Item I2
BOARD OF GOVERNORS
FIRE AND AMBULANCE DISTRICT 1
AGENDA ITEM SUMMARY
Meeting Date: September 17,2003
Bulk Item: Yes No ---K-
Division: County Administrator
Department: Fire Rescue
AGENDA ITEM WORDING: Approval of Renewal Agreement effective from October I, 2003
through September 30,2004, between Board of Governors of Fire and Ambulance District I of Monroe
County Florida and Roy Khanna for maintenance of Fire Rescue vehicles (Ambulances) including
inspections, preventative maintenance, and unscheduled maintenance and repairs resulting from failure
or malfunction.
ITEM BACKGROUND: The original agreement provides for annual renewals for up to three (3)
one-year periods, with approval of the District's governing Board. Weare requesting approval to
exercise that renewal clause for the first one-year period, commencing on October I, 2003 and ending
on September 30, 2004.
PREVIOUS REVELANT BOG ACTION: On March 19,2003, the Board approved an agreement
with Roy Khanna for maintenance of Fire Rescue vehicles (Ambulances) including inspections,
preventative maintenance, and unscheduled maintenance and repairs resulting from failure or
malfunction.
CONTRACT/AGREEMENT CHANGES: None.
STAFF RECOMMENDATIONS: Approval.
TOTAL COST:
$60,000.00
BUDGETED: Yes ---K- No
COST TO COUNTY: $60,000.00
141-13001-530-462
SOURCE OF FUNDS: Ad valorem taxes
REVENUE PRODUCING: Yes
No ---K- AMOUNT PER MONTH_ Year
APPROVED BY: County Arty YES
DIVISION DIRECTOR APPROVAL:
~
James L. Roberts
anagement YES
FIRE CHIEF APPROVAL:
..........
DOCUMENTATION:
Included
x
To Follow
Not Required_
DISPOSITION:
AGENDA ITEM # - /' /V _
Revised 1103
MONROE-COUNTY BOARD OF GOVERNORS
CONTRACT SUMMARY
Contract with:
Roy Khanna
Contract #_
Effective Date:
Expiration Date:
1 % 1/2003
09/30/2004
Contract Purpose/Description:
Renewal of agreement dated 3/19/2003 for maintenance of Fire Rescue Vehicles
(Ambulances) including inspections. preventative maintenance. and unscheduled
maintenance and repairs resulting from equipment failure or malfunction.
Contract Manager: Susan Hover
(Name)
6088
(Ext. )
Fire Rescue / Stop 14
(Department/Stop #)
for BOCC meeting on
09/1 7/2003
Agenda Deadline: 09/02/2003
CONTRACT COSTS
Total Dollar Value of Contract: $ 60,000.00
Budgeted? YesC8:/ No 0 Account Codes:
Grant: $
County Match: $
Current Year Portion: $ 60,000.00
13001-530462-_-_-_
- - - -
-----
- - - -
-----
- - - -
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ADDITIONAL COSTS
Estimated Ongoing Costs: $~yr For:
(Not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, etc.)
CONTRACT REVIEW
Date Out
Date In
Division Director ~?
"7""~
f12~/o3
Risk Management
County Attorney
Co
OMB Form Revised 2/27/01 Mep #2
RENEWAL AGREEMENT
This Aq-REEMENT dated the day of ,2003, by and between
the Board of Governors of Fire and Ambulance District I of Monroe County, Florida, hereinafter called the
"District" and Roy Khanna., whose mailing address is 3117 Carol Avenue, Palm Springs, FL 33461,
hereinafter called the "Contractor".
WITNESSETH
WHEREAS, the parties hereto did enter into an agreement dated March 19,2003 for scheduled general
and preventative maintenance of all Monroe County Fire Rescue ambulances, and for unscheduled maintenance
and repairs resulting from equipment failure or malfunction; and
WHEREAS, said agreement provided an option to the District to renew the contract for three additional
one year terms; and
WHEREAS, the DISTRICT has elected to exercise said option for the continuation of scheduled general
and preventative maintenance of all Monroe County Fire Rescue ambulances, and for unscheduled maintenance
and repairs resulting from equipment failure or malfunction; now therefore
IN CONSIDERATION of the mutual convenants and obligations contained herein, the parties agree as
follows:
I. The District elects to renew the contract for an additional year pursuant to paragraph 1 of the
agreement entered March 19,2003.
2. The effective date of this amendment is October 1,2003 and shall extend through September
30, 2004, under the same terms and conditions of the contract dated March 19, 2003.
3. All other terms and conditions of the contract dated March 19, 2003 shall remain in full force
and effect.
Attest: DANNY L. KOLHAGE, CLERK
BOARD OF GOVERNORS,
FIRE AND AMBULANCE DISTRICT 1
By:
Deputy Clerk
By:
Mayor/Chairman
ROY KHANNA
WITNESS:
Authorized Representative
: f7fcORD'M
..................
. PROOUCER
JOHNSON & MILLER INSURANCE
1225 N MILITARY TRAIL #2
WEST PALM BEACH, FL 33409
561-640-4333
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
CCMPANY
A
HERMITAGE
INSURANCE CO.
INSUREO
ROY KH.;NNA
CCMPANY
B
3117 CAROL AVE
PALM SPRINGS, FL 33461
,(561) 641-2360
C8MPANY
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THIS IS TO CE:RTIFY THAT THE POLICIES OF INSURANCE LISTED BELCW HAVE SE::N ISSUED TO THE INSURED NAMED ABOVE FOR THE POLiCY PERIOD
INDICAT::D, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CGNCITICN CF ,J,NY CONTRACT OR OTHER DCCUMENT WITH RESPECT TO WHICH THIS
CERTIFiCATE ,'"lAY BE ISSUED OR MAY PERTAIN, THE INSURANCE~FFCRCED 3Y THE POLICIES DESCRIBED HERE'N !S SUBJECT TO AU. THE TERMS,
::XCl..USlmJS AND CONCITIONS OF SUCH POLiCIES. LIMITS SHOWN ,'"lAY ;..;AVE 3E::N RESUC:::D BY ?J,ID CLJ,IMS.
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TYPE OF INSURANCE
POLICY NUMBER
;'lCLJCY EFFEC"TIVE
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OESCRIPTION OF OPERA TlONSILOCA TlONSNEHICLESISPECIAL ITEMS
MAINTENCE OF FIRE EQUIPMENT
: gERtiF.icAtE:"I:joijjER7~;:." ,~"'-' :<-';~~;'-'tlli;''':1k~~~fc.J::~:~~'':'.CAi>JCEilA;rioN;~~*.&~5;~!;~;;.~:~;~~~i.::;;::.;,.~~,~:;;;ii~
SHOULD ANY OF THE ABOVE OE5CRIBED POLICIES BE CANcaLEO BEFORE THE I
I
MONROE COUNTY BOARD OF COUNT'{ EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENOEAVOR TO MAIL
C OHM IS S I ONE RS ~ DAYS WRITTEN NOTICE TO THI1 CERTIFICATE HOLDER NAMEO TO THE LEFT,
!,
i\TTN: RISK MANAGEMENT aUT ,,;;:;LURE TO ".AIL SUCH NOT1CS.SHALL',MPOSE NO OBLIGATION OR LiABILlrl
'I' 1100 SIMONTON STREET I OF ANy'I<INO UPON THE ~Cl/"j,ANl'TS AGENTS OR REPRESENTATIVES.
KE'f WEST FL 33040 i )'UTHORIZ~ESENTATlVE ( ,
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l\IAINTENANCE OF FIRE/RESCUE VEHICLES
AGREEMENT is made and entered into by the Board of Governors of Fire and Ambulance
District 1 of Monroe County, Florida, hereinafter referred to as "DISTRICT", and Roy Khanna,
hereinafter referred to as "CONTRACTOR".
RECITALS
A. The DISTRlCT advertised a notice of calling for bids for MAINTENANCE OF
FIREIRESCUE VEHICLES, \vhich \vere opened on the ih day of January 2003;
B. The successful bidder was Roy Khanna;
C. The initial contract provides for a renewal of the contract for three additional one-year
terms.
D. This contract is an agreement bet\veen parties.
NOW, therefore, the parties agree as follows:
1. CONTRACT PERlOD AJ.'ID RENEWAL - The first contract term is a period from the
date on which it is signed by the last of the two parties and will expire on September 30,
2003. This contract may be renewed, at the option of the DISTRlCT, upon giving at least
30 days notice to CONTRACTOR. The option for renewal shall be for three additional
one-year terms conditioned upon annual appropriation of funds.
2. CONTR.A..CT TERivIINATION - This contract may be terminated for any reason by either
party on 30-day written notice without cause.
3. SUBJECT MATTER OF CONTRACT - This contract is for performing scheduled
general and preventative maintenance of all Monroe County Fire Rescue ambulances, and
for unscheduled maintenance and repairs resulting from equipment failure or malfunction.
4. RATES -The hourly rate shall be $65.00 per man-hour with no travel time or mileage
charge. Jobs requiring more than one technician will be charged at the rate of $35.00 per
man-hour for the second man. The charge for conducting an ambulance inspection with
each preventative maintenance performed will be $239.00.
5. WORK SCHEDULE - Regularly scheduled inspections and preventative maintenance
shall be conducted at such intervals as are approved by the DISTRlCT and by the Ford
Scheduled Maintenance Guide using "Special Operating Conditions" as the guide for the
Ford Maintenance. The modular portion of the vehicle shall be maintained in accordance
with the manufacturers recommendations.
6. P ARTS, FLUIDS AND LUBRICA1"'-TTS - 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%, with a copy of original parts supplier invoices for all parts
attached to the bill.
Page 1 of J
7. ENGINE OIL AND FILTER CHANGE - CONTRACTOR shall compl~te drivetrain
lubrication and any other fluids and/or filter changes shall b~ performed as recommended
by Ford.
8. WEEKLY MAINTENANCE SCHEDULE - CONTRACTOR shall provide to the
DISTRICT a preventative maintenance schedule that can be performed weekly by
Monroe County Fire Rescue personnel.
9. M.A.INTENAL"fCE LOG - CONTR.A.CTOR 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 \vithin 30 days of the
servIce.
A computerized ambulance inspection form shall be developed by the Contractor and _
approved by the Monroe County Fire Rescue Support Services Manager. This form will
be completed by the Contractor and forwarded to the office of the Support Services
Manager so that it can part of the service record of the vehicle.
10. CONITvfUNICATION - CONTRACTOR shall maintain a telephone or paging device such
that prompt notification of request for service is possible at all times.
11. RESPONSE TO SERVICE REQUEST - CONTRACTOR shall have 120 hours to
respond if one ambulance goes off line. If a second ambulance goes off line, the
Contractor must respond within 48 hours of notification to repair both vehicles. If a third
ambulance goes offline, the Contractor must respond immediately to get a minimum of
two ambulances back on line.
12. CERTIFICATION - CONTRACTOR shall provide evidence satisfactory to the
DISTRICT that its personnel who perform maintenance work are certified in general
mechanics and repair.
13. QUALIFICATIONS OF MAINTENAL"l"CE PERSONNEL - All personnel performing
maintenance, repairs, adjustments, and related work on the DISTRICT'S equipment shall
be certified or experienced in the work to be performed.
14. INDEMNIFICATION - CONTR.l\CTOR 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 A". 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.
PJge 2 of3
15. LOCA nON OF WORK :- This contract covers ambul::mces located at the following
stations:
a. Big Coppitt
b. Cudjoe
c. Big Pine
d. Conch Key
e. Tavernier
16. INSURANCE - As per Attachments "8"::md "C'.
17. PA ThlENTS - Payments shall be made by the DISTRICT \vithin 30 days of the
completion of the rendered services on each vehicle and proper invoicing by the
CONTRl-\CTOR. All unscheduled maintenance and repairs resulting from equipment
failure or maLfunction requiring serv'ice shall be billed by the CONTR...\CTOR at the
applicable rates as specified in Section four of this AGREEMENT. The CONTRA.CTOR
upon notitication by the DISTRlCT of an equipment failure or malfunction requiring
unscheduled maintenance shall. in a timely manner investigJ.te the prob lem ::md provide
to the DISTRICT an estimate or the cost for repJ.ir and vehicle dO\\TItime. The
CONTRA.CTOR upon receiving authorizJ.tion to proccd from the DISTRiCT shall
effectuate~uch repair; upon completion of same the contractor shall notifY the DIST~CT
of the outcome and actual cost. The DISTRlCT shall issue a separ3.te purchase order for
each occurrence of unscheduled maintenance and repair.
1 S. This contract takes effect on the date of the last party to sign.
19. Monroe County's performance and obligation to pay under this contract is contingent
upon an annual appropriation by the B.O.c.c.
20. Venue for any litigation arising under this contract must be in a court of competent
jurisdiction in Monroe County, Florida.
IN WITNESS WHEREOF, each party hereto has caused this contract to be executed by its duly
authorized representative.
I.r-'
Attest: DANNY L. KOLHAGE, CLERK
BOARD OF GOVERi'\fORS,
FIRE At"\TI kvIBULk'I.JCE DISTRlCT 1
~)1t~
By:~J.u..1..Q. ~~~
Deputy Clerk
By:
WITNESS: k.:Jc~ 7/;;_f[--erL
---
PJ~e3of3
1'190 EJitlon
MONROE COUNTY, FLORIDA
RISK MANAGEMENT
POLICY AND PROCEDURES
CONTR.\CT ADMINISTRATION
MANU AL
Indemnific:ltion and Hold Harmless
for
Other Contractors :lnd Subcontractor.>
The Contractor covenants and agrees to indern.ni.G' and hold h::umless Monroe County Board of
County Commissioners from any and aU cb.irns fo'r bodily injury (including death). pe'rsonal injury,
and property damage (including property o\vned by Monroe COUI1ty) and any other losses,
darr..ages, and expenses (including attorney's te~s) which arise out ot: in connection \vit~ or by
re:lSon ofsef'lices provided by the Contr::..cror or any of its Sulxontr::lctor(s) in any tier,
occ:lSioned by the negligence, errors, or ocher \"'-T'ongful 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 failure to purchase or maintain the required insurance, the
Contractor shall indemnify the County from any and all incre:lSed expenses resulting from such
delay.
The first ten dollars (SI0.00) 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 mthin this agreement.
TCS
Administration [nstruction
#~709.5
96
ATTAC[frlENT A
1')9<, EJltion
RISK MANAGEMENT
POLICY AND PROCEDURES
CONTR.\.CT ADMINISTR-\ TION
MANUAL
Gener:lllnsur.1nce Requiremen'ts
for
Other Contr.lctors :lnd Subcontr.1ctors
As 3. pre-requisite of the work governd. or the goods supplied under this contract (including the
pre-st::J.ging ofpersonnd and material), the Contractor sh::J.U obuin, at his/her OV.TI expense,
insurance 3..S specified in any lltt::J.ched schdules. \vhieh an~ nude pllft of this contr::J.ct. The
Contr::J.ctor will ensure that the insuranee obt:lind v.ill extend protection to ::ill SUDcontf::J.ctors
eng:lged by the Contr::J.ctor. As an alter:utive. the Contr::J.ctor m::J.Y require J.U Subcontr::J.ctors to
obtaL.! insur:mce consistent v.ith the attJ.cnd schdules.
The Contrllctor \vill not be permitted to commence work govemed by this contr::J.ct (including pre-
staging of personnel and material) until satisfactory evidence 0 r the required insur.mce has been-
furnished to the County as specified bdo\v. Delays in the commencement ohvork, resulting from
the failure of the Contractor to provide satisfactory evidence of the required insur311ce, shall not
extend de::J.dlines specified in this contr:lct 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
Contr::J.ctor's failure to provide satisfactory evidence.
The Contractor shall maintain the required insurance throughout the entire term of this contr:lct
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 insur:mce has been reinstated or
replaced. Delays in the completion of work resulting from the tailure of the Contractor to
maintain 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 had not been
suspended, except for the Contractor's failure to maintain the required insur:mce.
The Contractor shall provide, to the County, as satisfactory evidence of the required insur:mce,
either:
. Certificate 0 f Insurance
or
. A Certified copy of the actu::J.l insur:mce policy.
The County, at its sole optio~ has the right to request a certified copy of any or all insur:mce
policies required by this contract.
All insurance policies must specify that they are not subject to c:mceUation, non-renewal, material
change, or reduction in coverage unless a minimum of thirty (30) days prior notification is given
to the County by the insurer. -
The accept:mce and/or approval of the Contractor's insur:mce shall not be construed as relievin2:
the Contractor from any liability or oblig:ltion 3..Ssumed under Lllls contract or imposed by bw. -
Administration Instruction
#4i09.5
14
ATTAC~1DT B (Page l ot 2)
",
1996 Edition
The Monroe County Board of County Commissioners, its employees and officials ..viti be included
as "Additional Insured" on all policies, except for Workers' Compensation.
Any deviations from these General Insurance Requirements must be requested in ...mting on the
CoUnty prepared form entitled "Request for \Vaiver oflnsur.J.nce Requirements" and approved
by Monroe County Risk Management.
Administration Instruction
#4709.5
ATTAC~lE~T B (Page 2 of 2)
15
19<J6 EJilion
GENERAL LIABILITY
INSUR<\NCE REQUIREMENTS
FOR
CONTRACT
BETWEEN ..
MONROE COUNTY, FLORIDA
AND
Prior to the commencement of work govem~d bv this contract. the Contractor shall obtain
General Liabilitv Insurance. Coverag'e shall be ffiaintain~d throughout the lif~ of the contract and
include, as a rniillmu.m: - -
· 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 follo'Ning the acceptance of work by the County.
The Monroe County Board of County Commissioners shall be named as Additional Insured on all
policies issued to satisfy the above requirements.
GLl
Administration Instruction
1#4709.5
43
ATTACHMENT C (Page 1 of 3)
1996 Edition
VEHICLE LIABILITY
INSURANCE REQUIREl\'IENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORlDA
AND
Recognizing that the work governed by this contract requires the use ofvehic1es, the Contractor,
prior to the commencement of work, shall obtain Vehicle Liability Insurance. Coverage shall be
maintained throughout the life 0 f the contract a.nd include, as a minimum. u;lbility coverage for:
. O'l;Vtled, No n-O\vlled, 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
policies issued to satisfy the above requirements.
VLl
Administration Instruction
#4709.5
80 .
ATTACHXENT C (Page 2 of 3)
1996 Edition
GAR<\GE LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
,0\1 'iD
Recognizing that the work governed by this contract involves the servicing and/or repair of
County-ov.ned vehicles, the Contractor will be required to purchase and maintain a Garage Policy
'to include Garage Liability Insurance extending to vehicles, ov.TJ.ed or leased by the County, kft
v.ith the Contractor for servicing, repair, storage, or safekeeping. Coverage should include, as a
.-
minimum:
. Premises and Operations Liability
. Vehicle Liability
. Contractual Liability
. Products and Completed Operations Liability
. Garage Keepers' Legal Liability, to include:
Comprehensive and Collision
The Garage Keepers' Legal Liability shall extend to all County-ownedJ1eased vehicles in the care,
custody, and control of the Contractor.
The Contractor's insurance shall be primary to any coverage maintained by the County.
The minimum limits acceptable shall be:
$300,000 Combined Single limit (CSL) for liability
$ 25,000 Garage Keepers' Legal Liability
The Monroe County Board of County Commissioners shall be named as Additional Insured on all
policies issued to satisfy the above requirements.
GKl
Administration Instruction
1#4709.5
46
ATTAC~lENT C (Page J of J)
./
7
/-'
. /,:
, ~../
, .
I
I
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 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."
Page 6 of 10
.'
I, Roy
k'P '/ / ,fl-I'L 6-0
NON-COLLUSION AFFIDAVIT
IChA ~.vA-
~L
, of thc= city
of
according to law on my oath. and undc=r
pc=nalty of perjury, depose and say that;
I) I am~o1 '({'fI""~
the project described as ollows:
{)c'---
'v
, the bidder making the Proposal for
\.A('l...teN . C F{r.~Ti~""s ~f\.. /\. 'i).\.;QDE fov~"T FliJle. Reseve
\.J e ~ ('e I e.s
2) The prices in this bid havc= been arrived at indcpenccmly \vithout collusion, consultation,
communication or agreement for thc= purpose of restricting competition, as to any matter relating to such
prices with any other bidder or with any competitor: -
3) Unless otherwise required by law, the prices which have been quoted in this bid have not
been knowingly disclosed by the bidder and will not knowingly be disclosed by the bidder prior to bid
opc=ning, directly or indirectly, to any other bidder or to any competitor: and
4) No attempt has been made or will be made by the bidder to induce any other person,
partnership or corporation to submit, or not to submit, a bid for the purpose of restricting competition;
5) 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.
STATE OF fi8tl7:>!f
COUNTY OF (1141/ ~
/ J - Ie' c. 7
Date
PERSONALLY APPEARED BEFORE ME, thc= undc=rsii:,'11c=d authority,
fl1rNlI who, after tirst being sworn by mc=, (name of individual
affixed hislher signature in the space provided above on this
/~ ct day of J)c(!,E/f1l3tL.
4~pfr
, 2o:?~
My commission expires: I' _ Gl ~
/J~
OMB - MC? FORM # I
~'\'d"~ Elizabeth EI Koury
*_*My CommiS3ion CC7a7397
,.".~ Expires December 11, 2002
Pag\.: 7 0 f l 0
SWORN STATEMENT UNDER ORDINANCE NO. 10-1990
. MONROE COUNTY. FLORIDA
'ETIDCS CLAUSE
Ko'( lc.hA-""'A- ~
warrJJ1ts 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. 10-1990 or any County officer or employee in violation of
Section 3 of Ordinance No.1 0-1990. 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 fee,
commission, percentage, gift, or consideration paid to the former County ofticer'or employee.
f~&~~
,I) (signature)
Date: /'; - / () -() :J-
i
COUNTY OF
n~ L(])!t
.
tnb /J~
STATE OF
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
KtJ'j Kl-lfl-NN A who, after first being sworn by me, aftixed hislher
signature (name of individual signing) in the space provided above on this I tJ ct.. day of
J)~f:1C , 20~
~~k#(J
My commission expires:
Id- . 1/' 0 ~
OMS - Mep FORM #4
~'h.". Elizabeth EI KoulY
*iJ*MY Commission CC787397
,\;"",,' Expires December 11, 2002
?agt: 8 of to
DRUG-FREE \VORKPLACE F0R1\'1
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:
Rt'l't Kl\. A-V",v A-
(Name of Business)
I. 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, tl1e business's policy of
maintaining a drug-free workplace, any available drug counseling, rehabiiitation, 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).
4. In the statement specified in subsection (I), 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 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.
()ft-~~
Bidd~rYs Signature
/ J -:).7-07-
Date
OMB - Me? FORM #5
Page 9 of La
MONROE COUNTY FIRE RESCUE
AMBULANCES
VEHICLE LOCATION YEAR/MAKE/ MODEL VIN NUMBER COUNTY 10 Prime or
Backup
BIG COPPITT 2002 FORD AMBULANCE 1FDXF46F22ED14878 1416-215 Prime
81G COPPITT 1995 FORD AMBULANCE 1 FDLF47FOSEA60715 1416-54 Backup
CUDJOE 2001 FORD AMBULANCE 1FDXF46F61EC33364 1416-207 Prime
BIG PINE 2001 FORD AMBULANCE 1 FDXF46F61EC33365 1416-208 Prime
BIG PINE 1997 FORD AMBULANCE 1 FDLF47F8VEA7393 1416-059 Backup
CONCH KEY 2001 FORD AMBULANCE 1FDXF46F41EC33363 1416-206 Prime
CONCH KEY 1997 FORD AMBULANCE lFDLF47F3VEA18040 1416-080 Backup
TAVERNIER 1999 FORD AMBULANCE 11=DWF46F9XEB99233 1416-120 Prime
TAVERf\JIER 1984/94 FORD AMBULANCE 1FDLF47MBREA52323 1417-151 Backup
Page 10 of 10