10/15/2003 Contract
Clerk ollhe
Circul coun
Danny L. Kolhage
Office (305) 292-3550 Fax (305) 295-3663
Memnrandum
To: Dent Pierce, Director
Public Works Department
Attn: Beth Leto /
From: Isabel C. DeSantis, Deputy Clerk
Date: Wednesday, November 12,2003
At the meeting of October 15, 2003, the Board approved the following:
Rescind contract awarded July 15,2003 to Paul Lin & Associates and authorized
execution of a revised Contract between Monroe County and Paul Lin & Associates with
a proposal price in the amount of $24,400 to perform engineering services to obtain
environmental permits to construct a culvert for the Breezeswept Beach Estates Special
Taxing District.
Enclosed is a fully executed duplicate original ofthe subject document for your
handling. Should you have any questions concerning this matter, please do not hesitate
to contact this office.
Copies: Finance
County Attorney
File ./
LETTER OF TRANSMITTAL
Date: October 16, 2003
MONROE COUNTY
Engineering Department
1100 Simonton Street
Key West, Florida 33040
(305) 292-4469
ATTN: Jan/County Attorney's Office
Clerk's Office
RE: Breezeswept Beach Estates Culvert
ENCLOSED PLEASE FIND THE FOllOWING ITEM(S):
NO. DATE COPIES DESCRIPTION
4 sets Breezeswept Beach Estates Culvert Contract for Engineering Services: Original
and three originally executed copies of Contract for Engineering Services
Between Owner and Engineer (Paul Lin & Associates, Inc.) with original
certificates of insurance and waiver
THESE ARE TRANSMITTED AS CHECKED BELOW:
DFor Approval
DApproved as Noted
~For Your Use
DReturned for Corrections
DFor Review and Comment
DCopies for Approval
REMARKS:
Jao: This project was approved at the October 15,2003 BOCC meeting, Item #C7. Please forward to the Clerk's
office when they are ready. If you have any questions, please call me at extension 4469. Thanks - Jo
Clerk's Office: Please return an executed copy to Engineering for us to forward to the contractor. Thanks - Jo
RECEIVED
OCT 1 7 2003
MONROE COUNTY ATTORNEY
CONTRACT FOR
ENGINEERING SERVICES
BETWEEN OWNER AND ENGINEER
These contract documents should be used only after consultation with counsel.
The documents are not intended as legal advice appropriate to any specific situation, nor
do they purport do address all issues which may arise between the contracting parties.
The documents should be amended or supplemented where appropriate.
THIS CONTRACT FOR ENGINEERING SERVICES BETWEEN OWNER AND
ENGINEER (the "Contract") is made and entered into by MONROE COUNTY, BOARD
OF COUNTY COMMISSIONERS (the "Owner"), 500 Whitehead Street, Key West,
Florida 33040, and PAUL L1N & ASSOCIATES, INC., Post Office Box 562800, Miami,
Florida 33256 ("Engineer").
This contract is executed under seal and shall be effective on the date executed
by the last party to execute it.
The professional services required by this Contract are to be rendered for
Breezeswept Beach Estates Culvert identified as the Project, described as follows:
Professional services shall include, but not limited to, determining that the
proposed culvert will make a significant improvement to canal water flows/quality and
without adverse effects on the adjacent OFW. Consultant will provide expert advice and
assistance to the Owner with respect to the Florida Department of Environmental
Protection and Army Corps of Engineers' requests for specific information, including
those services contained in Attachments A and B.
NOW, THEREFORE, in consideration of the mutual promises, covenants and
agreements stated herein, and for other good and valuable consideration, the sufficiency
of which hereby acknowledged, the Owner and the Engineer agree:
FORM OF AGREEMENT
ARTICLE 1
1.1 REPRESENTATIONS AND WARRANTIES
By executing this Contract, the Engineer makes the following express
representations and warranties to the Owner:
1.1.1 The Engineer is professionally qualified to act as the Engineer for the Project and
is licensed to practice architecture by all public entities having jurisdiction over the
Engineer and the Project;
1.1.2 The ENGINEER shall maintain all necessary licenses, permits or other
authorizations necessary to act as Engineer for the Project until the Engineer's duties
thereunder have been fully satisfied;
1.1.3 The Engineer has become familiar with the Project site and the local conditions
under which the Project is to be designed, constructed, and operated;
1.1.4 The Engineer shall prepare all documents required by this Contract in such a
manner that they shall be accurate, coordinated and adequate for response to obtain
FDEP and ACOE permits, and shall be in conformity and comply with all applicable law,
codes and regulations. The Engineer warrants that the documents prepared as a part of
this Contract will be adequate and sufficient to accomplish the purposes of the Project,
therefore, eliminating any additional cost due to missing or incorrect information;
1.1.5 The Engineer assumes full responsibility to the extent allowed by law with
regards to his performance and those directly under his employ.
1.1.6 The Engineer's services shall be performed as expeditiously as is consistent with
professional skill and care and the orderly progress of the Work. The Engineer shall
submit, for the Owner's and Construction Manager's information, a schedule for the
performance of the Engineer's services which may be adjusted as the Project proceeds
if approved by the Owner, and shall include allowances for periods of time required for
the Owner's and Construction Management's review, and for approval of submission by
authorities having jurisdiction over the Project. Time limits established by this schedule
and approved by the Owner may not be exceeded by the Engineer except for delay
caused by events not within the control of the Engineer or foreseeable by him. In the
event the Engineer does not conform to the schedule, then the Engineer may be
assessed a charge up to one percent (1 %) of the fee per week until the work product is
produced in an acceptable manner. The penalty shall apply only to the completion of
documents required for bidding, said date being met with the delivery of one final set to
the Owner. The Owner shall assess the charge only after it is determined that the work
delay is solely the fault of the Engineer and his subconsultants and is not the fault of the
owner or other parties not under the control of the Engineer.
- 2 -
ARTICLE II
SCOPE OF ENGINEER'S BASIC SERVICE
2.1 DEFINITION
2.1.1 Engineer's Basic Services consist of those described in Paragraphs 2.2
through 2.5, and other services identified as part of Basic Services, and include normal
engineering services to assess water quality and flow analysis. The Engineer will
commence work on the services provided for in this contract promptly upon his receipt of
a written notice to proceed from the Owner. The notice to proceed must contain a
description of the services to be performed, the time within which services must be
performed.
2.1.2 Project schedule is as follows:
Phase I - Data Collection and Review
Phase II - Field Investigation
Phase III - Hydrographic Numerical Modeling
Phase IV - Hydrographic Engineering
Evaluation Report
Phase V - Client Directed Meetings
After Authorization
1 month
1 Y:2 months
5 months
6 months
6 months
2.1.3 The Engineer shall determine that the proposed culvert will make a significant
improvement to canal waters/quality and without adverse effects on the adjacent OFW.
The Engineer shall address all questions in Attachment A. All documentation of results
shall be presented in a report format suitable for submittal to the permitting agencies.
The Engineer shall be responsible for incorporating information contained in the Ramrod
Key Water Quality Study presented in the Proposal.
2.2 DATA COLLECTION AND REVIEW
2.2.1 The Engineer shall review long-term wind, current, wave and tide data from the
monitoring stations located within the project vicinity.
2.2.2 Ramrod Key Water Quality Studies 2001-2002, prepared by Breezeswept Beach
Estates Civic Association, shall be thoroughly reviewed and compiled to address the
Florida Department of Environmental Protection's request.
2.3 FIELD INVESTIGATIONS
2.3.1 Field investigations shall be performed to include, but not limited to, tide and
current measurements at critical areas to collect hydrographic data for the
development of a base map.
2.3.2 The canal system shall be surveyed to the extent that the physical dimensions,
orientation and water depth of each canal located in the Breezeswept Beach
Estates project limits will be identified.
2.4 HYDRODYNAMICS NUMERICAL MODELING
- 3 -
2.4.1 A hydrodynamics computer model shall be utilized to simulate tidal variation and
flow circulation within the canal system.
2.4.2 The numerical model shall be calibrated and verified using the field collected
data.
2.4.3 The modeling results shall be used in determining the optimum cross-section for
the proposed new culvert.
2.5 HYDROGRAPHIC ENGINEERING EVALUATION REPORT
2.5.1 All findings and numerical modeling results shall be submitted in a report format
that is suitable for submission to permitting agencies.
2.5.2 The report must include as a minimum an Introduction, Physical and
Meteorological Conditions, Water Quality, Field Investigations, Numerical
Modeling, Results and Conclusions.
2.5.3 Where possible, data and study results shall be presented in an AutoCad format.
When appropriate these files shall be provided to the Owner in an electronic
format.
2.6 CLIENT MEETINGS
2.6.1 Included shall be three (3) client directed meetings. Meetings shall be held
throughout the project at Owner's choosing at the project location or in Key West.
2.7 CORRECTION OF ERRORS, OM MISSIONS, DEFICIENCIES
2.7.1 The Engineer shall, without additional compensation, promptly correct any errors,
omissions, deficiencies, or conflicts in the work product of the Engineer or its
consultants, or both.
2.8 ADDITIONAL COST REIMBURSEMENT
2.8.1. The Engineer must reimburse the Owner for any added costs paid by the Owner
during construction that were incurred as the result of any omission, deficiency, or
conflict in the work product of the Engineer, its consultants, or both. This added
expense is defined as the difference in cost from that which the Owner would have paid
if the work was included in the bid, and the actual cost presented by the Contractor.
- 4 -
ARTICLE III
3.1 GENERAL
3.1.1 The services described in this Article III are not included in Basic Services with
the exception of those services specified in Attachments A and B. They shall be paid for
by the Owner as provided in this agreement as an addition to the compensation paid for
the Basic Services but only if approved by the Owner before commencement.
3.2 PROJECT REPRESENTATION BEYOND BASIC SERVICES
3.2.1 If additional meetings are required, the Engineer shall provide such services and
be compensated at the rates for additional services supplied in Attachment D.
3.4 OPTIONAL ADDITIONAL SERVICES
3.4.1 Providing detailed quantity surveys or inventories of material and equipment.
3.4.2 Providing analyses of owning and operating costs.
3.4.3 Providing planning surveys, site evaluations or comparative studies of
prospective sites.
3.4.4 Providing detailed estimates of the construction cost (an item by item
enumeration and analysis of all the costs that would go to make an Engineer's final
estimate.
3.4.5 Providing services of consultants for other than the previously listed engineering
scope of the Project provided as a part of Basic Services.
3.4.6 Providing any other services not otherwise included in this Agreement or not
customarily furnished in accordance with generally accepted engineering practice.
3.4.7 Providing assistance with public agencies requiring formal review of project and
preparation of documents, reports, studies, renderings, models, payment of fees,
applications and other material necessary to seek such approval not previously listed.
3.4.8 Providing representation before public bodies in conjunction with approval of
project, upon approval by owner.
3.5 CONTINGENT ADDITIONAL SERVICES
3.5.1 Providing services required because of significant changes in the Project
including, but not limited to, size, quality, complexity, the Owner's schedule, or the
method of bidding or negotiating and contracting for construction.
3.5.2 Providing services in connection with public hearings.
- 5 -
ARTICLE IV
OWNER'S RESPONSIBILITIES
4.1 The Owner shall provide full information regarding requirements for the
Project, including a program which shall set forth the Owner's objectives,
schedule, constraints and criteria, including space requirements and
relationships, flexibility, expandability, special equipment, systems, and site
requirements.
4.2 The Owner shall designate the Construction Manager to act on the Owner's
behalf with respects to the Project. The Owner or Construction Manager shall render
decisions in a timely manner pertaining to documents submitted by the Engineer in order
to avoid unreasonable delay in the orderly and sequential progress of the Engineer's
services.
