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DV091653• CONTRACT AGREEMENT AGREEMENT, MADE THIS day ofSJLtlu-1994, by and between, Spirit Marine Towing & Assistance ( "Contractor") , and the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA, of the County of Monroe, State of Florida ("Board"). The contractor and the Board, for the consideration named agree as follows: 1. The contractor shall furnish all the materials and perform all the work as required by the Specifications for the emergency removal of DV091653 for which a derelict vessel report is attached as exhibit A. 2. The work to be performed under this contract shall commence immediately from the date the Liaison provide, the cc-3 Notice to Proceed and shall be completed by September 3W 1094. �c 3. If the Notice to Proceed has not been given an' -or b�foro, .iI the 23rd Day of August, 1994 then this agreement shall be nulP and void. 4. The work to be performed under the contract is contingent upon approval of appropriate grant monies from the State Department of Environmental Protection, Derelict Vessel Program. If this grant is denied, this Agreement shall be null and void. The contractor understands the rules of the Department of Environmental Protection and shall comply with said rules, along with the rules and procedures instituted by the Board to ensure an orderly progress to the project. Both the intent and the letter of the specifications are understood by the contractor. 5. The Board shall pay the Contractor the total sum of $ 1,600.00 for the emergency removal and legal disposal of DV091653 Payment for the work shall be upon completion by the contractor and acceptance by the Board, subject to the terms and conditions of the Specifications (attached as Exhibit B) and this contract. 6. The attached Derelict Vessel Report and Specifications together with this Agreement, form the the contract. They are fully a part of this contract as if repeated herein verbatim. 7. The contractor shall indemnify the Board from and against any and all claims, demands, actions, proceedings, damages, liabilities, costs and expenses, including attorney fees, arising out of, connected with, or resulting from the Agreement. 8. The contractor acknowledges his/her intention to comply with the need to coordinate all work with the appropriate environmental agencies, the Florida Marine Patrol, and the County. 9. The contractor agrees to supply the County with a set of photographs of the vessel in all phases of the removal and disposal process. The contractor will be responsible for the camera, film, and development costs. 10. The contractor understands and agrees that the receipt of the Notice to Proceed from the County does not relieve his responsibility to obtain any appropriate permits. The contractor must inform the appropriate permitting authorities prior to initiation of work. 11. The parties agree that timely performance of this agreement is essential due to possible damage to the natural resources, hazard to navigation, or threat to human health and welfare. Therefore, the parties agree that the contractor shall be liable to the Board for $100 per day of liquidated damages for each day after that any of the contractor's obligations under this agreement remain unperformed. The parties agree that such amount is by the way of compensatory damages and does not constitute a penalty. 12. Due to the use of heavy equipment and, at times, dangerous work environment, the contractor understands and agrees to maintain an alcohol and drug free work environment. 13. The contractor will provide General Liability insurance the amount of $300,000, Workers Compensations the amount of $500,000, Federal Jones Act (46 U.S.C.A. subsection 688) with limits not less than those specified for Employer's liability, Vehicle Insurance in the amount of $300,000, watercraft Liability on the amount of $500,000, and Pollution insurance in the amount of $500,000. 14. The Board may terminate this agreement with or without cause at anytime upon giving the contractor up to ten days in writing. The contractor, upon receipt of the notice, shall immediately cease work. The Board shall pay the contractor the percentage of the contract sum which is proportional to the amount of work performed by the contractor in a manner satisfactory to the Board up to the date the contractor received notice of termination. IN WITNESS WHEREOF the parties hereto have executed this Agreement to day and year first written = _ pX BY: Title Firm (Seal) Attest: Witness BOARD OF C91APTY COMMISSIONERS OF MONRO C , LORID BY: (Seal) Attest: DA= L KOLHAGE, Clerk OFFENSE INCIDENT- REPOR F NARRATIVE CON 1 INUA'I ION ZONE Z DERELICT VESSEL # 09- _ - _......... _-- - .I 1. REG. #' S tvONc _.-; LENG'1'1[_-�__FT. ; MAKE:_ taC�McM�OE - HULL MATERIAL : WOOI)--- -.-.-- [' / G -- METAL O'1'I I ER---- MOTOR ATI'AC11ED YES NAME ON VESSE;I_,_ tempt-��; U'I'I[ER ].DEIJ'.l'IFIERS hnnc k -)p cnG 55 _ _.................................. _...... ....................................... GAL. _ hQ�7 MS � Si-►�E's nt�Tc�t+ _. .................._._...._........................................ 2. VESSEL OWNER: _..__..... _ __ .. Ut-►IL.N��n/1--1 � 1a��t-C1/�.til CZEF�IC-7(EE �/.ESS�.t.._.......... _............ ........_.................. __........ ... _........................ 3. EXACT LOCATION: __. _ \M.M , 3P�.9 P2ot�CrLZ-r OF Sut �Sutr�at= kk--/ ....0 M.P.< r,-,c2-L-J.- ............... ........................_..__.................................... 4. CONDITION: WRECKED _-,�_.; JIINICEU ►� _; I)].Sh111N'.t'LEU ? _;ABANDONED ✓ w ................ .............................. ........................ I ........... . Q 5. SUBMERGED _Qo CAPSIZED- ; L (STING—___; IN % FT. OF WATER _. _.. _ .. __... ............................................... OR 0I11 SHORE, `I'OUCIIING MEAN HIGH WATER LINE Yc5 .................................................. ............................... ................................................................................ 6. PROPERTY OWNER: STATE c.)P' FLORIDA YES _ NO OR ............. 9. NAVIGATION THREATENED? Y ES _� NO _... .... ............. ...._.... ._ . __....... _ _ _................... ........... .--- .......... _ 10. ENVIRONMENT ENDAPGERED? Y (?S 140 ....I ....................... _ 11. TOWED WITHOUT REPAIR? YES, NO ...................... ....- _ 12. RECOMMENDED DISPOSITION: LANDFILL l2EG�Yc.La- MLTi.�t_ Sc•tzo.P W v111cer1e1 nopvrinlp gnoaee pnnll nnymwed By: H i - - - Numbol Aiinvlml 1)1111 20 04rA t Ail' 1601 �t 1'nen 1 -1 COMMUNITY ........................... 3. . .................... .................................. UNKNOWN L�-- ............ ....... ........ .... .... ........................................ ... ...... REEF ; OTHER L.-- _ _........_................ _- ..... _................... ..... ........................ ........ ._.._............ ... ...... Or3i8 DATE 7115(94- Original O Supplement O OFFENSE INCIUFN 1 IiEI'OR INAI�IIA I IV I (,;()N 1 INUA I WN DERELICT VESSEL 09— 1 %-5 ZONE w ........................... . .............................. ............................. . ............................ ................................ ................................ ............................ . ............................ . ..__ ........... _ _... f- ac Q z......... .................. _ ...........-- ............... LOCATION: W vnraerlsl neponmp q,rnnnn f.rrnrl ��nrcars signature Reviewed By: Rnvinwer's Signature N_ i 1 ORES fAnnhnf Orlginnl U c) Date sunRlnr„ant t l 1)NR 70-045A ft.tr u� 3 At ,uLlh)(I ooO 1A'Wsa}VI i ,IA10 ptL rb 5 N tb 4 .ilosej. h)lracoaalal {I'ale►7uay C I j � o ;.':!Y.fj,•:.Lii�_•..N�%�t 'a�rjkg,(AY: W.Y1. j.,r.:'M�i��j,;,yj TO: FROM: 0 N `va+; vc-P-" I LORJ-DA. Nl /­\ RlN IE PA,-r.ROL 1)1S'I'IZI("I' NINJ 7796 (_)Vr�,1ZS(�,/�S 1 11GHWAY Sul -'Fr �iuu N/lARA'1'HON1 P'l,0RIDA 33050 ACS I N1 t l ,l N1 I ',SSAG 1 , 7(15l q 4- k-1 M G L- /, N c-4n #�3�g OFF lGerz, vtLE t-t% 5 LpPCZ NUMBER O l:� l'AG L;S S r N' I': (INCLUDING CUVLIt 5IlEr;'1') COMMLNYS: \00 01 OFFENSE INCIDENT REPORT NARRATIVE CONTINUATION REPORT A ENAe12CCtitC--r fZEMo�/l�t� -D If Q Cj - L Le S 3 1 MGTot ► LG. _ _ r _ ...I�j_. , _ j..,►v. t.itn►�► 12s IVu2 EM, V V-1SSf-� t_ LAC-- /N. ta... �t-ts _ _.c�.t�.t_..-c.�.tr� ac.� mot--► s�►� � � t-_,.c. o►a.. tit. �n . � _._ _.__. ............ 3 � . _%u- VESS�� tS 1�1/,t�E FtQQ(vt M+✓.T�l4l.C...__...__ _ ..._......-.. dtz1-)"-Ns. 1.4=.LS...U1�.55Et ........................ .................. .. .. ....................... .................. INA- t1D...... Ple,i .. 'i"(5 v e: SG I..... .......... _,f--1 I?.__..1.5._._ A.__ .PQ i�r->TrJ>l� CSAV......... . ............ W Q:�.N.t�....-..D►.ES�.__SP 1��--s . T.t tE_ ...�J�TSs�a., . - tS _-r►a� �]r3 �.�Cz_.._ q.�_ _ - _ ...-_ . _.......... z Q ............................ ...... \SM p.t-,u ............... _.... -...__...__.....__._ _... __._..__................ _.... _..............__........ ..._ __........... - . _......... _.. __....._ __ _. - __.. ......._........ ..... .-..... ._... ............ ...........__ ......... ........._....._. ... .................................................................................. .............. .........................................._............. __.......__..__.................... ................. _..... .._....................... . _ __..__.... _....__..._. ..._. _._.._.................... w Olficef(s) Reporting (plense print) O1 +can's S nnture Data 71 t . s-(`� a- > 3�g Rev a ed ey: \ NBS� DoteCitation NunAttestedmbor Nurlwt rrested Number Original L7 0 Supplement O a Otlll 70.045A f fAl (11971 �i DERELICT VESSEL REMOVAL CONTRACT SPECIFICATIONS FOR MONROE COUNTY, FLORIDA 1. INTENT: It is intended that these specifications shall cover all aspects of the work explicit provisions. The purpose of this section is to provide specific coverage for conditions applicable to this contract, where such coverage is not provided for in other portions of the contract documents. 2. BID FORMAT: THE BID MUST BE SUBMITTED ON THE BID RESPONSE FORM ENCLOSED IN THIS PACKAGE. A dollar amount per foot must be submitted for the removal of all derelict vessels on the primary list for which a Florida Marine Patrol Derelict Vessel Report is provided. Any deviation from this format will result in an unaccepted bid. A contract will not be granted on the basis of combined, related, linked, or discounted bids. Not applicable due to emergency contract for removal of one vessel for less than $25,000. 3. PLANS: There are no plans for this project, but copies of the Florida Marine Patrol Derelict Vessel Report with location Sketches have been bound into these documents for the Contractor's use. The Specifications include section on instructions to bidders, both general and specific, and a copy of each Derelict Vessel Report from the Florida Marine Patrol. Only those derelict vessels for which a report is included and listed on the Bid Response Form are to be bid upon and subsequently removed. The County reserves the right to remove any or all vessels from this contract at any time prior to actual removal from the water and disposition by the Contractor. The County has a limited amount of money to effect the removal of these abandoned vessels. We have established priorities based on public safety, navigation and traffic hazard, and environmental considerations. If bids exceed the County's resources for removal based on these considerations, we shall limit vessel removal based on the these considerations and cost effectiveness. 4. VESSEL IDENTIFICATION AND LOCATION: Each of the vessels have been given a derelict vessel identification number, which is shown with the location in the Florida Marine Patrol Derelict Vessel Report, included herewith. Each bidder is responsible for his own identification of each derelict vessel as to location, description and condition. If a Derelict Vessel cannot be (1) located, (2) removed, (3) verified and (4) disposed of, as specified in these procedures, then no payment will be made forthcoming to the Contractor for that vessel. Those four conditions must be met on each derelict vessel along with compliance with all laws and permits for payment to be made. It is understood that the Contractor has, by personal examination and inquiry, if necessary, satisfied himself as to the local conditions of each derelict vessel and as to the meaning, requirements and reservations of the specifications; for after contract letting, no deviation will be allowed. In case errors are discovered, they are to be reported by the Contractor to the County. The County assumes no responsibility should there be any discrepancies in what is stated in these documents and what the bidder evaluates. A contractor should take special care to remove only those derelict vessel's on his contract and for which he possessed a Florida Marine Patrol Derelict Vessel Report. Other derelict vessel's in the area but not under contract, cannot be molested. It may be possible to replace a derelict vessel of like kind, for the same or less money, when mutual agreement can be reached by the Florida Department of Environmental Protection, Monroe County Administrator of the Derelict Vessel Program, and the Contractor. This will be applicable when a contracted derelict vessel can not be located. No derelict vessel may be replaced and removed without the tri party consent noted in thisparagraph. A contractor may suggest a possible replacement vessel but he may not remove it without the appropriate consent above. 5. SCOPE OF WORK: The Contractor shall be responsible for providing all permits, supervision, labor, equipment, tools, fees and taxes required to complete this project to the satisfaction of the County. The Contractor's procedure and methods of removal may be of his own selection provided they secure results which satisfy the requirements of the Specifications and any necessary environmental permits. Any vessel which is removed and disposed of shall be removed from its present site in such a manner as to do the least possible damage to the natural environment surrounding the vessel. All debris from the vessel shall be removed and the site left in a reasonably clean condition. No oil or fuel shall be permitted to be dumped or spilled into or unto the water or land. All pollutants shall be removed from the derelict vessel prior to removal from the water. DV Specs --Page 2 The Contractor shall be responsible for making any and all arrangements for access to the vessel to be removed. If private property has to be traversed, then written permission of the owner is necessary. In removing a derelict vessel that may lie on or near grass or sponge flats extreme caution must be used to do the least possible damage. Prior to delivery of derelict vessels to the disposal site, the Contractor must remove all oil, gas and metal (including engines). He must dispose of them in any legal manner. Pure used oil will be taken by Monroe County for disposal. Mixture of oil, gas, seawater or any combination of the three must be transported from the County by an approved hazardous waste handler. The names of those firms will be supplied by the Monroe County Environmental Management Department. Metal becomes the property of the Contractor. In those cases where a derelict vessel number can not be found, i.e. derelict vessel is underwater, the contractor shall provide marine transportation to the site for the County representative to verify the vessel and location using the original Derelict Vessel Report from the Florida Marine Patrol. 6. MATERIALS AND WORKMANSHIP: The Contractor shall provide the necessary materials and equipment to safely complete the job. The Contractor agrees that all work shall be performed by competent employees who are experienced and qualified to do the work specified, and that all work will be performed in accordance with the best commercial practices. A list of equipment to be used and a description of the removal and transporting procedures to be followed must be provided to the County at the Prework Conference described below. Precaution shall be exercised at all times for the protection of persons and property. The safety provisions of the Occupational Safety and Health Act of 1970 (Public Law 91-596) and other applicable laws, including building and construction codes shall be observed. Machinery, equipment and other hazards shall be guarded in accordance with safety provisions of the "Manual of Accident Prevention in Construction", published by the Associated General Contractors of America, to the extent that such provisions are not in contradiction of applicable law. The Contractor shall store materials and shall maintain partly or wholly finished work during the continuance of the Contract and until the final acceptance. If any materials or part of the work become lost, damaged, or destroyed by any cause or means whatsoever, the Contractor shall satisfactorily repair and replace or not receive payment for the unaccomplished work. The Contractor shall DV Specs --Page 3 maintain suitable and sufficient guards and barriers, and at night, suitable and sufficient light or other appropriate security or protection for the prevention of accidents. Use of explosives is discouraged in carrying out the project. No blasting with explosives shall be done except under prior approval by the County and as permitted by all relevant government agencies such as the Department of Natural Resources, Department of Environmental Regulation, U.S.Army Corps of Engineers, U.S. Fish and Wildlife Service and the U.S. Coast Guard. When the use of explosives is approved the Contractor shall use the utmost care so as not to endanger life or property and whenever directed the number and sizes of the charges shall be reduced. All explosives shall be marked clearly "DANGER EXPLOSIVES", and shall be in the complete care of competent watchmen. The Contractor shall secure the proper competent watchmen. The Contractor shall assume all responsibility for damages caused by explosives. 7. ASSIGNMENT OF CONTRACT AND SUBCONTRACTS: It is expressly understood that the Contractor is in all respects an independent Contractor for this work, not withstanding under certain conditions he is bound to follow the directions of the County, and is in no respect an agent, servant, or employee of the County. Neither the Contract, nor any part thereof, nor any monies due or to become due thereunder, may be assigned by the Contractor without the prior written approval of the County. The Contractor is fully responsible to the County for the acts and omissions of his subcontractors and of persons either directly or indirectly employed by said subcontractor, as he is for the acts and omissions of persons directly employed by him. Nothing contained in the Contract Documents shall create an contractual relation between any subcontractor and the County. All subcontractors shall abide by the terms, conditions, and requirements of this Contract. It is the responsibility of the Contractor to pay all debt obligations incurred with subcontractors in an expedient manner. 8. LEGAL RESTRICTIONS, PERMITS AND TRAFFIC PROVISIONS: The Contractor shall comply with all applicable local, State and Federal requirements pertaining to the terms of this Contract. The Contractor will be responsible for obtaining, at his own expense, any licenses or permits that may be required and should inquire about permit requirements with the appropriate agencies. The Contractor shall comply with all the requirements of the Federal Pollution Control Act. The Contractor shall conduct his operations so that he shall DV Specs --Page 4 not close any thoroughfare nor interfere in any way with traffic on highways, or on water, without the written consent of the proper authorities. Work shall be done at any time that shall not interrupt or disturb members of the public. Off-loading sites (water to land for transport to the landfill or other disposal site by vehicle) must have written approval of the land owner. The Florida Marine Patrol should be contacted to initiate eviction proceedings for contracted derelict vessels which are inhabited at the time of removal and when another vessel is too close to the contracted derelict vessel to allow safe operations. Direct confrontations with other boaters should be avoided and the Florida Marine Patrol should be contacted immediately if such confrontations may result from removal of any contracted derelict vessels. 9. INSURANCE: The Contractor must obtain all insurance required by the County and submit proof of same to the county prior to acceptance of bid and contract approval by Board of County Commissioners but no later than five working days after notice of low bidder. All insurance shall be maintained until work has been completed and accepted by the County. The Contractor shall furnish the following certificates of insurance for review by the County's Risk Management Division: Certificate(s) of Insurance which clearly indicates that he has obtained the insurance coverage required in paragraphs a,b,c and d below. The Contractor hereby certifies that no modification or change in insurance shall be made without (3) days written advance notice to Monroe County, c/o the director of the Risk Management Division. a. Worker's Compensation Insurance as required by Florida Statutes. b. General Liability Insurance on a comprehensive basis, in an amount not less than $300,00.00 per occurrence for Bodily Injury and Property Damage combined, to include contractual liability. C. Pollution Liability Insurance in the Amount of $500,000 d. Water Craft Liability Insurance in the amount of $500,000 e. Automobile liability insurance covering all owned, DV Specs --Page 5 non -owned and hired vehicles used in connection with the work, in an amount not less than $100,000 per occurrence for Bodily Injury and Property and Damage combined. All insurance policies required above shall be issued by companies authorized to do business and under the law of the State if Florida. 10. COMMENCEMENT,DELAYS AND COMPLETION OF WORK: After receiving Board of County Commission approval of the Contract, and after reconciliation of any details or conditions which may directly or indirectly interfere or conflict with work of the Contract, the County will issue a "Notice to Proceed with Contract work" officially authorizing the Contractor to commence. The Contractor shall commence work on said date. If the Contractor should be delayed in the progress of the work included in the Contract by unforeseeable causes beyond his control, the time for the completion of the work may be extended upon agreement of the County representative. Requests for extension of time must be submitted in writing to the County representative. Extensions of time cannot legally be approved unless the written request is submitted in the time to permit it to be acted upon before the Contractexpiration date. To allow sufficient time for the administrative procedures required to obtain action by the County Commission, a request for time extension must be received by the County representative at least sixty (60) calendar days prior to the Contract expiration date. Liquidated damages resulting from factors beyond the control of the Contractor which occur too late to allow time for action by the Board of County Commissioners approving a time extension may be waived by the County Commission. Such waiver shall be granted only when the County representative determines that the delay is beyond the control of the Contractor, and in this event the Contractor shall not be charged with the liquidated damages or any excess cost when the delay in the completion of the work is due: a. To any duly issued order by the County or the State Department of Environmental Protection changing the Contractor's approved work schedule; b. To unforeseeable cause beyond the control and without the fault or negligence of the Contractor. C. To any delays of subcontractors or suppliers occasioned by any of the causes specified in subparagraphs (a) and (b) above. Provided further that the Contractor shall within ten (10) DV Specs --Page 6 from the beginning of such delay notify the County, in writing, of the causes of the delay. The County representative will ascertain the facts and the extent of the delay and notify the Contractor within a reasonable time of his decision in the matter. If the Contractor fails to complete the work within the time limit, and if the County should nevertheless permit the Contractor to continue and complete the same without official extension of time in writing, such permission shall not modify nor waive any liability of the Contractor for damages arising from non -completion of work within the time limit, but such liabilities shall be subject to continuation in full force against the contractor. 11. CHANGES AND INSPECTION: The vessels herein considered are to be removed for the County by the Contractor in accordance with the Specifications. The County may give instructions or directions to supplement the Specifications. These shall be binding upon the Contractor and upon all his subcontractors, employees and agents of every kind. All work and every process and operation shall be subject to inspection at all times, and the County and their representatives shall have free access to all aspects of the work. The Contractor shall remove and make good, as may be directed, without charge, any defective work. Oversight or error of judgement of inspectors, or previous acceptance, shall not relieve the Contractor from the obligation to make good any defect whenever discovered. The rights is reserved to change the Specifications consistent with regard to the general intention of the Contract for any part of the work or materials, either before or after work has begun. Notice of such changes shall be given in writing to the Contractor; such changes are not to be grounds for any claim by the Contractor for damages, nor for the forfeiture of the Contract. It is possible that a Derelict Vessel could disappear between the time of inspection by the contractor and the actual effort to remove it. No payment will be forthcoming in the case. Except when otherwise specified, the expense of all tests requested by the County will be borne by the County. 12. AUDIT RIGHTS: As a provision of the grant from the State of Florida to the County, and if so requested by the State, the successful bidder agrees to provide access to all records and allow the audit of any books, documents and papers related to this project for a period of up to one year and during and after termination of the contract. 13. CONTRACT AWARD: The County reserves the right to evaluate the submitted bids to award a contract to the bidders DV Specs --Page 7 submitting the lowest per foot bid for the derelict vessels listed in the bid package as one project and for which a Florida Marine Patrol Derelict Vessel Report is included. One bid will be accepted and a contract issued for the total removal of all listed derelict vessels as one project, up to the limit of available funds. The vessels are to be removed in the order listed and the per foot bid estimates should reflect this removal order. The actual number of vessels to be removed will depend on the accepted per foot bid price and the available funds. 14. PREWORK CONFERENCE: A meeting will be necessary involving a representative of the County, the Contractor and other parties with direct involvement prior to the signing of the contract. The time and place of this conference will be set by the County representative. At this time the Contractor shall provide the County with a schedule as to the order in which he proposes to remove the vessels awarded to him. 15. CONTRACT SECURITY: The Contractor agrees to execute and deliver simultaneously with the executed contract, a Contractor's Performance and Payment Bond. The contractor is expected to act and deliver in good faith all work, at the agreed price, in the allowed time. Failure to do so, could jeopardize the contractor's reputation with the County and potentially influence any future contracts with Monroe County. 16. EXECUTION OF CONTRACT DOCUMENTS: Due to the time frame involved with this project, the Contractor upon notification that he is to be awarded the contract documents for execution, shall return said documents properly executed along with any necessary bond and insurance within TEN WORKING DAYS. With the Contractor's cooperation, if this period can be reduced, it will assist in acceleration the execution of the contract documents. The Contractor, by virtue of signing the Contract, acknowledges that he and all his subcontractors have satisfied themselves as to the nature and location of the work, the general and local conditions, including, but not restricted to, those bearing upon transportation, handling, access to the pick-up and disposal sites; and the character of equipment and facilities needed to perform the work. Failure on the part of the Contractor to completely or properly evaluate any factors of his costs prior to bidding shall not form a basis for additional compensation if he is awarded the contract. If for any reasons, not acceptable to the County, the Contractor does not perform, the County shall have the right to levy liquidated damages against the Contractor. DV Specs --Page 8 Liquidated damages shall be assessea against the Contractor for any bid i t e :_ awarded to him whic.? ' s not completed and accepteC by the County within the number of calendar days specified in the Contra--t. Liquidated damages are accumulative. 17. NOTICE TO PROCEED: The Contractor shall commence work upon this project on the effective date of the Notice to Proceed and perform in a continuous manner until completion and acceptance by the County. For Contracts wherein a specified number of days for completion is stated in the Contract, the effective date of the "Notice to Proceed with Contract Work" will establish the "beginning date" of the project. 18. TERMINATION OF CONTRACT: This Contract may be terminated by the County, giving up to ten (10) days written notice to the Contractor; said notice shall be sufficient if delivered to the party personally or mailed by certified mail to his mailing address as specified on the accepted Bid. 19. FINAL CLEAN-UP: Upon completion of the work specified herein and before acceptance and final payment shall be made, the Contractor shall remove from the sites all machinery, equipment, surplus and discarded materials and temporary structures. All disposal of materials, rubbish and debris shall be made at a legal disposal site. 20. DISPOSAL SITES AND FEES: Contractor is responsible for disposal of all derelict vessels included in this contract and must make arrangements for legal disposal. It is the responsibility of the Contractor to pay all disposal fees incurred, and such removal related costs should be considered when bidding on this contract. The contractor will deliver the derelict vessel to the disposal site, where staff must be able to verify the derelict by its Florida Marine Patrol derelict vessel number or by some other means. It is the intent of this contract to remove derelict vessels from their present sites a legal present site a legal disposal site. Upon receipt of vessels at the landfill. They must be disposed of immediately. A legal disposal site is either the Long Key Landfill -Monroe County, MM 68 1/2, Long Key, Florida 33001, 305-664-9315, other landfills in neighboring countries or any other location for disposal as long as the FDNR Disposition Certification Form (attached) is fully documented. If a signature cannot be obtained on Florida Department of Natural Resources Disposition Certification, the Contractor must contact County Representative for written approval and instructions. DV Specs --Page 9 21. PROOF OF PROPER DISPOSAL AND NOTIFICATION TO MARINE PATROL: Contractor must submit prior to receiving any payment: A receipt for each vessel including the date of disposal, the Florida Marine Patrol Derelict Vessel Number, disposal site location, and the telephone number, title and signature of person at disposal site verifying delivery of said derelict vessel. A County Disposition Affidavit is to also required to be signed by the Contractor. If vessel is not identifiable and/or if the derelict vessel number is not visible. Recipient of debris should provide detailed receipt showing type and description of debris received. if person delivering vessel to disposal site is other than contractor a written statement with a description of what type of debris was transported, dates, times, name, address, and phone number of site. In addition to the above information, Contractor must submit three pictures of each vessel removed. The first photograph must be of the vessel at the current location prior to removal, the second photograph must be of the vessel after removal but in the same general area preferably while in tow, and the third photograph must be of the vessel at the disposal site with sufficient background to depict of disposal (i.e., building or sign identifying disposal site). The derelict vessel number, when present, must appear in all photographs. The Contractor will be responsible for the camera, film, and development costs. The photographs should be taken with a Polaroid camera that provides instant photos since this minimizes loss of documentation due to camera malfunction or loss overboard. This camera and film must be provided by the Contractor. The photos must be submitted on a vessel by vessel basis according to removal schedule. Without photos to document the removal and disposal of the contracted vessels final payment can not be assured. The Contractor must notify the Florida Marine Patrol and the County Representative in writing as to the work schedule of removal. This should be done after the prework conference with the County representative. Notification is to be made before doing any work on each vessel. This multiparty communication for each Derelict Vessel is a requirement of the contract. 22. PAYMENT: All payments for the removal and disposal of each vessel, shall be for the performance of the work as stipulated in these specifications and associated contractual documents. The unit rate of bid shall be totally inclusive for all phases of the operation. Contractor may request four partial payments by submitting an invoice for the number of vessels removed up to the date of the invoice, providing the Contract agreement does not explicitly prohibit partial photographs, disposal receipts, signed DV Specs --Page 10 of NON -COLLUSION AFFIDAVIT of the according to law on my oath, and under penalty of perjury, depose and say that; 1) I am / %7/' , the bidder making the Proposal forcthe 6roject described as follows: 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 prices 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 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. ( gnature of dder) STATE OF fl y ifs.- gel DATE COUNTY OF /fino PERSONALLY APPEARED BEFORE ME, the undersigned authority, (name of individual signing) who, after first being sworn by me, affixed his/her signature in the space provided above on this — ZZ__ day of /,1 tf �F &�T i 9� NOTARY PUBLIC My commission expires: Nofwy Pubii4 We of Fiorflo—, My Commission Expires March 24,1105 Bonded Thru Troy Fain • Insurance Inc. DRUG -FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that: (Name of Business) 1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Inform employees abotit the dangers of drug abuse in the workplace, the business's policy of maintaining a drug -free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Give each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection (1). 4. In the statement specified in subsection (1), notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893 (Florida Statutes) or of any controlled substance law of the United States or any state, for a violation occuring in the workplace no later than five (5) days after such conviction. 5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, or any employee who is so convicted. 6. Make a good faith effort to continue to maintain a drug -free workplace through implementation of this section. As the person authorized to sign this firm complies fully with the MCP#5 REV. 6/91 the statement, I ce ify that above gtii remelts . e Bidd rs Sig natur Date SWORN STATEMENT UNDER ORDINANCE NO. 10-1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE <%l< warrants that he/it has not employed, retained or otherwise had act on his/its behalf any former County officer or employee in violation of Section 2 of Ordinance No. 10-1990 or any County officer or employee in violation of Section 3 of Ordinance No. 10-1990. For breach or violation of this provision the County may, in its discretion, terminate this contract without liability and may also, in its discretion, deduct from the contract or purchase price, or otherwise recover, the full amount of any fee, commission, percentage, gift, or consideration paid to the forme ounty offor employee. v (signa ure) Date: STATE OF D 7_37/'- COUNTY OF 6- Subscribed and sworn to (or affirmed) before c�G me on ` date) by /�f'��%��o�✓ —(name of of f iant) . He/She is personally known to me or has produced (type of identification) as identification. NOTARY PUUBLIC MCP # 4 REV. 2 / 9 2 Notary Public, State of Plorth My Commission Expires March 24, 1495 Bonded Thru Troy Fain • Insurance Inc. SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. 1. This sworn statement is submitted to —� [print name of the Public entitv] by .� / //% ��C/ ri�i ✓lam [print individual's name and title] [print name of entity submitting sworn statement] whose business address is 3 30 J,,�3 and (if applicable) its Federal Employer Identification Number (FEM is (If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement:�� 2. I understand that a "public entity crime" as defined in Paragraph 287.133(l)(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 er services to be provided to any public entity or an agency or political subdivision pf 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(l)(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. I understand that an "affiliate" as defined in Paragraph 287.133(l)(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 entitycrime. The term "affiliate" includesthose 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 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(I)(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of tiie 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 submit ' g this sworn statement. [Indicate which statement applies.1 Nether 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, nor any of its officers, directors, exectutives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor an affiliate of the entity has been charged with and convicted of it 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 THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FORTHE PUBLIC ENTITY IDENTIFIED ON 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 OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THI FORM. [signathre] 10T7 t%yU� , 19 Sworn to and subscribed before me this dayof Personally known s/ / • �.�--' OR Produced identification (Type of identification) Notary Public -State of Notary Public, State of Florida My Commission expires MY Commission Expires March 24, 1991 de � 7toy n •Insurance Inc. (Printed typed or stamped commissioned name of notary public) Form PUR 7068 (Rev. 06/11/92) JS U R A N C E ISSUE DATE (MMMDNY) 8/19/94 AI:eltlo. CERTIFICATE PRODUCER ROGERS ATKINS GUNTER & ASSOC FOREHAND INSURANCE AGENCY INC P O BOX 25598 TAMPA FL 33622-5598 R&URED SEA TOW FLORIDA KEYS DUKE H PONTIN SPIRIT TOWING P O BOX 244 BIG PINE KEY KEY WEST FL 33043 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE COMPANIES AFFORDING COVERAGE COMPANY A SPHERE DRAKE INSURANCE COMPANY LETTER PROGRAM UNDERWRITERS INC COMPANY B LETTER COMPANY C LETTER LEETTERN MP LD COMPANY E LETTER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. L R TYPE OF INSURANCE POLICY NUMBER POLICY (MMIDD/YY) P D ATE (MMMONY) LIMA GENERAL LIABILITY COMPREHENSIVE FORM PREMISES/OPERATIONS UNDERGROUND EXPLOSION & COLLAPSE HAZARD PRODUCTS/COMPLETED OPER. CONTRACTUAL INDEPENDENT CONTRACTORS BROAD FORM PROPERTY DAMAGE PERSONAL INJURY PU7 6 9 6 7 Arrr,0VF0 R" R DATE [ WAIVER: N/A 2 2 3 9 4 - .!CN VANACDAFh - YES 2 2 3 9 5 BODILY INJURY OCC. _ BODILY INJURY AGG. _ PROPERTY DAMAGE OCC. S PROPERTY DAMAGE AGG. S BI 6 PD COMBINED OCC. $ 3 0 0 , 0 0 0 BI & PD COMBINED AGG. $ 3 O O, 0 0 0 PERSONAL INJURY AGG. $ AUTOMOBILE LI umm ANY AUTO ALL OWNED AUTOS (Pdv. pass.) ALL OWNED AUTOS ( oftw �) pdv. pass. HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY BODILY INJURY (Per WSW) BODILY INJURY (Per acok"Q = PROPERTY DAMAGE $ BODILY INJURY Q PROPERTY DAMAGE COMBINED $ EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE is S --- -- - - - AGGREGATE — - - __..__ _ __..... .. .................. WORKER'S COMPENSATION AND EMPLOYERS' LIABILITY STATUTORY LIMITS EACH ACCIDENT S DISEASE -POLICY LIMIT $ DISEASE -EACH EMPLOYEE S OT ER DESCRpT1pN OF-PFRATX)DO&OCATIONLVEHKXY.$AWECL4kL HEMS CEftFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE MONROE COUNTY BOARD OF COUNTY EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO COMMISSIONERS ATTN KIM BLANCO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE 5100 COLLEGE ROAD LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR KEY WEST FL 33040 UABILITY OF ANY KIND UPON THE COMPANY, TTS AGENTS OR REPRESENTATIVES. IIED R PRESENTATIVE i ten& ' B`jFO EHW l�' DD (B ) ACORD 25 (7/90) ®ACORD CORPORATION 110901 . ..... - oAIc tMM L-0 11 Agp:lolotll. CERTIFICATE OF INSURANCE 1/27/94 1 TRT i1TIFI WT90FD ASA MATTtA bt INFORMATION I Pnovu�el+ . ' i ONLY AND CONFERS NO ITIG11T5 UPON THE GERTIFiCATt Br J. s o t t i & S i l kwo r t h, I n G. HOLDER. THIS CERTIFICATE DOES NUT' AM6140, EXTEND Ofl Main Road, Box 1448 ALTER THE COVERAGE AFFORDED SY THE POLICIES BELOW. �~ COMPANIES AFFORDING COVERAGE Mattituck NY 11952 _. COMPANY A New i _ aCUnl D COMPANY �� ` �• } Spirit Marine Towing & Assistance I COM OM dba Sea Tow Florida Keys i rPAN'f 0 1501 W. Indies Drive Ramrod Key, FL 33043 OOMPANY f D THIS IS TO C[AlIN It4AT THE POLICIES Of INSLIRANCE LISTED [3[LOW HAVE BCCN ISSUED T THE INSURED LIMED A !E FC1 HE POLICY h TPII5 11.1DICAlED. NOTWITH3TANC•11+3 AI4Y REQUIREMENT, TERM OR CONDITION OFAI' COAT LICIEACT A SORIB D HEREINT VvSO RE TO ALL TI-IC T TPIIS 5 SU CT TO ALL TI'IE TL[ir.�:�, CERfiFIC AT= AMAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES SCRl13E0 HFREIW I, EXCLUSIONS AND CONDITIONS OF SUCH PCLICI�S. LIIAITS SHOWN MAY HAVE SEEN HF-OUCED BY PA —A MS_ �-• 4.. _ _.... _._ " 1 POLICY FECTIVE P EFOLICY EXPIRATION LIMI IS COI TYPE OF INSURANCE POLICY NUMBER PATE (MIkDD1YY) DATE (MM'DD/YY) LTR i 1 I__•__---.__..._ I. . . _... GFNERI\,AGG3AFhATF i .. 1_flil�T�1Ll� PRODUCTS•COMP/OPA,, G f COMMERCIAL GENERALLIADILITY _ _ n / a, _ • •_ , ' PERSONAL a ACV INJURY S n 1 CLAIMS MADE OCCUR t ' 9 / 15 / 9 3 9 / 15 / 94 EACH OCCURRLNCE S I CV8261.122 .. _I_.1, 000., p00• 1 OYVNER'S Q CONT FROT FIRE GAMAGE (Any One M u) i n l a Cert' 25 _ Protection & - Indemnity—inc�_�ud_oU C��tai—Ls_CG`^� _. _..._. _..__...__......_ n/�7t._. `` htt0 EXP {Acy one per..an) ,j S + AUTOMOBILE L IA6IUTY y +„ ^ y _ -- COMBINED SINGI E LIMIT i E ANY AUTO - ALL OYJNLO AUTOS n / a BODILY INJURY - } (PQr 06fo0'+) 001 IL DUIE D AU 109 I tippRQHEO RrA MANAGIM _ 1 1 ` 1ii1TEDAUlU5 vn ^ (BOCsockle t)RYE ! Mitt OWNED AUTOS BY + tt i �! L( PAOPERfY DnMAvC i >< _ -. •{ • ,. • _ AUTOA'iLY • EAA0CfD,EP+1'_S , • • GARAGE i IA81L I I'Y r N A _..?�-�•�$ GTHER THAri AUTG DhH.T: ' 1 NNT AU I U n/ a WWM FACH AOCID; NT s EACH OCCURRENCE 5 EXCESS LIABILITY _ I ircRFc�+TE E 1 i L'MBALLLA FORM i 01HEA TITAN t;MQRELi A FORM i Y .......... s .. ._...._. __..�.__�._ ..._... !' STATUTORYilull S • tNORKEJi9 COMPEHSiAT10N ANDt -• - --.. .... >EMrLOY9RS' LIAIUUTY ' AC1i ACCIDCNT = jy Act CV8261122 9/15/9 9/15J94 _ __ .. _...... II t 1,14U IF I )" ( INCL — DISEASE -POLICY LIAI+T - Jones E fl PART NERS F trrVTIVF Ce rt 2 5 DISEASE EACI I EMPLO. EE i I pFFk ERS AJIE i EXCL pot7ut;�n CVR�F,t)77. 9/1.5/93 9/15/94 Limit $500,000 Liability Cer� 25 County COrnmi30i0n0r0 azo n Protection & Indemnity an Monroe County,Floxida and Monroe County Board of od as Aaaltio0al Inouroa with respect to the pollution liability coverages. --._... ' Monroe County Boaxa or Cou>ty Colnmissioners,c/o Extensioti Service**, Attn: Kim Blanco 5100 Collage Road Key West, FL 33040 SHOULD ANY OF THE ABOVE pfe"EO POL"9 DE•CANCELLCO BEFORE THE EXPIRATION DATE THEREOF, THE ISSUIMG COMPANY W .L ENDEAYOR TO MAIL .4 5 „_ DAYS WMrr M "011ee TO T"t CtWnRCATE MILDER NAMED TO THE IETT, OUT FAILURE TO MAIL SKGN WTICI 5"U WME IIO 09LI13,ATION OR LIABILITY Of ANY KIND UPOM THE COMPANY• R6 AGENT'S OR REPRESENTATIVES. - :x� sw1M1r9•tiFw».�r>ktr4cA�'1!1!7�M►�'��'� - -. .... ....., . � Daniel V D .r�i....._ aotti L „� 1 , „ uNi uc 7lieirave�ersd �v: it ��i� RENEWAL OF POLICY DECLARATIONS LFL 0117819 BU&INP'uU AUTO FOLIC:Y P.O. r3`IU--Bu+i+ntim,K�' :ri5 kFNEWAL DECLARATION " THERE 15 NO GRACE ? RIUI), xF PAYMENT IS NOT RECEIVED BY 04/29/94 YOUR COVERAGE WILL EXPIRE. ' CFL 0117819 04 rKuM 04/29 9 U 'lU/29/94 000325400 POLICY PERIOD- 1.2:01 AM ST% D TIME AT ADDRESS OF THE NAMED INSURED AS STATED IiH;K1;1N. 1 PHONE 0 (813) 251--4900 NAMED INSURED PROFESSIONAL INSURANCE CTR INC DUKE H PONTIN SPIRIT TOWING 2003 W. KENNEDY BLVD DBA SEA TOW FL KEYS TAMPA, FL PO 130X 249 BIG PINE KEY 033043 33607 KEY WEST, FL I I , THE INSURANCE; AFFORDED IS ONLY WITH RESPECT TO SUCH AND SO MANY OF THE FOLLOWING COVERAGES AS ARE INDICATED WITH RESPECT TO EACH DESCRIBED VEHICLE. THE LIMIT Of THE COMPANY'S LIABILITY AGAI�ST EACH SUCH COVERAGE 0IIALL DE A3 a"TATED HEREIN, SUBJECT TO ALL THE 'TERMS OF THISPOLICY HAVING REFERENCE THERETO. SCHEDUL� OF COVERAGES AND LIMITS ~ OF LIABILITY � r FULL -TERM PREMIUM COVERAGES 000 COMBINED SINGLE LIMITS $631.00 BI/PD LIABILITY r BASIC PIP WITHOUT WC Q10,000 LIMIT EkCH PERSON NUN UWN�RSh11' 1,1A iL1TY :3UU, UUO CSL HIRED AUTO LIABILITY 300,000 CSL ATTACHMENT IDENTIFIED BY FORM NUMBER B&S 839 0591*1 CV 21--1 0693 ; CV 23 CV39 0891 , CV59 1292 ISSUE DATE103/11/94 TOTAL TERM PREMIUM 0591 , CV 24--1 0693 , CV28-1 0693 , _^AUTHORIZED REPRESENTATIVE Risk N.A_, -:;ss Control DATE IMTIAL ---- S� W/N :83AIWA �S-L/- 31va 1N3VijJ`�n�eQ :S1b tia03A08ddV $34.00 $19.00 $19.00 $703.00 INSURED COPY