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Item F2 BOARD OF GOVERNORS OF FIRE AND AMBULANCE DISTRICT I AGENDA ITEM SUMMARY Meeting Date: August 21, 2013 Division: Emergency Services Bulk Item: Yes X No Department: Fire Rescue Staff Contact Person: Holly Pfiester 289-6088 AGENDA ITEM WORDING: Approve to award contract for maintenance of and repairs to Monroe County Fire Rescue vehicles to Fire-Tech Repair Service, Inc., for a base term of three (3)years plus the option to renew for two (2)further one-year periods, and approval for the fire Chief to sign all documents as needed to complete the transaction. ITEM BACKGROUND: On July 16, 2013 at 3:00pm the Monroe County purchasing office opened one (1) response to our Request for Proposals --Maintenance of Monroe County Fire Rescue Vehicles. Upon review of the proposal received from Fire-Tech Repair Service Inc.,their submission was found to be in order and at substantially the same costs as their current contract. PREVIOUS RELEVANT BOG ACTION: At the May 15, 2013 Board of Governors meeting, the Board approved item G3, which was a request to issue a request for proposal (RFP)for maintenance of Monroe County Fire Rescue vehicles. On September 21. 2012, in item G4,the Board granted approval for the District to exercise the third and final one-year renewal period. The original (2009) contract was for a one-year term, with three (3) annual renewal periods of one year each. CONTRACT/AGREEMENT CHANGES: All the costs remain the same as the current contract, with the exception of per vehicle inspection and preventative maintenance costs for three types of vehicles (pumpers, tankers and squads), which increased from $295 per vehicle per inspection to $300. STAFF RECOMMENDATIONS: Approval. TOTAL COST: $80,000/year approx. INDIRECT COST: N/A BUDGETED: Yes X No COST TO COUNTY: See above SOURCE OF FUNDS: 11500 — 530462 REVENUE PRODUCING: Yes No X AMOUNT PER MONTH Year APPROVED BY: County Atty OMB/Purchasing Risk Management DOCUMENTATION: Included X Not Required_ DISPOSITION: AGENDA ITEM# MONROE COUNTY BOARD OF GOVERNORS CONTRACT SUMMARY Contract with: Fire-Tech Repair Service, Inc. Contract# Effective Date: 10/l/2013 Expiration Date: 09/30/2016 Contract Purpose/Description: Contract for maintenance of and repairs to Monroe County Fire Rescue vehicles to Fire- Tech Repair Service, Inc., for a base term of three (3) years plus the option to renew for two (2) further one-Year periods, and approval for the fire Chief to sign all documents as needed to complete the transaction. Contract Manager: Holly Pfiester 6088 Emergency Services/ Stop 14 (Name) (Ext.) (Department/Stop#) For BOG meeting on 08/21,12013 Agenda Deadline: 08/06/2013 CONTRACT COSTS Total Dollar Value $80,000/year approximately: Current Year $ of Contract: $ Hourly Rate $95 Portion: $ Parts =Cost*250'o Annual Pump Test $300 Overtime=1.5 /Hourly Rate Preventative Maintenance(Flat Rate Cost Per Vehicle): Rescue Vehicle Wout pump=$225 Aerials=$425 Pumpers $300 Tankers=$300 Squads=$300 Budgeted? Yes® No ❑ Account Codes: 1 1500 -- 530462 Grant: $ NIA County Match: $ N/A ADDITIONAL COSTS Estimated Ongoing Costs: $ 80,000 /year pprox. For: $ 0 (Not included in dollar value above) (eg.maintenance,utilities,janitorial,salaries,etc.) CONTRACT REVIEW Changes Date Out Date In Needed 1 r Division Director r''0X/ Yes❑No� Risk Management "I Yes❑ No"-a - ` O.M.B./Purchasing \-NAZ Yes❑NO County Attorney _0( 5 Yes❑ NOD � c� �� q50A0�3 Comments: OMB Form Revised 2 27 01 MCP#2 CONTRACT BETWEEN THE BOARD OF GOVERNORS OF FIRE AND AMBULANCE DISTRICT 1 OF MONROE COUNTY,FLORIDA AND FIRE-TECH REPAIR SERVICE,INC. FOR MAINTENANCE OF FIRE/RESCUE VEHICLES THIS CONTRACT, hereinafter `CONTRACT OR AGREEMENT' made and entered into this 0 day of October, 2013 by and between the BOARD OF GOVERNORS OF FIRE AND AMBULANCE DISTRICT 1, MONROE COUNTY, with principal offices located at 490 63`d Street, Marathon, FL 33050 (hereinafter referred to as the `DISTRICT'), and Fire-Tech Repair Service, Inc., P.O. Box 1570 / 103680 Overseas Highway, Key Largo, FL 33037 (hereinafter referred to as `CONTRACTOR') W ITNESSETH: WHEREAS, the DISTRICT advertised a notice of request for Proposals for MAINTENANCE OF FIRE RESCUE VEHICLES WHEREAS,the successful Respondent was Fire-Tech Repair Service, Inc. , and; WHEREAS,this CONTRACTOR represents that it is capable and prepared to provide such services, and; WHEREAS,the DISTRICT intends to enter into an Agreement for Maintenance of Fire Rescue vehicles, semi-annual inspections, Preventative Maintenance, and unscheduled maintenance resulting from malfunction or failure with the CONTRACTOR and; WHEREAS,this Contract is an `Agreement' between both parties, NOW, THEREFORE, in consideration of the promises contained herein,the parties agree as follows: 1. Contract Documents: This Contract consists of the Agreement,the Contractor's response to the RFP, and the documents referred to in the Agreement as a part of this Agreement. In the event of any conflict between any of the Contract documents, the one imposing the greater burden on the Contractor will control. 2. Contract Period and Renewal: The effective date of this Agreement shall be an initial three (3) year term commencing on October 1,2013 through September 30,2016. This Agreement may be renewed annually, not to exceed two (2), one-year renewals, subject to approval of the Fire Chief of Monroe County Fire Rescue, the Office of Management and Budget, and the Monroe County Board of Governors of Fire and Ambulance District 1. 3. Contract Termination: This Agreement may be terminated for any reason by either party on thirty (30)day written notice without cause. If the Contractor fails to fulfill the terms of this Agreement, or attachments, properly or on time, or otherwise violates the provisions of the Agreement or of applicable laws or regulations governing the use of funds, the County may terminate the Contract by written notice. The notice shall specify cause. All finished or unfinished supplies or services shall,at the option of the County, become property of the County. The County shall pay the Contractor fair and equitable compensation for expenses incurred prior to termination of the Agreement, less any amount or damages caused by the Contractor's breach. If the damages are more than compensation payable,the Contractor will remain liable after termination and the County shall pursue collection for damages. 4. Subject Matter of Contract: This Agreement is for all fire rescue vehicles described in `Attachment A' to receive: - Level I Preventative Maintenance/ Semi-Annual - Level II Preventative Maintenance/Annual - Pump Tests/Annually - Unscheduled maintenance and repair resulting from equipment failure or malfunction 5. Hourly Rate: The hourly rate shall be $ 95.00 per man-hour with no travel time or mileage charge. Level I (Semi-Annual)and Level II (Annual) Preventative Maintenance, and Pump Tests(Annually) are at quoted flat rates and excluded from hourly rate. b. Overtime and Holidays: The overtime and holiday rate shall be one and one half times the hourly rate of$ 142.50 (as outlined in Section 5) per man-hour for emergency repairs called outside normal business hours and federal holidays. 7. Inspections: During the year, Contractor shall perform twice per year on all vehicles described in `Attachment A': Semi-Annual Level I Preventative Maintenance Service Annual Level II Preventative Maintenance Service. The number of vehicles on `Attachment A' may fluctuate from time to time due to new purchases or removal of vehicles from inventory. The inspections shall be performed at the respective fire stations. Semi-Annual Level I Preventative Maintenance Service: 250 hours or 6 months (whichever comes first) Full vehicle inspection (to include at a minimum) outlined as follows: - Engine oil and filter change - Fuel filter change (every 6 months) - Air filter inspection and replacement if necessary - Chassis lubrication - Outboard (forward) impeller shaft lubrication - Lubrication of all valve control linkages - Clean or replace air compressor strainer - Clean engine crankcase breather - Inspection of generator and service of lubricant system, full system, and air filter according to its individual hours of operation (not to exceed 6 months) - Cooling system, including fan belts, radiator supports, hoses and clamps, and auxiliary cooler - Exhaust system, including hanger, clamps, muffler, and pipes - Exhaust regeneration system - Diesel exhaust fluid (D.E.F.) - Clutch, including free play, linkage, and fluid levels - Manual transmission, including seals, linkage, and lube level - Automatic transmission, including fluid level, seals, modulator adjustment, and linkage - Drive train, including u joints, center support, and companion flanges - Rear axle and springs, including oil links, spring hangers, center bolts, and u-bolts - Front end, including steering box, linkage, kingpins and bushings, spring hangers, and U-bolts - Mechanical brakes, including adjustment and fluid levels - Air brakes, including drain, adjustment, wear, and air leaks - Tires, including condition, wear,tread depth, year of tire and replacement recommendations - Electrical system, including running lights, emergency lights, battery cables, turn lights, 4-way flasher, headlights, stop lights, hazards and switches - Fuel system, including hoses and fittings, filters and brackets, and tank straps - Booster tank, including leaks and supports - Prime pump, including electrical wires, coupling, switch, and valve discharge - Plumbing and gates, including leaks, brackets, bleed valves, control arms and knobs, and linkage - Main pump, including vacuum test, pressure test, packing, clappers, and mounting - Pump transmission, including fluid levels, seals, shift motors, and manual override - Aerial ladder, including power takeoff, drive shaft and coupling, p.t.o. activating device outrigger controls, auxiliary power control and - Aerial operation, including engine rpm., hydraulic pressure, operation of all controls, warning devices, hoses and fittings, rung covers, ladder locks, and ring gear - Aerial platform, including lubrication,platform leveling, electrical system, turntable and platform controls, communications, and water tube. Annual Level II Preventative Maintenance: 1000 hours or one year (whichever comes first) Full vehicle inspection performed in Level I, plus at a minimum: - Replacement of coolant hoses, filter and coolant as needed - Replacement of all drive belts as needed - Replacement of pump transmission oil and filter - Replacement of engine transmission fluid and filter - Replacement of rear axle lube oil as needed - Inspection of front wheel bearing - Replacement and repacking as needed - Inspection and cleaning of relief valve strainer - Replacement of secondary fuel filters on both engine and generator - Inspection of front wheel bearing The above Level I and Level II inspections shall include, at no additional labor charge, the changing of all applicable filters and fluids used by the unit being inspected. Filters and fluids shall be billed at cost plus 25 %, as described in section 10 of this Agreement. Preventative Maintenance Inspections incorporating Level I (semi-annual) and Level II (annual) shall be conducted at such intervals as are approved by Monroe County Fire Rescue. Upon completion of inspection a computerized report will be forwarded to the logistics support services indicating the status of the items inspected. This will be done for every vehicle when Level I (semi-annual)and Level II (annual) Preventative Maintenance is performed on the vehicle. This report must be emailed to the logistics support services office. The form must either be in Microsoft Word or Excel. 8. Rates: Contractor shall charge Level I (semi-annual)and Level II(annual) Preventative Maintenance Service at flat-rate annual total cost of- RESCUE-TYPE VEHICLES (Without Pump) $ 225.00 PUMPERS $ 300.00 AERIALS $ 425.00 TANKERS $ 300.00 SQUADS $ 300.00 9. Pump Test Rate: Contractor shall perform an annual pump test at a flat rate cost of: PUMP TEST RATE (All vehicles requiring such test) $ 300.00 In order to facilitate the passing of the pump test, minor repairs and adjustments shall be made as needed; price includes clean-up after salt water use. The Contractor shall provide documentation of performance to Monroe County Fire Rescue. The documentation must be in the form of an electronic version report that is emailed to the logistics support services office within ten (10)days of completion of the test. The form must either be in Microsoft Word or Excel. 10. Parts, Fluids and Lubricants Rate: Contractor shall supply all parts, fluids, and lubricants used for maintaining and repairing vehicles to Monroe County Fire Rescue at: Cost+ 25 % For any individual parts, or if total of all parts for an individual repair, is $400.00 or over, a copy of original parts supplier invoices shall be attached to the bill. Contractor will be required to keep all original parts supplier invoices available at request by Monroe County Fire Rescue for spot checking and auditing purposes. 11. Engine Oil and Filter Change: Complete drive train lubrication and any other fluids and/or filter changes, shall be performed as recommended by the manufacturer. 12. Weekly Maintenance Schedule: Contractor shall also provide to Monroe County Fire Rescue a Weekly Preventative Maintenance Schedule which can be performed by the individual fire stations' personnel. The Contractor shall provide in-service training to the Lieutenants on all three (3) shifts at all of the stations at no extra cost. This will be scheduled by the Contractor with the on-duty Lieutenants and can be done during Level I and Level II Preventative Maintenance visits. 13. Maintenance Lot: Contractor shall maintain an inspection and maintenance chart on each vehicle containing at least the following information: - Date of Performance - Apparatus Serviced - Service Performed - Parts Used - Name of Service Person(s) - Total Downtime of Vehicle 14. Maintenance Chart: A copy of chart outlined above shall be supplied to the fire rescue office within ten (10) days of the service. 15. Response Email: Contractor shall respond to all original emergency field repair forms by emailing the original document to the logistics support services office with documentation of repairs made, parts used and any other miscellaneous information that is applicable. 16. Communication Device: Contractor shall maintain a telephone, cell phone, email or paging device such that prompt notification of request for service is possible twenty-four (24) hours a day. 17. Response Time to Service Request: Contractor shall maintain a state of readiness during normal working hours defined as 8:00 am—5:00 pm Monday thru Friday, and shall acknowledge and respond within two (2) hours to Monroe County Fire Rescue's initial notification during normal working hours; Contractor then has twelve (12)regular working hours to either make repairs, or respond to Monroe County Fire Rescue with a Repair Plan; Response(s) can be by phone or email. Contractor shall be available 24-hours a day per Item 16 of Contract; Contractor shall acknowledge and respond within four(4) hours to the Monroe County Fire Rescue's initial notification outside of normal working hours; Contractor then has thirty-six (36) hours to either make repairs, or respond to Monroe County Fire Rescue with a Repair Plan; Response(s) can be by phone or email. 18. Staffing: Contractor shall maintain adequate staff to ensure compliance. 19. Certification: Contractor shall provide evidence satisfactory to Monroe County Fire Rescue that its personnel who perform maintenance work are certified - EVT(Emergency Vehicle Technicians) - Pump Mechanics - General Mechanics - Repair Mechanics or personnel who are not certified, are overseen by certified personnel. 20. Qualifications of Maintenance Personnel: All personnel performing maintenance, repairs, adjustments and related work on Monroe County Fire Rescue equipment shall be a certified fire apparatus mechanic, or otherwise certified for the work to be performed. Personnel performing work who are not certified or experienced in such work shall be directly supervised(in person)by an individual with such certification. 21. Indemnification: Contractor shall indemnify and hold Monroe County harmless for all actions of Contractor's negligence as well as faulty or improper workmanship, for all work performed under this Contract, including all costs of collection, reasonable attorney fees, claim costs, and as per `Attachment G'. All property or equipment being directly maintained or repaired by Contractor shall be considered in its care, custody, and control while such work is in progress and until physical control of such property or equipment is restored to the County. 22. Location of Work: This Contract is for maintenance of fire rescue vehicles located at the following sites: - Stock Island—STATION 8 - Big Coppitt—STATION 9 - Sugarloaf—STATION 10 - Cudjoe —STATION 11 - Big Pine—STATION 13 - Crawl Key—MONROE COUNTY FIRE ACADEMY - Conch Key—STATION 17 - Layton—STATION 18 - Tavernier—STATION 22 23. Insurance: During the term of this Contract, the Contractor must keep in force and effect the insurance required by `Attachment H' which is attached and incorporated into this Contract. 24. Additional Required Statements/Verifications/Affidavits: Attached hereto: Attachment C Non-Collusion Affidavit Attachment D Public Entity Crime Statement Attachment E Drug Free Workplace Form Attachment F Lobbying& Conflict of Interest Clause (Ethics Clause) Attachment G Indemnification and Hold Harmless Attachment H Insurance Requirements and Request for Waiver—Workers Comp Attachment I Local Preference Form (if applicable) 25. Payments: All payments will be made in accordance with the Florida Local Government Prompt Payment Act. All unscheduled maintenance and repair resulting from equipment failure or malfunction requiring service shall be billed by the Contractor at the applicable rates as specified in contract. The Contractor upon notification by Monroe County Fire Rescue of an equipment failure or malfunction requiring unscheduled maintenance, shall in a timely manner investigate the problem and provide to Monroe County Fire Rescue an estimate of the cost for repair and vehicle downtime. The Contractor upon receiving authorization to proceed from Monroe County Fire Rescue shall effectuate such repair; upon completion of same the Contractor shall notify Monroe County Fire Rescue of the outcome and actual cost. Monroe County Fire Rescue shall issue a separate purchase order for each occurrence of unscheduled maintenance and repair. 26. Monroe County's performance and obligation to pay under this Contract is contingent upon an annual appropriation by the Board of County Commissioners of Monroe County. Florida. 27. Venue for any litigation arising under this Contract must be in a court of competent jurisdiction in Monroe County, Florida. This Agreement is not subject to arbitration. IN WITNESS WHEREOF,the parties have executed this Agreement the day and year first above written. (SEAL) BOARD OF GOVERNORS OF FIRE AND ATTEST: AMY HEAVILIN, AMBULANCE DISTRICT 1 OF MONROE COUNTY CLERK COUNTY,FL By: By: Deputy Clerk Mayor/Chairman FIRE-TECH REPAIR SERVICE,INC.: MONROE COUNTY ATTORNEY By. !PROVED S O F RM: Robert C. Burley CYNTHIA L. ALL ASSIS ANT COUNTY ATTORNEY Date O-a0(3 Date: Attachment A SCOPE OF WORK MONROE COUNTY FIRE RESCUE VEHICLE LIST LOCATION VEHICLE DESCRIPTION Stock Island 2003 Pierce Pumper Big Coppitt 1999 Southern Coach American Tanker 2007 Pierce Ladder j Sugarloaf 1986 Chevrolet Rescue Pumper _ 2007 Pierce Pumper _ 2010 Ferrara Tanker Pumper Cudjoe 2007 Pierce Pumper Bi Pine Key _ 2005 Pierce Pumper 1996 Dodge Brush Truck _ 2007 Hallmark Tanker Pum er _ J i Monroe County Fire Academy 1990 E-One Pumper _ — 1981 Saulsbury Tanker Pumper_._____ Conch Key 20,05 Pierce Pumper Layton 2010 Ferrara Pumper 1994 Navistar International Tanker Pumper 1992 Ford E-One Air Utility Tavernier 1992 Saulsbury Hose Reel Truck 1988_Spartan Rescue/Pumper _ _ 1988/2004 E-One Aerial Platform - 2001 Pierce Pumper Attaclunent B SUBMISSION RESPONSE FORM Maintenance of Monroe County Fire Rescue Vehicles Respondent's Name and Mailing Address: r'"!/' - s1rr- orv�c�° lf-1L Telephone and Fax Numbers: Email Address All amounts must be written AND in number format. In case of a conflict between the amount in 1 words and the amount in numbers, the amount in words shall control. Per vehicle price and hourly rate to be inclusive of travel,mileage,etc. Regularly scheduled semi-annual inspection and maintenance as specified on all apparatus. Cost per vehicle Total Cost Per Year Per Vehicle Rescue Type Vehicle without pump $ Pumpers oo C0,0�0 $ ..(_..�-iyC } Aerials CI ` $ j 00 ,i Tankers $ 11-3C, $ r' y Squads $ J��•Iny- ) $ Cost per vehicle Annual Pump Test $ Unscheduled Maintenance-Service resulting from equipment malfunction or failure Hourly Rate S Parts n' C-cal I have included: Proposal _ Submission Response Form Non Collusion Affidavit ./ Public Entity Crime Statement Lobbying and Conflict of Interest Clause Form i -- Drug Free Workplace Form 1 Indemnification and Hold Harmless Local Preference Form(if applicable) G (Check mark items above, as a reminder that their are included). I state that I am authorized to submit this Proposal. STATE OFF J(�SiVaZtu re of Respon ent) } ) COUNTY OF Date PERSONALLY APPEARED BEFORE ME,the undersigned authority, i-3-174c� who, after first being sworn by me, (name of individual signing)affixed his/her signature in the/ space provided above on this , zoo . day of l My cornmission expires: q71( 5vp Notary Public gtspaOfFlorida Debra S Naiser NOTARY PUBLIC -- � �d MyCommission EE 182489 Expiresp4/07/2018 } Attachment C NON-COLLUSION �A FF DAVIT I, Eol-) e- f'� /� t_�f tee , of the city of �- �—A U f':AL; erg f L.. according to law on my oath, and under penalty of penury, depose and say that; 1) I am !`tr's4�, the Respondent making the Solicitation for the project described as follows: (! , la} �� JW L:z j4; sc� e, 2) The prices in this solicitation have been airi�ndependently without collusion, consultation, communication or Agreement for the purpose of restricting competition, as to any matter relating to such prices with any other Respondent or with any competitor; 3) Unless otherwise required by law, the prices which have been quoted in this solicitation have not been knowingly disclosed by the Respondent and will not knowingly be disclosed by the Respondent prior to solicitation opening, directly or indirectly, to any other Respondent or to any competitor; and 4) No attempt has been made or will be made by the Respondent to induce any other person, partnership or corporation to submit,or not to submit, a solicitation for the purpose of restricting 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. STATE OF ( t re of Respondent) COUNTY OF n,16 11 i"V `- Date PERSONALLY APPEARED BEFORE ME, the undersigned authority, gQ�� C, & who, after first being sworn by me,(name of individual signing) iced hisiner signature in the space provided above on this C/ day of ul`—J , 20.13 . My commission expires: gl7/iC- NOTARY PUBLIC Notary PublicS Na State of Florida -MCP FORM�1 F Debra MY OF VMy Commisawn EE 182489 Expires 04/07/2016 Attachment D 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 solicitation on a contract to provide any goods or services to a public entity, may not submit a solicitation on a contract with a public entity for the construction or repair of a public building or public work, may not submit solicitations on leases of real property to public entity,may not be awarded or perform work as a bidder, supplier, subbidder,RESPONDENT or subRespondents under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017,Florida Statutes, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list.' By executing this form, I acknowledge that I/my company is in compliance with the above. w �e STATE OF ure of Respon t COUNTY OF V�Z�7��tt�� _ U� I Date PERSONALLY APPEARED BEFORE ME, the undersigned authority, Q r-� who,after first being sworn by me, (name of individual signing) aff`ix/ed'his/lieNgnature in the space provided above on this c day of —r.)ly , 20-Z'--', P aEi ate of Florida My commission expires`1�7�i4E Commission Er:162469 16 NOTARY PUBLIC Attachment E DRUG-FREE WORKPLACE FORM The undersigned Respondent in accordance with Florida Statute 287.087 hereby certifies that; (Name&Business) 1. Publishes a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Informs employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Gives each employee engaged in providing the commodities or contractual services that are under solicitation 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 solicitation, 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 contendre to, any violation of Chapter 893 (Florida Statutes) or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five(5)days after such conviction. 5. Imposes a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, or any employee who is so convicted. 6. Makes a good faith effort to continue to maintain a drug-free workplace through implementation of this section. As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. Respondent's Signatur Date 01VIB-MCP FORM#5 i Attachment F LOBBYING AND CONFLICT OF INTEREST CLAUSE SWORN STATEMENT UNDER ORDINANCE NO. 10-1990 MONROE COUNTY,FLORIDA ETERCS CLAUSE 1�2 5r'�7�'arrants that he/it has not employed, retained or othenvise had act on his/its behalf any former County officer or employee in violation of Section 2 of Ordinance No. 10-1990 or any County officer or employee in violation of Section 3 of Ordinance No. 10-1990. For breach or violation of this provision the County may, in its discretion,terminate this contract without liability and may also, in its discretion,deduct from the contract or purchase price,or otherwise recover, the full amount of any fee,commission, i percentage, gift, or consideration paid to the former County officer or employee. } Respondent's Si;mture L 3 } Date STATE OF L41�1 COUNTY OF 0,16 f?)) PERSONALLY APPEARED BEFORE ME, the undersigned authority, 012 � - `' �'f=9' who, after first being sworn b me, affixed his/her �.�Z tUt�' ,.- g Y signature(name of individual signing) in the space provided above on this 7 day of j J l _, zoo. l G NOTARY PUBLIC Notary public State of Florida iYt commission a irres: Debra s Naiser y eipi eF My Commission EE 182469 orµ Expires 0410712016 i OMB-MCP FORM#4 } Attachment G MONROE COUNTY,FLORIDA RISK MANAGENIENT POLICY AND PROCEDURES CONTRACT ADMINISTRATION MANUAL Indemnification and hold Harmless for Other Respondents and subProposers v The Responder covenants and agrees to indemnify and hold harmless Monroe County Board of w} County Commissioners AND Board of Governors for District 1, its servants, agents and employees from any and all claims for bodily injury(including death), personal injury,and property damage(including property owned by Monroe County) and any other losses,damages, and expenses (including consultant's fees) which arise out of, in connection with, or by reason of services provided by the Bidder or any of its subRespondents (s) in any tier, occasioned by the negligence, errors,or other wrongful act or omission of The Responder or its sub-Responder in any tier, their employees,or agents. 1 In the event the completion of the project(to include the work of others) is delayed or suspended as a result of the Responder's failure to purchase or maintain the required insurance, the Respondent shall indemnify the County fYom any and all increased expenses resulting from such delay. The first ten dollars ($10.00)of remuneration paid to the Respondent is for the indemnification provided for above. The extent of liability is in no way limited to, reduced, or lessened by the insurance requirements contained elsewhere within this Agreement. Respondent's Signature"' } Date l Y } Attachment H (1 of 4) b tl GENERAL LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT } NIAINTENANCE OF MONROE COUNTY FIRE RESCUE VEHICLES BETWEEN MONROE COUNTY,FLORIDA AND Prior to the commencement of work governed by this contract, the Respondent shall obtain General Liability Insurance. Coverage shall be maintained throughout the life of the contract and include,as a minimum: O Premises Operations l 0 Products and Completed Operations } 0 Blanket Contractual.Liability Personal injury Liability 1 G Expanded Definition of Property Damage The minimum limits acceptable shall be: $500,000 Combined Single Limit(CSL) L: If split limits are provided, the minimum limits acceptable shall be: $250,000 per Person $500,000 per Occurrence S 50,000 Property Damage } An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its provisions should include coverage for claims filed on or after the effective date of this contract. In addition, the period for which claims may be reported should extend for a minimum of twelve (12) months following the acceptance of work by the County. 7 The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. l 7 I Attachinent H (2 of 4) VEIIICLE LIABILITY } INSURANCE REQUIREMENTS FOR CONTRACT MAINTENANCE OF MONROE COUNTY FIRE RESCUE'VEHICLES BETWEEN VIONROE COUNTY,FLORIDA AND INC, Recognizing that the work governed by this contract requires the use of vehicles, the F Respondent, prior to the commencement of work, shall obtain Vehicle Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum, } liability coverage for: l o Owned, Non-Owned, and Hired Vehicles ) The minimum limits acceptable shall be: $100,000 Combined Single Limit(CSL) ) If split limits are provided, the minimum limits acceptable shall be: } $50,000 per Person ► $300,000 per Occurrence $ 25,000 Property Damage } The Monroe County Board of County Commissioners shall be named as Additional Insured on 1 all policies issued to satisfy the above requirements. } Attachment H (3 of 4) WORKERS' COMPENSATION INSURANCE REQUIREMENTS FOR CONTRACT MAINTENANCE OF MONROE COUNTY FIRE RESCUE VEHICLES BETWEEN MONROE COUNTY,FLORIDA AND Prior to the commencement of work governed by this contract, the Respondent shall obtain Workers' Compensation Insurance with limits sufficient to respond to the applicable state statutes. In addition, the Respondent shall obtain Employers' Liability Insurance with limits of not less than: $500,000 Bodily Injury by Accident $500,000 Bodily Injury by Disease, policy limits $500,000 Bodily Injury by Disease, each employee Coverage shall be maintained throughout the entire term of the contract. Coverage shall be provided by a company or companies authorized to transact business in the state of Florida. If the Respondent has been approved by the Florida's Department of Labor, as an authorized self-insurer, the County shall recognize and honor the Respondent's status. The Respondent may be required to submit a Letter of Authorization issued by the Department of Labor and a Certificate of Insurance, providing details on the Respondent's Excess Insurance Program. If the Respondent participates in a self-insurance fund, a Certificate of Insurance will be required. In addition, the Respondent may be required to submit updated financial statements from the fund upon request from the County. 1 Artachmew H ` (4of4) } MONROIE COUNTY,FLORIDA Request for Waiver of Insurance Requirements It is requested that the insurance requirements,as specified in the County's Schedule of Insurance Requirements,be waived or modified on the following contract. Respondent: 7V4- Contract for: �'"/! �. ^/ /f�fit/ /'Agy iV Address of Respondent: '>k 6Z2 } Phone: �,:.J Z_ —Y 1 Scope of Work: 4 Reason for Waiver: e-c'S Policies Waiver ^9( will apply to: Signatwe of Respondent: Approved _ No Approved Risk Management Date _ County Administrator appeal: } Approved: Not Approved: Date: Board of County Commissioners appeal: Approved: Not Approved: Meeting Date: I i Attach►nerrt I LOCAL PREFERENCE FORM Vendors claiming a local preference according to Ordinance 023-2009 must complete this form. Name of Bidder/Responder / e t\, i`Vy e- Date: 9-1�-2Lq1 j 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 solicitation? -�(Please furnish copy. ) �4 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? List Address: 1 1C), � -'1/ Telephone Number: �-- ,,5�— 1 3 B.Does the vendor/prime Respondent intend to subcontract 50%or more of the goods,services or construction to local businesses meeting the criteria above as to licensing and location? � x (f yes,please provide: 1.Copy of Receipt of the business tax paid to the Monroe County Tax Collector by the subRespondent dated at least one year prior to the notice or request for bid or solicitation. 2.SubRespondent Address within Monroe County from which the subRespondent operates: Tel.Number j V�- � 7 ' �. Print Name:_ Signature and Title uthorized Sign ory for Bidder/Responder STATE OF �f Y tC" COUNTY OF.LI-I UK rU On this day of 2t) [ before me, the undersigned notary public, personally appeared �= G h ,a�l own to me to be the person whose name is subscribe -above or who produced as identification, and acGow a ge tat elshe is the person who executed the above Local Preference Form for the purposes therein contained. Notary Public YOU Notary Public State of Floride ) n ' Debra S Naiserb r-� �. /vti ty e My Commission EE 182469Expires 0410712016 Print Name My commission expires: __ Seal