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Addendum 01/20/1993ADDENDUM TO AGREEMENT (Public Service Building Sewage Treatment Plant) THIS ADDENDUM TO AGREEMENT is made and entered into this 20th day of January, 1993, between the COUNTY OF MONROE and DAVIS WATER ANALYSIS, INC. in order to amend that certain agreement between the parties dated January 30, 1991, as amended on February 19, 1992, as follows: 1. In accordance with Paragraph VI of aforementioned agreement, the County and Contractor hereby exercises its option to renew said Agreement and hereby amend paragraph VII to read as follows: "VII Payment by the County to Davis Water Analysis, Inc. for the performance of said service remains at $2,467.20 per year to be paid $205.60 per month." 3. In all other respects, the agreement between the parties dated January 30, 1991 as amended on February 19, 1992, remains in full force and effect. IN WITNESS WHEREOF, the parties have hereunto set their hands and seal, the day and year first written above. (Seal) Attest: DANNY L. KOLHAGE, CLERK By: L C. tv", Deputy C erk BOARD OF COUNTY COMMISSIONERS OF MONRM COUNTY, FLORIDA By: i� DAVIS WATER ANALY IS, INC. U4 — By: r W' ness Witness r^ +n!.I ., H 01 Wd ►,7, �� 06 Td00 zl'"' A By Date ���'�"•RANCE ISSUE DATE (MM/DD/YY) 1112193 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Soutbernmwt Insurance Agency CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 1104 2Tumsn avenue POLICIES BELOW. 1. P.O. Box 323 COMPANIES AFFORDI G C ER E Key West, Fl. 33041 COMPANY A LETTER USF&G COMPANY B 1 INSURED Davis Water Analysis, Inc. LETTER COMPANY P.O. BOY 2548 LETTER C+ Rey West, Fl. 33045 Y COMPANY D LETTER COMPANY E LETTER COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DD/YY) DATE (MM/DD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ 100, 000. A X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ 10000000 X ICP30005858300 12128192 12128193 CLAIMS MADE OCCUR. PERSONAL & ADV. INJURY $ 100*0000 OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE $ 100, 000. FIRE DAMAGE (Any one fire) $ 50,000. MED. EXPENSE (Any one person) $ 5,0002 AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT $ 100,000. ALL OWNED AUTOS ICP30005858300 /93 BODILY `s 12128 92 12 28 $ SCHEDULED AUTOS person) A X HIRED AUTOS BODILY INJURY $ X NON -OWNED AUTOS (Per accident) GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION STATUTORY LIMITS AND EACH ACCIDENT $ DISEASE —POLICY LIMIT $ EMPLOYERS' LIABILITY DISEASE —EACH EMPLOYEE $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER rCANCEi.#,.ATIpN Kojwoe County Public Works SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Dlv. Public Facilities maintenance EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO P.O. BOIL 1029 MAIL --32 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE Rey West, Fl. 33041 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR A2W: Mike Hawn LIABILITY OF = KIND UPON THEPqMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORI FIESEtiTATIVE 040000S , , �_ S 1' < Cc'.'N,ry occof '-MONAL UGENSE plow R OE COUNTY -STATE OF FLOP110A THIS LIGEN,",EEXPIRES COST ANO,-' O I PENA14Y' , F U i I T SENT CURRENT 4- ASER Of UNITS HERE: TRANSFER FEE Z TO rAL DUE mo ru 0 z SIATE GERTIFK' ATE NUMBER F. NHr., H4RXICTCFC anr TAX Cr.3,LECTO' 4 4 "33 -T c P-P. LOY 11?9 fn PLEASE SEE PJ A - OF P IIJE AV0'9= LMEX'Srn IS P&PEEY -PO HQX x'.134 L1Ci'jS"'rJ TO 1:4 IN f'1111SINESS -IT k T'tta.T' it 'F-, V F.0 r f F.FV I h',V A!AA1 R) B r,Fci IrT!P,-, hl'/(Uljl: S! lo ""If") I R!K3A, 1 C' k, V V F, AND P 'A01 T FAC A T I H S T S 0 K I S L IN r. 11 W', 1 1, J I I S F I V M, r I f F I 10�r 1: [) CC) t J7,PV',L10L' SI-Y IN I IF1 F L A(, F I; OtF -' "I LICL ii 1 (71, 1,T4, 1`4 ��!t 1 99Z-1 99 C4 I y of Kuy West, I NO PEFUNDS 1.07. LICIE!ME musi, PF rpo.,AINEN i LY DI'3--L A)'FD rulm. P PT 1! 0!, P I I -.cmot1l 0 I 111 '1LTY `.-:GhLOULf- P 'jj c 10:' 41 JVA)trly 'f�;-3170 Mi fl--, TOTAL U1111115 I 6631 f 10!!T STRUT 7,TK 15t. —E rIT S -1 3 kK'�' I HE',S.- wSPZEIFF BUSINESS r 0101,114`1 PAID: 0 3 "FIL (K-CA',r- D A V I A I E R t 71 7 3 1 3 1 4 Z FIV/IMCIF V!- P All Tm Eta ONMr-n: S F 7, T C u U STATE OF FLORIDA DEPARTrkAF-VT OF FNVIRONMENTAL RED ULATION This acknowledges that T .10f'--i H. DAVIS has met the requirawynts of Chapter 403, Florido Statutes, and Chapter 17-602, Florida Administrative Code, and is licensed to perform the duties and responsibilities of a treatment plant op?rator. W"15 SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a), FLORIDA STATUTES. ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED AND SWORN TO 1N THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATIIS. t rf 1. This sworn statement is submitted to Awzve I'lo'44 AwZ- S. T (print na of thepupblic entity] by -� ocam_ av� 5, �i�rS.�`rc�_ i�c-�ec7d/y riprint Intllvidual',s name and,,title] 11 T for print name of entity submitting sworn statement] whose business address is and (if applicable) its Federal Employer Identification Number (FEIN) (If the entity has no FEIN, include the Social Security Number of the Individual signing this sworn statement: 2. 1 understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and dit'ectly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or of the United States, including, but not limited to, any bid or contract for goods 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 material misrepresentation. 3. 1 understand that "convicted" or "conviction" as defined in'Paragraph 287.133(1)(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any 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 entity crime; or 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, partners, 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. 1 understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity. 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.] ' 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 1, 1989. 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. 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 Bearings 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. [nttnch n copy of the final order] I UNDER.%TAA1iQmTibb1nQW, SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBI, IN PARAGRAPH 1. (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, THAT 'IIROUGII DECEMBER 31. OF THE CALENDAR YEAR IN WIIICII IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM TIIE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE TIIRESIIOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATU'CES FOR CATE(;ORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. [signature] Sworn to and subscribed before,me this Personally known OR Produced identification (Type of identification) Form PUR 7068 (Rev. 06118/92) day o[ / t/�/vl%jl/� . 19 Notary Public - State of 011G�� NOTARY PUBLIC STATE OF FLORIDA MY COMMISSION EXP. AUG.22,1993 My commission expires ENDED TNRU GENERAL INS. UND. (Printed typed or stamped commissioned name of notary public)