Item C41Meeting Date: May 21,
2014
Division: —
Public Works/En&eering
Bulk Item: Yes X
No
Department:
- Project Management
AGENDA ITEM WORDING: Approval of Amendment #1 to the Contract with Maureen Melville
for artwork at the Conch Key Fire Station through the Art in Public Places Program, This project is
funded by fund 308 revenue bond.
ITEM BACKGROUND: Maureen Melville's proposal for artwork was chosen by the Art in Public
Places Committee for art at the newly renovated Conch Key Fire Station. The executed contract for
Ms. Melville states an Agreement Period of ninety (90) days to complete her work. Ms. Melville
requested an additional 90 days because of scheduling conflicts during the summer. Amendment #1
increases the Agreement Period from ninety (90) days to one -hundred and eighty (180) days.
PREVIOUS RELEVANT BOCC ACTION: On March 19, 2014 the BOCC approved a contract
with Maureen Melville for artwork at the newly renovated Conch Key Fire Station through the Art in
Public Places Program.
-LIJN'r-RACT/AGREEMIENT CHANGES: Extend the Agreement Period from ninety (90) days to
one -hundred and eighty (180) days.
STAFF RECOMMENDATIONS: Approval as stated above.
TOTAL COST: N/A INDIRECT COST: N/A BUDGETED: Yes —No
DIFFERENTIAL OF LOCAL PREFERENCE: N/A
COST TO COUNTY: — N/A SOURCE OF FUNDS:
REVENUE PRODUCING: Yes No X AMOUNT PER MONTH Year
APPROVED BY: County Atty O?�Mifi/Purc&ing — Risk Managemen&
DOCUMENTATION: Included X Not Required
DISPOSITION: AGENDA ITEM #
WM
I
t ,
Contract ` t i r
Artwork1 theArts in PubHcEv Program for the Conch Kev► 1
Contract Manager: Ann R�jer X4439 Pra'cct MVmt/Sto2
(Name) (Department/Stop
S/,,?
for BOCC meeting DUAWK' Agenda Deadiinc:43AM t4
Total Dollar Value of Contract: 14,000.00 Current Yen Portion: 14,000.00
1, No ■Account Codes:1 : . 1 1.. . 11, 1-M : 1 Qc 0
Grant-
County Match:
ADDITIONAL COSTS
[Not included in dollar value above]
salaries.
Changes
� :774�v,
Date INeeded
.A..
Division Director
Yes[:] Noo W
a. .J
ManagementRisk
i
r
County Attorney J dDIV
YesONoE3"' 222-4 Zez=
Fhrm Rpukm 7P7,7In 1 mrm
FIRST1 TO CONTRACT
PUBLICFOR
IMONROE COUNTY ART IN
rhis AGREEMENT T dated the 21" day of May, 2014, is entered into by and
between the BOARD OF COUNNETY COMM SSI S FOR MONROE COUNTY,
hereinafter "County", and MAUREEN MEI,VILLE, hereinafter "Artist",
lm. "1
i ('
IIEREAS, paragraph I of the contract dat`d March 19, 2014 stipulates an
Agreement period of ninety (90) days after notice to proceed for which the Artist must
complete her work; and
WHEREAS, the Artist requests an additional ninety (90) days for completion of
the work due to other commitments given during the time period in which the Agreement
covers; now therefore
IN CONSIDERATIONof the mutualpromises, covenantsY..agreements statct
herein,iand valuableconsideration, i
Paragraph
AGREEMENT PERIOD: Thh; agreement shall be
1 . 1 1This agreement shall remain in cffcct for the 0 1 a! ►
stated period unless one party gives
paragraphs 7, 12, and 13 of the original Agreement dated March 19, 2014. All
work for which AIPP funds are to be expended must be completed by the stated
termination date.
2. All other terms iconditions comply
original Art in Public Places Award Agreement dated March 19, 2014.
Signature page 1 follow.
Art in Public Places — Conch Key Fire Station
IN WnNESS WHEREOF, the parties hem -to have caused this agreement to be executed the
day and yew first above written.
(SEAL)
ArrEST: A HEAVIUN. CPA® CLEPLK
By:
Deputy Clerk
=.km
WITNESSES: ARTIST:
-- � LV "�EN MAUREEN ILLE
TIYVA U11
STATE OF -yrelipil't
COUNTY OF AP. 'jw"
On this day of 06�L, before me, the undersiped not" public,
f-kra" to me to be the pason whom nam is subscribed
pei-mally appenred LA4jfjjt ),q, 11A [I"
above or who produced VA onvjl2s LjunSA, as identifiedioN aWacknowledptl that he/she is the
pmon who executed the above conwwt with Monsm County ror do artwork as the CONCH KEY FIRE
STATION 0 17 ror the purposes therein contained.
N x M-
-
N X-A I $:A M-ft M
f*wy pwft
ev"Momm it Vh jsY
ni"18
C =1" E*f" JIM 30. Will
AP
MONROE COUNTY ATTORNEY
ROVED AS TO FO
If
NATILEENE W cAds-EL
ASSISTANT COUNTY ATTORNEY
Date ? 5- - ;)-2 7 , C/
Art in Public Places - Coach Key F :im Station
Monroe County Art in
This AGREEMENT dated the l9th ay of March
d 2014, is entered into by and
between the BOARD OF COUNTY CONIMISSIONERS FOR MONROE COUNTY,
hereinafter "County", and MA EN1 MELVILLE, hereinafter "Artist",
W1-LhREAS, the Art in Public Places Ordinance #022-2001, codified at MCC §2-
322(A), provides for an appropriation of 1% of the construction costs for new
construction exceeding $ 500,000 and renovations exceeding $100,000; and
WHEREAS, the Ordinance established an Arts in Public Places (AIPP)
Committee to advise the County Conunission regarding art to be acquired and installed in
each public construction project subject to the AIPP allocation; and
WHEREAS, the AIPP Committee has selected and recommended to the BOCC
one or more artists for this project, and
WHEREAS, the Board of County Commissioners of Monroe County have
determined that it is in the interest of the promoting the understanding and awareness of
the visual arts to contract for the creation and installation of artwork at the Conch Key
Fire Station;
NOW, THEREFORE, in consideration of the mutual covenants and payments
contained herein, the parties have entered into this agreement on the terms and conditions
as set forth below,
:'-AGREEMENT PERIOD, This agreement is for a period of ninety (90) days after
notice to proceed to execute and complete thoir work. This agrmincjA shall
remain in effect for the stated peritod UnItss one party gives to the Other "wittell
notification of termination pursuant to and in compliance with paragraphs 7, 12,
and 13 below. All work for which AIPP foods are to be expended must be
completed by the stated termination date.
1)
41, SCOPE OF AGREEMENT: The Artist shall provide
Three stained glass windows depicting a commercial fi.Thh'-,0,' vessel, Pelicans
and lobster traps. The stained glass shall be installed on the upper window area
12 ft. x 4ft.
Artist, shall confer with and coordinate activities with the Deputy Chief, Gary
Boswell on the job in order to insure that there is as much cooperation and
cohesiveness in the incorporation of the art into the building so that there shall be
the least amount of interference between the Artist and the Fire Rescue Personnel,
Art in Public Places — Conch Key Fire Station
an
3. AMO-U T OF AGREEMENT AND PAYMENT: The County shall provide
amount not to exceed $I4,000. 0 for materials and services used to create and
install the project. The Hoard of County Commissioners assumes no liability to
fund this agreement for an amount in excess of this award. Monroe Cio ty's
performance and obligation to pay Linder this agreement is contingent upon an
artnual appropriation by the BOC:G. Pursuant to Florida's Prompt Payment Act,
upon receipt by County of an Invoice for each of three (3) phases, and
documentation to satisfy the Clerk that the appropriate phase has been
completed, payment shall be made for the following phases at the referenced
rate s-
1) [Nsign Phase:
33.31/0 of total payment;
?} Nl�rtcriaf
33.3% of total when artist subrnits receipt s far snateaials and
eligible costs equal to or greater than 33.3% oC the contract total_
"I'ravol expenses are included in this phase and shall be paid in
accordance to Florida State Statute l 12.061, or as described in 2) a
2} a Travel-
below:
All travel expenses shall be reported on a State of Florida Voucher
for RulmbuNement of Travel Expenses. tf Artist has airfare, the
original boarding Fuss, or equivalent. must be attached to the
Voucher. If Artist is in vehicle, mileage must be reported nta_ the
Voucher. Mileage is reirnbursable at .445 cents per mile. Meals
are to be reported as follows: Breakfast — when travel begins
before 6 a.m. and extends beyond 8 a.m. for $6.00; 1,unch — when
travel begins before l2 noon and extends beyond Z p.m. for
$11,00; and Diruler -- when travel begins before 6 p.m. and extends
beyond 8 p.tn. for $19.OU.
