Okaloosa County BOCC — January 21, 2014 — Skanska Final Payment

EXHIBIT H CONTRACT CLOSE-OUT CHECKLIST (To Be Prepared by the Contracts & Leases Coordinator) ‘pare: (oti3 TO: Contracts & Grants Manager, Finance Department Contracts & Grants Division SUBJECT: Contract No. COF- L408 ACA O MANAGING DEPARTMENT: _/-W/ _ BUS. SEAR CONTRACTOR'S NAME: Skansti-/lord Assoc. prosecttimie: (py Shue d Ha sida Gate The attached has met the final payment contract requirement in subject contract. < 8 4 ° 1. Final Invoice 2 Completed Contract/Lease Payment Approval Form ac Close-Out Documents Yes N/A a. Signed Release of Lien of Oo O b. Proof of Completion Advertisement ep C] C) c. Certificate of Insurance up CO cE] d. Consent of Surety to Final Payment ea LJ C) e. Proof of Performance/Payment Bond 0 Oj Continuation 12 Months Following : Final Payment Yes No 4. Agenda Request _ ca 5. Remarks / / -vb ba / ie. DATE Ashley S. Endris From: Donald Turner <dturner@co.okaloosa.fl.us> Sent: Friday, January 03, 2014 12:02 PM To: Ashley S. Endris Ce: Patti Hanna Subject: RE: Skanska Final Payment Yes, please make the change. Is there anything else FM needs to do to keep this item moving forward in the approval process? Sincerely, Don Donald L. Turner, Director Facilities Maintenance Office: (850) 689-5790 Fax: (850) 689-5630 From: Ashley S. Endris [mailto:aendris@clerkofcourts.cc] Sent: Friday, January 03, 2014 9:53 AM To: Donald Turner Cc: Patti Hanna Subject: Skanska Final Payment A correction needs to be made to the contract payment form for the Skanska final payment. This correction is to code for payment of retainage as follows: 3115-562170 $27,697.00 301-2051100 $10,000.00 Total $37,697.00 Please confirm that you would like me to make this correction. Thank you, Ashley Ashley S. Endris geek, Accountant og* a's Okaloosa County Clerk of Circuit Court 33 fy -34 Contracts and Grants ", ?& 1804 Lewis Turner Boulevard, Suite 206 *ee9e?"* Ft. Walton Beach, FL 32547 Tel: (850) 651-7200 x 4382 Brenda L. Bailey | | a | From: Brenda L. Bailey Sent: | Monday, November 25, 2013 10:26 AM To ee ‘dturner@co.okaloosa.fl.us'; Marcella B. Eubanks; Ashley S. Endris; a6 'krossi@co.okaloosa.fl.us'; Patti Hanna (phanna@co.okaloosa.fl.us) Ce . , Jack Allen; jkublik@co.okaloosa.fl.us Action Item 2302 Subject: Original Yocument package lacks Purchasing signature on Close-out Checklist. a niepreeae oben Title: Final Payment - SKANSKA Department: Facility Maintenance Category: Final Payment . Meeting: Board of County Commissioners - Regular Meeting (North) - Tuesday, December 3, 2013 8:30 AM pb “hk (noel vat eee yy ath sate | ; Project Title: Construction Services - Construction of the Judicial Center Skanska Lord Association Purchasing Contract# C09-1698-ACAO Expires: Upon Completion of Construction 3115 10% 562170 301-2051100 Amount Invit Cost Withheld Paid 1 860,075.00 (3,704.00) 856,371.00 2 592,378.00 (36,128.80) 556,249.20 3 196,681.00 (19,668.10) 177,012.90 4 579,077.00 (57,907.60) 521,169.40 5 846,020.00 (84,602.00) 761,418.00 6 441,382.00 (44,058.70) 397,323.30 7 425,833.00 (42,577.70) 383,255.30 8 755,916.00 (75,575.30) 680,340.70 9 1,085,213.00 (108,521.30) 976,691.70 10 1,051,710.00 (104,958.10) 946,751.90 11 899,475.00 (89,940.60) 809,534.40 12 921,724.44 (91,971.44) 829,753.00 Subtotal 8,655,484.44 (759,613.64) 7,895,870.80 13°-* 840,215.21 (56,670.62) 783,544.59 14 622,195.35 5,792.26 627,987.61 15 722,257.00 (67,889.70) 654,367.30 16 728,996.00 (69,237.40) 659,758.60 17 727,562.00 (70,250.50) 657,311.50 18 574,465.00 (26,985.00) 547,480.00 19 894,690.00 (82,604.35) 812,085.65 20 335,335.00 171,469.70 506,804.70 21 101,698.00 (9,415.85) 92,282.15 22 5,933.00 308,727.15 314,660.15 23 203,988.00 646,677.95 850,665.95 24 27,697.00 10,000.00 37,697.00 Totals 14,440,516.00 (0.00) 14,440,516.00 Contract Total $ 22,400,229.00 Change Order 1 (3,964,977.00) ODP 001 Change Order 2 (2,118,456.00) | ODP 002 Change Order 3 (1,876,280.00) Revised Contract Total $ 14,440,516.00 Balance to finish $ 0.00 Date Paid 02/18/10 03/31/10 04/15/10 05/13/10 06/17/10 07/15/10 08/12/10 09/16/10 10/14/10 11/10/10 12/09/10 12/30/10 02/24/11 03/17/11 04/21/11 05/19/11 06/16/11 07/21/11 08/11/11 09/15/11 10/27/11 12/15/11 02/23/12 Check Number 1003766 1005162&AJE6EI 1005492 1006371 1007293 1008049 V1008894 V 1009853 V1100322 V1101130 V1101990 V1102425 V1103828 V1104506 V1105475 V1106268 V1107038 V 1107967 V1108642 V1109514 V 1200623 V1201996 V 1203669 —— mgrangamnencernmaeen smear too cc TRY SAE aan SONAR aC cen ERENT CONTRACT/LEASE PAYMENT APPROVAL FORM COMPLETE AND FORWARD TO THE NEXT DEPARTMENT == ——] COMPLETED BY DEPARTMENT pate: 07/12/2013 VENDOR NAME: Skanska USA Building, Inc. VENDOR #: CONTRACT/LEASE#: CO09-1698- ACAO necicd # ORDER # “PROJECT A pr Ananarier g| ACCOUNTS eee (If Applicable) (Uf Applicable) 447, 697 24 ; Annex Extension 3115 562170 —-$-37,607,00— Bo\ | 205100 | $10,600 AE TOTAL $ 37,697.00 APPROVED FOR PROGRESS PAYMEN CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER: DATE: 7 | 2 K4 COUNTY SUPERVISOR/PRQJECT DATE: DEPARTMENT DIRECTOR: - DATE: ‘w]vel coy e.] ou Nas CONTRACTS & GRANT MANAGER: DATE: LZ) Z COUNTY ADMINISTRATOR: =: LEE. DATE: y/: Wir, 7 (4 (Payments>S25,000.) FINAL PAYMENT FINAL PAYMENT ve(V wol_ | (If "Yes", forward to Purchasing Services Coordinator for Close-Out) DATE: PURCHASING DIRECTOR: (Per Initial Agreemeny) DATE: \- 3- {4h CONTRACTS & GRANTS MANAGER: - (All Contracts) ; DATE: VA J Ss J / ‘- COUNTY ADMINISTRATOR APPROVAL: Jee 7 (Per Initial Agreement) 7 DATE: BOARD APPROVAL: (Per Initial Agreement) COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY FISCAL YEAR: DATE RECEIVED: REVIEWD BY: cones APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE1 OF —2.—«~ PAGES “TO OWNER: PROJECT: APPLICATION NO: 24 Distribution to: Okaloosa County Board of Okaloosa County Courthouse DATE: 95/08/13 County Commissioners Annex Extension — 602-C North Pearl Street 1940 Lewis Turner Blvd. Ra OWNER Crestview, FL 32536 Fort Walton Beach, FL 32547 PERIOD TO: 5/6/2013 X_ ARCHITECT FROM CONTRACTOR: VIA ARCHITECT: “ X_]cONTRUCTION MANAGER Skanksa USA Building Inc. Heery Design 55 Ivan Allen Jr. Boulevard, Suite 600 Atlanta, GA 30308 CONTRACT: Construction Manager 4700 Millenia Boulevard, Suite 550 Orlando, FL 32839 PROJECT NO: C09-1698-CAO CONTRACT DATE: June 21, 2008 CONSTRUCTION MANAGER'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Document G703, is attached. 1, ORIGINAL CONTRACT SUM $____22,400,229.00 2. Net change by Change Orders $ — =7,959,713.00: 3. CONTRACT SUM TO DATE (Line | + 2) $i 14,440,516.00 4. TOTAL COMPLETED & STORED TO $ 14,440,516.00 DATE (Column Gon G703) 5. RETAINAGE: a. of Completed Work 0.00 (Column D + E on G703) b._ of Stored Material 0.00 “(Column F on G703) Total in Column I of G703) $ 0.00 6. TOTAL EARNED LESS RETAINAGE $ ~ 14,440,516.00 (Line 4 Less Line 5 Total) 7, LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) $ 14,402,819.00 8. CURRENT PAYMENT DUE $e 31,697.00. 9. BALANCE TO FINISH, INCLUDING RETAINAGE , ae 0.00 (Line 3 less Line 6) CHANGE ORDER SUMMARY | ADDITIONS | DEDUCTIONS | Total changes approved in previous months by Owner 0.00 -6,083,433.00} Total approved this Month 0.00 sini onianl TOTALS 0.00] -7,959,713.00] NET CHANGES by Change Order -7,959,713.00 ARCHITECT'S CERTIFICATE FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief the Work covered by this Application for Payment has been completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. Construction Manager: Keith Shelton, Senior Project Manager RP Skanska USA Building Inc. RX RA | HU NV Ker By: Kewh WW Date: 28748 BSS: Gur A = #0 of 4 State of: Georgia = is aig oF <: Subscribed and swom to before me this day of May DID . eg © iO: Notary Public: aan s Sik, UBL st &: a * ‘d My Commission expires: > sy 5 Suse Oo Nin aa In accordance with the Contract Documents, based on on-site observations and the data i comprising the application, the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Doctments, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. (Attach explanation if amount certified differs from the amount applied. Initial all figures on this Application and onthe Continuation Sheet that are changed to conform with the amount certified.) ARCHITECT. Robert Egleston, Executive Associate AMOUNT CERTIFIED ........... $ epy Design / | This Certificate is not negétiat . The AMOUNT CERTIFIED is payable oly to the Contractor named herein. Issudnce, payment and acceptance of Payment are without prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702 - APPLICATION AND CERTIFICATION FOR PAYMENT - 1992 EDITION « AIA - ©1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006-5292 CONTINUATION SHEET AIA DOCUMENT G703 PAGE 3 OF 3 PAGED AIA Dooument G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing "APPLICATION NO: oY] Contractor's signed certification is attached. APPLICATION DATE: 05/08/13 In webulations below, amounts are stated to the nearest dollar. PERIOD TO: 05/06/13 Use Column 1 on Contracts where variable retainage for line items may apply. OKALOOSA COUNTY PROJECT NO: C09-1698-CAO a_|B Cc D E F G H 1 trem |DESCRIPTION OF WORK SCHEDULED CHANGE REVISED WORK COMPLETED MATERIALS TOTAL * BALANCE RETAINAGE NO. VALUE ORDER CONTINGENCY SCHEDULED | FROMPREVIOUS[ ~—~STRISPERIOD | PRESENTLY COMPLETED G+C) TO FINISH (CF VARIABLL VALUE APPLICATION STORED AND STORED (C-@) aT (+E) (NOT IN TO DATE DORE) (Q+E+E=) 1 ]Sitework 1,851,376.00 (1,349,489.00) 501,887.00 501,887.00 501,887.00 100% 2 |Demolition 59,257.00 ($9.257.0) 3 [Earthwork & Site Utilities 692,976.00 (78,352.00) 614,424.00 614,424.00 614,424.00 100% 4 [Reinforced Concrete 408,074.00 (408,074.00) 5 {Cement Finishing 6 | Tilt-Up Concrete $27,490.00 110,854 00) 816,636.00 816,636.00 816,636.00 100% 7 ‘|Masonry 488,626.00 118% 498,00) 300,128.00 300,128.00 300,128.00 100% 8 1S I and Misc. Steet 974,162.00 (456,019.00) 518,143.00 518,143.00 518,143.00 100% 9 |Rough Carpentry 56,700.00 (56,706.00) 10 }Millwork 1,159,880.00 (833,376,005 326,504.00 326,504.00 326,504.00 100% 11 | Waterproofing and Caulking 297,350.00 (169,522 00) 127,828.00 127,828.00 127,828.00 100% 12 | Roofing and Sheet Metal 430,709.00 (237,051 00) 193,658.00 193,658.00 193,658.00 100% 13. }Hollow Metal 549,702.00 (419.394.00) 130,308.00 130,308.00 130,308.00 100% 14 [Wood Doors 15,334.00 ss 15 |Special Acting Doors 21,308.00 (14,516.00) 6,798.00 6,798.00 6,798.00 100% 16 | Finish Hardware 2,000.00 (2,000.00) 17 }Glass, Glazing, and Storefront 699,035.00 (199,710 0G) 589,325.00 589,325.00 589,325.00 100% 18 [Lath, Plaster, and Stucco 19 [Drywall 640,770.00 (17.68 1,00) 623,089.00 623,089.00 623,089.00 100% 20 {Ceramic Tile 77,650.00 (49.311.00) 37,339.00 37,339.00 37,339.00 100% 21 |Acoustical 362,868.00 (362,868.00) 22. {Resilient Floors 268,150.00 (161,397.00) 106,753.00 106,753.00 106,753.00 100% 23 | Painting and Wall Covering 261,886.00 11,654.00 273,540.00 273,540.00 273,540.00 100% 24 |Special Flooring 211,932.00 (71,899.00) 140,033.00 140,033.00 140,033.00 100% 25 |Miscellancous Specialties 173,976.00 (108.170,00) 65,806.00 65,806.00 65,806.00 100% 26 | Toilet Partitions and Accessories 77,186.00 (77,186.00) 27 | Equipment 3,350.00 (3,350.00) 28 |Signage 115,024.00 115,024.00 115,024.00 115,024.00 100% 29 | Casework 30 |Fumishings 31 |Special Construction 315,471.00 (212.113 00) 103,358.00 103,358.00 103,358.00 100% 32 {Conveying Systems 250,238.00 (8,096.00) 242,142.00 242,142.00 242,142.00 100% 33 | Mechanical Systems 3,088,649.00 (1,394.223.00) 1,694,426.00 1,694,426.00 1,694,426.00 100% 34 | Electrical Systems 2,846,582.00 (634,615.00) 