09/22/2023 Agreement Monroe County Purchasing Policy and Procedures
ATTACHMENT D.5
COUNTY ADMINISTRATOR
CONTRACT SUMMARY FORM FOR CONTRACTS $100,000.00 and Under
Hammerhead Termite
Effective Date: TBD
Expiration Date: Within 00 days of Commencement
Contract Purpose/Description:
Harvey Government Center-Termite Fumigation Tenting
Job Location: Harvey 01overnment Genter 1200 Truman Ave, Key West, FL 33040
Contract is Original Agreement Contract Amendment/Extension Renewal
Contract Manager: William De antis 4�7 Facilities Wintenance Stop C
CONTRACT COSTS
Total Dollar Value of Contract: $ 18,600.00 Current Year Portion: $
(must be$100,000.00 or less) (If multiyear agreement then
requires BOCC approval,unless the
grsm, o,d,eo,ka ,�m,auw c
E'd00,000 00 or
Budgeted? Yes❑■ No ❑
Grant: $ N/A County Match: $ N,/A
Fund/Cost Center/Spend Catewry: 0,01 -205{11 -00061
ADDITIONAL COSTS
Estimated Ongoing Costs: $ /yr For:
(Not included in dollar value above) (e.g. maintenance,utilities,janitorial,salaries,etc.)
Insurance Required: YES LINO ❑
CONTRACT REVIEW
Reviewer Date In
Department Head Signature: William Desantis
Patricia Eables Digitally signed by Patricia Eables
County Attorney Signature: Data.2023.09.19 16.4436-04'00'
Jaclyn Flatt Digitally signed by Jaclyn Flalt
Risk Management Signature: Date_2023 09 20 12 21 17-04'00'
Lisa Abreu Digitally signed by Lisa Abreu
Purchasing Signature: Date_2023.0920 14 19 44-04'00'
John Quinn Digitally signed by John oulnn
OMB 1T/gyp) Signature: Date:2023.0920 1523 05-04.00•
Comments:
Revised BOCC 4/19/2023
Page 84 of 105
M N RO COUNTY
BOARD OF COUNTY COMMISSIONERS
REQUEST FOR SERVICES
FOR
H ARVE '" GOVERNMENT CENTER
TERMITE FUMIGATION TENTING
r
BOARD Of" COUNTY COMMISSIONERS
Mayor Craig Cates, District 1.
Mayor Pro Tina Holly Merrill R schcin, District
Miclielle Lincoln, District ?
.Tames K. Scholl, District
David Rice, District
COUNTY AUM11\16TRA OR
Roman Gastesi
Clerk of the Circuit Court Facilities Maintenance Director
ctor
Kevin Nl dak William DeSantis
/5/2Q23
PREPARED BY;
Monroe County Facilities Maintenance Department
Monroe County Facilities Maintenance
General Scope of Work
Job Name: HARVEY GOVERNMENT CENTER—TERMITE FUMIGATION TENTING
Job Location: HARVEY GOVT CENTER
1200 TRUMAN AVENUE
KEY WEST, FL 33040
Contact: Chrissy Collins
Facilities Maintenance
Chrissy Collins
Collins-ChrissyO.monroecounty-fl.gov
305—304-9722
PROJECT OVERVIEW
PROJECT INTENT AND SCOPE
GENERAL REQUIREMENTS
1. Project Overview
A) Monroe County ("Owner" or "County") shall enter into a contract with a qualified
Contractor to fu m i g a t e t h e Harvey Government Center located at 1200 Truman Avenue,
Key West, Florida. The term of this contract shall commence upon the date of issuance to
the undersigned by Owner of the Notice to Proceed/Purchase Order/Task Order or issuance
of a permit if one is necessary. Once commenced,the undersigned shall diligently continue
performance until completion of the Project. The undersigned shall accomplish Final
Completion of the Project within Sixty (60) days,thereafter.
The Contractor shall be required to secure and pay for all required permits, if any are
necessary, and approvals to perform the work which may include: Monroe County
Building Department, City of Key West Building Department,and any other permitting or
regulatory agencies, if applicable. Contractor shall include those permit fees as a part of
the Contractor's bid.
B) All quotes are due by Thursday,June 8, 2023, at 11:00 A.M., via email to Collins-
chrissy@monroecounty-fl.gov. All Quotes must state they will be good for one hundred
twenty(120)calendar days from submittal due date.
Page 2 of 52
2. Project Intent and Scope
Scope of Work:
The Contractor shall provide the following Scope of Work and provide all labor and
materials to Fumigate the Harvey Government Center:
• Treat premises for control of Drywood Termites
• Initial Treatment and Annual Renewal
3. General Requirements
A) The Contractor shall coordinate all activities with the Monroe County Facilities
Maintenance Department contact:
Chrissy Collins 305-304-9711 or Willie DeSantis 305-797-1250
B) The Contractor is required to provide protection for all existing surfaces including,
but not limited to:
i. Existing fixtures
ii. Personal Items
iii. Floors
iv. Vehicles and Personal Property
V. Landscaping
C) The Contractor shall ensure that all non-exempt employees for this effort are
compensated in accordance with all State and Local Laws.
D) The Contractor shall load, haul,and properly dispose of all construction debris and
materials.
E) The Contractor shall provide and maintain appropriate (OSHA required)
construction warning signs and barriers.
IF) The Contractor shall furnish all required work site safety equipment.
G) The Contractor shall furnish and maintain on-site material safety data sheets
(MSDS)for all materials used in the construction.
H) Construction work times shall be limited to:
Specified by the County
1) All materials must be approved by submittal prior to commencement of work.
Page 3 of 52
J) The Contractor shall provide a lump sum price by Thursday, June 8, 2023, at
11:00 a.m., via email as noted herein.
K) The Contractor needs to be aware of weather and location and plan accordingly.
L) The Contractor needs to be aware of the facility, its residents,and staff with unusual
schedules and plan accordingly.
M) The Contractor shall provide a safety lift plan for any crane/hoist work.
N) if applicable, Contractor shall provide paper or electronic copies of all original
device specifications, warranties, maintenance schedules, shop drawings, pen-nits, repair
and maintenance contacts,and any other information necessary for the proper function and
maintenance of the equipment.
O) The Contractor shall provide a schedule for all phases of the project.
P) The Contractor shall coordinate all activities with concurrent site work being
performed, if any.
Q) Insurance Requirements:
Workers Compensation Statutory Limits
Employers' Liability $100,000 Bodily Injury by Accident
$500,000 Bodily Injury by Disease, policy limits
$100,000 Bodily Injury by Disease,each employee
General Liability $200,000 per Person
$300,000 per Occurrence
$200,000 Property Damage
or
$300,000 Combined Single Limit
Vehicle: $200,000 per Person
(Owned, non-owned, $300,000 per Occurrence
and hired vehicles) $200,000 Property Damage
or
$300,000 Combined Single Limit
Builders Risk Not Required
Construction Bond Not Required
The Monroe County Board of County Commissioners, its employees and officials,
1100 Simonton Street, Key West, Florida 33040, shall be named as Certificate Holder
Page 4 of 52
and Additional Insured on General Liability and Vehicle policies. A "Sample"Certificate
of Insurance is attached,which may not be reflective of the insurance amounts required for
this project but is provided for"informational purposes"only.
R) The Contractor is required to have all current licenses necessary to perform the
work and shall submit the Contractor's License and Monroe County Business Tax Receipt
along with its Proposal. If the Contractor is not a current registered Monroe County
Vendor,then it shall also submit a properly completed and executed W-9 Form.
S) INDEMNIFICATION, HOLD HARMLESS, AND DEFENSE.
Notwithstanding any minimum insurance requirements prescribed elsewhere in this
agreement, the Contractor shall defend, indemnify and hold the County and the County's
elected and appointed officers and employees harmless from and against (i) any claims,
actions or causes of action, (ii) any litigation, administrative proceedings, appellate
proceedings, or other proceedings relating to any type of injury (including death), loss,
damage, fine, penalty or business interruption,and (iii)any costs or expenses that may be
asserted against, initiated with respect to,or sustained by,any indemnified party by reason
of,or in connection with,(A)any activity of the Contractor or any of its employees,agents,
contractors or other invitees during the term of this Agreement, (B) the negligence or
recklessness, intentional wrongful misconduct,errors or other wrongful act or omission of
the Contractor or any of its employees,agents,sub-contractors or other invitees,or(C)the
Contractor's default in respect of any of the obligations that it undertakes under the terms
of this Agreement, except to the extent the claims, actions, causes of action, litigation,
proceedings,costs or expenses arise from the intentional or sole negligent acts or omissions
of the County or any of its employees, agents, contractors or invitees (other than the
Contractor). The monetary limitation of liability under this contract shall be equal to the
dollar value of the contract and not less than $1 million per occurrence pursuant to Section
725.06, Florida Statutes. The limits of liability shall be as set forth in the insurance
requirements included in Paragraph 3 Q. herein. Insofar as the claims, actions, causes of
action, litigation, proceedings, costs or expenses relate to events or circumstances that
occur during the term of this Agreement,this section will survive the expiration of the term
of this Agreement or any earlier termination of this Agreement.
In the event that the completion of the project(to include the work of others) is delayed or
suspended as a result of the Contractor's failure to purchase or maintain the required
insurance,the Contractor shall indemnify the County from any and all increased expenses
resulting from such delay. Should any claims be asserted against the County by virtue of
any deficiency or ambiguity in the plans and specifications provided by the Contractor,the
Contractor agrees and warrants that the Contractor shall hold the County harmless and shall
indemnify it from all losses occurring thereby and shall further defend any claim or action
on the County's behalf.
The extent of liability is in no way limited to, reduced, or lessened by the insurance
requirements contained elsewhere within this Agreement.
United States Department of the Treasury Indemnification
Page 5 of 52
To the fullest extent permitted by law, the Contractor shall indemnify and hold harmless
the United States Department of the Treasury and its officers and employees, from
liabilities, damages, losses and costs, including, but not limited to, reasonable attorney's
fees, to the extent caused by the negligence, recklessness or intentional wrongful
misconduct of the Contractor and persons employed or utilized by the Contractor in the
performance of this Contract.
This indemnification shall survive the termination of this Contract. Nothing contained in
this paragraph is intended to nor shall it constitute a waiver of the sovereign immunity of
the United States or the County.
T) NON-COLLUSION. By signing this proposal,the undersigned swears,according
to law on his/her oath, and under penalty of perjury, that their firm executes this proposal
with prices arrived at independently without collusion, consultation, communication, or
agreement for the purpose of restricting competition,as to any matter relating to such prices
with any other bidder or with any competitor. Unless otherwise required by law,the prices
which have been quoted in this proposal have not been knowingly disclosed by the
proposer and will not knowingly be disclosed by the proposer prior to proposal opening,
directly or indirectly,to any other proposer or to any competitor.No attempt has been made
or will be made by the proposer to induce any other person, partnership or corporation to
submit, or not to submit a proposal for the purpose of restricting competition. The
statements contained in this paragraph are true and correct, and made with the full
knowledge that Monroe County relies upon the truth of the statements contained in this
paragraph in awarding contracts for this project.
U) EMPLOYMENT OR RETENTION OF FORMER COUNTY OFFICERS OR
EMPLOYEES. By signing this proposal, the undersigned warrants that he/she/it has not
employed, retained or otherwise had act on his/hers/its behalf any former County officer
or employee in violation of Section 2 of Ordinance No.0 10-1990 or any County officer or
employee in violation of Section 3 of Ordinance No. 010-1990. For breach or violation of
this provision the County may, in its discretion,terminate this Agreement without liability
and may also, in its discretion,deduct from the Agreement or purchase price, or otherwise
recover,the full amount of any fee,commission, percentage, gift,or consideration paid to
the former County officer or employee.
V) 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.
W) DRUG-FREE WORKPLACE.By signing this proposal,the undersigned certifies
that the contractor complies fully with, and in accordance with Florida Statute, Section
287.087,the requirements as follows:
Page 6 of 52
1) They will publish a statement notifying employees that the unlawful
manufacture, distribution, dispensing, possession, or use of a controlled substance
is prohibited in the workplace and specify the actions that will be taken against
employees for violations of such prohibition.
2) Inform employees about the dangers of drug abuse in the workplace, the
business's policy of maintaining a drug-free workplace, any available drug
counseling,rehabilitation,and employee assistance programs,and the penalties that
may be imposed upon employees for drug abuse violations.
3) Give each employee engaged in providing the commodities or contractual
services that are under bid a copy of the statement specified in subsection 1.
4) In the statement specified in subsection 1, notify the employees that, as a
condition of working on the commodities or contractual services that are under bid,
the employee will abide by the terms of the statement and will notify the employer
of any conviction of, or plea of guilty or nolo contendere to, any violation of
Chapter 893 (Florida Statutes) or of any controlled substance law of the United
States or any state, for a violation occurring in the workplace no later than five (5)
days after such conviction.
5) Impose a sanction on, or require the satisfactory participation in a drug abuse
assistance or rehabilitation program if such is available in the employee's
community, for any employee who is so convicted.
6) Make a good faith effort to continue to maintain a drug-free workplace through
implementation of this section.
ADDITIONAL CONTRACT PROVISIONS
1() Nondiscrimination/Equal Employment Opportunity.
The Contractor and County agree that there will be no discrimination against any
person,and it is expressly understood that upon a determination by a court of competent
jurisdiction that discrimination has occurred,this Agreement automatically terminates
without any further action on the part of any party,effective the date of the court order.
Contractor agrees to comply with all Federal and Florida statutes, and all local
ordinances, as applicable, relating to nondiscrimination. These include but are not
limited to: 1) Title V11 of the Civil Rights Act of 1964 (PL 88-352) which prohibits
discrimination in employment on the basis of race, color, religion, sex, 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 disability; 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 drug
abuse patient records; 8)Title VIII of the Civil Rights Act of 1968 (42 USC s.3601 et
Page 7 of 52
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. 12101 Note), as
may be amended from time to time, relating to nondiscrimination on the basis of
disability; 10) Monroe County Code Chapter 14, Article 11, which prohibits
discrimination on the basis of race,color,sex,religion,national origin,ancestry,sexual
orientation, gender identity or expression, familial status or age; and 11) Any other
nondiscrimination provisions in any Federal or state statutes which may apply to the
parties to, or the subject matter of,this Agreement.
During the performance of this Agreement, the Contractor, in accordance with Equal
Employment Opportunity (30 Fed. Reg. 12319, 12935, 3 C.F.R. Part, 1964-1965
Comp., p. 339) as amended by Executive Order 11375, Amending Executive Order
11246 Relating to Equal Employment Opportunity, and implementing regulations at 41
C.F.R. Part 60 (Office of Federal Contract Compliance Programs, Equal Employment
Opportunity, Department of Labor), see 2 C.F.R. Part 200, Appendix 11,¶C,agrees as
follows:
1) The Contractor will not discriminate against any employee or applicant
for employment because of race,color,religion, sex,sexual orientation,
gender identity,or national origin. The Contractor will take affirmative
action to ensure that applicants are employed, and that employees are
treated equally during employment, without regard to their race, color,
religion, sex, sexual orientation, gender identity, or national origin.
Such action shall include, but not be limited to the following:
Employment, upgrading, demotion, or transfer, recruitment or
recruitment advertising; layoff or termination; rates of pay or other
forms of compensation; and selection for training, including
apprenticeship. The Contractor agrees to post in conspicuous places,
available to employees and applicants for employment, notices to be
provided by the contracting officer setting forth the provisions of this
nondiscrimination clause.
2) The Contractor will, in all solicitations or advertisements for employees
placed by or on behalf of the Contractor, state that all qualified
applicants will receive consideration for employment without regard to
race,color, religion, sex,sexual orientation,gender identity,or national
origin.
3) The Contractor will not discharge or in any other manner discriminate
against any employee or applicant for employment because such
employee or applicant has inquired about, discussed, or disclosed the
compensation of the employee or applicant or another employee or
applicant. This provision shall not apply to instances in which an
employee, who has access to the compensation information of other
employees or applicants as a part of such employee's essential job
functions, discloses the compensation of such other employees or
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applicants to individuals who do not otherwise have access to such
information,unless such disclosure is in response to a formal complaint
or charge, in furtherance of an investigation, proceeding, hearing, or
action, including an investigation conducted by the employer, or is
consistent with the Contractor's legal duty to furnish information.
4) The Contractor will send to each labor union or representative of
workers with which it has a collective bargaining agreement or other
contract or understanding, a notice to be provided by the agency
contracting officer,advising the labor union or workers' representative
of the Contractor's commitments under section 202 of Executive Order
11246 of September 24, 1965, and shall post copies of the notice in
conspicuous places available to employees and applicants for
employment.
5) The Contractor will comply with all provisions of Executive Order
11246 of September 24, 1965,and of the rules, regulations,and relevant
orders of the Secretary of Labor.
6) The Contractor will furnish all information and reports required by
Executive Order 11246 of September 24, 1965, and by the rules,
regulations, and orders of the Secretary of Labor, or pursuant thereto,
and will permit access to his books, records, and accounts by the
contracting agency and the Secretary of Labor for purposes of
investigation to ascertain compliance with such rules, regulations, and
orders.
7) In the event of the Contractor's non-compliance with the
nondiscrimination clauses of this contract or with any of such rules,
regulations, or orders, this contract may be canceled, terminated, or
suspended in whole or in part and the Contractor may be declared
ineligible for further Government contracts in accordance with
procedures authorized in Executive Order 11246 of September 24,
1965, and such other sanctions may be imposed and remedies invoked
as provided in Executive Order 11246 of September 24, 1965, or by
rule, regulation, or order of the Secretary of Labor, or as otherwise
provided by law.
8) The Contractor will include the portion of the sentence immediately
preceding paragraph(1)and the provision of paragraphs(1)through(8)
in every subcontract or purchase order unless exempted by rules,
regulations, or orders of the Secretary of Labor issued pursuant to
section 204 of Executive Order 11246 of September 24, 1965, so that
such provisions will be binding upon each subcontractor or vendor. The
Contractor will take such action with respect to any subcontract or
purchase order as the administering agency may direct as a means of
enforcing such provisions, including sanctions for non-compliance;
provided, however, that in the event a contractor becomes involved in,
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or is threatened with,litigation with a subcontractor or vendor as a result
of such direction by the administering agency the Contractor may
request the United States to enter into such litigation to protect the
interests of the United States.
Title VI of the Civil Rijzhts Act of 1964. The Contractor and any subcontractor,
successor, transferee, and assignee shall comply with Title VI of the Civil Rights Act
of 1964, which prohibits recipients of federal financial assistance from excluding from
a program or activity,denying benefits of, or otherwise discriminating against a person
on the basis of race, color, or national origin (42 U.S.C. § 2000d et seq.), as
implemented by the Department of the Treasury's Title VI regulations, 31 CFR Part
22, which are herein incorporated by reference and made a part of this contract (or
agreement). Title VI also includes protection to persons with "Limited English
Proficiency"in any program or activity receiving federal financial assistance,42 U.S.C.
§ 2000d et seq., as implemented by the Department of the Treasury's Title VI
regulations, 31 CFR Part 22, and herein incorporated by reference and made a part of
this contract or agreement.
II) Termination Provisions.
A. In the event that the Contractor shall be found to be negligent in any aspect of
service, the County shall have the right to terminate this agreement after five (5)
days' written notification to the Contractor.
B. Either of the parties hereto may cancel this Agreement without cause by giving the
other party sixty (60)days' written notice of its intention to do so.
C. Termination for Cause and Remedies: In the event of breach of any contract terms,
the County retains the right to terminate this Agreement. The County may also
terminate this agreement for cause with Contractor should the Contractor fail to
perform the covenants herein contained at the time and in the manner herein
provided. In the event of such termination, prior to termination, the County shall
provide Contractor with five (5) calendar days' notice and provide the Contractor
with an opportunity to cure the breach that has occurred. If the breach is not cured,
the Agreement will be terminated for cause. If the County terminates this
agreement with the Contractor, County shall pay Contractor the sum due the
Contractor under this agreement prior to termination,unless the cost of completion
to the County exceeds the funds remaining in the contract; however, the County
reserves the right to assert and seek an offset for damages caused by the breach.
The maximum amount due to Contractor shall not in any event exceed the spending
cap in this Agreement. In addition, the County reserves all rights available to
recoup monies paid under this Agreement, including the right to sue for breach of
contract and including the right to pursue a claim for violation of the County's False
Claims Ordinance, located at Section 2-721 et al. of the Monroe County Code.
D. Termination for Convenience: The County may terminate this Agreement for
convenience, at any time, upon seven(7)days' notice to Contractor. If the County
terminates this agreement with the Contractor,County shall pay Contractor the sum
due the Contractor under this agreement prior to termination, unless the cost of
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completion to the County exceeds the funds remaining in the contract. The
maximum amount due to Contractor shall not exceed the spending cap in this
Agreement. In addition, the County reserves all rights available to recoup monies
paid under this Agreement, including the right to sue for breach of contract and
including the right to pursue a claim for violation of the County's False Claims
Ordinance, located at Art. IX, Section 2-721 et al. of the Monroe County Code.
E. Scrutinized Companies:
For Contracts of any amount, if the County determines that the
Contractor/Consultant has submitted a false certification under Section 287.135(5),
Florida Statutes or has been placed on the Scrutinized Companies that Boycott
Israel List,or is engaged in a boycott of Israel,the County shall have the option of
(1)tenninating the Agreement after it has given the Contractor/Consultant written
notice and an opportunity to demonstrate the agency's determination of false
certification was in error pursuant to Section 287.135(5)(a), Florida Statutes,or(2)
maintaining the Agreement if the conditions of Section 287.135(4), Florida
Statutes, are met.
III) Maintenance of Records.
The Contractor shall maintain all books, records, and documents directly pertinent to
performance under this Agreement in accordance with generally accepted accounting
principles consistently applied. Records shall be retained as applicable for 1)a period
of five (5) years after all funds have been expended or returned to the Department of
the Treasury, whichever is later; or 2) for a period of seven (7) years from the
termination of this Agreement or for a period of five (5)years from the submission of
the final expenditure report as per 2 CFR §200.33,whichever is greater. 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 seven (7)years following the termination of
this Agreement.
Further, the Contractor is subject to the following:
1) The Contractor shall maintain records and financial documents sufficient to
evidence compliance with Sections 602(c)and 603(c)of the Social Security
Act,Treasury's regulations implementing that section,and guidance issued
by the Department of the Treasury regarding the foregoing.
2) The Department of the Treasury Office of Inspector General and the
Government Accountability Office, or their authorized representatives,
shall have the right of access to records (electronic and otherwise) of the
Contractor in order to conduct audits or other investigations.
IV) Right to Audit.
Availability of Records. The records of the parties to this Agreement relating to the
Project,which shall include but not be limited to accounting records(hard copy,as well
as computer readable data if it can be made available; subcontract files (including
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proposals of successful and unsuccessful bidders, bid recaps, bidding instructions,
bidders list, etc.); original estimates; estimating work sheets; correspondence; change
order files (including documentation covering negotiated settlements); back charge
logs and supporting documentation; general ledger entries detailing cash and trade
discounts earned, insurance rebates and dividends; any other supporting evidence
deemed necessary by Owner or the Monroe County Office of the Clerk of Court and
Comptroller(hereinafter referred to as "County Clerk") to substantiate charges related
to this agreement, and all other agreements, sources of information and matters that
may in Owner's or the County Clerk's reasonable judgment have any bearing on or
pertain to any matters, rights, duties, or obligations under or covered by any contract
document (all foregoing hereinafter referred to as "Records") shall be open to
inspection and subject to audit and/or reproduction by Owner's representative and/or
agents of Owner or the County Clerk. Owner or County Clerk may also conduct
verifications such as, but not limited to, counting employees at the job site, witnessing
the distribution of payroll, verifying payroll computations, overhead computations,
observing vendor and supplier payments, miscellaneous allocations, special charges,
verifying information and amounts through interviews and written confirmations with
employees, subcontractors, suppliers, and contractors' representatives. All records
shall be kept for ten (10) years after Final Completion. The County Clerk possesses
the independent authority to conduct an audit of records,assets, and activities relating
to this Project. If an auditor employed by the County or Clerk determines that monies
paid to Contractor pursuant to this Agreement were spent for purposes not authorized
by this Agreement,or were wrongfully retained by the Contractor,the Contractor shal I
repay the monies together with interest calculated pursuant to Sec. 55.03 of the Florida
Statutes,running from the date the monies were paid to Contractor. The right to audit
provisions survive the termination or expiration of this Agreement.
V) Payment of Fees/Invoices.
County shall pay pursuant to the Florida Local Government Prompt Payment Act, Fla.
Stat.,Sec.218.70,upon receipt of a Proper Invoice from the Contractor. Payments due
and unpaid under the Contract shall bear interest pursuant to the Florida Local
Government Prompt Payment Act.
The Contractor is to submit to the County invoices with supporting documentation that
are acceptable to the Clerk. Acceptability to the Clerk is based on generally accepted
accounting principles and such laws, rules, and regulations as may govern the Clerk's
disbursal of funds. Invoices shall be submitted to Monroe County Facilities
Maintenance Department, Attention Chrissy Collins via email at collins-
ch rissy(a).mon roecou nty-fl.izov.
The County is exempt from sales and use taxes. A copy of the tax exemption certificate
will be provided upon request.
Final payment shall be made by the County, as the Owner,to the Contractor when the
Contract has been fully performed by the Contractor and the work has been accepted
by the County.
Page 12 of 52
VI) Public Records Compliance.
The Contractor must comply with Florida public records laws,including but not limited
to Chapter 119, Florida Statutes and Section 24 of article I of the Constitution of
Florida. The County and Contractor shall allow and permit reasonable access to, and
inspection of, all documents,records, papers, letters or other"public record" materials
in its possession or under its control subject to the provisions of Chapter 119, Florida
Statutes, and made or received by the County and Contractor in conjunction with this
contract and related to contract performance. The County shall have the right to
unilaterally cancel this contract upon violation of this provision by the Contractor.
Failure of the Contractor to abide by the terms of this provision shall be deemed a
material breach of this contract and the County may enforce the terms of this provision
in the form of a court proceeding and shall, as a prevailing party, be entitled to
reimbursement of all attorney's fees and costs associated with that proceeding. This
provision shall survive any termination or expiration of the contract.
The Contractor is encouraged to consult with its advisors about Florida Public Records
Law in order to comply with this provision.
Pursuant to Fla. Stat., Sec. 119.0701 and the terms and conditions of this contract, the
Contractor is required to:
(1) Keep and maintain public records that would be required by the County to
perform the service.
(2) Upon receipt from the County's custodian of records, provide the County with a
copy of the requested records or allow the records to be inspected or copied within a
reasonable time at a cost that does not exceed the cost provided in this chapter or as
otherwise provided by law.
(3) Ensure that public records that are exempt or confidential and exempt from public
records disclosure requirements are not disclosed except as authorized by law for the
duration of the contract term and following completion of the contract if the contractor
does not transfer the records to the County.
(4) Upon completion of the contract, transfer, at no cost, to the County all public
records in possession of the Contractor or keep and maintain public records that would
be required by the County to perform the service. If the Contractor transfers all public
records to the County upon completion of the contract,the Contractor shal I destroy any
duplicate public records that are exempt or confidential and exempt from publ is records
disclosure requirements. If the Contractor keeps and maintains public records upon
completion of the contract, the Contractor shall meet all applicable requirements for
retaining public records. All records stored electronically must be provided to the
County, upon request from the County's custodian of records, in a format that is
compatible with the information technology systems of the County.
(5) A request to inspect or copy public records relating to a County contract must be
made directly to the County, but if the County does not possess the requested records,
the County shall immediately notify the Contractor of the request, and the Contractor
must provide the records to the County or allow the records to be inspected or copied
within a reasonable time.
Page 13 of 52
If the Contractor does not comply with the County's request for records, the County
shall enforce the public records contract provisions in accordance with the contract,
notwithstanding the County's option and right to unilaterally cancel this contract upon
violation of this provision by the Contractor, A Contractor who fails to provide the
public records to the County or pursuant to a valid public records request within a
reasonable time may be subject to penalties under Section 119.10, Florida Statutes.
The Contractor shall not transfer custody, release, alter, destroy or otherwise dispose
of any public records unless or otherwise provided in this provision or as otherwise
provided by law.
IF THE CONTRACTOR HAS QUESTIONS REGARDING THE
APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO
THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS
RELATING TO THIS CONTRACT,CONTACT THE CUSTODIAN
OF PUBLIC RECORDS, BRIAN BRADLEY AT PHONE NO. 305-
292-3470, BRADLEY-BRIAN(a),,MONROECOUNTY-FL.GOV,
MONROE COUNTY ATTORNEY'S OFFICE, 1111 12T11 Street,
SUITE 408, KEY WEST, FL 33040.
VIn E-Verify System.
Beginning January I, 2021, in accordance with Fla. Stat.,Sec. 448.095,the Contractor
and any subcontractor shall register with and shall utilize the U.S. Department of
Homeland Security's E-Verify system to verify the work authorization status of all new
employees hired by the Contractor during the term of the Contract and shall expressly
require any subcontractors performing work or providing services pursuant to the
Contract to likewise utilize the U.S. Department of Homeland Security's E-Verify
system to verify the work authorization status of all new employees hired by the
subcontractor during the Contract term. Any subcontractor shall provide an affidavit
stating that the subcontractor does not employ, contract with, or subcontract with an
unauthorized alien. The Contractor shall comply with and be subject to the provisions
of Fla. Stat., Sec. 448.095.
VIIn Notice Requirement.
Any written notices or correspondence given pursuant to this contract shall be sent by
United States Mail, certified, return receipt requested, postage prepared, or by courier
with proof of delivery. Notice is deemed received by Contractor when hand delivered
by national courier with proof of delivery or by U.S. Mail upon verified receipt or upon
the date of refusal or non-acceptance of delivery. The place of giving Notice shall
remain the same as set forth herein until changed in writing in the manner provided in
this paragraph. Notice shall be sent to the following persons:
Page 14 of 52
For Contractor: 440(!cw
Q� c
os1`'
For Owner: Facilities Maintenance Department
Attention: Chrissy Collins
123 Overseas Highway—Rockland Key
Key West, FL 33040
And
Monroe County Attorney's Office
I 1 1112`h Street
Suite 408
Key West, Florida 33040
IX) Uncontrollable Circumstance.
Any delay or failure of either Party to perform its obligations under this Agreement
will be excused to the extent that the delay or failure was caused directly by an event
beyond such Party's control, without such Party's fault or negligence and that by its
nature could not have been foreseen by such Party or, if it could have been foreseen,
was unavoidable: (a)acts of'God;(b) Flood, fire,earthquake,explosion,tropical storm,
hurricane or other declared emergency in the geographic area of the Project; (c) war,
invasion, hostilities (whether war is declared or not), terrorist threats or acts, riot, or
other civil unrest in the geographic area of the Project, (d)government order or law in
the geographic area of the Project; (e) actions,embargoes, or blockades in effect on or
after the date of this Agreement; (f) action by any governmental authority prohibiting
work in the geographic area of the Project;(each, a "Uncontrollable Circumstance").
Contractor's financial inability to perform,changes in cost or availability of materials,
components,or services,market conditions,or supplier actions or contract disputes will
not excuse performance by Contractor under this Section.Contractor shall give County
written notice within seven (7) days of any event or circumstance that is reasonably
likely to result in an Uncontrollable Circumstance,and the anticipated duration of such
Uncontrollable Circumstance. Contractor shall use all diligent efforts to end
the Uncontrollable Circumstance, ensure that the effects of any Uncontrollable
Circumstance are minimized and resume full performance under this Agreement. The
County will not pay additional cost as a result of an Uncontrollable Circumstance.The
Contractor may only seek a no cost Change Order or Amendment for such reasonable
time as the Owners Representative may determine.
X) Adjudication of Disputes or Disagreements.
County and Contractor agree that all disputes and disagreements shall be attempted to
be resolved by meet and confer sessions between representatives of each of the parties.
If the issue or issues are still not resolved to the satisfaction of the parties, then any
party shall have the right to seek such relief or remedy as may be provided by this
Page 15 of 52
Agreement or by Florida law. This Agreement is not subject to arbitration. This
provision does not negate or waive the provisions of Sections 1,Nondiscrimination,or
Section 11,concerning termination or cancellation.
4. FEDERAL CONTRACT REQUIREMENTS
The Contractor and its subcontractors must follow the provisions, as applicable, as set
forth in 2 C.F.R. §200.326 Contract provisions and Appendix 11 to C.F.R. Part 200, as
amended, including but not limited to:
A) Clean Air Act (42 U.S.C. 4§7401-7671a.) and the Federal Water Pollution
Control Act(33 U.S.C. -4,&1251-1387). CONTRACTOR agrees to comply with all
applicable standards,orders,or regulations issued pursuant to the Clean Air Act,as
amended, (42 U.S.C. §§7401-7671q)and the Federal Water Pollution Control Act,
as amended (33 U.S.C. §§1251-1387)and will report violations to the Department
of the Treasury and the appropriate Regional Office of the Environmental
Protection Agency (EPA). The Clean Air Act(42 U.S.C. §§7401-7671q)and the
Federal Water Pollution Control Act(33 U.S.C. §§1251-1387),as amended,applies
to Contracts and subgrants of amounts in excess of$100,000.00. The contractor
agrees to include these requirements in each subcontract exceeding $100,000
financed in whole or in part with Federal assistance provided by the American
Rescue Plan Act funding. The Contractor agrees to report each violation to the
COUNTY, understands, and agrees that the COUNTY will, in turn, report each
violation as required to assure notification to the Department of Treasury/Federal
Agency and the appropriate EPA Regional Office.
B) Contract Work Hours and Safety Standards Act (40 U.S.C. S43701-3708).
Where applicable, which includes all FEMA grant and cooperative agreement
programs, all contracts awarded by the County in excess of$100,000 that involve
the employment of mechanics or laborers must comply with 40 U.S.C.,§13702 and
3704,as supplemented by Department of Labor regulations(29 CFR Part 5). Under
40 U.S.C. §3702 of the Act, each Contractor must compute the wages of every
mechanic and laborer on the basis of a standard work week of forty (40) hours.
Work in excess of the standard work week is permissible provided that the worker
is compensated at a rate of not less than one and a half times the basic rate of pay
for all hours worked in excess of forty (40) hours in the work week. The
requirements of 40 U.S.C. §3704 are applicable to construction work and provide
that no laborer or mechanic must be required to work in surroundings or under
working conditions which are unsanitary, hazardous, or dangerous. These
requirements do not apply to the purchases of supplies or materials or articles
ordinarily available on the open market, or contracts for transportation or
transmission of intelligence.
Compliance with the Contract Work Hours and Safety Standards Act.
(1) Overtime requirements. No contractor or subcontractor
contracting for any part of the contract work,which may require
Page 16 of 52
or involve the employment of laborers or mechanics shall
require or permit any such laborer or mechanic in any workweek
in which he or she is employed on such work to work in excess
of forty hours in such workweek unless such laborer or
mechanic receives compensation at a rate not less than one and
one-half times the basic rate of pay for all hours worked in
excess of forty hours in such workweek.
(2) Violation;liabilityfor unpaid wages;liquidated damages. In the
event of any violation of the clause set forth in Paragraph(b)(1)
of this section,the Contractor and any subcontractor responsible
therefor shall be liable for the unpaid wages. In addition, such
contractor and subcontractor shall be liable to the United States
(in the case of work done under contract for the District of
Columbia or a territory,to such District or to such territory),for
liquidated Damages. Such liquidated damages shall be
computed with respect to each individual laborer or mechanic,
including watchmen and guards, employed in violation of the
clause set forth in Paragraph(b)(1)of this section, in the sum of
$27 foreach calendarday on which such individual was required
or permitted to work in excess of the standard workweek of forty
hours without payment of the overtime wages required by the
clause set forth in Paragraph(b)(1)of 29 C.F.R. §5.5.
(3) Withholding for unpaid wages and liquidated damages. The
Federal agency shall, upon its own action or upon written
request of an authorized representative of the Department of
Labor, withhold or cause to be withheld from any moneys
payable on account of work performed by the contractor or
subcontractor under any such contract or any other Federal
contract with the same prime contractor, or any other federally-
assisted contract subject to the Contract Work Hours and Safety
Standards Act,which is held by the same prime contractor,such
sums as may be determined to be necessary to satisfy any
liabilities of such contractor or subcontractor for unpaid wages
and liquidated damages as provided in the clause set forth in
Paragraph (b)(2)of 29 C.F.R. §5.5.
(4) Subcontracts. The contractor or subcontractor shal I insert in any
subcontracts the clauses set forth in 29 C.F.R. §5.5, Paragraphs
(b)(1)through(4),and also a clause requiring the subcontractors
to include these clauses in any lower tier subcontracts. The
prime contractor shall be responsible for compliance by any
subcontractor or lower tier subcontractor with the clauses set
forth in 29 C.F.R. §5.5, Paragraphs (1)through (4).
C) Rights to Inventions Made Under a Contract or Agreement. If the Federal
award meets the definition of"funding agreement" under 37 CFR §401.2 (a) and
the recipient or subrecipient wishes to enter into a contract with a small business
Page 17 of 52
firm or nonprofit organization regarding the substitution of parties, assignment or
performance of experimental,developmental,or research work under that"funding
agreement,"the recipient or subrecipient must comply with the requirements of 37
CFR Part 401, "Rights to Inventions Made by Nonprofit Organizations and Small
Business Firms Under Government Grants, Contracts and Cooperative
Agreements,"and any implementing regulations issued by the awarding agency.
D) Debarment and Suspension (Executive Orders 12549 and 12689) A contract
award under a "covered transaction" (see 2 CFR §180.220) must not be made to
parties listed on the government-wide exclusions in the System for Award
Management(SAM), in accordance with the OMB guidelines at 2 C.F.R. Part 180
that implement Executive Orders 12549 (3 C.F.R. Part 1986 Comp., p. 189) and
12689 (3 C.F.R. Part 1989 Comp., p. 235), "Debarment and Suspension" and the
Department of Homeland Security's regulations at 2 C.F.R. Part 3000
(Nonprocurement Debarment and suspension). SAM Exclusions contains the
names of parties debarred, suspended, or otherwise excluded by agencies, as well
as parties declared ineligible under statutory or regulatory authority other than
Executive Order 12549. SAM exclusions can be accessed at www.sam.go<:.
