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� � VILLAGE OF TEQUESTA
- AGENDA ITEM TRANSMITTAL FORM
1. VILLAGE COUNCIL MEETING:
Meeting Date: Meeting Type: Regular Ordinance #: Click here to enter text.
March 13, 2014
Consent Agenda: Yes Resolution #: Click here to enter text.
Originating Department: Manager
2. AGENDA ITEM TITLE: (Wording form the SUBJECT line of your staff report)
1. Per Village Ordinance we are presenting the following agreements, proposals, commitments and
memorandum of understanding to Council:
3. BUDGET / FINANCIAL IMPACT:
Account #: Various Amount of this item:
Various
Current Budgeted Amount Available: Amount Remaining after item:
Budget Transfer Required: No Appropriate Fund Balance: No
4. EXECUTIVE SUMMARY OF MAJOR ISSUES: (This is a snap shot description of the agenda item)
1. Per Village Ordinance we are presenting the following agreements, proposals,
commitments and memorandum of understanding to Council:
a. ASI Paving, Incorporated Contract # B-14-010, Restriping per the December 2013 Road
Assesment - $2,286.00.
b. ASI Paving, Incorporated Contract # B-14-009, Asphalt repairs to the Country Club walking
paths. - $1, 725.00.
c. Palm Beach/Treasure Coast Affiliate Agreement - allowing the Village of Tequesta general
contact information to be shared to helpline callers within Palm Beach/Treasure Coast area.
There is no charge for this service.
5. APPROVALS: - �
Dept. Head: �"'T''� in ce �et�r: �Reviewed for Financial
Sufficiency
� No Financial Impact
Attorney: (for legal sufficiency) Yes ❑ No ❑
Village Manager:
• SUBMIT FOR COUNCIL DISCUSSION: ❑
• APPROVEITEM: ❑
• DENY ITEM: �
Form amended 08/26/08
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ESTI MATE
Village of Tequesta , January 17, 2014
345 Tequesta Drive B-14-010
Tequesta, FL 33469 Page 1 of 1
Attn: Matt Haluck .
, Ph: (
Fax: (�� Re: Pavement Markings
Email: mhaluckCa�teQUesta.org Per Road Assessment December 2013
1. As per supplied Diagram Map, restripe with DOT Approved paint (32) Stop Bars with
Double Yellow Divider Lines, and Merge with arrows
$ 2,286.00
Notes:
1. Permit Fees, if required, to be billed for actual.
2. Engineering, Plans, Surveys, Lay Outs, As-Builds, Testing, Inspections, not included
3. ASI Paving Inc. vvill provide Re-Stripe/Stripe with approved methods and practices. We do not
imply; improving, changing, difFering and/or creating new or other services and will not be liable
for future claims after work has been completed, accepted and paid for. We will offer technical
support to Customer/Owner for the purpose of assisting in records, data etc. and all legal fees
will be incurred by Customer/Owrner
4. Payment due upon completion.
ASI Paving Incorporated will provide the necessary labor, materials and equipment in accordance
with this agreement as outlined for the sum of:
$ 2,286.00
Authorization Owner/Owners Rep. Contractor
Date ; 7-/�,F—/�
,
Printed Name .� �('_hUl �l. ; .� t,�'�ZO
Signature
�
Title � �I�CL �' �(�
Notes:
Acxeptance to this contract will limit owner and contractor, as set forth and any changes, delefions, and or additions will be agreed upon
prior to commencemerrt of work.
P.O Box 741272 • Boynton Beach, Florida 33474-1272
Telephone: (561) 737-2024 • Sta.tewide 1-888-577-0100 • Fax: (561) 784-9560
ADDENDUM
Public Records: In accordance with Sec. 119.0701, Florida Statutes, the Contractor
must keep and maintain this Agreement and any other records associated therewith and that are
associated with the performance of the work described in the Scope of Services. Upon request,
the Contractor must provide the public with access to such records in accordance with access and
cost requirements of Chapter 119, Florida Statutes. Further, the Contractor shall ensure that any
exempt or confidential records associated with this Agreement or associated with the
performance of the work described in the Scope of Services are not disclosed except as
authorized by law. Finally, the Contractor shall retain the records described in this paragraph
throughout the performance of the work described in the Scope of Services, and at the conclusion
of said work, transfer to the Village, at no cost to the Village, all such records in the possession
of the Contractor and destroy any duplica.tes thereo£ Records that aze stored electronically must
be transferred to the Village in a format that is compatible with the Village's information
technology systems.
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C�NTRACT AUTHORIZATI�N
Village of Tequesta January 17, 2014
345 Tequesta Drive B-14009
Tequesta, FL 33469 Page 2 of 2
Attn: Matt Haluck
Ph: (
Fax: -
Email: mhaluck@tequesta.org
Re: Asphalt repairs
County Club Walking Path
ASI Paving Incorporated will provide the necessary labor, materials and equipment in accordanc�
with this agreement as outlined for the sum of:
initials
1, County Club to County Line
A. Repair Marked areas $ 850.00
B. Repafr Misc. areas $ 200.00
2. County Club South to Tequesta Drive
A. Repair Marked areas $ 475.0�
B. Repair Misc. areas $ 200.00
Authorization Ownerl ers Rep. Contractor
Date �� / �—/�
Printed Name l�lt ���1 � 1/(,��
Signature � — �
Title 1� � � �- ���I��CL
Notes:
Acceptance to thls c.ontrad will Ifmft owner and corttreclor, as set for•th and any changes, deleHons, and or addiUons arill 62 agreed upon
prior to commencement of work.
P.O Box 741272 • Boyaton Beach, Florida 33474-1272
Telephone: (56]) 737-202�1 • Stata�vide 1-888-577-0100 • Fax: (56l) 7849560
ADDENDUM
Public Records: In accordance with Sec. 119.0701, Florida Statutes, the Contractor
must keep and maintain this Agreement and any other records associated therewith and that are
associated with the performance of the work described in the Scope of Services. Upon request,
the Contractor must provide the public with access to such records in accordance with access and
cost requirements of Chapter 119, Florida Statutes. Further, the Contractor shall ensure that any
exempt or confidential records associated with this Agreement or associated with the
performance of the work described in the Scope of Services are not disclosed except as
authorized by law. Finally, the Contractor shall retai.n the records described in this paragraph
throughout the performance of the work described in the Scope of Services, and at the conclusion
of said work, transfer to the Village, at no cost to the Village, a11 such records in the possession
of the Contractor and destroy any duplicates thereof. Records that are stored electronically must
be transfened to the Village in a format that is compatible with the Village's information
technology systems.
floln, geasl�,'rreasure ev�sr�
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AFFILIATE RGREEMENT
Ta ensure cantinuity �f eare and support to clierrts, 211 Palm E3each{freasure Goast enters into the
fvllowing agreement writh:
�Ilage of Tequesta CICS1317
(Prirrt or type paur agency name here.)
�91 Palm BeaehlTreasure Goast agrees:
1. Tv refer callers, who meet the eligibility r�quirement(s� of the Affiliate, to t�e Affiliate without
regard to race, color, creed, disabilifi�, national o�gin, age, se�c, se�ual orientation or economic
status for assessm�ntJon-going senrices.
2. Tv be available as a resvurce to the #�ffiliate's clients 24 hvurs a day for telephone counseling and
infarmation and referral to cammunit� res�urces.
3. To be available tv the affiliate's staff for infarmation about and referrals to communit� resvurces.
The �ffiliate agrees:
1. To receive clients, vuho meet the eligibility requiremerrt�s), writhout regard to race, ealor, creed,
disabilit�r, n�tivnal vrigin, �ge, se�, se�ual onentation or econ�mic status whv �re referred by 211
Palm BeaehlTreasure Coast.
�. To ad�ise clients af the 24hour availability of �1� Palm �eachlTreasure Cvast senrices.
3. To advise staff vf the availabilit�r af 211 Palm BeachlTreasure Caa� as a resource.
4. To inform �19 Palm �eachlTreasure Cvast when ehanges arise vuithin the �ffiliate.
5. That informativn pravided is true and �ecurate to the best af their I�owledge and that this
information may be included in publish�d materials and in local or statewide databases.
6. Ta prrnride �11 Palm BeaehlTreasure Coast a yearly farmal update when requ�sted beginning at
the start of each catendar yearfor accuracy, deletivn and new c�ntent. Ageneies can update
farmally during the year using the anline update pracess proactively an the w�bsite.
This letter of agreement uvill remain in force until terminated by either part� contingent upon thirt�r �30� �
days written nvtice.
�11 P�LM BEACHITI�EASURE CQAST: AFFILI�TE:
/���� � .
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�usan K. Buza, ecutive Directvr
Januarv 3, 2a14 � � �'
Qate Signed Date Signed
11 /27/2013 Page 5 of 5
211 Palm Beach Treasure Coast I�ormetion from 211 Community Resource Database
i
a
Fax Cover Sheet �
271 Palm Beach/Tressur9e Coast
PO Box 3588
Lan�na, FL 33465
To: Judi Hechtrnan
Phone: (561) 383-2162
Emaii: judi.hechtman@�11 pbtc.org
Fax: (561 � 383-2172
Date• �- / t Pages: �
From:
Agency Name: � U���
Cor�Yact Name: °�, �� ��.(� � I l 4�(� �
Phone Number: ��Q ( s � ��^ Q� � �
I have reviewed the details of our agencylsite(s►/sen►ice�s)� and:
The irrtormation is corre�t
We are encl�ing co�ections �
.
Viliage of Tequesta Agency #: CICS1317
345 Tequesra Drive Last Formal Update: 3/11/2013
Tequesta, FL 33469 Recor9d Owned By: CICS
Date Entered: 11 /5/2010
Mailing Address: Aftli�iate Agreement Date: 3/11/2013
345 TEQUESTA DR
Tequesta, FL 33469 �
Phone Number EXT DeptlCont�ct Agency Fax
(561) 768-0460 (561) 768-0697
Agency CouMy: PALM BEACH Year Incorporated:
Also Known As: IRS Status:
Agency Type: Muniapal Govemment Agency FEIN:
Person In Charge: IlAichael R. Couao, Jr. License/Accred.:
In Charge Title: vllage Manager Annual Budget: $0.00
Email: mcou�o�tequesta.org Source of Funds:
VYebsite: wruvw.tequesta.org/ , ' , ,�
Hours of O�ra�on: Monday-Friday / 8:30 am-5 pm
Notes/Description: Municipal govemment Council meets 2nd Thursday,Jy�stn� �; pd ��
k .� _ ,# ; � � � - � , � � �
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Si�� Nae�ae: Tequesta Fire Department Sl�� !D: CICS1317AC
357 Tequesta Drive Last Fo��l lJpdate: 3/11/2013
Tequesta, FL 33469
11/27/2013 Page 1 of 5
211 Palm Beach Treasure Coast Information from 211 Community Re�urc� Database
Si�e h�iaiBing Ad �s:
J�aT US �b
Tequ� , FL 3 -3273
�
Phoroe Nuenber EXl' Dept/Contact Site �ax
()- 911 TO REPORT A FIRE
(561) 768-0550 f-7�� � �
Please Coe�aplete th6s ��c�on �nd inc9ude/�end a co�v of vour AFiCA License, if this s�t� provides:
Adult Day Care, Family Care Home, ALF, Nursing Home, Home Health Agenc�►, Homemaker andCompanion Senrice, Nurse Registry
Facili4ylProvitler Type:
Liceeese Numbec: License Expiration Date:
Also iCnown As:
Person In Charge: James Weinand �
�,,
In Charge T1YJe: Fire Chief Site Access�b6lity:
Site Email: Site Bus Access:
Sit� 1iV�bsa#e: . L,J la1 EL/ .��$��St�a. . o�'q
Si4� Houe�: 24 Hours A Day / 7 Days A Week �
NoteslDe�crip�ion: Local number to contact an individual fire department.
TO REPORT A FIRE, DIAL 911.
— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —
Site Seroice ID: CICS010709
Program Name:
Taxonomy Code Site Service
JR-19002000 Fire ControUExtinction
Target Terms:
In Charge: Title:
Seroice Phone: Ext: Phone 2: Fax:
Site Serolce Email:
Site Service YVebsite:
Site Service Fees: No fees charged.
Site Service Hours: 24 Hours A Day / 7 Days A Week
Servlce Area: Village of Tequesta
Service Intake Process: Contact by phone.
Seroice Eligibilfty: No restrictions.
Docunoent$ Requir�d:
Language(s): English.
Notes/Description: Loc�l number to contact an individual fire departrnent.
TO REPORT A FIRE, DIAL 911.
11/27/2013 Page 2 of 5
211 Palm Beach Treasure Coast Irrtormation from 211 Community R�aourc� Database
o e
Su�e Mame: Tequesta Police Department Sit� ID: CICS1317AA
357 Tequesta Drive Last Fo�enal Update: 3/11/2013
Tequesta, FL 33469
S' Mailing ddre�s:
Te B , FL 9-3273 � �-� ��
Phone Nurnber EXT D�p�/Contact Site Fax
(561) 768-0500 (561) 768-0695
Please Complete this section and include/send a co�v of vour AFICA License, if this s�te provides: "
Adult Day Care, Family Care Home, ALF, Nursing Home, Home Health Agency, Homemaker andCompanion Senrice, Nurse Registry
Facllity/Provider Type:
Liceras� Number: Lic�nse Expiration Date: .
Also 6(nown As:
Person In Charge: Christopher Elg
In Charge litle: Police Chief Sife Accessibility:
Sit� Email: Site Bus Access:
Site uVeb�i4e: wNUw.tequesta.org ,
Site Hours: 24 Hours/7 Days A Week
Notes/Desceiption: Local law enforcement agency.
— — — — — — — — — — — — — — — — — — — —�— — — — — — — — — — — — — — — —
S�te Seroice ID: CICS010707
Program Name:
Taxonomy Code Site Service
FL-6500 Municipal Police
Target Terms:
In Charge: Title:
Seroice Phone: Ext: Phone 2: Fax:
Site Seroice Email:
Site Seroice Website:
Site Sewice Fees: No fees charged.
Site Service Hours: 24 Hour�/7 Days A Week
Seroice Area: Tequesta
Sewice Int�ke Process: Call.
Service Eligibility: No restrictions.
Documents Required:
Language(s): Engiish.
Notes/De.script�on: Local law enforcement agency.
11/27/2013 Page 3 of 5
211 Palm B�ch Treasure Coast Infortnation from 211 Community Resource Database
e a
Sat� INart9e: Vllage of Tequesta S�te ID: CICS1317A6
345 Tequesta Drive Last Formal Update: 3/11/2013
Tequesta, FL 33469
S6te i�lailing Addr�:
345 TEQUESTA DR
Tequesta, FL 33469
Phone 6Vumb�r E�Y Dept/Contact S�� ��
(561) 768-0700 (561) 768-0697
Please Complete this sect6on and include/send a coav of vour AFlCA License, i� this site provicles:
Adult Day Care, Family Care Home, ALF, Nursing Home, Home Health Agency, Homemaker andCompanion Senrice, Nurse Registry
Facility/Provider Type:
L,icense Number: License Expiration Da#e:
Also Knot�rea As:
P�rson In Charge: IVlichael R. Cou7zo, Jr.
In Charge T�le: �Ilage Manager Site Accessib6lity:
Site Erreaii: Bus Access:
Site �il��i�e: wvvw.tequesta.org /
Si�e Hours: Monday-Friday / 8:30 am-5 pm �o
Notes/Description: Municipal govemment. Council meets 2nd Thursd y/,�pm.
— — — — — — — — — — — — — —
Site Senrice ID: CICS010708
Program Name:
Taxonomy Code Site Seroice
TD-6600.4500 Loc�l Officials Offices
Target Terms:
In Charge: Title:
Seroice Phone: Ext: Phone 2: Fax:
Site Senrice Email:
Site Service Website:
Site Seroice Fees: No fees charged.
Site Service Hour�: Monday-Friday / 8:30 am-5 pm
Service Arsa: vllage of Tequesta
Service Intake Process: Conta�t by phone.
Servlce Eligibility: No restrictions.
Documenis Required:
Language(s): English.
Not�/Description: Municipal govemment. Council meets 2nd Thursday / 7 pm.
11 /27/2013 Page 4 of 5
211 Palm B�ch Treasure Coast Information from 211 Community Resource Database
;
ADDENDUM
Public Records: In accordance with Sec. 119.0701, Florida Statutes, the Contractor
must keep and maintain this Agreement and any other records associated therewith and that are
associated with the performance of the work described in the Scope of Services. Upon request,
the Contractor must provide the public with access to such records in accordance with access and
cost requirements of Chapter 119, Florida Statutes. Further, the Contractor shall ensure that any
exempt or confidential records associated with this Agreement or associated with the
performance of the work described in the Scope of Services aze not disclosed except as
authorized by law. Finally, the Contractor shall retain the records described in this paragraph
throughout the performance of the work described in the Scope of Services, and at the conclusion
of said work, transfer to the Village, at no cost to the Village, all such records in the possession
of the Contractor and destroy any duplicates thereo£ Records that aze stored electronically must
be transferred to the Village in a format that is compatible with the Village's information
technology systems.