A Stale of Florida V oucher for Reimbursement of `1'raveI Expenses
is attached and made hart of this contract.
33.3%final payment due Alien cnstaltation is deemed compl4te
mi(l contractual agreement specilic:atiot s arc- vvrilied by the
Monroe County pl-o.ject Nlatragernent Department or #esign4e.
L .i iE' lu t.�>>t:�a�a+l x 3� s.tlita�rc. liar �frG rc} �! t.iflci icy tc.l�sl u:c`.i i��tltazl� , eat �ir� rlMA ►wr--
limited to:
A. Artist's design. fee
& Labor, materials, contracted services required for production and installation
C . artist's operating expenses related to the project
13. Travel related to this project, pursuant to statutory limitations see above
paragraph 3, item 2) a.}
E. Transportation of the work to the site (see above paragraph 3, item 2) a)
F, Installation to the site
Permits and fees necessary for the installation (applicable for exterior projects
which also require HARC revic )
l , legal crests directly related to the project
1e Liability costs of artist
2
Art in Public Places — Coach Key Fire Station
Payment shall be made upon presentation of an original invoice and documentation
A=
necessary to support the completion of the work. Artist shall also provide a release of
lien if applicable.
Final payment request must be submitted no later than 60 days after the completion of the
project.
4r OWNERSHIP and RIGHTS: Upon the installation of the artwork, County shall
own the artwork and all rights related thereto fully and completely.
5. RECORDS, The Artist shall keep such records as are necessary to document the
performance of aic agreement and give access to these records at the request of
res
the County, the Slate of Florida, or authorized agent and repentative of said
govvrrmicriL bodies. The Artist understands that it shall be responsible for
repayment of any and all audit exceptions which are identified by the Auditor
Ciffneral for the State of Florida, the Clerk of Court for Monroe County, the Board
of County Commissioners for Monroe County, or their agents and representatives.
6. MODIFfCATIONS /\-ND AML-"ND,,`v1EN_TS: Any and all modifications of the
terms of this agreement shalt be only amended in writing and approved the Board
of County Commissioners for Monroe County.
7, INDEPENDENT CONTRACTOR: At all times and for all purposes hereunder,
the Artist is an independent contractor and not an employee of the Board of
COLinty Commissioners of 1�vionme County. No statement contained in this
agreement shall be con'ARLed as to Cind the Artist or any of its employees,
contractors, servants or agents to the employees of the Board of County
(,Oml7ft'ssinnor. 1-1 rights,
I , (yf 1,vjonroe Coixity, and they shall be enth ad to none of the g
privileges or benefits of employees of Monroe County.
CON(PLIAANCE, WITH LAW: In c alTying out its obligations under this
agreement, the Artist shall abide by all statutes, ordinances, rules and regulations
pertaining to or i-egLIlatitig the provisions of this agreement, including those now
in effect and her after adoptod. Any violation of said statutes, ordinances, rules
or regulations shall constitute a material breach of this agreement and shall entitle
the County to terminate this agreement immediately upon delivery of vin'tten
notice of termination to the Artist.
