02/16/1994 AgreementBRANCH OFFICE
3117 OVERSEAS HIGHWAY
MARATHON, FLORIDA 33050
TEL. (305) 289-6027
Xannp 1. Iftotbage
CLERK OF THE CIRCUIT COURT
MONROE COUNTY
500 WHITEHEAD STREET
KEY WEST, FLORIDA 33040
TEL. (305) 292-3550
M E M O RAN D U M
TO: Dent Pierce, Director
Division of Public Works
FROM: Isabel C. DeSantis, Deputy Clerk toC,,�
DATE: March 3, 1994
BRANCH OFFICE
88820 OVERSEAS HIGHWAY
PLANTATION KEY, FLORIDA 33070
TEL. (305) 852-7145
On February 16, 1994, the Board granted approval and authorized
execution of the following:
1. Contract between Monroe County and Barnes' Alarm Systems,
Inc., for Alarm System Annual Certification and Alarm System
Maintenance for thirteen (13) alarm systems within county
buildings.
2. Renewal License with the Department of the Navy for use of
East Martello Battery Site (a/k/a The Bunker) for six months
ending June 30, 1994.
3. Change Order No. 3 for Big Pine Key Roads IV, with The Brewer
Company of Florida, Inc., in the decreased amount of $290.41,
and adding an additional 85 days to the Contract.
4. Change Order No. 3 for Big Pine Key Roads V, with The Brewer
Company of Florida, Inc., in the decreased amount of $258.50,
and adding an additional 35 days to the Contract.
Attached hereto are duplicate originals of the subject documents,
executed by all parties which should be returned to the
appropriate providers.
Should you have any questions concerning the above, please do not
hesitate to contact me.
cc: County Attorney County Administrator w/o doc.
Finance Director Risk Management, w/o doc.
File
C O N T R A C T
THIS AGREEMENT, made and entered into this 16th dty,Qf Ffibrtary,
1994, between Monroe County, Florida (Owner), anti B3arnes' Arm
Systems, Inc. (Contractor):
W I T N E S S E S:
That the parties hereto, for the consideration h�§,FeinakLer et
forth, mutually agree as follows:
C
w o
I. SCOPE OF THE WORK ;.' iN -;a
pp :J
The Contractor shall provide all labor, tools, 'and equipment
necessary to provide Alarm System Annual Certification and Alarm
System Maintenance for the following alarm systems:
a) Crime Laboratory, 530 Whitehead Street, Key West
b) Juvenile Detention, 500 Whitehead Street, Key West
c) County Courthouse, 500 Whitehead Street, Key West
d) J. Lancelot Lester Justice Building, 530 Whitehead Street,
Key West
e) Public Service Building, 5100 College Road, Stock Island
f) Bayshore Manor, 5200 College Road, Stock Island
g) Library, 700 Fleming Street, Key West
h) Library, 3251 Overseas Highway, Marathon
i) Ellis Building, 88800 Overseas Highway, Plantation Key
j) County Courthouse, Highpoint Road, Plantation Key
k) Plantation Key Detention Facility, 53 Highpoint Road,
Plantation Key
1) Monroe Regional Service Center, 2798 Overseas Hwy, Marathon
m) Marathon Government Center Annex, 490 63rd Street, Marathon
The Contractor shall provide all required documentation pursuant
to National Fire Protection Association Requirements, and shall
be on call twenty-four (24) hours per day, seven (7) days per
week.
II. INDEPENDENT CONTRACTOR
At all times and for all purposes under this agreement the Con-
tractor is an independent contractor and not an employee of the
Board of County Commissioners for Monroe County. No statement
contained in this agreement shall be construed so as to find the
contractor or any of his/her employees, contractors, servants, or
agents to be employees of the Board of County Commissioners for
Monroe County.
III. ASSURANCE AGAINST DISCRIMINATION
The Contractor shall not discriminate against any person on the
basis of race, creed, color, national origin, sex, age, or any
other characteristic or aspect which is not job related, in its
recruiting, hiring, promoting, terminating, or any other area
affecting employment under this agreement or with the provision
of services or goods under this agreement.
IV. ASSIGNMENT
The Contractor shall not assign this agreement, except in writing
and with the prior written approval of the Board of County Commis-
sioners for Monroe County and Contractor, which approval shall be
subject to such conditions and provisions as the Board and Con-
tractor may deem necessary. This agreement shall be incorporated
by reference into any assignment and any assignee shall comply
with all of the provisions of this agreement. Unless expressly
provided for therein, such approval shall in no manner or event
be deemed to impose any obligation upon the Board in addition to
the total agreed -upon price of the services/goods of the contrac-
tor.
V. COMPLIANCE WITH LAW
In providing all services/goods pursuant to this agreement, the
contractor shall abide by all statutes, ordinances, rules and
regulations pertaining to, or regulating the provisions of, such
services, including those now in effect and hereinafter adopted.
Any violation of said statutes, ordinances, rules and regula-
tions shall constitute a material breach of this agreement and
shall entitle the Board to terminate this contract immediately
upon delivery of written notice of termination to the contractor.
VI. INSURANCE
Contractor will be responsible for all necessary insurance cover-
age as indicated by an "X" on the attached forms identified as
INSCKLST 1-4, as further detailed on forms WC2, GL2, VL2, GIR 1,
and GIR2, all attached hereto and incorporated as part of this
Contract Document.
VII. HOLD HARMLESS
The Contractor shall defend, indemnify and hold the County, as
outlined on the attached form identified as IND1, attached hereto
and incorporated as part of this contract document.
VIII. TERM OF CONTRACT
This contract shall be for a period of one (1) year, commencing
on the day in which it has been executed by both parties. This
Contract term shall be renewable in accordance with Article X.
This contract hereby supersedes the contract between the parties
dated April 14, 1993.
IX. CANCELLATION
Either of the parties hereto may cancel this agreement with or
without cause by giving the other party sixty (60) days written
notice sent certified mail of its intention to do so.
2
X. RENEWAL
The Owner shall have the option to renew this agreement after the
first year, for two (2) additional one year periods. The con-
tract amount agreed herein may be adjusted annually in accordance
with the percentage change in the Consumer Price Index (CPI) for
Wage Earners and Clerical Workers in the Miami, Florida area
index, and shall be based upon the annual average CPI computation
from January 1 through December 31 of the previous year.
XI. FUNDING AVAILABILITY
In the event that funds from Facilities Maintenance Contractual
Services are partially reduced or cannot be obtained or cannot be
continued at level sufficient to allow for the purchase of the
services/goods specified herein, this agreement may then be termi-
nated immediately at the option of the Board by written notice of
termination delivered in person or by mail to the contractor.
The Board shall not be obligated to pay for any services provided
by the contractor after the contractor has received written no-
tice of termination.
XII. PROFESSIONAL RESPONSIBILITY
The Contractor warrants that it is authorized by law to engage in
the performance of the activities encompassed by the project
herein described, subject to the terms and conditions set forth.
The provider shall at all times exercise independent, profession-
al judgement and shall assume professional responsibility for the
services to be provided. Continued funding by the Board is con-
tingent upon retention of appropriate local, state, and/or feder-
al certification and/or licensure of contractor.
XIII. NOTICE REQUIREMENT
Any notice required or permitted under this agreement shall be in
writing and hand delivered or mailed, postage prepaid, to the
other party by certified mail, returned receipt requested, to the
following:
FOR COUNTY FOR CONTRACTOR
Monroe County Public Works Barnes' Alarm Systems, Inc.
5100 College Road 5615 3rd Avenue #8
Key West, FL 33040 Stock Island
ATTN: Facilities Maint. Director Key West, FL 33040
XIV. REGULATORY REQUIREMENTS
All work outlined shall be completed in accordance with require-
ments of the National Electric Code, the National Fire Protection
Association, and all State, County, and Local Ordinances.
3
XV. PAYMENT
a) MAINTENANCE
The County shall pay to the Contractor for the performance of
said service on a per month in arrears basis on or before the
15th day of the following month in each of twelve (12) months.
The Contractor shall invoice the County monthly for maintenance
of the thirteen (13) specified alarm systems. The invoice shall
identify each maintenance call with a Work Order Number provided
by the Facilities Maintenance Department, the location of the
alarm systems serviced, labor required, and material cost."
b) ANNUAL CERTIFICATION
Upon receipt of Annual Certification for the thirteen (13) alarm
systems, payment will be made within sixty (60) days after re-
ceipt of the Contractor's request for payment. Payment for Annu-
al Certification shall not exceed $4,000.00.
In witness whereof, the parties hereto have executed this agree-
ment the day and year first above written,
COUNTY OF MONROE, STATE OF
FLORIDA
Attest: DANNY L. KOLHAGE, Clerk
Barnes' Alarm Sy tems, Inc.
By I
Attest:
c
WITNESS
WITNESS
April 22, 1993
Id Printing
MONROE COUNTY, FLORIDA
INSURANCE CHECKLIST
FOR
VENDORS SUBMITTING PROPOSALS
FOR WORK
To assist in the development of your proposal, the insurance coverages marked with an "X" will
be required in the event an award is made to your firm_ Please review this form with your
insurance agent and have him/her sign it in the place provided. It is also required that the bidder
sign the form and submit it with each proposal.
W01tKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
X
Workers' Compensation
WC I
Employers Liability
WC2 �_
Employers Liability
WC3
Employers Liability
WCUSLH
US Longshoremen &
Harbor Workers Act
WCJA
Federal Jones Act
Statutory Limits
$100,000/$500,000/$100,000
$500,000/$500,000/$500,000
$1,000,000/$1,000,000/$1,000,000
Same as Employers'
Liability
Same as Employers'
Liability
Administrative JastnKiion INSCKLST ,
#4709.01 0 6
April 22. 1993
IM Printing
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 OccurTence
$100,000 Property Damage
or
$1,000,000 Combined Single Limit
Required Endorsement:
GLXCU Underground, Explosion and Collapse (XCU)
GLLIQ Liquor Liability
All endorsements are required to have the same limits as the basic policy.
Adminkrative IrLiImctic n
R-0709.01
INSCKLST 2.
7
April 22, 1993
1n Printing
VEHICLE LIABILITY
As a minimum, coverage should extend to liability for: -
• Owned; Nonowned; and Hired Vehicles
Required Limits:
VLl
VL2
VU
BRl
MVC
PRO1
PR02
PR03
POL l
POL2
POW
ED1
ED2
GK 1
GK2
GK3
MED I
1\-MED2
ME,D3
AdminiArativc Instruction
114709.01
-X
$50,000 per Person: $100,000 per Occurrence
$25,000 Property Damage
or
$100,000 Combined Single Limit
$100,000 per Person; $300,000 per Occurrence
$50,000 .Property Damage
or
$300,000 Combined Single Limit
$500,000 per Person; $1,000,000 per Occurrence
$100,000 Property Damage
or
$1,000,000 Combined Single Limit
MISCELLANEOUS COVERAGES
Builders'
Risk
Motor Truck
Cargo
Professional
Liability
Pollution
Liability
Employee
Dishonesty
Garage
Keepers
Medical
Professional
INSCUST3
Limits equal to the
completed project.
Limits equal to the maximum
value of any one shipment.
$ 250,000 per Occurrence/$ 500,000 Agg.
$ 500,000 per Occurrence/$1,000,000 Agg.
$1,000,000 per Occurrence/$2,000,000 Agg.
$ 500,000 per Occurrence/$1,000,000 Agg.
$1,000,000 per Occurrence/$2,000,000 Agg.
$5,000,000 per Occurrence/$10,000,000 Agg.
$ 10,000
$100,000
$ 300,000 ($ 25,000 per Veh)
$ 500,000 ($100,000 per Veh)
$1,000,000 ($250,000 per Veh)
$ 500,000/$ 1,000,000 Agg.
$1,000,000/$ 3,000,000 Agg.
$5,000,0001$10,000,000 Agg.
x
April 22, 1993
1�1 1'rinting
IF
Installation
Maximum value of Equipment
Floater
Installed
VLP1
Hazardous
$ 300,000 (Requires MCS-90)
VLP2
Cargo
$ 500,000 (Requires MCS-90)
VLP3
Transporter _
$1,000,000 (Requires MCS-90)
BLL
Bailee Liab.
Maximum Value of Property
HKL1
Hangarkeepers
$ 300,000
HKL2
Liability
$ 500,000
HKL3
$ 1,000,000
AIR1
Aircraft
$25,000,000
AI .2
Liability
$ 1,000,000
AIR3
$ 1,000,000
AEO1
Architects Errors
$ 250,000 per Occurrence/$ 500,000 Agg.
AE02
& Omissions
$ 500,000 per Occurrence/$1,000,000 Agg.
AE03
$ 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
BIDDERS STATEMENT
I understand the insurance that will be mandatory if awarded the contract and will comply in full
with all the requirements.
Bidder Signature
AdministntivcInstruction INSCKLs'I' q
#4709.01 9
April 22. 1993
1sl 1Yinting
MONROE COUNTY, FLORIDA
INSURANCE GUIDE
TO
CONTRACT AD.IIINISTRATION
General Insurance Requirements
for
Suppliers of Goods or Services
As a pre -requisite of the work governed, or the goods supplied under this contract (including the
pre -staging of personnel and material), the Vendor shall obtain, at his/her own expense, insurance
as specified in any attached schedules, which are made 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 all 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 e-vidence of the required insurance, shall not
extend deadlines specified in this contract and any penalties and failure to perform 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 teen 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 perform 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 insurance
policies required by this contract.
All insurance policies must 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 Vendors insurance shall not be construed as relieving the
Vendor from any liability or obligation assumed under this contract or imposed by law.
GIR1
Administrative Jnstrvclion
#4709.1
17
April 22. 1993
ba 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.
Administrative Jnstnmion G I R 2
#4709.1 0 18
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:
• Premises Operations
• Products and Completed Operations
• Blanket Contractual Liability
• Personal Injury Liability
• Expanded Definition of Property Damage
The minimum limits acceptable shall be:
$500,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$250,000 per Person
$500,000 per Occurrence
$ 50,000 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.
Administrative Inctnklion GL2
d4709.1
55
April 22. 1993
lsl l4inling
VEHICLE LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
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 Mired 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.
Adminkralivc Iminicji0n VL2
N4709.1
70
April 22. 199.1
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 statutes.
In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not less than:
$500,000 Bodily Injury by Accident
$500,000 Bodily Injury by Disease, policy limits
$500,000 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 tile
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, tile Contractor may be required to submit updated financial staternents frorn the fund
upon request from tile County.
Administrative lrrtmclion WC2
94709.1
82
April 22. 1993
lsl Printing
NIONROE COUNTY, FLORIDA
INSURANCE GUIDE
TO
CONTRACT ADM INISTRATION
Indemnification and Hold Harmless
for
Suppliers of Goods and Services
The Vendor 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 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 of others) 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 of liability is in no way limited to, reduced, or lessened by the insurance requirements
contained elsewhere within this agreement.
IND1
Administrative Instruction
#4709.1
16
SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a),
FLORIDA STATUTES. ON PUBLIC ENTITY CRIMES
THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
OFFICIAL AUTHORIZED TO ADMINISTER OATHS. Ooukt'i—Ll
1. This sworn statement is submitted to 60h0f— PL,(Sci(!L0v0,/t S
by U d C
for
[print nami of the public entity]
134)�/i F S , Cr- /U pyo�
[print individual's name and title]
F S // L1Ql/ Wt
S
[print name of entity submittidg sworn statement]
whose business address is
PL
and (if applicable) its Federal Employer Identification Number (FENS) is Cd) —02-7)1 k-k OS
(If the entity has no FEIN, include the Social Security Number of the individual signing this sworn
statement:
2. 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 ofany other state or of the United States, including,
but not limited to, any bid or contract for goods or services to be pro -tided to any public entity or an agency or
political subdivision pf any other state or of the United States and involving antitrust, fraud, theft, bribery,
collusion, racketeerint, conspiracy, or material misrepresentation.
I understand that"convicted" or "conviction" as defined in Paragraph 287.133(l)(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(lXa), 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 pooling of equipment or income
among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that
one person controls another person. A person who knowingly enters into a joint venture with a person who has
been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate.
5. I understand that a "person" as defined in Paragraph 287.133(lXe), 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 con-victed of a public entity crime subsequent to July 1, 1989.
The entity submitting this sworn statement, nor any of its officers, directors, exectutives, partners,
shareholders, employees, members, or agents who are active in the management of the entity, nor an affiliate of
the entity has 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 tke 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 Aldministrative
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 FORTHE PUBLIC
ENTITY IDENTIFIED ON 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 OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES
FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATIOM CONTAINED IN THIS FORM.
Sworn to and subscribed before me this day of
Personally known _
OR Produced identification
—D-� r�J► s . �r Carr"s e�
(Type of identification)
[signature]
19
Notary Public - State
—
g
47
(Pr n4Pc] t3cPed; er `stsinttd" "�3
commfssionea name of notary public)
Form PUR 7068 (Rev. 06/11/92)
i"
i
SWORN STATEMENT UNDER ORDINANCE NO. 10-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSEEdk/L)F-�-'/q/4)�W3c/S�WS,��arrants that he/it has not employed,
retained or otherwise had act on he/its behalf any former County officer
or employee subject to the prohibition of Section 2 of Ordinance No.
10-1990 or any County officer or employee in violation of Section 3 of
Ordinance No. 10-1990. For breach or violation of this provision the
County may, in its discretion, terminate this contract without liability
and may also, in its discretion, deduct from the contract or purchase
price, or otherwise recover, the full amount of any fee, commission,
percentage, gift, or consideration paid to the former County officer or
employee.
a`
(signatu e)
Date:
a117
STATE OF Vort ��✓
COUNTY OF
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
D34(-1= who, after first being sworn by me,
affixed his/her signature (.name of individual signing) in the space
r vided above on this _ ITday of
'? 19
S
NOTARY PUBLIC
My commission expires:
,r ICIAL N%O'TARY SEAT.
C NO. � r �
t _... - z ..- ----- - ----- -- -- - ______________________ _______________
A C O f: C C h T i 1-I C A i O F i N 5 U R A h1 C E ISSUE DATE (MM/'DD/YY) 12/09/93
--- -- ---- - — ---..------- — _.....- -...----------------------------------------------------------------------------
PRODUCER THIS CERTIFICATE IS ISSUED AS A 'MATTER OF INFORMATION ONLY AND CON-
! u• I o
ii0 RIGHT' UPON Ti-i" CEfiTil"ICATE HOLDER. THIS CERTIFICATE DOES NOTI
I rIi,ari � A��soC., Inc. I Ah1END, EXTEND UR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELO/-
'U00 Fairway 11'illJc Stc . 2'i0-----------------------------------------------------------------305�429-i61 I C0MPAN IES Ah FOIzDING COVERAGE I
Deerfield ir,r;c;: FL 334 1- COMPA;JY
! ! LETTER A I COLONY iN:UhANCE CO
:rU LUI;e I lApl 11 Ell1
I-----.-------..—_....-----------------------------------------r LETTER B ; . CO1'MERCC MUTi�nfl ,I
INSURED t 0MPANI� f AP/PR^00� CBY ISK M1\ANAGEMEN
! I l.L I I EIS 1. I/
Barnes Alarrrl S:,lL lrs, 1PC. I COMPAhiY I
LETTER D , BY ( ��
5165 3rd Avenue, ;i6 ; COMF'AN`i ! DATE I
Key Wc; L FL 33040- LETTER E
T - WAIVER:
COVERAGE"
! THIS 11 TO CERiliY IHAI Ili[ POLICIE> OF 111SURA'iCi LI`.ITED B}LOW IiA'd_ Bt�t; ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY !
PERIOD INDTCA1[D N0TW1ITHSTANuING ANY RE auTREI'1ENT, TLi% GR COPIDIIIC, CF Ah;Y CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH
TII15 CERTIFICGiL riA.'r L- ISSUED c4 11; i ELkIAIrI, inE i`�SUi; :1 i L AFFORD D, BY THl: POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE
TER'!' , ci;CLU': is--„: AND CUNDITIDr S u �I,:I ;'OLTCIE-) LII. -) iT 01'I iir1Y i1AVE SEEN REDUCED BY PAID CLAIiiS.
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%01 I I POLICY POLICY !
ILTRI TYPE OF IhiSURANCE I POLICY NUMBER EFF DATE EXP DATE LIMITS !
---+------------------------------ +------------------------- i_------------+------------- +----------------------------------------
! A ' GENERAL LIAbiLITY ' I
j BIN11C 93-290 ! 12/09/'3 I 12/09/94 ! GENERAL AGGREGATE I$ 1000000
(XJ COiMM GENiFrI. LIABiLITY I I ! PROD-COMP/OPS AGGREGATE I$ 1000000 '
CLAII
1dRFl!rADVERT
EING INJ I000000
,R0iW1RCEACH OCCURRENCE $ 10FIRE DAMAGE (ON E FIRE) �5000 I
`i JI MED EXPENSE (ONE PERSON),$ 5000
------- --------------- t-
AUTOMOUILL L;:. �LITY i i COMBINED SINGLE is I
! + LIMIT
I I f j ANY AUTO ! I I
ALL OWNtL :-1.;iO'') I I I BODILY INJURY I$ I
I I I SCHEi)ULC :Iii10S I I I I( PER PERS) I I
I I 11'IR`[ ''I'' I 1 1600ILY INJURY �$
I I I NON-Ohi;;: J)T05 ! !';�rc��!✓c<! ! i (PER ACC)
GA1i UL I�IT( i;11 r
I � � J � r clil I- �, ,T �- I I
PROF ER I Y DAMAGE , $
-------+------ - — -�j-2------------- — -i-------------------------+--------------
t �:mot'--t ' �.-7J. EACH OCCURRENCE �$ IU11, ofH ! i I AGGREGATE I$ I
(' I
It JI Gif._I, III II lye. I'11'DPII! I
I I , - ,
- - - - - - - - -" I
STATUTORY LIMITS I I
! ! WCRr;E4': C •;PFIi ;rTIO1! EACH ACCIDENT $ 100000
B I Ai;� 4 5'�3 000 I 12/O9/93 I 12/U9/94 I DISEASE-PULTCY LIMIT I$ 500000 !
EMPLOLIABILITY i DISEASE -EACH EMF'LOYEE �$ 100000 I ?
I
--i--------- ._._.. _.._..1 ------ - -------t-----------------+-------------------------+--------------I UTHEk
II
I I ! ! $
Ig I
DESCRIPTION OF OPEItAT10N /LOCATIONS/V*EHICLES/SPECIAL ITEMS !
! I'
I
C,TIF'CirTL :'OLr:.��LUDED AS ADDITIONAL I11SURED I
! A'"RESPECT':, hr.i;L Lli';sILITIY
rc'T-tr ,
�l.Aii: iIJL�.,_:________________________________________==CANCELLATION=====__________________________________________=_=__+
SiiUULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
! IIuIU,u� Cl,l lil r/, u l 5 THE EXPIRATION DATE ]HEREOF, THE ISSUING COMPANY WILL ENDEAVOR I f.
! I UWRITTEN NOTICE THE
CCERTIFICATE
T�D
uirLrT, dUTFAiLUkETO MATLUCHNOTICESHALIM
'5100 C0LLE' '`7 -
tCY I '
WEST3'O4C� ! Pu C '�G i,G_IGATICN Of LIADILITY OF ANY Y,IND UPON THE C011PANY,
ITS AGENTSS OhREPRESENTATiVE�, ,
AUIFIVR1iED PRETENTATIVE______________:_.__=___________________+
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h' - ACOkO CORPORATION 1990
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