Okaloosa County BOCC — March 3, 2015 — Contract Close-Out Checklist, Final Invoice and Certificate of Insurance- RS&H Inc — reading text

CONTRACT CLOSE-OUT CHECKLIST (To Be Prepared by the Purchasing Services Coordinator) DATE: 2/10/15 TO: Contracts & Grants Manager, Finance Department Contracts & Grants Office SUBJECT: Contract No. C09-1737-AP MANAGING DEPARTMENT: Okaloosa County Airports CONTRACTOR'S NAME: RS&H PROJECT TITLE: Final Payment The aftached has met the final payment contract requirement in subject contract. Yes No 1. Final Invoice H 2. Completed Confract/Lease Payment Approval Form IZ[/ L] 3. Close-Out Documents Yes No N/A a. Signed Release of Lien ] L] %? b. Proof of Completion Advertisement ] ] c. Certificate of Insurance [Z]/ L] Ol d. Consent of Surety to Final Payment ] ] [Q/ e. Proof of Performance/Payment Bond ] Ol E/ Continuation 12 Months Following Final Payment =< o @ = o 0 4. Agenda Request 5. Remarks R L B DATE P@ Services Eoordinator CONTRACT/LEASE PAYMENT APPROVAL FORM COMPLETE AND FORWARD TO THE NEXT DEPARTMENT = || DATE: 2/23/2015 COMPLETED BY DEPARTMENT VENDOR NAME: RS&H VENDOR #: 20300540 CONTRACT/LEASE# C09-1737-AP Destin ATCT TASK COUNTY/FEMA VENDOR BUDGET INVOICE # ORDER # PROJECT# |pppaprvENT#| ACCOUNT# ARIOURES (If Applicable) (If Applicable) 2010940009-6 Final 13 741418 562490 5.156.10 2010940009-6 Final 13 741422 562490 45832 2010940009-6 Final 13 741422 562490 114.58 TOTAL | $ 5.729.00 APPROVED FOR PROGRESS PAYMENT (please sign, as applicable and date) CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER: COUNTY SUPERVISOR/PROJECT MANAGER, y/4 7% DEPARTMENT DIRECTOR: R/ // CONTRACTS & GRANT MANAGER/ 7Y Tra’cy' Sfage, AAE. " Tracy Stage, AAL. COUNTY ADMINISTRATOR: (Payments>$25,000.) Sunil Harman, A.A.E., IAP DATE: 2-23 /S DATE: 2-23- & DATE: z%/gs DATE: DATE: > FINAL PAYMENT YES _Ao 2/z4|s ‘ 1] DATE: PATE: o7 2D pel DATE: %f /5” FINAL PAYMENT PURCHASING DIRECTOR: (Per Initial Agreement) CONTRACTS & GRANTS MANAGER: (All Contracts) COUNTY ADMINISTRATOR APPROVAL: (Per Initial Agreement) __ (f"Yes", forward to Purchasing Services Coordinator for Close-Out) %/M///;// /M / @ . 14 DATE: BOARD APPROVAL: (Per Initial Agreement) [ ] | | COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY FISCAL YEAR: DATE RECEIVED: REVIEWED BY Rsm 10748 Deerwood Park Boulevard S O 904-256-2500 Jacksonville, Florida 32256 F 904-256-2501 rsandh.com February 3, 2015 Mr. Tracy Stage, AAE Deputy Director Okaloosa County Airports 1701 State Road 85 N. Eglin AFB, Florida 32542 (850) 651-7160 x 1055 RE: Okaloosa County Airport System Destin Airport - Air Traffic Control Tower Permitting, Design and Bidding Services Contract No. CO9-1737-AP RS&H Project No. 201-0940-009 Task Order No. 13; Invoice 2010940009-6 (Final) Dear Mr. Stage, Enclosed is RS&H Invoice 2010940009-6 for the Destin Airport ATCT Permitting, Design and Bidding Services project. During the past period RS&H submitted the legal description for the wetland mitigation conservation easement. RS&H also maintained communication with the USACOE and NWFWD related to permit requests for encumbrance sketch and title commitment insurance. Please call me at (904) 256-2192 if you have any questions regarding this submittal. Sincerely, \N/Q“{fi : 2 Brad Went\:g Project Manager Enclosure cC: RS&H - File, Accounting RS&H, Inc FL Cert. Nos. AAC001886+1826000956-LCC000210 RSSH Tracy Stage Northwest Florida Regional Airport 1701 State Road 85 North Eglin AFB, FL 32542 1498 Project 2010940009 Contract No. C09-1737-AP Task Work Order No. 013 Lump Sum $424,203.00 Destin ATCT Design Professional Services through January 30, 2015 A.1 Schematic Design A.2 Design Development A.3 Construction Documents A.4 Bidding B.1 Air Traffic Control Tower Specialist B.2 Permitting Svcs-Site & Utilities B.3 Permitting Svcs-Wetland Mitigation Total Fee Billings to Date Fee Totals RS&H, Inc. P.O. Box 4850 Jacksonville, Florida 32201 904-256-2500/Fax 904-256-2520 Tax ID #59-2986466 January 30, 2015 Invoice No: 2010940009 - 6 Project Manager Bradley Wente For ACH payments: Bank Name: Wells Fargo Bank, NA Routing/Transit (ABA) Number: 121000248 Account Number: 2090003135029 Beneficiary Name: RS&H, Inc. Percent Previous Fee Current Fee Fee Complete Earned Billing Billing 87,455.00 100.00 87,455.00 87,455.00 0.00 83,274.00 100.00 83,274.00 83,274.00 0.00 143,442.00 100.00 143,442.00 143,442.00 0.00 22,742.00 100.00 22,742.00 22,742.00 0.00 30,000.00 100.00 30,000.00 30,000.00 0.00 41,637.00 100.00 41,637.00 37,473.30 4,163.70 15,653.00 100.00 15,653.00 14,087.70 1,565.30 424,203.00 424,203.00 418,474.00 5,729.00 Total Fee 5,729.00 Total this Invoice $5,729.00 Current Prior Total 5,729.00 418,474.00 424,203.00 5,729.00 418,474.00 424,203.00 ‘.,—»"“’r A & DATE (MM/DD/YYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE 6/25/2014 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: 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 certificate holder in lieu of such endorsement(s). PRODUCER Harden and Associates 501 Riverside Avenue, Suite 1000 Jacksonville FL 32202 CONTACT NAME: Todd Peters (RIS o, Ext:004-354-3785 (AIS, Nox904-634-1302 E-MAIL e ADDREss:tpeters@hardeninsight.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Charter Qak Fire Insurance Co 5615 INSURED REYNO-1 INSURER B :Travelers Indemnity Company 5658 RS&H, Inc. INSURER C :Travelers Property/Casualty Co 5674 jggfifogfifi;‘”gfg;zagg Bivd S INSURER D :Phoenix Insurance Company 5623 INSURER E :| exington Insurance Company 19437 INSURER F : COVERAGES CERTIFICATE NUMBER: 1332067967 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. INSR ADDL|SUBR POLICY EFF | POLICY EXP E‘I’sR TYPE OF INSURANCE INSR | WvD POLICY NUMBER (MM/DD/YYYY) (MMID%IYYYY) LIMITS A | GENERAL LIABILITY 6304711N755 B/28/2014 B/28/2015 EACH OCCURRENCE $1.000,000 X ] DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $1,000,000 } CLAIMS-MADE OCCUR MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY | $1,000,000 [ | GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG | $2,000,000 poLicy | X | RO Loc $ B | AUTOMOBILE LIABILITY 8104621M601 6/28/2014 B/28/2015 | GOMBINED SINGTETIMIT T ) 000 000 X ANY AUTO BODILY INJURY (Per person) | $ ALL OWNED SCHEDULED ; ALLOY - SEHED BODILY INJURY (Per accident) | $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident) Comp/Coll Deductible $1000/$1,000 C |[X | UMBRELLA LIAB X | occur CUP4711N755 6/28/2014 B/28/2015 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 pED X | RETENTION 10,000 s D | WORKERS COMPENSATION PVYDNUB5388B30713 12/1/2013 112/1/2014 X | HESTATY O C | AND EMPLOYERS' LIABILITY YIN PJUB915K337413 12/1/2013 [12/1/2014 ANY PROPRIETOR/PARTNER/EXECUTIVE | E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? EI N/A | (Mandatory in NH) | E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under - oo 15 o DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT | $1,000,000 | E Professional Liability 028395945 6/28/2014 B/28/2015 |Per Claim Limit $5,000,000 with Contractors Pollution Liab. |Aggregate Limit $10,000,000 Claims Made; 1/1/42 Retro Date Retention $50,000 | DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is included as Additional Insured on General Liability as respects to work completed by Named Insured where required by written contract. Cancellation clause is as shown except for non-payment which is 10 days CERTIFICATE HOLDER CANCELLATION Okaloosa County Attn: Tracy Stage 1701 State Road 85 N Eglin AFB FL 32542-1498 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 ) A e L(/i e /(, (o i 4 ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD