Item C22
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: September 17 , 2008 Division: Emergency Services
Bulk Item: Yes _ No ~ Department: Fire Rescue
Staff Contact Person: Camille Dubroff
AGENDA ITEM WORDING: Approval of the first Renewal Agreement effective from October 1,
2008 through September 30,2009, with Gila Corporation d/b/a Municipal Services Bureau (MSB) for
collections of outstanding account receivables from ground and air ambulance transports.
ITEM BACKGROUND: On October 18, 2007 the Board entered into an Agreement between the
Monroe County Board of County Commissioners and the Board of Governors Fire and Ambulance
District 1 of Monroe County with Gila Corporation d/b/a Municipal Services Bureau (MSB). The
original agreement provides for two additional one (1) year terms, with. approval of the District's
governing Board. We are requesting approval to exercise the first renewal option, commencing on
October 1, 2008 and ending on September 30, 2009.
PREVIOUS RELEVANT BOCC ACTION: On October 17,2007 the Board approved termination of
the service agreement between Palm Beach Credit Adjustors Inc. d/b/a Focus Financial Services and
Monroe County Board of County Commissioners and the Board of Governors for the Lower and Middle
Keys Fire and Ambulance District effective midnight October 17, 2007 and entered into a new service
agreement between Gila Corporation d/b/a Municipal Services Bureau (MSB) and Monroe County
Board of County Commissioners and Monroe County Board of Governors Fire and Ambulance District
1 effective October 18, 2007 for the collection of outstanding ground and air ambulance account
receivable balances.
CONTRACT/AGREEMENT CHANGES: Contract will be extended and the new expiration date
will be September 30,2009.
STAFF RECOMMENDATIONS: All conditions of the contract have been met and services provided
have been satisfactory. Staff recommends renewal of the contract.
TOTAL COST: $3.300.00/year BUDGETED: Yes ~ No_
*Estimate based on average amount paid over the past year to the current collection agency for ground
ambulance collections.
COST TO COUNTY: See above SOURCE OF FUNDS: 13001-530.340al)d [[001530340
REVENUE PRODUCING, Yes ?jNO ~ AMOUNT PER MONTH_. Yea._
APPROVED BY, County Atty OM~=ing _ Risk Managemen,ffi>
DOCUMENTATION: Included ~ Not Required
DISPOSITION: AGENDA ITEM #
Revised 8/06
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACT SUMMARY
Contract with: Gila Corpor,ation d/bla Contract # -
I Municipal Services Effective Date: 10/01/2008
i Bureau (MSB) Expiration Date: 09/30/2009
Contract Purpose/Description:
Renewal of a~reement dated 10/18/07 for collections of outstanding account receivables
from ground and air ambulance transport.
Contract Manager: Camille Dubroff 6010 Emergency Services I Stop 14
(Name) (Ext. ) (Department/Stop #)
for BOCC meeting on 09/1712008 Agenda Deadline: 09/02/2008
CONTRACT COSTS
Total Dollar Value of Contract $ $3,300.001 year Current Year
Portion: $
Budgeted? Yes[;g] NoD Account Codes: 13001-530-340_-_-
Grant: $ 11001-530-340_-_-
County Match: $ - - - -
-------
- - - -
- ~.--........ ~ -
ADDITIONAL COSTS
Estimated Ongoing Costs: $_/yr For:
(Not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, etc.)
CONTRACT REVIEW
'/ '
Change, _. "~ Date Out
fate In Needed ~ ~~/~.~. wer r~;O-g
Division Director -;;>-of YesDNo /~ ~
Risk Manag~ent,Q, ~-oi YesD No/# .
f? Jb- ~ i\;
O.M.B./Purc asing Q-l.-r:>3 YesD Ned" ~ ~
County Attorney ~ {vt/ ors YesD No~ ~r.~
Comments:
OMS Form Revised 2/27/01 Mep #2
RENEWAL AGREEMENT
This AGREEMENT dated the day of ,2008, by and between
the Board of County Commissioners and the Board of Governors of Fire and Ambulance District 1 ofMomoe
County, Florida, hereinafter called the "County" and Gila Corporation d/b/a Municipal Services Bureau,
hereinafter called MSB,
WITNESSETH
WHEREAS, the parties hereto did enter into an agreement dated October 18, 2007 for collections of
outstanding aCcolmt receivables from ground and air ambulance transports; and
WHEREAS, said agreement provided an option to the County to renew the contract for two additional
one (1) year terms, not to exceed two (2) renewals; and
WHEREAS, the County has elected to exercise said first one (1) year renewal option for the continuation
of collections of outstanding account receivables from ground and air transports; now therefore
IN CONSIDERATION of the mutual convenants and obligations contained herein, the parties agree as
follows:
1. The County elects to renew the contract for an additional year pursuant to paragraph 3 of the
agreement entered into on October 18, 2007.
2. The effective date of this amendment is October 1,2008 and shall extend through
September 30,2009, under the same terms and conditions of the contract dated
October 18,2007.
