HomeMy WebLinkAbout3. 10/13/2021 Agreement ATTACHMENT D.6
COUNTY ADMINISTRATOR
CONTRACT SUMMARY FORM FOR CONTRACTS LESS T 50,000.00
Contract with. G, Contract . �._ .._....... _.®__.._..__ _ .
mm Effective Date: October 1 ,2021
Expiration Date: S M Agreement
Contract Purpose/Description: -
Con ct een onr �p _of noun Commissioners and Cle T forbopfiL
concier e se i Pa h to Oov Pry o provide 1'censed r fessionl coon lo o su rt
care I' lei girMjn transitjoninMffLh#,,Monpqpun h lth Ian and onto i , S®
secondary Pavors and Phartnacv Plans.
Contract Manag : o0 45 Employee Services/Stop l
(Name)
CONTRACT COSTS
[Total Dollawr Value of Contract: S 3,500,00 Current Year Portion: $3,s
(must be less than 50, ) (If multiyear agreement then
requires BOCC approval,unless the
total a unwla6ac amount is less Oian
S 0,000 0l.,)).
Budgeted? Yes o cc®fif " " Codes:502-08002--5303 10
Gant: $ Workday: SC00038
CountyMatch:
ADDITIONAL� COSTS
Estimated Ongoing Costs: S /A /yr For:
(loot inwI A Ain dollar value above) fie.".ei®aircieicariic,uiii°aic5,`anittortal,Saiaiies,eti.j
CONTRACT REVIEW
Changes Date Out
Date In Neede r Digitally signed by Bryan Co
Department Head Yes Q�� 'Qate:2021.10.12 15 27 41
Risk Management 11-11-2021 Yes No �m.� 11-11-2021
rlsta Presnick
�g Date:2021.11.12
O.M.B./Purchasing Yes o Presnick l� 08:23:33-05'00'
� as 11-12-2021
County Attorney Yes a x
Comments:
Page 70 of 73
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CONSULTING SERVICES AGREEMENT
THIS CONSULTING SERVICES AGREEMENT("Agreement"), made and entered into as of 10/8/ 1
("Effective Date") by and between Cleartrack HR, LLC, an educational consulting business located at
305A Quality Circle, Huntsville, Alabama 35806 (hereinafter referred to as "Cleartrackhr"or
"Consulting Firm")and Monroe County Board of County Commissioners (hereinafter referred to as
"Employer,""Client,""You,"or"Your"). CAPITALIZED TERMS MAY BE DEFINED IN THE BODY OF
THE AGREEMENT, IN THE DEFINITIONS SECTION OF THE AGREEMENT, OR DESIGNATED AS
DEFINED IN ANOTHER DOCUMENT, LAW, OR REGULATION REFERENCED BY THE
AGREEMENT. DEFINITIONS SHALL BE APPLICABLE TO THE AGREEMENT AND ANY
ATTACHMENTS, AMENDMENTS, OR EXHIBITS, UNLESS INDICATED OTHERWISE.
1.0 Term. This Agreement is effective as of the Effective Date,and will remain in effect for a one(1)year period
after the Effective Date("Initial Term").
2.0 Fees for Services Performed. A schedule of fees for services to be provided by Cleartrackhr is attached hereto as
Exhibit C.You agree to timely pay all fees,costs,and expenses arising out of or resulting from the services
consistent with Exhibit C.
3.0 New Pricing Structure. Should Cleartrackhr adopt a new pricing structure that differs from the pricing structure
contained in Exhibit C,Cleartrackhr shall give You written notice of such new pricing structure not less than
ninety(90)days prior to the end of Your then-current term.The new pricing structure shall become effective
upon the first Renewal Term of this Agreement commencing after written notice of such new pricing structure.
In the event of such notice,this Agreement is terminable at the sole election of the Client within ninety(90)days
following delivery of the notice,by delivering notice of termination in writing to Cleartrackhr.
4.0 Consulting Firm and Services. Cleartrackhr is an Alabama-based limited liability company that was created to
provide Medicare and Medicaid related expertise and advice to employees of clients,and to assist employees of
clients in determining whether they may gain any benefits or advantages in obtaining medical insurance coverage
through Medicare or Medicaid as opposed to their current Employer-sponsored medical insurance plan. Such
expertise and advice shall be provided by America's Health Insurance Plans("AMP")certified professionals.
Such professionals will be available to provide assistance to employees of Client in determining which
healthcare option(s),between Medicare/Medicaid and Employer-sponsored medical insurance plans available to
Client's employees and their dependents,best suits each employee's individual needs and circumstances.
All advice provided by Cleartrackhr and its individual professionals is a product of the personal knowledge,
experience,and expertise of such individual professionals and Cleartrackhr regarding Medicare/Medicaid and
health insurance;such advice is not and shall not be construed as legal advice or authority,and Cleartrackhr is in
no way liable for any acts or omissions performed by Client,the employee, or the dependents of the employee at
any point before,during,or after the advice has been rendered.The decision as to which healthcare option(s)to
maintain,discontinue,or seek enrollment in shall be solely that of each employee,and Cleartrackhr shall make
no decision or determination as to the medical insurance plan enrollment or disenrollment of each employee
and/or each employee's dependents.Cleartrackhr will not complete any forms,applications,paperwork,or other
documents for or on behalf of Client, Client's employees,or dependents of employees. Client agrees and
acknowledges,and will convey to its employees,that Consulting Firm does not give legal,financial,or tax
advice.The advice provided by Consulting Firm is based on Medicare,Medicaid,and health insurance laws and
policies,but shall have no influence or part in any legal proceedings,public or private, in which Client or any
agency of local,state or federal government has an active role.
5.0 Access to Accurate Information. Client shall provide Consulting Firm with information that is accurate and
sufficient,upon which Consulting Firm will provide advice.Upon the request of Consulting Firm,Client shall
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promptly provide further information which Consulting Firm determines to be necessary for the provision of the
services described in this Agreement.Client acknowledges and understands that Consulting Firm's function is to
provide independent advice and information. Under no circumstances shall Consulting Firm be liable for any
advice provided that is based on incorrect or inaccurate information.
6.0 Confidential and Private Information.The parties acknowledge that in connection with Cleartrackhr's services,
Client may disclose to Cleartrackhr confidential and proprietary information of Client's employees. Such
information may include,but is not limited to,the following: data concerning the financial information of
Client's employees;the names of Client's employees;the dates of employment of Client's employees;the dates
of medical insurance enrollment of Client's employees;marriage and family information for Client's employees;
home addresses and last known addresses of Client's employees; Social Security numbers of Client's employees;
contact information for Client's employees,including but not limited to phone numbers and email addresses; and
information regarding the individual and family health histories of Client's employees. Cleartrackhr shall use all
Confidential Information solely to perform its obligations under this Agreement. The disclosure of Confidential
Information is subject to privacy laws. This obligation of confidentiality shall not,however,apply to
information that: (a)is or becomes available in the public domain through no wrongful act or omission of
Cleartrackhr;(b)is already in ClearTrack HR's rightful possession without an obligation of confidentiality prior
to disclosure by the County;(c)is rightfully disclosed to ClearTrack HR by a third party without an obligation of
confidentiality that is known to ClearTrack FIR.;(d)is independently developed by ClearTrack HR; or(e) is
required to be disclosed by law or pursuant to any order of a court of competent jurisdiction or regulatory order
properly served on ClearTrack HR.
A. ClearTrack HR agrees to regard and preserve as confidential all records and other information including but not
limited to participant demographic and benefit election information and any materials developed exclusively for
the County. ClearTrack HR will not,without written authority from the County,disclose to others during the
term of this Agreement or thereafter,any such records or other information except as required by applicable law.
B. Upon Termination of this Agreement,each party shall promptly return to the other party all copies of materials
involving confidential information in the other parry's possession or control.
7.0 Public Records Requirements: Pursuant to F.S. 119.0701 and the terms and conditions of this contract,the
CONTRACTOR is required to:
(1) Keep and maintain public records that would be required by the County to perform the service.
(2)Upon receipt from the County's custodian of records,provide the County with a copy of the requested
records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the
cost provided in this chapter or as otherwise provided by law.
(3) Ensure that public records that are exempt or confidential and exempt from public records disclosure
requirements are not disclosed except as authorized by law for the duration of the contract term and following
completion of the contract if the CONTRACTOR does not transfer the records to the County.
(4) Upon completion of the contract,transfer,at no cost,to the County all public records in possession of the
CONTRACTOR or keep and maintain public records that would be required by the County to perform the
service.If the CONTRACTOR transfers all public records to the County upon completion of the contract,the
CONTRACTOR shall destroy any duplicate public records that are exempt or confidential and exempt from
public records disclosure requirements.If the CONTRACTOR keeps and maintains public records upon
completion of the contract,the CONTRACTOR shall meet all applicable requirements for retaining public
records.All records stored electronically must be provided to the County,upon request from the County's
custodian of records,in a format that is compatible with the information technology systems of the County.
(5)A request to inspect or copy public records relating to a County contract must be made directly to the County,
but if the County does not possess the requested records,the County shall immediately notify the
CONTRACTOR of the request,and the CONTRACTOR must provide the records to the County or allow the
records to be inspected or copied within a reasonable time.
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If the CONTRACTOR does not comply with the County's request for records,the County shall enforce the
public records contract provisions in accordance with the contract,notwithstanding the County's option and right
to unilaterally cancel this contract upon violation of this provision by the CONTRACTOR. A CONTRACTOR
who fails to provide the public records to the County or pursuant to a valid public records request within a
reasonable time may be subject to penalties under section 119.10,Florida Statutes.
The CONTRACTOR shall not transfer custody,release,alter,destroy or otherwise dispose of any public records
unless or otherwise provided in this provision or as otherwise provided by law.
IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION
OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY
TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT,
CONTACT THE CUSTODIAN OF PUBLIC RECORDS, BRIAN BRADLEY AT
PHONE# 305-292-3470 BRADLEY-BRIAN@MONROECOUNTY-FL.GOV,
ONROE COUNTY ATTORNEYS OFFICE 1111 12TH Street, SUITE 408,
KEY WEST, FL 33040.
8.0 Medicare,Medicaid,and Health Insurance Regulations Access.Medicare,Medicaid,and health insurance laws
and regulations are publicly available,and You and Your employees may review such information,and
determine the benefits available to Your employees without the consultation of any third-party, including
Cleartrackhr.
9.0 Restrictions on Utilization of Services. Cleartrackhr strictly prohibits the services that it offers being shared with
anyone who is not an employee of Client or a dependent of such an employee,or who has not been expressly
authorized to utilize the services provided by Cleartrackhr. Such actions constitute grounds for the termination of
this Agreement; in the event of such termination,Client shall not be entitled to any refund for services that have
not been utilized. Employees of Client, and dependents of employees of Client,must provide demographic and
contact information to Cleartrackhr in an acceptable form or Employer must be able to promptly verify such
information prior to the commencement of the Initial Term of this Agreement.
10.0 Litigation.This Agreement shall be governed,construed,and enforced in accordance with the laws of the
State of Florida. Any litigation arising from or in relation to this Agreement shall occur in either the Circuit
Court in and for the Sixteenth Judicial Circuit,Florida,or the federal court sitting in the Southern District of
Florida.These courts shall have exclusive jurisdiction over any disputes or controversies arising from or in
relation to this Agreement.
11.0 Indemnification. To the extent allowed by law,Client agrees to indemnify,defend,and hold harmless
Consulting Firm, including but not limited to Cleartrackhr's officers, directors,employees,agents,licensees,and
assigns,from and against any and all actions,claims, lawsuits, liabilities,damages,costs,and expenses,
including reasonable attorneys' fees,arising out of the Client's actions under this Agreement.To the extent
allowed by law,Cleartrackhr agrees to indemnify,defend,and hold harmless the Client, including but not limited
to Client's officers,employees, agents,licensees and assigns,from and against any and all actions,claims,
lawsuits, liabilities,damages,costs and expenses,including reasonable attorneys'fees,arising out of
Cleartrackhr's actions under this Agreement. The indemnification described within this paragraph shall include,
but by no means be limited to,indemnification, defense,and holding harmless regarding any disclosure,
maintenance,or use of Confidential and Private Information of Client's employees as described in Section 6.0 of
this Agreement.
12.0 Assignment.This Agreement between You and Cleartrackhr shall not be assigned to any third party. Such an
assignment is strictly prohibited, and shall constitute a breach of the Agreement which renders the Agreement
void.
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13.0 Execution in Counterpart:Addendum.This Agreement may be executed in any number of counterparts.Each
such counterpart shall be deemed an original,but all counterparts together shall constitute one and the same
agreement.In the event that any provision and/or addendum is found to be unenforceable,the remaining portions
of this Agreement shall remain in full force and effect in the absence of such provision or addendum.
14.0 Termination. Either party may terminate this Agreement with cause upon thirty(30)days'notice to the other.
Cause is deemed as a breach of the obligations of either party to perform the obligations enumerated under this
Agreement.
15.0 Miscellaneous.
A. Entire Agreement. This Agreement including Exhibits A-D,all of which are incorporated by reference,
constitute the entire agreement between the parties. This Agreement supersedes all prior or
contemporaneous oral or written communications,proposals,and representations with respect to the
subject matter covered by this Agreement. The terms and conditions of this Agreement can only be
modified via a written agreement signed by all parties.
B. Notice. Any notice,communication or payment required under this Agreement shall be addressed as
follows:
Client Vendor
... ., m. .. ..r .. .
I Monroe County BOCC ClearTrack HR,LLC
1100 Simonton Street 1 305A Quality Circle
Suite 2-268 Huntsville,AL 35806
r Key West,FL 33040 Attn: Contracting Department
f Attn:Maddox-
nataliega monroecounty-
F fl gov
C. HIPAA and HITECH Compliance. C1earTrack HR and the County shall comply with all federal and
state laws and regulations governing the privacy and security of health information, including without
limitation,the Health Insurance Portability and Accountability Act(HIPAA),Health Information
Technology for Economic and Clinical Health Act(HITECI ,and their related regulations,and shall
remain in compliance with these laws and regulations,and any other applicable laws,rules or regulations
pertaining to the services,as they may be amended from time to time. The parties shall execute whatever
additional documents or agreements may be necessary to comply with these laws and regulations.
D. The County and Cleartrackhr understand and agree that County officers and employees are required to
comply with the standards of conduct for public officers and employees as delineated in Section 112.313,
Florida Statutes,regarding,but not limited to,solicitation or acceptance of gifts;doing business with
one's agency;unauthorized compensation;misuse of public position,conflicting employment or
contractual relationship;and disclosure or use of certain information,or the County's gift policy, set forth
in Section 1.05 of the County's Personnel Policies and Procedures Manual(Code of Ethics),available at:
E. F.S.448.095,verification of employment eligibility: Beginning January 1,2021,all contractors and
subcontractors must register with and use the E-Verify system to verify the work authorization status of
all newly hired employees. By entering into this Agreement,Cleartrackhr warrants that it has registered
with and uses the E-Verify system. If Cleartrackhr enters into any contracts with subcontractors, all
subcontractors must provide Cleartrackhr with an affidavit stating that the subcontractor does not employ,
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contract with,or subcontract with an unauthorized alien. Cleartrackhr shall maintain a copy of such
affidavit for the duration of the contract.
F. Non-discrimination. Client and Cleartrackhr agree that there will be no discrimination against any person,and it
is expressly understood that upon a determination by a court of competent jurisdiction that discrimination has
occurred,this Agreement automatically terminates without any further action on the part of any party,effective
the date of the court order. The parties agree to comply with all Federal and Florida statutes,and all local
ordinances,as applicable,relating to nondiscrimination. These include but are not limited to: 1)Title VI of the
Civil Rights Act of 1964(PL 88-352)which prohibits discrimination on the basis of race,color or national
origin;2)Title IX of the Education Amendment of 1972,as amended(20 USC ss. 1681- 1683,and 1685-1686),
which prohibits discrimination on the basis of sex;3)Section 504 of the Rehabilitation Act of 1973,as amended
(20 USC s.794),which prohibits discrimination on the basis of handicaps;4)The Age Discrimination Act of
1975,as amended(42 USC ss.6101-6107)which prohibits discrimination on the basis of age; 5)The Drug
Abuse Office and Treatment Act of 1972(PL 92-255),as amended,relating to nondiscrimination on the basis of
drug abuse;6)The Comprehensive Alcohol Abuse and Alcoholism Prevention,Treatment and Rehabilitation
Act of 1970(PL 91-616),as amended,relating to nondiscrimination on the basis of alcohol abuse or alcoholism;
7)The Public Health Service Act of 1912, ss. 523 and 527(42 USC ss.690dd-3 and 290ee-3),as amended,
relating to confidentiality of alcohol and drug abuse patient records; 8)Title VIII of the Civil Rights Act of 1968
(42 USC s.et seq.),as amended,relating to nondiscrimination in the sale,rental or financing of housing; 9)The
Americans with Disabilities Act of 1990(42 USC s. 1201 Note),as maybe amended from time to time,relating
to nondiscrimination on the basis of disability; 10) Any other nondiscrimination provisions in any Federal or
state statutes which may apply to Client and Cleartrackhr to,or the subject matter of,this Agreement.
16.0 �� Prior to execution of this Agreement,Cleartrackhr is required to provided certificates of insurance
showing the following coverages:
Coverage Minimum Limits Form#
Workers' Compensation Statutory WC 1
Employers Liability $100,000/$500 000/$100,000
Commercial general Liability $300,000 GL1
Vehicle Liability $300,000 VL2
Professional Liability $300,000 PROI
Monroe County BOCC shall be shown as an additional insured on commercial general and vehicle liability. The
coverages shall remain in force throughout the term of this Agreement. Cleartrackhr shall provide updated certificates
whenever the coverages expire.
<Rest of the page is intentionally left blank>
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IN WITNESS WHEREOF,the parties have caused this Agreement to be executed the date set forth below.
The parties hereby agree and consent to the terms and conditions of the Agreement and acknowledge such by
executing the Agreement below.
Executed Roman Gastesi Accepted Cleartrackhr,LLC
by: By:
Docuftned by;
Signature: Signature:
Printed Printed Heather McFarland
Name: Roman Gastesi Name:
Title: Monroe County Administrator Title: CEO
Date Date 10/14/2021
Signed: November 15, 2021 Signed:
305A Quality Circle
Address: 1100 Simonton St., Suite 205 Address: Huntsville,Alabama 35806
Email: gastesi-roman@monroecounty-fl.gov Email: hmefariand@cleartrackhr.com
Approved as to form and legal sufficiency:
Digitally signed by Cynthia L.
Hall
DN:cn=Cynthia L.Hall,
o=Monroe County BOCC,ou,
ernall=hall-
cyhi;,W,40rqonroecounty-
Date:2021.10.14 14:33:24
-04'00'
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EXHIBIT A
CLEARTRACKHR SCOPE OF SERVICES
CLEARTRACKHR shall provide the following services to You under this Agreement:
• A dedicated account manager that will assist Your company throughout the implementation of services;
• Custom communication materials to be distributed to Your employees;
• A 24/7 digital scheduler to be utilized by employees to schedule a consultation with an America`s Health
Insurance Plans(AHIP)certified counselor or other professional;
• A dedicated toll-free telephone number;
• AHIP certified counselors;
• Benefit consultation services for employees who are 65 years of age or older,or who are soon to be 65 years of
age,and who are currently enrolled in an existing Employer-sponsored medical insurance plan in order to assist
employees in determining the benefits of remaining on their current Employer-sponsored medical insurance plan,
or enrolling in Medicare and/or Medicaid;
• Benefit consultation to Your employees and/or dependents of employees who are disabled,have been diagnosed
with End-Stage Renal Disease(ESRD),or are currently on dialysis,regarding the benefits of remaining on the
current Employer-sponsored medical insurance plan(s)in which they are currently enrolled,or enrolling in
Medicare and/or Medicaid;
• Assistance to Your employees who have a disability lasting more than one year in determining what benefits are
available to them under their current Employer-sponsored medical insurance plan(s),as well as under Medicare
and/or Medicaid.
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EXHIBIT B
DUTIES OF CLIENT
You shall be responsible for the following support duties:
• Immediately inform Consulting Firm of any breach of information of which Client
becomes aware;
• Client shall provide Consulting Firm with accurate and sufficient information for
Consulting Firm to review the subject matter thereof and shall promptly provide
further information that Consulting Firm reasonably deems relevant to forming any
pertinent conclusions relevant to the matter for discussion;
• Provide a dedicated individual who will serve as a representative for Client to work
alongside Account Manager to resolve any pending issues;
• Provide and/or supply accurate information to Cleartrackhr for both authorized users
and applicable employees of Client.Authorized users include employees and their
dependents demographic and contact information must be provided to Cleartrackhr in
an adequate form or be able to be promptly verified by Employer in advance by
dedicated Client representative;
• Agrees to pay all invoices in a timely fashion as agreed upon within the Agreement;
• Providing a listing of all Medicare eligible employees,along with a correlating date of
birth for each such employee.
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EXHIBIT C
COMPENSATION&FEE SCHEDULE
Description COST Estimated Cost
Implementation $1,500 ) $1500
Consulting Services $95/1-lour TBD
Invoicing and Pg3nents. The invoice shall be sent to You on the I"(first)of each month.Invoices will be
delivered via email to the address provided by You are due and payable within 30-days of invoice. Invoices past
30 days shall incur interest at rate of 1.5%per month.
*Additional services requested by Client will be billed on a time and materials basis. Client must authorize all
additional services and fees, in writing,prior to work being performed.
You agree to timely pay all fees,costs and expenses arising out of or resulting from the service listed in Exhibit
C Compensation& Fee Schedule, in accordance with the Florida Local Government Prompt Payment Act.
Failure to pay may result in interruption of services and additional interest fees.
Monroe County's performance and obligation to pay under this Agreement is contingent upon annual
appropriation by the Monroe County Board of County Commissioners.
All invoices must be submitted to the County with supporting documentation and in a form acceptable to the
Clerk of Courts. Acceptability to the Clerk is based on generally accepted accounting principles and such laws,
rules,and regulations as may govern the Clerk's disbursal of funds.
This Agreement is subject to a not to exceed maximum of$49 999 99
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EXHIBIT D
FORMS
10
Monroe County Purchasing Policy and Procedures
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 CONTRACTOR under a contract with
any public entity,and may not transact business with any public entity in excess of the threshold amount
provided in Section 287.017, for CATEGORY TWO for a period of 36 months from the date of being
placed on the convicted vendor list."
I have read the above and state that neither&ftmfwrttll (Respondent's name)nor any
Affiliate has been placed on the convicted vendor list within the last 36 months.
W O aLA t
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STATE OF:
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ne
Subscribed and swom to (or affirmed) before me, by means of;d_physical presence(date)
or ® onliby
notarization, on
�r �F�,.-(p..� (name of affiant). He/She is personally known to me or
has produced
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Monroe County PurchasinaPolicy and Procedures
SWORN STATEMENT UNDER ORDINANCE1 -1 9
MONROE FLORIDA
ETHICS CLAUSE
ri
(Company)
"...warrants that he/it has not employed, retained or otherwise had ct on f Ordinance No. 010-1990 or�anY County officer or
County officer or employee in violation of Section 2 0
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 Agreement without liability and may also,in its discretion,
deduct from the Agreement or purchase price, or otherwise recover, the full amount of any fee,
commission, percentage, gift, or consideration paid to the former County officer or employee."
OignaWturre)&A
Date: io l ►� �
STATE OF: a-
COUNTY OF:
Subscribed and swam to(or affirmed)before me, by means of 1�physical presence or❑online
notarization, on
(name of affiant). He/She is personally
(date)by
known to me or has produced L
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identification.
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Monroe County Purchasing Policy and Procedures
DRUG-FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:
U tty Wdcy�
(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' policy of
maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee
assistance programs, and the penalties that may be imposed 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).
loyees that, as a condition of working
4. In the statement specified in subsection (1), notify the emp
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 guilty or nolo
contendere to,any violation of Chapter 893(Florida Statutes)or of any controlled substance law
of the United States or any state,for a violation occurring in the workplace no later than 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, or any employee who is
so convicted.
6. Make a good faith effort to continue to maintain a drug-free workplace through implementation
of this section.
As the person authorized to sign the statement, I certify that this firm complies fully with the above
requirements.
*( ig"nature)
Date: 10 1,4 ?Z 24
STATE OF:
COUNTY OF: �t
by means of physical presence or ❑ online
Subscribed and sworn to (or affirmed) before i
notarization, on � 9 (date) by
� k« �� ������, (name of affiant). He/She is personally known to me or
�• S g 4 g 8 q� identification)as identification.
has produced
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Monroe County Purchasing Policy and Procedures
NON-COLLUSION AFFIDAVIT
I, of the city of W&1rygt according to law Qn my oath,
and under penalty of perjury, depose and say that
a. I am CC0 of the firm of
RV,- LIL the bidder making the
Proposal for the project described in the Request for Proposals for
and that I executed the said proposal
with full authority to do so;
b. the prices in this bid have been arrived at independently without collusion, consultation,
communication or agreement for the purpose of restricting competition, as to any matter
relating to such prices with any other bidder or with any competitor;
C. unless otherwise required by law,the prices which have been quoted in this bid have not
been knowingly disclosed by the bidder and will not knowingly be disclosed by the bidder
prior to bid opening, directly or indirectly, to any other bidder or to any competitor; and
d. 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;
e. the statements contained in this affidavit are true and correct, and made with full
knowledge that Monroe County relies upon the truth of the statements contained in this
affidavit in awarding contracts for said project.
AA
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(Signature)Date: to It
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STATE OF: `COUNTY CIF: kAad i S®h
Subscribed and sworn to (or affirmed) before me, by means ofX1 physical presence or❑online
notarization, on (date)by
A -,<r (name of affiant). He/She is personally known to me or has
produced Al-- b L (type of identification)as
identification.
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,." U,•' OS R�.'', '� My Commission Expires: 202q
Revised 13OCC 3/18/2020 �` ►
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My Commission Expires August 28,2024
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CERTIFICATE OF LIABILITY INSURANCE DATE( IDD
11/10/2021
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUE (S),
AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: N the certificate holder Is an ADDITIONAL INSURED, the policy(i ) must be endorsed. H SUBROGA710NIS WANED,
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 endomement(s).
PRODUCER CONTACT
MCGRIFF INSURANCE SERVICES INC/PHS PHONE (866) 7-8730 FF
22273438 (888)443-6112
The Hartford Business Service Center (ac'No. )` No):
3600 Wiseman Blvd E-MAIL
San Antonio,TX 78251 ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURERA: Twin City Fire Insurance Company 29459
Cleartrack HR,LLC INSURER B:
305 QUALITY CIR NW#A
HUNTSVILLE AL 35806-4542 INSURER C:
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.NOTVATHSTANDING 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INS TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000
CLAIMS-MADE OCCUR DAMAGE TO RENTED $1 000 000
X General Liability MED EXP(Any one person) $10,000
A X 22 SBA RS9035 01/12/2021 01/1 022 PERSONAL&ADv INJURY $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER Approved Risk Man igernent GENERAL AGGREGATE $4,000,000
POLICY PRO- LOC /� C� PRODUCTS-COMP/OP AGG $4,000,000
JECT
OTHER: 11-11-2021
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $2,000,000
Me a=k1antl
ANY AUTO BODILY INJURY(Per person)
A ALL OWNED SCHEDULED X 22 SBA RS9035 01/12/2021 01/12/2022 BODILY INJURY(Per accident)
AUTOS AUTOS
HIRED NON-OWNED PROPERTY DAMAGE
X AUTOS X AUTOS (Per accident)
UMBRELLA LIAR OCCUR EACH OCCURRENCE
EXCESS LIAB CLAJMS-
11 AGGREGATE
ED I RETENTION$
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY ISTATUTE ER
ANY YIN E.L.EACH ACCIDENT
PROPRIETOR/PARTNER/EXECUTIVE W A
OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE
JM&ndatory In NH)
N yes,describe under E.L.DISEASE-POLICY LIMIT
A EMPLOYMENT PRACTICES 22 SBA RS9035 01/12/2021 01/1 022 Each Claim Limit $10,000
LIABILITY I I I I Aggregate Limit $10,000
DESCRIP770M OF OPERAnONS ILOCA77ONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more awe Is required)
Those usual to the Insured's Operations.Certificate holder is an additional insured per the Business Liability Coverage Form SS0008 and the Hired
Auto and Non Owned Auto Endorsement SSO438,attached to this policy.
CERTIFICATE HOLDER CANCELLATION
Monroe County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
Board of County Commissioners BEFORE THE EXPIRATION DATE THEREOF,NOTICE VWLL BE DELIVERED
1100 SIMONTON ST STE 2-268 IN ACCORDANCE VWTHI THE POLICY PROVISIONS.
KEY WEST FL 33040-3110 �AU�T+Ho D ,PoRESENTaTIVE
C.J cal.
®19 -2015 ACORD CORPORATION.All rights reserved.
( 161 ) The ACORD name and too are registeredof ACORD
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