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07/19/2023 Agreement
oul?r. Kevin Madok, CPA Monroe County, Florida Clerk of the Circuit Court& Comptroller DATE: July 21, 2023 TO: Ricliar(I Strickland Directoi-ol'Airports FROM: Pamela G. Hmico(&.C. SMECT: July 19" BOCC Meeting Auaclied are electroii1c copies ol'tlic 1'()Ilo%%,Iiig items for your limidlilig: 1112 Cowi-act to lowest bidder Ranger Construction Industries, Inc., in the miloillit of, S1,576,088.00, for the Runway !)-27 Repair Project at (lie Key NN'cst Inteniational Airport. Tlie project is Imide(I by FAA Grmil 37-73 (90(Xo), FDOTGrmit ('71007 mi(l/or G2E0'2 (5%) and Airport Operating Fund 401 (5%). Please be sure to provide dils office witli a copy ol'the recorded boii(I once tiled %%Iltli your office. Sliould you liavc any questions please 1'eel 1'ree to contact mc at (305) 292-3550. CC: County A(tonicy Fiiiaiicc File KEY WEST MARATHON PLANTATION KEY 500 Whitehead Street 3117 Overseas Highway 88770 Overseas Highway Key West, Florida 33040 Marathon, Florida 33050 Plantation Key, Florida 33070 Key West International Airport 01,23 Monroe County Runway 9-27 Repairs Bid Documems Project Manual S E C T 1 0 N D C 0 N T R A C T R,u,nway_9-27_,Repai,rs Key West International Air ort p _ THIS AGREEMENT made and entered into the 19th day of July,2023 by and between Ra Yer Construction Industries, Inc. Contractor, and the Monroe County Board of Commissioners, Key West, Florida, Owner. WITNESSETH: That the Contractor, for the consideration hereinafter fully set out hereby agrees with the Owner as follows: 1 m hat the Contractor, shall furnish all the materials, and perform all of the work in the manner and form as provided by the following enumerated documents; Instruction to Bidders, or of Proposal, General Provisions, Special Provisions, Technical Specifications, Form of Contract, Form of Bond, Drawings and Addenda, which are attached hereto and made a part hereof, as if fully contained herein, for the construction of: Runway 9-27 Repairs Ke a West International Air2ort Monroe County, Florida 2. That the Contractor shall commence the work to be performed under this agreement on a date to be specified in a written order of the Owner and shall fully complete all work hereunder within sixty(60) calendar days from the Notice-to- Proceed (Construction) as per Special Provision No. 2. 3. The Owner hereby agrees to pay to the Contractor for the faithful performance of the agreement, subject to additions and deductions as provided in the contract documents the Contract Lump sum of One Million Five Htindred LeyLnq-SLx Thousand Ei t w i t and 00/100 Dollars 4. On or before the 15th day of each calendar month, the Owner shall make partial payment tot Contractor on the basis of a duly certified and approved estimate of work performed during the preceding calendar month by the Contractor. County shall pay in accordance with the Florida Local Government Prompt Payment Act. Each Application for Payment shall be based upon the Schedule of Values for the project. The Schedule of Values shall allocate the entire Contract Sum among the various portions of the Work and be prepared in such form and supported by such data to substantiate its accuracy as the Director of Airports may require. This schedule, unless objected to by the Director of Airports, shall be used as a basis for reviewing the Contractor's Applications for Payment. Applications for Payment shall indicate the CONTRACT Key West International Airport 03,23 Monroe County Runway 9-27 Repairs Bid Documents Project Mantial percentage of completion of each portion of the Work as of the end of the period covered by the Application for Payment. Subject to the provisions of the Contract Documents, the amount of each progress payment shall be computed as follows: Take that portion of the Contract Sum properly allocable to completed Work as determined by multiplying the percentage completion of each portion of the Work by the share of the total Contract Sum allocated to that portion of the Work, less retainage of ten percent 10%. Payment will be made after delivery and inspection by County and upon submission of invoices with supporting documentation acceptable to the Clerk, on a monthly schedule in arrears. 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. Upon submission by the Contractor of evidence satisfactory tote Owner that all payrolls, material bills and other costs incurred by the Contractor in connection with the construction of the work have been paid in full, final payment on account of this agreement shall be made within twenty (20) days after the completion by the Contractor of all work covered by this agreement and the acceptance of such work by the Owner. 61 It is mutually agreed between the parties hereto that time is of the essence in this contract and in the event the construction of the work is not completed within the time herein specified, it is agreed that from the compensation otherwise to be paid to the Contractor, the Owner may retain the amounts described in the Liquidated Damages, Special Provision No. 3, per day for each day thereafter, Sundays and holidays included, that the work remains uncompleted, is sum shall represent the actual damages which the Owner will have sustained per day by failure of the Contractor to complete the work within the time stipulated and this sum is not a penalty being the stipulated damages the Owner will have sustained in the event of such default by the Contractor. 7. It is further mutually agreed between the parties hereto that if at any time after the execution ofthis agreement and the surety and hereto attached for its faithful performance, the Owner shall deem the surety or sureties upon such bond to be unsatisfactory, or if, for any reason, such bond ceases to be adequate to cover the performance of the work, the Contractor shall, at its expense within five (5) days after the receipt of notice from the Owner so to do, furnish an additional and or bonds in such for and amount and with such surety or sureties as shall be satisfactory to the Owner, In such event, no further payment to the Contractor shall be deemed to be due under this agreement until such new or additional security for the faithful performance of the work shall be furnished in manner and for satisfactory to the Owner. 8. MAINTENANCE OF 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. Records shall be retained for a period of seven years from the termination of this agreement or for a period of three years from the submission of the final expenditure report as per 2 CFR §200.333, whichever is greater. Each party to this Agreement or its authorized representatives shall have reasonable and timely access to such records of each CONTRACT 2 Key West Intenvational Airport 03;23 Monroe Count), Runway 9-27 Repairs Bid Documents Project Manual other party to this Agreement for public records purposes during the term of the Agreement and for seven 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, or were wrongfully retained by the Contractor, the Contractor shall repay the monies together with interest calculated pursuant to Sec. 55.03, of the Florida Statutes, running from the date the monies were paid by the County, 9 PUBLIC ACCESS. Public Records Compliance. Contractor must comply with Florida public records laws, including but not limited to Chapter 119, Florida Statutes and Section 24 of article I of the Constitution of Florida. The County and Contractor shall allow and permit reasonable access to, and inspection of, all documents, records, papers, letters or other "public record" materials in its possession or under its control subject tote provisions of Chapter 119, Florida Statutes, and made or received by the County and Contractor in conjunction with this contract and related to contract performance. The County shall have the right to unilaterally cancel this contract upon violation of this provision by the Contractor. Failure of the Contractor to abide by the terms of this provision shall be deemed a material breach of this contract and the County may enforce the terms of this provision in the form of a court proceeding and shall, as a prevailing party, be entitled to reimbursement of all attorney's fees and costs associated with that proceeding. This provision shall survive any termination or expiration of the contract. The Contractor is encouraged to consult with its advisors about Florida Public Records Law in order to comply with this provision. 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 CONTRACT Key West International Airport 01,21"), Monroe County Runway 9-27 Repairs Bid Documents Project ManUal 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 tote 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 Section 11 9.10, Florida Statutes. Contractor shall not transfer custody, release, alter, destroy or otherwise dispose of any public records unless or otherwise provided in this provision or as otherwise provided by law. IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS, BRIAN BRADLEY, AT (305) 292-3470, BRA DLEY.-BRIA .5MONROECOUNTY.-F MONROE COUNTY ATTORNEY'S OFFICE, 1111 12 th STREET, SUITE 408, KEY WEST, FL 33040. 10. HOLD HARMLESS AND INSURANCE: The successful Respondent all defend, indemnify and hold the County and the County's elected and appointed officers and employees harmless from and against (i) any claims, actions or causes of action, (i I) any litigation, administrative proceedings, appellate proceedings, or other proceedings relating to any type of injury (including death), loss, damage, fine, penalty or business interruption, and (iii) any costs or expenses (including, without limitation, costs of remediation and costs of additional security measures that the Federal Aviation Administration, the Transportation Security Administration or any other governmental agency requires by reason of , or in connection with a violation of any federal law or regulation, attorneys' fees and costs, court costs, fines and penalties) that may be asserted against, initiated with respect to, or sustained by, any indemnified party by reason of, or in connection with, (A) any activity of Respondent or any of its employees, agents, contractors or other invitees during the term ofthe Agreement, (8) the negligence or recklessness, intentional wrongful misconduct, errors or omissions, or other wrongful act or omission of Respondent or any of its employees, agents, sub-contractors or other invitees, or (C) Respondent's default in respect of any of the obligations that it undertakes under the terms the Agreement, except CONTRACT 4 Key West Inteniational Airport 01,23 Monroe County Runway 9-27 Repairs Bid Documents Protect Manual to the extent the claims, actions, causes of action, litigation, proceedings, costs or expenses arise from the intentional or sole negligent acts or omissions of the County or any of its employees, agents, contractors or invitees (other than Respondent). The monetary limitation of liability Linder this contract shall be equal to the dollar value of the contract and not less than $1 million per occurrence pursuant to Section 725.06, Florida Statutes. Insofar as the claims, actions, causes of action, litigation, proceedings, costs or expenses relate to events or circumstances that occur during the term of the Agreement, this provision will survive the expiration of the term of the Agreement or any earlier termination ofthe Agreement. In the event the completion of the project (including the or of others) is delayed or suspended as a result of the Contractor's failure to purchase or maintain the required insurance, the Contractor shall indemnify the County from any and all increased expenses resulting from such delay. The extent of liability is in no way limited to, reduced, or lessened by the insurance requirements contained elsewhere within this agreement. CERTIFICATES OF INSURANCE. Original Certificates of Insurance shall be provided to the COUNTY at the time of execution of this Agreement and certified copies provided if requested. Each policy certificate shall be endorsed with a provision that not less than thirty (30) calendar days' written notice shall be provided to the COUNTY before any policy or coverage is canceled or restricted. The underwriter of such insurance shall be qualified to do business in the State of Florida. If requested by the County Administrator, the insurance coverage shall be primary insurance with respect to the COUNTY, its officials, employees, agents and volunteers. Failure of CONTRACTOR to comply with the requirements of this section shall be cause for immediate termination of this agreement. 11. NON-WAIVER OF IMMUNITY: Notwithstanding the provisions of Sec. 768.28, on Statutes, the participation of COUNTY and 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. 112, NO PLEDGE OF CREDIT: CONTRACTOR shall not pledge the COUNTY'S credit or make it a guarantor of payment or surety for any contract, debt, obligation, judgment, lien, or any for of indebtedness. CONTRACTOR further warrants and represents that it has no obligation or indebtedness that would impair its ability to fulfill the terms of this contract, 13. NOTICE REQUIREMENT: 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: CONTRACT Key West Interriational Airport 03�'2 3 Monroe Counly Runway 9-27 Repairs Bid Documents Project Manual FOR COUNTY� Director of Airports C ounty Attorney's Office 3491 S. Roosevelt Blvd. I I I I 12th St., Ste. 408 Key West, 33040 Key West, FL 33040 FOR CONTRACTOR: Jamie 1645 West Palm Beach, FL. 33_409 14. GOVERNING L6W, VENUE AND INTERPRETATION: 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 will lie in the appropriate court or before the appropriate administrative body in Monroe COUNTY, Florida, 15. MEDIATION: The COUNTY and CONTRACTOR agree that, in the event of conflicting interpretations of the terms or a term of this Agreement by or between any of the the issue shall be submitted to mediation prior to the institution of any other administrative or legal proceeding. 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. 16. 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 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. 17. ATTORNEY'S FEES AND COSTS: 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 attorney's fees, in appellate proceedings. Each party agrees to pay its own court costs, investigative, and out-of-pocket expenses whether it is the prevailing party or not, through all levels of the court system. CONTRACT 6 Key West Intemational Airport 0 Monroe County Runway 9-27 Repairs Bid Documents Project Manual M ADJUDICATION OF DISPUTES OR DISAGREEMENTS: COUNTY and TRACTOR agree that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions between representatives of each of COUNTY and CONTRACTOR. If no resolution can be agreed upon within 30 days after the first meet and confer session, the issue or issues shall be discussed at a public meeting of the Board of County Commissioners. If the issue or issues are still not resolved to the satisfaction of COUNTY and CONTRACTOR, then any party shall have the right to seek such relief or remedy as may be provided by this Agreement or by Florida law. 19. 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, 20. BINDING EFFECT: The terms, covenants, conditions, and provisions of this Agreement shall bind and inure to the benefit of COUNTY and CONTRACTOR and their respective legal representatives, successors, and assigns, 21. 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. 22. 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 Linder 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, ore ployees outside the territorial limits of the COUNTY. 21 LEGAL OBLIGATIONS AND RESPONSIBILITIES' 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. 24. 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 CONTRACT 7 Key West Inteniational Airport 0123 Monroe County Runway 9-27 Repairs Bid Documents Project Manual 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 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. 25. NO PERSONAL LIABILITY: No covenant or agreement contained herein shall edeemed 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. 26. 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 COUNTY and CONTRACTOR hereto may execute this Agreement by signing any such counterpart. 27. NON-DISC RIM I NATION: Contractor agrees that there will be no discrimination against any person, and it is expressly understood that upon a determination by a court of competent jurisdiction that discrimination has occurred, this Agreement automatically terminates without any further action on the part of any party, effective the date of the court order. Contractor agrees to comply with all Federal and Florida statutes, and all local ordinances, as applicable, relating to nondiscrimination. These include but are not limited to: 1) Title V11 of the Civil Rights Act of 1964 (PL 88-352) which prohibits discrimination on the basis of race, color or national origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC ss. 1681-1683, and 1685- 1686), which prohibits discrimination on the basis of sex; 3) Section 504 of the Rehabilitation Act of 1973, as amended (20 US C s. 794), which prohibits discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975, as amended (42 US C ss. 6101-6107)which prohibits discrimination on the basis of age; 5) The Drug Abuse Office and Treatment Act of 1972 (PIL 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, ss. 523 and 527 (42 USC ss. 690dd-3 and 290ee-3), as amended, relating to confidentiality of alcohol and drug abuse patient records; 8) Title VIII of the Civil Rights Act of 1968 (42 US C s. et seq,), as amended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The Americans with Disabilities Act of 1990 (42 USC s. 1201 Note), as maybe amended from time to time, relating to nondiscrimination on the basis of disability; 10) Monroe County Code Chapter 14, Article 11, which prohibits discrimination on the basis of race, color, sex, religion, national origin, ancestry, sexual orientation, gender identity or expression, familial status or age; and 11) Any other nondiscrimination provisions in any Federal or state statutes which may apply to the parties to, or the subject matter of, this Agreement. CONTRACT 8 Key West Intenlational Airport 03 23 Monroe County Runway 9-27 Repairs Bid Documents Project Manual IN WITNESS WHEREOF the parties hereto have executed this agreement on the day and date _Im -above written in two (2) counterparts, each of which shall, without proof or accounting for the Ainterpart, be deemed an original contract. BOARD OF COUNTY COMMISSIONERS K VIN MADOK, CLERK OF NROE COUNTY, FLORIDA By _ As ieppUty Clerk Mayor Pro Teri NA OE COUNTY ATrDnNEY PlOv FOP&M CONTRACTOR P J By� ASSIG MY ATTORNEY Date 4&W=7/I0L23 Title- JamieTimmir(g -Vice President NOTARIAL JURAT STATE OF: Florida COUNTY OF: Palm Beach Subscribed and sworn to (or affirmed) before me, by means of 91 physical presence or El online notarization, on 07/06/2023 (date) by Jarnie Timming - Vice President (name of affiant). He/She is personally known to e or has produced (type of identification) as identification. Gregoria Estretla NOTARY PUBLIC STATE OF FLORIDA NOTARY PUBLIC COmnl#9 GG957057 1 Exrwes 211012024 *Who is authorized by the corporation to execute this contract. M J— Pr _rl C:) rri CONTRACT 9 Key West Intemational Airport 03,"23 Monroe Count) Runway 9-27 Repairs Bid Documents Pro.ject Manual INTENTIONALLY LEF'r BLANK 10 C ONTRACT' Key West International Airport 03/23 Monroe County Runway 9.27 Repairs Bid Documents Project Manual SECTION E DRUG FREE WORKPLACE FORM The undersigned Contractor, In accordance with Florida Statute 287.087, hereby certifies that: Ranger Construction Industries, Inc. (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 such employees about the dangers of drug abuse in the workplace, the business' policy of maintaining a drug-free workplace,any available drug counseling, rehabilitation and employee assistance programs and the penalties that may be imposed upon employees for drug abuse violations. 3. Give each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in Sub-section (1). 4. In the statement specified in Sub-Section (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. impose a sanction on or require the satisfactory participation in a drug abuse assistance or rehabilitabon program if such is available in the employee's community or any employee who is so convicted. 6. Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section. As a person authorized to sign the statement, I certify that this firm compli fully with the above requirements. 131;fe'�r:'s Signature Date: 5/4/2023 BIDDING REQUIREMENTS AND CONTRACT FORMS Key West International Airport 03/23 Monroe County Runway 9-27 Repairs Did Documents Project Manual SECTION L SWORNST STATUTES ON PUBLIC ENTITY CRIMES This for must be signed and sworn to in the presence of a Notary Public or other official authorized to administer oaths. I This sworn statement is submitted with Bid, Proposal or Contract No. Key West International Airport 03/23 Monroe County Runway 9-27 Repairs for 2. This sworn statement is submitted by (name of entity submitting sworn statement) whose business address is 1646 North Congress Avenue,West Palm Beach, FI 33409 and (if applicable) its Federal Employer Identification Number(FEIN)is: 59.2098662 (if the entity has no FEIN, include the'Social Security Number of the individual signing this sworn statement: NA 3. My name is Jamie Timminri and (please print name of individual signing) my relationship to the entity named above Is.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,vice President .................................- 4. 1 understand that a "public entity crime", as defined in Paragraph 287.133(1)(g), Florida Statutes, a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or of the United States, including, but not limited to, any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving anti-trust, fraud, theft, bribery, collusion, racketeering, conspiracy or material misrepresentation. 5. 1 understand that "convicted" or "conviction", as defined in Paragraph 287.133(1)(6), Florida Statutes. means a finding of guilt or a conviction of a public entity crime with or without an adjudication of guilt in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non-jury trial or entry of a plea of guilty or nolo contendere. BfDDrNG REQUUUMENTS AND CONTRACT FORMS 1-35 Key West International Airport 03/23 Monroe County Runway 9-27 Repairs Bid Documents Project Manual 6. 1 understand that an "affiliate", as defined in Paragraph 287.133(1)(a). Florida Sta totes, means: a. A predecessor or successor of a person convicted of a public entity crime; or b. An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person or a pooling of equipment or income among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. 7. 1 understand that a "person", as defined in Paragraph 287.133(1)(e), _Florida Statutes._means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity or which otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers, directors, executives, partners, shareholders, employees, members and agents who are active in management of an entity. 8. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. (indicate which statement applies.) X Neither the entity submitting this sworn statement nor any of its officers, directors, executives, partners, shareholders, employees, members or agents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1. 1989. - The entity submittling this sworn statement or one or more of its officers, directors, executives, partners, shareholders, employees, members or agents who are active in the management of the entity or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989, AND (please indicate which additional statement applies) - There has been a pmceeding concerning the conviction before a Hearing Officer of the State of Florida, Division of Administrative Hearings. The Final Order entered by the Hearing Officer did not place the person or afaLiate on the convicted vendor list. (Please attach a copy of the Final BIDDING REQUrREMENTS AND CONTRACT FORMS 1-36 Key West Intemational Airport 03/23 Monroe County Runway 9-27 Repairs Bid Documents Project Manual Order.) person or affiliate was placed on the convicted vendor list. There has been a subsequent proceeding before a hearing officer of the State of Florida, Division of Administrative Hearings.The Final Order entered by the hearing officer determined that it was in the public interest to remove the person or affiliate from the convicted vendor list. (Please attach a copy of the Final Order.) The person or affiliate has not been placed on the convicted vendor list. (Please describe any action taken by or pending with the Department of General Services.) Signature of Authorized epresentative: Jamie Timming Vice President 514/2023 Title Date NOT RI AL JURAT STATE OF- Florida COUNTY OF., gran Subscribed and sworn to (or affirmed) before me, by means of 9 physical presence,of-0 online notarization, on 5/412023 -(date) by Jam!q� _ (name of affiant).-Fie/she is personally known to me or has produced (type of'd ntification) as identification. A;w OTARY PU IC A4 01M, ELENA M ARANGO. INER Notary Public-State of Florida Commission 0 HH 324181 my Commission Expires October 20, 2026 B ENTS AND CONTRACT FORMS l-37 Key West International Airport 03/23 Monroe County Runway 9-27 Repairs Bid Documents Project Manual SECTION M. SWORN STArEMENT UNDER ORDINANCE NO, 10-1990 MONROE COUNTY1 FLORIDA ETHICS CLAUSE Jamie 1!MMj22_-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. (Signature) Date: 514/2023 NOTARIAL JURAT STATE OF: Florida COUNTY OF: Orana's Subscribed and sworn to(or affirmed) before me, by means of N physical presence or 13 online notarization, on 9412023 (date) by Jamie Ti ming . (name of afflant), He/She is personally known to me or has produced Personal)v Kn,2wn (type of identification) as identification. '9 CA;1 R"'6 4NTPU B V ELENA M ARANGO-MINER jSls- Me- Notary Public-Stela of Florida Commission I HH 324181 my commission Expires Q0 October 20, 2026 BIDDTNG RF-QUIREMENTS AND CONTRACT FORMS 1-38 Key West International Airport 03/23 Monroe County Runway 9-27 Repairs Bid Documents Project Manual SECTION Q NON-COLLUSION AFFIDAVIT Aqrnip Tim in of the city of West Palm each according to law on my oath, and under penalty of perjury, depose and say that: 1) 1 am Vice President of the firm of Ranger Construction Industries, Inc. the bidder� akin the t�hebid proposal for the project described in the Notice for Calling for bids for: Key West international Airport Monroe County Runway 9-27 Repairs 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 restOcting 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 Coun r lies upon the truth of the statements contained in this affidavit in awarding contra V. said project. 7gna_In WW:5 e Bid er) (Date) NOTA_RIALJURAT STATE OF: Florida COUNTY OF: Oran Subscribed and sworn to (or affirmed) before me, by means of 19 physical presence or 0 online notarization, on RMM91 (date) by (name of affiant). He/She is personally known to me or has produced Personally-Kngwn (type of identi cation) as 'Identification. qt? BIDDING REQUIREMENTS AND CONTRACT FORM 1-48 Key West International Airport 03/23 Monroe County Runway 9-27 Repairs Bid Documents Project Manual SECTION T ES LISTS Project Description(s):---KOY West Internotionalkrpod Monroe County Runway!9�27 Repairs Respondent Vendor Name: Ranger Construction Industries, Inc. Vendor FEIN: 59-2098662 _ Vendor's Authorized Representative Name and Title: Jamie Limming-Vice President Address: 1645 North Congress Avenue City: West Palm E3each State: Florida Zip 33409 Phone Number: (561)793-9400 Email Address: esUmating@rangerconstruction.com/chelsea.song@ ran gerconstructior,com Section 287.135, Florida Statutes prohibits a company from bidding Oil, submitting a proposal for, or entering into or renewing a contract for goods or services of any amount if, at the firne 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 oil,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 oil 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 287.135,Florida Statutes,the submission of a false certification may subject company to civil penalties,attoruey's fees,and/or costs. I further understand that any contract with the County may be terminated, at the option of the County, if the company is found to have submitted a false certification or lies 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 Ole Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List or been engaged in business operations in Cuba or Syria. Certified By: Jamie Timmin who is authorized " Jaime "mmin to sign on behalf of the above referenc d any. u Authorized Signature: Print Name:Jamie Timming Title:Vice resident Note:The List are available at the following Department of Management Services Site: hftg://%"vw.d s. orida.ca siness a)erations/state 7urchasin vendor info at ion/cony icted sus BIDDING REQUIREMENTS AND CONTRACT FORMS 1-51 77/3/2023 E(MM/DDIYYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 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: William Phelps George H. Friedlander Company PHONE FAx 1566 Kanawha Blvd. E. AIC No EXt: 321-254-8477 A/C,No:321-988-0209 Charleston V 25311 ADMDRE W SS: billphelps@friedlandercompany.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: CHARTER OAK FIRE INS CO 25615 INSURED RANG001 INSURER B:TRAVELERS IND CO OF CT 25682 Ranger Construction INSURER C:Travelers Property Casualty Co of Amer 25674 Industries, Inc. 1645 N Congress Avenue INSURER D West Palm Beach FL 33409 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:1966001693 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 EFF POLICY EXP LTR POLICY NUMBER MMDD/YYYY MMDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y CO-580713217-23 4/1/2023 4/1/2024 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence $500,D00 X Contractual Liab MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY� PE� LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY Y Y CAP-58076186-23 4/1/2023 4/1/2024 COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident C X UMBRELLALIAB X OCCUR Y Y CUP-58OBB407-23 4/1/2023 4/1/2024 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED RETENTION$ $ A WORKERS COMPENSATION Y UB-81-888782-23 4/1/2023 4/1/2024 X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $1,OOD,000 OFFICER/MEMBER EXCLUDED? - (Mandatory in NH) E.L.DISEASE-EAEMPLOYEE $1,000,000 If yes,describe under W " DESCRIPTION OF OPERATIONS below T - ^° E.L.DISEASE-POLICY LIMIT $1,000,000 7 . 723 matt bm a nt, . DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project: Runway 9-27 Repairs-Key West International Airport Monroe County Board Of County Commissioners, a Political Subdivision of the State of Florida, its officers,employees and agents are Additional Insured when required by written contract with respect to work performed for them by the Named Insured and at the specified project. A Waiver of Subrogation for Workers Compensation coverage is included.Excess policies shown in certificate are follow form over the General Liability,Automobile Liability and Employers Liability. Should any of the above described policies be cancelled before the expiration date thereof,the issuing insurer will mail 30 days written notice to the certificate holder,but failure to do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Monroe County Board of County Commissioners ACCORDANCE WITH THE POLICY PROVISIONS. C/O Director of Airports 3491 S. Roosevelt Blvd. AUTHORIZED REPRESENTATIVE Key West FL 33040 f @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD CO-5807B217 - 23 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. i BLANKET ADDITIONAL INSURED - AUTOMATIC STATUS i IF REQUIRED BY WRITTEN CONTRACT (CONTRACTORS) i This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to SECTION II —WHO IS AN (a) The Additional Insured — Owners, Les- INSURED: sees or Contractors — Scheduled Person Any person or organization that: or Organization endorsement CG 20 10 i a. You agree in a written contract or agreement to 07 04 or CG 20 10 04 13, the Additional include as an additional insured on this Coverage Insured — Owners, Lessees or Contrac- Part; and tors — Completed Operations endorse- I ment CG 20 37 07 04 or CG 20 3 7 04 13, b. Has not been added as an additional insured for or both of such endorsements with either the same project by attachment of an endorse- of those edition dates;or ment under this Coverage Part which includes (b) Either or both of the following: the Addi- such person or organization in the endorsement's tional Insured—Owners, Lessees or Con- schedule; tractors — Scheduled Person Or Organi- is an insured, but: zation endorsement CG 20 10, or the Ad- a. Only with respect to liability for "bodily injury" or ditional Insured — Owners, Lessees or "property damage" that occurs, or for "personal Contractors — Completed Operations en- injury" caused by an offense that is committed, dorsement CG 20 37, without an edition subsequent to the signing of that contract or date of such endorsement specified; agreement and while that part of the contract or the person or organization is an additional in- i agreement is in effect; and sured only if the injury or damage is caused, b. Only as described in Paragraph (1), (2) or(3) be- in whole or in part, by acts or omissions of low,whichever applies: you or your subcontractor in the performance (1) If the written contract or agreement specifical- of"your work"to which the written contract or ly requires you to provide additional insured agreement applies;or coverage to that person or organization by (3) If neither Paragraph(1)nor(2)above applies: J. the use of: (a) The person or organization is an addi- (a) The Additional Insured — Owners, Les- tional insured only if, and to the extent sees or Contractors — (Form B) endorse- that, the injury or damage is caused by ment CG 20 10 11 85;or acts or omissions of you or your subcon- (b) Either or both of the following: the Addi- tractor in the performance of "your work" I tional Insured—Owners, Lessees or Con- to which the written contract or agree- tractors — Scheduled Person Or Organi- ment applies; and zation endorsement CG 20 10 10 01, or (b) Such person or organization does not the Additional Insured—Owners, Lessees qualify as an additional insured with re- or Contractors — Completed Operations spect to the independent acts or omis- endorsement CG 20 37 10 01; sions of such person or organization. the person or organization is an additional in- The insurance provided to such additional insured is sured only if the injury or damage arises out subject to the following provisions: of"your work" to which the written contract or a. If the Limits of Insurance of this Coverage Part agreement applies; shown in the Declarations exceed the minimum (2) If the written contract or agreement specifical- limits required by the written contract or agree- ly requires you to provide additional insured ment, the insurance provided to the additional in- coverage to that person or organization by sured will be limited to such minimum required I the use of: limits. For the purposes of determining whether i i f CG D6 04 02 19 Q 2017 The Travelers Indemnity Company.All rights reserved. Page 1 of 2 { i I i I i I COMMERCIAL GENERAL LIABILITY this limitation applies,the minimum limits required result in a claim. To the extent possible, such by the written contract or agreement will be con- notice should include: sidered to include the minimum limits of any Um- (a) How, when and where the "occurrence" brella or Excess liability coverage required for the or offense took place; additional insured by that written contract or (b) The names and addresses of any injured agreement. This provision will not increase the persons and witnesses; and ' limits of insurance described in Section III—Limits Of Insurance. (c) The nature and location of any injury or b. The insurance provided to such additional insured damage arising out of the"occurrence"or does not apply to: offense. (1) Any "bodily injury', "property damage" or (2) If a claim is made or "suit" is brought against "personal injury" arising out of the providing, the additional insured: or failure to provide, any professional archi- (a) Immediately record the specifics of the tectural, engineering or surveying services, claim or"suit"and the date received;and including: (b) Notify us as soon as practicable and see (a) The preparing, approving, or failing to to it that we receive written notice of the prepare or approve, maps, shop draw- claim or"suit"as soon as practicable. ings, opinions, reports, surveys, field or- (3) Immediately send us copies of all legal pa- ders or change orders, or the preparing, pers received in connection with the claim or approving, or failing to prepare or ap- "suit", cooperate with us in the investigation prove,drawings and specifications; and or settlement of the claim or defense against (b) Supervisory, inspection, architectural or the"suit",and otherwise comply with all policy engineering activities. conditions. (2) Any "bodily injury" or "property damage" (4) Tender the defense and indemnity of any caused by "your work" and included in the claim or "suit" to any provider of other insur- "products-completed operations hazard" un- ance which would cover such additional fin- less the written contract or agreement specifi- sured for a loss we cover. However, this con- cally requires you to provide such coverage dition does not affect whether the insurance =3 for that additional insured during the policy provided to such additional insured is primary period. to other insurance available to such additional c. The additional insured must comply with the fol- insured which covers that person or organiza- lowing duties: tion as a named insured as described in Par- (1) Give us written notice as soon as practicable agraph 4., Other Insurance, of Section IV — 3 of an "occurrence" or an offense which may Commercial General Liability Conditions. I S� i t E I €t F 7 t i 1 !fi i I l Page 2 of 2 ©2017 The Travelers Indemnity Company.All rights reserved. CG D6 04 02 19 CO-5807B217 - 23 COMMERCIAL GENERAL LIABILITY i THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general i coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties,and what is and is not covered. A. Who Is An Insured—Unnamed Subsidiaries C. Incidental Medical Malpractice B. Blanket Additional Insured — Governmental D. Blanket Waiver Of Subrogation E Entities — Permits Or Authorizations Relating To E. Contractual Liability—Railroads Operations F. Damage To Premises Rented To You t i PROVISIONS a. An organization other than a partnership,joint A. WHO IS AN INSURED — UNNAMED venture or limited liability company; or SUBSIDIARIES b. A trust; The following is added to SECTION II —WHO IS as indicated in its name or the documents that AN INSURED: govern its structure. Any of your subsidiaries, other than a partnership, B. BLANKET ADDITIONAL INSURED — 3 joint venture or limited liability company, that is GOVERNMENTAL ENTITIES — PERMITS OR not shown as a Named Insured in the AUTHORIZATIONS RELATING TO OPERATIONS 3 Declarations is a Named Insured if: a. You are the sole owner of, or maintain an The following is added to SECTION 11—WHO IS ownership interest of more than 50% in, such AN INSURED: subsidiary on the first day of the policy period; Any governmental entity that has issued a permit and or authorization with respect to operations b. Such subsidiary is not an insured under performed by you or on your behalf and that you similar other insurance. are required by any ordinance, law, building code or written contract or agreement to include as an No such subsidiary is an insured for"bodily injury" additional insured on this Coverage Part is an or "property damage" that occurred, or "personal insured, but only with respect to liabi lity for"bodily and advertising injury" caused by an offense injury", "property damage" or "personal and committed: advertising injury"arising out of such operations. a. Before you maintained an ownership interest The insurance provided to such governmental of more than 50%i n such subsidiary; or entity does not apply to: b. After the date, if any, during the policy period a. Any "bodily injury". "property damage" or ' that you no longer maintain an ownership "personal and advertising injury" arising out of interest of more than 50% in such subsidiary. operations performed for the governmental For purposes of Paragraph 1, of Section 11—Who entity; or i Is An Insured, each such subsidiary will be b. Any "bodily injury" or "property damage" deemed to be designated in the Declarations as: included in the "products-completed 3 operations hazard". I i i CG D3 16 0219 ©2017 The Travelers Indemnity Company.All rights reserved. Page 1 of 3 i Includes copyrighted material of Insurance Services Office,Inc.,with its permission. i i s i I COMMERCIAL GENERAL LIABILITY C. INCIDENTAL MEDICAL MALPRACTICE pharmaceuticals committed by, or with the 1. The following replaces Paragraph b. of the knowledge or consent of,the insured. definition of "occurrence" in the S. The following is added to the DEFINITIONS DEFINITIONS Section: Section: b. An act or omission committed in providing "Incidental medical services"means: or failing to provide "incidental medical services", first aid or "Good Samaritan a. Medical, surgical,dental, laboratory, x-ray to a person, unless you are in or nursing service or treatment, advice or services instruction, the business or occupation of providing the related furnishing of professional health care services, food or beverraa ges;or 2. The following replaces the last paragraph of b. The furnishing or dispensing of drugs or Paragraph 2.a.(1) of SECTION 11 — WHO IS medical, dental, or surgical supplies or AN INSURED: appliances. Unless you are in the business or occupation 6. The following is added to Paragraph 4.b., of providing professional health care services, Excess Insurance, of SECTION IV — Paragraphs (1)(a), (b), (c) and (d) above do COMMERCIAL GENERAL LIABILITY not apply to "bodily injury" arising out of CONDITIONS: providing or failing to provide: This insurance is excess over any valid and (a) "Incidental medical services" by any of collectible other insurance, whether primary, your "employees" who is a nurse, nurse excess, contingent or on any other basis, that assistant, emergency medical technician is available to any of your "employees" for or paramedic; or "bodily injury" that arises out of providing or (b) First aid or"Good Samaritan services" by failing to provide "incidental medical services" any of your "employees" or "volunteer to any person to the extent not subject to workers", other than an employed or Paragraph 2.a.(1) of Section 11 —Who Is An volunteer doctor. Any such "employees" Insured. or "volunteer workers" providing or failing D. BLANKET WAIVER OF SUBROGATION to provide first aid or "Good Samaritan services" during their work hours for you The following is added to Paragraph 8.,Transfer will be deemed to be acting within the Of Rights Of Recovery Against Others To Us, scope of their employment by you or of SECTION IV — COMMERCIAL GENERAL performing duties related to the conduct LIABILITY CONDITIONS: of your business. If the insured has agreed in a contract or 3. The following replaces the last sentence of agreement to waive that insured's right of Paragraph S. of SECTION III — LIMITS OF recovery against any person or organization, we INSURANCE: waive our right of recovery against such person or For the purposes of determining the organization, but only for payments we make applicable Each Occurrence Limit, all related because of: acts or omissions committed in providing or a. "Bodily injury" or "property damage" that failing to provide "incidental medical occurs;or ' services", first aid or "Good Samaritan services to any one person will be deemed to b. "Personal and advertising injury" caused by be one"occurrence". an offense that is committed; 4. The following exclusion is added to subsequent to the execution of the contract or Paragraph 2., Exclusions, of SECTION I — agreement. COVERAGES — COVERAGE A — BODILY E. CONTRACTUAL LIABILITY—RAILROADS INJURY AND PROPERTY DAMAGE s LIABILITY: 1. The following replaces Paragraph c. of the Sale Of Pharmaceuticals definition of "insured contract" in the "BodilyDEFINITIONS Section: injury" or "property damage" arising j out of the violation of a penal statute or c. Any easement or license agreement; ' ordinance relating to the sale of Page 2 of 3 ©2017 The Travelers Indemnity Company.All rights reserved. CG D3 16 02 19 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 1 a i e i COMMERCIAL GENERAL LIABILITY 2. Paragraph f.(1) of the definition of "insured a. Any premises while rented to you or contract" in the DEFINITIONS Section is temporarily occupied by you with permission deleted. of the owner;or F. DAMAGE TO PREMISES RENTED TO YOU b. The contents of any premises while such The following replaces the definition of"premises premises is rented to you, if you rent such damage" in the DEFINITIONS Section: premises for a period of seven or fewer consecutive days. "Premises damage" means"property damage"to: i i i i 3 t5 t 3 1 3' P i i 3 s i 1 1 1 i 3 3 j� 1 i CG D3 16 02 19 ©2017 The Travelers Indemnity Company,All rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. i 6 j TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 00 03 13(00)-001 E POLICYNUMBER: UB-8L888982-23-25-D f' i WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT i We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: 7 DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. i i 3 3, t� 3 3 1 { i S 2 i 3 i i i 2 t { i I i DATE OF ISSUE: 04-19-22 STASSIGN: PAGE 1 OF k f CAP-5807B186-23 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. i BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties,and what is and is not covered. i A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE —LOSS OF B. BLANKET ADDITIONAL INSURED USE—INCREASED LIMIT C. EMPLOYEE HIRED AUTO 1. PHYSICAL DAMAGE — TRANSPORTATION { EXPENSES—INCREASED LIMIT D. EMPLOYEES AS INSURED J. PERSONAL PROPERTY E. SUPPLEMENTARY PAYMENTS — INCREASED K. AIRBAGS LIMITS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR F. HIRED AUTO — LIMITED WORLDWIDE COV- LOSS ERAGE—INDEMNITY BASIS M. BLANKET WAIVER OF SUBROGATION { G. WAIVER OF DEDUCTIBLE—GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS j f PROVISIONS A. BROAD FORM NAMED INSURED this insurance applies and only to the extent that The following is added to Paragraph A.1., Who Is person or organization qualifies as an "insured" l An Insured, of SECTION II—COVERED AUTOS under the Who Is An Insured provision contained in Section II, LIABILITY COVERAGE: Any organization you newly acquire or form dur- C. EMPLOYEE HIRED AUTO ing the policy period over which you maintain 1. The following is added to Paragraph A.1., 50% or more ownership interest and that is not Who Is An Insured, of SECTION II — COV- separately insured for Business Auto Coverage, ERED AUTOS LIABILITY COVERAGE: Coverage under this provision is afforded only un- An "employee" of yours is an "insured" while til the 180th day after you acquire or form the or- operating an "auto" hired or rented under a ganization or the end of the policy period, which- contract or agreement in an "employee's" ever is earlier. name, with your permission, while performing duties related to the conduct of your busi- B. BLANKET ADDITIONAL INSURED ness. The following is added to Paragraph c. in A.1., 2. The following replaces Paragraph b. in B.5., Who is An Insured, of SECTION If —COVERED Other Insurance, of SECTION IV — BUSI- AUTOS LIABILITY COVERAGE: NESS AUTO CONDITIONS: Any person or organization who is required under b. For Hired Auto Physical Damage Cover- a written contract or agreement between you and age, the following are deemed to be cov- that person or organization, that is signed and ered"autos"you own: t executed by you before the "bodily injury" or (1) Any covered "auto" you lease, hire, "property damage" occurs and that is in effect rent or borrow;and during the policy period, to be named as an addi- (2) Any covered "auto" hired or rented by tional insured is an "insured" for Covered Autos your "employee" under a contract in Liability Coverage, but only for damages to which an "employee's" name, with your CA T3 53 0215 ©2015 The Travelers Indemnity Company.All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office,Inc.with its permission, i i i S s v i I COMMERCIAL AUTO permission, while performing duties (a) With respect to any claim made or "suit" related to the conduct of your busk brought outside the United States of ness. America, the territories and possessions However, any auto that is leased, hired, of the United States of America, Puerto rented or borrowed with a driver is not a Rico and Canada: covered"auto". (1) You must arrange to defend the "in- D. EMPLOYEES AS INSURED sured" against, and investigate or set- The following is added to Paragraph A.1., Who Is tle any such claim or "suit" and keep I An Insured, of SECTION II —COVERED AUTOS us advised of all proceedings and ac- tions. 3 LIABILITY COVERAGE: Any "employee" of yours is an "insured" while us- (ii) Neither you nor any other involved ing a covered "auto" you don't own, hire or borrow "insured" will make any settlement s in your business or your personal affairs. without our consent. E. SUPPLEMENTARY PAYMENTS — INCREASED (Ili) We may, at our discretion, participate LIMITS in defending the "insured" against, or in the settlement of, any claim or 1. The following replaces Paragraph A.2.a.(2), "suit". of SECTION II — COVERED AUTOS LIABIL- ITY COVERAGE: (iv)We will reimburse the "insured" for sums that the "insured" legally must (2) Up to $3,000 for cost of bail bonds (in- pay as damages because of "bodily cluding bonds for related traffic law viola- injury" or "property damage" to which tions) required because of an "accident" this insurance applies, that the "in- we cover. We do not have to furnish sured" pays with our consent, but these bonds, only up to the limit described in Para- graph C., Limits Of Insurance, of 2. The following replaces Paragraph A.2.a.(4), SECTION 11 — COVERED AUTOS of SECTION Il — COVERED AUTOS LIABIL- ITY COVERAGE; LIABILITY COVERAGE. i (4) All reasonable expenses incurred by the (v) We will reimburse the "insured" for "insured" at our request, including actual the reasonable expenses incurred loss of earnings up to $500 a day be- with our consent for your investiga- cause of time off from work, tion of such claims and your defense of the "insured" against any such F. HIRED AUTO — LIMITED WORLDWIDE COV- "suit", but only up to and included ERAGE—INDEMNITY BASIS within the limit described in Para- The following replaces Subparagraph (5) in Para- graph C., Limits Of Insurance, of graph B.7., Policy Period, Coverage Territory, SECTION II — COVERED AUTOS of SECTION IV — BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in TIONS: addition to such limit. Our duty to (5) Anywhere in the world, except any country or make such payments ends when we have used up the applicable limit of jurisdiction while any trade sanction, em- insurance in payments for damages, bargo, or similar regulation imposed by the settlements or defense expenses. United States of America applies to and pro- hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, to contingent or on any other basis. auto" that you lease, hire, rent or borrow without a driver for a period of 30 days or less (c) This insurance is not a substitute for re- i and that is not an "auto" you lease, hire, rent quired or compulsory insurance in any or borrow from any of your "employees", country outside the United States, its ter- partners (if you are a partnership), members ritories and possessions, Puerto Rico and (if you are a limited liability company) or Canada. members of their households. Page 2 of 4 m 2015 The Travelers Indemnity Company.All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office,Inc,with its permission. i i i I 1 i i i COMMERCIAL AUTO You agree to maintain all required or (2) In or on your covered"auto". compulsory insurance in any such coun- This coverage applies only in the event of a total try up to the minimum limits required by theft of your covered"auto". local law. Your failure to comply with compulsory insurance requirements will No deductibles apply to this Personal Property not invalidate the coverage afforded by coverage. this policy, but we will only be liable to the K. AIRBAGS ' same extent we would have been liable s had you complied with the compulsory in- The following is added to Paragraph B.3., Exclu- � Y p p ry sions, of SECTION III — PHYSICAL DAMAGE surance requirements. COVERAGE: ` i (d) It is understood that we are not an admit- Exclusion 3.a. does not apply to "loss" to one or ted or authorized insurer outside the more airbags in a covered "auto" you own that in- United States of America, its territories flate due to a cause other than a cause of "loss" and possessions, Puerto Rico and Can- set forth in Paragraphs A.1.b. and A.1.c., but ada. We assume no responsibility for the only: I furnishing of certificates of insurance, or a. If that "auto" is a covered "auto" for Compre- for compliance in any way with the laws hensive Coverage under this policy; of other countries relating to insurance. b. The airbags are not covered under any war- G. WAIVER OF DEDUCTIBLE—GLASS ranty;and The following is added to Paragraph D., Deducti- c. The airbags were not intentionally inflated. ble, of SECTION III — PHYSICAL DAMAGE We will pay up to a maximum of $1,000 for any COVERAGE: one"loss". No deductible for a covered "auto" will apply to L. NOTICE AND KNOWLEDGE OF ACCIDENT OR glass damage if the glass is repaired rather than LOSS replaced. The following is added to Paragraph A.2.a., of H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF SECTION IV—BUSINESS AUTO CONDITIONS: USE—INCREASED LIMIT Your duty to give us or our authorized representa- , The following replaces the last sentence of Para- tive prompt notice of the "accident" or "loss" ap- graph AA.b., Loss Of Use Expenses, of SEC- plies only when the "accident" or "loss" is known { TION III—PHYSICAL DAMAGE COVERAGE: to: However, the most we will pay for any expenses (a) You(if you are an individual); i for loss of use is $65 per day, to a maximum of (b) A partner(if you are a partnership); $750 for any one"accident". (c) A member (if you are a limited liability com- 1. PHYSICAL DAMAGE — TRANSPORTATION pany); 3 EXPENSES—INCREASED LIMIT (d) An executive officer, director or insurance The following replaces the first sentence in Para- manager (if you are a corporation or other or- graph A.4.a., Transportation Expenses, of ganization);or i SECTION III — PHYSICAL DAMAGE COVER- (e) Any"employee" authorized by you to give no- AGE: tice of the"accident"or"loss". We will pay up to $50 per day to a maximum of M. BLANKET WAIVER OF SUBROGATION $1,500 for temporary transportation expense in- The following replaces Paragraph A.S., Transfer tutted by you because of the total theft of a cov- Of Rights Of Recovery Against Others To Us, ' eyed"auto"of the private passenger type. of SECTION IV — BUSINESS AUTO CONDI- J. PERSONAL PROPERTY TIONS : The following is added to Paragraph A.4., Cover- S. Transfer Of Rights Of Recovery Against age Extensions, of SECTION III — PHYSICAL Others To Us t DAMAGE COVERAGE: We waive any right of recovery we may have Personal Property against any person or organization to the ex- tent required of you by a written contract We will pay up to $400 for "loss" to wearing ap- signed and executed prior to any "accident" I parel and other personal property which is: or"loss", provided that the"accident" or"loss" I (1) Owned by an"insured";and arises out of operations contemplated by CA T3 53 02 15 m 2015 The Travelers Indemnity Company.All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office,Inc.with its permission. I I i i i COMMERCIAL AUTO such contract. The waiver applies only to the The unintentional omission of, or unintentional person or organization designated in such error in, any information given by you shall not contract, prejudice your rights under this insurance. How- N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col- The following is added to Paragraph B.2., Con- lect additional premium or exercise our right of cealment, Misrepresentation, Or Fraud, of cancellation or non-renewal. SECTION IV—BUSINESS AUTO CONDITIONS: i i i i 3 3 s s i r I i I 3 } 1 i i i 2 S 4 gt iP f 3 1 3 j[ 1 3 i i i 1 i Page 4 of 4 m 2015 The Travelers Indemnity Compa ny.All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office,Inc.with its permission. i