HomeMy WebLinkAboutReso 2012-1935RESOLUTION NO. 2012 - 19 35
A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF
SUNNY ISLES BEACH, FLORIDA, APPROVING THE AWARD OF
BID NO. 12 -05 -02 TO AND ENTERING INTO AN AGREEMENT
WITH THE GOODYEAR TIRE & RUBBER CO. FOR FLEET
MAINTENANCE AND REPAIR SERVICES, IN AN AMOUNT NOT
TO EXCEED SIXTY THOUSAND DOLLARS ($60,000.00),
ATTACHED HERETO AS EXHIBIT "A "; AUTHORIZING THE
MAYOR TO EXECUTE SAID AGREEMENT; AUTHORIZING THE
CITY MANAGER TO DO ALL THINGS NECESSARY TO
EFFECTUATE THIS RESOLUION; PROVIDING FOR AN
EFFECTIVE DATE.
WHEREAS, the City of Sunny Isles Beach is desirous of maintaining its considerable fleet of
vehicles; and
WHEREAS, the City advertised and issued Request for Proposals (RFP) No. 12 -05 -02 for
Fleet Maintenance and Repair Services, for which two (2) responses were received; and
WHEREAS, the City wishes to enter into an Agreement with The Goodyear Tire & Rubber
Co. for Fleet Maintenance and Repair Services in conformity with the specifications outlined in RFP
No. 12- 05 -02; and
WHEREAS, The Goodyear Tire & Rubber Co. is qualified, willing and able to provide the
desired services on the terms and conditions set forth; and
WHEREAS, the City desires to enter into an Agreement with The Goodyear Tire & Rubber
Co. to provide said services, in an amount not to exceed Sixty Thousand Dollars ($60,000.00),
attached hereto as Exhibit "A ".
NOW THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE
CITY OF SUNNY ISLES BEACH, FLORIDA, AS FOLLOWS:
Section 1. Incorporation of Recitals. The recitals set forth in this Resolution are incorporated
herein by reference as if fully set forth herein.
Section 2. Award of Bid and Approval of Agreement. The City Commission hereby awards Bid
No. 12 -05 -02 to and approves an Agreement with The Goodyear Tire & Rubber Co. for Fleet
Maintenance and Repair Services, in an amount not to exceed Sixty Thousand Dollars ($60,000.00),
attached hereto as Exhibit "A ".
Section 3. Authorization of Mayor. The Mayor is hereby authorized to execute said Agreement.
R2012- Goodyear Fleet Maintenance and Repair Srvs (Bid 12- 05 -02) Page 1 of 2
Section 4. Authorization of Cijy Manager. The City Manager is hereby authorized to do all
things necessary to effectuate this Resolution.
Section 5. Effective Date. This Resolution will become effective upon adoption.
PASSED AND ADOPTED this 19t1' day of July "" '
ATTEST:
a-- �
Jane A. Hines, CMC, City Clerk
AS TO FORM
, SUFFICIENCY:
City Attorney
Vote: 5-0
Mayor Edelcup
✓(Yes)
Vice Mayor Thaler
,(Yes)
Commissioner Aelion
(Yes)
Commissioner Gatto
(Yes)
Commissioner Scholl
(Yes)
Moved by:
Seconded by:
(No)
(No)
(No)
(No)
(No)
82012- Goodyear Fleet Maintenance and Repair Srvs (Bid 12- 05 -02) Page 2 of 2
Sµ s<O AGREEMENT BETWEEN THE CITY OF SUNNY ISLES
BEACH AND THE GOODYEAR TIRE AND RUBBER COMPANY
FOR FLEET MAINTENANCE AND REPAIR SERVICES
CONTRACT NO. C1112-055
THIS AGREEMENT, entered into this 1111 day of -v 2012, by and
between the CITY OF SUNNY ISLES BEACH (hereinafter referred as o the "City") and THE
GOODYEAR TIRE AND RUBBER COMPANY an Ohio corporation, authorized to do business in
the State of Florida (hereinafter referred to as the ("Contractor"), whose federal tax identification
number is
RECITALS
WHEREAS, the City is in need of a contractor to provide maintenance and repair services
to City owned vehicle and buses ("Services"), as more particularly described in Invitation to Bid
No. 12-05-02;
WHEREAS, the City advertised Invitation to Bid No. 12-05-02 and the Contractor
submitted a bid in response thereto, attached hereto as Attachment"A" and made a part hereof;
WHEREAS, the Contractor is qualified, willing and able to provide the Services on the
terms and conditions set forth herein; and
WHEREAS, the City desires to enter into this Agreement with Contractor to provide the
Services in a total amount not to exceed Sixty Thousand Dollars ($60,000.00).
NOW THEREFORE, in consideration of the foregoing and for the mutual covenants,
representations and warranties and other good and valuable consideration, the receipt and adequacy
of which is hereby acknowledged, the parties agree as follows:
1. RECITALS. The Recitals set forth above are hereby incorporated into this agreement and
made a part hereof for reference.
2. SERVICES. Contractor shall provide the Services pursuant to the terms and conditions set
forth in Invitation to Bid No. 12-05-02, incorporated herein by reference, and Contractor's response
thereto, attached hereto as Attachment"A" and made a part hereof.
