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02/16/2011 AgreementCONTRACT BETWEEN THE BOARD OF GOVERNORS OF FIRE AND AMBULANCE DISTRICT 1 OF MONROE COUNTY, FLORIDA AND ROY KHANNA FOR MAINTENANCE OF FIRE RESCUE AMBULANCES and OTHER VEHICLES THIS CONTRACT, hereinafter "CONTRACT OR AGREEMENT" made and entered into this 16` day of February, 2011 by and between the Board of Governors Fire and Ambulance District 1 of Monroe County, Florida, hereinafter referred to as "COUNTY ", and Roy Khanna hereinafter referred to as "CONTRACTOR ". WITNESSETH: WHEREAS, the COUNTY advertised a notice of request for proposals for MAINTENANCE OF FIRE RESCUE AMBULANCES AND OTHER VEHICLES, WHEREAS, the successful Respondent was Roy Khanna and; WHEREAS, this CONTRACTOR represents that it is capable and prepared to provide such services, and; WHEREAS, the COUNTY intends to enter into an agreement for the maintenance of Monroe County Fire Rescue Type I ambulances and other vehicles which shall include inspections, preventative maintenance and unscheduled maintenance and repairs resulting from failure or malfunction with the CONTRACTOR and; WHEREAS, this contract is an "Agreement" between both parties, NOW, THEREFORE, in consideration of the promises contained herein, the parties agree as follows: A. CONTRACT DOCUMENTS — This contract consists of the Agreement, the CONTRACTOR'S response to the RFP, the documents referred to in the Agreement as a part of this Agreement. In the event of any conflict between any of the contract documents, the one imposing the greater burden on the CONTRACTOR will control. B. CONTRACT PERIOD AND RENEWAL - The effective date of this Agreement shall be March 1, 2011 through February 28, 2014 for three (3) years. This Agreement may be renewed for a one (1) year term, subject to approval of the Fire Chief of Monroe County Fire Rescue, the Office of Management and Budget and the Monroe County Board of Governors Fire and Ambulance District 1. C. CONTRACT TERMINATION - This Agreement may be terminated for any reason by either party on 30 -day written notice without cause. If the CONTRACTOR fails to fulfill the terms of this Agreement, or attachments, properly or on time, or otherwise violates the provisions of the agreement or of applicable laws or regulations governing the use of funds, the County may terminate the contract by written notice. The notice shall specify cause. All finished or unfinished supplies or services shall, at the option of the County, become property of the County. The County shall pay the CONTRACTOR fair and equitable compensation for expenses incurred prior to termination of the agreement, less any amount or damages caused by the CONTRACTOR'S breach. If the damages are more than compensation payable, the CONTRACTOR will remain liable after termination and the County shall pursue collection for damages. D. SUBJECT MATTER OF CONTRACT - This Agreement is for performing scheduled general and preventative maintenance of approximately Ten (10) Type I ambulances, Two (2) Rehab units, One (1) MCI Truck and One (1) MCI Trailer with Monroe County Fire Rescue. This shall include inspections, preventative maintenance and unscheduled maintenance and repairs resulting from failure or malfunction. See "Attachment I" for the list of ambulances and other vehicles. The amount of ambulances and other vehicles may be added or deleted throughout the life of the contract by Monroe County Fire Rescue. E. RATES -The hourly rate shall be $75.00 per man-hour with no travel time or mileage charge. The charge for conducting an ambulance inspection with each preventative maintenance performed will be $275.00. F. OVERTIME AND HOLIDAYS - Rates per man-hour for emergency repairs called outside normal business hours and federal holidays shall be one and one half times the normal rate. G. WORK SCHEDULE - Regularly scheduled inspections and preventative maintenance shall be conducted at such intervals as are approved by the