Item C11BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: 8-20-08 Division: Community Services
Bulk Item: Yes X No — Department: Social Services
Staff Contact Person: Sheryl Graham X4592
AGENDA ITEM WORDING: Approval of an Addendum to the Contract between Monroe County
Board of County Commissioners and Hospice of the Florida Keys, Inc. d/b/a Visiting Nurse
Association.
ITEM BACKGROUND: The purpose of this Addendum is to include references to the State of
Florida, Department of Children and Families (DCF), CFOP 140-8, Community Care for Disabled
Adults (CCDA).
PREVIOUS RELEVANT BOCC ACTION: On June 18'h, 2008, the parties entered into a Contract
with the Hospice of the Florida Keys, Inc. for the purposes of providing in -home services countywide.
CONTRACT/AGREEMENT CHANGES: Addendum is to include references to the State of
Florida, Department of Children and Families (DCF), CFOP 140-8, Community Care for Disabled
Adults (CCDA).
STAFF RECOMMENDATIONS: Approval
TOTAL COST_ 1355.000 ApproximatelX Yes X No
COST TO COUNTY: $355,000 Approximated SOURCE OF FUNDS: Grants
REVENUE PRODUCING: Yes N/A No — AMOUNT PER MONTH YEAR
APPROVED BY: County Atty OMB/Purc asing X Risk Management _X
DOCUMENTATION:
DISPOSITION:
Revised 8/06
Included v Not Required To Follow
AGENDA ITEM #
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract with: VNA Contract #
Effective Date: 8-20-08
Expiration Date: 6-30-09
Contrail Purpose/Description:
Approval of an Addendum to the Contract between Monroe County Board of
CQt-M Commissioners and Ho ice of the Florida Ke s Inc. d/b/a Visitin Nurse
Association. Addendum is to include references to the State of Florida, Department of Children
and Families (DCF), CFOP 140-8, Communi Care for Disabled Adults (CCDA).
Contract Manager: Sheryl Graham 4592 Social Services/Stop #1
(Name) (Ext.) (Department/Stop #)
for BOCC me on 8/20/2008 Agenda Deadline: 8/05/2008
CONTRACT COSTS
Total Dollar Value of Contract: $ 355,000 Current Year Portion: $ 88,750
Budgeted? YesM No ❑
Grant: $ 355,000
County Match: $ N/A
Appx
Account Codes: 125-61530-
125-61534-
125-61536-
125-61537-
125-61538
ADDITIONAL COSTS
Estimated Ongoing Costs: $NA/yr For:
(Not included in collar value above) (eQ_ I
Appx
ities, janitorial, salaries, etc.)
CONTRACT REVIEW
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ate Out
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Risk Management
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O_M B./Purch sing
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County Attorney
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ADDENDUM
THIS ADDENDUM is entered into this 20"' day of August, 2008, A.D., between the
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS (hereinafter called the
"County"), and Hospice of the Florida Keys, Inc. d/b/a Visiting Nurse Association, (hereinafter
called the "Contractor").
WHEREAS, on June 18, 2008, the parties entered into a Contract for the purposes of
providing in -home services countywide; and
WHEREAS, the County and Contractor have requested a change to include references to
the State of Florida, Department of Children and Families (DCF), CFOP 140-8, Community Care
for Disabled Adults (CODA) as follows:
1. Section 5 (Contractor's Responsibilities) of the Contract dated June 18, 2008, shall
be amended to read:
A. The Contractor will perforin only authorized in -home services in the homes of elderly and/or
disabled residents in the Areas 1, 2, 3, and 4 for the unit rate(s) specified herein. Only those in -
home services that are specifically authorized by the County as documented by the Social
Services Department, a department within the Community Services Division, will be
reimbursable. In -home services will be provided by the Contractor in accordance with DOEA
definitions/specification, by agencies that hold necessary licenses, and by individual workers
qualified to perform such services as detailed in Florida Department of Elder Affairs (DOEA)
1998 Client Services Manual (12/21/98) and the Home and Community Based Services, Draft
Handbook, January 2003, the State of FL Department of Children and Families (DCF) CFOP
140-8, Community Care for Disabled Adults (CCDA), and in accordance with the Agency for
Health Care Administration (AHCA) guidelines as required and any subsequent modifications
thereto.
B. The in -home services Contractor will provide under these terms and conditions are
_X respite care, Xhomemaker, X personal care, X_chore, emergency home
repair/housing improvement, and _ material aid as defined by DOEA in the 1998 and 2003
draft handbooks, DCF CFOP 140-8 for CCDA, and AHCA guidelines as noted above and any
subsequent revisions thereto.
C. The Contractor will provide in -home services during the term of this contract for the unit
rates as agreed upon and that follow: $ 19.00_/unit for respite care, $ 19.00_ /unit for
homemaker, $ 25.00 /unit for personal care, $_25.60 /unit for chore, $ /unit for emergency
home repair/housing improvement, and $ /unit for material aid. A unit of each service in
defined by DOEA in the 1998 and 2003 draft handbooks, DCF CFOP 140-8 for CCDA, and
AHCA guidelines as noted above and any subsequent revisions thereto. The number of units of
services performed for each client must be preauthorized by the County.
E. The Contractor will in all cases provide in -home services within the timeframes required by
DOEA as defined by DOEA in the 1998 and 2003 handbooks, DCF CFOP 140-8 for CCDA, and
AHCA guidelines as noted above and any subsequent revisions thereto.
H. The Contractor must maintain approval status from the Alliance for Aging, Inc., as a
Medicaid Waiver Provider of Choice.
2. Section 6 (Contractor's Financial Records) of the Contract dated June 18, 2008,
shall be anrended to read:
Contractor shall maintain all books, records, and documents directly pertinent to performance
under this Agreement in accordance with generally accepted accounting principles consistently
applied. Each party to this Agreement or their authorized representatives shall have reasonable
and timely access to such records of each other party to this Agreement for public records
purposes during the teen of the Agreement and for six years following the termination of this
Agreement. If an auditor employed by the County or Clerk determines that monies paid to
Contractor pursuant to this Agreement were spent for purposes not authorized by this
Agreement, the Contractor shall repay the monies together with interest calculated pursuant to
Sec. 55.03, FS, running from the date the monies were paid to Contractor.
3. The remaining terms of the Contract entered into June 18, 2008, not inconsistent
herewith, shall remain in full force and effect.
IN WITNESS WHEREOF, the parties have caused these presents to be executed in their
respective names.
Attest:
DANNY L. KOLHAGE, CLERK
in
Deputy Clerk
Attest:
By:
OR WITNESSES:
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
Mayor Mario DiGennaro
HOSPICE OF THE FLORIDA KEYS
d/b/a VISITING NURSE ASSOCIATION
in
Liz Kern
)LINTY ATTOR EY
Di��C3
r -tart
ASSISTANT OUNTY ATTORNEY
Date
2
ADDENDUM
THIS ADDENDUM is entered into this 20"' day of August, 2008, A.D., between the
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS (hereinafter called the
"County"), and Hospice of the Florida Keys, Inc. d/b/a Visiting Nurse Association, (hereinafter
called the "Contractor").
WHEREAS, on June 18, 2008, the parties entered into a Contract for the purposes of
providing in -home services countywide; and
WHEREAS, the County and Contractor have requested a change to include references to
the State of Florida, Department of Children and Families (DCF), CFOP 140-8, Community Care
for Disabled Adults (CCDA) as follows:
1. Section 5 (Contractor's Responsibilities) of the Contract dated June 18, 2008, shall
be amended to read:
A. The Contractor will perform only authorized in -home services in the homes of elderly and/or
disabled residents in the Areas 1, 2, 3, and 4 for the unit rate(s) specified herein. Only those in -
home services that are specifically authorized by the County as documented by the Social
Services Department, a department within the Community Services Division, will be
reimbursable. In -home services will be provided by the Contractor in accordance with DOEA
definitions/specification, by agencies that hold necessary licenses, and by individual workers
qualified to perform such services as detailed in Florida Department of Elder Affairs (DOER)
1998 Client Services Manual (12/21/98) and the Home and Community Based Services, Draft
Handbook, January 2003, the State of FL Department of Children and Families (DCF) CFOP
140-8, Community Care for Disabled Adults (CCDA), and in accordance with the Agency for
Health Care Administration (AHCA) guidelines as required and any subsequent modifications
thereto.
B. The in -home services Contractor will provide under these terms and conditions are
X respite care, Xhomemaker, X_ personal care, X chore, emergency home
repair/housing improvement, and material aid as defined by DOEA in the 1998 and 2003
draft handbooks, DCF CFOP 140-8 for CCDA, and AHCA guidelines as noted above and any
subsequent revisions thereto.
C. The Contractor will provide in -home services during the term of this contract for the unit
rates as agreed upon and that follow: $ _ 19.00_/unit for respite care, $_19.00_ /unit for
homemaker, $ 25.00 /unit for personal care, $_25.00_/unit for chore, $ /unit for emergency
home repair/housing improvement, and $ /unit for material aid. A unit of each service in
defined by DOEA in the 1998 and 2003 draft handbooks, DCF CFOP 140-8 for CCDA, and
AHCA guidelines as noted above and any subsequent revisions thereto. The number of units of
services performed for each client must be preauthorized by the County.
E. The Contractor will in all cases provide in -home services within the timeframes required by
DOEA as defined by DOEA in the 1998 and 2003 handbooks, DCF CFOP 140-8 for CCDA, and
AHCA guidelines as noted above and any subsequent revisions thereto.
t
` A a.
H. The Contractor must maintain approval status from the Alliance for Aging, Inc., as a
Medicaid Waiver Provider of Choice.
2. Section 6 (Contractor's Financial Records) of the Contract dated June 18, 2008,
shall be amended to read:
Contractor shall maintain all books, records, and documents directly pertinent to performance
under this Agreement in accordance with generally accepted accounting principles consistently
applied. Each party to this Agreement or their authorized representatives shall have reasonable
and timely access to such records of each other party to this Agreement for public records
purposes during the term of the Agreement and for six years following the termination of this
Agreement. If an auditor employed by the County or Clerk determines that monies paid to
Contractor pursuant to this Agreement were spent for purposes not authorized by this
Agreement, the Contractor shall repay the monies together with interest calculated pursuant to
Sec. 55.03, FS, running from the date the monies were paid to Contractor.
3. The remaining terms of the Contract entered into June 18, 2008, not inconsistent
herewith, shall remain in full force and effect.
IN WITNESS WHEREOF, the parties have caused these presents to be executed in their
respective names.
Attest:
DANNY L. KOLHAGE, CLERK
Deputy Clerk
Attest:
By:
OR WITNESSES:
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
Mayor Mario DiGennaro
HOSPICE OF THE FLORIDA KEYS
d/b/a VISITING NURSE ASSOCIATION
Liz Kern
MODE COON ti- A" CRN Y
o DA, T
AD
ASSISTANT
Date CO TYATTORNEY
2
ADDENDUM
THIS ADDENDUM is entered into this 20"' day of August, 2008, A.D., between the
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS (hereinafter called the
"County"), and Hospice of the Florida Keys, Inc. d/b/a Visiting Nurse Association, (hereinafter
called the "Contractor").
WHEREAS, on June 18, 2008, the parties entered into a Contract for the purposes of
providing in -home services countywide; and
WHEREAS, the County and Contractor have requested a change to include references to
the State of Florida, Department of Children and Families (DCF), CFOP 140-8, Community Care
for Disabled Adults (CCDA) as follows:
1. Section 5 (Contractor's Responsibilities) of the Contract dated June 18, 2008, shall
be amended to read:
A. The Contractor will perform only authorized in -home services in the homes of elderly and/or
disabled residents in the Areas 1, 2, 3, and 4 for the unit rate(s) specified herein. Only those in -
home services that are specifically authorized by the County as documented by the Social
Services Department, a department within the Community Services Division, will be
reimbursable. In -home services will be provided by the Contractor in accordance with DOEA
definitions/specification, by agencies that hold necessary licenses, and by individual workers
qualified to perform such services as detailed in Florida Department of Elder Affairs (DOEA)
1998 Client Services Manual (12/21/98) and the Home and Community Based Services, Draft
Handbook, January 2003, the State of FL Department of Children and Families (DCF) CFOP
140-8, Community Care for Disabled Adults (CCDA), and in accordance with the Agency for
Health Care Administration (AHCA) guidelines as required and any subsequent modifications
thereto.
B. The in -home services Contractor will provide under these terms and conditions are
Xrespite care, Xhomemaker, _X_ personal care, X chore, emergency home
repair/housing improvement, and _ material aid as defined by DOEA in the 1998 and 2003
draft handbooks, DCF CFOP 140-8 for CCDA, and AHCA guidelines as noted above and any
subsequent revisions thereto.
C. The Contractor will provide in -home services during the term of this contract for the unit
rates as agreed upon and that follow: $ 19.00 /unit for respite care, $ 19.00 /unit for
homemaker, $ 25.00 /unit for personal care, $_25.00 /unit for chore, $ /unit for emergency
home repair/housing improvement, and $ /unit for material aid. A unit of each service in
defined by DOEA in the 1998 and 2003 draft handbooks, DCF CFOP 140-8 for CCDA, and
AHCA guidelines as noted above and any subsequent revisions thereto. The number of units of
services performed for each client must be preauthorized by the County.
E. The Contractor will in all cases provide in -home services within the timeframes required by
DOEA as defined by DOEA in the 1998 and 2003 handbooks, DCF CFOP 140-8 for CCDA, and
AHCA guidelines as noted above and any subsequent revisions thereto.
H. The Contractor must maintain approval status from the Alliance for Aging, Inc., as a
Medicaid Waiver Provider of Choice.
2. Section 6 (Contractor's Financial Records) of the Contract dated June 18, 2008,
shall be amended to read:
Contractor shall maintain all books, records, and documents directly pertinent to performance
under this Agreement in accordance with generally accepted accounting principles consistently
applied. Each party to this Agreement or their authorized representatives shall have reasonable
and timely access to such records of each other party to this Agreement for public records
purposes during the term of the Agreement and for six years following the termination of this
Agreement. If an auditor employed by the County or Clerk determines that monies paid to
Contractor pursuant to this Agreement were spent for purposes not authorized by this
Agreement, the Contractor shall repay the monies together with interest calculated pursuant to
Sec. 55.03, FS, running from the date the monies were paid to Contractor.
3. The remaining terms of the Contract entered into June 18, 2008, not inconsistent
herewith, shall remain in full force and effect.
IN WITNESS WHEREOF, the parties have caused these presents to be executed in their
respective names.
Attest:
DANNY L. KOLHAGE, CLERK
Deputy Clerk
Attest:
By:
OR WITNESSES:
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
IM
Mayor Mario DiGennaro
HOSPICE OF THE FLORIDA KEYS
d/b/a VISITING NURSE ASSOCIATION
LIZA
Liz Kern
MOO COUNTY aT
' P VEDAS
;. :..:.. �IERCADO .._.
,v'TyATTORNEY �%1Y
Date
2
CONTRACT
THIS AGREEMENT, made and entered into this 10 day of June , 2008, A.D., by
and between MONROE COUNTY, FLORIDA, a political subdivision of the State of Florida
(hereinafter called the "Owner" or "County"), and Hospice of the Florida Keys, Inc. d/b/a
Visiting Nurse Association , (hereinafter called the "Contractor").
WHEREAS, the County provides In -Home services to the elderly and disabled residing
throughout Monroe County; and
WHEREAS, the County receives funding from the Alliance for Aging, Inc., the Florida
Department of Children and Families, and the Florida Agency for Health Care Administration
for the purposes of providing in -home services countywide; and
WHEREAS, the County has provided in -home services to assist the vulnerable elderly
and/or disabled residents to remain in theirhomes and maintain independence for over 25 years;
and
WHEREAS, the County desires to contract for in -home services to ensure that such
services are available throughout the County; and
WHEREAS, Contractor is qualified and desires to provide in -home services;
NOW THEREFORE, in consideration of the mutual covenants and provisions contained
herein, the parties agree as follows: That the parties hereto, for the consideration hereinafter set
forth, mutually agree as follow:
1. THE CONTRACT
The contract between the Owner and the Contractor, of which this agreement is a part, consists
of the contract documents, which are as follows: This agreement and any amendments executed
by the parties hereafter, together with the response to RFP and all required insurance
documentation. In the event of a discrepancy between the documents, precedence shall be
determined by the order of the documents as just listed.
2. SCOPE OF THE WORK
The Contractor shall provide In -Home Services for the County. The Contractor warrants that it
is authorized by law to engage in the performance of the activities herein described, subject to
the terms and conditions set forth in these contract documents. The provider shall at all times
exercise independent, professional judgment and shall assume professional responsibility for the
services to be provided. Contractor shall provide services using the following standards, as a
minimum requirement:
A. The Contractor shall maintain adequate staffing levels to provide the services
required under this contract.
B. The personnel shall not be employees of or have any contractual relationship with
the County. [IF APPROPRI.ITE: To the extent that Contractor uses
subcontractors or independent contractors, this contract specifically requires that
the level of independence normally exercised by such subcontractors and
independent contractors be curtailed and that they be supervised by the
Contractor.]
C. All personnel engaged in performing services under this contract shall be fully
qualified, and, if required, to be authorized or permitted under State and local law
to perform such services.
3. PAYMENTS TO THE CONTRACTOR
The contractor shall submit to the County an invoice with supporting documentation acceptable
to the Clerk on a schedule as set forth in the contract. 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.
