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Item C05 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: Mav 16-17.2001 Bulk Item: Yes ~ No Division: Public Safety Department: Medical Examiner AGENDA ITEM WORDING: Approval of Agreement between Monroe County Board of County Commissioners and Zhiming Li, MD, to serve as Interim District Sixteen Medical Examiner ITEM BACKGROUND: Dr. Robert Nelms, MD, resigned his position of District Sixteen Medical Examiner, effective June I, 200 I. A Search Committee has been formed to seek qualified candidates to fill the position. This agreement with Dr. Li provides for him to serve as Interim Medical Examiner until the candidates are interviewed and the Governor formally appoints a District Sixteen Medical Examiner. PREVIOUS RELEVANT BOCC ACTION: On September 20,2000, the Board approved a one year agreement with Robert Nelms, Jr. for medical examiner services, through September 30, 2001. CONTRACT/AGREEMENT CHANGES: This is the same agreement that was in effect with Dr. . Nelms, except the pro rata payments will be processed weekly instead of monthly. STAFF RECOMMENDATION: Approval TOTAL COST: $97.056.72 (balance of contractual amount BUDGETED: Yes ~ No budgeted for agreement with Dr. Nelms through 9/30/01) COST TO COUNTY: $97,056.72 REVENUE PRODUCING: Yes No ---X- AMOUNT PER MONTH APPROVED BY: County Attorney YES 0 Risk Management YES DOCUMENTATION: Included:-X DISPOSITION: James R. "Reggie" Paros To Follow: _ Not ReqUired:I~~ Agenda Item #: ~ DIVISION DIRECTOR APPROVAL: APR-30-01 SUN 12:29 PM STATE ATTORNEY PK FAX NO. 3058527349 P. 02 MARK E. KOHL State Attorney c;W~ ~ SIXTEENTH JUDICIAL CIRCUIT OF FLORIDA 530 WHITEHEAD STREET KEY WEST. FLORIDA 33040-6547 TELEPHONE 305-292-3400 April 26, 2001 Dr, Zhiming Li Fisherman's Hospital Marathon, Florida 33050 Dear Dr. Li: As you are aware, Dr, Robert Nelms has tendered his resignation as Medical Examiner for the Sixteenth Circuit effective June 1,2001, The search committee for a new Medical Examiner has . not yet had the opportunity to consider candidates for the position of Medical Examiner. . r have been made aware of the sacrific~s you have made to serve this county as Associate Medical Examiner under Dr. Nelms. On behalf of Monroe County I wish to extend my gratitude, Therefore, it is my pleasure to request that you accept appointment as interim Medical Examiner for the SIxteenth Circuit, effective June 1, 2001, pending appointment of a pennanent Medical Examiner. Please notify me as soon as possible regarding your acceptance of this appointment. Thank you for your consideration. Sincerely, 4' ~(1 . Mark E. Kohl State Attorney ........ --' 08/04/1994 05:16 Mark F" Kohl State Attorney Dear Mr. Kohl. 7439017 MED EXAMINR Orf'IC~ or Tim M~DICAL EXAMIrmR DISTRICT SIXTeeN - MONRoe COUNTY FISHERMEN'S HOSPITAL. MARATHON. FLORIDA 33050 TELEPHONE 305-143-5533 EXT. 691 JY\~ I) 2.001 It is with gf(~at pleasure that I accept the position of Interim Medical Examiner for District 16, Monr()~ County Medical Examiner's Office, ~ ---&".; l\ ~ Zhiming Li, M.D, PAGE 01 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract # Contract with: Zhiming Li, MD Effective Date: June 1. 2001 Expiration Date: Upon appointment of Medical Examiner Contract Purpose/Description: Interim Medical Examiner services Contract Manager: James R. Paros (Name) 6002 (Ext. ) Public Safety (Department) for BOCC meeting on Mav 16 2001 Agenda Deadline: Mav 2 2001 CONTRACT COSTS Total Dollar Value of Contract: $291,170.00 Current Year Portion: $97,056.64 Budgeted? Yes!;gl No D Account Codes: 68000-530340 -_-_ Grant: $ _-_-_-_ County Match: $ _-_-_-_ - - - ---- ADDITIONAL COSTS Estimated Ongoing Costs: $_/yr For: (Not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, etc.) CONTRACT REVIEW Changes ~ ~f%te Out ~t Needed .. . lewer 511l1t>o/ Division Director --5/~/ Y esO NO~ .- Risk Managmnt ,4; l u. \ 0 \ YesO NO~ a, LJ""T---L-~~~"'- j ~~ 0\ ~~4-3'rtJ' YeSONo~~(J~O I~/ County Attorney q.Po/lf YesO NoD" ,C; fJ~ '1/70'/ Comments: OMB Form Revised 9/11195 MCP #2 AGREEMENT TillS AGREEMENT entered this day of , 2001, between the BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA (hereinafter "County"), 5100 College Road, Key West, Fl. 33040, and Zhiming Li, MD, Interim Medical Examiner, District Sixteen (Monroe County), (hereinafter "Interim Medical Examiner"), appointed by the Governor of the State of Florida. WHEREAS, Chapter 406, FS establishes Medical Examiner Districts, now, therefore, IN CONSIDERATION of the mutual covenants below: 1. CONTRACT PERIOD. This agreement is for the period June 1. 2001, through September 30. 2001. 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, paragraph 13 below. 2. SCOPE OF AGREEMENT. Interim Medical Examiner shall provide the work plan and services as described in detail in Exhibit A, an attachment to this document, which Exhibit is incorporated herein by reference. 3. AMOUNT OF AGREEMENT/PAYMENT. County shall appropriate funds for the Medical Examiner's Budget. County shall make payments in accordance with the budget for County fiscal year ending September 30,2001, which budget is attached hereto as Exhibit B and incorporated herein by reference, upon its approval by County. County has the authority, under FS 406.06(3), to establish reasonable salary, fees and other costs as are necessary for the operation of the Interim Medical Examiner's office. The Medical Examiner's Budget is intended to cover the anticipated normal activities/work load of the Interim Medical Examiner based upon past statistics and reasonable projections, and shall be disbursed through pro rata weekly payments. Reimbursement for use of cellular phones shall be made only for those phone calls which are documented as relating to Interim Medical Examiner activities. In the event of a disaster or occurrence ',unusual in nature or magnitude, the Interim Medical Examiner shall petition the Board of County Commissioners for reimbursement of all extraordinary expenses and compensation due to the disaster. The Interim Medical Examiner shall develop a schedule of reasonable ~d customary fees which shall be charged to third parties for specific services. Revenue received from the collection of such fees shall be retained and accounted for by the Interim Medical Examiner and used for operating expenses, thus reducing the overall level of County funding required for Interim Medical Examiner activities. 4. ACCOUNTING AND RECORDS. The Interim Medical Examiner shall keep logs of cellular telephone calls, denoting which calls to relate to Interim Medical Examiner activities and which calls do not. Records of Interim Medical Examiner pertaining to this Agreement shall be kept on generally recognized accounting principles, and shall be available to the County or to an authorized representative of County, FDLE and the Auditor General for audit. Both parties shall maintain such records as are necessary to account for state funds disbursed by the Medical Examiners Commission. All records related to this Agreement shall be kept for a minimum of three years subsequent to the termination of this Agreement. Interim Medical Examiner shall be responsible for repayment of any and all audit exceptions identified by County or its agents or representatives. In the event of an audit exception, the County's obligation under this Agreement shall be reduced if the exception is ascertained prior to the tennination of this Agreement. In the event there are insufficient moneys due to Interim Medical Examiner at the time of identification and notice thereof to Interim Medical Examiner to cover the amount of audit exception or the Agreement has tenninated, Interim Medical Examiner shall reimburse County for the amount of the audit exception. County shall provide the Medical Examiners Commission with the County Annual Expenditure Report, identifying total funds expended or encumbered and budgeted, for Medical Examiner services during the current County fiscal year (forms to be provided by Commission); a copy of the budget adopted by County for Medical Examiner for FYE September 30,2001, and a copy of any Medical Examiner Office financial audit report prepared for County. 2 5. MODIFICATIONS AND AMENDMENTS. Any and all modifications and amendments of this agreement shall be approved by the County and Interim Medical Examiner in writing. No modification or amendment shall become effective until approved in writing by both parties. 6. ASSIGNMENT. Interim Medical Examiner shall not assign this agreement, except in writing and with the prior written approval of County, which approval shall be subject to such conditions and provisions as County may deem necessary. This agreement shall be incorporated by reference into any assignment and any assignee shall comply with all of the provisions herein, unless expressly provided otherwise in an amendment authorizing such assignment. Unless expressly provided for therein, such approval shall in no manner or event be deemed to impose any obligation upon either party in addition to the covenants and promises contained herein. 7. INDEMNIFICATION. Interim Medical Examiner hereby agrees to indemnifY and hold harmless the County and any of its 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 (collectively the "Claims") arising directly or indirectly from any negligence or criminal conduct on the part of Interim Medical Examiner in the performance of the terms of this Agreement except to the extent that, in the case of aily act of negligence, Interim Medical Examiner reasonably relied on material supplied by, or any employee of, the County. Interim Medical Examiner shall immediately give notice to County, by certified mail to the Mayor of County, of any suit, claim or action against Interim Medical Examiner that is related to the activity under this contract and will cooperate with County in any investigation arising as a result of any suit, action or claim related to this contract. 8. ANTI-DISCRIMINA TION. Interim Medical Examiner will not discriminate against any person on the basis of race, creed, color, religion, sex, age, national origin, physical handicap, or any other characteristic which is not job-related, in its recruiting, hiring, promoting, terminating or any other area affecting employment under this Agreement. Interim Medical Examiner agrees to include this paragraph in all 3 contracts it enters into with other persons or entities and to abide by all Federal and State laws regarding non-discrimination, including but not limited to, Titles VI and VII of the Civil Rights Act of 1964 (42 USC 2000d), Executive Order 11246, Executive Order 11375 and U.S. Department of Labor Regulations (42 CFR Part 60). 9. ANTI-KICKBACK. Interim Medical Examiner warrants that he has not employed, retained or otherwise had acted on his behalf any former county officer subject to the prohibition in Section 2 of Ordinance No. 10-1990 or any county officer or employee in violation of Section 3 of Ordinance No. 10-1990, and that no employee or officer of the County has any interest, financially or otherwise, in Interim Medical Examiner except for such interests permissible by law and fully disclosed by affidavit attached hereto. For breach or violation of this paragraph, the County may, in its discretion, terminate this Agreement without liability and may also, in its discretion, deduct from the contract or purchase price, or otherwise recover, the full amount of any fee, commission, percentage, gift, or consideration paid to the former county officer or employee. 10. PUBLIC ENTITY CRIME. A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work:, may not submit bids on leases of real property to public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, any may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, fot CATEGORY TWO for a period of36 months from the date of being placed on the convicted vendor list. 11. COMPLIANCE WITH LAW. Interim Medical Examiner shall comply with all federal, state, and local laws, ordinances, regulations and rules applicable to the services to be performed by each party under the terms of this Agreement. Interim Medical Examiner shall maintain such licensure as is required by law to cany out the services in this Agreement. 12. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, Interim Medical Examiner is an independent contractor and not an employee, 4 agent or servant of the County or of the Florid~ Department of Law Enforcement. No statement in this Agreement shall be construed so as to find Interim Medical Examiner or any of its employees, contractors, servants, or agents to be employees of the County or State, and they shall be entitled to none of the rights, privileges, or benefits of e!l1ployees of County or State. The Interim Medical Examiner may subcontract for services as deemed necessary and shall be ultimately responsible legally, operationally, and financially for any such subcontracts. 