HomeMy WebLinkAboutCity of Tamarac Resolution R-2010-108Temp. Reso. #11904
July 7, 2010
Page 1 of 4
CITY OF TAMARAC, FLORIDA
RESOLUTION NO. R-2010-jJi
A RESOLUTION OF THE CITY COMMISSION OF THE CITY
OF TAMARAC, FLORIDA, AWARDING BID NO. 10-1813 "LIME
SLUDGE REMOVAL, HAULING AND DISPOSAL" TO AUSTIN
TUPLER TRUCKING, INC., AND AUTHORIZING THE
APPROPRIATE CITY OFFICIALS TO EXECUTE THE
AGREEMENT WITH AUSTIN TUPLER TRUCKING, INC. FOR
LIME SLUDGE REMOVAL, HAULING AND DISPOSAL;
AUTHORIZING AN EXPENDITURE OF FUNDS FOR AN
AMOUNT NOT TO EXCEED $107,960.00 ANNUALLY, AND
AUTHORIZING CONTRACT ESCALATION / DE-
ESCALATION AS PROVIDED UNDER THE AGREEMENT
BEGINNING OCTOBER 1, 2010 THROUGH SEPTEMBER 30,
2012, WITH TWO (2) ADDITIONAL TWO-YEAR RENEWAL
OPTIONS; PROVIDING FOR CONFLICTS; PROVIDING FOR
SEVERABILITY; AND PROVIDING FOR AN EFFECTIVE
DATE.
WHEREAS, lime sludge is a by-product of the water treatment process and must be
removed, hauled and disposed of from the City's Water Treatment Plant; and
WHEREAS, the City of Tamarac publicly advertised Bid No.10-18B "Lime Sludge
Removal, Hauling and Disposal" in the Sun -Sentinel on June 20, 2010 and June 27, 2010
and on the City's Internet web -site (a copy of the bid file is on file in the office of the City
Clerk); and
WHEREAS, twenty-seven (27) vendors downloaded bid documents and (4) vendors
submitted bids that were opened and reviewed to determine cost and responsiveness to
the City's specifications as based on a quantity of 11,000 cubic yards, tabulated as follows:
1
; and
Temp. Reso. #11904
July 7, 2010
Page 2 of 4
COMPANY NAME
UNIT PRICE
TOTAL BID $
Austin Tupler Trucking, Inc.
$9.79 / cu. yd.
$107,690.00
DRD Enterprises Inc. of
Davie
$10.25 / cu. yd.
$112,750.00
Tate Transport Corp.
$11.63 / cu. yd.
$127,930.00
Chin Diesel, Inc.
$22.00 / cu. yd.
$242,000.00
WHEREAS, Austin Tupler Trucking, Inc., submitted the lowest responsive
responsible bid at a price of $107,690.00 annually (a copy of said Bid is attached hereto as
"Exhibit 1" ); and
WHEREAS, sufficient funds are available from the Utilities Department Water
Treatment Plant Operating funds; and
WHEREAS, it is the recommendation of the Director of Utilities, the Acting Water
Plant Superintendent and the Purchasing & Contracts Manager that Bid No. 10-18B "Lime
Sludge Removal, Hauling and Disposal' be awarded to Austin Tupler Trucking, Inc. for a
period beginning October 1, 2010 through September 30, 2012 with two (2) additional two-
year renewal options, as the lowest responsive and responsible bidder; and
WHEREAS, the City Commission of the City of Tamarac, Florida deems it to be in
the best interest of the citizens and residents of the City of Tamarac to approve the award
of Bid No. 10-18B "Lime Sludge Removal, Hauling and Disposal" to Austin Tupler Trucking,
Inc., and execute an agreement with Austin Tupler Trucking, Inc., in an amount not to
exceed $107,690.00, and authorizing escalation / de-escalation provisions as provided
under the agreement.
Temp. Reso. #11904
July 7, 2010
Page 3 of 4
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF THE
CITY OF TAMARAC, FLORIDA, THAT:
SECTION 1: The foregoing "WHEREAS" clauses are hereby ratified and
confirmed as being true and correct and are hereby made a specific part of this resolution
upon adoption hereof and all exhibits attached hereto are incorporated herein and made a
specific part of this resolution.
SECTION 2: The award of Bid No. 10-18B for "Lime Sludge Removal,
Hauling and Disposal' to Austin Tupler Trucking, Inc. is hereby approved.
SECTION 3: The appropriate City Officials are hereby authorized to execute
an agreement between the City of Tamarac and Austin Tupler Trucking, Inc., (a copy of
which is attached hereto as "Exhibit 2") as part of said award.
SECTION 4: An expenditure for an amount not to exceed $107,690.00
annually beginning October 1, 2010 through September 30, 2012 and authorizing
escalation / de-escalation provisions as provided under the agreement is hereby
authorized.
SECTION 5: All resolutions or parts of resolutions in conflict herewith are
hereby repealed to the extent of such conflict.
SECTION 6: If any clause, section, other part or application of this Resolution
is held by any court of competent jurisdiction to be unconstitutional or invalid, in part or
application, it shall not affect the validity of the remaining portions or applications of this
Resolution.
Temp. Reso. #11904
July 7, 2010
Page 4 of 4
SECTION 7: This Resolution shall become effective immediately upon its
passage and adoption.
PASSED, ADOPTED AND APPROVED this d_Cday of 201047
ATTEST:
MARI_ON SWENSON, CMC
CITY CLERK
I HEREBY CERTIFY that
I have approved this
RESOLUTION as to form.
