10/20/1993
THE
AMERICAN
INS TIT UTE
o F
ARCHITECTS
.
AlA Document B151
Abbreviated Form of Agreement
Between Owner and Architect
for Construction Projects of Limited Scope
1987 EDITION
THIS DC)CUMENT HAS IMPORTANT LEGAL CONSEQUENCES; CONSULTATION WITH
AN A TTORNEY IS ENCOURAGED WITH RESPECT TO ITS COMPLETION OR MODIFICA TION.
AGREEMENT
made as of the
Nineteen Hundlred and
dO~
day of
October
in the year of
ninety-three.
BETWEEN the'Owner:
(Name and address) BOARD OF COillJT)~ CO~ISSIOrJERS
County of Monroe
500 Whitehead Street
Key West, FL 33040
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and the Architect:
(Name and address)
BErID]~R & DELAillJE ARCHITECTS, P. A.
720 Caroline Street
Key West, FL 33040
For the followirlg Project:
(Include detailed descnjJtion of Project, location, address and scope.)
Renovation of the SHERIFF'S SUBSTATIOrJ
ArID TAX COLLECTOR'S OFFICE
Courthouse Annex
Marathon, Florida
The Owner and. Architect agree as set forth below.
Copyright 1974,1978, @ 1987 by The American Institute of Architects, 1735 New York Avenue, N.W., Washington, D.C. 20006.
Reproduction of the material herein or substantial quotation of its provisions without written permission of the AlA violates the
copyright la~Ts of the United States and will be subject to legal prosecution.
AlA DOCUMENT 8151 · ABBREVIATED OWNER-ARCHITECT AGREEMENT. THIRD EDITION. AIA@ . @ 1987
THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W., WASHINGTON, D.C. 20006
8151-1987 1
WARNING: Unlicensed photocopying violates U.S. copyright laws and is subject to legal prosecution.
TERMS .AND CONDITIONS OF AGREEMENT BETWEEN OWNER AND ARCHITECT
ARTICLE 1
ARCHITECT'S RESPONSIBILITIES
1.1 ARCHITEC:T'S SERVICES
1.1.1 The Architect's services consist of those services per-
formed by the Architect, Architect's employees and Architect's
consultants as enulnerated in Articles 2 and 3 of this Agreement
and any other services included in Article 12.
1.1.2 The Architect's services shall be performed as expedi-
tiously as is consistent with professional skill and care and the
orderly progress of the Work.
1.1.3 The services covered by this Agreement are subject to
the time limitations contained in Subparagraph 11.5.1.
ARTICLE 2
SCOPE OF ~'RCHITECT'S BASIC SERVICES
2.1 DEFINITION
2.1.1. The Architect's Basic Services consist of those described
under the three phases identified below, any other services
identified in Article 12, and include normal structural, mechani-
cal and electrical engineering services.
2.2 DESIGN P."ASE
2.2.1 The Architect shall review with the Owner alternative
approaches to design and construction of the Project.
2.2.2 Based on the mutually agreed-upon program, schedule
and construction budget requirements, the Architect shall
prepare, for approval by the Owner, Design Documents con-
sisting of drawings and other documents appropriate for the
Project, and shall submit to the Owner a preliminary estimate of
Construction Cost.
2.3 CONSTRU<:TION DOCUMENTS PHASE
2.3.1 Based on the approved Design Documents, the Architect
shall prepare, for approval by the Owner, Construction Docu-
ments consisting of Drawings and Specifications setting forth in
detail the requirements for the construction of the Project and
shall advise the ()wner of any adjustments to previous
preliminary estimates of Construction Cost.
2.3.2 The Architect shall assist the Owner in connection with
the Owner's responsibility for filing documents required for
the approval of governmental authorities having jurisdiction
over the Project.
2.3.3 Unless provided in Article 12, the Architect, following
the Owner's approval of the Construction Documents and of
the latest preliminary estimate of Construction Cost, shall assist
the Owner in obtaining bids or negotiated proposals and assist
in awarding and preparing contracts for construction.
2.4
CONSTRUCTION PHASE-ADMINISTRATION
OF THE CONSTRUCTION CONTRACT
2.4.1 The Architect's responsibility to provide Basic Services
for the Construction Phase under this Agreement commences
with the award of the Contract for Construction and terminates
at the earlier of issuance to the Owner of the final Certificate for
Payment or 60 days after the date of Substantial Completion of
the Work.
2.4.2 The Architect shall provide administration of the Con-
tract for Construction as set forth below and in the edition of
AlA Document A20I, General Conditions of the Contract for
Construction, current as of the date of this Agreement.
2.4.3 Duties, responsibilities and limitations of authority of the
Architect shall not be restricted, modified or extended without
written agreement of the Owner and Architect with consent of
the Contractor, which consent shall not be unreasonably
withheld.
2.4.4 The Architect shall be a representative of and shall advise
and consult with the Owner (1) during construction until final
payment to the Contractor is due and (2) as an Additional Ser-
vice at the Owner's direction from time to time during the cor-
rection period described in the Contract for Construction.
2.4.5 The Architect shall visit the site at intervals appropriate
to the stage of construction or as otherwise agreed by the
Owner and Architect in writing to become generally familiar
with the progress and quality of the Work completed and to
determine in general if the Work is being performed in a man-
ner indicating that the Work when completed will be in accor-
dance with the Contract Documents. However, the Architect
shall not be required to make exhaustive or continuous on-site
inspections to check the quality or quantity of the Work. On
the basis of on-site observations as an architect, the Architect
shall keep the Owner informed of the progress and quality of
the Work, and shall endeavor to guard the Owner against
defects and deficiencies in the Work. (J1;lore extensiz 'e site
representation may be agreed to as an Additional Serz'ice, as
described in Paragraph 3.2.)
2.4.6 The Architect shall not have control over or charge of
and shall not be responsible for construction means, methods,
techniques, sequences or procedures, or for safety precautions
and programs in connection with the Work, since these are
solely the Contractor's responsibility under the Contract for
Construction. The Architect shall not be responsible for the
Contractor's schedules or failure to carry out the Work in
accordance with the Contract Documents. The Architect shall
not have control over or charge of acts or omissions of the
Contractor, Subcontractors, or their agents or employees, or of
any other persons performing portions of the Work.
2.4.7 The Architect shall at all times have access to the Work
wherever it is in preparation or progress.
2.4.8 Based on the Architect's observations and evaluations of
the Contractor's Applications for Payment, the Architect shall
review and certify the amounts due the Contractor.
2.4.9 The Architect's certification for payment shall constitute
a representation to the Owner, based on the Architect's obser..:
vations at the site as provided in Subparagraph 2.4.5 and on the
AlA DOCUMENT 8151 · ABBREVIATED OWNER-ARCHITECT AGREEMENT. THIRD EDITION. AIA@ . @ 1987
THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W., WASHINGTON, D.C. 20006
8151-1987 2
WARNING: Unlicensed photocopying violates U.S. copyright laws and is subject to legal prosecution.
data comprising the Contractor's Application for Payment, that
the Work, to the best of the Architect's knowledge, informa-
tion and belief, has progressed to the point indicated and that
quality of the Work is in accordance with the Contract Docu-
ments. The issuance of a Certificate for Payment shall not be a
representation that the Architect has (1) made exhaustive or
continuous on-site inspections to check the quality or quantity
of the Work, (2) reviewed construction means, methods, tech-
niques, sequences or procedures, (3) reviewed copies of requi-
sitions received from Subcontractors and material suppliers and
other data requested by the Owner to substantiate the Contrac-
tor's right to payment or (4) ascertained how or for what pur-
pose the Contractor has used money previously paid on
account of the Contract Sum.
2.4.10 The Architect shall have authority to reject Work which
does not conform to the Contract Documents and will have
authority to require additional inspection or testing of the
Work whenever, in the Architect's reasonable opinion, it is
necessary or advisable for the implementation of the intent of
the Contract Documents.
2.4.11 The Architect shall review and approve or take other
appropriate action upon Contractor's submittals such as Shop
Drawings, Product Data and Samples, but only for the limited
purpose of checking for conformance with information given
and the design concept expressed in the Contract Documents.
The Architect's action shall be taken with such reasonable
promptness as to cause no delay. The Architect's approval of a
specific item shall not indicate approval of an assembly of
which the item is a component. When professional certification
of performance characteristics of materials, systems or equip-
ment is required by the Contract Documents, the Architect
shall be entitled to rely upon such certification to establish that
the materials, systems or equipment will meet the performance
criteria required by the Contract Documents.
2.4.12 The Architect shall prepare Change Orders and Con-
struction Change Directives, with supporting documentation
and data if authorized or confirmed in writing by the Owner as
provided in Paragraphs 3.1 and 3.3, for the Owner's approval
and execution in accordance with the Contract Documents,
and may authorize minor changes in the Work not involving an
adjustment in the Contract Sum or an extension of the Contract
Time which are not inconsistent with the intent of the Contract
Documents.
2.4.13 The Architect shall conduct inspections to determine
the dates of Substantial Completion and final completion and
shall issue a final Certificate for Payment.
2.4.14 The Architect shall interpret and decide matters con-
cerning performance of the Owner and Contractor under the
requirements of the Contract Documents on written request of
either the Owner or Contractor. The Architect's response to
such requests shall be made with reasonable promptness and
within any time limits agreed upon. When making such inter-
pretations and initial decisions, the Architect shall endeavor to
secure faithful performance by both Owner and Contractor,
shall not show partiality to either, and shall not be liable for
results of interpretations or decisions so rendered in good faith.
ARTICLE 3
ADDITIONAL SERVICES
3.1 Additional Services shall be provided if authorized or con-
firmed in writing by the Owner or if included in Article 12, and
they shall be paid for by the Owner as provided in this Agree-
ment. Such Additional Services shall include, in addition to
those described in Paragraphs 3.2 and 3.3, budget analysis,
financial feasibility studies, planning surveys, environmental
studies, measured drawings of existing conditions, coordina-
tion of separate contractors or independent consultants, coor-
dination of construction or project managers, detailed Con-
struction Cost estimates, quantity surveys, interior design, plan-
ning of tenant or rental spaces, inventories of materials or
equipment, preparation of record drawings, and any other ser-
vices not otherwise included in this Agreement under Basic Ser-
vices or not customarily furnished in accordance with generally
accepted architectural practice.
3.2 If more extensive representation at the site than is
described in Subparagraph 2.4.5 is required, such additional
project representation shall be provided and paid for as set
forth in Articles 11 and 12.
3.3 As an Additional Service in connection with Change
Orders and Construction Change Directives, the Architect shall
prepare Drawings, Specifications and other documentation and
data, evaluate Contractor's proposals, and provide any other
services made necessary by such Change Orders and Construc-
tion Change Directives.
ARTICLE 4
OWNER'S RESPONSIBILITIES
4.1 The Owner shall provide full information, including a pro-
granl which shall set forth the Owner's objectives, schedule,
constraints, budget with reasonable contingencies, and criteria.
4.2 The Owner shall furnish surveys describing physical char-
acteristics, legal limitations and utility locations for the site of
the Project, a written legal description of the site and the ser-
vices of geotechnical engineers or other consultants when such
services are requested by the Architect.
4.3 The Owner shall furnish structural, mechanical, chemical,
air and water pollution tests, tests for hazardous materials, and
other laboratory and environmental tests, inspections and
reports required by law or the Contract Documents.
4.4 The Owner shall furnish all legal, accounting and insurance
counseling services as may be necessary at any time for the
Project, including auditing services the Owner may require to
verify the Contractor's Applications for Payment or to ascertain
how or for what purposes the Contractor has used the money
paid by the Owner.
4.5 The foregoing services, information, surveys and reports
shall be furnished at the Owner's expense, and the Architect
shall be entitled to rely upon the accuracy and completeness
thereof.
4.6 Prompt written notice shall be given by the Owner to the
Architect if the Owner becomes aware of any fault or defect in
the Project or nonconformance with the Contract Documents.
4.7 The proposed language of certificates or certifications
requested of the Architect or Architect's consultants shall be
submitted to the Architect for review and approval at least 14
days prior to execution.
3 8151-1987
AlA DOCUMENT 8151 . ABBREVIATED OWNER-ARCHITECT AGREEMENT · THIRD EDITION · AIA@ · @ 1987
THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W., WASHINGTON, D.C. 20006
WARNING: Unlicensed photocopying violates U.S. copyright laws and is subject to legal prosecution.
ARTICLE 5
CONSTRUCTION COST
5.1 DEFINITION
5.1. 1 The Construction Cost shall be the total cost or esti-
mated cost to the ()wner of all elements of the Project designed
or specified by the Architect.
5.1.2 The Construction Cost shall include the cost at current
market rates of labor and materials furnished by the Owner and
equipment designed, specified, selected or specially provided
for by the Architect, plus a reasonable allowance for the Con-
tractor's overhead and profit. In addition, a reasonable allow-
ance for contingencies shall be included for market conditions
at the time of bidding and for changes in the Work during
construction.
5.1.3 Construction Cost does not include the compensation of
the Architect and AJchitect's consultants, the costs of the land,
rights-of-way, financing or other costs which are the respon-
sibility of the Owner as provided in Article 4.
5.2 RESPONSIBILITY FOR CONSTRUCTION COST
5.2.1 It is recognized that neither the Architect nor the Owner
has control over the cost of labor, materials or equipment, over
the Contractor's methods of determining bid prices, or over
competitive bidding, market or negotiating conditions. Accord-
ingly, the Architect cannot and does not warrant or represent
that bids or negotiated prices will not vary from any estimate of
Construction Cost or evaluation prepared or agreed to by the
Architect.
5.2.2 No fixed limit of Construction Cost shall be established
as a condition of this Agreenlent by the furnishing, proposal or
establishment of a Project budget, unless a fixed limit has been
agreed upon in writing and signed by the parties hereto. Fixed
limits, if any, shall be increased in the amount of an increase in
the Contract Sum occurring after execution of the Contract for
Construction.
5.2.3 Any Project budget or fixed limit of Construction Cost
may be adjusted to reflect changes in the general level of prices
in the construction industry between the date of submission of
the Construction I)ocuments to the Owner and the date on
which proposals are sought.
5.2.4 If a fixed limit of Construction Cost is exceeded by the
lowest bona fide bid or negotiated proposal, the Owner shall:
.1 give written approval of an increase in such fixed
limit;
.2 authorize rebidding or renegotiating of the Project
within a rea."onable time;
.3 if the Project is abandoned, terminate in accordance
with Paragraph 8.3; or
.4 cooperate in revising the Project scope and quality as
required to reduce the Construction Cost.
5.2.5 If the Owner chooses to proceed under Clause 5.2.4.4,
the Architect, without additional charge, shall modify the Con-
tract Documents as necessary to comply with the flXed limit, if
established as a condition of this Agreement. The modification
of Contract Documlents shall be the limit of the Architect's
responsibility arising out of the establishment of a flXed limit.
The Architect shall be entitled to compensation in accordance
with this Agreement for all services performed whether or not
the Construction Phase is commenced.
, ARTICLE 6
USE OF ARCHITECT'S DRAWINGS,
SPECIFICATIONS AND OTHER DOCUMENTS
6.2 Submission or distribution of documents to meet official
regulatory requirements or for similar purposes in connection
with the Project is not to be construed as publication in deroga-
tion of the Architect's reserved rights.
ARTICLE 7
ARBITRA TION
7.2 In no eve
the date w n institution of legal or equitable roceedings
based on ch claim, dispute or other matter in ques 'on would
be barr by the applicable statutes of linlitations.
7.3 he award rendered by the arbitrator or arbitrators sh be
f aI, and judgment may be entered upon it in accordance w
applicable law in any court having jurisdiction thereof.
ARTICLE 8
TERMINATION, SUSPENSION OR ABANDONMENT
8.1 This Agreement may be terminated by either party upon
not less than seven days' written notice should the other party
AlA DOCUMENT 8151 · ABBREVIATED OWNER-ARCHITECT AGREEMENT. THIRD EDITION. AIA@ . @ 1987
THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W., WASHINGTON, D.C. 20006
8151-1987 4
WARNING: Unlicensed photocopying violates U.S. copyright laws and is subject to legal prosecution.
fail substantially to perform in accordance with the terms of this
Agreement through no fault of the party initiating the ter-
mination.
8.2 If the Project is suspended by the Owner for more than 30
consecutive days, the Architect shall be compensated for ser-
vices performed prior to notice of such suspension. When the
Project is resumed, the Archftect's compensation shall be equit-
ably adjusted to provide for expenses incurred in the interrup-
tion and resumption of the Architect's services.
8.3 This Agreement may be terminated by the Owner upon
not less than seven days' written notice to the Architect in the
event that the Project is permanently abandoned. If the Project
is abandoned by the Owner for more than 90 consecutive days,
the Architect may terminate this Agreement by giving written
notice.
8.4 Failure of the Owner to make payments to the Architect in
accordance with this Agreement shall be considered substantial
nonperformance and cause for termination.
8.5 If the Owner fails to make payment when due the Archi-
tect for services and expenses, the Architect may, upon seven
days' written notice to the Owner, suspend performance ofser-
vices under this Agreement. Unless payment in full is received
by the Architect within seven days of the date of the notice, the
suspension shall take effect without further notice. In the event
of a suspension of services, the Architect shall have no liability
to the Owner for delay or damage caused the Owner because
of such suspension of services.
8.6 In the event of termination not the fault of the Architect,
the Architect shall be compensated for services performed prior
to termination, together with Reimbursable Expenses then due
and all Termination Expenses.
8.7 Termination Expenses are in addition to compensation for
Basic and Additional Services, and include expenses which are
directly attributable to termination.
ARTICLE 9
MISCELLANEOUS PROVISIONS
9.1 Unless otherwise provided, this Agreement shall be gov-
erned by the law of the principal place of business of the
Architect.
9.2 Terms in this Agreement shall have the same meaning as
those in AlA Document A201, General Conditions of the Con-
tract for Construction, current as of the date of this Agreement.
9.3 Causes of action between the parties to this Agreement
pertaining to acts or failures to act shall be deemed to have
accrued and the applicable statutes of limitations shall com-
mence to run not later than either the date of Substantial Com-
pletion for acts or failures to act occurring prior to Substantial
Completion, or the date of issuance of the final Certificate for
Payment for acts or failures to act occurring after Substantial
Completion.
9.4 The Owner and Architect waive all rights against each
other and against the contractors, consultants, agents and
employees of the other for damages, but only to the extent
covered by property insurance during construction, except
such rights as they may have to the proceeds of such insurance
as set forth in the edition of AlA Document A201, General Con-
ditions of the Contract for Construction, current as of the date
of this Agreement. The Owner and Architect each shall require
similar waivers from their contractors, consultants and agents.
9.5 The Owner and Architect, respectively, bind themselves,
their partners, successors, assigns and legal representatives to
the other party to this Agreement and to the partners, suc-
cessors, assigns and legal representatives of such other party
with respect to all covenants of this Agreement. Neither Owner
nor Architect shall assign this Agreement without the written
consent of the other.
9.6 This Agreement represents the entire and integrated agree-
ment between the Owner and Architect and supersedes all
prior negotiations, representations or agreements, either writ-
ten or oral. This Agreement may be amended only by written
instrument signed by both Owner and Architect.
9.7 Nothing contained in this Agreement shall create a contrac-
tual relationship with or a cause of action in favor of a third
party against either the Owner or Architect.
9.8 The Architect and Architect's consultants shall have no
responsibility for the discovery, presence, handling, removal or
disposal of or exposure of persons to hazardous materials in
any form at the Project site, including but not limited to
asbestos, asbestos products, polychlorinated biphenyl (PCB) or
other toxic substances.
9.9 included in this Agreement is Attachment
"A", consisting of pages 1 through
ARTICLE 10
PAYMENTS TO THE ARCHITECT
10.1 DIRECT PERSONNEL EXPENSE
10.1.1 Direct Personnel Expense is defined as the direct
salaries of the Architect's personnel engaged on the Project and
the portion of the cost of their mandatory and customary con-
tributions and benefits related thereto, such as employment
taxes and other statutory employee benefits, insurance, sick
leave, holidays, vacations, pensions and similar contributions
and benefits.
10.2 REIMBURSABLE EXPENSES
10.2.1 Reimbursable Expenses include expenses incurred by
the Architect in the interest of the Project for:
.1 expense of transportation and living expenses in con-
nection with out-of-~ travel authorized by the
Owner; county ~ ~
.2 h~Qg di~t~vc~ ~9mQ;;PIQic~tiQni; ~ Ibl.
.3 f@@~ patg for ~"cYriRg al0flr@Y~Ht1:lorities haYing
j1lfiidictiQr ouer rhp PtQje('t;~,. ~L I\~
.4 reproductions;in e:x:cess of 25 copies; ~ V"v-
.5 pgl>to.l8~ aRlit kafilolHRg gf DfrilV'K:1W; ;Ivd >}O'&:dfi<'?tiQQi; ~
.6 @l(I0@R~@ of oH@rtim@ VlTork r~qYiriRg nigb.er tn~R re~h ~
lar FQt@~, if QwtRoriz@g tJy tb.~ O~'1;:;).~I;
.7 renderings and models requested by the Owner;
.8 expense of additional insurance coverage or limits,
including professional liability insurance, requested
by the Owner in excess of that normally carried by
the Architect and Architect's consultants; and
.9 ~KptlQt;tl Qf ~Q~Fllt~r aiQ"d deli;gn ?VQ dr.;.lft;Qg P\;rlip ~()Srf-
m@flt tifR@ ~Tb.@1A Y~~Q iQ. ~QQ.Q.~~tiQQ ~Titl~ tb~ PrQject ~ ~
5 '8151-1987
AlA DOCUMENT 8151 -ABBREVIATED OWNER-ARCHITECT AGREEMENT - THIRD EDITION - AIA@ - @ 1987
THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W., WASHINGTON, D.C. 20006
WARNING: Unlicensed photocopying violates U.S. copyright laws and is subject to legal prosecution.
10.3 PAYMENTS ON ACCOUNT OF BASIC SERVICES
10.3.1 An initial payment as set forth in Paragraph 11.1 is the
minimum payment under this Agreement.
10.3.2 Subsequent payments for Basic Services shall be made
monthly and, where applicable, shall be in proportion to ser-
vices performed within each phase of service.
10.3.3 If and to the extent that the time initially established in
Subparagraph 11.5.1 of this Agreement is exceeded or ex-
tended through no fault of the Architect, compensation for any
services rendered during the additional period of time shall be
computed in the manner set forth in Subparagraph 11.3.2.
10.3.4 When compensation is based on a percentage of Con-
struction Cost and any portions of the Project are deleted or
otherwise not constructed, compensation for those portions of
the Project shall be payable to the extent services are per-
formed on those portions, in accordance with the schedule set
forth in Subparagraph 11.2.2, based on (1) the lowest bona fide
bid or negotiated proposal, or (2) if no such bid or proposal is
received, the most recent preliminary estimate of Construction
Cost or detailed estimate of Construction Cost for such por-
tions of the Project.
10.4 PAYMENTS ON ACCOUNT OF ADDITIONAL
SERVICES AND REIMBURSABLE EXPENSES
10.4.1 Payments on account of the Architect's Additional Ser-
vices and for Reimbursable Expenses shall be made monthly
upon presentation of the Architect's statement of services
rendered or expenses incurred.
10.5 PAYMENTS WITHHELD
10.5.1 No deductions shall be made from the Architect's com-
pensation on account of sums withheld from payments to
contractors.
ARTICLE 11
BASIS OF COMPENSATION
The Owner shall compensate the Architect as follows:
11.1 AN INITIAL PAYMENT OF --0-- Dollars (S-----0-----
shall be made upon execution of this Agreement and credited to the Owner's account at fmal payment.
11.2 BASIC COMPENSATION
11.2.1 FOR BASIC SERVICES, as described in Article 2, and any other services included in Article 12 as part of Basic Services, Basic
Compensation shall be computed as follows:
(Insert basis of compensation, including stipulated sums, multIples or percentages, and identify phases to which particular methods of compensation apply, if necessary.)
See attached letter dated 1 October 1993.
11.2.2 Where compensation is based on a stipulated sum or percentage of Construction Cost, progress payments for Basic Services
in each phase shall total the following percentages of the total Basic Compensation payable:
(Insert additional phases as appropriate.)
Design Phase:
Construction Documents Phase:
Construction Phase:
Total Basic Compensation:
Thirty-five
Forty-five
Tvlenty
percent ( 35 %)
percent ( 45 %)
percent ( 20 %)
one hundred percent (100%)
B151-1987 6
AlA DOCUMENT 8151 · ABBREVIATED OWNER-ARCHITECT AGREEMENT. THIRD EDITION. AIA@ . @1987
THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W., WASHINGTON, D.C. 20006
WARNING: Unlicensed photocopying violates U.S. copyright laws and is subject to legal prosecution.
11.3 COMPENSATION FOR ADDITIONAL SERVICES
11.3.1 FOR PROJECT REPRESENTATION BEYOND BASIC SERVICES, as described in Paragraph 3.2, compensation shaH be
computed as follows:
Principals (Bert L. Bender, Robert L. Delaune):
$90.00/hr.
Associates:
$50.00 - $75.00/hr.
11.3.2 FOR ADDITIONAL SERVICES OF TI-IE ARCHITECT provided under Article 3 or identified in Article 12, compensation shall
be computed as follows:
(Insert basis of compensation, includinl!, rates and/or multiples of Direct Personnel E'\:pense j(Jr Principals and emph~vees, and ident~l)' PrinClJ}{lls and class(!l'
employees, if required Identl})' ~jJecific serl'ices to u'hich particular method'; (?f compensatio1l app~v. ~f necessary.)
Principals (Bert L. Bender, Robert L. Delaune):
$90.00/hr.
Associates:
$50.00 - $75.00/hr.
11.3.3 FOR ADDITIONAL SERVICES OF CONSULTANTS, including additional structural, mechanical and electrical engineering ser-
vices and those provided under Article 3 or identified in Article 12 as part of Additional Services, a multiple of One
(-1- ) times the amounts billed to the Architect for such services.
(Identify speCific types of consultants in Article 12. if required)
11.4 REIMBURSABLE EXPENSES
11.4.1 FOR REIMBURSABLE EXPENSES, as described in Paragraph 10.2, and any other items included in Article 12 as Reimbursable
Expenses, a multiple of One ( -1- ) times the expenses incurred by the Architect, the
Architect's employees and consultants in the interest of the Project.
11.5 ADDITIONAL PROVISIONS
11.5.1 IF THE BASIC SERVICES covered by this Agreement have not been completed within tvlenty-four
(24 ) months of the date hereof, through no fault of the Architect, extensioni:f the itect' s services beyond that time shall
be compensated as provided in Subparagraphs 10.3.3 and 11.3.2. :3D
11.5.2 Payments are due and payable fifteen flo ))>t.( ~ ) d ys from the date of the Architect's invoice.
Amounts unpaid thirty ( ~ ) days after the invoice date shall bear interest at the rate entered below, or
in the absence thereof at the legal rate prevailing from time to time at the principal place of business of the Architect.
(Insert rate of interest agreed upon.)
1.5% per month, 18% per annum.
(Usury laws and requirements under the Federal Truth in Lending Act, similar state and local consumer credit lau's and other regulations at the ()u'ller's and Archi-
tect's principal places of business, the location (~r the Project and elsewhere may allect the l'alidiZy of this prol'isioll. SpecUic legal adl'ice should he obtained If'ith
respect to deletions or modifications, and also regarding requirements such as uritten disclosures or u'ail'ers.)
11.5.3 The rates and multiples set forth for Additional Services shall be annually adjusted in accordance with normal salary revie",'
practices of the Architect.
AlA DOCUMENT 8151 · ABBREVIATED OWNER-ARCHITECT AGREEMENT. THIRD EDITION. AIA@ . @1987
THE AMERICAN INSTITUTE OF ARCHITECTS, \,735 NEW YORK AVENUE, N.W., WASHINGTON, D.C. 20006
8151-1987 7
WARNING: Unlicensed photocopying violates U.S. copyright laws and is subject to legal prosecution.
ARTICLE 6
USE OF ARCHITECT'S DRAWINGS,
SPECIFICATIONS AND OTHER DOCUMENTS
6.1 The Drawings, Specifications and other documents prepared by
the Architect for this Project shall become instruments of Owner
upon completion of this Project. The Architect shall be
permitted to retain copies, including reproducible copies of the
Drawings, Specifications and other documents for information and
reference in connection with the Owner's use and occupancy of the
Project. If the Drawings, Specifications or other documents are
used by the Owner for modifications and/or additions to this
proj the Archite t~ll not be held legally I' ble.
,.
------- ---~
DANNY L. KOLHAGE, CLERK
BY'Oo~C. ~
Deputy Cle k
ARTICLE 12
OTHER CONDmONS OR SERVICES
(Insert descriptions oJ other seroices, identify Additional Seroices included wit bin Basic Compensation and modifications to tbe payment and compensation terms
included in tbis Agreement.)
AS TO MONROE COUNTY:
/1PPROVED AS TO FORE.'
. ,:~,.,tf{tJ:/-~cY.
--"-',.4ttorney'ls Office
ATTEST: DANNY L. KOLHAGE, CLERK
By~Ct ~~.
Deputy Clerk
This Agreement entered into as of the day and year first written above.
OWNER
ARCp ~
~) n__
BErIDER & DELAillJJ~ ARCHITECTS, P. A.
B)~: BERT L. BErIDER, ARCHITECT
~
(Signature)
BOARD OF COmJT)~ COMMISSIOrJJ~RS
B)~: JACK LONDON - Mayor/Chairman
(Printed name and title)
DATE: October 20, 1993
AlA DOa IIIENT 8111 · ABBREVIATED OWNER-ARCHITECT AGREEkENT .1lfIRD EDmON . AlA. . @ 1987
THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W., WASHiNGTON, D.C. 20006
(Printed name and title)
8151-1987 8
WARNING: Unlicensed photocopying vIoI8tes u.s. copyright laws and is subject to legal prosecution.
A-rrACHMENT "A"
TABLE OF CONTENTS
RENOVATION OF SHERIFF'S SUBSTATION
and TAX COLLECTOR'S OFFICE
MARATHON, FL.
Professional Services Outline
Approach and Methodology
Public Entity Crimes
Non-Collusion Affidavit
Lobbying & Conflict of Interest Clause
Drug-free Workplace Form
Indemnification & Hald Harmless
General Insurance Requirements
General Liability
Architects Errors & Omissions Liability
Vehicle Liability
Workers' Compensation
PAGE
1A - 3A
4A - 6A
7A - 9A
lOA - l1A
12A
13A
14A
15A - 16A
17A
l8A
19A
20A
BENDER & DELAUNE ARCHITECTS, P.A.
1 October 1993
David S. Koppel, P.E.
County Engineer
Monroe County Florida
5100 College Road
Public Service Building, S.I.
Key West, FL 33040
Re: Renovation of the Sheriff's Substation and Tax Collector's
Office, Marathon, Florida
Dear Dave:
I enjoyed meeting with you and Desiree Peacock this morning and discussing
the project requirements for the renovation of the Sheriff s Substation and Tax
Collector's Office in Marathon. As we discussed, our firm will provide the
following professional services in connection with the project:
Programming: Analysis of proposed use of existing space and establishment
of requirements for compliance with the Anlericans With Disabilities Act,
FEMA Regulations and other applicable State, Federal and County regulations.
Measured Drawings and Analysis of Existing Conditions: This will include
a physical review of the structure on an item-by-item basis as well as of
production of floor plans, elevations and structural drawings required for the
renovation. A written report of findings will be provided.
Energy Analysis: An evaluation of existing mechanical systems will be
provided which will include cost benefit analysis, in order to determine the
need to upgrade existing systems.
Cost Estimates will be provided du.ring the Design and Construction
Documents Phases. The initial estimates will be used to establish a scope of
work for the project, with alternatives identified in order to assist you and the
County Commissioners with a useful decision nlaking tool.
720 CAROLINE STREET · KEY WEST, FL 33040 · 305 I 296 . 1347
FL LIC. # AA C002022
lA
David S. Koppel, P.E.
Page Two
1 October 1993
Design Documents will be prepared and alternatives explored for their impact
on the project budget. Cost benefit recommendations will be included with
preliminary design schemes.
Construction Documents will be prepared based on the approved design and
budget.
Bidding will include a Pre-Bid Conference on site and issuance of addenda
answering bidders questions. During this phase we will include 25 sets of
Plans and Specifications. Additional sets will be billed as a reimbursable
expense.
Contract Administration will include one scheduled weekly site visit and
meeting with the Contractor and Owner's Representative, review of Shop
Drawings and approval of Pay Requests. Additional site visits will be made as
needed.
The above services are outlined in more detail in our proposal under
"Approach & Methodology". We have attached a copy for your reference.
Additionally, our fee will include the following expenses as basic services:
long distance phone calls, travel within Monroe County and 25 sets of Plans
and Specifications for bidding and construction.
Based on the above, we propose the following estimate of our time and
subsequent fee:
Programming: Client meetings and Code Research
Principal (24 hours @ $90/hr.) ............... $ 2,160.00
Measured DrawingS/Analysis:
Field Work (2 persons @ 10 hrs. ea. @ $65/hr.)
Drawings (24 hrs. @ $65/hr.)..................
Field Analysis--Principal (10 hrs. @ $90/hr.).
Report of Conditions (4 hrs. @ $90/hr.i
6 hr s . @ $ 4 5 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1,300.00
1,560.00
900.00
630.00
Energy Analysis:
Henry Healey (Estimate).......................
3,500.00
Preliminary Design w/Cost Estimate:
Principal (60 hrs. @ S90/hr.).................
5,400.00
2A
Davis S. Koppel, P.E.
Page Three
1 October 1993
Construction Documents:
Architectural (7 sheets @ 24 hrs./sheet
@ $ 6 5 / hr. ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mechanical (2 sheets @ 24 hrs./sheet @ $6S/hr.)
Plumbing (1 sheet @ 24 hrs./sheet @ $65/hr.)...
Electrical (2 sheets @ 24 hrs/sheet @ $65/hr.).
Healey (MP E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Coordination:
Principal (40 hrs. @ $90/hr.)..................
Total Cost Through Construction Documents .....
Bidding Phase: 5 weeks @ 6 hrs./wk. @ $90.00.......
Construction: 16 weeks @ 8 hrs./wk. @ $90.00.......
10,920.00
3,120.00
1,560.00
3,120.00
3,600.00
3,600.00
$41,270.00
2,700.00
11,520.00
Document Printing Costs: ........................... 500.00
Total Bidding and Construction Phase .......... $14,720.00
Total Documents/Bidding/Construction ..... $56,090.00
Based on the above, we propose a fixed fee of $56,000.00. The scope of
work has been estimated at $600,000 to $650,000. The Monroe County
Commission has budgeted $400,000 for this project. The complexity of the
project and analysis of existing structure would justify a fee on the order of
11 % to 14%. Should the scope of the project be established at the $400,000
level, the proposed fee approximates 14 % . Should the project approach the
$600,000 level, the project fee approximates 10.7% In the event that
mechanical systems are deleted, we would be willing to reduce this proposed
fee by $5,000.
Please call to discuss this proposal and finalize an anticipated scope.
Sincerely,
~~..
Bert L. Bender
Architect
BLB:bka
Enclosure
3A
APPROACH and METHODOLOGY
Bender & Delaune Architects is a Key West based architectural firm which will
serve as the coordinating firm and the clients primary contact. We propose to
approach the project as follows:
As a comprehensive design firm, the architectural and engineering teams have
the ability and experience to provide our clients with the following services:
Programming Signage and Graphics
Master Planning Site Selection
Architectural Design Value Engineering
Energy Conservation Cost Control
Interior Design Construction Administration
Historic Preservation, Research and Restoration
We can provide every service necessary for the successful implementation of a
facility · Our approach to architecture is total. We either provide the service
directly or can manage the efforts of other professionals, taking responsibility
for the total project.
Our group utilizes a team approach to achieve optimum solutions. This team
approach brings together the client, architect, consultants, users, developers
and others, according to the needs of the project, in an intense work session to
focus on identifying the individual problems and requirements that are unique
to the project. This communications process is designed to elicit important
data known only by each team member regarding goals, facts and needs of the
project. This information is then focused into a concentrated problem solving
session to better meet the needs in the final design solution. Once identified,
alternatives are explored, solutions identified, and the design begins to emerge.
Phase I: Programming and Preliminary Analysis
A. Program: Meetings with the Owner will be conducted to establish and
confirm the physical requirements of the project and requirements for
individual sites.
This first stage of the total design process is programming (analysis).
Programming is problem seeking and design is problem solving. The
programming session begins with an orientation meeting attended by all
participants. Interviews are then conducted between Architect and
Client/U ser Groups so that sufficient information can be obtained to
4A
understand and define problems and goals. This information is
documented, evaluated, adapted and refined until we have distinguished
between wants and needs and determined the feasibility of the project
budget. Good programming is essential for the next phase - good
design.
B. Physical Review and Analysis (where additions and renovations are
required): Based on any available research and information provided by
the Owner, the architects will determine the appropriate details for the
individual buildings. This phase of the project will include photographic
documentation and drawings of the existing building conditions as
appropriate. We will conduct preliminary physical review of buildings
as to physical status, facade renovation, handicap accessible facilities,
and need of incorporation into the plans and specifications.
C. Schematic Design: Based on the program requirements established with
the Owner, the physical analysis documentation and the requirements of
any structural review of existing facilities, schematic designs will be
prepared. During this task we will prepare preliminary plans and
specifications for review by the Owners. We integrate design with
engineering and interiors with exteriors because we know the best
architecture is that which makes a total statement. Near the end of this
design phase the architectural team presents a schematic design solution,
along with material illustrating the rationale for the design. Cost
estimates, feasibility studies, project phasing and time schedules are
outlined, as needed, for client consideration and approval.
Phase II: Construction Documents/Specifications
A. Design Development: Following approval of schematic design,
development includes determination, design and coordination of
architectural, structural, mechanical and electrical systems, equipment
layouts and all related site development. This phase results in drawings
and documentation, plus additional materials as necessary to illustrate
"final" development and insure that all significant design questions
and/or problems have been solved.
This is the heart of the architectural process and the point at which the
actual form and character of the project is established. Collaboration
with client and consultant is imperative during this phase.
SA
B. Construction Documents: Working drawings and specifications will be
prepared, sufficiently detailed, in order to insure the desired result with
minimum possibilities of cost over runs.
This phase transforms the preceding approved "Design Development
Package" into a set of detailed, legal, bidding documents which relate to
the construction industry. These documents control and direct the
construction process via construction drawings and detail
materials/building systems specifications.
Phase III: Bidding Phase
The bidding phase will be conducted in the same manner as similar projects.
On historic preservation projects involving state grant funds, the sub-contract
bidders will be pre-qualified for specialized trades if deemed appropriate. We
will conduct pre-bid conferences, bid reviews, and pre-construction meetings.
General contract bidders on historic preservation projects will be post-qualified
when bids are received. A minimum of three low bidders will be evaluated to
determine the lowest and best bid. In addition to price, consideration will be
given to the bidder's past performance and experience with projects of
comparable scope and type.
Phase IV: Contract Administration
During construction we will schedule weekly meetings with the Contractor to
establish projected work for the upcoming week. This will maintain
communication with the Contractor and guarantee that construction is properly
planned. We will make all necessary on-site inspections, check and certify
payment requests for work and assist in final inspections and certification of
completion.
Our firm is based in Key West, allowing continuous site access and interaction
with the Contractor and the Client. This aspect, along with our proven track
record on projects of this type, will prove extremely beneficial in providing
quality projects. During construction, our location and concern for quality
work will allow for a high level of quality control.
While the majority of construction administration work will be conducted from
the Key West office of Bender & Delaune Architects, all consultants will be
available as needed, including staff from the office of each consultant.
6A
SECTION 00110
SWORN STATEMENT UNDER SECTION 287.133(3)(a),
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR
OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS.
1. This sworn statement is submitted
to
BOARD OF COUl'JT)~ CO~1MISSIOrJl~RS, MOrJROE COUl'JT)~, FLORIDA
(print name of the public entity)
BERT L. BErJDER, ARCHITECT
(print individual's name and title)
by
for
BErJDER & DELAUl'Jl~ ARCHITECTS, P. A.
(print name or entity submitting sworn statement)
whose business 1S
ARCHITECTURAL FIRM
and (if applicable) l~ Federal Employer Identification Number
(FEIN) is 65-0233075 (If the entity has no
FEIN, include the Social Security Number or the individual signing
this sworn statement: .)
L · I unders tand tha t a "pub lie en ti ty crime" as def ineci in
Paragraph 287.133(1)(g), Florida statues, means a violation or
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 good or services to be provided to any public entity
or an agency or political subdivision of any other state or of
the United states and involving antitrust, fraud, theft, bribery,
collusion, racketeering, conspiracy, or ma~erial
misrepresentation.
3. I understand that "convicted" or "conviction" as defined in
Paragraph 287.133(1)(b), Florida statues, means a finding of guilt
or a conviction of a public entity crime, with or without an
adjudication of guilt, in any federal or state trial court of record
relating to charges brought by indictment or information after
July 1, 1989, as a result of a jury verdict, nonjury trial, or entry
of a plea of guilty or nolo contendere.
4. I understand that an "affiliate" as defined in Paragraph
287.133(1)(a), Florida statutes, means:
1. A predecessor or successor of a person convicted of a
public ~ntity crime: or
7A
2. An entity 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, partnersl
shareholders, employees, members, and agents who are active
in the management of an affiliate. The ownership by one
person of shares constituting a controlling interest in
another person, or a 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 def.:.ned in Paragraph
287.133(1)(e), Florida statues, 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
contract and which bids or applies to bid on contracts for
the provision of goods or services le~ 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.
6. Based on information and belief, the statement which I have
marked below is true in relation to the entity submitting
this sworn statement. (Indicate which statement applies.)
x
Neither 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 I, 1989.
The entity submitting this sworn statement, or one
or more or its officers, directors, executives, partners,
shareholders, employees, members, or agents who are active
in the management of the entity, or an affiliate of the
entity has been charged w~th and convic~eci of a public
entity crime subsequent to July 1, 1989.
8A
The 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 entity
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 Hearings 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 UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING
OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE)
ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID
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 OR THE THRESHOLD
AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUES FOR CATEGORY
TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.
~S~re)
10/5/93
(date)
STATE OF
FLORIDA
COUNTY OF
MOrJROE
PERSONALLY APPEARED BEFORE ME, the undersigned autho~ity,
B]~rJDER & D]~LAmJ]~ ARCHITECTS, P.A. who, aft.er first being sworn by me,
BERT L. B]~rIDER, ARCHITECT (PR]~SIDErJTenarne of indi vidual signing)
affixed his/her signature in the space provided above on this
5th
day of
October
_.~
----'
'~:)'l]ry ?ct~!tD $'~ui~ ~Jj~lut'!dtr ~~
My C 0 rom i s S :. 011 e x p 1 r e 3 : My (om~Td.;~iJn E;(pir~~ 7~10Y 19, 1991
Iondad Thru IrQ)" rain" lFl$uran,.lnc;. ~
Form PUR -068(Rev. 04/10/91)
9A
SECTION 00110
NON-COLLUSION AFFIDAVIT
I, BERT L. BE~JDER
or the ci ty of KE)~ WJ~ST
according to law on my oath, and under penalty or perjury, depose
and say that;
1 . )
I am
PRJ~SIDE~JT
of the firm of
BJ~~,IDER & DELAillJE ARCHITECTS, P. A.
I the
bidder making the Proposal for the project described in
the notice for call ing for bids for: Design and Project
Administration for tl1e Renovation of the SHERIFF' S SUBSTATIO~J and
TAX COLLECTOR'S OFFICE.( Court11ouse Anne:x:, Marathon, Florida
and that I executed the said proposal with full authority
to do so;
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 proces 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 and will not be knowingly 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 :n this
affidavit in awarding ~ontrac~s for said project.
lOA
~~-
(Signature or Bidder)
10/5/93
(Da~e)
STATE OF:
FLORIDA
COUI'1TY [JF:
MormOE
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
BErJDER & DELAUl'JE ARCHITECTS, P.A. . who, after first being
BERT L. BErJDER, ARCHITECT,
sworn by me, PRFSIDlirIT
(name of individual signing)
affixed his/her signature in the space provided above on this
5th
day of
October
, 19
93
My commission expires:
t10'wfV r~.:1~,r,:, Siuj~ cf r~or:da
Ill, CornmL;:;jcn r:x~:!rcs Nk~)' 19, i 995
..........19I1QQg TMU 1rorl1lilllt Jn$urqn~e In'a. .-....'
llA
SECTION 00110
LOBBYING AND CONFLICT OF INTEREST CLAUSE
SWORN STATEMENT UNDER ORDINANCE NO. 010-1990
MONROE COUNTY, FLORIDA
"
BErIDER & Dl~LAUl'JE ARCHITECTS, P. A.
(Company)
"
" warrants that it has not employed, retained or otherwise had
act on its behalf any former County officer or employee subject to
the prohibition of Section 2 of Ordinance No. 010-1990 or any
County officer or employee in violation of Section 3 of Ordinance
No. 010-1990. For breach or violation of this provision the County
may, in its discretion, terminate this contract without liability
and may also, in its discretion, deduct from the contract or
purchase price, or otherwise recover, the full amount of any fee,
commission, percentage, gift, or consideration paid to the former
County officer or employee". _ ~~ _
, ,. . '\
\S~gnat.ure)
10/5./93
(Date)
STATE OF
FLORIDA
,::OUNTY OF
MOrJROE
FERSONALLY APPEARED BEFORE ME, the undersigned authority,
BEr,TDER & Dl~LAUl'Jl~ ARCHITl~CTS, P.A. p,.]ho, after first being
BERT L. BErIDER, ARCHITECT,
sworn by me, affixed his/her signature PR1\STD1\1\IT
(name of individual signing) ~n the space provided above on thi~
5th
day of
October
N~1 Dry
,ft'1 (Oi':1m~13~O:i f:~CJ}1 1~'! 199$
{)OOQt,tQ Thrv Troi foin. .. InsvrQI1C\i fn_
My commission expires:
12A
SECTION 00110
DRUG-FREE WORKPLACE FORM
The undersigned Contractor in accordance with Florida statute
287.087 hereby certifies that:
BEtIDER & DELAUl'JE ARCHITECTS, P. A.
(Name or Business)
1. Publish a statement notifying employees that the unlawful
manufacture, distribution, dispensing, possession, or use or a
controlled substance is prohibited in the workplace and specifying
the actions that will be taken against employees for violations or
such prohibition.
2. Inform such employees about the dangers of drug abuse in the
workplace, the business's policy of maintaining a drug-free
workplace, any available drug counseling, rehabilitation, and
employee assistance programs, and the penalties that may be imposed
upon employees for drug abuse violations.
3. Give each employee engaged in providing the commodities or
contractual services that are under bid a copy of the statement
specified in subsection (1).
4. In the statement specified in subsection (1), notify the
employees that, as a condition or working on the commodities or
contractual services that are under bid, the employees will abide by
the terms of the statement and will notify the employer of any
conviction of, or plea of guilty or nolo contendere to, any
violation of Chapter 893 (Florida statutes) or of any controlled
substance law of the United states or any state, for a violation
o c cur r J.. n g ). nth e W 0 r J~ p 1 ace r. 0 1 ate r t h a r: :E i. v e (5.) (1 a y s a :E t e r 3 U c h
conviction.
5. Impose a sanction on, or require the satisfactory'participation
in ~ drug abuse assistance or rehabilitatlon program if such is
available in the employee's community, or any employee ~ho is so
convicted.
6. Make a good faith effort to continue to maintain a drug-free
workplace through implementation of this section.
As a person authorized to sign the statement, I certify that this
firm complies fully with the above reqUirements~i~~ _
Bidder's Signature
10/5/93
r.it:F# 5 Rev. 6/91
Date
13A
I\pril 22.. 19()]
I stl'rinting
MONROE COUNTY, FLORIDA
INSURANCE GIJIDE
T(l
CONTRACT ADMINIS~rRA l')ON
Indemnification and I{old Ilarmless
for
Suppliers of Goods and Services
The Vendor covenants and agrees to indemnify and hold hannless Monroe County Board of
County Commissioners from any and aU claims f(>r bodily injury (including death), personal injury,
and property damage (including property owned by Monroe County) and any other losses,
damages, and expenses (including attorney's fees) which arise out of. in connection with, or by
reason of services provided by the Vendor or any of its Subcontractor(s) in any tier, occasioned
by the negligence, errors, or other wrongful.act or omission of The Vendor or its Subcontractors
in any tier, their employees, or agents.
In the event the completion of the project (to include the work orothers) is delayed or suspended
as a result of the Vendor's failure to purchase or maintain the required insurance, the Vendor shall
indemnify the County from any and all increased expenses resulting from such delay.
The extent ofliability is in no way limited to, reduced, or lessened by the insurance requirements
contained elsewhere within this agreement.
Administra1ive Instruc1ion .
114709.1
14A
^pril 22. 199.1
I st (1ril1tin~
MONROE COUNTY, FLORIDA
INSUIMNCE GIJIDE
TO
CONTRACT ADMINISTRATION
General Insurance Requirelllents
for
Stlppliers of Goods or Services
As a pre-requisite of the work governed, or the goods supplied under this contract (including the
pre-staging ofpersonneJ and material), the Vendor shall obtain, at his/her own expense. insurance
as specified in any attached schedules" which are nlade part of this contract. The Vendor will
ensure that the insurance obtained will extend protection to all Subcontractors engaged by the
Vendor. As an alternative. the Vendor may require aU Subcontractors to obtain insurance
consistent with the attached schedules.
The Vendor will not be permitted to commence work governed by this contract (including pre-
staging of personnel and material) until satisfactory evidence of the required insurance has been
furnished to the County as specified below. Delays in the commencement of work. resulting from
the failure of the Vendor to provide satisfactory evidence of the required insurance. shall not
extend deadlines specified in this contract and any penalties and failure to perfonn assessments
shall be imposed as if the work commenced on the specified date and time. except for the
Vendor's failure to provide satisfactory evidence.
The Vendor shall maintain the required insurance throughout the entire tenn of this contract and
any extensions specified in the attached schedules. Failure to comply with this provision may
result in the immediate suspension of all work until the required 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 deadlines specified in this contract and any penalties and
failure to perfonn assessments shall be imposed as if the work had not been suspended. except for
the Vendor's failure to maintain the required insurance.
The Vendor shall provide. to the County. as satisfactory evidence of the required 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 insllrance
policies required by this contract.
All insurance policies mllst specifY that they are not subject to cancellation. non-renewal. material
change, or reduction in coverage unless a minimum of thirty (30) days prior notification is given
to the County by the insurer.
The acceptance and/or approval of.the Vendor's insurance shall not be construed as relieving the
Vendor from any liability or obligation assumed under this contract or imposed by law.
Administrative )nstruction
#4709.1
15A
April 22.. 199]
) sf Printing
The Monroe County Board of County Commissioners, its employees and officials will be included
as "Additional Insured" 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 for Waiver of Insurance Requirements" and approved
by Monroe County Risk Management.
^dmini~1rarive JmtnK1-ion
//4109.1
16A
April 22. 199.1
J~ "rinling
GENERAL LIABILJ1Y
INSURANCE REQUIREMENTS
FOR
CONTRACT ARCHITECTIJRAL SER,TICES
BI~~l'WEEN
MONROE COUNTY, FLORII)A
AND
BErJDER & DELAmJJ~ ARCHITECTS, P.A.
Prior to the commencement of work governed by this contract, the Contractor shall obtain
General Liability Insurance. Coverage shall be maintained throughout the life of the contract and
include, as a minimum:
· Premises Operations
· Products and Completed Operations
· Blanket Contractual Liability
· Personal Injury Liability
· Expanded Definition of Property Damage
~rhe minimum limits acceptable shaH be:
$300,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$100,000 per Person
$300,000 per Occurrence
$ 50,000 Property Damage
An Occurrence Fonn policy is preferred. If coverage is provided on a Claims Made policy, its
provisions should include coverage for claims filed on or afler the etfective datc of this contract.
In addition, the period for which claims may be reponcd should extend for a minimum of twclve
(12) 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.
AdnliniNtralive J~1rudjon
#4709.1
GLl
17A
ARCI-IITECTS ERRORS AND Ol\'IISSIONS
LIABILI'"fV
INSURANCE REQUIREJ\;1EN'rS
FOR
CON"fJL\CT ARCHITECTURAL SERVICES
BETIVEEN
1\1QI'lROE COUNlY, FI~ORIDJ\
AND -
BENDER & DELAUNE ARCHITECTS, P.A.
April 22.. 199.1
I ~ Prinling
Recognizing that the work governed by this contract involves the furnishing of architectural
services, the Contractor shall purchase and rnaintain, thr(>ughout the life oCthe contract,
Architects Errors and Omissions Liability Insurance which will respond to damages resulting from
any claim arising out of the performance of professional services or any error or omission of the .
Contractor arising out of\vork governed by this contract.
The nlinimum limits of liability, shall be:
$250,000 per Occurrence/$500,OOO Aggregate
Adnlinistrativc Instn.K1ioD
114709.1
AEOI
l8A
40
^priI22~ 199]
1 sf I'rinling
VEI-IICLE LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT ARCHITJ~CTURAL SER,rICES
BE'"rwEEN
MONROE COUNTY, FLORIDA
AND
BEt\lDER & DELAUl'JE ARCHITECTS, P.A.
Recognizing that the work governed by this contract requires the use of vehicles, the Contractor,
prior to the commencement of work, shall obtain Vehicle Liability Insurance. Coverage shall be
maintained throughout the life of the contract and include, as a minimum, liability coverage for:
· Owned, Non-Owned, and Ifired Vehicles
The minimum limits acceptable shall be:
$100,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$ 50,000 per Person
$100,000 per Occurrence
$ 25,000 Property Damage
The Monroe County Board of County Commissioners shall be named as Additional Insured on all
policies issued to satisfy the above requirements.
Administrative )nstnlction
114709.1
VLI
19A
^pril 22~ 199J
Is. I'rinting
WORKERS' COMPENSA l'ION
INSURANCE REQUIREMEN'fS
FOR
CONTRACT ARCHITECTURAL SER\TICES
BETWEEN
M.ONI{OE COUNTY, FLORIDA
AND
BErJDl~R & DELAillJE ARCHITECTS, P .A.
Prior to the commencement of work governed by this contract, the Contractor shall obtain
Workers' Compensation Insurance with limits suflicient to respond to Florida Statute 440.
In addition, the Contractor shall obtain Employers. Liability Insurance with limits of not less than:
$100,000 Bodily Injury by Accident
$500,000 Bodily Injury by Disease, policy limits
$100,000 Bodily Injury by Disease, each employee
Coverage shall be maintained throughout 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 an 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 Contractors Excess Insurance Program.
I f the Contractor participates in a self-insurance fund, a Certificate of I nsurance will be required.
In addition, the Contractor may be required to submit updated financial statements from the fund
upon request from the County.
Adnlinistrath'e ~1nJction
114709.1
wel
20A
NOV-24-93 WED 9:52
CMI INTL/BUCKLEY
FAX NO. 309 266 0735
PI 02
CERTIFICATE OF INSURANCE:
PRODUCER ,'. " ." "
.CHI INTERNATIONAL, INC..
5805 BLUE LAGOON DRIVE, #280
MIAMI, FL
33126
PHONE 305....2 6 6~9 95.4
CSR 11 2~ 93
THJS CERTIFItAT& JS ISSUED AS A MATfER OF JNFORJ.jATJON ONLY AND
CONFERS NO RIGHTS UPON THE CEATtFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BE~OW.
.~.~~~................'----...........~----~y.........-------...._-------~-.
COMPANIES AFFORDING COVERAGE
...............-~--.~-R~P~.......~..........~__~-~~... .........~~--.........~.~------..~....~---------P...M.~________,.....______
INsUREO COMPANY lEtTER A WESTERN WORLD INSURANCE CO.
...----~-............---~PP..~...,....------........~M_____.____.....______~
COMPANY LEtTER B .
, ........... ......"".. ...APPR9VE9-BV .mSK-~'M[m-........ _ _ _ _ _ _ _ _ _ _ _....
.~~;~~;.~:;;~~.:;....B~--...~/~~--~......."-"........---------.
.......... - -- -............... - - -- -" ~- - - ~...... _ _ _ _ u _ _ _ ..... _ _ _ __
COMPANY LETTER E DATE
> COVERAGES <-----~-------m~~-----~--------------%-----~-~---------~=-----~u--------ca~------------~--~-----~-----~~.---~________
THIS IS TO-C~;Ti;Y-THAT POLICI;;-~F-iNSURANCE LISTED-8El~-HAVE BEEN-IS~Eib-TH~~'~;~D-;;Mi6~~80~I-fO;-;HE POLICy--------
PERIOD INOICATED~ NOTWITHSTANOING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT ~ITH RESPECT 10
WHICH THIS C~RTIFICATE HAY BE ISSUED OR MAY PERTAlN, THE INSURANce ~FfOROED BY THE POlICI,ES DESCRIBED HEREIN IS SUBJECT TO
ALL tERMS, EXCLUSIONS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAve BEEN REDUCED BY PAID CLAIMS.
Ben4er& Delaune Architects,
720 Caroline Street
Key West.. FL.
33D40
CO
LTR
~.a.~__~~.................___._.............M._~~.................~."".............~~____.........._____y..........______~.......
Type OF INSURANCE
POLICY NUMBER
POLICY EFF
DATE
POLl CY EXPIl
DAtE
LIMITS
~.. ----1..............._~~~....... .......-~---~.............. .~_~........... ~~___y........ .-a-------NN.......____~........__
GENERAL LIABILITY
A tXJ COMMERCIAL GEN LIABILITY
[ ) CLA~lt-tS MADE~' . '[ Xl 'oce.
[ ] OWNERS.S & CONTRACTO~.S
PROTi:CTIVE
TBD
GENERAL AGGREGATE 600, 000
........._---...... ...._-.~......
10/25/93 10/25/94 f'ROO"COMP/OP AGO. 300,000
----~.~......~._~. .......--...-T
PERS. & AD'\!. INJURY 300 I 000
..........._--..... ......'w......
EACH OC:CURRENCE
........~----...... ...._-~.......
300,000
[ l
t J
FIRE OAMAGE
(ANV ONE fIRE)
50,000
....6__~.......... ..-~9.........
... ...........~.~................~- -....................--.~..... .........-~..... ....'.------y.. .....------........ ~---.1...._...
AUTOMODILELIAB
HED. EXPENSE
(ANY ONE PERSON) 1, 000
CONS, SINGLE lIMIT
[ ] ANY AUTO
[ J ALL OWNED Autos
[ ] SCHEDULED AUTOS
[ 1 HIRED AUTOS .
[ ] NON-OWNED AUTOS
[ ] GARAGE LIABILITY
[ J
---.........._--... ......._---...
BODILY INJURY
(Pt:R PERSON)
...----~...-....._- r.........___y
BODILY INJURY
(PER ACCIDENt)
....._----......... -~......~.._--
... ...~..+-................~...... .........~--............~.- -y.........~--- -........~---- .......~--~....~... .---1.........
EXCESS LIABILITY , EACH OCCURRENCE
[ ] UMBRELLA FORM .........___......_ ..............
[ ] OTHER THAN UMBRELLA FORM AGGREGATE
.aw .~R..............~_~~.......... .~__~__...........____..... ......~__...... ...~___y.....~. .___.~.~....~___... .._...._~.....
PROPERTY DAMAGE
WORKERS' COMP
AND .
EMPLOYERS I LIAB I)ATE
... a..~r...............__y........ ...~~-............a..._~_ ~. . ... ~
OTHER . . LNh'lAL ~ G>~
ISTATUTO~V LIMITS
. EACH ACCIDENT
DISEAse-POL. L1MIT
DISEAse.EACH EMP.
.. ..._~--~...... .._---........_--....._...~---y...
-.1.-.-.-..W________R".~....._____..........~~____.......~-------~~~~...-------........~------N..W______~~...-.--T......_~____...
DESCRIPTION OF OPERATIONS/LOCAT'ONS/VEHICLES/SPECIAL ITEMS '
CERTIFICATB KOLDER IS ALSO NAMED ADDITIONAL INSURED ATIMA
~, ,
MONROE COUNTY SOARD, OF
COUNTY COMKrSS.IONERS
310 FLEMING STREET
'KEY WEST' FL
33040
_ACORD 25.s (7/90)
> CERTlrlCAT~ HOLDER <~====~====;=;RE==========;_K.e=> CANCe~LATION <=======;;Re:=====;=;;_;K.======;;;;_~~=====;;====~==========
= SHOULD ANY OF tHE ABOVE D~SCRI8ED POL1CIES BE CANcelLED BEFORE THE EX-
=' ~IRATION DATE THEREOF, THE JSSUING COMPANY WILL ENDEAVOR TO MAll 10
- DAYS WRJtTEN NOTICE TO THE CERTIFIcATE HOLDER ~AMED TO THE LEFT, SUT
~ FAILURE To MAIL SUCH HOTICE SHALL IMPOSE NO OBLIGATION OR l!ABIL1TY OF
: ~ - ~~~. ~~ ~~. ~~~~. ~~:. ~~~~~~~- ~ ~ · ~~~~~~ ~~: ~.~~~~~:~,~~: ~n' --... · .. .. - --. ·
: AUTHORIZED REPRESENTATIVE' W n")( L~
Lei h W. McCrea
CERTI ICATE OF INSURANCE:
PkODUCER
CMI INTERNATIONAL, INC.
5805 BLUE LAGOON DRIVE, #280
MIAMI, FL
33126
PHONE 305-266-9954
CSR 11 18 93
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
-~~~~;~~--------------------------------------------- -~~~~~;-~~~~~;-~-----ir~~~iP-~~~~~~~iC()ii-----------
-~~~~~;-~~~~~;-Es------i3y----i'~-;'-~~::~----------------------------
-----------------------------------~~--------------------------------
COMPANY LETTER C DATE ~
~~~~~~~~~~~~~~~~~~~~~~~~I~~~~~~;;~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
COMPANY LETTER E
> COVERAGES <====================================================================================================================
THIS IS TO CERTIFY THAT 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 TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Bender , Delaune Architects,
720 Caroline street
Key West FL
33040
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFF
DATE
POLICY EXP
DATE
LIMITS
GENERAL LIABILITY
GENERAL AGGREGATE
[ ] COMMERCIAL GEN LIABILITY
PROD-COMP/OP AGG.
[ ] CLAIMS MADE [ ] OCC.
PERS. & ADV. INJURY
[ ] OWNERS'S & CONTRACTOR'S
PROTECTIVE
EACH OCCURRENCE
[ ]
FIRE DAMAGE
(ANY ONE FIRE)
[ ]
MED. EXPENSE
(ANY ONE PERSON)
AUTOMOBILE LIAB
COMB. SINGLE LIMIT
[ ] ANY AUTO
[ ] ALL OWNED AUTOS
[ ] SCHEDULED AUTOS
[ ] HIRED AUTOS
[ ] NON-OWNED AUTOS
[ ] GARAGE LIABILITY
[ ]
BODILY INJURY
(PER PERSON)
EXCESS LIABILITY
[ ] UMBRELLA FORM
[ ] OTHER THAN UMBRELLA FORM
-------------------
eived BODILY INJURY
Loss Control (PER ACC I DENT)
--~~ ~;~~~;~;-~~~~~~----
-- - - -- - - - ---fNfflAL - - - - - - -- ~---bE - - - - - -- - - - - --- ~~~~- ~~~~;;~~~~ - - --
AGGREGATE
A WORKERS' COMP
AND
EMPLOYERS' LIAB
TBD
X ISTATUTORY LIMITS
11/18/93 12/31/94 EACH ACCIDENT 100,000
o I SEASE - POL. L I M IT 5 0 0 , 0 0 0
o I SEASE - EACH EMP. 100 , 000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
> CERTIFICATE HOLDER <===============================> CANCELLATION <============================================================
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX-
PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10
= DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
= FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF
= ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
MONROE COUNTY BOARD OF
COUNTY COMMISSIONERS
310 FLEMING STREET
KEY WEST FL
33040
_ACORD 25-S (7/90)
= AUTHORIZED REPRESENTATIVE
Lei h W. McCrear
wm'
RC!'()lution #191-1993
April 22. 1')<).1
I !it lTinling
l\lONROE COUNTY, FLORIDA
Request For Waiver
of
Insurance Requirements
H is requested LJlallhe insurance requirculcnls, as specificd in lhe CouHly's Schedule of Insurance
Rcquircnlcnls, be \vaivcd or nlodiCicd on lhe following contract. '
COJJlrnclor: Bender & Delaune Archi teets, P. A.
Conlraclfor: Benovation~ Sheriff I Substation & Tax Collector I s Office
Address ofCoulraclor: 720 Carol i ne Street
Key West, Florida 33040
Phone:
29~-1347 .
Scope of Work:
Professional Services in connection with th~
renovation of the building (design & contr~rr
administration).
Reason for Waiver:
Architect currently carries General Aggre~te in the
amount of $250,000 and his exposure limits are small.
Additionally/Monroe Co. cannot be named as agditionally
insured since the BOCC has no financial interest in this
vehicle.
?t\ ~~_
,
Sigualure of Contrnclor:
Risk Managclucnl
Approved)C Nol Approved
~~ ~d~~/
F/ ~.yh\3
~
Date
Count)' Adtninistrator appeal:
Approv~d:
Nol Approved: __
Da Ie:
Board of CouJlty Couuuissioncrs appeal:
Approved:
Nol Approved:
Mccli Ilg Dale:
Adrninistratj vc (mrtruction
#4709. I
W A I VER
5
---------------------------- -
NOV- 2-9j
1 U ; ti8 "
CMI 'INTL/BUCKLEY
FAX NO. 305 266 0735
PI 02
CE TIFICATE OF INSURANCE:
PRODUCER
CMI INTERNATIONAL, 'INC'.
5805 BLUE.,LAGOON DRIVE, #2.80
MIAMI, FL '. .-
33126 .,
PHONE 305-266--9954,
~SR 1 VJnJ:L~-_._._--
THIS CERTIFlCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGH1S' UPON, THE CERTIFICATE HOLDER.. ,THIS CERT'IFICATE
DOES NOT AMEND~ EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
. .. ...... .. ...... p - - - - - -...... ....... . . . . . . . . ...... . .... '" .... -..... - - - - - - - - - - - - - - - - - - - -
COMPANIES AFFORDING COVERAGE
.;~~~~~~.-....""-"--...................-".~.......... .~~;;~;"~~~~~;.j;....l:liit.~~~NlC():.............-.
Bender ,. Delaune Architects" .~~~;~~;.~~~T~;.B.........BY~..~... ,e.iVed....................-------.
~~ije c:ro~t~:s street .~;;~~~.~;;rE;' c........ ..... :~~/~~ ~u~:ot...................
Ket West 'II ...................._...-ii!lh..~--~ ...-......-.--...
33 40 .:~~~~~~.~~::~~.~........!M1Wi---.-NIA ~ ~~
COMPA~Y LETTER E "~~'--ur'-'"
> COVERACES <==~~=e~~se...D==-=-~~=~=~~~~e~~~R.=RS~~==~=--~~~-~~~===~~~~~=~~~~~~===~za~ww_______________.__~~===~=~~=~~~~~~=~~~=~
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE 'LISTED BEL~ HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR iHE POLICY
PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMeNT, TERM OR CONDITION OF ANY CONtRACT OR OTHER DOCUMENT W1TH RESPECT TO
~HICH THIS CERTI~lCAT! MAY BI ISSUED OR MAY PER1AIN, THI INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO
ALl TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY ~AJP CLAIMS.
____.~~.w.........._....__....-------.................-.----------.-.-.......................~---------------..~~...............,
CO
LTR
TYPE"O~ INSURANtE
PO~I~Y NUMBER
POLICY EFF
DATE
poLICY EXP
DATE
LIMITS
... ...._~.P.---_----.............. .........ft.~----........... ............... ...-------~--~ ~~................................
GENERAL LIA>>XLXTY
~ [ ] COMMERCIAL GENLIABIllTY
[ ] CLAIMS ,MADE [ ] OCC.
[ ) O~NERSIS & CONTRACTORIS
PROTECTIVE'
A rJa ARCH I TECTS PRO~
t 1 FESSIONAL LIAS
GENERAL .AGGREGATE 250, 000
................... .......~y.--~-
PROO.COMP/OP AGG.
----_.~--_....._.. ..............
PERS. & AOV. INJURY
~ACH OCCURRENCE 2 5 0 I 00 0
. . . . .. '. ~," . . ", . . . . - " ... .. e' . . . - ~ . .,.. .. - - -
..~.P_._~~_____..A. ..............
8655734
01/05/93 01/05/94
fiRE DAMAGE
(ANY ONE FIRE)
MED. EXPENse
(ANY ON! PERSON)
-........~....------I
..............1
.., .~tj~()i(~ia.ii:]6..i:I~~---- .-......................... ..............-
------.---.... ...................
COMB. SINGLE LIMIT
................... ....._._..yr~-
[ ] ANY AUTO
C ] All OWNED AUTOS
[ ] SCHEDULED AUTOS
( ] KtREO AUTOS
[ ] NON-OWNED AuroS
[ J "GARAGE LIABILITY
( 1
BOO I L Y .INJURY
(PER PERSON)
_....~.._.~........ ..............
EXCESS LIABILITY
[ ] UMBRELLA FORM
[ ] OTHER., THAN UMBREL~A FORH
.ived
Loss Control
'1'-1-3
BODILY I~JURY
(PER ACCIDEhlT)
................... ..............
DATE
PROPERTY DAMAGE
... ........-~"------~............. ...........................
INITIAL
EACH OCCURRENCE
..M.~........._.... ..............
AGGREGATE
.........................~.~.'.. .....------_.~~~_._~~...... ............... .............. .......~........... .........~....
ISTATUTORY LIMITS
EACH ACCIOENT
DISEAse.POL. LtMrT
DlSEAS~.EACH EMP,
WORKBRS' COMP
.. 'AND ... . .
EMPLOYERS' LXJ\B
..~ ...........______~_W_~.4...W.W. ........................... ............... ..............
OTHER
..................................
-~;~~;;;;i~~.~;~~~~~;i~~;;~~~;i~~;;~~~;~~;;;;~~~;~~.;~;~;.~....................................................................
> CERTIFICATE HOLDER <====~======~~~~~~~~~=~~~~~~~~~~> CANCELLATION <~~~~~~~:::~~~~~~:~~~~~~~~~~~~~~=~=~~========================
., ,.. , , . W' ;; SHOULD. ANY, Of tHE ABOVE DESCRIBED POLICIES BE CANCElL~D BEFORE THE EX- !
. PIRATION DATE THEREOf, THE ISSUING COMPANY WILL ENDEAVOR TO MAlt
. DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
. FAilURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIA81LITY OF
. ANY KIND UPON THE COMPANY, ITS AGENTS DR REPRESENTATIVES,
· · "~'\\J\~------
_I
MONROE COUNTY BOARD OF
COUNTY COMMISSIONERS
\
~....................._........
_ACORD 25-5 (1/90)
Lei h W. .McCrear
= AUTHORIZ!D REPRESENTATIVE
2
-~
..~.
. Bender
&
Delaune
Architects,
p.~l.
11 November 1993
720 ar<:.lin~ strcrt
key Wfst. {lorida ~3:4.:.
';05 . 296 · 1~47
D()11na Perez
Board of County Commissioners
Monroe County
Public Service Building
Stock Island
Key West, FL 33040
PL Lir.~",1e. '^^ C~(.~CI~1
Re: Automobile Insurance - Bender & Delaune Architects', P.A.
Dea.r Donna:
Per bur "telephone conversations, enclosed is a copy of the
Amended Declaration Page and Automobile Identification Card for
my personal automobile adding d/b/a Bender & Delaune Architects,
P.A. We have inquired as to adding the Board of Conunissioners as
additional insured and have been informed that since the Board of
Commissioners has no financial interest in this vehicle nor is it
leasi~g t~e vehicle, it cannot be listed as an additional
insured.
please call if you you need anything further.
....--AL-
.
BLB:bka
Enc~osure
TilePrudentlal ~
~
Prudential Property and Casualty
Insurance Company ,
11111111111111 11111111 11111111111111111111 1111111111 111111111/111111111111111111111111111111111
P. O. Box 2627
Jacksonville, FL 32232
1-800-437-5556
VLE2101700
A Subsidiary of The Prudential Insurance
Company .of America
Policy Number:
Agency Data:
39'~ 4A652282
753449,5 CGAB 806
Named Insured
and P.O. Address
Bender Nancy G Dba Bender &
Delaune Architects PA
619 Elizabeth Street
Key West FL 33040-6874
1..1 1'...11.11....1..111.1..11..1111.11..1.1..1.1.111. h ..1.1..1
November 3, 1993
Dear Policyholder:
The enclosed package reflects the recent change(s) made to your Car pOlicy. This package
includes your Amended Declarations P~ge and Identification Card(s)~ if required.
The Amended Dec'larations Page replaces the Declarations Page currently in your possession.
Please review it now to make sure it shows exactly the types and amounts of coverage you
requested. ' Important messages can be found on the reverse side of.the Amended Declarations
Page. Keep this document until it is replaced or changed. If it does not show the
coverages~ou requested. please,contact your agent or our Client Service Unit immediately
at 1-800-437-5556. If you wish to report a loss. please call 1-800-437-3535.
I f you have any quest i Or:lS about your po 1 icy. p I ease ca 11. your agent or our C 1 i ent Serv ice
Unit; or write to us at:
Prudent i a 1 Proper.ty and Casua 1 ty I nsurance Company
P.O. Box 2627
Jacksonville, Flori~a 32232
Thank you for ,insuring with The P~udential.
Sincerely,
~cf~
Insurance Services Department
III
017233 SERSO
AE27-004681
~Prudentl8l~ .
Prudential Property and Casualty
Insurance Company
111111 Il~llll I~IIIII 11111 11111 11111 11111 ~11111"IIIIII 11I1I1~IIIIIII 11111111111111111111111
~. O. Box 2627 '
Jacksonville, FL 32232
1-800-437-5556
A Subsidiary o'f The Prudential Insurance
Company of Amer i ca
Car Policy Amended Declarations
Policy Number: 39 4A652282
Agency Data: 753449 5 CGAB 806
Named Insured
and P.O. Address
Bender Nancy G Dba Bender &
Delaune Architects PA
619 Elizabeth Street
Key West FL 33040-6874
This policy period C9vers 6 months,
from 12/03/93 to 06/03/94, 12:01 A.M.
The Effective Date of this Pol icy Change is 12/03/93 at place of garaging.
Listed below are names and birth dates of licensed drivers resident in your household.
1 Bender Nancy Groff
09/16/50 2 Bender Bert Leslie
07/30/47
Listed below, are the cars covered by your pol icy.
CAR YEAR MAKE
MODEL
BODY TYPE
VEHICLE ID N~MBER TERRITORY SYMBOL
CLASS CODE
1
2
1985 Ford :Escort GL Wagon 40
1992 "M i tsub ish i E.c 1 ipse G ,Hc.hbk 3D
2FABP3599FB271813
4A3CS,4U7NE099294
036
036
6
J
711120
811 320
Listed bel,ow ar'e your pol icy coverages, 1 imits and premiums. .If a premium' charge does
not appear, that coverage is not provided.
COVERAGES
LIMITS
Bodily Injury'
Each Person
Each Acci'dent
Property Damage
Each Accident $ 50,000
Un insured 'Motor i st's " '
Bod i 1 y I nj ury
Each Person $ lQO,OOO
Each Accident $ 300,000
Personal Injury Protection
Co 1 1 i s i on
Deductible - $ '250
Comprehensive
Deductible' - S' 250
Towing - $~9 Each Disaplement
$
$
100,000
300,000
PREMIUMS
Car 1 Car 2
S 98 $ ,U 120 , "
$ 32 $ 41
$ 59 $ 59
TOTAL PREMIUM PER CAR
TOTAL POLr'CY PREMIUM
S 35 $ 40
$ 34 S 117
$ 13 $ 92
S 3 $ 3
------ ------
S 274 $ 472
$ 746
PAC 681 ED. 1/90
PAGE 1
AE27-004682
~JI
AE27-004684
. ThePrudentl81 ~
Prudential Property and Casualty
Insurance Company
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
P. O. Box 2627
Jacksonville, FL 32232
1-800-437-5556
A Subsidiery of The prudential Insurence
Company of Amer i ca
Bender Nancy G Dba Bender &
Delaune Architects PA
619 E.l i.zabeth Street
Key West FL 33040-68]4
PLEA.SE DO NOT DISCARD
AUTO ID CARDS ATTACHED BELOW
I tll I
~ FLORIDA AUTO INSURANCE
ThePrudentlal ~J ,IDENTIFICATION CARD
~
Policy No. Co. j Code Effective Date
394A652282-01646 06/03/93
f"Xl Personel Injury Protectionl f"Xl Bodily Injury
I~ Property Damage Liability ~ Liability
IV
G;
.&:.
;
U
85 FORD 2FABP3599FB271813
92 MITSUBISHI 4A3CS54U7NE099294,
Named Insured
BENDER NANCY G DBA BENDER &
Not val i d for mor,e. than one.. y.ear I from effect ive dete,
PAC 143/Fl E 10192 , .
-................................................. Cut Her e ......... ............ ........... ....................... .:..
a .... .. ...... ...... .... .... .......".. .... .. ........ .." .. .. .......... a .. .. .. "" .... .... .............." _.. ....... _......"..... _.... _. .."...... ... It"."... "."............................. -0_........ ,
. .
~ FLORIDA AUTO INSURANCE
ThePrudentlal_J" IDENTIFICAT,ION CARD
Policy No. Co. Code Effective Date
'394A652282-01646 06/03/93
f"Xl Personal Injury Protectionl f"Xl Bodi Iy Injury
l~ Property DlImage liabi I ity ~ liabi I ity
IV
G;
.&:.
;
(J
85 FORD 2FABP3599FB271813
92 MfTSUBISHf 4A3CS54U7NE099294
Named Insured
, .
BENDER NANCY G DBA BENDER & I
Not val id for more then one year from effective date
PAC 143/FL E 10/92 i
-.........................................:..:.... ,Cut Her e ....:... ~ ............ .......... ....... n. ,. ........ ......:~
-----, ~
, ThePrU_dentl81 ~.
Policy 'No. Co. Code
394A652282-01646
rjl Persona I I nj ury Protect i onl
~ Property Damage Liability
FLORIDA AUTO INSURANCE
I DENT I FICA T ION CARD
Effective Date
06/03/93
r-jl Bodily Injury
~ Liabi I ity ,
85 "F ORD
92 MITSUBISHI
Named Insured
2FABP3599FB271813
4A3CS54U7NE099294
BENDER, NANCY G '
Not val id for more than one year from effective date
PAC 14,3/FL E 10/92
ThePrudentlal ~.
~
Prudential .. "perty and Casualty
Insurance lpany
IIIIIIIIIIIIIIIIII.::~' ..~:: 1111111111 1111111111 11111111111111111111111111111111111111111111 ~II
P. O. Box 2627
'Jacksonville, FL 32232
1-800-437-5556
A Subsidiary of The Prudential Insurance
Company of Amer ica
Car Policy Renewal Declarations
Policy Number: 39 4A652282
Agency Data: 753449 5 CGAB 806
Named Insured
and P.O. Add.ress
Bender, Nancy G
619 El izabeth Street
'Key West FL 33040
This policy period covers 6 months,
from 12/03/92 to 06/03/93, 12:01 A.M.
a t p'] ace of gar a gin 9 .
Listed below are names and birth dates of licensed drivers resident in your household.
1 Bender Nancy Groff
09/16/50 2 Bender B'ert Lesl ie
07/30/47
Listed below are the-cars covered by your policy.
CAR YEAR MAKE
"MODEL
'BODY TYPE
VEH I CLE I D NUM'BER' 'TERR I TORY S~YMBOL
CLASS CODE
1
2
1985
1992
FRrd , Es~ort GL W~g,9n 40
Mitsubishi Ecl ipsegs Hchbk 3D
2FABP3599FB271813
4A3CS54U7NE099294
036
036
6
H
7 1 1 1 20
7 1 1 220
Listed below are your pol icy coverages, limits and premiums. If a premium charge does
not appear, that coverage is not provided.
COVERAGES
LIMITS
PREM I UMS '
Car 1 Car 2
Bodily Injury
Each Person
Each Accident
Proper ty Dama'ge
Each Accident "$", '50,000
Uninsured Motorists
Bodily Injury
Each Person $ 100~000
Each Accident $ 300,000
Personal Injury' Pr,6t~ction
Co 1 1 i s i on ' ·
Deduc t i b 1 e - $ 250., .
Comprehens i ve '
Deductible - $ 250
Towing - $50"1 Each Disablement
$ ",10.0,000
$ 300,000
$
92
$
86
s
s
38
$
S
36
51
51
TOTAL PREMIUM PER CAR
TOTAL POLICY PREMIUM
S 32 S 29
$ '45 '$ 122
$ 1 1 S 61
$ 3 $ 3
------ ------
$ 272 $ 388
S 660
PAC 681 ED. 1/90
PAGE 1
AE12-00921S
Pol icy.Number
39 4A652282
Your pol icy is m~de up of your app~,ication, your most recent Declarations, and the forms
and endorsements 1 isted below. Forms and endorsements being made part of your pol icy
with this transaction are provided in separate booklets or are indexed and reproduced
on pages which follow.
FORM
NUMBER
EDITION
DATE
POLICY FORMS AND MANDATORY ENDORSEMENTS
PAC 186
~/86
Car Policy, Parts 1, 2, and 3
Appl icable pol icy parts are those for whi'ch a
premium charge is shown in the ,Declarations.
F lor i d a Sp e cia 1 S tat e P'r ov i s ion s
Car Policy, Parts 4, 6, and 7
Applicable pol icy parts are those for which a
premium charge is shown in the'Declaratio'ns.
PAC 226/FL
PAC 190/FL
" ." 9(90
4/87
OTHER CHARGES & CREDITS
The De 1 uxe Package D,i.scount app 1. i es to your po 1 icy.
The Multi-Car,Discount appl ies to your policy.
A Safety Device Discount applies to Car(s) 2.
,An An t i-Lock I Br ake Discount app 1 iesl' to Car (s) 2.
Listed below are" the Loss Payees/Additional Interests present on the pol icy.
CAR 2 Barnett Bank 1010 Kennedy Dr Key West FL 33040
Listed below are Important Messages a~out your pol icy.
Persona 1 I nj ury 'Protect ion
Option I
Your pol icy is free of any accident,conviction or inexperienced driver surcharge.
IMPORTANT: Your pol icy premium may have changed due to rating by make and model of your
,.car. ,,~.lea~e check the vehicle description shown.
The "Stackingll referred to in PAC 4/FL, UNINSURED MOTORISTS, appl ies to all, cars
1 isted on the pol icy.
THE COMPANY MUST RECEIVE YOUR PREMIUM PAYMENT BY THE EFFECTIVE DATE OF YOUR RENEWAL FOR
COVERAGE TO CONTINUE. YOUR CHECK OR MONEY-ORDER WILL 'NOT BE DEEMED PAYMENT UNLESS HONORED
BY YOUR BANK~
If you have any questions, please contact your agent, or Gall our Pol icyholder Service
Office at 1-800-437-5556. If you need to report a claim, call us at 1-80o-lt37-3535.
A G DRINKWATER
AGENT
PAC 681 ED. 1/90'
PAGE 2
,92120392'1030
1111111111111 IIllll1f,II... ~!1I111111 1111111111 11111 11111 1~11111111I1I11111111111111I1111I1111
PCD 1716 FLi (Ed. 9/90)
Uninsured Motorists Coverage and Personal Injury Protection
This form contains important information about Uninsured Motorists Coverage and' Personal I nj ury
Protection. It also allows you to change the options and limits you previously selected .for these
coverages, should you wish to do ,so. PLEASE READ IT CAREFULLY.
If after reading this form you have any questions about the coverages it describes or the options
available to .you, please, call your Prueential agent or one 'of our Policyholder Service
Representatives at the number given on YOUr Declarations Page.
UNINSURED MOTORISTS COVERAGE
Uninsured Motorists ,Coverage (UM) protects you and others insured by your Car or RV policy against
the cost of accident-re~ated bodily i~juries caused by another driver w.hen:
The person or, organization responsible for the accident has no liability insurance;
The person or organizatiol:l responsible, for the accident has I iabi I ity insurance but the insurer
denies coverage or is insolvent; or
Neither the'driver nor the owner of the other car can be identified.
UNDERinsured Motorists Coverage is part of UNinsured Motorists Coverage. It protects you against
the cost of accident-related bodi Iy injuries caused by another driver when:
The person or organization responsible for the accident has liability insurance, but its limits are
less than the tot~1 damages yo~ sustained.
Payments made under UM are not reduced by amounts recovered from the liability insurance of
persons responsible 'for ,accidents. However, UM payments will not duplicate, and are excess over,
payments due under any workers compensation, disability benefits, or similar law; or the Personal
Injury Protection, Medical Payments, or Liability coverages of any other motor vehicle insurance
pol icy. The maximum 'We, will pay is the difference between the sum of these benefits and the
amount of the loss up to the limits you purchased.
If you do not wish to retain your current limits of Uninsured Motorists Coverage (see your
Declarations page), you may:
Reject Uninsured Motorists Coverage'; or
, .
Select Uninsured Motorists Coverage limits which are equal to or lower than your limits for Bodily
Injury Liability Coverage. The limits currently available are: "
Each Person/Each Accident Each Person/Each Accident
'$10,000/$20,000
15,0.00/ 30,000
20,000/ 40,000
25,000/ 25,000
35,000/ 35,000
25,000/ 50,000
50,000/100,000
1 OO,OPO/ 1 00,000
$100,000/$200,000
200,000/ 200,000
100,000/ 300,000
250,000/ 250,000
300,000/ 300,000
250,000/ 500,000
500,000/ 500,000
500,000/1,000,000
If you wish to change your Uninsured Motorists Coverage, please indicate your choice on the last
page of this form .and return it to u,s with your premium payment.
- 1 -
AE12-009212
NON-STACKING OF UNINSURED MOTORISTS COVERAGE
To reduce your premium and as an alternative to coverage without limitation, the limits of Uninsured
Motorist Coverage (see the Declarations) apply regardless of the number of policies, insureds,
insured vehicles, claims made or vehicles involved in an accident or loss. The limits of coverage on
the other vehicles insured by us cannot be added to or stacked on the limits of coverage of the
vehicle involved.
If you or anyone insured under this policy is in an accident in a non-owned vehicle orwhile a
pedestrian, you are entitled to the highest limit of Uninsured Motorists Coverage available for any
one vehicle as the named insured or an Insured resident relative. If you choose the coverage
available to you as an insured under this policy part, then we will pay those damages that are
excess over- amounts payable on the vehicle you occupy at the time of the accident. If you choose
the coverage available 'to you as an insured under another policy, then we will not pay for damages
under th i s po Ii cy part.
EXCLUSION - VEHICLES OWNED BY YOU OR RESIDENT RELATIVES: We will not pay for bodily injury
to you or a resident relative while using a vehicle not insured under this part owned by you or a
res i dent re I at i \i~.. .
PERSONAL INJURY PROTECTION
Personal Injury Protection (PIP) protects you and others insured by your Car or ~V policy for motor
veh i c I e ace i dent-re I ated bod i I Y injuri es. I t covers:
. t I. I 'r'
Up to 80 percent of medical expenses;
Up to 60 percent of lost income;
The cost of replacement services; and
Death benefits.
PIP pays up to $10,000 for each person injured in one accident. A death benefit of up to $5,000 is
included in this I im it, which app,1 ies regardless of the number of pol icies, insl:lreds,. insured cars,
claims made, or motor vehicles involved in the loss.
PIP payments are reduced. by amounts payable under any workers' compensat'ion laws of any state
or the federal government, or the Medicaid program.
Work Loss Benefit. Excl,usion
Unless you choose otherwise, PIP provides benefits for lost income if you or another person
insured by your Car or RVpolicy is injured in a motor vehicle accident and cannot work. However.
you may select "Work Loss Benefit Exclusion" option to exclude coverage for such lost income.
Policyholders who ~re not working (such as retirees) may wish to reduce their premiums with this
option.
Military Coordination of Benefits and Work Loss Benefit Exclusion "
You may be able to reduce your premium if you are eligible for benefits payable to active or
r e t ire d mil ita ry pe r SOh n e I wh i ch pro vi de co v era g e s si mil, art 0 PIP's. "M i I ; t a ry Coo r din a t j 0 n 0 f
Benefits arid Work Loss B'enefit Exclus'ion" option is available if such a plan covers the deductible
amount.
(Please determine if and to what extent any health or disability insurance policy you have will pay
for medical expenses or loss of income from motor vehicle accidents before requesting this
opt ion.)
Deductibles
You may also reduce your premium with a PIP deductible. Deductibles reduce the total amounts we
pay when losses Occur except that the deductible does not apply to death benefits. Options
include deductibles which apply only to you (the Named Insured), and deductibles which apply to
both you and your relatives. PIP coverages and options are fullydescribed in Part 6 of your Car or
RV policy. Those currently available include:
, , ,
- 2 -
1 11111 1111111 11111 IIf' ""1 ~IIII 11I11 111111111111111 111111111111111 111111111111111111111111 1111
PERSONAL 'INJURY PROTECTION (cont'd)
Full Coverage
'. $250
$250
$50.0
$500
$1,000
"$1,0,00
$2,000
$2,000
Work Loss Exclusion
Work Loss Exclusion
Military Coordinat'ion of Benefits
Mi'litary Coordination of Benefits
Work Loss Exclusion and Military
- Coordination of Benefits
Work Loss Exclusion and Military
Coordination of Benefits No Yes
If you wish to change your policy to include any of the above options, please indicate your choice
below and return it to us with your premium payment.
Options
Option H
Option I
Option J
Option K
Option L
- Option M
OptionN
Option 0
Option P
Option U
Option V
Option W
Option X
Option Y
Option Z
Deductible or Benefit
Named
Insured Only,
Named Insured
and Each Relative
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
Yes
· No
UNINSURED MOTORISTS ELECTION FORM
f have ~ead the explanation provided in this notice and have elected to:
'. ,
Reject Uninsured Motorists Coverage.
Purchase Uninsl,Jred Motorists .Coverage limits equal to or lower than my Bodily Injury
Liability Coverage limits. The Uninsured Motorists Coverage limits I wish to buy are:
Each Person ,Each Accident
$
/$
I understand and agree that selection .of one of the above options applies to my Car or RV insurance
policy and future renewals of or replacements for the policy which are issued with the same Bodily
Injury Liability 1 i.';' its. If I want to change my Bodily Injury Liability or Uninsured Motorists
Coverage in the future, I must notify the Company or my PrudenHal agent in writing.
I further understand that this change becomes effective on my policy's renewal date or the date this
form is rece!,'{ed ,by the Company, whic,t,lever is later.
Name (Please print) Pol icy Number
Signature
Date
- 3 -
AE12-009213
NON-STACKING OF UNINSURED MOTORISTS COVERAGE ELECTION FORM
I have read the explanation provided in this notice and have elected:
( ) Non-Stacking of Uninsured Motorists Coverage Limits
I understand and 'agree that the 'selection of the above Non-Stacking of Unins,ured M,€>torists
Coverage Limits option applies to my Car or RV policy and future renewals of or repla~ements for
that policy. I'f 1 vvant to change my Non-Stacking of Uninsured Motorists Coverage Limits option in
the future, I must notify the Company or my agent in writing.
I further understand .that. this change, .becomes effect ive on my pol icy's renewal date or the date th i s
form is rece'ived by the' Company, whichever is later.
Name (Please print) , Policy Number
Signature
Date
PERSONAL INJURY PROTECTION ELECTION FORM
I have read the explanation provided in this notice and have elected to:
Purchase the Personal Injury Protection option
I understand and agree that the selection of the above Personal Injury Proteq,ion optjon applies to
rny Car or RV policy and future renewals of or replacements for that policy. If I want to change my
Personal Injury Protection option in the future, I must notify the Company or my agent in writing.
I further understand that this change becomes effective on my policy's renewal date or the date this
form is recei.v~d by ~.~~ ~ompany, w~icheyer is later.
Name (Please print)
,Policy Number
Signature
Date
- 4 -
111111 11II111 IIIIIII~' "'II ~IIII 111111111111111 11111111111111111111 1111111111111111111111111111
PAC 19 FL (Ed. 10/89)
Car Rating Information Form
The rating of y,?ur policy is ',determined by the use of your car as shown in our files.
, I '
Premiums are determined by a Rate Class Code. The Rate Class Code is a six digit number. It is shown In Item 4 of your
Declarations. If 'you compare the specific numbers that make up the 6 digits of the, Rate Class Code shown for each car and the
number data, shown below, you will have a brief explanation of the rating. of your policy.
Rate Class Code Explanation (Sample Code is 854610)
The first digit (the 8 above) of the Rate Class is always number 7 or 8. It shows, the number of miles yo~r car is dri'ven in a
year.
Number 7 means:, Your car is driven under 7500 miles a year with a Limited Miteage Qiscount.
Number 8 means:' ''lour. car is driven 7500 or more miles a year.
2nd digit (the 5 'above) - Driver Class
No Youthful Driver
1 All except' as indicated below
2 Principal driver age 65 to 74
4 Principal driver, age 55-59
5 Principal driver, age 60 - 64
6 Only driver in household, female age 30-54
7 Principal senior driver, over 74
4th digit (the 6 above) - Use Class
No Youthful Driver
1 Pleasure
2 Work under 100 miles/week
3 Work, 1 00 or more miles/week
4 Business use
5 Farm use
Youthful Driver
4 Unmarried female occasional driver, under 25
5 Unmarried female owner or principal driver,
under 25
6 Married male, under 25,
7 Unmarried male occasional driver, under 25 ,
8 Unmarried male owner or principal driver, under 27
9 Umarried male owner or principal driver,
age 27-29 .
Youthful Driver
6 Pleasure, including work under 1 00
miles/week, or farm use, without Good
Student Discount
7 Pleasure, including work under 1 00 . #
miles/week, or farm use, with Good
Student Discount
8 Work, 100 'or more miles/week, or
Business Use, without Good Student Discount
9 Work, 100 or more miles/week, or
Business Use, with Good Student Discount
3rd Digit (the 4 above) - Driver Class
1 No Youthful Driver
5th digit '(th~ l' above) - Car Type - Multiple' Car
1 Only one car insured
2 More than one car insured with Multi
Car Discount
, ,
Youthful Driver,
2 Age under 2 1: without Driver Training Discount
3 Age under 2 1, with Driver Training Disc,ount
4 Age 2 j - 24
5 Age 25-29
6th digit (the 0 above) - Safe Driver, Incertive Plan
A ~r 0: No Poi~ts F or 5: Five Points
B or 1: One Point G or 6: Six Points
C or 2: Two' Points H or 7: Seven Points
D or 3: Three Points J or 8: Eight Points
E or 4: Four Points K or 9: Nine Points or More
Note: A letter code means: You have a "companion" policy (e.g. you have one car insured in PRUPAC and one insured in
PRUGEN)~ A number code means: Your cars are insured in the same subsidiary.
Safe Driver Incentive Plan Data
1. Points are assigned for for convictions and accidents occurring within the experience period 'for the' applicant or any reSIdent
driver as follows:
A. Car Convictions (not those dismissed or not prosecuted)
( 1) Thre~ .po,ints ar,e. .~ssigned for:
a. Driving while intoxicated or under the influence of drugs.
b. Failure to stop and report when involved in an accident.
c. Homicide or assault arising out of the operation of a car.
- 5 -
AE12-009214
d. Driving during the period while the license is suspended or revoked.
(2) Two points are assigned for accumulation Of points under a state point system or a ser'i'es of convictions which result
in filing evidence of Financial Responsibility (SR- 22).
(3) One point is' assigned for any 'other moving traffic infraction which results in a suspended or revoked driver's license;
or filing evidence of Financial Responsibility (SR- 22).
This infraction must be a second or subsequent offense committed with,in the last 18 months; or a violation due to
exceeding the lawful speed limit by more than 1 5 miles per hour.
B. Car Acci.dents
( 1) Occurring on or after December 1, , 989
a. New Business - One point is assigned for each at-fault accident involving the applica'1t or any, r~sident dr'iver of a
car, as of the date any company has made payments of $400 or more, to: the car driven; or other property.
b. Renewal Business - One point is .ssigned for each at-fault accident involving the insured or any resident driver of
the car, 'as' of, 'th'e. date the company has made, payments during the experience period of $400 or more: under Property
Damage liabil'ity coverage; or as a single car moving Collision loss
(2) Occurring on or after October 2, 1"987 and before December 1, 1989
a. New Business - Ofle point is assigned for each at-fault accident involving the applicant or any resident driver of a
car, ~~ of the date any ~onmpany has rT:l~de payments of $200 ,or more to: the car driven; or other property.
b. Renewal Business - One point is assigned for each at-fault accident involving the insured or any resident driver of
the car, as of the date the company has, made payments during the experience period of $200 or more: under Property
Damage liability coverage; or as a single car moving Collision loss.
(3) Occurring before October 2, 1987
New or Renewal Business - One point is assigned for each car accident involving the insured or any resident driver of the
car, as of the date any company has made payments during the experience period of $200 or more under Property
Damage liability coverage.
C. Exceptions
1. No poi~t is assigne'~ for an accident under "B" above if the accident occurred under one of the following
circumstances:
(1) Lawfully Parked: Car of applicant or other resident driver was lawfully, parked. A car rolling from a parked position IS
not Jawf.ully parked, but is caused by the/operation of the last., driver. (2) Not At-Fault: Applicant or other resident
driver is less than 50% at-fault for the accident. (3)'Rear-end Collision: Car of applicant or other resident driver was
struck in the rear by another vehicle. The applicant or other resident driver was not convicted of a moving traffic
violation in 'connection with the accident. '(4) Other Party Convicted: Driver of the other v~hicle invo!ved in such
accident was convicted of a movin'g traffic violation. The applicant or oth'er resident driver was not convicted of a
moving traffic violation in connection with the accident. (5) Hit-and-Run: Car was driven by applicant or other resident
driver and car ,vv.as damaged by a "hit':"and-run" driver. The accident must have. been reported to the police within 2 4
hours. (6) ,Comprehensive: Accidents involving payments only under Comprehensive 'coverage. (7) Emergency Cars:
Accidents occurring as a result of the operation of any car in an emergency if the driver at the time of the accident
was responding to -a call to duty as a member of any PoliCe or Fire Department, F;rst Aid Squad, or any law
enforcement agency. But, this exception does not apply after the emergency situation ceases or after the car ceases to
be used in the emergency. (8) Medical Payments or PIP: Accidents involving only Medical Payments or PIP. (9) Not
Liable,:, Finally adjudicated not to be liabl~ by a court of competent jurisdiction. (10) Dismissed: In receipt of a traffiC
citation which was dismissed or nolle prossed. (11) Lack of Fault: Not at fault, as evidenced by a written statement
from the in~ured establishing facts dem,onstrating lack of fault, which are not rebutted by the information in our flies
from which we had determined that the insured was substantially at fault.
2. Inexperienced Driver: One point is assigned if the principal driver of the car has not been licensed for two years.
NOTES
, ,
1. AnV points developed under the plan are assigned to the two cars with the highest "Total Base Premium" for most coverages
(not Comprehensive) combined and the remaining cars are rated at Sub-Class O.
2. "Experience period" means the three years right before the application effective date or preparation bf1renewal.
- 6 -
l~: