HomeMy WebLinkAboutUnique Charters
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FLORIDA AUTO INSURANCE IDENTIFICATION CARD
COMPANY: National Specialty Ins. Co.
POLICY #:LHM00024S
YEAR: 2002 :r~Wl: Ford E350
VEHICLE 10 #: 1 FBS631 L02HA22182
EFFECTIVE
DATE: 11/0912010
r RECE!~ED l
I . MAY 2 5 ~~ \oh;IS'......
I GfJ or "Llnny Is/i.)s Gead; I
L ul~ce 0: 1I1Q C!;Y Clerk
_.~'-~._-~--_..~
!Xl PERSONAL INJURY PROTECTION ~X BODilY INJURY
~ BENEfITS/PROPERTY DAMAoGE lIABILITY ~ LIABILITY
NAMED
INSURED:
ADDRESS:
(OPTIONAL)
Unique Transportation Inc
160 NW 176th Street
Miami, FL 33169
NOT VALID FOR MORE THAN ONE YEAR FROM EFFECTIVE DATE
THIS CARD MUST BE KEPT IN THE INSURED
VEHICLE AND PRESENTED UPON DEMAND
IN CASE OF ACCIDENT: Report all accidents to your
Agent/Company as soon as possible. Obtain the
following information:
1. Name and address of each driver, passenger
and witness.
2. Name of Insurance Company and policy number
for each vehicle involved.
Rental car coverage is provided. see outline of coverage.
MISREPRESENTATION OF INSURANCE IS A FIRST DEGREE MISDEMEANOR
ACORD SO FL (3194)
# 19240
(1) ACORD CORPORATION 1994
---
.~
Al.C~D' CERTIFICATE OF UABILITY INSURANCE I DAlE (MMfilM'Y'l')
MJDIiI2011
PRODUCER Rlcln<< llID}57G3!123 K.: ~elJ8.1753 lHI8 \O&:K1~1l! IS ~ M A MAnER OF INfORIIAncN
KMAT, 1Ne. ONLY 11m COWEftS NO ftIGKI'S UPON TIE CERTIAGIm:
15U2 GAUXIE AVE #217 HOLDER. nus cstlll'tlOATI! I:lOe5 Nar AIII;NI). EXTBID OR
APPLEVAL1EY.. aiD ALTAI! !IV aa ~
INSURERSAFFORIMG COVERAGE NAIC ##
NSUREO A:. Mi
UNfQUE ctWn'ERS.-..c ~8:
_ fIif 17111t Sf INSURER C:
SlmE 280-1
D: ,
MIAMI FL 33111
E:
COVERAGES
THE FOlClES OF lNQJRANCe USTeD ee.aw HI\'\IE ElE9l ISSUED TO THE lNSOAEl NAMED ASI:NE FOR lllE POLICW' PERIOD INDCATED, NO'TWJ1HSTANmlG
AN'f REQlJlREMENr, "TBiII OR COlO11ON 01' All'( CONTRACt' OR DI'HER OOCLUENT WrTH RESPECf mWHICH ~1S ~TE MAY BE lSSlJS) OR
M"V F'BffAlN, TIE INSlRAIIQ; AFF()ROS) BY' -mE F'(JlDI;S 0E;SCRIBEl) .-.N IS SlAG:!' m AlL na; TERMS, EXCLIJSIOI\IS AN) CONDITIONS OF' SUCH
f1IOUClE6. ot.GGREGAlEUMITS SHOWN MAY HAVE ~ ReClJCED BY Pill) CLAIMS.
LlR I..... TYl'EGF~ ~...-BER ':"=== r:===:- ...ns
~UM!ILIfV EACH~ $
cow.teRClAL GeIERAL L/AIIIUTY :=:esJO~\ $
'I cv.MS w.oe[] OCCUR UEC. SIP (,.,.,,_~ S
PERSOHAL & I\W INJlJRY $
-
GENERAL AGGREGATE $
-
~=n~n= PROOUCTS-CCMPjOP AGG $
$
~UAMJlY COMelNED SINGI.EUWT 5
Nl'I AUlO (al1lCCiclen1)
-
ALLOWtlED AlIl'OS BCCII..Y INJURY
- (Perfll""l'll') $
SCHEDtAE) Al1IOS
-
HIRE!) AUTOS BOCl1. Y lNJlIrr
- lPlIrac:ddlnO $
NON-ONNED AUTOS
-
- PROPERTY IJo'\IUIGE
(Pm'...-nt)
GARMI<~ IWTO ONLy -Ij;AACCDiNT
rl AtN AUTO OTMI:RlHAN ~NX
AUTO ONlY: AGG S
1PC&SSn---~ 6\CH occuRRENCe $
:J 0CCl.IR 0 a.J\IMSMADE AI)GflEGATe $
$
R::=s s
s
VlICIRtCmS"-'~1lDN AND wcee17B11 04IISI11 84III6t12 1'RlIl'Y LMJl,l I I aJHER
EllPLCJYBWUM&nY '1'/11 EL. EACH ACCD3'fr $ .....
A 1IIlt~---..--..~ 0 --
Gl'1'It._~ pa.IJIJEm EL ~ EfoIlIJJYEE $
~....
---- EL. 0JSEASE.f'0LIC' UMIT S .....
SPS:IN.~-
0THBt
DE5CRP11ON or OPERA"JION5IU)CA~CUISlONS ADDeD BY ENDQRSEMEHI'I.sPECIM. PROVISIONS
Evidence ofWodels eoop:!tkSation ......... ~
--
CERTIFlCA1E HOLDER
MiIdI Dade CcuIly
111 NW 1stSb88l.Fl:S4O
..... R. 3312i8
:noN
l5tfOUlO Nl'f OF tHE PIIIt:NS CEiaCRIBED ~ BE CANCeI-lS) BEFORE n-E
EXI'lRA1ION Do\TE lHEREOf'. THE ~ I'lSURER WlLLSII06AVOR1O MAL90 M"l'S
WRtfTEH NOTICE TO THE CERIlFlCATE HOLDER NAMED 10 TIE LEFr. BUT FAlUJRElO
go eoSI-W.L IIFC5E NO OGL CIA UABlJTYClF HlYGID lRlN THE INSlJRER. rrs
MEKl8OR~rrl\:
AtJnIOPJZEI) REmESBlTA
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ACORD
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ACORO(fl) CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYYVY)
~ 11/9/2010
PRODUCER Phone: 800-407-4077 Fax: 321-752-7980 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Euclid Insurance Agencies, LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4450 W Eau Gallie Blvd., #164 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Melbourne FL 32934
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERA:American Alternative Insuranc
Unique Charters, Inc. INSURER B:
160 N.W. 176th Street
suite 200-1 INSURER C:
Miami FL 33169 INSURER 0:
I INSURER E:
~
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I~~ ~P.,~~ POLICY NUMBER I ~P}Jqr..;\',!,'g~~\ i h~~lfr..~~~~~ LIMITS
A ~NERAL LIABILITY 92A2GLOOO030600 11/9/2010 11/9/2011 EACH OCCURRENCE $1 000 000
DAMAGETI:'~NTEO
lL OMERCIAL GENERAL LIABILITY PREMISes Ea occurrence) $100 000
- CLAIMS MADE [i] OCCUR MED EXP (Anyone person) $5 000
- PERSONAL & ADV INJURY $1.000 000
I-- GENERAL AGGREGATE $2 000 000
i;Zl'L AGGREAE LIMIT APnS PER: PROOUCTS - COMP/OP AGG $1. 000 000
X POLICY P,~~T LOC
A ~TOMOBILE LIABILITY 92A2CAOOO047900 11/9/2010 11/9/2011 COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $1,000,000
I--
,----- ALL OWNED AUTOS BODILY INJURY
$
lL SCHEDULED AUTOS (Per person)
)L HIREO AUTOS BODILY INJURY
$
lL NON-OWNED AUTOS (Per accident)
- PROPERTY DAMAGE $
(Per accident)
RGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
A ~ESS / UMBRELLA LIABILITY 92A2UBOOO028800 11/9/2010 11/9/2011 EACH OCCURRENCE $4 000 000
X OCCUR 0 CLAIMS MADE AGGREGATE $4 000 000
$
=1 DEDUCTI8LE $
RETENTION $ $
WORKERS COMPENSATION 1 T"Xc;,~;~:,~~ I 10J~-
AND EMPLOYERS' LIABILITY Y/N
ANY PROPRIETORlPARTNER/EXECUTIVE 0 E.L EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandalory In NH) E,L. DISEASE - EA EMPLOYEE $
If yes, oescrloe unoer
SPECIAL PROVISIONS below E.L DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate holder is named as additional insured with respect to the operations of the named insured only.
1994 Vanhool CHRTB YE2TA73B4R2024857
1999 Vanhool CHRTB YE2TC76B3X2042138
CERTIFICATE HOLDER
COVERAGES
Miami Dade Community College
North Campus
11380 NW 27th Ave.
Miami FL 33167
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER
WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE
CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO
SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON
THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ~
/~
ACORD 25 (2009/01)
@1988-2009ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
~
ACORV@ CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDD/YYVV)
~. 1/28/2011
PRODUCER Phone: 800-407-4077 Fax: 321-752-7980 THIS CERTIFICATE IS ISSUED AS A MATrER OF INFORMATION
Euclid Insurance Agencies, LLC ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
4450 W Eau Gallie Blvd., #164 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Melbourne FL 32934
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERA:Na t i anal Snecialtv Ins. Co. D2608
Unique Transportation Inc INSURER B:
160 NW 176th Street
Miami FL 33169 INSURER c:
INSURER 0:
I INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEO 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
TERNS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I~f: ~~: TVI>~ POUCY NUMBER POUCY EFFECTIVE POLICY EXPIRATION UMITS
A ~ERAL UABIUTY LHMOO0245 11/9/2010 11/9/2011 EACH OCCURRENCE $1 000 000
X- :31MERCIAL GENERAL UABllITY PREMISES lEa o:x:urrenml $100,000
- CLAIMS MADE 5LJ OCCUR MED E XP (Any one oerson) $ 5.000
- PERSONAl & ADV INJURY $1 000 000
t--- GENEAALAGGREGATE $2 000.000
~t. AGG~nE UMIT APFt PER: PRODUCTS - COMP!OP AGG $I 000 000
I X POLICY P,lYT LOC
I~OMOBILE UABIUTY COMBINED SINGLE liMIT $
PJolY AUTO (Ea accldent)
I--
t--- AlL OWNEO AUTOS BOOIL Y INJURY
$
SCHEOULEO AUTOS (per person)
t---
HIRED AUTOS BOOIL Y INJURY
t--- $
NQN.QWNED AUTOS (per acciderl)
t---
PROPERTY DAMAGE $
(per acciderl)
GARAGE UABIUTY AlTTO ONL Y . EA ACCIDENT $
R PJolY AUTO OTHERTHPJol EAACC $
AUTO ONL Y: AGG $
OESS I UMBRELLA LIABIUTY EACH OCCURRENCE $
OCCUR 0 CLAIMS MADE AGGREGATE $
$
R DEOUCTlBLE $
RETENTION $ $
WORKERS COMPENSATION 1 T~~HH,\!;,T 1OJ~-
AND EMPLOYERS' UABIUTY Y/N
ANY PR:lPRIETORIPARTr-ERlEXECunVE 0 E.L EACH ACCIDENT $
OFFlCEAlMEMlER EXCLUDED?
(Mandalory In NH) E.L OISEASE - EA EMPLOYEE $
~~I~~~,}i~S below E.L OISEASE . POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS /LOCATIONS/ VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
ertificate holder is named as additional insured with respect to the operations of the named insured only.
~nique Charter Inc. is listed as an additional insured on the General Liability policy
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER
WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE
MIAMI-DADE COUNTY CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO
111 NW 1st Street SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON
Miami FL 33128 THE INSURER, ITS AGENTS OR REPRESENTATIVES.
I AUTHOR~EDREPRESENTATIVE~ ~ E9-J /4
ACORD 25 (2009/01)
C 1988.2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACORVCfP CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIOD/YVVY)
~. 1/28/2011
PRODUCER Phone: 900-407-4077 Fax: 321-752-7990 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Euclid Insurance Agencies, LLC ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
4450 W Eau Gallie Blvd., 11164 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Melbourne FL 32934 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERA:Na t ional Snecialtv Ins. Co. In 608
Unique Transportation Inc INSURER B:
160 NW 176th Street
Miami FL 33169 INSURER c:
INSURER 0:
, INSURER E:
~
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 WHrCH THIS
CERTIFrCATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE
TEJUooIS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR 00' POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
LlMrrs
~NERAL LIABILITY EACH OCCURRENCE $
- COMMERCIAL GENERAL LIABILITY ~:r~~S lEa oa:urrencel $
- :::J CLAIMS MADE 0 OCCUR MEO EXP (Any one persal) $
- PERSONAl II ADV INJURY $
- GENERAL AGGREGATE $
~l AGG~nE LIMIT APPUES PER: PROOUCTS.COMP~AGG $
POLICY ~f19,: II LOC
A ~OMOBILE LIABILITY LHM-000245 11/9/2010 11/9/2011 COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $1,000,000
-
- AlL OWN EO AUTOS BOOIL Y INJURY
eX- (per pe,son) $
SCHEDULED AUTOS
~ HIRED AUTOS BOOIL Y INJURY
$
~ NON-QWNEO AUTOS (per accid9r1)
c-- PROPERTV DAMAGE $
(per accid9r1)
~AGE LIABILITY AUTO ONL Y . EA ACCIDENT $
ANY AUTO OlliER THAN EAACC $
AUTO ONL Y: AGG $
~ESS / UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR D CLAIMS MADE AGGREGATE $
$
~ DEDUCTiBlE $
RETENTION $ $
WORKERS COMPENSATION -rT~~mI,lI;, r IOJ~'
AND EMPLOYERS' LIABILITY Y/N
ANY POOPRIETORIPARTtoI;R/EXECUTTVE 0 E.L EACH ACCIDENrT $
OFFlCERlMEMlER EXCLUDED? E.L OISEASE . EA EMPLOYEE
(Mondolory In NH) $
~~I~~~":;~S below E.L OISEASE . POliCY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS
ertificate holder is named as additional insured with respect to the operations of the named insured only.
7002 Ford E350 VN 1FBS631L02HA22192
7006 Ford E250 VN 1 FTNS24W96DA9601 6
~006 Ford E250 VN lFTNS24WX6DA72609
COVERAGES
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEO
BEFORE THE EXPIRATION DATE THEREOF, THE rSSUING INSURER
WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE
MIAMI-DADE COUNTY CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO
111 NW 1st Street SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINO UPON
t-1iami FL 33128 THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE g~ tlb
I ..i" ,J, ,~.,
ACORD 25 (2009/01)
4:>1988.2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
BID FORM
Reference Summarized Reauirement as stated in Section 2.0 ParaQraoh 2.6 Initial As
Comoleted
Enter your firm's Email Address facsimile (FAX) machine and Phone number,
including
area code:
Paragraph Fax No. "3&-S-- b<;;2 ~'-(q20
2.5 A Emergency Contact No. 305 - 79C-- S-2-~D
Enter your firms em ail address:
Email. UIJ (QUE" CHA\'1t1<S @...tELL SDuTH. NET
Paragraph Provide a listing of communication equipment (e.g., mobile phones or two-
2.5 B way radio equipment) which is required for constant communication with all
vehicles providing transportation services as per section 2.6 B.
Attach to Prooosal
Paragraph Copy of Passenger Motor Carrier (PMC) Certificate of Transportation (If
2.5 C applicable)
Attach to ProDosal
Paragraph Listing of all motor coach equipment as described within this contract with
2.5 D USDOT registration Number.
Attach to Prooosal
4.2 TRANSPORTATION SERVICES-MOTOR COACH RENTALS
The hourly rate provided by the successful bidder(s) is an all inclusive transportation service which
consists of driver, supervisory personnel, motor coach vehicle, and fuel costs.
TRANSPORTATION SERVICES-MOTOR COACH RENTALS
Line# Est. Description
Hours
Per Hour Charge Extended Price
1 600 47 - 57 Passenger bus
$ 7: $
Optional Items
# Descriotion Per Hour Charae Extended Price
1 30 - 43 Passenger bus $ 7_0 $
2 14-33 Passenger Mini-bus $r63 $
Items 1 - 2 Total: $
PAGE 24 OF 28
BID No. 11-05-02
NON-COLLUSION AFFIDAVIT
Or ~\J'"
City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, FL 33160
Telephone: (305) 947-0606 Fax: (305) 949-3113
STATE OF FLORIDA
COUNTY OF \>A: ,\).f'"
The undersigned being first duly sworn as provided by law, deposes, and says:
This Affidavit is made with the knowledge and intent that it is to be filed with the City of Sunny Isles Beach City Commission and that it will be
relied upon by said County, in any consideration which may give to and any action it may take with respect to this Bid.
The undersigned is authorized to make this Affidavit on behalf of,
U IV \ 6)vE OM i<TFR.r / AJ C.
(Name of Corporation, Partnership, Individual, etc.)
aTRf\I\JS-PoQIt.\ Tlo AJ
(Type of Business)
, formed under the laws of
FLOtt, bA-
(State)
of which he is
SoLe
()v..JAJ~ .
(Sole Owner, artner, President, etc.)
Neither the undersigned nor any person, firm, or corporation named in above Paragraph 10.2, nor anyone else to the knowledge of the
undersigned, have themselves solicited or employed anyone else to solicit favorable action for this Bid by the City, also that no head of any
department or employee therein, or any officer of the City of Sunny Isles Beach, Florida is directly interested therein,
This Bid is genuine and not collusive or a sham; the person, firm or corporation named above in Paragraph 10,2 has not colluded, conspired,
connived or agreed directly or indirectly with any proposers or person, firm or corporation, to put in a sham Bid, or that such person, firm or
corporation, shall refrain from Bidding, and has not in any manner, directly or indirectly, sought by agreement or collusion, or communication
or conference with any person, firm or corporation, to fix the prices of said Bid or Bids of any other proposers; and all statements contained in
the Bid or Bids described above true; and further; neither the undersigned, nor the person, firm or corporation named above in Paragraph
10,2, has directly or indirectly submitted said Bid or the contents thereof, or divulged information or data relative thereto, to any association or
to any member or agent thereof,
I<A-N~Y ~(TH
AFFIANrS NAME
()wtJt~
AFFIANrS TITLE
, \b
TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this a. ~ day of
~ O\..--t
"
,20U
Personally Known
v
or Produced Identification
Type of identification
(Affix seal herl~k,.. RICHARD.A:NZERiBE........~
,>'~~~~::!:;"" Comm# 000737586 ~
"~m<;<.~
~~~;i Expires 12/14/2011 E
. ~/J;f,f,f;:.~ Florid<:l Notary Assn" Inc
,'I '" lUI II ..11" . '.~". .: c.. '!II" .......... I' I'
NOTARY PUBLIC (name printed or typed)
DECEMBER 28,2010
10f7
PUBLIC ENTITY CRIMES
City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, FL 33160
Telephone: (305) 947-0606 Fax: (305) 949-3113
SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a)
FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
PUBLIC ENTITY CRIMES
Pursuant to the provisions of paragraph (2) (a) of Section 287.133, Florida State Statutes - "A person or affiliate
who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a
Bid on a Contract to provide any goods or services to a public entity, may not submit a Bid on a Contract with a
public entity for the construction or repair of a public building or public Work, may not submit Bids on leases of
real property to a public entity, may not be awarded to perform Work as a Contractor, supplier, Sub-Contractor, or
Consultant under a Contract with any public entity, and may not transact business with any public entity in excess
of the threshold amount Category Two of Sec. 287,017, FS for thirty six months from the date of being placed on
the convicted vendor list".
THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER
OFFICIAL AUTHORIZED TO ADMINISTER OATHS.
11.1.
by
pnn 10 IVI S name an I e
for ~!i~~~subS~S
whose business address is:
ICo
Nv.J
/7bTH ~
STE.
OW-I
and (if applicable) its Federal Employer Identification number (FEIN) is b 5" -IO~ 7 ')7~
(If the entity had no FEIN, include the Social Security Number of the individual signing this sworn
statement: ,)
,
11.2. I understand that a "public entity crime" as defined in Paragraph 287.133(1 )(g), Florida Statutes, means a
violation of any state or federal law by a person with respect to and directly related to the transaction of
business with any public entity or with an agency or political subdivision of any other state or with the
United States, including, but not limited to, any Bid or Contract for goods or services to be provided to any
public entity or an agency or political subdivision of any other state of the United States and involving
antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.
11.3. I understand that "convicted" or "conviction" as defined in Para. 287.133(1 )(b), Florida Statutes, means a
finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any
federal or state trail court of record relating to charges brought by indictment or information after July 1,
1989, as a result of a jury verdict, non-jury trial, or entry of a plea of guilty or nolo contendere.
11.4. I understand that an "affiliate" as defined in Para. 287.133(1 )(a), Florida Statutes, means:
a,)
predecessor or successor of a person convicted of a public entity crime; or
b,)
Any entity under the control of any natural person who is active in the management of the entity
and who has been convicted of a public entity crime. The term "affiliate" includes those officers,
directors, executors, partners, shareholders, employees, members, and agents who are active in
the management of an affiliate. The ownership by one person of shares constituting a controlling
interest in another person, or a pooling of equipment or income among persons when not for fair
2of7
OECElAeER 28.2010
market value under an arm's length agreement, shall be a prime facie case that one person
controls another person. A person who knowingly enters into a joint venture with a person who
has been convicted of a public entity crime in Florida during the preceding 36 months shall be
considered an affiliate.
11.5. I understand that a "person" as defined in Para. 287.133(1)(e), Florida Statutes, means any natural
person or entity organized under the laws of any state or of the United States with the legal power to
enter into a binding Contract and which Bids or applies to Bid on Contracts for the provision of goods or
services let by a public entity, or which otherwise transacts or applies to transact business with a public
entity. The term "persons" includes those officers, directors, executives, partners, shareholders,
employees, members, and agents who are active in management of any entity.
11.6. Based on information and belief, the statement which I have marked below is true in relation to the entity
submitting this sworn statement (Indicate which statement applies.)
~. Neither the entity submitting this sworn statement, nor any of it's officers, directors, executives, partners,
shareholders, employees, members, or agents who are active in the management of the entity, nor any
affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1,
1989.
The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners,
shareholders, employees, members, or agents who are active in the management of the entity, or an
affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1,
1989.
The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners,
shareholders, employees, members, or agents who are active in the management of the entity, or an
affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1,
1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of
Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer of the
State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer
determined that it was not in the public interest to place the entity submitting this sworn statement on the
convicted vendor list. (Attach a copy of the final order.)
I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE
PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 11.1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND,
THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I
ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM T PUBLIC ENTITY PRIOR TO ENTERING INTO
A CONTRACT IN EXCESS OF THE THRESH UN PROVIDED IN SECTION 287.017, FLORIDA
STATUTES, FOR CATEGORY lWO OF ANY E INFORMATlpN CONTAINED IN THIS FORM,
By:
(Signatur~ IJD Y Sf'( ,771
(Printed Name)
Or LJ,J e:--rl
(Title)
~
\L-~toand~~~Oremethis;;>"'" daYOf~ .20~by
\ \
(AFF,IXcN@~~ftXR~~~~~}""5 ()~
~ ,"tR~~~ Comm# 000737586 E
~ "'~?i!\~~ : Signature: Notary Public - State of Florida
~ ~~~~~ Expires 12/14/2011 :
-:;trc"'~~<: Florida Notary Assn., Inc E Print or Type Commissioned Name
person':lIy~~'~:~"''''''''7'''~~';roduced Identification
Type of Identification Produced
1011998
3of7
EQUAL OPPORTUNITY /
AFFIRMATIVE ACTION
Or SU""
City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, FL 33160
Telephone: (305) 947-0606 Fax: (305) 949-3113
EQUAL OPPORTUNITY I AFFIRMATIVE ACTION STATEMENT
The contractors and all subcontractors hereby agree to a commitment to the principles and
practices of equal opportunity in employment and to comply with the letter and spirit of
federal, state, and local laws and regulations prohibiting discrimination based on race,
color, religion, national r ion handicap, marital status, and political affiliation or
belief.
Signed:
Title: tJ $L
Firm: ill Q~ ~"fCi2.-S
Address: I~O I-JvJ 11 brn 'ST. SiC. 200-1
~J\\ A r....H &,4 i<-ocJ\.)S J F L, S !J b 9
/
DECEMeER 28,2010 4 of 7
CONFLICT OF INTEREST
City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, FL 33160
Telephone: (305) 947-0606 Fax: (305) 949-3113
CONFLICT OF INTEREST STATEMENT
The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes, Proposers must
disclose with their Bids, the name of any officer, director, partner, associate or agent who is also an officer or employee of the
City of Sunny Isles Beach or its agencies.
STATE OF FLORI~ "t"'""
COUNTY OF ~Uc: ~
BEFORE ME, the undersigned authority, personally appeared~ftNb '-( ~ I Tl-fWhO was duly sworn,
deposes, and states:
18.1. I am the Ow ~\<- of
::,'tL'fl~~~S {g...)c...with a local office in N I C~A-R~" and principal office in
18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. {f - O.t:;- 02.. described
as: LBl'la3eap(. Ma;nlel,l'Il'1ee 8~fVjee8. The Affiant has made diligent inquiry and provides the information contained in this
Affidavit based upon his own knowledge.
18.3 The Affiant states that only one submittal for the above Bid is being submitted and that the above named entity has
no financial interest in other entities submitting Bids for the same project.
18.4 Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, participated in
any collusion, or otherwise taken any action in restraints of free competitive pricing in connection with the entity's submittal for
the above Bid. This statement restricts the discussion of pricing data until the completion of negotiations if necessary and
execution of the Contract for this project.
18.5 Neither the entity nor its affiliates, nor anyone 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 anyone associated with them have any potential conflict of interest due to any
other clients, contracts, or property interests for this project.
18.71 certify that no member of the entity's ownership or management is presently applying for any employee position or
actively seeking an elected position with the City of Sunny Isles Beach,
18.81 certify that no member of the entity's ownership or management, or staff has a vested interest in any aspect of the City
of Sunny Isles Beach,
18.9 In the event that a conflict of interest is identified in the provision of services, I, on behalf of the above named entity, will
immediately notify the City of Sunny Isles Beach.
~at:.c' _~i~_ ;).......~ d_aY?f"U , ~ ,201~, ~
~ ~ '_ . ....'D"i 'SHln\ <,WOe-Ie-...
AFFIANT . Print or Type Name and Title
Swom to and subscribed before me this "l..'f' day of ~
~ Personally Known -OR \
o Produced Identification ; TYP~ ~
, 201lt.
NOTARY PUBLIC ST.ATE.OE.F.L.QRIQA...
~ RICHARD A. NZERisE........:
. :\\\\\lltllll :
,1l~o..Y ~~% Comm# 000737586 ~
,; ~~~;-~ Expires 12/14/2011 :
: ~t1"!IJ:~~;:!". :
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"""'1:H-:~I:;'!'r-:. -., : 'Cl"''!'~lI''.''It..........i
OECBlElER 28. 2010
5of7
DISPUTE DISCLOSURE
City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, FL 33160
Telephone: (305) 947-0606 Fax: (305) 949-3113
DISPUTE DISCLOSURE FORM
Answer the following questions by placing a "X" after "Yes" or "No". If you answer "Yes", please
explain in the space provided, or on a separate sheet attached to this form.
19.1. Has your firm or any of its officers, received a reprimand of any nature or been suspended by the
Department of Professional Regulations or any other regulatory agency or professional associations within the last
five (5) years?
YES
NO r
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 ~
19.3. Has your firm had against it or filed any requests for equitable adjustment, contract claims, Bid protests,
or litigation in the past five (5) years that is related to the services your firm provides in the regular course of
business?
YES NO ~ 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 certify that all statements made are true and agree and understand that any misstatement or
misrepresentation of falsification of facts shall be cause for forfeiture of rights for further consideration of this Bid
for the City of Sunny Isles Beach.
"5/24/201{
Date
~AwY SNIn-f - OWN e-Q
Print or Type Name and Title
DECEUBER 28,2010
60f7
ANTI-KICKBACK
City of Sunny Isles Beach
18070 Collins Avenue
Sunny Isles Beach, FL 33160
Telephone: (305) 947-0606 Fax: (305) 949-3113
ANTI -KICKBACK AFFIDAVIT
STATE OF FLORIDA
COUNTY OF Uf\bE
)
)
)
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:
~t)L( ~MlrrJ
()Wt0~
Title:
The foregoing instrument was acknowledged before me this .2 'IrJ/ day of
MAl{ , 20-1L, by <"Rjo,<..iOt.t 8H /771 [name
of person], as G>c..c..>,.) rl< [type of authority], for
l>>J l Gl0C= c ft-1'tiL TC(<. S, I r.-JL... [name of party on behalf of whom instrument was
executed] .
AFAX NOTARY STAMP HERE:
.................................................
; RICHARD A. NZERIBE :
; ~...,\.\\\tIt::II~/~ :
_ ~ CQ(l)misf4n~~ Ncime
, ~t~"tJ:?\.~\.#. :
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Personally Known ~ OR Produced Identification
Type of Identification Produced
DECEMeER 28, 2010
70f7
DELIVER TO:
City of Sunny Isles Beach
City Clerk
18070 Collins Avenue
Sunny Isles Beach, FL 33160
PLEASE QUOTE PRICES F.O.B. DESTINATION, LESS TAXES, DEliVERED IN
CITY OF SUNNY ISLES BEACH, FLORIDA
NOTE: City of Sunny Isles Beach is exempt from all taxes (Federal, State, and Local). Bid price should be
less all taxes. Tax Exemption Certificate furnished upon request.
INVITATION TO BID
SECTION 4
BID SUBMITTAL FORMS
OPENING: 3:00 P.M.
OS/25/2011
Issued by:
Purchasing Agent
Date Issued:
05/09/11
This Bid Submittal Consists of
Pages 23 through 27
Sealed bids are subject to the Terms and Conditions of this Invitation to Bid and the accompanying Bid
Submittal. Such other contract provisions, specifications, drawings or other data as are attached or
incorporated by reference in the Bid Submittal, will be received at the office of the City Clerk at the
address shown above until the above stated time and date, and at that time, publicly opened for
furnishing the supplies or services described in the accompanying Bid Submittal Requirement.
IFB 11-05-02
TRANSPORTATION SERVICES-MOTOR COACH RENTALS
A Bid Deposit in the amount of 0% of the total amount of the bid shall accompany all bids
A Performance Bond in the amount of 0% of the total amount of the bid will be required upon execution
of the contract by the successful bidder and City of Sunny Isles Beach
Procurement AQent:
Marcanthony Tulloch
Firm Name:
LJ~\c&\JC ~s. /~.
Commodity Code(s):
962-16, 962-82
RETURN ONE ORIGINAL AND FOUR (4) COPIES OF BID SUBMITTAL PAGES AND AFFIDAVITS
FAILURE TO SIGN PAGE 27 OF SECTION 4 BID SUBMITTAL WILL RENDER YOUR BID NON-
RESPONSIVE
PAGE 23 OF 28
BID No. 11-05-02
SECTION 4
BID SUBMITTAL FOR:
ACKNOWLEDGEMENT OF ADDENDA
INSTRUCTIONS: COMPLETE PART lOR PART II, WHICHEVER APPLIES
PART I:
LIST BELOW ARE THE DATES OF ISSUE FOR EACH ADDENDUM RECEIVED IN
CONNECTION WITH THIS BID
Addendum #1, Dated
Addendum #2, Dated
Addendum #3, Dated
Addendum #4, Dated
Addendum #5, Dated
Addendum #6, Dated
Addendum #7, Dated
Addendum #8, Dated
PART II:
flf NO ADDENDUM WAS RECEIVED IN CONNECTION WITH THIS BID
FIRM NAME: ()f0(~ j/JC,
AUTHORIZED SIGNATURE: ~- bATE: 5!14!f{
TITLE OF OFFICER: 0 (}J t-.,) tQ.
PAGE 25 OF 28
BID No, 11-05-02
---~
/-'A.,:.u.r ...
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If.. .' ';)';':'1
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BID SUBMITTAL FORM
Bid Title: TRANSPORT A nON SERVICES-MOTOR COACH RENTALS
The undersigned Proposers proposes and agrees, if this Bid is accepted, to enter into an agreement with The City of
Sunny Isles Beach in the form included in the Contract Documents 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 Proposers accepts all of the terms and conditions of the Advertisement or Invitation to Bid and Instructions to
Proposers, 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 Proposers agrees to sign and submit the Agreement with
the Bonds and other documents required by the Bidding Requirements within ten days after the date of the City's
Notice of Award.
In submitting this Bid, the Proposer represents, as more fully set forth in the Agreement, that:
. The Proposer 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 Proposer 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 Proposer.
· 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 Proposer has not directly or indirectly induced or solicited any other
Proposers to submit a false or sham Bid; the Proposer has not solicited or
induced any person, firm or corporation to refrain from Bidding; and Proposer
has not sought by collusion to obtain for itself any advantage over any other
Proposers or over the City.
The City and the successful Proposer will establish completion times for each individual Work Item and
the successful Proposer 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.
FIRM NAME:
L) ltJ l Q of"
Street Address:
INc.-.
I
Ib\> 0t0. 17&t+-
Mailing Address (if different):
ST.
HII\NI.GA~~, )~I~q
PAGE 26 OF 28
BID No.
Telephone No. -"j05:65.:l-!r.%! ~$j5~ - #9:;0
Email Address:2!tJIQ..uz. &~~~ (36" FEIN No. DiS-1J1li#l:JJ5J2J3
SIGNATURE:
(SIGNATURE OF AUTHORIZED AGENT)
PRINT NAME: R Po Afp j fj5;;; I tt:..
TmE: (flbJ ~tE:A... ..
THE EXECUTION OF THIS FORM CONSTITUTES THE UNEQUIVOCAL OFFER OF PROPOSER TO BE BOUND
BY THE TERMS OF ITS PROPOSAL. FAILURE TO SIGN THIS SOUCITATION WHERE INDICATED ABOVE
BY AN AUTHORIZED REPRESENTATIVE SHALL RENDER THE PROPOSAL NON-RESPONSIVE. THE CITY
MAY, HOWEVER, IN ITS SOLE DISCRETION, ACCEPT ANY PROPOSAL THAT INCLUDES AN EXECUTED
DOCUMENT WHICH UNEQUIVOCALLY BINDS THE PROPOSER TO THE TERMS OF ITS OFFER.
PAGE 27 OF 28
BID No,