13ka
SAMIJ,EL S. GOF
CITY ATTORN
LT, •yto]
-
Record of COMMISSION VOTE:
MAYOR TALABISCO L-1 '
DIST 1: COMM BUSHNEL -:�-�
DIST 2: COMM GOMEZ_
DIST 3: COMM GLASSER�,•r a
DIST 4: VM DRESSLER
1
1
"EXHIBIT 1"
TR #11904
SUBMIT BID TO:
CITY OF TAMARAC
PURCHASING AND CONTRACTS DIVISION
7525 NW WH AVENUE
TAMARAC, FL 33321
954-597-3570
INVITATION FOR BID
Bidder Acknowledgement
BID NO.: 10-18B
BID TITLE: LIME SLUDGE Removal, Hauling & Disposal
BID OPENING DATEMME: 2:00 P.M., June 30, 2010
BUYER NAME: Keith K. Glatz, CPPO
BUYER PHONE: 954-597-3667
BUYER EMAIL: keithg@tamaraC.Org
PRE -BID CONFERENCE/SITE INSPECTION: N/A
BONDING: Not required for this bid.
GENERAL CONDITIONS
THESE INSTRUCTIONS ARE STANDARD FOR ALL $108 FOR COMMODITIES/SERVICES ISSUED BY THE CITY OF TAMARAC. THE
CITY OF TAMARAC MAY DELETE, SUPERSEDE OR MODIFY ANY OF THESE STANDARD INSTRUCTIONS FOR A PARTICULAR BID
! by INDICATING SUCH CHANGE IN THE INSTRUCTIONS TO BIDDERS, IN THE SPECIAL CONDITIONS OF THE BID, OR IN THE
SPECIFICATIONS/STATEMENT OF WORK. ANY AND ALL SPECIAL CONDITIONS THAT MAY VARY FROM THESE GENERAL
CONDITIONS SHALL PREVAIL OVER THESE GENERAL CONDITIONS AND ANY CONFLICTING PROVISION WITHIN ANY VENDORS
STANDARD TERMS AND CONDITIONS REGARDLESS OF ANY LANGUAGE IN VENDORS DOCUMENTATION TO THE CONTRARY.
SEALED BIDS
THIS FORM SHOULD BE EXECUTED AND SUBMITTED WITH ALL BID FORMS IN A SEALED ENVELOPE. THE FACE OF THE
ENVELOPE SHALL CONTAIN THE ABOVE ADDRESS, THE BID NUMBER AND THE BID TITLE. BIDS NOT SUBMITTED ON THE
ATTACHED BID FORM MAY BE DEEMED NON -RESPONSIVE, ALL BIDS ARE SUBJECT TO THE TERMS AND CONDITIONS
SPECIFIED HEREIN. THOSE BIDS THAT DO NOT COMPLY WITH THESE CONDITIONS MAY BE DEEMED NONRESPONSIVE.
BIDDER COMPANY NAME: AUSTIN TUPLER TRUCKING INC.
COMPANY ADDRESS: 6570 S.W. 47th. Court, Davie, FL 33314
COMPANY PHONE: (954) 583-0801
NAME OF AUTHORIZED AGENT: Glen T u p 1 e r
TITLE OF AUTHORIZED AGENT: President
AUTHORIZED AGENT EMAIL ADDRESS: t o 1 e r@ b e 11 south. n e t
BIDDER TAXPAYER ID OR SOCIAL SECURITY NUMBER: 5 9 --14 2 6 412
SIGNATURE OF AUTHORIZED AGENT:
I certify that this Bid Acknowledgement Is made without prior understanding, agreement or connection with any corporation,
firm or person submitting a Bid for the same commodities and/or services and is in all respects fair and without ooIlusion or
fraud. I agree to abide by all conditions of this Bid and Certify that I am authorized to sign this Bid as an agent for the Bidder.
a
of Tamarac
Purchasinq & Contracts Division
BID FORM
BID NO.10-1$B
LIME SLUDGE REMOVAL, HAULING & DISPOSAL
Submitted by: Austin Tu ler Truckin , Inc.. Date 6 2 /10
THIS BID IS SUBMITTED TO:
City of Tamarac
Purchasing and Contracts Manager
7525 Northwest 88th Avenue
Tamarac, Florida 33321
1. The undersigned Bidder proposes and agrees, if this bid is accepted, to enter into
a contract with the City to perform and furnish all Work as specified herein for the
Contract Price and within the Contract Period indicated in this bid.
2. This bid will remain subject to acceptance for sixty (60) days after the day of bid
opening. Bidder will sign and submit the necessary documents required by the City
within fifteen (15) days prior to the date of the City's Award.
a) Bidder has familiarized itself with the nature and extent of the contract
documents, locality, and all local conditions and laws and regulations that
in any manner may affect cost, progress, performance or furnishing of the
Work.
b) Bidder has given the City written notice of all conflicts, errors or
discrepancies that it has discovered in the contract documents and the
written resolution thereof by the City is acceptable to Bidder.
c) This Bid is genuine and not made in the interest of or on behalf of any
undisclosed person, firm or corporation and is not submitted in conformity
with any agreement or rules of any group, association, organization or
corporation; Bidder has not directly or indirectly induced or solicited any
other Bidder to submit a false or sham Bid; Bidder has not solicited or
induced any person, firm or corporation to refrain from bidding; and Bidder
has not sought by collusion to obtain for itself any advantage over any
other Bidder or over the City.
3. Bidder will complete the Work for the prices shown in the "Bid Form".
4. Bidder agrees that the Work will be substantially performed and complete in
accordance with the schedules established herein.
i
of Tamarac
& Contracts Division
BID�RM
(continued)
BID NO.10-18B
LIME SLUDGE REMOVAL, HAULING & DISPOSAL
We propose to furnish the following in conformity with the specifications and at the
prices indicated below. Said bid prices have been checked and certified to be correct.
Said prices are fixed and firm and shall be paid to Bidder upon successful completion of
its obligation as specified in the contract documents.
PROPOSED PRICE PER CUBIC YARD
(Estimated Volume = 11,000 C.Y. per year) $ 9.79
TOTAL BID PRICE PER YEAR
(Multiplier = 11,000) $ 107,690.00
Austin Tupler 'Trucking, Inc.
Company Name
Glen Tupler
Print Name
tupler@bellsouth.net
Above signer's email address (if any)
BF-18
Author! -)ad S nature
President
Title
(954) 583-0801
Direct Phone Number
City of Tannarac purchasing & Contracts Division
BI�ORM
(continued)
BID NO.10-18B
The City reserves the right to reject any bid, if it deems that a vendor has
deliberately provided erroneous information. The undersigned declare to have
specific and legal authorization to obligate their firm to the terms of this bid, and
further, that they have examined the Invitation to Bid, the instructions to Bidders, the
Specifications, and other documents included in this bid request, and hereby
promises and agrees that, if this bid is accepted, they will faithfully fulfill the terms of
this bid together with all guarantees and warranties thereto. The undersigned
bidding firm further certifies the product and/or equipment meets or exceeds the
specification as stated in the bid package; and also agrees that products and/or
equipment to be delivered which fail to meet bid specifications will be rejected by
the City within thirty (30) days of delivery. Return of rejection will be at the expense
of the bidder.
Authorized &anaiture
Glen Tupler
Typed/Printed Name
(954) 583-0801
Telephone
Austin Tupler Trucking, Inc.
Company Name
6570 S.W. 47th Court
Address
Davie, FL 33314
City, State, ZIP
(954) 583-0844 59-1426412
Fax Federal Tax ID Number
CGC037393
tnpler@bellsouth.net #379-0002732
Email address for above signer (if any) Contractor's License Number
SF-19
I
City of Tamarac
BIDS
(continued)
BID NO.10-18B
Bidder's Company Name: Austin Tupler Trucking, Inc.
& Contracts Division
TERMS: 0 % (percent discount, If any, If payment made within
DAYS; otherwise, terms are NET 30 days.
Delivery/completion: seven (7) calendar days after receipt of Notice to Proceed or
Purchase Order, whichever is applicable for this project.
To be considered eligible for award, one (1) original and three (3) copies of this bid
form should be submitted with the Bid. Copies must be provided within 3 business
days of City's request.
NOTE: Bid submittals without the manual signature of an authorized agent of the
Bidder, as evidenced by completion of the Certified Resolution form contained herein
(or acceptable Corporate Resolution) may be deemed non -responsive and ineligible for
award.
IF "NO BID" IS OFFERED, PLEASE PROVIDE THE FOLLOWING INFORMATION:
Please indicate reason(s) why a Bid Proposal Is not being submitted at this time.
Return the Bid Form to avoid removal of Bidder from the City of Tamarac's
vendor listing.
City of Tamarac Purchasing & Contracts Division
CE f TIFlgK QN
THIS DOCUMENT MUST BE SUBMITTED WITH THE BID
We (1), the undersigned, hereby agree to furnish the items)/service(s) described in the
Request for Proposal. We (1) certify that we(I) have read the entire document, including
the Scope of Services, Additional Requirements, Supplemental Attachments,
Instructions, Terms and Conditions, and any addenda issued. We agree to comply with
all of the requirements of the entire Request for Proposal.
Indicate which type of organization below:
INDIVIDUAL ❑ PARTNERSHIP ❑ CORPORATION ® OTHER ❑
If "Other", Explain:
��
Authorize Si nature
President
Title
Austin Tupler Trucking, inc.
Company Name
Davie, FL 33314
City/State/Zip
(954) 583-0844
Fax Number
Glen Tupler
Name (Printed Or Typed)
59-1426412
Federal Employer-I.D./Social Security No.
6570 S.W. 47th Court
Address
(954) 583--0801
Telephone
Glen Tupler
Contact Person
City of Tamarac
NQM&QLLLjSlVg AFFIDAVIT
State of FLORIDA
County of BROWARA t )55
GLEN TUPLER
deposes and says that:
Purchasing & Contracts Division
being first duly swom,
He/she is the President , (Owner, Partner, Officer,
Representative or Agent) of Au s t i n T u R I e r n & the
Proposer that has submitted the attached Proposal;
He/she is fully informed respecting the preparation and contents of the attached
Proposal and of all pertinent circumstances respecting such Proposal;
Such Proposal is genuine and is not a collusive or sham Proposal;
Neither the said Proposer nor any of its officers, partners, owners, agents,
representatives, employees or parties in interest, including this afffiant, have in
any way colluded, conspired, connived or agreed, directly or indirectly, with any
other Offeror, firm, or person to submit a collusive or sham Proposal in
connection with the Work for which the attached Proposal has been submitted; or
to refrain from bidding in connection with such Work; or have in any manner,
directly or indirectly, sought by agreement or collusion, or communication, or
conference with any Proposer, firm, or person to fix the price or prices in the
attached Proposal or of any other Offeror, or to fix any overhead, profit, or cost
elements of the Proposal price or the Proposal price of any other Offeror, or to
secure through any collusion, conspiracy, connivance, or unlawful agreement
any advantage against (Recipient), or any person interested in the proposed
Work;
The price or prices quoted in the attached Proposal are fair and proper and are
not tainted by any collusion, conspiracy, connivance, or unlawful agreement on
the part of the Offeror or any other of its agents, representatives, owners,
employees or parties in interest, including this affiant.
Signed, sealed and delivered
in the presence of:
LJ By ._
ss
GLEN TUPLER
rtness Printed Name
President
Title
7
City of Tamarac � � _ _ _ Pvchasino & Contracts Division
NQN-COLLUSlyl AEFJMT
(continued)
ACKNOWLEDGMENT
State of Florida
County of BROWARD
2010
On this the z8th day of June , 250_, before me, the undersigned Notary Public
of the State of Florida, personally appeared
GLEN TUPLER and
(Name(s) of individual(s) who appeared before notary)
whose name(s) Is/are Subscribed to within the instrument, and helshetthey
acknowledge that he/she/they executed it.
WITNESS my hand
and official seal.
NOTARY P ,STATE OF FLORIDA
NOTARY PUBLIC =FN
y �r-ryt:� YSEAL OF OFFICE:
• WAIMry Publi Print,
M Personally known to me, or
❑ Produced identification:
(Type ofIdentifiication Produced)
❑ DID take an oath, or [3 DID NOT take an oath
I
of Tamarac
Anchasinq & Contracts Division
REFERENCES
Please identify the government agencies for which you have provided and
completed similar rate studies during the last five years: *
Name of Project Manager
Name of other Staff who worked
on Assignment Arthur Resnick
Name of Jurisdiction or Agency City of Coral Springs
Name/Title - Point of Contact Arthur Resnick
Address 9551 West Sample Road
City State Zip Coral Springs, FL 33065
Phone &Fax (954) 344-lloo, (954) 344-1186
Population of Jurisdiction
MonthNear Completed Austin Tupler Trucking has been doing this type
of work or the past 8 years for the City of
Outcome/Results Coral Springs.
*Please attach additional sheets as necessary.
City of Tamarac Purchasing & Contracts Division
REFERENCES
Please identify the government agencies for which you have provided and
completed similar rate studies during the last five years: *
Name of Project Manager
Name of other Staff who worked
on Assignment
Name of Jurisdiction or Agency
NamelTitle - Point of Contact
Address
City State Zip
Phone & Fax
Population of Jurisdiction
Month/Year Completed
Outcome/Results
Town of Davie
Herb Hyman
6591 0range Drive
Davie, FL 33314-3399
(954) 797-1000, (954) 797--1049
Austin Tupler Trucking has been doing
EHTs type of worR lor tn6 73wn'Bf Davie
for the past two years.
*Please attach additional sheets as necessary.
ql of Tamarac Purchasing & Contracts Division
Rgf IERgNCES
Please identify the government agencies for which you have provided and
completed similar rate studies during the last five years. *
Name of Project Manager Mike Ponce (954) 804-0163 cell.
Name of other Staff who worked
on Assignment
Name of Jurisdiction or Agency
Name/Title - Point of Contact
Address
City State Zip
Phone & Fax
Population of Jurisdiction
MonthNear Completed
Outcome/Results
City of Pembroke Pines
P. Edelstein
10100 Pines Boulevard
Pembroke Pines, FL 33026
(954) 437-1111, (954) 437-1121
Austin Tupler Trucking has been doing
t IS type o workor t o City of
Pembro a Pines for the past two years.
*Please attach additional sheets as necessary.
City of Tamarac _ Purchasing and Contracts Division
VENDOR DRUG -FREE WORKPLACE
Preference may be given to vendors submitting a certification with their bid/proposal
certifying they have a drug -free workplace in accordance with Section 287.087, Florida
Statutes. This requirement affects all public entities of the State and becomes effective
January 1, 1991. The special condition is as follows:
IDgNTICAL TIE PROPOSALS - Preference may be given to businesses with drug -free
workplace programs. Whenever two or more bids that are equal with respect to price,
quality, and service are received by the State or by any political subdivision for the
procurement of commodities or contractual services, a bid received from a business that
certifies that it has implemented a drug -free workplace program shall be given
preference in the award process. Established procedures for processing tie bids will be
followed if none of the tied vendors have a drug -free workplace program. In order to
have a drug -free workplace program, a business shall:
Publish a statement notifying employees that the unlawful manufacture,
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.
Inform employees about the dangers of drug abuse in the workplace, 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.
Give each employee engaged in providing the commodities or contractual
services that are under bid a copy of the statement specified in subsection (1).
In the statement specified in subsection (1), notify the employees that, as a
condition of working on the commodities or 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 that five (5) days
after each conviction.
Impose a section 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.
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 form complies fully with the above requirements.
=-�.. Austin Tupler Trucking, Inc.
Authon d Stanature Company Name
CITY OF TAMARAC
PURCHASING AND CONTRACTS DIVISION
7525 NW 88'" AVENUE
TAMARAC,FL 33321
"Committed to Excellence —Always"
o .... .1%■iL6atl
BID NO. 10.18B
LIME SLUDGE REMOVAL, HAULING & DISPOSAL
DATE OF ADDENDUM: JUNE 24, 2010
TO ALL PROSPECTIVE BIDDERS:
The following clarifications, changes, additions and/or deletions are hereby made part of
the Contract Documents for Bid No. 10-18B, LIME SLUDGE REMOVAL, HAULING &
DISPOSAL
Please provide the proposed location where your firm plans to dispose of lime sludge
waste removed -from City premises:
Site Name Seneca Land Co. (Westwind)
Site 3501 W. Hallandale Beach Blvd., Pembroke Park, FL
Address:
Failure to provide the information requested above MAY result in the disqualification of
your bid response.
All other terms, conditions and specifications remain unchanged for Bid No. 10-18B.
Please acknowledge receipt of this Addendum No. 1, by returning it and/or
acknowledging it in your bid. Attached Revised Bid Schedule must be returned with Bid.
COMPANY NAME:
AUSTIN TUPLER TRUCKING, INC. GLEN TUPL President
6570 S.W. 47th Court
Davie, FL 33314
(954) 583--0801.
7525 NW 88th Avenue M Tamarac. Florida 33321-2401 M (954) 597-3570 M Fax (954) 597-3565 ■ www.tamarac.org
Equal Oppodurdty Employer
A-.QRD. CERTIFICATE OF LIABILITY
INSURANCE
DATE(
0611712010
PRODUCER (954) 971-1552
South Atlantic Insurance Services Inc.
7551 WILES ROAD SUITE 201
CORAL SPIRNGS FL 33067-
THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
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THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,
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,4coRn® CERTIFICATE 4F LIA
PRODUCER (281) 999-5544 Fax: (281) 577-2678
T' kin Street Merica MGA., Inc.
977 East Wallis Drive
Porter TX 77365
INSURED Harbor America East Inc.
Austin Tuplar Trucking Inc
Bus: (954)583-0801 Fax: (954)583-1557
6570 SW 47th Court
David I FL 33314
BILITY INSURANCE 4�1/2010 '
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC #
INSURERA:UlliCO Casualty Company
INSURER B:
INSURER C:
INSURER D:
INSURER I-'
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IAA POLIGYNUI718ER mum P LICYEXPIRATX)N .� TLIMITS
GENERAL LIABILITY EACH OCCURRENCE fDAMAGETURU_..... W_
COMMERCIAL GENERAL LIABILITY p �.�_
CLAIMS MADE 0 OCCUR MED EXP (Any aw Psn—.
PERSONAL 6 ADV INJURY S
R � _ GENERAL AGGREGATE_. -
GEM% AGGREGATE LIMIT APPLIES PER: PROTS - COMPIOP AGG
POLICY PRO LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO
(EaAVAIen q
ALL OWNED AUTOS
BODILY,INJURY
f.
_ SCHEDULED AUTOS
(par Pat—) -
_...._. . ........
HIRED AUTOS
BOD)LY INJURY f
_ NON -OWNED AUTOS
(PerrCdsil)
PROPERTY DAMAGE f
(Per wrklem)
GARAGE LIABILITY
AUTO ONLY - F..A_ACCIDENT
ANY AUTO
OTHER THAN EA ACC S _
AUTO ONLY: AGG f
EXCESS IUMBR ELLA LIABILTIY
EACH OCCURRENCE I m
OCCUR CLAIMS MADE
AGGREGATE i -
f _
DEDUCTIBLE
-
RETENTION S
f
A WORKERS COMPENSATION
WC S ATU- OTH-
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTNE rY1-'�
E.L EACH ACCIDENT _ f_IOQOQOQ
OFFIGERIMEMBER EXCLUDED?
(Mandatory In NH) S•-113000-01
4/1/2010 4/l/2011 E.L.DISEASE • EA eMPLOYEd S 1000000
_ -.- _I....-_...__._.,
IR yn, da>te:rbe antler
SPECIAL PROVISIONS WWII
E.L. DISEASE - POLICY LIMIT f 1000000
OTHER
DESCRIPTION OF OPERATIONS ILOC ATIONS I VEHICLES 1 EXCLUSIONS ADDED 13Y ENDORSEMENT ISPECI AL PROVISIONS
lWorkers$ Compensation coverage is extended to all payroll
active employees of Harbor Am r> ca East, Inc. leased to
Austin Tupler Trucking, Inc. Insured is afforded Workers'
Compensation i 8upleyers Lispility as a co -employer under
the policy for aIployees leased fxom Harbor America East,
Inc.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANYOF THE ABOVE DESCRIBED POIJGIP_81t CANCELLED BEFORE DIE EXPIRATION
City Of Tamarac
DATE THEREOF. THE ISSUING INSUREIt WLLANDFAVOR TO MAIL 30DAYS WRITTEN
7525 NW 8 8 th Ave
NOTICE TO THE CERTIPICATB HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL
Tamarac , rL 33322 - 62 00
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
ACORD 25 (2009101)
INS025 (2w9w)
Rick Walker/SM
01988.2009 AC4
The ACORD name and logo are registered marks of ACORD
)RD CORPORATION, All rights reserved,
CERTIFICATE OF INSURANCE
NALLSTATE INSURANCE COMPANY []ALLSTATE INDEMNITY COMPANY ❑ALLSTATE TEXAS LLOYD'S
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
CERTIFICATE HOLDER
NAMED INSURED
Name and Address of Pa to Whom this Certificate is issued
Name and Address of Insured
CITY OF TAMARAC
AUSTIN TUPLER TRUCKING, INC.
7525 N.W. Se AVENUE
M&G FILL CORP., GLEN CONTRACTING, INC.
TAMARAC, FL 33321
6570 S.W. 47T" COURT
DAVIE, FL 33314
l his is to oertay mat policies or Insurance inteo pew nave oven ISaueo w me msurea names aovv outnc%a w era ww1la un uaw I vvatw a w",
notwithstanding any requirement, term or condition of any contract or other document with respact to which this certificate may be Issued or may
pertain. The insurance afforded by the policies described herein Is subject to all the terms, excursions, and conditions of such policies.
TYPIR r)F IN4I IRANCF ANI] LIMITS
Policy Effective Expiration
COMMERCIAL GENERAL LIABILITY Number N/A Date Date
Limit Amount
GENERAL AGGREGATE LIMIT (Other than Products - Completed Operations)
$
PRODUCTS - COMPLETED OPERATIONS AGGREGATE LIMIT
$
PERSONAL AND ADVERTISING INJURY LIMIT
$
EACH OCCURRENCE LIMIT
$
PHYSICAL DAMAGE LIMIT
$ ANY ONE LOSS
MEDICAL EXPENSE LIMIT
$ ANY ONE PERSON
WORKERS' COMPENSATION 8 Policy Effective Expiration
EMPLOYERS, LIABILITY Number N/A Date Date
Cave a
Limits
WORKERS' COMPENSATION
STATUTORY - applies on In the follow p stews:
EMPLOYERS'
BODILY INJURY BY ACCIDENT
$ EACH ACCIDENT
BODILY INJURY BY DISEASE
$ EACH EMPLOYEE
LIABILITY
BODILY INJURY BY DIS E
$ POLICY LIMIT
AUTOMOBILE LIABILITY Policy Effective Expiration
Number 048675902 Date 08/08/09 Date 08/08/10
Cowran Basis Limits
x ANY AUTO x OWNED AUTOS x HIRED AUTOS Combined Single Limit of Liability
(Collision & Comprehenslve - $1,000 deductible) BODILY INJURY & PROPERTY DAMAGE I $ 1 U00 UOD EACH ACCIDENT
❑ SPECIFIED AUTOS x NON -OWNED AUTOS Split LIab1I1 Limit's
gpolly Info pro"flir Damage I Each
❑ OWNED PRIVATE PASSENGER AUTOS IPERSON
❑ OWNED AUTOS OTHER THAN PRIVATE PASSENGER $ $ 1 ACCIDENT
UMBRELLA LIABILITY Policy Effective Expiration
N/A Date Date
Number
EACH OCCURRENCE GENERAL AGGREGATE PRODUCTS - COMPLETED OPERATIONS AGGREGATE
$ $ is
OTHER (Show Policy Effective Expiration
type of Policy) Number Date Dam
DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS
CANCELLATION
Number of days notice 30 Dee Nt'I�arris radl Insurance Inc. e/18110
Autlwrized Reprwentatrve Data
Should any of the above described policies be cancelled before the axpiretion date, the Issuing company will endeavor to mail within the number of
days entered above, written notice to the certificate holler named above. But failure to mall such notice shall impose no obligation or
liability of any kind upon the company, No agents or representatives.
I Pe wry rur your 6Vsq
AGREEMENT
BETWEEN THE CITY OF TAMARAC
ITi'Tej
AUSTIN TUPLER TRUCKING, INC.
THIS AGREEMENT is made and entered into this day of , 20 1b
by and between the City of Tamarac, a municipal corporation qmith principal offices
located at 7525 N.W. 88th Ave., Tamarac, FL 33321 (the "CITY") and Austin Tupler
Trucking, Inc, a Florida corporation with principal offices located 6570 S.W. 47th Court,
Davie, Florida 33314 (the "Contractor") to provide for Lime Sludge Removal, Hauling
and Disposal from the City Water Treatment Plant Lagoon located at 7803 NW 615t
Street, Tamarac, Florida 33321.
Now therefore, in consideration of the mutual covenants hereinafter set forth, the City
and Contractor agree as follows:
1) The Contract Documents
The contract documents consist of this Agreement, Bid Document No. 10-18B "Lime
Sludge Removal, Hauling & Disposal„ including all conditions therein, (General Terms and
Conditions, Special Conditions and/or Special Provisions), drawings, Technical
Specifications, all addenda, the Contractor's bid/proposal included herein, dated June 30,
2010, and all modifications issued after execution of this Agreement. These contract
documents form the Agreement, and all are as fully a part of the Agreement as if attached
to this Agreement or repeated therein. In the event that there is a conflict between Bid
Document No. 10-18B, "Lime Sludge Removal, Hauling & Disposal", as issued by the City,
and the Contractor's Proposal dated June 30, 2010, Document No. 10-18B, "Lime Sludge
Removal, Hauling & Disposal" as issued by the City shall take precedence over the
Contractor's Proposal. Furthermore, in the event of a conflict between this document and
any other contract documents, this Agreement shall prevail.
2) The Work
2.1. The Contractor shall perform all work for the City required by the contract
documents as set forth below:
2.1.1 Contractor shall furnish all labor, materials, and equipment necessary
to excavate, remove, dewater and dispose of all lime sludge settled in
the Water Treatment Plant Lagoon per the terms, conditions and
specifications #10-186, City's Water Treatment Plant located at 7803
NW 61 $t Street, Tamarac, Florida 33321.
2.1.2 Contractor shall supervise the work force to ensure that all workers
conduct themselves and perform their work in a safe and professional
manner. Contractor shall comply with all OSHA safety rules and
regulations in the operation of equipment and in the performance of
the work. Contractor shall at all times have a competent field
....... .... ........ .............. ............. ............. ................. ..................... ............ .... ......... ........ ........
supervisor on the job site to enforce these policies and procedures at
the Contractor's expense.
2.1.3 Contractor shall provide the City with seventy-two (72) hours notice
prior to the beginning of work under this Agreement and prior to any
schedule change with the exception of changes caused by inclement
weather unless a different timeframe for commencement of work is
provided at the time that the City provides notice to the Contractor.
2.1.4 Contractor has been familiarized with the Contract Documents and the
nature and extent of the work required to be performed, locality, and
local conditions; and shall comply with any and all Federal, State, and
local laws and regulations now in effect, or hereinafter enacted during
the term of this Agreement, which are applicable to the Contractor, its
employees, agents or subcontractors, if any, with respect to the work
and services described herein,
2.1.5 Contractor has made or caused to be made examinations,
investigations and tests and studies as deemed necessary for the
performance of the Work at the Contract Price, within the Contract
Time and in accordance with the other terms and conditions of the
Contract Documents; and no additional examinations, investigations,
tests, reports or similar data are or will be required by Contractor for
such purposes.
2.1.6 Contractor has correlated the results of all such observations,
examinations, investigations, tests, reports and data with the terms
and conditions of the Contract Documents.
2.1.7 Contractor has given City written notice of all conflicts, errors or
discrepancies that have been discovered in the Contract Documents
and the written resolution thereof by City is acceptable to Contractor.
3) Insurance
3.1. Contractor shall obtain at Contractor's expense all necessary insurance in
such form and amount as specified in the original bid document or as
required by the City's Risk and Safety Manager before beginning work under
this Agreement including, but not limited to, Workers' Compensation,
Commercial General Liability, and all other insurance as required by the City,
including Professional Liability when appropriate. Contractor shall maintain
such insurance in full force and effect during the life of this Agreement.
Contractor shall provide to the City's Risk and Safety Manager certificates of
all insurances required under this section prior to beginning any work under
this Agreement. The Contractor will ensure that all subcontractors comply
with the above guidelines and will retain all necessary insurance in force
throughout the term of this agreement.
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.. ... .......... .. ... ........... ........ ......... ...
3.2. Contractor shall indemnify and hold the City harmless for any damages
resulting from failure of the Contractor to take out and maintain such
insurance. Contractor's General Liability Insurance policies shall be
endorsed to add the City as an additional insured. Contractor shall be
responsible for payment of all deductibles and self-insurance retentions on
Contractor's Liability Insurance policies.
4) Contract Term
The term of this Agreement is for a period of two (2) years, beginning on October 1,
2010, and ending September 30, 2012. Upon expiration, the City can renew the Agreement
for two (2) additional two (2) year terms, upon mutual agreement of the parties and under
the same terms and conditions.
5) Contract Sum
The Contract Sum for the above work is Nine Dollars and Seventy -Nine Cents per
cubic yard ($9.79/C.Y.), based on an estimated annual volume of Eleven Thousand
(11,000) cubic yards, for an amount not to exceed One Hundred Seven, Six Hundred Ninety
dollars and no cents ($107,690.00) per year. This price is subject to the terms contained in
Bid 10-18B, Special Conditions, Paragraph 6, Contract Escalation/De-Escalation.
6) Payments
City will pay Contractor monthly for work that has been completed and inspected.
Payment is based upon submission by Contractor of an invoice approved by the Water
Treatment Plant Superintendent or designee. The City shall pay the Contractor for work
performed subject to the specifications of the job and any additions or deductions by
approved change order as provided for in the Contract Documents. All payments shall
be governed by the Local Government Prompt Payment Act, F.S., Part VI I, Chapter 218.
7) Waiver of Liens
Prior to final payment of the Contract Sum, a final waiver of lien shall be submitted by all
suppliers, subcontractors, and/or Contractors who worked on the project that is the
subject of this Agreement. Payment of the invoice and acceptance of such payment by
the Contractor shall release City from all claims of liability by Contractor in connection
with the agreement.
8) Warranty
Contractor warrants the work against defect for a period of one (1) year from the
date of completion of work. In the event that defect occurs during this time, Contractor shall
perform such steps as required to remedy the defects. Contractor shall be responsible for
any damages caused by defect to affected area or to interior structure. The one (1) year
warranty period does not begin until substantial completion of the entire project, and the
subsequent release of any Performance or Payment Bonds, which may be required by the
original bid document.
9) Indemnification
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........ .......... .... ..... .......... - ...... ......... .......................
9.1 The Contractor shall indemnify and hold harmless the City, its elected and
appointed officials, employees, and agents from any and all claims, suits,
actions, damages, liability, and expenses (including attorneys' fees) in
connection with loss of life, bodily or personal injury, or property damage,
including loss of use thereof, directly or indirectly caused by, resulting from,
arising out of or occurring in connection with the operations of the Contractor
or its officers, employees, agents, subcontractors, or independent
Contractors, excepting only such loss of life, bodily or personal injury, or
property damage solely attributable to the gross negligence or willful
misconduct of the City or its elected or appointed officials and employees.
The above provisions shall survive the termination of this Agreement and
shall pertain to any occurrence during the term of this Agreement, even
though the claim may be made after the termination hereof.
9.2 Upon completion of all Services, obligations and duties provided for in this
Agreement, or in the event of termination of this Agreement for any reason,
the terms and conditions of this Article shall survive indefinitely.
9.3 The Contractor shall pay all claims, losses, liens, settlements or judgments of
any nature whatsoever in connection with the foregoing indemnifications
including, but not limited to, reasonable attorney's fees (including appellate
attorney's fees) and costs.
9.4 The City and Contractor recognize that various provisions of this Agreement,
including but not limited to this Section, provide for indemnification by the
Contractor and requires a specific consideration be given there for. The
Parties therefore agree that the sum of Ten Dollars and 00/100 ($10.00),
receipt of which is hereby acknowledged, is the specific consideration for
such indemnities, and the providing of such indemnities is deemed to be part
of the specifications with respect to the services to be provided by Contractor,
Furthermore, the City and Contractor understand and agree that the
covenants and representations relating to this indemnification provision shall
serve the term of this Agreement and continue in full force and effect as to the
City's and the Contractor's responsibility to indemnify.
9.5 City reserves the right to select its own legal counsel to conduct any defense
in any such proceeding and all costs and fees associated therewith shall be
the responsibility of Contractor under the indemnification agreement.
9.6 Nothing contained herein is intended nor shall be construed to waive City's
rights and immunities under the common law or Florida Statutes 768.28, as
amended from time to time.
10) Non -Discrimination & Equal Opportunity Employment
During the performance of the Contract, the Contractor shall not discriminate
against any employee or applicant for employment because of race, color, sex, religion,
age, national origin, marital status, political affiliation, familial status, sexual orientation, or
disability if qualified. The Contractor will take affirmative action to ensure that employees
are treated during employment, without regard to their race, color, sex, religion, age,
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national origin, marital status, political affiliation, familial status, sexual orientation, or
disability if qualified. Such actions must include, but not be limited to, the following:
employment, promotion; demotion or transfer; recruitment or recruitment advertising, layoff
or termination; rates of pay or other forms of compensation; and selection for training,
including apprenticeship. The Contractor shall agree to post in conspicuous places,
available to employees and applicants for employment, notices to be provided by the
contracting officer setting forth the provisions of this nondiscrimination clause. The
Contractor further agrees that he/she will ensure that Subcontractors, if any, will be made
aware of and will comply with this nondiscrimination clause.
11) Independent Contractor
This Agreement does not create an employee/employer relationship between the
Parties. It is the intent of the Parties that the Contractor is an independent contractor under
this Agreement and not the City's employee for any purposes, including but not limited to,
the application of the Fair Labor Standards Act minimum wage and overtime payments,
Federal Insurance Contribution Act, the Social Security Act, the Federal Unemployment Tax
Act, the provisions of the Internal Revenue Code, the State Worker's Compensation Act,
and the State Unemployment Insurance law. The Contractor shall retain sole and absolute
discretion in the judgment of the manner and means of carrying out Contractor's activities
and responsibilities hereunder provided, further that administrative procedures applicable to
services rendered under this Agreement shall be those of Contractor, which policies of
Contractor shall not conflict with City, State, or United States policies, rules or regulations
relating to the use of Contractor's funds provided for herein. The Contractor agrees that it is
a separate and independent enterprise from the City, that it had full opportunity to find other
business, that it has made its own investment in its business, and that it will utilize a high
level of skill necessary to perform the work. This Agreement shall not be construed as
creating any joint employment relationship between the Contractor and the City and the City
will not be liable for any obligation incurred by Contractor, including but not limited to unpaid
minimum wages and/or overtime premiums.
12) Assignment and Subcontracting
Contractor shall not transfer or assign the performance required by this Agreement
without the prior consent of the City. This Agreement, or any portion thereof, shall not be
subcontracted without the prior written consent of the city.
13) Notice
Whenever either party desires or is required under this Agreement to give notice to any
other party, it must be given by written notice either delivered in person, sent by U.S.
