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05/28/2019 Agreement
Countyof ®11Y'®� �" '© BOARD OF COUNTY COMMISSIONERS Mayor:Sylvia J.Murphy,District 5 • The Florida Keys Igiv.:7, Mayor Pro Tem banny L.Kolhage,District 1 k. Michelle Coldiron,District 2 s. , Heather Carruthers,District 3 David Rice,District 4 Monroe County Board of County Commissioners Office of the County Administrator The Historic Gato Cigar Factory 1100 Simonton Street, Suite 205 Key West,FL 33040 (305)292-4441 —Phone (305) 292-4544-Fax MEMORANDUM TO: • Pam Hancock, Deputy Clerk FROM: Lindsey Ballard, Aide to County Administrator DATE: June 20, 2019 SUBJECT: Small Contract Small contract for your records only. Enclosures: Amcon Group,LLC (fence repair)— 1 copy enclosed Amcon Group,LLC (new fence)— 1 copy enclosed i 1 ATTACHMENT D.6 COUNTY ADMINISTRATOR CONTRACT SUMMARY FORM FOR CONTRACTS LESS THAN $50,000.00 Contract with: Amcon Group LLC. _ _ Contract# _ Effective Date: 5/14/2019 Expiration Date: Contract Purpose/Description: New fence for Facilities new location in Rockland key. Contract is Original Agreement Contract Amendment/Extension Renewal _ Contract Manager: Steven Sanders 4338 1 (Name) (Ext.) (Department/Stop#) CONTRACT COSTS Total Dollar Value of Contract: $ 11,717.50 Current Year Portion: $ 11,717.50 (must be less than S50,000) (ff multiyear agreement then • requires BOCC approval,unless the total cumulative amount is less than S50,000,00). Budgeted? Yes❑ No ❑ Account Codes: aCk-St31 5. \. Grant:$ County Match: $ - ADDITIONAL COSTS Estimated Ongoing Costs: $ /yr For: (Not,included in dollar value above) (e.g.maintenance,,utilities,janitorial,salaries,etc.) CONTRACT REVIEW Changes Date Out Oe I Needed fewer Department Head ef Yes❑ Nop _f/ge ci Risk Management 10 1 H Ycs❑NoES O.M.B./Purchasing 5j3-8 jl' Yes❑ No - 5P-s(c't County Attorney 57rW Yes❑ No.!' "9 5/4 . - - Comments: n Monroe County Engineering 1: '=- 1100 Simonton Street,2-216 Key West,FL 33040 ;:ej > ' Project Management PROPOSAL TO: Monroe County Project Management 1100 Simonton St., Room 2-216 Key West, FL 33040 PROPOSAL FROM: /1 IMCOV\ 1Y U P tOG 3I Dr 7 12GS rniCA,Mi l 331 .7(e7 The undersigned, having carefully examined the Work and reference Drawings, Specifications, Proposal, and Addenda thereto and other Contract Documents for the construction of: ROCKLAND KEY FACILITY INSTALL NEW FENCE AND GATE and having carefully examined the site where the Work is to be performed, having become familiar with all local conditions including labor affecting the cost thereof, and having familiarized himself/herself with material availability, Federal, State, and Local laws, ordinances, rules and regulations affecting performance of the Work, does hereby propose to furnish all labor, mechanics, superintendents, tools, material, equipment, transportation services, and all incidentals necessary to perform and complete said Work and work incidental hereto, in a workman-like manner, in conformance with said Drawings, Specifications, and other Contract Documents including Addenda issued thereto. The undersigned further certifies that he/she has personally inspected the actual location of where the Work is to be performed, together with the local sources of supply and that he/she understands the conditions under which the Work is to be performed. The proposer shall assume the risk of any and all costs and delays arising from the existence of any subsurface or other latent physical condition which could be reasonably anticipated by reference to documentary information provided and made available, and from inspection and examination of the site. The undersigned agrees to commence performance of this Project within ten (10) calendar days after the date of issuance to the undersigned by Owner of the Purchase Order. Once commenced, undersigned shall diligently continue performance until completion of the Project. The undersigned shall accomplish Substantial Completion of the Project within Thirty (30) calendar days. The undersigned shall accomplish Final Completion of the Project within Thirty (30) calendar days thereafter. Page 8 of 22 I Monroe County Engineering ;*A £ 1100 Simonton Street,2-216 jy). ; Key West,FL 33040 Project Management The Base Proposal shall be furnished below in words and numbers. If there is an inconsistency between the two, the Proposal in words shall control. etQxvi Vitvsatik& SeUeh kv r 5eualeeo c //aYS, rO- _1T �5 Do ars (Total Base Proposal-words) $ ( I /it1c5O Dollars (Total Base Proposal— numbers) I acknowledge Alternates as follows: Alternate #1 Dollars (Alternate#1- Install (2) 10' swing gates (words) $ Dollars (Alternate#1— Install (2) 10' swing gates (numbers) I acknowledge receipt of Addenda No.(s) or None No. Dated { Monroe County Engineering k, ftr 1100 Simonton Street,2-216 t m No"v r Key West,FL 33040 Project Management ADDITIONAL CONTRACT PROVISIONS I. Nondiscrimination/Equal Employment Opportunity. CONTRACTOR and COUNTY 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. CONTRACTOR or COUNTY agrees 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 prohibits discrimination on the basis of race, color or national origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC ss. 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 s. 794), which prohibits discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975, as amended (42 USC ss. 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, ss. 523 and 527 (42 USC ss. 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 s. 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 s. 12101 Note), as may be amended from time to time, relating to nondiscrimination 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; 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. During the performance of this Agreement, the CONTRACTOR, in accordance with Equal Employment Opportunity (30 Fed. Reg. 12319, 12935, 3 C.F.R. Part, 1964-1965 Comp., p. 339), as amended by Executive Order 11375, Amending Executive Order 11246 Relating to Equal Employment Opportunity, and implementing regulations at 41C.F.R. Part 60 (Office of Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor). See 2 C.F.R. Part 200, Appendix II, ¶ C, agrees as follows: 10 ,{ �2t Monroe County Engineering 1100 Simonton Street,2-216 _ a Key West,FL 33040 '`c {` Project Management (1) The CONTRACTOR will not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, or national origin. The contractor will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, color, religion, sex, sexual orientation, gender identity, or national origin. Such action shall include, but not be limited to the following: Employment, upgrading, demotion, or transfer, recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The Contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the contracting officer setting forth the provisions of this nondiscrimination clause. (2) The CONTRACTOR will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. (3) The CONTRACTOR will not discharge or in any other manner discriminate against any employee or applicant for employment because such employee or applicant has inquired about, discussed, or disclosed the compensation of the employee or applicant or another employee or applicant. This provision shall not apply to instances in which an employee, who has access to the compensation information of other employees or applicants as a part of such employee's essential job functions, discloses the compensation of such other employees or applicants to individuals who do not otherwise have access to such information, unless such disclosure is in response to a formal complaint or charge, in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or is consistent with the CONTRACTOR's legal duty to furnish information. (4) The CONTRACTOR will send to each labor union or representative of workers with which it has a collective bargaining agreement or other contract or understanding, a notice to be provided by the agency contracting officer, advising the labor union or workers' representative of the contractor's commitments under section 202 of Executive Order 11246 of September 24, 1965, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. (5) The CONTRACTOR will comply with all provisions of Executive Order 11246 of September 24, 1965, and of the rules, regulations, and relevant orders of the Secretary of Labor. (6) The CONTRACTOR will furnish all information and reports required by Executive Order 11246 of September 24, 1965, and by the rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his books, records, and accounts by the contracting agency and the 11 { 1: L C`�, ?, ZZ J, z Monroe County Engineering A1/4- 1. 1100 Simonton Street,2-216 3 '')c ' Key West,FL 33040 -. '` Project Management Secretary of Labor for purposes of investigation to ascertain compliance with such rules, regulations, and orders. (7) In the event of the CONTRACTOR's non-compliance with the nondiscrimination clauses of this contract or with any of such rules, regulations, or orders, this contract may be canceled, terminated, or suspended in whole or in part and the CONTRACTOR may be declared ineligible for further Government contracts in accordance with procedures authorized in Executive Order 11246 of September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in Executive Order 11246 of September 24, 1965, or by rule, regulation, or order of the Secretary of Labor, or as otherwise provided by law. II. Termination. a. In the event that the CONTRACTOR shall be found to be negligent in any aspect of service, the COUNTY shall have the right to terminate this agreement after five (5) days' written notification to the CONTRACTOR. b. Either of the parties hereto may cancel this Agreement without cause by giving the other party sixty (60) days' written notice of its intention to do so. c. Termination for Cause and Remedies: In the event of breach of any contract terms, the COUNTY retains the right to terminate this Agreement. The COUNTY may also terminate this agreement for cause with CONTRACTOR should CONTRACTOR fail to perform the covenants herein contained at the time and in the manner herein provided. In the event of such termination, prior to termination, the COUNTY shall provide CONTRACTOR with five (5) calendar days' notice and provide the CONTRACTOR with an opportunity to cure the breach that has occurred. If the breach is not cured, the Agreement will be terminated for cause. If the COUNTY terminates this agreement with the CONTRACTOR, COUNTY shall pay CONTRACTOR the sum due the CONTRACTOR under this agreement prior to termination, unless the cost of completion to the COUNTY exceeds the funds remaining in the contract; however, the COUNTY 'reserves the right to assert and seek an offset for damages caused by the breach. The maximum amount due to CONTRACTOR shall not in any event exceed the spending cap in this Agreement. In addition, the COUNTY reserves all rights available to recoup monies paid under this Agreement, including the right to sue for breach of contract and including the right to pursue a claim for violation of the COUNTY's False Claims Ordinance, located at Art. IX, Section 2-721 et al. of the Monroe County Code. 17— _LimQi,,g I 'J, T Monroe County Engineering kyle 1100 Simonton Street,2-216 ‘ •-9 yr Key West,FL 33040 Project Management d. Termination for Convenience: The COUNTY may terminate this Agreement for convenience, at any time, upon seven (7) days' notice to CONTRACTOR. If the COUNTY terminates this -agreement with the CONTRACTOR, COUNTY shall pay CONTRACTOR the sum due the CONTRACTOR under this agreement prior to termination, unless the cost of completion to the COUNTY exceeds the funds remaining in the contract. The maximum amount due to CONTRACTOR shall not exceed the spending cap in this Agreement. In addition, the COUNTY reserves all rights available to recoup monies paid under this Agreement, including the right to sue for breach of contract and including the right to pursue a claim for violation of the COUNTY's False Claims Ordinance, located at Art. IX, Section 2-721 et al. of the Monroe County Code. e. Scrutinized Companies: For Contracts of any amount, if the County determines that the Contractor/Consultant has submitted a false certification under Section 287.135(5), Florida Statutes or has been placed on the Scrutinized Companies that Boycott Israel List, or is engaged in a boycott of Israel, the County shall have the option of (1) terminating the Agreement after it has given the Contractor/Consultant written notice and an opportunity to demonstrate the agency's determination of false certification was in error pursuant to Section 287.135(5)(a), Florida Statutes, or (2) maintaining the Agreement if the conditions of Section 287.135(4), Florida Statutes, are met. III. MAINTENANCE OF RECORDS. CONTRACTOR shall maintain all books, records, and documents directly pertinent to performance under this Agreement in accordance with generally accepted accounting principles consistently applied. Records shall be retained for a period of ten (10) years from the termination of this agreement. r. Each party to this Agreement or its authorized representatives shall have reasonable and timely access to such records of each other party to this Agreement for public records and audit purposes during the term of the Agreement and for ten (10) years following the termination of this Agreement. If an auditor employed by the County or Clerk determines that monies paid to CONTRACTOR pursuant to this Agreement were spent for purposes not authorized by this Agreement, or were wrongfully retained by the CONTRACTOR, the CONTRACTOR shall repay the monies together with interest calculated pursuant to Sec. 55.03 of the Florida Statutes, running from the date the monies were paid by the COUNTY. IV. PUBLIC ACCESS. The CONTRACTOR and COUNTY shall allow and permit reasonable access to, and inspection of, all documents, papers, letters or other materials in its 13 Monroe County Engineering 1100 Simonton Street,2-216 is — Key West,FL 33040 Project Management possession or under its control subject to the provisions of Chapter 119, Florida Statutes, and made or received by the CONTRACTOR and COUNTY in connection with this Agreement; and the COUNTY shall have the right to unilaterally cancel this Agreement upon violation of this provision by CONTRACTOR. CONTRACTOR shall be referred to herein also as "Contractor"for this provision only: 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 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 !? Monroe County Engineering 3° 1100 Simonton Street,2-216 ,'; Key West,FL 33040 kaii JProject Management 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- BRIANaMONROECOUNTY-FL.GOV, MONROE COUNTY ATTORNEY'S OFFICE 1111 12TH Street, SUITE 408, KEY WEST, FL 33040. V. Right to Audit Availability of Records. The records of the parties to this Agreement relating to the Project, which shall include but not be limited to accounting records (hard copy, as well as computer readable data if it can be made available; subcontract files (including proposals of successful and unsuccessful bidders, bid recaps, bidding instructions, bidders list, etc); original estimates; estimating work sheets; correspondence; change order files (including documentation covering negotiated settlements); backcharge logs and supporting documentation; general ledger entries detailing cash and trade discounts earned, insurance rebates and dividends; any other supporting evidence deemed necessary by Owner or the Monroe County Office of the Clerk of Court and Comptroller (hereinafter referred to as "County Clerk") to substantiate charges related to this agreement, and all other agreements, l5 ;4 c! \ f? A Monroe County Engineering 1091,K 1100 Simonton Street,2-216 tiKey West,FL 33040 Project Management sources of information and matters that may in Owner's or the County Clerk's reasonable judgment have any bearing on or pertain to any matters, rights, duties or obligations under or covered by any contract document (all foregoing hereinafter referred to as "Records") shall be open to inspection and subject to audit and/or reproduction by Owner's representative and/or agents or the County Clerk. Owner or County Clerk may also conduct verifications such as, but not limited to, counting employees at the job site, witnessing the distribution of payroll, verifying payroll computations, overhead computations, observing vendor and supplier payments, miscellaneous allocations, special charges, verifying information and amounts through interviews and written confirmations with employees, Subcontractors, suppliers, and contractors representatives. All records shall be kept for ten (10) years after Final Completion. The County Clerk possesses the independent authority to conduct an audit of Records, assets, and activities relating to this Project. If any auditor employed by the Monroe County or County Clerk determines that monies paid to Contractor pursuant to this Agreement were spent for purposes not authorized by this Agreement, the Contractor shall repay the monies together with interest calculated pursuant to Section 55.03, F.S., running form the date the monies were paid to Contractor. ft61 • • ,.,r Monroe County Engineering 1100 Simonton Street,2-216 Kcy West,FL 33040 Project Management In addition, Proposer states that he/she has included a certified copy of Contractor's License, Monroe County Occupational License, and Certificate of Liability showing the minimum insurance requirements for this project. Execution by the Contractor must be by a person with authority to bind the entity. IN WITNESS WHEREOF, the parties have caused this Agreement to be executed by their duly authorized representatives, as follows: Contractor: Mailing Address: !O(05 ( N 5 - t205 rn icum(% 331-1 f, Phone Number: 305 c?%( 34 Li _1 J E.I.N.: �-31=�--� (p' Email: (iM ngro �p - -12.,f►n ok s5 (0,9 ice. ( • Co Date: J5114/(g Signed: -zk r D i&)O--a `k,1, ) (Name) (Title) Contractor' 1 ness si ature: MONROE COUNTY ATTORNEY AP°R0Ci/E .,yS TO FORM Witness name: puC \c& dz-a.8 Date: (14 1 ';Rf'3t$AMBROSIO !Ai =COU TY ATTORNEY MO OE CO �. '90 9 Date: 5 (c( C ry ' ig Director of Project Management. �ha � ".+ Monroe County Engineering '�. 1100 Simonton Street,2-216 \ Key West,FL 33040 V Project Management VENDOR CERTIFICATION REGARDING SCRUTINIZED COMPANIES LISTS Project Description(s): 3OO L1 6 gat ctai nit AE. r ZO- s0 [1 9a�e Respondent Vendor Name: 4{NICC'Y1 C--t at)u Vendor FEIN: 46,-3 to7,( t, Vendor's Authorized Representative Name and Title: 0 lC f 10- ) Address: l 0(Q 3 ( M D' -5-ft-e t Z.0 City: i V1irx v'.J State: -c Zip: 3 3[7 j, Phone Number 3Q) quit-( 3 4S--1 Email Address:;¢t nc1{Ou 10. 2S421.1'V�x4 3 L9r-,.C;\ . cow\ Section 287.135, Florida Statutes prohibits a company from bidding on, submitting a proposal for, or entering into or renewing a contract for goods or services of any amount if, at the time of contracting or renewal, the company is on the Scrutinized Companies that Boycott Israel List, created pursuant to Section 215.4725, Florida Statutes, or is engaged in a Boycott of Israel. As the person authorized to sign on behalf of Respondent, I hereby certify that the company identified above in the Section entitled "Respondent Vendor Name"is not listed on the Scrutinized Companies that Boycott Israel List. I understand that pursuant to Section 287.135, Florida Statutes, the submission of a false certification may subject company to civil penalties, attorney's fees, and/or costs. I further understand that any contract with the COUNTY may be terminated, at the option of the COUNTY, if the company is found to have submitted a false certification or has been placed on the Scrutinized Companies that Boycott Israel List or engaged in a boycott of Israel. Certified By: ri,:s'LA'' n Z , who is authorized to sign on behalf of the abo enced compaikc Authorized Signature: Print Name: 1-74-D A o c Title: Note: The List are available at the following Department of Management Services Site: http://www.dms.myforida.com/business operations/state purchasing/vendor information/convict ed suspended discriminatory complaints vendor lists 1� • k. Monroe County Engineering 1100 Simonton Street,2-216 t ° Key West,FL 33040 Project Management NON-COLLUSION AFFIDAVIT I, n i La.S nrICZ4 M (Aof the city kq CA-) €-S i according to law on,my oath, and under penalty of perjury, depose and say that: 1. I am se..11'v\QtOk'u . Con.c\1a.c ( of the firm of (-wuc3 n C---vroup the proposer making the Proposal for the project described in the notice for calling foK prop,o als for: and that I executbd the said proposal with full authority to do so; 2. The prices in this proposal have been arrived at independently without collusion, consultation, communication or agreement for the purpose of restricting competition, as to any matter relating to such prices with any other proposer or with any competitor; and 3. Unless otherwise required by law, the prices which have been quoted in this proposal have not been knowingly disclosed by the proposer and will not knowingly be disclosed by the proposer prior to proposal opening, directly or indirectly, to any other proposer or to any competitor; and 4. No attempt has been made or will be made by the proposer to induce any other person, partnership or corporation to submit, or not to submit, a proposal for the purpose of restricting competition; and 5. The statements contained in this affidavit are true and correct, ,nd made with full Oo • •yam ai• •roject. 5-(04- [9 (Signature of Propo er) (Date) STATE OF: �--�n—' t • COUNTY OF: Pt"6-4\4 0 &Ur 1"-t PERSONALLY APPEARED BEFORE ME, the and signed authority, who, after first being sworn by me, (name of individual signing) affixed his/her signatur- j the space provided abov-. on this . _ 0 1;;;;;7: ••.• ANTHONY D i r 1, :\ Notary Public S for a i : , Commission N , 1890N► AR PUBLI '.,i„,•r,i1w./ My Comm.Expires Mar 5,2022 '" Bonded through National Notary Assn. My commission expires: a ( AL) ;2 'J, ', Monroe County Engineering 1100 Simonton Street,2-216 ; Key West,FL 33040 Project Management LOBBYING AND CONFLICT OF INTEREST CLAUSE SWORN STATEMENT UNDER ORDINANCE NO. 010-1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE g, 4vvicon AY )up , n (Company) "... warrants that he/it has not employed, retained or otherwise had act on his/its behalf any former County officer or employee in violation of Section 2 of Ordinance No. 010-1990 or any County officer or employee in violation of Section 3 of Ordinance No. 010-1990. For breach or violation of this provision the County may, in its discretion, terminate this contract without liability and may also, in its discretion, deduct from the contract or purchase price, or otherwise recover, the full amount of any fee, commission, percentage, gift, or consideration paid to the former C o cer or employe ". Sigrature) Date: 511 / l01 STATE OF: r COUNTY OF: Subscribed and sworn to (or affirmed) before me on 5 /! -2 d/ (date) by Eta ill Wescr-( _ .- (name of affiant). He/She is personally known to me p� or has produced 1 rz cs),y /4-vociv as identification. (Type of identification) NOTARY PUBLI My commission expires: l`,�,., ANTHONYDFERNANDEZ ,p1lY �Ataublic-State of Florida Yl•, 1.7))1, Corrfrnission#GG 189032 I •.'! My Conan.Expires Mar 5,2022 " 8ondcd through National Notary Assn. 11 ? 'A 2 Monroe County Engineering 'r 1100 Simonton Street,2-216 ‘kala.,100 ' - / Key West,FL 33040 Project Management DRUG-FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that: % cc _ r(1 (�ro v P (Name of Business) , 1. Publishes a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 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 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. 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 certi hat t ' it complies fully with the above requirements. Proposer's Signature `J 7/4"//1 Date a1 V. Via: Monroe County Engineering 1100 Simonton Street,2-216 li .' ;�C Key West,1.1., 33040 Project Management PUBLIC ENTITY CRIME STATEMENT "A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or CONTRACTOR under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, Florida Statutes, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list." I have read the above an state that neither n IcvotQ5 /1/1( ('� . r ., (Proposer's name) nor any Affiliate has been placed on the convicted vendor list within the last thirty-six (36) months. „Iv. (Signature) Date: Mill STATE OF: �C C ri( t) G COUNTY OF: -� Subscribed and sworn to (or affirmed) before me on the / 1( day of 141 20 1 T , b 1R-�os.ce-t ; N.sd,r--. (name of affiant). He/Sh: is •ersonally known to e or haproduced 14 t v. -_ ,•i =" ' P ce--L .. (type of identification) as identification. My Commission Expires: 4'........._.....--t- 7NTA-rrk T.—vs:77A.! . . . • THON FERNAND Z `:.: Notary'•• -State of Florida =/ 1 If CornmissioP 022 o'er My Comm.Expires '' Bonded through National Notary Assn. a� • ____,.....1 AMCOBUI-01 EMMA A`o ro CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD,YYYY) 6/6/2019 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 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(ies)must have ADDITIONAL INSURED provisions or 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). C NTACT PRODUCER N ME: Acrisure,LLC d/b/a InSource PHONE I�AIc,No):(305)670-9699 AX 9500 South Dadeland Boulevard (PJC,N o,Ext):(305)670-6111 4th Floor ADDREss;email@insource-inc.com Miami,FL 33156-2867 INSURER(S)AFFORDING COVERAGE NAIC a INSURER A:Scottsdale Insurance Company 41297 INSURED INSURER B: Amcon Group,Inc. INSURER C: 10631 N.Kendall Drive suite 1208 INSURER D: Miami,FL 33176 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED 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, • EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN SR ADDL SUB- POLICY EFF POLICY EXP UMITS LTR TYPE OF INSURANCE INSD WWI POUCY NUMBER JMMIDDIYYYYI (MMIDDIYYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE I X I OCCUR CPS2950798 01/22/2019 01/22/2020 pREMISEaaoc EDDnee) $ 50,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY f I JECT n LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: EBL AGGREGATE $ 1,000,000 BIND AUTOMOBILE LIABIUTY Eaa denntSINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ _ _AAUUTTOS ONLY SCHEDULEDOO Y l9IS T BODILY� INJURY(Per accident) $ AUTES ONLY ANUfOS ONLY By i (PeOramde^IDAMAGE $ UMBRELLA LIAR OCCUR 'ATE _ EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE WAIVER NiK' Yr6 AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN ANYCEWMEMBOER/PARTNDEWEX(ECUTIVE I I NIA E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yea,desaibe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,'may he attached If more space Is required) Certificate holder is named as additional insured as per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Monroe County BOCC ACCORDANCE WITH THE POLICY PROVISIONS. 500 Whitehead Street Key West,FL 33040 AUTHORIZED REPRESENTATIVE . /2-- /�- I . ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • Date CERTIFICATE OF LIABILITY INSURANCE 1 6/5/2019 Producer: Plymouth Insurance Agency This Certificate is issued as a matter of information only and confers no 2739 U.S. Highway 19 N. rights upon the Certificate Holder.This Certificate does not amend,extend or alter the coverage afforded by the policies below. Holiday, FL 34691 (727)938-5562 Insurers Affording Coverage NAIC# Insurer A: Lion Insurance Company 11075 Insured: South East Personnel Leasing, Inc. &Subsidiaries Insurer B: 2739 U.S. Highway 19 N. Insurers: Holiday, FL 34691 InsurerD:' Insurer E: Coverages • The policies of Insurance listed below have been issued to the Insured 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,exclusions,and conditions of such policies.Aggregate tells shown may have been reduced by paid claims. INSR ADOL Policy Effective Policy Expiration Limits LTR INSRD Type of Insurance Policy Number Date: Date (MM/DDYY) (MM/DD/YY) GENERAL LIABILITY Each Occurrence I Commercial General Liability T Damage to rented premises(EA Claims Made Occur occurrence) I Med Exp I • Personal Adv Injury I General aggregate limit applies per. General Aggregate $ J Policy Ell Project ❑ LOC Products-ComplOp Agg $ AUTOMOBILE LIABILITY is t NAC,EMENT Combined Single limit (EA Accident) $ Any Auto BY Bodily Injury All Owned Autos a-: (Per Person) $ Scheduled Autos Q J NMI WAIF �0 �,(ATE A,Y�r_ Bodily Injury Hired Autos (Per Accident) $ Non-Owned Autos Property Damage (Per Accident) I EXCESS/UMBRELLA LIABILITY ,Each Occurrence ROccur ❑Clams Made Aggregate Deductible A Workers Compensation and WC 71949 01/01/2019 01/01/2020 X I WC Scats I I ERH Employers Liability E.L.Each Accident st,00a,000 Any proprietor/partner/executive officer/member excluded? No E.L.Disease-Ea Employee st,000,000 If Yes,describe under special provisions below. E.L.Disease-Policy Limits s1,e00,0o0 Other Lion Insurance Company is A.M.Best Company rated A(Excellent). AMB#12616 Descriptions of Operations/Locations/Vehicles/Exclusions added by Endorsement/Special Provisions: Client ID: 81-73-013 Coverage only applies to active employee(s)of South East Personnel Leasing,Inc.&Subsidiaries that are leased to the following"Client Company": Amcon Group,Inc. Coverage only applies to injuries incurred by South East Personnel Leasing,Inc.&Subsidiaries active employee(s);while working In:FL Coverage does not apply to statutory employee(s)or independent contractor(s)of the Client.Company or any other entity. A list of the active employee(s)leased to the Client Company can be obtained by faxing a request to(727)937-2138 or email certificates@lioninsurancecomPany.com • Project Name: ISSUE 06-05-19(BP) Begin Date: ./18/2012 CERTIFICATE HOLDER CANCELLATION ' MONROE COUNTY BOARD OF COUNTY Should any of the above described policies be cancelled before the expiration date thereof,the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named to the left,but failure to COMMISSIONERS do so shall impose no obligation or liability of any kind upon the insurer,its agents or representatives. 500 WHITEHEAD STREET — KEY WEST, FL 33040 MONROE COUNTY, FLORIDA REQUEST FOR WAIVER OF INSURANCE REQUIREM It is requested that the insurance requirements, as specified in the County's Schedule of f '`' , Requirements, be waived or modified on the following contract. Contractor.`Vendor: Amcon Group, Inc. Project or Service: CO -\OLv\, • tit ContractorfVendor Address& Phone#: 10631 N Kendall Drive,Ste. 1208 Miami, FL 33176 General Scope of Work: 1-1Aca ka k 30 0 L.4- 4 4 4' zw .V 4-r t a,k i0/...Lick.ini....t-4. ,_ -QVIct, iv‘62-im ao I fo i .,:, lave- . . . . . . . 4104 Reason for Waiver or Am ton.n. C: a St . doe- -Doi' Pitt t /it -- ' - - Modification: Qcji- i i U((t £ .., - .:;+ :." f`a r Policies Waiver or Modification will apply to: Automobile Liability Signature of Contractor Vendor: Date: (-1�"t,-] Approved Not Approved Risk Management Signature: „Q__I e� ,.�_. Date: County Administrator appeal: Approved: Not Approved: Date: Board of County Commissioners appeal: Approved: Not Approved: , Meeting Date: Administrate%c Instruction 7500,7