1st Amendment 12/14/2016 AMENDMENT (1st AMENDMENT) TO AGREEMENT
This amendment to agreement (agreement) is entered into this + j day of
m, 2016 by and between MONROE COUNTY, a political subdivision of the State of Florida
(County or Grantor) and Key West Women's Club, Inc. a not for profit organized and operating
under the laws of the state of Florida (Grantee).
WHEREAS, there was an agreement entered into on October 21, 2015 between the
parties, awarding $80,954 to Grantee for the Hellings House Museum Phase I Repair and
Restoration Project; and
WHEREAS, it has become necessary to revise the termination date of the agreement to
December 30, 2016 to allow completion of the project due to delays in receiving custom materials
for the project, and
WHEREAS, it has become necessary to revise Exhibit A outlining Scope of Service, and
NOW, THEREFORE, in consideration of the mutual covenants contained herein the parties
agree to the amended agreement as follows:
1. Paragraph 1 of the agreement shall be revised to read as follows: This agreement is
for the period of October 21, 2015 to December 30, 2016. This agreement shall remain in effect
for the stated period unless one party gives to the other written notification of termination pursuant
to and in compliance with paragraphs 7, 12 or 13 of the original agreement dated October 21,
2015.
2. Any references to the date of September 30, 2016 shall be revised to read
December 30, 2016.
3. Exhibit A of the agreement shall be revised and attached hereto.
4. The remaining provisions of the agreement dated October 21, 2015 shall remain in
full force and effect.
THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK
Amendment #1
Key West Women's Club — Hellings House Museum — Phase I Repair and Restoration Project
ID# 1533
SS WHEREOF, the parties have set their hands and seal on the day and year first
ef .ag • ...A fin.
� , 1 e1a �. K. Board of County Commissioners
% , ' - , Clerk of Monroe County
.....4.
�► / 44? . )14.44.
Deputy Clerk Mayor/Chairman
Key West Women's Club, Inc.
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By -, , -
as V, Pr
esl
_1 x
Dawn Martin �- I - ;
Print Name � I_ --
Date: October 17, 2016 r
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AND TWO WITNESSES
i
le
(1) �r (2) i ; (*in t._ - /
(1) Debbie Wilcox (2) Roberta Spencer
Print Name Print Name
Dew 10 -17 -16 D 10 -11 -16
MONROE COUNTY ATTORNEY
nn A� PPROVED AS TO FORM:
CHRI,TINE M LIM _EAT- BARROWS
ASSIST�y CO TY ATTORNEY
Dale �K��ff /ra
Amendment #1
Key West Woman's Club - Heftier House Museum - Phase 1 Repair and Restoration Project
1DN 1533
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ACORD CERTIFICATE OF LIABILITY INSURANCE 1 lzi 0 "'°° 6 '
THIS CERTIFICATE IS $SUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON PO THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: N the cWtitiwN holder is an ADDITIONAL INSURED, the poticy(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 endoreement(s).
PRODUCER T ACT
NA
The Porter Allen Company, Inc. y s ,,,. (305) 294 -2542 I FAx
rivaNm. csosl:es -gyres
513 Southard Street
ADDRESS:
INSURERIe1 AFFORWNG COVERAGE NAM •
Key West FL 33040 INSURER A :Hudson Insurance Company
INSUREO INSURER Si
Key West Woman's Club, Inc. INSURER C:
PO Box 2924 NER
INSURER E:
Key West FL 33045 INSURER P1
COVERAGES CERTIFICATE NUMBER:CL1612 90 6927 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWTHSTANDING 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 AU. THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
VP TYPE OFOgURANCE POMP SUMER aN , LIME t
aENERALLIAeIUTY EACH OCCURRENCE $ 1,000,000
X COMMERCIAL OENE LL aLLITY else % 8 100,000
A I CLAMS-MADE OCCUR X N Rao 10006433 - 12/6/2016 12/0/2017 1ED EJIP (AAr one oor S 5, 000
—
PERSONAL 1 AOV INJURY $ 1, 000, 000
—
GENERAL AGGREGATE $ 2, 000, 00C
GEM. AGGREGE LMT APPLIES PER PRODUCTS • COMP/OP AGO $ =MUM i10 n Lac 8
AUTOMOBILE UAuaUTY . p ou L
-. - S
ANY AUTO BOOILY INJURY (Per Pelson) S
ALL SCHEDULED
AUTOS AUTOS 1100ILY INJURY (Pit nopde:N) S
HIRED AUTOS : AUTO D OPERTY . S
• uV$RELLA UAS • occuR r " , ' _
s
EXCESS LIAR gMIS MM& A • . ' r EACH OCCURRENCE , $
Erns' I � AGGREGATE S
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WORKERS COMPENSATION �. ���
1
ANOEMPLOYERS•UA$NJTY YIN Trae�7,�l *I
ANY PROPRIETCMARTNER,EXECUTIVE WAIVE Ni ! Y om.-- --
OFFICER/MEMBER ENCLUDEO7 NIA EL EACH ACCIDENT $
(1teMleloey N MI
N . Combs mat EL OISEASE. EA OY S
RMTI • • •, ,; TIONE Way L DISEASE • POUCY UNIT S
DESCRIPTION OUNTY BOARD OF COUNTY COMMISSIONERS O ONERS AND NONROZ CODE= TOOUSI
MONROE DEVELOPMENT COUNCIL IS THE
CERTIFICATE BOLDER AND ADDITIONAL INSURED FOR CAPITAL FUNDING .
CERTIFICATE HOLDER CANCELLATION
I
SHOULD ANY OF THE ABOVE DESCRIBED POLL 1ES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED Pt
Monroe County Board of County ACCORDANCE WITH THE POLICY PROVISIONS.
Commissioners and Monroe —
County Tourist Development Council AUTNOI RES ENYA
attn: Maria Slavik Risk (ads:) l P.O. BOX 1026
Key Weat, FL 33040 1+ ACORD 26 (2610106) O 1955.20RD CORPORATION. A5 rights reserved.
INS026 (201o05).D, The ACORD name and logo are registered marks of ACORD
lJ ( } 1996 Edition
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: Key West Women's Club, Inc.
Contract for: Heltings House Museum Phase I Repair and
Restoration
Address of Contractor: 319 Duval St
Key West FL, 33040
Phone: 305 -294 -2039
Scope of Work: Repair and Restoration
Reason for Waiver:
Waiver of Auto and Workers Comp. Insurance requirement: Key
West Women's Club does not have any automobiles or employees
Policies Waiver will
apply to: Auto and Workers Comp
� - Signature of Contractor: ?4V- ' ‘‘ ) / Y
Appra Not Approved
Risk Management:
Date: ?7/0- � County Administrat peal:
Approved Not Approved
Date:
Board or County Commissioners Appeal:
Approved Not Approved
Meeting Date:
Administration Instruction
#4709.2