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03/24/1994 ContractSection 00500 FORM OF AGREEMENT This agreement is set forth as of the Q9—th day of in the year of between the OWNER who is TH BOARD OF COUNTY COMMISSIONERS of Monroe County Florida; and the following CONTRACTOR: Name: Address: R & G Contractin .. fie,._,.___.._. 2121 Washington Street Hollywood, F1. 33020 j ,o n L z21 r.� (305) 920-7444 T 717 T' Phone:- N Z. for the purpose of performing all of the Work required bZ� they; Contract Documents for the following PROJECT: T. N � A - LOWER 1ATECUMBE BEACH BATHROOMS Lower Matecumbe Key Monroe County, Florida The Project has been designed by MONROE COUNTY ENGINEERING DEPARTMENT who is hereafter referred to as the ARCHITECT/ENGINEER and who assumes all duties and responsibilities and has the rights and authority assigned to the ARCHITECT/ENGINEER in the Contract Documents in connection with completion of the Work in accordance with the Contract Documents. The OWNER and the CONTRACTOR agree as set forth as follows: Article 1 - The Contract Documents The Contract Documents consist of this Agreement, the Request for Bid, the Conditions of the Contract (General and Supplementary), the Supplementary Insurance Documents, the General Requirements, the Technical Specifications, 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. 05/05/93 FORM OF AGREEMENT 00500-1 Article 2 - The Work The Contractor shall perform all the Work required by the Contract Documents for the following scope of work: A. The Scope of Work shall include, but not be limited to, the construction of a 330 square foot bathroom facility (1 men, 1 women, including 1 handicap stall in each) on the exisiting Lower Matecumbe Beach site and other related bathroom construction work as shown on the Plans and included in the Technical Specifications. The Project also consists of the installation of intermediate rails on 6 existing picnic shelters as shown on the plans. B. The Contractor shall: provide all labor, supervision, materials, supplies, equipment, tools, construction equipment, transportation, inspection, and proper execution and completion of all Work as specified on the Drawings and Technical Specifications. C. The Specifications contained herein are considered to be the minimum standards required. Construction shall comply with all applicable Federal, State, Local codes and ordinances. D. This contract is subject to the provisions of Section 255.05, F.S., and those provisions of Chapter 713, F.S., which are incorporated therein. E. This written contract and attached contract documents represent the entire agreement between the parties and may not be modified except as provided herein. F. This agreement is to be governed by the laws of the State of Florida. Article 3 - Schedule The CONTRACTOR shall commence Work to be performed under this Contract no later than ten (10) calendar days from Notice to Proceed and shall be substantially completed no later than ninety (90) calendar days from the Commencement Date. The CONTRACTOR also agrees to be complete and ready for final payment in accordance with the General Conditions no later than thirty (30) calendar days from the Substantial Completion Date. Substantial Completion shall be determined by the County Engineer. 03/02/94 FORM OF AGREEMENT 00500-2 The OWNER and the CONTRACTOR recognize that time is of the essence in this Contract 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 General Conditions. 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 complete. 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: $Twenty Six Thousand Three Hundred no/100 $26.inn_nn (WORDS) (DOLLARS) Article 5 - Payment Procedures The CONTRACTOR shall submit Applications for Payment in accordance with the General Conditions. Applications for Payment will be processed as provided in the General Conditions. 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 measured in accordance with the General Conditions and Supplementary Conditions of the Contract. 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 payment is made. Upon final completion and acceptance of the Work in accordance with the General Conditions and upon submittal of all closeout documentation 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. 12/28/93- FORM OF AGREEMENT 00500-3 Article 6 - Contractor's Representations In order to induce OWNER to enter into this Contract, CONTRACTOR makes the following representations: 1. CONTRACTOR has familiarized itself 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 -he written resolution thereof by the 0Wi-ER acceptable to the CONTRACTOR. 05/05/93 FORM OF AGREEMENT v0500-4 Article 7 - Contract Documents The Contract Documents which comprise the entire agreement between the OWNER and the CONTRACTOR concerning the Wort: consist of the following: 1. Notice of Award. 2. This Agreement (pages 1 to inclusive). 3. Bidding Documents - Notice of Calling for Bids, Instructions to Bidders, Bid Proposal, Pre -Bid Substitutions, Scope of Work, Milestone Schedule. 4. Notice to Proceed. 5. General Conditions (pages 0 to 31, inclusive). 