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06/15/2011 AgreementDANNY L. KOLHA GE CLERK OF THE CIRCUIT COURT DATE: July 5, 2011 TO: Dent Pierce, Director Public Works Division ATTN. Beth Leto, Assistant Director Public Works Division FROM. Pamela G. Hanc�C. At the June 15, 2011, Board of County Commissioner's meeting, the Board granted approval and authorized execution of Item C28 waiving of bid bond requirement and award of bid for a Contract with 3rd Generation Plumbing, Inc. for on -site sewer connection at the Key Largo Community Park in the amount of $38,850. Enclosed is a duplicate original of the above - mentioned for your handling. Should you have any questions, please do not hesitate to contact this office. cc: County Attorney Finance File,/ SECTION THREE CONTRACT FOR ON -SITE SEWER CONECTION AT KEY LARGO COMMUNITY PARK NAME OF CONTRACTOR MONROE COUNTY THIS CONTRACT (hereafter "Contract" or "Agreement "), made and entered into this 1 -1t day of S ynJfi— , 2011, by and between Monroe County, a political subdivision of the State of Florida, (hereafter "County "), whose address is 1100 Simonton Street, Key West, Florida, 33040 and3 QP--,.4 =a" �„„G,;,� � , a Florida Corporation (hereafter Contractor), whose address isZ9,oc C),,, (��_ tib� psi ; The parties hereto, for the considerations herein set forth, mutually agree as follows: 1. SCOPE OF WORK. a) The Contractor shall complete the following work at the Key Largo Community Park: i. The existing W WTP at the Park bathrooms /concession stand shall be abandoned along with the existing drainfields. The existing fiberglass dosing pump station will be upgraded and remain as a pump station. ii. The existing 2" force main from the Jacob's Pool pump station shall remain and be reversed to carry flow from the dosing pump station to the Jacob's pool pump station. iii. The existing Jacob's pool pump station shall be upgraded and a new 2" force main provided from this pump station to the final connection at the WWTD buffer tank in the Laguna Avenue R.O.W. iv. The Public Works Maintenance building connection to a remote septic tank shall be disconnected (septic tank to remain) with a new gravity sewer line installed and connected to the Jacob's pool pump station. b) All work shall be done in accordance with permits and /or requirements of the Key Largo Wastewater Treatment District, Florida Department of Health, Florida Department of Environmental Protection, and the Monroe County Building Department, including all required tests of existing and new equipment and appurtenances. c) All work shall be done in accordance with the plans and specifications prepared by Blue Water Engineering including all specified equipment or approved equal by Blue Water Engineering. 2. CONTRACT SUM. The County shall pay the Contractor for the faithful performance of said construction $ The Board of County Commissioners assume no liability to fund this agreement for an amount in excess of this award. Monroe County's performance and obligation to pay under this agreement is contingent upon an annual appropriation by the BOCC. a) Payment for expenditures permissible by law and County policies shall be made through reimbursement to Contractor upon presentation of Application for Payment Summary — AIA Document G702, invoices, canceled checks and other documentation necessary to support a claim 10 for reimbursement. Included in said documentation shall be proof that the Grantee has received and applied to the property matching funds equivalent to or greater than the amount invoiced to the Grantor. All submissions for payment shall have a proposed schedule of values and indicate the percentage of completion of the overall project as of the submission. This document should be signed by the project architect, engineer, general contractor or project manager. Photos of the progress of the work shall also be submitted with the payment application. When the project requires a county and /or municipal building permit(s), it shall be the responsibility of the project architect, engineer, general contractor or project manager to initiate the communication with the Monroe County Construction Management Department to facilitate the inspection of said phase and obtain the signature of a Monroe County Construction Manager as to the completion of said phase at which time the documentation shall be submitted for payment. The application for payment document must be certified through a statement signed by an officer of the organization and notarized, declaring that representations in the invoice are true and factual. Grantee shall also provide partial releases of liens or certifications of non -lien if applicable. Grantor shall retain 10% of any payment on work in progress until the Grantee has provided a Final Release of Lien for each vendor /Contractor for whom payment is requested. Final payment will not be made until the following documents are complete and submitted to the Grantor: AIA Document G -702 Application for Payment Summary AIA Document G -704 Certificate of Substantial Completion AIA Document G -706 Contractor's Affidavit of Debts & Claims AIA Document G -706A Contractor's Affidavit of Release of Liens AIA Document G -707 Consent of Surety to Final Payment Final Release of Lien Affidavit and Partial Release of Lien Q` L. ✓C`v- �7 e.:.•'.B+C C.1[y4.1N�`J CF-�S All payment requests must be submitted no later than the completion of project of , 2011. Invoices received after Feb. 29 , 2012 will not be considered for payment. 3. CONTRACTOR'S ACCEPTANCE OF CONDITIONS. a) The Contractor hereby agrees that he has carefully examined the sites and has made investigations to fully satisfy himself/herself that such sites are correct and suitable ones for this work and he /she assumes full responsibility therefore. The provisions of this Agreement shall control any inconsistent provisions contained in the Specifications. All Specifications have been read and carefully considered by the Contractor, who understands the same and agrees to their sufficiency for the work to be done. Under no circumstances, conditions, or situations shall this Contract be more strongly construed against the County than against the Contractor (and his Surety, if applicable). b) Any ambiguity or uncertainty in the Specifications shall be interpreted and construed by the design engineer — Blue Water Engineering & Design, and his decision shall be final and binding upon all parties. C) The passing, approval, and /or acceptance of any part of the work or material by the County shall not operate as a waiver by the County of strict compliance with the terms of this Agreement, and Specifications covering said work. Failure on the part of the Contractor, immediately after Notice to correct workmanship shall entitle the County, if it sees fit, to correct the same and recover the reasonable cost of such remediation work and /or repair from the Contractor, who shall in any event be jointly and severally liable to the County for all damage, loss, and expense caused to the County by reasons of the Contractor's breach of this Agreement and /or his failure to comply strictly and in all things with this Agreement and with the Specifications. 4. INDEPENDENT CONTRACTOR. At all times and for all purposes under this Agreement the Contractor is an independent contractor and not an employee of the Board of County Commissioners for Monroe County. No statement contained in this Agreement shall be construed so as to find the contractor or any of his /her employees, contractors, servants, or agents to be employees of the Board of County Commissioners for Monroe County. 5. ASSIGNMENT. The Contractor shall not assign this Agreement, except in writing and with the prior written approval of the Board of County Commissioners for Monroe County, which approval shall be subject to such conditions and provisions as the Board may deem necessary. This Agreement shall be incorporated by reference into any assignment and any assignee shall comply with all of the provisions of this Agreement. Unless expressly provided for therein, such approval shall in no manner or event be deemed to impose any obligation upon the Board in addition to the total agreed -upon price of the services /goods of the contractor. 6. COMPLIANCE WITH THE LAW. In providing all services /goods pursuant to this Agreement, the contractor shall abide by all statutes, ordinances, rules and regulations pertaining to, or regulating the provisions of, such services, including those now in effect and hereinafter adopted. Any violation of said statutes, ordinances, rules and regulation shall constitute a material breach of this Agreement and shall entitle the Board to terminate this contract immediately upon delivery of written notice of termination to the contractor. The Contractor shall possess proper licenses to perform work in accordance with these specifications throughout the term of this contract. 7. INSURANCE. Prior to execution of this Agreement, the Contractor shall furnish to the County Certificates of Insurance for the following coverage: Worker's Compensation - $100,000 Bodily Injury by Accident; $500,000 Bodily Injury by Disease, policy limits; $100,000 Bodily Injury by Disease, each employee Vehicle Liability - $100,000 combined single limit General Liability - $300,000 combined single limit Employee Dishonesty - $100,000 a) Certificates of Insurance must be provided to Monroe County prior to execution of this Agreement and within fifteen days after award of proposal, with Monroe County BOCC listed as additionally insured on all except Workers Compensation. Thereafter, the Contractor must keep in full force and effect all of the insurance coverages listed above during the term of this Agreement. If the insurance policies originally purchased that meet the requirements are canceled, terminated or reduced in coverage, then the Contractor must immediately substitute complying policies so that no gap in coverage occurs. b) All forms of insurance required above shall be from insurers acceptable to the County. c) All insurance policies must specify that they are not subject to cancellation, non - renewal, material change, or reduction in coverage unless a minimum of thirty days prior notification is given to the County by the insurer. 12 d) All insurance policies must specify that they are not subject to cancellation, non - renewal, material change, or reduction in coverage unless a minimum of thirty days prior notification is given to the County by the insurer. e) The insurance required of the Contractor by the terms of this Agreement is for the protection of the County, its property and employees, and the general public. The insurance requirement is not, however, for the protection of any specific member of the general public who might be injured because of an act or omission of the Contractor. The insurance requirements do not make any specific injured member of the general public a third party beneficiary under this Agreement. Therefore, any failure by the County to enforce these insurance requirements, or terminate this Contract if the Contractor becomes uninsured or underinsured, is not a breach of any duty or obligation owed to any specific member of the general public and cannot form the basis of any County liability to a specific member of the general public or his/her dependents, or estate or heirs. 0 Notwithstanding the provisions of paragraph 34, the County may immediately treat the Contractor in default if the Contractor fails to maintain the insurance required by this paragraph 8. Before terminating the agreement in this situation, the County need only provide the Contractor 24- hour notice by FAX or overnight courier. The County may, but need not, provide the Contractor with an opportunity to cure the default. 8. INDEMNIFY AND HOLD HARMLESS. Notwithstanding any minimum insurance requirements prescribed elsewhere in this agreement, Contractor shall defend, indemnify and hold the County and the County's elected and appointed officers and employees harmless from and against (i) any claims, actions or causes of action, (ii) any litigation, administrative proceedings, appellate proceedings, or other proceedings relating to any type of injury (including death), loss, damage, fine, penalty or business interruption, and (iii) any costs or expenses (including, without limitation, costs of remediation and costs of additional security measures that the Federal Aviation Administration, the Transportation Security Administration or any other governmental agency requires by reason of, or in connection with a violation of any federal law or regulation, attorneys' fees and costs, court costs, fines and penalties) that may be asserted against, initiated with respect to, or sustained by, any indemnified party by reason of, or in connection with, (A) any activity of Contractor or any of its employees, agents, contractors or other invitees on the Airport during the term of this Agreement, (B) the negligence or willful misconduct of Contractor or any of its employees, agents, contractors or other invitees, or (C) Contractor's default in respect of any of the obligations that it undertakes under the terms of this lease, except to the extent the claims, actions, causes of action, litigation, proceedings, costs or expenses arise from the intentional or sole negligent acts or omissions of the County or any of its employees, agents, contractors or invitees (other than Contractor). Insofar as the claims, actions, causes of action, litigation, proceedings, costs or expenses relate to events or circumstances that occur during the term of this Agreement, this section will survive the expiration of the term of this Agreement or any earlier termination of this Agreement. 9. RECORDS. Contractor shall maintain all books, records, and documents directly pertinent to performance under this Agreement in accordance with generally accepted accounting principles consistently applied. Each party to this Agreement or their authorized representatives shall have reasonable and timely access to such records of each other party to this Agreement for public records purposes during the term of the Agreement and for four years following the 13 termination of this Agreement. If an auditor employed by the County or Clerk determines that monies paid to the Contractor pursuant to this Agreement were spent for purposes not authorized by this Agreement, the Contractor shall repay the monies together with interest calculated pursuant to Sec. 55.03, FS, running from the date the monies were paid to Contractor. 10. GOVERNING LAW, VENUE, INTERPRETATION, COSTS, AND FEES. This Agreement shall be governed by and construed in accordance with the laws of the State of Florida applicable to contracts made and to be performed entirely in the State. In the event that any cause of action or administrative proceeding is instituted for the enforcement or interpretation of this Agreement, the County and Contractor agree that venue will lie in the appropriate court or before the appropriate administrative body in Monroe County, Florida. The County and Contractor agree that, in the event of conflicting interpretations of the terms or a term of this Agreement by or between any of them the issue shall be submitted to mediation prior to the institution of any other administrative or legal proceeding. 11. SEVERABILITY. If any term, covenant, condition or provision of this Agreement (or the application thereof to any circumstance or person) shall be declared invalid or unenforceable to any extent by a court of competent jurisdiction, the remaining terms, covenants, conditions and provisions of this Agreement, shall not be affected thereby; and each remaining term, covenant, condition and provision of this Agreement shall be valid and shall be enforceable to the fullest extent permitted by law unless the enforcement of the remaining terms, covenants, conditions and provisions of this Agreement would prevent the accomplishment of the original intent of this Agreement. The County and Contractor agree to reform the Agreement to replace any stricken provision with a valid provision that comes as close as possible to the intent of the stricken provision. 12. ATTORNEY'S FEES AND COSTS. The County and Contractor agree that in the event any cause of action or administrative proceeding is initiated or defended by any party relative to the enforcement or interpretation of this Agreement, the prevailing party shall be entitled to reasonable attorney's fees, court costs, investigative, and out -of- pocket expenses, as an award against the non - prevailing party, and shall include attorney's fees, courts costs, investigative, and out -of- pocket expenses in appellate proceedings. Mediation proceedings initiated and conducted pursuant to this Agreement shall be in accordance with the Florida Rules of Civil Procedure and usual and customary procedures required by the circuit court of Monroe County. 13. BINDING EFFECT. The terms, covenants, conditions, and provisions of this Agreement shall bind and inure to the benefit of the County and Contractor and their respective legal representatives, successors, and assigns. 14. AUTHORITY. Each party represents and warrants to the other that the execution, delivery and performance of this Agreement have been duly authorized by all necessary County and corporate action, as required by law. 15. ADJUDICATIONS OF DISPUTES OR DISAGREEMENTS. County and Contractor agree that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions between representatives of each of the parties. If no resolution can be agreed upon within 30 days after the first meet and confer session, the issue or issues shall be discussed at a public meeting of the Board of County Commissioners. If the issue or issues are still not resolved to the satisfaction of the parties, then any party shall have the right to seek such relief or remedy as 14 may be provided by this Agreement or by Florida law. 16. COOPERATION. In the event any administrative or legal proceeding is instituted against either party relating to the formation, execution, performance, or breach of this Agreement, County and Contractor agree to participate, to the extent required by the other party, in all proceedings, hearings, processes, meetings, and other activities related to the substance of this Agreement or provision of the services under this Agreement. County and Contractor specifically agree that no party to this Agreement shall be required to enter into any arbitration proceedings related to this Agreement. 17. NONDISCRIMINATION. Contractor will comply with all Federal and Florida statutes, and all local ordinances, as applicable, relating to nondiscrimination. These include but are not limited to: 1) Title VI of the Civil Rights Act of 1964 (PL 88 -352) which prohibits discrimination on the basis of race, color or national origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC ss. 1681 -1683, and 1685 - 1686), which prohibits discrimination on the basis of sex; 3) Section 504 of the Rehabilitation Act of 1973, as amended (20 USC s. 794), which prohibits discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975; as amended (42 USC ss. 6101 -6107) which prohibits discrimination on the basis of age; 5) The Drug Abuse Office and Treatment Act of 1972 (PL 92 -255), as amended, relating to nondiscrimination on the basis of drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91 -616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, ss. 523 and 527 (42 USC ss. 690dd -3 and 290ee -3), as amended, relating to confidentiality of alcohol and drug abuse patient records; 8) Title VIII of the Civil Rights Act of 1968 (42 USC s. et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The Americans with Disabilities Act of 1990 (42 USC s. 1201 Note), as may be amended from time to time, relating to nondiscrimination based of disability; 10) Secs. 13 -101, et seq., Monroe County Code, relating to discrimination based on race, color, sex, religion, disability, national origin, ancestry, sexual orientation, gender identify or expression, familial status or age; 11) Any other nondiscrimination provisions in any Federal or State statutes which may apply to the parties to, or the subject matter of, this agreement. The Contractor expressly understands that upon a determination by a court of competent jurisdiction that the Contractor has discriminated against any person, this agreement automatically terminates without any further action on the part of any party, effective the date of the Court order. 18. COVENANT OF NO INTEREST. County and Contractor covenant that neither presently has any interest, and shall not acquire any interest, which would conflict in any manner or degree with its performance under this Agreement, and that only interest of each is to perform and receive benefits as recited in this Agreement. 19. CODE OF ETHICS. County agrees that officers and employees of the County recognize and will be required to comply with the standards of conduct for public officers and employees as delineated in Section 112.313, Florida Statutes, regarding, but not limited to, solicitation or acceptance of gifts; doing business with one's agency; unauthorized compensation; misuse of public position, conflicting employment or contractual relationship; and disclosure or use of certain information. 20. NO SOLICITATION/PAYMENT. The County and Contractor warrant that, in respect to itself, it has neither employed nor retained any company or person, other than a bona 15 fide employee working solely for it, to solicit or secure this Agreement and that it has not paid or agreed to pay any person, company, corporation, individual, or firm, other than a bona fide employee working solely for it, any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of the provision, the Contractor agrees that the County shall have the right to terminate this Agreement without liability and, at its discretion, to offset from monies owed, or otherwise recover, the full amount of such fee, commission, percentage, gift, or consideration. 21. PUBLIC ACCESS. The County and Contractor shall allow and permit reasonable access to, and inspection of, all documents, papers, letters or other materials in its possession or under its control subject to the provisions of Chapter 119, Florida Statutes, and made or received by the County and Contractor in conjunction with this Agreement; and the County shall have the right to unilaterally cancel this Agreement upon violation of this provision by Contractor. 22. NON - WAIVER OF IMMUNITY. Notwithstanding the provisions of Sec. 768.28, Florida Statutes, the participation of the County and the Contractor in this Agreement and the acquisition of any commercial liability insurance coverage, self - insurance coverage, or local government liability insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability coverage, nor shall any contract entered into by the County be required to contain any provision for waiver. 23. PRIVILEGES AND IMMUNITIES. All of the privileges and immunities from liability, exemptions from laws, ordinances, and rules and pensions and relief, disability, workers' compensation, and other benefits which apply to the activity of officers, agents, or employees of any public agents or employees of the County, when performing their respective functions under this Agreement within the territorial limits of the County shall apply to the same degree and extent to the performance of such functions and duties of such officers, agents, volunteers, or employees outside the territorial limits of the County. 24. LEGAL OBLIGATIONS AND RESPONSIBILITIES. Non - Delegation of Constitutional or Statutory Duties. This Agreement is not intended to, nor shall it be construed as, relieving any participating entity from any obligation or responsibility imposed upon the entity by law except to the extent of actual and timely performance thereof by any participating entity, in which case the performance may be offered in satisfaction of the obligation or responsibility. Further, this Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the constitutional or statutory duties of the County, except to the extent permitted by the Florida constitution, state statute, and case law. 25. NON - RELIANCE BY NON - PARTIES. No person or entity shall be entitled to rely upon the terms, or any of them, of this Agreement to enforce or attempt to enforce any third -party claim or entitlement to or benefit of any service or program contemplated hereunder, and the County and the Contractor agree that neither the County nor the Contractor or any agent, officer, or employee of either shall have the authority to inform, counsel, or otherwise indicate that any particular individual or group of individuals, entity or entities, have entitlements or benefits under this Agreement separate and apart, inferior to, or superior to the community in general or for the purposes contemplated in this Agreement. 26. ATTESTATIONS. Contractor agrees to execute such documents as the County may reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug- 101 Free Workplace Statement. 27. NO PERSONAL LIABILITY. No covenant or agreement contained herein shall be deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe County in his or her individual capacity, and no member, officer, agent or employee of Monroe County shall be liable personally on this Agreement or be subject to any personal liability or accountability by reason of the execution of this Agreement. 28. EXECUTION IN COUNTERPARTS. This Agreement may be executed in any number of counterparts, each of which shall be regarded as an original, all of which taken together shall constitute one and the same instrument and any of the parties hereto may execute this Agreement by signing any such counterpart. 29. SECTION HEADINGS. Section headings have been inserted in this Agreement as a matter of convenience of reference only, and it is agreed that such section headings are not a part of this Agreement and will not be used in the interpretation of any provision of this Agreement. 30. PROFESSIONAL RESPONSIBILITY. The Contractor warrants that it is authorized by law to engage in the performance of the activities encompassed by the project herein described, subject to the terms and conditions set forth. The provider shall at all times exercise independent, professional judgment and shall assume professional responsibility for the services to be provided. Continued funding by the Board is contingent upon retention of appropriate local, state, and /or federal certification and /or licenser of contractor. 31. NOTICE REQUIREMENT. Any notice required or permitted under this agreement shall be in writing and hand delivered or mailed, postage prepaid, to the other party by certified mail, returned receipt requested, to the following: FOR COUNTY Joe Medallion Director, Upper Keys Operations 88770 Overseas Highway Tavernier, FL 33070 Phone:(305) 852 -7161 Fax: (305) 852 -7117 FOR CONTRACTOR �k� -�de� ? cS r-+o 7F3 -,W 32. CANCELLATION. a) The failure by the Contractor to comply with all the terms and conditions of this Agreement shall constitute a default/breach under the terms of this Agreement. Unless the County has accepted in writing a delay in performance of the services, the failure by the Contractor to perform said services shall also constitute a default/breach under the terms of this agreement. In the event of a default /breach of the Agreement, the County may cancel this Agreement for cause with seven days notice to the contractor. b) Except for the County's termination because of non - appropriation in paragraph 2 or because of lack of insurance coverage in paragraph 7, either of the parties hereto may cancel this agreement without cause by giving the other party thirty days written notice of its intention to do SO. 17 33. MUTUTAL REVIEW. This agreement has been carefully reviewed by the Contractor and the County, therefore this agreement is not to be construed against either party on the basis of authorship. IN WITNES WHEREOF, the parties have caused this Agreement to be executed this � d ay of , 2011. L. KOLHAGE, CLERK Wifiesses t w . #s pr9pared and Pedro J. sq., As a Bar N .: 0084050 P.O. Box 10 Key West, FL 33041 -1026 (305) 292 -3470 BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA By: A ► Ma or CONTRAC OR By: Title as to form by: n S /BI /I/ unty Attorney 18 • �:D c� o - - .� --7 = - s C' r� C: CA o BID PROPOSAL The Bid Proposal shall be submitted on the forms included in this section of the Bidding Documents as previously instructed therein. Item Description Bid Proposal Form 2. Non - Collusion Affidavit Lobbying and Conflict of Interest Clause (Ethics Clause) 4. Drug Free Workplace 5. Local Preference Form Monroe County Occupational License (Current copy to be submitted with bid) 19 PROPOSAL FORM TO: MONROE COUNTY BOARD OF COUNTY COMMISSIONERS C/O PURCHASING DEPARTMENT GATO BUILDING ROOM 1 -213 1100 SIMONTON STREET KEY WEST, FLORIDA 33040 PROPOSAL FROM: The undersigned, having carefully examined the work, specifications, proposal, and addenda thereto and other Contract Documents for the services of: ON -SITE SEWER CONNECTION AT KEY LARGO COMMUNITY PARK The Contractor, in submitting the foregoing proposal, agrees to comply with all contract specification documents. (Total Base B'id — words) Dollars $ cc (Total Base Bid — numbers) Days: (Number of contract days required to complete the work) I acknowledge receipt of Addenda No. (s) Ace, (Check mark (�) items below, as a reminder that they are included.) I have included the Bid Proposal which entails: • Lobbying and Conflict of Interest Clause !i • Non- Collusion Affidavit y • Drug Free Workplace Form • Public Entity Crime Statement _ • Insurance Requirements • Local Preference Form (if applicable) • Bid Bond (5% of Bid Price) (a Contract Bond is not required) In addition, I have included a current copy of Monroe County Occupational License ; Insurance Agents Statement ; and all requirements as stated in Section One, Article 1.04 Paragraphs A through C. Print Name3 Ptu— 6, rN— Title: t "P .5 "4Q— }- Mailing Address: V Telephone: - -_z,,5 -yf 5 - -4245 Fax: 3o5 1°ta Date: ,S 15 - it Signed: Witness: (Seal) 20 NON - COLLUSION AFFIDAVIT I, of the city of according to law on my oath, and under penalty of perjury, depose and say that: 1. I am of the firm of 3ri?,a making the Bid for the services /work/project described in the Request for Bids for and that I executed the said Bid with full authority to do so: 2. The prices in this bid/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 and percentage of return which have been quoted in this bid/Bid have not been knowingly disclosed by the responder and will not knowingly be disclosed by the responder prior to bid/Bid opening, directly or indirectly, to any other bidder /responder or to any competitor. 4. No attempt has been made or will be made by the bidder /responder to induce any other person, partnership or corporation to submit, or not to submit, a bid/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,pontracts for the pro ' ect /services /work. L o w"ell -I 17c'l / ( nature of Bidder) (Date) STATE OF: R 19 A COUNTY OF: M OA eO PERSONALLY APPEARED BEFORE ME, the undersigned authority, 3g rA t5 TI. who, after first being sworn by me, (name of individual signing) affixed his /her signature in the space provided above on this f y day of 6,� 20ff_. NOTARY PUBLIC My Commission Expires: R 1111i1 111 H(��� ®� ���\ ; �,�, \SSIpN�• �O� 16 2p ° 9.� � N #DD 977235 9 �' 0 / eonded 4. pA SWORN STATEMENT UNDER ORDINANCE NO. 10 -1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE 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) Dat e - _ ;2 Z STATE OF nJ.;clA COUNTY OF (MloncnF PERSONALLY APPEARED BEFORE ME, the undersigned authority, &r,&AQD who, after first being sworn by me, affixed his /her signature (name of individual signing) in the space provided above on this day of MAW , 20IL_. OMB - MCP FORM 44 NOTARY PUBLIC My commission expires: CG A. TO ' >. #Dp 977235 : ow �'•tio� eonded�gfi; 4�r� 9' DRUG -FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that: 7 (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 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 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 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 with the above requirements. STATE OF r IE>R A COUNTY OF Mo,p_O� 0 Mre* ,- // ,1 Signature of Respondent) 1:24 1 Date PERSONALLY APPEARED BEFORE ME, the undersigned authority, s 14. 0 6 S D who, after first being sworn by me, (name of individual signing) affixed his /her signature in the space provided above on this v� +h day of N u , 2011. /h f) My commission expires: NOTARY PUBLIC xQ Q dr 40 • < Bonded ��YPUbllic�rid.� PUBLIC ENTITY CRIME STATEMENT "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 public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list." By executing below, proposer states that he /she /it is in compliance. 'gnature STATE OF E InQ:cl6 (Signature of Respondent) COUNTY OF oN2o z� s _ . J � d , ATE PERSONALLY APPEARED BEFORE ME, the undersigned authority, — 7S;,A c a 1!6 r1. ,g_o who, after first being sworn by me, (name of individual signing) affixed his /her signature in the space provided above on this day of , 20 //. My commission expires: rWTARY PUBUC i G P • o N #DD 977295 %�9`A�•�d �• O 4ST11?I 24 INSURANCE CHECKLIST FOR VENDORS SUBMITTING PROPOSALS FOR WORK To assist in the development of your proposal, the insurance coverage's 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 respondent sign the form and submit it with each proposal. WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY 25 Workers' Compensation Statutory Limits WC1 X Employers Liability $100,000 1$500,0001$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 Workers Act Liability WCJA Federal Jones Act Same As Employers' Liability 25 GENERAL LIABILITY As a minimum, the required general liability coverage will include: • Premises Operations • • Blanket Contractual • • Expanded Definition Of Property Damage Required Limits: Products and Completed Operations Personal Injury GL 1 X $100,000 per Person; $300,000 per Occurrence $50,000 Property Damage or $300,000 Combined Single Limit GL2 $250,000 per Person; $500,000 per Occurrence $50,000 Property Damage or $500,000 Combined Single Limit GL3 $500,000 per Person; $1,000,000 per Occurrence $100,000 Property Damage or $1,000,000 Combined Single Limit GI-4 $5,000,000 Combined Single Limit Required Endorsement: GLXCU GLLIQ GLS Underground, Explosion and collapse (XCU) Liquor Liability Security Services All endorsements are required to have the same limits as the basic policy 26 VEHICLE LIABILITY As a minimum, coverage should extend to liability for: Owned; Non - owned; and hired Vehicles Required Limits: VL1 X $50,000 per Person; $100,000 per Occurrence $25,000 Property Damage or $100,000 Combined Single Limit VL2 $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 VL4 $5,000,000 Combined Single Limit MISCELLANEOUS COVERAGES BR1 Builders' Limits equal to the Risk completed project MVC Motor Truck Limits equal to the maximum Cargo value of any one shipment PRO1 Professional $ 250,000 per Occurrence /$ 500,000 Agg. PR02 Liability $ 500,000 per Occurrence /$1,000,000 Agg. PR03 $1,000,000 per Occurrence /$2,000,000 Agg. POL1 Pollution $ 500,000 per Occurrence /$ 1,000,000 Agg. POL2 Liability $1,000,000 per Occurrence /$ 2,000,000 Agg. POL3 $5,000,000 per Occurrence /$10,000,000 Agg. ED] Employee $ 10,000 ED2 X Dishonesty $100,000 GK1 Garage $ 300,000 ($ 25,000 per Veh) GK2 Keepers $ 500,000($100,000 per Veh) GK3 $1,000,000 ($250,000 per Veh) 27 MED1 Medical $ 250,000/$ 750,000 Agg. MED2 Professional $ 500,000/$ 1,000,000 Agg. MED3 $1,000,00013,000,000 Agg. MED4 $5,000,000 510,000,000 Agg. 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 Liability Maximum Value of Property HKL 1 Hangarkeepers $ 300,000 HKL2 Liability $ 500,000 HKL3 $1,000,000 AIR] Aircraft $ 1,000,000 AIR2 Liability $ 5,000,000 AIR3 $50,000,000 AEO1 Architects Errors $ 250,000 per Occurrence /$ 500,000 Agg. AEO2 & Omissions $ 500,000 per Occurrence /$1,000,000 Agg. AEO3 $1,000,000 per Occurrence /$3,000,000 Agg. EO1 Engineers Errors $ 250,000 per Occurrence /$ 500,000 Agg. EO2 & Omissions $ 500,000 per Occurrence /$1,000,000 Agg. EO3 $1,000,000 per Occurrence /$3,000,000 Agg. 28 INSURANCE AGENT'S STATEMENT I have reviewed the above requirements with the respondent named below. The following deductibles apply to the corresponding policy. POLICY Liability policies are Occurrence Insurance Agency RESPONDENTS STATEMENT Signature I understand the insurance that will be mandatory if awarded the contract and will comply in full with all the requirements. t- J ,gr��s I n1 WA" . Respondent Signature DEDUCTIBLES Claims Made- 29 LOCAL PREFERENCE FORM ''" A. "Vendors claiming a local preference according to Ordinance 023 -2009 must complete this form. Name of Bidder /Responder _ ��r. t ` +ti Date: C P? - /( 1. Does the vendor have a valid receipt for the business tax paid to the Monroe County Tax Collector dated at least one year prior to the notice or request for bid or proposal? (Please furnish copy). 2. Does the vendor have a'physical business address located within Monroe County from which the vendor operates or performs businesl on a day to day basis that is a substantial component of the goods or services being offered to Monroe County? L - List Address: z�, Telephone Number: 7 1 Fz B. Does the vendor /prime contractor intend to subcontract 50% or more of the goods, services or construction to local businesses meeting the criteria above as to licensing and location? Na If yes, please provide: 1. Copy of Receipt of the business tax paid to the Monroe County Tax Collector by the subcontractor dated at least one year prior to the notice or request for bid or proposal. 2. Subcontractor Address within Monroe County from which the subcontractor operates: I� ignature and Title of Authorized Signatory for Bidder /Responder Tel. Number */,# Print Name: —J-14 In 'PS V //I ISFUA STATE OF: A COUNTY OF: aA C 4 Subscribed and sworn to (or affirmed) before me on A,,, ('I016 0 (date) by Z AMIiS JSJ. (n ame of affiant). He /She is personally known to me or has produced (type of identification) as identification. NOTARY PUBLIC My Commission Expires: Ada /(, p ti s R, -- ---- - --•• Seal �• o L •• • t.,, AC# 5024234 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCT/ON INDUSTRY LICENSING BOARD Se:1#L10070600 • LICENSE NBR ". ; S 07 06/2010 108002635 CFC055684 ' - The PLUMBING CONTRACTOR Named bew IS CERTIFIED Under the` provisions of Chapter"'" -;;t-. t ; Expiration date: AUG 31, 2012 .4 . t .' : "'�- -. 70,E ,t I ° MASSARO, JAMES NIRAM JR I • 3RD GENERATION PLUMBING INC ti.,.t . _ t �* t 109 PIRATES CV "-.g*;""z MARATHON FL 33050-292t :4 ,s art 41" fir' CHARLIE CRIST CHARLIE LIEN a1�%fir,-' GOVERNOR INTERIM SECRETARY DISPLAY AS REQUIRED BY LAW ACC 4420990 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SEQ#L0905290 # DATE BATCH NUMBER LICENSE NBR 05/29/2009 088223712 QB47709 The BUSINESS ORGANIZATION 4 Named below IS QUALIFIED s Under the provisions of Chapter 489 FS . 1 Expiration date: AUG 31, 2011 (THIS IS NOT A LICENSE TO PERFORM WORK. THIS ALLOWS I COMPANY TO DO BUSINESS ONLY IF IT HAS A QUALIFIER. ) 1 3RD GENERATION PLUMBING INC 3980 OVERSEAS HWY MARATHON FL 33050 4 4 CHARLIE CRIST CHARLES W. DRAGO GOVERNOR SECRETARY DISPLAY AS REQUIRED BY LAW 3 SECS LZO1Qlido �:�MBEi LICENSE NBR 41 8/2010 100139491 CBC12583 a - .� : Tt ' n c CONTRACTOR K: {� ..,: _'`r' Xtme ©w IS C8°#tTIFIED _ Under provisions of Chapti '..-_:,4- ----tit,. Expiration date: AUG 31, 2012 .• 1 R + X' 1 ri dLa I. r 4 Ord$ NIRAM JR , 1'* er .» :TION PLUMBING INC 'L' � ;+ `' 0 OVERSEAS HWY 4 1�; d,d.: ti;i f r THON FL 33050 k4UD V`E 1 '' - Mi4 4),fa''L* 7.0.E ' p°.J `paw.,. x a. ^syS�t.•; ru - .1' jr „} T "�� !.i. rf ,7>�' ej .t ASS day ..a�,�+.,F)� � ' r�,k.-�'!��"�ttik�',��' t'i r mod)}. 5 �.kc. Lift c, d,5 ` 5,'_. - - �°, .. �� CHARLIE LIEN ,. ;.`- 1SPL.AY AS REQUIRED BY LAW SECRETARY 2010 / 2011 MONROE COUNTY BUSINESS TAX RECEIPT EXPIRES SEPTEMBER 30, 2011 Business Name: 3RD GENERATION PLUMBING INC Owner Name: JAMES N MASSARO Mailing Address: 3980 OVERSEAS HWY MARATHON, FL 33050 Rooms Seats RECEIPT# 30140 -72998 Business Location: 3980 OVERSEAS HWY MARATHON, FL 33050 Business Phone: 305- 743 -4245 Business Type: CONTRACTORS (CONTRACTORS /PLUMBING/ LANDSCAPING) Employees Machines Stalls 12 CFCO55680 EX 08 -08 Number of Machines: For Vending Business Only Vendin Tax Amount Transfer Fee Sub -Total Penalt g Type: Y Prior Years Collection Cost Total Paid 35.00 0.00 35.00 0.00 0.00 0.00 35.00 Paid 204 -09- 00000500 09/15/2010 35.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT Danise D. Henriquez, CFC, Tax Collector THIS IS ONLY A TAX. ` WHEN VALIDATED PO Box 1129, Key West, FL 33041 YOU MUST MEET ALL COUNTY AND /OR MUNICIPALITY PLANNING AND ZONING REQUIREMENTS. ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 06/23/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Robert Mihm Insurance Office of America, Inc. PHONE > n : 954- 318 -1379 AX 954 - 318 -1383 100 NE Third Avenue E -MAIL A c N Sui 850 P N D O DEI DU ER T MERI Ft. Lauderdale, FL 33301 INSURER(S) AFFORDING COVERAGE NAIC x INSURED INSURERA: FCCI Commercial Insurance Co. 33472 3rd Generation Plumbing Inc INSURER B: 3980 Overseas Highway INSURER C: Marathon, FL 33050 INSURER D: INSURER E INSURER F COVERAGES I'PRTICICATC N11aaDCD. 11 _1'1 14 _L -- — ..cvwrvn rwmD�n: 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM /DD/YYY POLICY EXP MM /DD/YYYY LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR CPPOO10790 -02 02/21/2011 02/21 /2012 EACH OCCURRENCE $ 1,000,00 , 000 , OO PREMISES rr n $ 100 ,00 ( MED EXP (Any one person) $ 5 , OO PERSONAL & ADV INJURY $ 1 000 OO GENERAL AGGREGATE , , $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY r X �EC LOC PRODUCTS - COMP /OP AGG $ 2,000, AUTOMOBILE X LIABILITY ANY AUTO CA0010155 -0 02/21/2011 02/21/2012 COMBINED SINGLE LIMIT (Ea accident) $ 1 ALL OWNED AUTOS BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ A SCHEDULED AUTOS X HIRED AUTOS PROPERTY DAMAGE (Per accident) $ X NON -OWNED AUTOS $ $ UMBRELLA LIAR EXCESS LIAB OCCUR C LAIMS - MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N ANY PROPRIETOR/PARTNER/EXECUTIVE❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below N/A ` U /� ( WC STATU- 0 H- TORY LIMITS ER $ E.L. EACH ACCIDENT $ L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT 1 $ A �ontractor's Equipment - eased or Rented Equipmen CPPOO10790- 0202/21/2011 02/21/2012 $50,000. limit $1,000. deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Monroe County BOCC is an Additional Insured as respects to General Liability and Automobile coverages as required under written contract. /"CDTr PIf•aTf• lJ/11 nrn _ _ _ _ _ -_ W IWOO -cvVZ1 A%,Vr1U I- VKVUKAI IVN. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Monroe County BOCC AUTHORIZED REPRESENTATIVE lam, 1n.�1 �NA(w� 1100 Simonton Street `� Key West, FL 33040 Robert Mihm/TRICIA W IWOO -cvVZ1 A%,Vr1U I- VKVUKAI IVN. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD ACOR a.y , v CERTIFICATE OF LIABILITY INSURANCE P01/21 ATE (MM/DD/YWV THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BEWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Risk Concepts Corporation CONTACT NAME: 41043rd Street West Suite N PHONE (A/C, No, Ext): 877- 746 -2209 FAX (A/C, No): E -MAIL ADDRESS: Bradenton FL, 34209 PRODUCER CUSTOMER ID #: INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: SoLdhern Eagle Insurance Coma 10151 INSURER B: Lloyds Syndicate A 48339 Administrative Concepts Corporation INSURER C: Aspen Insurance A 84806 406 43rd Street West INSURER D: Max Bermuda LTD A- 87119 Bradenton FL, 34209 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: U 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. TYPE OF INSURANCE �Uut AUTHORIZED REPRESENTATIVE POLICY NUMBER POLICY EFF POLICY ExP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ $ COMMERCIAL GENERAL LIABILITY FINS11 CLAIMS-MADE 1-1 OCCUR MED EXP (Anyone person PERSONAL & ADV INJURY GENERAL AGGREGATE $ 'L AGGREGATE LIMIT APPLIES PER: PROJ- PRODUCTS-COM P /OP AGG $ $ POLICY E cT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO Ea accident $ BODILY INJURY (Per Person) ALL OWNED AUTOS SCHEDULED AUTOS er $ PROPERTY DAMAGE (Per HIRED AUTOS NON -OWNED AUTOS / accident ) $ $ �O UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $. EXCESS LIAR H CLAIMS MADE DEDUCTIBLE RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETER/PARTNER /EXECUTIVE N OFFICERIMEMBEREXCLUDED? (Mandatory In NH) N/A 2011- 02682 -000 D1/01/2011 12/31/2011 STATU -TORY OTH- LIMITS ER EACH ACCIDENT rE.L. $ 1 DISEASE -EA EMPLOYEE i s 000 000.00 DISEASE- POLICY LIMIT I s 1 If yes describe under BC Workers Compensation Please note that Southern Eagle Insurance Company has reinsured its liabilities in excess of $250,000 under the policies of insurance listed above with the underwriters listed A- or better at the time of placement of such reinsurance. Such reinsurance D E Excess Coverage are subject to their own terms, conditions and limits. This is for informational purposes and nothing shall create any right under such reinsurances. DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, N more space Is required) Effective: Coverage is extended to the leased employees of alternate employer (Florida Operations Only): 02/22/2010 721013 3rd Generation Plumbing, Inc. DISCLAIMER: This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. CFRTIFICATF HOI HER CANCELLATION Monoroe County Board of County Commissioners SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 110 Simonton Street AUTHORIZED REPRESENTATIVE Key West Nas FL, 33040 Fax #: ACORD 25(2008/09) 462 - 20110103