Contractor is required to verify that none of the contractor's principals (defined at
2 C.F.R. §180.935) or its affiliates (defined at 2 C.F.R. §180.905) are excluded
(defined at 2 C.F.R. §180.940)or disqualified (defined at 2 C.F.R. §180.935). The
Contractor must comply with 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000,
subpart C,and must include a requirement to comply with these regulations in any
lower tier covered transaction it enters into. This certification is a material
representation of fact relied upon by the County. If it is later determined that the
contractor did not comply with 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000,
subpart C, in addition to remedies available to the County,the Federal Government
may pursue available remedies, including but not limited to suspension and/or
debarment. Bidders or Proposers agree to comply with the requirements of 2 C.F.R.
pt. 180, subpart C and 2 C.F.R. Pt. 3000, subpart C while this offer is valid and
throughout the period of any contract that may arise from this offer. The Bidder or
Proposer further agrees to include a provision requiring such compliance in its
lower tier covered transactions, including that the award is subject to 2 C.F.R. Part
180 and the Department of the Treasury's implementing regulation at 31 C.F.R.
Part 19.
E) Byrd Anti-Lobbying Amendment(31 U.S.C. -61352). Contractors that apply or
bid for an award exceeding $100,000 must file the required certification. Each tier
certifies to the tier above that it will not and has not used Federal appropriated funds
to pay any person or organization for influencing or attempting to influence an
officer or employee of any agency, a member of Congress, officer or employee of
Congress, or an employee of a member of Congress in connection with obtaining
any Federal contract, grant or any other award covered by 31 U.S.C. §1352. Each
tier must also disclose any lobbying with non-Federal funds that takes place in
connection with obtaining any Federal award. Such disclosures are forwarded from
Page 18 of 52
tier to tier up to the recipient who in turn will forward the certification(s) to the
awarding agency. If the award exceeds $100,000, the attached certification must
be signed and submitted by the Contractor to the County.
F) Compliance with Procurement of Recovered Materials as set forth in 2 CFR 6
200.322. The Contractor must comply with Section 6002 of the Solid Waste
Disposal Act, as amended, by the Resource Conservation and Recovery Act. The
requirements of Section 6002 include procuring only items designated in guidelines
of the Environmental Protection Agency (EPA) at 40 C.F.R. Part 247 that contain
the highest percentage of recovered materials practicable, consistent with
maintaining a satisfactory level of competition,where the purchase price of the item
exceeds $10,000 or the value of the quantity acquired during the preceding fiscal
year exceeded $10,000; procuring solid waste management services in a manner
that maximizes energy and resource recovery; and establishing an affirmative
procurement program for procurement of recovered materials identified in the EPA
guidelines.In the performance of this contract,the Contractor shall make maximum
use of products containing recovered materials that are EPA-designated items
unless the product cannot be acquired—
1.Competitively within a timeframe providing for compliance with the contract
performance schedule;
2. Meeting contract performance requirements; or
3. At a reasonable price.
Information about this requirement, along with the list of EPA-designated
items, is available at EPA's Comprehensive Procurement Guidelines website,
https://www.epa.eov/smmlcomprchensive-procurement-„"uidel i ne-cps-
ro =ram.
The Contractor also agrees to comply with all other applicable requirements of
Section 6002 of the Solid Waste Disposal Act.
G) Prohibition on certain telecommunications and video surveillance services or
equipment as set forth in 2 CFR 6 200.216. Recipients and subrecipients and their
contractors and subcontractors may not obligate or expend any federal funds to
(1)Procure or obtain; (2)Extend or renew a contract to procure or obtain; or
(3) Enter into a contract (or extend or renew a contract) to procure or
obtain equipment services, or systems that uses covered telecommunications
equipment or services as a substantial or essential component of any system, or as
critical technology as part of any system. As described in Public Law 115-232,
section 889, covered telecommunications equipment is telecommunications
equipment produced by Huawei Technologies Company or ZTE Corporation (or
any subsidiary or affiliate of such entities)
(i) For the purpose of public safety, security of government facilities,
physical security surveillance of critical infrastructure, and other national
Page 19 of 52
security purposes, video surveillance and
telecommunications equipment produced by Hytera Communications
Corporation, Hangzhou Hikvision Digital Technology Company, or Dahua
Technology Company(or any subsidiary or affiliate of such entities).
(ii)Telecommunications or video surveillance services provided by such
entities or using such equipment.
(iii)Telecommunications or video surveillance equipment or services
produced or provided by an entity that the Secretary of Defense, in
consultation with the Director of the National Intelligence or the Director
of the Federal Bureau of Investigation, reasonably believes to be an entity
owned or controlled by, or otherwise connected to, the government of a
covered foreign country.
H) Domestic Preference for Procurements as set forth in 2 C.F.R. 4200.322. The
County and Contractor should, to the greatest extent practicable, provide a
preference for the purchase, acquisition, or use of goods, products, or materials
produced in the United States (including but not limited to iron, aluminum, steel,
cement,and other manufactured products).These requirements of this section must
be included in all subawards including contracts and purchase orders for work or
products under federal award. For purposes of this section:
(1) "Produced in the United States" means, for iron and steel products, that all
manufacturing processes, from the initial melting stage through the application of
coatings,occurred in the United States.
(2)"Manufactured products"means items and construction materials composed in
whole or in part of non-ferrous metals such as aluminum; plastics and polymer-
based products such as polyvinyl chloride pipe;aggregates such as concrete;glass,
including optical fiber; and lumber.
I) Copeland "Anti-Kickback" Act (2 C.F.R. 200, Appendix II (D); 40 U.S.C.
63145). This section applies if the contract is in excess of 52,000 and pertains to
construction or repair, and further, if required by Federal program legislation.
Contractor shall comply with the Copeland "Anti-Kickback" Act (40 U.S.C.
§3145), as supplemented by Department of Labor regulations (29 C.F.R. Part 3),
"Contractors and Subcontractors on Public Building or Public Work Financed in
Whole or in Part by Loans or Grants from the United States").The Act provides in
part that Contractor shall be prohibited from inducing, by any means, any person
employed in the construction, completion, or repair of public work,to give up any
part of the compensation to which it is otherwise entitled. The County shall report
all suspected or reported violations to the Department of the Treasury.
5. Other Federal and/or Department of the Treasury Requirements (as
applicable)
Page 20 of 52
Section 602(b) of the Social Security Act (the Act), as added by Section 9901 of
the American Rescue Plan Act (ARPA), Pub. L. No. 117-2 (March 11, 2021), authorizes
the Department of the Treasury(Treasury)to make payments to certain recipients from the
Coronavirus State Fiscal Recovery Fund and the Coronavirus Local Fiscal Recovery Fund
(Fiscal Recovery Funds). Monroe County shall not enter into a Contract or make any
distributions of funds to Contractor using monies from the Fiscal Recovery Funds absent
Contractor's agreement and adherence to each tern and condition contained herein. The
Contractor and its sub-contractors must follow the provisions set forth herein, as
applicable, including but not limited to:
A) Americans with Disabilities Act of 1990 (ADA). as amended. The
Contractor will comply with all the requirements as imposed by the ADA,
the regulations of the Federal government issued thereunder, and the
assurance by the Contractor pursuant thereto.
B) Disadvantaged Business Enterprise (DBE) Policy and Obligation. It is
the policy of the County that DBE's, as defined in C.F.R. Part 26, as
amended, shall have the opportunity to participate in the performance of
contracts financed in whole or in part with County funds under this
agreement.The DBE requirements of applicable federal and state laws and
regulations apply to this Agreement. The County and its Contractor agree
to ensure that DBE's have the opportunity to participate in the performance
of the Agreement. In this regard,all recipients and contractors shall take all
necessary and reasonable steps in accordance with 2 C.F.R. §200.321 (as
set forth below), applicable federal and state laws and regulations to ensure
that DBE's have the opportunity to compete and perform contracts. The
County and Contractor and subcontractors shall not discriminate on the
basis of race, color, national origin, or sex in award and performance of
contracts,entered pursuant to this Agreement.
C.F.R. § 200.321 CONTRACTING WITH SMALL AND MINORITY
BUSINESSES, WOMEN'S BUSINESS ENTERPRISES, AND LABOR
SURPLUS AREA FIRMS
a. If the Contractor, with the funds authorized by this Agreement, seeks to
subcontract goods or services then, in accordance with 2 C.F.R. §200.321,
the CONTRACTOR shall take the following affirmative steps to assure that
minority businesses, women's business enterprises, and labor surplus area
firms are used whenever possible.
b. Affirmative steps must include:
(1) Placing qualified small and minority businesses and women's business
enterprises on solicitation lists;
(2) Assuring that small and minority businesses, and women's
business enterprises are solicited whenever they are potential
sources;
Page 21 of 52
(3) Dividing total requirements,when economically feasible, into smaller
tasks or quantities to permit maximum participation by small and
minority businesses,and women's business enterprises;
(4) Establishing delivery schedules, where the requirement permits,
which encourage participation by small and minority businesses,
and women's business enterprises;
(5) Using the services and assistance, as appropriate, of such
organizations as the Small Business Administration and the Minority
Business Development Agency of the Department of Commerce.
(6) Requiring the Prime contractor, if subcontracts are to be let, to take
the affirmative steps listed in paragraph(1)through(5)of this section.
C) Access to Records. Contractor and its successors, transferees, assignees, and
subcontractors acknowledge and agree to comply with applicable provisions
governing the access to records, accounts, documents, information, facilities and
staff by the United States Department of the Treasury. Contractors must: (1)
Cooperate with any compliance review or complaint investigation conducted by the
Department of the Treasury;(2)Give the Department of the Treasury access to and
the right to examine and copy records,accounts, and other documents and sources
of information related to the grant and permit access to facilities, personnel, and
other individuals and information as may be necessary, as required by the
Department of the Treasury regulations and other applicable laws or program
guidance; and(3) Submit timely, complete, and accurate reports to the appropriate
Department of the Treasury officials and maintain appropriate backup
documentation to support the reports.
D) Changes to Contract. The Contractor understands and agrees that any cost
resulting from a change or modification, change order, or constructive change of
the agreement must be within the scope of any Federal grant or cooperative
agreement that may fund this Project and be reasonable for the completion of the
Project. Any contract change or modification,change order or constructive change
must be approved in writing by both the County and Contractor.
E) Executive Compensation. As required by 2 C.F.R. Part 170, Appendix A, the
Contractor must report the names and total compensation of its five most highly
compensated executives and the names and total compensation of the five most
highly compensated executives of its subcontractors for the preceding completed
fiscal year if:
(a) the total federal funding authorized to date under the award funding this
Agreement equals or exceeds $30,000.00 as defined in 2 C.F.R. §170.320;
(b) the Contractor received 80 percent or more of its gross revenues from federal
procurement contracts(and subcontracts)and federal financial assistance subject to
the Transparency Act, as provided by 2 C.F.R. §170.320(and subcontracts);
Page 22 of 52
(c)the Contractor received $25,000,000.00 or more in annual gross revenues from
federal procurement contracts (and subcontracts) and federal financial assistance
subject to the Transparency Act, as defined in 2 C.F.R. §170.320 (and
subcontracts);and
(d) the public does not have access to information about the compensation of the
executives through periodic reports filed under Section 13(a) or 15(d) of the
Securities Exchange Act of 1934(15 U.S.C. 78m(a),78o(d))or Section 6104 of the
Internal Revenue Code of 1986. To determine if the public has access to the
compensation information, see U.S. Security and Exchange Commission total
compensation filings at http://www.sec.gov/answers/execomp.htm.
F) No Obligation by Federal Government. The Federal Government is not a patty
to this contract and is not subject to any obligations or liabilities to the County/non-
Federal entity,contractor or any other party pertaining to any matter resulting from
the contract.
G) Program Fraud and False or Fraudulent Statements or Related Acts. The
contractor acknowledges that 31 U.S.C. Chap. 38 (Administrative Remedies for
False Claims and Statements) applies to the Contractor's actions pertaining to this
contract. The Contractor understands that making false statements or claims in
connection with this award is a violation of federal law and may result in criminal,
civil,or administrative sanctions, including fines, imprisonment,civil damages and
penalties, debarment from participating in federal awards or contracts, and/or any
other remedy.
H) The Contractor shall utilize the U.S. Department of Homeland Security's E-Verify
system to verify the employment eligibility of all new employees hired by the
Contractor during the term of the Contract and shall expressly require any
subcontractors performing work or providing services pursuant to the Contract to
likewise utilize the U.S. Department of Homeland Security's E-Verify system to
verify the employment eligibility of all new employees hired by the subcontractor
during the Contract term.
I) The Contractor will be bound by the terms and conditions of the Federally Funded
State& Local Fiscal Recovery Fund Financial Assistance Agreement between the
County and the United States Department of Treasury attached hereto as
Attachment A and made a part of this Agreement.
J) The Contractor shall hold the United States and County harmless against all claims
of whatever nature arising out of the Contractor's performance of work under this
Agreement,to the extent allowed and required by law.
K) Energy Efficiency. If applicable, the Contractor will comply with the Energy
Policy and Conservation Act (P.L. 94-163; 42 U.S.C. §§6201-6422) and with all
Page 23 of 52
mandatory standards and policies relating to energy efficiency and the provisions
of the state Energy Conservation Plan adopted pursuant thereto.
L) Conflicts of Interest. The Contractor understands and agrees it must maintain a
conflict-of-interest policy consistent with 2 C.F.R. § 200.318(c) and that such
conflict-of-interest policy is applicable to each activity funded under the federal
award as set forth in Attachment A. The Contractor and subcontractors must
disclose in writing to Treasury or the pass-through entity, as appropriate, any
potential conflict of interest affecting the awarded funds in accordance with 2
C.F.R. § 200.112.
M) Remedial Actions. In the event of the Contractor's noncompliance with Section
602 of the Act, other applicable laws, Treasury's implementing regulations,
guidance, or any reporting or other program requirements, Treasury may impose
additional conditions on the receipt of a subsequent tranche of future award funds,
if any, or take other available remedies as set forth in 2 C.F.R. § 200.339. In the
case of a violation of Section 602(c)of the Act regarding the use of funds,previous
payments shall be subject to recoupment as provided in Section 602(e) of the Act
and any additional payments may be subject to withholding as provided in Sections
602(b)(6)(A)(ii)(III)of the Act, as applicable.
N) Compliance with Federal Law, Regulations and Executive Orders. This is an
acknowledgment that Department of the Treasury (Treasury) financial assistance
will be used to fund the contract only. The Contractor agrees to comply with the
requirements of Sections 602 and 603 of the Act, regulations adopted by Treasury
pursuant to Sections 602(f)and 603(f)of the Act, and guidance issued by Treasury
regarding the foregoing. The Contractor also agrees to comply with all other
applicable federal statutes, regulations, and executive orders, and the Contractor
shall provide for such compliance by other parties in any agreements it enters into
with other parties relating to this award.
Federal regulations applicable to this Department of Treasury award include,
without limitation,the following:
i. Uniform Administrative Requirements, Cost Principles, and Audit
Requirements for Federal Awards,2 C.F.R. Part 200, other than
such provisions as Treasury may determine are inapplicable to this
award and subject to such exceptions as may be otherwise
provided by Treasury. Subpart F—Audit Requirements of the
Uniform Guidance. implementing the Single Audit Act, shall apply
to this award.
ii. Universal Identifier and System for Award Management(SAM),2
C.F.R. Part 25,pursuant to which the award term set forth in
Appendix A to 2 C.F.R. Part 25 is hereby incorporated by
reference.
Page 24 of 52
iii. Reporting Subaward and Executive Compensation Information,2
C.F.R. Part 170, pursuant to which the award tern set forth in
Appendix A to 2 C.F.R. Part 170 is hereby incorporated by
reference.
iv. OMB Guidelines to Agencies on Govemmentwide Debarment and
Suspension (Nonprocurement), 2 C.F.R. Part 180, including the
requirement to include a term or condition in all lower tier covered
transactions(contracts and subcontracts described in 2 C.F.R. Part
180,subpart B)that the award is subject to 2 C.F.R. Part 180 and
Treasury's implementing regulation at 31 C.F.R. Part 19.
V. Recipient Integrity and Performance Matters, pursuant to which
the award term set forth in 2 C.F.R. Part 200,Appendix Xll to Part
200 is hereby incorporated by reference.
vi. Governmentwide Requirements for Drug-Free Workplace 31
C.F.R. Part 20.
vii. New Restrictions on Lobbying, 31 C.F.R. Part 21.
viii. Uniform Relocation Assistance and Real Property Acquisitions
Act of 1970(42 U.S.C. §§4601-4655)and implementing
regulations.
ix. Generally applicable federal environmental laws and regulations.
O) Hatch Act. The Contractor agrees to comply, as applicable, with requirements of
the Hatch Act(5 U.S.C.§§ 1501-1508 and 7324-7328),which limit certain political
activities of State or local government employees whose principal employment is
in connection with an activity financed in whole or in part by this federal assistance.
P) Publications. Any publications produced with funds from the federal award as set
forth in Attachment A must display the following language:"This project[is being]
[was] supported, in whole or in part,by federal award number[enter project FAIN]
awarded to [name of Recipient] by the U.S. Department of the Treasury."
Q) Debts Owed the Federal Government.
a. Any funds paid to the Contractor (1) in excess of the amount to which
Contractor is finally determined to be authorized to retain under the terms
of this award as set forth in Attachment A; (2) that are determined by the
Treasury Office of Inspector General to have been misused; or(3)that are
determined by Treasury to be subject to a repayment obligation pursuant to
Sections 602(e) and 603(b)(2)(D) of the Act and have not been repaid by
Contractor shall constitute a debt to the federal government.
b. Any debts determined to be owed the federal government must be paid
promptly by Contractor. A debt is delinquent if it has not been paid by the
date specified in Treasury's initial written demand for payment,unless other
satisfactory arrangements have been made or if the Contractor knowingly
Page 25 of 52
or improperly retains funds that are a debt as defined in Paragraph 14(a)of
the federal award as set forth in Attachment A. Treasury will take any
actions available to it to collect such a debt.
R) Disclaimer.
a. The United States expressly disclaims any and all responsibility or liability
to the Contractor or third persons for the actions of Contractor or third
persons resulting in death, bodily injury, property damages, or any other
losses resulting in any way from the performance of this award or any other
losses resulting in any way from the performance of services funded under
the federal award as set forth in Attachment A or any other losses resulting
in any way from the performance of services pursuant to any contract, or
subcontract under this award.
b. The acceptance of these funds provided by the federal award as set forth in
Attachment A by the Contractor does not in any way establish an agency
relationship between the United States and the Contractor.
S) Protections for Whistleblowers.
a. In accordance with 41 U.S.C. § 4712, the Contractor may not discharge,
demote, or otherwise discriminate against an employee in reprisal for
disclosing to any of the list of persons or entities provided below,
information that the employee reasonably believes is evidence of gross
mismanagement of a federal contract or grant, a gross waste of federal
funds, an abuse of authority relating to a federal contract or grant, a
substantial and specific danger to public health or safety, or a violation of
law, rule, or regulation related to a federal contract (including the
competition for or negotiation of a contract)or grant.
b. The list of persons and entities referenced in the paragraph above includes
the following:
i.A member of Congress or a representative of a committee of
Congress;
ii. An Inspector General;
iii. The Government Accountability Office;
iv.A Treasury employee responsible for contract or grant oversight or
management;
v. An authorized official of the Department of Justice or other law
enforcement agency;
vi. A court or grand jury;or
vii. A management official or other employee of Recipient, contractor,
or subcontractor who has the responsibility to investigate, discover,or
address misconduct.
c. The Contractor shall inform its employees in writing of the rights and
remedies provided under this section, in the predominant native language of
the workforce.