4. TERM OF CONTRACT
The term of this contract is for one year, commencing on the I st_ day of July_, 2008, and
ending on the 30th day of June_, 2009. The County shall have the option to renew this
agreement for two (2) additional one-year periods. The contract amount agreed to herein may be
adjusted annually in accordance with the percentage change in the Consumer Price Index (CPI)
for all urban consumers (CPI-U) for the most recent 12 months available.
5. CONTRACTOR'S RESPONSIBILITIES
A. The Contractor will perform only authorized in -home services in the homes of elderly and/or
disabled residents in the Areas 1,23, and/or 4 for the unit rate(s) specified herein. Only those in -
home services that are specifically authorized by the County as documented by the Social
Services Department, a department within the Community Services Division, will be
reimbursable. In -home services will be provided by the Contractor in accordance with DOEA
definitions/specification, by agencies that hold necessary licenses, and by individual workers
qualified to perform such services as detailed in Florida Department of Elder Affairs (DOEA)
1998 Client Services Manual (12/21/98), and the Home and Community Based Services, Draft
Handbook, January 2003 and in accordance with AHCA guidelines as required and any
subsequent modifications thereto.
B. The in -home services Contractor will provide under these terms and conditions is(are)
X respite care, X homemaker, X_ personal care, X chore, emergency home
repair/housing improvement, and material aid as defined by DOEA in the 1998 and 2003
draft handbooks and AHCA guidelines as noted above and any subsequent revisions thereto.
C. The Contractor will provide in -home services during the term of this contract for the unit
rates as agreed upon and that follow: S 19.00_/unit for respite care, $ 19.00 /unit for
homemaker, $ 25.00_/unit for personal care, S_25.00_/unit for chore, S !unit for
emergency home repair/housing improvement, and $ 'unit for material aid. A unit of each
4
service in defined by DOEA in the 1998 and 2003 draft handbooks and AHCA guidelines as
noted above and any subsequent revisions thereto. The number of units of services performed for
each client must be preauthorized by the County.
The Contractor can be reimbursed for authorized travel between client homes. Worker travel to
the home of the first client and worker travel from the home of the last client is not reimbursable.
Only eligible travel will be reimbursed that is properly documented on the State of Florida
Voucher for Reimbursement of Travel Expenses in accordance with FS 112.061 and Monroe
County approved reimbursement rate per mile.
D. The Contractor will provide the in-service(s) detailed in "B" above for the unit rate agreed
upon in "C" above in geographic Areas X 1, X 2, X_3, and X 4 in order to ensure
that in -home services are available in countywide.
E. The Contractor will in all cases provide in -home services within the time frames required by
DOEA as defined by DOEA in the 1998 and 20003 handbooks and AHCA guidelines as noted
above and any subsequent revisions thereto.
F. The Contractor agrees that the County Administrator will designate representatives to visit
the Contractor's facility(ies) periodically to conduct random open file evaluations and other
contract monitoring activities during the Contractor's normal business hours.
G. The Contractor has, and shall maintain throughout the term of- this contract, appropriate
licenses and approvals required to conduct it's business, and that it will at all times conduct its
business activities in a reputable manner. Proof of such licenses and approvals shall be
submitted to the County upon request.
6. CONTRACTOR'S FINANCIAL RECORDS
Contractor shall maintain all books, records, and documents directly pertinent to performance
under this Agreement in accordance with generally accepted accounting principles consistently
applied. Each party to this Agreement or their authorized representatives shall have reasonable
and timely access to such records of each other party to this Agreement for public records
purposes during the term of the Agreement and for four years following the termination of this
Agreement. If an auditor employed by the County or Clerk determines that monies paid to
Contractor pursuant to this Agreement were spent for purposes not authorized by this
Agreement, the Contractor shall repay the monies together with interest calculated pursuant to
Sec. 55.03, FS, running from the date the monies were paid to Contractor.
7. PUBLIC ACCESS
The County and Contractor shall allow and permit reasonable access to, and inspection of, all
documents, papers, letters or other materials in its possession or under its control subject to the
provisions of Chapter 119, Florida Statutes, and made or received by the County and Contractor
in conjunction with this Agreement: and the County shall have the right to unilaterally cancel
this Agreement upon violation of this provision by Contractor.
8. HOLD HARMLESS AND INSURANCE
The Contractor covenants and agrees to indemnify and hold harmless Monroe County Board of
County Commissioners of Monroe County from any and all claims for bodily injury (including
death), personal injury, and property damage (including property owned by 'Monroe County) and
any other losses, damages, and expenses (including attorney's fees) which arise out of,_ in
connection with, or by reason of services provided by the Contractor or any of its
Subcontractor(s) in any tier, occasioned by the negligence, errors, or other wrongful act of
omission of the Contractor or its Subcontractors in any tier, their employees, or agents.
The extent of liability is in no way limited to, reduced, or lessened by the insurance requirements
contained elsewhere within this agreement.
Prior to execution of this agreement, the contractor shall furnish the Owner Certificates of
Insurance indicating the minimum coverage limitations as indicated by an "X" on the attached
forms identified as INSCKLST 1-5, as further detailed on forms WCI, GLl, GIR 1, and VL1,
each attached hereto and incorporated as part of this contract document_, and all other
requirements found to be in the best interest of Monroe County as may be imposed by the
Monroe County Risk Management Department.
Non -Waiver of Immunity. Notwithstanding he provisions of Sec. 28628, Florida Statutes, the
participation of the County and the Contractor in this Agreement and the acquisition of any
commercial liability insurance coverage, self-insurance coverage, or local government liability
insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability
coverage, nor shall any contract entered into by the County be required to contain any provision
for waiver.
9. INDEPENDENT CONTRACTOR
At all times and for all purposes under this agreement the Contractor is an independent
contractor and not an employee of the Board of County Commissioners of Monroe County. No
statement contained in this agreement shall be construed so as to find the Contractor or any of his
employees, contractors, servants, or agents to be employees of the Board of County
Commissioners of Monroe County.
10. NONDISCRIMINATION
County and Contractor agree 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
nond1scriin1nation. These include but are not limited to: 1) Title VI 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 USC s. 794). which prohibits discrimination on the basis of
handicaps; 4) The Age Discrimination Act of 1975. as amended (42 USC ss. 6101- 6107) which
6
prohibits discrimination on the basis of age; 5) The Drug Abuse Office and Treatment Act of
1972 (PL 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 patent records; 8)
Title VIII of the Civil Rights Act of 1968 (42 USC 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 Ch. 13, Art. VI,
prohibiting discrimination on the bases of race, color, sex, religion, disability, 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.
11. ASSIGNMENT/SUBCONTRACT
The Contractor shall not assign or subcontract its obligations under this agreement, except in
writing and with the prior written approval of the Board of County Commissioners of Monroe
County and Contractor, which approval shall be subject to such conditions and provisions as the
Board may deem necessary. This paragraph shall be incorporated by reference into any
assignment or subcontract and any assignee or subcontractor shall comply with all of the
provisions of this agreement. Unless expressly provided for therein, such approval shall in no
manner or event be deemed to impose any additional obligation upon the board.
12. COMPLIANCE WITH LAW
In providing all services/goods pursuant to this agreement, the Contractor shall abide by all
statutes, ordinances, rules and regulations pertaining to, or regulating the provisions of, such
services, including those now in effect and hereinafter adopted. Any violation of said statutes,
ordinances, rules and regulations shall constitute a material breach of this agreement and shall
entitle the Board to terminate this contract immediately upon delivery of written notice of
termination to the contractor. The contractor shall possess proper licenses to perform work in
accordance with these specifications throughout the term of this contract.
13. DISCLOSURE AND CONFLICT OF INTEREST
The Contractor represents that it, its directors, principles and employees, presently have no
interest and shall acquire no interest, either direct or indirect, which would conflict in any
manner with the performance of services required by this contract, as provided in Sect. 112.311,
et. seq., Florida Statutes. County agrees that officers and employees of the County recognize and
will be required to comply with the standards of conduct for public officers and employees as
delineated in Section 112.313, Florida Statutes, regarding, but not limited to, solicitation or
acceptance of gifts; doing business with one's agency, unauthorized compensation: misuse of
public position, conflicting employment or contractual relationship; and disclosure or use of
certain information.
Upon execution of this contract, and thereafter as changes may require, the Contractor shall
notify the County of any financial interest it may have in any and all programs in Monroe
County which the Contractor sponsors, endorses. recornmends, supervises, or requires for
7
counseling, assistance, evaluation, or treatment. This provision shall apply whether or not such
program is required by statute, as a condition of probation, or is provided on a voluntary basis.
The County and Contractor warrant that, in respect to itself, it has neither employed nor retained
any company or person, other than a bona fide employee working solely for it, to solicit or
secure this Agreement and that it has not paid or agreed to pay any person, company,
corporation, individual, or firm, other than a bona tide employee working solely for it, any fee,
commission, percentage, gift, or other consideration contingent upon or resulting from the award
or making of this Agreement. For the breach or violation of the provision, the Contractor agrees
that the County shall have the right to terminate this Agreement without liability and, at its
discretion, to offset from monies owed, or otherwise recover, the full amount of such fee,
commission, percentage, gift, or consideration.
14. ARREARS
The 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 form of indebtedness. The Contractor
further warrants and represents that it has no obligation or indebtedness that would impair its
ability to fulfill the terms of this contract.
15. 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:
FOR COUNTY:
Monroe County Administrator
1100 Simonton Street
Key West, FL 33040
FOR CONTRACTOR:
Hospice of the Florida Keys, Inc
1319 William Street
Key West, FL 33040
16. TAXES
and County Attorney
PO Box 1026
Key West, Fl. 33041-1026
d/b/a Visiting Nurse Association
The County is exempt from payment of Florida State Sales and Use taxes. The Contractor shall
not be exempted by virtue of the County's exemption from paying sales tax to its suppliers for
materials used to fulfill its obligations under this contract, nor is the Contractor authorized to use
the County's Tax Exemption Number in securing such materials. The Contractor shall be
responsible for any and all taxes, or payments of withholding, related to services rendered under
this agreement.
I T TERMINATION
The County may terminate this contract for cause with seven (7) days notice to the
contractor. Cause shall constitute a breach of the obligations of the Contractor to perform the
services enumerated as the Contractor's obligations under this contract.
A. Either of the parties hereto may terminate this contract without cause by giving the other
party sixty (60) days written notice of its intention to do so.
18. GOVERNING LAW. VENUE INTERPRETATION COSTS AND FEES
A. This Agreement shall be governed by and construed in accordance with the laws of the
State of Florida applicable to contracts made and to be performed entirely in the State.
B. 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.
C. 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 them the issue shall be submitted to mediation
prior to the institution of any other administrative or legal proceeding.
D. 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.
E. Attorneys Fees and Costs. The County and Contractor agree that in the event any cause of
action or administrative proceeding is initiated or defended by any party relative to the
enforcement or interpretation of this Agreement, the prevailing party shall be entitled to
reasonable attorney's fees, court costs, investigative, and out-of-pocket expenses, as an award
against the non -prevailing party, and shall include attorney's fees, courts costs, investigative, and
out-of-pocket expenses in appellate proceedings. 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.
F. Adjudication of Disputes or Disagreements. County and Contractor agree that all disputes
and disagreements shall be attempted to be resolved by meet and confer sessions between
representatives of each of the parties. If no resolution can be agreed upon within 30 days after
the first meet and confer session, 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
the parties, then any party shall have the right to seek such relief or remedy as may be provided
by this Agreement or by Florida law.
9
.G. 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.
19. BINDING EFFECT
The terms, covenants, conditions, and provisions of this Agreement shall bind and inure to the
benefit of the County and Contractor and their respective legal representatives, successors, and
assigns.
20. 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.
21. CLAIMS FOR FEDERAL OR STATE AID
Contractor and County agree that each shall be, and is, empowered to apply for, seek, and obtain
federal and state funds to further the purpose of this Agreement; provided that all applications,
requests, grant proposals, and funding solicitations shall be approved by each party prior to
submission.
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 under this Agreement within the territorial limits of the
County shall apply to the same degree and extent to the performance of such functions and duties
of such officers, agents, volunteers, or employees outside the territorial limits of the County.
23. LEGAL OBLIGATIONS AND RESPONSIBILITIES
Non -Delegation of Constitutional or Statutory Duties. This Agreement is not intended to, nor
shall it be construed as, relieving any participating entity from any obligation or responsibility
imposed upon the entity by law except to the extent of actual and timely performance thereof by
any participating entity, in which case the performance may be offered in satisfaction of the
obligation or responsibility. Further, this Agreement is not intended to, nor shall it be construed
as, authorizing the delegation of the constitutional or statutory duties of the County, except to the
extent permitted by the Florida constitution, state statute, and case law.
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
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. ATTESTATIONS
10
Contractor agrees to execute such documents as the County may reasonably require, to include a Public
Entity Crime Statement, an Ethics Statement, and a Drug -Free Workplace Statement.
26. NO PERSONAL LIABILITY
No covenant or agreement contained herein shall be deemed to be a covenant or agreement of any
member, officer, agent or employee of Monroe County in his or her individual capacity, and no member,
officer, agent or employee of Monroe County shall be liable personally on this Agreement or be subject to
any personal liability or accountability by reason of the execution of this Agreement.
27. EXECUTION IN COUNTERPARTS
This Agreement may be executed in any number of counterparts, each of which shall be regarded
as an original, all of which taken together shall constitute one and the same instrument and any
of the parties hereto may execute this Agreement by singing any such counterpart.
28. SECTION HEADINGS
Section headings have been inserted in this Agreement as a matter of convenience of reference
only, and it is agreed that such section headings are not a part of this Agreement and will not be
used in the interpretation of any provision of this Agreement.
29. MUTUAL REVIEW
This agreement has been carefully reviewed by the Contractor and the County. Therefore, this
agreement is not to be construed against any party on the basis of authorship.
IN WITNESS WHEREOF the parties hereto have executed this Agreement on the day and
date first written above in four (4) counterparts, each of which shall, without proof or accounting
for the other counterparts, be deemed an original contract.
(SEAL)
Attest: DANNY L. KOLHAGE, CLERK
(SEAL)
Attest:
By: _
Title:
By: _
Title:
Deputy Clerk
WITNESS
WITNESS
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLOIDA
By:
Mayor/Chairman
HOSPICE OF THE FLORIDA KEYS, INC.
d/b/a VISITING NURSE ASSOCIATION
By:
Title:
}p E OUNTY ATJOR Y C
P RO ED AS yC7
_P
11 TY ATTORNEY
KS�ISTANT COU
Date
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 (including death), personal
injury, and property damage (including property owned by Monroe County) and any other
losses, damages, and expenses (including attorney's fees) which arise out of, in connection with,
or by reason of services provided by the Contractor or any of its Subcontractor(s) in any tier,
occasioned by the negligence, errors, or other wrongful act of omission of the Contractor or its
Subcontractors in any tier, their employees, or agents.
In the event the completion of the project (to include the work of others) is delayed or suspended
as a result of the Contractor's failure to purchase or maintain the required insurance, the
Contractor shall indemnify the County from any and all increased expenses resulting from such
delay.
The first ten dollars ($10.00) of remuneration paid to the Contractor is for the indemnification
provided for above.
The extent of liability is in no way limited to, reduced, or lessened by the insurance requirements
contained elsewhere within this agreement.
TCS
12
RISK MANAGEMENT
POLICY AND PROCEDURES
CONTRACT ADMINISTRATION
MANUAL
General Insurance Requirements
For Other Contractors and Subcontractors
As a pre -requisite of the work governed, or the goods supplied under this contract (including the
pre -staging of personnel and material), the Contractor shall obtain, at his own expense, insurance
as specified in any attached schedules, which are made part of this contract. The Contractor will
ensure that the insurance obtained will extend protection to all Subcontractors engaged by the
Contractor. As an alternative, the Contractor may require all Subcontractors to obtain insurance
consistent with the attached schedules.
The Contractor will not be permitted to commence work governed by this contract (including
pre -staging of personnel and material) until satisfactory evidence of the required insurance has
been furnished to the County as specified below. Delays in the commencement of work,
resulting from the failure of the Contractor to provide satisfactory evidence of the required
insurance, shall not extend deadlines specified in the contract and any penalties and failure to
perform assessments shall be imposed as if the work commenced on the specified date and time,
except for the Contractor's failure to provide satisfactory evidence.
The Contractor shall maintain the required insurance throughout the entire term of this contract
and any extensions specified in the attached schedules. Failure to comply with this provision
may result in the immediate suspension of all work until the required insurance has been
reinstated or replaced. Delays in the completion of work resulting from the failure of the
Contractor to maintain the required insurance shall not extend deadlines specified in this contract
and any penalties and failure to perform assessments shall be imposed as if the work had not
been suspended, except for the Contractor's failure to maintain the required insurance.
The Contractor shall provide, to the County, as satisfactory evidence of the required insurance,
either:
• Certificate of Insurance
or
• A Certified copy of the actual insurance policy
The County, at its sole option, has the right to request a certified copy of any or all insurance
policies required by this contract.
All insurance policies must specify that they are not subject to cancellation, non -renewal,
material change, or reduction in coverage unless a minimum of thirty (30) days prior notification
is given to the County by the insurer.
The acceptance and/or approval of the Contractor's insurance shall not be construed as relieving
the Contractor from any liability or obligation assumed under this contract or imposed by law.
(CiRI)
13
The Monroe County Board of County Commissioners, its employees and officials will be
included as "Additional Insured" on all policies, except for Workers' Compensation.
Any deviations from these General Insurance Requirements must be requested in writing on the
County -prepared form entitled, "Request for Waiver of Insurance Requirements" and
approved by Monroe County Risk Management.
(GIRL)
14
WORKERS' COMPENSATION
INSURANCE REQUIREMENTS
FOR
CONTRACT: In -Home Services
BETWEEN
MONROE COUNTY, FLORIDA
AND
Prior to the commencement of work governed by this contract, the Contractor shall obtain Workers'
Compensation Insurance with limits sufficient to respond to Florida Statute 440.
In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not less than:
$100,c00 Bodily Injury by Accident
$500,000 Bodily Injury by Disease, policy limits
$100,000 Bodily Injury by Disease, each employee
Coverage shall be maintained throughout the entire term of the contract.
Coverage shall be provided by a company or companies authorized to transact business in the State of
Florida and the company or companies must maintain a minimum rating of A -VI, as assigned by the A.M.
Best Company.
If the Contractor has been approved by Florida's Department of Labor, as an authorized self -insurer, the
County shall recognize and honor the Contractor's status. The Contractor may be required to submit a
Letter of Authorization issued by the Department of Labor and a Certificate of Insurance, providing details
on the Contractor's Excess Insurance Program.
If the Contractor participates in a self-insurance fund, a Certificate of Insurance will be required. In
addition, the contractor may be required to submit updated financial statements from the fund upon
request from the County.
(WCi)
15
GENERAL LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT: In -Home Services
BETWEEN
MONROE COUNTY, FLORIDA
AND
Prior to the commencement of work governed by this contract, the Contractor shall
obtain General Liability Insurance. Coverage shall be maintained throughout the life of
the contract and include, as a minimum:
• Premises Operations
• Products and Completed Operations
• Blanket Contractual Liability
• Personal Injury Liability
• Expanded Definition of Property Damage
The minimum limits acceptable shall be:
$500,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$250,000 per Person
$500,000 per Occurrence
$ 50,000 Property Damage
An Occurrence Form policy is preferred. If coverage is provided on a Claims Made
policy, its provisions should include coverage for claims filed on or after the effective
date of this contract. In addition, the period for which claims may be reported should
extend for a minimum of twelve (12) months following the acceptance of work by the
County.
The Monroe County Board of County Commissioners shall be named as Additional
Insured on all policies issued to satisfy the above requirements.
(GL1)
16
VEHICLE LIABILITY
INSURANCE REQUIREMENTS
FOR
CONTRACT: In -Home Services
BETWEEN
MONROE COUNTY, FLORIDA
AND
Recognizing that the work governed by this contract requires the use of vehicles, the Contractor, prior to
the commencement of work, shall obtain Vehicle Liability Insurance. Coverage shall be maintained
throughout the life of the contract and include, as a minimum, liability coverage for:
• Owned, Non -Owned, and Hired Vehicles
The minimum limits acceptable shall be:
$100,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$ 50,000 per Person
$100,000 per Occurrence
$ 25,000 Property Damage
The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies
issued to satisfy the above requirements.
(GL1)
17
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 Insured —If a letter from the Insurance
Company (not the Agent) is presented, stating that they are unable or unwilling to name the
County as an Additional Insured, Risk Management has been granted the authority to waive
this provision.
and
• The Indemnification and Hold Harmless provisions
Waiving of insurance provisions could expose the County to economic loss. For this reason, every
attempt should be made to obtain the standard insurance requirements. If a waiver or a modification is
desired, a Request for Waiver of Insurance Requirements form should be completed and submitted for
consideration with the proposal.
After consideration by Risk Management and if approved, the form will be returned, to the County
Attorney who will submit the Waiver with the other contract documents for execution by the Clerk of the
Courts.
Should Risk Management deny the Waiver Request, the other party may file an appeal with the County
Administrator or the Board of County Commissioners, who retains the final decision -making authority.
18
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:
Contract for:
Address of Contractor:
Phone:
Scope of Work:
Reason for Waiver:
Policies Waiver
will apply to:
Signature of Contractor:
Approved Not Approved
Risk Management, -
Date:
County Administrator appeal:
Approved Not Approved
Date:
Board of County Commissioners appeal:
Approved Not Approved
Meeting Date:
MONROE COUNTY, FLORIDA
19
INSURANCE CHECKLIST
FOR
VENDORS SUBMITTING PROPOSALS
FOR WORK
To assist in the development of your proposal, the insurance coverages marked with an "X" will
be required in the event an award is made to your firm. Please review this form with your
insurance agent and have him/her sign it in the place provided. It is also required that the
respondent sign the form and submit it with each proposal.
WORKERS' COMPENSATION
AND
EMPLOYERS' LIABILITY
X Workers' Compensation Statutory Limits
WC1 X Employers Liability $100,0001$500,0001$100,000
WC2 Employers Liability $500,000/$500,000/$500,000
WC3 Employers Liability$1,000,000/$1,000,000/$1,000,000
WCUSLH US Longshoremen & Same as Employers'
Harbor Workers Act Liability
WCJA Federal Jones Act Same As Employers'
Liability
(INSCKLST)
20
GENERAL LIABILITY
As a minimum, the required general liability coverage will include:
• Premises Operations • Products and Completed Operations
• Blanket Contractual • Personal Injury
• Expanded Definition
Of Property Damage
Required Limits:
GL 1 X $100,000 per Person; $300,000 per Occurrence
$50,000 Property Damage
or
$300,000 Combined Single Limit
GL2 $250,000 per Person; $500,000 per Occurrence
$50,000 Property Damage
or
$500,000 Combined Single Limit
GL3 $500,000 per Person; $ 1,000,000 per Occurrence
$100,000 Property Damage
or
$1,000,000 Combined Single Limit
GL4 $5,000,000 Combined Single Limit
Required Endorsement:
GLXCU Underground, Explosion and collapse (XCU)
GLLIQ Liquor Liability
GLS Security Services
All endorsements are required to have the same limits as the basic policy
(INSCKLST)
21
VEHICLE LIABILITY
As a minimum, coverage should extend to liability for:
• Owned; Non -owned; and hired Vehicles
Required Limits:
VLl X $50,000 per Person; $100.000 per Occurrence
$25,000 Property Damage
or
$100,000 Combined Single Limit
VL2 $100,000 per Person; $300,000 per Occurrence
$ 50,000 Property Damage
or
$300,000 Combined Single Limit
VL3 $500,000 per Person; $1,000,000 per Occurrence
$100,000 Property Damage
or
$1,000,000 Combined Single Limit
VL4 $5,000,000 Combined Single Limit
MISCELLANEOUS COVERAGES
BRl
Builders'
Limits equal to the
Risk
completed project
MVC
Motor Truck
Limits equal to the maximum
Cargo
value of any one shipment
PRO 1
Professional
$ 250,000 per Occurrence/$ 500,000 Agg.
PR02
Liability
$ 500,000 per Occurrence/$1.000,000 Agg.
PR03
$1.000,000 per Occurrence/$2,000,000 Agg.
POL l
Pollution
$ 500,000 per Occurrence/$ 1,000,000 Agg.
POL2
Liability
$1,000,000 per Occurrence/$ 2.000,000 Agg.
POL3
$5,000,000 per Occurrence/$ I O.000,000 Agg.
ED I
Employee
$ 10.000
ED2
Dishonesty
$100,000
GK l
Garage
$ 300,000 ($ 25,000 per Veh)
GK2 _
Keepers
$ 500,000 ($100,000 per Veh)
GK3
$1,000,000 ($250,000 per Veh)
(INSCKLST)
2-1
.MEDI
Medical
$ 250,000/$ 750.000 Agg.
MED2
Professional
$ 500,000/$ 1,000,000 Agg.
MED3
$1,000,000/$3,000,000 Agg,
MED4
$5,000,000/$10,000,000 Agg.
IF
Installation
Maximum value of Equipment
Floater
Installed
VLPI
Hazardous
$ 300,000 (Requires MCS-90)
VLP2
Cargo
$ 500,000 (Requires MCS-90)
VLP3
Transporter
$1,000,000 (Requires MCS-90)
BLL
Bailee Liability
Maximum Value of Property
HKLI
Hangarkeepers
$ 300,000
HKL2
Liability
$ 500,000
HKL3
$1,000,000
AIR]
Aircraft
$ 1,000,000
AIR2
Liability
$ 5,000.000
AIR3
$50,000,000
AEO I
Architects Errors
$ 250,000 per Occurrence/$ 500,000 Agg.
AEO2
& Omissions
$ 500,000 per Occurrence/$1,000,000 Agg.
AEO3
$1,000,000 per Occurrence/$3,000,000 Aag.
EO1
Engineers Errors
$ 250,000 per Occurrence/$ 500,000 A-g.
EO2
& Omissions
$ 500.000 per Occurrence/$1,000,000 Agg.
EO3
$1,000,000 per Occurrence/$3,000,000 Agg.
(INSCKLST)
23
INSURANCE AGENTS STATEMENT
I have reviewed the above requirements with the bidder named below. The following
deductibles apply to the corresponding policy.
POLICY
DEDUCTIBLES
Liability policies are Occurrence Claims Made
Insurance Agency Signature
BIDDERS STATEMENT
I understand the insurance that will be mandatory if awarded the contract and will comply in full
with all the requirements.
Bidder Signature
(INSCKLST)
24
NON -COLLUSION AFFIDAVIT
1, of the city of
my oath, and under penalty of perjury, depose and say that:
Iam
of the firm of
according to law on
the bidder making the Proposal for the project described in the Notice for Calling for bids for:
and that I executed the said proposal with full authority t do so:
2. the prices in this bid have been arrived at independently without collusion, consultation, communication or
agreement for the purpose of restricting competition, as to any matter relating to such prices with any other bidder
or with any competitor;
3. unless otherwise required by law, the prices which have been quoted in this bid have not been knowingly disclosed
by the bidder and will not knowingly be disclosed by the bidder prior to bid opening, directly or indirectly, to any
other bidder or to any competitor; and
4. no attempt has been made or will be made b the bidder to induce any other person, partnership or corporation to
submit, or not to submit, a bid for the purpose of restricting competition;
5. the statements contained in this affidavit are true and correct, and made with full knowledge that Monroe County
relies upon the truth of the statements contained in this affidavit in awarding contracts for said project.
(Signature of Bidder)
STATE OF:
COUNTY OF:
(Date)
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
first being sworn by me, (name of individual signing) affixed his/her signature in the space provided above on this
20
NOTARY PUBLIC
My Commission Expires:
who, after
day of
25
SWORN STATEMENT UNDER ORDINANCE NO.10-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
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)
STATE OF
COUNTY OF
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
who,
after Furst being sworn by me, affixed his/her signature (name of individual signing) in the space provided above on
this day of , 20
OMB - MCP FORM #4
My commission expires:
NOTARY PUBLIC
26
PUBLIC ENTHY CRIME STATEMENT
"A person or affiliate who has been placed on the convicted vendor list following a
conviction for public entity crime may not submit a bid on a contract to provide any goods
or services to a public entity, may not submit a bid on a contract with a public entity for the
construction or repair of a public building or public work, may not submit bids on leases of
real property to public entity, may not be awarded or perform work as a contractor,
supplier, subcontractor, or consultant under a contract with any public entity, and may not
transact business with any public entity in excess of the threshold amount provided in
Section 287.017, for CATEGORY TWO for a period of 36 months from the date of being
placed on the convicted vendor list."
27
DRUG -FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:
(Name of Business)
1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a
controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations
of such prohibition.
2. Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug -free
workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be
imposed upon employees for drug abuse violations.
3. Give each employee engaged in providing the commodities or contractual services that are
under bid a copy of the statement specified in subsection (1).
4. In the statement specified in subsection (1), notify the employees that, as a condition of
working on the commodities or contractual services that are under bid, the employee will abide by
the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation
of Chapter 893 (Florida Statutes) or of any controlled substance law of the United States or any state, for a violation occurring in
the workplace no later than five (5) days after such conviction.
5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is
available in the employee's community, or any employee who is so convicted.
6. Make a good faith effort to continue to maintain a drug -free workplace through implementation of this section.
As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements.
Bidder's Signature
Date
28