Item N19 N.19
BOARD OF COUNTY COMMISSIONERS
County of Monroe Mayor Heather Carruthers,District 3
IleOI1da Keys Mayor Pro Tern Michelle Coldiron,District 2
�p.° Craig Cates,District I
David Rice,District 4
Sylvia J.Murphy,District 5
County Commission Meeting
January 22, 2020
Agenda Item Number: N.19
Agenda Item Summary #6448
BULK ITEM: Yes DEPARTMENT: Risk Management
TIME APPROXIMATE: STAFF CONTACT: Maria Slavik(305) 295-3178
N/A
AGENDA ITEM WORDING: Approval to advertise solicitation for proposals for Pollution
Liability Insurance Coverage.
ITEM BACKGROUND: The Pollution Liability Insurance Policy issued by AWAC provides
coverage to the County for potential liability associated with an accidental discharge of pollutants
from one of its fuel storage tanks and the potential liability associated with a pollution incident at
other scheduled County locations. County Purchasing Policy requires competitive bids for insurance
every three years, current policy expires May 1, 2020.
PREVIOUS RELEVANT BOCC ACTION: This policy was last bid in January 2017, and
approved by the BOCC on April 12, 2017.
CONTRACT/AGREEMENT CHANGES:
N/A
STAFF RECOMMENDATION: Approval
DOCUMENTATION:
Pollution Liability RFP 2020
FINANCIAL IMPACT:
Effective Date: 5/l/2020
Expiration Date: 5/l/2023
Total Dollar Value of Contract: Approximately $75,000
Total Cost to County: Approximately$75,000
Current Year Portion:
Budgeted: Yes
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N.19
Source of Funds: Internal Service Fund Primarily Ad Valorem
CPI: N/A
Indirect Costs: N/A
Estimated Ongoing Costs Not Included in above dollar amounts: N/A
Revenue Producing: No If yes, amount:
Grant: N/A
County Match: N/A
Insurance Required: N/A
Additional Details:
REVIEWED BY:
Maria Slavik Completed 01/07/2020 9:46 AM
Paunece Scull Completed 01/07/2020 10:35 AM
Bob Shillinger Completed 01/07/2020 2:53 PM
Budget and Finance Completed 01/07/2020 3:15 PM
Kathy Peters Completed 01/07/2020 4:42 PM
Board of County Commissioners Pending 01/22/2020 9:00 AM
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N.19.a
MONROE COUNTY
REQUEST FOR PROPOSALS
FOR
2020 - 2023 Pollution Liability Insurance Program
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BOARD OF COUNTY COMMISSIONERS
Mayor, Heather Carruthers, District 3
Mayor Pro Tem, Michelle Coldiron, District 2
Craig Cates, District 1
David Rice, District 4
Sylvia Murphy, District 5
COUNTY ADMINISTRATOR
Roman Gastesi
CLERK OF THE CIRCUIT COURT COUNTY ATTORNEY
Kevin Madok, CPA Risk Management
January 23, 2020
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N.19.a
NOTICE OF CALLING FOR PROPOSALS
NOTICE IS HEREBY GIVEN TO PROSPECTIVE PROPOSERS that on March 10,
2020 at 3:00 P.M. the Monroe County Purchasing Office will open sealed proposals for
the following:
Monroe County Pollution Liability Insurance Program
Requirements for submission and the selection criteria may be requested from
DemandStar by Onvia at www.demandstar.com. The Public Record is available at the
Purchasing Office located at the Gato Building, 1100 Simonton Street, Key West, FL
33040. Technical questions should be directed, in writing, to Maria Slavik, Risk
Administrator, 1111 12t" St., Suite 408, Key West, FL 33040 or by facsimile to (305)
295-3179. All answers will be by Addenda.
Vendors shall submit a total of six 5 documents three 3 signed originals plus three 3 complete o
copies)and one(1)complete document saved,electronically tabbed and indexed in Adobe Acrobat file
(pdf) format delivered on a current common electronically saved form(i.e., flash drive,etc.)of the
proposal, in a sealed envelope in a sealed envelope clearly marked on the outside, with g
the Proposer's name and "Proposal for 2020/2021_Pollu_tio_n Insurance
Program" addressed to:
Monroe County Purchasing Office
1100 Simonton Street, Room 2-213
Key West, FL 33040
Phone: (305) 292-4466
Fax: (305) 292-4465
All proposals must be received by the County Purchasing Office before 3:00 P.M. on March 10,
2020. Any proposals received after this date and time will be automatically rejected.
Materials may be delivered by Certified Mail, Return Receipt Requested, hand-delivered a.
or couriered. Faxed or e-mailed proposals will be automatically rejected. Hand delivered
Proposals may request a receipt. If sent by mail or by courier, the above-mentioned
envelope shall be enclosed in another envelope addressed to the entity and address stated
above. Proposers should be aware that certain "express mail" services will not guarantee
specific time delivery to Key West, Florida. It is the sole responsibility of each Proposer to
ensure their proposal is received in a timely fashion.
All proposals must remain valid for a period of ninety (90) days from the date of the
deadline for the proposal stated above. The Board will automatically reject the
response of any person or affiliate who appears on the convicted vendor list prepared
by the Department of Management Services, State of Florida, under Sec. 287.133(3)
(d), Florida Statutes. Monroe County declares that all or portions of the documents and
work papers and other forms of deliverables pursuant to this request shall be subject to
reuse by the County.
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Dated at Key West, Florida, this 5th day of February, 2020.
Monroe County Purchasing Department
Publication Dates:
Keys Weekly- February 13, 2020
News Barometer— February 13, 2020
KW Citizen - February 8, 2020
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TABLE OF CONTENTS
NOTICE OF REQUEST FOR PROPOSALS
SECTION ONE — INSTRUCTION TO PROPOSERS
SECTION TWO — COUNTY FORMS
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Monroe County
Board of County Commissioners
REQUEST FOR PROPOSALS
FOR
2020 - 2023 Pollution Liability
Insurance Program
EFFECTIVE DATE: 5/1/20
BACKGROUND INFORMATION
The County is a non-chartered county established under the Constitution and the laws of the State of Z
Florida. The Clerk of the Circuit Court serves as the fiscal agent.
The Board of County Commissioners, constituted as the governing body, has all the powers of a
body corporate, including the powers to contract; to sue and be sued; to acquire, purchase, hold,
lease and convey real estate and personal property; to borrow money, and to generally exercise the . ,
powers of a public authority organized and existing for the purpose of providing community services
to citizens within its territorial boundaries. In order to carry out is function; the County is empowered
to levy taxes to pay the cost of operations. U)
A full time Risk Manager is employed to oversee the County's Property and Casualty insurance
program. A full time safety manager reports to the County Administrator.
CURRENT PROGRAM a.
The County's current policy was issued on May 1, 2017 on a three year basis by Ironshore Specialty
Insurance Co. The limits of the policy are $5 million per occurrence and a $5 million annual
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aggregate. All claims are subject to a $50,000 deductible. The three (3) year premium was
$71,792.
The policy extends to the legal obligations of the County that arise out of the discharge, dispersal,
release, seepage, migration or escape of smoke, vapors, soot fumes acids, alkalis, toxic chemicals, a.
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liquids, gases, or other similar hazardous materials from locations scheduled in the policy. The
policy will also pay for the expenses incurred for the investigation, monitoring, removal, disposal,
treatment or neutralization of property contaminated by such incidents. Coverage is provided on a
"Claims Made" basis with a retroactive date of 7/10/95.
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MONROE COUNTY
BOARD OF COUNTY COMMISSIONERS
REQUEST FOR PROPOSALS
FOR
POLLUTION LIABILITY INSURANCE
GENERAL INFORMATION AND COVERAGES REQUESTED
COVERAGES REQUESTED
Monroe County, Florida wishes to receive proposals for the following insurance protection:
➢ Pollution Liability
The County will consider modified proposals to the extent that they provide adequate coverage and
in view of the overall program objectives. Reasonable options are solicited where the desired
coverages cannot be provided as requested. All reasonable proposals will be eligible for review.
SEPARABILITY OF COVERAGES
Coverages that must be purchased in combination or as part of other coverages should be
specifically stated in the proposal(s). If different premiums apply to coverages when purchased
separately, they should be specifically stated. U)
RATING DATA
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A schedule of locations to be insured and a schedule of County owned Storage Tanks (to be
included as insured locations) are included below. IL
EVALUATION CRITERIA
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Award shall be made to the responsible proposer whose proposal is determined to be the most
advantageous to the County, taking into consideration the evaluation criteria set forth below:
Evaluation Factor Maximum Available Points
Terms a._.d conditions
��..... m�� ��������� wm��. .���,�,°, n rrrr.,��� ����,,.n�,rr,,,,,,,,,�,„� „����.��. ._- __. _______
n of coverages being 30
....._ _._.proposed. ... mm. m.. . . _ .,.
Financial stability of insurers being 15
proposed
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Experience
of proposing agent with
structuring Pollution Liability insurance 7
.Ex erie 4Ve�...�_... _.... �_w.�aw.� __ .�_.�... _...... w. mmmm.W....., --
p�..... mm of proposing agent with 8
_mmental entities
locaatlpreference m f applicable: l5 I ointm ��.. ����,m„������ ....
p p g g (including 10
Price 30
Total points earned are on a scale of 1 - 100 points
1 = lowest 100 = highest
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Loss HISTORY
There have been no known losses during the past five (5) years.
EFFECTIVE DATE OF COVERAGE
The effective date of coverage is May 1, 2020. The County would prefer to purchase a three (3)
year policy with premiums paid on an annual basis. The County will consider a single year policy if
a multi year policy is unavailable.
ASSIGNMENT OF MARKETS
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Due to the limited number of insurers that have the ability and desire to provide Pollution Liability
insurance, the County will not assign markets for this RFP. However, if a proposer submits the
County's account to an insurer and later elects to pursue a proposal from that insurer, it is requested
that the proposer release the insurer and waive the standard 10 day waiting period so other
proposers will have access to that insurer.
RFP SCHEDULE U)
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The following schedule will apply to the RFP process. Extensions of any of the deadlines will not be
honored.
..Date................... ..................................................................................Acti�it...................................................................................
......._..._....._..._..._�....... _.........._......_._..........................___._ .�....__..........m_......_..........Y._.......................__............................................._�_.
1123120 Posting of bid specifications on
Demandstar
.2/13/20 Deadline for requests for�additiona[
information
2118120........... -Addend um"to RFP issue�d�to.�..all..............................
�._.._........... p.ropo�sers �.�. _...._................................. ..m�� ............m...��.................................
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3/10/20 ..
Proposal return date andbid opening
4/15/20 ..m Board meetingand award of contract
511120 Effective Date
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VALID DATE OF PROPOSALS
Proposals are requested to remain valid until June 1, 2020 in the event that an extension of the
current program is undertaken.
RIGHT To REJECT PROPOSALS
Monroe County, Florida reserves the right to reject or waive any proposal individually, including any
portion of a proposal for any reason that it deems appropriate.
The County may elect to negotiate or not to negotiate with any individual Proposer.
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The County reserves the right to select the proposal(s) that it believes will best serve its interests.
The award of any multi-year contract is subject to an annual appropriation by the Monroe County
Board of County Commissioners.
ADHERENCE TO INFORMATION AND PROPOSAL
All statements contained in written proposals are intended to be relied upon by Monroe County. All
coverages must be issued as proposed unless the County authorizes individual changes. Any
changes authorized by the County will not alter any other items contained in this Request for
Proposal. Policies not issued in conformance with the submitted proposal will be considered
not in compliance and must be corrected.
SUBMISSION OF PROPOSALS
NUMBER OF COPIES OF PROPOSALS REQUIRED; BID OPENING DATE; DELIVERY LOCATION
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See also Notice of Request for Competitive Solicitation.
Vendors shall submit a total of six (6) documents (three (3) signed originals plus three (3) complete
copies) and one (1) complete document saved, electronically tabbed and indexed in Adobe Acrobat .�
file (pdf) format delivered on a current common electronically saved form (i.e., flash drive, etc.) of the
proposal, in a sealed envelope.
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Proposals must be received no later than 3:00 pm, March 10, 2020 addressed as follows:
Monroe County Board of County Commissioners CD
Office of Director of Purchasing IL
1100 Simonton Street
Suite 1-213
Key West, Florida 33040
Phone: (305) 292-4466
Fax: (305) 292-4515
Hand delivered proposals may request a receipt. Proposals received after the deadline will be
returned unopened. a.
All proposals should be contained in sealed envelopes, clearly marked on the outside with the E
following language:
Monroe County Florida
Proposal for Pollution Liability Insurance
2020/2023 Policy Year
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AUTHORITY OF PROPOSERS
An authorized representative of the insurance company underwriting the program should sign the
proposals. If the submitting agent/broker does not have the authority to sign the proposal, it should
be signed by an authorized representative of the company. Proposals submitted without binding
authority will not be given the same consideration as authorized proposals. Proposals should not be
contingent upon any subsequent inspection after the inception date.
REQUIRED LICENSE
All agents submitting proposals are required to be currently licensed in the State of Florida to
transact property and related coverages insurance. The County reserves the right to request
verification of such licensing. The agent should be licensed with the insurer submitting a proposal
and have the authority to bind coverage.
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STABILITY OF INSURERS
Insurers furnishing coverage should be stable and have a current A. M. Best Company rating of "A-"
or better and be of sufficient financial size to provide security. Insurers must be currently authorized
to transact insurance business in the State of Florida. If an insurer is proposed that has a Best rating
of less than A-, a copy of the insurer's most recent financial statement should be included for review.
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ADDITIONAL INFORMATION/INSPECTION
Every attempt has been made to furnish complete and accurate information to the best of the
County's knowledge. Proposers are encouraged to determine, at their expense, their own
information for underwriting purposes including any inspections and loss control surveys.
If additional information is required, written requests must be submitted prior to 3:00 pm, February
13, 2020 to:
Ms. Maria Slavik, CPM
Risk Management Administrator
Monroe County
1111 1211 St. Suite 408 IL
Key West, Florida 33040
Fax: (305) 295-3179
Email: Slavik-Maria@Monroecounty-fl.gov
Based upon the requests received, any addendum to the specifications will be prepared and posted
on DemandStar. Oral requests for additional information will not be entertained.
Payment Terms
The County desires to have the option of interest free, periodic premium payments. Please indicate
any terms available.
SAMPLE POLICIES AND CONTRACTS
Sample forms/endorsements and other coverage information are considered an integral part of the
proposal. If Insurance Services Office (ISO) forms are to be used, reference can be made to the
form numbers and edition dates.
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If Manuscript or non-ISO forms are proposed, specimen forms must be attached to the proposal for
review
RATE CHANGE/POLICY MODIFICATION
Ninety (90) days written notice is requested to be provided by the insurer prior to modification
resulting in restriction of existing policy terms or provisions required by the insurer.
TERMINATION/NON-RENEWAL NOTICE
Ninety (90) days written notice is requested to be given by the insurer for termination, non-renewal or
restriction of limits or coverage except for non-payment of premium.
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NAMED INSURED
The Named Insured wording of the policy should include the following:
Monroe County Board of County Commissioners and its elected officials.
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NOTICE OF CLAIM
Proposers are requested to modify policy language relating to notification to the insurer following a
loss to provide that:
"Notice of loss shall be given to the insurer as soon as practicable following
receipt of notice of the claim by the Risk Administrator of Monroe County,
Florida."
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CLAIM REPORTING LOCATIONS
Please indicate the address, telephone number and name of individuals to report claims to and the
procedures to be followed in notifying the insurer. Please provide a list of all insurer claim reporting
offices, their addresses, telephone numbers and contact persons who will adjust claims within the
limits of the County's operations. E
LOSS HISTORY REPORTS
Written loss history reports must be furnished at least quarterly. Reports should be completed in
plain English and should include a detailed description of individual claims and the amounts paid and
reserves for each claim.
WAIVER OF SUBROGATION
The standard policy wording involving subrogation should be modified to remove subrogation
between the County and entities owned, managed, or required to be removed by agreement,
contract or lease including interlocal and other governmental agreements.
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LOSS CONTROL SERVICES
The County wishes to utilize services of the successful insurer(s). Proposers should include a
statement of the intended loss control activities and the frequency of such services. Any additional
charges not included in normal policy premiums must be specifically identified by type and frequency
of service and specific costs or charges separately stated.
USE OF PROPOSAL FORMS
Proposers are required to submit their proposal on the forms included in this request.
Additional information or proposals may be submitted in addition to the initial proposal. The general
information proposal form must be signed in accordance with other requirements of this Request for
Proposal as well as individual coverage sections.
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In addition, if an addendum to this Request is issued, the Proposer must acknowledge receipt of
such addendum by completing and returning, with their proposals, the acknowledgment forms that
will accompany the addendum. However, the failure of the Proposer to acknowledge receipt of the
addendum will not render the addendum invalid.
All sections of the proposal forms must be completed. Responses such as "See Policy Form" or
"See Proposal" will not be acceptable. Part of the evaluation process will be the ability of the
proposer to understand and explain the terms and conditions of the policies. Fully responding to all 2
issues addressed in the proposal forms will demonstrate the proposer's understanding of the
program being submitted and the ability of the proposer to serve the needs of the County.
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COMPLETION OF REQUIRED FORMS
Proposers must complete and submit the required "Drug-free Workplace" "Non-Collusion Affidavit",
"Sworn Statement Under Ordinance No. 10-1990 Ethics Clause" and "Public Entity Crime Statement" Lu
forms in addition to completing the proposal forms.
2 CFR PART 200
If any Federal Funds are used to pay and/or services the vendor will be expected to comply with IL
the terms and conditions required by 2 CFR part 200, including Appendix II to 2 CFR part 200
(Contract Provisions for Non-Federal Entity Contracts under Federal Awards). E
Section 30. Federal Contract Clauses. If federal funds are used to pay for these services, the
following federal contract clauses from 2 CFR part 200 are incorporated in and made part of this
Agreement:
a. Debarment and Suspension (Executive Orders 12549 and 12689)—A contract
award (see 2 CFR 180.220) will not be made to parties listed on the government
wide exclusions in the System for Award Management (SAM), in accordance with
the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR
part 1986 Comp., p. 189) and 12689 (3 CFR part 1989 Comp., p. 235),
"Debarment and Suspension." SAM Exclusions contains the names of parties
debarred, suspended, or otherwise excluded by agencies, as well as parties
declared ineligible under statutory or regulatory authority other than Executive
Order 12549.
b. Byrd Anti-Lobbying Amendment (31 U.S.C. 1352)—Contractors that apply or bid
for an award exceeding $100,000 must file the required certification. Each tier
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certifies to the tier above that it will not and has not used Federal appropriated
funds to pay any person or organization for influencing or attempting to influence
an officer or employee of any agency, a member of Congress, officer or employee
of Congress, or an employee of a member of Congress in connection with
obtaining any Federal contract, grant or any other award covered by 31 U.S.C.
1352. Each tier must also disclose any lobbying with non-Federal funds that takes
place in connection with obtaining any Federal award. Such disclosures are
forwarded from tier to tier up to the non-Federal award.
c. Americans with Disabilities Act of 1990 (ADA) -- Contractor will comply with all the
requirements as imposed by the ADA, the regulations of the Federal government
issued thereunder, and the assurance by the CONTRACTOR pursuant thereto.
d. Disadvantaged Business Enterprise (DBE) Policy and Obligation - It is the policy
of the COUNTY that DBE's, as defined in 49 C.F.R. Part 26, as amended, shall
have the opportunity to participate in the performance of contracts financed in
whole or in part with COUNTY funds under this Agreement. The DBE
requirements of applicable federal and state laws and regulations apply to this
Agreement. The COUNTY and its CONTRACTOR agree to ensure that DBE's
have the opportunity to participate in the performance of this Agreement. In this
regard, all recipients and contractors shall take all necessary and reasonable
steps in accordance with applicable federal and state laws and regulations to
ensure that the DBE's have the opportunity to compete for and perform contracts.
The COUNTY and the CONTRACTOR and subcontractors shall not discriminate
on the basis of race, color, national origin or sex in the award and performance of
contracts, entered pursuant to this Agreement.
e. The Contractor shall utilize the U.S. Department of Homeland Security's E-Verify
system to verify the employment eligibility of all new employees hired by the AR
Contractor during the term of the Contract and shall expressly require any
subcontractors performing work or providing services pursuant to the Contract to
likewise utilize the U.S. Department of Homeland Security's E-Verify system to
verify the employment eligibility of all new employees hired by the subcontractor IL
during the Contract term.
f. No Obligation by Federal Government. The federal government is not a party to
this contract and is not subject to any obligations or liabilities to the non-Federal
entity, contractor, or any other party pertaining to any matter resulting from the
contract.
g. Program Fraud and False or Fraudulent Statements or Related Acts. The
Contractor acknowledges that 31 U.S.C. Chapter 38 (Administrative Remedies for
False Claims and Statements) applies to the Contractor's actions pertaining to
this contract.
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Monroe County, Florida
2020 - 2023 Pollution Liability Insurance Program
Request for Proposals
REQUESTED COVERAGES
FORM
The policy should extend to the legal obligations of the County that arise out of the discharge,
dispersal, release, seepage, migration or escape of smoke, vapors, soot fumes acids, alkalis, toxic
chemicals, liquids, gases, or other similar hazardous materials from locations scheduled in the Z
policy. The policy should also pay for the expenses incurred for the investigation, monitoring,
removal, disposal, treatment or neutralization of property contaminated by such incidents. if
coverage is provided on a "Claims Made" basis, the County desires to have full "Prior Acts"
coverage; however to maintain the continuity of the current program, any proposal with a retroactive
date later than 7/10/95 will receive less consideration.
DESIRED LIMITS AND DEDUCTIBLE
Desired Limits $50 million
Desired Deductible $50,000
Alternative limits and deductibles will be considered based on the level of protection being provided 2.4
and pricing. IL
UNDERWRITING INFORMATION
Specific underwriting information is provided as attachments.
Additional information regarding the County (to include budgetary information) can be obtained from
the County's Website at
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LOSS EXPERIENCE IL
There have been no known losses within the past five years. E
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Monroe County, Florida
2020 - 2023 Pollution Liability Insurance Program
Request for Proposals
Proposal Form
GENERAL INFORMATION
Use of the proposal forms will enable a faster more complete analysis of the proposal(s) submitted.
Please complete this general proposal form in addition to a separate proposal form for each
coverage proposed. Additional information can be attached to the forms.
Agent/Agency submitting proposal:
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Address:
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Telephone Number: .�
Does agent have binding authority? Yes No
If not, state procedure to bind.
Is agent licensed in the state of Florida? Yes No
Are the following coverages proposed.?
Legal obligations arising out of the discharge, disposal,
release, seepage, migration or escape of pollutants Yes No SR
Payment of expenses incurred for the investigation
monitoring, removal, disposal, treatment or
neutralization of property contaminated
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by pollution incidents Yes
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If not, provide specific details of coverages
provided
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Are coverages different from current program? Yes No
If so, state differences
Effective date(s) of coverage(s)
List payment plan, including interest or
service charges
Proposal valid until (date) Z
Rate Change/Policy Modification wording included
as requested? Yes No
Termination Notice wording included as requested? Yes No
Named Insured wording included as requested? Yes No
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If not, include actual wording to be used.
Claim reporting location included? Yes No
Will requested claim reporting wording be used? Yes No
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Claim Reports to be provided as requested? Yes No
If not, state details
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Loss Control services to be provided? Yes No
Details.
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Sample forms and policies included as required? Yes No
The proposer stated below is the authorized agent of the company or companies proposed, and is
authorized to bind coverages upon acceptance by the County. Deviations from the requested program
have been stated. Coverage will be issued as proposed.
Signature of Authorized Representative Date
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Monroe County, Florida
2020 - 2023 Pollution Liability Insurance Program
Request for Proposals
Proposal Form
POLLUTION LIABILITY
Company
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Underwriting office used
Address
Telephone Number
Is insurer authorized to transact insurance in the
State of Florida? Yes No
Basis of authorization:
Admitted insurer Yes No
Surplus Lines insurer Yes No
Current A. M. Best Co. rating
Is requested policy form proposed? Yes No
If not, list form(s) used
Coverages Provided
Legal Liability Yes No
Clean Up Yes No
Rates guaranteed for one year? Yes No
Are rating worksheets attached? Yes No
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Term of coverage being proposed
One year? Yes No
Two year? Yes No
Three year? Yes No
Limits/Premiums/Deductibles
Limit Deductible One Year Two Year Three
Premium Premium Year
Premium
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Legal Liability
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If a multi year program is being proposed,
will premiums be payable on an annual basis? Yes No
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The proposer stated below is the authorized agent of the company or companies proposed, and is
authorized to bind coverages upon acceptance by the County. Deviations from the requested
program have been stated. Coverage will be issued as proposed.
Signature of Authorized Representative Date
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MONROE COUNTY, FLORIDA
2020 - 23 POLLUTION INSURANCE
SCHEDULE OF INSURED LOCATIONS
FIRE AMBULANCE
STATION FIRE STATION SENIOR CITIZEN CENTER LIBRARY
23 EMERALD ROAD KEY DEER BLVD KEY DEER BLVD 200 KEY DEER BLVD
BIG COPPIT KEY, FL BIG PINE KEY, FL 33043 BIG PINE KEY, FL 33043 BIG PINE KEY, FL 33043
33040
,
SHERIFF'S SUBSTATION ,,,m,,,,,,,,,,,,,,,�,�,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
LIBRARY LIBRARY AVIATION SHERIFF'S
FIRE AMBULANCE 2331 OVERSEES HWY MM101.5 OVERSEES HWY OFFICE, 10100 OVERSEAS
MM21 CUDJOE KEY KEY LARGO, FL 33037 KEY LARGO, FL 33037 HWY, MARATHON, FL
CUDJOE KEY, FL 33042
............................................................................................................................................. .................................................................................................................................................................... ............................................................................................................................................................................................. ...........................................
SENIOR CITIZEN HEALTH DEPARTMENT SUB-COURTHOUSE/OFFICES SHERIFF'S SUB-STATION
CENTER 3333 OVERSEES HWY 3117 OVERSEES HWY OFFICES g
33RD STREET- GULF MARATHON, FL 33050 MARATHON, FL 33050 3103 OVERSEES HWY
MARATHON, FL 33050 MARATHON, FL 33050
............................................................................................................................................................................... .,,,,., ,,,,,,,,,..,,,,..................................................................................................................................................................................................... .........................................................
GOVERNMENT CENTER MARATHON GOV. AIRPORT TERMINAL PUBLIC WORKS OFFICES
ANNEX CENTER/EOC 9480 OVERSEES HWY 10600 AVIATION BLVD �,
490 63Rp STREET 27900 OVERSEES HWY MARATHON, FL 33050 MARATHON, FL 33050
MARATHON, FL 33050 „MARATHON FL 33050
............................................_.. . ..._... .............. .................................................................................................................................
............................... .,...
COUNTY `14
SHERIFF'S SUB- OFFICES/SOCIAL SHERIFF'S SPECIAL `14
STATION SERVICES DETENTION FACILITY OPERATIONS
88770 OVERSEES HWY HIGHPOINT ROAD 3981 OCEAN TERRACE 85 COCO PLUM ROAD
PLANTATION KEY, FL PLANTATION KEY, FL MARATHON, FL 33050 MARATHON, FL 33050
33070 33070 ®_
DETENTION FACILITY DETENTION FACILITY SENIOR CITIZEN CENTER r-
PUBLIC WORKS OFFICES
HIGHPOINT ROAD 5501 COLLEGE ROAD HIGHPOINT ROAD
103 KEY HEIGHTS DRIVE
PLANTATION KEY, FL STOCK ISLAND, FL PLANTATION KEY, FL DRIVE
PLANTATION KEY, FL
33070 33040 3307D
SHERIFF ADMIN.
BUILDING
5525 COLLEGE ROAD
STOCK ISLAND, FL
33040
19 of 30 Packet Pg. 2179
N.19.a
MONROE COUNTY, FLORIDA
2020 -23 POLLUTION INSURANCE
SCHEDULE OF INSURED LOCATIONS
FIRE &AMBULANCE SPOTTSWOOD BLDG,
STATION COURTHOUSE ANNEX/COURTROOMS 887700 OVERSEAS HWY,
MARINE AVENUE 500 WHITEHEAD STREET 510 WHITEHEAD STREET PLANTATION KEY, FLIL
TAVERNIER KEY WEST, FL 33040 KEY WEST, FL 33040 33070
........................................................................N....FL...33070............................
LIGHTHOUSE MUSEUM JUSTICE BLDG/RECORD LIBRARY SENIOR CITIZENS
938 WHITEHEAD STORAGE NUTRITION CENTER
STREET 530 WHITEHEAD STREET 700 FLEMING STREET KEY WEST TRUMAN AVE./WHITE ST.
KEY WEST, FL 33040 KEY WEST, FL 33040 , FL 33040 KEY WEST, FL 33040
0
AIRPORT TERMINAL COUNTY GARAGE GATO BUILDING & ARNOLD AIRPORT
3491 S. ROOSEVELT GENERATOR TERMINAL ANNEX
BLVD. S. ROOSEVELT LT BLVD. 1100 SIMONTON STREET S. ROOSEVELT BLVD.
KEY WEST, FL 33040
KEY W EST, FL 33040 KEY WEST, FL..3.3040..........�„� KEY WEST, FL 33040 .2
LONG KEY LANDFILL
AND TRANSFER CUDJOE KEY LANDFILL HOUSE FOR THE AGED FIRE STATION cv
STATION AND TRANSFER STATION 5200 COLLEGE ROAD OVERSEES HWY cv
MM 68 CUDJOE KEY, FL 33042 STOCK ISLAND, FL 33040 CONCH KEY, FL 33050 IL
LONG KEY, FL 33001
....................................................
LIBRARY GOVERNMENTAL HARVEY GOVERNMENT T
CENTER/COURTHOUSE HEALTH CLINIC
3251 OVERSEES HWY CENTER
HIGHPOINT ROAD 170901 HIGHWAY#1 (REAR)
MARATHON, FL 33050 1200 TRUMAN AVENUE
PLANTATION KEY, FL TAVERNIER, FL 33070
33070 KEY WEST, FL 33040
0
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FLEET MAINTENANCE COUNTY OFFICESIELLIS STATE ATTORNEYNOTING
FACILITY BUILDING REGISTRAR 60 HIGH POINT ROAD
10600 AVIATION BLVD 88800 US HIGHWAY#1 302 FLEMING STREET/501 ISLAMORADA FL 33070 ca
MARATHON, FL 33050 PLANTATION KEY, FL THOMAS STREET
33070 KEY WEST, FL 33040
KEY LARGO LANDFILL MURRAY E NELSON
AND TRANSFER GOVERNMENT& FREEMAN JUSTICE FIRE STATION, 6180 2"D
STATION CULTURAL BLDG., BUILDING, 302 FLEMING AVE., STOCK ISLAND
11100 COUNTY RD. 905 102050 OVERSEAS HWY, ST., KEY WEST, FL
KEY LARGO, FL KEY WEST, FL
All Listed Tanks are Above Ground Storage Tanks
20 of 30 Packet Pg. 2180
N.19.a
Monroe County, Florida
2020/2023 Pollution Liability Insurance Program
Request for Proposals
Underwriting Information
2018/19 Actual 2019/20 Projected
LL
Revenues $328,976,542 (Unaluldited $487,71819,333
Coverage has not been cancelled, denied or non-renewed.
Monroe County has not been investigated, cited and/or prosecuted for contravention or violation of
any standard or law relating to any release of pollutants.
There have been no pollution claims.
Monroe County is not aware of any past or present contamination on-site or emanating from any site
that could give rise to a claim.
Monroe County has not received any notices of violation, fine, penalties, complaints etc. within the
past 5 years.
Monroe County presently complies with statutes, standards, regulation relating to the protection of
the environment. 0
There has been no past, present or planned remediation, monitoring or sampling to investigate
potential contamination.
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There are no plans to sell or sublease any of the locations listed.
There are no known plans for future development, improvement, betterment, demolition or plans for
changes in site operations.
Underground storage tanks are in compliance with the 1998 US EPA standards for leak detection,
overflow protection and corrosion protection.
21 of 30 Packet Pg. 2181
N.19.a
Information on the County Owned landfills:
Ye. . .._................ ...°........._ All ze oca ion Lined
NoSi „ mmmmmmmm,
Mound 1 Top Lined
MM68 but Not 8
Long Key Bottom
Lined
......... ,,,.,„
Mound 2 Top Lined
MM68 but Not 6.5
e
Long Key Bottom
Lined
_......_..�.. �. . . �m _......„.„. . ,,,,,,.. .. _�
Key Largo Landfill, Top Lined
Key Largo but Not 7 2
Bottom
Lined
L
Cudjoe Key . _n d fill 1-1 ....L in_ed..... ,,..... ........ ° ...
..,
a Top
Cudjoe Key but Not 7
Bottom
Lined
Ground water monitoring devices and sub surface wells have been installed. They are evaluated 4
times a year by an independent contractor. No negative reports have been issued.
C4
All landfills were opened between 1974 and 1975. They were closed between 1994 and 1995. They
are top-lined but not bottom-lined.
All public waste is transported out of the County and disposed in properly licensed waste disposals
sites. The County has constructed three (3) Transfer Facilities. The disposal of public waste is
provided by independent contractors with the agreements containing favorable Hold
Harm lessllndemnification provisions in favor of the County and appropriate minimum insurance
requirements that the contractors must comply with.
22 of 30 Packet Pg. 2182
N.19.a
a�
REQUIRED FORMS
TO BE COMPLETED
2
BY
PROPOSER
a.
23 of 30 Packet Pg. 2183
N.19.a
RESPONSE FORM
RESPOND TO: MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
Purchasing Department
GATO BUILDING, ROOM 1-213
1100 SIMONTON STREET
KEY WEST, FLORIDA 33040
1 acknowledge receipt of Addenda No. (s) -
I have included
• Response Form
• Lobbying and Conflict of Interest Clause 2
• Non-Collusion Affidavit
• Drug Free Workplace Form
• Public Entity Crime Statement
• Proof of payment of Monroe County business
tax and relevant City business tax, unless
exempted, must be provided within ten days g
of award of the contract
• Local Preference form (if applicable)
.. ..��
• Proposal Forms (General Information, and
Pollution Liability) N,:H,.m.
(Check mark items above, as reminder that they are included.)
I have included a current copy of the following professional licenses and receipt for business taxes:
0
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Mailing Address: Telephone:
........................................................................................................................................................................................ Fax:
Date:
24 of 30 Packet Pg. 2184
N.19.a
Signed:
Witness:
Print Name)
{Title}
STATE OF:
COUNTY OF:
Subscribed and sworn to (or affirmed) before me on
(date) by ,�,�Nrv,��,„n,
. ...., � ° . (name of affiant). He/She is personally
known to me
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or has produced (type of identification) as °2
identification.
m w , , rrNOTARY PUBLIC
My Commission Expires:
N
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0
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5 of 30 Packet Pg. 2185
N.19.a
LOBBYING AND CONFLICT OF INTEREST CLAUSE
SWORN STATEMENT UNDER ORDINANCE NO. 010-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
li „
(Company)
"...warrants that he/it has not employed, retained or otherwise had act on his/her behalf any former Z
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 .02
provision the County may, in its discretion, terminate this Agreement without liability and may also, in
its discretion, deduct from the Agreement or purchase price, or otherwise recover, the full amount of a.
any fee, commission, percentage, gift, or consideration paid to the former County officer or
employee."
a�
as
(Signature)
Date --
STATE OF °R
COUNTY OF:
�m�m�m�mrvrv.�,m„m„m„m„m,,,,,,,,,m,.,.,,m,,,.Wm�m�rvrvrvrvrvrvrvrvrvrvrvmm,�,�mmrrrrrrrr�,rrrrrr�,m�n�,m„m,.�„�..�.����w
Subscribed and sworn to (or affirmed) before me on ..
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(date) by ..,,,�,m,,,�,. ri,,,��s..rr„ � nnnnn��.. rrrrrrrrrrrrrmmmmrrrrrrrrrrrrmmmmrrrrrrrrrrrrrrr,� (name of affiant). He/She is personally
0
known to me or has produced (type of
identification) as identification.
,...,......... NOTARY PUBLIC
MyCommission Expires: . .......................................................................... ................................
26 of 30 1 Packet Pg. 2186
N.19.a
NON-COLLUSION AFFIDAVIT
l, ....................................................... of the city of ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,............................... according to law on my
oath, and under penalty of perjury, depose and say that
1. 1 am ...°..°..°..°..°..°,.° °,.° ,w, w of the firm of
.. ...., the bidder making the
Proposal for the project described in the Request for Proposals for
and that 1 executed the said
proposal with full authority to do so; U_
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 Z
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 been 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;
4. No attempt has been made or will be made by the bidder to induce any other person,
partnership or corporation to submit, or not to submit, a bid for the purpose of restricting °2
competition; and
5. The statements contained in this affidavit are true and correct, and made with full
knowledge that Monroe County relies upon the truth of the statements contained in this
affidavit in awarding contracts for said project.
(Signature)
AR
Date:
.2
0
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STATE OF:
COUNTY OF:
Subscribed and sworn to (or affirmed) before me on ryryryryr ryW
(date) by �,,,,rrr nn ...... (name of affiant). He/She is personally
known to me or has produced °� ��. ...�- (type of
identification) as identification.
rr rrrrrrrrrrrr mmm �, . ,.
NOTARY PUBLIC
My Commission Expires: .....
27 of 30 Packet Pg. 2187
N.19.a
DRUG-FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:
(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' 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. 2
3. Gives 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), notifies 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 contenderre 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 a
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. a.
6. Makes a good faith effort to continue to maintain a drug-free workplace through
implementation of this section,,
AR
As the person authorized to sign the statement, I certify that this firm complies fully with the above
requirements.
rmnIL.,,mmmm °m,�, "- . ,m ... ..� .,..
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(Signature)
Date
STATE OF:
COUNTY OF:
Subscribed and sworn to (or affirmed) before me on (date) by
-, � � N �R„ (name of affiant). He/She is personally known to
meor has produced ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,-„ w,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,.,,,, (type of identification) as identification.
NOTARY PUBLIC
My Commission Expires:
28 of 30 Packet Pg. 2188
N.19.a
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, for CATEGORY TWO for a period of 36 months fro
the date of being placed on the convicted vendor list."
I have read the above and state that neither (Proposer's name) nor any
Affiliate has been placed on the convicted vendor list within the last 36 months. Z
(Signature).,��,,�,,.n�,�,�,�,�,�,�„�,�„�,.,�,.,�,.,��,,.�,� ,� �m
Date:
N
STATE OF: w. ° ., IL
N
COUNTY OF:
,�rvrvry rvrvrvrvrvry. .° .. m ......................
Subscribed and sworn to (or affirmed) before me on AR
(date) by .. {name of affiant). He/She is personally known to me or
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has produced
(type of identification) as
identification.
NOTARY PUBLIC
My Commission Expires:
29 of 30 Packet Pg. 2189
N.19.a
LOCAL PREFERENCE FORM
Vendors claiming a local preference according to Ordinance 023-2009 must complete this form.
Name of BidderlRes under Date:
1. Does the vendor have a valid receipt for the business tax paid to the Monroe County Tax Collector dated at least one
year prior to the notice or request for bid or proposal? „ ww, ,,, rvrvrvrvrvm„mryn(Please furnish copy. )
2. Does the vendor have a physical business address located within Monroe County from which the vendor operates or
performs business on a day to day basis that is a substantial component of the goods or services being offered to
Monroe County?, -------------------- a.
List Address:
Telephone Number ,,,,Fe ..
,,m,m,m,m,m„nnnnnw,m , .,,,,.,.,.,.,.,, mmm ............ a�
B. Does the vendor/prime contractor intend to subcontract 50%or more of the goods, services or construction to local
businesses meeting the criteria above as to licensing and location? ..........
1f yes, please provide:
1. Copy of Receipt of the business tax paid to the Monroe County Tax Collector by the subcontractor dated at least one g
year prior to the notice or request for bid or proposal. 2
2. Subcontractor Address within Monroe County from which the subcontractor operates:
N
,m N
mrmrmn . .
Tel. Number................. ...
a.
Print Name:
Signature and Title of Authorized Signatory for
Bidder/Responder
0
STATEOF .....................................................................................
a.
COUNTY OF
On this day of „,,,,,,,,,,,,,,,,,,,,,,,,,,,,, , 20,,,,,,,,,,,,,,,,,,,,,,,- before me, the undersigned notary public, personally appeared
,�,�,�,�,�,�,�,�,�,� c�
----„.................. k
....... known to me to be the person whose name is subscribed above or who produced
------ -,-- I as identification, and acknowledged that he/she is the person who executed the above Local �
Preference Form for the purposes therein contained.
Notary Public
aaa„mr�
Print Name rr.m. ........
,.,....
,.,..,.« s�...
My commission expires:,,,,,, Seal
30 of 30 Packet Pg. 2190