Item C15
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: December 21. 2005
Bulk Item: Yes..lL. No
Division: Emergency Services
Department: Fire Rescue
Staff Contact Person: Camille Dubroff
AGENDA ITEM WORDING: Approval to award bid and enter into an Agreement between Board of
County Commissioners District 6 of Monroe County and Fire Tech Repair Service, Inc. for
maintenance of Fire Rescue vehicles, including semi-annual inspections, preventative maintenance,
and unscheduled maintenance resulting from malfunction or failure.
ITEM BACKGROUND: On November 9, 2005 sealed bids were opened for maintenance of Fire
Rescue vehicles, including semi-annual inspections, preventative maintenance, and unscheduled
maintenance resulting from malfunction or failure. Fire Tech Repair Service, Inc. was the only bidder.
We are requesting that the Board accept the Fire Tech Repair Service, Inc. bid and enter into a contract
commencing on January 1,2006 and ending September 30,2006. The contract provides for annual
renewals for up to three (3) one-year periods, with the approval of the District's governing Board. The
previous contract was with Fire Tech Repair Service, Inc. which expired on February 28, 2005 and was
extended on a month to month basis while the bid process was under way. Itemized pricing for the
hourly labor rate was decreased from $75.00 to $73.00 per hour for the technician and the annual pump
test was decreased from $275.00 to $250.00 for the term of the contract. All other item pricing
provided through the contract for the various types of service will remain the same as in the previous
contract for the term of the contract with variations being due only to adjustment (additions and/or
deletions) in the schedule of the covered vehicles.
PREVIOUS RELEVANT BOCC ACTION: On February 28,2005 the Board extended the term of
agreement with Fire Tech Service, Inc. on a month-to-month basis. On March 16, 2005 the Board
approved the advertisement of sealed bids for the maintenance of Monroe County Fire Rescue's fire
apparatus, including preventive maintenance, unscheduled maintenance and annual pump testing. On
September 28, 2005 the Board approved the rejection of all bids received on June 30, 2005 and the
approval to re-advertise for sealed bids, as both bids came in at double the price of the previous year
costs.
CONTRACT/AGREEMENT CHANGES: Itemized pricing for the hourly labor rate was decreased
from $75.00 to $73.00 per hour for the technician and the annual pump test was decreased from
$275.00 to $250.00 for the term of the contract.
STAFF RECOMMENDATIONS: Approval.
TOTAL COST: $4.930.00* BUDGETED: Yes X No
*Cost to cover periodic inspection. preventative maintenance and pump testing. In addition. the
contract also includes fixed pricing for unscheduled repairs at $73.00/hour and parts at 25% over cost.
COST TO COUNTY: same as above
SOURCE OF FUNDS: Ad Valorem Taxes
REVENUE PRODUCING: Yes
No X
AMOUNTPERMONTH_ Year
APPROVED BY: County Atty Yes
DIVISION DIRECTOR APPROVAL:
DOCUMENTATION:
Included
x
Not Required
DISPOSITION:
AGENDA ITEM #I
Revised 2/05
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract with:
Fire Tech Repair Services, Inc. Contract #
Effective Date:
Expiration Date:
01/0 1/2006
09/30/2006
Contract PurposelDescription:
District 6 contract for the maintenance of Fire Rescue vehicles, including semi-annual
inspections, preventative maintenance, and unscheduled maintenance resulting from
malfunction or failure. Commencing on January 1,2006 and ending on September 30,
2006 with the option for annual renewal for up to three (3) one-year periods.
Contract Manager: Camille Dubroff
(Name)
6010
(Ext. )
Fire Rescue / Stop 14
(Department/Stop #)
for BOCC meetin,g on
12/21/2005
Agenda Deadline: 12/06/2006
CONTRACT COSTS
Total Dollar Value of Contract: $
Budgeted? Yes['8J
Grant: $
County Match: $
NoD
$4,930.00 plus repairs at
$73/hr and parts at 25%
over cost.
Account Codes:
Current
Year
Portion: $
12500-530-462
Estimated Ongoing Costs: $
(Not included in dollar value above)
ADDITIONAL COSTS
/yr For:
(eg. maintenance, utilities, ianitorial, salaries, etc.)
CONTRACT REVIEW
Date In
Changes
Needed .-.,/
YesD No~
Date Out
Division Director
Risk Management I \ - d,. S;
O.~B.lPurChasing 1I~S'
County Attorney / /-.J3'collS
Comments: S((. ~tc+1tm I~
OMB Form Revised 2/27/01 MCP #2
CONTRACT BETWEEN
THE BOARD OF COUNTY COMMISSIONERS
DISTRICT 6
OF MONROE COUNTY, FLORIDA
AND
FIRE TECH REPAIR SERVICE INC.
FOR MAINTENANCE OF FIRE/RESCUE VEHICLES
THIS CONTRACT, hereinafter "CONTRACT OR AGREEMENT' made and entered
into this day of , 2006 by and between Board of County
Commissioners District 6 of Monroe County, Florida, hereinafter referred to as
"DISTRICT", and Fire Tech Repair Service Inc. , hereinafter referred to as
"CONTRACTOR".
WITNESSETH:
WHEREAS, the DISTRICT advertised a notice of calling for bid for MAINTENANCE
OF FIRE/RESCUE VEHICLES on the 14th day of October and the 21 sl day of October
2005 in The Reporter, on the 16th day of October and the 23rd day of October 2005 in the
Key West Citizen and on the 15th day of October and the 22nd of November 2000 in The
Keynoter;
WHEREAS, the successful bidder was Fire Tech Repair Service Inc., and;
WHEREAS, this CONTRACTOR represents that it is capable and prepared to provide
such services, and;
WHEREAS, the DISTRICT intends to enter into an agreement for maintenance of
Fire/Rescue vehicles, semi-annual inspections, preventative maintenance, and
unscheduled maintenance resulting from malfunction or failure with the CONTRACTOR
and;
WHEREAS, this contract is an agreement between both parties,
NOW, THEREFORE, in consideration of the promises contained herein, the parties agree
as follows:
1. CONTRACT PERIOD AND RENEWAL - The effective date of this Agreement
shall be January 1. 2006 through September 30. 2006. This contract may be
renewed annually for one (1) year terms, not to exceed three (3) renewals, subject
to approval of the Fire Chief of Monroe County Fire Rescue, the Office of
Management and Budget and the Monroe County Board of County
Commissioners.
1
2. CONTRACT TERMINATION - This contract may be terminated for any reason
by either party on 30-day written notice without cause. If the CONTRACTOR fails
to fulfill the terms of this agreement, or attachments, properly or on time, or
otherwise violates the provisions of the agreement or of applicable laws or
regulations governing the use of funds, the County may terminate the contract by
written notice. The notice shall specify cause. All finished or unfinished supplies
or services shall, at the option of the County, become property of the County. The
County shall pay the CONTRACTOR fair and equitable compensation for
expenses incurred prior to termination of the agreement, less any amount or
damages caused by the CONTRACTOR's breach. If the damages are more than
compensation payable, the CONTRACTOR will remain liable after termination
and the County shall pursue collection for damages.
3. SUBJECT MATTER OF CONTRACT - This contract is for scheduled semi
annual inspections and preventative maintenance of fire rescue vehicles, annual
pump tests and for unscheduled maintenance and repair resulting from equipment
failure or malfunction.
4. RATES -The hourly rate shall be $73.00 per man-hour with no travel time or
mileage charge. Semi Annual inspections and annual pump tests are at quoted flat
rates and excluded from hourly rate.
5. OVERTIME AND HOLIDAYS - Rates per man-hour for emergency repairs
called outside normal business hours and federal holidays shall be one and one half
times the normal rate.
6. SEMI-ANNUAL INSPECTIONS - During the year CONTRACTOR shall
perform two inspections on vehicles described in "Attachment A" (Level I and
Level II Preventative Maintenance Service) at an annual total cost of:
Rescue-type vehicles, without pump $
Pumpers $
Aerials $
360.00
490.00
640.00
Exception shall be if a vehicle has been used 1,000 hours prior to yearly
preventative maintenance service, Level I and II Preventative Maintenance
Service shall be performed and charged the above rate.
Level I: 250 Hours or 6 months (whichever comes first)
Full vehicle inspection as per attached semi-annual inspection schedule plus:
Engine oil and filter change
Fuel filter change (every 6 months)
Air filter inspection and replacement if necessary
Chassis lubrication
2
Outboard (forward) impeller shaft lubrication
Lubrication of all valve control linkages
Clean or replace air compressor strainer
Clean engine crankcase breather
Inspection of generator and service of lubricant system, full system, and
air filter according to its individual hours of operation (not to exceed 6
months)
Level II: 1000 Hours or one year (which ever comes first)
Full service performed in Level I plus:
Replacement of coolant hoses, filter and coolant as needed
Replacement of all drive belts as needed
Replacement of pump transmission oil and filter
Replacement of engine transmission fluid and filter
Replacement of rear axle lube oil as needed -
Inspection of front wheel bearing
Replacement and repacking as needed
Inspection and cleaning of relief valve strainer
Replacement of secondary fuel filters on both engine and generator
The number of vehicles may fluctuate from time to time due to new purchases or
removal of vehicles from inventory. The inspections shall be preformed at the
respective fire stations.
7. WORK SCHEDULE - Regularly scheduled semi-annual inspections and
preventative maintenance shall be conducted at such intervals as are approved by
the DISTRICT.
8. PUMP TESTS - CONTRACTOR shall perform an annual pump test at a flat rate
cost of $250.00 each for all vehicles requiring such test. In order to facilitate the
passing of the pump test, minor repairs and adjustments shall be made as needed;
price includes clean-up after salt water use. The CONTRACTOR shall provide
documentation of performance to Monroe County. The documentation must be in
the form of an electronic version report that is emailed to the Captain of Support
Services. The form must either be in Microsoft Word or Excel.
9. PARTS, FLUIDS AND LUBRICANTS - All parts, fluids, and lubricants used for
maintaining and repairing vehicles shall be supplied by CONTRACTOR and
billed to the DISTRICT at cost plus 25%. For parts $400.00 and over, a copy of
original parts supplier invoices shall be attached to the bill. CONTRACTOR will
be required to keep all original parts supplier invoices available at request by
County for spot checking and auditing purposes.
3
10. ENGINE OIL AND FILTER CHANGE and complete drive train lubrication and
any other fluids and/or filter changes, shall be performed as recommended by the
manufacturer.
11. SEMI-ANNUAL INSPECTION SCHEDULE - CONTRACTOR shall perform the
following inspection and preventative maintenance twice per year on all vehicles:
( a) Cooling system, including fan belts, radiator supports, hoses and clamps,
and auxiliary cooler;
(b) Exhaust System, including hanger, clamps, muffler, and pipes;
(c) Clutch, including freeplay, linkage, and fluid levels;
(d) Manual Transmission, including seals, linkage, and lube level;
(e) Automatic Transmission, including fluid level, seals, modulator
adjustment, and linkage;
(f) Drive Train, including U -joints, center support, and companion flanges;
(g) Rear Axle and springs, including oil links, spring hangers, center bolts, and
U-bolts
(h) Front End, including steering box, linkage, kingpins and bushings, spring
hangers, and U-bolts;
(i) Mechanical Brakes, including adjustment and fluid levels;
G) Air Brakes, including drain, adjustment, wear, and air leaks;
(k) Tires, including condition and wear;
(1) Electrical System, including running lights, emergency lights, battery
cables, turn lights, 4-way flasher, headlights, stop lights, and switches;
(m) Fuel System, induding hoses and fittings, filters and brackets, and tank
straps;
(n) Booster Tank, including leaks and supports;
(0) Prime Pump, including electrical wires, coupling, switch, and valve
discharge;
(p) Plumbing and Gates, including leaks, brackets, bleed valves, control arms
and knobs, and linkage;
(q) Main Pump, including vacuum test, pressure test, packing, clappers, and
mounting;
(r) Pump Transmission, including fluid levels, seals, shift motors, and manual
override;
(s) Aerial Ladder, including power takeoff, drive shaft and coupling, P.T.O.
activating device and outrigger controls;
(t) Aerial Operation, induding engine RPM., hydraulic pressure, operation of
all controls, warning devices, hoses and fittings, rung covers, ladder locks,
and ring gear;
(u) Aerial Platform, including lubrication, platform leveling, electrical system,
turntable and platform controls, communications, and water tube.
The above inspections shall include, at no additional labor charge, the changing of
all applicable filters and fluids used by the unit being inspected. Air filters shall be
changed on first inspection and then yearly thereafter. Filters and fluids shall be
4
billed at cost plus 25%, as previously described in Section 9 of this
AGREEMENT.
Upon completion of inspection a computerized report will be forwarded to the
Captain of Support Services indicating the status of the items inspected. This will
be done for every vehicle when Preventative maintenance is performed on the
vehicle. This report must be em ailed to the Captain of Support Services at lubert-
peter@monroecounty-fl.gov. The form must either be in Microsoft Word or
Excel.
12. WEEKLY MAINTENANCE SCHEDULE - CONTRACTOR shall provide to the
DISTRICT a preventative maintenance schedule that can be performed weekly by
the individual Volunteer Fire Departments' personneL
13. MAINTENANCE LOG - CONTRACTOR shall maintain an inspection and
maintenance chart on each vehicle containing at least the following information:
(a) Date of performance,
(b) Apparatus serviced,
(c) Service performed,
(d) Parts used,
(e) Name of service person(s),
(f) Total downtime of vehicle
A copy of this chart shall be supplied to the Fire Rescue Office within 30 days of
the service.
14. COMMUNICATION - CONTRACTOR shall maintain a telephone or paging
device such that prompt notification of request for service is possible twenty-four
(24) hours a day.
15. RESPONSE TO SERVICE REQUEST - CONTRACTOR shall maintain itself in a
state of readiness during normal working hours, 8:00 am - 5:00pm Monday thru
Friday, and shall respond to the location where emergency repairs are needed
within 12 hours of receiving a request. For repairs required after normal working
hours, CONTRACTOR shall respond to the location where emergency repairs are
needed within 24 hours of receiving a request.
16. CERTIFICATION - CONTRACTOR shall provide evidence satisfactory to the
DISTRICT that its personnel who perform maintenance work are certified in pump
mechanics, general mechanics and repair.
17. QUALIFICATIONS OF MAINTENANCE PERSONNEL - All personnel
performing maintenance, repairs, adjustments and related work on Monroe
County equipment shall be a certified fire apparatus mechanic or otherwise
certified for the work to be performed. Personnel performing work who are not
certified or experienced in such work shall be directly supervised (in person) by
an individual with such certification.
5
18. INDEMNIFICATION - CONTRACTOR shall indemnify and hold the DISTRICT
and Monroe County harmless for any negligence on its part, or faulty or improper
workmanship, for all work performed under this contract, including all costs of
collection, reasonable attorney fees, claim costs, and as per "Attachment B". All
property or equipment being directly maintained or repaired by CONTRACTOR
shall be considered in its care, custody, and control while such work is in progress
and until physical control of such property or equipment is restored to the
DISTRICT.
19. LOCATION OF WORK - This contract is for maintenance of fire rescue vehicles
located at the following sites:
A. Key Largo (2 Stations)
20. INSURANCE - During the term of this contract, the CONTRACTOR must keep
in force and effect the insurance required by Attachments C", Attachments C" are
attached and incorporated into this contract.
21. ADDITIONAL REQUIRED STATEMENTSNERIFICATIONS/AFFIDA VITS.
Attached hereto in Attachment D" are Public Entity Crime Statement, Non-
Collusion Affidavit, Ethics Clause, and Drug-Free Workplace Form.
22. PAYMENTS - Payments for semi-annual inspection, preventative maintenance
and pump tests shall be made by the DISTRICT within 30 days of the completion
of the rendered services on each vehicle and proper invoicing by the
CONTRACTOR. All unscheduled maintenance and repair resulting from
equipment failure or malfunction requiring service shall be billed by the
CONTRACTOR at the applicable rates as specified in Section four, five and six
this AGREEMENT. The CONTRACTOR upon notification by the DISTRICT of
an equipment failure or malfunction requiring unscheduled maintenance shall, in a
timely manner investigate the problem and provide to the DISTRICT an estimate
of the cost for repair and vehicle downtime. The CONTRACTOR upon receiving
authorization to proceed from the DISTRICT shall effectuate such repair; upon
completion of same the CONTRACTOR shall notify the DISTRICT of the out
come and actual cost. The DISTRICT shall issue a separate purchase order for
each occurrence of unscheduled maintenance and repair.
23. Monroe County's performance and obligation to pay under this contract is
contingent upon an annual appropriation by the Board of County Commissioners.
24. Venue for any litigation arising under this contract must be in a court of competent
jurisdiction in Monroe County, Florida.
6
IN WITNESS WHEREOF, each party hereto has caused this contract to be executed by
duly authorized representative.
BOARD OF COUNTY
COMMISSIONERS of
MONROE COUNTY, FL
Municipal Services Taxing District 6
(SEAL)
Mayor/Chairman
Attest: Danny L. Kolhage, Clerk
Clerk
WITNESS:
Fire Tech Repair Service Inc.
Authorized Representative
7
'/o/.rt-
(', jrJn',." I/..l f.. hb,'~...(,-",...w'"
Attachment A
Monroe County Fire Apparatus
District 6
Lo<;?tion
Key Largo
Vehicle Description
1994 Saulsbury HD RescuelPumper
1983 Training Vehicle
2001 Pierce Pumper
2001 Pierce Rescue Pumper
1993 Boardman Tanker/Pumper
1988 E-One Aerial
2002 Pierce Air Cascade
1988 Dive Rescue Van
I QQt'j Edition
,-
MONROE COUNTY, FLORIDA
RISK MANAGEMENT
POLICY AND PROCEDURES
CONTRACT ADMINISTRATION
MANUAL
Indemnification and Hold Harmless
for
Other Contracton and Subeontracton
-
The Contractor covenants and agrees to indemnify and hold harmless Monroe County Board of
County Commissioners from any and all claims for bodily injury (including death), personal injury,
and property damage (including property owned by Monroe County) and any other losses,
damages, and expenses (including attorney's fees) which arise out ot; in connection with. or by
reason of services provided by the Contractor or any of its Subcontractor(s) in any tier,
occasioned by the negligence, errors, or other wrongful act or omission of The Contractor or its
Subcontractors in any tier, their employees, or agents.
In the event the completion of the project (to include the work of others) is delayed or suspended
as a result of the Contractor's fuilure to purchase or maintain the required insurance, the
Contractor shall indeIIlIlifY the County from any and all increased expenses resulting from such
delay.
The first ten dollars ($10.00) of remuneration paid to the Contractor is for the indemnification
provided for above.
The extent of liability is in no way limited to, reduced, or lessened by the insurance requirements
contained elsewhere within this agreement.
TCS
Administration [nstructioo
114709.5
Attachment B
t
1996 Edition
RISK MANAGEMENT
POLICY AND PROCEDURES
CONTRACT ADMINISTRATION
MANUAL
Geoerallosurance Requirements
for
Other Contradon and Subcontractors
As a pre-requisite of the work governed, or the goods supplied under this contract (including the
pre-staging of personnel and material), the Contractor shall obtain, at hisIher own expense,
insurance as specified in any attached schedules, which are made part of this contract. The
Contractor will ensure that the insurance obtained will extend protection to all Subcontractors
engaged by the Contractor. As an alternative, the COntractor may require all Subcontractors to
obtain insurance consistent with the attached schedules.
The Contractor will not be permitted to Commence work governed by this contract (including pre-
staging of personnel and material) until satisfactory evidence of the required insurance has been
furnished to the County as specified below. Delays in the commencement of work, resulting from
the failure of the Contractor to provide satisfi1ctory evidence of the required insurance, shall not
extend deadlines specified in this contract and any penalties and failure to perform assessments
shall be imposed as if the work commenced on the specified date and time, except for the
Contractor's failure to provide satisfactory evidence.
The Contractor shall maintain the required insurance throughout the entire term of this contract
and any extensions specified in the attached schedules. Failure to comply with this provision may
result in the immediate suspension of all work until the required insurance has been reinstated or
replaced. Delays in the completion of work resulting from the failure of the Contractor to
"naintain the required insurance shall not extend deadlines specified in this contract and any
penalties and fuilure to perform assessments shall be imposed as if the work had not been
suspended, except for the Contractor's fiillure to maintain the required insurance.
The Contractor shall provide, to the County, as satisfactory evidence of the required insurance,
either:
· Certificate of Insurance
or
· A Certified copy of the actual insurance policy.
The County, at its sole optio~ has the right to request a certified copy of any or all insurance
policies required by this contract.
All insurance policies must specify that they are not subject to cancellation, non-renewa4 material
change, or reduction in coverage unless a minimum of thirty (30) days prior notification is given
to the County by the insurer.
The acceptance and/or approval of the Contractor's insurance shall not be construed as relieving
the Contractor from any liability or obligation assumed under this contract or imposed by law.
Adm i ni5tration Instruction
#4709.5
Attachment C'
1 of 7
1996 Edition
The Monroe County Board of County Commissioners, its employees and officials will be
as "Additional Insured" on all policies, except for Workers' Compensation.
Any deviations from these General Insurance Requirements must be requested in writing on
CmU1ty prepared form entitled "Request for Waiver of'lnsurance Requirements" and approved
by Monroe County Risk Management.
Attachment C
2 of 7
AJminhtration [nstruction
#4709.5
1 QQ{j Edition
MONROE COUNTY, FLORIDA
RISK MANAGEMENT
POLICY AND PROCEDURES
CONTRACT ADMINISTRATION
MANUAL
WAIVER OF INSURANCE REQUIREMENTS
There will be times when it will be necessary, or in the best interest of the County, to deviate :from
the standard insurance requirements specified within this manual. Recognhing this potent~ and
acting on the advice of the County Attorney, the Board of County Commissioners has granted
authorization to Risk Management to waive and modifY various insurance provisions.
Specifically excluded from this authorization is the right to waive:
· The County as being named as an Additional Insured - If a letter from the Insurance
Company (not the Agent) is presented, stating that they are unable or unwilling to name
the County as an Additional Insure~ Risk Management has been granted the authofity to
waive this provision.
and
· The IndemnificatioD and Hold Harmless provisions
Waiving of insurance provisions could expose the COWlty to economic loss. For this reason,
every attempt should be made to obtain the standard insurance requirements. If a waiver or a
modification is desired, a Request for Waiver of IDsuraDee RequiremeDts form should be
completed and submitted for consideration with the proposal
After consideration by Risk Management and if approve~ the form will be returne~ to the
County Attorney who will submit the Waiver with the other contract documents for execution by
the Clerk of the Courts.
Should Risk Management deny the Waiver Request, the other party may file an appeal with the
County Administrator or the Board of County Commissioners, who retains the final decision
making authority.
Administration Instruction
#4709.5
Attachment C
3 of 7
1996 Edition
-.
GENERAL LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Prior to the commencement of work governed by this contract, the Contractor shall obtain
General Liability Insurance. Coverage shall be maintained throughout the life of the contract and
include, as a minimum:
-
· Premises Operations
· Products and Completed Operations
· Blanket Contractual Liability
· Personal Injury Liability
· Expanded Definition of Property Damage
The minimum limits acceptable shall be:
$300,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$100,000 per Person
$300,000 per Occurrence
$ 50,000 Property Damage
An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its
provisions should include coverage for claims filed on or after the effective date of this contract.
In addition, the period for which claims may be reported should extend for a minimum of twelve
(12) months following the acceptance of work by the County. .
The Monroe County Board of County Connnissioners shall be named as Additional Insured on all
policies issued to satisfY the above requirements.
-.
GLl
Administration Instruction
#4709.5
Attachment C
4 of 7
1996 Edition
-..
VEHICLE LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Recognizing that the work governed by this contract requires the use of vehicles, the Contractor,
prior to the commencement of work, shall obtain Vehicle Liability Insurance. Coverage shall be
maintained throughout the life of the contract and include, as a minimum, liability coverage for:
· Owned, Non-Owned, and Hired Vehicles
-.
The minimum limits acceptable shall be:
$100,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$ 50,000 per Person
$100,000 per Occurrence
$ 25,000 Property Damage
The Monroe County Board of County Commissioners shall be named as Additional Insured on all
:poHcies issued to satisfy the above requirements.
-
VLl
Administration Instruction
#4709.5
Attachment C
5 of 7
1996 Edition
WORKERS' COMPENSATION
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
-
Prior to the commencement of work governed by this contract, the Contractor shall obtain
Workers' Compensation Insurance with limits sufficient to respond to Florida Statute 440.
In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not less than:
$100,000 Bodily Injury by Accident
$500,000 Bodily Injury by Disease, policy limits
$100,000 Bodily Injury by Disease, each employee
Coverage shall be maintained throughout the entire term of the contract.
Coverage shall be provided by a company or companies authorized to transact business in the
state of Florida.
lithe Contractor has been approved by the Florida's Department of Labor, as an authorized self-
insw'er, the County shall recognize and honor the Contractor's status. The Contractor may be
required to submit a Letter of Authorization issued by the Department of Labor and a Certificate
ofInsurance, providing details on the Contractor's Excess Insurance Program.
If the Contractor participates in a self-insurance fund, a Certificate of Insurance will be required.
In addition, the Contractor may be required to submit updated financial statements from the fund
upon request from the County.
wel
,-.
Administration Instruction
#4709.5
Attachmnet C
6 of 7
I Q% Edinon
(
\,
MONROE COUNTY, FLORIDA
Request For Waiver
of
IDsanlDu Requirements
It is requested that the insurance requirements, as specified in the County's Schedule ofInsurance Requirements,
be waived or modified on the following contrad.
Contractor:
Contrad for:
Address of Contractor:
Phone:
Scope of Work:
Reason for Waiver:
Policies Waiver
will apply to:
Signature of Contractor:
Approved
Not Approved
Risk Management
Date
County Administrator appeal:
Approved:
Not Approved:
Date:
Board of County Commissioners appeal:
Approved:
Not Approved:
~,1<::eting Date:
,\dministration Instruction
#4109.5
Attachment C
7 of 7
PUBLIC ENTITY CRIME STATEMENT
.. A person or affiliate who has been placed on the convicted vendor list following a conviction for public
entity crime may not submit a bid on a contract to provide any goods or services to a public entity. may
not submit a bid on a. contract with a public entity for the construction or repair of a public building or
public work, may not submit bids on leases of real property to public entity. may not be awarded or
perform work as a contractor, supplier. subcontractor, or consultant Wider a contract with any public
entity. and may not transact business with any public entity in excess of the threshold amount provided
in Section 281.011. for CA TEGOR Y TWO for a period of 36 months from the date of being placed on
the convicted vendor list:. "
By signing below I acknowledge that I have read and understand the above-referenced statement.
STATE OF FLeu..t/cf)A
,
~ i.if-~7,..r,- /T",~)
(Signature ofDi ) ,
/ J- </J-CJ<;-
".. (
Date
COUNTY OFJ4!(!)" rc'r€-
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
_ko n r', rl 81.) \-- L -e,/ who, aBu lint being swom by me, (name of individual
signing) affixed hislher signature in the space provided above on this
!.-i + h day of (\0 V ellJ\B ~r ,20 C)~-
~/J7/72tML7 &-/~ My commission expires:
N ARY PUBLIC
v
. JEANNINE M. COOK
....."... ~ F.........
--'~m~l.!!~"""~ Notary PublIc . stat. \II -......
:-~ 'l\ ,..iWcrl~Jcrl2I.2OIJ7
"~~ '~mIIIIOn tI 00110701
"'~:~0fI~. .--...... NaIonaI NaIary""
'-,. tit'" IJUII"""'" IIfJ
Attachment D
1 of 4
NON-COLLUSION AFFIDAVIT
1, ,/Z)!J.o?( c".0.1/ I~
, of the city
of TA-v~~/l{/r:r-
according to law on my oath, and under
penalty of pajury, depose and say that;
1) I am C~../~s. d7 n.re-::fl""c.4 ~IY S~"'~r ?eJ;'t.. the bidder making the Proposal for
project described as follows:
(J1INX7("..ALl Co # ~me--<;a. ""'T Fete ~.~ 4pTr 4 V".ht"cf~ If?tQ-r#)t('l-':lJ~~/j?(.)/"
2) The prices in this bid have been anived at independently without collusion, consultation,
eommwication 01' ~ for the pIIlp08e of restricting COIDpctiti~ as to any matter Jl'!~g to md1
prices with any other bidder or with any competitor,
3) Unless otherwise ~ by law, 1he 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 otba' ~
pal1Dership or corporation to ~ or DOt to submit, a bid for 1bc purpose of restriding competition;
S) The statements <:ontained in this affidavit are true and correct, and made with full knowledge
that Monroe County relies upon the CIUth of the statements contained in this affidavit in awarding
contracts for said project.
COUNTY OF yJz 071 ro-c...
c~i?;;.>Z-t~ IT""')
(Signature ofBi er ,
II-Cf-r1~
Date
STATE OF r{ Of'(~
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
K..c.'ne rT 8 V t-I--c.f who, afterfint beina sworn by me. (_of~
signing) at1ixed hisIber signature in the space provided above on this
1-/ -t-k dayor nO '-'ern G e..r- .20 6 S~.
S2g~~~ 0.d Myoommiuionexpinos:
OMB - MCP FORM #1
m'.'~ ..w;.; M..cOOoC
..~~ Naby PubIc - Slate of FIcddo
. c. . ,.,......~ 1an2l,:aaJ1
1 '~1.,.. CommIIsIon # DOl 10703
1 ' .ar" blCIIdlVNaIola NoDvAm
Attachment D
2 of 4
SWORN STATEMENT UNDER ORDINANCE NO. 10--1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
!2o/'-P,.,t c 691'fe7
warrants that he/it bas not employed, retained
or otherwise had act on bislits behalf any former County officer or employee in violation of
Section 2 of Qrdinapee No. 1()"1990 or any County officer or employee in violation of
Scr.tioo 3 of Ordift8i11Ce No. 1 ()"1990. For breach or violation of this provision the County
may, in its discretion, terminJtte 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 fee,
commission, percentage, gift, or consideration paid to the former County officer or employee.
t7!c; >-~ ~~ ~er fl'/'K'J
SIgna
Date: / (- )/ -0 -r;-
STATE OF
F~f'td7A-
.
COUNTY OF
V/lon ro 'e-
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
12013 c rl 13 \1 r- l-C,/ who, _ lint being lIWOII1 by me, offixcd bisIbcr
signature (name of individual signing) in the space provided above on this 4 + h. day of
20 C) s-:
My commission expires:
OMB - MCP FORM #4
JEANNNE M. COOK
..... Nc*IrY "** . State or FtorIda
~ ElPIIlan2l.7lI1I
~tlDDla0103
~ tucMlaINc*:lyHm
Attachment D
3 of 4
DRUG-FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 281.081 hereby certifies that:
h'/~ ---ree"-- (Z~4/r ~/\IIC~ -;:-Y'L-
(Name of Business)
1. Publish a statement DOtifying employees that the unlawful manufacture, distribution, dispensing,
possession, 01' use of . controlled substance is prohibited in the workplace and specifying the actions
that will be taken against emplo)'CeS for violations of such prohibition.
2. lDfonn empIo~ about the daugen of dmg abuse in the workplace, the bmtme&.'. policy of
mstint~ a drug-fme workplace, any available .. ~i"g, rehabi1itation, aDd employee
usistance programs, and the peualties that may be imposed upon employees for drug abuse violatiODS.
3. Give each employee mpged in providing the c::ommodities or contractual services that are under bid
a copy of tile statement specified in subsection (1)..
4. In the -8tement specified in IIIbICCtion (I), notify the employeea that., as a ooDdition ofwOlting on
the cnamnOOitiea << ~al services that 8ft: 1IDda- bid, the employee will abide by the terms of the
statement and wiD notify the employer of any conviction of, or plea of guilty or nolo contendere to, any
vioIatiOll ofCbapter 893 (Florida Statutes) OI'ofany controlled substance Jaw of tile United States or any
state, for a violation occurring in the workplace no later than five (S) days after such conviction.
s. hqpose a l8DCtion on, or require the Hfisfactory participation in a drug abuse assistance or
rcbabilliaDon program if such is available in the employee's commWlity, or any employee who is so
convicted.
6. Mate a good faith effort to continue to maintain a drug-free woJ:tp1ace through implementation of
this section.
As the penon authorized to lign the Itat~ I certify that this firm complies fully with the above
--- ~
a;{~ & $",..17:-,,,.)
Biddel"s Signature /
//- Y-OC;-
.
Date
OMB - MCP FORM #S
Attachment D
4 of 4