01/19/1995 ContractBRANCH OFFICE
3117 OVERSEAS HIGHWAY
MARATHON, FLORIDA 33050
TEL. (305) 289-6027
GOUNTy 6
Jam[ JJM Cuip'G BOG!
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zo COUNTY. i.
;Dannp X. Rotbage
CLERK OF THE CIRCUIT COURT
MONROE COUNTY
500 WHITEHEAD STREET
KEY WEST, FLORIDA 33040
TEL. (305) 292-3550
MEMORANDUM
TO: Dent Pierce, Director
Division of Public Works
FROM: Ruth Ann Jantzen, Deputy Clerk ,�,�/-
DATE: February 8, 1995
BRANCH OFFICE
88820 OVERSEAS HIGHWAY
PLANTATION KEY, FLORIDA 33070
TEL. (305) 852-7145
On January 19, 1995 the Board of County Commissioners granted approval and
authorized execution of a contract between Monroe County and B & L Plumbing and
Heating Co., Inc., for the Public Service Building sewer connection, in the amount of
$99,850.00.
Enclosed please find a fully executed duplicate original of the above Contract for
your handling.
If you have any questions on the above, please do not hesitate to contact this
office.
cc: County Attorney
Finance
County Administrator, w/o document
File
FORM OF A(AXEDVWT
This agreement 's set forth as of the �th day of in
the year of between the OWNER who is TA BOA OF
COUNTY COMMISSIONERS of Monroe County Florida; and the following
CONTRACTOR:
Name: B & L Plumbing & Heating Co. Inc.
Address: 1865 Overseas Highway
Matathon, Florida 33050
Phone: ( 305 ) -4 ^-•
for the purpose of performing all of the Work required by the
Contract Documents for the following PROJECT:
PUBLIC SERVICE BUILDING SEWER CONNECTION
Stock Island
J , ^
Monroe County, Florida V,
The Project has been designed by MONROE COUNTY ENGINIRRING
DEPARTMENT who is hereafter referred to as i thy#
ARCHITECT/ENGINEER and who assumes all duties o� an.4
responsibilities and has the rights and authority assigned Im the
ARCHITECT/ENGINEER in the Contract Documents in connectioi' with
completion of the Work in accordance with the Contract Doculants�
The OWNER and the CONTRACTOR agree as set forth as follows:
Article 1 - The Contract Documents
The Contract Documents consist of this Agreement, the Bid
Form and Sheet, the Instructions to Bidders, the Conditions
and General Conditions, the Supplemental Insurance
Documents, the Drawings, and all Addenda issued prior to and
all Modifications issued after execution of this Agreement.
These form the Contract, and all are as fully a part of the
Contract as if attached to this Agreement or repeated
herein. An enumeration of the Contract Documents appears in
Article 7.
Article 2 - The Work
1. The scope of work shall include: the furnishing and
installation of a pump station, force main, and
separation/encasement structures, the connections at
both the Public Service Building discharge line and the
County Jail lift station, all necessary utility
connections, restoration of the asphalt pavement, and
12/30/94 REQUEST FOR BID Page-6
, r ,
the decommissioning/plugging of the existing sewage
treatment facility.
2. The work shall include all supervision, equipment,
labor, materials, maintenance of traffic, and
transportation required to install said equipment in
accordance with the details in the drawings attached
and specifications.
3. All equipment and materials shall be in strict
accordance with current Florida Department of
Enviromental Protection (FDEP) standards and
specification, the standards and specification of the
FDEP permit, Monroe County-s "Public Works Manual", and
the standards and specifications contained herein. If
any contradiction is discovered between these
documents, the most stringent standards shall govern
the work.
4. The specification contained herein are considered to be
the minimum standards required. The installation shall
comply with all Federal, State, County and Local codes
and ordinance.
5. The Contractor is responsible for contacting UNCLE for
utility locations.
6. The Contractor will furnish all names of
representatives authorized to represent and make
decisions on behalf of the Contractor.
7. The Contractor will provide an authorized
representative on -site during the period of
construction.
8. Monroe County reserves the right to reject any and all
bids in whole or in part and to waive any informalities
or irregularities in this bid, determined to be in the
best interest of the citizens of Monroe County.
