Item C01 � C.1
� � �, BOARD OF COUNTY COMMISSIONERS
County of Monroe � ��r�i
�r � s�� Mayor Heather Carruthers,District 3
The Florida.Keys Mayor Pro Tem Michelle Coldiron,District 2
Craig Cates,District 1
David Rice,District 4
Sylvia J.Murphy,District 5
County Commission Meeting
June 17, 2020
Agenda Item Number: C.1
Agenda Item Summary #6591
BULK ITEM: Yes DEPARTMENT: Project Management
TIME APPROXIMATE: STAFF CONTACT: Breanne Erickson (305) 292-4427
N/A
AGENDA ITEM WORDING: Approval of a contract with Carlos A. Alves and JC Carroll for
$6,000.00 for public art at the new Marathon Library recommended by the Art in Public Places
(AIPP) Committee and the Florida Keys Council of the Arts (FKCA).
ITEM BACKGROUND: Monroe County Ordinance No. 022-2001 provides for an appropriation
of 1% of the construction costs for new construction exceeding $500,000 and renovations exceeding
$100,000 to be set aside to promote understanding and awareness of the visual arts and enrich the
public environment for residents and visitors. Based on responses submitted on January 22, 2020, to
a second Request for Proposals, the AIPP Committee selected Carlos Alves and JC Carroll to
provide public artwork for the new Marathon Library. The initial artwork was for the design of a
terrazzo floor, but the design selected, due to budget constraints on this project, had to be modified
and will now be a ceramic and glass mosaic tile artwork piece. The artwork will hang on Wall "B"
in the Library's Adult Education Reception Lobby. The contract amount is for $6,000.
PREVIOUS RELEVANT BOCC ACTION:
March 21, 2019 — BOCC approved a contract with Pedro Falcon Construction for construction of
the new Marathon Library.
CONTRACT/AGREEMENT CHANGES:
N/A
STAFF RECOMMENDATION: Approval of Contract
DOCUMENTATION:
REV EXECUTED STAMPED Agreement Marathon Library Alves- Carroll (6/2/20)
REVISED Approval letter from FKCA—Alves-Carroll (6/2/20)
Certificate of Insurance & Waiver on Workers' Comp ( 6 9 20)
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FINANCIAL IMPACT:
Effective Date: 6/17/2020
Expiration Date: 90 days after Notice to Proceed issued
Total Dollar Value of Contract: $6,000.00
Total Cost to County: $6,000.00
Current Year Portion: $6,000.00
Budgeted: Yes
Source of Funds: 314-26008-560620-CC1501
CPI:
Indirect Costs:
Estimated Ongoing Costs Not Included in above dollar amounts:
Revenue Producing: No If yes, amount:
Grant: No
County Match:
Insurance Required: Yes
Additional Details:
Yes
02/19/20 314-26008 - CAPITAL OUTLAY BUILDING $6,000.00
CC1501
REVIEWED BY:
Cary Knight Completed 02/04/2020 3:01 PM
Patricia Eables Completed 02/04/2020 3:18 PM
Budget and Finance Completed 02/04/2020 4:46 PM
Maria Slavik Completed 02/05/2020 7:42 AM
Kathy Peters Completed 02/05/2020 12:05 PM
Board of County Commissioners Completed 02/19/2020 9:00 AM
Board of County Commissioners Pending 06/17/2020 9:00 AM
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Monroe County Art in Public Places Award Agreement
Marathon Library and Adult Education Center
This AGREEMENT dated the 17th day of June, 2020, is entered into by and between the
BOARD OF COUNTY COMMISSIONERS FOR MONROE COUNTY, hereinafter '
"County"/"BOCC", and CARLOS A. ALVES and JC CARROLL, hereinafter"Artist."
WHEREAS, the Monroe County BOCC recognizes the extent of cultural resources
available in the county for development, promotion, and enjoyment of the arts. It is the intent of
the BOCC to enrich culturally and benefit the citizens of this county through the establishment of
Art in Public Places; and
WHEREAS, the Art in Public Places Ordinance ##022-2001 (AIPP Ordinance), codified at --
MCC §2-233, authorizes the allocation of one percent(1%) of the County's construction costs for
new construction exceeding $500,000.00 and renovations exceeding $100,000.00 to be set aside
in a fund and used for acquisition, commission, installation and maintenance of works of art to be
used in, upon, or around the new or renovated County buildings; and
WHEREAS, the AIPP Ordinance established an Arts in Public Places Committee (AIPP)
to review responses to Requests for Proposals for art to be acquired, commissioned, installed, and
maintained in public construction projects and to advise the BOCC regarding the art subject to the
AIPP allocation; and It
WHEREAS, the BOCC desires to acquire public artwork to be installed, placed, and/or
located at the Monroe County Public Library, Marathon Branch, and Adult Education Center,
Marathon, Monroe County, Florida,to promote understanding and awareness of the visual arts and
to enrich the public environment for residents and visitors; and
WHEREAS, in conformity with the AIPP Ordinance and MCC §2-233, the Artists were
selected by the AIPP Committee to provide public artwork for this location; and
NOW, THEREFORE, in consideration of the mutual covenants and payments contained i
herein, the parties have entered into this agreement on the terms and conditions as set forth below.
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1. AGREEMENT PERIOD: This Agreement is for a period of ninety(90)days after issuance 2
of a notice to proceed to execute and complete the work. This Agreement shall remain in
effect for the stated period unless one party gives to the other written notification of
termination pursuant to and in compliance with paragraphs 12, and 13 below. All work for
which AIPP funds are to be expended must be completed by the stated termination date.
2. SCOPE OF AGREEMENT: The Artist shall perform all services, and provide and furnish
all supplies, materials, and equipment as necessary for transportation, creation, and
installation of artwork in the Marathon Library and Adult Education Center as follows:
Artist team is commissioned to create a ceramic and glass mosaic tile artwork with the Lu
proposed design, color and imagery of"Bubbles" not to exceed 72" wide x 60" high x 5"
deep, and deliver and complete the installation on "Wall B" in the Library's Adult Ed
Reception lobby as described and sketched in Attachment A, which is made a part hereof.
The "bubbles" design will be in shades of blues and greens to reflect the exquisite nature
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of water and the whimsical feeling of bubbles that are both ageless and timeless.The design
will share the concept that the Library inspires the imagination and learning.
Artists shall confer with and coordinate activities with Executive Director, Florida Keys
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Council of the Arts, Elizabeth Young, in order to insure that there is as much cooperation
and cohesiveness in the incorporation of the art in or around the building so that there shall
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be the least amount of interference between the Artist and the Marathon Branch Library
and Adult Education Center personnel or any construction staff.
3. AMOUNT OF AGREEMENT AND PAYMENT: The County shall provide an amount e
not to exceed Six Thousand and 001100 ($6,000.00) Dollars for the final approved
ceramic and glass mosaic tile artwork. The Board of County Commissioners assumes no
liability to fund this agreement for an amount in excess of this award. Monroe County's
performance and obligation to pay under this agreement is contingent upon an annual
appropriation by the BOCC. Pursuant to Florida's Prompt Payment Act, upon receipt by
County of an Invoice for each of three(3)phases and documentation to satisfy the Clerk
that the appropriate phase has been completed, payment shall be made for the following
phases at the referenced rates:
1) Design Phase: 33.3% of total payment;
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2) Materials: 33.3% of total when artist submits receipts for materials and ca
eligible costs equal to or greater than 33.3%of the contract total.
Travel expenses are included in this phase and shall be paid in
accordance with Florida State Statute It 2.06 1, or as described in 2) a
below:
2(a) Travel All travel expenses shall be reported on a State of Florida Voucher for
Reimbursement of Travel Expenses. If Artist has airfare, the original
boarding pass, or equivalent, must be attached to the Voucher. If Artist is
in a vehicle, mileage must be reported on the Voucher. Mileage is i
reimbursable at $0.53 cents per mile. Meals are to be reported as follows:
Breakfast when travel begins before 6 a.m. and extends beyond 8 a.m. for E
$10.00; Lunch m- when travel begins before 12 noon and extends beyond 2
p.m. for$15.00; and Dinner- when travel begins before 6 p.m. and extends
beyond 8 p.m. for$30.00.
A State of Florida Voucher for Reimbursement of Travel Expenses is
attached and made a part of this contract.
3) Completion: 33.3% final payment due when installation is deemed complete and
contractual agreement specifications are verified by the Monroe County
Project Management Department or designee.
Eligible costs and expenditures for the project and the total award include,,but are not limited to: LU
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A. Artist's design fee.
B. Labor, materials, and contracted services required for production and installation.
C. Artist's operating expenses related to the project.
D. Travel related to this project, pursuant to statutory limitations (see above
paragraph 3, item 2).
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E. Transportation of the work to the site (see above paragraph 3, item 2).
F. Installation to the site.
G. Permits and fees necessary for the installation (applicable for exterior projects
which may also require HARC review, if applicable).
H. Legal costs directly related to the project. '
I. Liability costs of artist.
Payment shall be made upon presentation of an original invoice and documentation
necessary to support the completion of the work. Artist shall also provide release of liens
if applicable.
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Final payment request must be submitted no later than sixty(60) days after the completion
of the project. �--
4. OWNERSHIP and RIGHTS: Upon the installation of the artwork and acceptance by the
County, the County shall own the artwork and title to the artwork shall pass to the County.
This Article 4 and the Artist's signature on this Agreement shall constitute and be construed
as the Artist's express waiver of rights as provided in 17 U.S.C. §106A, et al. al., to the
extent that the artwork may be removed, adjusted, replaced, and/or relocated, as deemed
necessary by the County without obtaining a waiver or permission from the Artist, and that
modification to the artwork resulting from conservation or public presentation involving
lighting and placement is not prohibited modification or considered alteration, distortion,
or mutilation of the artwork. Artist agrees that the County as owner of the building and/or
property that includes the artwork may, without the consent or permission of the Artist,
make or authorize the making of alterations and/or destruction of such building and/or
property. Artist agrees that where the artwork may be created or conceived in any fashion
by more than one author, the Artist's signature and waiver binds the entire group of
authors/artists.
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5. RECORDS: The Artist shall keep such records as are necessary to document performance
of the agreement and give access to these records at the request of the County, the State of
Florida, or authorized agents and representatives of said governmental bodies. The Artist
understands that it shall be responsible for repayment of any and all audit exceptions which
are identified by the Auditor General for the State of Florida,the Clerk of Court for Monroe
County, the Board of County Commissioners for Monroe County, or their agents and
representatives. For Public Records requirements see paragraph 21 below.
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MODIFICATIONS AND AMENDMENTS: Any and all modifications of the terms of
this Agreement shall be only amended in writing and approved by the BOCC. Extensions
of time to complete any terms of this Agreement must be made in writing and may be
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approved only by the BOCC.
7. INDEPENDENT CONTRACTOR: At all times and for all purposes hereunder, the Artist
is an independent contractor and not an employee of the Board of County Commissioners
of Monroe County. No statement contained in this agreement shall be construed as to find
the Artist or any of its employees, contractors, servants, or agents to be employees of the
Board of County Commissioners of Monroe County, and they shall be entitled to none of
the rights, privileges, or benefits of employees of Monroe County,
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8. COMPLIANCE WITH LAW: In carrying out its obligations under this Agreement, the
Artist shall abide by all statutes, ordinances, rules, and regulations pertaining to or
regulating the provisions of this Agreement, including those now in effect and hereafter
adopted. Any violation of said statutes, ordinances, rules, or regulations shall constitute a
material breach of this Agreement and shall entitle the County to terminate this Agreement '
immediately upon delivery of written notice of termination to the Artist.
9. HOLD HARMLESS/INDEMNIFICATION: The Artist hereby agrees to indemnify and
hold harmless the BOCC, Florida Keys Council of the Arts, AIPP Committee and Monroe
County and any of their officers and employees from and against any and all claims,
liabilities, litigation, causes of action, damages, costs, expenses (including but not limited
to fees and expenses arising from any factual investigation, discovery or preparation for
litigation), and the payment of any and all of the foregoing or any demands, settlements or
judgments arising directly or indirectly under this Agreement. The Artist shall immediately
give notice to the County of any suit, claim, or action made against the County that is
related to the activity under this Agreement, and will cooperate with the County in the
investigation arising as a result of any suit, action, or claim related to this Agreement.
10. NONDISCRIMINATION. Artist and County agree that there will be no discrimination
against any person, and it is expressly understood that upon a determination by a court of
competent jurisdiction that discrimination has occurred, this Agreement automatically
terminates without any further action on the part of any party,effective the date of the court It
order. Artist or County agrees to comply with all Federal and Florida statutes, and all local
ordinances, as applicable, relating to nondiscrimination. These include but are not limited
to: 1) Title VII of the Civil Rights Act of 1964(PL 88-352)which prohibits discrimination
on the basis of race, color or national origin; 2) Title IX of the Education Amendment of
1972, as amended(20 USC ss. 1681-1683, and 1685-1686),which prohibits discrimination
on the basis of sex; 3) Section 504 of the Rehabilitation Act of 1973, as amended(20 USC
s. 794), which prohibits discrimination on the basis of handicaps; 4) The Age
Discrimination Act of 1975, as amended (42 USC ss. 6101-6107) which prohibits
discrimination on the basis of age; 5) The Drug Abuse Office and Treatment Act of 1972
(PL 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; 6) The i
Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970(PL 91-616),as amended, relating to nondiscrimination on the basis of alcohol a,
abuse or alcoholism; 7) The Public Health Service Act of 1912, ss. 523 and 527 (42 USC
ss. 690dd-3 and 290ee-3), as amended, relating to confidentiality of alcohol and drug abuse
patient records; 8) Title VIII of the Civil Rights Act of 1968 (42 USC s. 3601 et seq.), as
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amended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The
Americans with Disabilities Act of 1990(42 USC s. 12101 Note),as maybe amended from
time to time, relating to nondiscrimination on the basis of disability; 10) Monroe County
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Code Chapter 14,Article II, which prohibits discrimination on the basis of race, color, sex,
religion, national origin, ancestry, sexual orientation, gender identity or expression,
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familial status or age; 11) Any other nondiscrimination provisions in any Federal or state
statutes which may apply to the parties to, or the subject matter of, this Agreement. LU
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11. ANTI-KICKBACK: The Artist warrants that no person has been employed or retained to
solicit or secure this Agreement upon an agreement or understanding for a commission,
percentage, brokerage or contingent fee, and that no employee or officer of the County has
any interest, financially or otherwise, in the said funded project, except for general
membership. For breach or violation of this warranty, the County shall have the right to
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annul this Agreement without liability or, in its discretion, to deduct from the agreement
price or consideration, the full amount of such commission, percentage, brokerage or
contingent fee.
12. TERMINATION: This Agreement shall terminate pursuant to Paragraph 1. TerminationCL
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prior thereto shall occur whenever funds cannot be obtained or cannot be continued at a
level sufficient to allow for the continuation of this Agreement pursuant to the terms herein.
In the event that funds cannot be continued at a level sufficient to allow the continuation
of this Agreement pursuant to the terms specified herein, this Agreement may then be
terminated immediately by written notice of termination delivered in person or by mail to
Artist. The County may terminate this Agreement without cause upon giving ninety (90)
days written notice of termination to Artist. The County shall not be obligated to pay for
any services or goods provided by Artist after Artist has received written notice of
termination.
13. TERMINATION FOR BREACH: The County may immediately terminate this Agreement
for any breach of the terms contained herein. Such termination shall take place
immediately upon receipt of written notice of said termination. Any waiver of any breach
of covenants herein contained to be kept and performed by Artist shall not be deemed or N
considered as a continuing waiver and shall not operate to bar or prevent the County from
declaring a forfeiture for any succeeding breach either of the same conditions or of any
other conditions.
14. ENTIRE AGREEMENT: This agreement constitutes the entire agreement of the parties
hereto with respect to the subject matter hereof and supersedes any and all prior agreements
with respect to such subject matter between the County and the Artist.
15. CONSENT TO JURISDICTION: This Agreement, its performance, and all disputes
arising hereunder, shall be governed by the laws of the State of Florida, and both parties
agree that the proper venue for any actions shall be in Monroe County.
16. ETHICS CLAUSE: Artist warrants that he/she has not employed, retained or otherwise i
had act on his,;her behalf any former County officer or employee in violation of Section 2 a
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 the provision the County may, at its
discretion terminate this Agreement without liability and may also, at its discretion,deduct
from the agreement or purchase price, or otherwise recover, the full amount of any fee,
commission,percentage, gift, or consideration paid to the former or present County officer
or employee.
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17. 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 an agreement to provide any goods or services to a public entity, may not submit a
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bid on an agreement 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 beLU
awarded or perform work as a contractor, supplier, sub-contractor, or consultant under an
agreement 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 thirty-six (36) months from the date of being placed on the convicted vendor list.
Artist represents that Artist is not on the Convicted Vendor list.
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18. AUTHORITY: Artist warrants that it is authorized by law to engage in the performance
of the activities encompassed by the project herein described. Each of the signatories for
the Artist below is authorized to contract Artist's services.
19. LICENSING AND PERMITS: Artist warrants that he or she shall have, prior to
commencement of work under this Agreement and at all times during said work, all
required licenses and permits whether federal, state, County or City.
20. INSURANCE: Artist agrees that it maintains in force at its own expense a liability
insurance policy which will insure and indemnify the Artist and the County from any suits,
claims or actions brought by any person or persons and from all costs and expenses
occurring during the Agreement or thereafter that results from performance by Artist of the
obligations set forth in this Agreement. At all times during the term of the Agreement and
for one (1) year after acceptance of the project, unless the requirement is waived by the
Monroe County Risk Manager,Artist shall maintain on file with the County a certificate
of the insurance of the carriers showing that the aforesaid insurance policy is in effect. All
insurance policies must specify that they are not subject to cancellation, non-renewal,
material change or reduction in coverage unless a minimum of thirty (30) days prior
notification is given to the County by the insurer.
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Acceptance and/or approval of Artist's insurance shall not be construed as relieving Artist
from any liability or obligation assumed under this contract or imposed by law.
The Monroe County Board of County Commissioners, its employees and officials will be
included as "Additional Insured" on all policies except worker's compensation.
Any deviations from these General Insurance Requirements must be requested in writing
on the County form titled "Request for Waiver of insurance Requirements" and must be
approved by Monroe County Risk Management. The following coverages shall be
provided prior to commencement of work governed by this contract:
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1. Workers' Compensation if, and as required by Florida Statutes
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2. General Liability Insurance. Coverage shall be maintained throughout the life of
the contract and include, as a minimum:
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• Premises Operations
• Products and Completed Operations
• Blanket Contractual Liability
• Personal Injury Liability
• Expanded Definition of Property Damage
The minimum limits acceptable shall be: >
$300,000 Combined Single Limit(CSL)
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
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which claims may be reported should extend for a minimum of twelve (12) months
following the acceptance of work by the County.
21. PUBLIC RECORDS COMPLIANCE: Contractor must comply with Florida public
records laws, including but not limited to Chapter 119, Florida Statutes and Section 24 of '
Article I of the Constitution of Florida. The County and Contractor shall allow and permit
reasonable access to, and inspection of, all documents, records, papers, letters or other
"public record" materials in its possession or under its control subject to the provisions of
Chapter 119, Florida Statutes, and made or received by the County and Contractor in
conjunction with this contract and related to contract performance. The County shall have
the right to unilaterally cancel this contract upon violation of this provision by the
Contractor. Failure of the Contractor to abide by the terms of this provision shall be deemed
a material breach of this contract and the County may enforce the terms of this provision in the form of a court proceeding and shall, as a prevailing party, be entitled to
reimbursement of all attorney's fees and costs associated with that proceeding. This
provision shall survive any termination or expiration of the contract.
The Contractor is encouraged to consult with its advisors about Florida Public Records
Law in order to comply with this provision.
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Pursuant to Fla. Stat., Sec. 119.0701, and the terms and conditions of this contract, the
Contractor is required to:
(1) Keep and maintain public records that would be required by the County to perform It
the service.
(2) Upon receipt from the County's custodian of records, provide the County with a copy
of the requested records or allow the records to be inspected or copied within a reasonable i
time at a cost that does not exceed the cost provided in this chapter or as otherwise provided
by law.
(3) Ensure that public records that are exempt or confidential and exempt from public
records disclosure requirements are not disclosed except as authorized by law for the
duration of the contract term and following completion of the contract if the contractor
does not transfer the records to the County.
(4) Upon completion of the contract, transfer, at no cost, to the County all public records
in possession of the Contractor or keep and maintain public records that would be required
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by the County to perform the service. If the Contractor transfers all public records to the
County upon completion of the contract, the Contractor shall destroy any duplicate public
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records that are exempt or confidential and exempt from public records disclosure
requirements. If the Contractor keeps and maintains public records upon completion of the
contract, the Contractor shall meet all applicable requirements for retaining public records.
All records stored electronically must be provided to the County, upon request from the
County's custodian of records, in a format that is compatible with the information
technology systems of the County.
(5) A request to inspect or copy public records relating to a County contract must be
made directly to the County, but if the County does not possess the requested records, the
County shall immediately notify the Contractor of the request, and the Contractor must W
provide the records to the County or allow the records to be inspected or copied within a
reasonable time.
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If the Contractor does not comply with the County's request for records, the County shall
enforce the public records contract provisions in accordance with the contract,
notwithstanding the County's option and right to unilaterally cancel this contract upon
violation of this provision by the Contractor. A Contractor who fails to provide the public
records to the County or pursuant to a valid public records request within a reasonable time CL
may be subject to penalties under Section l 19.10, Florida Statutes.
The Contractor shall not transfer custody, release, alter, destroy or otherwise dispose of
any public records unless or otherwise provided in this provision or as otherwise provided
by law.
IF THE CONTRACTOR HAS QUESTIONS REGARDING THE
APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE
CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS
RELATING TO THIS CONTRACT CONTACT THE CUSTODIAN
OF PUBLIC RECORDS, BRIAN BRADLEY AT PHONE# 305-292-
3470, BRADLEY-BRIAN()-,MONROECOUNTY-FL.GOV,, MONROE
COUNTY ATTORNEY'_S OFFICE, 1111 12T" Street, SUITE 408, KEY
WEST, FL 33040. y
22. RISK OF LOSS: Risk of loss or damage to the artwork shall be borne by the Artist until
acceptance of the artwork by the County as indicated after the final payment has been made.
The Artist shall carry insurance sufficient to cover the purchase price of the artwork to
cover risk of loss or damage to the artwork until final acceptance by the County.
23. NOTICE: Any notice required or permitted under this Agreement shall be in writing and
hand delivered or sent by United States Mail,postage prepaid,to the other party by certified
mail, return receipt requested, or by courier with proof of delivery. The place of giving
Notice shall remain the same as set forth herein until changed in writing in the manner
provided in this paragraph. Notice shall be sent to the following addresses:
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For Artist: For County: CL
Carlos A. Alves & JC Carroll Florida Keys Council of the Arts U)
1854 SW 9" Street 1100 Simonton Street
Miami, Fl. 33135 Key West, FL 33040
and
Monroe County Attorney
P. O. Box 1026
Key West, FL 33041 E
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24. WARRANTIES OF QUALITY AND CONDITION: Artist represents and warrants that
the artwork, as fabricated and installed, will be free from defects in material and
workmanship which cause or accelerate deterioration of the artwork and that reasonable
maintenance of the artwork will not require procedures substantially in excess of those '
described in the Artist's maintenance recommendations or proposal. The warranties
described in this Article shall survive for a period of five(5) years after final acceptance of
the artwork, with periodic required maintenance by the County, according to instructions
provided by the Artist. The County shall give written notice to the Artist of any breach of
this warranty during the five (5) year period. The Artist shall, at no cost to the County, cure
reasonably and promptly the breach of warranty by means of repair, restoration,
refurbishing, re-creation, or replacing the artwork.
25. REPAIRS AND RESTORATION: The County reserves the right to determine when and
if repairs and restorations to the artwork will be made after final acceptance. Repairs and
restorations to the artwork occurring five (5) years after the County's final acceptance of .�
the artwork will be the responsibility and at the expense of the County.
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[SIGNATURE PAGE TO FOLLOW]
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Execution by the Artist must be by a person with authority to buid the entity. Signature of the
person executing the document must be notari7ed and witnessed by another officer of the
entity, or by two (2) other witnesses, a-
(SEAL) BOARD OF COUNTY COMMISSIONERS
Al-I EST: KEVIN MADOK, CLERK OF MONROE COLIN I Y, 14LORIDA
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By: By ------ :E
Deputy Clerk Mayor"Chairman
WITNESSES: ARTI S A, ALVES
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Oil this 2 day of U p2020, before me, undersigned notary public,
personally appeared, by mcans of jif-'Physical presence or CJ online notarization,
known to me to be the person whose narric is subscribed above or
who ,produced Z—1 2, Dj Yll bas identification and acknowledged that he she is, the
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person who executed the above contract with Monroe County for the artwork at 1he Monroe
County Public Library, Marathon Branch and Adult Education Center for the purposes therein
contained
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Can this day of . . 2020, before me, undersigned notary public,
persor lly ppcared, by tttcan of physical presence or EJ untrue notarization,
known to nic to be the person whose name is subscribed alcove or
who prc r►c d as identification, and acknowledged that he_'she is the
person who cxccutcd the above contract with Monroe County for the artwork at the Munroe
County Public Library, Marathon Branch and Adult Education Center for the purposes therein
contained.
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C.1.a
NON-COLLUSIONICIT"
t, of the oiy. :mn,
according to low on ray oath, and ender penalty of perjury,depose and say that.
Iam
of the firm of
the proposer masking the Proposal for the project described In the notice for calling for .�
proposals for, f r,
and that l executed the said proposal with full authorrt to do so;
The prices in this proposal have beein arrived at independently without collusion,
consultation, communication, or agreement for the plurpose of restricting competition, as
to any matter relating to such prices with any other proposer or with any competitor, and
S
3. Unless otherwise required by law, the prices which have been quoted in this proposal _
have not been knowingly disclosed the proposer and will not knowingly be diisclosed
by the proposer prior to proposal opening, directly or indirectly, to any other Proposer or
to any competitor; and
. No ,attempt has been =do or wfl be made by the proposer to induce any other person,
partnership or corporation to subrnit, or not to submit. a proposal 'for the purpose of
restricting competition, and
The lreIs contained in this affidavit are true and correct, and made with full
kno i d of said project,
E
(Signature of Proposer) (Late)
i
STATE
OF, w
COUNTY'
-bade-
Subscribed n sworn to(or affirmed)before me, by means of physical presence or :online
notar ti n, on (dale)
by (name of afart . le/Sloe is personally
known to me or has producedl (type of ldentifi lion) as
entific lion, U
CONNIE TORRES NOTARY PUBLIC >
2.623
Leo r lrru S i6.Z023My cornnussion expires J& ,
4
Packet Pg.33
C.1.a
LOBBYING AND LICE OF INTEREST CLAUSE
SWORN .010-1990
FLORIDAMONROE COUNTY,
.� IPVw W
(CwipanyI
w r, ,,1 (A%WWAhn nd emValyed. retainedr otherwise had act on hi its behalf any
Countyowrcet of eroWee In YbWlon of of Ordinance No. 010-1990 or any �
;��n CROW -gar x 4� ` �; fc 3 f Ordinance . 1 -1 �, For preach r C44
CoWlya,terminate this contract with,out Ha iYity
contract or purchase price, or othe rwiserecover,
m� y fee. . ts gift, or consideration paid 10 the former
CoWti<offcw Oft",ftlployw. t ca
,09
n, .
Cate;
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,STATE OF
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swornCOUNTY OF -bzude E
Sdaxxbed and
t (or affirmed) for e> by means of Ili physIcal presence or EJ onhne
,x jr (date) CL
` ( are at a t) HeJShe is personally
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PUBLICNOTARY
OONNM TONtES
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8:My 16,2023 �
Packet Pg.34
C.1.a
DRUG-FREE WORKPLACE FORM
The undersigned vendor in accordance vAth Florida Statute 287.087 hereby ce 'tses that
Pg `.
of )
1 Publishes a statement nalifyino employeesthat the unlawful manufarlurs, di ti hutinn,dicpancing,
possession, or use of a controlled substanceis prohibitedin r place and specifiring, 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 l of
maintaining a drug4ree workplace, any available drug counseliing, rehabilhallion, and employee
assistance programs, and the penallies that may be Imposed upon employees for drug abuse
violations cV
cv
3 Gives each employee engaged In provicting the commodities of contractual services that ate under
proposal a copy of the statement speafled in subsection 1).
0
In the statement specified in uubrsection(1),notifies mplo ees that, as a condition or working
on the commodities or contradual services that are under proposal.the employee li abide by the
terms of the statement and will notify the employer of any conviction of- or plea of guilty or nolo
contenders to,any violation of Chapter (FloridaStatutes)or of any controlled substance law of
the United States or any state, for a violation c In the workplaceno Wer than tier (5)ddays
after such conviction
Imposes a sanctilon on, or require the satisfactory participation in a drug abuse asisistance or
re abilil Lion program if such Is available in the employee's community,or any employee who Is
r-
convicted
6. Makes a good faith effort to conUnue to maintain adrug-free workplace through implementation entation of
this sedon,
I
s the person authorized to sign ae statement, f certify that In rs sysplios full
requirements � E
Pro er's Ignature
Lu
Date
STATE F
COUNTY OF.
CJ
Subscribed and w&orn to(or affirmed)before me, by means otWphysical presence or 0 online
notan a bon,o ,2oZO,(date) by (name of a t). >
HeJ he is personallyn tome or has produced (type of i ntif )
as i0nti tion
CONNf1:TORRiES NOTARYPUBLIC
�} commission expires:
V CQlrur WION a GG 355430
IT v
1 •Ml EV"tE&-juV 16,2023
Packet Pg.35
C.1.a
PUBLICCL
T T
"A person or affiliate who has been placedon the convicted vendor list following a conviction for
pubit entity crimemay not subrnft a bid on a contract to provide any goods or services to a public
entity, may not submit a bid an a contract with a public entity for the conalruction or pair of a
public building or public work, may not a b tt bids on leases of real prop to public entity,
not be awarded r perform work as a contractor,supplier,subcontractor,or CONTRACTOR under
contract with any public entity, and my not transact business with any public entityIn excess
of the threshold airrerunt provided In Section 287,017, Florida Statutes, for CATEGORY TWO for
period of 36 monthsfrom,the dateof being placed on the convicted vendor list.
t have read the"ve and statethat nefthier >
(Pro poser's bor any hate has an don a con vendor isat within thelast
g
thirty-six t ths .a
Signature) .µ..µµµµµµµµµµµµµµµµme
Data . m
i
STATE OF,
COUNTY Cp
Subscribed and sworn t (or Armed) before rne, by means oXphysical presence or :j online
notarization, on�aw..... a—... ... ... a �a....(date) CD
by (name of a ant). HelShe is personally
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known to me or has prod uc
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OTARY PUBLIC
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C.1.a
VENDOR CERTIFICATION REGARDING SCRUTINIZED
Project Cascriptl (s)° c
Respondent VerWor Name:
�T-
Vendor FEIf
Vendor's Authortzed Representative Name and Mile m
Address
City " State: ipm
Phone Number Email a;
2
,Section 287,135, Florida SISW103 prohibits o company from dire n t for, or
enteringInto or renewing a contract for or a f any nt pif,, at ft eme of contradrig
renewal,the wm pare Is on the ScrutinIzed Companies that Boycott Israel List cmtedpmusnt to Section c`
1& 7 5, FI 'da SlatuteD, or Is engaged Ina Boycott of Weal SaWon 287,135, FlWicis StattAee,
prohibits a cwnpany from bidding on,submitting a proixisal for,, or onleft Into or retwMnq a contract for
goods or services of 31,000,000 or rnoro, that are on either the Scmgr&ed C=pwies vAth Activitles In
Sudan List or the Scrutinized Companies vAlh Activities in Lhe kan Potroleum Energy or Lists whichcj
re created pursuant to a 15 73, Florida Statutes- or Is engagtW n buisfirtm operationsin Cuba or
Syria,
s the person authorized to sign on behalf of ResponderA, I hereby ceAW OW ft canVany Identified
above in e Section enhtied 'Respondent en a 'Is not listed on the S*Mnted Companies t t
Boycott Israel List or angagod in a boycott of Israel and for Projecft of$1,000,000e is not I ted on
olther the Scrutinized Compsnles YAM Activities In Sudan Ust.ft Scrutinized Campardes # i s in
the Iran Petrolourn Enorgy Sector List,or engaged In businew wmilomCuba or
I understand that pursuant to Section 287,135,Ftodda Statutes.ft submissW of a false certification y
subject cxYmpany to civil penalties,attorn °a fees,ardlor costs, i kwftr ur4erstwxl that any contrad Wth
tho COUnty may be terminated, at the opdon of the County, It ft comMy is fourid to have submitted a
false caflification or has been placed on the ScnAnlzed CornpaWes Mw BoycM Israel List or engaged In
a boycott of Earael or ptaced on the SWinized Comparges with Aclivifts m Sudan List or the Scrutinized
Companies YAth Activities in the Iran Petroleum rEnergy Sector fist or been engaged In business oprifetions CD
h Cuba or Syria,
Certify By, ra dJ6 L
who is suftnzed
to sign on behalf ofthe above df r
,� `
Authorized Signature, w .
u.o
Print Nanne, 7 / �
Title
Note The List are available at the follovang Dopartment of Management SarAces Site >
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NON-COLLUSIONCL
CL
t
0
l f the ci
according to law on ath, and underynalty of P5 'ury, depose and say that. W
1. k l
of the firm of tic 0
the proposer akln P �for d scri in the notice to lino for
proposals for: c
an that l e rate th l p i with I authority t s i
cv
. The prices in this proposal have been arrived at indepandentty without collusion,
consultation, communication or agreement for the purpose of restricting competition, as
to any matter relating to such prices th any other proposer or with any competitor, and
. Unless otherwise required by low, the prices which have Noted In this proposal
have not been knowingly disclosed by the proposer and will not knowingly be disclosed
y the proposer prig to proposal opening, directly or indirectly, to any other proposer or
to any competitor, and
, No attempt has been made or will be d the proposer to induce any other person,
partnership r corporation to submit. or not to submit, a proposal for the purpose
restricting competition, and 0
. The state s contained in t d it aretrue correct, and made with full
n f t I
( tin ure rc� r) (Date) Q
2
STATE •
CL
COUNTY OF,
Subscribed and sworn to(or fbefore me, by means oLbtoysicai presence or o mine
notarization, ontv 12 (date) e®
y (name of affoarnt), H t h is personally �
known to me or has produced �' ( pe cf i titi tinny as W
identification.
nftw
"••. CaNI'1IE T4RRES TARY PUBLIC
WyC0WL0SM#GG355W
t `•� '�z EXpIRES r�18,2p23 commission Ines:
"°• .,!;�°.��8W40 Thne Holm!NOW
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C.1.a
LOBBYING f INTEREST
SWORN STATEMENT UNDER ORDINANCE NO.010-1990o
COUNTY,MONROE FLORIDA
ETHICSCLAUSE
r'
. :
(Company)
N
N
warrants that helit has not employed, retainedr otherwise had ct on hisrots 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 r
violation of this provision the County may, in Its discretion, terminate this contract without haWity ,
and may also, In its discrelion, deduct from the contract or purchase price, or otherwise recover,
the full amount of any fee, commission, percentage,, I or consi er ti I o t r r —
County officer o loy W. ,
r
( i err )
:
Fla
STATE
OF-
COUNTY : L
- - - -
Subscribed and sworn to or affirmed)before me, by means ofj0_2hysical presence or U online
notarization, On (date)
Lu
of hIsonllyrh
(type of identification) askn n to or h produced Lu
identification. Lu
Lu
i ;t+t '• 001�NIETORRE3 NOTARY PUBLIC a
My Co6lmiN N#GO 35UM �
t ) EXPIRES JWy 16.2423 My commission expires:
Vie. Bcj% d Ttru Pi tety Putrc lfiden K
4
Packet Pg.39
C.1.a
DRUG-FREEWORKPLACE
The undersigned vendor i or a ce with Florida Statute 287,087 herb certifies that
0
(Name of in ss)
t Publishes a statement notifying employees that the unlawful manufacture,distribution,dispensing, r,
possession, or use of a controlled substance is prohibited in the worliplace and specifying the
actions that will be taken against t e s for vidations of such pro " itiort .9
2, Informs employees about the dangers o/ drug abuse in the workplace, the business's poli of �
maintaining a drug-free woirkplace, any available drug n lin , rehabilitation, and employee
assistance rams, and the penalties that may be imposed upon employees for drug abuse
violadons.
Gives each employee engaged in providing sties or contractual services that are under
proposal a copy of the statement specified in subsection(1).
41 In the statement specified in subsection(1), notifies the emp4oyees that, as a condition of worldng U
on the commodities or contractual services that are under proposal,the employee Il abide the
terms of the statement and will notify the employer of any conviction of, or plea of guilty or note
contenders to,any violation of Chapter 803(Floridatatutes)or of any controlled substance law of
a United States or any state, for a violation occurring in the workplace no later than five( )days
after such conviction
5 imposes a sanction on, or require the satisfactory participation in a drug abuse assistance r
rehabilitation program If such is available in the employee's una ,or any employee who is so
0
convicted,
& Makes a good faith effort to continue to maintain a -freerk rough irriplernentalion of
this section. i
As the parson authorized to sin the statement. I rtify at this. r co II y Ith above �
requirements. E
ri—*-'1-15—kg—nature
Date
STATE F: Rai
bade
COUNTY
CJ
Subscribed n sworn to(or affirmed) before me,by means oLXrphysical presence or 0 online
notarization, o (data)b (name of a a t), >
HeJShe is personallyknown to me or has produced ( e of identification)
as Identification,
Wy cotu�tlsstota r 930
@XPIRES:July 1 c mission a es. et
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Packet Pg.40
C.1.a
CL
CL
PUBLIC ENTITY CRIMET T 'r
0
°A person or affiliate whohs been placed on the convicted vendor list following a conviction for
public entity crime not submit a bid on a contract to providey goods orservices to a public
erift may not submit a bidon a contract with a publicentity for the construction or repair of a
public building or public work, may not submit bids on leases oral property to public entity, rnay
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 ount provided In on 287,017, Florida Statutes, for CATEGORY TWO for
period of 36 rton s from the date o In4polaon
n thecost " (st
yen or
'
I have re t above an state that neither '
ra er's n r �.Affiliate s n t —convicted vendor list within the last
thirty-six( ont
)�' 4�2
store
Paw
0
TAT i
COUNTY F:
W
u scribe an or to (or affirmed) fore means ofi i I r serrc or [ online
notanzatton, on r —(date)
CL
y® C—gymil (name of nt). He/She He/She is personaVy
known to me or has r uc 14211LO ( ofi tific ti ) s
Lu
identification,
® c,
NOTARY
PUBLIC >
CoNtilts T
tB. My earn mission 'r :
s* �
Packet Pg.41
C.1.a
SCRUTINIZEDVENDOR CERTIFICATION REGARDING I
Project riph (s), f r
Respondent Vendor t
Vendor FEIN,
Vendor's rized Representative Name an i � I
Address'.
Phone Number S �_ Jf. _ if Address � f" � r�. r
N
N
S
,Section 287.135. FloridaStatutes rchi its a company from biddingon, submitting ro l for. or
entering Into or renwMng a conLract for goods or services of any amountif, at the time of ntr in
renewal,the company is on the r ini Companies that Boycott Israel List,created to Section r j
215.4725, Florida . or is engaged in a Boycott of Israel. Section 287.135, Florida Statutes, also
prohibits a companybidding n, submitting a proposal for. or entering into or renewing a contractfor
goods or services of $1,000,000or more. that are n either the ScrutinizedCompanies with Activities in <1
Sudan Lit or the ScrutinizedCompanies Activities in the Iran Petroleum Energyr Lisla which
were created runt to s, 215,473, Floridat t , or is engaged in business operations in Cubaof
Syriar
s the person authorizedto sign on behalf of Respondent, I hereby certify at the company identified
abovein the Section entitled 'Respondent Vendor Name' is not listed on the Scrutinized Companies th i cu
Boycott Israel I t or engaged in a boycottf Israel n r Projects of$1,000,000 or more is not[sted on
either the Scrutin® nies with Activitiesin Sudan UsL the Scruti need Companies with Activities sr.
the Iran Petroleum Energy r List,or engaged in business operations In Cuba or Syria.
I understand that pursuant to Section 287.135. Floridat t the submission of false certification ma 00)
subject any to civil penalties, allomey's f ter costs. I further understand that any contractt 6
the County term-nated, at the the County, if the company Is u to have submitted
falsecartificabon of has laced on the ScrutinizedCompanies at Boycott Israel List or engaged it
a boycott of Israel or placed on the ScrutinizedCompanies with Activities in Sudan List or the tin
Companies with Activities in the Iran Petroleum EnergyList or been engaged in business operatiom
in Cuba or Syria.
ifs y y �` is authorized
to sign on beha'If of the abowe re( nceed cbmpany, LU
Authorized i re � LU
Tint r �r
s :_ A
7a;
Note" The List are ava4able at the following t of Management Services Site,
e(
at,\",rk,vi
al a r-��,«':6�'1 x€is ,�,,,..Mr;„'r,.`.,.fr..,:a lit ,€,d..,a,✓w ' rSs ,..,a��..,iS„.v
6
Packet Pg.42
. C.1.b
ke s We.
Support Supporta We Connect "e Promote 9 We Give
FLOIRUIDA KEYS www.keysarts.com
COUNCIL OF THE -6
r LS
y 29, 2020
Carlos A Alves & JC Carroll CL
1854 SW 911 Street
Miami, FIL 33135
m 305-331-6806 carlosalvesmosafgs � .co _
Dear Carlos and JC, 0
Con rtltinl
Your design work has been recommended for purchase (and installation) in the new '✓
Marathon Library and Adult Education Center on Marathon Key, Florida.
The Monroe County Art in Public Places Committee would like to commission you for T
original public art based on your proposal dated January 20, 2020, and revised in May
00 based on materials and space in the building, and described as follows:
cv
'" ubbles design artwork in glass and ceramic tiles, measurement not to exceed 72" x 60", to be
installed on the Wall B in the Adult Ed lobby in shades of deep blues as per the preliminary design
sketches A final sketch will be attached to the artist agreement with this letter as Attachment A
Cost (commission) includes design, materials and installation 5inage provided by the Monroe
County Art in Public Places program c,
c�
Your total commission for the completed ork and Installation i 6,00
i
e next step is for you to please complete the enclosed Vendor File Request Form and
- , and send it to Ms. Breanne Erickson She is your contact for contracts, invoicing and
payment.
0
Her address is: Breanne Erickson; Contract Administrator
Facilities Development
1100 Simonton Street#2-216
Key West, FL 3040 >
305-2924427, rickson- rearm M2nro count t&, ov
Please provide proof of liability insurance naming the Board of Monroe County
Commissioners as an additional insured The proof of insurance or waiver must be Lu
attached to the contract before it can be approved Ask your insurance agent to send an U,
ORIGINAL certificate of insurance page to Breanne Erickson.
Alternatively, if you do not have insurance, or prefer to request a waiver and are willing to
accept all personal liability, and expect very minimal exposure to risk, you may complete
the enclosed "Request for Waiver of Insurance Requirements" and return it to Breanne
Historic Gato Building0 i o ton Street, Suite 63 * Key West,Florida 33040
305-295-4369 e Fax 305-295-4372 9 info@keysarts.com
Packet Pg.43
C.1.b
Your art budget wil, become ici I after a contract i agreement) is drawn up signedy
you and approved by the County Commiss,on rat their next rnetin and signed by the
County Mayor
executedAn copy will be returned
After this approval is acknowledged you may submit an invoice to Ms Enckson on behalf ,
of the Board of Monroe County Commissioners for your first payment CL
Your first invoice will be for one thirdof the commission s your 'Design ' You are
required to include copy of your proposal showing your plans/design and the r -
u on pnce
The secondinvoice should include receipts for materials and an appropriate fee for labor
The third n final invoice t include hot r hic proof of completion
Please send all invoices to BreanneErickson (more cific details will be in the
contract.)And please coy me on all correspondence dit cr kys s co
Pleasethe Committee requests that you do not make any announcements or
release information to the Press without prior approval of the Executive Director at the `)
Arts Council
Thank you for being a part of the Monroe County Art in Public Places Project at Marathon
Library and Adult Education Center If we can assist you with any additional questions or
information please let us know
0
,
Best regards,
" -t L I., tJ
u_
b You Susann 'Antonia: Chair
Executive Director Art in Public Paces Committee
F! Keys Council of the its Monroe County
LU
0
cc Breanne EricksonFacilities Development 3 -29 - 427 LU
Tricia Eables, Assistant County Attorney
Packet Pg.,U
C.1.b
ATTACHMENT"A"
is
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C.1.b
Form W=9 Requestfor Taxpayer Give Form to the
(Rev.December2014) Identification Number and Certification
requester. Do not
Department of the Treasury send to the IRS.
Internal Revenue Service
1 Name(as shown on your income tax return).Name is required on this`me:do not leave this line blank, _
O
sin
sin
N 2 Business name/disregarded entity name,if d.fferent from above re
3 Check appropriate box for federal tax classification;check only one of the following seven boxes: 4 Exemptions(codes apply only to >
° ❑IndividuaVsole proprietor or ❑ C Corporation ❑S Corporation ❑ Partnersh,p ❑Trustlestate certain entities,not individuals;see
yy instructions on page 3):
c single-member LLC
o Limited liability company.Enter the tax classification C=C corporation,S=S co ® Exempt payee code(if any)
CL
io
❑ Y fs Y= ( po corporation,P=partnership)
'0 Note.For a single-member LLC that is disregarded,do not check LLC;check the appropriate box in the line above for Exempteon from FATCA reporting
e the tax classification of the single-member owner. code(if any)
fZC ❑Other(see instructions)► IAppias to so;Mrus m fqk c—nd®ft 411
cs
v5 Address(number,street,and apt.or suite no.) Requester's name and address(optional)
® B City,state.and ZIP code
8 O
7 List account number(s)here(options)
Taxpayer Identification Number(TIN) W
Enter your TIN In the appropriate box.The TIN provided must match the name given on line 1 to avoid Social security number
backup when,sole .For individuals,eg is generally your social security number(page However,fora _ ®� Q
resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other
entities,it is your employer identification number(EIN).if you do not have a number,see Now to get a y
TIN on page 3. or >
Note.If the account is in more than one name,see the instructions for line 1 and the chart on page 4 for IEmployer identification number
guidelines on whose number to enter.
TF1 CNI
ff� Certitication
Under penalties of perjury,I certify that:
1. The number shown on this form is my correct taxpayer Identification number(or I am waiting for a number to be issued to me);and
sin
2. 1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue
Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am y
no longer subject to backup withholding;and
3. 1 am a U.S.citizen or other U.S.person(defined below);and
4.The FATCA code(s)entered on this form(If any)indicating that I am exempt from FATCA reporting is correct.
Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding CJ
because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage
interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and
generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the
Instructions on page 3. 0
Sign signature of
Here U.S.person► Date►
General Instructions •Form 1098(home mortgage interest),1098-E(student loan interest),1098•T
(tuition)
Section references are to the Internal Revenue Code unless otherwise noted. •Form 1099-C(canceled debt)
Future developments.Information about developments affecting Form W-9(such .Form 1099-A(acquisition or ab&,40nment of secured property..) 0.
as legislation enacted after we release it)is at www irs.gov/hv9. 0.
Use Form W-9 only if you are a U.S.person(inc uding a resident alien);to
Purpose of Form provide your correct TIN.
An individual or entity(Form W-9 requester)who is required to file an information 1t you do not return Form W-9 to the requester with a TIN,you might be subject LU
return with the IRS must obtain your correct taxpayer identification number(TIN) to backup withholding.See What is backup withholding?on page 2. _
which may be your social security number(SSN),individual taxpayer identification By sigrr:ng the Vied-out form,you: >
number(ITIN),adoption taxpayer identification number(ATIN),or employer 1.Certify
LU
identification number(EIN),to report on an information return the amount paid to that the TIN You are giving is correct(or you are waiting for a number
to be you,or other amount reportable on an information return.Examples of information °sued), ¢
returns include,but are not limited to,the following: 2,Certify that you are not subject to backup withholding..or
•Form 1099-INT(interest earned or paid) 3 Claim exemption from backup withholding 4 you are a U.S.exempt payee.If
•Form 1099-DIV(dividends,including those from stocks or mutual funds) applicable,you are also cert•fying that as a U.S.person,your allocable share of
any partnership income from a U.S.trade or business is not subject to the
•Form 1099-MISC(various types of income,prizes,awards,or gross proceeds) withholding tax on foreign partners'share of effectively connected income,and
•Form 1099-0(stock or mutual fund sales and certain other transactions by 4.Certify that FATCA code(s)entered on this form(I any)indicaVrg that you are
brokers) exempt from the FATCA reporting,is correct.See What fS FATCA importing?on
•Form 1099-5(proceeds from real estate transactions) page 2 for further information.
•Form 1099-K(merchant card and third party network transactions)
Cat,No.10231x Form W-9(Rev.12-2014)
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AC R® CERTIFICATE OF LIABILITY INSURANCE DATEtMMn)DlYYYr)
asloz>2o2o
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements.
PRODUCER CONTACT Steve Greep
Alexander,Greep,&Tate Insurance PNO (954)561=9496 FAX N®; (954)563-1350
2727 E Oakland Park Boulevard 0200 EDrt6r`e steve@alexandergreep.com
INSURERS AFFORDING COVERAGE NAIC A
Fort Lauderdale FL 33306 INSURERA: Covington Specialty Ins Co
INSURED
INSURER a
Carlos A.Alves,Inc. NSURER C:
Carlos Alves and Jane Carroll INSURER D:
1854 SW 9 Street INSURER E: ru
Miami FL 33135 INSURER F: _
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER
l00
INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS O
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �
DISR TYPE OF INSURANCE ADDL SUBR POLICY EFT POLICY EXP
LTR POLICY NUMBER (Mbimmmm LIM"
IX COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 W
CLAIMS-MAOF 9 OCCUR A DAGE TO W70gmma s 100,000 CD
MED EXP one person) S 5,000
A Y N VBA72344000 09/21/2019 09/21/2020 PERSONALaADV NJURY $ 1,000,000 _
MGEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2.000,000POLICY�JECT El LOC PRODUCTS-COMPIOPAGG S 1.000.000S O
OTNER: (,
3 AUTOMOBILE L]AB)LnY COMBIN®D SINGLE LIMIT $
/ 11
ANY AUTO i APPROVED RISK MANAGEME NT BODILY"NJURY(Per Perm) s
OWNED SCHEDULED BODILYI''..NJURY(Peraecident) S �.
AUTOS ONLY AUTOS
HIRED NON-0WNE0 PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY 'de
UMBRELLA LLAB =1L=S4"E
I EACH OCCURRENCE s
#EXCESS LIAR I „._-, AGGREGATE ^$
bE0 RETENTIONS c\J $ (t3
WORKERS COMPENSATION P7A E ®RH•
I AND EMPLOYERS`LIABILITY YIN -- —
ANY PROPRIETOWPARTNERIEXECUTWE ❑ NIA E.:L.EACH ACCIDENT S !U
06
1R.RTKINOF
FICERIMEM.BER EXCLUDED?
andatory fn NHI E.L DISEASE-EA EMPLOYE S U
as � der
OPERATIONS Irebw E.L.DISEASE-POLICY LWI)T S
N
OESCRIPTK)N OF OPERATIONS I LOCATIONS I VEHICLES ACORD 1e1,Additbnel Remarks Schedule, O
{ nsty be altaCNed if more Space is mquknd} �
Monroe County Board of County Commissioners is listed as additional insured.
Re:Marathon Library and Adult Education Center Wall Art O
O
U
O
CERTIFICATE HOLDER CANCELLATION
O
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ¢
Monroe County Board of County Commissioners ACCORDANCE WITH THE POLICY PROVISIONS.
1100 Simonton Street AUTHORIZED REPRESENTATIVE
Key West FL 33040
1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
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2018 Edition
MONROE 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.
ContractorNeador: Carlos A Alves
Project or Service ArtworkCL
Contr '
Address
&Phone
18,54 SW 9 St, Miami, FL 33135
Address&Phone t'F:
305.331.6806
General Scope of Work:
Creating Ceramic Artwork for Marathon Library Wall
Artwork to be made at our studio, then brought tocu
-
Marathon library to be hung W
Reason for Waiver or
Modification:
We bh*H quire workman's d6ffip as we are-tote
primary bu§mess owners arid W-iP nol a inng
additional employees
Policies Waiver or
Modification will apply to:
0
Signature of ContractorNendor.
Date 06/03/2020 Approved X Not Approved
Risk Management Si tore:
06
ai
Date:
County Administrator appeal_
Approved: Not Approved,
ai
Date
Board of County Commissioners appeal:
Approved Not Approved.
ai
Meeting Date:
Administrative lns ction 7500.7
104
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