07/16/2008 Murray E. Nelson Government CenterDANNY L. KOLHAGE
CLERK OF THE CIRCUIT COURT
DATE: July 22, 2008
TO: Dave Koppel, County Engineer
Engineering Division
FROM: Pamela G. Hand
Deputy Clerk
At the July 16, 2008, Board of County Commissioner's meeting the Board granted
approval and authorized execution of Contracts with the following for Art in Public Places at the
Murray E. Nelson Government & Cultural Center:
Stephen Frink Photographic, Inc.
John David Hawver Gallery.
Xavier Cortada.✓
Alan S. Maltz Gallery.
Roberta Cris Sandifer.
Enclosed is a ic� of each of the above - mentioned for your handling.
Should you have any questions please do not hesitate to contact this office.
6
cc: County Attorney
Finance
File
Monroe County Art in Public Places Award Asreem
This AGREEMENT dated the 16 day of ,Tgly 2008, is entered into by and
between the BOARD OF COUNTY COMMISSIONERS FOR MONROE COUNTY,
hereinafter "County", and Xavier Cortada, hereinafter "Artist',
EIN # 65- 0837394
WHEREAS, the Art in Public Places Ordinance #022 -2001, codified at MCC §2-
322(A), provides for an appropriation of 1% of the construction costs for new
construction exceeding $500,000 and renovations exceeding $100,000; and
wHMAS, the Ordinance established an Arts in Public Places (AIPP)
Committee to advise the County Commission regarding art to be acquired and installed in
each public construction project subject to the AIPP allocation; and
WHEREAS, the AIPP Committee has selected and recommended to the BOCC
one or more artists for this project; and
WHEREAS, the Board of County Commissioners of Monroe County have
determined that it is in the interest of the promoting the understanding and awareness of
the visual arts to contract for the creation and installation of artwork in the Murray E.
Nelson Government & Cultural Center, Key Largo, Florida.
NOW, THEREFORE, in consideration of the mutual covenants and payments
contained herein, the parties have entered into this agreement on the terms and conditions
as set forth below.
1. AGREEMENT PERIOD: This agreement is for the period July 16, 2008 through
60 days subsequent to date of issuance of Certificate of Occupancy or Certificate
of Completion for building. This agreement shall remain in effect for the stated
period unless one party gives to the other written notification of termination
pursuant to and in compliance with paragraphs 7, 12, and 13 below. All work for
which AIPP funds are to be expended must be completed by the stated
termination date.
2. SCOPE OF AGREEMENT: The Artist shall provide
A series of digital tapestries / eco-art
Artist shall confer with and coordinate activities with the construction contractor
on the job in order to insure that there is as much cooperation and cohesiveness in
the incorporation of the art into the building under construction, and so that there
shall be the least amount of interference between the Artist and the Contractor.
AMOUNT OF AGREEMENT AND PAYMENT: The County shall provide an
amount not to exceed $14,000.00 for materials and services used to create d
County
Pocllitles Developmeo+
JUN, 24 21108
install the project. The Board of County Commissioners assumes no liability to
fund this agreement for an amount in excess of this award. Monroe County's
performance and obligation to pay under this agreement is contingent upon an
annual appropriation by the BOCC. Pursuant to Florida's Prompt Payment Act,
upon receipt by County of an Invoice for each of three (3) phases, and
documentation to satisfy the Clerk that the appropriate phase has been
completed, payment shall be made for the following phases at the referenced
rates:
1) Design Phase: 33.3% of total payment;
2) Materials: 33.3% of total when artist submits receipts for materials and
eligible costs equal to or greater than 33.3% of the contract total;
and
3) Completion: 33.3% final payment due when installation is deemed complete
and contractual agreement specifications are verified by the
Monroe County Purchasing Department or designee.
rhWhle costs and eg,.penditures for the Rroieet and the total award include but are not
limited to:
A. Artist's design fee
B. Labor, materials, contracted services required for production and installation
C. Artist's operating expenses related to the project
D. Travel related to this project, pursuant to statutory limitations
E. Transportation of the work to the site
F. Installation to the site
G. Permits and fees necessary for the installation (applicable for exterior projects
which also require HARC review)
H. Legal costs directly related to the project
I. Liability costs of artist
Payment shall be made upon presentation of an original invoice and documentation
necessary to support the completion of the work. Artist shall also provide a release of
lien if applicable.
Final payment request must be submitted no later than 60 days after the completion of the
Project.
4. OWNERSHIP and RIGHTS: Upon the installation of the artwork, County shall
own the artwork and all rights related thereto fully and completely.
RECORDS: The Artist shall keep such records as are necessary to document the
performance of the agreement and give access to these records at the request of
the County, the State of Florida, or authorized agent and representative of said
government bodies. The Artist understands that it shall be responsible for
repayment of any and all audit exceptions which are identified by the Auditor
General for the State of Florida, the Clerk of Court for Monroe County, the Board
of County Commissioners for Monroe County, or their agents and representatives.
6. MODIFICATIONS AND AMENDMENTS: Any and all modifications of the
terms of this agreement shall be only amended in writing and approved the Board
of County Commissioners for Monroe County.
7. INDEPENDENT CONTRACTOR: At all times and for all purposes hereunder,
the Artist is an independent contractor and not an employee of the Board of
County Commissioners of Monroe County. No statement contained in this
agreement shall be construed as to find the Artist or any of its employees,
contractors, servants or agents to the employees of the Board of County
Commissioners of Monroe County, and they shall be entitled to none of the rights,
privileges or benefits of employees of Monroe County.
8. COMPLIANCE WITH LAW: In carrying out its obligations under this
agreement, the Artist shall abide by all statutes, ordinances, rules and regulations
pertaining to or regulating the provisions of this agreement, including those now
in effect and hereafter adopted. Any violation of said statutes, ordinances, rules
or regulations shall constitute a material breach of this agreement and shall entitle
the County to terminate this agreement immediately upon delivery of written
notice of termination to the Artist.
9. HOLD HARMLESS /INDEMNIFICATION: The Artist hereby agrees to
indemnify and hold harmless the BOCC Florida Keys Council of the Arts, AIPP
Committee and Monroe County and any of their officers and employees from and
against any and all claims, liabilities, litigation, causes of action, damages, costs,
expenses (including but not limited to fees and expenses arising from any factual
investigation, discovery or preparation for litigation), and the payment of any and
all of the foregoing or any demands, settlements or judgments arising directly or
indirectly under this agreement. The Artist shall immediately give notice to the
County of any suit, claim or action made against the County that is related to the
activity under this agreement, and will cooperate with the County in the
investigation arising as a result of any suit, action or claim related to this
agreement.
10. ANTI - DISCRIMINATION: The Artist agrees that they will not discriminate
against any of their employees or applicants for employment or against persons
for any benefit or service because of their race, color, religion, sex, national
origin, or physical or mental handicap where the handicap does not affect the
ability of an individual to perform in a position of employment, and to abide by
all federal and state laws regarding non - discrimination.
11. ANTI - KICKBACK: The Artist warrants that no person has been employed or
retained to solicit or secure this agreement upon an agreement or understanding
for a commission, percentage, brokerage or contingent fee, and that no employee
or officer of the County has any interest, financially or otherwise, in the said
funded project, except for general membership. For breach or violation of this
warranty, the County shall have the right to annul this agreement without liability
or, in its discretion, to deduct from the agreement price or consideration, the full
amount of such commission, percentage, brokerage or contingent fee.
12. TERMINATION: This agreement shall terminate pursuant to Paragraph #1.
Termination prior thereto shall occur whenever funds cannot be obtained or
cannot be continued at a level sufficient to allow for the continuation of this
agreement pursuant to the terms herein. In the event that funds cannot be
continued at a level sufficient to allow the continuation of this agreement pursuant
to the terms specified herein, this agreement may then be terminated immediately
by written notice of termination delivered in person or by mail to Artist. The
County may terminate this agreement without cause upon giving 90 days written
notice of termination to Artist. The County shall not be obligated to pay for any
services or goods provided by Artist after Artist has received written notice of
termination.
13. TERMINATION FOR BREACH: The County may immediately terminate this
agreement for any breach of the terms contained herein. Such termination shall
take place immediately upon receipt of written notice of said termination. Any
waiver of any breach of covenants herein contained to be kept and performed by
Artist shall not be deemed or considered as a continuing waiver and shall not
operate to bar or prevent the County from declaring a forfeiture for any
succeeding breach either of the same conditions or of any other conditions.
14. ENTIRE AGREEMENT: This agreement constitutes the entire agreement of the
parties hereto with respect to the subject matter hereof and supersedes any and all
prior agreements with respect to such subject matter between the County and the
Artist.
15. CONSENT TO JURISDICTION: This agreement, its performance, and all
disputes arising hereunder, shall be governed by the laws of the State of Florida,
and both parties agree that the proper venue for any actions shall be in Monroe
County.
16. ETHICS CLAUSE: Artist warrants that he has not employed, retained or
otherwise had act on his behalf any former County officer or employee in
violation of Section 2 of Ordinance No. 10 -1990 or any County officer or
employee in violation of Section 3 of Ordinance No. 10 -1990. For breach or
violation of the provision the County may, at its discretion terminate this
agreement without liability and may also, at its discretion, deduct from the
agreement or purchase price, or otherwise recover, the full amount of any fee,
commission, percentage, gift, or consideration paid to the former or present
County officer or employee.
17. PUBLIC ENTITY CRIME STATEMENT: A person or affiliate who has been
placed on the convicted vendor list following a conviction for public entity crime
may not submit a bid on an agreement to provide any goods or services to a public
entity, may not submit a bid on an agreement with a public entity for the
construction or repair of a public building or public work, may not submit bids on
leases of real property to public entity, may not be awarded or perform work as a
contractor, supplier, sub - contractor, or consultant under an agreement with any
public entity, and may not transact business with any public entity in excess of the
threshold amount provided in Section 287.017, for CATEGORY TWO for a
period of 36 months from the date of being placed on the convicted vendor list.
Artist represents that Artist is not on the Convicted Vendor list.
18. AUTHORITY: Artist warrants that it is authorized by law to engage in the
performance of the activities encompassed by the project herein described. Each
of the signatories for the Artist below are authorized to contract Artist's services.
19. LICENSING AND PERMITS: Artist warrants that he or she shall have, prior to
commencement of work under this agreement and at all times during said work,
all required licenses and permits whether federal, state, County or City.
20. INSURANCE: Artist agrees that it maintains in force at its own expense a
liability insurance policy which will insure and indemnify the Artist and the
County from any suits, claims or actions brought by any person or persons and
from all costs and expenses occurring during the agreement or thereafter that
results from performance by Artist of the obligations set forth in this agreement.
At all times during the term of the agreement and for one year after acceptance of
the project, unless the requirement is waived by the Monroe County Risk
Manager, Artist shall maintain on file with the County a certificate of the
insurance of the carriers showing that the aforesaid insurance policy is in renewal,
material change or reduction in coverage unless a minimum of thirty (30) days
prior notification is given to the County by the insurer.
Acceptance and/or approval of Artist's insurance shall not be construed as
relieving Artist from any liability or obligation assumed under this contract or
imposed by law.
The Monroe County Board of County Commissioners, its employees and officials
will be included as "Additional Inured" on all policies except worker's
compensation.
Any deviations from these General Insurance Requirements must be requested in
writing on the County form titled "Request for Waiver of Insurance
Requirements" and must be approved by Monroe County Risk Management. The
following coverages shall be provided prior to commencement of work governed
by this contract:
1. Workers Compensation if, and as required by Florida Statutes
2. General Liability Insurance. Coverage shall be maintained through out the
life of the contract and include, as a minimum:
• Premises Operations
• Products and Completed Operations
• Blanket Contractual Liability
21
• Personal Injury Liability
• Expanded Definition of Property Damage
The minimum limits acceptable shall be:
$300,000 Combined Single Limit (CSL)
0 .' �,i 'i 1 2 "08
If split limits are provided, the minimum limits acceptable shall be:
$100,000 per Person
$300,000 per Occurrence
$ 50,000 Property Damage
An Occurrence Form policy is preferred. If coverage is provided on a
Claims Made policy, its provisions should include coverage for claims
filed on or after the effective date of this contract. In addition, the period
for which claims may be reported should extend for a minimum of twelve
(12) months following the acceptance of work by the County.
NOTICE: Any written notice to be given to either party under his
agreement or related hereto shall be addressed and delivered as follows:
For Artist
For County:
Xavier Cortada
N
Florida Keys Counci�f Q ArVF
3621 SW Third Avenue
1100 Simonton Street - >"
Miami, FL 33145
Key West, FL 33040(' -` ,v
and " N
County Attorney
P.O. Box 1026
Key West, FL 33041 -(026
u1
1ESS WHEREOF, the parties hereto have caused this agreement to be executed the
rs above written.
