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HomeMy WebLinkAboutTenex #1 .., . ..., . ., . ..., . .., . ..., . ., . n . '1 . r, . n . f'l . ,.., . ,..., . .., . .., . I' . n . n . . SECTION 00300 BID FORM Bid of ~}~'/. fjJ7MQ(l1 SC~ ,. +-,~J C Address ef.D Sw \~\-k COt){\" I ~pa.nD (!)Ci, I Fe. -S30~C) Phone ~~- 783' f)rt0 To furnish all materials, equipment and labor and to perform all work in accordance with the Contract Documents for construction of: Median Closure at NE 175th Terrace on Collins Ave. and SR A1A/Collins Ave. at 183rd St. Streetscape Improvements located in the CITY OF SUNNY ISLES BEACH. To: CITY OF SUNNY ISLES BEACH 18070 Collins Avenue Sunny Isles Beach, Florida 33160 The undersigned Bidder has carefully examined the Bidding Documents and the site of the proposed work and is familiar with the nature and extent of the work and any local conditions that may in any manner affect the work to be done. The undersigned Bidder agrees to do all the work and furnish all materials called for by the Bidding Documents, in the manner prescribed therein and to the standards of quality and performance established by the Engineer for the unit price amounts stated in the spaces herein provided, for each of the items or combination of items stipulated. Unit price line items shall include cost of implementing all applicable safety requirements. Bidder acknowledges that estimated quantities scheduled are approximated for the sole purpose of obtaining comparative bids for determination of the lowest responsible responsive bidder and actual quantities required may increase or decrease. Bidder further agrees that payments will be made on the basis of actual quantities placed and accepted in the construction ~ ,c'"" ~ ..~ ,",""C, r~ . '1~..' fI'J;t'\ l-"" . _; ..;./ .~,,--,J It. '-.J '"-' '...,>' - - OCT 2 0 2009 .,.,. O~~' !,',rr;,' I'~I rs :::t'.CH C\ I' r ",'(J".f~ t ~"""_..... 09/09 00300-1 03-4122.F OCT-16-2009 FRI 09:58 AM CALVIN & GIORDANO FAX NO. 0 . p, 03/04 MEDIAN CLOSURE AT NE 175TH TERRACE ON COLLINS AVE. AND SR A1A/COL-LINS AVE. AT 183RD 51 STREETSCAPE IMPROVEMENTS Bid Estimated Estimated Item Description Quantity Unit Unit Price Total ". I.S ~ tV 1000 \\'0 J ()\"'O \\ 101(100 7 EA , ~') ~ 2 EA ~ \ 0 9 EA =\~ i ~~~~~ 7 EA 19 EA ~ 1 SO 5,270 SF \ ~ '1 C, _~ '2 )IO~1.. S 0 292 SF ~ -Ii \,1SL I. General 1 Mobilization/Demobilization (< 5% of total bid) Maintainance of Traffic. to included but not limited to all required barricades, board arrows, and off- duty officers as required for traffic control, during the entire construction 2 tIme. 1-5 ~ 'JO,Ol)O LS l2.Q.ooO . Sub.Total Ganeral II. MeDian CloBure at NE 175th Terrace 3 Proposed Median Closure (completel including all labor, equipment,permits and materials necessary for final product. Complete median closure to include, but not limited tD. all excavation, backfill. compactlon, base, eubgrade, paving, curbing, striping, signage, landscape and irrigation as Indicated in plans. Sub-Total Median Closure at NE 175th Torraco III. Streetscape Improvoments A. Treoand Palm protection. removal and relocation 4 Tree and Palm protection 3".24" caliper 5 Tree and Palm removal 3" . 12" caliper 6 Tree and Palm removal 13" - 24." caliper 7 Tree and Palm relocation 3" . 12" caliper e Tree and Palm relocation 13" - 24" celiper B. PavIng 9 Pavers set on sand 10 Pavors set on concrete C. Plants 11 Silver Buttonwood 12' th 8' csd 4' ct 3 tk 2" clpr 12 Small Leaf Clusia 48" ah 4B" as 14" ncd 13 Cocoplum 48" ah 36" as 14" ncd 14 Flax Lilly 18" an 16" es 10' ncd 15 Dwarf Fig 18" ah 18" liS 10 ned 16 Beech B18nl(6t Flower 12" ah 12" as 6" ned 17 Date Palm 24' oh 11' ct bb 16 EA 268 EA 116 EA 416 EA 1/057 EA 253 EA 30 EA 1 EA l1~l~ 1 EA 4 EA ~ "2"1 ~; 1 EA i ~() 6 EA 6 EA it b~SO 7 LF 415 LF \\ \.0 D. Irrigation Equipment (Furnish and Installl 1 B Automatic Controllar Rainbird esp-Ixm-sm8 19 Rain Sensor Switch Hunter mini-click-c-bpsw 20 Automatic Electric Valve Rainbird 160-peb-prll-d 21 Gate Valve Nibco T-113 22 Valva Box aUBzite pg 1 324bb 1 e 23 Valve Box Covers Quazite PIiJ 1324caOO 24 1-1/2" Irrigation Main PVC plastic pipe and fittIngs 25 2" Irrigation Main PVC plastic pipe and fittings E. Sprlnklllrs Including ABeociated SWlngjolnt. Piping. and RninQ8 26 Toro 570z-4p 409 EA j ~ 0 09/09 . Add#3 00300.2 ~ 'l.U ,roo \\"2~Q(A) ~ t\ 0 I tL"'I{) .} 21~gO ~., ") ~ ; /) ~, ~ ~ ~() '-\5. S'O l\,\SO j, \2.21.~ 03-4122.F OCT-16-2009 FRI 09:58 AM CALVIN & GIORDANO FAX NO, 0 p, 04/04 MEDIAN CLOSURE AT NE 175TH TERRACE ON COLLINS AVE. AND SR A1A/COLLINS AVE. AT 183RD ST STREETSCAPE IMPROVEMENTS Bid Estimated Estimated Item Deseri tion Quantity Unit Unit Price Total F. Furnishings (Furnish and Install) 27 Steel Bench Dumor 119 Series 74"1 x28"d x 32"ht 6 EA ~ '21"'bo \h \ tl. II 0 0 28 Steel Litter Aeceptable Dumor 84-22-1to 28"dla x 32"ht L l i q 00 J ." boD 4 EA 29 Bus Stop Shalter Tolar Shelters 6549.000301354 solar ( lighting 13'1 x 4'-S"d x S'-2"ht EA ~ 'lO.(')l1(') ) W.w\) . G. LIghting 30 Pole Light Holophane fixture /I Be" Odmh24-b-5-n-s.b.f2 'b S,ooO ~ L\O,O\X1 City Manufacturing pole 11 was 12-bk-2pcb-p3 B EA 3' Uplight Hydrel series 7000 /17000-70cmtS.120-mfl-wh- ~ \ 1'400 ~ ~L boo air 44 EA . H. Miscellaneous 32 Clear and Grubbing 1 LS \\ \0 Qf"X) t ~;~ 33 Removal of Existing Concrete 1,000 SV \. b 34 Base Optional 1,800 SV ~ ~ b \ l\ ~(I).') 35 Valve Boxes Adjust 3 EA -l~() ~ 36 Manhole Adju$t 1 EA t \~~1() '37 Curb and Gutter Cone. Type F 130 LF ',:>, Sub-Total Streetscape Improvements I. '121 ~ 6 "31.\ -tLJ I _ TOTALBAS'.'Dl1...ms:Th~III) ~-~ _~_::~ _ ~,l...Ll..Jt r;~...I1- ~Q. h..1J"..,\ ~ ~~ / oS \ _ ~ Written. II'" L . (\:y'o~ \,,-1'\o{'~ ('. "0) I 1~ ~ ~ ~ '-- __ \;:yO c-\- ~ ~ (Contractor) ~, (Date) 09/09 . Add#3 00300-3 034122.F ,., . ..., . BID SECURITY . Accompanying this Bid is a certified or cashier's check or a bid bond in the amount of 1 5 % of the bid payable to the Owner which may be forfeited as liquidated damages if, in the event this proposal is accepted, the undersigned fails to execute the Agreement and furnish and pay for the required performance and payment bonds for the Owner within 10 days after acceptance of the Bid; otherwise said certified or cashier's check or bid bond will be returned to the undersigned. ,.., . ,., r"1 . The undersigned Bidder agrees to commence work within 1Q days after the date of written Notice to Proceed, and further agrees to substantially complete the work within 130 consecutive calendar days after the date of written Notice to Proceed, subject to such extensions of time allowed by the Conditions of the Contract. r"1 . . The undersigned Bidder also agrees to complete the entire work within 160 days after the Contract time commences to run. ,., .., . The undersigned Bidder agrees that this Bid shall be good and may not be withdrawn for a period of 60 days after the scheduled closing time for receiving bids. ,., . The undersigned agrees to forfeit to the Owner, as liquidated damages for each calendar day elapsing between the date established as the date of substantial completion and the actual date of such substantial completion of the contract work, the amount of $1,500.00 per calendar day. ..., . The undersigned further agrees to forfeit to the Owner, as liquidated damages for each calendar day elapsing between the date established as the date of final completion and the actual date of final completion of the contract work, the amount of $1,000.00 per calendar day. ..., . .., . .., - ., . .., . , . ..... . ..., - ..., 09/09 00300-4 03-4122.F - ..., . r"1 . ,., ADDENDA Bidder aredges the ceiT No.'s 1. L,z. ,3. ,4. ,5. Dated this 2D day of (9(,1- 'luo9 . (month) (year) . r-, . ..., . . Contractor: ~lr::'I- e..1I'J~ Authorized Representative . I' "1 . Title ~\ Ot)J-r <&S') ~ I <f ~ t-.. UJ() (' + ~Of\t rl.fM{) C1uk! r t Address: r"'1 . 5561~f) * " . SEAL * r"'1 . - Attachments: Subcontractor List Bid Security Trench Safety Act documentation .., .., . ..., END OF DOCUMENT . .., . ., . ,., . r"'1 . ..., - ..., 09/09 00300-5 03-4122.F - ,.., . DOCUMENT 00401 ,.., . BID BOND BIDDER (Name and Address): ..., . II . SURETY (Name and Address of Principal Place of Business): " . OWNER (Name and Address): 'I . CITY OF SUNNY ISLES BEACH 18070 Collins Avenue Sunny Isles Beach, Florida 33160 ..., . BID BID DUE DATE: PROJECT (Brief Description including Location): ,..., . ,.., . ,.., . BOND BOND NUMBER: DATE: (Not later than Bid Due Date): PENAL SUM: I"'"'l . IN WITNESS WHEREOF, Surety and Bidder, intending to be legally bound hereby, subject to the terms printed on the reverse side hereof, do each cause this Bid Bond to be duly executed on its behalf by its authorized officer, agent, or representative. ..., . BIDDER SURETY ,..., . (Seal) (Seal) Bidder's Name and Corporate Seal Surety's Name and Corporate Seal ~ By: By: . Signature and Title Signature and Title (Attach Power of Attorney) ..., . Attest: Attest: Signature and Title Signature and Title ., . Note: (1 ) (2) Above addresses are to be used for giving required notice. Any singular reference to Bidder, Surety, Owner or other party shall be considered plural where applicable. .., . ,.., . - 09/09 00401 -1 03-4122.F - ..., . .., . 1. Bidder and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors and assigns to pay to Owner upon default of Bidder any difference between the total amount of Bidder's bid and the total amount of the bid of the next lowest, responsible and responsive bidder as determined by Owner for the Work required by the Contract Documents, provided that: 1 .1. If there is no such next lowest, responsible and responsive bidder, and Owner does not abandon the Project, then Bidder and Surety shall pay to Owner the penal sum set forth on the face of this Bond, and 1.2. In no event shall Bidder's and Surety's obligation hereunder exceed the penal sum set forth on the face of this Bond. r-, . .., . .-, . ,..., . 2. Default of Bidder shall occur upon the failure of Bidder to deliver within the time required by the Bidding Documents (or any extension thereof agreed to in writing by Owner) the executed Agreement required by the Bidding Documents and any performance and payment bonds required by the Bidding Documents and Contract Documents. .., . ,.., . 3. This obligation shall be null and void if: 3.1. Owner accepts Bidder's bid and Bidder delivers within the time required by the Bidding Documents (or any extension thereof agreed to in writing by Owner) the executed Agreement required by the Bidding Documents and any performance and payment bonds required by the Bidding Documents and Contract Documents, or 3.2. All bids are rejected by Owner, or 3.3. Owner fails to issue a notice of award to Bidder within the time specified in the Bidding Documents (or any extension thereof agreed to in writing by Bidder and, if applicable, consented to by Surety when required by paragraph 5 hereof). ,., . ...., . -. . .., . 4. Payment under this Bond will be due and payable upon default by Bidder and within 30 calendar days after receipt by Bidder and within 30 calendar days after receipt by Bidder and Surety of written notice of default from Owner, which notice will be given with reasonable promptness, identifying this Bond and the Project and including a statement of the amount due. ,.., - ., . -, . 5. Surety waives notice of and any and all defenses based on or arising out of any time extension to issue notice of award agreed to in writing by Owner and Bidder, provided that the total time for issuing notice of award including extensions shall not in the aggregate exceed 120 days from Bid Due Date without Surety's written consent. 6. No suit or action shall be commenced under this Bond prior to 30 calendar days after the notice of default, as required in Paragraph 4 above, is received by Bidder and Surety and in no case later than one year after Bid Due Date. 7. Any suit or action under this Bond shall be commenced only in a court of competent jurisdiction located in the state in which the Project is located. 8. Notices required hereunder shall be in writing and sent to Bidder and Surety at their respective addresses shown on the face of this Bond. Such notices may be sent by personal delivery, commercial courier or by United States Registered or Certified Mail, return receipt requested, postage pre-paid, and shall be deemed to be effective upon receipt by the party concerned. 9. Surety shall cause to be attached to this Bond a current and effective Power of Attorney evidencing the authority of the officer, agent or representative who executed this Bond on behalf of Surety to execute, seal and deliver such Bond and bind the Surety thereby. 10. This Bond is intended to conform to all applicable statutory requirements. Any applicable requirement of any applicable statute that has been omitted from this Bond shall be deemed to be included herein as if set forth at length. If any provision of this Bond conflicts with any applicable provision of this Bond conflicts with any applicable provision of any applicable statute, then the provision of said statute shall govern and the remainder of this Bond that is not in conflict therewith shall continue in full force and effect. 11. The term "bid" as used herein includes a bid, offer or proposal as applicable. -, . r-, . ,.... 09/09 . r 1 . 00401-2 03-4122.F I I I I I I I I I I I I I , I I , I I DOCUMENT 00401 BID BOND BIDDER (Name and Address): Tenex Enterprises, Inc. 850 SW 14th Court pnmp::mn Rp::H.h, 14'1 11060 SURETY (Name and Address of Principal Place of Business): First Sealord Surety, INc. 789 E.. Lancaster Ave. ,_VilJaIloY<il. PA. 19085 OWNER (Name and Address): ,CITY OF SUNNY ISLES BEACH 18070 Collins Avenue Sunny Isles Beach, Florida 33160 BID BID DUE DATE: 10/20/09 PROJECT (Brief Description including Location): M~i1ianClosured175 Terr on Collins Ave. and SR AlA at 183 St. BOND . -SOND NUMBER: 09 -<\'~L- DATE: {Not later than Bid Due Date}: 10/20/09 PENAL SUM: ' Five Percent IN WITNESS WHEREOF, Surety and Bidder, intending to be legally bound hereby, subject to the terms printed on the reverse side hereof,' do each cause this Bid Bond to be duly executed on its behalf by its authorized officer, agent, or representative. BIDDER Tenex Enterprises, Inc. (Seal) Bidder's Na,~m. an _ porate ~I BY.} ~m~~ - Signature--and Title ou adi President Attest: SURETY By: Signature and TitleMichele Council Attach Power of Attorney) Attorney in Fact Attest: Note: (1) (2) Above addresses are to be used for giving required notice. Any singular reference to Bidder, Surety, Owner or other party shall be considered plural where applicable. 09/09 0040.1-1 03-4122.F I I I I - I I I I I I I I I I I I I I ... 1. Bidder and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors and assigns to pay to Owner upon default of Bidder any difference. between the total amount of Bidder's bid and the total amount of the bid of the next lowest,. responsible and responsive bidder as determined by Owner for, the Work required by the Contract Documents, provided that: 1 .1. If there is no such next lowest, responsible and responsive bidder, and Owner .does not abandon. the Project, .then Bidder and Surety shall pay to Owner the penal sum set'forth on " " ."-.-.-- "c..the-face-oNhis'Sond;uand 1.2. In . no event shall Bidder's and Surety's obligation. hereunder" exceed the penal sum set forth on the face of this Bond. 2. Default of Bidder shall occur upon the failure of Bidder to deliver within the time required by the Bidding Documents (or any extension thereof agreed to in writing by Owner) the executed Agreement required by the Bidding Documents and any _ performance. and payment bonds required by the Bidding Documents and Contract Documents. -' . 3. This obligationshall be null and void if: 3.1. Owner accepts Bidder's bid and Bidder delivifrs Within the. time required by the Bidding.- Documents (or any extension thereof agreed to in writing by Owner) the executed Agreement required by' the Bidding Documents ... and any performance and payment bonds required by the Bidding Documents and Contract Documents, or . 3.2. All bids are rejected by Owner, or 3.3. Owner fails to issue a notice of award to Bidder. within the time specified in the Bidding' Documents (or any extension thereof agreed to in writing by Bidder and, if applicable, consented to by Surety when required by paragraph 5 hereof). 4. Payment under this Bond will be due and payable upon default by Bidder and within 30 calendar days after receipt. by Bidder arid within 30 calendar days after receipt by Bidder and Surety of wrinen notice of default from Owner, which notice will be given with reasonable promptness, identifying this Bond and the Project and including a statement of the amount due. 5. Surety waives notice of and any and all defenses based on or arising out of any time extension to issue notice of award agreed to in writing by Owner and Bidder, provided that the total time for issuing notice of award including extensions shall not in the aggregate exceed 120 days from Bid Due Date without Surety's written consent. 6. No suit or action shall be commenced, under this Bond prior to 30 calendar days after the notice of default, ' as required in. Paragraph 4 above, is received by Bidder and Surety and in no case later than one year after Bid Due'Date;--'-"- 7. Any suit or action under this Bond shall be commenced only in a court of competent jurisdiction located in the state in which the Project is located. 8. Notices required hereunder shall be in writing and sent to Bidder and Surety at their respective addresses shown on the face of this Bond. Such notices may be sent by personal delivery, commercial courier or by United States Registered or Certified Mail, return receipt requested, postage pre-paid, and shall be deemed to be effective upon receipt by the party concerned. 9. Surety shall cause to be anached to this Bond a current arid .effective-Po\fi!er' of. Attorney eviaenCiiig the authority of the officer, agent or representative who executed this Bond on behalf 'of Surety to execute, seal and deliver such Bond and bind the Surety thereby. 10. This Bond is intended to conform to all applicable statutory requirements. Any applicable requirement of any applicable statute that has been omitted from this Bond shall be deemed to be included herein as if set forth at length. . If any provision of this Bond conflicts with any applicable provision of this Bond conflicts with any applicable provision of any applicable statute, then the provision of said statute shall. govern. and the remainder of this. Bond that is not in conflict therewith shall continue in full force and effect. 11. The term "bid" as used herein includes a bid. offer or proposal as applicable. 09/09 00401-2 03-4122.F KNOW ALL MEN BY THESE PRESENTS: That First Sealord Surety, Inc., a corporation of the Commonwealth of Pennsylvania, (hereinafter the "Company") has made, constituted and appointed, and by these presents does make, constitute and appoint Michele Council and/or Gladys Keith all of Lake Placid, Florida its true and lawful Attorney-in-Fact, to make, execute and deliver on its behalf insurance policies, surety bonds, undertakings and other instruments of a similar nature as follows: .......... Not To Exceed Five Million Dollars------------------------------($5,OOO,OOO.OO) .......... Such insurance policies, surety bonds, undertakings and instruments for said purposes, when duly executed by the aforesaid Attorney-in-Fact, shall be n th~said, Corporation as fully andJqthe"~ame ext~nt(j~ if signed by try~..d,ulyaLJthoriz:~d officer of the Cor oratioJ]an sealed with its . = = t~]ac . ~~ - act .~ '~. thoritylier' "'vn are1hereb ified all -- r;: ;" .~ . :-;~i> :, ~ de='pur mg By- Iy adOpte ors of the with all Amendments thereto and are still in full force and effect: "Article XII: Policies, Bonds, Recognitions, Stipulations, Consents of Surety, Underwriting Undertakings, and Instruments Relating Thereto. Section 12-1. Insurance policies, bonds, recognitions, stipulations, consents of surety and underwriting undertakings of the Corporation, and releases, agreel\1ents and other writings relating in any way ther~to or to"1my claim or loss thereunder, shall be signed in the name and on behalf of the Corporation: a) by the Chairman of the Board, ,the President or a Vice President, and by the Secretary",or an Assistant Secretary; or b) by an Attorney- in-Fact for the Corporation appointed and authorized by the Chairman of the Board, the President, or a Vice President to make such signature; or c) by such other officers or representatives as the Board may from time to time determine. The seal of the Corporation shall if appropriate be affixed thereto by any such officer, Attorney-in-Fact or representative. The authority of such Attorney-in-Fact and Agents shall be as prescribed in the instrument evidencing their appointment. Any such appointment and all authority granted thereby may be revoked at any time by the Board of Directors or by any person empowered to make such appointment." ES~l'''\lli . _ c'~~yo ~"'D e(;._ #;.o"-~~'''' i Zr~:e.\~\ ~ 14.U": =-::. .."'t...... ~ h.t.'991 i.:'g (Seal) \C~~4~'%'! Attest: >;;......''''' .__"':c~,i' .{;....~I."'.,It\., Commonwealth of Pennsylvania County of Montgomery ~t'~ /" Gary L. Bragg, Secretary 1 I', By: First Sealord Surety, Inc. Joel ~ P,e,'deo! On this 20th day of January, 2004, before me personally appeared Joel D. Cooperman, Vice President of First Sealord Surety, Inc., with whom I am personally acquainted, who, being by me duly sworn, said that he resides in the Commonwealth of Pennsylvania, that he is Vice President of First y,JncA~e~ tiofld~~I!b_edjD~ndcwhich x~cutec:!Jhe foregoip . tr!l. ~~p()Yts theccqrporateiseal oJJhe ~id~(~ arlhe~e -= Icrii1~t~t rP.Qrai~ei~;Jhat . .i dca = ~nhe Board"l)tPire9{or - ifl1Gqr~oratibri . ii ii'. 'T'~~\ '''''~/?' '~~ -2.:;~'bY Ilk 1lf MMONW":'"'::.:'F ......" ,I ~, 1...+.~-v,4~\ ~ j ~ / AnthonyT. Slewa/t, NotaryPubllc (SeaIH~{" GI' ~)~l .",. r - Notary Public LowerMeltonTwp.,McdgomeryCounly \ \~ ~/ j MyCommlssionElcplJtieAug. 5. 2010 '\4-;...:t:SY\....1;O... l ~4~-p~;":~.. CERTIFICATE Member, P8M$ylvanla A8socIallon Of Notaries I, the unders'i!;l't\'ed Secretary of First Sealord Surety, Inc. do hereby certify that the original Power of Attorney of which the foregoing is a full, true and correct copy, is in full force and effect on the 'date of this Certificate and I do further certify that the Officer who executed the said Power of Attorney was one of the Officers authorized by the Board of Directors to appoint an Attorney-in-Fact as provided in Section 12-1 of the By-Laws of First Sea lord Surety, Inc. This Certificate may be signed and sealed by facsimile under and by authority of the following provisions of the By-Laws of First Sealord Surety, Inc.: "Section 12-2. The use of a printed facsimile of the corporate seal of the Corporation and of the signature of the Secretary or an Assistant Secretary on any .certifii!;(jtion of the correctnes!,pf clCqpy Ofi(jP instrument exesuh,rj by an authorized person pyrsuant t()..f'rticie XII,Sectiqn12-1..of the B -Laws apP9JrWp9T'anda\Jtt:iQJiz' "" =-c. ~". ~ '~si9o!i ~ ~ -, behaltof)'heCorQor~tiortswetYJ)i>ndS,}jnderwri' ~- - . other insfrumentS'Clesqioed i lil<Efeff nd s ~ ~ =~ ~- claltieerfmanually a'- ',~~'::~t::~,,""J',,~,.i: .. \~) '. ';",S1{ -', C~' ;-~ In Witness Whereof, I have hereunto set my hand and affixed the corporate seal of the Corporation to these presents - this 20 day of ~~, 20 () i This power of attorney is void unless the Bond number is inserted in this paragraph (insert Bond # here . @ ), the bond number is the same number as on the original bond, d the bond number has been inserted by an officer. or employee of the Company or by the agent. II. '.'.f.' rl'II:, ' (seal) - -....... 1II1I\'llll1lJlllllW~__~ ...--........- ........ THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. This sworn statement is submitted to CH~ of S VY'l f1 'I '1'< / f ~ [print name of the public entity] ,..., . ,..., . ,.., . ,., . ,.., . ,.., . ,., . ,., . .., . .., . .., . r"I - r""I - .., . ..., . .., . .., . SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES 1 . (Je-L... by Hf-.M. \ 0 +01) (, r\n -;:. [print individual's name and title] -MtJp;'i ~1. ~ C [print name of e~tity submitting sworn statement] for whose business address is ~~o Su ~tf\\rlJ.N.v \ \4 ~~ ~DL. ~v-f\- ,P"L 3,3 ~~ c-, I and (if applicable) its Federal Employer Identification Number (FEIN) is ~zz 06P~/ 9 2. (If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement: JAr .) I 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 of the United States, including, but not limited to, any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 3. I understand that "convicted" or "conviction" as defined in Paragraph 287.133(1 )(b), Florida Statues, 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. I understand that an "affiliate" as defined in Paragraph 287.133(1 )(a), Florida Statutes, means: 4. 5. 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 arm's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. I understand that a "person" as defined in Paragraph 287.133(1 )(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term" person" includes those officers, directors, executives, partners, shareholders, employees, members, ., . Form PUR 7068 (Rev. 06/11/92) ...., - 09/09 00402-1 03-4122.F M . .., . and agents who are active in management of an entity. 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] '-I Neither the entity submitting this sworn statement, nor any of its officers, directors, e~ves, 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. r, . ,.., . 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, 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, nor any 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] ., . II . .., . I UNDERSTANDJtiAT THE _SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 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. k Sb.~ - [signature] ,., . r-, . M - Sworn to and subscribed before me this -l ~ ~'" \/ w day of C? c:.. '\1Jo<::;;'- , 20,Q5. 1""1 Personally known - Notary Public - State of ~ L) r \, ot c '. OR Produced identification r"1 (Type of identification) .. "~~~r~. RYAN SPRADUN My commiSSion ex I~I':'~ MYCOMMISSION#BB920502 . ~.:;:._ . .'&: EXPIRES: August 27. 2013 -/1 ".r.,i~~" Bonded Thru Notary Public Underwriters (rinte ped or st commissioned name of notary public) . r"1 . " . ..., . ..., . Form PUR 7068 (Rev. 06/11/92) ..., 09/09 00402-2 03-4122.F . t"'" . ,., . DOCUMENT 00403 f"'\ TRENCH SAFETY ACT . (90-96, Laws of Florida) ,., . .., . Bidder acknowledges that included in the appropriate bid items of the proposal and in the Total Bid Price are costs for complying with the Florida Trench Safety Act (90-96, Laws of Florida) effective October 1, 1990. The bidder further identifies the costs of such compliance to be summarized below: r"1 . Trench Safety Measure (Description) Unit of Measure (LFSF) Unit (Quantity) Unit Cost Extended Cost r-, . A. ~It r""I B. C. D. r"1 . . Total $ .., . ..., . If applicable, the Contractor certifies that all trench excavation done within his control in excess of five feet in depth shall be in accordance with the Florida Department of Transportation's Special Provisions Article 125-1 and Subarticle 125-4.1 (TRENCH EXCAVATION SAFETY SYSTEM AND SHORING, SPECIAL - TRENCH EXCAVATION). ., . Failure to complete the above may result in the bid being declared non-responsive. ..., Contractor agrees that the above safety compliances and costs are included in his bid package. . ..., ~;L~ Signature of Bidding Contractor . II . .., . END OF DOCUMENT 1'"1 . n . 1"'"'1 09/09 00403-1 03-4122.F - ,.., . ., . .., ~" ~ ~ ~ Florida Department of Transportation . ..., . ..., . JEB BUSH GOVERNOR 605 Suwannee Street Tallahassee, FL 32399-0450 DENVER J. STUTLER, JR. SECRETARY ..., POLICY Effective: March 16, 2006 Office: Equal Opportunity Topic No: 001-275-015-i . ..., . DISADVANTAGED BUSINESS ENTERPRISE UTiliZATION .., . I It is the policy of the Florida Department of Transportation that disadvantaged businesses, as defined by 49 Code of Federal Regulations, Part 26, shall have an opportunity to participate in the performance of Department contracts in a non- discriminatory environment. The objectives of the Disadvantaged Business Enterprise Program are to ensure non-discrimination in the award and administration of contracts, ensure firms fully meet eligibility standards, help remove barriers to participation, create a level playing field, assist in development of a firm so it can compete successfully outside of the program, provide flexibility, and ensure narrow tailoring of the program. ., . ,.., . ,.., . The Department, its contractors, suppliers, and consultants shall take all necessary and reasonable steps to ensure that disadvantaged businesses have an opportunity to compete for and perform the contract work of the Department in a non-discriminatory environment. n The Department shall require its contractors, suppliers, and consultants to not discriminate on the basis of race, color, national origin, religion, gender, age, or disability in the award and performance of its contracts. . r"l . ., . This policy covers in part the applicable federal regulations and the applicable statutory references contained therein for the Disadvantaged Business Enterprise Program Plan, Chapters 337 and 339, Florida Statutes, and Rule Chapter 14-78, Florida Administrative Code. .., . -- .., . .., . February 2007 00404-1 03-4122.0. ,., . r"1 . ,.., t r;# ~i~G y\d::) ~ 275-030-" B EQUAL OPPORTUNITY OFFICE 04/05 Page' 013 .., . . 1""'1 DSE AFFIRMATIVE ACTION PLAN . ,.., . POLICY STATEMENT It is the policy of that disadvantaged businesses, as defined by 49 CFR Part 26, Subpart D and implemented under Rule Chapter 14-78, F.A.C., shall have the opportunity to participate as subcontractors and suppliers on all contracts awarded by the Florida Department of Transportation. The requirements of Rule Chapter 14-78. FAC.. shall applv to all contracts entered into between the Florida Department of Transportation and Subcontractors and/or suppliers to will also be bound by the requirements of Rule Chapter 14-78 F.A.C. ..., . ,., . n . , and its subcontractors shall take all necessary and reasonable steps in accordance with Chapter 14-78, F.A.C., to ensure that disadvantaged businesses have the opportunity to compete and perform work contracted with the Florida Department of Transportation. .., . , and its subcontractors shall not discriminate on the basis of race, color, religion, national origin, disability, sex, or age in the administration of contracts with the Department of Transportation. ., . , has designated and appointed a Liaison Officer to develop, maintain, and monitor the DBE Affirmative Action Plan implementation. The Liaison Officer will be responsible for disseminating this policy statement throughout and to disadvantaged controlled businesses. The statement is posted on notice boards of the Company. ,.., . ,.., . x r"1 , President . ., X . ,.., . ., . ..., . ...., .. February 2007 00404-2 03-4122.D. 1""'1 . ., . 'i . 275-030-118 EQUAL OPPORTUNITY OFFICE 04/05 Page 2 of 3 ,.., I. DESIGNATION OF LIAISON OFFICER . will aggressively recruit disadvantaged businesses as subcontractors and suppliers for all contracts with the Florida Department of Transportation. The Company has appointed a Liaison Officer to develop and maintain this Affirmative Action Plan in accordance with the requirements of Rule Chapter 14-78, F.A.C. .., . .., . The Liaison Officer will have primary responsibility for developing, maintaining, and monitoring the Company's utilization of disadvantaged subcontractors in addition to the following specific duties: (1) The Liaison Officer shall aggressively solicit bids from disadvantaged business subcontractors for all Florida Department of Transportation contracts; (2) The Liaison Officer will submit all records, reports, and documents required by the Florida Department of Transportation, and shall maintain such records for a period of not less than three years, or as directed by any specific contractual requirements of the Florida Department of Transportation. The following individual has been designated Liaison Officer with responsibility for implementing the Company's affirmative action program in accordance with the requirements of the Florida Department Transportation. PI . ,., . 1 . " . r"1 . II. AFFIRMATIVE ACTION METHODS .., . In order to formulate a realistic Affirmative Action Plan, has identified the following known barriers to participation by disadvantaged subcontractors, before describing its proposed affirmative action methods: n 1. Lack of qualified disadvantaged subcontractors in our specific geographical areas of work; 2. Lack of certified disadvantaged subcontractors who seek to perform Florida Department of Transportation work; 3. Lack of interest in performing on Florida Department of Transportation contracts; 4. Lack of response when requested to bid; 5. Limited knowledge of Florida Department of Transportation plans and specifications to prepare a responsible bid. In view of the barriers to disadvantaged businesses stated above, it shall be the policy of to provide opportunity by utilizing the following affirmative action methods to ensure participation on the contracts with the Florida Department of Transportation. will: . ,., . ,., . .., . ..., . I"'t . 1. Provide written notice to all certified DBE subcontractors in the geographical area where the work is to be subcontracted by the Company; 2. Advertise in minority focused media concerning subcontract opportunities with the Company; 3. Select portions of the work to be performed by DBEs in order to increase the likelihood of meeting contract goals (including, where appropriate, breaking down contracts into economically feasible Febnlm~~OO1acilitate DBE participation); 00404-3 03-4122.0. ,.., . ,..., . M . .., . M . ., . r-J . r-J . r"1 . 1"'1 . r-, . ,., . .., . ..., . ,.., . ..., . ,.., . ., . ., . ., . ..... - 275-030-118 EQUAL OPPORTUNITY OFFICE 04/05 Page 3 of 3 4. Provide adequate information about the plans, specifications, and requirements of the contract, not rejecting subcontractors without sound reasons based on a thorough investigation of their capabilities; 5. Waive requirements of performance bonds where it is practical to do so; 6. Attend pre-bid meetings held by the Florida Department of Transportation to apprise disadvantaged subcontractors of opportunities with the Company; 7. Follow up on initial solicitations of interest to DBE subcontractors to determine with certainty whether the DBE company is interested in the subcontract opportunity. understands that this list of affirmative action methods is not exhaustive and will include additional approaches after having established familiarity with the disadvantaged subcontracting community and/or determined the stated approaches to be ineffective. III. IMPLEMENTATION On contracts with specific DBE goals, will make every effort to meet contract goals as stated by utilizing its affirmative action methods. On projects with no specific goals, the Company will, as an expression of good faith, seek to utilize DBE subcontractors where work is to be subcontracted. IV. REPORTING shall keep and maintain such records as are necessary to determine the Company's compliance with its DBE Affirmative Action Plan. The Company will design its record keeping system to indicate: 1. The number of DBE subcontractors and suppliers used by the Company, identifying the items of work, materials and services provided; 2. The efforts and progress being made in obtaining DBE subcontractors through local and community sources; 3. Documentation of all contracts, to include correspondence, telephone calls, newspaper advertisements, etc., to obtain DBE participation on all Florida Department of Transportation projects; 4. The Company shall comply with Florida Department of Transportation's requirements regarding payments to subcontractors including DBEs for each month (estimate period) in which the companies have worked. V. DBE DIRECTORY will utilize the DBE Directory published by the Florida Department of Transportation. The Company will distribute Form Number 275-030-01, Schedule A Certification Form Number 1, to potential DBE contractors and assist in their completion. February 2007 00404-4 03-4122.D. DBE AFFIRMATIVE ACTION PLAN POLICY STATEMENT It is the policy of TENEX ENTERPRISES, INC. that disadvantaged businesses, as defined by 49 CFR Part 26, Subpart D and implemented under Ruler Chapter 14-78, F.A.C., shall have the maximum opportunity to participate as subcontractors and suppliers on all contracts awarded by the Florida Department of Transportation. The requirements of Rule Chapter 14-78, F.A.C., shall apply to all contracts entered into between the Florida Department of Transportation and TENEX ENTERPRISES, INC. Subcontractors and/or suppliers to the TENEX ENTERPRISES, INC. will also be bound by the requirements of Rule Chapter 14-78 F.A.C. TENEX ENTERPRISES, INC., and its subcontractors shall take all necessary and reasonable steps in accordance with Chapter 14-78, F.A.C., to ensure that disadvantaged businesses have the maximum opportunity to compete and perform work contracted with the Florida Department of Transportation. TENEX ENTERPRISES, INC., and its subcontractors shall not discriminate on the basis of, race, color, religion, national origin, disability, sex, or age in the administration of contracts with the Department of Transportation. TENEX ENTERPRISES, INC., has designated and appointed a Liaison Officer to develop, maintain, and monitor the DBE Affirmative Action Plans implementation. The Liaison Officer will be responsible for disseminating this policy statement throughout TENEX ENTERPRISES, INC. and to disadvantaged controlled businesses. The statement is posted on notice boards of the Company. ---- -- ) X ?-;:fl -L_--/ {/' HamiaF"ouladf, President Tenex Enterprises, Inc. 850 SW 14 CT POMPANO BEACH,FL 33060 x IrJ(;, Iv 9 t . I. DESIGNATION OF L1ASON OFFICER TENEX ENTERPRISES, INC. will aggressively recruit disadvantaged businesses as subcontractors and suppliers for all contracts with the Florida Department of Transportation. The Company has appointed a Liaison Officer to develop and maintain this Affirmative Action Plan in accordance with the requirements of Rule Chapter 14-78, F.A.C. The Liaison Officer will have primary responsibility for developing, maintaining, and monitoring the Company's utilization of disadvantaged subcontractors in addition to the following specific duties: (1) The Liaison Officer shall aggressively solicit bids from disadvantaged business subcontractors for all Florida Department of Transportation contracts; (2) The Liaison Officer will submit all records, reports, and documents required by the Florida Department of Transportation, and shall maintain such records for a period of not less than three years, or as directed by any specific contractual requirements of the Florida Department of Transportation The following individual has been designated Liaison Officer with responsibility for implementing the Company's affirmative action program in accordance with the requirements of the Florida Department of Transportation. Hamid Fouladi FEIN # 52-2069619 TENEX ENTERPRISES, INC. 850 SW 14 CT POMPANO BEACH,FL 33060 Tel: (954)788-8100 Fax (954) 788-0005 II. AFFIRMATIVE ACTION METHODS In order to formulate a realistic Affirmative Action Plan, TENEX ENTERPRISES, INC. has identified the following known barriers to participation by disadvantaged subcontractors, before describing its proposed affirmative action methods: 1. Lack of qualified disadvantaged subcontractors in our specific geographical areas of work; 2. Lack of certified disadvantaged subcontractors who seek to perform Florida Department of Transportation work; 3. Lack of interest in performing on Florida Department of Transportation contracts; 4. Lack of response when requested to bid; 5. Limited knowledge of Florida Department of Transportation plans and specifications to prepare a responsible bid. In view of the barriers to disadvantaged businesses stated above, it shall be the policy of TENEX ENTERPRISES, INC. to provide maximum opportunity by utilizing the following affirmative action methods to ensure participation on the contracts with the Florida Department of Transportation. TENEX ENTERPRISES, INC. will: 1. Provide written notice to all certified DBE subcontractors in the geographical area where the work is to be subcontracted by the Company; 2. Advertise in minority focused media concerning subcontract opportunities with the Company; 3. Select portions of the work to be performed by DBEs in order to increase the likelihood of meeting contract goals (including, where appropriate, breaking down contracts into economically feasible units to facilitate DBE participation) 4. Provide adequate information about the plans, specification, and requirements of the contract, not rejecting subcontractors without sound reasons based on a thorough investigation of their capabilities; 5. Waive requirements of performance bonds where it is practical to do so; 6. Attend pre-bid meetings held by the Florida Department of Transportation to apprise disadvantaged subcontractors of opportunities with the Company, 7. Follow up on initial solicitations of interest to DBE subcontractors to determine with certainty whether the DBE company is interested in the subcontract opportunity. TENEX ENTERPRISES, INC. understands that this list of affirmative action methods is not exhaustive and will include additional approaches after having established familiarity with the disadvantaged subcontracting community and/or determined the stated approaches to be ineffective. III. IMPLEMENTATION On contracts with specific DBE goals, TENEX ENTERPRISES, INC. will make every effort to meet contract goals as stated by utilizing its affirmative action methods. On projects with no specific goals, the Company will, as an expression of good faith, seek to utilize DBE subcontractors where work is to be subcontracted. IV. REPORTING ~ TENEX ENTERPRISES, INC., shall keep and maintain such records as are necessary to determine the Company's compliance with its DBE Affirmative Action Plan. The Company will design its record keeping system to indicate: 1. The number of DBE subcontractors and suppliers used by the Company, identifying the items of work, materials and services provided; 2. The efforts and progress being made in obtaining DBE subcontractors through local and community sources; 3. Documentation of all contracts, to include correspondence, telephone calls, newspaper advertisements, etc., to obtain DBE participation on all Florida Department of Transportation projects; 4. The Company shall comply with Florida Department Of Transportation's requirements regarding payments to subcontractors including DBE's for each month (estimate period) in which the companies have worked. V. DBE DIRECTORY TENEX ENTERPRISES, INC. will utilize the DBE Directory published by the Florida Department of Transportation. The Company will distribute Form Number 275-030-01, Schedule A Certification Form Number 1, to potential DBE contractors and assist in their completion. ,.., . 1""'1 . ,.., . r"1 . " . STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION BID OPPORTUNITY LIST Please complete and mail or fax to: Equal Opportunity Office 605 Suwannee St., MS 65 Tallahassee, FL 32399-0450 TELEPHONE: (850) 414-4747 FAX: (850) 414-4879 275-030-10 EQUAL OPPORTUNITY OFFICE 04/05 This information may also be included in your bid or proposal package. Prime Contractor/Consultant: 1i^,P:'{ e JJT ') ~ \.. C Address/Telephone Number: ~ct;~ t"\lC (,dJf\- r9n-Al(~ af'"L( +/- ~~or"0 Bid/Proposal Number: 0 9 - D9 - 0 ( Quote Submitted MMIYR: /t?/~fi i , . r1 . .., . rJ . ,., . n . ,.., . r, . 5. Year Firm Established: )91 <'h , 6. OOBE o Non-OBE 7. o Subcontractor o Subconsultant 6. o OBE o Non-DBE 7. o Subcontractor o Subconsultant 6. o OBE o Non-OBE 8. Annual Gross Receipts o Less than $1 million o Between $1 - $5 million $Between $5 - $10 million o Between $10 - $15 million o More than $15 million 49 CFR Part 26.11 requires the Florida Department of Transportation to develop and maintain a "bid opportunity list." The list is intended to be a listing of all firms that are participating, or attempting to participate, on DOT-assisted contracts. The list must include all firms that bid on prime cont~acts, or bid or quote subcontracts and materials supplies on DOT-assisted projects, including both DBEs and non-OBEs. For consulting companies this list must include all subconsultants contacting you and expressing an interest in teaming with you on a specific DOT assisted project. Prime contractors and consultants must provide information for Nos.1, 2, 3 and 4 and should provide any information they have available on Numbers 5, 6, 7, and 8 for themselves, and their subcontractors and subconsultants. 1. Federal Tax 10 Number: ,{72 th 9 b /9 2. Firm Name: "t'aJe; i<- -(~ 'J -:+-Y C 3. Phone: 9~~. ?6-g~ c(.tcn:> 4. Address: ~SI.<1) 14?{,.. U ') Q o^ ~~ ~ t'L .' F L ~;> 1!7 c:. .c::> ,., . ,.., . 1. Federal Tax 10 Number: 2. Firm Name: 3. Phone: 4. Address: . II 5. Year Firm Established: 8. Annual Gross Receipts o Less than $1 million o Between $1 - $5 million o Between $5 - $10 million o Between $10 - $15 million o More than $15 million II . I .., . ..., . 1. Federal Tax 10 Number: 2. Firm Name: 3. Phone: 4. Address: 5. Year Firm Established: 03-4122.0. February 2007 7. o Subcontractor o Subconsultant 00404-5 8. Annual Gross Receipts o Less than $1 million o Between $1 - $5 million o Between $5 - $10 million o Between $10 - $15 million o More than $15 million .., . STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 275-030-11A EQUAL OPPORTUNITY OFFICE 04/05 ...., ANTICIPATED DBE PARTICIPATION STATEMENT . ,.... . Financial Project Number: Contract Number: OJ -oct -() \ ,.., . Federal Aid Project Number (if applicable): .., . Prime Contractor Name: ~~ 6Y- e~ ') ~N"L Contract Oollar Amount: .., . . Is the prime contractor a Florida Oepartment of Transportation Certified Oisadvantaged Business Enterprise (OBE)? (yes 0 ) (no ~) Expected amount of contract dollars to be subcontracted to OBE(s): $ "-\ S to 00 It is our intent to subcontract ~ % of the contract dollars to OBE(s). Listed below are the proposed OBE sub-contractors: II ., . OBE (s) Name Type of Work/Specialty Dollar AmountlPercentaqe .., . S\-r..~J t ~.~~ l,,^-^\C \"':J T,..,A:\r ~~) loG /0 .., . II . ,.., . . ~ SUbmittedCj. ~ \1,....,0 F;...v'<"'l::.ritle: r ([e'b I O~ E-mail Address: ""'~IA&I J Q +CK~ e.it\-~ ~r 1~6\. (....-"\ Telephone Number: Fax Num~f. (Jb J,() 71 i - ~ too Oate:,/ ~/~/d.j Ff\-)( '. ~ sy 7 ~'b - 0<90 <; Note: This information is used to track and report anticipated OBE participation in all state and federally funded FOOT contracts. The anticipated OBE amount will not become a part of the contractual terms. .... II . ,., :~ . This form must be submitted at the pre-construction or pre-work conference. DOT staff must forward this to the Equal Opportunity Office, 605 Suwannee Street, MS 65 Tallahassee, FL 32399-0450 or fax to (850) 414-4879. If you have any questions, please contact the EOO at (850) 414-4747. M . .., I . February 2007 00404-6 03-4122.0. r-, . ,.., . Document 00405 ,., Restrictions, Prohibitions, Controls, and Labor Provisions: . -. 1. Equal Employment Opportunity: In connection with the carrying out of any project, the Agency shall not discriminate against any employee or applicant because of race, age, creed, color, sex or national origin. The Agency will take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, age, creed, color, sex, or national origin. Such action shall include, but not be limited to, the following: Employment upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of payor other forms of compensation; and selection for training, including apprenticeship. The Agency shall insert the foregoing provision modified only to show the particular contractual relationship in all its contracts in connection with the development or operation of the project, except contracts for standard commercial supplies or raw materials, and shall require all such contractors to insert a similar provision in all subcontracts, except demolition, removal, site improvements, or similar work, the Agency shall post, in conspicuous places available to employees and applicants for employment for project work, notices to be provided by the Department setting forth the provisions of the nondiscrimination clause. . 1'"'1 . ..., . .., . ,., . II . 2. Title VI - Civil Rights Act of 1964: Execution of this Agreement constitutes a certification that the Agency will comply with all requirements imposed by Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d. et. Seq.), the Regulations of the Federal Department of Transportation issued thereunder, and the assurance by the Agency pursuant thereto. ..., . 3. Title VIII - Civil Rights Act of 1968: Execution of this Agreement constitutes a certification that the Agency will comply with all requirements imposed by the Title VIII of the Civil Rights Act of 1968, (42 U.S.C. 3601, et seq.), which among other things, prohibits discrimination in housing on the basis of race, color, national origin, creed, sex, and age. .., . ....., 4. American with Disabilities Act of 1990 (ADA): Execution of this Agreement constitutes a certification that the Agency will comply with all the requirements imposed by the ADA (42 U.S.C. 12102, et. Seq.), the regulations of the federal government issued thereunder, and the assurance by the Agency pursuant thereto. . ,.., r-, 5. Prohibited Interests: Neither the Agency nor contractors or their subcontractors shall enter into any contract, subcontract, or arrangement in connection with the project or any property included or planned to be included in the project, in which any member, officer, or employee of the Agency during his tenure or for two years thereafter has any interest, direct or indirect. If any such present or former member, officer, or employee involuntarily acquires or had acquired prior to beginning of his tenure any such interest, and if such interest is immediately disclosed to the Agency relating to such contract, subcontract, or arrangement. The Agency shall insert in all contracts entered into in connection with the project or any property included in any project, and shall require its contractors to insert in each of their subcontractors to insert in each of their subcontracts, the following provisions: . . r-, . 1""1 . "No member, officer, or employee of the Agency during his tenure or for two years thereafter ,.., shall have any interest, direct or indirect, in this contract or the proceeds thereof." . The provisions of this subsection shall not be applicable to any agreement between the Agency and its fiscal depositories, or to any agreement for the utility services the rates for which are fixed or controlled ..., by a Governmental agency. . 6. Interest of Member of, or Delegated to, Congress: No member or delegate to the Congress of the ,., United States shall be admitted to any share or part of the Agreement or any benefit arising there from. . ..., 09/09 00405-1 03-4122.F . The Bidder shall furnish the following information. Failure to comply with this requirement may cause its rejection. Additional sheets shall be attached as required. Contractor's Name/Address: ~~ elJ'T 'J ~ ~~~ ~t 5~jt- ()o4.-c;) ~ ,Ii!- L- ~ ~ () Go- c:> ..., . .., . ...., . ..., . ,.., . .., . ..., . r"1 4. . 1"'1 . 1"'1 . -, . " . r"1 . .., - 7. Sll\\~ ,., . 1"'1 . ~ . ,.., . ..., 09/09 . DOCUMENT 00420 INFORMATION REQUIRED FROM BIDDERS GENERAL INFORMATION 1. 2. Contractor's Telephone Number: 9<5" - 771<6 - t lCaO Contractor's License: (j~L.d" \ "t-~ Primary Classification: 0 c_ \. 3. Number of years as a Contractor in construction work of the type involved in this Contract: tfJ 5. List the names and titles of all officers of Contractor's firm: 1/ /rIvt ( 0 ~IJ ut\. 0 :J.. - rQ~\OC'N' 6. Name of person who inspected site or proposed work for your firm: Name: -W frf" 1 0 8. TovvfdJ~ oq /u~cr I I What is the last project of this nature you have completed? J &'II,,,~ t\* '071t8;"7 Sc-Mr; :i-MIV "0"'sY"1 <;. C ~ I D ffO'l-(O-OV C. H-,\ c ~ Sc.; 1\ ",\ ":\ ~t~ (\.-:P(<..- t\ Have you ever failed to complete work awardeato you; if so, where and why? Date of Inspection: fio. 00420-1 03-4122.F ...., . ..., . 9. Name three individuals or corporations for which you have performed work and to which you refer: ,...., s~ f\TlkV H cD Q (lJ tf IJ1D IL '\ . ., . 10. List the following information concerning all contracts on hand as of the date of submission of this proposal. (In case of co-venture, list the information for all co-ventures). ..., . ., NAME OF PROJECT CITY TOTAL CONTRACT VALUE CONTRACTED DATE OF COMPLETION % COMPLETION TO DATE . ., . Sf]; f\-r-rP\G- r-lc-:J Wuf\.-fL.- ON - I-(~~ " . (Continue list on inset sheet, if necessary) r-1 11 . What equipment do you own that is available for the work? J)?(r~ I C.') 1\ \)f':Y\... r Prx)f) c.A';T ( 0 w\L ~ T /LvN.. ~11cr-('1 l(7/lffl)If'II\:rI~1 kYL~ I/CP-' ~ 0'1_ . ..., . ,.., . 12. equipment will you purchase for the proposed work? II . M NOTE: Attach additional sheets if required. - ,.., If requested by the City, the Bidder shall furnish a notarized financial statement, references and other information, sufficiently comprehensive to permit an appraisal of his current financial condition. . .., . ., . .., . r-1 . ,.., 09/09 00420-2 03-4122.F . .., . ,.., . LIST OF SUBCONTRACTORS ..., The Bidder SHALL list below the name and address of each Subcontractor who will perform work under this Contract in excess of one-half percent of the total bid price, and shall also list the portion of the work which will be done by such Subcontractor. After the opening of Proposals, changes or substitutions will be allowed with written approval of the City of Sunny Isles Beach. Subcontractors must be properly licensed. . ,., . Work to be Performed Subcontractor's Namel Address .., . ,., 5\~rS-urj \ ~~~~ 'L-,^"Jc:\V'~ :2-\ t \ v0 00\~\..J ~c:.r\~ ~~:'> - <;t:-J ~rc '\ :> H-:>tLJ'V'doJ 'S..;.~~ ~Q" 1. Tr~- ~~. __~ . 2. l rA"'- (il s c.. \' (0 ..., . ., . 3. J \ ...-c:,\- r : ~"'\ ,., 4. . .., . 5. .., - 6. " . 7. ..., . 8. ..., . .., 9. . .., 10. . .., . NOTE: Attach additional sheets if required. .., . " 09/09 00420-3 03-4122.F . Addendum NO.1 CITY OF SUNNY ISLES BEACH Median Closure at 17Sth Terrace & Collins Ave and SR A1A Collins at 183 St Streetscape Improvements CITY BID NO. 09-09-01 To All Bidders: Bidders for the above-referenced project shall take note of the following changes, additions, deletions, clarifications, etc. to the Plans and Specifications, which in accordance with the Contract Documents shall become a part of and have precedence over anything shown or described otherwise. 1. Mandatory Pre-Bid Conference Minutes (Q&A). END OF SECTION 09-09-01 Mandatory Pre-Bid Conference QA Page 1 of 3 Addendum NO.2 CITY OF SUNNY ISLES BEACH Median Closure at 17Sth Terrace & Collins Ave and SR A1A Collins at 183 St Streetscape Improvements CITY RFQ NO. 09-09-01 To All Bidders: Bidders for the above-referenced project shall take note of the following changes, additions, deletions, clarifications, etc. to the Plans and Specifications, which in accordance with the Contract Documents shall become a part of and have precedence over anything shown or described otherwise. 1. Mandatory Pre-Submittal Conference Sign-In Sheet. END OF SECTION ..'.. I .9CT-16-2009 FRI 09:58 AM CALVIN & GIORDANO FAX NO. 0 p, 02/04 DOCUMENT 00900 ADDENDUM Addendum No.3 (October 15. 2009) to Contract doc\.lments CITY OF SUNNY ISLES BEACH Median Closure at 175th Terrace on Collins Ave. and SR A 1 A/Collins Ave. at 1 83rd St. Streetscape Improvements CITY OF SUNNY ISLES BEACH BID NO. 09-09-01 COA PROJECT NO. 03-4122.F To All Bidders: Bidders for the above-referenced project shall take note of the following changes, additions, deletions, clarifications, etc. to the Plans and Specifications, which in accordance with the COlltract Documents shall become a part of and have precedence over anything shown or described otherwise. IN THE CONTRACT DOCUMENTS: 1. In Document 00300 replace sheets 00300-2 and 00300-3 in its entirety. All other docllments, specifications, drawings, terms and conditions remain the same. Bidders must acknowledge receipt of Addendum on Page 00300-5 END Of ADDENDUM 09/09 00900-1 03-4122.F Rug 20 2008 10:05AM PRITCHARD 954-530-9668 p.2 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 (850) 487-1395 PRITCHARD,. CALVrN E TENEX ENTERPRISES INC 771 RANCH RD. WESTON FL 33326 Congratulations! With this license you become one of the nearly one mIllion . Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to baroeque restaurants, and they keep Florida's economy strong, E....ery day we wOrk to improve the way we do business in order to serve you better. For Information about our services, please log onto wwloV.myflortdalleense.com. There you can find more Information about our divisIons and the regulations that impact you, subscribe to department newsletters and learn more about the Department's Initiatives. Our mission at the Department is: License Efficiently 0 Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license I I . " '. . .:_;ii!~~"~i~ 'CGCOl.41ZS ,,"OJ./3;;/08 oeoo 222, . CE:RTJ:~ IE~ .G~R1\.L qi)N. TRAC'rqR PRITCHARD, .' . 'V~1t . 3: .\' . T~X ENT!~:esE{ISESrNC' .. IS CER'l'IFIEb ImcS.t- thio P~1dQZI. of CJ1,4'h 1xp1....t.:l0ll l5&b.. AtlG 31, 20 LO LOQo7:!lt01U:S DETACH HERE If .. AC# 388494~O .:.. . ;:. - ..... . - .-. - -'- . = ~IC . '..,' I .- _' . ..'.,. ,,\\,( ., <:) 73 ' . .(to.S '.():$.OOZ:2t84' .' '.CQ'C':Ol4'i;';~;'<::; " " .:~. :,/.I~. " The 'G~ML'! eON'1'I$~T6~, . . . . ~. ., .. 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"....~.I~\ _;o"~u:::)~ ~:"'~:::;L::~;::;::~'Y2~~Z::::;:0::':::'->;?-:-/ ~~~,~'j i\:~J i"Z rJ -:1 d (J }7 )" ~". ~ .....1 / ,r " , f.".,~ " .~:I' ;;3Ar0A~UjR:8QADS (ASP[:1AL T f\NQ CONC~E:!I ,)~i::.:j~~;!..:.." ~f~;;~1~:\l~~~~i?l:;f.;:,~;:r.~:';\,,:"'\:,:, '~:~::":':'~f:;:' ::~~t: ,~~'~~;'.W" . ":':: ' \i~::ti;g~~1 &'l;~~i..~,~;_,,:~~;' ..: . ..:--::. :"PQUD\DI; HAMID'?:9UALlFYING, .. ] !;i'\.c TE'NEX' Er,{fERPRISES INC/ ,'.:'" ,"<',;::,;:",:;;.' ",~.,:,:':':'/l.:,-'/:' <:;' , ':,' "", ";.~.85o-SW :t4CT, . :.:,~.,!~,\~..,:: ,.i:,::;:;{,>\~;; .t';:-{~~")~'-l',':;'):;: ,.'," ~ ,....';'l;.';::,{';" ,:,;;'.;';:':' .'t'POMPANOtBEACH FL 330608526 \:c';\:~'E'5<fjIREs;:o'8;31/2010 .\ . 'S :~',';', r,~ ;<,~:;,';:t..\,-: " ,,' . ,"----' '. , '. "", ::," '",L~'_,,:,' ~', ,f f ", f I;' ,ffi.,1 ,iM :,f,\~. !5:l E,.~ ;'::,jf! _":';I'mrr. -r"""'..."!W '~f.rJ, ~ ,~~\~.....i':Z~i:~.:;.,,~i..,:..~~~.~7: "'i:'0.:~tJ.t~"';~t_~;zz",~_._ :~;.~~,,~~' -, S. D\.;.y~.t....,^/'ARD'CERTIFICATE OF COMPETENCY ~:v~'Y Vi . Detach and SIGN the reverse side of this . ~ COUNTY card IMMEDIATELY upon receipt! You ..=-_...,--......shouldcarry this card with you at all times. Contractor must obtain a photo 1.0. Certificate of Competency Card every four years. r- _.~~.~;.;;:;:~:- : ss~~~;:\::i't;):~~~~:~~~l;~~~~,~~~ ~ ~}::~~:,~::~~~~:X ..~,v".B~OWAR[)CQUNty.:JlQR'OA,_~\\');-'. ~~'-" r,'CF'-_h \!:;.iCERnF.'iCAfE:OF\CbMPetENC'C~'r_~\C: " cY;';::~:'.~'7~?\) ~:;,t :,"~' :~'.J' "?:~~::'~::\;.~~ ,,:~tf..,?'\~~':':<q.\) c~<;coy:ri~,,:,r)':i-.~':~:~; .) ~:"~>;~'~.\~\':~~:~':: r.:: ~:';ce;;~~'3A:MAJO:R~dAD~"[A'S'~~f\{f~A~6 't'~N8'~~" L-~~,;,~}~~!~~~~~~~#....:;...,~i ::..;,-: ':p()MPANO.BEACfrFL'330~08526 ....... ~ ..t:i;.~~;~.~~~~~~:~8;~t/;b;D-:'~~;~:~' ~-}~ ~;.~.:_~:,'.;~.~:~::~';~ ... ~) ~ :" ",' '. ~ ',' ".' . ,-:',:, ' - ",~.:"'" :'''~'' ~: "-" ~ ", '." " :,; '.~" ,.--' " FOULADI, HAMID 10037 N SPRING WAY CORAL SPRINGS FL 33076 L ' 503-207 (Rev. 3/07) BP200731047 , I . Company History Tenex Enterprises, Inc. was established in 1998 to engage in Roads and Public Works Construction with a strong commitment to excellence and safety. At Tenex we always seek only the best in each area of the work and actively promote and challenge individuals to rise to their full potential. Hard work is recognized and rewarded not only monetarily, but in every challenging assignment. As a result of these principals, the company has grown beyond its early expectations. The vision for the company is to have a core group of highly skilled and dedicated individuals both in management and the trades that can tackle any construction project in South Florida. During the history of the company, most of the projects undertaken have been from South Florida Municipalities. Please turn to the next page for a list of works completed accompanied with references. Company History City of Weston Contact: Sabrina Baglieri Assistant Director Construction Services Tel.: 954. 921. 7781 Jeffrey Skidmore Assistant City Manager / COO Tel.: 954. 389. 4321 PROJECT: Tequesta Trace Park Improvements Weston Library Park Three Village Road & Country Isles Public Works Facility Fueling Station Utilities Repair 1-75 @ Arvida South Bound Off Ramp Imp. Saddle Club Rd. & South Post Rd. Roundabout A YSO Facility @ Weston Regional Park Tequesta Park, Drainage Improvement Bonaventure Mater Plan - Phase V Construction of Eagle Point Park South Post Road Improvements Swale Stabilization Sidewalk Improvements Bonaventure & Saddle Club Road Improvements Road & Sidewalk Improvements Raquet Club. Road & Sidewalk Improvements Blatt Road City of Hallandale Beach Contact: Carlos Hernandez Assistant City Engineer Tel. (954) 457-1609 PROJECT: Ansin Boulevard Road & Drainage Improvements 25th yer / 3CTA 2000-2001-006 AMOUNT: $ 798,878.75 $ 2,074,501.00 $ 2,450,202.50 $ 286,000.00 $ 963,050.00 $ 888,292.00 $ 1,300,000.00 $ 391,340.80 $ 477,180.00 $ 836,494.00 $ 500,000.00 $ 1,350,000.00 $ 279,706.00 $ 200,000.00 $ 679,737.00 $ 410,000.00 $ 355,000.00 AMOUNT: $ 832,839.00 $ 351,110.00 P age I 2 of 6 COMPLETION: April 2009 Oct 2008 Aug 2008 Nov 2006 July 2006 April 2006 June 2005 June 2005 Feb. 2005 Dec. 2004 Dee. 2003 Dee. 2003 July 2003 Dee. 2001 Dec. 2000 June 2000 June 2000 COMPLETION: Dee. 2004 Oct. 2001 Company History P age I 3 of 6 Town of Lauderdale By The Sea Contact: John Olinzock Assistant to Town Manager / Project Manager Tel.: 954.776.0576 PROJECT: North Seagrape Drive Improvements City of Sunny Isles Beach Contact: Mr. Bill Evans, Public Works Director Tel.: 305-792-1711 PROJECT: Golden Shores Entrance Wall Atlantic Blvd. Parking Lot & Drainage Improvements City of Margate Contact: Samuel A. May Interim Public Works Director Tel.: 954. 972. 8126 PROJECT: Margate Blvd Streetscape Improvements East & West Palm Drive Coral Gate Park Royal Palm Blvd. & MW 61st and 63rd Ave East River Dr. Restoration AMOUNT: $ 1,160,373.18 AMOUNT: $ 198,180.00 $ 300,000.00 AMOUNT: $ 3,835,237.41 $ 734,018.25 $ 940,174.00 $ 71,425.00 $ 430,000.00 COMPLETION: October 2008 COMPLETION: Nov. 2005 Jan. 2005 COMPLETION: Aug. 2008 Aug. 2008 Aug. 2008 Oct. 2005 Mar. 2005 Company History City of Ft. Lauderdale Contact: Mike Fayyaz Assistant City Engineer Tel.: 954. 828.6527 PROJECT: Ft Lauderdale Airport Drainage Dillard Park Improvements Victoria Park Neighborhood Improvements SE 26th Ave Idlewyld Dr. - Las Olas Gateway Merchant Sunrise Blvd. Sunset Memorial Gardens Fence Wall AMOUNT: $ 364,753.00 $ 43,800.00 $ 84,420.00 $ 950,000.00 $ 135,558.00 $ 132,965.00 P age I 4 of 6 COMPLETION: Nov. 2006 Sept 2006 Sep 2006 Dee. 2003 Sep.2001 July 2009 (In Progress) Catholic Cemeteries of the Archdiocese of Miami Contact: Catholic Cemeteries of the Archdiocese of Miami Ine. John Kissel Project Coordinator Tel.: 305. 206. 6163 PROJECT: Lady of Mercy Roadway City of Tamarac Contact: Alan Lam, Project Manager Tel.: 954.597.3712 PROJECT: Southgate Boulevard Streetscape, Ine. NW 70th Ave Traffic Calming Improvements Westwood Drive Culvert Improvements AMOUNT: $ 700,000.00 AMOUNT: $ 1,239,469.00 $ 769,113.00 $ 174,580.00 COMPLETION: Oct. 2004 COMPLETION: Dee. 2006 Oct. 2006 March 2007 , , Company History P age I 5 of 6 City of Parkland Contact: Jim Berkman Public Services Director Tel.: 954-753-040 PROJECT: Trails End Sidewalk Improvements City of Coral Springs Contact: Art Resnick Purchasing Agent II 954-344-1100 PROJECT: Whispering Woods Park Creation of Wetland Area City of Lauderdale Lakes Contact: Phil A Alleyene Office of Engineer 954-562-2970 PROJECT: C-13 Greenway Trail AMOUNT: $ 317,652.00 AMOUNT: $ 324,800.00 $ 1,174,770.60 AMOUNT: $ 721,997.00 COMPLETION: March 2007 COMPLETION: Aug. 2008 Oct. 2007 COMPLETION: Dec 2006 . . J Company History P age I 6 of 6 City of Lauderhill Contact: Mr. Indar Maharaj 954-730-3010 PROJECT: AMOUNT: COMPLETION: Wolk Park Improvements $ 315,149.80 Dec 2006 Florida Department of Transportation Contact: Jorge Ortiz Project Coordinator 305-986-0846 PROJECT: AMOUNT: COMPLETION: SR 824 Pembroke Rd. $ 4,823.222.45 Jun 2007 " ACORD CERTIFICA TE OF LIABILITY INSURANCE I DATE (MMlDOIYYYY) TM. 06/1012009 PRODUCER Phoee: (813) 988-1234 Fax: 813-988"*89 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ASSOCIATES AGENCY. INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PO BOX 16190 HOLDER. THIS CERTIFICATE DOES NO~~MEND. EXTEND OR 11470 N. 53RD ST. " TeO RY .. """ ,;.,~~ 8E'l IW TEMPLE TERRACE FL 33687 INSURERS AFFORDING COVERAGE NAIC# ".~eeC'1 LIc#: R.."01756 INSURED INSURER A: SOUTHERN OWNERS INSURANCE CO TENEX ENTERPRISES [NC INSURER B: AUTO OWNERS INSURANCE CO. 8SO SW 14 COURT INSURER C: ZURICH POMPANO BEACH FL 33060 INSURER D: INSURER E: COVERAGES THE POUCIES OF INSURANCE USrED BELOW HAVE SEEN ISSUED TO T~E INSURED NAMED ABOVE FOR THE POuey PERIOD INDICATED, NOTWITr'.sTANDING Am REQUIREMEm. TERM OR CONDITION OF Am CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.. THE INSURANCE AFFORDED BY THE POLIClES DESCRIBED HEREIN IS SUBJECT TO ALL THe TERMS. EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES. AGGREGATE UMITS SHOI,\N MAY HAVE BEEN REOUCED BY PAID ClAIMS. iNSR 1= TYPE OF INSURANCE POUCYNUMBER ~~~:'.:;= ~~.re ~":~N LIMITS LTR GENERAL UABILITY 20698033 06125109 06125/10 EACH OCCURRENC!: s 1,000,000 X COMMERCIAL GENERAL L1ABIUTY OAMAGE TO RENTED S 300,000 PREMISES (Ea oceurenco) 1 CLAIMS MADEW OCCUR MED, EX? (Any one person) S 10,000 A rfES X contractual liability PERSONAL & ADV INJURY S 1,000,000 X includes .xcu" GENE~AGGREGATE S 3,000,000 -.:..:.. ~L AGGREGATE LIMIT APPn:ER: PROOUCTS-COMPIO? AGG. S 3,000.000 [Xl PRO. POLICY X JEeT LOC I ~TOMOBlI..E LIABILITY I 4732811101 06125/09 06125/10 I COMBINED SINGL!: LIMIT 1,000,000 I ~ AAY AUTO (Ea accident) S I - AU OWN!:D AUTOS BODILY INJURY (Fer person) S B -'--- SCHEDULED AUTOS ~._~ BODILY INJURY X . NON.oWNEDAUTOS (Per accident) S I PROPERTY DAMAGE $ {Per a:cident} I GARAGE UABIUTY . I AUTO ONLY - EA ACClOENT $ . R AmAUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ l PJ='""-~~"= 4732811102 06125/09 06125/10 EACH OCCURRENCE Is 3,000,000 X OCCUR U CLAIMS MADE AGGREGATE S 3,000,000 B ES $ ~ DEDUCTIBLE S X RETENTION S 10,000 S 1~ORKERS COMPENSAllON AND I ~ ~~~T~~S t I OTHER EMPLOYERS' UABIUTY . ANY PROPRIETORJPARTNERtEXeCUTIVE E.L EACH ACCIDEm S I OFFlCERlMEMBER EXC"UDED? E.L DISEASE.EA EMPLOYEE Is tt yu. ducribe lA'tdft' E.L DISEASE-POUCY LIMIT S SPECIAl PftOVlSIONS ....... . c I OTHER: Sullders Risk Incl Flood BR68334145 C6/30/09 06130/10 $800,000 LIMIT $5,000 DI:DUCT DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTJ SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD Am OF TH!: ABOYE DESCRIBED POUC1ES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WlUENDEAVORTO MAIL30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMeO TO TI-IE LEFT. BUT FAILURE TO DO SO SHAU IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHCRIZED REPRESENT ATIYE P~-d)~-1 77"- Attention: Bill Owen ACORD 25 (2001/08) Certificate # 179325. @ACORD CORPORATION 1988 ." .----., ACORD~ CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY) ~ 6/10/2009 PRODUCER (813)890-0415 F~X: (813)885-4311 i THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Prime Group Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 5440 Beaumont Center Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Sui te #445 Tampa FL 33634 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A; Employers Preferred Ins. Co. Tenex Enterprises, Inc. INSURER B: , 850 SW 14th Court INSURER c: I , INSURER 0: I Pompano ,BeaCh FL 33060 , INSURER E; , COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA TED. 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 OISUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I~~~~~ TYPl=nF POUCYNUMBER 16mq~~6~~1 ~!ftf~~~~~1 j ~NERALUABILITY I I i EACH OCCURRENCE I ; ~~~;;.~J~E~~:;;:'n""l $ ""Ii, -:"AMMERCIAL GENERAOL LIABILITY ., W CLAIMS MADE OCCUR i i i 1 MED EXP (Any one jle(!(ln> S -; ; , i PERSONAL & ACJV INJURY S ;- GENERAL AGGREGATE I s I' ~N'1.. AGGREGAT;E LIMIT A~S PER: PRODUCTS - COM PlOP AGG ! S ~~n~I'~ I I I~OMOBILEUABILlTY ! 'I COMBINED SINGLE LIMIT I s _ ANY AUTO ! ! (Ea aced.nt) I i _ ALL OWNED AUTOS i ! BODILY iNJURY i (Per porson) UMITS _ SCH,EDULED AUTOS _ HIRED AUTOS -... NON.cWNED AUTOS , $ i 1 I I 16/30/2009 I I I , 1$ PROPERTY DAMAGE I S (Per aco:dent) ! I AUTO ONLY. EA ACCIDENT $ I OTHER THAN EA ACC S i AUTO ONLY: AGG I S , is is EACH OCCURRENCE BODILY INJURY (Per aco:dent) nRAce LlAB1llTY M ANY AUTO i EXCESSI UMBREllA. LIABILITY ~. OCCUR 0 ClAIMS MADE DEDUCTIBLE RETENTION S A WORl<ERSCOMPENSAnON I AND EMPLOYERS'LIABIUTY Y t N ! ANY PROPRIETORIPARTNERf.EXECUTJVE 0 ! OFFICER/MEMBER exCLUDED? I ; (Mandatory In NH) ii'CV70614!l2 lit yes. describe under . SPECIAL PROVISIONS below I OTliER ; AGGREGATE i i I 16/30/2010 , ! $ S I s ! X I T~~~IfJ,~s I X I OJ~.1 1 E.L EACH ACCIDENT Is E.L D1SEAS= - fA EMPLOYES S E.L DISEASE - POLICY LIMIT S 1 000.000 1 000 000 1 000 000 OESCRlPTION OF OPERATIONS I LOCA nONS I VEHICLES t EXCLUSIONS ACOED BY ENDORSEMENT t SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHEABOVE DESCRIBED POUC1ES BE CANCELLED BEFORE TIlE EXPIRATJON DATE THEREOF. TIlE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRImN NOTICE TO TIlE CERTIFICATE HOLDER NAMED TO TIlE LEFT. 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