1st Addendum 04/19/1995 k
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BRANCH OFFICE CLERK OF THE CIRCUIT COURT BRANCH OFFICE
3117 OVERSEAS HIGHWAY MONROE COUNTY 88820 OVERSEAS HIGHWAY
MARATHON, FLORIDA 33050 500 WHITEHEAD STREET PLANTATION KEY, FLORIDA 33070
TEL. (305) 289 -6027 KEY WEST, FLORIDA 33040 TEL. (305) 852 -7145
TEL. (305) 292 -3550
MEMORANDUM
TO: Reggie Paros
Director of Public Safety
FROM: Ruth Ann Jantzen n' 2
Deputy Clerk
DATE: May 1, 1995
At the April 19, 1995 County Commission Meeting, the Board granted approval
and authorized execution of a Contract Agreement Addendum between Monroe County
and Professional Emergency Services, Inc., extending Medical Director responsibilities to
include Municipal Services Taxing District 5 ambulance service, at an increased rate of
$500.00 per month, and specifying an ending date of September 30, 1995.
Enclosed please find a fully executed duplicate original of the above Addendum
for return to Professional Emergency Services.
If you have any questions regarding the above, please do not hesitate to contact
this office.
Enclosure
cc: County Attorney
Fmance
County Administrator, w/o document
File
oilvaggir
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CONTRACT AGREEMENT ADDENDUM
THIS ADDENDUM TO CONTRACT AGREEMENT, made and
entered into this i day of , 1995 A.D., by
and between the Board of County Commissioners, Monroe County,
Florida, hereinafter referred to as the "COUNTY" and Professional
Emergency Services, Inc., hereinafter referred to as the
"Consultant", in order to amend the contract agreement between the
parties dated November 3, 1987, as follows:
Paragraph 1 shall be amended to read as follows:
WHEREAS, Monroe County is responsible for pre - hospital
emergency medical services in the following geographic areas:
Municipal Services Taxing Districts (MSTD) 1 -A, 1 -B, 1 -C,
1 -D, 2, 3, 4 -A, 4 -B and 5, Monroe County, Florida.
Article I, Item 1 shall be amended to read as follows: Z c o
1. Be responsible to the Director of Monroe Countyrfnergey
Medical Services Department for the performance of - services
of the Medical Director, as required by Section 401.205, r*1
so (-
Florida Statutes and 10D- 66.0505 Florida Administrative Cgglie,
and as more specifically defined in this agreement, for the r-
following geographic areas: Municipal Services Taxing
Districts (MSTD) 1 -A, 1 -B, 1 -C, 1 -D, 2, 3, 4 -A, 4 -B and 5,
Monroe County, Florida; excluding MSTD 6 and 7, Monroe
County, Florida.
Article I, Item 20 shall be amended to read as follows:
20. Assist in making applications for variances, as may be
needed from time to time in the operation of the ambulance
service, in compliance with 10D- 66.0635 Florida Administrative
Code.
4.
•
Article II, Item 6 shall be amended to read as follows:
6. To pay Professional Emergency Services, Inc. for the
services provided pursuant to this contract in the total amount
of $32,500.00, to be broken down as follows: For the months
of October 1994 through April 1995 at the rate of $2,500.00 per
month; for the months of May 1995 through September 1995 at
the rate of $3,000.00 per month. Payment may be mailed to:
Professional Emergency Services, Inc.
P.O. Box 1042
Tavernier, Fl. 33070
Article III, Item 1 shall be amended to read as follows:
1. The term of this contract shall end on September 30, 1995,
midnight.
In all other respects, the Contract Agreement between the
parties dated November 3, 1987 remains in full force and effect.
IN WITNESS WHEREOF, the parties hereto have caused this
Contract Agreement Addendum to be executed the day and year first
above written.
BOARD OF COUNTY
COMMISSIONERS
OF MO E COUNTY LORIDA
(SEAL) MAYO
Attest: Danny L. Kolhage, Clerk
LER ./
PROFESSIONAL EMERGENCY
SERVICES, `►
BY: , dt/
G/1 'UT Cir > N i R EMMER, D. O.
DATE: �( (
W TNES
SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a),
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
L
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
[print name of the public entity]
_ 7,_)(re '/ e ,Sc1n na) T evicA_A I ces _„L `Ki- G( �c1 cr�-r' • C�
[print individual's nanie e itle]
for
[print name of entity submitting sworn statement]
whose business address is
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50 7
and (if applicable) its Federal Employer Identification Number (FEIN) is .9- 0 2 4 3 0 5 65
(If the entity has no FEIN, include the Social Security Number of the individual signing this sworn
statement: _ .)
I understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), 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,
racketeering, conspiracy, or material misrepresentation.
I understand that "convicted" or "conviction" as defined in Paragraph 287.133(1)(b), 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 1, 1989, as a result
of a jury verdict, nonjury trial, or entry of a plea of guilty or nolo contendere.
I understand that an "affiliate" as defined in Paragraph 287.133(1)(a), 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 during the preceding 36 months shall be considered an affiliate.
I understand that a "person" as defined in Paragraph 287.133(1)(e), 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 by a public entity,
or which otherwise transacts or applies to transact business with a public entity. The term "person" includes those
officers, directors, executives, partners, shareholders, employees, members, and agents who are active in
management of an entity.1.2.3.4.5.
r , Y
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.]
✓ 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, executives, 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 with and convicted of a public entity crime subsequent to July 1,
1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida,
Division of Administrative Hearings and the Final Order entered 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]
6. 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 STATUTE . F I R CATEGORY TWO OF ANY
CHANGE IN THE INFORMATION CONTAINED IN THIS FO ' r 1
[signature]
Sworn to and subscribed before me this
day of , , 19 9,$ .
Personally SA
y known ANDRA. L .Ze44-41.1 Eiyvy)Ek_ •
C : Produced ic!ekl&ific ^*io; �,�!� �: Not ry l?vblic - State of _ _ / _ 4 o Je
(Type of identification) My Commission expi ARV PUBLIC STAB FLORIDA
NY COMMISSION EX . ,
BONDED THEW GENERAL I11S. UID. _
(Printed typed or stamped
commissioned name of notary public)
Form PUR 7068 (Rev. 06/11/92)
Ai
SWORN STATEMENT UNDER ORDINANCE NO. 10 -1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
r c „�. erc vice , A warrants that he/it has not employed, retained
or otherwise had act on his /its behalf any former County officer or employee in violation of
Section 2 of Ordinance no. 10 -1990 or any County officer or employee in violation of
Section 3 of Ordinance No. 10 -1990. For breach or violation of this provision the County
may, in its discretion, terminate this contract without liability and may also, in its discretion,
deduct from the contract or purchase price, or otherwise recover, the full amount of any fee,
commission, percentage, gift, or consideration paid to die former Co my officer or employee.
/ i
(signature)
Date: 44�� 4S
STATE OF ri., p R /
COUNTY OF (Y) p A } /Q.6 L
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
QS AA D L • SC tf cv m E • l ho, after first being sworn by me
8 y , affixed his/her
signature (name of individual signing) in the space provided above on this day of
___420,_:L______, 19 5)5. .
NOTARY PUBLIC
My commission expires:
NOTARY PUBLIC STATE OF FLORIDA
NY COMMISSION EXP. MAY 23,1995
MCP #4 BONDED THRU GENERAL INS. UND.
1