3. All other terms and conditions of the contract dated October 18, 2007 shall remain in full
force and effect.
Attest: DANNY L. KOLHAGE, CLERK BOARD OF COUNTY COMMISSIONERS -
of MONROE COUNTY, FLORIDA
By: By:
Deputy Clerk Mayor/Chairman
IB/ A MUNICIPAL
SB)
WITNESS:~,--
~d~-\- ehn~iq)htl.r- We I tv&-,- Authori ~Signature
;rmui:. :r: .Jw/lN,eI CO
Print Name & Title
,
A GJPJEIEMJEN'JI' lBETWEEN
'fJH[JE IfM1ARD OF COUNTY COMMIfSSlIONJElRS
ANlOl
'flIJE BOiUID lOF GlOVElRNOJRS
JF][RE AND AMBULANCE DISTRICT 1
lOF MONROE COUNTY, FLORIDA
AND
GILA CORPORATION d/b/a MUNIClP AL SERIVCES BUJREAU
FOR COLLECTION OF OUTSTANDING AMBULANCE ACCOUNTS
THIS AGREEMENT, ("AGREEMENT") made and entered into this 18th day of October, 2007
by and between the Board of County Commissioners and the Board Govemors of Fire and
Ambulance District 1 of Momoe County, Florida, (herein refen-ed to as the "COUNTY") and
Gila Corporation d/b/a Municipal Services Bureau (herein referred to as "MSB");
"WITNESSETH:
WHEREAS, MSB represents that they wish to provide services as hereinafter more specifically
enumerated to the COUNTY for collections of said outstanding accounts receivables from ground
and air ambulance transports;
WHEREAS, the COUNTY wishes to enter into an Agreement with MSB for collecting various
uncollected ground and air ambulance accounts receivables;
NOW, THERFORE, in consideration of the promises contained herein, the parties agree as
follows:
1. DEBT COLLECTION SERVICES - MSB will mail notices, telephone or otherwise contact
debtors with outstanding accounts with the COUNTY in order to attempt to collect those monies
owed by the Debtors. Demand for payment of each collection item will be in a non-threatening
manner and subject to all applicable Federal, State and locallaws, rules and regulations. As
payment of collection items are collected by MSB, it shall be remitted to the COUNTY by the
fifteenth of the month for the previous month's activity. Each remittance shall include a statement
for the commission due and shall be accompanied by a dated report which, as to each collection
time included in the remittance, shall state the name of the person from whom it was collected,
the amount remitted and identifying account number.
2. RESPONSffiILITY OF THE COUNTY - The COUNTY will provide, in addition to the
names and last known addresses of the Debtors, all information regarding the date(s) of the
alleged debt(s), the amount of such debt(s) and the date the judgment was entered against the
debtor, if applicable. The information supplied to MSB by the COUNTY must be in an ANSI file
fOlmat which is acceptable to MSB and shall be provided not less frequently than monthly. The
COUNTY will update and COHect any information it has provided MSB as soon as it is
practicable. The COUNTY will notify MSB of any payment of other satisfaction of judgment
made directly to the COUNTY. The COUNTY may provide this information in either hard copy
or electronically.
3. CONTRACT PERIOD AND RENEWAL - The effective date of this Agreement shall be
October 18, 2007 through September 30, 2008. This Agreement may be renewed annually for one
(1) year terms, not to exceed two (2) renewals, subject to approval of the Fire Chief of Monroe
County Fire Rescue, the Office of Management and Budget and the Momoe County Board of
1
, ,
."
County COllllnissioners and the Monroe County Board of Govemors Fire and Ambulance
Districtl.
4. CONTRACT TERJVIINA TION ~ Either party may tenninate this agreement by providing
ninety (90) days written notice. Upon notice oftenllination MSB shall take all steps necessary to
close out any accounts with an open balance and wi.ll be responsible for complying with all
provisions of this contract until the temllnation date. MSB wi.ll not assume new accounts after
such notice of termination. MSB wi.ll be paid for its services through the temllnation date and
MSB will not incur any expenses after notice oftermination except those necessary to properly
wind up its obligations under this contract and properly perform this contract. All money received
on accounts, by MSB, after the termination date wiH be forwarded to the COUNTY without
regular compensation being paid to MSB. MSB will further cooperate with any successor, debt
collection service provider by turning over all records and any other documents or equipment in
hard copy to useable electronic format to the COUNTY or the debt collection service provider.
MSB will pay the COUNTY all funds due and owing to it as of the termination date of this
contract. The provision for MSB to turn over documents and to provide all funds due and owing
the COUNTY will survive the temlination of this contract.
5. CAP ABILITY TO PROVIDE SERVICE - MSB represents that it is an established debt
collection service provider licensed to do business in the State ofFIOlida and capable of
providing all services required pursuant to this contract and that MSB has all necessary permits,
occupational licenses or any other license or permits required to provide services under this
agreement required by any local, state, government or the federal government. MSB further
represents that it has experience with debt collection practices and it has the requisite [mancial
resources, personnel and experience to perform all services required under this agreement.
6. REPORTS - MSB shall provide the COUNTY with montWy aging reports as of the last day of
each month, by the twenty-first day of the following month reflecting the status of all accounts
that are cun-ently active and MSB's collection results. This report will include the following
information:
a. Debtor's Name
b. Debtor's Account Number
c. Amount paid on the account during the preceding month including amounts received by
COUNTY as reported to MSB.
d. Unpaid balance of account
e. Amount of commission due Agency.
The COUNTY has the absolute right to audit any and all [mancial records ofMSB pertaining to
the collection activities carried on by MSB pursuant to this contract. MSB shall retain such
records not provided to the COUNTY for a period of three (3) years after the termination of this
contract unless such records are required for pending litigation then such records shall be
maintained until at least ninety (90) days after the conclusion of litigation including appeals.
7. VALID DEBTS - The COUNTY agrees that accounts placed with MSB for collection are
valid and legally enforceable debts and are not disputed or subject to any bankruptcy proceedings,
unless otherwise disclosed in writing by the COUNTY.
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8. corvnvHssION RA TES ~ For all accounts refened by the COUI\ITY to MSB for collection for
which the COUNTY is paid, regardless of whether payment is accepted directly by the COUl>JTY
or by MSB on the COUNTY'S behalf, the COUNTY will pay to MSB a twenty-five (25) percent
rate on the gross amount collected.
Service will be provided on a contingency fee basis with no up-front or additional costs
associated with the services.
The following services will be provided at no additional costs: On line access to accounts, bi-
lingual collection notices and staff, letter creation and distribution, background
checks/fingerprints scans for all current and future MSB employees, National Sldp ,tracldng
services, toll-free telephone numbers for debtors, independent security audit, and electronic
interface (in-house programmers).
The COUNTY will not be responsible to MSB for any conuuissions or fees for payments
returned to the COUNTY or MSB for insufficient funds.
9. NOTIFICATION OF COLLECTION - The COUNTY will immediately notify MSB of
accounts referred to MSB for collection that have been paid or disputed by the Debtors directly to
the COUNTY whenever that payment or dispute occurs. MSB agrees that once an account is
placed, that the COUNTY is to receive all commission due in the event that monies are collected.
By the fifteenth of each month, MSB will provide a detailed reporting to the COUNTY to
identify all accounts lmown to be collected during the prior month and to remit monies collected
on the County's behalf. MSB is required to invoice the COUNTY for commissions due; the
COUNTY agrees to review the invoice and forward payment to MSB in accordance with the
Florida Local Government Prompt Payment Act.
MSB makes no warranties or representation, expressed or implied, about the amount of funds that
will be collected, and MSB shall have no liability for any amounts uncollected. The only liability
ofMSB will be to forward any funds collected to the COUNTY subjected to MSB collecting its
commission amount.
10. LEGAL ACTION - MSB shall make no settlement for less than the total principal amount
owed without prior approval of the COUNTY.
MSB may not affect any debtor's credit histOlY as a result of unsuccessful collection efforts.
MSB will place accounts for litigation only with prior written consent of County.
MSB agrees that if the continued collection of an account would damage the reputation of the
COUNTY or if suit is seriously threatened or filed, the COUNTY may request, in writing, the
immediate return of the account.
If the COUNTY has been given legal authorization to write-off obligations which have been
referred to MSB, MSB will not collect any fees from the COUNTY relative to the accoUnts which
have been withdrawn from MSB's collection efforts.
11. NOTICES - All notices specified pursuant to this contract shall be sent to the following:
COUNTY: Monroe County Emergency Services
490 63rd Street Ocean
11arathon,F133050
3
MSB: Municipal Services Bureau
6505 Airport Blvd., Suite 100
Austin, TX 78752
12. INDEPENDENT CONTRACTOR - Neither MSB, nor any of its employees, agents, or
subcontractors are employees ofthe COUNTY. MSB is solely responsible and liable for any
action taken or made by MSB its' employees, agents or subcontractors.
13. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT of 1996
(HIP AA) - MSB will carry out its obligations under this contract in compliance with the privacy
regulations pursuant to Public Law 104-191 of August 21,1996, lmown as the Health Insurance
Portability and Accountability Act of 1996, Subtitle F - Administrative Simplification, Section
261, et seq., as amended ("HIP AA"), to protect the privacy of any personally identifiable
protected health infOlmation (PHI) that is collected, processed or learned as a result ofthe
Collection services provided hereunder.
