Okaloosa County BOCC — August 5, 2014 — Cell Phone Lot Project Closeout Checklist and Docs — reading text

Martina . Marks Insurance Agency, Inc. [AIG Nin, Ext}, 850-653-2161 LAS, Nok: 850-683-8946 P.O. Box 128 AoRESS: __jayme@marksinsurance.com Apalachicola, FL 32329-0429 INSURER(S) AFFORDING COVERAGE NAIC # . INSURERA: Southern Owners INSURED INsurERB: Auto Owners 32700 Cathey Const & Development Jnsurere: Bridgefield Employers PO Box 13107 INSURER Oe csummmnsnanmnue a wate weet Mexico Beach, FL 32410-3107 INSURER E : INSURERF : COVERAGES CERTIFICATE NUMBER: 00005877-473866 REVISION NUMBER: 14 THiS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEO 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, NgR TYPE OF INSURANCE Nee |W POLICY NUMBER MODMY) | gMMIDON PY) LIMITS A | GENERAL LIABILITY 084622-78120197-14 — 01/01/2014 | 01/01/2018 EACH OCCURRENCE s_....1,000,000 X | commercia.cenera.uasery ff Ae 300,000 | CLAIMS-MADE | X | OCCUR MED EXP (Any one person) | $ 10,800 seo PERSONAL & ADVINJURY | § 4,000,000 _ GENERAL AGGREGATE $ 2,000,000 ,GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG | $ 1,000,000 X! poucy |) BBS [Loe $ B | AUTOMOBILE LIABILITY 4732839101 01/01/2044 | 01/01/2045 ovrcaueny ME is 4,000,000 XK] any auto “ BODILY INJURY (Per person) | [at Swnen "SCHEDULED BODILY INJURY (Per accident)| § LX) niren autos |X| abtos [svaccany AEs s A LX! UMBRELALAB | | occur 47-255-030-02 01/01/2014 | 01/04/2018 EACH OCCURRENCE $ 1,600,000 EXCESS LIAB X | cLAs-MaDE AGGREGATE $ 1,000,000 loco |__| Retentions 10000 8 CAND EMPLOYERS" LIABILITY vin 0830-47903 ovor20t4 [01012018 Tartans |X (eR ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000 ,000 OFFICER/MEMBER EXCLUDED? [| NIA Penne ate teeta ene ae ent ew et ee cc mathe see Ie moataty eee (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE § 1,000,900 DESCRITION OF OPERATIONS below E.L, DISEASE - POLICY LIMIT | § 1,000,000 2 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES {Attach ACORD 101, Additional Remarks Schedule, if more space Is required} CERTIFICATE HOLDER CANCELLATION Northwest Florida Regional Airport 1701 Florida 85 Eglin AFB, FL 32542 ! SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACGORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE CP ASS (JPM) ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by JPM on May 13, 2014 at 14:14AM <¢ INSURANCE AGENCY, INC. PO. Box 129 * Apalachicola, FL 32329 * Phone (850) 653-2161 * Fax (850) 653-8946 « www. marksinsurance.com June 6, 2014 Okaloosa County 602-C North Pear! Street Crestview, FL 32536 Re: Cathey Construction General Liability Policy # 78120197-14 Gentlemen, Please be advised that this policy is written on an Occurrence basis, not a Claims-made basis. The Certificate of Liability Insurance that was provided to you dated 5/13/2014 indicates this fact. Please advise any questions. Regards, CO Oe we Chuck Marks, Agent CC: Cathey Construction & Development —"} ACORD’ _ CERTIFICATE OF LIABILITY INSURANCE neon 05/13/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: ff the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed, If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in tigu of such endorsement(s), PRODUCER NAME”) Jayme Martina Marks Insurance Agency, Inc. {Ale No, Exty,_ 850-653-2164 | TANG, Nox: 850-653-8946 P.O. Box 129 ADDRESS; __ fayme@markstnsurance.com Apalachicola, FL 32329-0129 INSURER(S) AFFORDING COVERAGE a NAIC # cents INSURERA: Southern Owners INSURED INSURERB: Auto Owners. 32700 Cathey Const & Development INSURER C: Bridgefield Employers PO Box 13107 INSURER Bt Mexico Beach, FL 32410-3107 INSURER E : INSURER F ; COVERAGES CERTIFICATE NUMBER: 00005877-0 REVISION NUMBER: 18 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE HODL|SUBR POLICY NUMBER | Rana AAEM YY) LMiTS A | GENERAL LIABILITY 084622-78120197.