CLEAN UP:
1. The Contractor shall be responsible for the removal of
all construction debris from the site.
Article 3 - Schedule
The Contractor shall commence work to be performed under
this Bid no later than ten (10) calendar days from the
Notice to Proceed and shall be substantially completed no
later than seventy-five (75) calendar days from the
Commencement Date however, the contractor shall have the
system operational and temporarily back fill the trenches
within forty-five (45) calendar days. The Contractor also
12/30/94 REQUEST FOR BID Page-7
agrees to be complete and ready for final payment no later
than thirty (30) calendar days from the Substantial
Completion Date. Substantial completion to be determined by
the County Director of Engineering. The OWNER and the
CONTRACTOR recognize that time is of the essence in this Bid
and that the Owner will suffer financial loss if the Work is
not completed within the times specified above, plus any
extensions of time allowed in accordance with the Request
for Bid. They also recognize the delays, expense and
difficulties involved in proving in a legal proceeding the
actual loss suffered by Owner if the Work is not completed
on time. Accordingly, instead of requiring such proof,
Owner and Contractor agree that as liquidated damages for
delay (but not as a penalty) Contractor shall pay Owner
fifty dollars ($50.00) for each day that expires after the
time specified above for Substantial Completion until the
Work is substantially completed.The Owner and Contractor
agree that work on the project will be continuous from the
Commencement Date thru the Completion Date. Any
demobilization once the work has started requires prior
approval by the Owner.
Article 4 - Contract Price
The OWNER shall pay the CONTRACTOR for completion of the
Work in accordance with the Contract Documents in current
funds in the following amount subject to unit price actual
quantity variations:
$Ninety nine thousand, eight hundred and $99,850.00
(WORDS) fifty dollars no/100 (DOLLARS)
Article 5 - Payment Procedures
The Contractor shall submit Applications for Payment using
the Application and Certificate for Payment, Worksheet, and
Partial Release of Lien forms provided.
The Owner shall make progress payments on account of the
Contract Price on the basis of the Contractor's Application
for Payment as recommended by the County Engineer once per
month during construction. All progress payments will be on
the basis of the progress of the Work, and Materials (free
of any encumberances) secured on approved sites. Payment
will be made approximately one (1) month from the submission
of the application if all documentation is complete.
Retention in the amount of ten percent (10%) will be
withheld from each progress payment until Final Release of
Lien is submitted, and final payment is made.
Upon final completion and acceptance of the Work and
compliance with F.S. 255.05 and F.S. 713, Owner shall pay
the remainder of the Contract Price, including release of
retention, as recommended by the County Engineer.
12/30/94 REQUEST FOR BID Page-8
Article 6 - Contractor's Representations
In order to induce OWNER to enter into this Contract,
CONTRACTOR makes the following representations:
1. CONTRACTOR has familiarized himself with the nature and
extent of the Contract Documents, Work, site, locality,
and all local conditions and Laws and Regulations that
in any manner may affect cost, progress, performance,
or furnishing of the Work.
2. The CONTRACTOR has studied carefully all reports of
explorations and tests of subsurface conditions and
drawings of physical conditions which are included in
the Contract Documents.
3. The CONTRACTOR has obtained and carefully studied (or
assumes responsibility for obtaining and carefully
studying) all such examinations, investigations,
explorations, tests, reports, and studies which pertain
to the subsurface of physical conditions at or
contiguous to the site or otherwise may affect the
cost, progress, performance or furnishing of the Work
as CONTRACTOR considers necessary for the performance
or furnishing of the Work at the Contract Price, within
the Contract Time and in accordance with the other
terms and conditions of the Contract Documents,
including specifically the provisions of paragraph 4.2
of the General Conditions; and no additional
examinations, investigations, exploration, tests,
reports, studies, or similar information or data be or
will be required by the CONTRACTOR for such purposes.
4. The CONTRACTOR has reviewed and checked all information
and data shown or indicated on the Contract Documents
with respect to existing Underground Facilities at or
contiguous to the site and assumes responsibility for
the accurate location of said Underground Facilities.
5. The CONTRACTOR has correlated the results of all such
observations, examinations, investigations,
explorations, tests, reports, and studies with the
terms and conditions of the Contract Documents.
6. The CONTRACTOR has given the OWNER written notice of
all conflicts, errors, or discrepancies that he has
discovered in the Contract Documents and the written
resolution thereof by the OWNER is acceptable to the
CONTRACTOR.
Article 7 - Contract Documents
The Contract Documents which comprise the entire agreement
between the OWNER and the CONTRACTOR concerning the Work
consist of the following:
12/30/94 REQUEST FOR BID Page-9
lip
1. Notice of Award
2. This Agreement (pages 6 to 12, inclusive).
3. Bidding Documents - Notice of Calling for Bids,
Instructions to Bidders
4. Notice to Proceed
5. General Conditions (pages 13 to 44, inclusive).
6. Conditions (pages 45 to 47, inclusive).
7. Supplementary Insurance Documents (pages 61 to 68,
inclusive).
8. Drawings, consisting of a cover sheet and sheets
numbered 1 through 1 , inclusive with each
sheet bearing the following general title:
PUBLIC SERVICE BUILDING SEWER CONNECTION
Stock Island
Monroe County, Florida
9. Addenda numbers 1 to 1 , inclusive.
There are no Contract Documents other than those listed
above in this Article. The Contract Documents may only be
amended, modified, or supplemented as provided in the
General Conditions.
Article 8 - Indemnification and Hold Harmless
The Contractor covenants and agrees to indemnify and hold
harmless Monroe County Board of County Commissioners from
any and all claims for 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
Contractor or any of its Subcontractor(s) in any tier,
occasioned by the negligence or other wrongful act or
omission of the Contractor or its Subcontractors) in any
tier, their employees, or agents.
The first ten (10) dollars of remuneration paid to the
Contractor is for the indemnification provided for above.
The extent of liability is in no way limited to, reduced, or
lessened by the insurance requirements contained in the form
of agreement.
12/30/94 REQUEST FOR BID Page-10
y
Article 9 - Miscellaneous
Terms used in this Agreement which are defined in Article 1
of the General Conditions will have the meanings indicated
in the General Conditions.
No assignment by a party hereto of any rights under or
interests in the Contract Documents will be binding on
another party hereto without the written consent of the
party sought to be bound; and specifically but without
limitation moneys that may become due and moneys that are
due may not be assigned without such consent (except to the
extent that the effect of this restriction may be limited by
law), and unless specifically stated to the contrary in any
written consent to an assignment no assignment will release
or discharge the assignor from any duty or responsibility
under the Contract Documents.
OWNER and CONTRACTOR each binds itself, its partners,
successors, assigns and legal representatives to the other
party hereto, its partners, successors, assigns and legal
representatives in respect of all covenants, agreements and
obligations contained in the Contract Documents.
Article 10 - Other Provisions
In cases of conflict within the described Contract Documents
in Article 7 of this Form of Agreement, the order of
precedence shall be as follows:
1. This Agreement
2. Instructions to Bidders with
3. Conditions
4. General Conditions
5. Drawings (large scale detail
scale general drawings)
all/any addenda
drawings over smaller
12/30/94 REQUEST FOR BID Page-11
f
IN WITNESS WHEREOF, the OWNER and CONTRACTOR have signed this
Agreement in quadruplicate. One counterpart each has been delivered
to the OWNER, CONTRACTOR, COUNTY ENGINEER and COUNTY PURCHASING
DEPARTMENT. All portions of the Contract Documents have been signed
or identified by the OWNER and CONTRACTOR or by the COUNTY ENGINEER
on their behalf.
This Agreement will be effective on
OWNER: Monroe County BOCC
Monroe County, FL
4 •
By By.
DA1 " L MIRAGE, Off
Attest
Address for giving notices
Monroe County Public Works
Engineering Department
5100 College Road
Key West, FL 33040
t
s
Addres's for giving n
ot
ice
s'
12/27/94 REQUEST FOR BID Page-12
rev. 4/22/93
MONROE COUNTY, FLORIDA
INSURANCE CHECKLIST
FOR
VENDORS SUBMITTING PROPOSALS
FOR WORK
To assist in the development of your proposal,
coverages marked with an "X" will be required in the
is made to your firm. Please review this form with
agent and have him sign it in the place provided.
required that the bidder sign the form and submit
proposal.
