10/14/1994 DV091779
Jaann!, 'I.. liolbagt
BRANCH OFFICE
3117 OVERSEAS HIGH'NAY
MARATHON, FLORIDA. 33050
TEL. (305) 289-6027
CLERK OF TI.IE CIRCUIT COURT
MONROE COUNTY
500 \VHITEHEAD STREET
KEY WEST, FLORIDA 33040
TEL. (305) 292-3550
BRANCH OFFICE
88820 OVERSEAS HIGHWAY
PLANT A TION KEY, FLORIDA 33070
TEL. (305) 852-7145
MEMORANDUM
TO: Peter Horton, Director
Division of Community Services
Ruth Ann Jantzen, Deputy Clerk ff~).
FROM:
DATE:
January 6, 1995
------------------------------------------------------------------------------------------------------------------------
On {ktober ~O. 1994, the Board of County Commissioners granted approval and
authorized execution of the following documents:
Contract Agreement between Monroe County and Arnold's Towing for the
emergency removal of Derelict Vessel DV091626, located in Stock Island, in the amount
of $1,260.00.
Contract Agreement between Monroe County and Arnold's Towing for the
emergency removal of Derelict Vessel DV09171S, located in Boca Chica Bay, in the
amount of ~~1 ,512.00.
Renewal Agreement between Monroe County and Frigola, DeVane, Wright and
Dorl, P.A.,for a period of six months.
On November 23, 1994, the Board of County Commissioners granted approval
and authorized execution of the following documents:
Contract Agreement between Monroe County and Frank Keev8n & Son, Inc., for
the emergency removal of DV091420, DV091422, DV091423, DV091425 and DV091661.
located in Boca Chica Bay, in the amount of $6,960.00.
Contract Agreement between Monroe County and Arnold's Towing for the
emergency removal or Derelict Vessel DV091779, in the amount of $1,680.00.
CONTRACT AGREEMENT
AGREEMENT, MADE THI S J.-1;rJ day of f\)trt~~ 1994, by
and betweE~n, Arnold's Towi~
("Contractor"), and
the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, of
the Count)r of Monroe, State of Florida ("Board").
The contractor and the Board, for the consideration named
agree as follows:
1. The contractor shall furnish all the materials and
perform all the work as required by the Specifications for the
emergency removal of DV091779 for which derelict vessel report
3
~
-T1
is attached as exhibit A.
o
~c~;: c-
2. ~~he work to be performed under this contract~,~:~.hall~
,
commence jLnunediately from the date the Liaison provi<tes theO\
-0 c-;
Notice to Proceed and shall be completed by November -30, 19~. __
~ ..I}
.c..
3. If the Notice to Proceed has not been given .on or before
r1
,--
\,-
......)
the 23rd (lay of November then this agreement shall be null and
void.
4. ~rhe work to be performed under the contract is
contingen1: upon approval of appropriate grant monies from the
State Department of Environmental Protection, Boating Improvement
Fund. If this grant is denied, this Agreement shall be null
and void. The contractor understands the rules of the Department
of Envirolwental Protection and shall comply with said rules,
along with the rules and procedures instituted by the Board to
ensure an orderly progress to the project. Both the intent and
the letter of the specifications are understood by the
contractol:- .
5. ~rhe Board shall pay the Contractor the total sum of
$1,680.00 for the emergency removal and legal disposal
of DV091779. Payment for the work shall be upon completion by
the contractor and acceptance by the Board, subject to the terms
and condi1tions of the Specifications (attached as Exhibit B) and
this contJract.
6. ~rhe attached Derelict Vessel Report and Specifications
together 'vi th this Agreement, form the the contract. They are
fully a part of this contract as if repeated herein verbatim.
7. ~rhe contractor shall indemnify the Board from and
against allY and all claims, demands, actions, proceedings,
damages, :Liabilities, costs and expenses, including attorney
fees, arising out of, connected with, or resulting from the
Agreement..
8. ~~he contractor acknowledges his/her intention to comply
with the need to coordinate all work with the appropriate
environmental agencies, the Florida Marine Patrol, and the County.
9. ~~he contractor agrees to supply the County with a set of
photographs of the vessel in all phases of the removal and
disposal process. The contractor will be responsible for the
camera, fj.lm, and development costs.
10. The contractor understands and agrees that the receipt
of the Notice to Proceed from the County does not relieve his
responsibility to obtain any appropriate permits. The contractor
must infol~rn the appropriate permitting authorities prior to
initiation of work.
11. The parties agree that timely performance of this
agreement is essential due to possible damage to the natural
resources, hazard to navigation, or threat to human health
and welfaJre. Therefore, the parties agree that the
contractor shall be liable to the Board for $100 per day of
liquidated damages for each day after November 30, 1994 that any
of the contractor's obligations under this agreement remain
unperformed. The parties agree that such amount is by the way of
compensatory damages and does not constitute a penalty.
12. Due to the use of heavy equipment and, at times,
dangerous work environment, the contractor understands and
agrees to maintain an alcohol and drug free work environment.
13. The contractor will provide General Liability
insurance the amount of $300,000, Workers Compensations the
amount of $500,000, Federal Jones Act (46 U.S.C.A. subsection
688) with limits not less than those specified for Employer's
liabili ty" Vehicle Insurance in the amount of $100,000,
Watercraft Liability on the amount of $300,000, and Pollution
insurance in the amount of $500,000.
14. The Board may terminate this agreement with or without
cause at cLnytime upon giving the contractor a minimum of ten
days in writing. The contractor, upon receipt of the notice,
shall irnme~diately cease work. The Board shall pay the
contractor the percentage of the contract sum which is
proportional to the amount of work performed by the contractor in
a mannersa.tisfactory to the Board up to the date the contractor
received the Notice to Proceed.
IN WITNESS WHEREOF the parties hereto have executed this
Agreement to day and year first
written ab:?}eo , '/1
BY:jS-Itl<.~ Lt2t~
,
?///' a4--~~UL,.IL~
Tlt1e
/-} " . ~ !-I'J . ~. A
~:?U!Lca-/~9?t~..-~ _ 4~~ .
Flrm
(Seal)
Attest:
/<7~
Witness
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
BY: ~~-F~
Mayor/Chair n
(Seal) At1:esti>AtmY L. ltOLlIAGB, aedI
~~(~A~~J
Clerk
't'l~()\.'E.O ~4..;' 'TO F~'"
"
't . T...'. ' J r" .,r /'1~: "
(./; .
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ATTACHMENT A
. . 1~-1994 15:29 FROl1 FLH. 11HRINE PHTROL DIST-9 TO 83052924417 P.03
OFFENSE INCIDI=NT REPORT NARRATIVE CONTINUATION IOBB.--\
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NAME ON VESSEL ; OTHER IDENTIFIERSTr; - n1Ilf;n~
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4. COHDI'1'I()N: WRECKEP _iJUNKEO-1-iDISMANTLED ----X-iABANDONED X
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c APLOAT OR ON SHORE I TOUCHING MEAN HIGH WATER LINE
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6. PROPBRT~r 01lKER: STATE OF FLORIDA
YEsL NO_
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OR.
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11. ~D WJrDOUT aBPAIR? YES _ NO _ UNKNOWN X
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12. RBCOllllB1mBD DI8p<?sITIOR: LANDFILL .A--iARTIFICIAL REEF_;OTHER _
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I Offtoer(eJ A~ng
~ ",,*,,~d By:
I. v. c...
~ Date
Number ArN8ted
ONR IO-04&A FMP tell 1 J
p... ..L of ..1...--
UCI-31-1994 15:30 f-ROM FLR. r1ARINE PATROL D15T-9 TO
83052924417
P.04
OFFENSE INCI[)ENT REPORT NARRATIVE CONTINUATION
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III Officer(.. Reporting (pie.... prin
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....
.
~ Reviewed By:
I
i Citetion Number
Q
C
08TS Numbe,
Origin" 0
Supplement 0
DNR 20-045A FMP C7ltlJ
Peg. -1- of ~
Attachment B
DERELICT VESSEL REMOVAL CONTRACT SPECIFICATIONS
FOR MONROE COUNTY, FLORIDA
1. INTE]~T: It is intended that these specifications shall
cover all aspects of the work explicit provisions. The
purpose of this section is to provide specific coverage for
conditions applicable to this contract, where such coverage
is not provided for in other portions of the contract
docurnen ts .
2 · BID ]~ORMAT: THE BID MUST BE SUBMITTED ON THE BID
RESP()NSE FORM ENCLOSED IN THIS PACKAGE. A dollar a'llount
per foot must be submitted for the removal of all derelict
vessels on the primary list for which a Florida Marine
Patrol Derelict Vessel Report is provided. Any
deviation from this format will result in an unaccepted
bid. A contract will not be granted on the basis of
combined, related, linked, or discounted bids. ~lot
applicable due to emergency removal of one or more
derelict vessels for less than $25,000 total.
3. PLANS: There are no plans for this project, but
copies of the Florida Marine Patrol Derelict Vessel
Report with location Sketches have been bound into
these documents for the Contractor's use. The Specifications
include section on instructions to bidders, both
general and specific, and a copy of each Derelict
VessE~l Report from the Florida Marine Patrol. Only
those derelict vessels for which a report is included
and listed on the Bid Response Form are to be bid
upon and subsequently removed.
The County reserves the right to remove any or all vessels
from this contract at any time prior to actual removal from
the water and disposition by the Contractor.
The C~ounty has a limi ted amount of money to effect the
removal of these abandoned vessels. We have established
priorities based on public safety, navigation and traffic
hazar'd, and environmental considerations. If bids exceed the
County's resources for removal based on these
considerations, we shall limit vessel removal based on the
these considerations and cost effectiveness.
4. VESSE:L IDENTIFICATION AND LOCATION: Each of the vessels
have been given a derelict vessel identification number,
which, is shown wi th the location in the Florida Marine
Patrol Derelict Vessel Report, included herewith.
Each bidder is responsible for his own identification of
each derelict vessel as to location, description and
condition. If a Derelict Vessel cannot be (1) located, (2)
removed, (3) verified and (4) disposed of, as specified in
thes~= procedures, then no payment will be made forthcoming
to the Contractor for that vessel. Those four conditions
must be met on each derelict vessel along with compliance
with all laws and permits for payment to be made.
It is understood that the Contractor has, by personal
examination and inquiry, if necessary, satisfied himself as
to the local conditions of each derelict vessel and as to
the meaning, requirements and reservations of the
specifications; for after contract letting, no deviation
will be allowed. In case errors are discovered, they are
to be reported by the Contractor to the County. The
Coun1:y assumes no responsibili ty should there be any
discrepancies in what is stated in these docQrnents and what
the bidder evaluates.
A contractor should take special care to remove only those
derelict vessel's on his contract and for which he possessed
a Florida Marine Patrol Derelict Vessel Report. Other
derelict vessel's in the area but not under contract, cannot
be mc)lested.
It may be possible to replace a derelict vessel of like
kind,. for the same or less money, when mutual agreement can
be rE~ached by the Florida Department of Environmental
ProtE~ction, Monroe County Administrator of the Derelict
Vessel Program, and the Contractor. This will be applicable
when a contracted derelict vessel can not be located. No
derelict vessel may be replaced and removed without the
tri party consent noted in thisparagraph. A contractor
may suggest a possible replacement vessel but he may not
remO'~le it without the appropriate consent above.
5. SCOPE: OF WORK: The Contractor shall be responsible for
provi.ding all permits, supervision, labor, equipment, tools,
fees and taxes required to complete this project to the
satisfaction of the County.
The Contractor's procedure and methods of removal may be of
his c~wn selection provided they secure results which satisfy
the requirements of the Specifications and any necessary
envi:ronmental perrni ts.
Any vessel which is removed and disposed of shall be
remov'ed from its present si te in such a manner as to do
the least possible damage to the natural environment
surrounding the vessel. All debris from the vessel shall be
remov'ed and the 8i te left in a reasonably clean condi tioD.
No oil or fuel shall be permitted to be dumped or spilled
into or unto the water or land. All pollutants shall be
removed from the derelict vessel prior to removal from the
water.
DV Specs--Page 2
The Contractor shall be responsible for making any and all
arrangements for access to the vessel to be removed. If
private property has to be traversed, then written
permission of the owner is necessary. In removing a derelict
vessel that may lie on or near grass or sponge flats extreme
caution must be used to do the least possible damage.
Prior to delivery of derelict vessels to the disposal site,
the Contractor must remove all oil, gas and metal (including
engines). He must dispose of them in any legal manner. Pure
used oil will be taken by Monroe County for disposal.
Mixtllre of oil, gas, seawater or any combination of the
three must be transported from the County by an approved
hazardous waste handler. The names of those firms will be
supplied by the Monroe County Environ.rnental Management
Department. Metal becomes the property of the Contractor.
In tllose cases where a derelict vessel number can not be
found, i.e. derelict vessel is underwater, the contractor
shall provide marine transportation to the site for the
County representative to verify the vessel and location
usin9 the original Derelict Vessel Report from the Florida
MariIle Patrol.
6 · MATEI~IALS AND WORKMANSHIP: The Contractor shall provide
the necessary materials and equipment to safely complete
the job. The Contractor agrees that all work shall be
perfc)rmed by competent employees who are experienced and
qualified to do the work specified, and that all work will
be pE~rformed in accordance with the best conunercial
pract:ices. A list of equipment to be used and a
description of the removal and transporting procedures to be
follc)wed must be provided to the County at the Prework
ConfE~rence described below.
Precaution shall be exercised at all times for the
protection of persons and property. The safety provisions
of t11e Occupational Safety and Health Act of 1970 (Public
Law 91-596) and other applicable laws, including building
and construction codes shall be observed. Machinery,
equiI~ent and other hazards shall be guarded in accordance
with safety provisions of the "Manual of Accident
PrevE~ntion in Construction", published by the
Associated General Contractors of America, to the extent
that such provisions are not in contradiction of applicable
law.
The C~ontractor shall store materials and shall maintain
partly or wholly finished work during the continuance of
the C~ontract and until the final acceptance. If any
mater'ials or part of the work become lost, damaged, or
destroyed by any cause or means whatsoever, the Contractor
shall satisfactorily repair and replace or not receive
payme'nt for the unaccomplished work. The Contractor shall
DV Specs--Page 3
main-tain sui table and sufficient guards and barriers, and
at night, suitable and sufficient light or other
appropriate security or protection for the prevention of
acci<ients.
Use of explosives is discouraged in carrying out the
project. No blasting with explosives shall be done except
undeJr prior approval by the County and as permitted by all
rele~'ant government agencies such as the Department of
NatuJ::-al Resources, Department of Environmental
Regulation, U.S.Army Corps of Engineers, u.s. Fish and
Wildlife Service and the u.S. Coast Guard. When the use of
explosives is approved the Contractor shall use the utmost
care so as not to endanger life or property and whenever
dire(~ted the number and sizes of the charges shall be
redu(~ed. All explosi ves shall be marked clearly "DANGER
EXPLC)SIVES", and shall be in the complete care of competent
watcl~en. The Contractor shall secure the proper competent
watcl~en. The Contractor shall assume all responsibility for
dama~1es caused by explosives.
7. ASSI(;NMENT OF CONTRACT AND SUBCONTRACTS: It is expressly
understood that the Contractor is in all respects an
independent Contractor for this work, not withstanding under
certain conditions he is bound to follow the directions of
the County, and is in no respect an agent, servant, or
emplc)yee of the County. Neither the Contract, nor any part
therE~of, nor any monies due or to become due thereunder, may
be assigned by the Contractor without the prior written
approval of the County.
The Contractor is fully responsible to the County for the
acts and omissions of his subcontractors and of persons
either directly or indirectly employed by said
subcc)ntractor, as he is for the acts and omissions of
persons directly employed by him. Nothing contained in the
ContI~act Documents shall create an contractual
relation between any subcontractor and the County.
All s~ubcontractors shall abide by the terms,
conditions, and requirements of this Contract. It is
the responsibility of the Contractor to pay all debt
obligrations incurred with subcontractors in an
expedient manner.
8. LEGAl. RESTRICTIONS, PERMITS AND TRAFFIC PROVISIONS: The
Contractor shall comply with all applicable local, State and
Feder'al requirements pertaining to the terms of this
Contr'act. The Contractor will be responsible for obtaining,
at hi.s own expense, any licenses or permits that may be
required and should inquire about permit requirements with
the a,ppropriate agencies. The Contractor shall comply wi th
all the requirements of the Federal Pollution Control Act.
The Contractor shall conduct his operations so that he shall
DV Specs--Page 4
not close any thoroughfare nor interfere in any way with
trafjEic on highways, or on water, without the written
consent of the proper authorities. Work shall be done at
any 1:ime that shall not interrupt or disturb members of the
public.
Off-loading sites (water to land for transport to the
landfill or other disposal site by vehicle) must have
written approval of the land owner.
The Florida Marine Patrol should be contacted to
initiate eviction proceedings for contracted
dereJLict vessels which are inhabited at the time
of removal and when another vessel is too close to the
contracted derelict vessel to allow safe operations.
Direct confrontations with other boaters should be avoided
and the Florida Marine Patrol should be contacted
immediately if such confrontations may result from removal
of allY contracted derelict vessels.
9. INSUI~ANCE: The Contractor must obtain all insurance
requj..red by the County and submit proof of same to the
county prior to acceptance of bid and contract approval by
Boarcl of County Commissioners but no later than five
working days after notice of low bidder. All insurance
shalJ_ be maintained until work has been completed and
accepted by the County.
The Contractor shall furnish the following certificates of
insurance for review by the County's Risk Management
Di vi~;ion:
Certificate(s) of Insurance which clearly indicates that he
has obtained the insurance coverage required in paragraphs
a,b,c and d below.
The C:ontractor hereby certifies that no modification or
change in insurance shall be made without (3) days written
advance notice to Monroe County, c/o the director of the
Risk Management Division.
a. WorkE~r' s Compensation Insurance as in the amount of
500 w (JIOO
b. GeneI~al Liability Insurance on a comprehensive basis, in an
arnourlt not less than $300,00.00 per occurrence for Bodily
InjuI"Y and Property Damage combined, to include contractual
liability.
c. Poll'LLtion Liability Insurance in the Amount of $500,000
d. Water" Craft Liabili ty Insurance in the amount of $500.000.
e. AutoITlobile liabili ty insurance covering all owned,
DV Specs--Page 5
non-owned and hired vehicles used in connection
with the work, in an amount not less than S100.000 per
occu]:-rence for Bodily Injury and Property and Damage
combined.
All insurance policies required above shall be issued by
companies authorized to do business and under the law of the
State if Florida.
10. COMMI~NCEMENT ,DELAYS AND COMPLETION OF WORK: After
receiving Board of County Cormnission approval of the
Contract, and after reconciliation of any details or
conditions which may directly or indirectly interfere or
conflict with work of the Contract, the County will issue a
"Notice to Proceed with Contract work" officially
authorizing the Contractor to commence. The Contractor shall
commE~nce work on said date.
If the Contractor should be delayed in the progress of the
work included in the Contract by unforeseeable causes beyond
his control, the time for the completion of the work may be
extended upon agreement of the County representative.
Requests for extension of time must be submitted in writing
to t11e County representative. Extensions of time cannot
legally be approved unless the written request is submitted
in the time to permit it to be acted upon before the
Contractexpiration date. To allow sufficient time for the
admiI:Listrative procedures required to obtain action by the
Count~y Commission, a request for time extension must be
received by the County representative at least sixty (60)
calendar days prior to the Contract expiration date.
Provided further that the Contractor shall within ten (10)
from the beginning of such delay notify the County, in
wr i ti.ng, of the causes of the delay. The County
representative will ascertain the facts and the extent of
the delay and notify the Contractor within a reasonable
time of his decision in the matter.
If the Contractor fails to complete the work within the time
limit, and if the County should nevertheless permit the
Contractor to continue and complete the same without
official extension of time in writing, such permission
shall not modify nor waive any liability of the Contractor
for damages arising from non-completion of work within
the time limit, but such liabilities shall be subject to
continuation in full force against the contractor.
11. CHANGES AND INSPECTION: The vessels herein considered are
to be removed for the County by the Contractor in accordance
with the Specifications. The County may give instructions or
directions to supplement the Specifications. These shall be
binding upon the Contractor and upon all his subcontractors,
employees and agents of every kind.
DV Specs--Page 6
All ~Nork and every process and operation shall be subject to
inspection at all times, and the County and their
representatives shall have free access to all aspects of
the ~~ork. The Contractor shall remove and make good, as may
be directed, without charge, any defective work. Oversight
or error of judgement of inspectors, or previous acceptance,
shall not relieve the Contractor from the obligation to make
good any defect whenever discovered.
The rights is reserved to change the Specifications
consistent with regard to the general intention of the
Contract for any part of the work or materials, either
befo):-e or after work has begun. Notice of such changes shall
be given in writing to the Contractor; such changes are not
to bE~ grounds for any claim by the Contractor for damages,
nor for the forfeiture of the Contract. It is possible that
a Derelict Vessel could disappear between the time of
inspection by the contractor and the actual effort to remove
it. No payment will be forthcoming in the case.
Except when otherwise specified, the expense of all tests
requE~sted by the County will be borne by the County.
12. AUDIT RIGHTS: As a provision of the grant from the State
of Florida to the County, and if so requested by the State,
the successful bidder agrees to provide access to all
recol~ds and allow the audi t of any books, documents and
papers related to this project for a period of up to one
year and during and after termination of the contract.
13. CONTFtACT AWARD: The County reserves the right to evaluate
the .submi tted bids to award a contract to the bidders
submi.tting the lowest per foot bid for the derelict vessels
listed in the bid package as one project and for which a
Flori.da Marine Patrol Derelict Vessel Report is included.
One bid will be accepted and a contract issued for the total
removral of all listed derelict vessels as one project, up to
the 1.imi t of available funds.
The vessels are to be removed in the order listed and the
per foot bid estimates should reflect this removal order.
The a.ctual number of vessels to be removed will depend on
the accepted per foot bid price and the available funds.
14 · PREWC~RK CONFERENCE: A meeting will be necessary
involving a representative of the County, the Contractor and
other parties with direct involvement prior to the signing
of th.e contract. The time and place of this conference will
be set by the County representative. At this time the
Contractor shall provide the County with a schedule as to
the order in which he proposes to remove the vessels awarded
to him.
15. CONTRACT SECURITY: The Contractor agrees to execute and
DV Specs--Page 7
deliver simultaneously with the executed contract, a
Cont~ractor' s Performance and Payment Bond. The contractor
is expected to act and deliver in good faith all work, at
the agreed price, in the allowed time. Failure to do so,
could jeopardize the contractor's reputation with the County
and potentially influence any future contracts with Monroe
Coun1ty.
16. EXEC1JTION OF CONTRACT DOCUMENTS: Due to the time frame
involved with this project, the Contractor upon notification
that he is to be awarded the contract documents for
execution, shall return said documents properly executed
alon(~ wi th any necessary bond and insurance wi thin TEN
WORKiNG DAYS. With the Contractor's cooperation, if this
period can be reduced, it will assist in acceleration the
execlltion of the contract documents.
The Contractor, by virtue of signing the Contract,
acknc)wledges that he and all his subcontractors have
satisfied themselves as to the nature and location of the
work, the general and local conditions, including, but not
restricted to, those bearing upon transportation, handling,
access to the pick-up and disposal sites; and the character
of e<;[uipment and facilities needed to perform the work.
FaillLre on the part of the Contractor to completely or
properly evaluate any factors of his costs prior to bidding
shall not form a basis for additional compensation if he is
awarded the contract.
If for any reasons, not acceptable to the County, the
Contractor does not perform, the County shall have the
right~ to levy liquidated damages against the Contractor.
Liqui,dated damages in the amount of $100 per day shall be
asses:sed against the Contractorfor any bid item awarded to
him ~rhich is not completed and accepted by the County
wi thi,n the number of calendar days specified in the
Contr'act. Liquidated damages are accumulative.
17. NOTIC~E TO PROCEED: The Contractor shall commence work
upon this project on the effective date of the Notice to
Proceed and perform in a continuous manner until
completion and acceptance by the County. For Contracts
wherein a specified number of days for completion is stated
in th,e Contract, the effective date of the "Notice to
Proceed wi th Contract Work" will establish the "beginni.ng
date" of the project.
18. TERMINATION OF CONTRACT: This Contract may be
terminated by the County, giving up to ten (10) days
written notice to the Contractor; said notice shall be
sufficient if delivered to the party personally or mailed
by certified mail to his mailing address as specified on
the accepted Bid.
DV Specs--Page 8
19. FINA:L CLEAN-UP: Upon completion of the work specified
herein and before acceptance and final payment shall be
made, the Contractor shall remove from the sites all
machinery, equipment, surplus and discarded materials and
tempc)rary structures. All disposal of materials, rubbish
and <iebris shall be made at a legal disposal site.
20. DISP<)SAL SITES AND FEES: Contractor is responsible for
disposal of all derelict vessels included in this contract
and rnust make arrangements for legal disposal. It is the
responsibility of the Contractor to pay all disposal fees
incuJrred, and such removal related costs should be
cons~i.dered when bidding on this contract.
The contractor will deliver the derelict vessel to the
disposal site, where staff must be able to verify the
derelict by its Florida Marine Patrol derelict vessel number
or by some other means. It is the intent of this contract to
remo~'e derelict vessels from their present sites a legal
present site a legal disposal site. Upon receipt of vessels
at tIle landfill. They must be disposed of inunediately.
A legal disposal site is either the Long Key
Landfill-Monroe County, MM 68 1/2, Long Key, Florida 33001,
305-664-9315, other landfills in neighboring countries or
any ()ther location for disposal as long as the FDNR
Dispc)sition Certification Form (attached) is fully
doc~lented. If a signature cannot be obtained on Florida
Department of Natural Resources Disposition Certification,
the Contractor must contact County Representative for
written approval and instructions.
21. PROOli' OF PROPER DISPOSAL AND NOTIFICATION TO MARINE
PATRC)L: Contractor must submit prior to receiving any
paymE~nt: A receipt for each vessel including the date of
disposal, the Florida Marine Patrol Derelict Vessel Number,
disposal site location, and the telephone number, title and
signature of person at disposal site verifying delivery of
said derelict vessel. A County Disposition Affidavit is to
also required to be signed by the Contractor. If vessel is
not i.dentifiable and/or if the derelict vessel number is not
visible. Recipient of debris should provide detailed receipt
showi.ng type and description of debris received. if person
delivering vessel to disposal site is other than contractor
a wri.tten statement with a description of what type of
debri.s was transported, dates, times, name, address, and
phone~ number of si te.
In addition to the above information, Contractor must
submi.t three pictures of each vessel removed. The first
photc~graph must be of the vessel at the current location
prior to removal, the second photograph must be of the
vessel after removal but in the same general area preferably
while in tow, and the third photograph must be of the vessel
DV Specs--Page 9
at tJt1e disposal site with sufficient background to depict of
disposal (i.e., building or sign identifying disposal site).
The derelict vessel number, when present, must appear in all
phot()graphs.
The (~ontractor will be responsible for the camera, film,
and development costs. The photographs should be taken with
a Polaroid camera that provides instant photos since this
rninirnizes loss of documentation due to camera malfunction or
loss overboard. This camera and film must be provided by the
ContI-actor. The photos must be submitted on a vessel by
vessel basis according to removal schedule. Without photos
to dc)cument the removal and disposal of the contracted
vessE~ls final payment can not be assured.
The (~ontractor must notify the Florida Marine Patrol and
the County Representative in writing as to the work schedule
of rE~moval. This should be done after the prework
conference with the County representative. Notification is
to be made before doing any work on each vessel. This
multj~party connnunication for each Derelict Vessel is a
requirement of the contract.
22. PAYMI~NT: All payments for the removal and disposal of
each vessel, shall be for the performance of the work as
stipulated in these specifications and associated
contractual documents. The unit rate of bid shall be totally
inclusive for all phases of the operation. Contractor may
request four partial payments by submitting an invoice for
the number of vessels removed up to the date of the invoice,
providing the Contract agreement does not explicitly
prohi.bi t partial payments. Photographs, disposal receipts,
signe~d DNR Disposition Certification form, a County
Disposition Affidavit for the vessels for which payment is
bein~r requested.
The c:ontractor understands and agrees that no payment will
be forthcoming for the removal and disposal of any derelict
vessel (1) not listed on this contract nor (2) for any
derelict vessel on this Contract "for which a written
certification verifying the removal of the subject vessel
has not been obtained from the Florida Marine Patrol and a
Repr€~sentative of the disposal site at the time of delivery.
A Flclrida Marine Patrol officer must certify the complete
removal of each derelict vessel from its location and any
equipment that may have been used to remove the vessel. No
payme~nt will be made wi thout the Florida Marine Patrol
verif'ication.
In ad,dition, property, public or private, if damaged during
the work or removed for the convenience of the work, shall
be replaced at the expense of the Contractor in a manner
accep1table to the County and the OWner, prior to the final
DV Specs--Page 10
paymE~nt for contracted work.
23. PUBLIC ENTITY CRIMES: Upon entering into the contract, the
Contractor agrees to sign and endorse the Public Entity
Crimes form (attached).
24. NON-(~OLLISION AFFIDAVIT: Upon entering into the contract,
the Contractor agrees to sign and endorse the Non-Collusion
Affidavit form (attached).
25. ETHI(~S CLAUSE: Upon entering into the contract, the
Contractor agrees to sign and endorse the Ethics Clause form
(attclched) .
26. DRUG FREE WORK PLACE FORM: Upon entering the contract, the
Contractor agrees to sign and endorse the Drug Free Work
Place form (attached).
27. DERELICT VESSELS AT ISSUE: The derelict vessels listed on
the I)erelict Vessel Bid Response Form shall be removed and
disposed of by the Contractor in accordance with the
provisions of these Specifications.
H: \A \BIF\ -'DV\DV-1993 \SPECS . NEW
DV Specs--Page 11
SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a),
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
THIS FORM l'tfUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
OFFICIAL AlJTHORIZED TO ADMINISTER OATHS.
~~~C ~U~/y
I
[print name of the public entity)
.p//?'/?~. A7fn~/c/.
(print individual's name and title) /
for ,4 7?feJlcf.s ~w-"~5
,
1.
This svvorn statement is submitted to
by
r:~.
[print name of entity submitting sworn statement]
whosel~~:ZssiS37\"J ,L}v~ 2~//--) ~>4~c/"'
./1ry vY~./,,F~ 33~~
I
and (if applicable) its Federal Employer Identification Number (FEIN) is 5 'j :);J. c; V'! Cj 2-
(If the 4entity has no FEIN, include the Social Security Number of the individual signing this sworn
statemt~nt :
.)
2. I under'stand that a "public entity crime" as defined in Paragraph 287.133(1)(g), 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 any other state or of the United States, including,
but not limited to, any bid or contract for goods cr services to be provided to any public entity or an agency or
politic~d subdivision 9f any other state or of the United States and involving antitrust, fraud,..theft, bribery,
collusion, racketeerint, conspiracy, or material misrepresentation.
3. I understand that"convicted" or "conviction" as defined in Paragraph 287.133(1)(b), Florida Statutes, means a
finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any Cederal or
state tr:ial court of record relating to charges brought by indictment or information after July 1, 1989, as a result
of a jur'y verdict, nonjury trial, or entry of a plea of guilty or nolo contendere.
4. I under'stand that an "affiliate" as defined in Paragraph 287.133(1)(a), Florida Statutes, means:
1. A p,oedecessor or successor of a person convicted of a public entity crime; or
2. An E~ntity under the control of any natural person who is active in the management of the entity and who has
been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners,
shareholders, employees, members, and agents wbo are active in the management of an affiliate. The ownership
by one person of shares constituting a controlling interest in another person, or pooling of equipment 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 has
been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate.
5. I understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statutes, 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 bindin~
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
managE~ment of an entity.
6. Based on information and ~elief, the statement which I have marked below is true in relation to the entity
submitfing this sworn statement. [Indicate which statement applies.]
~either the entity submitting this sworn statement, nor any of its officers, directors, executives, partners,
shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of
the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989.
- jrhe entity submitting this sworn statement, nor any of its officers, directors, exectutives, partners,
shareholders, employees, members, or agents who are active in the management of the entity, nor an affiliatE; of
the entity has heen charged with and convicted of a public entity crime subsequent to July 1, 1989.
- l'he entity submitting this sworn statement, or one or more of its officers, directors, executives, partners,
shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of
the entilty has been charged with and convicted of a public entity crime subsequent to July 1, 1989. However, there
has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative
Hearinl~s and the Final Order entered by the Hearing Officer determined that it was not in the public interest to
place the entity submitting this sworn statement on the convicted vendor list. [attach a copy of the final order]
I UNDER~T ANI)THA TTHE SUBMISSION OF THIS FORMTOTHE CONTRACTING OFFICER FOR THE PUBLIC
ENTITY IDENT'IFIED ON PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONL Y AND, THAT THIS
FORM IS V AL][D THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO
UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A
CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDAST A TUTES
FOR CATEGOI~Y TWO OF ANY CIIANGE IN THE INFORMATION CONTAINED IN THIS FORM.
~::I /~~
..
[signature]
Sworn to and subscribed before me this
>~
3
/
day of /"}/" Ve-,?'/ 6~ /'
, 19
7~/
Personally known
v
OR Produced id,entification
Notary Public - State of r ~
'~!otary ~u~:;:, S?cf.,~ of Fkdco
My Commission MrpiooR1isr,icn Expire~ Mnrrh 'l" 1995'
C 4rf//9 87..r.uTro~~~~
(Printed typed or stamped ~
commissioned name of notary public)
(Type of identifit~ation)
Form PUR 7068 (Rev. 06/11/92)
SWORN STATEMENT UNDER ORDINANCE NO. 10-1990
MONROE COUNTY, FLORIDA
ETIIICS C~LAusifE .
LJ-72/-~ / ~ ~ //. /C;
~/-'J~'~/~ ~ / vVY/ /Y / warrants that he/it has not employed,
9 /
retained or otherwise had act on his/its 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 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 form~ co~nty officer or employee.
;(YaUd ~
(signature)
Date: /;;/ 7~V
STATE OF'
F /c~ / -cI;;
~~~C
COUNTY C>F
Subscribed and swor~o (or affirmed) before
me on //- -3 -7~ (date) by
~0t:l7?/~ X. A7f~/~name of affiant).
~
-Be/~;he is personally known to me or has produced
as identification.
(type of identification)
,.... Not.rry Pubfjc, State of Florier. ........
My COIl1l1'1ission Expires March 24, 199J'
Bonded Tbru Troy fain · Insurance Inc:.
~'7r
NOTARY PUBLIC
C/cn/;<J /-{. ;ZS~dr~
MCPD4 RI~V. 2/92
NON-COLLUSION AFFIDAVIT
~~:n-? 7). Ax~J
,
~~rr?54 c
I ,
~d,y'/y
, of the .e-iLy'
of
according to law on my oath, and
under penalty of perjury, depose and say that;
1) I am A;iii;>y(;j~ /" "?w/ ~
making the Proposal for the project describe
, the bidder
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 inl 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
competi ta~r; and
4) no attempt has been made or will be made by the bidder to
induce an,y other person, partnership or corporation to submi t, 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
r~r5".'~
~N'~~C
F~ ;'( t22~U---t;J
(Signature of Bidder)
! //~ /'7 j/
I / DATE
COUNTY OF
PERSONALLY APPEARED BEFO~, the undersigned authority,
::L==>cr~~ '-X. 471'NP!t.Who, after first being sworn by me,
(name of individual signing)
affixed his/her signature in the space provided above on this
3-rsel day Of~~dfbF7 ' 19~
~.-~~.r-
NOTARY PUBLIC
My commission expires:
..- "ofary "'1r~ Staf. of Frorfclt---""
IIr Commissiot~ Expires March 24, 1 f9S
Iond,d Thrl~ Troy Foin . In5uronce Inc.
C 4?5/~ /4'. p~d"rd
DRUG-FREE WORKPLACE FORM
The tlnder:3igned vendor ill acC()rdallCe wi tll Florida Stattlte
287. 087 hl~reby certifi0~at: ___
--------.---..... de~~;;~B~Z:~;,yJ
1. Pllblisll a statemellt t10ti fying elnployees tllat tlle \lnlawflll
manllfacttlre, distrib\ltion, dlsperlsing, possessioll, or use of a
controlled substance is prollibited in the workplace and
specifying the actions that will be talten against employees for
violatiolls of stIch prohibi tion.
2. Inf10rm employees abO\lt tIle dangers of drtlg abtlSe in the
workplace, tIle btlSilless's policy of maintaining a drtlg--free
workpl ace, any ava i lab 1 e d r\lg CO\lnSe 1 i Ilg , rellabi 1 i ta t i on, and
employee assistance programs, alld the penalties that may be .
imposed tl]pOn employees for drtlg ab'llSe violations.
3 . Gi Vle eacll employee ellgaged ill provi di 11g tIle commodi ties or
contrac ttl.a 1 servi ce s tha tare tl11der bid a copy of tIle sta temen t
specified ill stlbsection (1).
4. In the statemellt specified ill stlbsectioIl (1), 110tify the
employees tllat, as a condi tioll of working on tIle commod! ties or
contracttl,al services tllat are tInder bid, tIle employee wi 11 abide
by the terms of the statement and will notify the employer of
any COllviction of, or plea of gttilty or 11010 contendere to, any
violation of Chapter 893 (Florida statutes) or of any controlled
8tlbstal1ce 1 aw of the Un i ted sta tes or allY s ta te, for a vi 0 1 a ti on
occllring in tIle worh:place 110 later t.ll Cl 11 five (5) days after such
conviction.
5 . Impose a sanction on, ()r reqll ire tIle sa ti sfactory
participation in a dr\lg abltSe assistallce or rellabilitation
program if SllC}l is available ill the employee's COmm\lllity, or any
employee who is so convicted.
6. Mah:e a good faitll effort to COlltilllle to maiIltain a
drug- free workpl ace tllrotlg)l i rnplemerl ta ti 011 of tIli 8 secti on.
As the perSOll atltllorized to Sigll tlle statelnerlt, I certify tllat
this firm cOln()lie's f\\lly witll tIle above reqlliremetlts.
-A~.~~~~
Bidders Sj.gnature
/1 !J/C;y
I Da te
MCP#5 REV. 6/91
,.. '. UI.JI)' ' SPECIALTY INSURIINCE COMPANY i"'.l~
\.. ..,,~.:.. MANCHES~:!:. NrW HIIMPSWRE , _, _, .....,../;\..,. "r ."... ".,' .'" _, ., " " _ '__
r '( l!lCY ':UMIR~;'~""\"'''' " .1I ~~~~nl i;;; A' ~~: 'r\l~; ~/ 'At ~{ ~ ",*:i'l: i,: ~~..;.,;';." ~ ~;;,' .' 1\<.: ~.: ',~!'
I .. .. 12:Ul AM SIO TIME AT nil: AUUHLSS
17002CA332211-01 4-30-94 TO 4-30-95 UF THE INSUREU ASSlbNED Ul:KEHI.
l_ _._
, ~m~"'~--;rl'~i1.~~1!~:(4}~~.
rJ/V,Hrl
IrJ'~I""n
/ I J I ,
'''^'l. If JG
^Dflnr~s
wrOLD's TOWI NG S ER VI CE
AIUirOLD'S AUTO & MARINE REPAIR. INC. NAME
5540 3RD AVE. AND
KEY WEST. FL 33040 ADDRESS
I. ',' ' ''':~~ If.~'''~f[~' E~~, · " ,w",
If' Ii ~.it+. !i.t'HjD~ ~'L,\!.;l".~;~'__5f'~ ~~~~\~!~~~I?~.:..c'.: .c..,~.2:.: ~~il1f~~~,~' t
A~ENT NO:
17002
INC.
STE.
COMMON POLICY OEClARAlIONS
UUSINESS DESCRIPTIUN
TOWING
---......~~--...-...-...-.-.-..-._~
pt- ~~
.4
Ir~ RETURN FOR THE PAYMENT OF THE PREMIUM, ANO SUBJf:CT O::'ALt THE TERMS Of TH
POLICY. WE AGREE kITH YOU TO PROVIDE THE INSURANC~ A 5~1AtEO IN THIS PULICY
,~:..: \ :..f' q
'IllS POLICY CONSISTS OF THE FULLOWING CUVERAGE P
FO~ WIUCH A PREMIUM IS INDICA fEO. THI 2.., HIUM
BE SUB.Jt:CT TO AOJUS TMt.:Nl. ,~.
C UHI1E R(: 1 AL
CUHHER(: IAl
L lJHHE RC: I Al
CUMMERCIAl
l:OMMERCIAl
------
1 nL___.
-----~~, .........-,
---~-
PRlMIUH SHOWN
TUTAL
INCEPlION. $___
S --_J.2..L 9 54
"'-----
.~:'Jo;. . .
--------------------------
--- --------.....----
--------------- -----
C DUN r ER S I GI~f: 0___________ ti y ___________________________
(OATE) (AU1HORIlE::D Rt;PRE:Sl;N~rlV~)
~ .
~ff~o/-1' ~}.n9G1 - ~"'y?7-5$Ad//,7/;y-/ C7/ /o~~ q~
-Z:: ...y"'s G" n/'Sl,...,r r' E"
-_K Y.G..2=!.~~~__________ ___________
~ -~-~~~~~~~~~~~~~
~Hh=~5V.~
It. I > ,~. . ~.j:i,\~.!f"" r . t: J:!~t.'fai~~"\~~~.r\....,. .~1l~'" .-.'ft'ri !:J "~p .,. ..1 ~
'='NA-1t)OO fRpV~1 . ~ rtTw.l~ -',1. .,. f. _ .
~ II li'Vy~.....
tJ\-d';'~4tl1.;.. >oj, v\J" Li:'\lu kO i U~ V uU UWl'4 (tonrdlt
r - -- ... ----DUeIlIPTlON---PURCHASEO------ m __________________ ___
-- J----- '----YurModel; !rlde N'IlIf; Bod, IJIlf ----~- Actual N(W IN) TERRITORY: Town &. Stale ~~'e the Covered
,.]!~ j ~ ~ Z - CIIE ~~~~ ~u;;r IjlV~~~ ~~li"C'I~ lfumbel JVlL --- -- ----. J :r:n~~~l New Cosl & us~o lUI f{ F. Y WF.~ ~to :'; be prlncIPll~~ ~a~a~ed
· Jll_ J2136_{;HEVROLET '158~~8 .--_9...000N It "
,JU- -J22LFORD #A15353 38.000 N II It
· ~~- 1987 INTERNATIONAL #46512Q 20.aOON It It
I ~-.- 1979 LANDOLL TRAlJ.ER 1079298 20.000 N It_ "
~ ~~-- _1.994 INTERNATIONAL #551465 45.000 Nit"
! ,::--. 1966 GMC "'DL023L It II
t.;f~-
i~
~--
t
r t r-----. ---~ _
i f
C8Y[UCfS-'REItIII$. lfllITS AfIlIIEDUCnlUS (Absence of · deductible or HIIIft entrr In IllJ CGlulllll below IIItlltlS that the limit or deductible entry In tile CCIllISI*ldin.
ITEM TWO coftim" ~..s instad)
I'ERSlM I!WRY PROfECrm AUTO. MED. PAY. ~ UNlNSURifl.srs COMPREIOSM ~. f:lS
limit limit Limn
(In Pre (1ft Pre. (1ft
Thou. mtum Thou. mium Thou.
UM~ u.~ u.~
'"---- - ---'--
r-- --..___~
r-- ---.-__.._
~ , c..e, ~'~f - p-. Bu'Jnf~s uS!
-. Alto Op", at ion : : =~
I .. (In "'I~S) c . commercilf
I 0l--50-~- C
02 50 S
J!~- _~Q__ c
, 04 50 C
05- ---50' c
, 06 5G C
~--
I 07 50 C
I =---
t ~ .-------
r---. -"'_ _
,.
.; r----- --___ ___
)
~ --.------.-.
. r---. _ "_ _
r----- - -.-- __. __'_ _
UAefUTY
. ~- Limit
'.IM (In
.... Thou. "'mi.,"
.. '1fId"
01 1348
02 999
03 1348
104 2213
05 149
06 1348
07 1348
,.
ClASSIFICATION
Size GW/, GCW Act Primary R .tinl
Of Vthide factor
Seatinl Capacity Group li,b. Ptty. O''''',e
14.500 6 l.35 ..95
6 1.00 1___0.0
14~500 6 L .3.5 .95
'26.1000 6 2.10 1.25
6 .15 .65
18~500 1 l.35 .95
14,500 l.35
Second,,,
Rafinl Code
F Ie tor
23.9 99
01499
23499
36499
58499
U4.9..2
. ... ~J9.99
Except for Towinr aff phy~ka' dam'g! toss is payab'~ to you and the 'oss
PI)ft named below as interest may appear at the time of the loss
COlLISION
I
1
j
i
f
I
I
I
J
j
I
!
i
I
I
TOWftG & lABOR
Pre.
mium
u..
IIincts
....;..,
....
.....
Limit
PrettWm "' Db. Prenrivm
....1Mftt
Pre-
....um
limit-
Prtmiom
17 17 170 30.1
17 17 48 85
17 17 221 . 1Q~
17 17 119 21_1
17 62 1 ) I
17 17 422 ]!i~
17 17
-
Total Premium --8753---XXX 119 XXX
xxxxx
102.ill 1042
XXXX l_Bli~ ill
.li"';f st.~ i,. Iff. TWO.
hem Stv'n In G': :j!t Covera~e Form - HonOurtrs' and Trailers Dealt/$' Supplementary Sr.htdule
ftfm T tn in Gar a p. fove' a~' r or m - jlu! 0 De alers' Supplementary Schedule.
, 191 ([ d 1 1 n 7) ,"'..,... '"""'N; 1 ~11'1'1' "'C
\/1 ~L \...-u Vt:tiAGE PART
MOTOR TRUCK CARGO DECLARA TlONS
i
f
Policy No. 17002CA33224-01
Effective Date. 4- 30-94
12.01 A. M. I Standard Time
DESCRIPTION
A. Covered Cargo consists of:
DO VEHICLES AHOloR CARGO WHILE 1) BEING ATTENDED "ON HOOK"; 2) "UNDER TOW"; 3) "BEING TRANSPORTED."
o OTHER__
(Describe Cargo)
LIMITS OF INSURANCE
1. Each vehicle that is covered must be described below or on a schedule that is a part of this policy A limit of Insurance
must be shown for each vehicle. This is the most that we will pay for a loss to cargo carried in or on the vehicle.
2. Descriptio~. of Vehicle:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
Trade Nam4!
01
02
03
04
05
06
07
Year Built
Type of Body
Factory or Motor Number
Limit of Insurance
$ 50,000
$ NO COVERAGE
$-..50.000__
S so .000
$ Nn (!nV"..GE
S Ii n , non
$ 1)0,000
$
$
$
3 F or two or more' described vehicles Involved in 8 single 10ss", the most we will pay for this 10ss" is: $ I nO .OOQ
.~
..
DEDUCTIBLE
The deductible amount I~f S 1 ,000 will apply to each loss aner all other adjustments have been made.
RA TE AND PREM'Uft~
Rate S VARIOUS
FORMS AND ENDORSEMENTS (other than applicable Forms and Endorsements shown elsewhere In lhe polley)
Forms and Endorsements applying to this Coverage Form and made part of this policy at time of issue:
Premium for this Coverage Form $ 1,000
NAS-MTC -DEe (06/93J
THESE OEClARA TIONS ARE PART OF THE POlICY OEClARA TIONS CONT AININO THE NAME Of THE INSURED ANO THE POlICY PERIOD
.. Inclusion of dale Optional
LA 591
(6-92)
~
t,
-;,
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CA 25 14 06 92
BROADENED COVERAGE-GARAGES
This endorsernent modifies insurance provided under the following:
GARAGE COVERAGE FORM
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below,
Endorsement effective Policy No.
at 12:01 A.M. standard time
Named Insured Countersigned by
SCHEDULE
(Authorized Representative)
Personal Injur)' and Advertising Injury Limit of Insurance $~uu.500~OjL___
The FIRE LEGAL LIABILITY COVERAGE Limit of Insurance is $50,000 for anyone fire unless another limit is shown below:
Fire legal Liability Limit of Insurance $____________~_____~
The premium fOr this endorsement is $---_-19L___
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as ap-
plicable to this endorsement.) ..
SECTION I-PERSONAL INJURY AND ADVERTISING IN-
JURY liABILITY COVERAGE
A. COVERAGE,
We wilt pay at! sums the "insured" legally must pay as
damages bt~cause of:
a. "~rsona' injury" caused by an offense committed:
(1) In the conduct of your business;.fnd
(2) In the Coverage Territory during the Policy
Period.
b. ~vertising injury" caused by an offense com-
mitted:
(1) In the course of advertising your goods, prod-
ucts or -services; and
(2) I n the Coverage Territory during the Policy
Period.
We have the right and duty to d~fend any "suit" asking
for these darnages. HO\Never, we have no duty to de-
fend "suits" for "personal injury" or "advertising injury"
not covered by this Coverage Form. We may investigate
and settle any claim or Usuit" as we consider appropri-
ate. Our dut~r to defend or settle ends when the Per-
sonal Injury and Advertising Injury Limit of Insurance
has been exhausted by payment of judgments 'Or set-
tlements.
1. WHO IS AN INSURED
The following are "insureds":
...... ., ~\ "'., -......,..,.....
OAUTHENTJCO
'''.~-:::::":~'''' \".
I. You and your spouse.
b. Your partners and their spouses, if you are a
partnership. None of your partners or their
spouses is an "insured" for "personal injury"
or "advertising injury" resulting from the con-
duct of any other partnership.
c. Your employees, executive officers, directors
and stockholders but only white acting within
the scope of their duties.
2. COVERAGE EXTENSIONS
Supplementary Payments. In (}ddition to the Per-
sonallnjury and Advertising Injury Limit of Insur-
ance,. we will pay for the "insured":
3. All expenses we incur.
b. The cost of bonds to release attachments in
any "suit" we defend, but only for bond
amounts within the Personal Injury and Ad-
vertising Injury Limit of Insurance.
c. All reasonable expenses incurred by the "in-
sured" at our request, including actual loss of
earnings up to $100 a day because of time off
from work.
d. Aft costs taxed against the uinsured" in any
"suit" we defend.
e. All interest on the full amount of any judgment
that accrues after entry of the judgment in any
Copyright, Insurance Services Office, fnc., 1991
1
....LECTING NOT TO PURCHASE CERTAIN VALUABLE COVERAGE WHICH PROTECTS
,11'10 YOllk ~AMllY OR YOU ARE PURCHASING UNINSURED MOTORIST LIMITS LESS THAN
.tJUR BODfLY "~JURY LIABILITY LIMITS WHEN YOU SIGN THIS FORM. PLEASE READ
CAREFULLY.
Uni,lsured Motorist coverage provides for payment of certain benefits for damages caused by owners or operators of unin-
sured motor vehicles because of bodily injury or death resulting therefrom. Such benefits may include payments for cer-
tain medical expenses, lost wages, and pain and suffering, subject to limitations and conditions contained in the policy.
For the purpose of this coverage, an uninsured motor vehicle may include a motor vehicle as to which the bodily injury
limits are less than your damages.
Florida law requires that autonlobile liability policies include Uninsured Motorist coverage at limits equal to the Bodily
Injury Liability limits in your policy unless you select a lONer limit offered by the company, or reject Uninsured Motorist entirely.
Please indicate wheth,=r you desire to entirely reject Uninsured Motorist coverage, or, whether you desire this coverage
at limits lower than the Bodily Injury Liability limits of your policy:
o a. I hereby reject Uninsured Motorist coverage.
iJ b. I hereby select the following Uninsured Motorist limits which are lower than my Bodily Injury Liability limits:
$ 30. C:f:X) each person (enter limit if applicable);
$ ~ 1'\ rvrY'\ each accident.
~.~
o c. I hereby select Un;nsured Motorist limits equal to my Bodily Injury Liability limits. (If you select this option dis-
regard the bold face statement above.)
ELECTION OF NON-STACKED COVERAGE
(Do not complete if you have rejected Uninsured Motorist)
You have the option to purchase, at a reduced rate, non-stacked (limited) type of Uninsured Motorists coverage. Under
this form if injury occurs in a vehicle owned or leased by you or any family member who resides with you, this policy
will apply only to the extent of coverage (if any) which applies to that vehicle in this policy. If an injury occurs while occupy-
ing someone else's vehicle, or you are struck as a pedestrian, you are entitled to select the highest limits of uninsured
motorist coverage available on anyone vehicle for which you are a named insured, insured family member, or insured
resident of the named insured's household. This policy will not apply if you select the coverage available under any other
policy issued to you or the policy of any other family member who resides with you.
If you do not elect to purchase the non-stacked form, your policy limit(s) for each motor vehicle are added together (stacked)
for all covered injuries. Thus, your policy limits would aufomatically change during the policy term if you increase or decrease
the number of autos covered under the policy.
~ I hereby elect the non-stacked form of Uninsured Motorist coverage.
I understand and agree that selection of any of the above options applies to my liability insurance policy and future renew-
als or replacements of such policy which are issued at the same Bodily Injury Liability limits. If I decide to select another
option at some future time, r must let the Company or my agent knQ\A/ in writing.
SigneQ~ u/ Cl~
(Named Insured)
Signed: ~j~ ~U
(Na~d Insured)
Date:
~d{ d9
;:;~y
ALB859c (rd. 10.87) UNIrORM PP'NIING t SUPPLY, INe.
R.(~ollJl ion 1/ J 91- (991
April 12. (f)9.\
I ~1 Printing
I\tIONROE COUNTY, FLORIDA
Request For Waiver
of
Insu ranee RequircRlents
H is requesled Ulallhe insurance rcquircHlcnls, as specified in the COUllty'S Schedule of IlISUfC-U1CC
RcquircIlllcnls, be \vaivcd or 1110dificd on lhe follo\-ving conlract .
Coulraclor:
Arnold's Towin~
Conlracl for:
Em~rgency Reoval of DV091779
Address of Contraclor:
1i1l40 1rd Av~nl1e Stock Island
Key West~ Fl 330&0
Phone:
(3~5)'296-9182
Scope of 'Work:
Emer~encv Removal of DV091779
Reason for Waiver:
Please waive watercraft insurance ~_.vessels used in
removal-very near shore), pollution insurance (a Tr~Maran
sailing vessel-no fuel on boa~-Land Jones Act coye~age.
~
tV
~/4
Signature of Cont.rnctor:
Approved
'"
)<
Not Approved
Risk Mana:gclllenl
~ ./
I .\~.
I J /c. -'-~:l'-~,--'"
, -, i ""\ / / t',' ..'"
/ .... ) / .' '.-~.' I '// ''--(
j. """-"" .....
Date
Counl)' Adrninislralor appeal:
ApIJrov~d:
Nol Approved: _._____
Date:
Board of Counly COlllltlissioncrs appeal:
Approved:
Not Approved: __.___
Meeting Date:
Ad.ninistrativc rnstrudiof1
WAIVER
114709. J
5