07/15/1992 Agreement •
Section 00500 r :L Er z 1-)Q " r
R,
FORM OF AGREEMENT
92 OCT -7 p4 :55
This agreement is set forth as of the 15 th day of Ju Ff in
the year of 1992 between the OWNER who is
County Commissioners of Monroe County Florida; and the fo1 o i
CONTRACTOR:
Name: PARKER REFRIGERATION, INC.
Address: 2405 SEIDENBERG AVENUE
KEY WEST, FLORIDA 33040
Phone: (305) 294 - 1345
for the purpose of performing all of the Work required by the
Contract Documents for the following PROJECT:
KEY WEST INTERNATIONAL AIRPORT
FIS RENOVATION
AIR CONDITIONING
Monroe County Board of Commissioners, who is hereafter referred
to as the ARCHITECT /ENGINEER and who assumes all duties and
responsibilities and has the rights and authority assigned to the
ARCHITECT /ENGINEER in the Proposal Documents in connection with
completion of the Work in accordance with the Contract Documents.
The OWNER and the CONTRACTOR agree as set forth as follows:
Article 1 - The Contract Documents
The Contract Documents consist of this Agreement, the
Proposal Form, the Insurance Documents, the Non - Collusion
Affidavit, the Sworn Statement on Public Entity Crimes, the
Equal Opportunity Report Statement, Certification of
Non - Segregated Facilities, Disadvantaged Business Enterprise
Data, the Lobbying and Conflict of Interest Clause, the
Sworn Statement under Ordinance # 10 -1990, the
Specifications and all Modifications issued after execution
of this Agreement. These form the Contract, and all are as
fully a part of the Contract as if attached to this
Agreement or repeated herein. An enumeration of the
Contract Documents appears in Article 7.
01/10/92 FORM OF AGREEMENT 00500 -1
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Article 2 - The Work
The Contractor shall perform all the Work required by the
Contract Documents for the following scope of work:
A. The scope of Work shall include, but not be
limited to, all Work shown on the Plans, and in
the Specifications. The Contractor is required to
provide a complete job as contemplated by the
Drawings and Specifications, which are a part of
this package.
B. Provide all labor, supervision, materials,
supplies, equipment, tools, construction
equipment, transportation,inspection and proper
execution and completion of all work as specified
on the Drawings and Technical Specifications
included in this package and listed as follows:
1. Install a chilled air system manufactured by
Carrier, Trane, Lennox, York or equal . This
system shall meet State Energy Policy and
Conservation Act.
2. Install fire dampers and volume control
dampers as necessary.
3. Install inlet and return grilles where
indicated on the plans.
4. Install sealant on ducts - new and existing.
5. Existing A/C systems and ducts may be utilized
if feasible. Install new duct where
applicable. All equipment that is not used
must be removed from site.
6. Units must be accessible for repair.
7. A/C system must be tested and balanced before
acceptance.
8. All equipment and ducts to be sized by the
Contractor.
C. The specifications contained herein are considered
to be the minimum standards required. The
installation shall comply with all applicable
Federal, State, Local codes and ordinances.
D. The County reserves the right to reject any and
all proposals in whole or in part and to waive any
informalities or irregularities in the proposals
determined to be in the best interest of the
citizens of the County.
01/10/92 FORM OF AGREEMENT 00500 -2
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Article 3 - Schedule
The CONTRACTOR shall commence Work to be performed under this
Contract no later than ten (10) calendar days from Notice to
Proceed and shall be substantially completed no later than
thirty (30) calendar days from the Commencement Date. The
CONTRACTOR also agrees to be complete and ready for final
payment in accordance with the General Conditions no later
than thirty (30) calendar days from the Substantial Completion
Date.
The OWNER and the CONTRACTOR recognize that time is of the
essence of this Contract and that the OWNER will suffer
financial loss if the Work is not completed within the times
specified above, plus any extensions of time allowed in
accordance with the Request for Proposal. They also recognize
the delays, expense and difficulties involved in proving in
a legal or arbitration proceeding the actual loss suffered by
OWNER if the Work is not completed on time. Accordingly,
instead of requiring such proof, OWNER and CONTRACTOR agree
that as liquidated damages for delay (but not as a penalty)
CONTRACTOR shall pay OWNER fifty dollars ($50.00) for each day
that expires after the time specified above for Substantial
Completion until the Work is substantially complete.
The OWNER and CONTRACTOR agree that work on the project will
be continuous from the commencement date thru the completion
date. Any demobilization once the work has started requires
prior approval by the OWNER.
Article 4 - Contract Price
The OWNER shall pay the CONTRACTOR for completion of the Work
in accordance with the Contract Documents in current funds in
the following amount:
TWENTY THOUSAND EIGHT HUNDRED FORTH THREE DOLLARS ($20,843.00)
Article 5 - Payment Procedures
The CONTRACTOR shall submit Applications for Payment in
accordance with the Request for Proposal. Applications for
Payment will be processed as provided in the Request for Proposal.
The OWNER shall make progress payments on account of the
Contract Price on the basis of the Contractor's Application
for Payment as recommended by the OWNER'S DESIGNATED
REPRESENTATIVE once per month during construction. All
progress payments will be on the basis of the progress of the
Work measured in accordance with the Request for Proposal and
Supplementary Conditions of the Contract.
01/10/92 FORM OF AGREEMENT 00500 -3
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Upon final completion and acceptance of the Work in
accordance with the Request for Proposal and upon submittal of
all closeout documentation, OWNER shall pay the remainder of
the Contract Price, including release of retention, as
recommended by the OWNER'S DESIGNATED REPRESENTATIVE.
Article 6 - Contractor's Representations
In order to induce OWNER to enter into this Contract,
CONTRACTOR makes the following representations:
1. CONTRACTOR has familiarized itself with the nature
and extent of the Contract Documents, Work, site,
locality, and all local conditions and Laws and
Regulations that in any manner may affect cost,
progress, performance, or furnishing of the Work.
2. The CONTRACTOR has studied carefully all reports of
explorations and tests of subsurface conditions and
drawings of physical conditions which are included
in the Contract Documents.
3. The CONTRACTOR has obtained and carefully studied
(or assumes responsibility for obtaining and
carefully studying) all such examinations,
investigations, explorations, tests, reports, and
studies which pertain to the subsurface of physical
conditions at or contiguous to the site or
otherwise may affect the cost, progress,
performance or furnishing of the Work as
CONTRACTOR considers necessary for the performance
or furnishing of the Work at the Contract Price,
within the Contract Time and in accordance with
the other terms and conditions of the Contract
Documents, including specifically the provisions
of the Request for Proposal; and no additional
examinations, investigations, exploration, tests,
reports, studies, or similar information or data
be or will be required by the CONTRACTOR for such
purposes.
4. The CONTRACTOR has reviewed and checked all
information and data shown or indicated on the
Contract Documents with respect to existing
Underground Facilities at or contiguous to the site
and assumes responsibility for the accurate location
of said Underground Facilities.
01/10/92 FORM OF AGREEMENT 00500 -4
5. The CONTRACTOR has correlated the results of all
such observations, examinations, investigations,
explorations, tests, reports, and studies with the
terms and conditions of the Contract Documents.
6. The CONTRACTOR has given the OWNER written notice
of all conflicts, errors, or discrepancies that he
has discovered in the Contract Documents and the
written resolution thereof by the OWNER is
acceptable to the CONTRACTOR.
Article 7 - Contract Documents
The Contract Documents which comprise the entire agreement
between the OWNER and the CONTRACTOR concerning the Work
consist of the following:
1. Proposal Form
2. This Agreement (pages 1 to 7, inclusive).
3. Insurance Documents
4. Non - Collusion Affidavit
Sworn Statement on Public Entity Crimes
6. Sworn Statement under Ordinance # 10 -1990
7. Equal Opportunity Report Statement
8. Certification of Non - Segregated Facilities
9. Disadvantaged Business Requirements
10. Lobby and Conflict of Interest Clause
11. Specifications
There are no Contract Documents other than those listed
above in this Article. The Contract Documents may only be
amended, modified, or supplemented as provided in the
Request for Proposal.
01/10/92 FORM OF AGREEMENT 00500 -5
Article 8 - Miscellaneous.
Terms used in this Agreement which are defined in Article 1
of the Request for Proposal will have the meanings indicated in
the Request for Proposal.
No assignment by a party hereto of any rights under or
interests in the Contract Documents will be binding on another
party hereto without the written consent of the party sought
to be bound; and specifically but without limitation moneys
that may become due and moneys that are due may not be
assigned without such consent (except to the extent that the
effect of this restriction may be limited by law), and unless
specifically stated to the contrary in any written consent to
an assignment no assignment will release or discharge the
assignor from any duty or responsibility under the Contract
Documents.
OWNER and CONTRACTOR each binds itself, its partners,
successors, assigns and legal representatives to the other
party hereto, its partners, successors, assigns and legal
representatives in respect of all covenants, agreements and
obligations contained in the Contract Documents.
Article 9 - Other Provisions
In cases of conflict within the described Contract Documents
in Article 7 of this Form of Agreement, the order of
precedence shall be as follows:
1. This Agreement
2. Proposal Documents with all /any addenda
3. General Requirements
4. Supplementary Conditions
5. Request for Proposal
6. Technical Specifications
7. Drawings (large scale detail drawings over smaller
scale general drawings)
01/10/92 FORM OF AGREEMENT 00500 -6
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IN WITNESS WHEREOF, the OWNER and CONTRACTOR have signed this
Agreement in triplicate. One counterpart each has been delivered
to the OWNER, CONTRACTOR, and COUNTY ENGINEER. All portions of
the Contract Documents have been signed or identified by the OWNER
and CONTRACTOR or by ARCHITECT /ENGINEER on their behalf.
This Agreement will be effective on JULY 15.. , 19 92
OWNER: Monroe County BOCC CONTRACTOR t- /9-s9r -fp _ r-f' . 2 Al"'
Monroe County, Fla //)1(. j, /tom; pi ,
By �. BY < ' i s-:,:___,--- L�
DAN-NY L. YO ��'� r�'`► �,;
Attest. - / //- , ,i . Attest l> ia:,, j 1_12
Address for giving not:/es Address for giving notices
Monroe County Engineer Dept. _ 1 /i ; , . :',, —, f - -- lam P% /- /
5100 College Road
Key West, FL 33040 --
APPROVED FOR LEGAL SUFFICIENCY
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01/10/92 FORM OF AGREEMENT 00500 -7
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, A* PROPOSAL FORM
BID TO: MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
c/o PURCHASING DEPARTMENT
PUBLIC SERVICE BUILDING ROOM 002
5100 COLLEGE ROAD, STOCK ISLAND
KEY WEST, FLORIDA 33040
' BID FROM: Parker Refrige
2405 Seidenberg Avenue
Key West, Fla. 33040
,. The undersigned, having carefully examined the Work and reference
Drawings, Specifications, Proposal, and Addenda thereto and other
Contract Documents for the construction of:
" � KEY WEST INTERNATIONAL AIRPORT
F.I.S. RENOVATION
KEY WEST, FLORIDA
AIR a DITIONING PROPOSAL
and having carefully examined the site there the Work is to be
• performed, having become. familiar with all local conditions including
labor affecting the cost thereof, and having familiarized himself with
material availability, Federal, State, and Local laws, ordinances, rules
and regulations affecting performance of the Work, does hereby propose
to furnish all labor, mechanics, superintendents, tools, material,
equipment, transportation services, and all incidentals necessary to
perform and complete said Work and work incidental hereto, in a
workman -like manner, in conformance with said Drawings, Specifications,
and other Contract Documents including Addenda issued thereto for a
total price of:
Twenty Thousand Eight Hundred Forty Three Dollars ($20,843.00
(words) (dollars) •
The successful bidder shall assume the risk of any and all costs and
delays arising from the existence of any subsurface or other latent
physical condition which could be reasonably anticipated by reference to
documentary information provided and made available, and from inspection
and examination of the site.
I acknowledge receipt of Addenda No.(s)
I have included all pages of the Request for Proposal which entails the
Proposal Form , the Sworn Statement of Public Entity Crimes , the
Sworn Statement Under Ordinance No. 10 -1990 (Ethics Clause) , and the
Non-Collusion Affidavit •
(Check mark items above, as a reminder that they are included.
p. 1 of 2
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The following is a list including the contact name, address, and
telephone number of references for our company and our products
installed in a similar application:
1. Gerald Adams School -c /o District School Board
P.O.Drawer 1430 •
Key West, Fla. 33040
PH:305- 296 -6523 •
2. Harris School - -c /o District School Board
P.O.Drawer 1430
Key West, Fla. 33040
PH:305- 296 -6523
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,.1 3.
Cooling Tower Replacement -c /o Southdiv Contracts
P.O.Box 9018 - N.A.S.
Key West,Fla. 33040
(use additional sheet if require &l :305 - 292 - 2983
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�� �= Bidders Mailing Address:
Parker Refrigeration, INc.
2405 Seidenberg Avenue
Key West, Fla. 33040
Phone Number: 305 - 294 - 1345
Name of Individual
responsible for the Work: John Parker III
Date: July 7,1992 `��� y .Signed:
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John Parker'III
(Name)
President
(Title)
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Witn 1 } , r7 ,-* 1iY ; Ai F7P
. (Seal)
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p. 2 of 2
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I . Exhibit B
WORM STATEMENT UuDER SECTION 2E7.133(3)Ca),
1 . FLORIDA STATUTES, (7M PUBLIC ENTITY CRIMES
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" "IS FORX MUST BE SIGHED IN THE PRESERCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS.
1. This sworn statement is submitted to Monr County Public Workds Dept.
(print name of the public entity)
by .Tnhn Parker III /President .
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(print individual's name and title)
for Parker Refrigeration, INc.
. (print name of entity submitting scorn statement)
whose business is Air C.nnrlirinning & Refrigeration, Contractor
1 and (if applicable) it Federal Employer Identification Number (FEIH) is 59-1150871
(If
the entity has no FEIN, include the Social Security Humber of the individual signing this sworn statement:
.) . ..
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1 2. 1 understand that a "public entity crime" as defined in Paragraph 28T.133(1)(g), Florida Statues, means
a violation of any state or federal taw by a person with respect to and directly related to the
transaction of business with any public entity or with an agency or political subdivision of any other
state or of the United States, including, but not limited to, any bid or contract for good or services
1 to be provided to any public entity or an agency or political subdivision of any other state or of the
United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or
material misrepresentation.
1 3. 1 understand that "convicted" or "conviction" as defined in Paragraph 287.133(1)(b), Florida Statues,
means a finding of guilt or a conviction of a public entity cri.ne, with or without an adjudication of
guilt, in any federal or state trial court of record relating -to charges brought by indictment or
information after July 1, 1989, as a result of a jury verdict, nonjury trial, or entry of a plea of
guilty or nolo contendere.
4. i understand that an "affiliate" as defined in Paragraph 28T.133(1)(a), Florida Statutes, means:
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1. A predecessor or successor of a person convicted of a public entity crime: or •
2.An entity under the control of any natural person who is active in the management of the entity and
who has been convicted of a public entity crime. The term "affiliate" includes those officers,
directors, executives, partners, shareholders, employees, members, and agents who are active in the
management of an affiliate. The ownership by one person of shares constituting a controlling interest
in another person, or a pooling of equipment or Income among persons when not for fair market value
under an arm's length agreement. shall be a prima facie case that one person controls another person.
A person who knowingly enters into a joint venture with a person who has been convicted of a public
entity crime in Florida during the preceding 36 months shall be considered an affiliate.
5. 1 understand that a "person" as defined in Paragraph 2 87.133(1)(e), Florida Statues, means any natural
person or entity organized under the laws of any state or of the United States with the legal power
to enter into a binding contract and which bids or applies to bid on contracts for the provision of
goods or services let by a public entity, or which otherwise transacts or applies to transact business
with a public entity. -The term "person" includes those officers, directors, executives, partners,
shareholders, employees, members, and agents who are active in management of an entity.
6. Based on information and belief, the statement which I have marked below is true in relation to the
entity submitting this sworn statement. (Indicate which statement applies.)
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X X Neither the entity submitting this sworn statement, nor
executives, partners, shareholders employees, who are of its officers, a directors,
o
members, or agents who are active in the management of
the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime
subsequent to July 1, 1989.
The entity submitting this sworn statement, or one or more of its officers, directors,
executives, partners, shareholders, employees, members, or agents who are active in the management of
the entity, or an affiliate of the entity has been charged with convicted of a public entity crime •
subsequent to July 1, 1989.
f" The entity submitting this sworn statement, or one or more of its officers, directors,
executives, partners, shareholders, employees, members, or agents who are active in the management of
the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime
subsequent to July 1, 1989. However, there has been a subsequent proceeding before a Hearing Officer
of the State of Florida, Division of Administrative Hearings and the Final Order entered
Officer determined that it was not in the by the Hearing
public interest to place the entity submitting this sworn
.:'I` statement on the convicted vendor list. (attach a copy of the final order)
I UNDERSTAND THAT THE SUBMISSION OF THIS FORH TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED iN
j� PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, THAT THiS FORM IS VALID THROUGH DECEMBER 31 OF THE
CALENDAR YEAR IN WHICH iT IS FILED. 1 ALSO UNDERSTAND THAT I AM REOUIRED TO INFORI) THE PUBLIC ENTITY PRiOR TO
ENTERING INTO A CONTRACT iN EXCESS OR THE THRESHOLD AMOUNT PROVIDED IN S CT 287.017, FLORIDA STATUES FOR
CATEGORY TWO OF ANT CHANGE IN THE INFORMATION CONTAINED IN THIS FORM '
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/ (Signatu
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July 7,1992
(date)
STATE OF Florida
CCUNTY Mnr,rpa
PERSONALLY APPEARED BEFORE HE, the undersigned authority,
calm Parker III who, after first being sworn by me, (name of individual signing)
affixed his /her signature in the space provided above on this 7 r h day of J u 1 Y , 19 9 2 .
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/v n. e.. A nCJt
NOTARY PUBLIC
My commission expires:
Notary Public, State of Florida
My Commission Expires D.c. 3, 1994
bonded Thru Troy Fein -Insurance Inc.
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Form PUR 7068(Rev. 04/10/91)
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TRINEMMor
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Exhibit C
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Non - Collusion Affidavit
II .
1, John Parker III of the city of Key West, Florida •
5 according to law on on). oath, and under pc-nalo. of perjury, depose and say that; ,.
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1,) l ain P.r,esident
M - •:-. .
of the jnnuof Parker RPfri , the bidder making
the Proposal for the project described in the notice for calling for bids for:
I K.W. International Airport,FIS Renovation
and that l crcctn ed the said proposal with full authonr• so do so;
11 I) the pricer in this bid have been arircd as independently without collusion, consultanion, conunurnication or °gement for
the purpose of restricting competition, as to any matter relating to such process with any other bidder or with any
• competitor,
3.) unlcu otherwise required by law, the pricer which have been quoted in this bid have not been knowingly disclosed b the
'. bidder and will not bsow usgly b.: disclbsca by the bidder and will not be knowingh• disclosed by the bidder prior to bid
opining direcry or indirect!); to any other bidder or to any competitor, and
I.) no wtanpt hat been mode or will be anode by the bidder to induce any other person, parnraship or corporation to submit,
or not to srrbmi; a bid fur the purpose of restricting competition;
ig S.) the statements contained its this or o re taste and correct, and mode wish full ksrow kdge that Alon roc County relies
upon the teeth of the srar1ert su nr used in this affidavit in awarding controcu for said project.
g 1 .( . /!• July 7 , 1992
(Ssgnanue - riddo) (Dart)
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STATE OF: Florida • .
ma
II COUNTY OF.: MOnroe • •
II PERSONALLY APPEARED BEFORE ME, the undersigned audionn,, John Parker III whno, after firm bring swam by
" John Parker III
(name of individual signing) offued blither srgtatrtrc m the space provided above on this_7 day
of July , 1 s _42
II
Vi? il Yt■7r,/ v fl
NOTARY P.UBLI
My c0J,; iision piniress, `
%t ory tubbe Dots of Mae
I . My Commission Expires Doc. 3, 1994
rondod Thn, Troy Foist • Mrwann Int'.
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Exhibit D
EQUAL OPPORTUNITY REPORT STATEMENT
(Must be completed and submitted with the Proposal)
Each Contractor shall complete and sign the Equal
Opportunity Report Statement. A proposal may be considered
unresponsive and may be rejected, in the Owner's sole discretion,
if the Contractor fails to provide the fully executed Statement
or fails to furnish required data. The Contractor shall also
prior to award, furnish such other pertinent information -
regarding its employment policies and practices as well as those
of its proposed Subcontractors as FAA, the Owner, or the
Executive Vice President of the President's Committee may
require.
The Contractor shall furnish similar Statements executed by
each of its• first -tier and second -tier Subcontractors•and shall
obtain similar compliance by such Subcontractors, before awarding
Subcontracts. No Subcontract shall be awarded to any
noncomplying Subcontractor.
EQUAL OPPORTUNITY REPORT STATEMENT
AS REQUIRED IN 41 CFR 60 -1.7 (b)
The Contractor shall complete the following statements by
checking the appropriate blanks. Failure to complete these
blanks may be grounds for rejection of proposal.
1. The Contractor has x has not developed and has on
file at each establishment affirmative action programs
pursuant to 41 CFR 60 -1.40 and 41 CFR 60 -2.
2. The Contractor has x has not participated in any
previous Contract or Subcontract subject to the equal
opportunity clause prescribed by Executive Order 11246, as
amended.
3. The Contractor has X has not filed with the Joint
Reporting Committee the annual compliance report on Standard
Form 100 (EEO -1 Report).
4. The Contractor does does not x -m•lo fifty or
more employees.
- !- r. INc .
/ (Name of ontractor)'
Dated: July 7,1992 .7nhn Parkrr III
Prpgilonf
(Title)
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Exhibit E
CERTIFICATION OF NON - SEGREGATED FACILITIES
(Must be completed and submitted with the proposal)
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The Contractor certifies that it does not maintain or
provide -:for its employees any segregated faciliteies at any of
its establishments, and that it does not permit its employees to
perform their services on any location under its control, where
segregated facilities are maintained. The Contractor certifies
further that it will not maintain or provide for its employees
segregated facilities at any of its establishments, and that it
will not permit its employees to perform their services at any
location under its control, where segregated facilities are
maintained. The Contractor agrees that a breach of this
certification is a violation of the equal opportunity clause in
this Contract. As used in this certification, the term
* "segregated facilities" means any waiting rooms, work areas,
!] restrooms and washrooms, restaurants and other eating areas,
timeclocks, locker rooms and other storage or dressing areas,
parking lots, drinking fountains, recreation or entertainment
areas, transportation and housing facilities provided for
employees which are segregated by explicit directive or are in
fact segregated on the basis of race, color, religion, or
national origin, because of habit, local custom, or any other
reason. The Contractor agrees that (except where it has obtained
identical certification from proposed Subcontractors for specific
time periods) it will obtain identical certifications from
proposed Subcontractors prior to the award of Subcontracts
exceeding $10,000 which are not exempt from the provisions of the
equal opportunity clause, and that it will retain such
certification in its files.
• !� Nc.
(N - e / a: Contractor)
Dated: July 7.1992 B o n er III
President
(Title)
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DISADVANTAGED BUSINESS ENTERPRISE DATA
(Must be completed and submitted with the Proposal)
Contractor's Required
Submission. Each prospective Contractor shall complete and
include the following proposed DBE subcontract work. Prior to award of
the Contract under this solicitation, the prospective Contracto
ability, attain in confirm, the
necessary, efforts made, to the best of the
established goal of DBE subcontract participation in this Contract,
DISADVANTAGED BUSINESS ENTERPRISE SUBCONTRACTORS -
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MBE SUBCONTRACTORS
Subcontract Dollar Value of
1 MBE Subcontractors Work Item Subcontract Work
Names /Addresses /Identi
Total Dollar Value of Subcontract Work
I Total Dollar Value of Basic Proposal
Percent of Total -0-
WOMEN SUBCONTRACTORS
Subcontract Dollar Value of
Women Subcontractors Work Item Subcontract Work
Names /Addresses /Iden
----------- _._.____--_
I . Total Dollar Value of Subcontract Work
Total Dollar Value of Basic Proposal
Percent of Total -p_
i OTHER DI3E SUBCONTRACTORS
Subcontract Dollar Value of
Other DBE Subcontractors Work Item Subcontract Work
1 Name_ /Addresses /Identity"
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Total Dollar Value of Subcontract Work
Total Dollar Value of Basic Proposal
Percent of Total -0-
Asian American. American Indian, and other economically
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LIST OF PROPOSED NON -DBE SUBCONTRACTORS
(Must be completed and submitted with the Proposal)
1
1 Responsible for:
Name:
"Address:
1 Responsible for •
Name:
I
Address:
I 1 Responsible for:
Tame:
1 Address:
LIST OP PROPOSED NON -DBE SUPPLIERS
(Must be completed and submitted with the Proposal)
Responsible for:
Name:
1 Address: •
1 Responsible for:
Name:
Address:
Responsible for:
Name:
Address:
MM
DISADVANTAGED BUSINESS UNAVAILABILITY CERTIFICATION
(Must be complete and submitted with the Proposal
for each unavailable DBE contacted)
I.
Name of Officer
Title
•
of
certify that on
I contacted the following disadvantaged Contractor
Date
3
to obtain a proposal for the following Work to be performed on:
Disadvantaged Contractor T Forms of Proposals
Ype o f Work (Unit Prices, etc.)
A
To the best of my knowledge and belief, said minority Contractor
was unavailable (exclusive of unavailability due to lack of
agreement on price) for Work on this project, or unable to
prepare a proposal for the following reason(s):
Signature:
1 Date:
I ,
, of
(Name) (Disadvantaged Co. Name)
was offered the opportunity on the above - identified work on
by
(Date)
The above statement is a true and accurate account of why I did
not submit a proposal on the project.
Signature:
Date:
Title:
Parker Refrigeration will be doing 100% of the work
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Exhibit G
LOBBYING AND CONFLICT OF INTEREST CLAUSE
SWORN STATEMENT UNDER ORDINANCE NO. 010 -1990
MONROE COUNTY, FLORIDA
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Parker Refri eration IN
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(Company)
a .... warranu that it has not cmpl0)r14 retained or o otherwise had act on its beta!
Section
2 of d No. 010.1990 o o • f any funno Couno• officer or anp1 c subject to the
prohibition of
For breach or Section ion of this finan N o . 0.1 my, y Counq• officer or employee in ►iolation of Section 3 of Ordinance No. 010 -1990
deduct from the contract or purchase price, or oth�rxisc r�covcr, the full amount of any fix, conunissian
County ay, in discretion, ta this contract without liability and may alto, in iu discretion, il 3 the fanner County officer or employee:
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pocouogt; � fS or consideration pore
g •
01 -.. _' r i
(Signature)
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John Parker III
cote JuiY ...
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ST4 TE OF ____Ea ,
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1 COUNTY OF Monroe
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P ERSONALLY APPEARED BEFORE AI& the undersigned authorrv, '
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t who. after just being swum •
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by n erred hislhcr signature
day of Ju 1� 19 9 27
n - (note of individual signing) in the space provided above on this 7 t h
I
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NOTAKY PUBLIC
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• commission Ciltircz:
r Wary Mk Side of Fiends
My Commission Expires Dec. 3, 1994 '
_ , bonded fibre Trey Fain • Mumma Mt:
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SUU I I1tKNMUS I 1NUKHNl.t I LL NO ..SU 1 (4 S 1.5 , y 1 0;1( IVO . UU1 r . U1/ U1
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.... _.. _ .. ,,.. . _. - - � � ISSUE DATE (MMroo
a1;1i1�IM. CERTIFICATE OF INSURANCE 9/23/
1 PRODUCER ; THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
Southernmost Insurance Agency ; CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
1104 Truman Avenue 1 POLICIES BELOW.
P.O. Box 323 COMPANIES AFFORDING COVERAGE •
Key West, Fl. 33041 •
COMPANY •
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LET1EH A united States Fideli 'y 6 Guaranty Company
COMPANY 9
INSURED LETTER {
Parker Refrigeration COMPANY "
LETTER •
2405 Seidenberg Avenue /
Key West, Fl . 33040 CO T PRNY o (6-.
• LET <
L �
COMPANY E
.,,. LETTER .._.__.�._., r.. �.,_. -- . «.,..... - ._...« ._....�..
THIS I$ 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.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE (MM /DD/YY) DATE (MWDD/YY)
GENERAL LIABILITY GENERAL AGGREGATE $1,500,000.
A X COMMERCIAL GENERAL LIABILITY PIiDUUCIS COMP /OP AGG. S 1,500,000.
CLAIMS MADE x . 00CUR. 1CP30001744301 2/28/92 2/28/93 PERSONAL & ADV. INJURY t 500, 000.
OWNER'S 1 CONTRACTOR'S PAOT. EACH OCCURRENCE $ 500, 000.
EIRE DAMAGE (Any one tiro) 1 50,000.
MED. EXPCN +E (Any one parson) $ 5,000. '
AUTOMOBILE UABILITY COMBJNED SINGLE i 500, 000.
ANY AUTO LIMIT
ALL OWNED AUTOS BODILY INJURY 1
SCHEDULED AUTOS (Poi person)
1CP30001744301 2/28/92 2/28/93
A X HIRED AUTOS (Per BODILY
accident)
S
• X NON•OWNED AUTOS
X GARAGE LIABILITY PROPERTY DAMAGE S
EXCESS LUIeIUTY -' --- _.._._�_.........,..- - -- - . �- --•- ---'^..• •..•,� EACH OCCURRENCE i ._..�~
• UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM
STATUTORY LIMITS
WORKER'S COMPENSATION
EACH ACCIDENT 1
AND DISEASE - POLICY LIMIT S
EMPLOYERS' LIABILITY DISEASE-EACH EMPLOYEE 1
OTHER -•T
DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /SPECIAL ITEMS
* ** *Monroe County * ** * * * * * * * * * *** * ** Additional Insured.
CEBTI,FJQ ]
ATE_HODER . CANCELLATION - � �
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE •
Monroe County EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
P.D. Box 1029. M AIL 3 D AYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
Key West, Fl. 33041 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
ATTN: Desire Peacock LIABILITY OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPR TATIV! __.— .... • •- --
dL T ot 01
ACORD 26 -S ( 7190) _-- _T...... • C>< CACORD CORPORATION 1990 ,
FLORIDA ROOFING, SHEET METAL &AIR CONDITIONING CONTRACTORS ASSOCIATION, INC.
R SELF INSURERS FUND
P.O. BOX 4907 • WINTER PARK, FL 32793 • (407) 671 -FRSA
1- 800 - 476 -3772 • FAX (407) 679 -0010
CERTIFICATE OF INSURANCE
ISSUED TO:
Monroe County, Board of Cty
Commissioners, Public Svc Bldg J�f L
o
5100 College Rd., Room 002 ( ,� i
Key West FL 33040 t - 1
This is to certify that Parker Refrigeration, Inc.
2405 SEIDENBERG AVE
KEY WEST FL 33040 -3854
being subject to the provisions of the Florida Workers' Compensation Act, has secured the ^payment of
compensation by insuring their risk with the FLORIDA ROOFING, SHEET METAL & AIR CONDITIONING
CONTRACTORS ASSOCIATION SELF INSURERS FUND.
COVERAGE NUMBER: 8 -70 -1111 LIMITS
Workers' Compensation Statutory - State of Florida
EFFECTIVE DATE: 04/07/83
Employers' Liability $100,000 - Each Accident
EXPIRATION DATE: 12/31/92 $100,000 - Disease, Each Employee
$500,000 - Disease, Policy Limit
REMARKS: Non - cancelable without 30 days prior written notice.
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This certificate is not a policy and of itself does not afford any insurance. Nothing contained in this certificate
shall be constructed as extending coverage not afforded by the policy(ies) shown above or as affording
insurance to any insured not named above.
DATE: 07/28/92 By: 4
Tom D d e, Administrator
FRSA -SIF
By:
Lucy Doyle - S A ccounts Rep a entative
FRSA -SIF