Okaloosa County BOCC — August 6, 2013 — Contract Payment Approval Form, Invoice and Insurance — reading text

CONTRACT/LEASE PAYMENT APPROVAL FORM COMPLETE AND FORWARD TO THE NEXT DEPARTMENT COMPLETED BY DEPARTMENT DATE: 10/8/2013 VENDOR NAME: BURTON & ASSOCIATES VENDOR # 012868 CONTRACT/LEASE#: C00-0443-WS TASK COUNTY/FEMA VENDOR BUDGET INVOICE # ORDER # PROJECT # DEPARTMENT # | ACCOUNT# AMOUNT $ (Uf Applicable) (if Applicable) 486 15 4101 531900 4,696.00 TOTAL | $ 4,696.00 \ APPROVED FOR PROGRESS PAYMENT (please sign, as applicable and date) CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER: 77) DATE: COUNTY SUPERVISOR/PROJECT MANAGER: ASD) by MWe ko DEPARTMENT DIRECTOR: pate: (0/6 (13 CONTRACTS & GRANT MANAGER: COUNTY ADMINISTRATOR: (Payments> $25,000.) awl WW DATE: 1n/ 8 i 2.013 DATE: DATE: FINAL PAYMENT FINAL PAYMENT YES V wo — (f "Yes", forward to Purchasing Services Coordinator for Close-Out) DATE: PURCHASING DIRECTOR: VI Al (Per Initial Agreement) DATE: CONTRACTS & GRANTS MANAGER: (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: INVOICE Burton « ASSOCIATES Bill To: From: Okaloosa County 200 Business Park Circle, Suite 101 Director St. Augustine, FL 320905 Attn: Mr. Jeff Littrell Telephone: (813) 443-5138 1804 Lewis Turner Parkway Facimile: (813) 443-8289 Fort Walton Beach, FL 32547 www.burlonandassociates.com Burton & Associates Invoice Invoice #: 00486 _ Term: Net 30 Date created: 10/01/2013 Date due: 10/31/2013 Client: Okaloosa County Status: Outstanding Project: FY 2013 Water and Sewer Revenue Sufficiency Analysis Update Total: $4,696.00 Project #: 00079 Payments: $0.00 Balance: $4,696.00 Description Task Order #15 This is an Invoice. for professional services rendered for the time period ending in 9/30/13. If you have any questions regarding this Invoice, please contact Brooke -Precourt at (813) 443-5138. A summary of project invoices showing all invoices issued and their payment status Is attached for your information, Details Name Description Qty Rate Amount Total Fees Billed (through current billing period) 100% Complete through 09/30/13 $23,879.00 Less: Previous Fees Billed $-19,183.00 Subtotal $4,696.00 y Total Amount Payable $4,696.00 Lo Contract Status Summary: Contract Amount $23,879 Less: Total Billings to date ($23,879) Contract Amount Remaining $0 For more information regarding our services, please visit our website at www.burtonandassociates.com 6L8"Ez$ 628'E2$ 1809 GALYWILSS WLOL) 69ZLS Wa Va A L HOTS S3SNAdxXE CSLVNILLSS orrezs | ozs Sez'ZL$ | Osg'9S | Sz0'es Bad ONILINSNOOD CALVWILSS TWLOL oo'erL %00"00L erb g L6 ve Sb SYNOH-NV GSLVWILSS TY LOL} OO'EPL %00°001 %00°001 3 ie) ie) v v “Buueay a]21 au0 puapy 0 oo'sEL Sobers %00°001 g z cA b b “Apnig eu} JO syNsos ayy JO HodeyY jeuLy ay} a1edalg 0 OO'6ZL | %EZ06 %00°00L sy L z | $0 “ApMg ay} Jo synseu ayy yo Woday Yeq yeuly ay) aedaig 0 Os'pzL | %~90'Z8 %00°001 z 0 1 L 0 “‘yeIs AunoD YM Yoday Yelg au] Maley 0 OS Zeb %I9'SE WOO COL g'OL 9 8 cA ¢g0 “Konig ou} Jo syNsei ayy JSWINDOP O} Wodey Yeiq e s1edeiq 0 “poday leuly ul siskjeuy Aouatoyjng anuaaay ou} JO S}INsa] ay; JUsWNDOG 6 ASEL painboy se yey Aunoy iy “siskpeue AQUAIOIINS SNUSAS! 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NSeL os seis Bas s0zs “<-ajel AMOR ‘ayejduo) ayejduroy radio poloid FeouaId =| weynsuog | s0}auIg ledioul SNSVL LOdrodd sunt peloig ase, 1eyon pafoid yoatord yoloig uO bain SYNOH-NVW GSLVIALLS3 L4jo | e6eq saivioossy ® NOLUNG SaDDOSSY P UOLING Ag parbdaig FIVAILST LSOD 9% NVIGNYOM LOFOAd ALVddN SISATVNV AONGIOIIINS JNNIATA YAMS AGNV UALVM E107 Ad AILNNOD VSOOTVXIO Project Invoices - FY 2013 Water and Sewer Revenue Sufficiency Analysis Update Burton a Associates 00486 00423 00380 00347 00285 Total Due 10/31/2013 09/15/2013 08/14/2013 07/17/2013 05/17/2013 Title Burton & Associates Invoice Burton & Associates Invoice Burton & Associates Invoice Burton & Associates Invoice Burton & Associates Invoice Total $4,696.00 $4,113.00 $1,711.00 $11,188.00 $2,171.00 $23,879,00 Payments $0.00 $4,113.00 $1,711.00 $11,188.00 $2,171.00 $19,183.00 Balance. Term $4,696.00 Net 30 $0.00 Net 30 $0.00 Net 30 $0.00 Net 30 $0.00 Net 30 $4,696.00 ‘a Acerts CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) OP ID PE 01/17/13 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. 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 certificate holder In tieu of such endorsement(s). IMPORTANT: If the cériiticate holder Is an ADDITIONAL INSURED, the polley(ies) must ba 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 Paoli PA 19301 PRODUCER . CONTACT Fanelli~Harley~Harper & Assoc | PHONE FAX Suite 101 {BIG No, Ext (AIC, Nop: 42 &. Lancaster Avenue ADDRESS: PRODUCER CUSTOMER ID #: BURTO-1 Phone: 610-995-9100 Fax:610-995-9107 INSURER(S) AFFORDING COVERAGE NAIC # INSURED of INSURERA: Haxtford Casualty Ins. Co. 29424 Burton & Associates, Inc. J a B: i i Attn: Michael Burton “x INSURERS: Twin City Fire Ins. Co. 29459 200 Business Park Circle, #101 INSURERC: AmGuard Insurance Company 42390 Saint Augustine FL 32095 INSURER D INSURER E+ INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 1S TO CERTIFY TRAT 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 YO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. FR ADDY SUBR YY EFF POLICY EXP NER TYPE OF INSURANCE INSR] WD. POLICY NUMBER URRIDBAYY) | (BRD) Limits GENERAL LIABILITY EACH OCCURRENCE $1,000,000 mo DAMAGE TO RENTED AL |X | COMMERCIAL GENERAL LIABILITY 39 SBM IP 0799 01/21/13 |O1/21/14 | PREMISES (Ea occurence) [8 300,000 CLAIMS-MADE OCCUR MEO EXP (Any ane person} | $ 10,000 Z PERSONAL &ADVINJURY | $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG | $ 2,000, 000 "Lroucy [x [58S Loc $ AUTOMOBILE LIABILITY COMBINED SINGLE UiMiT nian (Ea accident) $1,000,000 A ANY AUTO 39 SBM IP 0799 04/21/13 (01/21/14 FeopiyinjuRY @erparsonl TS noo] Abt OWNED AUTOS BODILY INJURY (Por accident)| § SCHEOULED AUTOS PROPERTY DAMAGE X_| HIRED AUTOS (Per accident) s X_| NON-OWNED AuTos s $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE 8 DEDUCTIBLE $ RETENTION $ $ CG”) WORKERS COMPENSATION BUWC 443518 OL7BI7i3 101721714 | XT We STATOR orn AND EMPLOYERS’ LIABILITY f2uh (aus bronvuirs | [ER ANY PROPRIETORUPARTNERIEXECUTIV! E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? tA (Mandatory in NH) E.L. DISEASE - EAEMPLOYEE| $ 1,000,000 it yes, describe ds OLSGRIPTION OF OPERATIONS below E.L, DISEASE - POLICY Limit | $ 1,000,000 B | Errors /Omissions PG 0261365 01/21/13 j01/21/14 | Oceur. $3,000,000 Aggregate $3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 401, Additional Ramarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION OKALOOS Okaloosa County Attn: John Christopher, Purch. 602-C North Pearl Street Crestview FL 32536 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 we - we we . 1 we / ; sy Kenneth R. Schultz & te Seberapety ACORD 28 (2009/09) © 1988-2009 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD