05/23/2019 Agreement PROPOSAL TO: Monroe County Project Management
I 100 Simonton St., Roorn 2-216
Key West, FL 33040
PROPOSAL PIRAK
12
The undersrgned, having carefully examined the Work and reference Maps, PiCtUres,
Drawings, Specifications, Proposal, and Addenda, if any, thereto and other Contract
Docurnents for thie construction of: gi L Cqn g-Pin imur�ijy�Eai± s
. -2__ _ _6_:p
and having carefLffly exarn ned thie site where the Work is to, be performed, having
becorrie, faimiiiar,with all local conditions inclu&ig labor affecfinig the cost thereof, and
having farnHiarized himself/herself with niaterW availablility, Federal, Mate, and Loca�
9aws, ordrnances, rules and reguiations affecting performance of the Work, does
hereby propose to furnish 0 labor, rnechanic;s, SUplerintendents, tools, material,
eqUiprnent, transportation services, and ail 4-16deritals necessary to perform and
complete said Work and work incidentaq hereto, in a workman.-Hke manner, in
conforr'na rice with said Drawings, Spe6ficatilons, and other Contract Dockirrients
in&ding Addenda issued thereto,
The Undersigned fUrther certifie,s that he/she has personaiiy pnspected the actual
location of where the'Work is to Ike performed, together with the local sources of supply
and that he/she understands the conditions under wNch the Work is to be p rfortn d.
The proposer shall assurne the risk of any and aHi costs and delays arising from the
existence of any SUbsurface or othier latent Physical condition which could be
reasonably anticipated by reference to doCUmentary information provided and made
avaHable, and from inspection and examination of the site,
'rhe undersigned agrees to cornmence perfon-riance of this Project no later than
ten (10) calendar days after the date of issuance of a notice to proceed by
Owner. Once commenced, undersigned shall diligently continue performance.
Until completion art the Project, The undersigned shall accomplish SUbstantial
Completion of the Project within Thirty (30) al radar days from the notice to
proceed. The undersigned Shall accomplish Final Coirnpletion of the Project
within Thirty (30) calendar days thereafter.
Nage 17 ol'34
The Base Proposa� shall be furnished below in words and FlUmbers, If there is ain
Inc,onsistency between the two, the Proposal in words shall corttroL
$ 4,9 000 GO
...... Dollars
(Tota111 Base Proposal- w�ords)
$ F thousad l do� lars and zero nts
--EQ_u-r!YA t n
t
(Total Base Proposa@I — nt,imbers)
I acknowledge Alternates as follows,
Alt ernate #1
$ Collars............ ...........
............... ----,,Dollars
(Alternate #1— numbers)
acknowledge receipt of Addenda No,(s) or on
Da te
N,tge 18 of'.34,
h-u adchikon, Proposer states that lie/she has included rrfified copy of Contractor's
I.Acense, Moinrce C'01U(Ity OCCLJPatiOna� Lcense, and Certificate of Uabihty showing the
mmimurn insuravu-,,, requirements ftx this Pr,roject
Execut*rr by the Contractor rTILJst be by a persori wth authority to bmd the errUty
N WITNESS WHEREOF, the paMes hav caused this ARreerrlent for BiiLL_Pirl,,e
Comm,urfltyj j Lk to be eXeCUted by' tlur..ls duly authonzed
rreirrr li.afives, gs folilows
Contractor
ar
Mw�mq Address,
-Yoij 70
Phone Nurnber
EJ,N
EimaO
V9
Date ILI FL ., Sig ned• .,
(N-arne)
Ik74eA&
(I ifle,
Confilactoi's V%,Nness sigriature
MONROF COUNTY
ATTORNEY
PPRO D A F M
�A,M ii,i e ss n a �r i e
CHR 8 AME3poSjo Date
.. ..... ASSI COUN RNEY
MONROE llll',`OUNTI� Date:
D a t e 4671
Kevin �,SS tant County Adrrmiristirator
............. ........ .........
P,age
EXHIRIT A
M i nowrih 0.
................
-&vq&LA--Amor Zan.. a Sw"Culltractor,engaged b�% NIOnrOC COUnty c[urhq; the
cnnqAUbMI of vow? amuchted %1,6 the btaIum inidicated project
(Chcdk onO
is a rnhoeky buMnms enterprise, as defined W Seaka 2817M. Fhrlda Statutes
is Irmuuc a nihniork) busirmss enterprise as deflned uin Sec.fion 288,7103, Florida Stati,jacs,
IS. 2SS.163(3) Minoriq Wncms emprise"' means on) smiaH biusiniess ccnwern as cletlined in
qlWan (6),(see ki%hidi is crrynhed to enp, hn umnmemb! vawnahmL Wdi h;
damicked W Fk)rkl& cuid ahkii is En &am 51-percenna"ned b) rnhuniq pemons "ho WV
mumbas or an insWir group thaOs of a patAcular racAL MY or pKe"Mmup or nadwW
cuigin. %%hich has been sul-�jcicticrid himnricn% to d6pwoue tnmunenL due to ideruikwhmi W and
V61h that a�1`011.)p resid6ill, M aNI LVFKICI`IrCj)ii eseirmnion of ommmcrt-citfl cmterjpirises under Ifiv grOUP"S
contrdL and Mtase n,minagerneituarid ddyvTom6ons nre conwoHed b) such persons. A Wrtariq
business enterpHse rna) yknario Walve the prook; ul'ia 1ircfiesskin. O%onership b it rniino6q
persian does nc.vt inic�ludie ownc,-!rship "hich is Ic rmuh of a MmY Urn a rulmniman'" Pow art to a
Mindy person %�Whn a rdwed hnmediate thmi!) group if the conflbille(I toual jjrjult,.t a,s
WI nwMers ur mud, mudo grOLIJ) CI�CCeds SI niUM For pwpases or this mflw.ec6on,. the terrm
I-related irninic.,,idiate My ymp- means ant,ar more chH&vn umkr 16 %ear% ofage ancl a parent
arsuch chUnm or fhe S[)O'LlSe of"such p�are rcs;iinu in tie �,airni: iouse 'or V ta unt.
F.S 288,703(6), -SmaH busimms" rite,,
arkr�t indqpdi cm�dend h� chan,,J operatedu husii
rress concet-n
diat emplk 21001 or jacan,11TIC11"It CUH Cime ernplo cs anid I.Ina, tioget1wr%v 4h rtsaffiRates. muas
o net%%anh of riot rnoire dwn 55 Man or an% 1% Wad in this snac nhkh has a SW BusWns
Mnhdaradon S(t0i ceirtifileaticm. As apokIle to sole 1'!wt-o pri clam h 4m. die $5 rnilhon rmt vomah
regakement shall mchl.1(1110 b0th persom,,d ancl IbiusmumaWss in%,estrnt.mv;.
r.j.,cy ma% refier-� E,-, ........ rniatiom,
... ............ .............................................
C
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Print N�nrnie:217". 1 Printec I Natne: UL (I L,(,ilk
I rde: tA(
-04m)-ep........... Thle OMB Dq�mttmient:,
. ................................
Verkleid % Pau:
A d d rc°si Any
I. LIN i L2 01 L ZOOU,2
CR) 'Slam,lip t-uo In,
..........................................................................................................................................................................................................................................................................
Pupe zi or34
fkal , j,
I FNJA N ct Njumber
m
P,,age 22 of'34
Certification Regarding
Debarmient, Suspensiori, linefigibility
And Voluntary ExclUSion
Contractor Covered Transactions
(1) 'I"he prospective contractorr of the Re6puent, cerfifies, by
subniisslon of this dGCUmerit, that neither it nor uts princ pa is presently debarred,
suspended, proposed for debts ire dectlared ineligble, 0�' VOkIntarHy exckided
frorn parflclpafion in thl tra raw acflon by any Federa� departr"nent or agenlr,,,y,
(2) Where the Recipient's contractor is unab e to cerfify to the abov(,� statement, the
priospectNe contractor shaH attach an exp anaflon to ths forn'),
CONTRAM"OR,
A
By
sign i'klre e c i p e r�t's N a m e
Narnle andl'iflle DM!s clri Cointrac,,' PqUmbe�
Street Address Ft. NAA Project Nurnber
ck voal
(.Wuty, State, pup
Date
Pagge 23 of"34
LOBBYING AND CONFLICT OF INTEREST CLAUSE
SWORN STATEMENT UNDER ORDINANCE NO, 010-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
�2zkI
'
(Eori,ipany)1!eede9
warrants that he/she has not employed, reta�nedl or otherwise had act on histher
beh,0 any former County officer or employee in vion aflorii of Secfiiion 2 of Ordinance No,
010-1990 or any COUnty officer oremployee rn vicilation of Section 3 of Ordinance No.
010-1990. For breach or violation of this provision the County rnay, in its discretion,
terniii iate than Agreement without fiabiky and may aisa, in its d screfion, deduct from the
Agreement or PUrchase phce, or olthierwise recover, thefi.111 arnount of any fee,
conirnission, percentage, gift, or consideration pa�ci to the fgrim,er COU rity officer or
emp�oyeel",
Signai' u'r_e
STATE OF: f7l_0 IZ4
C 0 U N T Y 0 F R_0
Sulbscdbed and sworn tio, (or affirmed) before rr-re on Hj? I
(date) ��4'A'CL_ WO("')Vs
===" ' _ ant), He/She is
(narne of affi,
per "n'aHy 060"10 me or has prodUced
(type of ide-n"-fification)
Ott T C
My commission expires,
Ero ChFisfine Wcod!s
NOTARY PUBLIC
$1 ATE OF FLORIDA
M562
(Seal) Expires 91412021
Page 24 oC34
NON-COLLUSION AFFIDAVIT
1061
of the 6ty o —L lf " d
k/Le—w— -,
according to law on my oatf"i, and under penaIty of perjury, depose and say that'.
i�k A2.21 k
of the firn'i of
the for dder mak��,ng the Propos,al for the project desc6bed in the Request
C.,
I Se ices fo�j
,,J r
401 7-
0- Ile
,anef that l exeCUted the said roposal ,nMti'l 'fuH authodty to do so:
2, The pric�es in this bid have been arrived at undependerutty WfthoUt c0usion,
consuftation, COMMMlication, or agreernent for the purpose of restricting
competition, as to any niatter reia tin g ter SUCh prices with any other bidder or
with any competitor,
3. Unless otherw I i I sle required by law, the prices, which have been quiloted in this
bid have not been know ngiy disclosed by tiie Kidd nu. and wifli not knowingly be
disctosied by the bredder prior to did opening, direr fly or indireefly, to arly other
bidder or to any competitor; and
4 No attenipt has, been rnade or wiH be made L.y the bHder to inducle any other
person, partnersNp, or, corporation to subrnit. or not to SUbrnit, a bid forthe
pUl"POSe of restricting compefifion;
tut. The staternents contarned in thin affida%61, are true and correct, and made with full
knowiedge that Monroe County rehes upon the trt,,ith of the statements contained in this
affidavit in awarding o Otracts foir said project,
(Signature of Respondent) (Date)
'f-,
STATE OF:
COUN'T"Y &F�
PERSONALLY APPEARED BEFORE ME, the undersigned authorfty,
who, after first being sworn by me, (name of Odividual signing) affix—edhi�Ter/ ..........signature in the space provided in on this 24a d a y of 4 ZC-k 20
NOTARY PUBUC
F-rin Christim VVOOds
My Corrmnussion Expire& NOTARY PUBLIC
STATE OF FLORIDA
Corm-a(3GII1562
(Sea�) I Expires 91412021
[laoc 25 ot'34
DRUG-FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute, Sec. 287.087 hereby
(1,'erfifies that:
A -
(Narne Of' Business)
I. PUbfish a statemer t notffyirig ernpdoyees that the wflawV amr%ifaCtUre, 6stribufion,
dispeinsinn, pos,s,ession, or Use of a confi,olied SUbstance is prohibited 41 the workp4ce
and specifying the actions that with be taken against ernpdoyees for 06ations Of SUCh
prohibition.
2 Worm enipioyeesabart the dangers of drug abuse in the workpiace, the business's
poficy of nia�ritaining a drug-free workplace, any avaiiadie drug cw,mseiing,
rehab ih-tation, and employee assistance pirograrns, and the penaifies that may be
rmposed upon employees for dRig abuse 0olations,
3, Give each ernpiloyee engaged in providing the cornrrio6fies o,r contractual services
that are Undier bid a copy of the, statement specified it'l SUbsection (1),
4,, in! the statement sple6fied in subsection (1), rmt fy the ernpoyees that, as a condition
of working on the cornrnodifies or contraCtLiat services that are urrde,�r bild, the employee
wifl abide by the tern-is of the statement and wield notify the en,ipk)yer of any conviction of,
or plea Of gUilty oir ratio cart eindere to, any vIolation of Chapter 8 (Florida StatUtes) or'
of any controHed substance law of the United States or any state, for a vioiafion
occurdng in the workplace no deter than five (5) days after SUCh Ccrry cfiorr,
5. impose a sanction on, or reqLdre the safisfaictory ioarticipation in a drug abuse
as,srstance or, rehabilitation progran-i rf such Is avaid,Ie in the employee's comMUnity,
fair any enipioyee who is so con victed,
6. Make a good faiith effort to confinUe to maintaire a dnjg-free workpilace through
urnpienierrtafion of tNs section.
As the person authorized to sign the statement, i certify that this firm complies fUlly with
the above reqwiements,
"0"
Respondent's SignatUre
Date
AFtY PUBLIC Erin Christi%wood$,
NOITARY PUBLIC
My Commission Expires, ,,-i
STATE OF FLORIDA
(Seai)
llagc 26 c)04
PUBL.[C ENTITY CRIME STA'rEMENT
"A pe,rson or affiHate who has been p1aced on the convicted vendor list foflowing a
conviction for pUbhc enfity crime may not submit a M or a contract to provide any goods
(-.rr services to a pUbk endty, may not subunit a bid on a contract with a pubhc entity for
the construction or repair of a pubfic b0ding or pubk work, may riot SUbiriift bids on leases
of reai property to PlUbhc entity, rriiay not be awarded or perforrn WOrk as a contractor,
SlUppfier, subcontractor, or CONTRACTOR under a contract Mth any public entity, and
may riot transact business with any pUbk enfity iin xcots s of the thresholld arnount
proMed in Section 287,017, Fior da StatUtes, for CATEGORY TWO, for a period of 36
rnonths from the date of b �ing p5aced on the convicted vendor fist,"
have read lt��h�eabb(,,,Ve and state that neither
ser's narne) nor aniy Affiliate
(Pr)po
has been placed conOcted vendor list with n the Bast thirty-six (36) months,,
gnatUre)
Date:
STATE OF: C>A
..........
COUNTY OF, MoNgDe-
Subscribed and sworn to (oir affirmed) before rne on the _4?A� _.day of M A
20__J.�j_, by ......... (narne of affiant).
....................
He/Stie is known to rTie or, has produced
.......... ........' (type of idenfification) as identification,
My Commission Expk'es:
NOTARY PLJ&.J0
(SEAL)
Erin Ctvisfine Woods
NOTARY PUBLIC
STATE OF FLORIDA
Corm*GG 111662
Expires 914)2021
Page 27 of'34
VENDOR CERTIFICATION REGARDING SCRU NNIZED COMPANIES LISTS
Project tssnsrifotirsr( wS .m. .,
Respondent'Vendor Pgaarrnra: � `.
Vendor FEiP4
five d)�)m,
Adds� � . ° �
Pra r�r
C.Ity _ ` t ta. �w
���°ncsrrs G��nrarnr� �:au° � �.��. �� _ ...�_. &�:rn°u��4 Address:
Section 287.135.. Florida StatUteS prarhniibfts ua company from in0cfing on, s nttirg ra proplosar for, or
entering into cir renewing contraict for goods or sasr"v^c s of any arnount Uf, at the tirne of contracting or
renewal, the company is or the Scrutinized Cwnpssriaas that Boycott lsra"ar d I,Jst, created pursuant to SectU sr
215 4725, Florida Statutes, or ns engaged in rs Boycott o I�rr,rrrp
s the person authorized to sdr r on baadn"w, ff of Respondent, 4 hec re,,by cf rbfyn that the c;cornpany idenfifieid
sabcnrs Yrn the Section entitled "Respondent Vendor I""~lrarras" is not Udst rt corl the Scrrtrrt seb Companies tbsnt:
Boycott Rsr eR d_ist or engaged Ur.n a boyceotn of psr aai and for.Projects c;ts of "t, tt,t)OC,, or rrnenr°ra as root listen earn
either the creutnr'nt at Companies pawnn ies ith Activ fi s it Su,uciaarn I_.icst flile ScirutJnuzed Ciomlornnndess i,U"i Activrfles irn
the dra n PetraawUeum Energy Sector tJst, or engaged it bu.usmess atne raatra ns in ro.udoaa or t;tyiraV
I r.,inderr$tC3rrd that pUrs uanr to SectJon 287.135, t`Go6daa Statutes, the suubrrdsr~yk)in cant a false cerfutic ati or may
suutoleac,t conipany to civil pe naitnras" ttorrney's tees, and/or costs. U further Understand that any contract ct itii
the COUNTY may be t rmiriaatrscf, at the op irnr of the COUNTY, of the acorn-apsarnyr is found to have rsi.ntamiitt et
a fa se certification n or has been placed on the Sc. u°rtinrzed Corr;;a".arnroieys that Boycott Rsrra l List or engaged
Urn as boycott of Israee arms p iace l on the e;reatiflz nrt 4°,cmparrGes,wrtf,u Actrvities ii n Sudan t„"ist or the tic rcatir"nized
u°;',eorngaaainues w,ith cfnv%es rn the lraar Petrro4es,,rrn Energy Sector Lira or tanncarn rarng_la geld in buusrress operations
uVl CLAba or Syria.
"sn"tafe Styr ar�� o�� � ��; � � ��. so. � � who rs authorized to
snr°n cr.n _..._
bebnafrt nssry.cn
rrre
h`dt9e. t`�va d6 t
�.
._..__.__._...w_...,., .. .. .. w. _ m.,., _w_.ww..v_......... ..
Note; .f'll e Ust are av aH bMee at the foRowiing Diepsrtr'nent of V"u^trrrnaaa e rnrent SeMoes S Ytes
to t;/tn�� ;nl .tP Va�rRt c,rrnPt usrra s CM r bras t wt�c f<t .lis �t a a7n rsu °y t°rratio y a ra ie�t ut
ended discriirnyn vein or_ trusts,
AC40RO CERTIFICATE OF LIABILITY INSURANCE DATE I )
05/23/2019
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 ALTERCOVERAGE AFFORDED BY THE POLICIES
BELOW. IS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURE IS),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT- If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)must 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 endorsements.
PRODUCER George A Zellner CO CONTACT Certificates
4114 Sunbeam Road PHONE (904)356-1492 FAx ,(904)354-4328
AM Me ;anSuite 101 ESS certificatesezelinerinsurance.com
Jacksonville FL 32257- C
Auto-Owners Insurance Company 18988
INSURED Mapfre Ins.Company of Florida
Affordable Asphalt,Inc. Nautilus Insurance Company
94411 Overseas Highway ..,,,,,,,.,,Western World Insurance Co.
Tavernier FL 3307D-
COVERAGES CERTIFICATE NREVISION
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTNTHSTANDING ANY REQUIREMENT„TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN„THE INSURANCE A FFORDED BY THE POLICIES DES CRIBED HEREI N IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN Y HAVE BEEN REDUCED BY PAID CLAIMS.
INSR p ,. APE OF iN5U.,.NCE.. ..., ....AOPL✓811BA° ..p.. ...Y EFF .� PO..ICY EXP....._. ...,. .. LIMITS......... .. . ..,....,,�.
D X COMMERCIAL GEN LLIABILITY X {NPPB543044 7/20/2018 7/20/2019 EACH-OCCURRENCE S 1,400„000
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CLAIMS-MADE 7bAii...ce To REo 100,000
C DE OCCUR - !PAd' ESAEAP' � S
�1lOw�l MsP� 9Toner�an 1,800
�J r F,ER�,QNAy,&ADV INJURY � f 1,400.000
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CEN' AGGREGJkTE LIMIT APPI IILS PER: �� �° GENEfIALAGGYEGATE 000,000
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x JECT E LOC PRO r MPS aPA 2,000 004
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6 M ED LE LIMITAUTOMOBILE LIABILITY X 5204070000554 0712012018 07r20r2019 (Ea amdenti S 1,0, 0 0 000
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ANY AUTO BODILY INJURY QPer psiS
�,.., A"'OWNED � x '5IX�'HE00.VLED BODILY INJURY;Peramidenl S
1
AIRED W.W-O PROPERTY DAMAGE
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ANY PROPRIETQRIPAATNE EC,,JTIVE ,)„FAr"H Al,,' D NT
OFFIC NIA EMBEREXCLUDED'P °i" .'
(MandaloryinNH) E.LPS� SE , MbY
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-" m. mV'-PPe,I°Y IMO'T
A Equipment 78554889 12/21/2018 1 212 112 0 1 9 Limit 140,000
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 1e1.Additional Rsmsrks Schedule,may he aHaehad it men space Is requlrsdi
Jobslde Ig Pine Community Park
31009 Atlantis Drive
Big Pine Key,FI 331343
The ceMficate holder is listed as additional insured with respects to general liability and auto liab+;lily if required by written contract,
CERTIFICATE HOLDER CANCELLATION AI 027821
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Monroe County Board of County Commissioners THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
500 Whitehead Street ACCORDANCE WITH THE POLICY PROVISIONS.
Suite#102
Key West FL 33040- AUTHORED REPRESENTATIVE �10,
I
Fax, it 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 2512014101) The ACORD name and logo are registered marks of ACORD