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5. 01/01/2006 to 09/30/2006DANNY L. KOLHAGE CLERK OF THE CIRCUIT COURT DATE: February 6, 2006 TO: Fire Chief Clark Martin Fire Rescue Department ATTN.• Camille Dubroff FROM: Pamela G. Hanc ck Deputy Clerk At the December 21, 2005, Board of County Commissioner's meeting the Board granted approval and authorized execution of an Agreement between the Board of Governors Fire and Ambulance District 1 and Fire Tech Repair Service, Inc. for maintenance of Fire Rescue vehicles, including semiannual inspections, preventative maintenance, and unscheduled maintenance resulting from malfunction or failure. At the same meeting the Board granted approval and authorized execution of a Contract between Board of County Commissioners District 6 of Monroe County and Fire Tech Repair Service, Inc. for maintenance of Fire Rescue vehicles, including semiannual inspections, preventative maintenance, and unscheduled maintenance resulting from malfunction or failure. Enclosed is a duplicate original of each of the above -mentioned for your handling. Should you have any questions please do not hesitate to contact this office. cc: County Attorney Finance File ,/ CONTRACT BETWEEN THE BOARD OF GOVERNORS FIRE AND AMBULANCE DISTRICT 1 OF MONROE COUNTY, FLORIDA AND FIRE TECH REPAIR SERVICE INC. FOR MAINTENANCE OF FIRE/RESCUE VEHICLES THIS CONTRACT, hereinafter "CONTRACT OR AGREEMENT" made and entered into this ) 5f- day of Cf illl. , 2006 by and between Board of Governors Fire and Ambulance District 1 of Monroe County, Florida, hereinafter referred to as "DISTRICT", and Fire Tech Repair Service Inc. , hereinafter referred to as "CONTRACTOR". WITNESSETH: WHEREAS, the DISTRICT advertised a notice of calling for bid for MAINTENANCE OF FIRE/RESCUE VEHICLES on the 14th day of October and the 21st day of October 2005 in The Reporter, on the 16th day of October and the 23rd day of October 2005 in the Key West Citizen and on the 15th day of October and the 220d of November 2000 in The Keynoter; WHEREAS, the successful bidder was Fire Tech Repair Service Inc., and; WHEREAS, this CONTRACTOR represents that it is capable and prepared to provide such services, and; WHEREAS, the DISTRICT intends to enter into an agreement for maintenance of Fire/Rescue vehicles, semi-annual inspections, preventative maintenance, and unscheduled maintenance resulting from malfunction or failure with the CONTRACTOR and; WHEREAS, this contract is an agreement between both parties, NOW, THEREFORE, in consideration of the promises contained herein, the parties agree as follows: 1. CONTRACT PERIOD AND RENEWAL - The effective date of this Agreement shall be Januarv 1. 2006 through September 30.2006. This contract may be renewed annually for one (1) year terms, not to exceed three (3) renewals, subject to approval of the Fire Chief of Monroe County Fire Rescue, the Office of Management and Budget and the Monroe County Board of Governors Fire and Ambulance District 1. 1 2. CONTRACT TERMINATION - This contract may be terminated for any reason by either party on 30-day written notice without cause. If the CONTRACTOR fails to fulfill the terms of this agreement, or attachments, properly or on time, or otherwise violates the provisions of the agreement or of applicable laws or regulations governing the use of funds, the County may terminate the contract by written notice. The notice shall specify cause. All finished or unfinished supplies or services shall, at the option of the County, become property of the County. The County shall pay the CONTRACTOR fair and equitable compensation for expenses incurred prior to termination of the agreement, less any amount or damages caused by the CONTRACTOR's breach. If the damages are more than compensation payable, the CONTRACTOR will remain liable after termination and the County shall pursue collection for damages. 3. SUBJECT MATTER OF CONTRACT - This contract is for scheduled semi annual inspections and preventative maintenance of fire rescue vehicles, annual pump tests and for unscheduled maintenance and repair resulting from equipment failure or malfunction. 4. RATES -The hourly rate shall be $73.00 per man-hour with no travel time or mileage charge. Semi Annual inspections and annual pump tests are at quoted flat rates and excluded from hourly rate. 5. OVERTIME AND HOLIDAYS - Rates per man-hour for emergency repairs called outside normal business hours and federal holidays shall be one and one half times the normal rate. 6. SEMI-ANNUAL INSPECTIONS - During the year CONTRACTOR shall perform two inspections on vehicles described in "Attachment A" (Level I and Level II Preventative Maintenance Service) at an annual total cost of: Rescue-type vehicles, without pump $ Pumpers $ Aerials $ 360.00 490.00 640.00 Exception shall be if a vehicle has been used 1,000 hours prior to yearly preventative maintenance service, Level I and II Preventative Maintenance Service shall be performed and charged the above rate. Level I: 250 Hours or 6 months (whichever comes first) Full vehicle inspection as per attached semi-annual inspection schedule plus: Engine oil and filter change Fuel filter change (every 6 months) Air filter inspection and replacement if necessary Chassis lubrication 2 Outboard (forward) impeller shaft lubrication Lubrication of all valve control linkages Clean or replace air compressor strainer Clean engine crankcase breather Inspection of generator and service of lubricant system, full system, and air filter according to its individual hours of operation (not to exceed 6 months) Level II: 1000 Hours or one year (which ever comes first) Full service performed in Level I plus: Replacement of coolant hoses, filter and coolant as needed Replacement of all drive belts as needed Replacement of pump transmission oil and filter Replacement of engine transmission fluid and filter Replacement of rear axle lube oil as needed _ Inspection of front wheel bearing Replacement and repacking as needed Inspection and cleaning of relief valve strainer Replacement of secondary fuel filters on both engine and generator The number of vehicles may fluctuate from time to time due to new purchases or removal of vehicles from inventory. The inspections shall be preformed at the respective fire stations. 7. WORK SCHEDULE - Regularly scheduled semi-annual inspections and preventative maintenance shall be conducted at such intervals as are approved by the DISTRICT. 8. PUMP TESTS - CONTRACTOR shall perform an annual pump test at a flat rate cost of $250.00 each for all vehicles requiring such test. In order to facilitate the passing of the pump test, minor repairs and adjustments shall be made as needed; price includes clean-up after salt water use. The CONTRACTOR shall provide documentation of performance to Monroe County. The documentation must be in the form of an electronic version report that is emailed to the Captain of Support Services. The form must either be in Microsoft Word or Excel. 9. PARTS, FLUIDS AND LUBRICANTS - All parts, fluids, and lubricants used for maintaining and repairing vehicles shall be supplied by CONTRACTOR and billed to the DISTRICT at cost plus 25%. For parts $400.00 and over, a copy of original parts supplier invoices shall be attached to the bill. CONTRACTOR will be required to keep all original parts supplier invoices available at request by County for spot checking and auditing purposes. 3 10. ENGINE OIL AND FILTER CHANGE and complete drive train lubrication and any other fluids and/or filter changes, shall be performed as recommended by the manufacturer. 11. SEMI-ANNUAL INSPECTION SCHEDULE - CONTRACTOR shall perform the following inspection and preventative maintenance twice per year on all vehicles: (a) Cooling system, including fan belts, radiator supports, hoses and clamps, and auxiliary cooler; (b) Exhaust System, including hanger, clamps, muffler, and pipes; (c) Clutch, including freeplay, linkage, and fluid levels; (d) Manual Transmission, including seals, linkage, and lube level; (e) Automatic Transmission, including fluid level, seals, modulator adjustment, and linkage; (t) Drive Train, including U-joints, center support, and companion flanges; (g) Rear Axle and springs, including oil links, spring hangers, center bolts, and V -bolts (h) Front End, including steering box, linkage, kingpins and bushings, spring hangers, and V-bolts; (i) Mechanical Brakes, including adjustment and fluid levels; G) Air Brakes, including drain, adjustment, wear, and air leaks; (k) Tires, including condition and wear; (1) Electrical System, including running lights, emergency lights, battery cables, turn lights, 4-way flasher, headlights, stop lights, and switches; (m) Fuel System, including hoses and fittings, filters and brackets, and tank straps; (n) Booster Tank, including leaks and supports; (0) Prime Pump, including electrical wires, coupling, switch, and valve discharge; (P) Plumbing and Gates, including leaks, brackets, bleed valves, control arms and knobs, and linkage; (q) Main Pump, including vacuum test, pressure test, packing, clappers, and mounting; (r) Pump Transmission, including fluid levels, seals, shift motors, and manual override; (s) Aerial Ladder, including power takeoff, drive shaft and coupling, P.T.O. activating device and outrigger controls; (t) Aerial Operation, including engine RPM., hydraulic pressure, operation of all controls, warning devices, hoses and fittings, rung covers, ladder locks, and ring gear; (u) Aerial Platform, including lubrication, platform leveling, electrical system, turntable and platform controls, communications, and water tube. The above inspections shall include, at no additional labor charge, the changing of all applicable filters and fluids used by the unit being inspected. Air filters shall be changed on first inspection and then yearly thereafter. Filters and fluids shall be 4 billed at cost plus 25%, as previously described in Section 9 of this AGREEMENT. Upon completion of inspection a computerized report will be forwarded to the Captain of Support Services indicating the status of the items inspected. This will be done for every vehicle when Preventative maintenance is performed on the vehicle. This report must be em ailed to the Captain of Support Services at lubert- peter@monroecounty-fl.gov. The form must either be in Microsoft Word or Excel. 12. WEEKLY MAINTENANCE SCHEDULE - CONTRACTOR shall provide to the DISTRICT a preventative maintenance schedule that can be performed weekly by the individual Volunteer Fire Departments' personnel. 13. MAINTENANCE LOG - CONTRACTOR shall maintain an inspection and maintenance chart on each vehicle containing at least the following information: ( a) Date of performance, (b) Apparatus serviced, (c) Service performed, (d) Parts used, (e) Name of service person(s), (f) Total downtime of vehicle A copy of this chart shall be supplied to the Fire Rescue Office within 30 days of the service. 14. COMMUNICATION - CONTRACTOR shall maintain a telephone or paging device such that prompt notification of request for service is possible twenty-four (24) hours a day. 15. RESPONSE TO SERVICE REQUEST - CONTRACTOR shall maintain itself in a state of readiness during normal working hours, 8:00 am - 5:00pm Monday thru Friday, and shall respond to the location where emergency repairs are needed within 12 hours of receiving a request. For repairs required after normal working hours, CONTRACTOR shall respond to the location where emergency repairs are needed within 24 hours of receiving a request. 16. CERTIFICATION - CONTRACTOR shall provide evidence satisfactory to the DISTRICT that its personnel who perform maintenance work are certified in pump mechanics, general mechanics and repair. 17. QUALIFICATIONS OF MAINTENANCE PERSONNEL - All personnel performing maintenance, repairs, adjustments and related work on Monroe County equipment shall be a certified fire apparatus mechanic or otherwise certified for the work to be performed. Personnel performing work who are not certified or experienced in such work shall be directly supervised (in person) by an individual with such certification. 5 18. INDEMNIFICATION - CONTRACTOR shall indemnify and hold the DISTRICT and Momoe County harmless for any negligence on its part, or faulty or improper workmanship, for all work performed under this contract, including all costs of collection, reasonable attorney fees, claim costs, and as per "Attachment B". All property or equipment being directly maintained or repaired by CONTRACTOR shall be considered in its care, custody, and control while such work is in progress and until physical control of such property or equipment is restored to the DISTRICT. 19. LOCATION OF WORK - This contract is for maintenance of fire rescue vehicles located at the following sites: A. B. C D. E. Stock Island Big Coppitt Sugarloaf Cudjoe Big Pine F. G. H. I. Monroe County Fire Academy (Marathon) Conch Key Layton Tavernier 20. INSURANCE - During the term of this contract, the CONTRACTOR must keep in force and effect the insurance required by Attachments C". Attachments C" are attached and incorporated into this contract. 21. ADDITIONAL REQUIRED STATEMENTSNERIFICATIONS/AFFIDA VITS. Attached hereto in "Attachment D" are Public Entity Crime Statement, Non- Collusion Affidavit, Ethics Clause, and Drug-Free Workplace Form 22. PAYMENTS - Payments for semi-annual inspection, preventative maintenance and pump tests shall be made by the DISTRICT within 30 days of the completion of the rendered services on each vehicle and proper invoicing by the CONTRACTOR. All unscheduled maintenance and repair resulting from equipment failure or malfunction requiring service shall be billed by the CONTRACTOR at the applicable rates as specified in Section four, five and six of this AGREEMENT. The CONTRACTOR upon notification by the DISTRICT of an equipment failure or malfunction requiring unscheduled maintenance shall, in a timely manner investigate the problem and provide to the DISTRICT an estimate of the cost for repair and vehicle downtime. The CONTRACTOR upon receiving authorization to proceed from the DISTRICT shall effectuate such repair; upon completion of same the CONTRACTOR shall notify the DISTRICT of the out come and actual cost. The DISTRICT shall issue a separate purchase order for each occurrence of unscheduled maintenance and repair. 23. Monroe County's performance and obligation to pay under this contract is contingent upon an annual appropriation by the Board of County Commissioners. 24. Venue for any litigation arising under this contract must be in a court of competent jurisdiction in Monroe County, Florida. 6 DANNY L. KOLHAGE CLERK OF THE CIRCUIT COURT DATE: February 6, 2006 TO: Fire Chief Clark Martin Fire-Rescue Department FROM: Camille Dubroff Pamela G. Hanc~ Deputy Clerk ATTN: At the December 21,2005, Board of County Commissioner's meeting the Board granted approval and authorized execution of an Agreement between the Board of Governors Fire and Ambulance District 1 and Fire Tech Repair Service, Inc. for maintenance of Fire Rescue vehicles, including semiannual inspections, prevent~tive maintenance, and unscheduled maintenance resulting from malfunction or failure. At the same meeting the Board granted approval and authorized execution of a Contract between Board of County Commissioners District 6 of Monroe County and Fire Tech Repair Service, Inc. for maintenance of Fire Rescue vehicles, including semiannual inspections, preventative maintenance, and unscheduled maintenance resulting from malfunction or failure. Enclosed is a duplicate original of each of the above-mentioned for your handling. Should you have any questions please do not hesitate to contact this office. cc: County Attorney Finance File.! IN WITNESS WHEREOF, each party hereto has caused this contract to be executed by its duly authorized representative. f:\"" ,- ,........ -. "'(~~*>~';'~f' 1 ('}t.~i" '\\~;~i::"':;\ . f .ti . < ..;,;"'~\~~ 'y ",:)!r, :Lr~<'~'::::"i / :__:/~: .> \'<:,',:_ :~riny L. Kolhage, Clerk ?J~'.c. Clerk I Zo/ 1.110 s WITNESS: BOARD OF GOVERNORS FIRE AND AMBULANCE DISTRICT 1 of~ROECOU~'JL.I '^~}1t~ U-:'--'Chairman Fire Tech Repair Service Inc. ~ ((k) Authorized Representative .-/ ~ 0 ~ )> :::0 Z OOz rr1'-< ;r;: O. , 0(")' c:-:=r.;: :;:: ::0 c, -i ~_. -< (j ~,- ....;"- . . ...~ "'Tl C; , r<1 )> ~ ~ ~ c:::r" ...., r"'1 CD I en :,po ::J: \D .. N 7 '"T1 - y- rr1 C7 -r'1 o ::;.0 :;0 I"'l1 C") o :;::0 o r:i d /l-t)C ,d Ve h: ( (f MQ "I'\),.eV\A.fu f (/, /0' - (1/30' Attachment A Monroe County Fire Apparatus District 1 Location Stock Island Vehicle Description 1990 E-One Pumper 1994 Southern Coach Tanker/Pumper Big Coppitt 1983/89 Ford Rehab Unit 1990 E-One Pumper 1999 Southern Coach Pumper 1978 LFRNC Pumper Sugarloaf 1993 Boardman Triple Comb Pumper 1986 Chevrolet Rescue Pumper 198111998 Saulsbury 3000 Gallon Tanker/ Pumper Cudjoe 2003 Pierce Pumper Big Pine Key 1989 Young Pumper 198111998 Saulsbury 3000 Gallon Tanker/ Pumper 1996 Dodge 3500 Brush Truck 1985 AMGC 6 x 6 Brush Truck Marathon Airport Monroe County Fire Academy (Marathon) 1997 E-One Ford 450 ARFF 1985 AMGC 6 x 6 Brush Truck 1978 LFRNC Pumper 1978 LFRNC Pumper Conch Key 1989 Young Pumper 198111998 Saulsbury 3000 Gallon Tanker/Pumper Lay ton 1992 E-One Rescue 1990 E-One Pumper Tavernier 1992 Saulsbury Hose Reel Truck 1988 Spartan Rescue/Pumper 1988/2004 E-One Aerial Platform 2001 Pierce Pumper 1992Ford Rehab Unit 19% Edition .,- MONROE COUNTY, FLORIDA RISK MANAGEMENT POLICY AND PROCEDURES CONTRACT ADMINISTRA nON MANUAL Indemnification and Hold Harmless for Other Contraeton and SlIbeontraeton - The Contractor covenants and agrees to indemnify and hold harmless Monroe County Board of County Commissioners from any and all claims for bodily injury (includina death), personal injury, and property damage (including property owned by Monroe County) and any other losses, damages, and expenses (including attorney's fees) which arise out ot: in connection with, or by reason of services provided by the Contractor or any of its Subcontractor(s) in any tier, occasioned by the negligence, errors, or other wrongful act or omission of The Contractor or its Subcontractors in any tier, their employees, or agents. In the event the completion of the project (to include the work of others) is delayed or suspended as a result of the Contractor's fililure to purchase or maintain the required insurance, the Contractor shall indemnifY the County from any and all increased expenses resulting from sUch delay. The first ten dollars ($10.00) of remuneration paid to the Contractor is for the indemnification provided for above. The extent of liability is in no way limited to, reduced, or lessened by the insurance requirements contained elsewhere within this agreement. TCS Administration Instruction #4709.5 Attachment B .~ , 1996 Edition RISK MANAGEMENT POLICY AND PROCEDURES CONTRACT ADMINISTRATION MANUAL GeDeral IDluraDce Requirements for Other Contracton aDd Subcontracton As a pre-requisite of the work governed, or the gQOds supplied under this contract (including the pre-staging of personnel and material), the Contractor shall obtain, at hisIher own expense, insurance as specified in any attached schedules, which are made part of this contract. The Contractor will ensure that the insurance obtained will extend protection to all Subcontractors engaged by the Contractor. As an alternative, the Contractor may require all Subcontractors to obtain insurance consistent with the attached schedules. The Contractor wiD not be permitted to commence work: governed by this contract (including pre- staging of personnel and material) until satis&ctory evidence of the required insurance has been furnished to the County as specified below. Delays in the commencement of work, resulting from the fiWure of the Contractor to provide satisf8ctory evidence of the required insurance, shallllOt extend deadlines specified in this contract and any penalties and fiWure to perform assessments shall be imposed as if the work commenced on the specified date and time, except for the Contractor's :&i1ure to provide satisfitctory 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 fiUlure of the Contractor to maintain the ~uired insurance shall not extend deadlines specified in this contract and any penalties and :&i1ure to perform assessments shall be imposed as if the work had not been suspended, except for the Contractor's fiillure to maintain the required insurance. The Contractor shall provide, to the County, as satisfactory evidence of the required insurance, either: · Certificate of Insurance or · A Certified copy of the actual insurance policy. The County, at its sole option, has the right to request a certified copy of any or all insurance policies required by this contract. All insurance policies must specifY that they are not subject to cancellation, non-renewal, material change, or reduction in coverage unless a minimum of thirty (30) days prior notification is given to the County by the insurer. The acceptance and/or approval of the Contractor's insurance shall not be construed as relieving the Contractor from any liability or obligation assumed under this contract or imposed by law. Administration Instruction #4709.5 Attachment C' 1 of 7 1996 Edition The Monroe County Board of County Commissioners, its employees and officials will be included as "Additional Insured" on all policies, except for Workers' Compensation. Any deviations from these General Insurance Requirements must be requested in writing on the County prepared form entitled "Request for Waiver of Insurance Requirements" and approved by Monroe County Risk Management. Attachment C 2 of 7 AJministration Instruction #4709.5 1 QQ" Edition MONROE COUNTY, FLORIDA RISK MANAGEMENT POLICY AND PROCEDURES CONTRACT ADMINISTRATION MANUAL WAIVER OF INSURANCE REQUIREMENTS There will be times when it will be necessary, or in the best interest of the County, to deviate from the standard insurance requirements specified within this manual. Recogni7ing this potent~ and acting on the advice of the County Attorney, the Board of County Commissioners has granted authorization to Risk Management to waive and modify various insurance provisions. Specifically excluded from this authorization is the right to waive: · The County as being named as an Additional Insured - If a letter from the Insurance Company (not the Agent) is presented, stating that they are unable or unwilling to name the COWlty as an Additional Insur~ Risk Management has been granted the authority to waive this provision. and · The Indemnification and Hold Harmless provisions Waiving of insurance provisions could e~se the County to economic loss. For this reaso~ every attempt should be made to obtain the standard insurance requirements. If a waiver or a modification is desired, a Request for Waiver of Insunnce Requirements form should be completed and submitted for consideration with the proposal. After consideration by Risk Management and if approved, the form will be returned, to the County Attorney who will submit the Waiver with the other contract documents for execution by the Clerk of the Courts. Should Risk Management deny the Waiver Request, the other party may file an appeal with the County Administrator or the Board of County Commissioners, who retains the final decision making authority. Administration Instruction #4709.5 Attachment C 3 of 7 1996 Edition - GENERAL LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT BETWEEN MONROE COUNTY, FLORIDA AND Prior to the commencement of work governed by this contract, the Contractor shall obtain General Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum: ,- · Premises Operations · Products and Completed Operations · Blanket Contractual Liability . Personal Injury Liability · Expanded Definition of Property Damage The minimum limits acceptable shall be: $300,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $100,000 per Person $300,000 per Occurrence $ 50,000 Property Damage An Occurrence Form policy is preferred. If coverage is provided on a Claims Made policy, its provisions should include coverage for claims filed on or after the effective date of this contract. In addition, the period for which claims may be reported should extend for a minimum of twelve (12) months following the acceptance of work by the County. . The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfY the above requirements. - GLl Administration Instruction #4709.5 Attachment C 4 of 7 1996 Edition ..-.., VEHICLE LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT BETWEEN MONROE COUNTY, FLORIDA AND Recognizing that the work governed by this contract requires the use ofvehicles, the Contractor, prior to the commencement of work, shall obtain Vehicle Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum, liability coverage for: · Owned, Non-Owned, and Hired Vehicles """ The minimum limits acceptable shall be: $100,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $ 50,000 per Person $100,000 per Occurrence $ 25,000 Property Damage The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfy the above requirements. .- VLl Administration Instruction #4109.5 Attachment C 5 of 7 -. WORKERS' COMPENSATION INSURANCE REQUIREMENTS FOR CONTRACT BETWEEN MONROE COUNTY, FLORIDA AND 1996 Edition Prior to the commencement of work governed by this contract, the Contractor shall obtain Workers' Compensation Insurance with limits sufficient to respond to Florida Statute 440. In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not less than: $100,000 Bodily Injury by Accident $500,000 Bodily Injury by Disease, policy limits $100,000 Bodily Injury by Disease, each employee Coverage shall be maintained throughout the entire term of the contract. Coverage shall be provided by a company or companies authorized to transact business in the state of Florida. If the Contractor has been approved by the Florida's Department of Labor, as an authorized self- insurer, the County shall recognize and honor the Contractor's status. The Contractor may be required to submit a Letter of Authorization issued by the Department of Labor and a Certificate ofInsurance, providing details on the Contractor's Excess Insurance Program. If the Contractor participates in a self-insurance fund, a Certificate of Insurance will be required. In addition, the Contractor may be required to submit updated financial statements from the fund upon request from the County. ,"""'" - Administration Instruction #4709.5 wet Attachmnet C 6 of 7 , I QQjIj Edition MONROE COUNTY, FLORIDA ( I, Request For Waiver of Ialunace Requiremeats It is requested that tbe insurance requirernen~ as specified in the County's Schedule ofInsurance Requirements, be waived or modified on the following contract. Contractor: Contrad ror: Address of Contractor: Phone: Scope of Work: Reason fOr Waiver: P"licles Waiver will apply to: Signature of Contractor: Approved Not Approved Risk Man_8ement Date County Administrator appeal: Approved: Not Approved: Date: Board of County Commissioners appeal: Approved: ~ot Approved: \1l:eting Date: Administration Instruction ;#4709.5 Attachment C 7 of 7 PUBLIC ENTITY CRIME STATEMENT "A person or affiliate who bas been placed on tbe convicted vendor list following a conviction for public entity crime may DOt submit a bid on a contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for tbe construction or repair of a public building or public work, may not submit bids on leases of real property to public entity, may not be awarded or perform wodt 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 SectioIl287.011, for CATEOORY TWO for a period of36 tnOIltbs &om the date ofbeing placed on tbe convicted vendor list." STATEOF R~rlcf)A- , COUNTY OF rn(!nt 1'0 L PERSONALLY APPEARED BEFORE ME, the undersigned authority, -PO Ii ~rl (< l ) V-"~ wbo, __ being __ by_ <_ofindividuol signing) affixed hislher signature in space provided above on this ~dayof~O\Jcm'\i:),r:-r . 20()(')s..- . )2r/-l/??/>>Lnu CJl'~ My_expinls: OTARY PUBLIC " Page 11 of14 NON-COLLUSION AFFIDAVIT fo h~;;r c Ifvy ('C>' 1, , of the city of TA-V~Ni"'r according to law on my oath, and under peoaIty of petjury, depose and say that; 1) 1 am~c:.../7rr.s_ of f5~ =-k:cl'\. ~/f<'/y".5~I\crc:: ~e bidder making the Proposal for the project described 'as follows: Jill j4-lY\Jf' /lAwf"'_ ~f8 }11(J}J{l"Jt:' r.:cJ.~ h'R'~ ~::!X?ue IJe(A71 JI'It!/[ Vp 4.vcf'tPJ &to- P'#C) --313 -o/f4J ~ 2) The prices in this bid have been arrived at independently without collusion, consultation, COIDIDUDication or agreement for the purpose of restricting competition, as to any matter n*ting to such prices with any other bidder or with any competitor; 3) Unless otherwise required by law, the prices which have been quoted in this bid have not beea 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 bas been made or will be made by the bidder to induce any other perIOD, pannership or corporation to submit, or not to submit, a bid for the purpose of restricting competition; S) 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. . STATE OF FLorrcbt ~~~-/T~) (Signature of Bidder) 1/- V-o -:;- Date COUNTY OF (JA(7(\ rO'C- PERSONALLY APPEARED BEFORE ME, the undersigned authority, (20 G e v-+ f3 lJ r-L e f who, after first being sworn by me, (name Of~ signing) affixed hislher signature in the space provided above on this ,-/-I--h dayof-1\n \)<:::0\ eel, 20 ().,S My commission expires: OMB - MCP FORM #1 Page 12 ofl4 SWORN STATEMENT UNDER ORDINANCE NO. 10-1990 MONROE COUNTY, FLORIDA ETHICS CLAUSE fZo&Uf ('/ g0r/~1 warrants that he/it has not employed, retained or otherwise had act on hislits behalf any former County officer or employee in violation of Section 2 of Ordinance No. 1()"1990 or any County officer or employee in violation of Section 3 of OrdiD8DCe No. 1 ().. 1 990. For breach or violation of this provision the County maYt in its discretion, terminate this contract without liability and may also, in its discretiODt . deduct from the contract or purchase price, or otherwise recover, the full amount of any fee, commission, percentage, ~ or consideration paid to the former County officer or employee. ~C/6:~~e.~) (signature) / Date: / (- y -0 S- o STATE OF FLc,/,tJ)* . COUNTY OF VJ1~Vl ffJ'-R _ PERSONALLY APPEARED BEFORE ME, the undersigned authority, k 0 G e rl (~ l ) r-- L -e i whot after first being swom by me, affixed hislher signature (name of individual signing) in the space provided above on this ~ day of 20.m; My commission expires: OMB - MCP FORM #4 Page 13 ofl4 DRUG-FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287 .087 hereby certifies that: ----- - c_ 5' ri' f'e. - I C'c h. p'-fj/I+/ 'r elVtC~ cr //1C- · (Name of Business) 1. Publish a statement notifying employees that the lDllawful manufacture, distribution, dispensing, possession, or use of a 00Dtr0Ued substance is prohibited in the wodtpIace and specifying the actions that wiD be taken against employees for violations of such prohibition. 2. Infonn employees about the dangers of drog abuse in the wOlkplaee, the bmuness's policy of maintaining a drug-he wodcpIac:e, any available drug counseling, rebabiIitation, and employee assistance programs, and the penalties that may be imposed upon employees for drog 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 01' contractual services that are under bid, the employee will abide by che tams 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 worlcplace no later than five (5) days after such conviction. S. I~ a sauction on, 01' require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's comunmity, or any employee who is so convicted. 6. Make a good faith effort to continue to maintain a drog-free worlcplace through implementation of this section. As the penon authorized to sign the statement, I certify that this firm complies fiJIIy with the above requirements. ) Bidder's Signature .J 1- c; '-0 S-- Date OMB - Mep FORM #5 Page 14 of 14