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2023-09-25 VII. C. Exhibit 5 • • Exhibit 5 CITY OF OKEECHOBEE, PUBLIC WORKS 09/25/2023 C'�t� v� Okeechobee Memo FLORIDA•,D,:nded 19IS To: Gary Ritter, City Administrator From: David Allen, Public Works Director Date: 9/15/2023 Re: Street Sweeping Services Purchase Order The Public Works Department is requesting a Purchase Order in the amount of$15,862.00 to USA Services for street sweeping services.The Purchase Order will cover sweeping services for the months of March through September 2023. USA Services has provided street sweeping services to the City for the last several years.The initial agreement with USA Services was based on a piggyback agreement based on a contract between USA Services and the City of Cape Coral.The Cape Coral contract is no longer in force; however, USA Services has continued to perform the sweeping for the City based on the Cape Corral contract price. Given the limited availability of street sweeping services, in Okeechobee, Public Works has continued to use USA Services as to perform sweeping for the City. The Public Works is in the process of issuing a new bid for sweeping sery ices for the City. • • , sCity of Okeechobee 9 , Checklist for Purchase Requisitions/Purchase Orders Today.Date: Sept 11, 2023 Vendor Originating Department l ISA SPrvicas of Florida Administration PO Box 74042 Finance Cleveland. OH 44194-0124 Clerk General Services Police Fire ' Public Works Section I. Please mark each item YES or NO to determine if the checklist of minimum requirements for an item and/or service is needed for your department prior to ordering/purchasing the item/service_ If the answer is YES to any of the below, please include the items fisted in Section II. YES NO • A. Is it a professional service? • B. Is the vendor coming on city property other than delivering an item(s)? C. Is it a contract for services? • D. Is the product or service more than City Administrator's approval limits($14,999)? Section II. Please mark all items included: YES NO III A. Approved signed contract by all parties • B. Provide all quotes for item/service • C. Current BTR with the City of Okeechobee if for services • D. Certificate of Insurance with requirements as previously indicated in the contract for services • E. W-9 if new Vendor F.Provide Bond if required G. If Council approval is required,minutes must be provided. If minutes are not available at time of submittal,the Department Head and City Administrator will certify Council approval and the agenda and item must be attached. (Minutes need to be provided when available) • Minutes provided • Required Certification Council Approval Department Signature City Administrator Signature Date Date signed Oats signed -._ __ S:VNDN'DIIte FormsPro.dureslChecld0st 3 Rwised date:2022 10 12 • • AC CERTIFICATE CERTIFICATE OF LIABILITY INSURANCE DATE 6n 2023 ) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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 HUB International Midwest Limited PHONE CSU Construction FAX 1411 Opus Place, Suite 450 (Aic,No.Exn:630-468-5600 (JC,No): Downers Grove IL 60515 ADDRESS: CSUConstruction@hubintemational.com INSURER(S)AFFORDING COVERAGE NAIC* INSURER A:Hartford Fire Insurance Company 19682 INSURED SWEECOR-01 INSURER 0:Navigators Specialty Insurance Company 36056 USA Services of Florida, LLC 4141 Rockside Road, Suite 100 INSURER C:Axis Surplus Insurance Company 26620 Seven Hills OH 44131 INSURER D:Safety National Casualty Corporation 15105 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1785138332 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 I IADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE I INSD WVD POLICY NUMBER IMM/DOIYYYYI (MM/DD/YYYY)I LIMITS 0 X COMMERCIAL GENERAL LIABILITY I GL6676535 6/1/2023 6/1/2024 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR 1 PREMISES(Ea occurrence) $1,000,000 X Contractual Liab MED EXP(Any one person) $5,000 X XCU Coy Ind PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY X mi, f LOC PRODUCTS-COMP/OP AGG $4,000,000 OTHER: $ D AUTOMOBILE LIABILITY CA6676536 6/1/2023 6/1/2024 COMBINED SINGLE LIMIT $2,000,000 CO accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS x HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY ^ AUTOS ONLY (Per accident) C UMBRELLA LIAB X OCCUR P-001-000882635 6/1/2023 6/1/2024 EACH OCCURRENCE $5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$n $ D WORKERS COMPENSATION LDS4068227 6/1/2023 6/1/2024 X OTH- AND EMPLOYERS'LIABILITY YIN STATUTE _ ER _ _ _ ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Leased 8 Rented Equipment 83MS AG3307 6/1/2023 6/1/2024 Limit. $100,000 B Pollution Liability CH23ECPZ01ECGIC 6/1/2023 6/1/2024 EachIncidenl1Ded: $1,000,000/613,000 D Stop Gap Liability-OH GL6676535 6/1/2023 6/1/2024 Limit: $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Job:Tampa office Sweeping the City of Okeechobee,FL. City of Okeechobee is included as an Additional Insured on General Liability,when required in a written contract or agreement with the Insured.Should a policy be cancelled before the expiration date,a 30 days notice is to be provided by the Insurer to the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Okeechobee 55 Southeast 3rd Avenue Okeechobee FL 34974 AUTHORIZEDREPR�E/S'ENTNATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • • " Cr.:Y'r:,.' ., A�< y 7 . "rir r�'Y. :r.. ..1$'b.= Y'x` ,, i(_fy',r ^,i ""t r ti ,,.40 ,' `ter'` Y'as.ram.``',.: d `� 's, " , .,, s.. f. t. _ 3,,,mk r 2ad F it .k.Y s. ,,.n,v'Cr sw.a..i4' « t a wsfix , 3 a `xy $ ,V,,, 1,- �t w s' a, st a > f, mas !a r avu Y. =5: »P.', �,.. ': t ?; •' t,.', o e�r y'.0.;,tip SaG ,1, °u< 14-, "S4 z� r'l-,�3 ,r<x ",: r',.'.,_-„„m:K''S.( e+_v>r {,x fi{'^! 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F ,� ' r C; "' • ��4 4 r eft ,� �� ��) u i 5^ y Y y i P Q S l ..yv 1 5' ] ra,�u ✓tiG J r 2 t' ► A a '-gyp 4; • y %� tk S , 6 C f 'r� f/ r3 y>` s fi rt ' • a ' 1 of ..+° u l Y t✓a '» , S n r r r � ,,': � s '"d'^" s .ti F 1. ,r k ? 9 o d i sr'r rY 9r ds� a x �- r ,a (' .dL`''`` 1 kG.�- .1 . ,. - , i„ . Tr t r ;i ei, t'', . .si�. f'L�•'+4cr st F„ 3 r "-u v- + :;W.64.. '' r s�9' s x ..si ,t; ig, r u vria 4, 6t.) rr s v z+ l r r:,r:. x..y it ',� ''.pw. .rr? s ! ;W - ✓ ✓ d 7 k ,('� ' w 9 •v'S' PURCHASE ORDER "t. CITY OF OKEECHOBEE IMPORTANT: THIS NUMBER MUST BE SHOWN ON v _ 4111= m 55 S.E.THIRD AVENUE ALL INVOICES,PACKAGES,CASES, OKEECHOBEE, FLORIDA 34974-2903 TICKETS AND CORRESPONDENCE. Tel:863/763-3372 Fax:863/763-1686 PLOR1 P, SHIP civo:Okeechobee 55 SE 3rd Avenue Okeechobee, FL 34974 To: USA Svces Of Ronda, <? I 448 Spring Harrirnotk Cr. 1_ Lo }}''n 111I /ryv,, s[ ,T INVOICE IN DUPLICATE:god, City of Ok c-ho e L_ 65 SE 3rd Avenue THIS ORDER SUBJECT TO CONDITIONS ON FACE.NO Okeechobee, FL 34974 —J CHANGES MAY BE MADE WITHOUT WRITTEN PERMISSION OF PROCUREMENT MANAGEMENT. DATE VENDOR NO. DELIVERY DATE SHIP VIA BEST WAY FO.B.DESTINATION TERMS ITEM ACCT.NUMBER QUANTITY UNIT DESCRIPTION UNIT AMOUNT NO. 3 0 1-549-3400 `::3$'a&.`i Sweeping Contract a26,7.1=.0 i Agreement to piggyback a contract act for `'ervioes for Cape Corot yr contract 9/1117-8131/22 first yr of 5. 2226.00 per month TOTAL $28,1 12.O0 CITY OF OKEECHOBEE IS EXEMPT FROM FEDERAL EXCISE AND TRANSPORTATION TAXES AND STATE SALES TAX.DO NOT INCLUDE THESE TAXES IN YOUR INVOICE. EXEMPTION CERTIFICATE WILL BE SIGNED UPON REQUEST STATE SALES TAX EXEMPTION 85-8012621656C-6 FEDERAL I.D.59-6000-393 AUTHORIZED SIGNATURE RECEIVING RECORD . PARTIAL 0 FINAL 0