Okaloosa County BOCC — July 1, 2014 — Change Order and Final Close-out checklist with documents for Airport Police Station — reading text

$0.00 $0.00 06 [MECHANICAL A___{Fire Sprinkler System $1,743.00 $1,743.00 $1,743.00 100.0% $0.00 $0.00 B__|HVAC $1,250.00 $1,250.00 $1,250.00 100.0% $0.00 $0.00 07 [ELECTRICAL A ___|Electrical Complete $4,000.00 $4,000.00 $4,000.00 100.0% $0.00 $0.00 CO1_|Change Order 1 A___|Return Allowances Balance ($286.59) $0.00 ($286.59) ($286.59) 0.0% $0.00 $0.00 Total Contract $82,563.41 $82,563.41 $0.00 $0.00 $82,563.41 100.0% $0.00 $0.00 10 ; Pile sleret CHANGE ORDER FORM Date: May 23, 2014 contract No.: C14-2151-AP Change Order No.:__ One (1) Owner: __ OKALOOSA COUNTY BOARD OF COUNTY COMMISSIONERS Contractor; Lord & Son Construction, Inc. Original Contract Price: $82,850.00 Net change by previously authorized Change Orders: 0.00 Present Contract Price: 82,850.00 This Change Order will (adefdeduci> (286.59) New Contract Price: $82,563.41 Original Contract Time: 60 0 Days Original Substantial Completion Date: April 27, 2014 Net change by previously authorized Change Orders: 0 Days This Change Order will (add/deduct): No Change New Contract Time: 60 Days April 27, 2014 New Substantial Completion Date: , Lf fp APPROVALS J, REQUESTED BY: _ §- EA, J Ex \\ Wana DATE: & O3 [el PROJECT ENGINEER ALA Bit fg pate: _6°6°"Y CONTRACTOR pate: “2°27 OWNER: WY, SAN NORMON DATE: Y, O¥ainoon, AN CS / OATE: This Change Order is an amendment to the Contract/Agreement between Contractor and the Owner, and all other contract provisions shall remain in full force and effect unless specifically amended in writing, signed by both parties. Bid No. AP 12-14 AFFIDAVIT OF PAYMENT To All Whom It May Concer: WHEREAS, the undersigned has been employed by _OKaloosa County Interior Modifications for Police Station to furnish labor and materials for _. NW Florida Regional Airport . work, under a contract dated 1/15/2014 for the improvement of property described as Police Station NW FL Reg. Airport in the County of _ Okaloosa , State of FLORIDA, of which Okaloosa County is the Owner, NOW, THEREFORE, this __27t2 day of May 20.14 The undersigned, as the Contractor for the above-named Contract pursuant to the Conditions of the Contract hereby certified that, except as listed below, be has paid in full or has otherwise satisfied ali obligations for all materials and equipment furnished, for all work, labor, and services performed, and for all known indebtedness and claims against the Contractor for damages arising in any manner in connection with the performance of the Contract referenced above for which the Owner or his property might in any way be held responsible. EXCEPTIONS: (If none, write "None". If required by the Owner, the Contractor shall furnish bond satisfactory to the Owner for each exception.) None ATTACHMENTS: 1. Consent of Surety to Final Payment. (Whenever Surety is involved, Consent of Surety is required.) 2. Contractor's Release or Waiver of Liens, conditional upon receipt of final payment. 3. Separate Releases or Waivers of Liens from Subcontractors and material and equipment suppliers, 4, Contractor's Affidavit of Release of Liens. Lord & Son Construction, Inc. _(SEAL) CONTRACTO ¢ of sole ownership, corporation or partnership) E-Signature of Authorized Répresentative) Leven D. Lord II (Affix corporate seal here) TITLE: ——Lzesident Bid No. AP 12-14 AFFIDAVIT OF RELEASE OF LIEN To All Whom It May Concern: WHEREAS, the undersigned has been employed by Okaloosa County to furnish labor and materials punterior Modifications for Police Station, NW FL Reg.Airport rk, under a contract dated _ 1/15/2014 for the improvement of property described as Police Okal Station in the County of aloosa , State of FLORIDA, of which Okaloosa County is the Owner, NOW, THEREFORE, this 27th day of May ,20_14 The undersigned, as the Contractor for the above-named Contract pursuant to the Conditions of the Contract hereby certifies that to the best of his knowledge, information and belief, except as listed below, the Releases or Waivers of Lien attached hereto include the Contractor, all Subcontractors, all suppliers of materials and equipment, and all performers of Work, labor or services, who have or may have liens against any property of the Owner arising in any manner out of the performance of the Contract referenced above. EXCEPTIONS: (if none, write “None”. if required by the Owner, the Contractor shall furnish bond satisfactory to the Owner for each exception.) ATTACHMENTS: is Contractor's Release or Waiver of Liens, conditional upon receipt of final payment. 2. Separate Releases or Waivers of Liens from Subcontractors and material and equipment suppliers. Lord & Son Construction, Inc. (SEAL) 7 CONTRACTOR (Name of s wnership, corporation or partnership) (Affix corporate Leven D, Lrod a (SEAL) seal here) (Signature of Authorized Representative) TITLE: President CONDITIONAL WAIVER AND RELEASE ON FINAL PAYMENT NOTICE: THIS DOCUMENT WAIVES THE CLAIMANT'S LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS EFFECTIVE ON RECEIPT OF PAYMENT. A PERSON SHOULD NOT RELY ON THIS DOCUMENT UNLESS SATISFIED THAT THE CLAIMANT HAS RECEIVED PAYMENT. Identifying Information Name of Claimant: John Linn dV. - Zins FRESTIGE Kirenens & BATES Name ofCustome: | Ord Y son C onstructi On Job Location: Interior Modifications for Police Station,NW FL Reg. Airport Owner: Okaloosa County Conditional Waiver and Release This dacument waives and releases lien, stop payment notice, and payment bond tights the claimant has for labor and service provided, and equipment and material delivered, to the customer on this job. Rights based upon labor or service provided, or equipment or material delivered, pursuant to a written change order that has been fully executed by the parties prior to the date that this dacumant Is signed by the claimant, are waived and released by this document, unless listed as an Exception below. This document is effective only on the clalmant's receipt of payment from the financial institution on which the following check Is drawn: Maker of Check: | ord & Son Construction Amountof Check: $ (9 G20. O04 Check Payable to: | inn 'S Pres 47 Ge Kitvhe ns Exceptions This document does not affect any of the following: Disputed claims for extras in the amount of: $ ZL ay oe Claimant's Signature: VA — : Vf iff Claimants Tite: PreBrdent “ve Date of Signature: 28 / ] 4 State of: County of: Sworn to and subscribed before me this 2? day of Mau 2014, =A Public Dudah 442 Giro Comm: FFOAI26> gyi, Judah Cash de Grast siden, NOTARY PUBLIC S| Fis ESTATE OF FLORIDA romee® Comet FFORS80: ET Expires 3/10/2013 A CONDITIONAL WAIVER AND RELEASE ON FINAL PAYMENT NOTICE: THIS DOCUMENT WAIVES THE CLAIMANT'S LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS EFFECTIVE ON RECEIPT OF PAYMENT. A PERSON SHOULD NOT RELY ON THIS DOCUMENT UNLESS SATISFIED THAT THE CLAIMANT HAS RECEIVED PAYMENT. Identifying Information Name of Caimant’ Fol Wy (ton (aS Cam Zany Name of Customer: Ld) £ Soa) Cop/st@ve tional, Tyne... Job Location: Interior Modifications for Police Station,NW FL Reg. Airport Owner: Okaloosa County Conditional Walver and Release This document waives and releases lien, stop payment notice, and payment bond rights the claimant has for labor and service provided, and equipment and material delivered, to the customer on this Job. Rights based upon labor or service provided, or equipment or material delivered, pursuant to a written change order that has been fully executed by the parties prior to the date that this document is signed by the claimant, are waived and released by this document, unless listed as an Exception below. This document is effective only on the claimant's receipt of payment from the financial Institution on which the following check Is drawn: Maker of Check: J avd and on AmountofCheck: $Q.1 274 00 Check Payable to: tot Walton Aar ( LYN PANY Exceptions This document does not affect any of the following: Disputed claims for extras in the amount of $ _- /? 7 Signature Claimant's Siena SZ Le Jf Claimant's Title: Shy noe nell Date of Signature: Sf 22 / WAZA State of: County of: Sworn to and subscribed before me this day of tay. 2014, No Notary Srna JANIS A MORE COMMISSION # EE158329 EXPIRES JAN 27 2016 BONDED THROUGH RL INSURANCE COMPANY CONDITIONAL WAIVER AND RELEASE ON FINAL PAYMENT __ NOTICE: THIS DOCUMENT WAIVES THE CLAIMANT } UMENT ¥ SLIEN, STOP PAYMENT -NOTIGE, AND PAYMENT BOND RIGHTS EFFECTIVE ON RECEIPT OF PAYMENT. ‘ON: SHOULD NOT RELY ON THIS DOCUMENT UNLESS SATISFIED THAT CLAIMANT HAS RECEIVED PAYMENT. Identifying Information ameof Claimant: TOC Constvucdign efCustomer: Lotb 4 Son Can srev CTL AJ fon,” Interior Modifications for Police Station,NW FL Reg. A _. Okaloosa County Exceptions ‘doas not affect any of the following: ‘for extras in the amount of: 3 >¥NTHIA GAMEZ MY: COMMISSION #FFo74989 EXPIRES: December 8, 2017 ° oridaNotarySenvice.com irport MAY-28-2014 11:14 From: 185843688933 18584388939 Page:i71 CONDITIONAL WAIVER AND RELIEASE ON FINAL PAYMENT NOTICE: THIS DOCUMENT WAIVES THE CLAIMANT'S LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS EFFECTIVE ON RECEIPT OF PAYMENT, A- PERSON SHOULD NOT RELY ON THIS DOCUMENT UNLESS SATISFIED THAT THE CLAIMANT HAS RECEIVED PAYMENT, nt, Caen ee Identifying information Name of Glalmant: i La) SQL OL | mi an : ’ Name of Customer: W9OC ConStvucds J] | Job Location: = Jntarior Modification: Lor Police Station, NW FL kag. Aid Ownar: Okaloosa County Conditions! Walvar and Relonse This docuriont waives and releases Hen, slop paymelt ailea, and payment bond rights the claimant has for labor arid servica provided, and equipment and material delivered, f the customer on this fob. Rights based upon labor or service provided, or equipment. or material delivered, pursuant to a written change order that has beon fully executed by the parties prior to the data that this document Is signed by ths claimant, ata walved ard released by this document, unless listed as an Exception below. This document Is affective only un the chintant's receipt of payment from the financial inatltutien en which the following check is drawn: Maker of Check: Dee Ch Aste UCHi ; Amount of Check: & (> Check Payable to. | ' [> Df) 0 ly Excaptlons This document does not affect any of tha following: Disputed claims for extras tn the amount of % ain 7/1 Slonekura ; Claimant's Signature; L ; | : Gaimants TWe: FF yaw nti oe Date of Signature: S/ 45 / { G ; wen 1 paces ney mee one t t LAC Strate of: County oF: | BES CYNTHIA GAMEZ Exf ty MY COMMISSION #FF074959 "S540 exPines December 8, 2017 FloridaNotaryService,com (407), 398-0153 rPOrt CONDITIONAL WAIVER AND RELEASE ON FINAL PAYMENT NOTICE: THIS DOCUMENT WAIVES THE CLAIMANT'S LIEN, STOP PAYMENT NOTICE, AND PAYMENT BOND RIGHTS EFFECTIVE ON RECEIPT OF PAYMENT. A PERSON SHOULD NOT RELY ON THIS DOCUMENT UNLESS SATISFIED THAT THE CLAIMANT HAS RECEIVED PAYMENT. Identifying Infermation | Name of Claimant, RigwAkN Me leo Deratr in C Name ofCustomer: Jo eh ¥ Son Con/STVUCTiI ow | JobLocation. Interior Modifications for Police Station,NW FL Reg. Airport Owner: Okaloosa County Conditional Walver and Release This document waives and releases lien, stop payment notice, and payment bond rights the claimant has _for labor and service provided, and equipment and material delivered, to the customer on this Job. Rights based upon labor or service provided, or equipment or material delivered, pursuant fo a written change order that has been fully executed by the parties prior to the date that this document is signed by the claimant, are waived and released by this document, unless listed as an Exception below. This document is effective only on the claimant's receipt of payment from the financial institution on which the following check is drawn: Maker of Check: JORD 0 Son (OnsS7TROCTION Amount of Check: $ Ja | | Check Payable: § AieWARD Mc E00 fAAWDNCE