Okaloosa County BOCC — July 1, 2014 — GenesisC2127_FinalPmt

CONTRACT CLOSE-OUT CHECKLIST (To Be Prepared by the Contracts and Lease Coordinator) DATE: 6-24-14 TO: Contracts & Grants Manager, Finance Department Contracts & Grants Office SUBJECT: Contract No. C14-2127-PW MANAGING DEPARTMENT: PUBLIC WORKS CONTRACTOR'S NAME: GENESIS CEI SERVICES PROJECT TITLE: 12™ AVENUE The attached has met the final payment contract requirement in subject contract. Yes No 1. Final Invoice Xl 2 Completed Contract/Lease Payment Approval Form xX] O 3. Close-Out Documents Yes No N/A a. Signed Release of Lien im O | b. Proof of Completion Advertisement im oO Xx c. Certificate of Insurance im O Xl d. Consent of Surety to Final Payment im O Xx e. Proof of Performance/Payment Bond im oO Xx Continuation 12 Months Following Final Payment Yes No 4, Agenda Request Xl O 5; Remarks Z b-a¥-ly Confracts and Léase Cooflinator DATE ko ge CONTRACT/LEASE PAYMENT APPROVAL FORM COMPLETE AND FORWARD TO THE NEXT DEPARTMENT COMPLETED BY DEPARTMENT DATE: 05/09/2014 VENDOR NAME: Genesis CEI Services VENDOR #: 21400154 CONTRACT/LEASE#: C14-2127-PW (1 2th Ave. Sidewalks) TASK COUNTY/FEMA VENDOR BUDGET INVOICE # ORDER # PROJECT# — | pepartmeNT #| “ACCOUNT # AMOUNTS (If Applicable) (If Applicable) . G004 NA 0437 uh? }, 731342 563490 $ 4,189.27 TOTAL $ 4,189.27 APPROVED FOR PROGRESS PAYMENT (lease sign, as applicable and date) ENS CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT Jason Autrey NJ John Hofstad COUNTY SUPERVISOR/PROJECT MANAGER: ) PL DEPARTMENT DIRECTOR: Es ADCONTRACTS & GRANT MANAGER‘ Eric Broome DATE: / DATE: COUNTY ADMINISTRATOR: DATE: (Payments> $25,000.) FINAL PAYMENT FINAL PAYMENT ved V |nol_| (If "Yes", forward to Purchasing Services Coordinator for Close-Out) DATE: PURCHASING DIRECTOR: (Per Initial Agreement) DATE: ZL ~ LF: - LE CONTRACTS & GRANTS MANAGER: 4 DATE: ble sD) Y¥ COUNTY ADMINISTRATOR APPROVAL: OE Va (Per Initial Agreement) (All Contracts) DATE: BOARD APPROVAL: oS (Per Initial Agreement) COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY FISCAL YEAR: DATE RECEIVED: REVIEWD BY: S Genesis CEI Services CONSTRUCTION, ENGINEERING & INSPECTION INVOICE CONSULTANT Genesis CEI Services, LLC FEID# 59-3669274 CUSTOMER / CLIENT Okaloosa County Board of County Commissioners Authorized Agent: Eric Broome, P.E. Project Manager Okaloosa County Public Works 1759 S. Ferdon Blvd Crestview, FI. 32536 (850) 423-4838 Contract No. C14-2127-PW RFQ 07-14 Genesis ProjectNo. OOCPW001 Project FIN: 428115-1-68-01 12th Ave Sidewalk Improvements Invoice Number: G004 Invoice Period Ending: 04/27/14 MAIN OFFICE 3910 US Highway 301 N. Suite 140 Tampa FL 33619 Tel 813.620.4500 Fax 813.620.4980 GenesisCEl.com, Contractual Total Billed Previous Amount Due Limits To Date Billings / This Period Salary Related Costs $ 17,010.26 18,139.19 $ 12,820.99 $ 5,318.20 Over budget amount: $ (1,128.93) Totals $ 17,010.26 18,139.19 $ 12,820.99 $ 4,189.27 By submittal of this invoice, the above named Consultant certifies that reimbursable costs contained in this invoice represent actual project costs as reflected in our accounting records. Me Magee Vice-President 04/28/14 William H. Klepac, P.E. Title Date GENESIS CEI INVOICE 04 PERIOD ENDING April 27, 2014 PROJECT DESCRIPTION: 12th Avenue Sidewalk Addition - Okaloosa County FINANCIAL PROJECT NUMBER: 428115-1-68-01 FEDERAL AID PROJECT NUMBER: COUNTY: OKALOOSA DATE PREPARED: 4/28/2014 Budget Manhours Actual CLASSIFICATION NAME FIRM Total Manhours Senior Project Engineer Bill Klepac, P.E. IGENESIS 16.50 3.00 Project Administrator Doug Pritchard |GENESIS 24,75 61.00 Contract Support Specialist_|Mike Graham GENESIS 37.95 43.00 RCS Robbin Moody GENESIS 0.00 0.00 Senior Inspector - Rdwy Greg Edmondson _|GENESIS 0.00 0.00 Senior Inspector - Bridge Shawn Moore GENESIS 0.00 0.00 Inspector - Roadway/Plant _|Scott Chastain GENESIS 0.00 0.00 Inspector - Roadway/Plant _|Sonny Edmondson _|GENESIS 0.00 0.00 Inspector - Roadway/Plant |p. Leber/R. Rutherford |GENESIS 148.50 131.50 Admin Cadey Moody JTRANS-STATE 0.00 0.00 Inspector's Aide (DBE) [TBD JTRANS-STATE 0,00 0.00 TOTAL| 227.70 238.50 NOTE: Duration of CE! Services budget is based on 90 Construction Days + 10% Weather + 20 Days Pre-Construction + 20 Days Post-Construction = 139 Days Estimated CEI Completion: 4/28/2014 L= Letting P= Pre-Construction T= Final C= Construction | certify the above listed hor are true and accurate aA WeHWY Dough Pritchard, Project Administrator Genesis CEI Services Associate Vice President Genesis CEI Services 12th Avenue Sidewalk Addition Okaloosa County