Okaloosa County BOCC — August 24, 2013 — Close-Out Documents - Contract No. C11-1849-WS0002 — reading text

the Company subject to the following provisions: The Attorney-in-Fact. may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements of indemnity and other conditional or obligatory undertakings and any and all notices and documents canceling or terminating the Company’s liability thereunder, and any such instruments so executed by any such Attorney-in-Fact shall be as binding upon the Company as if signed by the President and sealed and attested by the Corporate Secretary.” “Be it Further Resolved, that the signature of any such designated person and the seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signatures or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached.” (Each adopted at a meeting held on February 8, 2000). In Witness Whereof, WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY have caused these presents to be signed by their Senior Executive and their corporate seals to be hereto affixed this 21st day of JANUARY A.D., 2008 . Corporate we URA gs, ONAL i, WWSlieg, WESTFIELD INSURANCE COMPANY —— ‘ Sal “Se A. sits, WESTFIELD NATIONAL INSURANCE COMPANY BX I e 23 & f mm, 6%, 6 “So OHIO FARMERS INSURANCE COMPANY : WARTERES 3 3 : ; i=: . : 14a (8; NW: Sos sancee” : . : * ee eet” ats Mm a k ao “Cn. we State of Ohio Henan eeesinnsyee™™ County of Medina SSi PY pichard L. Kinnaird, Jr., Senior Executive 2, EST Fle tA “e 3 a On this 21st day of JANUARY A.D., 2008 , before me personally came Richard L. Kinnaird, Jr. to me known, who, being by me duly sworn, did depose and say, that he resides in Medina, Ohio; that he is Senior Executive of WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, the companies described in and which executed the above instrument: that he knows the seals of said Companies; that the seals affixed to said instrument are such corporate seals; that they were so affixed by order of the Boards of Directors of said Companies: and that he signed his name thereto by like order. Notarial geet . Seal x mK A - ies Affixed i Pa ee BS BS : a ED William J. Kahelin, Afgvorney at Law, Notary Public State of Ohio My Commission Does Not Expire (Sec. 147.03 Ohio Revised Code) County of Medina SSi 4 wes OS PE OF Os v J! “Praca gg steeee |, Frank A. Carrino, Secretary of WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said Companies, which is still in full force and effect: and furthermore, the resolutions of the Boards of Directors, set out in the Power of Attorney are in full force and effect. Witness Whereof, | have hereunto set my hand and affixed the seals of said Companies at Westfield Center, Ohio, this 23 day of fol AD. “TH(S oP aided oo aa gy . ry ° eesUhAge “, SURG BS ss “f a oe ° Mas en, ” (EP SEAL 3} canny St ! 4% is iS: Secret: 1 e. f= 1846 “2: Frank A. Carrino, Secretary . OD Secretary <A LO", we : ‘ % Cesena %* *eenst, oe? = Ms, ’ 4, . en ae BPOAC2 (combined) (06-02) American Suncraft Company, Inc. 10836 Schiller Road, Medway, Ohio 45341 Phone (937) 849-9475 Fax (937) 849-9474 Specializing in Water Storage Tank Maintenance July 22, 2013 RE: Okaloosa 2010-2011 Paint and Repair Water Tanks To whom it may concern: American Suncraft Company, Inc. agrees to continue Commercial General Liability including Completed Operations and Product Liability coverage for two years following acceptance of project. Robert Boling, Vice-President American Suncraft Company, Inc. Sincerely, @ ACCORD Ree CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY} 7/22/2013 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. certificate holder in lieu of such endorsement(s). 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 PRODUCER Brower Insurance Agency 409 E. Monument Ave., Suite 400 CONTACT NAME: Debra Br ISR, MLI fe No, Ext:513-707-5011 [ FAX oy:513-707-5671 10836 Schiller Rd E-MAIL = Dayton OH 45402 AppREss:dbrummett@browerinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Starr Surplus Lines Insurance 13604 INSURED AMERS8C INSURER B :Cincinnati Insurance Company 10677 American Suncraft Construction INSURER C :Torus Specialty Insurance Co 25496 Medway OH 45341 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1279812095 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 SBR POLICY EFF | POLICY EXP LIR TYPE OF INSURANCE INSR| WVD POLICY NUMBER (MMIDDIYYYY) | (MMIDDIYYYY) LIMITS A GENERAL LIABILITY SLSLNRG02028413 1/4/2013 1/1/2014 EACH OCCURRENCE $1,000,000 KT DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) _| $100,000 | CLAIMS-MADE |X | occuR MED EXP (Any one person) _| $5,000 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 | ass Loc $s B | AUTOMOBILE LIABILITY EPP0174510 4/1/2013 4/1/2014 eS oe RE UMT | 4 oon.con hs | ANY AUTO BODILY INJURY (Per person) | $ (eeeen He SCeepULES BODILY INJURY (Per accident) | $ a: | NON Sune PROPERTY DAMAGE $ HIRED AUTOS i— (Per accident) [| $ Cc UMBRELLA LIAB X | occur 31164C130ALI 1/1/2013 (1/1/2014 EACH OCCURRENCE $4,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ pep X_| RETENTIONSO $ 4 WORKERS COMPENSATION SLSLNRG02028413 4/1/2013 4/1/2014 WC STATU- OTH- AND EMPLOYERS’ LIABILITY YIN ToRvuMits |_| NY PROPRIETOR/PARTNERIEXECUTIVE | E.L. EACH ACCIDENT $1,000,000 °==/CER/MEMBER EXCLUDED? NIA } {Mandatory in NH) E.L. DISEASE - EA EMPLOYEE} $1,000,000 # yes, describe under OESERIBTION OF OF OPERATIONS below | E.L. DISEASE - POLICY LimIT | $1,000,000 B Leased/Rented Equipment EPP0174510 11/4/2013 1/1/2014 UR Equip. Limit: 150,000 Water Tank DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES {Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder and Polyengineering Inc are additional insureds with respect to General Liability coverage for 2013-2014 Paint & Repair CERTIFICATE HOLDER CANCELLATION Okaloosa County Board of Commissioners Polyengineering Inc 302 North Wilson St, Ste. 302 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 253 6 AUTHORIZED REPRESENTATIVE Crestview FL 325. : ' / ; i = | © 1988-2010 ACORD CORPORATION. All rights reserved. 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