03/24/1994 •
SECTION 00500
FORM OF AGREEMENT
This agreement h' et forth as of the 02� th day of_ in
the year of (.`1 between the OWNER who is THE BOARD OF
COUNTY COMMISSIONERS of Monroe County, Florida; and the following
CONTRACTOR:
Name: E. G. Braswell Construction, Inc.
Address: 5640 Laurel Avenue
Key West, Florida 33040
Phone: (305) 296 -0305
∎ Tl
rn
for the purpose of performing all of the Work required7by ¢ thg
Contract Documents for the following PROJECT: �<
i N
SOMBRERO BEACH BATHROOMS
HANDICAP ADDITION •
Marathon
Monroe County, Florida
The Project has been designed by MONROE COUNTY ENGINEERING
DEPARTMENT 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 Contract 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
Request for Bid, the Conditions of the Contract (General and
Supplementary), the Supplementary Insurance Documents, the
General Requirements, the Technical Specifications, the
Drawings, and all Addenda issued prior to 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.
02/01/94 FORM OF AGREEMENT 00500 -1
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,
the construction of handicap facilities as an addition
to the existing bathroom at Sombrero Beach. The
construction shall include the addition of two (2)
handicap stalls (1 men, 1 women), two (2) interior
showers, two (2) exterior showers, and the widening of
the existing concrete ramps. The Work also includes
all other related bathroom construction work as shown
on the Plans and included in the Technical
Specifications.
B. The Contractor shall: 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.
C. The Specifications contained herein are considered to
be the minimum standards required. Construction shall
comply with all applicable Federal, State, Local codes
and ordinances.
D. This contract is subject to the provisions of Section
255.05, F.S., and those provisions of Chapter 713,
F.S., which are incorporated therein.
E. The County reserves the right to reject any and all
bids in whole or in part and to waive any informalities
or irregularities in the bid determined to be in the
best interests of the citizens of Monroe County.
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 ninety (90) 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. Substantial Completion shall be determined
by the County Engineer.
02/01/94 FORM OF AGREEMENT 00500 -2
The OWNER and the CONTRACTOR recognize that time is of the
essence in 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 General Conditions. They also recognize
the delays, expense and difficulties involved in proving in
a legal 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 subject to unit price actual quantity
variations:
$ Twenty -six Thousand Fight Hundred Ninty -Five $26,895.00
(WORDS)Dollars no /100 (DOLLARS)
Article 5 - Payment Procedures
The CONTRACTOR shall submit Applications for Payment in
accordance with the General Conditions. Applications for
Payment will be processed as provided in the General
Conditions.
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 COUNTY ENGINEER once per
month during construction. All progress payments will be on
the basis of the progress of the Work measured in accordance
with the General Conditions and Supplementary Conditions of
the Contract. Payment will be made approximately one (1)
month from the submission of the application if all
documentation is complete.
Retention in the amount of ten percent (10 %) will be withheld
from each progress payment until final payment is made.
Upon final completion and acceptance of the Work in accordance
with the General Conditions and upon submittal of all closeout
documentation and compliance with F.S. 255.05 and F.S. 713,
OWNER shall pay the remainder of the Contract Price,
including release of retention, as recommended by the
COUNTY ENGINEER.
02/01/94 FORM OF AGREEMENT 00500 -3
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 paragraph 4.2 of the General Conditions; 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.
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.
02/01/94 FORM OF AGREEMENT 00500 -4
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. Notice of Award.
2. This Agreement (pages 1 to 7, inclusive).
3. Bidding Documents - Notice of Calling for Bids,
Instructions to Bidders, Bid Proposal, Pre -Bid
Substitutions, Scope of Work, Milestone Schedule.
4. Notice to Proceed.
5. General Conditions (pages 0 to 31, inclusive).
6. Supplementary Conditions (page 1).
7. Supplementary Insurance Documents (pages 1 to 11,.
inclusive).
8. General Requirements - Measurement and Payment,
Application for Payment, Submittals, Progress
Schedules, Temporary Controls, Construction Cleaning,
and Post -Bid Substitutions.
9. Technical Specifications.
10. Drawings, consisting of a cover sheet and sheets
numbered 1 through 4 , inclusive with each
sheet bearing the following general title:
SOMBRERO BEACH RESTROOMS
HANDICAP ADDITION
Marathon
,Monroe County, Florida
11. Addenda numbers 0 to , inclusive.
12. CONTRACTOR's Bid Proposal (pages 1 to 11, inclusive).
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 General
Conditions.
02/01/94 FORM OF AGREEMENT 00500 -5
Article 8 - Indemnification and Hold Harmless Agreement.
The Contractor covenants and agrees to indemnify and hold
harmless Monroe County Board of County Commissioners from
any and all claims for bodily injury (including death),
personal injury, and property damage (including property
owned by Monroe County) and any other losses, damages, and
expenses (including attorney's fees) which arise out of, in
connection with, or by reason of services provided by the
Contractor or any of its Subcontractor(s) in any tier,
occasioned by the negligence or other wrongful act or
omission of the Contractor or its Subcontractor(s) in any
tier, their employees, or agents.
The first ten dollars ($10.00) of remuneration paid to the
Contractor is for the indemnification provided for above.
The extent of liability is in no way limited to, reduced, or
lessened by the insurance requirements contained elsewhere
within this agreement.
Article 9 - Miscellaneous.
Terms used in this Agreement which are defined in Article 1
of the General Conditions will have the meanings indicated
in the General Conditions.
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.
02/01/94 FORM OF AGREEMENT 00500 -6
Article 10 - 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. Bidding Documents with all /any addenda
3. General Requirements
4. Supplementary Conditions
5. General Conditions
_6. Technical Specifications
7. Drawings (large scale detail drawings over smaller
scale general drawings)
IN WITNESS WHEREOF, the OWNER and CONTRACTOR have signedthis
Agreement in quadruplicate. One counterpart signed_
this,
each has been
delivered to the OWNER, CONTRACTOR, COUNTY ENGINEER and COUNTY
PURCHASING DEPARTMENT. All portions of the Contract Documents
have been signed or identified by the OWNER and CONTRACTOR or by
ARCHITECT /ENGINEER on their behalf. nn ��,,, pp
This Agreement will be effective on I1 JJ��//�� o al 2 , 19A.
OWNER: Monroe BOCC CONTRACTOR: E.G. (�PASWEC.L CONSTRiki..
nroe o�lrLtY , FL KEY WEST FLOJ JIN\
By A / By --Agfro....eVit_
DANNY k X OffiAGE, Cie*
•
Attest rI Attest M, Wi r
•
Address for giving notices: Address for giving notices:
MONROE COUNTY ENGINEERING DEPT. E: &ASW L_ CON ST .00T =ON � C IQ .
5100 COLLEGE ROAD
KEY WEST, FL 33040 5(14) LAUREL AVENUE_
KEY VI EST FL 3340
AppRC
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By
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* * * * * * * * * * * * * * **
END OF SECTION 00500
02/01/94 FORM OF AGREEMENT 00500 -7
, r--- - BOARD OF COUNTY COMMISSIONERS
__ �s:� .• re MAYOR, Jack London, Distrk 2
C U N TY of M 0 N RQ E` i • Mayor Pro Tem, A Earl Cheal District 4
KEY WEST FLORIDA t . Z.". • �• Wilhelmina Harvey, District 1
33040 • � „ .4 .v
(305)294 -4641 ! :' ;. 1r,U�?g r `•'� ^'� Shirley Freeman, District 3
f,�a t ,,., {j 1 iC , '� T ' - Mary Kay Reich, District 5
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F ' 3 7 l e ' i : ,-
S H E E T = ■
TO E. G. Braswell Construction Ilip4
Please t
quote the best price you offer on
5640 Laurel Avenue
the items listed below. Note Delivery Re-
Key West, Florida 33040
quirements, and state firm Delivery Date.
ATE 1 REPLY DUE BY •
D
3 -17-93 4 -REPLY U:0BM 1 Q Y "REQUIR BY 1 M.C. SALES TAX EXEMPT #
SEE
�Ty - SEPCIFICATIONS
UNIT • DESCRIPTION`• .�' = 54-03-022505-53C EM
I 1 UNIT 'PRICE AMOUNT
1 LOT SOMBRERO BEACHCRESTROOM
1 1 REMODELING r 1
1 $24,450.00
1
1 I 1
1 1
1 I
• 1 1
7 4 1 ;' 4 ; ?.. 1 1
SPECIAL NO i �' w TES: - A
VENDOR: PLEASE COMPLETE THIS ••INPORMATION ` >
1. Delivery Promised:
withir3 days We offer to furnish Y o
Sombrero Beach`" u the above commodities
2. F.O.B. Point: , Maxathon
or services at the prices indicated:
3. Terms: " "
• 4. Date of Proposal: April 2Q, 199 ' Vendor Name:
E•G.Braswell Construction, Inc.
ti "` " ";
5. Date quoted prices will expire By'
.
x 19_x_ (Title) pre dent
ADDRESS REPLY TO:
Monroe County Purchasing
510 0`.College Road ALL BIDS MUST`BE: SUBMITTED"
Cross Win � HE A"
g.Room #00 . SEALED" ENVEL MARKED ON THE OUTSIDE
Key West, : Florida 33040 ' ' „, x . , SEALEQ PRQPQSAL QR, SOME
Key ( 1orad - . 3 4 292 - 4465 , , ` �, N RILO BEACH , 19
93
"R0:00 AM'REMODELING ON `APRIL 20, 19 10:00 AM” (305)292-4515
SWORN STATEMENT PURSUANT TO SECTION 287.133(3Xa),
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
This sworn statement is submitted to Board of County Commissioners of Monroe County, Florida
[print name of the public entity]
by Edgar G. Braswell, President
[print individual's name and title]
for E. G." Braswell 'Construction, Inc.
[print name of entity submitting sworn statement]
whose business address is
5640 Laurel Avenue
Key West, Florida 33040
and (if applicable) its Federal Employer Identification Number (FEIN) is 65- 0 390 390
(If the entity has no FEIN, include the Social Security Number of the individual signing this sworn
statement:
2. I understand that a "public entity crime" as defined in Paragraph 287.133(1Xg), Florida Statutes, means a
violation of any state or federal law by a person with respect to and directly related to the transaction of business
with any public entity or with an agency or political subdivision of any other state or of the United States, including,
but not limited to, any bid or contract for goods or services 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, racketeerint, conspiracy, or material misrepresentation.
3. I understand that "convicted" or "conviction" as defined in Paragraph 287.133(IXb), Florida Statutes, means a
finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or
state trial court of record relating to charges brought by indictment or information after July I, 1989, as a result
of a jury verdict, nonjury trial, or entry of a plea of guilty or nolo contendere.
4. I understand that an "affiliate" as defined in Paragraph 287.133(1Xa), Florida Statutes, means:
1. A predecessor or successor of a person convicted of a public entity crime; or
2. An entity under the control of any natural person who is active in the management of the entity and who has
been convicted of a public 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 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 daring the preceding 36 months shall be considered an affiliate.
5. 1 understand that a "person" as defined in Paragraph 287.133(1Xe), Florida Statutes, 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 byt 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.]
X Neither the entity submitting this sworn statement, nor any of its officers, directors, executives, partners,
shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of
the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989.
The entity submitting this sworn statement, nor any of its officers, directors, exectutives, partners,
shareholders, employees, members, or agents who are active in the management of the entity, nor an affiliate of
the entity has been charged with and convicted of 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`vith and convicted of a public entity crime subsequent to July 1,1989. However, there
has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative
Hearings and the Final Order entered by the Hearing Officer determined that it was not in the public interest to
place the entity submitting this sworn statement on the convicted vendor list. [attach a copy of the final order]
I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC
ENTITY IDENTIFIED ON PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, THAT THIS
FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO
UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A
CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES
FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.
[signature]
g ]
Sworn to and subscribed before me this I % day of dp/e/ ( 19 3
Personally known
OR Produced identification I . 1721 OE P 5 'Nt
Notary Public - State of FL Die 1 � �Q
My commission ex it
(Type of identification) , ...,,, BRMI
;g btiusb
la W COMMON • CC256515 DPir
`.x ,. J` F4111,1'217 111 117
(1�' n,, 4 tyIA21rargeSPeat"MCe, un;
commissioned name of notary public)
Form PUR 7068 (Rev. 06/11/92)
NON- COLLUSION AFFIDAVIT
Edgar G. Braswell , of the city
of Key West according to law on my oath, and
under penalty of perjury, depose and say that;
1) I am Edgar G. Braswell the bidder
making the Proposal for the project described as follows:
2) the prices in this bid have been arrived at independently
without collusion, consultation, communication or agreement for the
purpose of restricting competition, as to any matter relating to such
prices with any other bidder or with any competitor;
3) unless otherwise required by law, the prices which have been
quoted in this bid have not been knowingly disclosed by the bidder
and will not knowingly be disclosed by the bidder prior to bid
opening, directly or indirectly, to any other bidder or to any
competitor; and
4) no attempt has been made or will be made by the bidder to
induce any other person, partnership or corporation to submit, or not
to submit, a bid for the purpose of restricting competition;
5) the statements contained in this affidavit are true and
correct, and made with full knowledge that Monroe County relies upon
the truth of the statements contained in this affidavit in awarding
contracts for said project.
•
ignature of Bidder)
STATE OF F M (b > Y 3
COUNTY OF 110A) R c DATE
Subscribed and sworn to (or affirmed) before
me on /Vie/ (, / 1 / �! 3 (date) by
e n/ gyp• - i3EA5 ,E1.4. (name of of f iant) .
He /She is personally known to me or has produced
TL. D /2iOf.12S L.C. as identification.
(type of identification)
'.g4 BRIGITTE SEARS /
My co MIS510N # CC256515 gtPIEiE$
February 16, 1997 • # -L ���
•` �'!i ui'i�;:e BONOFD !YR!)1 Pm FAN 145fWANCE
NOTARY PUBLIC
FORM MCP #1 REV. 2/92
` . •.' ∎�'• '`-` Jr' ~ 0 } ,, ,e R ISSUE DATE (MM /DDIYY)
11/�r�1. i � l� r I { " . 2 -8 -93
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
A. MAPLES INS. AGENCY DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
1051 E. SAMPLE RD
POMPANO BEACH, FL. 33064 COMPANIES AFFORDING COVERAGE
COMPANY A
LETTER ORION
COMPANY B
INSURED FIREMANS FUND
COMPANY C
EDGAR BRASWELL CONSTRUCTION LETTER GRANADA
5640 LAUREL AVE. COMPANY D
KEY WEST, FL. 33040 LETTER
' COMPANY E
LETTER
COVERAGES °..c' .'i , .'.'. A "_Ir '.+ _+ni , ri a
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.
CO TYPE OF INSURANCE POUCY NUMBEFI POLICY EFFECTIVE . POLICY EXPIRATION LIMITS
LTR DATE (MM/DD/YY) DATE (MM/DD/YY)
GENERAL. LIABILITY GENERAL AGGREGATE $ 500,000
A X COMMERCIAL GENERAL LIABILITY ! PRODUCTS - COMP /OP AGG. S
CLAIMS MADE OCCUR. PERSONAL & ADV. INJURY S
OWNER'S & CONTRACTOR'S PROT. MSO 3006507 2 -7 -93 2 -7 -94 EACH OCCURRENCE S
FIRE DAMAGE (Any one fire) S
MED. EXPENSE (Any one person) S
AUTOMOBILE LIABILITY COMBINED SINGLE
LIMIT S
ANY AUTO 5 0 0
ALL OWNED AUTOS CA 009320 11 -28 -92 11 -28 -93 BODILY INJURY
C x SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY $
NON -OWNED AUTOS (Per accident)
GARAGE LIABILITY
PROPERTY DAMAGE S
EXCESS LIABILITY EACH OCCURRENCE S
UMBRELLA FORM AGGREGATE S
OTHER THAN UMBRELLA FORM
STATUTORY LIMITS Y`
WORKER'S COMPENSATION
EACH ACCIDENT S 300,000
B AND 1411 -00- 103292 5 -9 -92 5 -9 -93 DISEASE — POLICY LIMIT S 500, 000
EMPLOYERS' LIABILITY DISEASE —EACH EMPLOYEE $ 100, 000
OTHER
DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES /SPECIAL ITEMS
CERTIFICATE HOLDER Wt O TION:•'1.. : 1A ;t .
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
I LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES
AUTHORIZED REPRESENTATIVE" /j i� f/Uitet
ACDRD`25.S #/90) litg" ' + • ? ' xnk`e 1111/111 2 ' 4 .' 04/ .% rr,•t.4 W1c > ". " , "` ; ,: CACORD CORPORATION 199
•
'AE'. 1 846306 STATE OF FLORIDA
•
• + DEPARTMENT OF PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
I
DATE LICENSE NO. BATCH NO.
06/19/92 CG 0046370 • 42523
THE CERTIFIED GENERAL COP fplCtR .
NAMED BELOW 1IS ,CERTZ D , B
UNDER THE PROVI HAR � .8 . F.S., FOR THE YEAR
EXPIRING AUG '19
7 4
1 11' s tt c
BRASMEL`Uprf '. RGI •:f
INDIVIDUuA
`
5640 LAURE ' 6.
KEY WEST.vI rj 5U40=;591
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GO CHILES DISPLAY IN A C ONSP I C UOUS PLACE GE/ • STU x' , JR
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IS 23296 .NS $ ,RA TRANSACTION whANDAMO«,.i,�vu
I ACCOUNT NUMBER
LOCATION: MONROE COUNTY
•
LICENSE YEAR OCCUPATIONAL LICENSE No. 50018318010
1992 -1993 City of Key West, Florida
NO REFUNDS
THIS LICENSE MUST BE PROMINENTLY DISPLAYED
LICENSE PERIOD BEGINNING 10191192 THROUGH 09/30/93
PENALTY SCHEDULE ".'' .,
300.00 330.00 345.D
LICENSE FEE OCTOBER NOVEMBER ��II''� bECEMBER — JANUARY RECI 00086147 TRI 0221
BUSINESS )'DTA1Tt, '1 ID CCE MCHI 028 LOC CVYW
ADDRESS: 5640 LAUREL AVE SI 1 CRI361 W1 10/01/92 14:30
TYPE { +.`,;
LICENSE: 790 CONTRACTORS:SPECt .+ k ` ACCTN5001- 8318 -01 -0
AMOUNT PAID: 300.00
BUSINESS GENERAL CONTRACTS EXCEEoIN61ft
NAME: ff a . ' . 156 OC 0 300.00
EDGAR 6. BRASWELL P2 388.00 CH 0.00
FINANCE DEPARTMENT
OWNER: EDGAR 6. BRASWELL. QUAL. & PRE DIVISION OF REVENUE
ADDRESS: 5640 LAUREL AVENUE CE___
CITY: STOCK ISLAND FL 330
J BY:
r ,
April 22. 197J
1st 1Yirwing
•
MONROE COUNTY, FLORIDA
INSURANCE GUIDE
TO
CONTRACT ADMINISTRATION
General Insurance Requirements
for
Contractors and Subcontractors
Prior to the commencement of work governed by this contract (including the pre - staging
of personnel and material), the Contractor shall obtain, at his/her own expense, insurance
as specified in the attached schedules, which are made part of this contract. The
Contractor will ensure that the insurance obtained will extend protection to all Sub -
Contractors engaged by the Contractor. As an alternative the Contractor may require all
Subcontractors to obtain insurance consistent with the attached schedules.
The Contractor will not be permitted to commence work governed by this contract
(including pre - staging of personnel and material) until satisfactory evidence of the required
insurance has been furnished to the County as specified below. Delays in the
commencement of work, resulting from the failure of the Contractor to provide
satisfactory evidence of the required insurance, shall not extend deadlines specified in this
contract and any penalties and failure to perform assessments shall be imposed as if the
work commenced on the specified date and time, except for the Contractor's failure to
provide satisfactory evidence.
The Contractor shall maintain the required insurance throughout the entire term of this
contract and any extensions specified in any attached schedules. Failure to comply with
this provision may result in the immediate suspension of all work until the required
insurance has been reinstated or replaced. Delays in the completion of work resulting
from the failure of the Contractor to maintain the required insurance shall not extend
deadlines specified in this contract and any penalties and failure to perform assessments
shall be imposed as if the work had not been suspended, except for the Contractor's failure
to maintain the required insurance.
The Contractor shall provide, to the County, as satisfactory evidence of the required
insurance, either:
• Certificate of Insurance
or
• A Certified copy of the actual insurance policy.
The County, at its sole option, has the right to request a certified copy of any or all
insurance policies required by this contract.
All insurance policies must specify that they are not subject to cancellation, non - renewal,
material change, or reduction in coverage unless a minimum of thirty (30) days prior
notification is given to the County by the insurer.
The acceptance and/or approval of the Contractor's insurance shall not be construed as
12/30/93 SUPPLEMENTARY INSURANCE DOCUMENTS 00900 -1
Aptil 22, 1993
• 1M 1'rin ing
relieving the Contractor from any liability or obligation assumed under this contract or
imposed by law.
The Monroe County Board of County Commissioners, its employees and officials will be
included as "Additional Insured" on all policies, except for Workers' Compensation.
In addition, the County will be named as an Additional Insured and Loss Payee on all
policies covering County -owned property.
Any deviations from these General Insurance Requirements must be requested in writing
on the County prepared form entitled "Request for Waiver of Insurance Requirements"
and approved by Monroe County Risk Management.
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SUPPLEMENTARY INSURANCE DOCUMENTS 00900 -
April 22. 1993
1st Printing
M ON RO E COUNTY, FLORIDA
INSURANCE GUIDE
TO
CONTRACT ADMINISTRATION
Indemnification and Bold Harmless
for
Contractors and Subcontractors
The Contractor covenants and agrees to indemnify and hold harmless Monroe County Board of
County Commissioners from any and all claims for bodily injury (including death), personal injury,
and property damage (including property owned by Monroe County) and any other losses,
damages, and expenses (including attorney's fees) which arise out of, in connection with, or by
reason of services provided by the Contractor or any of its Subcontractor(s) in any tier,
occasioned by the negligence, errors, or other wrongful act or omission of the Contractor or its
Subcontractor(s) in any tier, their employees, or agents.
In the event the completion of the project (to include the work of others) is delayed or suspended
as a result of the Contractor's failure to purchase or maintain the required insurance, the
Contractor shall indemnify the County from any and all increased expenses resulting from such
delay.
The first ten dollars ($10.00) of remuneration paid to the Contractor is for the indemnification
provided for above.
The extent of liability is in no way limited to, reduced, or lessened by the insurance requirements
contained elsewhere within this agreement.
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12/30/93 SUPPLEMENTARY INSURANCE DOCUMENTS 00900_3
•
April 22. 1993
1st Milling
MONROE COUNTY, FLORIDA
INSURANCE CHECKLIST
FOR
VENDORS SUBMITTING PROPOSALS
FOR WORK
To assist in the development of your proposal, the insurance coverages marked with an "X" will
be required in the event an award is made to your firm. Please review this form with your
insurance agent and have him/her sign it in the place provided. It is also required that the bidder
sign the form and submit it with each proposal.
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
X Workers' Compensation Statutory Limits
WC 1 _ ]� Employers Liability $100,000/$500,Q00/$
WC2 Employers Liability $500,000 /$500,000 /$500,000
WC3 Employers Liability $1,000,000 /$1,000,000 /$1,000,000
WCUSLH US Longshoremen & Same as Employers'
Harbor Workers Act Liability
WCJA Federal Jones Act Same as Employers'
Liability
INSCKLST
12/30/93 SUPPLEMENTARY INSURANCE DOCUMENTS 0090 -4
April 22. 1
1st Printing
GENERAL LIABILITY
As a minimum, the required general liability coverages will include:
• Premises Operations Products and Completed Operations
• Blanket Contractual • Personal Injury
• Expanded Definition -
of Property Damage
Required Limits:
GLI X $100,000 per Person; $300,000 per Occurrence
$50,000 Property Damage
or
$300,000 Combined Single Limit
GL2 $250,000 per Person; $500,000 per Occurrence
$50,000 Property Damage
or
$500,000 Combined Single Limit
GL3 $500,000 per Person; $1,000,000 per Occurrence
$100,000 Property Damage
or
$1,000,000 Combined Single Limit
Required Endorsement:
GLXCU Underground, Explosion and Collapse (XCU)
GLLIQ Liquor Liability
All endorsements are required to have the same limits as the basic policy.
INSCKLST
:2/50/97, SUPPLEMENTARY INSURANCE CU iF T Q - -
• 1
•
April 22. 1993
�a rriniing
VEFIJICLE LIABILITY
As a minimum, coverage should extend to liability for:
• Owned; Nonowned; and I -Tired Vehicles
Required Limits:
VL 1 X $50,000 per Person: $100,000 per Occurrence
$25,000 Property Damage
or
$100,000 Combined Single Limit
VL2 $100,000 per Person; $300,000 per Occurrence
$50,000 Property Damage
or
$300,000 Combined Single Limit
VL3 $500,000 per Person; $1,000,000 per Occurrence
$100,000 Property Damage
or
$1,000,000 Combined Single Limit
MISCELLANEOUS COVERAGES
•
BR 1 Builders' Limits equal to the
Risk completed project.
MVC Motor Truck Limits equal to the maximum
Cargo value of any one shipment.
PRO 1 Professional $ 250,000 per Occurrence/$ 500,000 Agg.
PRO2 Liability $ 500,000 per Occurrence/$I,000,000 Agg.
PRO3 $1,000,000 per Occurrence/$2,000,000 Agg.
POL1 Pollution $ 500,000 per Occurrence/$1,000,000 Agg.
POL2 Liability $1,000,000 per Occurrence/$2,000,000 Agg.
POL3 $5,000,000 per Occurrence/$ 10,000,000 Agg.
ED 1 - Employee $ 10,000
ED2 Dishonesty $100,000
GK 1 Garage $ 300,000 ($ 25,000 per Veh)
GK2 Keepers $ 500,000 ($100,000 per Veh)
GK3 $1,000,000 ($250,000 per Veh)
MED I Medical $ 500,000/$ 1,000,000 Agg.
MED2 Professional $1,000,000/$ 3,000,000 Agg.
MED3 $5,000,000 /$10,000,000 Agg.
INSCKLST
12'30/97, tii3PPLEMF. T II SUR.;NCE DOCUMENT= 00J_00—e:
•
Apra 22. 1993
lid Hinting
IF Installation Maximum value of Equipment
Floater Installed
VLP1 Hazardous $ 300,000 (Requires MCS -90)
VLP2 Cargo $ 500,000 (Requires MCS -90)
VLP3 Transporter $1,000,000 (Requires MCS -90)
BLL Bailee Liab. Maximum Value of Property
HKLI Hangarkeepers $ 300,000
HKL2 Liability $ 500,000
HKL3 $ 1,000,000
AIR 1 Aircraft $25,000,000
AIR2 Liability $ 1,000 000
AIR3 $ 1,000,000
AEO1 Architects Errors $ 250,000 per Occurrence/$ 500,000 Agg.
AEO2 & Omissions $ 500,000 per Occurrence/$ 1,000,000 Agg.
AEO3 $ 1,000,000 per Occurrence/$3,000,000 Agg.
INSURANCE AGENT'S STATEMENT
I have reviewed the above requirements with the bidder named below. The following deductibles
apply to the corresponding policy.
POLICY DEDUCTIBLES
Liability policies are _ Occurrence _ Claims Made
Insurance Agency Signature .
BIDDERS STATEMENT
I understand the insurance that will be mandatory if awarded the contract and will comply in full
with all the requirements.
Bidder Signature
INSCKLST
12/30/93 SUPPLEMENThF1" INStJFANCE, DOCUMENT._. ()0c0,2.-7
April 21. 1993
IM Milling
WORKERS' COMPENSATION
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Prior to the commencement of work governed by this contract, the Contractor shall obtain
Workers' Compensation Insurance with limits sufficient to respond to Florida Statute 440.
In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not less than:
$100,000 Bodily Injury by Accident
$500,000 Bodily Injury by Disease, policy limits
$100,000 Bodily Injury by Disease, each employee
Coverage shall be maintained throughout the entire term of the contract.
Coverage shall be provided by a company or companies authorized to transact business in the
state of Florida and the company or companies must maintain a minimum rating of A -VI, as
assigned by the A.M. Best Company.
If the Contractor has been approved by the Florida's Department of Labor, as an authorized self-
insurer, the County shall recognize and honor the Contractor's status. The Contractor may be
required to submit a Letter of Authorization issued by the Department of Labor and a Certificate
of Insurance, providing details on the Contractor's Excess Insurance Program.
If the Contractor participates in a self - insurance fund, a Certificate of Insurance will be required.
•
In addition, the Contractor may be required to submit updated financial statements from the fund
upon request from the County.
WC
12/30/93 SUPPLEMENTARY INSURANCE DOCUMENTS
GG "GC -
•
April 22. 1993
•
1st Printing
GENERAL LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Prior to the commencement of work governed by this contract, the Contractor shall obtain
General Liability Insurance. Coverage shall be maintained throughout the life of the contract and
include, as a minimum:
• Premises Operations
• Products and Completed Operations
• Blanket Contractual Liability
• Personal Injury Liability
• Expanded Definition of Property Damage
The minimum limits acceptable shall be:
$300,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$100,000 per Person
$300,000 per Occurrence
$ 50,000 Property Damage
An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its
provisions should include coverage for claims filed on or after the effective date of this contract.
•
In addition, the period for which claims may be reported should extend for a minimum of twelve
(12) months following the acceptance of work by the County.
The Monroe County Board of County Commissioners shall be named as Additional Insured on all
policies issued to satisfy the above requirements.
GLI
12/30/93 SUPPLEMENTARY INSURANCE DOCUMENTS 00900-9
April 22. 1993
1st Printing
VEIIICLE LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
• BETWEEN
MONROE COUNTY, FLORIDA
AND
Recognizing that the work governed by this contract requires the use of vehicles, the Contractor,
prior to the commencement of work, shall obtain Vehicle Liability Insurance. Coverage shall be
maintained throughout the life of the contract and include, as a minimum, liability coverage for:
• Owned, Non - Owned, and Ilired Vehicles
The minimum limits acceptable shall be:
$100,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$ 50,000 per Person
$100,000 per Occurrence
$ 25,000 Property Damage
The Monroe County Board of County Commissioners shall be named as Additional Insured on all
policies issued to satisfy the above requirements.
VLI
12/30/9= SUPPLEMENTARY INSURANCE DOCUMENTS 00900
RcsoIunum /1191 -1993 April 22. I99.1
1st Printing
MONROE COUNTY, FLORIDA
Request For Waiver
of •
Insurance Requirements
It is requested that the insurance requirements, as specified in the County's Schedule of Insurance
Requirements, be waived or modified on the following contract.
Contractor:
Contract for:
Address of Contractor:
Phone:
Scope of Work:
Reason for Waiver:
Signature of Contractor:
Approved Not Approved
Risk Management
Datc
County Administrator appeal:
Approved: Not Approved:
Datc:
Board of County Commissioners appeal:
Approved: Not Approval:
Meeting Datc:
• WAIVER
i2/30i9 5 SUPPLEMENTARY INSURANCE DOCUMENTS 00900-11
p III ISSUE DATE (MM /DD /YY)
AC•I I1. c ��ATE OF RAN 5 -3-94
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
p A � DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
4 1iAPLF , I t'?. I.W . ; . POLICIES BELOW.
{ F r .y. � ' i COMPANIES AFFORDING COVERAGE
• COMPANY
LETTER A ILLINOIS INS. EXCHANGE
COMPANY
INSURED LETTER B TRAVELERS
AFTROVED BY RISK MANAGEMENT
COMPANY EDGAR G. BRASWELL D /B /A LETTER C ARIES BY
E.G.BRASWELL CONST. COMPANY - Loki 1
5640 LAUREL AVE LETTER DATE
KEY WEST, FL. 33040 COMPANY ..�e� Y t
LETTER E WAIVER: eA
COVERAGES
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.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE (MM /DD /YY) DATE (MM /DD /YY)
GENERAL LIABILITY GENERAL AGGREGATE $ 500,000
A x COMMERCIAL GENERAL LIABILITY PRODUCTS- COMP /OP AGG. $ 500,000
CLAIMS MADE X OCCUR. DAC80007FA1612 2 -7 -94 2 -7 -95 PERSONAL & ADV. INJURY $ 500,000
OWNER'S & CONTRACTOR'S PROT. EACH OCCURRENCE $ 500,000
FIRE DAMAGE (Any one fire) $
MED. EXPENSE (Any one person) $ 5,000
AUTOMOBILE LIABILITY COMBINED SINGLE
C X ANY AUTO CO3211638 12 -11 -93 12 -11 -94 LIMIT
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS (Per person) $ 100,000
'HIRED AUTOS
BODILY INJURY
NON -OWNED AUTOS (Per accident) $ 300,000
GARAGE LIABILITY
PROPERTY DAMAGE $ 50,000
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION
STATUTORY LIMITS
B AND 6UB693V576593 12 -13 -93 12 -13 -94 EACH ACCIDENT $ 100,000
DISEASE — POLICY LIMIT $ 500,000
EMPLOYERS' LIABILITY
DISEASE —EACH EMPLOYEE $ 100,000
OTHER
DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES /SPECIAL ITEMS
•
Additional Insured.: Monroe County
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
Monroe County MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
ACORD 25-S (7/90) CACORD CORPORATION 1990
AC «1.84630 STATE OF FLORIDA
DEPARTMENT OF PROFESSIONAL REGULATION
C'NSTRUC1 - 10r I [ }' Y LIC SING UOA?fi
DATE LICENSE NO. BATCH NO.
06/19/92 CL, +: J46,371.1 4Z523
THE CERTIFIED GENERAL CT "ACTOR
NAMED BELOW I S C E.P T I F I )
UNDER THE PROVISIONS OF CHAPTER 449 FS, FOR THE YEAR
EXPIRING AUG 51 1992:
•
?ASY�ELL. EDGA' L Et) •f'
INDIVIDUAL`
564 LAOCtL AY.c
KEY WEST FI. S5 -5 1.5
•
•
LAWTON CHILES
GOVERNOR E DISPLAY IN A CONSPICUOUS PLACE GEO' E STUpT, JR
+ _ SECRETARY Q.P.R.
c R 1993 -1994 OCCUPATIONAL LICENSE ACCOUNT 30140- 002329t
MONROE STATE OF FLORIDA EXPIRE
SEPT . 30, 199`4
FACILITIES MUST BE DISPLAYED IN CONSPICUOUS PLACE
OR
MACHINES ROOMS SEATS EMPLOYEES 0-10
SUPPLE:ME '
TYPE OF X RENEWAL
BUSINESS 30140 GEN CONT CGC046370 NEW LICENSE
TRANSFI= R
BUSINESS ORIGINAL I,;x 1 8 . 0 1
ADDRESS MONROE COUNTY
00 - COUNTY OF MONROE
AMOUNT
NAME BRASWELL EDGAR G PENALTY
'MAILING 5640 LAUREL AVE SI ',DEEP , "''" E
TOIAt 18.W
ADDRESS KEY WEST F L 33040
• r... i4 cr. C•><
CD C'
r �
GEN CONT CGC046370
. o m
C
HARRY F KNIGHT CFC TAX COLLECTOR v co vr I 71
HIS BECOMES A TAX ,p — 7i G €
aECEIPT WHEN vAUDATED P 0 BOX 1129, KEY WEST FL 33041-1129
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