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Replace Channel Markers Cow Key Channelor t �z CONTRACT AGREEMENT AGREEMENT, MADE THIS /,�- ti day of /1/0 A/l fi�19 9 6 , 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 iperform all the work as required by the attached Specifications for the replacement of Channel Marker signage in Cow Key Channel. List of numbers is attached as Exhibit A. 2. The work performed under the Contract shall commence immediately from the date the Liaison provides the Notice to Proceed and shall be completed by December 31, 1996 3. The work performed under the Contract is contingent upon grant funding from the Florida Department of Environmental Protection Boating Improvement Fund. If grant funding is denied, then no compensation is due under this Contract. The Contractor acknowledges the contingent nature of the State Funding and agrees that, if the grant is denied, the Contractor may not make a claim for compensation under this agreement or by way of estoppel, detrimental reliance or otherwise. 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 requirements of the Specifications are understood by the Contractor. t tJC %J._7C c ;J 1 U� lid 4. The Board shall pay the Contractor the total sum of $7,465.35 for the installation of 12 Aids to Navigation in Cow Key Channel. 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. 5. The attached Specifications, together with this Agreement, form the Contract. They are fully apart of this Contract as if repeated herein verbatim. 6. The Contractor covenants and agrees to indemnify and hold harmless Monroe County Board of County Commissioners from any and all claims for bodily injury (including death), personal injury, and property damage (including property owned by Monroe County) and other losses, damages, and expenses (including attorney's fees) which arise out of, in connection with, or by reason of services provided by the Contractor or any of its Subcontractor(s) in any tier, occasioned by the negligence, errors, or other wrongful acts or omissions of the Contractor or its subcontractor(s) in any tier, their employees or agents. The purchase of the insurance required in paragraph 12 does not vitiate this indemnification provision. 7. The Contractor acknowledges his/her intention to comply with the need to coordinate all work with the appropriate environmental agencies, the U.S. Coast Guard, and the County. 8. The Contractor agrees to supply the County with a set of photographs of the repaired aid to navigation along with a letter certifying completion of work. Page 2 The Contractor will be responsible for the camera, film, and development costs. The Contractor also agrees to provide transportation for the Liaison to inspect completed project. 9. The Contractor understands and agrees that no payment will be made for this project without required photographs and written certification of completion. 10. Due to the use of heavy equipment and, at times, dan erous work environment, the Contractor understands and agrees to maintain an alcohol and drug free work environment. 12. The CONTRACTOR will be responsible for all necessary insurance coverage as indicated by an "X" on the attached forms identified as General' Insurance Requirements and INS''CKLST 1-4, as further detailed on forms WC1, WCJA, GL1, VL1, & WL1 (attached as Exhibit C). All policies must list Monroe County as additional insured with the exception of the Workers Compensation policy. 13. A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to a public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity in excess of the threshold amount provided in Section 287.017, for CATEGORY TWO ($10,000.00) for a period of 36 months from the date of being placed on the convicted vendor list. Page 3 14. The Board may terminate this Agreement with or without cause at any time upon giving the Contractor up to 10 days notice in writing. The Contractor, upon receipt of the notice, shall immediately cease work. The Board must pay the the Contractor the percentage of the contract price which is proportional to the amount of work performed in a manner satisfactory to the Board up to the date the contractor received the.notice of termination. 1 15. This contract is governed by the laws of the State of Florida. Venue for any litigation arising under this contract must be in Monroe County. Page 4 IN WITNESS WHEREOF the parties hereto have executed this agreement the day and year first written above. BY: — TITLE: Owner FIRM: Spirit Marine Towing & Assistance (Seal) Attest: Witness BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, F ORIDA BY: Mayor/Cha' man (Seal) Attest: D&MY L. KOLFiAGE, CIS c..p Clerk APPROVED AS TO FORM AN fL L S FIB R� N.DATE Page 5 EXHIBIT A Cow Key Channel 1 1-A 2 2-A 4 6 8 11 13 15 16 18 20 Summerland 2 Ramrod- ffiIBIT B GENERAL CONTRACT SPECIFICATIONS FOR INSTALLATION OF AIDS TO NAVIGATION AND REGULATORY BUOYS/SIGNS 1. SCOPE OF WORK: The Contractor shall be responsible for providing all 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 installation must satisfy the requirements of these Specifications and and all necessary environmental permits. 2. MATERIALS AND WORKMANSHIP: The Contractor shall 1 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 the the work specified, and that all work will be performed in accordance with the best commercial practices. A list of the equipment to be used and a description of the installation procedures to be followed must be. provided to the County at the Presswork 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. The Contractor shall store materials and shall be responsible for 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 becomes 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 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. 3. ASSIGNMENT OF CONTRACTOR 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 there under, 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 any contractual relations between any subcontractor and the County. All subcontractors shall abide by the terms and 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. 4. LICENSE. POLLUTION CONTROL ACT, AND TRAFFIC PROVISIONS: The Contractor shall comply with all applicable local, State and Federal requirements pertaining to the terms 1 of this Contract. The Contractor will be responsible for obtaining, at his own expense, any licenses that may be required. The Contractor shall comply with all the requirements of the Federal Pollution Control Act. The Contractor shall conduct his operations so that he shall 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. Consideration should be given at all times to -the welfare of the public. 5. INSURANCE: The Contractor must obtain all insurance required by the County and submit proof of same to the County prior to contract approval by Board of County Commissioners but not 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. Certificates of Insurance: provide proof that the Contractor has obtained the insurance coverage required in paragraphs a,b,c,d,and e below. a. Worker's Compensation Insurance as required by Florida Statutes. b. General Liability Insurance in the amount of $300,000. C. Water Craft Liability Insurance in the amount of $500,000. d. Automobile Liability Insurance covering all owned, 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 Damage combined. e. Federal Jones Act Coverage. All insurance policies required above shall be issued by companies authorized to do business under the laws of the State of Florida. All policies must list Monroe County as additional insured with the exception of the Worker's Compensation Policy. 6. 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 or shortly thereafter. If the Contractor should be delayed in the progress of the work included in the Contract by unforeseeable cause 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 time to permit it to be acted upon before the Contract expiration date. To allow sufficient time for administrative procedures required to obtain action by the County Commission, a request for time extension must be received by the County representative at least ten (10) 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 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 7. 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) days 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 her 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 linlit, but all such liabilities shall be subject to continuation of full force against the Contractor. CHANGES AND INSPECTION: The regulatory buoys herein considered are tb be installed 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 of his subcontractors, employees and agents of every kind. All work and every process and operation shall be subject to inspections at all times, by the County and their representatives shall have free access to all aspects of the work. The Contractor shall remove, or make good, as may be directed, without charge, any defective buoys. The right 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. 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 during and after termination of the Contract. 9. CONTRACT AWARD: The County reserves the right to evaluate the submitted bids and to award a contract to bidder other than the bidder submitting the lowest -bid. 10. PRESSWORK CONFERENCE: A meeting will be necessary involving a representative of the County, the Contractor and other parties with direct involvement prior to the commencement of the work. 