Item H11 H.11
i�`
County of Monroe
�y,4 ' ?, "tr, BOARD OF COUNTY COMMISSIONERS
Mayor Heather Carruthers,District 3
�1 `_ll Mayor Pro Tem Michelle Coldiron,District 2
The Florida.Keys` )-.�ff` Craig Cates,District 1
David Rice,District 4
w � Sylvia J.Murphy,District 5
County Commission Meeting
November 17, 2020
Agenda Item Number: H.11
Agenda Item Summary #7515
BULK ITEM: Yes DEPARTMENT: Tourist Development Council
TIME APPROXIMATE: STAFF CONTACT: Ammie Machan (305) 296-1552
N/A
AGENDA ITEM WORDING: Approval of an Amendment to Agreement with Friends of the
Pool, Inc. to revise Scope of Services and reduce funding allocation to $20,000.
ITEM BACKGROUND: See attached request from Friends of the Pool, Inc. requesting to revise
the Scope of Service.
DAC IV approved request and a reduction in funding at their meeting of October 6. 2020
TDC approved same at their meeting of October 27, 2020
PREVIOUS RELEVANT BOCC ACTION: BOCC approved original Agreement at their meeting
of October 16, 2019
CONTRACT/AGREEMENT CHANGES:
Amendment to Revise Scope of Services
STAFF RECOMMENDATION: Approval
DOCUMENTATION:
Swim Request, Amendment and Original Agreement
FINANCIAL IMPACT:
Effective Date: October 16, 2019
Expiration Date: November 29, 2020
Total Dollar Value of Contract: $20,000
Total Cost to County: No Cost to County
Current Year Portion: $20,000
Budgeted: Yes
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H.11
Source of Funds: TDC
CPI:
Indirect Costs:
Estimated Ongoing Costs Not Included in above dollar amounts:
Revenue Producing: No If yes, amount:
Grant:
County Match:
Insurance Required: Yes
Additional Details:
11/17/20 120-70030 - TDC SPECIAL EVENTS 120 $20,000.00
REVIEWED BY:
Maxine Pacini Completed 10/30/2020 11:51 AM
Christine Limbert Completed 11/02/2020 1:24 PM
Purchasing Completed 11/02/2020 1:26 PM
Budget and Finance Completed 11/02/2020 1:42 PM
Maria Slavik Completed 11/02/2020 2:05 PM
Liz Yongue Completed 11/03/2020 11:35 AM
Board of County Commissioners Pending 11/17/2020 9:00 AM
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H.11.a
ammie@fla-keys.com
Subject: FW: Swim for Alligator lighthouse revised itinerary
Attachments: Sniplmage.JPG;Alligator Swim ACR Participants 8.25.20.pdf,Alligator Swim ACR STAFF 8.25.20.pdf,
Alligator Swim LAS Participants 8.25.20.pdf, final statement.docx; Re_Swim Alligator Lighthouse
Procedure for Covid19-1_pdf.eml (17.8 KB)
From: Capt Rob <captrobdixon@gmail.com>
Sent:Wednesday, August 26, 2020 2:35 PM
To: ammie@fla-keys.com <adminasst@fla-keys.com>
Subject: Swim for Alligator lighthouse revised itinerary
0
Good afternoon Aimee,
As you know, due to the current circumstances that we are all experiencing, many things are in a constant
state of change. On 8/12 we learned that the Village of Islamorada would not issue a temporary-use permit for _
the swim portion of our event, the Swim for Alligator Lighthouse (see attached). After sending an event
cancellation statement (see attached), to all registrants, we learned that many of our very loyal participants are
keeping their reservations and coming to Keys anyway. As of today, 75% of reservations at the host hotels
remain (see attached). We anticipate the cancellation rate will be similar for swimmers staying at the other E
hotels. Friends of the Pool requests the Monroe County Tourist Development Council consider approving the 2
revised itinerary below for our 2020 event contract in accordance with the decision of the Village of Islamorada
to not permit the swim portion of our 4 day annual event. All phases of our event will be in strict accordance
with current federal, state and Monroe County Covid-19 safety guidelines. We will also be gathering data from
our registrants at hotel check in for the TDC to review. 0
Swim For Alligator Lighthouse 2020 revised itinerary:
9/10 PM....Swimmer meet and greet
9/11 AM....Swim camp with Olympian Jon Olsen
9/11 PM....Swimmers eat, drink and discuss Swim for Alligator Lighthouse 2021
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9/12 AM....Alligator Lighthouse Swim alumni reunion/water activities
9/12 PM....Saturday Swimmer/Family Social
9/13 AM....Farewell brunch
Sincerely,
Rob Dixon, President
Friends of the Pool Inc.
305-664-7149
Virus-free. www.avast.com
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H.11.a
AMENDMENT (JETAMENDMENT) TO AGREEMENT
THIS AMENDMENT to Agreement dated the day of 2020, is
entered into by and between the Board of County Commissioners of Monroe County, a
political subdivision of the state of Florida (County), on behalf of the Tourist
Development Council, and Friends of the Pool, Inc. (Event Contractor)
WHEREAS, there was an Agreement entered into on October 16, 2019 between
the parties, awarding $30,000 to Friends of the Pool, Inc. for the Swim for Alligator E
Lighthouse (Event) in September 2020
WHEREAS, it has become necessary to revise Paragraph 2 outlining Scope of
Services for the Event due to a reduction the scheduled activities due to the COVID-19
pandemic; and -
WHEREAS, due to the reduction in the Scope of Services the funding allocation
has been reduced to $20,000; and
NOW, THEREFORE, in consideration of the mutual convents contained herein
the parties agree to the amended Agreement as follows:
Q
2
1. Paragraph 2 of the Agreement shall be revised to read: Scope of Service: The
Event Contractor agrees to provide the County with an event as specified in the
Scope of Services below (Event):
a) A four (4) day event to include Swimmer meet and greet; Swim Camp with
Olympian; Swimmer evening meetup activity; Reunion; Swimmer/Family
Social; farewell brunch
2. Paragraph 1 of the Agreement shall be revised to read: The County agrees to E
pay $20,000 (Twenty Thousand Dollars - TDC District IV Funding Allocation) for:
Swim for Alligator Lighthouse in September 2020, from tourist development
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tax funds upon receipt of documentation from Event Contractor, on or before the
expiration date of agreement in paragraph 3, that they have met its obligations
under this agreement. Said documentation shall also include samples of the
Event Contractor's marketing program as outlined in their application.
Documentation submitted by Event Contractor will be reviewed and verified by E
the Tourist Development Council (TDC) Administrative Office, at which time,
County shall pay the sum noted above.
3. The remaining provisions of the Agreement dated October 16, 2019 remain in full
force and effect.
Amendment#1
Swim for Alligator Lighthouse
ID#2430
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H.11.a
IN WITNESS WHEREOF, the parties have set their hands and seal on the day and year
first above written.
(SEAL) Board of County Commissioners
Attest: Kevin Madok, Clerk of Monroe County
Deputy Clerk Mayor/Chairman
Friends of the Pool c.
I
Presi ent i
Print Name
Date:
AND TWO WITNESSES
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(2) ' E
Print Name Print Name
;
Date: Date: 2_ cr
MONROE COUNTY ATTORNEY
rt- +,rr� v.�q As To EONJt1rLT�9 �
CHRISTINE LIMBERT-BARROWS (�
ASSISTANT COUNTY ATTORNEY
DATE 10/30/20
Amendment#1
Swim for Alligator Lighthouse
ID#2430
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Turnkey Event Agreement
THIS Agreement is made and entered into by and between Monroe County, Florida, a
political subdivision of the State of Florida (County), and Friends of the Pool, Inc. (Event
Contractor) on this day of OdbbW , 2019.
WITNESSETH:
In consideration of the mutual covenants contained herein the parties agree as follows:
1. Payment: A Turnkey event shall be considered an all-inclusive event where the
Event Contractor has financial responsibility for every facet of the production, promotion and
management of the event. Payment under a contract for a Turnkey event will be made only
after completion of the event and proof that the scope, of services as described below in
paragraph 2 has been completed. If a Turnkey event is delayed or canceled for any reason,
no payment shall be forthcoming, even if the Event Contractor has out-of-pocket expenses
leading up to the actual event. The Tourist Development Council (TDC), therefore, strongly
recommends that the Event Contractor purchase insurance that covers the cancellation or `®
delay of an event due to "force majeure" or unforeseen circumstances (see paragraph 9). --
The County agrees to pay $30,000 (Thirty Thousand Dollars — TDC District IV Funding E
Allocation) for: Swim for Alligator Lighthouse in September 2020, from tourist development 2
tax funds upon receipt of documentation from Event Contractor, on or before the expiration
date of agreement in paragraph 3, that they have met its obligations under this agreement.