4.3 Prompt written notice shall be given by the Owner and Construction Manager to
the Engineer if they become aware of any fault or defect in the Project or non-
conformance with the Contract Documents.
4.4 The proposed language of certificate or certificates requested of the Engineer or
Engineer's consultants shall be submitted to the Owner for review and approval at least
14 days prior to execution. The Owner shall not request certifications that would require
knowledge or services beyond the scope of this Agreement.
4.5 The Owner shall furnish the required information and services and shall render
approvals and decisions as expeditiously as necessary for the orderly progress of the
Engineer's services and work of the contractors.
4.6 The Owner shall furnish the Engineer copies of written communications.
4.7 The Owner's review of any documents prepared by the Engineer or its
consultants shall be solely for the purpose of determining whether such documents are
generally consistent with the Owner's criteria, as, and if, modified. No review of such
documents shall relieve the Engineer of responsibility for the accuracy, adequacy,
fitness, suitability or coordination of its work product.
4.8 The Owner shall provide an electronic copy of the Ramrod Key Water quality
Studies 2001-2002 report.
4.9 Any information that may be of assistance to the Engineer that the Owner has
immediate access to will be provided as requested
- 6 -
ARTICLE V
5.1 INDEMNIFICATION AND HOLD HARMLESS
5.1.1 The Engineer covenants and agrees to indemnify and hold harmless Monroe
County and Monroe County Board of County Commissioners from any and all claims for
bodily injury (including death), personal injury, and property damage (including property
owned by Monroe County) and any other losses, damages, and expenses (including
attorney's fees) which arise out of, in connection with, or by reason of services provided
by the Engineer in any tier, occasioned by the negligence, errors, or other wrongful act
or omission of the Engineer in any tier, their employees, or agents. The first ten dollars
($10.00) of remuneration paid to the Engineer is for the indemnification provided for
above. The extent of liability is in no way limited to, reduced, or lessened by the
insurance requirements contained elsewhere within this agreement. Should any claims
be asserted against the Owner by virtue of any deficiency or ambiguity in the plans and
specifications provided by the Engineer, the Engineer agrees and warrants that he shall
hold the Owner harmless and shall indemnify him from all losses occurring thereby and
shall further defend any claim or action on the Owner's behalf.
ARTICLE VI
6.1 PERSONNEL
6.1.1 The Engineer shall assign only qualified personnel to perform any service
concerning the project. At the time of execution of this contract, the parties anticipate
that the following named individuals will perform those functions as indicated:
NAME
FUNCTION
Paul Lin
all functions
So long as the individuals named above remain actively employed or retained by the
Engineer, they shall perform the functions indicated next to their names.
ARTICLE VII
7.1 CONTRACT SUM
7.1.1 The Owner shall pay the Engineer in current funds for the Engineer's
performance of the Contract the Contract sum of TWENTY-FOUR THOUSAND FOUR
HUNDRED AND NO/100---DOLLARS ($24,400.00). See Attachment D for breakdown.
Should it be necessary to perform additional or unexpected work not called for in the
proposal, hourly rates are attached as Attachment D.
- 7 -
7.2 PAYMENTS
7.2.1 For its assumption and performances of the duties, obligations and
responsibilities set forth herein, the Engineer shall be paid monthly.
(A) The Engineer shall be paid for those services required by this Contract
the amounts as identified on the in Attachment C.
(B) For the performance of the optional additional services and contingent
additional services described in Article III of this contract, provided same are first
authorized in writing by the Owner, the Engineer shall be paid hourly at the rates
identified in Attachment D, or as negotiated.
(C) If the Engineer's duties, obligations and responsibilities are materially
changed through no fault of the Engineer after execution of this contract, compensation
due to the Engineer shall be equitably adjusted, either upward or downward;
(D) As a condition precedent for any payment due under this Contract, the
Engineer shall submit monthly, unless otherwise agreed in writing by the Owner, an
invoice to the Owner requesting payment for services properly rendered and
reimbursable expenses due hereunder. The Engineer's invoice shall describe with
reasonable particularity the service rendered. The Engineer's invoice shall be
accompanied by such documentation or data in support of expenses for which payment
is sought at the Owner may require.
7.3 REIMBURSABLE EXPENSES
7.3.1 Reimbursable expenses include expenses incurred by the Engineer in the
interest of the project outside of the basic scope of work:
a. Expense of transportation submitted by Engineer, in writing, and
living expenses in connection with out-of-county travel authorized by the
Owner, in writing, but only to the extent and in the amounts authorized by
Section 112.061, Florida Statutes;
b. Reproductions as requested only by the Owner (beyond 6 signed and
sealed complete reports, plus one complete reproducible set;
c. Postage and handling of Drawings and Specifications;
d. Expense of additional insurance coverage or limits, including professional
liability insurance requested by the Owner in excess of $1,000,000.
7.4 BUDGETS
7.4.1 The Engineer may not be entitled to receive, and the Owner is not obligated to
pay, any fees or expenses in excess of the amount budgeted for this contract in each
fiscal year (October 1 - September 30) by Owner's Board of County Commissioners.
The budgeted amount may only be modified by an affirmative act of the Owner's Board
of County Commissioners.
- 8 -
ARTICLE VIII
8.1 APPLICABLE LAW
8.1.1 This contract is governed by the laws of the State of Florida. Venue for any
litigation arising under this contract must be in Monroe County, Florida.
ARTICLE IX
9.1 OWNERSHIP OF THE PRELIMINARY DESIGN AND THE DESIGN FOR
CONSTRUCTION
9.1.1 The Drawings, Specifications and other documents prepared by the Engineer for
this Project are instruments of the Engineer's service for use solely with respect to this
project, and the Engineer shall be deemed the author of these documents and shall
retain all common law, statutory and other reserved rights, including the copyright. The
Owner shall be permitted to retain copies, including reproducible copies, of the
Engineer's Drawings, Specifications and other documents for information and reference
in connection with the Owner's use and occupancy of the Project. The Engineer's
Drawings, Specifications or other documents shall not be used by the Owner or others
on other projects, for additions to this Project or for completion of this Project by others,
unless the Engineer is adjudged to be in default under this Agreement, except by
agreement in writing and with appropriate compensation to the Engineer.
