Item D18
~4J
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
MEETING DATE: 9/21/05
DIViSiON: COUNTY ADMiNISTRATOR
BULK ITEM: YES
DEPARTMENT: A!RPORTS
5T AFF CONTACT PERSON: Peter Horton
AGENDA ITEM WORDING: Approva! of contract with Koch Corporation for the Noise !nsulation Program Ph 4
construction, for the West International Airport
ITEM BACKGROUND: Project wi!! be funded 95% by the Federal Aviation Administration, and 2.5% each by the Florida
Department of Transportation, and Passenger Facility Charge Revenue.
PREVIOUS RELEVANT SOGC ACTION: Approval to submit PFe Application:# 8, October 15, 2003.
CONTRACT/AGREEMENT CHANGES: New contract
STAFF RECOMtv1ENDATION: Approva!
TOTAL COST: 2,876,958.00
BUDGETED: Yes
COST TO AIRPORT: None
COST TO PFC: $71,923.95
COST TO COUNTY: none
SOURCE OF FUNDS:
FOOT, PFC Revenue
REVENUE PRODUCING: No
AMOUNT PER MONTH /YEAR:
APPROVED BY:
x
v
^
Risk
x
A!RPORT DiRECTOR APPROVAL
ATION: Included X
Not
ITEM #
DISPOSjTION:
ibev
APB
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract #
Contract with:
Corporation
Effective Date: Execution
Expiration Date: 180 days from
Contract Purpose/Description: Noise Insulation Program Ph IV Construction
Contract Manager: Bevette Moore
(name)
# 5195
(Ext. )
for BaGe meeting on: 9/21/05
Agenda Deadline: 9/6/05
CONTRACT COSTS
Total Dollar
Buageted?
Grant: Yes-
Contract: $2,876,958.00
Revenue
Estimated None
(not included in dollar value abovo)
COSTS
(eg. maintenance, utWties, janitorial, salaries. etc.)
CONTRACT REVIEW
in
Changes
Needed
No
Reviewer
Date
Airports
.:LIZ /_
Management
o
County
I
_1_,-
/ !
---
Key West International Airport. Monroe County .Noise Insulation Program
CONSTRUCTION CONTRACT
THIS AGREErvfENT effective 19'" d:lyof AUQust ,20~, between the MONROE
COL'NTY, a municipal corporation organized and existing under the laws of the State of Florida (hereinafter referred to as the
"Sponsor") and Koch COfDoration , (hereinafter referred 1O as the
"Comracror") ,
WITNESSETH
WHERE/,S, the
the "NIP"); and
is the sponsor of the Key West Intemaliofla! Airport Noise Insulation Program
referred to as
WHERE/\,S, the Sponsor has elected to implement the fourth phase of the NIP (hereinaher referred to as "Phase -+ and
WHEREAS, the Phase 4 NIP is managed by the consultant [earn consisting of the prime manager, [[rchirec" acoustician and
construction manager referred [0 as the Program Manager"); and
WHEREAS, the Contractor shaH perform all necessary work and labor in the Phase 4 NIP (hereinafter referred to :lS the
and
WHEREitS, the Work shall be in accoraa.'1ce with the approved Phase 4 NIP Construct[on Jated March 28,
2005 referred to as the and the Phase 4 NIP Construction Specificmions dared \);:u\;h 2005
(hereinafter referTed to as the "Specifications"): and
WHEREAS, the Work shall be completed in accordance with the Phase 4 NIP Construction Schedule (hereinafter referred to as the
of the sub.construction ccmstruction schedules (1-6) and towl construction schedulc: and
Phase 3 Total Construotion Period
Sub-ConstrucIion Period 1. (l 0
Sub-Construction Period :2 (10 homes)
Sub.Construction Period 3 (IO homes)
Sub-ConStruction Period 4 (10
Sub.Construction Period 5 homes)
Sub-Construction period 6 (7 homes)
180 working dnvs
30 working
30 working days
30 working days
30
30 days
30 working days
NO\-\' , THEREFORE, in consideration of the terms, covenants and conditions set forth herein, and other and valuuble
consideration, the receipt and of which arc the and the Contractor agree as
follows:
That the Contractor in considermion of the payment of the Contract
Seventy Six Thousand Nine Hundred fifty Eight Dollars ($ and
Specificadons, and agrees to furnish all materials (except as to be furnished the logether with all necessary to
furnish all necessary equipment. tools. labor, and other means of construction and do and perform all necessary work and labor for
the full of the Work under Comract No, THe No' 05KWi7, the Work to be in accordance witt;
and and for the and set forth above and as specified in the Bid Form of the Contracwr
which is hereto attached and hereby made a part of this agreement. The Work will be in accordance with Schedule,
Work and payments will be pursuant to and in accomance with and therein sct forth and addenda therew,
all being reference and a part of this agreement
The Contractor agrees to utilize [he
Disadvantaged Business
Renm;}; General Contracting, LLC
Florida Keys Electric
CONSTRUCTION CONTRACT/BON DS
00500 -
Contractor agrees that the Work shail be done and performed in a good and workmanlike manner, that all materials and labor shall
be in strict conformity in every respect whh the Drawings and Specifications for the improvement and shall be subject to
inspection and approval of the Sponsor through its duly authorized Program Manager and, in case any material or labor supolied
shan be rejected by the Sponsor as defective or unusable, such rejected material shall be removed and repiaced with appro~~d
material. and the rejected work shall be corrected to the satisfaction and approval of the Sponsor through its authorized Program
ivlanager, at no additional cost or expense to the Sponsor.
Contractor further agrees that he will commence the Work hereunder upon receipt of the executed copy thereof and will complete
the Work to the satisfaction and approvai of the Program JVhmager within the time Emits specified in Time of Completion
and Schedule sections in the Specifications.
It IS further agreed that any delay caused by the elements and other causes over which Contractor has no comra! Of by strikes or
other combined action of workers employed in the construction or in the transportation of materials, in no pan caused or
from default or collusion on the parr of the Contractor, shall be excused and the time for completion extended to the extent that
Program LYlanager may find and determine such condition to have delayed completion within the time limit through no
fauit of the Contractor, but the judgmenr of Program Manager in respect thereto shall be final and conclusive upon the
parties" Contractor agrees that neither it nor its Subcontractors shall have any claim for against the Sponsor
or its agents arising fmm delays in the \VorL Contractor understands that its sole remedy for a delay is an extension of time.
The and the Contractor agree thill the damages which would be incurred by the Sponsor in the event of of the
Project would be substantial but arc not capable of beIng precisely calculated as of the execution of this Comract. The Sponsor
and the Contractor therefore agree based upon their professional knowledge and experience with projects of this type and their best
estimates of the associated "'iiih of the Project that the Comractor {and his shall be liable for and shall forfeit
One Thousand Dollars ($1,000.00) from the Contract Sum for each calendar day (Sundays and included) after the final
Completion Dare that any part of the "Vork upon any property remains herein stipulated as agreed, as
and not as a penalty,
It is further understood and that no claim for extra Work done or materials furnished by the Contractor wiE be allowed
except as by the and Specifications, nor shan the Contractor do any work or furnish any materials not covered
the Drawings ilnd SpecHlcations and by this Contract unless such work is first ordered in as in the
and Specitlc~Hjons, Any extra vvork done or materials furnished by the ComraclOr without written order first being given therefore
as in the Drawings and SpecU1carions provided shall be at Contractor's risk, cost and expense, and Contractor agrees in such event
that ne will make no claim Cor compenStHlOn for such tXml work or materials.
Il is further agreed that in no event shall the COntfacting officers of the Sponsor be liable or responsible in any 1nanne-r
to the Contractor. Subcontractors, suppiiers, taborers or to other person or persons whomsoever for claim, demand, damages,
actions. or causes of action or character arising out of or by reason of the execution of this agreement or the performance and
of the Work and improvement provided herein,
Contr:lctor certifies to being not or debarred from emering iOlo or a Florida of
commcL or a State-aid or Coumy State.aid Contract administered the Depanment as agem of a
municipality or county pursuant to florid;! Statutes. Further, Contractor agrees not to utilize either or any
contractor, corporation, prmnership, or business however organized, which is or debarred from into or
contract as stated above. This restriction applies regardiess of whether the or disbarred party acts in the
of a Contractor, a Subcomractor. or as un equipmem or material
rr is funher thm the Contractor will abide by the provisions ofTit!e VI or the Clvii Act of 1964 and Federal
of the Department set rorth in Seollon 00210 of the win afford for
Business Enterprise as set forth in Section 00210 of the will comply with restrictions on Federa!
Public Works as set forth in Section 00210 of the Specifications, will compiy with the Geneml Clvil Rights Provisions a,:
set forth in Section Om! 0 of the and will with Buy American Steel and Manufactured Products for
Conmuction as set forth in Section 002 [0 of the
CONSTRUCTION CONTRACT/SONDS
00500 - ?
MONROE COUNTY NOISE INSULATION PROGRAM
By
STATE OF FLORIDA )
S5
MONROE COUNTY
This instrumem was acknowledged before me on
day of
,20_,
, as the authorized representative of Monroe CoUnty NIP.
Notary Public Signmure
iNowrial Seal)
Title C.
Koch, President
Contractor
Individual Co-Partnership
ST/'~TE OF FLORlDA
55
!\lONROE COUNTY
This instrurnent \.vas
before me en
Gay of
,20
Notary Public Signature
(Notarial
Contractor
cky
STATE OF
Jeffers
55
COUNTY
This instrument \vas
before me on
22nd
,20 04
C. Stephen Koch
as the authorized
(Nm2.rial
CONSTRUCTION CONTRACTBONDS
. E COUN~:rrOtNEY
:/ 8~O E.D AS ,:/)/8 ~~:
I ~ tI ~~'>i..v
! .
PEDRO J. )'1ERCADO
ASSISTANT CQt:JNTY A
{
~\
\ ,
, .
00500 + 3
Monroe Coumy Noise lnsulation Program (NIP)
PAYMENT AND PERFORMANCE BOND
Part A: Pavrnent Bond
'"
~"ID NO~ 4392332
as PrincipaL \vhose address is
KNOW ALL BY THESE PRESENTS, [hat "ve, KOCH C'ORPORATIOO
GREA'T AMERICllN msoRANCE c::aIJPANY
~8~202
, whose address is
Contractor,
, and Surety
duly authorized and licensed to do business in the State of Florida, as Surety, hereinafter called Surery, are held and firmly bound
unto the i\IONROE COUNTY NOISE L~SULAnON PR ", ~ '~
benefit of claimants as hereinafter provided in the amount of
Dollars, for the payment \vhereofPrincipa! and Surety bind themselves, their heirs, executors, adwinistrators. successors and
ass!gns, and severally, firmly by these presents. WHEREAS, Principal has written agreemem dated NqRf' 19~
20 05 ,entered lnto a comract wim Owner for NIP CONTRACT _THe No. 05KW17 , in accordance with
and specifications by/for i\IONROE COUNTY NIP which contract is by reference made parry of hereof and
is required by SeeticD 255.05, Florida Statutes, The said written agreement. drawings, specifications and amendments are
hereinafter referred to as the Comract.
NO\\' THEREFORE, THE CONDITION OF THIS OBLIGA TIOK as required Section Florida Statutes, is sllch
that, if the shall perform the said comract and pay every person entitled thereto for an the claims for labor
performed and materials furnished under the Comract, to be used or consumed in the public improvements or perfoHring
the public work as provided in the Contract, then this obligation shan be null and void; otherwise is shall remain in full foroe and
effecL to the conditions: 1) No assignment modification or change of the Contract, or change in the
work covered or any extension of time for the completion of the Comract shail release the sureties on the bond, 2} NO[
later than one year after the oompletion of the '.''lork under the Comract, 21ly party in imerest may maintain an actiol1 in his own
name ag:linst the and the Surety upon this bond fOf the recovery of any he may have sustained reason of rhe
failure of tne Principal to comply with the Contract or with the Contract between the Principal and his subcontracwrs. If the
amount realized on this bond is insufficient to satisfy all claims of the in it shall be distributed among the pro
rata.
Si2ncd and sealed this
19'I'H
of
AUGOSI'
,20 05
IN THE
OF:
l{.o::J]
ON
GREAT AMERICAN INSL'RANCE
Name of Surety
(-~'-,
'-- ..
i,
\..,C,-~.3--......
(: /\~~'
cn_J--""-- "1""
L
, ".;
~,
\Virness~ DIANE
L ~ PHELPS
v
CONSTRUCTION CONTRACT/BONDS
00500 - 4
Monroe COlll'HY Noise L,sulation Program (KIP)
PAYJYIENT AND PERFORMANCE BOND
Part B: Performance Bond
BCfiD oo~ 4392332
K1\10W PlL BY THESE PRESEl\'TS, that we, KOCH C'ORl?ORATIrn
Contractor,
as Principal, whose address is _ 1131 I.OGMil STREET, LOUIS\I1LLEr KY
GREAT AMERICAN
I.NSURANCE COMPANY
40204
, and Surety
, whose address is
580 WALNt:f'r S'1'REET f CINCINNATI, OR'
45202
duly authOlized and licensed to do businESS in the State of Floridq, as Surety, hereinafter caned are held and firmly boun.d
unto MONROE COUj\;TY NOISE INSULA nON PROGR s oblieee. hereinafter called owner. for the use and '
benefit of claimants as hereinafter ofOvided in the amount of - NJl'.E miRED
Dollars, for the payment whereofPrincipa! and Surety bind themselves, their heirs. executors. admmistrarob. su=ccessors and
assigns, joimly and severally, firmly by these presents. \\1IEREAS. Principal has written agreement dated~ 19
20 05 , entered into a contract with Owner for NIP CONTRACT THC NO, 05KWl7 , in accordance with drawings and
spccific:1tions prepared by/for MONROE COUNTY Nil' which contract is by reference made party of hereor and is required
Section Florida Statutes, The said written agreement, drawings, and amendments are hereinafter referred to
as the Contract.
:';0\\' THEREFORE, THE CONDITION OF THIS ORUGA TION, if the shall compiete the Comracr(s)
to its terms and shall save the l\fonroe County l'<1P harmless from all cost and charges that may accrue on account of ,he
doing of the \Vork specified and shall pay aE costs of enforccmem of the terms of the bond, if action is thereon,
reasonable attomey's costs and disbursements, in any case in which such action is maintained, or
appealed, and shall comply with the laws of the state appertaining to such then this shall be void but
olherwise it shall remain in full force and effect pursuant to Florida Statutes.
Signed and sealed this
19TH
of
AUGOS'l'
,20 05
IN THE PRESENCE OF:
Green
ro::JCH ~ON
'\ I Na e of Principal (Contractor)
f\ I!
i \ '
G'.REli..T AMERICAN
COMPANY
Name of Surety
Witness DIANE L~ PHELPS
(Seal)
\
,,)
: l_~ (~. ,
(;,-) C~ (;':);
CONSTRUCTION CONTRACT/BONDS
00500 - 5
TERRORISM COVERA..GE RIDER
NOTICE-DISCLOSIJRE OF TERRORISiYI COV.ERt\GE j.LN"D PF.ElYillJlVI
The Terrorism Risk Insurance Act of2002 establishes a prograxTI within the Dep8.1-rD.lent
of the Treasurj, u,'1der \vhich t.1.C federal government shares, "yilli the insurance 1..11dustry,
t.~e risk ofloss from future terrorlst attacks. The Act aDulies when the Secret~rv of the
~... -.;
T reasurv certifies t~at an event meets the de:fin:ition of an Act of T errorisffi. Tne Act
.provides that, to be certified, 8.1"1 Act of Terrorism must cause losses of at least five
ruillioil dollars fuid must have been coriunitted by an It"ldividual or individuals acting on
behalf of a.llY foreign person or foreign interest to coerce the governrnem or population of
the United States.
To be attached to and form part oiBond No. 4392332 , effective AUGJST 19$2005,
In accordance \-vith the Terrorism Risk Insura...'1ce Act of2002, 'Ne are providing this
disclosure notice for bonds on which Great American Insura.l1.Ce Company, its 8.L4:11iates
(including, but not limited Great American Allian.ce bsurance Company, Great
.D,.u.Tlerlcan Ll1suran.ce Company of NevI York and Great American Assurance Insurfu'1ce
is surety.
Th TY' 'S D. ~th H"' '1' . "'. ,
e ..Jillteatates GoVeITilllent. enartJ.uent O! e lreaSlLiV. "V~V1~1 Dav a Share or terrOrIsm
" .f. g.f ..l.- d
insured under the ofille Act, The federal s~lare equals 90% oft.1.at portion or
+' ,. , , ,,? b1 '
amount 0-,- suen 1IlSureC11osses exceedS tile appnca ,,;.e msurer
TIJs Coverage PartJPolicy covers certain losses by terrorism, In accordance \v1th
the Federal Terrorism PJsk bSUIfu'1Ce of2002; \ve are required to provide you a
disclosing the: of premillil1, if to coverage ansmg
from losses Terrorist Acts Certified that
that is
coverage
GREAT AMERICAN INSURANCE COMPANY@
Admi nistrative Office: 580 WALNUT STREET $ CINCiNNATI, OHIO 4520:2 $I 513-369~5000 e !=AX 513-723-2740
The number of persons ilUlhol1zed by
this power of attorney is not more than SiX
No.O 17163
PO\YER Of ATTORNEY
K'\OW A1.L MEN BY TUESE PRESENTS: That (he GREAT .;tvlERICAN INSURANCE COMPAN'(, a corporatIOn orgat1!led and eXISUIE
under ~nd by vinue of the la'.'.'s of the Slate of 01110. does herehv nominme. constitute and appOlmthe person or persons n:Hlled 11eiow '" true and ];:nvful anome'/'~
in-fact. for it and in ItS name. place and stead to execute in boh:llf of the s~ld Company. as surety. any and all Donds. undenJkings ;md COl1lraClS of suretyship. ;)1'
other written obllganons In the nature thereof: pnmded that the liabIlity of the said Company on any such bond, Of conrr3Cl of suretyship executed
under IhiS amhonty shal! nOl exceed the limit swted below.
Steven ''Vt Garrett
Willjam A. Kantlehner, in
Thomas J. Mitchell
Name
Deborah A. Yates
Jeffrey A. Brown
Address
all of
Limn of Power
ail
LouisvJile, Kentucky
Unlfmited
Diane L. PhelPS
This Power of AUornev revokes all previous powers issued 1n hehu!f of ,he :mOrDc\'isi-in-t'acl named aDme.
iN \"1 !TNESS WHEREOF the GREAT ,.\MERIC AN !NSURANCE COMPANY hus cuused tnest.: presents lO be signed und 1mbled by ns appropriale;
officers and its comorate seal hereutllo [iffixed this 22nd day of 2002
Anest
GREAT ,-\!\l1ERiC:\N iNSURANCE
ST\TE OF OHIO. COUNTY OF Hi\\HLTON _ ,s: DA'!iD C KiTCHiN '5'3.4'2.,602';
(}o this 22nd da\' of 2002 < before nleptTSOnJ!ly ~lppean:d DA\/fDC. K~TC!-H\, lorne known. ;it'U1i:
dufy' ~\\'orn, deposes ;lnd ~~ys that he n.::s~d~s Hl Cincinnali, (}hio. that he the Di\l::;lOr..::.d Senior VICe Pn.:s]dcnt the Bond Di\'JSion of Gre;Jt ,-\n1eT~c~H1
in~UfUn(c C\~rnp3ny. lhe Cc;n1pnny descrihed in .Jnd whkh executed [be aho\'( lnQrU!1ltfll: thm t1C !..:J10\VS rhe se:.:d or' the sa~d C{);nr~U1~: Ih~l lhc sea~ an'!\Cd
the sJ.id rnstrunlen~ i~ such ~:c:rpOf::Hi.: sea!: [hal it W~b so ;"1ffixcd h:v authority' Df his office under the By-La\\iS or SJld ~lnd rhJt he- signed his nan1l:
thereto by iikt.: ;lUlhoriiy.
Tim Power of is
hy- t.Hl1m~mous '.;:r~nen consent dOlted
by authority of the feHewlng rescdut~ons :ldOpk:C hy the E{)anJ of f)rn:crcrs of Circ;)t Arn~r1c~u1 ~n~ur::mcc
I, j99~
RE-S() LVED_+ That the f)il'ision Presidenl, rhe sti'eral DiJ'ision tilct' Presidenrs' and ASS/Shun \-'ice Prcsidcnrs. or (illY une oj' [fUlilf,
uurhori:::ed, (inre !o ri/}u;, In one mOJi:' in -t.n:Ctiie nn heha~r {~r the as .~'lIrct\.. tun" c"ind (ill honds,
OilJlr(1crs ,\'UrCf,\'.<,-/ijp, or dther nbJig/lffuns in ,he naJure lher(!tj:' [0 pre.'i('rihe lheH~ respccril>e dl1fieS (jnd flit, rcsnecrne ffFiut,r fheir
},Cl'oke any such {lppointmenf (if any rii'i!-f.<
(ind he Fe}),' is
(iNti
. una
R ES'iJL \/EI) FlJRTfiER: Tho.: T!it.
(~ornf1anr I/1di' he affixed h\' h?(simi/c J/) {{J/\O ;'"!Oli'cr
or orher H-rl~f!en ,-:r!J!(f;ailon' i~'[ the th1lure th{~r~lf)t: swh
fjf7ii.'er dad rhe sea! li( fhe J~; he
and ony or AS,\istnJit The
/;-lr rhe {~r{!cl.ltjtin f~(any /;,-1/,1(:/ under/af,.~.inr:.. (cohrrOi"{ or sut'en r/;(n,
!;eing herehi' odor/cd by rhe Cilinp-any os [he u6ginn! slj('h
il'iJh tlu' SOlliC f,~)fl'(! {inti <freer (IS Ihnu':!h n"funuul/\'
and hinding upon the
CERTiFiCATION
L RON/'.LD C. HA'iES. Assislal1l
R(:~'ofuliorb of the BonTd of Direcl0n; (.if \tJrch
of Grc:.lt Anlcrkan lns.urance COlnpDny. do hereMy ctrtif:, thni the
ha\'t" nor been n:\'oked and un: nO\l/ in fu!J force and effect
Pm'.'"r 'if ,c\1:ornn :Ind I he
and scaled [his
19'1'1b uI
AtJGUST
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0183
(850) 487-J.395
'C
r:'
n
!..,p
KOCH CORPORATION
1131 LOGAN ST
LOUISVILLE
'J., <",(\r,:\
~\j~\ ~\ ..; L'JV-'
iCY 40204
I ~/ q;p
,~
STAn!: QF FL~roA C..t';::'I'l;" .;." 'I
A .. _.bI l'~a 1.],
nEPM~ OF !'OSIMESS '.lUm ;: c
PROFESSIONAL ~lUtW~'XIcm:}:.
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I r,,""'~" ,'.~. .... :$-:,;-' './i:..;...:.-.~,:,
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~c\,Y. '. "\;",?....~~.~.,",.. .~~~;~:,t,7~~.:-
{NOT A LICENSi: TO -PE.'RFORM woRi~'-
ALLOWS OOMPANY 'rO 00 m:rS.INfi:SS "IF
IT'HAS A LICmf,SED QtW:J:Ji!"IJ;1':R.~f-"-'.:"
- .J:.$- QVM.U!W ~..'" ell!" ~t4'wi~,,'~t ~r~i9 w~(
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- ~m.._ d,..h. AUt,) U, ::\.001 r -. ;i;il~oi~ii'Otii~
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DETACH HERE'
,1lc,J2Q1',i$t2&:40: [ . ," c;;-.- SrATE~Of.FLORIDA. '" ",.:,~>\ "
.;~~ '~~~i;~' l2~ /,~~ {.~riE:Ehuf:ri~wi o'i. StTS:mE9 P:~&FESSiONAL REGULATION~'S ,:'.:~~',i~~( .'
1i!1:;t:;}.. 'S!~ . ';.:;:1-; r-::<' :' -; :CONSTRtfCTION::'~ Y';;~rCENsn-?G aOARD,SEQlLIH~05,J1ib-5'54
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NBR
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< .I-\,.~
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t':"'~h~)~S.nm:s'S ORGANIZATION" J,..~;.:~~,.
,':::';,~ea~:liii~' ,QUAL:I:F~ED' u"u~<::>'J::'~
. 'Ch:%clert:'he ~rov:l.eiotu; of Ch~pt:eXji-:;4'
. E.xpir&,tion 5iate: .lUG 31.,1" 2007'<.0.:.;0.:
~.;t~ f{rRI~~~ ~ N<:JT :JL IiJ:CmfSE;']!'O nfU:'O~., , ,\:'~BALLOW9
~:::. COHPA:NY:.. ,;1::0 ,.DO" BUSINESS,. ONLY.' I.Y" 1::T:::9As,:;.-,I,.gttnIFIER. )
~t~,~6cSl1'coijo~riQN.::" ':~;~ <t;:c;~,;'S~~:: .~h ,":
"X1;aij~~~~:ST " ~'~':~:~'~2f~1S,~F'I':> .
. lty 40204 '>Un "'-;i; .
~ .. .:';
'~, : T ....
DIANE CA.RR . ".,
SECRETARY
:j~f}' i;>~::,
L c~!i ~~ f ..'
DJSPLAY AS REQUIRED BY LAW
........-TM
........ --- .. ..111111 . '-"~ I '-'
UArl::
"" I _11""t.1J ....... . II '''''' U l'U"'\I'f \JL.;.;, 08/22/2005
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOL.DER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POL.ICIES BELOW.
40207~1292 INSURERS AFFORDING COVERAGE
I PROo"UCER
I .
I
,
! iNSUREO
,
i
I
I
!
Garrett-Stotz Company
6011 Brownsboro Park Blvd
Suite B
Louisville
KY
Koch Corporation
P. O. Box 4398
Louisville
KY
40204
I iNSURER A Amerisure Comnanies
INSURER B: Great American Insurance Company
..!t@JJJSf'l C:
INSURER D:
INSURE!'!. E.
COVERAGES
I THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE FOLlCY PERIOD INDICATED. NOTWITHSTANDING
! ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTfFICATE MAY BE ISSUED OR
' MAY PERTAIN. THE INSURANCE .A.FFORDED BY THE POLJCIES DESCRIBED HERE!N IS SUBJECT TO ALL THE TERMS, EXCLUSJONS AND CONomONS OF SUCH
! POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE 8EEN REDUCED BY PAID CLAIMS.
) !N~R! TYPe. 0'" iNSURANCE i POliCY NUMBER ! POLl~Y EFFECTIVE! POUCY EXPlRA1l0N I UII~ITS
!A : GE~ERALWAefun jcpp 1322729" hZ/3lf2004 112/31/2005 i EACHOCCIJRRENCE 1$
; X : CO"'.MERClAL GENE~J)ABIU1Y Ii, i FIRE DAMAGE Ip..rry one fire\ 1 $
I I I CIAlMS ?AACE : X I OCCUR! I i ; MEO EX!' lAm cnu~rwl) I $
iJ - j I! PERSONAl /I, AOV iNJURY I $
n . j ! I GENERAL AGGREGAfe: - .. i $
GEN'L AGGREGATE LIMIT APPliES PER: ! [ PRODUCTS. COMPtOp AGG ; S
;---; . X I PRO- l' I'
, POLICY: J \ 'FC~' ! lOC
A ~OMOBILELIAB!U;Y ICA 1322730 112/31/2004 112/3 I COM81NED S!NGLE UMIT
I~. ANY AUTO I i. (EE arotiml)
,-~ i i
I X I ALL OWNED AUTOS! ,I
! X I SCHEDULED AUTOS j I
i X ! HIRED AUTOS I rr-. ff' -:: ~,_ .~ .'
! X ! NON.QWNEDAUroS c ~L~V _ ----1.
Y_-k' ~,.2J3'C:_5 ______~
_)(1_ ...
1,000,000
100,000
5,000
1,000,000
2,OOO,QQQ.
2,000,000
,
J BOOIl YtNJURY
! (Per po;rsMf
1$
1_000,000
/s
I
I 800lL Y iNJURY
j (Per aCCdeni f
I PROPERTY DAMAGE
i (PeraCOdemi
,
Is
!
, ,. GA~GE liABILITY
. I ANY AUTO
!
1$
I
~ . ~ j ;:'\ ~
i
--j
'X EX~ESS WAOiiUTY I"' ICU 1322731
U OCCUR LJ CLAiMS MADE
112/31/2004
I
!
112/3
I
~UTO ONt. Y - EA ACCICENT - $
j O_THER THAN EA ACe ; $
: AuTO ONt. Y: AGe I $
LEACH OCCUR~ENCE t :$
~ AGGREGATE ! ~
i . i $
j
i
!
5.000,000 I
5,000,QOO.
:i DEDUCTiBLE
~
: WORKERS COMPENSATION AND
i EMPLOYERS' LlMllLjiY
!
!
rc 132 171002
112/31/2004
,
I
!
,112/31/2005
,
I
I
!
i
I
,
1$
I
I $
, X i WCSTATU. - 'OTH.!
! ! TDRY i 1MfTS ! I i':~ ~
LE.L EACH ACCIDENT i :I:
I.Fi.l. D!SEASE - EA EMPLOYEfd $
! E. L DISEASE - POUCY LIMIT ! $
100,000 :
100,000 !
