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04/19/1995 CONTRACT THIS AG:R.EEMENT, made and entered into this 19th day of April, 1995, A.D., b)( and between MONROE COUNTY, FLORIDA, party of the first part (h.ereinafter sometimes called the "Owner") , and Caffrey Construction, party of the second part (hereinafter sometimes called the "Contractor"). WITNESSED: That the parties hereto, for the consideratioll~he~in- U1 :- after set forth, mutually agree as follows: r~ o c_ ~ SCOPE OF THE WORK I ~ . .,., o ~ ~):"J ::z::, i-:t c- The Con1:ractor shall provide all labor, equipment, and ~ter~ls to: Repair the roof over the tipping floor at the cucidoe 3<ey Trans fer Station. The repairs shall include, but are not limi ted to, the following: Repair or replacement of existing panels and skylights Rep,air or replacement of fasteners Repair or replacement of purl ins Repair or replacement of ridge vents and trim flashing The con"tractor shall perform all of the work described in the Specification entitled: SPECIFICATION FOR ROOF REPAIRS AT THE KEY LARGO, LONG KEY, AND CUDJOE KEY TRANSFER STATIONS and their proposal, each attached hereto and incorporated as part of this Contract document. THE CONT'RACT SUM The County shall pay to the Contractor for the faithful performance of said service. The Contractor shall invoice the County for materials when they are delivered on site and at the completion of the project. The Contract amount shall be as stated by the Contractor's proposal as follows: Twenty three thousand one hundred seventy five and 00/100 dollars ($23,175.00) 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 itself that the si te is correct and sui table for this work and it assumes full responsibility therefore. The provisions of the Con.tract shall control any inconsistent provisions contained in the Specifications. All Specifications have been read and car'efuIly 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 Conltract be more strongly construed against the Owner than against the Contractor and its Surety. B. An-yr ambiguity or uncertainty in the Specifications shall be interpreted and construed by the Owner, and its decision shall be final and binding upon all parties. 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 COTltract, 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 reI)lacement and/or repair from the Contractor, who shall in any event be jointly and severally liable to the Owner fo~ all damage, loss, and expense caused to the Owner by reason of the COIltractor's breach of this Contract and/ or its failure to comply strictly and in all things with this Contract and with the Specifications. HOLD HA1~LE S S The Contractor shall defend, indemnify and hold the County, its officials, employees and agents harmless, from any and all claims, liabili1ties, 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 employee of the Board of County Commissioners for Monroe County. No statement contained in this Agreement shall be construed so as to find the Contractor or any of its employees, contractors, servants, or agents t.O be employees of the Board of County Commissioners for Monroe C~ounty. ASSURANCE AGAINST DISCRIMINATION The Con"tractor shall not discriminate against any person on the basis of race, creed, color, national origin, sex, age, or any other cJharacteristic or aspect which is not job related, in its recruiti.ng, hiring, promoting, terminating, or