Okaloosa County BOCC — September 16, 2014 — Jimmy Henderson Close-Out — reading text

CONTRACT CLOSE-OUT CHECKLIST (To Be Prepared by the Contracts and Lease Coordinator) DATE: 8-19-14 TO: Contracts & Grants Manager, Finance Department Contracts & Grants Office SUBJECT: Contract No. C14-2171-HD MANAGING DEPARTMENT: HD CONTRACTOR'S NAME: JIMMY HENDERSON II CONSTRUCTION PROJECT TITLE: MODULAR BUILDING FOR HEALTH DEPARTMENT The attached has met the final payment contract requirement in subject contract. Yes I. Final Invoice Xl 2: Completed Contract/Lease Payment Approval Form X 3: Close-Out Documents Yes No a. Signed Release of Lien CL] oO b. Proof of Completion Advertisement im OJ c. Certificate of Insurance xX CL] d. Consent of Surety to Final Payment O CL] e. Proof of Performance/Payment Bond oO oO Continuation 12 Months Following Final Payment Yes 4. Agenda Request x 5. Remarks ( 3-As 14 No O MIKO O é ontracts and Lease Coordinator DATE BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST DATE: September 2, 2014 TO: Honorable Chairman and Members of the Board FROM: Zan Fedorak SUBJECT: [PUR] Seeking Approval of Final Payment to Jimmy Henderson II Construction Company, Inc. (C14-2171-HD) DEPARTMENT: Purchasing (Health Department) BCC DISTRICT: All STATEMENT OF ISSUE: [PUR] Seeking Approval of Final Payment to Jimmy Henderson II Construction Company, Inc. (C14-2171-HD) BACKGROUND & ANALYSIS: On April 04, 2014, the County entered into a contract with Jimmy Henderson II Construction to repair and renovate a modular building at the Okaloosa County Health Department. Construction was completed on August 11, 2014 and the final $28,754 invoice has been submitted for payment. Health Department staff has reviewed the project and authorized the final payment. The total contract amount is $109,851. OPTIONS: Approval/Deny final payment to Jimmy Henderson II Construction for $28,754 to close out the contract for the repair and renovation of the modular building at the Okaloosa County Health Department (C14-2171-HD). RECOMMENDATION: Staff recommends approval of the final payment to Jimmy Henderson II Construction for $28,754 to close out the contract for the repair and renovation of the modular building at the Okaloosa County Health Department (C14-2171-HD). RECOMMENDED BY: APPROVED BY: Ernie Padgett, County Administrator CONTRACT/LEASE PAYMENT APPROVAL FORM COMPLETE AND FORWARD TO THE NEXT DEPARTMENT COMPLETED BY DEPARTMENT DATE: 15-Aug-14 VENDOR NAME: | Jimmy Henderson II Construction Company, Inc. VENDOR #: . 2 J4¢ 0 |t4 C CONTRACT/LEASE#: C14-2171-HD TASK COUNTY/FEMA VENDOR BUDGET INVOICE # ORDER # PROJECT # DEPARTMENT #| ACCOUNT # AMOMNTS (If Applicable) (If Applicable) #3 NA NA 1550 562690 $28,754.00 TOTAL | $ 28,754.00 APPROVED FOR PROGRESS PAYMENT (please sign, as applicable and date) «= CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER: DATE ZAS COUNTY SUPERVISOR/PROJECT MANAGER: pate: 8 lial DEPARTMENT DIRECTOR: \eveaas “Coe = Fr DATE: z\ (2 ey UC CONTRACTS & GRANT MANAGER: DATE: COUNTY ADMINISTRATOR: DATE: (Payments ~$25,000.) = ——_— ae ———— —— —_]] FINAL PAYMENT FINAL PAYMENT YES V no _ (If "Yes", forward to Purchasing Services Coordinator for Close-Out) DATE: BIE ef PURCHASING DIRECTOR: Su Soolorwk Zar fectorak (Per Initial Agreement) pate: GYQ-LQ/ Yo CONTRACTS & GRANTS MANAGER: / GA a = (All Contracts) DATE: 7 ¥ S L Ke COUNTY ADMINISTRATOR prove » Uhue (Per Initial Agreement) DATE: BOARD APPROVAL: (Per Initial Agreement) = — HH] COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY FISCAL YEAR: DATE RECEIVED: REVIEWED BY: JIMMY HENDERSON II CONSTRUCTION COMPANY, INC. 714-B Bob Sikes Boulevard, Fort Walton Beach, Florida 32547 Office: (850) 864-5426 Fax: (850) 864-5428 JimmyHendersonConst.com License # CG-C062300 Invoice Date: Tuesday, August 12, 2014 Owner: Okaloosa County Health Department. 221 Hospital Drive, Fort Walton Beach, Florida 32548 Contact: Shaun May Phone: (850) 699-4225 Project Title: Minor Repairs and Additions to the Okaloosa County Health Department Portable Building Contract Number: C€14-2171-HD Property Location: 215 Hospital Drive NW, Fort Walton Beach, Florida 32548 We are requesting the following payment for: e Upon Completion of Completion of Interior Trim work/Flooring(25%)......scccccsecseeeeeeeeseereereesees $23,454.00 e Change Order #4000... re neti ne neti nnie sete eeteteeeeaereereeds $750.00 @: CHANGE ORIET HS sc. cos osm case cos ne a. a se aie tas a, to at ih SR Ra Sale Con Aa SU ee seel $4,685.00 oi (Change Ord et Fcc car coapeevestomem en rena snow ay ueumessrenaemeemn aes emeeeen wi eN am st sin sive, SL aR ee ($135.00) AMOUNT DUE $28,754.00 AMOUNT RECEIVED : _$ CHECK #: DATE: / / FMEA ayy —z7, ee eae CERTIFICATE OF LIABILITY INSURANCE EeTeioaoxt [ 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(les) 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 CONTACT Gilmore Insurance & Bonding, Inc. PHONE =. (850) 244-3387 [RAE oy (050) 244-2610 | P.O. Box 249 GAL cg, _ info@insurancefastcom i | Mary Esther, FL 32569 INSURER(S) AFFORDING COVERAGE NAIC # Phone _ (850) 244-3387 Fax (850) 2442610 =| isuren a: Auto-Owmars Ins. Co. 18988 WSURED INSURER B: es Jimmy Henderson II Construction Company inc INSURER G 714-B Bob Sikes Blvd. INSURER D Fort Walton Beach, FL 32547 INSURER & ————— 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 Al.L. THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ ee _ ADDLISUBRI 7 — ie TYPE OF INSURANCE INSR|WVD POLICY NUMBER I et aaa Raricerena = LIMITS GENERAL LIABILITY | | EACH OCCURRENCE 3 1,000,000.00_ | f¥) COMMERCIAL GENERAL LIABILITY OO SE ET ana s 300,000.00 | ‘ [3 (1 ctamsmaoe fy] occur y 7861 8787-13 fortmars | 1orteote MED EXP (Anyone person) | $10,000.00 O_ ————_—- | Personal s aoviNJURY | $_1,000,000.00 OW __ _ | GENERAL AGGREGATE $__2,000,000.00 GENL AGGREGATE LIMIT APPLIES PER: | PRODUCTS - COMP/OP AGG| § _2,000,000.00 M1 eoucy (1 88% C1 voc Ul es: | AUTOMOBILE LIABILITY GONBINEOSINGLELIMT | 5 (7) any auto BODILY INJURY (Per person} | $ ieee ©) sey BODILY INJURY (Per accident) $ | (1 wrevavtos § (] Yonenes) PROPERTY Gace | s ne al a a 5, _| ia UMBRELIAAB — {_] CCCUR | EACH OCCURRENCE __$ L_] Excess LIAB (J c.ams.mane | | AGGREGATE is | _[f)oco [J revemons $ WORKERS COMPENSATION 7 WESTATU- Oe AND EMPLOYERS’ LIABILITY YIN J TORY LiMits ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA (Mandatory in NH) EL. DISEASE -EA EMPLOYE| $ it yes, doseribe under sa |__| DESCRIPTION OF OPERATIONS below TI _ | EL DISEASE - POLICY LIMIT] S$ | | lL | _| _ ii a : DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, f more space is required) | Certificate Holder is listed as additional insured with respects to the General Liability CERTIFICATE HOLDER "CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED szrone | Okaloosa County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 602 ¢ North Pearl St AUTIORMEDREPRESENTATVE em Crestview, FL 32536- VUZE Zz | sooo (G50) 0805088 a eee te ee © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) QF Lh The ACORD name and logo are registered marks of ACORD b tk /j p bz ( OK A ‘ e uv JIMMY -7 OP ID: KJ —_—_— ACOR™ CERTIFICATE OF LIABILITY INSURANCE — 03/18/2014 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). EROOUCER iy ee Phone: 850-432-7474 fONe"°" Kim Brady 1701 West Garden Street Fax: 850-438-4678] [12 'N, ex, 850-432-7474 [FAX no): 850-438-4678 Pensacola, FL 32502 adttss, kbrady@fbbins.com _ INSURER(S) AFFORDING COVERAGE NAIC # __| msurera:Association Insurance Company INSURED Jimmy Henderson II INSURERS: Construction Co., Inc. a Kara Lunsford INSURER G2 714 B Bob Sikes Bivd INSURER D: | Fort Walton Beach, FL 32547 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. INSR (DOL BUBR] a | POLICY EXP. LTR ‘TYPE OF INSURANCE ISR lwyp POLICY NUMBER Peta eran LIMITS GENERAL LIABILITY EACH OCCURRENCE s | ' DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) |S | CLAIMS-MADE OCCUR MED EXP (Any one person) | $ abe (ae beeeee een een eee i PERSONAL & ADV INJURY |S | _ GENERAL AGGREGATE s GEN'L AGGREGATE LIMIT APPLIES PETE | PRODUCTS - COMPIOP AGG | $ |poucy[ | BRS Loc : COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY ee s ANY AUTO | BODILY INJURY (Per person) | $ ALL OWNED SCHEDULED nies ScreD | BODILY INJURY (Per accident) $ NON-OWNED PROPERTY DAMAGE 3 HIREDAUTOS |__| AUTOS. ‘ef accident) sess $ NMBRELLA LIAB eccuR EACH OCCURRENCE _ s | EXCESS LIAR CLAIMS-MADE | AGGREGATE s neo | [Retentions $ WORKERS COMPENSATION WO STATU- | OlH AND EMPLOYERS" LIABILITY via XT PORP LARS Ter | A | ANY PROPRIETOR/PARTNER/EXECUTIVE WCV014533104 03/14/2014 | 03/14/2015 | £1. EACH ACCIDENT 8 1,000,000) CFFICERMEMBER EXCLUDED? NTA {Mandatory in NH) E.L. DISEASE - EA EMPLOYEH § 1,000,000) If yes, describa undar DESCRIPTION OF OPERATIONS below E.L, DISEASE - POLICY LIMIT | $ 1,000,000} DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Ramarks Schadule, if more space Is required) 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 Pearl St. Crestview, FL 32536 AUTHORIZED REPRESENTATIVE Tb Lube © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) feb ACORD namé/and logo are registered marks of ACORD 3bagir A “b| O k ner KK A