500,000 ;
. RETENTION
$
i~9 I j
, i i
IEQUIEFLOATER Cpp 13227'9 112/3 il2/31/2005
[BUILDERS RlSK BD\TDER '" ~ 108/22/2005 104/22/2006
ESCRif'TION OF Of'EP.ATIONSiLOCATIONSNEHfCLEsmxCUJSrONS AIJDEO BY ENOOI'tSEMENTlSPEC!AlI'ROVll:ifONS
.LL WORK INCLLTDING NlP CON'TRACT THC NO. 05KW 17, RESIDEi\'TIAL
BASE 4; IS CERTIFICATE HOLDER AS THEIR INTEREST
&AGGREGATEi
LIJIvHT $2JS76.958.00 i
. -
c
ERT!FICATE HOLDER
I AODmONAL INSURED: INSURER LETTER:
CANCELLATION
MONROE COl)"NTY NOISE INSUL.6" TION PROGRAM (NIP)
1100 S!MONTON SToRM.2~213
KEY WEST FL 33040
SHOULD ANY OF 'I11E ABOVE DESCRlB1.m I'OUCiES BE CAI>\CELLED BEFORE THE EXI'!RA TION
DATe: mEREO!', mE ISSUING INSURER WlU. ENtlEAVOR TO MAIl. ~ DAYS WRITTEN
NOTICE TO THE CElml'1CATE HOWER NAMED TO THE LEFT, But !"AlLURE TO 00 SO SHALL
IMPOSE NO OBiJGAi'lON OR UASlUTY OF ANY KIND UPON mE INSURER, ITS AGENTS OR
REPRESE is.
.4.00 RES A
CORD 25-S (7/97)
IMPORTANT
if the certificate holder is an ADDITIONAL iNSURED, the poHcy{ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s},
If SUBROGATION IS WAiVED, subject to the terms and conditions of the policy, certain poHdas may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in liell of such endorsement(s),
DISCLAIMER
The Certfficate of Insurance on the reverse srce of this form does not constitute a contract betiNeen
the issuing rnsurer(s}, authorized representative or producer, and the certificate nor does it
affirmatively or negatlveiy amend extend or alter the coverage afforded by the polides listed thereon.
ACORD 25-S (7/97)
SECTION 00450
NON~COLLUSION AFFlDA VIT
Li 51 G, Green
accoraing to law 011 my oath, and under penalty of perjury, depose and say that
4
i.
I am
Asst, Secretarv
Koch CorDoraticn
of the firm of
the bidder making the Proposal for the project described in the notice for calling for bids for:
Kev West International Aimort Noise Insulation Program. Phase 4
and that I executed the said proposal with full authority to do so;
2. the prices in tM!$ 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 ether
bidder or with any competitor;
3. unless othe(vvise required by law the prices which have been quoted in this bid have not been
disclosed by the bidder and 'Nil! not knowingly be disclosed by the bidder prior to oid opening, directly or
indIrectly, to any other bidder or to any competilor; and
4. no attempt has been made or wil! be made by the bidder to induce any other person. partnership or corporation
to submit, or not to submit a bid for the purpose or restricting competttion;
~
v.
the statements contained in this affidavit are true and correct. and made 'Nilh full
relies upon the truth of the statements contained in this affidavit in awarding contracts for
that the Sponsor
project
Signed
,~-'(C -- ~:L{GL------
(Must be same signature as on Stei Form)
June l~
(Date)
?nnr.;
........-".;50
STATE OF:
Kentuckv
,Jefferson
COUNTY' OF:
Onthis 1st dayef ,June ,intheyear Lisa G, /Creen
who is personally known to me, or who proCluced satisfactory identification, affixed his/her signature in the space
above.
J~-""""
, \ ( -
fn~\:r~l~~ )v\& ~Ll WG::XJ'Ln~
SiGNATURE OF NOTARY.PUBliC - ~
Notary Putlle, Stgte at KY
COrrL'11isS10n expl;es Sept 8~ 2006
END OF NON~COLLUSION AFFIDAVIT
i'JON-COLLUSION AFF! DAVIT
00450 - 1
SECTION 00451
LOBBYING AND CONFLICT OF INTEREST CLAUSE
SWORN STATEMENT UNDER ORDINANCE NO. 010-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
Koch
rporation
"
(Name of Business)
H warrants that has not employed, retained or otherwise had act on his/its any
former County officer or employee in vIolation of Section 2 of Ordinance 0~1990 or any
officer or employee in violation of Section 3 Ordinance Noo 010-1 For breach or
violation thIs provision may, in its this contract
may also, in its discretion, deduct the contract or purchase or otherwise recover,
amount any fee, commission, percentage, gift, or consideration to the former
officer or employee" 0
Signed
// ,.~.(l
'", ,
'~/~ L L L.~L--c
,June 15 2005
(Must be same signature as on Bid Form)
(Date)
STATE OF:
Ken
COUNTY OF:
Jefferson
Onthis 1st day of ,intheyear2005, Lisa G, Green
who is personaJly known to me, or Vtho satisfactory identification, affixed his/her signature in the space
provided aboveo
(~)
ENDOF LOBBYJNG AND CONFLICT OF INTEREST CLAUSE
LOBBYING AND CONFLICT
OF lNTEREST CLAUSE
00451 - 1
SECTION 00452
DRUG~FREE WORKPLACE FORM
The undersigned vendor in accordance with F!orida Statute 287.087 hereby certifies that
Koch Corporation
(Name of Business}
"
1> Publish a statement notifying empioyees that the unlawful manufacture, dIstribution, dispensing, possession, or use of
a controlled substance is prohibited in the wor',<place and specifying the actions that will be taken against employees
for vioiations of such prohibitiorL '
2. Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug-free
workplace, any avaiiab!e drug counseling, rehabilitation, and employee assistance programs, and the penalties that
may be impose upon employees for drug abuse violations.
3. Give each employee engaged in providing the commodities or contractual services that are under Did a copy of the
statement specified in subsection
4. In the statement sDecified in subsection (1), notify the employees that, as a condition of working on the commodities
or contractual services that are under bid, the employee wi!! abide the terms ot the statement and will notify the
employer of any conviction of. or plea of guilt or nolo contendere to, any violation of Chapter 893 {Florida or
of any state, for a violation occurring in the \'vorkp!ace no later that five (5) days after such conviction.
5. impose 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, any employee who is so convicted.
6. Make a good faith effort to continue to maintain a drug-free workplace through implementation of this sectiOfL
As the person authorized to sign the statement, 1 certify that this firm compiies
',-" v I." ," .
'I -, ,--' Li. ,L! i _
'-'""\. . -,,~
(Must be same signature as on Bid Form)
with the above requirements.
Signed by:
ne I, 2005
(Date)
STATE OF:
COUNTY OF:
Kertucky
rson
On this t day of , in the year 200~ LaG. Green
who is personaHy known to me. or who produced satisfactory identification, affixed his/her signature in the space
provided above.
/] \ \
( aM \~e~t~ ~ \J\Jl_~ L0~~
SIGNATURE OF NOTARY PUSllC 'v
PublJc, Slate at large. KY
commission expires Sept 8i 2006
END OF DRUG-FREE WORKPLACE FORM
DRUG.FREE WORKPLACE
FORM
00452. 1
SECTION 00453
EQUAL EMPLOYMENT OPPORTUNITY REPORT STATEMENT
The Bidder snarl complete the following statement by checking the appropriate blank spaces.
Failure to complete these blanks may be grounds for rejection of Proposals.
1. The Bidder has ~_ has not developed and has on file at each
establishment Affirmative Action Programs pursuant to 41 CFR 60~14 and 41 CFR 60-2.