9- HOLD HARMLESSANDEMNIFICATION The Artist hereby agrees to
indemnify and hold harmless the BOCC Florida Keys Council of the Arts, AIPP
Committee and Monroe County and any of their officers and employees from and
against any and at[ ctalms, liabilities, litigation, causes of action, damages, Costs,
expenses (including but not limitedtofees and expenses arising from any factual
ir.-yestigation, discovery or preparation iL)r litigation), and the payment of ally and
all of the foregoing or any demands, setrtenierits or judgments arising directly o-r
indirectly under this agreement. The Artist shall immediately give notice to the
3
Art in Public Places — Conch Key Fire Station
County of any suit, claim or action made against the County that is related to the
activity under this agreement, entg d will cooperate with -the County in the
investigation arising as a result of y suit, action or claim related to this
agreement.
ICI. ANTI -DISCRIMINATION: The Artist agrees that they will not discriminate
against any of their era3ployees or applicants foremployment or against persons
for any benefit or service because of their race, color; religion, sex, national
origin, or physical or mental handicap where the handicap does not affect the
ability of an individual to perform in a position of employment, and to abide by
all federa] and state laws regarding non-discrim tion,
ll. ITl-1 iC ACK: The ,artist warrants that no person has been employed or
retained to solicit or secure this agreement upon an agreernQut or understanding
for a commission, percentage, brokerage or contingcat fee, and that no employee
or officer of the County has any interest, financially or otherwise, in the said
funded project, except for general e bc:'rship. For breach or violation of this
wirrarnty, the County shall have the right to annul this agreement without liability
or, in its discretion, to deduct from the agreement price or consideration, t fall
cunt of such commission, percentage, brokerage or contingent fees
12, TERN11NaTIO'N. This agreement shall terminate pursuant to Paragraph #I.
Terrnination prior thereto shall occur whenever funds cannot be obtained or
cannot be corltiniic:d at a level sufficient to allow for the continuation of this
agreement pursuant to the terms herein. in the event that funds cannot be
continued at a level sufficient to allow the continuation oL this agreement pursuant
to the terms snecilied herein, this agreeirzent inay then be terminated irnmediately
by written no -Lice of termination delivered in person or by mail to Ai list. The
County may to ti inate this agreement without car.'se upon giving fit] clays written
notice of to ination to Artist. The County shall not be obligated to pay for y
services or goods provided by Artist after Artist has received written notice of
termination.
TEI;WINATIOC FOR BPt.EACII: The County may inninediately terluinate this
agreenrent for any bleach of the terms contained heresn. Such termination shall
take place immediately upon rec:::ipt cif vritten notice of said termination. any
waiver of any breach of covenants herein corstained to be kept and performed by
Artist shall not be deemed or considered as a continuing waiver and shall not
operate to bar or prevent the County from declaring a forfeiture for any
succeeding breach either of the same conditions or of any other conditions.
14. ENTIRE AGREEMENT- This agreement constitutes the entire agree ent of the
parties hereto with respect to the subject matter hereof and supersedes any and all
prior agreements with respect to such subject matter between. the County and the
Artist
Art in Public Places — Conch Key Fire Station.
15. CONSENT TO J-URIS DICTION: This agreement, its performance, and all
disputes arising hereunder, shall be governed by the laws of the. State of Florida,
and both parties agree that the proper venue for any actions shall be in Monroe
County.
IS. ETHICS CLAUSE: Artist warrants that he has not employed, retained or
otherwise had act on his behalf any former County officer oremployee in
violation of Section 2 of Ordinance No. 10-1990 or any County officer or
employee in violation of Section 3 of Ordinance No, 10-1990, For breach or
violation Of the provision the County may, at its discretion terminate this
agreement without liability and may also, at its discretion, deduct from the
agreement or purchase price, or otherwise recover, the fall amount of any fee,
commission, percentage, gift, or consideration paid to the former or present
County officer or employee,
17. PUBLIC ENTITY CRIME STATEMENNT: 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 to provide any goods or services to a public
entity, 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 riot submit bids on
leases of real property to public entity, may not be awarded or perform work as a
contractor, supplier, sub contractor, or consultant under an 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, for CATEGORY TWO for a
period of 36 months from the date of being placed on the convicted vendor list.
Artist represents that Artist is not on the Convicted Vendor list.
I AUTHORITY: Artist warrants that it is authorized by law to engage in the
performance of the activities encompassed by the project herein described, Each
of the signatories for the Artist below ar%-, authorized to contract artist's services.
19, LICENSING AND PERMITS: Artist warrants that he or she shall have, prior to
commencement of work under this agreement and at all times during said work,
all required licenses and permits whether federal, state, County or City,
20, INSURANCE- Artist -agrees that it maintains in force at its own expense a
liability insurance policy which will insure and indemnify the Artist and the
County from any suits, claims or actions brought by any person or persons and
from all costs and expenses occurring during the agreement or thereafter that
results from performance by Artist of the obligations set forth in this agreement.
At all times during the to of the agreement and for one year after acceptance of
the project, unless the requirement is waived by the Monroe County is
Manager, Artist shall maintain on file with the County a certificate of the
insurance of the carriers showing that the aforesaid insurance policy is in renewal,
material change or reduction in coverage unless a minimum of thirty (30) days
prior notification is given to the County by the insurer.
I
,Art in Public Places — Conch Key Fire Station
M
Acceptance andlor approval of Artist's insurance shalt not be construed as
relieving Artist from any liability or obligation assumed under this contract or
imposed by law.
The Monroe County Board of County Commissioners, its employees and officials
will be included as "'Additional lnunaf' on all policies except worker's
compensation.
Any deviations from these General Insurance Requirements must be requested in
writing on the County [arm titled (`Request for Waiver of Insurance
ReqLdrements and must be approved by Monroe County Risk Management. The
following coverages shall be provided Prior to commencement of work governed
by this contract-,
I , Workers Compensation if, and as required by Florida Starates
1 General Liability insurance. Coverage shall be maintained through out the
life of the contract and include, as a minimum:
a premises Operations
a Products and Completed operations
* Blanket Contractual Liability
0 Personal Injury Liability
a Expanded Definition of Property Damage
The minimum limits acceptable shall be:
$300,000 Combined Single Limit (CSL)
If split li its are provided, the minimum limits acceptable shall be
$ 100,000 per Person
$3100,000 per Occurrence
$ 50,000 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.
NOTICE: Any written notice to be given to either party under his
agreement or related hereto shall be addressed and delivered as follows:
Maureen Melville
1909 Massachusetts Avenue
Florida Keys Council of the Arts
1100 Simonton Street
Art in Public Places — Conch Key Fire Station
IN
McLean, Virginia 22101 Key West, FL 33040
and
County Attorney
P.O. Box 1026
Key West, FL 33041-1026
22, PUBLIC RECORD& The Artist agrees to comply with all requirements of Chapter 119 of
the Florida Statutes and specifically.
(a) Keep and maintain public records that ordinarily and necessarily would be required by
the public agency in order to perform the service.
(b) Provide the public with access to public records on the same terms and conditions that the
public agency would provide the records and at a cost that does not exceed the cost
provided in this chapter or as otherwise provided by law.
(c) Ensure that public records that are exempt or confidential and exempt from public
records disclosure requirements are not disclosed except as authorized by law.
(d) Meet all requirements for retaining public records and transfer, at no cost, to the
public agency all public records in possession of the artist upon teniiination of the
contract and destroy any duplicate public records that are exempt or confidential and
exempt from public records disclosure requirements. All mcords stored electronically
must be provided to the public agency in a ffirt'nat d-IM is compatible with the
infra-mation technology systems of the -public agency -
Remainder of this page left intentionally blank.
Signature page to follow as page 8.
I
Art in Public Places — Conch Key Fire Station
IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed the
day and year first above written.
T: AMYl-IEAV1LIN,CPA,CL.F.RK
L2LF� Deputy Cle"i
(111� 7'�S4
BOARDOYC
OFM0'N,,,j1R0- 0UNTY.FLORIDA
By:
Mayor/Chairman,
ARTIST'
MAUREEN,MELVILLE
Cam! -
STATE OF
N
"OUNTY OF
C -"0
On this
_&!! day of 20011q, before me, the undersigned notary public,
personally appeared rfr se name is subscribed
known to me to be the person who
above or who produced as identification, and acknowledged that he/she is the
person who executed the above contract with Monroe County for the artwork at the CONCH KEY FIRE
STATION # 17 for the purposes therein contained,
Name
My Cocunission Expires oq 1la)n
DESIREE MARIA TR CHE
Notary Public
Commonwealth of Virginia
7556859
My Commission Expires Sep 30,2017
,jNTy,,V-fTO8NRY
0,Y,ipoe co C 1 ',,S TO p F
M
Art in Public Places — Conch Key Fire, Station
u
Maureen Melville Conch Key Fire Station Public Art
PROPOSAL
I am an architectural glass artist. I have made any stained
glass windows and fused glass murals for public art projects.
Nly proposal is for stained glass windows for site 1, the upper
windows of the fire station. I have attempted to design windows that reflect
the location and character of Conch Key.
The left hand window depicts a commercial fishing vessel and a tuna,
the center window two pelicans with a suggestion of water behind the and
the third window a lobster trap and lobster with a few small fish.
Since the windows will be very visible to the passing traffic I chose to
make the very graphic and readable from a distance. This is why they
each have a different color background and why the images are very large
and simple. It is also why the color is so hold. I would describe my work as
a colorful, joyous mix of the abstract and the recognizable,
It's very difficult to depict stained glass in a rendering since it's
impossible to sho-,,v the transparency of the glass, These windows would
have strong, color but also be able to be seen through. Changing weather,
passing birds, time of day and year will all affect the took of the windows.
Stained glass would be very vibrant in this location during the day and lit up
on the exterior of the building at night and thus highly visible to the passing
trafll c .
I would make these windows with handmade colored glass from
Germany that would be painted with black glass paint. I also acid etch or
sandblast the glass for additional detail. it requires no maintenance aside
from an occasional cleaning. The color is in the glass and all paint is fired on
in the kiln and permanent. The stained glass would be laminated to pieces of
plate glass with optically clear, non -yellowing KIN silicone that expands
and contracts with extreme temperatures. This is a much more modern took
than traditional stained glass. The stained glass is installed inside the
building against the exterior windows so it is not exposed to the weather.
I have had experience working with any different committees and
communities. Some projects required ongoing communication and
adjustments to the design and other commissions went from design approval
to installation without any changes. I have worked successfully with both
groups. All my projects have been completed on time and on budget and I
fabricate all my own work.
This is a great location for stained glass and I believe it would be beautiful
both in the interior of the fire station and for the passing traffic. I hope you
will give me this opportunity to work in Conch Key.
LOBBYING AND CONFLICT OF INTEREST CLAUSE
SWORN STATEMENT UNDER ORDINANCE NO- 010-19"
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
I'- CT is that Wit has not ranployed, re-tainAl or otherwise bod act on hislits
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 Onficance No.
010-1990. For breach or violation of is 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 nner County ofricer or
d to the rmer County offir-,
employee 'a" Ion ignature
Data: ;7,
STATEOF_ te'L
COUNTY
Subscribed and sworn to (or affirmad) before me on -
(name of Wiant). He/She is
(date) by
personally known to me ' has produced L, f pyi,4
or
a . a ideadifiestion, (type of identification)
EFAIRIEEIDA JAN WRAN I Mary Pubft N
of Wginle
7512417
My Canostalan Ex0fill Sop 30.2011
iNO T�A�'R Y P
my ciammisSiorl expires:
NoN-coLLusiropr
L Of thefit' of
according to l o f -, y t
1. i am_� flrcLs
of the firm ofthe lL
bidder making the Proposal for din Project m'der Request for
Qua.l i fications
u
and that
I executed the stud PrOPONg with firll sudimity to do so:
n 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 pries with any other bidder or
with any competitor,
. unless atierwise required by taw, the prices which have been quoted in this
laid 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, whip or corporation to submit, or not to submit, a bid for the
purpose of restricting competition;
a the statements coutaincd in this affidavit ate true.and correct, and nee with
full knowledge tftat Mote County relies upon the talh of die statements
cbntaitx this:Wndent)
a/riling%c rpwts for said project.
r C{
cOUNTY OF:
PERSONALLY APPEARED OPPOSE , the undemigned au °ty,
�,��_ 0&0, aft fiat being itionce by lite, butow of individual -signing)
affixCA
hislber gignattim in the space provided above, o 2.4t"dayof
In 11Z_ 1
J AKRAM
salary Public
ner Virginia
F,7FAIREOSCIA
im ExPir" Sao 3A 90'1$
0-r
AR-Y P ICmMvy Omtni n'Ep' 3 C? {
The undersigned vendor in accordance with Florida Statute 267.087 hereby oertifies
Nl,�e.��� V f �-t•�
(Name of Sueineas)
oyeas at the unlawful manufacture, distribution,
disperangr ■ubstaro .is prohlbited in the Workplace
' i' against employees for violations of such
and specifying 2. Inform employees about the danoers of drug abuse in the workplace, the business's
policy of maintaining a drug -free workplace, any pvaileble drug counseling,
rehabilitation,
and employee assistance programa, and the penatties that may be
imposed upon
employs" for drug abuse violations.
3. Give each employes ontcontractual Services
bid a
4. In the statement specified in subsection (1), rotify the employees that, as a condition
of Working on the commodities or contractual services that are under bid, ft employee
Wilk abide by the terms of the statement and Wilk notify the armpioyer of any conviction of,
or plea of guilty or nob contenders to, any vio lion of Chapter 893 (Florida Statutes).Or
of any controlled substance law of the United States r or any state, for a violation
flue(5)
occun*q in the workplaoe no law than
such conviction.
5. impose a sanction on, or require the satisfactory P2d!C!Pgdcni
n a drug abuse
assistance or rehabillaVon program
is avidlable in tcommunity,
any sm*yee who is so convicted.
continue6. Make a good Wh effort to i .i drug-freethrough
implementation
s; r r . .,
17
■+
f. -
on the convicted vendor list
"A person or affiliate who has been placed
Mowing a conviction for public entity crime may not submit a bid on a
contract to provide any goads 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
publicnot submit bids on leases of real
property to public entity, may not . awarded or perform work as a
contractor, supplier, subcont Vtor, or corisuftant wider a contract with
any
public entity, and may not transact business with any public entity in excess
of the threshold amount provided vx Section 287.017, for CATEGORY
TWO for a period of 36 months from the date of being placed on the
convicted vendor .
- r t t t yt .: t . t �� �� • r t- t
3
(M
A E- P 1
��pR 0 DATE 1712 Y 4
TI1 T LIABILITY 1 � 04i01201
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the olicy(ies) ust a endorsed. if SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRa4uCER NRRMTF Cr lsi Paphln
Long &Foster Insurance Agency PHONErtt.70- 7-7600 V taic�Not: 703-63-10
14501 George Carter Way L
Chantilly, VA 2011 E-MAIL
ADORE $S:
Kelsi Pophin INSURERIS} AFFORDING COVERAGE NAIC 0
INSURER A :H a Wer 11000
INSURED Maureen MeMile INSURER B
1909 Massachusetts AV INSURER C
McLean, VA 2101
IN5URERII'
INSURER E :
INSURER F : -
COVERAGES CERTIFICATENUMBER: REVISION ER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSR '- 9 s__ POLICY EFF � POLfCV E%P LIMITS
LTR TYPE OF INSURANCE POLICY NUMBER MMIDDNYY Ilil 17ffQlYYYY
A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1,000,00
42SBARU7337 03126/2014 03126/2015 ltrw iGE TB Eri a 1,000 00
CLAIMS -MADE OCCUR EREMISES JEa ucrurranca S
X:Tl3umess Owners MED EXP fA y the pl. r ) 't i0,00
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY 0 PE LUC
OTHER'
AUTOMOBILE LIABILITY
ANY AUTO
ALL. OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
UMBRELLA LIAR OCCUR.
EXCESS LIAB CLAIMS -MADE
I7Eq RE7ENT][1rV S
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y r -N--1
ANY PROPRIE CRIPARTNERIEXECUTIVE F
OFFICERIMEMBER EXCLUDED? WA
A
iMamintary in NH)
If yes, describe under
h Fcr R ro-n ntir OF OPP NA-n CAI s biah,nr
PERSONAL A ADV INJURY S
GENERAL AGGREGATE $
r.: f
PRODUCTS - GOMPtC7_P AGO 5
COMBIN--D SINGLE LIPAIT
7$_
-'
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE $
:.
�P�r aCcidcni}
EACH OCCURRENC
rAG-RE-_LTE 1
E.L. EACH ACCIDENT 1.1
E.L. DISEASE - EA EMPLOYEE S
E.L- DISEASE • POLICY LIMIT I a
DESCRIPTION OF OPERATIONS r LOCATIONS r VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
donrce County Board of Commissioners is listed as additional insured Per
Eorat sS 00 08 04 05.
AIPPRr'
DA E
t11IAIVER J `a
1,000,00
2,00,®
2,000,00
CERTIFICATE BOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
Monroe County
Gard of Commissioners AUTHORIZED REPRESENTATIVE
1100 Simonton St.
Key West, FL 33040
I
C�7 1908-2014 ACORD CORPORATION. All rights reserved,
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
RIMC IVSURANCE ACT
Terrorism Coverage and Premium
in accordance with the federal Terrorism Risk Insurance Art (as amended "MIA"), we are required to make coverage available
under your policy for "certified acts of terrorism," 'Me actual coverage provided by your policy(ics) will be limited by the terms,
conditions, exclusions, limits, and other provisions of your policy(ies), as well as any applicable rules of law.
The portion of your premium attributable to this terrorism coverage is shown in the premium section(s) of this quote proposal or
binder.
I Definition of Certified Act of Terrorism
A "certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in concurrence with the Secretary of
State and the Attorney General of the United States, to be an act of terrorism under TRIA. The criteria contained in TRIA for a
"certified act of terrorism" include the following:
1, The act results in insured losses in excess of $5 million in the -aggregate, attributable to all types of insurance subject to
TRIA; and
1 The act results in damage within the United States, or outside the United States in the case of certain air carriers or vessels
or the premises of an United States mission; and
3, The act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed by an
individual or individuals acting as part of an effort to coerce the civilian population ofthe United States or to influence the
policy or affect the conduct of the United States Government by coercion.
I Disclosure of Federal Share of Terrorism Losses
The United States Department of the Treasury will reimburse insurers for 85% of that portion of insured losses attributable to
certified acts of terrorism that exceeds the applicable Insurer deductible. However, if aggregate industry insured losses under TRIA
e�cecd $100 Billion in a program Year (January I through December 31), the Treasury shall not make any payment for any portion
of the amount of such losses that exceeds $ 100 bilhom The United States government has not charged any premium for their
participation in covering terrorism losses,
Cap on Insurer Liability for Terrorism Losses
if aggregate industry insured losses attributable to "cetuded acts of terrorism" under TRIA exceed $ 100 Billion in a Program Year
(.1anuary I through December 31), and we have met, or will meet, our insurer deductible under TRIA, we shall not be liable for the
payment of any portion of the amount of such losses that exceed $100 billion. In such case, your coverage for terrorism losses may
be reduced on a pro- to basis in accordance with procedures established by the Treasury, based on its estimates of aggregate
industry losses and our estimate that we will exceed our insurer deductible. In accordance with the Treasury's procedures, amounts
paid for losses may be subject to further adjustments based on differences between actual losses and estimates,
date to Producer on TRIA: The premium for terrorism coverage and the TRIA disclosures above must be provided to the insured
or prospect at the time of quoting, If you are not using this quote proposal, you can use Hartford's stand-alone TRIA disclosure
form for quotes and binders, which is available on EBC or from the company.
i Acknowled�*ed and Accepted By
if (Signature of lelnsur-d)
Reference Number: 42SB,47864LC-002
Total Estimated Annual Premium for Spectrum: $500
(Date)