any other area affecting employment under this Agreement or with the provision of services or goods under this Agreement. ASSIGNME~NT 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 prov1s10ns as the Board and Contrac1:or 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 prov'iding all services/goods pursuant to this Agreement, the Contrac1tor 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 c:onsti tute 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 ETHICS Contractor warrants that it has not employed, retained or otherwise had act on its behalf any former County officer or employee subject to the prohibition of Section 2 of Ordinance No. 010-1990 or any County officer or employee in violation of Section 3 of Ordinance No. 020--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 former County officer or employee. INSURANC:E Upon execution of this Agreement, the Contractor shall furnish the Owner Certificates of Insurance indicating the minimum coverage limitati.ons as indicated by an "X" on the attached forms identified as INSCKLST 1-4, as further detailed on forms WC1, GLl, and VL1, each attached hereto and incorporated as part of this Contract document~ . FUNDING AVAILABILITY In the E~vent 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 the option of the Board by written notice of termination delivered in person or by mail to the Contractor. The Board shall not be obligated 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 describE~d. The provider shall at all times exercise independent, professional judgment and shall assume professional responsibility for the services to be provided. Continued funding by the Board is contingE~nt upon retention of appropriate local, state, and/or federal certification and/or licensure of Contractor. 4 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 Caffrey Construction P.O. Box 6651 Key West, FL 33041 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, wi thout proof or accounting for the other counterparts, be deemed an original Contract. COUNTY OF MONROE, STATE OF FLOR~D , l1 .. . ~~~...l~.~-j;u~ By May~/Chairman Attest: DANNY L. KOLHAGE, Clerk ~~c.. ~~ Clerk J~J~l (-.'"' / ./"/ , , Joseptl' Caffrey B y,/' .// /~ / Attest: ) ./ :V'wrV~J ~ I-- wiTNESS' I ',,-/ if"F'ROVED ;~sra t:ORA. . g,.. .,., .: ~ ......1. .~" '-FJ""-fIi .~'f k:':;,~f=N'" '~ ~~L.~ '\, -IJ -; /) 0-:>( ~~L~~'_. ~ WITNESS Atr..J;/T~(,t;; Ot/ice c:\files\contract\ckwof.doc 04/04/95 1223 PM 6 S\V()ftN Sl~A~rEl\lENI' rUr~SlJANT ~ro SECTION 287.J33(3)(a), EILQJ!IPA..Sl'A]lrrE-5.. ()N PlJ8LIC EN1'ITY CItlMES TIllS F4Jftl\Il\tllJsrr BE SIGNEI) AND S\V()llN "0 IN ~rlIE PRESENCE OF A NOTARY PUBLIC OR OTllEll OFFI(~IAL AUTII()RIZED TO AI)I\1INIS1'EIl. OATI'S.\ This sworn statement islub...... to ('t4r fifE '1 ('(rIJS'7!i(.I( T/O/J [print name of the public entity] by ':TUS'er (-I (:Ai" ~((~ y' (print individual's name and title] .- () (.) I""; 2~ for [print name of entity submitting sworn statement] whosc business address is 'I '-', --:-) / -, C,J.. / -AX /t:y ~(s! I ' and (if ~ipplicahle) its Federal Ernploycr Identification Nunlher (FEIN) is 66:/1' rl ,-,..