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09/29/1993( ii a HOUSEHOLD HAZARDOUS WASTE SERVICE AGREEMENT On this 29th day of September , 1993, the parties, the County of Monroe , State of Florida ("Customer"), and Chemical Waste Management, Inc., a Delaware corporation with principal offices located at 3001 Butterfield Road, Oak Brook, Illinois 60521, ("CWM"), hereby agree as follows: WHEREAS, Customer is in need of certain services for the treatment and disposal of household hazardous waste materials and operation of its household hazardous waste collection event and; WHEREAS, CWM agrees to provide Customer with such services upon the terms as set forth herein. 1. Waste Materials For purposes of this Agreement, Waste Materials shall be defined as those solid, liquid, semi -solid, or contained gaseous materials which are generally described in and which have certain hazardous, toxic, corrosive, or combustible physical, chemical, biological and radioactive constituents, characteristics and properties. The term "Waste Materials" also includes containers if they contain Waste Materials. The term "Unit of Waste Materials" refers to a single whole container of Waste Materials (such as a bottle, jar, or box) and also includes units of measure (such as pound or gallon). CWM shall not be required to accept waste materials not in household quantities, which shall be presumed to be limited to five gallons for liquids and forty pounds for solids per household. 2. CWM Services Throughout the effective period of this agreement, Chemical Waste Management -Southeast Services Area (CWM Services) shall provide Customer the services as outlined in Proposal #93PGB-012, dated July 23,1993. Waste Materials will be stored, treated or disposed of at a CWM approved facility(ies) (See Exhibit I attached hereto.) 3. C`om nsation For the services set forth above, Customer agrees to pay CWM in accordance with the rate schedule (Exhibit II) attached hereto and made a part hereof. In the event the original scope of services changes, the parties agree to execute a change order reflecting said changes. Unless otherwise stated in the attached rate schedule (Exhibit I1), Customer shall pay all applicable local, state or federal taxes upon receipt of invoice. All invoices are due and payable by Customer upon receipt. All amounts not paid when due shall beam interest at 11h% per month until paid. Customer guarantees payment of all such invoices when due notwith- standing any rights Customer may have to reimbursements from insurers or other third parties. In the event that CWM is required to undertake collection procedures or legal action to enforce the provisions of this agreement, CWM shall be entitled to recover interest, collection and court costs, and reasonable attorneys' fees. 4. Reiection or Revocation of Acceptance of Waste Materials CWM expressly maintain the right to reject any Waste Materials up to the point of acceptance thereof, by taking physical possession. Thereafter, CWM shall be precluded from rejecting or revoking acceptance as to such waste materials. Pr,nled On "PCLr. ph 5. Safely of Work Customer agrees to perform all services hereunder in a safe and workmanlike manner and in full compliance with all applicable laws, regulations, and ordinances of the federal, state and local government. The Customer agrees to cooperate fully with CWM in m* * l*zing any and all safety risks during CWM's performance of the services, including but not limited to selecting a reasonably safe collection area, wearing appropriate personal protective equipment, following restricted area rules, and following appropriate waste handling procedures. 6. Indemnification CWM agrees to indemnify and defend the Customer for claims, demands, liabilities, penalties, fines, causes of action and costs and expenses incidental thereto (including reasonable attorneys' fees) arising out of personal injury, death, loss or damage to property, and contamination or adverse effects on the environment, to the extent such injury, death, or loss or damage results from CWM's negligence, breach of this contract or wilful misconduct. 7. Entire Agreement Ok This Agreement represents the entire understanding and agreement between the parties hereto relating to the testing, transportation, storage, treatment, processing and disposal of Waste Materials and supersedes any and all prior agreements, whether written or oral, that may exist between the parties regarding same. Any acknowledgment of this Agreement containing additional or different terms from those contained in this Agreement shall constitute an acceptance of only those contained herein, and such additional terms shall be null and of no effect unless accepted by CWM in writing. No terms, conditions, prior course of dew, course of performance, usage of trade, understandings, purchase orders, or agreements purporting to modify, vary, supplement or explain any provision of this Agreement shall be effective unless in writing, signed by representatives of both parties authorized to amend this Agreement. In no event shall the preprinted toms or conditions found on any CWM or Customer purchase or work order be considered an amendment or modification of this Agreement, even if such documents are signed by representatives of both parties; such preprinted terms or conditions shall be considered null and of no effect. • ♦ 4 • �! a 4a_i NAY The performance of this Agreement, except for the payment of money for services already rendered, %;, may be suspended by either party in the event the deli YM or transportation of waste Materials by Customer, or transportation, storage, treatment or di posal of Waste Materials by CWM are prevented by a cause or causes beyond the reasonable control of such party. Such causes shall include, but not be limited to, acts of God, acts of war, riot, fire, explosion, accident, flood, or sabotage; lack of adequate fuel, power, raw materials, labor or transportation facilities; governmental laves, r�io�, requirements, orders or actions; breakage or failure of machinery or apparatus; national defense requirements, injunctions or restraining orders; labor trouble, strike, lockout or injunction (provided that neither party shall be required to settle a labor dispute against its own best ju ent). 9. Notice Any notice, communication or statement required or permitted to be given hereunder shall be in writing and deemed to have been sufficiently given when delivered in person or by registered or certified mail, postage prepaid, return receipt requested, to the address of the respective party below: 10. Exhi i s ere*: CUSTOMER: Monroe County Purchasing Department 5100 College Road Wing 2B, Room 504 Key West, Florida 33040 CWM: Chemical Waste Management, Inc. 2600 Delk Road, Suite 100 Marietta, Georgia 30067 Attn: Area General Manager Either party may, by notice to the other, change the addresses and names above given. The following exhibits and additional documents shall be made a part of this agreement as if set forth fully 1. Prmsal #93PGB-012 and its attachments The Customer warrants that the undersigned is duly authorized to enter in to this Agreement as a valid and< bindiag Agreement on behalf of Customer and that all resotntioa�s, authorizations, and other actions for the proper and binding execution hereof by Customer have been taken. This contract shall be governed by the laws of the State of Florida. Venue for any disputes under this contract shall be in Monroe County, Florida. p,Z'jEST ; DANVy L. MIRAGE, CLERK B%(Lnla1LL:. & 31Clerk CHEMICAL WASTE MANAGEMENT, INC. By: Title: By: APPROVED AS rJ Fr' ! PV EXHIBIT I CHEWCAL WASTE MANAGEMENT OWNED AND OPERATED FACILITIES Federal Employer ID #36-2989152 EPA Hazardous Waste Transporter ID # - ILD099202681 To serve the needs of our customers while observing your environmental standards, we are providing this list of permitted CWM and CWM approved facilities where your collected hazardous waste will be treated, disposed of or stored. Other CWM approved facilities may also be utilized in the proper handling of your waste. Non- CWM facilities have undergone an extensive environmental audit by CWM's experienced and trained environmental professionals and have been determined to meet our company's stringent standards of acceptability. This network of facilities will allow CWM to pursue the most economical means of disposing of your waste materials while complying with all regulatory and environmental regulations. Storage Facilities CWM Chemical Services, Inc. 5485 Tay -For Drive Millington, Tennessee 38053 USEPA ID #TND000772186 State ID #HWM-001 Treatment and DisRgsal Facilities Chemical Waste Management, Inc. Trade Waste Incineration #7 Mobile Avenue Sauget, Illinois 62201-1069 EPA ID #ILD098642424 ILEPA Site # 1631210009 Cicaa Waste Mtaeent, Inc. Highway 73 3.5 miles vest of Taylor's Bayou Port Arthur, Texas 77640 EPA ID #TXD0008388% State #HW50212-(l01 Box 1955 Route 2, John Brannon Road Carlyss, Louisiana '10663 USEPA ID #LAD000771201 Chem -Neckar Systems, Inc. (a subsidiary of CWM, Inc.) 220 Stoneridge Drive Columbia, South Carolina 29210 EPA ID #SCD048372429 Nuclear Regulatory Commission Operating #E363196426 Industrial Waste, Inc. (CWM Facility) 8810 Paul Starr Drive Pensacola, Florida 32514 USEPA ID #FLD980844096 CWM Pompano Beach Service Center 2700 N.W. 48th Street Pompano Beach, Florida USEPA ID #FLD000776708 CWM Chemical Services, Inc. (a subsidiary of CWM, Inc.) 11700 S. Stony Island Avenue Chicago, Illinois 60617 USEPA ID #ILD000672121 Illinois Site #00316000058 CI S Waste Ma ent, Inc- P.O. Box 55 HAY 17@ Milemarker #163 Emelle, Alabama 35459 USEPA ID #ALD000622464 CWM Rese�roe R C'Inc. (a subsidiary of CWM, Inc.) P.O. Box 453 4301 Infirmary Road West Carrollton, Ohio 45499 EPA ID #OHD093945293 CWM Resource Management, Inc. 531 Cook Road Morrow, Georgia 30260 USEPA ID # GAD096629832 Chemical Waste Management, Inc. 6901 Greenwood Road Corpus Christi, Texas 78469 USEPA ID #TXD000761254 Texas Department of Water Quality #01337 CHEMICAL WASTE MANAGEMENT AUDITED AND APPROVED FACILITIES ThermalKEM P.O. Box 2664 CRS Rock Hill, SC 29730 EPA ID #SCDO44442333 Air Quality control Permit #2440-0042 Wastewater Discharge Permit #860401 Incineration and Storage Permit #SCD044442333 Bethlehem Apparatus Company, Inc. 890 Front Street Hellertown, Pennsylvania 18055 EPA ID #PAD002390961D ENSCO American Oil Road Eldorado, Arkansas 71730 EPA ID #ARD0697481921 Rollins Environmental Services P.O. Box 609 Deer Park, Texas 77536 USEPA ID #TX:D055141378 Metro Recovery Systems, Inc. 2340 Rose Place Roseville, Minnesota 55112 EPA ID #MND981098478 BDT, Inc. 4255 Research Parkway Clarence, New York 14031 EPA ID #NYD0000632372 Stablex Canada Inc. 760 Blvd. Industriel Blainville, Quebec J7C3V4 CyanoKEM 12381 Schaefer Hwy. Detroit, MI 48227 USEPA ID #MID098011992 MENDED AUGUST 23, 1993 HAZARDOUS WASTE COLLECTION AND DISPOSAL SERVICES PROPOSAL FORM L. Collection Event Manpower and Equipment Charges A. Daily cost for manpower and equipment for $ 2,530.00 Per da y collection events, as detailed in Schedule "A". B. Overtime cost per hour for manpower and equip- 33.00 Per hour ment provided in Schedule "A". C. Unit costs for additional manpower and equipment -0- Per da as detailed in Schedule "B" . Y II. Packaging Charges A. Mixed Lab Packs (unit cost) Complete materials required for lab packs: - 5 gallon pail (metal or plastic) $ 13.00 -20 gallon fiber 16.00 -30 gallon (fiber or metal) 0. 00 -55 gallon (metal) 34.00 (Price to include DOT approved containers, labels and packaging media) B. Drummed Bulk Materials Bulk nateriais which do not arrive on site in shippable DOT approved containers will be repackaged and billed the following materials as required per unit. - -Manifest g Labelling (all containers) -85 gallon drum -55 gallon drum -30 gallon dry -20 or 30 gallon fiber drum - 5 gi l lon pail -poly drum liner -ve ruicul i t e oil--dri -corn absorbent -gaskets -rings/bolts * Amended pricing - 8/23/93 _ -4- 2 000 gain -- $1.00 each* .M �e III. Transportation Storage b Disposal A. Mixed Labs Landf ill - 5 gallon $ 81.00 -20 gallon 84.00 -30 gallon 95.00 -55 gallon 127.00 B . Drummed Liquids B.I Organic 1 - 5 gallon $ N/A -30 gallon 170.00 -55 gallon 218,00 -85 gallon 302.00 B. II Inorganic - 5 gallon $ N/A -30 gallon 170.00 -55 gallon 218.00 -85 gallon 302,00 C. Drummed Solids C . I Organic - 5 gallon ;.... -30 gallon 109 000 -55 gallon 145.O0 -85 gallon 192.O0 C.11 Inorganic - 5 gallon $ N/A -30 gallon 109.00 -55 gallon 145.00 -85 gallon 192.00 Page 2 Treatment Incineration $ 75.00 $ 75.00 110.00 121.00 171.00 188.00 318.00 350.00 1 FUELS BLEND $ 49 , OQ 66.00 186.00 88,00 121.00 298.00 338.00 $ NZA 213.Qo 283.00 330.00 lit/A 186.00 298 . o0 338.00 $...� J" $Qwwwwm"�O&LA 213.00 3ILO .00 EL3*00 54*. Qa 330.00 6 0.00 N/A i N/A 213.00 310.00 238.00 9:9.00 330.00 650.00 D. Chlorinated Pesticides and/or Halogenated wastes - 5 gallon $ N/A $ N/A -30 gallon 170.00 N/A -55 gallon 218.00 N/A -85 gallon 302.00 N/A N/A 186.00 298, 00 338.00 E. Reactives Cost per Pound F. PCB's Liquids Solids Capacitors Page 3 S 10.00 Cost per gallon $ CASE -BY -CASE Cost per gallon CASE -BY -CASE Cost per gallon 3.67 BASED UPON FULL 55-GALLON DRUM G . Empty Hazardous Waste Containers (with less than i" residue) Landfill Incineration - 5 gallon $ 8.00 $ 8.00 -30 gallon 33.00 65.00 -55 gallon 45.00 93.00 -85 gallon 50.00 93.00 H. Waste Oil 55 gallon drum I. Pickup Charges For businesses within Pala Beach County and Authority waste pickup. Per Unit* $ 40,00 *Drum or Equivalent 0 EXHIBIT 113" i%MI 1"3 t.i hnmmg NIONIZOE•: COUNTY, FLORIDA I`'SUFLN.'CC GUIDE TO CO.'TR.NCT ADNTINISTItkTIO Genernl Insurntce Requirements fo r Stippliers of Goods or Services Asa re -re; tiisite of the %&-ork go��erne d or the food supplied Linder this contractP t (Includim'? ;i1e pre -staging of ersonnel and material), the vendor shall obtain, at hisr'her ���n expense. insurance ass specified in any attached schedules, which are made part of this ° P - � � ' wextend protection to all contract. The Vendor will ensure that the insurance obtained ill e Sub -Contractors engaged by the Vendor. As an aiternative the Vendor may regUire all Sub -Contractors to obtain insurance consistent with the attached schedules. Vendor Nx•ill not be permitted to commence 1-vork (,ovemed by this contract' (includint, The P • .r.• required insurance re-stat,tnt, of personnel and material) until s:tt�5tacton evidence of the regu e P . has been furnished to the County as specified below. Delays in the comR�encement of «,• rk resaltin<, from the failt:re of the Vendor to pro�•ide satisfactory evidence of the 0 required insurance, shall not extend deadlines specified in this contract and any penalties and failure to P erform assessments shall be imposed as if the mvork commenced on the s ecified d: to and time, except for the Vendor's failure to provide satisfactory c`.Idence. P The Vendor shall maintain the required insurance throughout the entire term of this contract and anv extensions specified in the attached schedules. Failure to comply with this provision may result in the immedi.-ate suspension of all wort: until the require insurance has been reinstated or replaced. Delays in the completion of work resulting from the failure of the Vendor to maintain the required insurance shall not extend deadlinesspecified in this contract and any penalties and failure to perform assessments shalt be imposed as if the work had not been cuspexcept for the Vendor's failure to -ended, p maintain the required insurance. The Vendor shall rovide, ito the County, as satisfactory evidence of the required p � insurance, either.. • Certificate of Insurance or • A Certified copy of the actual insurance policy. The County, at its sole option, has the right to request a certified copy of any or all insurance policies required by this contract. All insurance policies must specify that they are not subject to cancellation, non -renewal, P tg a minimum of thirty da s rior material change, or reduction in aovera�e unless Y Y P notification is given to the County by the insurer. The acceptance and/or approval of the Vendor's insurance shall not be constnied as relieving the Vendor from any liability or obligation P ' ' i n assumed tinder this contract or imposed by law. A4wil zt 1"A 1W rtwo, n Board of Count Commissioners,, its employees and officials will be Tj�e Monroe Cou ty y included as "additional Insureds" on all policies, except for Workers' Compensation. Any deviations from these General Insurance Requirements must be requested in writing on the County prepared form entitled "Request best for Waiver of Insurance Requirements" and approved by Lionroe County's Risk Manager. 1 "3 1 %& TInntIng WORKERS' CUM PENS ATION INSURANCE REQUIREMENTS FOR CONTRACT Kenoxial of lRAza-rd.mts-Material MONROE COUNTY, FLORIDA AND CHEMICAL WASTE MMAGEMENT Prior to the commencement of %-vork governed by this contract, the Contractor shall obtain P �lIorkers' Compensation Insurance with limits suMicient to respond to the applicable state's statutes. In addition, the Contractor shall obtain Employers' Liability Insurance With limits of not Iess than: 51,000,000 Bodii`� Injury by Accident S 1.000,000 Bodily Injur}• by Disease, policy limits S 1,000,000 Bodily Injury by Disease, each employee Coverage shall be maintained throuiliout the entire term of the contract. Coverage shall be provided by a company or companies authorized to. transact business in the state of Florida and the company or companies must maintain a minimum rating of A - VI, as assigned by the A.,M. Best Company. If the Contractor has been approved by the Florida's Department of Labor, as ai n authorized self -insurer, the County shall recognize and honor the Contractor's status. The Contractor may be required to submit a Letter of Authorization issued by the Department of Labor and a Certificate of insurance, providing details on the Contractor's Excess Insurance Prooram. If the Contractor participates in a self-insurance fund, a Certificate of Insurance will be required. In addition, the Contractor may be required to submit updated financial statements from the fund upon request from the County. WC3 ,%Ml 22. t "3 t til �y� GENERAL LIABILITY INSURANCE REQUIRE`tENTS FOR CONTRACT Removal of Hazardous Material 9ETWEEN MONROE COUNTY, FLORIDA A NI) Prior to the commencement of %York uloverned b`• this contract, the contractor sh-all obtain General Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum: o Premises Operations o Products and Completed Operations o Blanket Contractual Liability o Personal Injury Liability o Expanded Definition of Property Damage The minimum Iimits acceptable shall be: SI.000,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: S 500,000 per Person S 1.000,000 per Occurrence S 100,000 Property Damage An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, olio its provisions should include coverage for claims fled 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 (11) months following the acceptance of work by the County. The Monroe County Board of County Commissioners shall be named as Additional � Insured on all policies issued to satisfy the above requirements. GL3 i %I Pnnt w4 VEHICLE LIABILITY INSURANCE REQUIREiNtE`'TS FOR CONTRACT Removal of Hazardous Material BETWEEN ,\vtONROE COUNTY, FLORIDA AND CHEKICAL WASTE MANAGEMENT Reco�nizin:; that the %4•ork go%-med by this contract requires the use of vehicles, the Contractor, Prior to the commencement of work, shall obtain Vehicle Liability Insurance. Coverafle shall be maintained throughout the life of the contract and include, as a minimum, liability coverage for: o O%%.,ned, Non -Owned, and Hired vehicles The minimum limits acceptable shall be: S1,000,000 Combined Single Limit (CSL) If split limits are pro%. -Id :d, the minimum limits acceptable shall ce. S 500,000 per Person S110001000 per Occurrence S 100,000 Property Daman The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. 0 VL3 t It l"nm * HAZARDOUS CARGO TRANSPORTERS LIABILITY INSURANCE REQUI RDMEN7S FOR CONTRACT _ gesQva1 of Hazardous Material BETWEEN MONROE COUNTY, FLORIDA AND CHEHICAL WASTE MANAGEMENT Prior to the commencement of work governed by this contract, the Contractor shall purchase Pollution Liabilitv insurance which extends to the hauling of tonic and hazardous P compliance with the tiiotor Carrier Act, the policy material by motorized vehicles. In comp P should be endorsed with an MCS-90 Endorsement, demonstrating financial responsibility . P fors ills and clean-u Any pollution exclusion limiting coverage under this policy shall p Y be removed. The minimum Iimits acceptable shall be: S 110001000 per Occurrence 0 VLP3 MONROE COUNTY, FLORIDA INSUFLANCE GUIDE TO COtiTrt.kCT .r1DtiIINISTR:kTIO`' Indeinnification and bold Harmless for Suppliers of Goods and Serti•ices The Vendor co%-enants and zwto indemnIN and hold harmless %Monroe County Board of County Commissioners from any and all claims for bodily injury (including death), personal injury10 and roperty damage (including property o%vned by Monroe Count v) and any other losses, p which arise out of in connection with, or b damages, and expenses (includinsz, attorneti s fees) Y reason of services provided by The Vendor or an`� of its subcontractors) in any tier, occasioned b the ne licence, errors, or other wrongful act or omission of The Vendor or its subcontractor(s) Y in any tier, their employees, or agents. In the event the completion of the project (to include the %�-or;: of others) is delayed or suspended as a result .of the Vendor's failure to purchase or maintain the required insurance, the Vendor shall indernnlf - the County from anv and all increased expenses resultin(y from such delay. The extent of liability is in no wav limited to, reduced, or lessened by the ins:lrznce requirements contained elsewhere within this agreement. NON-COLLUS ION AffT DAVIT I PATE I CX- BASIC IFI ELD of the city of CHMICAL WASTE MkXAGZK=r, I"C. according to law on my oath, and under penalty of perjury, depose and say that; 1) I am PATR I C!K BASIK P I EI.D , CamT CAI. WASTE MAHAGEKEN'!' ,� K h e bidder making the Proposal for the project described as follows: 2) the prices in this bid have been arrived at independently without collusion, consultation, communication or agreement for the purpose of restricting competition, as to any matter relating to such prices with any other bidder or with any competitor; 3) unless otherwise required by law, the prices which have been quoted in this bid have not been knowingly disclosed by the bidder and will not knowingly be disclosed by the bidder prior to bid opening, directly or indirectly, to any other bidder or to any competitor; and 4) no attempt has been made or will be made by the bidder to induce any other person, partnership or corporation to submit, or not to submit, a bid for the purpose of restricting competition; • 5) the statements contained in this affidavit are true and correct, and made with full knowledge that Monroe County relies upon the truth of the statements contained in this affidavit in awarding contracts for said project. STATE OF GZORGIA COUNTY OF COBB WON (Signature Bidder) JULY 23 , 1"3 DATE PERSONALLY APPEARED BEFORE ME, the undersigned authority, PATRICK BAS"IELD who, after first being sworn by me, (name of individual signing) 0 affixed his/her signature in the space provided above on this , 23RD day of JULY , 19 93 1 NARY PUBLIC My commission expires: N0Wy mac, cou*1 Go&* SWORN STATEMENT UNDER ORDINANCE NO* 10 -1990 MONROE COUNTY., FWR I DA I ETHICS CLAUSE CHMI-CAL, WsTZ HAM IH+Q, warrants that he/it has not employe retained or otherwise had act on his/its behalf any former County of f icl 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 this provision the County may, in its discretion, terminate this contract without liability and may also, in its discretion, deduct from the contract or purchase price, or otherwise recover, the full amount of any fee, commission, percentage, gift, or consideration paid to the f mer County officer or employee. sig ture) ' Date: JMY 23 , 1993 STATE OF A COUNTY OF ank Subscribed and sworn to ( or affirmed) before fie on JMY 23 , 1993 (date) by PATnCZ Bps"ILM (name of a f f i a n t) . -� He/She is personally known to rye or has produced i as identif ication. (type of identification) NOTARY PUBLIC Notary Pubk Cobb C U*9 GOONk MCP14 REV. 2/92 i . i SWOFLN STATEMENT PURSUANT TO SECT ON 217.13300h ON PUBLIC E.'YT't I CRIM ES THIS FOR1%1 MUST BE SIGNED A.�tD S�►'OR�'V TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINIS I R OATHS. ]. This sworn statement is submitted to MONROE COUNTY (print name of tho public entityl by PATRICIA PAPPACENO, PROPOSAL/CONTRACTS MANAGER sprint individual's name and title fo r CSBM I CAL WASTE MAKAG EKENT , I NC. [print name of entity submitting sworn statentert] whose business address is 2600 DELLK ROAD, SUITE 100 KARI ETTA r GEORGIA 30067 and or applicable) its Federal Employer Identification Number (FELL is 36 - 2989152 (If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement: .� 2. I understand that a "public entity crime" as defined in Paragraph 287.133(lxg), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of ate► other state or of the United States, including, but not limited to, any bid or contract for goods or services to be provided to any public entity or an or political subdivision .of any other state or of the United States and involving antitsnot, (rand, theft, bn'bery, conuson, racketeerint, conspiracy, or material misrepresentation. 3. I undkrstand that"convicted" or "convictiou" as defined in Paragraph 287.133(1)(b)t UK M ,, mmeens a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guibt, in my alms or state trial court of record relating to charges brought by indictment or Information after July 1, IM, as a result of a jury verdict, nonjury trial, or entry of a pies of guilty or nole cootendere. ,� 4. I understand that an "aftiliste" as defined in Paragraph 237.133(lXa),112EMA 5 .means: 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 is the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, ezecntives, rtAers, shareholders, employees, members, and agents who are active in the management of an affiliate. T1te oweership by one person of shares constituting a controlling interest in another person, or pooling of equiruent or income among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who bas been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. S. I understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statutts, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding 41 contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity. :� •�. , dase� �w Mfrw�sllN sw� eelit� Us ststeiwewt wikU I ►s.v aarlctd below is trvt is relatiN to the owlitp wbmktiw9 AU r►Ka *se(Tnikste wRicb sppliMI x Neitlwt the e.tky saOwktog this twKw itstwwa�t,..r my of ibmc .sn. directors, esec.tlres, v� sliareiolAers, employees, members. or �b who anscore in the manage eat of The entity. N► may aApieM of the esdry has bee charged with awd coavkted eta pubik entity crime sabugoest to July 1. 1M. ' _The entity svbmIttiwg this sworn statement; nor any of its oMcers, directors, execuutives, psrtneM shareholders, employeei� memhers, or agents who are active in the management of the entity, nor an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 19". The entity submitting this sworn statement, or out or more of its officers, directors, executives„ partners, shareholders, employees, members, or agents who are active in the management of the entity, or as amlinte of the entity his been charged with and convicted of a public entity crime subsequent to July 1,1989. However, there has been a subsegwmt proceeding before a Hearing Officer of the State of Florida, Division of Adminlstrati�►e Hearings and the Final Order entered by the Hearing Office: determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor tut. (attach a copy of the final orderl I UNDERSTAND THATTHE SUBMISSION OF TH IS FORM TO TH E CONTRAC ING OFFICER FORTHE PUBLIC EN711TY IDENTIFIED ON PARAGRAPH 1(ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, T'KAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFO RIM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 257.0171, FOR CATEGORY TWO OF ANY CHANGE IN THE MORMATION CONTALNED IN THIS FORM. Ain 492 a a kl%v� Isignaturej Proposal and Contracts Manager Sworn to and subscribed before me this 23RD day of JtTLY .19 Personally known 417 OR Produced identification Notary Public - State of r4 ��*' �� M Commission expires 1 N6 (Type of identification) Janet Peach (Printed typed or stamped commissioned name of notary public) Form PUR 7069 (Rev. 06/11192) t ;tmilrsKATE­ o r urP4}Y.� OnLLPFR e:�' PRODUCER Near North Ins Brokerage 875 North Michigan Avenue wM 194/S446 INSURED Chemical Waste Mariagemen t , Inc. CWM Services - Southeast Area 2600 De l k Road y Suite 100 Mariettay CA 30067 NOYAWoLlVLU � DATE (MMlDDlYY) IA 11 /09/93 .ISM,WA17AI:'1(f:i9i9{iF4--0.1S1eM'=.iXAUN.C'S-.if4Ra:}LYM} THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW COMPANIES AFFORDING COVERAGE COMPANY A LETTER Continental CaSua 1 t y Compan y COMPANY LETTER B APPROVED BY RISK MANAGEMENT COMPANY (L LETTER C By _"'t cl- COMPANY D DATE LETTER COMPANY WAIVER: NfA LETTER E COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ftO TR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (MMlDDlYY) DATE (MM/DD1YY) ALL LIMITS IN THOUSANDS GENERAL LIABILITY GENERAL AGGREGATE $ S 1 O 0 O A X COMMERCIAL GENERAL LIABILITY C L b0 7416 O9 1 / 01 /92 1 / 0 1 /9S PRODUCTS-COMP/OPS AGGREGATE $ S Ir O O 0 CLAIMS MADEX OCCUR. PERSONAL & ADVERTISING INJURY $ st000l X OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE $ 51000 X PROD/COMP. OPERATIONS FIRE DAMAGE (Any one fire) s 2YO00 _ X. CONTRACTUAL _ - _ _ . .. _..... _ . _ - _ . _ _ _....... _ - MEDICAL EXPENSE (Any one person) $ x AUTOMOBILE LIABILITY COMBINED ANY AUTO BUA0 07416207 SINX 1 / 01 /92 1 / 01 /95 LIMIT $ S r 0 0 O ALL OWNED AUTOS BODILY SCHEDULED AUTOS INJURY $ (Per parson) X HIRED AUTOS BODILY (!_,.... NON -OWNED AUTOS' INJURY $ (Per accident) GAAAGE LIABILITY _. PROPERTY DAMAGE $ EXCIIIISt LIAftjTY EACH AGGREGATE _ OCCURRENCE $y OTHER THAN UMBRELLA FORM' A< _. _. ,.. _-------- --__........ , . STATUTORY $ 1 0 0 O(EACH ACCIDENT) AM WC �. 0741 E 06 1 / 01 /92 ' 1 / 0 1 /9S $ S t O 0 Q(DISEASE—POLICY LIMIT) EkVLOYERB' LIABILITY $ 1 y O 0 O(DISEASE—EACH EMPLOYEE OTMEA Received Risk Mgmt. & Loss Control IESCRIPTION OF OPERATIONS/LOCATIONS/VENICLESWECIAL ITEMS DATE )ILL O PER AT I ONS AND THE EQUIPMENT OF THE I NSLRED . lox ADDITIONAL I NSUR DD : SEE ATTACHED. INMAL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE MQtVRC COUNTY HAZARDOUS WASTE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MR. RON STACK t ENV* MANAGEMENT MAIL 90 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE 5100 COLLEGE ROAD LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR RODM04 WI _ LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. KEY WEST, FL 33040 AUTHOINZED RErRESENTATIVE (1 1 IM a,f, lilt .mom 1429 Issued to ENDORSE FOR MOTOR CARRIER POLICIES OF INSURANCE FOR PUBLIC LIABILITY UNDER SECTIONS 29 AND 30 OF THE MOTOR CARRIER ACT OF 1980 Chemical Waste Management, Inc. Technical Services Division Dated at Chicago, Illinois Amending Policy No. BUA007416207 this 9 th 2600 Delk Road, Suite 100 of Marietta, GA 30067 day of November 9 lg Effective Date 1 / 01 / 9 2 Name of Insurance Company Continental Casualty Comp an Telephone Number 3(.� 2 80- 5 600 , CountersignW,6y, Fc Affm%vd OMB No. zizs-o 4 93 The policy to which this endorsement is attached provides primary or excess insure e, as indicated by "■", for the limits shown: 0 This insurance is primary and the company shall not be liable for amounts in excess of $ 5 , 000, 000 for each accident. o This insurance is excess and the company shall not be liable for amounts in excess of $ for each accident in excess of the underlying limit of $ for each accident. Whenever required by the Federal Highway Administration (FHWA) or the Interstate Commerce Commission (ICC), the company agrees to furnish the FHWA or the ICC a duplicate of said policy and all its endorsements. The company also agrees, upon telephone request by an authorized representative of the FHWA or the ICC, to verify that the policy is in force as of a particular dote. Cancellation of this endorsement may be effected by the copy or the inawrod by giving (1) thirty-five (35) days notice is writing to the other party (said 35 days notice to commence from the dab the nothx is mailed, proof of mailing shall be sufficient proof of notice), and (2) if the insured is subject to the ICUs jurisdiction, by pwvi&n thirty (3) days notice to the ICC (said 30 days notice to coaacae frond the date the notice is received by the ICC at its office in Washington, D. C. ). A►CCID ff includes coatiauous or repeated exposure to cvnditi ms which results in beadily injury, Ply or eavircomoutal Wini i ge which the insured , nor inteeded. 1M cm0a Z a land vehkle, i—M-P, tr ic, tractor, befl r, or Nor panapeued of &mm by cal pcawec and used on a y four tt'a arpOrting pry '&.7 v or any codes tof. BODILY INJURY metes injmry to the body, or disease to any person, inch death resulting from any of these. ENVIRONMW.NTAL RESTORATION means restitution for The insurance policy to which this endorsement is attached provides automobile liability insurance and is amended to assure compliance by the insured, within the limits stated herein, as a motor carrier of property, with Sections 29 and 30 1 the lam, cage, or destruction of resowu�oes sri�png out of the mccidemiai dish, re"rre or escape or upon the land, , wouca ne, or body of w►r, of any vo cadity tr ac ed by a n+or came. This in da The cost of rural acid the cost Of pertabe to at deems to husin a sac�ri felt, sk it, md wildli&. PRODAMAGE means damage to or loss of use of I &or* Fwall PUBLIC LIABU ITY mum liability for bodily injury, damitg0 e, and enviroameolsal restarmbon. of the Motor Carrier Act of 1980 and the Hiles and moons of the Federal Highway Adminimrstios (FHWA) and the Interstate Commerce Commission (ICC). The Motor Casrkr Act of 1980 requires limits of financial responsibility according to tie type of carriage and conum3dky tranrporNd by the matoc carrier. k is tbs MOTOR CARREWS oblivion to obtain the required limits of financial responsibrlity0 THE SCHEDULE OF LIMITS SHOWN ON THE REVERSE SIDE DOES NOT PROVIDE COVERAGE. The limits shown in the schedule are for infomution pugxmm only. In consideration of the premium stated in the policy to which this endorsement is attached, the insurer (the company) agrees to pay, within the limits of liability described herein, any final judgment recovered against the insured for public liability resulting from negligence in the operation, mainieaance or use of motor vehicles subject to the financial responsibility requirements of Sections 29 and 30 of the Motor Carver Act of 1980 regardless of whether or not each motor vehicle is specifically described in the policy and whether or not such negligence occurs on any route or in any territory authorized to be served by the insured or elsewhere. Such. ' ss is afforded, for public liability, does not apply to injury to or death of the insured's employees while engaged in the course of their employment, or property transported by the insured, designated as cargo. It is understood and agreed that no condition, provision, stipulation, or limitation contained in the policy, this endorsement, or any other endorsement thereon, or violation thereof, shall relieve the company from liability or from the payment of any final judgment, within the limits of liability herein described, All tive of the financial condition, insolvency or bankruptcy of the insured. However, all terms, conditions, and limitations in the policy to which the endorsement is aid shall remain in full force and effect as binding between the insured and the company. The insured agrees to reimburse the company for any payment made by the company on account of any accident, claim, or suit involving a breach of the terms of the policy, and for any payment that the company would not have bees obligated to make under the provision of the policy except for the agreement contained in this endorsement. It is further understood and agreed that, upon failure of the comfy to pay any final judgment recovered against the insured as provided herein, the judgment creditor may maintain an action is any court of competent jurisdiction against the company to compel such payment. The limits of the company's liability for the amounts pre- scribed in this endorsement apply separately, to each accident, and any payment under the policy because of any one accident shall not operate to reduce the liability of the company for the payment of final judgments resulting from any other accident. SCHEDULE OF LINTS Miaisnuin Type d Carriage ity Tcsmorted Insursnc�e (1) For -hire (In interstate or for- Propeaty (nonhazard s). S 750,000 eign co�wce,), (2) For4dn and Private (In inter- Haardous snba aces as delved in 49 CFR 171.8, 59000,000 Vie,, or inrae trairted is cnrgcr tics, pnie tanks, crpec- cova). type vehicles win is +ems of 3,500 water gabs; or in be Cass A or 3 aavves, poism gas (Poison A), COMP mid, guorcc)mposend sm,orhisMmyroum ctr+olsd tity 've n er s d eel is 49 CM 173.Q3. (3) For4dn and Privsta (In inter- Oil listed is 49 CFR 172.101;.nuftrish and 190009000 stab or fare* cx nerve: in bs rdous a dell is 49 CFR 171.8 and any quay ty) or 0A listed is 49 CFR 172.101, but (2) ©c eraa: in b is aaly) shave or (4) below. (4) For -hire and Privafe (In inter- Any qusntity of Class A or B explosives, any amity 59,0009000 state or faceip cos ee+ae). of pOiKW SM (per A), or highway route quantity radioactive materials as defined in 49 CFR 173.403. Note: The type of carnage listed under (1)9 (2)9 and (3) applies to vehicles with a gross vehicle weight rating of 10,000 pounds or more. The type of carriage listed under number (4) applies to all vehicles with a gross vehicle weight rating of lens than 109000 pounds. November 9, 1993 NEAR NORTH INSURANCE BROKERAGE CERTIFICATE ATTACHMENT The Monroe County Board of Commissioners is an additional insured on the above Commercial General Liability and Business Automobile Liability policies, to the extent of Chemical Taste Management, Inc.Is indemnity obligation contained in the Monroe County, Florida Insurance Guide to Contract Administration, Indemnification and Hold Harmless for Suppliers of Goods and Services, and limited to $1,000,000 combined single limit.