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4. 04/19/2023 Agreement Kevin Madok, cpA .4 Clerk of the Circuit court& Comptroller— Monroe County, Florida DATE: April 27, 2023 TO: Brian Bradle}', Maiiagcr Risk Maiiagemew FROM: Pamela G. Haiico(0., C'. SUBJECT: April 19' BOCC Meefiiig Attaclicd is mi electronic copy offlic Iollo%viiig item Ior your liandling: O I Contract witli Goo(littait-Gable Gould Company(1/b/a Adjusters International to provide Insurmice Adjusting Claim Services. I'lic semccs of the Cowractormll be used I'011omlig catastrophic events resulting M sigii1ficmit damage, such as hurricanes. Should you liaN,c any questions, please feel Frce to contact iiie at (305) 292-3550. cc: Couii1%,Attorney Fmaiice Filc KEY WEST MARATHON PLANTATION KEY PK/ROTH BUILDING 500 Whitehead Street 3117 Overseas Highway 88820 Overseas Highway 50 High Point Road Key West,Florida 33040 Marathon,Florida 33050 Plantation Key,Florida 33070 Plantation Key,Florida 330 305-294-4641 305-289-6027 305-852-7145 305-852-7145 AGREEMENT BETWEEN MONROE COUNTY AND GOODMAN-GABLE-GOULD COMPANY/ ADJUSTERS INTERNATIONAL FOR PUBLIC ADJUSTING CLAIM SERVICES THIS AGREEMENT is made and entered into this 19th day of April 2023, by MONROE COUNTY BOARD OF COUNTY COMMISSIONERS ("COUNTY"), a political subdivision of the State of Florida, whose address is 1100 Simonton Street, Key West, Florida 33040 and Goodman-Gable-Gould/Adjusters International (GGG/AI) ("CONTRACTOR" or "CONSULTANT"), whose address is 6767 N. Wickham Road, Suite 501, Melbourne, FL 32940. This Agreement shall consist of the terms, conditions and covenants contained in this Agreement, including all exhibits, and shall also include any and all representations contained in the Proposal submitted by the Contractor in response to the Request for Proposals (RFP) for Public Adjusting Claims Services, a copy of which is incorporated by reference. Section 1. SCOPE OF SERVICES CONTRACTOR shall do, perform and carry out in a professional and proper manner certain duties as described in the Scope of Services — Exhibit A—which is attached hereto and made a part of this agreement. CONTRACTOR shall provide the scope of services in Exhibit A for COUNTY. CONTRACTOR warrants that it is authorized by law to engage in the performance of the activities herein described, subject to the terms and conditions set forth in these Agreement documents. The CONTRACTOR shall at all times exercise independent, professional judgment and shall assume professional responsibility for the services to be provided. Contractor shall provide services using the following standards, as a minimum requirement: A. The CONTRACTOR shall maintain adequate staffing levels to provide the services required under the Agreement resulting from this RFP process. B. The personnel shall not be employees of or have any contractual relationship with the County. To the extent that Contractor uses subcontractors or independent contractors, this Agreement specifically requires that subcontractors and independent contractors shall not be an employee of the County. C. All personnel engaged in performing services under this Agreement shall be fully qualified, and, if required, to be authorized or permitted under State and local law to perform such services. Section 2. COUNTY'S RESPONSIBILITIES 2.1 Upon occurrence of an event that requires the Contractor's assistance, the County shall issue a notice to proceed to the Contractor. The County shall also provide a schedule of the structures that need to be evaluated. 1 Section 3. TERM OF AGREEMENT 3.1 The initial Agreement term will be for one (1) year beginning the 1st day of June 2023 ("Effective Date"). The Agreement shall be renewable at the County's sole option for three (3) additional consecutive one year terms. 3.2 Modification: If either party desires to modify this Agreement, it shall notify the other in writing at least thirty (30) days prior to the effective date of such modification. In the case of proposed modification, the party receiving the notification of the proposed modification shall itself notify the other party within ten (10) days after receipt of notice of its agreement to the proposed modification. Failure to do so shall terminate this Agreement. Section 4. PAYMENT TO CONTRACTOR 4.1 Compensation to the CONTRACTOR: Claims that result in recovering ranging from $0 to $1,000,000 from COUNTY's insurers will be billed at 7.0% of actual recovery. Claims in excess of $1,000,000 from COUNTY's insurers will be billed at 10% of actual recovery. 4.2 Payment will be made according to the Florida Local Government Prompt Payment Act, Section 218.70, Florida Statutes. The Provider shall submit the invoice and supporting documentation acceptable to the Clerk to the County's Risk Manager. 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. The Risk Manager shall review the request, note his/her approval on the request and forward it to the Clerk for payment. 4.3 Continuation of this Agreement beyond the initial fiscal year is contingent upon annual appropriation by Monroe County. Section 5. CONTRACT TERMINATION 5.1 Termination for Cause: Either party may terminate this Agreement because of the failure of the other party to perform its obligations under the Agreement. In the event of such breach, the party shall provide notice to the other party, and shall give the other party at least business days within which to cure the breach. If the breach is not cured within that time period, the Agreement may be terminated for cause. 5.2 Termination for Convenience: The COUNTY may also terminate this Agreement without cause upon thirty (30) days' notice to the CONTRACTOR. The COUNTY shall pay CONTRACTOR for work performed through the date of termination. Section 6. CONTRACTOR'S ACCEPTANCE OF CONDITIONS A. CONTRACTOR hereby agrees that he has carefully examined the RFP, his/her response, and this Agreement and has made a determination that he/she has the personnel, equipment, and other requirements suitable to perform this work and assumes full responsibility therefore. The provisions of the Agreement shall control any inconsistent 2 provisions contained in the specifications. All specifications have been read and carefully considered by CONTRACTOR, who understands the same and agrees to their sufficiency for the work to be done. Under no circumstances, conditions, or situations shall this Agreement be more strongly construed against COUNTY than against CONTRACTOR. B. Any ambiguity or uncertainty in the specifications shall be interpreted and construed by COUNTY, and its decision shall be final and binding upon all parties. C. The passing, approval, and/or acceptance by COUNTY of any of the services furnished by CONTRACTOR shall not operate as a waiver by COUNTY of strict compliance with the terms of this Agreement, and specifications covering the services. D. CONTRACTOR agrees that County Administrator or his designated representatives may visit CONTRACTOR'S facility (ies) periodically to conduct random evaluations of services during CONTRACTOR'S normal business hours. E. CONTRACTOR has, and shall maintain throughout the term of this Agreement, appropriate licenses and approvals required to conduct its business, and that it will at all times conduct its business activities in a reputable manner. Proof of such licenses and approvals shall be submitted to COUNTY upon request. Section 7. NOTICES Any notice required or permitted under this agreement shall be in writing and hand delivered or mailed, postage prepaid, to the other party by certified mail, returned receipt requested, to the following: To the COUNTY: Risk Manager 1111 12t" Street, Suite 408 Key West, Florida 33040 To the CONTRACTOR: Pat Cuccaro 6767 N. Wickham Rd., Suite 501 Melbourne, FL 32940 Section 8. RECORDS CONTRACTOR shall maintain all books, records, and documents directly pertinent to performance under this Agreement in accordance with generally accepted accounting principles consistently applied. Each party to this Agreement or their authorized representatives shall have reasonable and timely access to such records of each other party to this Agreement for public records purposes during the term of the agreement and for five (5) years following the termination of this Agreement. If an auditor employed by the COUNTY or Clerk determines that monies paid to CONTRACTOR pursuant to this Agreement were spent for purposes not authorized by this Agreement, the CONTRACTOR shall repay the monies together with interest calculated pursuant to Section 55.03 of the Florida Statutes, running from the date the monies were paid to CONTRACTOR. 3 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. 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 section119.10, 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, 4 CONTACT THE CUSTODIAN OF PUBLIC RECORDS, BRIAN BRADLEY AT PHONE# 305-292-3470 BRADLEY-BRIAN@MONROECOUNTY-FL.GOV, MONROE COUNTY ATTORNEY'S OFFICE 1111 12TH Street, SUITE 408, KEY WEST, FL 33040. Section 9. EMPLOYEES SUBJECT TO COUNTY ORDINANCE NOS. 010 AND 020-1990 The CONTRACTOR warrants that it has not employed, retained or otherwise had act on its behalf any former County officer or employee subject to the prohibition of Section 2 of Ordinance No. 010-1990 or any County officer or employee in violation of Section 3 of Ordinance No. 020- 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. Section 10. CONVICTED VENDOR By signing this agreement, CONTRACTOR represents that the execution of this Agreement will not violate the Public Entities Crime Act (Section 287.133, Florida Statutes). Violation of this section shall result in termination of this Agreement and recovery of all monies paid hereto, and may result in debarment from County's competitive procurement activities. 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 an Agreement with a public entity for the construction or repair of a public building or public work, may not perform work as a CONTRACTOR, supplier, subcontractor, or CONTRACTOR under Agreement with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017 of the Florida Statutes, for the Category Two for a period of 36 months from the date of being placed on the convicted vendor list. Section 11. GOVERNING LAW, VENUE, INTERPRETATION, COSTS AND FEES This Agreement shall be governed by and construed in accordance with the laws of the State of Florida applicable to Agreements made and to be performed entirely in the State. In the event that any cause of action or administrative proceeding is instituted for the enforcement or interpretation of this Agreement, the COUNTY and CONTRACTOR agree that venue shall lie in the appropriate court or before the appropriate administrative body in Monroe County, Florida. Section 12. SEVERABILITY If any term, covenant, condition or provision of this Agreement (or the application thereof to any circumstance or person) shall be declared invalid or unenforceable to any extent by a court of 5 competent jurisdiction, the remaining terms, covenants, conditions and provisions of this Agreement, shall not be affected thereby; and each remaining term, covenant, condition and provision of this Agreement shall be valid and shall be enforceable to the fullest extent permitted by law unless the enforcement of the remaining terms, covenants, conditions and provisions of this Agreement would prevent the accomplishment of the original intent of this Agreement. The COUNTY and CONTRACTOR agree to reform the Agreement to replace any stricken provision with a valid provision that comes as close as possible to the intent of the stricken provision. Section 13. ATTORNEYS FEES AND COSTS The COUNTY and CONTRACTOR agree that in the event any cause of action or administrative proceeding is initiated or defended by any party relative to the enforcement or interpretation of this Agreement, the prevailing party shall be entitled to reasonable attorney's fees, and court costs, as an award against the non-prevailing party. Mediation proceedings initiated and conducted pursuant to this Agreement shall be in accordance with the Florida Rules of Civil Procedure and usual and customary procedures required by the Circuit Court of Monroe County. Section 14. BINDING EFFECT The terms, covenants, conditions, and provisions of this Agreement shall bind and inure to the benefit of the COUNTY and CONTRACTOR and their respective legal representatives, successors, and assigns. Section 15. AUTHORITY Each party represents and warrants to the other that the execution, delivery and performance of this Agreement have been duly authorized by all necessary County and corporate action, as required by law. Section 16. ADJUDICATION OF DISPUTES OR DISAGREEMENTS COUNTY and CONTRACTOR agree that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions between representatives of each of the parties. If no resolution can be agreed upon within 30 days after the first meet and confer session, then any party shall have the right to seek such relief or remedy as may be provided by this Agreement or by Florida law. This Agreement shall not be subject to arbitration. Section 17. COOPERATION In the event any administrative or legal proceeding is instituted against either party relating to the formation, execution, performance, or breach of this Agreement, COUNTY and CONTRACTOR agree to participate, to the extent required by the other party, in all proceedings, hearings, processes, meetings, and other activities related to the substance of this Agreement or provision of the services under this Agreement. COUNTY and CONTRACTOR specifically agree that no party to this Agreement shall be required to enter into any arbitration proceedings related to this Agreement. 6 Section 18. NONDISCRIMINATION During the performance of this Agreement, the CONTRACTOR agrees as follows: 1. The contractor will not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, or national origin. The contractor will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, color, religion, sex, sexual orientation, gender identity, or national origin. Such action shall include, but not be limited to the following: Employment, upgrading, demotion, or transfer, recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the contracting officer setting forth the provisions of this nondiscrimination clause. 2. The contractor will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. 3. The contractor will not discharge or in any other manner discriminate against any employee or applicant for employment because such employee or applicant has inquired about, discussed, or disclosed the compensation of the employee or applicant or another employee or applicant. This provision shall not apply to instances in which an employee who has access to the compensation information of other employees or applicants as a part of such employee's essential job functions discloses the compensation of such other employees or applicants to individuals who do not otherwise have access to such information, unless such disclosure is in response to a formal complaint or charge, in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or is consistent with the contractor's legal duty to furnish information. 4. The contractor will send to each labor union or representative of workers with which it has a collective bargaining agreement or other contract or understanding, a notice to be provided by the agency contracting officer, advising the labor union or workers' representative of the contractor's commitments under section 202 of Executive Order 11246 of September 24, 1965, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. 5. The contractor will comply with all provisions of Executive Order 11246 of September 24, 1965, and of the rules, regulations, and relevant orders of the Secretary of Labor. 6. The contractor will furnish all information and reports required by Executive Order 11246 of September 24, 1965, and by the rules, regulations, and orders of the 7 Secretary of Labor, or pursuant thereto, and will permit access to his books, records, and accounts by the contracting agency and the Secretary of Labor for purposes of investigation to ascertain compliance with such rules, regulations, and orders. 7. In the event of the contractor's non-compliance with the nondiscrimination clauses of this contract or with any of such rules, regulations, or orders, this contract may be canceled, terminated or suspended in whole or in part and the contractor may be declared ineligible for further Government contracts in accordance with procedures authorized in Executive Order 11246 of September 24, 1965, and such other sanctions may be imposed and remedies invoked as provided in Executive Order 11246 of September 24, 1965, or by rule, regulation, or order of the Secretary of Labor, or as otherwise provided by law. Section 19. COVENANT OF NO INTEREST COUNTY and CONTRACTOR covenant that neither presently has any interest, and shall not acquire any interest, which would conflict in any manner or degree with its performance under this Agreement, and that only interest of each is to perform and receive benefits as recited in this Agreement. Section 20. CODE OF ETHICS The parties understand and agree that officers and employees of the COUNTY 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. Section 21. NO SOLICITATION/PAYMENT The COUNTY and CONTRACTOR warrant that, in respect to itself, it has neither employed nor retained any company or person, other than a bona fide employee working solely for it, to solicit or secure this Agreement and that it has not paid or agreed to pay any person, company, corporation, individual, or firm, other than a bona fide employee working solely for it, any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of the provision, the CONTRACTOR agrees that the COUNTY shall have the right to terminate this Agreement without liability and, at its discretion, to offset from monies owed, or otherwise recover, the full amount of such fee, commission, percentage, gift, or consideration. Section 22. FEDERAL CLAUSES The County anticipates that some or all of the funds to pay for the services covered by this Agreement may come from federal grant awards, as that term is defined in 2 CFR part 200. Therefore, the following clauses are included in this Agreement: 22.1. Contractor agrees to comply with all applicable standards, orders or regulations issued 8 pursuant to the Clean Air Act (42 U.S.C. 7401-7671q) and the Federal Water Pollution Control Act as amended (33 U.S.C. 1251-1387) and will reports violations to FEMA and the Regional Office of the Environmental Protection Agency (EPA). 22.2. Debarment and Suspension (Executive Orders 12549 and 12689)—A contract award (see 2 CFR 180.220) must not be made to parties listed on the government wide exclusions in the System for Award Management (SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR part 1986 Comp., p. 189) and 12689 (3 CFR part 1989 Comp., p. 235), "Debarment and Suspension." SAM Exclusions contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. 22.3. Byrd Anti-Lobbying Amendment (31 U.S.C. 1352)—Contractors that apply or bid for an award exceeding $100,000 must file the required Certification Regarding Lobbying (and, if applicable, the Disclosure of Lobbying Activities). Both forms are attached to this Agreement in Section Three. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31 U.S.C. 1352. Each tier must also disclose any lobbying with non-Federal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the non-Federal award. 22.4. Americans with Disabilities Act of 1990 (ADA) — The CONTRACTOR will comply with all the requirements as imposed by the ADA, the regulations of the Federal government issued thereunder, and the assurance by the CONTRACTOR pursuant thereto. 22.5. The Contractor shall utilize the U.S. Department of Homeland Security's E-Verify system to verify the employment eligibility of all new employees hired by the Contractor during the term of the Contract and shall expressly require any subcontractors performing work or providing services pursuant to the Contract to likewise utilize the U.S. Department of Homeland Security's E-Verify system to verify the employment eligibility of all new employees hired by the subcontractor during the Contract term. 22.6 SMALL AND MINORITY BUSINESSES, WOMEN'S BUSINESS ENTERPRISES, AND LABOR SURPLUS AREA FIRMS. The County strongly encourages the use of women-, minority- and veteran-owned business enterprises (SBEs) and wishes to see a of 5% of the contract or subcontracts awarded pursuant to this RFP go to SBEs. Contractor shall provide good faith effort and associated documentation. Contractors may search for Florida registered SBEs at: http://www.dms.mvflorida.com/aaency administration/office of supplier diversity osd Any proposal submitted in which the vendor is certified as an SBE, or in which the vendor proposes to use subcontractors that are certified as SBEs, must submit proof of the registration or certification from a federal, state or local authority in order to receive credit for the use of the SBE. 22.7 AUDIT OF RECORDS: Contractor shall grant to the County, Florida Division of Emergency Management (FDEM), Federal Emergency Management Agency (FEMA), Florida Department of Transportation, the Federal Government, and any other duly authorized agencies 9 of the State or Federal Government or the County where appropriate the right to inspect and review all books and records directly pertaining to the Contract resulting from this RFP for a period of five (5) years after final grant close-out by FEMA or DEM, or as required by applicable County, State and Federal law. Records shall be made available during normal working hours for this purpose. In the event that FEMA, DEM, or any other Federal or State agency, or the County, issues findings or rulings that the amounts charged by the Contractor, or any portions thereof, were ineligible or were non-allowable under federal or state Law or regulation, Contractor may appeal any such finding or ruling. If such appeal is unsuccessful, the Contractor shall agree that the amounts paid to the Contractor shall be adjusted accordingly, and that the Contractor shall, within 30 days thereafter, issue a remittance to the County of any payments declared to be ineligible or non- allowable. Contractor shall comply with federal and/or state laws authorizing an audit of Contractor's operation as a whole, or of specific Project activities. 22.8 Debarment and Suspension (Executive Orders 12549 and 12689)—A contract award (see 2 CFR 180.220) must not be made to parties listed on the governmentwide exclusions in the System for Award Management (SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR part 1986 Comp., p. 189) and 12689 (3 CFR part 1989 Comp., p. 235), "Debarment and Suspension." SAM Exclusions contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. 22.9 Beginning January 1, 2021, the Contractor shall utilize the U.S. Department of Homeland Security's E- Verify system to verify the employment eligibility of all new employees hired by the Contractor during the term of the Contract and shall expressly require any subcontractors performing work or providing services pursuant to the Contract to likewise utilize the U.S. Department of Homeland Security's E-Verify system to verify the employment eligibility of all new employees hired by the subcontractors during the Contract term. By entering into this agreement, the contractor or consultant verifies that it registers with and uses the E-Verify system. If the contractor enters into a contract with a subcontractor, the subcontractor must provide the contractor with an affidavit stating that the subcontractor does not employ, contract with, or subcontract with an unauthorized alien. The contractor must maintain the affidavit for the duration of this contract. 22.10 No Obligation by Federal Government. The federal government is not a party to this contract and is not subject to any obligations or liabilities to the non-Federal entity, Contractor, or any other party pertaining to any matter resulting from the contract. 22.11 Prohibition on certain telecommunications and video surveillance services or equipment (2 C.F.R. § 200.216: Recipients and subrecipients are prohibited from obligating or expending loan or grant funds to (a) procure or obtain, (b) extend or renew a contract to procure or obtain, or(c) enter into a contract to procure or obtain equipment, services or systems that uses covered telecommunications equipment or services as a substantial or essential component of any system or critical technology as part of any system. As used herein, the term "covered telecommunications equipment" means telecommunications equipment produced by Huawei Technologies Company or ZTE Corporation (or any subsidiary or affiliate). By entering into this 10 agreement, both the County and the Contractor agree that it has complied with the provisions in 2 C.F.R. § 200.216. 22.12 Domestic preference for procurements (2 C.F.R. § 200.322): As appropriate and to the extent consistent with law, the County should, to the greatest extent practicable under a Federal award, provide a preference for the purchase, acquisition, or use of goods, products, or materials produced in the United States (including but not limited to iron, aluminum, steel, cement, and other manufactured products). The requirements of this section must be included in all subawards including all contracts and purchase orders for work or products under this award. 22.13 (If applicable): Procurement of recovered materials will apply as set forth in 2 CFR part 200.322. Section 23. NON-WAIVER OF IMMUNITY Notwithstanding the provisions of Sec. 768.28, Florida Statutes, the participation of the COUNTY and the CONTRACTOR in this Agreement and the acquisition of any commercial liability insurance coverage, self-insurance coverage, or local government liability insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability coverage, nor shall any Agreement entered into by the COUNTY be required to contain any provision for waiver. Section 24. PRIVILEGES AND IMMUNITIES All of the privileges and immunities from liability, exemptions from laws, ordinances, and rules and pensions and relief, disability, workers' compensation, and other benefits which apply to the activity of officers, agents, or employees of any public agents or employees of the COUNTY, when performing their respective functions under this Agreement within the territorial limits of the COUNTY shall apply to the same degree and extent to the performance of such functions and duties of such officers, agents, volunteers, or employees outside the territorial limits of the COUNTY. Section 25. LEGAL OBLIGATIONS AND RESPONSIBILITIES Non-Delegation of Constitutional or Statutory Duties. This Agreement is not intended to, nor shall it be construed as, relieving any participating entity from any obligation or responsibility imposed upon the entity by law except to the extent of actual and timely performance thereof by any participating entity, in which case the performance may be offered in satisfaction of the obligation or responsibility. Further, this Agreement is not intended to, nor shall it be construed as, authorizing the delegation of the constitutional or statutory duties of the COUNTY, except to the extent permitted by the Florida constitution, state statute, and case law. Section 26. NON-RELIANCE BY NON-PARTIES No person or entity shall be entitled to rely upon the terms, or any of them, of this Agreement to enforce or attempt to enforce any third-party claim or entitlement to or benefit of any service or program contemplated hereunder, and the COUNTY and the CONTRACTOR agree that neither the COUNTY nor the CONTRACTOR or any agent, officer, or employee of either shall have the authority to inform, counsel, or otherwise indicate that any particular individual or 11 group of individuals, entity or entities, have entitlements or benefits under this Agreement separate and apart, inferior to, or superior to the community in general or for the purposes contemplated in this Agreement. Section 27. ATTESTATIONS CONTRACTOR agrees to execute such documents as the COUNTY may reasonably require, including, but not being limited to, a Public Entity Crime Statement, an Ethics Statement, and a Drug-Free Workplace Statement, Lobbying and Conflict of Interest Clause, and Non-Collusion Agreement. Section 28. NO PERSONAL LIABILITY No covenant or agreement contained herein shall be deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe County in his or her individual capacity, and no member, officer, agent or employee of Monroe County shall be liable personally on this Agreement or be subject to any personal liability or accountability by reason of the execution of this Agreement. Section 29. EXECUTION IN COUNTERPARTS This Agreement may be executed in any number of counterparts, each of which shall be regarded as an original, all of which taken together shall constitute one and the same instrument and any of the parties hereto may execute this Agreement by signing any such counterpart. Section 30. SECTION HEADINGS Section headings have been inserted in this Agreement as a matter of convenience of reference only, and it is agreed that such section headings are not a part of this Agreement and will not be used in the interpretation of any provision of this Agreement. Section 31. INSURANCE POLICIES 31.1 General Insurance Requirements for Other Contractors and Subcontractors. As a pre-requisite of the work governed, the CONTRACTOR shall obtain, at his/her 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; however, CONTRACTOR is solely responsible to ensure that said insurance is obtained and shall submit proof of insurance to COUNTY. Failure to provide proof of insurance shall be grounds for termination of this Agreement. The CONTRACTOR will not be permitted to commence work governed by this contract 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 satisfactory evidence of the required insurance, shall not extend deadlines specified 12 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 and/or termination of this Agreement and for damages to the COUNTY. Delays in the completion of work resulting from the failure 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 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 option, 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-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 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. The Monroe County Board of County Commissioners, its employees and officials will be included as "Additional Insured" on all policies, except for Workers' Compensation. 31.2 Insurance Requirements For Contract Between County And Contractor (Note:amounts of coverage are subject to change in final contract) 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 Bodily Injury Liability Expanded Definition of Property Damage The minimum limits acceptable shall be: $500,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $200,000 per Person $500,000 per Occurrence 13 $200,000 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 Commissioners shall be named as Additional Insured on all general liability policies issued to satisfy the above requirements. 31.3Vehicle Liability Insurance requirements 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: $300,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $200,000 per Person $300,000 per Occurrence $200,000 Property Damage The Monroe County Board of County Commissioners shall be named as Additional Insured on all vehicle liability policies issued to satisfy the above requirements. 31.4 Workers' Compensation Insurance Requirements Prior to commencement of work governed by this contract, the CONTRACTOR shall obtain Workers' Compensation Insurance with limits sufficient to respond to the applicable state statutes. In addition, the CONTRACTOR shall obtain Employers' Liability Insurance with limits of not less than: $500,000 Bodily Injury by Accident $500,000 Bodily Injury by Disease, policy limits $500,000 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. 14 31.5 Professional Liability Requirements Recognizing that the work governed by this contract involves the furnishing of advice or services of a professional nature, the Contractor shall purchase and maintain, throughout the life of the contract, Professional Liability Insurance which will respond to damages resulting from any claim arising out of the performance of professional services or any error or omission of the Contractor arising out of work governed by this contract. The minimum limits of liability shall be: $1,000,000 per occurrence/$2,000,000 Aggregate Section 32. INDEMNIFICATION, HOLD HARMLESS AND DEFENSE CONTRACTOR assumes and agrees to hold harmless, indemnify, protect, and defend the COUNTY and the COUNTY's elected and appointed officers and employees, Boards and Commissions, and any other agents, individually and collectively (collectively, "indemnified parties"), against any and all fines, penalties, lawsuits, claims, actions, causes of action, litigation, demands, obligations, administrative proceedings, appellate proceedings, or other proceedings relating to any and all types of injury (including death), loss, damage, fine, penalty, liability, judgment, or business interruption, and any and all costs, fees, attorney fees, or expenses that may be asserted against, initiated with respect to, or sustained by, any of the indemnified parties by reason of, arising out of, incident to, resulting from, or in connection with, (A) any and all activities, operations, or work of CONTRACTOR or any of its employees, agents, consultants, sub-contractors or other persons employed or utilized under any and all of the obligations and terms of this Agreement, (B) the negligence, errors, omissions, recklessness, or intentional or willful misconduct of CONTRACTOR or any of its employees, agents, consultants, sub-contractors or other persons employed or utilized, or (C) CONTRACTOR's non-conformance, breach, or default with respect to any of the obligations and terms under this Agreement. Insofar as the claims, actions, causes of action, litigation, proceedings, costs, fees, or expenses relate to events or circumstances that occur during the term of this Agreement, this section will survive the expiration of the term of this Agreement or any earlier termination of this Agreement. CONTRACTOR agrees that the indemnified parties may select the attorneys to appear and defend such claims, actions, causes of action, or litigation on behalf of the indemnified parties. CONTRACTOR further agrees to pay at the CONTRACTOR's expense the attorneys' fees and costs incurred by those attorneys selected by the indemnified parties to appear and defend such claims, actions, causes of action, or litigation on behalf of the indemnified parties at the trial and appellate levels. CONTRACTOR agrees that the first ten dollars ($10.00) of remuneration paid to CONTRACTOR represents specific consideration for the indemnification obligation provided above. The extent of liability is in no way limited to, reduced or lessened by the insurance requirements contained elsewhere with in this Agreement. The duty to defend under this Section is independent and separate from the duty to indemnify, and the duty to defend exists regardless of any ultimate liability of the CONTRACTOR, the COUNTY and any indemnified party. The duty to defend arises immediately upon presentation of a claim by any party and written notice of such claim being provided to the CONTRACTOR. 15 The CONTRACTOR's obligation to indemnify and defend under this Section will survive the expiration or earlier termination of this AGREEMENT until it is determined by final judgment that an action against the COUNTY or an indemnified party for the matter indemnified hereunder is fully and finally barred by the applicable statute of limitations At all times and for all purposes hereunder, the CONTRACTOR is an independent contractor and not an employee of the Board of County Commissioners. No statement contained in this agreement shall be construed so as to find the CONTRACTOR or any of his/her employees, contractors, servants or agents to be employees of the Board of County Commissioners for Monroe County. As an independent contractor the CONTRACTOR shall provide independent, professional judgment and comply with all federal, state, and local statutes, ordinances, rules and regulations applicable to the services to be provided. The CONTRACTOR shall be responsible for the completeness and accuracy of its work, plan, supporting data, and other documents prepared or compiled under its obligation for this project, and shall correct at its expense all significant errors or omissions therein which may be disclosed. The cost of the work necessary to correct those errors attributable to the CONTRACTOR and any damage incurred by the COUNTY as a result of additional costs caused by such errors shall be chargeable to the CONTRACTOR. This provision shall not apply to any maps, official records, contracts, or other data that may be provided by the COUNTY or other public or semi-public agencies. The CONTRACTOR agrees that no charges or claims for damages shall be made by it for any delays or hindrances attributable to the COUNTY during the progress of any portion of the services specified in this contract. Such delays or hindrances, if any, shall be compensated for by the COUNTY by an extension of time for a reasonable period for the CONTRACTOR to complete the work schedule. Such an agreement shall be made between the parties. ESS WHEREOF, the parties hereto have used these presents to be executed on the f April 2023. VI N MADOK, CPA. CLERK BOARD OF 0 TY COMMISSIONERS OF MO COUN FL*RIDA co-" by As Deputy Clerk y Fth firm Oi? (CORPORATE SEAL) GOOD MAN-GABLE-GOUL&- CD ATTEST: ADJUSTERS INTERNATIOPAL B by , 7itle: Pasauale Cuccaro Mgt�r 1-41 r Senior VicePresident/ Principal Approved as to form and legal sufficiency: Monroe County Attorney's Office 3-27-2023 CJIA-4.94 16 EXHIBIT A SCOPE OF SERVICES SPECIFICATIONS The firm shall provide adjusting services on an as needed basis. The firm will evaluate damage to County property and negotiate maximum settlements with its insurers following catastrophic events resulting in significant damage. In addition, the firm will assist the County in coordinating requests for Public Assistance from the Federal Emergency Management Agency (FEMA). The following services will be expected of the successful proposer: ➢ Investigate and analyze all property damage associated with claims assigned to the adjuster. ➢ Review all insurance policies and determine the recoveries available to the County from each policy. ➢ Review pre-loss estimates that could affect recovery and recommend modifications if necessary. ➢ Prepare a concise, well documented replacement cost estimate of buildings and personal property damaged and determine the Actual Cash Value (ACV) if applicable. ➢ Evaluate "code upgrade" coverages and costs, if applicable. ➢ Negotiate interim and final settlements with the County insurers. ➢ Advise County management regarding the capture and development of loss information (including direct damage, extra expenses, and loss of income). ➢ Coordinate and integrate all areas of the claim effort on behalf of the County. ➢ Assist in the coordination of advance payments with the County insurers. ➢ Coordinate all inspections and meetings with the County's insurers. ➢ Provide regular status reports. ➢ Review all claim data with County representatives prior to being submitted to the insurers. ➢ Conduct and/or participate in all settlement discussions with the County's insurers. ➢ Maintain all information obtained during the services provided to the County as confidential. ➢ Expedite and maximize all recoveries available to the County. ➢ Coordinate with the Federal Emergency Management Agency (FEMA) if required. ➢ Any and all services required to resolve County claims with its insurers. 17 LOBBYING AND CONFLICT OF INTEREST CLAUSE I SWORN STATEMENT UNDER ORDINANCE NO. 010-1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE i i 1 I "The Goodman-Gable-Gould Company/Adjusters International (Company) I "...warrants that he/it has not employed, retained or otherwise had act on his/her behalf any former County officer or employee in violation of Section 2 of Ordinance No. 010-1990 or any County officer or employee in violation of Section 3 of Ordinance No. 010-1990. For breach or j 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." (Signature) : i Date: 3 STATE OF FLORIDA COUNTY OF TV to (or affirm d) and subscribed before me by means of D-physical presence or❑ online notarization, this day of iNach 12023, by &)r k4-yy (name of affiant), He/she is personally known to me or has produced C Ns�- (type of identification) as identification. �O 3 f My Commission expires: NOTARY PUBLIC/ � ro \NpA C. JAOTA �, �0 '� 37 of 49 NON-COLLUSION AFFIDAVIT I, Neil C. Kahn of the city of Baltimore, Maryland according to law on my oath, and under penalty of perjury, depose and say that 1. 