FY2012 04/18/2012 DANNY L. KOLHAGE
CLERK OF THE CIRCUIT COURT
DATE: April24, 2012
TO: Lynda Stuart, Office Manager
Tourist Development Council
ATTN: Maxine Pacini
Administrative Assistant
FROM: Pamela G. Hanc
At the April 18, 2012, Board of County Commissioners meeting, the Board granted
approval and authorized execution of the following:
Item D1 Interlocal Agreement with the City of Key West covering the Rest Beach
Renourishment project in an amount not to exceed$245,000, DAC I, FY 2012 Capital Resources.
Item D2 Agreement with Florida Keys Community College and the Letters "FKCC"
covering the Tennessee Williams Backstage repair and repurposing project in an amount not to
exceed $100,000, DAC I, FY 2012 Capital Resources.
Item D3 Agreement with Key West Players, Inc., covering the Electrical Upgrade project at
the Waterfront Playhouse in an amount not to exceed $45,000, DAC I, FY 2012 Capital
Resources.
Item D4 Agreement with Upper Keys Community Pool, Inc. covering the Competition
Enhancements project in an amount not to exceed $50,500, DAC V, FY 2012 Capital Resources.
Item D5 Agreement with The Key West Harry S. Truman Foundation, Inc. covering the
Roof Repairs and Historic Floor Covering project in an amount not to exceed $42,878, DAC I,
FY 2012 Capital Resources.
Item D6 Agreement with Key West Botanical Garden Society, Inc. covering the Key West
Botanical Security and Accessibility Enhancements project in an amount not to exceed $22,700,
DAC I, FY 2012 Capital Resources.
Item D7 Amendment to Agreement with Hawk's Cay Resort to revise name of
organization to BH/NV Hawk's Cay Property Holdings, LLC, dba Hawk's Cay Resort; name of
event from Conchtoberfest to Christmas in the Keys Celebration, and date of event to November
3 — December 2, 2012.
Item D8 Amendment to Agreement with Florida Keys Land and Sea Trust, Inc. to extend
termination date to December 31, 2012 and revise Exhibit A.
Attached are electronic copies of each of the above - mentioned for your handling. Should
you have any questions, please feel free to contact me.
cc: County Attorney w/o documents
Finance
File
Grant Award Agreement
THIS AGREEMENT (agreement) is entered into this /o da Y of
2012 by and between MONROE COUNTY, a political subdivision of the State
of Florida (County or Grantor) and Key West Botanical Garden Society, Inc. a not for
profit organization organized and operating under the laws of the state of Florida
(Grantee).
WHEREAS, the district pennies of Tourist Development Tax may be used
to acquire, construct, extend, enlarge, remodel, repair or improve, convention centers,
sports stadiums, sports arenas, coliseums, auditoriums, fishing piers, museums, zoological
parks, nature centers, beach improvements and beach park facilities which are publicly
owned and operated or owned and operated by not - for - profit corporations, and
WHEREAS, Grantee has applied to TDC District I for funding for the
Security and Accessibility enhancements project; and
WHEREAS, the Grantor and Tourist Development Council (TDC) have
determined that it is in the best interest of the County, for purposes of promoting tourism
and preserving the heritage of the community, to attract tourists, and improving the
property for use as a nature center that is open to the public;
NOW, THEREFORE, in consideration of the mutual covenants and
payments contained herein, the Grantee and the Grantor have entered into this agreement
on the terms and conditions as set forth below.
1. GRANT AGREEMENT PERIOD. This agreement is for the period of April 18, 2012
through to September 30, 2013. This agreement shall remain in effect for the stated period
unless one party gives to the other written notification of termination pursuant to and in
compliance with paragraphs 7, 12 or 13 below.
2. SCOPE OF AGREEMENT. The representations made by the Grantee in its
proposal submitted to the TDC are incorporated herein by reference. The Grantee shall
provide the following scope of services: Materials and labor required to complete the
Security and Accessibility enhancements project. Segment(s) of the work is /are more
particularly described in Exhibit(s) A, detailing the work and the cost allocable to each
segment, attached hereto and incorporated herein by reference. Anything not
referenced within exhibit A will not be reimbursed. All work for which grant funds are
to be expended must be completed by the stated termination date of September 30, 2013
and all invoices pertaining to this project shall be submitted to the Finance Department of
Monroe County no later than September 30, 2013 to be considered for payment.
Acknowledgement Grantee shall be required to permanently display and maintain at
Grantee's expense, public acknowledgement of the support of the Monroe County Tourist
Development Council in a publicly prominent area of their facility in the following form:
"This project was made possible with the financial support of the Monroe County Tourist
FY 2012 Funding
Contract ID #: 1008
Key West Botanical
Development Council." If the Grantee has already complied with this requirement through
previous funding, said acknowledgement fulfills this condition. A photograph of said
acknowledgment shall be provided with the final request for reimbursement outlined in
Exhibit A of this agreement.
a.) There shall be a project manager to acknowledge receipt of goods or work
performed. This Project Manager shall be Misha McRAE, 5210 College Road, Key
West, FL 33040 (Telephone: 469- 744 - 8165 /E -mail: kwbgs(cD-kwbgs.org Should
there be a change in the project manager specified in the Grantee's application, a
new project manager shall be designated and notice with new contact information
shall be provided in writing to the TDC administrative office.
b.) If, and to the extent that, Grantee contracts for any of the work funded under
this agreement to be performed or completed, Grantee shall give notice to County
of the contractual relationship, provide County with a copy of any and all contracts
and shall require the contractor(s) to comply with all the terms of this contract.
Should Grantee contract the work and then decrease the scope of work to be
performed by a contractor, Grantee shall provide County with an amended contract
executed by Grantee and its contractor.
(i) A Grantee which is a governmental entity shall comply with the
procurement regulations and policies to which it is subject, and shall provide
Grantor documentation of the procurement requirements applicable to the
project and compliance therewith.
(ii) A Grantee which is a not - for - profit entity shall use procurement
processes for those parts of the project to be contracted (not performed by
the entity's employees) as follows. For work expected to be under $25,000,
the not - for - profit shall document in the file two written quotes or a notarized
statement as to why such written quotes were not feasible for the goods or
services. For work expected to be $25,000 or more, a competitive bid
process must be performed following Monroe County's procurement policies
and procedures must be followed, unless the commodities or services will be
provided by a "sole source" provider, in which case the not - for - profit must
submit a notarized statement with its request for payment explaining why the
vendor is the only source for the commodities or services.
c.) Grantee shall exercise good internal controls to assure that the project as
described in the funding application shall be completed on a timely basis within the
proposed budget and shall provide to County any certifications, including those by
the architect, engineer, contractor or an independent consultant if necessary,
required to establish that materials which are purported to be applied to the project
are in fact so applied. Further verification shall be required to show that equipment
and other fixtures and personal property covered by this agreement are delivered to
and installed in the project site. When any permit is required by any governmental
agency, copies of plans and other documents which are submitted to the applicable
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agency shall be submitted to the County Engineering Division to enable verification
that the scope of services under this agreement has been provided.
3. AMOUNT OF AGREEMENT AND PAYMENT. The Grantor shall provide an
amount not to exceed $22,700 (TDC District I funding) for materials and services used to
improve the property (applicant has noted that they will use an amount not to exceed
$11,350 in in -kind services). Reimbursement request must show that Grantee has paid in
full for materials and services relating to the segment prior to seeking the 50% (fifty
percent) reimbursement from Grantor. Payment shall be 50% (fifty percent)
reimbursement of the total cost of the segment, subject to the cap on expenditures for that
segment as set forth in Exhibit A. Reimbursement can be sought after each segment of
the agreement is completed and signed by the Monroe County Engineering Department as
outlined in 3.a. The Board of County Commissioners and the Tourist Development Council
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 shall be made upon the completion of a specific segment as
outlined in the Scope of Services and Exhibit A. Payment for expenditures
permissible by law and County policies shall be made through reimbursement to
Grantee upon presentation of Application for Payment Summary, AIA Document
G702 or similar certification as required below for governmental entities and not -for-
profit entities, invoices, canceled checks and other documentation necessary to
support a claim for reimbursement. Included in said documentation shall be proof
that the Grantee has received the property, realty or personalty, for each segment
of agreement as outlined in Exhibit A and paid an amount equal to or greater than
the amount invoiced to the Grantor. It shall be necessary for the Grantee to contact
the County Engineering Division and to arrange for inspections upon the completion
of each segment. The documentation needed to support the payment request shall
be in the form necessary for submission and available to the County Engineer at the
time of inspection. All submissions for payment shall have a proposed schedule of
values for segment(s) 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. It shall be the
responsibility of the project architect, engineer, general contractor, or project
manager to initiate the communication with the Monroe County Engineering Division
to facilitate the inspection(s) of the segment of the project. All submissions
requesting payment shall be approved in writing, and signed, by the Monroe County
Engineering Division as to the completion of the segment of the project for which
payment is requested. 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.
For projects exceeding $25,000 in TDC funding under this agreement, final payment
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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 (when
applicable)
Final Release of Lien or Affidavit and Partial Release of Lien
For projects for which TDC funding under this agreement is $25,000 or less, the AIA
documentation is not required, but sufficient documentation must be submitted to
County to provide similar assurances that the work has been completed and
contractors /suppliers paid.
All payment requests must be submitted no later than the completion of project of
September 30, 2013. Invoices received after September 30, 2013 will not be
considered for payment.
b.) If in -kind services were noted within your application, and you are applying
them to this project, documentation shall be submitted to the TDC Administrative
Office to show the receipt and application of in -kind donations of goods,
professional services, and materials. Said documentation should include invoices,
bills of lading, etc., and be verified as received and applied to the project through a
notarized statement of the project architect, engineer, general contractor or project
manager. The receipt and application to the project of volunteer labor are to be
documented and verified by notarized signature of the project architect, engineer,
general contractor, or project manager, and said documentation submitted to the
TDC Administrative Office. All submissions shall identify the items included in
Exhibit A and Grantee shall complete the Application for Payment form which is
provided within the payment/reimbursement kit provided to the Grantee, listing the
schedule of values which are sought to be reimbursed and shall 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.
Photographs showing progress on project shall be included in any payment request.
The Project Manager shall certify delivery to the project site and installation therein
of any goods or services provided other than through an architect, engineer, or
contractor. All work performed and goods received on site and incorporated into the
project shall be verified by one of the foregoing. Submission of any documentation
which is untrue, falsified, or otherwise misrepresents the work which has been
completed, paid, or donated shall constitute a breach of agreement, for which
breach the contract may be immediately terminated at the discretion of the County,
whose decision shall be final.
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c.) Grantee must submit all documentation for final payment on or before the
termination date of this grant of September 30, 2013. Invoices received after
September 30, 2013 will not be considered for payment.
d.) At any time that the documentation requirement policies of Monroe County
are revised, such as to require annual inventory reports for equipment purchased
under a TDC capital project grant, Grantee shall comply thereafter with such
increased requirements, or further funding under the agreement may be terminated
by County.
e.) Upon successful completion of this Grant agreement, the Grantee may retain
ownership of the real and personal property acquired and /or improved with funding
under this Grant agreement. However, the Grantee shall maintain, preserve and
operate the property which was acquired or improved under this agreement for the
uses and purposes which qualified the Grantee for tourist development tax funding.
Grantee shall complete and sign a Property Reporting Form (provided within
payment/reimbursement package) for personal property and forward said
completed form with the appropriate invoice to the TDC Administrative Office. Real
property acquired or improved through funding under this agreement shall remain
dedicated for the purposes set forth herein or for other purposes which promote
tourism and ownership of said property shall be retained by the Grantee. The
following terms shall apply:
(i) The Grantee shall have the use of the property, including both realty
and personalty acquired with funding under this agreement, at the project site
for so long as the facility is operated by Grantee, open to the public, and has
a primary purpose of promoting tourism. At such time as any of the
conditions in the preceding sentence shall cease to exist, the Grantee shall
transfer ownership and possession of equipment and personal property to a
local government or another not - for - profit organization which is a facility for
which tourist development taxes may be used pursuant to Florida Statute
with prior approval from TDC and BOCC.
(ii) At any time that the Grantee: (a) elects to stop the project or otherwise
decide not to place into service for tourist - related purposes the facility
acquired, constructed, or renovated with tourist development tax funding, (b)
demolishes the project facility or divests itself of ownership or possession of
the real property, or (c) ceases the use of the property with a primary
purpose of promoting tourism, Grantee shall, pursuant to the formula set
forth hereafter, refund to the County the Tourist Development funding. This
provision shall survive the termination date of all other provisions of this
contract for a period of ten years. Should the demolition, transfer of
ownership, or change to a non - tourist related purpose occur after the facility
has been used for tourist - related purposes for at least three (3) years, the
amount of refund shall be pro -rated based on a useful life of ten (10) years.
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(iii) The Grantee is responsible for the implementation of adequate
maintenance procedures to keep the real and personal property in good
operating condition.
(iv) The Grantee is responsible for any loss, damage, or theft of, and any
loss, damage or injury caused by the use of, real or personal property or
equipment purchased through funding under this agreement.
4. RECORDS AND REPORTS. The Grantee shall keep such records as are
necessary to document the performance of the agreement and expenses as incurred, and
give access to these records at the request of the TDC, the County, the State of Florida or
authorized agents and representatives of said government bodies. The Grantee shall also
provide such access to the personal property and equipment purchased under this
agreement. It is the responsibility of the Grantee to maintain appropriate records in
accordance with generally accepted accounting principles consistently applied to insure a
proper accounting of all funds and expenditures. The Grantee understands that it shall be
responsible for repayment of any and all audit exceptions which are identified by the
Auditor General for the State of Florida, the Clerk of Court for Monroe County, the Board of
County Commissioners for Monroe County, or their agents and representatives. In the
event of an audit exception, the current fiscal year grant award or subsequent grant
awards will be offset by the amount of the audit exception. In the event the grant is not
renewed or supplemented in future years, the Grantee will be billed by the Grantor for the
amount of the audit exception and shall promptly repay any audit exception.
a.) Public Access. The County and Grantee 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 Grantee in conjunction with this
agreement; and the County shall have the right to unilaterally cancel this agreement
upon violation of this provision by Grantee.
5. MODIFICATIONS AND AMENDMENTS. Any and all modifications of the terms of
this agreement shall be only amended in writing and approved by the Board of County
Commissioners for Monroe County. The terms, covenants, conditions, and provisions of
this agreement shall bind and inure to the benefit of the County and Grantee and their
respective legal representatives, successors, and assigns.
6. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, the
Grantee is an independent contractor and not an employee of the Board of County
Commissioners of Monroe County. No statement contained in this agreement shall be
construed as to find the Grantee or any of its employees, contractors, servants or agents
to the employees of the Board of County Commissioners of Monroe County, and they shall
be entitled to none of the rights, privileges or benefits of employees of Monroe County.
a.) 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
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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.
7. COMPLIANCE WITH LAW. In carrying out its obligations under this agreement, the
Grantee shall abide by all statutes, ordinances, rules and regulations pertaining to or
regulating the provisions of this agreement, including those now in effect and hereafter
adopted. Any violation of said statutes, ordinances, rules or regulations shall constitute a
material breach of this agreement and shall entitle the Grantor to terminate this agreement
immediately upon delivery of written notice of termination to the Grantee.
8. RESTRICTIONS ON AGREEMENTS ENTERED PURSUANT TO THIS
AGREEMENT. The Grantee shall include in all agreements funded under this agreement
the following terms:
a.) Anti - discrimination. Contractor agrees that it will not discriminate against any
employees or applicants for employment or against persons for any other benefit or
service under this agreement because of their race, color, religion, sex, national
origin, or physical or mental handicap where the handicap does not affect the ability
of an individual to perform in a position of employment, and to abide by all federal
and state laws regarding non - discrimination.
b.) Anti - kickback. Contractor warrants that no person has been employed or
retained to solicit or secure this agreement upon an agreement or understanding for
a commission, percentage, brokerage or contingent fee, and that no employee or
officer of the Contractor has any interest, financially or otherwise, in County. For
breach or violation of this warranty, the County shall have the right to annul this
agreement without liability or, in its discretion, to deduct from the agreement price or
consideration, the full amount of such commission, percentage, brokerage or
contingent fee. Contractor acknowledges that it is aware that funding for this
agreement is available at least in part through the County and that violation of this
paragraph may result in the County withdrawing funding for the Project.
c.) Hold harmless /indemnification. Contractor acknowledges that this
agreement is funded at least in part by the County and agrees to indemnify and hold
harmless the County and any of its officers and employees from and against any
and all claims, liabilities, litigation, causes of action, damages, costs, expenses
(including but not limited to fees and expenses arising from any factual
investigation, discovery or preparation for litigation), and the payment of any and all
of the foregoing or any demands, settlements or judgments (collectively claims)
arising directly or indirectly from any negligence or criminal conduct on the part of
Contractor in the performance of the terms of this agreement. The Contractor shall
immediately give notice to the County of any suit, claim or action made against the
Contractor that is related to the activity under this agreement, and will cooperate
with the County in the investigation arising as a result of any suit, action or claim
related to this agreement.
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d.) Insurance. Contractor agrees that it maintains in force at its own expense a
liability insurance policy which will insure and indemnify the Contractor and the
County from any suits, claims or actions brought by any person or persons and from
all costs and expenses of litigation brought against the Contractor for such injuries
to persons or damage to property occurring during the agreement or thereafter that
results from performance by Contractor of the obligations set forth in this
agreement. At all times during the term of this agreement and for one year after
acceptance of the project, Contractor shall maintain on file with the County a
certificate of the insurance of the carriers showing that the aforesaid insurance
policy is in effect. The following coverage's shall be provided:
1. Workers Compensation insurance as required by Florida Statutes.
2. Commercial General Liability Insurance with minimum limits of $500,000
per occurrence for bodily injury, personal injury and property damage.
3. Comprehensive Auto Liability Insurance with minimum limits of $300,000
combined single limit per occurrence.
The Contractor, the County and the TDC shall be named as additional insured,
exempt workers compensation. The policies shall provide no less than 30 days
notice of cancellation, non - renewal or reduction of coverage.
At all times during the term of this agreement and for one year after acceptance of
the project, Contractor shall maintain on file with the County a certificate of
insurance showing that the aforesaid insurance coverage's are in effect.
e.) Licensing and Permits. Contractor warrants that it shall have, prior to
commencement of work under this agreement and at all times during said work, all
required licenses and permits whether federal, state, County or City.
f.) Right to Audit. The Contractor shall keep such records as are necessary to
document the performance of the agreement and expenses as incurred, and give
access to these records at the request of the TDC, the County, the State of Florida
or authorized agents and representatives of said government bodies.
9. HOLD HARMLESS /INDEMNIFICATION. The Grantee hereby agrees to indemnify
and hold harmless the BOCC/TDC and the 3406 North Roosevelt Blvd. Corporation or any
of its officers and employees from and against any and all claims, liabilities, litigation,
causes of action, damages, costs, expenses (including but not limited to fees and
expenses arising from any factual investigation, discovery or preparation for litigation), and
the payment of any and all of the foregoing or any demands, settlements or judgments
arising directly or indirectly under this agreement. The Grantee shall immediately give
notice to the Grantor of any suit, claim or action made against the Grantor that is related to
the activity under this agreement, and will cooperate with the Grantor in the investigation
arising as a result of any suit, action or claim related to this agreement.
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a.) Non - Waiver of Immunity. Notwithstanding the provisions of Sec. 768.28,
Florida Statutes, the participation of the County and the Grantee 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.
b.) 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.
10. NONDISCRIMINATION. County and Grantee agree that there will be no
discrimination against any person, and it is expressly understood that upon a
determination by a court of competent jurisdiction that discrimination has occurred, this
agreement automatically terminates without any further action on the part of any party,
effective the date of the court order. County or Grantee agree to 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 patent 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 maybe amended from time to time, relating to nondiscrimination on
the basis of disability; 10) Any other nondiscrimination provisions in any Federal or state
statutes which may apply to the parties to, or the subject matter of, this agreement.
11. ANTI - KICKBACK. The Grantee warrants that no person has been employed or
retained to solicit or secure this agreement upon an agreement or understanding for a
commission, percentage, brokerage or contingent fee, and that no employee or officer of
the County or TDC has any interest, financially or otherwise, in the said funded project,
except for general membership. For breach or violation of this warranty, the Grantor shall
have the right to annul this agreement without liability or, in its discretion, to deduct from
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the agreement price or consideration, the full amount of such commission, percentage,
brokerage or contingent fee.
12. TERMINATION. This agreement shall terminate on September 30, 2013.
Termination prior thereto shall occur whenever funds cannot be obtained or cannot be
continued at a level sufficient to allow for the continuation of this agreement pursuant to
the terms herein. In the event that funds cannot be continued at a level sufficient to allow
the continuation of this agreement pursuant to the terms specified herein, this agreement
may then be terminated immediately by written notice of termination delivered in person or
by mail to Grantee. The Grantor may terminate this agreement without cause upon giving
written notice of termination to Grantee. The Grantor shall not be obligated to pay for any
services or goods provided by Grantee after Grantee has received written notice of
termination.
13. TERMINATION FOR BREACH. The Grantor may immediately terminate this
agreement for any breach of the terms contained herein. Such termination shall take place
immediately upon receipt of written notice of said termination. Any waiver of any breach of
covenants herein contained to be kept and performed by Grantee shall not be deemed or
considered as a continuing waiver and shall not operate to bar or prevent the Grantor from
declaring a forfeiture for any succeeding breach either of the same conditions or of any
other conditions. Failure to provide Grantor with certification of use of matching funds or
matching in -kind services at or above the rate of request for reimbursement or payment is
a breach of agreement, for which the Grantor may terminate this agreement upon giving
written notification of termination.
14. ENTIRE AGREEMENT. This agreement constitutes the entire agreement of the
parties hereto with respect to the subject matter hereof and supersedes any and all prior
agreements with respect to such subject matter between the Grantee and the Grantor.
15. 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. This
agreement is not subject to arbitration. 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.
a.) Venue. In the event that any cause of action or administrative proceeding is
instituted for the enforcement or interpretation of this agreement, the County and
Grantee agree that venue shall lie in the appropriate court or before the appropriate
administrative body in Monroe County, Florida.
b.) 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
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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 Grantee 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.
c.) Attorney's Fees and Costs. The County and Grantee 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, court costs, investigative, and out -of- pocket expenses in
appellate proceedings.
d.) Adjudication of Disputes or Disagreements. County and Grantee 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 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 may be provided by this agreement
or by Florida law. This agreement shall not be subject to arbitration.
e.) 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 Grantee 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 Grantee specifically agree that no party to this
agreement shall be required to enter into any arbitration proceedings related to this
agreement.
16. ETHICS CLAUSE: Grantee warrants that he has not employed, retained or
otherwise had act on his behalf any former County officer or employee in violation of
Section 2 or 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 the provision the Grantor
may, at its discretion terminate this agreement without liability and may also, at its
discretion, deduct from the agreement or purchase price, or otherwise recover, the full
amount of any fee, commission, percentage, gift, or consideration paid to the former or
present County officer or employee. The County and Grantee warrant that, in respect to
itself, it has neither employed nor retained any company or person, other than a bona 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 Grantee agrees that the County shall have
the right to terminate this agreement without liability and, at its discretion, to offset from
FY 2012 Funding
Contract ID #: 1008
Key West Botanical
11
monies owed, or otherwise recover, the full amount of such fee, commission, percentage,
gift, or consideration.
a.) Covenant of No Interest. County and Grantee 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.
b.) 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.
17. 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 an agreement to provide any goods or services to a public entity, may not submit a
bid on an agreement 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, sub - contractor, or consultant under an
agreement with any public entity, and may not transact business with any public entity in
excess of the threshold amount provided in Section 287.017, Florida Statutes, for
CATEGORY TWO for a period of 36 months from the date of being placed on the
convicted vendor list. By executing this document grantee warrants that it is in compliance
with this paragraph.
18. AUTHORITY: Grantee warrants that it is authorized by law to engage in the
performance of the activities encompassed by the project herein described. Each of the
signatories for the Grantee below certifies and warrants that the Grantee's name in this
agreement is the full name as designated in its corporate charter (if a corporation); they
are empowered to act and contract for the Grantee, and this agreement has been
approved by the Board of Directors of Grantee or other appropriate authority.
19. LICENSING AND PERMITS: Grantee warrants that it shall have, prior to
commencement of work under this agreement and at all times during said work, all
required licenses and permits whether federal, state, County or City.
20. INSURANCE: Grantee agrees that it maintains in force at its own expense a liability
insurance policy which will insure and indemnify the Grantee and the Grantor from any
suits, claims or actions brought by any person or persons and from all costs and expenses
of litigation brought against the Grantee for such injuries to persons or damage to property
occurring during the agreement or thereafter that results from performance by Grantee of
the obligations set forth in this agreement. At all times during the term of this agreement
and for one year after acceptance of the project, Grantee shall maintain on file with the
Grantor a certificate of the insurance of the carriers showing that the aforesaid insurance
policy is in effect. The following coverage's shall be provided:
FY 2012 Funding
Contract ID #: 1008
Key West Botanical
12
1. Workers Compensation insurance as required by Florida Statutes.
2. Commercial General Liability Insurance with minimum limits of $500,000
Combined Single Limit (CSL) If split limits are provided, the minimum
limits acceptable shall be $250,000 per Person $500,000 per occurrence
$50,000 property damage.
3. Comprehensive Auto Liability Insurance with minimum limits of $300,000
combined single limit per occurrence.
The Grantee, the Grantor, and the TDC shall be named as additional insured, except
workers compensation. The policies shall provide no less than 30 days notice of
cancellation, non - renewal, or reduction of coverage. Grantee shall provide to the County,
as satisfactory evidence of the required insurance, including the insurance policy
application and either:
• Original Certificate of Insurance, OR
• Certified copy of the actual insurance policy, OR
• Certificate of Insurance e- mailed from Insurance Agent/Company to
County Risk Management - Telephone Maria Slavik at (305) 295 -3178 for
details (Certificates can be e- mailed directly from the insurance agency
to: Slavik- MariaCcD-MonroeCounty- FL. Gov — The e-mail must state that
this is a certificate for a TDC project and should be forwarded to Maxine
Pacini at the TDC administrative office)
An original certificate or a certified copy of any or all insurance policies required by this
contract shall be filed with the Clerk of the BOCC prior to the contract being executed by
the Clerks office. The Insurance policy must state that the Monroe County BOCC and
Monroe County TDC is the Certificate Holder and additional Insured for this contract
(certificate only for worker's compensation coverage). Insurance information should be
mailed to:
Monroe County Board of County Commissioners
c/o Risk Management
P.O. Box 1026
Key West, FL 33041
21. NOTICE. Any notice required or permitted under this agreement shall be in writing
and had delivered or mailed, postage prepaid, to the other party by certified mail, returned
receipt requested to the following:
For Grantee: Misha McRAE
5210 College Road
Key West, FL 33040
FY 2012 Funding
Contract ID #: 1008
Key West Botanical
13
For Grantor: Lynda Stuart
Monroe County Tourist Development Council
1201 White Street, Suite 102
Key West, FL 33040
and
Cynthia Hall, Asst. County Attorney
P.O. Box 1026
Key West, FL 33041 -1026
22. CLAIMS FOR FEDERAL OR STATE AID. Contractor and County agree that each
shall be, and is, empowered to apply for, seek, and obtain federal and state funds to
further the purpose of this agreement; provided that all applications, requests, grant
proposals, and funding solicitations shall be approved by each party prior to submission.
23. 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.
24. 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 Grantee agree that neither the County nor the Grantee
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.
25. ATTESTATIONS. Grantee agrees to execute such documents as the County may
reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a
Drug -Free Workplace Statement.
26. 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.
FY 2012 Funding
Contract ID #: 1008
Key West Botanical
14
27. FORCE MAJEURE. The Grantee shall not be liable for delay in performance or
failure to complete the project, in whole or in part, due to the occurrence of any
contingency beyond its control or the control of its contractors and subcontractors,
including war or act of war whether an actual declaration thereof is made or not, act of
terrorism impacting travel in the United States, insurrection, riot or civil commotion, act of
public enemy, epidemic, quarantine restriction, storm, flood, drought or other act of God, or
act of nature (including presence of endangered animal species which cannot be timely
removed in a safe manner or any act of any governmental authority which prohibits the
project from proceeding as described in the scope of services and incorporated references
and which the Grantee has exercised reasonable care in the prevention thereof. However,
lack of planning for normal and expected weather conditions for the time of year the project
is to be executed shall not constitute an act of God excusing a delay. Any delay or failure
due to the causes stated shall not constitute a breach of the agreement; however, the
BOCC shall have the right to determine if there will be any reduction to the amount of
funds due to the Grantee after consideration of all relevant facts and circumstances
surrounding the delay in performance or failure to complete the project within the contract
period. Upon demand of TDC or BOCC, the Grantee must furnish evidence of the causes
of such delay or failure. BOCC shall not pay for any goods received or services provided
after the date(s) described in paragraph 1 and Scope of Services.
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.
REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
FY 2012 Funding
Contract ID #: 1008
Key West Botanical
15
- 04-WITNESS; WHEREOF, the parties hereto have caused this agreement to be executed
the.dAy and year first above written.
�SEALa` Board of County Commissioners
Avast: Danny L. Kolhage, Clerk of Monroe County
Deputy Cleric
(CORPORATE SEAL)
By.
Secretary
Print Name
Date:
OR TWO WITNESSES
(1)
Print Name
Date:
MayodChairma
Key West Botanical Garden Society, Inc.
IiQ
By
President
Print Nam
Date: I Z I
(2)
N
(2)
Print Name
Date: c-?
MONROE COUNTY ATTORNEY
AP OVE AS Tp F R
{�
ASSISTART C O UNTY ATTORNEY
Date — 3 — $. - �Zol
FY 2012 Funding
CoWad IDS.' 1008
Key West Botanical
16
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KWBOT-1 OP ID: TM
A`C_O�RO` CERTIFICATE OF LIABILITY INSURANCE
DA TE
03/19 /�12�
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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the ten, a 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(*).
PRODUCER 305- 294 -1098
Key West Insurance, Inc. 305 - 294 -8016
648 United Street, Suits 1
Key West, FL 33040
Key West Insurance, Inc.
NAME:
' PHONE o :
ASS:
INSURER(S) AFFORDING COVERAGE
NAIL A
INSURER A:Westem Heritag Insurance Com
CLAIMS MADE a OCCUR
MED EXP (Any one person)
INSURED Key West Botanical Garden
Society, nc.
5210 College Road
Key West, FL 33040
INSURERS:
PERSONAL & ADV INJURY
INSURER c
X Hired/Non -owned a
INSURER 0.
S 2
GEML AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG
$ 2,000,00
INSURER!:
INSURER :
AUTOMOBILE LL&A JTY
r`nVCQA[.FC CERTIFICATE NUMBER: REVISION NUMBER:
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.
1100 Simonton St
Key West, FL 33040
AUTHOROD REPRESEN ATIVE
Key t Insure e, Inc. '
INSR TYPE OF INSURANCE POLICY NUMaER Y
LWlli8
GENERAL LIABILITY
EACH OCCURRENCE
II 1,000,00
A X COMMERCIAL GENERAL LIABILITY X SCP0874330 12125/11 12125/12
P I F
t 100,00
CLAIMS MADE a OCCUR
MED EXP (Any one person)
$ 1,0
PERSONAL & ADV INJURY
S 1,000,00
X Hired/Non -owned a
GENERAL AGGREGATE
S 2
GEML AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG
$ 2,000,00
X POLICY PRO- LOC
$
AUTOMOBILE LL&A JTY
EOMBINE�D SINGLE LIMIT
III
BODILY INJURY (Per person)
$
ANY AUTO
BODILY INJURY (Per accident)
$
ALL ONMED SCHEDULED
AUTOS AUTOS
HIRED AUTOS AUTOS
(Per (
er a cicWt) D AMAGE
$
S
s"RE
um LLA LUIE
OCCUR
- -
EACH OCCURRE NCE
S
H
AGGREGATE
$
EXCESS LIAR
CLAIMS -MADE
k
' \
v
DED I I RETENTION
S
'
WORKERS COMPENSATION
WC STATU- I OTH-
AND EMPLOYERS' LUUBIJTY YIN
ANY PROPRIETORIPARTNERMXECUTIVE
E.L. EACH ACCIDENT
S
OFFICER/MEMBER EXCLUDED? ❑
NIA
(Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE
S
Nro desaiDSunder
DESCRIPTION OF OPERATIONS Dhow
E.L. DISEASE - POLICY LIMIT
S
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Aeaoh ACORD 101, Additional Phowl a SdhWule. N mere apace is nRLdred)
Amu sement Centers - parka /gardens to include special events
Mo nroe County BOCC and Monroe County TDC are named additional insureds as
their interest may appear.
CFRTIFICATF 14nLnFR CAMCFI 1 ATIC M
0 191P.2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered ms&s of ACORD
SHOULD ANY OF THE AB E DESCRIBED POLICIES BE CANCELLED BEFORE
Monroe County BOCC &
tY
Monroe County TDC
THE EXPIRATION D AVE HEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH�IiE P ICY PROVISIONS.
/
1100 Simonton St
Key West, FL 33040
AUTHOROD REPRESEN ATIVE
Key t Insure e, Inc. '
0 191P.2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered ms&s of ACORD
I I— l e DATE (MWDDM/YY)
ACORO CERTIFICATE OF LIABILITY INSURANCE 03/19/2012
THIS.CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPONTHE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTERTHE COVERAGE AFFORDED BYTHE 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(fes) 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).
ACT
PRODUCER NAME:
Risk Transfer Programs, LLC PHONE 866- 481 -9363 I FAX
219 East Livingston Street
Orlando, FL 32801 ADDR Er I
INSURER(S) AFFORDING COVERAGE NAIC e
,.,QUeee a .r- 111.0.i.f Mnr. —A Innrrarra r'.� 40134
INSURED Wes gp t�t�
Professional Employer Resources, Inc. fff���"
Professional Employer Resources Two, Inc.
INSURER a:
INSURER C:
INSURER D
500 North Maitland Ave.
Suite 200
LT R TYPE DF INSURANCE POLICY NUMBER P M/DDIYYY P M/DD/YY P
LT
Maitland, FL 32751
INSURER E
COVERAGES
CERTIFICATE NUMBER:5P5YNL4B
NUMBER:
THIS ISTO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO THE INSURED NAMED ABOVE FORTHE PULICY rtH1UU
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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.
LT R TYPE DF INSURANCE POLICY NUMBER P M/DDIYYY P M/DD/YY P
LT
UNITS
GENERAL LIABILITY
EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY
PREMISES Eaoccvrrence $
CLAIMS -MADE F1 OCCUR
MED EXP (Arty me race) S
_
PERSONAL & ADV INJURY $
GENERAL AGGREGATE S
GEN'L AGGREGATE LIMIT APPLIES PER: --
PRODUCTS - COMP/OP AGG $
POLICY F7 PRO- LOC
AUTOMOBILE LIABILITY
-
COMBINED S!0��
Ea cddert
BODILY INJURY (Per person)
S
ANY AUTO
BODILY INJURY (Per accident)
S
ALL OWNED SCHEDULED
-
AUTOS AUTOS
Peraaident
$
HIRED AUTOS � SEED
$
UMBRELLA UAS
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DED I RETENTIONS
$
A
WORKERSCOMPENaxnON
WSLTHPE00033601
07/01/2011
07/01/2012
X WCSTATU- OTH-
AND EMPLOYERS' LIABILITY
1,000,000
ANY PROPRIETOWFARTNER/EXECUTWE
a
E- L-EACH ACGOENT
S
E.L. DISEASE - EA EMPLOYEE
S 1,000,000
OFFICEREMBER EXCLUDED?
AM
(MmWirtory In NH)
N/A
E.L. DISEASE - POLICY LIMIT
S 1,000,000
It yyeess dexr'beunder
DESCRIPTION OF OPERATIONS below
S
S
$
S
DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Att.en ACORD 101,Addilonel Remarks SeMdule, it merespwe Is required)
Coverage is extended to the leased employees of altamate employer (Colorado, Florida, Georgia, Tennessee, Texas and Virginia Operations Only): Key West Botanical
Garden Society # 201 D03 (Effective 7/1 /11)
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATETHEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Monroe County BOCC 8 TDC
Marla Slavik
1201 White Street $102
AUTHORIZED REPRESENTATIVE
;'
Key West, FL 33041- 1026
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
Mar 161212:28p Key West Botanical Garden 305 -296 -2242 p.2
1996 Cdition
MONROE COUNTY, FLORIDA
Request For Waiver
of
Insurance Requirements
It is requested that the insurance requirements, as specified in the Couray's Schedule of Insurance Requirements, be
waived or modified on the following contra&
Contractor: �/�- S '
Contract for It, �
J
Address of Contractor.
Scope of Work:
Reason 1
Policies Waiver wiN
apply to:
Signature of Contractor:
Risk Management:
Date: IJ 19 _ (o'
County Administrator Appeal:
Approved Not Approved
Date:
Board of County Commissioners Appeal:
Approved
Not Approved