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Agreement with Dock & Marine Construction, Inc
jolc2 AGREEMENT BETWEEN THE CITY OF MIAMI BEACH, FLORIDA AND DOCK & MARINE CONSTRUCTION, INC FOR REMOVAL AND DISPOSAL OF DERELICT VESSELS, PURSUANT TO REQUEST FOR QUALIFICATIONS (RFQ) NO. 41-11/12 THIS AGREEMENT made and entered into this day of ,�f.0 ,•2014(Effective Date), by and between the CITY OF MIAMI BEACH, FLORIDA, a municipal corporation, having its principal offices at 1700 Convention Center Drive, Miami Beach, Florida, 33139, (hereinafter referred to as City)and DOCK& MARINE CONTRUCTION, INC. a Florida corporation, whose address is 752 N.E. 79th Street, Miami Florida 33138(hereinafter referred to as CONTRACTOR). SECTION 1 DEFINITIONS Agreement: This Agreement between the City and CONTRACTOR. City Manager: The Chief Administrative Officer of the City. CONTRACTOR: For the purposes of this Agreement, CONTRACTOR shall be deemed to be an independent contractor, and not an agent or employee of the City. Services: All services,work and actions by the CONTRACTOR performed pursuant to or undertaken under this Agreement, as described in Section 2 and Attachment "D" hereto. Fee: Amount paid to the CONTRACTOR to cover the costs of the Services. Proposal Documents: Proposal Documents shall mean City of Miami Beach REQUEST FOR QUALIFICATIONS(RFQ)No.41-11/12 for REMOVAL AND DISPOSAL OF DERELICT VESSELS, together with all amendments thereto, issued by the City in contemplation of this Agreement (the RFQ) and the Contractor's proposal in response thereto (Proposal), all of which are hereby incorporated and made a part hereof; provided, however, that in the event of an express conflict between the Proposal Documents and this Agreement, the following order of precedent shall prevail: this Agreement; the RFQ; and the Proposal. Risk Manager: The Risk Manager of the City, with offices at 1700 Convention Center Drive, Third Floor, Miami Beach, Florida 33139, telephone number(305) 673-7000, Ext. 6515, and fax number(305) 673-7023. 1 SECTION 2 SCOPE OF SERVICES 2.1 GENERAL The City is entering into this Agreement for the removal and disposal of derelict vessels, as set forth in City's Request for Qualifications No. 41-11/12, together with all amendments thereto (the RFQ), and CONTRACTOR's Proposal in response thereto (The RFQ and CONTRACTOR'S Proposal are collectively referred to as the Proposal Documents). The Proposal Documents shall set forth the Services to be provided pursuant to this Agreement; which Services are attached and incorporated in further detail as Attachment "D" hereto. The Services will be provided by CONTRACTOR to suffice any and all requirements as may be set forth by the Federal Emergency Management Agency(FEMA),which provides public assistance funds for debris clearance, removal, and disposal operations. SECTION 3 COMPENSATION 3.1 FEE When a need for the Services is identified by the City, the requesting City Department shall contact all prequalified contractors, including CONTRACTOR,to provide quotes on the work or services required. CONTRACTOR is required to visit the site; provide fixed price per vessel; submit the number of days required to perform the removal of the vessel;and the start date.The quote must be all inclusive(removal to disposal)to include every task to be completed for each vessel in accordance to FEMA or other applicable requirements. If CONTRACTOR's quote is accepted by the City,which acceptance shall be in the City's sole discretion and judgment,then a Work Order will be released to CONTRACTOR. The CONTRACTOR shall be required to submit a written estimate for the proposed Services or portion thereof before a Work Order, in the form provided in Attachment"A"to this Agreement, is issued by the City. The estimate shall be itemized by the number of work hours per classification, and by the cost of materials and equipment. Lump sum estimates shall not be accepted.The actual charge to the City for a specific project must be in accordance with the cost information submitted in CONTRACTOR's Proposal in response to the RFQ, and must be approved prior to commencement of any Services, or portion thereof, under a Work Order. 3.2 PAYMENT AND BILLING a. If the Services required to be performed by a Work Order are able to be clearly specified by the City, then the Work Order shall be issued on a "Fixed Fee" basis. The CONTRACTOR shall perform all Services required by the Work Order, but in no event shall the CONTRACTOR be paid more than the negotiated Fixed Fee amount stated therein. b. If the Services required to be performed are not such that they cannot be specifically set forth and defined by the City, then the Work Order may be issued on a"Time Basis Method", and contain a "Not-to-Exceed" amount. If a "Not-to-Exceed" amount is provided, the CONTRACTOR shall perform all Services required by the Work Order but, in no event, shall the CONTRACTOR be paid more than the "Not-to Exceed" amount specified in the applicable Work Order. c. If the Services are such that they cannot be specifically set forth and defined by the City,then 2 the Work Order may also be issued on a "Time Basis Method", and contain a Limitation of Funds amount. The CONTRACTOR shall not be authorized to exceed the amount without the prior written approval of the City. Said approval, if given at all, shall indicate a new Limitation of Funds amount. d. The CONTRACTOR shall advise the City whenever the CONTRACTOR has incurred expenses on any Work Order that equals or exceeds eighty percent(80%)of the Limitation of Funds amount. e. For Work Orders issued on a"Fixed Fee Basis,"the CONTRACTOR may invoice the amount due based on the percentage of total (Work Order) Services actually performed and completed, but, in no event, shall the invoice amount exceed a percentage of the Fixed Fee amount equal to a percentage of the total Services actually completed. f. For Work Orders issued on a "Time Basis Method" with a "Not-to-Exceed" amount, the CONTRACTOR may invoice the amount due for actual hours performed, but in no event shall the invoice amount exceed a percentage of the "Not-to-Exceed" amount equal to a percentage of the total Services actually completed. g. Each Work Order issued on a "Fixed Fee Basis" or "Time Basis Method" with a "Not-to- Exceed" amount shall be treated separately for retainage purposes. If the City determines that the Services have been substantially complete and the amount retained is considered to be in excess, the City may, at its sole and absolute discretion, release the retainage or any portion thereof. h. For Work Orders issued on a "Time Basis Method" with a Limitation of Funds amount, the CONTRACTOR may invoice the amount due for Services actually performed and completed. i. Payments shall be made by the City to the CONTRACTOR when requested as work progresses for Services furnished, but not more than once monthly. Each Work Order shall be invoiced separately.CONTRACTOR shall submit to the City,at the close of each calendar month, an itemized invoice properly dated including the following: - Description of Services rendered - Cost of Services - Name and address of the CONTRACTOR - Work Order number - RFQ No. - Notice(s)to Proceed issued by the City. - Records of vessel registration number, if applicable,and photographs of each wreckage. - Full name of individual performing the service. - Number of hours and dates worked. All invoices are subject to verification, approval, and processing by the City department requesting the temporary personnel. The original invoice shall be sent to: City of Miami Beach Public Works Sanitation Department 140 MacArthur Causeway Miami Beach, Florida 33139 3 SECTION 4 GENERAL PROVISIONS 4.1 RESPONSIBILITY OF THE CONTRACTOR a. The CONTRACTOR shall be responsible for the professional quality, technical accuracy, competence, methodology, accuracy and the coordination of all of the following which are listed for illustration purposes and not as a limitation: documents, analyses, reports, data, plans, specifications,and/or any and all other documents and/or Services of whatever type or nature furnished by the CONTRACTOR under this Agreement. The CONTRACTOR, shall, without additional compensation, correct or revise any errors or deficiencies in any and all documents and/or Services of whatever type or nature that are required to be furnished by the CONTRACTOR pursuant to this Agreement. b. Neither the City's review, approval or acceptance of, nor payment for, any of the Services required herein shall be construed to operate as a waiver of the City's rights under this Agreement, nor of any cause of action arising out of the performance of this Agreement,and the CONTRACTOR shall be and always remain liable to the City in accordance with this Agreement and applicable laws for any and all damages to the City caused by the CONTRACTOR'S negligent and wrongful performance of any of the Services furnished under this Agreement. c. In its performance of the Services,the CONTRACTOR shall comply with all Applicable Laws. 4.2 PUBLIC ENTITY CRIMES A State of Florida Form PUR 7068,Sworn Statement under Section 287.133(3)(a)Florida Statute on Public Entity Crimes shall be filed with the City's Procurement Division, prior to commencement of the Services herein. 4.3 DURATION AND EXTENT OF AGREEMENT The term of this Agreement shall be for an initial term of three(3)years, commencing on the last date of execution of the Agreement by the parties hereto, which shall be the Effective Date on page 1 hereof. At its sole discretion,the City may renew this Agreement, upon the same terms and conditions,for up to two(2)additional one(1)year terms, upon thirty(30)days written notice to CONTRACTOR (such notice to be provided prior to the end of the initial term (or a renewal term, as the case may be). 4.4 TIME OF COMPLETION The Services to be rendered by the CONTRACTOR shall commence upon receipt of a Notice to Proceed from the City, subsequent to the execution of the Agreement. The Services shall be ongoing for the Term of the Agreement, on an as needed basis, and subject to the issuance of a Work Order to CONTRACTOR(which Work Order shall be issued, if at all, at the sole discretion and judgment of the City). 4.5 INDEMNIFICATION CONTRACTOR agrees to indemnify and hold harmless the City of Miami Beach and its officers, employees and agents, from and against any and all actions, claims, liabilities, losses, and expenses, including, but not limited to, attorneys' fees, for personal, economic or bodily injury, wrongful death, loss of or damage to property, at law or in equity, which may arise or be alleged to have arisen from the negligent acts,errors, omissions or other wrongful conduct of the 4 CONTRACTOR, its employees, agents, sub-contractors, or any other person or entity acting under CONTRACTOR's control, including without limitations any and all temporary personnel assigned to the City pursuant to this Agreement, in connection with the CONTRACTOR's performance of the Services pursuant to this Agreement; and to that extent,the CONTRACTOR shall pay all such claims and losses and shall pay all such costs and judgments which may issue from any lawsuit arising from such claims and losses, and shall pay all costs and attorneys'fees expended by the City in the defense of such claims and losses, including appeals. The parties agree that one percent(1%)of the total compensation to the CONTRACTOR for performance of the Services under this Agreement is the specific consideration from the City to the CONTRACTOR for the CONTRACTOR's Indemnity Agreement. This indemnity shall survive termination of this Agreement. The CONTRACTOR's obligation under this Subsection shall not include the obligation to indemnify the City of Miami Beach and its officers, employees and agents,from and against any actions or claims which arise or are alleged to have arisen from negligent acts or omissions or other wrongful conduct of the City and its officers, employees and agents. The parties each agree to give the other parry prompt notice of any claim coming to its knowledge that in any way directly or indirectly affects the other party. 4.6 TERMINATION, SUSPENSION AND SANCTIONS 4.6.1 Termination for Cause If the CONTRACTOR shall fail to fulfill in a timely manner, or otherwise violate any of the covenants, agreements,or stipulations material to this Agreement,the City shall thereupon have the right to terminate this Agreement for cause. Prior to exercising its option to terminate for cause, the City shall notify the CONTRACTOR of its violation of the particular terms of this Agreement and shall grant CONTRACTOR ten (10) days to cure such default. If such default remains uncured after ten (10) days, the City, upon three (3) days' notice to CONTRACTOR, may terminate this Agreement and the City shall be fully discharged from any and all liabilities, duties and terms arising out of/or by virtue of this Agreement. Notwithstanding the above, the CONTRACTOR shall not be relieved of liability to the City for damages sustained by the City by any breach of the Agreement by the CONTRACTOR.The City, at its sole option and discretion, shall additionally be entitled to bring any and all legal/equitable actions that it deems to be in its best interest in order to enforce the City's right and remedies against the defaulting party. The City shall be entitled to recover all costs of such actions, including reasonable attorneys'fees. To the extent allowed by law,the defaulting party waives its right to jury trial and its right to bring permissive counter claims against the City in any such action. 4.6.2 Termination for Convenience of City NOTWITHSTANDING SECTION 4.6.1,THE CITY MAY ALSO,FOR ITS CONVENIENCE AND WITHOUT CAUSE, TERMINATE AT ANY TIME DURING THE TERM HEREOF BY GIVING WRITTEN NOTICE TO CONTRACTOR OF SUCH TERMINATION, WHICH SHALL BECOME EFFECTIVE THIRTY (30) DAYS FOLLOWING RECEIPT BY THE CONTRACTOR OF THE WRITTEN TERMINATION NOTICE. IN THAT EVENT, ALL FINISHED OR UNFINISHED DOCUMENTS AND OTHER MATERIALS,AS DESCRIBED IN SECTION 2 AND IN REQUEST FOR QUALIFICATIONS NO.41-11/12,TOGETHER WITH ALL AMENDMENTS THERETO, AND CONTRACTOR'S PROPOSAL RESPONSE,ATTACHED HERETO, SHALL BE PROPERLY ASSEMBLED AND DELIVERED TO THE CITY AT CONTRACTOR'S SOLE COST AND EXPENSE. IF THE AGREEMENT IS TERMINATED BY THE CITY AS PROVIDED IN THIS SUBSECTION, CONTRACTOR SHALL BE PAID FOR ANY SERVICES SATISFACTORILY PERFORMED,AS DETERMINED BY THE CITY AT ITS DISCRETION,UP TO THE DATE OF TERMINATION. PROVIDED, HOWEVER, THAT AS A CONDITION 5 PRECEDENT TO SUCH PAYMENT, CONTRACTOR SHALL DELIVER ANY AND ALL DOCUMENTS, MATERIALS, ETC, TO CITY, AS REQUIRED HEREIN. 4.6.3 Termination for Insolvency The City also reserves the right to terminate the Agreement in the event the CONTRACTOR is placed either in voluntary or involuntary bankruptcy or makes an assignment for the benefit of creditors. In such event, the right and obligations for the parties shall be the same as provided for in Section 4.6.2. 4.6.4 Sanctions for Noncompliance with Nondiscrimination Provisions In the event of the CONTRACTOR's noncompliance with the nondiscrimination provisions of this Agreement, the City shall impose such sanctions as the City, Miami-Dade County, and/ or the State of Florida, as applicable, may determine to be appropriate, including but not limited to, withholding of payments to the CONTRACTOR under the Agreement until the CONTRACTOR complies and/or cancellation,termination or suspension of the Agreement. In the event the City cancels or terminates the Agreement pursuant to this Subsection the rights and obligations of the parties shall be the same as provided in Section 4.6.2. 4.7 CHANGES AND ADDITIONS Changes and additions to the Agreement shall be directed by a written amendment signed by the duly authorized representatives of the City and CONTRACTOR. No alteration, change, or modification of the terms of this Agreement shall be valid unless amended in writing, signed by both parties hereto, and approved by the City. 4.8 AUDIT CONTRACTOR shall keep such records and accounts and require any and all subconsultants to keep such records and accounts as may be necessary in order to record complete and correct entries as to personnel hour charge to the City. All books and records relative to the Agreement, and the Services to be provided herein, shall be available at all reasonable times for examination and audit by the City and shall be kept for a period if three(3) years after the completion of all work/services to be performed pursuant to this Agreement. The City reserves the right to perform audit investigations of the CONTRACTOR's records and accounts. The City's audit rights shall include, without limitation: ascertaining CONTRACTOR's compliance with the Miami Beach Derelict Vessels Program requirements (pursuant to Subsection 2.2 herein and the Proposal Documents), compliance with FEMA's billing and invoicing requirements, and compliance with the City's Living Wage Ordinance. Without limitation, CONTRACTOR shall maintain any and all records necessary to document compliance with the provisions of this Agreement, and shall make available to the City, upon request, such records for audit and examination relating to all matters covered by this Agreement. 4.9 INSURANCE REQUIREMENTS CONTRACTOR shall obtain, provide and maintain during the term of the Agreement the following types and amounts of insurance (also referenced in Attachment "B" hereto) which shall be maintained with insurers licensed to sell insurance in the State of Florida and have a B+ VI or higher rating in the latest edition of AM Best's Insurance Guide. (Any exceptions to these 6 requirements must be approved by the City's Risk Management Department prior to implementation of same): 1. Workers'Compensation and Employer's Liability per the statutory limits of the State of Florida. 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 Checklist 3. Automobile Liability - $1,000,000 each occurrence - owned/non-owned/hired automobiles included. Said policies of insurance shall be primary to and contributing with any other insurance maintained by the CONTRACTOR or City, and shall name the City and the officers, agents and employees of said organizations as additional insures under this Agreement. Policies cannot be canceled without thirty(30) days prior written notice to the City. The CONTRACTOR shall file and maintain certificates of all insurance policies with the City's Risk Management Department showing said policies to be in full force and effect at all times during the term of the Agreement. No work shall be done by CONTRACTOR during any period when it is not covered by insurance as herein required. Such insurance shall be obtained from brokers or carriers authorized to transact insurance business in Florida and satisfactory to City. Evidence of such insurance shall be submitted to and approved by the City's Risk Manager prior to commencement of any work or services under the Agreement. If any of the required insurance coverages contain aggregate limits, or apply to other operations of the CONTRACTOR outside the Agreement, CONTRACTOR shall give City prompt written notice of any incident, occurrence, claim settlement or judgment against such insurance which may diminish the protection such insurance affords the City. The CONTRACTOR shall further take immediate steps to restore such aggregate limits or shall provide other insurance protection for such aggregate limits. 4.9.1 Failure to Procure Insurance CONTRACTOR's failure to procure or maintain required insurance coverage shall constitute a material breach of Agreement under which City may, at its sole option, immediately terminate the Agreement. 4.10 ASSIGNMENT, TRANSFER OR SUBCONTRACTING The CONTRACTOR shall not subcontract, assign, or transfer any work under this Agreement in whole or in part, without the prior written consent of the City. 4.11 SUB-CONTRACTORS The CONTRACTOR shall be liable for the CONTRACTOR's services, responsibilities and liabilities under this Agreement and the services, responsibilities and liabilities of any and all sub-contractors, and any other person or entity acting under the direction or control of the CONTRACTOR including without limitation, any and all temporary personnel provided in the City pursuant to the terms and conditions of the Agreement. When the term"CONTRACTOR" 7 is used in this Agreement, it shall be deemed to include any sub-contractors and any other person or entity acting under the direction or control of CONTRACTOR. For the purpose of this Agreement, CONTRACTOR acknowledges and agrees that any and all temporary personnel assigned by CONTRACTOR to provide services to the City pursuant to this Agreement shall be deemed to be independent contractors and agents or employees of the City, and shall not attain any rights or benefits under the Civil Service or Pension Ordinance of the City, or any right generally afforded Classified or Unclassified employees. Further each personnel shall not be deemed entitled to Florida Worker's Compensation benefits as an employee of the City, or accumulation of sick or annual leave. 4.12 EQUAL EMPLOYMENT OPPORTUNITY In connection with the performance of this Agreement, the CONTRACTOR shall not discriminate against any employee or applicant for employment because of race, color, religion, ancestry, sex, age, and national origin, place of birth, marital status, physical handicap, or sexual orientation. The CONTRACTOR shall take affirmative action to ensure that applicants are employed and that employees are treated during their employment without regard to their race, color, religion, ancestry, sex, age, and national origin, place of birth, marital status, disability, or sexual orientation. 4.13 CONFLICT OF INTEREST The CONTRACTOR agrees to adhere to and be governed by the Metropolitan Miami- Dade County Conflict of Interest Ordinance(No.72-82),as amended;and by the City of Miami Beach Charter and Code, which are incorporated by reference herein as if fully set forth herein, in connection with the Agreement conditions hereunder. The CONTRACTOR covenants that it presently has no interest and shall not acquire any interest, direct or indirectly which should conflict in any manner or degree with the performance of the Services. The CONTRACTOR further covenants that in the performance of this Agreement, no person having any such interest shall knowingly are employed by the CONTRACTOR. No member of or delegate to the Congress of the United States shall be admitted to any share or part of this Agreement or to any benefits arising therefrom. 4.14 PATENT RIGHTS; COPYRIGHTS; CONFIDENTIAL FINDINGS Any patentable result arising out of this Agreement, as well as all information, specifications, processes,data and findings, shall be made available to the City for public use. No reports,other documents, articles or devices produced in whole or in part under this Agreement shall be the subject of any application for copyright or patent by or on behalf of the CONTRACTOR or its employees or sub-contractors, without the prior written consent of the City. 4.15 NOTICES All notices and communications in writing required or permitted hereunder may be delivered personally to the representatives of the CONTRACTOR and the City listed below or may be mailed by registered mail, postage prepaid (or airmailed if addressed to an address outside of the city of dispatch). Until changed by notice in writing, all such notices and communications shall be addressed as follows: 8 I TO CONTRACTOR: Dock & Marine Construction, Inc. Attn: Glen Larson, Vice President 752 NE 79th Street Miami, Florida 33138 Phone: (305)-751-9911 Fax: (305) 751-4825 E-mail: glarson(D_dockand marine.net TO CITY: City of Miami Beach City Hall Attn: Eric Carpenter, Public Works Director 1700 Convention Center Drive, 4th Floor Miami Beach, Florida 33139 With copies to: City of Miami Beach City Hall Attn: Alex Denis, Procurement Director 1700 Convention Center Drive, 3rd Floor Miami Beach, Florida 33139 Notices hereunder shall be effective: If delivered personally, on delivery; if mailed to an address in the city of dispatch, on the day following the date mailed; and if mailed to an address outside the city of dispatch on the seventh day following the date mailed. 4.16 LITIGATION JURISDICTION/VENUE This Agreement 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 AGREEMENT,THE CONTRACTOR AND CITY EXPRESSLY WAIVE ANY RIGHTS EITHER PARTY MAY HAVE TO A TRIAL BY JURY OF ANY CIVIL LITIGATION RELATED TO, OR ARISING OUT OF, THIS AGREEMENT. 4.17 ENTIRETY OF AGREEMENT This Agreement and all Attachments hereto including without limitation, Request for Qualifications(RFQ)No.41-11/12,together with all amendments thereto,and CONTRACTOR's Proposal in response to the RFQ (the Proposal Documents), shall embody the entire Agreement and understanding between the parties hereto, and there are no other agreements and understandings, oral or written with reference to the subject matter hereof that are not merged herein and superceded hereby. Request for Qualifications No.41-11/12,together with all amendments thereto, and CONTRACTOR's Proposal in response are hereby incorporated by reference into this Agreement as Attachment"E"hereto; provided, however,that in the event of an expense conflict between that Proposal documents and this Agreement, the Agreement shall prevail. 4.18 LIMITATION OF CITY'S LIABILITY The City desires to enter into this Agreement only if in so doing the City can place a limit on the City's liability for any cause of action for money damages due to an alleged breach by the City of this Agreement, so that its liability for any such breach never exceeds the sum of$1,000. CONTRACTOR hereby expresses its willingness to enter into this Agreement with CONTRACTOR recovery from the City for any damage action for breach of contract to be 9 limited to a maximum amount of$1,000. Accordingly, and notwithstanding any other term or condition of this Agreement, CONTRACTOR hereby agrees that the City shall not be liable to the CONTRACTOR for damages in an amount in excess of$1,000 for any action or claim for breach of contract arising out of the performance or non-performance of any obligations imposed upon the City by this Agreement. Nothing contained in this paragraph or elsewhere in this Agreement is in any way intended to be a waiver of the limitation placed upon the City's liability as set forth in Section 768.28, Florida Statutes. 4.19 COMPLIANCE WITH APPLICABLE LAWS The CONTRACTOR, its sub-contractors, agents and employees, including without limitation,any and all temporary personnel assigned to the City pursuant to this Agreement,shall comply with all applicable Federal, State, Miami-Dade County and City Laws, and with all applicable rules and regulations promulgated by local, state and national boards, bureau and agencies as they relate to the Agreement and /or the provision of services hereto. 4.20 CONTRACTOR'S COMPLIANCE WITH FLORIDA PUBLIC RECORDS LAW Pursuant to Section 119.0701 of the Florida Statutes, if the Contractor meets the definition of "Contractor" as defined in Section 119.0701(1)(a), the Contractor shall: a) Keep and maintain public records that ordinarily and necessarily would be required by the public agency in order to perform the service; b) Provide the public with access to public records on the same terms and conditions that the public agency would provide the records and at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law; c) Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law; and d) Meet all requirements for retaining public records and transfer to the City,at no City cost, all public records created, received, maintained and/or directly related to the performance of this Agreement that are in possession of the Contractor upon termination of this Agreement. Upon termination of this Agreement, the Contractor shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. All records stored electronically must be provided to the City in a format that is compatible with the information technology systems of the City. For purposes of this Article, the term"public records"shall mean all documents, papers, letters, maps, books, tapes, photographs, films, sound recordings, data processing software, or other material, regardless of the physical form, characteristics, or means of transmission, made or received pursuant to law or ordinance or in connection with the transaction of official business of the City. Contractor's failure to comply with the public records disclosure requirement set forth in Section 119.0701 of the Florida Statutes shall be a breach of this Agreement. In the event the Contractor does not comply with the public records disclosure requirement set forth in Section 119.0701 of the Florida Statutes,the City may, at the City's sole discretion, avail itself of the remedies set forth under this Agreement and available at law. 10 ASSIGNMENT/ROAD MAP When a need for the Services is identified by the City, the requesting City Department shall contact all prequalified contractors, including CONTRACTOR,to provide quotes on the work or services required. CONTRACTOR is required to visit the site; provide fixed price per vessel; submit the number of days required to perform the removal of the vessel; and the start date. The quote must be all inclusive(removal to disposal)to include every task to be completed for each vessel in accordance to FEMA or other applicable requirements. If CONTRACTOR's quote is accepted by the City,which acceptance shall be in the City's sole discretion and judgment,then a Work Order will be released to CONTRACTOR. Failure to respond, either by not submitting a proposal in three (3) attempts, may result in your company being removed from the City's bid list. 11 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by their appropriate officials, as of the date first entered above. FOR CITY: CITY OF MIAMI BEACH, FLORIDA ATTEST: r By: R PaelGranlado., City Clerk Phi, p ; Mayor Date � ......... ..-�� ate :INCORP ORATED: FOR CONTRACTOR: --� • ,��{ ,,? <:�,-- CK & MARINE CONSTRUCTION, ATTEST: By: o"Z5Z2 Secl(e Plll ry President 'N h UZ � e � � ® Print Warne Print Name 1\ 11 k\ I 1�-I W Date Date APPROVED AS TO FORM & LANGUAGE F:\PURC\$ALL\PAMELA\RFQ\RFQ 41-11-12 Removal&Disposal of Derelict Vessel sWgreeMP c'k�A'N MKTA%fuction.doc City Attor. y Date 12 Exhibits: Attachment "A" — Work Order Attachment "B" — Insurance Requirements Attachment "C" —The City's Living Wage Ordinance Attachment"D"—Request for Qualifications No. 41-11/12,Addendum No. 1 thereto, and Contractor's response to the RFQ. 14 I MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov PROCUREMENT DEPARTMENT WORK ORDER Tel: 305-673-7490, Fax: 786-394-4010 "ATTACHMENT A" Date: Work Order Number: TO: Dock and Marine Construction, Inc. Attn: Glen Larson 752 ME/ 79th Street Miami, Florida 33138 (305) 751-9911 Pursuant to the Agreement between the City of Miami Beach and the above named firm for REMOVAL AND DISPOSAL OF DERELICT VESSEL SERVICES PURSUANT RFQ-41-11/12 (the Agreement), you are directed to provide the following: SCOPE OF SERVICES: (Attach additional pages if needed) ATTACHMENTS TO THIS WORK ORDER: METHOD OF COMPENSATION: [ ] drawings/plans/specifications [ ] fixed fee basis [ ] scope of services [ ] time basis not-to-exceed [ ] special conditions [ ] time basis-limitation of funds TIME FOR COMPLETION: The services to be provided by the CONTRACTOR shall commence upon execution of this Work Order by the parties Effective Date and shall be completed within of the Effective Date. Failure to meet the completion date may be grounds for Termination of the Agreement. Work Order Amount DOLLARS($ ) Reimbursable Expense Allowance: (If Applicable) $ City's Project Coordinator Contractor's Representative 15 . MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov PROCUREMENT DEPARTMENT INSURANCE REQUIREMENTS Tel: 305-673-7490,Fax: 786-394-4010 "ATTACHMENT "B" INSURANCE REQUIREMENTS The Provider shall furnish to the Department of Procurement, City of Miami Beach, 1700 Convention Center Drive, 3rd Floor, Miami, Florida 33139, Certificate(s) of Insurance which indicate that insurance coverage has been obtained which meets the requirements as outlined below: A. Worker's Compensation Insurance for all employees of the vendor as required by Florida Statute 440. B. Commercial General Liability Insurance on a comprehensive basis, including Personal Injury Liability, Products/Completed Operations, in an amount not less than $1,000,000 combined single limit per occurrence for bodily injury and property damage. City of Miami Beach must be shown as an additional insured with respect to this coverage. C. Automobile Liability Insurance covering all owned, non-owned and hired vehicles used in connection with the work, in an amount not less than $1,000,000 combined single limit per occurrence for bodily injury and property damage. All insurance policies required above shall be issued by companies authorized to do business under the laws of the State of Florida, with the following qualifications: The company must be rated no less than"B"as to management,and no less than "Class V"as to financial strength, by the latest edition of Best's Insurance Guide, published by A.M. Best Company, Oldwick, New Jersey, or its equivalent, subject to the approval of the City Risk Management Division. or The company must hold a valid Florida Certificate of Authority as shown in the latest"List of All Insurance Companies Authorized or Approved to Do Business in Florida" issued by the State of Florida Department of Insurance and are members of the Florida Guaranty Fund. Certificates will indicate no modification or change in insurance shall be made without thirty(30) days in advance notice to the certificate holder. CERTIFICATE HOLDER MUST READ: CITY OF MIAMI BEACH 1700 CONVENTION CENTER DRIVE 3RD FLOOR MIAMI BEACAH, FL 33139 Compliance with the foregoing requirements shall not relieve the vendor of his liability and obligation under this section or under any other section of this agreement. (Please attach a copy of the insurance certificate) 16 Attachment "C" City's Living Wage Ordinance 17 Attachment "D" Request for Qualifications No. 41-11/12, Addendum No. 1 thereto, and Contractor's response to the Proposal. 18 PROPOSER INFORMATION I Submitted by: Proposer(Entity): J 1�C.. �' a Signature: % l�r `'Unf Name(Printed): Address: 775a V'\.P '7 9 a"`,a�V City/State: ( C� �a Telephone: 2 Fax: E-mail: C Ack �(s r\A- N.\q i'``\r\ A Q—A- . Federal ID# - n \ :75LA 1 It is understood and agreed by Proposer that the City reserves the right to reject any and 'I all Proposals, to make awards on all items or any items according to the best interest of the City, and to waive any irregularities in the RFQ or in the Proposals received as a result of the RFQ. It is also understood and agreed by the Proposer that by submitting a proposal, Proposer shall be deemed to understand and agree than no property interest or legal right of any kind shall be created at any time until and unless a contract has been agreed to and signed by both artles. For Proposer: (Authorized Signature) (Date) (Printed Name) L I i 1 d I i 5/15/2012 City of Miami Beach RFQ No:41-11!12 y Removal$Disposal Derelict Vessels t 20034 t i REQUEST FOR PROPOSALS NO. 41-11112 ACKNOWLEDGMENT OF ADDENDA Directions: Complete Part I or Part 11,whichever applies. Part I: Listed_below are the dates of issue for each Addendum received in connection with this RFQ. Addendum No. 1, Dated r , C�I rC Addendum No. 2, Dated Addendum No. 3, Dated Addendum No. 4, Dated Addendum No. 5, Dated i Part II: No Addendum was received in connection with this RFQ. Verified with Procurement staff Name of staff Date C-) � r t� t=�sk ��) �i� Proposer-Name Date -� Signature j {r 1 5/15/2012 I City of Miami Beach RFQ No:41-11/12 Removal&Disposal Derelict Vessels 21 of 34 DECLARATION TO; City of Miami Beach City Hall 1700 Convention Center Drive Procurement Division Miami Beach, Florida 33139 Submitted this— --day of * 2012. The undersigned, as Proposer, declares that the only persons interested in this Proposal are named herein; that no other person has any interest in this responses or in the contract to which this response pertains; that this response is made without connection or arrangement with any other person; and that this response is in every respect fair and made in good faith, without collusion or fraud. The Proposer agrees if this response is accepted, to execute an appropriate City of Miami iBeach document(s)for the purpose of establishing a formal contractual relationship between the Proposer and the City,for the performance of all requirements to which the response pertains. The Proposer states that the response is based upon the documents identified by the following number: RFQ No. 41-11/12. WITNESS PROPOSER SIGNATURE PRINTED NAME PRINTED NAME r &racrtinj-YO WITNESS TITLE q I E-6nj PRINTED NAM j i i d 9 1 1 City of M ami Beach RFQ No;44-11112 Removal&Disposal Derelict Vessels ; 22 of 34 SWORN STATEMENT UNDER SECTION 287.133(3)(a), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS. 1. This sworn statement is submitted to _ _0 M X(`*r,�y� (?,_�C.n, [print name of public entity] r by 2n Lac.5a C--N [print individual's name and title] for C�.tC [print name of entity submitting sworn statement] Whose business address is 7�S Q L. And (if applicable) its Federal Employer Identification Number(FEIN) is -A—0q 27'A (if the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement) I understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any business with any public entity or with an agency or political subdivision of any other state or of the United States, including, but not limited to, any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. understand that "convicted" or "conviction" as defined in Paragraph 287.133(1)(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, '1989, as a result of a jury verdict; nonjury trial, or entry of a plea of guilty or polo contendere, understand that an "affiliate" as defined in Paragraph 287.133 (1)(a), Florida Statutes, means: i 1) A predecessor or successor of a person convicted of a public entity crime; or 2) An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. { The term "affiliate" includes those officers, directors, executives, partners, i shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person Who has been convicted I 5/15/2012 City of Miami Beach RFQ No:41-11/12 Removal&Disposal Dorollat Veesels 23 of 34 i of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. understand that a "person"as defined in Paragraph 287.133(1)(e), Florida Statutes means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. [indicate which statement applies.] Neither the entity submitting this sworn statement,'nor any officers, directors,executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members or agents who are active in management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by the hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list. [attach a copy of the final order] I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 i OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTE$ FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED , IN THIS FORM. r ignature] Sworn to and subscribed before me this day of unc- L f 2012 y Personal) kInown r FOR, roduced ide tifiBation 4 Notary Public-State of r My commission expires (Ty a of Identification} (Printed typed or stamped Commissioned name of Notary Public) RENEE ESPINOSA z; *' Fly COMMISSION#EE 189948 ' o; EXPIRES;July 14,2016 6/15/2012 ' ,p�;;�;,`' Bonded Thru Notary Public Undo wfters City of Miami Beach RFQ No;41-11/12 Removal&Disposal Derelict Vessels 24 of 34 QUESTIONNAIRE Proposer's Name: -- Principal Office Address: s�:5 _ -7 Official Representative: Individual Partnership (Circle One) �Cor oration Joint Venture If a Corporation,answer this; When Incorporated: In what State: If a Foreign Corporation: Date of Registration with Florida Secretary of State: Name of Resident Agent: i Address of Resident Agent: 0 I President's Name: Vice-President's Name: T'reasurer's Name: � l i 1 i 6/15/2012 City of Miami Beach RFQ No:41-11!12 Removal&Disposal Derelict Vessels 25 of 34 Questionnaire(continued) Members of Board of Director: If a Partnership: Date of organization: General or Limited Partnership*: Name and Address of Each Partner: NAME ADDRESS *Designate general partners in a Limited Partnership 1. Number of years of relevant experience In operating same or similar business: Z. Have any agreements held by Proposer for a project ever been canceled? Yes ( ) N o (1) - I If yes,give details on a separate sheet. ; 3. Has the Proposer or any principals of the applicant organization failed to qualify as a responsible Bidder/Proposer; or refused to enter into a contract after an award has been made; or failed to complete a contract during the past five (b) ' years; or been declared to be in default In any contract in the past 5 years? If yes, please explain: 1 .I y I :i i �l 5/15/2012 I� City of Had Beach RFQ No:41-11112 Removal&Disposal Derellct Vessels y 26 of 34 Questionnaire(continued) 4. Has the Proposer or any of its principals ever been declared bankrupt or reorganized under Chapter 11 or put into receivers hip?Yes ( ) No If yes, give date, court jurisdiction, action taken, and any other explanation deemed necessary on a separate sheet. S. Person or persons interested In this RFQ have ( ) have not (-,4) been convicted by a Federal, State, County, or Municipal Court of any violation of law, other than traffic violations. To include stockholders over ten percent (10%). (Strike out inappropriate words) Explain any convictions: 6. Lawsuits (any) pending or completed involving the corporation, partnership or individuals with more than ten percent(10%) interest: I A. List all pending lawsuits: B. List all judgments from lawsuits in the last five(5)years: C. List any criminal violations and/or convictions of the Proposer and/or any of its principals: L ��� V 7. Conflicts of Interest. The following relationships are the only potential, actual, or perceived conflicts of interest in connection with this Proposal: (if none, j state same.) i d4 I I I� 5/15/2012 City of Miami Beach RFQ No;41-11/12 Removal&Disposal Derelict Vessels 27 of 34 Questionnaire(continued) I 6. Public Disclosure. In order to determine whether the members of the Evaluation Committee for this Request for Qualifications have any association or relationships which would constitute a conflict of Interest, either actual or perceived, with any Proposer, and/or individuals and entities comprising or representing such Proposer, and in an attempt to ensure full and complete disclosure regarding this RFQ, all Proposers are required to disclose all persons and entities who may be Involved with this Proposal. This list shall include, without limitation, public relation firms, lawyers, and lobbyists. The Procurement Division shall be notified, in writing, if any person or entity is added to this list after receipt of Proposals. 9. Are there any pending discussions relative to mergers, acquisitions, partnerships, or assignment of contract? 10. Is the business entity a Miami Beach based Vendor? Yes ( ) No (L,)- If Yes, please submit a copy of a Business Tau Receipt issued by the City of Miami ' Beach, or documentation to demonstrate that the headquarters Is in the City of Miami Beach, or documentation which proves that goods and/or contractual services are being produced or performed, as appropriate, in the City of Miami Beach. 11. Is the business entity owned by a certified service-disabled veteran, and or a small business owned and controlled by veterans, as defined on Section 602 of the Veteran Benefit Health, and Information Technology Act of 2006, and cited in the Database of Veteran-owned Business? Yes ( ) No 1 6/16/2012 City of Miami Beach RFQ No;41-11/12 Removal&Disposal Derelict Vessels 28 of 34 Questionnaire (continued) The Proposer understands that information contained In this Questionnaire will be relied upon by the City in evaluating and making an award pursuant to the RFQ, and such information is warranted by the Proposer to be true and accurate. In the event that the City, in its sole discretion, deems necessary, the Proposer agrees to furnish such additional information, relating to the qualifications of the Proposer, as may be required by the City. The Proposer further understands that the information contained in this Questionnaire may be confirmed through a background investigation conducted by the City, conducted either through the Miami Beach Police Department or by a third party retained by the City for such purposes. By submitting this Questionnaire the Proposer hereby agrees to cooperate with this investigation including, but not limited to,fingerprinting and providing information for a credit check. PROPOSER WITNESS: IF INDIVIDUAL: Signature Signature Print Name Print Name WITNESS: IF PARTNERSHIP: Signature Print Name of Successful Proposer Print Name Address By: General Partner I Print Name ATTEST: IF CORPORATION: lic- Secr a Print Name of Corporation Print N -me Address By: Z C" President (CORPORATE SEAL.) � Print Name 1 5/15/2012 City of Miami Heach RFQ No:41-11/12 Removal&Disposal Derellct Vessels 29 of 34 I ACKNOWLEDGMENT LETTER . Proposers shall incorporate in their Proposal the following letter and Disclosure and Disclaimer attachment on the Proposer's letterhead stationary: RE: RFQ NO. 41-11/12 FOR THE REMOVAL AND DISPOSAL OF DERELICT VESSELS Dear Sir or Madame: I have read the City of Miami Beach's RFQ NO. 41-11/12 For the Removal and Disposal of Derelict Vessels. On behalf of our Proposal team, we agree to and accept the terms, specific limitations, and conditions expressed therein. In addition, we have read, rely upon, acknowledge, and accept the City's Disclosure and Disclaimer which is attached hereto and is -fully incorporated into this letter. Sincerely, -(S I 6_1-C\- C)CS cii V [NAME AND TITLE] "b C)C aL a-=C \cv C- [ORGANIZATION] [PROPOSER'S NAME] ti 1 .l 6/15/2012 City of Miami Beach RFQ No:41-11/12 Removal&Disposal Derelict Vessels 30 of 34 DISCLOSURE AND DISCLAIMER This Request for Qualifications ("RFQ") is being furnished to the recipient by the City of Miami Beach (the "City") for the recipient's convenience. Any action taken by the City in response to Proposals made pursuant to this RFQ, or in making any award, or in failing or refusing to make any award pursuant to such Proposals, or in cancelling awards, or in withdrawing or cancelling this RFQ, either before or after issuance of an award, shall be without any liability or obligation on the part of the City. In its sole discretion, the City may withdraw the RFQ either before or after receiving proposals, may accept or reject proposals, and may accept proposals which deviate from the RFQ, as it deems appropriate and in its best interest. In its sole discretion, the City may determine the qualifications and acceptability of any party or parties submitting Proposals in response to this RFQ. Following submission of a Proposal, the applicant agrees to deliver such further details, information and assurances, including financial and disclosure data, relating to the Proposal and the applicant including, without limitation, the applicant's affiliates, officers, directors, shareholders, partners and employees, as requested by the City in its discretion. The information contained herein is provided solely for the convenience of prospective Proposers. It is the responsibility of the recipient to assure itself that information contained herein is accurate and complete. The City does not provide any assurances as to the accuracy of any information in I this RFQ. Any reliance on these contents, or on any permitted communications with City officials, shall be at the recipient's own risk. Proposers should rely exclusively on their own investigations, interpretations, and analyses. The RFQ is being provided by the City without any warranty or representation, express or implied, as to its content, its accuracy, or its completeness. No warranty or representation is made by the City or its agents that any Proposal conforming to these requirements will be selected for consideration, negotiation, or approval. The City shall have no obligation or liability with respect to this RFQ, the selection and the award process, or whether any award will be made. Any recipient of this RFQ who responds hereto fully acknowledges all the provisions of this Disclosure and Disclaimer, is totally relying on this Disclosure and Disclaimer, and agrees to be bound by the terms hereof. Any Proposals submitted j to the City pursuant to this RFQ are submitted at the sole risk and responsibility of the party submitting such Proposal. This RFQ is made subject to correction of errors, omissions, or withdrawal from the market without : notice. Information is for guidance only, and does not constitute all or any part of an agreement. J I I The City and all Proposers will be bound only as, if and when a Proposal (or Proposals), as same may be modified, and the applicable definitive agreements pertaining thereto, are approved and executed by the parties, and then only pursuant to the terms of the definitive agreements executed among the parties. Any response to this RFQ may be accepted or rejected by the City for any reason, or for no reason,without any resultant liability to the City. j The City is governed by the Government-'in-the-Sunshine Law, and all Proposals and supporting i documents shall be subject to disclosure as required by such law. All Proposals shall be submitted in sealed bid form and shall remain confidential to the extent permitted by Florida Statutes, until the date and time selected for opening the responses.At that time, all documents received by the City shall become public records. h City o Miami RFQ No:0-11/12 City of Beach Removal&Disposal Derelict Vessels 31 of 34 Proposers are expected to make all disclosures and declarations as requested in this RFQ. By submission of a Proposal, the Proposer acknowledges and agrees that the City has the right to make any inquiry or investigation it deems appropriate to substantiate or supplement information contained in the Proposal, and authorizes the release to the City-of any and all information sought in such inquiry or investigation. Each Proposer certifies that the information contained in the Proposal is true, accurate and complete,to the best of its knowledge, information, and belief. Notwithstanding the foregoing or anything contained in the RFQ, all Proposers agree that in the event of a final unappealable judgment by a court of competent jurisdiction which imposes on the City any liability arising out of this RFQ, or any response thereto, or any action or inaction by the City with respect thereto, such liability shall be limited to $10,000.00 as agreed-upon and liquidated damages. The previous sentence, however, shall not be construed to circumvent any of the other provisions of this Disclosure and Disclaimer which imposes no liability on the City. In the event of any differences In language between this Disclosure and Disclaimer and the balance of the RFQ, it is understood that the provisions of this Disclosure and Disclaimer shall always govern. The RFQ and any disputes arising from the RFQ shall be governed by and construed in accordance with the laws of the State of Florida. ACCEPTED; [NAME AND TITLE] [ORGANIZATION] - ROPOSER'S NAME] i i I i i ,I i i i Y q� 1 51151212 City of Miami Beach RFQ No:41-11112 Removal&Disposal Derelict Vessels 32 of 34 k 752 C MARINE C®NSTRUCTI®N CORPORATI®N N.E. 79th Street a Miami, Florida 33138 m(305) 751-9911 o Fax (305)751-4825 City of Miami Beach Procurement Division 1700 Convention Center Drive Miami Beach,FL 33139 r RE:RFQ.41-11/12 For the Removal and Disposal of Derelict.Vessels. Subject: Introduction Letter Dock and Marine Construction Corp. Is a family owned operatlon and have been in business for 50 years. We have a waterfront location on 79th Street where we have been since we originated.We are fully licensed,bonded and insured. We have extensive experience;we have completed successful contracts with Dade County DERM,City of Miami,City of Miami Beach and private removal and disposal of derelict vessels.We have four operating barges and cranes with full crew. In addition we have working relationship with the environmental agencies, Marine Patrol division specializing in the removal of derelict vessels and the Fish and Wildlife Commission. We were pre-approved by the City of Miami I Beach in past years as a contractor for the Seawall rehabilitation project(This project was abandon due j t to lack of funding)and past derelict vessel removal contracts. We were the marine contractor that provided the in water support for the HDD Company that completed the Venetian crossing project with , FPL.We look forward to finalizing a working relationship with the City of Miami Beach and assisting in the removal of your derelict vessels. J I a 1 LICENSED&INSURED 0 uuCK AND MARINECONSTRUCTION CORPORATION 752 N.E. 79th Street o Miami, Florida 33138 e (305) 751-9911 Fax (305) 751-4825 City of Miami Beach Procurement Division 1700 Convention Center Drive Miami Beach, FL 33139 RE: RFQ.41-11/12 For the Removal and Disposal of Derelict Vessels. Subject: Listing of Relevant Equipment f 1. 2-Link Belt 1086 Cranes 2. Link Belt 98 Crane 3. Link Belt 98a Crane 4. Bycerus Erie 22b Crane 5. 2-37'Bertram tugs 6. 4-32'Custom tugs i 7. 2-30'x80'steel crane spud barges 8. 2 24'x70'steel crane spud barges 9. 2 16'X45'steel spud materials barges 10. 6000 pound capacity Caterpillar forklift 11. 2- Bobcat 450s 12. 4-F250 ford trucks 13. 3-lzuzu NPR trucks a 14. 2-Hydraulic 14 ton Rough Terrain Cranes I LICENSED& INSURED 752 NE 79th Street Mlaml,FL 305-310-5288 glarson @dockandmadne.net I OF IN L a IS'Um In ®bjeCtiue Provide information for Miami Beach Bid EXPOHOnCe 1989-Current Dock and Marine Construction Miami, FL Vice President ® Supervise all job sites Quote jobs Operate barge,crane,tug,on the job experience Diver, salvage, rescue, captain,firefighting, mechanical skills ■ Derelict Vessel Removal for Dade County, DERM and DEP g Engineering experience a Family run business established in the late 40's EdUCO[10111! 1993-2000 FIU Miami, FL Business Administration f intereStS Fishing,boating,diving,fine carpentry, restoring muscle cars, Relereum References are available on request. i I i I i I I I r I 2731 Ocean Club Blvd Hollywood,Fl traN MauK MOON Miami Beach Derelict Vessel Bid ExpersBltee 1987-1990 J.B.Garage Door Miami, Fl Installer Installer of overhead garage doors Maintenance ® Demolition and removal of damaged or failing doors 1990-1999 Chanin air Miami,FL AC Mechanic Installer of Air-conditioner units Duct Cleaning Maintenance and removal of units 1999-Current Dock and Marine Construction Miami,Fl Crane t Barge Operator Pile Driving Build Docks and seawalls g Removal of Derelict Vessels Read plans EdUCat[@U 1987 North Miami High N Miami High School Dip181118 1I11tereSIS Licensed captain 200 Ton neferenceS References are available on request. i I a E I I 1 a I I 7985 NW 31d Place Ft Lauderdale 33063 305-335-5838 0DIBUIVO Miami Beach Bid Enerience 1980-1999 Dock and Marine Construction Miami,FL Crane/Barge operator Pile Driver Build docks and seawalls Derelict Vessel Removal ® Diving i 1999-2001 Steel Fabricators Ft Lauderdale Iron Fitter Machine Operators Welding Plans and drawings 2001-Current Dock and Marine Construction Miami,Fl Crane/Barge operator Pile Driver Build Docks and seawalls ® Diving Education 1980 N Miami High N Miami,FL Wlgh School Diploma Licensed Capitan 200 ton(pending) 11110reStS Fishing,Boating,and Diving Ref ereIICeS References are available on request. 1 l A I d 1 269 NE 158th Street Wad,FL 786-514-1931 Denim Havildlull 0 bl e c tive Miami Beach Derelict Vessel Bid Experience 1992-1996 Fantastic Botanical Gardens Miami, FL Landscaper Landscape Design ® Operate Machinery such as bobcat,back ho,forklift Planting Plants 1996-2001 City of North Miami Miami, FI Maintenance supervisor ® Oversee maintance crews ® Heavy Equipment Operator 1 Current Dock and Marine Construction Miami,FI i Crane/Barge Opertor Build Docks and Seawalls Pile Driving ® Read Plans Operate Crane and Barge MUNN 1993 Indian River Community Collage Fort Pierce,Fl AA In Landscaping Desl9n IntereStS Boating,Diving References References are available on request. ,I i i J Bank of America Bank of America Customer Service&Support P.O.Box 25118 Tampa,FL 33622 May 20,2012 DOCI{&MARINE CONSTRUCTION INC f 752 NE 79TH ST MIAMI FL 33138-4712 Re: City of Miami Beach To DOCK&MARINE CONSTRUCTION INC; Thank you for your recent request for information regarding the status of your deposit accounts at Bank of America,N.A. Our records indicate the following status on your account(s): TYPE OF ACCOUNT CURRENT AVERAGE DATE ACCOUNT NUMBER BALANCE BALANCE OPENED CHECKING XXXXX 6737 $319,037.13 $181,718.92 1/1/1961 SAVINGS XXXXX 6078 $21,877.70 $21,867.50 3/1/1988 CHECKING XXXXX 6746 $5,002.37 $4,766.92 1/1/1970 Average balance information for accounts,if reported,is based on the previous twelve months. Average balance information is not available for time deposit accounts. We trust that this confidential information will be of assistance to you. Sincerely, Bank of America Customer Service&Support 1.800.862.1111 -Model Ref:NS242232 Our response is commensurate with the purpose and amount of your inquiry, The information provided is strictly confidential and intended for use solely by the requesting party and in reliance on your statement of intended purpose or use. The information is furnished as a matter of ! courtesy without a duty to do so and without responsibility,liability or warranty,express or implied,on the part of Batik of America to you or any third party. Liformation is obtained from electronic data sources,which may not contain all information in Bank of America's possession. Information is not guaranteed to be accurate and may be a matter of opinion. We do not accept any responsibility for errors,omissions or alterations after delivery. The information is constantly changing and therefore subject to change without notice, Bank of America will not update this response finless another written inquiry is received. This information applies to the name of the subject of the inquiry as styled in your request and does not include any indirect or related accounts or obligations,unless expressly specified in our response. Bank of America encourages you to contact more than one credit reference prior to making any credit decision. If you received this response by FAX,and you are not the intended recipient or an agent responsible for delivering it to the intended recipient,you are hereby notified that you have received this document in error,and that any review,dissemination,distribution or copying of the information contained in this message is strictly prohibited. If you have received this conununication in error,please notify us immediately by telephone and return the message to us by mail. A 9 i I 3 DOCK AND ARI CONSTRUCTION CORPORATION 752 N.E. 79th Street a Miami, Florida 33138 e(305) 751-9911 o Fax (305) 751-4825 CITY OF MIAMI BEACH Procurement Division 1700 Convention Center Drive Miarni Beach,FL 33139 RE: RFQ.41-11/12 For the Removal and Disposal of Derelict Vessels Subject:References Please find the following list of six similar projects that were successfully completed. ' i 1. Florida Power and Light Contact:John Pugsley j olgsley@ fpl.Coln Description:Various jobs at Port Everglades 2. Dinner Key Marina 3400 Pan American Drive Miami, FL 33133 Contact: Steven Bogner(305)-579-6980 ,�bo�s�.eC C�ci.�niami.fl.us Description: Derelict Vessel Removal and Numerous Concrete Mariana Repairs 3. Dade County DERM Contact:John Ricisak 305-372-6567 Ricif @,tnian dade.goy Description:Derelict Vessel Removal i LICENSED& INSURED DOCK IN CONSTRUCTS®N CORPORATION 752 N.E. 79th Street e Miami, Florida 33138 0 (305) 751-9911 a Fax (305) 751-4825 4. VP Boat Shows - National Marine Manufacturers Association Show Manager - Progressive Insurance Miaini International Boat Show Contact: Caadiy Rick Joule 954,441.3231 954.378.3031 crick-joule Ggati-111-l"I.or Description:Miami International Boat Show 5. Keystone Point Marina 1950 NE 135"'Street N Miami,Fl Contact:Patricia Hamilton(305)-9406236 Description: Concrete Seawall Repair 6. Strictly Sail America Contact:Kevin Murphy Strictly Sail Show Manager (401)-293-5207 kmurphy @nmma.org Description:Miami International Boat Show ri ' J i I I I j I J I i .I J LICENSED& INSURED City of Miami Beach Procurement Division 1700 Convention Center Drive Miami Beach, FL 33139 RE:RFQ.41-11/12 For the Removal and Disposal of Derelict Vessels. Subject:Methodology and Approach Depending on vessel size and type of material we propose the following methods. Small vessels of any type ranging from 10'to 30': Mobilize barge crane tug and crew to site. Care to be taken not to disturb shallow waters,or seagrasses. Barge shall be pinned down with hollow steel spuds to prevent gouging of the bay bottom. Barge shall be a minimum of 24'X70'with a maximum draft of 36" loaded.Barge deck shall be free of holes,shall have deck hatches, barge shall be free of any oils and fuels inside, and shall meet safety requirements acceptable to local standards, Rsi - :'f' 3.:�•r{.'"i� 'C•n>f'+ .:5�`\::..nl�Tl'.:�=:�n.r.. "L.:^ �F}} l - t:.=(Z.'.,'�^•..vp-- `'�::' ':S' ;'v -�.`jt.`t,;".li"'::..;....:Y�.a ']C���tT" .if , •�': Via.- )i:q'-.:•.�'!;::.. ^�":."_s�'-..:-` _ - }' _g _ --,fir`,:-_: ,.�,:;-'..i,-:,.;.,.,.,:.;-°:;� .�t•:�. _ �...'.w.i.:':i°• _ ;i.; <'+"`..:ci'-'+?-'.' -i'..7'%.�..c- :lv-'�.::i�l V'-'lf.r�aJik; S'!. tw v'F,: '.11'`^- "`J,: ,.i. •^,;u �J`i:ley:r_ �1'-5- .,,, f` W j'��� lty r•'tii. it".. - _'�•v.lw1'y.�•"' -- �Yr�&:,,^%Ia; fF _ yM.. :�(, ,. :.y-�`,iy.{�r °i12,tti�r "3r T:�`S^"r.'+''-,,y3'v?':rtii=}xa'r-:&""�.r3''1rd -•�..'�R: �ay •r 'ti '���� is- r:- •sc�:h 4'.,.,4:e�i 4— y�=i?�' - ,�. ''`w:? 4.sS .I '°-r•' .dti8�.. as ) 1• , v 1. J h:' '2i,�`•�' I { s I I I Y Additional equipment included with barge: Minimum 20 ton capacity lattice boom crane.(up to a 40 ton if longer reach is necessary) One tug boat that meets or exceeds USCG requirements minimum of 32'with twin engines,capable of handling barge to be pushed,tug shall have Jones act insurance as required, Tug boat bilge shall be free of oil. II1 2 support boats to deploy curtains and assist in collection of loose debris from tidal waters 1 1 9 1 s ,I • • • • . • bnSS r _ lrf'4*c - - e_r; v ok aix"r2�Y���M'^N 'Y'�C t �t 3R�1�+}��f✓.1.A,��fF(i W �' � ��<.�rt�G!y�r� �W L'!4�1.25eL1 S". x �i rti i ' >•a..��' .y:C�� �'+�� {` `''fir.i� < � ,'r•. C'k.-�2tr5•° y i, t -'r E'r z' "T' f., i `1 as�F,�_ .� ,� x i uri t ,.q�k1 1'fid f� w-•+�w �}+F i ,,.>� 13r- l �. k� . !.r Kr rh Y A� V r�'� 41 e���➢ �`� Ls>����'i' {y � � .:,fi}�•` �'..Y, ���' � fir; ��r'- vs:.y' e� i � a:r.tt ?! �dF _3Y �� : +wr w�j, fr �y .{4r ��1�1,-� ♦ f7 �SFt&y 3 T�+•*7,�y y. �.L,. i �fj, � �Tx �,Y. � �<.� ,�r�':. �tF't.. y L- T�. �tYs4!'c,�'�l`a'r��,ylt�., uE� t�i_t i ♦, � .A�,rrS'ua a+y �'Fyri u''k Y i ♦, �,b"Y"'.1 r s S3 �.'^?5 w„�y e. ��bt 'i$ N' $•,�- +��` '� F.S:���xV,y. .,, y r t S .0 41'„,t, t'?y ri 3 J ar'Y,ir 'ze •' •. -• • • '• • •. • • ••• •/. • we • • • /' • • / • i DATE(MMIDDlYYYY) CERTIFICATE F LIABILITY INSURANCE 0511712012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVE4Y AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE MOLDER. IMPORTANT' If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate-doss not confor rights to the certificate holder In lieu'of such endorsement e, PROPUCER Mitchell, - It&Cooper Marine Insurance c E T Ste hen York 9.44.2 Arthur Ind p s .866-539-7077 kc o: Monticello,KY 42633 DD n. INS RER S AFFORDING COVERAGE NAIC q . INSURERA I Northern Assurance Co. 38389 msumo Dock&Marine Construction,Inc. INSURER a:.Great Amarican.Insurance Cos 963" Dock•&Marine Construction Corporation INSURE 0:�_ 762 NE 79th Street INSUR�1ZO: Miami,FL 33138 wstlReliE: _ _ INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW RAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR.THE POLICY PERIOD INDICATED. .NOTVVITHSTANDING ANY REQUIREMENT,TERM OR CONDITION'OF ANY CONTRACT'01j OTFIER.DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE NWl'BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT'TO ALL THE TERMS, EXCLUSIONS ANR.00"DITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ INSR TypEgp'iNSURANCE DD 9 BR pOLtCYNUNIt3kR MO DD YFF 0 D EXP LIMITS L GENERAL uABIUTY ✓ EACH OCCURRENCE $9000000 r IA ✓ 06 MMEIIQIAL GENERAL LIABILITY P E s Ee o ence $60000- CLAIMS-MADE IT OCCUR MED EXP 060 arson $5000 i -Proteotton&Indemnity NSJH24076 08/13/2011 0811312012 PERSONAL 8,ADV INJURY $10- 00 P&I Includes crew GENERAL AGGREGATE s2000000 GEN'L AGGREGATE LIMIT APPLIES PER! coverage for 9 members PRQDUQTS--COMPIQPAGG ;1000000 POLICY P o' Lac I land Tower's Liability $ AUTOMOBILE 14AMI,j OMBINQ tSIN%E LIMIT ANY A(M BODILY INJURY(Per person) S ALTOS IED SCHEDULED BODILY INJURY(Per soddent)ATOS HIRED AUTOS AUTOSNRJED PPRQPERdenOAMAG $ ✓ uMseELLa unB ✓ OCCUR ✓ OMH 144-19.05 08/13/2011 08/13/2012 EACH OCCURRENCE s 1,000,000 B ExgESs LIA6 CL IMS-MADE AGGREGATE $1,000,000 DED' RETENTION s 10000 S WORKERS COMPENSATION STATU- 0TH- AND EMPLOYERS'LIABILITY Li ER ANY PROPRlgTOPjPAOTNE.R/rXECLJTIVE� NIA R.L.EACH ACCIDENT S OFFICER/MEMBER FXCLUDP01 (Mandatory In NH) E.L.D18EAGE-EA EM m i= 9 �I yy@@s desMbe under ESGtRIPTION OF OPEBAT IONS below I E.L.DISEASE-POLICY LIMIT S. ao DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(Attach ACORD 101,Additional Reinarks Schedule,II'more space Is required) MARINE CONSTRUCTION OPERATIONS .Certificate holder is additlohai Insured for RFQ No.41-11112 of The Removal and:Disposal of Parellct Vessels WaiVer'of StIbrogaUon is provided In favor of Additional Insured. I CERTIFICATE H LDER CANCELLATION City of Miami(leach.Glty Hall $MOULD ANY OF THE-ABOVE DESCRIBED POLICIES BE CANCEL[.ED.BEFORE ProCuremant Divisfon—Third Floor THE EXPIRATION PATE THEREOF, NpTICE WILL BE DELIVERED IN ! 7Qd GoI1V8titlpll�:@Ilit:r Drive ACCORDANCE WITH Ti POLICY pROVISIONIS, Miami Beach,FL 33139 AUTHORIZED REPRESENTATIVE ' /,, r 1 ©1988.2016 AC D CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are reglstered marks of ACO. Produced using Forma Bass web softward.www.Pormsaoss.com;OImpmaatve Publlehing 800-2081077 l A C® DATE(MMIDDfYYYY) CERTIFICATE OF LIABILITY INSURANCE 5/18/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Adriana Duran NSI Insurance Group P °NE (305)556-198II PAC o (305)556-3680 AIL 8181 Northwest 154th Suite 230 A E-MDDRESS:adrianad @naigroup.org PRODUCER 20000854 _ CUSTOMER Miami Lakes FL 33016 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA-Ma fre Ins Co, of Florida 34932 INSURER B:Insurance Cc of State of PA 19429 Doak & Marine Construction, Inc. INSURER'C: 752 NE 79 St INSURER D INSURER E: Miami FL 33138 INSURER F: COVERAGES CERTIFICATE NUMBER:WC/Auto 11-12 REVISION NUMBER: _ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MISR TYPE OF INSURANCE ADDLSUBR POLICY EFF PO ICy EXP LTR S POLICY NUMBER MWDD/YYYY MMIDDIYYYY LIMITS I GENERAL LIABILITY EACH OCCURRENCE $ f i DAMAGE TO RENTED 1 COMMERCIAL GENERAL LIABILITY PR S S a occu rence $ CLAIMS-MADE IJ OCCUR MED EXP(Any ore person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ KEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ i A ALL OWNED AUTOS 4150110004550 7/8/2011 7/8/2012 X BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) a X NONOWNEDAUTOS Non-owned $ 1,000,000 PIP-Basta $ 10,000 � UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ i EXCESS LIAB CLAIMS•MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ : $ B WORKERS COMPENSATION 5867963 WCSTATU- O H- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN S Longshore & Harbour OFFICER/MEMBERMLUDE07 y� N/A E.L.EL EACFIACCIDENT S 1,000 000 (Mandatory In NH) coverage included 0/20/2011 0/20/2012 E.L,DISEASE-EA EMPLOYE $ 11000,000 Ityyes desc��beunder DESGtRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 11000,000 j i I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) i 30 days notice of cancellation except 10 days for nonpayment of premium. RrQ No. 41-11/12 of The Removal and Disposal of Derelict Vessels. i CERTIFICATE HOLDER CANCELLATION , r SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 13EFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Miami Beach City Hall ACCORDANCE WITH THE POLICY PROVISIONS. j Procurement Division - Third Floor 1700 Convention Center Drive AUTHORIZED REPRESENTATIVE Miami Beach, FL 33139 - G Nenezian/ADRIAN " ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. IN S025(200909) The ACORD name and logo are registered marks of ACORD i I I ADDITIONAL COVERAGES Ref# Description Coverage Code f=orm No. Edition Date Uninsured motorist BI split limit UMISP Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 10,000 20,000 Ref# Description Coverage Code Form No. Edition Date HIRED AUTO LIAB HAUTL Limit 1 Llmit 2 Limit 3 Deductible Amount Deductible Type Premium 1,000,000 Ref# Description Coverage Code Form No. Edition Date Drug Free Credit DRUGF Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium -$3,037.00 Ref# Description Coverage Code Form No. Edition Date Expense constant EXCNT Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium ~ $200.00 Ref# Description Coverage Code Form No. Edition Date iExperience Mod Factor 1 EXP01 Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium ti i Ref# Description Coverage Code Form No. Edition Date Premium discount PDIS Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium , -$2,424.00 I Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Rof# Description Coverage Code Form No. Edition Date i Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date y Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium I Ref# Description Coverage Code Form No. Edition Date I Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limlt 2 Limit 3 Deductible Amount Deductible Type Premium i OFADTLCV Copyright 2001,AMS Services,Inc. I r - Form W11111111119 Request for Taxpayer Give Form to the (Rev.December 2011) Identification Number and Certification requester.Do not Department of the Treasury send to the IRS. Internal Revenue Service pda,)(as shown on your income tax return) ncy a ' N(\C- N siness name/disregarded entity name,if different from above m CD ca °- Check appropriate box for federal tax classification: C c ❑ Individual/sole proprietor ❑ C Corporation rporation ❑ Partnership ❑ Trust/estate CL ❑ Limited liability company.Enter the tax classification(C=C cor oration,S=S corporation,P=partnership) 10, E]Exempt payee o ------------------------------- a,, +r C N C CL ❑ Other(see instructions)► ' Address(number,street,and apt.or suite no.) Requester's name and address(optional) CL City,state,and ZIP code Cn List account number(s)h re(optional) Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on the"Name"line Social security number to avoid backup withholding.For individuals,this is your social security number(SSN).However,for a resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other - - entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TIN on page 3. Note.If the account is in more than one name,see the chart on page 4 for guidelines on whose N Employer identification number number to enter. Certification - 1 7 A I&V 4P- Under penalties of perjury,I certify that: 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me),and 2. 1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding,and 3. 1 am a U.S.citizen or other U.S.person(defined below). Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all i erest and dividends on your tax return. r r al estate transactions,item 2 does not apply.For mortgage interest paid,acquisition or abandon nt of secured property,cancellatio f deb;/,contributions to an individual retirement arrangement(IRA),and generally,payments other than intere and dividends,you are not req d to si the certification,but you must provi a your rrect TIN.See the instructions on page 4. Sign Signature of Here U.S.person► Date► //11j- h General Instructio Note.If a requester gives you a for other an Form W-9 to request your TIN,you must use the requester's for if it is substantially similar Section references are to the Internal Revenue Code unless otherwise to this Form W-9. noted. Definition of a U.S.person.For federal tax purposes,you are Purpose of Fora considered a U.S.person if you are: A person who is required to file an information return with the IRS must. °An individual who is a U.S.citizen or U.S.resident alien, obtain your correct taxpayer identification number(TIN)to report,for •A partnership,corporation,company,or association created or example,income paid to you,real estate transactions,mortgage interest organized in the United States or under the laws of the United States, you paid,acquisition or abandonment of secured property,cancellation •An estate(other than a foreign estate),or of debt,or contributions you made to an IRA. Use Form W-9 only if you are a U.S.person(including a resident •A domestic trust(as defined in Regulations section 301.7701-7). alien),to provide your correct TIN to the person requesting it(the Special rules for partnerships.Partnerships that conduct a trade or requester)and,when applicable,to: business in the United States are generally required to pay a withholding tax on any foreign partners'share of income from such business. 1.Certify that the TIN you are giving is correct(or you are waiting for a Further,in certain cases where a Form W-9 has not been received,a number to be issued), partnership is required to presume that a partner is a foreign person, 2.Certify that you are not subject to backup withholding,or and pay the withholding tax.Therefore,if you are a U:S.person that is a 3.Claim exemption from backup withholding if you are a U.S.exempt partner in a partnership conducting a trade or business in the United payee.If applicable,you are also certifying that as a U.S.person,your States,provide Form W-9 to the partnership to establish your U.S. allocable share of any partnership income from a U.S.trade or business status and avoid withholding on yo6r share of partnership income. is not subject to the withholding tax on foreign partners'share of effectively connected income. Cat.No.10231X Form W-9(Rev.12-2011) I