6, Supplementary Conditions (page 1). ?. Supplementary insurance Documents (pages 1 to 11, inclusive). klenerai Requirements - Measurement and Paimeint, Application for Payment, Submittals, Progress Schedules, Temporary Controls, �:onstrurtior. C'1 �anir. , and Post -Bid Substitutions. 9. Technical Specifications. 10. Drawings, consisting of a cover sheet and sheet numbered 1 through 2 inclusive with each sheet bearing the following general title: LOWER MATECUMBE BEACH RESTROOMS Lower Matecumbe Key Monroe County, Florida 11, Addenda numbers to inclusive. i2. CONTRyCTOR's Bid Proposal (pages 1 to 11, inclusive). There are no Contract Documents other --ian those 1isred ai)ove 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 Agreement. 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 Subcontractor(s) in any tier, their employees, or agents. The first ten dollars ($10.00) 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 elsewhere within this agreement. 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 tine 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. 05/ 0 S / FORM OF n,^.5ci0-o 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. 2. 3. 4. 5. 6. 7. This Agreement Bidding Documents with all/any addenda General Requirements Supplementary Conditions General Conditions Technical Specifications Drawings (large scale detail scale general drawings) drawings over smaller 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 ARCHITECT/ENGINEER on their behalf. This Agreement will be effective on OWNER: Monroe County BOCC By 19 CONTRACTOR: d �C a1J/ W-1 b54 sr l�a�/Ywo��• - � BY Y--W- Y r DAMY L. YOMaM est ,Attest Address for giving notices: Address for giving notices: �lpnroe County, FL MONROE COUNTY ENGINEERING DEPT. 5100 COLLEGE ROAD KEY WEST, FL 33040 **************** END OF SECTION 00500 APPROVED As TO F^^" AND LEGAL SUF Ey _j�_ 121/28/u FORM OF AGREEMENT 00500-7 n April 22. 199.1 Ist IYiMiig MONROE COUNTY, FLORIDA INSURANCE GUIDE TO CONTRACT ADMINISTRATION General Insurance Requirements for Contractors and Subcontractors Prior to the commencement of work governed by this contract (including the pre -staging of personnel and material), the Contractor shall obtain, at his/her own expense, insurance as specified in the attached schedules, which are made part of this contract. The Contractor will ensure that the insurance obtained will extend protection to all Sub - Contractors engaged by the Contractor. As an alternative the Contractor may require all Subcontractors to obtain insurance consistent with the attached schedules. The Contractor 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 Contractor to provide satisfactory evidence 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 Contractor's failure to provide satisfactory evidence. The Contractor shall maintain the required insurance throughout the entire term of this contract and any extensions specified in any 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 Contractor 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 Contractor's failure to maintain the required insurance. The Contractor 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 Contractor's insurance shall not be construed as 12/ 13/93 SUPPLEMENTARY INSURANCE DOC_UMEP:TS 009oc-i Alxil 22, 1993 1511'rintim, relieving the Contractor from any liability or obligation assumed under this contract or imposed by law. The Monroe County Board of County Commissioners, its employees and officials will be included as "Additional Insured" on all policies, except for Workers' Compensation. In addition, the County will be named as an Additional Insured and Loss Payee on all policies covering County -owned property. 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. ;-n% ')UPFLEMENTAFY INSURANCE DOCUMENTS 00900 Apra 22. 1993 lid IYirning MONROE COUNTY, FLORIDA INSURANCE GUIDE TO CONTRACT ADMINISTRATION Indemnification and Hold Harmless for Contractors and Subcontractors 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, errors, or other wrongful act or omission of the Contractor or its Subcontractor(s) 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 Contractor's failure to purchase or maintain the required insurance, the Contractor 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 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 elsewhere within this agreement. 12,/30j9; SUPPLEMENTARY INSURANCE DOCUMENTS 00900_3 April 22, 1993 Ist Priming 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. WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY X Workers' Compensation WC 1 _x Employers Liability WC2 Employers Liability WC3 Employers Liability WCUSLH US Longshoremen & Harbor Workers Act WCJA Federal Jones Act INSCKLST 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 BTTPPLEMENTAR i F j- I •r - N iTkTi 1 �O�.JMEiv � n^yn1. ATxil 22. 1993 Isl Priming 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 X $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 Underground, Explosion and Collapse (XCU) GLLIQ Liquor Liability All endorsements are required to have the same limits as the basic policy. tNSCKLST ii , SUPPLEMENTARY i1 ,� 4 , — -)_. ; i�'ti.i.- ,-,,- - - _ _ April 22. 1993 Id Printing VEHICLE LIABILITY As a minimum, coverage should extend to liability for: Owned; Nonowned; and Hired Vehicles Required Limits: VL1 X VL2 VL3 BR1 MVC PROI PR02 PR03 POL I POL2 POW EDI ED2 GK1 GK2 GK3 MED I MED2 ME.D3 $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' Limits equal to the Risk completed project. Motor Truck Limits equal to the maximum Cargo value of any one shipment. Professional $ 250,000 per Occurrence/$ 500,000 Agg. Liability $ 500,000 per Occurrence/$1,000,000 Agg. $1,000,000 per Occurrence/$2,000,000 Agg. Pollution $ 500,000 per Occurrence/$1,000,000 Agg. Liability $1,000,000 per Occurrence/$2,000,000 Agg. $5,000,000 per Occurrence/$10,000,000 Agg. Employee $ 10,000 Dishonesty $100,000 Garage Keepers $ 300,000 ($ 25,000 per Veh) $ 500,000 ($100,000 per Veh) $1,000,000 ($250,000 per Veh) Medical Professional $ 500,000/$ 1,000,000 Agg. $1,000,000/$ 3,000,000 Agg. $_5,000,000/$10,000,000 Agg. INSCKLST IIv�I1rt:,I:C i, i?MEIi� • Alxil 22, 1993 Ist Printing 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 HKLI Hangarkeepers $ 300,000 HKL2 Liability $ 500,000 HKL3 $ 1,000,000 AIRI Aircraft $25,000,000 AIR2 Liability $ 1,000,000 AIR3 $ 1,000,000 AEO1 Architects Errors $ 250,000 per Occurrence/$ 500,000 Agg. AE02 AE03 & Omissions $ 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 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 INSCKLST' 51 PPLEMENrHP, INSi1RANCE DOCUMENT_- April 22.1993 ist rriNins WORKERS' COMPENSATION INSURANCE REQUIREMENTS FOR CONTRACT BETWEEN MO'NROE 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 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 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. WC 1 12 93 SUPPLEMENTARYINSURAT,:CE DOCUMENTS pr,apt-;_,� April 22. 1993 ld 14iititg 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: $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 atier the etlective 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 12130/9- SUPPLEMENTARY INSURANCE DOCUMENTS 0090r'_a April 22. 1993 131 hilding 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 Ilired 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. VLl SUPPLEMENTAR INSURANCE DOCUMENTS 0090 i_ n Raaoltd" a191-1993 Atuit 22. 199-4 1 d Printing 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: Contract for: Address of Contractor: Phone: Scope of Work: Reason for Waiver: Signature of Contractor: Approved Not Approved Risk Management Date County Administrator appeal: Approved: Not Approved: Date: Board of County Commissioners appeal: Approved: Not Approval: Meeting Date: WAIVER i�% ,1 4 SUPPLEMENTARY !NSURANC:E DOCUMENT_ 00900-ii .4,. t, SECTION 0110 SWORN STATEMENT UNDER SECTION 287.133(3)(a), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PIIBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS. 1. This sworn statement is qubmitted to l'/dnraL M for .n G �� rrrcn fs (print name of the public entity) rin%t� -ndividual's ame and title) 1 (-r Con %/fit C_r. �A h (print name of entity s ting sworn statement) whose business is 2--'eh'? /`* % (nn l C-1 0/ and (if applicable) it Federal Employer Identification Number (FEIN) is S-' �� 4f (If the entity has no FEIN, include the Social r of the individual signing this sworn statement:. 2. I understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statues, means a violation of any state or.federal law by a person with respect to and directly related tothe ,transaction of business with any public entity or with an agency,or political subdivision of any other state or of the United.States�, including, but not limited to; any bid or contract for good or services to be providedIto 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 Statues, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, nonjury trial, or entry of,a plea of guilty or nolo contendere. 4. I understand that an "affiliate" as defined in Paragraph 287.133(1)(a), Florida Statutes, means: 1. A predecessor or successor of a person convicted of a public entity crime: or. 04/.29/ 93 BID PROPOSAL 00110 -- 5 2. An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. 5. I understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statues, 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 s orn statement. (Indicate which statement applies.) Neither the entity submitting this sworn statement, nor ahy.of-its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. 04/29/93 BID PROPOSAL 00110 - 6 The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative 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 FOR THE PUBLIC ENTITY IDENTIFIED IN 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 OR THE.THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORID STATUES FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS NRM. gnature) / J (date) STATE OFG- COUNTY OF G.rd-tX, n r� PERSONALLY EEARED BEFORE ME,. the undersigned authority, who, after first being sworn by me, (name of individual signing) affixed his/her signature in the space provided above on this S� day of ��A ►"';v 19 OTARY PUBLIC 4RY PuaL C 0 If. j My commission expires: 86WmUIONFXP aU*6001 iKs..u,ro� c►�.�� Form PUR 7068(Rev. 04/10/91) 04/29/ 93 BID PROPOSAL 0,0110 7 SECTION 00110 NON -COLLUSION AFFIDAVIT I 64 of the city of 1-1d1k tJ.adJ r according to law on my oath, and under penalty of perjury, depose and say that; ll , 1. ) I am / I'4.➢l' 0,ext- of the firm of Rck 6� a,1T_L2_,7:4 '4A the bidder making the Proposal for the pr ect described in the notice for calling for bids for: and that I executed the said proposal 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 proces 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 ;:andjwi'll not be knowingly 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. 04/29/93 BID PROPOSAL 00110 8 (Sign ure of Bidder) (Date) STATE OF:— F/0 T I^ F- COUNTY OF: 'aryLk' 1-r j -- PERSONALLY APPEARED BEFORE ME, the undersigned authority, pc,,f )�&o lJ_ 5 who, after first being sworn by me, (name of individual signing) affixed is/her signature inth.,e/ space provided above on.this day of Fv� RAW A �-�` , 19 N Y PUBLIC My commission expires: tWTAW PURLic STATE of F1iyum ' M`! r"ISSION EXP JULY ie, 594 F^NOEO Than QW.Aft INS. US. 04/.2.9/93 BID PROPOSAL 00110-9 SECTION 00110 LOBBYING AND CONFLICT OF INTEREST CLAUSE SWORN STATEMENT UNDER ORDINANCE NO. 010-1990 MONROE COUNTY, FLORIDA 91 . warrants that it has not employed, retained 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, Vat amount of any fee, commission, percentage, gift, or consi paid o the former County officer or employee". (Signature) (Date) STATE OF 04 COUNTY OF 10 =I�OCA; P S NALLY AP EAREDBEFORE- E the undersigned authority, 1 who, after first being sworn by me, affixed his/her.signature�� 24 (name of individual signing) in the �S �� „_ day of �� space provided above on this NN5TARY PUBLIC My commission expires: NOTARY PUBLIC STATE OF FLOM A MY COMMISSION EXP JULY 16.19 BONDED TMU .GENERAL INS. U30- 04/29/93 BID PROPOSAL 00110-10 SECTION 00110 DRUG -FREE WORKPLACE FORM The undersigned Contractor in accordance with Florida Statute 287.087 hereby ceX-ifies that: (Name of Business] 1. Publish a statementnotifyingemployees that the unlawful manufactures, 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 such 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 kri' 3. Give each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection QL 4. In the statement, specified in subsection (1), notify the employees that, as a statement.,,, working on the commodities or contractual services "thkt",are 'under bid, the employees will abide by the terms of the "stateent' and: will notify:r the employer of any m conviction` of { *or-' pi ea v :+`qtu ty, or nol o ; contendere to, any violation of Chapter 89 qil rida Statutes'_or of any controlled substance law of ,the Unz .e1"States' or anystate, for a violation occurring in the workplace.nc'later than five (5) days after such conviction 7 Yf f pa s 5. Impose a sanction3on,ori�reguire'thesatisfactory participation in a drug abuse'assistance or;rehabilitation program if such is available in the empl oyee"k'community;"or"any employee who is so convicted. 6. Make a good faith effort to continuehto maintain a drug -free workplace through implementation of this section. As_a person authorized to sign the statement I e tify at this firm complies fully with the above requireme s V4. 19- n C;)- c)— �y MCP#5 Rev. 6/91 Date 04/.29/93 HID _PROPOSAL 00110-11 BID TO: BID FROM: SECTION 00110 PROPOSAL FORM MONROE COUNTY BOARD OF COUNTY COMMISSIONERS c/o PURCHASING DEPARTMENT PUBLIC SERVICE BUILDING, ROOM 002 5100 COLLEGE ROAD, STOCK ISLAND KEY WEST, FLORIDA 33040 The undersigned, having carefully examined the Work and reference Drawings, Specifications, Proposal, and Addenda thereto and other Contract Documents for the construction of: LOWER MATECUMBE BEACH BATHROOMS LOWER MATECUMBE 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 hereto, in a workman -like manner, in conformance with said Drawings, Specifications, and other Contract Documents including Addenda issued thereto. The undersigned further certifies that he has personally inspected the actual location of where the Work 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 shall assume the risk of any and all costs and delays arising from the existence of any subsurface or other latent physical condition which could be reasonably anticipated by reference to documentary information provided and made available, and from inspection and examination of the site. The undersigned,shall perform the work at the Unit Price Indicated on the following Bid Form. Further, it is understood that the Bid Form Quantities are estimated for evaluation purposes only and that the final contract price will be determined from the actual quantities measured for payment in accordance with the Contract Documents. 04/29/93 BID PROPOSAL 1 00110 - 2 I acknowledge receipt of Addenda No . (s) 0 i, i-i .0 I have included pages 1 through 9 of the Bid Proposal which entails the Prop sai rorm:X-, the Sworn Statemenk of Public Entity -rimer ! the Non -Collusion Affidavit. OC the Lobbying and Conflict of Interest Clause A and the Drug -Free Workplace Form. (Check mark items above, as a reminder that they are included. Mailing Addr?ss. �� l,:, l /'�, . t cncre Number: Date.-LJr�- Sianed l� Y ,-pr (Name) (Title', Witness: ( seal £,- olioo 'Ivsoaq*da ais £6/6ZIVU C C h O -J v Qi 1�►7 0 CU 06 0