Okaloosa County BOCC — July 2, 2013 — Seago Fire Protection Final Payment7 2013 pdf — reading text

BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERION INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 8 ISSUEO OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN {S SUBJECT TO ALL THE TERMS __ EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. te TYPE OF INSURANCE nse | en AR POLICY NUMBER Boe vee fe! a mare GENERAL LIABILITY $ 4,000,! A x | COMMERGIAL GENERAL LIABILITY x GL2013FSC00338 ng1ogr2013 | G6/NS2014 s 400, |__| cramasaiane |__| occur % § |_| PERSONALS ADVINJURY |S 4,000, X {DED -$2,500 GENERAL AGGREGATE 3 2,000, GEN'L AGGREGATE LIMIT APPLIES PER: | PRODUCTS - GOMPIOP AGG | $ 2,006, i | iy iene. | poucy |X Lier | Uboc 2 RuTOMOSLE LIABILITY ’ COMBINED SINGLE LIT | g 4,000, x ‘ oaznora | oxazaeis Seat _— BX) anvauro 49-096654-06 BODILY BLIURY (Pov person) | 8 |__| ALL OWNED AUTOS BODILY INIURY (Per acaddent)| & |__| SCHEDULED AUTOS i PROPERTY DAMAGE $ | HIRED AUTOS (Per accident) _X| NON-OWNED AUTOS $ & Xx UMGRELLA LIAB EG OCCUR EACH OCCURRENCE $ 4,000 EXCESS LIAB Hf i ci | SLAMS ADE uM2013FSCo0t08 aerogr2013 | oeiagrz014 -ASSRESATE $ 4,000 1 pepueneie a Sc neta a me _ £ XC pevewion 40; - rome cE — WORKERS COMPENSATION x i WC STATUE | LOTH AND EMPLOVERS UABILITY yin _ TORY LIMITS |__| D ANY BROPRIETORIPARTHERIEXECUTIVE ca RIA 78058703 OaiGis/2013 | 410772044 | cv cach ACCIDENT. & soc (Mandatory in NH} “ : ALL OWNERS EXCLUDED EA, DISEASE -EA EMPLOYEE, $ Sat ifyes, desoribe uncer DESCRIPTION OF OPERATIONS betow ELL, DISEASE - POLICY LIMIT | $ iu AgencyWComp & Auto INTIOLLY OWNED SUBSIDIARY iGlark ins Services OF BROWN INS SERVICES LLC BESCRIPTION OF OPERATIONS ? LOGATIONS / VEHICLES (Attach AGORD 701, Additional Ramarks Schedule, if more space ts required) Certificate holder ineluded as additional insured to the General Liability policy on & primary non-contributory basis. 30 day cancellation notice to e certificate holder CERTIFICATE HOLDER SANCELLATION OKALOOZ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFO THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED Okaloosa County ACCORDANCE WITH THE POLICY PROVISIONS. 602-C North Pearl Street Grestview, FL 32536 AUTHORIZED REPRESENTATIVE i © 1968-2009 ACORD CORPORATION. All rights reserve 7 Co Hwy 183 S. « Ponce de Leon, F 2388 © ($50) 836-2289 Fax om fab i 4 on Or ® 2 ea & cA hao BH i ba 2 CERTIFICATE OF THE SUBCONTRACTOR CONDITIONAL WAIVER AND RELEASE OF LIEN UPON FINAL PAYMEENT The sadersigned Heanor, in consideration of the sum of $137,009.00 hereby waivers and releases the right to claim a lien for labor, services, or materials furnished through (Date) 6/04/2013 on the jol te Okaloosa County Jail Fire Sprinkler System The andersigned further certifies that all materials, labor, and services furnished or performed by him or anyone whe has furnished materials, labor, or services to the undersigned for use in the contract has been paid through the date of this instrument (except as Ested below) and the undersigned agrees to indemnify Okaloosa County, Fi ora for any cost, including aftormey’s fees, incurred by i im removing Hens or claims by anyone feraishiag vmaterial labor, or services for use in said project in accerdance with the coutract with the undersigned. Exceptions:_None 100% compiete l hereby certify that the work performed aad the materials supplied to date as shown on the above represent the actual value of accomplishment under the terms of the contract (and ali authorized changes thereto) between the undersigned and Okslcose County, Florida relating te the above referenced project. This waiver and release covers the Final payment held for labor, services, and miterials farnished. This release becomes in full force upon receipt and clearance of a payment check in the amount of § 132,009.00. Date: SEAGO IO RE PROTECTION, LLC Subscribed and sworn before me This o___.aay ay fli Notary Publics Bhat f " My Ca Title: LORE WEBSTER y Notary Public, Slate of Floriga £ 7 Commissiong EE 22625 , MY COMM. expires Aug. 16, 2015;