HomeMy WebLinkAboutFam International Log.
School Crossing Guard Services
BID SPECIFICATIONS
Invitation to Bid No. 11-05-03
OF S\J~
Publish Date:
05/09/11
Pre-Bid Conference:
Intentionally Omitted
Bid Due and Bid Opening Date:
OS/25/11 at 10:00 AM
Sunny Isles Beach Government Center
18070 Collins Avenue
Sunny Isles Beach, Florida 33160
RECE!m-;
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NON-COLLUSION AFFIDAVIT
0' sot-!
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 wn nJNJ
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,
TA
(Name of Corporation, Partnership, Individual, etc.)
a,,<;O(' LN ~L( Se{\J; a: S
(Type o(Business)
, formed under the laws of
FIOrr'{!)/t
(State)
of which he is
B(;~(\
Lec'J\
(Sole Owner, Partner, President, etc.)
Neither the undersigned nor any person, firm, or corporation named in above Paragraph 10.2, nor anyone else to the knowledge of the
undersigned, have themselves solicited or employed anyone else to solicit favorable action for this Bid by the City, also that no head of any
department or employee therein, or any officer of the City of Sunny Isles Beach, Florida is directly interested therein.
This Bid is genuine and not collusive or a sham; the person, firm or corporation named above in Paragraph 10.2 has not colluded, conspired,
connived or agreed directly or indirectly with any proposers or person, firm or corporation, to put in a sham Bid, or that such person, firm or
corporation, shall refrain from Bidding, and has not in any manner, directly or indirectly, sought by agreement or collusion, or communication
or conference with any person, firm or corporation, to fix the prices of said Bid or Bids of any other proposers; and all statements contained in
the Bid or Bids described above true; and further; neither the undersigned, nor the person, firm or corporation named above in Paragraph
10.2, has directly or indirectly submitted said Bid or the contents thereof, or divulged information or data relative thereto, to any association or
to any member or agent thereof.
'\T^anA" E , ~S
AFFIANT'S NAME
j),'r t'c-hr ~ ,SB::UC 'rl-~
AFFIANT'S TITLE I
TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this iuH'day of
Personally Known -V or Produced Identification
~ICt~
,20d
Type of identification
(Affix SMW~ftl.)
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DECEMBER 28, 2010
10f7
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 FLORIDA I
COUNTY OF ~r(\ t \!)ca
BEFORE ME, the undersigned authority, personally appeared '7fiCn?45' E' '- }fYY< ,who was duly sworn,
deposes, and states:
18.1. 1 am /) the
fm :r9~Cf!'~'" \ ~(?('1I i ,~ J
'F! L-e:..tr(~("~/~\ Fl. I
18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. described
as: Landscape Maintenance Services. The Affiant has made diligent inquiry and provides the information contained in this
Affidavit based upon his own knowledge.
DifQQ\or(\.Q- S~~~~
with a local office in F~ t . . d e i FI
of
and principal office in
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.
18.91n 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 C{Jt\'ty f Sunny Isles Beach.
~ A II
Da~ I day of IVI 0 ~ ' 20.1-0:'
-y ~ 71iOlr1I1S ./(y7t"'S DirN}>r ~ .~cu.t',L
AFFIANT ~rint or Type Name and Title 7
Sworn to and subscribed before me this J Di"h day of ~I a. y ,20M
if' Personally Known OR
o Produced Identification ; Type of Identification
NOTARY PUBLIC ST~_~IJI~~
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DECEMBER 28, 2010 ~ -:t.:: '. .. ~ ~
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5 of 7
DELIVER TO:
City of Sunny Isles Beach
City Clerk
18070 Collins Avenue
Sunny Isles Beach, FL 33160
INVITATION TO BID
SECTION 4
BID SUBMITTAL FORMS
OPENING: 10:00 A.M.
OS/25/11
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.
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 11-05-03
School Crossing Guard Services
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:
Commodity Coders):
990-27
[Am ~y()Q-kDnQ\
cS~r:u v;~/
I
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. 11-01-01
BID FORM
School Crossin Guard Services
# Description Est. Hours / Hourly Rate
Annuall
1 School Crossing Guard Supervisor 1,080 $ \5. so
2 School Crossing Guard 7,776 $ 15.00
Annual Grand Total:
PAGE 24 OF 28
BID No. 11-01-01
Extended Price
SECTION 4
BID SUBMITTAL FOR:
ACKNOWLEDGEMENT OF ADDENDA
INSTRUCTIONS: COMPLETE PART I OR 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:
0iJo ADDENDUM WAS RECEIVED IN CONNECTION WITH THIS BID
FIRM NAME: _t-lim ~ b--(')(A~'r'''a \ &CU/:ty
AUTHORIZED SIGNATURE: -;;;r~ ), ~ DATE: S/q1201J
, I
TITLE OF OFFICER: .Di{eC.}y {').Q. ,c;."c.uv:!y
PAGE 25 OF 28
BID No. 11-01-01
BID SUBMITTAL FORM
Bid Title: School Crossing Guard Sen'ices
The undersigned Proposers proposes and agrees, if this Bid is accepted, to enter into an agreement with The City of
Sunny Isles Beach and 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 tenns 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. This Bid will remain subject to acceptance for 90 days after the day of Bid opening. The Proposer agrees to
sign and submit the and other documents required by the Bidding Requirements within ten days after the date of the
City's Notice of A ward.
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:
F ~rY\ "'It11:rn~J;C)'JA I yr,uv, tr
Street Address:
5400 Sou-+h UJlf\./(f~ib,t /)/2.
Mailing Address (if different):
S Arn( 0 (~ !t~()~,
&,te ~O~
H.LuuA<7/c1a /~ \ PI 33.349
PAGE 26 OF 28
BID No.
Telephone No. ~-JS"X-()i"'(o Fax No. q~- J. S2-1s~8
Email Address:TC).pI.){./@\ttq1;11t-t..14(.OIl.t{.Cc)~ FEIN No. JJ lJ--I1J -OJ.3J 3J ilJ 8.J j
1
* "BY SIGNING THIS DOCUMENT THE BIDDER AGREES TO ALL TERMS
SIGNATURE: ~
(SIG~H;'~NT)
PRINT NAME: fh::mA ~ 17 ... ['.l"'P5
TITLEj)irpclnc (")~ S",rH( ;~
THE EXECUTION OF THIS FORM CONSTITUTES THE UNEQUIVOCAL OFFER OF PROPOSER TO BE BOUND
BY THE TERMS OF ITS PROPOSAL. FAILURE TO SIGN THIS SOLICITATION WHERE INDICATED ABOVE
BY AN AUTHORIZED REPRESENTATIVE SHALL RENDER THE PROPOSAL NON-RESPONSIVE. THE CITY
MAY, HOWEVER, IN ITS SOLE DISCRETION, ACCEPT ANY PROPOSAL THAT INCLUDES AN EXECUTED
DOCUMENT WHICH UNEQUIVOCALLY BINDS THE PROPOSER TO THE TERMS OF ITS OFFER.
PAGE 27 OF 28
BID No.
AFFIDAVITS
PAGE 28 OF 28
BID No.
OF
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. This sworn statement is submitted to City of Sunny Isles Beach
by ~g),~al f.:m-;- ~nClQrS
for
-- lJ. (t"'cJa-- oQ- Sri"' Ll ~'\' i f-t I
, 7
whose b~siness address is:. W -.j" D
5 Lfnc) ,Qo,1--f-h 1l/l/as.t f ' Ifr
/
El-. 0A,(dI'Fd.a(e ~ '1=/ <3~3,Z8
and (if applicable) its Federal Employer Identification number (FEIN) is 2 14 - 01....<1-? B8 Y .
(If the entity had no FEIN, include the Social Security Number of the individual signing this sworn
statement: .)
,<:;0,7t> SUk-,
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), FIQrida 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
DECEMBER 28,2010 2 of 7
EQUAL OPPORTUNITY /
AFFIRMA TIVE ACTION
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 region, sex, age, handicap, marital status, and political affiliation or
belief.
Signed: /;;;J A..------- i- /-
Title: bi'rec..fov- O.Q.- ,~c({'r;;Y
Firm: Frltn =rnr/l1ci-/c ~( ,See /-thY
Address: ,5'-100 S(J{~ dt7//l"rSi"y /).,e.. \ ~{e 9?~
R, )c;td~~!(! J F/()n/-IA J33Z<P
DECEMBER 28,2010
40f7
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
\/
-
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
J
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 J 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.
rAm :JntrJ1c;'lriYJ{~1 ~ r;~(-(jrrk/
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Print or Type Name and Title 1
DECEMBER 28, 2010
6 of 7
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Form W-9
Request for Taxpayer
Identification Number and Certification
Give Form to the
requester. Do not
send to the IRS.
(Rev. January 2011)
Department of the Treasury
Internal Revenue Service
Name (a]~r Y~~1a-naf; oncd 5ccU (It V I I n c.
C\i Business name/disregarded entity name, if different from above
Q)
Ol
CIl
Q. Check appropriate box for federal tax
5 classification (required): D Individual/sole proprietor ~ C Corporation D S Corporation
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en
D Partnership D TrusVestate
D Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ~
D Exempt payee
Requester's name and address (optiona~
url'v'G st. 50'
FL 80898
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" line Social security number
to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a []I] - OJ - ITID
resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other
entities, it is your employer identification number (EIN). If you do not have a nurnber, see How to get a
TIN on page 3.
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose I Employer identification number
number to enter.
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I arn waiting for a number to be issued to me), and
2_ I arn not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified rne that I am
no longer subject to backup withholding, and
3_ I am a U.S. citizen or other U.S. person (defined below).
Certification instructions. You must cross out itern 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and dividends on your tax return. For real estate transactions, itern 2 does not apply. For mortgage
interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangernent (IRA), and
generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the
instructions on page 4.
Sign Signature of
Here u.s. person ~
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Purpose of Form
A person who is required to file an information return with the IRS must
obtain your correct taxpayer identification number (TIN) to report, for
example, in corne paid to you, real estate transactions, rnortgage interest
you paid, acquisition or abandonment of secured property, cancellation
of debt, or contributions you made to an IRA.
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN to the person requesting it (the
requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you are waiting for a
nurnber to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt
payee. If applicable, you are also certifying that as a U.S. person, your
allocable share of any partnership income from a U.S. trade or business
is not subject to the withholding tax on foreign partners' share of
effectively connected income.
Date ~
4 19!20{ I
Note_ If a requester gives you a form other than Form W-9 to request
your TIN, you must use the requester's forrn if it is substantially similar
to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
. An individual who is a U.S. citizen or U.S. resident alien,
. A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United States,
. An estate (other than a foreign estate), or
. A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or
business in the United States are generally required to pay a withholding
tax on any foreign partners' share of income from such business.
Further, in certain cases where a Form W-9 has not been received, a
partnership is required to presume that a partner is a foreign person,
and pay the withholding tax. Therefore, if you are a U.S. person that is a
partner in a partnership conducting a trade or business in the United
States, provide Form W-9 to the partnership to establish your U.S.
status and avoid withholding on your share of partnership income.
Form W-9 (Rev. 1-2011)
Cat. No.10231X
TM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY)
04/12/2011
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
TWIW Insurance Services, LLC - #OE52073 WgNN~ Ext': 661. 616.4700 I r~~ Nol: 661. 616.4500
5001 California Avenue Ste 150 E-MAIL
ADDRESS:
Bakersfi el d, CA 93309 PRODUCER
CUSTOMER ID #.
INSURER(S) AFFORDING COVERAGE NAIC#
INSURED INSURER A : Steadfast Ins Co
Fam International Logistics Inc. INSURER B : American Guarantee and L iabil i
. 5400 South University Drive INSURER C :
suite 506 INSURER 0 :
Davie, FL 33328 INSURER E :
INSURER F :
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADDL SUBR ~~M%Y,Nlvl I (~2}-6%Yy~Vvl LIMITS
LTR INSR WVD POLICY NUMBER
GENERAL LIABILITY EOL93222590<: 02/18/2011 02/18/2012 EACH OCCURRENCE $ 5,000,000
- ~~~~~~~9E~~~J~~nce\
X COMMERCIAL GENERAL LIABILITY $ 100,000
= ~ CLAIMS-MADE [Xl OCCUR MED EXP (Anyone person) $ 5,000
A PERSONAL & ADV INJURY $ 5,000,000
GENERAL AGGREGATE $ 5,000,00C
f- 5,OOO,00C
GEN'L AGGREAE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
!Xl PRO- n $
POLICY JECT LOC
AUTOMOBILE LIABILITY EOL93222590' 02/18/2011 02/18/2012 COMBINED SINGLE LIMIT $ l,OOO,OOC
f- (Ea accident)
ANY AUTO BODILY INJURY (Per person) $
f-
- ALL OWNED AUTOS BODILY INJURY (Per accident) S
A SCHEDULED AUTOS PROPERTY DAMAGE
X HIRED AUTOS (Per accident) $
-
X NON.OWNEO AUTOS $
-
$
UMBRELLA L1AB M OCCUR UMB9224550-0 10/08/2010 10/08/2011 EACH OCCURRENCE $ 5,000,000
-
EXCESS L1AB CLAIMS.MADE AGGREGATE $ 5,000,000
B
f-- DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION I WCSTATU-T IOTH-
AND EMPLOYERS' LIABILITY Y/N TORY LIMITS ER
ANY PROPRIETOR/PARTNER/EXECUTIVE D N/A E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE S
~~~'i;~~if~~ ~~gPERATIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
)AMPLE
ACORD
COVERAGES
CERTIFICATE NUMBER: 2011/2012 Updated GL&AUTO
CERTIFICATE HOLDER
CANCELLATION
REVISION NUMBER:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Fam International
5400 South University Drive, AUTHORIZED REPRESENTATIVE ::J~
Suite 506
Ft ILauderdale, FL 33328 Shaun Kellv/THELC
ACORD 25 (2009/09)
@1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD