LAKE
COUNTY
SCHOOLS
Superintendent:
School Board Members:
Susan Moxley, Ed.D.
District 1
Bill Mathias
District 2
Rosanne Brandeburg
District 3
Tod Howard
District 4
Debbie Stivender
District 5
Kyleen Fischer
Leading our Children to Success
Procurement Services
29529 CR 561  Tavares  FL 32778
(352) 253-6760  Fax: (352) 742-8516  http://lake.k12.fl.us
NOTICE OF AWARD
December 6, 2013
Mr. Scott Seck
Horizon Engineering Group, Inc.
2603 Maitland Center Parkway, Suite B
Maitland, Florida 32751
RE: RFQ #3735DB Civil Engineering Consultant Services – Continuing Contract
Dear Mr. Seck:
At their meeting held on November 18, 2013, the Lake County School Board approved contracts
for the above referenced RFQ as shown below. A complete copy of the Committee
recommendation/rankings letter is posted on the LCSB Purchasing Department’s website located
at http://lake.k12.fl.us. A copy of your contract is enclosed.
Booth, Ern, Straughan & Hiott, Inc. located in Tavares, Florida
Klima Weeks Civil Engineering, Inc. located in Altamonte Springs, Florida
Horizon Engineering Group, Inc. located in Maitland, Florida
Per contract specifications, it is your responsibility to provide the Purchasing Department with
current copies of your certificate of insurance naming the School Board of Lake County, Florida,
as an additional insured and to maintain the required coverages for the duration of the contract
term. If you have not already done so, please forward this information as soon as possible.
Failure to submit a fully completed original certificate of insurance signed by an authorized
representative of the insurer providing such coverage may cause your company to be in default
and subject to cancellation of the contract.
The contract will be in effect through November 17, 2014. Purchase orders will be issued as
needed. We look forward to working with you. If you have questions, please contact me at 352253-6766 or bennettd@lake.k12.fl.us.
Sincerely,
Diane Bennett, CPPO
Certified Purchasing Agent
Enclosure
“Equal Opportunity in Education and Employment”
C. CONFLICT OF INTEREST (ATTACHMENT A)
SECTION C - PAGE 1
D. CONTRACT ACCEPTANCE STATEMENT (ATTACHMENT B)
SECTION D - PAGE 1
E. LOCATION TABLE FORM (ATTACHMENT C)
SECTION E - PAGE 1
F. PUBLIC ENTITY CRIMES AFFIDAVIT (ATTACHMENT D)
SECTION F – PAGE 1
SECTION F – PAGE 2
SECTION F – PAGE 3
G. NON-COLLUSION AFFIDAVIT (ATTACHMENT E)
SECTION G – PAGE 1
H. FEDERAL DEBARMENT FORM (ATTACHMENT F)
SECTION H – PAGE 1
The following chart summarizes our team structure.
Certified Purchasing Agent
Diane Bennett, CPPO
Point of Contact/Project Manager
Shannon Medeiros, PE
Civil Engineering Services
Site Design
Horizon Engineering Group
Scott Seck, PE
Jerry Warren, PE
Sarah Matin, PE
Drainage Design
Horizon Engineering Group
Pete Manz, PE
Lisa Olivera, PE
Kim Duong, PE
The following abbreviated resumes (Full resumes can be found in Tab I – SF 330) highlight the
qualifications of the key staff indicated above. Each are familiar with the sometimes urgent nature of task
orders that may be assigned under a continuing services contract, and are prepared to strive to meet each
request in a timely manner. All of the team members presented live in the Central Florida region, and
therefore within a short drive to any LCSB site.
SECTION J - PAGE 2
Client#: 1048426
ACORD
HORIZENG4
DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
TM
12/11/2013
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).
CONTACT
NAME:
PHONE
(A/C, No, Ext):
E-MAIL
ADDRESS:
PRODUCER
USI Insurance Services, LLC,
1715 N. Westshore Blvd. Suite 700
FAX
(A/C, No):
813 321-7500
813 321-7525
INSURER(S) AFFORDING COVERAGE
Tampa, FL 33607
NAIC #
Hartford Casualty Insurance Co
INSURER B : Phoenix Insurance Co
INSURER C : Everest National Insurance Co
29424
25623
10120
INSURER A :
INSURED
Horizon Engineering Group, Inc.
2603 Maitland Center Parkway
Suite B
Maitland, FL 32751
COVERAGES
INSURER D :
INSURER E :
INSURER F :
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
LTR
A
GENERAL LIABILITY
X
X
POLICY NUMBER
X 21SBATO5474
POLICY EFF
POLICY EXP
(MM/DD/YYYY) (MM/DD/YYYY)
04/01/2013 04/01/2014
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE
C
ADDL SUBR
INSR WVD
TYPE OF INSURANCE
X
OCCUR
LIMITS
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 2,000,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 2,000,000
$ 1,000,000
GENERAL AGGREGATE
$ 4,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PROPOLICY
LOC
JECT
PRODUCTS - COMP/OP AGG
$ 4,000,000
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY (Per person)
$
X
ANY AUTO
ALL OWNED
AUTOS
X
HIRED AUTOS
X
UMBRELLA LIAB
X
$
X
BA3D624181
10/01/2013 10/01/2014
SCHEDULED
AUTOS
NON-OWNED
AUTOS
BODILY INJURY (Per accident) $
PROPERTY DAMAGE
(Per accident)
$
$
A
EXCESS LIAB
X
X
OCCUR
21SBATO5474
04/01/2013 04/01/2014
CLAIMS-MADE
X RETENTION $10000
DED
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE
N/A
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
B Professional
Liability
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
$
WC STATUTORY LIMITS
OTHER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT
79AE001429131
$
04/01/2013 04/01/2014 $1,000,000 per claim
$1,000,000 annl aggr.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Professional Liability coverage is written on a claims-made basis.
RE: Lake County Schools, RFQ#3735DB Civil Engineering Consultant Services; School Board of Lake County,
Florida is an Additional Insured with respect to General Liability and Auto Liability.
CERTIFICATE HOLDER
CANCELLATION
School Board of Lake County,
Florida
29529 CR 561
Tavares, FL 32877
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
© 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05)
1 of 1
#S11406758/M10985841
The ACORD name and logo are registered marks of ACORD
KEBEW
This page has been left blank intentionally:
DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
12/23/2013
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).
Keevily Spero Whitelaw, Inc.
500 Mamaroneck Ave
CONTACT
Kyle McEvily
NAME:
PHONE
(A/C, No, Ext): (914)381-5511
E-MAIL
ADDRESS: kmcevily@keevily.com
Harrison
INSURER A :
PRODUCER
FAX
(A/C, No): (914)381-1134
INSURER(S) AFFORDING COVERAGE
NY 10528
NAIC #
Lumbermen's Underwriting
INSURED
23108
INSURER B :
Innovative Employer Solutions Inc
2836 5th Avenue North
INSURER C :
INSURER D :
INSURER E :
Saint Petersburg
FL 33713
INSURER F :
CERTIFICATE NUMBER:13-14 MSTR INNOVATIVE
COVERAGES
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
LTR
TYPE OF INSURANCE
ADDL SUBR
INSR WVD
POLICY NUMBER
POLICY EFF
POLICY EXP
(MM/DD/YYYY) (MM/DD/YYYY)
GENERAL LIABILITY
LIMITS
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
PROPOLICY
LOC
JECT
PRODUCTS - COMP/OP AGG
$
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY (Per person)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
OCCUR
$
$
SCHEDULED
AUTOS
NON-OWNED
AUTOS
$
$
BODILY INJURY (Per accident) $
PROPERTY DAMAGE
(Per accident)
$
$
A
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
EXCESS LIAB
CLAIMS-MADE
AGGREGATE
$
DED
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE
N/A
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
$
Y
X
WC STATUTORY LIMITS
OTHER
E.L. EACH ACCIDENT
420770
10/1/2013 10/1/2014
$
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT
$
1,000,000
1,000,000
1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
RE: RFQ #3735DB Civil Engineering Consultant Services – Continuing Contract. Waiver of subrogation
applies. Evidence of Insurance.
CERTIFICATE HOLDER
CANCELLATION
The School Board of Lake County, FL
201 West Burleigh Boulevard
Tavares, FL 32778
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
T McEvily III, CPCU/K
ACORD 25 (2010/05)
INS025 (201005).01
© 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
WORKERS’COMPENSATION AND EMPLOYERS’LIABILITY INSURANCE POLICY
WC 00 03 13
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
ENDORSEMENT
This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a
different date is indicated below.
(The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.)
This endorsement, effective on 12-18-2013 at 12:01 A.M. standard time, forms a part of
(DATE)
Policy No.
420770
(Effective 10-01-2013)
of the Lumbermen's Underwriting Alliance
issued to
Endorsement No.
(Carrier Code
18376)
INNOVATIVE EMPLOYER SOLUTIONS INC (ETAL)
Premium (if any) $ 100 Minimum to be adjusted at audit.
_____________________________________________
Authorized Representative
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce
our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you
perform work under a written contract that requires you to obtain this agreement from us.)
This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule.
Schedule
CERTIFICATE HOLDER:
SCHOOL BOARD OF LAKE COUNTY MEMBERS, EMPLOYEES
201 W BURLEIGH BLVD
TAVARES FL 32778
JOB DESCRIPTION: DESIGN WORK
CLIENT COMPANY:
HORIZON ENGINEERING GROUP
2500 MAITLAND CENTER PARKWAY
MAITLAND FL 32751
DATED: 12-23-2013
Copyright 1982, 1983 National Council on Compensation Insurance
WC 124
(Ed. 4-84)
DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
4/15/2015
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).
CONTACT
Robert Barrow, Jr.
NAME:
PHONE
(770)338-7392
(A/C, No, Ext):
E-MAIL
ADDRESS: bbarrow@barrowgroup.com
PRODUCER
BARROW GROUP LLC
110 E. Crogan St.
FAX
(A/C, No): (770)338-5440
INSURER(S) AFFORDING COVERAGE
Lawrenceville
GA
30046
INSURER A :AMTrust
INSURED
NAIC #
Financial Services
INSURER B :
Innovative Employer Solutions, Inc.
2936 5th Avenue North
Suite 101
St. Petersburg
FL 33713
INSURER C :
INSURER D :
INSURER E :
INSURER F :
CERTIFICATE NUMBER:HORIZON ENGINEERING
COVERAGES
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
LTR
ADDL SUBR
INSD WVD
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFF
POLICY EXP
(MM/DD/YYYY) (MM/DD/YYYY)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE
OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
PROPOLICY
LOC
JECT
LIMITS
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
PRODUCTS - COMP/OP AGG
$
$
OTHER:
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY (Per person)
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
$
SCHEDULED
AUTOS
NON-OWNED
AUTOS
$
$
BODILY INJURY (Per accident) $
PROPERTY DAMAGE
(Per accident)
$
$
A
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
EXCESS LIAB
CLAIMS-MADE
AGGREGATE
$
DED
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
$
X
Y/N
PER
STATUTE
OTHER
E.L. EACH ACCIDENT
N/A
TWC3423454
10/1/2014
10/1/2015
$
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT
$
1,000,000
1,000,000
1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CLIENT COMPANY: HORIZON ENGINEERING GROUP
CERTIFICATE HOLDER
Lake County Schools
29529 CR 561
Tavares, FL 32778
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
R Barrow, Jr./MOLLY
ACORD 25 (2014/01)
INS025 (201401)
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD