Okaloosa County BOCC — July 15, 2014 — MainStreetCloseout — reading text

CONTRACT CLOSE-OUT CHECKLIST (To Be Prepared by the Purchasing Contracts & Leases Coordinator) DATE: July 7, 2014 TO: Contracts & Grants Manager, Finance Department Contracts & Grants Office SUBJECT: Contract No. C14-2093-PW MANAGING DEPARTMENT: Public Works CONTRACTOR'S NAME: Main Street Construction Services, LLC. PROJECT TITLE: 12th Avenue Sidewalk Addition The attached has met the final payment contract requirement in subject contract. Yes No 1. Final Invoice xX O 2: Completed Contract/Lease Payment Approval Form X] 3: Close-Out Documents Yes No N/A a. Signed Release of Lien Xx CJ CL b. Proof of Completion Advertisement | i im c. Certificate of Insurance X C C] d. Consent of Surety to Final Payment x] CX O e. Proof of Performance/Payment Bond x C im Continuation 12 Months Following Final Payment Yes No 4, Agenda Request X C] 5. Remarks Purchasing Contracts & Leases Coordinator DATE CONTRACT/LEASE PAYMENT APPROVAL FORM COMPLETE AND FORWARD TO THE NEXT DEPARTMENT ————— pate: 06/23/2014 VENDOR NAME: Main Street Construction Services COMPLETED BY DEPARTMENT CONTRACT/LEASE#: ©14-2093-PW / 0437 VENDOR #; CGC1511274 TASK COUNTY/FEMA VENDOR BUDGET INVOICE # ORDER # PROJECT# — | nepaRTMENT #| ACCOUNT # AMOUNT S$ (ff Applicable) (Uf Applicable) FINAL 0437 B02 2.05 \\00 | $ 9,086.28 TOTAL $9,086.28 + APPROVED FOR PROGRESS PAYMENT (lease sign, a: licable and date CONTRACTOR'S E :/PROJECT MANAGER: DATE: 06/23/2014 te CONTRACTS & GRANT MANAGgtR: 7 COUNTY ADMINISTRATOR: (Payments>$25,000.) FINAL PAYMENT FINAL PAYMENT ves |wol_| (if "Yes", forward to Purchasing Services Coordinator for Close-Out) aa, be DATE: ZELE DATE: Ve DATE: PURCHASING DIRECTOR: (Per Initial Agreement) CONTRACTS & GRANTS MANAGER: (All Contracts) (Per Initial Agreement) BOARD APPROVAL: (Per Initial Agreement) FISCAL YEAR: DATE RECEIVED: REVIEWD BY: COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY APPLICATION FOR PAYMENT Z OK. Co. #0437 PERIODIC ESTIMATE NO.: finial PROJECT NO.: WORK PERIOD BEGIN DATE: _4/ ~ 19- 4Y% enn vate: 4- 2Y- Lf ROAD NAME: la th ALE. ORIGINAL CONTRACT SUM ¢_ 18, 665. 30 NET CHANGE BY CHANGE ORDERS ¢$— 49 Yp.°? CONTRACT SUM TO DATE ¢_ (81,75. 5° ANALYSIS OF WORK PERFORMED 1. Value of original contract work performed previously: $ | gy l LA 5. SO 2. Work performed this month: $ 6- . : 3. Total value of work performed to date: $ l 4 / , 72 S: so 4, Less: Amount retained at five (5%) percent: - $ - : 5. Net amount earned on contract work to date: $ ah ‘50 6. Less: Amount of previous payment: _ § / 72 , 63 / . aa 7. AMOUNT DUE THIS PAYMENT $ OQ ‘ 28 CERTIFICATION OF CONTRACTOR According to the best of my knowledge and belief, I certify that all items and amounts shown on the face of the Periodic Estimate are correct; that all work has been performed and/or materials supplied in full accordance with the terms and conditions of the contract between Okaloosa County and i > and that the items for which payment is requested have been paid and that there are no vendors-mechanics, or other liens or conditional sales contracts which should be satisfied or discharged before such payment is made. Werbo<t Bugeng WV ng (Nail Street Constrocltn Se pviees CLc. ay: Seatak Ge Wien (Firm Name) (Name‘of Authorized Officer & Title) ~~ CERTIFICATION OF ENGINEER I certify that I have verified this Periodic Estimate and that to the best of my knowledge and belief, it is a true and correct statement of work performed and materials supplied by the Contractor; and that the ik certified statemtént.oF this account and the amount due him is correct. A ae, Date: C02 Projec' ager the 12th Ave. Sidewalk Addition App. For Payment Mi Main Street Construction Services, LLC Project Title: 12th Avenue Sidewalk Addition Project Number: PW 38-13 Purchasing Contract No.: C14-2093-PW Expires: 04-42-2014 4/24/2014 731342 TOTAL 302-2051100 563490 COST 5% Amount Inv# Cost to date Withheld Paid 1 24,150.00 24,150.00 (1,207.50) 22,942.50 2 19,932.50 19,932.50 (996.63) 18,935.87 3 29,612.25 29,612.25 (1,480.61) 28,131.64 4 29,393.25 29,393.25 (1,469.66) 27,923.59 5 24,090.50 24,090.50 (1,204.53) 22,885.98 6 - 54,547.00 54,547.00 (2,727.35) 51,819.65 7 - 9,086.28 9,086.28 g - - - 9 - - - 10 - - - 11 - - - 181,725.50 181,725.50 0.00 181,725.50 Contract Total 186,665.50 Change Order #1 (4,940.00) Change Order #2 12 days added Change Order #3 Change Order #4 New Contract Total 181,725.50 Balance to finish w/o retainage Date Paid 02/27/14 02/27/14 03/27/14 03/27/14 04/17/14 05/08/14 Check Number V1403412 V1403412 V1404298 V1404298 V1404811 V1405503 —, . | IE 2 Main-of,, : ACORD CERTIFICATE OF LIABILITY INSURANCE THIS GERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA r CERTIFICATE DOES ‘NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND. OR ALTER THE COVERAGE AFFORDED B $ CE le OF INSURANGE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER( f TAN RUPE SER,. ND THE CERTIFICATE HOLDER.. : a oo “IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS: the terms and conditions ofthe policy, certain policies may require-an endorsement, A statement on this certificate does not-con _ certificate holder in jieu-of such:endorsement(s). : : PRODUCER a fonding FE CONTACT |, Wayne Walker : Valdorffins -&:-Bonding -F PHONE ; FAX. rer 45 Eglin Parkway NE, Ste 202 HON exe: 850-581-4925 [TS way. 850-881-4930 Fort Walton ‘Beach, FL 32548 BMA as: : K. Wayne Walker = oo : _ INSURER(S) AFFORDING. COVERAGE 2 NAIC # suRERA : Mid-Continent Casualty Company a insureD Main Street-Construction INSURER B: Services, LLC . 1700 E. 12th Street INSURER C: Lynn Haven, FL 32444 INSURER:D: INSURERE: : . INSURER ES: —_— . GOVERAGES | oo CERT \ coe pe * -REVISION NUMBER: y THIS 1S TO:CERTIFY THAT THE POLIC! SURAN ED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED. ABOVE FOR T ICY F INDICATED. NOTWITHSTANDING ANY MENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIGH 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. -_ ANSR . ; A ADE POLICY EFF POLICY EXP ia TYPE-OF INSURANCE INSHLWD POLICY NUMBER {MMIDDIVYYY) | (MMIDDIYYYY) : "| GENERAL LIABILITY : : FAGH OCCURRENCE _ 1,000,000) A. LC] commencia General UABILITY x 04GL.000898023 03/07/2014 | 03/07/2015 | DANES TORN irrence) | 8 100,000 - | CLAIMS-MADE [x] OCCUR MED EXP (Any ona person) EXCLUDED _ PERSONAL & ADV INJURY_| $= 1,000,000). ed GENERAL AGGREGATE 2,000,000). GEN'L AGGREGATE LIMIT APPLIES PER: ; . PRODUGTS-- COMP/OP AGG | ! 2,000,000; | pouicy Fao: [Lic ; { ; . : ° . COMBINED SINGLE LIMIT AUTOMOBILE.LIABILITY : . ; (Ea aceldanty LSS ANY AUTO : BODILY INJURY (Perperson) 1 * | |auros SCHEDULED ; BODILY INJURY (Per accident) ® NON-OWNED PROPERTY DAMAGE ; HIRED AUTOS AUTOS (PER ACCIDENT) _ UMBRELLA LIAB | occur | - EACH OCCURRENCE EXGHSS LIAB | -GLAIMS-MADE | AGGREGATE ‘ neo |__[ Rerenrions $: WORKERS COMPENSATION a [we STATU | [ory — AND-EMPLOYERS LIABILITY YIN : eS. ER As ANY PROPRIETORIPARTNER/EXECUTIVE E.L. EACH ACCIDENT : OFFICERIMEMBER EXCLUDED? NIA g 3 . __..| (Mandatory tn NH). ee pe re pre EL. DISEASE. EA EMPLOYEE!:S “eyes, dasctibe-under ~ . ; DESCRIPTION OF OPERATIONS below soi EL. DISEASE - POLICY LIMIT ‘DESCRIPTION OF-OPERATIONS / LOCATIONS | VEHICLES (Attach ACORD 101, Additional Remarks Schadute, if more space ls required) jit is hareby understood and agréed that the balow named certificate holder CERTIFICATE HOLDER GANGELLATION OKALBO3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE. GANCELLED BEFORE THE -EXPIRATION DATE THEREOF, NOTICE WILL ‘BE DELIVERED IN AGGORDANGE WITH THE POLICY PROVISIONS. . Okaloosa County Board of County ‘Commissioners AUTHORIZED REPRESENTATIVE 101 East James Lee Blvd, Crestview, FL 32536 A)oyie Nobla—- 31988-2010 ACORD CORPORATION. All rights reserved. wate (CERTIFICATE OF LIABILITY INSURANCE ZOU ___ anon yducer: Lion Insurance Company This Certificate is Issued as 8 matter of information only and confars 2739 US. Highway i9N. tights upon the Certificate Holder. s Certificate does not amend, - “ extend or alter the coverage afforded by the policies below. Holiday, FL 34691 aes : . eeomncmiineene sured: South East Personnel Leasing, Inc.& Subsidiaries 7 ‘Insurers Affording Coverage Insurer A: Llon Insurance Company 2739 U.S. Highway 19N. ay ee Holiday, FL, 34691 ee Le eas ty oY. verages— . ; : oliclas of Insurance listed below have been issued to the-naured rae Stt uta Cray Indicated: Notwithatanding any requirement, term or condition of any-contract or other ANPIIGSu {fol ment with respect to which this cattificata may.bs Issued or. may-pertaln: ea by fol fbjicie poseibgy herein ts subject to all the terms, exclusions, and conditions orsuch ies. Aggregate limits.ehown may have been reduced by pald claims. * $ i; eee es ———— ee cay tL Pollo Efective -. ap 1 Policy Expiration mite t) Ao, |. Type of insurance pakeilibol]® TIbre TY COI Dae Limits __ ORALO DS enyoony Ty, FL MMODNY) _ , GENERAL LIABILITY © i oe CRESTVIEW, FL. Each Occurrence. - T | Commercial General Liability ’ - GG “ ae . : aE : - amage to-rented pramises (EA "T /.Glaims Made. |, | Occur oecurrencs) Mad Exp =— —— : Personal. Adv Injury IGeneral aggregate limit applies per: . : . ; : G t Cyr Ellrve (1 2 - lho “Dew Products - Gomp/Op Agg AUTOMOBILE LIABILITY Combined Single Lint erg . ~ : (EA Aceldent) pivave Bodily Inju P==8 ail Owned Aulos y In : — (Par Parson) z 4 Scheduled Autos i TT Hirad Autos - | : Bodily (njury” an Pl Non-Owned Autos (Per Accident) es ; , Properly Damage ; ; (Par Accident) TEXxcESS/UMBRELLA LIABILITY Each Ocaurrence =I Occur [].come Made ; Aggregate : 1; Deductible ; ; ~ | Workers Compensation and we 7iedg | o1oi2014 = (01/01/2015 x} we state J! | Employers’ Liability. | tory Limits he | Any propristor/partner/executive.officar/member E.L. Each Accident. Me : excluded? NO ; EL. Disease - Ea Employee sstd00,0005 [if Yes, describe under special provistons‘below. EL, Disease - Policy Limnits--,87 if) Other | Lion Insurance Company ts A.M. Best Company rated A+ (Excellent). ‘AMB.#- : escriptions of Operationsit_ocations/Vehicles/Exclusions added by Endorsement/Special Provisions: Client 1b 82-6543 ; yverage only applies to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following "Client Company": > Main Street Construction Services, LLC : : : average only applies to injuries incurred by South East Personnel Leasing, Inc, & Subsidiarles active employee(s) , while working fn: FL. sverage does riot apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. : fist of the active employee(s) leased to the Cliant Company can be obtained by faxing a request to (727) 937-2138 or by calling (727) 938-5562. roject Name: : ° AX: 880-689-5970/ ISSUE 10-10-13 (EP) / Reissued 12/9/13 (SH) GERTIFICATE HOLDER j —_ CANCELLATION ; OKALOOSA COUNTY BOARD OF GOMMISSIONERS Should any of tha above described policies be cancellad pefora the oxplration.date thera coe . aan issuing Insurer will endeavor to mall 30 days written notice to the certificate holder named toh . faft, but failure to do so-shall impose no obligation ar tability of any Kind upon thé Insurer, It 101 EAST JAMES BLVD. agents or representatives, ; GRESTVIEW, FL $2536 CONTINUATION SHEET AIA DOCUMENT G703 PAGE10F1 AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NUMBER: Final Contractor's signed Certification is attached. APPLICATION DATE: 11-Jun-14 In tabulation below, amounts are stated to the nearest dollar. PERIOD FROM: 19-Apr-14 Use Column | on Contracts where variable retainage for line items may apply. TO: 2H very 42-2014 412TH AVE.