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CONTRACT CLOSE-OUT CHECKLIST (To Be Prepared by the Purchasing Services Coordinator) DATE: 10/28/2013 TO: Contracts & Grants Manager, Finance Department Contracts & Grants Office SUBJECT: Contract No. C13-2050-PW. MANAGING DEPARTMENT: PUBLIC WORKS CONTRACTOR'S NAME: GULF COAST TRAFFIC ENGINEERS, INC. PROJECT TITLE: AIRPORT RD SAFETY IMPROVEMENTS The attached has met the final payment contract requirement in subject contract. Yes No I Final Invoice Xx O 2. Completed Contract/Lease Payment Approval Form Xl | 3. Close-Out Documents Yes No N/A a. Signed Release of Lien im O b. Proof of Completion Advertisement Xx] im C c. Certificate of Insurance Xl L] CJ d. Consent of Surety to Final Payment x) L] LJ e. Proof of Performance/Payment Bond x O | Continuation 12 Months Following Final Payment Yes No 4, Agenda Request O Xx] 5. Remarks fo -2€-|/2 DATE Eric Broome From: Marcella B. Eubanks [MEubanks@clerkofcourts.cc] Sent: Monday, October 21, 2013 3:12 PM To: Eric Broome Ce: Brenda L. Bailey; Ashley S. Endris Subject: FW: Airport Rd. LAP - Final Attachments: GCTE_Final.pdf; HDR_Final.pdf Eric, you definitely have the funds remaining in the grant to cover the final invoice from HDR and the final on Gulf Coast is paid from retainage so it is good too. | have copied Ashley on this email that she may review the final pay request in advance of your agenda request. Are you working on a reimbursement request to FDOT through Sep 30, 2013? Thank you Marcella B. Eubanks Accountant Okaloosa County Clerk of Circuit Court Contracts and Grants 1804 Lewis Turner Boulevard, Suite 206 Ft. Walton Beach, FL 32547 Tel: (850) 651-7200 x 4383 From: Eric Broome [mailto:ebroome@co.okaloosa.fl.us] Sent: Friday, October 18, 2013 2:16 PM To: Marcella B. Eubanks Subject: Airport Rd. LAP - Final Marcella, We will be closing out this project and making final payment pending Board approval on Nov. 5". Just wanted to send these to you in advance to look over. Thanks, Eric Broome, P.E. Project Manager/Design Engineer Okaloosa County Public Works 1759 S. Ferdon Blvd Crestview, FL 32536 Office: (850) 689-5772 Direct: (850) 423-4838 Fax: (850) 689-5715 Please note: Due to Florida's very broad public records laws, most written communications to or from County employees regarding County business are public records, available to the public and media upon request. Therefore, this written e-mail communication, including your e-mail address, may be subject to public disclosure. fi APPLICATION FOR PAYMENT PERIODIC ESTIMATE NO.: 3 - FINAL PROJECT NO.: 429677-2-58-01 WORK PERIOD BEGIN DATE: N/A END DATE: N/A ROAD NAME: CR-188 Airport Road ORIGINAL CONTRACT SUM $ 143,004.60 NET CHANGE BY CHANGE ORDERS $ 2,815.02 CONTRACT SUM TO DATE $ 145,819.62 ANALYSIS OF WORK PERFORMED 4, Value of original contract work performed previously: $ 145,819.62 2. Work performed this month: $ 0.00 3. Total value of work performed to date: $ 145,819.62 4. Less: Amount retained at five (5%) percent: $ 0.00 5s Net amount earned on contract work to date: $ 145,819.62 6. Less: Amount of previous payment: $ 138,528.64 y is AMOUNT DUE THIS PAYMENT $ 7,290.98 CERTIFICATION OF CONTRACTOR According to the best of my knowledge and belief, I certify that all items and amounts shown on the face of the Periodic Estimate are correct; that all work has been performed and/or materials supplied in full accordance with the terms and conditions of the contract between Okaloosa County and Gulf Coast Traffic Enginners, Inc. , and that the items for which payment is requested have been paid and that there are no vendors-mechanics, or other liens or conditional sales contracts which should be satisfied or discharged before such payment is made. (Gres Coast TRAFFIC GWG SERS !fy, (Firm Name) lame of Authorized Officer & Title) DSOEL B. ENMDERSON VICE PRESINENT CERTIFICATION OF ENGINEER I certify that I have verified this Periodic Estimate and that to the best of my knowledge and belief, it is a true and correct statement of work performed and materials supplied by the Contractor; and that the Contractor's certified statement ofthis account and the amount due him is correct. Givre 7 aCe a Date: Leb Lo LUE ghtolt CO A —. a From: GULF COAST TRAFFIC ENGINEERS, INC 8203 KIPLING STREET PENSACOLA, FL 32514 (850)478-7066 HDR Construction Control Corp To: Attn: Jonathan Vannoy 4673 Hwy 20 East Niceville, FL 32578 Date: Estimate #: Invoice ID: Period through: September 30, 2013 EST#00002F 96597F September 06, 2013 GCTE Job: ST0784 CR-188 AIRPORT ROAD Location: #429677-2-58-01 SAFETY IMPROVEMENTS OKALOOSA CO Item Description Unit of Unit Units in Current Total Units Total measure Price Place this Billing in Place Billed Period 101-1 Mobilization Ls 4,200.00 0.000 1.000 4,200.00 102-1 Maint of Traffic Ls 1,800.00 0.000 1.000 1,800.00 102-60 Work Zone Signs ED 0.50 434.000 1,643.000 102-741 Barricade Temp Ty |, II,Drum ED 0.25 378.000 1,350.000 337.50 102-77 High Intensity Flash Light ED 0.50 406.000 1,537.000 768.50 104-103 Sediment Barrier LF 6.00 0.000 375.000 2,250.00 110-11 Clearing & Grubbing Ls 10,200.00 0.000 1.000 10,200.00 120-22 Borrow Excav Truck Measure cY 27.00 0.000 51.000 1,377.00 120-71 Regular Excavation LS 5,580.00 0.000 1.000 5,580.00 339-1 Misc Asphalt Pavement TN 390.00 0.000 17.200 6,708.00 536-11 Guardrail (Roadway) LF 24.00 238.000 238.000 5,712.00 536-73 Guardrail ( Removal) LF 3.60 0.000 38.000 136.80 536-85-24 Guardrail End Anch Assmbly EA 2,580.00 1.000 1.000 2,580.00 570-12 Performance Turf (Sod) SY 6.00 0.000 176.000 1,056.00 700-2011 Single Post Sign F&l <12sf AS 178.00 21.000 3 73.000 42,994.00 700-2012 Single Post Sign F&l 12-20 sf AS 187.00 0.000 1.000 187.00 700-2060 Single Post Sign (Remove) AS 12.50 0.000 58.000 725.00 700-4860 Sign Panels (Remove) EA 12.50 0.000 16.000 200.00 701-111114 Audible & Vibratory Pvmt Mrkng NM 5,100.00 0.000 6.925 35,317.50 705-101 Object Marker Ty 1) EA 47.50 0.000 3.000 142.50 706-3 Retro-Reflec Pymt Markers EA 4.00 0.000 360.000 1,440.00 7411-11125 Thermo Std Wh Sol 24" LF 5.00 0.000 54,000 270.00 7411-11211 Thermo Std Yel Sol 6" NM 4,500.00 0.000 2.710 12,195.00 711-17 Thermoplastic (Removal) SF 1.95 0.000 18,384.000 35,848.80 CHANGE ORDER #1 0.000 0.00 120-71 Regular Excavation LS 1,622.52 0.000 1.000 4,622.52 570-12 Performance Turf-Sod(225 SY SY 6.00 0.000 1.000 1,350.00 145,819.62 Total CONTRACTOR'S RELEASE OF LIENS STATE OF: Florina COUNTY OF: __ EScAMA: A Before me, the undersigned Notary Public in and for the said County and State personally appeared _“Jo&L E. ENDERSQU __, representing the Contractor, QuLF Cees 7 TRAFFIC EVG1WEE 2S 1 who being duly sworn according to law deposes and says that all labor, materials, and outstanding claims and indebtedness of whatever nature arising out of the performance of the Contract with OKALOOSA COUNTY BOARD OF COUNTY COMMISSIONERS the Owner, for -I ake ntract No. , have been paid in full and that for the final payment in the amount of_OKwloosn Co , the Contractor releases and discharges the Owner and- his authorized representatives from any liens or claims of any nature because of or arising from this contract and/or its performance, which it has had, has or May have in the future. By: Yea E, Eaclonpon O Sworn to and subscribed before me this 18 day of OBEN. 013 ( My Commission Expires: __ @Y -/0-/Y ‘ary Public) CATHERN E, RETHERFORD Notary Public - State of Florida ly Comm. Expires Apr 10, 2014 Commission # DD 957292 CR 188 (Airport Road) Safety Improvements Release of Liens Ol Daily News Published Daily Fort Walton Beach, Florida Distributed in Okaloosa, Santa Rosa & Walton Counties State of Florida, County of Okaloosa Before the undersigned authorized personally appeared ji Vus 241) b/. Age ; who on oath says that (s)he is l é get 4d V5) “A Gr1= of the Northwest Florida Daily News, a daily newspaper published at Fort Walton Beach, in Okaloosa County, Florida; that the attached copy of advertisement, being a Lz ab ¢ Gos in the matter of Ad Ver tisimint ot lj brapsehioy CR 183 Satety Improventats 7 7 in the Chi loose County Court, was published in said newspaper in the issues of Siptumbu, 25s Vetibyy 2 9 fo X03 ‘ ¥ 7 Affiant further says that the said Northwest Florida Daily News is a newspaper published at Fort Walton Beach, in said Okaloosa County, Florida, and that the said newspaper has heretofore been continuously published in said Okaloosa County, Florida, each day, and has been entered as second class mail matter at the post office in Fort Walton Beach, in said Okaloosa County, Florida, for a period of one year next preceding the first publication of the attached copy of advertisement; and affiant further says that (s)he has neither paid nor promised any person, firm or corporation any discount, rebate, commission or refund for the purpose of securing this advertisement for publication in the said newspaper. STATE OF FLORIDA COUNTY OF OKALOOSA Subscribed and sworn to (or affirmed) before me this /b bottler XxILS = (Date) } by Inet tra, LANtt2e _, who is/are personally known to me or has/have produced Bors madly Kn gn as identification. (Type of iderftification) Notary Public, Commission No. al (Name of Notary typed, printed or stamped) ELEANOR HYPES b) Notary Public - State of Florida f, dy Comm. Expires Jul 30, 2015 Commission # EE 116319 Bonded Through National Notary Assn. i? PEF PPE” Legal 4965 ADVERTISEMENT OF COMPLETION Gulf Coast Tratfic Engi- neers, Inc, 8203 Kipling Street, Pensacola, FL $2514 Gives notice of completion of CR-188 (Airport Rd) Safety Im- provements, - Okaloosa Co, and sets 18 Octo- ber 2013 as the date of final settlement: : All persons and_ firms should file all claims for payment to the below address prior to the settlement dates Okaloosa County (Owner) ATTN: Contracts and Leases Coordinator 602-C North Pearl Street Crestview FL 32536 By: Joel E. Enderson Vice President Legal 4965 Sept. 25, Oct. 2, 9, 16 Sihle Insurance . Group »” www.sihle.com 601 South Palafox Street * Pensacola, FL 32502 ° 850-332-5458 » Fax 850-607-2060 October 23, 2013 HDR Construction Control Corpcration 4673 State Road 20 E. Niceville, Fl. 32578 RE: CR-188 Airport Road Safety Improvement Please consider this letter as our commitment to provide a certificate of liability for a period of two years following completion of work on the above referenced project.. Upon renewal an insurance certificate will be mailed to the proper authority. A 1 year Maintenance Bond will be issued following final payment. Sincerely, rae Xo Alice Pousson : Commercial Account Manager a . Sihle Insurance Group Since 1974 cs) “The Difference is Service” Rule 14-24.001 F.A.C. STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 700-050-21 Rule BOE EAG: CONTRACTOR’S AFFIDAVIT AND SURETY CONSENT aan? (FORM 21-A) Page 1 of 2 STATE OF FLORIDA COUNTY OF __ ESCAM~ 1 Before me, the undersigned Notary Public, personally appeared ALai rz Ss. Coole to me well known or who has produced as identification, ~~ (Type of Identification) who being first duly sworn, deposes and says that he/she is: PRES\ OE=ENd (Title of duly authorized person) of Gulf CoOST T@AFE€ EAG iC, CRAB Tin (Contracting entity) (Type of entity) the Contractor on Financial Project |.D._4 24 G1). 2-58-0) Road No._Ci-) BB in Okaloosa County, Florida under Contract No._C13 - 20S OPW with the State of Florida Department of Transportation dated the l g day of ny: 7.) an Zo) % ; and that the Affiant based on his/her personal knowledge says that: 1. Said contract has been complied with in every particular by the Contractor and that all parts of the work have been approved by the District Director of Operations of the State of Florida Department of Transportation. 2. The Contractor has not offered or made any gift or gratuity to, or made any financial transaction of any nature with, any

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