Item C41BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: January
21, 2015
Division:
Public G orks/Enainee�
Bulk Item: Yes X
No —
Department:
Project Management
Staff Contact Person/Phone #:Kevin Wilson X4616
AGENDA ITEM WORDING: Approval of a contract with Amy Chan for artwork to be installed in
the Drug Court offices at the Freeman Justice Center. This contract is funded by Court Facilities.
ITEM BACKGROUND: On November 25, 2014, six respondents submitted proposals for artwork
through the Art in Public Places program for the Drug Court offices at the Freeman Justice Center.
The Monroe County Art in Public Places Committee recommends the proposal submitted by Amy
Chan, which include five original acrylic paintings on canvas.
PREVIOUS RELEVANT BOCC ACTION: Ordinance #022-2001 establishes funding of art in new
public construction and major renovations projects. 1% of the construction costs for County
construction, except for any sewage treatment plant, shall be set aside for the acquisition, commission,
installation and maintenance or works of art in said buildings. This appropriation shall apply only to
new construction exceeding $500,000 or renovations exceeding $100,000 in cost.
WCONTRACT/AGREEMENT CHANGES: N/A
STAFF RECOMMENDATIONS: Approval as stated above.
TOTAL COST: $4,100.00 INDIRECT COST: 'BUDGETED: Yes X No
DIFFERENTIAL OF LOCAL PREFERENCE: N/A
COST TO COUNTY: 4 100.00 SOURCE OF FUNDS: Fund 163
REVENUE PRODUCING: Yes No X AMOUNT PER MONTH Year
APPROVED BY: County Atty O�B/Purch shig Risk Management
DOCUMENTATION: Included X Not Required
DISPOSITION:
Revised 7/09
AGENDA ITEM #
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
Contract with: Amy Chan
CONTRACT SUMMARY
Contract #
Effective Date: 01/21/15
Expiration Date:
Contract Purpose/Description:
Five original acrylic paintings on canvas for the Dru& Court offices at the Freeman
Lice Building in Pub " aces,
Contract Manager: Ann Rier. X4439 Pro`ect M t/ ato #1
(Name) (Ext.) (Department/Stop #)
for BOCC mectin on 01/21/15
Deadline: 01/06/15
CONTRACT COSTS
Total Dollar Value of Contract: $ 4,100.00 Current Year Portion: $
Budgeted? Yes® No ❑ Account Codes: 163-81501-530340-
Grant: $
County Match: $ - -
ADDITIONAL COSTS
Estimated Ongoing Costs: $ /yr For:
Ott included is dollar value above e . maintenance, utilities, janitorial,
Date In
Division Director
Risk Management "1
AL ff,
O.M.B./Purchasing I
County Attorney/- w
1 Comments:
-CONTRACT_ REV_IE_W.
4,100.00
etc.
Changes Date Out
Needed `e i
YesO No ..
■ -a I aw-A .. "
BUDGET AND FINANCE
PURCHASING DEPARTMENT
TABULATION SHEET
OPEN DATE: NOVEMBER 25, 2014 AT 3:00 PM,
TITLE: ART IN PUBLIC PLACES FREEMAN JUSTICE CTR#2 DRUG COURT LOBBY AND MEETING
ROOM
RESPONDENTS
SEAN P. CALLAHAN
BOND
N/A
PROPOSAL AMOUNT
$4,100.00
FRAN DECKER
N/A
$2,600.00
STEPHEN LAPIERRE
N/A
$4,100.00
STEPHANIE JAFFE WERNER
N/A
$4,100.00
AMY CHAN
N / A
$4, 100.00
JONATHAN SCHORK
N/A
$4,100.00
e. Present'. Christina Brickell/OMB
the Public Present: None
hereby certify that this is a true and correct copy of said bid opening and that all bidders listed above have been checked against the
Late of Florida Convicted & Suspended Vendor listings. All bids listed above were received by the date and time specified.
Bid
Christina Brickell-OMB
This AGREEMENT dated the 21 day of Janua!y, 2015 is entered into by and
'i,etween the BOARD OF COUNTY COMMISSIONERS FOR MONROE COUNTY,
hereinafter "County", and AMY CHAN hereinafter "Artist",
WHEREAS, the Art in Public Places Ordinance 9022-2001., codified at MCC §2-
322(A), provides for an appropriation of 1% of the construction costs for new
construction exceeding $500,000 and renovations exceeding $100,000; and
WHEREAS, the Ordinance established an Arts in Public Places (AIPP)
Committee to advise the County Commission regarding art to be acquired and installed in
each public construction pro . ject subject to the AIPP allocation; and
WHEREAS, the AIPP Committee has selected and recommended to the BOCC
one or more artists for this project; and
WHEREAS, the Board of County Commissioners of Monroe County have
determined that it is in the interest of the promoting the understanding and awareness of
the visual arts to contract for the creation and installation of artwork in the Drug Court
Offices at the Freeman Justice Center;
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:
I AGREEMENT PERIOD: This agreement is for a period of ninety (90) days after
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 8, 12,
and 13 below. All work for which AIPP funds are to be expended must bA
completed by the stated termination date.
2. SCOPE OF AGREEMENT: The Artist shall provide five original acry/A
paintings on canvas, twopaintings 18"x 18"and]8"x 30"Jor the corner in the lobb
and 3 paintings, 24 " x 30 "for the meeting roo"L These paintings will be installed a
hung with security hangers provided by the Arts Council. I
Artist shall confer with and coordinate activities with Elizabeth Young of the Ar
Council in order to insure that there *is as much cooperation and cohesiveness
the incorporation of the art into the building so that there shall be the least amou
of interference between the Artist and Court Personnel. I
3. AMOUNT OF AGREEMENT AND PAYMENT: The County shall provide an
amount not to exceed $4,100.00 for materials and services used to create and
11
install the project. The Board of County Commissioners assumes no liability 0
fund this agreement for an amount in excess of this award. Monroe County
performance and obligation to pay under this agreement is contingent upon
annual appropriation by the BOCC. Pursuant to Florida's Prompt Payment A
upon receipt by County of an Invoice in a lump -sum amount of $4,100.00 aft
installation of the artwork and acceptance by the County, a
documentation to satisfy the Clerk, payment shall be made.
Llig,L b)[C cp� -d inclyde. but are not
I e.,�pe11cJi1t1rqs or the,
total awat
limited to:
A. Artist's design fee
B. Labor, materials, 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 2) a.)
E. Transportation of the work to the site (see above paragraph 3, item 2) a.)
F. Installation to the site
U Permits and fees necessary for the installation (applicable for exterior projects
which also require HARC review)
H. Legal costs directly related to the project
1. 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 a release of
lien if applicable.
Payment request must be submitted no later than 60 days after the completion of the
proj ect.
4. OWNERSHIP and RIGHTS: Upon the installation of the artwork, County shall
own the artwork and all rights related thereto fully and completely. The artist
hereby acknowledges that this work is not site specific and waives any rights as to
changes in installation and placement sites for the work by the County.
5. RECORDS: The Artist shall keep such records as are necessary to document the
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.
6. MODIFICATIONS AND AMENDMENTS: Any and all modifications of the
terms of this agreement shall be only amended in writing and approved the Board
of County Commissioners for Monroe County.
2
Art in Public Places — Drug Court Offices
7INDEPENDENT CONTRACTOR: At all times and for all purposes hereunder,
the Artist is an independent • and not an employee of the Board •
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 the employees of the Board • •
Commissioners of Monroe County, and they shall • entitled to none of the rights,
privileges or benefits of employees of Monroe County.
S. COMPLIANCE WITH LAW: In carrying out its obligations under this
agreement, the Artist shall • • 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 • to terminate this agreement immediately upon delivery of written
notice of termination to the Artist.
9i, HOLD HARMLESSANDEMNIFICATION: The Artist hereby agrees to
indemnify and hold harmless the BOCC Florida Keys Council of the Arts, AIPP
Committee and Monroe County and any • their 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 • the
County of any suit, claim or action made against the County that is related to the
activity •- this agreement, and will !•r with the County in the
investigation arising as a result of any suit, action or claim related to this
agreement.
10, ANTt-D[SCRIMINATION: The Artist agrees that they will not •
against any of their employees or applicants for employment or against persons
for any benefit or service because • their race, color, religion, sex, national
origin, or physical or mental handicap where the handicap does not affect the
ability of an individual to perform in a position of employment, and to abide by
all federal and state laws regarding non-discrimination.
IL ANTI -KICKBACK: The Artist warrants that no • 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 • or consideration, the full
amount of such commission, percentage, brokerage or contingent fee.
I
11 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 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.
11 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.
14ENTIRE 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
Ar-tist.
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 he has not employed, retained or
otherwise had act on his 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
4
Art in Public Places — Drug Court Offices
public entity, and may not transact business with any public entity in excess of t
threshold amI unt provided in Section 287.017, for CATEGORY TWO for
period of 36 months from the date of being placed on the convicted vendor li
Artist represents that Artist is not on the Convicted Vendor list. I
18AUTHORITY: 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 are authorized to contract Artist's services.
1,9. LICENSING AND PERMITS: Artist warrants that he or she shall have, prior W
commencement of work under this agreement and at all times during said work,
all required licenses and permits whether federal, state, County or City.
EO. INSURANCE: Artist agrees that it maintains in force at its own expense a
liability insurance policy which will insure and indemnify the Artist and the
County from any suits, claims or actions brought by any person or persons and
from all costs and expenses occurring during the agreement or thereafter that
results from performance by Artist of the obligations set forth in this agreement.
At all times during the term of the agreement and for one 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 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 official
will be included as "Additional Inured" on all policies except w I
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:
I . Workers Compensation 'if, and as required by Florida Statutes
2. General Liability Insurance. Coverage shall be maintained through out t
life of the contract and include, as a minimum: I*
Premises Operations
Products and Completed Operations
Blanket Contractual Liability
Personal Injury Liability
Z
1A
NN
9
II I III I I 11 1 1 � I I 111 1 p � III � I J�
An Occurrence Form policy is preferred. If coverage is provided on a
Claims Made policy, its provisions should include coverage for claims
filed on or after the effective date of this contract. In addition, the period
for which claims may be reported should extend for a minimum of twelve
(12) months following the acceptance of work by the County.
NOTICE: Any written notice to be given to either party under his
agreement or related hereto shall be addressed and delivered as follows:
Amy Chan
3208 Rosewood Avenue
Richmond, VA 23221
I
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
PUBLIC RECORDS: The Artist agrees to comply with all requirements of Chapter 119 of
the Florida Statutes and specifically:
(a) Keep and maintain public records that ordinarily and necessarily would be required
the public agency in order to perform the service.
(b) Provide the public with access to public records on the same terms and conditions that I
public agency would provide the records and at a cost that does not exceed the co
provided in this chapter or as otherwise provided by law. i
(c) Ensure that public records that are exempt or confidential and exempt from publ
records disclosure requirements are not disclosed except as authorized by law. I
(d) Meet all requirements for retaining public records and transfer, at no cost, to the
public agency all public records in possession of the artist upon termination of the
contract and destroy any duplicate public records that are exempt or confidential and
2
exempt from public records disclosure requirements. All records stored electronically
must be provided to the public agency in a format that is compatible with the
information technology systems of the public agency.
IN WITNESS WHEREOF, the parties hereto have caused this agreement to be executed the
day and year first above written.
(SEAL)
Attest: Amy Heavilin, Clerk
Deputy Clerk
ARTIST:
AMY C11 "*1
BY- r... __
,A y Chan
Date: _ J °2 `9
Mayor/Chairman
WITNESS TO ARTIST:
By:
Print Name: oe--
Date: 1 1.
STATE OF t rnA`
COUNTY OF
On this Z5 �^ day r 1 �H'1 S!r before me, the undersigned notary public,
personally appeared ±� 5®,a, known to me to be the person whose name is subscribed
above or who produced t S _i 11.1 C4.,..,.,,, as identification, and acknowledged that he/she is the
person who executed the above contract with Monroe County for the artwork in the Drug Court Offices at
the Freeman Justice Center for the purposes therein contained.
Notary tiblic
Name
Stephen M. Randolph
My Commission Expires Commonwealth of Virginia
Notary. Public
Commission No. 7023277
0My Commission Expires 113112018
MONROE COUNTY ATTORNEY
PPFibb'ED AS TO 1 ?
NXf!LErtNi_ W `;`=al t
7
Art in Public Places — Drug Court Offices
•
No
AREA #4
3 paintings, acrylic on canvas
24 VI x 30 71 each
l would like to introduce myself and present my work for consideration for the Freeman Justice
Center Drug Court Lobby and Meeting Room Project. l have created public commissions for the
Johns Hopkins Chi|dren's Center in Baltimore, the Scottsdale Civic [enter K4a|| and Virginia
Commonwealth University. l earned my BFAfrono Rhode Island School of Design and my K4F/\from
Virginia Commonwealth University. My work has been shown at venues such as Pierogi 2000and
Wave HiU, with grants from the Pollock Krasner Foundation and the Virginia Commission for the Arts.
In July of 20I3 I was a resident at The Studios of Key West, During my residency I developed o body
of work based on the underwater landscape l explored with my snorkel gear. The influence of
vibrant fish patterns, complex coral forms, and the atmospheric underwater palette remains an
important part ofnnywork today,
For the Freeman Justice Center would like to create two abstract paintings that further explores this
body of work, taking visual cues from the Keys ecosystem, The paintings will use bright layers of
tropical shapes, patterns and colors to form playful abstract compositions that encourage life and
positivity inthe space. The interlocking shapes will create asurface that meanders between flat and
deep space, with colors that reflect the patterns of light underwater. The size and palettes of the
paintings will relate to each other to help visually connect the spaces.
The paintings Ipropose are acrylic on canvas, filling areas#2, 3 and 4. The first painting would
round the corner between areas#2 and 3, activating both walls simultaneously, This piece would
consist of two canvasses (I8^ x 18" and I0^ x 30^) that touch at the corner to create the feel of
single piece, The second painting would fill area #4with three connected canvasses sized 24^ x 50^
If given the opportunity, l hope to create work for the Freeman Justice Center that will evoke the
unique Key West landscape, while positively enriching the experience of visitors to the space.
Canvas, supplies, hardware
Packing and crating
• • f
AMYCHAN
amybchan@gmail.com
www.amychan.org
M.
$250
$250
Pickup at destination and installation $200
Artist Fee $3000
TOTAL $4100
REQUEST•PROPOSALS
Application Cover Sheet
Freeman
1 r
a Drug Court Lobby & Meeting Room
� r
Date:�J . n - Z --
Applicant r i n:
Address:
b G'`.
w
proofMonroe County resident: Yes _ No
(If yes, Please attach
Total Budget/Cost: A
NumberTotal proposal:
Please briefly describe - following if applicable;not ,. . -
indicate with N/A.
required:
Special lighting
Other special requirements: l () D t4 _(_,-b NEUD
Cf-
Type/amount of projectc it : �.0 to C-7
i
Artisti i s a $300,000 liability insurance poliYes i)No if no, Pleaselain.
Please c c ll i items to indicate are attached:
sketchW--concept drawings; 5 pages maximum (8.5" x 11") including color or digital rendition,
Digital .•- PDF or . exceeding ..images maximum.
mmflm���
r * r • •-• * .•♦ • - •
• - 9IMMEM
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: /)M y C�C,yI
Contract for:
Address of Contractor: �f
rc 6r1d, U r� l
Phone: FU `i ` CFl c/ — ?Y S` 6
Scope of Work: r 4 0"r0-,
(76
(evv
60,
Reason for Waiver: �711 ,
pq
Policies Waiver /
will apply to: t4AO I t,t,." ,CL--r i V
x tj
Signature of Contractor: / C.. s
Approved Not Approved
Risk Management:
Date:
County Administrator appeal:
Approved Not Approved
Date:
Board of County Commissioners appeal:
Approved Not Approved
Meeting Date:
Administrative Instruction #4709.3 WAIVa REQ.DOC
A■r Oki
4
paintings, acrylic canvas
each
r r r
eIL I
s
- 7;
FLORIDA KEYS
COUNCIL OF THE v\
We Support • We Connect • We Promote e We Give
December 10, 2014
era �a ticnn*p
Amy Chan €
3208 Rosewood Avenue Vmr
Richmond, Virginia 23221 r a
804-814-9550 amybchan@gmail.com :.
Dear Amy,
www.keysarts.com
Congratulations!
Your work has been recommended for purchase and installation in the Drug Court lobby
and meeting room at the Freeman Justice Center in Key West, Florida.
The Monroe County Art in Public Places Committee will recommend your proposal to the
Monroe County Board of County Commissioners at their January 2015 meeting.
When approved, your contract will state the following as you proposed to the Committee:
Five original acrylic paintings on canvas (see attached images), two paintings
18"x18" and 18"x 30" for the corner in the lobby, and 3 paintings, 24" x 30" for the
meeting room. These paintings will be installed and hung with security hangers
(provided by the Arts Council). The paintings will use bright layers of tropical shapes,
patterns and colors to form playful abstract compositions that encourage life and positivity in the
space. The interlocking shapes will create a surface that reflects the patterns of light underwater.
The total commission price is $4,100.
To begin the process, please complete the enclosed Vendor File Request Form and
W-9, and send both to Ms. Ann Riger. She is your contact for contracts, invoicing and
payment.
Her address is: Ann Riger, Contract Administrator
Facilities Development
1100 Simonton Street # 2-216
Key West, FL 33040
Please provide proof of insurance naming the Board of Monroe County Commissioners
as an additional insured. The proof of insurance or waiver must be attached to the
contract before it can be approved. Ask your insurance agent to send an ORIGINAL
declarations page to Ann Riger.
Alternatively, if you do not have insurance, or prefer to request a waiver and are willing
to accept all personal liability, and expect very minimal exposure to risk, you may
complete the enclosed "Request for Waiver of Insurance Requirements and return it to
Ann Riger with the other forms noted above.
Historic Gato Building • 1100 Simonton Street, Suite 2-263 • Key West, Florida 33040
305-295-4369 9 Fax 305-295-4372 9 info@keysarts.com
Your art budget will become official after a contract is drawn up, signed by you,
approved by the County Commission and signed by the County Mayor. An executed
copy will be returned to you.
After this approval is acknowledged, you may submit an invoice to Ms Riger on behalf of
the Board of Monroe County Commissioners for your first payment.
• Your first invoice will be for one third of the commission as your "Design Fee".
You are required to include a copy of your proposal showing your plans/design
and the agreed -upon price.
• The second invoice should include receipts for materials and an appropriate fee
for labor.
• The third and final invoice must include photographic proof of completion.
Please send all invoices to Ann Riger and copy me by email. (More specific details will
be in the contract.)
Please note: the Committee requests that you do not make any announcements or
release any information to the Press without prior approval of the Executive Director at
the Arts Council. Additionally, once the County Commission approves this commission,
the Committee requests that no copies of these original paintings are made and sold to
the general public orpsoted on your website until the installation is complete.
Thank you for being a part of the Monroe County Art in Public Places Project at the
Freeman Justice Center. If we can assist you with any additional questions or
information, please let us know.
Best
E iza eth S Your g
xe five irect r
FI. ev council of the Arts
Susann D'Antonio, Chair
Art in Public Paces Committee
Monroe County
cc: Ann Riger, Facilities Development, 305-292-4439
Riger-Ann @ MonroeCounty-FL.GOV
wf
NON -COLLUSION AFFIDAVIT
`t
T, _t
of the city of _
according to law on my oath, and under penalty
of perjury, depose and say that,
1.) I amp, the bidder making the Proposal for the
project described as follows:
2.) the prices in this bid have been arrived at independently without collusion,
consultation, communication or agreement for the purpose of restricting
competition, as to any matter relating to such prices with any other bidder or with
any competitor;
3.) unless otherwise required by law, the prices which have been quoted in this bid
have not becra knowingly disclosed by the bidder and will not knowingly be
disclosed by the bidder prior to bid opening, directly or indirectly, to any other
bidder or to any competitor; and
4.) no attempt has been made or will be made by the bidder to induce any other
person, partnersiaip or corporation to submit, or not to submit, a bid for the
purpose of restricting competition;
5.)
the statements contained in this affidavit are true and correct, and made with full
knowledge that Monroe County relies �a,J�)0,11 the truth of t e statements contained
in this affidavit in awarding contracts riSrM sa'cl project.
t'
b4IV�.iguature of Bidder)
STATE OF
COUNTY OF Cv A
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
.r
who, after first being sworn by me,
(name of individual signing)
affixed his/her signature in the space provided above on this a day of
k/ —
20 I q_.
t 9a100
NOTARY
NOTARY PUBLIC REG # 7267i65
My Commission Expires: l 6�9MY COMMISSION -
�
X1013112017
PI}}fry ¢ 7 ��
SW : 1 N_STA "1 MI::NFI UND1 1 ORDINANCE NO. ] 0-1990
MQNR+ F1' C01jNTY, I"LOR1DA
ETHICS CLAUSE
�A C", --k
__ _ warrants that he/it has not employed, retained i V'
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
Date
STATE OF "�C " ►_
COUNTY OF i`-;(,I
County officer or employee.
(signature)
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
who, after first being sworn by me, affixed his/her
signature (name of individual signing) in the space provided above on this 6i day of
20 .
NOTARY PUBLIC
My commission expires:
OMB - MCP FORM #4
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:
(Name of Bugiuess)
1. Publish 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. Inform 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. Give each employee engaged in providing the commodities or contractual services that are under bid a
copy of the statement specified in subsection (1).
4. In the statement specified in subsection (1), notify the employees that, as a condition of working on the
commodities or contractual services that are under bid, the employee will abide by the terms of the
statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any
violation of Chapter 893 (Florida Statutes) or of any controlled substance law of the United States or any
state, for a violation occurring in the workplace no later than five (5) days after such conviction.
5. Impose 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. Make a good faith effort to continue to maintain a drug -free workplace through implementation of this
section.
As the person authorized to sign the statement, I certify that this firm complies fully with the above
requirements.
j
bidder's Signore
Date
OMB - MCP#5