1 am Executive Vice President of the firm of Goodman-Gable-Gould/Adjusters International the bidder making the Proposal for the project described in the Request for Proposals for Public Adiusting Claim Services and that I executed the said proposal with full authority to do so; 2. The prices in this bid have been arrived at independently without collusion, consultation, communication or agreement for the purpose of restricting competition, as to any matter relating to such prices with any other bidder or with any competitor; 3. Unless otherwise required by law, the prices which have been quoted in this bid have not been knowingly disclosed by the bidder and will not knowingly be disclosed by the bidder prior to bid opening, directly or indirectly, to any other bidder or to any competitor; and 4. No attempt has been made or will be made by the bidder to induce any other person, partnership or corporation to submit, or not to submit, a bid for the 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 pr gect. i (Signature) Date: STATE OF FLORIDA COUNTY OF Sworn to (or affirnm} and subscribed before me by means of}�physical presence or❑ online notarization, this _day of MCA 2023, by WA) (name of affiant). He/she is personally known to me or has produced p¢l,IGn Gwkr (type of identification) as identification. ale- NOTARY PUBLIC My Commission expires: 16 ,��rti�rrrrrr��� I C: W, 4,Q���/. NOTAR r PUBLIC 38 of 49 DRUG-FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statutes Section 287.087 hereby certifies that: Goodman-Gable-Gould/Adjusters International (Name of Business) 1. Publishes 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. Informs 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. Gives each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection (1). 4. In the statement specified in subsection (1), notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contenders 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. Imposes 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. Makes 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. (Signature) AAMMDDate: STATE OF: i COUNTY OF: AQArr(-(yVlE(2 l Subscribed and sworn to (or affirmed) before me on (date) by ka Kniq (name of affiant). He/She is personally known to me or has produced f C C xSG (type y }(t of i ntific Lion as identifi anon. �i ` Op,• :.w'` 4 NOTARY P BLJ y My Commission Expires: Z NOTA&y y PUBLIC coU0 39 of 49 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 Goodman-Gable-Gould/Adjusters International ? (Proposer's name) nor any Affiliate has been placed on the convicted vendor list within the last 36 months. (Signature) Date: STATE OF FLORIDA COUNTY OF Sworn to (or affirmed)and subscribed before�me by means of Ik physical presence or ❑ online notarization, this day of Aar4i 2023, by t, KA-HA) (name of affiant), He/she is personally known to me or has produced 'DR ttm*s LjM&sr (type of identification) as identification. NOTARY PUBLIC My Commission expires: / ``��51111l1I111/// � OTAR •oy N Y a 7fl.o3�.• P��• Cou ,��� 40 of 49 VENDOR CERTIFICATION REGARDING SCRUTINIZED COMPANIES LISTS Project Description(s): 114D �'1 Q ��' eek ,c Respondent Vendor Name: G-A �x - ►►1n' ►'Lcv .•� Vendor FEIN: rI (,W, Vendor's Authorized Representative Name and Title: { �a � wa {]p Address: 110 �10 Lcl city: State: C 4 Zip: a I" ?' Phone Number: Email Address: ri �rv , G G 0 'E' yVl Section 287,135, Florida Statutes prohibits a company from bidding on, submitting a proposal for, or entering into or renewing a contract for goods or services of any amount if, at the time of contracting or renewal,the company is on the Scrutinized Companies that Boycott Israel List,created pursuant to Section 215.4725, Florida Statutes, or is engaged in a Boycott of Israel. Section 287.135, Florida Statutes, also prohibits a company from bidding on, submitting a proposal for, or entering into or renewing a contract for goods or services of$1,000,000 or more, that are on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector Lists which were created pursuant to s. 215.473, Florida Statutes, or is engaged in business operations in Cuba or Syria. As the person authorized to sign on behalf of Respondent, I hereby certify that the company identified above in the Section entitled"Respondent Vendor Name" is not listed on the Scrutinized Companies that Boycott Israel List or engaged in a boycott of Israel and for Projects of$1,000,000 or more is not listed on either the Scrutinized Companies with Activities in Sudan List, the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or engaged in business operations in Cuba or Syria. I understand that pursuant to Section 287.13 5,Florida Statutes,the submission of a false certification may subject company to civil penalties,attorney's fees,and/or costs.I fin-ther understand that any contract with i the County may be terminated, at the option of the County, if the company is found to have submitted a false certification or has been placed on the Scrutinized Companies that Boycott Israel List or engaged in a boycott of Israel or placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List or been engaged in business operations in Cuba or Syria. Certified By: C. ,who is authorized to sign on behalf of the above r f enced company. Authorized Signature: (L(Xkl C Print Name: eL L' • -4 Title: ucz P! .rJ e, Note: The List are available at the following Department of Management Services Site: bttp://www,dms.myflorida.com/business operations/state urehasin /vendor information/convicted su spended_discriminatory complaints_vendor_lists 41 of 49 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY, AND VOLUNTARY EXCLUSION 3 3 i i I 3 1 1 1 1 I 11 42 of 49 APPENDIX A to 44 C.F.R. PART 18, CERTIFICATION REGARDING LOBBYING Certification for Contracts, Grants, Loans, and Cooperative Agreements I The undersigned certifies,to the best of his or her knowledge and belief,that: i (1)No Federal appropriated fiends have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan,the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2)If any funds other than Federal appropriated funds have been paid or will be paid to any person for j influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement,the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than$10,000 and not more than$100,000 for each such failure. The Contractor,&4rrt6n IA�*Jifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. IN addition,the Contractor understands and agrees that the provisions of 31 U.S.C. Ch. 38,Administrative Remedies for False Claims and Statements, apply to this certification and disclosure, if any. Date: 3( ijZAI Signature of Contractor's Authorized Official Printed Name: Title: el _ � Appr ved by OMB 0348-0046 i 43 of 49 I I I I i PAGE INTENTIONALLY LEFT BLANK i 44 of 49 APPENDIX B to 44 CFR PART 18 — DISCLOSURE FORM TO REPORT LOBBYING Disclosure of Lobbying Activities Complete this form to disclose Iobbying activities pursuant to 31 U.S.C. 1352 See reverse for public burden disclosure 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: a. contract X a.bid/offer/application X a. initial filing X b.grant b, initial award b.material change c, cooperative agreement c,post-award d.loan For material change only: e.loan guarantee Year quarter f. loan insurance Date of last report 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No.4 is Subawardec, X Prime Subawardee Enter Name and Address of Prime: Tier ,if Known: NIA Monroe County Board of County Commissioners 1100 Simonton Street Key West,FL 3 3 040-3 1 1 0 Congressional District, i known: FL26 Congressional District, i known: 6. Federal Department/Agency: 7. Federal Program Name/Description: I U.S.Department of Justice ! 1 Office of Justice Programs Bureau of Justice Assistance CFDA Number, if applicable: 16.738 i S. Federal Action Number,ifknown: 9. Award Amount, ifknown: BJA-2018-13626 $ 13,982 10. a.Name and Address of Lobbying Registrant b. Individuals Performing Services(including address if (rf individual, last name,first name, MI): different from No. 10a) (last name,first name, MI): N/A NIA 11, Information requested through this form is authorized by title 31 U.S.C.section 1352. This disclosure of lobbying Signature: activities is a material representation of fact upon which ( /! reliance was placed by the tier above when this transaction print Name: was made or entered into.This disclosure is required I ,, pursuant to 31 U.S.C. 1352.This information will be reported Title: �;Gu4 to the Congress semi-annually and will be available for public y inspection.Any person who fails to file the required 'ClI a disclosure shall be subject to a civil penalty of not less than Telephone No. 1)a Date: 7 $10,000 and not more than$100,000 for each such failure. Federal Use Only Authorized for Local Reproduction Standard Form-LLL(Rev.7-97) I 45 of 49 MONROE COUNTY, FLORIDA Respondent's Insurance and Indemnification Statement Insurance Requirement Reguired Limits Worker's Compensation Statutory Limits Employer's Liability $500,000/$500,000/$500,000 General Liability $500,000 Combined Single Limit Vehicle Liability $300,000 Combined Single Limit Professional Liability $1,000,000 per occurrence $2,000,000 aggregate INDEMNIFICATION AND HOLD HARMLESS FOR CONSULTANTS AND SUBCONSULTANTS The CONSULTANT covenants and agrees to indemnify and hold harmless COUNTY/Monroe County and Monroe County Board of County Commissioners, its officers and employees from liabilities, damages, losses and costs, including but not limited to, reasonable attorneys' fees, to the extent caused by the negligence, recklessness, or intentional wrongful conduct of the CONSULTANT, subcontractor(s) and other persons employed or utilized by the CONSULTANT in the performance of the contract. In the event that the completion of the project(to include the work of others) is delayed or suspended as a result of the CONSULTANT's failure to purchase or maintain the required insurance, the CONSULTANT shall indemnify the County from any and all increased expenses resulting from such delay. Should any claims be asserted against the COUNTY by virtue of any deficiency or ambiguity in the plans and specifications provided by the CONSULTANT, the CONSULTANT agrees and warrants that CONSULTANT shall hold the County harmless and shall indemnify it from all losses occurring thereby and shall further defend any claim or action on the County's behalf. The first ten dollars ($10.00) of remuneration paid to the CONSULTANT is consideration 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. This indemnification shall survive the expiration or earlier termination of the Agreement. RESPONDENT'S STATEMENT 1 understand the insurance that will be mandatory if awarded the contract and will comply in full with all the requi&ts, esplN�vl.t Signature 47 of 49 INSURANCE AGENT'S STATEMENT I have reviewed the above requirements with the bidder named below. The following deductibles apply to the corresponding policy. POLICY DEDUCTIBLES Business Auto $1,000 collision/$1,000 comprehensive Professional Liability (E&O) $25,000 Each Claim /$75,000 Aggregate Liability policies are X Occurrence X_Claims Made Maury, Donnelly& Parr, Inc. Insurance Agency Signature Print Name: Crystal Ridge 49 of 49 MOLECUL-01 KWENGLER ACOR©`° CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY) (►•-- 3/28/2023 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 INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Maury,Donnelly&Parr,Inc. PHONE FAX 24 Commerce St. (A/C,No,Ext): (410)685-4625 (A/C,No):(410)685-3071 IL Baltimore, MD 21202 ADDARESS: INSURERS AFFORDING COVERAGE NAIC# INSURERA:Massachusetts Bay Insurance Company 22306 INSURED INSURERB:Hanover Insurance Company 22292 The Goodman-Gable-Gould Company INSURERC:Evanston Insurance Company 35378 3903 Naylors Lane INSURER D: Baltimore, MD 21208 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. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MMIDD/YYYY MMIDD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR ZDQ J264551 00 1/1/2023 1/1/2024 DAMAGE TO RENTED 100 000 X PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 X POLICY JECTPRO- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT 1,000,000 Ea accident $ X ANY AUTO X AWQJ320165 1/1/2023 1/1/2024 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident) ccident $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE UHQJ26455200 1/1/2023 1/1/2024 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Errors&Ommissions =MKLV1PEO002582 1/1/2023 1/1/2024 See below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) APPROVED BY RISK MANAGEMENT Professional Liability Coverage- v gDeductible:$25K Claim/$75K Agg DATE Fu3/W2g120i2 3 Retroactive Prior WAIVER NIA- YES-Monroe County,Board of County Commissioners its employees,and officials will be included as Additional Insureds as respects to General Liability and Auto Liability for operations performed by Named Insured on all policies except for Workers Compensation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County BOCC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ty ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street Key West,FL 33040 AUTHORIZED REPRESENTATIVE i ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD