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Item B03M C ounty of f Monroe ELj » °o � BOARD OF COUNTY COMMISSIONERS /� r i � �� Mayor George Neugent, District 2 - Me Honda. Key y e ', I Mayor Pro Tern David Rice, District 4 ; - = = :' j y Danny L. Kolhage, District 1 Heather Carruthers, District 3 Sylvia J. Murphy, District 5 County Commission Meeting October 18, 2017 Agenda Item Number: B.3 Agenda Item Summary #3273 BULK ITEM: Yes DEPARTMENT: Project Management/ Facilities TIME APPROXIMATE: STAFF CONTACT: Cary Knight (305) 292 -4527 N/A AGENDA ITEM WORDING: Approval to waive bid irregularity and award a contract to Discount Rock & Sand, Inc., for the demolition of the Habitat for Humanity Bldg. on Big Pine Key in the amount of $69,000.00. Funded by Ad Valorem tax. ITEM BACKGROUND: On August 2, 2017, bids were opened for award of the demolition of the Habitat for Humanity Building project. Discount Rock & Sand, Inc., (DRS) submitted the lowest bid which was significantly lower than all other bids received. DRS inadvertently omitted its bid security bond. The DRS bid proposal documents were otherwise complete and responsive, and DRS is deemed a responsible bidder. DRS has provided good services on two other projects for the County. DRS timely remedied its omission and has provided sufficient and proper bid security to the County. Therefore, PM recommends to the BOCC that DRS is the lowest, responsive and responsible bidder for award of this contract. The building demolition and property preparation is for a future hurricane and disaster emergency response staging area. The bid tabulation sheet is attached for reference. PREVIOUS RELEVANT BOCC ACTION: 8/18/14 - BOCC approved a Lease Agreement with Habitat for Humanity (HH) for use of the County's building on Big Pine Key. In July 2016, an engineering report revealed structural and life safety deficiencies in the building. 9/21/16 - BOCC authorized termination of the Lease Agreement effective on 1/19/17. 10/14/16 - BOCC approved an Agreement with HH to vacate the structure and continue use of the property outdoor storage area until 7 /18/17. 6/21/17 - BOCC approved to advertise a RFP for the building demolition. CONTRACT /AGREEMENT CHANGES: N/A STAFF RECOMMENDATION: Approval as stated above. DOCUMENTATION: Bid Tabulation Sheet - Habitat for Humanity Bldg. Demo Project Discount Rock & Sand, Inc. proposal Habitat for Humanity Bldg. Demo 2017.08.09 Contract Signed Discount Rock & Sand Habitat Building Demo FINANCIAL IMPACT: Effective Date: August 19, 2017 Expiration Date: Total Dollar Value of Contract: $69,000.00 Total Cost to County: $69,000.00 Current Year Portion: $69,000.00 Budgeted: Yes Source of Funds: Ad Valorem — cost center 20501 CPI: Indirect Costs: Estimated Ongoing Costs Not Included in above dollar amounts: Revenue Producing: No Grant: County Match: Insurance Required: Additional Details: If yes, amount: $69,000.00 09/20/17 001 -20501 - FACILITIES MAINTENANCE $69,000.00 REVIEWED BY: Chris Ambrosio Completed 08/03/2017 1:42 PM Ann Mytnik Completed 08/03/2017 1:43 PM Cary Knight Completed 08/29/2017 12:48 PM Kevin Wilson Completed 08/30/2017 10:35 AM Budget and Finance Completed 08/30/2017 3:13 PM Maria Slavik Completed 08/31/2017 8:40 AM Kathy Peters Completed 09/01/2017 12:27 PM Board of County Commissioners Completed 09/20/2017 9:00 AM 10 lenoaddV) [I uolslnab] ;oafoad OwGa -6p18 A ;IuewnH aol ;e ;IgeH - ;aayg uol ;eingel p18 : ;uGwt43e ; ;V O W ao o� o W Z M C LU Q H Q�LN ^ m LL Z a 0 Q W -i =Q LL 0 H a H Zm W Q a= O LN J H H H O J LL Z O V W ce O x H z 0 O O Lf) O O O N O Q O m �.D O m 0 ,--i I 1 O M ,-I ko ko 0 z O o 0 0 U') U') U') z D m � � C � z _0 4-J U) ra U) w > 0 [D 0 66 z v ra x C: -�e O w u _0 Q " u o w ra [-- c m � 0 N L � � 0 U y L Cf } } N y N L CL O U s } } a rn a S U U � N � N } C3 � S c3 O � S � a � U S L a � o a � rn � o — s s Q � � a o M LL Q � � �} U U O 7 L � CO o U > O - 0 N o N 7 Q .L a U') -6 U') U 0 O m } v } L CO L o U LL N O Q L � O } H U') m Habitat for Humanity Building Demolition SECTION 00120 PROPOSALFORM The Proposal shall be submitted on the forms included in this section of the Proposal Documents as previously instructed herein. Item Description 1. Proposal Form 2. Bid Bond (Proposal Security) 3- Non - Collusion Affidavit 4. Lobbying and Conflict of Interest Clause 5. Drug -Free Workplace Form 6. Local Preference Form 7. Public Entity Crime Statement 8. Subcontractor Listing Form 9. Insurance Requirements and Checklist 10. Workers Compensation and Employers' Liability 11. General Liability 12. Vehicle Liability 13. Builders Risk (If needed) 14. Proposer's Insurance and Indemnification Statement 15. Insurance Agent's Statements 16. Contractor License: A Current Copy to be submitted with Proposal. Subcontractor Licenses to be Submitted Prior to Award of Notice to Proceed. INFORMATION REQUIRED TO BE PROVIDED 20 23 24 25 26 27 28 29 30 -31 32 33 34 40 40 -41 42 1. In order to determine if the persons or entity submitting proposals are responsible, all Proposals for contracts to be awarded under this section must contain the following information: A. A list of the entity's shareholders with five percent (5 %) 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 if a solely owned proprietorship, names(s) of owner(s). A copy of documentation demonstrating that the entity is a legally viable entity shall be attached. A B. A list of the officers and directors of the entity. Pages I PROPOSAL FORM 00120- Page 20 of 211 Habitat for Humanity Building Demolition C. Relevant Experience: The number of years the person or entity has been operating and, if different, the number of years it has been providing the service, goods, or construction services called for in the proposal specifications (include a list of similar projects). -4 D. The number of years the person or entity has operated under its present name and any prior names. ,4 7 1/, E. Answers to the following questions regarding claims and suits: a. Has the person or entity ever failed to complete work or provide the goods for which it has contracted? (If yes, provide details of the job, including where the job was located and the name of the owner.) YES F� NO 0 b. Are there any judgments, claims, arbitration proceeding or suits pending or outstanding against the person, principal of the entity, or entity, or its officers, directors, or general partners (this specifically includes any resent or o p prior entities in which the person, principal, entity, officer, E director or general partner of the proposing entity has been involved as a person, principal, entity, officer, director or general partner in the last five (5) years)? (If yes, provide details, include enough information about the 2 judgment, claim, arbitration or suit so that the Owner will able to obtain a copy of the judgment or claim or locate the suit by location and case number.) E YES NO c. Has the person, principal of the entity, entity, or its officers, major shareholders or directors within the last five (5) years, been a party to any law suits or arbitrations with regard to a contract for services, goods or construction services similar to those requested in the specifications with private or public entities? This specifically includes any present or prior entities in which the person, principal, entity, officer, director or general partner of the proposing entity has been involved as a person, principal, entity, officer, director or general partner in the last five (5) years. (If yes, provide details, include enough information about the judgment, claim, arbitration or suit so that the Owner will able to obtain a copy of the judgment or claim or locate the suit by location and case number.) YES F� NO ' T d. Has the person, principal of the entity, or its officers, owners, partners, major shareholders or directors, ever initiated litigation against Monroe County or been sued by Monroe County in connection with a contract to PROPOSAL FORM 00120- Page 21 of 211 Habitat for Humanity Building Demolition provide services, goods or construction services? This specifically includes any present or prior entities in which the person, principal, entity, officer, director or general partner of the proposing entity has been involved as a person, principal, entity, officer, director or general partner. (If yes, provide details, include enough information about the judgment, claim, arbitration or suit so that the Owner will able to obtain a copy of the judgment or claim or locate the suit by location and case number.) • r5) e. Whether, within the last five (5) years, the Owner, an officer, general partner, controlling shareholder or major creditor of the person or entity was an officer, general partner, 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 bids. (If yes, provide details and information about•the failure to perform services or furnish goods that will enable the Owner to thoroughly consider the matter.) SEE !+N 0 E �s Customer references (minimum of three), including name, current address and current telephone number. Credit References (minimum of 0 three), including name, current address and current telephone number. g. Financial statements for the prior three (3) years. Please provide in a separate sealed envelope for the Contractor's confidentiality, and clearly label the envelope "CONFIDENTIAL" one (1) original copy. ( "Any financial statement that an agency requires a prospective bidder to submit in order to prequalify for bidding or for responding to a bid for a road or any other public works project is exempt from F.S. 119.07(1) and s.24(a), Art. 1 of the State Constitution. ") SECTION 00120 PROPOSAL FORM 00120- Page 22 of 211 Habitat for Humanity Building Demolition PROPOSALFORM PROPOSAL TO: MONROE COUNTY BOARD OF COUNTY COMMISSIONERS c/o PURCHASING DEPARTMENT 1100 SIMONTON STREET ROOM 2 -213 KEY WEST, FLORIDA 33040 PROPOSAL FROM: 1 A , , , tA7 - 1a Al f% V6 cw,'7 c The undersigned, having carefully examined the Work and reference Drawings, Specifications, Proposal, and Addenda thereto and other Contract Documents for the construction of: Habitat for Humanity Building Demolition and having carefully examined the site where the Work is to be performed, having become o in familiar with all local conditions including labor affecting the cost thereof, and having familiarized himself /herself with material availability, Federal, State, and Local laws, ordinances, rules and regulations affecting performance of the Work, does hereby propose to furnish all labor, 0 mechanics, superintendents, tools, material, equipment, transportation services, and all 4s incidentals necessary to perform and complete said Work and work incidental hereto, in a 0 workman -like manner, in conformance with said Drawings, Specifications, and other Contract Documents including Addenda issued thereto. Cc The undersigned further certifies that he /she has personally inspected the actual location of where the Work is to be performed, together with the local sources of supply and that he /she understands the conditions under which the Work is to be performed. The successful proposer shall assume the risk of any and all costs and delays arising from the existence of any subsurface or other latent physical condition which could be reasonably anticipated by reference to documentary information provided and made available, and from inspection and examination of the site. The Base Proposal shall be furnished below in words and numbers. If there is an inconsistency between the two, the Proposal in words shall control. °---- Dollars (Total Base Proposal- words) 63 00 --- (Total Base Proposal — numbers) PROPOSAL FORM 00120- Page 23 of 211 Habitat for Humanity Building Demolition I acknowledge receipt of Addenda No.(s) No. Dated No. Dated No. Dated No. Dated Proposer, states by his /her check mark in the blank beside the form and by his /her signature that he /she has provided the following requirements (located in Section 00120): 1. Proposal Form 2. Proposal Security (Bid Bond) 3. Non - Collusion Affidavit 4. Lobbying and Conflict of Interest Clause 5. Drug -Free Workplace Form 6. Local Preference Form and requirements (if applicable) 7. Public Entity Crime Statement 8. Subcontractor List Form 9. Proposer's Insurance and Indemnification Statement 10. Insurance Agents Statement (signed by agent) 11. Answered Required Questions 12. Provided Customer References 13. Provided Three (3)- years of Financial Statements in separate envelope 14. Certified copy of Valid Florida Contractor's License 15, Current Monroe County Occupational License Business Name: +� e'a coat .� �c t3. C? a ! t/'� DBA: Business EIN# el 7 ?- Business ® Mailing Address: .4�srf{i��� ®�, �'`�°� Address: /� lJ 41 City' Y City,State State, Zip ��Ie4 ��, ��� Zip �� �-�- Local Phone: Phone: �?dJ r- 7 . Z I PROPOSAL FORM 00120- Page 24 of 211 Habitat for Humanity Building Demolition SECTION 00120 NON - COLLUSION AFFIDAVIT / - /A ,°a A-77 /-- � according to law on my my oath, and under penalty of perjury, depose and say that of the firm of e° C , 0&1. `7 the proposer making the Proposal for the project described in the notice for calling for proposals for: At 47 , and that I executed the said proposal with full authority to do so; 2. The prices in this proposal 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 proposer or with any competitor; and 3. Unless otherwise required by law, the prices which have been quoted in this proposal have not been knowingly disclosed by the proposer and will not knowingly be disclosed by the proposer prior to proposal opening, directly or indirectly, to any other proposer or to any competitor; and 4. No attempt has been made or will be made by the proposer to induce any other person, partnership or corporation to submit, or not to submit, a proposal for the purpose of restricting competition; and 5. The statements contained in this affidavit are true and correct, and made with full knowledg of S911d project. 9 ` f el z a� (Signature roposer) (Date) STATE OF: COUNTY OF: PERSONALLY APPEARED BEFORE ME, the undersigned authority, who, after first being sworn by me, (name of individual signing) affixed his /her signature in t e space provided above. on this ::.; y i , - day of __120 �f=� � f ,4 ,1 .�. NOTARY PUBLIC' My commission expires: PROPOSAL FORM 00120- Page 27 of 211 of the city �SaKy e SULLY ROCA o� NOTARY PUBLIC STATE OF FLORIDA Comm# GG079893 Expires 4/23/2021 I Habitat for Humanity Building Demolition LOBBYING AND CONFLICT OF INTEREST CLAUSE SWORN STATEMENT UNDER ORDINANCE NO. 010 -1990 MONROE COUNTY, FLORIDA d ETHICS CLAUSE (Company) warrants that he /it has not employed, retained or otherwise had act on his /its 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 contract without liability and may also, in its discretion, deduct from the contract 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 ". (Signature) Date: `7 -- 2 `` ? al STATE OF:r ? :' f `- COUNTY OF: a Subscribed and sworn to (or affirmed) before me on ,1 f M1 (date) by (name of affiant). :He /She is personally known to me or has produced as identification. (Type of identification) ±d NOTARY PUBLIC My commission expires: PROPOSALFORM 00120- Page 28 of 211 �otARYA�on NOTARY PUBLIC 0 -STATE OF FLORIDA ? Comm# GG079893 SI NCE 19� Expires 4 /23/2021 Habitat for Humanity Building Demolition DRUG -FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 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. 0 2. Informs employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug -free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon in employees for drug abuse violations. d 3. Gives each employee engaged in providing the commodities or contractual services that o are under proposal 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 proposal, 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, E for a violation occurring in the workplace no later than five (5) days after such conviction. 0 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. CU x 6. Makes a good faith effort to continue to maintain a drug -free workplace through implementation of this section. 0 As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. Proposer's Signature oe 7 Date PROPOSAL FORM 00120- Page 29 of 211 Habitat for Humanity Building Demolition LOCAL PREFERENCE FORM A. Vendors claiming a local preference according to Ordinance 023 -2009, as amended by Ordinance No. 004 -2015, must complete this form. Name of Bidder /Responder � � � ' -5,49 4 ,1410 Date: 1. Does the vendor have a valid receipt for the business tax paid to the Monroe County Tax Collector dated at least one (1) year prior to the notice of request for bids or proposals? Xf�- (Please furnish copy.) :tW A` � 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? }r'C - .5 (The physical business address must be registered as its principal place of business with the Florida Department of State for at least one (1) year prior to the notice of request for bid or proposal.) List Address: � �"r�,� �° �/ 1 V6, 4 �'` g .+�4s - Telephone Number: _ ?GS `- 7 1� e S — 1-5 6- P-4 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? Ael"T 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 (1) year prior to the notice or request for bid or proposal. 2. Subcontractor's physical business address within Monroe County from which the subcontractor operates: (The physical business address must be registered as its principal place of business with the Florida Department of State for at least one (1) year prior to the notice of request for bids or proposals) /aJ Ar"PL" .0 �L� i��i�i¢n.�yui Tel.Number 3,0f- 79,3. - r 6 � G Addr s lure and Title of Authorized Signatory for Bidder /Responder Print Name: STATE OF i COUNTY OF On this r day of J ;1w.a 20 before me, the undersigned notary public, personally appeared F, z known to me to be the person whose name is subscribed above or who produced as identification, and acknowledged that he /she is the person who executed the above Local Preference Form for the purposes therein contained. 4 My commission expires: -' , "1:;.. Print Name PROPOSAL FORM 00120- Page 30 of 211 I SULLY Q�ZPRygsson NOTARY PUBLIC -STATE OF FLORIDA � Conan# GG079893 s �NCE 19" Expires 4/23/2021 2017 / 2018 MONROE COUNTY BUSINESS TAX RECEIPT � EXPIRES SEPTEMBER 30, 2018 Business Name: DISCOUNT ROCK & SAND INC Owner Name: EDILBERTO LOPEZ, YANET GONZALEZ Mailing Address: QUALIFIER PO BOX 504484 MARATHON, FL 33050 -4484 COMP CARD: SP 3782 lax .Amount Transfer Fee L 35_00 0.00 ��ub Total 1 Penalty - Sub—Total U) RECEIPT -t 30140 -74862 35.00 Total Paid 35.00 Employees 0 Paid 000 -16- 00019496 07/05/2017 35.00 THIS BECOMES A TAX RECEIPT Danise D. Henriquez, CFC, Tax Collector THIS IS ONLY A TAX. WHEN VALIDATED PO Box 1129, Key West, FL 33041 YOU MUST MEET ALL COUNTY AND /OR MUNICIPALITY PLANNING AND ZONING REQUIREMENTS MONROE COUNTY BUSINESS TAX RECEIPT P.O. Box 1129, Key West, FL 33041 -11.29 EXPIRES SEPTEMBER 30, 2018 Business Name: DISCOUNT ROCK & SAND INC RECEIPT~ 30140 -74862 10500 AVIATION BLVD Business Location: MARATHON, FL 33050 Owner Name: EDILBERTO LOPEZ, YANET GONZAL_EZ Mailing Address: QUALIFIER PO BOX 504484 MARATHON, FL 33050 -4484 COMP CARD: SP 3782 Business Phone: 305 - 743 -5680 Business Type: CONTRACTOR (LANDSCAPE & CERTIFIED GENEF Employees 14 CTATF I Tr F -K1QP. ('C/'1 C7 C'l Tax Amount — -- M Sub—Total U) RECEIPT -t 30140 -74862 Collection Cost —— Total Paid 35.00 Employees 0 0.00 L) 10500 AVIATION BLVD 35 Business Location: MARATHON, FL 33050 Business Phone: 305- 743 -5680 0 LP Business Type: CONTRACTOR (LANDSCAPE & CERTIFIED GEN[ ) STAT LICENSE_CGC1523252 THIS BECOMES A TAX RECEIPT Danise D. Henriquez, CFC, Tax Collector THIS IS ONLY A TAX. WHEN VALIDATED PO Box 1129, Key West, FL 33041 YOU MUST MEET ALL COUNTY AND /OR MUNICIPALITY PLANNING AND ZONING REQUIREMENTS MONROE COUNTY BUSINESS TAX RECEIPT P.O. Box 1129, Key West, FL 33041 -11.29 EXPIRES SEPTEMBER 30, 2018 Business Name: DISCOUNT ROCK & SAND INC RECEIPT~ 30140 -74862 10500 AVIATION BLVD Business Location: MARATHON, FL 33050 Owner Name: EDILBERTO LOPEZ, YANET GONZAL_EZ Mailing Address: QUALIFIER PO BOX 504484 MARATHON, FL 33050 -4484 COMP CARD: SP 3782 Business Phone: 305 - 743 -5680 Business Type: CONTRACTOR (LANDSCAPE & CERTIFIED GENEF Employees 14 CTATF I Tr F -K1QP. ('C/'1 C7 C'l Tax Amount — -- �Yansier Fue Sub—Total Penalty I -- -- -- ff Prior Years -- Collection Cost —— Total Paid 35.00 Employees 14 0.00 L) i 0.00 35 STAT LICENSE_CGC1523252 0 Prior Years Collec Cost Total Paid 0.00 0.00 35.00 @ CL CL THIS BECOMES A TAX RECEIPT Danise D. Henriquez, CFC, Tax Collector THIS IS ONLY A TAX. WHEN VALIDATED PO Box 1129, Key West, FL 33041 YOU MUST MEET ALL COUNTY AND /OR MUNICIPALITY PLANNING AND ZONING REQUIREMENTS MONROE COUNTY BUSINESS TAX RECEIPT P.O. Box 1129, Key