13. TERMINATION FOR CAUSE OR LACK OF FUNDS AND NON-WAIVER. A. If Interim Medical Examiner fails to fulfill the terms of this Agreement, or attachments, properly or on time, or otherwise violates the provisions of the Agreement or of applicable laws or regulations governing the use of funds, County may terminate the Agreement by written notice of sixty days, which notice shall specify cause. All finished or unfinished supplies or services compensated under this Agreement shall, at the option of County or pursuant to state statute become property of County. The County shall pay Interim Medical Examiner fair and equitable compensation for expenses incurred prior to termination of the Agreement, less any amount of damages caused by Interim Medical Examiner's breach. If the damages are more than compensation payable, Interim Medical Examiner will remain liable after termination and County can affirmatively collect damages. : B. In the event that the Governor appoints a successor to the Interim Medical Examiner named herein, this Agreement shall terminate on the day prior to the effective date of such successor's appointment. C. In the event that funds from County cannot be continued at a level sufficient to allow for the purchase of services specified herein, this Agreement may be terminated upon giving written notice of thirty days to Interim Medical Examiner delivered in person or by mail to Interim Medical Examiner. D. The County shall not be obligated to pay for any services or goods provided by Interim Medical Examiner after the effective date of termination. E. Any waiver of any breach of covenants herein contained to be kept and performed by Interim Medical Examiner shall not be deemed or considered as a 5 continuing waiver and shall not operate to bar or prevent County from declaring a forfeiture for any succeeding breach either of the same conditions or covenants or otherwise. 14. INSURANCE. County shall provide insurance for Interim Medical Examiner in compliance with FS 406.16. 15. SEVERABILITY. If any provision of the Agreement shall be held by a court of competent jurisdiction to be invalid or unenforceable, the remainder of this Agreement or the application of such provision other than those as to which it is invalid or unenforceable, shall not be effected thereby; and each provision of the Agreement shall be valid and enforceable to the fullest extent permitted by law. 16. NOTICE. Unless specifically provided otherwise in this Agreement, any notice required or permitted under this Agreement shall be in writing and hand-delivered or mailed, postage prepaid by certified mail, return receipt requested, to the other party as follows: To County: County Administrator Public Service Building 5100 College Road, Stock Island Key West, Fl. 33040 (305) 292-4441 To Interim Medical Examiner: Zhiming Li, M.D. Fishermen's Hospital 3301 Overseas Highway Marathon, Fl. 33050 17. 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 a proper venue for any action shall be Monroe County. 18. REPORTS. Interim Medical Examiner shall develop a record-keeping system which can be used to provide County with a monthly report, which shall be submitted on a monthly basis and begin no later than a report for the month of June 1, 2001, and which shall include, as a minimum the following: A. Number of all investigations. B. Number of all autopsies performed. 6 C. Number of authorizations for all cremations and burials at sea and anatomical dissections. The activity report shall be submitted by the 10th day of the following month to the County Administrator. 19. 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 Interim Medical Examiner and the County. 20. FDLE. The Florida Department of Law Enforcement shall not be deemed to assume any liability for the acts, omissions to act, or negligence of the County or the Interim Medical Examiner, their agents, servants and employees; nor shall County or Interim Medical Examiner exclude its own negligence to FDLE or any third party. IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the date first above written. (SEAL) BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA Attest: DANNY L. KOLHAGE, CLERK By Mayor/Chainnan By Deputy Clerk INTERIM MEDICAL EXAMINER J,",\..\ L.' .~~ ~f)uJhL Wi s 7 EXHIBIT A SERVICES TO BE PROVIDED BY INTERIM MEDICAL EXAMINER This Exhibit, incorporated into the Agreement between County and Interim Medical Examiner, on the day of , 2001, sets forth the services to be provided by Interim Medical Examiner pursuant to paragraph 2 thereof The Interim District Medical Examiner agrees to fulfill his duties as set forth in Chapter 406, FS and rules promulgated by the Medical Examiners Commission as follows: A. OFFICE 1. The Office of the Interim Medical Examiner shall be established and maintained in such a manner that it provides for the necessary facilities and personnel to accomplish its duties and responsibilities. 2. The Office shall be an independent agency. B. APPOINTMENT 1. The Interim Medical Examiner shall be appointed by the Governor of the State of Florida. 2. The Interim Medical Examiner shall name and appoint quaIified professional, technical, clerical and other staff of the Office. The staff shall be directly responsible to the Interim Medical Examiner, and shall include associate medical examiners, secretary, forensic investigator(s), diener, custodian, histotechnologist, et cetera. C. INVESTIGATION OF DEATH The Interim Medical Examiner or his appointed associate medical examiners shall have the authority and responsibility: 1. To investigate and certify any death that falls in the following categories: a. Criminal violence suspected b. Suicide c. Accidental (motor vehicle, boating, aircraft, diving, snorkeling, swimming, electrocution, et cetera) d. Suddenly when in apparent good health e. Unattended by a practicing physician (over 30 days) f Suspicious or unusual circumstances g. Gunshot h. Sudden infant death syndrome (SillS) 1. Suspected poisoning j. Drowning k. Abortion I. In prison or police custody m. In state institution 8 n. Diseases constituting a .threat to public health o. Disease, injury, or toxic' agent resulting from employment p. Unexpected death associated with diagnostic or therapeutic procedure q. When body is to be cremated, dissected or buried at sea r. Unclaimed bodies s. When a dead body is brought into a new medicolegal jurisdiction without proper medical certification 2. To take charge of the dead body upon direct notification of such death. He or his duly authorized associate medical examiner or forensic investigator shall respond to the scene upon request by proper authorities whenever possible and appropriate. The dead body shall not be disturbed unless permission is granted by the Interim Medical Examiner or his designee. 3. To conduct an investigation of circumstances surrounding the death in conjunction with proper authorities. 4. To conduct all necessary examinations of the dead body which could include performance of any autopsy and retention of whatever tissues and biological specimens that he deems are necessary. 5. To take possession of any object or article which, in his opinion, may be useful in establishing the identify of the deceased and/or the cause and manner of death. 6. To reduce his investigation and findings in writing and shall keep such records in his Office. 7. To administer oath and have the power of subpoena. D. SPECIFIC TASKS In order to effect above general requirements, the specific duties itemized below describe in greater detail how duties are accomplished and the responses to be made. 1. Answering telephone a. Mode - telephone, digital pager, cellular telephone, radio b. Source of calls - Police, Sheriff, Navy, FBI, Highway Patrol, National Forestry or Park Service, Coast Guard, NTSB, FAA, funeral homes, family or acquaintances of deceased, attorneys, insurance companies, private investigators, newspaper reporters, TV or radio reporters, physicians, nurses, et cetera. 9 c. Nature of calls 1. Request for oral infoImation - toxicology results, cause of death, mechanism of death, et cetera 2. Request for written information or reports - autopsies, statistical reports, death certificates, et cetera 3. Questions about previous cases 4. Requests for immediate scene investigations 5. Notification of deaths 6. Cremation, dissection, or burial at sea approvals 7. Scheduling depositions 8. Electronic depositions 9. Request for testimony as expert witness in court 10. Other questions or considerations 2. Interim District Medical Examiner shall initiate such phone calls as are necessary to carty out his duties, including but not limited to the following: a. To whom: 1. Law enforcement agencies 2. Funeral homes 3. Witnesses, family, friends 4. Personal physicians or dentists 5. Attorneys 6. Others b. Nature of calls 1. Case investigations 2. Scheduling exams or autopsies 3. Answering digital pager 4. Returning phone messages 5. Calling secretary for information 6. Changing appointment times 7. Calling for toxicology results past due 3. Subpoenas a. Received at Office b. If conflicts in scheduling, would necessitate phone calls to reschedule 4. Automobile travel a. Scene investigations - up to 60 miles distant, one way, immediate response always requested, day or night, seven days a week - performed by Interim Medical Examiner, associate medical examiner, or forensic investigator appointed by Interim Medical Examiner. b. Autopsies usually scheduled within 24 hours, may be 50 miles away where performed 10 c. Florida Association of Medical Examiners (FAME) Conferences - usually at least once annually, in Florida, 50- 300 miles one way d. Depositions e. Court trial witnessing, usually 40-50 miles each way f Grand Jury, usually 50 miles each way, usually less than one week's notice 5. Autopsies/Examinations a. Time 2-4 hours, not counting travel, for autopsy, 1/2 to 1 hour for post mortem examination b. X-rays, sometimes taken by Interim Medical Examiner c. Photographs d. Collection of toxicology specimens, and/or esoteric tests (DNA probes) e. Gathering of some trace evidence - fluids, hair, particles, clothing, jewelry, et cetera f Preparation of bones and teeth for anthropological studies g. Microscopic examination after preparation by histotechnologist h. Collection of insects at scene to better estimate post mortem interval 6. Generation of reports a. Handwritten 1. Labeling tubes, photographs and x-rays 2. Notes during autopsy 3. Notes during telephone conversations 4. Correspondence 5. Preparing rough drafts on statistical reports, correspondence, contracts, et cetera 6. Keeping case log 7, Keeping cremation log 8. Completing death certificates 9. Budgets 10. Cellular telephone logs 11. Other reports requested b. Dictated 1. Autopsies, some postmortem exams 2. Some correspondence 3. Some statistical reports 4. Rules and regulations 5. Review laboratory examinations and prepare reports 6. Contracts 7. Other reports 11 c. Typing - usually by computer with word processor, e.g., county burial letters, appointment letters, new call schedules, et cetera 7. Depositions a. Some electronically (by telephone) b. Some in attorney's office, clerical or electronic c. Frequently travel 50 miles each way d. Grand Jury 8. Witness in Court a. Location - usually 50 miles each way b. Duration - 4 hours up to 3 days portal to portal c. Preparation of testimony - 2-6 hours minimum 9. Arrange transportation of bodies 10. Provide professional consultations 11. Prepare and present materials for teaching/public presentations 12. Counsel families 13. Continuing education - ASCP Check Samples, conferences - 20 hours per year generally required. 12 EXHIBIT B MONROE COUNTY Date: 1012512000 BOARD OF COUNTY COMMISSIONERS OlflceofManegmentand BUdgel APPROPRIATION DETAIL BY OFFICIAUDIVISION, DEPARTMENT, COST CENTER . ._....... -... Ofel/Div: MEDICAL EXAMINER Department: Medical Examiner Cost Center/Fund 68000 /001 MEDICAL EXAMINER Adopted 01 INCJ(DEC) % Change Adopted 00 Actual 99 Adopted 99 Operating Expenditures 530340 OTHER CONTRACTUAL SERVICE 291,170 0 0.0% 291,170 285,460 285,460 530440 RENTALS AND LEASES 15,597 5,380 52.7% 10,217 7,800 9,000 530451 RISK MANAGEMENT CHARGES 3,124 0 0.0% 3,124 3,004 3,004 Sub-total Operating Expenditures 309,891 5,380 1.8% 304,511 296,264 297,464 Cost Center Total MEDICAL EXAMINER 309.891 5,380 1.8% 304.511 296,264 297,464 Page 337 AGREEMENT THIS AGREEMENT entered this day of . 2001, between the BOARD OF COUNTY COl\1MISSIONERS OF MONROE COUNTY, FLORIDA (hereinafter "County"), 5100 College Road, Key West, Fl. 33040, and Zhiming Li,:MD, Interim Medical Examiner, District Sixteen (Monroe County), (hereinafter "Interim Medical Examiner"), appointed by the Governor of the State of Florida. WHEREAS, Chapter 406, FS establishes Medical Examiner Districts, now, therefore, IN CONSIDERATION of the mutual covenants below: 1. CONTRACT PERIOD. This agreement is for the period June 1. 2001, through. September 30.2001. 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, paragraph 13 below. 2. SCOPE OF AGREEMENT. Interim Medical Examiner shall provide the work plan and services as described in detail in Exhibit A, an attachment to this document, which Exhibit is incorporated herein by reference. 3. AMOUNT OF AGREEMENTIPAYMENT. County shall appropriate funds for the Medical Examiner's Budget. County shall make payments in accordance with the budget for County fiscal year ending September 30,2001, which budget is attached hereto as Exhibit B and incorporated herein by reference, upon its approval by County. County has the authority, under FS 406.06(3), to establish reasonable salary, fees and other costs as are necessary for the operation of the Interim Medical Examiner's office. The Medical Examiner's Budget is intended to cover the anticipated normal activities/work load of the Interim Medical Examiner based upon past statistics and reasonable projections, and shall be disbursed through pro rata weekly payments. Reimbursement for use of cellular phones shall be made only for those phone calls which are documented as relating to Interim Medical Examiner activities. ~ /-c ~ In the event of a disaster or occurrence' unusual in nature or magnitude, the Interim Medical Examiner shall petition the Board of County Commissioners for reimbursement of all extraordinary expenses and compensation due to the disaster. The Interim Medical Examiner shall develop a schedule of reasonable and customary fees which shall be charged to third parties for specific services. Revenue received from the collection of such fees shall be retained and accounted for by the Interim Medical Examiner an<t used for operating expenses, thus reducing the overall level of County funding required for Interim Medical Examiner activities. 4. ACCOUNTING AND RECORDS. The Interim Medical Examiner shall keep logs of cellular telephone calls, denoting which calls to relate to Interim Medical Examiner activities and which calls do not. Records of Interim Medical Examiner pertaining to tJ:1is Agreement shall be kept on generally recognized accounting principles, and shall be available to the County or to an authorized representative of County, FDLE and the Auditor General for audit. Both parties shall maintain such records as are necessary to account for state funds disbursed by the Medical Examiners Commission. All records related to this Agreement shall be kept for a minimum of three years subsequent to the termination of this Agreement. Interim Medical Examiner shall be responsible for repayment of any and all audit exceptions identified by County or its agents or representatives. In the event of an audit exception, the County's obligation under this Agreement shall be reduced if the exception is ascertained prior to the termination of this Agreement. In the event there are insufficient moneys due to Interim Medical Examiner at the time of identification and notice thereof to Interim Medical Examiner to cover the amount of audit exception or the Agreement has terminated, Interim Medical Examiner shall reimburse County for the amount of the audit exception. County shall provide the Medical Examiners Commission with the County Annual Expenditure Report, identifying total funds expended or encumbered and budgeted, for Medical Examiner services during the current County fiscal year (forms to be provided by Commission); a copy of the budget adopted by County for Medical Examiner for FYE September 30,2001, and a copy of any Medical Examiner Office financial audit report prepared for County. 2 5. MODIFICATIONS AND AMENDMENTS. Any and all modifications and amendments of this agreement shall be approved by the County and Interim Medical Examiner in writing. No modification or amendment shall become effective until approved in writing by both parties. 6. ASSIGNMENT. Interim Medical Examiner shall not assign this agreement, except in writing and with the prior written approval of County, which approval shall be subject to such conditions and provisions as County may deem necessary. This agreement shall be incorporated by reference into any assignment and any assignee shall comply with all of the provisions herein, unless expressly provided otherwise in an amendment authorizing such assignment. Unless expressly provided for therein, such approval shall in no manner or event be deemed to impose any obligation upon either party in addition to the covenants and promises contained herein. 7. INDEMNIFICATION. Interim Medical Examiner hereby agrees to indemnify and hold harmless the County and any of its 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 (collectively the "Claims") arising directly or indirectly from any negligence or criminal conduct on the part of "Interim Medical Examiner in the performance of the terms of this Agreement except to the extent that, in the case of any act of negligence, Interim Medical Examiner reasonably relied on material supplied by, or any employee of, the County. Interim Medical Examiner shall immediately give notice to County, by certified mail to the Mayor of County, of any suit, claim or action against Interim Medical Examiner that is related to the activity under this contract and will cooperate with County in any investigation arising as a result of any suit, action or claim related to this contract. 8. ANTI-DISCRIMINATION. Interim Medical Examiner will not discriminate against any person on the basis of race, creed, color, religion, sex, age, national origin, physical handicap, or any other characteristic which is not job-related, in its recruiting, hiring, promoting, terminating or any other area affecting employment under this Agreement. Interim Medical Examiner agrees to include this paragraph in all 3 contracts it enters into with other persons or entities and to abide by all Federal and State laws regarding non-discrimination, including but not limited to, Titles VI and VII of the Civil Rights Act of 1964 (42 USC 2000d), Executive Order 11246, Executive Order 11375 and U.S. Department of Labor Regulations (42 CFR Part 60). 9. ANTI-KICKBACK. Interim Medical Examiner warrants that he has not employed, retained or otherwise had acted on his behalf any former county officer subject to the prohibition in Section 2 of Ordinance No. 10-1990 or any county officer or employee in violation of Section 3 of Ordinance No. 10-1990, and that no employee or officer of the County has any interest, financially or otherwise, in Interim Medical Examiner except for such interests permissible by law and fully disclosed by affidavit attached hereto. For breach or violation of this paragraph, the County may, in its discretion, terminate this Agreement without liability and may also, in its discretion, deduct from the contract or purchase price, or otherwise recover, the full amount of any fee, commission, percentage, gift, or consideration paid to the former county officer or employee. 10. PUBLIC ENTITY CRIME. A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids on leases of real property to public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, any 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 of36 months from the date of being placed on the convicted vendor list. 11. COMPLIANCE WITH LAW. Interim Medical Examiner shall comply with all federal, state, and local laws, ordinances, regulations and rules applicable to the services to be performed by each party under the terms of this Agreement. Interim Medical Examiner shall maintain such licensure as is required by law to carry out the services in this Agreement. 12. INDEPENDENT CONTRACTOR. At all times and for all purposes hereunder, Interim Medical Examiner is an independent contractor and not an employee, 4 agent or servant of the County or of the Florida Department of Law Enforcement. No statement in this Agreement shall be construed so as to find Interim Medical Examiner or any of its employees, contractors, servants, or agents to be employees of the County or State, and they shall be entitled to none of the rights, privileges, or benefits of employees of County or State. The Interim Medical Examiner may subcontract for services as deemed necessary and shall be ultimately responsible legally, operationally, and financially for any such subcontracts. 13. TERMINATION FOR CAUSE OR LACK OF FUNDS AND NON-W AIVER. A. If Interim Medical Examiner fails to fulfill the terms of this Agreement, or attachments, properly or on time, or otherwise violates the provisions of the Agreement or of applicable laws or regulations governing the use of funds, County may terminate the Agreement by written notice of sixty days, which notice shall specify cause. All finished or unfinished supplies or services compensated under this Agreement shall, at the option of County or pursuant to state statute become property of County. The County shall pay Interim Medical Examiner fair and equitable compensation for expenses incurred prior to termination of the Agreement, less any amount of damages caused by Interim Medical Examiner's breach. If the damages are more than compensation payable, Interim Medical Examiner will remain liable after termination and County can affirmatively collect damages. B. In the event that the Governor appoints a successor to the Interim Medical Examiner named herein, this Agreement shall terminate on the day prior to the effective date of such successor's appointment. C. In the event that funds from County cannot be continued at a level sufficient to allow for the purchase of services specified herein, this Agreement may be terminated upon giving written notice of thirty days to Interim Medical Examiner delivered in person or by mail to Interim Medical Examiner. D. The County shall not be obligated to pay for any services or goods provided by Interim Medical Examiner after the effective date of termination. E. Any waiver of any breach of covenants herein contained to be kept and performed by Interim Medical Examiner shall not be deemed or considered as a 5 continuing waiver and shall not operate to bar or prevent County from declaring a forfeiture for any succeeding breach either of the same conditions or covenants or otherwise. 14. INSURANCE. The Interim Medical Examiner shall maintain and comply with the insurance requirements as specified in the attached schedules, which are inclusive of Professional Liability insurance in accordance with FS 406.16. The costs of the aforementioned insurance shall be a cost within the Medical Examiner's Budget. 15. SEVERABILITY. If any provision of the Agreement shall be held by a court of competent jurisdiction to be invalid or unenforceable, the remainder of this Agreement or the application of such provision other than those as to which it is invalid or unenforceable, shall not be effected thereby~ and each provision of the Agreement shall be valid and enforceable to the fullest extent permitted by law. 16. NOTICE. Unless specifically provided otherwise in this Agreement, any notice required or permitted under this Agreement shall be in writing and hand-delivered or mailed, postage prepaid by certified mail, return receipt requested, to the other party as follows: To County: County Administrator 5100 College Road, Stock Island Key West, Fl. 33040 To Interim Medical Examiner: Zhiming Li, M.D. Fishermen's Hospital 3301 Overseas Highway Marathon, Fl. 33050 17. 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 a proper venue for any action shall be Monroe County. 18. REPORTS. Interim Medical Examiner shall develop a record-keeping system which can be used to provide County with a monthly report, which shall be submitted on a monthly basis and begin no later than a report for the month of June 1, 2001, and which shall include, as a minimum the following: A. Number of all investigations. B. Number of all autopsies performed. 6 C. Number of authorizations for all cremations and burials at sea and anatomical dissections. The activity report shall be submitted by the 10th day of the following month to the County Administrator. 19. ENTIRE AGREEMENT. This Agreement constitutes the entire agreement of the parti~s hereto with respect to the subject matter hereof and supersedes any and all prior agreements with respect to such subject matter between Interim Medical Examiner and the County. 20. FDLE. The Florida Department of Law Enforcement shall not be deemed to ass~me any liability for the acts, omissions to act, or negligence of the County or the Interim Medical Examiner, their agents, servants and employees~ nor shall County or Interim Medical Examiner exclude its own negligence to FDLE or any third party. IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the date first above written. (SEAL) BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA Attest: DANNY L. KOLHAGE, CLERK By Mayor/Chairman By Deputy Clerk INTERIM MEDICAL EXAMINER J~~\~ ~..' Zhiming Li, M.D. ~)t ~J~ Wit s 7 EXHIBIT A SERVICES TO BE PROVIDED BY INTERIM MEDICAL EXAMINER This Exhibit, incorporated into the Agreement between County and Interim Medical Examiner, on the day of ,2001, sets forth the services to be provided by Interim Medical Examiner pursuant to paragraph 2 thereof: The Interim District Medical Examiner agrees to fulfill his duties as set forth in Chapter 406, FS and rules promulgated by the Medical Examiners Commission as follows: A. OFFICE 1. The Office of the Interim Medical Examiner shall be established and maintained in such a manner that it provides for the necessary facilities and personnel to accomplish its duties and responsibilities. 2. The Office shall be an independent agency. B. APPOINTMENT 1. The Interim Medical Examiner shall be appointed by the Governor of the State of Florida. 2. The Interim Medical Examiner shall name and appoint qualified professional, technical, clerical and other staff of the Office. The staff shall be directly responsible to the Interim Medical Examiner, and shall include associate medical examiners, secretary, forensic investigator(s), diener, custodian, histotechnologist, et cetera. C. INVESTIGA nON OF DEATH The Interim Medical Examiner or his appointed associate medical examiners shall have the authority and responsibility: 1. To investigate and certifY any death that falls in the following categories: a. Criminal violence suspected b. Suicide c. Accidental (motor vehicle, boating, aircraft, diving, snorkeling, swimming, electrocution, et cetera) d. Suddenly when in apparent good health e. Unattended by a practicing physician (over 30 days) f Suspicious or unusual circumstances g. Gunshot h. Sudden infant death syndrome (SillS) 1. Suspected poisoning J. Drowning k. Abortion l. In prison or police custody m. In state institution 8 n. Diseases constituting a threat to public health o. Disease, injury, or toxic agent resulting from employment p. Unexpected death associated with diagnostic or therapeutic procedure q. When body is to be cremated, dissected or buried at sea r. Unclaimed bodies s. When a dead body is brought into a new medicolegal jurisdiction without proper medical certification 2. To take charge of the dead body upon direct notification of such death. Heor his duly authorized associate medical examiner or forensic investigator shall respond to the scene upon request by proper authorities whenever possible and appropriate. The dead body shall not be disturbed unless permission is granted by the Interim Medical Examiner or his designee. 3. To conduct an investigation of circumstances surrounding the death in conjunction with proper authorities. 4. To conduct all necessary examinations ofthe dead body which could include performance of any autopsy and retention of whatever tissues and biological specimens that he deems are necessary. 5. To take possession of any object or article which, in his opinion, may be useful in establishing the identify of the deceased and/or the cause and manner of death. 6. To reduce his investigation and findings in writing and shall keep such records in his Office. 7. To administer oath and have the power of subpoena. D. SPECIFIC TASKS In order to effect above general requirements, the specific duties itemized below describe in greater detail how duties are accomplished and the responses to be made. 1. Answering telephone a. Mode - telephone, digital pager, cellular telephone, radio b. Source of calls - Police, Sheriff, Navy, FBI, Highway Patrol, National Forestry or Park Service, Coast Guard, NTSB, FAA, funeral homes, family or acquaintances of deceased, attorneys, insurance companies, private investigators, newspaper reporters, TV or radio reporters, physicians, nurses, et cetera. 9 c. Nature of calls 1. Request for oral information - toxicology results, cause of death, mechanism of death, et cetera 2. Request for written information or reports - autopsies, statistical reports, death certificates, et cetera 3. Questions about previous cases 4. Requests for immediate scene investigations 5. Notification of deaths 6. Cremation, dissection, or burial at sea approvals 7. Scheduling depositions 8. Electronic depositions 9. Request for testimony as expert witness in court 10. Other questions or considerations 2. Interim District Medical Examiner shall initiate such phone calls as are necessary to carry out his duties, including but not limited to the following: a. To whom: 1. Law enforcement agencies 2. Funeral homes 3. Witnesses, family, friends 4. Personal physicians or dentists 5. Attorneys 6. Others b. Nature of calls 1. Case investigations 2. Scheduling exams or autopsies 3. Answering digital pager 4. Returning phone messages 5. Calling secretary for information 6. Changing appointment times 7. Calling for toxicology results past due 3. Subpoenas a. Received at Office b. If conflicts in scheduling, would necessitate phone calls to reschedule 4. Automobile travel a. . Scene investigations - up to 60 miles distant, one way, immediate response always requested, day or night, seven days a week - performed by Interim Medical Examiner, associate medical examiner, or forensic investigator appointed by Interim Medical Examiner. b. Autopsies usually scheduled within 24 hours, may be 50 miles away where performed 10 c. Florida Association of Medical Examiners (FAME) Conferences - usually at least once annually, in Florida, 50- 300 miles one way d. Depositions e. Court trial witnessing, usually 40-50 miles each way f Grand Jury, usually 50 miles each way, usually less than one week's notice 5. Autopsies/Examinations a. Time 2-4 hours, not counting travel, for autopsy, 1/2 to 1 hour for post mortem examination b. X-rays, sometimes taken by Interim Medical Examiner c. Photographs d. Collection of toxicology specimens, and/or esoteric tests (DNA probes) e. Gathering of some trace evidence - fluids, hair, particles, clothing, jewelry, et cetera . f Preparation of bones and teeth for anthropological studies g. Microscopic examination after preparation by histotechnologist h. Collection of insects at scene to better estimate post mortem interval 6. Generation of reports a. Handwritten 1. Labeling tubes, photographs and x-rays 2. Notes during autopsy 3. Notes during telephone conversations 4. Correspondence 5. Preparing rough drafts on statistical reports, correspondence, contracts, et cetera 6. Keeping case log 7. Keeping cremation log 8. Completing death certificates 9. Budgets 10. Cellular telephone logs 11. Other reports requested b. Dictated 1. Autopsies, some postmortem exams 2. Some correspondence 3. Some statistical reports 4. Rules and regulations 5. Review laboratory examinations and prepare reports 6. Contracts 7. Other reports 11 c. Typing - usually by computer with word processor, e.g., county burial letters, appointment letters, new call schedules, et cetera 7. Depositions a. Some electronically (by telephone) b. Some in attorney's office, clerical or electronic c. Frequently travel 50 miles each way d. Grand Jury 8. Witness in Court a. Location - usually 50 miles each way b. Duration - 4 hours up to 3 days portal to portal c. Preparation of testimony - 2-6 hours minimum 9. Arrange transportation of bodies 10. Provide professional consultations 11. Prepare and present materials for teaching/public presentations 12. Counsel families 13. Continuing education - ASCP Check Samples, conferences - 20 hours per year generally required. 12 EXHIBIT B MONROE COUNTY Date: 1012512000 BOARD OF COUNTY COMMISSIONERS Olfice ot Managmen. and Budget APPROPRIATION DETAIL BY OFFICIAUDIVISION, DEPARTMENT, COST CENTER OfcllDiv: MEDICAL EXAMINER Department: Medical Examiner Cost Center/Fund 68000 /001 MEDICAL EXAMINER Sub-total Operating Expenditures Cost Center Total MEDICAL EXAMINER Adopted 01 INC/(DEC) % Change Adopted 00 Actual 99 Adopted 99 291,170 0 0.0% 291,170 285,460 285,460 15,597 5,380 52.7% 10,217 7,800 9,000 3,124 0 0.0% 3,124 3,004 3.004 309,891 5.380 1.8% 304,511 296,264 297,464 .-- 309,891 5,380 1.8% 304.511 296,264 297,464 Operating Expenditures 530340 OTHER CONTRACTUAL SERVICE 530440 RENTALS AND LEASES 530451 RISK MANAGEMENT CHARGES Page 337 1996 Edition Agreement'Between The Board of County Commissioners of Monroe County, Florida and Zhiming Li, MD General Insurance Requirements As a pre-requisite of the work governed by this contract (including the pre-staging of personnel and material), the Interim Medical Examiner shall obtain, at his/her own expense, insurance as specified in any attached schedules, which are made part of this contract. The County shall reimburse the Medical Examiner for the reasonable cost of the specified Medical Professional Liability. The Medical Examiner will ensure that the insurance obtained will extend protection to all Subcontractors engaged by the Medical Examiner. As an alternative, the Medical Examiner may require all Subcontractors to obtain insurance consistent with the attached schedules. The Medical Examiner will not be permitted to commence work governed by this contract (including pre-staging of personnel and material) until satisfactory evidence of the required insurance has been furnished to the County as specified below. Delays in the commencement of work, resulting frqm the failure of the Medical Examiner to provide satisfactory evidence of the required insurance, shall not extend deadlines specified in this contract and any penalties and failure to perform assessments shall be imposed as if the work commenced on the specified date and time, except for the Medical Examiner's failure to provide satisfactory evidence. The Medical Examiner shall maintain the required insurance throughout the entire term of this contract and any extensions specified in the attached schedules. Failure to comply with this provision may result in the immediate suspension of all work until the required insurance has been reinstated or replaced. Delays in the completion of work resulting from the failure of the Medical Examiner to maintain the required insu'rance shall not extend deadlines specified in this contract and any penalties and failure to perform assessments shall be imposed as if the work had not been suspended, except for the Medical Examiner's failure to maintain the required insurance. The Contractor shall provide, to the County, as satisfactory evidence of the required insurance, either: . Certificate of Insurance or . A Certified copy of the actual insurance policy. The County, at its sole option, has the right to request a certified copy of any or all insurance policies required by this contract. All insurance policies must specify that they are not subject to cancellation, non-renewal, material change, or reduction in coverage unless the insurer gives a minimum of thirty (30) days prior notification to the County. The acceptance and/or approval of the Medical Examiner's insurance shall not be construed as relieving the Medical Examiner from any liability or obligation assumed under this contract or imposed by law, Administration Instruction #4709.3 14 1996 Edition The Monroe County Board of County Commissioners, its employees and officials will be included as "Additional Insured" on all policies, except for Workers' Compensation. Any deviations from these General Insurance Requirements must be requested in writing on the County prepared form entitled "Request for Waiver of Insurance Requirements" and approved by Monroe County Risk Management. Administration Instruction #4709.3 15 1996 Edition Agreement.'Between The Board of County Commissioners of Monroe County, Florida and Zhiming Li, MD GENERAL LIABILITY Prior to the commencement of work governed by this contract, the Medical Examiner 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 The minimum limits acceptable shall be: $300,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $100,000 per Person $300,000 per Occurrence $ 50,000 Property Damage An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its provisions should include coverage for claims filed on or after the effective date of this contract. In addition, the period for which claims may be reported should extend for a minimum of twelve (12) months following the acceptance of work by the County. The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. GLl Administration Instruction #4709.3 53 1996 Edition Agreement .Between The Board of County Commissioners of Monroe County, Florida and Zhiming Li, MD VEHICLE LIABll..ITY Recognizing that the work governed by this contract requires the use of vehicles, the Medical Examiner, prior to the commencement of work, shall obtain Vehicle Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum, liability coverage for: · Owned, Non-Owned, and Hired Vehicles The minimum limits acceptable shall be: $300,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $100,000 per Person $300,000 per Occurrence $ 50,000 Property Damage The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. VL2 Administration Instruction #4709.3 81 1996 Edition Agreement Between The Board of County Commissioners of Monroe County, Florida and Zhiming Li, MD MEDICAL PROFESSIONAL LIABILITY Recognizing that the work governed by this contract involves the providing of professional medical treatment, the Medical Examiner shall purchase and maintain, throughout the life of the contract, Professional Liability Insurance which will respond to the rendering of, or failure to render medical professional services under this contract. The minimum limits ofliability shall be: $500,000 per Occurrence/$l,OOO,OOO Aggregate If coverage is provided on a claims made basis, an extended claims reporting period of four (4) years will be required, MED2 Administration Instruction #4709.3 67 1996 Edition Agreement Between The Board of County Commissioners of Monroe County, Florida and Zhiming Li, MD WORKERS' COMPENSATION Prior to the commencement of work governed by this contract, the Medical Examiner shall obtain Workers' Compensation Insurance with limits sufficient to respond to Florida Statute 440. In addition, the Medical Examiner shall obtain Employers' Liability Insurance with limits of not less than: $100,000 Bodily Injury by Accident $500,000 Bodily Injury by Disease, policy limits $100,000 Bodily Injury by Disease, each employee Coverage shall be maintained throughout the entire term of the contract. Coverage shall be provided by a company or companies authorized to transact business in the state of Florida and the company or companies must maintain a rating of A-VI, as assigned by the A.M. Best Company. If the Medical Examiner has been approved by the Florida's Department of Labor, as an authorized self-insurer, the County shall recognize and honor the Medical Examiner's status. The Medical Examiner may be required to submit a Letter of Authorization issued by the Department of Labor and a Certificate of Insurance, providing details on the Medical Examiner's Excess Insurance Program. If the Medical Examiner participates in a self-insurance fund, a Certificate of Insurance will be required. In addition, the Medical Examiner may be required to submit updated financial statements from the fund upon request from the County. wet Administration Instruction #4709.3 87 ~ay-~5-0l l2:36P Risk Management Sent By: HP La88rJet 3100; JetSuit9; 305 295 4364 MaY'1S.01 1 :45PMj P.Ol Page 1/1 '"'t!4tiUl'l i MONRO~ COUNTY. FLrRIDA .Request For Waiw of msuraace ReqUire&li" it is 'OlIUCSltd 1ba! the jftIU rcqwrcmcnu, as specified in the C t.V's ScheduJ; of IDsurancc RequirecMnts, be waived or modified 0.11 dae oJIgwiq canuaCL CoaIt8dor: L~ MD CO.llll'aClIW: Address of Contractor: Phone: Scope of Work: Reason tor Wm-er: Policies Waiver win apply to: Signanms ot COnlnctor: Risk Manapmenr Date COImfy AdmiAi~r:llor appeaJ: Date: Board of County Comndssiooe Adnaim.tnlicm lnstn1&.'tion '4709.] Cj Not API NOlA 10.1