HomeMy Public PortalAbout2012-02 Authorizing to publish a RFQ for a Health Insurance Broker of RecordRESOLUTION NO. 2012-2
A RESOLUTION OF THE VILLAGE COUNCIL OF THE
VILLAGE OF KEY BISCAYNE, FLORIDA, AUTHORIZING
THE VILLAGE MANAGER TO PUBLISH A REQUEST FOR
QUALIFICATIONS FOR A HEALTH INSURANCE BROKER
OF RECORD; AND PROVIDING FOR AN EFFECTIVE DATE.
WHEREAS, the Village of Key Biscayne (the "Village") desires to procure a health
insurance broker of record (the "Broker") for the Village; and
WHEREAS, the Village Council desires to authorize the Village Manager to publish a
Request for Qualifications for a Broker; and
WHEREAS, the Village Council finds that this Resolution is in the best interest and welfare
of the residents of the Village.
NOW, THEREFORE, BE IT RESOLVED BY THE VILLAGE COUNCIL OF THE
VILLAGE OF KEY BISCAYNE, FLORIDA, AS FOLLOWS:
Section 1. Recitals Adopted. Each of the above stated recitals are hereby adopted,
confirmed and incorporated herein.
Section 2. Village Manager Authorized. The Village Manager is hereby authorized
to publish a Request for Qualifications, in substantially the form attached hereto as Exhibit "A," for
a Broker for the Village.
Section 3. Effective Date. This Resolution shall be effective immediately upon
adoption.
PASSED AND ADOPTED this 10th day of January, 2012.
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MAYOR FRANKLIN H. CAPLAN
d' ,,,,
NCHITA H. ALVAREZ, MMC, VILLAGE CLERK
APPROVED AS TO FORM AND LEGAL SUFFICIENCY
REQUEST FOR QUALIFICATIONS
Notice is hereby given that the Village of Key Biscayne is seeking sealed Qualifications
for:
"RFQ NO. 2012-01, HEALTH INSURANCE BROKER OF RECORD SERVICES"
RFQ documents may be obtained from the Village's website
(http://www.keybiscayne.fl.gov/) or Jennifer Duque, Executive Assistant to the Village
Manager, Village of Key Biscayne, 88 W. McIntyre Street, Key Biscayne, FL 33149.
Qualifications will not be accepted from anyone who obtains the bid documents from
any other party.
A NON -MANDATORY PRE -QUALIFICATIONS CONFERENCE will be held in the
Village of Key Biscayne, Village Clerk's Office, 88 W. McIntyre Street, Key Biscayne, FL
33149 at , local time, on
Qualifications shall be received in the Village Manager's Office, Village of Key Biscayne,
Village Clerk's Office, 88 W. McIntyre Street, Key Biscayne, FL 33149 Use the
physical address for Village of Key Biscayne listed above for sending packages
by any means other than US Mail), either by mail or hand delivery, on or before
, local time, on , where shortly thereafter Qualifications will be
opened and read aloud. One (1) original and seven (7) complete copies must be
submitted in sealed packaging and clearly marked on all outer packaging, including
outer shipping package and/or envelope, "Sealed Qualifications RFQ # 2012-01,
Health Insurance Broker of Record Services." Late Qualifications shall not be
accepted or considered. Any uncertainty regarding the time a bid is received will be
resolved against the bidder.
The RFQ includes the following:
Section 1
Section 2
Section 3
Section 4
Section 5
— Background Information
— General Instructions
— Terms and Conditions
— Qualification Package Forms
— Agreement
All questions or comments on the RFQ shall be submitted in writing and directed to
Jennifer Duque, Executive Assistant to Village Manager at jmedina(c�keybiscayne.fl.gov,
or faxed to Fax: (305) 365-8936.
The Village of Key Biscayne reserves the right to reject any and all Qualifications, to
waive any and all informalities and irregularities, and to accept or reject all or any part of
any Qualifications as they deem to be in the best interest of the citizens of the Village of
Key Biscayne, or the Village may reject Qualifications and re -advertise.
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SECTION 1 — BACKGROUND INFORMATION
1.1 Introduction
The purpose of this section of the RFQ is to familiarize prospective Qualifiers
with the Village and its expectations for the health insurance broker of record.
Each Qualifier shall make its own examination, investigation, and research
regarding the proper method of doing the work, all conditions affecting the work
to be done, the labor, equipment and materials, and the quantity of work to be
performed. The Qualifier agrees that it has satisfied itself by the Qualifier's own
investigation and research regarding all such conditions, and is based upon such
investigation and research, and that the Qualifier shall make no claim against the
Village because of any estimates, statements or interpretations made by any
officer or agent of the Village which may prove to be in any respect erroneous.
The data contained in the RFQ is for informational purposes only. The
Village makes no warranty as to the accuracy of this information.
1.2 General Information
[Add Village of Key Biscayne Description]
The Village is soliciting services of a qualified firm to represent and manage the
Village's health insurance coverage for all full-time employees. The Village
currently offers health insurance from , and vision plans,
and AFLAC cancer, accident, hospital, and short-term disability policies. The
selected broker may receive copies of all communications to the Village as policy
holder and may receive all quotes, policies and notices on behalf of the Village.
The broker may also obtain and evaluate insurance quotes and policies and
recommend changes to existing policies.
1.3 Scope of Work to be Performed
The Village of Key Biscayne desires the broker of record to perform the following
services:
1. Advise and assist the Village in evaluating and selecting among coverage
alternatives such as plan coverages, deductibles, co -payments, out-of-
pocket payments, etc. In the event the Village determines that it is in its
best interest to enter into new contracts for insurance coverages, advise
and assist the Village in its competitive bidding process consistent with
Section 112.08, Florida Statutes.
2. Advise the Village of potential gaps or overlaps in coverages.
3. Assist the Village with receiving and reviewing claims data and
determining premium impact of any coverage changes.
4. Assist Village employees as requested in submitting claims, interpreting
coverage and appealing denials.
5. Assist the Village with Benefit Renewals through ensuring that all potential
carriers that meet Village needs receive claims and employee census data
and seek alternative coverage if requested.
6. Assist the Village with the Benefit Plan Design to contain cost and
maximize benefit effectiveness.
7. Assist with setting up the renewals timing schedule annually so that
decisions can be made in conjunction with Village budgetary decisions.
Assist with writing, reviewing, analyzing, and presenting Requests for
Qualifications during renewals. Provide side -by -side reporting for Village
review. Prepare and/or review and advise on contract renewals. Assist
with employee open enrollment meetings.
8. Provide written update on new State or Federal legislation or judicial
decisions impacting the Village and suggested action or changes in
operations or procedures to assure compliance.
9. Provide advice on data practice, records retention and privacy issues.
Research benefits questions and provide advice to the Village as needed.
10. Establish relationships with those providers that will most greatly benefit
the needs of the Village of Key Biscayne and its employees.
11. The successful Qualifier will be in contact with the Village Manager in all
matters as they relate to benefit insurance for the Village. Said Qualifier
will also be required to be available to address the Village Council or
Village staff as the need arises.
12. Prompt response to questions and requests is an absolute requirement.
13. Analyze and report utilization trends and costs. Help to provide the Village
Administration recommendations on how best to utilize available plans
and limit premium increases.
1.4 Special Considerations
The Village wishes to continue to offer one health insurance plan to
accommodate all employees. The Village prefers to not self insure for health
coverage.
SECTION 2 - GENERAL INSTRUCTIONS
2.1 RFQ Documents
These RFQ documents constitute the complete set of Qualifications
specifications and forms. All forms and documents must be executed, sealed,
and submitted as provided in Section 2 of this RFQ. Qualifications not submitted
on the prescribed Qualifications forms shall be rejected. By submitting a
Qualification, the Qualifier agrees to be subject to all terms and conditions
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specified herein. No exception to the terms and conditions shall be allowed.
Submittal of a response to this RFQ constitutes a binding offer by the Qualifier.
2.2 Mistakes
Qualifiers shall examine the RFQ documents, Agreement, Qualifications forms,
and all other instructions provided herein. FAILURE TO DO SO WILL BE AT
THE QUALIFIER'S RISK.
2.3 Additional Terms and Conditions
Additional terms and conditions not included with the RFQ shall be not evaluated
or considered. Any and all such additional terms and conditions shall have no
force and effect and are non -applicable to this RFQ.
2.4 Interpretations and Inquiries
All Qualifiers shall carefully examine the RFQ documents. Any ambiguities or
inconsistencies shall be brought to the attention of the Village or its agent in
writing. Any questions concerning the intent, meaning, and interpretation of the
RFQ documents shall be requested in writing, and received by the Village no
later than , local time, on . Written inquiries must be
addressed to:
Jennifer Duque,
Executive Assistant to the Village Manager
Village of Key Biscayne
88 W. McIntyre Street
Key Biscayne, FL 33149
No person is authorized to give oral interpretations of, or make oral changes to,
the RFQ documents. Therefore, oral statements will not be binding and should
not be relied upon. Any interpretation of, or changes to, the RFQ documents will
be made in the form of a written addendum to the RFQ document and will be
furnished by the Village to all Qualifiers who received an RFQ package. Only
those interpretations of, or changes to, the RFQ document that are made in
writing and furnished to the Qualifiers by the Village may be relied upon.
2.5 Verbal Agreements
No verbal agreement or conversation with any officer, agent, or employee of the
Village, either before or after execution of the Agreement, shall affect or modify
any of the terms or obligations contained in the Agreement. Any such verbal
agreement or conversation shall be considered as unofficial information and in no
way binding upon the Village or the Qualifier.
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2.6 No Contingent Fees
Qualifier warrants that it has not employed or retained any company or person,
other than a bona fide employee, agent or consultant working solely for the
Qualifier, to solicit or secure the awarding of this RFQ and resulting Agreement,
and that it has not paid or agreed to pay any person, company, corporation,
individual or firm, other than a bona fide employee, agent or consultant working
solely for the Qualifier, any fee, commission, percentage, gift, or other
consideration contingent upon or resulting from the award of this RFQ or making
of the Agreement. Violation of this provision shall result in the Qualifier's
Qualifications being rejected by the Village. The Village also reserves the right to
pursue any other remedies or actions available to it to respond to such violation.
2.7 Independence Affidavit
The Qualifier shall list and describe any relationships — professional, financial, or
otherwise — that it may have with the Village, its elected or appointed officials, its
employees or agents or any of its agencies or component units for the past five
(5) years, together with a statement explaining why such relationships do not
constitute a conflict of interest relative to performing the services sought in this
RFQ. Additionally, the Qualifier shall give the Village written notice of any other
relationships — professional, financial, or otherwise — that it enters into with the
Village, its elected or appointed officials, its employees or agents or any of its
agencies or component units during the period of the Agreement.
2.8 Disqualification of Qualifiers
More than one (1) Qualification from an individual, firm, partnership, corporation,
or association under the same or different names will not be considered.
Reasonable grounds for believing that a Qualifier is involved in more than one (1)
Qualification for the same work will be cause for rejection of all Qualifications in
which such Qualifiers are believed to be involved.
2.9 Assignment; Non -Transferability of Qualifications
Qualifications shall not be assigned or transferred without the express written
consent of the Village Manager. A Qualifier who is, or may be, purchased by or
merged with any other corporate entity during any stage of the Qualification
process, through to and including awarding of the Qualification and execution of
an Agreement, is subject to having its Qualification disqualified as a result of
such transaction. The Village Manager shall determine whether a Qualification is
to be disqualified in such instances.
If, at any time during the Qualification process, filings, notices, or like documents
are submitted to any regulatory agency concerning the potential acquisition of
Qualifier, or the sale of a controlling interest in the Qualifier, or any similar
transaction, Qualifier shall immediately disclose such information to Village.
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Failure to do so may result in the Qualification being disqualified, at the Village's
sole discretion.
2.10 Legal Requirements
Qualifiers are required to comply with all provisions of Federal, State, County,
and local laws, ordinances, rules, and regulations that are applicable to the
services being offered in this RFQ. Lack of knowledge of the Qualifier shall in no
way be a cause for relief from responsibility, or constitute a cognizable defense
against the legal effects thereof.
2.11 Familiarity with Laws and Ordinances
The submission of a Qualification on the services requested herein shall be
considered as a representation that the Qualifier is familiar with all Federal,
State, County, and local laws, ordinances, rules, and regulations which affect
those engaged or employed in the provision of such services, or equipment used
in the provision of such services, or which in any way affects the conduct of the
provision of such services; and no plea of misunderstanding will be considered
on account of ignorance thereof. If the Qualifier discovers any provisions in the
RFQ documents that are contrary to or inconsistent with any law, ordinance, or
regulation, he/she shall report it to the Village in writing without delay.
2.12 Advertising
In submitting a Qualification, Qualifier agrees not to use the results as a part of
any advertising or Qualifier sponsored publicity without the express written
approval of the Village.
2.13 Execute Agreement
The terms, conditions, and provisions in this RFQ shall be included and
incorporated in the final Agreement between the Village and the successful
Qualifier(s). The order of precedence will be the Agreement, the RFQ
Documents, the Qualifier's response, and general law. Any and all legal action
necessary to interpret or enforce the Agreement will be governed by the laws of
Florida. The venue shall be Miami -Dade County, Florida.
2.14 Withdrawal or Revision of Qualifications Prior to and After Opening
A Qualifier shall not withdraw, modify, or correct a Qualification after it has been
deposited with the Village. The withdrawal, modification, or correction of a
Qualification after it has been deposited with the Village shall constitute a breach
by the Qualifier. No Qualifier may withdraw its Qualifications within ninety (90)
calendar days after the Qualifications opening date.
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2.15 VILLAGE'S Exclusive Rights
The Village reserves the exclusive rights to:
1) Waive any deficiency or irregularity in the selection process;
2) Accept or reject any or all qualifications statements in part or in whole;
3) Request additional information as appropriate;
4) Reject any or all submittals, if found by the Village Council not to be in the
best interest of the Village;
5) Re -advertise the RFQ for Health Insurance Broker of Record Services.
2.16 Addenda
The Village reserves the right to issue addenda. Each Qualifier shall
acknowledge receipt of such addenda. In the event any Qualifier fails to
acknowledge receipt of such addenda, his/her Qualifications shall nevertheless
be construed as though the addenda had been received and acknowledged and
the submission of his/her Qualifications shall constitute acknowledgment of
receipt of all addenda, whether or not received by him/her. It is the responsibility
of each prospective Qualifier to verify that he/she has received all addenda
issued before submitting the Qualifications to the Village. All addenda shall be in
writing.
2.17 Examination of the Information
By the submission of a Qualification to do the work, the Qualifier certifies that a
careful examination of the documentation and all RFQ documents, including
addenda, has taken place, and that the Qualifier is fully informed concerning the
requirements of the RFQ documents, the physical conditions to be encountered
in the work, the quality and quantity of service to be performed, and of materials
to be furnished. The Qualifier will not be entitled to additional compensation upon
subsequently finding that conditions require methods other than that anticipated
in making the Qualifications. Negligence or inattention by the Qualifier in
determining conditions of the Agreement prior to submitting the Qualifications, or
in any phase of the performance of the work, shall be grounds for refusal by the
Village to agree to additional compensation for additional work caused by such
negligence or inattention.
2.18 Adjustments/Changes/Deviations
No adjustments, changes, or deviations to the RFQ will be accepted, unless the
conditions or specifications of the RFQ expressly so provide.
2.19 Governmental Restrictions
In the event that any governmental restrictions are imposed which would
necessitate alteration of the performance of the services offered on the
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Qualifications prior to delivery, it shall be the responsibility of the Qualifier to
immediately notify the Village. The Village reserves the right to issue an
addendum or to cancel the RFQ at no expense to the Village.
2.20 Public Records
Any material submitted in response to this RFQ shall be subject to public
disclosure consistent with Chapter 119, Florida Statutes (Public Records Law).
2.21 Public Entity Crime
A person or affiliate as defined in §287.133, Florida Statutes, who or which has
been placed on the convicted vendor list maintained by the Florida Department of
Management Services following a conviction for a public entity crime, may not
submit a bid on an Agreement to provide any goods or services to the Village
and may not transact business with the Village in an amount set forth in
§287.017, Florida Statutes, for Category Two for a period of thirty-six (36)
months from the date of being placed on the convicted vendor list.
By submitting a response to this RFQ, Qualifier certifies that they are qualified
under §287.133, Florida Statutes, to provide the services set forth in this
Agreement for Health Insurance Broker of Record Services.
2.22 Non -Collusion Affidavit
The Qualifier shall include the Non -Collusion Affidavit as set forth in Form 4 of
Section 4 of this RFQ and as described in Section 3 of the RFQ. Qualifier's
failure to include the affidavit shall result in disqualification.
2.23 Understanding RFQ Documents
By submitting a Qualification, the Qualifier acknowledges that they have read and
understands the RFQ, and fully and voluntarily accepts all of the terms and
conditions set forth in the RFQ.
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SECTION 3 — SPECIFIC TERMS AND CONDITIONS
3.1 Non -Mandatory Pre -Qualifications Meeting
A non -mandatory pre -Qualifications meeting will be held on , 2012, at
a.m., local time, in the the Village Manager' Conference Room, Village of
Key Biscayne, 88 W. McIntyre Street, Suite 210, Key Biscayne, FL 33149
At the pre -Qualifications meeting, representatives of the Village will be available
to answer questions and explain the intent of this RFQ. Questions about, or
requested modifications to, the RFQ documents which have been submitted in
writing and received by the Director of Administrative Services at least seven (7)
business days prior to the pre -Qualifications meeting will be addressed. To the
extent possible, the Village will also consider other questions or concerns that
may be raised at that time. After the pre -Qualifications meeting, the Village may
prepare written documentation to answer questions, which were addressed at the
pre -Qualifications meeting, which relate to interpretation of, or changes to, the
RFQ documents, which the Village deems appropriate for clarification.
3.2 Submittal, Receipt, and Opening of Qualifications
All Qualification Packages shall be submitted prior to , local time, on
to:
Jennifer Duque,
Executive Assistant to the Village Manager
Village of Key Biscayne
88 W. McIntyre Street, Key Biscayne, FL 33149
All Qualifiers are reminded that it is the sole responsibility of the Qualifier to
ensure that their Qualifications is received in the location above prior to
, local time, on where shortly thereafter Qualifications
will be opened and read aloud. Late Qualifications shall not be accepted or
considered. Any uncertainty regarding the time a bid is received will be resolved
against the bidder. Bids will not be accepted from anyone who obtains the bid
documents from any other party. Failure of a Qualifier to submit their
Qualifications prior to the date and time stated above shall render a Qualifier to
be deemed non -responsive and the Qualifications shall not be considered for
award.
One (1) original and seven (7) complete copies must be submitted in sealed
packaging and clearly marked on all outer packaging, including outer shipping
package and/or envelope, "Sealed Qualifications RFQ No. 2012-01, Health
Insurance Broker of Record Services."
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3.3 Preparation of Qualifications
No Qualifier shall take exception to the RFQ documents herein. Qualifications
taking exception to the RFQ documents may be rejected as non -responsive.
3.3.1 Number of Qualifications — One (1) original Qualification and seven (7)
complete copies of the Qualifications are required to be submitted to the
Director of Administrative Services by the date and time indicated above.
Each copy should contain all mandatory and optional information
submitted by the Qualifier. The Village at its discretion may request
additional copies, at no cost to the Village. Each copy shall contain all
required information in order to be considered responsive.
3.3.2 Qualifications Packaging —The outside of each sealed Qualification must
clearly indicate "RFQ No. 2012-01, Health Insurance Broker of Record
Services," and the Qualifier's name and address. The "Qualification
Package" must be included in the Qualification.
3.3.3 Signatures — All required signatures from an authorized representative
who has the legal authority to bind the Qualifier in contractual obligations
must be in ink. The Qualification must be typed or legibly printed in ink.
Use of erasable ink is not permitted. All blank spaces must be filled in and
noted, in ink or typed, with amounts extended and totaled as appropriate.
All corrections made by Qualifier to any part of the Qualification document
must be initialed in ink. Failure to manually sign the appropriate
Qualifications forms may disqualify the Qualifier and the Qualification will
not be considered.
Qualification by corporations must be executed in the corporate name by
the President or Vice -President (or other corporate officer if accompanied
by evidence of authority to sign) and the Corporate Seal shall be affixed
and attested by the Corporate Secretary or an Assistant Secretary. The
corporate address and State of Incorporation shall be shown below the
signature.
Qualification by partnerships must be executed in the partnership name
and signed by a partner. His/her title must appear under his/her signature
and the official address of the partnership must be shown below the
signature.
3.3.4 Qualifications Format — The Qualification must be typed or legibly
printed in ink on 8 '/2 x 11 -inch white paper. Pages shall be secured by
staple, Cerlox binding, or similar closure. Qualifications shall be organized
in chapters according to Table 3.3.4. A tab indicating the Chapter Number
shall separate chapters.
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All pages are to be consecutively numbered. If a form is provided and
there is insufficient space for a response on a form, the response may be
continued on a page inserted immediately following the form. Any
additional pages are to be numbered the same as the form, with the
addition of the letter "a," "b," "c," etc. If a form is provided and additional
forms are needed the form may be photocopied. The photocopied pages
are to be numbered the same as the form with the addition of the letter "a,"
"b," "c," etc.
Responses must be complete and unequivocal. In instances where a
response is not required, or is not applicable (or material) to the
Qualifications, a response such as "no response required" or "not
applicable" is required.
Table 3.3.4 - Qualifications Format (continued)
Qualification Package Forms are found in Section 4.
Qualification Package
Chapter 1
Letter of Intent
Chapter 2
Qualifier's Statement of Organization - Form
1
Chapter 3
Staffing - Form 2
Chapter 4
References — Form 3
Chapter 5
Financial Stability
Chapter 6
Broker Approach
Chapter 7
Non -Collusion Affidavit — Form 4
Chapter 8
Drug -Free Workplace — Form 5
Chapter 9
Acknowledgment of Addenda — Form 6
Chapter 10
Certification to Accuracy of Qualifications —
Form 7
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3.4 Qualification Package
The Qualifier's Qualification Package forms are located in Section 4 of these
RFQ documents. The Village Administration shall examine the documentation
submitted in the Qualification Package to determine the responsiveness of each
Qualifier. Failure to provide the required information will disqualify any such
Qualifications as non -responsive, and such Qualification will not be considered.
Qualifiers must provide the following information in the separate Qualification
Package:
3.4.1 Letter of Intent — The Letter of Intent is to be signed by an officer of the
company authorized to bind the Qualifier to its provisions. The Letter of
Intent is to contain a statement indicating the period during which the
Qualification will remain valid. A period of not less than ninety (90)
calendar days is required.
3.4.2 Qualifier's Statement of Organization — Qualifiers are permitted to
supply additional information that will assist the Village in understanding
the Qualifier's organization.
3.4.3 Staffing — Qualifiers must demonstrate significant staff expertise in
obtaining and maintaining insurance coverage for organizations the size of
the Village of Key Biscayne. The Qualifier must provide the name of the
individual or individuals who will provide services under this contract and
describe his/her qualifications. The Qualifier must provide an
organizational chart of the company.
3.4.4 References — Qualifier must identify successful experience in providing
similar broker services for public entities in the State of Florida. A
summary list showing at least three (3) of the most recently awarded and
serviced comparable jobs, going back no more than five (5) years must be
provided. This summary list must identify the name of the employer,
address, description of services rendered, dates of service, basis of
compensation (commission or flat fee), and a contact/reference person
with phone number. Using Form 3, Qualifiers shall provide references for
all jobs summarized.
3.4.5 Financial Stability — Qualifiers shall demonstrate financial stability.
Qualifiers must provide a statement of the Qualifier's financial stability,
including a copy of the most recent annual financial report/annual audit.
3.4.6 Broker Approach — Qualifier must provide a description of their approach
to providing services related to obtaining and maintaining health insurance
coverage for public employees to demonstrate their understanding of the
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Village's expectations and the requirements of Florida law. The description
should include a list of successful actions with other employers that have
been successful in providing comprehensive health insurance coverage at
a market competitive cost.
3.4.7 Non -Collusion Affidavit — Using Form 4, Qualifiers shall list and describe
their relationships with the Village.
3.4.8 Drug -Free Workplace — Qualifier shall certify that it has implemented a
drug -free workplace program in accordance with Section 287.087, Florida
Statutes. In order to receive consideration, a signed Certification of
Compliance, Form 5, must be submitted.
3.4.9 Acknowledgment of Addenda — Execute Form 6 acknowledging
Qualifier has received and reviewed all Addenda to the RFQ.
3.4.10 Certification to Accuracy of Qualifications — Qualifier shall certify and
attest, by executing Form 7, that all Forms, Affidavits, and documents
related thereto that it has enclosed in the Qualification Package, in support
of its Qualifications, are true and accurate. Failure by the Qualifier to
attest to the truth and accuracy of such Forms, Affidavits, and documents
shall result in the Qualifications being deemed non -responsive and such
Qualifications will not be considered.
3.5 Qualification Package Evaluation
The Village Administration shall examine the documentation submitted in the
Qualification Package to determine the responsiveness of each Qualifier.
Failure to provide the required information will disqualify any such Qualifications
as non -responsive, and such Qualifications will not be considered. The Village
Administration has the sole discretion to reject a Qualifier or qualify a Qualifier.
A Selection Committee will be appointed by the Village Manager. The
Committee may make such investigations as it deems necessary to determine
the ability of the Qualifier to perform the work, and the Qualifier shall furnish the
Village all such information and data for this purpose as the Village may
request before, during, and after the Qualifications period. The Selection
Committee reserves the right to make additional inquiries, interview some or all
Qualifiers, obtain credit reports, or any other action it deems necessary to fairly
evaluate all Qualifiers.
3.6 Qualifications Evaluation
The Bid shall be awarded by the Village utilizing a ranking and weighting
process in four (4) categories defined in Table 3.7 and paragraphs below.
Table 3.7 - Scoring Criteria
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Criteria
Weight
Experience & Qualifications of the Firm
30 %
Experience of the Individuals Assigned
30 %
Completeness of Broker Approach
30 %
Responsiveness and Compliance with
Submission Requirements (complete
and thorough)
10
Total
100 %
Experience & Qualifications of the Firm (30%): The degree to which the
Qualifier has demonstrated experience in providing broker of record services to
public entities with the State of Florida. Documentation meeting this criterion
includes:
• Brief history of firm including size and any specialty areas.
• Background company data, including financial references.
• Particular expertise or involvement in the insurance/employee benefits
industry.
• Municipal experience.
• List of providers associated with the firm.
Experience of the Individuals Assigned (30%): The degree to which the
Qualifier commits to assign individuals in the Firm that have experience providing
health insurance broker of record services to public entities within the State of
Florida. Documentation should include an introduction to the account team by
name with specific roles, qualifications and experience, and distribution of
responsibilities including support capabilities. Please provide a copy of your
State of Florida Broker's License.
Completeness of Broker Approach (30%): The degree to which the Qualifier
demonstrates its understanding of the Village's expectations for the broker.
Documentation should include:
• A description of service philosophy.
• Current use of technology, especially capability for computerized
legal/benefit design research and for sharing and editing documents
electronically.
• Action -plan and timetable for assuming responsibilities as well as future
design/cost containment plan.
• Detail of services that will be provided to the Village.
• Describe ways in which broker will be available to assist the Village and
its employees.
• Describe where employee assistance will be provided (phone, face-to-
face in the Village, or other).
Responsiveness and Compliance with Submission Requirements
(complete and thorough) (10%): The Qualification Package will be reviewed
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and scored based upon the Qualifier's responsiveness and compliance with the
submission requirements.
3.7 Estimated Schedule
The Village anticipates that RFQ activities will take place at the dates and times
listed below. However, these times and dates are subject to change at the
discretion of the Village.
DATE
Request for Qualifications Legal Advertisement
RFQ Release
Last Date for Submittal of Written Questions Prior to
Qualifications Due Date
Non -Mandatory Pre -Qualifications Conference at
a.m.
Qualifications Due by
Public Opening of Qualifications after
SECTION 4 - QUALIFICATION FORMS
All forms located in this section of the RFQ shall be included in the Qualification
Package. Forms not completed in full may result in disqualification. Please print
clearly or type information on all forms.
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Form 1
Qualifier's Statement of Organization — Please print clearly or type information on
all forms.
1. Full Name of Business Concern (Qualifier):
Principal Business Address:
2. Principal Contact Person(s), include their name, title, phone number, and email
address:
3. Form of Business Concern (Corporation, Partnership, Joint Venture, Other):
4. Provide names of partners or officers as appropriate and indicate if the individual
has the authority to sign in name of Qualifier. Provide proof of the ability of the
individuals so named to legally bind the Qualifier.
Name Address Title
If a corporation, in what state incorporated:
Date Incorporated:
Month Day Year
If a Joint Venture or Partnership, date of Agreement:
5. List all firms participating in this project:
Name Address
1.
2.
3.
4.
16 of 16
Form 1
Qualifier's Statement of Organization (continued)
6. Outline specific areas of responsibility for each firm listed in Question 5, if applicable.
1
2.
3.
4.
7. Identify the provisions of any agreement between parties, which assigns legal or
financial liabilities or responsibilities:
8. If responding firm(s) are a partially or fully owned subsidiary of another firm, or share
common ownership with another firm, please identify the firms and relationships.
REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK
17
Form 2
Staffing
Attach an organization chart for your organization.
The organization chart must show staffing by position, number of staff per position, and
organizational relationship of positions. For the professional or management level staff
person(s) that will be responsible for providing services, provide a detailed resume
indicating the individual(s) areas of expertise and experience. Resumes must be
provided in the following format; however, additional information may be provided at the
option of the Qualifier.
A. Name & Title:
B. Project Assignment:
Name of Company with which associated:
C. Years Experience with This Company:
With Other Similar Companies:
D. Education:
Degree(s):
Year/Specialization:
Professional References: (List a minimum of 3):
E. Other Relevant Experience and Qualifications:
18
Form 3
References
The Qualifier shall provide a minimum of three (3) references of public agencies or cities
to which the Qualifier provided similar services to those being proposed in this
Qualification.
Include with every contact person below, their official title.
1. Name of Public Agency:
Address:
Phone Number:
Principal Contact Person(s):
Year Contract Initiated:
2. Name of Public Agency:
Address:
Phone Number:
Principal Contact Person(s):
Year Contract Initiated:
3. Name of Public Agency:
Address:
Phone Number:
Principal Contact Person(s):
Year Contract Initiated:
19
Form 4
Non -Collusion Affidavit
The undersigned individual, being duly sworn, deposes and says that:
1. He/She is of the Qualifier that has submitted
the attached Qualifications;
2. He/She is fully informed respecting the preparation and contents of the attached
Qualifications and of all pertinent circumstances respecting such Qualifications;
3. Such Qualifications is genuine and is not a collusive or sham Qualification;
4. Neither said Qualifier nor any of its officers, partners, owners, agents,
representatives, employees, or parties in interest, including this affiant, has in
any way colluded, connived, or agreed, directly or indirectly, with any other
Qualifier, firm, or person to submit a collusive or sham Qualifications in
connection with the Agreement for which the attached Qualifications has been
submitted or to refrain from proposing in connection with such Agreement, or has
in any manner, directly or indirectly, sought by agreement or collusion or
communication or conference with any other Qualifier, firm, or person to fix the
price or prices in the attached RFQ, or of any other Qualifier, or to fix any
overhead, profit or cost element of the Qualifications or the response of any other
Qualifier, or to secure through any collusion, connivance, or unlawful agreement
any advantage against the Village of Key Biscayne, Florida or any person
interested in the proposed Agreement; and
5. If applicable, the cost Qualifications in the attached RFQ are fair and proper and
are not tainted by any collusion, conspiracy, connivance, or unlawful agreement
on the part of the Qualifier or any of its agents, representatives, owners,
employees, or parties in interest, including this affiant.
Print Name
Signature
Title
Date
STATE OF FLORIDA
COUNTY OF
)
) SS
)
BEFORE ME, an officer duly authorized by law to administer oaths and take
acknowledgments, personally appeared as , of
, an organization authorized to do business in the State of Florida,
and acknowledged executed the foregoing Agreement as the proper official of
20
for the use and purposes mentioned in it and affixed the
official seal of the corporation, and that the instrument is the act and deed of that
corporation. He/she is personally known to me or has produced
as identification.
IN WITNESS OF THE FOREGOING, I have set my hand and official seal at in the State
and County aforesaid on this day of , 2012.
Notary Seal
SIGNATURE OF NOTARY PUBLIC
My Commission Expires: PRINTED NAME OF NOTARY PUBLIC
21
Form 5
Drug -Free Workplace
The undersigned vendor (firm) in accordance with Chapter 287.087, Florida Statutes,
hereby certifies that does:
(Name of Company)
1 Publish a statement notifying employees that the unlawful manufacturing,
distribution, dispensing, possession, or use of a controlled substance is prohibited
in the workplace and specifying the actions that will be taken against employees for
violations of such prohibition.
2. Inform employees about the dangers of drug abuse in the work place, the
business's policy of maintaining a drug -free workplace, any available drug
counseling, rehabilitation, and employee assistance programs, and the penalties
that may be imposed upon employees for drug abuse violations.
3. Give each employee engaged in providing the contractual services that are under
bid a copy of the statement specified in subsection (1).
4. In the statement specified in subsection (1), notify the employee that, as a condition
of working on the contractual services that are under bid, the employee will abide
by the terms of the statement and will notify the employer of any conviction of, or
plea of guilty or nolo contendere to, any violation of Chapter 893 or of any
controlled substance law of the United States or any state, for a violation occurring
in the workplace no later than five (5) days after such conviction.
5. Impose a sanction on, or require the satisfactory participation in a drug abuse
assistance or rehabilitation program if such is available in the employee's
community, by any employee who is so convicted.
6. Make a good faith effort to continue to maintain a drug -free workplace through
implementation of this section.
As the person authorized to sign the statement, I certify that this firm complies fully
with the above requirements.
Signature
Print Name
Title
Date
STATE OF FLORIDA
COUNTY OF
) SS:
)
22
BEFORE ME, an officer duly authorized by law to administer oaths and take
acknowledgments, personally appeared as , of
, an organization authorized to do business in the State of
Florida, and acknowledged executed the foregoing Agreement as the proper official of
for the use and purposes mentioned in it and affixed the
official seal of the corporation, and that the instrument is the act and deed of that
corporation. He/She is personally known to me or has produced
as identification.
IN WITNESS OF THE FOREGOING, I have set my hand and official seal at in the State
and County aforesaid on this day of , 2012.
NOTARY SEAL
SIGNATURE OF NOTARY PUBLIC
My Commission Expires:
PRINTED NAME OF NOTARY PUBLIC
Form 6
Acknowledgment of Addenda
The Qualifier hereby acknowledges the receipt of the following addenda issued by the
Village and incorporated into and made part of this RFQ. In the event the Qualifier fails
to include any such addenda in the table below, submission of this form shall constitute
acknowledgment of receipt of all addenda, whether or not received by him/her.
Addendum
Number
Date
Received
Print Name
Title
Signature
7;
Form 7
Certification to Accuracy of Qualifications
Qualifier, by executing this Form, hereby certifies and attests that all Forms,
Affidavits, and documents related thereto that it has enclosed in the Qualification
Package in support of its Qualifications are true and accurate. Failure by the
Qualifier to attest to the truth and accuracy of such Forms, Affidavits, and
documents shall result in the Qualifications being deemed non -responsive and
such Qualifications will not be considered.
The undersigned individual, being duly sworn, deposes and says that:
1. He/She is of the Qualifier that
has submitted the attached Qualifications;
2. He/She is fully informed respecting the preparation and contents of the
attached Qualifications and of all Forms, Affidavits, and documents
submitted in support of such Qualifications;
3. All Forms, Affidavits, and documents submitted in support of this
Qualification and included in the Qualifications Package are true and
accurate;
4. No information that should have been included in such Forms, Affidavits,
and documents has been omitted; and
5. No information that is included in such Forms, Affidavits, or documents is
false or misleading.
Signature
Print Name
Title
Date
STATE OF FLORIDA )
) SS
COUNTY OF )
BEFORE ME, an officer duly authorized by law to administer oaths and take
acknowledgments, personally appeared as
, of , an organization authorized to do
business in the State of Florida, and acknowledged executed the foregoing
Agreement as the proper official of for the use and
purposes mentioned in it and affixed the official seal of the corporation, and that the
instrument is the act and deed of that corporation. He/she is personally known to
me or has produced as identification.
24
IN WITNESS OF THE FOREGOING, I have set my hand and official seal at in the
State and County aforesaid on this day of
2011.
Notary Seal
SIGNATURE OF NOTARY PUBLIC
PRINTED NAME OF NOTARY PUBLIC
My Commission Expires:
REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK
25
AGREEMENT
THIS IS AN AGREEMENT dated the day of , 2012,
between VILLAGE OF KEY BISCAYNE, a Florida municipal corporation,
hereinafter "VILLAGE," and a Florida
Corporation, hereinafter "CONTRACTOR."
WITNESSETH:
In consideration of the mutual terms and condition, promises, covenants, and
payments hereinafter set forth, VILLAGE and CONTRACTOR agree as follows:
SECTION 1 PREAMBLE
In order to establish the background, context and form of reference for this
AGREEMENT and to generally express the objectives, and intentions, of the
respective parties herein, the following statements, representations and
explanations shall be accepted as predicates for the undertakings and
commitments included within the provisions which follow and may be relied upon by
the parties as essential elements of the mutual considerations upon which this
AGREEMENT is based. VILLAGE obtained price quotes indicating the VILLAGE'S
desire to hire a contractor to perform work concerning:
"RFQ NO. 2012-01 - HEALTH INSURANCE BROKER OF RECORD
SERVICES"
On , the Village Council awarded the bid and
authorized the proper VILLAGE officials to enter into an AGREEMENT with
CONTRACTOR for services specified in their Qualifications and included in the
AGREEMENT as Exhibit A for "RFQ NO. - HEALTH INSURANCE
BROKER OF RECORD SERVICES."
SECTION 2 SCOPE OF WORK
2.1 The CONTRACTOR shall furnish all of the materials, software programs,
supplies, and labor necessary to perform all of the work described in Request for
Qualifications "Health Insurance Broker of Record Services, RFQ No.
which is included herein in this AGREEMENT as Exhibit B.
2.2 CONTRACTOR hereby represents to VILLAGE, with full knowledge that
VILLAGE is relying upon these representations when entering into this
AGREEMENT with CONTRACTOR, that CONTRACTOR has the professional
expertise, experience, manpower, and professional licenses to perform the services
to be provided by CONTRACTOR pursuant to the terms of this AGREEMENT.
26
2.3 CONTRACTOR assumes professional and technical responsibility for
performance of its services to be provided hereunder in accordance with
recognized professional standards of good consulting and management practices.
2.4 The Request for Qualifications (RFQ) is included in its entirety as part of this
AGREEMENT.
2.5 CONTRACTOR agrees to present health insurance options annually to
the Village no later than June 15 each year. The Village Manager can extend the
time based on circumstances beyond the control of the CONTRACTOR, or for
the convenience of the VILLAGE.
SECTION 3 CONTRACT SUM
3.1 The VILLAGE hereby agrees to pay or provide for the carrier to pay the
CONTRACTOR for the faithful performance of this AGREEMENT for work
completed in accordance with the fee schedule provided in Exhibit B.
3.2 For payment purposes, CONTRACTOR will do the work specified in the
Qualifications. CONTRACTOR will either invoice the Village for work performed
when work is completed or obtain compensation as a commission from the
health insurance carrier.
SECTION 4 CONTRACTOR'S INDEMNIFICATION
The CONTRACTOR agrees to protect, defend, indemnify, and hold
harmless the VILLAGE, its officers, employees, and agents from and against any
and all lawsuits, penalties, damages, settlements, judgments, decrees, costs,
charges, and other expenses or liabilities of every kind in connection with or
arising directly out of the work agreed to be performed herein, to the extent
caused by the negligence, recklessness, or intentional wrongful misconduct of
CONTRACTOR, its employees, servants, agents, and Subcontractors. Without
limiting the foregoing, any and all such claims, suits, etc., relating to personal
injury, death, damage to property, defects in materials or workmanship, actual or
alleged infringement of any patent, trademark, copyright or of any other tangible
or intangible personal or property right, or any actual or alleged violation of any
applicable statute, ordinance, administrative order, rule or regulation or decree of
any court, is included in the indemnity.
SECTION 5 RESERVED
SECTION 6 INSURANCE
6.1 The CONTRACTOR shall provide and maintain in force at all times during
the AGREEMENT with the VILLAGE such insurance, including Workers'
Compensation and Comprehensive General Liability Insurance, and Automobile
77
Liability Insurance and will assure to the VILLAGE the protection contained in the
foregoing indemnification undertaken by the CONTRACTOR, including the
following:
a. Workers' Compensation Statutory limits.
b. Commercial General Liability Insurance with limits of no less than
$1,000,000.00, including VILLAGE as an additional insured.
c. Automobile Liability coverage is to include bodily injury and
property damage arising out of operation, maintenance, or use of
any auto, including owned, non -owned and hired automobiles and
employee non -ownership with limits of not less than $300,000.00
per occurrence.
6.2 CONTRACTOR shall ensure that its Insurance provides adequate
coverage consistent with its obligations under this AGREEMENT.
6.3 A Certificate of Insurance acceptable to the VILLAGE shall be provided
listing the above coverages and providing thirty (30) days prior written notice to
the VILLAGE in the case of cancellation or change of insurer. Should
CONTRACTOR permit any required coverage to lapse, VILLAGE may, but is not
required to, immediately terminate this AGREEMENT. The VILLAGE shall be
named as an additional insured on the Liability Policies.
6.4 CONTRACTOR is advised to require all of its' Subcontractors to provide
the aforementioned coverage as well as any other coverages that the
AGREEMENT may consider necessary, and any deficiency in the coverages or
policy limits of any Subcontractors will be the sole responsibility of the
CONTRACTOR. CONTRACTOR shall provide proof of coverage by its
Subcontractors upon VILLAGE'S request.
SECTION 7 WARRANTIES AND ATTORNEYS FEES
CONTRACTOR warrants that its services are to be performed within the limits
prescribed by the VILLAGE with the usual thoroughness and competence of the
construction trade. In the event it becomes necessary for either party herein to
seek legal means to enforce the terms of the AGREEMENT, the prevailing party
shall be entitled to its reasonable attorney fees and court costs and paralegal
fees at both the trial and appellate levels, to the extent permitted by law.
78
SECTION 8 MISCELLANEOUS
8.1 The duties and obligations imposed by the Contract Documents and the
rights and remedies available hereunder to the parties hereto, and, in particular but
without limitation, the warranties, guaranties and obligations imposed upon
CONTRACTOR and all of the rights and remedies available to VILLAGE
thereunder, are in addition to, and are not to be construed in any way as a limitation
of, any rights and remedies available to any or all of them which are otherwise
imposed or available to any or all of them which are otherwise imposed or available
by laws or regulations, by special warranty or guarantee or by other provisions of
the Contract Documents, and the provisions of this Paragraph will be as effective
as if repeated specifically in the Contract Documents, and the provisions of this
Paragraph will survive final payment and termination or completion of the
AGREEMENT.
8.2 CONTRACTOR shall not assign or transfer the Contract or its rights, title or
interests therein without VILLAGE'S prior written approval as evidenced by a letter
signed by the Village Manager, which may be withheld for any or no reason. The
obligations undertaken by CONTRACTOR pursuant to the Contract shall not be
delegated or assigned to any other person or firm unless VILLAGE shall first
consent in writing to the assignment. Violation of the terms of this Paragraph shall
constitute a breach of Contract by CONTRACTOR and the VILLAGE may, at its
discretion, cancel the Contract and all rights, title and interest of CONTRACTOR
shall thereupon cease and terminate.
8.3 CONTRACTOR and its employees, volunteers and agents shall be and
remain independent contractors and not agents or employees of VILLAGE with
respect to all of the acts and services performed by and under the terms of this
AGREEMENT. This AGREEMENT shall not in any way be construed to create a
partnership, association or any other kind of joint undertaking or venture between
the parties hereto.
8.4 The remedies expressly provided in this AGREEMENT to VILLAGE shall not
be deemed to be exclusive but shall be cumulative and in addition to all other
remedies in favor of VILLAGE now or hereafter existing at law or in equity.
8.5 The validity, construction and effect of this Contract shall be governed by the
laws of the State of Florida. Subject to provisions hereof relating to arbitration, any
claim, objection or dispute arising out of this AGREEMENT shall be litigated in a
competent court of jurisdiction in Miami -Dade County.
8.6 Should any part, term or provision of this AGREEMENT be by the courts
decided to be invalid, illegal or in conflict with any law of the State, the validity of the
remaining portion or provision shall not be affected thereby.
8.7 In accordance with the Public Records Law, CONTRACTOR agrees to
permit VILLAGE to examine all records and grants VILLAGE the right to audit
29
any books, documents and papers that were generated during the course of
administration of this AGREEMENT. CONTRACTOR shall maintain the records,
books, documents and papers associated with this AGREEMENT in accordance
with the Public Records Act. Upon VILLAGE'S request, CONTRACTOR shall
provide VILLAGE with copies of all public records related to this AGREEMENT at
no cost to VILLAGE.
8.8 Neither party, nor its employees, shall have or hold any continuing or
frequently recurring employment or contractual relationship, or have any adverse
claim against the other party that is substantially antagonistic or incompatible
with that party's loyal and conscientious exercise or judgment related to its
performance under this AGREEMENT. This provision shall also apply to all of
CONTRACTOR'S Subcontractors used for the work.
SECTION 9 NONDISCRIMINATION AND EQUAL OPPORTUNITY
EMPLOYMENT
9.1 During the performance of this AGREEMENT, CONTRACTOR shall not
discriminate against any employee or applicant for employment because of race,
religion, color, sex or national origin. CONTRACTOR will take affirmative action to
ensure that employees are treated during employment, without regard to their race,
creed, color or national origin. Such action must include, but not be limited to the
following: employment, upgrading; demotion or transfer; recruitment or recruitment
advertising, layoff or termination; rates of pay or other forms of compensation; and
selection for training, including apprenticeship.
9.2 CONTRACTOR shall comply with all applicable local, state and federal labor
and safety laws and regulations.
SECTION 10 TERM AND TERMINATION
10.1 This AGREEMENT shall have an Initial Term of one (1) year, commencing
on the date of full execution by the VILLAGE. This AGREEMENT may be
renewed annually with the mutual consent of both parties. Compensation will be
determined at time of renewal.
10.2 It is expressly understood and agreed that the VILLAGE or the
CONTRACTOR may terminate this AGREEMENT at any time, without cause or
penalty, on thirty (30) days written notice, to the other party. However, if the
CONTRACTOR wants to terminate the AGREEMENT anytime between the
months of June and September the CONTRACTOR shall provide the Village with
ninety (90) days notice. In the event of termination, the VILLAGE'S sole
obligation to the CONTRACTOR shall be payment for services for work
previously authorized and performed. Such payment shall be determined on
services provided as specified in the RFQ Qualifications, and/or the percentage
of work performed by the CONTRACTOR up to the time of termination. Upon
30
such termination, the VILLAGE may, without penalty or other obligation to the
CONTRACTOR, elect to employ other persons to perform the same or similar
services. The CONTRACTOR'S sole obligation to the VILLAGE shall be to
provide for a smooth transition to another CONTRACTOR including outstanding
claims issues.
SECTION 11 NOTICES
Whenever the VILLAGE desires to give notice unto the CONTRACTOR, it must
be given by written notice, sent by certified mail, addressed to the party for
whom it is intended at the place last specified or by facsimile transfer with
confirmation thereof. The place for giving of notice shall remain such until it shall
have been changed by written notice in compliance with the provisions of this
paragraph. For the present, the parties designate the following as the respective
place for giving of notice, to -wit:
For VILLAGE:
Copy to:
For CONTRACTOR:
Village of Key Biscayne
John C. Gilbert, Village Manager
Village of Key Biscayne,
88 W. McIntyre Street, Suite 210
Key Biscayne, FL 33149
Telephone: 305-365-5514
Facsimile: 305-365-8914
Stephen Helfman, Village Attorney
Weiss Serota Helfman Pastoriza Cole & Boniske, P.L
2525 Ponce de Leon Blvd.
Coral Gables, FL 33134
Telephone: 305-854-0800
Facsimile: 305-854-2323
Notice by facsimile shall not be deemed received until the party receiving notice
receives a copy of such notice through certified mail, return receipt requested.
When any period of time is referred to in the Contract Documents by days, it will be
computed to exclude the first and include the last day of such period. If the last day
of any such period falls on a Saturday or Sunday or on a day made a legal holiday
by the law of the applicable jurisdiction, such day will be omitted from the
computation. A calendar day of twenty four (24) hours measured from midnight to
the next midnight shall constitute a day.
31
SECTION 12 DEFAULT
In the event the CONTRACTOR fails to comply with the provisions of this
AGREEMENT, the VILLAGE may declare the CONTRACTOR in default and
notify it in writing, giving a reasonable time to cure the default, but in no event
shall this time period exceed thirty (30) calendar days unless otherwise agreed to
by the parties. In such event, the CONTRACTOR shall only be compensated for
any services completed as of the date written notice of default is served.
SECTION 13 ACCEPTANCE OF AGREEMENT
Execution of this AGREEMENT by both parties signifies agreement with all the
terms and conditions and serves as a notice to proceed.
IN WITNESS WHEREOF, VILLAGE and CONTRACTOR have signed this
AGREEMENT, in duplicate.
IN WITNESS OF THE FOREGOING, the parties have set their hands and seal the
day and year first written above.
VILLAGE OF KEY BISCAYNE
Village Manager
ATTEST Printed Name of Village Manager
Jennifer Duque,
Executive Assistant to the Village Manager
APPROVED AS TO FORM:
Village Attorney Date
32
CONTRACTOR
Contractor's Name
WITNESSES :
Signature of President
Printed Name of President
Signature
Print Name
ATTEST
(Corporate Seal)
Secretary
STATE OF FLORIDA)
COUNTY OF
) SS:
)
BEFORE ME, an officer duly authorized by law to administer oaths and take
acknowledgments, personally appeared and
as and
respectively, of , a Florida corporation, and acknowledged
they executed the foregoing AGREEMENT as the proper officials of
, for the use and purposes mentioned in the
AGREEMENT and affixed the official seal of the corporation, and that the
instrument is the act and deed of that corporation.
IN WITNESS OF THE FOREGOING, I have set my hand and official seal at
in the State and County aforesaid on this day of , 2012.
Signature of Notary Public
My Commission Expires:
Printed Name of Notary Public
Notary Seal
_33