West, FL 33041 -11.29 EXPIRES SEPTEMBER 30, 2018 Business Name: DISCOUNT ROCK & SAND INC RECEIPT~ 30140 -74862 10500 AVIATION BLVD Business Location: MARATHON, FL 33050 Owner Name: EDILBERTO LOPEZ, YANET GONZAL_EZ Mailing Address: QUALIFIER PO BOX 504484 MARATHON, FL 33050 -4484 COMP CARD: SP 3782 Business Phone: 305 - 743 -5680 Business Type: CONTRACTOR (LANDSCAPE & CERTIFIED GENEF Employees 14 CTATF I Tr F -K1QP. ('C/'1 C7 C'l Tax Amount — -- �Yansier Fue Sub—Total Penalty I -- -- -- ff Prior Years -- Collection Cost —— Total Paid 35.00 0.0 35.00 0.00 0.00 i 0.00 35 Paid 000 -16- 00019496 07/05/2017 35.00 Habitat for Humanity Building Demolition PUBLIC ENTITY CRIME STATEMENT "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 ZJ f- 10.0A.IA17'- � , fib ". (Proposer's name) nor any Affiliate has been placed on the convicted vendor list within the last thirty -six (36) months. &; j (Signature) Date: - 2 -zIc -tail STATE OF: COUNTY OF: Subscribed and sworn to (or affirmed) before me on the o?G day of—// / 20 0 , by Ed,` / C�r�� �o2 6 Z (name of affiant). e She is pp- �on y k�o me or has produced (type of identification) as identification. My Commission Expires: 6 An,) i I RV SULLY ROCA �NOTARY PUBLIC NOTARY PUBLIC o STATE OF FLORIDA Comm# GG079893 NC 1 Expires 4/23/2021 I PROPOSAL FORM 00120- Page 31 of 211 Habitat for Humanity Building Demolition SUBCONTRACTOR LISTING FORM Division Subcontractor Contact Person Ph # w /area code Fax: Cell: Address I PROPOSAL FORM 00120- Page 32 of 211 Habitat for Humanity Building Demolition WORKERS' COMPENSATION INSURANCE REQUIREMENTS FOR Habitat for Humanity Building Demolition BETWEEN MONROE COUNTY, FLORIDA AND 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 and the requirements of Florida Statutes, Chapter 440. In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not less than $500,000 Bodily Injury by Accident $500,000 Bodily Injury by Disease, policy limits $500,000 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. 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. �- I INSURANCE REQUIREMENTS AND FORMS 00130- Page 3S of 211 AC "R" CERTIFICATE OF LIABILITY INSURANCE DATE B•3.b REVISION NUMBER: INSURED NAMED ABOVE FOR THE POLICY PERIODI INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER D CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED H U / ; 1 , EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TERM; THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIQ CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE INSD WVD -. POLICY NUMBER (MM MM /DDIYYYY L BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), COMMERCIAL GENERAL LIABILITY AUTHORIZE REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. � IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject CLAIMS -MADE OCCUR : D the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to tl CO certificate holder in lieu of such endorsement(s). PRODUCER CONTACT PERSONAL & ADV INJURY S Bouchard Insurance for WBS NAME: - - - —FAX- PHONE 0 P.O. Box 6090 (A/C, No, Ext) (866) 293 - 3600 ext. 623 (A/C,_No):__ - - - PRODUCTS - COMP /OP AGG S Clearwater, FL 33758 -6090 E -MAIL - ADDRESS: AUTOMOBILE LIABILITY - C COMBINED SINGLE LIMIT S _ INSURER(S) AFFORDING COVERAGE NAIC # - 0 - -- - - - INSURER A: AmericanZurichInSUran,ceCompany 40142 AI_L OWNED SC HEDULED . INSURED Workforce Business Services, Inc. Alt Emp Discount Rock &Sand Inc _.___.._ - -_- _. INSURER B 0 1401 Manatee Ave. West Ste 600 INSURER C : I Bradenton, FL 34205 -6 708 S UMBRELLA LIAR OCCUR E INSURER D EACH OCCURRENCE S EXCESS LIAB . _ __ C INSURER E DED RETENTIONS - - INSURER F : 0 M COVERAGES CERTIFICATE NUMBER 16FLO79866489 X STATUTE EER ANY PROPRIETOR /PAR "FNEWEXECUTIVE E THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE I REVISION NUMBER: INSURED NAMED ABOVE FOR THE POLICY PERIODI INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER D CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED H DOCUMENT WITH RESPECT TO WHICH THI EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TERM; INSR ADDLSUBR' _ LTR TYPE OF INSURANCE POLICY EFF ! POLICY EXP - - INSD WVD -. POLICY NUMBER (MM MM /DDIYYYY L LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS -MADE OCCUR : D DAMAGE TO RENTED '., PREMISES (Ea occurrence) S MED EXP (Any one person) ' - -- P PERSONAL & ADV INJURY S GEN't_ AGGREGAIE HMH APPLIES PFR - - - G GENERAL AGGRFGATE S POLICY P PRODUCTS - COMP /OP AGG S OTHER 5 5 AUTOMOBILE LIABILITY - C COMBINED SINGLE LIMIT S S (Ea accident) ANY AUTO I I BODILY INJURY (Per person) 5 AI_L OWNED SC HEDULED . AU rOS AUTOS B BODILY INJURY (Per accident) $ HIRED AU I OS NON -OWNED P PROPERTY DAMAGE - I _ (Per accident) S S UMBRELLA LIAR OCCUR E EACH OCCURRENCE S EXCESS LIAB . _ __ C AGGREGATE y DED RETENTIONS - - :WORKERS COMPENSATION S AND EMPLOYERS' LIABILITY Y / N X X STATUTE EER ANY PROPRIETOR /PAR "FNEWEXECUTIVE E E.L. EACH ACCIDENT ',' $ 1 r _ O 0 7@ O CL CL O E Q8 E� CERTIFICATE HOLDER CANCELLATION Monroe County BOCC 1100 Simonton Street, 2 -216 Key Vilest, FL 33040 Project Management SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AU I HURILED REPRESENTATIVE ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Habitat for Humanity Building Demolition GENERAL LIABILITY INSURANCE REQUIREMENTS FOR Habitat for Humanity Building Demolition 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 The minimum limits acceptable shall be: $500,000 Combined Single Limit An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its provisions should include coverage for claims filed on or after the effective date of this contract. In addition, the period for which claims may be reported should extend for a minimum of twelve (12) months following the acceptance of work by the County. The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. I INSURANCE REQUIREMENTS AND FORMS 00130- Page 36 of 211 A k 4i CERTIFICAT OF LIABILITY INSURANCE 0717 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TH CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE: A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE REP RESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. erV WM rrvv 1 . If UIe ceruncate noloer Is an AUIUI I IUNAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to tl terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to ti certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: ____ SERVICE INTEGRAL UNDERWRITERS CORP PHONe — - - F - - - - - -- jA1C No Ex�39304M0_- _ -... - ---- -. (AfC Nol: _$.77Z45 �15tJ_0 PO BOX 990337 E -MAIL ADDR ESS:_�J'Le n dez NQPI FS FI '�d11R - QIIu�QI�IUIld- U4111- - - - -- INSURED DISCOUNT ROCK & SAND. INC P.O. BOX 504484 MARATHON, FL 33050 COVERAGES rFaTIFU'ATI= K] RAOC INSURER(S) At-FO COVERAGE NAIC # INSURER A: JAMES RIVER INSURANCE COMPAN 12203 INSURER B' NATIONAL INDEMNIT , COMPANY OF THE S 42137 INSURER C INSURER D: INSURER E INSURER F ' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED r[CvIJIV1Y IvVmt rK: NAMED ABOVE FOR THE POLICY PERIO INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM: EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDU B Y PAID CLAIMS. 'ADDL SUBR! POLICY EFF '. POLICY EXP LTR TYPE OF INSURANCE POI -ICY NUMBER MMIDD/PYYY MM/DD LIMITS GENERAL LIABILITY ! - X COMMERCIAL GENE LIABILITY EACH OCCURRENCE - S : 000.000 DAMAGE TO�2ERTED -- - - -- - - - -� 3 N ! CLAIMS -MAD[ i OCCUR XI Y PREMISES _ (Ea occurrence s 5O 000 ! __ - DEDUCTIBLE 8500 MED EXP (A ny one per $ 5,000 00073861 -0 09/23/2016'09/23 /2017 PERSONA ADV INJURY 5 1,000,000 X CONTRACTUAL L IABILITY - - -- — - - -- - -' - -- -- - - - - - - -- GENER AGGREG S 2,000,ODO CN'I. AGGREGATE LIMn APPLIES PER SI_UC -- X 'POLICY X ft0 - PRODUCTS - COMP /OP AG G S 2 OOO.00O -- -- - -- -- J Cl. S AUTOMOBILE LIABILITY N N COMBINED SINGLE LIMIT II� S_1 00% 00_0 ANY AUTO _ - BODILY INJURY (Per person) $ INCL UDED ALL OWNED X SCHEDULED B ' AUIOS AUTOS NON -OWNED 74APBOO1755 02/28/2017 02/28/2018 BODILY INJURY (Per accident) S INCLUDED _ HIRED AUTOS AUTOS _ ______.___- PR PR OPERTY DAMAGE (P eracc!dent� $INCLUDED X I PIP 10,000 I _ -_ - -- _ - -- - s UMBRELLA LIAB OCCUR EACH OCCURREN S EXCESS LIAB LAI6. -MADE, - . __ - - -. -- -- =- -- - -�S - - - --- ' 1 AGGREGATE S DEC) I RE?ENT!ONS -------------— COVERAGE WORKERS COMPENSATION 5 WC STATU OTH I AND EMPLOYERS' LIABILITY _ TORY LIMITS ANY PROPRIETOR /PARTNER/EXECUTIVE r �- j OFFICE /MEMBER EXCLUDED? �. NIA I E EACH ACCIDENT 5 - (Mandatory in NH I ;' If yes, describe under --- -- - -- E.L.. DISEASF - FA EMPLOYEE S -- ----- -- - T - - -- - - -- - -- - -- -- OP DESCRIPlIQU OF E.L. DISEASE - POLICY LIMIT ! $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CONTRACTOR Additionally Insured: Project Name: Monroe County BOCC Habitat for Humanity Building Demolition 1100 Simonton Street. 2 -216 30320 Overseas Highway Key Vv(est. FL 33040 Big Pine Key, FL 33043 Project Management FICATE HOLDER "Monroe County BOCC 1100 Simonton Street, 2 -216 Key West. FL 33040 Project Management 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. JULIO HERNANDEZ AV IHURICED REPRESENTATIVE _ 1 © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Habitat for Humanity Building Demolition VEHICLE LIABILITY INSURANCE REQUIREMENTS FOR Habitat for Humanity Building Demolition BETWEEN MONROE COUNTY, FLORIDA AND Recognizing that the work governed by this contract requires the use of vehicles, the Contractor, prior to the commencement of work, shall obtain Vehicle Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum, liability coverage for: • Owned, Non - Owned, and Hired Vehicles The minimum limits acceptable shall be: $300,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $200,000 per Person $300,000 per Occurrence $200,000 Property Damage The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. - -, -� ' (�"'"'`'�°,��.�_. � L,s -. �j ,gym.° •E j�� /�^7`• j I INSURANCE REQUIREMENTS AND FORMS 00130- Page 37 of 211 __• "N n, �corrn CERTIFICATE OF LIABILITY INSURANCE F 07,17 I frla L t:K I It-ICA I t 15 165UED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TH CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE REPRESENTATIVE OR PR A ND THE C ERTIFICATE HOL unrvr— mm I : it the certmcate nolaer Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to tt terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to tir certificate holder in lieu of such endorsement(s). PRODUCER NAME: CUSTOMER SERVICE INTEGRAL UNDERWRITERS CORP PHONE — FAX - PO BOX 990337 E M Ext): 2393043290 _ - (A(c, No): 8777455560 ADDRESS:_ Jhernandez@integralund.com NAPLES FL 34116 -- - INSURED COVFRAGFR INSURER(S) AFFORDING COVERAGE _ NAIC # INSURER A: JAMES RIVER INSURANCE COMPAN 12203 INSURER B: NATIONAL INDEMNIT r COMPANY OF THE S 42137 rrcor!cir ... I .r INSURER C INSURER D INSURER E INSURER F _ -.._ .__...��... THIS IS TO KtVI51UN NUMBER: CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO INDICATED NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT THE INSURED NAMED ABOVE FOR THE POLICY PERIOl OR OTHER DOCUMENT WITH RESPECT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO WHICH THII EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID TO ALL THE TERM I_TR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYVY CLAIMS. MML -EX Y LIMITS GENERAL LIABILITY - EACH OCCURRENCE - 5 1.000 000 _ COMMERCIAL - GENERA! .. LIABILITY - DAMAGE TO RENTED - -- Y r X '. � _PREPAISES(Ea occurrence) S 50,000 -- CLAIMS MAO[ OCCUR A X DEDUCTIBLE $500 00073861 -0 09/23/2016 MED EXP (Any one person) 09/23/2017 -- S 5 X X CONT LIABILITY PERSONAL &ADV INJURY -- s 1,0_00,000 - - -- GEN AGGREGATE s 2,000,000 AGGREGRT E l.Ratrr APPLIES PER X X PRO- PRUDUC rS - COME' /UP AC G --. - -- -- $ 2,000,000 POLICY JECT LUC AUTOMOBILE LIABILITY N N COMBINED SINGLE LIMIT (Ea accideng_ - _ S_ 1,000,000 ANY AUTO ' ALL OWNED X SCHEDULED BODILY INJURY (Per person) - - -- -- _ _ s INCLUDED B AUTOS NON - O WNED NON-O WNED 74APBOO'1755 02128/2017 02/28/2018. BODILY INJURY (Per accident) S INCLUDED HIRED AUTOS , AUTOS PROPERTY DAMAGE - (Per accident) - - S INCLUDED X I PIP 10,000 _. - -- °.. s UMBRELLA LIAB (..._ ......,._ OCCUR EXCESS LIAB LAIMS:! - 1 CLAIMS-MADE EACH OCCURRENCE S - -_.. _.. - - -- -i. AGGREGATE S DED RETENTIONS : :COVERAGE .S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN WC STATU- OTH- TORY LIMITS ER ANY PROPRIETOR /PARTNERIEXECUTIVE!� - _ , - - - - - - CJFFlCOMEMBEP. EXCLUDED> n'. N ! A E_L EACH ACCIDENT S (Mandatory in NH) - - - '- It yes, describe under � �. , E.L. DISEASE - EA EMPLOYEE S F L DISEASE POLICY LIMIT S DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CONTRACTOR Additionally Insured: Project Name; Monroe County BOCC Habitat for Humanity Building Demolition, 1100 Simonton Street, 2 -216 30320 Overseas Highway Key West. FL 33040 Big Pine Key, FL 33043 Project Management L CATE HOLDER CANCELLATION Monroe County BOCC 1100 Simonton Street, 2 -216 Key West. FL 33040 Project Management SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE o iy• M� JULIO HERNANDEZ Z'� - DISCOUNT ROCK & SAND, INC P.O. BOX 504484 MARATHON, FL 33050 1 © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Habitat for Humanity Building Demolition PROPOSER'S INSURANCE AND INDEMNIFICATION STATEMENT INSURANCE REQUIREMENTS Worker's Compensation Employers Liability General Liability, including Premises Operations Products and Completed Operations Blanket Contractual Liability Personal Injury Liability Vehicle Liability (Owned, non - owned, and hired vehicles) Builder's Risk: Not Required Statutory Limits $500,000 Bodily Injury by Accident $500,000 Bodily Injury by Disease Policy Limits $500,000 Bodily Injury by Disease, each employee $500,000 Combined Single Limit $300,000 Combined Single Limit If split limits are preferred: $200,000 per Person $300,000 per Occurrence $200,000 Property Damage The contract shall not require a Public Construction bond equal to the contract cost. The bond must be issued by an A rated surety company doing business in the State of Florida. Hold Harmless and Indemnification. Notwithstanding any minimum insurance requirements prescribed elsewhere in this agreement, Contractor shall defend, indemnify and hold the COUNTY and the COUNTY's elected and appointed officers and employees harmless from and against (i) any claims, actions or causes of action, (ii) any litigation, administrative proceedings, appellate proceedings, or other proceedings relating to any type of injury (including death), loss, damage, fine, penalty or business interruption, and (iii) any costs or expenses that may be asserted against, initiated with respect to, or sustained by, any indemnified party by reason of, or in connection with, (A) any activity of Contractor or any of its employees, agents, contractors or other invitees during the term of this Agreement, (B) the negligence or recklessness, intentional wrongful misconduct, errors or other wrongful act or omission of Contractor or any of its employees, agents, sub - contractors or other invitees, or (C) Contractor's default in respect of any of the obligations that it undertakes under the terms of this Agreement, except to the extent the claims, actions, causes of action, litigation, proceedings, costs or expenses arise from the intentional or sole negligent acts or omissions of the COUNTY or any of its employees, agents, contractors or invitees (other than Contractor). The monetary limitation of liability under this contract shall be not less than $1 million per occurrence pursuant to F. S. 725.06. Insofar as the claims, actions, causes of action, litigation, proceedings, costs or expenses relate to events I INSURANCE REQUIREMENTS AND FORMS 00130- Page 38 of 211 Habitat for Humanity Building Demolition or circumstances that occur during the term of this Agreement, this section will survive the expiration of the term of this Agreement or any earlier termination of this Agreement. In the event that the completion of the project (to include the work of others) is delayed or suspended as a result of the Contractor s failure to purchase or maintain the required insurance, the Contractor shall indemnify the County from any and all increased expenses resulting from such delay. Should any claims be asserted against the County by virtue of any deficiency or ambiguity in the plans and specifications provided by the Contractor, the Contractor agrees and warrants that the Contractor shall hold the County harmless and shall indemnify it from all losses occurring thereby and shall further defend any claim or action on the County's behalf. The first ten dollars ($10.00) of remuneration paid to the Contractor is for the indemnification provided for the above. The extent of liability is in no way limited to, reduced, or lessened by the insurance requirements contained elsewhere within this AGREEMENT. PROPOSER'S STATEMENT I understand the insurance that will be mandatory if awarded the contract and will comply in full with all of the requirements herein. I fully accept the indemnification and hold harmless and duty to defend as set out in this proposal. 4 PROPOSER Signature I INSURANCE REQUIREMENTS AND FORMS 00130- Page 39 of 211 Habitat for Humanity Building Demolition INSURANCE AGENT'S STATEMENT I have reviewed the above requirements with the proposer named above. The following deductibles apply to the corresponding policy. POLICY DEDUCTIBLES 0 61 Liability policies are Occurrence Insurance Agency Claims Made Signatur End of Section 00120 I INSURANCE REQUIREMENTS AND FORMS 00130- Page 40 of 211 STATE OF FLORIDA v F DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION B.3.b CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395 p ` 2601 BLAIR S1 - ONE ROAD TALLAHASSEE FL 32.399 -0783 U) 06 0 W DAVALOS. CARLOS JR DISCOUNT ROCK & SAND, INC. 27132 S DIXIE_ HWY 0 NARANJA FL 33032 T 0 CJ 0 Congratulations! With this license you become one of the nearly 0 one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA < from architects to yacht brokers, from boxers to barbeque DEPARTMENT OF BUSINESS AND restaurants, and they keep Florida's economy strong. P ROFESSIONAL REGULATION - E Every day we work to improve the way we do business in order CG(A 523252 ISSUED: 08/29/2016 � to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact CERT11 GENERAL CONTRACTOR YOU, subscribe to department newsletters and learn more about DAVALOS, CARLOS JR DISCOUNT ROCK & SAND, INC. the Department's initiatives. > Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can E serve your customers. Ti you for doing business in Florida, IS ci_r;rIFIFID under tr,e provision, of Ch 489 FS � and congratulations on your new license! :��_ ,.,�;. cur . , ­h DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON. SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION C ONS TRU CTION INDUS LICENSING BO,tARn CC C1 523252 IVarnod below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration mate: AUG 31, 20 DAVALOS, CARLOS JR DISCOUNT ROCK & SAND, INC. 10500 AVIATION BLVD UNIT ##2 MARATHON FL 33050 a F ISSUED 08/29/2016 01SPI AY AS REOUIRFD BY LAW SEC,) # 1-160829000 Packet Pg. 77 Waste Management Inc. of Florida 10500 Aviation Blvd. Unit 2 C L) Marathon, Florida 33050 ROCK & SAND. Office: 305.743.5680 Fax: 305.289.4200 www.DiscountRockandSand.com Atlanta, GA 30348 CREDIT & BANKING REFERENCES CORPORATE NAME: Discount Rock & Sand, Inc. FEI/EIN NUMBER: 65- 0730773 C- CORPORATION FL RESALE CERT.: 54- 8012135807 -8 INCORPORATE DATE: January 27 th , 1997, in the State of Florida OFFICERS /OWNER: Edilberto Lopez, President /Secretary /Owner (100% Owner) OPERATIONS /FINANCE: Sergio E Calzado, Finance & Administration WEBSITE: Conrad Yelvington Distributors, Inc. NAICS /SIC CODES: 562119 — C &D and Yard Waste Collection, Hauling & Dumpster Rental Account No.: Space — Discount Rock & Sand 561730— Landscaping Services 238910 —Site Preparation Contractors Phone: 305 - 743 -4531 Fax: 305 - 289 -9030 562991— Portable Toilet Renting, Pumping, Servicing & Cleaning LICENSES: General Contractor: CGC1523252 Landscape: SP 3782 Specialty Hauler: CD /SL 025 DUNS NUMBER: 058 - 573 -408 E- VERIFY COMPANY ID: 911972 ADDRESS: CONTACT: 10500 Aviation Blvd, Marathon, FL 33050 Mail: P.O. Box 504484, Marathon, FL 33050 Account No.: 12040190 Office: 305.743.5680 Fax: 305.289.4200 Email: sales @discountrocksand.com REGISTRATIONS: Discount Rock & Sand, Inc., is registered as an approved contractor /vendor with: PO Box 640 (Attn: Michelle Olarte Smith) SAM Cage Code: 6DG72 (Government Systems for Award Management), Department of Tavernier, FL 33070 the Navy, Monroe County, Florida Department of Environmental Protection, and other government agencies. SCOPE OF WORK: Excavation & Grading, Demolition, Site Preparation, Parking Lots, Asphalt, Curbs, Sidewalks, Road Building, Trenching, Drainage Installation, Pavement Marking & Signs, BANKING: Debris Removal, Site Clearing, Sand, Gravel, Fill Material, Hauling Services Capital Bank - Account #90940214406 ABA #067011760 Account Officer: Becky Shifflet, Vice President /Branch Manager Off: 305 - 743 -7845 Fax: 305 - 743 -0358 11501 - Overseas Hwy, Marathon, FL 33050 Waste Management Inc. of Florida SDI Quarry, Inc. Account No.: 872- 0000128 - 2713 -5 Account No.: DISROC Phone: 305 - 230 -1111 PO Box 105453 Phone: 305- 670 -9610 Fax: 305 - 670 -6787 9350 S. Dixie Highway, Suite 1250 Atlanta, GA 30348 Miami, FL 33156 CEMEX Construction Materials Florida, LLC Florida Keys Electric Cooperative Association, Account No.: 9430565343 Inc. Account No.: 515610000 Phone: 305 - 558 -0315 Phone: 305 - 852 -2431 PO Box 905875 3421 Overseas Highway Charlotte, NC 28290 -5875 Marathon, FL 33050 Conrad Yelvington Distributors, Inc. Beachcomber Marina & Storage Account No.: 300295 Account No.: Space — Discount Rock & Sand Phone: 7 -5504 E Phone: 305 - 743 -4531 Fax: 305 - 289 -9030 PO Box 198680 98680 645 -43` Street Atlanta, GA 30384 Marathon, Florida 33050 NAPA Auto Parts J &S Service / McKenzie Petroleum Account No.: 28575 Account No.: 12040190 Phone: 305 - 743 -5106 Ph: 305 - 852 -2881 boisvertmichelle @bellsouth.net 12188 Overseas Highway PO Box 640 (Attn: Michelle Olarte Smith) Marathon, FL 33050 Tavernier, FL 33070 I 2017 FLO RIDA PROFIT CORPORATION ANNUAL REPO DOCUMENT# P97000009534 Entity Name: DISCOUNT ROCK & SAND. INC. Current Principal Place of Business: 10500 AVIATION BLVD MARATHON, FL 33050 Current Mailing Address: P.O. BOX 504484 MARATHON, FL 33050 FEI Number: 65- 0730773 Name and Address of Current Registered Agent: LOPEZ, EDILBERTO 1077 79TH STREET OCEAN MARATHON, FL 33050 US FILED Jan 09, 2017 Secretary of State CCO088936363 Certificate of Status Desired: No The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Officer /Director Detail Title PST Name LOPEZ, EDILBERTO Address 1077 79TH STREET OCEAN City -State -Zip: MARATHON FL 33050 Title OFFICER Name GONZALEZ, YANET Address 255 68TH STREET, OCEAN City- State -Zip: MARATHON FL 33050 Date I hereby certify that the information indicated on this repoij or supplemental report is true and accurate and that my electronic signatule shall have the same legal effect as if made ender oath: that/ am an ofticeroi director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 607. Florida. Statutes; and that my name appears above . or on an attachment with all other like empowered. SIGNATURE: EDILBERTO LOPEZ PRESIDENT 01/09/2017 I Electronic Signature of Signing Officer /Director Detail Date Detail by FnIaN Name Page 1 B.3.b Detail by Entity Na rn Florida Profit Corporation DISCOUNT ROCK & SAND, INC. 4P Filir}t� lt�fonnr�ti�r� Document Number P97000009534 0 CJ FEI /EIN Number 65- 0730773 Date Filed 01/27/1997 7@ State FL 0 Status ACTIVE in Last Event CANCEL ADM DISS /REV Event Date Filed 12/22/2003 0 E Event Effective Date NONE Princip f ddress 10500 AVIATION BLVD MARATHON, FL 33050 Changed: 02/24/2015 M_.ai{inu Acldre <as P.O. BOX 504484 MARATHON, FL 33050 Changed: 04/30/2002 is iytE_rci:9 A Brit Narne & Address LOPEZ, EDILBERTO 1077 79TH STREET OCEAN MARATHON, FL 33050 Name Changed 03/04/2011 Address Changed: 04/28/2006 Ofticet,'Dircc Det ail Name & Address Title PST LOPEZ, EDILBERTO 1077 79TH STREET OCEAN MARATHON, FL 33050 I Packet Pg. 80 littp: / /scarcli.sunbiz.ot Inquiry/ Corl)orationSearch/ SearchRestiltUetail ?iiiquirytyPC Entity... _ Detail by Fntity Name Title Officer Gonzalez, Yanet 255 68th Street, Ocean Marathon, FL 33050 ? ±?t?a!r arks Report Year Filed Date 2015 02/24/2015 2016 03/07/2016 2017 01/09/2017 Docu r7ter7k. Ir 1ac�r I Page B.3.b I Packet Pg. 81 littp: / /scai,cil.SUnbiz.ot-g/ Inquiry /('oi-poi-atioiiSearch/ Seat- cliReSLI ItDetail ?iiiquirytvpe= LntitN,.., E F _ — -. .... _ J _ I . . , __j Page B.3.b I Packet Pg. 81 littp: / /scai,cil.SUnbiz.ot-g/ Inquiry /('oi-poi-atioiiSearch/ Seat- cliReSLI ItDetail ?iiiquirytvpe= LntitN,.., Agreement Between Owner and Contractor Where the basis of payment is a S TIPULA TED SUM Made as of September 20, 2017, BETWEEN the Owner: Monroe County Board of County Commissioners 500 Whitehead Street Key West, FL 33040 And the Contractor: Discount Rock & Sand, Inc. 10500 Aviation Iv 2 Marathon, FL 33050 ARTICLE 2 locirtlenis, excep extent specifically indicated in the Contract Documents to be the responsibility of others, or as follows: N/A 11WqffL-!K- ykmq a Liquidated damages will be based on the Substantial Completion Date for all work, modified by all approved extensions in time as set forth by the Director of Project Management's signature of 2pproval on the Certificate of Substantial Completion. The liquidated damages table below shall be utilized to determine the amount of liquidated damages. WN 11111111071111 Pq 11 11 200.00/Day 500.00/Day The Contractor's recovery of damacies and sole remedy for anv delav caused by the Owner 4.2 The Contract Sum is based upon the following alternates, if any, which are described in the Contract Documents and are hereby accepted by the Owner: N/A 5.1 Based upon Applications for Payment submitted • the Contractor to the Director • Project Management, and upon approval for payment issued by the Director of Project Management and Architect, the Owner shall make progress payments on account of the Contract Sum to the contractor as provided below and elsewhere in the Contract Documents. F= AGREEMENT 00500- Page 2 of 14 Packet Pg. 83 FIRST CONTRACT AMOUNT 15 DAYS Under $50,000.00 $50.00/Day $50,000.00-99,999.00 100.00/Day $100, 000 00-499,999. 00 200.00/Day $500,000.00 and Up 500.00/Day WN 11111111071111 Pq 11 11 200.00/Day 500.00/Day The Contractor's recovery of damacies and sole remedy for anv delav caused by the Owner 4.2 The Contract Sum is based upon the following alternates, if any, which are described in the Contract Documents and are hereby accepted by the Owner: N/A 5.1 Based upon Applications for Payment submitted • the Contractor to the Director • Project Management, and upon approval for payment issued by the Director of Project Management and Architect, the Owner shall make progress payments on account of the Contract Sum to the contractor as provided below and elsewhere in the Contract Documents. F= AGREEMENT 00500- Page 2 of 14 Packet Pg. 83 no "1' 5.2 The period covered by each Application for payment shall be one (1) calendar month ending on the last day of the month, or as follows: 5.3 Payment will be made by the Owner in accordance with the Florida Local Government Prompt Payment Act, Section 218.735, Florida Statutes. 5.5 Applications for Payment shall indicate the percentage of completion of each portion of the Work as of the end of the period covered by the Application for Payment. 5.6 Subject to the provisions of the Contract Documents, the amount of each progress payment shall be computed as follows: 5.6.2 Add that portion of the Contract Sum properly allocable to materials and equipment delivered and suitably stored at the site for subsequent incorporation in the completed construction (or, if approved in advance by the Owner, suitably stored off the site at a location agreed upon in writing), less retainage; "I 61[19 WlMllgilml� 1111 1 , I I I I I a ir. I vp I ru I W-ROMOIS411-7I a mr. I ILIMIII MA 5.7 Retainage of ten percent (10%) will be withheld in accordance with Section 218.735 (8)(b), Florida Statutes. re kl =' I 00500- Page 3 of 14 Packet Pg. 84 ARTICLE 7 III&Wkwh- 7.1 TT'here reference is made in this Agreement to a provision ♦ the General Conditions or another Contract Document, the reference refers to that provision as amended or supplemented • other provisions • the Contract Documents. 7.2 Payment shall be made according to the Florida Local Government Prompt Payment Acl and Monroe County Code. Packet Pg. 85 7.3 Temporary facilities and services: As described in Section 01500, Temporary Facilities, of the Geter,91 Cono0itlats. 7.4 Monroe County's performance and obligation to pay under this contract is contingent upor. an annual appropriation by the Board of County Commissioners. INEWITWI I 00500- Page 5 of 14 Packet Pg. 86 provision with a valid provision that comes as close as possible to the intent of thp.. stricken provision. d) Attorney's Fees and Costs. 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, and shall include attorney's fees and courts costs in appellate proceedings. e) Binding Effect. The terms, covenants, conditions, and provisions of this Agreemen) shall bind and inure to the benefit of the County and Contractor and their respective legal representatives, successors, and assigns. f) Authority. 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. Each party agrees that it has had ample opportunity to submit this Contract to legal counsel of its choice and enters into this agreement freely, voluntarily and with advice • counsel. a - - WOM M M. M • INNUMUMILOns 11IRLYWRIGN W. . ! - 11 * 01 - !, ��M �I X6ZWNW= N ra n_ NEW In PINS 00500- Page 6 of 14 F Packet Pg. 877 �O i •� k) 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. 00500- Page 7 of 14 Packet Pg. 887 MIMM3= provision by the Contractor. Failure of the Contractor to abide by the terms of this provision shall be deemed a material breach of this contract and the County may enforce the terms of this provision in the form of a court proceeding and shall, as a prevailing party, be entitled to reimbursement • all attorney's fees and costs associated with that proceeding. This provision shall survive any termination or txpiration • the contract. The Contractor is encouraged to consult with its advisors about Florida Public Records Law in order to comply with this provision. Pursuant to F.S. 119.0701 and the terms and conditions of this contract, the Contractor is required to: (1) Keep and maintain public records that would be required by the County to perform the service. (2) Upon receipt from the County's custodian of records, provide the County with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law. (2) Ensure that public records that are exempt • confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the contractor does not transfer the records to the County. (5) A request to inspect or copy public records relating to a County contract must be made directly to the County, but if the County does not possess the requested records, the County shall immediately notify the Contractor of the request, and the Contractor must provide the records to the County or allow the records to be inspected or copied within a reasonable time. 00500- Page 8 of 14 Z K < Packet Pg. 897 MEMO= to a valid public records request within a reasonable time may be subject penalties under Section 119. 10, Florida Statutes. i The Contractor shall not transfer custody, release, alter, destroy or otherwiss dispose of any public records unless or otherwise provided in this provisi or as otherwise provided by law. I q.) Attestations. Contractor agrees to execute such documents as the County may reasonably require, to include a Public Entity Crime Statement, an Ethics Statement, and a Drug-Free Workplace Statement. t) No Personal Liability. No covenant or agreement contained herein shall be deemene to be a covenant or agreement of any member, officer, agent or employee of Monr County in his or her individual capacity, and no member, officer, agent or employee Monroe County shall be liable personally on this Agreement or be subject to a personal liability or accountability by reason of the execution of this Agreement. I u) 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. The first ten dollars ($10.00) of remuneration paid to the Contractor is for the indemnification provided for the above. OQ5O0' Page 10of14 Packet Pg w) Section Headings. Section headings have been inserted in this Agreement as a matter of convenience of reference only, and it is agreed that such section headings are not a part of this Agreement and will not be used in the interpretation of any provision of this Agreement. z) Florida Green Building Coalition Standards. Monroe County requires its buildings to conform to Florida Green Building Coalition standards. Special Conditions, if any are detailed in Section 00100 • the Project Manual for this Project. 77 Any written notices or correspondence given pursuant to this contract shall be sent by United States Mail, certified, return receipt requested, or by courier with proof of delivery Notice shall be sent to the following persons: For Contractor: Discount Rack & Sand, Inc. 10500 Aviation Blvd.- Unit 2 Marathon, Florida 33050 For Owner: Director of Protect Management Assistant County Administrator, PW & E 1100 Simonton St., Room 2-216 11 00 Simonton St. Key West, Florida 33040 Key West, Florida 33040 ARTICLE 8 91.11 The Contract may be terminated by the Owner as provided in Article 14 of the General ilk l: I �-$ = K1-ZX77MT■31 a# #1 - 1 The Contract Documents, except for Modifications issued after execution of this Agreement, are enumerated as follows: a) Drawings: Y R) Project Manual: None c) RFP and Bidding Documents - 08/02/17 9.1.1 The Agreement is this executed Standard Form of Agreement Between Owner and Contractor. 9.1.3 The Supplementary and other Conditions of the Contract are those contained in the Project Manual dated: N/A This Agreement is entered into as of the day and year first written above and is executed in at least two (2) original copies of which one (1) is to be delivered to the Contractor. Habitat for Humanity Building Demolition Execution by the Contractor must be by a person with authority to bind the entity, SIGNATURE OF THE PERSON EXECUTING THE DOCUMENT MUST BE NOTARIZED. (SEAL) Attest: Kevin Madok, Clerk BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA 83 Mayor/Chairman Dates MONROE COUNTY ATTORNEY Appif OVE D AS TO FORM, End of Section 00500 AGREEMENT 00500- Page 1 3 of 14 t»£ <.,« « I GENERAL REQUIREMENTS 01 740-Page 14 of 14 Packet Pg 95