12/10/2014 AgreementAMY REAVILIN, CPA
CLERK OF CIRCUR COURT &COMPTROLLER
Moxnoe couimr, FLORIDA
DATE: January 6, 2015
TO: Teresa Aguiar, PHR, CPM
Director of Employee Services
ATTN.• Christine Diaz
FROM: Lindsey Ballard, D.C Qy.
At the December 10, 2014, Board of County Commissioner's meeting the Board granted
approval and execution of Item C12 one -year consulting agreement with Adams Benefit Corporation, to
provide advice and assistance regarding dental and health insurance for: review and issuance of Request
for Proposals (RFPs), analysis of proposals submitted, and selection of carrier for dental and health
benefits.
Attached is a duplicate original of the above - mentioned for your handling. Should you have any
questions please do not hesitate to contact this office.
cc: County Attorney
Finance
*; S C AU n
,/File N'tl
� � p hi
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 Fox: 305 - 852 -7146
MONROE COUNTY
CONTRACTFOR
Health Plan and Dental Benefit Consulting ? Services
THIS AGREEMENT ( "Agreement ") is made and entered into this / ` day of December,
2014 by and between MONROE COUNTY ( "COUNTY "), a political subdivision of the State
of Florida, whose address is 1100 Simonton Street, Key West, Florida 33040 and Adams
Benefit Corporation ( "CONTRACTOR "), whose address is 600 Corporate Drive, #670, Ft.
Lauderdale, FL 33334 (collectively, the "Parties ").
Section 1. SCOPE OF SERVICES
CONTRACTOR shall do, perform and carry out in a professional and proper manner
certain duties as described in the Scope of Services — Exhibit A — which is attached hereto
and made a part of this agreement.
By entering into this Agreement, the CONTRACTOR warrants that it has not employed,
retained or otherwise had act on its behalf any former county officer or employee subject
to the prohibition of Section 2 -149 of the Monroe County Code or any current county
officer or employee in violation of Section 2 -150 of the Monroe County Code. For breach
or violation of this provision the county may, in its discretion, terminate this contract
without liability and may also, in its discretion, deduct from the contract or purchase price,
or otherwise recover, the full amount of any fee, commission, percentage, gift or
consideration paid to the former county officer or employee or current county officer or
employee.
Section 2. WARRANTIES
2.1 The CONTRACTOR warrants that all staff members, independent
contractors, subcontracted work, if any, and all service providers it uses,
engages or manages, comply with Health Insurance Portability and
Accountability Act (HIPAA) privacy and security rules. If necessary, the
CONTRACTOR will enter into a Business Associate Agreement with the
COUNTY.
2.2 The CONTRACTOR warrants that it has not employed or retained a
company or person, other than a bona fide employee, contractor or
subcontractor, working in its employ, to solicit or secure a contract with the
County and that it has not paid or agreed to pay any person, company,
corporation, individual or firm other than a bona fide employee, contractor or
subcontractor, working in its employ any fee, commission, percentage, gift or
other consideration contingent upon or resulting from the award or making of
a contract with the County. For the breach or violation of the provision, the
CONTRACTOR agrees that the COUNTY shall have the right to terminate this
Agreement without liability and, at its discretion, to offset from monies owed, or
otherwise recover, the full amount of such fee, commission, percentage, gift, or
consideration.
2.3 The CONTRACTOR warrants and agrees that it will comply with Monroe
County Code section 2 -347, which states that persons who assist in the
preparation of requests for competitive solicitation are prohibited from
submitting a proposal in response to the competitive solicitation.
Section 3. TERM OF AGREEMENT
The Agreement will begin on the date entered above and will continue for a period of one
(1) year, unless terminated in accordance with Section 6, below.
Section 4. COMPENSATION
Compensation to the CONTRACTOR for the services listed on Exhibit A will be as follows
( "Contract Price "):
Health Plan Consulting services: $18,000.00
Dental Plan Consulting services: $12,500.00
The Contract Price is all inclusive. No claims for reimbursement for expenses will be
reimbursed. Payments will be made in monthly installments, each of which is equal to
1/12' of the Contract Price, upon presentation of a proper invoice as outlined in Section 5
below.
Maximum number of visits for face -to -face meetings described in Exhibit A is eight (8). If
the COUNTY seeks more visits from Adams, each trip will be reimbursed at the rate of
three thousand dollars ($3,000.00), all inclusive, irrespective of the number of days for the
trip or the number of representatives who attend.
By entering into this Agreement, the CONTRACTOR warrants that it understands that the
Contract Price represents the full compensation for all services under this Agreement, and
further warrants that it will not retain any compensation of any kind, including but not
limited to commissions, fees, and other payments, from any entity is awarded a contract to
supply health plan or dental benefits to the County as a result of any advice supplied by
CONTRACTOR. The CONTRACTOR understands and agrees that in the event of breach
of this provision, the Agreement is voidable, and CONTRACTOR will disgorge any and all
compensation earned to that point in time and will waive any right to any additional
compensation from that point forward.
Section 5. PAYMENT TO CONTRACTOR
5.1 Payment will be made according to the Florida Local Government Prompt Payment
Act, Section 218.70, Florida Statutes, following presentation of an invoice in a form
satisfactory to the Clerk of Courts for Monroe County (Clerk). The request must
describe in detail the services performed and the payment amount requested. The
vendor must submit a W -9 before the claim can be paid. The COUNTY is not
liable for sales or use taxes.
5.2 Continuation of this Agreement is contingent upon annual appropriation by Monroe
County Board of County Commissioners.
5.3 The compensation listed in Section 5 will be payable in monthly installments. The
Contractor will submit such invoice monthly for services provided during the
2
preceding month.
Section 6. CONTRACT TERMINATION
Either party may terminate this Agreement because of the failure of the other party to
perform its obligations under the Agreement on thirty (30) days' written notice to the other
party. COUNTY may terminate this Agreement with cause upon thirty (30) days' notice to
the CONTRACTOR, provided that the County provides notice of the intent to default on
the CONTRACTOR and provides a ten (10) day opportunity to cure the defect prior to
issuing notice of termination. COUNTY shall pay CONTRACTOR for work performed
through the date of termination.
Section 7. PUBLIC RECORDS RESPONSIBILITY
CONTRACTOR shall maintain all books, records, and documents directly pertinent to
performance under this Agreement in accordance with generally accepted accounting
principles consistently applied. Each party to this Agreement or their authorized
representatives shall have reasonable and timely access to such records of each other
party to this Agreement for public records purposes during the term of the agreement and
for four years following the termination of this Agreement. If an auditor employed by the
COUNTY or Clerk determines that monies paid to CONTRACTOR pursuant to this
Agreement were spent for purposes not authorized by this Agreement, the
CONTRACTOR shall repay the monies together with interest calculated pursuant to
Section 55.03 of the Florida Statutes, running from the date the monies were paid to
CONTRACTOR.
In accordance with Florida Statutes Section 119.0701, the CONTRACTOR will:
(a) Keep and maintain public records that ordinarily and necessarily would be required
by the public agency in order to perform the service.
(b) Provide the public with access to public records on the same terms and conditions
that the public agency would provide the records and at a cost that does not exceed the
cost provided in this chapter or as otherwise provided by law.
(c) Ensure that public records that are exempt or confidential and exempt from public
records disclosure requirements are not disclosed except as authorized by law.
(d) Meet all requirements for retaining public records and transfer, at no cost, to the
public agency all public records in possession of the contractor upon termination of the
contract and destroy any duplicate public records that are exempt or confidential and
exempt from public records disclosure requirements. All records stored electronically must
be provided to the public agency in a format that is compatible with the information
technology systems of the public agency.
Section 8. GOVERNING LAW, VENUE, INTERPRETATION, COSTS AND FEES
This Agreement shall be governed by and construed in accordance with the laws of the
State of Florida applicable to Agreements made and to be performed entirely in the State.
3
In the event that any cause of action or administrative proceeding is instituted for the
enforcement or interpretation of this Agreement, the COUNTY and CONTRACTOR agree
that venue shall lie in the appropriate court or before the appropriate administrative body in
Monroe County, Florida.
Section 9. SEVERABILITY
If any term, covenant, condition or provision of this Agreement (or the application thereof
to any circumstance or person) shall be declared invalid or unenforceable to any extent by
a court of competent jurisdiction, the remaining terms, covenants, conditions and
provisions of this Agreement, shall not be affected thereby; and each remaining term,
covenant, condition and provision of this Agreement shall be valid and shall be
enforceable to the fullest extent permitted by law unless the enforcement of the remaining
terms, covenants, conditions and provisions of this Agreement would prevent the
accomplishment of the original intent of this Agreement. The COUNTY and
CONTRACTOR agree to reform the Agreement to replace any stricken provision with a
valid provision that comes as close as possible to the intent of the stricken provision.
Section 10. ATTORNEY'S FEES AND COSTS
The COUNTY and CONTRACTOR agree that in the event any cause of action or
administrative proceeding is initiated or defended by any parry relative to the enforcement
or interpretation of this Agreement, the prevailing party shall be entitled to reasonable
attorney's fees and court costs, as an award against the non - prevailing party.
Section 11. BINDING EFFECT
The terms, covenants, conditions, and provisions of this Agreement shall bind and inure to
the benefit of the COUNTY and CONTRACTOR and their respective legal representatives,
successors, and assigns.
Section 12. AUTHORITY
Each party represents and warrants to the other that the execution, delivery and
performance of this Agreement have been duly authorized by all necessary County and
corporate action, as required by law.
Section 13. COOPERATION
In the event any administrative or legal proceeding is instituted against either party relating
to the formation, execution, performance, or breach of this Agreement, COUNTY and
CONTRACTOR agree to participate, to the extent required by the other party, in all
proceedings, hearings, processes, meetings, and other activities related to the substance
of this Agreement or provision of the services under this Agreement. COUNTY and
CONTRACTOR specifically agree that no party to this Agreement shall be required to
enter into any arbitration proceedings related to this Agreement.
Section 14. NONDISCRIMINATION
4
COUNTY and CONTRACTOR agree that there will be no discrimination against any
person, and it is expressly understood that upon a determination by a court of competent
jurisdiction that discrimination has occurred, this Agreement automatically terminates
without any further action on the part of any party, effective the date of the court order.
The parties agree to comply with all Federal and Florida statutes, and all local ordinances,
as applicable, relating to nondiscrimination. These include but are not limited to: 1) Title
VII of the Civil Rights Act of 1964 (PL 88 -352) which prohibits discrimination in
employment on the basis of race, color, national origin; 2) Title IX of the Education
Amendment of 1972, as amended (20 USC ss. 1681 -1683, and 1685 - 1686), which
prohibits discrimination on the basis of sex; 3) Section 504 of the Rehabilitation Act of
1973, as amended (20 USC s. 794), which prohibits discrimination on the basis of
handicaps: 4) The Age Discrimination Act of 1975, as amended (42 USC ss. 6101 -6107)
which prohibits discrimination on the basis of age; 5) The Drug Abuse Office and
Treatment Act of 1972 (PL 29 -255), as amended, relating to nondiscrimination on the
basis of drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention,
Treatment and Rehabilitation Act of 1970 (PL 91 -616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or alcoholism; 7) The Public Health
Service Act of 1912, ss. 523 and 527 (42 USC ss. 690dd -3 and 290ee -3) as amended,
relating to confidentiality of alcohol and drug abuse patient records; 8) Title VIII of the Civil
Rights Act of 1968 (42 USC ss. 3601 et seq.), as amended, relating to nondiscrimination in
the sale, rental or financing of housing; 9) The Americans with Disabilities Act of 1990 (42
USC s. 1201), as may be amended from time to time, relating to nondiscrimination on the
basis of disability; 10) Monroe County Code Chapter 13, Article VI, which prohibits
discrimination on the basis of race, color, sex, religion, national origin, ancestry, sexual
orientation, gender identity or expression, familial status or age; and 11) any other
nondiscrimination provisions in any Federal or state statutes which may apply to the
parties to, or the subject matter of, this Agreement.
Section 15. CODE OF ETHICS
CONTRACTOR and COUNTY both understand and agree that officers and employees of
the COUNTY are required to comply with the standards of conduct for public officers and
employees as delineated in Section 112.313, Florida Statutes, regarding, but not limited
to, solicitation or acceptance of gifts; doing business with one's agency; unauthorized
compensation; misuse of public position, conflicting employment or contractual
relationship; and disclosure or use of certain information.
Section 16. PUBLIC ACCESS
The COUNTY and CONTRACTOR shall allow and permit reasonable access to, and
inspection of, all documents, papers, letters or other materials in its possession or under
its control subject to the provisions of Chapter 119, Florida Statutes, and made or received
by the COUNTY and CONTRACTOR in conjunction with this Agreement; and the
COUNTY shall have the right to unilaterally cancel this Agreement upon violation of this
provision by CONTRACTOR.
Section 17. NON - WAIVER OF IMMUNITY
Notwithstanding the provisions of Sec. 768.28, Florida Statutes, the participation of the
COUNTY and the CONTRACTOR in this Agreement and the acquisition of any
commercial liability insurance coverage, self- insurance coverage, or local government
liability insurance pool coverage shall not be deemed a waiver of immunity to the extent of
liability coverage, nor shall any Agreement entered into by the COUNTY be required to
contain any provision for waiver.
Section 18. PRIVILEGES AND IMMUNITIES
All of the privileges and immunities from liability, exemptions from laws, ordinances, and
rules and pensions and relief, disability, workers' compensation, and other benefits which
apply to the activity of officers, agents, or employees of any public agents or employees of
the COUNTY, when performing their respective functions under this Agreement within the
territorial limits of the COUNTY shall apply to the same degree and extent to the
performance of such functions and duties of such officers, agents, volunteers, or
employees outside the territorial limits of the COUNTY.
Section 19. LEGAL OBLIGATIONS AND RESPONSIBILITIES
Non - Delegation of Constitutional or Statutory Duties. This Agreement is not intended to,
nor shall it be construed as, relieving any participating entity from any obligation or
responsibility imposed upon the entity by law except to the extent of actual and timely
performance thereof by any participating entity, in which case the performance may be
offered in satisfaction of the obligation or responsibility. Further, this Agreement is not
intended to, nor shall it be construed as, authorizing the delegation of the constitutional or
statutory duties of the COUNTY, except to the extent permitted by the Florida constitution,
state statute, and case law.
Section 20. NON - RELIANCE BY NON - PARTIES
No person or entity shall be entitled to rely upon the terms, or any of them, of this
Agreement to enforce or attempt to enforce any third -party claim or entitlement to or
benefit of any service or program contemplated hereunder, and the COUNTY and the
CONTRACTOR agree that neither the COUNTY nor the CONTRACTOR or any agent,
officer, or employee of either shall have the authority to inform, counsel, or otherwise
indicate that any particular individual or group of individuals, entity or entities, have
entitlements or benefits under this Agreement separate and apart, inferior to, or superior to
the community in general or for the purposes contemplated in this Agreement.
Section 21. NO PERSONAL LIABILITY
No covenant or agreement contained herein shall be deemed to be a covenant or
agreement of any member, officer, agent or employee of Monroe County in his or her
individual capacity, and no member, officer, agent or employee of Monroe County shall be
liable personally on this Agreement or be subject to any personal liability or accountability
by reason of the execution of this Agreement.
Section 22. INSURANCE POLICIES
As a pre- requisite of the work governed, the CONTRACTOR shall obtain, at his /her own
expense, insurance as specified in any attached schedules, which are made part of this
contract.
Within ten (10) days following execution of this Agreement, the CONTRACTOR shall
provide, to the COUNTY, as satisfactory evidence of the required insurance, either:
G
• Certificate of Insurance
or
• A Certified copy of the actual insurance policy.
All insurance policies must specify that they are not subject to cancellation, non - renewal,
material change, or reduction in coverage unless a minimum of thirty (30) days prior
notification is given to the County by the insurer.
The acceptance and /or approval of the Contractor's insurance shall not be construed as
relieving the Contractor from any liability or obligation assumed under this contract or
imposed by law.
The Monroe County Board of County Commissioners, its employees and officials will be
included as "Additional Insured" on general liability and vehicle liability policies.
Section 23. INDEMNIFICATION
The CONTRACTOR does hereby consent and agree to indemnify and hold harmless the
COUNTY, its Mayor, the Board of County Commissioners, appointed Boards and
Commissions, Officers, and the Employees, and any other agents, individually and
collectively, from all fines, suits, claims, demands, actions, costs, obligations, attorney's
fees, or liability of any kind arising out of the sole negligent actions of the CONTRACTOR
or substantial and unnecessary delay caused by the willful nonperformance of the
CONTRACTOR and shall be solely responsible and answerable for any and all accidents
or injuries to persons or property arising out of its performance of this contract. The
amount and type of insurance coverage requirements set forth hereunder shall in no way
be construed as limiting the scope of indemnity set forth in this paragraph. Further the
CONTRACTOR agrees to defend and pay all legal costs attendant to acts attributable to
the sole negligent act of the CONTRACTOR.
At all times and for all purposes hereunder, the CONTRACTOR is an independent
contractor and not an employee of the Board of County Commissioners. No statement
contained in this agreement shall be construed so as to find the CONTRACTOR or any of
his /her employees, contractors, servants or agents to be employees of the Board of
County Commissioners for Monroe County. As an independent contractor the
CONTRACTOR shall provide independent, professional judgment and comply with all
federal, state, and local statutes, ordinances, rules and regulations applicable to the
services to be provided.
IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed
on the day of 2014.
(SEAL)
Attest: AMY 4AVILIN, Clerk
By:
Deputy Clerk
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By:
Mayor /Chairperson
ADAMS BENEFIT CORPORATION
By:
David B. Ad ms, President
MONROE COUNTY ATTORNEY
�PROV AS T� F RM'
YNTHIA L. ALL
ASSTS NT COUNTY A
Date
EXHIBIT A
SCOPE OF SERVICES
Scope of Work:
Monroe County will be issuing Requests for Proposals (RFPs) for Dental Insurance and
Health Insurance for policies to begin 1/1/16. Both RFPs will be managed and issued by
the County, along with assistance from Gallagher, the County's Insurance Consultant. In
order to have a third party review of both RFPs, an analysis of each proposal submitted
under the RFPs, and assistance in professional advice and analysis of each proposal,
Adams Benefit Corporation will provide consulting services to Monroe County. Adams
Benefit Corporation will provide the following services:
1. Review of draft RFPs provided by Gallagher to assure issue existing programs are
defined so the County obtains the best possible proposals and identification of
recommendations for changes in the RFP if needed to attract multiple proposals as
follows.
a. Meet with staff and Gallagher to determine any concerns or items that they
desire to be included in future insurance coverage with a minimum of four
(4) face -to -face meetings in Key West.
b. Require that all bids include performance guarantees on the terms
requested by the COUNTY.
c. Secure a dollar commitment from any prospective carriers, along with
guaranteed savings for dental and health (including a Wellness Initiative).
2. Review Proposals submitted for Dental and Health Insurance providers, according
to the attached timeline, as it may be amended from time to time and provide
detailed analysis of all bids received.
a. Analyze medical and dental proposals for quality of benefits provided, cost -
effectiveness, competitiveness and plan administration.
b. Review all medical and dental bids and obtain a network disruption report
from finalists to assure that coverage has a broad enough network of
providers with focus on expanding network providers in Dental, based on
County survey of dentists geographically located in Monroe county.
c. Summarize bid findings and conduct interviews with proposers and /or
finalists as a participant in the County Selection process. Adams will not be
a voting member of the selection committee. Meet with staff, Gallagher, and
selection committee to determine any concerns or items that they desire to
be included in future insurance coverage with a minimum of four (4) face -to-
face meetings in Key West.
d. Provide recommendations to assist with the selection of the successful
medical and dental plan and details as to why this was the choice.
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EXHIBIT B
REQUIRED FORMS
12
LOBBYING AND CONFLICT OF INTEREST CLAUSE
SWORN STATEMENT UNDER ORDINANCE NO. 010 -1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
" Adams Benefit Corporation
(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: / /
Printed Name: 0 Yr15
STATE OF: r1a -
COUNTY OF: a cia ow 00
Subscribed and sworn to (or affirmed) before me on /A
(date) by Zk G( B. (�¢/� �_ (name of affiant). He /She is personally
known to me or has produced IFG OL (type of
identification) as identification.
NOTARY PUBLIC
My Commission Expires: EIIAH.LOWE
" Y MY 00WAISSIdN A EE 06W
' ExPIHES: Mamh 4, Und20i�tKe►e
13
NON - COLLUSION AFFIDAVIT
I, O U [ id 6AJ#MP the city of p/"} `.�U(y(� a✓t according to law
on my oath, and under penalty of perjury, depose and say that
1. 1 am P re , i e nv n of the firm of
Co rp, the
CONTRACTOR making the Proposal forte project described 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; and
4. No attempt has been made or will be made by the bidder to induce any other
person, partnership or corporation to submit, or not to submit, a bid for the
purpose of restricting competition; and
5. The state a is contained in this affidavit are true and correct, and made with
full kno ed that Monroe County relies upon the truth of the statements
contain i this affidavit in awarding contracts for said project.
(Signature)
Date: / /h / //y
STATE OF: ✓ h I
COUNTY OF: �6/'o &0C4r f
Subscribed and swom to (or affirmed) before me on
//I , / '�(
(date) by _ J '1v J6 1Iq (name of affiant). He /She is
p ersonally known to me o has produced
(type of identification) as
15
identification.
T RY PUBLIC
SHEILA H. LOWE
5: MY COMMISSION w EE 069202
EXPIRES: March 4, 2015
W46d?hru Noun/ Public IJWW W
DRUG -FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statutes Section 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 contendere 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 authoriz d t sign the statement, I certify that this firm complies fully with
the above requiremen .
I
(Signature) /
Date: / ;/9 /[I 14 Y
_s
STATE OF: A d f
aws
16
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, Florida Statutes, for CATEGORY TWO for a period of 36
months from the date of being placed on the convicted vendor list."
I have read the above and state that neither (Respondent's
name) nor any Affiliate has been placed on the convicted vendor list within the last 36
months.
(Signature)
Date: //�//V
STATE OF: T,j r, 'A
COUNTY OF: 4/'d
Subscribed and swom to (or affirmed) before me on
/ h, //
(date) by /- 0 , d a A &MS (name of affiant). He /She is personally known
to me or has produced & OL (type of
identification) as identification.
D I M---
kutel 6 Ada -�
EXHIBIT C
INSURANCE COVERAGE REQUIREMENTS
17
2811 Mdan
WORKERS' COMPENSATION
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Prior to the comrnencement of work governed by this contract, the Contractor shall obtain
Workers' Compensation Insurance with limits sufficient to respond to Florida Statute 440.
In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not less
than:
5100,000 Bodily Injury by Accident
$500,000 Bodily Injury by Disease, policy limits
5100,000 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 Contractor has been approved by the Florida's Department of Labor, as an authorized se lf.
insurer. the County shall recognize and honor the Contractor's status. The Contractor may be
required to submit a Letter of Authorization issued by the Department of Labor and a Certificate
of Insurance, providing details on the Contractor's Excess Insurance Program.
If the Contractor participates in a self - insurance fund, a Certificate of Insurance will be required.
In addition, the Contractor may be required to submit updated financial statements from the fund
upon request from the County.
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VEHICLE LIAI3UM
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Recognizing that the work governed by this contract reqmu the use of vehicles, the Contractor,
prior to the commencement of work, shall obtain Vehicle Ilabi ity Insurance. Coverage shall be:
maintained throughout the life of the contract and include, as a minimum, liability coverage for.
• Owned, Non - Owned, and Hurd Vehicles
The minimum limits acceptable shall be:
$300.000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$200,000 per Person
$300,000 per Occurrence
$ 200,000 Property Damage
The Monroe County Board of County Commissioners shall be named as Additional Insured on
all policies issued to satisfy the above requirements.
f81 i ®dhim
PROFESSIONAL LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Recognizinf that the work governed by this contract involves the advice or services
of a professional nature, the Contractor shall purchase and maintain, th o ' u;nout the life of the
contract, Professional Liability Insurance which will respond to damages resulting from any
claim arising out of the pe fomhance of professional services or any error or omission of the
Contractor arising out of work governed by this contract.
The minimum limits of liability shall be:
$300,000 per X500,000 Aggregate
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2011 E&6=
GENERAL LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Prior to the commencement of work governed by this contras„ the Contractor shall obtain
General Liability Insurance. Coverage shall be maintained throughout the life of the contras and
include, as a minimum:
• Premises Operations
• Products and Completed Operations
• Blanket Contractual Liability
• Personal htjury Liability
• Expanded Definition of Property Damage
The minimum limits acceptable shall be:
$300,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be;
$200,000 per Person
S300.000 per Occurrence
S 200,000 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 fol of wing 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.
all
MONROE COUNTY, FLORIDA
WAIVER OF INSURANCE REQUIREMENTS
There will be times when it will be necessary, or in the best interest of the County, to
deviate from the standard insurance requirements specified within this manual.
Recognizing this potential and acting on the advice of the County Attorney, the Board of
County Commissioners has granted authorization to Risk Management to waive and
modify various insurance provisions.
Specifically excluded from this authorization is the right to waive:
• The County as being named as an Additional Insured — If a letter from the
Insurance Company (not the Agent) is presented, stating that they are unable or
unwilling to name the County as an Additional Insured, Risk Management has not
been granted the authority to waive this provision.
•
• The Indemnification and Hold Harmless provisions
Waiving of insurance provisions could expose the County to economic loss For this
reason, every attempt should be made to obtain the standard insurance requirements. If a
waiver or a modification is desired, a Request for Waiver of Insurance Requirement
form should be completed and submitted for consideration.
After consideration by Risk Management and if approved, the form will be returned, to the
County Attorney who will submit the Waiver with the other contract documents for
execution by the Clerk of the Courts.
Should Risk Management deny this Waiver Request, the other party may file an appeal
with the County Administrator or the Board of County Commissioners, who retains the final
decision - making authority.
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