Said documentation shall also include samples of the Event Contractor's marketing program _LM
as outlined in their application. Documentation submitted by Event Contractor will be reviewed
and verified by the Tourist Development Council (TDC) Administrative Office, at which time,
County shall pay the sum noted above.
Monroe County's performance and obligation to pay under this contract is contingent
upon an annual appropriation by the County. E
2. Scope of Services: The Event Contractor agrees to provide the County with an event
as specified in the Scope of Services below (Event): Cr
a) A four (4) day event to include opening pool party; warm up swim and safety meeting; _
open water race to Alligator Reef Light House; Awards banquet; and celebration brunch
3. Expiration of Agreement: This agreement expires on November 29, 2020 unless E
the date of the event is amended upon approval of the Advisory Committee and TDC Director
and the County shall not be obligated to pay for any services provided by Event Contractor
under this agreement if documentation as noted above is not received by the TDC
administrative office on or before this reimbursement deadline date.
4. Modification: The event name, time & date of the event and Schedule of
Activities may be amended upon written approval of the Advisory Committee and TDC
Event Name: Swim for Alligator Lighthouse
Turnkey Funding: FY 2020
I D #: 2430
/ , 1
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H.11.a
Director. Any changes to said contract other than stated above require approval by the
Advisory Committee, TDC and the County.
5. Non Occurrence of Event: The Event Contractor shall give written notice to the
TDC if it is found necessary to cancel an event. The notice shall contain the reason for the
cancellation.
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6. Indemnification and Hold Harmless: The Event Contractor covenants and agrees
to indemnify and hold harmless and defend Monroe County, its officers, employees and agents
including the TDC and Visit Florida Keys from any and all claims for bodily injury (including E
death), personal injury and property damage (including property owned by Monroe County)
and any other losses, damages and expenses (including attorney's fees) which arise out of, in E
connection with, or by reason of the services provided by Event Contractor, or other activities
and funding associated with this agreement, except those losses or damages caused by the
negligent or wrongful act or omission of County or its agents. _
7. Non-Waiver of Immunity: Notwithstanding the provisions of Sec. 768.28, Florida
Statutes, the participation of the Event Contractor and the County in this Agreement and the _
acquisition of any commercial liability insurance coverage, self-insurance coverage, or local
government liability insurance pool coverage shall not be deemed a waiver of immunity to the
extent of liability coverage, nor shall any contract entered into by the County be required to
contain any provision for waiver.
8. Claims and Venue: Event Contractor agrees to notify County immediately of any
claims, suits or action made against the Event Contractor that is related to the activity under
CD
this agreement, and will cooperate with County in the investigation arising as a result of any r
action, suit or claim related to this agreement. Any legal proceedings arising out of this
agreement shall be in accordance with the laws of the State of Florida in the 16th Judicial
Circuit for Monroe County; venue shall be in Monroe County, Florida.
9. Insurance Requirements: Event Contractor as a pre-requisite of the Special
Event governed by this agreement shall obtain, at its own expense, insurance as specified in
this section. If a Turnkey event is delayed or canceled for any reason, no payment shall be y
forthcoming, even if the Event Contractor has out-of-pocket expenses leading up to the actual
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event. The TDC, therefore, strongly recommends that the Event Contractor purchase
insurance that covers the cancellation or delay of an event due to "force majeure" or
unforeseen circumstances.
Event Contractor shall furnish the County with a certificate evidencing the
insurance required by this paragraph not later than twenty (20) days prior to the event.
Event Contractor must have their insurance agency email the certificates of insurance
directly to Maria Slavik in the Monroe County Risk Management Department. Slavik-
Maria MonroeCounty-FL.Gov — The email must state that this is a certificate for a TDC
event (state name of event as written within your contract) and should be forwarded to
Ammie Machan at the TDC administrative office. Your certificate must state that the
Monroe County Board of County Commissioners is a "Certificate Holder" and that
Event Name: Swim for Alligator Lighthouse
Turnkey Funding: FY 2020
ID #: 2430
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Monroe County, its employees and officials will be. included as "additional insured". If
you or your insurance agency needs to speak with Maria Slavik regarding the insurance
requirements, she can be contacted by telephone at (305) 295-3178, or by email at the
address stated above.
It is the Event Contractor's responsibility to confirm that the insurance has been
received and approved. You can do this by contacting Ammie Machan at Ammie fla-
keys.com or by calling (305) 296-1552.
Event Contractor will not be permitted to commence work associated with the Event
(including pre-staging of personnel and material) until satisfactory evidence of the required
insurance has been furnished to the County as specified below. Event Contractor shall
maintain the required insurance throughout the entire duration of the Special Event and any
extensions specified in any attached schedules. Failure to comply with this provision may
result in the immediate suspension of the Event until the required insurance has been _
reinstated or replaced. Event Contractor shall provide, to the County, as satisfactory evidence
of the required insurance, either:
Original certificate of Insurance
or
Certified copy of the actual insurance policy
A certified copy of any or all insurance policies required by this contract shall be filed
with the Clerk of the County prior to the Event.
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.
Acceptance and/or approval of Event Contractor's insurance shall not be construed as
relieving Event Contractor from any liability or obligation assumed under this contract or
imposed by law.
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 beCr
approved by Monroe County Risk Management.
Prior to commencement of work governed by this contract, Event Contractor shall ..
obtain General Liability Insurance. Coverage shall be maintained throughout the life of the
contract and include, as a minimum:
Premises Operations
Products and Completed Operations
Blanket Contractual Liability
Personal Injury Liability
Expanded Definition of Property Damage
Event Name: Swim for Alligator Lighthouse
Turnkey Funding: FY 2020
ID #: 2430
3
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H.11.a
The minimum limits acceptable shall be:
$1,000,000.00 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$ 500,000.00 per Person
$1,000,000.00 per Occurrence
$ 100,000.00 Property Damage
An Occurrence Form policy is preferred. If coverage is provided on a Claims Made E
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 E
minimum of twelve (12) months following the acceptance of work by the County. Recognizing
that the work governed by this contract involves the sales and/or distribution of alcoholic
beverages, the Contractor's General Liability Insurance policy shall include Liquor Liability with
limits equal to those of the basic coverage.
0
A separate Liquor Liability policy is acceptable if the coverage is not more restrictive
than the contractor's General Liability policy.
A Workers' Compensation insurance is required by Florida Statutes.
10. Permits: The Event Contractor will secure all required permits, licenses and shall
pay all appropriate business taxes.
11. Laws and Regulations: Any and all services, materials and equipment shall
comply fully with all Local, State and Federal laws and regulations.
12. Taxes: The County and TDC are exempt from Federal Excise and State of
Florida Sales Tax, but this in no way exempts the Event Contractor from applicable Federal
and State taxes.
13. Finance Charges: The County and TDC will not be responsible for any finance
charges.
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14. Relation of County/TDC: It is the intent of the parties hereto that the Event
Contractor shall be legally considered as an independent contractor and that neither it nor its
employees shall, under any circumstances, be considered servants or agents of the County ..
and TDC, and the County and TDC shall at no time be legally responsible for any negligence
on the part of said Event Contractor, its employees or agents, resulting in either bodily or
personal injury or property damage to any individual, firm or corporation.
15. Disclosure: The Event Contractor shall be required to list any or all potential
conflicts of interest, as defined by Florida Statutes Chapter 112 and Monroe County Code.
The Event Contractor shall disclose to the County and TDC all actual or proposed conflicts of
interest, financial or otherwise, direct or indirect, involving any client's interest which may
conflict with the interest of the County and TDC.
Event Name: Swim for Alligator Lighthouse
Turnkey Funding: FY 2020
1 D #: 2430
4
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• H.11.a
16. Assignment: The Event Contractor shall not assign, transfer, convey, sublet or
otherwise dispose of this agreement, or of any or all of its right, title or interest therein, or his or
its power to execute such agreement to any person, company or corporation without prior
consent of the TDC and County.
17. Compliance with Laws - Nondiscrimination: County and Event Contractor agree that
there will be no discrimination against any person, and it is expressly understood that upon a
determination by a court of competent jurisdiction that discrimination has occurred, this
Agreement automatically terminates without any further action on the part of any party,
effective the date of the court order. County or Event Contractor agree 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 LM
-
1686), which prohibits discrimination on the basis of sex; 3) Section 504 of the Rehabilitation
Act of 1973, as amended (20 USC s. 794), which prohibits discrimination on the basis of
handicaps; 4) The Age Discrimination Act of 1975, as amended (42 USC ss. 6101-6107) which _
prohibits discrimination on the basis of age; 5) The Drug Abuse Office and Treatment Act of
1972 (PL 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; 6)
The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation W
Act of 1970 (PL 91-616), as amended, relating to nondiscrimination on the basis of alcohol
abuse or alcoholism; 7) The Public Health Service Act of 1912, ss. 523 and 527 (42 USC ss.
690dd-3 and 290ee-3), as amended, relating to confidentiality of alcohol and drug abuse
patient records; 8) Title VIII of the Civil Rights Act of 1968 (42 USC ss. 3601 et seq.), as
amended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The
Americans with Disabilities Act of 1990 (42 USC s. 12101 Note), as maybe amended from time
to time, relating to nondiscrimination on the basis of disability; 10) Monroe County Code
Chapter 14, Article II, which prohibits discrimination on the basis of race, color, sex, religion,
national origin, ancestry, sexual orientation, gender identity or expression, familial status or
age; 11) any other nondiscrimination provisions in any Federal or state statutes which may
apply to the parties to, or the subject matter of, this Agreement.
18. Security Protection: The Event Contractor agrees to provide adequate security
for the event. Cr
19. Ethics Clause: The Event Contractor warrants that it has not employed, retained or otherwise had act on its behalf, any former County office 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 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.
20. Media Rights: The TDC shall have the right under this agreement to broadcast
or rebroadcast, for any purpose whatsoever, radio, television, sound, video or film production,
Event Name: Swim for Alligator Lighthouse
Turnkey Funding: FY 2020
I D#: 2430
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and still photographs, paid by the TDC and County, and produced by the TDC agencies of
record.
21. Logo: Marketing promotions that display our logo must use the "The Florida
Keys - Islamorada" logo/trademark (as per attached logo sample — Exhibit A). Electronic
format (eps or jpg file) of the appropriate logo may be obtained by contacting Danielle Salman
or John Underwood with Tinsley Advertising at 305-856-6060.
22. Severability: If any provision of this agreement shall be held by a court of
competent jurisdiction to be invalid or unenforceable, the remaining provisions shall not be E
affected thereby; and each provision of this agreement shall be valid and enforceable to the
fullest extent permitted by law. E
23. Authority: Each of the signatories for the Event Contractor below certifies and
warrants that: a) the Event Contractor's name in the agreement is the full name of the LM
person/entity or corporation as designated in its corporate charter, and b) they are empowered
to act and execute the agreement for the Event Contractor and c) this agreement has been
approved by the Event Contractor's governing board, as applicable to corporations.
24. Public Entities Crimes: A person or affiliate who has been placed on the
convicted vendor list following a conviction for public entity crime may not submit a bid on a W
contract to provide any goods or services to a public entity, may not submit a bid on a contract
with a public entity for the construction or repair of a public building or public work, may not
submit bids on leases of real property to public entity, may not be awarded or perform work as
a contractor, supplier, subcontractor or consultant under a contract with any public entity and
may not transact business with any public entity in excess of the threshold amount provided in
Section 287.017, for category two for a period of 36 months from the date of being placed on
the convicted vendor list.
25. Governing LawNenue: This agreement shall be governed by and construed in
accordance with the laws of the State of Florida applicable to contracts made and to be
performed entirely in the State. In the event that any cause of action or administrative
proceeding is instituted for the enforcement or interpretation of the agreement, the County and y
Event Contractor agree that venue shall lie in the appropriate court or before the appropriate
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administrative body in Monroe County, Florida. This agreement shall not be subject to
arbitration.
26. Accountinq and Records: Event Contractor shall maintain records pursuant to ..
generally accepted accounting principles for four (4) years after the event and shall permit
County and its agents and employees access to said records at reasonable times.
27. Notice: Any notice required or permitted under this agreement shall be in writing
and hand delivered or mailed, postage prepaid, to the other party by certified mail, returned
receipt requested to the following:
Event Name: Swim for Alligator Lighthouse
Turnkey Funding: FY 2020
ID #: 2430
6 Packet Pg. 1659
H.11.a
For Grantee: Rob Dixon
Friends of the Pool, Inc.
217 Matecumbe Ave.
Islamorada, FL 33036
For Grantor: Maxine Pacini
Monroe County Tourist Development Council
1201 White Street, Suite 102
Key West, FL 33040
And
Christine Limbert-Barrows, Asst. County Attorney
P.O. Box 1026
Key West, FL 33041-1026 _
28. Breach and Penalties: The parties agree to full performance of the covenants
contained in this agreement, and the County reserves the right at its discretion, provided such
breach is material, to terminate this agreement for any misfeasance, malfeasance or
nonperformance of the agreement terms or negligent performance of the agreement terms by
the Event Contractor.
29. Termination of Agreement: County may terminate this agreement without cause
by providing written notice to Event Contractor, through its officer, agent or representative, no
less than sixty (60) days prior to the event and may terminate for breach upon providing to
Event Contractor, through its officer, agent or representative, written notice at least seven (7)
days prior to the effective date of the termination. Notice is deemed received by Event
Contractor when hand delivered, delivered by national courier with proof of delivery, or by U.S.
mail upon verified receipt or upon the date of refusal or non-acceptance of delivery.
30. Miscellaneous: As used herein, the terms "contract" and "agreement" shall be
read interchangeably.
31. Entire Agreement: The parties agree that the agreement above constitutes the
entire agreement between the County and Event Contractor. Cr
Event Name: Swim for Alligator Lighthouse
Turnkey Funding: FY 2020
ID #: 2430
7
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H.11.a
HEREOF, the parties hereto have executed this agreement the day and year
41
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of Monroe Count
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MONROE COUNTY ATTORNEY
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CMSTINE LIMBERT-BARROWS
ASSISTANT C ATT RNEY
DATE: l
Event Name: Swim for Alligator Lighthouse
Turnkey Funding: FY 2020
ID#: 2430
8
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EXHIBIT A
Color ads four (4) color processing printing
Black &white ads shall include the appropriate generic or district logo in high resolution
TV: logo must appear at the conclusion of commercial
Radio Advertising: No logo is required. All radio announcements must say "Brought to you
by the Monroe County Tourist Development Council." E
2
Marketing promotions that display our logo must use the "The Florida Keys - Islamorada" ®_
logo/trademark. Electronic format (eps or jpg file) of the appropriate logo may be obtained by
contacting Danielle Salman or John Underwood with Tinsley Advertising at 305-856-6060.
The Florida Keys0
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Event Name: Swim for Alligator Lighthouse
Turnkey Funding: FY 2020
ID #: 2430
9
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101 i rmcn
INSURANCE CHECKLIST FOR VENDORS SUBMITTING PROPOSALS OR BIDS
FOR WORK
To assist in the development of your proposal, the insurance coverages marked with an "X" will
be required in the event an award is made to your firm.Please review this form with your insurance
agent and have him/her sign it in the place provided. It is also required that the bidder sign the
requiste form reflecting coverage and submit it with the proposal. E
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
Workers' Compensation Statutory Limits
0
Bodily Injury by Accident/Bodily
Injury by Disease, policy W
limits/Bodily Injury by Disease
each employee
WCI Employers Liability $100,000/$500,000/$100,000
WC2 Employers Liability $500,000/$500,000/$500,000 76
WC3 Employers Liability $.1,000,000/$1,000,000/$1,000,000
WCUSLH US Longshoremen& $1,000,000
Harbor Workers Act
WCJA Federal Jones Act $1,000,000 rr
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Adminislralim Inslruclion 7500.7
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H.11.a
2018 Edilion
GENERAL LIABILITY
As a minimum,the required general liability coverages will include:
Premises Operations Products and Completed Operations
• Blanket Contractual Personal Injury
Required Limits: a,
GLI $300,000 Combined Single Limit
GL2 $500,000 Combined Single Limit
0
$1,600,000 Combined Single Limit _
GL4 $2,000,000 Combined Single Limit
GLS $3,000,000 Combined Single Limit _
GL6 $4,000,000 Combined Single Limit
GL7 $5,000,000 Combined Single Limit
CD
Required Endorsement:
GLLIQ Liquor Liability
GLS Security Services
All endorsements are required to have the same limits as the basic policy.
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INSCKLST
Administrative Instruction 7500.7
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2018 Edition
BUSINESS AUTOMOBILE LIABILITY
As a minimum,coverage should extend to liability for:
• Owned; Non-owned; and Hired Vehicles
Required Limits:
VLl $50,000 per Person:$100,000 per Occurrence
$25,000 Property Damage w
Or
$100,000 Combined Single Limit
(The use of VLI should be limited to special projects that involve
other governmental entities or"Not for Profit"organizations. Risk
Management must approve the use of this form).
VL2 $200,000 per Person; $300,000 per Occurrence
$200,000 Property Damage _
or
$300,000 Combined Single Limit --
VL3 $500,000 per Person; $1,000,000 per Occurrence
$100,000 Property Damage
or
$1,000,000 Combined Single Limit
VL4 $5,000,000 Combined Single Limit
MISCELLANEOUS COVERAGES
BRl Builders' Limits equal to the
Risk Full Replacement Value of the completed
project.
CLI Cyber Liability $1,000,000
MVC Motor Truck Limits equal to the maximum y
Cargo value of any one shipment.
rr
PRO I Professional $ 300,000 per Occurrence.$ 500,000 Agg. °'
PR02 Liability $ 500,000 per Occurrence/$1,000,000 Agg.
PR03 $1,000,000 per Occurrencei$2,000,000 Agg.
POLI Pollution $ 500,000 per Occurrence/$(,000,000 Agg.
POL2 Liability $1,000,000 per Occurrence/$2,000,000 Agg.
POL3 $3,000,000 per Occurreiice/$6,000,000 Agg.
POLO $5,000,000 per Occurrence/$10,000,000 Agg.
EDt Employee $ 10,000
ED2 Dishonesty $100,000
GKl Garage $ 300,000 ($ 25,000 per Vehicle)
GK2 Keepers $ 500,000($100,000 per Vehicle)
GK3 $1,000,000 ($250,000 per Vehicle)
Administrative Instruction 7500.7
8
Packet Pg. 1665
2018 Editb n
MEDI Medical $ 300,0001$ 750,000 Agg.
MED2 Professional $ 500,000/$ 1,000,000 Agg.
MED3 $1,000,000/$ 3,000,000 Agg.
MED4 $5,000,000410,000,000 Agg.
IF Installation Maximum value of Equipment
Floater Installed
VLPI Hazardous $ 300,000 (Requires MCS-90)
VLP2 Cargo $ 500,000(Requires MCS-90)
VLP3 Transporter $1,000,000 (Requires MCS-90)
BLL Bailee Liab. Maximum Value of County Property that
will be in the Bailee's posession.
HK.LI Hangar keepers $ 300,000
HK.L2 Liability $ 500,000
HK.L3 $ 1,060,000 _
HK.L4 $ 5,000,000
AIRI Aircraft $ 1,000,000
AIR2 Liability $ 5,000,000
AIR3 $50,000,600
AE01 Architects Errors $ 250,000 per Occurrence/$ 500,000 Agg.
AE02 & Omissions $ 500,000 per Occurrencel$1,000,000 Agg.
AE03 $ 1,000,000 per Occurrence/$3,000,000 Agg. 76
AE04 $ 3,000,000 per Occurrencel$5,000,000 Agg.
ARP All Risk Property Full Replacement Value ofStmcture
EOJ Engineers Errors $ 250,000 per Occurrence/$ 500,000 Agg. `e
E02 & Omissions $ 500,000 per Occurrence/$1,000,000 Agg.
E03 $ I,000,000 per Occurrence/$2,000,000 Agg.
E 0 4 $ 5,000,000 per Occurrence/$!0,000,000 Agg.
WLl Water Craft $ 500,000 per Occurrence
m
WL2 Liability $ 1,000,000 per Occurrence r
U
Administrative Instruction 7500.7
9
Packet Pg. 1666
2111S Ldiun�:
INSURANCE. AGENT'S STATEMEN"r
I have reviewed the above requirements x%ith the bidder named below.The 1•ollowing deductibles
apply to the corresponding policy
Policy Deductibles
#SRPGAPML-101-0719 None
Certificate#:USP295591
0
Liability policies are _® Occurrence ❑Claims Made
Hamman-Miller-Beauchamp-Deeble,Inc. - s 08/14/2019
Insurance Agency Signature E
CD
BIDDERS
STATEMENT
[ understand the insurance that will be mandatot•v ' warded th contr ct and
will comply in full with all the requirement
C4— ice► ti
Bicldl:is 'Name and Tit e S,V)MM11
Company Nan1e: -`"' -1� t �_ -
\dmindr.lice inlnirlinn "gun-
Packet Pg. 1667