Okaloosa County BOCC — May 15, 2013 — CW Roberts Final Payment and Closeout Documents — reading text

mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a cerlified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and biding upon the Company with the same force and effect as though manually affixed, |, David M, Carey, the undersigned, Assistant Secretary, of American Fire and Casualty Company, The Ohlo Casually Insurance Company, Liberly Mutual Insurance Company, West American Insurance Company and Peertess Insurance Company do hereby certify that the original power of attomey of which the foregoing Is a full, tere and correct copy of the Power of Attorney executed by sald Companies, is In full force and effect and has not been revoked. IN TESTIMONY WHEREOF, | havo hereunto set my hand and affixed the seals of sald Companies this 1 7 th day of April. 2013 oan LIT log iS 4 y & 7 2 8 [ Neowogaten \s By: id David M. Carey, Assistant Secretary fs/ ~ POA-AFCC, LMIC, OCIC, PIC & WAIC UMS_12878_041012 STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 275-030-114 ANTICIPATED DBE PARTICIPATION STATEMENT EQUAL OPPORTUNITY OFS 1. FINANCIAL PROJECT NO. | 2. FAP NO. 3. CONTRACT NO. | 4, COUNTY(IES) 5. DISTRICT Okaloosa 6. PRIME CONTRACTOR NAME 7. FEID NUMBER C.W. Roberts Contracting Inc. 59~-1683951003 8. CONTRACT DOLLAR AMOUNT 9. REVISION? IF YES, REVISION NUMBER: $1,896,134.30 — 10. IS THE PRIME CONTRACTOR A FLORIDA 11, IS THE WORK OF THIS CONTRACT CERTIFIED “DBE”? (DISADVANTAGED EK] No CONSTRUCTION Bi] OR MAINTENANCE []? BUSINESS ENTERPRISE) O Yes 12. ANTICIPATED DBE SUBCONTRACTS: PERCENT OF DBE SUBCONTRACTOR or SUPPLIER TYPE OF WORK/SPECIALTY DOLLAR AMOUNT CONTRACT DOLLARS rN Mathes Electric Supply Electrical $11,493.77 0.61% B . A + Ingram Signalization Drilled Shafts $53,050.00 2.80% C D E F 11A TOTAL DOLLARS TO. 1B TOTAL PERCENT OF DBE’S CONTRACT $64,543.77 3.41% 13. SUBMITTED BY 12.DATE | 13, TITLE OF SUBMITTER John Reynolds 1/29/13 Estimator 14, EMAIL ADDRESS OF SUBMITTER 15, FAX NUMBER 16, PHONE NUMBER jreynolds@cwrcontracting.com 850-835-3519 850-835-3500 NOTE: THIS INFORMATION tS USED TO TRACK AND REPORT ANTICIPATED DBE PARTICIPATION IN ALL STATE AND FEDERALLY FUNDED FDOT CONTRACTS. THE ANTICIPATED DBE AMOUNT IS VOLUNTARY AND WILL NOT BECOME A PART OF THE CONTRACTUAL TERMS. THIS FORM MUST BE SUBMITTED AT THE PRE CONSTRUCTION OR PRE WORK CONFERENCE. FDOT STAFF FORWARDS THE FORM TO THE EQUAL OPPORTUNITY OFFICE. THE FOLLOWING SECTIONS ARE FOR FDOT USE 17 PROCESSED BY 18. DATE TO EO OFFICE 19. LETTING DATE 20. EXECUTED DATE 21, PRECON CONF DATE pIS T LJ FAX (J EMAIL “ TO EO BY 22 SUBMITTEDTOEO BY | > SHARED FOLDER EO 23 INCLUDED IN DBE PARTICIPATION REPORT OF (IM/D/Y) OFC CORPORATE OFFICE 3372 Capital Circle NE Tallahassee, Florida 32308 Phone: (850) 385-5060 * Fax: (850) 385-5420 HOSFORD OFFICE RO. Box 188 Hosford, Florida 32334 Phone! (850} 379-8116 » Fax: (850) 379-8188 FREEPORT OFFICE 160 Industrial Park Road Freeport, Florida 32439 Phone: {850) 835-3500 » Fax; (850} 835-3519 03/21/2013 Jim Collins, P.E, AVCON, Inc. RE: Rehabilitation of Public Parking Facilities; C. W. Roberts Contracting Inc. General Liability Coverage Dear Mr, Collins: WILDWOOD OFFICE 4208 County Road 124-4 Wildwood, Florida 34785 Phone: (352) 330-2540 + Fox: (352) 330-2609 PANAMA CITY OFFICE 1603 Bay Avenue Panama City, Florida 32405 Phone: (850) 769-6640 * Fox: (850) 769-7775 FORT MYERS OFFICE 13350 Rickenbacker Parkway Fort Myers, Florida 33913 Phone: (239) 225-0565 » Fo: (239) 225.0564 In reference to the work we preformed on the above mentioned project, our General Liability coverage for the project is written on a per “occurrence basis” as indicated on our certificate of insurance we provided. Thank you for your attention and if you have any questions please let us know, Sincerely, C.W. Roberts Contracting, Inc. fe ——~ Joseph Shuler, RM cin) @ DATE (MM/DDIYYYY} ACORD CERTIFICATE OF LIABILITY INSURANCE 03/07/2013 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 certiflcate 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 dees not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT MCGRIFF, SEIBELS & WILLIAMS, INC. : FAX P.O, Box 10265 (Ale Wo, Exy, 800-476-2214 (AIG, No}: irml EMAL Birmingham, Al. 35202 TAU RESS: iNSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Liberty Mutual Insurance Company 23043 INSURED Wi C.W. Roberts Contracting, Inc. INSURER B :Liberty Mutual Fire Insurance Company 23035 P.O. Box 188 INSURER C :Navigators Insurance Company 42307 Hosford, FL 32334 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:39Q5ET43 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 ADDL |SUBR LICY EFF | POLK LTR TYPE OF INSURANCE INSRI WD. POLICY NUMBER ORRIN) (aMoDyyyY) LIMITS A. | GENERAL LIABILITY TB26512007 13022 To0W2012 | 10/01/2013 | exon occURRENCE 5 1,000,000 x DAMAGE TO RENTED 300,000 COMMERCIAL GENERAL, LIABILITY PREMISES (Ea occurrence) _| $ ; ] clas. mabe occuR MED EXP (Any one person) | $ 5,000 _. _ PERSONAL & ADV INJURY _| § 1,000,000 GENERAL AGGREGATE 8 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG | § 2,000,000 pouicy | X | hRO- Loc $ COMBINED SINGLE Limit B | AvroMOBILE LIABILITY AS26512001 18082 ToOTzT2 | TO/OTTROTS_ | GOMBINED < 5 2,000,000 X | any auto BODILY INJURY (Per person} | $ ALL OWNED SCHEDULED - AiTOS [| SSH BODILY INJURY (Per accident) | $ x NON-OWNED PROPERTY DAMAGE g HIRED AUTOS AUTOS | (Per accident} Comp $2,500 Coll $2,500 € UMBRELLALIAB | X | occur LATZEXOOS4E72IV 70/01/2012 | 10/01/2013 | each occURRENCE g 5,000,000 X_| EXCESS LIAB CLAIMS-MADE AGGREGATE 8 5,000,000 ozo |_| retennions 8 A_ | WORKERS COMPENSATION WA?765D290113012 10/61/2012 | 40/01/2013 WC STATU- OTH- A | AND EMPLOYERS' LIABILITY YIN X |rory Limits ER ANY PROPRIETOR/PARTNER/EXECUTIVE EL. EACH ACCIDENT 8 1,000,000 OFFICER/MEMBER EXCLUDED? [J NiA (Mandatory in NH) E.L, DISEASE - EA EMPLOYEE| $ 1,000,000 yes, describe under 7,000,000 DESCRIPTION OF OPERATIONS below E.L, DISEASE - POLICY LIMIT | § 000, Ey 8 $ $ | $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is requlred) This certificate only applies Rehab of Public Parking Facilities, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Avcon, Inc. AUTHORIZED REPRESENTATIVE 320 Bayshore Drive, Suite A . . Niceville, FL 32578 “at BY. Bask Page tof ©1988-2010 ACORD CORPORATION, All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AVCON, INC. ENGINEERS & PLANNERS 320 Bayshore Drive, Suite A Niceville, Florida 32578 Phone: (850) 678-0050 Fax; (850) 678-0040 www.avconine.com April 30, 2013 Mr. Tracy Stage, A.A.E. Deputy Airports Director Okaloosa County Airports 1701 State Road 85 N. Eglin Air Force Base, Florida 32542 Reference: Engineer’s Certification Rehabilitation of Public Parking Facilities Northwest Florida Regional Airport, Eglin AFB, Florida AVCON No.: 2011.050.02 Dear Mr. Stage: Pursuant to our letter dated today recommending final payment for the above-referenced Okaloosa County contract with C. W. Roberts Contracting, Inc., this letter is provided to certify the completion of the work per the requirements of Paragraph 16 of the Joint Participation Agreement for this project. We have reviewed the Rehabilitation of Public Parking Facilities project site, the project punch-list items, and the contractor’s final submittals and know of no outstanding requirements to be performed by the contractor. To the best of our belief and knowledge, we hereby certify that the project was completed in accordance with applicable plans and specifications, is in place at the Northwest Florida Regional Airport, that Okaloosa County has adequate title to the property, and that the project is suitable for the intended purpose. We appreciate the opportunity to serve the County on this important project. If you have any questions or require additional information, please do not hesitate to contact me at your convenience. Sincerely, AVCON, INC. iy, hy ROBERT oo, . SP Kiet eG (bw SOx Ee = ee John Collins, PE. = zi -3e-13 lee Project Manager = m". STATE OF ig = ae a oRVh-eS , Leer e rs \ “11)ONAL. EN AAW CIVIL & STRUCTURAL ENGINEERING @ AIRPORT & AVIATION CONSULTING i! TRANSPORTATION DESIGN & PLANNING