Okaloosa County BOCC — October 21, 2014 — BILL SMITH ELECTRIC FINAL PAYMENT

CONTRACT CLOSE-OUT CHECKLIST (To Be Prepared by the Contracts and Lease Coordinator) DATE: 9-26-14 TO: Contracts & Grants Manager, Finance Department Contracts & Grants Office SUBJECT: ContractNo. C14-2145-WS MANAGING DEPARTMENT: WS CONTRACTOR'S NAME; BILL SMITH ELECTRIC PROJECT TITLE: REHABILITATION OF ELECTRICAL MANHOLES The attached has met the final payment contract requirement in subject contract. Yes No 1. Final Invoice XJ 2. Completed Contract/Lease Payment Approval Form Xx] 3. Close-Out Documents Yes No N/A a. Signed Release of Lien Xx] im CL] b. Proof of Completion Advertisement Xx im L] c. Certificate of Insurance K] C] im d. Consent of Surety to Final Payment Xx] im im e. Proof of Performance/Payment Bond XI im im Continuation 12 Months Following Final Payment Yes No 4, Agenda Request Ki O 5, Remarks SA Wy 0-3-1 Telos so ona and Lease Coordinator DATE eee BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST DATE: October 7, 2014 TO: Honorable Chairman and Members of the Board FROM: Jeff Littrell SUBJECT: Russell Stephenson WRF-Elect. Manhole Rehab Project DEPARTMENT: Water and Sewer BCC DISTRICT: 4 STATEMENT OF ISSUE: OCWS staff requests BCC approval of a final payment, in the amount of $39,466.20, to Bill Smith Electric, Inc. On contract #C14-2145-WS, BACKGROUND: Via the bidding process, Okaloosa County Water & Sewer entered into a contract with Bill Smith Electric, Inc. In 2014. This contract was for the rehabilitation of the electrical manholes at the Russell Stephenson WRE. All work concerning this project has been completed. Final inspections by OCWS staff and consultants have been overseen and work deemed sufficient. Now that the work has been completed and deemed sufficient, final payment is now due on the contract. OPTIONS: Approve or deny RECOMMENDATIONS: Staff recommends BCC approval of a final payment, in the amount of $39,466.20, to Bill Smith Electric, Inc. RECOMMENDED BY: APPROVED BY: Ernie Padgett, County Administrator CONTRACT/LEASE PAYMENT APPROVAL FORM COMPLETE AND FORWARD TO THE NEXT DEPARTMENT COMPLETED BY DEPARTMENT DATE: 09/10/2014 VENDOR NAME: Bill Smith Electric, Inc. VENDOR #: CONTRACT/LEASE #: __C14-2145-WS VENDOR TASK COUNTY/FEMA BUDGET | ACCOUNT # | AMOUNT $ INVOICE# ORDER # PROJECT # DEPARTMENT # w Cf Applicable) (&f Applicable) y 7 3 S 2 SOs Ae 002-FINAL | 4% wafer -4450- " ESHES: | 939346620 | 24495, uc Retainage " Gl LOS |[{ CO! $000 1/797. 2A Ie TOTAL 39,466.20 $ phe“ APPROVED FOR PROGRESS PAYMEN T (please sign, as applicable and date) i ce. CONTRACTOR’S ENGINEER/ARCHITECT/PROJECT MANAGER: NS 3 BURN “TNGEN DATE: fed ict lea c Pia COUNTY SUPERVISOR/PROJECT MANAGER: ways kd defor, ees fe) a a7 Va DATE: S Sf 2. S40 Y DEPARTMENT DIRECTOR: louh, LUZ 6A A/ _ DATE: 2/2 of CONTRACTS & GRANTS MANAGER: DATE: COUNTY ADMINISTRATOR: DATE: (Payments> $25,000.) FINAL PAYMENT FINAL PAYMENT YES _X_ NO (If “Yes”, forward to Purchasing u pate: 10/3 I 4 PURCHASING DIRECTOR (Per Initial Agreement) DATE:/~-G-/Y CONTRACTS & GRANTS MANAGER (All Contracts) eg COUNTY ADMINISTRATOR APPROVAL (Per Initial Agreement) DATE: BOARD APPROVAL (Per Initial Agreement) Services Coordinator for Close-Out) COMPLETED BY FINANCE —- ACCOUNTS PAYABLE ONLY FISCAL YEAR: DATE RECEIVED: REVIEWED BY: Bill Smith Electric, Inc. Project Title: Electric Manhole Rehabilitation Project Project Number WS 03-14 Purchasing Contract No.C14-2145-WS Expires: July-1+4,2044 Substantial Comp: 6-44-14, 8-10-14 Completion date: 120 days, plus 60 is 9-8-2014 4125- TOTAL 411-2051100 563326 COST 10% Amount Date Inv# Cost to date Withheld Paid Paid 1 179,712.00 179,712.00 (17,971.20) 161,740.80 08/14/14 2 21,495.00 21,495.00 17,971.20 39,466.20 3 - - - 4 - - - 5 - - - 6 - - - 7 - - - g - - - 9 - - - 10 - - - 11 - - 201,207.00 201,207.00 - 201,207.00 Contract Total 201,207.00 Change Order #1 60 days added Change Order #2 Change Order #3 Change Order #4 New Contract Total 201,207.00 Balance to finish w/o retainage Check Number 1408147 grantsacct rs From: Kimberly Kilpatrick <kkilpat@co.okaloosa.fl.us> Sent: Monday, October 06, 2014 3:18 PM To: grantsacct Subject: RE: question Sure that is fine! From: grantsacct [mailto:grantsacct@clerkofcourts.cc] Sent: Monday, October 06, 2014 1:05 PM To: Kimberly Kilpatrick Subject: question Kim, Is it okay if | write in on the payment request form the number of the budget department for the retainage? It is 411, right? Thanks. Derek grantsacct Accountant Okaloosa County Clerk of Circuit Court Contracts and Grants 1804 Lewis Turner Boulevard, Suite 206 Ft. Walton Beach, FL 32547 Tel: (850) 651-7200 x 4383 PLEASE NOTE: Florida has a very broad public records law. Email communications to or from Okaloosa County Clerk of Court employees are considered public records and are available to the public and media upon request. Your e-mail communications, including your email address, are subject to public disclosure. This email is intended for the addressee(s) indicated above only. If you have received this email in error, please delete it Immediately. To Owner: Okaloosa County Water and Sewer Department Invoice Date 9/3/2014 Rep. Constantine Engineering, Inc. 1988 Lewis Turner Blvd. Unit 3 Fort Walton Beach, FL 32547 Attn. Mr. Joey Crews Invoice No. 2 Final RSWRE ELECTRICAL MANHOLE REHAB Contract# €14-2145-WS Remit to: |Bill Smith Electric, Inc PO Box 1057 Gonzalez, FL 32560 ANALYSIS OF CONTRACT AMOUNT: (a) Original contract amount: $ 201,207.00 (b) Plus: Additions scheduled in change orders (c) Less: Deductions scheduled in change orders (d) Adjusted contract amount to date $ 201,207.00 ANALYSIS OF WORK PERFORMED (a) Cost of original contract work performed to date $ 201,207.00 (b) Change order work performed to date © Total Cost of work performed to date $ 201,207.00 (d) Owner Purchased Materials $ - (e) Sales tax 6% of (d) $ - (f) Less: Amount of Owner Purchased Material and Tax (d and e) $ - (g) Less: Amount retained in accordance with contract terms A. % RETAINER 10% B. RETAINER TO DATE $ - (h) Net amount earned on contract work to date $ 201,207.00 (i) Less: Amount of previous payments $ 161,740.80 () BALANCE DUE THIS PAYMENT $ 39,466.20 (k) Net Amount Remaining $ - CERTIFICATION OF CONTRACTOR: ; According to the best of my knowledge and belief, | certify that all items and amounts shown on the face of this Periodic Estimate for Partial Payment are correct, that all work has been performed and/or materials supplied in full accordance with the requirements of the referenced contract, and/or duly authorized deviations, substitutions, alterations, and/or additions, that the foregoing is a true and correct statement of the contract account up to and including the last day of the period covered by this Periodic Estimate, that no part of the "Balance Due this Payment" has been received, and that the undersigned and his subcontractors have complied with all the labor provisions of said contract. | further certify that the labor and materials listed on this request for payment have been used in the construction of this work or that all materials included in this request for payment and not yet incorporated into the construction are now on the site or stored at an approved location; and payment received from the last request for payment has been used to make payments to all first tier subcontractors and suppliers except as listed below. BIL TH ELECTRIC; . Date: 9/3/14 BY: [/, f Jake Smith, Project Manager CERTIFICATION OF ENGINEER: | certify that | have checked the above Periodic Estimate for Partial Payment and that to the best of my knowledge and belief it is a true and correct statement of work performed and/or material supplied by the Contractor; and that partiat payment claim and requested by the Contractor is correctly computed on the basis of work performed and/or material supplied to date. CONSTANTINE ENGINEERING, INC DATE: ba lio \y4 BY: Sonny \ Qrasod BOARD OF COUNTY COMMISSIONERS PAYMENT APPROVED BY: OKALOOSA COUNTY, FLORIDA DATE: Owner's Authorized Representative BILL SMITH ELECTRIC PO BOX 1057, GONZALEZ, FL 32560 OFFICE (850) 968-6500 FAX (850) 937-8113 OWNER: Okaloosa County Underground Electrical Service _ Repairs at Russell Stephenson : PROJECT: WWTP Contract # Ci4-2145-WS DATE: September 3, 2014 INVOICE NO: Final SCHEDULE OF VALUES A B C D | E F G H I MATERIALS TOTAL WORK COMPLETED PRESENTLY | COMPLETED FROM STORED & STORED % ITEM SCHEDULED PREVIOUS THIS (NOT IN TO DATE COMPLETE | BALANCE TO NO. DESCRIPTION OF WORK VALUE PERIOD PERIOD DORE) (D+E+F) (G/C) FINISH (C-G) 1 {Electrical Manhole Rehab $ 80,000.00 | $ 80,000.00 $ 80,000.00 100% - 2 {Dewatering System $ 54,554.00 | $ 54,554.00 $ 54,554.00 100% q - 3 |Elec. Conduit & Conductor Replacemen} $ 47,158.00 | $ 47,158.00 $ 47,158.00 100% $ - 4 __|High Level Monitoring System $ 8,500.00 |$ 8,500.00 q 8,500.00 100% $ - 5 _|Manhole Sump Pump Replacement $ 10,995.00 | $ 10,995.00 ¢$ 10,995.00 100% $ - 6 7 8 9 10 ii 12 13 ¢ 201,207.00 | $ 201,207.00 = $ - $ 201,207.00 100% $ - Constantine Engineering . Transmittal To: Kimberly Kilpatrick From: Joey Crews Address: | Okaloosa County Water & Address: | Constantine Engineering, Inc. Sewer Dept, 1988 Lewis Turner Boulevard, 1804 Lewis Turner Blvd, Unit 3 Fort Walton Beach, FL 32547 Fort Walton Beach, FL 32547 Phone: 850.651.7171 Phone: 850.244.5800 Subject: | RSWRF Electrical Manhole Rehab — Bill Smith Electric Inc. Final Payment Date: September 12, 2014 WE ARE SENDING YOU: X_| ATTACHED SPECIFICATIONS TRACINGS SHOP DRAWINGS x DOCUMENTS CATALOGS prints UNDER SEPARATE COPY OF LETTER OTHER: QUANTITY DESCRIPTION 1| Original Copy - 12 Month Continuation of Bond 3 | Original Copies of Bill Smith Electric Inc. — Final Payment Request 1| Release of Lien- Notarized 1| Original Copy - Consent of Surety 1| Certificate of Insurance CC | TCG File IF MATERIAL RECEIVED IS NOT AS LISTED, PLEASE NOTIFY US AT ONCE REMARKS: Please find attached final payment request from Bill Smith Electric Inc. for work performed on the referenced project. It includes full release of all previously held retainage. The Public Notice of Completion will be submitted as soon as it is received. Please call if you have any questions. 1988 LEWIS TURNER BLVD., UNIT 3, FORT WALTON BEACH, FL 32547 PHONE: 850.244.5800 FAX: 850.862.5808 WAY, TCGENG.COM NORTHWEST PLORIDA D 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_Rebecca Barney who on oath says that (s)he is Legal Advertising Clerk 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 Legal Bg NX =) \ in the matter of Notice os Cw, ON a rag ion Ss in the ONne Yeas SS County Court, was published in ¥- DSL, 2S AAs Ss SAG) said newspaper in the issues of | 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, fiem 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 Q ~2Q Q x \Y en (Date) , who is/ate personally known to me or by has/have produced P LISReWh as identification. (Type of identification) Chapt — Notary Public, Commission No. (Signature} (Name of Notary typed, printed or stamped) ; LEGAL 6721 “ai eSinith Hloetic: “iho. gives: notice, “of ‘coniple- «tion: Of the: Russell... Ste- phenadn-.-”.: Electrical’ [ Manhole.: -Rehabilitation and. -seis . September 19, 2014 as the ‘date of final settlement; All_ persons. and firtns should. file. claims. and payments to the below addressi ‘prior: - toy the settlement date. } Bi-Smi POR. ih Electric, tne. gonealee: y ‘92560. By: Jake Sinith {| Project Manager aera, | 15, aorta “one | LEGAL 6724 255.9! rzaal CONSENT OF SURETY OWNER o TO FINAL PAYMENT ARCHITECT Qo AIA Document G707 CONTRACTOR a " SURETY QO Bond No. 40098835 OTHER G TO OWNER: ARCHITECT'S PROJECT NO.: (Nanae ered adstross) Board of County Commissioners, Okaloosa County, Florida CONTRACT FOR: PROJECT: CONTRACT DATED: (Name and actives) Russell Stephenson - Electrical Manhole Rehabilitation Project In accordance with the provisions of the Contract between the Ownerand the Contractor as indicated abave, the Cason name and address of Surety) The Guarantee Company of North America USA One Towne Square, Suite 1470 Southfield, MI 48076 , SURETY, on bond of finsert naine and aeldress of Contractor) Bill Smith Electric, Inc. 1095 Hidden Terrace Drive Cantonment, FL 32533 (850) 968-6500 » CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees thar Anal payment to the Contractor shal! not relieve the Surety of any of its obligations to Chssert namie and adress of tener} Board of County Commissioners, Okaloosa County, Florida , OWNER, as set forch in said Surety’s bond. IN WITNESS WHEREOF, the Surery has hereunto set its hand on this date; July 30, 2014 Ginsent ta ieviting the month followed ins the meneric date and year. The Guarantee Company of North America USA {Seren Moke WIA AL sukeure of autibarieed wepresuntative) ane Qpeoacanpe he Come Mark W, Edwards, II Attorney-in-Fact acd (Printed ntemue cand tide) G707-——1994 The Guarantee Company of North America USA Southfield, Michigan POWER OF ATTORNEY KNOW ALL BY THESE PRESENTS: That THE GUARANTEE COMPANY OF NORTH AMERICA USA, a corporation organized and existing under the laws of the State of Michigan, having its principal office in Southfield, Michigan, does hereby constitute and appoint THE GUARANTEE” Ronald 8. Giadrosich, William M. Smith, Mark W. Edwards, Il, Robert R. Freel, Jeffrey M. Wilson, Robert M. Verdin, Evondia H. Woessner, Alisa B. Ferris McGriff Seibels & Williams, Inc. its true and lawful attorney(s)-in-fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract or otherwise. The execution of such instrument(s) in pursuance of these presents, shall be as binding upon THE GUARANTEE COMPANY OF NORTH AMERICA USA as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by its regularly elected officers at the principal office. The Power of Attorney is executed and may be certified so, and may be revoked, pursuant to and by authority of Article IX, Section 9.03 of the By-Laws adopted by the Board of Directors of THE GUARANTEE COMPANY OF NORTH AMERICA USA at a meeting held on the 31 * day of December, 2003. The President, or any Vice President, acting with any Secretary or Assistant Secretary, shall have power and authority: 1. To appoint Attorney(s)-in-fact, and to authorize them to execute on behalf of the Company, and attach the Seal of the Company thereto, bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof, and 2, To revoke, at any time, any such Attorney-in-fact and revoke the authority given, except as provided below 3. In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and authority hereby given to the Attorney-in-Fact includes any and alt consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. 4, In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attomey-in-Fact cannot be modified or revoked uniess prior written personal notice of such intent has been given to the Commissioner — Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation. Further, this Power of Attorney is signed and sealed by facsimile pursuant to resolution of the Board of Directors of the Company adopted at a meeting duly called and held on the 6th day of December 2011, of which the following is a true excerpt: RESOLVED that the signature of any authorized officer and the seat of the Company may be affixed by facsimile to any Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, contracts of indemnity and other writings obligatory in the nature thereof, and such signature and seal when so used shall have the same force and effect as though manually affixed. IN WITNESS WHEREOF, THE GUARANTEE COMPANY OF NORTH AMERICA USA has caused this instrument to be signed and its corporate seal to be affixed by its authorized officer, this 23rd day of February, 2012. THE GUARANTEE COMPANY OF NORTH AMERICA USA AAC ho —~ ft» aati gu epee STATE OF MICHIGAN Stephen C. Ruschak, Sr. Vice President, COO Randall Musselman, Secretary County of Oakland On this 23rd day of February, 2012 before me came the individuals who executed the preceding instrument, to me personally known, and being by me duly sworn, said that each is the herein described and authorized officer of The Guarantee Company of North America USA; that the seal affixed to said instrument is the Corporate Seal of said Company; that the Corporate Seal and each signature were duly affixed by order of the Board of Directors of Cynthia A. Takai IN WITNESS WHEREOF, | have hereunto set my hand at The Guarantee Notary Public, State of Michigan Company of North America USA offices the day and year ahove written. County of Oakland My Commission Expires February 27, 2018 Z , nthe a. Ta 7 £ Acting in Oakland County |, Randall Musselman, Secretary of THE GUARANTEE COMPANY OF NORTH AMERICA USA, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney executed by THE GUARANTEE COMPANY OF NORTH AMERICA USA, which is still in full force and effect. ae IN WITNESS WHEREOF, | have thereunto set my hand and attached the seal of said Company this 30th day of July , 2014 i § Scenes Randall Musselman, Secretary August 19, 2014 Board of County Commissioners Okaloosa County, Florida Re: Bill Smith Electric, Inc. Bond No. 40098835 with The Guarantee Company of North America USA To Whom It May Concern: Bond 40098835 in the amount of $201,207.00 was a legal instrument following the EICDC Standard form of Agreement Between the Owner and Contractor on the Basis of a Stipulated Price for the Russell Stephenson — Electrical Manhole Rehabilitation Project. A “Consent of Surety to Final Payment” was issued on July 30, 2014, giving our consent to close the bond and release the final payment to contractor. The contract allows for a one-year warranty period. The warranty period will run from August 8, 2014 to August 8, 2015. Sincerely, ¢ MA iJ ; El Ay Ir Mark W. Edwards, II Attorney-in-Fact 2211 7th Avenue South / Birmingham, Alabama 35233 P.O. Box 10265 / Birmingham, Alabama 35202-0265 TEL-(205) 252-9871 Fax—(205) 581-9463 The Guarantee Company of North America USA Southfield, Michigan POWER OF ATTORNEY KNOW ALL BY THESE PRESENTS: That THE GUARANTEE COMPANY OF NORTH AMERICA USA, a corporation organized and existing under the laws of the State of Michigan, having its principal office in Southfield, Michigan, does hereby constitute and appoint THE *GUARANTEE™ Ronald B, Giadrosich, William M. Smith, Mark W. Edwards, Il, Robert R. Freel, Jeffrey M. Wilson, Robert M. Verdin, Evondia H. Woessner, Alisa B. Ferris McGriff Seibels & Williams, Inc. its true and lawful attorney(s)-in-fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract or otherwise. The execution of such instrument(s) in pursuance of these presents, shall be as binding upon THE GUARANTEE COMPANY OF NORTH AMERICA USA as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by its regularly elected officers at the principal office. The Power of Attorney is executed and may be certified so, and may be revoked, pursuant to and by authority of Article IX, Section 9.03 of the By-Laws adopted by the Board of Directors of THE GUARANTEE COMPANY OF NORTH AMERICA USA at a meeting held on the 31° day of December, 2003. The President, or any Vice President, acting with any Secretary or Assistant Secretary, shall have power and authority: 1. To appoint Attorney(s)-in-fact, and to authorize them to execute on behalf of the Company, and attach the Seal of the Company thereto, bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof, and 2. To revoke, at any time, any such Attorney-in-fact and revoke the authority given, except as provided below 3. In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and authority hereby given to the Attorney-in-Fact Includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. 4. In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attorney-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner — Department of Highways of the Commonwealth of Kentucky at least thirty (80) days prior to the modification or revocation. Further, this Power of Attorney is signed and sealed by facsimile pursuant to resolution of the. Board of Directors of the Company adopted at a meeting duly called and held on the 6th day of December 2011, of which the following is a true excerpt: RESOLVED that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any Power of Attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, contracts of indemnity and other writings obligatory in the nature thereof, and such signature and seal when so used shall have the same force and effect as though manually affixed. IN WITNESS WHEREOF, THE GUARANTEE COMPANY OF NORTH AMERICA USA has caused this instrument to be signed and its corporate seal to be affixed by its authorized officer, this 23rd day of February, 2012. THE GUARANTEE COMPANY OF NORTH AMERICA USA ML ha f Circa fie era an __ STATE OF MICHIGAN Stephen C. Ruschak, Sr. Vice President, COO Randall Musselman, Secretary County of Oakland On this 28rd day of February, 2012 before me came the individuals who executed the preceding instrument, to me personally known, and being by me duly sworn, sald that each is the herein described and authorized officer of The Guarantee Company of North America USA; that the seal affixed to said instrument is the Corporate Seal of said Company; that the Corporate Seal and each signature were duly affixed by order of the Board of Directors of Cynthia A. Takai IN WITNESS WHEREOF, | have hereunto set my hand at The Guarantee Notary Public, State of Michigan Company of North America USA offices the day and year above written. County of Oakland My Commission Expires February 27, 2018 Cy nthe a . Vafpat Acting in Oakland County renee |, Randall Musseiman, Secretary of THE GUARANTEE COMPANY OF NORTH AMERICA USA, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney executed by THE GUARANTEE COMPANY OF NORTH AMERICA USA, which is still in full force and effect. Randall Musselman, Secretary IN WITNESS WHEREOF, | have thereunto set my hand and attached the seal of said Company this 19th day of August , 2014 BILL SMITH ELECTRIC FINAL WAIVER AND PO BOX 1057, GONZALEZ, FL 32560 RELEASE OF BOND AND LIEN OFFICE (850) 968-6500 FAX (850) 937-8113 WAIVER OF RIGHT TO CLAIM AGAINST THE PAYMENT BOND UPON FINAL PAYMENT The undersigned, in consideration of the final payment in the amount of $ 201,207.00 herby waives its right to claim against the payment bond, liens, & lien rights for labor, services, or materials furnished to Okaloosa County Board of Commissioners on the following project: Owner Name: Okaloosa County Board of Commissioners Project Name: Russell Stephensen Electrical Manhole Rehab Project City/State: Okaloosa County, Florida Job Name & #: Russell Stephensen Electrical Manhole Rehab Subcontract or PO #: 03-2014 In addition, the undersigned herby releases Bill Smith electric, General Contractor and Owner, its successors and assigns, of all claims or demands of any kind whatsoever (contract or equitable), which the undersigned now has or might have against Bill Smith Electric, General Contractor, Owner, Bill Smith Electric’s surety, and/or insurance carriers on account of labor performed and/or materials furnished for the construction of any improvements for the described project or on account of any other costs incurred in the prosecution of the work on the described project. The undersigned further certifies that all labor and materials used by the undersigned in the construction of said improvements have been fully paid for. Please Type: Bill Smith Electric, Inc. Name of Sub or Supplier (hte rtd Title: Project Manager Date: 8/13/14 Authojized Signature~> State of: Florida County of:___ Escambia The foregoing instrument was acknowledged to be true and correct before me by Jake Smith . who certified under oath that he/she is the Project Manager, of Bill Smith Electric, Inc. , and has full, complete and unbridled authority to execute the foregoing instrument on behalf of Bill Smith Electric, Inc. and has executed the same on this 13 day of August, 2014 -— <p ote, LISA M. RIETZ ae bs . Seal/Stamp: J Notary Public - State of Florida i Pub My Comm. Expires Jan 22, 2017 4 es Commission # EE 867444 "Banded Through Nationat Notary Assn. My Commission Exptée: 7 Date CERTIFICATE OF LIABILITY INSURANCE 1/28/2014 Producer; Lion Insurance Company ‘This Certificate is issued as a matter of information only and confers no 2739 U.S. Highway 19 N. rights upon the Certificate Holder. This Certificate does not amend, extend Holiday, FL 34 691 or alter the coverage afforded by the policies below. (727) 938-5562 Insurers Affording Coverage NAIC # Insured: South East Personnel Leasing, inc. & Subsidiaries | "Ue _Hon Insurance Company 11075 2739 U.S. Highway 19 N. Insurer B: Holiday, FL. 34691 Insurer C: Insurer D: Insurer E: Coverages me policies of insurance Teled ta low hava been issued to the eure’ named above for te policy period mmarcatece Nowmtietenel Ing any requirement, tern or conaon o ‘any contract or oner 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 terme, exclusions, and conditions of such policies. Aggregate limits shown may have been reduced by paid claims. ae . Policy Effective Policy Expiration aot WSR) RD Type of Insurance Policy Number Date Date Limits (MM/DD/YY) (MIM/DDIYY) {GENERAL LIABILITY Each Occurrence 3 Commercial General Liability Tpamage to rented premises (EA } Claims Made Cl Occur eccurrenice) joued Med Exp fk ~ , Personal Adv injury f General aggregate {imlt applies per: General it | Policy oO Project oO Loc jeneral Aggragate i Products - Comp/Op Agg AUTOMOBILE LIABILITY Combined Single Limit (EA Accident} Bp Any Aste Bodily injur jt All Owned Autos iy inlay (Par Person) p Scheduled Autos Hired Autos Bodlly Injury Non-Owned Autos (Per Accident} B Property Damage (Per Accident} bk EXCESS/UMBRELLA LIABILITY Each Occurrence Occur Clalms Made Aggregate Deductible A {Workers Compensation and wc 71949 01/01/2014 01/01/2015 Xq WC Statu- OTH- Employers’ Liability tory Limits ER Any proprietor/partner/executive officer/member E.L. Each Accident $1,000,000 excluded? WO E.L. Disease ~Ea Employee § $1,000,000 If Yes, describe under special provisions below. ° . nee E.L. Disease - Policy Limits $1,000,000 Other Lion Insurance Company is A.M. Best Company rated A- (Excellent). AMB # 12616 Descriptions of Operations/Loecations/Vehicles/Exciusions added by Endorsement/Special Provisions: Client ID: 93-67-085 Coverage only applias to active employee(s) of South East Personnel Leasing, Inc. & Subsidiaries that are leased to the following “Client Company": Bill Smith Electric, inc. Coverage only applies to injuries incurred by South East Personnel Leasing, Inc, & Subsidiaries active employee(s}, while working in; FL. Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937-2138 or by calling (727) 938-5562. Project Name: ISSUE 01-28-14 (ND) _ Begin Date 4/1/2043 CERTIFICATE HOLDER CANCELLATION poomaseeemmatcmns BOARD OF COUNTY OMMISSIONERS OKALOOSA COUN Should any of the above described policies be cancelled before the expiration date thereof, the Issuing insurer will endeavor to mail 30 days written notice to the certificate holder named to the left, but fallure to da so shait impose no obligation or flability of any kind upon the Insurer, its agents or representatives. 302 N, WILSON ST. #203 CRESTVIEW, FL 32536 Let ME snae ACORIY ee” CERTIFICATE OF LIABILITY INSURANCE BILLS-4 OP ID: JT DATE (MMIDDIYYYY) 01/30/2014 THIS CERTIFICATE 1S 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: [f the certificate holder ls an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain poflcies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lleu of such endorsement(s). PRODUCER Fisher Brawn Div, Pensacola 1701 West Garden Street Pensacola, FL 32502 Alan D. Moore, CPCU Phone: 850-432-7474) Fax: 850-438-4678 CONTACT NAME: Lynne Teeu, CPCU, CIC TASTE, xy, 850-444-7624 [EAE ney, 850-458-4678 AbouEss; Itecu@fbbins.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Amerisure Insurance Company 19488 INSURED Bill Smith Electric, Inc. INSURER B: Laura Smith ” PO Box 1057 INSURER Gi Gonzalez, FL 32560 INSURER D : INSURER E: INSURER E COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS [8 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. BR Rae TYPE OF INSURANCE Noe POLIGY NUMBER (AMEE) | ENT) Lats | GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000) A. |X | COMMERCIAL GENERAL LIABILITY GL 2077896 07/24/2043 | 07/24/2014 | CREE eT ew |s 300,000) | CLAIMS.MADE occuR MED EXP (Any one person) | $ 10,000 |X {Pollution $100000 PERSONAL & ADVINJURY 1 $ 1,000,000 CI GENERAL AGGREGATE $ 2,000,000 | GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS - COMP/OP AGG | $ 2,000,000) ~_ Lroucy | x | BB Loc Emp Ben, $ 1,000,000 OMBINED SI | AUTOMOBILE LIABILITY COMBINED SINGLET MITT 1,000,000 A |X | any auto ICA 2077895 07/24/2013 | 07/24/2074. | BOOILY INJURY (Per person) | $ janet 1 agsguen Sn Ps |X | HIRED autos AUTOS (Pat accident) ¢ $ LX |UMBRELLALIAB | X | occur EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE ‘CU 2077898 07/24/2013 | 07/24/2014 | asorEGATE 4 1,000,000) pep [X | Rerenrions 0 $ WORKERS COMPENSATION Wo statu. Orn AND EMPLOY ERS' LIABILITY YIN TORY LIMIT: ER ANY PROPRIETOR IPARTNER/EXECUTIVE ELL, EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NEA (Mandatory in NH) E.L, DISEASE - EA EMPLOYEE] $ if yes, describe under DESCRIPTION OF OPERATIONS below E.L, DISEASE - POLICY LIMIT | $ A. |Equipment Floater IM 2077897 07/24/2013 | 07/24/2014 |LeaseRent 125,000) Ded 4,000] DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Project: Russell Stephenson Electrical Manhole Rehabilitation Ws03-14 Should any of the above policies cancel before the expiration date thereof, 30 days written notice will be mailed to certificate older. CERTIFICATE HOLDER CANCELLATION Board of County Commissioners Okaloosa County, FL 602-C North Pearl Street Crestview, FL 32536 OKALO01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD © 1988-2010 ACORD CORPORATION. All rights reserved. . HOLDERcopE }4©- OKAL.004 BILLS-4 NOTEPAD: iInsureo's NAME Bill Smith Electric, Inc. OP ID: JT PAGE 2 DATE 01/30/44 Certificate Holdex is Additional Insured in regard to General Liability, Auto Liability and Umbrella Liability if required by written contract. General Liabi ity is primary and non-contributory if required by written jcontractk. Waiver of Subrogation epplics in favor of Certificate Holder in regard to General Liability, Auto Liability and Umbrella Liability if required by written contract, General Liability Additional Insured Endorsement is attached. | . BILLSMI-01 JLTECU ALORP CERTIFICATE OF LIABILITY INSURANCE se eemone 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 pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, sublect to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer tights ta the certificate holder in lieu of such endorsement(s). PRODUCER Renee’ Lynne.Tecu ial West Garden strode ne BuRN enn. (800) 487-2073 [TE no. (850) 438-4678 Pensacola, FL 32502 FouRESS: INSURER(S) AFFORDING COVERAGE NAIC # insurer a :Amerisure Insurance Company INSURED INsuRERB ;Amerisuré Mutual Insurance Co. Bill Smith Etectric, Inc. INSURER : Laura Smith RERD: PO Box 1057 INSURER D Gonzalez, FL 32560 INSURER E : INSURER F ; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS I$ 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. WSR [ADDLISUBRY POLICY EFF | POLICY EXP, LTR TYPE OF INSURANCE Insp | wyp POLICY NUMBER: (MMIODNYYY) | MMODIYYYY) LIMITS A | X | COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ] CLAMS: MADE occur IGL20778950202 07/24/2014 | 07/24/2015 | PRewigee x oerence) _| 100,000 MED EXP (Any oie parson}: $ 5,000! —_ PERSONAL & ADV INJURY | $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY Loc PRODUCTS - COMP/OP AGe | ¢ 2,000,000) OTHER § COMBINED SINGLE LIMIT. AUTOMOBILE LIABILITY. (Ea accident) $ 1,000, 009 A |X | any auto CA20778940202 07/24/2014 | 07/24/2015 | BODILY INJURY (Per person) | $ ALL OWNED SCHEDULED a aos [| AOS BODY NAURY (Per sete $ — O OPERTY DAI HIREDAUTOS AUTOS (ber ace den $ $ X | UMBRELLALIAB |X | occu, EACH OCCURRENCE q 1,000,000 B EXCESS LIAB CLAIMS-MADE lcu20778970203 07/24/2014 | 07/24/2015 | aserecare § veo |X] Reventions Y Aggregate $ 1,000,000 WORKERS COMPENSATION PER OTH. AND EMPLOYERS’ LIABILITY YIN siature |_| ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? NIA g (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE] ¢ ifyes, describe under DESCRIPTION.OF OPERATIONS below E.L.DISEASE -poicy Limit | § DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space [s required) Project: Russell Stephenson Electrical Manhole Rehabilitation WS03-14 Should any of the above policies cancel before the expiration date thereof, 30 days written notice will be mailed to certificate holder. Certificate Holder Note: Certificate Holder is Additional Insured 'in regard to General Liability, Auto Liability and Umbrella Liability if required by written contract, SEE ATTACHED ACORD 101 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Board of County Commissioners Okaloosa County, FL AGCORDANCE WITH THE POLICY PROVISIONS, 602-C North Pearl Street Crestview, FL 32536 AUTHORIZED REPRESENTATIVE a © 1988-2014 ACORD CORPORATION. Ail rights reserved. ACORD 25 (2014/01) The ACORD name and foge are registered marks of ACORD AGENCY CUSTOMER ID: BILLSMI-01 JLTECU ann Loc#: 4 ACORD ADDITIONAL REMARKS SCHEDULE Paye 1 of 1 Fisher Brown Bottrell Insurance, inc. Bill Smith Electslc, Inc. Laura Smith POLICY NUMBER PO Box 1057 SEE PAGE 1 Gonzalez, FL 32560 CARRIER NAIC CODE SEE PAGE 4 ISEE.P4 EFFECTIVE DATE: SEE PAGE 4 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Description of Operations/Locations/Vehicles: General Liability is primary and non-contributory if required by written contract. Waiver of Subrogation applies in favor of Certificate Holder in regard to General Liability, Auto Liability and Umbrella Liability if required by written contract. General Liability Additional Insured Endorsement is attached. ACORD 101 (2008/01) ® 2008 ACORD CORPORATION. All rights réserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTOR’S BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM All of the terms, provisions, exclusions, and limitations of the coverage form apply except as specifically stated below. SECTION Il - WHO IS AN INSURED is amended to include as an insured any person or organization, called an additional insured in this endorsement: 1, Whom you are required to add as an additional insured on this policy under a written contract or agreement relating to your business; or 2, Who is named as an additional insured under this policy on a certificate of insurance. However, the written contract, agreement or certificate of insurance must require additional insured status for a time period during the term of this policy and be executed prior to the "bodily injury", "property damage", “personal injury", or “advertising injury” giving rise to a claim under this policy. If, however, “your work” was commenced under a letter of intent or work order, subject to a subsequent reduction to writing within 30 days from such commencement and with customers whose customary contracts require they be named as additional insureds, we will provide additional insured status as specified in this endorsement. 3. if the additional insured is: {a) An individual, their spouse is also an additional insured. (b) A partnership or joint venture, members, partners, and their spouses are also additional insureds. (c) A limited liability company, members and managers are also additional insureds, {d) An organization other than a partnership, joint venture or limited liability company, executive officers and directors of the organization are also additional insureds. Stockholders are also additional insureds, but only with respect to their liability as stockholders, (e) A trust, you are an insured. Your trustees are also insureds, but only with respect to their duties as trustees, The insurance provided to the additional insured is limited as follows: 1. That person or organization is only an additional insured with respect to lability arising out of: {a) Premises you own, rent, lease, or occupy, or {b) Your ongoing operations performed for that additional insured, unless the written contract or agreement or the certificate of insurance requires “your work" coverage (ar wording to the same effect) in which case the coverage provided shall extend to “your work" for that additional insured. Premises, as respects this provision, shall include common or public areas about such premises if so required : in the written contract or agreement. : Ongoing operations, as respects this provision, does not apply to “bodily injury” or “property damage” occurring after: (1) All work including materials, parts or equipment furnished in connection with such work on the project (other i then service, maintenance or repairs) to be performed by ar on behalf of the additional insured(s) at the site : of the covered operations has been completed: or : Includes copyrighted material of Insurance Services Office, inc., with its permission, Copyright Insurance Services Office, Inc., 2003 CG 70 48 03 04 Page 1 of 2 (2) That portion of “your work” out of which the injury or damage arises has been put to its intended use by ary person or organization other than anather contractor or subcontractor engagad in performing operations for a principal as a part of the same project. The limits of Insurance applicable to the additional insured are the least of those specified in the written contract of agreement, or in the certificate of insurance or in the Declarations for this policy. If you also carry an Umbrella policy, and the written contract or agreement or certificate of insurance requires that the additional insured status also apply to such Umbrella policy, the limits of insurance applicable to the additional insured under this policy shall be those specified in the Declarations of this policy. The limits of insurance applicable to the additional insured are inclusive of and notin addition to the limits of insurance shown in the Declarations, The additional insured status provided by this endorsement does not extend beyond the expiration or termination of a premises lease or rental agreement nor beyond the term of this policy. Any person or organization who is an insured under the terms of this endorsement and who is also an insured under the terms of the GENERAL LIABILITY EXTENSION ENDORSEMENT, # attached to this policy, shall have the benefit of the terms of this endorsement if the terms of this endorsement are broader. If a written contract or agreement or a certificate of Insurance as outlined above requires that additional insured status be provided by the use of CG 20 10 11 85, then the terms of that endorsement, which are shown below, are incorporated into this endorsement as respects such additional insured, to the extent that such terms do not restrict coverage otherwise provided by this endorsement: ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: Blanket Where Required by Written Contract, Agreement, or Certificate of Insurance that the terms of CG 20 10 11 85 apply (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) ls amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. Copyright, insurance Services Office, Inc., 1984 CG 20 10 11 85 The insurance provided to the additional insured does not apply to "bodily injury", "property damage’, "personal injury", or “advertising injury" arising out of an architect’s, engineer's, or surveyor’s rendering of or failure to render any professional services including but not lmited to: 1, 2, The preparing, approving, or failing to prepare or approve maps, drawings, opinions, reports, surveys, change orders, design specifications; and Supervisory, inspection, or engineering services, Any coverage provided in this endorsement is excess over any other valid and collectible insurance available to the additional insured wheather primary, excess, contingent, or on any other basis unless the written contract, agreement, or certificate of insurance requires that this insurance be primary, in which case this insurance will he primary without contribution from such other insurance available to the additional insured. Includes copyrighted material of insurance Services Office, inc., with its permission. Copyright Insurance Services Office, Inc. 2003 Page 2 of 2 CG 70 48 03 04