~14 04/01/2014 | 0110112018 EACHOccURRENCE i 1,000,000 ; XL COMMERCIAL GENERAL LIABILITY PREM eeeee e $ 300,000 |_| CLAIMS.MADE | X | occur MED EXP (Any one person) | § 10,000 7 _ oe svt rman vismunenet wpa PERSONAL 8 ADV INJURY |S 4,000,000 | GENERALAGGREGATE 5 2,000,000 -GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG | § 1,000,000 X | poucy | i ies LOG $ BB | AUTOMOBILE LIABILITY 4732839101 01/01/2014 | 01/01/2018 fegaccueny Ls 1,000,000 X | ANY AUTO BODILY INJURY {Per person) | $ ‘ | AUTOS Soros eee _BODILY INJURY (Per accident)! $ Xj rrepautos |X | Autos NP fPeraccdeny LS $s A LX UMBRELLALIAB fF OCCUR 47-255-030-02 01/01/2014 | 04/01/2018 EACH OCCURRENCE $ 4,000,000 EXCESS LIAB X | cLaime-MADE! _AGGREGATE $ 1,000,000 DED | RETENTION S 10000 en s C | NO EMPLOYERS LiABiLitY vin 0830-47903 ovou20%4 | o1012018 TORY IMIS XI ANY PROPRIETOR/PARTNERIEXECUTIVE EL. EACH ACCIDENT 8 1,000,000 OFFICER/MEMBER EXCLUDED? NIA Fe er mrtaenee ceca Pelt ss cerundin dae {Mandatory in NH} i EL. DISEASE - EA EMPLOYEE § 1,000,000 OLSERIPTION OF: OPERATIONS below E,L. DISEASE - POLICY LIMIT | § 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHIGLES {Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Okaloosa County ACCORDANCE WITH THE POLICY PROVISIONS. 602-C North Peart Street Crestview, FL 32536 AUTHORIZED REPRESENTATIVE ore . ; C7 K SS (JPM) © 1988-2010 ACORD CORPORATION, All rights reserved. ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD Printed by JPM on May 13, 2014 at 01:12PM CONSENT OF OWNER SURETY COMPANY CONTR Stor TO FINAL PAYMENT SURETY mK OTHER Bond No. PRF09154203 (SIMILAR TO AIA DOCUMENT G707) | ye, Cell Phone Waiting Area at Northwest Florida PROJECT: Regional Airport (name, address) TO (Owner) ARCHITECT'S PROJECT NO: The Board of County Commissioners of Okaloosa County CONTRACT FOR: 302 N. Wilson St. Suite 302 Crestview, FL 32536 —_ __ CONTRACT DATE: May 6, 2014 Cc ONTRACTOR siney Construction & Development, LLC P.Q. Box 13107 103 N. 30th Street Mexico Beach, FL 32410 In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (here insert name and address of Surety Company) Fidelity and Deposit Company of Maryland 1400 American Lane , SURETY COMPANY, Schaumburg, IL 60196 on bond of (here insert name and address of Contractor) Cathey Construction & Development LLC P.O. Box 13107 103 N. 30th St. Mexico Beach, FL 32410 hereby approves of the final payment to the Contractor, and agrees that the final payment to the Contractor shall not relieve the Surety Company of any of its obligations to (here insert name and address of Owner) The Board of County Commissioners of Okaloosa County 302 N. Wilson St. Suite 302 Crestview, FL 32536 Further, as outlined in the contract documents, the original performance and payment bonds remain in full foree and effect for a period of one year following final payment to > OWNER, contractor, CONTRACTOR, as set forth in the said Surety Company's bond. IN WITNESS WHEREOF, The Surety Company has hereunto set its hand this day of 5th June, 2014 ; Fidelity and Deposit Company of Maryland Surety SC a Am | (br ignature of Authorized Representative Attest: (Seal): Jo M. Chonko / Attorney-in-Fact Title Note: This form is intended to be used as a companion document to the Contractor's Affidavit of Payment of Debts and Claims, Current Edition ~ 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 , 4 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 THOMAS 0. MCCLELLAN, 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 Michael W. BROWN and Jo M. CHONKO, both of Panama City, Florida, EACH its true and lawful agent and Attorney-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 4th day of June, A.D. 2013. ATTEST: ZURICH AMERICAN INSURANCE COMPANY ~— COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND iterate, | % : a mS) Ns, +s, ey Mr spone pt ae of, aw a) 105 3 inarsa3tt ts, "a, hay we: —! “2, An %s, ts a Pega ie Assistant Secretary Vice President -_ Eric D, Barnes Thomas O. McClellan State of Maryland City of Baltimore On this 4th day of June, A.D. 2013, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, THOMAS O. MCCLELLAN, Vice President, and ERIC D. BARNES, 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