Metro Express RFP # PW 2016-19SCHEDULE
SW 64th Avenue Drainage Improvement Project
RFP P1-
Time*
No
Event
Dates'
T
Advertisement/ Distribution of Solicitation & Cone of Silence
1
begins
8/3/2416
1 1:44 AM
Non-Mandator Pre- F e tin
8/12/2016
10:00 AM
3
Deadline to Submit Questions
8/17/2016
14.44 AM
4
Deadline to City Responses to Questions
8/2212416
14:44 AM
5
Deadline to Submit RFP Response
8126/201
10:00 AM
Projected Announcement of selected Contractor/Cone of Silence
6
ends
9/6/2416
7:44 P
END OF SECTION
Thomas F. Pepe
1211012015
3
INSTRUCTIONS for RESPONDENT
SW 64th Avenue Drainage Improvement Proje t
FP P d -19
~
8. Any questions concerning the Solicitation or any required need for clarification must be made in writing, by 10
13, Lobbying. All firms and their agents who intend to submit, or who submitted, bids or responses for this
i. All respondents, at the time of bid opening, must have fulfilled all pricer obligations and commitments to the
* • x v x
SW 64th Avenue Drainage Improvement Project
The response to this questionnaire shall be utilized as part of the CITY'S overall Proposal Evaluation and
RESPONDENT selection,
I. ,Number of similar projects completed.
) In the past 5 years
In the past 5 years On Schedule
b) In the past 10 years
_
In the past 10 years On Schedule
¢cgµ
2. Gist the last three ( ) completed similar projects.
a) Project Name:
�. �.O '• ? °
Owner Name:
' °
Owner Address:
JCS ) °
Owner Telephone:
t._
'30's-
Original Contract Completion Time
(Days):
Original Contract Completion Gate:
01 1 S
Actual Final Contract Completion
Gate:
Original Contract Price:
C
Actual Final Contract Price:
Q '# O
b) Project Name:
Owner Name:
C t
Owner Address:
iii 't
Owner Telephone.
a ooc
Original Contract Completion Time
B 0
(Days).
Original Contract Completion Cate:
j — 2-ci
Actual Final Contract Completion
Cate:
Original Contract Price:
Actual Final Contract Price
Thomas F. Pepe
12/101 2015
a) Bankruptcy petitions filed by or against the Respondent or any predecessor organizations,
b) Any arbitration or civil or criminal proceedings, or
Suspension of contracts
or debarring from Ridding or Responding by any public agency brought
c) against the Respondent in the last five (S) years
. Government References:
List other Government Agencies or {quasi- Government Agencies for which you have done business
within the past five (5) years.
Name . ofAge�c
t__
c. .
Address:
a
Telephone No.:
� os — -�- �S 3 — 0 1 j
Contact Person:
C
Type of Protect:
,; � �fc"�..4� n
Name of Agency:
Ir �zk
Address:
Telephone Pilo.«
' : - � 0C)
Contact Person;
w�t 1 c tr""1 !
Type of Project:
) { W c a V
Name of Agency:
Address:
-L-
Telephone No.:
- s
Contact Person:
a J � s o c
Type of Project:
Thomas F. Pope
12/1 1 iii
14
LIST OF PROPOSED SUBCONTRACTORS AND PRINCIPAL SUPPLIERS
SW 64th Avenue s •
RFP #` i * w
M �,
DRUG FREE WORKPLACE
ACKNOWLEDGEMENT OF CONFORMANCE WITH OSHA STANDARDS
RELATED PARTY TRANSACTION VERIFICATION
fr, ta�a '. kcg,5c ` "' individually and on behalf of '
( "Firm " ") have plarne of Representative CcampranylVendorll ntity read the City of South Miami (` City ")'s Code of Ethics,
Section 8A -1 of the City's Code of Ordinances and 1 hereby certify, under penalty of perjury that to the best of my
knowledge, information and belief.
(1) neither l nor the Firm have any conflict of interest (as defined in section 8A -1 ) .with regard to the contract or
business that 1, and /or the Firm, am (are) about to perform for, or to transact with, the
City, and
() neither 1 nor any employees, officers„ directors of the Firm, nor anyone who has a financial interest greater
than 5% in the Firm, has any relative(s), as defined in section 8A -1, who is an employee of the City or who is(are)
an appointed or elected official of the City, or who is(are) a member of any public body created by the City
Commission, i.e., a board or committee of the City, [while the ethics code still applies, if the person executing this
form is doing so on behalf of a firm whose stock is publicly traded, the statement in this section () shall be based
stalely on the signatory's personal knowledge and he/she is not required to make an independent investigation as to
the relationship of employees or those who have a financial interest in the Firm.]; and
(3) neither f nor the Firm, nor anyone who has a financial interest greater than 5% in the Firm, nor any member of
those persons' immediate family h.e., spouse, parents, children, breathers and sisters) has transacted or entered
into any contracts) with the City or has a financial interest, direct or indirect, in any business being transacted
with the city, or with any person or agency acting for the city, other than as follows:
(if necessary, use a separate sheet to supply additional information that will not fit on this line however, you
must make reference, on the above line, to the additional sheet and the additional sheet must be signed under
oath). [while the ethics code still applies, if the person executing this form is doing so on behalf of firm whose
stock is publicly traded, the statement in this section (3) shall be based solely on the signatory's personal
knowledge and he/she is not required to make an independent investigation as to the relationship of those who
have a financial interest in the Firm.); and
(4) no elected and/or appointed official or employee of the City of South Miami, or any of their immediate family
members (Le., spouse, parents, children, brothers and sisters) has a financial interest, directly or indirectly, in the
contract between you and/or your Firms and the City other than the following individuals whose interest is set
forth following their names:
(if necessary, use a separate sheet to supply additional information that will not fit on this line; however, you roust
make reference, on the above line, to the additional sheet and the additional sheet must be signed under oath).
The names of all City employees and that of all elected and/or appointed city officials or board members, who
own, directly or indirectly, an interest of five pet -cent (5 %) or more of the total assets of capital stock in the firm
are as follows;
(if necessary, use a separate sheet to supply additional information that will not fit on this line, however, you must
make reference, on the above line, to the additional sheet and the additional sheet must be signed under oath).
[while the ethics aide still applies, if the person executing this form is doing so on behalf of a firm whose ' stock is
publicly traded, the statement in this section (4) shall be based solely on the signatory's personal knowledge and
he/she is not required to make an independent investigation as to the financial interest in the Firm of city
employees, appointed officials or the immediate family members of elected and/or appointed official or employee.)
() 1 and the Firm further agree not to use or attempt to use any knowledge, property or resource which may
carne to us through our position of trust, or through our performance of our duties under the terms of the
contract with the City, to secure a'special privilege, benefit, or exemption for ourselves, or others. We agree that
we may not disclose or use information, not available to members of the general public, for our personal gain or
benefit or for the personal gain or benefit of any tither person or business entity, - outside of the normal gain or
benefit anticipated through the performance of the contract,
();1 and the Firm hereby acknowledge that we have not contracted or transacted any business with the City or
any person or agency acting for the City, and that we have not appeared in representation of any third party
before anyboard, commission or agency of the City within the past two years other than as
Thomas F. Pepe
1211012015
. - Conflict of interest and code of ethics ordinance.
( Designation.
This section shall be designated and known as the "City of South Miami Conflict of Interest and Code of Ethics
Ordinance." This section shall be applicable to all city personnel as defined below; and shall also constitute a
standard of ethical conduct and behavior for all autonomous personnel, quasi - judicial personnel, advisory
personnel and departmental personnel, The provisions of this section shall be applied in a cumulative manner. By
way of example, and not as a limitation, subsections (c) and (d) may be applied to the same contract or transaction.
(b) Definitions. nitions. For the purposes of this section the following definitions shall be effective;
(1) The terra "commission members" shall refer- to the mayor and the members of the city commission.
(2) The term "autonomous personnel" shall refer to the members of autonomous authorities, boards and agencies,
such as the city community redevelopment agency and the health facilities authority.
(3) The terra "quasi - judicial personnel " shall refer- to the members of the planning board, the environmental review
and preservation board, the code enforcement board and such other individuals, boards and
agencies of the city as perform quasi - judicial functions.
() The term "advisory personnel" shall refer to the members of cheese city advisory boards and agencies whose
scale or primary responsibility is to recommend legislation or give advice to the city commission.
( ) The term "departmental personnel" shall refer to the city clerk, the city manager, department heads, the city
attorney, and all assistants to the city clerk, city manager and city attorney, however titled.
() The terra "employees" shall refer to all other- personnel employed by the city.
( ) The term "compensation" shall refer to any money, gift, favor, thing of value or financial benefit conferred„ or
to be conferred, in return for services rendered or to be rendered,
(B) The terra "controlling financial interest" shall refer to ownership, directly or indirectly, of ten percent or more
of the outstanding capital stock in any corporation or a direct or indirect interest of ten percent or more in a firm,
partnership, or other business entity at the time of transacting business with the city,
(9) The term "immediate family " shall refer to the spouse, parents, children, brothers and sisters of the person
involved.
(I0) The term "transact any business " shall refer to the purchase or sale by the city of specific goads or services
for consideration and to submitting a bid„ a proposal in response to a Solicitation, a statement of qualifications in
response to a request by the city, or entering into contract negotiations for the provision
can any goods or services, whichever first occurs.
c Prohibition on transacting business with the city.
No person included in the terms defined in paragraphs (b)(I) through (fa) and in paragraph (b)(9) shall enter into
any contract or transact any business in which that person or a member of the immediate family has a financial
interest,: direct or indirect with the city or any person or agency acting fora the city, and any such contract,
agreement or business engagement enterer[ in violation of this subsection shall render the transaction voidable,
Willful violation of this subsection shall constitute malfeasance in office and shall affect forfeiture of office or
position. Nothing in this subsection shall prohibit or make illegal:
(I) The payment of taxes, special assessments or fees for set-vices provided by the city government,
(2) The purchase of bonds, anticipation notes or other securities that may be issued by the city through
underwriters or directly from time to time...
Waiver of prohibition. The requirements of this subsection may be waived for, a particular transaction only by four
affirmative votes of the city commission after public hearing upon finding that:
(1) An open -to -all sealed competitive proposal has been submitted by a city person as defined in paragraphs (b)(2),
(3) and (4),
(2) The proposal has been submitted by a person or firm offering services within the scope of the practice of
architecture, professional engineering, or registered lanai surveying, as defined by the laws of the state and
pursuant to the provisions of the Consultants' Competitive Negotiation Act., and when the proposal has been
submitted by i city person defined in paragraphs (b)(2), (3) and (4),
(3) The property or services to be involved in the proposed transaction are unique and the city cannot avail itself
of such property or services without entering a transaction which would violate this subsection but for waiver of
its requireiients, and
(4) That the proposed transaction will be in the best interest of the city.
This subsection shall be applicable only to prospective transactions, and the city commission may in no case ratify a
transaction entered in violation of this subsection.
Provisions cumulative, This subsection shall be taken to be cumulative and shall not be construed to amend or repeal
any other law pertaining to the same subject matter.
d Further prohibition on transacting business with the city.
Thomas F. Pepe
1211012015
No person included in the terms defined in paragraphs (b)(1) through (6) and in paragraph (b)(9) shall enter into
any contract or transact any business through a firm, corporation, partnership or business entity in which that
person or any member of the immediate family has a controlling financial interest, direct or indirect, with the city
or any person or agency acting for the city, and any such contract, agreement or business engagement entered in
violation of this subsection shall reader the transaction voidable. The remaining provisions of subsection (c) will
also be applicable to this subsection as though incorporated by recitation.
Additionally, no person included in the terra defined in paragraph (b)(1) shall vote on or participate in any way in
any matter; presented to the city commission if that person has any of the fallowing relationships with any of the
persons or entities which would be or might be directly or indirectly affected by any action of the city commission:
(1) Officer, director, partner" of counsel, consultant, ernployee, fiduciary or beneficiary, or
(2) Stockholder, bondholder, debtor, or creditor, if in any instance the transaction or matter Would affect; the
person defined in paragraph (b)(1) in a mariner distinct from the manner in which it would affect the public
generally. Any person included in the term defined in paragraph (b)(1) who has any of the specified relationships or
who would or might, directly or indirectly, realize a profit by the action of the city commission shall not vote on or
participate in any way in the matter.
( Gifts.
(1) definition, The term "gift." shall refer to the transfer of anything of economic value, whether in the farm of
money, service, loan, travel, entertainment„ hospitality, item or promise„ or in any other- form, without
adequate and lawful consideration.
(2) Exceptions. The provisions of paragraph; (e)(1) shall not apply to;
a. Political contributions specifically authorized by state law,
b. Gifts frorn rel- atives or members of one's household, Unless the person is a conduit on behalf of a third party to
the delivery of a gift that is prohibited under paragraph ();
c. ;Awards for professional or civic: achievement,
d. Material such as books, reports, periodicals or pamphlets which are solely informational or of an advertising
nature,
(d) Prohibitions. A per -son described in paragraphs (b)(1) through (6) shall neither- solicit nor dernand any gift. It is
also unlawful for only person or entity to offer, give or agree to give to any person included in the tears defined in
paragraphs (b)(l) through (6), or for any person included in the terms defined in paragraphs (b)(1) through (6) to
accept or agree to "accept from another person or entity, any gift for or because of:
a. An official public action taken, or to be takers, or which could be taken, or an orris bn or failure to take a public
action;
b. A legal duty performed or to be performed, or which could be pet-formed, or an ornission car- failure to perform
a legal duty;
e. A legal duty violated or to be violated, or which could be violated by any person included in the term defined in
paragraph (b)(1); or
d. Attendance or absence frond a public meeting at which official action is to be taken.
(4) Disclosure. Any person included in the terns defined in paragraphs (b)(1) through ( ) shall disclose any gift, or
series of gifts from anyone person or entity, having a value in excess of $25.00, T he disclosure shall be made by
filing a copy of the disclosure form required by chapter- 112, Florida Statutes, for "local
officers" with the city clerk simultaneously with the filing of the forms with the clerk of the county and with the
Florida Secretary of State.
Compulsory disclosure by employees of firms doing business with the city.
Should any person included in the terms defined in paragraphs (b)(1) through () be ernidoyed by a corporation,
firer, partnership or business entity in which that person or the immediate family does not have a; controlling
financial interest, and should the corporation, firm, partnership or business entity have substantial business
commitments to or from the city or any city agency, or be subject to direct regulation by the city or a city agency,
then the person shall file a sworn stater sent disclosing such employment and interest with the clerk of the city.
(g) Exploitation of official position prohibited.
No person included in the terms defined in paragraphs (b)(1) through (b) shall corruptly use or attempt to use an
official position to secure special privileges or exemptions for that person or others.
( Prohibition on use of corn fidentiol in for atiom
No person included in the terms defined in paragraphs (b)(1) through (6) shall accept employment or engage in ;
any business or professional activity which one might
reasonably expect would require or induce one to disclose confidential information acquired by reason of an
official position, nor shall that person in fact ever disclose confidential information garnered or gained through an
official position with the city, nor shall that person ever use such information, directly or indirectly, for personal
gain or benefit.
Thomas F. (Pepe
1211012015 '
(i) Conflicting employment proh bited.
No person included in the terms defined in paragraphs (b)(1) through (6) shall accept other employment which
world impair independence of judgment in the performance of any public duties.
(j) Prohibition on outside employment,
(I) No person included in the terms defined in paragraphs (b)(b) shall receive any compensation for services as an
officer or employee of the city from any source other than the city, except as may be permitted as follows:
a. Generatly ;prohibited, No full -time city employee shall accept outside employment„ either incidental, occasional or
idle Ise, where city time, equipment or material is to be used or where such employment or any part thereof is
to be performed on cony time.
. When permitted. A full -time city employee may accept incidental occasional outside employment so long as
such employment is not contrary, detrimental or adverse to the interest of the city or any of its departments and
the approval required in subparagraph c, is obtained.
c, Approval of department head required. Any outside employment by any full -time city employee must first be
approved in writing by the employee's department head who shall maintain a complete record of such
employment.
d, Penalty, Any person convicted of violating any provision of this subsection shall be punished as provided in
section I -I I of the node of Miami -lade County and, in addition shall be subject to dismissal by the appointing
authority. the city may also assess against a violator a fine not to exceed $500,00 and the costs of investigation
incurred by the city.
(2) All full -time city; employees engaged in any outside employment for any person, firm, corporation or entity
other than the city, or any of its agencies or instrumentalities, shall file, under oath, an annual report indicating the
source of the outside employment, the nature of the work being done and any amount of money or other
consideration received by the employee from the outside employment. City employee reports shall be filed with
the city clerk, The reports shall be available at a reasonable time and place for inspection by the public. The city
manager may require monthly reports from individual employees or groups of employees for good cause.
(k) Prohibited investments.
No person included in the terms defined in paragraphs (b)(1) through ( ) or a member of the immediate family
shall have personal investments its any enterprise which will create a substantial conflict between private interests
and the public interest.
(l) Certain appearances and payment prohibited,
(1) No per -son included in the terms defined in paragraphs (b)(1), (5) and () shall appear before any city board or
agency and make a presentation on behalf of a china pet-son with respect to any matter, license, contract,
certificate, ruling, decision, opinion rare schedule, franchise, or ocher benefit sought by the third Berson. Nor shah
the person receive any compensation or gift, directly or indirectly, for services rendered to a third person, who
has applied for or is seeking some benefit from the city or a city agency, in connection with the particular benefit
sought by the third person, Nor shall the person appear in any court or before any administrative tribunal as
counselor legal advisor to a party who seeks legal relief from the city or a city agency through the suit in question.
(2) No person included in the terms defined in paragraphs (b)(2)= (3) and (4) shall appear before the city
commission or agency on which the person serves, either directly ;ior through an associate, and make a
presentation on behalf of a third person with respect to any matter, license, contract, certificate, ruling, decision,
opinion, rate schedule, franchise, or other benefit sought by the third person. Nor- shall such person receive any
compensation or gift, directly or indirectly, for services rendered to a third party who has applied for or is seeking
sortie benefit from the city commission or agency on which the person serves in connection with the particular
benefit sought by the third party. Nor shall the person appear in any court or before any administrative tribunal as
counselor legal advisor to a third party who seeks legal relief from the city commission or agency on which such
person serves through the suit in question.
) Actions prohibited when finoncicrl interests involved.
No person included in the terms defined in paragraphs (b)" (1) through (6) shall participate in any official action
directly or indirectly affecting a business in which that person or any mercies° of the immediate family has ;a
financial interest, A financial interest is defined in this subsection to include, but not be limited to, any direct or
indirect interest In any investment, equity, or debt.
(n) Acquiring flnoncial interests.
No person included in the terms defined in paragraphs (b)(1) through (6) shall acquire a financial interest in a
project, business entity or property at a time when the person believes or has reason to believe that the financial
interest may be directly affected by official actions or by official actions by the city or city ; agency of which the
person is an official, officer or employee.
() Recommending ending professions l services.
Thomas F. Pepe
1211012015 "
No person included in the terms defined in paragraphs (b)(1) through (4) may recommend the services of any
lawyer or law firm, architect or architectural firm, public relations fires, or any other person or fine, professional
or otherwise, to assist in any transaction involving the city or any of its agencies, provided that a recommendation
may property be made when required to be made by the duties of
office and in advance at a public meeting attended by other city officials, officers or employees.
() Continuing application after city service.
(1) No person included in the terms defined in paragraphs (b)(1), (5) and (i) shall, for a period of two years after
his or her city service or employment has ceased, lobby any city official [as defined in paragraphs
(b)(1) through (ta) in connection with any judicial or other proceeding, application. Solicitation, RFt ,laid, request
for ruling or other determination, contract, clairn, controversy, charge, accusation, arrest or ocher particular
subject matter in which the city or one of its agencies is a party or has any interest whatever, whether direct or
indirect. Nothing contained in this subsection shall prohibit any individual from submitting a routine administrative
re Uest or application to a city department or agency during the two-year period after his or her service has
ceased.
(2) The provisions of the subsection shall not apply to persons who become employed by governmental entities,
50 1(c)(3) noon - profit entities or educational institutions or entities, and who lobby on behalf of those entities in
their official capacities.
( ) The provisions of this subsection shall apply to all persons described in paragraph (p)(1) whose city service or
employment ceased after the effective date of the ordinance from which this section derives,
(4) No person described in paragraph (p)(1) whose city service or employment ceased within two years prior to
the effective date of this ordinance shall fora per ~iod of two years after his or her service or employment enter
into a lobbying contract to lobby any city official in connection with any subject described in paragraph (p)(1) in
which the city or one of its agencies is a party or has any direct and substantial interest, and in which he or she
participated directly or, indirectly through decisions, approval, disapproval, recommendation, the rendering of
advice, investigation, or otherwise; during his or her city service or employment. A person participated "directly"
where he or she was substandaaly involved in the particular subject matter thrOUgh decision, approval, disapproval,
recommendation, the rendering of advice, investigation, or other ise, during his or her city service or
employment, A person participated "indirectly " where he or she knowingly participated in any way in the particular
subject matter through decision, approval, disapproval, recommendation, the rendering of advice, investigation, or
otherwise, during his or her city service or employment. All persons covered by this paragraph shall execute an
affidavit on a form approved by the city attorney prior to lobbying any city official attesting that the
requirements of this subsection do not preclude the per-son from lobbying city officials.
(S) Any person who violates this subsection shall be subject to the penalties provided in section l A- (p).
(q) City attorney to render opinions on request.
Whenever any person included in the terms defined in paragraphs (b)(1) through (fa) and paragraph (b)(9) is in
doubt as to the proper interpretation or application of this conflict of interest and code of ethics ordinance:, or
whenever any person who renders services to the city is in doubt as to the applicability of the ordinance that
person, may ssibmit to the city attorney a full written statement of the facts and questions. The city attorney shall
then render an opinion to such person and shall publish these opinions w ithosrt use of the name of the person
advised sinless the person permits the use of a name.
NOTICE TO PROCEED
PUBLIC CONSTRUCTION CONTRACT
SW 64th Avenue Drainage Improvement Proje t
p P16 -19
ExHlBlT#I
Attachment "A"
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EXHIBIT 2
SW 64th Avenue Drainage Improvement Project
FP #P W2016-19
Insurance' & Indemnification Requirements
EXHIBIT
CONSTRUCTION T
SW 64th Avenue Drainage Improvement Project
FP P 201 -1
! Y Y R
A
A
b 4
M
to hift
K
Thomas F, Pepe
I l/ 1012015
or when it would not have been issue but for the consideration of Work that is thereafter found to be defective to
2,3.5 The surety company shall hold a current certificate of authority as acceptable surety on federal
other persons and organizations must be submitted as specified in the Contract Documents, Within
function, in the opinion of the CONSULTANT, as the material or product so specified. %Proposed
4.4 The CONTRACTOR shall within forty -eight (48) hours of its discovery, and before such conditions are
6.9 The divisions and sections of the Specifications and the identifications of any Drawings shall not control
all claims of liability and all suits and actions of every name and description that may be brought against
OWNER or CONSULTANT, excluding only those claims that allege that the injUr•ies arose out of the
contractors interfere with the Ct NTRACTt R °s operations, the CONTRACTOR shall notify the
CONSULTANT immediately and in writing. lack of such notice to the CONSULTANT shall be
14, 12.2 the Work necessary to be completed for the purpose of certifying the work as being
I SAA The CITY reserves the right in the event the CONTRACTOR cannot provide an item(s) or service(s) in a
timely manner as requested, to obtain the good and /or services from other sources and deducting the
I T I OWNER and CONTRACTOR knowingly, irrevocably voluntarily and intentionally waive any right either
EXHIBIT 6
Supplementary iti
SW 64th Avenue Drainage Improvement Project
FP P 201 -1
ATTEST:
(President)
Secretary
(Business Address)
(City /State /Gip)
(Business Telephone)
IN THE PRESENCE OF:
INSURANCE COMPANY:
BY: .._.__(SEAL)
(Agent and Attorney -in -fact Signature)
(Business Address)
(City /State /Gip
(Busmess Telephone)
STATE OF FLORIDA
)
COUNTY OF MIAMI -DADS
}
)
On this, the ___ _,_��___ day of _.
Q_, before nee appeared
who is the
(Title), of - (Name of legal entity), a
w (State of
Incorporation) company or partnership, on behalf of the corporation and Who is
personally known by me or who provided me with the following type of identification � LL and Who took
an oath or affirmed that he/she is the person who Signed the foregoing payment bond.
WITNESS my hand and official seal.
Notary Public, Swe of Florida
NOTARY PUBLIC:
SEAL
(Nance of Notary Public: Print,. Stamp
or Type as commissioned,)
*Power of Attorney must be attached.
END OF SECTION
Thomas F. Pepe
1211012015
€4
Getter. Said recommendation shall be sent to the City Manager with a copy sent to the protesting party:
METRO-7
ID; MO
..... -...
CERTIFICATE OF LIABILITY INSURANCE tACTE (MM /DCltYYYY)
09/1112015
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. . TEAS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),
AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
PORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
me terms and conditions of the policy, certain policies may require an endorsement. A statement Can this certificate does not Confer rights to the
certificate holder in lieu of such endorsement s }.
PRODUCER CONTACT'
NAME:
Kahn- Carlin & Company, Inc. FAx PHONE
3350 S. Dixie HIi IfVaa (A /C, No, Ext): (AIC, Na ):
Miami, F 33 1 3?99 E -MAIL
4
Michael A. Bonet ADDRESS:
JNSURER() AFFORDING COVERAGE
NAIC tT
INSURER A. Zurich-Arnerlcan Insurance Co
16535
INSURED Metro Express, Inc. INSURER B American Guarantee & Liala Ins
26241
9442 NW 109th Street
INSURER C: North River insurance Co,
21105
Medley, FL 331713
INSURER D: Bridgefield Employers Iris Co
10701
INSURER E:
ENSURER F ;
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTI Y "CHAT THE POLICIES OF INSURANCE LISTED BELOW HAVER BEEN ISSUED TO THE ENSURED NAMED ABOVE FOR THE
POLICY PERIOD
INDICATED, NOTWITHSTANDIN G 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 AI_L THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
tNSR TYPE OF INSURANCE IAW SGBR ` POLIC IY EFF POLICY E1 XP LlraitTS
LTK _..„... PCdLIY NUCa98ER MMPCSptYYYY Mh4dDOtl*YYY
GENERAL LIABILITY EACH OCCURRENCE $
1,000,000
A coMttLra:t EVE@2ALCIA3[1 €1Y OL.O0184185 -00 09112/2015 0911212016 PR MIS Sr Recurs
_.._ F*REtvitSE:..S£�crcci }rrrce? . E_.
_ 3Q,_
CLAIMS-MADE X OCCUR MED EXP (Any one person} S
10,000
CU Included PERSONAL & ADV INJURY
1,000,000
F'ER PRO J ECT ACORE GENERAT. AcGRL GATE
2,000,000
GEN° €. AGGREGAT E ;_Intl r APPLIES PER" PRODUC I S - COMP OP AEG $
2,000,000
PRO-LOG
C E.tCY
AUTOMOBILE LIABILITY GMB €NED SINGLE LIMIT
Ea accident) 5
1,000,000
ANYALflO BAP 0184184 -00 0911212015 0911212016 BODILY INJURY (Per oersen)
ALL OWNED SCHEDULED ECiC76E_Y lh,JtIRY €kscr accident)
NUN -OWNED PROPERi`z" DAMAC3E_..
H €RED AUr0S AUTOS (PER ACCIDENT,
UMBRELLA L.IAB X OCCUR EACH C?CCt RRENCC 5
3,0 Q,00t�
C EXCESS LIAB CLAIMS -MADE! 581 - 105887 -2 091'1212015 0911212016 AGGREGATE. S
6,000,000
DEC) X RETENTION w 0 $
WORKERS COMPENSATION x WC: STATU- OTH-
AND EMPLOYERS` LIABILITY TT'R i HITS __ ER -
Y t N
D ANY PRUPRIETC3WPA €tTNERIEXECUTIVE 63035368 09122/2015 0912212016 El EACH ACCIDENT S
1,000,000
OFF I€,ERMEMBER EXC LUDEI�i=' � .NIA .. ..
(h9andatory in NH) EL DISEASE" - EA EMPLOYEE E
.:.:,
1,000,000
Ify s, describe under _
DESL.RIP I ION OF OPERATIONS below E L DISEASE - POLICY LIMI E $
1 000 000
DESCRIPTION OF OPERATIONS f LOCATIONS t VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
1
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