06/16/1993 AgreementAGREEMENT
This Agreement made and entered into this 16th day of June,
1993, A.D., by and between the Monroe County Board of County
Commissioners, Monroe County, Florida acting as Board of
Governors for MSTD 6, hereinafter "COUNTY" and R-Wave of Florida,
Inc. hereinafter "CONTRACTOR".
WHEREAS: That the parties hereto, for the consideration
hereafter set forth, mutually agree as follows:
1. SCOPE OF THE WORK
The CONTRACTOR shall furnish all labor, materials,
equipment, machinery, tools, apparatus and transportation
atd perform all other work as described in the
Specifications for the Preventive Inspection and Maintenance
of Biomedical Equipment for the Monroe County Board of
County Commissioners and as described in the CONTRACTOR'S
Bid Proposal dated May 13, 1993: all of which are hereto
attached and made part of this Agreement by reference.
2. CONTRACT SUM
The COUNTY shall pay to the CONTRACTOR a total amount
of $4,000.00 for the faithful performance of the Contract,
in lawful money of the United States. This will be paid in
12 equal monthly installments, on the first of the month for
the preceding month.
3. GENERAL PROVISIONS
..6 1-
A. The CONTRACTOR agrees to indemnify the COUNTY and`holdn
the COUNTY harmless from and against all claims, ,
-711
damages, losses and expenses, including reasonabld>
attorneys' fees in any action arising out of w
performance of the work herein, including bodily
injury, illness or death, or for property damage
including loss of use, resulting from the CONTRACTtd v S ;_
work.
B. The CONTRACTOR 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, the full amount of any fee,
commission, percentage, gift or consideration paid to
the former County officer or employee.
4.
5.
6.
7.
CONTRACT TERM
A. The Contract shall commence on July 15, 1993 and shall
expire one year from that date. The Contract shall be
renewed for an -additional one (1) year term at the
option of the COUNTY.
B. The CONTRACTOR shall not be held liable for delay in
delivery caused by strikes, inability to obtain
materials or equipment, production or manufacturing
problems and all other causes beyond the CONTRACTOR'S
control. The CONTRACTOR shall not be liable for any
incidental damages caused by delays in delivery.
CONTRACTOR'S ACCEPTANCE OF CONDITIONS'
The CONTRACTOR understands all provisions of this
Contract and of the Specifications and agrees to their
sufficiency for the work to be done. under no
circumstances, conditions or situations shall this
Contract be more strongly construed against the COUNTY
than against the CONTRACTOR.
PAYMENT
A. The CONTRACTOR shall invoice the COUNTY, in accordance
with the pricing and terms as outlined in the Contract
documents. Invoices shall: be submitted to the Monroe
County EMS Office, 490 63rd Street, Ocean, Suite
170, Marathon, Florida 33050, for approval and
processing.
B. All payments shall be made directly to the CONTRACTOR
at the CONTRACTOR'S office, R-Wave of Florida, Inc.,
3965-A Investment Lane, W. Palm Beach, FL 33404-1775.
INDEPENDENT CONTRACTOR
At all times and for all purposes hereunder CONTRACTOR
is an independent contractor and not an employee of the
Board of county Commissioners of Monroe County. No
statement contained in this Agreement shall be construed so
as to find the CONTRACTOR or any of his/her employees,
contractors, servants or agents to be employees of the Board
of County Commissioners of Monroe. County and they shall be
entitled to none of the rights, privileges or benefits of
employees of Monroe County.
S. COMPLIANCE WITH LAW
In providing all services pursuant to this Agreement,
the CONTRACTOR shall abide by all statutes, ordinances,
rules and regulations pertaining to, or regulating the
provisions of such goods, including those now in effect and
hereinafter adopted. Any violation of said statutes,
ordinances, rules or regulations shall constitute a material
breach of this Agreement and shall entitle the Board of
County Commissioners to terminate this Contract immediately
upon delivery of written notice of termination to the
CONTRACTOR.
9. SUBCONTRACTING/ASSIGNMENT
CONTRACTOR shall not assign, sublet, subcontract, sell
or transfer any interest in this Contract without the prior
written consent of the COUNTY thereto.
10. NOTICE - GENERAL
Any notice or notices required or permitted to be
given pursuant to this Contract may be personally served on
the other party by the party giving such notice or may be
served by certified mail, return receipt requested, to the
following addresses:
COUNTY:
CONTRACTOR:
11. ANTI DISCRIMINATION
Emergency Medical Services
490 63rd Street, Ocean, Suite 170
Marathon, Florida 33050
R-Wave of Florida, Inc.
3965-A Investment Lane
W. Palm Beach, FL 33404-1775
CONTRACTOR agrees they will not discriminate against
any of their employees or applicants for employment or
against persons for any other benefit or service, because of
their race, color, religion, sex or national origin, or
physical or mental handicap where the handicap does not
affect the ability of an individual to perform in a position
of employment and to abide by all Federal and State laws
regarding non-discrimination.
12. NON WAIVER
Any waiver of any breach of covenants herein contained
to be kept and performed by the CONTRACTOR shall not be
deemed or considered as a continuing waiver and shall not
operate to bar or prevent the COUNTY from declaring a
forfeiture for any succeeding breach either of the same
conditions or covenants or otherwise.
13. CONTRACTOR - GENERAL
`s'he CONTRACTOR warrants that it is authorized by law to
engage in the performance of the activities encompassed by
the program herein described, subject to the terms and
conditions set forth in the Attachment, which is attached
hereto and incorporated herein as part of this Agreement.
Each of the signatories for the CONTRACTOR, below,
certifies and warrants that:
A. The CONTRACTOR'S name in this Agreement is the full
name as designated in its corporate charter, if
CONTRACTOR is a corporation; otherwise, CONTRACTOR'S
name is the business entity, whether partnership or
sole proprietorship, under which CONTRACTOR normally
conducts business.
B. They are empowered to act and contract for the
CONTRACTOR and
C. This Agreement has been approved by the Board of
Directors of CONTRACTOR, if CONTRACTOR has a
corporation.
D. CONTRACTOR has, if this Contract calls for payment in
excess of $10,000, executed a sworn statement under
F.S. 287.133 (3) (a), on public entity crimes. Said
statement, if not al--tached hereto, is already on file
with the ElxiS Office/Clerk of Court for the calendar
year 1993.
14. ENTIRE AGREEMENT
This agreement constitutes the entire Agreement of the
parties hereto with respect to the subject matter hereof and
supersedes any and all prior agreements with respect to such
subject matter between CONTRACTOR and the EMS Office or the
COUNTY.
15. CONSENT TO JURISDICTION
This Agreement, its' performance and all disputes
arising hereunder, shall be governed by the laws of the
State of Florida and both parties agree that a proper venue
for any action shall be Monroe County.
16. CONDITIONS OF TBRMI1721-1I1ION
A. The performance of work or provision of goods under
this Agreement may be terminated, delayed or
temporarily suspended by the COUNTY, in whole or in
part, from time to time, wherever the COUNTY shall
determine chat such termination is in the best interest
of the Coww-2Y. 'the COUNTY shall pay all reasonable
costs incurred by the CONTRACTOR up to the time of
terminatioA and all reasonable costs to the CONTRACTOR
associated with termination.
B. 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 applica:�be laws or regulations governing the use of
funds, the COUNTY may terminate the Contract by written
notice of 60 days. The notice shall specify cause.
The COUNTY shall pa-1 the CONTRACTOR fair and equitable
.compensation for expenses incurred prior to termination
of the Agreement, less any amount of 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 can affirmatively
collect damages.
IN WITNESS WHEREOF, the parties hereto have executed this
Contract the day and year first above written.
BOARD OF COUNTY COMMISSIONERS
OF MONROE COU�1U p- . FLORIDA
BY:
(SEAL)
ATTEST: Danny L. Rolhage, Clerk
WITNESS:
r
of -
CORPORATION
AUTHORIZED REPRESENTATIVE
MONROE COUNTY EMERGENCY MEDICAL SERVICES
SPECIFICATIONS
for
BIOMEDICAL EQUIPMENT
These specifications are for the sole purpose of requesting price
proposals for providing a total of two (2) maintenance inspections
during the term of this proposal, one (1) every six (6) months and
corrective maintenance on an as needed basis for biomedical equipment
(as identified in Addendum A), owned and operated by the Municipal
Services Taxing District No. 6, of Monroe County, Florida.
Two (2) categories are specified in this proposal; 1) Mandatory
Work and Equipment; and (2) Optional Work and Equipment. The vendor
must price and agree to do all work and furnish all equipment listed
under both categories. Monroe County reserves the right to accept or
reject any or all of the work and equipment proposed.
Mandatory Work and Equipment
Preventive Maintenance Inspections
There shall be one (1) preventive maintenance inspection of
all LP-10's and LS-100's (including chargers) every six (6) months,
generally in October and in April, however, the first preventive
maintenance inspection shall be scheduled within fourteen (14) days
of execution, by Monroe County, of the Agreement. There will be
one preventive maintenance inspection/calibration of all LP-51s per
12 month period. Performance output and electrical safety
inspections shall be performed in accordance with the standards
established by the Joint Commission on the Accreditation of
Hospitals (JCAH) and/or the National Fire Protection Agency (NFPA).
Each inspection shall include the following:
1. Cleaning the equipment.
2. Calibration: Make required adjustments to bring the equipment
up to the factory specifications. The calibration results of each
piece of equipment shall be recorded and placed in a file that
contains a list of all Monroe County biomedical equipment.
NOTE: The successful vendor must provide Monroe County Emergency
Medical Services with documentation that their test equipment is
calibrated every six (6) months and is traceable to the National
Bureau of Standards (NBS).
3. Mechanical Inspection: Inspect each piece of equipment for
wear, repair as necessary and record the findings. The inspection
shall include patient cables and lead wires.
4. Leakage Current Measurements shall be recorded and filed.
5. Output Measurements: Defibrillator outputs
6. Lubrication: Each instrument shall be lubricated, as
appropriate, to manufacturer specifications.
7. Scheduling: Mutually agreed upon scheduling of each regular
inspection visit shall be made in advance. Inspections shall be
conducted on -site in Monroe County.
8. Documentation: Upon completion of preventive maintenance
inspections, a report outlining the performance of each piece of
equipment will be forwarded to the Monroe County Emergency Medical
Services Office within seven (7) calendar days.
Corrective Maintenance
All repairs, modifications and/or calibrations shall be
consistent with the device amendments to the Food, Drug and
Cosmetic Act regulated by the Food and Drug Administration (FDA).
All equipment that is repaired will be calibrated to OEM
performance verification procedures.
1. Service: Repair service shall be available Monday through
Friday, 8:00 AM-5:00 PM, using UPS to ship units in need of repair
to the location identified by the vendor as the repair facility.
The vendor will supply the appropriate shipping containers for each
piece of equipment to be repaired. All transportation/shipping
costs from the repair facility shall be the responsibility of the
vendor.
2. Loaners: Loaner(s) will be provided, on an as needed basis,
if it becomes necessary to remove a defibrillator, monitor, pacer
or blood pressure machine from service. The vendor shall provide a
unit(s), of exactly the same make and model, until the nonoperating
equipment is back in service. All costs associated with providing
a loaner to Monroe County, and its return, shall be the
responsibility of the vendor.
General Conditions
1. Parts: The cost of all parts, components and materials shall
be included as a cost within the Mandatory Work and Equipment
category unless otherwise specifically excluded. All parts shall
be guaranteed to be of new and of current manufacture and of at
least OEM quality, and no part or attachment shall be substituted
or applied contrary to the manufacturer's recommendation and
standard practices. All parts shall be guaranteed for a minimum
of six (6) months.
2. Labor: This proposal will include the cost of all labor
associated with the inspection, maintenance and repair of Monroe
County's biomedical equipment. All workmanship shall be equal to
the highest industry standards and performed in a professional
manner so as to insure it is safe and functional. All labor shall
be guaranteed for a minimum of six months.
3. Exclusions: Repair of the following items will not be covered
by this proposal: Blood pressure cuff bladders and tubing, patient
cables and cases. Inspection of these items shall be included.
Cases may be included if Option No. 3 is exercised.
Insurance: Each vendor must show that they have adequate
orkmen Compensation insurance to include statutory benefits. Each
vendor must also show that they have premises/operations and
products/completed operations insurance in the amount of $1,000,000
per occurrence/$2,000,000 aggregate.
5. Technical Assistance: The successful vendor must provide
technical assistance to Monroe County to establish regulatory
requirements for Monroe County's biomedical equipment.
6. Technician Training: The successful vendor must show, on
demand, the training qualifications of the technicians that will be
working on Monroe County Emergency Medical Service equipment.
7. Technical Data: The successful vendor must show, on demand,
that they have the technical library (current service manuals,
etc.) necessary to support the technician(s) working on the
biomedical equipment.
8. Default Provisions: In case of default, including failure to
respond in a timely manner to a request for service, by the vendor,
Monroe County may procure services from an outside vendor and hold
the vendor responsible for any charges incurred by Monroe County
for the repair of its equipment.
9. Contract Award: Monroe County reserves the right to reject
any or all proposals deemed to be unresponsive and to accept any
proposal which in its best interest best meets the specifications
herein. Monroe County reserves the right, before awarding the
proposal, to require a vendor to submit such evidence of his
qualifications as it may deem necessary. Documentation that may be
required is financial, technical and other qualifications and
abilities of a vendor in making the award in the best interest of
Monroe County. Monroe County shall be the final authority in the
award of the contract. Acceptance of a proposal shall be evidenced
by execution, by Monroe County, of the Agreement.
10. Familiarity With Laws: The vendor is presumed to be familiar
with all federal, state and local laws, ordinances, code rules and
regulations that may in any way affect the work. Ignorance of the
law shall in no way relieve the vendor from responsibility.
11 Licenses: All bidders must have all licenses that are
quired by Florida State law and submit copies of them with the
proposal.
12. Quantities: Original price proposals shall be based on those
quantities identified in Addendum A of this specification including
that biomedical equipment for which the manufacturer's warranty
will expire during the term of this proposal. Manufacturer
warranty expiration dates, when applicable, are listed in Addendum
A.
Panes Mn_ a
13. Quantity Increases/Decreases: Monroe County reserves the
right to increase or decrease the equipment listed in Addendum A of
this proposal, during the term of the proposal. Equipment
increases or decreases will be accomplished by contract addendum,
mutually agreed upon and executed by the vendor and Monroe County.
14. Errors or Omissions: The vendor shall take no advantage of
any apparent error or omission which might be discovered in this
specification, but shall forthwith notify the Monroe County EMS
Director at 490 63 St., Suite 170, Marathon, Florida 33050, of
such discovery. The EMS Director will then make such corrections or
interpretations as deemed necessary for reflecting the actual
spirit and intent of the specification.
Q.5Customer Listing: The vendor must provide Monroe County
rgency Medical Services a list of Pre -Hospital Emergency Medical
Services for whom the vendor has performed similar or identical
work within the last three years.
16. Initial Term of Proposal: It is the intent of Monroe County
to establish a contract that will commence on execution of the
Agreement, by Monroe County and expire one year from that date.
17. Renewal Option: Assuming the availability of budgeted funds,
this proposal may be renewed for an additional one (1) year term if
mutually agreed upon by both parties in writing.
18. Payment: The vendor shall invoice Monroe County in 12 equal
monthly installments, on the first of each month, for the preceding
month. Invoices shall be submitted to the Monroe County EMS
Director, 490 63 St., Suite 170, Marathon, Florida 33050, for
approval and processing.
19. Signature Required: All proposals must be signed with the
firm name and by an officer or employee having the authority to
bind the company or firm by his signature.
20. Proposal prices shall be valid for at least ninety (90) days
from the closing date for submittal of proposals.
21. Exceptions: Variances or exceptions MUST be noted by number
and explained in full detail on the last page(s) of these
specifications.
22. The vendor agrees to indemnify Monroe County and hold the
COUNTY harmless from and against all claims, damages, losses and
expenses, including reasonable attorneys' fees in any action
arising out of performance of the work herein, including bodily
injury, illness or death, or for property damage including loss of
use, resulting from the vendor's work.
Dann M^ d
Optional Work and Equipment
Option No. 1
Paddles, Adult: This proposal will include the cost of
replacing adult defibrillator paddles, on an as needed basis -
Specify unit cost.
Option No. 2
Everything in the proposal will remain the same except there
will be only one (1) preventive inspection. This inspection
shall be within fourteen (14) days of execution of the Agreement.
Option No. 3
Cases: This proposal shall include the cost of replacing
cases, for the monitors, defibrillators and pacer units, on an as
needed basis - Specify unit cost.
Dan= Nn_ 9
ADDENDUM A
DISTRICT 6 (KEY LARGO) BIOMEDICAL EQUIPMENT INVENTORY
Description
LP 5 Monitor
LP 5 Monitor
LP 5 Monitor
LP 5 Defibrillator
LP 5 Defibrillator
LP 5 Defibrillator
LS 100
LS 100 Charger
LS 100 Charger
LS 100 Auto BP
LS 100 Auto BP
LS 100 Auto BP
LP 10 With Pacer
LP 10 With Pacer
LP 10 With Pacer
Battery Support
Battery Support
LP 10 Charger
Power Supply
Power Supply
Serial Number
016425
047757
006109
005751
026573
015602
001574
001573
003870
001422
001424
003907
002259
00007541
00007546
000741
006546
000333
00002285
00002288
D..- - M- G
BID SHEET
Mandatory Work and Equipment
LA (X ) 1 o J
Optional Work and Equipment (price each option separately):
Option 1
Option 2
Option 3
Company Submitting Bid:
Address:
Contact Person & Telephone:
Authorized Signature of
Company Representative
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Date
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BIOMEDICAL SERVICE
WT
173 NEOWN f�C7. �
P17 NEWT 11803,3965-A7 INVESTMENT LANE
516.249.4693 •FAX 516-249-4696 W. PALM BEACH, FL 33404
407-842.3660.800-32R•WAVE • FAX 407-842-2147
MAY 14, 1993
PETER LUBERT
MONROE COUNTY EMS
490 63RD STREET
SUITE 140
MARATHON, FL 33050
DEAR PETE:
ENCLOSED ARE THE OPTION PRICING FOR THE BIOMEDICAL. EQUIPMENT
MAINTENANCE BID:
OPTION 1 OPTION 2 OPTION 3
DISTRICT 5 $950,00 $2250.00 $500.00
DISTRICT 6 $950.00 $3400.00 $500.00
LOWER &
MIDDLE KEYS $950,00 $11,000.00 $500.00
SINCERELY,
RICHARD D'ANIERI
PRESIDENT
PREVENTIVE MAIWENIANCE 0 SALES • SERVICE' • CALIBRATION
SWORN STATEMENT UNDER ORDINANCE NO. 10-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
WAVZ QiF FLOR�bA ___warrants that he/it has not employed,
retained or otherwise had act on his/its behalf any former County officer
or employee in voliation 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.
(signature)
Date -- 5-\7L) �')
STATE OF
COUNTY OF 1- Yl'\
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
Cwho, after first being sworn by me,
affixed his/her signature (name of individual signing) in the space
provided above on this ,.day of
19_.
NOTARYV PUBLIC
My commission expires: STATE OF FLORIDA
Cvl!NTY OF PALIA BEACH
NOTARY PUgL!C, STATE OF FLORIDA The foregcinq instrument 4':'a3 acknowledged before me this
My commission r xpn23 Jan. 21, 1 5 d?y of `[1by
DANA—
OwlSteo thou Patterson -@echt Agency who i �e ona y ;no;>a%r� rr:a ort^ s o han produced
as ldantlficatlon and who D, 0 yi,
take an oath.
NOTARY PUBLIC
SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(n),
FLORIDA STATUTES. ON PUBLIC ENTITY CRIMES
THIS FORM MUST BE SIGNET) AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
This sworn statement is submitted to R—WAVEr oF FLoRMA kwC..,,
by \Ci-I�RD hAQkF:,9 \ [ int. name of the public entity)
name n
for
[print name of entity submitting sworn statement]
whose business address is
_3965 — Al \NyE5SN1Q—NT LANE
and (if applicable) its Federal Employer Identification Number (FEIN) is t['' 30M% LA%j,
(if the entity has no FEIN, include the Social Security Number of the individual signing this
sworn statement:
I understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, means a
violation of any state or federal law by a person with respect to and directly related to the transaction of
business with any public entity or with an agency or political subdivision of any other state or of the United
States, including, but not limited to, any bid or contract for goods or services to be provided to any public
entity or an agency or political subdivision of any other state or of the United States and involving antitrust,
fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.
I understand that "convicted" or "conviction" as defined in Paragraph 287.133(1)(b), Florida Statutes, means
a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any
federal or state trial court of record relating to charges brought by indictment or information after July 1,
1989, as a result of a jury verdict, nonjury trial, or entry of a plea of guilty or nolo contendere.
I understand that an "affiliate" as defined in Paragraph 287.133(t)(a), Florida Statutes, means -
I. A predecessor or successor of a person convicted of a public entity crime; or
2. An entity under the control of any natural person who is active in the management of the entity and
who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors,
executives, partners, shareholders, employees, members, and agents who are active In the management of
an affiliate. The ownership by one person of shares constituting a controlling interest in another person,
or 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 2.87.133(1)(e), Florida Statutes, means any natural
person or entity organized under the laws of any state or of the United States with the legal power to enter
into a binding contract and which bids or applies to bid on contracts for the provision of goods or services
let by a public entity, or which otherwise transacts or applies to_ transact business with a public entity. The
term "person" includes those officers, directors, executives, partners, shareholders, employees, members, and
agents who are active in management of an entity.
6. Based on information and belief, the statement which I have marked below is true in relation to the entity
submitting this sworn statement. [indicate which statement applies.)
Neither the entity submitting this sworn statement, nor any of its officers, directors, executives,
artners, 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.
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 n copy of the final order]
I UNDERSTAND THAT TIIE, SUBMISSION OF THIS FORM TO TIIE CONTRACTING OFFICER FOR TIIE
PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND,
TIIAT THIS FORM IS VALID TIIROUGH DECEMBER 31 OF TIIE CALENDAR YEAR IN WHICH IT IS FILED,
I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM TIIE PUBLIC ENTITY PRIOR TO ENTERING
INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA
STATUTES FOR CATEGORY TWO OF ANY CHANGE, IN TIIE INFORMATION CONTAINED IN THIS FORM.
t
[signature)
Sworn to and subscribed before me this day of
191q.
Personally known
OR Produced identificatio
Notary Public - State of &L.y9r VA-
N //Q--
(Type of identification) - My ConW&XWFffOrP STATE OF F6eRien
My commission expires Jan. 21, 1995
bonded thr� Patterson Becht Agency
er -., (Panted typed or stamped
commissioned name of notary public)
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EXCE&& LIABILITY ✓ ..+�
UMDRELLAFDRN
01 HEH 1 HAN LIN10H I A
I
WORKER'S COMPENSATION
AND
EMPLOYERS' LIABILITY
..... OTHER ,.,..........�. ,
I
DFzCRiDTION Of OPERATIONSILOCATION S/VEHICLES/SPECIAL ITEMS
1
CFRTIFICALTE HOLDER CANCELLATION
County of MOTIrop SHOULD ANY OF THE ABOVE DESCRIBED
r+90 63 r. d S tYG'C t EXPI JION DATE THEREOF. 71il IS;,I
Ocean R u z t e ] 7 0 MAID) DAYS WRITTEN NOTICE TO TH
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Marathon I'LA 33050 LEFT, BUT,FAILUFI TO MAIL SUCH N01'1
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fER OF INFORMATIION ONLY AND
ICATE BOLDER. THIS CERTIFICATE
-HE COVERAGE AFFORDED BY THE
)ING COVERAGE
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MEd ABOVE FOR THE POLICY PERIOD
MENT WITH RESPECT TO WHICH THIS
iEIN IS SUNJECT TO ALL THC TERMS,
LIMITS
RAI AGGRFG'ATF E! f
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ONAI. & ADV. INJURY $ 1 f 0)O !000
OCCURRENCE $ l f " (`50,00o
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DAMAGE (Airy on50e lire) $ f VR 0ll
t XPENSE (Any ono r>crton) $ 5,000
3)NE0 SINGLE $
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+RTY DAMAGE $
IOCCURRENCE $
LEGATE $
S1ATuTORY IIMITS
i ACCIDENT 4
ASE—POLK!Y LIMIT $
ASE-EACH EMPLOYEE d
POLICIES BE CANCELLED BEFORE THE
JINO COMPANY WILL ENDEAVOR TO
E CERTIFICATE HOLDER NAMED TO THE
"E SHALL IMPg E NO 0$LIGATION OR
w, ITS AG /OR REPRESENTATIVES.
From : 116 249-4696 R-WAUE B I ONED I CAL =;EET O I C:E Jl_in. 09. 1993 09 : 49 AM P02
THE STATE INSURANCE FUND
19y talliff ii S1liEEJ NFW YORK, N Y. 10007
(212) 312-7368
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
11-WAVE I NC
173 NEWTOWN ROAD Ff,97
MA1 NV1)JW NY 11803 nnrc
6/01/93
157-805
PERIOD COVERED BY TH1 CERTIFICfl11
2/05/92 TO 2/05/94
POLICYHOLDER -- - Cf_ ITf`ICA�hIi01I�I:H
R—WAVh::INC COUNTY OF MONROE
173 NEWTOWN ROAD 490 6:3RD ST
PLAINVII;:W NY 11803 MARATHON VI, 33050
TI11 S IS TO CERTIFY FY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE'
INSURANCE FUND UNDER POLICY NO. 697 516-•1 UNTIL 2/05/94 , COVERING THE EN'11114E•.
OBLIGATION OF TI17S PC1L1CYlIOIp[31!:R FOR WORKIeRS' COMPENSATION UNDER THE NrW YORk WORK-
ERS' COMPENSATION LAW WITH RESPECT TO ALI, OPERATIONS 1 N TIM STATE OF' NEW YORK,
AND, WITH RPISPI",CI' TO Oc'XHATIONS OUTSIDE OP NEW YORK, TO 'i'11I. PCILICY11OLDER' S REGULAR
NEW YORK STATE EMPLOYEES ONLY.
IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 2/05/94 IN SUCH MANNER AS
TO A1,'Vf:CT THIS CERTIFICATE, 30 DAYS WRITTEN NOTICE' OF SUCH CANCI'aLLATION
WILL 13E GIVEN I'D THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO
ADDRESSED SHALL BF SUPPICIENT COMPLIANCE WITH THIS PROVISTON.
U-26.3
TI IL STA - INSURAN E f=UNf)
C
UL DD S7 A 11,1-1
P-UH-1 1E B I Of'IEEi I (-H- L =.EF.' 1 I i=:E i-trl, 01. 1 `3 3^ 02 : 46 PH F104
R "" AF
R-WAVE
BIOMEDICAL SERVICE
173 NEWTOWN RD.
3965-A7 INVESTMENT LANE
PLAINVIEW, NY 11803 W. PALM BEACH, FL 33404
516.249-4693 - 800-32R-WAVE - FAX 516.249-4696 4p7 842-3660 - 800-32R-WAVE - FAX 407-842.2147
�,
CUSTOMER LISTING OF PRI-HOSPITAL PROVIDERS
American Ambulance Service, Inc, Hicksville Fir,- Dietrjpt
P.O. Box 1550 20 East Marie Street
Hollywood, FL 33022 Hicksville, NY 11801
Dennis Magaro Oxen Magee
305-925--2000 516-933-6444
Belli,,orelMerrick Ambulance
P.O. Box 043
Merrick, NY 11566
Chrietopher Benea
516-785-9239
Brookhaven Volunteer Ambulance
32 Seeley Street
Brookhaven, NY 11719
Mike Fink
516-286-3400
Empress Ambulance
722 Nepperhan Avenue
Yonkers, NY 10703
Tony Marino
914-965-5040
Bellmore Fire Department
2427 New Place
Bellmore, NY 11710
Andy Messina
516-781-9240
Carle Place Fire Department
460 Broadway
Carle Place, NY 11514
Rich Bruckner
516-334-8886
Elmont Fire District
75 Meechem Avenue
Elmont, NY 11003
Stu Conrad
516-354-0644
Levittown Fire District
Gardeners Avenue
Levittown, NY 11756
Tom Brennan
516--731-5800
N. Masaapequa Fire Department
960 Hicksville Road
Seaford, NY 11783
John Erickson
516-694-0880
Oceanside Fire District
65 Foxhuret Road
Oceanside, NY 11527
Pat Dezinna
516-766-3010
Plainview Fine Department
Old Country Road
Plainview, NY 11803
Michael Pellerito
516-933-2640
Uniondale Fire District
P.O. Box 246
Uniondale, NY 11553
Steve Doherty
516-481-1633
Wantagh Fire District
3470 Park Avenue
Wantagh, NY 11793
Flick Pike
516-785-0180
• r r- ni it - 1 �._ � _ --'+F �b
P-k.14 !E B I CIP'1ED I i=HL '=EPI! I i=E jun. 01. 1'PK� C12 : 46 P11 P U 5
R--WAVE
BIOMLDICAL
173 NEWTOWN RD. 3965-A7 INVESTMENT LANE
PLAINVIEW, NY 11803 W. PALM BEACH, FL 33404
516-249.4693 * 800.32RAVAVE - FAX 516-249.4696 407-842-3660 • 800 32R-WAVE FAX 407-842-2147
Five Counties Ambulance Darlington County EMS
11 Drew Court Highway 151
Ronkonkoma, NY 11779 Darlington, SC 29532
Brian Kampe Robin Brock
516-981-9304 603-398-4441
Bernillo County Fire Department
4520 Bali Court N. E.
Albuqerque, NM 87111
505-299-5662 -.
Carsonville Area Ambulance
3972 Chandler Street
Carsonville, MI 48419
Wayne McCarty
313-657-9280
Claysburgh Ambulance
Bedford Street
Clayeburgh, PA 16625
Joe Claar
814-239-9915
Coastal EMS
3105 Norwich Street
Brunswick, GA 36152
Mickey Reeve&
912-265-0800
Clio Rescue Squad
P.O. Box 6005
Clio, SC 29525
Gene Stromberg
803-479-2881
Danville Lifesaving Crew
202 Christopher Lane
Danville, VA 24541
Jim Hogan
804-792-2739
Bi-County Ambulance
502 2nd Avenue S. E.
Dyersville, IA 52040
Dick Gudenkauf
319-465-5995
Delavan Ambulance Service
120 W. 4th Street
Del.avan, IL 61734
309-244-8528
Delmarva Ambulance Service
Route 1 Box 94
Vienna, MD 21869
Rummell Hurley
410-221--0580
Enoaburgh Ambulance Sarvica
Pearl Street Extension
Enoaburgh Fella, VT 05450
Gardner Stet&on
802-933-2118
A & 8 Ambulance
3601 Oaklawn Blvd
Hopwell, VA 23860
Russ Whiteasel
804-541-8555
Amaare Ambulance
256 S. Main Street
St. Albans, VT 05476
John Cohen
802-527 -1244
Beth Fire Department
864 High Street
Bath, ME 04530
Dave Hudson
207-443-5034
Lafayette Fire Department
1911 Tully Farms Road
Tully, NY 13159
Terry Shelter
315-424-7328