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Item N18 N.18 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.18 Agenda Item Summary #6447 BULK ITEM: Yes DEPARTMENT: Risk Management TIME APPROXIMATE: STAFF CONTACT: Maria Slavik(305) 295-3178 N/A AGENDA ITEM WORDING: Approval to Advertise Request for Proposals for Property/Boiler and Machinery Coverage Insurance. ITEM BACKGROUND: This policy will provide replacement cost property insurance coverage for county buildings, contents, communication towers and contractors equipment. County Purchasing Policy requires competitive bids for insurance every three years, current policy expires May 1, 2020. PREVIOUS RELEVANT BOCC ACTION: The current policy was previously bid on January 21, 2015. The last renewal was approved by the BOCC on April 17, 2019. CONTRACT/AGREEMENT CHANGES: N/A STAFF RECOMMENDATION: Approval DOCUMENTATION: Property and Boiler Machinery RFP FINANCIAL IMPACT: Effective Date: 5/1/2020 Expiration Date: 5/1/2021 Total Dollar Value of Contract: Approx. $1,250,000.00 Total Cost to County: Approx. $1,250,000.00 Current Year Portion: Budgeted: Yes Source of Funds: Internal Service Fund-Primarily Ad Valorem CPI: N/A Packet Pg. 2115 N.18 Indirect Costs: N/A Estimated Ongoing Costs Not Included in above dollar amounts: N/A Revenue Producing: N/A If yes, amount: Grant: N/A County Match: N/A Insurance Required: N/A Additional Details: REVIEWED BY: Maria Slavik Completed 01/06/2020 10:45 AM Paunece Scull Completed 01/06/2020 11:48 AM Bob Shillinger Completed 01/06/2020 12:09 PM Budget and Finance Completed 01/06/2020 3:13 PM Kathy Peters Completed 01/06/2020 4:51 PM Board of County Commissioners Pending 01/22/2020 9:00 AM Packet Pg. 2116 N.18.a MONROE COUNTY REQUEST FOR PROPOSALS FOR 2020/2021 Property and Boiler and Machinery Insurance Program tz rC el LL N N _ G � � 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 0 COUNTY ADMINISTRATOR Roman Gastesi CLERK OF THE CIRCUIT COURT COUNTY ATTORNEY Kevin Madok, CPA Risk Management January 23, 2020 Packet Pg. 2117 1 of 2 N.18.a NOTICE OF REQUEST FOR PROPOSALS NOTICE IS HEREBY GIVEN TO PROSPECTIVE PROPOSERS that on March 10, 2020 at 3:00 P.M. at the Monroe County Purchasing Office, the Board of County Commissioners of Monroe County, a. Florida, will open sealed proposals for the following: 2020/2021 PROPERTY AND BOILER AND MACHINERY INSURANCE PROGRAM MONROE COUNTY, FLORIDA 0 co 06 Requirements for submission and the selection criteria may be requested from DemandStar by Onvia at rwrwrw. e an star.co . 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, solely to Maria Slavik, Risk Administrator, 1111 121h Street, Suite 408 Key West, FL 33040, by facsimile to (305) 295-3179 or via email to . T a� 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 a. (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 the Proposer's name and "Proposal for 2020/2021 Property Insurance Program" addressed to: Monroe County Purchasing Office 1100 Simonton Street, Room 1-213 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 a. delivered by Certified Mail, Return Receipt Requested, hand-delivered 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. Monroe County's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Board of County Commissioners. 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. 2 of 42 1 Packet Pg. 2118 N.18.a vendor list prepared by the Department of Management Services, State of Florida, under Sec. 287.133(3)(d), Florida Statutes. 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. The Board reserves the right to reject any and all proposals, to waive informalities in any or all proposals, to re-advertise for proposals; and to separately accept or reject any item or items and to award and/or negotiate a contract in the best interest of the County. Dated at Key West this 50' day of February, 2020. Monroe County Purchasing Department Publication dates Keys Weekly—Thursday-February 13,2020 S CO News Barometer- Friday, February 14,2020 06 Key West Citizen- Saturday-February S,2020 0 T CO of 42 Packet Pg. 2119 N.18.a TABLE OF CONTENTS NOTICE OF REQUEST FOR COMPETITIVE SOLICITATIONS SECTION ONE - INSTRUCTION TO PROPOSERS SECTION TWO - COUNTY FORMS SECTION THREE --ATTACHMENTS Attachment A: Communication Towers and Equipment Statement of Values 2 Attachment B: Contractors Equipment Statement of Values Attachment C: EMAS Statement of Values Attachment D: Real and Personal Property Statement of Values Attachment E: Loss Runs 0 T) 0 0 L- 4 of 42 Packet Pg. 2120 N.18.a SECTION ONE - INSTRUCTION TO PROPOSERS Monroe County, Florida 2020/2021 Property Insurance Program Request for Proposals EFFECTIVE DATE: 5/1/2020 BACKGROUND INFORMATION Monroe County ("County") is a non-chartered county established under the Constitution and the laws of the State of Florida. The Clerk of the Circuit Court serves as the fiscal agent. a The population of the County is estimated at approximately 76,351 . The total current value of real and personal property owned by the County is approximately $247.8 million. This amount includes approximately $11.0 million of towers and communication equipment and approximately $4.0 million of mobile equipment. In addition, the County has expended approximately 7.5 million in an Emergency Materials Arresting System (EMAS) at the County's Key West International Airport. The EMAS will be discussed further later in this RFP. Approximately 72 locations are insured. FF Various smaller buildings used for maintenance and other activities are currently self-insured. .T 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 its function, the County is empowered to levy taxes to pay the cost of operations. The County has a full time Risk Manager who oversees a Self-Insured Liability Fund and the property and casualty insurance program. A full time safety manager reports to the Division Director for Employee Services. 0 I- IL 5 of 42 Packet Pg. 2121 N.18.a Monroe County, Florida 2020/2021 Property Insurance Program Request for Proposals General Information COVERAGES REQUESTED Monroe County, Florida wishes to receive proposals for the following insurance protection: am ➢ Real and Personal Property (currently includes Builders Risk) ➢ Electronic Data processing (EDP) ➢ Contractors Equipment ➢ Communication Towers and Equipment ➢ Emergency Materials Arresting System (EMAS) ➢ Boiler and Machinery 2 Coverage for Monroe County's Master Property Insurance Program is preferred on an "All-Risk Cause of Loss Form" to include, but not limited to: fire, lightning, collapse, flood and wind. Replacement cost settlement basis and Blanket Limits are desired. .2 a� The County will consider modified proposals to the extent that they provide adequate coverage W and achieve the overall program objectives. Reasonable options are solicited where the desired a. coverages cannot be provided as requested. All reasonable proposals will be eligible for review. CURRENT PROGRAM The County's current Property protection is currently provided through a layered program consisting of the following insurers: , Insurer � Limits Approximate Premium �, 11 .,...� ,, ,.,�.�m -.. � m.�� ..w __ ___ ......................................... __. .. __ ..... Lloyds of London, Hiscox Insurance Co. $5 million $870 512 ____............w.and Som o....Insurance Co._ aw.....__............ ...w_______........................ Great Lakes Insurance�� . _�_........_ Co. miliion........__......... 250 000...................... Landmark 377 IL American lnsurance $ �, _ .m 233 2 million excess of $ P $10 million a The Boiler and Machinery coverage is provided by Hartford Steam Boiler with limits of $100 Million. The annual premium of the coverage is approximately $10,748. Coverage is provided on a Blanket Limit basis and includes protection for Real and Personal Property, Contractors Equipment, EDP Equipment, Communication Towers and Boiler and Machinery and the County's EMAS. Various deductibles apply as displayed in the following table. 6 of 42 Packet Pg. 2122 N.18.a Program Deductibles Property/Peril Amount Building & Personal $50,000 Property Named Windstorm $1 million EDP Equipment & Media $5,000 except $50,000 for wind Contractors Equipment $5,000 except $50,000 for wind Communication Towers $5,000 except $50,000 for wind 5% of TIV at each location, Flood subject to $1 million per occurrence Boiler and Machinery $5,000 A Replacement Cost endorsement applies to the Building and Contents coverage with losses to Contractors Equipment and Computer Equipment being settled on an Actual Cash Value basis. Losses to Communication Towers will be settled based on a Scheduled Basis. 2 T RATING DATA IL All proposals should be based on the values reflected in the following separate Statement of Values (SOV). Please note the values are segregated into 4 sections to include: ➢ Real and Personal Property Statement of Values ➢ Contractors Equipment Statement of Values ➢ Communication Towers and Equipment Statement of Values ➢ EMAS Statement of Values (Emergency Materials Arresting System) 0 The County's Emergency Materials Arresting System is a system of composite blocks placed at the end of Key West International Airport's runway. They are designed to collapse and bring an aircraft to a safe stop in the event of a runway overrun. Since the EMAS blocks are designed to be damaged if they are ever called upon to stop an aircraft, the policy must have language that will overcome the "Intentional Damage" exclusion found in most Property Insurance policies. It should also be noted that the owner of an aircraft that is involved in a runway overrun that damages the County's EMAS blocks is typically held responsible for the cost of repairing/replacing the EMAS blocks. 0 BOILER INSPECTIONS The County has 4 small boiler-fired pressure vessels that will need State Certification. The Boiler Insurer will be required to provide these inspections. All of the vessels are located in the County's Stock Island Detention Center located in Key West, Florida. Three of the vessels are Teledyne Laars Boilers that have a maximum working pressure of 160 PSI and one Cleveland Range that has a maximum working pressure of 15 PSI. of 42 1 Packet Pg. 2123 N.18.a EVALUATION CRITERIA 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: ............ .. � mm... ,.,,—, Evaluation Factor Maximum Available Points ..Term...................... .................g..........................w._....... ............. ,.................................................. .�..,mm..�.,,,,........................................30....................................................... ................,,,,...... s and conditions of coverages being a. proosed __ Fin ancial stability of insurers bein ropo�sed 15 Experience of proposing agent with structuring large Property Insurance Programs ae Experience of proposing agent with 8 M mm......, . .......... e.�,,, .... .- ....-.. . ......... p �,....,..,�,�,_ Location of proos ng agent local reference if applicable: 5 points) e 10 Price 30�� rrrr�aaaa rrrr...� � _..._...... ._.. ...... ........ ,0........... �� m; �mmmmmm,.,mrrrrrrrrrrmrrr e Total points earned are on a scale of 1 — 100 points T 1 = lowest 100 = highest IL LOSS HISTORY Details on the County's losses for the past 5 years are included as an attachment. EFFECTIVE DATE OF COVERAGE The effective date of coverage is May 1, 2020. The County desires to purchase an annual policy with an option to renew it for an additional three (3) one (1) year periods. ASSIGNMENT OF MARKETS The County will not be assigning markets for this RFP. 0 I- RFP SCHEDULE IL The following schedule will apply to the RFP process. Extensions of any of the deadlines will not be honored. Date Activity.. .. Posting of....RFP on Demand Star w__...M 1/23120......... ............w___.............. 2/13/20 Deadline for requests for additional information ........ .._._......_..._. __................ 2/18/20 .... Postin of Addendum on Demand Star _......._....,. ..............�.W...—....�.........._.�.�_............................_......................................................._..........................�...._.................... 3 20 Proposal return date and bid opening ..,......4/15/20............ .....................Boa,rd,m,��tinand.appyroval �...... .... 5/1/20 Effective Date 8 of 42 Packet Pg. 2124 N.18.a PROPOSAL RETURN DATE AND BID OPENING All proposals must be received no later than 3:00 pm, March 10, 2020 at which time they will be opened in accordance with the County's purchasing procedures. In an effort to accommodate proposers and underwriters, the bid opening has been deferred to the latest possible date. However, sufficient time must be allotted for the review of the proposals and obtaining approval from the Board. Proposers should recognize that overnight mail service providers may not guarantee delivery to Monroe County by a specified time. Proposers are encouraged to verify restrictions imposed by the various vendors. SUBMISSION OF PROPOSALS NUMBER OF COPIES OF PROPOSALS REQUIRED; BID OPENING DATE; DELIVERY LOCATION 0 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. T Proposals must be received no later than 3:00 pm, March 10, 2020 addressed as follows: Monroe County Board of County CommissionersIL Office of Director of Purchasing 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. All proposals should be contained in sealed envelopes, clearly marked on the outside with the following language: IL Monroe County Florida E Proposal for Property and Boiler and Machinery Insurance 2020/2021 Policy Year 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. 9 of 42 Packet Pg. 2125 N.18.a The County may elect to negotiate or not to negotiate with any individual Proposer. The County reserves the right to select the proposal(s) that it believes will best serve its interests. 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 may be rejected. AUTHORITY OF PROPOSERS An authorized representative of the insurance company underwriting the program should sign proposals. If the submitting agent/broker does not have the authority to sign the proposal, it should s be countersigned by an authorized representative of the insuring 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. 0 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. 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. 0 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 by 3:00 P.M., February 13, 2020 to: Ms. Maria Slavik, CPM Risk Management Administrator Monroe County 1111 121h Street Suite 408 Key West, FL 33040, Fax: (305) 295-3179 Email: Slavik-Maria@Monroecounty-fl.gov All questions will be answered by way of an addendum posted on DemandStar. 10 of 42 Packet Pg. 2126 N.18.a All requests must in writing. Oral requests for information and interpretation 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 FORMS OR POLICIES Sample forms/endorsements and other coverage information are considered an integral part of the proposal and must be provided. If Insurance Services Office (ISO) forms are to be used, reference 22 can be made to the form numbers and edition dates. a If Manuscript or non-ISO forms are proposed, specimen forms must be attached to the proposal for review. RATE CHANGE/POLICY MODIFICATIONCL Ninety (90) days written notice is requested to be provided by the insurer prior to any increase in rates or modification resulting in restriction of existing policy terms or provisions required by the insurer. T a� 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. NAMED INSURED The Named Insured wording of the policy should include the following: Monroe County Board of County Commissioners and its elected officials. NOTICE OF CLAIM IL 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 Manager/Administrator of Monroe County, Florida." 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. LOSS HISTORY REPORTS I I of 42 Packet Pg. 2127 N.18.a 11 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 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. 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 should be specifically identified by type and frequency of service and specific costs or charges separately stated. CL USE OF PROPOSAL FORMS .� Proposers are required to submit their proposal on the forms included in this request. Information may be submitted in addition to the initial proposal. The general information proposal form must be signed in accordance with the requirements of this Request for Proposal as well as individual coverage sections. 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. 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 co all issues addressed in the proposal forms will demonstrate the Proposer's understanding of the r_ program being submitted and the ability of the Proposer to serve the needs of the County. 0 COMPLETION OF REQUIRED FORMS Proposers must complete the following four (4) forms which are included as attachments ➢ Drug-free Workplace ➢ Non-Collusion Affidavit ➢ Sworn Statement Under Ordinance No. 10-1990 Ethics Clause ➢ Public Entity Crime Statement In addition, the Proposer may complete and attach the following form, if applicable: ➢ Local Preference Farm 12 of 42 Packet Pg. 2128 N.18.a 2 CFR PART 200 If any Federal Funds are used to pay and/or services the vendor will be expected to comply with 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). 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 fisted 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 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 0. 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 Contractor during the term of the Contract and shall expressly requ' 13 of 42 1 Packet Pg. 2129 N.18.a 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 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. co T) IL 0 L_ IL 14 of 42 Packet Pg. 2130 N.18.a Monroe County, Florida 2020/2021 Property Insurance Program Request for Proposals REQUESTED COVERAGES FOR REAL AND PERSONAL PROPERTY FORM The County desires coverage on an "All-Risk Cause Of Loss Form" to include, as a minimum, fire, extended coverage perils, vandalism, malicious mischief, theft, flood, wind and sinkhole. Coverage should apply to real and personal property including inventories and portable personal property at all locations. Separate sections for equipment and computer hardware/software are Included in this RFP. Coverage for equipment and computer hardware/software may be proposed as separate contracts. 2 The causes of loss covered should be stated in the proposal, and policy forms should be identified as ISO or independent. If ISO policy forms are to be used, please state form numbers and edition cc dates. If independently filed forms (Non ISO) are proposed, specimen policy forms must be attached to the proposal forms in this Request. The County desires to purchase `Blanket" coverage. If blanket coverage is proposed, newly acquired property and substitutions of existing property should be added at the same blanket rate(s) for the remainder of the policy term. Property should be covered at main locations, in transit and at off-site locations and include builders risk (as may be requested), installation and testing. Extra expense coverage is desired as an optional proposal on an agreed amount and fixed per diem basis. Coverage may be proposed on a single-line basis if desired, (e.g., fire and related perils only; windstorm only; flood only; difference in conditions, etc.). The County's current policy includes $5.0 million of builder's risk coverage. The County would like 2 to maintain this feature. ENGINEERED MATERIAL ARRESTOR SYSTEM The County has installed an Engineered Material Arrestor System (EMAS) at the Key West International Airport. An EMAS is a bed of engineered materials (blocks) built at the end of a runway and is designed to stop an aircraft overrun with no human injury and minimal aircraft damage. The value of the existing EMAS is $7,475.733. The County desires to have its EMAS insured as any other structure. COINSURANCE REQUIREMENTS The preferred method is an agreed amount basis with the coinsurance provision waived. 15 of 42 1 Packet Pg. 2131 N.18.a LIMITS AND RATING INFORMATION Limits should correspond to the Statement of Values which is attached: ➢ Real and Personal Property Statement of Values ➢ Contractors Equipment Statement of Values ➢ Communication Towers and Equipment Statement of Values ➢ EMAS Statement of Values (Emergency Materials Arresting System) The County's current program contains a sublimit of $10 million for Wind and Flood losses. At a minimum all proposals should include such coverage. The County will consider proposals with higher Wind and Flood limits. SETTLEMENT BASIS The County prefers that all claims be settled on a Replacement Cost basis. The settlement basis for each type of loss or class of property should be clearly stated. If a replacement cost settlement basis is utilized, the standard language requiring replacement structures to be built on the same location should be removed and permission granted to rebuild at an alternate site location. It is requested that all coinsurance requirements be waived through an agreed amount endorsement. g T Exceptions to these provisions should be fully and clearly disclosed and will be considered in the evaluation. IL DEDUCTIBLES The County desires to maintain the current deductibles. Following is a summary of the current deductibles. if alternative deductibles are proposed, they should be clearly disclosed within the proposals. 0 Amount Property Building & Personal $50,000 Property Building & Personal IL .. Property at locations with $100,000 total values greater than $250,000 Wind & Hail $1 million 5% of TIV at each location, Flood subject to minimum of$1 million per occurrence LOSS EXPERIENCE Please refer to the Loss Runs that are attached and made part of this RFP. 16 of 42 Packet Pg. 2132 N.18.a Monroe County, Florida 2020/2021 Property Insurance Program Request for Proposals REQUESTED COVERAGES FOR BOILER AND MACHINERY COVERAGE FORM The County desires coverage on a "Comprehensive" basis to include all County owned pressure vessels, refrigeration equipment, pumps, compressors, heating and air-conditioning systems, turbines, gears and gear sets and all other mechanical/electrical equipment. Coverage should be provided on an "All Risk" basis to include, mechanical breakdown. 06 The causes of loss covered should be clearly stated in the proposal, and policy forms should be identified as ISO or independent. If ISO policy forms are to be used, please state form numbers and edition dates. If independently filed forms (Non ISO) are proposed, specimen policy forms must be attached to the proposal forms in this Request. Extra expense coverage is desired as an optional proposal on an agreed amount and fixed per U) diem basis. COINSURANCE REQUIREMENTS IL The preferred method is an agreed amount basis with the coinsurance provision waived. LIMITS AND RATING INFORMATION The County does not maintain a detailed listing of equipment/structures that are typically insured under a Boiler and Machinery policy. Proposers are encouraged to refer to the attached Statement of Values to determine the limits that are being offered. SETTLEMENT BASIS The County prefers that all claims be settled on a Replacement Cost basis. 0 It is requested that all coinsurance requirements be waived through an agreed amount endorsement. Exceptions to these provisions should be fully and clearly disclosed and will be considered in the evaluation. DEDUCTIBLES The County desires to maintain its current Boiler and Machinery deductible of $5,000. If an alternative deductible is proposed, it should be clearly disclosed within the proposals. 17 of 42 Packet Pg. 2133 N.18.a BOILER INSPECTIONS The County has 4 small boiler-fired pressure vessels that will need State Certification. The Boiler Insurer will be required to provide these inspections. All of the vessels are located in the County's Stock Island Detention Center located in Key West, Florida. Three of the vessels are Teledyne Laars Boilers that have a maximum working pressure of 160 PSI and one is a Cleveland Range that has a maximum working pressure of 15 PSI. Loss EXPERIENCE There have been no losses within the past 5 years. 0 06 T a� a 18 of 42 Packet Pg. 2134 N.18.a Monroe County, Florida 2020/2021 Property Insurance Program Request for Proposals REQUESTED COVERAGES FOR CONTRACTORS AND MISCELLANEOUS EQUIPMENT FORM The County desires coverage on an "All-Risk Cause Of Loss Form" to include, at a minimum, fire, extended coverage perils, vandalism, malicious mischief, theft, wind, flood, transit, and sinkhole. Coverage should apply to mobile equipment, contractor's equipment, and miscellaneous equipment at all locations. This coverage may be proposed as a separate policy from a different insurer if needed. 0 The causes of loss covered should be stated in the proposal, and policy forms should be identified as ISO or independent. If ISO policy forms are to be used, please state form numbers and edition dates. If independently filed forms (Non ISO) are proposed specimen policy forms must be attached to the proposal forms in this Request. .2 T Blanket coverage is preferred. Newly acquired equipment and substitutions of existing equipment W should be automatically covered, subject to ninety (90) day reporting and added at the same a. blanket rate(s) for the remainder of the policy term. Equipment should be covered at main locations, in transit and at off-site locations. It is requested that the following exclusions be deleted: • Weight of load exceeding capacity of boom. • Loss or damage resulting from strikes, lockouts, labor disturbances, etc. • Automobiles or similar conveyance if equipment is permanently attached. COINSURANCE REQUIREMENTS The preferred method is an agreed amount basis with the coinsurance provision waived. IL LIMITS AND RATING INFORMATION A schedule of County owned equipment has been included as supplement to this RFP. The limits proposed should correspond to the amounts listed in Attachments A - D. SETTLEMENT BASIS While coverage is currently provided on an actual cash value basis, it is preferred that all losses be settled on a replacement cost basis. Values presented in the exhibits represent the original cost. Insurers are encouraged to establish replacement cost values to permit including an agreed amount endorsement as requested above. If replacement cost is not available at a reasonable cost, the County will consider maintaining an actual cost value policy. 19 of 42 Packet Pg. 2135 N.18.a DEDUCTIBLES The County's current deductible is $5,000 for all losses except those that are wind related. Wind losses are subject to a $50,000 per occurrence deductible. The County prefers to maintain these deductibles. Loss EXPERIENCE There have been no losses within the past five (5) years. 0 06 T a� IL IL a 20 of 42 Packet Pg. 2136 N.18.a Monroe County, Florida 2020/2021 Property Insurance Program Request for Proposals REQUESTED COVERAGES FOR EDP EQUIPMENT AND MEDIA FORM The County desires coverage on an "All-Risk Cause Of Loss Form" to include, at a minimum, fire, extended coverage perils, vandalism, malicious mischief, theft, wind, flood, mechanical breakdown and sinkhole. This coverage may be proposed as a separate policy from a different insurer if co needed. The causes of loss covered should be stated in the proposal, and policy forms should be identified as ISO or independent. If ISO policy forms are to be used, please state form numbers and edition dates. If independently filed forms (Non ISO) are proposed, specimen policy forms must be `� attached to the proposal forms in this Request. Blanket coverage is preferred. Newly acquired computer equipment and substitutions of existing aD equipment should be added at the same blanket rate(s) for the remainder of the policy term. Computer equipment should be covered at main locations, in transit and at off-site locations. Computer software should be covered for direct loss from "all risks causes of loss" and include loss from accidental erasure and include "brown out" and "black out" coverage. Limits should be sufficient to include replacement of software and data. COINSURANCE REQUIREMENTS 0 The preferred method is an agreed amount basis with the coinsurance provision waived. LIMITS AND RATING INFORMATION Detail information on the County's EDP equipment is not available. The values of the County's EDP Equipment are included with the Personal Property values contained in Attachment entitled a. "Real and Personal Property Statement of Values". DESIRED SETTLEMENT BASIS Computer Equipment (hardware) Replacement Cost Software Replacement Cost Extra Expense Actual Loss Sustained 21 of 42 Packet Pg. 2137 N.18.a DEDUCTIBLES The County desires to maintain the current deductibles. Currently the deductible for EDP losses is $5,000 except $50,000 for wind related losses. LOSS EXPERIENCE There have been no losses within the past five (5) years. 