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EXHIBIT H
CONTRACT CLOSE-OUT CHECKLIST
(To Be Prepared by the Contracts & Leases Coordinator)
DATE: el. Whe
TO: Contracts & Grants Manager, Finance Department Contracts & Grants Division
SUBJECT: Contract No._C/2-/ 95 PW
MANAGING DEPARTMENT: _/u d/ic. Wak
CONTRACTOR'S NAME: Hero Ze evn and Revdels
PROJECT TITLE: Aoxund Drains as ¢ [epa'es
The attached has met the final payment contract requirement in subject contract.
Yes No
1. Final Invoice ca |
2. Completed Contract/Lease Payment Approval Form oh LC]
3. Close-Out Documents Yes No N/A
a. Signed Release of Lien La LJ CJ
b. Proof of Completion Advertisement Ze C C]
c. Certificate of Insurance i) L] L]
d. Consent of Surety to Final Payment na L] L]
e. Proof of Performance/Payment Bond [ye LC] LJ
Continuation 12 Months Following
Final Payment
Yes No
4, Agenda Request Ee LJ
5. Remarks C a P va st $5 )
I2Lult2-
DATE
EXHIBIT I
CONTRACT/LEASE
PAYMENT APPROVAL FORM
COMPLETE AND FORWARD TO THE NEXT APPROVING DEPARTMENT
COMPLETED BY DEPARTMENT
DATE: 12/12/2012
VENDOR NAME: Aero Training and Rental VENDOR #:
COUNTY AGREEMENT # (Contact Contract/Lease Coordinator, if unknown) C12-1958-PW
TASK COUNTY/FEMA
VENDOR ORDER # PROJECT # BUDGET
INVOICE # (if applicable) (applicable) DEPARTMENT# ACCOUNT # AMOUNT
See Attached 302 2051100 $7,560.36
TOTAL $7,560.36
APPROVED FOR PAYMENT (please initial, as applicable and date) :
ENGINEER/ARCHITECT/PROJECT MANAGER DATE:
KK bth DATE: _]9~)9-12
DATE: (ef f/fe
COUNTY PROJECT MANAGER:
DEPARTMENT HEAD:
FINAL PAYMENT. YES
CONTRACTS & GRANTS
IDATE: CONTRACTS & GRANTS MANAGER:
DATE: COUNTY ADMINISTRATOR APPROVAL : (Only Payments $25,001 - $50,000)
FINAL PAYMENT APPROVAL (if needed):
PURCHASING DIRECTOR: (Only Contracts < = $25,000)
COUNTY ADMINISTRATOR : {Only Contracts between $25,001 to $50,000)
Contracts Over $50,000 — BCC Approved
COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY
FISCAL YR:
IDATE RECEIVED:
Form revised 1-20-2011
APPLICATION FOR PAYMENT
PERIODIC ESTIMATE NO.: 5/FINAL PROJECT NO.: C12-1958-PW
WORK PERIOD BEGIN DATE: __ October 9, 2012 END DATE: November 10, 2012
ROAD NAME: _ Country Club Drive, Williams Way, Wedgewood Court
ORIGINAL CONTRACT SUM $ 146,301.00
NET CHANGE BY CHANGE ORDERS $ 4,906.10
CONTRACT SUM TO DATE $ 151,207.10
ANALYSIS OF WORK PERFORMED
1. Value or original contract work performed previously: $ 151,207.10
2. Work performed this month: $ 0.00
3. Total value of work performed to date: $ 151,207.10
4, Less: Amount retained at five (5%) percent: $ 0.00
5. Net amount earned on contract work to date: $ 151,207.10
6. Less: Amount of previous payments: $ (143,646.74)
7. AMOUNT DUE THIS PAYMENT $ 7,560.36
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 Aero Training &
Rental, 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.
©
Aero Training & Rental, Inc. Gay __ Lewis Cooper, Presifent
(Firm Name) (Name of Authorized Officer & Title)
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 of this account and the amount due his is correct.
p/m _ Date: _/2-/7*/2
Project Manager
Foxwood Drainage Repairs — Phase I App. For Payment ML
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LEWIS J. COOPER, PRESIDENT
AERO TRAINING & RENTAL, INC.
537 GULFSHORE DRIVE
DESTIN, FL. 32541
Phone (770) 560-8038
Fax (770) 573-4872
Email aerort@aol.com
October 11, 2012
RE: Foxwood Drainage Repairs —
Phase I, Contract #C12-1958-PW
Robert VandenBroeck
Okaloosa County Public Works Department
1759 South Ferdon Boulevard
Crestview, FL 32536
Dear Mr. VandenBroeck,
We hereby certify that we will provide insurance on this project for a two
year period starting October 11, 2012 and ending October 11, 2014. An insurance
certificate is attached that will expire on November 22, 2012. Coverage will be
renewed annually at that date.
If you need any additional information, please do not hesitate to contact me
at (678) 227-8868 or Lewis Cooper at (770) 560-8038.
It has been a pleasure working with you and your organization and look
forward to the opportunity of working with you again in the future.
Singerely,
A Caughey
Secretary/Treasurer
AEROTRA-01 ROAN
ACORP CERTIFICATE OF LIABILITY INSURANCE “sneizo12
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.
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
certificate holder in lieu of such endorsement(s).
PRODUCER
Yates Insurance Agency
(404) 633-4321
CONTACT
NAME:
PHONE
{A/IC, No, Ext):
| (ne, No}:
2800 Century Parkway NE E-MAIL
Suite 300 ADDRESS: :
Atlanta, GA 30345 INSURER(S) AFFORDING COVERAGE NAIC #
insurer A :National Trust Insurance Company
INSURED Aero Training & Rental, Inc. INSURER B :FCCI Insurance Company
902 Kendall Park Drive INSURER C:
Winder, GA 30680 INSURER D:
INSURER E : - _ |
INSURER F :
COVERAGES CERTIFICATE NUMBER: 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.
ADDL|SUBRI ~~ ; -
Nae TYPE OF INSURANCE Areal WED POLICY NUMBER [MMIDDIYYYY) | (MODY YY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000;
A |X | COMMERCIAL GENERAL LIABILITY X | X |CPP0007725 11/22/2011 | 11/22/2012 PRES E oo Coane] $ 300,000
| CLAIMS-MaDE | X | OCCUR MED EXP (Any one person) | $ 10,000
PERSONAL & ADVINJURY /j $ 1,000,000;
_ GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG | $ 2,000,000
pouicy | X | SRO: LOC $
AUTOMOBILE LIABILITY COMBINED INGLE LIMIT I 1,000,000
A |X | anyauto X | X (\CA0009716 11/22/2011 | 14/22/2012 | BODILY INJURY (Per person) | $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) | $
— NON-OWNED PROPERTY DAMAGE $
4 HIRED AUTOS AUTOS (Per accident)
b- : —
X | UMBRELLA LIAB | X | occuR EACH OCCURRENCE $ 2,000,000,
B EXCESS LIAB CLAIMS-MADE UMB0005973 11/22/2014 | 14/22/2012 | acorecate 5 2,000,000
DED al RETENTION $ 10,000 $
WORKERS COMPENSATION X | WG STATU- OTH
AND EMPLOYERS’ LIABILITY YIN TORY LIMITS ER
A | ANY PROPRIETOR/PARTNER/EXECUTIVE X |010WC11A58756 11/22/2011 | 19/22/2012 | EL. EACH ACCIDENT $ 500,000
OFFICER/MEMBER EXCLUDED? NIA
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,000
if yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT | $ 500,000
Re: Foxwood Drainage Repairs - Phase I.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
The County of Okaloosa, all entities names in and its respective agents, consuitants, servants and employees are additional insured in regards to
the General Liability and Auto Liability as required by written contract. The insurances evidenced on this Certificate of Insurance are intended to
be Primary & Non-Contributory with respect to The GL County of Okaloosa, all entities names in and its respective agents, consultants, servants
and employees as an Additional Insured. Waiver of Subrogation in favor of The County of Okaloosa, all entities names in and its respective
agents, consultants, servants and employees in regards to the General Liability, Auto Liability and Workers Compensation as required by written
contract. Umbrella follows form, but subject to policy terms, conditions, forms, and exclusions.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Okaloosa County ACCORDANCE WITH THE POLICY PROVISIONS.
602-C North Pear! Street
Crestview, FL 32536-
AUTHORIZED REPRESENTATIVE
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© 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACORD 25 (2010/05)
CONTRACTOR'S RELEASE OF LIENS
STATE OF: GEORGIA
COUNTY OF: BARROW
Before me, the undersigned Notary Public in and for the said County and State personally
appeared Lewis Cooper , representing the Contractor,
Aero Training & Rental, Inc. _ 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 _Foxwood Drainage Repairs — Phase I_, Contract No. Ci2-
1958-PW, have been paid in full and that for the final payment in the amount of__ $7,560.36,
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,
ww had, has or May have in the future.
C
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Sw pyto and subscribed before me this
we day of Otfober 2012
(Notary Public) wt ne Barrow County, Georgia
My Commission Expires April 30, 2013
My Commission Expires:
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GEORGIA
APR, 30, 2013
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WORTH WEST FLORID 4
Dai
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Published Daily
Fort Walton Beach, Florida
Distributed in Okaloosa, Santa Rosa & Walton Counties
State of Florida, County of Okaloosa
A inf.
Before the undersigned authorized personally appeared i } A Uli. lal i LSe_
4 ¢ A fpocice + 7
who on oath says that (s)he is La Oak Ad: 1 Jiv¥dtr Sing CC] by ke
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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 i é “ph. Ban
Mh iit: SUbot: ot Cowal ledion
“Ok LD ood Dra fain a Repei tS
in the matter of
in the ( Ulylee St County Court, was published in said newspaper in the issues of
O eb Pay iy ae 3} Alwimber qT dbta
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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 C
Subscribed and sworn to (or affirmed) before me this 7 a Tie mrtbir AHA
' (Date)
a Sit ? bdeher “by bot , who is/are personally known to me or
()
b/ : tes
has/have produced f &_aInagélu “hyn new as identification.
(Type of idengif ication)
Notary Public, Commission No.
t] Ode tify Lat \ Ba/
(Signature). / \
. ( ] wn. ..ing6 ame of Notary typed, printed or stamped)
“ELEANOR HYPES ;
Notary Public - State of Florida ‘
My Coinm. Expires Jul 30, 2015 {
Commission ¥ EE 116319 =f
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tee Bonded Through National Notary Assn.
legal snag
ADVERTISEMENT OF
COMPLETION
Aero Training & Rent.
ais, ine., 53?—Gulfshore
Drive, Destin FL. 32841
gives notice of Cornpie-
tion of Foxvood: Drain:
age. Repairs anch-sets
November 40,2012 as
the date of final settle.
sent,
Ail persons and. firrns
should. Sle all clairris for
payment to. the | below
address prior to the
settioment date:
Gralousa County
(Oumen
ASTTN: Contracts and
Leases Coorelinator
602-C.North Pear
Streat
Crestview, FL 82538
By: Lewis Cooper
Presiclent
Legal 3228. +...
Oct. 17, 24, 31, Nov. 7,
2012
te WATA Document G707" - 1994
Consent Of Surety to Final Payment
PROJECT: (Name and address) ARCHITECT’S PROJECT NUMBER: OWNER: [_]
Foxwood Drainage Repairs Phase | .
Okaloosa County, FL CONTRACT FOR: Construction ARCHITECT: L]
CONTRACTOR: [_]
TO OWNER: (Name and address) CONTRACT DATED:
Okaloosa County Board of County SURETY: XX]
Commissioners, 101 East James Lee OTHER: [_]
Blvd., Crestview, FL
In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the
(Insert name and address of Surety)
Western Surety Company Bond No. 929547095
P.O. Box 5117
Sioux Falls, SD 57117
, SURETY,
on bond of
(Insert name and address of Contractor) '
Aero Training & Rental, Inc.
537 Gulfshore Drive
Destin, FL 32541
, CONTRACTOR,
hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the
Surety of any of its obligations to
(Insert name and address of Owner)
Okaloosa County Board of County Commissioners
101 East James Lee Blvd.
Crestview, FL 32536
, OWNER,
as set forth in said Surety’s bond.
IN WITNESS WHEREOF, the Surety has hereunto set its hand on this date: October 12, 2012
(Insert in writing the month followed by the numeric date and year.)
Western Surety Company
(Surety)
(Signature of authofize
Attest: Nae Mm" / Gary Spuller, Attorney in Fact
(Seal): (Printed name and title)
AIA Document G707 ™ — 1994. Copyright © 1982 and 1994 by The American Institute of Architects. All rights reserved. WARNING: This AIA® Document is
protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA® Document, or any portion of it, 4
may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. This document was produced by
AIA software at 09:48:48 on 10/12/2012 under Order No.6039367116_1 which expires on 07/12/2013, and is not for resale.
User Notes: (1297380696)
Western Surety Company
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT
Know Ail Men By These Presents, That WESTERN SURETY COMPANY, a South Dakota corporation, is a duly organized and existing corporation
having its principal office in the City of Sioux Falls, and State of South Dakota, and that it does by virtue of the signature and seal herein affixed hereby
make, constitute and appoint
P D Yates, Jr, P D Yates, III, Alan R Yates, Michael L Angel, Karen A Maynard, Michael S
Brickner, Kevin M. Neidert, Robert N Reynolds, Marie M Hartley, Betsy J Holmes, Brian K
Hughes, Gary Spuller, Daniel Yates, Dana D Rutledge, Individually
of Atlanta, GA, its true and lawful Attomey(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on its behalf bonds,
undertakings and other obligatory instruments of similar nature
- In Unlimited Amounts -
and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized offer of the corporation and all the acts of said
Attomey, pursuant to the authority hereby given, are hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By-Law printed on the reverse hereof, duly adopted, as indicated, by
the shareholders of the corporation.
In Witness Whereof, WESTERN SURETY COMPANY has caused these presents to be signed by its Vice President and its corporate seal to be
hereto affixed on this 4th day of October, 2012.
WESTERN SURETY COMPANY
aul T. Bruflat, Vice President
State of South Dakota ss
County of Minnehaha
On this 4th day of October, 2012, before me personally came Paul T. Bruflat, to me known, who, being by me duly swom, did depose and say: that he
resides in the City of Sioux Falls, State of South Dakota; that he is the Vice President of WESTERN SURETY COMPANY described in and which executed
the above instrument; that he knows the seal of said corporation; that the seal affixed to the said instrument is such corporate seal; that it was so affixed
pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and acknowledges
same to be the act and deed of said corporation.
My commission expires 7) MOHR
June 23, 2015 SourH DaKora 7 7 ahr?
; y J. Mohr, Notary Public
CERTIFICATE
1, L. Nelson, Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attomey hereinabove set forth is still in
force, and further certify that the By-Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed
my name and affixed the seal of the said corporation this 12th day of _October ; 2012
WESTERN SURETY COMPANY
L. Nelson, Assistant Secretary
Form F4280-7-2012
PERFORMANCE BOND
KNOW ALL PERSONS BY THESE PRESENTS: that Bond No. 929547095
Aero Training & Rental, Inc.
(Name of Coritractor)
537 Gulfshore Drive, Destin, FL 32541
{Address of Contractor)
@ Corporation , hereinafter called Principal and
(Corporation, Partnership or Individual)
Western Surety Company
(Name of Surety)
P.O. Box 5077, Sioux.Falls, SD 57117
(Address of Surety)
nereinafter called Surety, are held and firmly bound unto
OKALOOSA COUNTY BOARD OF COUNTY COMMISSIONERS
(Name of Owner)
101 EAST JAMES LEE BOULEVARD, CRESTVIEW, FL 32536
(Address of Owner)
hereinafter called OWNER in the total aggregate penal sum of Che Hundred Forty Six Thousand
Three Hundred One and no/100--- Dollars ($ 146,301.00 ) in
lawful money of the United States, for the payment of which sum well and truly to be made, we
binc ourselves, our heirs, executors, administrators, successors, and assigns, jointly and
severally, firmly by these presents.
THE CONDITION OF THIS OBLIGATION is such that whereas, the Principal entered into a
certain contract with the OWNER, dated the day of , 2012,
a copy of which is hereto attached and made a part hereof for FOKWOQD DRAINAGE
REPAIRS - PHASE f.
NOW, THEREFORE, if the Principal shall well, truly, and faithfully perform its duties, all the
undertakings, covenants, terms, conditions, and agreements of said contract during the original
term thereof, and any extensions thereof which may be granted by the OWNER, with or without
notice to the SURETY and during the one year guaranty period and if the PRINCIPAL shall
satisfy all claims and demands incurred under such contract, and shall fully indemnify and save
harmless the OWNER from all costs and damages which it may suffer by reason of failure to do
so, and shall reimburse and repay the OWNER all outlay and expenses which the OWNER may
incur in making good any default, then this obligation shall be void, otherwise to remain in full
force and effect.
Foxwood Drainage Repairs — Phase | Performance Bond Hi
537
PERFORMANCE BOND
PROVIDED, FURTHER, that the said SURETY, for value received hereby stipulates and agrees
that no change, extension of time, alteration or addition to the terms of the contract or to
WORK to be performed thereunder or the SPECIFICATIONS accompanying same shall in any
way affect its obligation on this BOND, and does hereby waive notice of any change, extension
of time, alteration or addition to the terms of the contract ar to the WORK or to the
SPECIFICATIONS.
PROVIDED, FURTHER, that it is expressly agreed that the BOND shall be amended
automatically and immediately, without formal and separate amendments hereto, upon
amendment to the Contract not increasing the contract price more than twenty percent, so as
to bind the PRINCIPAL and the SURETY to the full and faithful performance of the CONTRACT
as so amended. The term “Amendment”, wherever used in this BOND, and whether referring
to this BOND, or the CONTRACT DOCUMENTS, shail include any alteration, addition, extension,
or modification of any character whatsoever.
PROVIDED, FURTHER, that no final settlernent between the OWNER and the PRINCIPAL shall
abridge the right of the other beneficiary hereunder, whose claim may be unsatisfied. The
OWNER is the only beneficiary hereunder.
IN WITNESS WHEREGF, this instrument is executed in three counterparts, each one of which
shall be deemed an original, this the _ day of , 2012.
ATTEST
Aero Training & Rental, Inc.
(PRINCIPAL) SECRETARY PRINCIPAL
(SEAL)
BY: (S)
537 Gulfshore Dr.,Destin, FL 32541
ADDRESS
WITNESS AS TO PRINCIPAL
Gulfshore Dr.,Destin, FL 32541] Western Surety Company
ADDRESS SURETY
Foxwood Drainage Repairs — Phase 1 Performance Bond H?
PERFORMANCE BOND
ATTEST
waa/iiwaa biaucley
WITNESS TO SURETY
Marie M. Hartley, Witness Gary Spuller, Attorney in Fact
2800 Century Parkway NE Ste 300 2800 Cent Pay} NE
Atlanta, GA 30345 Atlanta CA he” Ste 300
ADDRESS ADDRESS
Note: Date of BOND must not be prior to date of Contract. This bond is given to comply with
section 255.05 Florida Statutes, and any action instituted by a claimant under this bond
for payrnent must be in accordance with the notice and time limitation provisions in
Section 255.05(2), Florida Statutes.
If CONTRACTOR is partnership, all partners should execute BOND.
IMPORTANT: Surety companies executing BONDS must appear on the Treasury Department's most current list
(Circular 570 as amended) and be authorized to transact business in the state where the project is located.
Foxwood Drainage Repairs — Phase J Performance Bond H3
PAYMENT BOND
KNOW ALL PERSONS BY THESE PRESENTS: that Bond No. 929547095
Aero Training & Rental, Inc.
(Name of Contractor)
537 Gulfshore Drive, Destin, FL 3254]
(Address of Contractor)
A Corporation , hereinafter called Principal and
(Corporation, Partnership, or Individual)
Western Surety Company
(Name of Surety)
P.O. Box 5077, Sioux Falls, SD 57117
(Address of Surety)
hereinafter called Surety, are held and firmly bound unto
OKALOOSA COUNTY BOARD OF COUNTY COMMISSIONERS
(Name of Owner)
101 EAST JAMES LEE BOULEVARD, CRESTVIEW, FL 32536
(Address of Owner)
hereinafter called OWNER, and unto all persons, firms, and corporations who or which may
furnish labor, or who furnish materials to perform as described under the contract and to their
successors and assigns in the total aggregate penal sum of One Hundred. Forty Six Thousand
Three Hundred One and no/100-~ Dollars ($ ) in
iawful money of the United States, for the payment of which sum well and truly to be made, we
bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and
severally, firmly by these presents.
THE CONDITION OF THIS OBLIGATION is such that whereas, the PRINCIPAL entered into
a certain contract with the OWNER, dated the day of ;
2012, a capy of which is hereto attached and made a = part hereof for
Foxwood Drainage Repairs -— Phase I
NOW, THEREFORE, if the PRINCIPAL shall properly make payment to all persons, firms, and
corporations furnishing materials for or performing labor in the prosecution of the WORK
provided for in such contract and any authorized extensions or modification thereof, including
all amounts due for materials, lubricants, oil, gasoline, coal and coke, repairs on machinery,
equipment and tools, consumed or used in connection with the construction of such WORK, and
for all labor cost incurred in such WORK, including that by a SUBCONTRACTOR, and to any
mechanic or material man lien holder, whether it acquires its lien by operation of State or
Federal law, then this obligation shall be void, otherwise to remain in full force and effect.
Foxsvood Drainage Repairs — Phase | Payment Bond
PAYMENT BOND
PROVIDED, that beneficiaries or claimants hereunder shall be limited to the
SUBCONTRACTORS, and persons, firms and corporations having a direct contract — with the
PRINCIPAL or its SUBCONTRACTORS.
PROVIDED, FURTHER, that the said SURETY, for value received hereby stipulates and agrees
that no change, extension of time, alteration or addition to the terms of the contract or to
WORK to be performed thereunder or the SPECIFICATIONS accompanying same shall in any
way affect its obligation on this BOND, and does hereby waive notice of any change, extension
of time, alteration or addition to the terms of the contract or to the WORK or to the
SPECIFICATIONS.
PROVIDED, FURTHER, that no suit or action shall be commenced hereunder by any claimant:
(a) unless claimant, other than one having a direct contract with the PRINCIPAL, shall have
given written notice to any two of the following: The PRINCIPAL, the OWNER, or the SURETY
above named within ninety (90) cays after such claimant did or performed the last of the work
or labor, or furnished the last of the materials for which said claim is made, stating with
substantial accuracy the amount claimed and the name. of the party to whom the materials
were furnished, or for whom the work or labor was done or performed. Such notice shall be
served by mailing the same by registered mail or certified mail, postage prepaid, in an envelope
addressed to the PRINCIPAL, OWNER or SURETY, at any place where an office is regularly
maintained for the transaction of business, or served in any manner in which legal process may
be served in the state in which the aforesaid project is located, save that such service need not
be made by a public officer; (b) after expiration of one (1) year following the date of which
PRINCIPAL ceased work on said CONTRACT, is being understood, however, that if any
limitation embodied in the BOND is prohibited by any law controlling the construction hereof,
such limitation shall be deemed to be amended so as to be equal! to the minimum period of
limitation permitted by such law.
PROVIDED, FURTHER, that it is expressly agreed that the BOND shall be deemed amended
automatically and immediately, without formal and separate amendments hereto, upon
amendment to the Contract not increasing the contract price more than twenty percent, so as
to bind the PRINCIPAL and the SURETY to the full and faithful performance of the CONTRACT
as so amended. The term “Amendment”, wherever used in this BOND, and whether referring
to this BOND, or the CONTRACT DOCUMENTS, shall include any alteration, addition, extension,
or modification of any character whatsoever.
PROVIDED, FURTHER, that no final settlement between the OWNER and the PRINCIPAL shall
abridge the right of the other beneficiary hereunder, whose claim may be unsatisfied.
Foxwood Drainage Repaus — Phase | Payment Bond J2
IN WITNESS WHEREOF, this instrument is exe
Shall be deemed an original, this the
ATTEST
(PRINCIPAL) SECRETARY
aT
(SEAL)
WITNESS AS TO PRINCIPAL
53? Gulfshore Drive, Destin, FL 32541
ADDRESS
ATTEST
WITNESS TO SURETY
Marie M. Hartley, Witness
2800 Century Parkway NE Suite 300
Atlanta, GA 30345
ADDRESS
cuted in three counterparts, each one of which
day of , 2012.
Aero Training & Rental, Ine
PRINCIPAL
BY: (S)
53/7 Gulfshore Drive, Destin, FL 3254]
ADDRESS
Western Surety Company
SURETY
ho
be
B
ATTORNEY-IN-BACT “
Gary Spuller, Attorney in Fact
2800 Century Parkway NE, Suite 300
Atlanta, GA 30345
ADDRESS
Note: Date of BOND must not be prior to date of Contract. This bond is given to comply with
section 255,05 Florida Statutes, and any action instituted by a claimant under this bond
for payment must be in accordance with the notice and time limitation provisions in
Section 255,05(2), Florida Statutes.
If CONTRACTOR is partnership, all partners should execute BOND.
IMPORTANT: Surety companies executing BONDS must appear on the Treasury Department's most current list
(Circular 570 as amended) and be authorized to transact business in the state where the project is located.
Foxwood Drainage Repairs — Phase J
Payment Bond I3