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 install the listed aids to navigation. The Contractor must also provide transportation to the proposed project site for placement of temporary markers. The location 1 of these temporary markers will be provided by the County representatives. Temporary markers will be provided by the County. 11. 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, shall return said documents properly executed along with his insurance within Ten Working Days. With the Contractor's cooperation, if this period can be reduced, it will assist in acceleration of 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 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 reason, not acceptable to the County, the Contractor does not perform, the County shall have the right to levy liquidated damages against the Contractor. Liquidated damages shall be assessed against the Contractor for any bid item awarded to him which is not completed and accepted by the County within the number of calendar days specified in the Contract. Liquidated damages are accumulative. 12. NOTICE TO PROCEED: The Contractor shall commence 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. 13.TERMINATION Of CONTRACT:This Contract may be terminated by the County, without cause, 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. 14. FINAL CLEAN-UP: Upon completion of the work specified here in 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. 1 15. Certification: Bidder must also certify, upon completion of the project, all installations were in accordance with these specifications, the Florida Department of Environmental Protection, and the Coast Guard permit requirements as specified in the "Specifications for the Installation of Aids to Navigation" and associated attachments. 16. PAYMENT:Payment will be upon completion by the Contractor and acceptance by the Board of County Commissioners. Contractor mtist submit complete documentation, including the required'photographs for the work for which payment is being requested. The Contractor must provide transportation, upon request by the County representative, to the installed site for review of work either in progress or completed. In addition, property, public or private, if damaged during the work or removed for the convenience of the work, shall be repaired or replaced at the expense of the Contractor in a manner acceptable to the County prior to final payment for contracted work. 17. NON -COLLUSION AFFIDAVIT: Acceptance of the Bid is contingent upon receipt of the signed and endorsed Non - Collusion Affidavit form (attached). 18. ETHICS CLAUSE: Acceptance of the Bid is contingent upon receipt of the signed and endorsed Ethics Clause form (attached). 19. DRUG FREE WORK PLACE FORM: Acceptance of the Bid is contingent upon receipt of the signed Drug Free Work Place form (attached). SPECIFICATIONS FOR THE REPAIR/REPLACEMENT/ OR INSTALLATION"OF AIDS TO NAVIGATION , MONROE COUNTY, FLORIDA Specifications for installation of treated wood piles complete with U.S Coast Guard approved Daybeacons, in the locations indi- cated are in the enclosed materials. A. DAYBEACON PILES: 1. Pile shall be of timber treated with chromated copper r arsenate (C.C.A.). 2. Pile shall be of timber which will stand the driving for which they are intended. 3. A straight line drawn from the center of the butt to the center of the tip shall not at any point face further away from center of the pile than a distance -equal to 10i of the length of the pile. _ 4. Minimum butt diameter = 12" measured 3' from end. Minimum tip diameter = 811. 5. Piles to be sufficient length to provide a minimum of four feet penetration into existing sea floor and the base of the dayboard must be eight feet above mean high water. 6. Pile shall be driven or best installation practices used. B. DAYBEACONS: Daybeacons to be constructed and erected as indicated on the enclosed sketches and documents. There are two day boards per daybeacon. 1. Construct all daybeacons as noted in the U.S. Coast Guard Specifications enclosed. — All Signage must be Aluminum — 1 L LJ i VJ ci I Jy iV0 .UUG r .Ul PRIVATE AIDS TO NAVIGATION SPECIFICATIONS LATERAL AIDS TO NAVIGATION Lateral aids to navigation are designed with specific shapes and colors which tell the mariner how to pass an aid to navigation and stay 1n the channel. Generally, when returning from sea, starboard (right) hand aids are red, and o and aids are green . Private aids to navigation are usually one of the following four basic types of markers: Type (Abbreviation) Definition DAY13EACON (DBN) Pile with green square (SCE) or red triangle (TR) dayboards. UGHT (LT) Pile with green square (SG) dayboards and flashing greon light or red ii triangle (M) dayboards and flashing red light. BUOY (B) Green can buoy or red nun buoy. LIGHTED BUOY (LB) Green buoy with flashing green light or red buoy with flashing red light. In all cases, red aids to navigation are even numbered and green aids to navigation are odd numbered. The numerals are retroreflective to Increase nightime recognition. On daybeacons and lights, flourescent background material and retroreflective borders are Included on dayboards. Retroreflective numerals and borders should be the same color as the background material, but In a contrasting darker shade. The size, material, and construction of .all private aids to navigation, both fixed and floating, shall be such as to be observable under normal conditions of visibility at a distance such that the significance of the aid will be recognizable before the observer stands Into danger. In most cases the Coast Guard requires green can and red nun buoys to be at least 3 feet above mean high water. Daybeac:ons and lights should be 8 to 16 feet above mean high water with minimum green square dayboard size of 2 feet by 2 feet, and a minimum red triangle size of 3 feet by 3 feet. Dayboards should be mounted atop plies so that none of the pile Is visible above the dayboard. ............... ........... ............... TOP OF FaM 3= �4 .._._ •.-. .......... B017W or > 8 rKvr DATBOARDS MEAN HIGH wATER MUD LUTE ELEVAT1oN VAXVA'110N 1101XiSWE YIA"OARn,,�:mf? I L' . Ul—I _ iU:Jy NO.uuo F.02 * DAYBOARD DIMENSIONS The dimensions for da boards on lateral aids to navigation are listed in the table below. The minimum acceptabie dimensions are 2 foot by 2 foot green square dayboards and 3 foot by 3 Boot red triangle dayboards, which provide a nominal range of 1/2 "mile. Larger sizes are optional, but may be required by the Coast Guard for certain circumstances. Nominal Type Dayboard Size Number Size Dist. Base to Numbor Retroreflective Range(nmi) (single) (double) (single) (double) Border Size 1/2 Square 24" by 24" 8" 6" 5" 4' 1.60 Traingle 36' by 36' 8" 6" 5' 4' 1.54 1 Square 36" by 36' 12' 12" 12" 12' 2.0" Triangle 48" by 48" 12" 12' 10" 7' 2.0" 2 7 Square 48` by 48" 16" 16" 16` 16' 3.0" Triangle - 72" by 72" 16' 16' 16" 12" 3.0" M 12* 'Ali 3' 3SG * Please use this size. 2" R' 2' GREEN REFL' REFLECTIVE 80RD BORDER 12' GREEN REFLECTIVE' • 12' RED NUMBER REFLENUMBER GREEN FILM FLUORESCENT RED FILM 4TR 2" RED 2' GREEN REFLECTIVE REFLECTIVE BORDER BORDER 6' GREEN REFLECTIVE 12/ RED 4' NUMBERS REFLECTIVE NUMBERS FLUORESCENT GREEN FILM 7- FLUORESCENT RED FILM 4TR lll Ul, l UJ , `Jo l V -,4V 'VU . VUO r . V4 I, 9Nv vtya�� a� � let✓a � ��`,' lbove are general recam»ndations and may be adapted to specific circmstanoes. They should also be modified as necessary to meet the requirements of prudent sound engineering practice and the demands og the marine environn_nt. } MOLT. f1t.0 Lt-1 - w,7SCt 0-019 1 ` 1 {anrwa4tt %T%%6L.X•3k or Itt t ' {tau t � 4 t. _7!.4 tttlLtt _ SEE •oatc: U� ' L DAYNA ." VrC%A LII-x f!Ew -T•t mr. tR-901r,"010l) t/ 0 O •T -R s t►oeroM - :o � I1 HATSRIRL LIST 1t�aQuantity matarlalc Size tll-1 2 6061 Aluminum alloy bo is nuts 6 washers '-(-Ji`X 22� LIl�2 t (opt lane 1) Concrete, Qrestrese4 1 th es.r u(red 10^ X 10N L11-3 2 Oo board Size as derdod 1.11-4 2 6061 Aluminum alloybolts nuts 6 washers 1/.2" X 14^ L11-5 1 wood, pressuro treated, IengtA os teQulrod 12" d1e. /lofe 1: All altpminu-. t.olts a*et reCogoixed standards for marine use. ID W-I iJ yb 1J:4U 1,40 Ui6 r-uz S.E. ALL WATERWAYS WARNING MARKERS SXstcm All waterways Function: No lateral significance warning markers 1 nn i* 2" ORANGE REFLECTIVE BORDER-- A& 3NW WHITE 3' BLACK LETTERS SHOAL I 3" IQANER � SHOAL 6" BLACK LETTERS " 3' LETTERS *Use the dimensions in Table 5-10 for 2- and 3-nnu ranges. **The word "DANGER" is to be placed on all warning daymarks. Informational words may be Placed below. or above and below, to suite particular needs. Examples: * SHOAL MARINE * DANGER DANGER ROCK CONSTRUCTION Figure 5-21. All waterways warning marker. Data Sheet 5-E(13). All waterways warning markers (nominal ranges, 1, 2, and 3 nmi). 5-32 ' MIBIT C April 22, 1991 I IYinfing MONROE COUNTY, FLORIDA INSURANCE CHECKLIST FO R VENDORS SUBMITTING PROPOSALS FOR NVORK To assist in the development of your proposal, the insurance coverages marked with an "X" will be required in the event an award is made to your firm. Please review this form with your insurance agent and have him/her sign it in the place provided. It is also required that the bidder sign the form and submit it with each proposal. t� WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY X Workers' Compensation Statutory Limits WC I Employers Liability $100,000/$500,0@0/$100,000 WC2 Employers Liability $500,000/$500,000/$500,000 WC3 Employers Liability$1,000,000/$1,000,000/$1,000,000 WCUSLH US Longshoremen & Same as Employers' Harbor Worl4ers Act Liability WCJA % Federal Jones Act Same as Employers' Liability Adminklmtivc Inztmcllon INSCKLS T 114709.01 April 22. 1991 GENERAL LIABILITY As a minimum, the required general liability coverages will include: • Premises Operations Products and Completed Operations • Blanket Contractual Personal Injury • Expanded Definition of Property Damage Required Limits: GLI X $100,000 per Person; $300,000 per Occurrence $50,000 Property Damage 1` or $300,000 Combined Single Limit GL2 $250,000 per Person; $500,000 per Occurrence $50,000 Property Damage or $500,000 Combined Single Limit GL3 $500,000 per Person; $1,000,000 per Occurrence $100,000 Property Damage or �. $1,000,000 Combined Single Limit Required Endorsement: GLXCU Underground, Explosion and Collapse (XCU) GLLIQ Liquor Liability All endorsements are required to have the same limits as the basic police. Admini%irative ]rrjmcji, INSCKLS N•1709 0I Nprd 2 i 1991 1m IYinlm, VEFLICLE LIABLLITY As a minimum coverage should extend to liability for: , • Owned; Nonowned; and Hired Vehicles Required Limits: VLl X $50,000 per Person: $100,000 per Occurrence $25,000 Property Damage or $100,000 Combined Single Limit VL2 t $100,000 per Person; $300,000 per Occurrence $50,000 Property Damage or $300,000 Combined Single Limit VL3 $500,000 per Person; $1,000,000 per Occurrence $100,000 Property Damage or - �- $1,000,000 Combined Single Limit BR1 MVC PRO PR02 PR03 POLI POL2 POL3 EDl ED2 GKl GK2 GK3 MED I MED2 M F,D3 MISCELLANEOUS COVERAGES Builders' Limits equal to the Risk completed project. Motor Truck Limits equal to the maximum Cargo value of any one shipment. Professional $ 250,000 per Occurrence/$ 500,000 Agg. Liability $ 500,000 per Occurrence/$1,000,000 Agg. $1,000,000 per Occurrence/$2,000,000 Agg. _ Pollution $ 500,000 per Occurrence/$1,000,000 Agg. Liability $1,000,000 per Occurrence/$2,000,000 Agg. $5,000,000 per Occurrence/$10,000,000 Agg. Employee $ 10,000 Dishonesty $100,000 GaraL,e Keepers Medical Professional $ 300,000 ($ 25,000 per Veli) $ 500,000 (S 100,000 per Veh) $1,000,000 ($250,000 per Veh) $ 500,000/$ 1,000,000 Agg. $1,000,000/$ 3,000,000 Agg. $5,000,000/$10,000,000 Agg. Administnlivc Ircanxlion INSCKI,S I' N4 709.01 Alxil 22. 1993 Ist 14inling IF Installation Maximum value of Equipment Floater Installed VLPI Hazardous $ .300,000 (Requires MCS-90) VLP2 Cargo $ 500,000 (Requires MCS-90) VLP3 Transporter $1,000,000 (Requires MCS-90) BLL Bailee Liab. Maximum Value of Property HKL1 Hangarkeepers $ 300,000 HKL2 Liability $ 500,000 I i KL3 $ 1,000,000 ALR 1 Aircraft $25,000,000 AIR-2 Liability $ 1,000,000 A]R3 $ 1,000,000 AEO1 Architects Errors $ 250,000 per Occurrence/$ 500,000 Agg AF-02 & Omissions $ 500,000 per Occur7-ence/$1,000,000 Agg AE03 $ 1,000,000 per Occurrence/$3,000,000 Ago WLI x Watercraft Liability $500,000 INSURANCE AGENT'S STATEMENT I have reviewed the above requirements with the bidder named below. The following deductibles apply to the corresponding policy. . POLICY DEDUCTIBLES Liability policies are —Occurrence _ Claims Made Insurance Agency Signature BIDDERS STATEMENT I understand the insurance that will be mandatory if awarded the contract and will comply in full with all the requirements. Bidder Signature AdminisUalive Irrtnu,ion INSCKLS"r b4709 01 11e it 22. 199 1 1st IYuNing WORKERS' COMPENSATION INSURANCE REQUIREMENTS FOR CONTRACT BETWEEN AlONROE COUNTY, FLORIDA AND Prior to the commencement of work governed by this contract, the Contractor shall obtain Work1rf' Compensation Insurance v\-ith limits sufficient to respond to Florida Statute 440. In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not less than: $100.000 Bodily Injury by Accident $500,000 Bodily Injury by Disease, policy limits $100,000 Bodily Injury by Disease, each employee Coverage shall be maintained throunhout the entire term of the contract Coverage shall be provided by a company or companies authorized to transact business in the state of Florida and the comp'Any or compark!s must maintain a minimum rating of A -VI, as assigned by the A.M. Best Company. If the Contractor has been approved by the Florida's Department of Labor, as an authorized self - insurer, the County shall recognize and honor the Contractor's status. The Contractor may be required to submit a Letter of Authorization issued by the Department of Labor and a Certificate of Insurance, providing details on the Contractor's Excess Insurance Program. If the Contractor participates in a self-insurance fund, a Certificate of Insurance will be required. in addition, the Contractor may be required to submit updated financial statements from the fund upon request from the County. Adminestrnii%c Imltuclion WC 1 114709 1 NVORKERS' COA1PENSATION INSURANCE REQUIREN[ENTS FOR CONTRACT BETWEEN MONROE COUNTY, FLORIDA AND Recognizing that the work governed by this contract involves Maritime Operations, the Contractors Workers' Compensation Insurance Policy shall include coverage for claims subject to the Federal Jones Act (46 U.S.C.A. subsection 688) with limits not less than those specified for Employer's Liability. The Contractor shall be pei-mitted to provide Jones Act Coverage throwgh a -separate Protection and Indemnity Policy, in so far as the coverage provided is no less restrictive than would have been prov�ided by a Workers' Compensation policy. Aden' nL<ra vc Instruction WCJA 114709, 1 Aix it 22. 1997 lat Priming GENERAL LIABILII Y INSURANCE REQUIREMENTS FOR CONTRACT BETWEEN MONROE COUNTY, FLORIDA AND Prior to the commencement of work governed by this contract, the Contractor shall obtain General Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum: t1 • Premises Operations • Products and Completed Operations • Blanket Contractual Liability • Personal Injury Liability • Expanded Definition of Property Damage The minimum limits acceptable shall be: $300,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits*acceptable shall be: $100,000 per Person $300,000 per Occurrence $ 50,000 Property Damage An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its provisions should include coverage for claims filed on or after the effective date of this contract. In addition, the period for which claims may be reported should extend for a minimum of twelve (l 2) months following the acceptance of work by the County. The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. Adnun.�uviivc I.ntnjdion GI-1 N4 709 I April 22. 1991 lct IYngntt; VEHICLE LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT BETWEEN MONROE COUNTY, FLORIDA AND Recognizing that the work governed by this contract requires the use of vehicles, the Contractor, prior tB the commencement of work, shall obtain Vehicle Liability insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum, liability coverage for: • Owned, Non -Owned, and Ilired Vehicles The minimum limits acceptable shall be: $100,000 Combined Single Limit (CSL) If split limits are provided, tlLe minimum limits acceptable shall be: $ 50,000 per Person $100,000 per Occurrence $ 25,000 Property Damage The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. Administrntivc Irtttnoclion V L I d 4 709 I Al tit 22. 1991 1s1 Printing WATER CRAFT LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT BETWEEN MONROE COUNTY, FLORIDA AND Prior toll the commencement of Nvork governed by this contract, the Conti -actor shall obtain Water Cratl Liability Insurance with terns no Icss restrictive than those found in the standard "American Institute Hull Clauses" (June 2, 1977 edition). Coverage shall be maintained throughout the life of the contract and include, as a ininilt1mw • Injury (including death) to any Person • Damage to Fixed or Movable Objects • Costs Associated with the Removal of \ recked \%esse!s • Contractual Liability with Respect to this Contract If the policy obtained states That coverage applies for the "Acts or Omissions of a Vessel", it shall be endorsed to provide covera�oe for the legal liability of tite shipowner. The minimum limits acceptable shall be: $500,000 Combined Single Limit (CSL) Coverage provided by a Protection and Indemnity Club (P&I) shall be subject to the approval of the County. The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. Admimstbit,e Irnlnulion WL.1 H4 709 1 INDEMNIFICATION AND HOLD HARMLESS for CONTRACTORS AND SUBCONTRACTORS (a) The Contractor covenants and agrees to indemnify and hold harmless Monroe County Board of County Commissioners from any and all claims for bodily injury (including death) personal injury, and property'damage (including property owned by Monroe County) and any other losses, damages and expenses (including attorney's fees) which arise out of, in connection with, or by reason of services provided by the Contractor or any of its Subcontractor(s) in any tier, occasioned by the negligence or other wrongful actor omission of the Qontractor or its Subcontractor(s) in any tier, their employees, or agents. In the event the completion of the project (to include the work of others) is delayed or suspended as a result of the Contractor's failure to purchase or maintain the required insurance, the contractor shall indemnify the County from any and all increased expenses resulting from such delay. The first ten dollars ($10.00) of remuneration paid to the Contractor is forthe indemnification provided for above. The extent of liability is in on way limited to, reduced, or lessened by the insurance requirements contained elsewhere within this agreement. DRUG -FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that: �/ 4�% Ax/ ,�,a 1'e!�d//z^ (Name of Business) 1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispens- ing, 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 about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug -free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. 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 ofworking 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 (Norida Statutes) or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction. 5. 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 the statement, I certify that this firm complies fully vNrith the above requirements. — /Z_/ Bi er's Signature Date MCP#5 REV. 6/91 SWORN STATEMENT UNDER ORDINANCE NO. 10-1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE ZIZ � A4 W? I Z/� warrants that he/it has not employed, retained or otherwise had act on his/its behalf any former County officer or employee in violation of Section 2 of Ordinance no. 10-1990 or any County officer or employee in violation of Section 3 of Ordinance No. 10-1990. For breach or violation of this provision the County may, in its discretion, terminate this contract without liability and may also, in its discretion, deduct from the contract or purchase price, or otherwise recover, the full amount of any fee, commission, percentage, gift, or consideration paid to the former County officer or employee (signature) Date: f D STATE OF jl i-3/ O"r COUNTY OF/7/Od F PERSONALLY APPEARED BEFORE ME, the undersigned authority, who, after first being sworn by me, affixed his/her signature (name of individual signing) in the space provided above on this `3e day of 19 NOTARY PUBLIC My commission expires: C ' ��, b K. Meeee , March 24� EXPIRES Rliu. ODMXDTft V& PAIN N16ANX, INC. MCP#4 NON -COLLUSION AFFIDAVIT of VW -;oatr.0 012 according to law on my oath, and under penalty of perjury, depose and say that; 1) 1 am <4A 4 T / /?" z/v":!� , the bidder making the Proposal for the project described as follows: 2) The prices in this bid have been arrived at independently without collusion, consultation, communication or agreement forthe 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. STATE OF f����it Z^'"" (Signature of Bidder) COUNTY OF _ D�/�/e7 C-r— P �l DATE PERSONALLY APPEARED BEFORE ME, the undersigned authority, who, after first being sworn by me, (name of individual signing) affixed his/her signature in the space provided above on this .3e day of �<`-�`-�, 19 NOTARY PUBLIC My commission expires: ,.••• 'n 610da K McBee 4, W COMMISSION N CC529329 EXPIRES March 24.1999 •��f� BONOE�71:�17R0YFlugrlBUiWICEx1C. MCP #1 .................................: >:::;::::%..... DATE (MM/DO/Y 10/ 1A Id PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PROFESSIONAL INSURANCE CTR ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW. 2003 W KENNEDY COMPANIES AFFORDING COVERAGE TAMPA FL 33606 COMPANY A BANKERS & SHIPPERS INS COMPANY INSURED COMPANY SPRIT TOWING e DBA DUKE PONTIN COMPANY PO BOX 244 C �D BIG PINE KEY FL 33043 I n Dp� THIS IS TO CERTIFY THAT THE.POLICIES_OF INSIIIiANCE LISTED RIELgW HAVE_BFEN ISSUED To THE IN.¢URFn NAMFn ARnur_ Fnm TIaF PnI u-Y Pcglor! INDICATED, N6TWITHSTA4OING ANY REQUIREMENT, TERM OR 66NDMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. C II TYPE OF SU CE POLICY MBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS t IRIDATE (MM/DD/YY) DATE (MMIDD/YY) GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE F—] OCCUR OWNER'S 6 CONTRACTOR'S PROT GENERAL AGGREGATE i PRODUCTS • COMP/OP AGG i PERSONAL 6 ADV INJURY i EACH OCCURRENCE i FIRE DAMAGE (Any or* 6n) i MED EXP (Any one parson) i AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CFL7376695" —�©��^ — { --------- -- -. 11/06/96 05/06/97 - — COMBINED SINGLE LIMB 300,000 i BODILY INJURY (Per person) i X BODILY INJURY (Par sociderq) i PROPERTY DAMAGE i GARAGE LIABILITY ANY AUTO AUTO ONLY • EA ACCIDENT i OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE i EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM , I BY . "rN t N I EACH OCCURRENCE i AGGREGATE i WORKERS COMPENSATION AND EMPLOYERS' LIABILITYTHE PROPRIETOR/ PARTNERS(EXECUTIVE INCL OFFICERS ARE: EXCL DATE a'l,,"'FR: NIA L/ TC -- `— STATUTORY LIMITS EACH ACCIDENTi DISEASE • POLICY LIMIT i DISEASE • EACH EMPLOYE i OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEWCLE&SMCIAL ITEMS MARINE CONTRACTING 1979 GMC DUMP TRUCK SN: T16DA9V601349 ADDITIONAL INSURED: MONROE COUNTY BOARD OF COUNTY COMMISSIONERS MONROE COUNTY BOARD OF COUNTY COMMISSIONERS ATTN: KIM MCGEE 5100 COLLEGE KEY WEST, FLOR/I�DaA 33040 c c . `�'Q I n SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIONIL DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MA 3 0 DAYSWRITTENWJRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT A��/u�KP�4 MAIL SUCH NOTICE NO OBLIGATION OR LIABILITY OF Y upow 'TFI€) CO EI¢S%OR REPRESENTATIVES. M. rItukjlu_uvl U1VLJ15KWK1115K0 1114U __ _.................................................................. . _.__............................................................... . .... _......................_.................................................._.......................: COME B INSURED _...._.__......................... ............................................ _......... ....................................... SEA TOW FLORIDA KEYS COMPANY C DUKE H PONTIN SPIRIT TOWING LETTER P O BOX 244 BIG PINE KEY -. ..... _.... ........... D _ _....... .......... COMPAN D .... _...... _.. KEY WEST FL 33043 LETTERY COMPANY , E Al LETTER 0OVERAGEE 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 Bt ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _. _ .._...... _.... _.. ............ ._ .. _. .. ............ ........ ........ ... ._ _ __... CO TYPE OF INSURANCE POLICY NUMBER LTR POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DDNY) DATE (MM/DDNY) LIMITS ............ A G-ENERAL LIABILITY PU7 9 5 0 4 4/ 10 9 6 4/ 10 9 7 GENERAL AGGREGATE $ 3 0 0 r 0 0 0 X COMMERCIAL GENERAL LIABILITY __. _ ...._ .. PRODUCTS-COMP/OP AGG. ..._...._ ........._. $ CLAIMS MADE OCCUR. PERSONAL & ADV. INJURY $ OWNER'S 3 CONTRACTOR'S PROT. EACH OCCURRENCE s3 O O O 0 O FIRE DAMAGE (Any one fire) S MED. EXPENSE (Any One person) : S AUTOMOBILE LIABILITY + COMBINED SINGLE _ ANY AUTO LIMIT ALL OWNED AUTOS BODILY INJURY i SCHEDULED AUTOS (Per person) HIRED AUTOS _. BODILY INJURY t NON -OWNED AUTOS (Per accident) GARAGE LIABILITY _ ..__.._ . _.....__... PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE S UMBRELLA FORM __ AGGREGATE $ OTHER THAN UMBRELLA FORM _........ ........ ............... ............. WORKER'S COMPENSATION STATUTORY LIMITS .:.. EACH ACCIDENT t AND_ . .... ............ DISEASE —POLICY LIMIT >< EMPLOYERS' LIABLJTY ....... ........ .................... ....._....<................... I .............. ...-. DISEASE —EACH EMPLOYEE S OTHER DESCRIPTION OF OPERATIONSA.00ATIONSNEMCLES/SPECIAL ITEMS COMPANY A IS SPHERE DRAKE INSURANCE CO — MONROE COUNTY BOARD OF COUNTY COMMISSIONERS IS ADDITIONAL INSURED BUT ONLY OPERATIONS PERFORMED BY THE NAMED INSURED — DOES NOT PROVIDE COVERAGE FOR TOWING & SALVAGE —PREMISES ONLY CERTIFICATE HOLDER ' CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MONROE COUNTY BOARD OF COUNTY MAIL 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE COMMISSIONERS KIM B 6ij/h[aEC-,: LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 5100 COLLEGE ROAD LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. KEY WEST FL 33040 AUTH flu EESENT/+TIVE H B FOf2E �/HAi/GNi/ND DD (B ) 25-S (7/90) OACORD CORPORATION 191 CEI )RODUCER S U R. ANC E DATE (MMIDD/YY) 16JAN96 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 POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY Royal Insurance Co. INSURED COMPANY Spirit Marine Towing & Assistance B d/b/a Sea Tow Florida Keys r - - ---- - COMPANY 911 West Indies Drive C Ramrod Key, FL 33043 COMPANY D CO LTR Alan R. Mott Agency, Inc. 184 East Main Street PO Box 995 Huntington, NY 11743 &RAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. t POLICY EFFECTIVE I POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) ! DATE (MM/DD/YY) ! -- LIMITS GENERALAGGREGATE.$ ' GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY PRODUCTS COMP/OP AGG $ CLAIMS MADE OCCUR PERSONAL & ADV INJURY $ � � ! Q OWNER'S & CONT PROT EACH OCCURRENCE S — FIRE DAMAGE (Any one fire) $ MED EXP.(Any one person) $ AUTOMOBILE LIABILITY .COMBINED SINGLE LIMIT $ ANY AUTO _ ALL OWNED AUTOS BODILY INJURY f(Per person) $ i SCHEDULED AUTOS - HIRED AUTOS APPROVED BY RISK, MANAGEMENT BODILY INJURY (Per accident) $ NON -OWNED AUTOS oR1 G _ BY �LA�GO PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY -- EA ACCIDENT I $ �, ANY AUTO ,r,l 11� R: (\I - Vc OTHER THAN AUTO ONLY EACH ACCIDENT li $ AGGREGATE:$ I EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ PARTNERS/EXECUTIVE INCL OFFICERS ARE: EXCL OTHER Protection & A. Indemnity 1 (Liability) EACH OCCURRENCE $ Received AGGREGATE $ Risk Mgmt. & Loss Control _- $ DATE �— STATUTORY LIMITS EACH ACCIDENT -- INITIAL - DISEASE POLICY LIMIT +$ DISEASE - EACH EMPLOYEE , $ POH222891 11/10/95 11/10/96 $500,000. DESCRIPTION OF OPERATION5ILOCATION5/VEHICLE5I5PECIAL 171JAS 75 Spacecraft 25' 74 Thunderbird 24' 80 Spirit 34' CERTIFICATE HOLDER & ADDITIONAL , IN Monroe County Board of County Commissioners Att: Kim Blanco 5100 College Road Key West, FL 33040 ACORD 25-S (3/93) cC r�,(GF� CANCELLATION ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHOR[ D REPRESENTATIVE � �RPORATION 1993