2,211,967.00 2,186,972.00 24,995.00 2,211,967.00 100% 35 |General Conditions 2,644,474,00 34,460.00 2,678,934.00 2,678,934.00 2,678,934.00 100% 36 |Payment and Performance Bonds 195,788.00 981.00 196,769.00 196,506.00 263.00 196,769.00 100% 37 | Business License 6,242.00 45.00 6,287.00 6,279.00 8.00 6,287.00 100% 38 | Builders Risk 395,143.00 2,088.00 397,231.00 396,677.00 554.00 397,231.00 100% 39 |General Liability 221,675.00 1,149.00 222,824.00 222,519.00 305.00 222,824.00 100% 40 |Subguard 235,278.00 22,873.00 258,151.00 257,826.00 325.00 258,151.00 100% Al [Fee 936,508.00 4,696.00 941,204.00 939,957.00 1,247.00 941,204.00 100% 42 |Owmer Contingency 43. Construction Contingency 652,434.00 (652,434.00) 44 [Owner Direct Purchase Orders 45 {OCO No. | - Inctuded in Individual Line Items Above 46 }OCO No. 2 - Included in Individual Line ltems Above 47 {OCO No. 3 - Included in Indivudual Line tems Above SO Project Total 22,400,229.00 (7,9§9.713.00) 14,440,516.00 14,412,819.00 27,697.00 14,440,516.00 100% gebPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE1 OF 2 PAGES * TO OWNER: "PROJECT: APPLICATION NO: 24 Distribution to: . - Okaloosa County Board of Okaloosa County Courthouse DATE: 05/08/13 County Commissioners Annex Extension 602-C North Pearl Street 1940 Lewis Turner Blvd. X JOWNER Crestview, FL 32536 Fort Walton Beach, FL 32547 PERIOD TO: 5/6/2013 X JARCHITECT FROM CONTRACTOR: VIA ARCHITECT: X_|CONTRUCTION MANAGER Skanksa USA Building Inc. Heery Design 55 Ivan Allen Jr. Boulevard, Suite 600 Atlanta, GA 30308 CONTRACT: Construction Manager Orlando, FL 32839 4700 Millenia Boulevard, Suite 550 PROJECT NO: C09-1698-CAO CONTRACT DATE: June 21, 2008 CONSTRUCTION MANAGER'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Document G703, is attached. 1. ORIGINAL CONTRACT SUM $ ___.22,400,229.00 2. Net change by Change Orders $ x - =7,959,713.00 3. CONTRACT SUM TO DATE (Line 1 + 2) $ -14,440,516.00 4. TOTAL COMPLETED & STORED TO $ 14,440,516.00 DATE (Column G on G703) 5. RETAINAGE: a of Completed Work 0.00 (Column D + E on G703) b. of Stored Material 0.00 ‘(Column F on G703) Total in Column I of G703) $ 0.00 6. TOTAL EARNED LESS RETAINAGE $ 14,440,516.00 (Line 4 Less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) $ 14 402,819.00 8. CURRENT PAYMENT DUE $ 37,697.00. 9. BALANCE TO FINISH, INCLUDING RETAINAGE ~~ 0.00 (Line 3 less Line 6) ~~ CHANGE ORDER SUMMARY | ADDITIONS | DEDUCTIONS | Total changes approved in previous months by Owner 0.00 -6,083,433.00} Total approved this Month 0.00} lane TOTALS 0.00] -7,959,713.00 NET CHANGES by Change Order -7,959,713.00 The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief the Work covered by this Application for Payment has been completed in accordance with the Conrract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. Viselestyy, Construction Manager: Keith Shelton, Senior Project Manager _\\¥ R HUA, Skanska USA Building Inc. & on eesti Oe Sy 2 SS!ON % By: Koad, QL Date: SG OS re a 26! o,<: State of: Georgia Douglas sO:7 se lees Subscribed and sworn to before me this 8th day of May rNKA Lo Py Bw $3 ‘7 = = Nay Pie. = , Omens eS My Commission €xpires: 4,4, 6) Tesesese &S In accordance with the Contract Docurnents, based on on-site observations and the data comprising the application, the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. 31,697. aXe) (Attach explanation if amount cértified differs from the amount applied. Initial all figures on this pstmt and onthe Continuation Sheer that are changed to conform with the amount certified.) Robert Egleston, Executive Associate nS ol iS eg fable. Te ALAN GREED eae ly tb the Contractor named herein. Issuance, payment and acceptance of payment are without Prejudice to any rights of the Owner or Contractor under this Contract. AMOUNT CERTIFIED sew e see ceee AIA DOCUMENT G702 - APPLICATION AND CERTIFICATION FOR PAYMENT - 1992 EDITION - AIA - ©1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006-5292 a CONTINUATION SHEET AIA DOCUMENT G703 eis Ges wanes ‘AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO- 74 Contractor's signed certification is attached. APPLICATION DATE: 05/08/13 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 05/06/13 Use Column I on Contracts where variable retninage for line items may apply. OKALOOSA COUNTY PROJECT NO: C09-1698-CAO A_1B c D 7 E F Go H 1 (TEM |DESCRIPTION OF WORK SCHEDULED CHANGE REVISED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE ORDER CONTINGENCY SCHEDULED | FROM PREVIOUS | | THISPERIOD | PRESENTLY COMPLETED (G+C) TO FINISH (OF VARIABLE VALUE STORED («c-Q) RATE) @+e) (NOTIN TO DATE DORE) (DAEs) 1 | Sitework 1,851,376.00 {1,349.489.00) 501,887.00 501,887.00 501,887.00 100% 2 [Demolition 59,257.00 (S9.257.)), 3 }Earthwork & Site Utilities 692,976.00 (78,552.05 614,424.00 614,424.00 614,424.00 100% 4 | Reinforced Concrete 408,074,00 (498,074.00 5 }Cement Finishing 6 | Tilt-Up Concrete 827,490.00 (10,854 00) $16,636.00 816,636.00 $16,636.00 100% 7 +|Masonry 488,626.00 {188 498.00) 300,128.00 300,128.00 300,128.00 100% 8 {Structural and Misc. Stee! 974,162.00 1456,.019.00) 518,143.00 518,143.00 518,143.00 100% 9 | Rough Carpentry 56,700.00 {56,700,00) 10 | Millwork 1,159,880,00 (833,376.00) 326,504.00 326,504.00 326,504.00 100% 11 |Waterproofing and Caulking 297,350.00 (169,522 00) 127,828.00 127,828.00 127,828.00 100% 12 [Roofing and Sheet Metal 430,709.00 (227.051 00) 193,658.00 193,658.00 193,658.00 100% 13 |Hollow Metal 549,702.00 4419.394.00) 130,308.00 130,308.00 130,308.00 100% 14 | Wood Doors 15,334.00 (IS.334.00) 1S |Special Acting Doors 21,308.00 (14,510.00) 6,798.00 6,798.00 6,798.00 100% 16 }Finish Hardware 2,000.00 (2.000.000) 17 |Glass, Glazing, and Storefront 699,035.00 (169,710 00) 589,325.00 $89,325.00 589,325.00 100% 18 }Lath, Plaster, and Stucco 19 [Drywall 640,770.00 (17,481.00) 623,089.00 623,089.00 623,089.00 100% 20 Ceramic Tile 77,650.00 (40,311.00) 37,339.00 37,339.00 37,339.00 100% 21° ‘| Acoustical 362,868.00 (362,868.00) 22. |Resilient Floors 268,150.00 (361,397.00) 106,753.00 106,753.00 106,753.00 100% 23° | Painting and Wall Covering 261,886.00 11,654.00 273,540.00 273,540.00 273,540.00 100% 24 |Special Flooring 211,932.00 (71,899.00) 140,033.00 140,033.00 140,033.00 100% 25 |Miscellancous Specialties 173,976.00 (108.1 70.00) 65,806.00 65,806.00 65,806.00 100% 26 Toilet Partitions and Acocssories 77,186.00 (77,186.00) 27 | Equipment 3,350.00 (3,330.00) 28 Signage 115,024.00 115,024.00 115,024.00 115,024.00 100% 29 {Casework 30 | Furnishings 31 |Special Construction 315,471.00 42$2.113.00) 103,358.00 103,358.00 103,358.00 100% 32 {Conveying Systems 250,238.00 8,096.00) 242,142.00 242,142.00 242,142.00 100% 33 |Mechanical Systems 3,088,649.00 (1.394.223.0053 1,694,426.00 1,694,426,00 1,694,426.00 100% 34 | Electrical Systems 2,846,582.00 (634,615.00) 2,211,967.00 2,186,972.00 24,995.00 2,211,967.00 100% 35 |General Conditions 2,644,474.00 34,460.00 2,678,934.00 2,678,934.00 2,678,934.00 100% 36 {Payment and Performance Bonds 195,788.00 981.00 196,769.00 196,506.00 263.00 196,769.00 100% 37 {Business License 6,242.00 45.00 6,287.00 6,279.00 8.00 6,287,00 100% 38 | Builders Risk 395,143.00 2,088.00 397,231.00 396,677.00 $54.00 397,231.00 100% 39 |General Liability 221,675.00 1,149.00 222,824.00 222,519.00 305.00 222,824.00 100% 40 |Subguard 235,278.00 22,873.00 258,151.00 257,826.00 325,00 258,151.00 100% 41 {Fee 936,508.00 4,696.00 941,204.00 939,957.00 1,247.00 941,204.00 100% 42. [Owner Contingency 43 {Construction Contingency 652,434.00 {082,434.00) 44° |Owner Direct Purchase Orders 45 JOCONo. | - Included in Individual Line Items Above 46 JOCO No. 2 - Included in Individual Line Items Above 47 JOCO No. 3 - Included in Indivudual Line items Above 50 Project Total 22,400,229.00 (7,959.713.00) 14,440,516.00 14,412,819.00 27,697.00 14,440,516.00 100% tao Revd 5-14-15 HEERY Date: May 13, 2013 To: Ernie Padgett Title: Okaloosa County Administrator Company: Okaloosa County Administrative Services Addtess: 1804 Lewis Turner Blvd. Fort Walton Beach, FL 32547 Phone No. Fax No. TRANSMITTAL From: Bob Egleston Email Address: Transmittal / Fax toggles above Return Fax: Re: Project: Okaloosa County Courthouse Annex Extension Project No: 3007900 Via. Ground Distribution: File: A01-04 Qty. Description Dated Action Required 2 Skanska Final Pay Application 5/8/13 2 Skanska Change Order 003 5/7113 Comments Mr. Padgett - Enclosed are the final Skanska documents for the County's signature on the Courthouse Annex Extension Project. If you have any questions, please call Keith Shelton with Skanska. HEERY INTERNATIONAL, INC. Millenia Lake |, 4700 Millenia Boulevard, Suite 550 Orlando, FL 32839 1 of 1 p 407.992.6300 f 407.992.6399 Document2 SKANSKA | Transmittal Cover Sheet Detailed, Grouped by Each Transmittal Number Okaloosa County Courthouse Annex Project # 219515 Skanska USA Building Inc. 1940 Lewis Turner Blvd. Tel: 850-315-4683 Fax: 850-315-4688 Fort Walton Beach, FL 32547 Reference Number: 0385 Patti Hanna : Keith Shelton Okaloosa County Skanska USA Building Inc. 5489 Old Bethel Road GMC Health & Wellness Center Crestview, FL 32536 201E. Greene Street Tel: 850-689-5790 Milledgeville, GA 31061 Fax: Tel: 478-454-0178 Fax: 478-454-0192 O Acknowledgement Required As Requested . FedEx - Overnight 0001 1.00 Closeout Waiver and Release of Lien Upon Final Payment 0002 1.00 Closeout Proof of Completion 0003 1.00 Closeout Certificate of Insurance 0004 1.00 Closeout Consent of Surety Company to Final lt pale arent Proof of Sony Cnn Yeor Please find attached the original Waiver nil Release of Lien —_ Final Payment, Proof of Complation ieheaclaatherk Certificate of Insurance, and Consent of Surety Company to Final Payment and Proof of Performance and Payment Bonds Conitnuation for 1 Year for the Okaloosa County Courthouse Annex Extension project. Should you have any questions or need additional information, please do not hesitate to contact me. Thanks- File: 0+270 Ke 12.10.13 Signature Signed Date Prolog Manager Printed on: 12/10/2013 7Southeast Page 1 WAIVER AND RELEASE OF LIEN UPON FINAL PAYMENT The undersigned lienor, in consideration of the final payment of $37,697.00, hereby waives and releases its lien and right to claim a lien for labor, services, or materials furnished to Okaloosa County Board of County Commissioners on the job of Okaloosa County Board of County Commissioners to the following property: Okaloosa County Courthouse Annex Extension 1940 Lewis Turner Blvd Fort Walton Beach, FL 32547 Commencing at the General Land Office monument dated 1937, 2" pipe with brass cap, which is at the quarter section corner common to section 25 and 26, T-1-S R-24-W, being also a comer of a tract of land conveyed to the Board of Public Instruction, Okaloosa County, Florida, on 30 December 1970, and a comer of a tract of land owned by the United States of America at Eglin Air force Base, thence N 87°48'29" W, along the said boundary of said Board of Public Instruction tract which is along the boundary of said United States tract 1150.83 feet to an unnumbered 4"x4" concrete monument; thence S 01°47'58" W, along the boundary of said Board of Public Instruction tract which is along the boundary of said United States tract 1726.18 feet more or less to an unnumbered 4"x4" concrete monument on the northern right-of-way line of the State Road 189 and to the point of beginning; thence S 65°40'01" W along the northern right-of-way line of said road 1718.69 feet to a rod and cap #4167; thence N 01°47'58" E, 882.25 feet; thence N 90°00'00" E, 938.86 feet; thence S 00°00'00" W, 173.65 feet; thence N 90°00'00" E, 599.45 feet more or less to the point of beginning. The parcel described herein contains 16.30 acres, more or less and is a portion of Parcel 1 (Tract 943) and a portion of Parcel 2 (Tract 944) as recorded in the Official Records Book 2663, page 4937, Okaloosa County, Florida. DATED on October 11, 2013. Lienor, Skanska USA Buildin " By: bod Authorized representative DRAIN RRR 4 3 ra . WORTHWEST ily News Published Daily Fort Walton Beach, Florida Distributed in Okaloosa, Santa Rosa & Walton Counties State of Florida, County of Okaloosa Before the undersigned authorized personally appeared M GWA Lin _ WW f | 45t a who on oath says that (s)he is Loge Add ths: a Chak 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 uf ToS in the matter of Ad Vir tst mint of Comp ction Os) oese (: dunks Cowthous: Amney in the beg hoesa Coury ae was published in said newspaper in the issues of August ZU 28 Siykimbur # Ut 2013 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 Subscribed and sworn to (or affirmed) before me this M1 Ne phrmdd O13 Lf (Date) Lhe , who is/are personally known to me or has/have produced frsm Ghky 7 y ow a] as identification. (Type of idéntification) Notary Public, Commission No. (Signatu: (Name of Notary typed, printed or stamped) , fPma st Ma eee a a pews Bucs ® ay v \ Seite, ELEANOR We . - ; 1 SK Ns Notary Public - State of Florida ot )°s My Comm, Expires Ju 130, 2015 { ' RSW YsF Commission # BE 110919 / 2 i ae Bonded Through National Notary Aven. OAS Pe =, J DATE(MM/DD/YYYY) ACORIY : es CERTIFICATE OF LIABILITY INSURANCE t2naz013 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. r =r oer? THT oe 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 2 certificate holder in lieu of such endorsement(s). -_ 2 PRODUCER CONTACT s Aon Risk Services Northeast, Inc. PHONE Bie: Jericho NY Broadway Office (NC. No. Ext): {AiG No.): a 390 North Broadway E-MAIL 2 Jericho NY 11753 USA ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA: Zurich American Ins Co 16535 Skanska USA Building, Inc. IWSURERB: American Zurich Ins Co 40142 35 Han) Ven Sr Boulevard INSURER C: Arch Insurance Company 11150 Atlanta GA 30308 USA INSURERD: American Guarantee & Liability Ins Co 26247 INSURER E: _ INSURER F: COVERAGES CERTIFICATE NUMBER: 570052122885 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. Limits shown are as requested} TYPE OF INSURANCE POLICY NUMBER FOLEY EFF 7 POvicy EXP LIMITS a Cee aici | A | GENERAL LIABILITY GL 1/2014) Each OCCURRENCE $2,000,000) — | DAMAGE TO RENTED X | COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $2,000,000 || CLAMS-MADE [x] occuR MED EXP (Any one person) $10,000 rx | xcu PERSONAL & ADV INJURY $2,000,000 3 X | 50 RR Delete GENERAL AGGREGATE $4,000,000 g GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $4,000,000 & r | POLICY [x] X | Loc s c AUTOMOBILE LIABILITY 11CAB8907901L 08/31/2013] 08/7 31/7 2014 COMBINED SINGLE LIMIT $2,000,000 oi AOS | (Ea accident) _ : z x ¢ TX ] anyauto 11¢A88908001 08/31/2013] 08/31/2014} BODILY INJURY (Per person) 8 rx | ALLOWNED [1] Sari MA BODILY INJURY (Per accident) 2 | * | AuTos S L—-{ PROPERTY DAMAGE [X_]HIRED AUTOS | x | ees (Per accident) € 6 D Tx] umprewtauas | x | occur AEC489601907 08/31/2013|08/31/2014| EACH OCCURRENCE $10,000,000] © || excess uss || CLAIMS-MADE AGGREGATE $10,000,000 DED | |RETENTION B | WORKERS COMPENSATION AND wc489601709 08731/2013[0873172014] y | WC STATU-| [OTH EMPLOYERS’ LIABILITY YIN TORY LIMITS ANY PROPRIETOR / PARTNER / EXECUTIVE E.L. EACH ACCIDENT $2,000,000 OFFICERVMEMBER EXCLUDED? NIA (Mandatory in NH) E.L. DISEASE-EA EMPLOYEE $2,000,000 b SERIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $2,000, 000) of the General Liability, Automobi d Monopolistic States - OH, NO, WA, WY and Puerto Rico. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, f more space is required) RE: Project No. 219515, Okaloosa County Courthouse Annex Extension, . at . . Okaloosa County Board of County Commissioners and Okaloosa County are included as Additional Insured in accordance with the policy provisions of the General Liability, Automobile Liability and Umbrella Liability policies. granted in favor of Okaloosa County Board of County Commissioners and Okaloosa Count ae Liability and umbrella Liability policies. A waiver of Subrogation is in accordance with the policy provisions workers' Compensation Coverage Not Included in CERTIFICATE HOLDER CANCELLATION Okaloosa County Board of County Commissioners 602-c North Pearl Street Fort Walton Beach, FL 32536 USA POLICY PROVISIONS. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WL BE DELIVERED IN ACCORDANCE WITH THE U AUTHORIZED REPRESENTATIVE Metre boo TRS RS Se Ae I ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 02 24 10 93 EARLIER NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement effective Policy No. GLO4896018-06 12:01 A.M. standard time Named Insured- Skanska USA Building Inc. Countersigned nay (Authorized Representative) SCHEDULE Number of Days’ Notice 90 (If no entry appears above, information required to complete this Schedule will be shown in the Declarations as applicable to this endorsement.) For any statutorily permitted reason other than nonpayment of premium, the number of days required for notice of cancellation, as provided in paragraph 2. of either the CANCELLATION Common Policy Condition or as amended by an applicable state cancellation endorsement, is increased to the number of days shown in the Schedule above. CL 648 (10-93) CG 02 24 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 . 4 "CONSENT OF oanen = : AR SURETY COMPANY conrracTor:C TO FINAL PAYMENT SURETY a) Conforms with the American Institute of OTHER Architects, AlA Document G707 PROJECT: Bond Nos.:105285571; 8937386; 015-029-735; 8192-99-06 (name, address} FL 32547 TO (Owner) ARCHITECT'S PROJECT NO: OKALOOSA COUNTY BOARD OF COMMISSIONERS CONTRACT FOR: 602-C North Pearl St. Courthouse Annex Extension Fort Walton Beach FL 32536 _] CONTRACT DATE: CONTRACTOR: SKANSKA USA BUILDING INC. - GOVT. In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the there insert name and address of Surety Company) TRAVELERS CASUALTY AND SURETY LIBERTY MUTUAL INSURANCE COMPANY FIDELITY AND DEPOSIT COMPANY OF COMPANY OF AMERICA 175 Berkeley Street MARYLAND One Tower Square Boston MA 02116 1400 American Lane, Tower |, 18th Floor Hartford, CT 06183 Schaumburg, IL 601 and FEDERAL INSURANCE COMPANY, 15 Mountain View Rd., PO Box 1615, Warren NJ 07061-1615 4 COMPANY on bond of _ {here insert name and address of Contractor) SKANSKA USA BUILDING INC. - GOVT. 55 Ivan Allen Jr. Blvd. Atlanta GA 30308 , CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety Company of any of its obligations to there insert name and address of Owner) OKALOOSA COUNTY BOARD OF COMMISSIONERS 602-C North Pear St. Fort Walton Beach FL 32536 , OWNER, and that the Performance and Payment Bonds will remain in effect for at least one (1) year from the date final payment to the Contractor becomes due. as set forth in the said Surety Company's bond. IN WITNESS, WHEREOF, the Surety Company has hereunto set its hand this 18th day of September, 2013 FEDERAL INSURANCE COMPANY TRAVELERS CASUALTY AND Sa rt hi > aidaiatal OF AMERICA LIBERTY MUTUAL INSURANCE COMP FIDELITY AND DEPOSIT COMPANY OF MARYLAND WITNESS: Surety Company , 7. * a Signafire of AuthoriZed Repfésentative Maria Signorile Attorney-in-Fact Title NOTE: This form is to be used as a companior dccument to AIA DOCUMENT G706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS, Current Edition ONE PAGE wate ani i bal mpaaiimauteerh ain cna Sonne MAM ee OF Vigilant Insurance Company 15 Mountain View Road x. Chubb POWER Federal Insurance Company Attn: Surety Department Surety ATTORNEY Pacific Indemnity Company Warren, NJ 07059 Know Ail by These Presents, That FEDERAL INSURANCE COMPANY, an indiana corporation, VIGILANT INSURANCE COMPANY, a New York corporation, and PACIFIC INDEMNITY COMPANY, a Wisconsin corporation, do each hereby constitute and Spot James F. Dunn, Beth Marian Kitchens-Harmon, Maria Signorile and Wesley P. Williams of Atlanta, each as their tue and lawful Attorney- in- Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behatf as surety thereon or otherwise, bonds and undertakings and other writings obligatory in the nature thereof (other than bail bonds) given or executed in the course of business, and any instruments amending or altering the same, and consents to the modification or alteration of any instrument referred to in said bonds or obligations. in Witness Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and attested these presents and affixed their corporate seals on this ‘1st dayot August, 2012. ‘ae fa LeveGih fi blonde ‘Wendel, WE Noms, J, Vice Present STATE OF NEW JERSEY wate 7 ss. County of Somerset Onthis ‘1st dayot August, 2012 _ before me, a Notary Public of New Jersey, personally came Kenneth C. Wendel, to me known to be Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, the companies which executed the foregoing Power of Attomey, and the said Kenneth C. Wendel, being by me duly swom, did depose and say that he is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY and knows the corporate seals thereof, that the seals affixed to the foregoing Power of Attomey are such corporate seals and were thereto affixed by authority of the By- Laws of said Companies; and that he signed said Power of Attorney as Assistant Secretary of said Companies by like authority, and that he is acquainted with David B. Norris, Jr., and knows him to be Vice President of said Companies; and that the signature of David B. Nomis, Jr., subscribed to said Power of Attomey is in the genuine handwriting of David B. Norris, Jr., and was thereto subscribed by authority of said By- Laws and in deponent's presence. KATHERINE J. ADELAAR Notarial Seal NOTARY PUBLIC OF NEW JEKSFY | No. 2316685 Commission Expires July 14, 2034 Vd fo_— !—-f Notary Public : CERTIFICATION Extract from the By- Laws of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY: *All powers of atlomey for and on behalf of the Company may and shall be executed in the name and on behalf of the Company, either by the Chairman or the President or a Vice President or an Assistant Vice President, jointly with the Secretary or an Assistant Secretary, under their respective designations. The signature of such officers may be engraved, printed or lithographed. The signature of each of the following officers: Chairman, President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary and the seal of the Company may be affixed by facsimile to any power of attomey or to any certificate relating thereto appointing Assistant Secretaries or Attomeys- in- Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such power of attomey or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached.” 1, Kenneth C. Wendel, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY (the "Companies”) do hereby certify that (i) the foregoing extract of the By- Laws of the Companies is true and correct, (i) the Companies are duly licensed and authorized to transact surety business in all 50 of the United States of America and the District of Columbia and are authorized by the U.S. Treasury Department; further, Federal and Vigilant are licensed in Puerto Rico and the U.S. Virgin Islands, and Federal is licensed in American Samoa, Guam, and each of the Provinces of Canada except Prince Edward fsland; and (iii) the foregoing Power of Attomey is true, correct and in full force and effect. Given under my hand and seals of said Companies at Warren, NJ this IS-th ayer (oP m ber, 2013 IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM, VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE, OR BY Telephone (908) 903- 3493 Fax (908) 903- 3656 e-mail: surety@chubb.com Form 15-10- 0225B-U (Ed. 5-03) CONSENT BN ISH re RTT T STI eM eNNa vette WARNING. THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER POWER OF ATTORNEY } TRAVELERS) sumincincumaiy compan St. Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters, Inc. Travelers Casualty and Surety Company of America St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St. Paul Guardian Insurance Company Attorney-In Fact No. 224870 Certificate No. 0 0 5 4 6 6 3 9 9 KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut, that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc., is a corporation duly organized under the laws of the State of Wisconsin (herein collectively called the “Companies”), and that the Companies do hereby make, constitute and appoint Beth M. Kitchens-Harmon, Maria Signorile, and James F. Dunn of the City of ___Atlanta , State of Georgia , their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF, the Companies have caused this instrument to be signed and their corporate seals to be hereto affixed, this 30th April 2013 day of ’ Farmington Casualty Company : St. Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters, Inc. Travelers Casualty and Surety Company of America St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St. Paul Guardian Insurance Company State of Connecticut By: : City of Hartford ss. Robert L. Raney, Senior Vice President On this the _ 0th day of __ April , 2013 hefore me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. Wan @. Adrtou2t In Witness Whereof, I hereunto set my hand and official seal. "Ne Marie C. Tetreault, Notary Public My Commission expires the 30th day of June, 2016. 58440-8-12 Printed in U.S.A. WARNING: THIS POWER OF ATTORNEY IS INVALID 'WITHOUT THE RED BORDER sumer: WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER € This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company, Fidelity , © and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance E Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, which resolutions are now in full force and effect, reading as follows: SG RELATE SG RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company‘s name and seal with the Company’s seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary; and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company’s seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attomeys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. Sisco alec RR eae oe tae 1, Kevin E. Hughes, the undersigned, Assistant Secretary, of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which is in full force and effect and lias not been revoked. IN TESTIMONY WHEREOE., I have hereunto set my hand and affixed the seals of said Companies this / Ft, day of Sephe mb Cr 3. | ; ‘ Kevin E. Hughes, Assistant To verify the authenticity of this Power of Attomey, call 1-800-421-3880 or contact us at www.travelersbond.com. Please refer to the Attommey-In-Fact number, the above-named individuals and the details of the bond to which the power is attached. WARNING: THIS POWER OF ATTORNEY 1S INVALID WITHOUT THE RED BORDER - Not valid for mortgage, note, loan, letter of credit, bank deposit, __ SO ete interest rate or noes value a gverantece: _ THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. 5481261 ~ This Power of Attomey limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. : Certificate No. American Fire and Casualty Company Liberty Mutual Insurance Company The Ohio Casualty Insurance Company Peerless Insurance Company West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire & Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of the State of Ohio, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, that Peerless Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, and West American Insurance Company Is a corporation duly organized under the laws of the State of Indiana (herein _ collectively called the “Companies’), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, BETH MARIAN KITCHENS-HARMON; JAMES F. DUNN; MARIA SIGNORILE; WESLEY P. WILLIAMS allofthe city of___ATLANTA__, stateof____@A___each individually i there be more than one named, is true and lnwtul stiomey-in-fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and alll undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall beat: binding spon tie Gormpenise a Hfipy: five een Guly signed by Hie prvekient ered alte by the secretary of he Conmpartae it ak own proper persons. INWITNESS HEREOF ths Pover cht es been sutsrbedby an auorzed fico te Conpanks anti carratsealofthe Compares haveben afd eos 25th 25th day of _duly__, 2012, American Fire and Casualty Company The Ohio Casualty Insurance Company Liberty Mutual Insurance Company Peerless Insurance Company West American Insurance Company es : : ; By: , : STATE OF WASHINGTON ss Gregory W. Davenport, Assistant Secretary COUNTY OF KING Onthis_25th_dayof__Juy _—,_2ot2., 2012_, before me personally appeared Gregory W. Davenport, who acknowledged himself to be the Assistant Secretary of American Fire and Casualty Company, Liberty Mutual Insurance Company, The Ohio Casualty Company, Peerless insurance Company and West American Insurance Company, and that he, as such, being authorized so to do, ‘execute the foregoing instrument for the purposes therein contained by signing on behaif of the corporations by himself as a duly authorized officer. Washington, on the day and year first above written. IN WITNESS WHEREOF, ce ge SET eg, 25 4s Casares nish ‘This Power of Atomey is made end executed pursuant fo and by authority ofthe folowing By Jaws and KilNrizations of American Fie and Casually Company, The Ohio Casualty Insurance | Company, Liberty Mutual Insurance Company, West American Insurance Company and Peerless Insurance Company, which resolutions are now in full force and effect reading as follows: ARTICLE IV- OFFICERS - Section 12. Power of Atiomey. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the President may prescribe, shall appoint such attomeys-in-fact, as may be necessary to act In behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attomeys-in-fact, subject to the limitations set forth In their respective powers of attomey, shall have full power fo bind the Comoration by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attomey-in-fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. ARTICLE Xill - Execution of Contracts ~ SECTION 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attorneys-in-fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attomeys-in-fact subject to the limitations set forth in their respective powers of attorney, Ms ie fi panes a) Sine Be Gosapenyy by iy signers and ebecidion oF: Ay Sih senate end WS int thereto the seel of hho Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. To confirm the validity of this Power of Attorney call Certificate of Designation - The President of the Company, acting pursuant to the Bylaws of the Company, authorizes Gregory W. Davenport, Assistant Secretary to appoint such attomey-in-fact as may de necessary to act on batraif of the Company ts make, execute, sea! acknowieaye and defver as surely any and at ondertakings, bonds, recogmizaross and otter surety obligations. Authorization - By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shail be valid and biding upon the Company with the same force and effect as though manually affixed. 1, David M. Carey, the undersigned, Assistant Secretary, of American Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, West American Insurance Company and Peerless insurance Company do hereby certify that the original power of attomey of which the foregoing Is a full, ne RE eee Atfomey executed by said Companies, sin ful fore and effet and hes not been revoked y IN TESTIMONY WHEREOF,!have hereunto set my hand and affixed the seals of said Companies Ete ay i optermb er mB. 3000 David M. Carey, Assistant Secretary POA-AFCC, LMIC, OCIC, PIC & WAIC (MS _12873_041012 ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of New York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Maryland, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"), by GEOFFREY DELISIO, Vice President, in pursuance of authority granted by ‘Article V, Section 8, of the By-Laws of said Companies, which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute, and appoint Wesley P. WILLIAMS, Maria SIGNORILE, Beth KITCHENS-HARMON and James F. DUNN, all of Atlanta, Georgia, EACH its true and lawful agent and Attomey-in-Fact, to make, execute, seal and deliver, for, and on its behalf as surety, and as its act and deed: any and all bonds and undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies, as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York, New York., the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8, of the By-Laws of said Companies, and is now in force. IN WITNESS WHEREOF, the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 13th day of August, A.D. 2012. ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND _ nighties Assistant Secretary Vice President Gregory E. Murray Geoffrey Delisio State of Maryland City of Baltimore On this 13th day of August, A.D. 2012, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, GEOFFREY DELISIO, Vice President, and GREGORY E. MURRAY, Assistant Secretary, of the Companies, to me personally known to be the individuals and officers described in and who executed the preceding instrument, and acknowledged the execution of same, and being by me duly swom, deposeth and saith, that he/she is the said officer of the Company aforesaid, and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies, and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF, J have hereunto set my hand and affixed my Official Seal the day and year first above written. Wie yt 4, shyitt.dy “ty, San”, ? ; th wis a Quam % os. maw S$ 2 ae RS DR SSEO? Constance A. Dunn, Notary Public My Commission Expires: July 14, 2015 POA-F 032-0008C EXTRACT FROM BY-LAWS OF THE COMPANIES "Article V, Section 8, Attorneys-in-Fact. The Chief Executive Officer, the President, or any Executive Vice President or Vice President may, by written instrument under the attested corporate seal, appoint attoreys-in-fact with authority to execute bonds, policies, recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such attorney-in-fact to affix the corporate seal thereto; and may with or without cause modify of revoke any such appointment or authority at any time." CERTIFICATE I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate; and J do further certify that Article V, Section 8, of the By-Laws of the Companies is still in force. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998. RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary and the Seal of the Company may be affixed by facsimile on any Power of Attorney...Any such Power or any certificate thereof bearing such facsimile signature and seal shall be valid and binding on the Company." This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the Sth day of May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 10th day of May, 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice-President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect as thougr manually affixed. iN ‘TESTIMCNY WHEREOF, I have hereunto subscribed my name and affixed the corporate seals of the said Companies, this ///ixiay of Lepattn b 2. 2 James M. Carroll, Vice President