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Item C12BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY MEETING DATE: 10/20/04 DIVISION: COUNTY ADMINISTRATOR BULK ITEM: YES DEPARTMENT: AIRPORTS AGENDA ITEM WORDING: Approval of contract with Koch Corporation for the Noise Insulation Program, Phase 3 construction, for the Key West International Airport. ITEM BACKGROUND: This project will be funded 95% by the Federal Aviation Administration, and 2.5% each by the Florida Department of Transportation, and Passenger Facility Charge Revenue. PREVIOUS RELEVANT BOCC ACTION: Award of bid to Koch Corporation, 8/18/04. CONTRACT/AGREEMENT CHANGES: New agreement STAFF RECOMMENDATION: Approval TOTAL COST: $2,046,889.00 COST TO AIRPORT: None COST TO PFC: $51,172.22 COST TO COUNTY: None REVENUE PRODUCING: No XKIk1r1*t#-9Aam- SOURCE OF FUNDS: FAA, FDOT, PFC Revenue AMOUNT PER MONTH NEAR: APPROVED BY: County Attorney X OMB/Purchasing X Risk Management X DIRECTOR OF AIRPORTS APPROVAL /000 Meter J. Rorton DOCUMENTATION: Included X DISPOSITION: /bev APB To Follow Not Required AGENDA ITEM # MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract # Contract with: Koch Corporation Effective Date: Execution Expiration Date: 120 days Contract Purpose/Description: Noise Insulation Program (Ph III Construction) Contract Manager: Bevette Moore # 5195 Airports - Stop # 5 (name) (Ext.) (Department/Courier Stop) for BOCC meeting on: 10/20/04 Agenda Deadline: 10/5/04 CONTRACT COSTS Total Dollar Value of Contract: 2,046,889.00 Current Year Portion: 2,046,889.00 Budgeted? Yes Account Codes: 404-63094-530490-GAKA91 Grant: Yes - FAA 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 Yes No Airports Director /Za/ (4 Risk Management /-4/� ( ) O.M.B./Purchasing /Q / ( ) V County Attorney Comments: Reviewer <ee,J, a-Men.c4Jd County Attorney Date Out Key West International Airport -Monroe County Noise Insulation Program CONSTRUCTION CONTRACT THIS AGREEMENT effective 30* day of August , 20 04 between the MONROE COLJNTY, a municipal corporation organized and existing under the laws of the State of Florida (hereinafter referred to as the "Sponsor") and Koch Corporation (hereinafter referred to as the "Contractor"). WITNESSETH WHEREAS, the Sponsor is the sponsor of the Key West International Airport Noise Insulation Program (hereinafter referred to as the "NIP"); and WHEREAS, the Sponsor has elected to implement the third phase of the NIP (hereinafter referred to as "Phase 3"); and WHEREAS, the Phase 3 NIP is managed by the consultant team consisting of the prime manager, architect, acoustician and construction manager (hereinafter referred to as the Program Manager") WHEREAS, the Contractor shall perform all necessary work and labor in the Phase 3 NIP (hereinafter referred to as the "Work"); and WHEREAS, the Work shall be performed in accordance with the approved Phase 3 NIP Construction Drawings dated April 30, 2004 (hereinafter referred to as the "Drawings" and the approved Phase 3 NIP Construction Specifications dated April 30, 2004 (hereinafter referred to as the "Specifications"); and WHEREAS, the Work shall be completed in accordance with the following Phase 3 NIP Construction Schedule (hereinafter referred to as the "Schedule"), consisting of the sub -construction construction schedules (1-4) and total construction period schedule; and Phase 3 Total Construction Period 120 days Mon 3121/05 Tue 8/16/05 Sub -Construction Period 1 (9 homes) 30 days Mon 3/21/05 Fri 4/29/05 Sub -Construction Period 2 (10 homes) 30 days Mon 4/25/05 Fri 6/6/05 Sub -Construction Period 3 (10 homes) 30 days Mon 5/31/05 Fri 7/12/05 Sub -Construction Period 4 (10 homes) 30 days Mon 7/6/05 Fri 8/16/05 NOW, THEREFORE, in consideration of the terms, covenants and conditions set forth herein, and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Sponsor and the Contractor hereby agree as follows: That the Contractor in consideration of the payment of the Contract price thereof amounting to Two Million Forty Six Thousand Eight Hundred Eighty Nine Dollars ($2,046,889.00), shall perform all work set forth in the Drawings and Specifications, and agrees to furnish all materials (except as specified to be furnished by the NIP), together with all necessary to furnish all necessary equipment, tools, labor, and other means of construction and do and perform all necessary work and labor for the full completion of the Work under Contract No. THC NO. 04KW 13 the Work to be performed in accordance with approved Drawings and Specifications and for the price and compensation set forth above and as specified in the Bid Form of the Contractor which is hereto attached and hereby made a part of this agreement. The Work will be performed in accordance with Schedule. Work and payments will be pursuant to and in accordance with Drawings and Specifications, therein set forth and addenda thereto, all being incorporated by reference and being a part of this agreement. The Contractor agrees to utilize the following Disadvantaged Business Enterprises: Kenmar General Contracting LLC CONSTRUCTION CONTRACT/BONDS 00500 - 1 1 Contractor agrees that the Work shall be done and performed in a good and workmanlike manner, that all materials and labor shall be in strict conformity in every respect with the Drawings and Specifications for the improvement and shall be subject to inspection and approval of the Sponsor through its duly authorized Program Manager and, in case any material or labor supplied shall be rejected by the Sponsor as defective or unusable, such rejected material shall be removed and replaced with approved material, and the rejected work shall be corrected to the satisfaction and approval of the Sponsor through its authorized Program Manager, at no additional cost or expense to the Sponsor. Contractor firrther agrees that he will commence the Work hereunder upon receipt of the executed copy thereof and will complete the Work to the satisfaction and approval of the Program Manager within the time limits specified in Time of Completion and Schedule sections in the Specifications. It is further agreed that any delay caused by the elements and other causes over which Contractor has no control or by strikes or other combined action of workers employed in the construction or in the transportation of materials, in no part caused or resulting from default or collusion on the part of the Contractor, shall be excused and the time for completion extended to the extent that Program Manager may find and determine such condition to have delayed completion within the time limit through no fault of the Contractor, but the judgment of Program Manager in respect thereto shall be final and conclusive upon the parties. Contractor agrees that neither it nor its Subcontractors shall have any claim for damages against the Sponsor or its agents arising from delays in the Work. Contractor understands that its sole remedy for a delay is an extension of time. The Sponsor and the Contractor agree that the damages which would be incurred by the Sponsor in the event of delay of the Project would be substantial but are not capable of being precisely calculated as of the execution of this Contract. The Sponsor and the Contractor therefore agree based upon their professional knowledge and experience with projects of this type 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 Thousand Dollars ($1,000.00) from the Contract Sum for each calendar day (Sundays and Holidays included) after the final Completion Date (8/16/05) that any part of the Work upon any property remains incomplete, herein stipulated as fixed, agreed, as liquidated damages, and not as a penalty. It is further understood and agreed that no claim for extra Work done or materials furnished by the Contractor will be allowed except as provided by the Drawings and Specifications, nor shall the Contractor do any work or furnish any materials not covered by the Drawings and Specifications and by this Contract unless such work is fast ordered in writing as provided in the Drawings and Specifications. Any extra work done or materials furnished by the Contractor without written order first being given therefore as in the Drawings and Specifications provided shall be at Contractor's risk, cost and expense, and Contractor agrees in such event that he will make no claim for compensation for such extra work or materials. It is further agreed that in no event shall the contracting officers of the Sponsor be personally liable or responsible in any manner to the Contractor, Subcontractors, suppliers, laborers or to other person or persons whomsoever for claim, demand, damages, actions, or causes of action or character arising out of or by reason of the execution of this agreement or the performance and completion of the Work and improvement provided herein. Contractor certifies to being not disqualified or debarred from entering into or receiving a Florida Department of Transportation contract, or a municipal State -aid or County State -aid Contract administered by the Department of Transportation as agent of a municipality or county pursuant to Florida Statutes. Further, Contractor agrees not to utilize either directly or indirectly any contractor, corporation, partnership, or business however organized, which is disqualified or debarred from entering into or receiving contract as stated above. This restriction applies regardless of whether the disqualified or disbarred party acts in the capacity of a Contractor, a Subcontractor, or as an equipment or material supplier. It is further agreed that the Contractor will abide by the provisions of Title VI of the Civil Rights Act of 1964 and Federal Regulations of the Department of Transportation, set forth in Section 00210 of the Specifications, will afford opportunity for Disadvantaged Business Enterprise as set forth in Section 00210 of the Specifications, will comply with restrictions on Federal Public Works Projects as set forth in Section 00210 of the Specifications, will comply with the General Civil Rights Provisions as set forth in Section 00210 of the Specifications, and will comply with Buy American Steel and Manufactured Products for Construction requirements as set forth in Section 00210 of the Specifications. CONSTRUCTION CONTRACT/BONDS 00500 - 2 SEP-24-04 09:25 FRUM=MUNRUL GUUNTY ATTY UFFl(:E lU:J46bWUWJblU PAI;G 1/1 M0Nlt0L C01IN1 Y NOISL• INSULATION 11W)GRAM By _ .. STATE OF FLORIDA ) ) SS MONROE COUNTY ) This instrument was acknowledged before me on day of , 20 by as the authorized representative of Monroe County NIP. (Notarial Sea]) Notary Public Signature CON T By C. S ph n Koch Title President Contractor Individual & Co -Partnership Acknowledgment STATE OF FLORIDA ) ) SS MONROE COUNTY ) This instrument was acknowledged before me on day of -, , 20 by Notary Public Signature (Notarial Seal) AP D M Contractor Corporate Acknowledgment BY All 0 � STATE OF KENTUCKY ) SS JEFFERSON COUNTY ) This instrument was acknowledged before me on 30th day of Aueust .20 04 by C._St®hen Koch as the authorized r rasentative (s of V.6ch C oration _ NAry Pub a Signature (Notarial Seal) CONSTRUCTION CONTRACT/BONDS 00500 - 3 MONROE COUNTY NOISE INSULATION PROGRAM ILIM STATE OF FLORIDA ) ) SS MONROE COUNTY ) This instrument was acknowledged before me on day of , 201 by as the authorized representative of Monroe County NIP. (Notarial Seal) By U C. Title Pr Contractor Individual & Co -Partnership Acknowledgment STATE OF FLORIDA ) SS MONROE COUNTY ) This instrument was acknowledged before me on day of by (Notarial Seal) Contractor Corporate Acknowledgment STATE OF KENTUCKY ) ) SS JEFFERSON COUNTY ) Public Signature 0 Notary Public Signature 20 , This instrument was acknowledged before me on 30th day of August , 20 04 , by C. Stephen Koch as the :;j7en of Ko6ch CgWration N Pubtfc Signature (Notarial Seal) CONSTRUCTION CONTRACT/BONDS 00500 - 3 Monroe Cau* Now insulation Proms (W PAYM ENT AND PERFORMANCE BOND Part A: Payment Bond BM No. SWW5371 KNOW ALL BY THESE PRESENTS, that we, ROCS itmaN Contractor, as Principal, whose address is XL STY DOMWKE COMPANY , and Surety . whose address is 25 — BLVD. , IRIUM, NJ QM9 daily authorized and licensed to do business in the Stator of Florida, as Surety, hereinafter called Surety, are hold and firmly bound unto the MONROE COUNE'Y NOISE TNSULATION IFROGRA as obli , hen:inaftcr called owner, for the use and benefit of claimants as biereinafter provided in the amomit Of eim EMM! Dollars, for the Payment whareof Prin*W and Surety bind themselves, thek heirs, executors, adminrstt'ators, successm and assigns, jointly and severaft, firmly by time presents. WSEREAS, Principal hat wrW m affeement dated , 20 , entered into a conttact with Owner tar NIP Phase 3 CONTRACT 7w al - , in accordance with drawings and specifications prepared Wfor MONROE COUNTY Nip which contract is by Tefercnce made panty of hereof and is required by Section 255.05, Florida Statutes- The said written agreement, drawingsv specifications and amendments are hereinafter referred to as the Contract. NOW ,rE=VORE, THE CONDITION OF THIS OBLIGATION, as required by Section 255.05, FlQQd& Statutes, is such titan, if the Principal shall faithfully pe r=Lv faun said carttract and pay every person entitled thereto for all the claims for labor performed and materials fnmishe:d under the Contract, to be used or consumed in making the public improvements or performing the public work as provided in the Contract, then this obligation shall be null and void; oiherwisc is shall remain in full force and effect, subj ect, however, to the following c0nditib0s:1) No assignment, modification or change of the Contract, or change in the work covered thereby, or my extension of time far the: completion of the Contract shall release the sureties an the bond. 2) Not law than one year after the completion of the work under the Contract, any party in interest nosy maintain an action in his own name against the Principal and the Surety upon finis bond for the recrnrety of any damages he may have sustained by reason of the failure of the Principal to comply with the Contract or with the Cootract between the Principal and his subwntractors. If the amount realized on this bond is insufficient to satisfy all clahns of the parties in full, it shall be distributed among the parties pro rota. Signed and sealed this 30th day of August , 20 Q4 mi THE PRESENCE OF: (Contractor) 1 By: ILA i Lisa G, Green C,Step n Koch: President XL SPECIALTY IlNSINUANCE COMPANY Name of Surety NWIFE oww'-ft A s i :SDI A r- o- � a; CONSTRUCTION CONTRACTIBONDS 00500 - 4 .tl, Moixo•CountyNahe haulatlon tm9r9m (NIP) PAYMENT AND PERFORMANCE- BOND Fart B: Performance Bond KNOW ALL BY THESE PRESENTS, that we, 1; 0: s•,; 1� • BM NO. SBOO85371 Contractor, as Principal, whose address is xL SPECIALTY nis RANCE 00[''1PANY , and Surety 25 1 12MENCE BLVD. , MARREN, W 07059 , wbose address duly mghoemd and licensed to do busiaess in the State of Florida, as Surety, hereindfkr called Surety, are held and firmly bound hmto MONROE COUNTY NOi1S8 INSULATION PROG thftmolwar, for the use and benefit of claimants as herehudler Provided In the amomtt of Dollars, for the payment whereof Principal and anreiybind themselves, their heiaa, executors, adminisdatars, successors and assigns, joimiy and severally, firmly by these preseats. VVIlIERIEAS, Principal has written agreement dated , 20 . entered late a contrail with Owner for NLP CONTRACT� p�in accordance with drawings and specifications prepared byffior MONROE COUNTY W which c *Mact is by &r made party of hereof and is required by Section 255.05, Florida Statates. The aid written agreemen, drawings, specifications and amendments are hereinafter referred to as the Contract. NOW THEREFORE, THE CONDITION OF THIS ODUGATION, If the Principal shall faithfully complete the contract(s) according to its terrng and awl save the Monroe Cotmty NIP harmless $om all host and charges that may accruo on account of the doing of the Work specified and *An Pay all costs of err#brcernent of the terms of the bond, if action Is brought thereon, including rmonable attomey's fees, costs and disbursements, in say case in which such action is successfully maintained, or successfully appealed, and shall comply with the laws of. the state appertainliag to sucb Contraco(s), then this obligation shall be void but otherwise it shall remain in full force and effect pursuant to Florida Statates. Signed and sealed this 30th day of A.ncm St . 2004 TN THE PRESENCE OF: 74/t,/ 83r ---Q Wig Lisa G, Green C, Ste of Principal (Contractor) Koch, President xL SPECIALTY INSURANCE COMPANY Name of Surety 1�2-- �Wess By.(Seal) IANE L. PEDELPS STEVEN M. GARREl'r, AZ'1�i1�Y—IN—FACT CONSTRUCT ON rONTRACT/BONDS 00500 - 5 ';SURETY DISCLOSURE -NOTICE CONCERNING FEDERAL TERRORISM RISK,'INSURANCE,AC-i-,,, "(7.1- nr W VVI Hu 11 ..!qFW%ol0lLY11; , aul al now . %owl 1110gagly 4% 7 111 4, - :. �'pk�•t. y.p .,+* .e~�., .•• '1.�. 4�i' s�' ."p''._ N Wq, DISC 0) URE OF PREMIUMi d,tt T4 f portion coverage. or c acts o The on"of the Dona prem Hrri,a rye '15 Po a q terrorism under the Act isZero 'Dollars ($0.00) e,z MA xty _w"". lave �, fF.- - JwFl ar. .X k A �4 r IN 64; i LG k'! Ni A v-� ,t7 Y YT Ole 71- ACORD CERTIFICATE OF LIABILITY INSURANCE 08/27/2004 PRODUCER Garrett -Stott Company THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6011 Brownsboro Park Blvd HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite B Louisville KY 40207-1292 INSURERS AFFORDING COVERAGE INSURED Koch Corporation INSURER A: Amerlsure Companies INSURER B: P. O. Box 4398 Louisville KY 40204 - ( INSURER C: INSURER D: INSURER E: GU V CKAtaG7 ! THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iNSR �A TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR POLICY NUMBER CPP 1322729 POLICY EFFECTNE 12/31/2003 POLICY EXPIRATION 12/31/2004 EACH OCCURRENCE 1,000,000 FIRE DAMAGE arm 100,000 MED EXP one 3 5,000 PERSONAL 5 ADV INJURY $ 1,000 000 GENERAL AGGREGATE $ 2,000,000 GEICL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG S 2,000,000 ! POLICY X PRO LOC A AUTOMOBILE LIABILITY CA 1322730 12/31/2003 12/31/2004 COMBINED SINGLE LIMIT (Es accWW) $ 1.000,000 ANY AUTO X ALL OWNED AUTOS SCHEDULED AUTOS BODILY IMURY (P- Paon) er S X X BODILY INJURY S HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per acment) S Ex GARAGE L'Am ILITY AUTO ONLY -EAACCIDENT S ANY AUTO OTHER THAN EA ACC AUTO ONLY. AGG S S ExcEss LIABILITYCU X OCCUR CLAIMS MADE 1322731 12/31/2003 12/31/2004 EACH OCCURRENCE 5,000,000 AGGREGATE 5 000,000 DEDUCTIBLE S RETENTION S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC 132177002 12/31/2003 12/31/2004 X I wC STATU- oTH- EL EACH ACCIDENT $ 100,000 EL DISEASE - EA EMPLM S 100,000 E.L. DISEASE - POLICY LIMIIT S 500 000 OTHER EQUIP.FLOATER CPP 1322729 12/31/2003 12/31/2004 $80,000 PER ITEM & AGGREGATE DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECULL PROVISIONS ALL WORK INCLUDING MONROE COUNTY NOISE INSULATION PROGRAM (NIP) PHASE 3 CONTRACT THC NO, 03KW20 MONROE COUNTY BOARD OF COUNTY COMMISSIONERS 1100 SIMONTON STREET KEY WEST FL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURER ITS AGENTS OR 33040 1 AUTHORIZED REPRESENTATIVE AGORD 25-3 (7/97) W A16UKU L;UKYUKA I IUN INCO IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmativeiy or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S (7197) SECTION 00410 BID FORM BID TO: MONROE COUNTY PURCHASING DEPARTMENT 1100 SIMONTON STREET ROOM 2-213 KEY WEST, FLORIDA 33040 BID FROM: Koch Corporation 1131 Logan Street Louisville, KY 40204 The undersigned, having carefully examined the Work and reference Drawings, Specifications, Proposal, and Addenda thereto and other Contract Documents for the construction of: Key West International Airport Noise Insulation Program - Phase 3 and having carefully examined the site where the Work is to be performed, having become familiar with all local conditions including labor affecting the cost thereof, and having familiarized himself with material availability, Federal, State, and Local laws, ordinances, rules and regulations affecting performance of the Work, does hereby propose to furnish all labor, mechanics, superintendents, tools, material, equipment, transportation services, and all incidentals necessary to perform and complete said Work and work incidental hereto, in a workman -like manner, in conformance with said Drawings, Specifications, and other Contract Documents including Addenda issued thereto. The undersigned further certifies that he has personally inspected the actual location of where the Work is to be performed, together with the local sources of supply and that he understands the conditions under which the Work is to be performed. The successful bidder shall assume the risk of any and all costs and delays arising from the existence of any subsurface or other latent physical condition which could be reasonably anticipated by reference to documentary information provided and made available, and from inspection and examination of the site. The undersigned acknowledges that if awarded this contract on the basis of this Proposal, they will commence pre -work activities within ten (10) days, after the date specified as the "Notice to Proceed with Pre -Construction Activities." The Bidder and Bidders Surety shall also agree to be liable for and shall make payment to the Sponsor based on the following: 1. For each day after the Completion Date for the entire Work of the Contract that any part of the Work upon any parcel remains incomplete the bidder shall incur $1,000.00 per day in liquidated damages as provided in the Agreement. I acknowledge receipt of Addenda No.(s) 1, 2 (Check mark items below, as a reminder that they are Included.) BID FORM 00410 - 1 I have included the following items, which have been appropriately executed and notarized: Section Description 00430 00431 00450 00451 00452 00453 00454 Y 00455 00456 00457 00458 00459 t/ NA Bid Bond Performance of Work by Subcontractors Non -Collusion Affidavit Lobbying and Conflict of Interest Clause Drug -Free Workplace Form Equal Employment Opportunity Report Statement Disadvantaged Business Enterprise Assurance Certification of Non -Segregated Facilities Certification Regarding Debarment, Etc. Certification Regarding Foreign Participation Sworn Statement on Public Entity Crimes Buy American Certification Copies of Contractor and Subcontractor Licenses The Bid is broken down into the following categories: 1. Bonds and Insurance: 2. Pre -construction Work: 3. General Conditions: 4. Windows: 5. Doors: 6. Storm Products: 7. Hurricane Shutters: 8. Wall Modification: 9. Mechanical: 10. Electrical: Measurement Visit & Precon. Mtg: $ 3 -Awe aolfai 4ny 'fix V44'jz< (Total Bid — in words) N yAA �W:T (Total Bid — in figures) Included in the Total Bid above are the following line items: 1. Cost of conducting the duct leakage test (x) the number of homes: (x) 29 homes = $ / 2 , -4 S 2. Remediation cost for an estimated 3 hours of sealing (per home): p per hour labor (x) 3 hours (x) 29 homes = $ O. 70L4) oiu rumor 00410 - 2 Mailing Address: Koch Corporation 1131 Logan Street Louisville, KY 40204 Phone Numbel(s): lip J502-616-3571 Signed by: C. STephgn Koch, President STATE OF: Kentucky 7/13/04 (Date) COUNTY OF: Jefferson On this 13th day of July , in the year, C. Stephen Koch who is personally known to me, or who produced satisfactory identification, affixed his/her signature in the space provided above. .� 1 SIGNAYURE OF NOTARY BLIC ` END OF BID FORM BID FORM 00410 - 3 SECTION 00431 PERFORMANCE OF WORK BY SUBCONTRACTORS The BIDDER hereby states that he proposes, if awarded the Contract, to use the following subcontractors on this project: List below ALL proposed subcontractors (including DBE subcontractors) and trade specialties. If type of work to be performed will be performed by Contractor's own forces, place "NA" in the space provided. Add any additional categories as needed. s. Mechanical (HVAC) Sub -Zero Electrical RORIM Window Installation Kenmar General Contracting, LLC Carpentry Drywall �1 Masonry Painting / Staining Thermal Insulation Sarasota Manatee Insulation Acoustic Storm Protection Door Installation Hurricane Shutters Kenmar GeneraVtontracti na, LLC Estimated Total Cost f I f that YTER states will be performed by Subcontractors: Signed by: (MUST qe same signature as on Bid Form) C. Stephen Koch, President 7/13/04 (Date) END OF PERFORMANCE OF WORK BY SUBCONTRACTORS PERFORMANCE OF WORK 00431 - 1 BY SUBCONTRACTORS SECTION 00450 NON -COLLUSION AFFIDAVIT I C. Stephen Koch according to law on my oath, and under penalty of perjury, depose and say that: 1• lam President ofthefirmof Koch Corporation the bidder making the Proposal for the project described in the notice for calling for bids for: Key West Intemational Airoort Noise Insulation PrOciram Phase 3 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 bidder or with any competitorto such prices with any other, 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 and indirectly, to any other bidder or to any competitor 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 purpose of restricting competition; 5• the statements relies upon the Signed by: (Wust be C, Ster in this affidavit are true and correct, and made with full knowledge that the Sponsor stat ments contained in this affidavit in awarding contracts for said project. I signature as on Bid Form) Kbch. President STATE OF: Kentucky COUNTY OF: Jefferson 7/13/04 (Date) On this —13-t►Ld8y of 0V in the year C. Stephen Koch who is personally known to me, or who produced satisfactory identmeation, affixed his/her signature in the space provided above. SIG4 AIE OF NOT Y P IC END OF NON -COLLUSION AFFIDAVIT NON -COLLUSION AFFIDAVIT 00450 -1 ETHICS CLAUSE SECTION 00451 LOBBYING AND CONFLICT OF INTEREST CLAUSE SWORN STATEMENT UNDER ORDINANCE NO. 010-1990 MONROE COUNTY, FLORIDA Koch Corporation „ (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 or violation of this provision the County may, in its discretion, terminate this contract without liability and may also, in its discretion, deduct from the contract or purchase price, or otherwise recover, the full amount of any f , commission, percentage, gift, or consideration paid to the former County officer or employee". Signed by. (Must be Fame signature as on Bid Form) C. Steph n Koch, President STATE OF: I Kentucky COUNTY OF: Jefferson 7/13/04 (Date) On this 13th dayof July in the year 2Q04 C. Stephen Koch who is personally known to me, or who produced satisfactory identification, affixed his/her signature in the space provided abov1� - SI G AT RE OF NO Y P LIC END OF LOBBYING AND CONFLICT OF INTEREST CLAUSE LOBBYING AND CONFLICT 00451 - 1 OF INTEREST CLAUSE SECTION 00452 DRUG -FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that Koch Corporation (Name of Business) 1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. 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 programs, and the penalties that may be impose upon employees for drug abuse violations. 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), notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilt or nolo contendere to, any violation of Chapter 893 (Florida Statutes) or 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 participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, any employee who is so convicted. 6. Make a good faith e t continue to maintain a drug -free workplace through implementation of this section. As the person aU rize s n the �4ement, I certify that this firm complies fully with the above requirements. Signed by. STATE OF: COUNTY OF: ((Must be fame signature as on Bid Form) C. Stephen Koch, President Kentucky Jefferson 7/13/04 (Date) On this 13th day of Ju 1 y , in the year 004 C . Stephen Koch who is personally known to me, or who produced satisfactory identification, affixed his/her signature in the space provided abo e. /�- IATURE OFIVOTAR�UIC END OF DRUG -FREE WORKPLACE FORM DRUG -FREE WORKPLACE 00452 -1 FORM SECTION 00453 EQUAL EMPLOYMENT OPPORTUNITY REPORT STATEMENT The Bidder shall complete the following statement by checking the appropriate blank spaces. Failure to complete these blanks may be grounds for rejection of Proposals. 1. The Bidder has X has not developed and has on file at each establishment Affirmative Action Programs pursuant to 41 CFR 60-14 and 41 CFR 60-2. 2. The Bidder has X has not participated in any previous contract or subcontract subject to the Equal Opportunity Clause prescribed by Executive Order 11246, as amended. 3. The Bidder has X has not filed with the Joint Reporting Committee the annual compliance report on Standard Form 100 (EEO-1 Report). 4. The Bidder Signed by: C, S X does not ie signature as on Bid Form) phen Koch, President STATE OF: I Kentucky COUNTY OF: Jefferson employ fifty (50) or more employees. 7/13%04 (Date) On this 13th day of July , in the year 2004 C. Stephen Koch who is personally known to me, or who produced satisfactory identification, affixed his/her signature in the space provided a ve. S GNATURE O OTA PUBLIC END OF EEO REPORT STATEMENT EEO REPORT STATEMENT 00453 -1 SECTION 00454 DISADVANTAGED BUSINESS ENTERPRISE ASSURANCE The Bidder shall complete the following statement by checking the appropriate box (check one only). Failure to complete this statement may be grounds for rejection of Bid. Signed (Must be C. Ster STATE OF: COUNTY OF: The Bidder assures that he shall meet the requirements of the DBE Provisions, for the Monroe County's DBE Policy and Program, and shall utilize not less than the prescribed goal of 15.5% DBE participation (See Page 00454-2). The Bidder is unable to assure DBE participation of the prescribed goal of 15.5% in this Contract, but shall provide for a minimum of percent ( %) participation. (If this box is checked, Bidder shall fill in the percentage blanks and document on a separate attachment to this Assurance, his efforts in attempting to meet the goal as instructed in "A Means to Ensure that Competitors Make Good Faith Efforts to Meet the DBE Goal" on Page 00454-2.) as on Bid Form) n Koch, President Kentucky Jefferson 7/13/04 (Date) On this 13th day of July , in the year 2004 C. Stephen Koch who is personally known to me, or who produced satisfactory identification, affixed his/her signature in the space provided above. SIGRA T URE OF WTARYAt 60C Ut3E ASSURANCE 00454 - 1 SECTION 00454 A MEANS TO ENSURE THAT COMPETITORS MAKE GOOD FAITH EFFORTS TO MEET THE DBE GOAL This solicitation will include a statement that the apparent successful competitor will be required to submit DBE participation information and that as a condition of receiving the contract, the competitor must meet the DBE goal or demonstrate to the Sponsor that it made good faith efforts. The actual clause to be used is: "The bidder shall make good faith efforts, as defined in Appendix A of 49 CFR Part 26, Regulations of the Office of the Secretary of Transportation, to subcontract 15.5 percent of the dollar value of the prime contract to small business concerns owned and controlled by socially and economically disadvantaged individuals (DBE). In the event that the bidder for this solicitation qualifies as a DBE, the contract goal shall be deemed to have been met. Individuals who are rebuttably presumed to be socially and economically disadvantaged include women, Black Americans, Hispanic Americans, Native Americans, Asian -Pacific Americans, and Asian -Indian Americans. The apparent successful competitor will be required to submit information concerning the DBEs that will participate in the contract. If the bidder fails to achieve the contract goal stated herein, it will be required to provide documentation demonstrating that it made good faith efforts in attempting to do so. A Bid that fails to meet these requirements will be considered non- responsive." The DBE participation information will be required prior to committing the Sponsor to award the contract to the apparent successful competitor. A Bidder may not meet the requirements of the bid specification by stating that it will accomplish all work of the contract using its own employees. It, first, must demonstrate to the Sponsor's satisfaction, that it made good faith efforts to meet the goal, and despite those efforts, was unable to subcontract any of the work to DBEs. DBE ASSURANCE 00454 - 2 SECTION 00454 REQUIRED CLAUSES FOR FAA -ASSISTED CONTRACTS The following clauses should be included in all FAA -assisted contracts (but not in leases) between the sponsor and any contractor: Policy: "It is the policy of the Department of Transportation that disadvantage business enterprises as defined in 49 CFR Part 26 shall have the maximum opportunity to participate in the performance of contracts financed in whole or in part with Federal funds under this agreement. Consequently, the DBE requirements of 49 CFR Part 26 apply to this agreement." DBE Obligation: "The recipient or its contractors agrees to ensure that disadvantage business enterprises as defined in 49 CFR Part 26 have the maximum opportunity to participate in the performance of contracts and subcontracts financed in whole or in part with Federal funds provided under this agreement. In this regard, contractors 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. Recipients and their contractors shall not discriminate on the basis of race, color, national origin, or sex in the award and performance of DOT -assisted contracts." Section 26.13(b) requires sponsors to advise each contractor and subcontractor who performs on an FAA -assisted project that failure to carryout the above requirements shall constitute a breach of contract. The following clause may be used for this purpose: "AII bidders, potential contractors, or subcontractors for this DOT -assisted contract are hereby notified that failure to cant' out the DOT policy and the DBE obligation, as set forth above, shall constitute a breach of contract which may result in termination of the contract or such other remedy as deemed appropriate by the recipient and the FAA." DBE ASSURANCE 00454 - 3 SECTION 00454 SCHEDULE OF DBE PARTICIPATION i sOWN 50 A6 ntraclal`� -� _ o yi n =� Wollat talu 7Mte Kenmar General -Contracting 1075 Duval St., C21PMB150 Key West, FL 33040 Window Installation Hurricane Shutters 7 Ft.Afz,+ U F.ltt,�iC 5-730 o?r U 'Q-' Cc1r-c7,k (4,1 -I1 �Z,�� 3 Total Dollar Value of DBE Subcontracted Work Total Dollar Value of Bid Total DBE Percentage The undersigned will schedule, conditiong( Signed by: to nearest 1 /10 percent) $ 3950 f ss $_ oq 1 f '7 % a form4 agreement with the DBE Subcontractors identified herein for work listed in this V acontract with the Sponsor. 7/13/04 ire as on Bid Form) h, President STATE OF: Kentucky COUNTY OF: Jefferson (Date) On this 13th day of July , in the year 2004 C . Stephen Koch who is personally known to me, or who produced satisfactory identification, affixed his/her signature in the space provided above SIGNAIURE OF OTARY ROBLIC DBE ASSURANCE 00454 - 4 SECTION 00454 DBE SUBCONTRACTOR IDENTIFICATION AFFIDAVIT according to law on my oath, and under penalty of perjury, depose and say that: I am ! ris 1 �Gt �'►'� 1 of the firm of whose address is 741 lJ V,+L I hereby declare and affirm that I am a Minority (MBE) or Female (WBE) Business Enterprise as defined by 49 CFR Part 26, and that I will provide information to document this fact. This firm is interested in bidding on the following categories of work being procured for the Key West International Airport Noise Insulation Program - Phase 3: NIAI�Wl �VkL �1u�9'n�✓1 -� U Trz S This firm has current DBE / MBE / WB/E_certification from the following agencies: rze I DO SOLEMNLY DECLARE AND AFFIRM UNDER THE PENALTIES OF PERJURY THAT THE CONTENTS OF THE FOREGOING DOCUMENT ARE TRUE AND CORRECT, AND THAT I AM AUTHORIZED ON BEHALF OF THE FIRM TO MAKE THIS AFFIDVVI Signed by: -'/ 3 a (Date) STATE OF: COUNTY OF: #g0nrOe On this I Z)A day of A in the year,,y I e' ^ I M Ar n(> who is personally known to me, or who produced satisfactory identification, affixed his/her signature in the space .,,,,• Caroline Vazquez : MYCOMMISSION# DD20M7 EXIRES April3Q 2007 BONDEOIMTROYFAIN INSURAKEWC DBE ASSURANCE 00454 - 5 Received Fax JL1 12 2004 5.00PM Fax Station —:--HP LASERJET 3330 n 2 07/12/2004 03:51 502-636-3468 KDCH CDRP ACDUSTICAL SECTION 00454 DBE SUBCONTRACTOR IDENTIFICATION AFFIDAVIT according to law on my oath, and under penalty of perjury, depose and say that: I am ryl eV<X-Z L of the firm of o r 1 C kcu. 4 whose address is 5730 /1d /+VI I hereby declare and affirm that I am a V' Minority (MBE) or PAGE 02/02 Female (WBE) Business Enterprise as defined by 49 CFR Part 26, and that I will provide information to document this fact. This firm Is Interested in bidding on the following categories of work being procured for the Key West International Airport Noise Insulation Program - Phase 3: This firm has current DBE / MBE / WBE certificatlon from the following agencies: 1 DO SOLEMNLY DECLARE A04AFFIRM UNDER THE PENALTIES OF PERJURY THAT THE CONTENTS OF THE FOREGOING DOCUMENT A A D CORRECT, AND THAT I AM AUTHORIZED ON BEHALF OF THE FIRM TO MAKE THIS AFFIDAVIT Signed by: -7 A 31 (Date) STATE OF: P �V C"' C"' COUNTY OF: _ M 6-1 G—.. On this . /L3 day ofCin the year a L VYkVmO-A4 v who Is personally known to me, or who produced satisfactory identification, affixed his/her si re In space Provided above. A NM11 MW Leon 4 1� ANC SIGNATURE OF N TARY PUBLIC ` '-, ^II �# WM721 EARS; DBE ASSURANCE 00454 - 5 SECTION 00455 CERTIFICATE OF NON -SEGREGATED FACILITIES CERTIFICATION TO BE SUBMITTED BY CONSTRUCTION CONTRACTORS AND THEIR SUBCONTRACTORS (APPLICABLE TO CONTRUCTION CONTRACTS AND RELATED SUBCONTRACTS EXCEEDING TEN THOUSAND ($10,000.00) DOLLARS (US $) WHICH ARE NOT EXEMPT FROM THE EQUAL OPPORTUNITY CLAUSE) The construction contractor certifies that he does not maintain or provide, for his employees, any segregated facilities at any of his establishments and that he does not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. The construction contractor certifies that he will not maintain or provide, for his employees, segregated facilities at any of his establishments and that he will not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. The construction contractor agrees that a breach of this certification is a violation of the equal opportunity clause in this contract. As used in this certification, the term "segregated facilities" means any waiting room, work areas, restrooms and washrooms, restaurants and other eating areas, time docks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directives or are in fact segregated on the basis of race, color, religion, or national origin because of habit, local custom, or any other reason. The construction contractor agrees that (except where he has obtained identical certifications from proposed subcontractors for specific time periods) he will obtain identical certifications from proposed subcontractors prior to=U400pportitity of subcontracts exceeding ten thousand ($10,000.00) dollars (US) which are not exempt from the provisions of clause and that he will retain such certifications in his files. Signed by: �'_ LYT" J ' \ ' 7/13/04 (Must be lame signature as on Bid Form) C. Stephen Koch, President STATE OF: Kentucky COUNTY OF: Jefferson (Date) On this 13th day of JUIY , in the year 2004 C. Stephen Koch who is personally known to me, or who produced satisfactory identification, affixed his/her signature in the space provided above. v `- J WGRATURE OF OTAR UBLIC END OF CERTIFICATE OF NON -SEGREGATED FACILITIES NON -SEGREGATED 00455 - 1 FACILITIES - SECTION 00456 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY, AND VOLUNTARY EXCLUSION — 49 CFR PART 29 (Version 1, 1/5/90) The bidder certifies, by submission of this proposal or acceptance of this contract, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. It further agrees by submitting this proposal that it will include this clause with modification in all lower tier transactions, solicitations, proposals, contracts, and subcontracts. Where the bidder/ offeror/ contractor of any lower tier participant is unable to certify to this statement, it shall attach an explanation to this solkitation/proposal. Signed by. (Must Me me signature as on Bid Form) C. Step n Koch, President STATE OF: Kentucky COUNTY OF: Jefferson 7/13/04 (Date) On this 13th day of July ,in the year 2004 C. Stephen Koch who is personally known to me, or who produced satisfactory identification, affixed his/her signature in the space provided above. i SIGNATURE OFINOTAW PUBLIC END OF CERTIFICATION REGARDING DEBARMENT, ETC. DEBARMENT, SUSPENSION, ETC. 00456 - 1 SECTION 00457 CERTIFICATION REGARDING FOREIGN PARTICIPATION The Contractor or subcontractor, by submission of an offer and/or execution of a contract certifies that it: 1. Is not owned or controlled by one or more citizens or nationals of a foreign country included in the list of countries that discriminate against U.S. firms published by the Office of the United States Trade Representative (USTR); 2. has not knowingly entered into any contract or subcontract for this project with a contractor that is a citizen or national of a foreign country on said list, or is owned or controlled directly or indirectly by one or more citizens or nationals of a foreign country on said list; 3. has not procured any product nor subcontracted for the supply of any product for use on the project that is produced in foreign country on said list. Unless the restrictions of this clause are waived by the Secretary of Transportation in accordance with 49 CFR 30.17, no contract shall be awarded to a Contractor or subcontractor who is unable to certify to the above. If the Contractor knowingly procures or subcontracts for the supply of any product or service of a foreign country on this said list for use on the project, The Federal Aviation Administration may direct, through the sponsor, cancellation of the contract at no cost to the Government. Further, the Contractor agrees that, if awarded a contract resulting from this solicitation, it will incorporate this provision for certification without modification in each contract and in all lower tier subcontracts. This Contractor may rely upon the certification of a prospective subcontractor unless it has knowledge that the certification is erroneous. The Contractor shall provide immediate written notice to the sponsor if the Contractor learns that its certification or that of a subcontractor was erroneous when submitted or has become erroneous by reason of changed circumstances. The subcontractor agrees to provide immediate written notice to the Contractor, if at any time it learns that its certification was erroneous by reason of changed circumstances. This certification is a material representation of fact upon which reliance was placed when making the award. If it is later determined that the Contractor or subcontractor knowingly rendered an erroneous certification, the Federal Aviation Administration may direct, through the sponsor, cancellation of the contract or subcontract for default at no cost to the Government. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render, in good faith, the certification required by this provision. The knowledge and information of a contractor is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. This certification a false, fictitious, Section 1001. Signed by. n the jurisdiction of an agency of the United State of American and the making of may render the maker subject to prosecution under Title 18, United State Code, C. 9ep�i*-'K-0cfl, 're i entFonn) STATE OF: Kentucky COUNTY OF: Jefferson 7/13/04 (Date) On this 13th day of J�lY , in the year 2004 C . Stephen Koch who is pe Ily known k9 me,ZI produced satisfactory identification, affixed his/her signature in the space providecJ a e.L � SIGNATURE OF N ARY UBLIC FOREIGN PARTICIPATION 00457 -1 SECTION 00458 SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES 1. This sworn statement is submitted to the Sponsor by C. Stephen Koch for Koch Corporation whose business address is: 1131 Logan Street Louisville, KY 40204 And (if applicable) its Federal Employer Identification Number (FEIN) is 61-0461707 (If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement: 2. 1 understand that a 'public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any 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 guilt, 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 nolo contendere. 4. 1 understand that an "affiliate" as defined in Paragraph 287.133 (1)(a), Florida Statutes, 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. 1 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 term "persons' includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity. VULSLI : tNTITY CRIMES 00458 - 1 Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this swom statement. [Indicate which statement applies.] X Neither the entity submitting this swom 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. 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. 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 sworn 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. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCE OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES FOR CATEGORY TW F NY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. Signed by:—LI 7/13/04 (M st be s me i n lure as on B'd Form) (Date) C.teph n i�t3�c�i, President STATE OF: Kentucky COUNTY OF: Jefferson On this 13th day of Judy in the year 2004 C, Stephen Koch who is personally known to me, or who produced satisfactory identification, affixed his/her signature in the space provided above. SIGNATURE OF NOTAR PUBLIC END OF SWORN STATEMENT ON PUBLIC ENTITY CRIMES PUBLIC ENTITY CRIMES 00458 - 2 SECTION 00459 BUY AMERICAN CERTIFICATION The Contractor agrees that only domestic steel and manufactured products will be used by the Contractor, subcontractors, materialmen, and suppliers in the performance of this Contract, as defined in (2) below. 2. The following terms apply to this clause: A. Steel and Manufactured Products. As used in this clause, steel and manufactured products include (1) those produced in the United States or (2) a manufactured product produced in the United States, if the cost of its components mined, produced or manufactured in the United States exceeds sixty (60%) percent of the cost of all its components and final assembly has taken place in the United States. B. Components. As used in this clause, components means those articles, materials, and supplies incorporated directly into steel and manufactured products. C. Cost of Components. This means the costs for production of the components, exclusive of final assembly labor costs. By submitting a Bid under this solicitation, except for those Items listed by the Bidder below or on a separate and dearly identified attachment to this Bid, the Bidder certifies that steel and each manufactured product, is produced in the United States (as defined in the clause Buy American — Steel and Manufactured Products for Construction Contracts) and that components of unknown origin are considered to have been produced or manufactured outside the United States. A list of articles, materials, and supplies excepted from this provision is attached in Section 00210 of these Contract Documents. PRODUCT None Signed by: (Must belsame signature as on Bid Form) C. Step en Koch, President STATE OF: Kentucky COUNTY OF: Jefferson COUNTRY OF ORIGIN 7/13/04 (Date) On this 13th day of July , in the year 2004 C. Stephen Koch' who is personally known to me, or who produced satisfactory identification, affixed his/her signature in the space provided above. SIGNATURE OF N6TARY PUBLIC END OF BUY AMERICAN CERTIFICATION BUY AMERICAN 00459 -1 owl STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 SWANSON, ARTHUR_ KOCH CORPORATION 1131 LOGAN ST LOUISVILLE KY 40204 #1430411 DETACH HERE STATE OF FLORIDA K 0 C H i.0 P cSTATE of FLORIDA A0I 1430411 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CRC1327098 06/01/04 030693633 CERTIFIED -RESIDENTIAL CONTRACTOR SWANSON, ARTHUR KOCH CORPORATION IS CERTIFIED uadar the proviaioaa of C3%.489 PS. napiracsoa dates AUG 31, 2006 L04060101075 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD SEQ#L04060101075 • LICENSE NBR i 01 2004 030693633 1 CRC 3.327098 -'. The RESIDENTIAL.: CONTRACTOR '=_= - _ :,; _° T-^ Named below IS . CERTIFIED "� "' ' - -- _ -• Under the' provisions of Chapter`�4_89'FS. ; = Expiration date: 'AUG 31, 2006=< 1=�'�',I" SWANSON, ARTSUR KOCH CORPORATION. 1131 LOGAN ST LOUISVILLE KY 40204 JER RTT.qH DIANE CARR Kev West International Airport Disadvantaged Business Enterprise (DBE) Office of Small Business Development certifies January 21, 2004 Mr. Raymond Vazquez Florida Keys Electric, Inc. Key West, Monroe County, Florida, 33040 RE: Disadvantaged Business Enterprises Certification Dear Raymond Vazques, Please be advised that your firm Florida Keys Electric Inc has met the required criteria to he Certified as a Disadvantaged Business EnteEprise (DBE), under rules promulgated by the U.S. Department Of Transportation (DOT) in 49 CFR Part 26. Commencing January 20, 2004 and expiring January 20, 2007 Florida Keys Electric Inc. name will be identified in the Airport's Directory of Certified Disadvantaged Business Enterprises. Florida Keys Electric Inc. certification status will be effective for three (3) years from the date of this letter provided there are no changes in the organization in the areas of ownership, control, independence and/or daily operations of the firm during the approved certification period. Please note that you are required to within fifteen (15) days to notify the Airport (DBELO) Director Jerome Fain Jr., of said changes listed above. In addition, it is your responsibility to contact this office sixty (60) days before expiration of this certification letter to initiate your certification renewal. The hey West International Airport reserves the right to re-evaluate a your business certification prior to Florida Keys Electric's participation on an airport project, or at any time the Airport (DBELO) determines that such re- evaluation is warranted for cause. If you have, anv questions regarding the DBE Program of the Airport please call me at (305) 296-8 Since er r. S & 0 rati anager/DBELO -<%ANNO L04 cc CP m toot coo" -CC m 0 r 0.- -zf" -&CP ock zor, m r" at Z to Mm 'U&A- 0 w ow crm Loc. Or- rn hi N 3=0 -A r 30 -74 77 154 0 7C Ln T7 r t a n to n n w d I-- �Cz& a O X7 r+ cD tr I— cD R "S O N [=7 N G m \ a to UI z x m R W R r C C In n m Crl Cn r. w to . w [T] P � � H m O to "9 a _ C.ir ra ul \ W O n m ►+rOx7 N N r W H G to tnozy (n OOO yt� O• C �•�C m rhnmLn •o *o z rn 's r• H r O ►t -V ' r+J r+ n ►i O r• y x7 cD O O I --I . rt I.' R I X w as - r+ n ?� R cD [n K I-- � O 'C! o to r "C M C (D n n R %0 H r+ N \ z I— Fo W c C o n a ril \ > tr N O r n .p .O C•• r N ►-1 N rncri N • O o R � m tan n !S 3 r+ a `C r ul P r+ O o n m c� cD m ED z r cD ui n r+ r• t 52 r tq co—+ 0 O n a R a w w It$ w � w a aw V o R (D tr O G C N u! w cD r W a O 't7 cD to K In O — O In N C N N X u OD O w O t� W N r ot�=:::__ ,Kos mm 0 m =-� ;� _ t�bc rr 0 � yz�N r-:r m H'Jq O m. t-+ H to �'d H 04 $ Ea . = _ � W O HW C m r a til cr - 1� - zz C: p H H =- CCsf ?Hd am n "WO HO rNH Hmtii1H w 0 0U$0 w bi :r 0 o pi < .CID v x� �a H s t=! H n� DOr M KL30 K W a 0 Cil 00 s F-� u d tis to tid tid 0 zO H hd n rm CO) oz D z H tid -4 Ea m O AH 0 0b O ro � w D COH HO Qz to r 00 :w tia d� H H 0 x CO) m o - w o� Key West International Airport Florida Keys Marathon Airport Disadvantaged Business Enterprise (DBE) Program Kenmar General Contracting, LLC July 1, 2004 Ms. Vicki Marino 1075 Duval Street Key West, Florida 33040 RE: DISADVANTAGED BUSINESS ENTERPRISE CERTIFICATION Dear Ms. Marino: The Key West International & Florida Keys Marathon Airports are pleased to announce that your company has been certified as a Disadvantaged Business Enterprise (DBE) which is subject to continued eligibility and also subject to actions of any other governmental agencies which may affect the DBE status of your firm. This agency's certification enables the company to compete in work at the Key West International and/or Florida Keys Marathon Airports as a DBE owned and operated company. It is not a guarantee that the company will receive work. DBE certification by the Key West International & Florida Keys Marathon Airports shall be for a period of three (3) years. On each anniversary date during the three (3) year certification period an Affidavit of Continuing Eligibility must be submitted. If any time there is a change in'the ownership and control of the company, a new Application is to be forwarded without delay to the Key West International & Florida Keys Marathon Airports for certification at the end of the three (3) year period a new Application must be submitted to the Key West International and Florida Keys Marathon Airports ninety (90) days prior to expiration of your current certification. Questions concerning the certification process may be directed to this office at (305)296-8099. yome ain Jr. Disadvantaged Business Enterprise Liaison Officer CERTIFICATION EXPIRATION DATE: July 1, 2007 - 7't v 0 �i .. C!p► ?t��i - aot�1 1 O H p. p A 4 Q O 4t - L4;1 H G' C' b7 Fr 7i -'�1 H Fj Fj a m H O Hcr ct H] 4 _ o dO m Kl cr < wb. �► .: r to 0 F' A.... - 01 zO :�O_ Ny O H 0 Qn ' Hl�1Qm HH -x - w O H'A r y p H �. .:.. t-• rh OdV. im u H Wd V 0 0) COO 0 . W to O.:. o �t9Clsn® s twn 30 RM OH -..� rn 1pF��tw 'y Q t W iw 1 b• . r o 70 -; H" Q .j n Oa a zEa MH HO Qz og Q MU �H H Q9 1-3 ca A K r 0 w 0 Ch N w 0 o _ J � o• � p o o a � M °0 p O N O O OIIISE V. 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N r V H v C% - :r W :s CD f- •• Cr1 f7 Old cD llt K N x7 tD x7 to N < u Z \ r r N N w p w 1 r O O O O • tar r O ,Q O K W N r Cl � r r+ m rn N THE AMERICAN INSTITUTE OF ARCHITECTS BOND # KOCH071304 KNOW ALL MEN BY THESE PRESENTS, that we KOCH CORPORATION 1131 LOGAN STREET LOUISVILLE, KY 40204 (Here insert full name ,and address or legal title of Contractor) as Principal, hereinafter called the Principal, and XL SPECIALTY INSURANCE COMPANY 25 INDEPENDENCE BLVD. WARREN, NJ 07059 a corporation duly organized under the laws of the State of Delaware as Surety, hereinafter called the Surety, are held and firmly bound unto MONROE COUNTY BOARD OF COUNTY COMMISSIONERS PURCHASING OFFICE, 1100 SIMONTON ST, RM 2-213, KEY WEST, FL 33040 (Here insert full name ,and address or legal title of Owner) as Obligee, hereinafter called the Obligee, in the sum of Five Percent (5%) of the Amount of the Bid ($ ), for the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has submitted a bid for PHASE 3 - NOISE INSULATION PROGRAM KEY WEST INTERNATIONAL AIRPORT, AIP #3-12-0037-2504 CONTRACT NO. THC NO. 03KW20 (Hare inset fill name, address and description of project) NOW, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a Contract with the Obligee in accordance with the terms of such bid and give such bond or bonds as may be specified in the bidding or Contract Documents with good and sufficient surety for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof, or in the event of the failure of the Principal to enter such Contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith contract with another party to perform the Work covered by said bid then this obligation shall be null and void, otherwise to remain in full force and effect. /� Signed and sealed this 13th day of July, 2004. A fln 1 1 n AIA DOCUMENT A310 BID BOND AIA ® FEBRUARY 1970 ED THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 N.Y. AVE., N.W. WASHINGTON, D.C. 20006 WARNING: Unlicensed photocopying violates U.S. copyright laws and is subject to legal prosecution.