3. TERM. Subject to the provisions relating to the termination of this Agreement as set forth
in Section 10 hereunder, this Agreement shall commence on the first calendar day of the month
succeeding approval of this Agreement by the City Commission and shall end one (1) year
thereafter.
4. RENEWAL. Prior to, or upon completion of the initial one year term, the City shall have
the option to renew this Agreement for an additional four(4) one year renewal terms.
Page 1 of 8
C1112-055—THE GOODYEAR TIRE AND RUBBER COMPANY
5. COMPENSATION. As the entire compensation under this Agreement and during the term
of this Agreement, in whatever capacity rendered, the City shall pay Contractor an amount not to
exceed Sixty Thousand Dollars ($60,000.00) for the performance of the Services. Payment to
Contractor for all charges and tasks under this Agreement shall be in accordance with this
Agreement and the schedule of charges reflected in Attachment "A" and under the following
conditions:
a. Disbursements. There are no reimbursable expenses associated with this contract.
b. Payment Schedule. Invoices received from the Contractor pursuant to this
Agreement will be reviewed by the initiating City Department. If services have been
rendered in conformity with the Agreement, the invoice will be sent to the Finance
Department for payment. Invoices must reference the contract number assigned
hereto. Invoices will be paid in accordance with the State of Florida Prompt
Payment Act.
c. Availability of Funds. The City's performance and obligation to pay under this
Agreement is contingent upon an annual appropriation for its purpose by the City
Commission. In the event the City Commission fails to appropriate funds for the
particular purpose of this Agreement during any year of the term hereof, then this
Agreement shall be terminated upon ten (10) days written notice and the Contractor
shall be compensated for the Services satisfactorily performed prior to the effective
date of termination.
d. Final Invoice. In order for both parties herein to close their books and records, the
Contractor will clearly state "final invoice" on the Contractor's final/last billing to
the City. This certifies that all services have been properly performed and all
charges and costs have been invoiced to the City. Since this account will thereupon
be closed, any other additional charges, if not properly included on this final invoice,
are waived by the Contractor.
Contractor shall make no other charges to the City for supplies, labor, taxes, licenses, permits,
overhead or any other expenses or costs unless any such expense or cost is incurred by Contractor
with the prior written approval of the City. If the City disputes any charges on the invoices, it may
make payment of the uncontested amounts and withhold payment on the contested amounts until
they are resolved by agreement with Contractor. Contractor shall not pledge the City's credit or
make it a guarantor of payment or surety for any contract, debt, obligation,judgment, lien, or any
form of indebtedness. The Contractor further warrants and represents that it has no obligation or
indebtedness that would impair its ability to fulfill the terms of this Agreement.
6. INDEPENDENT CONTRACTOR RELATIONSHIP. The Contractor is an independent
contractor and shall be treated as such for all purposes. Nothing contained in this agreement or any
action of the parties shall be construed to constitute or to render the Contractor an employee,
partner, agent, shareholder, officer or in any other capacity other than as an independent contractor
other than those obligations which have been or shall have been undertaken by the City. Contractor
shall be responsible for any and all of its own expenses in performing its duties as contemplated
under this agreement. The City shall not be responsible for any expense incurred by the Contractor.
Page 2 of 8
C1112-055—THE GOODYEAR TIRE AND RUBBER COMPANY S I B
The City shall have no duty to withhold any Federal income taxes or pay Social Security services
and that such obligations shall be that of the Contractor, other than those set forth in this agreement.
Contractor shall furnish its own transportation, office and other supplies as it determines necessary
in carrying out its duties under this agreement.
7. INSURANCE. Contractor shall, at its sole cost and expense, during the period of any work
being performed under this Agreement, procure and maintain the following minimum insurance
coverages to protect the City and Contractor against all loss, claims, damage and liabilities caused
by Contractor, its agents, contractors or employees, as more particularly set forth below:
(a) General liability insurance with limits of Two Million Thousand Dollars
($2,000,000) combined single limit occurrence. Coverage must be afforded on a
form no more restrictive than the latest edition of the Comprehensive General
Liability Policy, without restrictive endorsements, as filed by the Insurance Services
Office, and must include:
Premises and/or Operations.
Independent Contractors.
Broad Form Property Damage.
- Broad Form Contractual Coverage applicable to this specific Agreement.
Personal Injury Coverage with Employee and Contractual Exclusions
removed with minimum limits of coverage equal to those required for Bodily
Injury Liability and Property Damage Liability.
The City of Sunny Isles Beach is to be named as an additional insured with
respect to liability arising out of operations performed for the City by or on
behalf of Contractor or the acts or omissions of Contractor in connection with
such operation.
(b) Workers' Compensation insurance to apply for all employees in compliance
with the Workers Compensation Law of the State of Florida and all applicable
federal laws.
(c) Business Automobile Liability Insurance with minimum limits of One
Million Dollars ($1,000,000.00) per occurrence combined single limit for Bodily
Injury Liability and Property Damage Liability. Coverage must be afforded on a
form no more restrictive than the latest edition of the Business Automobile Liability
Policy, without restrictive endorsements, as filed by the Insurance Services Office
and must include:
Owned vehicles.
Hired and non-owned vehicles.
Page 3 of 8
C1112-055—THE GOODYEAR TIRE AND RUBBER COMPANY '°� _•.
Employers' non-ownership.
Such policies of insurance shall not diminish Contractors indemnification obligations hereunder.
The insurance policy shall be issued by such company, in such forms and with such limits of
liability and deductibles as are acceptable to the City and shall be endorsed to be primary over any
insurance, which the City may maintain. Before any work under this Agreement is performed, and
at any time upon request, Contractor shall furnish to the City certificates of insurance evidencing
the minimum required coverage and appropriately endorsed for contractual liability with the City
named as an additional insured. All policies shall contain a waiver of subrogation endorsement.
All policies and certificates shall be in forms and issued by insurance companies acceptable to the
City Manager or his designee. All insurance policies and certificates of insurance shall provide that
the policies may not be canceled or altered without thirty (30) calendar day's prior written notice to
the City Manager or his designee.
8. OWNERSHIP OF DOCUMENTS AND EQUIPMENT. All documents prepared by the
Contractor pursuant to this agreement and related services to this agreement are intended and
represented for the ownership of the City only. Any other use by Contractor or other parties needs
to be approved in writing by the City in order to be properly authorized.
9. INDEMNIFICATION. Contractor agrees to indemnify and hold harmless, the City, its
officers, agents, employees from, and against any and all claims, actions, liabilities, losses and
expenses including, but not limited to, attorney's fees for personal, economic or bodily injury,
wrongful death, loss of or damage to property, at law or in equity, which may arise or may be
alleged to have risen from the negligent acts, errors, omissions or other wrongful conduct of the
Contractor, agents or other personal entity acting under Contractor's control in connection with the
Contractor's performance of services pursuant to that agreement and to that extent the Contractor
shall pay such claims and losses and shall pay all such costs and judgments which may issue from
any lawsuit arising from such claims and losses including wrongful termination or allegations of
discrimination or harassment, and shall pay all costs and attorneys' fees expended by the City in
defense of such claims and losses including appeals. The parties agree that ten percent(10%) of the
total compensation is a specific consideration from the City to the Contractor for this indemnity.
10. TERMINATION.
A. If, through any cause within the reasonable control the Contractor shall fail to fulfill
in a timely manner or otherwise violate any of the covenants, agreements or stipulations material to
this agreement, the City shall have the right to terminate the services then remaining to be
performed. Prior to the exercise of its option to terminate for cause, the City shall notify the
Contractor of its violation of the particular terms of the agreement and grant Contractor ten (10)
days to cure such default. If the default remains uncured after ten (10) days the City may terminate
this agreement
(i.) In the event of termination, all finished and unfinished documents, data and other
work product prepared by Contractor (and sub Contractor(s)) shall be delivered to
the City and the City shall compensate the Contractor for all services satisfactorily
performed prior to the date of termination, as provided in Paragraph 5 herein.
Page 4 of 8
C 1 112-055—THE GOODYEAR TIRE AND RUBBER COMPANY " a '
(ii.) Notwithstanding the foregoing, the Contractor shall not be relieved of liability to the
City for damages sustained by it by virtue of a breach of the agreement by Contractor
and the City may reasonably withhold payments to Contractor for the purposes of
set-off until such time as the exact amount of damages due the City from the
Contractor is determined.
B. Termination for Convenience of City. The City may, for its convenience and
without cause terminate the services then remaining to be performed at any time by given written
notice which shall become effective ten (10) days following receipt by Contractor. The terms of
Paragraphs A(i)and (ii) above shall be applicable hereunder.
C. Termination for Insolvency. The City also reserves the right to terminate the
remaining Services to be performed in the event the Contractor is placed either in voluntary or
involuntary bankruptcy or makes any assignment for the benefit of creditors.
11. ASSIGNMENTS, TRANSFERS, SUBCONTRACTING. The Contractor shall not
subcontract, assign or transfer any work under this agreement with the prior written consent of the
City. Should the Contractor subcontract any services under this agreement, it shall be done with
continued liability for the Contractor. The Contractor shall remain responsible for services,
responsibilities and liabilities of any person or entity acting under Contractor.
12. WAIVER OF RIGHT TO JURY TRIAL. Each of the parties hereto hereby knowingly,
voluntarily and intentionally, waive the right which any may have to a jury trial in respect of any
action, proceeding, litigation or counterclaim based hereon or arising out of, under, on or in
connection with this agreement or any course of conduct, course of dealing, statements (whether
verbal or written) or actions of either of party.
13. ARBITRATION. It is the intention of the parties that whenever possible, if a dispute or
controversy arises hereunder then such dispute or controversy shall be settled by arbitration in
accordance with the procedures, rules and regulations of the American Arbitration Association.
The decision rendered by the Arbitrator shall be final and binding upon the parties and judgment
upon the award rendered by the arbitrator may be entered in any court having jurisdiction.
Arbitration shall be held in Miami-Dade County, Florida. All costs of arbitration and attorneys'
fees incurred by the parties shall be paid by the non-prevailing party or, if neither party prevails on
the whole, each party shall be responsible for a portion of the costs of arbitration and their
respective attorneys' fees as may be determined by the court on confirmation.
14. CONFIDENTIAL INFORMATION. The Contractor shall not, either during the term of
this Agreement or any time for a period of TEN (10) years subsequent to that date upon which the
Contractor shall leave the employment of the City for any reason whatsoever, disclose to any
person or entity, other than in the discharge of the duties of the Contractor under this Agreement,
any information which the City designates in writing as "confidential." As a violation by the
Contractor of the provisions of this Section could cause irreparable injury to the City and there is no
adequate remedy at law for such violation, the City shall have the right, in addition to any other
remedies available to it at law or in equity, to enjoin the Contractor in a court of equity for violating
such provisions.
Page 5 of 8
C1112-055—THE GOODYEAR TIRE AND RUBBER COMPANY 4 ra A;
15. NOTICES. All notices and other communications required or permitted to be given
under this Agreement by either party to the other shall be in writing and shall be sent (except as
otherwise provided herein) (i) by certified or registered mail, first class postage prepaid, return
receipt requested, (ii) by guaranteed overnight delivery by a nationally recognized courier service,
or (iii) by facsimile with confirmation receipt (with a copy simultaneously sent by certified or
registered mail, first class postage prepaid, return receipt requested or by overnight delivery by
traditionally recognized courier service), addressed to such party as follows:
If to the City: Chief Fred A. Mass With a copy to:
Acting City Manager Hans Ottinot
City of Sunny Isles Beach City Attorney
18070 Collins Avenue City of Sunny Isles Beach
Fourth Floor 18070 Collins Avenue
Sunny Isles Beach, Florida 33160 Fourth Floor
Tel: (305) 792-1701 Sunny Isles Beach, Florida
33160
Tel: (305) 792-1702
If to the Contractor: Jose Sierra, Store Manager
The Goodyear Tire and Rubber
Company
1700 N.E. 163rd Street
North Miami Beach, FL 33162
16. GOVERNING LAW. This Agreement shall be governed by and construed in accordance
with the laws of the State of Florida.
17. AUDIT. The Contractor shall make available to the City or its representative all required
financial records associated with the Agreement for a period of THREE (3)years.
18. NON-DISCRIMINATION. The Contractor agrees to comply with all local and state civil
rights ordinances and with Title VI of the Civil Rights Act of 1984 as amended, Title VIII of the
Civil Rights Act of 1968 as amended, Title 1 of the Housing and Community Development Act of
1974 as amended, Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities
Act of 1990, the Age Discrimination Act of 1975, Executive Order 11063, and with Executive
Order 11248 as amended by Executive Orders 11375 and 12086.
The Contractor will not discriminate against any employee or applicant for employment because of
race, color, creed, religion, ancestry, national origin, sex, disability or other handicap, age,
marital/familial status, or status with regard to public assistance. The Contractor will take
affirmative action to insure that all employment practices are free from such discrimination. Such
employment practices include but are not limited to the following: hiring, upgrading, demotion,
transfer, recruitment or recruitment advertising, layoff, termination, rates of pay or other forms of
compensation, and selection for training, including apprenticeship. The Contractor agrees to post in
conspicuous places, available to employees and applicants for employment, notices to be provided
by the City setting forth the provisions of this non-discrimination clause.
Page 6 of 8
C 1112-055—THE GOODYEAR TIRE AND RUBBER COMPANY °�� .�
The Contractor agrees to comply with any Federal regulations issued pursuant to compliance with
Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 708), which prohibits discrimination
against the handicapped in any Federally assisted program.
19. CONFLICT OF INTEREST. The Contractor agrees to adhere to and be governed by the
Miami-Dade County Conflict of Interest Ordinance Section 2-11.1, as amended; and by the City of
Sunny Isles Beach Ordinance No. 99-82, which are incorporated by reference herein as if fully set
forth herein, in connection with the Agreement conditions hereunder. The Contractor covenants
that it presently has no interest and shall not acquire any interest, direct or indirectly which should
conflict in any manner or degree with the performance of the services. The Contractor further
covenants that in the performance of this agreement, no person having any such interest shall
knowingly be employed by the Contractor. No member of, or delegate to the Congress of the
United States shall be admitted to any share or part of this agreement or to any benefits arising
therefrom.
20. ENTIRE AGREEMENT. This Agreement, together with all terms and conditions
contained in Fleet Maintenance and Repair Services, Invitation to Bid No. 12-05-02, contains the
entire agreement of the parties, and may be amended, waived, changed, modified, extended or
rescinded only by a writing signed by the party against whom any such amendment, waiver,
change, modification, extension and/or rescission is sought.
[Remainder of page intentionally left blank.]
Page 7 of 8
C1112-055—THE GOODYEAR TIRE AND RUBBER COMPANY S / p
IN WITNESS WHEREOF, the parties hereto have executed this Agreement in duplicate
on the day and year first written above.
WITNE S#1: THE GOODYEAR TIRE AND
II RUBBER COMPANY
Signat ��
4 Uc&\%4A BY:
,' A,M
Print Name Signa e and Ti e / re"4,016--rt,
WITNESS#2:
Signature
Print Name
ATTEST: CITY OF SUNNY ISLES BEACH
B 1 BY: ►1
Jane A. Hines, CMC, City Clerk •rman S. Edelcup, Mayor
APPROVED AS TO FORM AND
LEGAL SUF CIENCY
.4
B
ans Ottinot, ity Attorney
Page 8 of 8
SIB
C1112-055—THE GOODYEAR TIRE AND RUBBER COMPANY
CITY OF SUNNY ISLES BEACH
18070 Collins Avenue
Sunny Isles Beach, Florida 33160 OP_`"61,
305.947.0606 - e
www slbfl net [y�y
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DELIVER TO: INVITATION TO BID
City of Sunny Isles Beach SECTION 4 OPENING• 10.00 A.M.
City Clerk BID SUBMITTAL FORMS 06/19/2012
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
05/18/2012 Pages 32 through 38
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 12-05-02
Fleet Maintenance&Repair Services
A Bid Deposit in the amount of 00/0 of the total amount of the bid shall accompany all bids
A Performance Bond in the amount of 00/0 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
y�e cvd-,ba er- AL= ed.
Commodity Codes):
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. 12-05-02 32
CITY OF,SVNNY.ISLES BEACH
1 8070 Collins Avenue
Sunny Isles Beach, Florida 33160 0�5ilr1NY 44\�
305.947.0606 \�
www.sibfl net ' " • n
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BID FORM
GROUP #1 - CARS AND TRUCKS UP TO 11/2 TON
Front Suspension and Steering Cap Repair, including frame straightening and rebuilding
components. A 11/2 Ton vehicle shall be defined as a manufacturer's assigned Gross Vehicle
Weight Rating (GVWR) of 15,000 lbs. as designated in the identification plate on the vehicle.
A Indicate the actual Posted Shop Labor Rate $ e
B Percentage Discount from the Posted Shop Labor .
Rate
C Discounted Hourly Shop Labor Rate $ :7 5
AND
Percentage Discount off the O.E.M. / MSRP List for parts d e'��
d
FLAT RATE SERVICES
No. Description Extended Cost
D Alignment of Front Axle Only (complete) $ ' `j r
E Alignment of Front and Single Rear Axle (complete) $
F Oil Change $
(Up to 5 quarts of Oil and Oil Filter()
GROUP #2 -TRUCKS OVER 11/2 TON
Front Suspension and Steering Cap Repair, including frame straightening and rebuilding
components. A 11/2 Ton vehicle shall be defined as a manufacturer's assigned Gross Vehicle
Weight Rating (GVWR) of 15,000 lbs. as designated in the identification plate on the vehicle.
A Indicate the actual Posted Shop Labor Rate
B Percentage Discount from the Posted Shop Labor
Rate (2_0
C Discounted Hourly Shop Labor Rate $ � _
City of Sunny Isles Beach !Request for Proposal No. 12-05-02 33
__ CITY OF SUNNY ISLES BEACH _-.
1 3070 Collins Avenue .
Sunny Isles Beach, Florida 33160 �pA 5 ;:t6��
�
305.947.0606
WWW.SIhf[l.n @f V+:. n',lir
i� r
`S�. 9,-.---FT 0 9., 44P
CirrOFSi10P‘;o
AND
Percentage Discount off the O.E.M. I MSRP List for parts
-2-v A
FLAT RATE SERVICES
No. Description Extended Cost
D Alignment of Front Axle Only (complete) $ wag .ii if—
E Alignment of Front and Single Rear Axle (complete) $ G 4
l
F Oil Change $ �.
(Up to 5 quarts of Oil and Oil Filter0 /9
GROUP #3 - BUS
Front Suspension and Steering Cap Repair, including frame straightening and rebuilding components.
A Indicate the actual Posted Shop Labor Rate $ /1 /,
B Percentage Discount from the Posted Shop Labor %
Rate At
0
C Discounted Hourly Shop Labor Rate $
it /a2/-
AND /f
Percentage Discount off the O.E.M. I MSRP List for parts �� / , %
FLAT RATE SERVICES r/
No. Description Extended Cost
D Alignment of Front Axle Only (complete) $ ,�
E Alignment of Front and Single Rear Axle (complete) $
F Oil Change $ ff ��II
(Up to 5 quarts of Oil and Oil Filter0 (Y4-
Required Documents For Group 3
Reference Required Document Acknowledgment
Section
4 City of Sunny Isles Beach I Request for Proposal No. 12-05-02 34
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I E T A I L
RETAIL HUMAN RESOURCES POLICY
POLICY NUMBER POL-621
POLICY TOPIC Drug Free Workplace
PUBLISH DATE 8/26/2011
1.0 Purpose
Goodyear Retail is committed to provide a drug-free workplace.The safety and security of associates,
guests as well as property of Goodyear Retail is of vital importance. The purpose of this policy is to
create and maintain a drug and alcohol free work environment by identifying existing associates who use
or abuse illicit drugs, abuse prescribed medication or abuse alcohol.
2.0 Procedure
DEFINITIONS
• An Accident shall be defined as any occurrence associated with the damage to a vehicle, property or
person.
• An Injury shall be defined as any occurrence that warrants medical attention.
INJURY ACCIDENT
Any injury requiring medical attention No Fault Accident resulting in damage
Oil Out Violation
Good to Go Violation
Improper Hoist Usage
Fen der Be nder
Collision - on property or not,by fault or
not
Process for Pre -Employment Druq Test, Suspicion of on-the-lob impairment and
Post Accident/Post Injury
1. Pre- Employment Druq Test:
The Manager is responsible for ensuring that a preemployment drug test Chain of Custody (COC)form is
given to the candidate who is made an offer. Non Management positions (Automotive Technician,
General Service, General Maintenance Technician, Customer Advisor, Tire & Service Advisor, Alignment
Specialist) will be given a Urinalysis Drug Test. Management positions (Team Leader, Store Manager,
Store Manager Trainee, Asst Store Manager, Service Manager)will be given Hair Follicle Drug Test.
The Store Manager is responsible for providing the correct form to the Associate to bring to Quest
Diagnostic.
2. Suspicion of on-the-iob Impairment:
When there is a suspicion of on-the-job impairment,the manager should contact his/her District Manager
and HR Specialist immediately. The Manager will need to provide the District Manager and HR Specialist
the details of the suspicion of alcohol or drugs. In a situation where the Manager cannot contact both the
DM and HR Specialist, s/he should have at least the approval from one of the two listed. The DM and
HR Specialist will inform the Manager the proper steps and procedures. The Manager should NEVER
allow the suspected associate to drive during this time and should arrange to have the associate driven to
the nearest drug testing location.
When the associate refuses to take a drug test,the Manager must inform the associate that by refusing to
drug test, it will lead to termination of employment for Insubordination.
In situations where the smell of Alcohol is apparent, the associate should be given a Breathalyzer test
rather than a drug test. A Breathalyzer test can be performed at most local Quest Diagnostic locations.
3. Post Accident:
• No Injury-The Manager needs to ensure that the associate goes to the nearest Quest Diagnostics
Center for a Urinalysis Testing. The Manager should provide the associate with a post-accident
Chain of Custody(Post-ACC form).
• The associate must seek testing immediately. No more than 24 hours should pass from the incident
to the testing.
• The manager can locate the nearest Quest Diagnostics by going to www.questdiagnostics.com.
• With Injury-The Manager should provide the associate with the Post Accident Release Form to take
with them to the hospital, urgent care or emergency room. A urinalysis testing will be performed.
Associates are asked not to use alcohol for 8 (eight) hours following an accident, or until the associate
takes a post-accident drug test, whichever occurs first.
4. Post Injury:
Associates who are injured and it results in Medical attention (actually going to seek attention, not first
aid - i.e.; band aid,eye wash)will be given a Urinalysis Drug Test. The Manager should provide the
associate with a Post-Incident Authorization Letter to provide to the caring facility.
Whether or not the accident or injury is the associate's fault, any associates that is involved in any kind of
work related accident or injury will be required to take a post-accident drug/alcohol test immediately
following the incident. The manager should provide the associate with a post-accident Chain of Custody
(POST-Acc form).
Associates are asked not to use alcohol for 8 (eight) hours following an accident, or until the associate
takes a post-accident drug test, whichever occurs first.
The Manager or appointed representative should:
Print the B-159 Injury Investigation Form,the Post Incident Authorization Letter, the Work
Tolerance Form and the Early Return to work Form from Pit Row.
II. Complete the B-159 Injury Investigation Form
III. Compete and Sign the Post Incident Authorization Form
IV. Call Liberty Mutual at 1-800-883-9556
V. Take the associate for treatment and remain with the associate until the test is completed,
the associate will need to take:
• Completed & Signed Post Incident Authorization Form
• The Work Tolerance Form
• Chain of Custody Form, if needed
In the case of a major accident or injury that requires immediate medical attention (ambulance
transportation) a Goodyear associate will accompany the injured associate and take the form to the
hospital. In the event the associate is hospitalized, arrangements will be made for the drug/alcohol testing
to be done there. If the accident occurs after the Urgent Care Center is closed for the evening, the
associate should report to the Emergency Room, where emergency room personnel will call in the
appropriate drug testing personnel to perform the test.
a fl / flJ7 . v
PIP.°
�7
R 1✓ T A I L
RETAIL HUMAN RESOURCES POLICY
POLICY NUMBER POL-540
POLICY TOPIC Equal Employment Opportunity
PUBLSH DATE 4/28/2010
1.0 Purpose
The following procedures have been established in order to maintain compliance with EEO laws and
other government and Corporate policies regarding equal employment opportunities
2.0 Procedure
1. All actions, either planned or anticipated, involving personnel must be screened by the District
Manager before any final decision is made. Such actions include hires and refusals to hire.
Promotions, demotions, transfers, reductions in the work force and terminations must be
approved by the District Manager and Goodyear Retail Akron Human Resources.All
recommendations or actions by the Human Resources Department must be consistent with the
affirmative action program of the facility, Company policy, labor agreement(if applicable),
Federal, state and local laws.
2. The Corporate Human Resources Employment Practices &Regulatory Compliance Department
has the responsibility to insure that all Company EEO Programs are consistent and comply with
the applicable laws and regulations. Consequently, all facilities of the Company will keep the
Corporate Human Resources Employment Practices & Regulatory Compliance Department
advised of the status of their respective Affirmative Action Program.
3. The Corporate Human Resources Employment Practices &Regulatory Compliance Department
is responsible for all contracts and approvals of information submitted to a government agency.
4. All contracts, whether by letter or otherwise, from a Federal, state or local government agency
concerning EEO matters must be cleared with the Corporate Human Resources Employment
Practices & Regulatory Compliance Department regarding any action to be taken.
5. All questions relating to the interpretations of EEO laws, regulations and Executive Orders, etc,
should be referred through the Goodyear Retail Akron Human Resources department and the
Law Department for clarification.
Strict adherence to all EEO policies and procedures is mandatory.
Forms
• Online Employment Application-to be completed by candidates interviewed fact to fact. Follow
True Screen process.
• Voluntary Self Identification Form -This form should be filled out as part of the online employment
application- by the person applying for employment.
• Interviewer Visual Observation-This form should be filled out by the person doing the interview
ONLY if the candidate did not self identify themselves.
3.0 References
.. CITY OF SUNNY ISLES BEACH
18070 Collins Avenue
Sunny Isles Beach, Florida 33160 5-o'`KY
305 947.0606
;Ibfl.net '' o ,n
>. FLOO
O 4'
OA,OFgisN1,s-0
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. 12-05-02 35
_. . .. CITY OF SUNNY ISLES BEACH
1 8070 Collins Avenue
Sunny Isles Beach, Florida 33160 '°-HµYes,
305 947 0606 ! ° `e
www.51hfl n,:t
41":
r`rYofsUNP�Q
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:
NO ADDENDUM WAS RECEIVED IN CONNECTION WITH THIS BID
FIRM NAME: �UG�LL ��bs- �v
AUTHORIZED SIGNATURE: DATE: G �' " ��
TITLE OF OFFICE-:
City of Sunny Isles Beach I Request for Proposal No. 12-05-02 36
SIB
CITY OF SUNNY ISLES BEACH
"" 18070 Collins Avenue
Sunny Isles Beach, Florida 33160 ;;;; rst�,
305 947 0606 0`,' s�`
w-ww.sibfl.net
I ul ln''
S
F°4'OPSUSIPao
Firm Name:
6:517 ear
Street Address:
/700 !,J. �_. /,‘.8r s'7—
Mailing Address(if different):
/1/v4 ii r�G� , � � � =3/Cd
Telephone No.( � Q'r 7 / sy Fax No. 3°fir 4111J--- )'Yo
Email Address:a 50C'"f ‘bbo ec.c4)`^- FEIN No. J_-J /JJJJ-
*"By signing this document the bidder agrees to all Terms
Signature:
(Signature of authorize agent)
Print Name: �4SE (elf f4
Title:
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.
4 City of Sunny Isles Beach I Request for Proposal No. 12-05-02 38
4
NON - COLLUSION AFFIDAVIT
City of Sunny Isles Beach
18070 Collins Avenue
P c
Sunny Isles Beach,FL 33160
OF SUN TNO Telephone:(305)947-0606 Fax:(305)949-3113
STATE OF FLORIDA
COUNTY OF )
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,
oOdd�e, A 7<,(7/ice=(Name of Coorporat' n,Partnership, Individual,etc.)
a, 416
Ji , ,formed under the laws of r2
(Type of Bus' ess) (State)
of which he is
(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.
jl- 1'r A
AFFIANT'S NAME AFFIANT'S TITLE '�r r
TAKEN,SWORN AND SUBSCRIBED TO BEFORE ME this day of ,200
Known or Produced Identification
Type of identification
(Affix seal here)
NOTARY PUBLIC(name printed or typed)
DECEMBER 28,2010 1 of 7
L)
SUNNY„S,F
PUBLIC ENTITY CRIMES
' , City of Sunny Isles Beach
r 18070 Collins Avenue
of D'7. ; \° ,' Sunny Isles Beach,FL 33160
c''>or s u N ''‘49 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
[punt individual's name and title]
for aV Eici ee A 1-(/((.= ee- -*
jprmt name of e ty submitting sworn statemen Jg
whose business address is:
/ 7,1✓ A/-6 i6. ; 1-f°
/1/1/14, 114(t<V,ti) gea,,X R, 7 7t 6
and (if applicable) its Federal Employer Identification number(FEIN) is .
(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
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. 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 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 I FORMATION CONTAINED IN THIS FORM.
By:
(Signature)
(Printed Name)
(Title)
Sworn to and subscribed before me this day of , 20 , by
(AFFIX NOTARY STAMP HERE)
Signature: Notary Public—State of Florida
Print or Type Commissioned Name
Personally Known OR Produced Identification
Type of Identification Produced
1011996 3 of 7
4
•
SIB
SJNNy,s4e
��� ��_, EQUAL OPPORTUNITY /
• AFFIRMATIVE ACTION
°P ' City of Sunny Isles Beach
SF ��FLO0.� `'�..
C'''OF SUN'aa 18070 Collins Avenue
Sunny Isles Beach,FL 33160
Telephone:(305)947-0606 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. e
Signed: J osez_ Sr i rr ti—
Title: � r Pl.41.r.1_16�-aL. -
Firm: �,&cr . C-
Address: /7OU V.0- 7 5re' J'l
/ el fl/ l' 66 4 fc 3;s 7‘-. 2
DECEMBER 28,2010 4 of 7
VA I L)
ss)0NY ISzFJ �
CONFLICT OF INTEREST
): City of Sunny Isles Beach
18070 Collins Avenue
..5'P 9'•F L O p S Sunny Isles Beach,FL 33160
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 FLORIDA
COUNTY OF
BEFORE ME, the undersigned authority, personally appeared , who was duly sworn,
deposes,and states:
18.1. I am the of
with a local office in and principal office in
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.
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 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.
18.8 I 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.
Dated this day of , 2010.
AFFIANT Print or Type Name and Title
Sworn to and subscribed before me this day of , 2010.
O Personally Known OR
Produced Identification ;Type of Identification
NOTARY PUBLIC STATE OF FLORIDA
DECEMBER 28,2010 5 of 7
SV1.1NY,s4,
cs DISPUTE DISCLOSURE
�' $ City of Sunny Isles Beach
18070 Collins Avenue
•'�gI. J-
1" Sunny Isles Beach,FL 33160
c'r r su „ Telephone:(305)947-0606 Fax:(305)949-3113
r of SUN
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?
r
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 •K
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?
NICYES 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.
61/3/.9-ei/d-
Firm
Date
-� ,.
V
Authoriz-a S's ature Print or Type Name and Title
6of7
DECEMBER 28,2010
SVANY 7SFJ'
ANTI - KICKBACK
l City of Sunny Isles Beach
�D9 P' 18070 Collins Avenue
'SF F L o g .,� Sunny Isles Beach,FL 33160
C/lY of SUN" Telephone:(305)947-0606 Fax:(305)949-3113
ANTI-KICKBACK AFFIDAVIT
STATE OF FLORIDA )
COUNTY OF )
I, the undersigned, hereby duly sworn and deposed say that no portion of this sum herein Bid
will be paid to any employees of the City of Sunny Isles Beach or its elected officials as a
commission, kickback, reward or gift, directly or indirectly by me or any member of my firm or
by an officer of the corporation.
By: 13 1L f LC r
Title:
The foregoing instrument was acknowledged before me this day of
, 20 , by [name
of person], as [type of authority], for
[name of party on behalf of whom instrument was
executed].
AFFIX NOTARY STAMP HERE:
Notary Public— State of Florida
Print or Type Commissioned Name
Personally Known OR Produced Identification
Type of Identification Produced
DECEMBER 28,2010 7 of 7
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RMO TS WON TtlE@tF R1 •• �;A
•
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAOEE wont*%V = _
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN NE 1%%t)1Nt 114%ba `(%),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
Willie of Ohio, Inc. NAME
-
PHONE FAX
c/o 26 Century Blvd. (PJC No exn 877-945-7378 (AC No)• 888-467-2378
P. 0. Box 305191 nnnRFSS- certificates@willis.com
Nashville, TN 37230-5191
INSURER(SFAFFORDINGCOVERAGE NAIC#
INSURER A:Travelers Property Casualty Company of Am 25674-002
INSURED
INSURER B: Lexington Insurance Company 19437-001
The Goodyear Tire & Rubber Company -
1144 East Market Street INSURER C:
Akron, OH 44315
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:17641959 REVISION NUMBER:
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 ADO'L sueR POLICY EFF POLICY EXP
QTR TYPE OF INSURANCE IMSRn VWn POLICY NUMBER
IMMIDDIMCf] tMINIOQ/YYYYt LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY PREMISES(Eao�rence) $
CLAIMS-MADE OCCUR MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
. GElIcL AGGREGATE LIMIT APPUESPER: PRODUCTS-COMP/OPAGG S
RO-
POLICY PI CT LOC - $
A AUTOMOBILE LIABILITY TC2JCAP144T5602 2/1/2012 2/1/20-13 (Esaccide t)ING.ELIMIT $ 1,000,000
X ANY AUTO BODILYINJURY(Perperson) $
ALL OWNED SCHEDULED -
AUTOS AUTOS BODILYINJURY(Peraccident) $
HIRED AUTOS NON-OWNED PROPERTY a A DAMAGE 'S
AUTOS
$
$ UMBRELLALIAB X OCCUR 62785192 8/1/2011 8/1/2012 EACH OCCURRENCE $ 1,000,000
X EXCESS UAB CLAIMS-MADE AGGREGATE $ 1,000,000
DED RETENTIONS
WORKERS COMPENSATION WCSIATU- UIH-
AND EMPLOYERS'LIABILITY TORY LIMITS ER
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE N/A EL.EACH ACCIDENT S
OFFICER/MEMBER EXCLUDED?
IMandatorylnNH) EL.DISEASE-EA EMPLOYEE S
ffy es,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach Acord 101,Addltonal Remarks Schedule,If more space Is required)
The above Excess Liability policy is excess of the following self-insured retentions: $25,000,000
CSL Each Occurrence Product Liability and $3,000,000 CSL Each Occurrence General Liability.
Garage Keepers Legal Liability Included under Auto Liability coverage.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Metropolitan Dade Consumer Service AUTHORIZED REPRESENTATIVE
Consumer Service Department
140 West Flagler Street Suite 902
Miami, FL 33130-1561
C011:3685151 Tp1:1401391 Cert: 6 19 01988-2010 ACORD CORPORATION.All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD