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02/21/2018 AgreementC°uer, e Kevin Madok CPA ' Coun , Clerk of the Circuit Court & Comptroller J troller — Monroe Florida � "R OE COUH 4 DATE: March 15, 2018 TO: Tammy Sweeting Executive Assistant FROM: Pamela G. Hanco&C. SUBJECT: February 21" BOCC Meeting Enclosed is a duplicate original of Item C2, (Ann Mytnik) Contract for $5,000.00 with Lucy Paige for public art at Bernstein Park recommended by the Art in Public Places Committee and the Florida Keys Council of the Arts, for your handling. Should you have any questions, please feel free to contact me at extension 3550. cc: County Attorney Finance File KEY WEST 500 Whitehead Street Key West, Florida 33040 305 - 294 -4641 MARATHON 3117 Overseas Highway Marathon, Florida 33050 305- 289 -6027 PLANTATION KEY 88820 Overseas Highway Plantation Key, Florida 33070 305 - 852 -7145 PK/ROTH BUILDING 50 High Point Road Plantation Key, Florida 33070 305 -852 -7145 i Monroe County Art in Public Places Award A g ree ment This AGREEMENT dated the 21 day of February 2018, is entered into by and between the BOARD OF COUNTY COMMISSIONERS FOR MONROE COUNTY, hereinafter "County" or `BOCC ", and LUCY PAIGE, hereinafter "Artist". WHEREAS, the Monroe County BOCC recognizes the extent of cultural resources available in the county for development, promotion, and enjoyment of the arts. It is the intent of the BOCC to enrich culturally and benefit the citizens of this county through the establishment of Art in Public Places; and WHEREAS, the Art in Public Places Ordinance #022 -2001 (AIPP Ordinance), codified at MCC §2- 233(l), authorizes the allocation of one percent (1 %) of the County's construction costs for new construction exceeding $500,000.00 and renovations exceeding $100,000.00 to be set aside in a fund and used for acquisition, commission, installation, and maintenance of works of art to be used in, upon, or around the new or renovated County buildings; and WHEREAS, the Ordinance established an Arts in Public Places (AIPP) Committee to review responses to Requests for Proposals for art to be acquired, commissioned, installed, and maintained in public construction projects and to advise the BOCC regarding the art subject to the AIPP allocation; and WHEREAS, the BOCC desires to acquire public artwork to be installed and located at the newly developed Bernstein Park to promote understanding and awareness of the visual arts and to enrich the public environment for residents and visitors; and WHEREAS, in conformity with the AIPP Ordinance and MCC §2 -233,. the Artist was selected by the AIPP Committee to provide public artwork for this location; and 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 issuance of a notice to proceed to execute and complete their work. This agreement shall remain in effect for the stated period unless one party gives to the other written notification of termination pursuant to and in compliance with paragraphs 12 and 13 below. All work for which AIPP funds are to be expended must be completed by the stated termination date. 2. SCOPE OF AGREEMENT: The Artist shall provide: Two (2) mixed media acrylic paint and paper collage wood framed panels with polyurethane finish for protection, measuring 3' x 4' x 112" each depicting children and families at play. Art in Public Places — Bernstein Park, Lucy Paige Artist shall confer with and coordinate activities with Monroe County personnel and /or Elizabeth Young, Executive Director of the Florida Keys Council of the Arts, in order to insure that there is as much cooperation and cohesiveness in the incorporation of the art in or around the building or onto the retaining wall so that there shall be the least amount of interference by the Artist. 3. AMOUNT OF AGREEMENT AND PAYMENT: The County shall provide an amount not to exceed Five Thousand and 00 /100 ($5,000.00) Dollars for materials and services used to create and install the project. The Board of County Commissioners assumes no liability to fund this agreement for an amount in excess of this award. Monroe County's performance and obligation to pay under this agreement is contingent upon an annual appropriation by the BOCC. 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 rates: 1) Design Phase: 33.3% of total payment; 2) Materials: 33.3% of total when artist submits receipts for materials and eligible costs equal to or greater than 33.3% of the contract total. Travel expenses are included in this phase and shall be paid in accordance with Monroe County Code of Ordinances, Sec. 2 -106 et. seq., as described in 2a) below: 2a) Travel: All travel expenses shall be reported on a State of Florida Voucher for Reimbursement of Travel Expenses as adopted by Monroe County. If Artist has airfare, the original boarding pass, or equivalent, must be attached to the Voucher. If Artist travel is in a vehicle, mileage must be reported on the Voucher. Mileage is reimbursable at fifty -three ($0.53) 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 $10.00; Lunch — when travel begins before 12 noon and extends beyond 2 p.m. for $15.00; and Dinner — when travel begins before 6 p.m. and extends beyond 8 p.m. for $30.00. A State -of Florida Voucher for Reimbursement of Travel Expenses as adopted by Monroe County is attached and made part of this contract. 3) Completion: 33.3% final payment due when installation is deemed complete and contractual agreement specifications are verified by the Monroe County Project Management Department or its designee. 2 Art in Public Places — Bernstein Park, Lucy Paige Eligible costs and expenditures for the project and the total award include, but are not limited to: A. Artist's design fee B. Labor, materials, and contracted services required for production and installation C. Artist's operating expenses related to the project D. Travel related to this project, pursuant to statutory limitations (see above paragraph 3, item 2a). E. Transportation of the work to the site (see above paragraph 3, item 2a). F. Installation to the site G. Permits and fees necessary for the installation (applicable for exterior projects which also require HARC review) H. Legal costs directly related to the project I. Liability costs of artist Payment shall be made upon presentation of an original invoice and documentation necessary to support the completion of the work. Artist shall also provide any release of liens, if applicable. Final payment request must be submitted no later than sixty (60) days after the completion of the project. 4. OWNERSHIP and RIGHTS: Upon the installation of the artwork and acceptance by the County, the County shall own the artwork and title to the artwork shall pass to the County. This Article 4 and the Artist's signature on this Agreement shall constitute and be construed as the Artist's express waiver of rights as provided in 17 U.S.C. §106A, et.al., to the extent that the artwork may be removed, adjusted, replaced, and /or relocated, as deemed necessary by the County without obtaining a waiver or permission from the Artist, and that modification to the artwork resulting from conservation or public presentation involving lighting and placement is not prohibited modification or considered alteration, distortion, or mutilation of the artwork. Artist agrees that the County as owner of the building and /or property that includes the artwork may, without the consent or permission of the Artist, make or authorize the making of alterations and /or destruction of such building and /or property. Artist agrees that where the artwork may be created or conceived in any fashion by more than one author, the Artist's signature and waiver binds the entire group of authors /artists. 5. RECORDS: The Artist shall keep such records as are necessary to document performance of the agreement and give access to these records at the request of the County, the State of Florida, or authorized agent and representative of said government bodies. The Artist understands that it shall be responsible for repayment of any and all audit exceptions which are identified by the Auditor General 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. For Public Records requirements see paragraph 22 below. 3 Art in Public Places — Bernstein Park, Lucy Paige 6. MODIFICATIONS AND AMENDMENTS: Any and all modifications of the terms of this agreement shall be only amended in writing and approved by the BOCC. Extensions of time to complete any terms or conditions of this Agreement must be made in writing and may be approved only by the BOCC. 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 County Commissioners of Monroe County. No statement contained in this agreement shall be construed as to find the Artist or any of its employees, contractors, servants or agents to be employees of the Board of County Commissioners of Monroe County, and they shall be entitled to none of the rights, privileges, or benefits of employees of Monroe County. COMPLIANCE WITH LAW: In carrying out its obligations under this agreement, the Artist shall abide by all statutes, ordinances, rules, and regulations pertaining to or regulating the provisions of this agreement, including those now in effect and hereafter adopted. 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 written notice of termination to the Artist. 9. HOLD HARMLESS /INDEMNIFICATION: 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 its officers and employees from and against any and all claims, liabilities, litigation, causes of action, damages, costs, expenses (including but not limited to fees and expenses arising from any factual investigation, discovery or preparation for litigation), and the payment of any and all of the foregoing or any demands, settlements, or judgments arising directly or indirectly under this agreement. The Artist shall immediately give notice to the County of any suit, claim, or action made against the County that is related to the activity under this agreement, and will cooperate with the County in the investigation arising as a result of any suit, action, or claim related to this agreement. 10. NON - DISCRIMINATION: The parties agree that there will be no discrimination against any person, and it is expressly understood that upon a determination by a court of competent jurisdiction that discrimination has occurred, this Agreement automatically terminates without any further action on the part of any party, effective the date of the court order. The parties agree to comply with all Federal and Florida statutes, and all local ordinances, as applicable, relating to nondiscrimination. These include but are not limited to: 1) Title VII of the Civil Rights Act of 1964 (PL 88 -352), which prohibit discrimination in employment on the basis of race, color, religion, sex, and national origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC §§ 1681 -1683, and 1685- 1686), which prohibits discrimination on the basis of sex; 3) Section 504 of the Rehabilitation Act of 1973, as amended (20 USC 4 Art in Public Places — Bernstein Park, Lucy Paige § 794), which prohibits discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975, as amended (42 USC §§ 6101- 6107), which prohibits discrimination on the basis of age; 5) The Drug Abuse Office and Treatment Act of 1972 (PL 92 -255), as amended, relating to nondiscrimination on the basis of drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91 -616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, §§ 523 and 527 (42 USC §§ 690dd -3 and 290ee -3), as amended, relating to confidentiality of alcohol and drug abuse patient records; 8) Title VIII of the Civil Rights Act of 1968 (42 USC §§ 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The Americans with Disabilities Act of 1990 (42 USC §§ 1201), as amended from time to time, relating to nondiscrimination in employment on the basis of disability; 10) Monroe County Code Chapter 14, Article II, which prohibits discrimination on the basis of race, color, sex, religion, national origin, ancestry, sexual orientation, gender identity or expression, familial status or age; and 11) any other nondiscrimination provisions in any federal or state statutes which may apply to the parties to, or the subject matter of, this Agreement. 11. ANTI - KICKBACK: The Artist warrants that no person has been employed or retained to solicit or secure this agreement upon an agreement or understanding for a commission, percentage, brokerage or contingent fee, and that no employee or officer of the County has any interest, financially or otherwise, in the said funded project, except for general membership. For breach or violation of this warranty, the County shall have the right to annul this agreement without liability or, in its discretion, to deduct from the agreement price or consideration, the full amount of such commission, percentage, brokerage or contingent fee. 12. TERMINATION: This agreement shall terminate pursuant to Paragraph 1. Termination prior thereto shall occur whenever funds cannot be obtained or cannot be continued 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 of this agreement pursuant to the terms specified herein, this agreement may then be terminated immediately by written notice of termination delivered in person or by mail to Artist. The County may terminate this agreement without cause upon giving ninety (90) days written notice of termination to Artist. The County shall not be obligated to pay for any services or goods provided by Artist after Artist has received written_ notice of termination. 13. TERMINATION FOR BREACH: The County may immediately terminate this agreement for any breach of the terms contained herein. Such termination shall take place immediately upon receipt of written notice of said termination. Any waiver of any breach of covenants herein contained 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. 5 Art in Public Places — Bernstein Park, Lucy Paige , 14. ENTIRE AGREEMENT: This agreement constitutes the entire agreement 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. 15. CONSENT TO JURISDICTION: 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. 16. ETHICS CLAUSE: Artist warrants that she has not employed, retained or otherwise had act on her behalf any former County officer or employee 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 full amount of any fee, commission, ,percentage, gift, or consideration paid to the former or present County officer or employee. 17. 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 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 not 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 Florida Statutes, Section 287.017, for CATEGORY TWO for a period of thirty-six (36) months from the date of being placed on the convicted vendor list. Artist represents that Artist is not on the Convicted Vendor list. 18. 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 is 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. 6 Art in Public Places — Bernstein Park, Lucy Paige At all times during the term of the agreement and for one (1) year after acceptance of the project, unless the requirement is waived by the Monroe County Risk 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 effect. All insurance policies must specify that they are not subject to cancellation, non - renewal, material change or reduction in coverage unless a minimum of thirty (30) days prior notification is given to the County by the insurer. Acceptance and/or approval of Artist's insurance shall 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 Insured" on all policies except workers' compensation. Any deviations from these General Insurance Requirements must be requested in writing on the County form titled "Request for Waiver of Insurance Requirements" and must be approved by Monroe County Risk Management. The following coverages shall be provided prior to commencement of work governed by this contract: 1. Workers' Compensation if, and as required by Florida Statutes 2. 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 • Expanded Definition of Property Damage The minimum limits acceptable shall be: $300,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $100,000 per Person $300,000 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 7 Art in Public Places — Bernstein Park, Lucy Paige for which claims may be reported should extend for a minimum of twelve (12) months following the acceptance of work by the County. 21. NOTICE: Any written notice to be given to either party under this agreement or related hereto shall be in writing and hand delivered or mailed, postage pre -paid, by certified mail, return receipt requested, and addressed and delivered as follows: For Artist: Lucy Paige 1007 Loggerhead Lane Sugarloaf, FL 33042 For County: Florida Keys Council of the Arts 1100 Simonton Street Key West, FL 33040 and County Attorney P.O. Box 1026 Key West, FL 33041 -1026 22. PUBLIC RECORDS COMPLIANCE: Contractor must comply with Florida public records laws, including but not limited to Chapter 119, Florida Statutes and Section 24 of Article I of the Constitution of Florida. The County and Contractor shall allow and permit reasonable access to, and inspection of, all documents, records, papers, letters or other "public record" materials in its possession or under its control subject to the provisions of Chapter 119, Florida Statutes, and made or received by the County and Contractor in conjunction with this contract and related to contract performance. The County shall have the right to unilaterally cancel this contract upon violation of this 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 of all attorney's fees and costs associated with that proceeding. This provision shall survive any termination or expiration of 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 Art in Public Places — Bernstein Park, Lucy Paige within a reasonable time at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law. (3) Ensure that public records that are exempt or 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. (4) Upon completion of the contract, transfer, at no cost, to the County all public records in possession of the Contractor or keep and maintain public records that would be required by the County to perform the service. If the Contractor transfers all public records to the County upon completion of the contract, the Contractor shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the Contractor keeps and maintains public records upon completion of the contract, the Contractor shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the County, upon request from the County's custodian of records, in a format that is compatible with the information technology systems of 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. If the Contractor does not comply with the County's request for records, the County shall enforce the public records contract provisions in accordance with the contract, notwithstanding the County's option and right to unilaterally cancel this contract upon violation of this provision by the Contractor. A Contractor who fails to provide the public records to the County or pursuant to a valid public records request "within a reasonable time may be subject to penalties under Section 119.10, Florida Statutes. The Contractor shall not transfer custody, release, alter, destroy or otherwise dispose of any public records unless or otherwise provided in this provision or as otherwise provided by law. IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS, BRIAN BRADLEY AT PHONE# 305- 292 -3470 BRADLEY - BRIAN6 MONROECOUNTY- FL.GOV, MONROE COUNTY ATTORNEY'S OFFICE 1111 12 Street, SUITE 408, KEY WEST, FL 33040. 23. RISK OF LOSS: Risk of loss or damage to the artwork shall be borne by the Artist until acceptance of the artwork by the County as indicated after the final 9 Art in Public Places — Bernstein Park, Lucy Paige payment has been made by the County. The Artist shall carry insurance sufficient to cover the purchase price of the artwork to cover risk of loss or damage to the artwork until final acceptance by the County. 24. WARRANTIES OF QUALITY AND CONDITION: Artist represents and warrants that the artwork, as fabricated and installed, will be free from defects in material and workmanship which cause or accelerate deterioration of the artwork and that reasonable maintenance of the artwork will not require procedures substantially in excess of those described in the Artist's maintenance recommendations or proposal. The warranties described in this Article shall survive for a period of five (5) years after final acceptance of the artwork, with periodic required maintenance by the County, according to instructions provided by the Artist. The County shall give written notice to the Artist of any breach of this warranty during the five (5) year period. The Artist shall, at no cost to the County, cure reasonably and promptly the breach of warranty by means of repair, restoration, refurbishing, re- creation, or replacing the artwork. ® 5. RE AND RESTORATION: The County reserves the right to determine CD An and if repairs and restorations to the artwork will be made after final ptance. Repairs and restorations to the artwork occurring five (5) years after °- ounty's final acceptance of the artwork will be the responsibility and at the nse of the County. "IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed by,its authorized representative on the day and year first above written. '� (SEAL) r 19j e 1 BOARD OF COUNTY COMMISSIONERS �z,� ATTEST KEVIN MADOK, CLERK OF MONROE COUNTY, FLORIDA By By: Deputy Clerk MayoftChairman MO OE COUNTY ATTORNEY'S OFFICE PPR01(ED AS O Ff�� . PATRICIA EABLES ASSISTANT COU TY A�RNEY DATE: 1 - 1� - IV 10 Art in Public Places — Bernstein Park, Lucy Paige WITNESS: Signature Q a.i yi4 t - Print Name DATE: ARTIST: LUCY PAIGE ti Signature bwa Print Name/ DATE: STATE OF D COUNTY OF On this day of fl , 201 before me, the undersigned notary public, personally appeared Lucy Paige, known to me to be the person whose name is subscribed above or who produced 9iil/EB S Li tffir as identification, and acknowledged that she is the person who executed the above contract with Monroe County for the artwork at Bernstein Park, for the purposes therein contained. ANN M. MYTNIK Notary Public - State of Florida Commission # GG 009808 My Comm. Expires Jul 24, 2020 11 Art in Public Places — Bernstein Park, Lucy Paige My Commission Expires :. Mytnik -Ann From: Lucy Paige <lucypaige @mindspring.com> Sent: Wednesday, December 20, 2017 10:54 AM To: Mytnik -Ann Subject: Lucy Paige - Bernstein Park Info -from original proposal if helpful Bernstein Park -Art in Public Places Proposal My proposal for this project is art work for the targeted space #3; the covered areas under the community building and the shaded recreation area. The intended subject of the art is to depict children and families as they might actually utilize the new Bernstein Park grounds and facility. The art work would portray children of varying ages and ethnic backgrounds as they play together on the recreation fields and playground. Depictions might include the kids practicing and on youth sports teams as they play soccer, softball, basketball and football. Other images would reflect the younger kids playing on the colorful playground equipment; sliding, swinging and hanging on jungle bars. The art would show kids running, kids biking, kids kicking balls, kids throwing balls, kids just hanging out together; kids with parents and kids with coaches. Adults engaged with the kids as well as also using the exercise trail and playing fields might also be incorporated into the art work. The style of the proposed art is a combination of line drawing, acrylic painting and paper collage to create playful scenes utilizing varying individuals and /or groups of characters, their play equipment (bats, balls and bikes) as well as suitable background images. The background, clothing, and other images would bring in local and recognizable Stock Island, Key West and Florida Keys features. For several years I have been creating a series of "Beach Day" paintings which incorporates this painting /collage style. These pieces utilize beach going characters as they swim, snorkel and sunbathe and their colorful beach umbrellas, blankets, bags and other play items. Unlike these smaller paintings with small characters, the characters in these proposed art panels would be much larger in size and in scale with the panel size. Digital images of a sample of the "Beach Day" paintings are provided in this package. 14 4' lfx /lwa 11 m � *0 e I = F u F � {f ����� ,,� �� STATE OF FLORIDA VOUCHER FOR REIMBURSEMENT OF TRAVEL EXPENSE TRAVELER AGENCY HEADQUARTERS Check One: OFFICER/EMPLOYEE — NON-EMPLOYEE/IND. CONTRACTOR RESIDENCE CITY Date 2018 Travel Performed From Point of Origin To Destination Purpose or Reason (Name of Conference) Hour of Departure and Hour of Return Meals for Class A & B Travel Per Diem or Actual Lodging Expenses Class C Meals Map Mileage Claimed Vicinity Mileage Claimed Other Expenses Amount Type M M M M M M M M M M M M M M Statement of Benefits to the State: (Conference or Convention) Column Total Column Total Column Total Miles Column Total SUMM TOTAL @ $0.53 per mile Revolving Fund: Check No. Check Date Agency Voucher No. Advance: LESS ADVANCE RECEIVED $( ) Warrant No. LESS CLASS C MEALS (Officers /Employees Only) $( ) Warrant Date NET AMOUNT DUE Statewide Doc. No. Agency Voucher No. I hereby certify or affirm that the above expenses actually incurred by me as necessary travel expenses in the performance of my official duties; attendance at a conference or convention was directly related to official duties of the agency; any meals or lodging included in a conference or convention registration fee have been deducted from this travel claim; and that this claim is true and correct in every material matter and same conforms in every respect with the requirements of Section 112.061, Florida Statutes. TRAVELER'S SIGNATURE: DATE PREPARED: TITLE: Pursuant to Section 112.061 (3)(a), Florida Statutes, I hereby certify or affirm that to the best of my knowledge the above travel was on official business of the State of Florida and was performed for the purpose(s) stated above. SUPERVISOR'S SIGNATURE: SUPERVISOR'S TITLE: DATE APPROVED: FOR AGENCY USE: = Travel Performed by Common Carrier or State Vehicle This section required to be completed only when common carrier is billed directly to the state agency. Date Ticket Number or State Vehicle Number From To Amount Name of Common Carrier or State Agency Owning Vehicle GENERAL, INSTRUCTIONS Class A Travel— Continuous travel of 24 hours or more away from official headquarters. Breakfast —when travel begins before 6 A.M. and extends beyond 8 A.M. Class B travel — Continuous travel of less than 24 hours which involves overnight Lunch —when travel begins before 12 noon and extends beyond 2 P.M. absence from official headquarters. Dinner —when travel begins before 6 P.M. and extends beyond 8 P.M. or Class C travel— Travel for short or day trips where the traveler is not away from his when travel occurs during night -time hours due to special assignment. official headquarters overnight. NOTE: No allowance shall be made for meals when travel is confined to the city or town of official headquarters or immediate vicinity except assignments of official business outside the traveler's regular place of employment if travel expenses are approved and such special approval is noted on the travel voucher. Rates of Per Diem and Meals shall be those prescribed by Section 112.061, Florida Statutes. Per Diem shall be computed at one -fourth of authorized rate for each quarter of fraction thereof. Travel over a period of 24 hours or more will be calculated on the basis of 6 -hour cycles, beginning at midnight; less than 24 -hour travel will be calculated on the basis of 6 -hour cycles, beginning at the hour of departure from official headquarters. Hour of departure and hour of return should be shown for all travel. When claiming per diem, the meal allowance columns should not be used. Claims for actual lodging at the single occupancy rate plus meal allowances should include the commercial lodging expenses in the "Per Diem or Actual Lodging Expenses" column and include the appropriate meal allowances in the "Meals for Class A & B Travel" column. Claims for meal allowances involving travel that did not require the traveler to be away from his headquarters overnight should be included in the "Class C Meals" column. Vicinity travel must appear in the separate column. When travel is by common carrier and billed directly to the traveler, the amount and description should be included in the "Other Expenses" column. A copy of the ticket or invoice should be attached to this form. If travel is by common carrier and billed directly to the State agency, then the "Travel Performed by Common Carrier or State Vehicle" section above should be completed. The name of the common carrier should be inserted in the "Map Mileage Claimed " column in these instances. Justification must be provided for use of a non - contract airline (or one offering equal or lesser rates than the contract airline) or rental car (or one having lower net rates) when contract carriers are available. Additionally, justification must be provided for use of a rental car larger than a Class `B" car. If travel is performed by the use of a State -owned vehicle, the word "State" should be inserted in the "Map Mileage Claimed" column on the reverse side of this form, and the above section designated as "Travel Performed by Common Carrier or State Vehicle" should be completed. Incidental travel expenses which may be reimbursed include: (a) reasonable taxi fare, (b) ferry fares and bridge, road, and tunnel tolls, (c) storage and parking fees, (d) telephone and telegraph expenses, and (e) convention or conference registration fee. If meals are included in the registration fee, per diem should be reduced accordingly. Receipts should be obtained when possible. The official Department of Transportation map should be used in computing mileage claimed from point of origin to destination whenever possible. If travel is complimentary, the abbreviation "Comp." Should be inserted in the "Map Mileage Claimed" column. No mileage is allowed. When any State employee is stationed in any city or town for a period of over 30 consecutive work days, such city or town shall be deemed to be his official headquarters and he shall not be allowed per diem or subsistence after the period of 30 consecutive days has elapsed, unless extended by the approval of the agency head. If travel is to a conference or convention, the "Statement of Benefits to the State" section must be completed or a copy of the Authorization to Incur Travel Expense, Form DBF- AA-13, must be attached. Additionally, a copy of the agenda and registration receipt must be attached. Any fraudulent claim for mileage, per diem, or other travel expense is subject to prosecution as a misdemeanor. GERALD LEWIS Comptroller 1996 Edition MONROE COUNTY, FLORIDA Request For Waiver of Insurance Requirements It is requested that the insurance requirements, as specified in the County's Schedule of Insurance Requirements, be waived or modified on the following contract: Contractor: Lt4(; �GIIGI -U Contract for: Address of Contractor: J 1 ®G►G1 9 20� �fidi'I.�J Phone: Scope of Work: , 18 241 k E I a Z GVW�t�J(�G� 7G1 /I�G Reason for Waiver: Raak Will ly— & "Ikle j9f1 —_ .S /�� 1 0 _ l - Ii fllc" 0� &d4ia cv i,ZL er . Policies Waiver aetu Li A O will apply to: Iq./)r,lin�S &M Signature of Contractor: Approved Not Approved Risk Management: Date: County Administrator appeal: Approved Date: Board of County Commissioners appeal: Approved Meeting Date: Administrative Instruction #4709.3 Not Approved Not Approved WAIV_REQ.DOC tai :�ataadd� I'� u-aip"rul tMilaqa+lppy - '. - - tp+.ohddy alnaatdi %iawo!wiu coAtunaoJrp pmEl tal2q :Gt*ddiriQINXTeuquapv fqulw j iddy .P � .►�.�. lagia�4616�Jd>I�o 00 `1 0 11 0 4 IA YAW �� /Aw ( T/ - - - - �-- ......_ _- ___. - -._.. .air�aluguRl�� #Ai�Jy11•r164! 'JOWIS102 nul''+liltl+IJ 04h Im I 1lialit la piliklua aq' vauuaa�nla aaun�uwrtJa �InP R � 7��� X11 �! A llaada Im'e�uaslxc�tanilaa "llmnsal9 tIl 11111t palkallWi q p gau®wai1abrIl aauuansul !o Aulua jg panbon z toe U Awmr n�tlP� 11 Q1: E'Gly6a' IUUI "4 3rw 1996 Edition MONROE COUNTY, FLORIDA Request For Waiver of Insurance Requirements It is requested that the insurance requirements, as specified in the County's Schedule of Insurance Requirements, be waived or modified on the following contract: Contractor: LK/J! y Contract for: xtickiui �G���✓�/� `` P/aces Address of Contractor: /(QP�- LOd1�,P� l Lani& 3.642_ Phone: 3es- OM_#2 i( Scope of Work: ����_yY1/?l'lf i1''i pI%n (i7( y/I C 4//1 ii- Gt P.e ea1ge) pig wee' ?gals t51i h 3 w/& oc/ &int Reason for Waiver: Pane Will k ea/Tie-led D —S/ � • ,o lAfide,cf et o/ ii pf& i It//G1AM 0chal,//, p�t/� /c Oviet /idtdee . Policies Waiver qtiU&t I L1 (bl(!4 will apply to: IA.,nr,1 e et om 6'm Signature of Contractor: L PArf Ti Ap roved Ju �� QNot Approved Risk Management: lS Date: County Administrator appeal: Approved Not Approved Date: Board of County Commissioners appeal: Approved Not Approved Meeting Date: Administrative Instruction WAIV_REQ.DOC #4709.3