250,000 per Veh) $ 500,000/$ 1,000,000 Agg. SI,OOO,OOOI$ 3,000,000 Agg. $5,OOO,000/SIO,OOO,OOO Agg. K Api122. 1'J"J.l 'If ''rintinC IF Installation Floater Maximum value of Equipment Installed VLPI VLP2 VLP3 BLL Hazardous Cargo Transporter $ 300,000 (Rc()uires MCS-90) S 500,000 (Requires MCS-90) $1,000.000 (Requires MCS-90) Bailee Liab. Maximum Value of Property IIKLI J J K L2 JIKLJ Hangarkecpers Liability $ 300,000 $ 500,000 $ 1,000,000 $25,000,000 $ 1,000,000 $ 1,000,000 S 250,000 per Occurrencel$ 500,000 Agg. $ 500,000 per Occurrencel$I.OOO,OOO Agg. $ 1,000.000 per OccurrencelSJ,OOO,OOO AU. AIRI AIR2 AIRJ Ajrcrafi Liability AEOI AE02 AEOJ Architects Errors . & Omissions INSURANCE AGENT'S STATEMENT I have reviewed the above requirements with the bidder named below. The following deductibles apply (0 the corresponding policy. POLlCY DEDUCTIBLES Liability policies are _ Occurrence Claims Made Insurance Agency Signature BIDDERS STATElvlENT J understand the insurance that will be mandatory if awarded the contract and will comply in full with all the requirements. Bidder Signature ^drninis1nlivc'"<tn'L1ion 114709.0' INSCKLST &of 9 ADDENDUM NO.1 FOR SPECIFICA TION FOR GROUND WATER AND SURFACE WATER SAMPLING AND ANALYSIS AT THE KEY LARGO, LONG KEY AND CUDJOE KEY LANDFILLS GENERAL Bids shall be submitted in a format that shows the contractor's prices for sampling, analysis, and reports for each of the County's Landfills per quarter. .. The selected contractor shall be prepared to sign a three (3) year rehewable contract. The fint l8IDpIiDl event will be due during the month of February 1995. SPECIFICA TION FOR GROUND WATER AND SURFACE WATER SAMPLING AND ANALYSIS AT THE KEY LARGO, LONG KEY AND CUDJOE KEY LANDFILLS GENERAL As part of the permits and consent orders for the Monroe County Landfills, the Florida Depuunent 0( Environmental Protection (DEP) requires ground water and surface water at each of the landfill. to be sampled and analyzed for the required monitoring parameters. The monitoring parametel1 performed on samples from the County's landfills consist of the following: Monitoring parameters required by DEP Monitoring parameters to asses the impact Qf sludge and septage disposal at the Iandfill on the surrounding environment ., Monitoring parameters requested by other governmental agencies u part of the closure permitting process. These sampling events occur on a quarterly basis with the report of the analyses submitted to DEP, South Florida Water Management District (SFWMD) and other agencies within sixty (60) days of the amplina event. SAMPLING The contractor shall sample at the County Landfills' eleven (11) ground water monitoring wells, ~ at Cudjoe Key, 3 at Long Key, and 3 at Key Largo and three (3) surface water monitorinlloaltlOlll, one at each landfill. The following field parameters will be tested during the sampling event. Static water level in wells before purging Specific conductivity pH Temperature Color and Sheens (by observation) ANAL YSIS The contractor shall perform a laboratory analysis of the samples for the followilll parlmeter,s,: Total Dissolve Solid. Total Organic Carbon Total Phosphorous Nitrite Zinc Mercury Cadmium Total Suspended Solids Total Nitrogen Total Kjeldahl Nitrogen Nitrate Lead Chromium Nickel The Key Largo Landfill ground water monitoring well samples require an additionalanalysi. tor Ammonia. The Long Key Landfill ground water monitoring well samples require an additionallemi-annual uaIytia for PCB. and Pesticides. The surface water samples require additional analysis for the following parameten: Chemical Oxygen Demand Chloride Aluminum Iron Ammonia Sulfate Arsenic Fecal Coliform REPORTS Thc contractor shall summarizc the results from the analyses in a report form. The report shall include graphs that show the concentrations of specific parameters of each sampkover time. The report .hall also include the analytical rcsults listed on the required DEP repor.. forms. The contractor shall_mit the specified number of copies to the County and the following a~~~cies: Monroe County, 2 copies DEP, Ft. Myers Office, 2 copies DEP, Marathon Office, I copy SFWMD, 1 copy US Fish and Wildlife, 1 copy (Key Largo Landfill data Only) DNR, 1 copy (Long Key Landfill data only) ~ - west palm 1860 Old Okeechobee Road, Suite 401 West Palm Beach, Fl33409 Telephone: (407) 478-4803 F8IC: (407) 478-0214 January 23, 1995 .a9. 1 of 2 Board of ~ounty Commissioners Attn: Mike Lawn. Environmental Management/public Service Building 5100 College Road Key West, FL 33040 We are pleased to quote the following for your consideration. REF: Key Largo, Long Key and Cudjoe Kpy Landfills Sampling/Analyaia PROJECT TITLE: Ground Water and Surface Water Sampling and Analyaia at I the Key Largo, Long Key and,Cudjoe Key Landtill. DESCRIPTION OF SERVICES: SAMPLING: Static Water Level in Wells Before Purging.$ N/C Specific Conductivity......................$ N/C pH. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ N / C Temper at ure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ N I C Color and Sheens {by observation)..........$ N/C Sampling Cost/Quarter or /Trip.............$560.00 PRICE BASE: Total Dissolved Solids............$ Total Organic Carbon..............$ Total Phosphorus..................$ N i tr i te. . . . . . . . . . . . . . . . . . . . . . . . . . . $ Zinc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 12.00/bf\ .. 5.00 I. 12.00 \Y. 12.00 10.00 31. 00 13.00 9.00 12.00 32.00 18.00 14.00 14 .00 11. 00 Mercury. . . . . . . . . . . . . . . . . . . . . . . . . . . $ Cadmium. . . . . . . . . . . . . . . . . . . . . . . . . . . $ Total Suspended Solids............$ Total Nitrogen....................$ Total Kjeldahl Nitrogen...........$ Nit rat e. . . . . . . .' . . . . . . . . . . . . . . . . . . . $ Le a c.l. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ Ch rom i um. . . . . . . . . . . . . . . . . . . . . . . . . . $ N i cke 1. . . . . . . . . . . . . .' . . . . . . . . . . . . . " $ Continued Toxikon Corporation, Headquarters 225 Wildwood Avenue, WOburn, MA 01801, (617) 933-6903 Toxikon Environmental Sciences, 106 Coastal Way, Jupiter, FL 33477, (407) 575-2477 ~ - west palm 1860 Old Okeechobee Road, Suite 401 West Palm Beach, Fl33409 Telephone: (407) 478-4803 Fax: (407) 478-0214 paqe 2 of 2 ADDITIONAL: Key Largo-------Ammonia...........................$ 22.00 ~~ Long Key--------PCBs and Pesticides...............$115.00 , Surface Water---Chemical Oxygen Demand............$ 27.00 W Chloride..........................$ 14.00 Aluminum. . . . . . . . :. . . . . . . . . . . . . . ~ . . $ 14.00 Iron. . . . . . . . . . . . . . . . . . . . .-..' . . . . . . . $ 11.00 Ammonia. . . . . . . . . . . . . . . . . .. .~.. . . . . . . $ 2 J . 00 Sulfate................_.~~........$ 14.00 Arsenic. . . . . . . . . . . . . . . . . . .~. . . . . . . . . $ 14.00 Fecal Coliform....................$ 23.00 - 5 - Day Turnaround Time - Sample Kit Provided at NO COST - Shipping To & From Client at NO COST - Reports Faxed Upon Completion, Hardcopy - Net 30 Days II /O~,60 TERMS: via' u.s. Mail PREPARED BY: DATE: 1/~3/fS r I p.y(5 APPROVED tW: DATE: <' Toxikorl Corporation, Headquarters 225 Wildwcad Avenue, WOburn, MA 01801, (617) 933-6903 Toxikon Environmental Sciences, 106 Coastal Way, Jupiter, FL 33477, (407) 575-2477 DRUG-FREE WORkPLACE FORM The undersigned vendor in accordance witll Florida statute 287.087 hereby certifies that: . - --- ..--. - ".- (Name of Business) 1. Publish a statement notifying employees that the unlawful manufact\lre, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug~free workplace, any avai lable drug cOltnseU ng, rehabi Ii tation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Give each employee engaged in provfding the commodities or contractual services that are under bid a copy of the statement specified in subsection (1). 4. In the statement specified in subsection (1), notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893 (Florida statutes) or of any controlled Bubstance law of the United States or any state, for a violation occuring in the workplace no later than five (5) days after such conviction. 5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if SUCll is available in the employee's community, or any employee who is so convicted. 6. Malte a good fai th effort to conti nue to maintain a drug-free worJtplace through implementation of this section. As the person authorized to sign the statement, I certify that this finn complies fully with the above requirements. Bid~~ 8-~-96 Date MCP#5 REV. 6/91 swarm ST1\TEMENT UNDER OROHl1\NCE NO. 10-1990 MONROE COUN1Y, FLORID~ ETHICS CLAUSE -"/Ox, kOt) Gr~-horwi'lrr;ll1t:s that he/it has not employed retained or otherwise had act on his/its behalfariy form~r County office: or employee in violation of Section 2 of Ordinance No. 10-1990 or any County officer or empioyee in violation of Section 3 of Ordinance No. 10-1990. For breach or violation of this provision the County may, in its discretion, terminate tIlls contract without liability and may also, in its discretion, deduct from the contract or purchase pric~, or l otherwise recover, the full amount of any fee, commission, percentage, ~ift, or consideration paid to the employee. Date: ST~TE OF rlo ('"I C/ C( Pa.) /YI /?;e u{ It -'.; ...,," COUNTY OF me Subscribed and sworn to (or affirmed) before on 6'-/-/t (YJIJ' C /, /115 ~ ~ 11 YD.-vem c k/c. ,. (date) by (name of affiant). He/She is personally known to me or has produced as identification. rx-y Po ~~ '?- PIA LINN ~ . c; COMMISSION # CC 356291 . ':!?> i!f EXPIRES MAR 15 1998 .-/. ..... <'0 -"i!f' BONDED THAU' Z ~ ~ F rc ATLANTIC'30NDt'NG co., INC. (type of identifi~ation) UOTARY PUBLIC MCPt4 REV. 2/92 SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES TillS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUT RIZ D TO AD INISTER OATHS.I This sworn statement i..ubRI'" to #~ 0 YO e (print name of the ublle entity] .:r; J, n Y tLr.e m C j, fA.- Ie Ad /11 i n Iprint Individual's name and title] ~ XI k '" ('0 y-.e D (<-f:, i> h . [print name of entity su ittlng sworn statement] by La.J AJj y. for whose business address is /Y6o old ()l~~c~br"e-- Rei s~ /f-o/ ~isf-fa/m &ach,'F/ 33'f()9 .. and (if applicahle) its Federal Employer Identification Numi)~r {FEIN) is tJ 1- ;;1-7 7 d-I 8:D (If the cnti.y has nil FEIN, include the Social Sccuri.y Numbcr of thc individual signing this twor. statement: .) I undcrstand that a "puhlic entity crime" as defined in Paragraph 2H7.133(J)(g), Florida $tatutes. -.eaR' a violation of any state or federal law by a I)cnon with reSIJcct to and dircctly related to the tran.adi..., business with any puhlic cntity or with an agency or political subdivision of any othcr stat~ or ofthe United States,including, but not limitcd to, any bid or contract for goods or services to he provided to any public entity or _agncy .1' political subdivision of any other state or of the United'States and involving antitrust, fraud, lIIdI, bribery, collusion, racketeering, conSIJiracy, or material misrepresentation. I understand that "co~victed" or "conviction" as defined in Paragraph 287.133(1)(b), Florida Stat~ means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in ..,. federal or state trial court of record relating to charges brought by indictment or information after July 1, 1'''. as a result of a jury verdict, nonjury trial, or entry of a plea of guilty or nolo contendere. 1 understand that an "affiliate" as defined in Paragraph 287.133(1)(a), Florida Statutes, rheans: 1. A predecessor or Successor of a person convicted of a public entity crime; or 2. An entity under the control of any natural person who is active in the management of thc entity... who has been convicted ofa public entity crime. The term "affiliate" includes those officers, directors, cllccutiws.partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or pooling of cquipmetlll or income among persons when not for fair:Jl1arket value under an arm's length agreement, shall be a prima farircasc that one person con'rols another person. A person who knowingly enters into a joint venture with a penon who has been co",'icted of a puhlic entity crime in Florida during the preceding 36 moiHhs shall be considerN an affiliate. I understand that a "person" as defined in Paragraph 2H7.133( I)(e), Florida Statutes, meal1$ any na..rat person or entity organized under the laws or any state or ofthe United States with the legal power to enter illt. a binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a .....ic entity, or which othcrwise transacts or applies to transact business with a puhlic entity. The term "person" .dudes those officers, ,directors, executivcs, partners, shareholders, employees, memhers, and agents who are active in management of an entity.I.2.3.4.5. , , . Bascd on informatioll alld bclief, thc statemcnt which I have marked below is true in rel.ti..te tile entity submlUing tllis Sworn statement. (Indicate which statement applies. I - Neither the entity suhmitting this Sworn statement, nor any of its officers, directors, ellcc:utives, partners, shareholders, emf)loyees, members, or agents wllo'ane active in the management .rthe entity, nor any affiliate of the entity has been charged with and convicted o' a puhlic enlity crime suble4lftDt te Ju'y I, 1989. - The entity submitting this Sworn statement, nor any of its officers, directors, Uec:utiws, partners, shareholder's, employees, members, oragents who arc active in the management onhcentity, neran affiliate of the cntify has been charged with and convicted of a public entity crime subsequent to July I, 1989. - TI~e entity submiUing this Sworn statement, or one or more of its officers, directors, eJ:cc:utives, partners, shareholders, employees, members, or agents who are active In the management oCthe entity, or an affiliate of the entity has beell charged with and convicted of a public entity crime subsequent t. July J, 1989. However, there has been a subse(luent proceeding before a Hearing Officer or 'he State.r Florida, Division of Administrative Hearings and the Final Order entered hy the Hearing Offic:er determined that it was nof in the public interest to place the en lily submiUing this SWorn statement on the c:onvicted vendor list. (AUach a copy of the final order I 6. I UNDERSTAND THAT THE SUBMISSION OF THIS ,FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED ON PARAGRApH I (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, TIIATTIIISFORM ISVALIDTIIROUGII DECEMBER31 OFTHECALENDAR YEAR IN WIIICIIIT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.fH7, FLORIDt\ STATJ.lIES FOR CATEGORY TWO OF ANY CHANGE IN TilE INFORMATION CONTAINED IN nffS FORM. . 7/J/~ ' . ,;gna'uro) , Sworn to and subscribed before me this ~ day of J/ftych ,19 q -5. Personally known ~ h y/ y If. {/ r' rw LIw Ie... I OR Produced identification Notary Public: - State or flOrf d <... .~. My C.mm;....n o~ . Il~ (Printed typed or stamped commissioned name or notary public:) (Type of identification) Form rUR 7068 (Rev. 06/11/92) "';';~~ ..\;", " '_ /, L: >~~) ~ ~r ~i<l (";C:i',;;;i:'~;IO[' i; C.C 35.8." 291 '8. ',. ~ FXPIRi:::; MhHI5.1t:9f\ ~~.i-' .. aONQEG PiH'J f'~ :.' "1 ,..ANiiC ,llON01NG CO., INC.