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Job Order Contracting Agmt w/ Ric-Man Internationalv~i7 ~/~-D~ JOB ORDER CONTRACTING AGREEMEN BETWEEN CITY OF MIAMI BEACH, FLORIDA AND RIC-MAN INTERNATIONAL, INC. FOR HORIZONTAL RIGHT-OF-WAY (ROW) CONSTRUCTION PROJECTS FOR THE CITY OF MIAMI BEACH, FLORIDA INVITATION TO BID NO.23-08/09 Project Manual 00800 CONTRACT CONTRACT l THIS CONTRACT is entered into this ~~ day of Zc+~~cY , 2009 (Effective Date), by and between the CITY OF MIAMI BEACH, a political subdivision of the State of Florida, hereinafter referred to as CITY, and RIC- MAN INTERNATIONAL, INC., hereinafter referred to as CONTRACTOR. W I T N E S S E T H, that CONTRACTOR and CITY, for the considerations hereinafter named, agree as follows: ARTICLE 1 SCOPE OF WORK 1.1. The scope of work under this Contract shall be determined by individual Job Orders issued hereunder. Upon receipt of a Notice to Proceed, the CONTRACTOR shall furnish any and all labor, materials, equipment, services and incidentals necessary to perform all of the work for the Project described in the Job Order. ARTICLE 2 CONTRACT TIME 2.1. This Contract shall be for an initial term of one (1) year, commencing upon the Effective Date. The Contract may be renewed, at the City's option, for four (4) additional twelve (12) month terms, subject to the requirements of Section 3 of the JOC Supplemental Conditions. The Maximum Contract Duration shall be no more than five (5) years, or when the Maximum Not to Exceed Contract Value is reached, whichever is first 2.1.1. Once the Contract is in place, individual Job Orders will be issued through Blanket Purchase Orders and Notices to Proceed, issued by the Contract Administrator. The time for completion of individual Job Orders will be contained in the Notice to Proceed. CONTRACTOR shall not begin work without a signed Blanket Purchase Order and Notice to Proceed. 2.2. Time is of the essence throughout this Contract. Job Orders shall be substantially completed within the specified calendar days listed on each individual Notice to Proceed, and completed and ready for final payment in accordance with Article 5 hereof within the time specified on each individual Notice to Proceed. Contract Project Manual 2.3. Liquidated Damages may be applied to individual Job Orders at the discretion of the CITY. The dollar amount(s) relative to Liquidated Damages are not intended to be applied as penalties, but rather to be applied as damages to the CITY for its inability to obtain full beneficial occupancy and/or use of the Project. Liquidated Damages on construction projects other than streetscape or utility proiects are hereby fixed at $1,000 per day and agreed upon between the parties, recognizing the impossibility of precisely ascertaining the amount of damages that will be sustained by the CITY as a consequence of such delay, and both parties desiring to obviate any question of dispute concerning the amount of said damages and the cost and effect of the failure of the CONTRACTOR to complete the Project on time. 2.3.1 Liquidated Damages relative to a streetscape or utility project. The additional cost realized by the CITY consists of the following components: Additional construction administration by CITY, Program Manager, and/or Consultant. Additional resident observation by CITY and/or Program Manager. Loss of use of facilities, including, without limitation, loss of parking revenue, sidewalk cafe fees, etc. The cost realized by the CITY for extended Project milestone completion consists of the sum of the Program Management (PM) fee; the City Construction Management (CM) cost; additional Consultant fees that would be incurred by the CITY for each day that the Project completion is delayed; and those costs realized by the CITY for loss of facility use. It is estimated that the PM component of CITY incurred expense could reasonably consist of one resident observer ($75 per hour for 8 hours per day = $600), one Project Coordinator ($125 per hour for 4 hour per day = $500), and one Project Administrator ($50 per hour for 4 hours per day = $200). Hence, the estimated PM component of the liquidated damage value to be used on streetscape or utility projects would be $1,300 per day. It is estimated that the Construction Management component of CITY incurred expense would be based on the recognized rate of 4% of total Project cost. Hence, a $5,000,000 Project that has construction duration of 300 working days would result in a CM cost component of $800 per day. This value will vary by Project. Loss of Parking Revenue: If applicable, will be incorporated in the Job Order/Notice to Proceed. Contract 2.4. CITY is authorized to deduct liquidated damages from monies due to CONTRACTOR for the Work under the Job Order or as much thereof as CITY may, in its sole discretion, deem just and reasonable. Project Manual Contract 2.5. CONTRACTOR shall be responsible for reimbursing CITY, in addition to liquidated damages, for all costs incurred by the CITY in administering the construction of the Project beyond the completion date specified in the Notice to Proceed, plus approved time extensions. All such costs shall be deducted from the monies due CONTRACTOR for performance of Work under the Job Order by means of unilateral credit change orders issued by CITY as costs are incurred. ARTICLE 3 THE CONTRACT SUM AND ADJUSTMENT FACTORS 3.1. The Contract is an indefinite-quantity contract with no minimum values. The Estimated Contract Term Value for ITB No. 23-08/09 -HORIZONTAL RIGHT-OF-WAY (ROW) is Five Million Dollars ($5,000,000) per term. The Maximum Not To Exceed Contract Value for ITB No. 23-08J09 - HORIZONTAL RIGHT-OF-WAY (ROW) is Twenty-five Million Dollars ($25,000,000). 3.2. Payment shall be at the lump sum price stated in the Notice to Proceed for each Job Order. This price shall be full compensation for all costs, including overhead and profit, associated with completion of all Work in full conformity with the requirements as stated or shown (or both) in the Contract Documents using the following Adjustment Factors: 3.2.1. Normal Working Hours Construction: CONTRACTOR shall perform any or all functions called for in the Contract Documents and the Detailed Scope of Work, scheduled during Normal Working Hours, in the quantities specified in individual Job Orders against this Contract, for the unit price sum specified in the Construction Task Catalog® multiplied times the Adjustment Factor of: 1 0 2 2 3 3.2.2. Other Than Normal Working Hours Construction: CONTRACTOR shall perform any or all functions called for in the Contract Documents and the Detailed Scope of Work, scheduled during Normal Working Hours in the quantities specified in individual Job Orders against this Contract, for the unit price sum specified in the Construction Task Catalog® multiplied times the Adjustment Factor of: ~. 0 4 5 6 Project Manual 3.2.3. Non Pre-priced Work Tasks: CONTRACTOR shall perform any or all functions called for in the Contract Documents and the Detailed Scope of Work that are Non Prepriced Tasks multiplied times the Adjustment Factor of: 1 0 1 5 8 ARTICLE 4 PROGRESS PAYMENTS 4.1. For Job Orders intended to have a duration of thirty (30) days or less, CITY will make only one final payment. For Job Orders intended to have a duration of more than thirty (30) days the CONTRACTOR may make Application for Payment for Work completed during the Project at intervals of not more than once a month. CONTRACTOR'S application shall show a complete breakdown of the Project components; the quantities completed and the amount due; and such other supporting evidence as may be required by CITY. CONTRACTOR shall include with each Application for Payment, an updated Progress Schedule acceptable to CITY (and as required by the Contract Documents), and a release of liens and consent of surety relative to the Work which is the subject of the Application. Each Application for Payment shall be submitted in triplicate. CITY shall make payment to CONTRACTOR within thirty (30) days after approval by CITY of CONTRACTOR'S Application for Payment and submission of an acceptable updated Progress Schedule. 4.2. Ten percent (10%) of all monies earned by CONTRACTOR shall be retained by CITY until Final Completion and acceptance by CITY, in accordance with Article 5 hereof, except that after ninety percent (90%) of the Work has been completed, the Contract Administrator may reduce the retainage to five percent (5%) of all monies previously earned and all monies earned thereafter. Any reduction in retainage shall be in the sole discretion of the CITY and shall be recommended by the Contract Administrator. CONTRACTOR shall have no entitlement to a reduction. Any interest earned on retainage shall accrue to the benefit of CITY. All requests for retainage reduction shall be in writing in a separate stand- alone document. 4.3. CITY may withhold, in whole or in part, payment to such extent as may be necessary to protect itself from loss on account of: 4.3.1. Defective work not remedied. 4.3.2. Claims filed, or reasonable evidence indicating probable filing of claims by other parties, against CONTRACTOR or CITY because of CONTRACTOR'S performance. Contract Project Manual 4.3.3. Failure of CONTRACTOR to make payments properly to subcontractors, or other failure to pay materials or labor. 4.3.4. Damage to another contractor not remedied. 4.3.5. Liquidated damages and costs incurred by CITY, as noted in Section 2.3. 4.3.6 Failure of CONTRACTOR to provide any and all documents required by the Contract Documents. ARTICLE 5 ACCEPTANCE AND FINAL PAYMENT 5.1. Upon receipt of written notice from CONTRACTOR that the Project is ready for final inspection and acceptance, CITY shall, within ten (10) calendar days, make an inspection thereof. If the CITY finds that the Work is acceptable; the requisite documents have been submitted; the requirements of the Contract Documents have been fully satisfied; and all conditions of the permits and regulatory agencies have been met, a Final Certificate of Payment (Form 00922) shall be issued by CITY stating that the requirements of the Contract Documents have been performed and the Work is ready for acceptance under the terms and conditions thereof. 5.2. Before issuance of the Final Certificate for Payment, CONTRACTOR shall deliver to the CITY a complete release of all liens arising out of the Job Order (or at the CITY's sole discretion, receipts in full in lieu thereof); an affidavit certifying that all suppliers and subcontractors have been paid in full and that all other indebtedness connected with the Work has been paid; a consent of the surety to final payment; the final corrected as-built drawings; and a final invoice. 5.3. If, after the Work has been substantially completed, full completion thereof is materially delayed through no fault of CONTRACTOR, and the CITY so certifies, CITY shall, upon certification of the CITY and without terminating the Job Order, make payment of the balance due for that portion of the Work fully completed and accepted. Such payment shall be made under the terms and conditions governing final payment, except that it shall not constitute a waiver of claims. 5.4. Final payment shall be made only after the City Manager or his designee has reviewed a written evaluation of the performance of CONTRACTOR (prepared by the Contract Administrator) and approved final payment. The acceptance of final payment by CONTRACTOR shall constitute a waiver of all claims by CONTRACTOR, except those previously made in strict accordance with the provisions of the General Conditions and identified by CONTRACTOR as unsettled at the time of application for final payment. Contract Project Manual ARTICLE 6 MISCELLANEOUS 6.1. This Contract is part of, and incorporated into, the Contract Documents, as defined herein. Accordingly, all of the documents incorporated into the Contract Documents shall govern this Project. 6.2. Where there is a conflict between any provision set forth within the Contract Documents and a more stringent State or federal provision which is applicable to the Project, the more stringent State or federal provision shall prevail. 6.3. Public Entity Crimes: 6.3.1. In accordance with the Public Crimes Act, Section 287.133, Florida Statutes, a person or affiliate who is a contractor, consultant or other provider, who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a bid on a contract to provide any goods or services to the CITY, may not submit a bid on a contract with the CITY for the construction or repair of a public building or public work, may not submit bids on leases of real property to the CITY, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with the CITY, and may not transact any business with the CITY in excess of the threshold amount provided in Section 287.017, Florida Statutes, for category two purchases for a period of 36 months from the date of being placed on the convicted vendor list. Violation of this section by CONTRACTOR shall result in cancellation of the CITY purchase and may result in CONTRACTOR debarment. 6.4. Independent Contractor: 6.4.1. CONTRACTOR is an independent contractor under this Contract. Any and all work and/or services provided by CONTRACTOR pursuant to this Contract shall be subject to the supervision of CONTRACTOR. In providing such work and/or services, neither CONTRACTOR nor its officials, employees, contractors and/or agents shall act, or purport to act, as officers, employees, contractors and/or agents of the CITY. This Contract shall not constitute or make the parties a partnership or joint venture. 6.5. Third Party Beneficiaries: 6.5.1. Neither CONTRACTOR nor CITY intends to directly or substantially benefit a third party by this Contract. Therefore, the parties agree that there are no third party beneficiaries to this Contract and that no third party shall be entitled to assert a claim against either of them based upon this Contract. The parties expressly acknowledge that it is not their intent to create any Contract Project Manual rights or obligations in any third person or entity under this Contract. 6.6. Notices: 6.6.1. Whenever either party desires to give notice to the other, such notice must be in writing, sent by certified United States Mail, postage prepaid, return receipt requested, or by hand-delivery with a request for a written receipt of acknowledgment of delivery, addressed to the party for whom it is intended at the place last specified. The place for giving notice shall remain the same as set forth herein until changed in writing in the manner provided in this section. For the present, the parties designate the following: For CITY: City of Miami Beach Procurement Division Attn: Gus Lopez, Procurement Director 1700 Convention Center Drive Miami Beach, Florida 33139 With copies to: City Attorney City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 For CONTRACTOR: Ric-Man International, Inc. Attn: Rene Castillo 1210 Washington Avenue, Suite 250 Miami Beach, Florida 33139 6.7. Assignment and Performance: 6.7.1. Neither this Contract nor any interest herein shall be assigned, transferred, or encumbered by either party. In addition, CONTRACTOR shall not subcontract any portion of the work or services required by this Contract except as authorized by Section 18 of the General Conditions. CONTRACTOR represents that all persons delivering any work and/or services required by this Contract have the knowledge and skills, either by training, experience, education, or a combination thereof, to adequately and competently perform the duties, obligations, and services set forth in the scope of work for the particular Job Order, and to provide and perform such work and/or services, to CITY'S satisfaction, for the agreed compensation. Contract Project Manual 6.7.2. CONTRACTOR shall perform its duties, obligations, and any work and services under this Contract, in a skillful and respectable manner. The quality of CONTRACTOR'S performance and all interim and final product(s) provided to or on behalf of CITY shall be comparable to the best local and national standards. 6.8 Materiality and Waiver of Breach: 6.8.1. CITY and CONTRACTOR agree that each requirement, duty, and obligation set forth in the Contract Documents is substantial and important to the formation of this Contract and, therefore, is a material term hereof. 6.8.2. CITY'S failure to enforce any provision of this Contract shall not be deemed a waiver of such provision or modification of this Contract. A waiver of any breach of a provision of this Contract shall not be deemed a waiver of any subsequent breach and shall not be construed to be a modification of the terms of this Contract. 6.9. Severance: 6.9.1. In the event a portion of this Contract is found by a court of competent jurisdiction to be invalid, the remaining provisions shall continue to be effective unless CITY or CONTRACTOR elects to terminate this Contract. An election to terminate this Contract based upon this provision shall be made within seven (7) days after the finding by the court becomes final. 6.10. Applicable Law and Venue: 6.10.1. This Contract shall be enforceable in Miami-Dade County, Florida, and if legal action is necessary by either party with respect to the enforcement of any or all of the terms or conditions herein exclusive venue for the enforcement of same shall lie in Miami- Dade County, Florida. By entering into this Contract, CONTRACTOR and CITY hereby expressly waive any rights either party may have to a trial by jury of any civil litigation related to, or arising out of, the Contract. 6.11. CONTRACTOR shall specifically bind its sub-contractors to the provisions of this Contract. 6.12. Amendments: 6.12.1. No modification, amendment, or alteration in the terms or conditions contained herein shall be effective unless contained in a written document prepared with the same or similar formality as this Contract and executed by CITY and CONTRACTOR. Contract Project Manual 6.13. Prior Agreements: 6.13.1. This document incorporates and includes all prior negotiations, correspondence, conversations, agreements, and understandings applicable to the matters contained herein and the parties agree that there are no commitments, agreements or understandings concerning the subject matter of this Contract that are not contained in this document. Accordingly, the parties agree that no deviation from the terms hereof shall be predicated upon any prior representations or agreements, whether oral or written. It is further agreed that no modification, amendment or alteration in the terms or conditions contained herein shall be effective unless set forth in writing in accordance with Section 6.12 above. Contract [REMAINDER OF THIS PAGE LEFT INTENTIONALLY BLANK] Project Manual IN WITNESS WHEREOF, the parties have set their hands and seals the day and year first above written. Contract ATTEST: CITY OF MIAMI BEACH, FLORIDA ~ Qom. ~--- Robert Parcher, City Clerk Matti erre a Bower, Mayor CONTRACTOR MUST EXECUTE THIS CONTRACT AS INDICATED BELOW. USE CORPORATION OR NON-CORPORATION FORMAT, AS APPLICABLE. [If incorporated sign below.] ,4TTFST• Cerparate Seal) [If not incorporated sign below.] CONTRACTOR CONTRACTOR/RIC-MAN INTERNATIONAL, INC. By ( ignature and Title) ~I ~ ~i-~ . (Type Name/Title Signed Above ~~ day o ~_, 20~ WITNESSES: (Name) By (Signature) (Type Name Signed Above) day of , 20 CITY REQUIRES FIVE (5) FULLY-EXECUTED CONTRACTS, FOR DISTRIBUTION. APPROVED AS TO FORM & LANGUAGE & FOR ELUTION it orney at EXHIBIT 5 CONTRACTOR BID SUBMISSION COPY RIC-MAN INTERNATIONAL, INC. A ~ORt~ORATI®E~6 IEV TIDE STATE 4F FL.CdE~EDA 2601 ~fi0ifes Rd. E~or~~ano E3each, FL 33073 PN: (J54) 426-1042 F7C: X954) 426-0717 1210 V0llashington Ave. Site 250, ~~Eiarni E3each, FL 33139 PFi: {305) 535-1744 FX: (305) 535-1745 Tax iD N~arraber 59-23003J6 Efo~iAlL: RCASTII._E_®(c~RlG-E'JIARl.EJS `7l(): pity cif .~~i~m~. ~e~c,~ ~''rocurea~te~.t Di~tis~~n. ~~c~ca Cc~n~e~cti~~ ~era.tc~r Dri~c ~~~ ~~t~ ~~: ..~~iC~.~, ~c~~~,~ 3: ca c~ ~ r~ ~4f~'d~"" REAf)Y' INi7EX~ frOQQH2 GENERALCON7RAC70RS 2601 Wiles Road • Pompano Beach, Florida 33073 BROWARD: (954) 426-1042 • FAX: (954) 426-0717 ~~ introduction The Ric-Man Team has put together a highly qualified team of construction and design professionals who are totally committed to the success of this project. All of the key personnel that we are proposing to carry out this project have participated in the proposal and bid preparation, giving them already a great deal of knowledge of this project. Our team brings the following strengths to the execution of this project: • Past design and construction experience in the City of Miami Beach on Streetscape and Utility projects. • Strong knowledge of the geotechnical and traffic conditions in the project area. • Local present and in-house capabilities to self-perform the design and construction activities required by this project. • Established working relationship as a result of the Washington Avenue Design-Build Project for Washington Avenue Improvemen#s Phase II, IV, & V. Team Organization One of the most important factors in the delivery of any project is the close coordina#ion and timely communication among all parties involved. Our team will place a strong emphasis on sustaining an excellent communication line with the City via oral, written or personal contact. Our project manger, Mr. Rene Castillo will maintain a close communication link with all parties involved on this project. Another important aspect in putting our team together is the past relationship established between Ric-Man and all of sub-consultants. It is Ric-Man's sole responsibility to make sure that our sub-consultants comply with the schedule and quality of their deliveries. Ric-Man has worked with all of the sub-contractors before and has developed a solid working relationship that will serve as an asset to the City's needs. Our team is as good as our people. Our team has been subdivided into three major components as it has been requested in this ITB. Construction Project Manager Construction Superintendent Estimator Staffing Quality Ric-Man International (RMI) will be responsible for the management and construction work related to this contract. Ric-Man was established in 1979 and has in staff over 90 employees. The team leader selected for this endeavor will be Mr. David Mancini who will serve as Principal-in-Charge. Mr. Mancini will serve as the primary contact with the City. Mr. Mancini brings over twenty-five years of experience in the construction of infrastructure projects and water and sewer main facilities. Mr. Rene Castillo (General Manager) & (Estimator) - Mr. Castillo has over twenty years of experience in construction. Mr. Castillo oversees estimating, project managers, Operations office, as well as all aspects of bidding, construction, billing, payment and negotiations. Mr. Albert Dominguez (Construction Project Manager) & (P.E.) - Mr. Dominguez was the Construction Manager for the Washington Avenue Project. He has over ten years of experience working on projects similar to this one. Mr. Dominguez has managed several projects throughout Miami-Dade County. Mr. Remo lafrate (Construction Superintendent) - Mr. lafrate has over thirty years experience in the supervision of construction projects managing multiple crews and contractors simultaneously. Mr. lafrate coordinates and supervises all construction operations on our sanitary sewer, water mains, storm sewer, pump stations, microtunnel, jack and bore, directional drilling. He has more than 40 home neighborhood improvements and road projects. Mr. Nelson Liberti (Underground Utility and Sitework Superintendent)- Mr. Liberti has over fifteen years of hands-on experience in major construction projects as both supervisory/planning and worker positions. He was the Construction Superintendent for the Washington Avenue Project. Staffing R+~sumes Please find attached the Key Staff Personnel Resumes at the end of this section. President /Principal -® y , ~PoMWNO Bf0.tH FL0A~00. ,' David Mancini has over 30 years construction experience in South Florida and over 7 years experience in Michigan were he worked under his father Mr. Richard Mancini the founder of Mancini Equipment, Ric-Man Construction, Ric-Man International, LEDDS Enterprises and LEDDS Development. As president, David Mancini administers all construction, maintenance and accounting operations; he oversees our General Manager Mr. Rene L. Castillo and Controller Mr. Jerry M. Wichert. Mr. Mancini; a hands on type of person, has constructed and/or design built a variety of projects consisting of; water mains, sanitary sewers, drainage, pump stations, jack and bores, micro tunnels, directional drilling, --oadways, and 5 (five) neighborhood improvement projects. Some of these projects have included sub-aqueous crossings, landscaping, streetscape, signalization and street lighting. I-Iighl%ghts 30 years of Roadway and Infrastructure construction experience 5 years of Design Build experience Member of the ECA F,ngineering Contractors Association Licenses: Qualified Business Organization - QB0008454 State of Florida Underground Utility License # CUC 044220 Broward County 3A Major Roads License #00-1650-W Experience Principal /President -1985 to present -Ric-Man International, Inc.- up to$ 35 million projects Superintendent - 1983 to 1985 -Ric-Man Construction, Inc. - up to $ 12 million projects Foreman - 1978 to 1983 -Ric-Man Construction, Inc. - up $ 40 million projects 11!~y Proj{Acts Washington Avenue Improvement (Miami Beach, Fl) Design Build Project: Over''/2 mile of complete roadway, infrastructure and beautification improvement along a heavy pedestrian and retail/hotel corridor. Project consisted of drainage, water mains, sidewalks and curb & gutters, landscaping, gravity wells, roadway, signalization, lighting and markings. _ __ ,, Installation of 30" WM under Miami River (MDWS Dept): °~~~~~ ' ~~~ ~< ~~~:'~ Partial Design Build. Over 800 feet of new 30" WM designed as open cut but ~~~'~'-~ ~ converted by Mr. Mancini to Design Build Directional Drill, saving the County time } '~ and money and resolving easement issues. Project consisted of directional drilling -_,~ ~ _ '" water main under river, sidewalks and curb & gutters, and roadway restoration. ~, ~I DesignBuild for Replacement of 48-Inch Force Main (Broward CW&WWS): ' Over 5,000' of 48" PCCP removal in DOT R/W replaced with 48" DIP in 8 months ~'~ x,~! a =~~ including design, permits and construction. David authorized the purchase of the pipe prior to award meeting the deadline. Project included a subaqueous crossing. ' . ~ ~ Yt'+ . ~~ ~ _.~,~ ; Broadview Neighborhood (Broward County Water & Wastewater Services): ~ ~~ 4f;~~>"'~""f``~....-=I Over 120,000 feet of water mains throughout a 470 residential neighborhood. ~~.~ ~: ~~~ This project also required service connections on private property behind ~~ Z ~~ i x. =~- ~ .i homes. S Broward County Landfill (Broward County) 1983 included the construction of several cells. _--~_ ,~ -- ~.. _ ~~7'~ std:,. _:~ ~ .;-~ ' ~- POMRINO BEaGN_~ONIW _._ Officer /General 1VIanager /Corporate Secretary Mr. Castillo, an Officer of Ric-Man International, has 13 years experience overseeing and directing the Estimating Department, Project Managers, and Construction Operations of a -nulti-million dollar company. He oversees over $38 Million Dollar projects per year, including Construction /Design Build of; sanitary sewers, water mains, force mains, drainage, pump stations, directional drilling, jack & bores, and micro tunnels. Projects includes 9 major neighborhood improvement with over 200 homes including; streetscape, lighting and signalization. Mr. Castillo has a love for the improvement of our industry's infrastruct~ue, thereby reducing the impact of the environment and wildlife, which he enjoys photographing. Roadway and Infrastructure construction experience since 1971 (37 years) 5 years of Design Build experience Underground Utility Construction from 4" to 120" Pipelines Has worked for all sides of the fence such as Count (Inspector /Supervisor); Desi ~n~Firm (Surveyor/Inspector/Draftsman); Contractors (Foreman/Superintendent/Estimator/Project Manager) Member of the E.C.A. Engineering Contractors Association F.E.S. Florida Engineering Society Broward Supporter Intermediate Work Zone Traffic Control Certified OSHA 10 Training Certification # 001909733 Experience Officer /General Manager -1993 to 2001 & 2004 to present -Ric-Man International, Inc.- up to $37 ,000,000 Project Manager-2001 to 2004 -Foster Marine Contactors, Inc. -up to $10 million dollar projects Estimator I Project Manager - 1990 to1993 -Ric-Man International, Inc. - up to $25 million projects Superintendent - 1984 to 1990 -Ric-Man International, Inc. - up to $18 million dollar projects Foreman - 1983 to1984 -Ric-Man International, Inc. - up $5 million dollar projects Assistant Project Engineer - 1981 to 1983-Miami-Dade Water and Sewer Authority up to $3,000,000 projects Inspector - 1979 to 1981 -Miami-Dade Water and Sewer Authority $1,500,000 projects Surveyor /Draftsman - 1975 to 1.979 -Beiswenger Hoch and Associates (Sewer Plants, Service Plazas, Rdwy) Inspector - 1972 to 1975 -Beiswenger Hoch & Associates Road & Bridge Inspector (Florida's Turnpike Ext.) Density Man 1971 to 1972 -Beiswenger Hoch and Associates (Florida's Turnpike Ext.) Ivey 1'.ro~ects __~ NE 163 ST Emergency Repair (MDWSD, Fl) Remove and replace 48" PCCP ,~ farce main and deteriorated MHs. After a large sink hole developed on Sunny ~'`_ ~ '• ; ~ ~ Isles Blvd, MDWSD required the immediate mobilization and repair of their ~#'~ ~~~ ~ ~~ critical FM otirt of the beach. Work was completed ahead of schedule and with ~ ~ ~ ~,.~' minimal impact to traffic. Turnpike & Sunrise Blvd. Crossings (Plantation) In-house Design Build of 3 critical directional drills required by the Turnpike to relocate the City's WM within 6 months. The project required quick turnaround of design, permits and construction. Mr. Castillo anticipated all the delays and circumvented the typical red tape delivering the project ahead of schedule and on budget. NE 6th Avenue Drainage Improvements (Oakland Park) Over 2,630 feet of 4x6 r- box culvert. Original design called for the box culvert to be installed vertically ~' ~~~ which would have resulted in major utility support and massive de-watering. Mr. ~.,~ A Castillo succeeded in convincing the Engineer, City and County ~to revise the { design to horizontal installation, thereby saving time, and impact to the residents. ~ - '~ '`~''~ `~- Highlights m ~, T1 1? ~, s 5 ~ 'rti. .,. __ . ......, ..»,,. .. ~,. I ., - BFPC-• , Project Manager Mr. Dominguez, a Senior Project Manager, has been with the company since 2002 and is a great asset to the Kic- Man team. He supervises over $25 Million Dollars of projects per year, managing the construction of several projects throughout Miami-Dade County. His daily duties include: public relations coordinator, schedule work for subcontractors and correspondence with engineers and owners. Mr. Dominguez has experience in Roadwork, Sanitary, Water main & Force main, Drainage, Streetscape, Signalization, Lighting, Landscape and Directional Drilling, as well as Design Build Projects. He is also a qualified Primavera P3 user. l Iiglilsghts Has worked for the City of Miami as both the Assistant and Acting Director for the Public Works Department Roadway and Infrastructure construction experience since 1993 6 years of Design Build experience Underground Utility Construction from 4" to 96" Pipelines Member of the F.E.S. Florida Engineering Society Broward Supporter Experience Senior Project Manager - 2004 to Present -Ric-Man International, lnc. - up to $27 million projects Acting Director - 2002 to 2003 -City of Miami, Dept. of Public Works Assistant Director - 1999 to 2002 -City of Miami, Dept. of Public Works Direct Transportation Statistics Administrator - 1994 to 1999 -Florida Dept. of Transportation, District 6 Management Systems Administrator - 1993 to 1999 -Florida Dept. of Transportation, District 6 Nautilus Neighborhood No. 7 Improvements (Miami Beach, FI) Project consisted of installing a new Water Main and connecting homes in front and rear, drainage improvements including 250+ structures, 18,000 LF of drainage pipe, and 6 Pump Stations. lighting, landscaping, and hardscape improvements throughout. Construction had to contend with accommodating the needs of the 772 residents and working around 2 schools and a hospital. Washington Avenue Improvements Program (Miami Beach, Fl) Project consisted of refurbishing Washington Avenue from 5`h Street thru 16th Street with over 11,000 LF of Water Main, Sanitary and Drainage pipe, from store front to store front. Construction had to contend with heavy pedestrian traffic on side of the busiest street in Miami Beach. Close coordination with 200 business owners, public transportation, shopper and 500 residents. --- Lumus Neighborhood Improvements (Miami Beach, Fl) Project consisted of refurbishing 10 urban streets (6`" St. -Espanola Way) with over 13,000 LF of ~ ,',"~;~`~ -~~_ Water Main, and Drainage pipe. Close coordination with 119 business owners, ,~~ ~z ~ ~i 485 residents, public transportation, schools, restaurants, valet parking and night ~ ~ ~" clubs. The project also included the conversion of two streets to one-way-pair - ~~-< ~. __ conversion. ,~ t `_ Project Manager PoMPAryp BE~GH. FtOH~a'_~ Mr. Barreneche has over five years experience in construction management. His experience includes water main and sanitary construction, neighborhood improvements, design build, directional drilling, drainage, box culverts, pump stations and also water and force mains. He is also experienced in design concepts and is working towards his engineering license. Juan is very meticulous in his record keeping and has very good communication skills. Mr. Barreneche is also proficient in the use of Microsoft Projects, Primavera, AutoCad, and ArcGIS. highlights Neighborhood Improvements experience since 2003 (6 years) 3 years of Design Build experience Underground Utility Construction from 4" to 48" Pipelines Holds a B.S. in Civil Engineering from the University of Florida Has worked for Chen & Associates as an Engineering Inspector Member of the F.E.S. Florida Engineering Society, Broward Chapter Workzone Traffic Control: Intermediate Level Certified Experience Estimator/ Project Manager-2005 to Present-Rie-Man. International, Inc. - up to $27 million in projects Associate F,ngineer - 2003 to 2005 -Chen & Associates - up to $7 million dollar projects Land Development Intern -2002 -WCI Communities-Managed construction of community entry features I~e~ 1'~°oj±3cts Neighborhood No. 7 -Nautilus Right-Of--Way Infrastructure Improvement ~ z Project (Miami Beach) Design Build project for the City of Miami Beach with ~~~_~ ~~ ~~~?~ ~ •~ _ ~~ proposed improvements including but not limited to streetscape, storm water and ~;~`~ , '' ~ ~- water systems improvements. Projects consisted of 500+ homes in an upscale neighborhood. - =--~-= y~,~. ~ ~ Design/Build For Replacement of 48" Force Main (Broward CW & WWD) _ Over 5,000' of 48" PCCP removal in DOT R/W replaced with 48" DIP in 8 ~ .~g. '- ~:a ~ ~_ months including design, permits and construction. Project included a t' i '~ subaqueous crossing. NF, 6th Avenuf }_... -_~ 3 i. f_~t~ .__ l r ~, box culvert. Original design called for the box culvert to be installed vertically ~ t` `~° which would have resulted in major utility support and massive de-watering. ~ ~ ;3 t"=" Worked with the Engineer to modify to a horizontal alignment and added an 8" water main as a design-build change order. __ T :; ~ __I ----_-_ _ Drainage Improvements (Oakland Park) Over 2,630 feet of 4x6 j Installation of 30" WM under Miami River (MDWS Dept) Partial Design Build. Over 800 feet of new 30" WM designed as open cut but converted to Design Build. Juan prepared the drawings and path for the directional drill and was accepted by the County. Project consisted of directional drilling water main tinder river, sidewalks and curb & gutters and roadway restoration. Project Manager ~ ~ ~' ~ G -, -. `MPgry~9EA OP OA_ construction management and oversees over $19 Million Dollars of projects per year. His experience includes water main, force main, drainage and sanitary sewer, including neighborhood improvement projects, design build, directional drilling, jack and bores, micro tunnels, box culverts, and pump stations. Mr. Castillo has over 9 years experience in Highlights Roadway and Infrastructure constriction experience since 1992 (17 years) 9 years of Design Build experience underground Utility Construction from 4" to 54" Pipelines Has worked for other contractors specializing in earthwork Member of the F.E.S. Florida Engineering Society Broward Supporter Microsoft Project 2007 Level I & II Certified Workzone Traffic Control: Intermediate Level Certified OSHA 10 Training Certification # 001909737 Experience Project Manager/Estimator - 2002 to Present -Ric-Man International, Inc. - up to $25 million dollars projects Project Coordinator 2000 to 2002 -Foster Marine Contractors, Inc. Estimator - 2000 -Mora Engineering Contractors, Inc. -Bid on projects up to $1 1 million dollars Estimator/Project Manager - 1999 to 2000 - Giannetti Contracting, Inc. -Bid on projects up to $12 million dollars Assistant Estimator/Project Manager - 1992 to 1999 -Ric-Man International, Inc. -Bid on projects up to $5 million dollars I{ey Projects NE 163 ST Emergency Repair (MDWSD, Fl) Remove and replace 42" DIP force main and deteriorated MHs. After a large sink hole developed on Sunny Isles Blvd, MDWSD required the immediate mobilization and repair of their critical FM out of the beach. Work was completed ahead of schedule and with minimal impact to traffic. Broadview Park 105,000 LF of pipe and 2,000 homes (Broward County Water & Wastewater Division) Over 120,000 feet of water mains throughout a 470 residential neighborhood. This project also required service connections on private property behind homes. La Mancha Avenue 1.5,000 LF of 30" DIP FM and 15,000 LF of 36" WM, ~_ two 36" Directional drills and 4sub-aqueous crossings (Palm Beach County Water Utilities Department, Fl) Construction of a parallel 24" DIP Force main and 30" DIP Water main part of this work was along busy Okeechobee t Boulevard, requiring extensive MOT coordination and difficulty with asub- ~" " '"" -' contractor going out of business. Work included 2 directional drills and 4sub-aqueous crossings. Project was completed ahead of schedule and Ric-Man collected an early completion bonus for this work. General Superintendent 1, ,~ y~: ~ . Mr. Iafrate, the General Superintendent of Ric-Man International, has l1 years of construction experience in Michigan and over 20 years of construction experience in Florida. He has supervised 7 upscale home neighborhood improvements and road projects, overseeing $32 Million Dollars of projects per year. These projects include Construction/Design Build of, sanitary sewers, water mains, force mains, drainage, pump stations, directional drilling, jack and bores, micro hmnels, roadways, streetscapes, emergency repairs, and hurricane cleanup. Highlights Roadway and Infrastructure construction experience since 1977 (32 years) 7 years of Design Build experience underground Utility Construction from 4" to 120" Pipelines Has worked for Ric-Man International as a superintendent since 1.990 (18 years) OSHA 10 `Training Certification # 001909708 Experience General Superintendent-2006-Present -Ric-Man International, Inc. - up to $27 million projects Superintendent - 1990 to 2005 -Kic-Man International, Inc. - up to $20 million projects Foreman - 1985 to 1989 - D.N. Higgins Underground Contractors - up to $12 million dollar projects Foreman - 1980 to 1985 - Lanzo Construction - up $8 million. dollar projects Foreman - 1964 to 1980- Greenfield Construction - up $15 million dollar projects La Mancha Ave Pipeline Extension Project (Palm Beach County Water Utilities Department, Fl) Construction of a parallel 24" DIP Force main and 30" DIP Water main. Part of this work was along busy Okeechobee Boulevard, requiring extensive MOT coordination and difficulty with a sub-contractor going out of business. Work included 2 directional drills and 4sub-aqueous crossings. Project was completed ahead of schedule and Ric-Man collected an early completion bonus for this work. DESIGN BUILD - 54" SEWER FORCE MAIN (MDWSD) Design and construct 9,100 ft of 54" PCCP along Opa-Locka Airport requiring high security procedures, crossing 18 feet under NW 57th Avenue, a six lane roadway, night construction in 4 phases and 2sub-aqueous crossings; one 21 foot deep. The project required close tolerances and careful tabulation of special pieces and fitting to avoid delays. Part of this work required underwater pipe installation with divers. Water Transmission Main Extension Phase I (Village of Wellington, Palm Beach, Fl) Over 6,000 feet of 24" DIP Watermain along residential streets and businesses. The work included lsub-aqueous crossing and 4 directional drills. Unusual high water table required dewatering in only a 3 foot excavation. Due to erratic street lay-out the MOT had to be tailored to varying rush hour traffic patterns. Ivey Projects Superintendent ®'~"~~~. ~ ~~. PoM~'0 eFACN. FlOfna .~ Mr. Hernandez has over 18 years of experience in South Florida working for municipalities from Miami-Dade County through Palm Beach County. Luis Hernandez has successfully completed 5 neighborhood improvement projects from 21,000 to 105,000 feet of water mains and sanitary sewers. Luis is also familiar with directional drilling, micro tunnel, pump stations, and aerial crossings. Mr. >-lernandez is one of our most dedicated employees, willing to do whatever it takes to perform his duties and satisfy our clients. He has shown great zeal in handling several crews and projects simultaneously. Quality is his job 1. highlights Roadway and Infrastructure conshliction experience since 1997 (11 years) 5 years of experience working on Design Build Underground Utility Construction from 4" to 96" Pipelines I-Ias worked for Ric-Man International since 2001 (7 years) OSHA 10 Training Certification # 001909710 Experience Superintendent -- 2006 to Present -Ric-Man International, Inc. - up to $37 million projects Foreman - 2002 to 2006 -Ric-Man International, Inc. - up to $12 million projects Pipe layer-2001 to 2002 -Ric-Man International, lnc. - up to $8 million dollar projects Laborer- 1997 to 2001 -Ric-Man International, Inc. - up $6 million dollar projects Neighborhood No. 7 - Nautilus Right-Of--Way Infrastructure Improvement Project (Miami Beach) Design Build project for the City of Miami Beach with proposed improvements including but not limited to streetscape, storm water and water systems improvements. Projects consisted of over 500 homes, 6 pump stations, road re-construction, street lighting, landscaping and directional drilled services. llesign/Build For Replacement of 48" Force Main (Broward CW & WWD) Over 5,000 feet of X18" PCCP had to be removed in DOT R/W after the Turnpike decided to widen their road. The pipe had to be replaced with 48" DIP within $ months. This included design, permits, procurement and construction. Although we were impacted by unknown contamination the project which included a subaqueous crossing was completed on time. -- - - _ __~ NE 6th Avenue Drainage Improvements (Oakland Park) Over 2,630 feet of ~-- 4x6 box culvert. Large equipment and materials required the close coordination ~~~;~ ,~, with residents while closing 2 (two) blocks at a time. This project also included ~ ~` ,~,.,. ~~ the crossing of Oakland Park Boulevard, a five lane roadway. ' ' . r "~ t .~`' .~" Broadview Neighborhood (Broward County Water & Wastewater Division) Over 120,000 feet of water mains throughout a 470 residential neighborhood. This project also required service connections on private property behind homes. Superintendent ~~ ~~~ ~.df ~ s~l~-. (', ~MPgNQ BEALN.~~ro~-J Mr. Liberti, Superintendent for Ric-Man International, has 16 years experience in roadway and infrastruchire. Nelson oversees over $12 Million Dollars of projects per year. These include Construction/ design build, sanitary sewers, water mains, force mains, drainage, pump stations, directional drilling, jack and bores, and micro tunnels. Mr. Liberti's work has included 3 major neighborhood improvement projects with over 200 homes including; streetscape, fighting and signalization. 1Elighlights Roadway and Infrastructure construction experience since 1993 (16 years) 5 years of Design Build experience underground Utility Construction from 4" to 72" Pipelines OSHA 10 Training Certification # 001909709 Experience Superintendent - 2003 to Present -Ric-Man International, Inc. - up to $45 million projects Foreman - 2001. to 2003 -Ric-Man International, lnc. - up to $10 million projects Operator-2000 to 2001 -Ric-Man International, Inc. - up to $8 million projects Operator/ Machinist - 1999 to 2000 -Magnum Environmental Driver /Equipment Operator- 1998 to 1999 -Town of Gate, Highway Department Machine Operator/Assembly - 1994 to 1998 -ITT Automotive ~e~~ P t•t3 j e.ets NE 163 ST Emergency Repair (MDWSD, Fl) Remove and replace 48" PCCP force main and deteriorated MHs. After a large sink hole developed on Sunny Isles Blvd, MDWSD required the immediate mobilization and repair of their critical FM out on the beach. Work was completed ahead of schedule and with minimal impact to traffic. Turnpike & Sunrise Blvd. Crossings (Plantation) In-house Design Build of 3 critical directional drills required by the Turnpike to relocate the City's WM within 6 months. The project required quick hirnaround of design, permits and construction. NE 6th Avenue llrainage Improvements (Oakland Park) Over 2,630 feet of 4x6 box culvert. Original design called for the box culvert to be installed vertically which would have resulted in major utility support and massive de-watering. ., i i ~aF ~ 3'-! ~ ~ .~ ... ...,. _... - 3. - _ m. _ ~ - ~.M~'FMO BFAGH Ft~ -~ Foreman Mr. Rodriguez, Forman for Ric-Man (nternational, has over 7 years experience. Ernesto has worked as a pipe layer on the main line crew and the '`mud" crew, performing concrete work at structures. He also operates loaders and excavators along with performing various other tasks. Mr. Rodriguez currently supervises our main line crew during construction of water mains, sanitary sewers, directional drilling, drainage installation, and pump stations. Highlights Underground Utility Construction from 4" to 54" Pipelines Experience Foreman - 2004 to Present -Ric-Man International, Inc. Operator/Pipe Layer - 2001 to 2004 -Ric-Man International, Inc. Key Projects La Mancha Ave Pipeline Extension Project (Palm Beach County Water Utilities Department, Fl) Construction of a parallel 24" DIP Force main and 30" DIP Water main. Part of this work was along busy Okeechobee Boulevard, requiring extensive MOT coordination and difficulty with a sub- contractor going out of business. Work included 2 directional drills and 4 sub- aqueous crossings. Project was completed ahead of schedule and Ric-Man collected an early completion bonus for this work. ~ ~~i Neighborhood No. 7 -Nautilus Right-Of--Way Infrastructure Improvement Project (Miami Beach) Design Build project for the City of Miami Beach with t= ~, ~ ~~'~ proposed improvements including but not limited to streetscape, storm water and ~•~'°'`'~~~" ~ water systems improvements. Projects consisted of 500+ homes in an upscale - , ~ neighborhood. __, DESIGN BUILD - 54" SEWER FORCE MAIN (MDWSD) Design and construct 9,100 ft of 54" PCCP along Opa-Locka Airport requiring high security procedures, crossing 18 feet under NW 57`-' Avenue, a six lane roadway, night construction in 4 phases and 2 subaqueous crossings; one 21 foot deep. The project required close tolerances and careful tabulation of special pieces and fitting to avoid delays. Part of this work required underwater pipe installation with divers. 0 93 ~~ ~,~~ 5• a ..~- .'~ '::: :. ., ~. .' :.~:. ~. ~: ... -: .. :,.: ,-: ,..;:. ..::' PoM'IM06EACN.FtOPIM~ Project Coordinator Ms. Ortiz has 5 years experience assisting in construction management and preparing bids for municipal projects. She supports the Project Mangers with daily routine tasks, attending pre-bid meetings and pre-construction meetings. In addition to this, she is responsible for soliciting and acquiring quotes from subcontractors, ensuring to meet or exceed all Disadvantaged/Small business goal percentages, and that all documents are properly completed and executed for all bid proposal packages on all projects. Higl~Iil;hts Management assistance in Roadway and Infrastructure construction. Preparing and soliciting bids for municipal projects Putting together qualification packages for short listed contracts Experience with Building Contractors as well as Underground Utilities AutoCAD Level 1 and 2 Certified. Experience Project Coordinator - 2007 to Present- Ric-Man International, Inc. - up to $27 million dollar projects Office Administrator - 2006 to 2007- Ric-Man International, Inc. Project Coordinator 2004 to 2006- Cucchiara Construction, Inc. - up to $12 million dollar projects Receptionist- 2004 -Cucchiara Construction Ivey Duties Search Bid Advertisements Project Buy Outs Preparation of Purchase Orders Preparation of Agreements Preparation & Submittal of Shop Drawings Coordinate Subcontractors Coordinate Suppliers Scheduling Subcontractors I~e~, Pr~~,j ~ cts ~ Broadview Park Bid Package No. 2 (Sanitary Sewer Installation) (Broward '` r ~ ~~;~~ ~, ~~# ~° County Water and Wastewater Services) This project consists of 74,000 LF of y`~,4t-, ~_'\ ~ ~'> ~. sanitary sewer, force main, drainage, raw water mains and 700 sanitary laterals to ~'~'- - ~ ,; the residents as well as several businesses. Neighborhood consisted of ~.. . °~ ~ .r F -,- approximately 700 homes. a ~" ~-~ °-- '~ ~-~' THE sr--~~,, STATE OF FLORIDA '~'' V= ~Y;DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ~~ _ x ~~ ~~ :~ ~ CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 ~''` 1940 NORTH MONROE STREET ~~,°,n...ut.,~~.~ TALLAHASSEE FL 32399-0783 RIC-MAN INTERNATIONAL INC 2601 NW 48TH ST POMPANO BEACH FL 33073 DETACH HERE ~~ ~„~ STATE OF FLORIDA - --~=_ =:~=_ ~~s DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION a ~~~`` CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 lJ `~ w. ~,y-_V ~,~;a°~ 1940 NORTH MONROE STREET °~.~,.t~°'' TALLAHASSEE FL 32399-0783 MELEHAN, FRANCIS P RTC-MAN INTERNATIONAL INC 2501 WILES-ROAD POMPANO BEACH FL 33073 STATE OF FLORIDA AG# 3 ~ ,rj ~ 9 ~ (~' Congratulations! With this license you become one of the Hearty one mi!lion ~ ~ DEPARTMENT OF BUSINESS AND Floridians licensed- by the Department of Business and Professional Regulation. ~) Our professionals and businesses range from architects to yacht brokers, from ~_,~-~ PROFESSIONAL REGULATION boxers to barbeque res#aurants, and they keep Florida's economy strong. CGC 15.0 6 0 Q8 08 / 2 9 / 0 8 .0 8 8 0 0 3 9 3 0 `. Every day we work to improve the way we do business in order to serve you better. - , For information about our services, please log onto www.myfloridalicense.com. CERTIFIED. GENERAL CONTRACTOR There you can find more information about our divisions and the regulations #hat MELEHAN, FRANCIS P - impact you, subscribe to department newsletters and learn more about the RLC-MAN INTERNATIONAL, ,ING _- - Department's initiatives. - _ '?ur mission at the Departmen# is: License Efficiently, Regulate Fairly. We 'OnStan#ly strive t0 serve you better SO that you can serve your customers. =s CERTIFIED under tha provxei.ona oP ch.489 gs Thank you for doing business in Florida, and congratulations on your new license! _ ~Pirnt~.on a8ce: A4G- 31,. 2010 L68082902275; . DETACH HERE AC# ~ ~ ~ 9 g 9 6 `STATE OF; FLORIDA DEPARTMENT"'OF RIF~I~~SS-AND PROFESSIONAL REGULATION _ _ CONSTRUCTION°IIrIDi)'STRX_ LICENSING BOARD. SEQ#L08082902275 " ,.. r . : ~ - LTCENS-E =NBR -; - ~_ 08.29 2.008 08$003930 CGC15U~0.0>3~~`x = -The GENERAL. CONTRACTOR- = ~ ~ ~-~. _, .~. - . ~: Named below IS CERTIFIED = 4- ~ ~ ~. .Under the provisions ~f Chagte~ «g8~_ FS _ ~ _ ~ '. Expiration date:``AUG 31, 2:01.0 --~' Y ~ -. _ - ~. ~ _ .: ~ .. ~: ::. .~ . _ .. . <~ -_ -:. MELEHAN, FRANCIS P -=` _; _ _ . RIG-MAN_INTERNATIONAL INC `.' :~ - 2601=WILES-ROAD `:` _ POMPANO` BEACH. FL 33073 ~_ „_ ,~ -- - CHARLIE-GRIST -- - = _ CHARLES W. DRAGO GOVERNOR - - - = SECRETARY - ~ '= ttilOt71- A-V ~~nC=OCIII" fl[7Cll QV f AIAJ e v ~d ~ fi - Board of County Commissioners, Broward County, Florida BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT FORM N0.401-280fAC25-061 ~ ~--FOR PERIOD OCTQBER ~I, 2008 THRU SEPTEMBER 30, 2009 RV200835367(Rev.3108) ~_ OzRENEWAL ^ TRANSFER SEG #____ _~__~r~~ ~j C~ANEW DATE BUSINESS OPENED , ; '~ ~ ~u ~ STATE OR COUNTY CERT/REG # Business Location Address: ~., ~? ~ 3 ? (~ ~ ~ tl U :. CF LI I. F! fi• v7 J OCT. -10%~~ V .. NOV. -15°~ * DEC. - 20% * After DEC. 31 - ?5% ' Plus Tax Collection Fee of up to $25.00 Based on Cost of Business Tax if Paid On or After November 30. y'= __r-;„r ACCOUNT NUMBER ~~.E~;;w`'? Er 1:_t~tF~~EE~4Ia ~:~~.1ti Pia r `;--~= a U ~ f ~'~ $: U ~ ~' 17 `1 t~ L t ; ~'~ V l# ~ C~ " ~ EJ 4 ~ _ }^ R r- (~ ((~ {} 4~ j ~~ .~''-. at 1 Eli Fi {L' ~ 7{'`d' !'i ~ ~ t.} S ~ ,~i, ._ ~ ~f ~ THIS RECEIPT MUST BE CONSPICUOUSLY DISPLAYED ~ ~, ~ ~ ~~ ~,~ ~ « ; TO PUBLIC VIEW AT THE LOCATION ADDRESS ABOVE. J z~- ~ {~ ~ 1 }; i ~, 4? r n z i'I E= '~ ~ ~ ~ ~ ~ :S ~,~~ ~ TYPE OF BUSINESS TAX PAID 8~;~~~IVARD L . ~.OUNTY tl!~~i; ~'~ I f ~~ BROWARD COUNTY REVENUE COLLECTION ~~®~ ~ 6.~®~ 115 S A d Aven a Rrri A-400 ~n J "' ..j l . JN C`V r f~~ ~1 , =` ~:~ ;- ~~r-- ~; ~:: _ ~_ n news u , FORT LAUDERDALE, FL 33301 PAYMENT RECEIVEDAS VAL(DATEDABOVE *SEE INSTRUCTIONS ON REVERSE SLOE www.broward.orglrevenue. ~.I~CI~I~_l~<~3t,`6.iEi ;,I f1jt~"-r..'I;f 7vt~.i lili'.~'iCf~ ~ ~F..l'~~..I~LSG:?~~ ~ F~j~ ~ i ,f ~' ~ ~ i~ ~ f ~~ ;3 ~~ ~+ 7 ~ Y ~ ~ ~' ~ 4.`-;" Board of County Commissioners, Broward County, Florida BROWARD COUNTY LOCAL BUSfNES5 TAX RECEIPT FORM N0.401-280/AC 25-061. -` ~OR PER~OD OCTOBER ~, 200$ THRU SEPTEMBER~30, 2009 RV200835367(Rev.3108) - - Q,;RENEWAL ^ TRANSFER SEC ' # '~ ~ :+ TAx '' '~ ~-e. ~ ~ ~ .BACK TAX ~' f U (ANEW DATE BUSINESS OPENED PENALTY T.C. FEE STATE OR COUNTY CERT/REG #i TRANSFER Business Location Address: M )-~ ~- c1 ~- /'.~ ~ ~ ~~ ~~ ~3 (~ '~ ~$ ~: j1. ~ ~ T - TOTAL ~ f~ t3 [~ 3 ~ i'~~'• 3 il ~ N t1 Ft t : ~ ~'J ~ fY L~ w .'. Q V ~ 'r3 OCT.-10%~~ ~cJ,rNOV.-15% 'DEC. - 2U% ' AtCer DEC. 31- 25°k Plus Tax Collection Fee of up to ~25.DD Based on Cost of Business Tax if Paid Cn or Afler November 30. -' -,_' 1~C ACCOUNT Nt1MBER ) ~" ~= ~ r' :^,~~ ~ ~z~~~ Ifz T `~ fi"etsT'u~`,i-',! Tfi~~ THIS RECEIPT MUST BE CONSPICUOUSLY DISPLAYED ~ ~ ~d •~ x~ ~r ~ ~ C ~ ~ ~ y. I TU PUBLIC VIEW AT THE LOCATION ADDRESS ABOVE. i:. ~ ~ ~ B ~ ~ ~ ` ~ > ~ ~: ` ~ ~ ~ ~ Y [~~~ ~, BF `~j~~J'l~ L TYPE OF BUSINESS TAX PAID COUNTY ~~~,~~~;;;~ s ~~;~~i Csr11~~, tt7 €+t'uI~" BROWARD COUNTY REVENUE COLLECTION 2Vw ~ 6O®Q 115 S. Andrews Avenue Rm A-100 `+ ^ti. F~ ri! C-. ...ti. .~J ~. ~` s=. t~ r-, _,_i ~. FORT LAUDERDALE, FL 33301 PAYMENT RECEIVEDAS VALIDATED ABOVE 'SEE INSTRUCTIONS ON REVERSE SIDE www.broward.orglrevenue %~~'iL~vvC;:)is';J f}r~~i3,Z{~~~~ ' CSt' C~IG{~Z:tl~::~~s !(~tJS` f pits i ~. ,~ p ~ J f i ~ ) ~ 4~ 3A MAJOR ROF.US (ASFHALI AN7 CO!~'CR~-I! 00-1650-W MANCINI, DAVID A. -QUALIFYING R1C-MAN INTERNATIONAL INC A- ~ _ ~~ _~,~~ ~ERTIF{~;A.TE C~~ C~M~~1"EN~Y i ~ i7~t€~~h and Si~N the reverse side of this ~- ~ t'~~~.,1~'~'~ card iMMEi~iATELY upon receipt! Yau • " should CCifry tt11S Card With }/~U Ctt all til°I'1€.'S. Contrart~r must obtain a p~ot~ 4.d. Certificate of G®mpetency Gard every tour years. MANCINI, DAVID A. 2601 NW 48 ST POMPANO BCH FL 330730000 503-207 (Rev. 3.~0',)8P20073104? ;, aj 7 ~ f rz . ,_ 131~CJ~ARD CC~t31`dTY} FLE7RlI~l~` `. Ef ~ ' ~~" `' ~ ~~~'IFICATIr C)~ ~C3MP~~1F~~X `; =~~ 3A MAJOR:ROADS {ASPHALT AND CONCRE'~' . ` . 00-1650-W MANCINI, DAVID A_ -QUALIFYING RIC-MAN INTERNATIONAL INC 2601 NW 48 ST POMPANO BCH FL 330730002 EXPIRES 08!31!2000 LUl ii~01~1(I~I=iC ( hiLitilhl. i-,a:: ~~C-l1=1=1'~4~~~ I=li.t~=1 L ~'U0:' 1, :-1: ~ ~, e~- ~-~~-~;= ,t.<< ~~~. C1iARLlE Ck15'I' COVER'*!OR bQ ~ Su~,vanneQ Street Tallal~assaa, FL 32399-0450 STEPitANiE C. KOPELOUSO~ 5L:C72I:TARY Au~juat_ 1, 2008 RIC-MAN INTGF.NATIONP.L, 2601 N. W. 98T~1 STREET POMPANO BEACH, FI,ORI DA Dear Sit/Madam; Irac, 33073 "P.EVISED" RE: CLRTZFICATE OF gUALIEICATION Ths~ Department of Transportation hie qualified your company for the a.mcunt and the type of work i ndic.ated below. Unless your company is notified otherwise, this rating swill e,<pire E/30/7.009. However, the new application i3 due d/30/~009. In Aecosdanee with Fa. 337.141 (1a ;,,5, your next appll.e~tion must b€~ fiXed w~,tha,n (A) nrantl~4 0£ the ending elate o~E tho applicant's ~~r~lited annual financial ntatementa ansl, i~,' apg~licZbl~, the audited interim finarsCSial statements. 5oction 337,14 (4) F,S, provides that your certificate w111 be valid for 1B months aftez your financial statem°nt date, This gives a two month period to allow you tc bid on jobs as we p.rocest, your new application For qualification, To remain qualified with the Department, a neH, application must be Submitted subsequent to any significant change in the financial position or the structure of your firm as de4cribed in Section 19-22.005(3), Florida Administrative Code. MAXIMUM CAPACITY RATING; $d~0,850,000.00 Ffl01' APk~RO`IT~D WOF21{ CI.AS~y~"~: DRAINAGE, E'ENCING, I'LEX2i;LE PAVING, GRADING, GRASSING, SEEDING ANp SODDING, GUARDRAIL, MINOR BRIDGES ~'I}Cl'P APPROVIvl~ ~AECSAZ,IT'l CY,ASSf~,3 OE' G~OftfC; JACKING, WATER MAINS, OC'EN CUT SE~n'ERS 6 ["EFT DEEP AbID OVER, CONTAMINATIODI RcC4EDIATION, SEWER fiEHABILITATION, PUMP STATIONS AND DTR.F.C`I'lON7-1T. DF2ILLTNC;, UNDERGROUND UTILITY. Please be advised the Department of Transportation has considered your company's qualification in all .~,ork classes requested. WQ have evaluated your company's organization, management, work e>:perience, work performance and adequacy of equipment as directed by section 19-27_.003, Florida Administrative Code. Based on this evaluation, the Department is not able, at this time, to prequalify your company for the work classes; DE$RI$ F~MOVA2, P~VE;MI;Nr MAi~EfxNG ROADWAY SXGTIING xz~~r.c sxer~~~,. W?!VW . CI0 t . S Cet+; . f ~ . U v '~ RECYCLED PAPiH FLOI /COI I l Rl=1C ( i=IDI°i.((I. f-,_u; :~ `_;O~l t~=1-191_lt~~ Ruch 1 .:'00: 1:~ :-1` i ~. G~ R1C-M~1N INTER1dAi iONP,L, T_,4C. August 1, 200u Paae two You may apply, in writing, for a Revised Certificate of Qualification at any time priox to the e:;piration date of this certificate according to Section 19-2?..0041(3), Elcrid, Administrative Code. Please be advi.secl.iF certi`ication in additional classes of work is desired, decutnentt~Lion is needed to show thac your company has done such work with your own forces and equipment or that Experience was c~aineoisdich another contractor and that you have the necessary equipment for each additional class of work requested. Sincerely, Juanita Moore, Manager Contracts Administration Offica .7M ; c j i=llOTiCUI'i-(I~RCT Alai°IIi'd. 1=i.;<: '~~0~!::.-i4'~i-'lip A~_tq 1 20G~ 1~ ~~'l'~~ P. U=l N07'ICF_OT? r`;.D11%III~In~Itr'L?`Nf', F}T<tiR~[l~G RIG~Z'l." You tnay petitio^ for rtn adminiMgative hearing pursurartt to se:,aens I20S59 and 120.57, 1'lorida.S`li^.tttt„s. ;f You disn.~rss vvfth. thr r'acw sr~r.:d in the fot v~'oin, No'tioe of intended Deponent Actinn (hereitl.ift~r T(otice), you tray pctltion for a formal tu~rzuAistr'ntlv°: hc;zrinv pursuant to seel~en 120.57(1), Florida Statulns. 7f Vou QgI'e° Wltll tnc stn3ed in thrr Notice, you may pctiti^n far en infr~r-cAnl ac~inL~¢•rltiv~ hem°t"1~ pctrGU~?slt do section ]20.$7(?}, .Florida ~tute5. Yoti: must fife the l,etition t~ritli; Glerl< of hgency I'roceediugs Depnettt of Trr~nsportatian I-Inydon Duets 13ui1din~ ~i0a Suwns~nec 5'treet, MS 5B Z~llahastree, ;?bride 32399~4A58 The petition far an admutlstrativG FieKritlg must conform to the rs.c#uirctnen[s of seotion 120,5{S)(b}~, Florida St~ttttss, and either Rulc 2E-106?O1(2) oz Rule 2&-106:301(2), Florida Adminis~arive Cody, and must be filed, with the Clerk ®f y;~cnoy Prooeedines by 5:00'p,rn•; n^ later than 10 days after you.rroeived the 1.(otice. Tae petirion for an aclnvni,~rativb heztrin.g snc~ultt inolucle a copy of Elie Notice, End must he le~'i61e, on Sri E3y 11 inch whtte paper, and cant.~in: 1. Your name, address, telephone number; my Dcpartmenc of 1r~utsporttxtion identifyinn number on tlrc NoticN, ~if known, tho nzrnc end idcntifica+-iob number of c~h ~a~ency affectPWd, if known, and name, nddrtis;, and telephone number oz your representative, if n~ty; which slnrsll b° thti-urld;sss for service pt~vos°.s duxixtg fhc cow.,e of the procwedilx~..g; 2, Afl c~~planation of kro~a• yatt3° suhsCarrti7l interests will be ttf~seciad by the Kck'son der;,rrr'heh m the Notice; 3, A st~.toment ofiwhcn rrnd hnw ynu receivod the Notice.; p~, A stat;tnent of rsll disprstcd isataes of material fact. Ifithere ~-~ none, y^u. etas: so indicate; 5. A concise s'mremenf of the ultimate facts s.lleged,' inctudmg the specific fits tie petitioner contLnda warrant rovorsal or modification of the agency.'s proposed action; a<s well as an cxpla7ration of how the alleged 1`a.ers, relate to the specific rules and staattes tho petitioner eonti~nds require reversal or modification of the sency's proposed actioC; 6. A s~stement of the relier" sought, staxirt~ precisely the desired action tho petitioner wishes the agency should tAke in respect to the agency's proposed antian. ' If there.:srre di.cpuced i~euss o~ mamri3l fact s formal hew; ina will hn LWId, where. you may present evidence and argtrnaezlt on RLl Issues i.Ttv.olved and conduct Dross-exa¢unation, tf there arc no dis~utsd issv~s of meterial fact fxtforffiaI hearing will be h:,lc!, where you may present evidence or a writxeu sr~ucment Ear consideration by t'ae Departxpvnt, , Mediation, ptrrstu2z,t td socrion 120.573, Florida Statutes, may be available if agreed ro by aL pasti;s, and on su;.h t~rma as zuap.be agreed anon by all parti°s. The ri~t'to an administrative hearing is noc ~~teeted when medi~ion dOt's I~Ot reRtll[ itr E 6CCtICTrleIlt. ' A pctYtion for w administrative hearing shall be tti5missed, if it is noc in suostaxrtial complia~e •v,~itb Ure raquiremenu of either Rule ?3-1DG,201(2) or Rt1o 2$-106.301(3,), i~7oritl~r Adminisn'ative Cady, or iF the psu-rian has not been timely pled, 1f y©us pedtiDn is dis~ivsed you will tusve waived your ri/-ht to 2•lave tn~ mtanded action reviawvfl puxstrart: to chapeer 120, ?~laricla St~~tuces, and the acuon set foz`tb in thL Notice shall be cQnctu.siv:, and nt~.21 • r 629133-0 NEW BUSINESS NAME /LOCATION RECEIPT NO. RIC MAN INTERNATIONAL INC STATE# CUC044220 1210 WASHINGTON AVE 200 .33139 MIAMI BEACH OWNER RIC MAN INTERNATIONAL INC Sec. T pe of Business ~ WORKER/S 1 6 SPECIALTY BUILDING CONTRACTOR 86 THIS IS ONLY ALOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMITTHE HOLDER TO VIOLATE ANY EXISTING OR REGULATORY OR ZONING LAWS OFTHE COUNTY OR CITIES. NOR DO NOT FORWARD DOES IT EXEMPT THE HOLDER FROM ANY OTHER RIC MAN INTERNATI DNAL INC REOU RED BV LAW THIS IS DAVID MANCINI PRES THE HOLDER SIOUALOIFICA• 2601 NW 4S ST rloN. POMPANO BCH FL 33073 PAYMENT RECEIVED MIAMI-0ADE COUNTY TAX COLLECTOR: 10/06/2008 60010000037 ~„~) ,IIIIII~~III„I.,X111111,Ii~~lll~l!„1~(IIII„~~11,~1~~12 000546.00 ' SEE OTHER SIDE P ~r FIRST CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 655709-5 i s~ +,°~+ C~ s..r J ~"t y--~ $-a ~ C-t ~ ~ Cat ~ ,~ ~ V i f .r' .-~ •i~-t Cat '~ ~ 1.~+ ~ ~ ~ ^ C .t t.-t ~~ ..~ ~ y~'.!~~ W 3-r yH ,ice .~..~ .~,t t'i .r ,--t ~ +f-~ ~ a 4 ~ ("e`.l t3 -~" ~~~ ~..~ 9 V • tr/\ ~1--r u .+..r t }~J ~ ~~ ~~ .~~' ~~ Q +F~-r y.~ r ~i-t .~ W i-r ea ~~ #-t ~^ ~ t-+ tc'S / ~? ~ ~ ~ ~~_ *""'-+ ~ ~ ~ ~-+ rr t-t ~.. .r ~+ .~. 3-a Cat S~- ,_..i ~ ~ Cat 3-a '~ Cal ~ ~ ~F-+ ~_ +~ .-~+ r ~ ~_ ~+ r i~ ~_ ~_ G e-' t4S t~.i ~ ~_ '~ ~ ~. ~+-+ ~ ter.., . 4- ~ ~ r '~ x .~- ,t .~- ~Y G :~ C= ~,. J w i~ .~" *~ ,,~ e~.r t_.- ~'~ 1~ :~- CJ .~-+ s• ~ .~ ` ~l ~ L'.' Ct s-+ ~d -~' + ~+ '~-+ ~~ ~ }~ ""' .--+ ~-~/ 4 t-t ("~^l ~ tY ,3'.r" to .--r w w W i~. C1 .-+~i 3-r ^~ ~1 .~- ~., ,R #+ T~ 1 U 1~~ ~ ~~ ts~ -~" Q .--~ w ~+ ~i .~ ~_ ra t<S ~..-~1 ~ ~~-+ ~~F•-t t~+ ~-/ ~ ~ w ~ 1`v ~~ ~~ ~ u .~. .~ w ~~ Y tr a~i :.+ ~ ~ C^`.r ~ ~ ~ t`- ~ .3-:" +-+ q ~ '+-+ tt~"' ~ ~ ~ ~_ ~ ~ '.~ ~~ ~._ •~+ ~• ~}'V W ~' s-. r ,r.'_ ~~ '~ .~i' y. r ~~r ,~l $ . r_,! '~'~ ~~ y--f •r 1 _~ z 0 0 H ~.Ty t; v CU ~ w 3. ~+.'' °u i ~ ~ c~ v ~' y a> h r } V ~ ~ ~ •,v H ~ / W W r V r••y 4~ •,~ .. Q 3 0 0 N 00 o~ m A 0 .~ .~ k W ~p A O q N '~ ~ ~ 0o a O~ Ei V ~`' $ ~~ m m ~~ ~ s H `~ r~ ~./ ~i 0 E-+ .y E~ W U ~ ti ~ w ~ ~ ~v V ~ ~ ti •,~ ~ ~ 4~ ~ '+~ w ~ ~s v ~ •~ M~1 •. O N 4~ O 0 0 .. a. A a v. 18 '~ g, a t(~i l8 ' d L TL09zbbS6 Ol LS96 b8S bS6 ~1~ i f1Qd0~lg - NdW-9 i d dd 8S : 88 9002 L T 190 '.~'~ ~'~ ~~ ^ ~ -~ ~~ 9TfCTc ilk ~'f.CYa3f ~A. rv"f0~r ~' 7M~C#'S"~ 7~+~~~t'J9Y~fs`f7C~3~d RENE CASTILE() South Florida chapter has completed a Safety Training Course in: INTERMEDIATE WORK ZONE TRAFFIC CONTROL [FOOT PROVIDER #045] 09/08/2010 Ralph Kindig Jr. Expiration Instructor-Ralph Kindig Jr. ,~.~- 2 DBPR - DOMINGUEL, ALBER"f A, Professional Engineer hops://www.mylloridalicense.con~/LicenseDetail.asp?SID=&id=75... Bus~ines~ Professi~n;al ~~.- - ~ .- ti.u'{.~~ i-.~i',~~ e~ Log On _~r PUbIIC SerVlceS Search for a Licensee Apply for a License View Application Status Apply to Retake Exam Find Exam Information File a Complaint AB&T Delinquent Invoice & Activity List Search ~ User Services Renew a License Change License Status Maintain Account Change My Address View Messages Change My PIN View Continuing Ed t~- Term Glossary Online Help (FAQs) 3:32:24 PM 4/23/2009 Licensee llet~iils Licensee Information Name: DOMINGUEZ, ALBERTA (Primary Name) (DBA Name) Main Address: 825 SW 23 Road MIAMI Florida 33129-0000 County: DADE License Mailing: LicenseLocation License Information License Type: Professional Engineer Rank: Prof Engineer License 48131 Number: Status: Current,Active Licensure 07/15/1994 Date Expires: 02/ 28/ 2011 Special Qualification Effective Qualifications View Related License Information View License Complaint ~ Terms of Use 1 ~ Privacy Statement I I of 1 4/23/2009 3:39 PM STATE OF FLORIDA ~, ~ BOARD OF PROFESSIONAL ENGINEERS 2507 CALLAWAY RD STE 200 f TALLAHASSEE, FL 32303-5266 ~n ~. DETACH HERE Juan Jose Barreneche 779 NW 42ND AVE PLANTATION, FL 33317 ~"° C GJ L 0 ~~ ~~ c Q • L L y ~ Q ~ ~ ~ o a ''~ E -v } ~ ~ W ~ ~ a~ .i.~ ~ o c :'`" C F= O V ~ ~ ~~ r ~ ~/ ~ V u 0 =v Q L 0 d~ d ~',~ 0 O~ `~ .r~ r .~ ~~ r Oft C .~ .~ L Q Q ~o [~ ~ Y 7 C A C ® ~ _° o- O ~ u ~ u'~ •~ tri ~ ~~ y r ~ a O 0 /~ ~ V W ~. ~ ,~ v U U 7 y ~+ ~6 N t~ ~m~ i .', ~i M \~ 7 c -`'` j~ ;_ 5 o ~~ 1 ~; ; ~i ~ ~ Os. ~' C7 ~ J C ~ ~~~ a o~ ~~, ~~ c ~ ~~. v c O .w+ rC! C L Q7 C r~ c L U '..~ OA C ~ •~ i° L T ~ ~ o ±-; Z . ~' ~ ~ ~. ~ V ~ W ~ ~ ~~ 1 fCS '~+.~ ~ `~ v:. ~ ~ +~ ~ i O ~.., ~ v~ V ~' r w ti/ j U U O ~ O 0 = V 0 a 1 a~ o u- c=-, ~ m g a J d~ ~~ O ~~ ~~~ .~~ r .~ ~o an c .~ .~ L O Q Z N NL ~, ~ ~ ~° • ~- ~ cv ~ ~ ~ N ~ L 4! a, ~ a O ~.. E ~ U .mod ~ 41 u u a~ c a, _c L O } .L„ V ~,~„ ~ J C .~ ~ C .C O ~ 0 Z ~~ Q ~ ~ ~ a = ~- O ~ ~ V t~0 W w >+ 4 L . Q . ~ ~ ~ I V ~ '~= ~ o u i O ~ V ~ V a ~ t ~ ~ 7 u ~ ~ ~ o 0 = V 0 L {L ~~ 0 W cs.' a ~ m 2 ~ a ® J d~ d ~~ O ~~ ~~G r~ '? .~~ ~o //. on c .~ .~ t`- _O a cn O S L rV1/1 C S +' V~ ~ ~o ~ o0 V N ~~ ~ ~ ~` ~ L. Ti' ~ .~ a ~ 0 a ~ ~ N d V u N v v RS i l'i ~~, ~ Y ~,~ s `~..1 („' 1 ~~ c ^ W N L O u h- on •.! " c = ,Q ~~ .^ ~a W ~ ~ O ~ C ~ z i ~ Q Cf = ~ ~ V ~ C L i.I ~ O >' !,L tt ww ~ ~ ~ v, '~ ~ " ,~ O ~ ~ w ~ ~' o ~ ~ ~ ~ a V ~ U ~ ~ O Q = V 0 L 0 d~ d ~~ O Q~ .rG r .~ ~~ r on c .~ .~ L F.. O_ a t ~ o i. y c w c ~° a.O +rs o Q ,~ V ~ '~ ~ ~ N c .~ ~ ao ~~ 0 ~• v 11{1 >+ w u u a~ ('~ \M, (.'f' ~° ~~ O, o ~.., O ,, L ~ ~ "`1 o ~ V ~ ~ V ~ ~ ~ ~ C ~;:>. =.rka u c C Q C L C t0 ~_ N L o .C C~ ~~„ Ott C , J .~ `~ ,~ ~ ~. T . o .~ ~L ~ 4 ~ ~ 'Q _ a. _ ~. ~ ~ V rC v ~. ~l.I ~L - o ~ ~..el v ~ ~ ~ ~i/ ~ ~ ® U ~ 1'~° V ,ry `/ ] U u 1"`~ O O TT i I t V o L LL. o~ ® J ~. v a ® m Q a d~ d ~',} 0 ~~ ~~o ~4 r .~ ~~ I OA C .~ .~ F O Q T ~n O L v ~ v ~ '~ ~ o° t~' ~ ~ N T U L!'1 ~ fV ~ ~ G O O >. v- N U '~ ~1 c d N ~~. ~ ' w~ h., G O J N a O ~- 4 b.' N V tom. V ~~~~..y i..i L ~ ~ ~~ C t.. o ~ U ~,,,, ~ c J ~ •~ Q W L ., ~ c s .O~: o Z ~~ Q ~ 3 a = ~- o ~ "~ E -n ° a }.. W ~ u ~ ~ 4 +-~ , . ~ ttS ~ ~ ~ ~ •"- C ~ ~ U ~' o L }.~ u i ~- V ~ ~ /y •i/ ] V U ~ y 'L~. tom." ~ Q _ V r L 0 !1. p1 ~', ® O a ~ ~ _ O --~ a° ~., d~ d y~ 0 ~~ ~~o ~~ .~ ~o on c ~c .~ N 0 Q x 0 m L N~ ~~ Q °° ~ ^~ U ~ .~ /L ~ ~ W `~ L ~ ~ ~ a ~ °'~' o O u ~~ J ~. Ql U U 3 C1 V1 ~6 ~J ~' '',-'I ~s i /' ;~~ o'~! ~. O ~ '~ J C7 C ~ ~+ N a ''•:~ , L l.) N \ O ~ `~ t'.. U +.+ t.., N (~ C ~~~x n i c Q~ N L O v },, ~ J W ~ Z ~ ~ ~ L \ ~ ~ Q ~ c +`?~ a = ~ ~ `+- A LL, cL i-~ ~ 0 C C ~ ~ G ~ ~ ~ ' ~i ~ V ~ ~ Q. ~ ~y •/ ~ V U ~ ~ O 0 _ ~ Q L a~ 0 ® ~ W s c: ® m '4 ,~ a° d~ ~~ O O~ ~~ .~~ r .~ ~~ r ~c .~ H O a s 0 a~ L C C p~ Gl 3~, ~ o •~ o O u N ~ ~ t,n c N ~ L a~.+ .~ N O J u >+ w N N N v V v c N R x C L O u ~.,,,, ~ J c ~c Q r~ W _ C Cs O ~'', 4y Z \ qJ q~i 'Q ~ S O Q ~ ~ U ~ W ~+ 4 LL L. - O ~ c ••~1 c ~ N C ~ 4= ~ ~ ®_ +C u ~ o ~ l 1'~ ~ ~i v a a V ~ t,~, V J u ~ ~ = O V 0 T L 0 d~ d yr~ 0 ~~ ~~P r~ i . ~, ~o r an c .~ .~ t~ O a x 0 s c • *" ~, ,~..~ c ~ ~ a~ ~_ ° N. U J -~ tl1 c ~ `~ ~ v ~ v ~. Q ~ ~ ~ W O Z ~ N VI U! U V 7 a, N ~ * a o \ '~ Q ~. J C~ .~ C N L o ~ V ~ 3 ~ U ~.J L ~- I :*wS ks r: T ~r+* ,~~ ~ _. ~$ 4th d b ~` ~ i. 1~ a N L O v F..,,, ~ J c ~ • L o ~1- ~ L . . a, ~ Q o *' E -a ~ r o Q v ~ L1.1 C L ~.+ ~- A C ~ ~ v 1 w ~ u C ~.+ s- o ~.. ~ ~ ~ ~ a V ~ U y..,. ~ ~ O Q = V O L O ~.{~ d~ d '~~j 0 O~ ~ r~ .~ ~o C .~ .~ L Q Q 2 A} 0 I ~ ~ n~ L W •~ Q o L.. o u ~ ~ ~ N ~ L ~ ,~ ~ a O ° C~ v ~ ~' v~ v v v a~ c v a V1 c Q `o ~ u ~+ }J L V1 (~ C / , Project Manual Supplement to BidlTender Form 00901 SUPPLEMENT TO BIDITENDER FORM THIS COMPLETED FORM SHOULD BE SUBMITTED WITH THE BID, HOWEVER, ANY ADDITIONAL INFORMATION NOT INCLUDED IN THE SUBMITTED FORM AS DETERMINED IN THE SOLE DISCRETION OF THE CITY, SHALL BE SUBMITTED WITHIN THREE (3} CALENDAR DAYS OF THE CITY'S REQUEST. March 2009 City of Miami Beach Page 125 of 185 Project Manual 00902 NON-COLLUSION CERTIFICATE Submitted this 24 day of Apri 1 , 2009 Non-Collusion Certificate The undersigned, as Bidder, declares that the only persons interested in this proposal are named herein; that no other person has any interest in this proposal or in the contract to which this proposal pertains; that this proposal is made without connection or arrangement with any other person; and that this proposal is in every respect fair and made in good faith, without collusion or fraud. The Bidder agrees if this proposal is accepted, to execute an appropriate City of Miami Beach document for the purpose of establishing a formal contractual relationship between the Bidder and the City of Miami Beach, Florida, for the performance of all requirements to which the Bid pertains. The Bidder states that this proposal is based upon the documents identified by the following number: Bid No. 23-os/o9 HORIZONTAL (ROW) PRINTED NAME Corporate Secretary TITLE (IF CORPORATION) March 2009 City of Miami Beach Page 126 of 185 ~~~nc ~u~ ~ ~ ~ i v Project Manual Drug Free Workplace Certification 00903 DRUG FREE WORKPLACE CERTIFICATION The undersigned Bidder hereby certified that it will provide adrug-free workplace program by: (1) Publishing a statement notifying its employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the offeror's workplace, and specifying the actions that will be taken against employees for violations of such prohibition; (2) Establishing a continuing drug-free awareness program to inform its employees about: (i) The dangers of drug abuse in the workplace; (ii) The Bidder's policy of maintaining adrug-free workplace; (iii) Any available drug counseling, rehabilitation, and employee assistance programs; and {iv) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace. (3) Giving all employees engaged in performance of the Contract a copy of the statement required by subparagraph (1 ). (4) Notifying all employees, in writing, of the statement required by subparagraph (1 ), that as a condition of employment on a covered Contract, the employee shall: (i) Abide by the terms of the statement; and (ii} Notify the employer in writing of the employee's conviction under a criminal drug statute for a violation occurring in the workplace no later than five (5) calendar days after such conviction; (5) Notifying City government in writing within ten (10) calendar days after receiving notice under subdivision (4) (ii) above, from an employee or otherwise receiving actual notice of such conviction. The notice shall include the position title of the employee. (6) Within thirty (30) calendar days after receiving notice under subparagraph (4) of a conviction, taking one of the following actions with respect to an employee who is convicted of a drug abuse violation occurring in the workplace: (i) Taking appropriate personnel action against such employee, up to and including termination; or (ii) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a federal, state, or local health, law enforcement, or other appropriate agency; and March 2009 City of Miami Beach Page 127 of 185 Project Manual Drug Free Workplace Certification (7) Making a good faith effort to maintain adrug-free orkplace program through implementation of subparagraphs ('1) through (6); -~~ /. STATE OF FLORIDA (Print Vendor Name) COUNTY OF BROWARD The foregoing instrument was acknowledged before me this 24 day of, Apri 1 20 2009 ~bY Rene Castillo as Corporate Secretary (title) of Ric-Man International , Inc. (name of person whose signature is being notarized) (name of corporation/company), ~n ~O 171 ~2 person described herein, or who produced as identification, and who did/did not take an oath. NOTARY PUBLIC: ti'V ~L L~ ; ~~ ~~ (Signature) V Hamill Ortiz (Print Narrfea~';~~Y G~r~IC-srA.:~: ~F ~.oxlryA S~:an~ll ;, Orii~ -,~, r~ pi es ~i JU Y 2442011 My commission expires: ,~ =~i;u:D7~~~;rJn~rrnl~rrtcsorrvtxcco.,rrrc. March 2009 City of Miami Beach Page 128 of 185 Project Manual Trench Safety Act Acknowledgment 00904 TRENCH SAFETY ACT ACKNOWLEDGMENT On October 1, 1990 House Bill 3181, known as the Trench Safety Act became law. This incorporates the Occupational Safety & Health Administration (OSHA) revised excavation safety standards, citation 29 CFR.S.1926.650, as Florida's own standards. The Bidder, by virtue of the signature below, affirms that the Bidder is aware of this Act, and will comply with all applicable trench safety standards. Such assurance shall be legally binding on all persons employed by the Bidder and subcontractors. The Bidder is also obligated to identify the anticipated method and cost of compliance with the applicable trench safety standards. BIDDER ACKNOWLEDGES THAT INCLUDED IN THE ADJUSTMENT FACTORS OF THE PROPOSAL ARE COSTS FOR COMPLYING WITH THE FLORIDA TRENCH SAFETY ACT. IN ORDER TO BE CONSIDERED RESPONSIVE. THE BIDDER MUST COMPLETE THIS FORM. SIGN AND SUBMIT IT WITH THEIR BID DOCUMENT. Ric-Man Int tional, Inc. March 2009 City of Miami Beach Page 129 of 185 Project Manual Licenses, Permits and Fees 00905 CITY OF MIAMI BEACH LICENSES, PERMITS AND FEES Pursuant to the Public Bid Disclosure Act, each license, permit or fee a Contractor will have to pay the City before or during construction or the percentage method or unit method of all licenses, permits and fees REQUIRED BY THE CITY AND PAYABLE TO THE CITY by virtue of this construction as part of the Contract is as follows: Building Permits, Public Works Permits, Zoning Permits, and Fees required by the City for Construction will be reimbursed to the Contractor by the City for the cost of the Permit/Fee only as a Reimbursable task item with no marked-ups, meaning using an Adjustment Factor of 1.0000. The cost for obtaining these Permits is to be included in the Contractor's Adjustment Factor. LICENSES, PERMITS AND FEES WHICH MAY BE REQUIRED BY MIAMI- DADE COUNTY, THE STATE OF FLORIDA, STATE OR OTHER AGENCIES THAT ARE NOT INCLUDED IN THE ABOVE LIST SHALL BE REIMBURSED BY THE CITY. IT IS THE RESPONSIBILITY OF THE CONTRACTOR TO OBTAIN ALL PERMITS AND REQUIRED DOCUMENTS. 2 Occupational licenses from City of Miami Beach firms will be required to be submitted within fifteen (15) days of notification of intent to award. Occupational licenses will be required pursuant to Chapter 205.065 Florida Statutes. March 2flfl9 City of Miami Beach Page 130 of 185 Project Manual Recyclable Content Information 00906 RECYCLED CONTENT INFORMATION In support of the Florida Waste Management Law, Bidders are encouraged to supply with their bid, any information available regarding recycled material content in the products bid. The City is particularly interested in the type of recycled material used (such as paper, plastic, glass, metal, etc.); and the percentage of recycled material contained in the product. The City also requests information regarding any known or potential material content in the product that may be extracted and recycled after the product has served its intended purpose. March 2009 City of Miami Beach Page 131 of 185 Project Manual Nondiscrimination Declaration 00907 NONDISCRIMINATION DECLARATION } ~,_;,. CITY OF MIAMI BEACH DECLARATION: NONDISCRIMINATION IN CONTRACTS AND BENEFITS Section 1. Vendor Information Name of Company: Ric-Man International Name of Company Contact Person: Rene Casti 110 Phone Number: 954-426-1042 Vendor Number (if known): Fax Number: 954-426-0717 E-mail: RCasti 11 o@ri c-man . us Federal ID or Social Security Number: 59-2300398 Approximate Number of Employees in the U.S.: 85 (If 50 or less, skip to Section 4, date and sign) Are any of your employees covered by a collective bargaining agreement or union trust fund? Yes X No Union name(s): Section 2. Compliance Questions Question 1. Nondiscrimination -Protected Classes A. Does your company agree to not discriminate against your employees, applicants for employment, employees of the City, or members of the public on the basis of the fact or perception of a person's membership in the categories listed below? Please note: a "YES" answer means your company agrees it will not discriminate; a "NO" answer means your company refuses to agree that it will not discriminate. Please answer yes or no to each category. Race x Yes _ No Sex X Yes _ No Color X Yes _ No ~_: Sexual orientation X Yes _ No Creed x Yes _ No 'Gender identity (transgender status) "Yes _ No `Religion x Yes _ No Domestic partner status X Yes _ No National origin "Yes _ No Marital status x Yes _ No Ancestry "Yes _ No Disability "Yes _ No Age "Yes _ No AIDS/HIV status "Yes _ No Height "Yes _ No Weight "Yes _ No B. Does your company agree to insert a similar nondiscrimination provision in any subcontract you enter into for the performance of a substantial portion of the contract you have with the City? Please note: you must answer this question even if you do not intend to enter into any subcontracts. x Yes No March 2009 City of Miami Beach Page 132 of 185 Project Manual Nondiscrimination Declaration Question 2. Nondiscrimination -Equal Benefits for Employees with Spouses and Employees with Domestic Partners Questions 2A and 2B should be answered YES even if your employees must pay some or all of the cost of spousal or domestic partner benefits. A. Does your company provide or offer access to any benefits to employees with spouses or to spouses of employees? "Yes No B. Does your company provide or offer access to any benefits to employees with (same or opposite sex) domestic partners"` or to domestic partners of employees? X Yes No *The term Domestic Partner shall mean any two (2) adults of the same or different sex, who have registered as domestic partners with a government body pursuant to state or local law authorizing such registration, or with an internal registry maintained by the employer of at least one of the domestic partners. A Contractor may institute an internal registry to allow for the provision of equal benefits to employees with domestic partner who do not register their partnerships pursuant to a governmental body authorizing such registration, or who are located in a jurisdiction where no such governmental domestic partnership exists. A Contractor that institutes such registry shall not impose criteria for registration that are more stringent than those required for domestic partnership registration by the City of Miami Beach. If you answered "NO" to both Questions 2A and 2B, go to Section 4 (at the bottom of this page), complete and sign the form, filling in all items requested. If you answered "YES" to either or both Questions 2A and 26, please continue to Question 2C below. C. Please check all benefits that apply to your answers above and list in the "other" section any additional benefits not already specified. Note: some benefits are provided to employees because they have a spouse or domestic partner, such as bereavement leave; other benefits are provided directly to the spouse or domestic partner, such as medical insurance. ENEFIT Yes for Employees with S ouses Yes for Employees with Domestic Partners No, this Benefit is Not Offered Benefit Documentation is Submitted with this Form Health a ac ^ ~ Dental ~ ~ ^ ~ Vision ~ ~ ^ Retirement (Pension, 401 k ,etc. ~ ~( ^ ~ Bereavement ^ ^ c~ ^ Famil Leave ^ ^ ~ ^ Parental Leave ^ ^ ,~ ^ Employee Assistance Pro ram ^ ^ ~ ^ Relocation & Travel ^ ^ ® ^ Company Discount, Facilities & Events ^ ^ ® ^ Credit Union ^ ^ ~ ^ Child Care ^ ^ ® ^ Other: ^ ^ ~ ^ Note: If you cannot offer a benefit in a nondiscriminatory manner because of reasons outside your control, (e.g., there are no insurance providers in your area willing to offer domestic partner coverage) you may March 2009 City of Miami Beach Page 133 of 185 Project Manual Nondiscrimination Declaration be eligible for Reasonable Measures compliance. To comply on this basis, you must agree to pay a cash equivalent, submit a completed Reasonable Measures Application with all necessary attachments, and have your application approved by the City Manager, or his designee. Section 3. Required Documentation YOU MUST SUBMIT SUPPORTING DOCUMENTATION to verify each benefit marked in Question 2C. Without proper documentation, your company cannot be certified as complying with the City's Equal Benefits Requirement for Domestic Partner Ordinance. For example, to document medical insurance submit a statement from your insurance provider or a copy of the eligibility section of your plan document; to document leave programs, submit a copy of your company's employee handbook. If documentation for a particular benefit does not exist, attach an explanation. Have you submitted supporting documentation for each benefit offered? xYes _ No Section 4. Executing the Document I declare under penalty of perjury under the laws of the State of Florida that the foregoing is true and correct, and that I am authorized to bind this entity contractually. Executed this 24 d Apri 1 , in the year 2009 at Pompano Beach FL (City) (State) 2601 Wiles Road Signat Mailing Address ene Castillo Pompano Beach, FL 33073 Name of Signatory (please print) City, State, Zip Code Corporate Secretary Title March 2009 City of Miami Beach Page 134 of 185 f ~~ h,. "~ Dre~m s ~ _ . , ,, ~, ~~ ~~~~,~, t ,~ r ~ y, ~ ; ~, - ,t , /~ I I ~'~. " .~ / ~ Fy j1 ~; ~~f ~ ,'~~,`~v ~',r a !' is x' N~ ~ ~<<;~~ ~~'~ ~~ ~I ' 17~~ i ~-,~ a~~tn~, } ,I; c;. ~ f ,r:r ~I ~ T Planning. ,~~ ~, a. ~ 1(!. ~~~~~~~~~~ti :.; /` I ~` ... 1 ~ . ..~Ci:l~ stir en. S q41 .:ial{.... . ~RANSAMERICA RETIREMF,NT SERVICES pia ~ H ih i ih~~r Ric-NGan interna~i0nal, inc. 401~k) 9~r®fi~Sharing PAan YOUR CONTRIBUTIONS • lrederal "I~ax I.aw limits the before-tax contributions to $15,500 in 2008 and `};16,500 in 200). Eligibility You must complete 7 year(s) of service and clrrring this period, yon must complete 7000 hours of service. Yon must beat least 21 years of age. Frequency of Contribution Changes You may increase or decrease your contribution [o the plan every six months, on January and )uly 1 . You may also stop making mnirihutions at any time. Entry Date(s) January 1 and July 1. COMPANY CONTRIBUTION Roliovers You may roll over your plan account balance hom a prior qualified retirement plan at any time. Vesting Your contrihr.r~ions are automatically 100% vested. Your rollover contributions are 100'%, vested. Matching Contrlbutions • "['he Company will make anon-discretionary Matching Contribution of 20% of the (first 5% of compensation that you contribute to the plan. The Company Matching Contribution will not exceed l %~ of your eligible compensation. Eligibility r must complete t year(s) of service and driring this lod, you must complete 1000 hours of service. -trust be at feast 21 years of age. Entry Dates} January 1 and July 1. Vesting The Company's contributions are vested as Follows Years of Service* Percent Vested Upon completion of 2 years 20% Llpon completion of 3 years 40% upon completion of 4 years GO°/, tfpon completion of 5 years 80% Upon completion of 6 years 700% Non-Matching Contributions • `['he Company may make a discretionary Non-Matching Contribution to the plan on behalf of all eligible employees. • ~'o be eligible to receive Non-Matching Contributions, you must complete 1,000 hor_rrs of service during the plan year and you must be employed on the last day of the plan year. Eligibility You must complete 1 year(s) of service and during this period, you must complete 1000 hours of service. You must he at lease 21 years of age. Entry Date(s) January 1 and July 1. Vesting ['he Company's contributions are vested as follows Years of Service* percent Vested upon completion of 2 years 20% (.lpon completion of 3 years 40% Upon completion of 4 years (0% Upon completion of 5 years HOo/u LlpOn COnlpletlOn Of ~ yeill"5 IOO°/u 'A year u~ service Jar ue~ting credit for Company contributions is based either on cornpletinn nJ I,000 Mows of Service or elapsed time. IJ thr, plan wes elapsed tune, crerlit is given regarrlless o~the number' of hours worked in n designated nuelve-month-pennd. Your years oEservice with a predecessor of the Company will not count toward your eligibility. fl00201-000 }~}'~ f»I: t p r 'i i LOANS • Your plan offers ~ loan feature. Please check widr your plan administrator ancl~or refer to your Summary flan ~ Description for details. IN SERVICE WITHDRAWALS Hardship • If you meet the cfe(inition of hardship you may make a withdrawal from the plan. Ivor more information about the strict n.rles governing harclslrip witltdrrwals, refer to your Summary flan Desniption. WHEN YOU RETIRE OR LEAVE THE COMPANY Subject to plan provisions, upon retirement, termination, disability or death, you-or in some cases your beneficiary-can: • i<eep your money in the plan, subject to certain restrictions. • Directly roll over your plan account balance into another eligible savings plan or IRA. - You can request a Rollover IRA I<it online at www."I'A-Retirement_com or by calling 1-800-892-7587. - [3y choosing to Keep your money in the plan or by electing a direct rollover of your retirement savings rather than cashing out, you will avoid the 20~% mandatory federal income tax withholding as well as the ]0% early withdrawal penally that's assessed if you have not reached age 5~ r/z. • Receive your plan account balance in cash. • Receive your plan account balance as an annuity or in installments. Contact your plan administrator or refer to your Summary Plan Description for additional information. Some of these options can have significant tax consequences. Your tax advisor can help you make the decision that is best for you. Por more information, refer to your Summary Plan Description. For additional plan information, please contact your plan administrator- or refer to your Summary Plan Description. INVESTMENT CI-IOIGES Tlu° plan offers 42 investment choices. • Refer to "(nvestment Choices" located in this enrollment workbook for a description of your investment choir_es. • Some of the investment choices offered by the plan contain trading restrictions. Prior to tinaliring your investment choices under the plan, please refer to your "Investment Choices" For more information on these restrictions. • "1'0 obtain a complete set of (nvestment Fact Sheets containing detailed, up-to-date information on each of the investment choices, contact your plan administrator or log on to www.TA-Retirement.com. ONLINE ENROLLMENT INSTRUCTIONS You can enroll online atwww.TA-Retirement.corn or via telephone at 1-800-401-8726. • F;nrollment instructions are included in this enrollment workbook, and will also be sent to the mailing address you have on file with your employer. • If you are unable to enroll online or via telephone, your plan administrator can assist you in obtaining a paper enrollment form. "That's all there is to it! Rernemher -it's never too early or too late to save for retirement.l'ransarnerica Retirement Services is here to simplify your journey on the road to a secure retirement. MANAGE YOUR ACCOUNT VIA WEB SITE www,TA-Retirement.com [n addition to providing access to your plan account information, the Web site is loaded with useful information, helpful tips and interactive tools, all designed to help you discover, build and manage your plan. Simply log on to the Web site wish your LTsername and Password to manage your retirement account online, check investment account performance, access the asset allocation tool and online calculators, monitor your investment .portfolio, obtain investment education and more. Until you create your own unique tlsername and Password, you can access investment choice performance and many other valuable tools by entering your plan's contract number: 800201-000. nANAGE YOUR ACCOUNT VlA TELEPHONE 00-401-8726 I'he automated telephone system olfers you direct access to your plan account in(<~rnu~tion. You can access the system 24 hours allay -seven days a week. INVESTMENT CHOICE INFORMATION VlA WEB SITE 'I'o access your Performance Overview and Investment Tact Sheets, follow the simple steps outlined below: Step 1 : Go to www."fA-12ctiremcnLcom Step 2: Click on "lrund In(ornrttion" above the navigation baron the right hand side of the page Step 3: Enter your Contract ID and click "Submit" Step 4: Your Performance Overview will appear Step 5: Click on the investment choice's name to view the Investment fact Sheet ACCOUNT REBALANCING Account Rebalancing allows you to maintain the investment percentage you originally established, taking into consideration market earnings and losses. • Set up Account Rebalancing via the Web site or by telephone. • Automatically rebalance your accocmt by redistributing the percentage oFyour total portfolio held in eacl_i investment choice. - A one-time account rebalance will initiate one rebalance as of the close of the bt.rsiness day. - A periodic rebalance will establish a future schedule for rebalancing based on the period selected (Monthly, Quarterly, Semi-Annually, Annually). • 'There is no minimum balance required and no minimum amount to transfer. ',UTOMATED PERIODIC TRANSFERS ~.ttomated Periodic"Transfer allows yor.r to transfer portions of your plan account balance from one investment choir e to other in regular increments. Llse Automated Periodic"Transfer to gradually h~ansfer assets from a conservative investment choice to a more aggressive investment choice or vice versa. • You must transfer at least $100 from the holding investment choice: for each periodic transfer. • Once established, Automated Periodic.'I'ransfer will continue until you request that it he stopped. • [f there is not enough money in the holding investment choice, the system will ignore the transfer request and check again the next period. • Some restrictions may apply. Contact your plan administrator. ADVICE'SOLUTlONS: THE INTERACTIVE INVESTMENT AND RETIREMENT PLANNING TOOL Retirement. A Journey Made Simple' Simple and easy to use, AclviceSolutions can help you plan your journey to a better future! With AdviceSohttions you get the investment advice you need to make confident Financial decisions. Simple Solutions for a Complex World You don't have to be an expert to use AdviceSohitions -you can choose (morn three investment experience levels - L3eginner, Intermediate, or Advanced. ADVICESOLUTIONS: AFTER YOU'VE BEEN ENROLLED IN THE PLANy YOU CAN ACCESS ADVICESOLUTIONS BY FOLLOWING THE STEPS OUTLINED BELOW Step 1: Go to wwtv."T'A-Retirement.com Step 2: Enter your Username and Password and click on the' _~ button (If you access AtfviceSolrrtions without entering this information you will be taken to a demo version of the tool.) tep 3: Clicl<on "Transactions" tep 4: Click on the "Click here to manage your account." link located in the body of the page ep ~: Click on the ilclvice.Soltltinns logo on the left hand side of the page ~p G: Click on the ~IrluiceSnh-itiorrs logo in the center of the page to view the site Arli~ireSoh~tinni is a retirement Manning module, solely provided for educational ~iurpose~ and neither"Transamerica Retirement Services nor advice fiameworl<s act as fiduciary in providing the recommendation. STATEMENT OF ACCOUNT • You will receive a personalized statement of your account on ~ regular basis. ~i~~~.~i~lL ~i~~~LLI~~.I~~ ~ivl~~'6~~J~~'~~i~~ ~dlc-CVI~n Il~~ern~~i©n~Il, Inc. ~~(~~..(IZ) Pro~i~:.~4~~~1n~ ~I~n Pt,rnsE 12EAD cARe>'~u1.LY You mint designate a beneficiary by completing section ~ and submitting it to your plan ad tT~ i n istrator. Your company offers tcvo options to enroll in your retirement savings plan: • You may enroll online. O IZ • You may enroll by phone. Please Note: Yogi can enroll today or any dcty in the future. Certerally, the contriht.ltion you elect t.uill ~no into elf ect on the plan's next. e~rttry date; hotuever, yott [.viii need to checlr t.uith yot.tr ernplr~yer to hind out the exact date your payroll decluct.io~ns [.viii start. Refer to yot.tr enrollment hit. or Sttrrtmcrry Plan Description foryottr plan's spectf~dc entry dates, To Enroll by the Internet Log into: www.TA-Retirement.com In order to enroll online yor[ will need Co provide tas rvith your ctn-rent e-mail ndrlress. If you ilo not have nrt e-rnnil nrldress you con enroll uia the teiephorte, Please refer to the telephone instructions on the next page. • laiCl< on the rust time user"r Kegister now link located on the top left-hand corner of your screen within the "Your Account L,OC(N" section • Select "( am an employee" and click Continue {inter your Social Security Number and click Continue Enter your Date of Birth and 7IP/Postal Coda and click Continue • Create your own unique Username and tassword and click Next • Agree to the site Terms of Use • Agree to the Consent ro Do Business hlectronically agreement • On the Welcome to Plan Enrollment screen, please click on Start • Carefully read and accept the ['articipant Agreement for ['Ian Enrollment by clicking on Agree • On the Ulan Enrollment -Address screen, please verify your information and make all necessary updates. When all oFthe information is correct click Next 1. SET LIP YOt1R CONTR[BLITION RATE Your contribution rate is the amount ttrat will be withheld from each paycheck. f.nter the rate to be withheld from each paycheck and confirm by clicking Next. The contribution race you select will be sent to your employer to be deducted from your paycheck based on payroll cutoff dates. 2. ENTER INVESTMENT ELECTIONS FOR T'LIT'LIRE CONTRIBUTIONS (see (nvestment Choices worksheet) Your contributions will be invested according to the selections you make here, until you elect otherwise. linter the percentage to be allocated to each investment option, in whole percentage increments. `Ehe total of your allocation percentages must equal 100%. Click Next. 3. PLAN ENROLLtil13NT - REV[EW A summary of elections that you have made will be shown on dais page. Review the information carefully. Click on Confirm. 4. PLAN ENROLLMENT -CONFIRMATION A copy of your requested elections may be printed For your records. By clicking Continue you will be taken to the Account Setup screen. 5. ACCOUNT SET'LIP Set up your Username and Password help question and answer, indicate your email preferences, and click Submit. Cteview your changes and click Confirm- The confirmation page displays the options you have updated in your account setup. Click Continue to use the www.'fA-Retirement.com site. CON"I'INUF,D ~ ,. E k~ Gy ~ Enroll by Phone: ~0-401-TRAN (8726) ', To utilize the phone enrollment process you will need to use a touchtone phone. Press ~ to indicate you hive a touchtone phone. You will then he prompted to enter your 9 digit Social Security number followed by the pound sign (tt), and your 4 digit Password (your default password is your month and day of Firth in MMDD format)" followed I>y the pound sign (!t). ~ ~~ ~~ 1. PERSONALIGI~ YOUR PASSWORD As a first tune user, you will be prompted to change_ your password on initial use "I'he system will request you to enter your new 4 digit password, followed by the pound sign (#). Re-enter your ~I digit password, Followed by the pound sign (#) to confirm. A message will indicate that your password was changed successfully. ~: 2. ONLWF, ENROLLMENT DISCLOSURE You will be asked to complete the online enrollment process. "1'he disclosure message will ask you if you agree to the terms and conditions of utilii.ing the online enrollment process. Listen carefully to the terms and conditions, press 1 to agree to the terrrts and conditions of online enrollment. 3. SET UP DEFERI2AL~CON"TRII3UTION RATE Your contribution me is the amount that will be withheld from each paycheck. linter the rate to be withheld from each paycheck followed by the pound sign (#). Press 1 to confirm the rate.'!'he contribution rate you select will be sent to your employer to be deducted from your paycheck based on payroll cutoff dates. 4. SET UP INVESTIvLENT ELECTIONS (See Investment Choices Worksheet) Your contributions will lre invested according to the selections you make here. You will be prompted to enter the percentage to he allocated to each inveshnent option in your plan until the total allocated equals J00'%,. Percentages roust be in whole percentage increments. Press 1 to confirm your elections. have successfully completed the phone enrollment process and you may now I-tang up to end the call or hold and you will be connected to the main menu. '1f we do not have a date of birth on lilt, your password is a randomly generated number as indicated in your enrollment leper Ry cc~rnpleting the enrollment process online, you are authorizing payroll deduction of plan contributions. Authorization of plan contributions constitutes a "cash or deferred arrangement" under Section 401(1) of the Internal Revenue Code and such contributions are subject to the withdrawal restrictions of the plan. Contributions can he received in cash rather than contributing them to the plan. Contributions made w the plan are subject to certain limitations imposed by federal law and these contributions may be reFunded to comply with these laws. Ley submitting this authorization online, you understand that neither ,the plan tnrstee, their affiliates nor their investment options are liahle (or any loss when acting upon your insUUCtions believed to be genuine. ry:• C ;: ~I~liis worhshecl is designed lu help you enter your investment selections durinl; lie enrollment process. You have three options: "1ur,~et ,~drttm~it)'-ti~r'ries, ,S'Irr~(r,Sic,~llnrrrfion Series, and Creole Your Oit~n Irit~esnr[ent 1'orlJolin. f=irst, review your inveslntenl choices in "Investnrenl ;~u~ices" in this enrollment world~ot~k and refer to the Investment I~act Sheets For more detailed infonnalion about any particular investment choice. "I~ien return here, and complete the Worksheet and use it to help you entt~r.your invesunent elections durinl; tht~ nrrcrll[nent process as nullined on tic previous pages. Please f~0 NO`f submit this Worksheet. ISe(ore Yon select investnre~nt choices, please note that certain options contain trading restrictions. Additional in (orrnation regarding leading restrictions can be Found in your "Investment Choices". Please carefully read this inFormation prior to making your final iiwestment choice selection. you must designate a beneficiary by completing section 4 and submitting it to y<iur plan adminish~ator. Option I: Target Maturity Series 'fhe Target Mauirity Series below are designed for you to allocate IDO'%, oFyour contribution to tl[e one invesunent option that most dosely matches your projected retirement date.'I'hese invesmu^nt choices are diversified and structured to grow more conservative as the investment choice's target date approaches. You rnrry assn c{~oosn, to spa<nrl your cat~uril~nrtions over rnore Chore nree invesureeru chvir:e 6y trertNng hour ntvn irwestrnenl portfolio antler Option fll. (check one) Ia I~raiis,rnrerica Vanguard l'arget Retiremeiu 2005 Ret Ohl ~_~ 100'%~ N9 'I'rausamerica Vanguard "Target Retirement 2(l l0 Ret Opi U 100°/, 14 "Iransamerica Vanguard'I'argel Retirement 2015 Ret Opt U 100°/~ I' I 'Transamerica Vanguard'I'arget Retirement 2020 Ret Opt (~ 100%, 15 Transamerica Vanguard "Target Retirement 2025 Ret Opt ~( 100'%, P2 "IYansamerict Vanguard'Target Rtttiremenl 2030 Res Opt ~~ 100'%, IG 'Transamerica Vanguard"I';uget Retirement 2015 Ret Opt ^ 100% Pa "IYansarnerica V~urguard'Target Retire_meru 2(140 Ret Opt ^ 100'%. 17 'I"ransamerica Vanguard ~farget Retirement 2045 Ret Op[ ~J I (l0'%v ('4 "Transamerica Vanguard'I'arget Retirement 2050 Re( Opl ^ 100°/~ if you selectee( Option / cthove, l,~a to the Liene~iciary Designafir~n Tnrnr. Otherwise, proceed to Oplinrt ]I. Option II: Strategic Allocation Series The Strategic Allocation Series are designed for you to allocate 100t% of your conu-ibutions to the one investment choice that most closely matches your investment mix reflective oFyour selected time horizon, with shorter time horizon investment choices tending to be more conservative. You rnrry also choose to spread your contributior~i aver rnore than oree invesunent cl~[oice by creating your own invesunent art/olio [.ender Option 111. Please note: ]f you scored a 7 or below on your Risk Tolerance Questionnaire, the Strategic t111ocation Series may not be ronservative enough for you. Hy selecting Option I!I you can design a more conservative portfolio for your shorter time Iu~rir.on (2 - 7 years). (check one) I8 'Transamerica Asses Allocation - Conseivn(ive Portfolio [] 1 00"/~ Ret Opt (Short Inlerrnediate I lorizon 5 12 years) 19 Transamerica Asset Allocation - Moderue Portfolio ~ ~ 100'%~ Ret Opt (Inteniiediate I lorizon A - 15 years) J0 'Transamerica t\sset Allocation - tvlotle.rue Growth Porttolio~ 100'%~ Ret Opt (I nterrnediate~l.ong I lorizon 14 - 20 years) _ J 1 "Transamerica Asset Allocation -Growth Portfolio Res Upt U 100°/~ (Long I lorizon 20 or more years) If you selected Option 11 above, go to the lieraeficinry Designation Donn. Otherwise, proceed to Option 111 Option III: Create Your Own Investment Portfolio IFyou prefer to create your own investment portfolio, yotu plan provides that choice -just select (corn the Following available invesunent Choices: All elections rrutst be in whole percentages and total 100'% i Rlc-IVlan International, Inc. 401(k) Profit Sharing Plan Investment Choices %oFContribution Cash Equivalents 21 't'ransamerirt Staile Value Advantage Option ~~_~uo/o Bond Interrnedlate Term 15 Franldin "Total Return Ret Opt ~ ~~ l~ n~, M2 Loomis Bayles Investment Grade I'tond Ret Opt ^~~~~~%, I12 SSgA Bond Index Rel Opt ~~~~t~, high Yfeld Bond 87 Columbia I filth Income Inv Opt ^~~l~J% nternatlonal/Global bond til5 Oppenheimer International Bond Ret Opt ^~~~y~ lybrld Balanced CI American Puntls Balanced lnv Opt ~~~~'Yo Strategic Allocation Series I8 "1-ransamerica Asset Allocation -Conservative Portfolio Ul~a% Ret Opt 19 "Transamerica Asset Allocation - tiluderate Portfolio Itet ~~~~~~ Opt I ~ CON'I'INULI) --~ ~~ ! i' ~~li ~~! '. `ad ' `~ F21c-Man international, Inc. 401(k) Profit Sharing Plan I nvestment Choices (continued) %oFContribution ~ 10 Fransanu^rica Asset Allocation -Moderate Growth ~~~,~~ Portfolio liet Opt 1 I I~ransamerica Asset Allocation -Crowth Portfolio Ret ~OO,y„ Opt ~~ Target MaturltySerles 1:3 Vanguard 'Iarget Retirement 2005 Ret Opt ~^~,yo N9 Vanguard "Target Retirement 2010 ReI Opt ~~~ ~~~,%~ ~ 14 Van ward "l~nr;c t Retirement 2015 Ret O ~t 1~ 1 I o ~__~^^ ,, 1'1 Vanguard'I'arget Itetirernent 2020 Ret Opt ~~~,yo i IS Vanguard'I'arget Retirement 2025 Ret Opt ~~~,yo '1 I'2 Vanguard'iarget Retirement 2030 Ret Opt ~~~% IC, Vanguard'1'arget Retirement 2035 Ret Opt ~~~~o/~ f3 Vanguard 'target Retirement 2040 Ret Opt ~~~% 17 Vanguard Target Retirement 2045 Ret Opt ~~~o/n P4 Vanguard'1'arget Retirement 2050 Ret Opt ~~~% Large/Mid Value Equity Large Cap , Q5 [31ackRocl< Equity Dividend Inv Opt U^~% I +I Q1 SSgA Russell 1000 Value Index Ret Opt ~~^% Mld Cap ~' ~ - 95 Columbia Mid Cap Value Inv Opt ~~^o/u ~~ !' Large/Mid Blend Equity Large Cap F2 Mutual Shares Inv Opl ~~^,~ [0 Neuberger Kerman Partners Inv Op( ~-~~~~% _- Mld Cap ----_ 1 [9 AlM Mid Cap Core fiquity Inv Opt ^C~~% _..rge/Mid Crowth Equity Large Cap f0 American Funds Crowth fund oFAmerica Inv Opt ^~~^o/o ~~; --- Q3 SSgA Russell 1000 Growth Index Itet Opt % ^ ^ ^ ~~~ Mld Cap 5~t Franklin Sma(I-Mid Cap Growth Ret Opt ~~~% I !E' - - -- - - 35 - Transamerica Crowth Opportunities Ret Opt ~^^% ~~ Small Company Equity Value - NS -- Vanguard Small-Cap Value index Ret Opt ~~~% !~ ~. I f6 Wells Fargo Ac(vantage Small Cap Value Inv Opt ~~~o~, , ~'. Blend IS Fec(erated MD'TSmall Cap Rlend Ret Opt _ ~~^~yo ~ ~I Growth '' DA Fidelity Advisor Small Cap Inv Opt C~L 1LJ% ~ - - N6 Vanguard Small-Cap Growth Index Ret Opt ~ ~^~% I~~ International Equity I<4 ___ American Funds GuroPacific Crowth Ret Opt rr ~~ o u^^ /u 'I! li Specialty 18 IIS Templeton Foreign Ret Opt ~~~,% I American Century inflation-Adjusted Bond Inv Opt ~~~% '' ~~ LI First American Real Istate Securities Ret Opt ~~~o~, ~: L8 [vy Science ~ "l'echnololry Inv Opt ~^^% MO Jennison Natural Resources fnv Opt ~^^% _ - i ~ ~~ SOCfA( tiI;CLIRI'I'Y NUMB{-:R MLIS"I' 13I COMI'LLiI'LI) ~~'~ ~~ ~ ~ _ --_)-[~_ I -~-~~ ~_ _ ~ t, ~®dl®v~r ~®rl-~ tic-fi/~~r~ 9ntern~~iol~~f, inc. ~0~.(k} ~'rofi~ .~h~r~r~g ~17~ Four Simple Steps I. Contact your plan adrninistruor or refer to your Surnrnary flan Description u~ make sure you're eligible to mil over your plan account balance from ~ prior qualified retirement plan. 2. Contact your prior company and request a rollover distribution. If you have an IRA, contact your IRA investment manager and request a withdrawal. (1e sure. to have the distribution check made payable to Transamerica, FIl(~ "Reference Your Name" (e.g., `Transamerica, FIlO Jane lloe) and have it sent directly to you. 3_ Complete the Rollover) orln below. 4. Submit the Rollover I~onn alone; with the distribution check to your plan administrator. You mast designate a beneficiary by completing Section 4 and submitting it to your plan administrator. Employee Information - Please Print Mr Mrs. l I I I I IL I I L I I r ~ I L-~ L-1~ Ms. FIRST NAME M.I. LAST NAME REEr ADDRESS 1 ~ / I I I / I I I I I 1 I I / I ~ I / l I I I I TE OF I]IRTH (MM/DD/YYYY) DATE OF HIRE (MM/DD/YYYY) f I I I I l ~ STATE ZIP MARRIED O NOT MARRIED 2. Previous Plan/IF2A Information _L__~ I I -_._L-rL_l_ _I I L-.~L-1__~~_..__~_1--1_L_L_ -I~-1-.1. vIG OF PRIOR PLAN CONE` o o <l01(k) 401(a) 403(a) A03(d) APT. NO. 1 I I ProlilOiaring tiloneyOPurchase GovernrrOienl457 _ ConduOit IRA _ _ _ _ _ TradillOal IRA Rolh 401(0- Dirarl Roth 401(0- Indirect For Rosh 4177 (Ir) rollovers, please complete the injormntinn belour. This in~nrrnutin.n shnulrl Puure beer! provided Pry your rollover instinuinn. Year o(first Roth 40l(I<) Contribution ____. _______ Roth Contribu[ion I~asis __ _ __- ("This is the non-taenble portion of your tlistributiorl) `Your plan may not accept rollovers from all plan types listed above. Contact your plan admirtislralor to make sure your rollover qualifies. rrasoN To coN~rACr: T NAME ADDNFSS APT. NO. I I I I ~ I I I J I ~ I I ! S fATE ZIP _J_1_J tI I i LL-LLJ - DNE NUMHER . Tax Information All of this distribution amount would be taxable to me iF f did not roll it over. / ~~ ~ is the amount of after-tax contributions included in this rollover. The remainder will be taxable income to me if I did not roll it over. No part oC this rollover is a minimum required distribution. No part of this rollover is a hardship withdrawal. u L-i_~ M.I. LAST NAME CONTiNL(lil) ~ -- _ ___ -- - - - _- - SOCIAL 5[CUItITY NL1ML11~,R MUST' lil C OMIT I~:ff~l) ~ ~ ~ _- -- ~~~ - -, I __ I__-- -- Y 4. Employee Authorizatlon ^ is Ithc single sum rollover contribution amount I wish to contribute-'I'bis amount re presents a distribution from another qualified retirement Klan. A check made payable. to "I'ransarnerrca, 1-130 "Reference Your Name" (c.g., `fransamerinr, FLlO Jane Doe) is attactred. I understand the withdrawal restrictions that apply to these contributions. -- DATE [MPLOYEF SIG NA TURF i 5. Plan Administrator Authorizatlon ~~ I authorize these rollover funds to be deposited into the participant's account. PLAN AOMINISTFlATOR SIGNATURE ~ DATE 6. Investment Mix ^~-^~ ^^^ ^ is the amount or rollover contributions that T would like invested, as indicated below, ~^^ in whole percentage increments. F2(c-Man Internatlonal, Inc. 401(k) Profit Sharing Plan Investment Choices °/v of Contribution Cash Equivalents R1 `fransamerica Stable Value Advantage Option ^^^% Bond IntermedlateTerm 1.5 I•'ranklinl'otal Return Ret Opt ^^^~/, M2 Loomis Bayles Investment Grade Bond Re[ opt ^ o/, ^^ 112 SSgA Bond index Ret Opt -- --- r ^^L~o/n High Yield Bond ----- 87 Columbia l{igh Income Inv Opt ^^^% Internatlonal/Global Bond MS Oppenheimer International Bond Ret Opt ^^^o~, Hybrid Balanced G1 American funds Balanced lnv Opt ^^^% Strategic Allocation Series IA Transamerica Asset Allocation -Conservative ^^^% Portfolio Ret Opt I 19 `fransamerica Asset Allocation -Moderate Portfolio ^^^% Ret Opt ~ 10 "fransamerica Asset Allocation -Moderate Growth o ^^^ /o i Nortfolio Ret Opt J 1 'fransamerica Asset Allocation -Growth I~'ortfolio ^^^% ~i Ret Opt _ __ _ ~ ii; Target MaturitySerles 13 ---- -- Vanguard 'Target Retirement 2005 Ref Opt ^^^c/, I ~' ~~ N9 Vanguard `target Retirement 2010 Ref Opt ^^^o~, 14 Vanguard "target Retirement 20 t5 Itet Opt ^^^ °/u P1 Vanguard `target Retirement 2020 Ret Opt ^^^% 15 Vanguard"target Retirement 2025 Ret Opt ^^^~~, P2 Vanguard Target Retirement 2030 Ret Opt ^^^% I6 Vanguard "target 12etirement 2035 Ret Opt ^^^% P3 Vanguard Target Retirement 2040 Ref Opt ^^^% 17 Va ngllard largel IZeIII E'Inenl ~O4j Itel Op[ ^^~lo/u CON "I'1NUGD ~ -. ru t >f ~~ ~ - -- - --- - - SOCIAI SI;CURI'I'Y NUrVIIlLR MLIS"1' 13C CONIPI,I:'I'1;I) I •~" ~ 4- ~, t~, i ''?~;. 9' ~q - - ~- f --- _ - - --- -- - - - -~ ~ ~ ~ I - ___, -- - - ~ ~`: 6. Investment Mlx (C ontinued) ~ ~` ' 'Ic-Man International, Inc. 401(k) Profit Shari ng Plan Investment Cho ices (continued) , ,;'; o/, of Conuibuiic~n ~ ~;:: PSI Vnn[;uardTar~;et Retirement 2050 Ret Opt ^~^~~~ ~ r`, _ %:~ Large/Mid Value Equity ~ Large Cap Q? - -- -- - ------ 13lacl:Itocl< Cc~uity Dividend (nv Opt - ~~~^`%~ I ~ { • , "~~~~ Q1 SSgA Russell 1000 Value Index Ret Opt ~~~~~~, ~ .~a ~ ktt~~.~;: - ~- `;` :~ Mid Cap 95 Colun~rbia Mid Cap Value. lnv Olt ~ ~~~~~`%~ ~ ~~ Large/Mid Blend Equity Large Cap 1~2 Nlu[ual Shares Inv Opt __ ~~~~~~ ~ r`~ i.+~;:`, 10 Neuberger [terrnan Partners Inv Opt ~~~~~%, i , I Mld Cap 119 AlM Ntid Crap Core L,quity lnv Opt ~~~~ ~~, Large/Mid Growth Equity Large Cap I~0 American funds Crowth fund of America Inv Opt L-~^~~ ~y~~ i;'„I,, : i r.. C~3 SSgA Russell 1000 Growth Index Ret Opt ~~C~~~w , Mid Cap 54 Franklin Small-Mid Cap Crowth Ret Opt ~~~'Y~ 35 Transarnericn Crowth Opportunities Ret Opt ~^~% Small Company Equity Value NR Vanguard 5inall-Cap Value Index Ret Opt ~~~ c~, fC Wells Fargo Adv,intage Small Cap Value [nv Opt ~~^,~~ Blend 15 Federated MDT Small Cap Blend Ret Opt U~~'~~ t Growth - -- -- f3A Fidelity Advisor Srnall Cap Inv Opt ~~~~ ~%~ NC Vanguard Small-Cap Crowth Index Ret Opt ~~~~~%u rternational Equity K4 American Funds FuroPacific Growth Ret Opt ~~^n~, 18 Templeton [oreign Ret Opt I~JDIJ'~, Specialty - _ - 118-- American Century inflation-Adjusted Cloud Inv Opt ~~~o~u Ll first American Real Estate Securities Ret Opt ~~^o~o :,-• i.e [vy Science & Technology Cnv Opt ~~~ ~~, '. i ,~-, MO Jennison Natural Resources Inv Opt ~~~~o~a 1lnilecl ~-lealtllC'aI-e of Florid<~, rnc. AFFIbAVITOi DO;~1ES"f[CPAP.7NLRSiItP Eech of tf;c undersigned attest that we satisfy the definition of Dcrneslic Partnership set forth in h below and agree to the benefits set forth in If below. "fJorncstic Partnership" is defined as folo~ss: f\ Domestic Partnership consists of an employee and one other person o(thc same or opposite sex. Such persons must salisry all o.f the following requirements: a_ They share the same permanent residence and the common necessities of life; b They are not related by blood or a degree of closeness which vrould prohibit marriage in [he law of state in which they reside; c Each is at least 18 years of age d• Each is mentally cornpctent to consent to contract; ~• 1`(either is currently marred to another person under either statutory or common law; f They are financially interdependent and have furnished at Izas1 three of the follovving documents evidencing such financial interdependence: (1) have a single dedicated relationship of at Icast 6 months duration; (ii) joint ownership ofa residence; (iii) at letist two of the fotlowing: common ownership of an automobile; joint checking, bank or investment accotmf; joint credit account; (lv) a will andlor life insurance policies which designates the other as primary beneficiary. [I. Termination of Domestic Partnership: The undersigned employee or partner shall inform of any termination oCthe Domestic Partnership and sha!1 complete and nle with the an affidavit of Termination o(Domzstic Partnership. The undersigned person acknowledges chat upon the termination of [heir domestic partnership, health plan coverage of the domestic partner who is not an employee as well as any dependents of such domestic partner, shalt cease. Any person vvho knowingly and with intent to injure, defraud, or deceive any insurer Fles a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. Hy Date: SUBSCRIBED and SWORN TO HEFORF, iv(E Ch's day of Lary Public (Signature of employee or partner) Please Print Name By; _ (Signature of domestic partner of employee or Fanner) Please Print Name DPr1FFf DA VIT (I 1197) YOUR BENEFITS Unitec~~-~ealthcaz~e~ ~ A Uniledllealth Group Company Florida -Choice Traditional with Deductible - 15/250/100% Plan 7DF ~l'Jc; w~nl to help you lake control and make the most of your heallh care benefits. That's why we provide con~~eni~nt sr::rvic,a to gel your heallh care questions answered quickly and accurately: ° Check personalized data: Find individualized information on your benefit coverage, check the status of claims, and search for physicians and hospitals using www.rnyuhc.com~, • Researching heallh information: Find resources by calling Care245m or NurseLine~ or by logging on to www.myuhc.com. ' Get help; Contact Customer Care al the telephone number on the back of your ID card when you need assistance locating physicians and other health care professionals in your network or when you have coverage or benefit questions. PLAN HIGHLIGHTS Types of Coverage Network Benefits t -,. r-~no.~,.',rc~, :err... '~c~e~ ~ °ct tyYr r y [l ® _ [r~ t ~ r1[Y iar~ ~.tit`~~,r ,~.yy;;~~~t^'~=~' i Y ~?77+'(~T~jt, afr .~v~t~rC-.. {''~rurr+-re c~r't-"~.~`'~~t "}w ;;~j ~ "3',^ i~_~-3 ~ ~~. ~~, z:; ~..1_:.,.~~~~.'L ~~ .,--F '4- ,T ,, l'i ~ _ ~r { '~P~~.a)~F,:3+^~ x'rd ~f''~Cf~ S41wiYSrr'F r e~rv'`-~~ ,1 ~E.'_.'~,`a'l `~`" `,~ S } 1~ 3v rF '1 'fi -~ ~[_.~._.-..~:...~u.t',~f,....-:~.t11:._:.:t' n".L_41~'~it~~.~c.s~s_.~:sc.:~fi..~ca.~'J.f.RUL:..fua...~ c.u..._}.~rn~~:5~.:~t-cSa..r:.3~..`J.. .-:~_7..~~.L-~:.~~.,..~..~ti ..._~___r._.,. Individual Deducfibte $250 per year Family Deductible $500 per year > Member Copayments do not accumulate towards the Deductible, ~f Lt"'' ~~.~f r ~rr'jl ~~. 1 ,E.' '",7~!: ~ ~lj~y~~,~'~,~~r ~3t'~1~5~ .~ 'f ,'r.,~C~~'t-j'r.'~t t.r',-~'rC~rYS 5 IFri _~~ ,a ~~t7 43j r.Y ~ ~;1~ 1 .' '~ S, ii U f if h s a '~ ' ..,__;n '.~ 17,E t, ,~ ,t .. ~ F~~,,.1~ r ...~-' ~ ~! --.r r,,.~ .titter ~, ,r. u-[ ~:. J- ~ ~- .. ~ ..y.:.a _~.r.,..-~.~~~.r.s=::Y~~.~,-.~:;~airz,~f'"t~_~..t.:~,.... ~-fi~~k,%_ ,• m._,:i..._.3E".~ = ..~.ts.,.>~,.~l~~icc.~.~..~~c__._i,.e~v~~.._z,__.[y1:...,.d_...~~~:.___L_,,.~~»,u individual Out-of-Pocket Maximum $250 per year Family Out-of-Pocket Maximum $500 per year > The Out-of-Pocket Maximum includes the Annual Deductible. > Member Copayments do not accumulate towards the Out-of-Pocket Maximum. _ t} ~r `'' Sr;~ ~, ~'~>'~>,~.,~ ~"ti t'~c7J!. ~'F.?jr,<c.r~., i~~ E- ` hls ~., ,~a^~~~;~tr-`,~J ~r-~,Y[ v~~"r~_,~,`~'i"-f.~`aa~~'~~ t ~ r ~-.~.y~'~~~ ' ~~''~n_._.~..':R~ ~ .k2 ~: ~x gym, _ ~i!_s_,t~~..! 100% after Deductible has been met. _ _ ry_?4 3 r TS4.. - '~ i,-r . 4ir ~ ~~c~.~ y[ -( ~y 9". t r-mtt""~ .r^/j~'~l c'am' V -P `7 i~ l.t ~ ~~ I ~ 4 ~h~ '~.a'itn''!1"7~ ~' ~ ;_ ti~~. ~"[' ~~~ ,~Y'4~3`-.~ :t ~ `, ac ~.j {{r-'~4 /i " ;,C~'r 3~+ ,E[ i {~i4. Ij~y~i ~< %: ~.-'4[;i~ 7r, 1..~~ . i../~ eL'-~u-~t~~ll:s9~~„~G7~~,~n~...1'e:~c p'~Y" i . +~e~~4~e"a'..r~Y~h. , ~ ,, c~ t y4''1(f,, ~,S~f, "x`'Ri•'~SS^', -~''~q~_;,;<,5~~~ :'~~ „i.r •.:L~.~'s_'.i`.'".y3ir~i~'~.~~: The maximum amount we will pay during Maximum of $5,000,000 per Covered Person. the entire period of time you are enrolled under the Policy, Prescription drug benefits are shown under separate cover T 'Benefit Summary is intended only to highlight your Benefits and should not be relied upon to fully determine your coverage. If 3enefit Summary conflicts in any way with the Certificate of Coverage (COC), the COC shall prevail: It is recommended that ~ 'view your COC for an exact description of the services and supplies That are covered, those which are excluded or limited, :her terms and conditions of coverage. 'EL7DF07 ,~# Rev. Date Benefit Accumulator 3-3380 0707 Calendar Year lJnitedHealthcare Insurance Compan;r YOUR BENEFITS ADDITIONAL CORE BENEFITS Types of Coverage N Network Benefits N~ ~ ~ ~ ~ ~. _i_r ~ ~.~,~ _c_r~r..,c,.--;:-~ r -r ~ n-rx ~ r ,r,,rr~.-~+rr ~o,~~. ~,. c y r, ,`~~,~i 111~~1!.~~_~ I~n~-~~r li~~r(~ii Irll( 11rr~tl i'~~~rtlaii7~i f~1~yy~~~ r,..~~~,~.~r~.~~`__..}(~...~{$1.~..i..~~l.:.~,;gat'~r.,,~-'1.lru_.f"_::~~1~.~..~~.%....~.~.'J`'._. j1. ~"~ A , Ground Ambulance 100% after Deductible has been met. Transportation costs of a newborn to the nearest appropriate facility for treatment are covered up fo $1,000 per transport. Air Ambulance 100% after Deductible has been met. Transportation costs of a newborn to the nearest appropriate facility for treatment are covered up to $1,000 per transport. Pre-service Notr,"ication is required for Non-Emergenr~y Ambulance. 4' J r ,~.1°~ w -}j-r, p ,~~-.r~:.._-j-~~ ,b. ar ^' F ^-t's.. '"F' C~ *-r,L str'?v.F-i'1@Cd a. ~" ~Ti~", r..ii. 1 Y-~7 _~l .c ~ r;'n ~. ;i ~~itlt ~r`~~~.~~11517 ~// r~t 1/t~.. I°i~ V ~ dl~ I z hr~l9~- 1~ f~e~r 'v t} -~+~ .J:f fiS fy ~~ ~: ~r ~.i(">~r ~~ i ~ h~ ~H'~~~, Ht :~t fi! , -i ..... ~.c-l; ~:L.'_'>L _. ....,.>77. ~,._ia.,~~.,_~;..~.,=.~.»~..:.~ '.:,~~.J'7_. :i._,._. ~`~?7~_.~.f'LS..~.L.l:~ ._._,C~,w.:.ll._v_....,_~._.._7 L 'St~~.~.... ~ ~S F.i~ ~r `~P =_~...... ~..__.. t,S _:~ 100% after Dedu ;tible has been met. Y rl~y~.~~~~ ~aY'r t ~r9'.`~' ''il.; r"(~°'TM'r?".~_ ~'~~~'?'r'`~,sit,~. r+-^~`a~' [?rtc_~'h7~F ~'F"TiT~i "'~"°'0jR~1'i`j*-~-~"{r'J~T r-.sr r ~..~ ~ _;1 ~. Jr 'k~"~'~ }'ki~l~.7~( ~Sr]5ari~(rnt- ~e~~7 .r 1 ~~ `ht.t,lm x S -r.ni[f-t~,f_; r~' ~t_t~ ri fi~~ y {__ L. A +-TKi.j.:5..,:.x~i (~ l ;r •,. ,. Y hh .._t~~r .~.W<. L:i r r ~ =7F~11.rv., ...N ~~y?-1 r~' .~~~.SL_~ 7'"'~. ~`ia-t-r rh~S ~T~~~ny~~1 ra ~r. .j,_t.~. ~-4r,.5r='~~"~"'~~ .>~_`~'r -n~ S"h ~" F ".;, j 4Z, Cv+t~~ 1 ~~ Benefits are limited as follows: 100% after Deductible has been met. $3,000 rnaxirnum per year $900 maximum per tooth Pre-service Notification is required. °Fv '~J ~-~~xn _v~ e^~ ^c r'Yr; ~--,1.~- rr T "~"h"~c'f FX~~T4 :-~zt^r-t m ,tu~'~'ar n^-r~~c'-^---~~' ;~z-~-^~^p .sr~`j~I>r' coil ~µ~ 7!m l- L r~.-7 ¢~ ~ ~ , e,} J.rti,r ~.. s _f V,; '?i ~,1~ ~.. /ski ~~xi.. .sv'1 jL ~r :.1~"T~ r ~Y ~i ~H:~:~j ~z.L,.~~tl it }zi. _i" r` ~~,ry ~13~ .,~~~' r,. ~, '':''r._~.__.a.~jY .`_1u~ y..~_.~~._....'~.::~.~c.~~:~;v.s.y.... F:isd~i~r'~'`~.._.~._...,,~a..~':~~u.~r_m..,~.. i - - L~.._..~c~~' ,.....ter __.... Diabetes Self Management and Training Depending upon where the Covered Health Service is provided, Benefits will be the Diabetic Eye ExaminationslFoot Care same as those stated under each Covered Health Service category in this Benefit Summary. Diabetes Self Management Items Depending upon where the Covered Health Service is provided, Benefits will be the same as those stated under Durable Medical Equipment and in the Outpatient Prescription Drug Rider T J: } ~ 9 7 ..'f{~l's, I; I u ti = ' I" t/~~ J Y~~ F s-~7- r'Y1~"A~. r`T"t °f`S~ll' .. '.Y ~ ~K I 1 "'{"~ IhS. ~"~"i'P~.~ ~T"P `L~~ ~n ~t/'~ ~FYZ,~n Cc7 0 ~i ~ , ~a ~, Jl kl :' J fsY~"('r,~~? ~.>•1~.ry~ {~ `~ ~W i ~ J 1 G~~.~~ 7f t,.,~,~ F t y ft~ilt R}. .~~` ~~ :vr 18- 1-'~. "n {t'-a I fC ~l ~J ~ A'l ~`~l ~i .l k.~~'~ i1 a ~~~ t~~,. (~ 4 ey~rl-.~~ r ,r . `~',". ~ 1 :fir .+~ v .i~. ,~~,_ _ _~t ,1 ~` r ,... _:,L,_ -+~X a ~~r, ts.v~t _a r-S~ .rs_.,~.rr.rYS~F- . ~n--c ~. ~ ...;7:Jre _ x , ;.3 Benefits are lirnifed as follows: 100% after Deductible has been met. $2,500 per year and are limited fo a single purchase of a type of Durable Medical Equipment (including repair and replacement) every Three years. H~;`v T~'.^'r.'-`,r x s 'Tt ~ - m-v, r ra=' sF -~, r -,.~c~ z; v .r~~ n •~-~ r -s -r ~:1 yy J ~ ~ ~P ,jt~ -3~ - 7 y,"T~!"r~' "I 7f .. 1!t 7 .. L c ~ t+^ e ~; i lw "'°'T 2~ -i,.~x ahl, i h?-. ~ '{--T ~ : ~i,l ~;-l,Sa~.~ ~~SS.lci~~t~f;,,. ~~ra.~t~it .;~,,+~ a~'~z' ~='i;~ fJA ~' ~r,,ra _ } i,~ ti~ z rt C,jl ~.,_ ~, ~ ~$,J~ r: ti~ zt.~t"- ..~,ru...::~'{.~rt. `l. w-}h`~_,.. 5a~:.~~~a ~,~ ~ 1-iifi~ ~'" r~9'1~_'y 'i...~x [~ iY~ a.~.. rte. !.K?:.x ~(~...;~.~ri ek _s.Y~._-~:~ u.u Benefrts are limifed as follows: 100% after Deductible has been met. 60 visits per year >;~-.x~+.,.;m.. ~, yJr ~,,,_..,.,,_ r~ ~ ~ ~"" -, .3TMPr1 ~"'~.:r 1 ~ CA' . r c ,i. 1 "=:' r~ ~ i~~ tt1 ~'S` r`Y7 Af-~~^~i~ r,~vt v~ ~~1P~ i`y 1 c^~v ^[~ s~ y .r--~ .,(r'T7;T p S .v"a: air }~iTl:'~" s~T~r6~~ rh,F'-i.~ _ ... ~~.-,~ <-4~~ rro~ .ri ,~ ~-: N J. i ~r~ 1 -° rC' _.S iyy., ~ ~ ~ ai >c,: ~ '( li -t ~.. A;.~•• t f, i . ~ r ;._,~ ~- 'i•.,, is -} ~x 7-i - .~. .~--.:4.. ~ 1 1~. ~5~~ "S~~'7 4 ~-7r i J a z ~ 1 ~ :Z ~ E .;.I ~L'ik._i._~iS~-.: ,Z; t ~~irf't ~-:~kv- ~." J~ (ti-~.: ~ ,.._~ ~ ~ T ~4y,__r,_~.. r, ~~,~. ~~,. _.~:_l 100% after Deductible has been met. YOUR BENEFITS ADDITIONAL CORE BENEFITS Types of Coverage Network Benefits )~ r ~ i 5 ~:. ~ ors »Z--~ rr _~R~'{' n' 1`TI"f ~Sl s .~: r- tr ~...- I r f ', •I' I j~.l l-I ~ I TI rl~( I ei~S~lj ~~FS ~fL{I ~1r1~1~~ ~11,t. M1 ~~~~ rl ~lf ~~~.~.~'.~(r'}r ! ~ i _1~ J I~-1 1 ~: it i ! ~ ... ,.._.._..~... ~.._'_~ I. ,.,_ti. . _ ~:. .._ ..-. ... ~,.~t.~,..4r_....~___.,1-1~,. .~:J.. ~~_ __„_rr ...._ .a,__r~~.._.. ~~.....iL _L.r...i~.._...._,..__„~r.L .~... ..__r_.. ~..___.~___ :L.., .* Diagnostic scopic procedures include, 100% after Deductible has been met. but are not limited to: Colonoscopy Sigmoidoscopy Endoscopy For Preventive Scopic Procedures, refer to the Preventive Care Services ' category. ~ ,; v-.~.>-~ -~ .-.ter;-' nor cM : -. ~~:~ , n" iT7 can ~'"`"t"ip i r am.+ap'-zr-'..^~*^ , 'F.. 1v ~ T j ~~ ~ i-' c F .'.I ~~ i~ I~! 'd~~.~4' I~Jr ~((II I ~x. +~y~t~y~y11}y SI ~~~~'_"1fr~' T ~~]}1J`jl .. ( ~ /~ _j"Mi i1~ r '?';`~~~J;j~tir rr~:,~ tI ~ ~ ~t' ~ ``,.!'; ~' i~. til `~-1," ' r'-~ ~.:- r~. 1Y I j-1 ~y ',Y ~1~~~Y ~-.SI + I.4 ~. ~-.f~ l-I ~~{~~fF '~,r~yr'~~i~- 1~~~~{1,~~~~1.u2..u .~'.Cy~1.~:~~t_...~~~nl `~. 1.r_~cl.~_s~.l.. f..~. u...r~...~_i~u.nr:Wt<~ ......~r...r.l_u ... J r..... ~ .....~...... _,..~1.Es........ u~.._.v.~L ~Jr..t;~.._L..14:1.n..I__4~._Ja....... tt_.u. ...c...a.... -L - Benefits are limited as follows: 100% after Deductible has been met. 60 days per year ~xti-^-:,Y~_s 4. rsml.- tr,~.r.t,.-.,.,.~ ~ .p.~.~ .~-az^a-..~ 11{~Sf ~{f?'3')ri .I~si:'..3T~}~,~ - Lc .:~';°. dv: ~°._7l'F7`~~rt,T1^"F{i~~ hr_~y :r ~ 1~1 ~i'."rA R rYi"~ '~'~.lt ~ "I r-.~~~' ff ~f >°~~I f i-/~r ~+f'~`( ~~w3L,~.).t'~L rs3"~y~1~:',c"r~3>.Y~~":4~_~1r ''~~.E,.',:rs~`4e.ttc,:~I~1'YSn..:3"~' er•-,~~:tr r3r~,.•ISr !F k y~ ,!v.~ t -:~ :~._......... ~~~~",~vr~'r.. ~_.1:L..:xa,.z~.~.. ' ,.~~ r7..1~:~....3`Sr.~ ~L~. ~.cr.~-=,.v~:1L'~:I~ f SP.:iJ,.....c1.3>~~:li~:!]Y_.:.i.tlli::_.~1'.L......1.~c:.'''~`~=.~5.r'.~i.n.1...._r,.. .....J......s 100% after Deductible has been met. n p -•.'.~- _.~ ai'~ ~ ~ ~'.~?~-`r~~r i`~'~'sl^~:u l ~!r"'-"n+.j'C'r{ ~ ~°s: ~.~ '~. t!teTG"f`^'i; ~~~~~°}~Sq,r-!~•I Lrr~'~t'^'~' _rrr-~rn ~ r~-~7'v'~"° ,T"' ""[` ti, t ~ - ~ 1 1~:1 fir, ~ ~j~• rai +_ r Ia dr 1'1 ~. ~ d,a a _~: >U,t~~t ~~ t4~~ .r~ ~'t i' S k „?!~_..'I C' ~ ~j it ~ j:~~~,, ~~ r. l~ll L!, ~ ~=~s~x1 r ~J ~~.f~~ ,f- j'?~I '4~f~ ~ ..t,.~~vf/, `~a~.~.~...._`r~ci,~ i::i:...._a~:ll:'~~iyr~.,?!i?.r..~.:rtiH,~~..~'`.r.'i'a~:~s.;,.rc. II,..~.,~. L~o~..~ r 4 i~1 _..~_.._.:~...._r .:_L_:~. .,~ .'. .,nom ...r _-.4;.~:..::ica:_7.-2; _. JS "~ v ._.._~ Therapeutic treatments include, but are 100% after Deductible has been met. not limited to: Dialysis Intravenous chemotherapy or other intravenous infusion therapy Radiation oncology , yr ~ .. r, .s-~tcr yr ark- Ki' B".7ra7'~"'t ^..f,~.n s--~ L`~- !r°t~ zt'-~^cxi _ i... r^-~^„.--~ T ~ >rj cT"~t - j a )?i C I ~ r I~ r.~5 ~1 r . ~. 1S 1 1 rr -..._ y. _ cr ar r v !i'+' z, h 5 t r ~~ En ~- ~ _. r r . i ~ LLj ' .:. w I ~ l 'S i ~ t.. _ .u t i r ~ . ~ ? jtfi ~. t --r ti'F.~~;'~ ~"^ r Ji YJ k .: ii r i t r - y .. t i :{ ~_Jf~....';-.r~,.-..u Y._a.~.-_.. ...........r ~' ~.ri.~ru. 1 Tr l! ~Y~ l_~ ,V.~ ..c2~__.~.. "lr__..,s..,_._..,-_._1~k..i~iJ.__.~.-.rr.~...__l._..=_...__._ ~ .._. ~. 100% after Deductible has been met. For Network Benefits, services must be received of a Designated Facility. Pre-service Noti><cation is required. C' -5c,.,,~ >,' 1 ~ r:. - ~?-~,-rv-~ c _ ~`~AS-r^.y^ f>,.,-P'~"4F3-m,.. ;~ ~°`~~,~'^"S,T~ e.~v~t1 _r„ ~ r ?`~ ..~ -r`', i '~'f J ',F' n~ i;P~ r1c- t p 1, 11~ Ir tt L` -I y3C f, Iii "~ ~ 7`~'L uXi 11~r i%>1'g r.- ~ ~1~ ,r~-~ S~. i s l v r1 F.~ Qti~E~w ~ Je ~ r t ! f .r: a r s ~. ~ S X41 x. ~~~~ 'r'te .f,~ti.J rr5 ~t ~tr ~ : co, ,t >ra,..,;,~=t~~z ~',:~ a ~.,.. t r - ~ k ~~1"r. r_ ~,~~,,~1:.s_.cv ~' ~ ~.,y: -y~~uoc...'Z,.J...xi.....:__~...:::: ._,t~....i '~.u -T_v..,i:?L;>._~ __~air~, =.~.i~.3 ..u.~,ybi~'~e..~'a..~~~_~~ u -~_n_a_.::::..~~.:~'' Benefits are limited as follows ! 100% after you pay a $15 Copaymenf per visit. 1 exam every 2 years YOUR BENEFITS STF~ fE (~9AND~`~TED BENEFITS Types of Coverage Network Benefits ~.:i ~ ( j-T-t ~t 1~} t I+I~~ illy ~7--~ +~ ~T i. f t -a 7 ~~ ~ ~ ~ t ~ ~ ~. i _ G .. ii ~ ~ ~ i 100% after Deductible has been mef. Pre-Service Notification is required. Benefit Summary is intended only to highlight your Benef is and should not be relied upon to fully determine your coverage. I( 3enefit Summary conflicts in any way tivith the Certificate of Coverage (COC), the COC shall prevail. It is recommended tl`lat revieU/ your COC for an exact description of the services and supplies that are covered, those which are excluded or limited, ~ other terms and conditions of coverage. A9EDICAL EXCLUSIOIJS CON fINUED provided as described under Durable MecJical Equipment in Section 1 of ti'ie COC. ° Diabetic supplies for avhich Benefits are provided as described under Diabetes Services in Section 1 0( COC. • Ostomy supplies for which Benefits are provided as described under Ostomy Supplies in Section 1 of the Coc. Tubing and masks, except when used with Durable Medical Equipment as described under Durable Medical Equipment in Section 1 of the COC. E, ~- 5 T r -~ Y ~ 1++»-,- y~ r~~ 3 ~ v ^tv.^- .rtru^a,x7'1 s i i I~ i I f ~ ~ ~~ t• X ~I ~~ d ~ G ~~ _ r~~ ir~,4 a i t~~ 1. ~~1..~~ L~~!.t:.:i.;~.v...~`~`~..,.,~~....i..yR".~i2~ ._.,il ~.:,.~^;.. ~.~~~.~,...t ,.,,yi:~?'~I.Ir(?'(iici. ~ ~`~~~ Services performed in connection with conditions not classified in the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association. Mental Health Services and Substance Abuse Services that extend beyond the period necessary for short-term evaluation, diagnosis, treatment, or crisis intervention. Mental Health Services as treatment for insomnia and other sleep disorders, neurological disorders and other disorders with a known physical basis. Treatment for conduct and impulse control disorders, personality disorders, paraphilias and other Mental Illnesses that will not substantially improve beyond the current level of functioning, or That are not subject io favorable modification or management according to prevailing national standards of clinical practice, as reasonably determined by the Mental Health/Substance Abuse Designee. Services utilizing methadone treatment as maintenance, _A.A.M. (1-Alpha-Acetyl-Methadol, Cyclazocine, or their quivalents). Treatment provided in connection with or to ornply with involuntary commitments, police detentions and !her similar arrangements, unless authorized by the Mental ~alth/Substance Abuse Designee. Residential treatment rvices. Services or supplies for the diagnosis or treatment of ~ntal Illness, alcoholism or substance abuse disorders that, in me reasonable judgment of the Mental Health/Substance Abuse Designee, are any of the following: • Not consistent with prevailing national standards of clinical practice for the Treatment of such conditions. ° Not consistent with prevailing professional research demonstrating that the services or supplies will have a measurable and beneficial health outcome. Typically do not result in outcomes demonstrably better than other available treatment alternatives that are less intensive or more cost effective. ° Not consistent with the Menfal Health/Substance Abuse Designee's level of care guidelines or best practices as modified from lime to time. The Menfal Health/Substance Abuse Designee may consult with professional clinical consultants, peer review committees or other appropriate sources for recommendations and information regarding whether a service or supply meets any of these criteria. ~~-l' ~^~t~"~~,~ f^p-iiiaJ„~.~ ~ ~~T.f'-'E' '~~F~`.1~ ~ et+~ ~'~-lie. ~u ;;,~~.Y Q T~~r-'3~~i-i'~w~k~ ~ ~r=.itTA~"'~ e~ . "~~~~`_'1ts- '-'~ividual and group nutritional counseling. This exclusion does apply to medical nutritional education services that are provided by appropriately licensed or registered health care professionals when both of the following are true: • Nutritional education is required for a disease in vihich patient self-management is an important component of treatment. • There exists a knowledge deficit regarding the disease which requires the intervention of a trained health professional. Enteral feedings, even if the sole source of nutrition. Infant formula and donor breast milk. Nutritional or cosmetic therapy using high dose or mega quantities of vitamins, minerals or elements and other nufnhon-based therapy. Examples include supplements, electrolytes, and foods of any kind (including high protein foods and low carbohydrate foods). Television; telephone; beauty/barber service; guest service. Supplies, equipment and similar incidental services and supplies for personal comfort. Examples include: air conditioners, air purifiers and filters, dehumidifiers; batteries and battery chargers; breast pumps; car seats; chairs, bath chairs, feeding chairs, toddler chairs, chair lifts, recliners; electric scooters; exercise equipment; home modiFcations such as elevators, handrails and ramps; hot Pubs; humidifiers; Jacuzzis; mattresses; medical alert systems; motorized beds; music devices; personal computers, pillows; power-operated vehicles; radios; saunas; stair lifts and stair glides; strollers; safety equipment; speech generating devices; Treadmills; vehicle modifcafions such as van tiffs; video players, whirlpools. ~ ~ _u S P4 X_~~ F Ir A _, t ~~~ Cosmetic Procedures. See the definition in Section 9 of the COC. Examples include: pharmacological regimens, nutritional procedures or treatments. Scar or tattoo removal or revision procedures (such as salabrasion, chemosurgery and other such skin abrasion procedures). Skin abrasion procedures performed as a treatment for acne. Liposuction or removal of fat deposits considered undesirable, including fat accumulation under the male breast and nipple. Treatment for skin wrinkles or any treatment to improve the appearance of the skin. Treatment for spider veins. Hair removal or replacement by any means. Replacement of an existing breast impfanf if the earlier breast implant was performed as a Cosmetic Procedure. Note: Replacement of an existing breast implant is considered reconstructive if the initial breast implant followed mastectomy. See Reconstructive Procedures in Section 1 of the COC. Treatment of benign gynecomastia (abnormal breast enlargement in males). Breast reduction except as coverage is required by the Women's Health and Cancer Right's Act of 1998 for which Benefits are described under Reconstructive Procedures in Section 1 of the COC. Physical conditioning programs such as athletic training, body-building, exercise, fitness, flexibility, and diversion or general motivation. Weight loss programs whether or not they are under medical supervision. Weight loss programs for medical reasons are also excluded. Wigs regardless of the reason for the hair loss. :;'Ci ... Excision or elimination of hanging skin on any part of the body Examples include plastic surgery procedures called abdominoplasfy or abdominal panniculectomy, and brachioplasty. Medical and surgical treatment of excessi~~~e sweating (hyperhidrosis). Medical and surgical treatment for snoring, except when provided as a part of treatment for ~ } ) , r ,I } I I t J:1'111 ~ f l i ! ~ ~ it 11 `) I l l ~l~ t ~i:. , I :.~y t. i, I - J ~I _ ., _I. 1~r1_ ~.W ___..IJ r....__ '. ~_ ...~ => The Annual Oeduclible, Oul-of-Pocket Maximurn and Benefit limits are calculated on ~ calenc!ar year basis. > All Benefits are reimbursed based on Eligible Expenses. For a definition of Eligible Expenses, please refer to your Certificate of Coverage. MOST COMMONLY USED BENEFITS Types of Coverage Primary Physician Office Visit Specialist Physician Office Visit Network Benefits 100% after you pay a $15 Copayment per visit. 100% after you pay a $15 Copayment per visit. 4 : r I -h~'Yn' t CT `T' t 'I "~ aT *°7 rt e 1 [ ~ L ~ F~s.~,- s. _'r. l { { '~ ~ ~ r I, ~: m i ~ "C '~" .~ { ~. r I tiJ` r{ ..~-< r{I .. !~,' ftY -: ' .t - , I ,, ~_F._ ., "- I~ rt j ~ } I l i ~ 17 7°r ~,F r~ l ~~ ~,"~~ ~ e I K j, cr 5 ~, I~ ~' ~~ ~ ~ r~ ) ,~,~~..,~ ' .~~ ~.~.,`~__::...1~_~.1;.~_.I_~ ~ 'r:r.,_. ~ _.~? ~.. __.._.~ ~ _ _ .._ ... r F .. l~.i_._. ._ Covered Health Services include but are not limited to: Primary Physician Office Visit Child Health Supervision Services are not subject fo any Annual Deductible. Benefits are limited fo one visit, payable to one provider, for all of the services provided at each visit. Specialist Physician Office Visit Child Health Supervision Services are not subject to any Annual Deductible. Benefits are limited to one visit, payable to one provider, for all of the services provided at each visit. Lab, X-Ray or other preventive tests 100% after you pay a $15 Copayment per visit. 100% after you pay a $1 S Copayment per visit. 100% Deductible does not apply. ~~yrt / ~' .'+. 7 1`,r~~ y ~ Y ,{ ~,1 ~ t ( 4~ 1 a,~1 ~ -L I I ~ ~ `.7. t JGirT i k7. 'tl '"i". t ` IuI _:d ~~j~r~~`~,r ~^,~~, ,~1 y~"~~- _l~',` L r~ l lit' I.~:`n~.~. I ~1 I 4~.~r iii...' ~t ~~'~_~i,G~~;L _.:.i. .GF...~~~y:.u~,.~~_:ru.~.,.._._l._+.~.,i...._1~~.~..~.:.1 1 100% after you pay a $35 Copayment per visit. ~~ ti:?<,^~'S ~, rrT: .; -' ~ r°'v.; ~k.~.r)'~'i- "f-:.. ~ anr_n~°r-~. a^-3~''~-. 1~T~'~r ktr'7' `fl~r••l"~., ~' S1 ,~~ l~ ~'-h'~,1'~~'(h r~~T { { _"a'"- ^~'~ ~ it S~~V } 1 {i I~r f 1-- --v 3- F r C I r' r I V} T 7~ ~ 5'y ~, I .^r f i ~`.N~a -+ II t,E.. ~ I `l f1 ~ ~d J }I ~f ~ C' 1 1~1`9:~-q-l~ ~l. ,tiP .+h Srt_;~`~j ~i1 .~ `Il 5 j.y} I:.. ~.. .~' 'L t^' ~ .it G r~ L`F Y .1.~~,. ` ~. t~ 1L_~.?t._ }`~~~ h l-~j.~3i^~~~.~1 . ~ ~v4 '., ~ ~ ~ ~~h~.l::J~~C'~l ~l!~rr~:.ALL:~r]~aL ~~Y^Y.]i-y~~~i~ :~.. ~1- ^v:.]Ll~ Liu__ 1'_ .~A:i 100% after you pay a $100 Copayment per visit. Pre-service Notification is required if results in an Inpatient Stay. r~dF - s( 1-.. --i.°r„2"~-r'~(°y rtG~ :{C" T°i } i"3-1"~ ~"1~ f'7F;'Y yT k?z7?`6 .1 ~-s-.".~'~-ar.ill'~~ Ffe'~17-~, i~ J~ rr `n~-'w ,L~f t'rs°<~--yrii~?-r7 .T.~ ^°^.'-c ltr ~ rf,. ~` , i t_,_i ~~~ ~.~-( 5,~I Z; ,~~ I CI F.J IY ~~ ~ Il I~IY~Y11 }~ c: ry4 `Y}i .j1f ~1 1- ~ at)7 k~ r t~~:l S1Y .~~ YiiT~,) ~+ll! r-r~( J L .t..7 1. 2,` a lrYktr ('J.~.._.~..14..__u_ l ( /`i ,r h: r) i h 3 - I ~ ~ S4~ .,~ r ~,- -;. ~::C,L__:v',«_`._a:.,;~d:,~~,.~~., :l».~~., ~.::) ~,: tl,... ~iw1_ 1_!r-.3r.P'+~=-,~.z 1~F. ~,3. T;r ~.~ r ,f4i~.n 7r .%4 ~ ._i~e fql~~~ cir _~ri_.c~.~...~.-G..!:~.,...c.~_ ~. 100% after Deductible has been met. ADDITIOPJAL CORE BENEf 11 Types of Coverage t~letwork Benefits _ For Preventive Lab, X-Ray and 100% Deductible does not apply. Diagnostics, refer to the Preventive Care Services category L~ t ,`'i~ I!1 i_i`~~ i yt t ill ~`Lt~a r ~ 1 I liT 1y l,li t I i I 1111,.1 'Itl l 1J~..~.1_ ~~ ,..~ . I lt, i _, .,.. 1,. ._,.~, .~ ._... , . 100% after Deductible has been met. , .... .. , ":" r: .. ;~_;1 ..r.., ~~~... ''_.vl I._ v--i'I f. r.: ~... 'i.~, .. , .... )r 1, r _ 1 _ Benefits are limited as follows: 100% after Deductible has been met. $2,500 per year This includes medications administered 100% after Deductible has been met. in an outpatient setting, in the Physician's alth Agency f~lo°:~`a~~7bIJ~HOT`el i1~1~~ ~~T11`~Irjlj,yl~.~ti1~~k. 1 1 { 1 [,il~i ~ i`: f'. f,- ti ~ ~,~Jf .._ ..c„ .~ ~ J.. 1 Y ~f ~ ~ ` (1 ~ :. ~-~I. ~ ~ ~ ._ S L...~,:;i~...~ ..f."r.:. __..~....~~.." 4..._ _:~'.~ I . ,.~~-:. ~tY~.. ! f i f... Jt_ ..,.. -::~ ..... ..~... L4.! tf.u.1-.1,-~_`C....._..,.... _1.._~_r1~-~`....~.~,Y _...,... ...1,~ ~ ..~ .......,. .. .~. 100% after Deductible has been met. - ,~ n i > .u .+GS R .:T r ,.,-C .i"-y 1~ nS '~,^"~ YC , S'S -n Rti. .r T'.r^^n, -7 ~~ F T. 'Y tr ,K.~ipc 21 ry, ~r 1'~ 'lll: 7 Y ,~-. :r ~ ~7 7 jl ~~~~~lrTi ` ~J.'1JJ~-~/,~'''1113r°~~'„i 111c~~r,~ r,-~St' 'r .~~.~. ~'y I~,:~ ~t 1 _~~~c t -.!: t ~ I~!i!~ F ~ v11.~~„..=._1 {..9..,..,_~;~ su.?~~..y, ~~`r_. ~.~ro _..~_..,:,i. ~1 ..~.~_.~.. _:i t.~.L: _ ~ _ z__ _.._,_..__ .a..~.~ _.t.:..~ ~~_,... ___tal~s....i.. ~ , :-._..__.r ..Y..._ie, ...~..aL:u,:..l_s_..~...,..a:..ri.,....1.~=.:!._.~.. y~~-... Depending upon where the Covered Health Service is provided, Benefits will be the same as those stated under each Covered Health Service category in this Benefit Summary. For services provided in the Physician's Office, a Copayment will only apply to the initial office visit. `i;~ ~ ~ r ~ r F'fr I '-"F r -m'~ `. C~°_"5rA '7 cC' ~-~ "k~",; Ffr~ nj 1'"n-- r T-t'~ S _I', ~ a - ~a L f~ . t 1 '- ~,_,.t,~~J'' ~ t i J r - ~ u t - e [.k 4. ~. a-to-+:' ! 1': '7- a --J. ~j _ir~. x~jt f~~l~l t~1 .1Jt1 ?,'.. )1~6-~w~ t:~J r it f ~ S .. rt~r r ` ~...,~..~ .~+~,~,~'C_~.~.~~i...y_...~,.::i,._~,. _..>c:.~.~..~,..,K~.~~~ . -_. t. _.~ hr~..~ ~.~z LLa. .i..m .u.>, ~,. w.r<`:-\5 ecr,,,..1c_6i....ye~..~1LSt~, l.lr~.r.._..~,._-~iti~.t.,.~.__ Benefits are limited as follows: 100 ~o after Deductible has been met. $2,500 per year and are limited to a single purchase of each type of prosthetic device every threes years yM ay . ~ r r Fr ETC' r t a A: :1 ~ 'S 'S C'7rd t-t• . _ ~ t : n ` 7s-1 .. _ ~ rJ. -r ) n 7~ii J f Ir ~f nfj.;~l~.t rr7~ la !; rbr` ~:, 9~ 'r.» ;,, t. :, I,• t,lt lilt ~ i u. rRlc.r 14 Tr fi.l ~ Tom:- t 1- 't ,i..±. ~S „~r_.,`'~ ~ ~.~~. ., 4 :L1w~l.~.o-•..~.1~..~.w1>__..__J7.....lx.~:Y~7 L.xV_.~:e.~~~1~nolu...t''/..~L..i..a._,~..i'r~~."4W_'Lr~:1 y.~r::f-1...~sF -r.. 5~~1 _vvL.._1 --"/L€ ._.uf..~. ..a, .J. _~- Depending upon where the Covered Health Service is provided, Benefits will be the same as those stated under each Covered Health Service category in this Benefit Summary. III?; t r~ Ay+~x. s ^r.'. .- ~F'!"F ,3`. 1 ~` ^~ f X17 ~~(4 f; ;-~ '.'1' T<"`~ J-,-~ _ f-~ ut ~ r.7.t.-~+ snr_„ v1T~•~ Y~t f i t ~ t i 1 I . ~- '1 P ~~L `~ 1 !G a i ~ ~ ~Zac~T~~ IIII' 4~1~~~ ~~rJ1y.~-l r ~a~rJl i~l r t^~4 f~¢'~ft~l~ ~.~~J-tr~„i ~ ~ :o-,1 ag~1K .Ys~ `r17 }~...ui:;r :,.L~->..~_.. __~u=~~,. ~ ~ ~ ~. , ___ _ .,7`a... ~l'SL:1•_:~ Yj:.~~ _. - ~t L~.?.-..i+~:-:~•s,~,~:a~'ti~!__.~.r___ -"~'~ ~ •-- ` Benefits are limited as fo!fows: 100% after you pay a $15 Copayment per visit. 20 visits ofchiropractic treatment 20 visits of physical therapy 20 visits of occupational therapy 20 visits of speech therapy 20 visits of pulmonary rehabilitation 36 visits of cardiac rehabilitation 30 visits of post-cochlear implant aural therapy ST/1TE (11ANDATED BENEFITS Types of Coverage Network Benefils - [ ;f I~)III~ 4 1 Il ~~ f l r''[I('ly (lt-)J tt l~ll i t I ~~ r .._,._ __.. ...._.._ ,__ z. ~ i i ,.-s_ UJ-_ . _..~~ .. ,., t. ,.... ._ I ~...,_. _,. ._.., _, .__.. ._ ,~_ ., ..... _ ............ .. i ... Depending upon where the Covered Health Service is provided, Benefils will be the same as those slated under each Covered Health Service category in this Benefit Summary. Pre-Service Notification is required ,z n ~r tk v 7 .1 (irr f I i• 1 i-(f ill a `I t~ F14/ rllii~~1 it I~ l .i, iy ivt ~. r. , J i I~ -rl ,, . ~.., _ ~ ._ ._.. .._..~ .r,.r. _+i_ ._._._.~.:~. ~,..1 ~~~ u,~_,._,. ~... ~_,~~ „_ r_ .._...._„~.. ..,~.~„_~ ~~~.~ .......~,..~~.... _, .~__. ~,.~~ ~._,.. .._..~.~... is i. ,,..._ .. Depending upon where the Covered Health Service is provided, Benefits will be the same as those stated under each Covered Health Service category in Phis Benefit Summary. Pre-Service Notification is required -r..t' t ~-. ,~ .-5 vF *vr, ~r ~-.~ ~ r- z rrr -. .r, i r ~s ~ ~s r .r ;- t^ ~ t ., , I I I U C i .~., x i b., i t r.. I ~ - i r u~ :r: ~ .. F r~ ~ .. c a r, i , tom. 11~ {, ~'(~ ~ f`nLx,f r~ r ~~~ s ~r ~~ rer, 1'. y tl k 4 r I ~, i lr : r ,.~ _~. 4 ~ F', v ~ J t _._ _....~.~ .J.J-e..i..l,.. .;_'.~~~iLFsa.._i.~~Z~~3~ ~l ..~.?L:c..r,____..::_l.._1~.i _~i..~_.n.,.......~.._!~, t,.~..~.._~.._.Y:~i.......~r....~~.~~.~..~li .... ._ ~_i.~_.L:......u..a _ .I._t Participation in a qualifying clinical trial Depending upon where the Covered klealth Service is provided, Benefits tivill be the for the treatrneni of: same as those stated under each Covered Health Service category in this Benefit Cancer Summary. Cardiovascular (cardiac/stroke) Surgical musculoskeletal disorders of the spine, hip and knees Pre-service Notification is required I i' 4 51 >:J ~ ~'~~(r ~ ,7^tl~ L Y,. r `C ll='..~r ~ sv~`.:~y Y ~ ~r ~~ - r i f ~:- `r i~.r~ "( -,~ ~ r J-V d 'l r ~ .II l~ l~l~~ t~ ~f( ~I~f~rr~ ~~I~r,lat Xj ~,~~~~~~,1~; ~J. , I ,~, r w ~} F..J~ ,r. _ , r .._ ~ ..ea.. _~~. ..~ _,e, ~.:~_:"~L .~..~.L = _E_.._i...4 ..:_,4.~.,_.__<~G i i`1 ~r_.u.~.~~ ~_:.a~urv..c,l _._:.?! .~~~sfLn..r .'t iF~l..y..,......:...z~_i~_.L~-:.Sr~.=.~iyt... ~!~ .a.~_ ..L_:~.~,. .,. ~, f.. ,1.~ Depending upon where the Covered Health Service is provided, Benefits will be the same as those stated under each Covered Health Service category in this Benefit Summary. Pre-Service Notification is required. ~ 1 .' C ~,.r - ''-; _T 'T' ,y l cY'-mra5 "4 x r ~ 1. ~ ~s-+r- a ~ -f E'~";'t : `P" r ` f ~ f ` r (J ~ .:. l I ~ t 1 i r l~ 'r l J f 11 i ~--7, 3,~ ~ r f T 7 ~ ~ Fri ~~ _,), 1 1 aj,H ~`~ ~1,~_ ni ~). 7 ~ ~ ~ 411x1 s I K ~~ III it i 1 t ~ ~ r/ r !a r ~ -` ~ ~ ~P . "1. ~ ~ . t , _C 1 C ~ ~,: 7 >~ ~ i ~ w ~~ r ' - , Benefits are limited as follows: 100% after Deductible has been met. 30 days per year for Mental Health Services and 30 days per year for Substance Abuse Services. Prior Authorization is requl~edfrom the NlH/SA Des~~nee. F...rr ytt ~rn'C i.~. ~~ ~""'~.= -~7~`-(Vrrw ~ cv-~sru~ rq^ -., (~'c _2 -t a ~ _ i~ xFi 1 t}t F 1 x:.,~~r,,;~~~4~~~ ~' ~~; ~~~ v~.,,~~A ~~1,~~C~ '° ~~It I~1` ht) ~/~ l~~Fi ~ 1 ~-`J~ i 61.~f` ~~~A 1 I r-tJ I r f~ , i ~`~1.;? F ~^ ~4 7 r 5 ~~ 1 ;..~1' F' { F! ~ ~ ~ ~ r:. L L 4 Benefits are limited as follows: u 100% after you pay a $15 Cop~ymenl per visit. 30 visits per year for Mental Health Services and 44 visits per year for 5ubsfance Abuse Services. Prior Authorization is required from the MH/SA Designee. MEDICAL EXCLUSIONS Il is recommended Thal you review your COC for an exact rescriphon of the services and supplies that are covered, those hich are excluded or limited, and o(I~er terms and conditions of coverage. I { h ~ r , , I ( ~~~ Acupressure; acupuncture; aromatherapy; hypnotism; massage therapy; rolling; art, music, dance, horseback (herapy; and other forms of alternative freatrnenf, as defined by the National Center for Complementary and Alternative Medicine (NCCANI) of the National Institutes of Health. This exclusion does not apply to Chiropractic Treatment and osteopathic care for which Benefits are provided as described in Section 1 of the COC. , I l .l ~ ~ f i ilT t~ tl ~. i ~l 1 .~.~..:r .~ ... _.~ - Dental care (which includes dental X-rays, supplies and appliances and all associated expenses, including hospitalizations and anesthesia). This exclusion does not apply to accident-related dental services for which Benefits are provided as described under Dental Services -Accident Only, Bones or Joints of the Jaw and Facial Region and Dental Services -Anesthesia and Hospitalization in Section 1 of the COC. This exclusion does not apply to dental care (oral examination, X-rays, extractions and non-surgical elimination of oral infection) required for the direct treatment of a medical condition for which Benefits are available under the policy, Limited to: Transplant preparation; prior to initiation of r~rnunosuppressive drugs; the direct treatment of cancer or left palate. Dental care that is required to treat the effects of a ~edical condition, but that is not necessary to directly treat the edical condition, is excluded. Examples include treatment of nlal caries resulting from dry mouth after radiation treatment as a result of medication. Endodontics, periodontal surgery and restorative Treatment are excluded. Preventive care, diagnosis, treatment of or related to the Teeth, jawbones or gums. Examples include: extraction, restoration, and replacement of Teeth; medical or surgical treatment of dental conditions; and services to improve dental clinical outcomes. This exclusion does not apply to accidental-related dental services for which Benefits are provided as described under Dental Services -Accidental Only and to dental services for which Benefits are provided as described under Bones or Joints of the Jaw and Facial Region and Cleft Lip/Cleft Palate in Section 1 of the COC. Dental implants, bone grafts and other irnplanl-related procedures. This exclusion does not apply to accident-related dental services for which Benefits are provided as described under Dental Services -Accident Only in Section 1 of the COC. Dental braces (orthodontics). Treatment of congenitally missing, rnalpositioned, or supernumerary teeth, even if part of a Congenital Anomaly. This exclusion does riot apply to dental services for which Benefits are provided as described under Cleft Lip/Cleft Palate in Section 1 of the COC. ultrasonic nebulizers; and ventricular assist devices. Devir_es and computers to assist in cornmunicalion and speech efr,~pl for speech aid prosthetics and tracheo-esophogeal voice prosthetics. Oral appliances for snoring. Repairs to prosthetic devices due to misuse, malicious damage or gross neglect. Replacement of prosthetic devices due to misuse, malicious damage or gross neglect or to replace lost or stolen items. i '~ ~~ rT. a:Y L ~ - i ~ Prescription drug products for outpatient use that are filled by a prescription order or refill. Self-injectable medications. This exclusion does not apply to medications which, due to their characteristics (as determined by us), must typically be administered or directly supervised by a qualified provider or licensed/certified health professional in an outpatient setting. This exclusion does not apply to Benefits as described under Diabetes Services in Section 1 of the COC. Non-injectable medications given in a Physician's office. This exclusion does not apply to non-injectable medications that are required in an Emergency and consumed in the Physician's office. Over-tl~e- counter drugs and treatments. Growth hormone therapy. .rprr'~,fiyl'~~ ~Y(! i({s R{SjpT?~Lj ~G-~,-xi. r~r ~I r~'7 ~ ) i - .r, yti~~; ~F l~y+~Y`~~~"~''l'.I IL, ~,~F ~. I,~T"~"'L:ss~~~f 11t~~_~I ^I t ! ~ r f l } ~ J ~.. -~' Experimental or Investigational and Unproven Services and all services related to Experimental or Investigational and Unproven Services are excluded. The fact that an Experimental or Investigational or Unproven Service, treatment, device or pharmacological regimen is the only available treatment for a particular condition will not result in Benefits if the procedure is considered to be Experimental or Investigational or Unproven in the treatment of that particular condition. This exclusion does not apply to medically appropriate medications prescribed for the treatment of cancer. The drug must be recognized for the treatment of that indication, and published within a standard reference compendium or recommended in medical literature This exclusion does no( apply to Covered Health Services provided during a clinical trial for which Benefits are provided as described under Clinical Trials in Section 1 of the COC. l~ ~~~NXL~T~ f~ ^.a I ~ ( ~ L a ..: I Routine foot care. Examples include the cutting or removal of corns and calluses. This exclusion does riot apply to preventive foot care for Covered Persons with diabetes for which Benefits are provided as described under Diabetes Services in Section 1 of the COC. Nail trimming, cutting, or debriding. Hygienic and preventive maintenance foot care. Examples include: cleaning and soaking the feet; applying skin creams in order to maintain skin fone. This exclusion does riot apply to preventive foot care for Covered Persons who are of risk of neurological or vascular disease arising from diseases such as diabetes. Treatment of flat feet or subluxation of the foot. Shoes; shoe orthoiics; shoe inserts and arch supports. ~- ~ guy ~:.~, ,_ ..~,x..r,. -:. + _ ,-..~ ,. a. ` ~ ~fi.~~..~ r ~t~_ Devices used specifically as safety items or fo affect performance in sports-related activities. Orthotic appliances t straighten or re-shape a body part. Examples include toot .~otics, crania! banding and some types of braces, including r-the-counter orthotic braces. The following items are 'uded, even if prescribed by a Physician: blood pressure monitor, enuresis alarm; home coagulation testing ~ment; non-v:~earable external defibrillator; trusses; i ~ , T ~, i ~ r1 ~r, ~' ~ 11;at ~ z. Prescribed or non-prescribed medical supplies and disposable supplies. Examples include: elastic stockings, ace bandages, gauze and dressings, urinary catheters. This exclusion does not apply to: • Disposable supplies necessary for the effective use of Durable Medical Equipment for which Benefits are f~IEDICAL EXCLUSIONS CONTINUED documented obstructive sleep apnea. Speech therapy except as required for treatment of a speech impediment or speech dysfunction that results from Injury, slrol:e, cancF=r, Congenital ,Homely, or autism spectrum disorders. Psychosurgery. Sex Transformation opera ions. Physiological modalities and procedures that result in similar or redundant therapeutic effects when performed on (he carne body region during the same visit or office encounter. Biofeedback. Services for the evafualion and lrealrnenf of temporomandibularjgint syndrome (TMJ), whether the services are considered to be medical or dental in nature. Uppor and lower jawbone surgery except as requirod fcr direct lreatrnent of acute traumatic Injury, dislocation, tumors or cancer. Orthognalhic surgery, jaw alignment and treatment for the temporomandibularjotnt, except as a treatment of obstructive sleep apnea. This exclusion does not apply to Benefits as described under Bones or Joints of the Jaw and Facial Region and Dental Services - Anesfhesia and Hospitalization in Section 1 of the COC. Surgical and non-surgical treatment of obesity. Stand-alone multi-disciplinary smoking cessation programs. Services performed by a provider who is a family member by birth or marriage. Examples include a spouse, brother, sister, parent or child. This includes any service the provider may perform on himself or herself. Services performed by a provider with your same legal residence. Services provided at a free- standing or Hospital-based diagnostic facility without an order written by a Physician or other provider. Services which are ;elf-directed to afree-standing or Hospital-based diagnostic acility. Services ordered by a Physician or other provider who an employee or representative of afree-standing or Hospital- ased diagnostic facility, when That Physician or other provider 3s not been actively involved in your medical care prior to during the service, or is not actively involved in your medical are after the service is received. This exclusion does not apply to mammography. Foreign language and sign language interpreters. z __ ~ ~7(i~ l f;.~~~'1~ti a .L ~, yi~.P,S i r ~r Kq? i. 7 r~ n _d r ~..c r7 y -t ~l 7 c ..Ih z' 7 .~ f ~ Y G ~`!.S>?^1~.a. S.~ :t ro.Jc~~,._..._''..L. l...~:.Ci.~.. ~2,..a., i.: ~,.~~ Health services and associated expenses for infertility treatments, including assisted reproductive fc-chnology, regardless of the reason for the treatment. This exclusion does not apply to services required to treat or correct underlying causes of infertility. Surrogate parenting, donor eggs, donor sperm and host uterus. Storage and retrieval of all reproductive materials. Examples include eggs, sperm, testicular tissue and ovarian tissue. The reversal of voluntary sterilization. ,~ rrr r-I - ^~...., -r r mr_,.~,u~-/~ 'qr.£ iL ~~~,i,I (' z !r~- t -^~Vr~m~ ---mss . 4~~~~i~`~~Sf r.l`.~'.,'..~ "~~~7 ~' ^~ I~'~~n.Lt~~'1"t-`5~"rte ~ IP\LS xlt~x J~- ~. ~.~ Health services for which other coverage is paid under arrangements required by federal, state or local law. Examples include coverage paid by workers' compensation, no-fault auto insurance, or similar legislation. Health services for treatment of military service-related disabilities, when you are legally entitled to other co~aerage and facilities are reasonably available fo you. Health services while on active military duty. qq `1 r.r--~t. r ~ TF Ju tU '~ i t AC.{(~" i t T. .a 4 q.. ~~k{~F?~'t r^a ~ >~. .~r.l .~ ~~i -..h .~ rE ~: i7'rr u mJt.l?~,'~~ `'ct9 ~1'~`~j T.~> f ~tH,F 1~~x ,~,(+~ t ~yXl '}rr~t7 ,~~. ~.' .,e T -~ . ~ k, C4~-r,r X114 1-~q`F~ ~Ith services for organ and tissue transplants, except those ribed under Transplantation Services in Section 1 of the ~. Health services connected with the removal of an organ >sue from you for purposes of a transplant to another persor~. (Donor costs that are directly n~~lated to organ removal are payable for a transplant through the organ recipic-nl's Benefits under the Policy.) Health services for Irar~splan(s involving permanent mechanical or animal organs r -r t r =~~ r t i i r 4 -~.4~~1 .'~ r .~~ 71 - r Health services provided in a foreign country, unless required as Emergency Health Services. Travel or Transportation expenses, even though prescribed by a Physician. Some travel expenses related !o Covered Health Services received front a Designated Facility or Designated Physir_ian may be reimbursed al our discretion. t rr~r ~~~7L~]~tiTl'c._....~~_.Uit~I ~.L ~~. 7~i4,. ~.,.. ._2_. 7..._ ..,:___ _k.,._~ .....~ ~ _... .... ; Multi-disciplinary pain management programs provided on an inpatient basis. Custodial care; domiciliary care. Private duly nursing. This means nursing care that is provided to a patient on a one-to-one basis by licensed nurses m an inpatient or home setting when any of the following are true: no skilled services are identified; skilled nursing resources are available in the facility; the skilled care can be provided by a Home Health Agency on a per visit basis for a specific purpose. Respite care; rest cures; services of personal care attendants. Work hardening (individualized treatment programs designed to return a person to work or to prepare a person for specific work). ~`~,~`' z'r~~-5--~rr^~arvsc~rz s~ -7' ~ ~(u z -- i ~T ~~'~,e z .t ~~ 7 P\'a {1+19f}~i~~y~„~2~1J F ,ti d l Jr y ~ !' s r a~~S.;.'.J!_r:s.ra:r: ,.r~_5,>_:"_,.y~Lr....,.r.. ~._~!,! _ .... ~. _ ,..:z~~ _.. Purchase cost and fitting charge for eye glasses and contact lenses. Implantable lenses used only to correct a refractive error (such as Intacs corneal implants). Purchase cost and associated fitting and testing charges for hearing aids, Bone Anchor Hearing Aids (BAHA} and all other hearing assislive devices. Eye exercise therapy. Surgery that is intended to allow you fo see better without glasses or other vision correction. Examples include radial keratotomy, laser, and other refractive eye surgery, ~~ f Health services and supplies that do not meet the definition of a Covered Health Service -see the definition in Section 9 of the COC. Physical, psychiatric or psychological exams, testing, vaccinations, immunizations or treatments that are otherwise covered under the Policy when: required solely for purposes of career, school, sports or camp, travel, employment, insurance, marriage or adoption; related to judicial or administrative proceedings or orders; conducted ror purposes of medical research; required to obtain or maintain a license of any type. Flealth services received as a result of war or any act of war, uvhether declared or undeclared or caused during service in the armed forces of any country. Health services received after rite dafe your coverage under the Policy ends. This applies to all health services, even if the health service is required to treat a medical condition That arose before the date your coverage under the Policy ended. This exclusion does not apply to health services covered under Extended Coverage for Pregnancy or Extended Coverage for Total Disability in Section 4 of the COC. Health services for which you have no legal responsibility to pay, or for which a charge would not ordinarily be made m the absence of coverage under the Policy. Charges in excess of Eligible Expenses or in excess of any specified limitation. Long term (more than 30 days) storage. Examples include cryopreservation of tissue, blood and blood products. Autopsy. UnitedHealthcare Insurance Company TABLE of CONTENT PAG E SECTION I -- DEf=INITIONS ................................................................................................... ..................... 1 SECTION II -ELIGIBILITY, EFFECTIVE DATE AND TERMINATION OF COVERAGE ....... ..................... 2 A. Eligibilify ............................................................................................................... ..................... 2 8, Eligibility for Medicaid Not Considered ................................................................ .................... 2 C. Effactive Date of Coverage .................................................................................. _..............,.... 2 D. Dependent Coverage and Effective Date of Coverage for Dependents ............... .................... 2 E. Lata Enrollea ..................... ............................. ...................3 F. Termination of Coverage ........................................................................................ ................... 3 G, Cancellation of Policy ............................. ........................................................... .................. 4 SECTION !II -PREMIUMS ......................... ,,,,_,,,..,,,,._., 5 A. Payment of Premiums .................................... ...................................... ................... ................., 5 B. Grace Per(od ....................... ......................,.................. ......,........... 5 C. Ernpioyae or Dependent Covered by This Policy in Error ....................................... ................. 5 D. Premium Adjustments ............................._............................................................... ................. 6 E. Change In Premium Rates ..................................................................................... ................. 6 SECTION IV -PAYMENT OF BENEFITS .................................. .., .............................................. ................ 6 A- Benefits Payable .......:............................................................................................... ................ 6 B. Deductible ............................... ...........,.......... .............., 6 C. Benefrt Maximum ................ ................................ D. Expenses Incurred ....................................... .......................................... .................... ......:........ 6 E. Covered Expenses ............................ .......................:.................,.... ............................ .............: 7 F. Exclusions and Limitations .............................. ............................................ . 7 G. No Loss - No Gain .............................. .................................. ...................... .....,.......... - ...... --..... I H. Late Applicant Limitations ...................... - I• Notice and Proof of Claim ................................. ........................................................... . 7 ......... J. Payment of Claims ....................... .......... ............ 8 K. Procedures for Review of C(aims Which are Denied in Whole or in Parf ..................... ............ 8 L. Necessary Dental Care ......................................... ........................................................ .......... . 8 M. Covered Benefits ........................ ........... ........... 8 N• Recovery of Benefits Paid By Mistake ................ g O. Benefits Available From Other Sources -Subrogation ................................................._ ...._._ 9 P. Treatment Outside of the United States ......................................................................_ ......... 9 ~ Assignment of Benefits .._ ............... g SECTION V -COVERED SERVICES AND MATERIALS AND EXCLUSIONS AND LIMITATIONS . ....... 10 A. Covered Services and Materials ..................................................................................... ....... 10 B. Exclusions and Limifafions .............................................................................................. ....... 10 C. Alternate Procedures .................. ................................................................ ....... 10 D. Pre-Determination of Benefits ........................................................................................... ...... 10 SECTION VI -COORDINATION OF BENEFITS {GOB) ...................................................................... ...... 10 SECTION VII -STANDARD PROVISIONS .......................................................................................... ...... 11 A. Enfiro Contract -Changes and Inconteslabllity ................................................................ ...... 11 B, Waiver of Rights ............................... ...........,............................. ,..... 11 C. Legal Actions ...................... ..................:.,.......,............,........ .............................................. ..... 11 D. Physical Exam .................... .. .................,............................................................ . .............. ..... 11 E. Right of Recovery ....... ..................... ........................,.......................................... ................ ..... 12 F. Term of Policy _.., ............... .................................................... ..... 12 G. Notice of C(afm ..................... ..,........_...,...................................._................ ..... 12 H. Proof of Loss ......................... ................,........,......... .... 12 I. Grievances And Appeals ........................ ........................,................,..................... .... 12 J. Right to Examine Records ......................... ..............................._........................_..._ .... 13 K. Conformity with Siate Statutes ............................................................................................ .... 13 L. PolicyNon-Participation ....................................................................................................... ...13 M. Certificates ................. ....................................,.,.................. .., 13 N. Waiver of Rights ................................................................................................................... ... 13 O. Binding Arbitration ................................................................................................................ ... 13 SECTION VI11 -CONTINUATION OPTIONS .......................................................................................... ... 13 P Y ) ............. A. Federal C08RA (Policyholders with 20 or more Em to ees ................................. .. 13 B. State "Cal-C08RA" (Policyholders with less than 20 employees) ....................................... .. 15 C. Extension of Benefits ............................................................................................................ .. 17 SECTION 1X, - STATEMENT OF ERISA RIGHTS .................................................................................... .. 17 SEC7lON X -FAMILY AND MEDICAL LEAVE CONTINUATION ....................._.......................,............. . it3 SECTION I --DEFINITIONS GENERAL, DEFINITIONS "eenefit Year" - A Benefit Year for each Covered Person, is the consecutive twelve-month period of coverage, starting on the date such person first became covered under this Plan, and each consecutive Twelve-month poriod of coverage thereafter. "Calendar Year" -Shall mean the 12 month period commencing at 12:01 A.M. on January 1st and ending at 12:01 A.M. on the following January 1st and each subsequent 12 month period thereafter. "Contrack Year" - Shat mean the 12 month period commencing at 12:01 A.M. on the date of execution of the contract between the Organization and SafeHealth and ending at 12:01 A.M. on the following 12 month anniversary thereafter, "Covered Expenses" -Covered Expenses under this Pian shall be only those that are Medically Necessary and which are Included in the Covered Expense sections of this Plan. Expense is considered to be incurred on the date service is rendered or supplies are furnished. Exeepf as indicated under Dental Expense Benefits. "Covered Person or Individual" -Shall mean an Eligible Covered Person or Eligible Dependent whose coverage under this Plan Is in force with respect to any covered benefits. "Dentist" - A licensed graduate-of a recognized dental facility having received a diploma as a D.D.S., D.M.D, or L.D.S., which entitles him to treat teeth and the associated tissues of mouth. "Dental Hygienist" -Shall mean a qualified dental hygienist who has taken and passed a course in dental hygiene under a recognized dental facility, and has received a diploma as a qualified dental .hygienist. "Denturist" - A dental technician specializing in making and fitting dentures as a direct service to the public rather than through a licensed dentist. "Eligibility" -Shall mean any person upon becoming a Covered Person of the Policyho{der insurance Trust, or any person becoming employed by a covered employer Is eligible to apply for insurance under this Plan, subject to underwriting rules and requirements of the insurance Company. "injury" -Injury wherever used (n this Pian, means bodily injury of a Covered Person caused by an accident occurring while this Plan is in force and resulting directly and Independently of all other causes in expenses covered by this Plan when said expenses are incurred while this Plan is in force as to the Covered Person. "Insured" -Shall refer to the Covered Person eligible to subscribe to the benefits provided under this Plan. Eligibility will be determined by the employer or Organization. Insured is sometimes referred to as "Covered Person". "Medically Necessary" -With respect fo each service or supply, the term "Medically Necessary" shall be defined as those services or supplies which meet all the criteria listed herein: 1. It is rendered for the treaEmen( or diagnosis of a covered inJury or illness; and 2. It Is appropriate for the symptoms, consistent with the diagnosis, and Is otherwise in accordance with generally accepted medical/dental practice and professionally recognized standards; and 3. R is (he mos( appropriate supply or le;-el of service needed to provide safe and adequate care. "Organization" Tiie employer or other entity which has contracted with SafeHealth fo insure benefits under this Plan. "Plan" -Shall mean the insurance coverage provided by this Policy to a Covered Person. "Provider" -means any licensed dentist, denturisl, or other professional provider of services which are reimbursable under this Policy. "5lckness" - 5lckness wherever used in this Plan, means a condition or an episode, other than inJury, marked by a pronounced deviation from the Covered Person's normal well stale, causing expense covered by this Plan when said expenses are Incurred wh(le this Plan is In force as to the Covered Person. "SafeHealth, We, Us, Company, Insurance Company" - Shall mean SafeHealth Life Insurance Company. SECTION II - ELIG181LITY, EFFECTIVE DATE AND TERi4~INATION OF COVERAGE The foliowing provisions set forth the general efigibilify provisions under this Poilcy. A. Eligibility Tha persons eligible to apply for Insurance under this Policy are the employees or Covered Persons of the Policyholder; a who are actively at work for the Policyholder (or in the case of associations, are Covered Persons of the association) on the date it becomes a Policyholder; or who become employed by this Policyholder (or in the case of associations, when they become Covered Persons) after it becomes a Policyholder and who have been actively at work for this Policyholder for the Waiting Period specified by this Policyholder. The term employee may include individual proprietors, partners, officers, and managers. If a spouse or ch11d is covered as an eligible employee, he or she may not be covered under the Policy as a dependent. If both husband and wife are covered as eligible employees, an eligible child may be insured as the dependent of only one of them. B, Eligibility for Medicaid Not Considered SafeHealth shall not consider the availability or eligibility for medical assistance under Medicaid, when considering eligibility for coverage or making payments under this Policy. C. Effective ^afe of Coverage SafeHealth may impose an initial eligibility requirement for a Covered Person that must be satisfied before some or all coverage becomes effective under fhe Policy. In order for coverage to become effective, a written and signed enrol(rnent application must be received by SafeHealth and any required premiums must be paid. SafeHealth must receive such enrollment application within 30 days of the date (hat each eligible person becomes eligible for coverage. If SafeHealth does not receive it within 30 days, such person will be considered a late enrollee. D. Dependent Coverage and Effective Date of Coverage for Dependents Your Organization is responsible for determining dependent e!iglbility. In fhe absence of such a determination, SafeGuard defines eligible dependents to be: The la~.~~ful spouse or domestic partner of the Covered Person, if the Organization provides such The children or grandchildren of the Covered Person up to age 25 for whom he or she provides a care (including adopted chlldren, foster chlldren, step-children, or other children for whom the Covered Person Is required to provide dental care pursuant to a court or administrative order.) • Chlldical hands a I and who aresdependelnt o the Covered Person foretheirnsupp d~sa bd'~lity or phy P maintenance; and • Other dependents if the Organization provides benefits for these dependents. Newborn children and newborn adopted children are covered from birth. Legally adopted children, foster children, and step-children are covered from the day they are placed with the employee. SafeHealth will also honor any court ordered coverage for any other dependants, If a claim Is dented due' to a handicapped child having reached the age of 25, the policyholder shall establish that the child Is and continues to be disabled, Addition or deletion of Dependents will be allowed only during open enrollment unless there Is a change in family status such as marriage, birth, adoption, death, divorce, or acquiring or losing coverage due to a change in the spouse's enrollment status, To enroll dependents, a written enrollment application must be delivered to SafeHealth and any required premiums must be paid. SafeHealth must receive such enrollment application within 30 days of the date that the dependent become e(igble for coverage, otherwise the dependent will be considered a late enrollee. E. Late Enrollee An employee or dependent who does not enroll during the initial 30-day enrollment period will be considered a "eatnoef covlered due toefhis provis o'In aret bat elogib~ered coveredtlservlcesxf open enrollment period. Gharg If an employee ar dependent enrolls after the initial 30-day enrollment period, he or she will not be considered a late enrollee in the following situations if he or she was covered under another dental plan during his or her initial enrollment period and; a) certified during his or her initial enrollment period that coverage under another dental plan was the reason for declining enrollment; b) has {ost or will lose coverage under another dental plan as a result of: I) termination of employment of the person: ii) change in employment status of the person; iii) Termination of the other plan's coverage; iv) cessation of an Policyholder's .premium confribufion toward an employee's or dependent's coverage; or v) death of a spouse, or divorce; and c) requests enrollment within 30 days after termination of coverage under another dental benefit plan; or d) a court orders coverage be provided for a spouse or child of an insured employee and request for enrollment under this plan is made within 30 days of the issuance of the court order; or e) he or she is employed by a Policyholder chat offers multiple dental plans and the employee elects a different plan during an open enrollment period. F. Termination of Coverage Coverage will automatically terminate on the earliest of the following dates i the date this Policy is canceled; ?_. the dale that premiums are not paid, subject to the grace period; 3. th© dafe that employees are no longer in an employee class that is eligihle for coverage under the Policy or no longer meet fhe dofinlflon of employee; 4. the date that fhe employee enters active duty with the armed forces of any country; 5. the last day of the month in which and employee is no longer employed on a full-time basis by the Policyholder; or 6. the last day of the month in which the employee's employment with the Policyholder terminates; 7. the date a Covered Person becomes covered under another dental plan which is sponsored by the Policyholder; 8, upon notice from SafeHealth If SafeHealth determines that a Covered Person has performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fart under the terms of coverage; 9, upon notice from SafeHealth if a Covered Person permits any other person to use his or her identification card to obtain services under this dental plan; 10. upon notice from SafeHealth If a Covered Person assaults or threatens bodily injury to one of Safe Health's employees or an affiliate or an employee of a provider; 11. on the last day of the month that a Covered Person no longer works or lives within the service area; or 12. the first premium due date that follows the date a Covered Person's employment status changes and either he or she become employed less than full time or his or her active work for the Policyholder ends, except when Note A or Note B below applies. Mote A: If active work ends because an injury or sic{<ness disables the insured so that he or she is unable to engage in his/her occupation, this insurance may be continued during that disability until the premium is no longer paid, Coverage for disabled employees will be permitted only if the employer has rules regarding the length time if will continue coverage for disabled employees. P(ote B: IF active employment ends because of a temporary lay off, coverage may be continued while the layoff or leave continues until the earlier of (1) fhe first premium due dafe that falls on or that next follows the 60th day after the date the (nsured was last actively at work; or (2) the end of the Iasi month for which premium was paid. Coverage for employees on layoff or leave may be continued only if the employer has rules regarding the length of lime if will continue coverage for employees on layoff or leave. Dependent coverage will automatically ierminale on the earliest of the following dates' 1. the date that a Covered Person's coveraye terminates; 2. the date that a required contribution or payment for dependent premiums is not made; 3. the Iasi day of the month in which a dependent no longer meet the definition of dependent; or 4. the dafe that a dependent enters active duty with the armed forces of any country. G. Cancellation of Polley Except as prohibited bylaw, [he Policy and all cf the insurance ends on fhe Earliest of the following; • The date tha premlum is not paid when due. Unless the Policyholder gives written notice to SafeHealth to end the Policy, the grace period applies. • The first premium due dale after the Policyholder glues Safel-lealth 45 days written notice fo end the Policy. If the Policyholder does not give advance notica and the Policy ends because the premlum Is not pald, the grace period applies. • The first premlum due date after SafeHealth gives the Policyholder 45 written notice to end the Pollcy if SafeHanlintentonallnmisrepre~entatiodneof material factd edea thertPrmstlof the coveragetes fraud or made • The first premium due date after SafeHealth glues the Policyholder 45 written notice to end the Policy ii the Policyholder materially changes ifs nature of business. The first premlum due date after SafeHealth gives the Policyholder 45 written notice to end the Policy if SafeHealth determines the Policyholder has failed to comply with Policyholder contribution or group participation provisions. • The premium due date that SafaH t (least 45 days beforeoth e Pollcy Is Ito behcanceled ive the Policyholder advance written notice of a SECTION Ill -PREMIUMS A. Payment of Premiums Premiums are due on or before the first day of the month. if a Coverad Person's coverage becomes effective on the ~ 6othod th ~ month for that person.tThel monthly prem~um is set forth on the fa eesheet of premium will b this Policy. B. Grace Period If the premlum is received by SafeHealth 4vithin 31 calendar days of the premium due date, the group coverage will continue in force. If the premium is not received by SafeHealth within 31 calendar days of the premium due date, SafeHealth will mail a notice to the the Ida~e atetedt145ttleyno ices tthehpollcy will policy will terminate. If the premium is not received by lerminafe. The Covered Person is responsible for any dental expenses whic~ n(y e en b the Employerddoes not grace period in the event of termination of this policy for non-pay notify Covered Person of the termination. C. Employee or Dependent Covered byTtiis Policy In Error Any person enrolled in error or In violation of this policy is riot entitled to any benefits. SafeHealth will make proper adjustment to cover any premiums paid under such circumstances. SafeHealth may recover any benefits paid while enrolled In error, SafeHealth's may deduct amount paid by mistake from future benefits of the employee or from any dependent of the employea's family. SafeHealth shall have the right, upon notice, to examine the employer's records, including payroll records, with respect to eligibility and monthly premiums under this Policy. The employer shall have the right, upon notice, to examine our records pertaining to employer with respect only to enrollment, eligibility and receipt of monthly premiums under this Policy. D. Premium Adjustments Refunds in connection with the retroactive or unreported termination of a Covered Person's coverage under Phis policy will be limited to If~e 2-month period prior {o the date the request fof refund was made. If a retroactive termination refund Is given, the Employer must: (1) repay SafeHealth the amount of any claims incurred and paid after a Covered Person's adjusted termination date; and, (2) assume full responsibility for the terminated Covered Person's unpaid claims, if any. E. Change (n Premium Rates SafeHealth reserves the right to change premium rates; however, such premium race shall not be changed without 45 days advance written notice from SafeHealth to the policyholder. Notice shall be sent by SafeHealth to the last known address of policyholder. SafeHealth guarantees that it will not increase the premium rates during the Initial contract year, SECT{ON IV -PAYMENT OF BENEFITS This provision of dental benefits Is subject to all of the terms and provisions of this policy. Services rendered before the effective date of this policy will not be covered. A. Benefits Payable if you, white insured under the Dental Expense Benefits of this Policy, incur expenses for any Dental Procedure covered in the accompanying Summary of Benefits attached as Exhibit A and incorporated herein by reference, and if such procedure is perfomed by a Dentist who is not a member of the Participating Panel of Dentists of SafeHealth Life Insurance Company, while this insurance is in force, the Company will pay the percentage shown in the Summary of Benefits for such expenses incurred In excess of the Deductible, subject to any applicable Waiting Period and the Exclusions and Limitations section of the Summary of Benefits and not to exceed the Benefit I~laximum for all procedures as shown in the Summary of Benefits. 8. Deductible The Deductible Is the Amount of Covered Dental Charges to be incurred by a Covered Person in each Calendar Year or Contract Year before benefits will be payable toward Covered Dental Charges ho or she incurs during the rest of that year. , No benefits under this Policy will be paid Toward Covered Charges used to meet the Deductible. The Deductible amount for each Covered Person during each Calendar Year or Contract Year Is as shown in the Summary of Benefits. No deductible credits will be allowed for denial expenses incurred prior to the effective date of your coverage under this Policy. C. Benefit Maximum The maximum amount payable for all Covered Dental Procedures for each Covered Person shall not exceed in the aggregate, the Benefit Maximum shown in the Summary of Benefits, during each Calendar Year. D. Expenses Incurred Expanses will be considered to have been incurred on the dale the dente; service is rendered. However, certain treatment can take time to complete; therefore, work is considered to have begun as follows ~~,~,r ~.~nt~~rr=s +:,~han lha imoression is taken. For roof canal treatment, when the Tooth is opened. Or~hodontla Expenses' Payment for orthodontia treatment, if applicable, will be made in equal installments. Installments will be paid at the end of each quarter during The course of treatment. Payments will stop iF coverage ends. If treatment stops before completion, benefits will only be paid for services received. E. Covered Expenses Except as excluded under the Exclusions and Limitations, eoP Benefit e The ben f t isentendted fo cover for the dental services and supplies listed in The Summary = treatment that Is customarily given by Dentists throughout the country to eliminate oral disease and to replace missing Teeth. The Company will compare the charge for each treatment with the charges for comparable treatment made by the other Dentists In the area. Covered Expenses are charges which are not more than the amount customarily charged by the majority of Dentists in your area, as determined by the Company, fn most cases, the Dentist's charges will be-well wifhin the range of prevailing fees in the area. However, If the Dentist's charge is more than the customary charges determined by the Company, you will have to pay the difference. Of course, unusual dental complications will be Taken into consideration. The possibility of an alternate treatment can also affect the amount of the Covered Expense. See Alternate Procedures for how this works. F. Exclusions and Limitations The Exclusions and Limitations for this Policy are listed on the Summary of Benefits, attached as Exhibit A and Incorporated herein by reference, G. tdo Loss - No Gain If Insured has had continuous group dental coverage for the previous 12 months, the Company wDl apply any deductible or co-insurance payments credited by the previous carrier in the calculation of its allowable charges. H. Late Applicant Limitations Any person who applies ff r all levelgs of coverage:rPreelnltive,aGenereand Ma]or rst year beneFit limitation of $100.00. This applies o I. Notice and Proof of Claim Wrleeealthlat SafeHeaith Life Ins~irancel CompanyfePosttOificteBox830930s LagunlaeHrlisy CA g9265~4- Saf H 0930. SafeHealth will furnish the Policyholder forms for filing proof of loss, if applicable. A written proof of claim within the relevant time period will also suffice. Such 4vritten proof must cover the occurrence, the character and the extent of The loss. SafeHealth will respond to submitted claims as follows: 1. Expedited Claims wit! be decided upon no later than 72 hours following receipt of the claim. If additional information is needed to make a determination, SafeHealth will notify the Covered Person within 24 hours following receipt of The claim. 2. Pre-Service Claims. A Covered Person may, but Is not required fo, request apre-treatment estimate of payment for proposed services. Apre-treatment esfirnate of payment will be decided upon no later Phan 15 days following receipt of the claim. If additional information is needed to make a determination, SafeHealth will notify the Covered Person within 15 days following receipt of the pre-treatment estimate. 3. Post-Service Clalrns will be decided upon no later than 30 days following receipt of the claim, ff additional information Is needed to make a determination, SafeHealth will notify the Covered Person within 30 days following receipt of the clalrn. The Covered Person will have up to 45 days to provide the additional Information. SafeHealth will make a final determination within 15 days Following receipt of the additional information, or within 15 days of the end of the 45-day period if the Covered Person has not responded. Payment of Claims Benefits will be paid directly to the Covered Person, if applicable, unless otherwise directed, for covered services. SafeHealth cannot require that services be rendered by a particular provider. Any accrued benefits unpaid ai the time of death of a Covered Person may, at SafeHealth's option, be paid to the estate of the Covered Person estate. All other benefits will be payable to the Covered Person. Any accrued benefits unpaid of death will be paid fo the estate of the Covered Person, except as may be provided in any specific benefits of this Certificate, or on any attached Certificate Riders or Endorsements. K. Procedures for Review of Claims Which are Denied in Whole or in Part V`/ithin 60 days after a Covered Person or his/her beneficiary received a writ7en notice of denial of a claim, he or she may: 1. Request, in writing, to review the claim. 2. Rev{ew pertinent documents. 3. Submit issues and documents, in writing, fo us. SafeHealth will reply no later than 30 days after the receipt of a request for review, Jn the event special circumstances require an extension of Time for processing a decision wilt be made as soon as possible bu# no later than 60 days after the receipt of a request for review. The decision made upon review shall be in writing and shall include specific reasons for the determination, with specific references fo the pertinent plan provisions on which determination is based. L. Necessary Dental Care Benefits will be allowed only for the expense of services and supplies, which, in the Judgment of SafeHealth, are Necessary Dental Care. Although a provider may prescribe a service or supply, it does not make the charge a covered expense, M. Covered Benefits Except as excluded under the Exclusions and Limitations, covered benefits are listed in the Schedule of Benefits. ~l. Recovery of Benefits Pald By h~lista4~e SafeHealth will have the right to recover the payrnen! from the person paid or anyone else vrho benefited 1. Safef lealth makes a payment to which a Covered Person is not entitled under this policy; or 2 SafeHealth pays a person who is not eligible for Benefits at all. SafeHealth's right of recovery includes the right to deduct the amount paid by mistake from Future benefits of the employee or from any dependent. O. Benefits Available Prom Other Sources -Subrogation Si(uations may arise in which a Covered Person's dental expenses are the responsibility of a source other than SafeHealth. SafeHealth may have a legal right to recover the costs of dental expenses from a third party. For example, the Covered Person may be entitled to care or reimbursement from a government agency or program, including care for military service related conditions if such care Is reasonably available. The following rules will apply in such situations. "lnjured person" under this section, means a Covered Person who sustains compensable injury. "Safetiealth's dental expenses" means the expenses incurred and the reasonable value of the Benefits provided by SafeHealth for the care or treatment of the injury sustained. If the injured person was lnjured by an act or omission of a third party giving ris© to a claim of legal liability against the third party, SafeHealth will have the right to recover its dental expenses from the third party. This right is commonly referred io as subrogation. SafeHealth will be subrogated to and may enforce all rights of the injured person to the extent of SafeHealth's dental expenses. SafeHealth's equitable and contractual rights of subs°ogation are limited in accordance with Oregon law. The injured person and his or her agents must cooperate fully with SafeHealth in its efforts to collect SafeHealth's dental expenses. This cooperation will include, but Is not limited fo, supplying SafeHealth with information about any defendants andlor insurers related to the Injured person's claim. The injured person and his or her agents will permit SafeHealth to intervene in any action filed against any third party. The lnjured person or his or her agents will do nothing to prejudice SafeHealth's subrogation rights SafeHealth will not pay any attorneys' fees or collection costs to attorneys representing the injured person where ik has retained ifs own lagal counsel or acts on its own behalf to represent its Interests, unless there is a written fee agreement signed by SafeHealth prior to any collection efforts. When reasonable collection costs have been incurred with SafeHealth's prior written agreement fo recover SafeHealth's dental expenses, there will be an equitable apportionment of such collection costs between SafeHealth and the injured person subject to a maximum responsibility of SafeHealth equal to one-third of the amount recovered on behalf of SafeHealth. This provision does not apply to occupationally incurred disease, sickness and/or injury. SafeHealth will not recover anything under this section until the Covered Person has recovered all damages sustained In connection with the injury. P. Treatment Outside of the United States No benefits are payable for dental services and supplies obtained outside the United States, except for covered charges incurred for emergency treatment, and then only up to the maximum benefit allowance as shown in the Schedule of Benefits. Payment is based on United States currency. C~. Assignment of Benefits No Benefit, right or interest under this policy can be assigned or transferred except to a provider. SafeHealth will pay benefits to a Covered Person unless an assignment of benefits is signed. If no SECTION V -COVERED SERVICES AND P•AATERIALS AND EXCLUSIONS AND LIMITATIONS A. Covered Services and Materials Please refer to the Schedule of Benefits attached as Exhibit A. B. Exclusions and Limitations Please refer to the Schedule of Benefits attached as Exhibit A. C, Alternate Procedures There is often more than one way customarily used by Dentists to ireaf a dental problem, Different materials or procedures may be used to correct the same problem. For example, a Tooth could be repaired with an amalgam filling. That same tooth could also be repaired with a more expensive cap (crown) or gold filling. The Company will allow as Covered Expenses only Elie least expensive services and supplies which are appropriate and meet acceptable dental standards. You and the Dentist may decide That you want the more expensive treatment. If so, you must pay the charges which are greater than the Covered Expense for the less expensive treatment. Because the Company has this Alternate Procedures provision, it is lmportanf for you to use Pre-Determination of Benefits, It will fell you how much the Company will pay for treatment. D. Pre-determination of Benefits This is a way of telling you ahead of time how much will be paid for dental work. It will help to avoid surprises. Many fimes dental work Is likely to cost more fhan $300. If so, you should ask the Dentist to file for Pre-Determination of Benefits with the Campany. Most Dentists know about this procedure. Here is how it works • Get a dental claim form from your employer. Give it to your Dentist. The Dentist will tell the Company what work needs to be done. This work is called the "treatment plan." « The Dentist lists the services and charges on the claim form and sends It fo the Company. • The Company tells you and The Dentist what amount the benef-rf will pay. You should discuss the treatment plan with the Dentist before the work is done, if the Dentist changes the treatment plan, the amount of payment may change. If The Dentist makes a mayor change, a new dental claim form should be sent to the Company. If you do not use Pre-Determination of Benefits, payment will be based an whatever Information the Company has about the case. SECTION Vl -COORDINATION OF BENEFITS (COB) We coordinate our benefits with those who may be entitled to from other policies. This prevents duplication of payment if a Covered Person is covered by anothar group insurance plan, no fault automobile insurance or a government program, not including Medicare or Medicaid. The combined benefits from all policies may pay up to, but no more fhan, the iolal covered expense. If there is a Policy primary to this one, it will pay first. Then, this Policy will pay the difierenca between the primary policy payment and t,~ie usual and customary fee that SafeGuard pays its contracted dental care Wh(ch Policy is Primary? The Policy which covers a person as an employee is prir~~ary for that person. For example, if a Covered Person is covered under his or her spouse's Policy, that Policy is primary for the spouse and secondary for the Covered Person and this Policy Is primary for the Covered Person and secondary for the spouse. For dependents covered by both parents' Policies, the parents' birthdays will be used to determine which Policy is primary. The parent whose birthday falls first In the lime of year avill be primary for the motdher's For example, if the mother's birthday Is In June and the father's in July of that same year, Policy will be primary for the children. However, if the other Policy does not use this birthday rule, the father's Policy will be primary for the children. (n the case of divorced or separated parents, the Policy of the parent with custody will pay first, then the Policy of the step-parent with custody, and finally the Policy of the parent without custody. if financial responsibility for health and dental care has been assigned to one parent by court order, the Policy of that parent will pay first. If a Covered Person covered as an employee under two Policies and both Policies coordinate benefits, the Policy that covers the Covered Person as an active employee will be primary, If a Covered Person Is covered as an active employee under this Policy and as a retiree or lard off employee with the other Policy, our Policy will pay before the other Policy. If the other Policy does not coordinate benefits, that Policy will be primary. If a spouse is also covered as an employee and/or retiree, those Policies wiN be primary far the spouse and secondary for the Covered Parson, SECTION VIl - STANDARD PROVISIONS A. Entire Contract -Changes and Incontestability The Policy, the application of the Policyholder, and the individual applications, if any, of the Insured Persons make up the entire contract between SafeHealth and the Policyholder. Any statement made by the Policyholder, or by any Covered Person shall, In the absence of fraud, be deemed a representation and not a warranty. No such statement shall void the insurance or reduce the benefiis under this Policy or be used in defense to a claim far loss incurred or disability commencing after the insurance coverage with respect to which claim is made has been in effect for two years from the date it became effective. No change in the Policy will be effecfive until it is approved by one of SafeHealth ofrlcers. This change and approval must be noted on or attached to the Policy. ~!o agent may change the Policy or waive any of its prov(slons. g, Waiver of Rights If SafeHealth fails or chooses not to enforce any provision of Phis Policy, such omission wit( not affect SafeHealth's right to do so at a later dale, or fo enforce any other provision. C. Legal Actions No action at law or in equity may be brought to recover benefits prior to the expiration of 60 days after written Proof of Loss has been furnished. No such action may be brought after the applicable statute of limitations. D, Physical Exam ~afr-Healih has the right to have any Covered Person examined at SafeHealth's expense wi~u!e a claim is E. Right of RecovQry SafeHealth has the right to recover any excess benefits paid from any persons fo, or for, or with respect fo whom, such payments were made, or from any other insurers, health care service plans or other organizations. F. Term of Policy This policy will remain in effect for the term specified on the Face Sheet. The policy will be renewed automatically, from year to year thereafter, until terminated. G. Notice of Cfa(m Written notice of claim must be given within 20 days after a covered loss starts or as soon as reasonably possible. The notice may bz given to the insurer at its home office or to the insurer's agent, Noflce should include the name of the insured and the policy number, Et. Proof of Loss If the policy provides for periodic payment for a continuing loss, written proof of loss must be given to SafeHealth within 90 days after the end of each period forwhlch SafeHealth is liable. For any other loss, written proof must be given within 90 days after such loss. If it was not reasonably possible to give written proof in the time required, SafeHealth shall not reduce or deny the claim for this reason if the proof is filed as soon as reasonably possible. !n any even, the proof required must be given no later than one (1) year From the time specified unless the claimant was legally incapacitated. I. Grievances And Appeals SafeHealth's Member Services Department is available to respond to any questions or complaints. If the problem is not resolved at that level, grievance and appzals rights set forth below apply, SafeHealth will assist a Covered Person in filing a Grievance when he or she has a complaint and asks for help to put it in writing. 1. Grievance. A Covered Person aggrieved by an Adverse Benefit Decision has 180 days from the date of the Adverse Benefit Decision to file a Grievance requesting reconsideration of the decision, The Covered Person must submit all information in support of the Grievance. SafeHealth will acknowledge the Grievance within 7 days and report its decision and rationale within 30 days (72 hours for Expedited Claims). SafeHealth may have an additional 15 days to resolve the issue if the Covered Person is notified within fhe first 30 days of the delay and of the specific reason for fr~z delay, The Covered Person will be informed of the dztermination fn writing and notified of further appeal rights. 2. Appeal. A Covered Person has 60 days following receipt of the written determination to file a written appeal. The request will be reviewed by the Appeals Committee, which will Involve different staff than have been Involved before. SafeHealth will acknowledge the Appeal within 7 days and will make its review and report ifs decision and rationale wlfhfn 30 days. The Covered Person will be Informed of the committee's determination in writing and notified of further appeal rights as well as the possible right of Covered Persons participating in ERISA-qualified plans fo seek legal redress under Section 502(a) of ERISA. 3. Subsequent Appeal. A Covered Person not satisfied with the determination of the Appeals Committee has 60 days after receipt of the determination to file a written request with SafeHealth for further review. The request will be forwarded fo an Appeals Committee comprised of different Individuals than the earlier Appeals Committee. The Covered Person or a representative of the Covered Person may appear before this committee. SafeHealth will acknowledge the Appeal avithin 7 days and avill make Its review and report its decision and rationale within 30 days. The ____ :~~.^~~ ,,c,rarrnin, flnn and rationale in wri!inq and notified of furl aer lane folseei<t legalWedlresstureidar Seciliong502(a) of ERldSAersons participating in ERISA-qualifie P J. Right to Exarnlne Records SafeHealth has the right to examine all pertinent medical, dental, or other records ofto l~osercases with pertaining to any cases for which Benefits are claimed and discuss matters periaining the Covered Person's providers. If the Coverod Person does not consent to the release of records or discussions with providers, SafeHealth w(II be unable to defennlne the proper payment of any Benefits and will deny the claim accordingly. Consent to the release of records and discussion with providers is a condition of payment of any Benefits by SafeHealth. Neither the consent to nor the actual examination of the records or discussion with providers will constitute a guarantee of payment. SafeHealth has the right to examine payroll records at reasonable times regarding premium payments made under this policy. K. Conformity with State Statutes Any provision of the Policy endedrto,rconformttolthethminlmumfrequ cements ofisuch IaPolicy was delivered or issued for delivery, is am L. Policy Non-Participation The Policy is not in lieu of and does not affect any requirements for coverage by workers' compensation insurance. M. Certificates SafeHealth will issue to the Policyholder, for delivery to the Covered Person an Individual certir"icate describing the benefits to which the Covered Person is entitled under the Policy and to whom they are payable. ~1, Waiver of Rights If SafeHealth fails fo enforce any provision or condition of the Policy, this failure will not affect its right io do so at a later date, nor will if affect their right to enforce any other provision or condition of the Policy. O. Binding Arbitration Each and every disagreement, dispute or controversy concerning the construction, Interpretation, performance or breach of this Master Policy, or th© provision of Dental services may be valunfarily submitted to arbitration in accordance with the American Arbitration Association rules and regulations, whether such dispute involves a claim in fort, contract or otherwise. Arbitration shall be initiated by written notice to the President, SafeHealth Life Insurance Company, 95 Enterprise, Suite 100, Aliso Viejo, California 92656-2605. The notice shall include a detailed description of the mailer to be arbitrated. SECTION V(11 -CONTINUATION OPTIONS A. Federal COBRA (Policyholders with 20 or more Employees) 1. P, Covered Person who would otherwise lose coverage under this policy may continue uninterrupted coverage upon arrangement with Employer in compliance with the Federal Consolidated Omnibus Budget Raconcilialion Acl of 1985 (COBRA). Eligibility is conditioned upon payment of the applicable monthly premium io Employer. Tha folloaving are "qualifying events" a) Termination of employment, including lay-off or reduction in hours (exrepf for gross misconduct); b) Death of the Covered Employee; c) Divorce or legal separation; d) Loss of eligibility of a covered Dependent child; or e} While covered Dependents are on continuation with the Employee, the Employee becomes entitled to Medicare benefits. 2. Coverage under COBRA continues only upon timely payment of the applicable monthly premium Eo Employer and ends on the earlier of: a) Termination of this group policy; b} Coverage under any other group health plan, including Medicare, which does not contain any exclusion or limitation with respect fo any pre-existing condition; c) Expiration of 36 calendar months of continuation by a covered dependent after the Employee's death, divorce, legal separation or entitlement fo Medicare; d) Expiration of 18 calendar months after termination of employment, lay-off or reduction in hours; e) For a disabled Covered Person, expiration of 29 months after termination of employment if; (1) The Covered Person was totally disabled at the Time of the termination of employment within the meaning of the Social Security Act, or Is determined disabled by the Social Security Administration effective any time within the first 60 days of COBRA continuation coverage; and (2) The Member notified employer of the disability within the initial 18-month continuation period. f) When fhe applicable maximum period of continuation of group coverage has been exhausted, or at any limo during the period of continuation, the Covered Person may convert fo an individual conversion plan, 3. If a retired Covered Person, as a result of employer's Chapter 11 reorganization, loses a significant portion of retiree benefits, the retiree and any covered Dependents may contin~.ie coverage under the group plan based on the following conditions; a) The retiree is eligible for continuation coverage for the rest of his or her life; b) The retiree's covered spouse and covered dependent children are eligible for continuation coverage for the rest of the retiree's life and for an additional 36 months after the retiree's death; c) If the retiree is deceased at the time of employer's Chapter 11 reorganization, the retiree's covered surviving spouse and covered dependent children are eligible for continuation coverage for the rest or' his or her life. ~I. Application for continuation must be made in accordance with fhe COE3~R,A regulations, and must ~- ~~-~~ ~•- „,~,t~o~ ~~~~~~~+ ~n Fmnlover ~r~ifhin 60 days after any qualifying event. The Employer will _~ _ < ~afeGuard P.O. Box 30910 Laguna Hills, CA 92654-0910 Ric Man International 2601 NW 48th St Pompano Beach FL 33073-3072 02828 I11'1111II11II11I i1I II III II III IIIIIII111 I11~11111111111'111'll JGS AMGUNT~ -.~_.. Gosr car SafeGuard Dental & Vision PO Box 30910 ! aguna Hills, CA 92654 (800)7:50-4303 %' ~` ' ~ ~, w e •C7~ ~~ o a ~~~~ D1, Group ID: 97156421 SafeGuard Dental & Vision Statement Reconciliation Instructions This statement for SafeGuard is comprised of seven sections: 1 A Consolidated Summary for all divisions (for organizations with divisional billing) 1 Premium & Payment Summary 2 Eligibility Adjustments -Please review all changes. 3 Manual Adjustments 4 Eliaibility Roster with Premium 5 Summary by Plan, Rate Code & Premium 6 Reconciliation Worksheet If your organization has more than one division, you will receive Sections 1 through 6 for each division. ~.~ch division will have its own group numf~er, forF identification; ~:-~ f ...~...,~~. Please follow these steps: '~r.~," ~ ...4 IN~~JNiYwiVLM.e i.•y,.. ..i. Vrn=.k'M~.K • If you are paying for multiple groupsor~d~v„~sio,~n.s with one.~faeck, please include all detail to help us allc~ca#e your--payment appropriately. Please mcl~de -your group number on your check. • Credits for terminations and charges for member additions not reflected on this invoice will be reflected on your next month's invoice. • If you adjust the amount due, this may result in an overpayment or underpayment, now and on the next month's billing. • If you have any billing or eligibility issues, please contact the Group Billing and Eligibility Department at (800) 750-4303. To ensure the accuracy of your eligibility and your account balance, please pay as billed. b SafeGuard Dental & Vision PO Box 30910 Laguna, Hills, CA 92654 Section 1 -Page 1 (800)750-4303 SECTION 1: Premium and Payment Summary From 02/27/09 to 03/31/09 Ric Man International Invoice Date .................. 03/31 /09 2601 NW 48th St For Month Of ............... April 2009 Pompano Beach FL 33073-3072 Invoice Number ............ 2459443 Recipient Group ID ..... 97156421 Ric Man International (Group ID: 97156421 ) Previous Balance: $ 5,489.36 Payments Received: $ -5,489.36 Eligibility Adjustments (Section 2): $ -90.04 Other Adjustments (Section 3): $ 0.00 Other Debits: $ 0.00 Adjusted Balance: $ -90.04 Current Premium (Section 4): $ 2,654.64 ~.. Total Due by April 30 $ ____.._,2,564.60 Plan Premium Amount Amount Paid SG185A-FL Plan Total ..................................................... $214.35 $ VA2332WS Plan Total ..................................................... $2,440.29 $- Current Premium (Section 4) $2,654.64 '~ V' l ~ ~ 5"~ ~ 5~ TOTAL DUE: $2,564.60 $L Make checks payable to: SafeGuard Dental & Vision Group !D: ;7156421 Amount Pa1d: Check #: SafeGuard Dental & Vision PO Box 30910 Laguna Hills, CA 92654 II~I~„~I~I~II~~~I~I~~I~~III~~,I~I~~~~~IIII~~~~~~IIII„~~~II,I SafeGuard Dental & Vision PO Box 30910 Laguna Hills, CA 92654 (800)750-4303 Section 1 -Page 1 SECTION 1: Premium and Payment Summary From 02/27/09 to 03/31/09 Ric Man International 2601 NW 48th St Pompano Beach FL 33073-3072 Invoice Date ............... For Month Of .............. Invoice Number .......... Recipient Group ID ..... 03/31 /09 April 2009 2459443 97156421 Ric Man International (Group ID: 97156421 ) Previous Balance: Payments Received: Eligibility Adjustments (Section 2): Other Adjustments (Section 3): Other Debits: Adjusted Balance: $ 5,489.36 $ -5,489.36 $ -90.04 $ 0.00 $ 0.00 $ -90.04 Current Premium (Section 4}: $ 2,654.64 Total Due by April 30 $ 2,564.60 Plan Premium Amount Amount Paid SG185A-FL Plan Total ..................................................... $214.35 $__ VA2332WS Plan Total ..................................................... $2,440.29 $ Current Premium (Section 4) $2,654.64 ~~ 5~ ~~~ TOTAL DUE. $2,564.60 $ Make checks payable to: SafeGuard Dental & Vision Amount Paid: Check #: SafeGuard Dental & Vision PO Box 30910 Laguna Hills, CA 92654 SafeGuard Dental & Vision PO Box 30910 Laguna Hills, CA 92654 (800)350-4303 SECTION 2: Eligibility Adjustments -changes from 02/27/09 to 03/31/09 Group ID: 97156421 / Ric Man International Invoice Number 2459443 for the month of April 2009 Section 2 -Page 1 tast Forst Plait Rate Eff Prern~um Action Retro Total Date Member [d 1Varne Name Narze Code na#e Amount Code tdtont}is Premium Entered Terminations XXX-XX-5047 (Stephenson (Neville IVA2332 I 10 02/01/09 XXX-XX-0933 Burnley Trevor SG185A 10 03/01/09 $ 37.95 ST 2.0 $ 75.90 03/13!09 $ 14.14 ST 1.0 $ 14.14 03/05/09 $ 90.04 Summary of Eligibility Adjustments Additions Terminations Family Status Changes Total $ 0.00 $ -90.04 $ 0.00 $ -90.04 C SafeGuard Dental & Vision PQ Box 30910 Laguna Hills, CA 92654 (800)750-4303 Group ID: 97156421 / Ric Man International Invoice Number 2459443 for the month of April 2009 Action Legend for Section 2 Action Legend -Page 1 ST Terminate Subscriber SafeGuard Dental & Vision PO Box 30910 Laguna Hills, CA 92654 (800)750-4303 SECTION 4: Eligibility Roster with Premium Group ID: 97156421 / Ric Man International Invoice Number 2459443 for the month of April 2009 Section 4 -Page 1 C~> Subscriber Name N[emb~r;1L7 E€f DE ' I*ac li} ~'lao Rate Cade Premium Aiken, Gaston )OCX-XX-6083 09/05 97000000 VA2332WS 31 $125.24 Jonatha X)OC-XX-6083 09/05 97000000 VA2332WS $0.00 Khalil X)OC-XX-6083 09/05 97000000 VA2332WS $0.00 Marques X)OC-XX-6083 09105 97000000 VA2332WS $0.00 Tamia XXX-XX-6083 09/05 97000000 VA2332WS $0.00 Tierra X)OC-XX-6083 09/05 97000000 VA2332WS $0.00 ', Yvette X)OC-XX-6083 09/05 97000000 VA2332WS $0.00 Angilot, Julien X)OC-XX-9902 01/05 97008459 SG185A-FL 20 $24.77 Julien )OCX-XX-9902 07/05 97008459 SG185A-FL $0.00 Bailey, Earcel D X)OC-XX-1579 06/06 97009341 SG185A-FL 20 $24.77 Bobetta X)O(-XX-1579 06/06 97005123 SG185A-FL $0.00 Barreneche, Juan J )OCX-XX-2250 06/05 97000000 VA2332WS 20 $75.90 Yvette X)OC-XX-2250 08/06 97000000 VA2332WS $0.00 Benjamin, Lem X)OC-XX-4624 11/04 97000000 VA2332WS 10 $37.95 Cameron, Byron W )OCX-XX-1280 11/04 97000000 VA2332WS 20 $75.90 Sheila )OCX-XX-1280 11!05 97000000 VA2332WS $0.00 Castillo, Rene L X)OC-XX-6416 11/04 97000000 VA2332WS 10 $37.95 Castillo, Rene L X)OC-XX-6481 11/04 97000000 VA2332WS 10 $37.95 Cateura, Edilber )OCX-XX-0894 11/06 97000000 VA2332WS 10 $37.95 Curry, Derrick J )OCX-XX-7079 11/08 97000000 VA2332WS 10 $37.95 Dominguez, Albert A )OCX-XX-1550 04/05 97000000 VA2332WS 31 $125.24 David X)O(-XX-1550 04/05 97000000 VA2332WS $0.00 Kalla X)OC-XX-1550 04/05 97000000 VA2332WS $0.00 Kelly X)OC-XX-1550 04/05 97000000 VA2332WS $0.00 Reuben )OCX-XX-1550 04/05 97000000 VA2332WS $0.00 Dumais, Richard R X)OC-XX-9022 02/07 97000000 VA2332WS 10 $37.95 Fernandez, Yamile X)OC-XX-5559 09/06 97000000 VA2332WS 10 $37.95 Gayle, Robert S X)OC-XX-2489 11/04 97000000 VA2332WS 40 $83.51 Demetri XXX-XX-2489 11/04 97000000 VA2332WS $0.00 Larhone )OCX-XX-2489 11/04 97000000 VA2332WS $0.00 Scott )OOC-XX-2489 11/04 97000000 VA2332WS $0.00 Gonzalez, Julio XXX-XX-8269 11/04 97000000 VA2332WS 10 $37.95 Goulbourn, Denis X)OC-XX-1123 05/06 97000000 VA2332WS 10 $37.95 Hernandez, Luis )OCX-XX-2618 11/06 97000000 VA2332WS 31 $125.24 Jendry Escandon X)OC-XX-2618 11/06 97000000 VA2332WS $0.00 Junior X)OC-XX-2618 11/06 97000000 VA2332WS $0.00 Meyda Perez X)OC-XX-2618 11/06 97000000 VA2332WS $0.00 Hewling, Clive S )OCX-XX-4593 03/07 97000000 VA2332WS 10 $37.95 Holcombe, Earnest L )OCX-XX-1751 11/04 97000000 VA2332WS 31 $125.24 Billy X)OC-XX-1751 11/04 97000000 VA2332WS $0.00 Lakiely X)OC-XX-1751 11/04 97000000 VA2332WS $0.00 Sharon X)OC-XX-1751 11/04 97000000 VA2332WS $0.00 Stephan )OCX-XX-1751 11/04 97000000 VA2332WS $0.00 Hunt, Triston X)OC-XX-7487 11/08 97010287 SG185A-FL 31 $41.74 •n rnRRn C~ihc,~rihor C SafeGuard Dental & Vision PO Box 30910 Laguna Hills, CA 92654 (800)750-4303 SECTION 4: Eligibility Roster with Premium Group ID: 97156421 / Ric Man International Invoice Number 2459443 for the month of April 2009 Section 4 -Page 2 C* Subscriber Name __ _ Nierriber ID Eff Dt Fac iI? Pfan Rate Cade Premium Skyler XXX-XX-7487 11/08 97010287 SG185A-FL $0.00 Starie XXX-XX-7487 11/08 97010287 SG185A-FL $0.00 lafrate, Remo X)OC-XX-1731 11/04 97000000 VA2332WS 20 $75.90 Anna X?OC-XX-1731 11/04 97000000 VA2332WS $0.00 Jiminez, Hector X)OC-XX-4978 08/06 97000000 VA2332WS 40 $83.51 Hector )OCX-XX-4978 08/06 97000000 VA2332WS $0.00 Priscil X)OC-XX-4978 08/06 97000000 VA2332WS $0.00 Liberti II, Nelson )00C-XX-0143 11/04 97000000 VA2332WS 31 $125.24 Audra Liberti X)OC-XX-0143 11/04 97000000 VA2332WS $0.00 Nelson Liberti I X)OC-XX-0143 11/04 97000000 VA2332WS $0.00 '~, Louvierre, Jerry J X)OC-XX-7098 11/04 97000000 VA2332WS 10 $37.95 Love, Jimmie )OCX-XX-3704 11/04 97000000 VA2332WS 10 $37.95 Maccenat, Ospaul )00C-XX-5436 02/06 97060766 SG185A-FL 20 $24.77 Christm X)OC-XX-5436 05/07 97060766 SG185A-FL $0.00 Malek, Thomas A )OCX-XX-2327 11/04 97000000 VA2332WS 10 $37.95 Mancini, David A X)OC-XX-8057 11/04 97000000 VA2332WS 40 $83.51 David Mancini Jr X)OC-XX-8057 11/04 97000000 VA2332WS $0.00 Richard X)OC-XX-8057 11104 97000000 VA2332WS $0.00 Mazzarella, Donna )00C-XX-9401 01/09 97000000 VA2332WS 10 $37.95 Milian, Felix X)OC-XX-9375 11/06 97000000 VA2332WS 20 $75.90 Irene Ondaz X)OC-XX-9375 11/06 97000000 VA2332WS $0.00 Miller, Trevor X)OC-XX-8745 11/07 97000000 VA2332WS 40 $83.51 Kieran XXX-XX-8745 11/07 97000000 VA2332WS $0.00 Lorrez X)OC-XX-8745 11/07 97000000 VA2332WS $0.00 Raheem Xk~C-XX-8745 11/07 97000000 VA2332WS $0.00 Montesono, Juan Ca X)OC-XX-5105 11/06 97000000 VA2332WS 20 $75.90 Laura Rojas X)OC-XX-5105 11/06 97000000 VA2332WS $0.00 ":ace, Eileen ~-?QC-4287 11/07 97000000 VA2332WS 10 337.95 Nace, Joseph L )00C-XX-6246 11/05 97000000 VA2332WS 10 $37.95 Ortiz, Hamill E X)OC-XX-4938 11/07 97000000 VA2332WS 10 $37.95 Parrado, Fernand XXX-XX-5221 09108 97000000 VA2332WS 10 $37.95 Perez, Francis X)OC-XX-4285 11/08 97000000 VA2332WS 20 $75.90 Isabel )OCX-XX-4285 11/08 97000000 VA2332WS $0.00 Prieto, Leonard )OCX-XX-8507 01/09 97000000 VA2332WS 10 $37.95 Reyes, Neftali X)OC-XX-2792 11/04 97000000 VA2332WS 10 $37.95 Smith, Larry X)OC-XX-6727 11/05 97000000 VA2332WS 20 $75.90 Barbara X)OC-XX-6727 11/05 97000000 VA2332WS $0.00 Smith, Nathani X)OC-XX-9817 01/07 97004646 SG185A-FL 10 $14.14 St. Louis, Nestor X)OC-XX-7348 01/05 97010314 SG185A-FL 10 $14.14 Tosto, Joseph X)OC-XX-8133 06/07 97005171 SG185A-FL 31 $41.74 Jonatha )00C-XX-8133 06/07 97005171 SG185A-FL $0.00 Michell X)OC-XX-8133 06/07 97005171 SG185A-FL $0.00 Stephan Wolf X)OC-XX-8133 06/07 97005171 SG185A-FL $0.00 ~~ nr~nnn c..i., ....-:~-...,, SafeGuard Dental & Vision PO Box 30910 Laguna,Hills, CA 92654 {800)750-4303 Section 4 -Page 3 SECTION 4: Eligibility Roster with Premium Group ID: 97156421 / Ric Man International Invoice Number 2459443 for the month of April 2009 Vanderlip, Roger P X)OC-XX-8533 11 /04 97000000 VA2332WS 10 $37.95 Washington, Evlysta X)OC-XX-9985 05/06 97005757 SG185A-FL 10 $14.14 Wichert Jr., Gerard X)OC-XX-7891 11/04 97000000 VA2332WS 20 $75.90 Nancy Ross XXX-XX-7891 11 /04 97000000 VA2332WS $0.00 Williams, Wayne )OCX-XX-8506 01!06 97000000 VA2332WS 20 $75.90 Daegria XXX-XX-8506 01/06 I 97000000 VA2332WS $0.00 Woolley, Warrick S I X)OC-XX-3755 01!05 97005510 SG185A-FL 10 $14.14 -------------------- 48 Subscribers -• Current Premium ................... $2, 654.64 ... $2,654.64 •r rnRR~ c,h~~r~hor C SafeGuard Dental & Vision PO Box 30910 Laguna Hills, CA 92654 (800)750-4303 Section 5: Summary by Plan, Rate Code and Premium Group ID: 97156421 / Ric Man International Invoice Number 2459443 for the month of April 2009 SG185A-FL Piai~ Totals VA2332WS Plan Totals ............... Current Premium Rate Code Legend 10 -Subscriber Only 20 -Subscriber + 1 31 -Subscriber + Family 40 -Subscriber + Children Section 5 -Page 1 10 20 31 4 3 2 $14.14 $24.77 $41.74 $56.56 $74.31 $83.48 ....... 9 $214.35 10 21 $37.95 $796.95 20 9 $75.90 $683.10 31 5 $125.24 $626.20 40 4 $83.51 $334.04 ....... 39 $2,440.29 $2, 654.64 C SafeGuard Dental & Vision P.O. Box 30910 °' Laguna, Hills, CA 92654-0910 Section 6 -Page 1 ~°" (800)750-4303 Fax: (949)360-3695 SECTION 6: Reconciliation Worksheet Group ID: 97156421 / Ric Man International Invoice Number 2459443 for the month of April 2009 Record all eligibility terms on this worksheet. Retroactive adjustments will be accepted for only as far back as the first of the preceding month. Terminations will not be processed unless clearly indicated below. If applicable, please identify either DENTAL (D) or VISION M for the eligibility change Additions -cannot be processed without an Enro~Irnent arm ~arnily Stetus Changes canrkot ba processed wit~czut a OFiange Forrn Photocopy this page if additional space is needed. United Health Care Dept. CH 10151 60055015100009 Palatine IL 60055-0151 -- ~_ _ t_~ I F~F) 1 ~ 1()~y i ~1,~t/~,~;) ,.~ ~, 0406473PBB0074801 RIC-MAN INTERNATIONAL, INC. EILEEN NACE 2601 NW 48TH ST POMPANO BEACH FL 33073 ~~~~ ~ !~ 1=~~ AC~7 #' o AMOUNT COST GAT Account Summary Previous Balance Payments (-) Bi11 Greup Adjustments (+/-) Late Payment Charge (+) Current Charges (+) 0016271165 Current Adjustments (+/-) 0016271249 Total Balance Due .~l UnitedHealthcare ,III A UnitedNealth Group Company Page: 1 of 8 Invoice No: 00016256448 Invoice Date: Feb 09, 2009 Customer No: 415745 Bill Group:l $76,366.90 $-38,290.46 $O.^v0 $0.00 ~ $39,575.34 $1,486.64 / $79,138.42 /~~J Ltd--IL ~~'/ /J~~~"~~~~'i ~ aj ~ Q7(o • ~~~~~u' a~/~~~ ~~ ~ ~ ~ ~~ ~ ~ .~ a ~~ 0~~1, ~ ~l c .~~ , ~ Please Detach and Return the Portion Below with Remittance .~ United Healthcare Dept. CH 10151 60055015100009 Palatine IL 60055-0151 UnitedHealthcare A UnitedHealth Group Company Page: 2 of 8 0406473PBB0074802 RIC-MAN INTERNATIONAL, INC. EILEEN NACE 2601 NW 48TH ST POMPANO BEACH FL 33073 Invoice No: 001 6271 1 65 Invoice Date: Feb 09, 2009 Customer No: 415745 Bill Group: 1 Coverage Pd: 03/01-03/31/2009 Due Date: Mar 01, 2009 Invoice Summary Total Employee Volume 7escription Count (000's) Rate Net Amount 02J5104-RIC-MAN INTERNATIONAL, INC. CHOYC EMPLOYEE 58 $0.00 $21,556.28 EMPLOYEE & CHILD(REN) 7 $0.00 $4,917.01 EMPLOYEE & FAMILY 7 $0.00 $7,561.54 EMPLOYEE & SPOUSE 3 $0.00 $2,319.18 Subtotal - 02J5104-RIC-MAN INTERNATIONAL, INC. 75 $0.00 $36,354.01 0? 75-RIC-MAN INTERNATIONAL, INC. !C+ EMPLOYEE 2 $0.00 $800.32 EMPLOYEE & CHILD(REN) 1 $0.00 $756.31 EMPLOYEE & SPOUSE 2 $0.00 $1,664.70 Subtotal - 02J5105-RIC-MAN INTERNATIONAL, INC. 5 $0.00 $3,221.33 TOTAL 80 $0.00 $39,575.34 Page: 3 of 8 0406473PBB0074802 RIC-MAN INTERNATIONAL, INC. EILEEN NACE 2601 NW 48TH ST POMPANO BEACH FL 33073 Invoice Detail Policy No. Name ID Plan Coverage 02J5104 AIKEN, GASTON XXXXX6083-00 CHDYC EC 02J5104 AMPARO, GERMAN XXXXX0179-00 CHDYC E 02J5104 ANGILOT, JULIEN XXXXX9904-00 CHDYC E 02J5104 BAILEY, EARCEL D XXXXX1579-00 CHDYC ES ~: )4 BAPTISTE, RIVIL R XXXXX6958-00 CHDYC E ~2J5104 BARRENECHE, JUAN J XXXXX2250-00 CHDYC ESC ~2J5104 BENDER, CALVIN XXXXX1096-00 CHDYC E ~2J5104 BENITIZ, ENRIQUE XXXXX6444-00 CHDYC E ~2J5104 BENJAMIN, LEM XXXXX4624-00 CHDYC E ~2J5104 BERMUDEZ, JACQUELINE XXXXX8599-00 CHDYC E )2J5104 BURNLEY, TREVOR XXXXX0933-00 CHDYC E )2J5104 CAMERON, BYRON XXXXX1280-00 CHDYC E )2J5104 CASTILLO JR, RENE L XXXXX6416-00 CHDYC E )2J5104 CATEURA, EDILBERTO XXXXX0894-00 CHDYC E )2J5104 CORNETT, BENNY G XXXXX5121-00 CHDYC E )2~~~-''74 CURRY, DERRICK XXXXX7079-00 CHDYC E )2J5104 DOMINGUEZ, ALBERT A XXXXX1550-00 CHDYC ESC )2J5104 DORAH, AARON XXXXX8159-00 CHDYC E Invoice No: 001 6271 1 65 Invoice Date: Feb 09, 2009 Customer No: 415745 Bill Group: 1 Coverage Pd: 03/01-03/31 /2009 Due Date: Mar 01, 2009 Volume(000's) Charge Amount $702.43 $371.66 $371.66 $773.06 $371.66 $1,080.22 $371.66 $371.66 $371.66 $371.66 $371.66 $371.66 $371.66 $371.66 $371.66 $371.66 $1,080.22 $371.66 0406473PBB0074803 RIC-MAN INTERNATIONAL, INC. EILEEN NACE 2601 NW 48TH ST POMPANO BEACH FL 33073 Invoice Detail Policy No. Name ID Plan Coverage 02J5104 DUMAIS, RICHARD R XXXXX9022-00 CHDYC E 02J5104 FATAL, DIEUJUSTE XXXXX4337-00 CHDYC E 02J5104 FATAL, PETRARD XXXXX7144-00 CHDYC E 02J5104 FERNANDEZ, YAMILE XXXXX5559-00 CHDYC E O 04 GAYLE, DENROY XXXXX1919-00 CHDYC E 02J5104 GAYLE, ROBERT XXXXX2489-00 CHDYC EC 02J5104 GONZALEZ, JULIO XXXXX8269-00 CHDYC E 02J5104 GOULBOURN, DENIS XXXXX1122-00 CHDYC E 02J5104 HERNANDEZ, LUIS A XXXXX2618-00 CHDYC ESC 02J5104 HEWLING, CLIVE S XXXXX4593-00 CHDYC E 02J5104 HOLCOMBE, EARNEST XXXXX1751-00 CHDYC ESC 02J5104 HOLNESS, OMAR R XXXXX6268-00 CHDYC EC 02J5104 HUNT, TRISTON J XXXXX7487-00 CHDYC E 02J5104 IRAHETA, MIKE A XXXXX9302-00 CHDYC E 02J5104 JIMENEZ, HECTOR XXXXX4978-00 CHDYC E O7 -~04 JOHNSON, RONALD D XXXXX3939-00 CHDYC E 02J5104 JOHNSON, TARON L XXXXX0950-00 CHDYC E 02J5104 KALTZ, RYAN J XXXXX8797-00 CHDYC E Page: 4 of 8 Invoice No: 0016271165 Invoice Date: Feb 09, 2009 Customer No : 415745 Bill Group: 1 Coverage Pd: 03/01-03/31/2009 Due Date: Mar 01, 2009 Volume(000's) Charge Amount $371.66 $371.66 $371.66 $371.66 $371.66 $702.43 $371.66 $371.66 $1,080.22 $371.66 $1,080.22 $702.43 $371.66 $371.66 $371.66 $371.66 $371.66 $371.66 Page: 5 of 8 0406473P8B0074803 RIC-MAN INTERNATIONAL, INC. EILEEN NACE 2601 NW 48TH ST POMPANO BEACH FL 33073 Invoice Detail Policy No. Name ID Plan Coverage 02J5104 LIBERTI II, NELSON A XXXXX0143-00 CHDYC ESC 02J5104 LORENZO, JOEGLYS XXXXX6760-00 CHDYC E 02J5104 LOVE, JIMMIE L XXXXX3704-00 CHDYC E 02J5104 MACCENAT, OSPAUL XXXXX5436-00 CHDYC E 0. )4 MALEK, THOMAS XXXXX2327-00 CHDYC E 02J5104 MALONE, REGINALD XXXXX7420-00 CHDYC E D2J5104 MAZZARELLA, DONNA XXXXX9401-00 CHDYC E D2J5104 MCDUFFIE, JAMES F XXXXX4857-00 CHDYC E 02J5104 MEMBRENO, LUIS A XXXXX7998-00 CHDYC ES J2J5104 MILIAN, FELIX XXXXX9375-00 CHDYC E ]2J5104 MILLER, TREVOR H XXXXX8745-00 CHDYC E ]2J5104 MONTESINO, JACIEL XXXXX7173-00 CHDYC EC J2J5104 MONTESINO, JUAN C XXXXX5105-00 CHDYC E ]2J5104 MOREAU, DIDIER XXXXX2556-00 CHDYC E ]2J5104 NACE, EILEEN A XXXXX4287-00 CHDYC E ]2~~~'04 NACE, JOE L XXXXX6246-00 CHDYC E ~2J5104 NAJARRO, ORLANDO XXXXX3781-00 CHDYC EC )2J5104 NESTOR, ST LOUIS XXXXX7348-00 CHDYC E Invoice No: 0016271165 Invoice Date: Feb 09, 2009 Customer No: 415745 Bill Group: 1 Coverage Pd: 03/01-03/31/2009 Due Date: Mar 01, 2009 Volume(000's) Charge Amount $1,080.22 $371.66 $371.66 $371.66 $371.66 $371.66 $371.66 $371.66 $773.06 $371.66 $371.66 $702.43 $371.66 $371.66 $371.66 $371.66 $702.43 $371.66 Page: 6 of 8 0406473PB80074804 RIC-MAN INTERNATIONAL, INC. EILEEN NACE 2601 NW 48TH ST POMPANO BEACH FL 33073 Invoice Detail Policy No. Name ID Plan Coverage 02J5104 ORTIZ, HAMILL E XXXXX4938-00 CHOYC E 02J5104 PALMER, gRENTON XXXXX1611-00 CHOYC E 02J5104 PARRADO, FERNANDO XXXXX5221-00 CHOYC E 02J5104 PENA, DANIEL 5 XXXXX8022-00 CHOYC E C 04 PEREZ, FRANCISCO G XXXXX4285-00 CHOYC E 02J5104 PERKINS, ADAM M XXXXX6277-00 CHOYC EC 02J5104 PRIETO, LEONARDO XXXXX8507-00 CHOYC E 02J5104 REYES, NEFTALI XXXXX2792-00 CHOYC EC 02J5104 RODRIGUEZ, ERNESTO XXXXX2388-00 CHOYC ESC 02J5104 SAINTIL, LESLIE XXXXX0805-00 CHOYC E 02J5104 SMITH, NATHANIEL XXXXX4981-00 CHOYC E 02J5104 STEPHENSON, NEVILLE XXXXX5047-00 CHOYC E 02J5104 TOSTO, JOSEPH R XXXXX8133-00 CHOYC ESC 02J5104 TRACY, PAUL 5 XXXXX1443-00 CHOYC E 02J5104 VANDERLIP, ROGER P XXXXX8533-00 CHOYC E 02~'~104 WASHINGTON, EVLYSTA 8 XXXXX9985-00 CHOYC E 02J5104 WATSON, MICHAEL XXXXX1416-00 CHOYC E 02J5104 WICHERT JR, GERARD M XXXXX7891-00 CHOYC ES Invoice No: 001 6271 1 65 Invoice Date: Feb 09, 2009 Customer No: 415745 Bill Group: 1 Coverage Pd: 03/01-03/31 /2009 Due Date: Mar 01, 2009 Volume(000's) Charge Amount $371.66 $371.66 $371.66 $371.66 $371.66 $702.43 $371.66 $702.43 $1,080.22 $371.66 $371.66 $371.66 $1,080.22 $371.66 $371.66 $371.66 $371.66 $773.06 Page: 7 of 8 0406473PBB0074804 RIC-MAN INTERNATIONAL, INC. EILEEN NACE 2601 NW 48TH ST POMPANO BEACH FL 33073 Invoice No: 0016271165 Invoice Date: Feb 09, 2009 Customer No: 415745 Bill Group: 1 Coverage Pd: 03/01-03/31/2009 Due Date: Mar 01, 2009 Invoice Detail Policy No. Name ID Plan Coverage Volume(000's) Charge Amount 02J5104 WILLIAMS, MARC A XXXXX7478-00 CHOYC E $371.66 02J5104 WILLIAMS, WAYNE A XXXXX8506-00 CHDYC E $371.66 02J5104 WOOLLEY, WARRICK S XXXXX3755-00 CHOYC E $371.66 02J5105 CASTILLO, RENE L XXXXX6481-00 CHOYC+ E $400.16 O: )5 IAFRATE, REMO XXXXX1731-00 CHOYC+ ES $832.35 02J5105 LOUVIERRE , JERRY J XXXXX7098-00 CHOYC+ E $400.16 02J5105 MANCINI, DAVID A XXXXX8057-00 CHOYC+ EC $756.31 02J5105 SMITH, LA RRY E XXXXX6727-00 CHOYC+ ES $832.35 TOTAL $39,575.34 PLEASE VISIT EMPLOYER ESERVICES AT WWW.EMPLOYERESERVICES.CDM TO perform real-time eligibility transactions, view and pay your invoices, request ID cards and more! Employee and dependent information contained in this report is based on the most current information provided by the Employer, acting as Plan Sponsor and/or Plan Administrator (the organization which established the employee welfare plan for its employees) to the Company (a division of UnitedHealth Group contractually administering claims on behalf of the Employer). Changes to employees and dependent information are the responsibility of the Employer, acting as Plan Sponsor and/or Plan Administrator, and must be submitted to the Company on a timely basis. Please do not submit employee changes by noting them on this invoice. This address is used for payment purposes only and written instructions sent to this address will not be processed. Balance reflected is as of the invoice date and may be subject to change pending verification of payment or direct debit bank processing. Any changes will be reflected on your next invoice. Please contact your Billing/Accounts Receivable Representative if you have any questions. Thank you.1-888-842-4571 This invoice covers eligibility charges from the following entities: United Healthcare Insurance Company United Health Care Jept. CH 10151 60055015100009 Palatine IL 60055-0151 UnitedHealthcare A UnitedHealth Group Company Page: 8 of 8 0406473PBB0074805 RIC-MAN INTERNATIONAL, INC. EILEEN NACE 2601 NW 48TH ST POMPANO BEACH FL 33073 Invoice No: 0016271249 Invoice Date: Feb 09, 2009 Customer No: 415745 Bill Group: 1 Coverage Pd: 01/01-02/28/2009 Due Date: Mar 01. 2009 Adjustment Invoice Detail Policy No. Name ID Charge Period Plan Coverage Volume(000's) Status Adjustment Amourr 02J5104 BENDER, CALVIN XXXXX1096-00 02/01-02/28/2009 CHOYC E Add $371.66 02J5104 CORNETT, BENNY G XXXXX5121-00 02/01-02/28/2009 CHOYC E Add $371.66 02J5104 PRIETO, LEONARDO XXXXX8507-00 01/01-01/31/2009 CHOYC E Add $371.66 02/01-02/28/2009 CHOVC E Add $371.66 TOTAL $1,486.64 PLEASE VISIT EMPLDYER ESERVICES AT WWW.EMPLOYERESERVICES.CDM TO perform real-time eligibility transactions, view and pay your invoices, request ID cards and more! Employee and dependent information contained in this report is based on the most current information provided by the Employer, acting as Plan Sponsor and/or Plan Administrator (the organization which established the employee welfare plan for its employees) to the Company (a division of UnitedHealth Group contractually administering claims on behalf of the Employer). Changes to employees and dependent information are the responsibility of the Employer, acting as Plan Sponsor and/or Plan Administrator, and must be submitted to the Company on a timely basis. Please do not submit employee changes by noting them on this invoice. This address is used far payment purposes only and written instructions sent to this address will not be processed. Balance reflected is as of the invoice date and may be subject to change pending verification of payment or direct debit bank processing. Any chanaes will be reflected on your next invoice. Please contact your Billing/Accounts Receivable Representative if you have any questions. Thank you.i-888-842-4571 This invoice covers eligibility charges from the following entities: United Healthcare Insurance Company Project Manual Contractor's Qualification Statement 00908 CONTRACTOR'S QUALIFICATION STATEMENT ITB Number: 23-o8io9 Contractor Name: Ric-Man International, Inc The undersigned certifies under oath that the information provided herein is true and sufficiently complete as not to be misleading: Submitted By: Rene Castillo (Name) Corporate Secretary (Title) Address: 2601 Wiles Road Pompano Beach, FL 33073 Corporation Partnership ^ Individual ^ Joint Venture ^ Other ^ Principal Office Location 2601 Wiles Road, Pompano Beach, FL 33073 Name of the Project: Job Order Contract -ITB No.: 23-0$09 1, Organization 1.1 How many years has your organization been in business as a contractor? 2s years 1.2 How many years has your organization been in business under its present business name? 26 years 1.2.1 Under what other names has your organization operated? None March 2009 City of Miami Beach Page 141 of 185 Project Manual Contractor's Qualification Statement 1.3 If your organization is a corporation, answer the following: 1.3.1 Date of incorporation 1983 1.3.2 State of incorporation Florida 1.3.3 President's Name David Mancini 1.3.4 Vice President's Name Paul Jankowski 1.3.5 Secretary's Name Rene Castillo 1.3.6 Treasurer's Name Lisa Jankowski 1.4 If your organization is a partnership, answer the following: 1.4.1 Date of organization 1.4.2 Type of partnership (if applicable) 1.4.4 Name(s) of General partner(s) 1.5 If your organization is individually owned, answer the following: 1.5.1 Date of organization 1.5.2 Name of Owner 1.6 If the form of your organization is other than those listed above, describe it and name the principals: March 2009 City of Miami Beach Page 142 of 185 Project Manual 2. Licensing Contractor's Qualification Statement 2.1 List licensing evidencing your organization is legally qualified to conduct business in Florida and perform the scope of work described in this ITB respective to the Job Order Contract that you are bidding (see Invitation To Bid -Bid Table), and indicate registration or license numbers (also attach photocopy of license(s)): CUC 044220 CGC 1506008 3. Experience 3.1 List the categories of work your firm normally performs with its own forces. Water, Sewer, Drainage, restoration 3.2 Claims and suits. (If answer to any of the questions below is yes, please attach details). 3.2.1 Has your organization ever failed to complete work awarded to it? Yes, Fort Lauderdale Water Works 2011-Sail Boat Bend- Terminated by owner for convenience. 3.2.2 Are there any judgments, claims, arbitration proceedings or suits pending or outstanding against your organization or its officers? Yes, See attached "Litigation" 3.2.3 Has your organization filed any law suits or request arbitration with regard to construction contracts within the last five (5) years? Yes, See attached "Litigation" 3.3 Within the last five (5) years, has any officer or principal of your organization ever been an officer or principal of another organization when it failed to complete a construction contract? (If the answer is yes, please attach details). No. March 2009 City of Miami Beach Page 143 of 185 c ~ O ~ O C OJ U O ~ ~ QJ O U - m o o r~ a- ~ 0 ~, L DJ m ~ ~ L U ' ~ ~' C (D ~ T.3 ~ U (O ~ U O ~~ O o U T _ ~ U O a ~ ~ O~ N N ~ C O (6 m ~ m ~ o o m -o ~ 3 .~ ~ o o a m ~ ~ > c v ~ L E c - ~ n . , ~ Q U Y ~ ~ ~ ~ ~ (D ~ O O ~ ?. 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E O ~ O , _O ~ m _ _ p o o _O O ~ ~ O ~ _O ~ _O `•- O _ O ~ p ' U U E 0 3 Z U U U U~ U U~ U c -o U U co U~ U a L F- F- ~ F- ~ ~ ~ f- Z Z Z Z Z Z Z Z W ~ W D W ~ W ~ W 0 W ~ W ~ W ~ ~~ _ _ _ _ _ _ W Q U U U U U U U U S O Q Q Q Q Q Q Q Q O~ ~ o r ~ ~ 0 ~ 0 ~ 0 ~ 0 0 ,n ti o rn O ~, r- ~' ~ O m, O U ~ O CV C ~ ~ O ~ C ro O "-' U ~ C N ~ U O O ~ ro~ ro Z O c0 _ O ~ = ro Q7 ~ ~ ~ ~ ~ O O p 3 ~ O C ~ ~ l II c n ~ Q U~ C ~ O U ~ U U ro ~ o Z ca T c U ro ~ ~ o ° o- c a voi -o ~ CU c,i ~ ~ ~ aci a~>>i ~ O7 c C '~ = U ~ L QJ ~ ~ Y' C =~ U C 6 C L ~ U ~ ~ m e -c3 ~ ~ ro ro '~ c~ U U .o ~ Z o > U i U i ~ .~ (O U a> ~ >' L . s o c ~ ~, ~ ~ U O E U O C ` ~ C ~ U ~ CB ~ L(7 ~ ~ ~ ~ ~ ' ~ O ~ cn ~ ~ _ ~ -o -o ~ _ . _ U W .~ ~ D U U~ ~ Q U ~ a a z z Q z z ~ '~ ~ °' o N U o Z o c~ ao a~ o p U U W ~ ~ .-- ~ 0 Q _ o U ~ U U C ~.-- _ O ~' ro 7-. ~ o U ~ 7 (n C .- OJ ro ro _ J O = ~ ~ ~ U U cG O _ ~ % ~ ~ > ~ N ro ~ ~ ro o ro m ~ 0 c --~ ro ~ a~ -o cD N _T ~ N ~ 4= U U ~ ~,•~ O ~ t O N a m N O ~ (D ro C C ~ u~i ~ - C ca U '~ p ~ 0 U c ~ t 9 ~ m ' O N 0 U ~ CV ~ ~_ ~ ~ ~~ ro ro ~ = C U Q) lf7 C ~ ~ t ~ N ~ O Q ~ O N to N - C C ~ C ~~ ~ ~~ ° z 3 .~ `° J ~ J w Q w Q = C7 = C7 O ~ O ~ c~ c o 0 0 Irk Project Manual Contractor's Qualification Statement 4. Attach Organizational Chart hereto. 5. Attach Staffing Plan hereto. March 2009 City of Miami Beach Page 144 of 185 City of North Miami Beach, Florida --Bid 2009-03-23H Federal Aid Roads Sidewalk Home Calendaror Events Li~~ing in NCAB Husiness8 i! Dsvelopmatd ~ At A Glanre Building PermRs Demaoraphics Slats 8 Fats Development News NMB CRA Oceninq a Business Purchasinn Currant Bids 2008 Bid Awards 2009 Bid Awards Vendor lnfortnaticn Public Safety AssistancelGrants~Leans H Planning 8 Urban ! ~ Ltesign Inside City Gnvernmerf~ City Charter& Code S"lorhing for h~i'r.H Visiting NMH City Directory Gcing Gn:zn FAQ Halp(W LiniG Press Releases Ahoct NMB Ahoert Ibis Site Search GO 57 rai s;l< Search Tics Bid 2009-03-23H Federal Aid Roads Sidewalk TuasJay, ip~i 27, ICf.9 at f l;fp AM CLOSING DATE: TUESDAY, APRIL 21, 2009 c:J7 DovvNtono Bids must be received no later than I I:DO a.m. on APRIL 21, 2009 and are to be submitted to: Administrative Services Director Administrative Services Department City of North Miami Beach 1701 I NE 19 AVENUE, SUITE 315 NORTH MIAMI BEACH, FLORIDA 331 b2 Only companies pre-qualifiied under RFQ 2003-23A are allowed to bid: Mr. Jose Sanchez Horizon Contractors, Inc. 8175 W. 32 Avenue, Suite I, Hialeah, FI 33018 Mr, Martin Marks Marks Brothers, Inc. 9455 NW 104 Street, Medley, Rorida 33 i 78 Mr. Martin Vila M. Vila & Associates, Inc. 12097 NW 98 Avenue, Hialeah Gardens, Florida 33018 Mr. Jorge Munilla MCM Corporation, Inc. 6201 S~V 70 Street, 2 Ffoor, Miami, Florida 33143 Mr. Ronald E. Penta Ocean Bay Construction, Inc. 2200 N W I b Street, Pompano Beach, Florida 33064 Mr. David Mancini Ric-Man International, Inc 2601 NW 48 Street, Pompano Beach, Florida 33073 Mr. Ed Dominguez Southeastern Engineering Contrattors, Inc. 12054 N.W. 98 Avenue, Hialeah Gardens, Fla 33018 Mr. Charles P. Munz The Redland Company, Inc 23799 SW 167 Avenue, Homestead, Florida 33031 Mr. Ronnie Smith Williams Paving Company, Inc. 1 1300 NW South River Drive, Medley, Florida 33178 The "Cone of Silence" is in effect in accordance with Section 2-1 Li (t) of the Miami-Dade County Code, as amended- last updated wednzsda~, Marti 25, 21M19 PrnlerJnendly Versio Thi~.e r orrcul ;,a a; :ha Oita or ~P:arn'a~air.' aaac., FWnCa Hom< I Calendar of Events ~ tivina in NMB I Brninaaa 8 Dev<laarrent ~ Planning 8 UrCan 7eaion I inside Gb Gavemment I CiN CTaner 8 Cade I NbMina br 1~A Q ~ Visiting NM110 I CiN Oiedorv I Going Green I E$Q I HeloNl L'nla I press RHeaaes I Agovt NMB I Abnur Vns Site Pabe 1 of 2 http://citynmb.comlindex.asp?Type=B_EV&SEC= { 87C05223-A2FB-430D-9611-O~1F4E9... 3/26/2009 aOARD OF COUNTY COAAMISSIONERS Ric-Man International, Inc. 2601 NW 48th Street Pompano Beach, FL 33073 Re: Letter Of Recommendation To Whom It May Concern: PU[iLIC WORKS DEPARTMENT October 20, 2008 I have had the great pleasure of working `with Ric-Man International, Inc. on a St. Lucie County construction project. The project ipvolved infrastructure improvements to an existing neighborhood, and included the installation of a desperately needed sanitary and storm sewer system for the existing residents. The job also involved the reconstruction of local roadways, and was considered to be a success primarily due to Ric-Man's efforts. The personnel at Ric-Man International, Inc. performed superbly. They consistently provided quality service to the County staff and the citizens of St. Lucie County. Their experienced crew and project leaders take a "proactive approach" to conflicts in the field in order to ensure that the project stays on schedule and within budget. This contractor provided an excellent maintenance-of traffc {MOT) program, offering good traffic flow throughout the construction area and ensured continuous resident and vehicle operator safety. They also worked tirelessly to keep the local public and community informed of the project's progress. I would not hesitate to recommend Ric-Man International, Inc. to perform construction contracting services. I look forward to working with them on future` projects in St. Lucie Caunty. If you have any questions or require any additional information, please feel free to contact me at (772) 462-2153. Thank you. Sincerely, Kyie J. Croce, P.E. Senior Project Engineer St. Lucie County Engineering JOSEPH E. SMITH, District No. 1 DOUG COWARD, Disrdcr No. 2 • PAULA A. LEWiS, Oisrrkr No. ~ CHARLES GRANDE, Olurio No. 4 • CHRIS CRAFT, Disrricr No. 5 County Adminlsiroror - Dougios M. Anderson 2300 Vlrgini4 Avenue Fr. Pierce, FL 34982 Public Works: (772) 462-1485 FAX (772) 462-2362 Division of Engineering: (772) 462-1707 FAX 462-2362 Division of Road & bridge: (772) 4b2-2511 FAX 462-2363 www. cost-I ucie. f{, us 8~~~I1IAR-D ~~~~~ Public Works and Transportation Departrnent • Water and Wastewater Services WATER AND WASTEWATER ENGINEERING DIVISION 2555 West Copans Road • Pompano Beach, Florida 33069 • 954-831-0745 • FAX 954-831-0798ro925 January 28, 2008 Nora W. Laudermilk CPPB, Procurement Official City of West Palm Beach 1045 Charlotte Avenue West Palm Beach, FL 33401 Subject: LETTER OF REFERENCE RIC MAN INTERNATIONAL Dear Ms. Laudermilk: Ric-Man International has completed several Bid Packages in Broward County's ongoing Neighborhood Improvement Program. They have completed each project on time and under budget with special emphasis placed on public awareness. They do not file frivolous change order requests and pay attention to directives and specifications. I plan to work with them on future Neighborhood Improvement projects and highly recommend them. Sincere) ; Patrick J. acGre or Expansion Project Administrator PJ M/cy G: IE~UI.. bic-man letter of reference. doc Broward County Board of County Commissioners Josepnus Eggelletbn, Jr. • Sue Gunzburger • Kristin D. Jacobs • Ken Keechl • Ilene Lieberman • Stacy Ritter • John E_ RodsUom, Jr. • Diana Wasserman-Rubin ~ Lois Wexlar www,broward.org ,;; ~~~~ &ASS~C~AT~S Civil and Environmental Engineers January 25, 2008 Nora W. Laudermilk, CPPB, Procurement Official City of West Palm Beach 1000 45th Street -Suite 15 West Palm Beach, FL 33407-2434 Dear Ms. Lauderdmilk: 500 West Cypress Creek Road Suite 410 Fort Lauderdale, FL 33309 Telephone: (954) 730-0707 Fax: (954) 730-2030 This letter is to address Ric-Man International, Int.'s experience and ability to perform utility and roadwork within the public right-of-way. We have worked with Ric-Man International, Inc. for over 8 years. They are a highly experienced firm managed by resourceful and dedicated employees. Ric-Man International, Inc. has a high work ethic and completes their projects on time and on budget. When the scope of a project changes, my firm is often able to add work through change orders at reasonable prices because of the speed and quality of their construction. Ric-Man International, Inc. has a great sense of public awareness and is quick to respond to the few resident complaints received on projects. We frequently find that homeowner's associations within their projects request that we use them exclusively. In addition, they provide a very safe environment for their employees and the general public. Professionalism and expertise are found at all levels throughout Ric-Man International, Inc., from David Mancini, president, and Rene L. Castillo, general manager, to the construction personnel. Ric- Man International, Int.'s staff brainstorms for new, incisive ideas and procedures which they follow through on in a timely manner, thus saving time and money, and reducing impact to the general public. We highly recommend Ric-Man International, Inc. for any neighborhood improvement type project. Should you have any questions you may contact me at 954.730.0707 ext 104. J AND ASSOCIATES Moore, PE "Providing quality, responsive and professional service to clients, peers and the public for z0 years" 1/30/08 CRAVEN 1H4MPSON & ASSOCIPJES ING Engineers Planners Surveyors 3563 N.W. 53rd Street Fort Lauderdale, FL 33309-6311 (954)739-6400 Fax (954) 739-8409 Nora Laudermilk CPPB Procurement Official City of West Palm Beach, FL RE: Ric Man International, Inc. Dear Ms. Laudermilk, We are glad to recommend Ric Man International, Inc. as a very experienced Contractor in performing drainage, water, sewer, pump stations, roadway, sidewalks and landscaping. They have worked on several of our Projects over the past ten (10) years and have completed quality work in a timely fashion utilizing many subcontractors, including minority contractors, for different aspects of the Work. We have a great working relationship with Ric Man International, Inc. and seek their assistance for determining practical solutions to many difficult scenarios that arise during the course of any Project. They have always been helpful to us in cost analysis for other than normal construction applications. We consider them a top quality construction company and highly recommend them. Should you require any additional information regarding Ric Man International, Inc. please contact myself. Sincerely, Craven Associates Pat ' .Gibney, P.E. Project Manager West Paim Beach „~;~_, ~.,:.~ M1AMlC~~~ ,,,, P,hLr I r;,.,, ;i l~~,n;.,.rl r.. ~.: .~.::.:.r,:~,_ ,.,.:...., ..::Si ~ 5... pls. \ora tl' 1,audermiLc. (`PPR Prclcurcttttirrt t)i'licial l C)4ti C'llarluttc Ati e. 4Ve~t 1'altn 13cacl:, Fl; ; ;4C~ I General Scrvice5 ~dmmistratiun `. Jrh,fUt_.I~ II ~.~,~y ;,9 F":'fl'1P I11 ?. i c,,.ll'1:.-3t1~1. ~rr~i ll.th r)I; I~O:~ CJCic~• r;1 t^e i~irc~~ ir;r ~ ~'s,J 1 ~t ~r,t•c.t Sure ?~t'C T ~[; -':' - I l ij~ F :iii.;-3?>-) 1 ?~ rniamidade.gol PLF: IZiC-Matt Illterratioaa% ?ttc. I:euer {rf l~~:ci?nlmenilataolt l~c~°.r ~,1. Laudcrlrli'1.= C)~ cr the ?act ~ti ~ cars i h~ vs per~~mal1}' to nt1~~~c1 nunlerl~ns prnjcct~ ~~ iih Ritz-Marl Itltett:~tiimal. Tilsit' irtte;rity and productivity i~ ~;cll ~_l,lir,-e ~:~'cr'a~r~ . A~ a_°t i ~n~~er~,~r~>utrr~ F.nkineeritt~~ C=c?ntr,1L;;,r, Ric-elan lIl'errlatlir'ld, hat'l 1Ltl"i11511C~i allwl 1rr51'dlle(~ t110LlS~irld~ i?~ l~'c't Ot ~`1hL' 1''{?T'.1 1?(i-inch ctmcrste t-?r~:-su`essscl pipe to ~-inch ductile irtin pipe:: hcnh iti 'tt~atcr lines and in dcel~ ~<=rritarl~ sch~ers. T.flsir pcr~t>hnel at's. ~'~crv Ll~ell e~pi•ricnced in ilttd.:r~rc>L:nil tttlitics and rl~radti't~a~ti ccm.t~tt4tiou.- -I'hev h7;, c alo heri~r'tils: e~pccial,,• ~~:sll at tlir.ctic,nl! :~rillin~~, Iutmps st<ation~. tlh;~c{ut:ou cl-osin~~s..~nd aerial cros~irr Tlle~ t~~ork ',~er~° closclt Leith ['lt' `o~~;,rnin~* <~++?et.cii;s. ~ttcil a L•L)U1'. l~'ith this cli);~ raI?l~,trt the}' 1t:i'.e l~zelt t:tilc tc?~clase tlt.~ji,r itl_crect~~n~ i,ucll is ltendall Drive, a utajnr <cs lade I'C1<aj lUr 8 V:et.~er1Cl_ l~"[ll~~ lilStaillll!? <3 ~~~~~ *~ `; ... YI't-..1re.~Sei1 CQIli'rt'lc cylit.dsr i ~e. ~L~hiclr th~~' ct?til ~lztstl a~cti.d 1>1 S- t p } ~_ } ~llet~l tl~~. 1 ltt?i~l'I'StaT]Ll ~`f1311' ?1'al~CCt 'i11Cti tl1C'l'.e (~} lllal(11~ CI`OSSIII~'S; 1ZIC-~'latl lri.15 l~erli,rtnscl rtl~enl such ct'ossin;~s in 1~1%atni-Da~Ie C~~utty tx- tyre «~ater and Sevrer L}spartnrent_ :111 ec;n~;;•rleej on schedllle even ai~ter several tu-li~re.scctr conllict Lyere. erlC[?unterei~3, n2~Ity c?ver a si?lels ~~;:ekend. l hcy o~l;ll <:ll tlrs necrs;lrti egt:iptlent, thsrc. tiro ncr ilela~'s irr renting or ~'1'{?~llrtni~', cilLl?1?I71~t11, ~ti'lllti.lr I'i;~Llll~ in havilt~s tl'ri: 1'1`~?It 41Yilelrllts: LlL t11~ r"t;~llt i1111e ~y;tll Iii? l::\L'Ll~e$, l lll~ahlS,' reCtr111n1C'I1Ca Rlc-~'l~1Cr- II1tC.I'nL+tlt)11~1 X15 Otll: i?1 the ~li'Clillr ctrltra~:tors in St~utlt l~ loritlt. Ii' vptt t~3csire y,ru :r.~~" ctstltact llls at ?~C-~€G9-?(~}{~l lin- zldditional it} lorrlrirtion. Silycerel~. C~CrI1SlrLtct€OTl w~'~~Ild!;!Lr .z lliatni-llade Cnunt~,- CiS:1, DC~T) 1 ;? ~~". l~la;~ler street, Suits ?~(} I~liami, F'I ~ ;1 ;{~ i C' I engineering & environmental services Mr. Alexander Diaz, Town Manager May 15th, 2008 Town of Golden Beach Re: Referral for Ric-Man International Mr. Diaz, r ,.. .-;+;~~ L,n4.n .-, of R;~..AJ!_ n"c.rn-~ti of rn;~rrmmy ~i rr hair ~a!-* ir;ec 4n }ha ~ u... '`/Yi ri~~ ly Oi i v..~ :ub'.~ .r. ,~. 3~ , I u~~ : ,[,.~~nta~ !n n..,n~ t .... J .. Town Of Golden Beach. My firm, Nova Consulting, Inc has been acquainted with Ric- Man International for many years as a pipeline and underground contractor for many projects through Miami-Dade WASD. This includes the 54-inch FM design/build project for Miami-Dade in which Nova Consulting, Inc, was the designer and prime contractor, and Ric-Man International was our installation sub-contractor. This was a difficult installation project and Ric-Man International, with their vast experience, provided the expertise needed to make this a successful project. With all the endeavors that I am familiar with, Ric-Man International has performed admirably, and professionally. In the future, if Nova Consulting, Inc was to require the services of a pipeline and underground contractor, Ric-Man International would be our first choice. I do not hesitate in recommending this contractor to the Town of Golden Beach. If we can be of further assistance do not hesitate to contact me at (305) 436-9200. Respectfully, ..._. ,~ ~ ~ ~ Steven S. Eagle, PE Senior Principal Engi eer 10486 N.W. 31st Terrace • Miami, Florida 33172 • Phone: 305-436-9200 • Fax: 305-436-9265 • www.nova-consutting.com ..~ ~~~~~~J~ City o~ ~.~I~L,.~hT~ PAR.I~ hebruary s; 2o~s To Whom It 1\~ay Caneenl It is my pleasure to write this letter of reference on behalf RIC-Mr~N Inter~latiotlal, firm that recently con~hleted a 53.E million-dollar drainage improvement project for the City of Oakland Park• 'T'his project inclueled installation of 2,630 L~ 4' by T boy culvert, 2,600 L~F of water r~lains anti total restoration of a major Broward County road and efficient night aiad weekend operatioi~ls crossing Oakland Pa~•k I3lwd, Their teamwork in cooperation with our staff whcrc the key elements in completing this project, 50 days, ahead ol'schedule and within budget. In conclusion I would just say that we would not have any problems in contracting with RIC-Nft~N in the future, an excellent contractor. Ij Since •el'y,,^ .;'`3 ~~n erez Project Manager ~" Engineering ~; Comt~nunity Development Department 3650 N.E. 12th. ~wontre f Oakland Paz•k, Florida 3333=I .~.~~_~_ «TWt~n~.c~akland~~r~rkFLc-~~•s~ ~...~.a...~... W.._,_. ~~ ~ ' ;~ d 1 1 ~ 1; ~~ P ,. a~! ~~ water utilities Department January 31, 2008 En$ineerin~ p.o. Box 16097 Nora W. Loudermilk, CPPB West Palm Beach, FL 33416-6097 procurement Official, (561) 493-6000 City of West Palm Beach Fax: (561) 493-6113 www.pbcwater.com I am delighted and privileged to write this letter of recommendation for Ric- Man International, Inc. I have been working with David Mancini and Rene Castillo their President and General Manager for over 18 years. They have ~ performed many projects for me while at Broward County and now at Palm Beach Utilities. Ric-Man International specializes in neighborhood improvements projects, consisting of drainage, water and sewer including pump stations, directional drilling and sub-aqueous crossings as well as Palm Beach County Board of County roadways, concrete work, and landscaping. Commissioners Ric-Man has consistently completed all my projects ahead of schedule. In Eddie L. Greene, Chairperson some instances they collected from the County bonus payments for Jeff Koons, Vice Chair expediting their work. We have received very few complaints from residents due to Ric-Man's procedures in direct communication with local Karen T. Marcus residents advising them of ahead of time of what they can expect and Robert J. Kanjian resolving the minor issues that have come up diligently. Mary McCarty The County has often benefited from Ric-Man International's efficient and Burt Aaronson innovative ideas and procedures which expedite the work and reduce costs. Their communication skill result in efficient construction, good Jess R. Santamaria documentation, and prompt coordination with utility companies, municipalities and the general project. i erilorace working with Ric-i1~ar7 internaiionai ifl the future and highly recommend them to any municipality desiring an experienced and County Administrator resourceful contractor. Robert Weisman If you desire you may contact me at (561) 493-6088. S' cerely, o ep Tanacredi, P. E. :4n Equa! Opportunity Affirman've .4ctian Employer' printed on recycled paper QOARD OF COUNTY COMMISSIONERS Ric-Man International, Inc. 2601 NW 48th Street Pompano Beach, FL 33073 Re: Letter Of Recommendation To Whom It May Concern: PUQLIC WORKS DEPARTMENT October 20, 2008 I have had the great pleasure of working with Ric-Man International, Inc. on a St. Lucie County construction project. The project involved infrastructure improvements to an existing neighborhood, and included the installation of a desperately needed sanitary and storm sewer system for the existing residents. The job also involved the reconstruction of local roadways, and was considered to be a success primarily due to Ric-Man's efforts. The personnel at Ric-Man International, Inc. performed superbly. They consistently provided quality service to the County staff and the citizens of St. Lucie County. Their experienced crew and project leaders take a "proactive approach" to conflicts in the field in order to ensure that the project stays on schedule and within budget. This contractor provided an excellent maintenance-of-traffic (MOT) program, offering good traffic flow throughout the construction area and ensured continuous resident and vehicle operator safety. They also worked tirelessly to keep the local public and community informed of the project's progress. I would not hesitate to recommend Ric-Man International, Inc. to perform construction contracting services. I look forward to working with them on future projects in St. Lucie County. If you have any questions or require any additional information, please feel free to contact me at (772) 462-2153. Thank you. Sincerely, ----. Kyle J. Croce, P.E. Senior Project Engineer St. Lucie County Engineering JOSEPH E SMITH, Disrricr No. 1 DOUG COWARD. District No. 2 PAULA A. LEWIS, District No. 3 CHARLES GRANDE, Disrricr No. 4 CHRIS CRAFT, Disrricr No. 5 County Administrator - Douglas M. Anderson 2300 Virginia Avenue Fr. Pierce, FL 34982 Public Worl~s: (772) 462-1485 FAX (772) 462-2362 Division of Engineering: (772) 462-1707 FAX 462-2562 Division of Rood ~ Dridge: (772) 462-2511 FAX 462-2365 www. co. sr-luc i e. fl . us r &ASSOCIATFS Civil and Environmental Engineers. May 7, 2008 Mr. Alexander Diaz, Town Manager Town of Golden Beach I Golden Beach Drive Golden Beach, FL 33160 Dear Mr. Diaz: 500 West Cypress Creek Road Suite 410 Fort Lauderdale, FL 33309 Telephone: (954) 730-0707 Fax: (954) 730-2030 This letter is to address Ric-Man International, Inc.'s experience and ability to perform utility and roadwork within the public right-of--way. We have worked with Ric-Man International, Inc. for over eight years. They are a highly experienced firm managed by resourceful and dedicated employees. Ric-Man International, Inc. has a high work ethic and completes their projects on time and under budget. When the scope of a project changes, my firm is often able to add work through change orders at reasonable prices because of the speed and quality of their construction. Ric-Man International, Inc. has a great sense of public awareness and is quick to respond to the few resident complaints received on projects. We frequently find that homeowner's associations within their projects request that we use them exclusively. In addition, they provide a very safe environment for their employees and the general public. Professionalism and expertise are found at all levels throughout Ric-Man International, Inc., from David Mancini, president, and Rene L. Castillo, general manager, to the construction personnel. Ric- Man International, Inc.'s staff brainstorms for new, incisive ideas and procedures which they follow through on in a timely manner, thus saving time and money, and reducing impact to the general public. We highly recommend Ric-Man International, Inc. for any neighborhood improvement type project. Should you have any questions you may contact me at 954.730.0707 ext 104. Sincerely, AND ASSOCIATES bore, PE "Providing quality, responsive and professional service to clients, peers and the public for 20 years" B~;c~;WARD COUN?Y ^a~•'•~®•~•^ aubllc works and 7ranspor[atlon Department -Water and Wastewater Services WATER AND WASTEWATER ENGINEERING DIVISION 2555 West Copans Road • Pompano Beach, Florida 33069 • 954-831-0745 • FAX 954-g31-074810925 March 24, 2008 Mr. Robert Pushkin, Assistant City Manager City of North Bay Village 7903 East Drive North Bay Village, FL 33141-3310 RE: RIC-MAN INTERNATIONAL LETTER OF RECOMMENDATION Dear Mr. Pushkin: Ric-Man International is ,presently completing two projects valued at over $ 20 million in neighborhood improvement construction projects wish Broward County Water and Wastewater Services- These projects consist of water main installation; sewer and sewer lift station installation as well as paving, drainage and landscaping. One project is 98% complete and the other is 50% complete. The project has enjoyed the support of residents due to Rio-Man's care and concern for the affected homeowners and businesses. RicrMan has performed several of these comprehensive neighborhood improvement projects and the County has been very pleased with their performance. Ric~Man also performed an emergency installation of almost 10,000 linear feet of 20" water main along the State Road 7 corridor. This work was complete under the three million dollar budget and completed in two months time- This was one month ahead of a very tight schedule imposed by FDOT. Additionally, Rio-Man was crucial in making emergency repairs to our utility system following the passing of Hurricane Wilma. We would highly recommend them for any utility installation or emergency repairs for your City. Si r,lly, .' ~tiV" Alan .Garcia, P-E- Director AWG/lm 0322 ricman recommendation.doc Broward County Board of County Commissioners Jcsephus Eggeneuon, Jr. • Ben Graber • Sue Gunzburger • Kristin D. Jacobs • Ilene Ueberman • John E. Rodstrom. Jr. • Jim Scott • Diana Wasserman-Rubin • Lou Wexler www.broward.org ~~ - e~d °.{ti ~II~'i 2000 City Hall Drive, Lauderhill, Florida 33313 June 21St, 2006 TO WHOM IT MAY CONCERN, This is a letter of reference in favor of RIC-MAN International, Incorporated. RIC-MAN International, Inc. was awarded a contract by the City of Lauderhill for $837,000 in December 2005 to extend sewer mains. This project was completed under budget and ahead of schedule. For the duration of this project there was a very good relationship between City staff and that of RIC-MAN International, Inc. They cooperated with us to resolve any issues quickly and efficiently. The staff of Ric-Man always acted very professionally. The City of Lauderhill was very pleased with the work of RIC-MAN International, Inc. and a second contract was awarded to RIC-MAN International, Inc. for $1,220,000 for the replacement of water and sewer mains. The City of Lauderhill hereby recommends RIC-MAN International, Inc. to anyone requiring their services for similar projects. Yours truly, l ~~ ~l~ Indar Maharaj Capital Projects Manager ~~:. V E~enberg-Ei~he~° Elementary School 1420 Washington Avenue, Miami Beach, Florida 33139 Phone 1305) 531-0419 • Fax (3051 534-3925 Internet http://fienberg.dadeschools.net "Educating the Leaders of Tomorrow" Rudolph F. Crew, Ed.D. Superintendent of Schools Miami-Dade County Public Schools Dr. Martin Karp School Board Member Miami-Dade County Public Schools November 1, 2006 TO WHO IT MAY CONCERN: Olga M. Figueras Principal Assistant Principals: Bettye Y. White Maria G. Zabala I am writing this letter of recommendation on behalf of the Construction Team at Ric-Man International. As this project began and our surrounding began to change with the implementation of this project, this group made each phase of the project run smoothly, making sure at the end of each day business continue as usual. They kept us informed, maintained our surroundings as clean as possible, worked longer hours. This evidences that working together as a team, projects can run well and be completed in a timely manner. If you should need any additional information, you may contact me at (305) 531-0419 ext. 144. Sincerely, ~~ Olga M. Figueras, Principal OMF:oIr Mission Statement The mission of Fienberg/ Fisher Elementary and Adult Center is to develop independent, life long, academically successful, healthy learners by working in partnership with our families and community. y' Miami-Dade Water and Sewer Department P. O. Box 330316 • 3071 SW 38th Avenue Miami, Florida 33233-0316 T 305-665-7471 ADA Coordination Agenda Coordination Art in Public Plates Audi) and ~btanagomenl Services Aviation 3uilding Code Complinncc ISuilding &isincss Dc•vclopnu•n1 Cap i I a I Improvements Citizen's Indeprndrnl Tnin<pnrtalinn Trust ConlnuIIlicalinna Community A<tian Agonty Community \ EG1nUnlIC Dceclopmonl Community Rclatirnts (~rln SUnler 1e1\'It('t Curruclions A Rchabililatiun Gnmh~wido llealtht arc Planning Cultural Ailairs F lr•rliuns bncrgcnq~ M1lanagunu~nl Fnyiloycc Rel,rtionc Fnterpricc TcchnnnGv Sen~it rs Fmironinenlal Rcsr rune<~11ana>;eilrcnl Fair Emplucmcnt Practices Fin, ntc Fin• Kcsarc General Services Administration Historic Prc•x•rvatiun I Inmclcs< Trull Flouring Agen\, Fiuusing Finan c' AW hnrity Human Scrvitc5 Independem Review Panel International Trade Consortium Juvenile Assessment Ccmcr ,~Icdical E~amincr Metropolitan Planning Organization I'a rk and Kccreatinn Planning and Zoning Police Prncurcnsnl rtlanagemcnt Properly Appraisor Public Lihran~ Ssslcm Puhli<. Works Saio Neighborhood Parke Seaport Solid \-baste ~blarragensnt Stmlegic Nusine» Managcmcnl Teen, Metrt~ van~a Urban Revitalization Task Force Vizcaya ~Aluscum and Gardens Water and Sewer miamidade.gov March 22, 2006 Mr. Robert Pushkin, Assistant City Manager City of North Bay Village 7903 East Drive Harbor Island, Florida Re: Ric-Man International Dear Mr. Pushkin: Ric-Man International has successfitlly completed several million dollar projects over the past 23 years. They have consistently completed projects ahead of schedule. There have been several occasions in which emergency work was necessary in which Ric-Man International provided the department a very fair price and efficiently completed the emergency work even in scenario where modifications had to be made as the work progressed. They are very resourcefi~l in coming up with time saving and cost effective modifications resulting in improvement in our own design. We will continue to use Ric-Man International on any future emergency work and highly recommend their expertise. If you need additional information contact me at telephone number 786- 552-8148 Sincerely, /// / Armando ubio Constnlction Manager II C: Rene Castillo, General Manager Ric-Man International File OFFICE OE THE MAYOR Rae Carole Armstrong, Mayor UTILITIES DEPARTMENT Hank Breitenkam, Director March 28, 2006 -"-`~ CITY COUNCIL ~___..~~ Sharon Uria, President Jerry Fadgen, President Pro Tem 1 Diane Veltri Bendekovic Dr. Robert A. Levy P~1rit3tlOri Rico Petrocelli the grass is greener' RE: Letter of Recommendation in favor of Ric-Man International, Inc. To Whom It May Concern: Ric-Man International, Inc. is currently doing adesign-build, $1.55 million dollar Capital Improvement Project for the City of Plantation that includes the directional boring of a 20" HDPE force main in a 24" sleeve and a 10" HDPE water main in a 12" sleeve under Florida's Turnpike, as well as an 8" HDPE water. main under the Sunrise Boulevard canal and roadway. Ric-Man has successfully completed the Turnpike portion of the project in order to avoid conflicts for the City with the Turnpike expansion project contractor. Every step of the way, Ric-Man's project coordinator keeps the City staff informed of the project's status and makes us cognizant of upcoming coordination requirements. There have not been any surprises with Ric-Man. Their staff is professional, meets deadlines, and can be counted on to give you the "straight story". Immediately following Hurricane Wilma, Ric-Man's help was an essential part of this department's response to the repair of broken water mains. They didn't need any direction except to the location of the job. They got the job done under quite adverse conditions. Ric-Man has earned my trust and confidence to get the job done. Should you have any questions, please do not hesitate to contact me at 954-797- 2293, or E Mail, hbreitenkamCa~plantation.org Yours truly.!-, ;, __---~~ Hank Breitenkam, Director of Utilities SOU ~`~C 73rd _wcnur ~ Plantation, Fl~,rici;i 33317 n- i -rn~ n~-~n . _i _ .__i._.rn . _.._ _ -- ~'F°~'p~~ N.E. Focal Point CASA~, Inc. '"y'~~ '~~` `` (*Children's, Alzheimer's, Senior, and Adult Services) 1 vim/ 227 NW 2°d Street, Deerfield Beach 33441 ~~~gt~ (954) 480-4460 Fax (954) 480-4493 Child Care Center Alzheimer's Center oc.4Center Adult Day Services ,r ,r-t ~- , (954) 480-4473 (954) 480-4460 9 ~ '~}8QL44~4~~ ~r~'~ (954) 480-4470 President Todd Llttle~Ohn First Vice President Cathy Giroux Second Vice President Marsha Milot Secretary Liz McGill Treasurer Dan Dodge Commissioner of Hillsboro Beach Associate Treasurer Joan Fink ~ecial Events .Nilliam Ciroux Directors Connie Caloggero Mary Celentano Winnie Frazer Shelly Greenberg Ed Hahn Charles Moran Richard Sales Duane Timm Rhea Weiss Hcrcrwry :Vicmvers Dan Dodge Director of Senior Services Donna DeFronzo ~,~, United Way a sro..ara cony June 6, 2006 David Mancini Ric-Man International Inc. 2601 NW 48 Street Pompano Beach, FL 33073 JiIN r 7 2006 ~. Dear David , The Officers and Board of Directors join me in thanking you for your donation to the auction for the "Cuisine of the Region" on Wednesday, Apri126, 2006 at the Deerfield Country Club. The event was a great success and approximately $45,000 was raised for Children's, Alzheimer's, Senior and Adult Services at the N.E. Focal Point. Our tax-exempt number is 59-2746841 for your records. Your donation to the auction helped make this a financially successful event. We appreciate your generosity and kindness. Without contributors like you, we could not provide much needed services to our community. Thank you once again and best wishes to you for continued succe~~! ~ t / c~~ ~ J~Sincerelynyo r~s, l.~!G° l ~~ / I - ~~ ~~ ;', ~i_ ~ uDonna DeFronzo Director of Senior Services DD:dr ~ ~ ~ ~ ~~~ -~~ ~~N_ ~ - ~ ~~~~ `~~~.. L ~ I/1 A NOT FOR PROFIT CORPORATIO~/w ~- ~ ~~ ` / POI ~1T,~' r //~~ ~~ ,//~ N.E. Foca! Point CASA', /nc. is a tae-eeempt, not for-profit charitable orgnniantion under Internal Revenue Code SO/c3. Yarr gift is taz deductible to extend appropriate for you cooler !RS regulntiwrs. "A copy of [he official registratiar and financial information may be obmined from Jre Division of Consumer Service .6X calling m(lhfr[eQe/("J8~,0~0-4/3~5-7351) within the state. Registration does not imply endorsement, approval, or recommendation by the state. " ynJ/j~ + (/J~ ,f' / V ' ~,;,~~ ~ n~ tt~e ,~ ~ HIGH ROAD ~ounc~.ation, inc . ~,~~/ _~. December 15, 2004 VIA U.S. MAIL Mr. David Mancini 2601 NW 48t'' St. Pompano Beach, FL 33073 DEC 1 7 ZH4 BY: Dear David: On behalf of all the directors of the High Road Foundation, and especially, Fredde and I, thank you for your continuing interest in the High Road Golf Tournament. Each year the High Road takes small steps in the right direction and in 2005 we hope to lengthen our stride. While I didn't have the opportunity to talk at length with you at the Golf Tournament, I want to thank you for taking the time to participate. The High Road kids that benefit from the proceeds of the tournament do not attend the tournament. But if they did, I'm certain you would be gratified by their appreciation. I'm also certain that you would enjoy watching their talent, whether it be in music or dance or art or athletics. Next year' s tou_rnam.er.t will hP the Fri.dav following Halloween. How's that for advance notice? On behalf of the High Road Foundation kids and directors, thanks for taking the time. Sin^cyerely, JF 1. \\ ~' ~~ 4 , DAVID R. ELDER DRE:mco 601 Bric~ell Key Drive, suite 401 • Miami, Florida 33131 Telephone: (305) 373-6522 • Fax: (305) 373-6066 `,~~\ \,~~',' SERVE•CONSERVE MIAMI-DADE WATER .AND SEWER DEPARTMENT P.O. Box 330;16, Miami, Florida 39233-0316. 3071 S. W. 38"' Avenue • iVliami, Florida 33146 July 26, 2004 Mr. David Mancini Ric-Man International, Inc. ~ ~'~~~~ [] 2601 N. W. 48~' Street Pompano Beach, Florida 33073 ~n~ ~~ Dear Mr. cirri: I want to thank you for your support of water and sewer funding at July 20'i'`s general obligation bond program meeting. Ultimately, the Board passed all eight items and the items will be placed on the November 2, 2004 ballot. I appreciate your continuing support for the Department's Capital Plan. Very truly yours, ~,J~-~- William M. Brant, P. E. Director -= -=:_: -r _- r ~ ,%~J `,, Iney ~rrC very ~,u~N..n:~rv~ ~~, N. ~y --. -- - .. • , da not hesitate to ,coritact`ine if yora'.reed additional information ~,/"~ Seri"cerely - ~. ]~ •r~ ~~ ~ r '~ Larry R Deetjen jCity'Manager j r'~' LRD/ts '. , z „- _ Att~chmenfi ~, - •cm/lett~ers/refchecl<ric-man 11 ay~r 316ert P~.. Capelliui, P.E. Vice 07¢yor Amadeo Trinchitella Corrun.issinners Goryndcilen A. Clarke--Reed Ste1~e Gonot Peb~}' 1_~oland C,'ity D1un~ieer ~~ 5 - ~. - .. InterrietCoast ~' AUG-19-2003 05:11PI~ FROlh- T-404 P 00;/001 F-245 l~u ~Y.c. ~econn ~tvenuc cr_rnelt115hacti, t•1ur~da 33491.-3GJd '1'clcj~hunc (95~f) ~fD0-4200 Pax (9:i4~) 9$0-1'?E,R {~~~ August 19, 2003 TRANSMITTED VIA FACSIMILE NO, 0051 673-T782 ~.= ~~~, ,.f D E E R F 1 E L C7 ~ Fs E A C Ti Jorge M. Gonzalez, City Manager City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 R~: W~~hingt4 e ~e~-R~ P~Q1~cf Dear Mr_ Gon lez J ft is my understanding that bavid Mancini of Ric-Man Construction Company of Dee~eld beach, Florida is competing for a stre~~tscape - improvement "de~~ign build" project in Miami Beach. Mr: Mancini sand his team did an excellent streetscape project in Deerfield Beach along the ocean that involved extensive storm drainage work, pedestrianJbicycle walkway improvements, new street furniture, and landscaping in an intensely active and urban environment_ The project was completed in a timely fashion and the quality of ~nrork was outstanding_ Today I arrt proud to walk along the stretch of our ocean that was beautifred by Mr, Mancini and hopefully he will bid on Phas~~t1 improvements that are now under design in our community. t utd be more than happy to answer any specific questi}~s about Mr. ancini and his company at your convenrfence. Mayor ~ty Manager ` f 416ert R. Cnpcllini, P.E. \ / Vice IVfn~~or v ~-RD/tS ~~aeo'I~-uuhitcun cc: pavid Mancini, Ric-Man Construction Commissioners GNyndolcn ,l. Gl~irlcr.•.Rce~ cen/letters/miamibchrefricman $tzve Gonot 7'eg~;y Noland Llty ,41anaSer Lart•y A. Dcogcn J0 ~ ~~iC8ff18tGOfl8t _ ' (krofinid Uc~:h~ ^Pflal([T 16~i~>'~ ~~`~.~~ ~,~ww.dee,rfield-br.ts~•h.cum LiJ n,:~Y~i,d r~i,~~~ ~~I,. GEO~C~E CIVIC ASS®C;~ATIO~, ~1~IC. 3501 NW 8~~r S~'RLFT T01~.7[' LAIJ~)~R~DAI~ ~, FI., 33311 :1UNE 18, 2003 MR. DAVID MANCINI, OWNT;R RIC-MAN INTERNATIONAL 2601 NW 48~z-r STREET POMPANO BEACI:I, FL 33073 DEAR MR. MANCINI: PLEASE FORGIVE IvIE FOR'TIIE LONG DELAY IN SENDING YOU THIS LETTER.. I WAS LATE COMING BACK FROM OUR MOST INFORMATIVE CONFEI~LNCE. I WOULD LIKE TO TAKE THIS OPPORTUNITY TO THANK YOU FOR YOUR-~~IOST GL',NEROUS CONTRIBUTION TOWARD THE SENDING - OF OUR. DELEGATES TO ':I'I~IE NATIONAL NUSA CONFERENCE IN CHATTANOOGA, TENNESSI3E ON MAY 21-24,2003_ IT GIVES IvIE GREAT PLEASURE TO SAY, AS A RESULT OF YOU, WE WERE ABLE TO ACFIIEVE OUR GOAL. WE WERE ABLE TO SEND 8 DELEGATES INSTTAD OF 6 TO TILE CONFERENCE. TI-IE CONI~ERENCL; EXCELLED IN EVERY DEPARTMENT. THE WORKSHOPS ~~%ERE EXTREMELY TIMELY AND INl~ ORMATIVE. TIIE GLENWOOD TOUR WAS PIIENOMI~NAL. IT SHOWCASED CHATTANOOGA' S NEIGII130IZ1I00D SPIRIT. I HOPF_, AND PRAY THAT WE WOULD BE ABLE TO PROGRESS IN TIIE BUILDING OF OUR NEIGIIBORI-IOOD AS A RESULT OF ATTENDING TIIA.T CONFERENCE. I IIOPIJ THAT THE VISION SHARED 1N CHATTANOOGA SERVES AS A CATALYST FOR CHANGE IN OUR COMMUNITY. ONCE AGAIN, THANK YOU I'OR YOUR T'INANCIAL ASSISTANCE IN MAKING IT POSSIBLE FOR US TO ATTEND THIS CONFERENCE IN CHATTANOOGA, TENNI/SSEE. AS A RESULT OF IT, I HOPE WE VJIL L CONTINUE TO EMBRACE THE CONCEPT OF OUR. NEIGHI30RIIOOD AS WE CONTINUE "BUILDING ON A VISION". VERY WARM REGAR~S, ~. ~''~~ CLARENCE A. WRIGIIT,1'-AST PRESIDENT i'iRR-13-2003 D4 : 09P FROh1: T0: 9544260717 P:2'2 ST. GFORGE C~I~V~C A.SSOCIA~I~IDN, INC. 3501 N W 8TI~ STRE~;'1' FORT L~UDERDA_L~, FL 3 331 1 MAL: SA2ITH, VICE -PRESIDENT C'LP~1zENC.E A. WR1C1FfT, Fi:GSIllI;NI UZE.LL LEWIS, 7RE~CURF.R C.A$TFT.I.A biXQN,SLC1~1,4kY March 13.2003 Mr, Rea H. Chen, 1'residcnt Chen and Lnvirc~nmenlal b:nfiineers S 100 N_ W. 33rd Avenue k'ort Lauderdale, >;1 33300 F~tx (954) 730 2030 De;~r Mr. C;hcn: This will probably he, one of the last official ac.ls Thal 1 would have the opportunity to do as president of the Sl. George Civic Astinciatinn, lac. Before I step down, I want to personally thank }~uu for t1Le quality of work your c.om~~any is doing in this neighborhood and to tell you how appreciative wc. arc that yoLi were ]~.wardcd this contract. 1 thiril: that county staff will testify that I am the first person to col;.~plain if your wort: is not done proPessiunally, 1 hs~Ve had the opportunity of ub5ervirr~ you, your contractor, Ric Man International, ar~d The Office of T'.nvirunment.al Service work fogethe~r as a team. 1 am very impressed with vvllat T Dave nb~en~ed. Tt's a ple.a.5ure to work with a conlpru7y that has the nei~hhc~rhood's interest at heart and _ riot just working for only the money in a contract. YJnf~nunately, that has not been the case. with most of the companies we hsvc had working in our neighborhood. f also have ubscsvcd other companies doing the neighborhood irnprovcmcnt projects thoul;h out this county and I sincerely thi.t~k you are tclps un that list. 1 wish to (hank you for being awarded this contract and tl~anlc the county stal~l~ l~or awarding it to you. Yuu have measured up ui rill xespects. Also, I hope you wi11 be awarded the contract t.o do the work in Sl. George East. 1'hankil.Lg you again for the professional job you are doing in oclr neighborhood. 1ZC5 fll~ Ll1'Sti //%~y lar~.nce A. ~Vri(gl~/1Jt, President Fax Copy: Diana ~UasserTnan-RubizL, Mayoz---Commissioner ,Tole F,ggelletiun Roger Dcsjarlais---Dick Brossard---Tony Hui---David Mancini "A COR]ItitCinlTt' ON THE v]OVE" ST. GEORGE CIVIC ASSOCIATION, INC C/0 CLARENCE A. V~~ItIGI-IT 3751 NV6' 8Ttr PLACE FORT LAUDERDALE, FLORIDA 33311 Clarence A, Wright, President Mae smith, Vice President Pebrttary 18, 2003 Nlr. David Mancini, Owner Ric-Man International 2601. NW 48u' Street Pompano Beach, Florida 33073 Dear Mr. Mancini: Castella Dixon, Secretary Ozell Lewis, Treasurer I must tell. you that we are pleased with the work your company is doing in the St. George Neighborhood. I have not had many complaints and I think this is credited to your employees. I am encouraged at the rate the job seems to be progressing. Even at our association meetings, there have been very few complaints. The residents appreciate the quality of work and the manner in which it is being done. Respectfully yours, !t Clarence A. Wright, President "A COMMUNITY ON TIIE MOVE" ST. GEORGE CIVIC ASSOCIATION, INC Cl0 CLARI~NCE A. WIZIGIIT 3751 NW ~T~i PLACE TORT I~AUDERDALT, FLORIDA 33311 Clarence A. Wright, President Mae Smith, Vice President rebr~.~ary 18, 2003 Mr. David Mancinv_, Owner Ric-Man International 2601 NW 48th Street Pompano Beach, Florida 330%3 CastellaT_)ixon, Secretary Ozefl Lewis, "hreasiirer Dear Mr. Mancini: _ I._must tell you that we are pleased with the work your company is doing in the St. George ~'~ Neighborhood. I have n.ot had many complaints and I thir~l~ this is creclitecl to your employees. I am encouraged at the rate the job seems to be progressing. Even at our association meetings, there have been very few co~_~nplaints. The residents appreciate the quality of work and the manner in which it is being? done. Mr. Mancini, our association would like to obtain a 501-3C, tax exempt status, and send delegates to the 28th Annual Conference On Neighborhood Concerns. This conference is being held in Chattanooga, Tennessee, May 21-24, 2003. The title of this year's conference is: "Building On A Vision", I have had. the privilege of attending a couple of these conferences and the wealth of information obtained. on. the ways that we can improve our neighborhood has been overwhelming. In order for a-s to accomplish these goals, we need an amount of $5,000.00, We will appreciate any assistance that you might be able to give us tov~ard -this endeavor. Thanking you in advance for your support. Res~c ally yours, f., ~__ C: arence A. Wright, President "A~COMNIUNiTY ON TIZE MOVE" ~~~ords_rRr ~v~_ \\` ~' lrc~ _~' ~~ 6:, ~~ ~ K `°`''asm Q ~ ~~ x o ~ r C of Broward County Executive Committee f<enneth B. Bierman David K. Blattner, F_sq. Francis Brogan, Jr., Eso. John S. Chaperon Julie Cobb Walter J. Crosson Tracy S. Dunham Timothy J. Ermatinger C. Kennon I letlage John C. Johnson Kathy Koch Virginia I. Miller Ralph Page Carlos Reyes, Esq. UUI too baS~;er Michael L Sutten Frank Till, EdD Board of Directors Class Ending 2004 Clifford J. Bauer ~' `°h Campbell ~n Cavagnaro pony M. Degina Stephanie Desir-Jean Ray Ferrero, Jr. Judy Henry James Jackson Audrey Millsaps David K. Patterson S. Britt Sikes, Jr. Michelle Tuggle Class Ending 20D5 James R. Foster John R. Hargrove, Esq Dorothy J. Mancini William Markham Miriam Oliphant Alan Price Maria Sanjuan Bonnie Staskowski Lynne Wines Ben Williams i~idss ~ dint'- cuDo Richard S. Blattner D. Keith Cobb Joseph M. Cobo James A. Cummings Paul E. Daly Jorge DeApodaca Lloyd DeVaux Ken Dunn Silvia Flores, MD Floyd Johnson Paul 0. Lopez, Esq. ~ 'Vursey on Polish ~. . •urvis Catherine M. Rodriguez, Esq. Joyanne Stephens, PhD Positional Member Michael Jezek President, Council of United Way Agency Executives Francis ~urogan, :J r., Esq. FcSert C, iVlacCcnnell 2003 Annual Camp sign Chair President; CEO Frank Till, E!if7 2004 Annual Campaign Chair November 12, 2003 Mr. David Mancini i~ ~-i ~ ~ ' -_ I ~ Lr ! ~ it "f i-~ Dr-~~ l ! I ~ ~i ~I I!~`k ` j~ J I Owner Ric-Man International, Inc. 2601 NW 48th St. Deerfield Beach, FL 330;'3 John S. Chaperon Chairman of Cho Board John C.Jahnsan chair-Elect «, ~, , ~_ C- ~ 1 ~~ ~>~~ ~ ~vncca,~ ~%~<QC~r~rr~~c~ ~aC~~ ~~ ~~`f'°Jx ~ ~r.~a, l!),n ~~i vii ii ~~~, f r~;~n .,~ /+. n'.i~i. i,.n. 7 ~.. ~ ~- Dear David, ~1/2~/I2~i~000:~ l Because of your support of the Mayor's Uala, eye achieved ~x~l7at i3roward County's first Mayor, Diana Wasseri71ac1-Rubin, set out tp do. Yes, we had great fiu7 celebrating the mUltltUde Of cL11tt1reS G;a11111g the dlVerSe ell`J~:.1017S Of I3COWard COLInty theLC h0117e. But Vlore importantly, we~ raised X318,000 nevi dollars that are being directed solely into the United Way of B:oward County's Corrcnunity Solutions F~.cnd. Trained volunteers clearly a«rare of communitypriorities actively manage this ruled. This means that the Fzcnd produces the highest ret-urn for donor dollars by ensuring measurable outcomes in three critical care areas: helping children succeed, responding to emergency needs, and improving the health and wellness of so many people needing our help. On behalf of the many recipients of services, we thank you for building our comnnu7lty jh~•~~t1(71'. \/[lilt i_Y111!11"~,A;'lt inVPCjtlTP77t VI inia I. Miller Gala Chairperson Miller Construction Company Ansin Building #y.,`, ~.'~ ~.~~, Public Works Departrnenl -Office of Environmentol Services ~E~ ~. Environmental Engineering Division BROWARD COUNTI' 2555 W. Copans Road _ _ _____`_ Pompano Beach, FL 33069 (954) 831-0745 FAX (954) 831-0798/0925 September 6, 2001. To whom it may concern: I have been working as Construction Manager for the North Andrews Neighborhood Improvement Project for whichRicMan International Inc.has beer.the Contractor. I am pleased to say that this company has performed extremely well on this project. Not only are the office and ~feld staff competent in their construction activities, but have been helpfixl in mitigating construction related conflicts and responding to the needs arld concerns of the residents. They have been mindful of the project contract constraints and technical specifications, and have managed to stay on schedule while delivering above-average quality end-products. This Contractor and its staff are cooperative and wel l informed of the industry standards, generally applying this knowledge to the success of the project. This Contractor complies with all Broward County requirements and Consultant's requests in a timely and professional manner. Therefore, I would not hesitate to recommend this Contractor for consideration for any project which he rnight be eligible to bid. on. You~~ Glenn E. R~yy~s, P.E Project M' r}~ ger. f3ROV1ARD COtJNT`f BOARD Of COUNTY COMMISSIONERS - An Equal Opportunity Employer and Provider of Services - .. ~ - ,. -~..._ _ ~_ ~_.____ ,. ~,.~,a n.,,,,,, tni.,~~~rrnnn f?iihin 01/10/02 11'1D 12:42 l~'A~ 954 Z'L;1 bUUl ina~ u_ii raliti ~d~x°E.~ ~~z~~re~~s I'~eig~tl~c~~•hc~c~€~ A'ss~~;i~~f~~~ 169 [~I~Xr 44~' Street, Box 6, Ft. Lauderdale, F1,33309 Phone (9~4} 632 -1667 Fax:(954)229-6001 Email:nana ,apex@hotmail.com Ricman Interna~~ional 2601 NW 48`t' ~~treet Pompano I3eacli, F1.33073 Mr. David Mancini, After alzvost tu~ir years of experience with North Andrews Gardens getting new utilities, sidewalks, and roads, our association has become experts in dealing with contractors and homeowners. Four contractors; have now made tr°ir mark on my neighborhood and I felt that your company neede-sl to lrnow that we find you to be the best: As president of North Andrews Homeowner A.;;>ociation, with a phone listing for my cell number, I have received far less.. - _ _ in complaints az~d far more in coope-ration from Rieman International than the other contractors. Th~e~~ work went fast anc the inconvenience to the neighborhood was very reasonable. We would welc~~~me your company back in our area to d~? this work and hope that you are successful with._ofher phases of our project 'Thank you for being a responsible contractor and much success. You have earned. it. ~~~ ~ Martin Falk President-NAN;"-~ rt'.~';1 Recce, Macon anrJ ~~ssociates, Tne. qu~ust 29, 2001 Re: Ric-Man International 'I o tiVhom It May Concern: `The tfndersi6ned ha,:~, diract experience in adminititrating corli.racts with the. above referenced contractor. 1 have found that Rio-Man lnternational rnarntalns fully stalled cre«~s and maintains the equipment/resources necessary to s;~ccessfi~lly completethe task astiigned. Their office and .field staff are proFessional, courteous a.ld responsive to the consult.aitts/owners needs to ensure drat tl~e project can be completed within the contract budget and time allotted. A recently completed project within the Village oCTequesta Country Club area required extensive public relations for the infrastructure improvements within file existing neighborhood, "Thr~u6h, lZic-Man's comrntrneirt to work closely with the undersigned, the Owner and residences, a _ difficult project ~a~as completed on time and under budget to the satisfaction of aft. This would not have been attainable without Che added experience/ef~'ort that 1v"1r. Remo Iafrate, Ric-Mans superintendent on site, brought to the project. }3ased upon may past experiences with Ric-Man lnternational, I would not hesitate to recommend them on fifture projects f=or my clients. If you have tiny questions, please contact me, Very tllily yours, ~~ "r110n1riS C. ~TrS~Y, ~.~. 6415 1,nkc ~4~orth Ro~dtl `Suite J07 I,~lce ~'4'nrtli, FL 33x63-2907 `telephone (561) 433-3216 ~ ,P'aeximilz (S(7) d33-RO11 e-rnail: rccrnac(~i?oale.ncr ~' `~e~ztce c~~~~nexcccz A~~ril 14, 2000 To Whom It Mav Concern: cm' of T~JR r LADDER. SALE Ric-IVI~n International, Inc. is a~contractor who has presently completed 9>% const:ruction of a $~?,817,4-03.52 c-ontract with the City of fort Lauderdale. This project consists of water mains, frn-ce. mains; almo,;t: 20,000 feet of deep sanita~,~ sewers, and 11,000+ feet of siol7n sewers. The project als~~.l~ontains tllree (3) pump staf:ions, roadwork, ~ixid concrete ~~rork. Ric-Man 11as handled this work in a satisfactory lnannl:;r. Because of the low bid pr7ces,l:he. City .has added additinual slot~rn~waaer in certain areas. The City would re.c~ominend the 2ward of similar or larger pz-ojects to Ric=Man Intetnaiional, Irc in the fulazre. Sincerely, ./ Maurice Tobon, PE Project engineer PUBLIC SERVICES DEPARTMEt+1T 949 N.W. '38 STREET, FORT LAUDERbALE, FL 3339 (95~a) 776-5151, FAX (954) ~'~92-7881 3'1 PRINTED OPI RECYCLED PAPER ~ ,4. CITY OF FORT LAUDERDALE ~enice rr~ ~mezica August 18, 1993 ~~~~o k L °? .. Rene Castillo, Project Manager Ric-Man International, Inc. 2601 N.W. 48th Street Pompano Seach, FL 33073 RE: Improvement 1696/Project 9061 - PS 40 & 42, FM's, Sanitary Sewers and Water Mains for Tarpon River Dear Rene: _ , I am writing to thank ~ ou for °~- 1 your fine work on the referenced project. While the relationship between contractor and owner can often be strained =and confrontational, your shared interest in a well constructed job, and your willingness to cooperate with regard to the various "challenges" faced during construction contributed to a far more .productive working relationship. Your willingness to properly attend to the visual aspects of the project,. such as the restoration of work areas, and addressing individual property owner concerns, minimized objections to our construction presence in the area. These facets of the project reflect positively on both Ric-Man and the City of Fort Lauderdale, and your contributions in this regard are appreciated. °sAgain, thanks for a job well done. I look forward to working with you'on~.future projects. Sincerely, CITY OF FORT LAUDERDALE /,' /~ /J / Paul R. Bohlander Assistant City Engineer PRB/cb/1-castillo ` Gc: George Stillman, City Engineer Susan Holland, Engineer III John Malek, Engineering Inspector Supervisor Dan Mancini, Ric-Man International, Inc 100 N. ANDREW"S AVENUE, FORT LAUDERDALE, FLORIDA 33301 EQUAL OPPORTUNITY EhIP LOYER ~ - - PRINTED ON RECYCLED PAPER ~~ Hamill Ortiz From: Roger Vanderlip Sent: Wednesday, April 15, 2009 10:30 AM To: Ric-Manlnternational Subject: FW: a job well done thank you -----Original Message----- From: Audreea Farnsworth [mailto:daneCa~terranova.net] Sent: Wednesday, April 15, 2009 10: OZ AM To: Roger Vanderlip Subject: a job well done thank you hello,my name is Audrey Farnsworth I live at 36 N Marlin ave in key largo FL, recently your company has been doing sewage work ion our area. Vl/hile on my street there was a large pile of debris put onto my property because my neighbor asked the company to please push the debris over and that she would take care of the pile. Unfortunatly unbennounced to them that they were trying to do a favor she had no intention of taking care of this. thus leaving the lg pile of debris in m y yard. So I politley asked if there was anything anyone could do to remove the pile. Your company was wonderful they went above and beyond and cleaned up the pile for me. Wich if they had not vvould have been very hard to break down to be able to go into recycling buckets.I have a back condition and greatly appreciate the help and extra effort your company has made.Agin i continue to be greatful and thank you fully and when possible I would gladly recomend your company for jobs. Sincerely, Audrey J Farnsworth i 12/13/2008 Ric Man International, Inc Pompano Beach, Florida Attra~ David Mancini Re~ StillwrightPoint, Key Largo Project Dear Mr. Mancini; " ~ ~ZV~~ ~~Fr ~ ~ 2oos BY: My name is Michael Gannon, hive in Key Largo, Fl, where your crew is currently working on the Stillwright Pt. pipe-laying project. The reason for this letter rs to inform you of the unparalleled performance of your men. They are all very professional, courteous, friendly, and helpful. The job remains clean and safe at all times, which is quite a challenge in this tight, little neighborhood with limited right of way, all of which I am sure you are a ware. I ha ve had the pleasure of meeting- a good number- of your men, all of whom are great people and a credit to your company. Unfortunately, I only know a few of their names, those of whom are, Ryan, Louis and Remo, I have forwarded a letter of commendation to Charles Fishburn, Key Largo Waste Water Director, in your behalf. I know exactly what your crew is up against on this project, as I am a Licensed General Engineering Contractor myself. I, as well as many of my neighbors, would like to wish you all a very Happy Holiday season, and sincerely thank you all for a good job. Respectfully, _ /~ ~ ~-~ R. Michael Cannon 16 North Drive Key Largo, Fl 33037 305-393-3113 c/c Charles Fishburn, KLWWD Nov 10 2003 5:0'7~'M I<LWTD 3054535f]0 1 P • Z R~ ln+n November 17, 2008 Ms. Susan Fort Hammaker RN PHD 6 North Drive Key Largo, Florida 33037 Dear Susie, fQL d2T~ l,-te~-v8 I wanted to thank you for always keeping our neighborhood informed as to the progress of Ric-Man and their related waste water system installation. While I am not a full time Key Largo resident and mainly in residence Friday - Sunday, I have been no less affected or should I say not effected by Ric-Mans operations. I have no hand9 on knowledge of the particulars of the contract with Ric-Man and the Wastewater Board. I do however, removing all modesty, have two attributes that I possess that give me comfort in giving you my comments on Ric-Mans performance to date. One is tl~t I am the partner in our company who directly oversees approximately 400 million in construction of Resort Properties from raw land to "heads to bens" as our industry calls it. This experience at least provides me with the capability to know what I'm looking at in a construction atmosphere such as is occiuring currently in 5tillwright Point. Secondly, I probably own one of the most expensive residences in Stillwright point. That I feel at least financially gives me a vested interest in the quality of construction and competence of management. I guess I wanted to try and qualify myself somewhat before giving you some feedback on Ric-Mans performance. Again, I am ultimately handicapped as I am not aware of the particulars of their up front proposal, current contract, or future pending contract possibilities. For the record, my observations are: Ric-Man has continually been ahead of any timetable schedule published to our neighborhood homeowners_ I presume on this track they will likely finish a few months ahead of their final completion date, which in many contracts I negotiate provides for a bonus as well as of course a penalty for any delayed completion_ tiro, III 33301 163 Fiesta Way Fort Lauderdale, FL 954/524-5924 Nov 1D 200E3 5: OiPM I<LWTO 30.`-4505D0 ~ p. 3 2. Ric-Man has worked under severe adverse seasonal high tide issues without missing a beat. 3. Ric-Man. appears to have a continued staff of over 25 on the job in our Neighborhood at all times. This provides for not only expedient and efficient work production, but personnel for traffic detour and redirection and the accommodation of special traffic needs. Same other neigllbo:rhoods currently being developed by different contractors that I have driven through have personnel that you literally have to search out due to the minimal number of them. 4. Ric-Man has gone out of their way to accommodate residents and their daily routines or special needs without a single bit of attitude.. This cooperative attitude they exhibit is obviously appreciated by several residents as many of us are happy to provide them with non-alcoholic beverages, buy their lunch on certain days and generally reach out where we can in appreciation_ 5. Even with the low level of Stillwright Point and high water table which of Course generates a lot of mud and slippery wet surfaces, Ric-Man ends every Day leaving our neighborhood in a neat and safe condition.. In going forward, I am sure your Board may consider Ric-Man for additional work in other neighborhoods. Unlike when you may have first interviewed them and checked and relied on their references, you now have completion (almost) of one neighborhoods contracts which now qualifies as your own personal experience with them. This is something in my business that is invaluable, especially when the experience is a good one_ I have had the good fortune of working with a few contractors around the country that due to my continued win.-win experience with them, I have continued to use them in some cases for over 12 years. So, from this John Q Citizens opinion, from Stillwright Point, I would highly recommend that your Board give every consideration possible to Ric-Man for future contracts. And for the record, Mr. Michael Dempsey is an administratorlu~spector extraordinaire_ To you end all of your fellow Board Members, keep uP the hard work because in the case of our neighborhood, your dedication and commitment is highly evident. Rene Castillo Jr. From: Susan Hammaker [fordhamm@terranova.net] Sent: Monday, October 13, 2008 4:22 PM To: Charles Fishburn; Margaret Blank Cc: Krkcon@aol.com Subject: Fwd: Thanks Another compliment from a SPOA North Drive Resident. Susie Begin forwarded message: From: Krkcon aol.com Date: October 10, 2008 7:40:30 AM EDT To: fordhamm(a~terranova.net Subject: Thanks Suzie, I've been impressed with Ric-man. Friendly, helpfull, pleasant and all working under horrible conditions at times. I'm doing my bit by not using my car, going on my bike when I have to get out. Using your pool for my personal joy and recreation. Thank you so much for letting me come daily to clean out the leaves and sit in the sun on your dock. It will be nice to be done with this construction, but it has not been as horrible as we predicted. Thank you for keeping us updated, and please convey my thanks to the Ric-man workmen. They carried my groceries through the flooded street, helped me come and go, worried about me riding through the muddy puddles on my bike. We know you are very busy, but we miss you....... Connie New MapQuest Local shows what's happening at your destination. Dining, Movies, Events, News & more. Try it out! Susan Ford Hammaker RN PhD 305-451-9667 cel 1305-747-6060 fax 305-451-3273 fordhamm(a~terranova.net Rene Castillo Sr. From: Albert Dominguez Sent: Monday, June 30, 2008 10:18 AM To: David Mancini; Rene Castillo Sr. Cc: Adams, Steven M Subject: FW: Kind words from a resident FYI From: Lipner, Shari [mailto:ShariLipner@miamibeachfl.gov] Sent: Friday, June 27, 2008 7:07 PM To: Yami Fernandez; Albert Dominguez Cc: Saltrick, Richard; Chartrand, Jorge Subject: Kind words from a resident Robert Johnson, resident of 4490 Royal Palm, told me he was very impressed with the fine job being done by Ric-Man on the Nautilus project. He said he understood that the work can be messy, but has noticed that the areas are cleaned up regularly and wanted to also mention that he admired the professional demeanor of the crews he has encountered. Good job, guys! i11~ ~ < ~°i " a Shari Holbert Lipner, Community Information Coordinator OFFICE OF CAPITAL IMPROVEMENT PROJECTS ,'77 17th Street, Miami Beach, FL 33139 Tel: 305-673-7071 ext. 6709 /Fax: 305-673-7073 / vvvvw. m iam ibeachfl. qov sharilipnerna miamibeachfl.gov We are committed to providing excellent public service and safety to al! who live, work and play in our vibrant, tropical, historic community. Please d~ not l,~rint this e-mail unless necessary P1..I~~,1SE: tl~{~T~: f'loricia has a very hroat3 pnhiic rc-cords lu~v. 1~9ost is°riftea~ camnwwuications to or from C,'ify of 1liami Seac)~ ufiicixJs and emplati~ees rear~li~og public business are public records av°ailable to the public and media upon rei~uesi. Four e-mail eo~umuuicutioas naay be subject Ya p~~hlit disclosure. Page 1 of 1 Hamill Ortiz From: Norman Mensh [nmensh@the-beach.net] Sent: Wednesday, July 16, 2008 3:59 PM To: Yami Fernandez Subject: Ric-man To Whom It May Concern, We were pleased with Yamil Fernandez and the crew for the construction done in our neighborhood. Any problems or requests that we had were efficiently handled by Yami, brought to the attention of the contractor and handled in a timely manner to our satisfaction.lt was nice to see that the needs of the residents were taken into consideration. The work crew was polite and quick to please. Any debris was always cleaned upon the completion of the area. We wish you success in the future. Joan and Norman Mensh 4361 Royal Palm Ave. Miami Beach 7/17/2008 Page 1 of ] Hamill Ortiz From: mitch@sherbrookehotel.com Sent: Wednesday, July 16, 2008 9:30 AM To: Yami Fernandez Subject: Re: Ric-Man International Dear Mayor and Commission: About 16 months ago, Ric-Man International replaced the below ground infrastructure and made substantial above ground improvements, including the installation of four monstrous traffic light masts on the infamous corner of 9th and Collins. Ric-Man was accommodating, efficient, and took a "No-Nonsense" approach to the job. I am satisfied with their work and highly recommend this contractor. Your's Truly, Mitch Novick Sherbrooke Hotel ----- Original Message ----- From: Yami Fernandez To: Mitch@sherbrookehotel.com Sent: Wednesday, July 16, 2008 9:00 AM Subject: Ric-Man International We truly appreciate your help Mr. Novick. Your letter would be a great help. Thank you, Yami YAMILE FERNANDEZ PUBLIC INFORMATION OFFICER Ric-Man International, Inc. 1210 Washington Avenue, Suite 200 Miami Beach, FI. 33139 Phone: (305) 535-1743 Fax: (305) 535-1745 Email: yfernandez@ric-man.us 7/17/2008 Hamill Ortiz From: zmiami68@aol.com Sent: Monday, July 14, 2008 4:41 PM To: Yami Fernandez Subject: Post Avenue Dear Yamile: As a resident on Post Avenue, I wanted to let the City of Miami Beach know that Post Avenue between 44th Street and 47th Street looks beautiful after the installation of the street lights and the repaving of the street. Now that the new street lights have been turned on, I was wondering if the old street lights (on telephone poles) will be removed, or at least turned off. In my opinion, the old lights, which still remain on in addition to the new lights, detract from the beauty of the new lights. For example, there is an old light on a telephone pole in front of 4526 Post Avenue that remains on, and it does not look nice when it is turned on at the same time as the new lights. At your convenience, can you please let me know if anything is planned to be done with the old lights. Thank you. Jonathan Zwibe) 4534 Post Avenue Miami Beach, FL 33140 Tel: (305) 458-4288 Page 1 of 1 Hamill Ortiz From: Lipner, Shari [ShariLipner@miamibeachfl.gov] Sent: Friday, July 11, 2008 3:42 PM To: Yami Fernandez Cc: Carmenates, Aurelio; Menocal, Victor Subject: FW: comments from a resident & local businessman (dunkin-baskin) A compliment! Thanks, Yami (or Yamina....) MIAM11~~1~C Shari Holbert Lipner, Community Information Coordinator l'lr.~za~e do r~or prrru thrs e-nrui( vrtlc s~s necrse~urr ""(?T(';: e-mail cummuuic~itiuns may be subject w public discfosnre. From: Michael Lefkowitz [mailto:mlefk@elitefranchiseadvisors.com] Sent: Thursday, July 10, 2008 3:40 PM To: Gross, Saul; Fwd -Saul Gross Subject: comments from a resident & local businessman (dunkin-baskin) said: i must tell you that i am very impressed at how competently and my concerns were handled. the tree was pruned back as you had suggested, and i was contacted yesterday by a city rep (sorry forgot her name--perhaps yamina??) who advised me that not only was the paving of the street between 41st and 42nd streets & sheridan ave would be done after 12 noon as PER MY EARLIER REQUEST, but the street would be open rather quickly as to lessen the economic impact on my dunkin baskin store. wow! is all i can say and thank you. please forward my commnets to the appropriate department heads and city officials who should share in the glow of a job WELL done. all the best, michael 7/18/200 Page 1 of 1 Hamill Ortiz _. _ _ _ From: Lipner, Shari [ShariLipner@miamibeachfl.gov] Sent: Friday, June 27, 2008 7:07 PM To: Yams Fernandez; Albert Dominguez Cc: Saltrick, Richard; Chartrand, Jorge Subject: Kind words from a resident Robert Johnson, resident of 4490 Royal Palm, told me he was very impressed with the fine job being done by Ric- Man on the Nautilus project. He said he understood that the work can be messy, but has noticed that the areas are cleaned up regularly and wanted to also mention that he admired the professional demeanor of the crews he has encountered. Good job, guys! MIAMl~~,~ Shari Holbert Lipner, Community Information Coordinator OFFICE OF CAPITAL IMPROVEMENT PROJECTS 777 17th Street, Miami Beach, FL 33139 Tel: 305-673-7071 ext. 6709 /Fax: 305-673-7073 / www.miam_ beachfl,goy shanlipner@miamibeachfLg.oy We are committed to providing excellent public service and safety to al! who live, work and play in our vibrant, tropical, historic community. Alense do no! hrin! this r-snail urdess ne~es.euiy' PL.1;.15F; NO]'P:: 1~ lorida has a very broad public records hrn. ~Tost tirrittcn conununications to or from City o1' 37iami F3cach of'GciaLs and ernployecs regarding public business arc public records available ro the public:uul media upon request. }'our r:-mail eonununiraiions may be subject to public disclosure. 7/18/2008 Hamill Ortiz prom: Adams, Chuck [ChuckAdams@miamibeachfl.govJ Sent: Tuesday, June 24, 2008 10:48 PM To: Chapman, Ronald; Beingolea, Miguel; Rodriguez, Irma Cc: Nealy, Eric; acole-smith@smgmb.com; Whittinham, Tasha; Frances, Saul; Yami Fernandez; Sklar, Max; Hayes, Victor; Wong, Claudia Subject: INS Timing is everything. Yami, Thank Albert and your pro j mgr for the assist this morning on Prairie Ave. (my e-mail contacts can't find either so please pass it on). Lt Chapman, Thanks for the heads up this morning re the change in the plan (that was a gift) and we were able to adjust. Our staff sensed less traffic frustrations due to the access of the Beach High lot (over 300 ,paces). What was your read? Anyway thanks to all of your staff and their proactive pushing our porkers to us and getting our parkers out quickly so we could serve the next wave. I am not aware of any issues/complaints? Again, thanks to all getting us through the last one till December. Irma, Please confirm in a-mail, all future calendared INS Ceremonies on the calendar (intranet and Web page) are left on the calendar but shown as cancelled. Also we have talked about this, can we have IT show a date on these calendars, indicating revised as of or something to reference in the event that folks have printed copies. This will let them know what's the most current calendar. hank you, Chuck i Sent by ~'huck Adams, CPFM Assistant Parking Director City of Miami Beach Parking Department 309 23rd St #200 Miami Beach, FI 33139 (305) 673-7000 X 6863, FAX (786) 394 4684,Cell (786) 412 6431, Home phone (305) 538 7311 Cadams@miamibeachfl.gov Page 1 of~ 1 Hamill Ortiz From: Norman Mensh [nmensh@the-beach.net] Sent: Wednesday, June 04, 2008 5:52 PM To: Yami Fernandez Subject: Norman's bushes Thanks for all your help and your willingness to make all the inqueries to the engineers and city. Before you go any further, Norman feels that 2 and I/2 feet wouldn't be aesthetic. Therefore, he decided that they should take the bushes out. They probably knew that would be the response. You are great. Joan ~„~"` 7/18/2008 Page 1 of 1 Hamill Ortiz From: Norman Mensh [nmensh@the-beach net] Sent: Saturday, February 09, 2008 8:14 PM To: Yami Fernandez Subject: Re: Driveway Thank you very much. You are great. Norman ----- Original Message ----- From: Yami Fernandez To: Norman Mensh Sent: Friday, February 08, 2008 3:56 PM Subject: RE: Driveway HI Norman! How have you been? I hope you are doing well. I will speak with our superintendent concerning your driveway and keep you updated. I'm pretty sure they'll be completely the driveway improvements after they are done with the street widening but I just want to confirm. Yami From: Norman Mensh [mailto:nmensh@the-beach.net] Sent: Friday, February 08, 2008 1:07 PM To: Yami Fernandez Subject: Driveway Hi Yamile, Are they planning to correct my driveway when they put in the bicycle path in a week or so? We want to make sure that we are home to move the cars because we are away frequently. Have a great weekend. Norman Mensh 4361 Royal Palm 7/18/2008 Page 1 of 1 Hamill Ortiz From: Zalman Rudd [zalmanrudd@gmail.com] Sent: Tuesday, November 13, 2007 11:23 AM To: Yami Fernandez Subject: construction job To whom this may concern, I am a resident on 43rd and Royal Palm Avenue in Miami Beach. We have just gone through some major renovations done by RIC-MAN International. Construction of this magnitude can be annoying at best. I wanted to take the time to write that the company listed above did a great job of limiting the annoyance as best they possibly could. They were courteous and and helpful. Often times helping us maneuver our vehicles in and out of our driveways and always willing to move a truck or digger or any other piece of major equipment when necessary. They were especially kind in allowing our children to watch and even answered a few questions regarding the equipment. I am sure you receive mostly negative criticism as like I mentioned jobs like this can be tough, but I wanted to share with you the other side in how the employees/contractors were great. Thanks for making an otherwise difficult task that much easier. Zalman Rudd 7/18/2008 Page 1 of 1 Hamill Ortiz From: JYLOWE@aol.com Sent: Monday, October 15, 2007 8:28 AM To: Yami Fernandez Cc: HildaFernandez@miamibeachfl.gov Subject: Resolved Standing Water Issue at 4400 Post Ave Mr. Fernandez, Thank you for your prompt and effective response to my a-mail regarding the standing water surrounding my home at 4400 Post Ave. The water is gone, I can now look forward to bringing our property back to its bright and delightful appearance. Sincerely, Joyce Lowe See what's new at AOL.co_ m and Make AOL Your Homepage. 7/18/2008 Page 1 of 1 Hamill Ortiz From: Lipner, Shari (ShariLipner@miamibeachfl.gov] Sent: Thursday, August 09, 2007 5:04 PM To: Yami Fernandez; Menocal, Victor Cc: Saltrick, Richard; Carmenates, Aurelio; Albert A. Dominguez Subject: FW: Excellent employee This early in the project, and Yami is already getting "fan mail." Way to go! MIAMIf3EAOF~ Shari Holbert Lipner, Community Information Coordinator OFFICE OF CAPITAL IMPROVEMENT PROJECTS 777 17th Street, Miami Beach, FL 33139 Tel: 305-673-7071 ext. 6709 /Fax: 305-673-7073 / www miambeachfl.gov sharilipner al~miamibeachfl.aov We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community From: Norman Mensh [mailto:nmensh@the-beach.net] Sent: Thursday, August 09, 2007 5:00 PM To: Lipner, Shari Cc: yfernandez@ric-man.us Subject: Excellent employee We called concerning the capital improvements on our street and spoke to Yamile Fernandez.She was very polite and extremely efficient in answering our questions and she did not hesitate to call us back several times during the day with answers. It is most refreshing to deal with such a competent person. She really deserves a lot of praise for a job very well done. Norman and Joan Mensh 4361 Royal Palm Ave. 7/18/2008 Page 1 of 1 Hamill Ortiz From: Norman Mensh [nmensh@the-beach.net~ Sent: Thursday, August 09, 2007 5:00 PM To: sharilipner@miamibeachfl.gov Cc: Yami Fernandez Subject: Excellent employee We called concerning the capital improvements on our street and spoke to Yamile Fernandez.She was very polite and extremely efficient in answering our questions and she did not hesitate to call us back several times during the day with answers. It is most refreshing to deal with such a competent person. She really deserves a lot of praise for a job very well done. Norman and Joan Mensh 4361 Royal Palm Ave. ~""~ 7/18/2008 Page 1 of 1 Hamill Ortiz From: Mitch Scott [sherbrooke@the-beach.net] Sent: Wednesday, April 18, 2007 9:05 AM To: 'yfernandez@ric-man.us' Subject: Re: Mast Arm Relocation Dear Yami: The relocation of the mast arm to where the existing fire hydrant is located, is the perfect solution. I applaud you, your organization, and all other entities involved for the efforts made during this exercise. You too, have a great day! Mitch Novick -----Original Message ----- From: Yami Fernandez __ _ __. _ To: 'Mitch Scott' Sent: Wednesday, April 18, 2007 8:19 AM Subject: Mast Arm Relocation Dear Mitch, Just wanted to touch base with you and confirm that you are ok with placing the mast arm on the N.E. corner of Collins Avenue and 9th Street where the existing fire hydrant is presently located. I would truly appreciate an email reply confirming your approval. I hope our efforts to maintain ongoing communications with you during the decision making of the relocation of the mast arm was to your expectations. If there is anything else I could possibly assist you with please do not hesitate to contact me. I hope you have a wonderful day. Thank you for all your patience, YAMILE FERNANDEZ PUBLIC INFORMATION OFFICER Ric-Man International, Inc. 1210 Washington Avenue, Suite 200 Miami Beach, FI. 33139 Phone: (305) 535-1743 Fax: (305) 535-1745 Email: yfernandez@ric-man.us 7/18/2008 Page l of 1 Hamill Ortiz From: Wendy Hernandez [wendy@robinscompanies.com] Sent: Thursday, September 28, 2006 12:53 PM To: 'Yami Fernandez' Subject: RE: 8TH STREET WASHINGTON CONSTRUCTION Thank you very much. We definitely appreciate your concern for the businesses and look forward to a much more beautified Washington Avenue. Regards, Wendy From: Yami Fernandez [mailto:yfernandez@ric-man.us] Sent: Thursday, September 28, 2006 12:50 PM To: Wendy Hernandez Subject: RE: 8TH STREET WASHINGTON CONSTRUCTION Hi Wendy, We have been moving along very well on 8th Street. The work on 8th Street has not been as difficult as it was on 7th Street due to different circumstances. When doing the work on 7th St. we were delayed by hurricane Eduardo, the NFL Kick-Off event and Memorial Day weekend. Each one of these events delayed us approximately 2'/z weeks if not more. Fortunately the work on 8th Street is progressing at a fabulous rate. The contractor 's has until January to completely finish 7th and 8th Street completely done (completely meaning all the drainage, sidewalk replacement, signing, and paving} but his goal is to get it done before Christmas. We are getting signs made in order to show that the businesses are open. Please let me know if there is anything else I can possibly assist you with. I hope you have a wonderful day. Thank you for all your patience, Yami From: Wendy Hernandez [mailto:wendy@robinscompanies.com] Sent: Thursday, September 28, 2006 12:10 PM To: Yamile Fernandez Subject: 8TH STREET WASHINGTON CONSTRUCTION Yami, what is the schedule for the construction in this area? 8th Street is constantly blocked and the operations of the retail businesses on this block is being gravely hindered. Is there anything that can be done, like signage, to help? Please let me know. Thank you. Wendy Hernandez Property Manager SRC Properties, LLC 230 5th Street Miami Beach, Florida 33139 (305) 674-0600 Phone (305) 674-0619 Fax wendy@robnsco_m_ panies.c_o__m 7/18/2008 Page 1 of 1 Hamill Ortiz From: Larry Apple [larrya@apimaging.com] Sent: Wednesday, September 13, 2006 4:57 PM To: 'Yami Fernandez' Subject: RE: Clean Up Adjacent To Your Business Dear Yami: Yes they were here yesterday and did a much needed clean up. Thank you. Things look a lot better. I appreciate your giving this matter your attention. Your company has been very responsive to all our needs. Sincerely, Larry Apple President Associated Photo & Imaging 305-373-4774 -----Original Message----- From: Yami Fernandez [mailto:yfernandez@ric-man.us] Sent: Wednesday, September 13, 2006 11:34 AM To: Larry Apple Subject: Clean Up Adjacent To Your Business Dear Mr. Apple, was just touching base with you concerning the clean up adjacent to your business. We had a couple of our guys out there cleaning up and I was just checking up with you. Please let me know if there is anything else can do to help you. I hope you have a wonderful day. Thank you, Yami 7/18/2008 Page 1 of 1 Hamill Ortiz From: Almagro-Johnson, Olivia [OliviaAlmagro-Johnson@miamibeachfl.gov] Sent: Friday, September 08, 2006 9:44 AM To: 'Menocal, Victor'; 'Vidal, Bert J.'; 'yfernandez@ric-man.us' Cc: 'Chartrand, Jorge' Subject: Re: NFL kick-off Victor and Yami, Yesterday afternoon, I went by the site and was impressed by how quickly things were getting done. I saw the crew working fast to put down the asphalt and moving equipment around. Thanks for all of your assistance. Olivia MIAMI ~~O Olivia Almagro-Johnson, Community Information Coordinator CAPITAL IN[PROVti~tENT PRO.IC C"I;5 OI'FICF 1700 Convention Center Drive, ;Miami Beach, I'L 33139 Tel: 305-673-7071 / hax: 305-673-7073 / w~sw.rniamibeachFl,.gov_ Direct: 305-673-7000 ext 6582 / oalmagro-Johnson@miamibeachfl.gov We ru•e conrmi#erl to providing eccellent public service and safety to ull who live, work and play in our vibrmrt, tropical historic conrmunip~. Ofticc Location / llclivcries: __ 777 - 17th Street, Suite 201 Miami Beach, F1, 33139 7/18/2008 Page 1 of 2 Hamill Ortiz From: Lipner, Shari [ShariLipner@miamibeachfl.gov] Sent: Wednesday, May 31, 2006 2:39 PM To: 'Yami Fernandez' Subject: RE: washington av. construction Awesome! MIAMiI~E~CiH Shari Holbert Lipner, Community Information Coordinator CAPITAL IMPROVEMENT PROJECTS OFFICE 1700 Convention Center Drive, Miami Beach, FL 33139 Tel: 305-673-7071 I Fax: 305-673-7073 I www.miamibeachfl,gov Direct: 305-673-7000 ext 6709 / sharlpner@miamibeachfl gov We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical historic community. Office Location /Deliveries: _. _.. 777 - 17th Street, Suite 201 Miami Beach, FL 33139 From: Yami Fernandez [mailto:yfernandez@ric-man.us] Sent: Wednesday, May 31, 2006 11:42 AM To: vmenocal@hazenandsawyer.com; sadams@hazenandsawyer.com; Lipner, Shari; Almagro-Johnson, Olivia Subject: FW: washington av. construction Hi guys, Here's one for the "Job well done" file! It's nice to receive email acknowledging the hard work but it's extra nice to receive one from a Scott Robbins rep. since they weren't to happy about the construction at the beginning. From: Melissa Dunn [mailto:Melissa@robinscompanies.com] Sent: Wednesday, May 31, 2006 11:12 AM To: yfernandez@ric-man.us Subject: washington av. construction yamile, thank you for responding to my email with your follow-up phone call this morning. i work in the contruction industry right here in south beach (by washington avenue), and travel on washington several times a day. i want to commend your firm for a job well done. your staging throughout this long project was thoughtfully coordinated the entire time. your men left the sites debris-free and safe at the end of each day. make it a point to empower your entire team (including all the men who literally sweep the streets) by letting them know their pride and dedication in their work makes all the difference. sincerely, melissa Bunn 7/18/2008 Page 2 of 2 MELISSA DUNN Broker, Scott Robins Companies 230 5th Street Miami Beach, FL 33139 w 305.674.0600 x306 f 305.674.0619 melissaCarobinscompanies.cnm www. robinscompani es. com i/18/2008 Page 1 of 1 Hamill Ortiz From: Melissa Dunn [Melissa@robinscompanies.com] Sent: Wednesday, May 31, 2006 11:12 AM To: 'yfernandez@ric-man.us' Subject: Washington av. construction yamile, thank you for responding to my email with your follow-up phone call this morning. i work in the contruction industry right here in south beach (by Washington avenue), and travel on Washington several times a day. i want to commend your firm for a job well done. your staging throughout this long project was thoughtfully coordinated the entire time. your men left the sites debris-free and safe at the end of each day. make it a point to empower your entire team (including all the men who literally sweep the streets) by letting them know their pride and dedication in their work makes all the difference. sincerely, melissa dunn MELISSA DUNN Broker, Scott Robins Companies 230 5th Street Miami Beach, FL 33139 w 305.674.0600 x306 f 305.674.0619 melissaC~robinscompanies. com www. robinscompan ies. com 7/18/2008 Page 1 of 1 Hamill Ortiz From: chronosetc.com [email@chronosetc.com] Sent: Friday, May 26, 2006 3:52 PM To: 'Yami Fernandez' Subject: Re: Washington Avenue Streetscape Improvement Project-MOT thanx same to u ----- Original Message ----- From: Yami Fernandez _. _ To: 'chronosetc.com' Sent: Friday, May 26, 2006 1:51 PM Subject: RE: Washington Avenue Streetscape Improvement Project-MOT Anytime!!! I hope you guys have a GREAT weekend! From: chronosetc.com [mailto:email@chronosetc.com] Sent: Friday, May 26, 2006 1:47 PM To: Yami Fernandez Subject: Re: Washington Avenue Streetscape Improvement Project-MOT thank you very mach for u help !after a phone call to u they move the tracks and clear all water.you the best .igor ----- Original Message ----- From: Yami Fernandez To: Yami Fernandez Sent: Friday, May 26, 2006 1:36 PM Subject: Washington Avenue Streetscape Improvement Project-MOT Attached you will find the Maintenance of Traffic (MOT) bulletin for next week's work in order to keep you updated. I hope you all have a wonderful Memorial Day weekend. Thank you, Yami Yamile Fernandez Public Information Officer Ric-Man International 1210 Washington Avenue, #200 Miami Beach, FI. 33139 (305) 535-1743 (305) 535-1745 7/18/2008 Project Manual Bidder's Past Projects SAMPLE PROJECT 1 OF 5 CONTRACTOR'S NAME: Ric-Man International, Inc CLIENT'S NAME: City of Miami Beach CLIENT'S CONTACT NAME: Jose Perez CLIENT'S ADDRESS: 1700 Convention Center Drive Miami Beach FL 33139 CLIENT'S PHONE: 305-673-7080 FAX 305-673-7073 CLIENT'S EMAIL ADDRESS: aureliocarmenates@miamibeachfl.gov OVERALL DESCRIPTION OF THE PROJECT: Design Build of New Drainage Pump Station, Roadway TYPE OF CONTRUCTION PROVIDED: New CONSTRUCTION TRADES PROVIDED ON THE PROJECT: Traffic Control, drainage, pedestrian access, wells SPECIAL FEATURES OF THE PROJECT (describe how work was performed in City/Urban environment and/or Beach/Bay Front Vicinity): Adjacent to a school (work was coordinated with school and major work was scheduled on off schools days). Home access to driveways was always maintained. Was the experience described above as a Prime Contractor or as a subcontractor? Prime x Sub-Contractor What changes and/or modifications were experienced during the course of the project? Additional catch Basins and piping. March 2009 City of Miami Beach Page 148 of 185 Project Manual (SAMPLE PROJECT 1 OF 5, CONTINUED) How did those changes/modifications affect the schedule? No effect on time of Budget Bidder's Past Projects CONTRACT AWARD AMOUNT $ $1,997,900.00 FINAL COST AT COMPLETION: $ same as above VALUE OF WORK PERFORMED AS THE PRIME: $ 1,700,000.00 TOTAL VALUE OF SUBCONTRACT: $ SCHEDULE START DATE: 297,900.00 March 2008 SCHEDULE COMPLETION DATE: November 2008 ACTUAL START DATE: March 2008 ACTUAL COMPLETION DATE: November 2008 PROJECT MANAGER: Albert Dominguez DESIGNER: APCTE & Ric-Man International, Inc PROJECT MANAGER: Carlos Gil & Albert Dominguez TELEPHONE NO: 305-592-7283 *ATTACH ADDITIONAL SHEETS IF NECESSARY* March 2009 City of Miami Beach Page 149 0# 185 Project Manual Bidder's Past Projects SAMPLE PROJECT 2 OF 5 CONTRACTOR'S NAME: Ric-Man International, Inc. CLIENT'S NAME: City of Lauderhill CLIENT'S CONTACT NAME: Indar Maharaj CLIENT'S ADDRESS: 2000 City Hall Drive, Lauderhill, FL 33313 CLIENT'S PHONE: 954-~30-4225 FAX 954-730-4241 CLIENT'S EMAIL ADDRESS: indarmaharaj@lauderhill-fl.gov OVERALL DESCRIPTION OF THE PROJECT: Emergency 24" Linestop and Valve Replacement TYPE OF CONTRUCTION PROVIDED: Emergency Repair CONSTRUCTION TRADES PROVIDED ON THE PROJECT: Installation of gate valve SPECIAL FEATURES OF THE PROJECT (describe how work was performed in City/Urban environment and/or Beach/Bay Front Vicinity): Was the experience described above as a Prime Contractor or as a subcontractor? Prime x Sub-Contractor What changes and/or modifications were experienced during the course of the project? March 2009 City of Miami Beach Page 150 of 185 Project Manual Bidder's Past Projects (SAMPLE PROJECT 2 OF 5, CONTINUED) How did those changes/modifications affect the schedule? CONTRACT AWARD AMOUNT $ $9,413.00 FINAL COST AT COMPLETION: $ same as above VALUE OF WORK PERFORMED AS THE PRIME: $ 9,413.00 TOTAL VALUE OF SUBCONTRACT: $ SCHEDULE START DATE: 0 February 2007 SCHEDULE COMPLETION DATE: February 2007 ACTUAL START DATE: February 2007 ACTUAL COMPLETION DATE: February 2007 PROJECT MANAGER: Rene Castillo Jr. DESIGNER: N/A PROJECT MANAGER: TELEPHONE NO: *ATTACH ADDITIONAL SHEETS IF NECESSARY* March 2009 City of Miami Beach Page 151 of 185 Project Manual Bidder's Past Projects SAMPLE PROJECT 3 OF 5 CONTRACTOR'S NAME: Ric-Man International, Inc CLIENT'S NAME: Miami Dade Water and Sewer Department CLIENT'S CONTACT NAME: ,loe Armao CLIENT'S ADDRESS 3071 SW 38th Avenue, Miami, FL 33146 CLIENT'S PHONE: 786-586-4198 FAX CLIENT'S EMAIL ADDRESS: OVERALL DESCRIPTION OF THE PROJECT: 150' of 54" Sanitary Sewer Emergency Repair TYPE OF CONTRUCTION PROVIDED: CONSTRUCTION TRADES PROVIDED ON THE PROJECT: Traffic Control Pedestrian Access paving pipeline dewatering bypass SPECIAL FEATURES OF THE PROJECT (describe how work was performed in City/Urban environment and/or Beach/Bay Front Vicinity): Set up 24" bypass pipes 600' long while allowing pedestrian and traffic access. Remove and Replaced 600' of 54" prestressed pipe in middle of roadway. Was the experience described above as a Prime Contractor or as a subcontractor? Prime x Sub-Contractor What changes and/or modifications were experienced during the course of the project? Had to modify 2 existing structures, quickly to avoid delays and stay within the DOT time limit. March 2009 City of Miami Beach Page 152 of 185 Project Manual Bidder's Past Projects (SAMPLE PROJECT 3 OF 5, CONTINUED) How did those changes/modifications affect the schedule? None we worked late into the night and on the weekend to accomplish this. CONTRACT AWARD AMOUNT $ 848,027.00 FINAL COST AT COMPLETION: $ same as above VALUE OF WORK PERFORMED AS THE PRIME: $ s4s,o27.00 TOTAL VALUE OF SUBCONTRACT: $ 0 SCHEDULE START DATE: February 2007 SCHEDULE COMPLETION DATE: February 2007 ACTUAL START DATE: February 2007 ACTUAL COMPLETION DATE: February 2007 PROJECT MANAGER: Rene Castillo Jr. DESIGNER: Miami Dade Water and Sewer Department PROJECT MANAGER: same as above TELEPHONE NO: same as above *ATTACH ADDITIONAL SHEETS IF NECESSARY* March 2009 City of Miami Beach Page 153 of 185 Project Manual Bidder's Past Projects SAMPLE PROJECT 4 OF 5 CONTRACTOR'S NAME: Ric-Man International, Inc CLIENT'S NAME: City of Miami Beach CLIENT'S CONTACT NAME: Fernando Vasquez CLIENT'S ADDRESS: 1700 Convention Center Drive Miami Beach, FL 33139 CLIENT'S PHONE: 305-673-7080 FAX CLIENT'S EMAIL ADDRESS: fernandovasquez@miamibeachfl.gov OVERALL DESCRIPTION OF THE PROJECT: Design Build of 1400' of 12" water main for DOT emergent TYPE OF CONTRUCTION PROVIDED: New CONSTRUCTION TRADES PROVIDED ON THE PROJECT: pipe IaVinq and earth work SPECIAL FEATURES OF THE PROJECT (describe how work was performed in City/Urban environment and/or Beach/Bay Front Vicinity): Design, Permit, Mobilize in 10 Days. Construction complete in 60 Days. Was the experience described above as a Prime Contractor or as a subcontractor? Prime x Sub-Contractor What changes and/or modifications were experienced during the course of the project? Additional pip footage requested by client. March 2009 City of Miami Beach Page 154 of 185 Project Manual Bidder's Past Projects (SAMPLE PROJECT 4 OF 5, CONTINUED) How did those changes/modifications affect the schedule? Minimal time extension CONTRACT AWARD AMOUNT $ 517,000.00 FINAL COST AT COMPLETION: $ x18,034.00 VALUE OF WORK PERFORMED AS THE PRIME: $ 18,034.00 TOTAL VALUE OF SUBCONTRACT: $ 0 SCHEDULE START DATE: July 2007 SCHEDULE COMPLETION DATE: August 2007 ACTUAL START DATE: July 2007 ACTUAL COMPLETION DATE: August 2007 PROJECT MANAGER: Albert Dominguez DESIGNER: APCTE & Ric-Man International PROJECT MANAGER: Albert Dominguez TELEPHONE NO: 305-592-7283 *ATTACH ADDITIONAL SHEETS IF NECESSARY* March 2009 City of Miami Beach Page 155 of 185 ect Manual SAMPLE PROJECT 5 OF 5 Bidder's Past Projects CONTRACTOR'S NAME: Ric-Man International, Inc CLIENT'S NAME: City of Miami Beach CLIENT'S CONTACT NAME: Mike Alvarez CLIENT'S ADDRESS: 1700 Convention Center Drive, Miami Beach, FL 33139 CLIENT'S PHONE: 305-673-7080 FAX CLIENT'S EMAIL ADDRESS: rnikealvarez@miamibeachfl.gov OVERALL DESCRIPTION OF THE PROJECT: 36" water main emergency repair at Julia Tuttle TYPE OF CONTRUCTION PROVIDED: Repair CONSTRUCTION TRADES PROVIDED ON THE PROJECT: pipe laying and earth work SPECIAL FEATURES OF THE PROJECT (describe how work was performed in City/Urban environment and/or Beach/Bay Front Vicinity): Work was time/coordinated with tide. Must be complete in 36 hours. Due to water supply requirements Was the experience described above as a Prime Contractor or as a subcontractor? Prime x Sub-Contractor What changes and/or modifications were experienced during the course of the project? None March 2009 City of Miami Beach Page 156 of 185 Project Manual Bidder's Past Projects (SAMPLE PROJECT 5 OF 5, CONTINUED) How did those changes/modifications affect the schedule? CONTRACT AWARD AMOUNT $ 51,635.00 FINAL COST AT COMPLETION: $ same as above VALUE OF WORK PERFORMED AS THE PRIME: $ 51,635.00 TOTAL VALUE OF SUBCONTRACT: $ 0 SCHEDULE START DATE: November 2007 SCHEDULE COMPLETION DATE: 36 hours ACTUAL START DATE: november 2007 ACTUAL COMPLETION DATE: 36 Hours PROJECT MANAGER: Albert Dominguez DESIGNER: N/A PROJECT MANAGER: TELEPHONE NO: *ATTACH ADDITIONAL SHEETS IF NECESSARY* March 2009 City of Miami Beach Page 157 of 185 Project Manual Form of Certificate of Insurance 00912 FARM OF CERTIFICATE OF INSURANCE BID TITLE Horizontal (R01/1n ITB No. 23-08/09 Insurance Checklist XXX 1. Workers' Compensation and Employer's Liability per the Statutory limits of the state of Florida. XXX 2. Comprehensive General Liability (occurrence form), limits of liability $ 1,000,000.00 per occurrence for bodily injury property damage to include Premises/ Operations; Products, Completed Operations and Contractual Liability. Contractual Liability and Contractual Indemnity (Hold harmless endorsement exactly as written in "insurance requirements" of specifications). XXX 3. Automobile Liability - $1,000,000 each occurrence - owned/non-owned/hired automobiles included. 4. Excess Liability - $ .00 per occurrence to follow the primary coverages. XXX 5. The City must be named as an additional insured on the liability policies; and it must be stated on the certificate. XXX 6. Other Insurance as indicated: _ Builder's Risk Insurance will be determined on aproject-by-project basis. Liquor Liability $ .00 Fire Legal Liability $ .00 _ Protection and Indemnity $ .00 Employee Dishonesty Bond $ .00 _ Other $ .00 XXX 7. Thirty (30) days written cancellation notice required. XXX 8. Best's guide rating B+: VI or better, latest edition. XXX 9. The certificate must state the bid number and title. BIDDER AND INSURANCE AGENT STATEMENT: We understand the Insurance Requirements of these specifications and that evidence of this insurance may be required within five (5) d~ Ric-Man International,lnc Bidder March 2009 City of Miami Beach Page 159 of 185 EXHIBIT 6 PERFORMANCE BOND ~- I i -- NIELSON, ALTER & ASSOCIATES July 23, 2009 City of Miami Beach, Florida 1700 Convention Center Drive Miami Beach, Florida 33139 RE: Authority to Date Bonds and Powers of Attorney Principal: Ric-Man International Bond No. 964013081 Project: ITB No. 23-08/09 -Job Order Contract-Horizontal ROW To Whom It May Concern: Please be advised that we, the Surety, hereby authorize you to date the attached Bonds and Powers of Attorney concurrent with the date of the contract. Once the Bonds and Powers of Attorney have been dated, please provide us with a copy for our files. If you have any questions, please do not hesitate to contact this office. Sincerely yours, NIELSON, ALTER 8~ ASSOCIATES Olga Iglesias Production/CSR Attachments 8000 Governors Square Boulevard Suite 101 Miami Lakes, FL 33016 P: 305.722.2663 F: 305.558.9650 www.nielsonbonds.com BOND N0. 964013081 Protect Manual Form o1 Periormancs Bond 00844 FORM OF PERFORMANCE BOND BY THIS BOND, We Ric~Man International, Inc . as Principal, hereinafter called CONTRACTOR, and IJ]oerty textual ~"~~ ~O• as Surety, are hound to the City of Miami Beach, Florida, as Obligee, hereinafter called CITY. In the amount of , an initlal Two Mitllon {$2,000,000.00) for HORIZONTAL ROW, fat-t~A6Ft~lA for the payment whereof CONTRACTOR and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally. WHEREAS, CONTRACTOR has by written agreement entered into a Contract, ITB No.: 23-08/09 ,awarded the t 5th day of July , 20 09 with CITY which Contract Documents are by reference incorporated herein and made a part hereof, and specifically Include provision for liquidated damages, and other damages identified, and for the purposes of this Bond are hereafter refisrred to as the "Contract"; THE CONDITION OF THIS BOND is that if CONTRACTOR: 1. Performs the Contract between CONTRACTOR and CITY for construction of Job Order Contract ITB ~l23-08/09 the Contract being made a part of this Bond by reference, at the times and in the manner prescribed in the Contract; and 2. Pays CITY all losses, liquidated damages, expenses, costs and attorneys fees including appellate proceedings, that CITY sustains as a result of default by CONTRACTOR under the Contract; and 3. Performs the guarantee of all work and materials furnished under the Contract for the time specified in the Contract; then TWIS BOND IS V01D, OTHERWISE IT REMAINS IN FULL FORCE AND EFFECT. Whenever CONTRACTOR shall be, and declared by CITY to be, in default under the Contract, CITY having performed CITY obligations thereunder, the Surety may promptly remedy the default, or shall promptly: Prol~at Manuat Form of Performance Band 3.1. Complete the Project in accordance with the terms and conditions of the Contract Documents; or 3.2. Obtain a bid or bids for completing the project in accordance with the terms and conditions of the Contract Documents, and upon determination by Surety of the lowest responsible Bidder, or, if CITY elects, upon determination by CITY and Surety joint<y of the lowest responsible Bidder, arrange fvr a contract between such Bidder and CITY, and make avaiiable as work progresses (even though there should be a default or a succession of defaults under the Contract ar Contracts of completion arranged under this paragraph) sufficient funds to pay the cost of completion less the balance of the Job Order Amount; but not exceeding, induding other costs and damages for which the Surety may be liable hereunder, the amount set forth in the first paragraph hereof. The term "balance of the Jab Order Amount," as used in this paragraph, shall mean the total amount payable by CITY to CONTRACTOR under the Contract and any amendments thereto, less the amount property paid by GITY to CONTRACTOR. No right of action s! corporation other that The Surety hereby v Contract Documentf connected with the C this Bond. tail accrue on this bond to or for the use of any person or t CITY named herein. raives notice of and agrees that any changes in or under the and compliance or noncompliance with any formalities ~ntract or the changes does not affect Surety's obligation under Signed and sealed this ~_ day of --~~ ~~ _, 20 ~ Project Manual Form ofi Performance Bond R1o-Marl II1~E:I7[1~t~OI1a1.~ I[1C. Name of o tion) By (Signature and Title) ;~,~'fiy..~~ (Type Nameri'itle Signed Above) ~~ day of -/~ 20~ LIBERTY MUTUAL INSURANCE COMPANY IN THE PRESENCE OF: INSU MPA r By Ag t a ttorney-in-Fact 175 Berkeley Street {Address: Street) Boston MA 02117 (CitylState~p} Telephone No.: (617) 357-9500 {CORPORATE SEAL) EXHIBIT 7 PAYMENT BOND BOND N0. 964013081 project Manuel Form of Finaf Receipt 0091b FORM OP PAYMENT BOND BY THIS BOND, We itic-Man International, Inc . as Prindpal, hereinafter called CONTRACTOR, and idb~ty M,>L~1 ~~"0e O'` as Surety, are bound to the City of Miarni Beach, Florida, as Obligee, hereinafter called CITY, in the amount of , an initial Two Million Dollars ($2,000,000.00) for HORIZONTAL ROW, forR6AIrINB for the payment whereof CONTRACTOR and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally. WHEREAS, CONTRACTOR has by written agreement entered into a Contract, BidlCantract No.: 23--Ut3~09 .awarded the ` 15thday of July , 20 09 with CITY which Contract Documents are by reference incorporated herein and made a part hereof, and specifically include provision for liquidated damages, and other damages identified, and far the purposes of this Bond are hereafter referred to as the "Contract"; THE CONDITION OF THIS BOND is that (f CONTRACTOR: 1. Pays CITY all losses, Liquidated damages, expenses, costs and attorneys fees including appellate proceedings, that CITY sustains because of default by CONTRACTOR under the Contract; and 2. Promptly makes payments to all claimants as defined by Florida Statute 255.05('1) for all Tabor, materials and supplies used directly or indirectly by CONTRACTOR in the performance of the Contract; THEN CONTRACTOR'S OBLIGATION SHALL BE VOID; OTHERWISE, IT SHALL REMAIN IN FULL FORCE AND EFFECT SUBJECT, HOWEVER, TO THE FOLLOWING CONDITIONS: 2.1. A claimant, except a laborer, who is not in privity with CONTRACTOR and who has not received payment for its labor, materials, or supplies shat!, within foray five (45) days after beginning to furnish labor, materials, or supplies for the prosecution of the work, furnish to CONTRACTOR a notice that he intends to look to the bond for protection. 2.2. A claimant who is not in privity with CONTRACTOR and who has not received payment for its labor, materials, or supplies shall, within Winery (90) days after pertormance of the labor or after complete delivery of the materials or supplies, deliver to CONTRACTOR and to the Surety, written Project Manua[ Form of Fteal Recafpt notice of the performance of the labor or delivery of the materials or supplies antl of the nonpayment. 2,3. No action for the labor, materials, or supplies may be i»stituted agai»st CONTRACTOR or the Surety unless the notices stated under the preceding conditions {2.1) and (2.2) have been given. 2.4. Any action under this Bond must be instituted in accordance with the Notlce and Time Limitations provisions prescribed in Section 255.05(2), Florida Statutes. ' The Surety hereby waives notice of and agrees that any changes in or under the Contract Documents and compliance or noncompliance with any formalities connected with the Contract or the changes does not affect the Surety's obltgaHon under this Bond, Signed and sealed this ~ 7 ~ day of ~~ /l , 20~ .c-Mail Intexnat3onal, Inc. ~e o tion) l~ (Signature and Title) 7,~r//v ,~ ~,~1,r/e.,tJj ~4+4~1'1r VI`/11 C ~G/''IL~ IN THE !'F2ESENC~ aF: ~~ 37-~S ®Qi+fp !S HEREBY AMENDED SO THAT THE PROVISIONS AND ~~~-Ttfk!ti OF SECTION 255.05 OR SECTION 713.23 R011-E~-'t SFRTUTES, WHtCNEVER IS APPr_tCABt,E. ARE 1lNCORPC~RATED HEREIN BY REFERENCE. This bond is given to comply with section 255.05 Florin Statutes, and any action instituted by a rlaimant under t. bond for payment must be in accordance with the r~otice a time limitation provisions in Section 255.05(2), Florida Statut (Type NamelTitle Signed Above) LIBERTY L INSURANCE COMPANY INSURA MP N By Age and omey-in-Fact 175 Berkeley Street (Address: Street) Bs>ston. MA 02117 (City/StatelZip) Telephone No.: c6~7~ 7- soo 2524545 THIS POWER OF ATTORNEY IS NOT VALID UNLESS tT IS PRINTED ON RED BACKGROUND. This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. LIBERTY MUTUAL INSURANCE COMPANY BOSTON, MASSACHUSETTS POWER OF ATTORNEY KNOW ALL PERSONS BY THESE PRESENTS: That Liberty Mutual Insurance Company (the "Company"), a Massachusetts stock insurance company, pursuant to and by authority of the By-law and Authorization hereinafter set forth, does hereby name, constitute and appoint MARY C. ACEVES, CHARLES J. NIELSON, WARREN ALTER, KRISTI MESSEL, CHARLES D. NIELSON, DAVID R. HOOVER, ALL OF THE CITY OF MIAMI LAKES, STATE OF FLORIDA .......................................................... each individually if there be more than one named, its true and lawful attorney-in-fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act a* d deed *a *y* a*d all undertakings, bonds, recognizances and other sureltyy obligga**o *s in the penal sum not exceeding FIFTY MILLION AND 00/100 DOLLARS ($ 50,000,Q00.00 )each, and the execution of such undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents, shall be as binding upon the Company as if they had been duly signed by the president and attested by the secretary of the Company in their own proper persons. That this power is made and executed pursuant to and by authority of the following By-law and Authorization: .p a d ~N Y ~« A ~ 'O ~ ~c N O d _~ d ~ _~ ~~ ~ ~N 'Oi y O O d C t~0 L N t.~ ~ ~~ ~~ w~ 'O v TO c ~ d O '' Z v', ARTICLE XIII -Execution of Contracts: Section 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attorneys-in-fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys-in-fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. By the following instrument the chairman or the president has authorized the officer or other official named therein to appoint attorneys-in-fact: Pursuant to Article XIII, Section 5 of the By-Laws, Garnet W. Elliott, Assistant Secretary of Liberty Mutual Insurance Company, is hereby authorized to appoint such attorneys-in-fact as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. That the By-law and the Authorization set forth above are true copies thereof and are now in full force and effect. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Company and the corporate seal of Liberty Mutual Insurance Company has been affixed thereto in Plymouth Meeting, Pennsylvania this 31st day of March 2009 ' LIBERTY MUTUAL INSURANCE COMPANY x:,,,,> f3" j£ p '~_ Byrom - ~ /,L/_ ~..~.. ~~o;;~•' Garnet W. Elliott, Assistant Secretary COMMONWEALTH OF PENNSYLVANIA ss `°-" COUNTY OF MONTGOMERY On this 31st day of March 2009 ,before me, a Notary Public, personally came Garnet W. Elliott, to me known, and acknowledged that he is an Assistant Secretary of Liberty Mutual Insurance Company; that he knows the seal of said corporation; and that he executed the above Power of Attorney and affixed the corporate seal of Liberty Mutual Insurance Company thereto with the authority and at the direction of said corporation. IN TESTIMONY N first above written. F CERTIFICATE ~~~Y d.~i subscribed my name and affixed my notarial seal at Plymouth Meeting, Pennsylvania, on the day and year COA4MONWeAi.TH OF Pf NNSYI VANIA L ~~ -~-~_ Natar;ai Seal _ (//I~~~~J~ ~ ~~~~~~r ~ w 7:rsaaPaatr:Pn, NCLxy PN~lic ~~~" wry" /(~ /`!'yam`'/O~ PlymMath Avp., Montanmery Ccuniy By y My Cmm~uss!un EZpires tv7arch 2&,2013 Ter sa Pastella, Notary Public Atemb_a, Penrisyivanie Assxia[on or NnWrles I, the undersigned, Assistan~i"~ec°r`etary of Liberty Mutual Insurance Company, do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy, is in full force and effect on the date of fhis certificate; and I do further certifythat the officer or official who executed the said power of attorney is an Assistant Secretary specially authorized by the chairman or the president to appoint attorneys-in-fact as provided in Article XIII, Section 5 of the By-laws of Liberty Mutual Insurance Company. This certificate and the above power of attorney may be signed by facsimile or mechanically reproduced signatures under and by authority of the following vote of the board of directors of Liberty Mutual Insurance Company at a meeting duly called and held on the 12th day of March, 1980. VOTED that the facsimile or mechanically reproduced signature of any assistant secretary of the company, wherever appearing upon a certified copy of any power of attorney issued by the company in connection with surety bonds, shall be valid and binding upon the company with the same force and effect as though manually affixed. IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seal of the said company, this day of ~~~`~~l f By , `~~~~ David M. Carey, Ass' "t Secretary R Z v u a t u S C a C 'C vF ~.V i=LL I~ t Q~ Od d L O R a' R yC ~ Q O = w ~ "a .~ '~ a > -~ ~c "" a OC c, v~ T EXHIBIT 8 INSURANCE CERTIFICATE Project Manual Form of Final Receipt 0091 FORM OF CERTIFICATE OF INSURANCE BID TITLE ~~'v~;to.rJyiq/ cif _w~~/e Go~.J-~iurf~~'.1~.~'/~Gel ITB No. ~ 3 ' G Fl 9 Insurance Checklist XXX 1. Workers' Compensation and Employer's Liability per the Statutory limits of the state of Florida. XXX 2. Comprehensive General Liability (occurrence form), limits of liability $ 1,000,000.00 per occurrence for bodily injury property damage to include Premises/ Operations; Products, Completed Operations and Contractual Liability. Contractual Liability and Contractual Indemnity (Hold harmless endorsement exactly as written in "insurance requirements" of specifications). XXX 3. Automobile Liability - $1,000,000 each occurrence - owned/non-owned/hired automobiles included. _ 4. Excess Liability - $ .00 per occurrence to follow the primary coverages. XXX 5. The City must be named as an additional insured on the liability policies; and it must be stated on the certificate. XXX 6. .Other insurance as indicated: _ Builder's Risk Insurance will be determined on aproject-by-project basis. Liquor Liability $ .00 _ Fire Legal Liability $ .00 _ Protection and Indemnity $ .00 _ Employee Dishonesty Bond $ .00 _ Other $ .00 XXX 7. Thirty (30) days written cancellation notice required. XXX 8. Best's guide rating B+: VI or better, latest edition. XXX 9. The certificate must state the bid number and title. BIDDER AND INSURANCE AGENT STATEMENT: We understand the Insurance Requirements of these specifications and that evidence of this insurance may be required within five (5) days after bid opening. _,._~ Bidder Sign a of Bid .~~ci~ ~~u-y ACORD CERTIFICATE OF LIABILITY INSURANCE oP roNB DATE(MNIODM'Y'y) RICMA-2 07/21/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE McNish Group HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 26622 Woodward Avenue Ste 200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Royal Oak MI 48067 Phone: 248-594-4800 Fax: 248-544-4801 INSURERS AFFORDING COVERAGE NAIL # INwaeD INSURERA Amerisure Insurance Co. 19468 INSURER E: wt.... iruarAn^A CA Rlc-Man International IRC • INSURER C: 2601 Wiles Road ano Beach FL 33073 Pom INSURER D: p INSURER E: COVERAGES THE POLICIES OF INBURANLE LISTED BELLY/ HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOP THE POLICY PERIOD WDICATED. NDTWITHBTANDING ANY REQUIREMENT, TERM OR CONDRION OF AHY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIN CERTIFKATE MAY BE 188UED OR MAY PlRTAIN, THE INBURANLE AFFORDED BY THE POLICIES DESCRIBED NEREtN IS SUBIECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREWTE L W ITS 9H0WN MAY NAVE BEEN REDUCED BY PAID CLAWS. WSR LTR DD'L NSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MNIDDIYY) POLICY EXMRATION GATE (MMIODRY) LIMITf OENEML LUBILITY EACH OCCURRENCE S 1 , OOO , OOO , A X COMMERLIALCENERALLIABILITY CPP205166901 02/01/09 02/01/10 DAMAGE TO RENTED 300 PREMISES (E,R000r.r,w) s ,000. CLAWS MADE ~ OCCUR MED E%P (My wH pMi^n) S 10,000, X Owner/Cont Prot. PERSONALSADVINJURY 3 1,000,OOO. X C0ntraCtTla1 GENERAL AGGREGATE S 2,000,000, OEN'L AGGREGATE LWIT APPLIES PER: PRODUCTS-COMP/OP AGG f 2, OOO, GOO, PRo- POLICY X JECT LOC AUTO MOBKE LMEILRY A X ANY AUTO CA205166703 02/01/09 02/01/10 ~~ BI~HEMa1NOLEUMR s 1,000,000. ALL OWNED AUTOS BOOILV INJURY S SCHEDULED AUTOS // / ~ (NrP^O°^) X HIREDAUTOB /~ /y X NON-OWNED AUTOS 1 i AL/2` 1 '~ © ~ BODILY INJURY (PPr^'~^^D i ' 1/J < PROPERTY DN.IAOE f (P~r AccIMM) OARAOE L4BNTY AUTO OMLY-EA MCR)ENT i ANY AVTO OTHER THAN EA ACC S AUTO ONLY: AGO i E%CFSSNMBRELLA LMBILITY EACH OCCURRENCE S 1 , OOO , OOO B X OCCUR ^ CLAW9YADE CU205167001 02/01/09 02/01/10 AOQREOATE s 1,000,000 - S DEDUCTIBLE 3 X RETENTION 3 0 , f WORMERS COMPENSATM)N AND WC BTATU- OTH- X ' TORY LWRS ER A EMPLOYERS LIABILRY ANY PROPRIETORIPARTNERIEXECUTIVE WC205166601 02/01/09 02/01/10 E.L. EACH ACCIDENT i 500,000. OFFICERRAEMBER EXCLUOEDT u b w a E.L. DISEASE ~ EA EY0.0YEE S SOO , OOO , .cr . Nrl .r r^S. SPECIAL PR0VISION9 bbw E.L. DISEASE - POLICY LWR S 5OO , OOO , A OTHER Install Floater CPP205166901 02/01/09 02/01/10 5,000 Ded 150,000. A Limited Pollution CPP205166901 02/01/09 02/01/10 1,000 Ded 100,000. DESCRIPTION OF OPERATroNBILOCAT1ONSl VEHICLEBIE%CLUBI0N8 ADDED BY ENDORSEMENTISPECIAL PROVISIONS Job order contract P#23-08/09 for Horizontal Citywide Construction Services. Certificate Holder is Additional Insureds as required by written contract with respects to the coverages referenced herein per the activities and operations performed by the Named insured IrIVM1G TTVLNCR T_a N('GI 1 aTl(lN MIAMIMI SHOULD ANY OF IHE ABOVE 0ESCRIBED POLXi%-xl EE CANCELLED BEFORE THE E%PIMTroN GATE THEREOF, IHE U38UINO INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN NOTICE TO THE CERTPM:AIE HOLDER NAMED TO THE LEFT. EUT FAILURE TOW 30 SHALL City of Miami Beach, Florida Risk Manager IMPOSE NO OELNSATION OR LMBILITY OF ANY NWD UPON THE INSURER. ITE AGENTS OR 1700 Convention Center Drive RE.RESENTATIVES. Miami Beach FL 33139 AIJnlO R vassal ~ ^""'"' "' (""""'°~ ©ACORD CORPORATION '1988