3rd Amendment 06/21/2017KEVIN MADOK, CPA
MONROE COUNTY CLERK OF THE CIRCUIT COURT & COMPTROLLER
DATE: June 27, 2017
TO: Alice Steryou
Contract Monitor
FROM: Pamela G. Hanco *.C.
SUBJECT: June 21 st BOCC Meeting
Attached is a duplicate original of C28, third amendment to the Maintenance Agreement
with Black Fire Protection, Inc. for "Full Maintenance — Fire Protection Systems" to
provide an address change to the notice requirement and revise the non - discrimination
language in the original agreement to reflect current statutory requirements, for your handling.
Should you have any questions, please feel free to contact me at ext. 3130. Thank you.
cc: County Attorney via email
Finance via e -,nail
File ✓
Full Maintenance Program - Fire Protection Systems
THIRD AMENDMENT AGREEMENT
FULL MAINTENANCE PROGRAM — FIRE PROTECTION SYSTEMS
MONROE COUNTY, FLORIDA
THIS hereinafter "Third Amendment Agreement" is made and entered into this 21st day
of June, 2017, between MONROE COUNTY (hereinafter "County" or "Owner "), a political
subdivision of the State of Florida, whose address is 1100 Simonton Street, Key West, Florida,
33040, and BLACK FIRE PROTECTION, INC. ( "CONTRACTOR "), a Florida corporation,
whose address is 1014 SW 19` Street, Ft. Lauderdale, Florida 33315.
WHEREAS, the parties hereto did on December 11, 2013, enter into an agreement for
inspection, testing, maintenance, and repairs per NFPA 25 for fire protection systems, including
associated piping and equipment, located in Monroe County (hereinafter "Original Agreement");
and
WHEREAS, on November 17, 2015, the BOCC approved the First Renewal Amendment
Agreement; and;
WHEREAS, on January 20, 2016, the BOCC approved correction of a minor scrivener's
error in a Second Amendment Agreement; and;
WHEREAS, on December 14, 2016, the BOCC approved a Second Renewal
Amendment Agreement; and;
WHEREAS, the Contractor has a new business address and the Original Agreement, as
amended, shall be revised to reflect the new business address; and
WHEREAS, County desires to revise language in paragraph 13, Nondiscrimination, of
the Original Agreement in accordance with all current applicable laws; and
WHEREAS, Contractor agrees and consents to such revisions in its Original Agreement;
and
WHEREAS, the parties find it mutually beneficial to amend its Original Agreement as to
the Contractor's new business address and the revised language for Nondiscrimination
compliance; and
NOW THEREFORE, IN CONSIDERATION of the mutual promises and covenants
set forth below, the parties agree as follows:
1. In accordance with Paragraph 18: NOTICE REQUIREMENT of the Original
Agreement shall be revised as follows:
FOR COUNTY
Monroe County
Facilities Maintenance Department
1100 Simonton Street, Room 2 -216
Key West, FL 33040
FOR CONTRACTOR
Kirby Black
Black Fire Protection, Inc.
1014 SW 19 Street
Ft. Lauderdale, FL 33315
Page 1 of 3
Full Maintenance Program - Fire Protection Systems
2. In accordance with paragraph 13, Nondiscrimination, of the Original Agreement, shall be
revised as follows:
13. NONDISCRIMINATION. The parties agree that there will be no discrimination
against any person, and it is expressly understood that upon a determination by a
court of competent jurisdiction that discrimination has occurred, this Agreement
automatically terminates without any further action on the part of any party, effective
the date of the court order. The parties agree to comply with all Federal and Florida
statutes, and all local ordinances, as applicable, relating to nondiscrimination. These
include but are not limited to: 1) Title VII of the Civil Rights Act of 1964 (PL 88-
352), which prohibit discrimination in employment on the basis of race, color,
religion, sex, and national origin; 2) Title IX of the Education Amendment of 1972,
as amended (20 USC §§ 1681 -1683, and 1685- 1686), which prohibits discrimination
on the basis of sex; 3) Section 504 of the Rehabilitation Act of 1973, as amended (20
USC § 794), which prohibits discrimination on the basis of handicaps; 4) The Age
Discrimination Act of 1975, as amended (42 USC §§ 6101- 6107), which prohibits
discrimination on the basis of age; 5) The Drug Abuse Office and Treatment Act of
1972 (PL 92 -255), as amended, relating to nondiscrimination on the basis of drug
abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment
and Rehabilitation Act of 1970 (PL 91 -616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or alcoholism; 7) The Public Health
Service Act of 1912, §§ 523 and 527 (42 USC §§ 690dd -3 and 290ee -3), as amended,
relating to confidentiality of alcohol and drug abuse patent records; 8) Title VIII of
CM the Civil Rights Act of 1968 (42 USC §§ 3601 et seq.), as amended, relating to
n!�idiscrimination in the sale, rental or financing of housing; 9) The Americans with
p► Disabilities Act of 1990 (42 USC §§ 1201), as amended from time to time, relating to
a Q indiscrimination in employment on the basis of disability; 10) Monroe County Code
nk& pter 13, Article VI, which prohibits discrimination on the basis of race, color, sex,
C) 9agion, national origin, ancestry, sexual orientation, gender identity or expression,
�' ac 5Awilial status or age; and 11) any other nondiscrimination provisions in any federal
°° %,state statutes which may apply to the parties to, or the subject matter of, this
A
f.
Except as set forth in paragraphs 1 and 2 of this Third Amendment Agreement, in all
r respects, the terms and conditions set forth in the Original Agreement, as amended,
{ `r, in in full force and effect.
.t: VIN MADOK, CLERK
Y:
Deputy Clerk
Date: L'. 2i0 1 - 7
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
B
Y:
Mayor
Date: 2 Z ' 1- 7
MO aROVED NTY ATTORNEY'S OFFICE
Page 2 of 3 AS F
PATRICIA EABLES
ASSISTANT COQ I,Y A i gRNEY
LATE: _�? G
Full Maintenance Program - Fire Protection Systems
CONTRACTOR:
BLACK FIRE PROTECTION, INC.
Witnesses for CONTRACTOR:
�e�
Sign
Printed Name and Date
S' nature
Printed Name and Date
Signa a of person authorized to
legally bind Corporation
Date: % r 7
- o Z�x
Print Name and Title
Address:
Page 3 of 3
F -9 Request for Taxpayer
t,= 8�,e�,,,, Identification Number and Certification
irt}emal Revenue Service
i Name (as ehcwn 4n your Inn to tax ►ethArk
N
0
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It
name
3�-Ctheck appm Wiate box for federal tax clesstNcation; check o of the following seven boxes:
u Intlividual/sole proprietor or 0 only C Corporation S Corporation
-
single nber LLC El Partnership ❑ T. ,/.t.
EJ UmIted I iblity Company' Enter the tax classification (C-C corporation, S=S corporation. P= p ) P.
Note. For a single - member LLC that is disregarded, do not Check LLC; check the
the tax 01111- 1161 -9 of the single rrretnber oyaeer. a ppropriate box in the &re above for
❑ Other (see instr nsJ ►
- (Rumoer, street, and apt, or
_lip \ �j S
Ss �P e
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account numbar(s) here faotiorw
nitre f=orm to the
requester. Do not
- send to the IRS.
4 Exemptions (codes apply oriy to
Certain entitles not individuals; see
irm0uctiorns on Page 3):
Exempt payee code Of any)
Exemption from FATCA reporting
code (if arty)
VAib d aWiubnr use
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 4 to avoid $octal security number
backup withholding. For individuals, this is generally your social security number (SSM However, for a
resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other
TIN on page S. I 1 I� II m
entities, it is Your em oloyer identification number (EIN). If you do not have a number, see Now to get a
or
Note. If the account is in more thafi'one name, see the instructions for fine 1 and the chart on page 4 for ornPtoYer Identification numb
on whose number to enter.
m _gin
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued tome); and
2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b)1 have not been notified by the Internal Revenue
Service (IRS) thatA am subject to backup withholding as a result of a failure to report 811 interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. 1 am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (d any) indicating that I am exempt from FATCA reporting is correct.
Certification Instructions. You must cross out item 2 above If you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all Interest and dividends on your tax return. For real estate transactions, Item 2 does not apply. For mortgage
Interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and
generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the
instnictions on page 3.
Here Signature of
U.S. person ►
General Instructions
Section references are to the Internal Revenue Code unless otherwise noted.
Future developments. Information about developments affecting Form W -9 (such
as legislation enacted after we release ft) is at www.*a.gov{fwg.
Purpose of Form
An indMdual or entity 0 orm W-9 reWestsrj who is required to file an information
return with the IRS must obtain your correct taxpayer Identification number (11N)
which may be your social security number (5SN), indlvtdual taxpayer Identification
number p11N), adoption taxpayer Identification number MM, or employer
Identification number (EIN) to report on an Information return the amount paid to
you, or other amount reportable on ark information ream. Examples of Information
returns include, but are not limited to, the following:
• Form 10994NT finterestawned or paid`)
• Form 1099 -DIV (dividends, including those from stacks or mutual finds)
• Form 1099 -MISC (va- ous types of income, prizes, awards, or gross proceeds)
• Form 1099 -B (stock or mutual fund sales and certain other transactions by
brokers)
• Forte i tOWS (proceeds from real estate transactions)
• Form 1099 -K (merchant card and third party network transactions)
Des b.
• Form 1098 (home mortgage kart mt), 1099 -E (student loan interest), 1098 -T
(tuition)
• Form 1089 -C (canceled debt)
• Form 1 t199 -A (acquisitim or abandonment of secured property)
Use Form W -9 orgy N you are a U.S. parson (including a resident alien), to
provide your correct TIN.
H you do not raum Form W-9 to the requester with a TIN, you ,night be subject
to bacltup Widitk*V. See Kftt is backup wit ftk3Vtrg? on page 2.
W signing the filled -out form, you:
1.
to the that the TIN you are giving Is corr oect (or yu are waking for a number
2. Certffy that you are not sublect to backup witlinolding, or
S: Claim exemption from backup withholding it you are a U.S. exempt payee. If
applicable, you are also oartif tng that as a U.S. person, your allocable share of
any partnership Income from a U.S. trade or buskless is mot subject to the
withholding tax ion foreign pattiners` share of effectively connected Income. and
4. Certify lhatfATCA code(s) entered on this fomr Af ary) Indicating that you are
exempt from the FATCA reporting, is correct See Wtrat is FATCA reporting? on
page 2 for further information.
Cat No, 10231X Form w -9 (Rev. 12 -2014)