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CONTRACT & LEASE INTERNAL COORDINATION SHEET Contract/Lease Number:_C12-1939-AP Tracking Number: Ma Contractor/Lessee Name: CW Roberts Contracting, Inc. Grant Funded: YES X_NO___ Frpose LFinal CO, Final Payment and Closeout Documents for Rehab of Public Parking Facilities at VPS Date/Term: 1, GREATER THAN $50,000 Amount: $304,406.64 2. [) GREATER THAN $25,000 Department: Airport VPS 3. [J $25,000 OR LESS Dept. Monitor Name: Dino Villani Document has been reviewed and includes any attachments or exhibits. Purchasing Review cae cai SIS | Purchasifig Director or designee Risk Management Review a roved as written: a Date: Risk Manager oPdesignee County Attorney Review Approved as written: Date: | County Attorney Following Okaloosa cov oma Contract & Grant Document has been received: Date: Contracts & Grants Manager (To Be Prepared by the Purchasing Services Coordinator) pate: 3y Sg) 3 TO: Contracts & Grants Manager, Finance Department Contracts & Grants Office SUBJECT: ContractNo, C/2-/F3A-AP MANAGING DEPARTMENT: _44%pon/- CONTRACTOR'S NAME: Clo Koberts Confrose Wile PROJECT TITLE: heheh of Publp: [ar fons Facilities @ Mita The attached has met the final payment contract requirement in subject contract. Yes No 1. Final Invoice ma CI 2. Completed Contract/Lease Payment Approval Form Ee oO 3; Close-Out Documents Yes No N/A a. Signed Release of Lien nue C] im b. Proof of Completion Advertisement cae CJ C] c. Certificate of Insurance Ky [J CI d. Consent of Surety to Final Payment EY | im e. Proof of Performance/Payment Bond rea im im) Continuation 12 Months Following Final Payment Yes No 4, Agenda Request a LJ 5. Remarks CELL UE- Z7E B Casing Services Coordinator DATE AVCON, INC. ENGINEERS & PLANNERS 320 Bayshore Drive, Suite A Niceville, Florida 32578 Phone: (850) 678-0050 Fax: (850) 678-0040 www.avconinc.com 2010.050.02/payapplication/PayApp10 Final-Transmittal April 30, 2013 Mr. Tracy Stage, A.A.E. Airports Deputy Director Okaloosa County Airports 1701 State Road 85 N. Eglin Air Force Base, Florida 32542 Reference: Pay Application No. 10 - Approved Rehabilitation of Public Parking Facilities project at Northwest Florida Regional Airport Okaloosa County Contract No. C12-1939-AP Dear Mr. Stage: Please find enclosed five (5) signed copies of the contractor’s final Pay Application No. 10 in the amount of $304,406.64 covering the period from 12/1/12 through 1/13/13 for the above-referenced project. Based on observations by our staff, we believe that the application amount accurately reflects the value of work performed and accepted for this contract. Based on the materials furnished and work performed, we recommend final payment to the Contractor in the requested amount of $304,406.64 per our certification on the enclosed applications. The amount includes release of all retainage. The payment summary is as follows: Total Earned: $ 1,922,885.50 Original Contract Amount: $ 2,350,450,00 0% Retainage: $ — C.O. #1 (9/6/12): $ (7,868.91) Total Earned Less Retainage: $ 1,922,885.50 C.O. #2 (3/19/13): $ (419,695.59) Less Previous Payments: $ 1,618,478.86 Revised Contract Amount: $ 1,922,885.50 Invoice Amount (this period): $ 304,406.64 % Complete: 100.00% The following documentation has been provided by the Contractor as part of the close-out process and is enclosed for your records: * Consent of Surety Company to Final Payment (1 copy) ¢ Final release of liens from C. W. Roberts Contracting, Inc. (1 copy) e Final release of liens from Acme Barricades, Inc. (1 copy) ¢ Final release of liens from Jerry D. Duncan, Inc. (1 copy) ¢ Final release of liens from Goodson Contractors, Inc. (1 copy) ¢ Final release of liens from Gustin, Cothern & Tucker, Inc. (1 copy) Final release of liens from Sheet Metal Masters, Inc. (1 copy) Final release of liens from Professional Home Builders, Inc. (1 copy) Final release of liens from Bill Smith Electric, Inc. (1 copy) Final release of liens from Goodson Contractors, Inc. (1 copy) Final release of liens from Insite Contractors, Inc. (1 copy) CIVIL & STRUCTURAL ENGINEERING M AIRPORT & AVIATION CONSULTING ™ TRANSPORTATION DESIGN & PLANNING Mr. Tracy Stage, A.A.E. April 30, 2013 Page 2 Final release of liens from Ingram Signalization, Inc. (1 copy) Final release of liens from Guettler & Guettler, Inc. (1 copy) Notice of Completion Advertisement (1 copy) Statement from Surety that Payment and Performance bonds will remain in effect for one (1) year following final payment (1 copy) Statement of DBE participation from Anderson Columbia Co., Inc. (1 copy) Statement from C.W, Roberts Contracting, Inc. that liability insurance is written on a per “occurrence basis.” (1 copy) Certificate of Liability Insurance (1 copy) Engineer’s Certification (1 copy) Please note that Pay Application No. 10 was originally submitted by the contractor on March 20, 2013 and was rejected due to a typographical error. The revised pay application was submitted today. Three (3) copies of the final closeout documents, including the closeout book and record drawings, will be submitted under a separate cover. If you have any questions regarding this project, please do not hesitate to contact us at your convenience. Sincerely, AVCON, INC. Jeb Clon John Collins, P.E. Project Manager Enclosures CONTRACT/LEASE PAYMENT APPROVAL FORM COMPLETE AND FORWARD TO THE NEXT DEPARTMENT COMPLETED BY DEPARTMENT DATE: 5/1/2013 VENDOR NAME: CW Roberts Contracting, Inc. VENDOR #: 20101504 CONTRACT/LEASE#: C12-1939-AP Rehab of Pub Parking Facilities TASK COUNTY/FEMA VENDOR BUDGET INVOICE # ORDER # PROJECT # — | pppartTMEeNT#| SCCOUNT# AMOUNTS Of Applicable) (f Applicable) Pay App 10 Final 741110 563485 112,118.09 Pay App 10 Final 74026 363490 6,228.79 Pay App 10 Final 74026 563490 6,228.78 Pay App 10 Final 421 2051100 179,830.98 TOTAL | $ 304,406.64 APPROVED FOR PROGRESS PAYMENT (please sign, as applicable and date) CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER: DATE: COUNTY SUPERVISOR/PROJECT MANAGER: DATE: DEPARTMENT MANAGER: CN tage DATE: 6° 2:73 DEPARTMENT DIRECTOR: i—= EE Ding Ue DATE: Solos CONTRACTS & GRANT MANAGER: DATE: COUNTY ADMINISTRATOR: DATE: (Payments> $25,000.) = FINAL PAYMENT FINAL PAYMENT YES Ko. Cf "Yes", forward to Purchasing Services Coordinator for Close-Out) DATE: PURCHASING DIRECTOR: (Per Initial Agreement) DATE: ' CONTRACTS & GRANTS MANAGER: (All Contracts) DATE: COUNTY ADMINISTRATOR APPROVAL: (Per Initial Agreement) DATE: BOARD APPROVAL: (Per Initial Agreemeni) COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY FISCAL YEAR: DATE RECEIVED: REVIEWD BY: Rehab of Publlo Parking FAditiee CContraot Amount: North Parking Lot (VPS) $1,922.828.80 [Payee inv # Date] Gross Amount | Lass Relamnage | Net Pald Balance | % Complete] WV Roberls Gent iai20i2|Pay App s_| 4ta20i2] 20,953.50 2,885.05 26,958.15. $0.00 4 Original Contract Sum 2,350,450.00 sresia0i2|Pay Apo 2 | szsaoi2| ia5aeoaz | is.sda9a | 12194009 2 Net Change By Change Orders 427,864.50 e26/2012|Pay Appa | evzvizor2| 2sag0ssa | 75,000.04 | r26.a1805 3 Contract Sum to Date 1,022,885.50 so2012[Pay App 4 | 7762012] 400,542.28 40,054.33 280,468.05, 4 Total completed and Stored to Date (Calumn G on G703) 1,922,885.50 arzor2oi2|Pay App é | 8/21/2012] 174,430.04 17,448.99 156,985.95, 5 Retainage wieoialpay Apps | sriamzoi2| oa.reses | 9,916.60 | 63,040.06 a. 10% of completed Work (column 0+ Ean 2708) 0.00 40/18i2012|Pay App? | to/tor2012| 108,193.40 16,819.34 149,574.12 b, = % of Stored Material — (coumn F on 703 wiinerora|Pay apes [irvzanoi2| atzetes4 | s17o1.e7 | 20685407 Total in Column | of G707 0.00 12ideaiajPay App 9 | iztea012] 290,004.96 23,000.43 207,003,03 6 Total Earned Less Retalnage 1,922,885,50 arsoreota|Pay App to | siuzots| i24a7aes | r7oasoee | 0440864 7 Less Previous Certificates for Payment 1,618,478.86 8 Current Payment Due 304,406.64 9 Balance to Finish, Including Retainage 0,00 TOTAL] § 1,922,886.60 $1,022,088, 50 | $ 100.0%] Contract Amount - Gross Amount Balance to Flniatt $0.09 Contract Amount - Nel Patt Balance to Finteh $0.00 APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGEONEOF 2 PAGES 1811041 TO OWNER; PROJECT: APPLICATION NO: 10 Revised w= Distribution to: Okaloosa County Board of Commissioners Rehabilition of Public Parking Facilities. [= Jowwar 1804 Lewis Tumer Blvd. Suite 100) (_Jarcurecr Ft. Watton Beach, FL 32547 PERIGD TO: 13/2013 ge (#_]conrractor FROM CONTRACTOR: VIA ARCHITECT: (_Jencinerr C. W. Roberts Contracting, Inc. 2" P.O. Box [88 PROJECT NOS; Hosford, Florida 32334 CONTRACT FOR: CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT ‘The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application is made for payment, as shown below, in connection with the Contract. information and betief the Work covered by this Application for Payment has been Continuation Siieet, AIA Document 0703, is attached completed in accordance with the Contract Documents, tint all amounts hive been paid by the Contractor for Work for which previaus Certificates for Payment were iasued aid payments received from the Owner, and that eurrent payment shown horein is now due. 1, ORIGINAL CONTRACT SUM $____2,350,450.00 ~ CONTRAGTOR; C..W. Roberts Contracting, Ine, 2. Net change by Change Orders § (427,564 SO) ae 3. CONTRACT SUM TO DATE (Line 1 +2) Sr 4, TOTAL COMPLETED & STORED TO § 522 785.50, “ By; Date: March 20, 2013 DATE — (Column G on G703) ert 7 5. RETAINAGE; A {Pee se weeny Ruows!) a.__0 %of Completed Work $ 0.00 7 County ss - ‘Colima D +E on G703) d sfipduipnefore me skis” S<ZOUN dy of ggutdigg |S PATRICIA A. LINGH oy b, % of Stored Material 8 3 i Seay “ ‘Cohemn F on G703) ~ My Commissiod expres: 4 ef Expl ‘Tota! Retainage (Lines Sa + Sb or ” ond Ty Fe earn OSE Total in Column 1 of G703) $ 0.000" 6. TOTAL EARNED LESS RETAINAGE 3 T0232 885.50" —n necordance with the Contract Documenis, based on on-site observations and the data (Line 4 Less Line 5 Total} ee comprising the application, the Architect certifies to the Owner that ta the best of the 7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, information and belief the Work hes progressed as indicated, PAYMENT (Line 6 from prior Certfiente) 3 1,618,478,.864-~ the quality of the Work is in accordance with the Contract Documents, and the Contractor 8, CURRENT PAYMENT DUE $C is entitted to payment of the AMOUNT CERTIFIED, 9, BALANCE TO FINISH, INCLUDING RETAINAGE $ 0.00 pe" AMOUNT CERTIFIED «0.0... 8 204. nob loy (Line 3 less Line 6) (Auach explanation (f amount certified differs from the amount applied, knittal all figures on this CHANGE ORDER SUMMARY. DDITION: DEDUCTION: Total changes approved Application and onthe Continuation Sheet that are changed to conform with the amount certified ) in previous months by Owner $0.00 $7,868.91 | ARCHITECT: ‘Total approved this Month $0,00 $419,695.59] By: Aco Latha Date: 4- JO-13 a TOTALS $0.00 $427,564.50 ],-- This @€rtificate is net negotiable, The AMOUNT CERTIFIED 4s payable only to the ‘Contractor named nerein, Issuance, payment atid acceplance of paynient are without NET CHANGES by Change Order ($427,564.50) Je“ prejudice to any rights of the Owner or Contractor incler this Contract. “BA DOGUMERT 6702 APRUCATION AND CENVEATION FUR PAVAENT “TES2EOTION- A> THEE THEAHERN STINE OF ANGTECTS,TaDNEW VORKAVE, HW, WAGHINGTON, DE 20062 Users may obtain valldatlon of thls document by requesting a completed AIA Document D401 - Certification of Document's Authenticity fron the Licenses. Fo fs Lge 4 CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF2 PAGES AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing, Contractor's signed certification is auached, 1m tabulations below, amounts are stated to the nearest doltar, Use Column I on Contracts where varinble relaiuage for tine tems may apply "APPLICATION NO: 10 Revised APPLICATION DATE; 372072013 PERIOD TO;

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