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HomeMy WebLinkAboutL&L Truck Repairs-- — u W t1, o.,% `ryY of JULl�yt� Oat W Sunny lij)D$ 80 h � _ C3ft ---i . '4ty Gfierlc DELIVER TO: INVITATION TO BID City of Sunny Isles Beach SECTION 4 OPENING: 02;30 P.M. City Clerk BID SUBMITTAL FORMS 07/31/2012 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. Issued by: Purchasing Agent Date Issued: This Bid Submittal Consists of 07/18/2012 Pages 28 through 32 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 12 -07 -01 Fleet Bus Maintenance & Repair 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 Agent: Firm Name: Marcanthony Tulloch ��.. � �cu c�L i2 -s✓pa� J�s . -�--� c. Commodity Code(s): RETURN ONE ORIGINAL AND FOUR COPIES OF BID SUBMITTAL PAGES AND AFFIDAVITS FAILURE TO SIGN PAGE 38 OF SECTION 4 BID SUBMITTAL WILL RENDER YOUR BID NON- RESPONSIVE City of Sunny Isles Beach I Request for Proposal No 12 -07 -01 "IV or sUN N,_ BID FORM BUS Front Suspension and Steering Cap Repair, including frame straightening and rebuilding components. A Indicate the actual Posted Shop Labor Rate $_ B Percentage Discount from the Posted Shop Labor Rate C Discounted Hourly Shop Labor Rate $ -� S AND Percentage Discount off the O.E.M. / MSRP List for parts FLAT RATE SERVICES No. Description Extended Cost D Alignment of Front Axle Only (complete) $ -75 E Alignment of Front and Single Rear Axle (complete) $ 75 F Oil Change $ (Up to S quarts of Oil and Oil Filter0 Required Documents For Group 3 Reference Required Document Acknowledgment Section 2.20 Drug and Alcohol Testing Program (The contractor shall either attach a copy of their drug and alcohol testing policy and / or acknowledge that a policy will be developed an adhered to during the life of this contract. City of Sunny Isles Beach I Request for Proposal No. 12 -07 -01 SECTION 4 BID SUBMITTAL FOR: ACKNOWLEDGEMENT OF ADDENDA INSTRUCTIONS: COMPLETE PART I OR PART Il, WHICHEVER APPLIES PART I: LIST BELOW ARE THE DATES OF ISSUE FOR EACH ADDENDUM RECEIVED IN CONNECTION WITH THIS BID PART II: FIRM NAME: Addendum #1, Dated Addendum #2, Dated Addendum #3, Dated Addendum #4, Dated Addendum #5, Dated Addendum #6, Dated Addendum #7, Dated Addendum #8, Dated O ADDENDUM WAS RECEIVED IN CONNECTION WITH THIS BID AUTHORIZED SIGNATURE: TITLE OF OFFICER: City of Sunny Isles Beach I Request for Proposal No. 12 -07 -01 Q � YY v of SUN P�` OF SUN Ar BID SUBMITTAL FORM Bid Title: Fleet Bus Maintenance & Repair Services The undersigned Proposers propose and agree, 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 accept 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 agree 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 Proposers represent, as more fully set forth in the Agreement, that: • The Proposers have familiarized themselves 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 Proposers have 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 Proposers. 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 Proposers have not directly or indirectly induced or solicited any other Proposers to submit a false or sham Bid; the Proposers have not solicited or induced any person, firm or corporation to refrain from Bidding; and the Proposers have not sought by collusion to obtain for itself any advantage over any other Proposers or over the City. The Proposers understand and agree that the Bid is for unit prices to furnish and install individual Work Items for maintenance and /or repair work, complete in place. Estimates are provided for the purposes of Bid Evaluation and to establish unit prices for individual Work Items for maintenance and /or repair work to be contracted by the City under individual Purchase Orders, based on the unit prices established under this Bid. The City and the successful Proposers will establish completion times for each individual Work Item and the successful Proposers agree that the work will be completed within the time frames agreed upon and stipulated in the individual Purchase Orders and /or Notice to Proceed. City of Sunny Isles Beach I Request for Proposal No. 12 -07 -01 " *V or glm N' � Firm Name: ._ L Street Address: � %4Ab M w c`c. Mailing Address (if different): Telephone No. � . '7 "43 -' © CS Fax No. '� 7 3 Email Address: C k jSC&O uRkcb, (.bm FEIN No. * "By signing this document the bidder agrees to ail Terms ( Jghatdrd"of authorized agent) Print Name: 0.W CeMC - � �< (eA Title:_ V��S ( c v 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. City of Sunny isles Beach I Request for Proposal No. 12 -07 -01 SVrNY•15�E, .. Y A. NON - COLLUSION AFFIDAVIT City of Sunny Isles Beach 18070 Collins Avenue �ypc'APti °o� "� Sunny Isles Beach. FL 33160 rr, o, suN - + Telephone: (305) 947.0606 Fax: (305) 949 -3113 STATE OF FLORIDA ) COUNTY OF Nl I 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 relled upon by sold 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, 1 \ (Name of Corporation, Partnership, Indlividual, etc) �^ t a\` Q =L 11IA%s \Q �F.�Ct t(, formed under the laws of �t� (� C' (Type of Business) (State) of which he is �aW ( ? — �\ � C ' (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. HT'S NAME AFFIANT'S TITLE TAKEN, SWORN AND SUBSCRIBED TO BEFORE ME this day of 00_ Personalty Known �° J or Produced Identification ; Type of identification / ,-/ (Affix seal here) NOTARY PUBLIC (name printed or typed) pu Not Public Slate of Florida a °4; 0S, "M, Duran My Con',mission EE012243 �'orf� °a �XpIre50712712014 DECEMBER28, 2010 1 of 7 a >. PUBLIC ENTITY CRIMES U S City of Sunny Isles Beach " 18070 Collins Avenue yP�?s.r�.r�op9o4`e Sunny Isles Beach, FL 33160 P�Tr oa sust �� 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_ �Gwr�(-p— uV �-A Inn t inamdual s nameanaI e nnrname or entity stfornaling swum stalemenil whose business address is: 1 -7 Ck-q o A) U-) and (if applicable) its Federal Employer Identification number (FEIN) is G5 ° Os t1 bv�& (If the entity had no FEIN, include the Social Security Number of the individual signing this sworn statement: ) 11.2. 1 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. 1 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. 1 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 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. 1 understand that a 'person as defined in Para. 287.133(1)(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding Contract and which Bids or applies to Bid on Contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term persons includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of any entity. 11.6. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. (Indicate which statement applies.) Neither the entity submitting this sworn statement, nor any of it's officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list. (Attach a copy of the final order.) I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 11.1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES, FOR CATEGORY TWO OF ANY, CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. By. �E,t tL�r ec L) , /( i�,'0.Y Pue` ^ Notary Public State of Florida $I nature) Ik • Osvaldo Duran. �1 CJn .toms v My commission EE012243 Expires 07/2712014 (Printed Nam (Title) Sworn to and subscribed before me this day of -- ttAl 20 17- , by Osvaldo Durali MY,co'"n,ki,o" 4012244 Sign ure: Notary/Pqblic - to of Florida Prin or Type ii) sione ' d( e Personally Known OR Produced Identification! /'/ Type of Identification Produced 10/1998 3 of 7 v SUNNY IS EQUAL OPPORTUNITY U Y AFFIRMATIVE ACTION City of Sunny Isles Beach c�ri, sud'�o 18070 Collins Avenue Sunny Isles Beach, FL 33180 Telephone: (305) 847 -0808 Fax (305) 949.3113 EQUAL OPPORTUNITY /AFFIRMATIVE ACTION STATEMENT The contractors and all subcontractors hereby agree to a commitment to the principles and practices of equal opportunity In employment and to comply with the letter and spirit of federal, state, and local laws and regulations prohibiting discrimination based on race, color, religion, national region, sex, age, handicap, marital status, and political affiliation or belief. Signed: v R Title: Firm: L4- L . \ro& Address: osceMeeK28, 2010 4 of 7 SUr1NY.Ib��� CONFLICT OF INTEREST u - _ City of Sunny Isles Beach 18070 Collins Avenue F L0, Sunny Isles Beach, FL 33160 c�}I" of sun � 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 FLO,, IDA COUNTY OF /. � iu, BEFORE ME, the undersigned authority, personally appeared � • ,r & who was duly sworn, deposes, and states: 18.1. 1- am the Tr esSi � of � .t- L Toc r—' with a local office in VWkO.—t,k and principal office in VA Wk V%A 18.2. The above named entity is submitting a Bid for the City of Sunny Isles Beach, Bid No. J 0 -7 ° V 1 described as: Landscape Maintenance Services. The Affiant has made diligent inquiry and provides the information contained in this Affidavit based upon his own knowledge. 18.3 The Afflant states that only one submittal for the above Bid is being submitted and that the above named entity has no financial interest in other entities submitting Bids for the same project. 18.4 Neither the Afflant nor the above named entity has directly or indirectly entered into any agreement, participated in any collusion, or otherwise taken any action in restraints of free competitive pricing in connection with the entity's submittal for the above Bid. This statement restricts the discussion of pricing data until the completion of negotiations if necessary and execution of the Contract for this project. 18.5 Neither the entity nor its affiliates, nor any one associated with them, is presently suspended or otherwise ineligible from participation in contract letting by any local, State, or Federal Agency. 18.6 Neither the entity, nor its affiliates, nor any one associated with them have any potential conflict of interest due to any other clients, contracts, or property Interests for this project. 18.71 certify that no member of the entity's ownership or management is presently applying for any employee position or actively seeking an elected position with the City of Sunny Isles Beach. 18.81 certify that no member of the entity's ownership or management, or staff has a vested interest in any aspect of the City of Sunny Isles Beach. 18.9 In the event that a conflict of Interest Is identified in the provision of services, I, on behalf of the above named entity, will immediately notify the City of Sunny Isles Beach. D ted this day of � V =' FIANT Prifit or Type Name an 'Title Sworn to and subscribed before me this day of 2010. 0 Personally Known OR Produced Identification Type of Identification NOTARY PUBLIC STATE OF FLORIDA rO1P:0- Notary Public State of Florida Osvaldo Duran ExpeS07/27/2014012243 QECEMBER 28, 2010 5 Of 7 4.4VtINY..IS���. f 8�� DISPUTE DISCLOSURE x City of Sunny Isles Beach '+ 18070 Collins Avenue Ase �➢ 4, p�qQ ?v�s� *. Sunny Isles Beach, FL 33160 .c,�Y Or svN Aav 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 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.. Firm Date 1UJ4 eNALQ ,� rikd igna ure Print or Type Name and Title DECEMBER 26, 2010 6 of 7 ii u _ x k � t k. 0 ryk »_1 pf- OF ;UN -I.NU STATE OF FLORIDA ) COUNTY OFjft h 14 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 I, the undersigned, hereby duly sworn and deposed say that no portion of this sum herein Bid will be paid to any employees of the City of Sunny Isles Beach or its elected officials as a commission, kickback, reward or gift, directly or indirectly by me or any member of my firm or by an officer of the corporation. By: Title: foregoing instrument was acknowledged bef re me this day of 20 by [name as i` &A [type of authority], for -ccee K. [name of party on behalf of whom instrument was executed]. AFFIX NOTARY STAMP HERE: Notary Pub Ic — State of Flori a P int or, ype_Co_mrnDiss&ed game Personally Known OR Produced I entific ton Type of Identification Produced DECEMBER 28, 2810 7 of 7 ar n� �` Notary Public State of Florida ; Osvaldo Duran My Commission EE012243 ca Expires 0712712014 OF t Notary Pub Ic — State of Flori a P int or, ype_Co_mrnDiss&ed game Personally Known OR Produced I entific ton Type of Identification Produced DECEMBER 28, 2810 7 of 7 DATE (MM /DD/YYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 5/16/2012 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CNS INSURANCE GROUP, ( HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 6264 MIRAMAR PARKWAY ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. MIRAMAR, FL 33023 954- 966 -2400 INSURERS AFFORDING COVERAGE I NAIC# INSURED L & L TRUCK REPAIR, INC INSURER A: THE BURLINGTON INS. CO. INSURER B: 17 440 N.W. 2 AVE INSURER C: MIAMI, FL 33169 INSURER D: 1305- 4930081 INSURER E: COVERAGES 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 j MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH I POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L T POLICY NUMBER POLICY EFFECTIVE DATE(EXIDD4) LIMITS DATE(MM/DD/YY) I DATE(MMIDDlYY) GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMSMADE 1 1 OCCUR GEN'L AGGREGATE LIMIT APPLIES PEI PRO- LOC POLICY F—I JECT AUTOMOBILE LIABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON - OWNEDAUTOS GARAGE LIABILITY X ANYAUTO A I X GAR. KEEPERS EXCESSIUMBRELLA LIABILITY ElOCCUR I CLAIMSMADE DEDUCTIBLE RETENTION $ WORKERSCOMPENSATIONAND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below OTHER 10477 05/21/12 05/21/13 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS TRUCK REPAIR CERTIFICATE HOLDER CONSUMER SERVICE DEPT. CONSUMER PROTECTION DIVISION 140 W. FLAGLER ST SUITE # 902 MIAMI,FL 33130 EACH RRENCE OCCU ;$ PREMISES (Ea occurence) $ i MED EXP (Any one person) I $ PERSONAL &ADV INJURY I $ 'GENERAL AGGREGATE S PRODUCTS - COMP /OP AGG ''S COMBINED SINGLE LIMIT i $ (Ea accident) BODILYINJURY I $ (Per person) BODILYINJURY I $ (Peraccident) PROPERTY DAMAGE (Peraccident) i$ AUTOONLY -EA ACCIDENT $ OTHERTHAN EAACC $ AUTO ONLY: AGG I $ EACH OCCURRENCE !$ AGGREGATE I$ $ E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT ! S 100,00 100,0 100,00( SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTI NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SH IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS REPRESENTATIVES. AUTHORIZED REPRESENTATVYJ A i © ACORD CORPORATION 198 ACORD 8) MIAMI -DADE COUNTY 2011 LOCAL BUSINESS TAX RECEIPT 2012 FIRST -CL/SS TAX COLLECTOR MIAMI -DADE COUNTY - STATE OF FLORIDA U.S. POSTAGE 140 W. FLAGLER ST. EXPIRES SEPT. 30, 2012 PAID 1st FLOOR MUST BE DISPLAYED AT PLACE OF BUSINESS MIAMI, FL MIAMI, FL 33130 PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 PERMIT NO. 231 465285 -6 euLINFsLNIWACKTtNAIRS INC 17440 NW 2 AVE 33169 MIAMI GARDENS OWNER L & L TRUCK REPAIRS INC Se"21T 41;�}I�i"TTRUCK / VAN SERVICE THIS IS ONLYS AHLOOC'AL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR RENEWAL REC IPTNO. 485795 -0 STATE # MV448631 EMPLOYEE /S 2 - ZONING LAWS OF THE DO NOT FORWARD COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER L & L 1 R U CK REPAIRS INC PERMIT REQUIRED BYRLAW. THISSIS LAURENCE BUTLER NOT A CERTIFICATION OF 17440 N W 2 AVE THE HOLDER'S QUALIFICA- TIONS. MIAMI FL 33169 PAYMENT RECEIVED. MIAMI -DADE COUNTY TAX COLLECTOR: 07/12/2011 60110000271 000045.00 iffljI11ofIfIlllllIJIL fill llllifII10111jIIIlII lip, 1fioI1l SEE OTHER SIDE i 1 v FA ,rte C N N ch a� m C m .n C� C ch C U C O N m L d R N C C O C N C 0 m a� s f �C G M Cpl w Cl N N 0 CL c W U O L U C^1 W L Q N Q (D C) N N �+ Cn CD U) C @ o U CU q cn 0 Q n cn (a i (n 73 LLI O C 75 L F- U `- O .0 o .O L rA_' •— M W 4.0 cu � L U � • UL C 1 O h W tr— m > H Q A A N o -a a. Qi N H c 0) cccv L A _7 .E C O /off V c c 0 N E Q w Q O U1 Y 0 aS c co L I- ca c ca c U V c 4) N O L c� ` E (a N CL U) c0 Q a) L NN� > LL U) �% Q Q N c0 Y r C M C U C3).L U N> M 7 E- W � a) _ ui J J Z UL W v ui co C O' m� cCU d' cLS C N N ch a� m C m .n C� C ch C U C O N m L d R N C C O C N C 0 m a� s f �C G M Cpl w Cl N N 0 CL 10 TO-T��l JNt-uc�< � �ay.paC� �ren�e�5 D3 I�� f icc YVC'k (3C)5) b52