-) _5 ..J (77/ (If the entity has nn FEIN, include the Sucial Sccurity NUlllher ur the individual signing this sworn staCenlcnt: o \~] ,'3 f;. ~) 1 (et .) I undcr~;.and Chat a "puhlic entity crillle" as defined in ParaJ.:raJlh 287.133(1 )(g), Florida StatulA .cans a violation uf any sCate or fcdcralla\v hy a person with respect to and directly related to the transRcU.. .rbu~incss with any puhlic entity nr with an a~l~ncy or pulitical subdivision orallY other state or ofthc tJnitcd Stata.incrudinJ:, hut not lilnifl~(1 tn, an)' hid or rontrarf for ~onds or scr\,ices to he provided to any public entity or _ .~cncy or political suhdh'isiun uf any othcr sCale ur of the lJniic(j 'States and involving antitrust, fraud, tllcft, bribery, cullusion, rac kef cering, conspiracy, or III a t cl"ial .nisrcllrcscntation. I under~.tand that ttcon\'ich~d" or "con\'i(-tinn" as defined in rara~ral)h 281.133(1)(b), ElDIidl..S1alllla, means a finding of ~uilt or a co~"iclion of a puhlic l~nCi'y crilnc, with or without an adjudication of ~tlilt, in ..Y federal or sf ate trial court of record rclafillJ,: to fhargcs hrou~ht hy indichncnt or illfornlation after J ulyl, 1919, as a .'csult of a jury verdirt, nonjury frial, or entry of a plea of ~uilCy or nolo contendere. I undcr~~tand that an "affiliate" as defined in rara~raph 2H7.133(1)(a), Florida Statutes, nJcans: 1. A prcdeces~or or slIccessor of a person convicted of a puhlic en.iCy crilllc; or 2. An entity under the control of any natural p{~rson \\'ho is arti,'c in the managclnent of 'he entity..t who has been con vir I cd u fa puh) ic ent i. y crillll'. 'fhe (crln "affiliate" includes those orfircr~, directurs, clccutiva, partners, sharehulders, l~lnplnyces, nlcnlhl~rs, and aJ;l~nfs \"lao arc acti,'c in the Inana~cmcllt of an affiliate. 1M ow~rship hy one pcrson nf shares cuns'ihlfin~ a conerulling in'crcst in ano'her person, or'l)oolin~ of cquipmCllt or incolllc am()n~ persons "'hen nnt fHI- fai~.lnarkcl vahH~ under an arnl's Ic..~Ch a~rcClncnt, shall he . Ilrinl. 'Mie tase that one pl~r:~()n funC rnls annt her pl~rsun. A pl~rsun ,vho knuwill~ly enters into a joint vcnture with. ,.... who has hl~cn cun victcd uf a puhlic entity crinH.~ in Flurida durinJ; (he prcceding J(t rnunths shall bc considcre4 a. .ffiliatc. I under~iland that a "persnn It as dl~filled in I)ara~rftl)h 287.133( .)(c), Florida Statute., mean.lny nat.r.' person or cn.if)' nrganiJ'.ed under the lan's uf any state or or the IJnitcd Statcs with the legalllO\\'cr to enter i.e. . bindiuJ.: contracl and ,vhich hids ur applies en hid on fontrafts for the provision of ~unds or services let hy. pllblic entity, or which nthl~r,,'isl~ transacts nr applies to transact husiness with a public entity. The 'errn "Ilcrson" i_ludes those officers" .dircftHrs, executi\'es, (lartncl'S, sha..(~hulders, cnlpluyccs, nlcnlhcrs, and aJ.:cnts who ."e acti\'e in 111 a nag (~ 111<: n t n fan l~ n t if Y . I. 2 .3.4. 5. Based on infnrrnatinn and belief, the statcnlent \vhich I ha\'c Inarkcd below is true in relation to the entity suhnliUin~ this s\\'orn statclllcnt. Ilndicafc ,,'hich s.atcnlcnt applies.) ~K- Neither the entity sulnniUinJ,: Chis s,\'orn statc.ncnt, nor any of its officers, directors, exccutiv('~, partners, shar.choldcrs, el1'ploYCl'\~, rtH\.nh(\rs, tn. a~ents who'al1c active in the nlana~emcnt of the entity, nor any affiliate of the entify has heen charged \vith and cunvic'cd of a puhlic entity cri,nc suhsequent to July 1,19X9. __ l'hc entity sulHllitCing this s\vnrn statclncnt, nor any or its officl'rs, dircctor~, executives, partners, shar~h()hlcrs, cruplo)'('\cs, (llcruhers, or a~l'nCs ,,'ho arc active in the nlana~cmcnt of the entity, nor.n affiliate of the entity has hcen chargcd \\'ith and l'onvirtcd of a puhlic l~ntity c,-hue suhsCtlucnt to July I, 1989. __ l~l~c entify suhlniUin~ this s\vorn staCclucnt, or one or more of its officers, directors, executives, partners, Sharl\huldcrs, crHpluYl~CS, (nclnhl~rs, or agents \\'110 arc activc in thc m.nR~clnent of Ihe entity, or an a ffiliatc of t he entity has hecn char-~l'\d lvieh and convicted of a puhlic entity crime subsequent to July I, 19~t9. II u\\'c\'cr, therc ha~ hccn a suhsecllIl'nt procccdinJ.: hefore a Ilearing Officer of the State .r Florid., [}i,'ision ur Adlninistra.ive Ilcarin~s and the Final ()r(h~r entered hy the Ilearing Officer deter.l.ed that it \~(as nut in rtH,~ puhlic iIlCCIOl\S' tn place thc entity suhnlitting this sw(u-n statement on the convicted vendor list. IAUach a copy of the final orderJ (). I lJNI)EI~ST AND l'IIA T I'll E SlJIl1\1ISSI()N OF ~rlIIS FORM TO TilE CON1"IUCTING OFFICER FOR vrllE PlJIlLIC ENTll'Y IDEN"IFIEI) ()N PAltAGRAPll1 (()NE) ABOVE IS FOR TIIAT rUBIJIC EN1'rr\' ON L \' AN(), l'IIA l'l'IIIS F()1{1\1IS V ALl () rrllllOlJGIII)E(:EMDElt J I OF PfllE CAIJEN[)Alt "[AR IN WIIIC]I rr IS FILEI). I ALS() lJNI)Ell.S'rANll 1'IIA'r I AM REQlJlltEI) "0 INFOltM l'IIE rUnLIC ENTrrV rRIOI{ 1'0 EN'rEH.lNG IN'r() A (:()NrrltACT IN ~:XCESS OF l'IIE Tlllt..:SIIOLll A1\l()lJNT rl~O\'IDEl) IN SEC:1'ION 287.017, EI~Qllil)A S:l~M1LT~S FOR CA1'EGOllY l'WO OF ANY CI:IAN(;E IN TilE INF()1~1\1Arrl()N (:{)NrfAINEll IN '1,.'1 I ,IS.."C/?"", F~-'(] JII,tl\1'" ,,' ",:/4,,' // "/"'.""'/" ~ f Jr" -)/ / " ;' .... .,' ,..- ,/ 1 ,..'~ ~ i / / ~ . . (~r / / L/f _ ... - :. . /i (~i~llatur9l' / // . S,,'orn to and subscrihed hefore nle this /7Pt day of "I~ / ... ,19 tJ~- \ // / // ) /J · - ' , ~ / .'~! . !.' / /~~4a:V~ -V / ----/ Notary Public - Statc of ~J..r;If:-ILJI1 Personally known OIl Produced identificacion V./~ Fl.Dt. L/(~. e/b()-'I1'6-Sf-0.21.~.. MyCommissiollcxpircs ff~t?Sr ;;./'1% rr}/flC () f id l'1l. i fie aC ion) , >'t\\~\' ~~: ~ H U 1 !I Iii ~ ,.------ . -''',\ .. , ) ,1/, I I' ~!! I / / ~ J' ~." .~ t",; ~ l: /I~<'/~'>:~:~~ ~ol2&t/e. ,lA-T .;A./ I u.-t /9~ .< _ '~';~(J'j:;., (Printed 'Ylled or stamll~d ~ "~;, cOlnlni~sioncd nalne of notary puhlic) Form rlJR 7068 (Rev. 06/11/92) SPECIFICA l'ION FOR ROOF REPAIRS AT THE KEY LARGO, LONG KEY AND CUDJOE KEY TRANSFER STATIONS GENERAL Since 1982 there has little or no maintenance on the roofs of the Transfer Stations because of their height and lack of equipment. Over the years, some of the metal purlins and sheet metal cover have deteriorated due to the salt atmosphere. To continue in its present state, the roof could become a serious safety problem. Proposals shaIl be submitted in a format that shows the work to be accomplished at each site and the cost of repairs at each site. DESCRIPTION The contractor shall furnish and instaIl all labor, materials and equipment necessary to repair the roofs over the tipping floors at the Key Largo, Long Key and Cudjoc Key Transfer Stations. The repairs shall include, but not limited to, the following: Repair or rcplacenlcnt of existing panels and skylights. Repair or replacement of fasteners. Repair or replacement of pUflins. Repair or replacement of ridge vents and triJn flashing. OTHER Demolished metal shaIl be stacked neatly on site. Permits wiIl be the responsibility of the County. Proposals shall include warranty information. The proposal will state whether the presented prices are based on being awarded a contract for work at three sites, two sites or one site. Site locations arc as follows: Key Largo Transfer Station 11180 County Rd. 905 Mr. 1. Richcreek 305.. 367.. 3244 Long Key l'fansfcr Station MM 68, US 1 Mr. 1. Julien 305-664-9315 Cudjoe Key Transfer Station Blitnp Rd. MM21.5 Mr. D. Mason 305-745-1771 A W AR.D OF CONTRACT In evaluating the proposals, the County shall consider the qualifications of the bidder, whether or nol the proposal complies with the requirements and the price of repair at each site. SE~' NOLI: "'Of~ M 5~f, (h;= r/P&; peJ. 60x 66"S/ ~~' aS~ p :?3d~/. , ,_ / S6S-' Zc;6 - cr9~c; PROPOSAL SUBMITTED TO: PROPOSAL aAJ s hcJc Ic),J Page No.--.--!__ ~ . of / -Pages PHONE~ I I DATt -&1 AJ /f'~ft ----~~--, JOB NAME: .5 J? 7 /rJ- / / NAME: STREET: STREET: .u_ J-STArr-H-~U_~_- CITY: CITY: STATf: w. her.oy submit specifications and estimates for: :) ;;~~? f~ S /II tZaf de o~ ~ 2) /4-?&tCE 2~1 ~/ tli/culk1e/AI ;;~O~ c:~7/ du;(/~ o / / /~.. 1\ r?()Ar~ Ll"'/ /W//./Ic p?oo!-.:J 3) /;4fch /2o/E-,;A.J ,.L' '( 0"-/ ""'/1 '/ / /J / I ~ /?t:P~CE- ~'/1/e /pool ~.. EC~/~_,(J\ / /-/150 (o/'~/c 7 I'. ,J (julk/ef / 4/J'C//f, 5~7 /J~~' AAJ/ .v~CCJf.A~l 'rvR(,;J J. .5) (JARf-?rI#J't liJ flaK Iw~/(o,.J - SeE i>oofk! J./) j?/IC~ I{ /J/~ C /' '/ o~f ENe /os-eel w. hereby propose to furnish labor and materials - complete in accordance with the above specifications, for the sum of _ __..._ dollars ($ 2 5,1 / '( S, 00 ) with payment to be mad. as follow" 'vi cj L1-. J'!_7:~_.. .______.____. __ ...... _ ___ ,50 %> _ /77,1q r ER (/It.. ON ~ % - ~JOt?1< Ca/'~~€rE All material is guerantNd to be as specified. All work to be completed in a work manlike manner according to ~tandard practices. Any alteration or deviation 'rom .bo". specifications involving extra costs, will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accirients or delays beyond our control. This proposal su~i.ct t acceptan~ __within ------~.J1-...-----.h---.--- days and is void 'h......'t.. .t the option lof the undersigned. // /;':~/~' / ,-"I / /' / ,- / // /.,~ Author'ized Signature ~.- _~_~,_--- ,. // r( __. _'~ ACCEPTANCE ~' PROl:>>OSAl'/(/ r, ,. The .t.ve pric." JlMCifications and conditions are hereby Accepted. You are authorized to do the work as specified. Payment will be made .. ......" ...... ACCEPTED: Signature Oet. Signature __.------______. April 22. 199.:1 1 ~t I'ri uti ng GENERAL LIABIIJI~ll' INSURANCE REQUIREMIGNrrS FOI{ CONTRACT IJI~'rWI~~N MONI~OE COUN1'Y, I?LOI{II)A AND Prior to the COlnmCnCCITICnt of work g()vcrncd by this contract, the (~ontract()r shall olltain General l,iability Insurance. Coverage shall be 1l1uintaincd t.hroughoullhc life of the contract and include, as a minirnuln: · Premises Operations · Products and Completed Operations · Blanket Contractual Liability · Personal Injury Liability · Expanded Definition of Property Danlage rrhc mininlum limits acceptable shall be: $300,000 Conlbined Single Litnit (CSIJ) I f split limits are provided, the nlinimurn linlits acceptable shall be: $100,000 per Person $300,000 per Occurrence $ 50,000 Property Damage An Occun.ence Fonn policy is preferred. If coverage is provided on a C:lainls Made policy, its provisions should include coverage for clairns filed on or after the cflectivc date of this contract. In addition, the period for which c]ainls Inay be repolted should extend for a lllinirnurn of twelve (12) months following the acceptance of work by the Counly. l'he Monroe County Board of County COll1missioners shall be named as Additional Insured on all policics issued to satisfY the above rcquircl11cnts. Adrninitdralivc In:..1rudion 114709.1 GLl 54 April 22. 19<)) 1st l'rinlint; I \ VEIIJCL.E LIAIJILI'>rY INSURANCE REQUIREMENrrS FOR CON~rRAC1~ BErrWEEN l\10NI~O.E COUNrIY, liLOI{ID,\ AND Itccognizing that the work governed by this contract requires the use of vehicles, the C()nlraclor, prior to the CortlnlcnCClllcnt of work, shull obtain Vehicle ljability Insurance. Coverage shall be Inaintained throughout the life of the contract and include, as a mininlurn, liability covcrngc for: · Owned, Non-Owned, and I lired Vehicles . l'hc tninimunllilnits acceptable shall be: $]00,000 Combined Single Limit (CSL) , \ ---- If split linlits arc provided, the 111inilnurn limits acceptable shall be: $ 50,000 per I>crson $ J 00,000 per Occurrence $ 25,000 Property Damage rrhe Monroe County noard of County Comnlissioncrs shall be naJlled as Additional Insured on all policies jissucd to satisfy the above rcquirClTICnls. ^dlninistrntivc 1n.\1nI<...1ion 114709.1 VLI 75 I\pril 22.. I <J9J I ~t Print ing .~'\.."'--- . WOI{!<:ERS' COMI)ENSA l'ION INSURANCE I{EQUII{I~MEN'rS FOI{ CONTRi\CrI' n I~rr"V E EN M.ONI{OE COlJNr]~y, )rLORIDA AND }>rior to the conunenceOlcnt of work g()vcrncd by this contract, the C()nlractor shallohtain Workers' COfllpcnsation Insurance with lilnits suflicicnllo respond to I'Iorida Statute 4i10. In addition, the Contractor shall obtain Eruployersl Liabilily Insurance with lilnits of nolless than: $100,000 Bodily Injury by Accident $500,000 130dily I~;ury by Disease, policy linlils $1.00,000 Bodily Irtiury by Disease, each employee Coverage shall be tnaintained throughout the entire lerm of the contract. Coverage shall be provided by a conlpany or cOlllpanics authorized to transact business in the stale of I~'J:orida and the cOlnpany or cOlnpanics Illust nlaintain a nlinirnum rating of A-VI, as assigned by the A.M.. Best COlnpany. If the Contractor has been approved by the fl()rida's Department of Labor, as an authorized self- insurer, the County shall recognize and honor the Contractorls status. The Contractor ll1ay be required 10 subtnit a Letter of Authorization issued by the Dcpartrllcnt of Labor and a Certificate of Insurance, providing details on the Contractorls Excess Insurance !>rogra111. I f the Contractor participates in a self-insurance fund, a Certificate of I nsurancc will be required. In addition, the Contractor may be required to subnlil updated financial statenlcnts fronl the fund upon request from the County. Administrative lru.tru,-,1ion 1/4709.1 WCI 81 April 22~ 199.1 1st Prin. ing 1\10NROE COUNTY, FLORlDA INSURANCE Cl-lECKLISrr FOI{ VENDOltS SUBMll~l'ING I)ROPOSA1JS FOI{ \VORK r-ro assist in the development of your proposal, the insurance coverages 111arked wilh an "X" will be required in the event an award is rnade to your firnl. 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 fc.rm and submit it with each proposal. \\'()ltKERS' COM PENSA l'ION AND EM1>LOYEltS' LIABILITY we] WC2 We3 WCUSLI-j WCJA x y Workers' Cornpensation Employers Liability Employers Liability Enlployers Liability US Longshorernen & Harbor Workers Act Federal Jones Act Statutory Limits $100,000/$500,000/$100,000 $500,000/$500,000/$500,000 $1,000,000/$1,000,000/$1,000,000 Sarne as Employers' Liability Sarne as Enlploycrs' [,iability ^dnlini~1rntivc Jnsln.,-1ioD 114709.01 INSCKLS"r 6 Ap,il 22~ 199J 1st Printing GENERAL LIABIIJITY As a minimum, the required general liability coverages will include: · Prenlises Operations · Blanket Contractual · Expanded Definition of Property Damage Jtequired Limits: GLI 'I GL2 GLJ Required l~ndorsement: GLXCU GLLIQ Products and COll1pJeted Operations Personal II~ury . . $100,000 per I>erson; $300,000 per Occurrence $50,000 J)ropcrty DaJnagc or $300,000 C0l11bined Single Linlit $250,000 per Person; $500,000 per Occurrence $50,000 Property DaJnage or $500,000 COll1bined Single Limit $500,000 per Person; $1,000., 000 per ()ccuITence $100,000 Property Damage or $] ,000,000 Combined Single Linlit Underground, Explosion and Collapse (XCV) Liquor L,iability All endorsements are required to have the same limits as the basic policy. ^dmini~1rativc ]n~Lru(..1ion 1/4709.0 I INSCKLs'r 7 i\pril 22. I <)C)J ) s1 Printing VEI-UCLE 1,,]ABILrry As a rninirnum, coverage should extend to liability for: . Owned; Nonowned; and I-Jired Vehicles Required L,imits: VLl r " VL2 VL3 IlRl MVC PROI PR02 PIt03 POLl PO 1..,2 J>O L3 EDt ED2 GKl GK2 GK3 MEDI MED2 MED3 Adnlinistrativc Instruction 114709.0 I $50,000 per I:>erson: $100,000 per Occurrence $25,000 Property Damage or $100,000 COlnbined Single Limit $1.00,000 per J>erson; $300.,000 per Occurrence $50,000 '>ropcrty Dalnagc or $300,000 Conlbincd Single I.jlnit $500,000 per Person; $1,000,000 per Occurrence $100,000 Property Damage or $1,000.,000 Combined Single Linlit M1SCELLANEOUS COVEI{AGES Builders' Risk Limits equal to the cOlnplctcd project. Motor Truck Cargo Lirnits equal to the maxirnum value of anyone shipolcnt. I'rofessional Liability $ 250,000 per Occurrence/$ 500,000 Agg. $ 500,000 per Occurrence/$I ,000,000 Agg. $ I ,000., 000 per Occurrcncel$2, 000,000 Agg. $ 500,000 per ()ccurrence/$I.,OOO.,OOO Agg. $1,000,000 per Occurrcncc/$2,000,OOO Agg. $5,000,000 per Occurrence/$] 0,000,000 Agg. J>()lIuti()n Liability Elnployee Dishonesty $ 10,000 $100,000 $ 300,000 ($ 25,000 per Veh) $ 500,000 ($]00,000 per Veh) $1,000,000 ($250,000 per Veh) $ 500.,000/$ 1,000,000 Agg. $1,000,000/$ 3,000.,000 I\gg. $5,000,000/$10,000,000 Agg. Garage Keepers Medical Pro fossi()nal INSCKLS'f' 8 IF VLPI VLP2 VLP3 BLL I-IKL 1 I-IKL2 l-IKL3 AIRl AIR2 AIRJ AEOI AE02 AE03 ^pril 22. I <)~J I st Printing Installation Floater Maxitnurn value of l~quiplnent InslaIIed lIazard()us Cargo Transporter $ 300,000 (J~equircs rvl(~S-90) $ 500,000 (I~equires MCS-90) $1,000,000 (Requires MCS-90) Bailee Liab. MaxinlUlll Value of j)roperty Hangarkeepcrs ~Liability $ 300,000 $ 500,000 $ 1,000,000 $25,000,000 $ 1,000,000 $ 1,000,000 Aircraft Liability Arcllitccts Errors & Olnissions $ 250,000 per Occurrcnce/$ 500,000 Agg. $ 500,000 per Occurrcnce/$I ,000,000 Agg. $ 1,000,000 per Occurrcnce/$3,OOO,000 Agg. INSURANCE AGENT'S S"rA~rEMENrr I have reviiewed the above requirenlcnls with the bidder nanlcd below. l'hc folJowing deductibles apply to the corresponding policy. POLICY- DEDuc'rIBLES Liability p()licics are _ Occurrence _ Clailns Made -----,-- Signature Insurance Agency JlIDDEI~S Sl~A l~ElvlE_N~r I understand the insurance that will be mandatory if awarded the contract and will comply in full with all the requirements. Adrninistralivc Jn~n.(,,1ion 1/4709.0 I Signatlire--- Bidder INSCKLs'r 9