Page 26 of 52
T) Increasing Seat Belt Use in the United States.Pursuant to Executive Order 13043,
62 FR 19217(Apr. 18, 1997),the Contractor is encouraged to adopt and enforce
on-the job seat belt policies and programs for its employees when operating
company-owned, rented, or personally owned vehicles and encourage its
subcontractors to adopt and enforce on-the-job seat belt policies and programs
for their employees when operating company-owned, rented, or personally
owned vehicles.
U) Reducing Text Messaging While Driving. Pursuant to Executive Order 13513,
74 FR 51225 (Oct. 6, 2009), the Contractor should encourage its employees,
subrecipients, and subcontractors to adopt and enforce policies that ban text
messaging while driving,and the Contractor should establish workplace safety
policies to decrease accidents caused by distracted drivers.
Page 27 of 52
PROPOSAL FORM
PROPOSAL TO: Monroe County Facilities Maintenance
123 Overseas Highway—Rockland Key
Key West,FL 33040 Aez "
PROPOSAL FROM: k 1-a/
The undersigned, having carefully examined the Work and reference Drawings,
Specifications, Proposal, and Addenda thereto and other Contract Documents for the
construction of:
Harvey Government Center—Termite Fumigation Tenting
and having carefully examined the site where the Work is to be performed, having become
familiar with all local conditions including labor affecting the cost thereof, and having
familiarized himself with material availability, Federal, State,and Local laws,ordinances,
rules and regulations affecting performance of the Work, does hereby propose to furnish
all labor, mechanics, superintendents, tools, material, equipment, transportation services,
and all incidentals necessary to perform and complete said Work and work incidental
hereto, in a workman-like manner, in conformance with said Drawings,Specifications,and
other Contract Documents including Addenda issued thereto.
The undersigned further certifies that he/she has personally inspected the actual location of
where the Work is to be performed,together with the local sources of supply and that he/she
understands the conditions under which the Work is to be performed. The proposer shall
assume the risk of any and all costs and delays arising from the existence of any subsurface
or other latent physical condition which could be reasonably anticipated by reference to
documentary information provided and made available, and from inspection and
examination of the site.
The undersigned agrees to commence performance of this Project within Ten (10)
calendar days after the date of issuance to the undersigned by Owner of the Notice to
Proceed/Purchase Order/Task Order or issuance of a permit if one is necessary. Once
commenced, undersigned shall diligently continue performance until completion of the
Project. The undersigned shall accomplish Final Completion of the Project within Sixty
(60)days, thereafter.
Page 28 of 52
The Base Proposal shall be furnished below in words and numbers. If there is an
inconsistency between the two,the Proposal in words shall control.
`-xlezq #X40V 4�lz4A4,-1_' Dollars.
(Total Base Proposal-words)
$ /f� 66v. Dollars.
(Total gase Proposal—numbers)
I acknowledge Alternates as follows:NIA
I acknowledge receipt of Addenda No.(s)or None
No. Dated
No._Dated
Page 29 of 52
In addition, Proposer states that lie/she has provided or will provide the (I I ourity, along with this
Proposal, a certified copy of Contractor's License, Monroe County Business Tax Receipt, and
Certificate of Insurance showing the 111inimusil insurance reqUirenICIIIS l"OrthiS PI-QjCCt.
Execution by the Contract-m- must be by a person with author-ity to bind the entity.
By signing this agreement below, the Contractor has read and accepts the terms and conditions set
forth by (Ile 1Vl0111-0C C01.111ty (101eral, RcqLJirCI1lCI1(S for Construction found at the link can II'le
Monroe County web page: l'it t wHII-i-no n roeC0 UM VX i V icp I u s.corn/13 ids,asj)x?Ca d D=18; AND
accepts all ofthe terns and conditions and all federal required contract provisions herein.
IN WITNISS WI IEREOF, the parties have caused this Agreement to be CXCCUted by their duly
authorized representatives, as J'ollovvs:
Contractor:
Mailing Address: � � A4�14,ox�
336 K-?
Phone Number:
EA.N.- .......
Z
Email: 7-tU,4�
.......... .......... ...................-----------------
Date: A Signed:
k
Name Titic
Contractor's Witness signature: -------------------------
Witness name:
Date:
The County accepts the above proposal:
MONROE COUNTY. FLORIDA
9/22 2 0 23
Date:
............
B I� t
Couni")� Administrator or Desionce
tAorfi3OE COUP41Y ATTORNEY'S OFFICE
eM" 13,AS TO U M
%M 4�9�
PATRICIA E-ABLES Page 30 of 52
ASS4,S'TAtF -MAT70ANEY'
DATE,
NON-COLLUSION AFFIDAVIT
p
of the city of
according to law on my oa , and under penalty of ped ry, depose and say that:
a. I am he— or d'7A-.%r'
of the firm of a.r••.n �er••�• Z Go.� I-r'o
the bidder making the Proposal for the project described in the Request for
Proposals for: ! r
+-C -4'
vt * 4 r+z,r'y a A , d r 0 f the- #aa►Ve y 6o✓ern P""4 Cam+--e r
and that I executed the said proposal with full authority to do so;
b. The prices in this bid have been arrived at independently without collusion,
consultation, communication or agreement for the purpose of restricting
competition, as to any matter relating to such prices with any other bidder or with
any competitor; and
C. Unless otherwise required by law, the prices which have been quoted in this bid
have not been knowingly disclosed by the bidder and will not knowingly be
disclosed by the bidder prior to bid opening, directly or indirectly, to any other
bidder or to any competitor; and
d. No attempt has been made or will be made by the bidder to induce any other
person, partnership or corporation to submit, or not to submit, a bid for the purpose
of restricting competition; and
e. The statements contained in this affidavit are true and correct, and made with full
knowledge that Monroe County relies upon the truth of the statements contained
in this affidavit in awarding contracts for said project.
(Signature of Proposer) (Date)
STATE OF: /0—
COUNTY e-
Subscribed and sworn to (or affirmed) before me, by means o*physical presence or
O online notarization, on fi /7 ;Zd 3 (date) by
/'17Q.-l( [ ,n be.-c (name of affiant).�/Sh is personally kno 0
me or has produced
(type of identification) as identification.
° 4?
McRomm.Expires=:rn"NOTARY PUBLIC
April 19,2027
No.HH 37a491
My commission expire , ���S�Z127 (SEAL)
.-,`
OFFLO�,���'.
Page 31 of 52
LOBBYING AND CONFLICT OF INTEREST CLAUSE
SWORN STATEMENT UNDER ORDINANCE NO. 010-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
O'n ems-�».�1 ���,,r c o� ��01 ,.
(Company)
warrants that he/she/it has not employed, retained or otherwise had act on his/her/
its behalf any former County officer or employee in violation of Section 2 of Ordinance
No. 010-1990 or any County officer or employee in violation of Section 3 of Ordinance
No. 010-1990. For breach or violation of this provision the County may, in its discretion,
terminate this Agreement without liability and may also, in its discretion, deduct from the
Agreement or purchase price, or otherwise recover, the full amount of any fee,
commission, percentage, gift, or consideration paid to the former County officer or
employee".
�i i�wGL�
(Signature)
Date: 9//7/�20.23
STATE OF: �7I Dr dc,
COUNTY OF: (Yl o r) row
Subscribed and sworn to (or affirmed) before me, by means ofg physical presence or
O online notarization, on� 20 Z-n (date) by
(name of affiant). Ife/She is
r h produced
as identification. (Type of identification)
,,``, �\NAM,,,,,,,,
(M*ApOl
NOTARY PUBLIC
y Comm.Expires%.m 19,2027
My commission expkesi No.HH 37A401 �f ��'fZr27
G,t' (SEAL)
Ve i.y QQ,.
Page 32 of 52
DRUG-FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute, Sec.287.087 hereby)certifies that:
(Name of Business)
1. Publish a statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession,or use of a controlled substance is prohibited in the workplace and
specifying the actions that will be taken against employees for violations of such
prohibition.
2. Inform employees about the dangers of drug abuse in the workplace,the business's policy
of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and
employee assistance programs,and the penalties that may be imposed upon employees for
drug abuse violations.
3. Give each employee engaged in providing the commodities or contractual services that are
under bid a copy of the statement specified in subsection(1).
4. In the statement specified in subsection (1), notify the employees that, as a condition of
working on the commodities or contractual services that are under bid,the employee will
abide by the terms of the statement and will notify the employer of any conviction of, or
plea of guilty or nolo contendere to, any violation of Chapter 893 (Florida Statutes) or of
any controlled substance law of the United States or any state, for a violation occurring in
the workplace no later than five(5)days after such conviction.
5. Imposes 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, for any
employee who is so convicted.
6. Make a good faith effort to continue to maintain a drug-free workplace through
implementation of this section.
As the person authorized to sign the statement, I certify that this firm complies fully with the above
requirements.
Proposer's Signat dre
9/1:Z/ao,23
Date
STATE OF: -FI or1&_
COUNTY OF: y n L->h cm e
Subscribed and sworn to (or affirmed)before me, by means ofaphysical presence or O online
notarization,on (date) by jorAe t,)p_jnkrrA
(name of affiant). is personally know--n-16—m-eVr has produced
ty p e__oT TO e f ation)as identificatio .
�.•`•A�SpTARyC'F''- NOTARY PUBLIC
V �,O My Comm.Expires)�,
(SEAL) *119.2027 f _ My Commission Expires: Zo
No.HH 378491 Z
UBt���p�,�- Page 33 of 52
OF F��.�•`. g
PUBLIC ENTITY CRIME STATEMENT
"A person or affiliate who has been placed on the convicted vendor list following a
conviction for public entity crime may not submit a bid, proposal, or reply on a contract to
provide any goods or services to a public entity, may not submit a bid, proposal, or reply
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 a public entity, may not be
awarded or perform work as a contractor, supplier, subcontractor, or consultant under a
contract with any public entity, and may not transact business with any public entity in
excess of the threshold amount provided in Section 287.017, Florida Statutes, for
CATEGORY TWO for a period of thirty-six (36) months from the date of being placed on
the convicted vendor list."
I have read the above and state that neither
e m---k W c.l,3 (Respondent's name) nor any Affiliate
has been placed on the Convicted vendor list within the last thirty-six (36) months.
(Signature
Date: _ _ d0lgoa3
STATE OF: P-I brt A0.
COUNTY OF: k"on nc t
Subscribed and sworn to (or affirmed) before me, by means o�4physical presence or
❑ online notarization, on the l`7 day of Wcd= ,
20,;?:-5 (date (name of affiant).
(re/ he i ersonall k e or has pro uced
(type of identification) as
identificatio
NOTARY PUBLIC \NAr/Iij''�%,,
�� 'aOTA91- F�. (SEAL)
�
s
My Commission Expires: 9 2 Z 1My Comm.Expires =
Apnl 19.2027
No HH 378491
Page 34 of 52
VENDOR CERTIFICATION REGARDING SCRUTINIZED COMPANIES LISTS
Project Description(s): ft,"'+ O'. Or .�r . -tit_ COn-�D! D 1 Ulvccl{ 'f'a'"A'- ys
Respondent Vendor Name: 1&m e r A
Vendor FEIN: 11-204 fl ed as
Vendor's Authorized Representative Na a and Title:
Address: Q� at r �no
city '' State: FL Zip:
Phon umber OD Email Address: I'm X o P atrs �r-4/h�a'�i�01. C a M
Section 287.135, Florida Statutes prohibits a company from bidding on, submitting a proposal for, or
entering into or renewing a contract for goods or services of any amount if, at the time of contracting or
renewal,the company is on the Scrutinized Companies that Boycott Israel List,created pursuant to Section
215.4725, Florida Statutes, or is engaged in a Boycott of Israel. Section 287.135, Florida Statutes, also
prohibits a company from bidding on, submitting a proposal for, or entering into or renewing a contract for
good or services of$1,000,000 or more, that are on either the Scrutinized Companies with Activities in
Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector Lists which
were created pursuant to s. 215.473, Florida Statutes, or is engaged in business operations in Cuba or
Syria.
As the person authorized to sign on behalf of Respondent, I hereby certify that the company identified
above in the Section entitled"Respondent Vendor Name" is not listed on the Scrutinized Companies that
Boycott Israel List or engaged in a boycott of Israel and for Projects of$1,000,000 or more is not listed on
either the Scrutinized Companies with Activities in Sudan List,the Scrutinized Companies with Activities in
the Iran Petroleum Energy Sector List,or engaged in business operations in Cuba or Syria.
I understand that pursuant to Section 287.135, Florida Statutes,the submission of a false certification may
subject company to civil penalties,attorney's fees,and/or costs. I further understand that any contract with
the County may be terminated, at the option of the County, if the company is found to have submitted a
false certification or has been placed on the Scrutinized Companies that Boycott Israel List or engaged in
a boycott of Israel or placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized
Companies with Activities in the Iran Petroleum Energy Sector List or been engaged in business operations
in Cuba or Syria.
� ) /
Certified By: /N�-k W tr n �'� , who is authorized to sign
on behalf of the above referenced com any.
Authorized Si nature:x
Print Name: et.r�5
Title:
Note:The List are available at the following Department of Management Services Site:
htto://www.dms.mvflorida.com/business operations/state purchasing/vendor information/convicted susp
ended discriminatory complaints vendor lists
Page 35 of 52
APPENDIX A. "C.F.R. PART 18— CERTIFICATION REGARDING LOBBYING
(To be submitted with each bid or offer exceeding $100,000)
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief, that:
1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or
employee of an agency, a Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with the awarding of any Federal
contract, the making of any Federal grant, the making of any Federal loan, the entering
into of any cooperative agreement,and the extension, continuation, renewal, amendment,
or modification of any Federal contract, grant, loan, or cooperative agreement.
2. If any funds other than Federal appropriated funds have been paid or will
be paid to any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of
Congress, or an employee of a Member of Congress in connection with this
Federal contract, grant, loan, or cooperative agreement, the undersigned shall
complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying,"
in accordance with its instructions.
3. The undersigned shall require that the language of this certification be
included in the award documents for all subawards at all tiers (including
subcontracts, subgrants, and contracts under grants, loans, and cooperative
agreements) and that all subrecipients shall certify and disclose accordingly. This
certification is a material representation of fact upon which reliance was placed
when this transaction was made or entered into. Submission of this certification is
a prerequisite for making or entering into this transaction imposed by section
1352, title 31, U.S. Code. Any person who fails to file the required certification
shall be subject to a civil penalty of not less than $10,000 and not more than
$100,000 for each such failure.RalrgrA&J'J'e.%at try/
The Contractor, rar*ft, 4-c , certifies or affirms the truthfulness
and accuracy of each statement of its certification and disclosure, if any. In
addition, the Contractor understands and agrees that the provisions of 31 U.S.C.
Chap. 38, Administrative Remedies for False Claims and Statements, apply to
this certification and disclosure, if any.
Signature of Contractor's Authorized Official
it > R/Z il-2
Name and Title of Contractor's Authorized Official Date
Page 36 of 52
DISCLOSURE OF LOBBYING ACTIVITIES
Coat q=7W FORM TO DISCLOSE LOM-MG ACTIMIFS PU8MAN'f M 31 US.C_13r_
1. Type of Federal Action: 3 Status of Federal Action: 3. Rzport Type:
Ra.Can= ❑a.bd'Of r;applicaton ❑a.inftfal
b. i b. initial=aid b. mneoal cJwp
C. caoptsative agreenmr c. post-named
d. lam For Material Chimp OW
e. I=gamma peat gonraes
f loan msamace due of last report
4. None ad Address ofReportmg Entity S. If Repwft Entity in No.4 is Sabawardee,
Enter Name and Address of Pemse:
❑prime ❑Sub mudee
Tur .ifknotm
ctagessiamal District,iSlmocm Coupessionai Di st&t,if karwa
6. Federal DepaitmmffAppocy: 7_ Federal Propsm NamerDncrfpfiom:
CFDA Number,ifappticabie
a Federal Action Number,Ukaawn: 9. Award Amomik ff knaaa
10. a.Name and Address of Lobby Entity b. Indiriduals Performing Services (inofid ag
(If tobvAnal,last name,first name.IQ addstrs ff dais mg faom No.10a)
pan ulm.first name.bp
(Mach Coatmnadon Sheets)ifn,ecesmy)
11. Amamt of Payment(check all that apply) 13. TyW ofPaymead(cktek aD that aggly)
S ❑actaral ❑plaamed a. raziou
b. oce4imeflee
IL Foam of Payment(check all that apply): c mission
n a. cash d. contin fee
❑ b. im4dmd: speaafp: name a domed
vahae f other spec ffy
I& Briar¢Docnptwn of Stanm Performed or to be puh med amdDah(s)of Sersia,admdittg
otbcer(s),tmployee(s),or mtmber(s)coatxted,for Payment Imdfcated is Item U:
(attach Caatinaatim Sheet(s)if aeceSW.V)
IS. Contimaatioa Skeet(:)attacked yes ❑ NO ❑
16. lefaamttioa sagamd OnvA tip fa ►b sated by
Tuts31U.S,C..SovdwI332-Thisdss1w=d1obbyiaa Signal"
tstiamu xat pLud byt5a tins sbova advmltis Q
was made az art md=to.Tbis&Waasa is nq=sd paint Name:
Pw=c�k to 31 UAC.1352.'MI bfoimstioa a mbs
zVeamdtoCcav %u=kmadlyndvatoavaila Win Title:
P ' YPwM s'bo has to S1s ebs atiga8ad
dwbnm*"bs=bjaa to a card pemlty ofxm but 6=
S10.000 mdaoss=stays 9100.000 for rich=Ch fm`hm Tdglbone No.: Due
Awhm zed for LocalRgwWaction
Federal!Use Only-, St mdmd Form-LIL
2-6c PART2YCWNTY
Page 37 of 52
INSTRUCTIONS FOR COMPLETION OF SF-LLL,
DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity,whether subawardee or prime Federal recipient,at the initiation or receipt of
covered Federal action or a material change to previous filing pursuant to title 31 U.S.C.section 1352. The fil ing of a form is required for
such payment or agreement to make payment to lobbying entity for influencing or attempting to influence an officer or employee of any
agency,a Member of Congress an officer or employee of Congress or an employee of a Member of Congress in connection with a covered
Federal action. Attach a continuation sheet for additional information if the space on the form is inadequate. Complete all items that apply
for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and
Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence,
the outcome of a covered Federal action.
2. Identify the Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change
to the information previously reported,enter the year and quarter in which the change occurred. Enter the
date of the last, previously submitted report by this reporting entity for this covered Federal action.
4. Enter the full name,address,city,state and zip code of the reporting entity. Include Congressional District if
known. Check the appropriate classification of the reporting entity that designates if it is or expects to be a
prime or subaward recipient. Identify the tier of the subawardee,e.g.,the first subawardoe of the prime is the
first tier. Subawards include but are not limited to subcontracts,subgrants and contract awards under grants.
5. If the organization filing the report in Item 4 checks"Subawardce"then enter the full name,address,city,state
and zip code of the prime Federal recipient. Include Congressional District.if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at least one
organization level below agency name,ifknown. For example,Department of Transportation,United States
Coast Guard.
7. Enter the Federal program name or description for the covered Federal action(item I). If known,enter the full
Catalog of Federal Domestic Assistance(CFDA)number for grants,cooperative agreements,loans and loan
commitments.
8. Enter the most appropriate Federal identifying number available forthe Federal action identification in item 1(e.g.,
Request for Proposal(RFP)number,Invitation for Bid(IFB)number,grant announcement number,the contract
grant.or loan award number,the application/proposal control number assigned by the Federal agency). Include
prefixes,e.g., "RFP-DE-90-001."
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency,enter the
Federal amount of the award/loan commitments for the prime entity identified in item 4 or 5.
10. (a)Enter the full name,address,city,state and zip code of the lobbying entity engaged by the reporting entity
identified in item 4 to influenced the covered Federal action.
(b)Enter the full names of the individual(s)performing services and include full address ifdifferent from 10(a).
Enter Last Name,First Name and Middle Initial(MI).
]I. Enter the amount ofcompensation paid or reasonably expected to be paid by the reporting entity(item 4)to the
lobbying entity(item 10). Indicate whether the payment hab been made(actual)or will be made(planned).
Check all boxes that apply. If this is a material change report,enter the cumulative amount of payment made or
planned to be made.
12. Check the appropriate box. Check all boxes that apply. If pay ment is made through an in-kind contribution,
specify the nature and value of the in-kind payment
13. Check the appropriate box. Check all boxes that apply. If other,specify nature.
14. Provide a specific and detailed description of the services that the lobbyist has performed or will be expected to
perform and the date(s)ofany services rendered. Include all preparatory and related activity not just time spent in
actual contact with Federal officials. Identify the Federal officer(s)or employce(s)contacted or the offiect(s)
employce(s)or Members) of Congress that were contacted.
15. Check whether or not a continuation sheet(s)isattached.
16. The certifying official shall sign and date the form,print his/her name title and telephone number.
Public reporting burden for this collection of information is estimated to average 30 minutes per response,including time for reviewing
instruction,searching existing data sources,gathering and maintaining the data needed,and completing and reviewing the collection of
information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden,to the Office of Management and Budget,Paperwork Reduction Project
(0348-0046),Washington,D.C.20503. SF-LLL-Instructions Rev.06-04-
9WENDIFn
Page 38 of 52
INSURANCE REQUIREMENTS AND FORMS
MONROE COUNTY,FLORIDA RISK MANAGEMENT POLICY AND PROCEDURES
General Insurance Requirements For
Other Contractors,Subcontractors and Professional Services
As a pre-requisite of the work and services governed, or the goods supplied under this contract
(including the pre-staging of personnel and material), the Contractor shall obtain, at his/her own
expense, insurance as specified in any attached schedules, which are made part of this contract. The
Contractor will ensure that the insurance obtained will extend protection to all Subcontractors engaged
by the Contractor. Alternatively, the Contractor may require all Subcontractors to obtain insurance
consistent with the attached schedules.
The Contractor will not be permitted to commence work governed by this contract (including pre-
staging of personnel and material) until satisfactory evidence of the required insurance has been
furnished to the County as specified below. Delays in the commencement of work, resulting from the
failure of the Contractor to provide satisfactory evidence of the required insurance, shall not extend
deadlines specified in this contract and any penalties and failure to perform assessments shall be
imposed as if the work commenced on the specified date and time,except for the Contractor's failure
to provide satisfactory evidence.
The Contractor shall maintain the required insurance throughout the entire term of this contract and
any extensions specified in the attached schedules. Failure to comply with this provision may result in
the immediate suspension of all work until the required insurance has been reinstated or replaced.
Delays in the completion of work resulting from the failure of the Contractor to maintain the required
insurance shall not extend deadlines specified in this contract and any penalties and failure to perform
assessments shall be imposed as if the work had not been suspended,except for the Contractor's failure
to maintain the required insurance.
The Contractor will be held responsible for all deductibles and self-insured retentions that may be
contained in the Contractor's Insurance policies.
The Contractor shall provide,to the County, as satisfactory evidence of the required insurance,either:
•Certificate of Insurance or
•A Certified copy of the actual insurance policy.
The County,at its sole option, has the right to request a certified copy of any or all insurance policies
required by this contract.
All insurance policies must specify that they are not subject to cancellation, non-renewal, material
change,or reduction in coverage unless a minimum of thirty(30)days prior notification is given to the
County by the insurer.
The acceptance and/or approval of the Contractor's insurance shall not be construed as relieving the
Contractor from any liability or obligation assumed under this contract or imposed by law.
Page 39 of 52
The Monroe County Board of County Commissioners, its employees and officials, at 1100
Simonton Street, Key West, Florida 33040, will be included as "Additional Insured" on all policies,
except for Workers' Compensation.
Any deviations from these General Insurance Requirements must be requested in writing on the
County prepared form entitled"Request for Waiver of Insurance Requirements"and approved by
Monroe County Risk Management Department.
Page 40 of 52
PROPOSER'S INSURANCE AND INDEMNIFICATION STATEMENT
INSURANCE REQUIREMENTS
Workers Compensation Statutory Limits
Employers Liability $100,0001$500,0001$100,000
Bodily Injury by Accident/Bodily
Injury by Disease, policy limits/Bodily
Injury by Disease each employee
General Liability $200,000 per Person
$300,000 per Occurrence
$200,000 Property Damage
or
$300,000 Combined Single Limit
Vehicle $200,000 per Person
(Owned, non-owned,and hired vehicles) $300,000 per Occurrence
$200,000 Property Damage
or
$300,000 Combined Single Limit
Builders Risk Not Required
Construction Bond Not Required
The Monroe County Board of County Commissioners,its employees and officials, 1100 Simonton
Street, Key West, Florida 33040, shall be named as Certificate Holder and Additional Insured on
General Liability and Vehicle policies.
INDEMNIFICATION,HOLD HARMLESS,AND DEFENSE.Notwithstanding any minimum
insurance requirements prescribed elsewhere in this agreement,Contractor shall defend,indemnify
and hold the County and the County's elected and appointed officers and employees harmless from
and against (i) any claims, actions or causes of action, (ii) any litigation, administrative
proceedings, appellate proceedings, or other proceedings relating to any type of injury(including
death),loss,damage,fine,penalty or business interruption,and(iii)any costs or expenses that may
be asserted against, initiated with respect to, or sustained by, any indemnified party by reason of,
or in connection with, (A) any activity of Contractor or any of its employees, agents, contractors
or other invitees during the term of this Agreement,(B)the negligence or recklessness, intentional
wrongful misconduct, errors or other wrongful act or omission of Contractor or any of its
employees, agents, sub-contractors or other invitees,or(C)Contractor's default in respect of any
of the obligations that it undertakes under the terms of this Agreement, except to the extent the
claims, actions, causes of action, litigation, proceedings, costs or expenses arise from the
intentional or sole negligent acts or omissions of the County or any of its employees, agents,
contractors or invitees (other than Contractor). The monetary limitation of liability under this
Page 41 of 52
contract shall be equal to the dollar value of the contract and not less than$1 million per occurrence
pursuant to Section 725.46, Florida Statutes. The limits of liability shall be as set forth in the
insurance requirements included in Paragraph 3.Q. herein. Insofar as the claims, actions, causes
of action, litigation, proceedings, costs or expenses relate to events or circumstances that occur
during the tern of this Agreement, this section will survive the expiration of the tern of this
Agreement or any earlier termination of this Agreement.
In the event that the completion of the project (to include the work of others) is delayed or
suspended as a result of the Contractor's failure to purchase or maintain the required insurance,
the Contractor shall indemnify the County from any and all increased expenses resulting from such
delay. Should any claims be asserted against the County by virtue of any deficiency or ambiguity
in the plans and specifications provided by the Contractor,the Contractor agrees and warrants that
the Contractor shall hold the County harmless and shall indemnify it from all losses occurring
thereby and shall further defend any claim or action on the County's behalf.
United States Department of the Treasury Indemnification
To the fullest extent permitted by law,the Contractor shall indemnify and hold hannless the United
States Department of the Treasury and its officers and employees,from liabilities,damages,losses
and costs, including, but not limited to, reasonable attorney's fees, to the extent caused by the
negligence, recklessness or intentional wrongful misconduct of the Contractor and persons
employed or utilized by the Contractor in the performance of this Contract.
This indemnification shall survive the termination of this Contract. Nothing contained in this
paragraph is intended to nor shall it constitute a waiver of the sovereign immunity of the United
States or the County.
The extent of liability is in no way limited to, reduced, or lessened by the insurance requirements
contained elsewhere within this Agreement.
PROPOSER'S STATEMENT
I understand the insurance that will be mandatory if awarded the contract and will comply
in full with all of the requirements herein. I fully accept the indemnification and hold
harmless and duty to defend as set out in this proposal.
PROPOSER Signature
Page 42 of 52
INSURANCE AGENTS STATEMENT
l have reviewed the above requirements with the proposer named above. The following
deductibles apply to the corresponding policy.
POLICY DEDUCTIBLES
Liability policies are,ZOccurrence Claims Made
.j ow
Insurance Agency S' re
Page 43 of 52
INSURANCE AGENTS STATEMENT
I have reviewed the above requirements with the proposer named above. The following
deductibles apply to the corresponding policy.
POLICY DEDUCTIBLES
Workers Compensation 0
Liability policies are Occurrence Claims Made
Regan Roth Insurance � �/� 4w
Insurance Agency Signature
Page 43 of 52
MONROE COUNTY,FLORIDA
REQUEST FOR WAIVER OF INSURANCE REQUIREMENTS
It is requested that the insurance requirements,as specified in the County's Schedule of Insurance
Requirements,be waived or modified on the following contract.
Contractor/Vendor:
Project or Service:
ContractorNendor
Address& Phone##:
General Scope of Work:
Reason for Waiver or
Modification:
Policies Waiver or
Modification will apply to:
Signature of ContractorNendor:
Date: Approved Not Approved
Risk Management Signature:
Date:
County Administrator appeal:
Approved: Not Approved:
Date:
Board of County Commissioners appeal:
Approved: Not Approved:
Meeting Date:
Page 44 of 52
DATE(MM/DD/YYYY)
ACCOR" CERTIFICATE OF LIABILITY INSURANCE 9/11/2023
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME: Daniel Wall
Great Scot! Insurance, Inc. PHONE FAX
12155 Metro Pkwy A/C No Ext: 239-561-3400 A/c,No):239-561-0496
E-MSuite 28A ADDRESS: dan@gsiinsurance.com
Fort Myers FL 33966 INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA: Imperium Insurance Company-HIIG 35408
INSURED HAMMTER-01 INSURER B:
Hammerhead Termite Control, Inc.
30385 Quail Roost Trail INSURERC:
Big Pine Key FL 33043-3350 INSURERD:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:1912671174 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICY NUMBER MM/DD MM/DD
A X COMMERCIAL GENERAL LIABILITY Y IIC-GL-04544-07 12/17/2022 12/17/2023 EACH OCCURRENCE $1,000,000
CLAIMS-MADE OCCUR DAMAGE TO RENTED
PREMISES Ea occurrence $100,000
MED EXP(Any one person) $5,000
PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
POLICY❑ PRO ❑
JECT LOC PRODUCTS-COMP/OP AGG $2,000,000
X
OTHER: $
A AUTOMOBILE LIABILITY Y IIC-CA-00968-07 12/17/2022 12/17/2023 COEaMBINED ident SINGLE LIMIT $1,000,000
acc
ANY AUTO BODILY INJURY(Per person) $
OWNED X SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
X HIRED X NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY ,T, Per accident
X COMP$1,000 X COLL$1,000 A 16K _ $
UMBRELLA LIAB OCCUR - - EACH OCCURRENCE $
EXCESS LAB .23Ng _ AGGREGATE $CLAIMS-MADE y ....91,1 -
DED RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $
OFFICE R/M EMBER EXCLUDED? N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
A EQUIPMENT FLOATER IIC-IM-00395-07 12/17/2022 12/17/2023 INLAND MARINE LIMIT 107,000
A PROPERTY IIC-CP-00567-07 12/17/2022 12/17/2023 CONTENTS LIMIT 10,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
Exterminator
The Monroe County Board of Commissioners,its employees and officials is listed as an additional insured in regards to general liability and Auto Policy.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
The Monroe County Board of Commissioners, Its ACCORDANCE WITH THE POLICY PROVISIONS.
employees and officials
1100 Simonton Street AUTHORIZED REPRESENTATIVE
Key West FL 33040
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT
CAREFLULLY.
COMMERCIAL AUTOMOBILE BROAD FORM
ENDORSEMENT
This endorsement modifies insurance provided under the
following: BUSINESS AUTO COVERAGE FORM
With respect to coverage provided by this endorsement,the provisions of the Coverage
Form apply unless modified by this endorsement.
A. The following is added to Paragraph A.1 Who Is An Insured. of SECTION II —LIABILITY
COVERAGE:
1. Broadened Insured Status.
a. The following are"insureds"for covered "autos":
(1) Any subsidiary which is a legally incorporated entity of which you
own a financial interest of more than 50%of the voting stock on
the effective date of this Coverage Form.
However, the insurance afforded by this provision A.1. does not
apply to any subsidiary that is an insured under any other
automobile liability policy, or would be an insured under such
policy but for the termination of such policy or the exhaustion of
such policy's limits of insurance.
(2) Any organization you newly acquire or form, and over which
you maintain majority interest.
b. The insurance afforded by provision A.1.(2)above.:
(1) Is effective on the acquisition or formation date, and is afforded
only until the end of the policy period of this Coverage Form,or
the next anniversary of its inception date, whichever is earlier.
(2) Does not apply to "bodily injury"or"property damage" resulting
from an "accident" that occurred before you acquired or formed
the organization.
(3) Does not include any newly acquired or formed organization that
is:
IIC CA 33 01 04 13 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 6 ❑
with its permission
i. Ajoint venture or partnership;or
ii. An insured under any other automobile liability policy, or
would be an insured under such policy but for the
termination of such policy or the exhaustion of such policy's
limits of insurance.
2. Blanket Additional Insured When Required Under Written Contract
The following are insureds:
a. Any person,organization or governmental entity with respect to the
operation, maintenance,or use of a covered "auto" if you are required to
add such person, organization or governmental entity to this policy as an
additional "insured" in order to comply with the terms of any written contract
or agreement, provided such contract or agreement:
(1) Is currently in effect or became effective during the term of this policy; and
(2) Was executed prior to the"accident"or"loss if:
i. The terms and conditions of the written"insured contract"
had been agreed on prior to the"accident"or"loss"; and
ii. You can definitively establish that the terms and conditions of
the written "insured contract" ultimately executed are the
same as those which had been agreed upon prior to the
"accident"or"loss".
b. Subparagraph a. above does not apply if you have hired or borrowed
a covered "auto"from such person,organization or governmental
entity unless the covered "auto" is a "trailer"connected to a covered
"auto" you own.
B. Paragraph 2. Coverage Extensions, a. Supplementary Payments of SECTION II —
LIABILITY COVERAGE is changed as follows:
1. Subparagraph a. (2) is replaced by the following:
Up to$3,000 for cost of bail bonds (including bonds for related traffic law
violations)required because of an "accident"we cover.We do not have to furnish
these bonds.
2. Subparagraph a. (4) is replaced by the following:
All reasonable expenses incurred by the "insured" at our request, including
actual loss of earnings up to $1,000 a day because of time off from work.
C. The following is added to SECTION III— PHYSICAL DAMAGE COVERAGE, D.
Deductible,
1. Physical Damage- Glass Breakage
If you carry Comprehensive Coverage for the damaged covered "auto" the following
applies:
IIC CA 33 01 04 13 Includes copyrighted material of Insurance Services Office, Inc. Page 2 of 6 ❑
with its permission
Any deductible shown in the declarations will not apply to glass breakage if such glass
is repaired, rather than replaced. If the glass must be replaced and there is no other
damage associated with the"loss", the deductible will be$250 unless a lower deductible
is shown on the declarations page for this coverage.
2. Multiple Deductible Protection
If you carry Comprehensive and Collision coverages for the damaged covered "auto"
the following applies:
a. Whenever a covered "auto" and trailer are each damaged in the same
"accident'while operating as a combined truck and trailer unit, only one
deductible shall apply to the "accident'. If different deductibles apply to the
covered "auto"and trailer, the larger of the two deductibles shall apply.
b. If another Policy or coverage form issued by us that does not provide"auto"
physical damage coverage applies to the same"loss"or"accident', the
smaller of the deductibles specified in either form applies to the"loss"or
"accident'.
D. Section III— Physical Damage Coverage is changed as follows:
Paragraph A. Coverage, 4. Coverage Extensions, a. Transportation Expenses is deleted and replaced by
the following:
a. Increased Temporary Transportation Expense
(1) If you carry Comprehensive Coverage for the damaged covered "auto"
and the auto is damaged because of a "loss" payable under
Comprehensive Coverage, we will pay up to $50 per day to a
maximum of $1,500 for temporary transportation expense incurred by
you because such covered "auto" is inoperable and withdrawn from
use due to the "loss". We will begin paying temporary transportation
expenses on the day the auto becomes inoperable due to the "loss". If
such "loss" is because of the total theft of the "covered auto" we will
pay for temporary transportation expenses incurred during the period
beginning 24 hours after the theft. We will cease paying temporary
transportation expenses when the above maximum payable has been
reached or the covered "auto" is returned to use or we pay for its
"loss", regardless of the policy expiration.
(2) If you carry Collision Coverage for the damaged covered "auto" and
the auto is damaged because of a "loss" payable under Collision
Coverage, we will pay up to $50 per day to a maximum of $1,500
for temporary transportation expense incurred by you because such
covered "auto" is inoperable and withdrawn from use due to the
"loss". We will begin paying temporary transportation expenses on the
day the auto becomes inoperable due to the "loss". We will cease
paying temporary transportation expenses when the above maximum
payable has been reached or the covered "auto" is returned to use or
we pay for its "loss", regardless of the policy expiration.
(3) Deductible provisions are not applicable to temporary transportation
expense.
IIC CA 33 01 04 13 Includes copyrighted material of Insurance Services Office, Inc. Page 3 of 6 ❑
with its permission
2. Paragraph A. Coverage, 2. Towing is deleted and replaced by the following: Extended Towing
Coverage
We will pay up to $250 for towing and labor costs incurred each time a covered
"auto" is disabled. However, the labor must be performed at the place of
disablement.
3. The following is added to Paragraph A. Coverage, 4. Coverage Extensions
Hired Auto Physical Damage Coverage
If hired "autos" are covered "autos"for Liability Coverage and if Comprehensive,
Specified Causes of Loss, or Collision coverages are provided under the Business
Auto Coverage Form for any"auto" you own, then the Physical Damage Coverages
provided are extended to "autos" you hire or borrow, subject to the following limit.
The most we will pay for"loss"to any hired "auto" is:
a. $50,000;
b. The actual cash value of the damaged or stolen property at the time of the
"loss"; or
c. The cost of repairing or replacing the damaged or stolen property;
Whichever is smallest, minus a deductible. The deductible will be equal to the
largest deductible applicable to any owned "auto"for that coverage. No deductible
applies to"loss" caused by fire or lightning. Hired Auto Physical Damage
Coverage, provided herein, is excess over any other collectible insurance. Subject
to the above limit, deductible and excess provisions, we will provide coverage
equal to the broadest coverage applicable to any covered "auto" you own.
We will also cover loss of use of the hired "auto" if it results from an "accident', you
are legally liable and the lessor incurs an actual financial loss, subject to a
maximum of$1000 per"accident'.
This extension of coverage does not apply to any"auto" you hire or borrow from
any of your"employees", partners (if you are a partnership), members (if you are a
limited liability company), or members of their households.
4. The following is added to Paragraph A. Coverage, 4. Coverage Extensions
Extra Expense-Stolen Vehicles
If you carry Comprehensive Coverage for a covered "auto"which is stolen we will
pay for all reasonable and necessary expenses to return the stolen covered "auto"
to you. Such necessary expenses shall not exceed the actual cash value of the
"auto"or$5,000, whichever is less.
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with its permission
5. The following is added to Paragraph A. Coverage, 4. Coverage Extensions
Lease Gap Coverage
If a long-term leased "auto" is a covered "auto" and the lessor is named in the
policy as a "Loss Payee, we will pay in the event of a total "loss" your additional
legal obligation to the lessor for any difference between the actual cash value of
the "auto" at the time of the "loss" and the"remaining balance"of the lease, subject
to a payment of 50% or a limit of$25,000, whichever is less, for this difference
amount. However, this insurance is applicable only when the covered "auto" is not
subject to any other Lease Gap or similar coverage.
E. Exclusion 3.a. of Paragraph B. Exclusions of Section III— Physical Damage Coverage is
deleted and replaced by the following:
Accidental Discharge of an Airbag
3. We will not pay for"loss"due and confined to:
a. Wear and tear, freezing, mechanical or electrical breakdown. Mechanical
breakdown does not include the accidental discharge of an airbag in any"auto"
you do not hire with a driver.
F. SECTION IV—BUSINESS AUTO CONDITIONS is changed as follows:
1. The following is added to A. Loss Conditions, 2. Duties in the Event of an Accident, Claim, Suit, or
Loss:
a. Your obligations in subparagraph a. relative to notification requirements applies
only when the"accident'or"loss" is known to:
(1) You, if you are an individual;
(2) A partner, if the named insured is a partnership;
(3) A member, if the named insured is a joint venture or limited liability
company; or
(4) An executive officer or insurance manager, if the named insured is an
organization other than a partnership,joint venture or limited liability
company.
b. Your obligation in subparagraph b. relative to providing us with documents
concerning a claim or"suit'will not be considered breached unless the
breach occurs after such claim or"suit' is known to:
(1) You, if you are an individual;
(2) A partner, if the named insured is a partnership;
(3) A member, if the named insured is a joint venture or limited liability
company; or
(4) An executive officer or insurance manager, if the named insured is an
organization other than a partnership,joint venture or limited liability
company.
IIC CA 33 01 04 13 Includes copyrighted material of Insurance Services Office, Inc. Page 5 of 6 ❑
with its permission
2. The following is added to A. Loss Conditions
Unintentional Failure to Disclose Hazards
If you unintentionally fail to disclose any hazards existing on the effective date of this
policy,we will not deny coverage under this Coverage Form because of such failure.
However,this provision does not affect our right to collect additional premium due to
us as a result of these undisclosed hazards in accordance with our filed rating rules.
3. The following is added to paragraph 5. Transfer Of Rights Of Recovery Against Others To Us
a. Non-Owned Auto Waiver of Subrogation
We waive any right to recover any damages against any of your officers, directors,or
"employees"which arise because of any payment under the insurance afforded by this
policy for the operation, maintenance, use, loading, or unloading of non-owned
"autos". This waiver extends only to payments in excess of other valid and
collectible insurance available to the officer, director, or"employee".
b. Blanket Waiver of Subrogation When Required Under written Contract
We waive any right to recover any damages against any person,organization or
government entity when you have waived such right of recovery under a written
"insured contract" provided such written "insured contract" is:
(1) Currently in effect or becoming effective during the term of this policy;
and
(2) Executed prior to the"accident" or"loss" if:
i. the terms and conditions of the written"insured contract" had been
agreed on prior to the"accident"or"loss";and
ii. you can definitively establish that the terms and conditions of the
written "insured contract" ultimately executed are the same as those
which had been agreed upon prior to the"accident" or"loss".
G. SECTION V— DEFINITIONS is changed as follows:
1. Mental Anguish Resulting From "Bodily Injury"
The definition of"bodily injury' is replaced by the following:
"Bodily injury' means bodily injury, sickness or disease sustained by a
person, including death resulting from any of these. "Mental anguish" is
"bodily injury' if it results from bodily injury, sickness or disease.
2. Mental Anguish
The following definition is added:
"Mental anguish" means any type of mental or emotional illness or distress
which results from bodily injury, sickness or disease.
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with its permission
IIC GL 50 04 10 17
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL LIABILITY BROADENING ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
COMMERCIAL GENERAL LIABILITY DECLARATION
In addition to words and phrases contained in the Commercial General Liability Coverage Form, other words and
phrases that appear in quotation marks have special meaning. Refer to Paragraph VI. DEFINITIONS of this
endorsement. For the purposes of the coverage provided by this endorsement these definitions apply in place of
their definitions stated elsewhere in the policy.
The following provisions apply only with respect to the coverage provided by this endorsement. However, the
coverage expansions provided throughout this endorsement do not apply if coverage is excluded either by the
provisions of the Coverage Part or by endorsement.
I. COVERAGE A—BODILY INJURY AND PROPERTY DAMAGE LIABILITY
A. Non-Owned Watercraft
Paragraph 2.g. (2)(a) of SECTION I-COVERAGES, COVERAGE A BODILY INJURY AND
PROPERTY DAMAGE LIABILITY is replaced with the following:
(a) Less than 51 feet long; and
B. Property Damage Extension
The following is added to Exclusion j.:
1. Borrowed Equipment
Paragraphs (3) and (4) of this exclusion do not apply to "property damage"to borrowed equipment
while not being used to perform operations at the job site.
2. Elevators
The following is added to Exclusion j.:
Paragraphs (3) and (4) of this exclusion do not apply to "property damage" arising from the use of
elevators.
II. SUPPLEMENTARY PAYMENTS-COVERAGES A AND B
In the SUPPLEMENTARY PAYMENTS—COVERAGES A AND B:
A. The limit for the cost of bail bonds is increased from $250 to $1,000; and
B. The limit for loss of earnings is increased from $100 a day to $500 a day.
III. WHO IS AN INSURED
A. Paragraph 2. Under SECTION II—WHO IS AN INSURED is expanded to include the following:
1. Additional Insured by Contract, Agreement or Permit
Any person(s)or organization(s) is an additional insured when you have agreed, in a written contract,
written agreement or because of a permit issued by a state or political subdivision, that such person(s)
or organization(s) be added as an additional insured on your policy, provided the injury or damage
occurs subsequent to the execution of the contract or agreement.
IIC GL 50 04 10 17 Includes copyright material of Insurance Services Office, Inc., Page 1 of 7
with its permission.
IIC GL 50 04 10 17
A person or organization is an additional insured under this provision only for that period of time
required by the contract or agreement.
However, no such person or organization is an insured under this provision if such a person or
organization is included as an insured by an endorsement issued by us and made part of this Coverage
Part.
a. Vendors
Any person(s)or organization(s) (referred to herein as vendor)with whom you agreed, because of a
written contract or agreement to provide insurance, but only with respect to "bodily injury" or
"property damage" arising out of"your products"which are distributed or sold in the regular course
of the vendor's business, subject to the following additional exclusions:
(1) The insurance afforded the vendor does not apply to:
(a) "Bodily injury" or"property damage"for which the vendor is obligated to pay damages by
reason of the assumption of liability in a contract or agreement. This exclusion does not apply
to liability for damages that the vendor would have in the absence of the contract or
agreement;
(b) Any express warranty unauthorized by you;
(c)Any physical or chemical change in the product made intentionally by the vendor;
(d) Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing,
or substitution of parts under instructions from the manufacturer, and then repackaged in the
original container;
(e)Any failure to make such inspections, adjustments, tests or servicing as the vendor has
agreed to make or normally undertakes to make in the usual course of business, in
connection with the distribution or sale of the products;
(f) Demonstration, installation, services or repair operations, except such operations performed
at the vendor's premises in connection with the sale of the products;
(g)Products which, after distribution or sale by you, have been labeled or relabeled or used as a
container, part or ingredient of any other thing or substance by or for the vendor.
(h)"Bodily Injury" or"Property Damage" arising out of the sole negligence of the vendor for its
own acts or omissions or those of its employees or anyone else acting on its behalf.
However, this exclusion does not apply to:
i. The exceptions contained in contained in Subparagraphs(d)or(f); or
ii. Such inspections, adjustments, tests or servicing as the vendor has agreed to make or
normally undertakes to make in the usual course of business, in connection with the
distribution of sale of the products.
(2)Any insured person or organization, from whom you have acquired such products, or any
ingredient, part or container, entering into, accompanying or containing such products.
b. Lessors or Equipment
(1)Any person(s)or organization(s)from whom you lease equipment, but only with respect to
liability for"bodily injury", "property damage" or"personal and advertising injury" caused, in
whole or in part, by your maintenance, operation or use of equipment lease to you by such
person(s)or organization(s).
(2) With respect to the insurance afforded to these additional insureds, this insurance does not
apply to any"occurrence"which takes place after the equipment lease expires.
c. Lessors of Land or Premises
Any person(s)or organization(s)from whom you lease land or premises, but only with respect to
liability arising out of the ownership, maintenance or use of that part of the premises leased to you,
and subject to the following additional exclusions:
This insurance does not apply to:
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with its permission.
IIC GL 50 04 10 17
(1)Any"occurrence"which takes place after you cease to be a tenant in that premises.
(2) Structural alterations, new construction or demolition operations performed by or on behalf of
such person or organization.
d. Architects, Engineers or Surveyors
(1)Any architect, engineer, or surveyor engaged by you but only with respect to liability for"bodily
injury" "property damage" or"personal and advertising injury" caused, in whole or in part, by your
acts or omissions or the acts or omissions of those acting on your behalf:
(a) In connection with your premises; or
(b) In the performance of your ongoing operations.
(2) With respect to the insurance afforded to these additional insureds, the following additional
exclusion applies:
This insurance does not apply to "bodily injury" or"property damage" or"personal and
advertising injury" arising out of the rendering of or the failure to render any professional services
by or for you, including:
(a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions,
reports, surveys, field orders, change orders or drawings and specifications; or
(b)Supervisory, inspection, architectural or engineering activities.
e. Permits Issued By State or Political Subdivisions
Any state or governmental agency or subdivision or political subdivision but only with respect to
operations performed by you or on your behalf for which the state or governmental agency or
subdivision or political subdivision has issued a permit or authorization.
The insurance does not apply to:
(1) "Bodily injury", "property damage" or"personal and advertising injury" arising out of operations
performed for the federal government, state or municipality; or
(2) "Bodily injury" or"property damage" included within the "products-completed operations hazard".
f. Any Other Party
Any other person(s)or organization(s)who is not an insured under Paragraph a. through e. above,
but only with respect to liability for"bodily injury", "property damage" or"personal and advertising
injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting
on your behalf:
(1) In the performance of your ongoing operations;
(2) In connection with your premises owned by or rented to you; or
(3) In connection with "your work" and included within the "products-completed operation hazard",
but only if:
(a) The written contract or agreement requires you to provide such a coverage to additional
insureds; and
(b)The Coverage Part provides coverage for"bodily injury" or"property damage" included within
"products-completed operations hazard".
With respect to the insurance afforded to these additional insureds, this coverage does not apply to:
"Bodily injury", "property damage" or"personal and advertising injury" arising out of the rendering of,
or failure to render, any professional architectural, engineering or surveying services, including:
(1) The preparing, approving, or filing to prepare or approve, maps, shop drawings, opinions,
reports, surveys, field orders, change orders or drawings and specifications; or
(2) Supervisory, inspections, architectural or engineering activities.
The limit of insurance that apply to additional insureds under this extension is described in
SECTION III— LIMITS OF INSURANCE.
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with its permission.
IIC GL 50 04 10 17
How this Insurance applies when other insurance is available to the additional insured is described
in the Other Insurance Condition in SECTION IV—COMMERCIAL GENERAL LIABILITY
CONDITIONS.
2. Subsidiaries
Any subsidiary and subsidiary thereof of yours, which is a legally incorporated entity, of which you own
a financial interest of more than 50% of the voting stock on the effective date of the Coverage Part. The
insurance afforded herein for any subsidiary not named in this Coverage part as a named insured does
not apply to injury or damage with respect to which an insured under this Coverage Part is also an
insured under another policy or would be an insured under such policy but for its termination or the
exhaustion of its limits of insurance.
3. Newly formed Or Acquired Organizations
Paragraph 3.a. of SECTION II—WHO IS AN INSURED, is increased from 901h day to 180th day.
However, this expansion does not apply if coverage for newly formed or acquired organizations is
excluded either by the provisions of the Coverage Part or by endorsement.
IV. LIMITS OF INSURANCE
A. Damage to Premises Rented To You
Paragraph 6. of SECTION III—LIMITS OF INSURANCE is replaced with the following:
6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay
under Coverage A for damages because of"property damage"to any one premises, while rented to
you, or in the case of damage by fire, while rented to you or temporarily occupied by you with
permission of the owner.
The most we will pay in any one "occurrence" is the higher of the following:
(a) $300,000; or
(b)The amount shown in the Declarations for Damages To Premises Rented to You Limit.
B. Medical Payments
Paragraph 7. of SECTION III—LIMITS OF INSURANCE is replaced with the following:
7. Subject to Paragraph 5. above, the Medical Expense Limit is the most we will pay under Coverage C for
all medical expenses because of"bodily injury" sustained by any one person.
The most we will pay because for"bodily injury" sustained by any one person is the higher of the
following;
a. $10,000; or
b. The amount shown in the Declarations for Medical Expense Limit.
V. SECTION IV-COMMERCIAL GENERAL LIABILITY CONDITIONS
The following items are amended:
A. Duties In The Event Of Accident, Claim, Suit Or Loss
The following items are added to Paragraph 2. of SECTION IV-COMMERCIAL GENERAL LIABILITY
CONDITIONS:
e. Additional Insurance Other Insurance
If we cover a claim or"suit" under this Coverage Part that may also be covered by other insurance
available to an additional insured, such additional insured must submit such claim or"suit"to the other
insurer for defense and indemnity.
However, this provision does not apply to the extent that you have agreed in a written agreement that
this insurance is primary and non-contributory with the additional insured's own insurance.
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with its permission.
IIC GL 50 04 10 17
f. Knowledge Of An Occurrence, Offense, Claim or Suit
Paragraph a. and b. apply to you or to any additional insured only when such "occurrence", offense,
claim or"suit" is known to:
(1) You or any additional insured that is an individual;
(2)Any partner, if you or an additional insured is a partnership;
(3)Any manager, if you or an additional insured is a limited liability company;
(4)Any"executive officer" or insurance manager, if you or an additional insured is a corporation;
(5)Any trustee, if you or an additional insured is a trust; or
(6)Any elected or appointed official, if you or an additional insured is a political subdivision or public
entity.
This duty applies separately to you and any additional insured.
B. Other Insurance
The following items are added to paragraph 4.b. of SECTION IV-COMMERCIAL GENERAL LIABILITY
CONDITIONS:
(1) This insurance is excess over any of the other insurance, whether primary, excess, contingent or on
any other basis;
(a) Property Damage to Borrowed Equipment or Use of Elevators
If the loss arises out of"property damage"to borrowed equipment or the use of elevators to the
extent not subject to Exclusion j.of SECTION I-COVERAGES, COVERAGE A BODILY INJURY
AND PROPERTY DAMAGE LIABILITY;
(b)When You Are Added As An Additional Insured To Other Insurance
Any other insurance available to you covering liability for damages arising out of the premises or
operations, or products and completed operations, for products and completed operations, for which
you have been added as an additional insured by that insurance; or
(c)When You Add Others As An Additional Insured To This Insurance
Any other insurance available to an additional insured.
However, the following provisions apply to other insurance available to any person or organization
who is an additional insured under this coverage part:
i. Primary Insurance When Required By Contract
This insurance is primary if you have agreed in a written contract or written agreement that this
insurance be primary. If other insurance is also primary, we will share with all that other
insurance by the method described in c. Method of Sharing, in the policy.
ii. Primary And Non-Contributory To Other Insurance When Required By Contract
If you have agreed in a written contract, written agreement, or permit that this insurance is
primary and non-contributory with the additional insured's own insurance, this insurance is
primary and we will not seek contribution from that other insurance.
Paragraphs a. and b. do not apply to other insurance to which the additional insured has been
added as an additional insured.
C. Representations
Paragraph 6. of SECTION IV-COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced with the
following:
a. When You Accept This Policy
By accepting this policy, you agree:
(1) The statements in the Declarations are accurate and complete;
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with its permission.
IIC GL 50 04 10 17
(2) Those statements are based upon representation you made to us; and
(3) We have issued this policy in reliance upon your representations.
b. Unintentional Failure to Disclose Hazards
If you unintentionally fail to disclose any hazards existing at the inception date or your policy, we will not
deny coverage under this Coverage Part because of such failure. However, you must report such error or
omission to us as soon as practicable after its discovery.
D. Transfer Of Rights OF Recovery Against Others To Us
Paragraph 8. of SECTION IV-COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced with the
following:
If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those
rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured
will bring "suit" or transfer those rights to us and helps us enforce them.
However, we waive any right of recovery we may have against any person or organization to the extent
required of you by a written contract executed prior to any"occurrence" or"suit" arises out of operations
contemplated by such contract. The waiver applies only to the person or organization designated in such
contract.
VI. DEFINITIONS
A. Amended Definitions
1. Advertisement
The following is added to the definition of"advertisement":
However, "advertisement"does not include:
The design, printed material, information or images contained in, on or upon the packaging or labeling
of any goods or products; or
An interactive conversation between or among persons through a computer network.
2. Coverage Territory
Final paragraph in the definition of"coverage territory" is replaced by the following:
Provided the insured's responsibility to pay damages is determined in the United States of America
(including its territories and possessions), Puerto Rico or Canada, in a "suit" on the merits according to
the substantive law in such territory or in a settlement we agree to.
3. Insured Contract
(1) Paragraph a. in the definition of"insured contract" is replaced by the following:
A contract for a lease of premises. However, that portion of the contract for a lease of premises while
rented to you or temporarily occupied by you with permission of the owner is subject to the Damage To
Premises Rented To You Limit described in SECTION III- LIMITS OF INSURANCE.
(2) The First paragraph of Paragraph f. in the definition of"insured contract" is replaced by the following:
That part of any other contract or agreement pertaining to your business (including an indemnification of
a municipality in connection with work performed for a municipality) under which you assume the tort
liability of another party to pay for"bodily injury" or"property damage"to a third person or organization,
provided the "bodily injury" or"property damage" is caused, in whole or in part, by you or by those
acting on your behalf. Tort liability means a liability that would be imposed by law in the absence of any
contract or agreement.
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with its permission.
IIC GL 50 04 10 17
4. Mobile Equipment
Paragraph f. (1) in the definition or"mobile equipment" is replaced by the following:
(1) Equipment, of at least 1,000 pounds gross vehicle weight, designed primarily for:
5. Personal and Advertising Injury
Paragraph f. in the definition of"personal and advertising injury" is replaced by the following;
f. Copying, in your"advertisement", a person's or organization's "advertising idea" or style of
"advertisement".
B. Added Definitions
"Advertising idea" means any idea for an "advertisement".
IIC GL 50 04 10 17 Includes copyright material of Insurance Services Office, Inc., Page 7 of 7
with its permission.
ATTACHMENT A
CORONAVIRUS STATE AND LOCAL FISCAL RECOVERY FUNDS FINANCIAL
ASSISTANCE AGREEMENT
Page 46 of 52
OMB Approved No. 1505-0271
Expiration Date: 1110,,2021
U.S.DEPARTMUNTOF THE TREASURY
CORONAVIRUS STATE.AND LOCAL FISCAL RECOVERY FUNDS
Recipient name and address: DUNS Number:073876757
Monme County Board of Commissioners Taxpayer ldentification Numbcu 596000749
1100 Simonton Street.Room 2-213 Assistance Listing Number and Title:21.027
Key West,Florida 33040
Sections 602(b)and 603(b)of the Social Security Act(the Act)as added by section 9901 of the American Rescue Plan Act,Pub.L.
No.117-2(March 11.2021)authorizes the Department of the Treasury(Treasury)to male payments to certain recipients from the
Coronavinrs State Fiscal Recovery Fund and the Coronavirus Local Fiscal Recovery I-tmd.
Recipients hereby agrees,as a conditiun to receiving such payment from Treasury,agrees to the terms attached hereto
Recipient:
Dm 2902"Tina Boan aosigned :111
Authorised Representative Signature(above)
Authorized Representative Name: I ina Goan
Authorized Rcprescntativc'l'itic: Senior Director Budget&Finance
Date Signed:
U.S.Department of the Treasury:
Authorized Representative Signature(above)
Authorized Representative Name: Jacob Leihenluft
Authorised Representative Title: Chief Recovery Officer.Coe of Recovery Programs
Date Signed: May 14.2021
PAPERWORK REDUCnON AC-r NOTICE
The information collected will be used for Use t 7.S.G n ernmau to process m1unts far support The estimated burden aswcrsted with this collection of
irlcrmadon is 15 minutes per response.Comments mwerning the accuracy of this Widen estimate seed suggestions far reducing this burden dwuld be directed
to"Office of Prir aey.Tmnsfiamm-)and Rewrds.Derwmnera of the Trrtsury,1500 Pemmyh om Ave..N W_Washington,D.C.20220.DO NOT send the
fume to this adit&L An agtrcy may not induct or spotn r.and a lemon is not mquacil to reWmW to.a collection or inf4mzt:on unless it displays a valid
omttrol member assigned by Mill
Page 47 of 52
U.S.DEPARTbf NT OF THE TREASURY
CORONAVIRUS STATE FISCAL RECOVERY FUND
AWARD TERMS AND CONDITIONS
1.Use of Fonds.
a. Recipient understands and agrees that the funds disbursed under this award may only be used in compliance with sections
602(c)and 603(c)of the Social Security Act(the Act)and Treasury's regulations implementing that section and guidance.
b. Recipient will determine prior to engaging in any project using this assistance that it has the institutional,managerial,and
financial capability to ensure proper planning,management,and completion of such project.
2.Period of Performance.The period of performance for this award begets on the date hereof and ends on December 31,2026.As
set forth in Treasury's implementing regulations,Recipient may use award funds to cover eligible costs incurred during the period
that begins on March 3,2021 and ends on December 31,2024,
J Rego ino Recipient agrees to comply with any reporting obligations established by Treasury,as it relates to this award
4_Maintenance of and Access_to Records
a. Recipient shall maintain records and financial documents sufficient to evidence compliance with sections 602(c)and
603(c),Treasury's regulations implementing those sections,and guidance regarding the eligible uses of funds.
b. The Treasury Office of Inspector General and the Government Accountability Office,or their authorized representatives,
shall have the right of access to records(electronic and otherwise)of Recipient in order to conduct audits or other
investigations.
c. Records shall be maintained by Recipient for a period of five(5)years after all funds have been expended or returned to
Treasury,whichever is later.
5.Pre-award Costs.Pre-award costs,as defined in 2 C.F.R.§200.458,may not be paid with funding from this award.
6.Administrative Costs.Recipient may use funds provided under this award to cover both direct and indirect costs.
7.Cost Sharing.Cost sharing or matching funds are not required to be provided by Recipient.
8.Conflicts of interest Recipient understands and agrees it must maintain a conflict of interest policy consistent with 2 C.F.R.§
200.318(c)and that such conflict of interest policy is applicable to each activity funded under this award Recipient and
subrecipients must disclose in writing to Treasury or the pass-through entity,as appropriate,any potential conflict of interest
affecting the awarded funds in accordance with 2 C.F.R.§200.112.
9.Comp fiance with Applicable Law and Regulations.
a. Recipient agrees to comply with the requirements of sections 602 and 603 of the Act,regulations adopted by Treasury
pursuant to sections 602(f)and 603(f)of the Act,and guidance issued by Treasury regarding the foregoing.Recipient also
agrees to comply with all other applicable federal statutes,regulations,and executive orders,and Recipient shall provide for
such compliance by other parties in any agreements it enters into with other parties relating to this award,
b. Federal regulations applicable to this award include,without limitation,the following:
i Uniform Administrative Requirements,Cost Principles,and Audit Requirements for Federal Awards,2 C.F.R Part
200,other than such provisions as Treasury may determine are inapplicable to this Award and subject to such
exceptions as may be otherwise provided by Treasury,Subpart F—Audit Requirements of the Uniform Guidance,
implementing the Single Audit Act,shall apply to this award.
ii. Universal Identifier and System for Award Management(SAM),2 C.F.R.Part 25,pursuant to which the award term
set forth in Appendix A to 2 C.F.R Pan 25 is hereby incorporated by reference.
iii. Repotting Subaward and Executive Compensation Information 2 C.F.R.Part 170,pursuant to which the award term
set forth in Appendix A to 2 C.F.R.Part 170 is hereby incorporated by reference.
iv. OMB Guidelines to Agencies on Governmentwide Debarment and Suspension(Nonproctrement),2 C.F.R.Part
180,including the requirement to include a term or condition in all lower tier covered transactions(contracts and
subcontracts described in 2 C.F.R.Part 180,subpart 13)that the award is subject to 2 C.F.R.Part 180 and Treasury's
implementing regulation at 31 C.F.R.Part 19.
Page 48 of 52
v. Recipient Integrity and Performance MaUcrs,pursuant to which the award term set forth in 2 C.F.R_Part 200,
Appendix XII to Part 200 is hereby incorporated by reference.
vi. Governmentwide Requirements for Thug-Free Workplace,31 C.F.R_Part 20.
vii. New Restrictions on Lobbying,31 C.F.R.Part 21.
viii. Uniform Relocation Assistance and Real Property Acquisitions Act of 1970(42 U.S.C.§§4601-4655)and
implementing regulations.
ix Generally applicable federal environmental laws and regulations.
c. Statutes and regulations prohibiting discrimination applicable to this award,include,without limitation,the following:
i. 'title VI of the Civil Rights Act of 1964(42 U.S.C.§§2000d et seq.)and Treasury's implementing regulations at 31
C.F.R.Part 22,which prohibit discrimination on the basis of race,color,or national origin under programs or
activities receiving federal financial assistance;
ii. The Fair Housing Act,Title VIII of the Civil Rights Act of 1968(42 U.S.C.§§3601 et seq.),which prohibits
discrimination in housing on the basis of race,color,religion,national origin,sex,familial status,or disability;
iii. Section 504 of the Rehabilitation Act of 1973,as amended(29 U.S.C.§7941 which prohibits discrimination on the
basis of disability under any program or activity receiving federal financial assistance;
iv. The Age Discrimination Act of 1975,as amended(42 U.S.C.§§6101 et seq.),and Treasury's implementing
regulations at 31 C.F.R.Part 23,which prohibit discrimination on the basis of age in programs or activities
receiving federal financial assistance;and
v. Title II of the Americans with Disabilities Act of 1990,as amended(42 U.S.C.§§12101 et seq.),which prohibits
discrimination on the basis of disability under programs,activities,and services provided or made available by state
and local governments or instrumentalities.or agencies thereto.
10.Remedial Actions_In the event of Recipient's noncompliance with sections 602 and 603 of the Act,otter applicable laws,
Treasury's implementing regulations,guidance,or any reporting or other program requirements,Treasury may impose additional
conditions on the receipt of a subsequent tranche of future award finds,if any,or take other available remedies as set forth in 2
C.FR§200.339.In the case of a violation of sections 602(c)or 603(c)of the Act regarding the use of funds,previous payments
shall be subject to recoupment as provided in sections 602(c)and 603(e)of the Act.
I L Hatch Ace Recipient agrees to comply,as applicable,with requirements of the Hatch Act(5 U.S.C.§§1501-1508 and
7324-7328),which limit certain political activities of State or local government employees whose principal employment is in
connection with an activity financed in whole or in part by this federal assistance.
12.False Statements Recipient understands that making false statements or claims in connection with this award is a violation of
federal law and may result in criminal,civil,or administrative sanctions,including fees,imprisonment,civil damages and
penalties,debarment from participating in federal awards or contracts,and/or any other remedy available by law.
13_Publications.Any publications produced with funds from this award must display the following language:"this project[is
being][was)supported,in whole or in part,by federal award number[enter project FAIN]awarded to Monroe County Board of
Commissioners by the U.S.Department of the Treasury."
14.Debts Owed the Federal Government_
a. Any funds paid to Recipient(1)in excess of the amount to which Recipient is finally determined to be authorized to retain
under the terms of this award;(2)that are determined by the Treasury Office of Inspector General to have been misused;or
(3)that are determined by Treasury to be subject to a repayment obligation pursuant to sections 602(c)and 603(e)of the
Act and have not been repaid by Recipient shall constitute a debt to the federal government.
b. Any debts determined to be owed the federal government must be paid promptly by Recipient.A debt is delinquent if it has
not been paid by the date specified in Treasury's initial written demand for payment,unless other satisfactory arrangements
have been made or if the Recipient knowingly or improperly retains funds that are a debt as defined in paragraph 14(a).
Treasury will take any actions available to it to collect such a debt.
Page 49 of 52
15 Diselaimer
a. The United States expressly disclaims any and all responsibility or liability to Recipient or third persons for the actions of
Recipient or third persons resulting in death,bodily injury,property damages,or any other losses resulting in any way from
the performance of this award or any other lasses resulting in any way from the performance of this award or any contract,
or subcontract under this award.
b. The acceptance of this award by Recipient does not in any way establish an agency relationship between the United States
and Recipient.
16.Protections for Whistlehlowers.
a. In accordance with 41 U.S.C.§4712,Recipient may not discharge,demote,or otherwise discriminate against an employee
in reprisal for disclosing to any of the list of persons or entities provided below,information that the employee reasonably
believes is evidence of gross mismanagement of a federal contract or grant,a gross waste of federal funds,an abuse of
authority relating to a federal contract or grant,a substantial and specific danger to public health or safety,or a violation of
law,rule,or regulation related to a federal contract(including the competition for or negotiation of a contract)or grant.
b. The list of persons and entities referenced in the paragraph above includes the following:
i A member of Congress or a representative of a committee of Congress;
ii An Inspector General;
iii The Government Accountability Office;
iv. A Treasury employee responsible for contract or grant oversight or management;
v. An authorized official of the Department of Justice or other law enforcement agency;
vi A court or grand jury;or
vii A management official or other employee of Recipient,contractor,or subcontractor who has the responsibility to
investigate,discover,or address m isconduct
c. Recipient shall inform its employees in writing of the rights and remedies provided under this section,in the predominant
native language of the workforce.
17 Increasing Seat Belt Use in the United States.Pursuant to Executive Order 13043,62 FR 19217(Apr. 18,1497),Recipient
should encourage its contractors to adopt and enforce on-the-job seat belt policies and programs for their employees when
operating company-owned,rented or personally owned vehicles.
19 Reducing T�essagio8 While Driving,pursuant to Executive Order 13513.74 FR 51225(Oct.6,2009),Recipient should
encourage its employees,subrecipients,and contractors to adopt and enforce policies that ban text messaging while driving,and
Recipient should establish workplace safety policies to decrease accidents caused by distracted drivers.
Page 50 of 52
ONS Approved No.1505-0271
Expiration Date:11/30/2021
ASSURANCE OF COMPLIANCE WITH CIVIL RIGHTS REQUIREMENTS
ASSURANCE OF COMPLIANCE WITH TITLE VI OF THE
CIVIL RIGHTS ACT OF 1964
As a condition of receipt of federal financial assistance from the Department of the Treasury,the Monroe County Board of
Commissioners(hereinafter referred to as"the Recipient')provides the assurances stated herein.The federal financial assistance
may include federal grants,loans and contracts to provide assistance to the recipient's beneficiaries,the use or rent of Federal land
or property at below market value.Federal training,a loan of Federal personnel,subsidies,and other arrangements with the
intention of providing assistance.Federal financial assistance does not encompass contracts of guarantee or insurance,regulated
programs,ftcenses,procurement contracts by the Federal government at market value,or programs that provide direct benefits.
This assurance applies to all federal financial assistance from or funds made available through the Department of the Treasury,
including any assistance that the Recipient may request in the future.
The Civil Rights Restoration Act of I987 provides that the provisions of this assurance apply to all of the recipient's programs,
services and activities,so long as any portion of the recipient's program(s)is federally assisted in the manner proscribed above.
1. Recipient ensures its current and future compliance with Title VI of the Civil Rights Act of 1964,as amended,which
prohibits exclusion from participation,denial of the benefits of,or subjection to discrimination under programs and
activities receiving federal funds,of any person in the United States on the ground of race,color,or national origin(42
U.S.C.§2000d et seq.),as implemented by the Department of the Treasury Title VI regulations at 31 CFR Part 22 and
other pertinent executive orders such as Executive Order 13166;directives;circulars;policies;memoranda and/or guidance
documents.
2. Recipient acknowledges that Executive Order 13166,"Improving Access to Services for Persons with Limited English
Proficiency,"seeks to improve access to federally assisted programs and activities for individuals who,because of rational
origin,have Limited English proficiency(LEP).Recipient understands that denying a person access to its programs,
services,and activities because of LEP is a form of national origin discrimination prohibited under Title VI of the Civil
Rights Act of 1964 and the Department of the Treasury's implementing regulations.Accordingly,Recipient shall initiate
reasonable steps,or comply with the Department of the Treasury's directives,to ensure that LEP persons have meaningful
access to its programs,services,and activities.Recipient understands and agrees that meaningful access may entail
providing language assistance services,including oral interpretation and written translation where necessary,to ensure
effective communication in the Recipient's programs,services,and activities.
3. Recipient agrees to consider the need for language services for LEP persons during development of applicable budgets and
when conducting programs,services and activities.As a resource,the Department of the Treasury has published its LEP
guidance at 70 FR 6067.For more information on LEP,please visit httn:/hvww lee aov.
4. Recipient acknowledges and agrees that compliance with this assurance constitutes a condition of continued receipt of
federal financial assistance and is binding upon Recipient and Recipient's successors,transferees and assignees for the
period in which such assistance is provided.
5. Recipient acknowledges and agrees that it must require any sub-grantees,contractors,subcontractors,successors,
transferees,and assignees to comply with assurances 1-4 above,and agrees to incorporate the following language in every
contract or agreement subject to Title VI and its regulations between the Recipient and the Recipient's sub-grantees,
contractors,subcontractors,successors,transferees.and assignees:
The sub-grantee,contractor,subcontractor,successor,transferee,and assignee shall comply with Title VI of the
Civil Rights Act of 1964,which prohibits recipients offederol financial assistance from excludingfrom a program
or actitrily,denying benefits of,or otherwise&wriminnatiog against a person on the basis of race,color,or
national origin(42 U.SC§2000d et seq.),as implemented by the Department of the Treasury's Title N
regulation%31 CFR Part 22,which are herein incorporated by reference and made a part of this contract(or
agreement).Title F1 also includes protection to persons with"Limited English Proficiency•'in any program or
activity receiving federal financial assistance,42 U.SC.§2000d et seq.,as implemented by the Department of die
Treasury's T itle VI regulations,31 CPR Part 22,and herein incorporated by reference and made a part of this
contract or agreement
6. Recipient understands and agrees that if any real property or structure is provided or improved with the aid of federal
financial assistance by the Department of the Treasury,this assurance obligates the Recipient,or in the case of a subsequent
transfer,the transferee,for the period during which the real property or structure is used for a purpose for which the federal
financial assistance is extended or for another purpose involving the provision of similar services or benefits.If any
Page 51 of 52
personal property is provided,this assurance obligates the Recipient for the period during which it retains ownership or
possession of the property;
i. Recipient shall cooperate in any enforcement or compliance review activities by the Department of the Treasury of the
aforementioned obligations.Enforcement may include investigation,arbitration,mediation,litigation,and monitoring of
any settlement agreements that may result from these actions.That is,the Recipient shall comply with information requests,
on-site compliance reviews,and reporting requirements.
8. Recipient shall maintain a complaint log and inform the Department of the Treasury of any complaints of discrimination on
the grounds of race,color,or national origin,and limited English proficiency covered by Title VI of the Civil Rights Act of
1964 and implementing regulations and provide,upon request,a list of all such reviews or proceedings based on the
complaint,pending or completed,including outcome.Recipient also must inform the Department of the Treasury if
Recipient has received no complaints under Title VI..
9. Recipient must provide documentation of an administrative agency's or court's findings of non-compliance of Title VI and
efforts to address the non-compliance,including any voluntary compliance or other agreements between the Recipient and
the adm inistrative agency that made the finding.If the Recipient settles a case or matter alleging such discrimination,the
Recipient must provide documentation of the settlement.If Recipient has not been the subject of any court or administrative
agency finding of discrimination,please so state.
10. if the Recipient makes sub-awards to other agencies or other entitics,the Recipient is responsible for ensuring that
sub-recipients also comply with Title VI and other applicable authorities covered in this document State agencies that make
sub-awards must have in place standard grant assurances and review procedures to demonstrate that that they are effectively
monitoring the civil rights compliance of sub-recipients.
The United States of America has the right to seek judicial enforcement of the terms of this assurances document
and nothing in this document alters or limits the federal enforcement measures that the United States may take in order to
address violations of this document or applicable federal law.
Under penalty of perjury,the undersigned official(s)certifies that he/she has read and understood its obligations as
herein described,that any information submitted in conjunction with this assurance document is accurate and complete,and
that the Recipient is in compliance with the aforementioned nondiscrimination requirements.
Recipient Date
Tina Boan ascmyaoaodD/hnaBoen
Me M»nR llZ 04M4fl.ppm'
Signature of Authorized Official:
PAPERWORK REDUCTION ACT NOTICE
The intbrmadon collected will be used for the U.S.tlovamment to process requents for support.The estimated burden associated with this collection of
Information is 15 minutes per response.Comments concerning the accuracy of this burden estimate and suggestiana for reducing this burden should to directed
to the Office of Privacy,Tmnsparenry and Records,Department of the Tteastay,1500 PaMivania Ave.,N.W.,washinplon,D.C.20220.DO NOT send the
form to this address.An agmuy may not conduct or sponsor,and a person is not required to respond to,a collection of infermsdlon unless it displays a valid
control number assigned by OMB.
Page 52 of 52
THIS AGREEMENT PROVIDES FOR RETREATMENT OF THE INFESTED AREA OF THE COVERED STRUCTURE(S)
IN THE EVENT THAT DRYWOOD TERMITES REINFEST THE COVERED STRUCTURE(S), BUT THIS AGREEMENT
DOES NOT PROVIDE FOR THE REPAIR OF DAMAGE CAUSED BY DRYWOOD TERMITES.
Orkin Pest Control
COMMERCIAL GRID#
1 DRYWOOD TERMITE RETREATMENT FUMIGATION AGREEMENT
(Does Not Cover Subterranean or Formosan Termites)
THIS AGREEMENT IS CONTINGENT UPON THE APPROVAL AND SIGNATURE OF THE ORKIN BRANCH
MANAGER,WHO HAS SOLE AUTHORITY TO EXECUTE IT ON BEHALF OF ORKIN.
Orkin shall fumigate and treat Customer's structure for Drywood termites using the treatment specified in the Treatment Report.
Customer shall receive the following Service after the original treatment is performed.
LIMITED 5-YEAR RENEWABLE DRYWOOD TERMITE RETREATMENT SERVICE ("Service") (CO): Orkin will retreat the structure for any
live reinfestation of Drywood termites at no cost to Customer during the Service period if an infestation of Drywood termites is found and all
payments including annual renewal payments are current. The Service will expire one (1) year from the date of the original treatment,
unless it is timely renewed by the Customer.The Service may be renewed from year to year for a period which shall not exceed five(5)
years from the date of the original treatment. This Service does not cover any damage to the structure or contents. Customer agrees to
maintain the treated structure free from any condition conducive to termite infestation including moisture, roof leaks, improper ventilation or faulty
plumbing, spray foam insulation. Customer agrees to repair roof leaks and other structural leaks, to eliminate organic matter, and to
caulk, paint and screen the structure as needed to prevent Drywood termite infestation. The existence of any of these conditions or the failure
by the Customer to make the repairs or to take the actions set out above shall void the retreatment Service. In the event the structure is
structurally modified or altered (to include installation of spray foam insulation), the retreatment Service is void. ORKIN IS PERFORMING
A SERVICE AND EXPRESSLY DISCLAIMS ANY GUARANTEE OF ANY KIND, WHETHER EXPRESS OR IMPLIED FOR ANY INJURY
OR DAMAGE RELATED TO THE SERVICE PERFORMED. CUSTOMER EXPRESSLY RELEASES ORKIN FROM ANY CLAIMS FOR
TERMITE DAMAGE OR REPAIR. Orkin assumes no responsibility for roof damage or shrub damage that occurs during the fumigation
procedure unless caused by the sole negligence of Orkin. Orkin is not responsible for vandalism,theft or breaking and entering and any resulting
personal or property damage during the fumigation and aeration procedure.
CUSTOMER'S OBLIGATIONS TO MAINTAIN RETREATMENT SERVICE: Customer agrees to maintain caulking, painting and screening of the
treated structure as needed to prevent Drywood termite infestation. Customer agrees to maintain the treated structure free from the conditions
conducive and in accordance with the terms of the paragraph above. Customer is required to identify and correct, at Customer's expense, all
conducive conditions identified at the structure occurring after the execution of this Agreement. This responsibility rests exclusively with
Customer, not with Orkin. Failure to honor the requirements to maintain the structure or to allow Orkin access for inspections or treatments, as
appropriate,will void the Service.
Customer expressly waives and releases Orkin from any liability for any claim or damages to the structure or contents, including
treatment or retreatment, caused by an infestation of Wood Destroying Fungi, Subterranean Termites, Formosan Termites, Boring
Beetles, or any other Wood Destroying Insects. Customer also waives and releases Orkin from liability for any claim or injuries,
damages,or losses of whatever nature or type related to mold or fungal growth.
RENEWAL: Customer shall pay an annual renewal fee of$4,745.00 . The annual renewal will not increase for three(3)years after ini-
tial treatment.Thereafter, Orkin shall have the right to increase the annual renewal fee each year by an amount not to exceed ten percent(10%).
REINSPECTION: Orkin shall reinspect the treated structure as deemed necessary by Orkin or requested by Customer.Annual inspection will be
made by Orkin if required by applicable State law or regulations.
LIMITATION OF LIABILITY: Customer acknowledges that Orkin is performing a service and waives any claims for personal or property
damages related to the service Orkin performs, except for any damage to the structure caused by Orkin in the performance of its services.
Customer agrees that Orkin shall not be responsible for any damage to the premises while treating the structure, including any damage to
shrubs, trees or plants. When performing the treatment, it may be necessary for Customer to remove floor coverings, floors, excavate crawl
spaces and provide access to walls, ceilings or floors. Customer shall be responsible for the cost of dismantling and reconstructing any item that
is required to provide adequate access for treatment. Customer expressly waives any claim in any lawsuit, arbitration or legal proceeding against
Orkin for breach of Agreement, negligence, other tort, or violation of any statute, rule or regulation, for loss of use, diminution of value, business
interruption, economic, compensatory, or incidental or consequential damages of any kind, or any exemplary, treble, liquidated or any type of
punitive damages. Customer agrees that under no circumstances shall Orkin be liable for any amount greater than the amount paid by the
Customer to Orkin for the termite service to be performed.
I HAVE READ THE FRONT AND BACK OF THIS AGREEMENT AND AGREE TO ITS TERMS.
Harvey Goverment Center Key West 6/12/23 1.Service Purchased:
Customer Date a. Initial Treatment Cost......................$ 39,546.00
1200 Truman Ave
Street Address(Treated Premises) b. Minus Adjustments......................($ 0.00)
Key West Florida 33040 c. Additional Renewal for Years ........ $ 0.00 Subtotal(sum a-b+c)................................. $39,546.00
City State Zip Code
2.
(305)304-9711 (305)304-9711 Other Items:
a. Sales Taxes............................. $ 0.00
Home Phone Work Phone 0.00
b. Other Fees.............................. $
County Name Monroe Is this within the City Limits? in Yes ❑No Subtotal(sum a+b)............................... $ 0
3.TOTAL:Price(sum 1+2).................................. $39,546.00
Chrissy Collins 4. LESS:Down Payment......................... ...........($ 0.00)
Billing Name(if different) 5. Unpaid Balance(3 minus 4) ................................ $39,546.00
1200 Truman Ave
Billing Address(if different) METHOD OF PAYMENT: ❑ FINANCED-See Separate Finance Agreement
Key West Florida 33040 ❑ CASH
City State Zip Code
Type of structure to be treated Building ❑ CHECK#
❑ PAYMENT OPTION FORM-
Unpaid Balance Must Be Financed or Due Upon Completion
Martin 1315843 5684 Maloney ave
Inspector Name(PRINT) Employee ID#or Certification# Branch Street Address
(305)393-6184 Key West Florida 33040
Branch Telephone Number City State Zip Code
THIS AGREEMENT IS NOT VALID UNTIL APPROVED BY THE BRANCH MANAGER
6/12/23 6/12/23
Branch Manager's Signature Date Customer's Signature Date
AG1486POD 2/2019FIorida LOCATION Customer Email: collins-monroecounty-fl.gov
LIMITED ASSIGNABILITY: This Agreement is assignable as a retreat only Agreement to the new owner of the property
under the following conditions: (a) the new owner presents the Orkin branch office written notice requesting that the
Agreement be assigned; (b)Orkin conducts an inspection of the property, the results of which are satisfactory to Orkin; (c)
Orkin consents in writing to the assignment of the Agreement;and (d)the new owner pays a transfer fee.
CHEMICAL INFORMATION WARNING: Customer shall notify all persons on the premises that Orkin will be applying
pesticides or termiticides in and around the premises, and that virtually all pesticides and termiticides have some odor
which may be present for a short time after application. If Customer knows of any person on the premises who believes
they have a sensitivity to pesticides or termiticides or who has a medical condition affected by pesticides or termiticides,
then Customer shall so notify Orkin in writing.At Customer's request, Orkin will provide information about the chemicals to
be used in treating the premises.
ENTIRE AGREEMENT: This Agreement and the attached Treatment Report shall be the entire Agreement between
Customer and Orkin. No other agreements, understandings or representations,whether written or oral,with respect to the
Agreement shall be binding as they shall be merged into and superseded by this Agreement. Customer warrants and
acknowledges that Customer has not relied on or been induced by any other agreements, understandings or
representations,whether written or oral, in signing this Agreement. The terms of the Agreement stated herein may not be
amended or altered unless a written change is approved and signed by a Corporate Officer of Orkin. No other employees
or agents of Orkin have authority to amend or alter any part of this Agreement. If any provision or portion thereof, of this
Agreement is found to be invalid or unenforceable, it shall not affect the validity or enforceability of any other part of this
Agreement.
FORCE MAJEURE (Circumstances beyond Orkin's control): Orkin's obligations under this Agreement shall be
cancelled if Orkin cannot perform its responsibilities due to Acts of God, including, earthquakes, storms, fires, floods, or
because of a material change in circumstances including but not limited to acts of war, inaccessibility of the property,
strikes, unavailability of termiticide,baits or other supplies from ordinary sources.
TERMINATION BY ORKIN: Orkin may terminate this Agreement, without notice, if the obligations set forth in this
Agreement are not met by Customer,or in the event of a change in state or federal law or regulation that materially affects
Orkin's obligations under this Agreement.
CUSTOMER IS ADVISED THAT THE WORK CALLED FOR UNDER THIS AGREEMENT MAY BE
ASSIGNED TO AND PERFORMED BY A LICENSEE OTHER THAN ORKIN.
I HAVE READ THE FRONT AND BACK OF THIS AGREEMENT AND AGREE TO ITS TERMS.
BRANCH MANAGER'S INITIALS CUSTOMER'S INITIALS
Owner's Name: Harvey Goverment Center Key West
Address of Fumigation: 1200 Truman Ave Key West Florida 33040
Inspector's Signature:
ROOF RELEASE
I (We) Harvey Goverment Center Key V , Owner(s) of the property listed above expressly release Orkin Pest
Control Company from any and all responsibility for any damage done to roof covering as a result of covering my
(our) property for the purpose of fumigation for Drywood Termites. It has been explained to me (us) that it will be
necessary for workmen to walk on the roof in order to prepare the building for injection of fumigants. Orkin will
exercise all possible care and caution while on the roof, but damage to roof covering material, awnings, and patio
covering is possible. By my (our) signature below, I (we) release Orkin from any and all responsibility for damage to
the roof.
Type of Roof: ❑Composition ❑ Rolled Composition ❑Tile ❑Shake ❑Shingle ❑Cal Pac
❑Simulated Tile ❑ Metal Covering ❑ Rock&Tar
❑Other
6/12/23
Owner(s)/Agent Signature Date
Owner's Name: Harvey Goverment Center Key West
Address of Fumigation: 1200 Truman Ave Key West Florida 33040
Inspector's Signature:
ROOF RELEASE
I (We) Harvey Goverment Center Key V , Owner(s) of the property listed above expressly release Orkin Pest
Control Company from any and all responsibility for any damage done to roof covering as a result of covering my
(our) property for the purpose of fumigation for Drywood Termites. It has been explained to me (us) that it will be
necessary for workmen to walk on the roof in order to prepare the building for injection of fumigants. Orkin will
exercise all possible care and caution while on the roof, but damage to roof covering material, awnings, and patio
covering is possible. By my (our) signature below, I (we) release Orkin from any and all responsibility for damage to
the roof.
Type of Roof: ❑Composition ❑ Rolled Composition ❑Tile ❑Shake ❑Shingle ❑Cal Pac
❑Simulated Tile ❑ Metal Covering ❑ Rock&Tar
❑Other
6/12/23
Owner(s)/Agent Signature Date
(THE BOTTOM PORTION OF THIS FORM MUST BE ATTACHED TO THE LOCATION COPY OF THIS AGREEMENT.)
PROCEDURE FOR
SULFURYL FLUORIDE FUMIGATION
FOR EFFECTIVE FUMIGATION
the following steps will be necessary prior to fumigating
INTERIOR PREPARATION
❑ 1. Unlock and open all drawers and interior doors including garage, utility and storerooms, closets, cabinets, cupboards,
chests, etc.,to facilitate rapid circulation and aeration. Additionally, at least one window per room of a tarped building
must be open before fumigation, unless prohibited by state or local ordinances.
❑ 2. All people must leave and all living things be removed from your home,such as pets, birds, fish in aquariums and
growing plants.
❑ 3. All items for human consumption such as foods, beverages, drugs and medicines, (including those items in refrigerators
and freezers)which are not in air-tight containers such as sealed glass or metal containers must be either: (a) Removed
from the structure prior to fumigation, or(b) Placed in double "Nylofume"bags, and twist sealed with masking tape. Food
not properly prepared is subject to disposal by the certified fumigator.
❑ 4. Remove all mattresses and pillows with waterproof covers such as"can't wet"mattresses for infants and sickroom. If the
waterproof covers are removable, it is only necessary to remove the covers, not the mattresses. All other mattresses can
be fumigated.
❑ 5. Extinguish all sources of heat, including open flames and pilot lights(hot water heaters, ranges, wall heaters, etc.).
Natural gas service to the premises must be turned off prior to date of fumigation. All glowing electric heaters and
electrical heating elements such as those in pianos, organs, etc., must be shut off before fumigation. Occupant arranges
for utility company to turn gas back on and assumes any charges incurred.
❑ 6. Turn off all air conditioning units and all automatic switch controls for appliances and lighting systems, which will be
included in the space to be fumigated.
❑ 7. Electricity must be available and left on for operation of fans.
❑ 8. Open all openings into crawl spaces or attics.
EXTERIOR PREPARATION
❑ 1. Exterior doors will be locked, and secured with secondary locking mechanisms, which should only be removed by Orkin
personnel;Orkin will not be liable for damage caused by customer's attempt to remove secondary locking mechanisms.
Keys to structure must remain either in the possession of the certified fumigator,or be left on the premises.
❑ 2. Lower all awnings attached to structure.
❑ 3. Remove all vines and trellises attached to the structure. Check ornamentals and shrubbery to be sure workmen have
room (minimum clearance is 18 inches)to drop tenting materials between them and the structure.
❑ 4. Customer, on the day of fumigation, must water the ground immediately surrounding the structure for a distance of 18
inches outward and thoroughly saturate the same 18-inch soil strip to a depth of 8 inches.
❑ 5. Orkin is not responsible for vandalism, theft or breaking and entering during the fumigation and aeration procedures.
Customer should arrange for security while structure is left unattended.
❑ 6. A thorough inspection of the crawl space must be made if accessible.
❑ 7. Inspect all foundation vents to ensure they are closed to prevent entry of pets or stray animals.
❑ 8. Inform neighbors of impending fumigation and ask that they manage their pets in a responsible manner.
COMPLETING FUMIGATION
• Upon completion of the fumigation, we will aerate the building thoroughly and check it with gas-detecting equipment
until the structure is safe for re-occupancy.
• Reentering:When the structure is safe for re-occupancy, there will be a notice posted on the front door. DO NOT
ENTER UNLESS SAID NOTICE IS POSTED ON THE DOOR.
• It will not be necessary to wash dishes, pots, pans, silverware, etc., as the gas leaves no residue.
• Our servicemen take every precaution to protect your property. However, we cannot assume responsibility for
broken roof tiles or shrub damages caused during the fumigation procedure unless this damage results from
Orkin's sole negligence.
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
I acknowledge receipt of the Fumigation Preparation Notices.
6/12/Z 6/12/Z
Inspector's Signature Date Customer's Signature Date
FUMIGATION PREPARATION NOTICES—VIKANE OR SULFURYL FLUORIDE
STATE°OF FLORIDA
Pepartnlent of S(griculture atlb eCottounter 9perbictO
BUREAU OF LICENSING AND ENFORCEMENT
Date File No. Expires
November 10,2022 JBI13477 November 30,2023
THE PEST CONTROL COMPANY FIRM NAMED BELOW HAS
REGISTERED UNDER THE PROVISIONS OF CHAPTER 482 FOR THE
PERIOD EXPIRING:November 30,2023 AT
30385 QUAIL ROOST TRAIL
BIG PINE KEY,FL 33043
Fumigation
HAMMERHEAD TERMITE CONTROL,INC. General Household Pest and
30385 QUAIL ROOST TRAIL Rodent Control
BIG PINE KEY,FL 33043 Lawn and Ornamental
Termite and Other WOO
Control
�
NICOLE"NIKKI"F [ED,COMMISSIONER
2023 / 2024
MONROE COUNTY BUSINESS TAX RECEIPT
EXPIRES SEPTEMBER 30r 2024
RECEIPT# 47145-84889
Business Name: HAMMERHEAD TERMITE CONTROL
Owner Name: WEINBERG MARK PRES Business Location: 30385 QUAIL ROOST TRAIL
BIG PINE KEY, FL 33043
Mailing Address:
30385 QUAIL ROOST TRAIL Business Phone: 305-515-2800
BIG PINE KEY, FL 33043 Business Type: PEST CONTROL(PEST CONTROL)
Employees 1
STATE LICENSE: JE48947
Tax Amount Transfer Fee I Sub-Total Penalty Prior Years Collection Cost Total Paid
22.00 0.00 22.00 1 0.00 1 0.00 0.00 22.00
Paid 000-22-00058433 07/23/2023 22.00
THIS BECOMES A TAX RECEIPT Sam C. Steele, CFC,Tax Collector THIS IS ONLY A TAX.
WHEN VALIDATED PO Box 1129, Key West, FL 33041 YOU MUST MEET ALL
COUNTY AND/OR
MUNICIPALITY
PLANNING, ZONING AND
LICENSING
REQUIREMENTS.
MONROE COUNTY BUSINESS TAX RECEIPT
P.O. Box 1129, Key West, FL 33041-1129
EXPIRES SEPTEMBER 30, 2024
Business Name: HAMMERHEAD TERMITE CONTROL RECEIPT# 47145-84889
30385 QUAIL ROOST TRAIL
Business Location: BIG PINE KEY, FL 33043
Owner Name: WEINBERG MARK PRES
Mailing Address: Business Phone: 305-515-2800
30385 QUAIL ROOST TRAIL Business Type: PEST CONTROL(PEST CONTROL)
BIG PINE KEY, FL 33043
Employees 1
STATE LICENSE: JE48947
Tax Amount Transfer Fee Sub-Total Penalty Prior Years Collection Cost Total Paid
22.00 0.00 22.00 0.00 0.00 0.00 22.00
Paid 000-22-00058433 07/23/2023 22.00