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HomeMy WebLinkAboutUnique Charters, Inc. �` OT\ OF SUNNY ISLFS'$E CF r. L'10 S_.;, _ t.` T S x % 18070 Collins'Avenue a ; t ?#+s. 30x '1l ..-A Y-3 N. f f y s., . j° x2 Sunny Iles Beach Flo fdo 3160 ( 4 set.424.-:. x " 305.047 0000 I o/rec " �'➢ t�.;.,�.."<.,,.. �x s " .o�..�. - ' S v r r>ibn net V -V c _ •i 1 `•-._ °"a' T nrt or ;c>r l'IoS Invitation to Bid Vi _ Goods&Services a 5 1 ^' r c 2,,,-In r Y ci„Cf . U di. /0 —cikoct.y....:,-26.0.-z,„ • C U J A yk` '- I 4f:7-ctirr y t f � } pP yP 9 F * F L O Q'\ `'� C/ rY OF SUN PCO MOTOR COACH TRANSPORTATION SERVICES Invitation to Bid No. 16-03-01 Publish Date: Bid Due and Bid Opening Date: 03/16/2016 03/30/2016 at 2:30 PM Pre-Bid Conference: Where to Deliver Proposal None Sunny Isles Beach Government Center 18070 Collins Avenue 1\\ ' Sunny Isles Beach, Florida 33160 All Questions Due: 03/22/2016 by 5:00 PM City of Sunny Isles Beach I Invitation to Bid No. 16-03-01 x" ==:- ' _ CITY OF SUNNY ISLES BEACH 18070 Collins Avenue Sunny Isles Beach, Florida 33160 t= R += ♦1 (paw,i 305.947.0606 . wwwsibfLnet u 4.: • y n • we. S- y r eel .01 sus�a BID FORM 1 BID COVER Bid Title: MOTOR COACH TRANSPORTATION SERVICES The undersigned Bidder proposes and agrees, if this Bid is accepted, to enter into an agreement with The City of Sunny Isles Beach to perform and furnish all Work as specified or indicated in the Contract Documents for the Contract Price and within the Contract Time indicated in this Bid and in accordance with the other terms and conditions of the Contract Documents. The Bidder accepts all of the terms and conditions of the Advertisement or Invitation to Bid and Instructions to Bidders. This Bid will remain subject to acceptance for 90 days after the day of Bid opening. The Bidder agrees to sign and submit the Agreement with other documents required by the Bidding Requirements within ten days after the date of the City's Notice of Award. In submitting this Bid, the Bidder represents, as more fully set forth in the Agreement, that: • The Bidder has familiarized himself/herself with the nature and extent of the Contract Documents, Work, site, locality, and all local conditions and Law and Regulations .that in any manner may affect cost, progress, performance, or furnishing of the Work. • The Bidder has given the City written notice of all conflicts, errors, discrepancies that it has discovered in the Contract Documents and the written resolution thereof by City is acceptable to the Bidder. • This Bid is genuine and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization, or corporation; the Bidder has not directly or indirectly induced or solicited any other Bidder to submit a false or sham Bid; the Bidder has not solicited or induced any person, firm or corporation to refrain from Bidding; and Bidder has not sought by collusion to obtain for itself any advantage over any other Bidders or over the City. Exact Legal Company Name: UNIQUE CHARTERS, Inc Business Name (dba), if any: Street Address: 160 NW 176TH STREET SUITE 200-i MIAMI GARDENS, FL 33169 Mailing Address (if different): City of Sunny Isles Beach I Invitation to Bid No. 16-03-01 18 1` • r CITY OF SUNNY ISLES BEACH 18070 Collins Avenue Sunny Isles Beach, Florida 33160 tia""v"i-- s/ 1i 305.947.0606 `°�, �•, - www.sibll.ner r �- • .. d., �4 'CM'Of sus'''''g Telephone No.: (305) 652-4961 Fax No.: (305) 652-4920 Email Address: uniquecharters@bellsouth.net FEIN No.: 65-1047573 *By signing this document the bidder agrees to all Terms Authorized Signature. • Print Name: Kris smith Title: Operations Manager THE EXECUTION OF THIS FORM CONSTITUTES THE UNEQUIVOCAL OFFER OF BIDDER TO BE BOUND BY THE TERMS OF ITS PROPOSAL. FAILURE TO SIGN THIS SOLICITATION WHERE INDICATED ABOVE BY AN AUTHORIZED REPRESENTATIVE SHALL RENDER THE PROPOSAL NON-RESPONSIVE. THE CITY MAY, HOWEVER, IN ITS SOLE DISCRETION, ACCEPT ANY PROPOSAL THAT INCLUDES AN EXECUTED DOCUMENT WHICH UNEQUIVOCALLY BINDS THE BIDDER TO THE TERMS OF ITS OFFER. City of Sunny Isles Beach I Invitation to Bid No. 16-03-01 19 ■\ .4•4__,n,_ CITY OF SUNNY ISLES BEACH 18070 Collins Avenue Sunny Isles Beach, Florida 33160ti� ;,N"'�-; 305.947.0606 °/ e www.sibB.net "r. ^L 0 �C,ry OF SUN i't‘ BID FORM 2 ADDENDA ACKNOWLEDGEMENT INSTRUCTIONS: COMPLETE PART I OR PART II, WHICHEVER APPLIES PART I: UST BELOW ARE THE DATES OF ISSUE FOR EACH ADDENDUM RECEIVED IN CONNECTION WITH THIS BID Addendum #1, Dated Addendum #2, Dated Addendum #3, Dated Addendum #4, Dated Addendum #5, Dated Addendum #6, Dated Addendum #7, Dated Addendum #8, Dated PART II: NJ NO ADDENDUM WAS RECEIVED IN CONNECTION WITH THIS BID COMPANY NAME: UNIQUE c:ARTERS, INC. AUTHORIZED SIGNATUR-Irmeir DATE: 0/a/ TITLE OF OFFICER: °perations Manager City of Sunny Isles Beach I Invitation to Bid No. 16-03-01 20 1� CITY OF SUNNY ISLES BEACH 18070 Collins Avenue Sunny Isles Beach, Florida 33160 0o"�� . 305.947.0606 viwwsibfl.nel �( •_ --o 7 0 CePrOI SUN Oa • r.. BID FORM 3 VENDOR REQUIRED INFORMATION & DOCUMENTS Section Summarized Requirement Initial to indicate completed Contact Information: (available 24/7) 2.5a Telephone (305) 652-4961 KS Email un gcecharters@bellsouth.ne_t Fax (305) 652-4920 2.5b Vehicle Communication System (Attach to this page, Bid Form 3) 2.5c Vendor Fleet Listing xs (Attach to this page, Bid Form 3) 2.5d Vendor Hourly Rate (47-57 Passenger motor coach) KS $ 75.00 City of Sunny Isles Beach I Invitation to Bid No. 16-03-01 21 ,f, Ri Uiilllgue Charters ffne 'where oou caw always expect a wkiztue experience.' 3/29/2016 Our Method of communication is: MOBILE PHONES FLEET INFORMATION Bus #: 714 Bus #: 712 Make: Van Hool Make: Van Hool Model: T-2145 Model: T-945 Year: 2003 Year: 1999 Seats: 57 Seats: 57 Own Own Bus #: 111 Bus #: 5702 Make: Van Hool Make: Van Hool Model: T-2045 Model: T-945 Year: 2001 Year: 1999 Seats: 55 Seats: 55 Lease Lease Bus #: 858 Bus #: 1204 Make: Van Hool Make: Van Hool Model: T-2145 Model: T-2145 Year: 1999 Year: 1998 Seats: 57 Seats: 55 Lease Lease Phone (305 ) 652-4961 Fax (305 ) 652-4920 160 NW 176'"Street Suite 200- I Miami. Fl. 33169 uniquechartersThbellsouth.net www.uniquechartersinc.com Uiigue taco 'Where dou caw alwatds expect a uvaque expert-ma.' 3/29/2016 Our method of communication between dispatch and driver is: MOBILE PHONES Phone (305 ) 652-4961 Fax (305 ) 652-4920 160 NW 176'"Street Suite 200- I Miami. Fl. 33169 uniuuechartersnbellsouth.net wtcw.uniquechartersinc.com `SVNN♦/rrFJ NON - COLLUSION AFFIDAVIT V - • City of Sunny Isles Beach 18070 Collins Avenue �r�'•no�� a Sunny Isles Beach,FL 33160 'or sun's Telephone:(305)947-0606 Fas(305)949-3113 STATE OF FLORIDA COUNTY OF miami dade The undersigned being first duly sworn as provided by law,deposes,and says: This Affidavit is made with the knowledge and intent that it is to be filed with the City of Sunny Isles Beach City Commission and that it will be relied upon by said County,in any consideration which may give to and any action it may take with respect to this Bid. The undersigned is authorized to make this Affidavit on behalf of, UNIQUE CHARTERS, INC. (Name of Corporation,Partnership,Individual,etc.) a Corporation ,formed under the laws of Florida (Type of Business) (State) of which he is Operations Manager (Sole Owner,Partner,President,etc.) Neither the undersigned nor any person, firm, or corporation named in above Paragraph 10.2, nor anyone else to the knowledge of the undersigned, have themselves solicited or employed anyone else to solicit favorable action for this Bid by the City,also that no head of any department or employee therein,or any officer of the City of Sunny Isles Beach,Florida is directly interested therein. This Bid is genuine and not collusive or a sham;the person,firm or corporation named above in Paragraph 10.2 has not colluded,conspired, connived or agreed directly or indirectly with any proposers or person, firm or corporation,to put in a sham Bid, or that such person,firm or corporation, shall refrain from Bidding,and has not in any manner,directly or indirectly,sought by agreement or collusion,or communication or conference with any person,firm or corporation,to fix the prices of said Bid or Bids of any other proposers;and all statements contained in the Bid or Bids described above true; and further; neither the undersigned, nor the person, firm or corporation named above in Paragraph 10.2,has directly or indirectly submitted said Bid or the contents thereof,or divulged information or data relative thereto,to any association or to any member or agent thereof. Kris Smith Operations Manager AFFIANT'S NAME AFFIANT'S TITLE TAKEN,SWORN AND SUBSCRIBED TO BEFORE ME this day day of M 0w a t ,204_4 Personally Known ✓ or Produced Identification • Type of identification -' (Affix seal here) ,��L,+'—r(�"v RICHARD A.NZERIBE .. NOTARY PUBLIC(name printed or typed)A. ) rc NOTARY PUBLIC .2",„1 ' STATE OF FLORIDA tai Cam*FF920228 ' Expires 12/14/2019 DECEMBER 28.2010 1 of 7 sori yO�N'1j(,:re� '" PUBLIC ENTITY CRIMES V ' I7 Z City of Sunny Isles Beach �, = o�•' 18070 Collins Avenue r'•r Ot' Sunny Isles Beach,FL 33160 e"�o, ru•' ,, Telephone:(305)947-0606 Fax:(305)949-3113 SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a) FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES PUBLIC ENTITY CRIMES Pursuant to the provisions of paragraph (2) (a) of Section 287.133, Florida State Statutes - "A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a Bid on a Contract to provide any goods or services to a public entity, may not submit a Bid on a Contract with a public entity for the construction or repair of a public building or public Work, may not submit Bids on leases of real property to a public entity, may not be awarded to perform Work as a Contractor, supplier, Sub-Contractor, or Consultant under a Contract with any public entity, and may not transact business with any public entity in excess of the threshold amount Category Two of Sec. 287.017, FS for thirty six months from the date of being placed on the convicted vendor list". THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. 11.1. This sworn statement is submitted to City of Sunny Isles Beach by Kris Smith / Operations Manager [print mdmduars name and tele] for UNIQUE CHARTERS, INC. [pmt named entity submitting sworn statement) whose business address is: 160 NW 176TH STREET SUITE 200-1 MIAMI GARDENS, FL 33169 and (if applicable) its Federal Employer Identification number FEIN is 65-1047573 PP ) (FEIN) (If the entity had no FEIN, include the Social Security Number of the individual signing this sworn statement: .) 11.2. 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 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 Contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 11.3. I understand that"convicted" or"conviction" as defined in Para. 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 trail court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non-jury trial, or entry of a plea of guilty or nob contendere. 11.4. I understand that an"affiliate"as defined in Para. 287.133(1)(a), Florida Statutes, means: a.) predecessor or successor of a person convicted of a public entity crime; or b.) Any 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, executors, 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 DECEMBER 2B,2010 2 of 7 market value under an arm's length agreement, shall be a prime 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. 11.5. I understand that a "person" as defined in Para. 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 "persons" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of any entity. 11.6. 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 of it's 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 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. 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 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 11.1 (ONE)ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 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 STATUTES, FOR CATEGORY TWO OF ANY, CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. By:ia (Sig ature) Kris Smith (Printed Name) Operations Manager (Title) Sworn to and subscribed before me this )-C-1 day of M cti — , 20 t , b��y77� (AFFIX NOTARY STAMP HERE) a --�a_ �?. 7,7-10 Signature: Notary Public—State of Florida Print or Type Commissioned Name Personally Known t/ OR Produced Identification .:A , RICHARD A.NQR1BE Type of Identification Produced NOTARY PUBLIC STATE OF FLORIDA Ceniai�a 301 y1 Expires 12/14/2019 es rtrvf:/, Fr eie S �; EQUAL OPPORTUNITY / - AFFIRMATIVE ACTION ' . ' •' City of Sunny Isles Beach et" o. •oma ,+0 o. , 76070 Collins Avenue Sunny Isla Beach,FL 33160 Telephone:(305)947-0606 Fax:(305)949-3113 EQUAL OPPORTUNITY/AFFIRMATIVE ACTION STATEMENT The contractors and all subcontractors hereby agree to a commitment to the principles and practices of equal opportunity in employment and to comply with the letter and spirit of federal, state, and local laws and regulations prohibiting discrimination based on race, color, religion, national region, sex, age, handicap, marital status, and political affiliation or belief. Signed illar Title: Operations Manager Firm: UNIQUE CHARTERS, INC Address: 160 NW 176TH STREET SUITE 200-1 MIAMI GARDENS, FL 33169 DEC BARER 28,2010 4 of 7 y,sN♦114 es -1 n CONFLICT OF INTEREST G - z • .\ City of Sunny Isles Beach \ 18070 Collins Avenue soy I " '•• o ‘o0 s. Sunny Isles Beach,FL 33160 ,0s SOW " Telephone:(305)947-0606 Fax:(305)949-3113 CONFLICT OF INTEREST STATEMENT The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes. Proposers must disclose with their Bids, the name of any officer,director, partner, associate or agent who is also an officer or employee of the City of Sunny Isles Beach or its agencies. STATE OF FLORIDA COUNTY OF Miami Dade BEFORE ME, the undersigned authority, personally appeared Kris Smith who was duly sworn, deposes,and states: 18.1. I am the Operations Manager of UNIQUE CHARTERS, INC with a local office in 160 NW 176TH STREET SUITE 200-1 and principal office in 160 NW 176TH STREET SUITE 200-1 MIAMI GARDENS, FL 33169 MIAMI GARDENS, FL 33169 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. 16-03-01 described as: Landscape Maintenance Services. The Affiant has made diligent inquiry and provides the information contained in this Affidavit based upon his own knowledge. 18.3 The Affiant states that only one submittal for the above Bid is being submitted and that the above named entity has no financial interest in other entities submitting Bids for the same project. 18.4 Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, participated in any collusion, or otherwise taken any action in restraints of free competitive pricing in connection with the entity's submittal for the above Bid. This statement restricts the discussion of pricing data until the completion of negotiations if necessary and execution of the Contract for this project. 18.5 Neither the entity nor its affiliates, nor any one associated with them, is presently suspended or otherwise ineligible from participation in contract letting by any local, State,or Federal Agency. 18.6 Neither the entity, nor its affiliates, nor any one associated with them have any potential conflict of interest due to any other clients, contracts, or property interests for this project. 18.71 certify that no member of the entity's ownership or management is presently applying for any employee position or actively seeking an elected position with the City of Sunny Isles Beach. 18.81 certify that no member of the entity's ownership or management, or staff has a vested interest in any aspect of the City of Sunny Isles Beach. 18.9 In the event that a conflict of interest is identified in the provision of services, I, on behalf of the above named entity, will immediately notify the City of Sunny Isles Beach. Dated this ` 1 day of ��,.r.L.... , 2016 Kris Smith/Operations Manager AFF Print or Type Name and Title Sworn to and subscribed before me this a..C'1 day of — , 201b .1l Personally Known OR O Produced Identification :Ty dentification t NOTARY PUBLIC STATE OF FLORIDA • RICHARD A.NZERIBE NOTARY PUBLIC �dI,4 STATE OF FLORIDA _ Orme FF920222 Mourne(28.2010 5 Of 7 Expires 12/14/2019 ottV$NT ,s,FJs ;, DISPUTE DISCLOSURE VCity of Sunny Isles Beach � 18070 Collins Avenue 40%If. .y•r`o o•` Sunny Isles Beach,FL 33160 'o. ,us 'v Telephone:(305)947-0606 Fax:(305)949-3113 DISPUTE DISCLOSURE FORM Answer the following questions by placing a "X" after "Yes" or "No". If you answer "Yes", please explain in the space provided, or on a separate sheet attached to this form. 19.1. Has your firm or any of its officers, received a reprimand of any nature or been suspended by the Department of Professional Regulations or any other regulatory agency or professional associations within the last five (5) years? YES NO x 19.2. Has your firm, or any member of your firm, been declared in default, terminated or removed from a contract or job related to the services your firm provides in the regular course of business within the last five (5) years? YES NO x 19.3. Has your firm had against it or filed any requests for equitable adjustment, contract daims, Bid protests, or litigation in the past five (5) years that is related to the services your firm provides in the regular course of business? YES NO x If yes, state the nature of the request for equitable adjustment, contract daim, litigation, or protest, and state a brief description of the case, the outcome or status of the suit and the monetary amounts of extended contract time involved. I hereby certify that all statements made are true and agree and understand that any misstatement or misrepresentation of falsification of facts shall be cause for forfeiture of rights for further consideration of this Bid for the City of Sunny Isles Beach. �qyJ46 111//// UNIQUE C-ARTERS, INC. ye / //Firm D / / / A''� _ iris Smith, Operations Manager Authoriz•. Signature Print or Type Name and Title DEcenaFA ze,2010 6 of 7 t y0$NY IS,EJ ANTI - KICKBACK City of Sunny Isles Beach 18070 Collins Avenue `•�•r1o� o�` Sunny Isles Beach,FL 33160 o. sus Telephone:(305)947-0606 Fax:(305)949-3113 ANTI-KICKBACK AFFIDAVIT STATE OF FLORIDA ) COUNTY OF Mian: Dade ) I, the undersigned, hereby duly sworn and deposed say that no portion of this sum herein Bid will be paid to any employees of the City of Sunny Isles Beach or its elected officials as a commission, kickback, reward or gift, directly or indirectly by me or any member of my firm or by an officer of the corporation. Title: Operations Manager The foregoing instrument was acknowledged before me this °l day of Y n cz L , 20 (CD , by k (� `3nee - [name of person], as Oi°0C 77Ot) S /1--bi OFA [type of authority], for (%Nr/ _ (172 S [name of party on behalf of whom instrument was executed]. AFFIX NOTARY STAMP HERE: -RS P ` Notary Public — State of Florida RICHARD a NZERIBE NOTARY — PUBLIC-- _.P�'. . STA tt TE OF FLORIDA '. Cam.FF920228 Print or Type Commissioned Name Expires 12/14/2019 Personally Known ' OR Produced Identification Type of Identification Produced DECOIBER 28,2010 7 of 7 001790 Local Business'Tax Receipt ® E - s Miami-DadeCounty,_ _State -of• :Florida ' .THIS IS NOTABILL DONOTPAY ,-, ( Y �Y. 5185053 BUSINESS NAME/LOCATION 'I`" n RECEIPTNO _ EXPIRES'— ?!3 UNIQUE'CHARTERSINC v . t4 RENEWAL 'SEPTEMBER 30 2016t' i 160 NW.176 ST 200-1 ;; 5479387 Must be displayed at place'of.business ..5 MIAMI F1 33169 _ h --a-,' t , ct -, - Pursuariitc County:Code =yr `rel+` i ? ,p'-'"' r Chapter8As`Art:9&10>:....j..'L._ 1 'Y OWNERo-- SEC.TYPE OF BUSINESS ..:7-SV PAYME T}RECEIVED s rUNIQUE CHARTERS INC `t • _ata SERVICE BUSINESS ;t.; BY TAX COLLECTOR R 'r- i; Ern Ib ee s ;10 +3 -,..' ..7"-L` -- % '" P y � � s7s.ao o9/oe/zols - ,-_ s'CREDRPARD 15-044745`' _1 iY This Local Business Tax Receipt only confines payment-1)1111e Loial Business Tex.The Receipt is note Mensa, 7' C permit ore canlficdtion of the holders qualifications,tido business. Holdei mest comply with any governmental- ornongorenunental regulatory laws and requirements which apply to the business:e-f- . 'a' •-The RECEIPT,NO.above must be displayed on all commercial vehicles Miaml-Ode Code Sec a-DB 1 t For more Information.visitwwwmiemidede.00vhakmlecto[„i. -' • • z`r•Sje?,nr:•11,4ZIC;OF&PlItt591-1Gro:MSNSULPianlitSV: „K.?, -c-rz. • W:1?..47:17‘ r.:::„trA• . ars to!149 ' ••• ri--1.1 frwr.W Wt - 14- ; 0 fOt.,4,:s : '13 • , fr't .cft r • 43: au ,flre„ p PC..-t5vr rr, vit,4 k-i A eivit P “JI.4,F. 'Nib gat Mit n 7.c.Vtr;: • rirer, ./1141AillECT-47PPOl_t . ,v.i -A„• • rez,1„ 44-Aiiy.t?Nt : ;14%.,?; r. il C1 -ta1 1.fi • • • • • -- 1 , • • • • • • • ACCORD CERTIFICATE OF LIABILITY INSURANCE DATE s 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 ACT NAME Melody Gibson RRL Insurance Agency PHONEFAX 4450 W Eau Gallie Blvd., #115INC Na Eat1.800-407 4077 I(A/C,Hoi:321-752-7980 E-MAIL Melbourne FL 32934 ADDRESS: INSURER(S)AFFORDING COVERAGE L NAC II INSURER A:New York Marine and General Insuran 6608 INSURED INSURER B: Unique Charters, Inc. INSURER C: 160 N.W. 176th Street Suite 200-1 INSURER D Miami FL 33169 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:693677312 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. PORI TYPE OF INSURANCE DDL SUBR I M/DDYIYEYYY)I IMWDOMYYY) INSR WVO POLICY NUMBER LIMITS A GENERAL LIABILITY Y GL201500005285 11/9/2015 11/9/2016 EACH OCCURRENCE 51,000,000 DAMAGE X COMMERCIAL GENERAL UABILITY PREMISES(Ea occurreDnce) 5100.000 CLAPASdMDE X OCCUR MED EXP(Any one person) 55.000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE 52,000,000 GENL AGGREGATE LIMIT APPUES PER: PRODUCTS-COMP/OP AGG 51,000,000 X I POLICY[JFa LI LOC $ A AUTOMOBILE LABILITY Y AU201500005792 11/13/2015 11/13/2016 {COMBINED INGLE LIMIT I $5,000,000 — ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED _ AUTOS X AUTOS BODILY INJURY(Per accident) S X X NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTO$ (PotaxMent) S I $ UMBRELLA LIAR OCCURI$ EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE I AGGREGATE I$ DED RETENTIONS I $ WORKERS COMPENSATIONWC STAT)- OTH- AND EMPLOYERS'LIABILITY YIN I TORY I IMO'S I I ER I ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? n NIA E.L.EACH ACCIDENT S (Mandatory In NH) E.L.DISEASE-EA EMPLOYE$ $ I/yes,desvibe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101.Additional Remarks Schedule,If more space is requfred) CERTIFICATE HOLDER CANCELLATION 30 DAYS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Keolis Transit America ACCORDANCE WITH THE POLICY PROVISIONS. 1500 SW 40th St Fort Lauderdale FL 33315 AUTHORgaan RR//EP�RESE` TA p '22 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD