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HomeMy WebLinkAboutHB Hoffman Inc.City of Sunny Isles Beach | Invitation to Bid No. 16-09-02 17 Section 4 Bid Submittal Instructions & Forms BID DATES & TIMES Bid Issuance ........................................................... 09/15/2016 Questions Due ........................................... 10/07/2016 5:00pm Bid Due & Opening .................................... 10/31/2016 2:30pm BID PACKET Bidders must include the following Bid Forms, Bonds & Affidavits and in the following order: Bid Form 1 ................................................................ Bid Cover Bid Form 2 ...................................... Addenda Acknowledgement Bid Form 3 ............................................................... Bid Pricing Bid Bond Affidavit............................................................... Non-Collusion Affidavit...................................................... Public Entity Crimes Affidavit.............................. Equal Opportunity/Affirmative Action Affidavit........................................................ Conflict of Interest Affidavit........................................................ Dispute Disclosure Affidavit................................................................ Anti-Kickback BID SUBMITTAL Submit one (1) original, four (4) copies, and one (1) electronic file in a sealed envelope addressed to the City Clerk at: Attn: City Clerk City of Sunny Isles Beach 18070 Collins Ave., 4th Floor Sunny Isles Beach, FL 33160 The sealed envelope must clearly state: IMPORTANT, BID ENCLOSED Bid No. 16-09-02 New HVAC Chiller Systems for Government Center OPENING DATE AND TIME: Thursday, 10/31/2016 at 2:30PM City of Sunny Isles Beach | Invitation to Bid No. 16-09-02 18 BID FORM 1 BID COVER Bid Title: New HVAC Chiller Systems for Government Center 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 ITB and Instructions to Bidders, including without limitation those dealing with the disposition of Bid Security. 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 and other documents required by this ITB 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. The Bidder understands and agrees that the Bid is for unit prices to furnish and install individual Work Items for maintenance and/or repair work, complete in place. Estimates are provided for the purpose of Bid evaluation and to establish unit prices for individual Work Items for maintenance and/or repair work to be contracted by the City under individual Purchase Orders, based on the unit prices established under this Bid. The City and the successful Bidder will establish completion times for each individual Work Item and the successful Bidder agrees that the work will be completed within the time frames agreed upon and stipulated in the individual Purchase Orders and/or Notice to Proceed. Exact Legal Company Name: ______________________________________________________________ Business Name (dba), if any: ______________________________________________________________ Street Address: __________________________________________________________________________ HB Hoffman, LLC N/A 1340 Stirling Road, Ste 3B, Dania Beach, FL 33004 Mailing Address (if different):Same as above Telephone No,: 954-362-7325 Fax No.t 95+362-7327 Email Address: kbays@hbhoffmanllc.com FEIN No.: 27-2f$O44 * By signing this document the bidder agrees to all Tems ./ th Authorized Sionature: [d^t*6".// Print Name: Kara Hoffman Bays ''f itle: Presiden! THE EXECUTION OF THIS FORM CONSTITUTES THE UNEQUIVOCAL OFFER OF BIDDER TO BE BOUND BY THE TERMS OF ITS BID, FAILURE TO SIGN THIS SOLICITATION WHERE INDICATED ABOVE BY AN AUTHORIZED REPRESENTATIVE SHALL RENDER THE BID NON- RESPONSIVE. THE CITY MAY, HOWEVE& IN ITS SOLE DISCRETION/ ACCEPT ANY BID THAT INCLUDES AN EXECUTED DOCUMENT WHrCH UNEQUTVOCALLY BrNDS THE BTDDER TO THE TERMS OF ITS OFFER, cityofsunny|s|esBeach||nVitationt"',o';.ry City of Sunny Isles Beach | Invitation to Bid No. 16-09-02 21 BID FORM 3 BID PRICING BIDDER AGREES TO PERFORM ALL THE WORK DESCRIBED IN THE CONTRACT DOCUMENTS INCLUDING ALL LABOR, EQUIPMENT, SUPERVISION, TESTING AND PERMITTING TO PROVIDE A COMPLETE TURN-KEY PROJECT CONFORMING TO THE REQUIREMENTS DETAILED BY THE SPECIFICATIONS, MANUFACTURER, OWNER, STATE, FEDERAL AND LOCAL AGENCIES FOR THE FOLLOWING LUMP SUM AND/OR UNIT PRICES. WORK INCLUDES BUT IS NOT LIMITED TO GENERAL, ELECTRICAL AND MECHANICAL CONSTRUCTION. BID ITEM # DESCRIPTION UNIT EST. QUANTITY UNIT COST EXTENDED COST Demolition of Existing HVAC Cooling Towers 1. Removal and disposal of existing infrastructure including but not limited to 50- TON Chiller, 200-Ton air cooled chiller, wood service platforms, chilled water pumps, piping and relocation of exiting expansion tank LS 1 $ $ Subtotal of Demolition of Existing HVAC Chiller Systems $ New HVAC Chiller Systems 2. New 250-TON water cooled Chiller to installed on existing structural curbs with modified steel frame including but not limited too new cooling tower, chilled water pumps, condenser pumps, piping, wall mounted variable frequency drives, filtration/treatment system, backflow preventer and electrical components LS 1 $ $ Subtotal of New HVAC Chiller Systems $ Temporary Chiller System 3. Temporary Chiller to serve the replace the existing Chiller system for the entire facility as needed during system turnover LS 1 $ $ 80,000.00 80,000.00 80,000.00 666,121 100,000 100,000.00 666,121.00 666,121.00 City of Sunny Isles Beach | Invitation to Bid No. 16-09-02 22 Temporary Chiller System $ PROJECT CLOSE OUT 4. As-built record drawings (electronic AutoCAD &PDF format and hard copy) LS 1 $ $ Subtotal of Project Close Out $ BID SUBTOTAL (1 – 4) $ CONTINGENCIES 5. Project Contingency (To be used at the sole discretion and direction of the Owner) 1 15% $ 6. Permit Allowance 1 $15,000 $15,000 BID TOTAL (1 – 6): $ 100,000.00 8,000 8,000.00 8,000.00 854,121.00 128,118.00 997,239.00 City of Sunny Isles Beach | Invitation to Bid No. 16-09-02 23 AFFIDAVITS NON.COLLUSION AFFIDAVIT Ciiy of Sunny lsles Beach 18070 Collins Avenue Sunny lslgs Bsach, FL 33160 Telephoner (305)947-0606 Fax (305) 949-3113 STATE OF FLORIDA ) couNTY oF _) The undersigned being first duly swom as provided by law, deposes, and saysl This Affidavit is made with the knowledgo and intent that it is to be filed with the City of Sunny lsl€s Beach City Commission and that it will be rolied upon by said County, in any consideration which may give to and any action it may take with respect to this Bid. The undersignod is authoriz€d to make this Affidavit on beh€lfof, a, Contrator , formed under the laws of Florida (Type of Business)(Stato) ofwhich he is President (Sole Owner, Partner, President, etc.) Neither the undersigned nor any person, firm, or corporation named in above Paragtaph 10.2, nor anyone else to the knowledge of the undersigned, have themselves solicited or employed anyone elso to solicit f€vorable action fof thls Bid by the City, also that no head of any departmont or employee therein, or any oflicer ofthe City of Sunny lsles Beach, Florida is dlrectly Interested thereln. This Bld is genuine and not collusive or a sham; the person, firm or corporation namod above in Paragraph 10.2 has not colluded, conspired, connived or agaood directly or indlrectly with any prcposers or person, firm or corporation, to put In a sham Bid, or that such pe6on, firm or corpo€tion, shall reftain trom Bidding, and has not in any manner, direcuy or indirectly, sought by agreement or collusion, or communication or conference wlth any porson, firm or comoration, to fix the prices of said Bid or Bids of any othor proposors; and all statemonts contained in tlon named above In Paragraph the Bid or Bids described above true; and further: neither the undersigned, nor the person, firm or corporbe lhereto, to any assoqiation or President AFFIANT'S TITLE TAKEN, SWORN AND SFSCRTBED TO BEFORE ME this _lL day of f)e.emher , 2001.6 Persorally Knowr -Vl or Produced lderlitication -: Type of identification (Affix seal here) {Name of Corporatlon, Partnership, lndivldual, etc.) DECEMBER26,20lO 1of10 2 of 10 Kara Hoffman Bays President HB Hoffman, LLC 1340 Stirling Road, Ste 3B Dania Beach, FL 33004 27-2143044 market value under an arm's lengtb aEreement, shall be a prime facie case that one person controls another person. A person who knowingly enters into a ioint 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. {1.5. I understand thal a "person" as defined in Para. 287 .133(1)(e), Florida Statules, 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 Contracls for the provision of goods or services let by a public entity, or which otherwise transacts or appljes 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. I 1.6. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. (lndicate which statement applies.) X 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 agenls 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 interesl to place the entity submitting this sworn statement on the convicled vendor lisl. (Attach a copy of the final order.) I UNDERSTAND THAT THE SUBMISSION OF THIS FORI\il TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 11.1 (ONE) ABOVE IS FOR THAT PUBLIC ENTIry 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 INFORI\4 THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AI\,4OUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES, FOR CATEGORY TWO OF ANY, CHANGE IN THE INFORI\4ATION CONTAINED IN THIS FORM- (Prinled Name) President (Title) Sworn to and subscribed before me this /3 day of_D9.g9!Ibq_, 20 16 , by By: Signature: OR Produced ldentification Type of ldentification Produced 10/1998 SIEPHANIE POLO MY CoMMlSstoN # GG 002356 EXP|REST Jlty 23, 2020gonaeO ruu tfofery p;r4lic Unaerwriroc 3ofl0 t'rt ,'- pn EQUAL OPPORTUNITY / AFFIRMATIVE ACTION City of Sunny lsles Beach 18070 Coltins Avenue Sunny lsles B€ach, FL 33160 Telephone: {305)947-0606 Fax: (305) 949-3113 EQUAL OPPORTUNITY/AFFTRMATM 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. Tifle:President Firm: HB Hoffman. LLC Address: 1340 Stirling Road, Ste 38 Dania Beach, FL 33004 sisned: { ,4ILT DECEMEER2S,201O 4of10 CONFLICT OF INTEREST City of Sunny lsles Beach 18070 Collins Avenue Sunny lsles Beach, FL 33'160 Telephone: (305) 947-0606 Faxr (305)949-3113 CONFLICT OF INTEREST STATEMENT The award of any contract hereunder is subject to the provisions of Chapter 112, Flo(ida 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 lsles Beach or its agencies. STATE OF FLORIDA COUNTY OF BEFORE lVE, the undersigned authority, personally appeared Kara Hoffman Bays who was duly sworn, deposes, and states: 18.1. I am HB Hoffman, LLC Presiclent witn a loffi ano orinlioat of office in 18.2. The above named entity js submitting a Bid for the City of Sunny lsles Beach, Bid No. 16-09-02 described asr 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 Afflant 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 submilting Bids for the same project. 18.4 Neither the Atfiant nor the above named entity has direcUy 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 entily 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, 18,7 | 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 lsles Beach. 18.8 | 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 lsles Beach. 18,9 In the event that a conflict of jnterest is identifled in the provision of services, l, on behalf of the above named entity, will immediately notify the City of Sunny lsles Beach. , zol0.2016 Sllprn to and subscribed before me thisg Personally Known - day of December ,2010, 16 OR Produced ldentification _i Type of ldentificatj NOTARY PUBLIC STATE OF FLORIDA sTEPft l.ilE PoLO MY CoMMtsstoN # GG 002356 EXPIRES: Juty 23, 2020 Eonded Thru Notary pubDc UndorujieE Print or Type Name and Title DECEMBER 28,201O Sle,pLat,z (tb DISPUTE DISCLOSURE City of Sunny lsles Beach 18070 Collin6 Avenue Sunny lsles Beach, FL 33160 Tel€phone: (305) 947{606 FaK (305) 049-3113 DISPUTE DISCTOSURE FORM Answer the following questions by placing a "X" after '.Yes,, or '.No". ff you answer ..yes', please explain in the space provided, or on a separate sheet attached to this folm, l9'1' 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 NOX 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 equltable adjustment, contract claims, Bid protesb, or litigation in the past five (5) years that is related to the seruices your firm provides in the regular course of business? YES- NO X If yes, state the nature of the request for equitable adjustment, contract claim, 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 certiry that all statements made are true and agree and understand that any misstatement or misrepresentation of falsification of facts shall be cause for fofeiture of rights for further cons'tderation of this Bid for the City of Sunny Isles Beach. L2/19t\6 Date Kara Hoffman Bavs President Print or Type Name and Title Firm /----7Y--, Authorized Slgnature DECEMBER2S,20iO 6of10 ANTI-KICKBACK City of Sunny lsles Beach 18070 Colllns Avenue Sunny lsles Beach, FL 33160 Tslophone: (305) 947{606 Faxr (305) 949-3113 ANTI-KICKBACK AFFIDAVIT STATE OF FLORIDA COUNTY OF 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. By: Title: The foregoing December instrument was acknowledged before me this | 3 a"v ot 20_!5...- by Kara Hoffman Bays [nameof personl, as President ltype of authority], for HB Hoffman, LLC fname of party on behalf of whom instrument was AFFIX NOTARY STAMP HERE: Personallv Known OR Produced Identification Type of Identification Produced ) ) ) /^L^^r$t ,./v - Presideut Notary Public - State of Florida STEPMI{IE POLO MY CoM tsstoN * GG 002356 PolRESr July 20 A020 Print or Type'Commissioned Name DECEMBER28,201O 7of10 City of Sunny Isles Beach 18070 coilins Avsnu€ Sunny tsl€s Bsach, FL 33160 Telephone: (305) 947-0806 Fax (305)949,3113 STATE OF FLORIDA ) coUNTY OF lvliami-Dade ) KNOI / - ALL MEN By THESE. . PRE5ENTS, that we, HB Hoffman. LLC as pdrcipat, andunltga stqtg rire tn , as diEiil?Fietd ana flrmty-bounirrito the city of dunny tstesBeach, a munlclpal corpoEtion of lhe State of Florida in lhe sum of Five PeI.ent of Amolnt Bicr Do ers (g 5"6 oi amounL Big- lawiulmoney of the Unlted SlEl€s, for the payment of which sum well and lruly to be made, we bind ourselves, ow heirs, exeiii6El-admirrrsrrators and successors jqintly and severally, f rmly by these presents, THE CONDITION OF THIS OBLIGATION lS- SUCH that whereas th€ F ncipal has submift€d the accompanying Bid dated,October 31sL ^2gjxror: New HVAC Chiller Syster4s for covernr]ent CenLei.zt to WHEREAS, jt was a conditlon precedent 10 the submission of said Bjd that a caEhier's check or Bid Bond in the amount of five percent (O%) of the Base Bid be submiited wilh said Bid as a guarantee that ihe Proposers \iyould, If awardEd lhe Contract, enter into a written Contract with tho City for lhe pertormance o{ said contract, within ten (1o) consecuiive calendaf days after wdtt€n notice heving been given of the Alrard oflhe Conkact NOW, THEREFORE, ihe condfions of ihis obligaiion are slch (hat if the Princlpal wlhin ten (1O) consecuiive calendar davs after wrilennotice ofsuch acceptance, enters inlo a wrltten Contract wlth the City oF Sunny lsles Beach and iurnishes the pedormence gr:icl sanqra*.-notice ofsuch acceptance, enters inlo a wrltten Contract wlth the CitV oF Sunnv damages for failure thereof of said Principal. N WITNESS WHEREOF, thE DOCU[JENT CONTINUES ON NEXT PAGE IN PRESENCE OF: HB Hoffman, LLC lndivlduai or Partnership PrIncipal 1340-3B Stirlins Rd Business Address Dania Beach. FL. 33004 Chy, State, and Zip Cod€ (954) 362-7325 Buslnsss Telephone Afflx Calporaie Seal lUth d6yof---Q9!9b9f ,20_1]0_, the namE and the cofpora;te seal of each corporate party being being dulysigned byitsundersignedr€presenta{v€. (954\ 362-7327 Business Facaimile 4-6.Es.'1.As Per Aitached Power of Attorney Uliled statecEle+:uatqlgeqe-y _ 'lmpress Corporate Seal IMPORTANT sulety conDanies executing bonds musl appear on the Treasury Department's most curfent list (circularsTO as amended)and be authorized to ttansact business in the Slate ofFlorida- IofI0 The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person)$ PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS PER STATUTE OTH- ER E.L.EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes,describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE (A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACT NAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S)AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INS025 (201401) 12/12/2016 Frank H. Furman, Inc. 1314 East Atlantic Blvd. P. O. Box 1927 Pompano Beach FL 33061 Sandra LaRue (954)943-5050 (954)942-6310 sandra@furmaninsurance.com HB Hoffman, LLC 1340 Stirling Rd Suite 3B Dania Beach FL 33004 Ohio Security Insurance Co 24082 Commerce & Industry Insurance Co 19410 16-17 GL/Auto/UMB A X X X X BKS57103267 1/26/2016 1/26/2017 1,000,000 300,000 15,000 1,000,000 2,000,000 2,000,000 A X X X BAS57103267 3/18/2016 1/26/2017 1,000,000 B X X EBU021339095 3/18/2016 1/26/2017 5,000,000 5,000,000 A Leased/Rented Equipment BKS57103267 1/26/2016 1/26/2017 Limit $50,000 Deductible $1,000 City of Sunny Isles Beach is listed as additional insured for general liability as required by written contract. Dirk DeJong/SL City of Sunny Isles Beach Office of the City Clerk 18070 Collins Avenue Sunny Isles Beach, FL 33160 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS AUTOSAUTOS NON-OWNEDHIRED AUTOS SCHEDULEDALL OWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD 12/12/2016 Automatic Data Processing Insurance Agency, Inc. 1 Adp Boulevard Roseland, NJ 07068 HB HOFFMAN LLC 1340 STIRLING RD Dania, FL 33004 FirstComp Insurance Company 27626 590739 A Y N MWC0023612-05 01/26/2016 01/26/2017 X 1,000,000 1,000,000 1,000,000 Job Reference: ITB 16-09-02 Office of the City Clerk City of Sunny Isles Beach 18070 Collins Avenue North Miami Beach, FL 33160