Loading...
03/01/2015 to 02/28/2018 Agreement AMY HEAVILIN, CP CLERK OF CIRCUIT COURT & COMPTROLLER - �=-' MONROE COUNTY, FLORIDA DATE: February 26, 2015 TO: Jose Tezanos, Emergency Management Planner ATTN: Holly Pfiester FROM: Lindsey Ballard, D. C At the February 18, 2015 Board of County Commissioner's meeting the Board granted approval and execution of Item G2 award contract for maintenance of and repairs to Monroe County Fire Rescue ambulances, and other vehicles, to Roy Khanna (individual) for a base term of three (3) years plus the option to renew for two (2) further one -year periods, and approval for the Fire Chief to sign all documents as needed to complete the transaction. cc: County Attorney (Electronic) Finance (Electronic) N ./ File 'Er MABEE - nu d.d1 500 Whitehead Street Suite 101, PO Box 1980, Key West, FL 33040 Phone: 305 - 295 -3130 Fax: 305 - 295 -3663 3117 Overseas Highway, Marathon, FL 33050 Phone: 305- 289 -6027 Fax: 305 -289 -6025 88820 Overseas Highway, Plantation Key, FL 33070 Phone: 852 -7145 Fax: 305 - 852 -7146 n BOARD OF COUNTY COMMISSIONERS Mayor Danny L. Kolhage, District 1 C ounty of Monroe • Mayor Pro Tem Heather Carruthers, District 3 George Neugent, District 2 The Florida Keys David Rice, District 4 Sylvia J. Murphy, District 5 Robert B. Shillinger, County Attorney ** Office of the County Attorney Pedro J. Mercado, Assistant County Attorney ** 1111 12 Street, Suite 408 Natileene W. Cassel, Assistant County Attorney ** Key West, FL 33040 Cynthia L. Hall, Assistant County Attorney ** (305) 292 -3470 — Phone Christine Limbert- Barrows, Assistant County Attorney ** (305) 292 -3516 — Fax Derek V. Howard, Assistant County Attorney ** Lisa Granger, Assistant County Attorney Steven T. Williams, Assistant County Attorney Peter H. Morris, Assistant County Attorney Chris Ambrosio, Assistant County Attorney ** Board Certified in City, County & Local Govt. Law MEMORANDUM TO: Lindsey Ballard, Deputy Clerk FROM: Kathy M. Peters, CP, County Attorney's Office RE: BOG AGENDA ITEM G-2: BOCC Meeting 2/18/15 DATE: February 24, 2015 Enclosed please find the documents as received by this office for transmittal to the Clerk for processing that correlate with the above - referenced agenda items approved by the Board of Governors of Fire and Ambulance District 1 on February 18, 2015. Please note: The contract has an "entered into" date typed into the first paragraph of "...this I day of March, 2015.." but this contract was approved by the BOG on 2/18/15. The "entered into" date is the day the BOCC approved the contract. The effective date of the contract is March 1, 2015 which is set out in Section 2. at the bottom of page 1. G. FIRE & AMBULANCE DISTRICT 1 BOARD OF GOVERNORS 2. Approve to award contract for maintenance of and repairs to Monroe County Fire Rescue ambulances, and other vehicles, to Roy Khanna (individual) for a base term of three (3) years plus the option to renew for two (2) further one -year periods, and approval for the Fire Chief to sign all documents as needed to complete the transaction. KMP: D EC��L , 7:2 1 i Enclosure l-� Monroe County Emergency Services Fire Rescue /EMS — Emergency Management — Trauma Star — KWIA — Fire Marshal — Fire Academy — UKHCTD RECEIVED LETTER OF TRANSMITTAL FEB 2 4 2015 Date: February 23, 2015 MONROE COUNTY ATTORNEY Attention: Kathy Peters County Attorney's Office Re: Approve to award contract for maintenance of and repairs to Monroe County Fire Rescue ambulances, and other vehicles, to Roy Khanna (individual) for a base term of three (3) years plus the option to renew for two (2) further one -year periods, and approval for the Fire Chief to sign all documents as needed to complete the transaction. ''1, -. Sat o �c r eo ( ,rte o(e1c- s e ��. ENCLOSED PLEASE FIND THE FOLLOWING ITEM(S): 5¢) i r. 5 e4,4 - a • - ()ay._ # DESCRIPTION 1 original Board of G ern• rs of Fire and Ambulance District 1 Agenda em G2 February 18, 2015 — APPROVED THESE ARE TRANSMITTE ' S CHECKED BELOW: [ ] For Execution [ X ] For Your Processing [ ] For Review and Comment [ ] For Review and Signature [ ] Returned for Corrections [ ] For Approval REMARKS: Clerk of Court (Lindsey) — Please scan back a copy of agenda item to me once executed. 14., Holly Pfiester , 289 -6088 Stop 14 BOARD OF GOVERNORS OF FIRE AND AMBULANCE DISTRICT 1 AGENDA ITEM SUMMARY Meeting Date: February 18, 2015 Division: Emergency Services Bulk Item: Yes X No _ Department: Fire Rescue Staff Contact Person: Holly Pfiester 289 -6088 AGENDA ITEM WORDING: Approve to award contract for maintenance of and repairs to Monroe County Fire Rescue ambulances, and other vehicles, to Roy Khanna (individual) for a base term of three (3) years plus the option to renew for two (2) further one -year periods, and approval for the Fire Chief to sign all documents as needed to complete the transaction. ITEM BACKGROUND: On December 16, 2014 at 3:OOpm the Monroe County purchasing office opened one (1) responke to our Request for Proposals — Maintenance of Monroe County Fire Rescue Ambulances and Other Vehicles — from Roy Khanna (individual) who also holds the current contract for same dating back to 2007. This RFP includes flat — rate preventative maintenance in addition to repairs which are billed at an hourly rate. It also includes the addition of the Key West International Airport ARFF vehicles, which were not included in Roy Khanna's previous contract, as the KWIA Station No. 7 was not under the purview of MCFR the last time an RFP went out. Taking these differences into consideration, and upon validating the vendor has not markedly increased his hourly rate since 2007, staff recommends approval. PREVIOUS RELEVANT BOG ACTION: At the September 17, 2014 Board of Governors meeting, the Board approved item G3, which was a request to issue a request for proposal (RFP) for Maintenance of Monroe County Fire Rescue Ambulances and Other Vehicles. On February 19, 2014, in item G2, the Board granted approval for the District to exercise the only one -year renewal period. The original (2011) contract was for a three -year (3) term, with one (1) annual renewal. CONTRACT /AGREEMENT CHANGES: The hourly rate increases from $75 to $95, the Level I and Level II preventative maintenance for ambulances and rescues increased in totality by $315 per year, and the Level I and Level II preventative maintenance flat —rate cost(s) for KWIA vehicles are new. STAFF RECOMMENDATIONS: Approval. TOTAL COST: $1 20,000 approx. — 141 District 1 L &M Key and $50,000 approx. — 404 International Airport INDIRECT COST: N/A BUDGETED: Yes X No COST TO COUNTY: See above SOURCE OF FUNDS: 141 — 11500 — 530462 and 404 — 63 100 — 530462 REVENUE PRODUCING: Yes No X AMOUNT PER MONTH Year --6'1 APPROVED BY: County Atty Q..k • 1 : /Purc asing ✓ Risk Management DOCUMENTATION: Included X Not Required, DISPOSITION: AGENDA ITEM # G r MONROE COUNTY BOARD OF GOVERNORS CONTRACT SUMMARY Contract with: Roy Khanna (individual) Contract # Base Term — 3 years Effective Date: 03/1/2015 Expiration Date: 02/28/2018 Two (2) 1-year renewal options 03/1/2018 thru 02/28/2019 and 03/1/2019 thru 02/28/2020 Contract Purpose/Description: Contract for maintenance of and repairs to Monroe County Fire Rescue ambulances, and other vehicles, to Roy Khanna (individual) for a base term of three (3) years plus the option to renew for two (2) further one -year periods, and approval for the Fire Chief to sign all documents as needed to complete the transaction. Contract Manager: Holly Pfiester 6088 Emergency Services / Stop 14 (Name) (Ext.) (Department/Stop #) For BOG meeting on 02/18/2015 Agenda Deadline: 02/03/2015 CONTRACT COSTS Total $120,000 / year approx. — Fund 141 District 1 L &M Key Current Dollar $ 50,000 / year approx. — Fund 404 International Airport Year Value Portion: $ N/A Of Contract: Hourly Rate = $95 Parts = Cost + 25% Overtime = Vendor Refused OT or Holiday Pay Level 1 — Semi Annual Preventative Maintenance: Level II — Annual Preventative Maintenance: (Flat Rate Cost Per Vehicle): (Flat Rate Cost Per Vehicle): Rescue Ambulances = $275 Rescue Ambulances = $865 Rehab Units = $275 Rehab Units = $865 MCI Trailer and Utility = $100 MCI Trailer and Utility = $175 ARFF Vehicles = $1,800 ARFF Vehicles = $1,800 Budgeted? Yes® No ❑ Account Codes: 11500 — 530462 and 63100 — 530462 Grant: $ N/A County Match: $ N/A ADDITIONAL COSTS Estimated Ongoing Costs: $ included above For: $ 0 (Not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, etc.) CONTRACT REVIEW Changes Date Out Date In Needed Revie - Division Director Yes❑ No , If / , -3�-kr Risk Management 1 Yes❑ No�i fli „.3-if O.M.B./Purc ng )-(3 115 Yes❑ NoEr , ti ��i/ �� I a/30 ter' < County Attorney . 0 0 Yes❑ NoI ' / to , , L /V 10 8 Comments: OMB Form Revised 2/27/01 MCP #2 BUDGET FINANCE PURCHASING DEPARTMENT TABULATION SHEET OPEN DATE: DECEMBER 16, 2014 AT 3:00 PM, TITLE: MAINTENANCE OF MONROE COUNTY FIRE RESCUE AMBULANCES AND OTHER VEHICLES RESPONDENT'S NAME: ROY KHANNA 1'` Site Visit of Year Level I — Semi Annual PM (Labor Only - Parts Extra) I Rescue Ambulances $ 275.00 Rehab Units $ 275.00 MCI Trailer and Utility $ 100.00 ARFF Vehicles $ 1,800.00 2 Site Visit of Year Level I — Semi Annual PM and Level II — Annual PM (Labor Only - Parts Extra) Rescue Ambulances $ 1,140.00 Rehab Units $ 1,140.00 MCI Trailer and Utility $ 275.00 ARFF Vehicles $ 3,600.00 Total Cost Per Vehicle / Per Year for Level I & Level I (Labor Only - Parts Extra) Rescue Ambulances $ 1,415.00 Rehab Units $ 1,415.00 MCI Trailer and Utility $ 375.00 ARFF Vehicles $ 5,400.00 continued Unscheduled Maintenance Resulting from Equipment Failure or Malfunction (Travel Time and Mileage NOT charged separately — Amount Below Inclusive) Hourly Rate $ 95.00 Overtime/Holiday Rate $ N/A DON'T WANT — (One and One Half Times Hourly Rate) NOT APPLICABLE All Parts Used for Maintenance and Repair of Vehicles Parts Cost + 25 % Bid Committee Present: Emie Coughlin - Purchasing Dept. Members of the Public Present: None I hereby certify that this is a true and correct copy of said bid opening and that all bidders listed above have been checked against the State of Florida Convicted & Suspended Vendor listings. All bids listed above were received by the date and time specified. Bid Opened By: Emie Coughlin - Purchasing Manager CONTRACT BETWEEN THE BOARD OF GOVERNORS OF FIRE AND AMBULANCE DISTRICT 1 OF MONROE COUNTY, FLORIDA AND ROY KHANNA (INDIVIDUAL) FOR MAINTENANCE OF FIRE RESCUE AMBULANCES AND OTHER VEHICLES THIS CONTRACT, hereinafter `CONTRACT OR AGREEMENT' made and entered into this 1 day of March, 2015 by and between the Board of Governors of Fire and Ambulance District 1, Monroe County, Florida with principal offices located at 490 63 Street, Marathon, FL 33050 (hereinafter referred to as the "COUNTY "), and Roy Khanna, Individual, 1033 Valencia Road, Key Largo, FL 33037 (hereinafter referred to as `CONTRACTOR') WITNESSETH: WHEREAS, the COUNTY advertised a notice of request for Proposals for MAINTENANCE OF FIRE RESCUE AMBULANCES AND OTHER VEHICLES WHEREAS, the only Respondent was Roy Khanna, individual, and; WHEREAS, this CONTRACTOR represents that he is capable and prepared to provide such services, and; WHEREAS, the COUNTY intends to enter into an Agreement for Maintenance of and Repair to Fire Rescue Ambulances, and Other Vehicles; semi - annual and annual preventative maintenance inspections, and unscheduled maintenance resulting from malfunction or failure with the CONTRACTOR and; WHEREAS, this Contract is an `Agreement' between both parties, NOW, THEREFORE, in consideration of the promises contained herein, the parties agree as follows: 1. Contract Documents: This Contract consists of the Agreement, the Contractor's response to the RFP, and the documents referred to in the Agreement as a part of this Agreement. In the event of any conflict between any of the Contract documents, the one imposing the greater burden on the Contractor will control. 2. Contract Period and Renewal: The effective date of this Agreement shall be an initial three (3) year term commencing on March 1, 2015 through February 28, 2018. This Agreement may then be renewed annually, not to exceed two (2) renewals, subject to approval of the COUNTY. 3. Contract Termination: This Agreement may be terminated for any reason by either Page 1 of 9 terms of this Agreement, or attachments, properly or on time, or otherwise violates the provisions of the Agreement or of applicable laws or regulations governing the use of funds, the County may terminate the Contract by written notice. The notice shall specify cause. All finished or unfinished supplies or services shall, at the option of the County, become property of the County. The County shall pay the Contractor fair and equitable compensation for expenses incurred prior to termination of the Agreement, less any amount or damages caused by the Contractor's breach. If the damages are more than compensation payable, the Contractor will remain liable after termination and the County shall pursue collection for damages. 4. Subiect Matter of Contract: This Agreement is for all fire rescue ambulances and other vehicles described in `Attachment A' to receive: Level I Preventative Maintenance / Semi - Annual Level II Preventative Maintenance / Annual Unscheduled maintenance and repair resulting from equipment failure or malfunction 5. Hourly Rate: The hourly rate shall be $ 95 per man-hour with no travel time or mileage charge. Level I (Semi - Annual) and Level II (Annual) Preventative Maintenance are at quoted flat rates and excluded from hourly rate. 6. Overtime and Holidays: The vendor has declined the overtime and holiday rate for emergency repairs called outside normal business hours and federal holidays. Calls made outside normal business hours and during federal holidays shall also be at the hourly rate of $ 95 (as outlined in Section 5 above). 7. Inspections: During the year, Contractor shall perform twice per year on all vehicles, including the modular portion of the vehicles, described in `Attachment A'. Semi- Annual Level I Preventative Maintenance Service - Annual Level II Preventative Maintenance Service. The number of vehicles on `Attachment A' may fluctuate from time to time due to new purchases or removal of vehicles from inventory. The inspections shall be performed at the respective fire stations. Semi - Annual Level I Preventative Maintenance Service: 250 hours or 6 months (whichever comes first) Full vehicle inspection (to include at a minimum) outlined as follows: Engine oil and filter change Page 2 of 9 Fuel filter change (every 6 months) Air filter inspection and replacement if necessary Chassis lubrication Lubrication of all valve control linkages - Clean or replace air compressor strainer Clean engine crankcase breather - Inspection of generator and service of lubricant system, full system, and air filter according to its individual hours of operation (not to exceed 6 months) Cooling system, including fan belts, radiator supports, hoses and clamps, and auxiliary cooler - Exhaust system, including hanger, clamps, muffler, and pipes Exhaust regeneration system Diesel exhaust fluid (D.E.F.) Automatic transmission, including fluid level, seals, modulator adjustment, and linkage Drive train, including u-joints, center support, and companion flanges Rear axle and springs, including oil links, spring hangers, center bolts, and u -bolts Front end, including steering box, linkage, kingpins and bushings, spring hangers, and U -bolts Mechanical brakes, including adjustment and fluid levels - Air brakes, including drain, adjustment, wear, and air leaks Tires, including condition, wear, tread depth, year of tire and replacement recommendations Electrical system, including running lights, emergency lights, battery cables, turn lights, 4 -way flasher, headlights, stop lights, hazards and switches Fuel system, including hoses and fittings, filters and brackets, and tank straps Booster tank, including leaks and supports Prime pump, including electrical wires, coupling, switch, and valve discharge Plumbing and gates, including leaks, brackets, bleed valves, control arms and knobs, and linkage Main pump, including vacuum test, pressure test, packing, clappers, and mounting Pump transmission, including fluid levels, seals, shift motors, and manual override Annual Level II Preventative Maintenance: 1000 hours or one year (whichever comes first) Full vehicle inspection performed in Level I, plus at a minimum: Replacement of coolant hoses, filter and coolant as needed Replacement of all drive belts as needed Replacement of pump transmission oil and filter - Replacement of engine transmission fluid and filter Replacement of rear axle lube oil as needed Inspection of front wheel bearing Replacement and repacking as needed Page 3 of 9 Inspection and cleaning of relief valve strainer Replacement of secondary fuel filters on both engine and generator Inspection of front wheel bearing The above Level I and Level II inspections shall include, at no additional labor charge, the changing of all applicable filters and fluids used by the unit being inspected. Filters and fluids shall be billed at cost plus 25 %, as described in section 10 of this Agreement. Preventative Maintenance Inspections incorporating Level I (semi - annual) and Level II (annual) shall be conducted at such intervals as are approved by Monroe County Fire Rescue. Upon completion of inspection a computerized report will be forwarded to the logistics support services indicating the status of the items inspected. This will be done for every vehicle when Level I (semi - annual) and Level II (annual) Preventative Maintenance is performed on the vehicle. This report must be emailed to the Logistics Support Services office and The Contract Administrator's office, over period of contract. The form must either be in Microsoft Word or Excel. 8. Rates: Contractor shall charge Level I (semi - annual) Preventative Maintenance Service at Flat —Rate annual total costs of: RESCUE AMBULANCES $ 275.00 REHAB UNITS $ 275.00 MCI TRAILER AND UTILITY $ 100.00 ARFF VEHICLES $ 1,800.00 Contractor shall charge Level II (annual) Preventative Maintenance Service at Flat —Rate annual total costs of: RESCUE AMBULANCES $ 865.00 REHAB UNITS $ 865.00 MCI TRAILER AND UTILITY $ 175.00 ARFF VEHICLES $ 1,800.00 Page 4 of 9 Each year, the Contractor shall perform a minimum of Two (2) Level I (semi annual) Preventative Maintenance Service(s), and One (1) Level II (annual) Preventative Maintenance Service for a Total Annual cost of: RESCUE AMBULANCES $ 1,415.00 REHAB UNITS $ 1,415.00 MCI TRAILER AND UTILITY $ 375.00 ARFF VEHICLES $ 5,400.00 9. Parts, Fluids and Lubricants Rate: Contractor shall supply all parts, fluids, and lubricants used for maintaining and repairing vehicles to Monroe County Fire Rescue at: Cost + 25 % For any individual parts, or if total of all parts for an individual repair, is $400.00 or over, a copy of original parts supplier invoices shall be attached to the bill. Contractor will be required to keep all original parts supplier invoices available at request by Monroe County Fire Rescue for spot checking and auditing purposes. 10. Engine Oil and Filter Change: Complete drive train lubrication and any other fluids and/or filter changes, shall be performed as recommended by the manufacturer. 11. Weekly Maintenance Schedule: Contractor shall also provide to Monroe County Fire Rescue a Weekly Preventative Maintenance Schedule which can be performed by the individual fire stations' personnel. The Contractor shall provide in- service training to the Lieutenants on all three (3) shifts at all of the stations at no extra cost. This will be scheduled by the Contractor with the on -duty Lieutenants and can be done during Level I and Level II Preventative Maintenance visits. 12. Maintenance Log: Contractor shall maintain an inspection and maintenance chart on each vehicle containing at least the following information: Date of Performance - Apparatus Serviced Service Performed Parts Used Name of Service Person(s) Total Downtime of Vehicle 13. Maintenance Chart: A copy of chart outline above shall be supplied to the fire rescue office within ten (10) days of the service. Page 5 of 9 14. Response Email: Contractor shall respond to all original emergency field repair forms by emailing the original document to the logistics support services office with documentation of repairs made, parts used and any other miscellaneous information that is applicable. 15. Communication Device: Contractor shall maintain a telephone, cell phone, email or paging device such that prompt notification of request for service is possible twenty -four (24) hours a day. 16. Response Time to Service Request: Contractor shall maintain a state of readiness during normal working hours defined as 8:00 am — 5:00 pm Monday thru Friday, and shall acknowledge and respond within two (2) hours to Monroe County Fire Rescue's initial notification during normal working hours; Contractor then has twelve (12) regular working hours to either make repairs, or respond to Monroe County Fire Rescue with a Repair Plan; Response(s) can be by phone or email. Contractor shall be available 24 -hours a day per Item 16 of Contract; Contractor shall acknowledge and respond within four (4) hours to the Monroe County Fire Rescue's initial notification outside of normal working hours; Contractor then has thirty -six (36) hours to either make repairs, or respond to Monroe County Fire Rescue with a Repair Plan; Response(s) can be by phone or email. 17. Staffing: Contractor shall maintain adequate staff to ensure compliance. 18. Certification: Contractor shall provide evidence satisfactory to Monroe County Fire Rescue that its personnel who perform maintenance work `Attachment J' are certified: - EVT (Emergency Vehicle Technicians) certified as Level III Master Ambulance Technician - Automotive Service Excellence (ASE) certified Master Medium/Heavy Truck Technician - Pump mechanics - General Mechanics - Repair Mechanics Or, personnel who are not certified are overseen by certified personnel. 19. Qualifications of Maintenance Personnel: All personnel performing maintenance, repairs, adjustments and related work on Monroe County Fire Rescue equipment shall be a certified fire apparatus mechanic, or otherwise certified for the work to be performed. Personnel performing work who are not certified or experienced in such work shall be directly supervised (in person) by an individual with such certification. Page 6of9 20. Indemnification: Contractor shall indemnify and hold Monroe County harmless for all actions of Contractor's negligence as well as faulty or improper workmanship, for all work performed under this Contract, including all costs of collection, reasonable attorney fees, claim costs, and as per `Attachment G'. All property or equipment being directly maintained or repaired by Contractor shall be considered in its care, custody, and control while such work is in progress and until physical control of such property or equipment is restored to the County. 21. Location of Work: This Contract is for maintenance of fire rescue vehicles located at the following sites: - KWIA (Key West International Airport) — STATION 7 - Stock Island — STATION 8 - Big Coppitt — STATION 9 - Sugarloaf — STATION 10 - Cudjoe — STATION 11 - Big Pine — STATION 13 - Crawl Key — MONROE COUNTY FIRE ACADEMY - Conch Key — STATION 17 - Layton — STATION 18 - Tavernier — STATION 22 22. Insurance: During the term of this Contract, the Contractor must keep in force and affect the insurance required by `Attachment H' which is attached and incorporated into this Contract. 23. Additional Required Statements / Verifications / Affidavits: Attached hereto: Attachment C Non - Collusion Affidavit Attachment D Public Entity Crime Statement Attachment E Drug Free Workplace Form Attachment F Lobbying & Conflict of Interest Clause (Ethics Clause) Attachment G Indemnification and Hold Harmless Attachment I Local Preference Form Page 7 of 9 24. Payments: All payments will be made in accordance with the Florida Local Government Prompt Payment Act. All unscheduled maintenance and repair resulting from equipment failure or malfunction requiring service shall be billed by the Contractor at the applicable rates as specified in contract. The Contractor upon notification by Monroe County Fire Rescue of an equipment failure or malfunction requiring unscheduled maintenance, shall in a timely manner investigate the problem and provide to Monroe County Fire Rescue an estimate of the cost for repair and vehicle downtime. The Contractor upon receiving authorization to proceed from Monroe County Fire Rescue shall effectuate such repair; upon completion of same the Contractor shall notify Monroe County Fire Rescue of the outcome and actual cost. Monroe County Fire Rescue shall issue a separate purchase order for each occurrence of unscheduled maintenance and repair. 25. Monroe County's performance and obligation to pay under this Contract is contingent upon an annual appropriation by the Board of Governors of Fire and Ambulance District 1 of Monroe County, Florida. 26. Venue for any litigation arising under this Contract must be in a court of competent jurisdiction in Monroe County, Florida. This Agreement is not subject to arbitration. IN WITNESS WHEREOF, the parties have executed this Agreement 1 day of March, 2015 THE BOARD OF GOVERNORS OF FIRE AND AMBULANCE DISTRICT 1 OF MONROE COUNTY, FLORIDA George Neugent, Commissioner District 2, Monroe County \l es David Rice, Commissioner District 4, Monroe County y Danny Kolhage, Commissioner District 1, Monroe County Norm Anderson, Mayor, City of Layton ye/ Clark Snow, Councilman, City of Layton y(f In the event a Layton member above was unable to attend, the Alternate's vote below shall serve Katie Scott, Alternate, City of Layton Page 8 of 9 (SEAL) BOARD OF GOVERNORS OF FIRE AND ATTEST: AMY HEAVILIN, AMBULANCE DISTRICT 1 OF MONROE COUNTY CLERK COUNTY, FL "e' 1 i J • ,i , A i �, 1 ' B v ` D e k ' or / Chairman RESPONDENT: ASSISTANT COUNTY ATTORNEY By: Ibi Roy Khanna, Owner Date: t`Pg " /S� MONROE COUNTY ATTORNEY • • ROV, D AS,TVM. ` . HALL ASSIS ' NT COUNTY ATTORNEY Date ___.__i=3Q - a 0 f 5 Page 9 of 9 Attachment A SCOPE OF WORK MONROE COUNTY FIRE RESCUE AMBULANCES AND OTHER VEHICLES LIST F 1 LOCATION T DESCRIPTION SERIAL NO AND COUNTY ID P or R ' CALL 1996 T-1500 10TBK8Z17WS064431 / 2401-313 Reserve ARFF — 107 2007 Striker 10TBKAK107S094275 / 2401-5973 Prime ARFF —7 Key West 2012 Ford 350 Truck 1FT8W3BT3CE31413 / 2401-7394 Prime ARFF — 207 2010 Ford 550 Truck 1FDAW5HR2AEB04654 / 6819 MCI MCI 2005 MCI Trailer 1WC200J2X53052439 / 1416-306 MCI MCI Stock 2001 Ford Ambulance 1FDXF46FXIEC33366 / 2418 Prime R — 8 Island 2006 Sterling Ambulance 2FZACFCS76AV92511 / 1416-5098 Prime R —9 Big Coppitt 1994 Ford Rehab Unit 1FDLF47M6REA52322 / 1417-159 Prime Rehab — 9 2002 Ford Ambulance 1FDXF46F22ED14878 / 1416-215 Reserve R — 109 Cudjoe 2008 Horton Ambulance 3HTMNAAM68N698467 / 6507 Prime R —11 Big Pine 2006 Sterling Ambulance 2FZACFCS37AX62073 / 1416-5806 Prime R — 13 Key Conch Key 2009 Ford Ambulance IFDXE45P79DA90438 / 1416-6845 Prime R — 17 2009 Ford Ambulance 1FDXE45P19DA83131 / 6813 Prime R — 22 1FDXF46F9XEB99283/1416-120- 1998 Ford Ambulance 4287 Reserve R — 122 Tavernier 1992 Ford Rehab Unit 1FDFL47F2SEA30339 / 4295 Prime Rehab — 22 2001 Ford Rescue 1FDXF46F61EC33364 / 1416-059 Training Training (bie Attachment B REVISED SUBMISSION RESPONSE FORM Maintenance of Monroe County Fire Rescue Ambulances and Other Vehicles Respondent's Name goy Ki - Mailing Address - 3■17 C44r- c3. t_ rt9. F 0 33 VA-4...-e.4C., I A- Lo -re e,._ K e....y 1441 3 . 3 c , 3 . 7 E mail goy g_fchAsn noi Phone — T/a- - 4 . 71 - Fax • ! :30.5-74.4 —17063 All amounts must be in number format AND written. In case of a conflict between the amount in numbers and the amount in words, the amount in WORDS shall control. l Site Visit of Year , Level I — Semi Armual PM — oral exte_A Rescue Ambulances $ c.a75 .0 0 - not) 110-1 ceve--",ty DoLL-t-74 Rehab Units °1' Avribre-> ve_ 4 - 1 -1 1 1 - S 4 600 MCI Trailer and Utility $/0 € oit.e an bitzet) zym ARFF Vehicles 2 Site Visit of Year Level I — Semi Annual PM and Level ll — Annual PM er)Ly—P/4115 Rescue Ambulances $ 90 D ,011-elltoos44-,-ap P±J c+- Forty poci_44-e Rehab Units $ VA p/re_ P.9t-t141/ MCI Trailer and Utility $ e' ii;Ja htiArxeb q- 1/. D 4 " -- # 45 ARFF Vehicles $ 0 e Thre-e - 1110v5Ai---,11) ic 4/1-11)yre boe-L 04'S Total Cost Per Vehicle / Per Year ror-tetiet. z -- Pf4-ier5 c Rescue Ambulances $ / t /r}, 0 V k'elltotif-4- -, -)> hOnbre-1)-1--6-(71 e> 47/-141- , e Rehab Units $ L it kt-e. -revc £nPre-t?-4- cek- MCI Trailer and Utility $ 3 - 0 r hanDre Ae continued L ! . 1 AF Vehicles I L 1 $ *'./ ,M, ° C Unscheduled Maintenance Resulting from Equipment Failure or Malfunction r (Travel Time and Mileage NOT charged separately - Amount Below Inclusive) Hourly Rate ! , , . 1 Overtime/Holiday Rate $ /)1p, T;t9 tA'<r 0.49- 1-11 (One and One Half Times Hourly Rate) 1 / _ Moli coci-e--e All Parts; Used for Maintenance and Repair of Vehicles , ■ Parts ; ! Cost + c l...5 % i 4 .. -,-- I HAVE INCLUDED (Check mark items as a reminder that they are included) Proposal Submission Response Form Non Collusion Affidavit ,./ IZ' ■ Public Entity Crime Statement ; I V- 1 Lobbying and Conflict of Interest Clause Form . I V , Drug Free Workplace Form (kW Indetniti flcation and Hold Harmless !------- ---- - - I ; - Local Preference Form (if applicable) ) I STATE THAT I AM AU7HORIZED TO SUBMIT THIS PROPOSAL -tr i-1 1 STATE OF (Signature of Respondent) ,-) COUNTY OF Po-L. I, - e 4 e 4 Date /i41/ PERSONALLY APPEARED BEFORE ME, the undersigned authority, Ko- tdaVVW CA- who, after first being sworn by me, (name of individual signing) affixed his/ter signature in the space provided above on this EL b 1 1 0 7 3/ 5 1 6 7 0 A day of le to,,t , 20 1 My commission expires: I „ GOLAM MUSTAFA NOTARY PUBLIC I d• fe lt. x :0:9 *mu Public - male of Smith z . .. r ' (-, 4 ,,,:op ' t • My Comm. Expos Dec 29, 2017 L c/ / i 4 n„,p Conimission • FF 079915 ------ — -...- --- • -ragercItzfar"- Attachment C NON- COLLUSION AFFIDAVIT I, P- K-h Pt , of the city of © according to law on my oath, and under Penalty of perjury, diSose and say that; 1) I am 112 " Y\ P , the Respondent making the Solicitation for the project described as follows: pr°t°osFiL -- p rt -ne- Pylon rn e Co vvlty • 1ve ReCcue ,97/i /3b'gx 5 /4-777D ter Ve tC — L'eS 2) The prices in this solicitation 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 Respondent or with any competitor; 3) Unless otherwise required by law, the prices which have been quoted in this solicitation have not been knowingly disclosed by the Respondent and will not knowingly be disclosed by the Respondent prior to solicitation opening, directly or indirectly, to any other Respondent or to any competitor, and 4) No attempt has been made or will be made by the Respondent to induce any other person, partnership or ershi corporation to submit, or not to submit, a solicitation for the purpose of rP° restricting competition; and 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. STATE OF FL02 (Sign of Respondent) So 11 -` r COUNTY OF go ue06 Date PERSONALLY APPEARED BEFORE ME, the undersigned authority, >� (61470/04 who, after first being sworn by me, (name of individual signing) affixed his/her signature in the space provided above on this Jp day of ,4'V t ,Fe , 20 / . „/ ` y;0, ission xp' : N • ARYPUBLIC 13irotlRY ^� Mrco 1 EE 040951 � I EV � Yr EXPIRES: December 11 , 2014 k iise OMB - MCP FORM #1 j F ' Bonded Thu Notary Pubic Undo/lien thwe Attachment D 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 solicitation on a contract to provide any goods or services to a public entity, may not submit a solicitation on a contract with a public entity for the construction or repair of a public building or public work, may not submit solicitations on leases of real property to public entity, may not be awarded or perform work as a bidder, supplier, subbidder, RESPONDENT or subRespondents under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, 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 form, I acknowledge that I/my company is in compliance with the above. STATE OF TG0414 (Sign of Respondent)SO&' a - 41- - " COUNTY OF Mon/efIF I/ — 0 3 — / Date PERSONALLY APPEARED BEFORE ME, the undersigned authority, �y iNel who, after first being sworn by me, (name of individua signing) affixed his/her signature in the space provided above on this day of Ah' I g a2 , 20 . / ` / .! j 4 • i mmission e •. • y� ELIZABETH air MYCOM COMMISSION/ NOTARY PUBLIC EXPIRES: December 11, 2014 ' it • Bonded nw NotarguIfic uoaan r L ,r Attachment E DRUG -FREE WORKPLACE FORM The undersigned Respondent in accordance with Florida Statute 287.087 hereby certifies that: (Name of Business) 1. Publishes a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Informs employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug -free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Gives each employee engaged in providing the commodities or contractual services that are under solicitation a copy of the statement specified in subsection (1). 4. In the statement specified in subsection (1), notifies the employees that, as a condition of working on the commodities or contractual services that are under solicitation, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendre to, any violation of Chapter 893 (Florida Statutes) or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction. 5. Imposes a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, or any employee who is so convicted. 6. Makes a good faith effort to continue to maintain a drug -free workplace through implementation of this section. As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. Respon // s Signature 5 Ou4 - - — i Date OMB - MCP FORM #5 Attachment F LOBBYING AND CONFLICT OF INTEREST CLAUSE SWORN STATEMENT UNDER ORDINANCE NO. 10-1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE P-p1 t rl 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 employee. commission, percentage, gift, or consideration paid to the former County officer or Respondent's Signature . a , 4 e' Date STATE OF hiaseiDg COUNTY OF AO dileE PERSONALLY APPEARED BEFORE ME, the undersigned authority, R oy )g/l who, after first being sworn by me, affixed his/her signature (name of individual signing) in the space provided above on this 03y of L, ' G • _ 20 /r. NOT ' Y '1JB �t BJZABE1H a KOURY {; - MY COMISSION / EE O40651 .' —�- EXPIRS e E: December 11 2 be, 0i4 My commission expires: L" " ' Boneed : Dec mbe Ins 01! 1 • OMB - MCP FORM #4 t hree Attachment G MONROE COUNTY, FLORIDA RISK MANAGEMENT POLICY AND PROCEDURES CONTRACT ADMINISTRATION MANUAL Indemnification and Hold Harmless for Other Respondents and subProposers The Responder covenants and agrees to indemnify and hold harmless Monroe County Board of County Commissioners AND Board of Governors for District 1, its servants, agents and employees 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 consultant's fees) which arise out of, in connection with, or by reason of services provided by the Bidder or any of its subRespondents (s) in any tier, occasioned by the negligence, errors, or other wrongful act or omission of The Responder or its sub- Responder 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 Responder's failure to purchase or maintain the required insurance, the Respondent 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 Respondent 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. 'C.4 Respondent's Signature Se Le ®wr►`er f l (y Date L Attachment H (1 of 4) GENERAL LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT MAINTENANCE OF MONROE COUNTY FIRE RESCUE VEHICLES BETWEEN MONROE COUNTY, FLORIDA AND gay n Prior to the commencement of work governed by this contract, the Respondent 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 Defmition of Property Damage The minimum limits acceptable shall be: $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 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. L royrkhanna @cs.com ACORD • CERTIFICATE OF GARAGE INSURANCE DATE 11912014 I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFI HOLDER. THIS R EPRESENTATIVE THISERTI CERTIFICATE CERTIFICATE IN COVERAGE I SURANCE DOES NOT CONSTITUTE UTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED ELOW OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER IA E" Deborah B Howard Al24072 Insurance Capital Management LLC wc.NNo, �): 561 - -2199 l F NO 561- 209 -5581 1035 S. State Road 7 E-MAIL ic mllcl ahoo.com ADDRESS: icmlIc13@yahoo.com Suite 315 -9 INSURER(S) AFFORDING COVERAGE NAIC # Wellington, FL 33414 INSURERA: Colony Insurance Company INSURED INSURER B : Roy Khanna INSURER C : 3117 Carol Avenue INSURER D : Palm Springs, FL 33461 INSURER E : INSURER F : COVERAGES PROD / CUSTOMER ID: CERTIFICATE #: REVISION #: PERIOD THIS IS TO TT THE NDICATED. ANY REQUIREMENT, CUM TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MWDD/YYYY) (MWDD/YYYY) GARAGE LIABILITY AUTO ONLY (Ea accident) $ 1,000,000. ALL OWNED HIRED AUTOS A AUTOS ONLY X GP8177220 1/912014 01/09/2015 NON -OWNED AUTOS OTHER THAN ACCIDENT $ 1,000,000. USED IN GARAGE BUSINESS AUTO ONLY AGGREGATE $ 2,000,000. 1 Sealer Service Liability COMP/ GARAGE KEEPERS UABILITY 7 OTC LOC $ 180,000. SPECIFIED LOC LEGAL LIABILITY GP8177220 0110912014 01/0912015 — PERILS $ A DIRECT BASIS V COLLISION LOC $ 180,000. 7 - 1 PRIMARY n EXCESS LOC $ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED I CLAIMS -MADE El OCCUR PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _$ POLICY ❑ a El LOC PRODUCTS - COMP /OP AGG $ JE OTHER: $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS -MADE AGGREGATE -$ ■ DED 1 1 RETENTION $ $ WORKERS COMPENSATION I MUTE I I ER AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICERMEMBER EXCLUDED? y / N N / A (Mandatory in NH) E L DISEASE - EA EMPLOYEE $ If yes, desert a under I E.L. DISEASE - POLICY LIMIT $ REMARKS below REMARKS (ACORD 101 Additional Remarks Schedule, may m be attached If ore space Is required) Monroe County 'Board of County Commissioners is l as an additional insured as indicated above with an "x" CERTIFICATE HOLDER CANCELLATION Monroe County Board of County Commissioners SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: Rick Management THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 Simonton Street ACCORDANCE WITH THE POLICY PROVISIONS. k ti, Key West FL 33040 Fax 305- 289 -6061 AUTHORIZED REPRESENTATIVE Fax 305 - 292 -4487 Al24072 CZLi.z © 2010, 2014 ACORD CORPORATION. All rights reserved. ACORD 30 (2014101) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Web software. www.FomksBoss.com; 0 Impressive Publishing 800 -208 -1977 Attachment H (2 of 4) VEHICLE LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT MAINTENANCE OF MONROE COUNTY FIRE RESCUE VEHICLES BETWEEN MONROE COUNTY, FLORIDA AND RD‘j K-ki in Recognizing that the work governed by this contract requires the use of vehicles, the Respondent, 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 Hired 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 $300,000 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. L INSURANCE CAPITAL PRI/GREIF/YE' 1035 SO. SR7, *315-9 WEWNGTON, FL 33414 876668 1069 2 AT 0.406 PGUIA02S 012 001069 k ome Named insured Policy number 02121612 Underwritten by: Progressive Express Ins Company March 1, 2014 ROY K KHANNA Policy Period: Apr 3, 2014 - Apr 3, 2015 3117 CAROL AVENUE Page 1 of 2 PALM SPRINGS, FL 33461 progressiveagentcom 11 1111 Online Service Make payments, check billing activity, print policy documents, or check the status of a claim. Commercial Auto 1-561-223-2199 Insurance Coverage Summary INSURANCE CAPITAL Contact your agent for personalized service. This is your revised Renewal 1400 Declarations Page RIF customer service if your agent is unavailable or to report a daim. Your coverage begins on April 3, 2014 at 12:01 a.m. This policy expires on April 3, 2015 at 12:01 a.m. This coverage summary replaces your prior one. Your insurance policy and any policy endorsements contain a hill explanation of your coverage. The policy limits shown for an auto may not be combined with the limits for the same coverage on another auto, unless the policy contract allows the stacking of limits. The policy contract is form 6912 (06/10). The contract is modified by forms 2852FL (10/04), 1652F1 (08/12), 1198 (01/04), 5701 (02/11), 4852FL (10/04), 4881FL (01/13) and Z228 (01/11). The named insured organization type is a sole proprietorship. (11W Outline of coverage Description Limits Deductible Premium Liability To Others $677 Bodily Injury and Property Damage Liability $100,000 combined single limit Uninsured Motorist Non-Stacked $10,000 each person/$20,000 each accident 100 Basic Personal Injury Protection 204 Without Work Comp-Named Insured Only $10,000 each person $0 Comprehensive 77 See Auto Coverage Schedule limit of liability less deductible Collision 71 See Auto Coverage Schedule Limit of liability less deductible Subtotal policy premium $1,129.00 Florida Hurricane Catastrophe Fund Assessment 14.68 Fees 20.00 Total 12 month policy premium and fees ;1,163.68 Rated drivers 1. ROY K KHANNA 2. DEBRA L KHANNA L Cording Form 6489 FL (11/12) Attachment H (3 of 4) WORKERS' COMPENSATION INSURANCE REQUIREMENTS FOR CONTRACT MAINTENANCE OF MONROE COUNTY FIRE RESCUE VEHICLES BETWEEN MONROE COUNTY, FLORIDA AND 1Q-0■j K_ti 1-14 v - Prior to the commencement of work governed by this contract, the Respondent shall obtain Workers' Compensation Insurance with limits sufficient to respond to the applicable state statutes. In addition, the Respondent shall obtain Employers' Liability Insurance with limits of not less than: $500,000 Bodily Injury by Accident $500,000 Bodily Injury by Disease, policy limits $500,000 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. If the Respondent has been approved by the Florida's Department of Labor, as an authorized self - insurer, the County shall recognize and honor the Respondent's status. The Respondent may be required to submit a Letter of Authorization issued by the Department of Labor and a Certificate of Insurance, providing details on the Respondent's Excess Insurance Program. If the Respondent participates in a self - insurance fund, a Certificate of Insurance will be required. In addition, the Respondent may be required to submit updated financial statements from the fund upon request from the County. k ope Attachment H (4 of 4) 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 contra Respondent: h D t– p L- /r1A - s ti A c e G /'7on rot CDUVi / Contract for: feesc i4-n D Address of Respondent: 14933 Vtrie_rn c �A"� Key G - g i Ft 3 3o 37 Phone: 3 5 - 766 — X63 or Scope of Work: M141 nten c.-e. A• l r) ,P.e/441 rS 1 F;✓e ee SC ij e_ frmei/L ,ce5 - 1) a77e - ✓e-A rCrL t how Reason for Waiver: fly (.141 -✓ ' r 'c C -, Or more_ - ei'ri pLo ye e S 1 - v- Repiirc7 . 117-17). p r l� not hr4ve e plo y-e, _ Policies Waiver GIS rKe r5 I ( p vt�► pe.n rj I` "� 1 a ✓ti "fin 5" vr�4't� will apply to: Signature of Respondent: - - 50Lf �wh`P� Ap • ved Not Approved Risk Management Date County Administrator appeal: Approved: Not Approved: Date: Board of County Commissioners appeal: Approved: Not Approved: Meeting Date: L Attachment 1 LOCAL PREFERENCE FORM Vendor claiming a local preference according to Ordinance 023-2009 must complete this form. l p� / Date Name ofBidder /Respond er I� _ dated at least 1. Does the vendor have a valid receipt for the business tax paid to the Monroe County Tax Collector one year prior to the notice or request for bid or solicitation? (Please furnish Oopy. the vendor operates address located within Monroe County from which o Does the vendor have a physical td business of the goods or services being offered to m.�? oaadaymdaybasistl>axffia Monroe - List Address: '4 4') - e 3 Telephone Number: 3 05 - l° 6 - 6 B. Does vendor /prime Respondent intend to subcontract a% 5 or more actin goods, services or construction to local businesses meeting the criteria above as to licensing and location. ffyes, please provide: 1. Copy of Receipt of the business tax paid to the Monroe County Tax Collector by the subRespondent dated at least one year prior to the notice or request for bid or solicitation. 2. SubRespo ndcet Address within Monroe County from which the subRespondent operates: Tel. Number • Sp Le 01,/n print Name: S and Title of Authorized Signatory for g : er/Responder STATE OF n0_ 061 COUNTY OF /}/alo 6 ej`_, the undewhosrsigned is subscribed h o produced e -.�. /_ of � identification, � acknowledged that he/she is the person who executed the above F orm for the purposes therein contained. /1 � ' T.1 public — prirnt Nanoe; �!ttFEO10951 / a?O Seal " My commission expires: ti0ae` Wary Public Undsmiten . L . ti -fi., 'g .'' _ vi Z 1 O V) Z Z O V3 z ' 0 ''� v N W '" Q a Z � Z - o i N P- 5a �° 10 O 2 ¢riiOa`cue Q O Y. Z ZJZ > M a o o 0 O �- ¢¢ U w UI }} Z < -J W c W �_~UO 'fin w p o v V � Z,..,N ffr CZ :1 N M Z N p J � O O� Q a n. - V o Oii o W . Z t- o Q . Ce 4 X N v • 0 ci y . U > 43. tee ;,: g 5 oil J. H u 0 RI PI eic .. - (Y d H N N O n` J F 1L. >, - V> Ill c c c N N Vl W in vi CO W 3i m ° O V d 0 Z x - m m m 0 c o ' N N W o a W c .+ N V) i. ac N m W > c Z w a -- - N r V) " 0 0 U G X `' 111 0 >4' Z ad n N W y cp __ Q M 0` 1" G i V X O tVi a 7, C Vl o le 0 n. ;, ,y a R H ti O 0 Q Z U LL C 0 W o } Z in .. z r CO m k a Y 0 0 N. N. 1- ~ O Z M E a >- M >. L 0 0 - ?. s-,'� G Y ce O Y in 0 cL 4 z it 4.::''' hi ;.; m le z I o o r W ¢ O to to 4) : 4) : 7.67 E o z at ° 1 U to H N s W w¢ i'F. m Oz x -o M w> H .r- tO ) N w a. , 4 ' , a A . . h t .t >� �, � r Aye 4 ; nd 41''.4s-1,..` A 'A A '4 ;A . ,r ,?,�, e� k ,6 , c ''` .t; Y .- _ _. .. .. 'r' ._. ' ,, `a'- Attachment J CERTIFICATIONS ' r .iv d in ; E P r..t !'Up ,?hr .:-� , fiS, t -7 44z1. A ,b ..• a y�y qp�y Na4 2 a s1Y ai -7Ckc-;.' ' • sue ll I NT. • y� ,$ ' -41C t` 00 00 00 Y •. 61 N Q V N \ t P O O O O a eJ `1 t • )8 �� W O O O O • 4:F M1 I 'F` ' 0 CI 0 rTl 4 ea wa C d a, s i„ B W _ a L° t s s t 0� �.%•r �, c aO0o Q E Q a to w •yi m W 'J". u h '. s /77__ I--I u v CO ffl H oilsa co C CO rv^.. F.L. W _t //. . V W �o '� 7 7 a . a • s4; • El U V E d , d ' � . y F 4 4 '� ,y } 1 �. N� t '; 41 , • t l(kl i. q-„M1V, f Wr ea'y .�. S^t I 4 T.k i ( jh` d.���� r r hit :'t 4\t' �. • '3 "41 y O O O O O O c 7__ •_\ ;-, N N N N N N ty N N Vl 00 N N \ V. O O O O N &i 4•/405� (.�� W -. O O O c -, v Si T l W o ZrN oct ;) w, a a � CAu 44 F A I l CS CA I 4,T sf cr. z F v a, m r ( t -a I > ..+ C N y V W iii is • �- „t • -," °--1 u y t R 4- d o esi`� � µ , e o ' u `• hiiiam ; ct 10 rr 11 " 1 C4 it 46, , e , �. � �n `.�tld:.vU'�' -of k •[ �. . • S• v • • p1z -i : • • • a • • x • i • y r � s • Aru aa1 `#wG '".1 -a? Y --kl ,,,Cii.$ Wilk ah A / V & ; LrY�^ �' aa✓jV _-z —. _/� Ulf l l 2J {� iy m A Sy 2 f i(f..n; lVr A b ?�' y°S��✓ i v .r �e� �; ,; h rya-fi � � �� ,ii^ "L.: � W t x �': P E . Via. z,• Z r. row. N c, t 2�':.�91 I 5s k 1 • I—i W o o 8 9 • k. I 4 F � n ,f, # ‘414 v? • ie •..N^. .W. e ° •• asp J a�i d ¢� a `�i _ _ l vs 7 w E • ia 1 () -• H C4 w e Q a A. 0 • r k A �. Ufr. W > fv v •? ___ bi CV la y 2 (� 41 , \ F • acrl" > '� d A •yF �� F r. b� '-T .% Jtf e, �' / �/3, I, rn,, s r„12� � 4'.'� '- 1 y?n ocnr a.wiv IFS a 4 L E il ���ppp /� III :11 CJ c 4 � • c E M Z N N N N N {NV N N \ 1111 • i • W C M M M O. M M M . d W i i W i W W i as g_ _ ' e z, iM =~ w H a. - Cw Z k % 1 -.- Vat- vW c O T raiLj ,-A. W W Q E .2 m �2 Ill � ., fai `Ml z a v = J � �_ � _ W of z .. 0 z ♦ < E wr it ; 2 I U W w a v 4} Y O _ = v • p r' N w • N {_.._.. C ■r�■ J S S U • • v., i LQ �I ,,, 'g 9 Q • 0 9 .a C W/' w ti W •• 0 O I_ s v } C •,g S 1. O c I . i l9 W w' O 'b O u • hIV MN S' r hti fa Q W � 60 � Ea € W Z CC W • ib.Hr-- 1,,,s77--,1,4-7! 2 d r� y0 Z `° u i i ® /}E t(. V Ilj Z Z ¢ y,I £ !V:..-Z:4;,‘-'T bi *.'&uCCI d1 acJe /� O E W t9 6 Z J > W • F •� J' ai Can/ Q i w c' c u_ r t: iE] / x' u y� K a .ca h w ¢ N W ¢ W ¢ �: Xx UP E t LtiE kr i 4I 5 a4 447;,P.AI i Aq i0 a + ei,. Y. �,r f t Sr y�y D. t F Y l: i a ; . aril. \.' '1 / §f -.WA v . .;lam �:n'i J co co co m co m m 10 • • Yt3 42 A p {L NNN C. N N N p p .f .. V L N. • M M M M M M M M • .y.. M F - W W W 2 2 2 • f a.a m o - > Z 'cam -, -, -1 U < x • C F VV� f: • T u v WW da ._ t..) m ��F .ar /� Q a A W • w Fy' "'fir �, ° LLWf' z S Z o u • a "« $' rY w Q 3 W r',C � O �` W x x �h= fn I J 4 Y V U Fti • • N u OP o ;t cz W • ¢ 3 w rn • s`-- j . o u 'sr 9, a ❑ C < CO o > .Y i v v W ;� z m r. 2 G ` 6 I-- 2 J 6 C • b Z f .. \ �' ( 'N W U CIV 6 Wn • N ▪ i . Li 2 ~ Ulli Li G z L Q Wn y F = Z • '• � < cca4 = z ` S▪ it?' $F l : 1 r $�y-!ID t �'14 Y� any ,e -4. 3 ro (�H a ify" �:�U C� @i � n, '� 4n�"S n n' n" . .m,i•'` 'ne { v �£1✓}., mH34n %��.7•m ..:