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Item N06County of Monroe A BOARD OF COUNTY COMMISSIONERS Mayor George Neugent, District 2 The Florida. Key y w ) �i� Mayor Pro Tem David Rice, District 4 �r Danny L. Kolhage, District I Heather Carruthers, District 3 Sylvia J. Murphy, District 5 County Commission Meeting January 18, 2017 Agenda Item Number: N.6 Agenda Item Summary #2518 BULK ITEM: Yes DEPARTMENT: Risk Management TIME APPROXIMATE: STAFF CONTACT: Maria Slavik N/A AGENDA ITEM WORDING: Approval to Advertise Request for Proposals for Pollution Liability Insurance. ITEM BACKGROUND: County Purchasing policy requires competitive bids for insurance every three years, and the current policy expires May 1, 2017. PREVIOUS RELEVANT BOCC ACTION: The current policy was previously bid in January, 2011 and approved by the BOCC on April 20, 2011. CONTRACT /AGREEMENT CHANGES: N/A STAFF RECOMMENDATION: Approval to Advertise DOCUMENTATION: PROPOSAL FOR POLLUTION LIABILITY RFP 2017 FINANCIAL IMPACT: Effective Date: N/A Expiration Date: N/A Total Dollar Value of Contract: $200 Estimated Advertising Cost Total Cost to County: See Above Current Year Portion: N/A Budgeted: Yes Source of Funds: 08502 - 530 -498 CPI: N/A Indirect Costs: N/A Estimated Ongoing Costs Not Included in above dollar amounts: Revenue Producing: N/A Grant: N/A County Match: N/A Insurance Required: N/A Additional Details: If yes, amount: Estimated Advertising Cost Only 01/18/17 503 -08502 -RISK MGMT INSURANCE Pollution Liability $200.00 REVIEWED BY: Cynthia Hall Budget and Finance Bob Shillinger Kathy Peters Board of County Commissioners Completed 12/22/2016 11:28 AM Completed 12/23/2016 8:07 AM Completed 12/23/2016 10:34 AM Completed 12/23/2016 10:44 AM Completed 01/18/2017 9:00 AM MONROE COUNTY REQUEST FOR PROPOSALS FOR 2017 - 2020 Pollution Liability Insurance Program BOARD OF COUNTY COMMISSIONERS Mayor, George Neugent, District 2 Mayor Pro Tem, David Rice, District 4 Danny Kolhage, District 1 Heather Carruthers, District 3 Sylvia Murphy, District 5 COUNTY ADMINISTRATOR Roman Gastesi CLERK OF THE CIRCUIT COURT Kevin Madok, CPA COUNTY ATTORNEY Risk Management May, 2017 NOTICE OF CALLING FOR PROPOSALS NOTICE IS HEREBY GIVEN TO PROSPECTIVE PROPOSERS that on March 14, 2017 at 3:00 P.M. the Monroe County Purchasing Office will open sealed proposals for the following: Monroe County Pollution Liability Insurance Program Proposers must submit a total of five (5) proposals (two (2) signed originals and three (3) complete copies) in a sealed envelope clearly marked on the outside with the Proposer's name and: "Monroe County Pollution Liability Insurance Program" addressed and delivered to: Monroe County Purchasing Office 1100 Simonton Street, Room 1 -213 Key West, FL 33040 Phone: (305) 292 -4466 Fax: (305) 292 -4465 All proposals must be received by the County Purchasing Office before 3:00 P.M. on March 14, 2017. Any proposals received after this date and time will be automatically rejected. Materials may be delivered by Certified Mail, Return Receipt Requested, hand - delivered or couriered. Faxed or e- mailed proposals will be automatically rejected. Hand delivered Proposals may request a receipt. If sent by mail or by courier, the above - mentioned envelope shall be enclosed in another envelope addressed to the entity and address stated above. Proposers should be aware that certain "express mail" services will not guarantee specific time delivery to Key West, Florida. It is the sole responsibility of each Proposer to ensure their proposal is received in a timely fashion. Monroe County's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Board of County Commissioners. All proposals must remain valid for a period of ninety (90) days from the date of the deadline for the proposal stated above. The Board will automatically reject the response of any person or affiliate who appears on the convicted vendor list prepared 2 of 30 by the Department of Management Services, State of Florida, under Sec. 287.133(3) (d), Florida Statutes (1997). Monroe County declares that all or portions of the documents and work papers and other forms of deliverables pursuant to this request shall be subject to reuse by the County. All proposals, including the recommendation of the County Administrator and the requesting Department Head, will be presented to the Board of County Commissioners of Monroe County, Florida, for final awarding or otherwise. The Board reserves the right to reject any and all proposals, to waive informalities in any or all proposals, to re- advertise for proposals, and to separately accept or reject any item or items and to award and /or negotiate a contract in the best interest of the County. Dated at Key West, Florida, this day of , 2017. Monroe County Purchasing Department Publication Dates: Reporter (Fr Keynoter (Sa) KW Citizen (Su 3 of 30 TABLE OF CONTENTS NOTICE OF REQUEST FOR PROPOSALS SECTION ONE - INSTRUCTION TO PROPOSERS SECTION TWO - COUNTY FORMS 4 of 30 Monroe County Board of County Commissioners REQUEST FOR PROPOSALS FOR 2017 - 2020 Pollution Liability Insurance Program EFFECTIVE DATE: 5/1/17 BACKGROUND INFORMATION The County is a non - chartered county established under the Constitution and the laws of the State of Florida. The Clerk of the Circuit Court serves as the fiscal agent. The Board of County Commissioners, constituted as the governing body, has all the powers of a body corporate, including the powers to contract; to sue and be sued; to acquire, purchase, hold, lease and convey real estate and personal property; to borrow money, and to generally exercise the powers of a public authority organized and existing for the purpose of providing community services to citizens within its territorial boundaries. In order to carry out is function; the County is empowered to levy taxes to pay the cost of operations. A full time Risk Manager is employed to oversee the County's Property and Casualty insurance program. A full time safety manager reports to the County Administrator. CURRENT PROGRAM The County's current policy was issued on May 1, 2014 on a three year basis by Ironshore Specialty Insurance Co. The limits of the policy are $5 million per occurrence and all claims are subject to a $50,000 deductible. The three (3) year premium was $76,436. The policy extends to the legal obligations of the County that arise out of the discharge, dispersal, release, seepage, migration or escape of smoke, vapors, soot fumes acids, alkalis, toxic chemicals, liquids, gases, or other similar hazardous materials from locations scheduled in the policy. The policy will also pay for the expenses incurred for the investigation, monitoring, removal, disposal, treatment or neutralization of property contaminated by such incidents. Coverage is provided on a "Claims Made" basis with a retroactive date of 7/10/95. 5 of 30 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS REQUEST FOR PROPOSALS FOR POLLUTION LIABILITY INSURANCE GENERAL INFORMATION AND COVERAGES REQUESTED COVERAGES REQUESTED Monroe County, Florida wishes to receive proposals for the following insurance protection ➢ Pollution Liability The County will consider modified proposals to the extent that they provide adequate coverage and in view of the overall program objectives. Reasonable options are solicited where the desired coverages cannot be provided as requested. All reasonable proposals will be eligible for review. SEPARABILITY OF COVERAGES Coverages that must be purchased in combination or as part of other coverages should be specifically stated in the proposal(s). If different premiums apply to coverages when purchased separately, they should be specifically stated. RATING DATA A schedule of locations to be insured and a schedule of County owned Storage Tanks (to be included as insured locations) are included below. EVALUATION CRITERIA Award shall be made to the responsible proposer whose proposal is determined to be the most advantageous to the County, taking into consideration the evaluation criteria set forth below: Evaluation Factor Maximum Available Points Terms and conditions of coverages being 30 proposed Financial stability of insurers being 15 proposed Experience of proposing agent with structuring Pollution Liability insurance 7 Experience of proposing agent with 8 governmental entities Location of proposing agent (including 10 local preference if applicable: 5 points) Price 30 Total points earned are on a scale of 1 — 100 points 1 = lowest 100 = highest 6 of 30 LOSS HISTORY There have been no known losses during the past five (5) years. EFFECTIVE DATE OF COVERAGE The effective date of coverage is May 1, 2017. The County would prefer to purchase a three (3) year policy with premiums paid on an annual basis. The County will consider a single year policy if a multi year policy is unavailable. J ASSIGNMENT OF MARKETS 0 Due to the limited number of insurers that have the ability and desire to provide Pollution Liability insurance, the County will not assign markets for this RFP. However, if a proposer submits the County's account to an insurer and later elects to pursue a proposal from that insurer, it is requested that the proposer release the insurer and waive the standard 10 day waiting period so other proposers will have access to that insurer. RFP SCHEDULE The following schedule will apply to the RFP process. Extensions of any of the deadlines will not be honored. Date Activity 1/16/17 Posting of bid specifications on Demandstar 2/7/17 Deadline for requests for additional information 2/14/17 Addendum to RFP issued to all proposers 3/14/17 Proposal return date and bid opening 4/19/17 Board meeting and award of contract 5/1/17 Effective Date SUBMISSION OF PROPOSALS All proposals must be received no later than 3:00 pm, March 14, 2017 at which time they will be opened in accordance with the County's purchasing procedures. In an effort to accommodate proposers and underwriters, the bid opening has been deferred to the latest possible date. However, sufficient time must be allotted for the review of the proposals and obtaining approval from the Board. Proposers should recognize that overnight mail service providers may not guarantee delivery to Monroe County by a specified time. Proposers are encouraged to verify restrictions imposed by the various vendors. 7 of 30 Two (2) originals and three (3) copies of each proposal must be delivered to the following address by the date and time specified above: Monroe County Board of County Commissioners Office of Director of Purchasing 1100 Simonton Street Suite 2 -213 Key West, Florida 33040 Phone: (305) 292 -4464 Fax: (305) 292 -4465 Hand delivered proposals may request a receipt. Proposals received after the deadline will be returned unopened. All proposals should be contained in sealed envelopes, clearly marked on the outside with the following language: Monroe County, Florida Pollution Liability Insurance Program VALID DATE OF PROPOSALS Proposals are requested to remain valid until June 1, 2017 in the event that an extension of the current program is undertaken. RIGHT TO REJECT PROPOSALS Monroe County, Florida reserves the right to reject or waive any proposal individually, including any portion of a proposal for any reason that it deems appropriate. The County may elect to negotiate or not to negotiate with any individual Proposer. The County reserves the right to select the proposal(s) that it believes will best serve its interests The award of any multi -year contract is subject to an annual appropriation by the Monroe County Board of County Commissioners. ADHERENCE TO INFORMATION AND PROPOSAL All statements contained in written proposals are intended to be relied upon by Monroe County. All coverages must be issued as proposed unless the County authorizes individual changes. Any changes authorized by the County will not alter any other items contained in this Request for Proposal. Policies not issued in conformance with the submitted proposal will be considered not in compliance and must be corrected. 8 of 30 AUTHORITY OF PROPOSERS An authorized representative of the insurance company underwriting the program should sign the proposals. If the submitting agent/broker does not have the authority to sign the proposal, it should be signed by an authorized representative of the company. Proposals submitted without binding authority will not be given the same consideration as authorized proposals. Proposals should not be contingent upon any subsequent inspection after the inception date. REQUIRED LICENSE All agents submitting proposals are required to be currently licensed in the State of Florida to transact property and related coverages insurance. The County reserves the right to request verification of such licensing. The agent should be licensed with the insurer submitting a proposal and have the authority to bind coverage. STABILITY OF INSURERS CL Insurers furnishing coverage should be stable and have a current A. M. Best Company rating of "A" or better and be of sufficient financial size to provide security. Insurers must be currently authorized to transact insurance business in the State of Florida. If an insurer is proposed that has a Best rating of less than A -, a copy of the insurer's most recent financial statement should be included for review. ADDITIONAL INFORMATION /INSPECTION Every attempt has been made to furnish complete and accurate information to the best of the County's knowledge. Proposers are encouraged to determine, at their expense, their own information for underwriting purposes including any inspections and loss control surveys. If additional information is required, written requests must be submitted prior to 3:00 pm, February 7, 2017 to: Ms. Maria Slavik, CPM Risk Management Administrator Monroe County 1111 12 St. Suite 408 Key West, Florida 33040 Fax: (305) 295 -3179 Email: Slavik- Maria @Monroecounty - fl.gov Based upon the requests received, any addendum to the specifications will be prepared and posted on DemandStar. Oral requests for additional information will not be entertained. Payment Terms The County desires to have the option of interest free, periodic premium payments. Please indicate any terms available. SAMPLE POLICIES AND CONTRACTS Sample forms /endorsements and other coverage information are considered an integral part of the proposal. If Insurance Services Office (ISO) forms are to be used, reference can be made to the form numbers and edition dates. 9 of 30 If Manuscript or non -ISO forms are proposed, specimen forms must be attached to the proposal for review RATE CHANGE /POLICY MODIFICATION Ninety (90) days written notice is requested to be provided by the insurer prior to modification resulting in restriction of existing policy terms or provisions required by the insurer. TERMINATION /NON- RENEWAL NOTICE Ninety (90) days written notice is requested to be given by the insurer for termination, non - renewal or restriction of limits or coverage except for non - payment of premium. NAMED INSURED The Named Insured wording of the policy should include the following: Monroe County Board of County Commissioners and its elected officials. NOTICE OF CLAIM Proposers are requested to modify policy language relating to notification to the insurer following a loss to provide that: "Notice of loss shall be given to the insurer as soon as practicable following receipt of notice of the claim by the Risk Manager of Monroe County, Florida. " CLAIM REPORTING LOCATIONS Please indicate the address, telephone number and name of individuals to report claims to and the procedures to be followed in notifying the insurer. Please provide a list of all insurer claim reporting offices, their addresses, telephone numbers and contact persons who will adjust claims within the limits of the County's operations. LOSS HISTORY REPORTS Written loss history reports must be furnished at least quarterly. Reports should be completed in plain English and should include a detailed description of individual claims and the amounts paid and reserves for each claim. WAIVER OF SUBROGATION The standard policy wording involving subrogation should be modified to remove subrogation between the County and entities owned, managed, or required to be removed by agreement, contract or lease including interlocal and other governmental agreements. LOSS CONTROL SERVICES 10 of 30 The County wishes to utilize services of the successful insurer(s). Proposers should include a statement of the intended loss control activities and the frequency of such services. Any additional charges not included in normal policy premiums must be specifically identified by type and frequency of service and specific costs or charges separately stated. USE OF PROPOSAL FORMS Proposers are required to submit their proposal on the forms included in this request. Additional information or proposals may be submitted in addition to the initial proposal. The general information proposal form must be signed in accordance with other requirements of this Request for Proposal as well as individual coverage sections. In addition, if an addendum to this Request is issued, the Proposer must acknowledge receipt of such addendum by completing and returning, with their proposals, the acknowledgment forms that will accompany the addendum. However, the failure of the Proposer to acknowledge receipt of the addendum will not render the addendum invalid. All sections of the proposal forms must be completed. Responses such as "See Policy Form" or "See Proposal" will not be acceptable. Part of the evaluation process will be the ability of the proposer to understand and explain the terms and conditions of the policies. Fully responding to all issues addressed in the proposal forms will demonstrate the proposer's understanding of the program being submitted and the ability of the proposer to serve the needs of the County. COMPLETION OF REQUIRED FORMS Proposers must complete and submit the required "Drug -free Workplace" "Non- Collusion Affidavit ", "Sworn Statement Under Ordinance No. 10 -1990 Ethics Clause" and "Public Entity Crime Statement" forms in addition to completing the proposal forms. 11 of 30 Monroe County, Florida 2017 - 2020 Pollution Liability Insurance Program Request for Proposals REQUESTED COVERAGES FORM The policy should extend to the legal obligations of the County that arise out of the discharge, dispersal, release, seepage, migration or escape of smoke, vapors, soot fumes acids, alkalis, toxic chemicals, liquids, gases, or other similar hazardous materials from locations scheduled in the policy. The policy should also pay for the expenses incurred for the investigation, monitoring, removal, disposal, treatment or neutralization of property contaminated by such incidents. If coverage is provided on a "Claims Made" basis, the County desires to have full "Prior Acts" coverage; however to maintain the continuity of the current program, any proposal with a retroactive date later than 7/10/95 will receive less consideration. DESIRED LIMITS AND DEDUCTIBLE Desired Limits $50 million Desired Deductible $50,000 Alternative limits and deductibles will be considered based on the level of protection being provided and pricing. UNDERWRITING INFORMATION Specific underwriting information is provided as attachments. Additional information regarding the County (to include budgetary information) can be obtained from the County's Website at http://www.rr nr eCOL,n fl,go v/`. LOSS EXPERIENCE There have been no known losses within the past five years. 12of30 Monroe County, Florida 2017 - 2020 Pollution Liability Insurance Program Request for Proposals Proposal Form GENERAL INFORMATION Use of the proposal forms will enable a faster more complete analysis of the proposal(s) submitted. Please complete this general proposal form in addition to a separate proposal form for each coverage proposed. Additional information can be attached to the forms. Agent/Agency submitting proposal Address Telephone Number: Does agent have binding authority? If not, state procedure to bind. Yes No Is agent licensed in the state of Florida? Are the following coverages proposed.? Yes kNn Legal obligations arising out of the discharge, disposal, release, seepage, migration or escape of pollutants Payment of expenses incurred for the investigation monitoring, removal, disposal, treatment or neutralization of property contaminated by pollution incidents Yes If not, provide specific details of coverages provided Yes No kNn 13 of 30 Are coverages different from current program? Yes No If so, state differences Effective date(s) of coverage(s) List payment plan, including interest or service charges J 0 Proposal valid until (date) 0 Rate Change /Policy Modification wording included CO as requested? Yes No Termination Notice wording included as requested? Yes No Named Insured wording included as requested? Yes No N 0. If not, include actual wording to be used. J Claim reporting location included? Yes No Will requested claim reporting wording be used? Yes No J J Claim Reports to be provided as requested? Yes No 0. If not, state details 0. Loss Control services to be provided? Yes No Details. 14 of 30 Sample forms and policies included as required? Yes No The proposer stated below is the authorized agent of the company or companies proposed, and is authorized to bind coverages upon acceptance by the County. Deviations from the requested progran have been stated. Coverage will be issued as proposed. Signature of Authorized Representative Date 15 of 30 Monroe County, Florida 2017 - 2020 Pollution Liability Insurance Program Request for Proposals Proposal Form POLLUTION LIABILITY Company Underwriting office used Address Telephone Number Is insurer authorized to transact insurance in the State of Florida? Basis of authorization: Admitted insurer Surplus Lines insurer Current A. M. Best Co. rating Is requested policy form proposed? If not, list form(s) used Coverages Provided Legal Liability Clean Up Rates guaranteed for one year? Are rating worksheets attached? Yes No Yes No Yes No Yes Yes Yes No No No Yes No Yes No Yes No Yes No 10 16 of 30 Term of coverage being proposed One year? Two year? Three year? Limits /Premiums /Deductibles 10 10 10 If a multi year program is being proposed, will premiums be payable on an annual basis? Yes No The proposer stated below is the authorized agent of the company or companies proposed, and is authorized to bind coverages upon acceptance by the County. Deviations from the requested program have been stated. Coverage will be issued as proposed. Signature of Authorized Representative Date 17 of 30 Limit Deductible One Year Two Year Three Premium Premium Year Premium Legal Liabilit Clean U If a multi year program is being proposed, will premiums be payable on an annual basis? Yes No The proposer stated below is the authorized agent of the company or companies proposed, and is authorized to bind coverages upon acceptance by the County. Deviations from the requested program have been stated. Coverage will be issued as proposed. Signature of Authorized Representative Date 17 of 30 MONROE COUNTY, FLORIDA 2017 - 20 POLLUTION INSURANCE SCHEDULE OF INSURED LOCATION$[chl FIRE AMBULANCE STATION FIRE STATION SENIOR CITIZEN CENTER LIBRARY 23 EMERALD ROAD KEY DEER BLVD KEY DEER BLVD 200 KEY DEER BLVD BIG COPPIT KEY, FL BIG PINE KEY, FL 33043 BIG PINE KEY, FL 33043 BIG PINE KEY, FL 33043 33040 SHERIFF'S SUBSTATION LIBRARY LIBRARY AVIATION SHERIFF'S / FIRE AMBULANCE 2331 OVERSEES HWY MM101.5 OVERSEES HWY OFFICE, 10100 OVERSEAS MM21 CUDJOE KEY KEY LARGO, FL 33037 KEY LARGO, FL 33037 HWY, MARATHON, FL CUDJOE KEY, FL 33042 SENIOR CITIZEN HEALTH DEPARTMENT SUB — COURTHOUSE /OFFICES SHERIFF'S SUB — STATION CENTER 3333 OVERSEES HWY 3117 OVERSEES HWY OFFICES 33 STREET — GULF MARATHON, FL 33050 MARATHON, FL 33050 3103 OVERSEES HWY MARATHON, FL 33050 MARATHON, FL 33050 GOVERNMENT CENTER MARATHON GOV. AIRPORT TERMINAL PUBLIC WORKS OFFICES ANNEX CENTER /EOC 9480 OVERSEES HWY 10600 AVIATION BLVD 49063 RD STREET 27900 OVERSEES HWY MARATHON, FL 33050 MARATHON, FL 33050 MARATHON, FL 33050 MARATHON, FL 33050 SHERIFF'S SUB— COUNTY STATION OFFICES /SOCIAL DETENTION FACILITY SHERIFF'S SPECIAL 88770 OVERSEES HWY SERVICES 3981 OCEAN TERRACE OPERATIONS PLANTATION KEY, FL HIGHPOINT ROAD MARATHON, FL 33050 85 COCO PLUM ROAD 33070 PLANTATION KEY, FL MARATHON, FL 33050 33070 DETENTION FACILITY DETENTION FACILITY PUBLIC WORKS OFFICES SENIOR CITIZEN CENTER HIGHPOINT ROAD 5501 COLLEGE ROAD 103 KEY HEIGHTS DRIVE HIGHPOINT ROAD PLANTATION KEY, FL STOCK ISLAND, FL PLANTATION KEY, FL 33070 PLANTATION KEY, FL 33070 33040 33070 SHERIFF ADMIN. BUILDING 5525 COLLEGE ROAD STOCK ISLAND, FL 33040 a 18 of 30 MONROE COUNTY, FLORIDA 2017 - 20 POLLUTION INSURANCE SCHEDULE OF INSURED LOCATIONS FIRE & AMBULANCE SPOTTSWOOD BLDG, STATION COURTHOUSE ANNEX /COURTROOMS 887700 OVERSEAS HWY, MARINE AVENUE 500 WHITEHEAD STREET 510 WHITEHEAD STREET PLANTATION KEY, FL TAVERNIER, FL 33070 KEY WEST, FL 33040 KEY WEST, FL 33040 33070 LIGHTHOUSE MUSEUM JUSTICE BLDG /RECORD LIBRARY SENIOR CITIZENS 938 WHITEHEAD STORAGE 700 FLEMING STREET NUTRITION CENTER STREET 530 WHITEHEAD STREET KEY WEST, FL 33040 TRUMAN AVE. /WHITE ST. KEY WEST, FL 33040 KEY WEST, FL 33040 KEY WEST, FL 33040 AIRPORT TERMINAL COUNTY GARAGE GATO BUILDING & ARNOLD AIRPORT 3491 S. ROOSEVELT S. ROOSEVELT BLVD. GENERATOR TERMINAL ANNEX BLVD. KEY WEST, FL 33040 1100 SIMONTON STREET S. ROOSEVELT BLVD. KEY WEST, FL 33040 KEY WEST, FL 33040 KEY WEST, FL 33040 LONG KEY LANDFILL AND TRANSFER CUDJOE KEY LANDFILL HOUSE FOR THE AGED FIRE STATION STATION AND TRANSFER STATION 5200 COLLEGE ROAD OVERSEES HWY MM 68 CUDJOE KEY, FL 33042 STOCK ISLAND, FL 33040 CONCH KEY, FL 33050 LONG KEY, FL 33001 LIBRARY GOVERNMENTAL HARVEY GOVERNMENT W 3251 OVERSEES HY CENTER /COURTHOUSE HEALTH CLINIC CENTER MARATHON, FL 33050 HIGHPOINT ROAD 170901 HIGHWAY #1 (REAR) T AVENUE PLANTATION KEY, FL TAVERNIER, FL 33070 KEY WEESTST, FL 33040 KEY F 33070 , FLEET MAINTENANCE COUNTY OFFICES /ELLIS STATE ATTORNEY/VOTING FACILITY BUILDING REGISTRAR 60 HIGH POINT ROAD 10600 AVIATION BLVD 88800 US HIGHWAY #1 302 FLEMING STREET /501 ISLAMORADA, FL 33070 MARATHON, FL 33050 PLANTATION KEY, FL THOMAS STREET 33070 KEY WEST, FL 33040 KEY LARGO LANDFILL MURRAY E NELSON AND TRANSFER GOVERNMENT & FREEMAN JUSTICE ND FIRE STATION, 2 STATION CULTURAL BLDG., BUILDING, 302 FLEMING AVE., STOCK ISLAND 11100 COUNTY RD. 905 102050 OVERSEAS HWY, ST., KEY WEST, FL KEY LARGO, FL KEY WEST, FL Ground Storage Tanks 19 of 30 [s2]1[ch3] [s4] 20 0 30 Monroe County, Florida 2017/2020 Pollution Liability Insurance Program Request for Proposals Underwriting Information 2015/16 Actual Revenues $328,9­76,542 (Unaudited' Coverage has not been cancelled, denied or non - renewed. 2016/17 Projected Monroe County has not been investigated, cited and /or prosecuted for contravention or violation of any standard or law relating to any release of pollutants. There have been no pollution claims. Monroe County is not aware of any past or present contamination on -site or emanating from any site that could give rise to a claim. Monroe County has not received any notices of violation, fine, penalties, complaints etc. within the past 5 years. Monroe County presently complies with statutes, standards, regulation relating to the protection of the environment. There has been no past, present or planned remediation, monitoring or sampling to investigate potential contamination. There are no plans to sell or sublease any of the locations listed. There are no known plans for future development, improvement, betterment, demolition or plans for changes in site operations. Underground storage tanks are in compliance with the 1998 US EPA standards for leak detection, overflow protection and corrosion protection. 21 of 30 Information on the County Owned landfills: Location Lined Size Acres Yes I No Mound 1 Top Lined MM68 but Not 8 Long Key Bottom Lined Mound 2 Top Lined MM68 but Not 6.5 Long Key Bottom Lined Key Largo Landfill, Top Lined Key Largo but Not 7 Bottom Lined Cudjoe Key Landfill, Top Lined Cudjoe Key but Not 7 Bottom Lined Ground water monitoring devices and sub surface wells have been installed. They are evaluated 4 times a year by an independent contractor. No negative reports have been issued. All landfills were opened between 1974 and 1975. They were closed between 1994 and 1995. They are top -lined but not bottom - lined. All public waste is transported out of the County and disposed in properly licensed waste disposals sites. The County has constructed three (3) Transfer Facilities. The disposal of public waste is provided by independent contractors with the agreements containing favorable Hold Harmless /Indemnification provisions in favor of the County and appropriate minimum insurance requirements that the contractors must comply with. 22 of 30 REQUIRED FORMS TO BE COMPLETED LIAl PROPOSER rt re 23 of 30 RESPONSE FORM RESPOND TO: MONROE COUNTY BOARD OF COUNTY COMMISSIONERS Purchasing Department GATO BUILDING, ROOM 1 -213 1100 SIMONTON STREET KEY WEST, FLORIDA 33040 I acknowledge receipt of Addenda No. (s) I have included • Response Form • Lobbying and Conflict of Interest Clause • Non - Collusion Affidavit • Drug Free Workplace Form • Public Entity Crime Statement • Proof of payment of Monroe County business tax and relevant City business tax, unless exempted, must be provided within ten days of award of the contract • Local Preference form (if applicable) • Proposal Forms (General Information, and Pollution Liability) (Check mark items above, as reminder that they are included.) I have included a current copy of the following professional licenses and receipt for business taxes Mailing Address: Telephone: Fax: Date: 24 of 30 Signed: Witness: STATE OF (Print Name) (Title) COUNTY OF Subscribed and sworn to (or affirmed) before me on (date) by known to me or has produced identification. (name of affiant). He /She is personally NOTARY PUBLIC My Commission Expires: (type of identification) as 25 of 30 LOBBYING AND CONFLICT OF INTEREST CLAUSE ETHICS CLAUSE SWORN STATEMENT UNDER ORDINANCE NO. 010 -1990 MONROE COUNTY, FLORIDA N (Company) "...warrants that he /it has not employed, retained or otherwise had act on his /her behalf any former County officer or employee in violation of Section 2 of Ordinance No. 010 -1990 or any County officer or employee in violation of Section 3 of Ordinance No. 010 -1990. For breach or violation of this provision the County may, in its discretion, terminate this Agreement without liability and may also, in its discretion, deduct from the Agreement or purchase price, or otherwise recover, the full amount of any fee, commission, percentage, gift, or consideration paid to the former County officer or employee." (Signature) Date: STATE OF: COUNTY OF: Subscribed and sworn to (or affirmed) before me on (date) by known to me or has produced identification) as identification. NOTARY PUBLIC My Commission Expires: (name of affiant). He /She is personally (type of 26 of 30 NON - COLLUSION AFFIDAVIT I, of the city of oath, and under penalty of perjury, depose and say that F1ii1 Proposal for the project described according to law on my of the firm of the bidder making the in the Request for Proposals for and that I executed the said proposal with full authority to do so; 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; 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; 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. (Signature) Date: STATE OF COUNTY OF Subscribed and sworn to (or affirmed) before me on (date) by known to me or has produced identification) as identification. (name of affiant). He /She is personally (type of NOTARY PUBLIC My Commission Expires: 27 of 30 DRUG -FREE WORKPLACE FORM The undersigned vendor 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' 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 bid 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 bid, 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 contenderre 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. (Signature) Date: STATE OF: COUNTY OF: Subscribed and sworn to (or affirmed) before me on (date) by (name of affiant). He /She is personally known to me or has produced (type of identification) as identification. NOTARY PUBLIC My Commission Expires: 28 of 30 PUBLIC ENTITY CRIME STATEMENT "A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or CONTRACTOR 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, for CATEGORY TWO for a period of 36 months fro the date of being placed on the convicted vendor list." I have read the above and state that neither (Proposer's name) nor any Affiliate has been placed on the convicted vendor list within the last 36 months. (Signature) Date: STATE OF COUNTY OF Subscribed and sworn to (or affirmed) before me on (date) by has produced identification. (type of identification) as NOTARY PUBLIC My Commission Expires: (name of affiant). He /She is personally known to me or 29 of 30 LOCAL PREFERENCE FORM Vendors claiming a local preference according to Ordinance 023 -2009 must complete this form. Name of Bidder /Responder Date: 1. Does the vendor have a valid receipt for the business tax paid to the Monroe County Tax Collector dated at least one year prior to the notice or request for bid or proposal? (Please furnish copy. ) 2. Does the vendor have a physical business address located within Monroe County from which the vendor operates or performs business on a day to day basis that is a substantial component of the goods or services being offered to Monroe County? List Address: Telephone Number: B. Does the vendor /prime contractor intend to subcontract 50% or more of the goods, services or construction to local businesses meeting the criteria above as to licensing and location? If yes, please provide: 1. Copy of Receipt of the business tax paid to the Monroe County Tax Collector by the subcontractor dated at least one year prior to the notice or request for bid or proposal. 2. Subcontractor Address within Monroe County from which the subcontractor operates: Tel. Number Print Name: Signature and Title of Authorized Signatory for Bidder /Responder STATE OF COUNTY OF On this day of , 20 , before me, the undersigned notary public, personally appeared , known to me to be the person whose name is subscribed above or who produced as identification, and acknowledged that he /she is the person who executed the above Local Preference Form for the purposes therein contained. Notary Public Print Name My commission expires: Seal 30 of 30