Item C06BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: July 16, 2008 Division: Budget and Finance
Bulk Item: Yes ❑ No ® Department: Grants
Staff Contact Person: David P. Owens
AGENDA ITEM WORDING: Approval to request proposals for FEMA Public Assistance
consulting services.
ITEM BACKGROUND: The County has hired consultants for help with manaaina the
FEMA public assistance reimbursement process in the Oast_ This RFP will inclriria
to protect the County from de -obligation of federal and state disaster funding A draft
RFP is attached.
PREVIOUS RELEVANT BOCC ACTION: Approval of previous letter of enaaaement with
Adiusters International at BOCC meeting Julv 2004 for FEMA public assistance
consultma services.
CONTRACT/AGREEMENT CHANGES: n/a
STAFF RECOMMENDATION: approval
TOTAL COST: to be determined at time of BUDGETED: Yes ® No ❑
engagement; costs are now eligible for
Partial reimbursement from FEMA/State
87.5%
COST TO COUNTY: to be determined SOURCE OF FUNDS: FEMA (75%)/State
(12.5%)/ad valorem taxes (12 5%)
REVENUE PRODUCING: Yes ❑ No ® AMOUNT PER MONTH
YEAR
APPROVED BY: COUNTY ATTYA O URCHASING ❑ RISK MANAGEMENT
DOCUMENTATION: INCLUDED: ® NOT REQUIRED: ❑
DISPOSITION: AGENDA ITEM #:
MONROE COUNTY
REQUEST FOR PROPOSALS
FOR
FEMA Public Assistance
Consulting Services A
TYIPOMMISSIONERS
nnaro, District 4
Charles "Sonny" McCoy, District 3
Spehar, District 1
or Neugent, District 2
via J. Murphy, District 5
COUNTY ADMINISTRATOR
Roman Gastesi
CLERK OF THE CIRCUIT COURT BUDGET AND FINANCE DIVISION
Danny L. Kolhage Grants Administration Department
July 2008
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NOTICE OF CALLING FOR PROPOSALS
NOTICE IS HEREBY GIVEN TO PROSPECTIVE PROPOSERS that on Date at 3:00
P.M. the Monroe County Purchasing Office will open sealed proposals for the following:
FEMA PUBLIC ASSISTANCE
CONSULTING SERVICES
MONROE COUNTY, FL
RFP-OMB-346-19-2007-PU R/CV
Requirements for submission and the selection crite
DemandStar by Onvia at www.demandstar.com
fl.gov/pages/msd/proposals htm or call toll-fre
Record is available at the Purchasing Office
Simonton Street, Key West, FL 33040. Tec
writing, to David P. Owens, Grants Adminis r,
Street, Suite 2-213, Key West, FL 33040 or by
will be by Addenda.
be requested from
e -800-N
The Public
ed at thlding, 1100
questionsdirected, in
The B0 Simonton
i 305) 292-4515. All answers
Proposers must submit a total of ree (3) 41�ed originals and three (3)
complete copies of each proposal in ea lope rly marked on the outside
with the Proposer's name and: roe Proposal for FEMA Public
Assistance Consulting", ay�essed an d to.
�Aonr ounty chasing Office
100 S nton St , Room 1-213
33040
hone. ) 292-4466
Fax: (305) 292-4465
All pr als must be eiveM the County Purchasing Office before 3:00 P.M.
on Dat proposals r ived after this date and time will be automatically rejected.
Materials a delivere y Certified Mail, Return Receipt Requested, hand -delivered
or couriered. xed -mailed proposals will be automatically rejected. Hand
delivered Prop equest a receipt. If sent by mail or by courier, the above -
mentioned envelo II be enclosed in another envelope addressed to the entity and
address stated abov . Proposers should be aware that certain "express mail" services
will not guarantee specific time delivery to Key West, Florida. It is the sole responsibility
of each Proposer to ensure their proposal is received in a timely fashion.
Monroe County's performance and obligation to pay under this contract is contingent
upon an annual appropriation by the Board of County Commissioners.
All proposals must remain valid for a period of ninety (90) days from the date of the
deadline for the proposal stated above. The Board will automatically reject the
response of any person or affiliate who appears on the convicted vendor list prepared
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by the Department of Management Services, State of Florida, under Sec. 287.133(3)(d),
Florida Statute (1997). Monroe County declares that all or portions of the documents
and work papers and other forms of deliverables pursuant to this request shall be
subject to reuse by the County.
All proposals, including the recommendation of the County Administrator and the
requesting Department Head, will be presented to the Board of County Commissioners
of Monroe County, Florida, for final awarding or otherwise. The Board reserves the right
to reject any and all proposals, to waive informalities in any or
advertise for proposals, and to separately accept or reject any
award and/or negotiate a contract in the best interest of the County
Dated at Key West,
Publication Dates:
Reporter (Fr)
Keynoter (Sa)
KW Citizen (Su)
Monroe County Purchasing
all proposals, to re -
item or items and to
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TABLE OF CONTENTS
NOTICE OF REQUEST FOR PROPOSALS
SECTION ONE - Instructions to Respondents
SECTION TWO - County Forms
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SECTION ONE: INSTRUCTIONS TO RESPONDENTS
1. Objective of the Request For Proposals
The Respondent awarded a contract shall provide the FEMA Public Assistance Consulting
Services described herein. Elaborate upon services in general here.
of The FEMA Public Assistance Consulting Servicest must comply with the requirements
2. Background Information
Monroe County ("County") is a non -chartered county esi
and the laws of the State of Florida. The Clerk of the Circuit Co
population of the County is estimated at approximately 81,00QJ
The Board of County Commissioners, constituted
a body corporate, including the powers to contract; to s
lease and convey real estate and personal property; t
powers of a public authority organized and existing fo
to citizens within its territorial boundaries. In order to car
to levy taxes to pay the cost of operations.
The County seeks to......
3. Evaluation Criteria
Each proposal will be
• Ability to provide sin
• Experience with simi
• Qualifications of staff.
• Total cost►
4. Req
shall be sub
under the Constitution
s as the fiscal agent. The
ing IM has all the powers of
i; to a� , purchase, hold,
nd to gen exercise the
roviding co unity services
ion, the County is empowered
given to each of the following criteria:
relating to the specifications of this Request for Proposals
David P. Owe Administrator
1100 Simonton 5W, Suite 2-213
Key West, Florida 13040
Facsimile (305) 292-4515
All requests must be received no later than 3:00 PM, , 2008. If necessary, an
addendum to the RFP will be issued shortly thereafter and distributed to all interested respondents,
responding with the County's best ability to answer all questions.
5. Content of Submission
The proposal submitted in response to this Request for Proposals (RFP) shall be printed on 8-
1/2" x 11" white paper and bound; shall be clear and concise, tabulated, and provide the information
requested herein. Statements submitted without the required information will not be considered.
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Responses shall be organized as indicated below. The Respondent should not withhold any
information from the written response in anticipation of presenting the information orally or in a
demonstration, since oral presentations or demonstrations may not be solicited. Each Respondent
must submit adequate documentation to certify the Respondent's compliance with the County's
requirements. Respondent should focus specifically on the information requested.
6. Format.
The response, at a minimum, shall include the following:
A. Cover Page
A cover page that states "PROPOSAL FOR FEMA PUBLIC ASSISTANCE
be included. The cover page should contain Respondent's name, addres
of the Respondent's contact person(s).
B. Tabbed Sections
Tab 1.
Tab 2
Tab 3.
Tab 4.
Executive Summary
The Respondent shall provide a narral
demonstrates how the firm will work with
Project. Describe the firm's of techr
how this technology will be roc
currently in use or planned fo s
locally given the extensive amc. of fie,.
milar Projects
TING SERVICES" must
number, and the name
RFm's qualities and capabilities that
my to fulfill the requirements of this
the office and in the field. Describe
roject. List any specific software
Nfirm's methodology for working
ec� ection required.
history of the firm or organization
are similar in scope and size to the
a list of past projects indicating the following:
FI
II address of the referenced project client
lephone number of client contact for referenced project
ion and completion of contract
of the project and services
Project Approach
The Respondent shall describe the approach and methodology it will use to accomplish
the work defined herein. The project approach shall include information on schedule
and availability.
Tab 5. Staffing for this Project & Qualifications of Key Personnel
The Respondent shall describe the composition and structure of the firm (sole
proprietorship, corporation, partnership, joint venture) and include names of persons
with an interest in the firm.
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Tab 6.
Tab 7
The Respondent shall include a list of the proposed staff that will perform the work
required if awarded this contract. An organizational chart and management plan should
be included in this section. The Respondent shall also include minimum qualifications
for each class of employee of the project team and identify his/her role on the team.
Include in this section the location of the main office and the location of the office
proposed to work on this project.
Other Information
Respondent shall provide any additional project experience that will give an indication
of the Respondent's overall abilities. _
Project Budget
Respondent shall use a format similar to that of
as much detail. The titles of persons working
number of hours. hourly rate, and total amot
expenses not included in these hourly rat- 2
Ask for fully -loaded and travel-sepa ud
n below, with at least
number of each,
Fisted. Any other
brand total shown.
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SAMPLE PROJECT
BUDGET
FEMA Public Assistance Consulting Services
You may use a spreadsheet of your own design, but it must be in
similar format, and include at least as much
information.
Personnel Costs
Position Description
# on
project
# of
hours
hourly
rate
am
research consultant
1
100
150.00
100
research assistant
2
100
80.0
8,000.1
1,250.00
administrative assistant
1
25
250.00
250.00
100.00
25.00
1,000.00
600.00
Total Personnel Costs
Other Costs (if not included
above
_
Miscellaneous
Office Supplies
Postage
Printing and Binding
Rent
Tele hone
_
800.00
125.00
Travel
Utilities
List others b
Total Other Costs
2,900.00
Total Project Cost
$27,150.00
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Tab 8. Litigation
Provide answers to the following questions regarding claims and suits:
(a) Has the Respondent ever failed to complete work or provide the goods for which it has contracted? (If
yes, provide details.)
(b) Are there any judgments, claims, arbitration proceeding or suits pending or outstanding against
the Respondent, or its officers or general partners? (If yes, provide details.)
(c) Has the Respondent, within the last five (5) years, been a party to
with regard to a contract for services, goods or construction sAn
the RFP? (If yes, the Respondent shall provide a history of a
in which the Respondent is involved as a result of the provisi
which are requested or described herein.)
(d) Has the Respondent ever initiated litigation agai
connection with a contract to provide services, good;
details.) -A
(e) Whether, within the last five (5) years, an officer,
major creditor of the Respondent was an o ficer, gene
creditor of any other entity that failed to V%i;�
the request for bids.
Tab 9.
County Forms
Respondent shall complete a
RFP, as well as copies of,A
section, i.e. Tab 8: A
Forms
Submission F
Lobbying and
Non-Collusi
Drug Free
Public Entity
Request of W
COPIES OF RFP
A.
N.
y lawsuit or arbitration
ar to those requested in
nding claims and litigation
ie or similar services
by the county in
f yes, provide
irtner, controlling shareholder or
r, controlling shareholder or major
Lh goods similar to those sought in
ified below and located in Section two in this
ial licenses and shall include them in this
irements (optional)
Only compete sets of RFP Documents will be issued and shall be used in preparing
responses. The County does not assume any responsibility for errors or
misinterpretations resulting from the use of incomplete sets.
Complete sets of RFP Documents may be obtained in the manner and at the locations
stated in the Notice of Request for Proposals.
7. STATEMENT OF PROPOSAL REQUIREMENTS
See also notice of Request for Proposals.
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Interested firms or individuals are requested to indicate their interest by submitting a
total of six (6), three (3) signed originals and three (3) complete copies of the proposal, in a
sealed envelope clearly marked on the outside, with the Respondent's name and "Monroe
County Proposal for FEMA Public Assistance Consulting Services", addressed to Monroe
County Purchasing Department, 1100 Simonton Street, Room 1-213, Key West, FL 33040,
which must be received on or before 3:00 P.M. local time on January 1, 9999. Hand
delivered Proposals may request a receipt. No proposals will be accepted after 3:00 P.M.
Faxed or e-mailed proposals shall be automatically rejected. It is the sole responsibility of
each Respondent to ensure its proposal is received in a timely fashion.
8. DISQUALIFICATION OF RESPONDENT
A.
Q
C.
NON -COLLUSION AFFIDAVIT: Any person subm
invitation must execute the enclosed NON-COLLL
that collusion exists among the Respondents, the
collusion shall be rejected, and no participants
future proposals for the same work.
PUBLIC ENTITY CRIME: A person or
vendor list following a conviction for a
a contract to provide any goods or servic:
proposal on a contract with a public entity
building or public work, may mit Pr
contractor, supplier, subcont n
and may not transact busines -th a
provided in Section 287.017, fo TEG
date of being placed on the con d
9. EXAMINATION O
losal in response to this
DAVIT. If it is discovered
f all participants in such
he will be considered in
Pic
been placA%the convicted
e may not su it a proposal on
entity, may not submit a
nstruction or repair of a public
n leases or perform work as a
a contract with any public entity,
xcess of the threshold amount
for a period of 36 months from the
4tegory Two: $25,000.00
person submitting a bid or proposal in
ie enclosed DRUG -FREE WORKPLACE
Failure to complete this form in every detail
result in immediate disqualification of the bid
DN4W OF INTEREST ETHICS CLAUSE: Any person submitting
respo e to this invitation must execute the enclosed LOBBYING
� INTEREST CLAUSE and submit it with his/her bid or proposal.
this form in every detail and submit it with the bid or proposal may
disqualification of the bid or proposal.
A. Each Respondent shall carefully examine the RFP and other contract documents, and
inform himself/herself thoroughly regarding any and all conditions and requirements
that may in any manner affect cost, progress, or performance of the work to be
performed under the contract. Ignorance on the part of the Respondent shall in no way
relieve him/her of the obligations and responsibilities assumed under the contract.
B. Should a Respondent find discrepancies or ambiguities in, or omissions from, the
specifications, or should he be in doubt as to their meaning, he shall at once notify the
County.
10. INTERPRETATIONS, CLARIFICATIONS, AND ADDENDA
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No oral interpretations will be made to any Respondent as to the meaning of the contract
documents. Any inquiry or request for interpretation received fourteen (14) or more days prior to the
date fixed for opening of responses will be given consideration. All such changes or interpretation will
be made in writing in the form of an addendum and, if issued, will be furnished to all known
prospective Respondents prior to the established Proposal opening date. Each Respondent shall
acknowledge receipt of such addenda in his/her Proposal. In case any Respondent fails to
acknowledge receipt of such addenda or addendum, his/her response will nevertheless be construed
as though it had been received and acknowledged and the submission of his/her response will
constitute acknowledgment of the receipt of same. All addenda are a part of the contract documents
and each Respondent will be bound by such addenda, whether or not received by him/her. It is the
responsibility of each Respondent to verify that he/she has received all anda issued before
responses are opened.
11. GOVERNING LAWS AND REGULATIONS
The Respondent is required to be familiar with and s
federal, state, and local laws, ordinances, rules, professio
that in any manner affect the work. Knowledge of occup
such licenses for Monroe County and municipalities
Respondent.
12. PREPARATION OF RESPONSES
Signature of the Respondent: The R
provided for the signature. If the Respondent r
", or "Sole Owner" must appear beneath such
at least one of the partnere
w the firm
written beneath such signsponde
Response on behalf of tho st be st,
evidence of his authority tRe nse mu
response the name and ah
13. MODIFICATI
r respoMW., for complying with all
ense requireMlIfts and regulations
license require1W and obtaining
ro &unty are thaWonsibility of the
Lust Sign sponde forms in the space
' the w "doing business as
e of a partnership, the signature of
PM the VWds "Member of the Firm" should be
corporation, the title of the officer signing the
along with the Corporation Seal Stamp and
submitted. The Respondent shall state in the
an interest in the submitting entity.
Wri odification a acc from Respondents if addressed to the entity and address
indicated i Notice of Req for Pr osals and received prior to Proposal due date and time.
Modification t be submitte a sealed envelope clearly marked on the outside, with the
Respondents n nd "Modi tion to Proposal - Monroe County Proposal for The Tavernier
Historic District We L Survey and Publication." If sent by mail or by courier, the above -
mentioned envelope closed in another envelope addressed to the entity and address stated
in the Notice of Reque roposals. Faxed or e-mailed modifications shall be automatically
rejected.
14. RESPONSIBILITY FOR RESPONSE
The Respondent is solely responsible for all costs of preparing and submitting the response,
regardless of whether a contract award is made by the County.
15. RECEIPT AND OPENING OF RESPONSES
Responses will be received until the designated time and will be publicly opened. Respondents
names shall be read aloud at the appointed time and place stated in the Notice of Request for
11 of 27
Proposals. Monroe County's representative authorized to open the responses will decide when the
specified time has arrived and no responses received thereafter will be considered. No responsibility
will be attached to anyone for the premature opening of a response not properly addressed and
identified. Respondents or their authorized agents are invited to be present.
16. DETERMINATION OF SUCCESSFUL RESPONDENT
The contract shall be awarded based on the following criteria:
• Ability to provide services listed.
• Experience with similar projects.
• Qualifications of staff.
• Price.
The County reserves the right to reject any and all respon
irregularities as may be deemed best for the interests of the Co�
modifications are incomplete, unbalanced, conditional, obethe:
requested or irregularities of any kind, or that do not compv
Respondent and the contract documents, may be rejec
17. AWARD OF CONTRACT
A. The County reserves the rigl
geographic area or other, and to waive any
of the work contemplated.
B. The County also reserves the ri
previously failed to perform promo com
C. The recomy
of Monroe County, Florida,
18. CERTIFICA'
The
Certificate nsurancc
contract, wi nroe C
forms are not ed v
selected Respon P
Florida and having
A.M. Best rating of VI,
Respondent is providing
Worker's Compensation
waive technical errors and
ses that contain
additions not
the Instruction to
is for the services based on
or to re -advertise for all or part
? Wonse of a Respondent who has
of a similar nature on time.
to the Board of County Commissioners
E REQUIREMENTS
res DIWle for all necessary insurance coverage as indicated below.
provido Monroe County within fifteen (15) days after award of
JC listed as additional insured as indicated. If the proper insurance
thfteen (15) day period, the contract may be awarded to the next
I be written by companies licensed to do business in the State of
vice of process in the State of Florida. Companies shall have an
required insurance shall be maintained at all times while
ce to County.
Statutory Limits
Employers' Liability Insurance
Bodily Injury by Accident $100,000
Bodily Injury by Disease, policy limits $500,000
Bodily Injury by Disease, each employee $100,000
General Liability, including
Premises Operation
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Products and Completed Operations
Blanket Contractual Liability
Personal Injury Liability
Expanded Definition of Property Damage
$500,000 Combined Single Limit
If split limits are provided, the minimum limits acceptable shall be:
$250,000 per person
$500,000 per occurrence
$50,000 property damage
Vehicle Liability
(Owned, non -owned and hired vehicles) $300,000 Comb[ ingle Limit
If split limits are provided, the minimum limits acceptabl, I b
$100,e
r person
$3C r occurrence
$ 0 propil&damage
Professional Liability
Monroe County shall be named as an
Liability policies.
19. INDEMNIFICATION
The Respondent tC
County as outlined below.
The Res
County, its co
bodily injur ludir
owned by oe Ci
attorney's fed ur1
services provid
errors, or other wr,
employees, servants
Occurrence
General Liability and Vehicle
shall defend, indemnify and hold harmless the
d agrees to indemnify, hold harmless and defend Monroe
s, loyees, agents and servants from any and all claims for
onar,111pry, and property damage, including damage to property
y othePlosses, damages, and expenses of any kind, including
penses, which arise out of, in connection with, or by reason of
ent or any of its Subcontractor(s), occasioned by the negligence,
ission of the Respondent, its Subcontractor(s), their officers,
In the event that tiie service is delayed or suspended as a result of the Vendor's failure to
purchase or maintain the required insurance, the Vendor shall indemnify the County from any and
all increased expenses resulting from such delay.
The first ten dollars ($10.00) of remuneration paid to the Respondent is consideration for the
indemnification provided for above. The extent of liability is in no way limited to, reduced, or
lessened by the insurance requirements contained elsewhere within this agreement.
20. EXECUTION OF CONTRACT
The Respondent will be required to execute a contract with the County (draft attached) for the
13 of 27
services provided for in this RFP. The Respondent with whom a contract is negotiated shall be
required to return to the County four (4) executed counterparts of the prescribed Contract together
with the required certificates of insurance.
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SECTION TWO: COUNTY FORMS AND INSURANCE FORMS
[This page intentionally left blank, with forms to follow.]
15 of 27
RESPONSE FORM
RESPOND TO: MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
Purchasing Department
GATO BUILDING, ROOM 1-213
1100 SIMONTON STREET
KEY WEST, FLORIDA 33040
I acknowledge receipt of Addenda No. (s)
I have included
• Response Form
• Lobbying and Conflict of Interest Clause
• Non -Collusion Affidavit
• Drug Free Workplace Form
• Public Entity Crime Statement
• Monroe County occupational license and relevant
City occupational licenses are required to be
obtained within ten days of award of the contraA
I have included a current copy of the following professio upational licenses:
Mailing Address:
Signed:
e)
STATE OF:
Name
nder
COUNTY OF:
Subscribed and sworn t ed) before me on
(date) by
or has produced
ax:
Date:
(name of affiant). He/She is personally known to me
(type of identification) as identification.
OTARY PUBLIC My Commission Expires:
16 of 27
LOBBYING AND CONFLICT OF INTEREST CLAUSE
ETHICS CLAUSE
SWORN STATEMENT UNDER ORDINANCE NO.010-1990
MONROE COUNTY, FLORIDA
(Company)
"...warrants that he/it has not employed, retained or otherwise ha( o
County officer or employee in violation of Section 2 of Ordinanc 0
or employee in violation of Section 3 of Ordinance No. 010-
provision the County may, in its discretion, terminate this A� ent wit
its discretion, deduct from the Agreement or purchase pr' r otherwise
any fee, commission, percentage, gift, or consideration o the former C
STATE OF:
COUNTY OF:
Subscribed and sworn to (or
(date) by
known to rrAff�ias p
identification)"Wentification.
i his/her behalf any former
1990 or any County officer
Sreachn or violation of this
bil4ity and may also, in
r, the full amount of
icer or employee."
(name of affiant). He/She is personally
NOTARY PUBLIC
My Commission Expires:
(type of
17 of 27
NON -COLLUSION AFFIDAVIT
1, of the city of
oath, and under penalty of perjury, depose and say that
according to law on my
1. I am of the firm of
the bidder making the
Proposal for the project described in the Request for Proposals for
and that executed the said
proposal with full authority to do so;
2. the prices in this bid have been arrived at independent out collusion, consultation,
communication or agreement for the purpose of rest mpetition, as to any matter
relating to such prices with any other bidder or wit cl itor;
3. unless otherwise required by law, the prices have bee ted in this bid have not
been knowingly disclosed by the bidder an of knowingly b losed by the bidder
prior to bid opening, directly or indirectly, y ote,a
'dder or to mpetitor; and
4. no attempt has been made or will be ma th,r to induce any other person,
partnership or corporation to submit, or not . bid for the purpose of restricting
competition;
5. the statements contained in thb
are true orrect, and made with full
knowledge that Monroe County es truth I statements contained in this
affidavit in awarding contracts fo id pro
STATE C
COUNTY
Subscrib(
(date) by
known to
identification) as identification.
ture)
(name of affiant). He/She is personally
NOTARY PUBLIC
My Commission Expires:
(type of
18 of 27
DRUG -FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:
(Name of Business)
2
3.
4
5
n
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.
Inform employees about the dangers of drug abuse in the workplace, the business' policy of
maintaining a drug -free workplace, any available drug counselin abilitation, and employee
assistance programs, and the penalties that may be imposed employees for drug abuse
violations.
Give each employee engaged in providing the commo, ontractual services that are
under bid a copy of the statement specified in subsecti
In the statement specified in subsection (1), notif employ hat, as a condition of
working on the commodities or contractual servic t are under bi,. employee will abide
by the terms of the statement and will notify th - loyer o any convic f, or plea of guilty
or nolo contenderre to, any violation of Ch 893 (F a Statutes) f any controlled
substance law of the United States or any stat tion occurring in the workplace no
later than five (5) days after such conviction.
Impose a sanction on, or require th tisfactory p ation in a drug abuse assistance or
rehabilitation program if such is ave emplo community, or any employee who
is so convicted.
Make a good faith effort to continue tc intain ree , rkplace through implementation
of this section.
As the person authorized
requirements.
STATE OF:
COUNTY OF:
Subscribed and sworn
or has produced
affirmed) before me on
date) by
above
(name of affiant). He/She is personally known to me
(type of identification) as identification.
NOTARY PUBLIC
My Commission Expires:
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PUBLIC ENTITY CRIME STATEMENT
"A person or affiliate who has been placed on the convicted vendor list following a conviction for public
entity crime may not submit a bid on a contract to provide any goods or services to a public entity,
may not submit a bid on a contract with a public entity for the construction or repair of a public building
or public work, may not submit bids on leases of real property to public entity, may not be awarded or
perform work as a contractor, supplier, subcontractor, or CONTRACTOR under a contract with any
public entity, and may not transact business with any public entity in excess of the threshold amount
provided in Section 287.017, for CATEGORY TWO for a period of 36 months fro the date of being
placed on the convicted vendor list."
I have read the above and state that neither
any Affiliate has been placed on the convicted vendor list within the
STATE OF:
COUNTY OF:
Subscribed and sworn to (or J0111111111ftfore me
(date) by 11
& -2 (name
has produced
identification.
(Si
Da
ent's name) nor
months.
ant). He/She is personally known to me or
(type of identification) as
NOTARY PUBLIC
My Commission Expires:
20 of 27
MONROE COUNTY, FLORIDA
RISK MANAGEMENT
POLICY AND PROCEDURES
CONTRACT ADMINISTRATION MANUAL
Indemnification and Hold Harmless
For
Other Contractors and Subcontractors
The Contractor covenants and agrees to indemnify and hold harmless Monroe County Board of
County Commissioners from any and all claims for bodily injury (includirr ath), personal injury, and
property damage (including property owned by Monroe County) and ther losses, damages, and
expenses (including attorney's fees) which arise out of, in conne ith, or by reason of services
provided by the Contractor or any of its Subcontractor(s) in any t! oned by negligence, errors,
or other wrongful act of omission of the Contractor or its Sub acto ny tier, their employees,
or agents.
In the event the completion of the project (to include t rkeo�tLers) is dela� suspended as a
result of the Contractor's failure to purchase or mai theinsurance, Contractor shall
indemnify the County from any and all increased expenom such delay.
The first ten dollars ($10.00) of remuneratio to the Co for the indemnification provided
for above.
The extent of liability is in no way limited tJVuce ene by the insurance requirements
contained elsewhere within this agreement.
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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 the applicable state statutes.
In addition, the Contractor shall obtain Employers' Liability Insurance ojWits 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 to
Coverage shall be provided by a company or compani ed to transact business in the state
of Florida.
If the Contractor has bee
insurer, the County shall rE
to submit a Letter of Authi
providing details on the Cc
If the Contractor participl
addition, the Contractor m
request from the County.
Labor, as an authorized self -
he Contractor may be required
and a Certificate of Insurance,
a Certificate of Insurance will be required. In
lated financial statements from the fund upon
22 of 27
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 Dam
The minimum limits acceptable shall be:
$500,000 Combined Single Limit (CS
If split limits are provided, the minimum li
$250,000 per Person
$500,000 per Occurn
$50,000 Property Dal
An Occurrence Form pol
provisions should include
addition, the periadAisawd
months followi
The Monr.jq
policies issue
W is provided on a Claims Made policy, its
iiwn
or after the effective date of this contract. In
may be reported should extend for a minimum of twelve (12)
kLby the County.
inty 073mmissioners shall be named as Additional Insured on all
requirements.
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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 covgWe for:
Owned, Non -Owned, and Hired Vehicles
The minimum limits acceptable shall be:
$300,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable
$100,000 per Person
$300,000 per Occurrence
$50,000 Property Damage
The Monroe County Board of
policies issued to satisfy the i
as Additional Insured on all
24 of 27
PROFESSIONAL LIABILITY
INSURANCE REQUIREMENTS
FOR CONTRACT BETWEEN
MONROE COUNTY, FLORIDA
AND
Recognizing that the work governed by this contract involves the furnishing of advice or services of a
professional nature, the Contractor, shall purchase and maintain, throughout the life of the contract,
Professional Liability Insurance which will respond to damages resulting jAgm any claim arising out of
the performance of professional services or any error or omission of �fr
tractor arising out of work
governed by this contract.
The minim
$250,000 per occurrence/$500,000 agg
25 of 27
MONROE COUNTY, FLORIDA
RISK MANAGEMENT
POLICY AND PROCEDURES
CONTRACT ADMINISTRATION MANUAL
WAIVER OF INSURANCE REQUIREMENTS
There will be times when it will be necessary, or in the best interest of the County, to deviate from the
standard insurance requirements specified within this manual. Recognizing this potential, and acting
on the advice of the County Attorney, the Board of County Commissioners has granted authorization
to Risk Management to waive and modify various insurance provisions.
Specifically excluded from this authorization is the right to waive:
• The County as being named as an Additional Ins
Company (not the Agent) is presented, stating that th
County as an Additional Insured, Risk Management
this provision.
and
• The Indemnification and Hold Harmless provi
attempt should be made to obtain the stand
is desired, a Request for Waiver of Ins
submitted for consideration with the proposal.
After considE
Attorney whc
the Courts.
Should Risk
County Admi
authority.
La letter from the Insurance
or unwilling to name the
gMW the authority to waive
)ss. For this reason, every
If a waiver or a modification
should be completed and
, the form will be returned, to the County
:t documents for execution by the Clerk of
Na_T1111111111est, the other parry may file an appeal with the
County Commissioners, who retains the final decision -making
26 of 27
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:
Con
Add
Phoi
Sco f
Rea;
Polic
will a
Sign,
Risk
Date:
Coun
Date:
Board of County Commissioners appeal:
Approved Not Approved
Meeting Date:
RESPONDENT SIGNATURE
27 of 27