Item C50BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
MEETING DATE: 3/17/04 DIVISION: COUNTY ADMINISTRATOR
BULK ITEM: YES DEPARTMENT: AIRPORTS
AGENDA ITEM WORDING: Approval of contract with H.I.P.P. Industries, Inc., (Hospitality Institutional Public
Preservation) for the Noise Insulation Program for the Key West International Airport.
ITEM BACKGROUND: This project is funded 90% by the Federal Aviation Administration, and 5% each by the Florida
Department of Transportation and Passenger Facility Charge Revenue.
PREVIOUS RELEVANT BOCC ACTION: Award of bit to H.I.P.P. Industries, February 18, 2004.
CONTRACT/AGREEMENT CHANGES: New Contract
STAFF RECOMMENDATION: Approval
TOTAL COST: $1,337,244.00
COST TO AIRPORT: None
COST TO PFC: $66,862.20
COST TO COUNTY: None
REVENUE PRODUCING: No
APPROVED BY: County Attorney X
BUDGETEC: Yes
SOURCE 0*: FUNDS: FAA, FDOT, PFC Revenue
AMOUNT PER /YEAR:
OMB/Purchasing X Risk Manao-ement X
DIRECTOR OF AIRPORTS APPROVAL
I V-
Peter J. Horton
DOCUMENTATION: Included
DISPOSITION:
/bev
APB
To Follow X Not Required
AGENDA ITEM # ca)
AGENDA ITEM WITH LATE DOCUMENTATION
DIVISION: County Administrator
DEPARTMENT: Airports
SUBJECT: Approval of contract with H.I.P.P. Industries for the Noise Insulation
Program for the Key West International Airport.
DATE ITEM WILL BE AVAILABLE: Monday 3/8/04
AGENDA ITEM NUMBER: Unknown
BEV/apb
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
MEETING DATE: 3/17/04 DIVISION: COUNTY ADMINISTRATOR
BULK ITEM: YES DEPARTMENT: AIRPORTS
AGENDA ITEM WORDING: Approval of contract with H.I.P.P. Industries, Inc., (Hospitality Institutional Public
Preservation) for the Noise Insulation Program for the Key West International Airport.
ITEM BACKGROUND: This project is funded 90% by the Federal Aviation Administration, and 5% each by the Florida
Department of Transportation and Passenger Facility Charge Revenue.
PREVIOUS RELEVANT BOCC ACTION: Award of bit to H.I.P.P. Industries, February 18, 2004.
CONTRACT/AGREEMENT CHANGES: New Contract
STAFF RECOMMENDATION: Approval
TOTAL COST: $1,337,244.00 BUDGETED: Yes
COST TO AIRPORT: None SOURCE OF FUNDS: FAA, FDOT, PFC Revenue
COST TO PFC: $66,862.20
COST TO COUNTY: None
REVENUE PRODUCING: No AMOUNT PER /YEAR:
APPROVED BY: County Attorney X OMB/Purchasing X Risk Management X
DIRECTOR OF AIRPORTS APPROVAL
I +f-
Peter J. Horton
DOCUMENTATION: Included ✓ To Follow
DISPOSITION:
/bev
APB
Not Required
AGENDA ITEM # (26-
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract #
Contract with: H.I.P.P. Industries Effective Date: Execution
Expiration Date: 295 days from NTP
Contract Purpose/Description: Noise Insulation
Contract Manager: Bevette Moore # 5195 Airports - Stop # 5
(name) (Ext.) (Department/Courier Stop)
for BOCC meeting on: 3/17/04 Agenda Deadline: 3/2/04
CONTRACT COSTS
Total Dollar Value of Contract: $1,337,244.00 Current Year Portion: - $1,070,000.00
Budgeted? Yes Account Codes: 404-63075-560630-GAKA72
Grant: Yes, FAA & FDOT
County Match: PFC Revenue
ADDITIONAL COSTS
Estimated Ongoing Costs: N/A For: .
(not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, etc.
CONTRACT REVIEW
Changes
Date In Needed Reviewer Date Out
Yes No
Airports Director
Risk Management
O.M.B./Purchasing 3/ ll()q
County Attorney
Comments:
�Oprieu�a oOarl�. C� " —
Rob Wolfe
3/el-v
3 /1 /ay
3 /a-/0 l
,
' SECTION 00500
AGREEMENT
MONIROE COUNTY -CONTRACTOR NOISE INSULATION CONTRACT
Key West International Airport
Noise Insulation Program
This Monroe County -Contractor Noise Insulation Contract ("the Contract") is made and
entered into by ,tnd between the undersigned contractor ("the Contractor"), and Monroe
County ("ithe SponSar").
I�t�as�cr i e'`t s71Tur�c PLAN rrz�sJWan0l)
CONTRACTOR � . -f .P • VV LJaJ 1 ' IJ46 PHONi(—q4)) 3(o5i ` snr7
ADDRESS t? 1 PT FAX # (611 D, 1663 •' wl�b
CITYSTATEL ZIP CODE 3�23(o
MAILING ADDRESS (if different than actual location) 1115144�-
l.
RECITALS:
If 1. The Sponsor s the operator of Key West International Airport ("the Airport") and administers
the Noise InSUlation Program.
2. The Sponsor and certain homeowners (hereinafter referred to as "the Homeowner") have
previously ensred into the Monroe County -Homeowner Noise Insulation Contracts which
described cerain obligations to be performed by the Sponsor and the Homeowner as part of
- the Noise Ins station Program. The Monroe County -Homeowner Noise Insulation Contracts
i.
are attached hereto and made a part of this Agreement
3. The parties hereto desire to enter into this Contract for the modification of the Homeowner's
Premises in accordance with the Monroe County -Homeowner Noise Insulation Contracts
and the Noise Insulation Program.
4. The Contractor has been approved by the Sponsor for work in this program and has agreed
to maintain all insurance and bond requirements for performance of the work contained
herein.
AGREEMENT URS Corporation 00500 - 1
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' 1
MONROE COUNT%CONTRACTOR NOISE INSULATION CONTRACT
5. The Contractor has been selected to perform the Statement of Work (as described in the 1
Project ',Manual Volumes 1 & 2 and the Monroe County -Homeowner Noise Insulation
Contracts) attached hereto. ,
6. Nothing in this Gont-tact shall be construed to create any relationship between the Sponsor,
its officers, representatives, employees, agents or consultants, and the Contractor, other
than that: of independent contractors.
F
:E
AGREEMENT:
NOW, THEREFORE, for and in consideration of the Premises and mutual covenants set forth '
herein, and other hood and valuable consideration, the receipt and sufficiency of which are
hereby acknowledged, the parties agree as follows: s
1. The original of his contract with the required attachments and the plans and specifications
shall remain on file at the offices of the Airport. The required attachments shall include at a
minimum:
Contraotor's Proposal (Bid)
Public i;cn struction Bond
Payme it Bond I
Perforrianre Bond
Contractor Affidavit i
Power of Attorney
Insurance Certificate(s)
Project Manual, Volumes t & 2
Monraq! County -Homeowner Noise Insulation Contracts with all Exhibits
and such other ;and further attachments as may be mutually agreed, all of which are r
incorporated herein by reference as if copied verbatim. In the event of any conflict between
the provisions of this contract and the provisions of any attachment(s), the more restrictive
on the Contractor shall apply.
2. The Contractor agrees to commence and complete the project, furnish and pay for all r
materials, supplies, tools, equipment, labor, and other services required to complete the
Work, and do and perform all the Work required to complete the project, all in strict and
complete comfiliance with the terms and conditions of this and the other contract documents
for the Project. all of which are deemed a part hereof as fully and completely as if set out
and copied verbatim herein.
AGREEMENT URS Cofporation 00500.2
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MONROE COUNIT—CONTRACTOR NOISE INSULATION CONTRACT
3. The Contractor agrees to use all of those acceptable mechanical, electrical. Plumbing trades
and/or other subcontractors set forth in his proposal and only them. in the construction of the
Project unless a substitution or deletion is first approved by the Sponsor and to certify to the
Sponsor when said subcontractors receive each period payment.
4. The Work to )e performed under this Contract shall commence within ten (10) calendar
days after wrrten Notice -to -Proceed is issued by the Sponsor. The Work of the Contract,
including punch list items, must be totally complete within two hundred ninety five (295)
calendar days ('Itie "Completion Date") unless extended in writing by the Sponsor or the
Sponsor's Re3re<;entative, due to circumstances beyond the reasonable control of the
Contractor. Tt a specified time intervals shall be computed from the date stipulated in the
Notice.•to-Proceel. Work on each individual Premises shall reach substantial completion
within twelve (12`, working days of the commencement date for that individual Premises.
The Sponsor 3rx1 the Contractor agree that the damages which would be incurred by the
Sponsor in th a -:vent of delay of the Project would be substantial but are not capable of
being precise y calculated as of the. execution of this Contract. The Sponsor and the
Contractor thiirefore agree based upon their professional knowledge and experience with
projects of thi 3 t,�rpe and their best estimates of the damage associated with delay of the
Project: that the Contractor (and his surety) shall be liable for and shall forfeit One Hundred
Twenty-five D )Mars ($125.00) from the Contract Sum for each particular property included in
the Project as defined in the Monroe County -Contractor Noise Insulation Contract, for each
working day (:iundays and Holidays excluded) after the twelve (12) day timeframe allocated
to reach Substantial Completion for each particular property, and shall forfeit One Thousand
Dollar:: ($1,00.00) from the Contract Sum for each calendar day (Sundays and Holidays
included) afte • the Completion Date that any part of the Work upon any property remains
incomplete, herein stipulated as fixed, agreed, as liquidated damages, and not as a penalty.
All Work which does not conform to the requirements of this Contract, plans, and
specifications will be considered unacceptable, unless otherwise determined acceptable by
the Sponsor.
Unacceptable Work, whether the result of poor workmanship, use of defective materials,
damage through carelessness, or any other cause found to exist prior to the final
acceptance cf the Work, shall be removed immediately and replaced in an acceptable
manner.
Work done ct,ntrary to the instructions of the Sponsor, Work done beyond the lines shown
on the plans or as given, except as herein specified, Work done in an unacceptable manner
or any extra Work done with authority, will be considered as unauthorized and will not be
paid for unde. the provisions of this Contract. Work so done may be ordered removed or
replaced at th-3 Contractor's expense.
Upon -failure on the part of the Contractor to comply forthwith with any order of the Sponsor
made under She provision of this subsection, the Sponsor will have the authority to cause
unacceptable Work to be remedied or removed and replaced and unauthorized Work to be
removed and to deduct the costs incurred from any monies due or to become due the
Contractor. If the Contractor defaults or neglects to carry out the Work in accordance with
the Contract 'DcM;uments, and fails to take corrective action within a seven-day period after
AGREEMENT UAS Corporation 00500 - 3
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MONROE COUNT", `-CONTRACTOR NOISE INSULATION CONTRACT
written notice frog,, i the Sponsor, the Sponsor may, after such seven-day period, give the
Contractor a secwA written notice to correct the deficiencies. If within a three-day period, no
action is taken io correct the deficiencies, the Sponsor may complete the Work and issue a
Change Order c educting the value of the Work.
5. By execution of this Contract, Contractor represents that it has visited the Premises and
familiarized itself whh all conditions under which the Work is to be performed. Contractor
has further sat isfied itself that the Statement of Work fully indicates the extent and
requirements of all Work to be performed hereunder.
If, after comm 3nc lament of the Work, Contractor discovers that modifications to the
Statement of Work are required as a result of conditions at the premises that were not
reasonably discoverable prior to commencement of the Work, Contractor shall immediately
initiate the charge order procedure described in paragraph 16, below.
6. Contrac:or sha I is a solely responsible for all construction means, methods, techniques,
sequences, and procedures, and for performing, scheduling and coordinating all portions of
the Work in a proper manner and in strict compliance with all applicable codes, rules,
regulations and laws.
7. Contractor war; ants to Sponsor that all materials and equipment incorporated in the Work
will be new unlas.,; otherwise specified, and that all Work will be of good quality, free from
faults.and defects, and in strict conformity with the Statement of Work. All work not so
conforming to 1 hese standards may be considered defective, and may be rejected. Any
defective or u iatithorized work or materials shall be immediately remedied, removed,
replaced or disposed ed of at Contractor's expense.
8. To ensure com:)Iiance with the Statement of Work, the Homeowner has agreed that all Work
done and matodal:s fumished shall be subject to inspection by a Sponsor representative.
Work done or materials used without this inspection may be ordered removed and replaced
at the Contract )r's expense.
9. The Contractor shall be responsible for the acts and omissions of all its agents and
employees and all its subcontractors, suppliers, their agents and employees, and all other
person:; pedonning any of the Work for the Contractor.
10. The Contractor shall be responsible for safety precautions and programs in conjunction with
the Work. It stall comply with all applicable codes, rules, regulations, laws, and orders of
any public autt ority having jurisdiction over the safety of persons or property.
11. (a) The Sporsor agrees to pay the Contractor for said Work the total sum of ($
__ ) dollars and pursuant to the terms and conditions of this and the
other Contract Documents. Incremental payments shall be made for the Work on each
property incluc ed as the percentage of completion of the Work on each such property is
judged satisfactodY completed with the project milestones and in accordance with this and
the other Cont *act Documents. This procedure, which is incorporated in the Monroe County -
Homeowner N:)ise Insulation Contracts, is as follows:
AGREEMENT URS Corporation 00500 - 4
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MONROE I:OUNTY-tCONTRACTOR NOISE INSULATION CONTRACT
(1) When tho Contractor determines that the Work is completed, the Contractor will
request thid the Architect make an inspection of the Work. The homeowners have
consented to :such inspection. If the Architect determines that the Work is in compliance
with the Statement of Work, and the Homeowner accepts the Work and signs the
Certificate )f Final Inspection, the Sponsor will issue payment of the Contract Sum plus
Sponsor-alipmved Allowance Changes and Change Orders less retainage.
(2) If the Sponsor or the Architect determines that the Work is not in compliance with
the Staterren't of Work, the Architect shall so notify the Contractor, and shall provide a
list of item:; which are requested to be completed by the Contractor in order for the work
to be acce;)t&d.
(3) Upon ,ofripletion of the items required under paragraph (2) above, the Homeowner
shell sign the Certificate of Final Inspection to signify they accept the Work. The
Sponsor iesarves the right to make final determination of acceptability of the
Contractor s Work. If the Sponsor determines Contractor has put forth a reasonable and
normally eXpe cted effort to correct the list of discrepancies, and the Architect certifies the
Work to bai acceptable and complete, the Sponsor will issue payment in the. amount of
the Contract Sum, less previous payments, plus the Sponsor -approved Allowance
Changes end Change Orders less retainage.
(4) No fir at payment shall be made to the Contractor pursuant to paragraph 11, until:
(1) A Cecificaate of Final Inspection has been signed by the Homeowner, or in the
absence cif the Homeowner, signed by the Sponsor's Representative; (2) Contractor
provides F: Final Contractor's Affidavit and Final Release of Liens; and (3) Proof of
cancellatic n of the "Notice of Contract" by the Clerk is obtained by the Contractor and
submitted to the Sponsor.
12. The ContracOr shall at all times keep the work site free from accumulation of waste
materials or nibbiash caused by its operations, and it shall clean any glass surfaces and shall
leave the woti. site "broom clean" upon completiorrof the Work.
13. The Contractor shall comply with and, in all its subcontractor agreements, require that each
such subcontractor will comply with and be bound by this Contract.
14. It is the intent of the Homeowner to occupy the Premises throughout the construction period.
The Contractor shall conduct its business in such a way as to create as little impact as
possible to Homeowner.
` 15. In addition to the Contractor's obligations to correct all deficient work appearing during the
course of peiforrning this Contract, the Contractor shall remedy all defects due to faulty
' materials, equipment, or workmanship which appear within a period of one (1) year from the
date of completion of the Work under this Agreement, or within such longer period of time as
may be pre: cribed by law. Further, the Contractor agrees to assign directly to the
Homeowner any warranties or guaranties furnished or supplied by manufacturers of
materals or equipment installed in the Premises.
AGREEMENT URS Corporation 00500 - 5
MONROE C12UNTY-CONTRACTOR NOISE INSULATION CONTRACT
16. (a) If the Contractor determines that the Work must be modified from the Statement of Work,
the Contractor sltail promptly notify the Architect in writing. The Contractor shall not proceed
until directed by the Sponsor and the Architect.
(b) The Contractor .and the Sponsor agree that the following procedures will be followed:
(1) Tie Sponsor may delete any Work set forth in the Statement of Work by a Contract
Change Circler, Construction Change Directive, or Construction Feld Directive,
signed bI the, Sponsor and delivered to the Contractor. The Sponsor may delete any
Work sei. forth in the Statement of Work if such Work requires additional work to be
performed, the cost of which is excessive as determined by the Sponsor, or if the
Contract.ir encounters asbestos or other situations which may pose a health
concern. Tree Homeowner will be notified of any changes in writing.
(2) The Contractor acknowledges and agrees that any additional work as a result of
conditions at the premises that were not reasonably discoverable prior to
commercernent of the Work may not be approved by the Sponsor and may be the
responsibility of the Homeowner. In such event, the Homeowner may be required to
remedy such conditions prior to the completion of the Contract, or the Sponsor will
tarminata the Homeowner's participation in the Noise Insulation Program. The
Homeowner may re-enter the Noise Insulation Program after correction of any such
conditions :so long as the Program is ongoing. If the Homeowner's participation in the
Noise Insulation Program is terminated by the Sponsor on this basis, the Sponsor
shall pz.y the Contractor that portion of the Contract Sum earned prior to the
Homeowner's termination.
17. (a) To the maximurn extent permitted by law, the Contractor shall protect, defend, indemnify
and hold the Hxneowner, the Consultant (including but not limited to the Architect), and the
Sponsor, and their officers and employees completely harmless from and against any and
all liabilities, demands suits, claims, losses, fines or judgments arising by reason of the injury
or death of afiy person or damage to any property, including ail reasonable costs for
investigation and defense thereof (including but not limited to attorney fees, court costs, and
expert fees), cf any nature whatsoever arising out of or incident to this Contract or the
Contractor's performance under this Contract or the acts or omissions of the Contractor's
officers., employees, agents, contractors, subcontractors, licensees or invitees regardless of
where the injury, death or damage may occur, unless such injury, death or damage is
caused by the sole negligence of the Sponsor or the Homeowner and regardless of whether
or not the Couractor is or can be named a party in any litigation. The Sponsor or the
Consultant sh<<II give the Contractor reasonable notice of any such claims or actions. The
provisions of this section shall survive the expiration or earlier termination of this Contract.
(b) The indemidication obligation of subparagraph 17.(a) above shall not be limited in any
way by compensation benefits payable by or for the Contractor, under applicable workers, or
workman's compensation benefit or disability laws. The Contractor expressly waives any
immunity the Contractor might have had under such laws, and, by agreeing to enter into this
Contract, acknowledges that the foregoing waiver has been mutually negotiated by the
parties.
AGREEMENT UAS Corporaf ion 00500.6
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MONROE COUNTr-CONTRACTOR NOISE INSULATION CONTRACT
18. The Contractor shall pay all attomeys' fees and expenses incurred by the Homeowner or the
Sponsor in esti.blishing and enforcing the Homeowner's and/or the Sponsor's rights under
this. Contract, w.ielher or not suit is instituted.
19. The Contractor agrees to maintain comprehensive public liability and comprehensive
property damac a insurance, on an occurrence basis, amounts of not less than the following:
BODILY INJURY & PROPERTY DAMAGE $1,000,000 Combined Single Limit
WORKMAN'S COMPENSATION
EM12LOYEIIS LIABILITY
Statutory
$ 500,000 Each Accident
$ 500,000 Policy Limit
$ 500,000 Each Employee
PRODUCTS LIABILITY & COMPLETED OPERATIONS $ 1,000,000 Each Accident
FIRE & ExrENDED COVERAGE An amount equal to 100% of the value of the
improvements (facility).
Fleet insurance, or such other types of coverage, may be acceptable; however, the
minimum shall be $1,000,000 combined single limit.
The following shall be named as additional insured under all policies of insurance (except
Workman's Cc mpensation):
1. Monrce County
2. The Homeowner
The Contractcr agrees that all insurance policies shall contain a severability of interest or
cross -liability frovision endorsement which shall read generally as follows:
In the event of one of the assured incurring liability to any other of the assured,
this policy shail cover the assured against whom claim is or may be made in the
same manner as if separate policies had been issued to each assured. Nothing
containei herein shall operate to increase the limits of liability.
The Contractcr agrees that all insurance policies shall provide that they will not be altered or
canceled with gut thirty (30) days advance written notice to the Sponsor. Such insurance
must provide that it will be considered primary insurance as respects any other valid and
collectible insurance, or self -insured retention, or deductible the Sponsor may possess. Any
other insurance or self -insured retention of the Sponsor shall be considered excess
insurance only.
AGREEMENT URS Corporation 00500 - 7
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momROE COUNTn'-CONTRACTOR NOISE INSULATION CONTRACT
The Sponsor sh all have the right to change the insurance coverage and the insurance limits
required of they Contractor, without any cost to the Sponsor, if such changes are �
recommended cr imposed by the Sponsor's insurers.
The Contractor ::hull obtain all insurance required from an insurance company or companies
licensed to do b isi!ness in the State of Florida. The insurance company must be acceptable
to the Sponsor, Approval may be denied a company based in its Best rating or other I
indication of financial inadequacy.
The Contractor shall provide to the Sponsor such evidence of compliance with the
Sponsors insurance requirements as the Sponsor may- from time to time request. At a j
minimum, the C )ntractor shall provide, at the commencement of the Contract a Certificate of
Insurance. All such certificates shalt be completed to show compliance with the Contractor's ,
obligations hereunder, specifically as to the indemnification and notice provisions. The
Sponsor may also require copies of the declaration page, insurance policy, and
endorsements tltersto.
.i
If the Contractor or its insurance company fails to promptly respond to the Sponsor's request i
for adequate evidence of compliance with the insurance provisions, the Sponsor may, in
addition to all is ether remedies, charge the Contractor an amount equal to ten percent
(10%) of the coinp+ensation required hereunder until such evidence is provided. i
If the Contractcr shall at any time fail to insure or keep insured as aforesaid, the Sponsor
may do all things necessary to effect or maintain such insurance and all monies expended
by it for that piupose shall be repayable by the Contractor in the month the premium or
premiums are paid by the Sponsor. If any insurance policies required hereunder cannot be
obtained for arty reason, the Sponsor may require the Contractor to cease any and all
operations until coverage is obtained. If such insurance coverage is not obtained within a
reasonable period of time, to be determined solely by the Sponsor, the Sponsor may
terminate this C onlract.
20. If the Contractc r defaults or neglects to carry out the Work in accordance with the Contract
Documents or I ails to perform any provision of the Contract, the Sponsor may, after seven
(7) days' writteii notice to the Contractor and the Homeowner, and without prejudice to any
other remedy 11 may have, make good such deficiencies and may terminate the Contract
and take possession of the site and of all materials and may finish the work by whatever ?
method it may deem expedient.
21. If, in the! Homeowner's opinion, the Work is unsatisfactory or the Contractor is damaging the
Premises durirg the course of the Work, the Homeowner should immediately notify the
Architect and the Sponsoes Representative. If the situation is reasonable and cannot be
resolved to the Homeowner's satisfaction, the Homeowner may, upon written notice to the
Sponsor, seek-orrective•action or withdraw from the program.
22. The Contractor[ shall at all times comply with all federal, state, and local laws, ordinances
and regulations which apply to the Work to be performed under this Contract. Such
compliance shill include, but is not limited to, the payment of all applicable taxes, royalties,
license fees, panalties, and duties. NOTICE: All Home Improvement Contractors must be
AGREEMENT URS Corporation 00500 - 8
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MONROE COUNTY -(CONTRACTOR NOISE INSULATION CONTRACT
licensed by the State of Florida. Any inquiries about a Contractor should be transmitted to
the State Offices of the Contractor's Licensing Board.
23. This Contract shall be construed in accordance with and be governed by the laws of Florida.
Venue for anti lifigation arising under this contract must be in a court of competent
jurisdiction in Klonrce County, Florida.
24. The Contractoi assures that, to the extent applicable, it will undertake an affirmative action
program as required by 14 Code of Federal Regulations Part 152, Subpart E, to insure that
no person shall on the grounds of race, creed, color, national origin, handicap or sex be
excluded from pad^licipating in or receiving the services or benefits df any program or activity
covered by sad subpart. The Contractor assures that it will require that its covered sub -
organizations prairide assurances to the Contractor that they similarly will undertake
affirmative ac:ion programs and that they will require assurances from their sub -
organizations, as required by 14 Code Federal Regulations Part 152, Subpart E, to the
same effect.
Further, the Contractor shall comply with the regulations relative to the nondiscrimination in
Federally-assit ted programs of the Department of Transportation (hereinafter DOT) Title 49,
Code of Federal Regulations, Part 21, as they may be amended from time to time
(hereinafter re`erred to as the "Regulations"), which are herein incorporated by reference
and made a part of this Contract.
(a) The Contractor, with regard to the Work Performed by it during the term of this Contract,
shall not discriminate on the ground of age, sex, race, creed, color, handicap, or national
origin in the selection and retention of subcontractors, including procurement of materials
and leases of equipment. The Contractor shall not participate either directly or indirectly in
the discrimination prohibited by Section 21.5 of the Regulations.
(b) In all solicitations either by competitive bidding or negotiation by the Contractor for Work
to be performed under a subcontract, including procurement of materials and leases of
equipment, each potential subcontractor or supplier shall be notified by the Contractor of the
Contractor's obiiigations under this Contract and the Regulations relative to
nondiscrimination on the grounds of age, sex, race, creed, color, handicap, or national
origin.
(c) The! Contrector shall provide all information and reports required by the Regulations or
directive issued pursuant thereto, and shall permit access to its books, records, accounts,
other sources of information, and its facilities as may be determined by the Sponsor or the
Federal Aviation Administration to be pertinent to ascertain compliance with such
Regulations, crdeis and instructions. Where any information required of a Contractor is in
the exclusive possession of another who fails or refuses to fumish this information, the
Contractor sh 3tl .so certify to the Sponsor or the Federal Aviation Administration, as
appropriate, and ,shall set forth what efforts it has made to obtain the information.
(d) In the event of the Contractor's noncompliance with the nondiscrimination provisions of
this Contract, i he Sponsor shall impose such contract sanctions as it or the Federal Aviation
Administration may determine to be appropriate, including but not limited to:
AGREEMENT URS Corporation 00500 - 9
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MONROE COUNT.' -CONTRACTOR NOISE INSULATION CONTRACT
(1) Withhofiing of payments to the Contractor under this Contract until the Contractor
oomplie s aridtor
(ii) 0ancell ation, termination, or suspension of this Contract, in whole or in part.
(e) In the carrying out of the Contract Work, the Contractor shall not discriminate against any
employee or applicant for employment because of race, creed, color, sex, age, handicap, or
national origin. The Contractor shall take affirmative action to ensure that applicants are I
employed, and 7hat employees are treated during employment, without regard to their race,
creed, color, sex, age handicap, or national origin. Such action shall include, but not be
limited to the fcllorving: employment, upgrading, demotion, or transfer, recruitment or other 1
forms of compelsal:ion; and selection for training, including apprenticeship. The Contractor
agrees to , post in conspicuous places, available to employees and applicants for
employment, moticas to be provided by the government setting forth the provisions of this
nondiscrimination clause. The Contractor shall, in all solicitations or advertisements for
employees placed by or on behalf of the Contractor, state that all qualified applicants shall i
receive considora ion for employment without regard to race, creed, color, sex, age, i
handicap or national origin. The Contractor shall incorporate foregoing requirements of this
paragraph in all subcontracts for services covered by this Contract.
(f) The Contras! or shall include the provisions of this Section in every subcontract, including
procurement of materials and leases of equipment, unless exempted by the regulations or
directives issued pursuant thereto. The Contractor shall take such action, with respect to
any subcontrac or procurement, as the Sponsor or the Federal Aviation Administration may
direct as a mea is of enforcing such provisions including sanctions noncompliance.
25. It is the policy of the Department of Transportation and the Sponsor that disadvantaged
business enterprises as defined in 49 CFR Part 26 shall have the maximum opportunity to j
participate in tt a performance of contracts financed in whole or in part with Federal funds
under this Conlrac:t. Consequently, the DBE requirements of 49 CFR Part 26 apply to this
Contract.
The Contractor agrees to ensure that disadvantaged business enterprises as defined in 49
CFR Part 26 have the maximum opportunity to participate in the performance of contracts
and subcontra+Ks financed in whole or in part with Federal funds provided under this
contract._ In ' his regard, Contract shall take all necessary and reasonable steps in
accordance with 49 CFR Part 26 to ensure that disadvantaged business enterprises have
the maximum opportunity to compete for and perform contracts. Contractor shall not
discriminate on the basis of race, color, national origin or sex, in the award of DOT assisted
contracts. For the purposes of this Contract, the Contractor shall in the review of proposals
for Workk to be 3erformed seek to meet the Sponsor's goal of a minimum of 15% of the work ;
to be awarded :o qualified DBE firms on the Noise Insulation Program.
The calculator of percentage of Disadvantaged Business Enterprise participation shall be
as a percentac a of the total dollar amount of all contracts awarded to complete the Noise
Insulation Program.
26. Conflicts of Irterest: Neither the contracting party (parties), or its employees nor any
member of the r family or organization, shall have any direct or indirect interest, financial or
othe,wise, in tie business of any individual, entity or corporation involved in this project,
AGREEMENT URS Corporation 00500 - 10
.. . . —., • .a.. uv u—l... ,. ..., �..... ....... ..... r " Lv. U. .IVVI C yJr. V 1J
MONROE COUNTY-I:ONTRACTOR NOISE INSULATION CONTRACT
directly or indi redly involving the Airport. The undersigned warrants that they (or it)
presently have no interest which would conflict in any manner with nay of the contractual
responsibilities under this Agreement. The contracting party (parties) certifies that they (or
it) haves not employed or retained any company, firm or person, other than bona fide
employees wcrldng solely for them to provide the necessary labor, management and
material to per orin the work under this Contract; that no payment has been paid or agreed
to be paid to airy company, firm or person other than bona fide employees working solely for
the undersigned find no fee, commission, percentage, gifts or any other consideration is to
be paid contirgent upon or resulting from the award or making of the Agreement. For
breach or violEtion of this warranty, the Airport shall have the right to annul this Agreement
without liability
27. The Sponsor rial► terminate the Homeowner's participation in the Noise Insulation Program
upon delivery :)f written notice to the Homeowner d (a) the Homeowner fails or refuses to
correct conditions at the premises pursuant to paragraph 16b(2) above; (b) the Homeowner
fails to abide W any of the terns or conditions of the Monroe County -Homeowner Noise
Insulation Co trzw ; . or (c) the Homeowner is unreasonable, uncooperative or fails to
exercise good faith in the performance of the Monroe County -Homeowner Noise Insulation
Contract. If tho Sponsor terminates a Homeowner, they will pay the Contractor that portion
of the contract sum for the individual Homeowner earned prior to termination.
28. The Contractor makes oath he has complied with all the provisions of the applicable
Contractor's Lceinsing Act of the State of Florida.
AGREEMENT UAS Corporation 00500 - 11
MONROE COUN'rY.=KTRACTOR NOIRE& RMLATION CONTRACT
IN WITNESS WHEF:EOF, the pNIN hereon have encuted ftl16 Agreement on the la"date
set torch below.
CONTRACTOR:
Florida State Cemmmm's License e
Expiration Date
BY
TItIe:
Oats: -
STATE OF:
COUNTY OF:
On ihta day of in Ow year --,
Who is pwwwWAy krav» to me, or who produced aatistadory ldant COGn, affcad higftr 00"Wre in VW
space provided abor'o.
SIGNATURE OF NOTARY PUBLIC
MONROE COUNTY:
BY —
MONROE COUNTY ATTGnigE'v
P D ORM:
ILI ROWAT N. WOLFE
oauigT--'ram-TN , ATTORNEY
n
Nerve: 7..I"Rt
TNb: 919
Dun.
AMEEUEWr UAS Corporawn 00500.12
SECTION 00458
SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a),
FLORIDA STATUTES ON PUBLIC ENTITY CRIMES
1 • This sworn statement is submitted to Monroe County Board of County Commissioners
by �JV �f.-1, R 9ZQ4Q F—q
Ste. 57'�
And (if applicable) Its Federal Employer Identification Number (FEIN) is G 5404 -141 L � 2
(If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement:
0/A
2. I understand that a 'public entity crime' as defined in Paragraph 287.133 1 violation of any state or federal law by a person with respect y related
t, Florida Statutes, means s
with an pest to and direct) related to the transaction of business
y public entity or with an agency or political subdivision of any other state or of the United States,
Including, but not limited to, any bid or contract for goods or services to be provided to any public entity or an
agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft,
bribery, collusion, racketeering, conspiracy, or material misrepresentation.
3. 1 understand that 'convicted" or 'conviction* as defined in Paragraph 287.133 (1)(b), Florida Statutes means a
finding of guilt or a conviction of a public entity crime, with or without an adjudication of guild, in any federal or
state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of
a jury verdict, nonjury trial, or entry of a plea of guilty or polo contendere.
4. 1 understand that an 'affiliate' as defined in Paragraph 287.133 (1)(a), Florid_ a Statuto, means:
a. A predecessor or successor of a person convicted of a public entity crime: or
b. An entity under the control of any natural person who is active in the management of the entity and who has
been convicted of a public entity crime. The term 'affiliate' includes those officers, directors, executives,
partners, shareholders, employees, members, and agents who are active in the management of an affiliate.
The ownership by one person of shares constituting a controlling interest In another person or a pooling of
equipment or Income among persons when not for fair market value under an arm's length agreement, shall
be a prima facie case that one person controls another person. A person who knowingly enters into a joint
venture with a person who has been convicted of a public entity crime in Florida during the preceding 36
months shall be considered an affiliate.
5. I understand that a 'person' as defined in Paragraph 287.133(1)(e), Florida Statutes, means any natural person
or entity organized under the laws of any state or of the United States with the legal power to enter into a binding
contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity,
or which otherwise transacts or applies to transact business with a public entity. The tern -persons' includes
those officers, directors, executives, partners, shareholders, employees, members, and agents who are alive in
management of an entity. .
PUBLIC ENTITY CRIMES
URS Corporation 00458 -1
6 Based on information and belief, the statement .which I have marked below is true in relation to the entity
submitting this sworn statement. [Indicate which statement applies.]
_je� Neither the entity submitting this swum statement, nor any of its officers, directors, executives, partners,
shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of
the entity has been charged and convicted of a public entity crime subsequent to July 1, 1989.
/JJ* The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners,
shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of
/e,entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989L.
The entity submitting this swom statement, or one or more of its officers, directors, executives partners,
shareholders, employees, members, or agents who are active in the management of the entity or an affiliate of
the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. However,
there has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of
Administrative Hearing and the Final Order entered by the Hearing Officer determined that it was not in the public
Interest to place the entity submitting this swom statement on the convicted vendor list. [attach a copy of the final
order]
I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC
ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, THAT THIS
FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. 1 ALSO
UNDERSTAND THAT I AM REQUIRED TO IN RM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A
CONTRACT IN EXCESS OL M LINT PROVIDED IN SECTION 287.017, F'LO UDA STATUTES
FOR CATEGORY OF ANY CHI I HE F94ATION CONTAINED IN THIS FORM.
be same signature as on Bid F r
(Date)
STATE OF:
COUNTY OF:
On this day of the ear f r—/ RwL'Owle
who is rsonally kn to me, o o produced satisfactory identification, affixed his/her signature in th ace
provided abov .
DONNA P. AMATO
SI AT E OF NOTARY PUBL C •± Notary Public - State of Florida]
My Commsscn Expire@ Apr20, Zoos
� Commission • 00021204
END OF SWORN STATEMENT ON PUBLIC ENTITY CRIMES
PUBLIC ENTITY CRIMES i
URS Corporation 00458 - 2
SECTION 00452
DRUG -FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that
�SPt?��r�N�T�Io►kl, �U.13l,UG �I6�
(Name of Business)
1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, Possession,
a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees
for violations of such prohibition. p on, or use of
2. Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug -free
workplace, any available drug counseling, rehabilitation, and employee assistance r
may be impose upon employees for drug abuse violations. programs, and the penalties that
3• Give each employee engaged In providing the commodities or contractual services that are under bid a copy of the
statement specified in subsection (1).
_
4. In the statement specified in subsection (1), notifythe employees
or contractual services that are under bid, the employee p yees that, as a condition of working on the commodities
employer of any conviction of, or plea of guilt or no o �ntenderewill ito, any Violation f Chapter 893 (Florida the terms of the statement and will
Statutes) '
of any state, for a violation occurring In the workplace no later that five (5) days after such conviction.
5. Impose a sanction on, or require the satisfactory • such Is available in the employee's community, any emdpa ee who is snvirug c assistance or rehabilitation program It
6. Make a good
o con ma' in a rug- wo 6e through implementation of this section.
As the on authorized to sign the to n
at complies fully with the above I � requirements.
Sign by; -
(Must be same signature as on 8
(Date)
STATE OF;
COUNTY OF. -
On this _day o / j J
° Isper—sonall kno� In the yearc244 ax h i e 1 � C3 c 2 Q (�
provided a ove. to me. who produced satisfactory identification, affixed h7sw/hner
the space
DONNANotary PublicSI NATURE OF NOTARY PUBLIC MyC°'"r"is�°n'Commissio
END OF DRUG -FREE WORKPLACE FORM
DRUG -FREE WORKPLACE
FORM
URS Corporation
00452-1
i•
SECTION 00451
LOBBYING AND CONFLICT OF INTEREST CLAUSE
SWORN STATEMENT UNDER ORDINANCE NO. 010-1990
MONROE COUNTY, FLORIDA
c r t"L:S CLAUSE
��PITA�ta.TLl �,S?'t7Lt-J7,�tJ4.(, p1i1.8(.1G pa-�S�v�-r�o��
. a
(Name of Business)
warrants that he/it has not employed, retained or otherwise had act on his/its 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
violation of this provision the County may, in its discretion, terminate this contract without liabilor
ity
and may also, irl its discretion, deduct from the contract or purchase price, or otherwise recover, the
full amount of any fee, mission
officer or employ , percentag7tft, or consideration paid to the former County
iigne by` _
(Must be same signature as on id Form)/ (Date) % v
STATE OF:
COUNTY OF:
"thee_a . In the year
provided above. me, who Produced sa�
ARY PUBLIC
vw e Po eaA r L
ai�AtaYtSrs! lure in the space
[)01lNA P. AMATO
I Notary P0114 - aplta of FlorW4
rrrycoM01 Fxp10apr�p,�
COMMI1 las ti pQQR1A04
END OF LOBBYING AND CONFUCT OF INTEREST CLAUSE
LOBBYING AND CONFLICT
OF INTEREST CLAUSE
URS Corporation
00451 -1
SECTION 00450
NON -COLLUSION AFFIDAVIT
E AA
according to law on my oath and under penalty of perjury, depose and say that.
1. lam C. 0.
of the firm of Q U, ��
�iT�'t r l7LI,Tib►J�Q PU.�3U
the idder making the Proposal for the ro `l P gf'� C. p le�descnbed in the notice for calling for bids or.
K_West International Airport Noise Insulation Program Phase 2
and that I executed the said proposal with full authority to do so;
2. the prices in this bid have been arrived at independently without collusion, consultation, communication or
agreement for the purpose of restricting competition, as to any matter relating to such _prices ,with any other
bidder or with any competitor,
3. unless otherwise required by law, the prices which have been quoted in this bid have not been knowingly
disclosed by the bidder and will not knowingly be disclosed by the bidder prior to bid opening, directly or
indirectly, to any other bidder or to any competitor, and
4. no attempt has been made or will be made by the bidder to induce any other person, partnership or corporation
to submit, or not to submit, a bid for the purpos, f ncting competition;
5. Lstatements con �n this affi avit are and correct, and made with full knowledge that Monroe County
th of the stat t1 cant ' ed in this affidavit in awarding contracts for said project
Signed _
(Must be same signature as,6 id Form) / `
(Date)
v
STATE OF:
COUNTY OF:
On this day of in the year,
prov ed ave. �Q Vl 1 e. 1
who is ers pall kno to me, who produced satlsfa
bo
SIGNATURE OF NOTARY PUBLIC
Irp in the space
_NeINIII
DONNA P. AMATO
_• •'e NotaryPublic-
Sfata of Florida
�ti•1;3;1^. - MyCWrr1b11ME,0nWApr29,2W8
Commliilon 0 00021204
END OF NON -COLLUSION AFFIDAVIT
NON -COLLUSION AFFIDAVIT
URS Corporation 00450 - 1
a. .. .• .av •.-1— .-aw ..v.0 tea...• ay.. — C. UUL
03/05/2004V 14:0G 94:.-639050 HIPP IND PAGE e4
92/05/2BO4 17: e5 9 113639B50 HIPP IND PAGE K
Bond Number: 100MOM
SECTION 00514
PUBLIC CONSTRUCTION BOND
BY THIS SOND, 'Ne
, Industries, 1/Ho pitality 7rttiLULh!al Public; as Pnnrlpal
seza s,�
and Ca itol IcdWrdiy aa, a corporation, as
Surety, are bound to ttre Monroe County Board of County Commissioners, herein called Sponsor, in the
sum Of $; 1,336, 244.U) for payment of which we bind ourselves, or heirs,
personal reprew 7W#ivee, successors, and assigns, loirttly and severa/x.
Twe CONE)MO'I Ole THIS BOND is that If Principal:
1. Perform.. ttie contract dated _ 2003, between
Principal arnt Sponsor for construction of Key Want lntannatlonai Airport Nolse Inautation Program
— Phase 2, the contract being made a part of this bond by referonce, at the timos and in tho
manner )r sm'bed In to contract, and
2. PrompN5 rnakc= poynwnt to all claimants. as dedhed in Section 255.05(1), Florida Statutes,
aupplyin ) Principal with labor, materials, or suppNes, used dlrecoy or Indirectly by Principal In the
protaccn ion of the work provided fnr in the contraci and;
3. Pays Sp owsor all losms, dorm SON including OaMages for delay, expenses costs, and atbmeys
foot, iruiWing appellate proesedings, that Sponsor sustains because of a dlefsiuit by Princtipttl
under We nnnu-=; and
4. Perfomra the quarwifee of all work and nuftriwls fisnished under the cororect for the time
specifle 1 in the contract, then this bond is void: dlitnAse it remains in full force.
Any changes in or under the cordr2ct documer" and oomplianes with any lbrrnaimm oonnaetod with tho
contract or the c Mantles does rrot aft -et Surety's vbtlgadon under ttriss bond.
DATED OW _ _ . 2003.
PUBLIC CONS-rRtJ17TH7N BOND
H.I.P.P.
BY:
Capitol. IndrCorporationv
`
BY., David B. Attcrney-Irr
14"11Aaiis= ent^
URS Cdrporaffon '
00614-1
..�1.1 -1 u♦ ..a... .-v....i...— av — .1— — t). .•1VVa-C ',Vjuu.)
03/05/2004 14; 06 ':412IS-D9050 HIPP IND PACE 9h
CAPITOL INP MNITY CORPORATION 100010 6 8
POWER O)F ATTORNEY
KNOW ALL MEN BY THXSF. P11 VATNTS. That the CAPITOL INDEMNITY CORPORATION. a cotporstion of the State of Wiscunsin, having its
principal offices in the. City of M tdixm, Wisconsin. does make, constitute and appoint
DAVID B. SiIICK —
its tree and lawful A;totrlCy{a)-i:t-E:u:t, to make execute, sell and dciivec for and on its behalf, as surety, and as its act and deed, arty and all toads,
undertakings and contracts or St ren�;"gip. prmidcd Qwt oo Mond or undertaking or contract of swatychip exccotr-d itnAer this outhority shall gtceed :r.
amount the Sum of
--•------�----.....__---_—.— NOT TO EXCEED $3.000,000,00
This Power of AMMJCY is &Mt W :m,i. is signed and sealed by %csiinfle ttndii andhy thcauthority of the following Retiolugon adopted by the Board
of Directors of CAPITOL RM:?M Q,*TY CORPORATION at a marting duly called and held on dais Out day of'Msy, 2002.
"RESOLVED, that the Presidett, and >=xecutive Viee-President, the Secretary or Treasurer, acting individually or otherwise, be and they hereby are
grantadthe power and authoritntiott to appoint by a ruwrt of Attotncy for the purposes only of oxosutine and attesting bnnde and undertakings and
other writings abligttory. in th nxt ere thereof. azc or tort vicopre6ide»ts, assistant vactotariee No attorneys} -in -fact; each appointee to have the
powers, and duties tntual to suet offrrrs to the business of the Corporation; the sigpatu►e of such officers and seal of the Corporation tay,ba, affixed to
ruck pourer of am%rr ry tar to an,,, certificate gelatin¢ lbernto by facsimile, and any such Pcwcr of attomcy or certificate bearintl such facsimile signatures
or facsimile seal shall be valid and hin+iing upon :he Corporation in the furore with respect to any bond or undertaking or other Writing oaltgstory in
the nature thcMaf tc. which it 11 an:u:hed- Any surd appointmeat may be revoked for cause, or without cause, by any of said officers, at any time"
IN W1T1rESS WIII?REOF, tb : CAPITOL INDEMNITY CORPORATION has causad the" priesattts to be signed by its unite, wdersigned and it,
corporate -seal ter be b;rctq s(E xed duty attested by its TreaSurer, thin Ist day of Octoberj-2W3.
r
Mk3l.* CAPITOL INDEMNITY CO1itPORATION
Wst,t,m °s 4
Thomas K. Muti on SEAL David F. Pauly
7lstiryrer President and CEO
STAT)i' OF VYISCOMIN
COUNTY OP DAle a.s_
On the 1st day of I. ictnber, 2t:83 k.cfore me penttanny came David F. Patt(y. to me known, who being by me duly sworn, did dcDose and say, that he
resides, in the County of Dan!, :Late of Wisconsin; that he is President and CEO of CAPITOL INDEMNITY CORPORATION, the corporation
described in and which axecu.ed the above instrument; that he knows the seal of the said corporation; that the seal affixed to said irlstrumeM is such
cotpoiate seal; that it was so : tiered by order of the Board of Dircctois oftaid Corporation and that ba signed his name thereto by like order.
;KU
A
• taUtsar
Kathleen A. Paulson
STATH OF WISCaaNSlM Notary Public- Dane Co.. WI
S •= M Commisiioa Exrirc= In-1S-�MIE
COt1NffY or ' DANL : GTi[riIMCA76 ` Y
I, the,ttadersigncd, duly. ;It :o the otiice stated bclow,.noty the incumbent, in CAPITOL INDEMMITY CORPORATION, a Wisconsin
Corporation, authnreed to m rite 11tis certificate, DO HIREEY CERTIFY that the foregoing attached Power of Attorney remains in full force and has
not been revoked; and fiMhes mere, that the Resolution of tits Hoard of Directors, set forth in the Power of Attomcy is now to force.
Signed and sealed: at the Cit% of Madison, State of Wisconsin thine —fir— day of 2
p
I=.. W. Smi"
\�+ s Aasesmrit Secretary
THiS DOCUMB14T IS NOI VAIAD UNLESS PRMTED UiQ_B%11� SMALII!U tsAc&t%R6uNTj WITH A RED SERIAL :NUMBER III THE L;rrER
RIGHT. HAND CORNER. "'lie l:eP.CK OF TiIIS DOCUMIIN-J;;OI-& tDTS hkW&EF APM IF YO[f H E ANY QUESTIONS CONCERMNG
THE AL'THr-NT_riTY OF' ilI i D1xUMt5NT CALL 800-i75-4450-^ ", "`':
.. CI[.aoznn , 1aa31
lAO l Vl\1 -I.'11 —.,
03/05/2004 14:06 ' 1 3039050
HIPP IND
Au. w. u. :auure C. wt
PAGE 05
ins ured's Name
H.I.P.P. Indw.,triPs, Inc.11iospitality Institutional
Insured's Malling Address
1385 5" Stree S2•rai5gts. FL 34236
P :)livy Number
10001068 -
IMPORTANT NOTICE TO OBLIGEES/POLICYHOLDERS
TERRORISM RISK INSURANCE ACT OF 2002
You are hereby notified that, under the Terrorism Risk Insurance Act of 2002, effective
November 26, 2002, we must make terrorism coverage available in your bond/policy.
However, the ai;tua►i coverage provided by your bond/policy for acts of terrorism, as is
true for all coN erages, is limited by the terms, conditlons, exclusions, limits, other
provisions of y3u- bond/policy, any endorsements to the bond/policy and generally
applicasble rules of law.
Any terrorism c3werage provided by this bondipolicy is partially reinsured by the United
States of America under a formula established by Federal Law. Under this formula, the
United States will pay g0% of covered terrorism losses exceeding a statutorily -
established deductible paid by suretieslinsurers until such time as insured losses under
the program reach $100 billiorl. if that occurs, Congress will determine the procedures
for, and 'the soc.ICIa of, any payments for losses in excess of $100 billion.
The premium charge that has been established for terrorism coverage• under this
bondipolicy is Either shown on this form or elsewhere in the bondlpolicy. if there is no
premium shows for terrorism on ff s-form or elsewhere in the bond/policy, there is no
premium for the o3verage.
Terrorism premium: ( $0
L
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