HomeMy WebLinkAboutPlaymore West Inc - Bryant Court
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SERVICES AGREEMENT
THIS AGREEMENT made this ~ I~~ay of (1u.5/,tb-1' , 2006, by and between the CITY OF
SEBASTIAN, a municipal corporation of the State of Florida, 1225 Main Street, Sebastian, Florida, 32958,
("City") and Playmore West, Inc., 10271 Deer Run Farms Rd., Suite #1 ,Ft. Myers, FL 33912
("Contractor."), set forth that
WHEREAS, the City desires to engage a Contractor who has special and unique competence in
the removal of existing lighting, sale and installation of Playground Equipment which shall be erected at
the Bryant Court Park, Sebastian, Florida; and
WHEREAS, the Contractor represents that it has such competence and experience in providing
these services; and
WHEREAS, the City in reliance on such representation has selected the Contractor in accordance
with the requirements of law; and
WHEREAS, the City and the Contractor desire to reduce to writing their understanding and
agreements on such;
IT IS, THEREFORE, AGREED as follows:
1. TERM. This Agreement shall commence on the day it is executed by both parties and the term of the
Agreement shall extend until the Project is complete.
2. AGREEMENT DOCUMENTS. The Agreement Documents (also called CONTRACT DOCUMENTS)
consist of this Agreement, Supplemental Agreement(s), Specifications, Work Orders, Change Orders,
Addenda if any, any other documents listed in the Agreement Documents, and written modifications
issued after execution of this Agreement, if any.
(a) Intent. The Specifications are an integrated part of the Contract Documents and as such
will not stand alone if used independently. The Specifications establish minimum standards of quality for
this Project. They do not purport to cover all details of performing the Work. The intent of the Agreement
Documents is to set forth requirements of performance, type of equipment and structures, and standards
of materials and construction. It is also intended to include all labor and materials, equipment, and
transportation necessary for the proper execution of the Work, to require new material and equipment
unless otherwise indicated, and to require complete performance of the Work in spite of omission of
specific reference to any minor component part and to include all items necessary for the proper
execution and completion of the Work by the Contractor. Performance by the Contractor shall be required
only to the extent consistent with the Agreement Documents and reasonably inferable from them as being
necessary to produce the intended results.
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(b) Entire and Sole Aoreement. Except as specifically stated herein, the Agreement Documents
constitute the entire agreement between the parties and supersede all other agreements, representations,
warranties, statements, promises, and understandings not specifically set forth in the Agreement
Documents. Neither party has in any way relied, nor shall in any way rely, upon any oral or written
agreements, representations, warranties, statements, promises or understandings not specifically set forth
in the Agreement Documents.
(c) Amendments. The parties may modify this Agreement at any time by written agreement.
Neither the Agreement Documents nor any term thereof may be changed, waived, discharged or
terminated orally, except by an instrument in writing signed by the party against which enforcement of the
change, waiver, discharge or termination is sought.
(d) Construino Terms. This Agreement shall not be construed against the party who drafted the
same, as both parties have obtained experts of their choosing to review the legal and business adequacy
of the same.
3. EMPLOYMENT OF CONTRACTOR. The City hereby agrees that it may engage the Contractor and
the Contractor hereby agrees to perform professional services for the City by selling and properly installing
play .equipment which shall be erected at the Bryant Court Park, Sebastian, Florida, more specifically
described in Exhibit "A", which is attached hereto and incorporated herein by this reference.
4. SPECIFICATIONS AND RELATED DATA. The intent of the Specifications, Work Orders and other
Contract Documents is that the Contractor furnishes all labor and materials, equipment, supervision and
transportation necessary for the proper execution of the Work unless specifically noted otherwise. The
Contractor shall do all the work described in the Specifications and other Contract Documents and all
incidental work considered necessary to substantially complete the Work ready for use, occupancy, or
operation in a manner acceptable to the City.
Any discrepancies found between the Specifications and site conditions, or any errors or
omissions in the Specifications, shall be immediately reported to the City. The City shall promptly
determine the validity and seriousness of the claimed condition and correct any such error or omission in
writing, or otherwise direct Contractor. Any work done by the Contractor after his discovery of such
discrepancies, errors or omissions shall be done at the Contractor's risk.
Any correction or errors or omissions in Specifications may be made by the City when such
correction is necessary for the proper fulfillment of their intention as construed by City. Where said
correction of errors or omissions, except as provided in the next paragraph below, adds to the amount of
work to be done by the Contractor, compensation for said additional work shall be negotiated between the
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correction of errors or omissions, except as provided in the next paragraph below, adds to the amount of
work to be done by the Contractor, compensation for said additional work shall be negotiated between the
parties and must be issued as a written change order before any such additional work is performed or no
additional compensation shall be made.
The fact that specific mention of any part of work is omitted in the Specifications, whether
intentionally or otherwise, when the same usually and customarily required to complete fully such work as
is speCified herein, will not entitle the Contractor to consideration in the matter of any claim for extra
compensation, but the said work must be installed or done the same as if called for by the Specifications.
All work and material usual and necessary to make the Work complete in all its parts, whether or not they
are indicated or mentioned in the Specifications, shall be furnished and executed the same as if they were
called for by the Specifications. The Contractor will not be allowed to take advantage of any errors or
omissions in the Plans and Specifications. The City will provide full information when errors or omissions
are discovered.
5. COMPENSATION. The City will pay the Contractor the flat amount of $30,635.00.00 for performance
of the Work hereunder.
Claims. Claims arising from changes or revisions made by the Contractor at the City's request
shall be presented to the City before work starts on the changes or revisions. If the Contractor deems that
extra compensation is due for work not covered herein, or in Supplemental Agreement, the Contractor
shall notify the City in writing of its intention to make claim for extra compensation before work begins on
which the claim is based. If such notification is not given and the City is not afforded by the Contractor a
method acceptable to the City for keeping strict account of actual cost, then the Contractor hereby waives
its request for such extra compensation. The City is not obligated to pay the Contractor if the City is not
notified as described above. The Contractor may refuse to perform additional work requested by the City
until an appropriate agreement is executed by the parties. Such notice by the Contractor and the fact that
the City has kept account of the costs as aforesaid shall not in any way be construed as proving the
validity of the claim.
6. RELEASES. When it is determined, as a result of a joint inspection of the Work by the Contractor, City,
and Project Manager that the Work has been completed in accordance with the terms of the Contract
Documents, the Project Manager shall certify completion of the Work to the City. At that time, the
Contractor may submit the Contractor's final request for payment. Prior to final payment, the Contractor
shall execute and deliver to the City a Contractor's Affidavit and Release of Claim for all claims against the
City arising under or by virtue of the work order.
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Also, each request for payment must have a Claimant's Sworn Statement of Account, executed by the
supplier or subcontractor, attached from each supplier or subcontractor who has notified the City of his
right to file a Claim (Notice to City) or who is listed in the Contractor's Affidavit and Release of Claim as an
unpaid potential Claimant.
7. PROJECT SCHEDULES. The Contractor shall perform the services outlined under Paragraph 3 of
this Agreement in a timely manner consistent with the assignment schedules as mutually agreed upon by
the City and the Contractor. No extension of time shall be valid unless given in writing by the City. No
monetary compensation shall be given for such delay.
A delay beyond the Contractor's control occasioned by an "Act of God" may entitle the Contractor
to an extension of time in which to complete the Work as determined by the City provided, however, the
Contractor shall immediately give written notice to the City of the cause of such delay. "Rain day"
extensions shall be granted upon written request of the Contractor to the City's Project Manager when
said Project Manager determines that weather conditions make it counterproductive to work on said days.
"Rain day" requests must be submitted at the end of each work week or be waived, and the cumulative
"rainday" extensions granted shall be processed as a Change Order with each pay submittal.
The City shall have the authority to suspend the Work wholly or in part, for such periods as may
be deemed necessary and for whatever cause, by serving written notice of suspension to the Contractor.
In the event that the Project Manager shall become aware of any condition which may be cause for
suspension of the Work, the Project Manager shall immediately advise the City of such condition. The
Contractor shall not suspend operations under the provisions of this Paragraph without the City's
permission. In the event that the City suspends the Work, the Contractor shall be granted an extension of
time to complete the Work for as many calendar days as the Work was suspended; except, however, that
the Contractor will not be granted an extension of time to complete the Work if the suspension was caused
by a fault of the Contractor.
8. TERMINATION OF CONTRACT WITHOUT CAUSE. This Agreement may be terminated by the City
without cause provided at least five (5) days written notice of such termination shall be given to the
Contractor. In the event the City without cause abandons, terminates or suspends this Agreement for
greater than thirty days, the Contractor shall be compensated for services rendered up to the time of such
termination on a quantum meruit basis and any work done by the Contractor shall remain the property of
the City.
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9. CITY'S PROJECT MANAGER. City shall designate a Project Manager. All work done shall be subject
to the review of the Project Manager and City. Any and all technical questions which may arise as to the
quality and acceptability of materials furnished, work performed, or work to be performed, interpretation of
Specifications and all technical questions as to the acceptable fulfillment of the Contract on the part of the
Contractor shall be referred to the Project Manager who will resolve such questions.
All materials and each part or detail of the Work shall be subject at all times to construction review
by the Project Manager and the City. Such construction review may include shop inspection, and any
material furnished under the Specifications is subject to such inspection. The Project Manager and the
City shall be allowed acce~s to all parts of the Work and shall be furnished with such information
and assistance by the Contractor as is required to make a complete and detailed review.
The City shall not be responsible for the acts or omissions of the Contractor.
10. CONTRACTOR'S DUTY. Contractor shall supervise and direct the Work, using Contractor's best
skill and attention. Contractor shall be solely responsible for and have control over construction means,
methods, techniques, sequences and procedures and for coordinating all portions of the Work under this
Contract, unless the Contract Documents give other specific instructions concerning these matters.
Unless otherwise provided in the Contract Documents, Contractor shall provide and pay for labor,
matet.ials, equipment, tools, construction equipment and machinery, utilities, transportation, and other
facilities and services necessary for the proper execution and completion of the Work, whether temporary
or permanent and whether or not incorporated or to be incorporated in the Work.
Unless otherwise provided in the Contract Documents, Contractor shall pay all sales, use and
other similar taxes.
Contractor currently holds and shall maintain at all times during the term of this Contract all
required federal, state and local licenses necessary to perform the Work required under the Contract
Documents.
11. PERSONNEL. The Contractor represents that it will secure at its own expense all personnel and sub-
Contractors required for services which are necessary as described under Exhibit "A" of this Agreement.
All services described under Exhibit "A" of this Agreement shall be performed by the Contractor or sub-
Contractor and all persons engaged in work under the Agreement shall be qualified to perform such
services and authorized under federal, state and local laws to perform such services. Personnel who
perform services under this Agreement shall not be employees of the City.
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All workmen must have sufficient knowledge, skill and experience to perform properly the work
assigned to them. Any foreman or workman employed by the Contractor or subcontractors who, in the
opinion of the City does not perform his work in a skillful manner, or appears to be incompetent or to act in
a disorderly or intemperate manner shall, at the written request of the City, be discharged immediately and
shall not be employed again in any portion of the Work without the approval of the City.
The Contractor shall at all times be responsible for the conduct and discipline of his employees
and/or any subcontractor or persons employed by subcontractors.
12. PROTECTION OF PERSONS AND PROPERTY. The Contractor shall be responsible for initiating,
maintaining and supervising all safety precautions and programs in connection with the Work in
accordance with the U.S. Department of Labor Occupational Safety and Health Act and the laws of the
State of Florida.
This Contract requires that the Contractor and any and all subcontractors hired by the Contractor
comply with all relevant standards of the Occupational Safety and Health Act. Failure to comply with the
Act constitutes a failure to perform. The Contractor agrees to reimburse the City for any fines and/or court
costs arising from penalties charged to the City for violations of OSHA committed by the Contractor or any
and all subcontractors.
The Contractor shall take all reasonable precautions for the safety of, and shall provide all
reasonable protection to prevent damage, injury or loss to, all employees on the Work and all other
pers0ns who may be affected thereby; all the work materials and equipment to be incorporated therein,
whether in storage on or off the project site, under the care, custody or control of the Contractor or any of
his subcontractors; and other property on the project site or adjacent thereto, including trees, shrubs,
lawns, walks, pavements, roadways, structures and utilities not designated for removal, relocation or
replacement in the course of construction.
The Contractor shall perform any work and shall furnish and install materials and equipment
necessary during an emergency endangering life or property. In all cases, he shall notify the Project
Manager and City of the emergency as soon as practicable, but he shall not wait for instructions before
proceeding to properly protect both life and property.
The Contractor shall be held fully responsible for such safety and protection until final written
acceptance of the Work.
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13. CONTRACTOR'S RESPONSIBILITY FOR WORK. Until acceptance of the Work by the City, it shall
be under the charge and care of the Contractor, and he shall take every necessary precaution against
injury or damage to the Work by the action of the elements or from any other cause whatsoever, whether
arising from the execution or from the non-execution of the Work. The Contractor shall rebuild, repair,
restore and make good, without additional compensation, all injury or damage to any portion of the Work
occasioned by any cause, other than the sole and active negligence of the City, before its completion and
acceptance.
Materials and equipment shall be stored so as to incur the preservation of their quality and fitness
for the Work. When considered necessary, they shall be placed on wooden platforms or other hard clean
surfaces, and not on the ground, and/or they shall be placed under cover. Stored materials and equipment
shall be located so as to facilitate prompt inspection.
14. CLEANING UP. The Contractor shall at all times keep the premises free from accumulation of waste
materials or rubbish caused by his employees or work. At the completion of the Work, he shall remove all
his rubbish, tools, scaffolding and surplus materials and shall leave his work "broom clean" or its
equivalent, unless more exactly specified, and shall insure that all debris and other unsightly objects are
removed and disposed of in a satisfactory manner. At no additional expense to the City, the Contractor will
restore to their original conditions or better, as nearly as practicable, those portions of the site not
designated for alteration and all such property, structure, utilities, landscaping, etc., disturbed or damaged
during the prosecution of the Work. Final payment will be withheld until such clean up and repairs are
completed
The Work will be considered complete only after all debris and unused material due to or
connected with the Work have been removed and the surrounding area left in a condition satisfactory to
the City. In the event the City finds that the Contractor has not complied in keeping the job site clean, the
City may, after twenty-four (24) hours written notice to the Contractor to correct the situation, elect to have
the job site cleaned by an independent labor force. The cost of cleaning by said independent labor force
shall be deducted from moneys due the Contractor.
15. SUBCONTRACTS AND ASSIGNABILITY. The Contractor shall not assign any interest in the work
orders or this Agreement and shall not transfer any interest in the same without the prior written consent of
the City. Any sub-contracts or other work which is performed by persons or firms other than the
Contractor under this Agreement or any work orders shall have prior written approval of the City Manager.
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Any subcontracts or outside associates or Contractors required by the Contractor in connection with
services covered by this Agreement or any work orders must be specifically approved by the City
Manager.
16. INDEMNIFICATION. The Contractor shall indemnify and save harmless the City, its agents,
subcontractors, servants, and employees from and against claims, liability, losses, or causes of action to
the extent arising from any misconduct, negligent act, or omission of the Contractor, its agents, servants
or employees in the performance of services under this contract.
17. COMPLIANCE WITH LAW. The Contractor expressly agrees to comply with all known laws and
regulations relating to providing services under this Agreement. The failure of the Contractor to adhere to
any known law or regulation pertaining to furnishing services under this Agreement shall constitute a
material breach of this Agreement.
18. WAIVER. The waiver by the City of any of the Contractor's obligations or duties under this
Agreement shall not constitute a waiver of any other obligation or duty of the Contractor under this
Agreement.
19. GOVERNING LAW. This Agreement shall be governed by the laws of the State of Florida and
venue for any action pursuant to the Agreement Documents shall be in Indian River County, Florida.
The parties hereto expressly waive trial by jury in any action to enforce or otherwise resolve any
dispute arising hereunder..
20. CONSTRUING PROVISIONS. This Agreement shall not be construed against the party who drafted
the same, as both parties have obtained experts of their choosing to review the legal and business
adequacy of the same.
21. INSURANCE. The Contractor agrees to carry insurance, of the types and subject to the limits as set
forth below and maintain said insurance during the life of this agreement:
(a) Workers' Compensation - Contractor shall purchase workers' compensation
insurance as required by law.
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(b) Commercial General Liability - Contractor shall purchase Commercial General Liability
insurance with a combined single limit of at least $1,000,000.
(c) Commercial Auto Liability - Contractor shall purchase Commercial Auto Liability insurance
with a combined single limit of at least $1,000,000.
Further, Contractor shall maintain such insurance as is reasonably required to satisfy its obligations for the
Work paid for by the City but not yet accepted.
The insurance company selected shall be A+ or better per the Best's Key Rating Guide. The
Contractor and the insurance company(s) shall agree to furnish the City thirty (30) days written notice of
their intent to cancel or terminate said insurance. It is the full responsibility of the contractor to insure that
all sub-contractors have full insurance coverage as stated above.
The Contractor shall not commence the Work under this contract until he has obtained all the
insurance required under this paragraph and certificates of such insurance have been submitted to the
City, nor shall the Contractor allow any subcontractor to commence work on his subcontract until all
insurance required has been so obtained and approved by the City. The Contractor shall carry and
maintain until acceptance of the Work, insurance as specified herein and in such form as shall protect him
and any subcontractor performing work under this Contract, or the City, from all claims and liability for
damages for bodily injury, including accidental death, under this Contract, whether by himself or by any
subcontractor or by anyone directly or indirectly employed by either of them.
The Contractor shall furnish to the City certificates of insurance in duplicate showing proof of
insurance, naming the City as an additional insured party, prior to the start of construction as provided in
the Oontract.
22. GUARANTEE. The Contractor shall warrant all equipment furnished and work performed by him for
a period of two (2) years from the date of final written acceptance of the Work by City.
All equipment and material warranties or guarantees shall be drawn in favor of the City and the originals
thereof furnished to the City for review and acceptance prior to final payment.
Such guarantee shall in no way limit or relieve the Contractor of liability from subsequent claims of
beach of contract due to substandard materials or workmanship, nor shall such warranty period shorten
the statute of limitations for bringing a breach of contract or other action based upon any such
deficiencies.
Any materials, equipment or work which do not satisfactorily meet the Specifications may be
condemned by the City by giving a written notice to the Contractor. All condemned materials, equipment or
work shall be promptly taken out and replaced.
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Any defective work whether the result of poor workmanship, use of defective materials, damaged through
carelessness or from other cause shall be removed within ten (10) days after written notice is given by the
City, and the work shall be re-executed by the Contractor. The fact that the City may have previously
overlooked such defective work shall not constitute an acceptance of any part of it. Should the Contractor
fail to remove rejected work or materials within ten (10) days after written notice to do so, the City may
remove them and may store the materials and equipment.
The making of the final payment by the City to the Contractor shall not relieve the Contractor of
responsibility for faulty materials or workmanship. The City shall promptly give notice of faulty materials
and workmanship and the Contractor shall promptly replace any such defects discovered within two (2)
years from the date of final written acceptance of the Work by the City.
IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed, the day
and year first above written.
Approved as to form and legality for
re~re City of Sebastian only:
Rich Stringer, City At r y
Signed, sealed and delivered in the presence of:
Name:
CONTRA~T~ 17 v?
By: /,/4 /~
Name: Lt/J.C"i. 1t1/~5 ~ L <...
Title: Cd - {' t2. '2 s I/~ f.,.,.vo r
Name:
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EXHIBIT "A"
(Drawings Attached)
BID SPECIFICATIONS FOR
BRYANT COURT PARK PLAYGROUND EQUIPMENT
PLAYGROUND
Playground specifications based on Burke model 3000 -966 Suitable equivalents will be
accepted. Playground must meet all ADA accessibility guidelines. Features include ADA
transfer station, loop rung ladder, centipede climber, ADV climber with atom, spiral
slide, triple rail slide, 3 pipe walls, tunnel with ports, post mounted steering wheel and 2
tunnel panels. Dimensions, fall heights, child capacity and age range listed on enclosed
drawing.
FLOORING
Flooring for playground will be safety rubber flooring.
AREA AND LOCATION FOR PLAYGROUND
Play area is 34ft. 1/2in. x 33ft. 9in. Playground will be located on the southwest corner of
the property. City crews will stake out area for playground.
BENCHES (5)
Bench specifications based on Pride Enterprises 6ft. Contour Bench. Suitable equivalents
will be accepted. Benches constructed with 3in. x 4in. Pressure Treated #1 Southern
Yellow Pine. Hot dipped 2 1l2in. x 2 1/2in. galvanized steel tubing with a 3in. x 1/4in.
flat T-bar for added stability. Assembled using hot dipped galvanized carriage bolts.
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SERIES: 3000
SITE PLAN
DRAWN BY:Ckey
3000-966
May 22, 2006
A c:Iv anced Rec. Co ncepls
3000-966
BCI Burke Company, LLC PO Box 549 Fond du Lac, Wisconsin 54936-0549 Telephone 920-921-9220
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, SERIES: 3000 3000-966 Advanced Rec. Concepts
ELEV A TION PLAN 3000-966
DRAWN BY:Ckey
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BRYANT COURT PARK PLAYGROUND EQUIPMENT
BID OPEN: JUNE 26, 2006
BID PROPOSAL PRICE FORM
The undersigned having become thoroughly familiar with all of the Bidding Documents incorporated herein, hereby
proposes to perform everything required to be performed in strict conformity with the requirements of these
documents, meeting or exceeding the specifications as set forth herein for the price(s) quoted below. The price(s)
quoted is (are) inclusive of any Addenda which may be issued.
By the signature below, the Vendor agrees that this Bid Proposal is made without any other understanding,
agreement, or connection with any person, corporation, or firm submitting a bid for the same purpose and that the
bid is in all respects fair and without collusion or fraud. If awarded any work under this bid proposal, the Vendor
agrees to enter into said agreement within ten (10) consecutive calendar days notice by the City, and agrees to all the
terms and conditions of all documents stated herein with the City of Sebastian for the below stipulated price which
shall remain fIrm for sixty (60) days following bid opening date.
PLAYGROUND PRICE
RUBBER SAFETY FLOORING p;p ~O."C()LC'1i:. Z.s~Tl-"'C K
FIVE (5) BENCHES PRICE
INSTALLATION CHARGES
FREIGHT CHARGES FOR ALL EQUIPMENT
TOTAL PRICE
$ l3/IOO
$ ~I q ., 0
$ I, . L/7 5
$ L/ J 7 LJ (/
$ Z J JSo
$ 30 J b ~s-
NOTE: VENDOR WARRANTS TOTAL DELIVERY, INSTALLATION AND COMPLETION TIME SHALL NOT EXCEED _
CONSECUTIVE CALENDAR DAYS.
~~ ?vlC[; l2(/s.s~L<-
.
Authorized Signature
Printed Name
PtA-V'M.O 'f2C vl S)-, I fl-JC , C C? - t?tz E"5 J KJ J: /V \"
Firm Name & Address IO"lt J OlEa .re~;A~.) 1C'e:?" s"tlt~ I
FT, A/lYE"/25, 1=L 339. I L
6-25-00
Z. 3 ery ~ "7 c:>t I - 2.. '-I 0 I:)
Date Signed
Phone Number
DRUG-FREE WORKPLACE FORM
that
does:
The undersigned Contractor, in accordance with Florida Statute 287.087 hereby certifies
1. Publish a statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession, or use of a controlled substance is prohibited in the workplace
and specifying the actions that will be taken against employees for violations of such
prohibition.
2. Inform employees about the dangers of drug abuse in the workplace, the business' policy
of maintaining a drug free workplace, any available drug counseling, rehabilitation,
employee assistance programs and the penalties that may be imposed upon employees for
drug abuse violations.
3. Give each employee engaged in providing the commodities or contractual services that
are under bid a copy of the statement specified in Paragraph 1.
4. In the statement specified in Paragraph 1, notify the employees that, as a condition of
working on the commodities or contractual services that the employee will abide by the
terms of the statement and will notify the employer of any conviction of, or plea of guilty
or nolo contendere to any violation of Chapter 1893 or of any controlled substance law of
the United States or any state, for a violation occurring in the workplace no later than five
(5) days after such conviction.
5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance
or rehabilitation program if such is available in the employee's community, by any
employee who is so convicted.
6. Make a good faith effort to continue to maintain a drug free workplace through
implementation of Paragraph 1 through 5.
As the person authorized to sign this statement, I certify that this firm complies fully
with the above requirements.
Date:
6 .- ? ') --c?b
~~
Signature
SWORN STATEMENT UNDER SECTION 287. 133(3)(a),
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC
OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS.
1. This sworn statement is submitted with Bid, Proposal or Agreement No.
f!:#.r41"1 CT. .Ikp for THE CITY OF SEBASTIAN.
2. This sworn statement is submitted by PtA.rMO~ t::. 'WI: 5 T, I tV("',
(name of entity
submitting sworn statement) whose business address is
/t:l~71 Oft'lZ ,eV'~I=A-~.MS RIJ,} 'Sv1TC ( Pr../'4.Ylte.5, ;t--3:?"'f/<-and (if
applicable) its Federal Employer Identification (FEIN) is
6r~fSq4c>t5 (If the entity has no FEIN, include the Social Security
Number of the individual signing this sworn statement:
.)
3. My name is ?c/K'L (2JS5C LL- (please print
name of individual signing) and my relationship to the entity named above is
C:??-/-?t?~5J /.)1:',....,'-
4. I understand that a "public entity crime" as defined in Paragraph 287.133(l)(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 public entity
or with an agency or political subdivision of any other state or with the United
States, including, but not limited to, any bid or Agreement 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.
5. I understand that "convicted" or "conviction" as defined in Paragraph
287.133(l)(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 nolo contendere.
6. I understand that an "affiliate" as defined in Paragraph 287.133(1)(a), Florida
Statutes, means:
(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,
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 ann'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 of a public entity
crime in Florida during the preceding 36 months shall be considered an affiliate.
7. I understand that a "person" as defined in Paragraph 287.l33(l)(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 Agreement and
which bids or applies to bid on Agreements 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.
8. Based on information and belief, the statement which I have marked below is true
in relation to the entity submitting this sworn statement. (Please 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 management of the entity, nor any affiliate of the entity have 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 the 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,
AND (Please indicate which additional statement applies.)
_ There has been a proceeding concerning the conviction before a
hearing officer of the State of Florida, Division of Administrative Hearings. The
final order entered by the hearing officer did not place the person or affiliate on
the convicted vendor list. (Please attach a copy of the final order.)
_ The person or affiliate was placed on the convicted vendor list. There has
been a subsequent proceeding before a hearing officer of the State of Florida,
Division of Administrative Hearings. The final order entered by the hearing
officer determined that it was in the public interest to remove the person or
affiliate from the convicted vendor list. (Please attach a copy of the final order.)
_ The person or affiliate has not been placed on the convicted vendor list.
(Please describe any action taken by or pending with the Department of General
Services. )
~p-e
(Signature)
?- 2 ~-O'b
Date:
STATE OF FLORIDA
COUNTY OF L-e...e..,
The foregoing instrument was acknowledged before me this 0> 3 day of
~t.Lne, 2006 by kk...e. ~u-~eLt ,
e('>- ~ "p_~~d.e.-1+- (title) on behalf of~l"'~r.!.. WefJ, -:CW.. (name of
partnership), a partnership. He/she is personally kri n to me or has produced
as identification and did ( ) did not ( ) take an oath.
~-MEUSSA..VEGAHHHH""11
Com"'" DD0238319
ElcpIrea 815121X11
m IcInded \tIN (800)432-4254.
ClfI\1 . Nola ~ Inc :
--~......~......"....
~~v
Name: \-\e\J-SS'1 ~
My Commission Expires: -6/
Commission Number: 'be> I:> ri"6 '8' '3 I. '\
08/31/2006 15:36
2397912401
PLAYMORE
PAGE 02/02
,1-1&\m: 1..;~1"lI ~c.!.\r,U;~ L,: '? ,I.{}: 1 :!:.f.v,r.U1 . ).lIV1 .u,~: 11' Date: ~/.31r.m1jl1'.7.~~qPll.9
ACORD CERilF1CATI: OF LIABILITY lNSURANCE II DATi. rtAlWDONY.YY.\,
1M, 0813112006
1;11,_: (311) B34.~~OO Fox: (317) ~72-71~2 THIS e~~TIFleATE Ie "SUED AI A MATT'I!R OF IMf'ORMATION
CITY SECURlTJES CORP '3W..'f ~ c~ ~ lH1I9r!, ~ 1\t! (;.'i!MW\CA,,1l;
P.O. BOX 44992 HOJ.DER. THI~ CERTIFICATE COES NOT IoMENO, ElXTlOND OR
,1'~\ofIN.4~~8lN J8l114.qggz .....~ ~~ A~"'D BY ~PfJtAAn SEtQW;
( INSURERS AFFORDING CO"ERAG~ I .NAIC.il!
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INSURED liNSURI:R A: Burlington Insurance
PLAYMORE WEST IkC.. CaA. PLA.YMClR,E. ~R~m~ I~RB: .,
PRODUCTS & SERVICES IMulrER {;:
10271 DIiER RUN FARMS ROAD INSURER 0: I
.
FORT MYERS FL 33812 ,.INSUJtl~ .I: ,I
COVERAGES
T1-tE POLICIES r::F INS~"/II\,;E lISTED_~l9)N (oI^~ _~ 1l5~IiO TO THE 1N~J'tI!:D N~j\~QV"- FOR Ti'<F. ,p9"If,;V t'CRlOO KIICA~ N01WITHSITANI.lIN(J:
ANV REOUJl6lEm, ~ O~ CONcmON CF ANY CO ACT Oft O'IHSl OOClIMENT WI111 RESPECT T(lV\o1~ICH r.1:xC!m1FICATI!: MAY ISSLED OIl
M/(t'.JEF<rili't'(. fTr.iIi j(rtI(% I\FRJFlt1EO F.rfn;I'OLICIES ~t:l Hl!:REIN IS SUIlJeCT TO AI.I. Tt-IE TERMS. ClUSlGIIIS AND CONDrTY.lN$ ($ SUCH
PCtICE9. MGIlEGA'I'e lMTS SHOWN MAY HAV BeEN REDUCED ~ PAre CLAIMS.
r.:.t= -. .I ,I ,I FOUCV_IIN "
TYJ'E OP INSURANC! POlICV NUMB!!Ft 'OI.l~y EFFE;lIVE 1.IMlm
I. ~E;NtiiRAl. LlABIU1Y I, HGl.OO13413 I) 07119106 Ij 071111107 eACH OCCUllRENCIi s 1,000.000
r fxl COMMliRC'^t. GeNEA~AIlLITY I =~w.~~:nI!' .
$ 50,000
r ~'~._~~ I I : 'MW. c.>IF'(MyOftO 0......,) $ eXt:lUded
~ i' "" C;'" ;:.,,'^'" "'" """" "",' II ~RSONIIJ. & Ii,CfI/ IN.Mv $ 1,000,000
GENERAL AGGoRGiGA TE $ 2,000,000
.~~m:u::rs.C:Q!>APIClP .^C-G, $ ~tWl.MO
POLICY n ~ nlOC f f "
I' AUTOMOIIU! LIABILITY II { II CO~D SIN(J:lE lMr
~ ANY AlIro rEo a".clderll :r
--
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i --I NON.OVIIN!:O AUTOS i II I~.r SCCldOnt) $
II '1~M'f'U'.l.IilIGe ,..
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'I IcEKC'ESS 'UMBRELLA U"ILI'I'Y I, II II EAeH OCCURReNCE $
o oeM 0 ClAI'I4SMADi I AOORE;GA11< $
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CERTIFICATE HOLDER ADDED AS ADDITIONAL INSURED ONLY AS THI5IR INTERI!STS IIIAY APPEAR.
CERTIP'1CATE HOLDER
CANCELLATION
SHOIA.O ANY O. THE AtlOIIE OESCRIBED F'C4.IClas rar. CAWCilLED 8EFO~'1'HI!Extt~A'tOol
DATe 1'HE~EOJr. THI!: ISSUING INSlJlER 1MU.I!fll:lIi^VOl'lTO MAIL 3ll OAYi; Itt'EN NOTICE TO
lf1E' ~;rn.1'C^ re: fltWS<' IIlIWflT ro 1l'lli" u"').T, surF"JC~~ rtrpo- SO SHAll INI'OSE"IIIC1
CITY OF SEBASTIAN OBLIGATION OR llABllTY OF Am I<I~IO UPON Ti'E: NS\lReFl, _ AGeNTS OR REl"ResENTI\TlVES.
1225 MAIN STREET
RSA.."I.TJ4N, F.L ~5t ^UINOf{ll.~IJ H~f'HI~:iI.NTA'I'IVE
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08/23/2005 13:42 23979124Bl
AA/?,/200612:06 239549Ge~o
PLA '(t>~ORE
GA~LOCK INSURANU:..
PAGE 02/02
PAGt: 02/03
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Box 1om8
III Coral R. 31910
INIllRED Pl8ymDlll Wilt tlo.
DBA Playmar& ReonalfonIIProlludt & 8ervloe$
10271 De.. Ran F8tlM lid It 2
Fort ~ FL 339..
INSURERS AFFOftDING COWRAGE
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