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Backup Documents 11/14/2017 Item #16A16 ' IOINAL DOCUMENTS CHECKLIST & ROUTING SLIP ( d(� - 17711E. O ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO RI 6 A 1 6 U '1! ��; THEDB BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATU P ' n paQ Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at The infe"the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Mond preceding the Board meeting. Risk Managementi **NEW** ROUTING SLIP • Complete routing lines#1 rough#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. Risk Risk Management 6 ' 11115117 2. County Attorney Office County Attorney Office J f/7/f7 4. BCC Office Board of County —1 Commissioners \i S, 1\ '\1-1 4. Minutes and Records Clerk of Court's Office 5. Procurement Services Procurement Services PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. Name of Primary Staff Barbara Lance for Brenda Brilhart Contact Information 239-252-8998 Contact/ Department Agenda Date Item was November 14,2017 / Agenda Item Number 16.A.16 ii Approved by the BCC V Type of Document Waiver/Agreement / Number of Original V 9- Attached Documents Attached PO number or account N/A 17-7216-WV Collier Metro Forecasting number if document is County Interactive Models ✓/ to be recorded Growth Model INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature STAMP OK ser- OKI 2. Does the document need to be sent to another agency for additional signatures? If yes, N/A provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be BL signed by the Chairman,with the exception of most letters,must be reviewed and signed by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the BL document or the final negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's BL signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip N/A should be provided to the County Attorney Office at the time the item is input into SIRE. Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! 8. The document was approved by the BCC on 11/14/2017 and all changes made during '',:`.„ the meeting have been incorporated in the attached document. The County ` -, Attorney's Office has reviewed the changes,if applicable. 9. Initials of attorney verifying that the attached document is the version approved by the r, + BCC,all changes directed by the BCC have been made, and the document is ready for the 1, • Chairman's signature. ,r 1 6 A 1. 6 MEMORANDUM Date: November 21, 2017 To: Barbara Lance, Purchasing Tech Procurement Services From: Ann Jennejohn, Deputy Clerk Minutes & Records Department Re: Contract #17-7216-WV, for services related to Collier County Interactive Growth Model updates Contractor: Metro Forecasting Models, LLC Attached, please find an original copy of the contract referenced above, (Item #16A16) approved by the Board of County Commissioners on Tuesday, November 14, 2017. The second original contract will be held in the Minutes and Records Department for the Official Record. If you have any questions, please contact me at 252-8406. Thank you. Attachment 1 6 A 1 6 AGREEMENT #17-7216-WV for Collier County Interactive Growth Model Ver3 (CIGM Ver3) THIS AGREEMENT, made and entered into on this ''? day of NOirtrAbtr 2017, by and between Metro Forecasting Models, LLC, authorized to do business in the State of Florida, whose business address is 9001 Highland Woods Boulevard, Suite 2, Bonita Springs Florida 34135, (the "Consultant") and Collier County, a political subdivision of the State of Florida, (the "County"): WITNESSETH: 1. AGREEMENT TERM. The Agreement shall be for a one (1) year period, commencing on Date of Board award and terminating one (1)year from that date or until all outstanding Purchase Orders issued prior to the expiration of the Agreement period have been completed or terminated. The County may, at its discretion and with the consent of the Consultant, renew the Agreement under all of the terms and conditions contained in this Agreement for two (2) additional one (1) year periods. The County shall give the Consultant written notice of the County's intention to renew the Agreement term prior to the end of the Agreement term then in effect. The County Manager, or his designee, may, at his discretion, extend the Agreement under all of the terms and conditions contained in this Agreement for up to one hundred and eighty (180) days. The County Manager, or his designee, shall give the Consultant written notice of the County's intention to extend the Agreement term prior to the end of the Agreement term then in effect. 2. COMMENCEMENT OF SERVICES. The Consultant shall commence the work upon issuance of a Notice to Proceed. 3. STATEMENT OF WORK. The Consultant shall provide services with the development and implementation of a Collier County Interactive Growth Model Ver 3 in accordance with Exhibit A- Scope of Services, hereto attached and made an integral part of this Agreement. This Agreement contains the entire understanding between the parties and any modifications to this Agreement shall be mutually agreed upon in writing by the Parties, in compliance with the County's Procurement Ordinance, as amended, and Procurement Procedures in effect at the time such services are authorized. ed) Page 1 of 16 Agreement No.17-7216-'MJ Collier County Interactive Growth Model Ver 3 Metro Forecasting Models,LLC 16A16 4. THE AGREEMENT SUM. The County shall pay the Consultant for the performance of the services outlined in Exhibit A-Scope of Services of this Agreement upon completion or partial completion of the work tasks as accepted and approved by the County Project Manager or his designee for a total not-to-exceed amount of Two Hundred Twenty Thousand Dollars ($220,000). The County shall pay the Consultant an annual license fee of $2,000 for the use of the Interactive Growth Model ® Program software, including the updated Version 3, and spreadsheet programs and Exhibit C "License and Copyright Agreement, attached hereto is incorporated to this Agreement. The annual license fee is waived for the first year after completion of the CIGM Ver3. The County shall pay the Consultant for the performance of this Agreement upon completion or partial completion of the work tasks as accepted and approved by the County Project Manager or his designee and the price methodology as defined in Section 4.1. Payments shall be made to the Consultant when requested as work progresses, but not more frequently than once per month. Payment will be made upon receipt of a proper invoice and in compliance with Chapter 218 Fla. Stats., otherwise known as the "Local Government Prompt Payment Act." 4.1 Price Methodology: Lump Sum (Fixed Price): A firm fixed total price offering for a project; the risks are transferred from the County to the Consultant; and, as a business practice there are no hourly or material invoices presented, rather, the Consultant must perform to the satisfaction of the County's project manager before payment for the fixed price contract is authorized. 4.2. Payments will be made for services furnished, delivered, and accepted, upon receipt and approval of invoices submitted on the date of services or within six (6) months after completion of the Agreement. Any untimely submission of invoices beyond the specified deadline period is subject to non-payment under the legal doctrine of "laches" as untimely submitted. Time shall be deemed of the essence with respect to the timely submission of invoices under this Agreement. 5. SALES TAX. Consultant shall pay all sales, consumer, use and other similar taxes associated with the Work or portions thereof, which are applicable during the performance of the Work. Collier County, Florida as a political subdivision of the State of Florida, is exempt from the payment of Florida sales tax to its vendors under Chapter 212, Florida Statutes, Certificate of Exemption # 85-8015966531C-2. 6. NOTICES. All notices from the County to the Consultant shall be deemed duly served if mailed or faxed to the Consultant at the following Address: Metro Forecasting Models, LLC 9001 Highland Woods Boulevard, Suite 2 Bonita Springs, Florida 34135 Attention: David Farmer, PE, AICP Telephone: (239) 913-6949 Email: davemetroforecasting.com Page 2 of 16 Agreement No.17-7216-W/Collier County Interactive Growth Model Ver 3 Metro Forecasting Models,LLC 16A16 All Notices from the Consultant to the County shall be deemed duly served if mailed or faxed to the County to: Board of County Commissioners for Collier County, Florida c/o Planning & Zoning Services Division 2800 North Horseshoe Drive Naples, FL 34104 Telephone: 239-252-6819 Attention: Michael Bosi, Division Director Email: MichaelBosiAcolliergov.net The Consultant and the County may change the above mailing address at any time upon giving the other party written notification. All notices under this Agreement must be in writing. 7. NO PARTNERSHIP. Nothing herein contained shall create or be construed as creating a partnership between the County and the Consultant or to constitute the Consultant as an agent of the County. 8. PERMITS: LICENSES: TAXES. In compliance with Section 218.80, F.S., all permits necessary for the prosecution of the Work shall be obtained by the Consultant. The County will not be obligated to pay for any permits obtained by SubContractors/SubConsultants. Payment for all such permits issued by the County shall be processed internally by the County. All non-County permits necessary for the prosecution of the Work shall be procured and paid for by the Consultant. The Consultant shall also be solely responsible for payment of any and all taxes levied on the Consultant. In addition, the Consultant shall comply with all rules, regulations and laws of Collier County, the State of Florida, or the U. S. Government now in force or hereafter adopted. The Consultant agrees to comply with all laws governing the responsibility of an employer with respect to persons employed by the Consultant. 9. NO IMPROPER USE. The Consultant will not use, nor suffer or permit any person to use in any manner whatsoever, County facilities for any improper, immoral or offensive purpose, or for any purpose in violation of any federal, state, county or municipal ordinance, rule, order or regulation, or of any governmental rule or regulation now in effect or hereafter enacted or adopted. In the event of such violation by the Consultant or if the County or its authorized representative shall deem any conduct on the part of the Consultant to be objectionable or improper, the County shall have the right to suspend the Agreement of the Consultant. Should the Consultant fail to correct any such violation, conduct, or practice to the satisfaction of the County within twenty-four (24) hours after receiving notice of such violation, conduct, or practice, such suspension to continue until the violation is cured. The Consultant further agrees not to commence operation during the suspension period until the violation has been corrected to the satisfaction of the County. Page 3 of 16 Agreement No.17-7216-WV Collier County Interactive Growth Model Ver 3 Metro Forecasting Models,LLC 16A16 10. TERMINATION. Should the Consultant be found to have failed to perform his services in a manner satisfactory to the County as per this Agreement, the County may terminate said Agreement for cause; further the County may terminate this Agreement for convenience with a thirty (30) day written notice. The County shall be sole judge of non- performance. In the event that the County terminates this Agreement, Consultant's recovery against the County shall be limited to that portion of the Agreement Amount earned through the date of termination. The Consultant shall not be entitled to any other or further recovery against the County, including, but not limited to, any damages or any anticipated profit on portions of the services not performed. 11. NO DISCRIMINATION. The Consultant agrees that there shall be no discrimination as to race, sex, color, creed or national origin. 12. INSURANCE. The Consultant shall provide insurance as follows: A. Commercial General Liability: Coverage shall have minimum limits of $1,000,000 Per Occurrence, $2,000,000 aggregate for Bodily Injury Liability and Property Damage Liability. This shall include Premises and Operations; Independent Consultants; Products and Completed Operations and Contractual Liability. B. Workers' Compensation: Insurance covering all employees meeting Statutory Limits in compliance with the applicable state and federal laws. The coverage must include Employers' Liability with a minimum limit of $100,000 single limit per occurrence. C. Professional Liability: Shall be maintained by the Consultant to ensure its legal liability for claims arising out of the performance of professional services under this Agreement. Consultant waives its right of recovery against County as to any claims under this insurance. Such insurance shall have limits of not less than $1,000,000 each claim and in the aggregate. Special Requirements: Collier County Board of County Commissioners, OR, Board of County Commissioners in Collier County, OR, Collier County Government shall be listed as the Certificate Holder and included as an "Additional Insured" on the Insurance Certificate for Commercial General Liability where required. This insurance shall be primary and non-contributory with respect to any other insurance maintained by, or available for the benefit of, the Additional Insured and the Consultant's policy shall be endorsed accordingly. Current, valid insurance policies meeting the requirement herein identified shall be maintained by Consultant during the duration of this Agreement. The Consultant shall provide County with certificates of insurance meeting the required insurance provisions. Renewal certificates shall be sent to the County thirty (30) days prior to any expiration date. Coverage afforded under the policies will not be canceled or allowed to expire until the greater of: thirty (30) days prior written notice, or in accordance with policy provisions. Page 4 of 16 Agreement No.17-7216-VW Collier County Interactive Growth Model Ver 3 Metro Forecasting Models,LLC 16A16 Consultant shall also notify County, in a like manner, within twenty-four (24) hours after receipt, of any notices of expiration, cancellation, non-renewal or material change in coverage or limits received by Consultant from its insurer, and nothing contained herein shall relieve Consultant of this requirement to provide notice. Consultant shall ensure that all subconsultants comply with the same insurance requirements that the Consultant is required to meet. 13. INDEMNIFICATION. To the maximum extent permitted by Florida law, the Consultant shall defend, indemnify and hold harmless Collier County, its officers and employees from any and all liabilities, damages, losses and costs, including, but not limited to, reasonable attorneys' fees and paralegals' fees, whether resulting from any claimed breach of this Agreement by Consultant, any statutory or regulatory violations, or from personal injury, property damage, direct or consequential damages, or economic loss, to the extent caused by the negligence, recklessness, or intentionally wrongful conduct of the Consultant or anyone employed or utilized by the Consultant in the performance of this Agreement. This indemnification obligation shall not be construed to negate, abridge or reduce any other rights or remedies which otherwise may be available to an indemnified party or person described in this paragraph. This section does not pertain to any incident arising from the sole negligence of Collier County. 13.1 The duty to defend under this Article 13 is independent and separate from the duty to indemnify, and the duty to defend exists regardless of any ultimate liability of the Consultant, County and any indemnified party. The duty to defend arises immediately upon presentation of a claim by any party and written notice of such claim being provided to Consultant. Consultant's obligation to indemnify and defend under this Article 13 will survive the expiration or earlier termination of this Agreement until it is determined by final judgment that an action against the County or an indemnified party for the matter indemnified hereunder is fully and finally barred by the applicable statute of limitations. 14. AGREEMENT ADMINISTRATION. This Agreement shall be administered on behalf of the County by the Planning and Zoning Division. 15. CONFLICT OF INTEREST. Consultant represents that it presently has no interest and shall acquire no interest, either direct or indirect, which would conflict in any manner with the performance of services required hereunder. Consultant further represents that no persons having any such interest shall be employed to perform those services. 16. COMPONENT PARTS OF THIS AGREEMENT. This Agreement consists of the following component parts, all of which are as fully a part of the Agreement as if herein set out verbatim: Insurance Certificate(s), Exhibit A- Scope of Services, Exhibit B- Fee Schedule and Exhibit C- License and Copyright Agreement. 17. SUBJECT TO APPROPRIATION. It is further understood and agreed by and between the parties herein that this Agreement is subject to appropriation by the Board of County Commissioners. Page 5 of 16 Agreement No.17-7216-WV Collier County Interactive Growth Model Ver 3 Metro Forecasting Models,LLC 16A16 18. PROHIBITION OF GIFTS TO COUNTY EMPLOYEES. No organization or individual shall offer or give, either directly or indirectly, any favor, gift, loan, fee, service or other item of value to any County employee, as set forth in Chapter 112, Part III, Florida Statutes, Collier County Ethics Ordinance No. 2004-05, as amended, and County Administrative Procedure 5311. Violation of this provision may result in one or more of the following consequences: a. Prohibition by the individual, firm, and/or any employee of the firm from contact with County staff for a specified period of time; b. Prohibition by the individual and/or firm from doing business with the County for a specified period of time, including but not limited to: submitting bids, RFP, and/or quotes; and, c. immediate termination of any Agreement held by the individual and/or firm for cause. 19. COMPLIANCE WITH LAWS. By executing and entering into this Agreement, the Consultant is formally acknowledging without exception or stipulation that it agrees to comply, at its own expense, with all federal, state and local laws, codes, statutes, ordinances, rules, regulations and requirements applicable to this Agreement, including but not limited to those dealing with the Immigration Reform and Control Act of 1986 as located at 8 U.S.C. 1324, et seq. and regulations relating thereto, as either may be amended; taxation, workers' compensation, equal employment and safety (including, but not limited to, the Trench Safety Act, Chapter 553, Florida Statutes, and the Florida Public Records Law Chapter 119, including specifically those contractual requirements at F.S. § 119.0701(2)(a)-(b) as stated as follows: IF THE CONSULTANT HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONSULTANT'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT: Communication and Customer Relations Division 3299 Tamiami Trail East, Suite 102 Naples, FL 34112-5746 Telephone: (239) 252-8383 The Consultant must specifically comply with the Florida Public Records Law to: 1. Keep and maintain public records required by the public agency to perform the service. 2. Upon request from the public agency's custodian of public records, provide the public agency with a copy of the requested records or allow the records to be - inspected or copied within a reasonable time at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law. 3. Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the Consultant does not transfer the records to the public agency. 4. Upon completion of the contract, transfer, at no cost, to the public agency all public records in possession of the Consultant or keep and maintain public records required by the public agency to perform the service. If the Consultant Page 6of16 Agreement No.17-7216-WV Collier County Interactive Growth Model Ver 3 Metro Forecasting Models,LLC 16A16 transfers all public records to the public agency upon completion of the contract, the Consultant shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the Consultant keeps and maintains public records upon completion of the contract, the Consultant shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the public agency, upon request from the public agency's custodian of public records, in a format that is compatible with the information technology systems of the public agency. If Consultant observes that the Contract Documents are at variance therewith, it shall promptly notify the County in writing. Failure by the Consultant to comply with the laws referenced herein shall constitute a breach of this Agreement and the County shall have the discretion to unilaterally terminate this Agreement immediately. 20. OFFER EXTENDED TO OTHER GOVERNMENTAL ENTITIES. Collier County encourages and agrees to the successful proposer extending the pricing, terms and conditions of this solicitation or resultant Agreement to other governmental entities at the discretion of the successful proposer. 21. AGREEMENT TERMS. If any portion of this Agreement is held to be void, invalid, or otherwise unenforceable, in whole or in part, the remaining portion of this Agreement shall remain in effect. 22. ADDITIONAL ITEMS/SERVICES. Additional items and/or services may be added to this Agreement in compliance with the Procurement Ordinance, as amended, and Procurement Procedures. 23. DISPUTE RESOLUTION. Prior to the initiation of any action or proceeding permitted by this Agreement to resolve disputes between the parties, the parties shall make a good faith effort to resolve any such disputes by negotiation. The negotiation shall be attended by representatives of Consultant with full decision-making authority and by County's staff person who would make the presentation of any settlement reached during negotiations to County for approval. Failing resolution, and prior to the commencement of depositions in any litigation between the parties arising out of this Agreement, the parties shall attempt to resolve the dispute through Mediation before an agreed-upon Circuit Court Mediator certified by the State of Florida. The mediation shall be attended by representatives of Consultant with full decision-making authority and by County's staff person who would make the presentation of any settlement reached at mediation to County's board for approval. Should either party fail to submit to mediation as required hereunder, the other party may obtain a court order requiring mediation under section 44.102, Fla. Stat. 24. VENUE. Any suit or action brought by either party to this Agreement against the other party relating to or arising out of this Agreement must be brought in the appropriate federal or state courts in Collier County, Florida, which courts have sole and exclusive jurisdiction on all such matters. Page 7 of 16 Agreement No.17-7216-WV Collier County Interactive Growth Model Ver 3 Metro Forecasting Models,LLC 16A16 25. AGREEMENT STAFFING. The Consultant's personnel and management to be utilized for this Agreement shall be knowledgeable in their areas of expertise. The County reserves the right to perform investigations as may be deemed necessary to ensure that competent persons will be utilized in the performance of the Agreement. The Consultant's shall assign as many people as necessary to complete the services on a timely basis, and each person assigned shall be available for an amount of time adequate to meet the required. 26. ORDER OF PRECEDENCE. In the event of any conflict between or among the terms of any of the Contract Documents, the County's Board approved Executive Summary, the Contract Documents shall take precedence. 27. ASSIGNMENT. Consultant shall not assign this Agreement or any part thereof, without the prior consent in writing of the County. Any attempt to assign or otherwise transfer this Agreement, or any part herein, without the County's consent, shall be void. If Consultant does, with approval, assign this Agreement or any part thereof, it shall require that its assignee be bound to it and to assume toward Consultant all of the obligations and responsibilities that Consultant has assumed toward the County. 28. SECURITY. The Consultant is required to comply with County Ordinance 2004-52, as amended. Background checks are valid for five (5) years and the Consultant shall be responsible for all associated costs. If required, Consultant shall be responsible for the costs of providing background checks by the Collier County Facilities Management Division for all employees that shall provide services to the County under this Agreement. This may include, but not be limited to, checking federal, state and local law enforcement records, including a state and FBI fingerprint check, credit reports, education, residence and employment verifications and other related records. Consultant shall be required to maintain records on each employee and make them available to the County for at least four (4) years. All of Consultant's employees and subconsultants must wear Collier County Government Identification badges at all times while performing services on County facilities and properties. Consultant ID badges are valid for one (1) year from the date of issuance and can be renewed each year at no cost to the Consultant during the time period in which their background check is valid, as discussed below. All technicians shall have on their shirts the name of the Consultant's business. The Consultant shall immediately notify the Collier County Facilities Management Division via e-mail (DL-FMOPS(a�colliergov.net) whenever an employee assigned to Collier County separates from their employment. This notification is critical to ensure the continued security of Collier County facilities and systems. Failure to notify within four (4) hours of separation may result in a deduction of$500 per incident. (SIGNATURE PAGE TO FOLLOW) Page 8of16 Agreement No.17-7216-1M/Collier County Interactive Growth Model Ver 3 Metro Forecasting Models,LLC 1 6 A 1 6 IN WITNESS,WHEREOF, the parties hereto, have each, respectively, by an authorized person or agent, have executed this Agreement on the date and year first written above. ATTEST: BOARD OF COUNTY COMMISSIONERS Dwight E. Brock, Clerk of Courts COLLIER O Y, FLORIDA By: /J By: //L�1L✓ A Penny Tayl•� airma 41 Dated: \ \.3 A- (sEititist asto chairman's Consultar�iguaV1 bIses: Metro Forecasting Models, LLC Consultant First n gy: r rf (A,1,' Ian,- A( fries _ Signature 1 TT e/ rint witness nameT Yp p , r7✓ TType/print signature and titleT 7----.7&(.4"-,4', ' Send Witness l T)tkiiiik \ '��i J WW1 ype/print witness nameT Appr ed as to For and egality: "2/— . /..,e....cd-lt__, As i talt County Attorney amu.+ cal))-- /2 —71-41...e.A., Print Name {tem# _Lf " Agena�� IL " ) I Rat'%1 -A •;iuty e '7'. , = ) y '~A "' 4. Page 9 of 16 Agreement No.17-7216-WV Collier County Interactive Growth Model Ver 3 Metro Forecasting Models,LLC 1 6 A 1 6 EXHIBIT A Scope of Services The Consultant will assist County staff members in the development and implementation of the Collier Interactive Growth Model Ver 3 (CIGM Ver 3) and will instruct the staff on the method to be used for annual updating operation and maintenance of the model upon completion of the CIGM Ver 3. A. Scope of Services The County in consultation with the Consultant will organize a staff task force for the development and implementation of the CIGM Ver 3. The County will appoint staff members within the county government and request representatives from other agencies on a as need basis. The County will also assign staff members with experience with comprehensive planning. One member assigned to the staff task force member will be a staff member with experience in Geographic Information System (GIS). The purpose of the task force is to provide input for the development and application of the CIGM Ver 3. The taskforce will also assist the Consultant in identifying and collecting pertinent data that are instrumental to the development of the CIGM Ver 3 and the many sub-models. Work Task 1.0 — Develop Baseline Database The Consultant will develop the current year baseline data for current development with staff assistance that can be updated annually. Individual TAZs for the total county will be delineated. Each TAZ will be inventoried for current development such as housing unit by type, population characteristics, retail space by building area, office/services by building area industrial and wholesale by building area, school plants and enrollment, public parks, and other data considered relevant. Upon completion of the cell data and cell delineation, it will serve as the baseline for the CIGM. This will provide an opportunity to test Collier County's data bank to query land use data. The model can be easily updated annually. It could also be used to provide an annual report to the County Commissioner about the current population and development. It is estimated there are approximately 732 TAZ's in the study area. Data will be entered for each TAZ into the computer program for export to the main spreadsheet for processing. The baseline scenario will be developed for each TAZ from the following sources: • Parcel property attributes from County data bank; • Simulation models of similar communities. • 911 data bank • TAZ overlays on the most current aerial photos • DRI's, building permits, large scale developments Page 10 of 16 Agreement No.17-7216-VW Collier County Interactive Growth Model Ver 3 Metro Forecasting Models,LLC 16A16 Work Task 2.0 — Develop Buildout Database The Consultant will also develop a build-out database with staff assistance from the build-out scenario or model. Similar to the current year baseline database, individual TAZs will be delineated. Each TAZ will be inventoried for build-out development such as housing unit by type, population characteristics, retail space by building area, office/services by building area, industrial and wholesale by building area, school plants and enrollment, public parks, and other data considered relevant. Data will be entered for each TAZ into the computer program for export to the main spreadsheet for processing. The database can be updated to reflect the changes in future land uses to produce resultant changes. The build-out scenario will be developed for each TAZ from the following sources: • Current zoning by land use type and intensity, vested rights and current practices; • Comprehensive Plan, its future land use plan, community's vision and current and future trends as well as stakeholder's perceptions; • Parcel property attributes from County data bank; • Simulation models of similar communities. Work Task 3.0 — Develop Population and Housing Model Population and Housing Model: This model produces the forecast single family and multifamily units by parcels per zone including the rate of change for household size and vacancy rates in 5 year increments from the baseline year (i.e.) to build out (i.e. 2080) for each of the 732 disaggrated zones. This task also includes the inventory of current housing units by type, then ground proofed and the developed acres of housing for each zone. The demographic of the population by zones are analyzed for forecasting. This task requires an estimate of housing development by type and acreage at build out for each zone (the supply) by estimating the yield according to zoning, the comprehensive plan and other variables. Also, the forecast of household size and vacancy rates to build out. The Consultant will upload the baseline and build out data, and the Consultant will process the data in 5 year increments and provide reports of the output data in Excel format in 5 year increments. Work Task 4.0 — Develop Commercial Sub Model Commercial Sub Model: This sub model determines and forecasts the internal demand for retail space and office space by 732 disaggrated zones in 5 year increments to buildout. This task also includes the inventory of current commercial space by type, then ground proofed and the developed acres of commercial use for each zone. This task requires an estimate of commercial development by type and acreage at build out for each zone by estimating the yield according to zoning, the comprehensive plan and other variables. Whereas the internal supply of commercial development exceeds internal demand for commercial, analysis will be conducted to determine the external population that supports the internal supply of developed commercial space less that that meets the needs of the internal demand for commercial space. The sub model will forecast the internal demand for neighborhood, community and regional commercial centers by zone and year and the supply of commercial (c Page l l of 16 Agreement No.17-7216-WV Collier County Interactive Growth Model Ver 3 Metro Forecasting Models,LLC 16416 land to meet those needs. The data can also be analyzed for the community's economic objectives. This model also provides a land budget for the area required to meet the needs of the county residents. The Consultant will process the data in 5 year increments and provide reports of the output data in Excel format in 5 year increments. Work Task 5.0 — Develop Industrial Sub Model Industrial Sub Model: This sub model determines the apportionment of land for industrial and wholesale activities to meet future needs by 732 disaggrated zones in 5 year increments to build out. This is not a demand model, but a design model, based on community policy for industrial development. The design for the apportionment of land for industrial development can be based on balancing the tax base and labor force. Industrial planning can be an essential component for the concentration of resources for economic development. This will serve as guidelines for apportionment of future industrial land uses as a function of time and population. This model can be updated annually from the data query. The Consultant will process the data in 5 year increments and provide reports of the output data in Excel format in 5 year increments. Work Task 6.0 — Develop Hotel/Motel Sub Model Hotel/ Motel Sub Model: This sub model determines the current supply and location and the apportionment of land for hotel/motels to meet current and future needs in 5 year increments to build out by zones. This will serve as guidelines for apportionment of future hotel/motel land uses as a function of time and population. This model can be updated annually from the data query. The Consultant will upload the baseline and build out data, and the Consultant will process the data in 5 year increments and provide reports of the output data in Excel format in 5 year increments. Work Task 7.0 — Develop Government Sub Models Government Sub Models: The government sub models consist of Schools, Parks, Libraries, Fire and Police Stations. These models can be used to establish level of services. They are presented as a package for the CIGM Ver 3. Schools Sub Models: To develop a school facility model to determine timing and location in 5-year increment future of school plant facilities (elementary, middle and high) to meet the needs of the County's school age population over time. The supply model will be the state and local guidelines for school plants by type and enrollment. The Consultant will upload the baseline and build out data, and the Consultant will process the data in 5 year increments and provide reports of the output data in Excel format in 5 year increments. Park Sub Model: To develop an open space model to determine standards and the needs of the population for develop open spaces (neighborhood, community and regional parks), Page 12 of 16 Agreement No.17-7216-VW Collier County Interactive Growth Model Ver 3 Metro Forecasting Models,LLC 16A16 the timing of facilities and their location as a function of population. This model can be updated every five years for scheduled capital improvement programs. The Consultant will upload the baseline (inventory and location of current facilities) and build out data (future needs for facilities), and build out data, and the Consultant will process the data in 5 year increments and provide reports of the output. Fire Stations Sub Model: To develop a sub-model to determine the need, service area, and spatial distribution of fire stations (pumper and ladder stations). The Consultant will upload the baseline (inventory and location of current facilities) and build out data (future needs for facilities), process the data in 5 year increments and provide reports of the output data in Excel format in 5 year increments. The criteria are the ISO standards for a Class 1 insurance rating. Sheriff Sub Station Sub Model: To develop a sub-model to determine the need, service areas, and facilities for County's law enforcement. The Consultant will upload the baseline and build out data, and the Consultant will process the data in 5 year increments and provide reports of the output data in Excel format in 5 year increments. Library Sub model: The county current level of service for library services will apply. The Consultant will upload the baseline and build out data, and the Consultant will process the data in 5 year increments and provide reports of the output data in Excel format in 5 year increments. Work Task 8.0 — Develop Specialty Sub Models Utility (water and Sewer) Sub Model: The Consultant, with assistance from staff, will develop a Water and Wastewater Utility model to determine the future infrastructure requirements based on current level of service or state standards for potable water consumption and wastewater generation to meet the needs of the population over time. This model will include one potable water utility and one wastewater utility to provide a basis for future infrastructure planning related to potable water demand and wastewater generation. This model can be updated annually from the data query. This model can also be calibrated on a regular basis during the year to reflect flow changes due to weather or seasonal population. The CONSULTANT will process the data in 5 year increments and provide reports of the output data in Excel format in 5 year increments. Storm Water Impervious Surface Sub Model: The Consultant, with assistance from staff, will develop an Impervious Area model to provide data that policy makers can use to determine future storm water management policies and facilities to meet the needs of the population over time. This model will include grouping the study area in up to five basins to provide a basis for future infrastructure improvements related to flood control, conveyance and water quality. This model can be updated annually from the data query. The Consultant will process the data in 5 year increments and provide reports of the output data in Excel format in 5 year increments. Page 13 of 16 Agreement No.17-7216-WV Collier County Interactive Growth Model Ver 3 Metro Forecasting Models,LLC 1 6 A 1 6 Work Task 9.0 — CIGM Alternative Scenarios The ability to download data in 5 year increments by clusters (i.e. RFMUD, RLSA, Immokalee, etc.). This gives us the ability to test different planning scenarios. For example, we can test the staff's different planning designs for the RFMUD, RLSA, etc., to determine which the most efficient design for the decision making that is in the best interest of the county. The Consultant shall test 2 small clusters (i.e. RFMUD) and 2 large clusters (i. e. RSLA) from the staff land use design and guidelines for the scenario to be tested. B. Follow-up Meetings: The Consultant will meet monthly, either in person or via conference call, with the County's task force and other key stakeholders to review the progress of the work tasks. The Consultant will revise any component of the model, if necessary, based upon comments received during these meetings. However, any changes within the components of the IGM Ver 3 as described previously herein will be considered a change in scope and additional costs may be assessed. Any request for changes of scope or additional costs must be mutually agreed upon in advance by the parties through the execution of an Amendment to the Agreement. C. Schedule of Services: The Consultant, upon a written Notice to Proceed, shall complete the work described under Scope of Services within twelve (12) Months. This time estimate assumes that the County has adequate GIS capabilities and that information required from County staff is timely. D. Final Product: As models are completed, and upon completion of the CIGM Ver3, the Consultant will deliver to the County an electronic format of the computer model for use by the staff. Consultant hereby grants to the County a royalty-free, nonexclusive and nontransferable copyright and license to use the Interactive Growth ModelTM Ver 3 program furnished herein and appropriate passwords for access to the CIGM Ver 3. E. License and Copyright Agreement: The parties agree to the terms and conditions of Exhibit C "License and Copyright Agreement" for the use of Consultant's Interactive Growth Model ® Program software, including the updated Version 3and Spreadsheets Programs. F. Annual Updates Options: At the option of the County and pursuant to Section E. Additional Services the Consultant may perform the annual updates, as needed. G. Additional Services: Any additional services must be approved in writing via an Amendment to this Agreement prior to starting such services. The agreed upon scope, compensation and schedule for Additional Services shall be set forth in the Amendment authorizing those Additional Services. The County will not be responsible for the costs of Additional Services commenced without such express prior written approval. Page 14 of 16 Agreement No.17-7216-VW Collier County Interactive Growth Model Ver 3 Metro Forecasting Models,LLC 1 6 A 1 6 EXHIBIT B FEE SCHEDULE The Consultant proposes a lump sum fee of $220,000, (Two Hundred Twenty-Two Thousand Dollars) billable monthly based on a percent of completion of the task(s) found under Exhibit A - Scope of Service in the monthly invoices. Payments will be made in accordance with the following Schedule; however, the payment of any task item noted below shall not be due until completed to the County's satisfaction. Work Task Description Lump Payment Sum Fee Schedule 1.0 Develop Baseline Database $30,000 Monthly Upon 2.0 Develop Buildout Database $30,000 Percent Complete 3.0 Develop Population and Housing Model $30,000 of Task 4.0 Develop Commercial Sub Model $20,000 5.0 Develop Industrial Sub Model $10,000 6.0 Develop Hotel/ Motel Sub Model $10,000 7.0 Develop Government Sub Models $30,000 8.0 Develop Specialty Sub Models $40,000 9.0 Develop CIGM Alternative Scenarios $20,000 TOTAL FEE (Tasks 1-9) $220,000 Page 15 of 16 Agreement No.17-7216-WV Collier County Interactive Growth Model Ver 3 Metro Forecasting Models,LLC 16A16 EXHIBIT C LICENSE AND COPYRIGHT AGREEMENT BY AND BETWEEN METRO FORECASTING MODELS, LLC THE LICENSOR AND THE COLLIER COUNTY THE LICENSEE 1. This is a legal agreement between Metro Forecasting Models, LLC and Collier County. By accepting, receiving, and using his Interactive Growth Model® Program including the updated Version 3. The Collier County is agreeing to be bound by the terms of this Agreement. 2. Metro Forecasting Models, LLC grants to the Collier County a royalty free, nonexclusive, and nontransferable copyright and license to use the Interactive Growth Model® Program including the updated Version 3, furnished hereunder, upon the terms and conditions set out below. 3. Collier County acknowledges that the Interactive Growth Model® Program including the updated Version 3 is a research tool and that it is being supplied "as is" without any accompanying services or improvements other than by this agreement and contract. 4. The Collier County agrees to use the Program solely for internal purposes and shall not distribute or transfer to another location or to any other person without prior written permission from Metro Forecasting Models LLC. 5. Title and copyright to the Interactive Growth Model® Program including the updated Version 3 and any associated documentation shall at all times remain with Metro Forecasting Models LLC, and the Collier County agrees to preserve the same. Collier County agrees not to make any copies except for its internal use or the distribution of data results for public use. The Collier County agrees to place the appropriate copyright notice on any such copies. 6. All intellectual programs rights in the Interactive Growth Model® Program including the updated Version 3 and user documentation are owned by Metro Forecasting Models LLC and are protected by applicable intellectual property laws (including patents, trademarks, and copyright laws) and international treaty provisions. 7. Metro Forecasting Models, LLC warrants and represents that his Interactive Growth Model® Program including the updated Version 3 will be accepted, received and used by Collier County, is original, does not violate any law, trade or disclose regulation, or infringe on the copyrights, trademarks, trade names or patents of any other person or entity, or is otherwise injurious to the rights of any other person, and that Metro Forecasting Models LLC have obtain all the necessary consents, prior to submission of his Interactive Growth Model® Program including the updated Version 3 to Collier County. To the maximum extent permitted by Florida law, the Consultant, Metro Forecasting Models, LLC, agrees to defend, indemnify and hold harmless Collier County, its officers and employees against any and all claims, losses, liabilities and expenses, including attorney fees and legal expenses, resulting from or attributable to any claims brought based on the foregoing. The duty to defend under this section is independent and separate from the duty to indemnify, and the duty to defend exists regards of the any ultimate legality of Collier County. Page 16 of 16 Agreement No.17-7216-WV Collier County Interactive Growth Model Ver 3 Metro Forecasting Models,LLC 1 6 A 1 6 Cot ier County Collier County Administrative Services Department Waiver Request r@ ntSer,,,cv. r„s „ Instructions Completed waiver requests accompanied by the business case and backup documentation must be submitted to the division's Procurement Strategist for any amount above $3,000. Purchases above $3,000 require three quotes or formal competition. The division must provide justification to the Procurement Director to request consideration to waive the competitive purchasing process and purchase from a single vendor. Waivers of greater than $50,000 will require approval by the Board of County Commissioners. To qualify for a waiver: select a waiver category, provide the research conducted and the supporting rationale and acquire the approval signature from your director. Send the waiver request, the business case and contract materials to your Procurement Strategist. Requester Name: Mike Bosi Vendor Name: Metro Forecasting Models, LLC Division:Growth Management Item /Service:Collier Inter-Active Growth Model (CIGM) Budget Year: 2017/18 Anticipated Cost:$ 220,000.00 Sole Source: ❑ Single Source: 0 Standardization: E Emergency: Describe the public health or safety issues that requires the immediate product or service (i.e., The supply of vaccination was completely depleted within hours of delivery to the employee health center; the current vendor will not receive another shipment for 2 weeks). Compatibility / Proprietary (One of a Kind or No Substitute Available): Describe the research completed to determine that there is only one product or service capable of meeting the County's existing conditions and that no other vendor can provide a product, component,or replacement part that may be substituted. In 2006,as part of the East of CR951 Build out Study,the BCC entered into a single source contract with Metro Forecasting Models,LLC(formerly known as Van Buskirk,Ryffel&Associates) to develop the Collier Inter-Active Growth Model(CIGM)and at the January 11,2017 BCC workshop to discuss the GMP restudies within the Eastern portion of the county,the BCC directed staff to update the CIGM to the updated Version 3. Based upon the original CIGM Authorized Distributor: Describe the research completed to find similar features and operability, and a letter from the manufacturer naming the single source authorized distributor(s)in the southwest Florida region. It is a felony to knowingly circumvent a competitive process for commodities or services by fraudulently specifying sole source. Florida Statute 838.22(2). Requested by:Mike Bosi Signature: michael p bosi .m. n, . Date:07-19-2017 20,,°,., .83;-0.0 ° Date:08-03-2017 Division Director:Mike Bosi Signature: michael p bosi °p-�°aU"a ' '° D01.2201700.0308:2051 L9100' cn=adamnorthrup@colliergo Procurement Strategist:Adam Northrup Signature: v.net /F44. Date: '00'04-07:21:54 2017.08.09 tedcoy man@collie °d�ayme9�°aree.e, Procurement Director:Edward F. Coyman Jr. Signature: ov.net DN:m=ledcorna^Q°°°,e.g°°.net Date: r g Dale:2017.08.09 10:57:27-04'00' Attachments: ❑ Business Case, ❑■ Sole/Single Source Letter, ❑ Executive Summary for Standardization 16816 Business Case for Standardization, Sole, or Single Source Waivers Provide a Business Case for each waiver you have requested, articulating the product and service it performs. 1. Provide information on why a particular product and/or vendor was chosen. As noted the County has utilized the CIGM since it's development in 2008 to allocate population growth spatially,with corresponding needed supporting land use,but the model has not been updated to include additional sub-models or improved reporting capabilities and to continue with the utilization of the CGIM for capital planning purposes,the Board directed staff to enter into an single source contract with the vendor to update tin 2. If the product requested is one-of-a-kind item, provide background information on ho w this was determined and backup resources utilized. The original single source memo utilized to authorize the original CIGM development has been provided and a search of the Internet has yielded few to no like vendors offering similar products. 3. What would the impact be to change to a di fferent product (include: training, inventory parts, maintenance, project (or staff time)to replace the item? The impact from the change from the CIGM to another vendor is not known at this time due to the fact that staff is not aware of a similar product that is offered that provides the same type of long range projections,spatial based that allocates population,support land uses necessary,as well as infrastructure needs related to the population growth. 4. If unique features are required to successfully perform the required function, identify those features and why they are required and cannot be substituted. (Be specific) As noted the CIGM allocates population over time and specifies the location of that population,and corresponds that population to need land uses to services that population,in addition to the infrastructure required to support the population. Again,staff is unable to find a similar type of product within the market place. 5. Provide information on other models available and why they were rejected. Provide brand name, model, vendor name, date and name of each resource contacted. To "exactly match existing equipment" or to "inter-member (connect) with existing equipment" is not normally an acceptable justification for sole brand. When you determine this is a justified factor that should be considered; the quantity, manufacturer, brand, model, property number of the existing equipment, and necessity for"interfacing" must be provided. As noted no other models have been identified within the market place. 6. Provide product listing of sole/single sourced items you are purchasing. Collier Inter-Active Growth Model Version 3 Requester: Mike Bosi Signature: michael p bosiw`m� ��m@,� �� 7/1 9/1 7 Er Mike Bosi michael p bosia„; °� , m 7/1 9/1 7 Division Director: Signature: �.p so, ,�.ar **Waiver requests that exceed $50,000 require board approval and must be signed by department head** FrenchJame D'9'ta"ysgnedby Jamie French Daatte::22017.08.03 Des 8/3/1 7 017. Department Head: Signature: S 08:23:56-04'00' Date: 16A16 AD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) L....--- 10/06/2017 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 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 NAME: Hiscox Inc. PHONE (A/C.No.Ext): ( 888202-3007 FAX ) (A/C,Not: 520 Madison Avenue E-MAIL 32nd Floor ADDRESS: contact@hiscox.com New York, NY 10022 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Hiscox Insurance Company Inc 10200 INSURED INSURER B: Metro Forecasting Models INSURER C: 9001 Highland Wood Blvd Suite 2 INSURER D: Bonita Springs,FL 34134 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. ILTRR ADDL TYPE OF INSURANCE NSD SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR DAMAGES RENTED PREMISES SES((Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A _ Y UDC-1772787-CGL-17 06/24/2017 06/24/2018 PERSONAL&ADV INJURY $ 0 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- X POLICY JECT LOC PRODUCTS-COMP/OPAGG $ S/T Gen.Agg OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS I AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Collier County Government,as Additional Insured for any and all work performed in Collier County. CERTIFICATE HOLDER CANCELLATION Collier County Board of County Commissioners SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 3295 Tamiami Trail East, Bldg. C2 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Naples FL 34122 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /} ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1 6 A 1 6 ARL® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4.....-/ 10/06/2017 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 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 NAME: Hiscox Inc. PHONE (A/C.No.Ext): ( 888 202-3007 FAX ) (A/C,No): 520 Madison Avenue E-MAIL contact@hiscox.com 32nd Floor New York,NY 10022 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Hiscox Insurance Company Inc 10200 INSURED INSURER B: Metro Forecasting Models INSURER C: 9001 Highland Wood Blvd INSURER D: Suite 2 Bonita Springs,FL 34134 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ADDL LTR INSD SWVD POLICY NUMBER UBR POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Professional Liability Y UDC-1772787-EO-17 06/24/2017 06/24/2018 Each Claim:$2,000,000 Aggregate:$2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Collier County Government,as Additional Insured for any and all work performed in Collier County. CERTIFICATE HOLDER CANCELLATION Collier County Board of County Commissioners SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 3295 Tamiami Trail East, Bldg. C2 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Naples FL 34122 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 004 • ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ......................................................... 1 6 A 16 TRAVELERSJ� Report Claims Immediately by Calling* 1-800-238-6225 Speak directly with a claim professional 24 hours a day, 365 days a year *Unless Your Policy Requires Written Notice or Reporting WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY A Custom Insurance Policy Prepared for: METRO FORECASTING MODELS LLC 9001 HIGHLAND WOOD BLVD SUITE BONITA SPRINGS FL 34134 i I 16A16 TRAVELERS WORKERS COMPENSATION ONE TOWER SQUARE AND HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY TYPE V INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (IHUB-5J99803-5-17) NEW-17 INSURER: THE TRAVELERS INDEMNITY COMPANY OF AMERICA 1. NCCI CO CODE: 13439 INSURED: PRODUCER: METRO FORECASTING MODELS LLC AUTOMATIC DATA PROC INS 9001 HIGHLAND WOOD BLVD SUITE 1 ADP BLVD MS 625 BONITA SPRINGS FL 34134 ROSELAND NJ 07068 Insured is A LIMITED LIABILITY COMPANY Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 07-01-17 to 07-01-18 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: FL B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 500000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 500000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: AL AR AZ CA CO CT DC DE GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY OK OR PA RI SC SD TN TX UT VA VT WI WV D. This policy includes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 06-06-17 AD OFFICE: PAYROLL 70A PRODUCER: AUTOMATIC DATA PROC INS XV770 16A16 TRAVELERS J WORKERS COMPENSATION ONE TOWER SQUARE AND HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY TYPE V INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (IHUB-5J99803-5-17) CLASSIFICATION SCHEDULE: PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER$100 OF ANNUAL CLASSIFICATIONS CODE NO REMUNERATION REMUNERATION PREMIUM SEE EXTENSION OF INFORMATION PAGE - SCHEDULE(S) SIC-CODE: 7374 NAICS: 518210 STANDARD TOTAL ESTIMATED ANNUAL STANDARD PREMIUM $ 335 PREMIUM DISCOUNT NONE 0900-09 EXPENSE CONSTANT 200 TERRORISM 20 TOTAL ESTIMATED PREMIUM 555 DEPOSIT AMOUNT DUE 555 Minimum Premium: $ 223 EMPLOYERS LIABILITY MINIMUM: $ 75 DATE OF ISSUE: 06-06-17 AD OFFICE: PAYROLL 70A PRODUCER: AUTOMATIC DATA PROC INS XV770 COUNTERSIGNED-AGENT 1 6 A 1 6 TRAVELERS J WORKERS COMPENSATION AND ONE FORD, CTU HARTFORD, CT 0 06183 EMPLOYERS LIABILITY POLICY 61 EXTENSION OF INFO PAGE-SCHEDULE WC 00 00 01 ( A) POLICY NUMBER: (IHUB-5J99803-5-17) INSURER: THE TRAVELERS INDEMNITY COMPANY OF AMERICA 13439-FL INSURED'S NAME: METRO FORECASTING MODELS LLC PREMIUM BASIS ESTIMATED RATES ESTIMATED TOTAL ANNUAL PER $100 OF ANNUAL CLASSIFICATION CODE REMUNERATION REMUNERATION PREMIUM LOCATION 001 01 FEIN 473162367 ENTITY CD 001 METRO FORECASTING MODELS LLC 9001 HIGHLAND WOOD BLVD SUITE BONITA SPRINGS, FL 34134 SIC CODE: 7374 NAICS: 518210 CLERICAL OFFICE EMPLOYEES NOC 8810 100000 .26 260 FL MANUAL PREMIUM $ 260 1.10% EMPL. LIAB. INCREASED LIMITS(9807) $ 3 ADD FOR INCREASED LIMITS MINIMUM (9848) 72 EXPERIENCE MODIFICATION: NONE MODIFIED PREMIUM NONE TOTAL ESTIMATED ANNUAL STANDARD PREMIUM 335 EXPENSE CONSTANT(0900) 200 TERRORISM (9740) 20 TOTAL ESTIMATED PREMIUM 555 DEPOSIT AMOUNT DUE 555 DATE OF ISSUE: 06-06-17 AD SCHEDULE NO: 1 OF LAST 16A16 TRAVELERS WORKERS COMPENSATION AND ONE FORD, SQUARE HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 00 01 (A) POLICY NUMBER: (IHUB-5J99803-5-17) LISTING OF ENDORSEMENTS EXTENSION OF INFO PAGE We agree that the following listed endorsements form a part of this policy on its effective date. WC 00 00 01 A - 001 INFORMATION PAGE WC 00 00 01 A - 001 INFORMATION PAGE 2 WC 00 00 01 A - 001 EXTENSION OF INFORMATION PAGE - SCHEDULE WC 00 00 01 A - 001 ENDORSEMENT LISTING WC 00 04 14 00 - 001 NOTIFICATION OF CHANGE IN OWNERSHIP ENDT WC 09 04 03 B - 001 FL TRIPRA ENDORSEMENT WC 00 03 08 00 - 001 PARTNERS, OFFICERS AND OTHERS EXCL ENDT WC 00 04 19 00 - 001 PREMIUM DUE DATE ENDORSEMENT WC 09 03 03 00 - 001 FL EMPLRS LIAB COVERAGE ENDT WC 09 04 07 00 - 001 FL NON-COOPERATION WITH PREM AUDIT ENDT WC 09 06 06 00 - 001 FL EMPLOYMENT AND WAGE INFORMATION REL. DATE OF ISSUE: 06-06-17 ST ASSIGN: Page 1 of LAST 16A16 TRAVELERS J� WORKERS COMPENSATION AND ONE FORD, SQUARE HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 04 14 (00) POLICY NUMBER: (IHUB-5J99803-5-17) NOTIFICATION OF CHANGE IN OWNERSHIP ENDORSEMENT Experience rating is mandatory for all eligible insureds. The experience rating modification factor,if any,applicable to this policy, may change if there is a change in your ownership or in that of one or more of the entities eligible to be combined with you for experience rating purposes. Change in ownership includes sales, purchases, other transfers, mergers, consolidations, dissolutions, formations of a new entity and other changes provided for in the applicable experience rating plan manual. You must report any change in ownership to us in writing within 90 days of such change. Failure to report such changes within this period may result in revision of the experience rating modification factor used to determine your premium. DATE OF ISSUE: 06-06-17 ST ASSIGN: 1 6 A 1 6 TRAVELERS' WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 09 04 03 ( B) POLICY NUMBER: (IHUB-5J99803-5-17) FLORIDA TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT ENDORSEMENT This endorsement addresses requirements of the Terrorism Risk Insurance Act of 2002 as amended by the Terrorism Risk Insurance Program Reauthorization Act of 2015. Definitions The definitions provided in this endorsement are based on and have the same meaning as the definitions in the Act. If words or phrases not defined in this endorsement are defined in the Act,the definitions in the Act will apply. 1. "Act" means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any amendments, including any amendments resulting from the Terrorism Risk Insurance Program Reauthoriza- tion Act of 2015. 2. "Act of Terrorism" means any act that is certified by the Secretary of the Treasury, in consultation with the Secretary of Homeland Security, and the Attorney General of the United States as meeting all of the following requirements: a. The act is an act of terrorism. b. The act is violent or dangerous to human life, property or infrastructure. c. The act resulted in damage within the United States, or outside of the United States in the case of the premises of United States missions or certain air carriers or vessels. d. The act has been committed by an individual or individuals as part of an effort to coerce the civilian popu- lation of the United States or to influence the policy or affect the conduct of the United States Government by coercion. 3. "Insured Loss" means any loss resulting from an act of terrorism (including an act of war, in the case of work- ers compensation)that is covered by primary or excess property and casualty insurance issued by an insurer if the loss occurs in the United States or at the premises of United States missions or to certain air carriers or vessels. 4. "Insurer Deductible" means, for the period beginning on January 1, 2015, and ending on December 31, 2020, an amount equal to 20%of our direct earned premiums, during the immediately preceding calendar year. Limitation of Liability The Act may limit our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a calendar year and if we have met our Insurer Deductible, we may not be liable for the payment of any portion of the amount of Insured Losses that exceeds $100,000,000,000; and for aggregate Insured Losses up to $100,000,000,000, we may only have to pay a pro rata share of such Insured Losses as determined by the Secretary of the Treasury. Policyholder Disclosure Notice 1. Insured Losses would be partially reimbursed by the United States Government. If the aggregate industry In- sured Losses exceed: a. $100,000,000, with respect to such Insured Losses occurring in calendar year 2015, the United States Government would pay 85%of our Insured Losses that exceed our Insurer Deductible. b. $120,000,000, with respect to such Insured Losses occurring in calendar year 2016, the United States Government would pay 84%of our Insured Losses that exceed our Insurer Deductible. DATE OF ISSUE: 06-06-17 ST ASSIGN: Page 1 of 2 ©Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 1 6 A 1 6 TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 09 04 03 ( B) POLICY NUMBER: (IHUB-5J99803-5-17) c. $140,000,000, with respect to such Insured Losses occurring in calendar year 2017, the United States Government would pay 83%of our Insured Losses that exceed our Insurer Deductible. d. $160,000,000, with respect to such Insured Losses occurring in calendar year 2018, the United States Government would pay 82% of our Insured Losses that exceed our Insurer Deductible. e. $180,000,000, with respect to such Insured Losses occurring in calendar year 2019, the United States Government would pay 81% of our Insured Losses that exceed our Insurer Deductible. f. $200,000,000, with respect to such Insured Losses occurring in calendar year 2020, the United States Government would pay 80% of our Insured Losses that exceed our Insurer Deductible. 2. Notwithstanding item 1 above, the United States Government may not have to make any payment under the Act for any portion of Insured Losses that exceed $100,000,000,000. 3. The premium charged for the coverage for Insured Losses under this policy is included in the amount shown in Item 4 of the Information Page or the Schedule below. Schedule .02 Rate per$100 of Remuneration This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by DATE OF ISSUE: 06-06-17 ST ASSIGN: Page 2 of 2 ©Copyright 2015 National Council on Compensation Insurance, Inc. All Rights Reserved. 1 6 A 16 TRAVELERS` WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 00 03 08 (00)— 001 POLICY NUMBER: (IHUB-5J99803-5-17) PARTNERS, OFFICERS, AND OTHERS EXCLUSION ENDORSEMENT The policy does not cover bodily injury to any person described in the Schedule. The premium basis for the policy does not include the remuneration of such persons. You will reimburse us for any payment we must make because of bodily injury to such persons. SCHEDULE PARTNERS OFFICERS DAVE FARMER OTHERS DATE OF ISSUE: 06-06-17 ST ASSIGN: Page 1 of 1 16A16 TRAVELERS WORKERS COMPENSATION ONE TOWER SQUARE AND HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 0419 (00) POLICY NUMBER: (IHUB-5J99803-5-17) PREMIUM DUE DATE ENDORSEMENT This endorsement is used to amend: Section D. of Part Five of the policy is replaced by this provision. PART FIVE PREMIUM D. Premium is amended to read: You will pay all premium when due. You will pay the premium even if part or all of a workers compensation law is not valid. The due date for audit and retrospective premiums is the date of the billing. DATE OF ISSUE: 06-06-17 ST ASSIGN: Page 1 of 1 1 6 A 1 6 TRAVELERS J ONE TOWER SQUARE WORKERS COMPENSATION HARTFORD, CT 06183 AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 09 03 03 (00) POLICY NUMBER: (IHUB-5J99803-5-17) FLORIDA EMPLOYERS LIABILITY COVERAGE ENDORSEMENT C. Exclusion 5, Section C. of Part Two of the policy, is replaced by the following: This insurance does not cover 5. bodily injury intentionally caused or aggravated by you or which is the result of your engaging in conduct equivalent to an intentional tort, however defined, or other tortious conduct, such that you lose your im- munity from civil liability under the workers compensation laws. DATE OF ISSUE: 06-06-17 ST ASSIGN: Page 1 of 1 1 6 A 1 6 TRAVELERS J k WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 09 04 07(00) POLICY NUMBER: (IHUB-5J99803-5-17) FLORIDA NON-COOPERATION WITH PREMIUM AUDIT ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Florida is shown in Item 3.A. of the Information Page. This endorsement adds the following provisions to Part Five—Premium, G. Audit, of the policy: We are required to complete the premium audit process no later than 90 days after policy termination. If you fail to return voluntary audit requests or refuse to cooperate in completing a final physical audit, you must pay a premium to us not to exceed three times the most recent estimated annual premium on this policy subject to the following conditions: 1. We make two good faith efforts to obtain the voluntary audit report or complete the physical audit. 2. We document the audit file regarding the above attempts to obtain the required audit information. 3. After the two good faith attempts to obtain records, we send a letter by certified mail to you advising you of the specific records that are required and the premium that will be charged if you continue to refuse access to the records. If you do not provide all of the specific records required and if we satisfy the conditions above on or before 90 days from the date of policy termination, we may continue to try and conduct the audit and/or re-open the audit for up to three years from the date of policy termination. Alternatively, we may immediately bill you for your final premium. If you provide all of the specific records required to complete the premium audit process within the three year period, we will determine your final premium in accordance with Part Five — Premium, E. Final Premium of the policy. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium $ Insurance Company Countersigned by DATE OF ISSUE: 06-06-17 ST ASSIGN: Page 1 of 1 ©2013 The Travelers Indemnity Company.All rights reserved. 1 6 A 1 6 TRAVELERS WORKERS COMPENSATION ONE TOWER SQUARE AND HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 09 06 06 (00) POLICY NUMBER: (IHUB-5J99803-5-17) FLORIDA EMPLOYMENT AND WAGE INFORMATION RELEASE ENDORSEMENT This policy requires you to release certain employment and wage information maintained by the State of Florida pursuant to federal and state unemployment compensation laws except to the extent prohibited or limited under federal law. By entering into this policy, you consent to the release of the information. We will safeguard the information and maintain its confidentiality. We will limit use of the information to verifying compliance with the terms of the policy. DATE OF ISSUE: 06-06-17 ST ASSIGN: Page 1 of 1 1 6 A 1 6 WORKERS COMPENSATION TRAVELERS w AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 POLICY NUMBER: (IHUB-5J99803-5-17) NOTICE OF ELECTION TO ACCEPT A BENEFIT DEDUCTIBLE AND/OR COINSURANCE PROGRAM FOR WORKERS' COMPENSATION COVERAGE IN FLORIDA Florida Policyholders The Florida law now permits an employer to buy Workers' Compensation Insurance with a deductible coinsurance or in a deductible coinsurance combined option. The program is applied to indemnity and medical benefits and applies separately to each accident during the policy term, regardless of the number of employees who sustain injury in the accident. The deductible amount is subject to a minimum and a maximum for each accident, depend- ing which program is selected. Effective January 1, 1994 the State of Florida passed in special session a $2,500 State Authorized deductible. Any amount paid by the employer in this deductible option (4) shall reduce the amount of loss that goes into Ex- periencing Rating of such employer. There is no premium credit applied to this program. To prevent putting you in an uninsured position, your policy has been issued at full rates without this program be- ing applied. If you wish to have one of the options apply to your policy, fill in the information requested at the bottom of this form. Retain your copy for your records and send the agent and company copies to your agent within sixty (60) days after the effective date of your policy. An endorsement will then be attached to your policy to reflect the change. If you decide that you do not want this benefit deductible and/or coinsurance program to apply, or if you already have it on the policy, you may disregard this form.Your policy will continue in force as issued. For a complete explanation of how this program operates or the savings available by choosing one of these op- tions, please contact your agent. DATE OF ISSUE: 060617 WO9N1CO6(Rev.06-09) Page 1 of 2 1 6 A 1 6 Item #1: PROGRAM AMOUNT Item #2: Program 1 - Coinsurance/Deductibles Program 2- Coinsurance Deductible Amount w/$21,000 Policy Premium Coinsurance Policy Premium Coinsurance Reduction Amount Reduction $ 500 See $ 5,000 See 1,000 Your 10,000 Your 1,500 Agent/ 15,000 Agent/ 2,000 Broker 20,000 Broker 2,500 21,000 Use Florida Coinsurance and Deductible Use Florida Deductible Endorsement Endorsement WC 09 06 03. WC 09 06 04. Program 3- Deductibles Program 4 - Deductible Deductible Policy Premium Deductible$2,500 (No Policy Premium Credit) Amount Reduction $ 500 See 1,000 Your 1,500 Agent/ 2,000 Broker 2,500 Use Florida Benefits Deductible Endorsement Use Florida Benefits Deductible Endorsement WC 09 06 05. WC 09 06 05. Yes, I want the program/amount that I selected in Item #1 to be applied to my policy for medical and in- demnity benefits under the Florida Workers' Compensation Law. I understand that the company shall pay the deductible or coinsurance amount and seek reimbursement from the employer shown below. I understand that in accordance with Florida Laws, I have the option of modifying the above program choice at the time of renewal of my Workers' Compensation policy with the insurance company named below. Date: Employer: Name: Title: Signature: Insurance Company: DATE OF ISSUE: 060617 WO9N1CO6(Rev.06-09) Page 2 of 2 1 6 A 1 6 TRAVELERS J PRIVACY NOTICE THE TRAVELERS INSURANCE COMPANIES PRIVACY POLICY Thank you for selecting THE TRAVELERS INSURANCE COMPANIES as your workers compensation insurer. At THE TRAVELERS INSURANCE COMPANIES a subsidiary of Travelers, we recognize that privacy is important to you. That is why we are committed to protecting your privacy through the adoption of the following privacy principles: Collection Of Information We collect, retain, and use information about you, or about participants, beneficiaries or claimants under your workers compensation coverage, only where we believe that it will help or is necessary to provide you products and services or otherwise conduct our business. We collect nonpublic personal financial information about you, or about participants, beneficiaries or claimants under your workers compensation coverage, from the following sources: • information we receive from you or through your agent or broker on applications or other forms; • information we receive from or about you in the process of adjusting claims; • information about your other transactions, including risk control and other consulting services, with us, our affiliates or other third parties; • information about your coverages and loss activity with other carriers; and • information we receive from a consumer reporting agency. Such information includes identifying information such as policyholder, participant, beneficiary or claimant name, address, and social security number; financial information such as income, payment history, or credit history; and, under certain circumstances, health information such as information about an illness, disability, or injury. It could also include information on claims with other insurance companies and us and the condition and mainte- nance of your property. Disclosure Of Information We usually do not disclose nonpublic personal information about you, or about participants, beneficiaries or claimants under your workers compensation coverage, without your consent. However, in some circumstances we may disclose information to others without your prior authorization. The most common disclosures are to the following persons: • our affiliated property and casualty insurance companies; • state insurance departments, for their regulation of our business; • other government authorities; • our agents and brokers as necessary to conduct our business; • organizations that perform underwriting and claims investigations; • another insurance company to which you have applied for a policy or submitted a claim; • insurance support agencies, law enforcement agencies and our reinsurers; and • any other third party, as permitted or required by law. Most importantly, THE TRAVELERS INSURANCE COMPANIES does not and will not disclose or sell nonpublic personal information about you, or about participants, beneficiaries or claimants under your workers compensation coverage, to anyone for marketing purposes. WUNNABO9 Page 1 of 2 16x16 Confidentiality And Security We restrict access to nonpublic personal information about you, or about participants, beneficiaries or claimants under your workers compensation coverage, to those who need it to serve your insurance needs and to maintain and improve customer service. We maintain physical, electronic, and procedural safeguards that comply with federal and state laws and regulations to guard your nonpublic personal information. Disclosure and Protection of Former Customers' Information We may disclose all the personal information we have collected, as described above. However, even if you no longer have a customer relationship with us, we will continue to follow our privacy policies and practices to protect your information. Changes In Privacy Policy We may choose to modify our policy regarding the treatment of personal information at any time. Before we do so, we will notify you and provide an updated privacy notice. WUNNABO9 Page 2 of 2 16A16 CERTIFICATION OF EMPLOYER WORKPLACE SAFETY PROGRAM PREMIUM CREDIT Employer Name: Name of Contact Person: Telephone#: Policy#: (IHUB-5J99803-5-17) Effective Date of Policy: 07-01-17 I am submitting a copy of my workplace safety program that meets the requirements of Section 440.1025, Florida Statutes. I certify that this safety program has been implemented in my workplace and is being maintained as submitted to my carrier. This is to certify that my workplace safety program meets or exceeds the following provisions as provided for in Section 440.1025, Florida Statutes: 1) Written safety policy and safety rules 5) First aid 2) Safety inspections 6) Accident investigation 3) Preventative maintenance 7) Necessary record keeping 4) Safety training The workplace safety program and application I am submitting for the purpose of obtaining a premium credit do not contain any misleading or untrue information. I am aware that I may be subject to an on-site inspection by my carrier, for the purpose of validating the accuracy of this information. I am aware that if I knowingly and willfully falsify or conceal a material fact, make a false, fictitious or fraudulent statement or representation; or make or use any false document knowing the document to contain any false, ficti- tious or fraudulent entry or statement to my carrier of workers compensation insurance under Section 442, Florida Statutes, I will be guilty of a misdemeanor of the second degree, punishable as provided in sections 775.082 or 775.083, Florida Statutes, and will be subject further to a penalty in the amount of $500 a day, not to exceed $50,000 for each occurrence; and I am also aware that if I, in any matter within the jurisdiction of the division, knowingly and willfully falsify or con- ceal a material fact, make any false, fictitious, or fraudulent statement or representation, or make or use any false document, knowing the same to contain any false, fictitious, or fraudulent entry, that I commit a misdemeanor of the second degree, punishable as provided in sections 775.082 or 775.083, Florida Statutes. Moreover, I under- stand that an employer who commits such an act will be subject further to a penalty in the amount of$500 a day, not to exceed $50,000 for each occurrence. Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. State of Florida County of Sworn to, or affirmed, and subscribed before me (Signature) this day of 20 , by (Print Name and Title) (Date) (Signature of Notary) (Expiration Date and Number) W09N8B05 16A16•. . NAMED INSURED: METRO FORECASTING MODELS LLC M POLICY NUMBER: (IHUB-5J99803-5-17) +� EFFECTIVE DATE: 07-01-17 N U A L GUNTHER OPERATOR: MANUALLY INSERT 1 COPIES OF THE J ................................. ................................ ................................. FLORIDA OVERSIZED POSTING NOTICES I� WO9P1 - (ENGLISH) S E AND R W09P2 - (SPANISH) ATTACH STICKERS THAT MATCH DATA BELOW: R EMPLOYER—Name: METRO FORECASTING MODELS LLC i E 9001 HIGHLAND WOOD BLVD SUITE i Address: BONITA SPRINGS FL 34134 CARRIER—Name: THE TRAVELERS INSURANCE COMPANIES Address: (VARIES BY LOCATION) AGENT—Name: AUTOMATIC DATA PROC INS POLICY NUMBER: (IHUB-5J99803-5-17) R E D WO9X1 V10 1 6 A 16 M A U ...:............................ L . I N S' See instructions on other side. ..............................: T R E Q U I E 16 A1 M A U A L STICKER LABELS AND/OR POSTING NOTICES FOR MANUAL INSERT I FOR POLICY PRINTED IN JOB #: G6640PNM N S E Named Insured: METRO FORECASTING MODELS LLC R T . Policy Number: (IHUB-5J99803-5-17) Effective Date: 07-01-17 F O M ...............................:. ................................ ................................. ................................ ................................. A T I 0 1 6 A 1 6 M A N J A N S E R T :......... 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W W Z r W W Z >. 0 0 -J a a a a 4 sa s s 0 s W W W W 1 6 A 1 6 TRAVELERS J WORKERS COMPENSATION AND ONE TOWER SQUARE HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY OVERPRINT PAGE POLICY NUMBER: (IHUB-5J99803-5-17) INSURED'S NAME: METRO FORECASTING MODELS LLC POLICY EFFECTIVE: 07-01-17 POLICY EXPIRY: 07-01-18 NEW/RENEWAL: N SOLICITOR: L5 SAI: 6249x7211 RESPONSIBILITY: I MSI: I SIC CODE: 7374 PAYMODE/DIRECT BILL CODE: P AUDIT FREQUENCY: A REINSURANCE: WATCH FILE: 0 SURVEY CODE: 2 NEG COMM: PROGRAM CODE: U10 NBR OF POL IN SAI: AGENCY BILL: Y AMS BINDER#: PARENT FEIN: 473162367 NAICS: 518210 PKG POL NBR: UNKNOWN STATE PREDOMINANT CLASS&SYMBOL (* indicates if selected as Policy predominant) ST POLICY ST ST POLICY ST ST SYMBOL PREDOM CLASS ST SYMBOL PREDOM CLASS FL IHUB * 8810 COMMISSION/INSTALLMENT SUMMARY ACCT EFF GROSS COMM MO DATE AMT RATE 07-17 07/01/17 555.00 .2500 TOTALS $ 555.00 OFFICE: PAYROLL 70A PRODUCER: AUTOMATIC DATA PROC INS XV770 RATER: AD ISSUE DATE: 06-06-17 CHANGE EFFECTIVE DATE: 07-01-17 WUNT6H96 16A16 WORKERS COMPENSATION NET RATE SUPPLEMENT NAMED INSURED: METRO FORECASTING MODELS LLC QUOTE NO: (IHUB-5J99803-5-17) POLICY PERIOD: 07-01-17 TO 07-01-18 DATE: 06-06-17 EXPENSE CONSTANT- FLAT CHARGE: $ INCLUDED LOSS CONSTANT- FLAT CHARGE: $ INCLUDED TOTAL - FLAT CHARGES: $ INCLUDED CLASS STATE LOCATION CODE DESCRIPTION NET RATE FL 001 8810 CLERICAL OFFICE EMPLOYEES NOC .5550 WUNM2D06 PAGE NO.: 1