Okaloosa County BOCC — June 2, 2015 — final invoice & other documentation — reading text

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. iy TYPE OF INSURANCE isolwvo, POLICY NUMBER (RO YY) | (DO YY) LIMITS A | X | COMMERGIAL GENERAL LIABILITY Y | N | GLO5817438-01 8/1/2014 |8/1/2015 | EACH OGCURRENCE s 2,000,000 DAMAGE TO RENTED l CLAIMS-MADE OCCUR PREMISES {Ea occurrence) | $ 500,000 x| CONTRACTUAL MED EXP (Anyoneperson) | $ 10,000 Y X,C,U COVERAGE PERSONAL & ADVINJURY | $ 2,000,000 [ "GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 | X | pouicY RO Loc PRODUCTS - COMPIOP AGG | § 5,000,000 OTHER: 5 A | AUTOMOBILE LIABILITY N | ~ | BAP 5817437-01 812014 [812015 | netieny o TS £ 390,000 X | ANy auTO BODILY INJURY (Per person) | $ XXX XNXXX || Aoros™? Egfiggxi BODILY INJURY (Per accident) ] $ XXXX XXX | | HIRED AUTOS AUTOS mfi/\w\es § XXXXXXX $ XXXXXXX D [ X | UMBRELLALIAB | ¥ | occur N | N | AUC 3807886-10 8/1/2014 | 8/1/2015 | EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5.000.000 DED RETENTION $ § XXXXXXX PEK OTH- A | R XL By FOUTIVE NIA SoroAr DoAYy |F173014 [B1A013 [ELeAcAccERT * 5.000.000 {Mandatory In NH) E.L. DISEASE - EA EMPLOYEE] $ 5 000,000 if yes, describe under 2 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT | 3 5.000.000 C | EQUIPMENT FLOATER N N | 026159794 8/1/2014 8/1/2015 ALL LEASED, OWNED OR RENTED EQUIPMENT. $5,000,000 LIMIT PER OCCURRENCE. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THiIS HOLDER, APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM{S) REFERENCED. RE: NEW WATER WELL & FACILITIES — DEL CERRO 1T (MC-7) PUBLIC SUPPLY WELL — MID COUNTY WELL #7; OKALOOSA COUNTY WATER & SEWER, ENGINEER, AND ENGINEER’S CONSULTANTS ARE INCLUDED AS ADDITIONAL INSUREDS AS RESPECTS GENERAL LIABILITY FOR ONGOING AND COMPLETED OPERATIONS AS REQUIRED BY SIGNED, WRITTEN CONTRACT. 30 DAYS NOTICE OF CANCELLATION APPLIES. CERTIFICATE HOLDER CANCELLATION 12256292 OKALOOSA COUNTY WATER & SEWER 1804 LEWIS TURNER BLVD., SUITE 300 FT. WALTON BEACH FL 32547 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 REPRESENTAT] Al ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CONTRACTOR'S RELEASE OF LIENS STATE OF: Florida COUNTY OF: Okaloosa Before me, the undersigned Notary Public in and for the said County and State personally appeared _J. Robert Baker , representing the Contractor,__Layne Christensen , 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 the Board of County Commissioners, Okaloosa County. Florida, the Owner, for Del Cerro I (MC-7) Public Supply Well, Contract No. C13-2026-WS _have been paid in full and that for the final payment in the amount of $212,628.39 , 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. /4 /4 Sworn to and subscribed before me this Ifi\ day of A/{Q/j 201S . - (Notary Public) My Commission expires _()| ’, IQ//QO 17 END OF SECTION 01700 Del Cerro 11 (MC-7) Public Supply Well 01700-6 Job No. 41-451 CRESTVIEW ~ News Bulletin CRESTVIEW NEWS BULLETIN EXTRA Published Bi-Weekly Crestview, Okaloosa County, Florida STATE OF FLORIDA COUNTY OF OKALOOSA Before the undersigned authority personally appeared Dawn M. Barnes, who on oath says that she is Receptionist of the Crestview News Bulletin, a bi-weekly newspaper published at Crestview in Okaloosa County, Florida; that the attached copy of advertisement, being a Legal # 20150235 NOTICE OF COMPLETION in the matter of DEL CERRO II in the Okaloosa County Court, was published in said newspaper in the issues of 02/18/2015 02/25/2015 03/04/2015 03/11/2015 Affiant further says that the said Crestview News Bulletin is a newspaper published at Crestview in said Okaloosa County, Florida, and that the said newspaper has heretofore been continuously published in said Okaloosa County, Florida, each week and has been entered as periodicals matter at the post office in Crestview, in said Okaloosa County, Florida, for a period of 1 year next preceding the first publication of the attached copy of advertisement; and affiant further says that she 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. Y Y S G (Signature of Applicant) Sworn to and subscribed before me this 11th day of March, 2015, by Dawn M. Barnes, X who is personally known to me or ___ who has produced as identification. ublic-State of Florida) (Si#film of Notal iR, CAROLYN V. BARNES MY COMMISSION # FF 163951 ¢ EXPIRES: November 12, 2018 Bondad Tatu Netary Public Understiers Notaly Public ECEIWE MAR | 6201 CRESTVIEW [ 638 North Ferdon Blvd. « Crestview, FL 32536 qews Bufletm 850.682.6524 « Fax 850.682.2246 : legals@crestviewbulletin.com mvw.erastyiewbulletin.ecom LEGAL ADVERTISING PROOF & INVOICE Please review carefully for errors and return with either approvat or changes, Thank you. ustomer Layne Christensen Company, Inc. Date 2/16/2015 Fite/Case No. 3720 North Palafox Street Account No. 33852097 Start Date 2/18/2015 Pensacola, FL 32505 Order No. 34313876 End Date 3/11/2015 Reference No. 34698206 (Statement customers only - appears on monthty statement) escription 20150235 NOC DEL CERRO i Amount Due $141.30 (if ad below has been approved for publication) 1gal # 20150235 NOTICE OF COMPLETION wne Christensen smpany, [nc. of 3720 orth Palafox Strest, insacola, FL. 32505 ves notice of impletion of Del arro Il (MC-7) Public 1pply Well and sels arch 20, 2015 as the e of final tttement, All wsons and firms wuld file claims for wment to the tlowing address prior the settlement date: caloosa Board of sunty ymmissioners, cfo slyengineering, [nc. 0. Box 841, ralimar, FL 32579. }/18/2015 /252015 4/04/2015 411/2015 Please return this portion with remittance. Include your account number on your check to ensure proper credit, Thank you for your business. CRESTVIE “’I. 638 North Ferdon Blvd. « Crestview, FL 32536 qews Bu]l 850.682.6524 « Fax 850.682.2246 legals@crestviewbulletin.com nww.crestviewbulletin.com ustomer Layne Christensen Company, Inc. Date 2/16/2015 File/Case No. ’3;720 NOI“*‘ fff‘;‘zfggssmfl Account No. 33852097 Start Date 2/18/2015 ensacola, Order No. 34313876 End Date 3/11/2015 Reference No. 34698206 {Statement customers only - appears on monthly statement) escription 20150235 NOC DEL CERRO I Amount Due $141.30 (if ad below has been approved for publication) 16/153:30:50 PM