9.1.2 Submission or distribution of documents to meet official regulatory requirements
or for similar purposes in connection with the Project is not to be construed as
publication in derogation of the Engineer's reserved rights.
ARTICLE X
10.1 SUCCESSORS AND ASSIGNS
10.1.1 The Engineer shall not assign its right hereunder, excepting its right to payment,
nor shall it delegate any of its duties hereunder without the written consent of the Owner.
Subject to the provisions of the immediately preceding sentence, each party hereto
binds itself, its successors, assigns and legal representatives to the other and to the
successors, assigns and legal representatives of such other party.
- 9 -
ARTICLE XI
11.1 NO THIRD PARTY BENEFICIARIES
11.1.1 Nothing contained herein shall create any relationship, contractual or otherwise,
with or any rights in favor of, any third party.
ARTICLE XII
12.1 INSURANCE
12.1.1 The Engineer shall obtain insurance as specified in the attached Composite
Attachment E and maintain the required insurance at all times this contract is in effect.
Errors and Omissions Insurance shall also be maintained for a period of one year after
final completion of the project. In the event the completion of the project (to include the
work of others) is delayed or suspended as a result of the Engineer's failure to purchase
or maintain the required insurance, the Engineer shall indemnify the County from any
and all increased expenses resulting from such delay.
12.1.2 The coverage provided herein shall contain an endorsement providing sixty (60)
days notice to the Owner prior to any cancellation of said coverage. Said coverage shall
be written by an insurer acceptable to the Owner and shall be in a form acceptable to the
Owner.
ARTICLE XIII
TERMINATION
13.1 Either party hereto may terminate this contract upon giving seven (7) days written
notice to the other in the event that such other party substantially fails to perform its
material obligations set forth herein. Termination expenses shall include all expenses till
date of termination and any additional services required in order to stop performance of
services, subject to audit for verification.
13.1.1 Monroe County's performance and obligation to pay under this contract is
contingent upon an annual appropriation by the Board of County Commissioners and the
approval of the Board members at the time of Contract initiation and its duration.
- 10-
ARTICLE XIV
ENTIRE AGREEMENT
14.1 This contract is constitute of the form of agreement (Articles I-XIV), the
attachments are made a part of the Contract, and the documents referred to in the form
of agreement as a part of this Contract. In the event any conflict between any of those
Contract documents, the one imposing the greater burden on the Engineer will control.
14.2 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 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 of the Florida Statutes, for CATEGORY TWO for a period of
36 months from the date of being placed on the convicted vendor list.
- 11 -
IN WITNESS WHEREOF, each party has caused this Agr~ement to be executed
by its duly authorized representative this f::;- M day of
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BOARD OF COUNTY COMMISSIONERS'
OF MONROE COUNTY, FLORIDA
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(Sea;)
Attest:
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ATTACHMENT A
1. Explain why proposed culverts are necessary. What environmental benefits the
project will have. If the water quality is to be improved by the proposed project,
indicate which water quality parameters are to be improved (Le. dissolved oxygen,
etc.).
2. Provide a complete description of the waterway system. In particular, identify the
reaches to be culverted. See 62-312.060(5)(a) F.A.C.
3. Provide reasonable assurance that the project will not result in the degradation of
water quality in the adjacent Outstanding Florida Waters.
4. Submit water quality data for the Breezeswept Beach Estates canals. The canal
water should meet the Class III water quality standards in Rule 62-301, FAC. at all
times.
5. Provide a detailed and specific description of the mean tidal range and periodity.
6. Provide normal operational discharge / intake flows, in addition to volume
discharges for specified storm (flood) events.
7. Provide a drainage map serving the proposed culvert, including back water
calculations.
8. Provide detailed and specific description of the outfall / intake topography, and
water body bathymetry.
9. Provide monthly averaged wave height and direction for the project area shoreline.
10. Provide an estimate of the mean annual and mean monthly littoral drift direction and
volume.
11. Provide the invert elevation for the proposed structure.
12. Provide sediment grain size distribution and silt / clay content percentage at the
outfall / intake location.
13. Provide estimated change in existing erosion / deposition rates and patterns due to
the proposed structures.
14. Provide a detailed and specific description of the proposed flow cross section and
the max design discharge through the cross section, if applicable.
15. Provide a detailed and specific description of the maximum, minimum, and mean
flow volume and amplitude for ebb and flood tide.
16. Provide a flushing / flow estimate of the circulation through the waterway prior to
and following the proposed culvert connections, including maximum / minimum
discharges, if applicable. The estimate is to be based on specific head level
differences due to tide through the waterway. Provide a description of the database
utilized in the above estimates.
ATTACHMENT B
r
NA
~-
TCflCH RAMAOCI C~
~
Proposed Culvert Location
Location Is Fixed
TORCH
.....00
~EL
Breezwswept Beach Estates
Ramrod Key
Monroe County, Florida
~
CJ
IEVFOLNJ HARBOR
ATTACHMENT C
PROPOSAL PRICE
From Paul Lin & Associates, Inc.
Breakdown of proposal price:
1) Mobilization
$500
2) Data Collection ... ... ... ... ... ......... ...... ... ... ... ... ... ...... ... ... ... ... ...... $1,500
3) Hydrographic Survey ...... ... ... ... ... ... .. . ... ... ... ... ... .. . .. . ... ... . .. ... ... ... $2,800
4) Base Map ... ...... ... ... ... ... ... ... ... ...... ... ... ... ... ......... ......... ... ... ... $2,000
5) Tidal Data . .. .. . .. . .. . . .. .. . . .. . .. .. . .. . .. .. .. . .. .. . . .. .. .. .. . .. .. . .. . .. . . .. .. . . .. ... $1,700
6) Modeling ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . .. . . . . . . $12,000
7) Report .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . $ 3,000
8) Client Directed Meetings (3)
$900
Total Lump Sum: $24,400
* The hourly rate schedule is attached.
ATTACHMENT D
Paul Lin & Associates, Inc.
Hourly Rate Schedule
TITLE
HOURLY RATE
$ 130.00
$ 11 O. 00
.
$ 100.00
$ 95.00
$ 75.00
$ 65.00
$ 60.00
$ 45.00
$ 40.00
Expert Witness
Senior Engineer
~
Project Manager
Project Engineer
Permit Specialist
Designer
CADD/Engineering Technician
Administrative Assistant
Clerical
REIMBURSABLE EXPENSES
Xerox Copies (B&W) - Cost Per Sheet
Xerox Copies (Color) - Cost Per Sheet
Fax Transmissions - Cost Per Page
Mileage - Cost Per Mile
Other out-of-pocket expenses (i.e., travel expenses,
rentals, purchase of maps, etc.)
$0.30
$2.00
$0.50
$0.30
Cost
COMPOSITE
ATTACHMENT E
MONROE COUNTY, FLORIDA
INSURANCE CHECKLIST
FOR
VENDORS SUBMITTING PROPOSALS
FOR WORK
To assist in the development of your proposal, the insurance coverages marked with an "X" will
be required in the event an award is made to your firm. Please review this form with your
insurance agent and have him/her sign it in the place provided. It is also required that the
bidder sign the form and submit it with each proposal.
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
WC1
WC2
WC3
WCUSLH
x
X
Workers' Compensation
Employers Liability
Employers Liability
Employers Liability
US Longshoremen &
Harbor Workers Act
Federal Jones Act
WCJA
INSCKLST
Statutory Limits
$1 00,000/$500,000/$1 00,000
$500,000/$500,000/$500,000
$1,000,000/$1,000,000/$1,000,000
Same as Employers'
Liability
Same as Employers'
Liability
8
GENERAL LIABILITY
As a minimum, the required general liability coverages will include:
. Premises Operations
. Blanket Contractual
. Expanded Definition
of Property Damage
· Products and Completed Operations
· Personal Injury
Required Limits:
GL1
$100,000 per Person; $300,000 per Occurrence
$50,000 Property Damage
or
$300,000 Combined Single Limit
GL2
x
$250,000 per Person; $500,000 per Occurrence
$50,000 Property Damage
or
$500,000 Combined Single Limit
$500,000 per Person; $1,000,000 per Occurrence
$100,000 Property Damage
or
$1,000,000 Combined Single Limit
GL3
GL4
$5,000,000 Combined Single Limit
Required Endorsement:
GLXCU
Underground, Explosion and Collapse (XCU)
GLLlQ
GLS
Liquor Liability
Security Services
All endorsements are required to have the same limits as the basic policy.
INSCKLST
9
VEHICLE LIABILITY
As a minimum, coverage should extend to liability for:
. Owned; Non-owned; and Hired Vehicles
Required Limits:
VL1
x
VL2
VL3
VL4
BR1
BR2
MVC
PR01
PR02
PR03
Agg.
POL1
POL2
Agg.
POL3
Agg.
ED1
ED2
$50,000 per Person; $100,000 per Occurrence
$25,000 Property Damage
or
$100,000 Combined Single Limit
$100,000 per Person; $300,000 per Occurrence
$50,000 Property Damage
or
$300,000 Combined Single Limit
$500,000 per Person; $1,000,000 per Occurrence
$100,000 Property Damage
or
$1,000,000 Combined Single Limit
$5,000,000 Combined Single Limit
MISCELLANEOUS COVERAGES
Builders' Risk
Limits equal to the completed project.
(Includes Windstorm)
Limits equal to the completed project.
Builders' Risk
Motor Truck
cargo
Limits equal to the maximum
value of anyone shipment.
Professional
Liability
$ 250,000 per Occurrence/$ 500,000 Agg.
$ 500,000 per Occurrence/$1,OOO,OOO Agg.
$1,000,000 per Occurrence/$2,000,OOO
Pollution
Liability
$ 500,000 per Occurrence/$1,OOO,OOO Agg.
$1,000,000 per Occurrence/$2,000,OOO
$5,000,000 per Occurrence/$10,OOO,OOO
Employee
Dishonesty
$ 10,000
$100,000
INSCKLST
10
GK1 Garage $ 300,000 ($ 25,000 per Veh)
GK2 Keepers $ 500,000 ($100,000 per Veh)
GK3 $1,000,000 ($250,000 per Veh)
MED1 Medical $ 250,000/$ 750,000 Agg.
MED2 Professional $ 500,000/$ 1,000,000 Agg.
MED3 $1,000,000/$ 3,000,000 Agg.
MED4 $5,000,000/$10,000,000 Agg.
IF Installation Maximum value of Equipment
Floater Installed
VLP1 Hazardous $ 300,000 (Requires MCS-90)
VLP2 Cargo $ 500,000 (Requires MCS-90)
VLP3 Transporter $1,000,000 (Requires MCS-90)
BLL Bailee Liab. Maximum Value of Property
HKL1 Hangarkeepers $ 300,000
HKL2 Liability $ 500,000
HKL3 $ 1,000,000
AIR1 Aircraft $ 1,000,000
AIR2 Liability $ 5,000,000
AIR3 $50,000,000
AE01 Architects Errors $ 250,000 per Occurrence/$ 500,000 Agg.
AE02 & Omissions $ 500,000 per Occurrence/$1 ,000,000 Agg.
AE03 $1,000,000 per Occurrence/$3,000,OOO Agg.
AE04 $3,000,000 per Occurrence/$5,000,000 Agg.
E01 X Engineers Errors $ 250,000 per Occurrence/$ 500,000 Agg.
E02 & Omissions $ 500,000 per Occurrence/$1 ,000,000 Agg.
E03 $1,000,000 per Occurrence/$3,OOO,OOO Agg.
INSCKLST
11
Jun 04 03 10:54a
Paul Lin
(305)969-2759
p.2
t4~e,{~ 1,,\ c..\,;~\' ~
INSURANCE AGENT'S STATEMENT
I have reviewed the above requirements with the bidder named below. The following
deductibles apply to the c'OIT&Sponding policy.
POLICY
~11 /;0 '/~f, 63S-, 300 10
DEDUCTIBLES
~o
liability policies are :llccurrence
Claims Made
BIDDERS STATEMENT
I understand the insurance that will be mandatory if awarded the contract and will
comply in full with all the requirements.
q {>.v \, \.,.. \ fi <y A$~oc ~ClJ1 ~
Bidder
vI.- t,.1~
INSCKLST
12
ve ~~ c-L e irl>' ~.d'i Xv!
INSURANCE AGENTS STATEMENT
I have reviewed the above requirements with the bidder named below. The following
deductibles apply to the corresponding policy.
POLICY DEDUCTIBLES
~1S~18~,.'V~\" ~q'O ~\ooo."o
Liability policies are '6- Occurrence Claims Made
SAM
INSUUNCE 1','
, uranCEliAuOlW Ignature
(305) 235-8441
BIDDERS STATEMENT
I understand the insurance that will be mandatory if awarded the contract and will
comply in full with all the requirements.
~(Mr\ VlV\ <v AHo cili-k.H 11Mc.-
Bidder
fAv\" t,..\N
INSCKLST
12
~10t'ISlO""P- L\~ki\iK"J
INSURANCEAGEN1"S S.TA~N.T
t have reviewed the 8bove requIrements with tha bidder named below. The following
deductiblee apply to the oonaspondlng poUcy.
POLICY
A6' gDZtt8" 5"
,JEDUCTIBLES
/0. 0 0 () .
,
Liability policies 8re _ Occurrence ~ Claims Made
W-'-, 1...,. Sf.(t!. I",.
Insurance Agency /
~k'~.r Lc~.
Slgn.tuna
SlPDERS STATEMENT
I und8t'8tandthft lnauraneethat wIlI'bamend8tCWy if IlVI8rded, the oontnlc:l andwlU
comply in full with ell the ntqulNmenta.
~Av~ ~IJJ q, ~.se.(~v~~,~,.
Bidder
INSCKLST
I>\' \, {,J
12
GENERAL LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Prior to the commencement of work governed by this contract, the Contractor shall
obtain General Liability Insurance. Coverage shall be maintained throughout the life of
the contract and include, as a minimum:
. Premises Operations
. Products and Completed Operations
. Blanket Contractual Liability
. Personal Injury Liability
· Expanded Definition of Property Damage
The minimum limits acceptable shall be:
$ 500,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$ 250,000 per Person
$ 500,000 per Occurrence
$ 50,000 Property Damage
An Occurrence Form policy is preferred. If coverage is provided on a Claims Made
policy, its provisions should include coverage for claims filed on or after the effective
date of this contract. In addition, the period for which claims may be reported should
extend for a minimum of twelve (12) months following the acceptance of work by the
County.
The Monroe County Board of County Commissioners shall be named as Additional
Insured on all policies issued to satisfy the above requirements.
GL2
13
VEHICLE LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Recognizing that the work governed by this contract requires the use of vehicles, the
Contractor, prior to the commencement of work, shall obtain Vehicle Liability Insurance.
Coverage shall be maintained throughout the life of the contract and include, as a
minimum, liability coverage for:
. Owned, Non-Owned, and Hired Vehicles
The minimum limits acceptable shall be:
$100,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$ 50,000 per Person
$100,000 per Occurrence
$ 25,000 Property Damage
The Monroe County Board of County Commissioners shall be named as Additional
Insured on all policies issued to satisfy the above requirements.
VL1
14
WORKERS' COMPENSATION
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Prior to the commencement of work governed by this contract, the Contractor shall
obtain Workers' Compensation Insurance with limits sufficient to respond to Florida
Statute 440.
In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not
less than:
. $ 100,000 Bodily Injury by Accident
$ 500,000 Bodily Injury by Disease, policy limits
$ 100,000 Bodily Injury by Disease, each employee
Coverage shall be maintained throughout the entire term of the contract.
Coverage shall be provided by a company or companies authorized to transact business
in the state of Florida.
If the Contractor has been approved by the Florida's Department of Labor, as an
authorized self-insurer, the County shall recognize and honor the Contractor's status.
The Contractor may be required to submit a Letter of Authorization issued by the
Department of Labor and a Certificate of Insurance, providing details on the Contractor's
Excess Insurance Program.
If the Contractor participates in a self-insurance fund, a Certificate of Insurance will be
required. In addition, the Contractor may be required to submit updated financial
statements from the fund upon request from the County.
WC1
15
ENGINEERS ERRORS AND OMISSIONS
LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
Recognizing that the work governed by this contract involves the furnishing of
engineering services, the Contractor shall purchase and maintain, throughout the life of
the contract, Engineers Errors and Omissions 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.
This insurance shall be maintained in force for a period of two years after the date of
Substantial Completion of the Project.
The minimum limits of liability shall be:
$250,000 per Occurrence/$500,000 Aggregate
E01
16
DRUG-FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies
that:
? A v l, L-1-tJ <} A~? 0 ( 1- {>. i ~ S, i-t1 (, .
(Name of Business)
1. Publish a statement notifying employees that the unlawful manufacture,
distribution, dispensing, possession, or use of a controlled substance is prohibited in the
workplace and specifying the actions that will be taken against employees for violations
of such prohibition.
2. Inform employees about the dangers of drug abuse in the workplace, the
business's policy of maintaining a drug-free workplace, any available drug counseling,
rehabilitation, and employee assistance programs, and the penalties that may be
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 (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 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.
Bidders Sig
hi ~ lo~
Date
vl. ~\N
As the person authorized to sign the statement, I certify that thi
the above requirements.
17
I,
NON-COLLUSION AFFIDAVIT
Of. q IJ>> \ 1" v') , f. ~ . ofthe city
toI'\ 1.A ~ 1- according to law on my oath, and under
of
penalty of perjury, depose and say that;
1) I am ec.-v \ \.,., Y\ <y ~ ~ $ i) ( ~ 0.. hI .$ / "[,.. G . . the bidder making the
Proposal for the project described as follows:
_0\ttte~()e,Y-t ?Jel-i"L.- ~~k?,hn Cu-\ ve.Jt
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 project.
STATE OF
~(...or2~9A
1(
COUNTY OF
tv\ 1.A tJ}1.... Q N:J f:...
DATE
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
9,. ~ prJ \.,. v y.~ I ~. ~. who, after first being sworn by me, (name of
Individual signing) affixed her signature in the space provided above on this
.. . -"-~O t?:il-
""
My commission expires:
NOTARY PUBLIC
18
SWORN STATEMENT UNDER ORDINANCE NO. 10-1990
MONROE COUNTY. FLORIDA
ETIDCS CLAUSE
~Avl., /'1-~ <y A~~(),,~~i")
warrants that he/it has not employed, retained
or otherwise had act on his/its behalf any former County officer or employee in violation of
Section 2 of Ordinance No. 10-1990 or any County officer or employee in violation of
Section 3 of Ordinance No. 10-1990. 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 officer or employee.
i
)./
)
Date:
STATE OF
vL,..O ~~ 0 A
t-'t1-AVI"" OAQ~
COUNTY OF
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
(j'f. q Av~ \'1,.) I ~. ~. who, after first being sworn by me, affixed his/her
signature name of individual signing) in the space provided above on this tJ6 day of
NOTARY PUBLIC
My commission expires:
:J !' . "...... \ ~ .,
19
MONROE COUNTY, FLORIDA
Request For Waiver
of
Insurance Requirements
It is requested that the insurance requirements, as specified in the County's Schedule of Insurance
Requirements, be waived or modified on the following contract:
Contractor:
_~ AI) \,. ~ \N ~ /XU 0 (;~p.i ~) J 11Jc..
Contract for:
_0(l~~~~~(,)~f1 g~A(,Y\ ~~1 A1~~ CU/"v6f2i
f.O.r3o)C. tb~goo
J4:4Wt,. ~ ~~1,rh
Address of Contractor:
Phone: ';0 ~ " 'tb-1 '" ~ \11
Scope of Work: \11 i7f2DG( rzAf\1 l C ~(;(1.N~~~ lJ.l'i ~vA L.\J A 1 \ ON
NV~~lCA~ ~oO~L-ING{'
(z~A1ZA1"oH
II I
Reason for Waiver: 1'0 (2q'l.l'~-t ~()oi.l)e(' ~'( ~o"'lC~s CoWlf1et1S~-t:rOVl
U II ,()/th I
~!U"~V1(,4' Yflou.,,,emet1-f. S,yJl,.t ~I ~,.,{\
M~Oli~~ts. c; J,..,O$ 1(.<> ~~, .
Signature of Contractor: eVl-t
Not Approved
Risk Management:
Date:
County Administrator appeal:
Approved
Not Approved
Date:
Board of County Conunissioners appeal:
Approved
Not Approved
Meeting Date:
07/22/03
SUPPLEMENTARY INSURANCE DOCUMENTS
00900-13
Sep 08 03 11:00a
Paul Lin
(305)969-2759
11'.2
ST A TE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
CERTIFICA TE OF EXEMPTION FROM FLORIDA WORKERS' COMPENSATION LAW
09-03-2003
NON-CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from
Florida Workers' Compensation Law.
EFFECTIVE
08/06/2003
EXPIRA TION DATE N / A
PERSON
SSN
FEIN
BUSINESS
LIN
590-14-8988
650848605
PAUL C
PAUL LIN & ASSOCIATES INC
8040 SW 139TH TERRACE
MIAMI FL 33158
NOTE: Pursuant to Chapter 440. 1 0 ( 1) , (g) , 2 , F . S. , a sole proprietor, partner, or an
officer of a corporation who elects exemption from the Florida Workers'
Compensation law may not recover benefits or compensation under ChaPter 440.
STATE OF flORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
NON - CONSTRUCTION INDUSTRY
CERTIFICA TE OF EXEMPTION FROM flORIDA
WORKERS' COMPENSATION LAW
.6
l
o
EFFECTIVE:
EXPIRA TION:
PERSON:
SSN:
FEIN:
BUSINESS:
08/06/2003
N/A
UN PAUL
590-14-8988
650848605
PAUL UN & ASSOCIATES INC
8040 SW 139TH TERRACE
MIAMI Fl 33158
H
E
R
E
NOTE: Pursuant to chapter 440. 1011/, (9), 2, F. S . I
a sole proprietor I partner I or officer of an corporation
who elects exemption from the Florida Workers' Compensation
law may not rscover benefits or compensation under Chapler 440.
CUT HERE
* Carry bottom portion on the job, keep upper portion for your records.
Paul Lin & Associates, Inc.
P.O. Box 562800, Miami, FL 33256
Tel: (305) 969-2177 / Fax: (305) 969-2759
16000
August 27,2003
Mr. David Koppel, P.R
Monroe County
Engineering Department
1100 Simonton Street
Room 2-216
Key West, FL 33040
RE: ENGINEERING SERVICES FOR THE "BREEZESWEPT BEACH ESTATES CuLVERT"
PROJECT AT RAMROD KEy, MONROE COUNTY.
Dear Mr. Koppel:
Pursuant to my discussion with Jo Walters at Monroe County, this letter is to clarify the questions
regarding the submitted Hourly Rate Schedule for the above referenced project. As you know,
this rate schedule is only applied to the work that may be required by Monroe County in addition
to the scope identified in the contract. The additional works, if occurred, will most likely be
involved in task related to engineering and permitting, and to a lesser extent on drafting and
typing, I expect to perform these tasks, if required by the County, myself and invoice the works
according to their corresponding rates.
I hope the above information helps to clarifY the questions you may have regarding the Hourly
Rate Schedule. Should you have any questions, please do not hesitate to contact me.
Sincerely,
PAUL IN & ASSOCIATES, INC.
r:J
Home Office:
One Nationwide Plaza
Columbus, OH 43215 - 2220
CERTIFICATE OF INSURANCE
The company indicated below certifies that the insurance afforded by the policy or policies numbered and
described below is in force as of the effective date of this certificate. This Certificate of Insurance
does not amend, extend, or otherwise alter the Terms and Conditions of Insurance coverage contained in any
policy numbered and described below.
INSURED:
PAUL LIN & ASSOCIATES INC
8040 SW 139 TERRACE
MIAMI, FL 33158
CERTIFICATE HOLDER:
MONROE COUNTY BOARD OF COUNTY
COMMISSIONERS
ATTN ENGINEERING DEPT
1100 SIMONTON ST 2-216
KEY WEST, FL 33040
I POLI CY NUMBER I POLICY I POLICY
TYPE OF INSURANCE I & ISSUING CO, IEFF, DATE IEXP. bATE
LIABILITY I 77-BO-708638-3001 I 01-18-03 I 01-18-04
[X] Liability and I NATIONWIDE I I
Medical Expense I MUTUAL FIRE I I
Personal and I INSURANCE CO. I I
Advertising Injuryl I I
[X] Medical Expenses I I I
[X] Fire Legal I I I
Liability I I I
I I I
I I I
[ ] Other Liability I I I
AUTOMOBILE LIABILITY 77-BA-708638-3001 01-18-03 01-18-04
[X] BUSINESS AUTO NATIONWIDE
MUTUAL FIRE
[ ] Owned INSURANCE CO.
[X] Hired
[X] Non-Owned
EXCESS LIABILITY
T
[ J Umbrella Form
IBy
I
I DATE
I vVAIVCR
I
I
I
i
I
. I
I
I
I
I
I
N!A
] Workers'
Compensation
and
[ ] Employers'
Liability
I
I
I
Any One Occurrence..",... $ 1,000,000 I
I
I
I
5,000 I
50,000 I
I
General Aggregate* ....... $ 2,000,000 I
Prod/Comp Ops Aggregate* . $ 1,000,000 I
I
I
I
I
I
I
I
$ I
$ 1. 000 ,000 I
I
I
I
I
I
I
I
I
I
I
I
[
DESCRIPTION OF OPERATIONS/LOCATIONS
VEHICLES/RESTRICTIONS/SPECIAL ITEMS
CERTIFICATE HOLDER INCLUDED AS
ADDITIONAL INSURED
LIMITS OF LIABILITY
(*LIMITS AT INCEPTION)
Included in Above - Any One Person or
Organization
ANY ONE PERSON ",.....". $
Any One Fire or Explosion $
Bodily Injury
(Each Person) , , . . . . , .. $
(Each Accident) ......., $
Property Damage
(Each Accident) ."",'.
Combined Single Limit... .
Each Occurrence ...."... $
Prod/Comp Ops/Disease
Aggregate* .,.........
$
STATUTORY LIMITS
BODILY INJURY/ACCIDENT.., $
Bodily Injury by Disease
EACH EMPLOYEE.""".. $
Bodily Injury by Disease
POLICY LIMIT ...."..
$
Effective Date of Certificate: 01-18-2003
Date Certificate Issued: 07-30-2003
,
Authorized Representative:
Countersigned at:
ACORDN CERTIFICATE OF LIABILITY INSURANCl;;.uftlg ~ DATE (MM/DDIYY)
07/31/03
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Global Insurance Services, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
21301 Powerline Road #211 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Boca Raton FL 33433 INSURERS AFFORDING COVERAGE
Phone: 561-487-6001 Fax:561-451-9825
INSURED INSURER A: AllSouth Professional Liab
INSURER B:
Paul Lin & Associates, Inc. INSURER C:
Paul Lin
PO Box 562800 INSURER 0:
Miami FL 33256-2800
I INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I~f: TYPE OF INSURANCE POLICY NUMBER DATIr,'M'Mioor;.}yt; 1'8l-+i~~J'r~?N LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
-
COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $
I CLAIMS MADE D OCCUR MED EXP (Anyone person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREnE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
~ PRO- ~
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $
ANY AUTO (Ea accident)
-
ALL OWNED AUTOS BODILY INJURY
- $
SCHEDULED AUTOS (Per person)
-
HIRED AUTOS BODILY INJURY
- $
NON-OWNED AUTOS (Per accident)
f--
f-- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO APPMO~,r ,- OTHER THAN EA ACC $
OJ l,M..r, '1 AUTO ONLY: AGG
I '\!P' $
EXCESS LIABILITY CY_Ji II ! Il.Ih ~f) ,., EACH OCCURRENCE $
:=J OCCUR D CLAIMS MADE , j
DATE _ "( I;;;?:) 167 - AGGREGATE $
WAIVER $
=1 DEDUCTIBLE NIA_ ~YES: - $
RETENTION $ - $
WORKERS COMPENSATION AND I TORY L1MITST IU~~-
EMPLOYERS' LIABILITY
EL EACH ACCIDENT $
EL DISEASE - EA EMPLOYEE $
EL DISEASE - POLICY LIMIT $
OTHER
A AllSouth Prof Liab 807486 OS/27/03 OS/27/04 Liability 500,000
Deduct 10,000
DESCRIPTION OF OPERATlONSlLOCATlONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
The Monroe County Board of County Commissioners (Engineering Dept) is an
additional named insured as their interest might appear (ATIMA) .
CERTIFICATE HOLDER I y I ADDmONAL INSURED; INSURER LETTER: CANCELLATION
MONRCOU SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Monroe County Board DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL .J..L DAYS WRITTEN
of County Commissioners NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
Engineering Department IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
1100 Simonton St - Ste 2-216
Key West FL 33040 REPRESENlliIVES.
I \ ~ENTA:: -
ACORD 25-5 (7/97)
@ACORDCORPORATION 1988