Item C7BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: May 21, 2014 Division: Employee Services
Bulk Item: Yes X No Department: Risk Management
Staff Contact Person: Teresa AgWar X4458
AGENDA ITEM WORDING: Approval to solicit proposals for Workers' Compensation and Risk
Management consulting services.
ITEM BACKGROUND: May, 2010 was the last time the service was advertised to solicit proposals.
The current contract expires September 30, 2014.
PREVIOUS REVELANT BOCC ACTION: At the September 15,2010 BOCC meeting, the current
contract was approved.
TOTAL COST: gpprox. $800 advertising MIRECT COST: —BUDGETED: Yes X No
1011 W W D) 1.14 phill i 1�11 n.- IN lal 511 no
-,131VENUE PRODUCING: Yes No AMOUNT PER MONTH Year
APPROVED BY: County Atty OMB/Purcls'ing RiskManagement
VC
DOCUMENTATION: Included X Not Required
DISPOSITION: AGENDAITEM#
Revised 2/27/01
Lem :to] 0
MayorBOARD OF COUNTY COMMISSIONERS
•
Mayor Pro Tem, Danny L. Kolhage, District 1
George N•- District
DistrictHeather Carruthers,
David Rice, District
COURTCLERK OF THE CIRCUIT DIVISION
Amy Heavilin Teresa E. Aguiar, Director
1 of 41
SECTION ONE - Instruction to Proposers
SECTION • - Draft Agreement
EXHIBIT A - Scope • Services
SECTION THREE - County Forms and Insurance Forms
1. Schedule of Insurance Coverages
2. Internal Service Fund Combined Statement of Net Assets as of 9/30/2012
3. Combining Statement of Revenue, Expenses and Changes to Net Assets as of
9/30/2012
4. Combining Statement of Cash Flow as of 9/30/2012 (2 pages)
5. Loss Runs for Workers' Compensation for last two years
;101 :4;j :16];Le I
The Proposer awarded a contract shall provide Consulting Services in the areas of Workers'
Compensation and Risk Management and other related services as set out in the Scope of
Services — Exhibit A.
•••
Monroe County maintains two internal service funds for funding its self -insured property liability
and workers' compensation coverages. Retentions vary according to the type of coverage. In
addition, varying levels of excess coverage are purchased from commercial insurance carriers,
depending on the type of coverage.
Property/Liability claims are self-administered while Workers' Compensation utilizes the
services of a Third Party Administrator. All Constitutional Officers, including the Sheriff,
participate in these programs. Between the County and Constitutional Officers, there are
approximately 1700 employees and volunteers. The County's operating budget is
approximately $323,000,000. The most recent financial reports for the two Internal Service
Funds, Schedules of Insurance and Insurance Agencies are provided as Attachments "2"
through "4".
The scope of work is included in Exhibit A of this document.
The firm must certify at least annually that all staff members, independent contractors,
subcontracted work, if any, all service providers it uses, engages or manages, comply with
Health Insurance Portability and Accountability Act (HIPAA) privacy and security rules.
Proposals received from firms that have contractual relationships which would preclude
the firm from being unbiased in the services provided to the County will not be considered
for evaluation.
The Proposer must provide a listing of any contractual relationship between the Proposer
and any persons or business entities that provide services in the areas of Workers'
Compensation and/or Risk Management.
The Proposer must warrant that it has not employed or retained a company or person,
other than a bona fide employee, contractor or subcontractor, working in its employ, to
solicit or secure a contract with the County and that it has not paid or agreed to pay any
person, company, corporation, individual or firm other than a bona fide employee,
contractor or subcontractor, working in its employ any fee, commission, percentage, gift
or other consideration contingent upon or resulting from the award or making of a
contract with the County.
The firm and its employees who are responsible and accountable for the county's
account and subcontractors, if any, must have all necessary current licenses issued by
the Florida Department of Insurance. Proper documentation shall be attached to the
proposal in Section Three.
The County will not consider any insurance company, insurance agency, insurance
broker, third party administrator, or officer, director, agent or employee of any of the
foregoing. If a proposer is a consultant and is not a broker but accepts fees or
commissions, that proposer is not precluded from bid consideration but must disclose the
fees and commissions received within the past 12 months and the source.
The County will not consider any consulting firm owned or controlled by an insurance
company, insurance sales organization, third party administrator or any consulting firm
which owns or controls any insurance company, insurance sales organization, or third
party administrator.
5. COMPENSATION
Respondent* The County is requesting that the
documentation acceptable to the Clerk on a schedule as set forth in the
contract. Acceptability to the Clerk is based on generally accepted accounting
principles and such laws, rules and regulations as may govern the Clerk's
disbursal of funds.
The contractor will submit such invoice monthly for services provided during the
preceding month. The invoice will include a record of employee time worked
and differentiate time worked at the rate for the different classification.
Upon receipt of the contractor's invoice in the proper form as stipulated above
and upon acceptance by the Clerk, Monroe County will make payment in
accordance with the Florida Local Government Prompt Payment Act, Section
218.70, Florida Statutes.
Award shall be made to the responsible proposer whose proposal is determined to be the most
advantageous to the County, taking into consideration the evaluation criteria set forth below:
Experience and Qualifications
25 points
Ability to provide all required services
30 points
Cost of services
35 points
Location of firm (local preference if
applicable: up to 5 additionalpoints)
10 points
Total points earned are on a scale of 1 — 00 points
lowestf1 = highest
A Selection Committee will be analyzing proposals and providing recommendations to the
County Administrator who will ultimately make a recommendation to the Board of County
Commissioners regarding which individual or firm should be hired.
Request for additional information or clarification relating to the specifications of this Request for
Proposals shall be submitted in writing directly to:
Maria Slavik, Risk Administrator
Monroe County
1100 Simonton Street, Suite 2-268
Key West, FL 33040
Facsimile (305) 295-3179
All requests for additional information must be received no later than 3:00 p.m. , 2014.
Any requests received after that date and time will not be answered. If an answer is issued, an
addendum to the RFP will be issued shortly thereafter and distributed to all interested
proposers, responding with the County's best ability to answer all questions. Oral reouests will
not be answered.
All addenda are a part of the contract documents and each Proposer will be bound by such
addenda, whether or not received by him/her. It is the responsibility of each Proposer to verify
that he/she has received all addenda issued before responses are opened.
The proposal submitted in response to this Request for Proposals (RFP) shall be printed on 8-
1/2" x 11 " white paper and bound; shall be clear and concise, tabulated, and provide the
information requested herein. Statements submitted without the required information will not be
considered. Responses shall be organized as indicated below. The Proposer should not
withhold any information from the written response in anticipation of presenting the information
orally or in a demonstration, since oral presentations or demonstrations may not be solicited.
Each Proposer must submit adequate documentation to certify the Proposers compliance with
the County's requirements. Proposer should focus specifically on the information requested.
Format. The proposal, at a minimum, shall include the following:
A. Cover Page
A cover page that states "Requests for Proposals for Workers' Compensation and Risk
Management Consulting Services". The cover page should contain Proposers name, address,
telephone number, and the name of the Proposers contact person.
B. Tabbed Sections
Tab 1. General Information
(a) An overview of the firm's experience.
(b) The length of time the firm has been providing Workers' Compensation and Risk Management
Consulting Services
(c) Statement of the firm's commitment to higher education of its consultants within the insurance
and risk management disciplines.
(d) Other experience.
(e) Description of reference material and computer software specific to workers' compensation and
risk management
(f) Resumes of all key members of the account team that will be assigned as consultants including
professional designations.
(g) Customer references (no more than three Florida government clients along with their telephone
numbers, addresses and names of the persons who can be contacted to provide a reference).
(Florida government clients will be preferred, and current clients of the firm will be preferred over
former.)
Tab 2. Relevant Experience
A record of performance and professional accomplishments by Proposer and employees, including
professional accomplishments, and any work with large companies or government entities.
The Proposer shall provide a list of similar contracts or agreements currently in force to include:
Name and full address
Telephone number of client contact
Date of initiation and completion of contract
Summary of the services and geographical area served
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availability, staffing, whether sub -contractors are used, and any other relevant information
explaining how the services will be accomplished.
(b) The Proposer should describe the delivery of individual services listed in the Scope
of Services (Exhibit A) in this RFP and how this will be accomplished. The Proposer should
respond in detail and avoid a generalresponse.
In accordance • of the Monroe CountyCode, the Proposer
provide the f•I • • • r
(1) A list of the person's or entity's shareholders with five (5) percent or more of the stock or,
if a general partnership, a list of the general partners; or, if a limited liability company, a
list of its members; or, if a solely owned proprietorship, names(s) of owner(s);
(2) A list of the officers and directors of the entity;
(3) The number of years the person or entity has been operating and, if different, the
number of years it has been providing the services, goods, or construction services
called for in the bid specifications (include a list of similar projects);
(4) The number of years the person or entity has operated under its present name and any
prior names;
(5) Answers to the following questions regarding claims and suits:
a. Has the person, principals, entity, or any entity previously owned, operated or
directed by any of its officers, major shareholders or directors, ever failed to
complete work or provide the goods for which it has contracted? If yes, provide
details;
b. Are there any judgments, claims, arbitration proceeding or suits pending or
outstanding against the person, principal of the entity, or entity, or any entity
previously owned, operated or directed by any of its officers, directors, or general
partners? If yes, provide details;
c. Has the person, principal of the entity, entity, or any entity previously owned,
operated or directed by any of its officers, major shareholders or directors, within
the last five (5) years, been a party to any lawsuit, arbitration, or mediation with
regard to a contract for services, goods or construction services similar to those
requested in the specifications with private or public entities? If yes, provide
details;
d. Has the person, principal of the entity, or any entity previously owned, operated
or directed by any of its officers, owners, partners, major shareholders or
directors, ever initiated litigation against the county or been sued by the county in
connection with a contract to provide services, goods or construction services? If
yes, provide details;
e. Whether, within the last five (5) years, the owner, an officer, general partner,
principal, controlling shareholder or major creditor of the person or entity was an
officer, director, general partner, principal, controlling shareholder or major
creditor of any other entity that failed to perform services or furnish goods similar
to those sought in the request for competitive solicitation.
Proposer shall provide any additional information which will present evaluators with insight
about the knowledge, skills and abilities of the Proposer.
If the Proposer cannot fully comply with any of the terms contained in the draft contract, shown
in Section Two, all deviations to the terms must be spelled out in this section, i.e. Tab 5.
Proposer shall complete and execute the forms specified below and located in Section Three
in this RFP as well as a copy of a business tax receipt from the Tax Collector office
and shall include them in this section, i.e. Tab 6:
Forms
Submission Response Form
Lobbying and Conflict of Interest Ethics Clause
Non -Collusion Affidavit
Drug Free Workplace Form
Public Entity Crime Statement
Any Proposer claiming a local preference as defined in Monroe County Ordinance 023-
2009 must complete the Local Preference Form and attach it to the Proposal.
i
A. Only complete sets of RFP Documents will be issued and shall be used in
preparing responses. The County does not assume any responsibility for errors
or misinterpretations resulting from the use of incomplete sets.
B. Complete sets of RFP Documents may be obtained in the manner and at the
locations stated in the Notice of Request for Proposals.
See also Notice of Request for Competitive Solicitation
Interested firms or individuals are requested to indicate their interest by submitting
three (3) signed originals and three (3) complete copies (total = six (6) )of the proposal,
in a sealed envelope clearly marked on the outside with the Proposers name and
"Requests for Proposals for Workers' Compensation and Risk Management
Consulting Services", addressed to Monroe County Purchasing Department, 1100
Simonton Street, Room 2-213, Key West, FL 33040, which must be received on or
before 3:00 P.M. local time on . Hand delivered Proposals may
request a receipt. No proposals will be accepted after 3:00 P.M. Faxed or e-mailed
proposals shall be automatically rejected. It is the sole responsibility of each Proposer tt
,-nsure its proposal is received in a timely fashion.
A. NON -COLLUSION AFFIDAVIT: Any person submitting a proposal in response to
this invitation must execute the enclosed NON -COLLUSION AFFIDAVIT. If it is
discovered that collusion exists among the Proposers, the proposals of all
participants in such collusion shall be rejected, and no participants in such
collusion will be considered in future proposals for the same work.
B. PUBLIC ENTITY CRIME: A person or affiliate who has been placed on the
convicted vendor list following a conviction for a public entity crime may no)
submit a proposal on a contract to provide any goods or services to a public
entity, may not submit a proposal on a contract with a public entity for the
construction or repair of a public building or public work, may not submit
Proposals on leases or perform work as a contractor, supplier, subcontractor, or
contractor under a contract with any public entity, and may not transact business
with any public entity in excess of the threshold amount provided in Section
287.017, for CATEGORY TWO for a period of 36 months from the date of being
placed on the convicted vendor list. Category Two: $25,000.00
C. DRUG -FREE WORKPLACE FORM: Any person submitting a bid or proposal in
response to this invitation must execute the enclosed DRUG -FREE
WORKPLACE FORM and submit it with his/her proposal. Failure to complete
this form in every detail and submit it with the bid or proposal may result in
immediate disqualification of the bid or proposal.
D. LOBBYING AND CONFLICT OF INTEREST ETHICS CLAUSE: Any person
submitting a bid or proposal in response to this invitation must execute the
enclosed LOBBYING AND CONFLICT OF INTEREST CLAUSE and submit it
with his/her bid or proposal. Failure to complete this form in every detail and
submit it with the bid or proposal may result in immediate disqualification of the
bid or proposal.
A. Each Proposer shall carefully examine the RFP and other contract documents,
and inform himself/herself thoroughly regarding any and all conditions and
requirements that may in any manner affect cost, progress, or performance of
the work to be performed under the contract. Ignorance on the part of the
Proposer shall in no way relieve him/her of the obligations and responsibilities
assumed under the contract.
B. Should a Proposer find discrepancies or ambiguities in, or omissions from, the
specifications, or should he be in doubt as to their meaning, he shall at once
notify the County.
The Proposer is required to be familiar with and shall be responsible for complying with all
federal, state, and local laws, ordinances, rules, professional license requirements and
regulations that in any manner affect the work. Knowledge of business tax requirements and the
responsibility for paying the tax in Monroe County and municipalities within Monroe County are
the responsibility of the Proposer.
Signature of the Proposer: The Proposer must sign the response forms in the space provided
for the signature. If the Proposer is an individual, the words "doing business as
or "Sole Owner" must appear beneath such signature. In the case of a partnership, the
signature of at least one of the partners must follow the firm name and the words "Member of
the Firm" should be written beneath such signature. If the Proposer is a corporation, the title of
the officer signing the Response on behalf of the corporation must be stated along with the
Corporation Seal Stamp and evidence of his authority to sign the Response must be submitted.
The Proposer shall state in the response the name and address of each person having an
interest in the submitting entity.
Written modification will be accepted from Proposers if addressed to the entity and address
indicated in the Notice of Request for Proposals and received prior to Proposal due date and
time. Modifications must be submitted in a sealed envelope clearly marked on the outside with
the Proposer's name and "Modification to Proposal - Monroe County Proposal for Workers'
Compensation and Risk Management Consulting Services". If sent by mail or by courier,
the above -mentioned envelope shall be enclosed in another envelope addressed to the entity
and address stated in the Notice of Request for Proposals. Faxed or e-mailed modifications
shall be automatically rejected.
The Proposer is solely responsible for all costs of preparing and submitting the response,
regardless of whether a contract award is made by the County.
Responses will be received until the designated time and will be publicly opened. Proposers'
names shall be read aloud at the appointed time and place stated in the Notice of Request for
Proposals. Monroe County's representative authorized to open the responses will decide when
the specified time has arrived and no responses received thereafter will be considered. No
responsibility will be attached to anyone for the premature opening of a response not properly
addressed and identified. Proposers or their authorized agents are invited to be present.
The County reserves the right to reject any and all responses and to waive technical errors and
irregularities as may be deemed best for the interests of the County. Responses that contain
modifications are incomplete, unbalanced, conditional, obscure, or that contain additions not
requested or irregularities of any kind, or that do not comply in every respect with the Instruction
to Proposer and the contract documents, may be rejected at the option of the County.
A. The County reserves the right to award separate contracts for the services based
on geographic area or other, and to waive any informality in any response, or to re -advertise for
all or part of the work contemplated. It is possible that one or more Proposers will be chosen.
B. The County also reserves the right to reject the response of a Proposer who has
previously failed to perform properly or to complete contracts of a similar nature on time.
C. The recommendation of staff shall be presented to the Board of County
Commissioners of Monroe County, Florida, for final selection and award of contract.
D. The County reserves the right to reject all proposals.
041119•34AII1I1 _ 11*61A_1.`[•T X�I�ll a i�ir ►ll 7
The Proposer shall be responsible for all necessary insurance coverage as indicated below.
Certificates of Insurance must be provided to Monroe County within fifteen (15) days after award
of contract, with Monroe County BOCC listed as additional insured as indicated. If the proper
insurance forms are not received within the fifteen (15) day period, the contract may be awarded
to the next selected Proposer. Policies shall be written by companies licensed to do business in
the State of Florida and having an agent for service of process in the State of Florida.
Companies shall have an A.M. Best rating of VI or better and a financial rating of A- from A.M.
to County.
Statutory Limits
Employers' Liability Insurance
Bodily Injury by Accident $100,000
Bodily Injury by Disease, policy limits $500,000
Bodily Injury by Disease, each employee $100,000
General Liability, including
Premises Operation
Products and Completed Operations
Blanket Contractual Liability
Personal Injury Liability
$200,000 per person
$300,000 per occurrence
Vehicle Liability
(Owned, non -owned and hired vehicles) $100,000 Combined Single Limit
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Monroe County shall be named as an Additional Insured on the General Liability policy
and Vehicle Liability Policies.
23. INDEMNIFICATION
The Proposer to whom a contract is awarded shall defend, indemnify and hold harmless the
County as outlined below.
The Proposer covenants and agrees to indemnify, hold harmless and defend Monroe County,
its commissioners, officers, employees, agents and servants from any and all claims for bodily
injury, including death, personal injury, and property damage, including damage to property
owned by Monroe County, and any other losses, damages, and expenses of any kind,
including attorney's fees, court costs and expenses, which arise out of, in connection with, or
by reason of services provided by the Proposer or any of its Subcontractor(s), occasioned by
the negligence, errors, or other wrongful act or omission of the Proposer, its Subcontractor(s),
their officers, employees, servants or agents.
In the event that the service is delayed or suspended as a result of the Vendor's failure to
purchase or maintain the required insurance, the Vendor shall indemnify the County from any
and all increased expenses resulting from such delay.
The first ten dollars ($10.00) of remuneration paid to the Proposer is consideration for the
indemnification provided for above. The extent of liability is in no way limited to, reduced, or
lessened by the insurance requirements contained elsewhere within this agreement.
The Proposer will be required to execute a contract with the County for the services provided for
in this RFP. The Proposer with whom a contract is negotiated shall be required to return to the
County one (1) executed counterpart of the prescribed Contract together with the required
certificates of insurance. A Draft of the contract is attached in Section Two.
If the Proposer cannot fully comply with any terms contained in the draft contract, shown in
Section Two, all deviations to the terms must be spelled out in Tab 5, Other Information.
6-1*01111111911111 1,•
1111 M044muB
MONROE COUNTY
CONTRACT FOR
WORKERS' COMPENSATION AND RISK MANAGEMENT CONSULTING SERVICES
THIS AGREEMENT ("Agreement") is made and entered into this day of
by MONROE COUNTY ("COUNTY'), a political subdivision of the State of
Florida, whose address is 1100 Simonton Street, Key West, Florida 33040 and
("CONTRACTOR"), whose address is
CONTRACTOR shall do, perform and carry out in a professional and proper manner certain
duties as described in the Scope of Services — Exhibit A — which is attached hereto and made a
part of this agreement.
CONTRACTOR shall provide the scope of services in Exhibit A for COUNTY. CONTRACTOR
warrants that it is authorized by law to engage in the performance of the activities herein
described, subject to the terms and conditions set forth in these Agreement documents. The
CONTRACTOR shall at all times exercise independent, professional judgment and shall
assume professional responsibility for the services to be provided. Contractor shall provide
services using the following standards, as a minimum requirement:
A. The CONTRACTOR shall maintain adequate staffing levels to provide the
services required under the Agreement resulting from this RFP process.
B. The personnel shall not be employees of or have any contractual relationship
with the County. To the extent that Contractor uses subcontractors or
independent contractors, this Agreement specifically requires that
subcontractors and independent contractors shall not be an employee of or
have any contractual relationship with County.
C. All personnel engaged in performing services under this Agreement shall be fully
qualified, and, if required, to be authorized or permitted under State and local law
to perform such services.
The CONTRACTOR must warrant that it does not have contractual relationships that
would preclude the firm from being unbiased in the services provided to the County.
The CONTRACTOR must provide a list annually, listing any contractual relationship
between the CONTRACTOR and any persons or business entities that provide services
in the areas of Workers' Compensation and/or Risk Management.
The CONTRACTOR must provide an adequate staff of experienced personnel, capable of
and devoted to the successful accomplishment of work to be performed under any
contract with the County. The CONTRACTOR must assign specific individuals to the key
positions. Once assigned to work under any contract with the County, key personnel
shall not be moved or replaced without prior written notification to the County.
The following persons will provide the services under this Agreement:
Any change to the above listed personnel requires notification to the County, in writing,
within three (3) business days after implementation of the change.
The CONTRACTOR must warrant that it has not employed or retained a
company or person, other than a bona fide employee, contractor or subcontractor,
working in its employ, to solicit or secure a contract with the County and that it has not
paid or agreed to pay any person, company, corporation, individual or firm other than a
bona fide employee, contractor or subcontractor, working in its employ any fee,
commission, percentage, gift or other consideration contingent upon or resulting from the
2ward or making of a contract with the County.
The firm and its employees who are responsible and accountable for the county's
account and subcontractors, if any, must have all necessary current licenses issued by
the Florida Department of Insurance. Proper documentation shall be attached to the
contract.
The CONTRACTOR must warrant that it is not owned or controlled by an insurance
company, insurance sales organization, third party administrator or any consulting firm
which owns or controls any insurance company, insurances sales organization, or third
party administrator.
1 Provide all best available information as to the COUNTY'S requirements forth, --
Scope of Services described in Exhibit A to this Agreement.
4.1 The initial Agreement term (the Initial Term) shall be for three (3) years beginning the
— day of -0 2014 (the effective date), and renewable at the County's option
for two (2) additional consecutive one year terms.
4.2 The terms of this Agreement shall be from the effective date hereof and continue for
a period of three (3) years. This Agreement shall be automatically renewed for successive
one-year terms until either party gives the other notice of cancellation in accordance with the
terms set forth in this Agreement. The CONTRACTOR must provide the Employer at least
ninety (90) days' notice of intent to terminate. The COUNTY must provide the
CONTRACTOR with at least ninety (90) days' notice of intent to terminate.
Compensation to CONTRACTOR shall be $ per year.
limited to carriers, third party administrators • providers. The CONTRACTOR
understands and • that in the event of • • this provision, the Agreement is
I •
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6.1 Payment will be made according to the Florida Local Government Prompt Payment Act
Section 218.70 Florida Statutes. Any request for payment must be in a form satisfactory
to the Clerk of Courts for Monroe County (Clerk). The request must describe in detail
the services performed and the payment amount requested. The CONTRACTOR must
submit invoices to the appropriate offices marked Group Insurance. The respective
office supervisor and the Director of Employee Services, who will review the request,
note his/her approval on the request and forward it to the Clerk for payment.
6.2 Continuation of this Agreement is contingent upon annual appropriation by Monroe
County Board of County Commissioners.
6.3 The compensation listed in Section 5 will be payable in monthly installments. The
CONTRACTOR will submit such invoices monthly for services provided during the
preceding month.
Either party may terminate this Agreement because of the failure of the other party to perform its
obligations under the Agreement. Either party may terminate this Agreement without cause
upon ninety (90) days' notice to the other party in accordance with Section 9 of this Agreement.
The County shall pay CONTRACTOR for all work performed through the date of termination.
A. CONTRACTOR hereby agrees that he has carefully examined the RFP, his response,
and this Agreement and has made a determination that he/she has the personnel,
equipment, and other requirements suitable to perform this work and assumes full
responsibility therefore. The provisions of the Agreement shall control any inconsistent
provisions contained in the specifications. All specifications have been read and
carefully considered by CONTRACTOR, who understands the same and agrees to their
sufficiency for the work to be done. Under no circumstances, conditions, or situations
shall this Agreement be more strongly construed against COUNTY than against
CONTRACTOR.
B. Any ambiguity or uncertainty in the specifications shall be interpreted and construed by
COUNTY, and its decision shall be final and binding upon all parties.
C. The passing, approval, and/or acceptance by COUNTY of any of the services furnished
by CONTRACTOR shall not operate as a waiver by COUNTY of strict compliance with
the terms of this Agreement, and specifications covering the services.
D. CONTRACTOR agrees that County Administrator or his designated representatives may
visit CONTRACTOR'S facility (ies) periodically to conduct random evaluations of
services during CONTRACTOR'S normal business hours.
E. CONTRACTOR has, and shall maintain throughout the term of this Agreement,
appropriate licenses and approvals required to conduct its business, and that it will at all
times conduct its business activities in a reputable manner. Proof of such licenses and
approvals shall be submitted to COUNTY upon request.
Any notice required or permitted under this agreement shall be in writing and hand delivered or
mailed, postage prepaid, to the other party by certified mail, returned receipt requested, to the
following:
To the COUNTY: Risk Management Administrator
1100 Simonton Street, Suite 2-268
Key West, Florida 33040
To the CONTRACTOR:
CONTRACTOR shall maintain all books, records, and documents directly pertinent to
performance under this Agreement in accordance with generally accepted accounting principles
consistently applied. Each party to this Agreement or their authorized representatives shall
have reasonable and timely access to such records of each other party to this Agreement for
public records purposes during the term of the agreement and for four years following the
termination of this Agreement. If an auditor employed by the COUNTY or Clerk determines that
monies paid to CONTRACTOR pursuant to this Agreement were spent for purposes not
authorized by this Agreement, the CONTRACTOR shall repay the monies together with interest
calculated pursuant to Section 55.03 of the Florida Statutes, running from the date the monies
were paid to CONTRACTOR.
Pursuant to Florida Statute 119.0701, Contractor and its subcontractors shall comply with all
public records laws of the State of Florida, specifically to:
(a) Keep and maintain public records that ordinarily and necessarily would be required
by Monroe County in the performance of this Agreement.
(b) Provide the public with access to public records on the same terms and conditions
that Monroe County would provide the records and at a cost that does not exceed
the cost provided in Florida Statutes, Chapter 119 or as otherwise provided by law.
(c) Ensure that public records that are exempt or confidential and exempt from public
records disclosure requirements are not disclosed exempt as authorized by law.
(d) Meet all requirements for retaining public records and transfer, at no cost, to Monroe
County all public records in possession of the contractor upon termination of this
Agreement and destroy any duplicate public records that are exempt or confidential
and exempt from public records disclosure requirements. All records stored
electronically must be provided to Monroe County in a format that is compatible with
the information technology systems of Monroe County.
Section 11. EMPLOYEES SUBJECT TO COUNTY ORDINANCE NOS. 010 AND 020-1990
The CONTRACTOR warrants that it has not employed, retained or otherwise had act on its
behalf any former County officer or employee subject to the prohibition of Section 2 of
Ordinance No. 010-1990 or any County officer or employee in violation of Section 3 of
Ordinance No. 020-1990. For breach or violation of this provision the COUNTY may, in its
discretion, terminate this agreement without liability and may also, in its discretion, deduct from
the agreement or purchase price, or otherwise recover the full amount of any fee, commission,
By signing this agreement, CONTRACTOR represents that the execution of this Agreement will
not violate the Public Entities Crime Act (Section 287.133, Florida Statutes). Violation of this
section shall result in termination of this Agreement and recovery of all monies paid hereto, and
may result in debarment from County's competitive procurement activities.
A person or affiliate who has been placed on the convicted vendor list following a conviction for
public entity crime may not submit a bid on an Agreement with a public entity for the
construction or repair of a public building or public work, may not perform work as a
CONTRACTOR, supplier, subcontractor, or CONTRACTOR under Agreement with any public
entity, and may not transact business with any public entity in excess of the threshold amount
provided in Section 287.017 of the Florida Statutes, for the Category Two for a period of 36
months from the date of being placed on the convicted vendor list.
Section 13. GOVERNING LAW, VENUE, INTERPRETATION, COSTS AND FEES
This Agreement shall be governed by and construed in accordance with the laws of the State of
Florida applicable to Agreements made and to be performed entirely in the State.
In the event that any cause of action or administrative proceeding is instituted for the
enforcement or interpretation of this Agreement, the COUNTY and CONTRACTOR agree that
venue shall lie in the appropriate court or before the appropriate administrative body in Monroe
County, Florida.
Section 14. SEVERABILITY
If any term, covenant, condition or provision of this Agreement (or the application thereof to any
circumstance or person) shall be declared invalid or unenforceable to any extent by a court of
competent jurisdiction, the remaining terms, covenants, conditions and provisions of this
Agreement, shall not be affected thereby; and each remaining term, covenant, condition and
provision of this Agreement shall be valid and shall be enforceable to the fullest extent permitted
by law unless the enforcement of the remaining terms, covenants, conditions and provisions of
this Agreement would prevent the accomplishment of the original intent of this Agreement. The
COUNTY and CONTRACTOR agree to reform the Agreement to replace any stricken provision
with a valid provision that comes as close as possible to the intent of the stricken provision.
The COUNTY and CONTRACTOR agree that in the event any cause of action or administrative
proceeding is initiated or defended by any party relative to the enforcement or interpretation of
this Agreement, the prevailing party shall be entitled to reasonable attorney's fees, and court
costs, as an award against the non -prevailing party. Mediation proceedings initiated and
conducted pursuant to this Agreement shall be in accordance with the Florida Rules of Civil
Procedure and usual and customary procedures required by the Circuit Court of Monroe
County.
Section 16. BINDING EFFECT
The terms, covenants, conditions, and provisions of this Agreement shall bind and inure to the
benefit of the COUNTY and CONTRACTOR and their respective legal representatives,
successors, and assigns.
• � 1
Each party represents and warrants to the other that the execution, delivery and performance of
this Agreement have been duly authorized by all necessary County and corporate action, as
required by law.
Section 18. ADJUDICATION OF DISPUTES OR DISAGREEMENTS
COUNTY and CONTRACTOR agree that all disputes and disagreements shall be attempted to
be resolved by meet and confer sessions between representatives of each of the parties. If the
issue or issues are still not resolved to the satisfaction of the parties, then any party shall have
the right to seek such relief or remedy as may be provided by this Agreement or by Florida law.
This Agreement shall not be subject to arbitration.
Section 19. COOPERATION
In the event any administrative or legal proceeding is instituted against either party relating to
the formation, execution, performance, or breach of this Agreement, COUNTY and
CONTRACTOR agree to participate, to the extent required by the other party, in all
proceedings, hearings, processes, meetings, and other activities related to the substance of this
Agreement or provision of the services under this Agreement. COUNTY and CONTRACTOR
specifically agree that no party to this Agreement shall be required to enter into any arbitration
proceedings related to this Agreement.
Section 20. NONDISCRIMINATION
COUNTY and CONTRACTOR agree that there will be no discrimination against any person,
and it is expressly understood that upon a determination by a court of competent jurisdiction that
discrimination has occurred, this Agreement automatically terminates without any further action
on the part of any party, effective the date of the court order. The parties agree to comply with
all Federal and Florida statutes, and all local ordinances, as applicable, relating to
nondiscrimination. These include but are not limited to: 1) Title VII of the Civil Rights Act of
1964 (PL 88-352) which prohibits discrimination in employment on the basis of race, color,
national origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC ss. 1681-
1683, and 1685-1686), which prohibits discrimination on the basis of sex; 3) Section 504 of the
Rehabilitation Act of 1973, as amended (20 USC s. 794), which prohibits discrimination on the
basis of handicaps: 4) The Age Discrimination Act of 1975, as amended (42 USC ss. 6101-
6107) which prohibits discrimination on the basis of age; 5) The Drug Abuse Office and
Treatment Act of 1972 (PL 29-255), as amended, relating to nondiscrimination on the basis of
drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and
Rehabilitation Act of 1970 (PL 91-616), as amended, relating to nondiscrimination on the basis
of alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, ss. 523 and 527 (42
USC ss. 690dd-3 and 290ee-3) as amended, relating to confidentiality of alcohol and drug
abuse patient records; 8) Title VIII of the Civil Rights Act of 1968 (42 USC ss. 3601 et seq.), as
amended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The
Americans with Disabilities Act of 1990 (42 USC s. 1201), as may be amended from time to
time, relating to nondiscrimination on the basis of disability; 10) Monroe County Code Chapter
13, Article Vl, which prohibits discrimination on the basis of race, color, sex, religion, national
origin, ancestry, sexual orientation, gender identity or expression, familial status or age; and 11)
any other nondiscrimination provisions in any Federal or state statutes which may apply to the
parties to, or the subject matter of, this Agreement.
Section 21. COVENANT OF NO INTEREST
COUNTY and CONTRACTOR covenant that neither presently has any interest, and shall not
acquire any interest, which would conflict in any manner or degree with its performance under
this Agreement, and that only interest of each is to perform and receive benefits as recited in
this Agreement.
Section 22. CODE OF ETHICS
COUNTY agrees that officers and employees of the COUNTY recognize and will be required to
comply with the standards of conduct for public officers and employees as delineated in Section
112.313, Florida Statutes, regarding, but not limited to, solicitation or acceptance of gifts; doing
business with one's agency; unauthorized compensation; misuse of public position, conflicting
employment or contractual relationship; and disclosure or use of certain information.
Section 23. NO SOLICITATION/PAYMENT
The COUNTY and CONTRACTOR warrant that, in respect to itself, it has neither employed nor
retained any company or person, other than a bona fide employee working solely for it, to solicit
or secure this Agreement and that it has not paid or agreed to pay any person, company,
corporation, individual, or firm, other than a bonafide employee working solely for it, any fee,
commission, percentage, gift, or other consideration contingent upon or resulting from the award
or making of this Agreement. For the breach or violation of the provision, the CONTRACTOR
agrees that the COUNTY shall have the right to terminate this Agreement without liability and, at
its discretion, to offset from monies owed, or otherwise recover, the full amount of such fee,
commission, percentage, gift, or consideration.
Section 24. PUBLIC ACCESS
The COUNTY and CONTRACTOR shall allow and permit reasonable access to, and inspection
of, all documents, papers, letters or other materials in its possession or under its control subject
to the provisions of Chapter 119, Florida Statutes, and made or received by the COUNTY and
CONTRACTOR in conjunction with this Agreement; and the COUNTY shall have the right to
unilaterally cancel this Agreement upon violation of this provision by CONTRACTOR.
Section 25. NON -WAIVER OF IMMUNITY
Notwithstanding the provisions of Sec. 768.28, Florida Statutes, the participation of the
COUNTY and the CONTRACTOR in this Agreement and the acquisition of any commercial
liability insurance coverage, self-insurance coverage, or local government liability insurance
pool coverage shall not be deemed a waiver of immunity to the extent of liability coverage, nor
shall any Agreement entered into by the COUNTY be required to contain any provision for
waiver.
All of the privileges and immunities from liability, exemptions from laws, ordinances, and rules
and pensions and relief, disability, workers' compensation, and other benefits which apply to the
activity of officers, agents, or employees of any public agents or employees of the COUNTY,
when performing their respective functions under this Agreement within the territorial limits of
the COUNTY shall apply to the same degree and extent to the performance of such functions
and duties of such officers, agents, volunteers, or employees outside the territorial limits of the
COUNTY.
SectionOBLIGATIONS AND RESPONSIBILITIO
Non -Delegation of Constitutional or Statutory Duties. This Agreement is not intended to, nor
shall it be construed as, relieving any participating entity from any obligation or responsibility
imposed upon the entity by law except to the extent of actual and timely performance thereof by
any participating entity, in which case the performance may be offered in satisfaction of the
obligation or responsibility. Further, this Agreement is not intended to, nor shall it be construed
as, authorizing the delegation of the constitutional or statutory duties of the COUNTY, except to
the extent permitted by the Florida constitution, state statute, and case law.
Section 28. NON -RELIANCE BY NON-PARTIES
No person or entity shall be entitled to rely upon the terms, or any of them, of this Agreement to
enforce or attempt to enforce any third -party claim or entitlement to or benefit of any service or
program contemplated hereunder, and the COUNTY and the CONTRACTOR agree that neither
the COUNTY nor the CONTRACTOR or any agent, officer, or employee of either shall have the
authority to inform, counsel, or otherwise indicate that any particular individual or group of
individuals, entity or entities, have entitlements or benefits under this Agreement separate and
apart, inferior to, or superior to the community in general or for the purposes contemplated in
this Agreement.
CONTRACTOR agrees to execute such documents as the COUNTY may reasonably require,
including, but not being limited to, a Public Entity Crime Statement, an Ethics Statement, and a
Drug -Free Workplace Statement, Lobbying and Conflict of Interest Clause, and Non -Collusion
Agreement.
Section 30. NO PERSONAL LIABILITY
No covenant or agreement contained herein shall be deemed to be a covenant or agreement of
any member, officer, agent or employee of Monroe County in his or her individual capacity, and
no member, officer, agent or employee of Monroe County shall be liable personally on this
Agreement or be subject to any personal liability or accountability by reason of the execution of
this Agreement.
Section 31. EXECUTION IN COUNTERPARTS
This Agreement may be executed in any number of counterparts, each of which shall be
regarded as an original, all of which taken together shall constitute one and the same instrument
and any of the parties hereto may execute this Agreement by signing any such counterpart.
Section 32. SECTION HEADINGS
Section headings have been inserted in this Agreement as a matter of convenience of reference
only, and it is agreed that such section headings are not a part of this Agreement and will not be
used in the interpretation of any provision of this Agreement.
33.1 General Insurance Requirements for Other Contractors and Subcontractors.
As a pre -requisite of the work governed, the CONTRACTOR shall obtain, at his/her own
expense, insurance as specified in any attached schedules, which are made part of this
contract. The CONTRACTOR will ensure that the insurance obtained will extend protection to
all Subcontractors engaged by the CONTRACTOR. As an alternative, the CONTRACTOR may
require all Subcontractors to obtain insurance consistent with the attached schedules; however
CONTRACTOR is solely responsible to ensure that said insurance is obtained and shall submit
proof of insurance to COUNTY. Failure to provide proof of insurance shall be grounds for
termination of this Agreement.
The CONTRACTOR will not be permitted to commence work governed by this contract until
satisfactory evidence of the required insurance has been furnished to the COUNTY as specified
below. Delays in the commencement of work, resulting from the failure of the CONTRACTOR
to provide satisfactory evidence of the required insurance, shall not extend deadlines specified
in this contract and any penalties and failure to perform assessments shall be imposed as if the
work commenced on the specified date and time, except for the CONTRACTOR's failure to
provide satisfactory evidence.
The CONTRACTOR shall maintain the required insurance throughout the entire term of this
contract and any extensions specified in the attached schedules. Failure to comply with this
provision may result in the immediate suspension of all work until the required insurance has
been reinstated or replaced and/or termination of this Agreement and for damages to the
COUNTY. Delays in the completion of work resulting from the failure of the CONTRACTOR to
maintain the required insurance shall not extend deadlines specified in this contract and any
penalties and failure to perform assessments shall be imposed as if the work had not been
suspended, except for the CONTRACTOR's failure to maintain the required insurance.
The CONTRACTOR shall provide, to the COUNTY, as satisfactory evidence of the required
insurance, either:
• Certificate of Insurance
or
• A Certified copy of the actual insurance policy.
The County, at its sole option, has the right to request a certified copy of any or all insurance
policies required by this contract.
All insurance policies must specify that they are not subject to cancellation, non -renewal,
material change, or reduction in coverage unless a minimum of thirty (30) days prior notification
is given to the County by the insurer.
The acceptance and/or approval of the Contractor's insurance shall not be construed as
relieving the Contractor from any liability or obligation assumed under this contract or imposed
by law.
Tim
33.2 General Liability Insurance Requirements For Contract Between County And
Contractor
(Note: amounts of coverage are subject to change in final contract)
Prior to the commencement of work governed by this contract, the CONTRACTOR shall obtain
General Liability Insurance. Coverage shall be maintained throughout the life of the contract
and include, as a minimum:
• Premises Operations
Bodily• ,♦
• Expanded Definition of op D. .•a
The minimum limits acceptable shall be:
If split limits are provided, the minimum limits acceptable shall be:
00 000 per
$300,000 per Occurrence
- - l
An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its
provisions should include coverage for claims filed on or after the effective date of this contract.
In addition, the period for which claims may be reported should extend for a minimum of twelve
(12) months following the acceptance of work by the County.
The Monroe County Board of County Commissioners shall be named as Additional Insured on
all policies issued to satisfy the above requirements.
33.3 Vehicle Liability Insurance requirements
The minimum limits acceptable shall be owner and non -owned and hired vehicles:
$100,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limit is:
$50,000 per Person
$100,000 per Occurrence
$25,000 Property Damage
33.4 Workers' Compensation Insurance Requirements
Prior to commencement of work governed by this contract, the CONTRACTOR shall obtain
Workers' Compensation Insurance with limits sufficient to respond to the applicable state
statutes.
In addition, the CONTRACTOR shall obtain Employers' Liability Insurance with limits of not less
than:
$100,000 Bodily Injury by Disease, each employee
Coverage shall be maintained throughout the entire term of the contract.
Coverage shall be provided by a company or companies authorized to transact business in the
state of Florida.
Recognizing that the work governed by this contract involves the furnishing of advise or services
of a professional nature, the Contractor shall purchase and maintain, throughout the life of the
contract, Professional Liability Insurance which will respond to damages resulting from any
claim arising out of the performance of professional services or any error or omission of the
Contractor arising out of work governed by this contract.
The minimum limits of liability shall be:
$300,000 per occurrence and $500,000 aggregate
Section 34. INDEMNIFICATION
The CONTRACTOR does hereby consent and agree to indemnify and hold harmless the
COUNTY, its Mayor, the Board of County Commissioners, appointed Boards and Commissions,
Officers, and the Employees, and any other agents, individually and collectively, from all fines,
suits, claims, demands, actions, costs, obligations, attorneys fees, or liability of any kind arising
out of the sole negligent actions of the CONTRACTOR or substantial and unnecessary delay
caused by the willful nonperformance of the CONTRACTOR and shall be solely responsible and
answerable for any and all accidents or injuries to persons or property arising out of its
performance of this contract. The amount and type of insurance coverage requirements set
forth hereunder shall in no way be construed as limiting the scope of indemnity set forth in this
paragraph. Further the CONTRACTOR agrees to defend and pay all legal costs attendant to
acts attributable to the sole negligent act of the CONTRACTOR.
At all times and for all purposes hereunder, the CONTRACTOR is an independent contractor
and not an employee of the Board of County Commissioners. No statement contained in this
agreement shall be construed so as to find the CONTRACTOR or any of his/her employees,
contractors, servants or agents to be employees of the Board of County Commissioners for
Monroe County. As an independent contractor the CONTRACTOR shall provide independent,
professional judgment and comply with all federal, state, and local statutes, ordinances, rules
and regulations applicable to the services to be provided.
The CONTRACTOR shall be responsible for the completeness and accuracy of its work, plan,
supporting data, and other documents prepared or compiled under its obligation for this project,
and shall correct at its expense all significant errors or omissions therein which may be
disclosed. The cost of the work necessary to correct those errors attributable to the
CONTRACTOR and any damage incurred by the COUNTY as a result of additional costs
caused by such errors shall be chargeable to the CONTRACTOR. This provision shall not apply
to any maps, official records, contracts, or other data that may be provided by the COUNTY or
other public or semi-public agencies.
The CONTRACTOR agrees that no charges or claims for damages shall be made by it
for any delays or hindrances attributable to the COUNTY during the progress of any
portion of the services specified in this contract. Such delays or hindrances, if any, shall
be compensated for by the COUNTY by an extension of time for a reasonable period for
the CONTRACTOR to complete the work schedule. Such an agreement shall be made
between the parties.
1A WITNESS WHEREOF, the parties hereto have caused these presents to be executed on th(.-
day of 20—.
(SEAL)
-2
2 - .
ATTEST:
By
M
Mayor/Chairman
NEEMM=
EXHIBIT A
SCOPE OF SERVICES
This draft list is not all inclusive and the Proposer shall include in Tab 3 any and all services
which are necessary in order to accomplish the objective as stated in Section One, Number
1, of the Request for Proposals, which is incorporated herein by reference.
The key personnel identified by the Consultant are considered to be essential to the work
performed.
The scope of services may include, but not be limited to, the following.
• The County, the Clerk, the State Auditor General, and agents thereof shall have access
to Contractor's books, records, and documents required by this contract for the purposes
of inspection or audit during normal business hours, at the Contractor's place(s) of
business.
Departmentc/o Purchasing
00 Simonton
GATO BUILDING, ROOM 2-213
1100 SIMONTON STREET
KEY WEST, FLORIDA 0•
1 acknowledge receipt of Addenda No. (s)
. -+
Lobbying• and Conflict of Interest Clause
• Non -Collusion Affildavit
Workplace• Drug Free .,
• Public Entity Crime Statement
• Copy of business
• - ! Office
• Local Preference Form (if applicable) El
In addition, I have included a current copy of the following professional and occupational
If the applicant is not an individual (sole proprietor), please supply the following information:
APPLICANT ORGANIZATION:
(Registered business name must appear exactly as it appears on www.sunbiz.org)
1_=Mq1),30r,M1 11h, T
i-ionaa P-,epart nent of Division of . . • a
We request respondents
• • •I ;` is quote fixedannual fee that encompasses
entire Scope of Services requested in Exhibit A.
Fee for services included in contract: $
peryear
The fee is an all-inclusive cost. No additional costs or fees will be paid-, including but not limited
to travel costs, ms, t2L�Lhone charges, facsimile charges, and postage charges.
Mailing Address:
Signed:
STATE OF:
COUNTY OF:
(Print Name)
(Title)
Subscribed and sworn to (or affirmed) before me on
(date) by
has produced
Telephone:
Fax:
Date:
Witness:
(name of affiant). He/She is personally known to me or
(type of identification) as identification.
NOTARY PUBLIC
My Commission Expires:
0-I r ' 0;r • 1 'I *•rl
*10 1 &f s r
"...warrants that he/it has not employed, retained or otherwise had act on his/her behalf any
former County officer or employee in violation of Section 2 of Ordinance No. 010-1990 or any
County officer or employee in violation of Section 3 of Ordinance No. 010-1990. For breach or
violation of this provision the County may, in its discretion, terminate this Agreement without
liability and may also, in its discretion, deduct from the Agreement or purchase price, or
otherwise recover, the full amount of any fee, commission, percentage, gift, or consideration
paid to the former County officer or employee."
Subscribed and sworn to (or affirmed) before me on
(date) by
personally known to me or has produced
(type of identification) as identification.
(Signature)
(name of affiant). He/She is
My Commission Expires:
1.
of
the city of
I am of the firm of
the bidder making the
Proposal for the project described in the Request for Proposals for
proposal with full authority to do so; and that I executed the said
2. The prices in this bid have been arrived at independently without collusion,
consultation, communication or agreement for the purpose of restricting
competition, as to any matter relating to such prices with any other bidder or with
any competitor;
3. Unless otherwise required by law, the prices which have been quoted in this bid
have not been knowingly disclosed by the bidder and will not knowingly be
disclosed by the bidder prior to bid opening, directly or indirectly, to any other
bidder or to any competitor; and
4. No attempt has been made or will be made by the bidder to induce any other
person, partnership or corporation to submit, or not to submit, a bid for the purpose
of restricting competition; and
5. The statements contained in this affidavit are true and correct, and made with full
knowledge that Monroe County relies upon the truth of the statements contained in
this affidavit in awarding contracts for said project.
(Signature)
r®-
COUNTY OF:
Subscribed and sworn to (or affirmed) before me on
(date) by (name of affiant). He/She is
personally known to me or has produced
(type of identification) as identification.
- -
-
My Commission Expires:
DRUG-FR E WORKPLACE FORM
The undersigned vendor in accordance with Florida Statutes Section 287.087 hereby certifies
that:
(Name of Business)
1. Publishes a statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession, or use of a controlled substance is prohibited in the workplace
and specifying the actions that will be taken against employees for violations of such
prohibition.
2. Informs employees about the dangers of drug abuse in the workplace, the business'
policy of maintaining a drug -free workplace, any available drug counseling, rehabilitation,
and employee assistance programs, and the penalties that may be imposed upon
employees for drug abuse violations.
3. Gives each employee engaged in providing the commodities or contractual services that
are under bid a copy of the statement specified in subsection (1).
4. In the statement specified in subsection (1), notifies the employees that, as a condition
of working on the commodities or contractual services that are under bid, the employee
will abide by the terms of the statement and will notify the employer of any conviction of,
or plea of guilty or nolo contendere to, any violation of Chapter 893 (Florida Statutes) or
of any controlled substance law of the United States or any state, for a violation
occurring in the workplace no later than five (5) days after such conviction.
5. Imposes a sanction on, or require the satisfactory participation in a drug abuse
assistance or rehabilitation program if such is available in the employee's community, or
any employee who is so convicted.
6. Makes a good faith effort to continue to maintain a drug -free workplace through
implementation of this section.
As the person authorized to sign the statement, I certify that this firm complies fully with the
above requirements.
(Signature)
Subscribed and sworn to (or affirmed) before me on (date) by
to me or has produced
(name of affiant). He/She is personally known
(type of identification) as identification.
"A person or affiliate who has been placed on the convicted vendor list following a conviction for
public entity crime may not submit a bid on a contract to provide any goods or services to a
public entity, may not submit a bid on a contract with a public entity for the construction or repair
of a public building or public work, may not submit bids on leases of real property to public
entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or
CONTRACTOR under a contract with any public entity, and may not transact business with any
public entity in excess of the threshold amount provided in Section 287.017, Florida Statutes, for
CATEGORY TWO for a period of 36 months from the date of being placed on the convicted
vendor list."
I have read the above and state that neither (Respondent's name)
nor any Affiliate has been placed on the convicted vendor list within the lasti 36 months.
(Signature)
Date:
Subscribed and sworn to (or affirmed) before me on
(date) by (name of affiant). He/She is personally known to me
or has produced
identification) as identification.
(type of
My Commission Expires:
MONROE COUNTY, FLORIDA
RISK MANAGEMENT
POLICY AND PROCEDURES
Indemnification and Hold Harmless
For
The Contractor covenants and agrees to indemnify and hold harmless Monroe County Board
County Commissioners from any and all claims for bodily injury (including death), person
injury, and property damage (including property owned by Monroe County) and any oth
losses, damages, and expenses (including attorney's fees) which arise out of, in connecti•
with, or by reason of services provided by the Contractor or any of its Subcontractor(s) in a
tier, occasioned by negligence, errors, or other wrongful act of omission of the Contractor or i
Subcontractors in any tier, their employees, or agents.
In the event the completion of the project (to include the work of others) is delayed
suspended as a result of the Contractor's failure to purchase or maintain the required insuranc
the Contractor shall indemnify the County from any and all increased expenses resulting fro
such delay.
The first ten dollars ($10.00) of remuneration paid to the Contractor is for the indemnificatio
provided for above.
The extent of liability is in no way limited to, reduced, or lessened by the insurance requirement
contained elsewhere within this agreement.
• 'KERS' COMPENSATION
REQUIREMENTSINSURANCE
•,
• 'KER'S COMPENSATIONCONSULTING
BETWEEN
MONROE COUNTY,'
L' •
Prior to the commencement of work governed by this contract, the Contractor shall obtain
Workers' Compensation Insurance with limits sufficient to respond to the applicable state
statutes.
In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not less than:
#4 ### , , .
of 1## :.. . • -
Coverage shall be maintained throughout the entire term of the contract.
Coverage shall be provided by a company or companies authorized to transact business in the
Qtate of Florida.
If the Contractor has been approved by the Florida's Department of Labor as an authorized self -
insurer, the County shall recognize and honor the Contractor's status. The Contractor may be
required to submit a Letter of Authorization issued by the Department of Labor and a Certificate
of Insurance, providing details on the Contractor's Excess Insurance Program.
If the Contractor participates in a self-insurance fund, a Certificate of Insurance will be required.
In addition, the Contractor may be required to submit updated financial statements from the fund
upon request from the County.
GENERAL LIABILITY
INSURANCE REQUIREMENTS
FOR
BETWEEN
MONROE COUNTY, FLORIDA
AND
Prior to the commencement of work governed by this contract, the Contractor shall obtain
General Liability Insurance. Coverage shall be maintained throughout the life of the contract and
include, as a minimum:
• Premises Operations
• Products and Completed Operations
• Blanket Contractual Liability
• Personal Injury Liability
• Professional Liability
• Expanded Definition of Property Damage
The minimum limits acceptable shall be:
If split limits are provided, the minimum limits acceptable shall be:
$ 200,000 per Person
$ 300000 per Occurrence
$200,000 Property Damage
An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its
provisions should include coverage for claims filed on or after the effective date of this contract.
In addition, the period for which claims may be reported should extend for a minimum of twelve
(12) months following the acceptance of work by the County.
The Monroe County Board of County Commissioners shall be named as Additional Insured on
all policies issued to satisfy the above requirements.
MONROE COUNTY, FLORIDA
RISK MANAGEMENT
POLICY AND PROCEDURES
CONTRACT ADMINISTRATION MANUAL
There will be times when it will be necessary, or in the best interest of the County, to deviate
from the standard insurance requirements specified within this manual. Recognizing this
potential and acting on the advice of the County Attorney, the Board of County Commissioners
has granted authorization to Risk Management to waive and modify various insurance
provisions.
Specifically excluded from this authorization is the right to waive:
• The County as being named as an Additional Insured — If a letter from the Insurance
Company (not the Agent) is presented, stating that they are unable or unwilling to name
the County as an Additional Insured, Risk Management has not been granted the
authority to waive this provision.
Uri
0 The Indemnification and Hold Harmless provisions
Waiver of insurance Provisions could expose..the Counly to economic loss. For this reason,
every attempt should be made to obtain the standard insurance requirements. If a waiver or a
modification is desired, a Request for Waiver of Insurance Requirement form should be
completed and submitted for consideration with the proposal.
After consideration by Risk Management and if approved, the form will be returned, to the
County Attorney who will submit the Waiver with the other contract documents for execution by
the Clerk of the Courts.
Should Risk Management deny this Waiver Request, the other party may file an appeal with the
County Administrator or the Board of County Commissioners, who retains the final decision -
making authority.
VEHICLE LIABILITY
'NSURANCE REQUIREMENT%-*i,
FOR CONTRACT BETWEEN
MONROE COUNTY, FLORIDA
AND
l
0 - iwim•MWOM 0
0111FILFUCtur, prior io ine commencement OT wom, snail obtain Vehicle Liability Insurance.
Coverage shall be maintained throughout the life of the contract and include, as v
minimum, liability coverage for:
.............................................
If split limits are provided, the minimum limits acceptable shall be:
Ir i, y1 i *I R i
Recognizing that the work governed by this contract involves the furnishing of advice or
services of a professional nature, the Contractor, shall purchase and maintain,
throughout the life of the contract, Professional Liability Insurance which will respond to
damages resulting from any claim arising out of the performance of professional
services or any error or omission of the Contractor arising out of work governed by this
contract.
The minimum limits of liability shall be:
MONROE COUNTY, FLORIDA
RISK MANAGEMENT
POLICY AND PROCEDURES
CONTRACT ADMINISTRATION MANUA]
There will be times when it will be necessary, or in the best interest of the County, to
deviate from the standard insurance requirements specified within this manual.
Recognizing this potential and acting on the advice of the County Attorney, the Board of
County Commissioners has granted authorization to Risk Management to waive and
modify various insurance provisions.
Specifically excluded from this authorization is the right to waive:
The County as being named as an Additional Insured — If a letter from the
Insurance Company (not the Agent) is presented, stating that they are unable or
unwilling to name the County as an Additional Insured, Risk Management has
not been granted the authority to waive this provision.
M-7
Indemnification and Hold Harmless provisions
Vaivinq of insurance Provisions could exDose the County to economic loss. For thil-,
reason, every attempt should be made to obtain the standard insurance requirements.
If a waiver or a modification is desired, a Request for Waiver of Insurance
Requirement form should be completed and submitted for consideration with the
proposal.
After consideration by Risk Management and if approved, the form will be returned, to
the County Attorney who will submit the Waiver with the other contract documents for
execution by the Clerk of the Courts.
Should Risk Management deny this Waiver Request, the other party may file an appeal
with the County Administrator or the Board of County Commissioners, who retains thi,
final decision -making authority.
Request For Waiver
of
Vo'&ILQLT -rf e g
It is requested that the insurance requirements, as specified in the County's Schedule of
Insurance Requirements, be waived or modified on the following contract:
Contractor:
Contract for:
Address of Contractor:
Phone:
Scope of Work:
Reason for Waiver:
Policies Waiver
will apply to:
Signature of Contractor:
Approved Not Approved
Risk Management:
Date:
County Administrator appeal:
Approved Not Approved
Date:
Board of County Commissioners appeal:
Approved Not Approved
Meeting Date:
BIDDER SIGNATURE
• Compensation Statutory
Employer's• 1 1 1 1 1 Bodilyby
500,000 Bodily Inj. by Disease, policy
100,000 • • by Disease,p .
Liability,General • •300,000 Combined Single Limit
Premises Operation
ContractualProducts and Completed Operations
Blanket
Personal Liability
nxpanded Definition of Property Damage
Vehicle Liability
Professional
1 0
per P- •
11 11•
per Occurrence
$25,000
Property Damage
10111
Combined Single Limil
11 1It per Occurrence and
$500,000 Aggregate
The Monroe County Board of County Commissioners shall be named as Additional
insured on general liability and vehicle liability policies.
uug��= 3
A. Vendors claiming a local preference according to Ordinance 023-2009 must complete this form.
Name of Bidder/Responder Date:
I. Does the vendor have a valid receipt for the business tax paid to the Monroe County Tax Collector dated at
least one year prior to the notice or request for bid or proposal? _ (Please furnish copy. )
2. Does the vendor have a physical business address located within Monroe County from which the vendor
operates or performs business on a day to day basis that is a substantial component of the goods or services
being offered to Monroe County?
List Address:
Telephone Number:
B. Does the vendor/prime contractor intend to subcontract 50% or more of the goods, services or construction
to local businesses meeting the criteria above as to licensing and location?
If yes, please provide:
1. Copy of Receipt of the business tax paid to the Monroe County Tax Collector by the subcontractor dated at
least one year prior to the notice or request for bid or proposal.
2. Subcontractor Address within Monroe County from which the subcontractor operates:
Signature and Title of Authorized Signatory for
Bidder/Responder
STATE OF:
Subscribed and sworn to (or affirmed) before me on
(date) by
has produced
identification.
Tel. Number
Print Name:
name of affiant). He/She is personally known to me or
(type of identification) as
NOTARY PUBLIC
My Commission Expires:
EXHIBIT B
Organization Name:
Primary Contact/Representative:
Title:
Address:
City, State, Zip Code:
Telephone Number:
Fax Number:
E-mail Address:
1 - Does the firm have any contractual relationships that would preclude the
firm from being unbiased in the services provided to the County?
2. Is the firm an insurance company, insurance agency, insurance broker,
third party administrator, or employee of any of the foregoing?
a. If yes, are you a consultant? If you are a consultant, do you accept
fees or commissions?
b. If yes, are you a broker? If you are a broker, do you accept fees or
commissions?
3. Is the firm owned or controlled by an insurance company, insurance
sales organization, third party administrator or any consulting firm which
owns or controls any insurance company, insurance sales organization,
or third party administrator?
4. Please provide a list of any contractual relationships between the firm
and any persons or business entities that provide services in the areas of
workers' compensation and/or risk management.
5. If the County changes from the current consultant as a result of this RFP the
successful firm will need to have a transition plan. Please describe your
transition plan.
6. Describe your client service approach and how you respond to client
requests. Include what you consider non-urgent/routing requests and
urgent requests.
7. If required, would you attend the Board of County Commissioner
meetings to provide any recommendations and supporting documentation
for approval?
If yes, how much notice will you require in order to attend the meeting?
8. Detail the ability of the firm to monitor regulatory and legislative
developments at both the State and Federal level and how this will be
communicated to the County.
1.1. How do you measure client satisfaction?
10. Provide any supplemental information, which was not provided in Tab 5
your proposal, that you consider relevant or beneficial. I
The Representative stated below is the authorized agent of the Proposer and is authorized
to bind the company upon acceptance by the County. Deviations from the requested
program have been stated. Coverage(s) or services will be issued as proposed.
Authorized Representative Print Name Finn Telephone Date
Authorized Representative Signature
Policy Period Annual Premium
• Workers' Compensation Excess — PGIT
10/1/13—10/1/14
$401,366.00 yr
• Workers' Compensation Third Party
10/1/12—10/1/15
$70,918.00 yr
Administrator —Ascension Benefits
Insurance Solutions
• Workers' Compensation AD&D for Police
Officers & Firefighters (including Volunteers) -
10/1/12—10/1/14
$5,982.00 yr
Hartford
• Airport Liability —Arthur J. Gallagher
7/27/13 — 7/27/14
$32,149 yr
• Airport Public Officials — Darwin
7/27/13 — 7/27/14
$8,479 yr
• Bayshore Manor Assisted Living Facility —
4/30/13 — 4/30/14
$18,476 yr
Arthur J. Gallagher
• Crime Policy —Travelers
10/1/13—10/1/14
$4,556 yr
• Florida Municipal Insurance Trust — FLOC
10/1/13 — 9/30/14
$217,933 yr
• Leased Vehicles Policy — Porter Allen
9/18/13 — 9/18/14
$17,566 yr
• Pollution Liability Policy — Marsh USA
511111— 5/1/14
$72,334 3 yrs
• Professional Liability Policy— Marsh USA 4/26/13 — 4/26/14 $20,000 yr
• Property Policy— Marsh USA 5/1/13 — 5/1/14 $793,853 yr
• Portable Equipment Policy - VFIS 10/1/13 — 9/30/14 $1,631 yr
• Weatherization Policy — Lloyds of London 4/22/13 — 4/22/14 $17,035.95 yr
• Windstorm Policy— Citizens 5/29/13 — 5/29/14 $344,715
4/7/14 — 4/7/15 $9,146
Flood Insurance P.annual
MONROE COUNTY, FLORIDA
COMBINING STATEMENT OF NET ASSETS
INTERNAL SERVICE FUNDS
SEPTEMBER 30, 2012
ASSETS
Current Assets:
Cash and Cash Equivalents
Investments
Accounts Receivable, Net
Due from Other Funds
Due from Other Govemmentai Units
Interest Receivable
Total current assets
Worker's Group Risk
Compensation Insurance Management
Fund Fund Fund
$ 859,542 $ 2,954,052 $ 1,154,812
4,600,194
10,737,340
5,865,345
-
3,484
4,614
28,081
168,431
-
4,487
36,900
-
14,978
35,760
19,510
5,407,282
13,935,907
7,044,281
Noncurrent Assets:
Land and Other Nondepreciable Assets - - -
Capital Assets, Net of Accum. Depreciation - 643 15.172
Total Noncurrent Assets - 643 15,172
Total Assets
LIABILITIES
Current Liabilities:
Accounts Payable
Accrued Wages and Benefits Payable
Claims and Judgements Payable
Due to Other Funds
Due to Other Governmental Units
Accrued Comp. Absences Payable
Total Current Liabilities
Noncurrent Liabilities:
Accrued Comp. Absences Payable
OPEB Liability
Total Noncurrent Liabilities
Total Liabilities
NET ASSETS
Invested in Capital Assets, Net of Related Debt
Unrestricted
Total Net Assets
5,407,282 13,936,610 7.059.453
38,787
1.043,387
36,357
9,297
8,291
8,724
1,812,039
1,016,833
172,970
3,004
1,190
677
8,890
1,819
578
1,632
1,873,836
2,070,279
220,380
28,433 24,049 22,567
113,570 531704 115,626
142,003 77,753 138,193
2,015,839 2,14T 8�2 358,553
- 643 15,172
3,391,443 11,787,935 6,685,728
$ 3,391,443 $ 11,788,578 $ 6,700,900
G-81
MONROE COUNTY, FLORIDA
COMBINING STATEMENT OF REVENUES, EXPENSES AND
CHANGES IN FUND NET ASSETS
INTERNAL SERVICE FUNDS
FOR THE YEAR ENDED SEPTEMBER 30, 2012
Worker's Group
Risk
Compensation Insurance
Management
Operating Revenues: Fund Fund
Fund
Charges for Services $ 2,529,491 $ 13,823,209
$ 2,735,469
Miscellaneous 6,713 50,000
67,210
Total operating revenues 2,536,204 13,873,.209
2,802,679
Operating Expenses:
Personnel Services
234,833
215,573
223,054
Operations
Depreciation and Amortization
335,031
1,611,486
1,736,445
Asserted and Paid Claims
_
2,017,917
214
10,370,993
2,075
269.,162
Total operating expenses
2,587,781
12,188,266
2,230,736
Operating Income/Loss
(51,577)
1,074,943
571,943
Non -Operating Revenues/(Expenses):
Investment Income
15,993
54,314
34,170
Insurance Recoveries
351,616
482,554
790,216
Gain (Loss) on Disposition of Assets
-
-
Totai Non -Operating Revenues/(Expenses)
367,609
536,868
824,446
Income/Loss Before Transfers
316,032
2,211,81.1
1,396,389
Transfers to Other Funds
(57,190)
_ (76,101)
(810,593)
Change in Net Assets
258,842
2,135,710
585,796
Total Net Assets -October 1
3,132,$01
9.652.868
6.115.104
Total Net Assets-September30
$ 3,391,443
$ 11,788.578
$ 6,700,900
(Continued)
G-83
• •FLORIDA
• ., •
I.
INTERNAL SERVICE FUNDS I
e ,
kh-
Operating Activitles:
Cash received for services
Cash rec'vd from other funds for goods and secs
Cash received from Insurance recoveries
Cash payments to suppliers for goods and svcs
Cash payments for employee services
Cash payments to other funds
Cash payments for claims
Other operating revenue
Net Cash Provided by/(Used in)
Operating Activities
Noncapital Financing Activities:
Transfers to other funds
Capital and Related Financing Activities:
Acquisition of capital assets
Investing Activities -
Investment income
Proceeds from sales and maturities of investments
Purchase of investment securities
Net Cash Provided/(Used) in Investing Activities
Net Increase/(Decrease) In Cash and
Cash Equivalents
Cash and Cash Equivalents:
October 1
September 30
Worker's Group Risk
Compensation Insurance Management
Fund Fund Fund
$ 116.939
$ 3,676,707
$ 33,245
2,405,768
10,133,040
2,700,377
351,616
489,417
786,696
(399,469)
(862,528)
(1,853,454)
(88,998)
(136,856)
(83,431)
(25,603)
(1,472
)
(1,918,485)
(13,935,702)
(208,785)
6,713
50,000
67,210
448,481
(607,389)
11418,683
(67,190) _ (76,101) (810,593)
(16,958)
76,755
217,550
111,191
2,861,482
8,741,797
3,651,983
(3,085.010)
_ (7,858,637)
(4,000,692)
(146,773)
_ 1,100,710
(237,518)
G-85
244,518 417,220 351,614
615,024 2.536,832 803,198
$ 859,542 $ 2,954,052 $ 1,154,812
(Continued)
MONROE COUNTY,FLORIDA
FUNDSINTERNAL SERVICE
FOR 30,2012
Reconciliation of operating Incomel(loss)
to net cash provided by/(used In)
operating activities:
Operating income/(loss)
Adjustments to reconcile operating income/(loss)
to net cash provided by/(used in) operating
activities:
Depreciation and Amortization
Nonoperating Income -Insurance Recoveries
Change in assets and liabilities:
(Increase)/Decrease in Accounts receivable
(Increase)/Decrease In Due froth other funds
(Increase)/Decrease in Due from other gov t units
((ncrease)/Decrease in Due fm constitutional ofca
Increase/(Decrease) in Accounts payable
Increase/(Decrease) in Accrued wages/benefits
Increase/(Decrease) in Ciaimsfjudgments payable
Increase/(Decrease) in Due to other funds
Increase/(Decrease) in Due to other gov9 units
Increase/(Decrease) in Due to constitutional ofcrs
Increase/(Decrease) in Comp. absences payable
Increasel(Decrease) in OPEB liability
Total adjustments
Net cash provided by/(used in)
operating activities
Noncash Investing, capital, and financing activities:
Gain (Loss) on disposition of assets
Change in fair value of investments
Cash Reconciliation:
Unrestricted
Worker's Group Risk
Compensation Insurance Management
Fund Fund Fund
$ (51,577) $ 1,674,943 $ 571,943
-
214
2,075
351,616
482,554
790,270
-
6,863
(3,580)
-
(25,576)
_
(1,189)
12,374
-
(8,161)
(260)
_
(428)
791,206
(55,346)
(303)
(1,814)
76
99,432
(3,584,709)
60,377
438
11190
677
2,341
2,566 -
(1,847)
1,819 578
1,632
51,927 15,048
50,400
500,058 (2,282,332)
844,740
$ 448,481 $ (607,389) $ 1,416,683
$�859,542 $ 2,954,052 $ 1,154.812
G-87
(Continued)
Monroe County Board Of County Commissioners
All Claims as of 4111201412:00:00 AM
2011
Claim
Outstanding
Claim
Division Name LOB Claim Number
T
Event Date
Reserves
Total Paid to Date
Total incurred
Status
Accident Description
Monroe County Board Of County
Exposure,
Exposure, face, eye and mouth: While giving out medication with the nurse In unit
In Key Westjail an inmate threw a liquid into my face through the crack of
Commissioners WC WCO222011106181
M
10/42011
$0.00
$178.00
$178.00
C
his door.
Back: The dmnt tripped and fell on the rug by the elevator.
WCO222011106297
M
1011IM011
$0.00
$702.12
$702.12
C
Bads (Spine): The cmnt was IIPong a hydraulic spreader from the gmund to tadder
tuck 9 rear compartment when he suddenly felt a sharp pain through his ardire
WCO22201110Gi25
L7
90/142019
$0.00
$4,609.66
$4,601.66
C
Spinal cord.
Bads (ter): looking for a file In boxes, the 1 W picked up a box, lost grip and
lwlsted out of her hands and felt a slight pull In her bark.
WCO222011106725
M
90212011
$0.00
$7,493.39
$7,493.39
C
Neck: while working on the night of 1028111, the 1 W scratched the right side of her
neck By the time she left work, the area was red and Inflamed. The area continued
WCO222011106576
M
10Y18/2011
$0.00
$0.00
$0.00
C
to get redder and by 10130/11 It was a hard abscess.
Knees: the I W twisted both knees when weadlrg on steep slopes. He mis-stepped.
WCO222MI106409
M
11/1/2011
$0.00
$4.42720
$4.427.20
C
Shudder, Arm (upper), Elbow. Forearm (LT): the I W got irejmed while taking a 300
pow and tallar than him resisting subject during a training exercise In arms class.
WCO222011106487
BLT
11112o19
$948.75
$29,993.75
$30 94250
O
Legs (upper, buttock area): multiple abscesses on upper leg and bullock area. No
other health problems that would cause ahsecesses. The RN was out of work for a
WCO22201110657T
M
11/62011
$0.00
$0.00
$0.00
C
week with one abscess and have had to have them lanced and packed -multiple
Knee ": the IW responded to a domestic disturbance In progress, and he was bit
by their family dog.
WCO222091907720
M
11/132011
$0.00
$768.46
S768.46
C
Head, Neck, Chest, Shoulder (RT), Arm (RT): the FVV slipped on the staircase and
fell approximately 5.6 steps.
WCO222011106446
LT
19/142091
$79,900.58
$152,709.42
$232,610.00
O
Ankle (RT): the I W went to County Yard to have a vehicle checked. As he walked
around comer, his right That slid Into a pal Pole and rolled his right ankle.
WCO222011106476
M
91/962011
$0.00
$221.97
$221.97
C
Arm (LT): by tree, wasp stung the 1 Ws left arts.
WCO222011106491
M
11/21/2011
$0.00
$154.32
$154.32
C
Calf (RT): the lVV was attempting to make contact with Michael Haggerty In
reference to a neighbor dispute. The gate was open and without going In yard, she
WCO222011106608
M
112WO11
$0.00
$990.82
$990.82
C
yelled and knock when Mr. Haggedys white dog bite her on the right lower leg. Dog
Back (tower): the IW was taking the stretcher out of the track Ater to stretcher
was set, he made a wrong gesture and had real bad beck pain.
WCO222071106578
LT
12/42011
$9,510.46
$50,494.54
$60,090.00
O
Exposure, Arm (RT): the I W arrived on scene and was directed to back hallway
were Dep. Boyden and a nurse were on the floor with a white female. There was
WCO222011106768
M
12/42011
$0.00
$1281.78
$1,281.78
C
blood on the floor and on the female. He put on rubber gloves In to hold of the
Knee (RT): the 1W was vacuuming and right knee gave out
WCO222011106592
LT
110512011
$6,269.77
$36,977.64
$43.247.41
R
Hand (RT), Ankle (LT): the IW fell while climbing over a fence during an
investigation resulting in a small cut on his right hand and sprained left ankle.
02220
WC11906609
LT
12152011
$0.o0
$6,731.04
$6,T31.04
C
the IW tripped and fall on the hall way.
WCQ222011106659
M
12JI412011
$0.W
$,045.11
$2,045.11
C
While securing subject In handcuffs, subject suddenly spun around and punched
WCO222011106695
M
12JI612011
$0.00
$1,28320
31=20
C
him on the chin. Struggle ensued. He sustained a bnulsed Jew and a contusion to
the left knee.
Bads (lower): after weeding, the IW stepped up over 18" wall and experienced
WCO222091906726
M
12/22f2019
$0.00
$6,761.96
$6,761.16
C
shooting pain in lower bads
Foot/Arkle (RT): an police motorcycle from stationary position, the IW entered
WCO222011106746
LT
12/3012011
$0.00
highway. As he turned on highway (to catch violator) the beck tire Mt lase gravel
$5,566.92
$5,566.92
C
and the motorcycle stid sideway, His right foot come eft the pegs and got ought
Lungs: Test positive for TB/Annual Physical.
WCO222012107048
M
1/3P1012
$0.00
$10.00
$10.00
C
Few. Chin, Neck open wound an chin due m scratch with fingenhalls, while
WCO222012106888
M
1/52012
moving an Inmate from the call. The Inmate lunged toward & scratched the neck
$0.00
$1,52623
$1,52623
C
and face area of the IW.
Finger (RT, mule): white on a watch order in an abandoned building, the IW lost
WCO222012106863
LT
1/152012
$87925
his footing and attempted to catch himself with his right herd. In the process, his
$30,250.75
$31.130.00
R
right middle finger bent backward.
Shoulder (LT): while striking pin with sledge hammer, the IW felt something tear or
WCO222012107006
BLT
1/19/2012
$0.00
$61,919.01
$61,919.01
C
move In left shoulder.
Badc tine IW was under porch at lighthouse running pipe for bladder tank, and
WCO222012906959
M
112412012
$0.00
$325.48
$325.48
C
something bit his back.
Hand (RT), Eyebrow (RT): Inmate became aggressive after being informed to turn
WCO2220121069M
M
1/2512012
$0.00
around and cuff up. He hit the IW tow times to face with open palm, striking and
$26200
$26200
C
scratching the IW with nails.
Shoulder (LT): closing large door over head on the fire prop.
WCO222012107332
BLT
112712012
$0,00
$63,833.16
$63,833.16
C
Eye (LT): Me IW was chipping up brush and something blew under safety glasses
WCO222012907004
M
1/31/2012
$0.00$222.06
3222g6
C
Into his left eye.
Feet Arms, Eye (LT): while ground fighting, the mat grabbed the We toes. Poked
WCO222012107107
M
2/10/2092
$0.00
$866.50
$866.50
C
In the left eye and bruising on both arms.
Nedk the IW stopped for a red light and the next Oft he know, he was hit from
WCO222012107163
M
2/1912012
$0.00
$3,42222
$3,42222
C
behind.
Balk pulling out coconut has with badchoe, the bee swung around and the IW
WCO222012707245
M
2/29/2012
$0.00
$5,679.69
$5,671.69
C
caught It twisting his back
Wrist (LT): the IW was weed wacdng and rack hit left wriat
WCO222012107239
M
21282012
$0.00
$325.99
$W5.99
C
Eye (RT): while operating buzz bar, debris blew In the I Ws right eye.
WCO222012107264
M
3/52012
$0.00
$1,215.49
$1,215.49
C
Exposure: an Inmate was sent to hospital. While there, he vomited Mood, and
02220
WC12907344
M
31102092
$0.00
$1,893.94
$9,893.14
C
began to throw IL the IW went to restrain him, he than threw the vomit at him.
Arms: while attempting to place Innate IM in restraint chair, the inmate scratched
WCO222012107357
M
3/14/2c)92
$0.00
$889.00
$889.00
C
both of IWs arms cawing bleeding.
Eye (RT): placing inmate Eaves In restraint chair, she started spitting on spit In the
WCO2220121073a5
M
W14/2092
$0.00
s999.41
s999.41
c
We eye.
Forearm: during simulation training, the IW received an open wood to her right
WCO222012107599
M
WW12012
fare=. After which she handled training equipment that had previously been
$0.00
$0.00
$0.00
C
handled by several people.
Toes (LT): opened door and bottom of door hit the I Ws toes on left foot Cuttng
WCO222092107345
M
3119/2092
$0.00
$2,598.79
$2,598.79
C
them and felt like toe nails hem back.
Knee (LT): reln)ury of left knee. the IW stood suddenly, and felt pain, grinding In left
WCO222012907501
M
4/112092
$0.00
$0,00
$0,gg
C
knee.
Bads: the IW strained back when making a residents bed.
WCO222012107504
M 4/4I2092
$0.00
$1,841.12
$1,841.12
C
Shoulder (RT): lifting park bench, the I Ws shoulder popped.
WCO222012107536
BLT 4/9=12
$0.00
$53,582.66
$53.582..66
C
Back (lower): wheeling patient on stretcher, the uncooperative patent tried to get
off stretcherwhile movi g. the IW twisted his bed* after stabilizing stretcher.
WCO222012107543
M 4/99/2012
$0.00
$432.74
$432.74
C
Side (RT): the IW went to answer phone on the left of her chair. She put right arm
across body and lifted phone. Immediate pain on right side.
WCO222012107619
M 4/19/2012
$0.00
$273.00
$273.00
C
Berk (lower): the IW was palming toll booth pleas. While moving 5 gallon paint pet
and >4>ayin8 point with bnghar died roller, he Injured Its lower beck.
WCO222012107632
M 4/2M12
$0.00
$737.36
S737.36
C
Back (lover): removing weeds by hard and shovel, the IW felt a very painful pinch
In beck.
WCO222012107687
BLT 4P1TJ2012
$0.00
$9.035.47
$9,035.47
C
Wrist (LT): the IW started to exhibit symptoms of carpel tunnel. She started to Feel
a sharp pain In right wrist As the day went on, the pain progressively got worse.
WCO222012107695
M 4/25f2012
$0.00
$1,628.67
$1.628.67
C
Her right tomb, pointer and middle fingers started to feel swollen and there was a
Back: changing vacuum bag, the IW leaned back and back stared huNng.
WCOMD12107694
M 5/MO12
$0.00
$349.81
$349.81
C
Heel (RT): the IW stepped off tanker 9 and bruised right heel.
WCO222012107708
M 5/1/2012
$0.00
$0.00
$0.00
C
Fool (LT): outside banter door at the Marathon Govt Center, the IW gouged foot
She was tryng to hold It open to let a cart get trough
WCO222O12107776
M 5t1/2012
$O.OD
$399.gg
$399.00
C
Arta, Finger (RT): the IW suspects possible muse as work related due to nature of
work as
WCO222012115840
M 5f6/2092
$0.00
$1,285.73
$1,295.73
C
ofyearstrarslhstorluringthecompWerstrenhhousiydungBhtworkdayfornumber
Heel (RTj: the IW did root sea a small section of base grave In the parking lot He
attempted
bmom the motorcycle around and the rear lire slid ham under him.
WCO222012107T75
M 5IBf2092
$0.00
$941.64
$941.64
C
must the
rig motorcycle to fat. No visible damage was noted on the motorcycle.
Wrist (RT): the deal of the I Ws right bike shoe was dipped into the bike pedal.
While pushing off on the pavement with her left foot to gain momentum, her deal
WCO222012107777
M 5111/2012
($0.00)
$999.90
$999.90
C
slipped an the pavement. She fell to the right and was unable to undippad her right
Arm (LT, upper): the IW took wrong step of rain truck while Tubing vehicle. He hurl
arm trying to stop fail.
WCO222012707804
M 5/11/2092
$0.00
$1,129.94
$1,129.94
C
Ankle (RT): while conducting a seauify round, the IW missed a step coming doom
the stairs and fell, twisting snide.
WCO222012107817
LT 5112/2092
$0.00
$5,717.05
$5,797.05
C
Wrist Hip (LT): after washing N911 FK the IW was standing on the right side back
compartment deck, she was stepping down and missed the right main lardlg gear
WCO222012115841
BLT 5/26/2012
$0.00
$9,416.43
$9.416.43
C
fire and fell backward twisting an to her left side.
Injured back, while working a detail at Higgs beach for the Reggae Conceit I took
a person down to the ground, refernoe to a non -compliant subject. My beck has a
WCO222012115084
BLT 5/26/2012
$0.00
$9,014.19
$9,014.19
C
small lump on my T-7fr-8 and I am In pain.
Fingers, Knee, Shoulder (RT): trying to get out of the way of a backing vehicle, the
IW tripped on orb.
WCO222012915984
BLT 5f2612092
$0.00
$6,792.03
$6,792.03
C
Forearm (RT): working unit B-1, the IW had traveled around the unit to observe the
Inmates. While on the top tier, she leaned on the railing, going up and down the
WCO222012116174
M 6=012
$0.00
$10.00
$10.00
C
stairs she used the hand rail. On Mon 614, she observed a rash forming on her
Thumb, Hand, Arm )LT): suspect possible muse as work related due to nature of
work as a using the computer strenuously during 8 hour work day for
WCO222012115968
M 614/2012
$0.00
$1,249.40
$1,249.40
C
numberof yeareletor,
Testicle: while moving patient on stretcher over loose gravel nods. Loading Into
stretcher, the IW herniated right testicle. At time of accidem, he thought just polled
WCO222012115953
LT 6/11/2012
$0.00
$13.674.15
$13,674.15
C
e min muscle, but g pain Intensified dung the day and sough medical attention.
Sinn (RT): during group ride, the i Ws front fire hit the rear lire of the rider In from of
her. She lost balance and fail to the ground The bike landed on her right shin.
WCO222012177573
M 6015n2092
$0.00
$88.93
$88.93
C
Shoulder (LT): the IW was moving ballot boxes around, when he went at dose a
drawer and his shoulder just made a snapping noise.
WCO222012116032
M 6/19/2012
$0.00
$217.17
$217.17
C
Heart high stress environment caused heart dysfunction.
WCO222012117120
M
6=012
$0.00
$0.00
$0.00
C
Face: while performing dales on card sound ROW, the IW was bitten on face by
WCO222012116072
M
7/2/2092
S0.00
5354.70
5354.70
C
moshtultoes.
Tailbone, Bark (Lower): The IW fell backwards after being pushed to the ground by
WCO242012116135
M
7/312012
�
$0.00
$218.09
$216.01
C
another person.
Shoulder (LT): the IW Injured her left shoulder while gPong and moving mall totes
WC0M012116396
BLT
7/11/2012
$15.547.11
$W.772.67
552,619.78
0
filled with absentee ballots that they were delivering to the post office for
processing.
Exposure: the IW has been exposed to all shower areas withing MCDC that had
WCO222012916982
M
7193/2012
$0.00
$10.00
510.00
C
maid.
Foot (LT): the IW stepped up on a step and felt a sharp pain In left foot
WCO222012116172
LT
7116/2012
$0.00
$8,486.22
$6,486M
C
Deputy Valdes was handling a residential alarm call for service. Deputy Valdes
WC0M012116209
LT
7/1912012
$0.00
$14,489.88
$14,409.88
C
stepped on a loose brick paver causing him to Most his left knee and ankle while
walking around the eight side of the house. He stated that he felt its knee pap and
Leg (LT): the IW woke up 7/19/92In room 205 of the La ®ulnta Inn In WPB with
WCO222012197260
M
7/19/2092
50.00
$189.11
$189.99
C
numerous bed bug bites.
Thumb (LT): cuffing grass and wasp stung the IW.
WCO22.2012116251
M
7/2N2012
$0.00
$492.08
i492.08
C
Shoulder (RT): when entering fire buck on an emergency call, the IW twisted and
WCO222092916277
LT
7/15@092
S0.00
$52,682.74
$52,682.74
C
felt a pop in shoulder, with pain and cannot raise arm above shoulder.
Finger (LT, index): removing dog from rear passenger seat of patrol car during a
WCO221012196278
M
7/2512012
•
50.00
$989.50
$181.50
C
medical call with the owner, dog bit the IW.
Exposure: the IW felt bad and was vomiting. He believes he was suffering from
WCO222012196324
M
7/3012012
;0.00
$2,477.50
52,477.50
C
heatstroke.
Knees, Ankle (LT): the IW stepped In pot hole and fell down.
WC=012116314
M
e/112092
$0.00
$095.46
$895.46
C
Forearm (RT): during altercation with detainee, he Mt the IW's arm.
WCO222012116313
M
11=012
$0.00
$1,221.33
$1,221.33
C
Knees, Elbow (RT): the IW fell down three stairs the Judge's platform to the main
WCO222092116392
BLT
Bi3l1t192
$5,593.15
$39,138.95
$44,739.30
R
Boor. He may have slipped on the metal edging on me nm on the stairs.
Bads: while Igtrg weights, the IW re -aggravated a previous work related back
WCO222012196308
M
BI52012
50.00
59,637.40
$9,637.40
C
Injury causing her to have to drop the weights.
Forearm: dog bit the IWs arm during K-9 demonstration for Sheriffs office
WCO212092916371
M
flI712092
$0.00
$2,689.55
$2,681.55
C
feau%ion.
Knees, Shin (LT), Ankle (RT): the IW tripped and fell down steps.
WCO222012116531
M
IVBQ012
$0.00
$321.08
$321.08
C
Exposure: positive reading for TB.
WCD222012116933
M
B/8/2012
$0.00
$10.00
$10.00
C
Hand (RT): while doing a perimeter check of the facility. the IW noticed a gap In the
WCO222012116423
M
/111812012
$0.00
$1.411.75
$1,411.75
C
rec yard razor wire. While Inspecting the fencing and wire, he ad right hand with
to razor wire.
Arm (RT): assisting rescue movng paged, the IW pulled muscle on right side.
WCO222012116460
M
811912012
$0.00
$1.753.67
$1,753.67
C
Back: the IW was traveling southbou d on US1, when a silver SUV struck his
WCO222012116424
M
80=12
$0.00
$3,039.17
vehicle in the rear, causing rear and damage. As a result of the crash, the IW
$3,039.17
C
sustained bed* pain and was hansported to Fishermen hospital for treatment
Trauma emotional trauma as a result of traffic crash. the IW was transported to
WCO222012116493
M
812412092
S0.00
$1,992.75
$1,992.75
C
emergency room for treatment
Ankle (LT): walking slowly, surface charged.
WCO222012116567 M 9/2/2012 $0,00 $1,953.14 $1,953.14 C
Exposure: allempbrg to control a combative prisoner, prisoner was able to turn her
head and spit In the IW a face. Saliva struck Ore Iw on left side of mouth with a
WCO222012116667 M 9f7/2012 $0.00 $1,875.90 $1,675.90 C portion 0rareof entering his mouth.
Wrist (RT): while attempting to place subject under anesL subject grabbed wooden
40 post The IWused several hammer fist strikes to loosen subjects grip. Missed
WCO222012116WO M 9122/2012 $0.00 $1.168.31 $1.168.31 C one strike and hit post Injuring wrlsL
Knee (RT): while doing PT on duty, the IW was performing squats when knee
buckled
WCO222012116827 LT 912gf2012 $43.207.09 $49,602.99 $93,010.00 O
Monroe County Board Of County Commissioners Sun: $162,156,08 $SWim.07 $1,003,047.15
we ToW Saar $182,15"ll SIMAS ,S7 $1I,003,047.15
2012
Claim
Outstanding
Claim
Division Name LOB Claim Number
Type
Event Date
Reserves
Total Paid to Date
Total Incunfed
Status
Accident Descdp0on
Monroe County Board Of County
Foot (RT): the IW was perfldpaling In defereive tactics training and during the
Commissloners WC WCO222012116946
M
10M M012
$0.00
$1,543.50
tr®imng, another students shin was an the top of her right That as that student was
$1,543.50
C
attempting to complete a takedown maneuver. Her foot was pinned when she was
Breathing: after the redman drill In DT class, the IW could not control his breathing
WCO222092117091
LT
10/18/2092
$0.00
$69,43923
$69,43123
C
and his pulse rate was extremely high.
Shoulder (LT): the IW felt someone on her back and they had pulled her arm
WCO222092117025
8L7
9011 BI2072
(50.00)
S43,80249
$43,802.41
C
behind her. That's when she felt popping and ripping.
Shoulder (RT): cutting trees and or loading Into pick up for disposal.
WCO222012117910
BLT
90UM012
$0.00
$54.441.36
$54,441.36
C
Knee, Foot (RT): dimblng down from was, the IW fell backward on to large pipe
WCO222D92917158
LT
99/512012
$4,61291
$52,423.35
$57,036.26
O
and hit chest Inured right knee and fooL
Shoulder (RT), Back: the IW went to sit on the chair and it railed beds, she tried to
WCO222072997235
M
99/5/2012
$0.00
59,206.78
$9,206.78
C
stop It but could not and roiled back Into the shredder.
Elbow. Knee, Hip (RT): hip an escorting arrestee to patrol vehicle, errestee pulled
WCO222012117236
BLT
11f712092
chard from cuff and pushed the IW, causing him to lose balance and fall down on
$1,160.63
$6,859.38
$8,020.01
R
his right side.
Ankle (RT): advancing hose line on Are scone, foaling was lost on hill side,
WCO222012717238
M
11/1212092
50.00
$438.59
$138.59
C
resu0lrg in rolling eight ankle and pop.
Chest Annual physical TB positive.
WCO2220121175D4
M
11/1212012
$0.00
$0.00
$0.00
C
Elbow (RT): while handing rescue equipment an a call, the IW Misted right elbow.
WCO222012917195
M
11113I2012
$0.00
$186.26
$986.26
C
Unable to flex or extend.
Leg (RT): the IW stepped Into weeds and art lower right leg with barb wire.
WCO222012117234
M
11/13/2012
$0.00
$84.00
;84.00
C
Eye (LT): moving manikin off table, computer cable struck the IWs left eye.
WCO222012117281
M
11/13/2012
$0.00
$205.40
$205.40
C
Finger (RT): taking down scaffolding, the IW received ad on finger.
WCO222012117276
M
11/74/2012
$0.00
$428.00
$428.00
C
Wrist (LT): the IW lifted leaf blower and twisted wrist felt a snap in wrist
WCO222012117252
M
11/1612012
$0.00
$390.50
$390.50
C
Due to a recent charge in positions in November. The bottom of her feet became
WCO222012197485
M
11/1912012
$1,667.45
$30,342.55
532,010.00
O
sore from walking and standing all day. As time passed it progressively gat worse.
Shoulder (RT): fifitrg scanner lid when peper)ams and carrying boxes.
WCO222012117361
M
17/28I2012
$0.00
$2.904,04
$2904.04
C
Back (lower): while raising stretcher, Vol FF Tim Farley failed to release handle on
WCO222012117336
M
121=012
$0.00
$514.42
$514.42
C
stretcher and the IW caught the stretcher from slamming down, shock loading his
back
Shoulder (LT): while liPorg a be" backup unit on to a cart to remove the old
WCO222012117405
LT
12/tM012
$0.00
batteries, the IW felt something pop In shoulder. He dropped the unit and
$3,451.87
$3.451.87
C
Immediately fait sharp pain in left shoulder.
Foot (LT): the IW stepped on board with nail and punctured left arch.
WCO222012117408
M
12/11/2012
$0.00
$237.50
$237.50
C
Exposure: upon Intake butler, the IW was spit in face.
WCO222013117550
M
1/6I2013
$0.00
$1.90.52
$1,999.52
C
WCO222013117551
M
1/6M13
$0.00
$2,735.76
WCO22201311759D
M
11fi/2013
$0.00
$291.84
WCO222013117881
M
1/7/2013
$1,955.00
$13.055.00
WCO222013117626
M
1/92013
$0.00
$90.13
WCO222013117640
M
1IM013
$0.00
$98.13
WCO222013117641
M
119l2013
$0.00
$88.13
WCO222013117613
M
1/11/2013
$0.00
$1.798.34
WCO222013117651
M
1/12/2013
$0.00
$651.60
WCO222013117911
BLT
1/1312013
$12.913.15
$49.096.85
WCO222013117652
M
1/1512013
$0.00
$2.158.95
WCO222013117817
M
1/18/2013
$0.00
$0.00
WCO222013119404
M
1/21/2013
$0.00
$0.00
WCOM 13117691
M
1/22/2013
$0.00
$490.64
WCO222013117772
M
113RcP013
$0.00
$4,738.16
WCO222013117773
M
11 WO13
$0.00
$9,114.32
WC0M01311 T786
M
1/31/2013
$0.00
$401.08
WCO222013117883
M
214/2013
$350.31
$309.69
WCO222013118052
M
2J11/2013
$0.00
$474.90
WCO222013117912
BLT
2/19M13
$0.00
$4,501.60
WCO222013117953
LT
2/21/2013
($0.00)
$22,86122
WCO222013117963
M
2/22/2013
$0.00
$2.799.95
WCO222013117986
M
2/252013
$0.00
$161.00
WC0222013118034
M
2128P2013
$0.00
$10.00
Exposure: upon Intake butter, the IW was spit on.
$2,735.76 C
Knees, Hip (RT), Hands: the IW went to get the print mug shot off the printer and
skinned knees, hip and hands.
$291.84 C
Neck, Shoulder (RT): while moving chairs to set up courtroom for constitutional
officers. the chairs Upped (using another rolling chair to help move them), the IWs
$15.010.00 R shoulder cracked cawing pain in shoulder and neck, right arm.
Exposure: subject was convulsing and loamkg at the mouth. the I W hold subjects
lop so he would not kick media. He helped carry bedchoard and subject to
$98.13 C ambulance.
Exposure: the IW was exposed to patent infected with bacterial meningitis In the
course of tramsportlrg patent to hospital.
$98.13 C
Exposure (bacterial meningitis): subject was convulsing and foaming at mouth. The
IW held subject's logs so he would not kick medics. Helped carry backboard and
$88.13 C subject to ambiance.
Bicep (LT): picking W the reyce cans to put Into the recycle dumpstar, This arm
Witted as he was putting down the container. Felt faint dizzy, pain in the left bcep
$1.798.34 C area.
Blood Exposure: a male fell during road race, while assisting him to the sidewalk,
the IW was exposed to blood on right hand.
$651.60 C
Leg (LT), Elbow (RT): while working a traffic crash, the IW slipped In the rocks on
the embenkmerht causing her to scrape left leg, lending on arms and on her
$62.010,00 O previous Injured right elbow.
Ankle (RT): Injury occurred while exiting a wooded area that was blocked of with a
barricade. To exit, the IW had to Jump on the barricade and over gully. Landed an a
$2.158.95 C piece of wooded which tipped when she landed, causing her to twist ankle and
Lungs: annual physical - positive PPD reading.
$0.00 C
Metal Stress: due to herrassmed from union president advising her wants to get
rid of her.
$0.00 C
Eye (RT): while building kahinels for the new juvenile room, debris got Into right
eye. Eye rinsed out Not sure if a piece of wood , sand or metal.
$490.64 C
Heed, Neck Bads: the I W was driving southlnumd on the turnpike, a car about two
cars ahead of the IW lost the entire rear bumper. The bumper fell In to two lanes of
$4.738.16 C travel. She swerved to the left to avoid hitting the bumper. She hit the guardrail,
Head. Neck, Back, Hip, Leg, Foot (RT) : the IW was riding In a passenger side on
the turnpike, she looked up an saw a large pile of debris In the turnpike. the driver
$9,114.32 C swerved to the left to avoid hitting the debris. The car hit the guardrail, bounced of
Eye (RT): walking (trough the bushes, branch hit the IW in the right eye.
$401.08 C
Foot (RT): the IW noticed pain In right foot while jogging on treadmill, participating
In County required physical training.
$660.00 R
Foot (RT): the hW stepped on rusty nail while cleaning mops.
$474.90 C
Finger (RT): while feeding and petting a lemur trough the food port, an inmate
came up and dish the IW. she looked away and the lemur grabbed her hand
$4,501.60 C trmrgh the food port would not let go. She pulled her hand away, leaving her
Groin (RT): while taking a patient down stake, the IW falt a pop In groin.
$22,86122 C
Head, Neck, Back, Shoulder (RT): while sidling Tawken 13, the IVV fell backward
hitting head, buttocks, shoulder and neck.
$2,799.95 C
Forearm, Finger (LT), Thumb (RT): the I W was bitten by a cat while trying to
remove it from a reclining chair it was trapped in.
$161.00 C
Hear. while standing inspection, had clutched chest The IW stated had pain,
became semiconscious, weak and pale.
$10.00 C
WCO222093118036
M 2f21712093
$0.005868.01)
5866.00
C
Eye )LT): while teaching a class, the ON was poked In the eye by a stack of papers
she was holding.
WCO222013118069
BLT MUM
$27.369.65
$30,640.35
$58,010,00
O
Arm (RT): while attempting to place a subject into handcuffs, Him was a straggle
between the IW the
backward and forward. subject resulting In right arts erg force" pilot
WCO222013118208
WCO=013118162
M 3l14/2013
M 311IM2013
$g.Og
$0.00
$0.00
$2,553.36
$0.00
$2,553.36
C
C
Blood: while participating In first aid refresher training, the IW stood up from a
seated position an the training mal. He fail dlny and thought he was going to throw
up. He thought he was feeling funny because he had stood up so quickly.
Whine straggling to arrest a subject he was resisting, as 1 struggled to take him
down to the ground I struck my right knee on the ground. During the, event I was
also exposed to blood as well.
Head: the IW was In continuous stop and go traffic. The buck In from of her
WC0M013118262
M 3/27/2013
($o.W)
s997.74
$997.74
c
stopped and slightly mowed back and the h W hit Bra truck.
WCO222p13118298
M 3/30/2013
$0.00
$7,208.94
$7208.94
C
Exposure: effecting an arrest of stabbing suspect who was physically restating,
when blood from suspects clothing possibly made contact with the Ws mouth
WCO222073118374
LT 4iW2D73
50.00
$21,464.62
$21,464.62
C
Head, Face, Elbows, Hands, Knee (RT), Neck Back, Finger (LT): the IW was
running to catch up to deputy Minor during active shooter training. He tripped on
his own foot Fell, hitting right knee, elbows and hands. The right side of head hit
Lungs: while directing tra18c, the IW Wkaled smoke form fire.
WCO222CH3118407
M 4/612093
$0.00
$2,082.54
$2,082,54
C
Buck (lower): shoveling debris during fire Investigation. the IW strained lower back.
WCO222013118520
BLT 4/6e2013
$4.199.06
$7t8W.94
$12,000.00
O
Eyes: upon arrival, tie wind shifted and filled parking lot with thick !lack smoke,
WCO222013118608
M 416I2013
$0.00
59,547.09
$9,547.09
C
where the IW was exposed before doing PPE, facamask.
WCO222013999150
M 4l912093
$0.00
$409.50
$409.50
C
Exposure: while speaking to a victim who has a trackeostomy. She removed her
hard and fluid came out and flew Into the IWs left eye.
WC0922013118501
M 4/11/2013
$533.50
$2,476.50
$3,01O.W
O
Finger (LT): upon removing the prong fiom the defendants shK the IW poked left
finger with tire barb.
WC022201319a577
BLT 411 M2013
$23,49327
$41,506.73
$65,000.00
O
Shoulder (LT): the IW was opening the hood of the darn buck and felt pain in his
left shoulder. The shoulder had been tickling him for a while, but when he opened
the hood, the pain Intent ied.
Foot (RT): the IW slipped on wet floor. Right foot came out from under him, but did
WC0M113118425
M 4/12/2013
$0.00
$1,55226
59,55226
C
not felt.
Exposure: trustee was clearing out the refrigerator In the Finance Office with a
WCO222013118478
M 4/17/2013
$0.00
$1,793.35
$1,793.35
C
bleach and water solution.
Heart Irregular heartbeat The IW was transported to the ER.
WCO222013118563
LT 412MO13
$10.910.51
$36.630.69
$47,54120
OL
'
Forearm (LT): Insect bite on left forearm which became Infected.
WCO222013119128
M 5/1/2013
$0.00
$90.75
$90.75
C
WCO222013118707
M W1012013
$o.W
$T,o2D.36
S7,020.3e
c
Face, Ann (LT): MVA, the IW hit ano0er col from behind. She says she blanked
OUL
WCO22209391 e781
BLT 5/1012013
$69,206.19
$105.793.81
$175,WO.00
OL
Back (lower): after cxdtlny down bees and lording them Into chipper on Friday, the
IWs back was very sore. Injury progressively worsen resulting in a trip to the ER
on5/13113.
Heart rapid heartbeat and blurred vision.
WCO222013118826
M 50/2013
$0.00
$6=37
$6,282.37
C
Heart the IW was helping someone at the boat dock He bent over and blanked
WCO222013119055
M 5+24/%913
$O.W
$o.W
$0.00
c
outs end fell Into boat
Knee, Hand (RT), Back: the IW slipped and fell at Sally Pert entrance In from of the
WCO222013118861
M M29n2013
$88.13
$88.13
C
Jan.
WCO222013119116
M 612112013
$0.00
$1,222.75
$1,222.75
C
Finger (LT): while making a repair to the emergency fights on the county vehicle,
knife used to splice the switch• slipped and cut the IWs finger.
Exposure: the IW was not feeling good. Not sure If the climate she Intake was
WC0222013119132
M Si 2013 se.ao s2272.77 $2,272.77
c responsible. After popper spraying felt worse.
WCO222013119185
M 7/4/2013 $0.00 $1,067.95 $1,067.95
Ankle (RT): the IW was returning back to his vehicle after completing a trelBc stop
and pieced his right foot onto the edge of the pavement. His right That lolled to the
C right off of the edge of the pavement Into a depression In the mud
WCO222013119174
M 717=13 $318.92 $887.08 $1200.00
Finger (LT): the IW responded to a beck up cell with a fleeing suspect. Due to the
fast nature of the indent there was no time for him to wear protective gloves. As
O the suspect was actively fleeing the scene and leading to his cement location at
Eye (RT): the IW was getting odor ben out of the closet it filled and sprayed In eye.
WCO222013199184
M 7/9Q013 $0.00 S666.DD $666 W
C
W CO222013119201
M 719f2013 $0.00 $0.00 $0.00
Dehydration: during obstacle course, the IW started to feel faint and light headed,
which became a lot worse once she was done, to the point of not being a ble to
C move. She was then taken to the ER.
WCO222013119204
M 7/9f2013 $0.00 $155.50 $155.50
Berk while gflkg the stretcher and patient into the rescue unit the IW heard a pop
C and had a shoaling pain In middle and lower bedL
Lungs: annual physical - PPD positive.
WCO222013119235
M 711(Y2093 $0.00 $0.00 $0.00
C
WCO222093199274
M 7/29i1013 $10,024.36 $24.975.64 $35,O00.00
Heart after turbo draft training, they returned to station and the IW felt palpitations.
He connected himself to EKG and saw blgenlny. Asked crew to transport him to
OL ER.
WCO222013119335
M 7/25=13 $0,00 $2,003.87 $2,003.87
Leg (LT), Hips, Forearm (RT): the IW walked Into restmom and slid Waiting left leg.
She landed on left leg then onto hip. As she was falling, right forearm robbed
C against edge of door and fill floor. Janitorial services mopped bathroom and shut
WCO222013119326
WCO222013919356
LT 7i2H2013 $0.00 $28,776A7 $28,776.41
M 7/30IY013 $0.00 $0.00 $0.00
Knee, Leg, Foot (RT): while conducting a welfare check off of Key Haven boat
C RampWhen, theIW stepped up onto a highl concrete curb leading to the boat dock.
stepping up, she left something In right knee that did not fell right. The knee
Heart the IW got from his desk to his petrol car. He experienced a shortness of
C breath, chest pain, tingling clown left arm and minor tingling down right arm.
WCO2220931 t9369
M 811@093 $0.00 $3.4(0.37 $3,400.37
Head: the IW was entering library from back door Into the kitchen. She pushed the
door be(* In a way Met usually makes it stick But It swung back and hit her In the
C head
Leg (LT): trimming trees on road, the IW got polsomvood on L leg.
WCO222013119401
M 8=013 $0.00 $613.50 $613.50
C
WCO222013119423
LT 8I9013 $3.072.50 $51.327.50 $54,400.00
Ann, Shoulder, Knee (LT), Nose: attempted to walk under folding ladder located In
a halfway. The IW lost his fooling and stumbled about 6 feet failing onto One
O Carpet.
WCO2220t3199499
WCO222013119688
M 8l71/2013 $D,DD $U
M 8129/2013 $0.00 5309.00 $301.00
the IW was at the airport performing airport duties. He was speaking to Jorge
C MMarasma from Budget Rental and Indicated he Old riot feel well. He was pale and
complaining of chest pains. Jorge called 911 and he was transported to hospital.
Exposure: Inmate spit saliva on left arts while being escorted to sick bay for
C Pausing.
Annual Physical. Positive PPD (TB).
WCO222013119798
M 8`2112013 $0.00 $0.00 $0.00
C
WCO222013119644
M 91312019 $0.00 $0.00 $0.00
Ankle, Knee, Hip (RT), Elbows, Neck. the IW took elevator to first floor, stepped
C out and fall. Elevator stopped epprnx 6' above floor.
Sinus: Wake up every morning coming oft shift at station with heavy congestion.
WCO222093919724
M 902013 $0.00 $0.00 $0.00
C
WC0M013119725
M 9r9=3 $0.00 $0.00 $0.00
Lungs: congestion and coughing up green flem after sleeping In double bunk room
overnight
C
WCO222013119748
BLT 9/1112013 $1,60620 $16,893.80 $18,500.00
Hand, Finger (RT): while moving rubber molding for Installation, the I Ws right hand
Was smashed against the wall by an who
O soreness to the hand and severW.y bruising Inmatewaswas Irving to gyp' Swelling and
rg palm to finger.
Knee (LT), Head: the IW hipped and Tag when going out near bash can to throw
WCO222013119743
M 911IM013 $0.00 $3,725.66 $3,725.66
C something away. She fell forward bumping left knee and head
WCO222013119790
M 9/1812013 S0.00 5209.77 $209.77
Shoulder (LT): loading tree limbs to dump truck. the IWs left shoulder snapped, felt
numbness to small finger on left hand.
C
Knee (RT): when the IW got out of truck, he missed a step and bent eight knee.
WCO22201311982B M 9I242013 $74.98 $425.02 $500.00 O
Monroe County Board Of County Commlaaloamq sum: $173,40&59 $812,538.51 5986,005.10
WC Total stark $173AMM $966,008.10