Okaloosa County BOCC — August 24, 2013 — RON Apron Hi Mast Lighting -VPS_Close-out Checklist with close-out documents — reading text

CONTRACT CLOSE-OUT CHECKLIST (To Be Prepared by the Purchasing Services Coordinator) DATE: oy rf} 2 TO: Contracts & Grants Manager, Finance Department Contracts & Grants Office SUBJECT: ContractNo. _€/2-/9§F-AP MANAGING DEPARTMENT: LY por CONTRACTOR'S NAME: BU Sith Ve&le, [pe PROJECT TITLE: KO yoo Ligh VEG Lan: 75 The attached has met the final payment contract requirement in subject contract. Yes No 1. Final Invoice a 2. Completed Contract/Lease Payment Approval Form A CJ 3. Close-Out Documents Yes No N/A a. Signed Release of Lien um C] LJ b. Proof of Completion Advertisement cue C] C] c. Certificate of Insurance va C] C] d. Consent of Surety to Final Payment cA C] C] e. Proof of Performance/Payment Bond [e}~ C] LJ Continuation 12 Months Following Final Payment Yes No 4, Agenda Request [I~ LJ 5. Remarks CLL. sNeNy a eng Services Coordinator DATE SCUET ANT Nh | i Jam N MCLODIS ‘CON, IN aie Ge AVCON, INC. 4 ENGINEERS & PLANNERS 320 Bayshore Drive, Suite A Niceville, Florida 32578 Phone: (850) 678-0030 Fax: (850) 678-0040 www.ayconinc.com July 11, 2013 Mr. Tracy Stage, A.A.E. Deputy Airports Director Okaloosa County Airports 1701 State Road 85 N. Eglin Air Force Base, Florida 32542 Reference: Engineer’s Certification RON Apron High Mast Lighting project Northwest Florida Regional Airport, Eglin AFB, Florida AVCON No.: 2011.050.04 Dear Mr. Stage: Pursuant to our letter dated today recommending final payment for the above-referenced Okaloosa County contract with Bill Smith Electric, Inc., this letter is provided to certify the completion of the work per the requirements the AIP grant assurances for this project. We have reviewed the RON Apron High Mast Lighting project site, the project punch-list items, and the contractor’s final submittals and know of no outstanding requirements to be performed by the contractor. To the best of our belief and knowledge, we hereby certify that the project was completed in accordance with applicable plans and specifications, is in place at the Northwest Florida Regional Airport, that Okaloosa County has adequate title to the property, and that the project is suitable for the intended purpose. We appreciate the opportunity to serve the County on this important project. If you have any questions or require additional information, please do not hesitate to contact me at your convenience. Sincerely, AVCON, INC. wWwwuiiiyy, y : Se 0% ; “ go, ! S *% Sh OK Vinke . ote y— S z é = . — = +e = John Collins, P.E. = 3i/- {41 le = Project Manager 2 O. ATE OF # vs ZSegtlonoh eS “1p, ONAL x \S AW CIVIL & STRUCTURAL ENGINEERING B® AIRPORT & AVIATION CONSULTING B TRANSPORTATION DESIGN & PLANNING BILL SMITH ELECTRIC PO Box 1057 Gonzalez, FL 32560 Office (850) 968-6500 Fax (850) 937-8113 BillSmithElectric.com FINAL WAIVER OF LIEN June 10, 2013 We, the undersigned Contractor, having performed labor or furnished materials or services in the construction, alteration, or improvement of real property described as: NWF Regional Airport, RON High Mast Lighting, Okaloosa County Board of County Commissioners Will release and discharge any claim, lien or otherwise, which we might have had against the above described property upon payment of $ 47,314.08 All parties performing labor, furnishing materials or services on the site of improvement through us have been paid in full to this date. State of: Florida County of: Escambia He o/ ya — T 7 Notary Pliblic State ‘ef Florfd hide My Commission Expires: January 22, 2017 BILL SMITH ELECTRIC FINAL WAIVER AND PO BOX 1057, GONZALEZ, FL 32560 RELEASE OF BOND AND LIEN OFFICE (850) 968-6500 FAX (850) 937-8113 WAIVER OF RIGHT TO CLAIM AGAINST THE PAYMENT BOND UPON FINAL PAYMENT The undersigned, in consideration of the final payment in the amount of $18. 780-00 __ herby waives its right to claim against the payment bond, liens, & lien rights for labor, services, or materials furnished to Bill Smith Electric or N/A on the following project: Owner Name: Okaloosa Board of County Commisioners Project Name:RON Apron High Mast Lighting at NWF Reg Airport Project City/State: Eglin AFB, FL Job Name &#: RON Apron High Mast Lighting Subcontract or PO #:_0859 In addition, the undersigned herby releases Bill Smith electric, General Contractor and Owner, its successors and assigns, of all claims or demands of any kind whatsoever (contract or equitable), which the undersigned now has or might have against Bill Smith Electric, General Contractor, Owner, Bill Smith Electric’s surety, and/or insurance carriers on account of labor performed and/or materials furnished for the construction of any improvements for the described project or on account of any other costs incurred in the prosecution of the work on the described project. The undersigned further certifies that all labor and materials used by the undersigned in the construction of said improvements have been fully paid for. Please Type:Ellis Crane Works, Inc. Name of Sub or Supplier ~ Vian We | Title: Quer Date: 5 bali? Authorized Signature State of: F/ oridae County of: Qanta ROoS@ The foregoing De gument was acknowledged to be true and correct before me by Nancy E/sis who certified under oath that he/she is the OWAEr _, of ths Liane orbs, “and has full complete ahd unbridled authority to execute the foregoing instrument on behalf of E/ is Crane and has executed the same on this_’9 oatien day of Pon 2O/S Seal/Stamp: ORs ; italics Expires August 16, 2015 My Commission Expires: HORTHWEST FLORIDA ® Dail News Published Daily Fort Walton Beach, Florida Distributed in Okaloosa, Santa Rosa & Walton Counties State of Florida, County of Okaloosa Before the undersigned authorized personally appeared IV) HUW LL Me Asc. who on oath says that (s)he is Lupe Ad uy sing Gee of the Northwest Florida Daily News, a daily newspaper published at Fort Walton Beach, in Okaloosa County, Florida; that the attached copy of advertisement, being a Le i Ya 10 in the matter of Nadie, ot C hn pletion High Mast Lighting in the Db lo 0454. County Court, was published in said newspaper in the issues of ey 20 a7 Sune 3 18, dors Affiant further says that the said Northwest Florida Daily News is a newspaper published at Fort Walton Beach, in said Okaloosa County, Florida, and that the said newspaper has heretofore been continuously published in said Okaloosa County, Florida, each day, and has been entered as second class mail matter at the post office in Fort Walton Beach, in said Okaloosa County, Florida, for a period of one year next preceding the first publication of the attached copy of advertisement; and affiant further says that (s)he has neither paid nor promised any person, firm or corporation any discount, rebate, commission or refund for the purpose of securing this advertisement for publication in the said newspaper. STATE OF FLORIDA COUNTY OF OKALOOSA Subscribed and sworn to (or affirmed) before me this _/ 2: we XOV 3 (Date) by Notte te WW bere. who is/are vert aly known to me or has/have reduced D, ASM cht au kan Iawwry as identification. 7 (Type of idedtification) " (Signature) (Name of Notary typed, printed or stamped) Sonded Through Nationa! Nelary Assa. 2 DS ararRgpE gs Cpe epee Ty: ‘Legal 4270 : :Bil] Smith Electric, -Inc. ‘gives ‘notice of comple- tion of the Northwest | ‘Florida’ Regional Airport | ‘Ron “Apron High’ Mast | Ughting, and sets June | 10, 2013 as the date of final. settlement. All per- ,scns and firms “should file al] claims and_pay- ments. to the below ad- dress prior to the’ ‘settie- Ment date, -Bill Smith Electric, Inc. PO Box 1057 Gonzalez, Fl 32560 * By: Jake Smith Project Manager ‘Legal 4270 * May 20, 27, June 3, 10, 2013 Page 1of1 05/15/2013 15:28:47 Ad Number 34576781 Ad Key Order Number 34252482 Salesperson 25 - Maureen Wiltse PO Number Publication Northwest Florida Daily News Customer 33867494 Bill Smith Electric, Inc Section Classified 2006 Contact Sarah Harper Sub Section Classified 2006 Address‘ PO Box 1057 Category 1100 Legal Advertising Address2 Dates Run 05/20/2013-06/10/2013 City St Zip Gonzalez FL 32560 Days 4 Phone (850) 986-6500 Size 1x 2.65, 25 lines Fax (850) 937-8113 Words 75 Credit Card sesananeene 7326 Ad Rate Legals Rate Printed By Maureen Wiltse Ad Price 164.00 Entered By Maureen Wiltse Amount Paid 164.00 Amount Due 0.00 Keywords 4270 High Mast Lighting Notes Notice of Completion Zones Legal 4270 Bill Smith Electric, Inc. gives notice of comple- tion of the Northwest Florida Regional Airport Ron Apron High Mast Lighting, and sets June 10, 2013 as the date of final settlement. All per- sons and firms should file all claims and pay- ments to the below ad- dress prior to the settle- ment date. Bill Smith Electric, Inc. PO Box 1057 Gonzalez, Fl 32560 By: Jake Smith Project Manager Legal 4260 May 20, 27, June 3, 10, 2013 ay BILLS-4 OP ID: LG “CORE CERTIFICATE OF LIABILITY INSURANCE or onotn. REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. 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 certificate holder in lieu of such endorsement(s). 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 Phone: 850-432-7474 Fax: 850-438-4678 PRODUCER Fisher Brown Div, Pensacola 1701 West Garden Street Names” Lindsey Gustman PHONE et). 850-470-2642 | (Wc, No); 850-438-4678 Pensacola, FL 32502 Aopness: |gustman@fbbins.com Alan D.M CPCU - a oor INSURER(S) AFFORDING COVERAGE NAIC # = insurer A: Amerisure Insurance Company 19488 INSURED Bill Smith Electric, Inc. Kz ) INSURER'RE Laura Smith S&S PO Box 1057 é [78 INSURER Ce Gonzalez, FL 32560 INSURER D : INSURER E: INSURER F: REVISION NUMBER: CERTIFICATE NUMBER: COVERAGES 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 ADOL|SUBRI POLICY EFF | POLICY EXP LTR TYPE OF INSURANCE lien POLICY NUMBER | mmoorrer) (MMIDDIYYYY) LIMITS GENERAL LIABILITY | EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A | X | COMMERCIAL GENERAL LIABILITY GL 2077896 | 07/24/2013 | 07/24/2014 | PaRMISES (es ovcurrence) | $ 300,000 | CLAIMS-MADE OCCUR MED EXP (Any one person) | $ 10,000) X | Pollution $100000 PERSONAL & ADVINJURY | $ 1,000,000 i GENERAL AGGREGATE $ 2,000,000 | GEN'L AGGREGATE LIMIT APPLIES PER: | | PRODUCTS - COMP/OP AGG | $ 2,000,000 pouicy | X | So | LOC | | Emp Ben. $ 1,000,000 AUTOMOBILE LIABILITY | | ie ee ts 1,000,000 A | X | anyauto CA 2077895 07/24/2013 | 07/24/2014 | BODILY INJURY (Per person) | $ ria aes BODILY INJURY (Per accident)| $ X X | NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) { $ X | UMBRELLA LIAB X | occur EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE CU 2077898 07/24/2013 | 07/24/2014 | accrecaTE $ 1,000,000 veo _| X | RETENTION s 0 3 WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS!’ LIABILITY ar TORY tines | ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? [| jNIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE} $ If yes, describe under DESCRIPTION OF OPERATIONS below i E.L. DISEASE - POLICY LIMIT | $ A jEquipment Floater IM