WORKER'S COMPENSATION
AND
EMPLOYERS' LIABILITY
Workers' Compensation
WC1
Employers' Liability
WC2
Employers' Liability
WC3 X
Employers' Liability
WCUSLH
US Longshoremen &
Harbor Workers Act
WCJA
Federal Jones Act
12/06/94
the insurance
event an award
your insurance
It is also
it with each
Statutory Limits
$100,000/$500,000/$100,000
$500,000/$500,000/$500,000
$1,000,000/$1,000,000/$1,000,000
Same as Employers' Liability
INSCKLST
1
Same as Employers' Liability
REQUEST FOR BID
rev. 4/22/93
Page-61
GENERAL LIABILITY
As a minimum, the required general liability coverages will include:
- Premises Operations - Products and Completed Operations
- Blanket Contractual - Personal Injury
- Expanded Definition
of Property Damage
Required Limits:
GL1 $100,000 per Person; $300,000 per Occurrence
$50,000 Property Damage
OR
$300,000 Combined Single Limit
GL2 $250,000 per Person; $500,000 per Occurrence
$50,000 Property Damage
OR
$500,000 Combined Single Limit
GL3 �_ $500,000 per Person; $1,000,000 per Occurrence
$100,000 Property Damage
OR
$1,000,000 Combined Single Limit
Required Endorsement:
GLXCU L,_ Underground, Explosion and Collapse (XCU)
GLLIQ
Liquor Liability
All endorsements are required to have the same limits as the basic
policy.
INSCKLST
2
rev. 4/22193
12/06/94 REQUEST FOR BID Page-bz
• I I
VEHICLE LIABILITY
As a minimum, coverage should extend to liability for:
- Owned; Nonowned; and Hired Vehicles
Required Limits:
VL1
$50,000 per Person; $100,000 per Occurrence
$25,000 Property Damage
OR
$100,000 Combined Single Limit
VL2 _�
$100,000 per Person; $300,000 per Occurrence
$50,000 Property Damage
OR
$300,000 Combined Single Limit
VL3
$500,000 per Person; $1,000,000 per Occurrence
$100,000 Property Damage
OR
$1,000,000 Combined Single Limit
MISCELLANEOUS COVERAGES
BR1
Builders' Limits equal to the
Risk completed project.
MVC
Motor Truck Limits equal to the maximum
Cargo value of any one shiipment.
PRO1
Professional $ 250,000 per Occurrence
PRO2
Liability $ 500,000 per Occurrence
PRO3
$1,000,000 per Occurrence
POL1
Pollution $ 500,000 per Occurrence
POL2
Liability $1,000,000 per Occurrence
POL3
$5,000,000 per Occurrence
ED1
Employee $ 10,000
ED2
Dishonesty $100,000
GK1
Garage $ 300,000 ($ 25,000 per Veh.)
GK2
Keepers $ 500,000 ($100,000 per Veh.)
GK3
$1,000,000 ($250,000 per Veh.)
MED1
Medical $ 500,000/$ 1,000,000 Agg.
MED2
Professional $1,000,000/$ 3,000,000 Agg.
MED3
$5,000,000/$10,000,000 Agg.
INSCKLST
3 rev. 4/22/94
12/06/94 REQUEST FOR BID Page-63
IF
Installation
Floater
VLP1
Hazardous
VLP2
Cargo
VLP3
Transporter
BLL
Bailee Liab.
HKL1
Hangarkeepers'
HKL2
Liability
HKL 3
AIR1
Aircraft
AIR2
Liability
AIR3
AEO1
Architects
Errors
AEO2
&
Omissions
AEO3
Maximum Value
of Equipment
Installed
$ 300,000
(Requires MCS-90)
$ 500,000
(Requires MCS-90)
$1,000,000
(Requires MCS-90)
Maximum Value
of Property
$ 300,000
$ 500,000
$1,000,000
$25,000,000
$ 1,000,000
$ 1,000,000
$ 250,000 per Occurrence/
$ 500,000 Agg.
$ 500,000 per Occurrence/
$1,000,000 Agg.
$1,000,000 per occurrence/
$3,000,000 Agg.
INSURANCE AGENT'S STATEMENT
I have reviewed the above requirements with the bidder named below.
The following deductibles apply to the corresponding policy.
POLICY DEDUCTIBLES
Liability policies are Occurrence Claims Made
Insurance Agency Signature
BIDDER'S STATEMENT
I understand the insurance that will be mandatory if awarded the
contract and will comply in full with all the requirements.
Bidder Signature
INSCKLST
4 rev. 4122/93
12/06/94 REQUEST FOR BID Page-64
April 22, 1993
1st Printing
WORKERS' COMPENSATION
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Prior to the commencement of work governed by this contract, the Contractor shall obtain
Workers' Compensation Insurance with limits sufficient to respond to the applicable state's
statutes.
In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not
less than:
$1,000,000 Bodily Injury by Accident
$1,000,000 Bodily Injury by Disease, policy limits
$1,000,000 Bodily Injury by Disease, each employee
Coverage shall be maintained throughout the entire term of the contract. I
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 Contractor's Excess
Insurance Program.
If the Contractor participates in a self-insurance fund, a Certificate of Insurance will be
required. In addition, the Contractor may be required to submit updated financial
statements from the fund upon request from the County.
WC3
April 22, 1993
Ist Printing
GENERAL LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
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:
o Premises Operations
o Products and Completed Operations
o Blanket Contractual Liability
o Personal Injury Liability
o Expanded Definition of Property Damage
The minimum limits acceptable shall be:
$1,000,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
( $ 500,000 per Person
$ 1,000,000 per Occurrence
$ 100,000 Property Damage
An Occurrence Form policy is preferred. If coverage is provided on a Claims Made
policy, its provisions should include coverage for claims filed on or after the effective date
of this contract. In addition, the period for which claims may be reported should extend
for a minimum of twelve (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.
GL3
April 22, 1993
1st Printing
GENERAL LIABILITY
C INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
C
Recognizing that the work governed by this contract involves either underground
exposures, explosive activities, or the possibility of collapse of a structure, the
Contractor's General Liability Policy shall include coverage for the XCU (explosion,
collapse, and underground) exposures with limits of liability equal to those of the General
Liability Insurance policy.
GLXCU
April 22, 1993
1st Printing
VEHICLE LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Recognizing that the work govmed 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:
o Owned, Non -Owned, and Hired Vehicles
The minimum limits acceptable shall 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
The Monroe County Board of County Commissioners shall be named as Additional
Insured on all policies issued to satisfy the above requirements.
VL2
BID FORM
BID TO: MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
C/O PURCHASING DEPARTMENT
PUBLIC SERVICE BUILDING, ROOM 002
5100 COLLEGE ROAD, STOCK ISLAND
KEY WEST, FLORIDA 33040
BID FROM: -S- Lb�itl ,� �T I „( it%C� 00092
THE UNDERSIGNED, HAVING CAREFULLY EXAMINED THE WORK AND REFERENCE
DRAWINGS, TECHNICAL SPECIFICATIONS, BID, AND ADDENDA THERETO AND
OTHER CONTRACT DOCUMENTS FOR THE CONSTRUCTION OF:
PUBLIC SERVICE BUILDING SEWER CONNECTION
FOR: INSTALLATION OF PUMP STATION AND SEWER LINE
STOCK ISLAND
MONROE COUNTY, FLORIDA
AND HAVING CAREFULLY EXAMINED THE SITE WHERE THE WORK IS TO BE
PERFORMED, HAVING BECOME FAMILIAR WITH ALL LOCAL CONDITIONS
INCLUDING LABOR AFFECTING THE COST THEREOF, AND HAVING
FAMILIARIZED HIMSELF WITH MATERIAL AVAILABILITY, FEDERAL, STATE,
AND LOCAL LAWS, ORDINANCES, RULES AND ]REGULATIONS AFFECTING
PERFORMANCE OF THE WORK, DOES HEREBY PROPOSE TO FURNISH ALL
LABOR, MECHANICS, SUPERINTENDENTS, TOOLS, MATERIAL, EQUIPMENT,
TRANSPORTATION SERVICES, AND ALL INCIDENTALS NECESSARY TO PERFORM
AND COMPLETE SAID WORK AND WORK INCIDENTAL HBREM, IN A
WORKMAN -LIKE MANNER, IN CONFORMANCE WITH SAID DRAWINGS, TECHNICAL
SPECIFICATIONS, AND OTHER CONTRACT DOCUMENTS INCLUDING ADDENDA
ISSUED THERETO.
THE UNDERSIGNED FURTHER CERTIFIES THAT HE HAS PERSONALLY
INSPECTED -THE ACTUAL LOCATION OF WHERE THE WORM IS TO BE
PERFORMED, TOGETHER WITH THE LOCAL SOURCES OF SUPPLY AND THAT HE
UNDERSTANDS THE CONDITIONS UNDER WHICH THE WORK IS TO BE
PERFORMED. THE SUCCESSFUL BIDDER SHALT, ASSUME THE RISK OF ANY
AND ALL COSTS AND DELAYS ARISING FROM THE EXISTENCE OF ANY
SUBSURFACE OR O'PHEIt LATENT PHYSICAL CONDITION WHICH COULD BE
REASONABLY ANTICIPATED BY REFERENCE TO DOCUMENTARY INFORMATION
PROVIDED AND MADE AVAILABLE, AND FRDM INSPECTION AND EXAMINATION
OF THE SITE.
THE UNDERSIGNED SHALL, PERFORM THE WORK FOR THE LUMP SUM PRICE
INDICATED ON THE FOLLOWING BID FORM DOCUMENT:
08/19/94 REQUEST FOR BID Page 11
I ACKNOWLEDGE RECEIPT OF ADDENDA NO. (S)
1
I HAVE INCLUDED PAGES 11-13, Ar 15-20 OF THE BIB PROPOSAL
WHICH ENTAILS THE �ID FORM , BID SHEET�/ , PUBLIC ENTITY
CRIME AFFIDAVIT , NON -COLLUSION AFFIDAVIT_, DRUG FREE
WORKPLACE FORM — SWORN STATEMENT UNDER ORDINANCE NO. 10-1990
(PLEASE CHECK -MARK ITEMS ABOVE, AS A REMINDER THAT THEY ARE
INCLUDED)
MAILING ADDRESS: 1014 �/
W"
lW—e4-�6,o FA
3:3�s s�
PHONE NUMBER:
DATE: C� SIGNED:
(TITLE)
T
WITNESS: z
(SEAL)
08/20/94 REQUEST FOR BID Page 12
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08/19/94 REQUEST FOR BID Page 13
SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a),
FLORIDA STATUTES ON PUBLIC ENTITY CRIIVIF.S
THIS FORM MUST BE SIt;NM AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
1. This sworn statement is submitted
by 44 �— S
[print individual's name and title]
for 1-1)-4- l— rr Llle*"
[print name oftoe public eat�tyl
[print name of entity submitting sworn sta -T-ntl
whose business address is
6.-DjC
Ai Ae A-t�x A;
and (if applicable) its Federal Employer Identification Number (FEIN) is 6 S ` C3S 4—�4- k
(If the entity has no FEIN, include the Social Security Number of the individual signing this sworn
statement: ,)
Z I 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 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 Unted 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. I understand that"convicted" or "conviction" as defined in Paragraph 287.133(1)(b), Florida Statutes, means a .
finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any 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(ixa), Florida Statutes. means:
L A predecessor or successor of a person convicted of a public entity erimr; or
Z An entity under the control of any natural person who is active in the managent of the entity and who has
been convicted of a public entity crime. The term "af Miate" includes those ofBeers, directors, executives, partners,
shareholders, employees, members, and agents who are active in the management of sin affiliate. The ownership
by one person of shares cones a controlling interrst in another person, or pooling of equipment or income
among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that
one person controls another person. A person who imowiugly eaters into a joint westun a with a person who has
been convicted of a public entity crime in Florida during the preceding36 months shall be considered an affiliate.
5. I understand that a "person" as defined in Paragraph 287.133(lxe), Florida SIXML 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 provides of goods or services let by a public entity,
or which otherwise transacts or applies to transact businesswith a public entity. The term "person" includes those
officers, directors, emmtives, partners, shareholders, employees, members, and agents who are active in
management of an entity.
08/19/94 REQUEST FOR BID Page 15
6. Based on information and beiieE, the statement which I have marked below is true in relation to the entity
submitting this sworn statemenL [Indicate which statement applies.]
Neither the entity submitting this sworn statement, nor any of Its oi$cers, directors, executives, partners,
shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of
the entity has been charged with and convicted of a public entity crime subsequent to July 1,1989.
The entity submitting this sworn statement, nor any of its Oak=%, directors, exectutives, partners,
shareholders, employees, members, or agents who are active in the management of the entity, nor an affiliate of
the entity has been charged with and convicted of a public entity crime subsequent to July 1,1989.
The entity submitting this sworn statement, or one or more of itr officers, directors, executives, partners,
shareholders, employees, members, or agents who are active in the moment of the entity, or an affiliate of
the entityhas been charged with and convicted ofa public entityerimesubsom mttoJuly 1,1989. However, there
has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative
Hearings and the Final Order entered by the Hearing Officer determined that it was not in the public interest to
place the entity submitting this sworn statement on the convicted vendor list. [attach a copy of the final orderl
'UNDERSTAND THATTHE SUBNIISSION OF THIS FORM TO THE CONTRACTING OFFICERFORTHE PUBLIC
ENTITY MEN71FIED ON PARAGRAPH 1(ONE) ABOVE IS FORTHAT PUBLIC ENTITY ONLY AND, THAT THIS
FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO
UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A
CONTRACTINEXCESS OFTHETHRESHOLDAMOUNTPROVIDED INSECTTON287.017,F0$Il?ASTA=S
FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.
Sworn to and subscribed before me this day of
Personally (mown
OR Produced identification
(Type of identification)
[signaturel
Nor U
19-21L.
Notary Public - State of -�/� n
My Commission expires ( 9 7 -7
(Printed typed or stamped
commissioned name of notary public)
CHERYL A. SCANLON
s COMMISSION 4 CC 294523
EXPIRES JUN 14,1997
Atlantic Son dMpp Co., Inc.
$00-732.2245
08/19/94 REQUEST FOR BID Page 16
NON -COLLUSION AFFIDAVIT
I, of the city of "'/ A fit/
according to law on my oath, and under penalty of perjury, depose
and say that;
1.) I am
P2 ; �,+-
of the firm of )_ 1�14+��•'ti %� 6 .�C the
bidder making the Bid for the oroject described in this
Request for Bid for:
PUBLIC SERVICE BUILDING SEWER CONNECTION
FOR: INSTALLATION OF PUMP STATION AND SEWER LINE
Stock Island
Monroe County, Florida
and that I executed the said bid 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 process with any other bidder or with any
competitor;
3.) unless otherwise required by law, the prices which have
been quoted in this bid have not been knowingly
disclosed by the bidder and will not knowingly be
disclosed by the bidder prior to bid opening, directly.—
or indirectly, to any other bidder or to any
competitor; and
4.) no attempt has been made or will be made by the bidder
to induce any other person, partnership or corporation
to submit, or not to submit, a bid for the purpose of
restricting competition;
5.) the statements contained in this affidavit are true and
correct, and made with full knowledge that Monroe
County relies upon the truth of the statements
contained in this affidavit in awarding contracts for
said project.
/Z�� - /_/Z� C L
(Signature of Bidd
08/19/94 REQUEST FOR BID Page 17
(Date)
STATE OF:
COUNTY OF:
PERSONALLY APPEARED BE RE ME, the undersigned authority,
, 4 who, after first being
sworn by me, _ lil (name of individual signing)
affixed his/her signature in the space provided above on this
— 1� - day of Dv eYK eYL , 19
My commission expires:
NOTAI& PUBLIC
-Or P41 CHERYL A. SCANLON
kima y COMMISSION / CC 294523
EXPIRES JUN 14, 1997
a At ��n� ?246,� Inc.
08/19/94 REQUEST FOR BID Page 18
i,
LOBBYING AND CONFLICT OF INTEREST CLAUSE
SWORN STATEMENT UNDER ORDINANCE NO. 010-1990
MONROE COUNTY, FLORIDA
L'Oni i
(Com]
(2�,1:
Y)
it
warrants that it has not employed, racsiuec: 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 cons ide a on paid to the former
County officer or employee". D
(Signature
!� 1
(Date)
STATE OF ll� ' ,A
COUNTY OF
PERSONALLY PLEyRED FORE ME, the undersigned authority,
(eL�s who, q4ter fir t being
sworn by me, affixed his/he signature
(name of individualsigning)in the sp c provided above on th's
NO' day of N`�%P�Y►�e�i- , 19
V�
NOTAXY PUBLIC
My commission expires:
CHERYL A. SCANLON
$ COMM18810N E CC 294523
EXPIRES JUN 14 1"7
A11a t Bondinng� Cs., Inc.
WOP 000-732.2245
08/19/94 REQUEST FOR BID Page 19
DRUG -FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087
hereby cert' ies that:
�- ktm�,'
(Name of Business)
1. Publish a statement notifying employees that the unlawful
manufacture, distribution, dispensing, possession, or use of
a controlled substance is prohibited in the workplace and
specifying the actions that will be taken against employees
for violations of such prohibition.
2. Inform 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 of working on the commodities
or contractual services that are under bid, the employee
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 occurring in the
workplace no later than five (5) days after such conviction.
5. Impose a sanction on, or require the satisfactory_
participation in a drug abuse assistance or rehabilitation
program if such is available in the employee's community, or
any employee who is.so convicted.
6. Make a good faith effort to continue to maintain a drug -free
workplace through implementation of this section.
As the person authorized to sign the statement, I certify that
this firm complies fully with the aijovW�-evireqWfits. /?
Bidder's S
Date
MCP#5 REV. 6/91
08/19/94 REQUEST FOR BID Page 20
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 TYPE OF INSURANCE POLICY NUMBER 'POLICY EFFECTIVE :POLICY EXPIRATION TYPE
LTR DATE (MM/DDNY) DATE (MMIDD/YY)
GENERAL LIABLTY OSP207770 06/11/94 06/11/95 GENERAL AGGREGATE $ 2000000
A:...... ..
X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. S 2000000
CLAIMS MADE X ; OCCUR.: PERSONAL & ADV. INJURY S 1000000
................ ........:
........................................ ... .....
OWNERS & CONTRACTORS PROT. EACH OCCURRENCE $ 1000000
FIRE DAMAGE (Any one fire) $ 50000
........................................................................................................................................................
A AUTOMOBILE LIABLMY
X
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
X
HIRED AUTOS
X
INON-OWNED AUTOS
GARAGE LIABILITY
A : EXCESS LIABLRY
X UMBRELLA FORM
OTHER THAN UMBRELLA FORM
.......................................................
WORKER'S COMPENSATION
B AND
EMPLOYERS' LIABLTY
OTHER
GST125158 06/11/94 06/11/95
CLA354854
71826109
.......:.................. ............................................. .... ....................... I .............
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESVIECIAL MEMS
ADDITIONAL INSURED: MONROE COUNTY
PROJECT: PUBLIC SERVICE BUILDING SEWER CONNECTION
MONROE COUNTY BUILDING DEPT.
5100 COLLEGE ROAD WEST
STOCK ISLAND
KEY WEST FL 33040
06/11/94 06/11/95
............... :................................. ..........................
01/01/94 01/01/96
MED. EXPENSE (Any one person) $
5000
COMBINED SINGLE
$
1000000
LIMIT
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
S
EACH OCCURRENCE
.........................................................................................
$
5000000
AGGREGATE
$
5000000
STATUTORY LIMITS
EACH ACCIDENT S 100000
.....................................................................................
DISEASE - POLICY LIMIT $ 500000
DISEASE - EACH EMPLOYEE $ 100000
....................................................................................
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 30 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.
nw,AuFn RF r-=A .., A