BOARD OF COUNTY COMMISSIONERS
L. KOLHAGE, CLERK OF MONROE COUNTY, FLORIDA
Clerk
WITNESSES:
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Monroe County Art in Public Places
REQUEST FOR PROPOSALS
Application Cover Sheet
Date: o
Applicant Contact Information:
Name:
Address: 3 (.7 - ( "6u u _ ta*:i 3N 3 `MertGkla+n t� 'i �� WllS / L 33
Phone(s): 3D 5 S i
E•Mail: �k(A Vtoy" � CAY�t�G . CAS (—
Website: NSW W # Carr toAk a "vv, LV W U) • W tH 1 � � • tlt t
Total Budget/Cost: j r 50
c� 3 muhc Is / k sdr- r%IS���ir•+, ! via�� �"�'' „h,�
Total Number of Art Places included M proposal:
ir�:GttVur,� Txf�i 1 c'cr-..a',,,a�Ca618>rA - ins hJ
Please briefly describe the following if applicable; If not applicable indicate with N /A.
Special lighting required: h of) Q,
Other special requirements: K p V1 C
Type/amount of project access desired: o nlv\ Vo 1 hs\ P t'e ( 6
Installation time required: Nn hl rV a�
Maintenance requirements: Wt t rl t w`ti
wil( '�'
ArtisrNnsintains a $300,000 liability insurance policy: No if no, please explain.
Please check the following items to indicate they are attached:
• Written proposal.
• Itemized budget.
• Concept drawings; 2 pages maximum (8.5” x 11") including color sketch or digital rendition.
Digital images PDF or JPG not exceeding 75dpi — 5 images maximum.
• If 3- dimensional art proposal, one small model.
Note: Support materials will not be returned to the applicant without prior pre -paid shipping.
Signature confirming that all information provided for this application is true and correct.
Type or print name
Xavier Cortada
3621 SW Third Avenue, Miami, FL 33145
3 Meridian Avenue, Key Largo, FL 33037
Phone: 305- 858 -1323 or 305431 -2111
email: xavicra'cortada.com website: wAxw.cortada April 1, 2008
Monroe County Purchasing Department
(for the Monroe County Art in Public Places Committee)
1100 Simonton Street #1 -213
Key West, FL 33040
Dear Committee Members,
Please accept this budget with the RFP for the Monroe County Murray E. Nelson Government and Cultural
Center. I'd like to propose the creation of the following art pieces:
A. Hand - painted environmental and historic murals in the Lobby Area: $45,000
One 264 sq. foot mural ($30,000).
Two 100 sq. foot mural ($12,500 each)
B bby Dormer. Hanging "digital tapestries" of native leaves: 514,000
A series of one -ofa kind "digital tapestries" to hang from the bottom of the Lobby Dormer's
wood trusses like leaves on a tree.
C. Vestibules: Framed works on paper: $7,250
1. One of a land digital painting 48" x 32" of Murray Nelson, framed behind plexy glass. ($3,500)
2. Signed, numbered limited- edition archival Prints on Somerset Velvet, each piece measure 32"
x 24" and would be framed behind plexy glass:
Mangroves A- edition of 10. ($ 1,250)
Mangroves B- edition of 10. ($ 1,250)
Mangroves C— d&tion of 10. ($ 1,250)
D. Exterior: Eco -art Installations: $2,600
Native Flags Eco -art: Flags, educational sigoage and markets for selected native trees on the
property to encourage individuals to use natives to reforest the Upper Keys..
All works ( tbeee murals, a series of digital tapestries, one digital Painting, three archival prints, and an
exterior eco-art installation) will be created for a total of $77,850.
Sincerely,
Xavier Cortada
Xavier Cortada
3621 SW Third Avenue, Miami, FL 33145
3 Meridian Avenue, Key Largo, FL 33037
Phone: 305-858-1323 or 305 -431 -2111
email: xaviergi cortada.com website: �tiVN w.crortada ,com
(D B- obby Dormer. Hanging "digital tapestries" of native leaves ($14,000):
create eight to twelve one -of-a kind "digital tapestries' that will hang from the bottom of the Lobby
Dormer's wood trusses like leaves on a tree.
I will create the images for these tapestries by photographing th shadow cast when I place a piece of white
drawing paper beneath the leaves of native trees in the nature preserve behind my Bay Haven (MM94.5)
home. I will then manipulate these photo images with digital technology to create a series of layered,
colorful "digital tapestries."
The digital tapestries will serve as reminders of place and markers of time: Climbing up the staircase could
be like climbing the branch of a tree where one is coming up on "leaves." The experience is intense and
personal: if one were looking at the details of the leaves mace of chlorophyll instead of ink, one would
witness the boundless beauty and interplay of nature at work on every branch on that tree. From any
vantage point one can imagine the tree canopy and ecosystem that was once there. The experience can
serve as an invitation to find a more balanced approach to coexisting with nature.
C. Vestibules: Framed works on paper.
1. One of a kind digital painting 48" x 32" of Murray Nelson, framed behind plexy glass. ($3,500)
2. Signed, numbered limited edition archival prints on Somerset. Velvet, each piece measures 32"
x 24" and would be framed behind plexy glass:
Mangroves A--edition of 10. ($ 1,250)
Mangroves B--edition of 10. ($ 1,250)
Mangroves C--edition of 10. ($ 1,250)
D. Exterior. Eco -art Installations.
Native Flags Eco -art: Flags, educational sgnage and markers for selected native trees on the property to
encourage individuals to use natives to reforest the Upper Keys ° . In implementing the installation, Cortada
will work in close collaboration with other key environmental organizations and groups, including staff
scientists and experts, to identify the kinds of trees onsite, which are desired for an urban reforestation
effort. Once the preferred native plants have been identified, Cortada will create flags installations and
literature , along with signage marking the desired Florida native plant species.
This eco -art effort could serve as the educational component for the Native tree leaves "digital tapestries"
banging from trusses inside the building. A project website, www.nativcflags.net, would provide
information on how to further engage in urban reforestation efforts. ($2,600)
Sincerely,
I
Xavier Cortada
' The hammers are ightless and viewable from both sides Their size will be determined in consultation with project architents.
The tapestries will be printed using a color -fast, dye sublimation process and on are- rdardamd fabric —the artist used a similar printing
process for banners in a recent commission to the Frost Art Museum.
4 Residents would be informed that by planting native trees across the community they would increase biodiversity (rebuilding habitat
and food source for native species ofb'nds and animals) and help address global climate change concerns (e.g.: reduce carbon
dioxide, reduce electric bills/shade, water conservation).
Xavier Cortada
3621 SW Third Avenue, Miami, FL 33145
3 Meridian Avenue. Key Largo, FL 33037
phone: 305-858-1323 or 305 -431 -2111
email: ,acIer web site: xNAiNN_cortada,col7) April 1, 2008
Monroe County Purchasing Department
(for the Monroe County Art in Public Places Committee)
1100 Simonton Street #1 -213
Key West, FL 33040
Dear Committee Members,
Please accept this letter as my reply to the RFP for the Monroe County Murray E. Nelson Government and
Cultural Center. I would be a truly honored to be allowed to make my artistic contribution to a place I so
treasure --and has so inspired my environmental art pieces in recent commissions across our state
(including 2007's l-Hspamc Heritage artwork, h "I'oss.do tatate 11 0 -us can mwfcaGnns nlc is_ ttU t J 5_l al).
I'd like to propose the creation of the following art pieces (three murals, a series of digital tapestries, one
digital pai nting, three archival prints, and an exterior eco-art installation) for a total of $77,850. The work
aims to encourage residents around issues of and to encourage community involvement and commitment to
addressing sustainability issues through the reforestation of their urban setting and other community
actions.
A. Hand - painted environmental and historic murals in the Lobby Area
In the Lobby Area, I intend on painting one 264 sq. foot mural that interweaves images of the history of the
Upper Keys with elements of its natural environment, especially its mangrove ecosystem. Mangroves are
my metaphor for an interconnected community made of individuals set their roots, reach out and help build
a stronger community.' ($30,000). The lobby would also include murals on the flora and fauna of Key
Largo as two 100 sq. foot murals ($12,500 each).
I propose painting these three murals as panels in my Key Largo home (MM 94.5), which would then be
taken to the site and attached to the walls I will work with the stakeholders to determine the most relevant
walls. The preferred wall locations for these three pieces are:
2. Main Lobby Staircase Wall: South Wall, 22 x 20'6"
3. Wall above Growth Management Area: Large Wall, 24'6" x 11'0"
4a. Wall around lobby perimeter (above entrance)
r I've used this thematic approach -- the intermingling of nature and history -- in the creation of some of my other commissioned
Florida murals. please visit the following webpages to see images of murals of my portrayal of individuals (e.g., bishops,
incorporators, rail road tycoons, conquistadores, and citizens) surrounded by mangroves:
Entrance to Miami City Hall (Miami): see ada_com_ nm_it -haa hill,
Enhance to Commission Cha®6en at Miami -Dade Coumty Hall (Miami):
see hflp www_,of lath ..un_.3,.rdle 17' _lH?4= our- ..omm �mitr hau
• Entrance to Florida secretary of state's otDcr (Tallahassee):
jrhe munal image was used in 2006 and the 2008 Florida Heritage Month Poster)
sea h
tin .:- wr«v.cortad?x tlorida
e h ill) s' j star fl us o mnunicatimui xcss- rci cases' 200'- 0 9= �.afin
se
Entrance to Florida History Museum (Tallahassee):
(Both murals were unveiled at the Capitol by the Governor during 2003 Hispanic Heritage Month.)
sue hitp. Nmw- cortada c 'fallery i>ainf os 2003 insn t�n+_v' , trnn
sea ham. %yaw nadac mdi ^003tfl- hlsp-lnxit- t
Courtyard of Verot IR& School (Ft Myen):
see htw ' ++ cntnda wm'aallcty i min[iug. 211ny b� =h ot ^«YOtlam
' As an ahemate to the two 100 square -foot annals, I can ueate on loo square foot glass mosaic mural at the staircase wall for
$25,01)0. Alternatively, the mural can hang in the exterior, in the atrium foyer area, see:
ht�'._ ivnnc.corlad+ cynl, vul)cr+ m—Aic hnd lntn
1988 Edition
MONROE COUNTY, FLORIDA
RISK MANAGEMENT
POLICY AND PROCEDURES
CONTRACT ADMINISTRATION
MANUAL
WAIVER OF INSURANCE REQUIREMENTS
1J N
There will be times when it will be necessary, or in the best interest of the County, to deviate from the
standard insurance requirements specified within this manual. Recognizing this potential, and acting on
the advice of the County Attorney, the Board of County Commissioners has granted authorization to Risk
Management to waive and modify various insurance provisions.
Specifically excluded from this authorization is the right to waive:
The County as being named as an Additional Insured —If a letter from the Insurance
Company (not the Agent) Is presented, stating that they are unable or unwilling to name the
County as an Additional insured, Risk Management has been granted the authority to waive
this provision.
and
The Indemnification and Hold Harmless provisions
Weivino of insurance provisions could expose the County to economic loss For this reason, every
attempt should be made to obtain the standard insurance requirements. If a waiver or a modification is
desired, a Request for Waiver of Insurance Requirements form should be completed and submitted
for consideration with the proposal.
After consideration by Risk Management and if approved, the form will be returned, to the County
Attorney who will submit the Waiver with the other contract documents for execution by the Clerk of the
Courts.
Should Risk Management deny the Waiver Request, the other party may file an appeal with the County
Administrator or the Board of County Commissioners, who retains the final decision- making authority.
Admi W00 Uwtriofioo WAIVERMOC
04708.3
It is requested that the insurance requirements, as specified in the County's Schedule of Insurance
Requirements, be waived or modified on the following contract:
Contractor. \I(Alli�,L e�aeTaDtlr
Contract for:
Address of Contractor.
Phone:
Scope of Work:
Reason for Waiver:
Policies Waiver
will apply to:
Signature of Contractor.
Risk Management:
Date:
County Administrator appeal:
Approved
Date:
Board of County Commissioners appeal:
Approved
Meeting Date:
Adn*ddmdn lrabuftn
04709.3
Not Approved
Not Approved
WA1v-REQ.D0C
1995 Edition
MONROE COUNTY, FLORIDA
Request For Waiver
IUN 4 2606
Of
- --
Insurance Requirements
It is requested that the insurance requirements, as specified in the County's Schedule of Insurance
Requirements, be waived or modified on the following contract:
Contractor. \I(Alli�,L e�aeTaDtlr
Contract for:
Address of Contractor.
Phone:
Scope of Work:
Reason for Waiver:
Policies Waiver
will apply to:
Signature of Contractor.
Risk Management:
Date:
County Administrator appeal:
Approved
Date:
Board of County Commissioners appeal:
Approved
Meeting Date:
Adn*ddmdn lrabuftn
04709.3
Not Approved
Not Approved
WA1v-REQ.D0C