Item G2
BOARD OF GOVERNORS
FIRE AND AMBULANCE DISTRICT 1
AGENDA ITEM SUMMARY
Meeting Date: September 17, 2008 Division: Emergency Services
Bulk Item: Yes - No -X- Department: Fire Rescue
Staff Contact Person: Camille Dubroff
AGENDA ITEM WORDING: Approval of the third Renewal Agreement effective from October 1,
2008 through September 30,2009, with Fire Tech Repair Service, Inc. for maintenance of Fire Rescue
vehicles, including semi-annual inspections, preventative- maintenance and unscheduled maintenance
resulting from malfunction or failure.
ITEM BACKGROUND: On December 21,2005 the Board awarded bid and entered in to an
Agreement between the Board of Governors Fire and Ambulance District 1 of MOlU'oe County and Fire
Tech Repair Service, Inc. The original agreement provides for annual renewals up to three (3) one-year
periods, with approval of the District's governing Board. We are requesting approval to exercise the
renewal option for the third and final one-year period, commencing on October 1, 2008 and ending on
September 30,2009.
PREVIOUS RELEVANT BOG ACTION: On December 21,2005 the board approved an agreement
with Fire Tech Repair Service, Inc. for maintenance of Fire Rescue vehicles, including semi-annual
inspections, preventative maintenance and unscheduled maintenance resulting from malfunction or
failure commencing on October 1,2005 and ending on September 30,2006. On September 20, 2006
the Board approved the first renewal agreement effective from October 1, 2006 through September 30,
2007 for maintenance of Fire Rescue vehicles, including semi-annual inspections, preventative
maintenance and unscheduled maintenance resulting from malfunction or failure. On September 19,
2007 the Board approved the second renewal agreement from October 1, 2007 through September 30,
2008, with Fire tech Repair Service Inc. for maintenance of Fire Rescue vehicles, including semi-
annual inspections, preventative maintenance and unscheduled maintenance resulting from malfunction
or failure.
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 renewing as the contract allows.
TOTAL COST: $18,230.00 * BUDGETED: Yes ~ No -
*Cost to cover periodic inspections, preventative maintenance and pump testing. In addition, the
contract also includes fixed pricing for unscheduled repairs at $73.00/hour and parts at 25% over cost.
COST TO COUNTY: See above SOURCE OF FUNDS: 11500-530462
REVENUE PRODUCING: Yes_ No..Jl A~UNTPERMONTH_ Year_
~ P:b- ~'
APPROVED BY: County Arty ::7- OMB/Purchasing _ Risk Managemen ;
DOCUMENTATION: Included X Not Required
DISPOSITION: AGENDA ITEM #
Revised 8/06
MONROE COUNTY BOARD OF GOVERNORS
CONTRACT SUMMARY
Contract with: Fire Tech Repair Service Contract #_
Inc. Effective Date: 1 % 1/2008
Expiration Date: 09/30/2009
Contract Purpose/Description:
Renewal of agreement dated 1/112006 for maintenance of Fire Rescue Vehicles
maintenance of Fire/Rescue vehicles, semi-annual-inspections, preventative
maintenance and unscheduled maintenance resulting from malfunction or failure.
Contract Manager: Camille Dubroff 6010 Emergency Services / Stop 14
(Name) (Ext.) (Department/Stop #)
for BOCC meeting on 09/1712008 Agenda Deadline: 09/02/2008
CONTRACT COSTS
Total Dollar Value of Contract: $ $18,230.00*Plus Cunent Year
repairs at $73/hr and Portion: $
pmis at 25% over
cost.
Budgeted? Yes[Z] No D Account Codes: 11500-530462-_-_-_
Grant: $ _-_-_-_-_
County Match: $ _-_-_-_-_
- - - -
............... ------- ~ - --
ADDITIONAL COSTS
Estimated Ongoing Costs: $~yr For:
(Not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, etc.)
CONTRACT REVIEW
Changes Date Out
Dale In Needed ~
Division Director _ YesD NoD v ~ li2'id{
RiskManagW'e~~ ~/J.l1)1 YesDNoB.. ' . X-3-.}d
eJLt.. t; fJ,.AJ e.
O.M.B./Purchasing l1"',;U-Ol YesDNo[0 . t~ ~1J '7)-;).& ~Cf6 ~
County Attorney 0- ,q~ Or YesD No[2g ~~ i. tI-aJI '6- IV- 06
Comments:
OMB Fonn Revised 2/27/01 Mep #2
RENEWAL AGREEMENT
This AGREEMENT dated the day of ,2008, by and between
the Board of GovemOfs of Fire and Ambulance District 1 of Monroe County, Florida, hereinafter called the
"District" and Fire Tech Repair Service, Inc., whose mailing address is PO Box 1570, Key Largo, FL 33037,
hereinafter called the "Contractor".
WI rnE S SETH
WHEREAS, the parties hereto did enter into an agreement dated January 1, 2006 for maintenance of
Fire/Rescue vehicles, semi-annual inspections, preventative maintenance and unscheduled maintenance
resulting from malfunction or failure; and
WHEREAS, said agreement provided an option to the District to renew ,~~e contract for three additional
one year terms; and
WHEREAS, the DISTRICT has elected to exercise said third one (1) year renewal option for the
continuation of maintenance of Fire/Rescue vehicles, semi-annual inspections, preventative maintenance and
unscheduled maintenance resulting from malfunction or failure; now therefore
IN CONSIDERATION of the mutual convenants and obligations contained herein, the parties agree as
follows:
1. The District elects to renew the contract for an additional year pursuant to paragraph 1 of the
agreement entered January 1,2006.
2. The effective date ofthis amendment is October 1,2008 and shall extend through September
30,2009, under the same terms and conditions ofthe contract dated January 1,2006.
3. All other terms and conditions of the contract dated January 1,2006 shall remain in full force
and effect.
Attest: DANNY L. KOLHAGE, CLERK BOARD OF GOVERNORS,
FIRE AND AMBULANCE DISTRICT 1
By: By:
Deputy Clerk Mayor/Chairman
vnTNESS:~~ ,
Camille Dubroff
CYNTHIA L. HAI..:L
ASSISTA~T COUNTY ATTORNEY
Date .. (S .. ')...00 r
RENEWAL AGREEMENT
"9:1J ), ~ ~
This AGREEMENT dated the _!_~day of ~J.~ n __. ,2007, by and between
the Board of Governors of Fire and Ambulance District 1 of Momoe County, Florida, hereinafter called the
"District" and Fire Tech Repair Service, Inc., whose mailing address is PO Box 1570, Key Largo, FL 33037,
hereinafter called the "Contractor".
WITNESSETH
WHEREAS, the parties hereto did enter into an agreement dated January 1, 2006 for maintenance of
FirelRescue vehicles, semi-annual inspections, preventative maintenance and lUlscheduled maintenallce
resulting from malfunction or failure; and
WHEREAS, said agreement provided an option to the District to renew !he contract for three additional
one year terms; and
WHEREAS. the DISTRICT has elected to exercise said second one (1) year renewal option for the
continuation of maintenance of Fire/Rescue vehicles, semi-annual inspections, preventative maintenance and
unscheduled maintenance resulting from malfunction or failure; now therefore
IN CONSIDERATION of the mutual convenants and obligations contained herein, the parties agree as
follows:
1. The District elects to renew the contract for an additional year pursuant to paragraph 1 of the
agreement entered January 1, 2006.
2. The effective date of this amendment is October 1, 2007 and shall extend through September
30,2008, under the same terms and conditions of the contract dated January 1, 2006.
3. All other terms and conditions of the contract dated January 1,2006 shall remain in full force
and effect.
Attest: DANNY L. KOLHAGE, CLERK BOARD OF GOVERNORS,
FIRE AND AMBULANCE DISTRICT 1 -
By: ,M,a.L.fl(}. ft]xf ~ ByLdL-
\.0 l?~pu.t-.y Clerk o't- /9-07 "Mayor/Chairman
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RENEVV AL AGREEMENT
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This AGREEMENT dated the J?I day of t.}(.'7ZJ6{l!_ ,2006, by and between
the Board of Govemors of Fire and Ambulance Disttict 1 of Moru-oe County, Florida, hereinafter called the
"'Distilct" and Fire Tech Repair Service, Inc., whose mailing address is PO Box 1570, Key Largo, FL 33037,
hereinafter called the "Contractor".
WITNESSETH
WHEREAS, the parties hereto did enter into an agreement dated January 1, 2006 for maintenance of
Pire/Rescue vehicles, semi-annual inspections, preventative maintenance and unscheduled maintenance
:esulting from malfunction or failure; and
WHEREAS, said agreement provided an option to the Distdct to renew the contract for tIu'ee additional
lUe year terms; and
.... :..~
~
'WHEREAS, the DISTRICT has elected to exercise said first one (1) year renewal option for the
ontinuation of maintenance of Fire/Rescue vehicles, semi-annual inspections, preventative maintenance and
nscheduled maintenance resulting from malfunction or failure; now therefore
IN CONSIDERATION ofthe mutual convenants and obligations contained herein, the parties agree as
)l1ows:
L The District elects to renew the contract for an additional year pursuant to paragraph 1 oftlle
agreement entered January 1,2006.
2, The effective date of this amendment is October 1,2006 and shall extend through September
30,2007, under the same temls and conditions of the contract dated January 1, 2006.
3. All other terms and conditions of the contract dated January 1,2006 shall remain in full force
and effect.
Attest: g.&~ L. KOLHAGE, CLERK BOARD OF GOVERNORS,
#~ (, ~ >~;,~. - , FIRE AND AMBULANCE DISTRICT 1 -~
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i'~~ By: L-"---- )1f~
By~t:~~,,':.' . r.~~~
Dep\liy qerk Mayor/Chairman
WITNESS: Fir:~~ice, (&~ )
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Authorized Representative
MONROE COUNTY ATTORNEY
APPROVED AS TO FORM:
~d.d!-_ ~/1 ~<~:-"~cit.<.
SUSAN M. GAf GtSlE'f -, 7
Assls.rA~:r COUNTY ATTORNEY .
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C<CDNIr1~iC'jf llliIE1rW'lfJE:EI\J
TI-KIE JBl{JiPMlill)) (QllF <G([>>WJEffi;I'~<<]J'&~
lFI[1Pl1E A.hID .t:':!1MflBHUL4NClE lJ]JIS'lT'RIIC'Jf 1L
([})IF lWONROE CO[JNlrY~ FLORIDA
A.Nli)
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1F1rRE TECH REPAlrR SERVICE .lINe.
FOR MAlrNmNANCE OF FIRE/RESCUE VEHICLES
TIlIs CONTRACT, hereinafter "CONTRACT OR AGREEMENT" made and entered
into this f * day nf -1a'l. . , 2006 by and between Board nf Govemors
Fire and Ambulance Dislrict 1 of Monroe Connty, Aorida, hereJiiafter referred 10 as
"DISTRICT", and Fire Tech Repair Service Inc. , hereinafter referred to as -
"'CONTRACTOR". -
WITNESSETH:
WIiEREAs, the su"""ssful bidder was Fire Tech Repair Service Inc., and;
WHEREAS, tbis CONTRACCOR represents tbat it is capable and prepared to provide
such services, and;
WHEREAs, the DISTRICT intends to enter into an allfeeD1ent for maintenance of
FirelRescuc vehicles, semi-annual inspecti""s, preventative maintenance, and -.
unscheduled maintenance resulting from malfunction or failure with the CONTRAcroR
and;
WHEREAS, this contract is an agreement between both parties,
NOW, THEREFoRE, in consideration of the promises contained herein, the parties agree
as follows:
1. CONTRAcr PERIOD AND RENEWAL - The effective date of Ibis Agreemeut
shall be Janu8fJ( 1. 2006 through Selltember 30, 2006. This OOIItract may he
renewed annually for one (1) year terms, nolto exceed three (3) renewals, subject
to approval of the Fire Chief of Monroe County Fire Rescue, the Office of
Management and Budget and the Monroe COunty Board of Governors Fire and
Ambulance District 1.
1
2, CONfI"~4cr TErJ.\1INAnON - Thi. """tract may be termjmted t", ""Y '",,"on
by ei!l,., pOliy On 311-day wrille.. ""lice witllout "''''se. If!he CONTRACTOR f.ils
!o r"Ifi!! tlw I:effilS of llJis agreeme..~ "" a!taclm!ents, properly Of 00 time, Of
olhorwi.. violaio. Ihe P"'visions of !he agleemen! or of .pplicable I.ws 0'
..gel.tioos governing ihe USe of funds, lbe County may lerm.inaie the COntract by
Written noti"". The notice shaU specify cause. All finished or unfinished supplies _._
Or services shall, .i the option of lbe County, become property of the Connty. The
County silalJ pay the CONTRACTOR fair and equitable oompen8;liion ful
expenses incurred prior to (ermin.lion of Ibe agr""men~ less any llmount Or
damages caus.d by lbe CONTRACTOR's breach. If the dOlOagem are more thon
<lOIilpensation payable, Ihe CONTRACTOR will remain liable after lenmination
and the COUi.Rty shall pursue collection for damages.
,"
3. SUBJ:Ecr MAlTER OF CONTRAcr - This contract is ror scheduled semi -
aanual inspec!iolls and preven/oIive maintenance of fire rescue vehicles, annuol -
pump tests and ror unscbeduled maintenance and repair resulting from equipment
failure or malfunction.
4. RATES -The hourly rate shalJ he $73.00 per man-hour with no traveltime or
mileage cbarge. Semi Amnuol inspections and annual pump lests are at quoted flat
rates and excluded from houdy rate.
5. OVERTIME AND HOLIDAYS - Rales per man-hour ror emergency repairs
called outside nOrmal busin"slmurs and federal hOlidays shail be One .nd one holt
times the normal rate. ~
6. SEMI-ANNuAL INSPECTIONS - Durimg lite year CONTRACTOR sball
perfunn twn inspections on vehicl.. described in "Attaclnnenl A" (!.eve I I and
Level II Preventative Maintenance Service) at an annual total cost of:
Rescue~type vehicles, without pump $ 360.00 -~
Pumpers $ 490.00
Aerials $ 640.00
Exception shall be if a vehicle hos been used 1,000 bours Prior to yearly
preventative maintenance service, Level I and n Preventative Maintenance
Service shall be performed and charged the above rate.
Level I: 250 Hours or 6 months (whichever comes fir~
Pnll vehicle inspection as per attached semi-annual Inspection schedUle plus:
- Engine oil and filter change
- Fuel filter change (every 6 months)
- Air filter inspection and replacement if necessary
- Chassis lubrication
2
~ (t)&i:!J';:P31l'(] (1f(!)niV~1"tD1) Jill]]p[;;]lleF Sh1afi: h!bJI'k~~J!(J1m
- L!!lliJl'ica€~iQ!]] of aU V8JHVe; C(iiXRKfOB H1ffiEW)g68
c_ CReam 011 reri.JIlacf': autr COl11t1lpre8~(JJf stFmmer
- CReam engin.e crankcase breather
- Illspocoo" of gellerato, and ""m"" of lubricOlllt system, full system, ""d
air filter according to its individuai hours of Ol"'rotJo" (not to .""""<1 6
months) --.
Level DI.: 1000 Hours or ORte xear (which ever comes rust)
Full service pell'lfonned in level I plus:
- Replacement of coolant hoses~ filter and coolant as needed
~ Replacement of all. drive belts as needed
- Replacement of pump transmission oill and filter .
Replacement of engine transmission fluid and filter -.~~
-
~
B Replacement of rear rode lube oil as needed _
- Inspection of front wheel bearing
a Replacement and repacking as needed
- Inspection and cleaning of relief valve strainer
- Replacement of secondary fuel filters on both engine and generator
The number of vehicles may fluctuate from time to time due to new purchases or
removal of vehicles from inventory. The mspections shall be preformed at the
respective fire stations.
7. WORK SCHEDULE - Regu/arly SCheduled semi-annual inspections and
preventative maintenance shall be conducted at such intervals as are approved by
the DISTRICT.
8. PUMp TESTS - CONTRAcroR shan perfonn an annual pump test at a flat rate
COst of $250.00 each for aU vehicles requiring such test. In order to facilitate the
Passing of the pump test, minor repairs and adjustments shan be made as needed; -~
price inclUdes clean-up after salt water use. The CONTRAcroR shall provide
doc:umentation of performance to Monroe County. The dOCllmenta/ion must be in
the form of an electronic version report that is emailed to the Captain of Support
Services. The fonn must either be in Microsoft Word or Excel.
9. PARTS, FWIDS AND LUBRICANTs - All parts, f1nids, aud lubricants used for
maintaining and repairing vehicles shan be SUPplied by CONTRAcrOR and
biUed to the DISTRlcr at cost plus 25%. For jlarts $400.00 and over, a COpy of
origilla/ Parts supplier invoices shall be attached to the biD. CONTRAcrOR wiU
be required to keep aU original parts supplier inVOices available at request by
County for spot checking and auditing purposes.
:3
l{OI I8NGjIJ\1jE OIL A[~JJ HLIJE:R CHlLI\fGE ""~ complote drive i,.;" l"bric.iJon Ill1ld
ony 01110.. J1l.io1, anfl;o.. ru"" clllll1lgo., s!;lll1 "" l"'IT(lr,>'ed .. ''''''''''''''.nded by the
Iil.em:m1f8!CKlJEeli' .
H. SEMI-ANlIlUM, INSPECTION SCHED1UUl - COllfIRACTOR shalll"'rfo1ID liJ.
following inspection and preventative maiIDlenance twice per year OlD all vebicles:
._.~
(a) Cooling system, including fan belts, radialor supports, hoses, and cl.mps,
and auxiliary cooler;. .
(b) Exbanst System, incJuding hanger, clamps, muffler, and pipes;
(e) CJlutch, induding freeplay, linkage, and fluid levels;
(d) Manual Tramsmissioll1, including seals, linkage, and lube level;
(e) Automatic Transmission, including fluid! level, seals, modulator
adjustment, and linkage; "
(t) Drive Train, including V-joints, center support, and companion flangeS; -
(g) Rear Axle and springs, includiug oil links, spring hangers, center bolts, and -
U~bolts
(h) Front End, including steering box, linkage, lringpius and bushings, spring
hangers, and U -bolts;
(i) Mechanical Brakes, mcluding adjustment and fluid levels;
CD Air Brakes, including dram, adjustment, wear, 2nd air leaks;
(k) Tires, including condition and wear;
(1) Electrical System, including running lights, emergency lights, battery
cables, turn lights, 4-way .!lasher, beadlights, stop lightS, and switches;
(m) Fuel System, including hoses and fittings, filters and brackets, and tank
straps;
(n) Booster Tank, including leaks and supports;
(0) Prime Pump, including electrical wires, coupling, switch, and valve
discharge;
(P) Plumhing and Gales, including leaks, brackets, bleed Valves, control arms
and knobs, and linkage;
(q) Main Pump, inclUding vacuum tes~ pressure les~ paclring, clappers, and
mounting;
(r) Pump TranSmission, including fluid levels, seals, shift motors, and manual
override;
(s) Aerial Ladder, including power takeoff, drive shaft and coupling, P. T.O.
activating device and outrigger COntrols;
(t) Aerial Operation, including engine RPM., hydraulic pressure, operation of
all controls, warning devices, hoses and fittings, rung COvers, ladder locks,
and ring gear;
(u) Aerial Platform, including lubrication, platform leveling, electrical system,
turntable and platfonn controls, COmmunications, and water tube.
The above inspections shall include, at no additional labor charge, the changing of
all spplicable filters and fluids used by the unit being inspected. Air filters shall be
Changed on first inspection and then yearly thereafter. Filters and fluids shall be
4.
tmed! at 0iJ1St pllis 25%, as pre~nkmsH)F described JlJrl Secdcm 9 of tJhli8
AGREEMENT.
Upon comp~etioh1 of afwpectioll ;2 -computerized report vviU be forwarded to the
Captain. of Support Services indicating dl!.e status Df the items inspected. TIllS wm
be done for every vehicle when Preventative maintenance is performed Dn the
vehicle. This repmt must be ~maiied to the Captain Qf Support Sexvices at lubert-
peter@monroecounty-fl.gov. The form mu.st either be in Microsoft VVord or ---
Excel.
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12. WEEKLY MAINTENANCE SCHEDULE - CONTRACTOR shall provide to the
DISTRICT a preventative maintenance schedule that can be perfDrmed weekly by
the individual Volunteer Fire Departments! personnel.
13. M..lUNTENANCE WG - CONTRACTOR shall maintain an inspection amd
maintenance chart on each vehicle containing at least the following information; -
~
(a) Date QfperfQnnance, (d) Parts used,
(b) Apparatus serviced, (e) Name Qf service person(s),
(c) Service performed, (f) Total downtime of vehicle
A CQPY Qf this chart shall be supplied to the Fire Rescue Office within 30 days olf
the service.
14. COMMUNICAnON ~ CONTRACTOR shall maintain a telephone or paging
device such that prompt nQtification of request for service is PQssible twenty-four
(24) hours a day.
15. RESPONSE TO SERVICE REQUEST ~ CONTRAcrOR shall maintain itself in a
state Qf readiness during nQrmal working hours, 8:00 am - 5:00pm Monday thru
Friday, and shall respond tQ the IQcation where emergency repairs are needed
within 12 hQurs of receiving a request. For repairs required after normal wQrking
hours, CONTRACTOR shall respond to the locatiQn where emergency repairs are -
needed within 24 hQurs of receiving a request.
16. CERTIFICATION - CONTRACTOR shall prQvide evidence satisfactQry to the
DISTRICT that its personnel who pedorm maintenance wQrk: are certified in pump
mechanics, general mechanics and repair.
17. QUAliFICATIONS OF MAINTENANCE PERSONNEL _ All persQnnel
perfQnning maintenance, repairs, adjustments and related work on MQnroe
County equipment shall be a certified fue apparatus mechanic Qr Qtherwise
certified fQr the wQrk tQ be performed. Personnel perfQrming work who are nQt
certified Qr experienced in such work shall be directly supervised (in person) by
an individual with such certificatiQn.
5
)U3/r KN])m\1[I"TJUFKCAT~ON " COl\rrJ[U-'1CrO~ sh81nn JUmdem]jIJi(l' 8!Il]d hoM ~rae DlS'JrJlUClr
8@d] MOJi]Kile Ci!Ji\!.lllffi~Y hm1i1ill.!les8l fm @Eny m.eg]ngem.ce ()Jj]]I. ntfl pEr[~ Of fa~dty (liX' J1mRJlJ!'Oper
woiilrnmcmgfanp, few an wC~fk peITOrmI1K;d! 1!]IT1der tllis cont['@.ct, mdudmg aU costs of
oonHectioKil, reasomabHe attorney fees, daim costs, alilrl a~ per ';Attad.1ment B;'. AU
pJl"Opef~Y Of equrrpmeJl1t ~~mg dill'ectly M?1imtl.ili:ted or repaire~ by CON1ffiAC'I'OR
shaRi be considered in its care, custody, an.d contml while such work is in progress
and until physical control of such property OE' equipment is restored to the
DISTRICT. -.-
19. LOCATION OF WORK -This contract is for mamtenance offlre fescue vehicles
located at the foHlowing sites:
A, Stock: Island JP, Monroe County Fire Academy (Marathon)
B. Big Coppitt G. Conch Key
C Sugadoaf H. LaytOIfl
D. Cudjoe JL Tavernier -
-
Eo Big Pine
20. ]INSURANCE - During the term of this contract~ the CONTRACTOR must keep
in force and effect the insurance required by Attachments e". Attachments C" are
attached and incorporated into this contract.
2:t ADDITIONAL REQUIRED STATEMENTSNER1FICATIONS/AFFIDA VITS.
Attached hereto lin. "Attachment D" are Public Entity Crime Statement~ Non.-
Collusion Affidavit, Ethics Clause, and Drug-Free Workplace Ponn ,
22, PAYMENTS - Payments for semi-annual inspection, preventative maintenance ,
and pump tests shall be made by the DISTRICT within 30 days of the completion
of the rendered services on each vehicle and proper invoicing by the
CONTRACTOR. All unscheduled maintenance and repair r~sulting from
equipment failure or malfunction requiring service shall be billed by the
CONTRACTOR at the applicable rates as specified in Section four, five and six of
tbis AGREEMENT. The CONTRACTOR upon notification by the DISTRICT of -~
an equipment failure or malfunction requiring unscheduled maintenance shall, in a
timely manner investigate the problem and provide to the DISTRICT an estimate
of the cost for repair and vehicle downtime. The CONTRACTOR upon receiving
authorization to proceed from the DISTRICT shall effectuate such repair; upon
completion of same the CONTRACTOR shall notify the DISTRICT of the out
come and actual cost. The DISTRICT shall issue a separate purchase order for
each occurrence of unscheduled maintenance and repair.
23. Monroe County's performance and obligation to pay under this contract is
contingent upon an annual appropriation by the Board of County Commissioners.
24. Venue for any litigation arising under this contract must be in a court of competent
jurisdiction in Monroe County, Florida.
6
Xl\! 'tVrfN1ESS 'WlftERIEOF, each pan"ty hereto .ha.g caused thils contract ~o 1iJe: execm!ed! by Jits
QU]y authorized n"ipres';:Ki\l:ative.
BOARD OF GOVERNORS FJIRE
A1\ID AJM[lBlUlA.l\JCJE DlfS'fRICT 1
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'<~:~. .~~~t~l:J~ailnY L Kolhage, Clerk
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Clerk #~/"o!~s -
WITNESS:
Fire Tech Repair Service Inc.
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Authorized Representative ----
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LocatR@Ii! Vehicle Description
Stock Island 1990 JE~One Pumper --
1994 .southern Coach TankerflI1mrnpelr
Big CoppiU 1983/89 Ford Rehab Unit
1990 E~Orue Pumper
1999 Southern Coach Pumper
1978 LFRNC Pumper
Sugadoaf 1993 Boardman Triple Comb Pumper -
-
1986 Chevrolet Rescue Pumper
1981/1998 Saulsbury 3000 Gallon Tanker/
Pumper
Cudjoe 2003 Pierce Pumper
Big Pine Key 1989 Young Pumper
1981/1998 Saulsbury 3000 Gallon Tamter/
Pumper
1996 Dodge 3500 Brush Truck
1985 AMGC 6 x 6 Brush Truck
Marathon Airport 1997 E~One Ford 450 ARFF
Monroe County Fire Academy 1985 AMGC 6 x 6 Brush Truck
(Marathon) 1978 LFRNC Pumper
1978 LFRNc Pumper -
Conch Key 1989 Young Pumper
1981/1998 Saulsbury 3000 Gallon
Tanker/Pumper
Layton 1992 E~One Rescue
1990 E-One Pumper
Tavernier 1992 Saulsbury Hose Reel Truck
1988 Spartan Rescue/Pumper
1988/2004 E-One Aerial Platfonn
2001 Pierce Pumper
1992Ford Rehab Unit
! t.K~{i I!til5~ii.l"
..~~ [vII(Q)NIJ?l@1!t <CCD.llUN1rWg W!L(Q)~IDlA
!RillSK ~A<<;IMEm
fOlLRCW AND PROCEDUUS
CON1rRACT ADMINISTRA nON
MANuAL
--
KIilHlil(iSml!llm~:1iti.@liB aod 8@M. &arm.Hea
row
Othelf Cll'lllll\traet@n allild Sns!Dc@Jl!ltnet@!ffil
TM Contractor CCV@wmtl'J and apees to inde~ amd hold harmless Monroe COlWty Board! of
Coumy Co~ hill.,," and all claims 10r bodily iqjury (iDo~ death). _na! "yUfy,
and property <Iamogo (~ pro~ Owned by Moome eo...,. and lII\V otbloi' 10...... --:;..;
dam8geo, and el<peDscll (incIudmg attorliJIlYs &es) which am.. oUl 0 In COIlIIcctlo" with, or by -
reason of services provided by tbe Contractor or any of its Subcontractor(s) in any tier,
occasioned by the nePJence, errors, Of other wrongful act or omission of The Contractor or its
SubcoDtmctors in any tier, their employees, or agems.
In the event the completiom oftbe project (to iaclwte the work of others) is delayed or suspended!
as a. result of the CoBltmctorBs &ilure to Iollrebase Off maintain b required imurance, the
Contractor shall iH1demnity the County m my and all ~ expenses resulting &000 such
delay.
-.. The first ten doUan ($I()'OO) ofremWlemtion paid to the Contractor is for the indelnll'lfficatwm
provided. fur above.
1m, extent of liability is in no way limited to, reduced. or lessened by the insunmce requirements
contained elsewhere within this agreement.
.
- ~
-
yeS
AdminislraLion rnstruai(Jn Attachment B
#4709.'
,~
;
li ~}.~;j 8,r3IjU~fr3
IffiJl~J1;f: lMIJLRJA~ ]Ef%1lEf'\f'lI'
1F(D!LlI<CW ~JD) J?JRcnXCm;}IDOJlIDE~
(1):Q)Nlrr~i~C'F Jdi)fi1fm~m5\1rJltA\ 1Tl[ON
MANlJAIL
G@:H1J@lNi!S Jlllll$!Whlll~e Req !!ll6lfemeJlllt'$
- f@lf
Ot!Jn@1i' C@l!iltn€t@n mlllJd SWb€fllllltE'll(\;t@n ---
As a pre-ooquisite oft!liil work g01lelMll, or the 8QOd$ =Iied under this coJJtr8ct (irlobl;"ll the
pre-staging of ~ aDlIl material), the Cont.actor obtain, at hiaIIrer own ~
insurance ~ in any a_bed scIIeduIes, 1Nhicb are made part of this coli1r&:t. n,.,
Coillmlotor - tIlat t!liil m...r_ obtained will ~ J>fOtec!jan to alii S"""OIlimoIors
""88I/I1i<I by t!liil CoiD!ractor. As....~. the Cooimcto. ma,v te4uire alii S~r. to
obtain ~ oom!stem with the attached scheduJq~ _ -:.,.:.
-
-
The C01llmctor will",,! be peuoitted to colilllleJoce WOrk 1IO-..ed by this CODIract (includinll pre-
sta&ins of""""""", and ~:ril satis&ctory eoideJiee of the ooquired iIIsurance has been
furiiisiie4 to the CcnnIly os spec' below. ~ in the colllll1Olll:ement of work, ""'"::If Will
tbe fiIiIure of the CoDtnctor to J"'>\Iide satisliRGtmy ovicIeuce of the ooquired insnraoce. ""I
oxtend deadIiues specified in thiS co1llmct aud lII\lf ~ and liIiIure to Jl<lI'fi>nn__.
sbaII be ~..... as iftbo _rlt co~ on tile specified date and time, """opt Ibr tbo
Comracto s:&iIure to provide satismctory evidence.
The C01llmctor sbaII ma;,wg" the ooquired inanrance tIuo~ the entiIe femt oftlUs _
aud ~ specified in the attacbed ~ F ... to comp(v witIa this pro1lision DIlI\Y
result "I the inDDediat., SUSpensIon ofaD Work 1DJtiI the ooql!ir!:4 ~ ..... been ~ or
replaced. ~ in the completion of work ~m the liIiIute of the CODlractor to
maintain the '!'luiml insurmcc shall ""t e1ltend apec/&d in this conlract and lII\lf
penalties aud fiIiIute to ~rm --...m.. sbaIl be ~sed os if the WOrk bad ""t been
suspend~ except tOr . Contractor's &ilure to maintain the required insurance.
-
The Contractor sbaII provide, to !be COIlllty. as satis&ctmy evidence of the ooquired inaumnce,
either: u
. Certificate of Insurance
or
e A Certified copy of the actual ~ policy.
The Collllty. at its sole optioll; ..... the right to request a certified copy of any or all insurance
policies req~ by this contract.
AU ~licies must specifjr !bat they "'" ""t subject to ClbIceIIation, non-renewal, material
change, 0.. ction in coverage unless a minimutn 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 oot be construed as relieving
the Contractor from any liability Or obligation ".1IIIled lUlder this contract or imposed by law.
Administration lnstr'Uction Attachment C'
il4709.5 1 of 7
8 ~;-~~J [2eD~~!J:D
"!I'l]t& I~Jrr'1J)m't!J!& (;<!1)[Il@~Y BQJ)&i1i'dl of CQ))mJl1i.y C(l}\1ffimr1i.8~<<i))IT:8ll.s) fr~B €;?rn~n:QlY@~8 2!Ji.R@ <Qila3iQ;';~ '~i1r[j!IlIb~ Q~~R\ill'~(;d:
@s ,oA@Qlfi~:i(\))~ ITJj'~@rllm 6]J]ffi &nll1l Ei:D1lill,~11@8p &J~@jpJ[ 1RQ)!f %V@llJk~J[ffio C(!JnDmp~JimKi[@lllio
Almy oo~~wm lfrOlill ~ra~~g Gs;E1'1~ll'Mill KmmF8Um~@' Req-wre;:lOJW!1~Zl m\OOt b@ 1l'€;)ltJl~&~edl W w-&furn~ ~lQl ~h@
C"""'-y prop-olllIDm ~ "Jm.'iJ"'&~ ff,w 'lJ'lf!ll"'e~ @ffhlo"""llD<e@ R..<II"ilr."@llDlto" ""'<I ~jlll''''''oo
by M!GM'@@ C@ooty ~Jk MSllll\~lg~~J.Ol~o
._-
. ..
-
~
Attachment C
2 of 7
AJministration ltIslruction
#4709.5
~ ;r:'~'~:~h E~jf!d~r~r;..
KlICDr1W~(D)Et Cq))GJFJJTW\l ]FrL(QlfHillii1JA
iRill~OC [\1ITM\iJA<(;iMfJEr~
IP@lLK<CYf !U~]] Ir~@CIl!;IDJ~~
C([jlN~C1l ADMllNIS1l1ltA'lEON
MLAJ.\nUAIL
W AlfVER €O' 1IN~URANCE REQUIREMENTS
.-.-
.
There will be time$ whe@ it will be necesmuy, OlL' in the best interest of the County, to deviat~ from
tire mmdard ~e requirements specified within this manuaL Recognizfug this potell1t~ ood
acting on the advice of th,g Coumy Attomey, the Board of County Commissionm has gnmted
authorization to Risk Mamhgement to waive and modifY various ~ce provisions.
Specifically excluded nom this authorization is the right to waive: -::...;.
~
0 The COUDllty as bebllllBamed as _a Additiolllal Illlsured _ If a letter from. the Insurance
Company (not the Agen.t) is presented, stating that they are unable or unVl!illing to IWime
the COWlty as an Mditionmll Insured, Risk Management bas been granted the authomy to
waive this provision.
and
liD The Iodemrmiftead@1Ili and Bold Bmnrmless provisions
Waivin, ofinsma1'\t"!e orovisions could. e)(pOse the Connty to economic loss. For this reason,
every attempt should be made to obtain the standard insurance requirements. If a waiver Of a
modification is desired, a Request for Waiver of III!lanace R.equirememts form should be
completed and. submitted for consideration with the proposal..
After consideration by Risk Management and if approved, the fonn will be re~ 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 depy the Waiver Request~ the other party may file an appeal with the
County Administrator or the Board of County Commissioners, who retains the final decisi()lf]1.
making a.uthority.
Administration lnsrruCl:ion Attachment C
#4709.5 3 of 7
19;jl;j E:ili~nM!
a:; lli:f:J1ElFU.01 ILIL~1lli..li'1f'V
IIT'1$iIJlWJti\YCCIl1: nndQl1lm1~KMI1EW1T'3)
W\QJ JRl
CON'lI'l{>>Jt.C1r =
lHHE'nVEEN
MONROE COUNTY~ FLORIDA
AND
--
y
Prior to the commencement of work governed by this contraICt9 the ConmwtOE' shalJl obtain
Genem1 Liab~ Ins_. eo-age shall be ~ throughout too lire of the coll!ract ami
irJ.clude~ 8$ a minimum:
e Premises Operations
Products and Completed Operatiom -
I!l -
e Blanket Contractual Liability
E> Personal I$ry Liability
Ell Expanded Definition of Property Damage
The minimum limits acceptable shall be;
$300~OOO Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable shall be:
$100,000 per Person
$300,000 ~ Occurrence
S 50,.000 petty Damage
An Occurrence Fonn policy is preftorred. If coverage is provided on a Claims Made policy, its
provisions should include coverage fur claims filed on or after the e1Il:ctiye date of this contract.
In addition, the~d fur which claims may be reported should extend fur a minimum of twelve
(I2) months fo owing th,e acceptance of work by the County. .
The Monroe County Board of County ComnUssio""lll sbaD be mmcd .. Additional Insured on aU
policies issued to satisfy the above requirements.
GLI
Admi llistration Instruction Attachment C
#4709.5 4 of 7
R ~'1~(il l1@nhi~B
\/1EJBIITCCILlE JLJlfl~JI1LIT1I'l{
lJI0~1JJ1illJlJ\I em: ~(Jl([JITJRSlEI\liITI1N1rf]
WQJ)~
<C<<:DN'ITJJlh<CT ~
BETVVEEN
MONROE COUNTY9 FLORIDA
- AND
--
R€lcognizing thm€ thg work gov6~d by this contract requires ilie use of vehicles, the Cc:m.tmctor,
prior to the commencement of WOi'~ shall obtmin Vehicle Liability IDSWCmce. Coverage shall be
maintained throughout the life of the contract and inelude~ 00 a minim.~ liability Cov~age foIl':
0 Owne4, NonmO~ and Hired Vehicles -:.....
-
The ilninimum limits acceptable shall be:
$100,000 Combined Single Limit (CSL)
If split limits are provided, the minimum limits acceptable sba.ll be:
$ 50,000 pel!' Person
$1 00,000 ~r Occurrence
$ 25,000 roperty Damage
The Monroe County Board of County COmmissioners shall be named as Additional Insured on all
policies issued to satisfy the above l'equirements.
.
VLl
Administration Instruction Attachment C
#4'109.5 5 of 7
i .~>).~,~ ~id~hd~E.~:
'W(Q)lPl1I:&JEh~3g CC(jJ)]MIWn1f,j'@\&1TI[r[j)l\l
IIPJt)TIJ~CClE IPJn:~ID~tMr~I'\Jll~
Wi[!) 1ill,
(:(j]W1rJR!.AC'JI'
]ffiE1'WlEE1~
MONROE COUN1I1f9 nOmTIJ]A
- AND
---
PriQf to the C(\l~l!'U:emmt (Qlf work governed by this tOll1tyact~ tire Contlmctof sh.d obmm
Workelfs' Compensation I!IlSU1rmce with limits sufficient to !respond to Florida StatUlte 440.
IlDl &ddilio~ too Contractor sball obtain Employers' Liability 1!mmm(bj~ with !limits of oot les$ tmm:
$100,000 Bodily Injury by Accident -.....l.
$500,000 Bodily In~ury by Disease, ~1icy limits -
$100,000 Bodily Injury by Disease, each employee
Coverage shall be maintained throughout the entire term of the contract.
Cov~e shall be provided by fA company or companies authorized to transact business in the
state 0 Florida.
If the Contractor bas been approved by the Florida's Department ofLaoori> as an authorized ~lf..
insurer, the CoWIty shaU Il'eco~ and honor the Contractors status. The Contractor may be
required to submit a Letter 0 Authorization issued by the Department of Labor and a Certmcat@
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!
Attachmnet C
Administration Instruction 6 of 7
#4709.5
f
i
"
t B'?~:, EJB~(:~JU
R1IT@[z]{glQ)rn; ~@OJk~1f\) Wlt@iilllIDL-Q
~~tID@@€ !W@TF 'WWMJfu~@lJ'
@ff
IlI!iJ@~mlIit~ ~~U1lf!M!!l\ll@!iI!1~
I' i. '"'1- !bot !be i._~ ...........n., .. .~l&.I .. lb. C....IJf. s.~....'" on......... Requi_...",
D(g waiv~ tw lillll@d1illi.gd aail ftHD@ ~H~@wiB'n1 ~anUri4r'
Coo.~r. Fif2.6.. - T tI!c!'i R.$pJf/ IlL. S ~0Ct: :::t:/i}f-.
Ca@ftl!;!! ~ll': r;s12..e.- APP;f~ru<c .IJ?J9//llrd:;elflI'VCf:-
Addll'~ofCG@~ao~ ~o_ ao:'" I ho "
~
_.~ 1<~'1 L." ~" I t<L ~()3"). -
-
Piuaoe: ':?aJ:. 79~" J7'9' / .:?t.tr... S1..2.. - <<;$PS'R
.
SeopeafWoll'k: _;<1:( A/7l!JVAAlC€... "-'" F' J}ee., fU.,e<-t If v It /IleuS.
~ '
~ 1br WmiVf,lr. . _": -:::.I! PO "''''P(o;,,(~ - 'VtJ!ZK IS ~/lF~b .11?, ~
P"Uclos Waiver =Mly ow4J~s. Am:, .!:'1.AI~~M.S ~
f.Jo/4<'.t1?~/V'5 ~PJUU.ShT/bA/
will apply 00:
Si8ll01u".feo._ - ~ ------- =
Appmved it ~
Not.A.pproVed
Risk Manl!lgement rn ~j ,
. p~ " n
R :6.:YO-; -
Date
.
COUlBty Admiojsb'ator appeal:
Approved: - Net Approved: -
-
Date:
Board ofCounly Commissioners appeal:
Approved: Not Approved: -
.\.fe~rirt8 Date:
r\dministlatian lnst.ructian Attachment C
;14101).' 7 of 7
IF'TD!J1rLLlI~:: TItr~f1TTI'ln:r q:;JIDJrr%~ 8nrA 'lITJ',lNflIu~M;'1T
(' t "'~n' t -" I\"ru", r~ ~~ - M." , '~A=..Il~ W . e. nn. .~ e. n.""JJii
"J'i1 )Y5-lJ8Dilill i[~? &lfiLl]ill'!@ Uilill@1 !.l!!2illl!J@@Iill fiJi;@~,gm tUill! ~g Gnill!m!@tie'4ll Vltil!.i3.\!llWJ' ul!l]ll !l@U @WUiJ. ~ ~WllQ,'l\Il@illlllmJ Ifllw ((;:
omuliiiy """'. -, OM!! lliIl~ " IOOO! "" m ~ .. ~ "", ~ M 00lM""" .. "jli1!Iiolie ...~lIJ" '""'tV
lill@:~ ~mrnii~ @ lhMl @ill @, OO~~ wmiRll:n &! W-lI.H@' @i!J!fii1ty fM HOO OO~moo l!)\r ~ (ME' ~ nmbUlk; bmi~ @'J'
)j5)tdfJ:DJIk; Wi'@~ liIID&y Wl@~ ~1lll_nfr bneis @!iii R~~ @f refill pmp~ to ,ubH~ M\bi~p lWiy OO~ be ~wme@l @11'
peri'o.rm w~llk &E &J, OOilll~ltol!'p nppOOrp m~~!l'o ~ oonmllimt -der i! oon~ \llflith .Y plllJbBi~
~fi1tity~ mmd may not ~fiIDt inmmeu wi~ mily punblic ftllt!ity m €mQfliS @ffhe threshold Im@wt pi'@'lflldelil[
fuID ~$fi 281.@R1/p f(!1lCA'fOOORV TW01 (@if a pm~ @fJ' IlIfIllOOll~ inm d!l.e ~ @f~ JP~ '@fill
ft~ OOlmvi~red 'lfeiRdOll' llimt. Cl
By SBgWnj ooD@w II $cbawRedge Rimrc H awe Ifeiild aM mullemtm1d the aOOVf:aJreferem.cedl stat@Jmllelllt
STATED!' TL<..~t!dJ.&. pe JL~ J{f4f7~t:~..)
(Siaruture ofBi , ~C.
COUNTY OF ;110 " J'/"J~ 11- r --eJ <;-
Date
PERSONALLY APPEARED BEFORE ME, the undersigned eufuorityo
_f20 n c: rl G u I-~L -e 'i. ...u, -lim beiug __ by..... (fiame of ilI1dividuml
IripmB) 3fih~ his/her mipamre in the space provided above OD this
1--1 t h day of () 0 V e: r'r)\!3 -e r -8 20 0..s - .
a /7 /J7 0?/ kt-:> ~"'" My commission el<pires:
N JUly PUBLIC
t/
JEAHNHE M. COOK
~'I'IJiIIc. ~ ofFlodda
-., 1I,2DG7
CammfII;Ian" D01107CD
BcndICIIIVNaIanaI AllIn.
Attachment D
1 of 4
f:~(l)i~~(C;'.dJ)IlJl"j~~llil]!0 ~\1FW ]l1})Jt. Wll.'T
",-,
'/ ! =~ {
E.=--/~.odl G~..r'O;;~~~==~___ =~~-~~,~ "-- =-" @(f ~@ @lllW
~
of ~&v~::'tUtEe- ~~ . - ~it:@f@Wag t@ Hffi~lr onn lTIffiJf @81ltrm~ _ M~f1'
~1W@1f~?p ~\OO@!illlil@ ~y ~
.lb !~" ,,p Ii'b-r.-<<t. ~PS"'~'?e~"~~DM~~fu,
~~~~~~f@ie~~ . _ _
~)~dI1.g g. dF )'ftrMr~-('(\ k;T1' ~- ~.~4-;/19-irt/il::' Vl">h,-dtsct. RuQ-r~(>; -~l,l~fJv;t:,
2) n.. pica in I!Us bitII haw !10m -..... lit ~y vril!rcut ooIhJoi.... -ulla2i....
~..._.....~"'~~"" iI>_-"""'IiDs 10>_ -",...
prilCei with my~~~widi -,~ -
3) UnIon othawi&e ""'IUrimd bjr law, die prica which have '- quoIiod in lido bid have IllOI
....... knowinaIY diackJoed bjr iIIo bicIcIor lIIIIIII vrilllIOIllDowiualJr be ............ bjr .. bi4cIo. priOJr fill> lIid
@~ ~y Of' ~YP to my o61er bidder Oli'to Iny competitor; ad!
4) No............. """"'..... "" will be ........ bjr tlieloiddo.r eo iDduco _.....-.....
~ or ............111> lI1I1Joalt" .... _,., lHBlnnit. ..lIid ... die pIDpOse "'~ ~
S) n.. ...........1lI_1ailIIIIIII in I!Us allIdavit.... _lIIIIIII """'""" lIIIIIII..... wiIh fidI ~
tIIIat M_ Cuooay.... .... Olio: ....1Ii "'iIIo.--.. -iIDIDed In lido alIidavit io ..-.
contmcts fur u!d ~ect
. ~ -: ,-Y---t;<k../Taf>-.)
STATEOF fiorl~
(Sipatum 0 Bi
COUNTY OF }1z O71ro"t... 11-7'-r'J~
Date
PBllSONALL Y APPBARBD BBFORB ME, the undenigo.ed authority,
r-T -t- J-t:. who. after fiat beinc S'MJmm by me, (D&me ofiodividual
l.iipio,) dhed hi&Jber si~ in tlpace provided above H ..
~+h n _
day'" . Q \Je.d .20 15 S "
~ n /J??U/M,? (;, " My--.... ezpiRla:
OTA.RY PUBUC
-17--~-__
..vAN_ II.; COOK
OMB ~ Mep FORM #1 Ncbv ",-. .. GfFlolfda
2tI07
~fJDD1101OI
1ozIded. NaIoIIlI1~-.
Attachm.ent D
2 of 4
!Sv:;fIWill1f;J' 8\'ITA'ITLfR@l?,Ii'J'IT ill]'iJ1IDlEuT:.; @EfJflDillNRJKjCC~LZ :!i::J'Q)o ll@)o,l1q,~"S@
k0IT@lNh~@l2; OOIDj!~TIFYfD TIJ11@TIUlIDliA
gH1~Cill <Clk.4JlV$ill
.f1.oiA ~r"- c. 6<.> f' {IE"? _ _O$io IMllOOiJi! _ _ ""'I'io;w<>lll., ~
@!!' i!lltlll~ l!uM!t ~ 00 11lWftt!il ~!lmMf my fliMlMler ~ty @!ficer 00 empRoyee in mlmoo @f
Sfddo@ 2 @f~ N@~ !6J=,H9M ~ mmy ~ @ffi~ @If empw~ MIl vi@~ €it .__..
f.
~ 3 @fOMnM~ N@~ lo..ll990. 1100 b~ @ii'm@hMi@!m oftbU ~ioiR. ~
Jm&yp Bml i~ ~@m.;; ~iiil1uUe ~ eon~ without limbilliy ad mmy., m _ _~~
'"
",ct &om the OOI!~ @If ~~ pnlOOg or @th~ mooverp ~ ftill.~o_ @f.y fecp
eommiiq~ ~o ~ ~ ~~oo paid to the ftwmer Coumy ofikeJr Of' empJo~. -0'
;:(~ ~~----ft(-r./T,;rr.)
Due: / 1- Y'" -0 ~
STAtEOF Ft.e>rtcOA,.
,
COUNTY OF f/?I c!>n ra e
PERSoNALLY AP'J!ARm) BEFORE ME, the 1IDdenigoed autbodtyt ..
~D (l Cr. 13 II r- 1-... 'j.. who, alWfint beiog _ by iDe, ~ IdoIhor
sDpa!Um <name ofindividull'lipina) in the space provided above 0I11hia 1-1 -th day Olf
20 os:
My ccmmiuion api:ral:
.EANNINE M. COCItC
e:g---"-
OMB - MCP FORM 114 · .. :e.' . ~DOJClnl.~7~
~II __
IIandId NaIcIrIIGII. . AB\
Attachment D
3 of 4
llDW)U}(fY- rj'F!)H17 '\~"U(r'j)F0j7!}!)H ,0\(["19' l'3J([l1F'IT0'il
uu .i d..J:=.J.....1. ~....::.._;~~.!..;:U IV ~ ~\.:..:.:..i:~ ~L:. .~ ,f~..J. _~~.-....'\
, ,
~ ~ ~ ~ ~~.""=..L...--- .~=.-..-~ _ .- -,=
1tl1@ 1lll!Jt~@r~~ '!f~li' full ~ w.ril@a Wllm_ Sw.~ &;$1.@iO' ~fuJy ~lii1!11ffioo ~:
;::;/~ ---reef..- [~pA-tlr ~F\I/C~ --
{-14-
(Nam@ ofButrineu) "-..-
1. hhlish Ii ~ ~ &mpl@~ thma the mkwfu1l mmn~D dWin'buti~ ~i9
~-... m' 'Wlle ef 6A ~ ~ u prohibited. . wodp~ tmd ~~ the ~~~
~ win be ~~ cmpi@~ _ <W€lllmmu ofsmd>> pmhibitiw.
2D Iof4rnn ~yeeI ~ ~ ~ @f -. ~ iml die w~ . ~igs 1Nik'.w @f
R1l1If.\~.1 & ~ ~ S)" ~ 6.'i!iI ~",~ ad ~
~ IiftllIfWlMB and die peaaI- thatmaJ be impoM upmB emp~ tmr fig ~ vio~"
-
--
:I. Give each employee coppd m. ~ d:te otmIlmOOitiu or ~ ~ tbu am ~ bid -
ti copy or the statement speci8ed in subsection (l). ,
4. In dHlmtatemem ~ m ~ (Jl). W!tify die employea thmt, U & ~ ofwcd:DS 00.
€he ~ Oi'~Q~ ~ dW Ie"'~ the ~ wiD ~ bydHil temu of.
~.. wiD ~ the emp~ of., convietiom 0( (V pia of piIt.y Oil' DOlo ~ ~ amy
~ of~ m (PIeri"~) Ql'ofmycmD:olWlU~ law oIebe Ulmited~ oray
state. fOIl' a violati.mm ~ in the workplace 00 later thm fivCl (5) da)'lll after lmCh a:onvietioo.
S. ~ a ~ OB" << ~ eb= -ti~ ~ in 1I .. mbue Uli.~ Of
reMbilimtiom pmpm if lmI!:h is ~Ie hi die ~91i1 eom..i....js,y. _ my emp~ wOO is m
~cW.
'"
6. Make a good faith eftOrt to comimIe to maintain a dmg.fiee workplace thmugh implemeJ1tatiolll of
this sectiOIl.
Am * ~ R~ m RP ., ~ I cerdifg dud dais &m complies ftIUy wida tM mbove
~. ~~~~~r_/~~~)
.
Bidders Sipatm'e ,
11- Y' -as-
Date
OMS - Mer FORM 1#5
Attachment D
4 of 4
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