Certified Mail, U.S. Express Mail, air or ground courier services, or by messenger service, as
follows:
CITY
City Manager
City of Tamarac
7525 N.W. 88th Avenue
Tamarac, FL 33321
With a copy to City Attorney at the following address:
Goren, Cherof, Doody & Ezrol, P.A.
3099 East Commercial Blvd., Suite 200
Fort Lauderdale, FL 33308
CONTRACTOR
Austin Tupler Trucking, Inc.
6570 S.W. 47th Court
Davie, FL 33314
Attn: Glen Tupler, President
(954) 583-0801 Fax (954) 583-0844
tuplergbellsouth.n t
14) Termination
14.1 Termination for Convenience: This Agreement may be terminated by the
City for convenience, upon seven (7) days of written notice by the City to the
Contractor for such termination in which event the Contractor shall be paid its
compensation for services performed to termination date, including services
reasonably related to termination. In the event that the Contractor abandons
this Agreement or causes it to be terminated, Contractor shall indemnify the
city against loss pertaining to this termination.
14.2 Default by Contractor: In addition to all other remedies available to the City,
this Agreement shall be subject to cancellation by the City for cause, should
the Contractor neglect or fail to perform or observe any of the terms,
provisions, conditions, or requirements herein contained, if such neglect or
failure shall continue for a period of thirty (30) days after receipt by Contractor
of written notice of such neglect or failure.
15) Uncontrollable Forces
15.1 Neither the City nor Contractor shall be considered to be in default of this
Agreement if delays in or failure of performance shall be due to Uncontrollable
Forces, the effect of which, by the exercise of reasonable diligence, the non-
performing party could not avoid. The term "Uncontrollable Forces" shall mean
any event which results in the prevention or delay of performance by a party of
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its obligations under this Agreement and which is beyond the reasonable
control of the nonperforming party. It includes, but is not limited to fire, flood,
earthquakes, storms, lightning, epidemic, war, riot, civil disturbance, sabotage,
and governmental actions.
15.2 Neither party shall, however, be excused from performance if nonperformance
is due to forces, which are preventable, removable, or remediable, and which
the nonperforming party could have, with the exercise of reasonable diligence,
prevented, removed, or remedied with reasonable dispatch. The nonperforming
party shall, within a reasonable time of being prevented or delayed from
performance by an uncontrollable force, give written notice to the other party
describing the circumstances and uncontrollable forces preventing continued
performance of the obligations of this Agreement.
16) Agreement Subject to Funding
This agreement shall remain in full force and effect only as long as the expenditures
provided for in the Agreement have been appropriated by the City Commission of the City of
Tamarac in the annual budget for each fiscal year of this Agreement, and is subject to
termination based on lack of funding.
17) Venue
This Agreement shall be governed by the laws of the State of Florida as now and
hereafter in force. The venue for actions arising out of this agreement is fixed in
Broward County, Florida.
18) Signatory Authority
The Contractor shall provide the City with copies of requisite documentation
evidencing that the signatory for Contractor has the authority to enter into this Agreement.
19) Severability; Waiver of Provisions
Any provision in this Agreement that is prohibited or unenforceable in any jurisdiction
shall, as to such jurisdiction, be ineffective to the extent of such prohibition or
unenforceability without invalidating the remaining provisions hereof or affecting the validity
or enforceability of such provisions in any other jurisdiction. The non -enforcement of any
provision by either party shall not constitute a waiver of that provision nor shall it affect the
enforceability of that provision or of the remainder of this Agreement.
20) Merger; Amendment
This Agreement constitutes the entire Agreement between the Contractor and the
City, and negotiations and oral understandings between the parties are merged herein.
This Agreement can be supplemented and/or amended only by a written document
executed by both the Contractor and the City.
..
...........
21) No Construction Against Drafting Party
Each party to this Agreement expressly recognizes that this Agreement results from
the negotiation process in which each party was represented by counsel and contributed to
the drafting of this Agreement. Given this fact, no legal or other presumptions against the
party drafting this Agreement concerning its construction, interpretation or otherwise accrue
to the benefit of any party to the Agreement, and each party expressly waives the right to
assert such a presumption in any proceedings or disputes connected with, arising out of, or
involving this Agreement.
Remainder of Page Intentionally Blank
o ne utry w rau u1
IN WITNESS WHEREOF, the parties have made and executed this Agreement on
the respective dates under each signature. CITY OF TAMARAC, signing by and through its
Mayor and City Manager, and CONTRACTOR, signing by and through its President duly
authorized to execute same.
CITY OF TAMARAC
Beth Talabisco, Mayor
Date y�
ATTEST: , I Jeffr er, City Manager
Marion Swenson, CIVIC Date
City Clerk
V�S l Appro a as to form d legal sufficiency:
Date � /'
CityoKttorney
E
ignature of Corporate SScretary
-T
Type/Print Name of Corporate Secy
(CORPORATE SEAL)
Date
Austin Tur ler Trucking, Inc.
Companv Name
Signature o r sident/Owner
Glen Tu ler
Type/Print Name of President/Owner
June 30, 2010
Date
r cfi% i,r. .. p..... )ro
CORPORATE ACKNOWLEDGEMENT
STATE OF FLORIDA
SS
COUNTY OF BROWARD
I HEREBY CERTIFY that on this day, before me, an Officer duly authorized in the State
aforesaid and in the County aforesaid to take acknowledgments, personally appeared Glen
Tupler, President, of Austin Tupler Trucking, Inc.,
a Florida Corporation, to me known to be the person(s) described in and who executed the
foregoing instrument and acknowledged before me that he/she executed the same.
WITNESS my hand and official seal this 30 day of June , 2010.
gesture of Notary Public
S t f of
ISO
�'al.Notary Public State of Florida
Marta 7riana-Watson
nrr�°� EX rah Or tam
❑X Personally known to me or
❑ Produced Identification
Type of I.D. Produced
❑ DID take an oath, or
® DID NOT take an oath.