12/15/2010 AgreementDANNY L. KOLHA GE
CLERK OF THE CIRCUIT COURT
DATE: January 10, 2011
TO: Fire Chief James Callahan
Fire -Rescue Department
ATTN. Susan Hover
FROM: Pamela G. Hanco� C.
At the December 15, 2010, Board of Governors' meeting, the Board granted approval and
authorized execution of Item G2 a 12 month service agreement with Bio-Med Waste Solutions,
Inc. for the collection and disposal of biomedical waste generated from emergency medical calls
and transports of Monroe County Fire Rescue.
Enclosed is a duplicate original of the above -mentioned for your handling. Should you
have any questions, please do not hesitate to contact this office.
cc: County Attorney
Finance
Filet/
6IO-MED WASTE SOLUTIONS, INC.
ENVIRONMENTALLY SOUND MEDICAL WASTE TREATMENT
SERVICE AGREEMENT
BOARD OF GOVERNORS
CUSTOMER NAME: FIRE AND AMBULANCE DIST 1 BILLING INFORMATION IF DIFFERENT
MONROE COUNTY FIRE RESCUE
ADDRESS: 490 63rd Street Ocean ADDRESS:
aTr, sT, zw: Marathon, FL 33050 CITY, ST, ZIP:
PHONE: _30S) 289-6088 PHONE:
FAX: (305) 289-6007 FAX:
E-MAIL: hover-susanQmonroecountY-8.gov E-MAIL: '
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_
CONTACT: Susan Hover CONTACT:
r--D_
-
SCOPE OFSERVICES;
o
* 810-MED WILL PROVIDE PICKUP, TRANSPORT, TREATMENT AND DISPOSAL OF REGULATED MEDICAL
_
WASTE IN ACCORDANCE WITH STATE OF FLORIDA DEPARTMENT OF HEALTH RULES AND REGULATIONS.
* CUSTOMER WILL PAY MONTHLY RATE ASSET FORTH BELOW BY THE 10th CALENDAR DAY OF EACH
:-o
MONTH UNLESS NOTED OTHERWISE BELOW.
fv 0
* 810-MED WASTE SOLUTIONS, INC. AND CUSTOMER AGREE TO TERMS AND CONDITIONS AS SET
FORTH ON SEPARATE PAGE.
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DESCRIPTION OF REGULATED MEDICAL WASTE TO BE REMOVED:
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SHARPS CONTAINERS:
00 p
96 GALL.LOCKABLE CONTAINER ONE PER LOCATION FOR 8 LOCATIONS (SEE ATTACHED dw
A) Q O
SMALL (2 CU. FT.)BOX:
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LARGE (4 CU. FT.) BOX:
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FREQUENCY (MIN.13/YEAR):�� '`-°
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ADDITIONAL BOXES: ; 's
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BILLING RATE: $50•00 PER SERVICE a -''
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CUSTOMER: SIGNATURE L+
BOARD OF GOVERNORS Fl ND A BCE NDISTRICT 1
8�MED WASTE SOLUTIONS. INC. ( ► -7-1, b
MICHAEL REINSTEIN, PRESIDENT
DATE
EFFECTIVE DATE; January 1, 2011
SERVICE AGREEMENT EXPIRES 12 MONTHS FROM EFFECTIVE DATE
24HR PHONE: 786-546-4739 � 8201 NW 64th 5T., #$
FAX: 954-944-1977 MIAMI, FL 33166
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Page 1 of 2
8IO-MED WASTE SOLUTIONS, INC.
ENVIRONMENTALLY SOUND MEDICAL WASTE TREATMENT
SERVICE AGREEMENT TERMS AND CONDITIONS
1. CUSTOMER IS RESPONSIBLE TO ENSURE THAT ALL REGULATED MEDICAL WASTE CONFORMS TO STATE OF FLORIDA
DEPARTMENT OF HEALTH RULES AND REGULATIONS AND THAT NO HAZARDOUS WASTE IS MIXED WITH REGULATED
MEDICAL WASTE.•
2. IF BIO-MED WASTE SOLUTIONS, INC. DETERMINES THAT HAZARDOUS WASTE HAS BEEN MIXED WITH REGULATED
MEDICAL WASTE THEN THE WASTE SHALL BE RETURNED TO CUSTOMER FOR PROPER DISPOSAL. MONTHLY PICKUP
FEES WILL STILL BE INCURRED BY CUSTOMER.
3. TRACKING/SHIPPING DOCUMENTS WILL BE PREPARED BY BIO-MED WASTE SOLUTIONS, INC. IN ACCORDANCE WITH
STATE OF FLORIDA DEPARTMENT OF HEALTH RULES AND REGULATIONS AND MAINTAINED FOR THREE YEARS.
4. BIO-MED WASTE SOLUTIONS, INC. RESERVES THE RIGHT TO SUSPEND SERVICE IF INVOICES ARE NOT PAID WITHIN
30 DAYS OF DUE DATE.
5. CUSTOMER IS RESPONSIBLE FOR ALL EQUIPMENT PLACED IN SERVICE BY BIO-MED WASTE SOLUTIONS AND
ACCEPTS LIABILITY FOR THE EQUIPMENT AND CONTENTS UNTIL PICKED UP BY BIO-MED WASTE SOLUTIONS, INC.
CUSTOMER AGREES TO DEFEND, INDEMNIFY AND HOLD HARMLESS BIO-MED WASTE SOLUTIONS, INC FROM ANY AND
ALL CLAIMS OF LOSS, DAMAGE OR INJURY ARISING FROM ANY MANNER OF USE OF EQUIPMENT PLACED IN USE UNDER
THIS AGREEMENT.•
6. BIO-MED WASTE SOLUTIONS, INC. SHALL INDEMNIFY AND HOLD HARMLESS CUSTOMER FROM ANY LIABILITIES
ARISING FROM THE NEGLIGENCE OR WILLFULL MISCONDUCT IN THE PERFORMANCE OF THIS AGREEMENT. CUSTOMER
WILL INDEMNIFY AND HOLD HARMLESS BIO-MED WASTE SOLUTIONS, INC. FROM ANY LIABILITIES ARISING FROM THE
NEGLIGENCE OR WILLFULL MISCONDUCT OF CUSTOMER INCLUDING BUT NOT LIMITED TO PROPER LABELING,
SEGREGATION AND PACKAGING OF MEDICAL WASTE.
7. EACH PARTY AGREES TO PAY THEIR OWN ATTORNEYS FEES AND COSTS IF A SUIT 1S FILED BY CUSTOMER, BIO-MED
WASTE SOLUTIONS, INC OR THIRD PARTY, FOR ANY REASON WHATSOEVER.
8. ETHICS CLAUSE: COMPANY WARRANTS THAT HE/IT HAS NOT EMPLOYED, RETAINED OR OTHERWISE HAD ACT ON HIS/
ITS BEHALF ANY FORMER COUNTY OFFICER OR EMPLOYEE IN VIOLATION OF SECTION 2 OF ORDINANCE NO. 10-1990 OR
ANY COUNTY OFFICER OR EMPLOYEE IN VIOLATION OF SECTION 3 OF ORDINANCE NO.10-1990. FOR. BREACH OR
VIOLATION OF THIS PROVISION THE COUNTY MAY, IN ITS DISCRETION, TERMINATE THIS CONTRACT WITHOUT LIABILITY
AND MAY ALSO, IN ITS DISCRETION, DEDUCT FROM THE CONTRACT OR PURCHASE PRICE, OR OTHERWISE RECOVER,
THE FULL AMOUNT OF ANY FEE, COMMISSION, PERCENTAGE, GIFT, OR CONSIDERATION PAID TO THE FORMER COUNTY
OFFICER OR EMPLOYEE.
9. INSURANCE: WITHIN FIVE (6) DAYS OF EXECUTION OF THIS AGREEMENT BY BOTH PARTIES AND PRIOR TO
PERFORMANCE, COMPANY WILL PROVIDE PROOF OF INSURANCg IN THE FORM PAQUIRED BY EXHIBIT B TO THIS
AGREEMENT.
CUSTOMER: SIGNATURE DEC 1 5 2010
BOARD OF GOVERNORS
110-MED WASTE SOLUTIONS, INC.
MICHAEL REINSTEIN,
I PHONE: 786-546-4739
954-944-1977
M 0 N R 0 E COUNTY ATTORNEIt"
A FoROV D QS
YNTHIA L. HALL
ASSISTANT COUNTY ATTORN' <-4,-,..,
Date 11' vi- %O(G
=L /(b-'�lto
DATE
8201 NW 64th ST., #8
MIAMI, FL 33166
NY Y004AGE CLERK
z
DEPqfY CLEPK
Locations included under Service Agreement
Stock Island Fire Station 8
6180 2"d Street (MM 5)
Key West, fl 33040
Big Coppitt Fire Station 9
28 Emerald Dr. (MM 10)
Key West, FI 33044
Cudjoe Fire Station 11
20950 Overseas Highway (MM 21)
Cudjoe Key, FI 33042
Big Pine Fire Station 13
390 Key Deer Blvd. (MM 30.5)
Big Pine Key, FI 33043
Trauma Star Hangar
10100 Overseas Highway
Marathon, FI 33050
Conch Key Fire Station 17
10 s. Conch Ave. (MM 63)
Conch Key, FI 33050
Layton Fire Station 18
68260 Overseas Highway (MM 68)
Layton, FI 33001
Tavernier Fire Station 22
151 Marine Ave. (MM 92)
Tavernier, FI 33070
EXHIBIT A (Page 1 of 1)
2005 Edition
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:
$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
Administration Instruction
#7500
EXHIBIT B (Page 1 of 5)
2005 Edition
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 Hired Vehicles
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
The Monroe County Board of County Commissioners shall be named as Additional Insured on
all policies issued to satisfy the above requirements.
VL3
Administration Instruction
#7500
EXHIBIT B (Page 2 of 5)
2005 Edition
HAZARDOUS CARGO TRANSPORTERS LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Prior to the commencement of work governed by this contract, the Contractor shall purchase
Pollution Liability Insurance which extends to the hauling of toxic and hazardous material by
motorized vehicles. In compliance with the Motor Carrier Act, the policy should be endorsed
with an MCS-90 Endorsement, demonstrating financial responsibility for spills and clean-up.
Any pollution exclusion limiting coverage under this policy shall be removed.
The minimum limits acceptable shall be:
$1,000,000 per Occurrence
VLP3
Administration Instruction
#7500
EXHIBIT B (Page 3 of 5)
2005 Edition
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 the
state of Florida.
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.
WC2
Administration Instruction
#7500
EXHIBIT B (Page 4 of 5)
BIOMEDWA-1 JKC
A� oRo' CERTIFICATE OF LIABILITY INSURANCE DATE 11/22/2010Y)
11/22/2010
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Exclusive Programs, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
www.exclusiveprograms.com HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO Box 29-4170 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Boca Raton, FL 33429-4170 INSURERS AFFORDING COVERAGE NAIC #
INSURED Bio-Med Waste Solutions, Inc. INSURER A Great Divide Insurance Company
8201 NW 64th Street INSURER B Delos Insurance Company
Miami, FL 33166- INSURERC:
INSURER D:
INSURER E
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
ADDL
INSRC
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MMIDDtYYYYI
POLICY EXPIRATIONLTR
DATE (MMIDDLYMI
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
X
X COMMERgAL GENERAL LIABILITY
CLAIMS MADE a OCCUR
GLP01519430-10
8/4/2010
8/4/2011
PREMISUAMAUIES Ea occurence
$ 100,000
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS- COMP/OP AGG
$ 2,00000
X POLICY 7 PRO- 7LOC
JECT
B
AUTOMOBILE
LIABILITY
ANY AUTO
DBW10644-00
12/7/2010
12/7/2011
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,00
X
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person)
$
X
X
HIREDAUTOS
NON-OWNEDAUTOS
BODILY INJURY
(Per accident)
$
X
Pollution - $1,000,000
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: qGG
EXCESS / UMBRELLA LIABILITY
OCCUR CLAIMS MADE
(
EACH OCCURRENCE
$
AGGREGATE
$
$
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑
OFFICERMEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
SPECIAL PROVISIONS below
WC STATU OTH-
T CRY LIMIT ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
$
E.L. DISEASE - POLICYLIMIT
$
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Certificate holder is listed as additional insured as their interest may appear.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBEDPOUCIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
Monroe Cty. Board of Cty. Commissioners
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
1100 Simonton Street
Key West, FL 33040-
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
[AUTHORIZED REPRESENrATIVE _
N%'URu ca tcuuta/uT) 01988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
BIOMEDWA-1 JKC
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized
representative or producer, and the certificate holder, nor does it affirmatively or negatively amend,
extend or alter the coverage afforded by the policies listed thereon.
AI.VKU LO tLuu`J/ul)
Form Approved:
OMB No.: 2126-0008
U.S. Department ENDORSEMENT FOR
of Transportation MOTOR CARRIER POLICIES OF INSURANCE FOR PUBLIC LIABILITY
UNDER SECTIONS 29 AND 30 OF THE MOTOR CARRIER ACT OF 1980
Federal Motor Carrier
Safety Administration
8201 NW 64TH STREET, #8
Issued to RTO-MET) WASTR g0T.TTTTnN& TNrof MTAMT, FT. 31166
Dated at Melbourne. FL this 07 day of December 2010
Amending Policy No. DBW10644-00 Effective Date 12/07/2010
Name of Insurance Company Delos Insurance Company
Countersigned by
Authorized Company Representative
The policy to which this endorsement is attached provides primary or excess insurance, as indicated by "[X]," for the limits shown:
[X] This insurance Is primary and the company shall not be liable for amounts in excess of $_$1,000,000 for each accident.
[ ) This insurance is excess and the company shall not be liable for amounts in excess of $ for each accident in excess of the
underlying limit of $ for each accident
Whenever required by the Federal Motor Carrier Safety Administration (FMCSA), the company agrees to furnish the FMCSA a duplicate of said policy
and all its endorsements. The company also agrees, upon telephone request by an authorized representative of the FMCSA, to verify that the policy is in
force as of a particular date. The telephone number to call is: (212) 702-3700
Cancellation of this endorsement may be effected by the company of the insured by giving (1)thirty-five (35) days notice In writing to the other party (said
35 days notice to commence from the date the notice is mailed, proof of mailing shall be sufficient proof of notice), and (2) If the Insured is subject to the
FMCSA's registration requirements under 49 U.S.C. 13901, by providing thirty (30) days notice to the FMCSA (said 30 days notice to commence from
the date the notice is received by the FMCSA at its office in Washington, D.C.).
DEFINITIONS AS USED IN THIS ENDORSEMENT
Accident includes continuous or repeated exposure to conditions or which Property Damage means damage to or loss of use of tangible
results in bodily injury, property damage, or environmental damage which property.
the insured neither expected nor intended.
Motor Vehicle means a land vehicle, machine, truck, tractor, trailer,
semitrailer propelled or drawn by mechanical power and used on
highway for transporting property, or any combination thereof.
Bodily Injury means injury to the body, sickness, or disease to any
person, including death resulting from any of these.
The insurance policy to which this endorsement is attached provides
automobile liability Insurance and is amended to assure compliance by
the insured, within the limits stated herein, as a motor carrier of property,
with Sections 29 and 30 of the Motor Carrier Act of 1980 and the rules
and regulations of the Federal Motor Carrier Safety Administration
(FMCSA).
In consideration of the premium stated in the policy to which this
endorsement is attached, the insurer (the company) agrees to pay, within
the limits of liability described herein, any final judgment recovered
against the insured for public liability resulting from negligence in the
operation, maintenance or use
of motor vehicles subject to the financial responsibility requirements of
Sections 29 and 30 of the Motor Carrier Act of 1980 regardless of
whether or not each motor vehicle is specifically described in the policy
and whether or not such negligence occurs on any route or in any
territory authorized to be served by the insured or elsewhere. Such
insurance as is afforded, for public liability, does not apply to injury to or
death of the insured's employees while engaged in the course of their
employment, or property transported by the insured, designated as cargo.
It is understood and agreed that no condition, provision, stipulation, or
limitation contained in the policy, this endorsement, or any other
endorsement the or violation thereof, shall relieve the company from
liability or from the payment of any final
Environmental Restoration means restitution for the loss, damage, or
destruction of natural resources arising out of the accidental discharge,
dispersal, release or escape into or upon the land, atmosphere,
watercourse, or body of water, of any commodity transported by a
motor carrier. This shall include the cost of removal and the cost of
necessary measures taken to minimize or mitigate damage to human
health, the natural environment, fish, shellfish, and wildlife.
Public Liability means liability for bodily Injury, property damage, and
environmental restoration
judgment, within the limits of liability herein described, irrespective of
the financial condition, insolvency or bankruptcy of the insured.
However, all terms, conditions, and limitations in the policy to which
the endorsement is attached shall remain in full force and effect as
binding between the insured and the company. The insured agrees to
reimburse the company for any payment made by the
company on account of any accident, claim, or suit involving a breach
of the terms of the policy, and for any payment that the company
would not have been obligated to make under the provisions of the
policy except for the agreement contained in this endorsement.
It is further understood and agreed that, upon failure of the company
to pay any final judgment recovered against the insured as provided
herein, the judgment creditor may maintain an action in any court of
competent jurisdiction against the company to compel such payment.
The limits of the company's liability for the amounts prescribed in this
endorsement apply separately to each accident and any payment
under the policy because of any one accident shall not operate to
reduce the liability of the company for the payment of final judgments
resulting from any other accident.
THE SCHEDULE OF LIMITS SHOWN ON THE REVERSE SIDE DOES NOT PROVIDE COVERAGE. The limits shown in the schedule are for
information purposes only.
MC 1622p (01-07) Wolters Kluwer Financial Services l Uniform Forms TM Form MCS-90 (4/2000)
Lrf
SCHEDULE OF LIMITS
PUBLIC LIABILITY
Type of carriage
Commodity transported
Jana 1, 1985
(1) For -hire (In interstate or foreign
Property (nonhazardous)
$ 750,000
commerce, with a gross vehicle weight
-
rating of 10,000 or more pounds).
I
j
I
(2) For -hire and Private (In interstate,
j Hazardous substances, as defined in 49 CFR
$5,000,000
foreign, or intrastate commerce, with a171.8,
transported in cargo tanks, portable
j
gross vehicle weight rating of 10,000
Aanks, or hopper -type vehicles with capacities
or more pounds).
' in excess of 3,500 water gallons; or in bulk
1Division 1. 1, 1.2, and 1.3 materials, Division!
2.3, Hazard Zone A, or Division 6.1, Packing
I Group I, Hazard Zone A material; in bulk'
Division 2.1 or 2.2; or highway route
controlled quantities of a Class 7 material, as
defined in 49 CFR 173.403
(3) For -hire and Private (In interstate or]
Oil listed in 49 CFR 172.101; hazardous
$1,000,000
foreign commerce, in any quantity; or in j
waste, hazardous materials, and hazardous
intrastate commerce, in bulk only; with a
j gross vehicle weight rating of 10,000 or
substances defined in 49 CFR 171.8 and
listed in 49 CFR 172.101, but not mentioned
more pounds).
(2) above or (4) below. s
1(4) For -hire and Private (In interstate or
—In
An quantity of Division 1.1 1.2 or 1.31
Y q tY �
$5,000,000
1 foreign commerce, with a gross vehicle ]
material; any quantity of a Division 2.3,1
weight rating of less than 10,0001
Hazard Zone A, or Division 61, Packing
.pounds).
Group I, Hazard Zone A material; or highway 1
route controlled quantities of a Class 71
i
material as defined in 49 CFR 173.403.
Form MCS-90 (4/2000) MC 1622p (01-07)
2005 Edition
MONROE COUNTY, FLORIDA
Request For Waiver
of
Insurance Requirements
It is requested that the insurance requirements, as specified in the County's Schedule of Insurance Requirements, be
waived or modified on the following contract.
Contractor: Q ( O - 11kt Q t fAS-V;E S et'V -ft a 1^1 C ,
Contract for: Q t O - M60t on, t,JA jTic Pt C� JP /Trr �. �T -l��GTit
Address of Contractor: g Z o( f4W
M t aM1 �L 3 3 t � to
Phone: �"$i, . . 4,0+ 3e
Scope of Work: -Nte0 4 Cis(, GiAS Z 16 -f t c KA7 Ay-- G% 16j7' f►AF,
S1DrTtaN.S A3 LIISTea o/`r ejetlaOcT" A
�'v�fz-f � tt� w r'✓ Ey'S
Reason for Waiver: bt10i L cM,Pf�•►SpTta N Sam EM1'LEsT ER-
R/Jo a ,4t PLe—
wo RK�I�S
Policies Waiver wiftnts e'O ry Fr-t.rta-tto rJ
will apply to:
Signature of Contractor:
Appmvea (P' --- Not Approved
Risk Management
Date E 7-�
County Administrator appeal:
Approved:
Date:
Board of County Commissioners appeal:
Approved:
Meeting Date:
Not Approved:
Not Approved:
MONROE COUNTY, FLORIDA
Administration Instruction
#7500.1
e fgk-5
ro
106
EXHOT 8 (Page 5 of 5)