In conformity therewith, MSB agrees that it will:
a. Not use or further disclose PHI except as permitted under this contract or required by law;
b. Use appropriate safeguards to prevent use or disclosure of PHI except as permitted by this
contract;
c. To mitigate, to the extent practicable, any hannful effect this is Imown to MSB of a use or
disclosure of PHI by MSB in violation of this contract;
d. Report to Monroe County any use or disclosure of PHI not provided for by this contract of
which MSB becomes aware;
e. Ensure that any agents or subcontractors to whom MSB provides PHI, or who have access
to PHI, agree to the same restrictions and conditions that apply to MSB with respect to such
PHI;
f. Make PHI available to Monroe County and to the individual who has a right to access as
required under HIPAA within 30 days of the request by Monroe County regarding the
individual;
g. Incorporate any amendments to PHI when notified to do so by Monroe County;
h. Provide an accounting of all uses or disclosures of PHI made by MSBH as required under
HIPAA privacy rule within sixty (60) days;
i. Malee their internal practices, books and records relating to the use and disclosure of PHI
available to the Secretary of the Department of Health and Human Services for purposes of
determining MSB's and Monroe County's compliance with HIP AA; and
j. At the termination of the contract, return or destroy all PHI received from, or created or
received by MSB on behalf of Monroe County, and if return is infeasible, the protections of
this contract will extend to such PHI.
4
;
The specific uses and disclosures of PHI that may be made by MSB on behalf of Monroe County
include:
a. Preparation of invoices and reminder notices and documents pel1aining to collections of
overdue accounts to patients and others who are responsible for payment of the services
provided by Monroe County;
b. Uses required for the proper management ofMSB as a business associate.
c. Other uses or disclosures of PHI as pernlitted by the HIP AA privacy rule.
Notwithstanding any other provisions of this contract may be terminated by Monro'e County if
MSB has violated a term or provisions of this contract pertaining to MSB' s material obligations
under the HIP AA privacy rule, or if MSB engages in conduct wllich would, if committed by
Monroe County, result in a violation of the HIP AA privacy rule by Monroe County.
14. INDEMNIFICATION - MSB covenants and agrees to indemnify, hold harmless and defend
the Monroe County Board of County Commissioners and the Monroe County Board of
Governors Dishict 1, its conunissioners, officers, employees, agents and servants from any and
all claims for bodily injury, including death, personal injury, and property damage, including
damage to property owned by Monroe County, and any other losses, damages, and expenses of
any kind, including attorney's fees, court costs and expenses, which arise out of, in connection
with, or by reason of services provided by MSB or any of its Subcontractors in any tier,
occasioned by the negligence, enors, or other wrongful act or omission ofMSB or its
Subcontractor(s) in any tier, their officers, employees, servants or agents.
ill the event that the service is delayed or suspended as a result ofMSB's failure to purchase or
maintain the required insurance, MSB shall indenmify the County fl:om any and all increased
expenses resulting from such delay.
The extent of liability is in no way limited to, reduced, or lessened by the insurance requirements
contained elsewhere within this agreement.
This indemnification shall survive the expiration or earlier termination of the Agreement. (See
Attachment A).
15. INSURANCE - During the term of this Agreement, MSB must keep in force and affect the
following insurance:
Worker's Compensation- Prior to the commencement of work governed by this contract, MSB
shall obtain Worker's Compensation illsurance with limits sufficient to respond to Chapter 440,
FIOlida Statutes. ill addition, MSB shall obtain EmpLoyer's Liability Insurance with limits not less
than:
$100,000 Bodily fujury by Accident
$500,000 Bodily illjury by Disease, policy limits
$100,000 Bodily illjury 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.
5
IfIvISB has been approved by the Florida's Department of Labor, as an authorized self-insurer,
the County shall recognize and honor MSB' s status. MSB may be required to submit a Letter of
Authorization issued by the Department of Labor and a Certificate of Insurance, providing details
on MSB's Excess Insurance Program.
IfMSB participates in a self-insurance fund, a Certificate ofInsurance will be required. In
addition, MSB may be required t9 submit updated financial statements from the fund upon
request from the County.
General Liability - Plior to the commencement of worle govemed by this contract, MSB 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:
$300,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$100,000 per Person
$300,000 per Occurrence
$ 50,000 Property Damage
An Occurrence FOiln 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.
Professional Liabilitv Insurance - Recognizing that the work governed by this contract involves
the furnishing of advice or services of a professional nature, MSB shall purchase and maintain,
throughout the life of the contract, Professional Liability Insurance which will respond to
damages resulting from any claim arising out of the performance of professional services or any
error or omission of MSB arising out of work governed by this contract.
The minimum limits of liability shall be:
$250,000 per Occurrence/$500,000 Aggregate
Monroe County shall be named as an Additional insured on all policies.
The provisions of Attachment B are attached and incorporated into this agreement.
16. PAYMENTS - Payments shall be made by the COUNTY pursuant to the Florida Local
Government Prompt Payment Act after the completion of the rendered services and proper
invoicing by MSB.
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17. CONTn-.rGENCY- Monroe County's perf0l111ance and obligation to pay under this
Agreement is contingent upon an annual appropriation by the Board of County Conmussiollers.
18. 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 tlus
Agreement and will not be used in the interpretation of any provision of this Agreement.
19. OWNERSHIP OF THE PROJECT DOCUMENTS - The documents prepared by
MSB for this Project belong to the COUNTY and may be reproduced and copied
without aclmowledgement or permission ofMSB.
20. SUCCESSORS AND ASSIGNS - MSB shall not assign its right hereunder, except its right to
payment, nor shall it delegate any of its duties hereunder without the wlitten consent of the
COUNTY. MSB will not employ any subcontractor to perform any duties under this agreement
unless such fact is made lmown to the COUNTY and prior written pennission is granted. The
COUNTY shall have the right to prohibit a subcontractor from performing any part ofthe
contract; such right shall be reasonable exercised. Subject to the provisions ofthe immediately
preceding sentence, each party hereto binds itself, its successors, assigns and legal representatives
to the other and to the successors, assigns and legal representatives of such other party.
21. NO THIRD PARTY BENEFICIARIES - Nothing contained herein shall create any
relationship, contractual or otherwise, with or any rights in favor of, any third party.
22. PUBLIC ENTITIES CRIMES - 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 contracts 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 MSB, supplier,
subcontractor, or MSB under a contract with any public entity, and may not transact business
with any public entity in excess of the threshold amount provided in Section 287.017 of the
Florida Statutes, for CATEGORY TWO for a period of 36 months from the date of being placed
on the convicted vendor list.
By signing this Agreement (including Attaclunent C), MSB represents that the execution of this
Agreement will not violate the Public Entity Crimes Act (Section 287.133, Florida Statutes).
Violation of this section shall result in termination of this Agreement and recovery of all monies
paid hereto, and may result in debarment from COUNTIES competitive procurement activities.
In addition to the foregoing, MSB further represents that there has been no determination, based
on an audit, that it or any subcontractor has committed an act defined by Section 287.133, Florida
Statutes, as a "public entity crime" and that it has not been formally charged with committing an
act defmed as a "public entity crime" regardless of the amount of money involved or whether
CONUSULTANT has been placed on the convicted vendor list.
MSB will promptly notify the COUNTY if it or any subcontractor is formally charged with an act
defmed as a "public entity crime" or has been placed on the convicted vendor list.
23. MAINTENANCE OF RECORDS - MSB 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 its 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
7
following the termination of this Agreement. If an auditor employed by the COU1\fTY or County
Clerk detennines that monies paid to MSB pursuant to this Agreement were spent for pUl]Joses
not authorized by this Agreement, the MSB shall repay the monies together with interest
calculated pursuant to Sec. 55.03, of the Florida Statutes, mnning from the date the monies were
paid by the COUNTY.
24. GOVERNING LAW, VENUE, INTERPRETATION, COSTS AND FEES - This Agreement
shall be governed by and construed in accordance with the laws of the State of Florida applicable
to contracts made and to be perfOlTIled entirely in the State.
In the event that any cause of action or administrative proceeding is instituted for the enforcement
or interpretation of this Agreement, COUNTY and MSB agree that venue shall lie in Mom"oe
County, FIOlida, in the appropriate court or before the appropriate administrative body. The
Parties waive their lights to a hia1 by jruy. This Agreement is not subject to arbitration.
25. 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 ternls, cc;ovenants, conditions and
provisions of this Agreement, shall not be affected thereby; and eachc remaining term, covenant,
condition and provision of tbis 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 MSB 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
provlSlOn.
26. ATTORNEY'S FEES AND COSTS - The COUNTY and MSB agree that in the event any
cause of action or administrative proceeding is initiated or defended by any pmty 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.
27. BINDING EFFECT - The terms, covenants, conditions, f!:nd provisions of this Agreement
shall bind and inure to the benefit of the COUNTY and MSB and their respective legal
representatives, successors, and assigns.
28. AUTHORITY - Each palty represents and wan"ants to the other that the execution, delivery
and perfOlmance of this Agreement have been duly authorized by all necessary County and
corporate action, as required by law.
29. CLAllv1S FOR FEDERAL OR STATE AID - MSB 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.
30. ADJUDICATION OF DISPUTES OR DISAGREEMENTS - COUNTY and MSB 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 15 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
8
of the parties, then Hny partY shall have the right to seek such relief or remedy as may be provided
by this Agreement or by Florida law.
31. COOPERATION - In the event any administrative or legal proceeding is instituted against
either party relating to the fonnation, execution, perfoilllance, or breach of this Agreement,
COUNTY and MSB agree to pmiicipate, 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 MSB specifically
agree that no paliy to this Agreement shall be required to enter into any arbitration proceedings
related to this Agreement.
32. NONDISCRIMINATION - MSB and COUNTY agree that there will be nO' discrimination
against any person, and it is expressly understood that upon a detemunation 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. MSB or
COUNTY agrees to comply with all Federal and Florida statutes, and all local ordinances, as
applicable, relating to nondiscrinunation. 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 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 dmg abuse patent records; 8)
Title VITI 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 Chapter 13, Article VI,
which prohibits discrimination on the basis of race, color, sex, religion, national origin, ancestry,
sexual orientation, gender identity or expression, familial status or age; 11) Any other
nondiscrimination provisions in any Federal or state statutes which may apply to the parties to, or
the subj ect matter of, this Agreement.
33. COVENANT OF NO INTEREST - MSB and COUNTY covenant that neither presently has
any interest, and shall not acquire any interest, which would conflict in any manner or degree
with its performance under this Agreement, and that only interest of each is to perform and
receive benefits as recited in this Agreement.
34. CODE OF ETHICS - 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. (Attachment D).
35. NO SOLICITATIONIPAYMENT - MSB and COUNTY 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
9
any perSall, company, corporation, individual, or finn, other than a bona fide employee working
solely for it, any fee, COllU1ussion, 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, MSB agrees that the COUNTY shall have the right to temunate this Agreement
without liability and, at its discretion, to offset fi"Ollllllonies owed, or otherwise recover, the full
amotUlt of such fee, conunission, percentage, gift, or consideration.
36. PUBLIC ACCESS - MSB and COUNTY shall allow and pemllt 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 MSB and
COUNTY in connection with this Agreement; and the COUNTY shall have the right to
unilaterally cancel this Agreement upon violation of this provision by MSB.
37. NON-W AlVER OF IMMUNITY - Notwithstanding the provisions of Sec. 768.28, Florida
Statutes, the participation ofMSB and the COUNTY 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 he required to contain any
provision for waiver.
38. 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 perfonning their respective functions
under this Agreement within the territorial limits of the COUNTY shall apply to the same degree
and extent to the perfomlance of such functions and duties of such officers, agents, volunteers, or
employees outside the territorial limits of the COUNTY.
39. LEGAL OBLIGATIONS AND RESPONSIBILITIES - no 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 tl;1e extent pennitted by the Florida
constitution, state statute, and case law.
40. 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 MSB and the
COUNTY agree that neither MSB nor the COUNTY 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.
41. ATTESTATIONS AND TRUTH IN NEGOTIATION - Coincident with execution of this
Agreement, MSB agrees to execute a Public Entity Crime Statement, Ethics Statement, and a
Drug-Free Workplace Statement (Attachments C-E).
42. 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
10
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.
43. EXECUTION IN COUNTERPARTS - Tlus Agreement may be executed in any number of
counterpatis, 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 sigtung any such counterpmt.
IN wrr~SSWHEREOF, each party hereto has caused this Agreement to be executed by its
duly ailthoxized tepresentative.
.. ;
Attesd,~,ANNYL.KOLHAGE, CLERK
MONROE COUNTYBOARD OF COUNTY By.~/tL
'9Ql\ifMISSJONERS
B;~Q1vJ (! . f)vsJ aJ>>J
Deputy Clerk ../
M yor/Chairman
GILA CORPORATION INC. d/b/a
WITNESS 1 P MUNICIPAL SERVICES BUREAU
BY.~
Print Name: I ;f~ ~J7:) V\OIM,5-eJ
Print Name and Title
:\\unu,lf. Date: ?/~7 /0'7
/f.9il: TIM M. YANTES
... ~~. ....r-;. .
3 : :;; Notary Pub he, State of Texas
;.j:..... {~j My Commission ExpIres Title: CIV/O
"',1,f.f,~~'" October T 9, 200B
11
MONROE COlJJNTY9 IFILOR1U[1)A
IRJI:SK MANAGEMENT
lP'OILJrCY AND lP'ROClED1UUS
CONTRACT AD MIrNliS'fJRA ']['1[0 N
MANlJJAL
indemnification and Hold HaJrmRess
for
Other ContractoJrS
The Contractor covenants and agrees to indemnifY, hold harmless and defend the Monroe
County Board of County Commissioners and the Monroe County Board f Govemors District 1,
its commissioners, officers, employees, agents and servants from any and all claims for bodily
h~ury, including death, personal injury, and
property damage, including damage to property owned by Monroe County, and any other losses,
damages, and expenses of any land, including attorney's fees, court costs and expenses, which
arise out of, in connection with, or by reason of services provided by the contractor or any of its
Subcontractors in any tier, occasioned by the negligence, errors, or other wrongful act or
omission of the contractor or its Subcontractor(s) in any tier, their officers, employees, servants or
agents.
In the event that the service is delayed or suspended as a result of the contractor failure to
purchase or maintain the required insurance, MSB shall indemnify the County from any and all
increased expenses resulting from such delay.
The extent of liability is in no way limited to, reduced, or lessened by the insurance requirements
contained elsewhere within this agreement.
This indemnification shall survive the expiration or earlier termination of the Agreement
con:J2ture
0/:1-7/07
Date
TCS
Attachment A
(1 of 1)
12
'VV ([}l RlIillID.S ~ <CO IV1LIiJ)lEN SA.1rJI 0 N
JINS1UJRAN ClE J.llEQ lUIflRlEMIEN1rS
lFOJft
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
\\ASE
Prior to the commencement of work governed by this contract, the Contractor shall obtain
Workers' Compensation Insurance with limits sufficient to respond to Florida Statute
440.
In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not
less than:
$100,000 Bodily Injury by Accident
$500,000 Bodily Injury by Disease, policy limits
$100,000 Bodily Injury by Disease, each employee
Coverage shall be maintained throughout the entire tenn of the contract.
Coverage shall be provided by a company or companies authorized to transact business in
the state of Florida.
If the Contractor has been approved by the Florida's Department of Labor, as an
authorized self-insurer, the County shall recognize and honor the Contractor's status. The
Contractor may be required to submit a Letter of Authorization issued by the Department
of Labor and a Certificate of Insurance, providing details on the Contractor's Excess
Insurance Program.
If the Contractor participates in a self-insurance fund, a Certificate of Insurance will be
required. In addition, the Contractor may be required to submit updated financial
statements from the fund upon request from the County.
we!
Attachment B
(1 of 3)
13
GENERAIL ILiAnUILliTY
liNSURANCm: RlEQU.lLREMlENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
IJ\AS~
Prior to the commencement of work govemed 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:
G Premises Operations
G Products and Completed Operations
II) Blanket Contractual Liability
" Personal Injury Liability
G Expanded Definition of Propeliy Damage
The minimum limits acceptable shall be:
$300,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$100,000 per Person
$300,000 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.
GLI
Attachment B
(20f3)
14
lP']ROJFIESS}fONAIL LlIAllUILI'f'1'
llNSURANCJE REQUiREMENTS
FOR
CONTRACT
BETWEEN
MONROE COUNTY, FLORIDA
AND
'N\ S :t>
Recognizing that the work governed by this contract involves the furnishing of advice or
services of a professional nature, the Contractor shall purchase and maintain, throughout
the life of the contract, Professional Liability Insurance which will respond to damages
resulting from any claim ~sing out of the performance of professional services or any
error or omission of the Contractor arising out of work governed by this contract.
The minimum limits ofliability shall be:
$250,000 per Occurrence/$500,000 Aggregate
PR01
Attachment B
(30f3)
15
lPUJEiLllC JEN1rll1rY CroMIE: S1f A TIEMJEN1f
"A person or affiliate who has- been placed on the convicted bidder list following a
conviction for public entity Clime may not 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 perfonn work as a bidder,~upplier,
subbidder, 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 of36 months from the date of being placed
on the convicted bidder list."
"
By executing this fonn, I acknowledge that limy company is in compliance with the
above.
,
-
STATE OF , C-XOI '\
~'
COUNTY OF \'''''1)
Date~
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
~\uc...G: CUVlt\'fV\. '\ {\~5 who, after first being sworn by me, (name of
individual signing) affixed hlslher signature in the space provided above on this
IJ-f day of 5e~~elMb~r ,20 0/
IO/,q(ort
\\U~UII.i
$f:.Wrr.J:--. TIM M. YANTES
""~""~ N t P .
g : i ~ 0 ary ublrc: Srate of Texas
~:~. ... ~~i My CommIssion EXplf9S
",ttfJ,1~"" October 19, 2008
Attachment C
16
lLAJJaIBiYJING AND CONFLICT OF lINTEREST ClLAUSE
SWORN STATEMENT UNDER ORIDHINANCE NO. llO-ll990
M.oNROIS COUNTY, FLORIDA
ETHiCS CLAUSE
i\!\S.B warrants that he/it has not elTIployed,
retained or otherwise had act on his/its behalf any former County officer or'employee in
violation of Section 2 of Ordinance No.1 0-1990 or any County officer or employee in
violation of Section 3 of Ordinance No.1 0-1990. For breach or violation of this
provision the County may, in its discretion, terminate this contract without liability and
may also, in its discretion, deduct from the contract or purchase price, or otherwise
recover, the full amount of any fee, commission, percentage, gift~. or consideration paid to
the fonner Count fleer or employee.
,
Date: or /2) /07
~
STATE OF , e.)(tIl5
COUNTY OF ~~ \f i J
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
G,VC-I:; C<..2 WI",,; ~S who, after first being sworn by me, affixed
his/her signature (name of in . . dual signing) in the space,provided above on this
{J7"f):.. dayof 5-ep~eW\1-(.,( ,20JLl.
N~P~
My commission expires: lO/ 1'1 (ot
'.
OMS - Mep FORM #4 ,\\,...,IIllJ
~~~'" TIM M. YANTES "
1"'( ':"~ Notary Public: S~ate of Texas ~
\~. .....i My CommISSion ExpIres I
~:~i:~$~ October 19. 2008
Attachment D
17
Jl)) IR 1U <G- JFiRJE IE W (j) IRKJFlLA iCE F<G IRM
The undersigned contractor i!l accordance with Florida Statute 287.087 hereby certifies
that:
Q dOL CDVp' ell h jtA__ + SffV ICeS bVlVeAlA.(~)
N LA. Y\ lu pa12
(Name of Business) 1. Publishes a statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession, or use of a controlled substance is prohibited in the workplace
and specifying the actions that will be taken against employees for violations of such
prohibition.
2. InfonTIs 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. Gives each employee engaged in providing the commodities or contractual services
that are under bid a copy ofthe statement specified in subsection (1).
4. hI the statement specified in subsection (l), notifies 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 contendre 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. hnposes a sanction on, or require the satisfactory participation in a drug abuse
assistance or rehabilitation program if such is available in the employee's community, or
any employee who is so convicted.
6. Makes a good faith effort to continue to maintain a drug-free workplace through
implementation of this section.
As the person authorized to sign the statement, I certify that this firm complies fully with
the above requirements.
,
Contrac{orrs-S: ature
~/a7/D7
Date
OMB - MCP FORM #5
Attachment E
18
r----ACORIJm CERTIFICATE OF LIABILITY INSURANCE j 11/1612007
PRODUCER Pathfinder/LL&D Insurance Group LLC Tl-US CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1160 Dairy Ashford #220 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 441587 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Houston TX 77244-1587 INSURERS AFFORDING COVERAGE
INSURED Gila Corporation INS!-,RER A: Hartford Unqerwriters Insurance Company
dba Municipal Services Bureau/Gila Group : INSURER 6: Hartford Underwriters Insurance Company
6505 Airport Blvd., Suite 100 INSURER c: Federal Insurance Company
, INSURER D:
Austm TX 78752 ...
, , INSURER E;
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
..--..,..- - -- -- ~. _~Tn __ . _____~~" c ___ ~ ~T_.' .______~,..__~ _.
INSR i TYPE OF INSURANCE POllCV NUMBER . PDLICV EFFECTIVE . POLICY EXPIRATION I LIMITS
,9I~ERALLIABILITY :61SBQRS8500 103/0112007 '03/01/2008 i.s~.fHOCCUR_RENC!, T ~j,.1~QO,OQQ
A I.., 99_MMERC1ALGENER.M..!JABllITY i I '.FIR~ gp..M~GJ;.ffir1YQne f1[~J~ I,QgO,Q~Q
r I' .
I -J .ICLAIMSMADE IX ,OCCUR I "IM.t;QEXP[lilly'cne~I)l.__+.l~_ ____ __ ~QOO_
~~J -- - - - i i . f PERSONIlb.MQY lNJUR..'L..i L.. _.QxcluEed
~---~ _.- ~.. --~ - -------- I,' ~AL AGGF!ffiill__ ~.L. __ 2,000,000
~r GEN'L AGGREQ.,o,IE LIMIT APrPl:!SS PER: I PRODUCTS - COMP/OP AGG~___ . .__ 12Q9_Q!OOO
,X POLICY , PRO- LOC I
~IOMOBILELlABILlTV i61SBQRS8500 :03/01/2007 !03/01/2008 'COMBINEDSINGLELlMIT 1$ 1000000
~ j' ANY AUTO I I I I ~E~.~.:clde~:J. -___ ~_ jl______ . ._..-'______
A :-". ALL OWNED AUTOS I: I I BODILY INJURY $
I ] SCHEDULED AUTOS I I (~er.':e,".~~ .__ _ .. _ _ ___ ._. .._
~I ,
. HIRED AUTOS , BODILY INJURY
XJ NON-OWNED AUTOS I 11~:~_",-CCI~e.n_l! _ _n__ _I $ _n ___n.. .__
." .' ------- - - ...- I PROPERTY DAMAGE ) $
(Per accidenlf I
~RAGE LIABILITY I I I'AUTO ONLY - EA ~Q9.!QE-"!T .1 $.. .._ _ __.._
l -~ ANY AUTO I' OTHER THAN ~ACC. .1. ___. __. __.
I AUTO ONLY: AGG
, EX~ESS L1ABILITY,_ i6lSBQRS8500 03/01/2007 03/0112008 '[' EACH OCCURRENCE _n. _.~.!._ .___. 4,000,002..
~ OCCUR l J CLAIMS MADE I I AGGREGATE______._____f-L_.___ 4,09P,000
A i - - DEDUCTIBLE I ~-=~=----=~~.~-__l~~_-'~ -=m.~_~~_
X RETENTION $10,000
I WORKERS COMPENSATION AND 61 WEQRT784 7 103/01/2007 103/0 112008 ~.Ki T~~~m~~ I i~!...__ ____..
: EMPLOYERS' LIABILITY I I 1 000 000
B I I ; ~ E.L EACH ACCIDENT n ----Ll. .____ ' ,
, I I.' I E.L. DISEASE - EA EMPLOYEE1 $ .._ 1,000,000
i I I I E,L. DISEASE- POLICY LIMIT ! 1,000,000
C ! oTHERProfessional Liab ,8197-6649 ill/01l2007 11101/2008 $1,000,000 Limit
' I I I
! ' ! I
I ,
DESCRIPTION OF OPERATlONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate holder is named as Additional Insured with respects on all policies as required by written contract. This certificate
replaces any and all previously issue certificateds for the certificate holder as pertains. Subject to policy terms, conditions and
exclusions.
CERTIFICATE HOLDER i ADDITIONAL INSURED'INSURER LETTER' CANCELLATION
SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Monroe County Board of County Commissioners DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
490 63rd street Ocean NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANV KIND UPON THE INSURER, ITS AGENTS OR
Maralhon FL 33050
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ~
--s I _
., '----'
ACORD 25-S (7/97) @ACORD CORPORATION 1988
J
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25-S (7/97)