07/21/1994 AgreementAGREEMENT
THIS AGREEMENT made and entered into this 21st day of
Julv , 1994, 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
z
The CONTRACTOR shall furnish all labor, materia-ls,-.d
equipment, machinery, tools, apparatus, and trays grtataion =nd
perform all other work as described in the attac r m c�
Specifications for the Preventive Inspection and;1?hinte1Mnce*,of
Biomedical Equipment for the Monroe County Boar(Je f,Cou�ty
Commissioners as described in the Notice of Calhxng--for Bids
dated June 21, 1994, and as described in the CONTRACTS B'd
Proposal: all of which are hereto attached and mdide pa of�
this agreement by reference. to ,=`?
2. CONTRACT SUM
The COUNTY shall pay to the CONTRACTOR a total amount of
$5,000 which includes Options 1 and 3 as described in the
Contractor's bid proposal which is attached hereto 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
A. The CONTRACTOR agrees to indemnify the 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
CONTRACTOR'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. CONTRACT TERM
A. The Contract shall commence on July 15, 1994 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 will 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.
C. The first preventive maintenance inspection shall be
performed within 15 days of the date the purchase order is
issued.
5. 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.
6. 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, West Palm Beach, FL 33404-1775.
7. 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. 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.
8. 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
of Monroe County to terminate this contract immediately upon
delivery of written notice of termination to the rONTRACTOR.
r
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:
Emergency Medical Services Office
490 63rd Street, Ocean, Suite 170
Marathon, Florida 33050
CONTRACTOR: R-Wave of Florida, Inc.
3965-A Investment Lane
West Palm Beach, FL 33404-1775
11. ANTI DISCRIMINATION
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 WAVIER
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
The 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 of sole proprietorship, under
which CONTRACTOR norwally conducts bus-iness.
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 is 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 attached hereto, is already on file with the EMS
Office/Clerk of Court for the calendar year 1994.
14. ENTIRE AGREEMENT
This Agreement constitutes the entire agreement of the
parties hereto with respect to the subject matter hereof and
superseded 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 be 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 TERMINATION:
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 that such
termination is in the best interest of the COUNTY. The
COUNTY shall pay all reasonable costs incurred by the
CONTRACTOR up to the time of termination, 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
applicable 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 pay 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.
COUNTY ATTORNEY
TEL:305-292-3516 Jul 07,94 10:02 No.003 P.01
IN WITNESS WHEREOF, the parties hereto have executed this
contract the day and year first above written.
(SEAL)
ATTEST: Danny L. Kolhage, Clerk
aajo-a C. &'A
�
CLERR
WITNESS:
BOARD OF COUNTY COMMISSIONERS
OF MOLAR COUNTY, FLORI
BY:
2,- NAVE F VI�A Wc--
RPORATIONt
AUTHORIZED REPRESENTATIVE
ri .: v,
/Ip
Atlar�pyy
r.:_rj , �
NOTICE OF CALLING FOR BIDS
NOTICE ,.IS HEREBY GIVEN TO WHOM IT MAY CONCERN that on
Tuesday, June 21, 1994, at 1000 A.M., at the Office of
Director of Purchasin th��
g, a Committee consisting of the Director of
Purchasing, the County Administrator, the County Attorney, and
the requesting Department Head or Division Di
designees, nectar, ar their.
g , will open sealed bids for;
PREVENTIVE MAINTENANCE INSPECTION AND
CORRECTIVE MAINTENANCE OF BIOMEDICAL EQUIPMENT FOR
THE LOWER AND MIDDLE KEYS FIRE AND DISTRICT S - TAVERNIER, AND DISTRICT U�CE DISTRICT 1�
Specifl,cations - KEY LARGO
and a list of inventor
been Y of equipment have
prepared for each District, and bidders may bid on o
or all three Districts; however, n�. two
ver, bid price must be broken down
separately by District.
Bids must be received by the Office of e the Director of
Purchasing, '5100 College Road, Public Service Wing, Room 002, Key West 8uildin g, Croas
Florida 33040, on or before 10:00 A.M.
on June 21. 1994.
All bids, including the recommendation dation Of
ator re
and the the County
be questing Department Head or Division
Director, will Presented
..
the Lower s to the Board
and Middle Keys °f or
of
y Fire and Ambulance
District 1, and the
Board of Governors
of District 5 and 6,
Otherwise. for final awArdi
.
nb or
The Boards will automatically re e
or affiliate who ct the bid of an
appears on the convicted Y person
the Department og � vendor list prepared by
eneral Services
State of Fl
2$7.133(3)(d) Forida
la.Stat. (1989). , under Sec.
Interested bidders shall submit two (2) signed originals and
two (2) complete copies of each bid in a sealed envelope marked
on the outside, "Sealed Bid fnr
Biomedical Equipment, etc," All bids are to remain valid for a
period of ninety (90) days after the date set for the opening
thereof.
Specifications and/or further information may be obtained by
contacting Pete Lubert, Support Services Manager, Monroe County
Emergency Medical Services, 490 63rd Street, Ocean, Suite 170,
Marathon, Florida 33050 - 305-289-6004.
The Boards reserve the right to reject any or all bids, to
waive irregularities and informalities in any or all bids, and to
readvertise for bids.
The Boards also reserve the right to separately accept or
reject any item or items of a bid and to award and/or negotiate
contract in the best interest of the County. a
DATED at' Key West, Florida
this 18th day of May, 1994.
n
I
R• M. COFER
Director of Purchasing
for Monroe County, Florida
0
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) d ys
of execution, by Monroe County, of the Agreement. There w.11 be
one preventive maintenance inspection/calibration of all LP-5's per
12 month period. Performance output and electrical safety
inspections shall be performed in accordance with the otandards
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 lubricpted, 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, either on site or 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
Page No. 2
cables and cases. Inspection of these items shall be pincluded.
Cases may be included if Option No. 3 is exercised.
4. Insurance: Each vendor must show that they have adequate
Workmen 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
required 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.
F
k►
Page No. 3 r
13. Quantity Increases/Decreases: Monroe County resgrves 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.
15. Customer Listing: The vendor must provide Monroe County
Emergency 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.
to
y
Page No. 4
a
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.
F
to
Page No. 5 V
ADDENDUM A +
DISTRICT 6 (KEY LARGO) BIOMEDICAL EQUIPMENT INVENTORY
Description Serial Number
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
LP 10 With Pacer
LP 10 Charger
Power Supply
Power Supply
016425
047757
006109
005751
026573
015602
001574
001573
003870
001422
001424
003907
002259
00007541
00007546
0029396 (has not been delivered yet)
000333
00002285
00002288
E
Page No. 6
. JUN- 1'7-B4 08. 0B FROM. M C PUBL fC ' SAFETY
ID. 2eB8013
PAGE 2
DID SHEET
U
Mandatory Work and Equipment '
x 5200,go
Optional Work and Equipment (price each option separately);
Option 1
Option 2
Option 3
Authvrizod Signature or
Company Representative
v
E
0
25oo. c)Q
Date
-94 W ED 1 6 = S? R-W AWE CFLOR I DA >
F' _ 01
Attachment 2
R=WAVE
BIOMEDICAL SERVICE
173 NEWTOWN RD. •
PLAINVIEW, NY 11803 3965-A7 INVESTMENT LANE
516-249-4693 - FAX 516.249-4696 W. PALM BEACH, FL 33404
407-842.36M 0 800-32R-WAVE -FAX 407-80-91 V
July 6, 1994
Monroe County EMS
Attention: Michele Stevens
Fax # 305.289.6013
Dear Ms. Stevens:
Per your request I have faxed you the Option Bid Sheets for District #1, Tavenier
and Key Largo. The amount for Option #1 and #3 is included in the mandatory
bid price for all three bids.
Thank you for your help in this matter. Please call me if you need any more
information.
Sincerely,
Richard D'Anied
President
PREVENTIVE MAINTENANCE • SALES 0 SERVICE 0 CALIBRATION
JUL-- 6- 9 4 WED 1 6 : S 9 R - W AVE C F L O R I D A > P_ 0 1 11-04 08s 89 PROM s M C PtML fC ' BAFETV i p • QeeB• f PAGs
DID SHEET Attachment 2 '
mandatory work and Equipment 5I
Optional work and Equipment (price each option separately):
Option I
option Z�-Q
Option 3
Author xod 8 Pagnatur� � -- o
Company RAproaantativa
8
i
(0-20 C-)
Date —"
NON -COLLUSION AFFIDAVIT
Y � 1P- UJA"rC uF t Wj4 1►JC_ of the city
of An)E, 5� L^_bE:n& 1A according to law on my oath, and
under penalty of perjury, depose and say that]
l ) I am �"'21 , the bidder
making the Proposal for the project described ae.foilowss
2) the prices in this bid have beers 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 bidder or with any competitor;
31 unless otherwise required by law, the prices which have been
quoted in this bid have not been knowingly disclosed by the bidder
and opening, directlynot lorly he indirectly,�sed by the to any otherdder bidderior to bid
competitor; and or to any
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
contratrts for:said project.
iS 9nature of 8 er)
STATE OF _P7 i,.aR 1 I, f1 -9 L 1
COUNTY OF PA lL•-1 DATE
PERSONALLY APPBARLD BEFORE MR, the undernignsd authority,
IC .
09 N 1 who, after first being sworn by me,
name of n v dual s qn ng)
affixed hie/her signature in the space provided above on thin
0 t %I day of �J-Oo E
19qq
My commission expires;
""j LEE ANN PETROFF
* * My Non CC336033
EN*" Doc. 13, iifpl
eond.d by HM
SWORN STATF,MENT PIJRSUANT TO SECTION 287.133(3)(a),
FLORIDA STATUTE$, ON PUBLIC ENTITY CRIMES
THIS FORM 11tUST BE SIGNED AND SWORN TO IN TIE PRESENCE OF A NOTARY PUBLIC OR OTHER
OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
This sworn statement is submitted to )t�- WAVE, O Fl.CAVDA V►
[print name of the public entity]
by lRkOAARD-)SMter-L WE;
[print Individual's name and title]
for PoCNNXZ) tA►-1k' 9—%
[print name of entity submitting sworn statement]
whose business address is
-3165- A`1 INVE i�Ft�
P. j3,
and (if applicable) its Federal Employer Identification Number (FEIN) is 0-50 3`7 7) y y
(if the entity has no FEIN, include the Social Security Number of the Individual signing this
sworn statement: - .1
2. I understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, means a
violation of any state or federal law by a person with respect to and directly related to the transaction of
business with any public entity or with an agency or political subdivision 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.
3. 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.
4. 1 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
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. 1 understand that a "person" as defined in Paragraph 287.133(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. [Indicnte which statement applies.)
Neither the entity submitting this sworn statement, nor any of its officers, directors, executives,
partners, shareholders, employees, members, or agents who are active in the management of the entity, nor
any affiliate of the entity has been charged with and 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 a copy of the final order]
I UNDERSTAND THAT TIIE SUBMISSION OF THIS FORM TO TIIE CONTRACTING OFFICER FOR THE
PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR TIIAT 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 TIIE PUBLIC ENTITY PRIOR TO ENTERING
INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 297.017, FLORIDA
STATUTES FOR CATEGORY TWO OF ANY CIIANGF. IN THE INFORMATION CONTAINED IN THIS FORM.
Sworn to and subscribed before me this - h day of
Personally known E T C H ARE) CY A N I t; rrk l.,
OR Produced identification �Ie /
PENS 5 t_IcENSE.
(-i'ype of identification)
Form PUR 7068 (Rev. 06/18/92)
1
[signature]
19�.
r.
Notary ublicat'of_��`
—% My Conynision CC330=
�r Bone bya. 13, 1ti�7
My commissiot} taa�a by wu
800-422-15%
(Printed typed or stamped
commissioned name of notary public)
a niece W►Tt (jV"LA lTT)
.:.:...tr.:::..... ............ 07/00/94
''n?r:nit^:;z:t.%%zti:0000ci:i•:rioots0c2<ct.•,o-cik..,.c,,,...41.....::.. ..
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
Frank J. Becker Agency DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
173 sarle Ave. POLICIES BELOW.
Lynbrook, NY 11563 COMPANIES AFFORDING COVERAGE
COMPANY A COMMERCIAL UNION INS CO
LETTER
COMPANY INSURED LETTER B
R-Wave Of Florida, Inc. COMPANY C L! l
3965-A7 Investment Lane LETTER
West Palm Beach, NY 33404 COMPANY D YES
LETTER WAIVER N/A
COMPANv E
LETTER 4
THIS 18 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD E
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, ME iNSURANCE AFFORDED 01.1 THE MOUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
1
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY EFFECTIVE POLICY EMRATM LuxTS
0 TYPE OF BISUNIANCE POLICY NUMBER DATE (MM/DD f ) DATE (MMNDO/YY)
A W1 JTY GENERAL AGGREGATE 8 3,000,000
X COMMERCIAL GENERAL LIABILITY CJR 13158 6 0 8 / 01 / 94 0 8 / 01 / 95 PRODUCTS'COMP/OP AGG. 8
CLAM MADE Fx-1 OCCUR PERSONAL 6 ADV, INJURY 8 1, 0 0 0, 0 0 0
ON111*3'SaCONTRACTORS PROT EACH OCCURRENCE t 1,000,000 �pp
= 50 , 000
X PROIISBS/OPERATIONS FIRE DAMAGEDAMAGE(MY one he) t
mEDZ(PE (Arryonepww 8 5, 000
AUTOMODILELIABWTY COMBINED
SINGLE 8
LIMIT
ANY AUTO
ALL OWNED AUTOS BODILY INJURY :
(Per Person)
SCHEDULED AUTOS
FIRED AUTOS Rea ived BODILY W41AW 8
(Per soddenq
NON-OVWNEDAUTOS Risk Mgmt. & Loss Control
GARAGE I'AN TY PROPERTY DAMAGE8
DATE S—!`
EKCESS LIABNJTY Ilvi', il:L ..�__ EACH OCCURRENCE 8
UMBRELLA FORM
�J.0 AGGREGATE 8
OTHER THAN UMBRELLA FORM
STATUTORY LIMITS
wowun 'S COMPOISATiWI EACH ACCIDENT 8
AND DISEASE -POLICY LIMIT 8
EMPLOYERt' LIABILITY DISEASE -EACH EMPLOYEE 8
OTHER
DESCRIPTION OF OPERATIOMS/LOCATIONSNEHICLES/SPECIAL ITEMS
COUNTY OF MONROE IS INCLUDED AS ADDITIONAL INSURED FOR WORK PERFORMED BY
THE INSURED
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE s
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
COUNTY OF MONROE MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE r
EMERGENCY MED . LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR Y
490 63 rD ST . , OCEAN, SUITE 1..0 IJABIUIY F ANY ION UPON THE COMP , ITS ENTS OR REPRESENTATIVES. €
F
MARATHON, FL 33050 AUTHORGO^
:.w
,y +���{�y •.....v..:•.�:::::::v.�::.:w:::::::n...::v.�:::::::v:..:..::.......................L}:::::}::�w::i:•ii:4i: iiii::. �:::: :w:.:ii}i:•i:v.. ..:..... ::. �:::::::. �::::::::::::: :•::n. ,
THE STATE INSURANCE FUND
199 CHURCH STREET NEW YORK, N.Y. 10007
(212) 312-7368
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
APPROVf_0 BY RISK MANAGEMENT
DaTE
WAIVER: N/a,._YES_..�
R-WAVE INC
173 NEWTOWN ROAD
PLAINVIEW NY 11803
897 516-1
8/09/94
492-065
PERIOD COVERED BY THIS CERTIFICATE
2/05/94 TO 2/05/95
POLICYHOLDER ERITFICATE HOLDER
R-WAVE INC MONROE COUNTY
173 NEWTOWN ROAD 490 63RD ST
PLAINVIEW NY 11803 MARATHON FL 33050
U-26.3
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE
INSURANCE FUND UNDER POLICY NO. 897 516-1 UNTIL 2/05/95 , COVERING THE ENTIRE
OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK-
ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK,
AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR
NEW YORK STATE EMPLOYEES ONLY.
IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 2/05/95 IN SUCH MANNER AS
TO AFFECT THIS CERTIFICATE, 30 DAYS WRITTEN NOTICE OF SUCH CANCELLATION
WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO
ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION.
Risk. MgVfTmt. & Loss Control
DATE --_ — // _ 1 /
M171AL _.._... --
cc
THE STA-LE INSURAN E FUND
HER TJACOBS
DIRECTOR, INSU ANCE FUND UNDERWRITING.'