04/01/1992 Contract
CONTRACT
F:LEO r nF Rr-copn
day of April,
and .~~E /fJrQT4D:qllp:4 0
THIS AGREEMENT, made and entered into this 1st
1992, between Monroe County, Florida (OWner),
MAINTENANCE (Contractor):
WIT N E SSE S:
That the parties hereto, for the consideration
forth, mutually agree as follows:
here iHa!~r;_:! Hlkrf\ G E
f'10NROE COUNl Y. Fl.A.
I.
SCOPE OF THE WORK
The Contractor shall provide janitorial services, including all
necessary supplies and equipment required in the performance of
same, for Jackson Square, located in Key West, Monroe County,
Florida. The Contractor agrees to furnish janitorial services in
accordance with the Public Works Manual entitled "Public Works
Specification Manual/Janitorial/Jackson Square, attached hereto
and incorporated as part of this contract document. The manual
shall serve as minimum contract standards, and shall be the basis
of inspection and acceptance of all the work. The Contractor
shall insure all exterior doors are locked upon their departure.
II. INDEPENDENT CONTRACTOR
At all times and for all purposes under this agreement the Con-
tractor is an independent contractor and not an employee of the
Board of County Commissioners for Monroe County. No statement
contained in this agreement shall be construed so as to find the
contractor or any of his/her employees, contractors, servants, or
agents to be employees of the Board of County Commissioners for
Monroe County.
III. ASSURANCE AGAINST DISCRIMINATION
The Contractor shall not discriminate against any person on the
basis of race, creed, color, national origin, sex, age, or any
other characteristic or aspect which is not job related, in its
recruiting, hiring, promoting, terminating, or any other area
affecting employment under this agreement or with the provision
of services or goods under this agreement.
IV. ASSIGNMENT
The Contractor shall not assign this agreement, except in writing
and with the prior written approval of the Board of County Commis-
sioners for Monroe County and Contractor, which approval shall be
subject to such conditions and provisions as the Board and Con-
tractor may deem necessary. This agreement shall be incorporated
by reference into any assignment and any assignee shall comply
with all of the provisions of this agreement. Unless expressly
provided for therein, such approval shall in no manner or event
be deemed to impose any obligation upon the Board in addition to
the total agreed-upon price of the services/goods of the contrac-
tor.
~l.
COMPLIANCE WITH LAW
In providing all services/goods pursuant to this agreement, the
contractor shall abide by all statutes, ordinances, rules and
regulations pertaining to, or regulating the provisions of, such
services, including those now in effect and hereinafter adopted.
Any violation of said statutes, ordinances, rules and regula-
tions shall constitute a material breach of this agreement and
shall entitle the Board to terminate this contract immediately
upon delivery of written notice of termination to the contractor.
VI. INSURANCE
Upon execution of this agreement, the Contractor shall furnish
the Owner Certificates of Insurance indicating the following
minimum coverage limitations:
Commercial General Liability including completed operations
and contractual liability, with minimum limits of
$500,000.00 per occurrence.
Comprehensive Auto Liability with minimum combined single
limits of $300,000.00 per occurrence.
Worker's Compensation - as required by Florida Statutes.
Dishonesty bond with minimum limits of $5,000.00 per occur
rence.
Monroe County is to be named additional insured on both the Gener-
al Liability and Auto Liability Policies. The minimum coverage
limitations must be maintained throughout the contract term.
VII.
HOLD HARMLESS
The Contractor shall defend, indemnify and hold the County, its
officials, employees and agents harmless, from any and all
claims, liabilities, losses and causes of action which may arise
out of the performance of the Contract except such claims, liabil-
ities, losses and causes of action which may arise because of the
County's negligent actions or omissions. Compliance with the
insurance requirements shall not relieve the Contractor from the
obligations imposed by this article.
VIII.
TERM OF CONTRACT
This contract shall begin on April 4, 1992 and end on April 3,
1993. This Contract term shall be renewable in accordance with
Article x.
2
IX. CANCELLATION
Either of the parties hereto may cancel this agreement with or
without cause by giving the other party sixty (60) days written
notice sent certified mail of its intention to do so.
X.
RENEWAL
The OWner shall have the option to renew this agreement after the
first year, and each succeeding year, for two additional one year
periods. The contract amount agreed herein may be adjusted annu-
ally in accordance with the percentage change in the Consumer
Price Index (CPI) for Wage Earners and Clerical Workers in the
Miami, Florida area index, and shall be based upon the annual
average CPI computation from January 1 through December 31 of
the previous year.
XI. FUNDING AVAILABILITY
In the event that funds from Facilities Maintenance Contractual
Services are partially reduced or cannot be obtained or cannot be
continued at level sufficient to allow for the purchase of the
services/goods specified herein, this agreement may then be termi-
nated immediately at the option of the Board by written notice of
termination delivered in person or by mail to the contractor.
The Board shall not be obligated to pay for any services provided
by the contractor after the contractor has received written no-
tice of termination.
XII.
PROFESSIONAL RESPONSIBILITY
The Contractor warrants that it is authorized by law to engage in
the performance of the activities encompassed by the project
herein described, subject to the terms and conditions set forth
in the Public Works Manual entitled "Standard Janitorial Specifi-
cations and Requirements, Key West Courthouse Annex", which is at-
tached hereto and incorporated herein as a part of this con-
tract/agreement. The provider shall at all times exercise inde-
pendent, professional judgement and shall assume professional
responsibility for the services to be provided. Continued fund-
ing by the Board is contingent upon retention of appropriate
local, state, and/or federal certification and/or licensure of
contractor.
XIII.
NOTICE REQUIREMENT
Any notice required or permitted under this agreement shall be in
writing and hand delivered or mailed, postage prepaid, to the
other party by certified mail, returned receipt requested, to the
following:
FOR COUNTY
Monroe County Public Works
5100 College Road
Key West, FL 33041
ATTN: Mike Lawn
FOR CONTRACTOR
ACE BUILDING MAINTENANCE
P.O. Box 2763
Key West, FL 33041
XIV. PAYMENT
The County shall pay to the Contractor for the performance of
said service on a per month in arrears basis on or before the
15th day of the following month in each of twelve (12) months.
The Contractor shall invoice the County monthly for janitorial
services performed under the Specifications contained herein.
The Contract amount shall be as stated by the contractors propos-
al as follows: Seventeen Thousand One Hundred Sixty Dollars
($17,160.00) per year to be paid One Thousand Four Hundred Thirty
Dollars ($1,430.00) per month.
In witness whereof, the parties hereto have executed this agree-
ment the day and year first above written,
COUNTY OF MONROE, STATE OF
FLORIDA
By~~~..lI",v~ ......... ~ I. ~'-\.-
Mayor /Chairman ,
Attest: DANNY L. KOLHAGE, Clerk
ACE BUILDING MAINTENANCE
G+d1tjc
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By
Attest:
By
Date
4
SWORN STATEMENT UNDER ORDINANCE NO. 10-1990
MONROE COUNTY, FLORIDA
ETHICS CLAUSE
-"'It e 8tH LI.~"ul HitIJt-.tlfllll '" ,
warrants that he/it has not employed,
retained or otherwise had act on he/its behalf any former County officer
or employee subject to the prohibition of Section 2 of Ordinance No.
10-1990 or any County officer or employee in violation of Section 3 of
Ordinance No. 10-l990. For breach or violation of this provision the
County may, in its discretion, terminate this contract without liability
and may also, in its discretion, deduct from the contract or purchase
price, or otherwise recover, the full amount of any fee, commission,
percentage, gift, or consideration paid to the former County officer or
l
)dtJ /Mj<-
(si ature)
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employee.
Date:
STATE OF
I
STATE OF FLORIDA
COUNTY OF MONROE
SUBSCRIBED AND SWORN to (or affirmed) before me on
9th of April, 1992
(date) by Judy Bobick
(name of affiant). She is personally known to me.
]
If
My commission expires:
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ACE BUILDING MAINTENANCE
PROMPT PROFESSIONAL SERVICE
COMMERCIAL. RESIDENTIAL
LICENSED. INSURED
EXCLUSIVE "HOST DRY CLEAN" CARPET CLEANING
P.O. BOX 2763
KEY WEST. FLORIDA 33045
(305) 294-6206
March 2, 1992
Director of Purchasing
5100 West College Rd.
PSB, Wing II
Stock Island, Key West, Florida
ATTN: Mr. Cofer
REF: Janitorial bid for JACKSON SQUARE
Dear Mr., Cofer:
I am pleased to submit my bid for janitorial
services at Jackson Square as:
$1,430.00 per month
(One thousand, four hundred and thirty dollars)
Thank you for giving me this opportunity to
submit this bid.
Sincerely,
CJ<<iJ/ l~tJ-aL
Judy Bobick
Owner
..
PUBLIC WORKS SPECIFICATION MANUAL
JANITORIAL
JACKSON SQUARE
TWO DAYS PER WEEK SERVICE/OFFICES
FIVE DAYS PER WEEK/HALLWAYS & RESTROOMS
TABLE OF CONTENTS
TITLE
PAGE
A. DESCRIPTION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2
B . WORK HOURS .........'..................................... 2
C. GENERAL CLEANING ........................................ 2
D. RESTROOM SANITATION ..................................... 2
E. FLOOR TREATMENT ......................................... 3
F. PERI ODI C SERVI CES ....................................... 3
G. COORDINATION OF THE WORK ................................ 3
H. PAPER PRODUCTS AND SUPPLIES ............................. 4
I . RECYCLING. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4
J. INSPECTION OF THE WORK .................................. 4
K. INSURANCE/INDEMNIFICATION/HOLD HARMLESS ................. 4
L. PUBLIC ENTITY CRIME AFFIDAVIT ........................... 5
M. NON-COLLUSION AFFIDAVIT ................................. 5
A. DESCRIPTION
1. The Contractor shall furnish janitorial services, includ-
ing all necessary supplies and equipment required in the
performance of same, for the State Attorney's Office and
Trailer, the Supervisor of Elections Office, the Adminis-
tration Building, and the two offices in the building
adjacent to the Administration Building, located within
Jackson Square, Key West, Monroe County, Florida.
B. WORK HOURS
1. The Contractor shall clean all required offices two (2)
nights per week, Tuesday and Friday, each week, and all
required restrooms and public hallways five (5) nights
per week, Monday through Friday. Work shall be per-
formed between the hours of 5:00 p.m. and 7:00 a.m.
C. GENERAL CLEANING
General cleaning shall include the following:
1. All tile floors are to be dust mopped and/or damp mopped
as necessary.
2. All furniture and furnishings dusted and spot cleaned.
3. All walls and woodwork spot cleaned to a height of six
(6) feet monthly.
4. Low ledges, sills, rails, and baseboards dusted and/or
spot cleaned.
5. All ashtrays emptied, damp cleaned, and polished.
6. All cigarette burns cleaned and debris removed.
7. Clean and polish all drinking fountains.
8. All trash receptacles emptied, trash can liners changed.
9. All glass entrance doors shall be washed and polished
inside and outside.
lO. All other glass partitions, interior doors, mirrors,
windows, etc., to be washed and polished as needed.
11. Vacuum all upholstered furniture.
12. Carpets in all traffic areas are to be vacuumed each
night, complete area also to be vacuumed each night.
l3. All carpeting will be regularly inspected and spot
cleaned.
D. RESTROOM SANITATION
Restroom sanitation shall include the fOllowing:
1. All floors swept with a straw broom, loose dirt removed.
2. Wash and disinfect floor and upon completion, floor is
to be mopped to a damp dry condition.
3. Stall partitions damp cleaned.
4. All commodes, urinals, basins and vanities shall be
scoured and disinfected.
5. All urinal traps shall be specially cleaned and disin-
fected.
2
6. All sanitary napkin receptacles will be cleaned, waste
disposed, and disinfected.
7. All supplies shall be replaced.
8. All slop sink closets to be cleaned completely each
week, and mops, buckets, etc., removed to storerooms
after usage.
9. All other work necessary to maintain a clean and sani-
tary condition in these restrooms shall be accomplished,
whether it is specifically noted in these specifications
or not.
E. FLOOR CLEANING
1. Buildings with floors requiring stripping, refinishing,
and buffing shall receive this treatment on a regularly
scheduled basis, so as never to allow a build-up of old
finish to accrue anywhere on the floors of the complex.
2. Treatment of these floors shall be performed a minimum
of one (1) time per month.
3. All other flooring shall be cleaned as described in
Sections Band E of this specification.
F. PERIODIC SERVICES
8.
9.
10.
The services below shall be included and shall be performed
at the frequency indicated as follows:
1. All door vents cleaned weekly.
2. All high dusting (i.e. pictures, door frames, air vents,
etc., shall be cleaned monthly.
All walls dusted monthly
All interior windows washed bimonthly.
All janitor rooms and closets to be cleaned at all times.
Clean/Shampoo all carpeted areas a minimum of once every
six (6) months.
Sweep all stairs, landings, breezeway area, and brick
area once a week.
Pressure clean breezeway twice a month.
Pressure clean entrance area and walls once a
All air conditioner filters shall be replaced
month. Filter material shall be supplied
County Public Works as required.
3.
4.
5.
6.
7.
month.
once a
by Monroe
G. COORDINATION OF THE WORK
1. Contractor shall provide maximum amount of Janitorial
Services with the minimum amount of interference to
building tenants.
2. Coordination of the work with the County area representa-
tive shall be the responsibility of the Contractor. The
Contractor shall perform the work during hours and times
as specified.
3. Keys shall be issued to the Contractor by the area repre-
sentative at the start of the Contract. Written confir-
mation of receipt of keys shall be signed by the Contrac-
3
tor. The Contractor shall return all keys as issued
upon expiration of the Contract or termination.
4. The Contractor shall be responsible for the cost of
changing locks, etc., for all keyed secured areas for
which the Contractor does not return the keys.
H. SUPPLIES
1.
The Contractor shall provide all supplies necessary for
the cleaning performance of his work under the con-
tract. All supplies, including but not limited to, hand
soap, sanitary napkins, paper towels, toilet paper, and
trash can liners, shall be supplied by the Contractor.
The Contractor shall maintain stock in each facility in
a minimum amount sufficient to last through the next
cleaning day.
...,
L..
I . RECYCLING
1. The Contractor shall be required to participate in the
recycling program on a per office basis. County offices
recycling office paper, aluminum, and newspaper shall
have receptacles indicating specific use. The Contrac-
tor shall be responsible for emptying receptacles to
designated containers.
J. INSPECTION OF THE WORK
1. The tenants of each facility shall be the deemed the
County's representative on a daily basis, and shall
determine if deficiencies exist.
2. Random inspections shall be performed by County Represen-
tatives from the Public Works Division administering the
contracts.
3. Deficiencies shall be corrected within a twenty-four
(24) hour period of notification to the Contractor.
Failure of the Contractor to correct such deficiencies
shall result in prorated deduction from the monthly
invoice.
K. INSURANCE/INDEMNIFICATION/HOLD HARMLESS
1. The successful proposer will be required to indemnify,
defend, and hold-harmless the County from any and all
claims, liabilities, costs, including attorney fees,
etc., that the County may incur due to the negligent
acts, errors, or omissions of the janitorial service
company.
2. Minimum insurance requirements:
a) Commercial General Liability including completed
operations and contractual liability, with minimum
limits of $500,000.00 per occurrence.
4
b) Comprehensive Auto Liability with mlnlmum combined
single limits of $300,000.00 per occurrence.
c) Workers Compensation as required by Florida Stat-
utes.
d) Surety bond with minimum limits of $5,000.00 per
occurrence.
Monroe County is to be named additional insured on both
the General Liability and Auto Liability policies.
A certificate of insurance indicating the above insur-
ance coverages will be required before execution of
contract. All insurance coverages are subject to re-
view by Risk Management, and the County retains the
right to request any changes, or clarification of cover-
age forms, that may be in its best interest.
L. PUBLIC ENTITY CRIME AFFIDAVIT
1. Any person submitting a bid or proposal in response to
this invitation must execute the enclosed Form PUR
7068, SWORN STATEMENT UNDER SECTION 287.133(3) (A),
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES, including
proper check(s), in the space(s) provided, and enclose
it with his bid or proposal. If you are Submitting a
bid or proposal on behalf of dealers or suppliers who
will ship commodities and receive payment from the re-
sulting contract, it is your responsibility to see that
copy(s) of the form are executed by them and are includ-
ed with your bid or proposal. Corrections to the form
will not be allowed after the bid or proposal opening
time and date. Failure to complete this form in every
detail and submit it with your bid or proposal will
result in immediate disqualification of your bid or
proposal.
M. NON-COLLUSION AFFIDAVIT
1. Any person SUbmitting a bid or proposal in response to
this invitation must execute the enclosed NON-COLLU-
SION AFFIDAVIT. If it is discovered that collusion
exists among the bidders, the bid or proposals of all
participants in such collusion will be rejected, and no
participants in such collusion will be considered in
future proposals for the same work.
5
A.~..III."
CERTIFICATE OF INSURANCE
ISSUE DATE (MMIDD/YY)
'I
I
THE PORTER ALLEN COMPANY
513 SOUTHARV STREET
KEY WEST, FLORIVA 33040
(305) 294-2542
03/18/92
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW.
PRODUCER
COMPANIES AFFORDING COVERAGE
f~T~~NY A
INSURANCE COMPANY OF NORTH AMERICA '
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INSURED
f~T~~~NY B
JUVY EAVY VBA
ACE BUILVING & MAINTENANCE
PO BOX 2763
KEY WEST, FLORIVA 33040
f~T~~~NY C
f~T~~~NY D
f~T~~~NY E
'....
COVERAGES
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,
CO
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POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DD/YY) DATE (MMIDD/YY)
LIMITS
TYPE OF INSURANCE
POLICY NUMBER
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE
OCCUR.
GENERAL AGGREGATE $
PRODUCTS-COMP/OP AGG, $
PERSONAL & ADV, INJURY $
OWNER'S & CONTRACTOR'S PROT,
EACH OCCURRENCE
$
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
FIRE DAMAGE (Anyone fire) $
MED, EXPENSE (Anyone person) $
COMBINED SINGLE $
LIMIT
BODILY INJURY $
(Per person)
BODILY INJURY $
(Per accident)
PROPERTY DAMAGE $
EACH OCCURRENCE $
AGGREGATE $
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EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION
AND
EMPLOYERS' LIABILITY
STATUTORY LIMITS
EACH ACCIDENT $
DISEASE-POLICY LIMIT $
DISEASE-EACH EMPLOYEE $
OTHER
A
EMPLOYEE VISHONESTY
COVERAGE
V24594324
03/11/92
03/11/93
LIMIT:
$5,000.
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS
JOB LOCATION: JACKSON SQUARE
KEY WEST, FLORIVA
CERTIFICATE HOLDER"&"'AVv ITZaNAL INSURE1):eA'NCEl..l.AfIM
MONROE COUNTY BOARV OF COUNTY COMMISSIONERS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
WING II, PUBLIC SERVICE BUILVING EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
STOCK ISLANV MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
KEY WEST, FLORIVA 33040 LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY IN UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES,
AUTHORIZED.R
@ACORD CORPORATION 1990
ACORD 25-S (7/90)
A.~.tltl..,
CERTIFICATE OF INSURANCE
ISSUE DATE (MM/DDIYY)
THE PORTER ALLEN COMPANY
513 SOUTHARV STREET
KEY WEST, FLORIVA 33040
(305) 294-2542
03/16/92
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLy'ANO--
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW,
PRODUCER
COMPANIES AFFORDING COVERAGE
f~T~~NY A
INSURANCE COMPANY O~NORTH AMERICA
~~tvr .
.7)1 '1/ 'l U
INSURED
I JUVY EAVY VBA ACE BUILVING & MAINTENANCE
I PO BOX 2763
KEY WEST, FLORIVA 33040
I
COVERAGES
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.
f~T~~~NY B
f~T~~~NY C
f~T~~~NY D
f~T~~~NY E
CO
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TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION
DATE (MM/DD/YY) DATE (MM/DD/YY)
LIMITS
IA
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE X OCCUR.
OWNER'S & CONTRACTOR'S PROTo
V24594324
03/11/92
GENERAL AGGREGATE $ 500,000.
PRODUCTS-COMP/OP AGG. $ 500,000.
03/11/93 PERSONAL&ADV.INJURY $ 500,000.
EACH OCCURRENCE $ 500, 000 .
FIRE DAMAGE (Anyone fire) $ 50,000.
_~ED. EXPE~~~_~~~y one person) $_5, 000.
COMBINED SINGLE
LIMIT $ 300,000.
I
.,
A
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
X SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
GARAGE LIABILITY
H01079311
10/03/91
10/03/92
BODILY INJURY
(Per person)
$
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE $
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
EACH OCCURRENCE
AGGREGATE
$
$
WORKER'S COMPENSATION
AND
EMPLOYERS' LIABILITY
STATUTORY LIMITS
EACH ACCIDENT $
DISEASE-POLICY LIMIT $
DISEASE-EACH EMPLOYEE $
OTHER
DESCRIPTION OF OPERA T10NS/LOCA TIONS/VEHICLES/SPECIAL ITEMS
JOB LOCATIONS: 1) JACKSON SQUARE KEY WEST, FLORIVA
CERTIFICATE HOL.DER &'A1JOJT10NAtTNSf.tR.E1J e~ef$l.v.11(')".
MONROE COUNTY BOARV OF COUNTY COMMISSIONE1l.S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
WING II, PUBLIC SERVICE BUILVING EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
KEY WEST, FLORIVA 33040 MAIL -1..Q DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTAT
@ACORD CORPORATION 1990
._ ACORD 2508 (7/90)
C ~STRUCTION INDUSTRY
NOTICE OF ELECTION TO BE EXEMPI' FROM
THE PROVISIONS OF THE FLORIDA WORKERS' COMPENSATION LAW
"'fAIL TO: Department of Labor & Employment Security
Bureau of W.C. Compliance
2728 Centerview Drive, 100 Forrest Bldg.
Tallahassee, Florida 32399-0661
STATE USE ONLY
POSTMARK DATE I
I
This notice ahaU be in effect for two (2) years from the
:s0 ~\ ~~ l~~~ft- TYPt j~(~INT:
RE: _ . ~E- 'I Pt'l ~\tN (\N ~
ll.<~al BU'lOm N~tr or Sole Proprietonh~ Pan II' or Corponlion) ~",If ~)
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\~hlhn8 t~~ WCSt hOR\ &f\ J3D'10 (StRdMdtaa.~~ 2(~ i!iq Co
(Clryl (SlalC) (ZIp) (~dcnI~~NlIllIbat
Nature of Business or Trade: :1'{A0 r1?)R I A L . S-f ~ 'V/(-R.--.
effectlwt date or until
or unlil revotcd. wblc~r comes first,
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As of 12:01 a.m. 30 days following the date of the mailing of this (onn. you are hereby notified that the following Sole Proprietor.
Pann~r 0r Corporate Officer of the above named business does elect to be exempt from. the provisions of the Florida Workers'
COllip~01sation Law, I understand that by this action I am not entitled to benefits under chapcer 4<<). Florida Statutes. By filing this
form I have not exceeded the exemption limit of three Partners or three Corporate Officers. I further cenify that any employees of the
business named above an: covered by workers. compensation Insurance.
The following are the certified or registered licenses held ~ meqursuant to chapter~ Statutes (lfnone, so state):
(1)1', p" ~~.-... Number: ;:j(:SCO I 1.3 01 Bi Type: .0 , NIU1Iber:;;J.&5b r
INSURANCE CARRIER INFORMATION (If Applicable): A construction industry employer with one (1) or more employees must
maintain Workers' Compensation coverage. Failure to comply will result in" five.hundred dollar ($SOO) fine and a one-hundred
dollar ($100) fine for each day of noncompliance (see section 440.43. F.S.).
Name,of Carrier
Carrier Address
-----
."---
'.........
'--..
.~
Insurance Agent (Agency)
Agency Address
~
~
..--'
------- .
/-EFFECTlVE DATE
Policy Number
... ..... .~'. -.
rlf'.,
'-.....~
~.
.:
Signature :9-{ L/ Soclal~;ritY N~mber ::2.~ 3 -1l/ I 5 9 ?;
Type/Print Name '-. U E.Li 1"( l
P .. Pro' ~/Pa I
OSition: pneior _ ltner -lor/Officer mtte)
. ......
IMPORTANT: Individual exemption filing fee. pursua~t to Section 440.05. F.S:~ 'l~"~n dotlan and fifty cents (S7~SO) and is
p3}ahle only by money order or cashier's check, to W.C. Administrative 1iust Fund. AUture to enclose fee will result in return of
request and delay of certification.
........,.:
':;'; :.,
SWORN TO AND SU~i~tEFORE ME 11115
AT ~ FlDRIDA
~.,
15rt-
~ ~- . : -', .
l ES f{ >f{ '1 RC~I :04 (~f7I9l)
NON-COLLUSION AFFIDAVIT
I,
KEY WFc:::rr
or perjury, depose and say that;
1) I am JUDY BOBICK
\.
ACE BUILDING MAINTENAN~E the bidder
project described as follows:
Jnnv "RO"RTf'T{
according
, of the city of
to law on my oath, and under penalty
making
the
of the firm of
Proposal for the
2) the prices in this bid have been arrived at
ly without collusion, consultation, communication
for the purpose of restricting competition, as to
relating to such prices with any other bidder or with
tor;
3) unless otherwise required by law, the prices which have
been quoted in this bid have not been knowingly disclosed by the
bidder and will not knowingly be disclosed by the bidder prior to
bid opening, directly or indirectly, to any other bidder or to
any competitor; and
4) no attempt has been made or will be made by the bidder
to induce any other person, partnership or corporation to submit,
or not to submit, a bid for the purpose of restricting competi-
tion;
independent-
or agreement
any matter
any competi-
5)
correct,
upon the
awarding
the statements contained in this affidavit are true and
and made with full knowledge that Monroe County relies
truth of the statements contained in this affidavit in
contracts for said project.
~e~~rJ
3-1"-92
DATE
STATE OF
COUNTY OF
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
who, after first being sworn by me,
(name of individual signing)
-affixed his/her signature in the space provided above on this
day of , 19
NOTARY PUBLIC
My commission expires:
t
I
-J
STATE OF FLORIDA
COUNTY OF MONROE
SUBSCRIBED AND SWORN to (or affirmca) before me on
16th of March, 1992 (date) by Judy Bobick
(name of affiant). She is personally known to
~Ml
SWORN STATEMENT PURSUANT TO SEcrION 287.133(3)(0),
FLORIDA STATIITES. ON PUBUC ENTl'lY CRIMES
THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBUC OR
OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
1. This swam statement is submitted to MONROE COUNTY BOARD OF COMMISSIONERS
(priDe name of the publlc entityj
~ JUDY BOBICK, OWNER
[prine individuai's DBIIle and dtle)
for 1\1"'1;> OTTTT nTl\T(~ MJI. TN'T'F.~NCF.
[print name of entity submitting swom statement)
whose business address is
P () "Rnv ?7Ft'?.
Key West, Florida 33040
and (if applicable) its Federal Employer Identification Number (FEIN) is
65-0226837
(If the entity has no FEIN, include the Social Security Number of the individual signing this S'wom
statemenc
.)
2. I understand that a .public entity crime. as defined in Paragraph 287.133 (1) (g). Florido Statutes.
means a violation of.any state or federal law ~ a person with respect to and directly related to
the tranSaction of business with any public entity or with an agency or political subdivision of any
other state or of the United States, including, but not limited to, any bid or contract for goods or
services to be provided to any public entity or an agency or political subdivision of any other state
or of the United States and involving antitrust, fraud, theft, bribery. collusion, racketeering,
conspiracy, or material misrepresentation.
3. I understand that .convicted. or .conviction. as defined in Paragraph 287.133(1)(b). Florida Stlltutes.
me:ms a finding of guilt or a conviction of a public entity crime, with or without an adjudicltian of
guilt. in any federal or state trial coun of record relating to charges brought by indictment or
information after July 1, 1989, as a result of a jury verdict, nonjury trial, or entry of a plea oiguilty
or nolo contendere.
\
/
4.
I understand that an -affiliate- as defined in Paragraph 287.133(1)(a), Florida Statutes. me:lns:
1. A predecessor or successor of a person convicted of a public entity crime; or
2. An entity under the canuol of any natural person who is active in the management of the entity
and who has been convicted of a public entity crime. The term "affiliate. includes those officers,
directors, executives, panners, shareholders, employees, members, and agents who are active in the
management of an affiliate. The ownership by one person of shares constituting a controlling
interest in another person, or a pooling of equipment or income among persons when not for fair
market value under an arm's length agreement, shall be a prima facie case that one person contIois
another person. A person who knowingly enters into a joint venture with a person who has been
convicted of a public entity crime in Florida during the preceding 36 months Shall be considered
an affiliate.
5. I understand that a "person. as defined in Paragraph 287.133(1)(e), Florida St:tttJtes. me:lns any
'1. natural person or entity organized under the laws of any Slate or of the United States with the legal.
power to enter into a binding contract and which bids or applies to bid on contrncts for the prO\;sion
of goods or services let by a public entity, or which otherwise transacts or applies to transact business
with a public entity. The term "person" includes those officers, directors, e."Cecutives, panners,
shareholders, employees, members, and agents who are active in management of an entity.
,
I
6. Based on information and belief, the statement which I have ftllIrYed below is true in relation to
the entity submitting this swam statement. (buIIcate which Si'lf.....~t applies.)
- Neither the entity submitting this sworn statement, nor any of its officers, directors, executives,
panners, shareholders, employees, members, or agenrs who arc active in the management of the
entity, nor any atliJiate of the entity has been cbarged with and convicted of a public entity aime
subsequent to July 1, 1989.
- The entity submitting this swam statement, or one or more of its officers, directors, executives,
parmers, shareholdezs, employees, membctS, or agents who are active in the management of the
entity, or an affiliate of the entity has been charged with and convicted of a public entity aime
subsequent to July 1, 1989.. . . . .
- The entity submitting this sworn statement, or one or more of its officers, directors, executives,
panners, shareholders, employees, members, or agents who arc active in the management of the
entity, or an affiliate of the entity has been charged with and convicted of a public entity aime
subsequent to July 1, 1989. However, there has been a subsequent proceeding before a Hearing
Officer of the State of Florida, Division of .Adminftttative Hearings and the Fmal Order entered by
the Hearing Officer determined that it was not in the public interest to place the entity submitting
this swam statement on the COnvicted vendor lfst. [atmc:h a copy of the fbm1 order]
I UNDERSTAND THAT THE SUBMIssION OF nns FORM TO THE CONTRACTING OFFICER FOR
THE punuc ENTITY mEN UJ!lJW IN 'PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY
ONLY AND, THAT nns FORM IS VALID THROUGH DECEMBER. 31 OF TBE CALENDAR YEAR IN
WHICH IT IS FILED. I AlSO UNDERSTAND THAT I AM REQumED TO INFORM THE PUBUC
EN1TIY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE 'IHRESHOLD AMOUNT
PROVIDED IN SECl"ION 287.017, FLORIDA STATUTES FOR CATEGORY mo OF ANY CHANGE IN
THE INFORMATION CONTAINED IN THIS FORM.
STATE OF
~
,3/& /f 2-
[date}
COUNTY OF
...
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
[nume of individuul signing]
who, after first being swam by me, affixed his/her signature
in the space provided above on this
day of
.19
NOTARY punuc
My commission expires:
Form PCR -:'068 (Rev, 04/10191)
STATE OF FLORIDA
COUNTY OF MONROE
SUBSCRIBED AND SWORN to (o~ affirmca) before me on
(name of affiant). She is
16th of March, 1992 (date) by Judy Bobick
i-
,
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lAX
COST AND
PENALTY
,,'" -
COUN r Y-S fAI E OF FLOHllJA
: l' Ef. i: f R .W, 19 <:' 2
'....
i" IJ (II ;1\ I,; L:
THIS LICENSE EXPIRES ::;;;:
:J
UNITS
4/1-U.;9-G3
iJUM~jeK I:>>~ UNIT 3:
f hTt:R tURREUT NU ~r3 ER
TRANSFER FEE
TOTAL DUE
:.:~U:
OF
~HAR"Y F. KNIGHT, C.F.C.
lAX COlLECTO~ Z94-~403
P.V. 30X 1129
KEY WEST, Fl 33041-1129
STATE CERTIFICATE NUMBER
~.;
[:11'
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I"
AC~ 8UILDING P.'INTEN~NCE
:AOY J U f) \' OWNER
P 0 eox 1763
KiY WEST Fl 33040
PLEASE SEE BACK OF FORM
THE AdOVE LlCENSEf IS HERECY
lICENS~O .TO ENGAGE IN THE BUSINESS
PROfESSION OR OCCUPAlION Of :
Il;,~'fMt~'1~~1f-b3HfMYI(E 25.30 Cl 1I0~i
IN(
(;[11
PAil
);1,HWJ~~'2i~; h ~ i-k~~~~ dNlY WilEN VAlll)A" \) By III
MACHINE SltOWlNG TIlANSACTION NUMRHl DAI r, AND AMOllN
oe
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,.- -.~'
1.
ACCOUNT NUMBER IS 20560
LOCATION: MOallE UHIT
n
No. 'If:i.11617.,JQ,:
NO REFUNDS
THIS LICENSE MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
OCCUPATIONAL LICENSE
City of Key West, Florida
LICENSE YEAR
1.))1-19:,'7
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REC# f002~05~ TR# f324
1D ceE ;'THii ,12~ ;_':f -! YL/
CR~i :.~ ir 11 i~~''J: ,~:irii:
.~r..!'T~Jn01- ~ ~.. ~:l
ACE B~I~D!~S MAr~TEti~NCF
;~Mourn FA I D: 55. :30
, ~. oee,LTC t::t:: ;~:1
& Jb ;..,....,.'/;,
r;~ '. ;~~ -'!!i [""4 fr.=: ~::,
FINANcEtn~PARTMENi '
DIVISION OF REVENUE
:' C ! A L ~ L ,~I\ ,~ 1 n: :~~
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e I J f: ~':. ,t'), 10'
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TYPE
LICENSE:
BUSINESS ~
NAME: {
OWNER:
ADDRESS:
CITY:~
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