Item D21
if!:yw4
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
MEETiNG DATE: 9/21105
DIVISION: COUNTY AD!\.4!NISTRATOR
BULK ITEM: YES
DEPARTMENT: A!RPORTS
STAFF CONTACT PERSON: Peter Horton
AGENDA iTEM WORDING: Approval of award of bid to Across Builders Corp, in the amount of $144,116,00, for the
Terminal Canopy Project at the Florida Marathon Airport, and approval for the Mayor to execute contract pending
review by the County Attorney.
!TEM BACKGROUND: This project IS funded 95% by the Federal Aviation Administration, and 5% by Passenger Facility
Charge Revenue.
PREVIOUS RELEVANT SOCC ACTION: Approval to submit PFC Application '# 8, October 15, 2003, and Application # 9,
August 18. 2004.
CONTRACT/AGREEMENT CHANGES: New bid, and new contract.
STAFF RECOMMENDATION: Approval
TOT AL COST:
111:LOO
BUDGETED: Yes
COST TO A!RPORT: None
COST TO PFC: $7205.80
COST TO COUNTY: None
SOURCE OF FUNDS: FAA & PFC Revenue
REVENUE PRODUCiNG: No
PER MONTH /YEAR:
APPROVED BY: County Attorney
contract
receipt
N/A
Risk Management N!A
AIRPORT DIRECTOR APPROVAL
Included X
Not
AGENDA ITEM #
DISPOSITION:
!bev
APB
August 23, 2005
},;1r. James R "Reggie" Paros
Airport Manager
Florida Keys I'vlarathol1 ~Ajrport
9400 Overseas Highvvay
F133050
. Rehabilitate Terminal
Florida Keys
Recommendation to
AIPNoo 1 3-1
. Paras,
),
)
on the bid .~
the amount of$ 44,h O.
Subject to the BOCC's concurrence In
Corp
A draft
contractor is
letter to
See attachnlcms.
"
)
URS Corporation
7650 Corporate Center Drive, Suite 400
[",jam!. FL 33126-1220
Tei: 305.262.7466
Fax: 305.26L4017
contract
Bni
it IS
F :'\rn:.lf3thl'Jj'-,Rth2b i j i t~L~ Crt~nni:w I C ::ii1op:-/\rc{::tlnlt1,;L';1.'.-ard. doc
f-
Z
W
:a:
~
<(
Cl.W~
WUIr"'
OMWO
u.,WO
Ulu.,:J:"
WO~M
U
-ClZ
&20
IW iI'OifM u
!U)~~~
IW:r:-i<
'2:U;:)C
r-=~Z
<1.:;:)sC
c:::CL....
f-
U1
-
Z
-
::E
o
<(
f-
a:::
o
0..
0:::
-
<(
Z
o
:r:
f-
<(
0:::
<1.:
:;E:
U1
>-
W
~
<(
Cl
-
0:::
o
-J
!.I..
>-
0..
o
Z
<(
U
-J
<(
Z
-
L
0:::
w
f-
LU
S
-
-J
-
CO
<(
J:
w
oc
W
-J
r-
-
r-
oc
--,
--'
0..
"-
Ui
o
o
N
"""
Ui
"""
I
V
"""
N
,
:E
0-
<4
t
o
-
CO
o
o
I I
!.W
U
-
ct:
n.
.-I
.-I
~
~
.-I
W
!!.\
,~
"-
"'I-
o
0\
e
'Vi
e!
s:;
V
t-
::r
Cl..
I
III
IlJ
~
o
+-
v
:>
III
.2
l:-
e!
U
"t::l
r::
o
;;....
I:..
I:..
(\)
L
iU !.l.l
+- e
III <:)
EZ
w..;:.
C l::
,y! (l)
-1 ~
I:..
Cl..
~ v
(Il-
\I)..c
(\) :;:7
La..
Cl.. (\)
llJL
llJ +-
+- 'l-
+- 0
'E III
E l:-
e (\)
u~
-0 ~
ro ~I
a
z
o
.;:0
b,
w
s::;;~
~ a31
Us::.
if; U
Q)
>- I
,
,
b-
Z
LU
a
z
o
0-
W
!.W
0:::
CL
k.
o
U
~
Ul
b..
(j)
"0
::l
d:l
Ul
Ul
o
l-
V
<l.
llJ
.s::
+-
+-
\I)
c:
'0
0"1
o
-0-0
~ ~
u4:
w 'u
.s:: w
u 0-
t: III
W W
~ .E
w +-
>-0
o ::
L 0
W W
> "F-
o 0
..0-0
o IlJ
-Os:;
I\) +-
+- ~
1Il..a
Ill<:;l
t.. W
I\) >
" '~
" u
15 (\)
t-
-a ~
b ~
.s:: 5:
+- I\)
-0 i;
5 ..0
o
~"
,- I\)
c _
(\) III
.0. =
o III
-0 -0
1515
::2-
Cl '<(
III
vi
Of
>- ,E
CL.-
o .~
u -
+- ~
U 0
~-o
t.. t:
t.. W
0>
U-o
-0 tl.l
S::"
o c
~ (\)
? 5r
+: ::J
o V)
,!!! "{l
,~ -g
.s:: +-
+- U
+- .;;
o c
.s:: 0
-iU
>-0
~"t::l
+- ';'-
~ 5
UtL
>- 'l-
..0 e
w w
t.. +-
W 0
.s::""
f-iV)
J.
0'
Ifl
.::;
'-
li)
c..
::r
V)
0'1
,:;:
WI
o
.r.
u
I:..
:=
0-
>-
t..
t..
~
s::
U
+-
If!
r:::
t..
UJ
o
VI
::1
>.
co
"'0
w
=
W
0-
o
"
ro
BIDDER TABULATION (8-9-05)
FLORIDA KEYS MARATHON AIRPORT
PFC APP NO,: 8, AlP NO,: 3.12-0044-2004 & 3-12-0044,021-2005
REHABILITATE TERMINAL CANOPY
SCHEDULE OF BID ITEMS PHASE I (FACING US1}
!TEM
SPEC#
DESCRIPTION
i UNIT' ESTIMATED!!
ACROSS BUILDERS
CORP.
UNIT
PRICE !N EXTENDED
MBERS TOTAL
QUANTITY
P<<i01..3,1 Mobitization LS 1.00
:2 Surface preparation (Plan specification No.2) SF 5,319.00
3 sand blasting (Plan specification No.2) S>' 2,565.00
4 primer (Plan specification No.i) SF 2.565.00
5 Semi-gloss finish (Plan specification No.3) SF 5.319,00
6 Furnish and InstaHatlon of canvas fabric SF 5,319.00
TOTAL
SCHEDULE OF BID ITEMS PHASE if (FACiNG TAXIWAY}
QUANTI1f
UNIT
PRiCE IN
NUMBERS
EXTENDE
rOTAL
iTEM
SPEC#
ESTIMATED
URS ESTtMATE
2
preparaUon (Plan specification No.2)
TOTAL
53.00 $13,500.00
3
sand blasting (Plan specification No.2)
4
Red primer (pian specification No.1)
5
.Seml..g~os$ f~ni$h (P!an speclT"icaUQf1 No,3)
[)
Furnish and instaHatlon of canvas fabriC (Pian SF
S 1 0.00 S45~OOO.OC;
$8.10
$82,082.50.
PHASE I
$85.668.00
PHASE ![
382.082.50
TOTAL
SECTION C
PROPOSAL
Contract
BiD TO:
Purchasing Office
1100 Simonton Street
Room 2-213
Key West, Florida
~ A 0'YO~S' bu"; 1 dflYS ~;[) vp .
I
Ie 0 :B CA ':1 v/ ew ;j)y ~If i i.j1IS'
<5 U VI n If / sOl tn / FL. ::? 16 0
ie-I., 7J6277706/
BID
Submitted (Date): U 7 ~ ~ 13- 05
The undersigned, as Bidder, hereby declares that has the site of the
and informed himself fully regard to aU conditions pertaining to the the
work is to done; that he has examined the plans specifications for the work and
contractual documents relative thereto, has read documents, Contract
Documents, Genera! Provisions, Provisions and Specifications furnished; and
he relative the
The Bidder proposes and agrees, if this proposal is accepted, the
Monroe Board Commissioners, in the form of contract all
necessary materials, equipment tools, apparatus, means of transportation
and necessary to and to complete the construction
B53habiHtate T ermlna! Canopy
Florida Kevs Mar;3Jhon Airport
Monroe County, Florida
in accordance shown, noted, described and reasonably
intended requirements of the plans, specifications contract documents to the full
and entire satisfaction of the Monroe Board Commissioners, with a definite
understanding that no money wifl be allowed for extra work except a set forth the
attached Contract Documents for unit prices listed opposite each Item.
1-14
The Contractor shari complete the Schedule of Values included as Attachment "A". The
Schedule shall be added and the final total base bid amount will be:
$ DiAl(. l-/uMol}'?cP j;>~ ~"h~orJ,Ja>>J O'\A12. tUAud rPJ a..J siJ!:/t'?7bollars
(tetal b~se bid - words)
It is agreed that the description under each item, being briefly stated, implies, although It
does not mention, all incidentals and that the prices stated are intended to cover all
such work, materials and incidentals as constitute Bidder's obligations as described in
the specifications and any details not specifically mentioned, but evidently included jn
the contract shall be compensated for the item which most it
The quantities for items listed on attached Schedule of Btd Item sheets are
estimated quantities only for the purpose of comparing bids. difference betliveen
these estimated quantities and actual required for construction will not be
allowed as basis for claims the Contractor for extra compensation. Compensation will
be based on the unit prices and construction quantities be modified as
stipulated by Sections 20-05 and 90-03 of the General Provisions.
The bidder further proposes and agrees hereby commence an
adequate force, plant and equipment stated the the Contractor
the Owner to proceed and complete performance within period stated
in the Instructions to Bidders from and after stated the Notice-ta-Proceed.
The undersigned further agrees that
contract and the bond within ten (1
being given of the award of the
specified herein accompanying
into funds of the Monroe
such failure; otherwise, the check or
returned the undersigned.
case failure on his part to execute the sajd
consecutive calendar days after written notice
the check or in the amount as
bid and monies payable shall be paid
of as liquidated damages
bond this shall
Monroe performance
, upon an annual appropriation
to
IS
dollars
Commissioners"
for
I have included Division I which entails the proposal forms,
Schedule of Bid Items (Attachment
Bid Bond
The Drug-Free Workplace
,/
~
~~.
11
i-15
ATTACHMENT "A"
SCHEDULE OF IB~D ITEMS
PHASE i (facing US1)
BIDDER NAME: 4<:- YD S <;; tf u ;' l/-<. v 5 CD 7 f:;,.
AIRPORT NAME: FLORIDA KEYS III!ARATON MRPORT I
PFe APP NO.:
Fill! ITEM NO,:
a
AlP NO.: 3.124l044<2004 AND 3.12..0044.2105
I PROJECT DESCRIPTION:
I nEM
41469319401
REHABIUTATE TERMINAL CANOPY
SPEC
No.
ITEM DESCR!PTION
UNIT I ESTiMATED
QUANT!TY
UNIT PRICE
IN
NUMBERS
EXTENDED
TOTAL
Mobilization
P.1Q1<:U LS 1.01} 8
Cents
Surface Preparation (Plan Specification NtL 2)
AT Ot^<e= j CO ~3 1 CJ
:2 Dolla rs SF 5,319
AND il<<-<"o
Cents
St_l Sand Blasting (plan Specification No.2}
AT -rhYf~ 50
:3 DoHat;;, SF 2,565 9
r, J j .-
AND +-, ~O
Cents
Red Primer (plan Specification No.1)
AT Tv.,] 0
i!- DoHan, SF 2,565 jO ~
..-
Cents
5
Semi-Gloss Finish (plan Specification !\Io. 3)
AT YuJ'P
AND I W~,",l~
Dollars
SF
5,319
;2
I 701
Cents
1-17
BIDDER NAME:
AIRPORT NAME:
PFC API" NO.:
FM ITEM NO.:
ATTACHMENT "A"
SCHEDULE OF SID ITEMS
PHASE n (Facing Taxmway)
8
All" NO.: 3-114l044-20ij4 AND 3.12:-0044-2105
PROJECT DESCRIPTION: REHABIUTATE TERMINAL CANOPY
41469319401
!TEM
SPEC
No.
"I
P-101<U
ITEM DESCRIPTION
UN!T
ESTIMATED
OUANTITY
MobiHzation
lS
1-19
uw 3.1
UN!T PRICE
!N
NUMBERS
I
I
i
EXTENDED
TOTAL
.)
SECTION D
BID BOND
Contract
II MEN BY THESE PRESENTS, that we:
y .z:-c h yy /a as Principal, hereinafter called
the Principal, and (1 yosS Ap' ~y a corporation duly
organized under the laws of the State of Florida! as Surety, hereinafter caUed the
Surety, are held and firmly bound unto the Monroe County Board Commissioners as
Obligee, hereinafter called t Obligee, j the sum f:
\
~\j , Y"'-x v<
doflars ($~;300 ':;:. ), for the payment which sum we!!
to be made, the said Principal and the said Surety bind ourselves, our heirs, executors,
administrators, successors and assigns, jointly and severally \ by these presents.
WHEREAS, the
has submitted a bid
Rehabilitate Terminal Canopy
Florida Keys Marathon Aimort
Monroe County, Florida
NO\I'V, THEREFORE, if the Obligee shaH accept bid shall into a
contract the Obligee in accordance with the terms such give such bond
or bonds as may be bidding or Documents with good and
sufficient surety for the faithful performance of such and for the prompt
payment of labor and furnished the prosecution thereof, or the event
failure of the Principal to enter such contract and give bond or bonds, if the
Principal shall pay the the difference not to pena!ty
between specified said such larger which
may in faith contract another party to perform covered by said
then this obligatlon be and otherwise to effect.
PROVIDED further, that jf the the bid acceptable
to the Obligee but shall meet DBE goals as set bid specifications, then
Principal shaH, upon request of Obligee, to such additional evidence
of Principal's good faith efforts such goals manner and within the time
required in such specifications" F aHure to supply such informatton as required shall
result in a forfeiture of bid bond in the same manner to the same degree as
though Obligee had accepted Principal's bid and had thereafter failed or
refused to enter into the with Obligee as set forth immediately preceding
paragraph,
1-21
SECTION E
DRUG~FREE WORKPLACE FORM
The undersigned Contractor, in accordance with Florida Statute 287.087, hereby
certifies that:
eyOS~
v\' ~'(
Business)
,
1. Publish a statement notifying employees that the unlawful manufacture,
distribution, dispensing, possession or use of a controHed substance is prohibited
the workplace specifying the actions that be taken against employees
for violations of such prohibition.
2. such employees about the dangers of abuse in the workplace, the
business' policy maintaining a drug-free available
counseling, rehabilitation and employee assistance programs penalties
may imposed upon employees drug abuse
Give each employee engaged
services that are bid a
providing the or contractual
statement specified in Sub-section (1 i.
, ,
4. the statement specified in Sub-Section (1), notify the employees that as a
on commodities or contractual that are under
bid, the employee abide by the terms of the statement and will notify' the
employer of any conviction of or plea of guilty or nolo contendere any vrolation
Chapter 893 (Florida Statutes) or controlled substance law the United
States or state occurring in the workplace no later than
days after
impose a sanction on or satisfactory partidpation in a drug abuse
assistance or rehabilitation program if such is the employee's
community or employee so convicted.
6.
to maintain a
workplace through
to
requirements.
the
I certify that complies fully with
~~..... on ~~.
\ J ". t
."~$ ,
~ ~i"'~
, Ii
~
Date: 07-28-oS"'
1-23
fa
Date:
Firm Name:
By:
Ahleiro Vil~
My Ccmmis$ion 0030110'{
!-25
SECTION H
ACKNOWLEDGMENT OF RECEIPT OF ADDENDUM
^ '
III Signature Date
No.
I
I
I
I
I
I
!
I --
i
I
1-27
SECTION J
B~DDER'S AFFIDAVIT IN COMPLIANCE WITH
FLORIDA TRENCH SAFETY ACT
(SECTION 553m60=553s64, FLORIDA STATUTES)
STATE FLORIDA )
) 55
OF MONROE )
BEFORE ME, the undersigned authorIty, personaHy appeared
eyl &l '
o 1//01'0 (", '~\Jn 'L,{ I r:t
who, being duly sworn, deposes and says as follows:
!S
(Name Bidder)
being its 1>~ ~d e.tJ t '
(Owner) (President or other Corporate Officer)
and as
has fuB
execute
Bidder's Affidavit.
-'
L
full legal name
business address
person or
this
bid: r
A-~'YQss; ~~ \, Jov <;: ~)Y'-bt')VO, +:O~
\ OCJ 13,as_j\- \/(' ~LD ))" ~ ~ J ~/,-L)
u \
Stkvl V\ v} Is. 4( ';;: f ::fL ~ 331 6D
! '
2, submISSion of subsequent the
undersigned bidder certiffes as successful bidder (Contractor) trench
excavation done his control (by his own forces or by subcontractors)
shaH be in with OSHA Trench Safety Standards
in 19 CFR, s,1926,650, Sub-part induding ail subsequent revisions
or updates to Standards as adopted the Department labor and
Employment Security,
3. The bidder acknowledges that induded in the various items listed in the
Schedule of Prices Bid and in the Tota! Amount Bid are costs for complying with
1-29
SECTION K
SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a),
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
This must be signed and sworn to in the presence of a
official authorized to administer oaths.
or other
1. sworn statement is submitted with Bid, Proposal or
AI"? -lVo - 3-/2 -(Jol/v ~){:Jg1/ OMJJ 3~f:J. -00,,/<< -:VoS:
for 12,;zL10:&/lf'k1e ~YW;VJ.cx [ CD\/\nj J .
2< sworn statement by Ac YO S's Pc.n'/d.# v<: CYJ-( 'P .
{flame of ent!ty subm!ttlng sworn stat~ment)
whose business address is~j~J BC\O lit'-\, W ])'1. .Jt/V/r; s. Is J.f? J) TL .
331 t; 0
(jf applicable) its Federal Employer Identification Number (FEIN) is:
X- Ob07.:L,C;R
(If the has no FE!N, indude
signing sworn statement:
Socia!
Number the
. )
3.
name IS
my
'11
name of fndividual signing)
and
relationship the
~ ,J J
is ,iJk? lr1 d .e Gl 1:,
4. I understand that a Paragraph 287.1
Florida Statutes, means a a
respect and related to transaction with any
or with an agency or political subdivision other state or of
States, not or or to
be provided to any entity or an agency or political subdivision of any other
state or of the United States and involving anti-trust, fraud, bribery,
collusion, racketeering, or mis~representation,
I understand that "convicted" or , as defined Paragraph
287 .133( 1 )(6), Florida Statutes,' means a of guilt or a of a
public entity crime with or without an of guilt in any federal or state
tria! court of record relating to charges brought by indictment or after
July 1, 1989, as a result of a jury verdict, or entry of a plea of guilty
or nolo contendere.
1-31
Officer of the State of Florida, Division of Administrative Hearings. The
Final Order entered by the Hearing Officer did not place the person or
affiliate on the convicted vendor list. (Please attach a copy of the Final
Order.)
The person or affiliate was placed on the convicted vendor list. There has
been a subsequent proceeding before a hearing officer of the State of
Florida, Division of Administrative Hearings. Final Ordef entered by
the hearing officer determined that it was In the interest to remove
the person or affiliate from the convicted vendor (Please attach a
copy of the Final OrdeL)
The or
(Please describe
Genera! Services.)
has been
action taken by or
on the convicted vendor list
with Department of
Signature Authorized Representative:
f/i!oa~~7J
2.'::::>
L ,I j
He; }f d ..;z,(j L
. Title
07 -2 )?-- o-c
Date
8T A TE OF FLORIDA
OF:
The foregoing
20a.r-
-'
was
before me
(Sole, Corporation or Partnership)
me or who has produced
an oath.
!s
as rdenUfication and who
oJ,J~~lic, State of Florida at Large)
. My CCmm!~s!on 0030, 107
Of"" Expires May 00, 2000
(Print name of Notary PUblic)
My Commission Expires
Alve!ro Vale<..Qa
MY commission 0030, 107
'I ~res May 06, 2008
1-33
SECTION M
CERTIFICATION OF NONSEGREGATED FACILITIES
Contract
(As Required by Division iii, Section 120 Subsection 120-02
Equal Emp!oyment Opportunity Requirements of the Genera! Provisions)
The federally assisted construction contractor certifies that he does maintain or
provide, for his employees, any segregated faciliUes at any of his establishments and
that he does permit his employees to perform their services any location, under
his controi, where segregated facilities are maintained. The federally assisted
construction contractor certifies that he will not maintain or provide, for employees,
segregated fadlttias any establishments and that will not permit his
employees to perform their services at any under control, where
segregated facilities are maintained. federally assisted
agrees that a breach of this certification is a Violation the equal opportunity clause in
this contract As used in this certification, the term "segregated facilities" means any
waiting rooms, work areas, restrooms and washrooms, restaurants and other eaUng
areas, timelocks, rooms other storage or dressing areas, parking lots,
drinking fountains, recreation or entertainment areas, transportation, and housing
facilities provided for employees which are segregated explicit directives or are
fact segregated on the basis of race, color, religion, or because of habit,
local custom, or any reason. The federally construction
agrees (except where has identical certifications from proposed
subcontractors specific wfl! obtain identical certifications from
proposed subcontractors exceeding $10,000
are not exempt clause that
retain certifications in
f t
([) . '
~K'?rl~lL ~"
Title
1-35
GENERAL DECISION: FL20030050 FL50
Date: June 13, 2003
superseded Genera] Decision No~ Fl:020050
St.ate: Florida.
Construct en
BUILDING
County ~ies) :
MONEGE
BUILDING CONSTRUCTION
PROJECTS
(does not include
residential
. ,
conS':ructlon
consisting of s
Lc;;lJ.J.. homes and 2p2rtrnents up 0 and incl'udina il
stories ~)
Modification Number
Publication Date
06/13/2003
COUNTY (ies)
tvl0NF~OE
StJFLI017?
01/25/1990
Fates
Fringes
C~~;_RPENTERS
12u60
l uS 2,
CEIvlENT t~1ASONS
ELECTRICIANS
u q u
?n
R()NtJOHK.EES
~ 45
1 ill
LABORERS; GENERAL
~ l r:..,
P}\INTERS
8aSO
i '~,i
..:..... '-..i'
PLUMBERS & PIPEFITTERS
Q "n
-.-' ~ .J '-'
PLASTERERS 8,10
ROOFERS 8.47
TRUCK DRIVERS 5...15
WELDERS - Receive rate
welding is incidenta L
scribed fer craft performing operat ~"- to wh ch
Unlisted classificatiofls needed for work Dot inc tJded wit
scope c the
ided _r~ the labor
classifications listed
v be added after award only 2S y
st2Dddrds cont.rac't c12u~~E:s (2 erE 5 ~ 5 {a) (1.) (ii) ) ~
in ~ne isting above, the ~~SU~~ designa ion means that rates isted ~~der that
identifier do not reflect. collect vely bargained
'~~laae aDa I.:'2.~qe
". ~~
b!~~efi t.
rate.s~
her desiqnat CflS indicate unions whose
. . .
rates have bee~ G2
.fIT:':;, nee
;::0 DC:
Iln.g~
1-37
SECTION 0
CERTIFICATION REGARDING DEBARTMENT, SUSPENSION,
INELIGIBILITY, AND VOLUNTARY EXCLUSION = 49 CFR PART 29
(Version 1. 5/90)
bidder/offerer certifies, by submission of this proposal or acceptance of this
contract, that neither It nor its IS presently debarred, suspended, for
debartment, declared ineligibility, or voluntarily excluded participation this
transaction by Federal department or agency, It further agrees by submitting this
proposal that it indude this cause without modification in all transactions,
solicitations, proposals, contracts, subcontracts. Where
any participant is to it shall attach an
explanation to solicitation/proposaL
')1 I J
! ry.e Sf C/{l t{ C"
Title
!-39
b. Contractors recelVlng federally assisted construction contract
awards exceeding $10,000 (Ten Thousand Dollars) which are not
exempt from the provisions of the equal opportunity clause will be
required to provide for the forwarding of the following notice to
prospective subcontractors for supplied and construction contracts
where the subcontracts exceed $10,000 (Ten Thousand Dollars)
and are exempt from provisions of the equal opportunity
clause.
NOTE
signed
THE CONTRACTOR: This Certification is
to the with the Proposal.
if completed,
Certification of Non-Segregated Facilities
The Construction Contractor certifies that he does not maintain or provide, his
employees segregated facilities any his establishments and he does not
permit his employees perform servlces at location, control where
segregated facilities are maintained. The Construction Contractor further certifies that
he will not maintain or provide, for his employees segregated facilities
establishments and that he wi!! not permit his employees to their services at
any location, under his control where segregated facilities are maintained. The
construction contractor agrees that a breach of this certification is a violation of the
equal opportunity clause in this Contract used this the term
"segregated facilities" means any waiting rooms, work areas, restrooms and
washrooms, restaurants eating areas, timeclocks, locker rooms and other
storage and dressing areas, parking lots, drinking fountains, recreation or entertainment
areas, transportation, and housing facilities provided for employees are
segregated by explicit directives or are fact segregated on of race, color,
religion, or national origin because habit, local customs, or other reason.
Construction Contractor that (except he has obtained identical
certifications from subcontractors for time periods) he will obtain
identical certifications from proposed subcontractors prior subcontracts
(Ten Thousand which are from the of
retain certifications
r)-f 2i'~.t{ tc
1. Project The VVork in Contract
is included AlP Project No~ 3-12-0044-2004 and 3-12-0044-2105 which
is being undertaken and accomplished by the Owner in accordance with
the terms and conditions of a grant agreement betvveen the Owner and
HI-a3
INSURANCE AGENT'S STATEMENT
! have reviewed the above requirements with the bidder named below. The following
deductibles apply to the corresponding policy:
POLICY
DEDUCTIBLES
policies are:
o Occurrence
o
Signature
BIDDER'S STATEMENT
I understand
comply in
insurance
all the
be
if awarded
and
kvo~r Z3C/(/';~d ~YI2'
Bidder ---- l~
m-92
LIST OF PROJECTS MADE BY CONTR>\CTOR AND SUBCONTRACTORS.
L GREYNOLDS PARK CONDOMINIUM
BALBINA HARRIS
TEL 305 308 3593
JOB: REPLACE DRAINAGE SYSTEM
OVERLAY.
DATE: 04/ OS
PARKING
ASPHAL T
2. NEW LINK
SERGIO ROITBERG
TEL. 401
JOB: RENOVATION HOUSE
DATE: 08/04
3. GOLDEN TOUCH AND
LILIANA GIRALDO/LIYES} CORP.
TEL. 305 409
OF
DA TE: 06/04.
4.
16
FERNANDO OSORIO
TEL 561 0051
JOB: CO!v{PLETE
DA TE: 02/05,
5, DEVELOPMENT
SUNSET
LUIS CUTIE.
TEL 2828101
DA TE: 06/05
HUMBERTO
TEL 355
CANOPY
03/05
(l 1.500
6.
}\.&AACCOUNTING
& NOTARY PUBLIC
Your complete tax and accounting solution
ACROSS BUILDERS
FINANCIAL STATEMENT
JUNE 30
3725 KENSINGTON ST HOLLYWOOD, FL 33021
TEL 9!*985-4058 CELL 305-213-8929
FAX 954-894-9058 EMAIL AJveiro@comcaslnet
I
I
I
ACROSS BUILDERS CORP
ACROSS BUILDERS BALANCE SHEET
June 301 2005
Page 1
ASSETS
Bank of America Operating Ac
Bank of America Reserve Acct
Bank of America Alum
411012.18
10,509.60
691484.70
Current Assets:
Cash in Bank - Checking
Total Current Assets
20,600.44
141,606.92
Fixed Assets;
Equipment and Tools
Automobiles
Furniture & Fixtures
Total Fixed Assets
Fixed Assets (Less Depr.)
15,000.00
21,156.80
81000.00
44,156,80
44,156.80
Other Assets:
Total .~ssets
1851763.72
":<:%;DATE ~
~ ,:
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD SEQ#L04062300:235
: ~ LICENSE NBR
06 23 2004 030627930 CGC1507416
The GENERAL CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 499 FS.
Expiration date: AUG 31. 2006
1451978
ECHAVARRIA. ALVARO HERNAN
ACROSS BUILDERS CORP
100 BAYVIEW DR #1415
SUNNY ISLES FL 33160
JEB BUSH
GOVERNOR
DISPLAY AS REQUiRED BY LAW
DIANE CARR
SECRETARY
AC# 1458013
FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD SEQ#r,0406230027(
NBR
r~Jil:tl1 .ll H~1..~ ~~"'r.1 -4-~,~~_._~
: =~,*1l'~r
06 23 2004 030516284 2101
The BUSINESS ORGANIZATION
Named below IS QUALIFIED
Under the provisions of 489 FS.
Expiration data: AUG 31, 2
(THIS IS NOT A LICENSE TO PERFORM WOmt# TRIS ALLOWS
COMPANY TO DO BUSINESS ONLY IF IT HAS A QUALIFIER.)
ACROSS BUILDERS CORP
100 BAYVIEW DR #1415
GOLDEN BEACH FL 33160
AS
BY LAW
CITY OF SUNNY ISLES BEACH
2004
Occupational License
EXPIRES SEPTEMBER 30. 200S
MUST BE DISPLAVED AT PLACE OF BUSINESS
2005
0L04-2297
Date Paid
9/21/2004
lJUS1NESS NAME! LOCA nON
ACROSS BUILDERS CORP.
100 lilt YVIEW DRfVE #1415
SUNNY iSLES BEACH, FL 3':U60
LICENSE NUMBER.. OL. 04 ~ 2050
OWNER/CORP.
AL V AHO H. I<THA V ARiUA
Busiruss Code:
0077
Contractor.. "
Genem! Building
Thill 1$ iiiI'! l'X:C!Jpatiorll~! !:ax only. It dcu not ~It tn<.! liCMSM to \iiolate $Oxlsting regulatory or
laM of the City or Mrnml D@lde Nor ;::loa it exempt the iicoo~ .,flY o'ItWr iicMlle or
raqulfllid by law. Th!$ 1$ not 1il ~fi~tjol1 of the HC$fl$M'lijC qUliiI!/ficatiom..
City of Sunny Isies Beach 17070 Collins Avenue, Suite #250
Sunny Isles Booch, F!orida 33160
09~17~2004
TOM GALLAGHER
CHEF FiNANCIAL OFFICER
ST A TE OF flORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSA liON
". CERTIFICATE OF EXEMPTION FROM FLORIDA WORKERS' COMPENSATiON LAW"
CONSTRUCTION INDUSTRY EXEMPTION
H
This certifies that the individual listed below has elected to be
Florida Workers' Compensation Law,
EFFECTIVE DATE: I) 31:2 5/2 004
PERSON:
FEIN:
BUILDERS
1 00 SA Y VIEW DRiVE
#1415
MIAMi BEACH Fl:3 :3 1 6 I)
SCOPE OF BUSINESS 1 - CONTRACTOR
OR TRACE:
IMPORTANT: to Chapter 440, 05( 14L F 0
exemption from c~apter by fi~ing a certificate
benefits or compensation under this chapter,
corporation,
section may not recover
Ale - 252 CBHlf'tCA TE OF ELECTION TO BE EXEMPT REViSED 0 t ~ 04
lasa! 413-16D:
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
ST A TE OF FlORlOA
DtPAAT!il!ENT OF FlNANC!AL SERViCES
D!V!S1QN Of WOOKERS' COMPENSATION
CONSTflUCTION~STRY
CERTlRCA TE OF EXEMPT!ON FROM FLORIDA
WORKERS' COMPENSATION LAW
EFFECTIVE 0312512004
**
F
o
L
D
PERSON:
H
E
R
E
Pursuant (0 440 f.S, H. othcer 01
who eiect, from this br
e Cfri'lrlicet€ 01 elecHon Ul11W this section m~y not fOW,",
D<lfteti15 Dr un(ie; this
.n
H MiAM! 8EACH 33150
SCOPE Of BUSiNESS 00 TRADE
< - CONTRACTOR
'"
bottom portion on the job $ keep upper portion for your records.
'\iC-252 CERTifICATE Of ElECTION TO BE EXENlPT REVISED 01-04
ACROSS BUILDERS CORP
ACROSS BUILDERS BALANCE SHEET
June 30, 2005
Page 2
LIABILITIES & EQUITY
Current Liabilities:
Long-Term Liabilities:
Due To Investor
Due To Chrysler
Total Long-Term Liabilities
Total Liabilities
lO,700.00
14; 810 AD
25,510 AD
25 1510 AO
Stockholders Eq~ity:
Capital Stock
Beginning Retained Earnings
Current Period Profit (Loss)
Total Stockholders Equity
~0~al Y~ah11J..'t~eq & Equ~r~?
-.lc""",c,,... ~ .LJ,.,t.,. .......~~ ~ ~ .,.&.~:t
23/000.00
-5,492.92
:142t746.24
:1.60,253,32
1.85,763,72
jU~,--l .~;b1:
A;,~:l: ;~t.'1
~" 00--1; ."'lL
(".,1; ~-;.;.. (.',~~}j:-.L ,"~."
CERTtf:ICATE OF LIABILITY INSURANCE ....... 5!19l2.rLQ.~_
THIS CefmF1CATE IS ISSUfm AS A ilAATIER OF iNFORMATION
ONLY !<NO CONFERS NO RIGHTS UPON THE: Cr'RTIF\CATl:
HOLDER. THiS CERTIFICATE DOES NOT AM!;'ND. EXn:ND Of'1
ALTl!'R THE: COvERAGE AFFORDED ev me I"OllCIES BELOw.
~-n.--""",,~~ ._--~-- ~c~_.,.
ACORD",
~~~-
ALL CI~Y ~NSURANCE
7200 CORPORATE CENTER DR. #412
MIAMI, F'L 3~126
.. .1i.9_;;;::- 4. 3~_2y!Q..
,""j~J:'T ACROSS BUXLDEM COR!?
100 :BATvIEW ORrv"'E
SUNN~ ISLES, FL 33160
786-277-7081
INSURERS AfFORDING COlll!RAGE
c' 'NSUR~R t. MID~C9J:!IZ~~~SJJ~~~~~y
~~?~_.. __~,_c"__"'_' ................._ ..m_" .--. ..-........-....
1 iNSUR~ c.
r
NA!CIt
cc._' '-""'~."..+-'_..~~~~'.
. ~__,..~~.----.-'-Y.~,--~-_.._-~-_c,--
N~U'5lIfj;"'. D
~~~_ _~~.____.~,~.__"____,.,--,--L-,-..,.,,.~c---_~-~'_L'-r-C._-
1"$\.11\1'''- E'
COVr!'RAG!!iS
T,..T POL !ClES OF INSlJRi'NCE USTE:O $EWW Hi'.'iF BEEN ISSUED TO TI-.lE INSuRED NI'.MED ABOV!'! "0Ii11HE POLlCv pl"i'{!CD INDICATED. NolWiTKST,~NDik(~,
ANY R.EOU~EMENT. TERM Cft, CONDr'f~Of~ or ANY C,C-tIT"I1;~-C:T OR OiH!Ft. ClOCUMSNT \I"~irrh ~E.S;PECr ore vvHlCH TK1$ CFR:nr:;.'ICA'f'!S .MfY Be ;~K
MAY PERTAtN. 'fl-'E INSURANCE AFFOi'tDED S'" THE POLiCIES DESCRIBED "l@!ll:([N IS SUBJECT TO N..L THE TtRMS, EXCt.,US10NS4ND Cc.lNDffi01,S SUC>-'
?OLlC\ES. AGGR!G~,TE LIMITS SHOWN !vuw\-i"VE BEEN REDUC"D BY PAtDCLAlMS.
~~:~=-~;:-v.;~'~~~~~;~... '~-:';;~y ~:,;;;;~~~~11}i~:;J~7J~~:;t~~~~il~~~?0~ _...._._.~--,,~-~., tl~:~,-_.n.
I I
A
04GL582522
02101
02/05/06
; SACk DCC'.iRl"ENct I ~ 1,000 000 I
f ~MAGf.. fv R"-oC~~~t-,.,~occ"_~--..---_-j~ ;.- c<Y"__'<
j PRr;:',,\j~!;S I~. 'l;:"'.<,~_...L:..-_~,J.Q.q..dJ 0 {)
, MGDeF:g~rA'ffy 0041 ~~~~_l~...c_c~ci~~.LUP1;'p_,.i
, p"RSQNr< ~!:f:!.Yf..iJVi\V'_~~n......1,J?Jto_~J,lQ.
GbN€RA.. A~.5~~::?__...j2._1---, JlQ Q ,J:HHL
f!.:~()l:nJ~~~!,!Cl! ",('If:.. . ,,--_:L..Q9j),,09J'),
,
Glf..'~eK....l t..A.:f\,~7''''
~5EM.;..:gA_
Y''o-''31i n-y
C\_;;'~J'._~;:' f,At,..[J;,. u;'",; -:-:}r>~;~ (j~' ~
_"~~'L
nJ . >'O\_>C.Y ,
,~.UTO;,JC~~~L;;::
n,,'.,r A"P'~Il;S
,f;gr """'-"1 v:>C __'LrT-,~~'-=--_"~-~
if-J}!L TY
\1 COMl'llNt:D S''-'Gcf. '.;'4'1
{C/p'"at:d~~1
I--------------.:-......~-~-
i 1
AMY !'....:jTO
.<;Ly. ()'r'\'Nt':~) 4})"'!'O':~
SC-M~ttf_E.O
,-,,~~._w~~._,,~....,.. _..n. _.___.,_.'__"'~,..~,
HtRr D A)Jl <)::~
NO~' C;N;i-NEC AJTO~~
~NY Au'rc
Ct.}\fh-h h:ftA~t:
_:^-GC;~9"~~___2..
;i:
'----~..~._-~----"'._.--."-,....---~'"-'- --_._"---,-_._~<
~._._..------~-_.~_.~------
, ! $ '.
.,".}- ~ ~
~~~~_"~_..~~,~o_~
(11.~!j{:3't:~'_>>tfl1t.E:lf
~ ~ t?t;;::~Ai.- P?;DV5~ON$ !~~~
O-""FP
I
~.,~__.._ ____..~_~'--._- ---1--._ _ .-+- ___~..~-~--~v~._~
0w~Ri'P'rt0~ Of C~-€R.t.,.ftOM3 i Lv.,-ATH)N;:, \'EriiCLt$! fy.CUJg'("N3 ADore ~v fi'.i80,g~~'EM'f! M~'SC'A.L PRD\f.S!C~5
CANCELLATION
SHO.JLO AM'! 0" T'ill At'k')\i'E C@8-.CR'~fC "DL'C'E1'f BE CAfolCLLL6Q
CERTI!'lCAT!;: i40LDitR
Th~ b.y.~n:'.;.f, ,;'CY:-.jl
INSUP-ED \ S COpy
[s.,-i"rt TMtRfC+, H~ r5..S1f~JGN~Pf.p\ W:LL r:Nt:-PJ~'...~ TC'
'C..f>.'/S (A'R ':'"'H"
-Y0T~CE TO T"~ ~RT%i'~CA,'0 HOlP~ N.~1J 10 THt. U':r-T :A:iJ1 tj,lLtJPE Ie DO 80 gJ.-.lt..;~~",
I fMP""0St "JO I)Bd~':;;r,-r:ON O~ -LjA..~;~Jr~' 0';:: /-)'~\ '-".\Ntl}N)N );.j::,U~fN. ;i'~
, I"EMl~41'~''a:; ,- ~
:j"_~'-'()RIl"O ,*,ffi~--" -_~ ---=-:-
l ~~ ..-'~--~
, ~ ~ =, ~~~~~~_~~ri"A<f!aN10SS
ijF:
ACORD;!!:! (1001/1$1:\\
3 U :~;
3C(j !6~) ,I
r: .Ci
~
~
a_
im
~
~
~
e
.ag
::
~
=
II
~
u
.16
t:..1
t:S
i?
lD
I
~
f'W
rJJ
o
FU
o
o
-
.:t
rJJ
-
o
o
I!lW
-
l::F'
-
o
o
o
o
w
-'
-
-
~ m
-
'b
-
-
W'1
l::F'
-
U"l
.:r
~
SECTION D
CONTRACT TO
Rehabilitate Terminal Canopy
Florida Kevs Marathon Airport
THIS AGREEMENT made and entered into
by and between
and
of
Contractor,
Commissioners, Key West, Florida, Owner.
WITNESSETH:
That the Contractor, for the consideration hereinafter fully set
Owner as foHows:
agrees with
1 ~ That furnish all materials" ail the
the manner and form as provided by the following enumerated Instruction to
Bidders, Proposal, General Special Provisions, Technical
Specifications, Form of Form Bond, and Addenda, which
are attached hereto and made a part hereof, as if fully herein, for the
construction of:
Rehabilitate Terminal Canopy
Florida Kevs Marathon Airport
County, Florida
That Contractor shall commence the work be
agreement on a date specified in a written order
fully complete all hereunder within sixty mOl
to-Proceed as Special Provision No.2.
performed under
Owner and
the
the Contractor
additions and
the
performance
in
with lump sum and unit prices set the
On or before the 15th day each calendar the party shall
partial payment to the on the Contractor basis of a duly certified and approved
estimate of work perfolTI1ed during preceding calendar month the
Contractor, less ten percent 0%) of the amount of such estimate which is to be
11-6
retained by the Owner until all work has been performed strictly in accordance
with this agreement
5. Upon submission by the Contractor of evidence satisfactory to the Owner that all
payrolls, material bills and other costs incurred by the Contractor in connection
with the construction of the work have been paid in full, final payment on account
of this agreement shat! be made within tWenty (20) days after the completion by
the Contractor of all work covered by this agreement and the acceptance of such
work by the
6, It mutually agreed between parties hereto that is of the essence in this
and in the event the of the work is not completed within the
time herein specified, it is agreed that from the compensation other/vise to be
paid to the Contractor, the Owner retain amounts described in the '
Liquidated Damages Section day thereafter, Sundays and
holidays included, that the work remains uncompleted, which sum shall represent
the actual damages which the will have sustained per day by failure of the
Contractor to complete the work within the time stipulated and this sum is not a
penalty being the stipulated damages Owner will have sustained in event
of such default by the Contractor.
It is further agreed between the parties hereto that if at time after
execution of agreement the bond hereto attached for
faithful performance, the Owner shall deem the surety or sureties upon such
bond be unsatisfactory, or for any reason, such ceases to be adequate
cover the performance of the work, the Contractor at its expense within
five (5) days after the receipt notice from the so to do, furnish an
additional bond or bonds in such form and amount and with such surety or
sureties as shall be to the Owner. such event, no further payment
the Contractor shall be deemed to be due under this agreement until such new
or additional security the performance of work shaH be furnished
manner and satisfactory Owner.
VVITNESS WHEREOF the parties
date above written two
accounting for the counterpart,
on
day
or
this
each of which shall,
an
(Contractor)
County Board of Commissioners)
By:
Title: '
President*
WITNESS:
11-7
STATE OF FLORIDA
COUNTY OF
I, the undersigned authority, a Not.ary Public in. and for said County and State hereby
certify that whose name as of Is
signed to foregoing instrument and who is known to me, acknowledged before me
on this day that beIng informed of the contents of the within instrument, he, his
capacity as such, executed the same voluntarily on the date the same bears date.
Given under
hand
seal this
of
__.20~
Notary Public
*
is authorized the
to
this contract
11-8
SECTION E
DRUGwFREE WORKPLACE FORM
The undersigned Contractor, in accordance w~th Florida
certifies
287.087, hereby
A-e y/OS C
1, Publish a statement notifying employees that the unlawful manufacture,
distribution, dispensing, possession or use of a controlled substance is prohibited
in the workplace and spedfying actions that be taken against employees
for violations of such prohibition.
2, Inform such employees about the dangers workplace, the
business' a drug-free available drug
counseling, rehabilitation and employee assistance programs and the penalties
may be imposed upon employees for drug abuse violations.
Give each employee engaged in providing commodities or contractual
services that are under bid a of the statement specified ~n Sub-section (1),
In the statement specified in Sub-Section (1), notify the employees as a
of working on the commodities or contractual ser"Jlces are under
bid, the employee abide terms of the statement and will notify the
employer of conviction of or plea of guilty or nolo contendere to any
of Chapter 893 {Florida or of any controlled substance of the
States or any state for a violation in the workplace no five (5)
days
5. a on or satisfactory participation in a drug abuse
assistance or rehabilitation program if such is the
or any employee so
6, Make a
implementatIon
a
a
the requirements.
With
Date: 07-28~OS'
1-23
Date: 07 - -28, cJ..f"
Firm Name: a !//CfYO 6etACI uayvr'a
By ,_~f!:~~~{;i)-~
Title: 1')R ?r<'dJLuZ:f: '
~ro Valoocig
My Commi~ OOWl Hl7
1-25
SECTION J
B~DDER'S AFFIDAVIT IN COMPLIANCE WITH
FLORIDA TRENCH SAFETY ACT
(SECT~ON 553.60~553~64, FLORIDA STATUTES)
5T ATE OF FLORIDA )
) S5
COUNTY OF MONROE )
BEFORE ME, the undersigned authority, personally appeared
CY /1/01'0 Cck \1(") yy; CL~
who, being duly sworn, deposes and says as follows:
That he is the duly authorized representative A~ YO S S ~ u '( I J f' Y \' r P y P .
(Name of Bidder)
being its V~~de u~t ~
(Owner) (Partner) (President or other Corporate Officer)
and as such, has fuB
to execute
Bidder's Affidavit.
1.
fuB legal name
business address the person Of
submitting
o~
submission
underslgned bidder certifies
excavation done within his
shall be
that as
bidder all trench
his own forces or by his subcontractors)
adherence OSHA Trench Safety Standards
in 19 CFR, 8.1926.650, subsequent revisions
or updates to these Standards as adopted the Department of labor
Employment Securjty.
3. The bidder acknowledges that included in the various items listed the
Schedule of Prices Bid and in the Total Amount Bid are costs for complying with
1-29
SECTION K
SWORN STATEMENT PURSUANT TO SECTION 287.133(J)(a),
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
This be signed and swom
official authorized to administer oaths~
in
presence
a Notary Public or
1.
This sworn statement is submitted
Bid, Proposal or
A\?-lVo .3-/;1 ~()otlt/-;200i/ ()>>.tf 3~f:1~OV)fet <2IeS:
for 12.e L't (). , r' If' k i e.. ~ y W ; "teE L Cr;n/, n1d' >
This sworn statement is submitted Arc."YO s s: DU /I~ v) G::>-I'P'
(name of entity submimng swom stat~ment)
whose
is it)o Be\ ~ v /t W ])'1. "'* /t//,f---J S. Is /~ Jj T L .
()
33/CO
and (if applicable) its Federal Employer Identification Number (FEIN) is:
y- ObO,?.2S'X
(If the entity has no FEIN, include Social Security Number the individual
signing this sworn statement: .)
3. name is a lVI/YO &~L/ {La 'lY /a.
my name of individual signing}
relahonship to the entity named
is '7 iIC )r1 \jg L{ {~
4. I understand a crime", as defined in Paragraph 1 1 )(g),
Florida Statutes, means a violation state or federal law by a person with
respect and related to transaction business public entity
or with an agency or political subdivision of any other state or of United
States, including, but not limited or contract goods or to
be provided to any public entity or an agency or political subdivision of other
state or of and involving fraud, bribery,
collusion, conspiracy or material mis-representation,
or , as in Paragraph
Florida Statutes; means a finding gum or a of a
public entity crime with or without an adjudication of gUilt in federal or state
tria! court of record relating to charges brought by indictment or information after
July 1, 1989, as a result of a jury verdict, non-jury trial or entry of a plea of guilty
or nolo contendere.
1-31
Officer of the State of Florida, Division of Administrative Hearings, The
Final Order entered by the Hearing Officer did not place the person or
affiliate on the convicted vendor list (Please attach a copy of the Final
Order. )
The person or affiliate was placed on the convicted vendor list There has
been a subsequent proceeding before a hearing officer of the State of
Florida, Administrative Hearings" The Final Order entered by
the hearing officer determined that it was in the public interest to remove
the person or affiliate from the vendor list (Please attach a
copy ofthe OrdeL)
The person or affiliate has not been placed on the convicted vendor list
(Please describe action taken by or with the Department of
Genera! Services")
Signature of Authorized Representative:
J
L ~ I
K}[ ~LA L-
Title
o7-c2 f- 04-
Date
STATE
COUNTY OF: )3 ~""~
foregoing instrument was
before me
dav of
J
20Al~
-'
, ~
IS personahY
as identification
(Sole, Corporation or Partnership)
to me or who
who take an oath.
~~~lic, State of Florida at large)
My Commi3Sioo 00301107
Expifes May 00,20013
(Print name of Notary Public)
~ro WIe11Cia
My commission 00301101
Explres May 00.20013
(8ig
My Commission Expires
1-33
SECTION M
CERTIFICATION Of NONSEGREGATED fACILITIES
Contract
(As Required by Division Ill, Section 120 Subsection 120:,02
Equal Employment Opportunity Requirements of General Provisions)
The federally assisted construction contractor certifies that he does maintain or
provide, for his employees, segregated facilities of his establishments and
that he does not permit his employees to perform their services at location, under
his control, where segregated facilities are maintained. The federally assisted
construction contractor certifies that he will not maintain or provide, for his employees,
segregated facilities at any of his establishments and not permit
employees to perform their services at location, under his control, where
segregated facilities are maintained. assisted
agrees that a breach this certification is a violation the equal opportunity clause in
this contract. used this certification, the term "segregated faciHUes" means any
waiting rooms, work areas, restrooms and washrooms, restaurants and other eating
areas, time!ocks, locker rooms and other storage or dressing areas, parking lots,
drinking fountains, recreation or entertainment areas, transportation, and housing
fadHties provided for employees which are segregated explicit directives or are in
fact segregated on basis of race, color, religion, or national origin because habit,
or other reason. federally assisted construction contractor
agrees that (except where he obtained identical certifications proposed
subcontractors for specific time periods) will obtain certifications
subcontractors prior to the award of subcontractors $10,000 which
are from provisions of the clause and will
retain such certifications his fHes~
~/. ,J)
" L/K '?;to? tl.L '
Title
1-35
SECT~ON 0
CERTIFICATION REGARDING DEBARTMENT, SUSPENSION,
INELIGIBILITY, AND VOLUNTARY EXCLUSION ~ 49 CFR PART 29
(Version 1. 5/90)
The bidder/offerer certifies, by submissfon of
contract, that it nor its principals
proposal or acceptance
this
debarred, suspended, proposed for
debartment, declared ineligibility, or voluntarily excluded from this
transaction by any Federal department or agency. It further submitting this
proposal that it include this cause modification an transactions,
solicitations, proposals, contracts, and subcontracts. the bidder/offerer/contractor
any lower certify
explanation to this solidtation/proposaL
statement, it
attach an
'J1 . J j
i ry.e$,-{cl.{J L( t'
Title
1-39
INSURANCE AGENT'S STATEMENT
I have reviewed the above requirements with the bidder named below. The following
deductible;:; apply to the corresponding policy:
POLICY
DEDUCTIBLES
liability policies are:
o Occurrence
o Claims Made
insurance
Signature
BiDDER9S STATEMENT
I understand insurance that be
comply in with aU the requirements.
if awarded the contract and
kyo:;r Z3C/f'i/~rJ &Y/2.
Bidder /
111-92