X
2. The Bidder has has not participated in any previous contract or
subcontract subject to the Equal Opportunity Clause prescribed by Executive Order 11246,
as amended.
3, The Bidder has _~ has not
the annual compliance report on Standard
med the Joint Reporting Committee
1 00 (EEO~ 1
4
The Bidder does
x
does not ~_ employ fifty
or more employees,
'-'
Signed
'-' L c L,., "----.-.. >
ne 1, 2005
(Must be sams signature as on Bid Form)
(Date)
STATE OF:
Ken tuc ky
COUNTY OF:
Jefferson
On this 1s t ~day of ne j In the year _, Lisa G" Greer
who is personaHy known to me, or who produced satisfactory identification, affixed his/her signature in the space
provided above.
Sept. 8,
END OF EEO REPORT STATEMENT
EEO REPORT STATEMENT
00453 - 1
SECTION 00454
DISADVANTAGED BUSINESS ENTERPRISE ASSURANCE
The Bidder shall complete the following statement by checking the appropriate box (check one
only). Faiiure to complete this statement may be grounds for rejection of Bid.
v
The Bidder assures that he shall meet the requirements the DBE
Provisions, for the Monroe County's DBE Policy and Program, and shall
utilize not fess than the prescribed goal of 15.5'% DBE participation (See
Page 00454-2).
-,
The Bidder is unable assure DBE participation of the prescribed goal
15.5% in this Contract, but shall provide for a minimum of
_ percent %) participation.
(if this box is checked, Bidder shaJl filt percentage blanks
document on a separate attachment to Assurance, his efforts
attempting to the goal as instructed in "A Means to Ensure that
Competitors Make Good Faith Efforts to Meet the DBE Goal" on Page
00454-2.)
Signee by:
~ --,_'~/ L lL;,---/
(Must be S'ame signature as on Sid Form)
,lune 1 ~ 2005
(Date)
STATE OF:
tucky
COUNTY OF:
,Jefferson
Or. this 1 s t day of ne , in the year 200,5 Lis a G, Green
who IS personally known to me, or who produced satisfactory identification, affixed his/her signature in the space
provided above,
r)
ThJ2CQ~ S \J\L~~.2j '\ - - ~
SIGNATURE OF NOTARY PUBLIC ~~
Notary Public,
SECTION 00454
DBE ASSURANCE
00454 - 1
A MEANS TO ENSURE THAT COMPETITORS MAKE
GOOD FAITH EFFORTS TO MEET THE DBE GOAL
This soiicitatjon will include a statement that the apparent successful competitor will be required to
submit DBE participation information and that as a condition of receiving the contract, the
competitor must meet the DBE goat or demonstrate to the Sponsor that it made good faith efforts,
The actual clause to be used is:
"The bidder shall make good faith efforts, as defined in Appendix A of 49 CFR Part 26, Regulations
of the Office of the Secretary of Transportation, to subcontract 15.5 percent of the dollar value
the prime contract to small business concerns owned controlled by socially and economically
disadvantaged individuals (D8E). In the event that the bidder for this solicitaticn qualifies as a DBE,
the contract goal shal! be deemed to have been met Individuals who are rebuttably presumed to
be socially and economically disadvantaged Include women, Black Americans, Hispanic Americans,
Native Americans, Asian~Pacific Americans, and Asian-Indian Americans. The apparent successful
competitor will be required to submit information concerning the DBEs that participate in the
contract. If the bidder fails to achieve the contract goal stated herein, it wiil be required to provide
documentation demonstrating that it made good faith efforts in attempting to so, A Bid fails
to meet these requirements wilt be considered non~responsive""
The D8E participation information required
to apparent successful competitoL
to committing
Sponsor to award the
A Bidder may not meet the requirements of the by that it '!JiII accomplish all
of the contract using its own employees. It, must demonstrate to the Sponsor's
satisfaction, that it made gcod faith efforts to meet the goal, and despite those efforts, was unable
to any of the work to
DBE ASSURANCE
00454 - 2
SECTION 00454
REQUIRED CLAUSES FOR FAA~ASSISTED CONTRACTS
The following clauses should be included in all FAA~assisted contracts (but not in leases) between
the sponsor and any contractor:
Policy: is the policy of the Department of Transportation that disadvantage business enterprIses
as defined in 49 GFR Part 26 shall have the maximum opportunity to partiCipate in the performance
of contracts financed in whole or in part with Federal funds under this agreement. Consequently,
the DBE requirements of 49 eFR Part 26 apply to this agreement."
DBE Obliqatlon: "The recipient or its contractors agrees to ensure that disadvantage business
enterprises as defined in 49 CFR Part 26 have the maximum opportunity to participate in the
performance of contracts and subcontracts financed in whole or in part Federa! funds provided
under this agreement this regard, contractors shall ail necessary and reasonable steps in
accordance with 49 CFR Part 26 to ensure that disadvantaged business enterprises have the
maximum opportunity to compete for and perform contracts. Recipients and their contractors
not discriminate on the basis of race, color, national or sex in the award and performance
DOT~assisted contracts."
Section 2K 13(b) requires sponsors to advise each contractor and subcontractor performs on
an FAA-assisted project that faifure to carryout the above requirements shall constitute a breach
contract. The following clause may used for purpose:
bidders, potential contractors, or subcontractors DOT~assjsted contract are hereby
notified that failure to carrj out the DOT pollCy and the obligation, as set aoove,
constitute a breach oontract which result in termination of the contract or other remedy
as deemed by the recipient and the FAA.. "
DGE ASSURANCE
00454 . 3
SECTION 00454
SCHEDULE OF DBE PARTICIPATION
I Type of Work Subcontracted
El ectri ca 1 \'!ork
!
I Di)llar Value of Work ,
I
I ZLl8 1'2C;0t'i
I J \0 vi'
i Nam& and Address of DeE Subcontractor
Florida Keys Electric
5730 2nd ,~ve.
Key Hest, Fl 33040
~t~ ~K btrJfRAL
'16
~ 'i we:. '::>1' \= L :S3t:
"I'< '-'7[\"- ~ f
u-:.h.,) i t~ t t ~~
'\!, U\(;'Z.\M~ S~L( nIbiL.
!)2Q f c:,J cO
h 0 bJ!c. ,
,
i
i
j
I
Total DoHar Value of DBE Subcontracted Work
$ ~~t1 21>LvD
f) <J,/1 r;- ,~ (: D
$ N I l) I <0/1 :Jes ,
Tatai DOllar Value of B!d
Total DaE
to nearest 1/10 percent}
0/0
The undersigned will enter lnto a formal agreement with the DBE Subcontractors identified herein for work listed in this
conditioned 'upon execution of a with the
b".
'1-
}L.;~l
(Must be same
v
~ A .~ .
-'LLLf~f
as on 8id Form)
STATE OF:
Kentuckv
Jefferson
COUNTY OF:
On this 1 s t day of ne i in the year 200;1 Li saG q
'lvho is personally known to me, or who produced satisfactory identification, affixed his/her
provided above.
~
,{ 0\ l~ .
Xl~~,,- ~ f L~~.J ~JOL10A~
SIGNATURE OF NOTARY PUBLIC ~
in the space
"iot~rv D ,hi' QI
'$ ~d<. 1- Lw!iC. ~Late at Laree vv
c::;mrr;;:::Srtl....,." b-Y;';,;,~::-:.:. .t"-.. ~ ,,"\ I
.... ~^_ ',,'. ,".- ;:: "nnc
DBE ASSURANCE
00454 - 4
'~O:::J co rf::....UU.,J ..:J; Ulrn
r.lUI-iUd ~.....e.::l~ 1.-..L.I;:;:'",,--,...11 Lv ~ilili.,.l ~'a.J...... r-"-'~ ....,'-,..'i.,.)~
p.;.;:
SECTION 00454
DBE SUBCONTRACTOR IDENTiFICATION AFFIDAVIT
t
penllitty 01 j:!!N}wy, ~e llind ::wy t~t
lam
of the I1rm of
woo:'!.e 8dd~$~ is
! lil'!rooy dac!are llFlll affirTI'llh:1lt I !'l.M 111 ~ Mlflfirity 1MSEl (if F~Mi
defined by 49 erR Part ~f'lIa that I Will prtMde rf1!i:Hm8ti(:l~ ttl! uJXlJroom 1111$ faa,
&sin!lS$ Enterpris$ ail
'"hl$ firm is intel"'-Stea In b!cldi~ 01'1 the ronOlMF1g c:mt'!gOfiM d ~ b@i!'ltJ ~red ft:lF ~III K~ Welt! !nwmatloMI
NO!l!i@ !nsulatlcm ~rl:lgram, Pha~@ 4, .
Thi~ firm m.u: ctiffl'll'i! DSE 1 ME!:! \I'm!:. ClllrtmC<!ilol'I from Ih,*:fo!~ a9ene~$:
rt-
I 00 SOLeMN!.. Y OeCLARE AND AFFIRM UNOER Tl'#: peNALTIes OF peRJURY THAT ri'!E CONTENTS OF THe
FOREGOI NG OOCLJi'\l.ENT ~RE TRue ANO AND TF!A '!' I AM AUTHORiZED ON SEHAlr- OF THe F1Ri'.i
fO MAKE THISAF'ADAVIT. .
:s
SI~r1<id
STATE Of:
COUNTY OF~
munrOl.-
!W;;, spl:!~
eND Of oe
CBE ASSURANce
00454. 0
SECTION 00455
CERTIFICATE OF NON~SEGREGATED FACiLITIES
CERTIFICATiON TO BE SUBMITTED BY CONSTRUCTION CONTRACTORS AND THEiR
SUBCONTRACTORS (APPLICABLE TO CONTRUCTION CONTRACTS AND RELATED
SUBCONTRACTS EXCEEDING TEN THOUSAND ($10,000.00) DOLLARS $) WHICH ARE
NOT EXEMPT FROM THE eQUAL OPPORTUNITY CLAUSE)
The construction contractor certifies that he does not maintain or provide, for his employees, any segregated facilities at
any of his establishments and that he does not permit his employees to perform their services at any location, under his
control, where segregateD facilities are maintained. The construction cOl1tractor certifies that he will not maintarn or
provide, for his employees. segregated facilities at any of his establishments and that he wm not permit his employees to
perform their servtee;:; at any !ocatlorL under his control, where segregated facilities are maintained. The construction
contractor agrees that a breach of this certificaHon is a vioiation of the equal opportunity clause in this contract As used in
this certification, the term "segregated facilities" means any waiting room, work areas, restrooms 8mi washrooms,
restaurants and other eating areas, time clocks, locker rooms and otner storage or dressing areas, parkil1g tots, drinking
fountains, recreation Of entertainment areas, transportation, and housing facilities provided for employees which are
segregated by expilcit directives or are in fact segregated on the basis of race, r6Hglol1, or national origin because of
habit, local custom, or any other reason, The construction contractor agrees that (except where he has obtained identical
certifications from proposed subcontractors for specific time periods) he will obtain identical certifications from proposed
subcontractors prior to the award of subcontracts exceeding ten thousand ($10.000.00) dollars (US) which are not
from the provisions of the equal opportunity dause and that he wilt retain such certifications in his files,
"
Signed by:
~.)
~\Ltt' ."...~/CC("I ~
(Must be same signature as on Bid Form)
June 1. 2005
(Date)
STATE OF:
ntucky
COUNTY OF:
Jefferson
Onthi3 1st clayaf June ,intheyear 200? Lisa G. Green
who is personally kr:oVVl1 to me, or who satisfactory identification. affixed his/her signature in the space
provided above,
r~
. ~0~ ~ ~\0JLLT~LC2;~v~~~~
SIGNATURE OF NOTARY PUBUC ~
i(Y
3.20C6
END OF CERTIFICATE OF NON~SEGREGATED FACILITIES
NON-SEGREGA TED
FACILITiES
00455 - 1
SECTiON 00456
CERTIFICATION REGARDING DEBARMENT, SUSPENSION,
INELlG!8!LlTY1 AND VOLUNTARY EXCLUSION - 49 CFR PART 29
(Version 1, 1/5/90)
The bidder certifies, by submission of this proposal or acceptance of this contract, that neither it nor
its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from participation in this transaction by any Federal department or agency, It
further agrees by submittlng this proposal that it will include this clause with modification in all lower
tier transactions, solicitations, proposals, contracts, and subcontracts, Where the bldder! offeror/
contractor of any lower tier participant is unable to certify to this statement, it shall attach an
explanation to this solicitation/proposal.
Signed by: v
y / ,.00 -
. , Ii; L.<~'
(.,----;l ~ L", <
(Must be'same srgnature as on Brd Form)
(Date)
STATE OF:
Kentuckv
COUNTY OF:
Jefferson
00 this 1st day or June ,intheyear200~ Lisa G, Green
who is personally known to me, or who produced satisfactory rdentification, affixed his/her signature in the space
provided above.
() \'
6~~~ s ~. JtSDJrv-JWlOOUt',~c'~
SIGNATURE OF NOTARY PU8LJC...~, '~
'r.,-",,_;;y
!, 2t
END OF CERTIFICATION REGARDING DEBARMENT, ETC,
DEBARMENT, SUSPENSION, ETC,
00456 ~ 1
SECTION 00457
CERTIFICATION REGARDiNG FOREIGN PARTICIPATION
The Contractor or subcontractor, by submission of an offer anctior execution of a contract certifies that it
1 . is not owned or controlled by one or more citizens or nationals of a foreign countrf included in the list of countries that
discriminate against U,S, firms pubiished by the Office of the United Slates Trade Representative
2. has not knowingly entered into any contract or subcontract for this project with a contractor that is a citizen or national
of a foreign country on said Hst, or is owned or controlled directly or indirectly by one or more citizens Of nationals of a
foreign country on said list;
3. has not procured any product nor subcontracted for the supply of any proauct for use on the project that is produced
in foreign country on said !1st
Unless the restdctions of this clause are waived by the Secretary of Transportation in accordance with 49 CFR 30.171 no
contract shall be awarded to a Contractor or subcontractor who is unable to certify to the above. If the Contractor
knowingly orocures or subcontracts for the supply of any product or service of a foreign country on this said !ist for use on
the project, The Federal Aviation Administration may direct, through the sponsor, cancellation of the contract at no cost to
the Government
Further, the Contractor agrees that. if awarded a contract resulting from this solicitation, [t will incorporate this
certification without modification in each contract and in all lower tier subcontracts. This Contractor may
certification of a prospective subcontractor unless it has knowledge that the certification is erroneous.
for
upon the
The Contractor shail provide immediate written notice to the sponsor if the Contractor learns that its certification or that or
a subcontractor was erroneous when submitted or has become erroneous reason of changed circumstances_ The
subcontractor agrees to provldG immediate written notice to the Contractor, if at any time it learns that its certification was
erroneous by reason of changed circumstances.
This certificatkm is a materia! representation of fact upon which relfance was placed when the award, If it is iater
determined that the Contractor or subcontractor knowingly rendered an erroneous certification, the Federaf Aviation
Administration may direct, through the sponsor, cance!!ation of the contract or subcontract for default at no cost to the
Government
Nothing contained in the foregoing Shall be construed to require establishment of a system of records in order to render, in
good faith, the ceriification required by this The knowledge and information of a contractor is not required to
exceed that which is possessed by a person in the course of business
This certification concerns a matter within the jurisdiction of an agency of the United State of American and the
a fictitious, fraUdUlent certification may render the maker subject to under Titie 18, United State
Section 100i.-
Signed
,...,~'
) ~ ,f ,
~jc ffl
(Must basame
v'
I
~-;-</ L-C.-u ~-r.
~
as on Bid Form)
ne 1, 2005
(Date)
STATE OF:
Kentucky
-.Jefferson
COUNTY OF;
On this 1st day of June ,intheyear 2005 Lisa G, Green
who is personally kno"vl1 to me, or who satisfactory ider:tiflcation, affixed his/her signature in the space
ovided above.
Notary Public. State 2t Laroe KY
MV"'''fn ; ~.~ -' ~,.
, ~U ,m'S:)lun eXPires Sept. 8, 2006
FOREiGN PARTICiPATION
00457 - 1
SECTION 00458
SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a),
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
1 . Th!s sworn statement is submitted to the Sponsor
by.. Lisa G. Green
fur Koch Corporation
'lihose business address is:
1131 Logan Street
Louisvil1e~ KY a0204
And (if applicable) its Federal Employer Identification Number (FEIN) is
61-0461707
{If the entity has no FEIN, include the Social
Number of the individual
this swom statement
2. ! understand that a "public 8nt!ty crime" as defined in Paragraph 287,133(1 Florida Statutes, means a
violation of any state or federal law by a person with respect to and directly related to the transaction of business
v-tith any public entity ot with an agency or pomical subdivision of any other state or of the United States,
but not limited to, any bid or contract for goods or services to be to any publlc Of an
agency or political subdivision of any other state or of the United States and antitrust, fraud, theft,
bribery, collusion, racketeering, conspiracy, or materia! misrepresentation.
3, I understand that "convicted" or "conviction" as defined in Paragraph 287.133 (1 Florida Statutes, means a
finding of guilt or a conviction of a public entity crime, \'\lith Of \'\Iithout an adjudication of gwlt, in any federal Of
state trial court of record to charges brought by indictment Of information after 1, 1989, as a result of
a jury verdict nonjury trial, or entry of a plea of guilty or nolo contendere.
4,
i understand that an "affiliate" as defined in Paragraph 287,133 (1
means:
a. A predecessor or successor of a person convicted of a
b, An entity under the control of any natural person who is active In the of the entity and who has
been convicted of a entity crime, The tem; "affiliate" includes those directors, executives,
partners, shareholders, employees, members, and who are active in the management of an affiliate,
The ownership by one person of shares constituting a controlling interest in another person or a pooling of
or income among persons when not for fair market value lHloer an arm's agreement, shaH
be 1;1 prima facie case that one person controls another person, A person who knowingly enters into a joint
venture with a person who has been convicted of a crime in Florida during the 36
months shaH be considered an affiliate.
5. ! understand that a "person" as defined in 287~ 133(1 He), Florida Statutes, means any natura! person
or organized under the laws of any state or the United States with the power to enter into a binding
contract arid which bids or applies to bid on contracts for the or services let by a public entity,
or which otherwise transacts or applies to transact business vvith a The term includes
those officers, directors, executives, shareholders, and who are active in
management of an entity,
PUBLiC ENTITY CRIMES
00458 - 1
6 Based on information and belief, the statement which I have marked below is true in relation to the entity
submitting this sworn statement (indicate which statement applies.]
....L Neither the entity submitting this swom statement, nor any of its officers, directors, executives, partners,
shareholders, employees, members, or agents who are active in the management of the EHltity, nor any affiliate of
the entity has been charged and convicted of a public entity crime subsequent to July i, 1989.
_ The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners,
shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of
the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989,
_ The entity submttting this sworn statement, or one or more of its officers, directors, executives, partners,
shareholders, employees, members, or agents who are active in the management of the entity or an affiliate or
the ent!ty has been charged with and convicted of a public entity crime subsequent to 1, 1989, However,
there has been a subsequent proceeding before a Hearing Officer of the State of F!orida, Division of
Administrative Hearing and the Final Order entered by the Hearing Officer determined that it was not in the p[.lblic
interest to place the entity submitting this swom statement on the convicted vendor list. (attach a copy of the final
order}
I UNDERSTAND THAT THE SUBMISSiON OF THIS FORM TO THE CONTRACTING OFFiCER FOR THE PUBUC
ENTITY IDENTIF!ED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTiTY ONLY AND, THAT THIS
FORM IS VALlD THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED, I ALSO
UNDERSTAND THAT 1 AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A
CONTRA,CT iN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTiON FLORiDA STATUTES
FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THiS FORM,
Signed by:
"~< - '-'4 ,- ,
(,4 ~ L-CLr ~
, (Must be;3ame signature as on Bid Form)
ne 1, 2005
(Date)
STATE OF:
!{pnTucky
Jefferson
COUNTY OF:
Onthie 1st dayof June ,intheyear2005
who is personally known to me, or who produced
provided above,
l isa G, Green
Identificmion, affixed his/her signature in the space
'^-~
SIGNATURE OF NOTARY PUBLIC
at KY
d. 20G6
END OF SWORN
ON PUBLIC ENTITY CRIMES
PUBllC ENTITY CRIMES
00458 - 2
SECTION 00459
BUY AMERiCAN CERTIFICATION
1. The Contractor agrees that only domestic steel and: manufactured products wiB be used by the ContractoL
subcontractors, materialmen, and suppiiers in the perfor;mance of this Contract. as defined in (2) below.
2. The foHowing terms apply to this clause:
A Steel and Manufactured Products. As used in this dause, steel and manufactured products include ("1) those
produced in the United States or (2) a manufactured product produced in the Unitea States, if the cost of its
components mined, produced or manufactured in the United States exceeds sixty (60%) percent of the cost of
all its components and final assembly has taken place In the Uniteo States.
B. Components. As used In this clause, components means those arUcles, materials> ana supplies incorporated
directly into steel and manufactured productEL
C, Cost of Comoonents. This means the costs for production of the
labor costs.
exclusive of final assembly
By submitting a Bid under this solidtatiol1. except for those items Hsted by the Bidder below or on a separate and olearly
identified attachment to this Bid, the Bldder certifies that steel and each manufactured is produced in the United
States (as defined in the Clause Buy American ~ Steel and Manufactured Products for Construction Contracts) and that
components of unknown origin are considered to have been produced or manufactured outside the United States.
A list of articles. malerials, and supplies excepted from this provision is attached in Section 00210 of these Contract
Documents.
OF ORIGIN
None
Signed by:
J b;>>' ,1
'" // /,
. C.",it ..~ (.A...W ~.
"" (Mus! be same sigmiture as on Bid Form)
STATE OF:
Kentucky
COUNTY OF:
Jefferson
On this 1 s t day of J un e , in the year 2!ill5
who is persona!!y known to me. or who produced
provided above,
/\
( j
Lisa G. Green
identification. affixed his/her signature in the space
BUY AMERICAN
00459 - 1