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

"has POLICE STATION. ~' ORFS 1 NE AIR : BID No. AP.12-14 and. sets “April: 27, 220 as: ‘the-date of final- sot tlement.-. Alf persons Legal 5863. 5. March27, 2014 BS April 3,10, 17, 2044 CONTRACTS | Page 1 of 1 03/24/2014 16:05:55 Ad Number 34639534 Ad Key Order Number 34284472 Salesperson 122 - Colleen Cadogan PO Number Publication Northwest Florida Daily News Customer 33870379 Lord & Son Construction Section Classified 2006 Contact Sub Section Classified 2006 Address1 P.O. Box 1808 Category 1100 Legal Advertising Address2 Dates Run 03/27/2014-04/17/2014 City St Zip Fort Walton Beach FL 32549 Days 4 Phone (850) 863-5158 Size 1 x 4.03, 38 lines Fax (850) 862-4904 Words 97 Credit Card Ad Rate Legals Rate Printed By Colleen Cadogan Ad Price 246.68 Entered By Colleen Cadogan Amount Paid 0.00 Amount Due 246.68 Keywords 5863 COMPLETION Notes Zones Legai 5863 ADVERTISEMENT OF COMPLETION Notice is hereby given that Lord & Son Con- struction, Inc., 19 David St, Fort Walton Beach, FL 32547, has com- pleted the Contract for Construction of INTERIOR TERMINAL MODIFICATIONS FOR POLICE STATION NORTHWEST — FLOR- IDA REGIONAL AIR- PORT BID NO. AP 12-14 and sets April 27, 2014 as the date of final set- tlement. All persons and firms should file all claims for payment to the below address prior to the settlement date. OKALOOSA COUNTY ATTN: © CONTRACTS AND LEASES COORDI- NATOR 602-C NORTH PEARL STREET CRESTVIEW, FLORIDA 32536 Legal 5863 March27, 2014 April 3, 10, 17, 2014 | CONSTRUCTION, INC. CONSTRUCTION MANAGER / GENERAL CONTRACTOR Trusted Performance ... Lasting Value May 28, 2014 Okaloosa County 602-C North Pearl Street Crestview, Florida 32536 Re: Contract #C14-2151-AP Interior Modifications for Police Station, NW Florida Regional Airport Dear Sir or Madam: State of FL. Certified General Contractor #CG C008942 State of FL. Certified General Contractor #CG C057094 State of AL Certified General Contractor #12776 State of GA Certified General Contractor #GCCO002537 State of MS Certified General Contractor #087714-MC This letter serves to assure that Lord & Son Construction, Inc. will maintain the coverage indicated on the attached Certificate of Liability Insurance for a period of two years following final payment. Re , Leven D. Lord II President LDL/jm Attachment ine. F > Associated Builders and Contractors, Inc. North Florida Chapter - 19 David Street - Fort Walton Beach, Florida 32547 P.O. Box 1808 » Fort Walton Beach, Florida 32549 850-863-5158 - FAX 850-862-4904. info@lordandson.com www.lordandson.com Specializing in Commercial Construction Since 1975 i ' ACORIT, | CERTIFICATE OF LIABILITY INSURANCE OP ID: PJ DATE (MM{DDIYYYY) 05/28/2014 LORD-04 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: Ifthe certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certaln policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). Dale Waldorft Waldorffl & Bondi FWB Name: Dale Waldorff aldorff Ins & Bonding - 25 Eglin Parkway NE, Ste 202 (Ale, No, Ex): 850-561 4925 [TA Noy. 850-581-4930 Fort Walton Beach, FL 32548 EMAL CONTACT INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Amerisure Insurance 19488 INSURED Lord & Son Construction, Inc. INSURER B: Amerisure Mutual 23396 P.O. Box 1808 NSURER ©: Fort Walton Beach, FL 32549 : INSURER D: INSURER E : INSURER F; COVERAGES 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. hin’ TYPE OF INSURANCE INSR | WvD POLICY NUMBER (MMIDBIYYY) (MMIDDIYYYY) LIMITS [ GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A. |X | coMMERCIAL GENERAL LIABILITY X | X |GL20147370901 01/04/2044 | 01/01/2015 | BAM CE OREN ence) | 8 300,000 | CLAIMS-MADE occur MED EXP (Any one person) | $ 10,000 | X | Contractual PERSONAL & ADVINJURY | $ 1,000,000 | X |XCU Coverage GENERAL AGGREGATE $ 2,000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP/OP AGG | $ 2,000,000 | |eoucy [|X ]FB& [| Loc $ AUTOMOBILE LIABILITY COMBINED SINGLELIMIT |g 1,000,000 B {XJ any auto X | X |CA13828541302 04/04/2014 | 01/01/2015 | BODILY INJURY (Per person) | $ |_| ALL OWNED SCHEDULED BODILY INJURY (Per accident) | $ | X | HIRED AUTOS Autos (EER ACCIOENT) $ $ |X [UMBRELLALIAB | X | occur EACH OCCURRENCE $ 10,000, 000 B EXCESS LIAB CLAIMS-MADE (CU13838561002 01/01/2044 | 01/01/2015 | accrEGATE $ 40,000,000 pep | X | RETENTIONS 0 $ WORKERS COMPENSATION We STATU- OTH AND EMPLOYERS’ LIABILITY VIN |_[roay' thats LX [ee AV | ANY PROPRIETOR/PARTNER/EXECUTIVE X WC138285710 01/01/2014 | 01/01/2015 | €, EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? NIA (Mandatory in NH) ELL, DISEASE - EA EMPLOYEE| $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below EL. DISEASE - POLICY LIMIT | $ 500,000 A |Leased Equipment CPP138285514 01/01/2044 | 01/01/2015 |Limit: 150,000 Ded: 2,500; DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Interior Terminal Modification for Police Station at Northwest Florida Regional Airport. Certificate holder is added as additional insured as respects General Liability and Auto Liability when required by written contract.Waiver of Subrogation applies in favor of certificate holder.30 days notice of cancellation applies.10 days cancellation for nonpayment. CERTIFICATE HOLDER CANCELLATION Okaloosa County 602-C North Pearl Street Crestview, FL 32536 OKALBO1 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 jph bbl ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACCORD Wanner INSURANCE BINDER CSR: PJ DATE (MM/DDIYYYY) 1116/2014 THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM. AGENCY COMPANY BINDER # 1762 Waldorff Ins & Bonding - FWB Amerisure Insurance 5 Eglin Parkway NE, Ste 202 pate EFFEGTWE Te EXPIRATION Fort Walton Beach, FL 32548 X TE Pam Jarman LA] AM LA | 12:01 AM 01614 12:01 pM O7M6iN4 NOON PG No, ext: 850-581-4925 [{avG, Noy: 850-584 ~4930 THIS BINDER [5 ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY CODE: | sus cove: PER EXPIRING POLICY # BINDER CUSTOMER, ip. LORD-04 DESCRIPTION OF OPERATIONSIVEHICLES/PROPERTY (Including Lacation} INSURED Okaloosa County Contractor: Lord & Construction, Inc. P.O. Box 1808 OCP-interior terminal modifications for Fort Walton Beach FL 32549 Police station at Northwest Florida Regional Airport | COVERAGES LIMITS TYPE OF INSURANCE COVERAGE/FORMS DEDUCTIBLE {| COINS % AMOUNT PROPERTY CAUSES OF LOSS BASIC BROAD SPEC GENERAL LIABILITY EACH OCCURRENCE 5 1000000 COMMERCIAL GENERAL LIABILITY RENTED PREMISES $ ] CLAIMS MADE occUR MED EXP (Any one parson) 5 X_(Owner & Contractor Prot. PERSONAL &ADVINJURY _| § GENERAL AGGREGATE $ 2000000 RETRO DATE FOR CLAIMS MADE PRODUCTS - COMP/OP AGG _| $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY (Per person} | 5 ALL OWNED AUTOS BODILY INJURY (Per accidanl) | $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIREO AUTOS MEDICAL, PAYMENTS 5 NON-OWNED AUTOS PERSONAL INJURY PROT $ UNINSURED MOTORIST s s AUTOPHYSICAL DAMAGE oepycTeLe |__| ALL VEHICLES |__| SCHEDULED VEHICLES ACTUAL CASH VALUE COLLISION. STATED AMOUNT 5 OTHER THAN COL, OTHER GARAGE LIABILITY AUTO ONLY -EAACCIDENT | $ ANY AUTO OTHER THAN AUTO ONLY EACH ACCIDENT | § AGGREGATE |$ EXCESS LIABILITY | EACH OCCURRENCE 8 UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE SELF-INSURED RETENTION | $ WC STATUTORY LIMITS WORKER'S COMPENSATION E.L_ EACH ACCIDENT $ EMPLOYER'S LIABILITY E.L. DISEASE - EA EMPLOYEE | $ E.L. DISEASE - POLICY LIMIT_| 5 CONDITIONS! FEES : TAXES s COVERAGES ESTIMATED TOTAL PREMIUM | § NAME & ADDRESS MORTGAGEE ADDITIONAL INSURED LOSS PAYEE LOAN# AUTHORIZED RERRESENTATIVE ; Pam Jarman: AY ‘\ mo \ ot. \ AS : a i ote sf vAnan ALE Vt | ACORD 75 (2004/09) NOTE: IMPORTANT STATE INFORMATION ON REVERSE SIDE ©,ACORD CORPORATION 1993-2004 Bond #: 929571639 Bid No. AP 12-14 CONSENT OF SURETY For Final Payment Project Name Interior Terminal Modifications for Police Station Location Northwest Florida Regional Aiport Project No. AP 12- 14 Contract No. C14-2151-AP a en Type of Contract CONSTRUCTION Cmmount of § 82,563.41 In accordance with the provisions of the above-named contact between the Owner and the Contractor, the following named surety: Western Surety Company, 333 Wabash Avenue, Chicago, IL 60604, Phone: 312-822-5000 on the Payment Bond of the following named Contractor: Lord & Son Construction, PO Box 1808, Fort Walton Beach, FL 32549, Phone: 850-862-5521 hereby approves of final payment to the Contractor, and further agrees that said final payment to the Contractor shall not relieve the Surety Company named herein of any of its obligations to the following named Owner: as set forth in said Surety company's bond: Okaloosa County Board of County Commissioners, 302 N Wilson Street, Crestview, FL 32536, Phone: 850-689-5600 IN WITNESS WHEREOF, the Surety Company has hereunto set its hand and seal this 27th day of M 2014. Western Surety Company {Owl Osan Gignature of Authorized Represintative) (Affix corporate seal here) TITLE, Pamela L. Jarman, Attorney-in-Fact & FL Licensed Resident Agent IF SIGNED BY ATTORNEY-IN-FACT POWER OF ATTORNEY MUST BE ATTACHED. Western Surety Company POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT Know. All Men By These Presents, That WESTERN SURETY COMPANY, a South Dakota corporation, is. a duly organized and existing corporation having its principal office inthe City of Sioux Falls, and State of South Dakota, and.that it does by virtue of the signature and seal herein affixed hereby male, constitute and appoint Dale Waldorff, Benjamin H French, Pamela L Jarman, Paul A Locascio, K Wayne Walker, Rebekah G Wolf, Clyde D Hare, Individually -of Fort Walton Beach, FL, its true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign, seal and exécute for and on its behalf bonds, undertakings and other obligatory instruments of: similar nature - In Unlimited Amounts - and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said Attorney, pursuant to the authority hereby-given, are hereby ratified.and confirmed. This Power of Attorney is made anid executed pursuant to and by authority of the By-Law printed on the reverse hereof, duly adopted, as indicated, by the shareholders of the. corporation. In Witness Whereof, WESTERN SURETY COMPANY has caused these presents to. be signed by its Vice President and its corporate seal to be WESTERN SURETY COMPANY 200 hereto. affixed on this 25th day of June, 2013. eSURET, vt ee ae Cones th, Stay On" =} g. i mmc Widths NEST sibility se ‘Paul T. Bruflat, Vice President aw