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Item G2
BOARD OF GOVERNORS FIRE AND AMBULANCE DISTRICT 1 AGENDA ITEM SUMMARY Meeting Date: Februa 16 2010 Division: Emergency Services Bulk Item: Yes No X Department: Fire Rescue Staff Contact Person/Ext: Camille Dubroff X 6010 AGENDA ITEM WORDING: Approval to award bid and enter into an agreement between Board of Governors Fire and Ambulance District 1 of Monroe County and Roy Khanna for maintenance of Fire Rescue ambulances and other vehicles, including quarterly inspections, preventative maintenance, and unscheduled maintenance resulting from malfunction or failure. ITEM BACKGROUND: On January 11, 2011 sealed bids were opened for the maintenance of Fire Rescue ambulances and other vehicles, including quarterly inspections, preventative maintenance, and unscheduled maintenance resulting from malfunction or failure. Roy Khanna was the only bidder. We are requesting that the Board accept the Roy Khanna bid and enter into an agreement commencing on March 1, 2011 and ending February 28, 2014. The agreement provides for one renewal for a one (1) year term, with the approval of the Board. The previous agreement was with Roy Khanna which expires on February 28, 2011. Itemized pricing for the hourly labor rate was increased in the new contract from $73.00 to $75.00 and the quarterly preventative maintenance ambulance inspection rate -` was increased from $265.00 to $275.00. Parts are to be marked up by 25% over cost by Contractor. PREVIOUS RELEVANT BOG ACTION: On November 17, 2010 the Board approved to advertise for sealed bids for the maintenance of Monroe County Fire Rescue ambulances and other vehicles including inspections, preventative maintenance, and unscheduled maintenance and repairs resulting from failure or malfunction. CONTRACT /AGREEMENT CHANGES: The hourly labor rate in the new contract has increased from $73.00 to $75.00 and the quarterly preventative maintenance ambulance inspection rate increased from $265.00 to $275.00. STAFF RECOMMENDATIONS: All conditions of the previous agreement have been met and services provided have been satisfactory. Staff recommends entering into a new agreement with Roy Khanna. TOTAL COST: $110,000 * INDIRECT COST N/A BUDGETED: Yes X No *Current contract estimate based on last year costs. DIFFERENTIAL OF LOCAL PREFERENCE Yes COST TO COUNTY: same as above. SOURCE OF FUNDS: 13001 -530 -462 REVENUE PRODUCING: Yes V6T X AMOUNT PER MONTH Year c APPROVED BY: County Atty urc hasing _ Risk Management DOCUMENTATION: Included X Not Required DISPOSITION: AGENDA ITEM # Revised 07109 MONROE COUNTY BOARD OF GOVERNORS CONTRACT SUMMARY Contract with: Roy Khanna Contract # Effective Date: 3/1/2011 Expiration Date: 2/25/2014 Contract Purpose/Description: New agreement dated 3/1/2011 for scheduled general and preventative maintenance of Monroe County Fire Rescue ambulances and other vehicles; and for unscheduled maintenance and repairs resulting from equipment failure or malfunction. Contract Manager: Camille Dubroff (Name) for BOG meeting on 2/16/2011 6010 Emergency Services / Stop 14 (Ext.) (Department /Stop #) genda Deadline: 02/01/2011 CONTRACT COSTS I Total Dollar Value of Contract: $ FY 10- $110,000.00 Current Year Budgeted? Yes® No ❑ Grant: $ County Match: $ Portion: $ Account Codes: 13001 -530 -462 - $110.000.00 ADDITIONAL COSTS Estimated Ongoing Costs: $ /yr For: (Not included in dollar value above) (eg. maintenance, i etc. CONTRACT REVIEW I Comments: Date Out OMB Form Revised 2127101 MCP #2 Changes Date In Needed Division Director V Yes❑ No[ Risk Managem nt Yes[:] Nof. O.M.B./Purc sing 0 l YesM Not County Attorney a�\ \ Yes❑ No[ I Comments: Date Out OMB Form Revised 2127101 MCP #2 m W �- -1 � U c LL1 ©O Ui L(] L!) LU N U of vii O cu V s W fu 2: Z 4.1 u N 4 Z G �- to W O m L 0-J T- 0) t m 0 a U ) h Q v a U � a LL m p LL W U L 0 } m W 0 s L- ° Zz0 ° F p LL cyl z L _ C z 2 U a n a n C H O m C W U m o rn W W ® [ u' 0-+- c a ine Z z "a EO W C ® LL O U W ° I'a- V Z 4 } to L Ot Lll ❑ d y °ZS ° U z N v1 0 } u U N DC TA L L ° cs Z JW L m W o u LL ay Ei ;4 o _ w s} -_ f ::: i I H V) Cd SUBMISSION PROPOSAL RESPONSE FORM Maintenance of Monroe County Fire Rescue Ambulances and Other Vehicles Respondents Name and Mailing Address: ko v �� n Telephone and Fax Numbers: G 4 1'6 - o ICA' C All amounts must be written AND in number format. In case of a conflict between the amount in words and the amount in numbers, the amount in words shall control. Prices are to be inclusive of travel, mileage, etc. Hourly hate for Scheduled Preventative Maintenance: $ J 0 Charge for for conducting ambulance and other vehicle inspections (with each preventative maintenance): G� Q.� off-- -. i Parts to be marked ups: % over bbst to the Contractor I have included: • Proposal _✓ • Submission Response Form +/ • Non Collusion Affidavit / • Public Entity Crime Statement • Lobbying and Conflict of Interest Clause Form • Drug Free Workplace Form / • Indemnification and Hold Harmless • Local Preference Form {/ (Check mark items above, as a reminder that they are included). I state that I am authorized to submit this proposal: STATE OF k0 011 - COUNTY OF 1 (U : S ature of Respondent) 50 (- � - --3 V-- / v Date PERSONAL Y APPEARED BEFORE ME, the undersigned authority, K,0 � __ who, after first being sworn by me, (name of indi l signing affixed jys/her si ature in the space provided above on this day of , 2014a. pc,✓sl '--r— Organization Cade Ea,laendit€are Detail items Budget grouped by Organizatinn Code, Account Object Monroa Count Board of County Commissioners Fiscal Year 2011 t1?, 13001 Lk & hill. Ambulance 530440 Rentals And Le: 13001 Lk & Mk Ambulance 530440 Rentals And Leases Notes: These tough gook computers are mobile units used to capture EMS patient care incident reports and send them to the server for billing and reporting. The units currently in use are quickly becoming obsolete, and are in need of replacement. Leasing is a better option than outright purchase since all the units can be replaced at once, keeping consistency and reducing repair costs. The cost to lease 8 tough boons for 48 months is $707.01 per month. The cost for one Fiscal Year is $8,465, 530440 Rentals And Leases 41,923 41,923 41,923 0 0 13001 Lk & Mk Ambulance 4 1,92 3 4 41, 923 p 0 530440 Rentals And Leases 41,923 41,923 41,923 0 0 530451 Risk Management Charges 13001 Lk & Mk Ambulance 530451 Risk Management Charges FYI proposed Risk 1 94,565 94,565 94,565 0 0 Notes: This is an estimate based on previous year. Risk Management will update this line item to the correct figure for FYI 1. 13001 Lk & Mk Ambulance 94,565 94,565 94,565 0 0 530451 Risk Management Charges 94,565 94,565 94.565 0 - n 530460 Repair And Maintenance 13001 Lk & Mk Ambulance 530460 Repair And Maintenance 01) SCBA Annual Inspection and Certification 1 1,000 1,000 1,000 Notes: NFPA Standard 1981 requires annual recertification of all Self Contained Breathing Apparatus (SCBA) to assure that they are operating correctly and providing the required respiratory protection for firefighters. The cost for this annual inspection and ceriification is $100 per pack, and there are 5 rescue units with 2 air packs per, for a total of 10 air packs. 02) Stretchers 1 5,000 5,000 5,000 Notes: Average annual expense. Historical experience. 03) Medtronic Physle Control 1 23,000 23,000 23,000 Notes: Maintenance of LifePak defibrillators as required by Joint Committee Accreditation of Hospitals (JCAH). Historical experience. 04) ALS Trainer Manikin Replacement Parts 1 2,000 2,000 2,000 Notes: Historical experience. 13001 Lk & Mk Ambulance 110,000 110 ,00 0 110, 0 0 530462 Vehicle Maint 110,000 110,0 11 0,00 0 0 0 530470 Printing And Binding -V , �f '13001 Lk & Mk Ambulance 530470 printing And Binding 01) Forms 1 600 600 600 0 0 Notes: Historical experience, cost of printing forms as required for field operattions. 13001 Lk & Mk Ambulance 600 600 60 0 0 0 530470 Printing And Binding 600 600 600 0 0 .Max V5 42 1011/2010 5304GO Repair And Maintenance 31,000 31,000 31,000 0 0 13001 Lk & Mk Ambulance 31, 3 1, 0 00 3 1,000 0 0 530460 Repair And Maintenance 31,000 31,000 31,000 0 0 5304.62 Vehicle Maint 13001 Lk & Mk Ambulance 1 530462 Vehicle Maint 01) Vehicle Maintenance 1 110,000 110,000 110,000 0 0 Notes: Historical experience to cover 8 rescue units, Battalion Chief vehicles, and a USAR vehicle. 13001 Lk & Mk Ambulance 110,000 110 ,00 0 110, 0 0 530462 Vehicle Maint 110,000 110,0 11 0,00 0 0 0 530470 Printing And Binding -V , �f '13001 Lk & Mk Ambulance 530470 printing And Binding 01) Forms 1 600 600 600 0 0 Notes: Historical experience, cost of printing forms as required for field operattions. 13001 Lk & Mk Ambulance 600 600 60 0 0 0 530470 Printing And Binding 600 600 600 0 0 .Max V5 42 1011/2010 CONTRACT BETWEEN THE BOARD OF GOVERNORS OF FIRE AND AMBULANCE DISTRICT I OF MONROE COUNTY, FLORIDA AND ROY KHANNA FOR MAINTENANCE OF FIRE RESCUE AMBULANCES and OTHER VEHICLES THIS CONTRACT, hereinafter "CONTRACT OR AGREEMENT" made and entered into this 16`" day of February, 2011 by and between the Board of Governors Fire and Ambulance District 1 of Monroe County, Florida, hereinafter referred to as "COUNTY ", and Roy Khanna , hereinafter referred to as "CONTRACTOR ". WITNESSETH: WHEREAS, the COUNTY advertised a notice of request for proposals for MAINTENANCE OF FIRE RESCUE AMBULANCES AND OTHER VEHICLES, WHEREAS, the successful Respondent was Roy Khanna and; WHEREAS, this CONTRACTOR represents that it is capable and prepared to provide such services, and; WHEREAS, the COUNTY intends to enter into an agreement for the maintenance of Monroe County Fire Rescue Type I ambulances and other vehicles which shall include inspections, preventative maintenance and unscheduled maintenance and repairs resulting from failure or malfunction with the CONTRACTOR and; WHEREAS, this contract is an "Agreement" between both parties, NOW, THEREFORE, in consideration of the promises contained herein, the parties agree as follows: A. CONTRACT DOCUMENTS — This contract consists of the Agreement, the CONTRACTOR'S response to the RFP, the documents referred to in the Agreement as a part of this Agreement. In the event of any conflict between any of the contract documents, the one imposing the greater burden on the CONTRACTOR will control. B. CONTRACT PERIOD AND RENEWAL - The effective date of this Agreement shall be March 1, 2011 through February 28, 2014 for three (3) years. This Agreement may be renewed for a one (1) year term, subject to approval of the Fire Chief of Monroe County Fire Rescue, the Office of Management and Budget and the Monroe County Board of Governors Fire and Ambulance District I . C. CONTRACT TERMINATION - This Agreement may be terminated for any reason by either party on 30 -day written notice without cause. If the CONTRACTOR fails to fulfill the terms of this Agreement, or attachments, properly or on time, or otherwise violates the provisions of the agreement or of applicable laws or regulations governing the use of funds, the County may terminate the contract by written notice. The notice shall specify cause. All finished or unfinished supplies or services. shall, at the option of the County, become property of the County. The County shall pay the CONTRACTOR fair and equitable compensation for expenses incurred prior to termination of the agreement, less any amount or damages caused by the CONTRACTOR'S breach. If the damages are more than compensation payable, the CONTRACTOR will remain liable after termination and the County shall pursue collection for damages. D. SUBJECT MATTER OF CONTRACT - This Agreement is for performing scheduled general and preventative maintenance of approximately Ten (10) Type I ambulances, Two (2) Rehab units, One (1) MCI Truck and One (1) MCI Trailer with Monroe County Fire Rescue. This shall include inspections, preventative maintenance and unscheduled maintenance and repairs resulting from failure or malfunction. See "Attachment I" for the list of ambulances and other vehicles. The amount of ambulances and other vehicles may be added or deleted throughout the life of the contract by Monroe County Fire Rescue. E. RATES -The hourly rate shall be $75.00 per man -hour with no travel time or mileage charge. The charge for conducting an ambulance inspection with each preventative maintenance performed will be $275.00. F. OVERTIME AND HOLIDAYS - Rates per man -hour for emergency repairs called outside normal business hours and federal holidays shall be one and one half times the normal rate. G. WORK SCHEDULE - Regularly scheduled inspections and preventative maintenance shall be conducted at such intervals as are approved by the COUNTY and by the manufacturer. The modular portion of the vehicle shall also be maintained in accordance with the manufacturer's recommendations. H. PARTS, FLUIDS AND LUBRICANTS - All parts, fluids, and lubricants used for maintaining and repairing vehicles shall be supplied by CONTRACTOR and billed to the COUNTY at cost plus 25 % . For parts $200.00 and over, a copy of original parts supplier invoices shall be attached to the bill. CONTRACTOR will be required to keep all original parts supplier invoices available at request by County for spot aecking and auditing purposes. L ENGINE OIL AND FILTER CHANGE and complete drive train lubrication and any other fluids and/or filter changes, shall be performed as recommended by the manufacturer. WEEKLY MAINTENANCE SCHEDULE - CONTRACTOR shall provide to the COUNTY a preventative maintenance schedule that can be performed weekly by the individual Fire Departments' personnel. The contractor shall provide in service training to the Lieutenants on all three shifts at all of the stations at no extra cost. This will be scheduled by the contractor with the on -duty Lieutenants and can be done during Preventative Maintenance visits. K. MAINTENANCE INVOICE and LOG- CONTRACTOR shall maintain an inspection and maintenance log on each vehicle AND shall also provide an invoice at the completion of each scheduled maintenance repair. The log and invoice shall contain at a minimum, but not be limited to, the following: (a) Starting date and time (b) Completion date and time (c) Billable labor hours (d) County Identification number of Apparatus serviced (e) Service performed (f) Parts used and cost (g) Name of service personnel (h) Vehicle mileage (i) Engine hours (if applicable) A copy of this log and invoice shall be supplied to the Fire Rescue Office within 30 days of the service. L. The Contractor shall respond to all original Emergency Field Repair Forms by emailing the invoice to the Logistics Support Services office with documentation of repairs made, parts used and any other miscellaneous information that is applicable (ex: Tires need to be changed). M. COMMUNICATION - CONTRACTOR shall maintain a telephone or paging device such that prompt notification of request for service is possible twenty -four (24) hours a day. The CONTRACTOR shall have two (2) hours to contact Monroe County Fire Rescue upon initial notification if reached by telephone or paging device and twelve (12) hours if contacted by email. N. RESPONSE TO SERVICE REQUEST - CONTRACTOR shall maintain itself in a state of readiness during normal working hours, 8:00 am — 5:00pm Monday thru Friday, and shall respond to the location where emergency repairs are needed within twelve (12 hours of receiving a request. For repairs required after normal working hours, CONTRACTOR shall respond to the location where emergency repairs are needed within twenty -four (24) hours of receiving a request. Contractor must notify the Logistics Support Office in advance of vacations or potential lapses in service so other arrangements can be made for service coverage. O. CERTIFICATION - CONTRACTOR shall provide evidence satisfactory to the COUNTY that they are an Emergency Vehicle Technician (EVT) certified as Level III Master Ambulance Technician and Automotive Service Excellence (ASE) certified Master Medium/Heavy Truck Technician. P. QUALIFICATIONS OF MAINTENANCE PERSONNEL - All personnel performing maintenance, repairs, adjustments and related work on Monroe County equipment shall be a certified or experiences in the work to be performed. Personnel performing work who are not certified or experienced in such work shall be directly supervised (in person) by an individual with such certification. Q. INDEMNIFICATION - CONTRACTOR shall indemnify and hold the COUNTY and Monroe County harmless for any negligence on its part, or faulty or improper workmanship, for all work performed under this contract, including all costs of collection, reasonable attorney fees, claim costs, and as per "Attachment B ". All property or equipment being directly maintained or repaired by CONTRACTOR shall be considered in its care, custody, and control while such work is in progress and until physical control of such property or equipment is restored to the COUNTY. LOCATION OF WORK - This contract is for maintenance of Fire Rescue vehicles located throughout Monroe County. R. INSURANCE - During the term of this contract, the CONTRACTOR must keep in force and affect the insurance required by Attachments G. Attachment G is attached and incorporated into this contract. S. ADDITIONAL REQUIRED STATEMENTS /VERIFICATIONS /AFFIDAVITS. Attached hereto in Attachments B, C, D, E and F are Non - Collusion Affidavit, Public Entity Crime Statement, Drug -Free Workplace Form, Conflict of Interest Clause, and Indemnification to Hold Harmless. T. PAYMENTS - Payments for semi- annual inspection, preventative maintenance and pump tests shall be made by the COUNTY within 30 days of the completion of the rendered services on each vehicle and proper invoicing by the CONTRACTOR. All payments will be made in accordance with the Florida Local Government Prompt Payment Act. All unscheduled maintenance and repair resulting from equipment failure or malfunction requiring service shall be billed by the CONTRACTOR at the applicable rates as specified in Section four, five and six of this AGREEMENT. The CONTRACTOR upon notification by the COUNTY of an equipment failure or malfunction requiring unscheduled maintenance shall, in a timely manner investigate the problem and provide to the COUNTY an estimate of the cost for repair and vehicle downtime. The CONTRACTOR upon receiving authorization to proceed from the COUNTY shall effectuate such repair; upon completion of same the CONTRACTOR shall notify the COUNTY of the outcome and actual cost. The COUNTY shall issue a separate purchase order for each occurrence of unscheduled maintenance and repair. 4 U. Monroe County's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Board of County Commissioners of Monroe County, Florida. V. Venue for any litigation arising under this contract must be in a court of competent jurisdiction in Monroe County, Florida. This Agreement is not subject to arbitration. IN WITNESS WHEREOF, each party hereto has caused this contract to be executed by its duly authorized representative. (SEAL) ATTEST: DANNY L. KOLHAGE, CLERK R-M Deputy Clerk BOARD OF GOVERNORS OF FIRE AND AMBULANCE OF MONROE COUNTY, FL DISTRICT 1 By: Mayor /Chairman , )WIN ness signature Y -*x Approved by MONROE COUNTY on Name and Address of Respondent: Roy Khanna 1033 Valencia Road KeyLargo, FL 33037 By: � rot_A--� Signatur of Respondent � (arA��/w Print Name and Title Date: ' - a o I 2011, Item ## 5 SUBMISSION PROPOSAL RESPONSE FORM Maintenance of Monroe County Fire Fescue Ambulances and Other Vehicles Respondents Name and Mailing Address: itt Telephone and Fax Numbers: All amounts must be written AND in number format. In case of a conflict between the amount in words and the amount in numbers, the amount in words shall control. Prices are to be inclusive of travel, mileage, etc. Hourly Rate for Scheduled Preventative Maintenance: $ Charge for conducting ambulance and other vehicle inspections (with each preventative maintenance): Parts to be ar -lied u b - �cv °lo the Contracfor over costa I have included: o Proposal o Submission Response Form v ' o Non Collusion Affidavit o Public Entity Crime Statement t/ o Lobbying and Conflict of Interest Clause Form �J o Drug Free Workplace Form t!" o Indemnification and Hold Harmless t/ o Local Preference Form (Check mark items above, as a reminder that they are included). I state that I am authorized to submit this proposal. STATE OF -- (Signature of Respondent) 500 -e-- COUNTY OF Date PERSONAL APPEARED BEFORE ME, the undersigned authority, K""0 4 W t I who, after first being sworn by me, (name of individual signingl affixed his/her signature in the space provided above on this day of 1, ��! (t�� -- - ,of the city of " -� L + trc c according to law on my oath, and under penalty of perjury, depose and say that; 1) 1 am _R-o- y K1 -- . the respondent making the Proposal for the project described as follows: j�djq-/M 1 CiL '�� -14' Acs `s R P- P--,,D -r/ 3 Sy -J;k� / PukVcV 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 respondent or with any competitor; 3) Unless otherwise required by law, the prices which have been quoted in this proposal have not been knowingly disclosed by the respondent and will not knowingly be disclosed by the respondent prior to proposal opening, directly or indirectly, to any other respondent or to any competitor; and 4) No attempt has been made or will be made by the respondent 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 knowledge that Monroe County relies upon the truth of the statements contained in this affidavit in awarding contracts for said project. STATE OF ISO I Pei' COUNTY OF O (dig of Respondent) 15 o L I )-- - J-0 --/ b Date PERSONALLY APPEARED BEFORE ME, the undersigned authority, A (/ L ($ who, after first being sworn by me, (name of individu l signing) affixed his/her signature in the space provided above on this OMB - MCP FORM #1 Attachment B 26 PUBLIC ENTITY CRIME STATE +ITT "A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a proposal on a contract to provide any goods or services to a public entity, may not submit a proposal on a contract with a public entity for the construction or repair of public building or public work, may not submit proposals on leases of real property to public entity, may not be awarded or perform work as a bidder, supplier, subbidder, or RESPONDENT 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." By executing this form, l acknowledge that I/my company is in compliance with the above. STATE OF f! 7 M COUNTY OF (Sigl&ureof Respondent) -5 a t, - e [,)-- -- J- o Date PERSONALLY APPEARED BEFORE ME, the undersigned authority, '= who, after first being sworn by me, (name of individual signing) at his/her signature in the space provided above on this day of , 20 X. My expires: } 1— `NOTARY PUBLIC EU7MEMELKOURY ?,N %;,� MY CDMMISSIDN # EE 0448 EXPIRES' D80emb sr 11, V4 . BandedTW t nW Public lledemri m 11,f Attachment C 27 The undersigned Respondent in accordance with Florida Statute 287.087 hereby certifies that: c - of Business) 1. Publishes a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Informs employees about the dangers of drug abuse in the workplace, the business'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 employees for drug abuse violations. 3. Gives each employee engaged in providing the commodities or contractual services that 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 contendre to, any violation of Chapter 893 (Florida Statutes) or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction. 5. Imposes a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, or any employee who is so convicted. 6. Makes a good faith effort to continue to maintain a drug - free workplace through implementation of this section. As the person authorized to sign the statement, I certify that this firm complies fully with the above requiremeat�n Signature 5 p L-e Dai'eP� •[ T IOWSISJUM4 MER Attachment D 28 TV , IL�I[i]CI :ZI�E�Kil�J��'�iA �aCi7 ►x:1'1- �. ETHICS CLAUSE 0 `', A 14, 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. 10 -1990 or any County officer or employee in violation of Section 3 of Ordinance No. 10 -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 ounly officer or employee. ,1 /,r, (Signature) c o 4-4 C w," Date: 0' r STATE OF MOff,1�� COUNTY OF M 0 &)eO C PERSONALLY APPEARED BEFORE ME, the undersigned authority, –2 04 ! mq who, after first being sworn by me, affixed hi er signature (name of individual signing) in the space provided above on this — c N day of My commission expires: OMB - MCP FORM 44 y+..! �.z ELIZABETH EL KOURY r MY COMMIMONf # EE 040851 a EXPfRES: December 11, 2014 Bonded?hru Notary Pubrz Undwmiier$ Attachment E 29 Indemnification and Hold Harmless for c Other Bidders and Subbidders The Bidder covenants and agrees to indemnify and hold harmless Monroe Board of Governors for Fire and Ambulance District 1, its servants, agents and employees from any and all claims for bodily injury (including death), personal injury, and property damage (including property owned by Monroe County) and any other losses, damages, and expenses (including attorney's fees) which arise out of, in connection with, or by reason of services provided by the Bidder or any of its Subbidder(s) in any tier, occasioned by the negligence, errors, or other wrongful act or omission of The Bidder or its Subbidders in any tier, their employees, or agents. In the event the completion of the project (to include the work of others) is delayed or suspended as a result of the Bidder's failure to purchase or maintain the required insurance, the Respondent shall indemnify the County from any and all increased expenses resulting from such delay. The first ten dollars ($ 10.00) of remuneration paid to the Respondent is for the indemnification provided for above. The extent of liability is in no way limited to, reduced, or lessened by the insurance requirements contained elsewhere within this agreement. Respondent's Signature 50&0 Date -° TCS Attachment F 30 GENERAL LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT CE OF M BETWEEN MONROE COUNTY, FLORIDA AND ROY KHANNA 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 • 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 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. ..p, GLI Attachment G (1 of 4) 31 VEHICLE LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT MAINTENANCE OF MONROE COUNTY FIRE RESCUE AMBULANCES AND OTHER VEHICLES BETWEEN MONROE COUNTY, FLORIDA AND ROY KHANNA 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: $100,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $ 50,000 per Person $100,000 per Occurrence $ 25,000 Property Damage The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. _�, VL1 Attachment G (2 of 4) 32 WORKERS' COMPENSATION INSURANCE REQUIREMENTS FOR CONTRACT MAINTENANCE OF MONROE COUNTY FIRE RESCUE AMBULANCES AND OTHER VEHICLES BETWEEN MONROE COUNTY, FLORIDA AND ROY KHANNA Prior to the commencement of work governed by this contract, the Contractor shall obtain Workers' Compensation Insurance with limits sufficient to respond to Florida Statute 440. In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not less than: $100,000 Bodily Injury by Accident $500,000 Bodily Injury by Disease, policy limits $100,000 Bodily Injury by Disease, each employee Coverage shall be maintained throughout the entire term of the contract Coverage shall be provided by a company or companies authorized to transact business in the state of Florida. 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 addiction, the Contractor may be required to submit updated financial statements from the fund upon request from the County. WC1 Attachment G (3 of 4) 33 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 conjract. Contractor; Ki) y Contract for: )Eie e- Address ol'Comractor: Phone: G;/ 6 f Scope of Work: P97,41m C )� � 0 f ff n cee - fr4j rl 1 Reason for Waiver: AV f fq-- r t� /,� f� Y Y^ i' a" -<- -e=,Vt tit! -e} y' e e Policies Waiver will apply to: r Signature of Contractor: Approved Not Approved Risk Management Date County Administrator appeal: Approved: Not Approved: Date: Board of County Commissioners appeal: Approved, Not Approved: Meeting Date: T Altachrnent G (4 ul'4) 34 CERTIFICATE OF LIABILITY INSURANCE 12/2( ©12010' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the POlicy(fes) most be endorsed, If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu Of such endorsement(s). PRODUCER - -' JOHNSON & MILLER INSURANCE B DA JOH SON -WEBS 1.225 N Military Trail #2 � P D �Q =t :( -6.1. 640 4333 VC, O (561) 640 -0514 W Palm Beach, FL 33409 ADDEssbjwebb joh sonmillerinsurance.com CUSTOMER ".1 f INSURED INSURER(S) A ORDING COVERAGE i NAIc# ROY KHANNA i INSURER A HERMITAGE INSURANCE CO al Si R I ,T, T GON NATIONAL 3117 CAROL AVE r i wsufk b v ?:l :NT PALM SPRINGS, FL 33461 rNSURERD (561) 641 -2360 INSURER I INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURI D NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR LTR TYPE OF INSURANCE ADDL SUER I LI INSR WVD POLICY NUMBER (MMIDDIYYYY MMlf3DlYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE s 1 r 0 00, 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea o ccurrence j $ 511, 000 CLAIMS -MADE CI OCCUR A J GEN'L AGGREGATE LIMIT APPLIES PER X POLICY JPRO- ECT LOC AUTOMOBILE LIABILITY i ANYAUTO �I ALL OWNED AUTOS B X SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X J N HGL-532267 -09 X i N � FLC9323840 _I UMBRELLA UAB OCCUR i EXCESS UAB C LAIMS -MADE DEDUCTIBLE N RETENTION S WORKERS COMPENSATION , AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER /EXECUTIVE OFFICEP/MEMBER EXCLUDED? � NIA N C IMandalory in NH) If VeS, describe under I�-2/2/1012/2/11 I j ;4 3/10 i i 4�3�11 MEO EXP (Any one person) PERSONAL & ADV INJURY $ 5 , 0 0 0 S 1,000,000 GENERAL AGGREGATE $ 1, 0 0 0, 0 0 0 PRODUCTS - CCMPIOP AGG $ 1 1 000,000 COMBINED SINGLE LIMIT (Ea accident) $ $ 1,000,000 BODILY INJURY (Per p ers on) S BODILY INJURY I $ PROPERTY DAMAGE (Per accident - S 1 S 9 - EACH OCCURRENCE S AGGREGATE $ E . EACH ACCIDENT TS ` I U E . DISEASE - EA EMPLOYEE $ .• 1 th [ E. L. DISEASE - POLICY LIMIT I S f ! N 1 1 `- i L�tt<t DESCRIPTION OF OPERATIONS 1 LOCATIONS ! VEHICLES (Attach ACORD 101, AddRienat Remarks Schedule, if more space is required) MONTOE COUNTY BOARD OF COUNTY COMMISSIONERS SHALT, BE LISTED AS ADDITIONAL INSURED CERTIFICATE HOLDER ..0, CA TION MONROE COUNTY BOARD OF COUNTY COMMISSIONERS ATTN: RISK MANAGEMENT 1100 SIMONTON STREET KEY WEST, FL 33040 FAX: 305- - 289 -6061 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTA 1 (91988-2dtC RD CORPORATION. All rights reserved. ACORD25(2009109) The ACORD name and Pogo are registered marks of ACOq LOCAL PREFERENCE FORM Vendors claiming a local preference according to Ordinance 023 -2009 must complete this form. Name of Bidder /Responder r �' � �"�� Date: 1. Does the vendor have a valid receipt for the business tax paid to the Monroe County Tax Collector dated at least one year prior to the notice or request lbr bid or proposal? - ✓ (Please furnish copy. ) 2. Does the vendor have a physical business address located within Monroe County from which the vendor operates or perfarms business on a day to day basis that is a substantial component of the goods or services being offered to Monroe County ?____V�- List Address: /�'✓ �l> -1� � �l j G3 �t - ' - 7 Telephone Number: _ C�`�7 --q � ?_ B. Does the vendor /prime conlr'actor intend to subcontract 50% or more of the goods, services or construction to local businesses meeting the criteria above as to licensing and location? lfyes, please provide: 1. Copy of Reccipt of the business tax paid to the Monroe County Tax Collector by the subcontractor dated at least one year prior to the notice or request for bid or proposal. 2. Subcontractor Address within Monroe County from which the subcontractor operates: Tel. Number Sign ure and "Title of Authori•red Signatory for Bidder /Responder �c�L -� e�� ✓�-L� Print Name: a ! STA'I'li OI' $1 EF COl1N 'CY O1 =n . On this : -sue.? day o I'J 20 ,'L , bel6re roe, the undersigned notary public, personally appeared known to me to be the person whose name is subscribed above or who u s e Produced —__ _ ass iclenlification, and acknowledged that he/she is the person who CXCCU Led the above Local Prel'erence form for the purposes therein contained. f r s Notary 1?ublic Print Name My cummission expires = _ rT Seal Attachment H „� ... Y mambo. yw EI•-48Efh! £L KOIIRY : *- MY COMMISSION # EE 008si a: EXPIRES: Occernber 11, 2014 ��,th Eondcd rhos Notary p&jc tJndersvdters 35 CURRENT MONROE COUNTY :FIRE RESCUE AMBULANCES and OTHER VEHICLES 16 Radio VEHICLE Prime or Call LOCATION YEARIMAKE/ MODEL COUNTY ID Backup Sign 2002 FORD STOCK ISLAND AMBULANCE 1FDXF46F22ED14878 1416 -215 Prime R -8 2006 STERLING BIG COPPITT AMBULANCE 2FZACFCS76AV92511 1416 -5098 Prime R -9 2001 FORD BIG COPPITT AMBULANCE 1FDXF46F81EC33365 1416 -208 Backup R -109 1994 FORD REHAB Rehab - BIG COPPITT UNIT 1 FDLF47M6REA52322 1417 -159 Backup 9 2010 FORD PICK UP BIG COPPITT TRUCK 1FDAW5HR2AEB04654 6819 MCI MCI MCI BIG COPPITT 2005 MCI TRAILER 1WC200J2X53052439 5621 MCI Trailer Trailer 2008 NORTON CUDJOE AMBULANCE 3HTMNAAM68N698467 6507 Prime R -11 2006 STERLING BIG PINE AMBULANCE 2FZACFCS37AX62073 1416 -5806 Prime R -13 TRAINING 1997 FORD RESCUE 1 FDXF46F61 EC33364 1416 -059 Back up R -39 2009 FORD CONCH KEY AMBULANCE [FDXE45P79DA90438 1416 -6845 Prime R -17 2001 FORD CONCH KEY AMBULANCE 1 FDXF46F41 EC33363 1416 -206 Backup R -117 2009 FORD TAVERNIER AMBULANCE 1FDXE45P19DA83131 6813 Prime R -22 1998 FORD TAVERNIER AMBULANCE,, 1FDXF46F9XEB99283 1416.120 Backup R122 1992 FORD REHAB Rehab - TAVERNIER UNIT 1FDFL47F2SEA30339 4295 Backup 22 Attachment I 16