Okaloosa County BOCC — November 4, 2014 — ERMC Close Out Checklist

CONTRACT CLOSE-OUT CHECKLIST (To Be Prepared by the Purchasing Services Coordinator) DATE: 10-27-14 TO: Contracts & Grants Manager, Finance Department Contracls & Grants Office SUBJECT: ContractNo. 20801565 MANAGING DEPARTMENT: NWE Regional Airport CONTRACTOR'S NAME: ERMC IV.,.LP PROJECT TITLE: The attached has met the final payment contract requirement in subject contract. Yes No 1. Final Invoice [a C 2. Completed Contract/Lease Payment Approval Form ot C] 3. Close-Out Documents Yes No N/A ca. Signed Release of Lien C] J C] b. Proof of Completion Advertisernent [] [| | c. Certificate of insurance wt "] C] d. Consent of Surety fo Final Payment LJ | im @. Proof of Performance/Payment Bond CJ Cl CJ Continuation 12 Months Follawing Final Payment Yes No A, Agenda Request ca Cl] 3: Remarks 10 Dk DATE CONTRACT/LEASE PAYMENT APPROVAL FORM COMPLETE AND FORWARD TO THE NEXT DEPARTMENT COMPLETED BY DEPARTMENT DATE: 10/27/2014 VENDOR NAME: ERMC VENDOR #: 20801565 CONTRACT/LEASE#, C08-1660-AP TASK COUNTY/FEMA VENDOR BUDGET ORDER # PROJECT # ACCOUNT # AMOUNT $ INVOICE # Of Applicable) Gi Appifeabte) DEPARTMENT # 636-1842 . 4202 546620 $ 7,387.00 TOTAL | $ 7,387.00 APPROVED FOR PROGRESS PAYMENT (iease sign, as applicable and date) CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER: DATE: COUNTY SUPERVISOR/PROJECT MANAGE 7A L, fy Sn DATE: /6. 2720F TRACYSTAGE A.ALE. DEPARTMENT DIRECTOR: DATE: 7¢9/: SUNIL AALE. _ CONTRACTS & GRANT MANAGER/< Lie Vite A - a SP fof. DATE: 40 pf IF COUNTY ADMINISTRATOR: DATE: (Payments>$25,000.) FINAL PAYMENT FINAL PAYMENT YES Y NO . (If "Yes", forward to Purchasing Services Coordinator for Close-Qut) DATE: PURCHASING DIRECTOR: (Per Initial Agreement) pate: WLI SY CONTRACTS & GRANTS MANAGER: (All Contracts) ‘ : DATE: L2G fo COUNTY ADMINISTRATOR APPROVAL: > 7 Tos (Per Initial Agreement) oo ee DATE: BOARD APPROVAL: (Per Initial Agreement) COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY FISCAL YEAR: DATE RECEIVED: REVIEWED BY: LR WE soft sie7 ERMC IV, LP 5913 EDEN DRIVE HALTOM GITY, TX 76117 Phone: 817-834-0244 Fax: 817-834-0254 636-1342 06/30/14 Bill To: NW Florida Regional Airport 1701 State Rd N Eglin AFB, FL 32542 Attn: Larica Redmond ~“$7387.00| + 7,387 00 QUARTERLY PIT for MAY 2014 Performed PM's on all equipment per contract INSPECTION REPORTS LEFT AT SITE IN VPS $7,387.00 $7,387.00 CONTRACT/LEASE PAYMENT APPROVAL FORM COMPLETE AND FORWARD TO THE NEXT DEPARTMENT COMPLETED BY DEPARTMENT DATE: 10/27/2014 VENDOR NAME: ERMC VENDOR #: 20801565 CONTRACT/LEASE#: C08-1660-AP TASK COUNTY/FEMA VENDOR BUDGET ORDER # PROJECT # ACCOUNT # AMOUNT $ INVOICE # Of Applicable) (Uf Applicabte) DEPARTMENT # 636-1847 4202 546620 $ 7,387.00 TOTAL | $ 7,387.00 APPROVED FOR PROGRESS PAYMENT (please sign, as applicable and date) CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER: DATE: SG) DATE: /0:27-7% CY STAGE A.ALE. COUNTY SUPERVISOR/PROJECT MANAGER; DEPARTMENT DIRECTOR: DATE: Ly pf Y VP, CONTRACTS & GRANT MANAG wa eo fouhbn— DATE: 49-E Po COUNTY ADMINISTRATOR: DATE: (Payments> $25,000.) FINAL PAYMENT FINAL PAYMENT YES So NO Of "Yes", forward to Purchasing Services Coordinator for Close-Out) | DATE: PURCHASING DIRECTOR: . (Per Initial Agreement} pate: OSH Lo CONTRACTS & GRANTS MANAGER: lati LA he le (All Contracts) ‘ , DATE: COUNTY ADMINISTRATOR APPROVAL: (Per Initial Agreement) DATE: BOARD APPROVAL: (Per Initial Agreement) COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY FISCAL YEAR: DATE RECEIVED: REVIEWED BY: ERMC IV, LP §943 EDEN DRIVE HALTOM GITY, TX 76117 ee: Sew oS... Phone: 817-834-0244 ; CREATING SAFE, GLEAN & WORRY-FREE ENVIRONMENTS Fax: 817-834-0264 FACILITY ASSET SERVICES Bill To: 636-1847 NW Florida Regional Airport 09/30/14 1701 State Rd N Rages. 1 Eglin AFB, FL 32542 aR oft ¥ Attn: Larica Redmond : fn aes QUARTERLY PM Performed PM's on all equipment per contract for August 2014 INSPECTION REPORTS LEFT AT SITE IN VPS $7,387.00] i $7,387.00) “CHATTANOOGA, rN 374° L__ Passenger seniger Loading Bridge Quarterly’ PM Report | [~ Customer Approval “J ’ {Start date - Pid. LL 4 [Name- Dew fol Coe fe. | [Completion date ~ ZI. sy | |Signature RE SrA 2 C LE , ERMC Technician 1- —y5a7 CTasencnee ) Date - "97; [zor7 | | ERMC Technician 2 - | —y ACORD Mme CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 10/1/2014 THIS CERTIFICATE IS ISSUED AS A MAT CERTIFICATE DOES NOT AFFIRMATIVEL BELOW. THIS CERTIFICATE OF INSURA REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. ANCE DOES NOT CONSTITUTE A CONT TTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS .Y OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES RACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. the terns and conditions of the policy, certain policies ma If SUBROGATION IS WAIVED, subject to y require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). propuceR Jeff Lett COMACT Rita Graham Insurity Group PPHONE (423) 424-4637 | FAX ay, (423) 424-4699 6148 Lee Highway AboRess: “i tag@insuritygroup.com Suite 206 INSURER(S) AFFORDING COVERAGE NAIC # Chattanooga TN 37421 isureRA:‘The Ins. Co. of the State of PA {19429 INSURED IWSURERB:National Union Fire Insurance 1.9445 ERMC IV, LP insurERC New Hampshire Insurance Company [23841 6148 Lee Highway, Suite 300 isuReRO:;St. Paul Fire & Marine 24767 ( insuRERE:Tllinois National Ins Co 23817 Chattanooga IN 37421 INSURER F : COVERAGES CERTIFICATE NUMBER:14/15 ERMC IV LP - G/A/W REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEL INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CON CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN M OW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD DITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AY HAVE BEEN REDUCED BY PAID CLAIMS. ee TYPE OF INSURANCE Renin POLICY NUMBER (AMIDE AE) | MaMDBIYYYY) LIMITS | GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X_| COMMERCIAL GENERAL LIABILITY PREMISES (Ea oveurrence) $ 100,000 A | CLAIMS-MADE OccuR GL1929725 20/2/2014 10/1/2035 | mem EXP (any one person) | $ Excluded Xj] $500,000 SIR PERSONAL & ADVINJURY | $ 1,000,000 _ GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG | $ 2,000,000 POLICY [x] FRO- [x] Loc Gen Agg Per Location $ 2,000,000 [AUTOMOBILE LABILITY GQUBNED SNGIE THT TT 900,000 A | X ANY AUTO BODILY INJURY (Per person) | $ | ALL OWNED | | SCHEDULED CcaA0939849 0/4/2014 [10/1/2015 | BopILy INJURY (Per accident)| $ | X | Rep AUTOS nurs ee (Ber aeuktony ACE $ PIP-Single limit $ |X| umereauias | XT occur EACH OCCURRENCE $ 5,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE 3 5,000,000 peo | X | rerentions 10,000 beo14s29234 10/1/2014 |10/1/2015 5 io ansctane haan POSEZIOLAS — Galltormin RO/A7ROTE KOPUPEOIS |e TESTE] OF YIN ANY CEQRRIETOR/PARTNER/EXECUTIVE [| NIA E.L. EACH ACCIDENT $ 1,000,000 (Mandatory in NA) C038238120 - Florida E.L_ DISEASE - EA EMPLOYEE) $ 1,000,000 DESCRIPTION OF OPERATIONS below $250,000 SIR both policys E.L. DISEASE - POLICY Limit | $ 1,000,000 Excess Liability ZUP-11R92592-13-NF LO/1/2014 (10/1/2015 | occurrence Limit $5,000,000 Aggregate Limit $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 1 01, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION Northwest Florida Regional Airport 1701 State Road 85 N Eglin AFB, FL 32542 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 Jeff Lett/ALEA ACORD 25 (2010/05) INSO25 (201008).01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are reaistered marks of ACORD