0 06 T)a� 0 0 L- 2 of 42 Packet Pg. 2138 N.18.a Monroe County, Florida 2020/2021 Property Insurance Program Reauest for Proposals Communication Towers and Equipment FORM The County desires coverage on an "All-Risk Cause Of Loss Form"to include, at a minimum, fire, extended coverage perils, vandalism, malicious mischief, theft, wind, flood, transit, and sinkhole. Coverage should extend to scheduled towers, radio equipment, shelters and general equipment owned by the County (BOCC) or Monroe County Sheriff's Office (MCSO). In addition, coverage should extend to County owned equipment located on towers not owned or insured by the County. The causes of loss covered should be stated in the proposal, and policy forms should be identified as ISO or independent. If ISO policy forms are to be used, please state form numbers and edition dates. If independently filed forms (Non ISO) are proposed, specimen policy forms must be attached to the proposal forms in this Request. T LIMITS AND RATING INFORMATION 0 Limits should correspond to the values shown on the attached Statement of Values for Communication Towers and Equipment. It is imperative that coverage extends to County owned equipment that is mounted on or associated with towers owned by third parties. SETTLEMENT BASIS 0 The County desires to have all losses settled on a "Scheduled Value" basis. 0 DEDUCTIBLES The County desires to maintain the current deductibles. All losses are currently subject to a $5,000 deductible except wind related losses that are subject to a $50,000 deductible. LOSS EXPERIENCE IL 0 There have been no losses within the past five (5) years. Packet Pg. 2139 N.18.a SECTION TWO - COUNTY FORMS Monroe County, Florida 2020/2021 Property Insurance Program Request for Proposals Proposa[ 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. co Agent/Agency submitting proposal: Address 2 Telephone Number: D 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? Real and Personal Property Y s No Contractors Equipment Yes No EDP Equipment and Media Yes No Communication Towers and Equipment Yes No Builders Risk Yes No E Boiler and Machinery Yes No o Packet Pg. 2140 N.18.a 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 0 Proposal valid until (date) 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 T a� If not, include actual wording to be used. Claim reporting location included? Yes No Claim reporting wording to be used? Claim Reports to be provided as requested? Yes No 0 If not, state details Loss Control services to be provided? Yes No If yes, please provide details 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 25 of 42 Packet Pg. 2141 N.18.a Monroe County, Florida 2020/2021 Property Insurance Program Request for Proposals Proposal Form REAL AND PERSONAL PROPERTY Company Underwriting office used 06 Address 0 Telephone Number Is insurer authorized to transact insurance in the T State of Florida? Yes No Basis of authorization: Admitted insurer Yes No Surplus Lines insurer Yes No Current A. M. Best Co. rating a Is requested policy form proposed? Yes No If not, list form(s) used 0 I- Settlement basis used Coinsurance % required Agreed amount basis provided? Yes No Causes of Loss insured 26of42 Packet Pg. 2142 N.18.a Is Blanket Coverage provided for? Real Property Yes No Personal Property Yes No Real and Personal Property Combined Yes No Rates guaranteed for one year? Yes No New/substitute properties added at blanket rate? Yes No Permission granted to rebuild at alternate site? Yes No 0 Are rating worksheets attached? Yes No Will coverage be provided for the County's Engineered Material Arresting System (EMAS)? Yes No Limits/PremiumslDeducfibles If proposing by location, please provide a separate sheet(s) displaying the rate, limit, annual aT premium, deductible, and perils coverage (fire, wind, all risk, etc.). Limit X Ratel$100 = em Deductible Perils Prrem. Covered Real X = Personal X - Inventory X _ Extra X = Expense 0- IL Builders Risk X _ Engineered Material Arrestor X = System EMAS The proposer stated below is the authorized agent of the company or companies proposed, and are 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 27 of 42 Packet Pg. 2143 N.18.a Monroe County, Florida 2020/2021 Property Insurance Program Request for Proposals Proposal Form BOILER AND MACHINERY Company Underwriting office used co Address 0 Telephone Number Is insurer authorized to transact insurance in the T State of Florida? Yes No Basis of authorization: Admitted insurer Yes No Surplus Lines insurer Yes No Current A. M. Best Co. rating ° Is coverage provided for the following perils? Mechanical Breakdown Yes No Electrical Breakdown Yes No Ammonia Contamination Yes No Hazardous Substance Spoilage Yes No Water Damage Yes No Drying Out of Electrical Equipment s Is coverage provided on a Comprehensive basis? Yes No Settlement basis used Coinsurance % required 28 of 42 Packet Pg. 2144 N.18.a Is coverage provided on an Agreed Amount basis? Yes No Is coverage provided on an All Risk basis Yes No Rates guaranteed for one year? Yes No New/substitute properties added at blanket rate? Yes No Are rating worksheets attached? Yes No Will insurer provide the required State inspections? Yes No s co 06 Limits/Premiums/Deductibles _.............. Limit ._...._ .X Ratel$1,.. ,,.... P em 00 De ductible = Boiler and Machmer X T The proposer stated below is the authorized agent of the company or companies proposed, and are 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 0 I- 29 f 42 Packet Pg. 2145 N.18.a Monroe County, Florida 2020/2021 Property Insurance Program Request for Proposals Proposal Form CONTRACTORS EaUIPMENT Company 0 Underwriting office used CO Address 0 Telephone Number Is insurer authorized to transact insurance in the T State of Florida? Yes No Basis of authorization: Admitted insurer Yes No Surplus Lines insurer Yes No Current A. M. Best Co. rating a Is requested policy form proposed? Yes No If not, list form(s) used Settlement basis used Coinsurance % required Agreed amount basis provided? Yes No Causes of Loss insured Blanket coverage? Yes No Rates guaranteed for one year? Yes No New/substitute properties added at blanket rate? Yes No Are rating worksheets attached? Yes No 30 of 42 Packet Pg. 2146 N.18.a Are the following exclusions deleted?: Weight of Load Yes_ _ No Damage from Strikes etc. Yes No Automobiles Yes No Limits/Premiums/Deductibles Limit x Ratel$100 = Ann'I Deductible Perils Prem. Covered Contractors & Miscellaneous x = Equipment The proposer stated below is the authorized agent of the company or companies proposed, and are authorized to bind coverages upon acceptance by the County. Deviations from the requested program have been stated. Coverage will be issued as proposed. T a� Signature of Authorized Representative Date 0 1 of 42 Packet Pg. 2147 N.18.a Monroe County, Florida 2020/2021 Property Insurance Program Request for Proposals Proposal Form EDP EouIPMENT AND MEDIA Company 0 Underwriting office used Address 0 Telephone Number Is insurer authorized to transact insurance in the aT State of Florida? Yes No Basis of authorization: Admitted insurer Yes No Surplus Lines insurer Yes No Current A. M. Best Co. rating a Is requested policy form proposed? Yes No If not, list form(s) used Settlement basis used Coinsurance % required Agreed amount basis proposed? Causes of Loss insured Is Mechanical Breakdown coverage proposed? Yes No 32of42 Packet Pg. 2148 N.18.a Is blanket coverage proposed for? Hardware Yes No Media Yes No Rates guaranteed for one year? Yes No New/substitute equipment added at blanket rate? Yes No Software covered for replacement cost? Yes No Media covered for actual cash value? Yes No Extra Expenses covered? Yes No 0 Are rating worksheets attached? Yes No Limits/Premiums/Deductibles Limit x Ratel$100 = Ann'I Deductible Perils Prem. Covered T Equipment X = Media X = Extra X = Expense 0 The proposer stated below is the authorized agent of the company or companies proposed, and are authorized to bind coverages upon acceptance by the County. Deviations from the requested a program have been stated. Coverage will be issued as proposed. 0 I- Signature of Authorized Representative Date Packet Pg. 2149 N.18.a Monroe County, Florida 2020/2021 Property Insurance Program Request for Proposals Proposal Form COMMUNICATION TOWER AND EouIPMENT Company Underwriting office used co Address 0 Telephone Number Is insurer authorized to transact insurance in the T 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 Settlement basis used 0 Coinsurance % required Agreed amount basis used? Yes No Causes of Loss insured Blanket coverage? Yes- No Rates guaranteed for one year? Yes No New/substitute properties added at blanket rate? Yes No Does coverage extend to equipment mounted on towers owned by third parties? Yes No 34 of 42 Packet Pg. 2150 N.18.a Are rating worksheets attached? Yes No Limits/Premiums/Deductibles Item Limit x Ratel 100 = Ann'I Deductible Perils Prem. Covered BOCC owned X _ towers — BOCC owned Radio Equipment X — BOCC owned X - Shelters BOCC owned Gen Equipment X = 06 MCSO owned Radio X = Equipment MCSO owned Shelters X = MCSO owned Gen Equipment X — aT The proposer stated below is the authorized agent of the company or companies proposed, and are authorized to bind coverages upon acceptance by the County. Deviations from the requested program have been stated. Coverage will be issued as proposed. 0 Signature of Authorized Representative Date 0 I- 35 of 42 Packet Pg. 2151 N.18.a REQUIRED FORMS TO BE COMPLETED BY PROPOSER co T)a� 0 L- 36 of 42 Packet Pg. 2152 N.18.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 acknowledge receipt of Addenda No. (s) mmmmnnnnnnmmmm,°,,,, .....°,°,°,°,°,°,°,°,°,.....°,°,°,°,°,°,°,°,°,°,°,°,°,°,°,°,°...�mmrrrrrrrrrmm.......................... � � have included c • Response Form • Lobbying and Conflict of Interest Clause • Non-Collusion Affidavit • Drug Free Workplace Form • Public Entity Crime Statement 06 • Proof of payment of Monroe County business tax and relevant City business tax, unless exempted, must be provided within ten days of award of the contract o Local Preference form (if applicable) • Proposal Forms (4): 0 • REAL AND PERSONAL PROPERTY T • CONTRACTORS EQUIPMENT • EDP EQUIPMENT AND MEDIA LL • COMMUNICATION TOWER AND EOUIPMENT have included a current copy of the following professional licenses and receipt for business taxes: c ,... . m_ ,.� .......... ................... . Check mark items above as reminder that they are included 0 Mailing Address: , Telephone: w. „mmm° - Fax: Date: .o................................. Signed: Witness: . ... .W (Prink Name)............................................................................. c (Title) STATEmmu��........................................................................... STATE OF: COUNTY OF: - ____or affirmed _________________- Subscribed and sworn to ( ) before me on � ......... .,,,,,,..„ (date) b ( y„ _ . . (name of affiant). He/She is personally known to me or has produced °........... ......... ..... , (type of identification)as identification. PUBLIC My Commission Expires: 37 of 42 Packet Pg. 2153 N.18.a LOBBYING AND CONFLICT OF INTEREST CLAUSE SWORN STATEMENT UNDER ORDINANCE NO. 010-1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE BY r .�.,��t �_� �� M �� „��........h�Company) ��. mm ....�m��,,,,',h ,.,. ....... ....... N ...warrants that he/it has not employed, retained or otherwise had act on his/her 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 Agreement without liability and may also, in its discretion, deduct from the Agreement or purchase price, or otherwise o recover, the full amount of any fee, commission, percentage, gift, or consideration paid to the former County officer or od employee." 0 (Signature, .,...h,,,,, 0 Date: . .,,....._........................................................................................... STATE OF: COUNTY OF: Subscribed and sworn to(or affirmed) before me on (date) by ...., (name of affiant). He/She is personally known to me or has produced - - .- ........ ......... ......... (type of identification)as identification. 0 NOTARY PUBLIC 0 a. My Commission Expires: ............................... 38 of 42 Packet Pg. 2154 N.18.a N N-COLLUSION AFFIDAVIT I, of the city of ................................................. ,,,u,...... according to law on my oath, and under penalty of perjury, depose and say that 1. i am of the firm of ,.,,,,,nnnnnnhhhh ,,,,, „�,,,hhhh nW„,.hhh„ hhhhhhh »h,.,.hhhhhhhhhhhrm�,rrrrn ...,,hn rrrrrnnnnrr ,,.,,.,.,., m�rvmrvrvrvrvry „ ,,..,rn„....°,°„rir.�mmnn,-----hhh----- mmrr the bidder making the Proposal for the a. protect described in the Request for Proposals for °m mrm m . ,,,, and that I executed the said proposal with full authority to do so; 2. The prices in this bid have been arrived at independently without collusion, consultation, communication or agreement for the purpose of restricting competition, as to any matter relating to such prices with any other bidder or with any competitor; 3. Unless otherwise required by law, the prices which have been quoted in this bid have not been a, 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; 06 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 competition; and 5. The statements contained in this affidavit are true and correct, and made with full knowledge that o Monroe County relies upon the truth of the statements contained in this affidavit in awarding contracts a. `. for said project. FF 0 0 (Signature) Date: . °, .. STATE OF: COUNTY OF: Subscribed and sworn to (or affirmed) before me on , . . ,,,,,,.. (date) bym „ m„(name of affiant). He/She is personally known to me or has as produced , mmmm ...... � � � mm (type of identification) as identification. 0- a NOTARY PUBLIC My Commission Expires: „----------------.--- 39 of 42 Packet Pg. 2155 N.18.a ORUG-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. E 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 o and will notify the employer of any conviction of, or plea of guilty or nolo contenderre to, any violation of od Chapter 893 (Florida Statutes) or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5)days after such conviction. 5. Imposes a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, or any employee who is so convicted. 6. Makes a good faith effort to continue to maintain a drug-free workplace through implementation of this section. As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. g 0.� (Signature) Date: ....................................................................................,. . ....................................................................... STATE OF: 0 COUNTY OF: Subscribed and sworn to (or affirmed) before me on ....................................................................................(date) by .............. ......� (name of affiant). He/She is personally known to me or has o 0 produced .(type of identification) as identification. NOTARY PUBLIC ca My Commission Expires: . ................. 40of42 Packet Pg. 2156 N.18.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 from the date of being placed on the convicted vendor list." have read the above and state that neither ,,,,,,,,w,,,,, (Proposer's name) nor any Affiliate has been placed on the convicted vendor list within the last 36 months. (Signature) . ,. ................................. . Date:............................... .. ........................................... 0 STATE OF: -- a-- .......... � 0 COUNTY OF: 0 as Subscribedand sworn to(or affirmed) before me on,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,u IL (date) by,...........ri„. ...... ........... .... _, (name of affiant). He/She is personally known to me or has produced as (type of identification) as identification. 0 0 NOTARY PUBLIC My Commission Expires: 0 0 0 a. 41 0 0 of 42 Packet Pg. 2157 N.18.a LOCAL PREFERENCE FORM A.Vendors claiming a local preference according to Ordinance 023-2009 must complete this form. Name of Bidder/Responder ......... ........� Date; ., ....... ....... 1. Does the vendor have a valid receipt for the business tax paid to the Monroe County Tax Collector dated at least E one year prior to the notice or request for bid or proposal? ,,-1111,, ,,(Please furnish copy. } 2. Does the vendor have a physical business address located within Monroe County from which the vendor operates OC or performs business on a day to day basis that is a substantial component of the goods or services being offered to :E Monroe County?. List Address: 2 S Telephone Number ......... ....... ............................................., .,................................... .,.,, ..,.. .,,,,,� .. 06 ..,.....,., B. Does the vendor/prime contractor intend to subcontract 50%or more of the goods, services or construction to local 0 businesses meeting the criteria above as to licensing and location? If yes, please provide: FF 0 1. Copy of Receipt of the business tax paid to the Monroe County Tax Collector by the subcontractor dated at least a0 one year prior to the notice or request for bid or proposal. as 2. Subcontractor Address within Monroe County from which the subcontractor operates: Tel Number �„ 0 Print Name: Signature and Title of Authorized Sig natory igna#ory for Bidder/Responder 2 S STATE OF COUNTY OF . , 0 On this mm day of mm,,,,,,,,,,,,,,,,,,,, , 20„,,,,,,,,,,w,w,, ,, before me, the undersigned notary public, personally appeared oi mm, known to me to be the person whose name is subscribed above or who produced r- as identification, and acknowledged that he/she is the person who executed the above E Local Preference Form for the purposes therein contained. 0 0 Notary Public Print Name My commission expires:.................................................................................................. Seal! 42 of 42 Packet Pg. 2158