COUNTY and by the manufacturer. The modular portion of the vehicle shall also be maintained in accordance with the manufacturer's recommendations. H. PARTS, FLUIDS AND LUBRICANTS - All parts, fluids, and lubricants used for maintaining and repairing vehicles shall be supplied by CONTRACTOR and billed to the COUNTY at cost plus 25 % . For parts $200.00 and over, a copy of original parts supplier invoices shall be attached to the bill. CONTRACTOR will be required to keep all original parts supplier invoices available at request by County for spot checking and auditing purposes. I. ENGINE OIL AND FILTER CHANGE and complete drive train lubrication and any other fluids and/or filter changes, shall be performed as recommended by the manufacturer. J. WEEKLY MAINTENANCE SCHEDULE - CONTRACTOR shall provide to the COUNTY a preventative maintenance schedule that can be performed weekly by the individual Fire Departments' personnel. The contractor shall provide in service training to the Lieutenants on all three shifts at all of the stations at no extra cost. This will be scheduled by the contractor with the on -duty Lieutenants and can be done during Preventative Maintenance visits. K. MAINTENANCE INVOICE and LOG- CONTRACTOR shall maintain an inspection and maintenance log on each vehicle AND shall also provide an invoice at the completion of each scheduled maintenance repair. The log and invoice shall contain at a minimum, but not be limited to, the following: (a) Starting date and time (b) Completion date and time (c) Billable labor hours (d) County Identification number of Apparatus serviced (e) Service performed (f) Parts used and cost (g) Name of service personnel (h) Vehicle mileage (i) Engine hours (if applicable) A copy of this log and invoice shall be supplied to the Fire Rescue Office within 30 days of the service. L. The Contractor shall respond to all original Emergency Field Repair Forms by emailing the invoice to the Logistics Support Services office with documentation of repairs made, parts used and any other miscellaneous information that is applicable (ex: Tires need to be changed). M. COMMUNICATION - CONTRACTOR shall maintain a telephone or paging device such that prompt notification of request for service is possible twenty -four (24) hours a day. The CONTRACTOR shall have two (2) hours to contact Monroe County Fire Rescue upon initial notification if reached by telephone or paging device and twelve (12) hours if contacted by email. N. RESPONSE TO SERVICE REQUEST - CONTRACTOR shall maintain itself in a state of readiness during normal working hours, 8:00 am — 5:OOpm Monday thru Friday, and shall respond to the location where emergency repairs are needed within twelve (12) hours of receiving a request. For repairs required after normal working hours, CONTRACTOR shall respond to the location where emergency repairs are needed within twenty -four (24) hours of receiving a request. Contractor must notify the Logistics Support Office in advance of vacations or potential lapses in service so other arrangements can be made for service coverage. O. CERTIFICATION - CONTRACTOR shall provide evidence satisfactory to the COUNTY that they are an Emergency Vehicle Technician (EVT) certified as Level III Master Ambulance Technician and Automotive Service Excellence (ASE) certified Master Medium/Heavy Truck Technician. P. QUALIFICATIONS OF MAINTENANCE PERSONNEL - All personnel performing maintenance, repairs, adjustments and related work on Monroe County equipment shall be a certified or experiences in the work to be performed. Personnel performing work who are not certified or experienced in such work shall be directly supervised (in person) by an individual with such certification. Q. INDEMNIFICATION - CONTRACTOR shall indemnify and hold the COUNTY and Monroe County harmless for any negligence on its part, or faulty or improper workmanship, for all work performed under this contract, including all costs of collection, reasonable attorney fees, claim costs, and as per "Attachment B ". All property or equipment being directly maintained or repaired by CONTRACTOR shall be considered in its care, custody, and control while such work is in progress and until physical control of such property or equipment is restored to the COUNTY. LOCATION OF WORK - This contract is for maintenance of Fire Rescue vehicles located throughout Monroe County. R. INSURANCE - During the term of this contract, the CONTRACTOR must keep in force and affect the insurance required by Attachments G. Attachment G is attached and incorporated into this contract. S. ADDITIONAL REQUIRED STATEMENTS/VERIFICATIONS /AFFIDAVITS. Attached hereto in Attachments B, C, D, E and F are Non - Collusion Affidavit, Public Entity Crime Statement, Drug -Free Workplace Form, Conflict of Interest Clause, and Indemnification to Hold Harmless. T. PAYMENTS - Payments for semi - annual inspection, preventative maintenance and pump tests shall be made by the COUNTY within 30 days of the completion of the rendered services on each vehicle and proper invoicing by the CONTRACTOR. All payments will be made in accordance with the Florida Local Government Prompt Payment Act. All unscheduled maintenance and repair resulting from equipment failure or malfunction requiring service shall be billed by the CONTRACTOR at the applicable rates as specified in Section four, five and six of this AGREEMENT. The CONTRACTOR upon notification by the COUNTY of an equipment failure or malfunction requiring unscheduled maintenance shall, in a timely manner investigate the problem and provide to the COUNTY an estimate of the cost for repair and vehicle downtime. The CONTRACTOR upon receiving authorization to proceed from the COUNTY shall effectuate such repair; upon completion of same the CONTRACTOR shall notify the COUNTY of the outcome and actual cost. The COUNTY shall issue a separate purchase order for each occurrence of unscheduled maintenance and repair. U. Monroe County's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Board of County Commissioners of Monroe County, Florida. V. Venue for any litigation arising under this contract must be in a court of competent jurisdiction in Monroe County, Florida. This Agreement is not subject to arbitration. IN WITNESS WHEREOF, each party hereto has caused this contract to be executed by its duly authorized representative. BOARD OF GOVERNORS Of w FIRE AND AMBULANCE °- c Ja OF MONROE COUNTY, FL-� ca -� DISTRICT 1 w o ATTEST: DANNY L. KOLHAGE, CLERK =0 0 o By: By: `--- r ' Cn o Deputy Clerk Mayor / Chairman MONR9f COUNTY ATTORNE AP VE ST F M 4 L. AL ASSISTA T OUNTY ffq, TORNEY [date_ 0( -Xot , naNe i ness signature Name and Address of Respondent: Roy Khanna 1033 Valencia Road KeyLargo, FL 33037 By: Signs of Respondent � a � Ca ✓ Alw ►- Print ame and Title Date: Approved by MONROE COUNTY on �Q bYLI pM (Q , 2011, Item # SUBMISSION PROPOSAL RESPONSE FORM Maintenance of Monroe County Fire Rescue Ambulances and Other Vehicles Respondents Name and Mailing Address: k j f-f1 A-n r,; i4 L 4i— -y ch . L ' '` 7 Telephone and Fax Numbers: 3 1) !5 - — 0 — %& -(/ ( c All amounts must be written AND in number format. In case of a conflict between the amount in words and the amount in numbers, the amount in words shall control. Prices are to be inclusive of travel, mileage, etc. Hourly Rate for Scheduled Preventative Maintenance: Charge for conducting ambulance and other vehicle inspections (with each preventative maintenance): J Parts to be qp b �a�ed � ° Io over cost the Contrac or I have included: • Proposal • Submission Response Form o Non Collusion Affidavit ✓' • Public Entity Crime Statement _✓ • Lobbying and Conflict of Interest Clause Form c/ • Drug Free Workplace Form o Indemnification and Hold Harmless t/ o Local Preference Form ✓ (Check mark items above, as a reminder that they are included). state that ! am authorized to submit this proposal. STATE OF F�o it, 6:�__ /�/� (Signature of Respondent) COUNTY OF [ r t O �O C i Date PERSONALV APPEARED BEFORE ME, the undersigned authority, 0 C who, after first being sworn by me, (name of individual signing affixed his/her signature in the space provided above on this c , day of �� Z Ajj! ' , 20 J"O. My commission expires: NOTARY PUBLIC EUZABErH EL KOURY Attachment A ':`` W OUMMISSION # EE 040851 EXPIRES: December 11, 2014 •tif�• Bonded Ttuu Notary N* UedKWFN s K'7 25 NON- COLLUSION AFFIDAVIT of the city of K:�-y 4- 1-W�t c according to law on my oath, and under penalty of perjury, depose and say that; 1) I am P-C Y 1�, 1 c�►-�► ,� , the respondent making the Proposal for the project described as follows: nIA -1 7-,e C f, t% f Alch 1-e e- Ce"I.>. t D & 7�h _ l /1' c. L KFP- P -,v - 3 5y -j PV C 2) The prices in this proposal have been arrived at independently without collusion, consultation, communication or agreement for the purpose of restricting competition, as to any matter relating to such prices with any other respondent or with any competitor; 3) Unless otherwise required by law, the prices which have been quoted in this proposal have not been knowingly disclosed by the respondent and will not knowingly be disclosed by the respondent prior to proposal opening, directly or indirectly, to any other respondent or to any competitor; and 4) No attempt has been made or will be made by the respondent to induce any other person, partnership or corporation to submit, or not to submit, a proposal for the purpose of restricting competition; and 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. STATE OF )qD Jl V&' COUNTY OF 0 00/-40 65' ignature of Respondent) 5 0 L '� /--- ,>- v—/t Date PERSONALLY APPEARED BEFORE ME, the undersigned authority, 6 14'A - P-V P� who, after first being sworn by me, (name of individuhl signing) affixed his/her signature in the space provided above on this day of P0( , 20 �d ELZABE'tH EL KOURY Nfy C 1SSlOri eXp eS: _ ;,r. MY COMMISSION # EE 040851 NOT-AMY PUBLIC - 1 = pp � Decem 11 2014 Notary P ub k OMB - MCP FORM #I Attachment B 26 PUBLIC ENTITY CRIME STATEMENT "A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a proposal on a contract to provide any goods or services to a public entity, may not submit a proposal on a contract with a public entity for the construction or repair of a public building or public work, may not submit proposals on leases of real property to public entity, may not be awarded or perform work as a bidder, supplier, subbidder, or RESPONDENT under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, Florida Statutes, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list." By executing this form, I acknowledge that l/my company is in compliance with the above. STATE OF COUNTY OF 1 � "4 k :.',� 6' (Sig7 ature of Respondent) � o L - e ,)- -- 3-0— 1 V Date PERSONALLY APPEARED BEFORE ME, the undersigned authority, who, after first being sworn by me, (name of individua4 signing) affixed his/her signature in the space provided above on this day of .- Gt'd:. , 20 /. A�cW, My co)nmission expires: 'NOTARY PUBLIC gupgm&KWW 1 MY COMMISSION # E 0" 14 " EXPIRES: De U Banded flKU NW PUND Attachment C 27 DRUG -FREE WORKPLACE FORM The undersigned Respondent in accordance with Florida Statute 287.087 hereby certifies that: of Business) 1. Publishes 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. Informs 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. Gives each employee engaged in providing the commodities or contractual services that are under proposal a copy of the statement specified in subsection (1). 4. In the statement specified in subsection (1), notifies the employees that, as a condition of working on the commodities or contractual services that are under proposal, 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 contendre 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. Imposes 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. Makes 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 above requiremeat5: Signature j p J_,e 0 w tom_ -° / �_ — 1) / 0 Dale' OMB - MCP FORM #5 Attachment D 28 LOBBYING AND CONFLICT OF INTEREST CLAUSE SWORN STATEMENT UNDER ORDINANCE NO. 10-1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE 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 unty officer or employee. (Signature) y P 4-e Date: STATE OF 0e t - - - V 14 COUNTY OF A 0 #JeD C PERSONALLY APPEARED BEFORE ME, the undersigned authority, who, after first being sworn by me, affixed hi er signature (name of individual signing) in the space provided above on this oW day of _0�� 2016 14 4 • � V My commission expires: d0— //_ / L7 OMB - MCP FORM #4 Attachment E 29 ,j P"% EIZABM EL k MY COMMISSION E EXPIRES: Decem ?,' . � ; . B=M Thru Notary Pu Attachment E 29 MONROE COUNTY, FLORIDA RISK MANAGEMENT POLICY AND PROCEDURES CONTRACT ADMINISTRATION 15 r:\►lil:�il Indemnification and Hold Harmless for Other Bidders and Subbidders The Bidder covenants and agrees to indemnify and hold harmless Monroe Board of Governors for Fire and Ambulance District 1, its servants, agents and employees 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 Bidder or any of its Subbidder(s) in any tier, occasioned by the negligence, errors, or other wrongful act or omission of The Bidder or its Subbidders 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 Bidder's failure to purchase or maintain the required —. insurance, the Respondent shall indemnify the County from any and all increased expenses resulting from such delay. The first ten dollars ($10.00) of remuneration paid to the Respondent 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 elsewhere within this agreement. Respondent's Signature 5c,- Date TCS Attachment F 30 GENERAL LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT OE COUNTY FIRE RESCUE AMBULANCES AND OTHER VEHICLES BETWEEN MONROE COUNTY, FLORIDA AND ROY KHANNA 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: $300,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $100,000 per Person $300,000 per Occurrence $ 50,000 Property Damage An Occurrence 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. GL1 Attachment G (1 of 4) 31 VEHICLE LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT MAINTENANCE OF MONROE COUNTY FIRE RESCUE AMBULANCES AND OTHER VEHICLES BETWEEN MONROE COUNTY, FLORIDA AND ROY KHANNA 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: $100,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $ 50,000 per Person $100,000 per Occurrence $ 25,000 Property Damage The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. VU Attachment G (2 of 4) 32 WORKERS' COMPENSATION INSURANCE REQUIREMENTS FOR CONTRACT MAINTENANCE OF MONROE COUNTY FIRE RESCUE AMBULANCES AND OTHER VEHICLES BETWEEN MONROE COUNTY, FLORIDA AND ROY KHANNA Prior to the commencement of work governed by this contract, the Contractor shall obtain Workers' Compensation Insurance with limits sufficient to respond to Florida Statute 440. In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not less than: $100,000 Bodily Injury by Accident $500,000 Bodily Injury by Disease, policy limits $100,000 Bodily Injury by Disease, each employee Coverage shall be maintained throughout the entire term of the contract. Coverage shall be provided by a company or companies authorized to transact business in the state of Florida. 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. VATOFI Attachment G (3 of 4) 33 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: ``��� ►� RF - P5 y J -0 .i— -'a°� C v Contract for: r1�r�ii�� i�A�tc:� /�?nstI -&e ` ", !Fell < Address of Cuntractor: Risk Management Date County Administrator appeal: Approved: Date: Not Approved: Board of County Commissioners appeal: Approved: Meeting Date; Not Approved: Attachment G (4 ul "4) 34 7 3 G j Phone: C `_ �U/1- C/ C Scope of Work: fil? 47vj J e- y�ia A°z Z) /` ,/J 9WIi- or r 0 - 1 1-41 C �Z) t' t t' Sd' = t Z �� / ice"► G 5 °7 1� c� 1f l7 c%L J Reason for Waiver: �f, �t �✓ y) G'V ." vi' 4` C. E _�< iGcT �' f "j r4- Is-r f l k Policies Waiver will apply to: Signature of Contractor: 1�-— ti Approved Not Approved Risk Management Date County Administrator appeal: Approved: Date: Not Approved: Board of County Commissioners appeal: Approved: Meeting Date; Not Approved: Attachment G (4 ul "4) 34 i CERTIFICATE OF LIABILITY INSURANCE 1 DATE (MNVDD/YYYY) HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER - - JOHNSON & MILLER INSURANCE A JO SON -WEBB 1225 N Military Trail #2 _ AI o. Xt: 61 640 4333 aC (561) 640 -0514 W Palm Beach, FL 33409 _ P Ab�_�ssbjWebb joh sonmillerinsurance . com - CUSTOMERID�• irvsut;eR(S) A O NAICN INSURED ROY KHANNA NSURER A HERMI AGE CO * s N N 3117 CAROL AVE 'Y iNS / tf `!T PALM SPRINGS, FL 33461 l - —r INSURER D (561) 641 -2360 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. VSR ADDL SUER -TR TYPE OF INSURANCE INSR lnrvo POLICY NUMBER MM DDIYYYY MM /DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY i REMISES (Ea occurrence ) $ 50,000 �y CLAIMS -MADE X I OCCUR MED EXP (Any one person) $ 5,000 A IX NIHGL- 532267 -09 12/2/10'12/2/11 1 000 AND EMPLOYERS' LIABILITY I 1 i WCSTATU OTH YIN TORY LIMITS ER _ 1 I i ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? IN /A N A .. EACHACCIDENT $ (Mandatory in NH) !! -! ' 1 ! / ' If yes, describe under ! U ! x L (2 E L L E.L. DISEASE - EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.. DISEASE - POLICY LIMIT $ N i Ct DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) MONTOE COUNTY BOARD OF COUNTY COMMISSIONERS SHALL BE LISTED AS ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION MONROE COUNTY BOARD OF COUNTY ! I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE COMMISSIONERS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ! ATTN: RISK MANAGEMENT ACCORDANCE WITH HE POLICY PROVISIONS. 1100 SIMONTON STREET KEY WEST, FL 33040 AUTHORIZ REPRESENTA VE FAX: 305- 289 -6061 - ACORD25(2009/09) ©1988 -21 The ACORD name and logo are registered marks of ACO L' ACORD CORPORATION. All rights reserved. PERSONAL & ADV INJURY GENERAL AGGREGATE $ , , 000 G � E N'L AGGREGATE LIMIT APPLIES PER �► POLICY PRO JE T LOC PRODUCTS - COMP /OP AGG $ 1,000,000 $ B AUTOMOBILE LIABILITY ANYAUTO 1 ALL OWNED AUTOS -; SCHEDULED AUTOS I HIRED AUTOS NON -OWNED AUTOS � � X N i i FLC9323840 ( ;14/3/11 COMBINED SINGLE LIMIT (Ea accident) 1,000,000 BODILY INJURY Per person) ( P ) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ ) $ i I� UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE I N EACH OCCURRENCE $ _ AGGREGATE $ DEDUCTIBLE RETENTION $ WORKERS COMPENSATION $ AND EMPLOYERS' LIABILITY I 1 i WCSTATU OTH YIN TORY LIMITS ER _ 1 I i ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? IN /A N A .. EACHACCIDENT $ (Mandatory in NH) !! -! ' 1 ! / ' If yes, describe under ! U ! x L (2 E L L E.L. DISEASE - EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.. DISEASE - POLICY LIMIT $ N i Ct DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) MONTOE COUNTY BOARD OF COUNTY COMMISSIONERS SHALL BE LISTED AS ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION MONROE COUNTY BOARD OF COUNTY ! I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE COMMISSIONERS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ! ATTN: RISK MANAGEMENT ACCORDANCE WITH HE POLICY PROVISIONS. 1100 SIMONTON STREET KEY WEST, FL 33040 AUTHORIZ REPRESENTA VE FAX: 305- 289 -6061 - ACORD25(2009/09) ©1988 -21 The ACORD name and logo are registered marks of ACO L' ACORD CORPORATION. All rights reserved. LOCAL. PREFERENCE FORM Vendors claiming a local preference according to Ordinance 023 -2009 must complete this form. I s� Yl ► � ' Name of Bidder /Responder �' Date: 1. Does the vendor have a valid receipt 1 the business tax paid to the Monroe County Tax Collector dated at least one year prior to the notice or request for bid or proposal? (Please furnish copy. ) 2. Does the vendor have a physical business address located within Monroe County from which the vendor operates or performs business on it day to day basis that is a substantial component of the goods or services being offered to Monroe County?_ __ e- 1 7' ­----- _ List Address: �' �- Iq-� � 1'7 r'f 1_� ��� �- j c 3 3 G - 3 -7 Telephone Number:_ _3,,,� q!5 3__-I 13. Does the vendor /prime contractor inlend to subcontract 50% or more of the goods, services or construction to local businesses meeting die criteria above as to licensing and location? Aa If yes, please provide: 1. Copy of Receipt of the business tax paid to the Monroe County Tax Collector by the subcontractor dated at least one year prior to the notice or request for bid or proposal. 2. Subcontractor Address within Monroe County from which the subcontractor operates: --------------- - - - - -- — - - - - - -- Tel. Number Print Name: Sign urc and 'fide of Authorized Signatory for 13 idder /Responder } o L- e= COUNTY OI On this _ __ day of "' ; 20 belbre me, the undersigned notary public, personally appeared known to me to be the person whose name is subscribed above or who produded rc% identification, and acknowledged that he/she is the person who executed the above Local Preference form for the purposes therein contained. Notary Public - Print Name My commission expires:_ _ Alluchmenl ff Seal 8 2AM711 EL My ISSION # S 04al Saw TNU N�arl plc 1, 2014 Merueiters 35 CURRENT MONROE COUNTY FIRE RESCUE AMBULANCES and OTHER VEHICLES 16 Radio VEHICLE Prime or Call LOCATION YEAR/MAKE/ MODEL COUNTY ID Back Sign 2002 FORD STOCK ISLAND AMBULANCE 1 FDXF46F22ED14878 1416 -215 Prime R -8 2006 STERLING BIG COPPITT AMBULANCE 2FZACFCS76AV92511 1416 -5098 Prime R -9 2001 FORD BIG COPPITT AMBULANCE 1 FDXF46F81 EC33365 1416 -208 Backup R -109 1994 FORD REHAB Rehab - BIG COPPITT UNIT 1 FDLF47M6REA52322 1417 -159 Backup 9 2010 FORD PICK UP BIG COPPITT TRUCK 1 FDAW5HR2AEB04654 6819 MCI MCI MCI BIG COPPITT 2005 MCI TRAILER 1WC200J2X53052439 5621 MCI Trailer Trailer 2008 HORTON CUDJOE AMBULANCE 3HTMNAAM68N698467 6507 Prime R -11 2006 STERLING BIG PINE AMBULANCE 2FZACFCS37AX62073 1416 -5806 Prime R -13 TRAINING 1997 FORD RESCUE 1 FDXF46F61 EC33364 1416 -059 Back up R -39 2009 FORD CONCH KEY AMBULANCE IFDXE45P79DA90438 1416 -6845 Prime R -17 2001 FORD CONCH KEY AMBULANCE 1 FDXF46F41 EC33363 1416 -206 Backup R -117 2009 FORD TAVERNIER AMBULANCE 1FDXE45P19DA83131 6813 Prime R -22 1998 FORD TAVERNIER AMBULANCE 1FDXF46F9XEB99283 1416 -120 Backup R122 1992 FORD REHAB Rehab - TAVERNIER UNIT 1 FDFL47F2SEA30339 4295 Backup 22 Attachment I 16 SUBMISSION PROPOSAL RESPONSE FORM Maintenance of Monroe County Fire Rescue Ambulances and Other Vehicles Respondents Name and Mailing Address: Ko y CG " =3 3 �'rl Li�G =i Telephone and Fax Numbers: , _ y S , r� _ a, C All amounts must be written AND in number format. In case of a conflict between the amount in words and the amount in numbers, the amount in words shall control. Prices are to be inclusive of travel, mileage, etc. Hourly Rate for Scheduled Preventative Maintenance: s 7, EYy /V`f Charge for conducting ambulance and other vehicle inspections (with each preventative maintenance): Parts to be marked u % over bbst to the Contractor I have included: • Proposal • Submission Response Form • Non Collusion Affidavit • Public Entity Crime Statement • Lobbying and Conflict of Interest Clause Form • Drug Free Workplace Form • Indemnification and Hold Harmless • Local Preference Form (Check mark items above, as a reminder that they are included). I state that I am authorized to submit this proposal STATE OF 64f, f])4- COUNTY OF d10#J fU S tore of Respondent) 50 (- Date PERSONAL Y A BEFORE ME, the undersigned authori ty, 0 who, after first being sworn by me, (name of individual signin PPEARED affixed s/her sig in the space provided above on this pfd day of ���0t -- , 2043. My commission expires: NOTARY PUBLIC ELKK M Attachment A EXPIRES: December 11,2014 Bood Thru Naary Fubk underwriters 25 Owv► •er