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#12-5902 (Southern Sanitation, Inc.)A G R E E M E N T 12-5902 for Sewage Hauling THIS AGREEMENT, made and entered into on this (90,�day of J 2012, by and between Southern Sanitation, Inc., authorized to do business in the State' of Florida, whose business address is PO Box 7736, Naples, FL. 34101, hereinafter called the "Contractor" and Collier County, a political subdivision of the State of Florida, Collier County, Naples, hereinafter called the "County ": WITNESSETH: 1. COMMENCEMENT. This Agreement shall commence on the date of the issuance of a Purchase Order. The contract term shall be for an initial two (2) year period, with an option by the parties to renew the contract yearly for a total contract length not to exceed four (4) years. The County shall give the Contractor written notice of the County's intention to extend the Agreement term not less than ten (10) days prior to the end of the Agreement term then in effect. 2. STATEMENT OF WORK. The Contractor shall provide Sewage Hauling in accordance with the terms and conditions of Bid #12 -5902 and the Contractor's proposal referred to herein 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 Contractor and the County Project or Contract Manager or his designee, in compliance with the County Purchasing Policy and Administrative Procedures in effect at the time such services are authorized. 3. COMPENSATION. The County shall pay the Contractor for the performance of this Agreement the aggregate of the units actually ordered and furnished at the unit price of three hundred dollars ($300.00) per hour, together with the cost of any other charges /fees submitted in the proposal. Any additional items and /or services may be added by written contract modification in compliance with the Purchasing Policy. Any County agency may purchase products and services under this contract, provided sufficient funds are included in their budget(s). Payment will be made upon receipt of a proper invoice and upon approval by the Project Manager or his designee, and in compliance with Chapter 218, Fla. Stats., otherwise known as the "Local Government Prompt Payment Act ". Page 1 of 7 3.1 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 contract. 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. 4. SALES TAX. Contractor 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. 5. NOTICES. All notices from the County to the Contractor shall be deemed duly served if mailed or faxed to the Contractor at the following Address: Southern Sanitation, Inc. PO Box 7736 Naples, FL. 34101 Attention: Matthew Beebe, President Phone: 239 - 352 -2600 Fax: 239 - 352 -6600 All Notices from the Contractor to the County shall be deemed duly served if mailed or faxed to the County to: Collier County Government Center Purchasing Department 3327 Tamiami Trail, East Naples, Florida 34112 Attention: Purchasing & General Services Director Telephone: 239 -252 -8975 Facsimile: 239 - 252 -6480 The Contractor 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. 6. NO PARTNERSHIP. Nothing herein contained shall create or be construed as creating a partnership between the County and the Contractor or to constitute the Contractor as an agent of the County. 7. 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 Contractor. 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 Contractor. The Contractor shall also be solely responsible for Page 2 of 7 payment of any and all taxes levied on the Contractor. In addition, the Contractor 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 Contractor agrees to comply with all laws governing the responsibility of an employer with respect to persons employed by the Contractor. 8. NO IMPROPER USE. The Contractor 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 Contractor or if the County or its authorized representative shall deem any conduct on the part of the Contractor to be objectionable or improper, the County shall have the right to suspend the contract of the Contractor. Should the Contractor 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 Contractor further agrees not to commence operation during the suspension period until the violation has been corrected to the satisfaction of the County. 9. TERMINATION. Should the Contractor 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 immediately 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. 10. NO DISCRIMINATION. The Contractor agrees that there shall be no discrimination as to race, sex, color, creed or national origin. 11. INSURANCE. The Contractor shall provide insurance as follows: A. Commercial General Liability: Coverage shall have minimum limits of $1,000,000 Per Occurrence, $1,000,000 aggregate for Bodily Injury Liability and Property Damage Liability. This shall include Premises and Operations; Independent Contractors; Products and Completed Operations and Contractual Liability. B. Business Auto Liability: Coverage shall have minimum limits of $1,000,000 Per Occurrence, Combined Single Limit for Bodily Injury Liability and Property Damage Liability. This shall include: Owned Vehicles, Hired and Non -Owned Vehicles and Employee Non - Ownership. C. 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 $1,000,000 for each accident. Page 3 of 7 D. Pollution Liability Insurance: Coverage shall have a minimum of $1,000,000 per occurrence. Special Requirements: Collier County Government shall be listed as the Certificate Holder and included as an Additional Insured on the Comprehensive General Liability Policy. Current, valid insurance policies meeting the requirement herein identified shall be maintained by Contractor during the duration of this Agreement. Renewal certificates shall be sent to the County ten (10) days prior to any expiration date. There shall be a thirty (30) day notification to the County in the event of cancellation or modification of any stipulated insurance coverage. Contractor shall insure that all Sub Contractors comply with the same insurance requirements that he is required to meet. The same Contractor shall provide County with certificates of insurance meeting the required insurance provisions. 12. INDEMNIFICATION. To the maximum extent permitted by Florida law, the Contractor shall 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, to the extent caused by the negligence, recklessness, or intentionally wrongful conduct of the Contractor or anyone employed or utilized by the Contractor 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. CONTRACT ADMINISTRATION. This Agreement shall be administered on behalf of the County by the Public Utilities Waste Water Department. 14. CONFLICT OF INTEREST: Contractor 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. Contractor further represents that no persons having any such interest shall be employed to perform those services. 15. COMPONENT PARTS OF THIS CONTRACT. This Contract consists of the following component parts, all of which are as fully a part of the contract as if herein set out verbatim: Contractor's Proposal, Insurance Certificate, Bid #12 -5902 Specifications/ Scope of Services. Page 4 of 7 16. 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. 17. 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, 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 contract held by the individual and/or firm for cause. 18. IMMIGRATION LAW COMPLIANCE. By executing and entering into this agreement, the Contractor is formally acknowledging without exception or stipulation that it is fully responsible for complying with the provisions of 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. Failure by the Contractor 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. 19. 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 contract to other governmental entities at the discretion of the successful proposer. 20. 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. 21. ADDITIONAL ITEMS /SERVICES. Additional items and /or services may be added to this contract in compliance with the Purchasing Policy. 22. 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 Contractor 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 Contractor with full decision - making authority Page 5 of 7 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. 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. 23. STANDARDS OF CONDUCT: PROTECT MANAGER, SUPERVISOR, EMPLOYEES. The Contractor shall employ people to work under this Agreement who are neat, clean, well - groomed and courteous. Subject to the American with Disabilities Act, Contractor shall supply competent employees who are physically capable of performing their employment duties. The County may require the Contractor to remove an employee it deems careless, incompetent, insubordinate or otherwise objectionable and whose continued employment to perform work under this Agreement is not in the best interest of the County 23.1 The Contractor's personnel and management to be utilized for this project shall be knowledgeable in their areas of expertise. The County reserves the right to perform investigations as may be deemed necessary to insure that competent persons will be utilized in the performance of the contract. The Contractor shall assign as many people as necessary to complete the work on a timely basis, and each person assigned shall be available for an amount of time adequate to meet the requirements of the work. 24. ORDER OF PRECEDENCE: In the event of any conflict between or among the terms of any of the Contract Documents, the terms of the Agreement shall take precedence over the terms of all other Contract Documents. _ 25. ASSIGNMENT: Contractor 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 Contractor does, with approval, assign this Agreement or any part thereof, it shall require that its assignee be bound to it and to assume toward Contractor all of the obligations and responsibilities that Contractor has assumed toward the County. Page 6 of 7 IN WITNESS WHEREOF, the Contractor and the County, have each, respectively, by an authorized person or agent, hereunder set their hands and seals on the date and year first above written. Dwight E. $troo,'(� @C of Courts Br. O First Witness ire 1oca b - -p,7-)r.f 1 y*& /print witness name% /hint witness namef Approved as to form and legal sufficiency: Assistant c6lunty Attorney IEM 1 U PP.pA* rl Print Name Page 7 of 7 BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY, FLORIDA By: IL 4 W. " . Fred W. Coyle, Chairman SOUTHERN SANITATION, INC. Contractor By: f- l&ture Typed signature and title From:Suzanne Benejan FaXID:lns by Ken Brown Page 4 of 4 Date:8/22/2012 02:47 PM Page:4 of 4 SOUTH34 OP ID: SU 'x1, '411 CERTIFICATE OF LIABILITY INSURANCE D Y) 08122//2 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 321 -397 -3870 NAME: Insurance By Ken Brown, Inc. 321 - 397 -3888 PO BOX 948117 Maitland, FL 32794 -8117 David R. Griffiths PHONE FAX AIC No Ext : AIC No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC A INSURERA: Progressive Express 10193 $ 1,000,00 INSURED Southern Sanitation Inc INSURER B: North Pointe Insurance Company 27740 P.O. Box 7736 Naples, FL 34101 INSURER C: Rockhill Insurance Co. 11116/11'�� 11/16112 DAMAG 0 R NT D PREMISES Ea occurrence $ 100,00 INSURER D: CLAIMS -MADE 1K OCCUR INSURER E : INSURER F : MED EXP (Any one person) 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE IN POLICY NUMBER LICY FF� MMIDDIYWY 0 X MMfDDlYYYY LIMITS �-$ GENERAL LIABILITY li EACH 0CCU RR EN CE $ 1,000,00 B X COMMERCIAL GENERAL LIABILITY X 1,,2094117986 11116/11'�� 11/16112 DAMAG 0 R NT D PREMISES Ea occurrence $ 100,00 CLAIMS -MADE 1K OCCUR MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS- COMPIOP AGG $ 2,000,00 X I POLICY JECT 7 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1 000 OD BODILY INJURY (Per person) _ $ A X ANY AUTO 083584050 12/15/11 12/15/12 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED AUTOS NON -OWNED AUTOS $ UMBRELLA LIAB 7CLAIMS-MADIE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNERIEXECUTIVE YIN OFFICERfMEMBER EXCLUDED? F7 i NIA WC STATUS OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) if yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ C Pollution Liabilit RPKGE00390502 12/10/11 12/11/12 ;incident 1,000,00 Transportation I� laggregate 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Collier County Government is listed as additional insured as respects to General Liability per NP01 96 per written contract For any and all work performed on behalf of Collier County. Fax:239- 252 -6592 CERTIFICATE HOLDER CANCELLATION COLLIER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Collier Count Government Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 3327 Tamiami Trail East Naples, FL 34112 AUTHORIZED REPRESENTATIVE �-$ ACORD 25 (2010105) © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD From:Suzanne Benejan FaxIDAns by Ken Brown Page 2 of 4 Date:8f22/2012 02:47 PM Page:2 of 4 Southern Sanitation Inc 2094117986 COMMERCIAL GENERAL LIABILITY NP 01 96 0510 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTOMATIC ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Except as provided below, all other terms and conditions of this policy remain unchanged. The following provision is added to (SECTION 11), Who Is An Insured. 4. Any entity you are required in a written contract to name as an insured, is an additional insured (hereinafter called additional insured), but: a. Only as respects contracts that were executed prior to the occurrence of "bodily injury", "property damage" or "personal and advertising Injury", and b. Only with respect to liability for "bodily injury ", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or acts or omissions of those acting on your behalf in connections with your premises, "your work" for the additional insured, or acts or omissions of the additional insured in connection with the general supervision of "your work" to the extent set forth below: (1) The Limits of Insurance provided on behalf of the additional insured are not greater than those required by such contract. (2) All insuring agreements, exclusions and conditions of this policy apply. (3) In no event shall the coverages or Limits of Insurance in this Coverage Form be increased by such contract. c. Except when required otherwise by contract, this insurance does not apply to: (1) "Bodily injury" or "property damage" occurring after all work on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (2) `Bodily injury" or "property damage" occurring after that portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. (3) "Bodily injury" or "property damage" arising out of any act or omission of the additional insured(s) or any of their employees, other than the general supervision of work performed for the additional insured(s) by you. (4) "Property damage" to: (a) Property owned, used or occupied by or rented to the additional insured(s); (b) Property in the care, custody or control of the additional insured(s) or over which the additional insured(s) is for any purpose exercising physical control; or (c) "Your work" for the additional insured(s). d. With respect to additional insureds who are architects, engineers or surveyors, this insurance does not apply to "bodily injury," "property damage," "personal injury" or "advertising injury" arising out of the rendering of or the failure to render any professional services by or for you, including: (1) The preparing, approving, or failing to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or specifications; and (2) Supervisory, inspection or engineering services. e. The insurance afforded by this endorsement for the benefit of the additional insured shall be primary insurance, and any other insurance maintained by the additional insured shall be excess and non- contributory. f. No person or organization is an additional insured with respect to the conduct of any current or past partnership or joint venture that is not shown as a Named Insured in the declarations. NP 01 96 05 10 Page 1 of 1 From:Suzanne Benejan FaxlD:Ins by Ken Brown Page 3 of 4 Date:8/22/2012 02:47 PM Page:3 of 4 POLICY NUMBER: COM WERC1AL GENERAL LIABILITY CG 24 0410 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV -- COMMER- CIAL GENERAL LIABILITY CONDITIONS) is amended by the addi ion of the following. We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or'your work' done under a contract with that person or organization and included in the "products- completed operations hazard ". This waiver applies onlytothe person ororganization shown in the Schedule al,ove_ 2U JOW162 200MI4001 CG 24 04 '10 03 Copyright, Insurance Services Officei Inc., 1992 Page 9 of 1 0 • i —t�� i" 07 -10 -2012 \ti t,f JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 07109/2012 PERSON: BEEBE FEIN: 593717924 BUSINESS NAME AND ADDRESS: SOUTHERN SANITATION P.O. BOX 7738 NAPLES FL 34101 SCOPES OF BUSINESS OR TRADE: 1- SEWER CONSTRUCTION - ALL OPERA EXPIRATION DATE: 07109/2014 MATTHEW IMPORTANT: Pursuant to Chapter 440 . 05044, F.S., an officer of a corporation who elects exemption from this chapter by tiling a certificate of election under this section may not recover henefits or compensation under this chapter. Pursuant to Chapter 440.05112), F.S., Certificates of election to he exempt... apply only within the scope of the husiness or trade listed on the notice at election to be exempt. Pursuant to Chapter 440.054131, F.S., Notices of election to be exempt and ceffilicares Of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate me longer meets the requirements at this sactian for issuance of a certificate. The department shall revoke a eentiicaie at any time for failure of the person named on the certificate to meat the requirements of this section. QUESTIONS? 18501 413 -11 O'WC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION IMPORTANT F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who () CONSTRUCTION INDUSTRY elects exemption from this cnapter by filing a certificate of election CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA L under this section may not recover benefits or compensation under this WORKERS' COMPENSATION LAW - - -•^0 D chapter. EFFECTIVE: 07/09/2012 EXPIRATION DATE: 07/09/2014 Pursuant to Chapter 440.054127, F.S., Certificates of election to be PERSON: MATTHEW BEEBE H exempt., appfv only within the scope of the business or trade listed on FEIN: 593717924 E the notice of election to be exempt, NAME AND ADDRESS: E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt sourr+ ERN SANITATION SOUTHERN and certificates of election to be exempt shall be subject to revocation v.o. Rox 7736 if, at any time after the filing of the notice ar the issuance of the NAPLES, r1 34101 certificate, the person named on the notice or certificate no longer meet the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the SCOPE OF BUSINESS OR TRADE: person named an the certificate to meet the requirements of this I- SEWER CONSTRUC71ON - ALL OPERA section allESTIONS? (850) 413 -16179 CUT HERE * Carry bottom portion on the job, Iceep upper portion for your records. SW "C -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 6'd 0099Z9£6£Z uoge1lueS uaegInoS dZt, :6o Zb C)C 6nV